Major Challenge Of Drug Delivery Addressed By Researchers’ Innovation

Main Category: Cancer / Oncology
Also Included In: Arthritis / Rheumatology;  Infectious Diseases / Bacteria / Viruses
Article Date: 31 Jan 2012 – 0:00 PST

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A new physical form of proteins developed by researchers at The University of Texas at Austin could drastically improve treatments for cancer and other diseases, as well as overcome some of the largest challenges in therapeutics: delivering drugs to patients safely, easily and more effectively.

The protein formulation strategy, developed by faculty and students in the Cockrell School of Engineering’s Department of Chemical Engineering, is unprecedented and offers a new and universal approach to drug delivery – one that could revolutionize treatment of cancer, arthritis and infectious disease.

“We believe this discovery of a new highly concentrated form of proteins – clusters of individual protein molecules – is a disruptive innovation that could transform how we fight diseases,” said Keith P. Johnston, a chemical engineering professor and member of the National Academy Engineering. “It required integration of challenging contributions in fundamental science and engineering from three of our chemical engineering research groups.”

The research, led by Johnston, Chemical Engineering Professor Thomas M. Truskett and Assistant Professor Jennifer Maynard, was published online recently ahead of a print version to appear soon in the ACS Nano journal.

“The real challenge in developing therapeutics is how do you deliver them to patients.” Maynard said.

Typically, protein biopharmaceuticals are administered intravenously at dilute concentrations in a hospital or clinic. Scientists and engineers have long tried to produce safe drugs at higher concentrations, so that a patient could self-inject the drugs at home, similar to an insulin shot. But doing so has been stymied by the fact that proteins, in high-concentration formulations, form aggregates that could be dangerous to patients and gels that cannot be injected.

The Cockrell School research team has introduced a new physical form of proteins, whereby proteins are packed into highly concentrated, nanometer-sized clusters that can pass through a needle into a patient to treat disease. The novel composition avoids the pitfalls of previous attempts because drug proteins are clustered so densely that they don’t unfold or form dangerous aggregates.

“This general physical concept for forming highly concentrated, yet stable, protein dispersions is a major new direction in protein science,” Johnston said.

A key advance came in 2004, when Truskett predicted that protein-based drugs in solution would be stable if they could somehow be formulated at ultra-high concentrations. At that time, Johnston had nanoparticles of concentrated stable protein but didn’t know how to disperse them in an injectable form.

In 2009, the team formed protein nanoclusters in water simply by properly adjusting the pH (to lower protein charge) and adding sugar to crowd protein molecules together. Upon dilution or subcutaneous injection into a mouse the proteins separate back to individual stable molecules with biological activity. Once injected, the protein in the bloodstream attacks targeted cells and tumors similarly as for protein delivered via IV therapy. To provide a roadmap for improving the design of nanoclusters, chemical engineering graduate students, Andrea Miller and Ameya Borwankar worked with Truskett and Johnston to develop a new thermodynamic theory.

Another breakthrough for the team came in 2009 when a chemical engineering senior, Brian Wilson, created a transparent dispersion of extremely concentrated protein, which was later found to be formed of nanoclusters.

“Through Brian’s discussions about the research both inside and outside of the classroom, numerous undergraduate students at UT are now realizing the enormous opportunities they have to contribute to science, engineering and human health when they get involved in research projects,” Johnston said.

Since the research began in 2004, three patent applications have been filed through the university’s Office of Technology Commercialization.

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HPV Vaccine Not Linked To Autoimmune Disorders, Study

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Main Category: Cervical Cancer / HPV Vaccine
Also Included In: Immune System / Vaccines;  Sexual Health / STDs;  Arthritis / Rheumatology
Article Date: 28 Jan 2012 – 16:00 PST

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A two-year study of nearly 190,000 girls and women, finds that Gardasil, the human papillomavirus (HPV) vaccine made by
Merck Co, does not trigger autoimmune disorders such as lupus, rheumatoid arthritis, type 1 diabetes and multiple
sclerosis. The results are published in the Journal of Internal Medicine.

Study lead author Dr Chun Chao, a research scientist at the Kaiser Permanente Department of Research Evaluation in
Pasadena, California, said in a statement released on Friday, that:

“This kind of safety information may help parents with vaccination decisions.”

“”These findings offer some assurance that among a large and generalizable female population, no safety signal for autoimmune
conditions was found following HPV4 vaccination in routine clinical use,” said Chao.

Gardasil is a “quadrivalent” vaccine because it helps protect against 4 types of HPV. In girls and young women age 9 to 26, it
targets 2 types that cause about 75% of cervical cancers, and 2 other types that cause 90% of cases of genital warts.

The vaccine, which is given as three injections over six months, also helps protect boys and men age 9 to 26 against 90% of
cases of genital warts.

Genital warts is the most common sexually transmitted infection in the US, where it infects about 6.2 million people every year.
It can also lead to cervical cancer in women.

Gardasil received US Food and Drug Administration (FDA) approval in 2006. But a longstanding concern about links with autoimmune disorders has surrounded the
vaccine, and many parents won’t let their children be vaccinated because of this.

However, Chao and fellow co-investigators from Kaiser Permanente told the press “most speculated associations have stemmed from
case reports that have not been confirmed by large, controlled epidemiologic studies”, and their investigation “presents findings
from a well-designed, post-licensure safety study of the vaccine on a large, ethnically diverse population”.

For the study, Chao and colleagues used electronic health records of 189,629 girls and women age 9 to 26 years in California.
The participants had been followed for six months after receiving each dose of the quadrivalent HPV vaccine in 2006-2008.

They found no increase in any of 16 autoimmune disorders in the vaccinated population compared to a matched population of
non-vaccinated girls and women. The 16 autoimmune disorders they looked for were:

“… immune thrombocytopenia, autoimmune hemolytic anemia, systemic lupus erythematosus, rheumatoid arthritis, juvenile
rheumatoid arthritis, type 1 diabetes, Hashimoto’s disease, Graves’ disease, multiple sclerosis, acute disseminated
encephalomyelitis, other demyelinating diseases of the central nervous system, vaccine-associated demyelination, Guillain-Barré
syndrome, neuromyelitis optica, optic neuritis and uveitis.”

The researchers explained that the clinical trial data on the vaccine, and the subsequent adverse event reports, have important limitations
when it comes to assessing its safety profile.

This is because clinical trials are often based on a highly selected group of participants, the sample sizes are too small, and the
follow up is too short, to catch rare safety events such as autoimmune disorders.

And the adverse event reports are not easy to interpret because there is no comparison group, and it is hard to tell if the condition
developed before or after the vaccine.

So in their study, Chao and colleagues used methods like in-depth reviews of medical charts to ensure accuracy of diagnosis and
that the disease occurred after vaccination. Plus, disease incidence in the vaccinated group was contrasted with incidence in a
comparable unvaccinated group.

The results showed that:

  • Overall, there were 1,014 new-onset cases of an autoimmune disorder, of which 719 were eligible for case review, and 31
    (40%) were confirmed as new onset (ie emerged after vaccination).
  • Of these cases, “no cluster of disease onset in relation to vaccination timing, dose sequence or age was found for any
    autoimmune condition”.
  • None of the estimated incidence rate ratios was signficantly raised, except that for Hashimoto’s disease (IRR = 1.29, 95%
    confidence interval: 1.08-1.56).
  • “Further investigation of temporal relationship and biological plausibility revealed no consistent evidence for a safety signal
    for autoimmune thyroid conditions.”

The authors note that neither the investigators, nor an independent safety review committee, found any autoimmune safety
concerns in the study.

The study appears to have been well received by experts not connected to the investigation.

Dr. Harry Fischer, chief of the division of rheumatology at Beth Israel Medical Center in New York City welcomed the findings
and described the study as well-designed:

“This article speaks to the safety of the vaccine and helps to confirm that it does not contribute to the development of
autoimmune diseases,” he said, in a report from USA Today.

Merck Co funded the study.

Written by Catharine Paddock PhD


Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

  • Additional
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  • Citations

“Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine”;

C. Chao, N. P. Klein, C. M. Velicer, L. S. Sy, J. M. Slezak, H. Takhar, B. Ackerson, T. C. Cheetham, J. Hansen, K.

Deosaransingh, M. Emery, K.-L. Liaw and S. J. Jacobsen; Journal of Internal Medicine, Volume 271, Issue 2, February

2012, Pages: 193-203; Article first published online : 15 NOV 2011, DOI: 10.1111/j.1365-2796.2011.02467.x; Link to

Abstract.

Additional sources: Kaiser Permanente, USA Today report.

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In Rheumatoid Arthritis, Steroids Prevent Protein Changes Seen In The Joints

Main Category: Arthritis / Rheumatology
Also Included In: Immune System / Vaccines
Article Date: 28 Jan 2012 – 0:00 PST

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Rheumatoid arthritis (RA) is a chronic inflammatory disease where the body begins to attack the joints and organs of the body. Proteins within inflamed joints are often modified by citrullination, a process that converts the protein building block arginine into citrulline. These two amino acids have very different physical properties and consequently conversion can result in aberrant changes in the three-dimensional structure of an affected protein. New research published in BioMed Central’s open access journal Arthritis Research Therapy shows that glucocorticoid therapy can reduce the amount of citrullination and the amount of the enzyme peptidylargininedeiminase 4 (PAD4) responsible for citrullination in the joints of people with RA.

People with RA have excessive amounts of protein citrullination in their inflamed joints. It is thought that these proteins are involved in initiating and maintaining the joint inflammation seen in people with RA. Researchers from three countries, Sweden, America, and the Netherlands collaborated to look at the levels of citrullinated proteins in the joints of people with RA, and compared the before and after effect of current treatments – methotrexate and glucocorticoids.

As expected elevated levels of citrullinated proteins (CP) were found in the knees of people with RA, compared to the joints of the control group. The new research also discovered enhanced levels of the enzymes (PAD2 and 4), responsible for these aberrant proteins, in the biopsies of people with RA. Additionally both the level of CP and of PAD correlated with the extent of inflammation – the more CP and PAD the worse the inflammation.

Treatment with methotrexate, an anti rheumatic drug, used to treat RA, had no effect on the levels of CP or PAD. However a single injection of glucocorticoid was able to reduce both the level of protein citrullination and PAD4, and this was matched by a decrease in visible signs of inflammation.

The beneficial effect of glucocorticoids was limited to cells from the inflamed joints. A synthetic glucocortioid (DEX) was tested in on both synovial fluid and blood from people with RA, but only the cells from the synovial fluid responded with a decrease in CP and PAD2 or PAD4.

Dr Anca Catrina from the Karolinska Institute and University Hospital who led the research explained that future tailoring of RA management and the development of new treatments is dependent on a better knowledge of the disease. She said, “Our work has been able to establish for the first time that different treatments have different effects on protein citrullination, an important process in the progression of RA.”

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Andre the Giant Hero: A Lesson for the World from One Incredible Sea Turtle

 

Ground-breaking technology saves the life of an endangered sea turtle, an inspiring story with an important message for the world.

Photo credit: Loggerhead Marinelife Center

In June 2010, an endangered green sea turtle—soon to be known to the world as “Andre”—washed ashore near death. He was just one of Florida’s hundreds of sea turtles hit by boats each year. A team of dedicated people came to his rescue, giving him a chance that many turtles in his situation don’t have. Though filled with much grief and sorrow, Andre’s story is also extremely inspirational and is filled with passion, creativity, and hope.

Photo credit: Loggerhead Marinelife Center

 

The Tragedy

Between 1,500-1,800 sea turtles become stranded on Florida’s beaches each year. According to the Florida Fish and Wildlife Commission (FWC), about 100-300 of them have injuries resulting from collisions with boats and only a dismal 10%-20% of these animals are found alive. With those odds, and given his critical condition, it’s a miracle Andre had survived at all.

Photo credit: Loggerhead Marinelife Center

When he was discovered by beachgoers at Juno Beach, large areas of his shell had been broken off in the boat strike and roughly three pounds (1.4 kilograms) of sand weighed down on his exposed vital organs. His spine, also then vulnerable and visible through the gaping holes in his shell, had also been shattered. Infection was rampant throughout his delicate body and death seemed imminent.

Photo credit: Loggerhead Marinelife Center

If he hadn’t been found, Andre likely would’ve suffered a slow and agonizing death on that beach. Sadly, this is the fate met by 80%-90% of sea turtles that survive being run over by boats in this state. However, his swift rescue and the events that took place after yielded a drastically different outcome for this beautiful marine creature.

Photo credit: Loggerhead Marinelife Center

 

The Miracle

Andre was rushed to the Loggerhead Marinelife Centre (LMC), a nearby non-profit organization focused on ocean conservation and operating on three principles: research, education, and rehabilitation. The facility specializes in the rehabilitation of sick and injured sea turtles. There, a passionate, tenacious team led by wildlife veterinarian, Dr. Nancy Mettee, raced against the clock to save the reptile’s life.

Photo credit: Loggerhead Marinelife Center

After reaching out to a local hospital for guidance, they were soon put in touch with medical technologies and therapies group, Kinetic Concepts Inc. (KCI). The company is pioneering new methods and procedures for improving wound-healing in humans. KCI and Dr. Mettee and her team put their heads together to find a way to address Andre’s most urgent issues: clearing infection, restoring blood supply to his injuries, and stimulating the body’s repairing processes.

Photo credit: Loggerhead Marinelife Center

They decided to use something called the “Strattice Reconstructive Tissue Matrix”, an innovative technology produced by KCI that had never been used on a non-human animal. It serves as a sort of acellular skin scaffolding, providing structural support for the extensive injuries and simultaneously facilitating the body’s natural healing progressions.

Photo credit: Loggerhead Marinelife Center

Additionally, the team used KCI’s “V.A.C. Therapy”, another ground-breaking technology that was never intended for use on aquatic or marine animals. This approach uses negative pressure at the wound site to promote healing and was custom-fitted for Andre to improve the effectiveness of the Strattice device while underwater. Working in collaboration, these two methods ultimately saved the turtle’s life over the months that followed.

Photo credit: Loggerhead Marinelife Center

The next step in Andre’s recovery would require repairing his badly damaged shell. Using their creativity once again, the team realized they may be able to achieve this with the use of orthodontic equipment, as it allowed for tension on some areas and flexibility in others. With generous assistance from local orthodontist, Dr. Alberto Vargas, six of these devices were placed on Andre’s carapace in February 2011. Four of them pulled the shell together, while the other two pushed portions of the shell apart to increase growth. These all worked very similarly to the “palate expanders” used on humans for teeth and jaw corrections, requiring his caregivers to tighten the appliances with a key every day.

Photo credit: Loggerhead Marinelife Center

The solutions used to save Andre made history. They had never been used on one of these creatures before and they revolutionized veterinary practices used in sea turtle rehabilitation. Thanks to the devotion of the caring individuals involved in his recovery, Andre was given a desperately needed second chance. His recovery would not have been possible without their passionate determination.

Photo credit: Loggerhead Marinelife Center

 

Andre’s Great Release

After thirteen months of medical treatments at LMC, the team decided the legendary reptile was finally fit to be returned to the Atlantic Ocean—just in time for green turtle mating season! The remarkable journey saw his release take place on August 3rd, with hundreds of his cheerleaders in attendance. It was a joyful celebration, offering hope that at least a few of humanity’s destructive mistakes could potentially be reversed.

Andre on his way to his big return to the ocean! (Photo credit: Tracy Burnley)

LMC received heaps of “get well” cards for this brave animal. He was “adopted” by over 200 supporters from 25 states and several foreign countries. Hundreds of people watched his recovery through a webcam positioned over his tank, as he became an icon for sea turtle conservation. All of these well-wishes and positive energy were present on the day Andre made his first oceanic swim in over a year, which likely marked one of the happiest days of this lucky turtle’s life.

Free at last! (Photo credit: Tracy Burnley)

 

The Saddest Ending to One of the Happiest Stories

Sadly, this is the part that no one wanted to hear. Just three weeks after Andre’s miraculous send-off, his lifeless body washed ashore at Hutchinson Island, Florida. A cause of death was unable to be determined, as he was discovered in extremely poor condition. There are a number of possibilities that could’ve led to this tragic incident, which could include another encounter with a boat propeller, predation, being captured in fishing gear, or even deteriorated muscle strength from the year-long stay in captivity, which was absolutely essential for his survival.

Photo credit: Loggerhead Marinelife Center

Beyond those committed to his successful recovery, Andre touched the hearts of thousands of people all around the world—including one special Bush Warrior, probably much like yourself. Avid Bush Warriors fan, Tracy Burnley, brought Andre’s story to our attention, after she personally attended his celebrated release. Inspired by the dedication of the team that nursed him back to health, and by Andre’s overwhelming will to survive, Tracy put forth an unbelievable amount of time and energy to make the following video in honor of this courageous little being.

“Watching him being returned to the sea after such a long, hard journey was truly an honor. He had amazing will to live. I’m so glad he got to swim free again. He deserved that time out there, enjoying the ocean,” says Tracy. “It would not have been possible without the staff of Loggerhead Marinelife Center and the generosity of KCI. They matched him step by step, determined not to give up. Now, the treatments they used on him are already being used on other sea turtles.”

 

Sea Turtles in Peril

Every individual animal on this planet serves a purpose. At the most essential level, each one has an ecologic role to play, enabling ecosystem functioning to continue. Once in a while, a very special animal comes along with a very important job to complete: to call our attention to a crucial issue. Sadly, these exceptional creatures endure much suffering in order to achieve this. Many would say this was the purpose of Andre’s life. His devastating loss sheds light on the plight our world’s sea turtles and also reminds us that even the greatest efforts may not be enough to overcome the damage done.

Photo credit: Loggerhead Marinelife Center

There are seven species of sea turtle on our beautiful planet. All of them are threatened with extinction. The massive Leatherback, the gorgeous Hawksbill, and the tiny Kemp’s Ridley are all considered ‘Critically Endangered’, with the third being the most endangered of all sea turtles. Green Sea Turtles, like Andre, and Loggerheads are both classified as ‘Endangered’, while the Olive Ridley is listed as ‘Vulnerable’ and the Flatback as ‘Data Deficient’.

Photo credit: NOAA

A number of factors have combined to drive these marine animals toward the point of no return. Poaching of adults, hatchlings, and eggs is certainly one of the biggest threats to their existence. While the Hawksbill turtle is more specifically targeted by poachers for its beautiful, yet coveted shell, all species are poached for their meat and eggs.

Poached sea turtles (photo via callingthecoast.wordpress.com)

Hundreds of thousands of sea turtles die when they are incidentally captured in longline, trawling, and gillnet fisheries each year. It’s believed millions are killed annually, after ingesting or becoming entangled in marine debris—most frequently, that of littered coveted plastics. Changes to nesting beaches, as a result of erosion, development, beach nourishment and dredging, and other human activities, are also a significant threat to these sea creatures. Pollution both directly and indirectly impacts these animals, as it poisons the turtles and their food and destroys delicate nearshore habitats, like coral reefs. Artificial light pollution on nesting beaches also disorients nesting females and hatchlings, which can be detrimental to their survival.

Photo credit: Proyeto Tamar Brazil

Offshore oil drilling mishaps, such as the tragic BP disaster in the Gulf of Mexico, and other oil spills have emerged as increasing threats to the sensitive turtles and have long-term repercussions. The impacts of global warming and climate change have had serious consequences for these animals, as well. Rising temperatures have been found to heavily skew sex ratios in nests and extreme weather events can have catastrophic effects for nesting beaches. For example, last week’s Hurricane Irene destroyed at least 170 nests across North Carolina, South Carolina, and Georgia.

Oil-covered sea turtle (photo via Sea Turtle Restoration Project)

Sea turtles play a vital role in the marine ecosystems they inhabit. Their existence is essential to the continued functioning of our oceans. As more and more of the sea’s organisms are lost, we become closer to a worldwide calamity. Every individual of every organism inhabiting our planet’s oceans (and on land) is growing increasingly important each day. Society must realize that, in the end, the damage we inflict on these ecosystems will lead to our own suffering. The oceans are earth’s heartbeat, the basis of nearly all processes that make the third rock from the sun inhabitable.

 

How Can You Help?

  1. Stop using plastic bags. They often resemble some sea turtles’ favorite food: jellyfish. Unaware of the dangers associated with eating them, sea turtles (and other marine organisms) gobble them down and many are killed as a result. Use eco-friendly re-useable bags when you’re shopping. Locate a recycling facility or bin in your community that specifically accepts plastic bags, so that you can safely discard any you have now. You can also write to your local legislators and encourage them to ban the use of plastic bags at stores in your area.

  2. Volunteer to clean up litter. Organize community clean-up events at your local beaches to get rid of litter before it enters the ocean. If you’re just visiting, pick up any litter you come across during your stay. Even if you don’t live anywhere near the beach, be aware that litter makes its way to the ocean from all over the place—including the most interior regions of land masses.

  3. Support ocean conservation organizations. If you can donate even $5, every little bit helps. Do your research and find the best organization to support. You can help Andre’s friends at Loggerhead Marinelife Center by clicking here. If you can’t contribute financially to an organization or group, consider volunteering your time and skills. If you are unable to volunteer on-site, offer any skills you may have that can be done online, or from a distance, including accounting, writing, grant writing, graphic design, website support, or any other thing you think might be helpful.
  4. Raise awareness. Make it a point to share this link with at least five people. Follow up with them to make sure they’ve read the article and encourage them to share it with an additional five people. Share our other links to ocean conservation stories, as well.

    To make an even bigger impact with your awareness efforts, participate in our Walking on Wildlife campaign! It’s easy, fun, and effective! All you need is your creativity, your passion, an hour of your time, and some sidewalk chalk! Click here to find out how to do it.

 

Related Stories

Haunted by the Tortoiseshell Trade: Will the Hawksbill Sea Turtle Survive?

Meet the Flatback Turtle: The World’s Only Endemic Sea Turtle Species

Is the Arctic the Next Niger Delta? US Government, Royal Dutch Shell Fueling Icy Meltdown

More Victims of the Oil Spill? Scores of Dead Baby Dolphins Washing Up on Gulf of Mexico Shores

Massive Coral Die-Off in Indonesia: One of the Most Rapid and Severe in Recorded History

 

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Sedentary Lifestyle A Problem For 2 In 5 Adults With Rheumatoid Arthritis

Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics;  Obesity / Weight Loss / Fitness
Article Date: 27 Jan 2012 – 1:00 PST

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A new study, funded by a grant from the National Institute for Arthritis and Musculoskeletal and Skin Diseases (NIAMS), found that two in five adults (42%) with rheumatoid arthritis (RA) were inactive. Taking measures to motivate RA patients to increase their physical activity will improve public health according to the findings now available in Arthritis Care Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).

The ACR estimates nearly 1.3 million adults in the U.S. are diagnosed with RA, a chronic autoimmune condition characterized by systemic joint inflammation that can damage joints, impair function, and cause significant disability. Until the early 1980s, medical experts recommended medication and rest for those with arthritis. However, current medical evidence now suggests that regular, moderate physical activity benefits arthritis sufferers by maintaining joint flexibility, improving balance, strengthening muscles, and reducing pain.

“While there is much evidence of the benefits of physical activity, RA patients are generally not physically active, and physicians often do not encourage regular physical activity in this patient population,” explains Dr. Jungwha Lee, an Assistant Professor in the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine in Chicago, Illinois. “Our study aims to expand understanding of the risk factors associated with inactivity among adults with RA and encourage clinical interventions that promote participation in physical activity.”

Dr. Lee and colleagues analyzed data on 176 RA patients, 18 years of age or older enrolled in a randomized controlled trial to assess the effectiveness of an intervention promoting physical activity. The team evaluated pre-intervention data for inactivity which was defined as no sustained 10-minute periods of moderate-to-vigorous physical activity during a week. Researchers also assessed the relationships between inactivity and modifiable risk factors such as motivation for physical activity, obesity, and pain.

Results show that 42% of RA patients were inactive; participating in no moderate-to-vigorous physical activity periods of at least ten minutes during a 7-day period of objective activity monitoring. Researchers found that 53% of study participants lacked strong motivation for physical activity and 49% lacked strong beliefs in the benefits of physical activity. These two modifiable risk factors account for 65% of excess inactivity in this study group.

While previous research relied on self-reported physical activity measures, the strength of the current study lies in the use of accelerometers – devices used to measure acceleration and movement – to objectively assess physical activity in participants. “Physical inactivity among RA patients is a public health concern,” concludes Dr. Lee. “Our results suggest that public health initiatives need to address the lack of motivation to exercise and promote the benefits of physical activity to reduce the prevalence of inactivity in those with RA.”

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Restoration and Repair of Damaged Medical Equipment: Fiberglass, Plastics, Metals, Composites…. (http://www.integritymed.com)

A very challenging restoration on a fluoro handle from a Toshiba CT Scanner for an insurance company. The cost for replacing this part would have been over $12,000. We did the job for 1/10 of the OEM cost.

Over the years, having a full medical equipment paint and body shop in-house we’ve gotten pretty good at doing cosmetic “face-lifts” on the equipment we sell.  As a matter of fact, 90% of the equipment that leaves our refurbishing facility– whether headed to Azerbaijan or the Mayo Clinic– gets either a partial, or total “head-to-toe” cosmetic refurbishing.  This usually includes sanding down to the original surface, fiber-glass fill and repairs, bondo for smoothing pitted and dented metal panels, primer, and finally a fully matched factory repaint, along with new decals.  Yes, we do this all here in-house.

A GE Diamond Mammography unit badly damaged in shipping. Left view show the back metal cover crushed and bent. Right view shows same cover’s interior, removed prior to repair.

As our guys took on greater challenges, our “Restoration Team” was born.  These days we do many restoration jobs for insurance companies, shipping companies, other medical equipment dealers, hospitals, and even the OEMS’s.  Our restorations are THAT good.  Take a look here for some recent examples.  Also, watch this space as our “Restoration Team” will soon get their own blog.

GE Diamond mammography cover fully repaired and repainted, waiting to be reinstalled on the system.

Removing broken covers on a digital mammography system or a CT Scanner is often careful work, and may require us to replace damaged clips and/or brackets that serve as closures to fit the covers back together.  Much of this type of work involves fitting dissimilar materials, such as plastic and metal, or fiberglass and metal, and occasionally requires us to have custom pieces molded or tooled off-site.  We are well prepared to do this work, in addition to welding of nearly all metals– aluminum, stainless steel, brass, and others.

GE Diamond mammography back cover fully restored, and reinstalled. System was pre-staged, tested, and re-certified prior to shipping back to the customer. The insurance company saved nearly $6,800.

On some restoration jobs we are further asked to “Pre-Stage” the equipment prior to return to the client, i.e. to do final or preliminary testing after the cosmetic restoration has been completed to verify functionality.  Our large equipment staging areas are equipped with single-phase and 3-phase power, from 110v to 480v, to accommodate all types of medical equipment testing.

Future plans are to provide repairs and restorations of medical equipment or systems damaged by water, fire or smoke.  In this case we are developing the capability to clean, repair, and decontaminate a wide variety of equipment without disturbing internal circuitry, in order to enter the field of true electronics recovery.  Stay tuned.

David

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Going To Physician Visits With Older Loved Ones Could Improve Care

Main Category: Primary Care / General Practice
Also Included In: Seniors / Aging;  Medicare / Medicaid / SCHIP
Article Date: 25 Jan 2012 – 1:00 PST

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Family companions who routinely accompany older adults to physician office visits could be helpful to health care quality improvement efforts, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The authors found that three-quarters of older adults who attend physician visits with a family companion are consistently accompanied over time, nearly always by the same companion. The results are featured in the January 2012 issue of the Journal of the American Geriatrics Society.

“Continuity of care is a central tenant of an effective patient-provider partnership,” said Jennifer L. Wolff, PhD, lead author of the study and an associate professor with the Bloomberg School’s Department of Health Policy and Management. “Our study documents that the patient-provider relationship often includes a consistently present and actively engaged family member. This work suggests that quality of care improvements may result from more productive communication and education that targets both patients and their companions.”

Wolff and her colleagues at the Johns Hopkins schools of Public Health, Nursing and Medicine, and Weill Cornell Medical College analyzed a national survey of Medicare beneficiaries ages 65 years or older. The researchers studied the influence of socio-demographic characteristics, health status and physical function in regard to consistent accompaniment to physician visits. They also examined the activities performed by older adults’ family companions during medical visits.

The researchers found that 75 percent of the 9.5 million older adults who attended routine physician visits with a family companion were consistently accompanied at 12 months follow-up. Nearly 9 in 10 (87.9%) beneficiaries who were consistently accompanied over time were accompanied by the same companion. Patients who were older, less educated and diagnosed with multiple chronic conditions were more likely to be consistently accompanied at one year follow-up.

Nearly 35.5 percent of accompanied beneficiaries were physically disabled and received help with daily activities from their family companion. Companions of these patients were more active in visit communication by providing information directly to the doctor (70.5%), asking the doctor questions (67.1%) and explaining the doctor’s instructions to the patient (54.5%).

“Initiatives to improve older adults’ quality of chronic illness care have typically focused on improving health care professional and patient competencies, and have ignored the fact that Medicare beneficiaries often manage their health conditions and attend routine physician visits with a family member, predominantly a spouse or an adult child,” said Wolff. “Results from this study may help inform health reform initiatives that seek to improve care quality and lower costs, such as the Patient Centered Medical Home.”

Previous studies have shown that Medicare beneficiaries who attend routine physician visits with a family companion are disproportionately vulnerable by age, education and health, and that their Medicare expenditures are twice as high as those beneficiaries who are not accompanied by a companion.

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“Going It Together: Persistence of Older Adults’ Accompaniment to Physician Visits by a Family Companion” was written by Jennifer L. Wolff, PhD, Cynthia M. Boyd, MD, MPH, Laura N. Gitlin, PhD, Martha L. Bruce, PhD, MPH, and Debra L. Roter, DrPH.

This research was funded by the National Institute of Mental Health.

Johns Hopkins University Bloomberg School of Public Health

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Psoriatic Arthritis

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Academic Journal
Main Category: Arthritis / Rheumatology
Also Included In: Dermatology;  Eczema / Psoriasis
Article Date: 23 Jan 2012 – 10:00 PST

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Around 7.5 million Americans, which is about 2.2% of the population, suffer from psoriaris, an autoimmune disease causing red, flaky skin. A new review in the Journal of the American Academy of Orthopedic Surgeons (JAAOS) reveals that patients with psoriatic arthritis (PsA), a type of arthritis that affects nearly 48% of patients with the skin disease psoriasis, gain substantial benefits from medications or biologic agents that target T-cells, white blood cells involved in the body’s immune system.

Lead study author Michael S. Day, M.D., MPhil, a resident orthopedic surgeon with the Department of Orthopedic Surgery at NYU Hospital for Joint Diseases explains:

“Although these new immunosuppressive agents are expensive, they are the only agents that have demonstrated a decrease in radiologic progression of peripheral arthritis, and can be used to manage associated types of inflammation, as well as skin and nail disease.”

PsA can occur in all intensities, ranging from mild symptoms that involve only a few joints, to severe symptoms, which affect more joints and cause substantial pain. Dr. Day states that even though skin lesions appear before arthritic symptoms in approximately 15% of patients, those with more severe psoriasis are not necessarily at greater risk for developing PsA.

Study co-author, Dr. Susan M. Goodman, an assisting attending rheumatologist and internist at Hospital for Special Surgery explains:

“When patients in dermatology clinics are screened for evidence of inflammatory arthritis, many have evidence of joint inflammation that they did not report, suggesting that many of these patients are undiagnosed and untreated.”

Initial treatments for PsA currently include nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation, pain and fever, however Goodman adds that in the near future, patients will be able to avoid progressing to end-stage arthritis and joint destruction through drugs designed to provide a more targeted therapy.

The fact that PsA and rheumatoid arthritis (RA) are very similar has encouraged PsA researchers to consider treating patients early and aggressively, a strategy that has shown to be successful in RA patients.

Patients with joint deformities as a result of PsA can also be considered for surgery, however few large-scale, high-quality clinical trials exist says Dr. Day, adding that:

“The disease typically follows a moderate course, but up to 48 percent of cases develop into destructive arthritis in which the inflammatory process leads to bone erosion and loss of joint architecture.”

Dr. Goodman said: “Initially, it was believed that PsA had a more benign course than does RA, but this belief has been disproven.”

Even though orthopedic surgeons play an important part on the PsA treatment team, the basis for a successful surgery of PSA patients is the collaboration between dermatologists, rheumatologists, internists and family physicians.

Dr. Day states: “PsA is a systemic inflammatory disease with multi-organ system effects. As such it should be treated with a multi-disciplinary approach.”

“Those who do progress to joint destruction may benefit from surgery, and may provide researchers with insights and further data regarding outcomes as well as the risks of surgery in this population,” adds Dr. Goodman.

Written by Petra Rattue

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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Early, Aggressive Treatment May Help Reduce Symptoms And Improve Joint Function In Psoriatic Arthritis (PsA)

Main Category: Arthritis / Rheumatology
Also Included In: Eczema / Psoriasis
Article Date: 20 Jan 2012 – 1:00 PST

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Medications or biologic agents that target T-cells, white blood cells involved in the body’s immune system, appear to offer significant benefit to patients suffering from psoriatic arthritis (PsA), a type of arthritis that affects up to 48 percent of patients with the skin disease psoriasis, according to a new review article in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). About 7.5 million Americans – roughly 2.2 percent of the population – have psoriasis, an autoimmune disease that causes red, flaky skin.

“Although these new immunosuppressive agents are expensive, they are the only agents that have demonstrated a decrease in radiologic progression of peripheral arthritis, and can be used to manage associated types of inflammation, as well as skin and nail disease,” said lead study author Michael S. Day, MD, MPhil, a resident orthopaedic surgeon with the Department of Orthopaedic Surgery at NYU Hospital for Joint Diseases.

PsA can range in intensity from mild, involving only a few joints, to severe, where more joints are affected and pain may be significant. In about 15 percent of patients with PsA, skin lesions appear before arthritic symptoms; however, patients with more severe psoriasis are not necessarily at greater risk for developing PsA, Dr. Day said.

“When patients in dermatology clinics are screened for evidence of inflammatory arthritis, many have evidence of joint inflammation that they did not report, suggesting that many of these patients are undiagnosed and untreated,” said study co-author, Dr. Susan M. Goodman, an assisting attending rheumatologist and internist at Hospital for Special Surgery.

Currently, initial treatments for PsA include nonsteroidal anti-inflammatory drugs (NSAIDs) that reduce inflammation, pain and fever. In the near future, drugs aimed at providing more targeted therapy will allow more PsA patients to avoid progressing to end-stage arthritis and joint destruction, she added.

Similarities between PsA and rheumatoid arthritis (RA) have spurred PsA researchers to consider early, aggressive treatment, an approach that has proved to be successful in RA patients.

Surgery may also be considered for patients who have joint deformities as a result of PsA, but so far there have been few large-scale, high-quality clinical trials, Dr. Day said. “The disease typically follows a moderate course, but up to 48 percent of cases develop into destructive arthritis in which the inflammatory process leads to bone erosion and loss of joint architecture,” he said.

“Initially, it was believed that PsA had a more benign course than does RA, but this belief has been disproven,” said Dr. Goodman.

Orthopaedic surgeons play a key role on the PsA treatment team. Dr. Day added that collaboration with dermatologists, rheumatologists, internists and family physicians is essential to the successful surgical treatment of PsA.

“PsA is a systemic inflammatory disease with multi-organ system effects,” said Dr. Day. “As such it should be treated with a multi-disciplinary approach.”

“Those who do progress to joint destruction may benefit from surgery, and may provide researchers with insights and further data regarding outcomes as well as the risks of surgery in this population,” Dr. Goodman said.

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Disclosure: From the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY (Dr. Day), the Department of Orthopedic Surgery (Dr. Nam, Dr. Su, and Dr. Figgie), and the Department of Rheumatology (Dr. Goodman), Hospital for Special Surgery, New York. Dr. Su or an immediate family member serves as a paid consultant to Smith Nephew and has received research or institutional support from Smith Nephew and Cool Systems. Dr. Figgie or an immediate family member has received research or institutional support from Ethicon. None of the following authors or any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Day, Dr. Nam, and Dr. Goodman.

American Academy of Orthopaedic Surgeons

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Managing Rheumatoid Arthritis Pain With Muscle Relaxants And Neuromodulators

Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 19 Jan 2012 – 0:00 PST

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Pain management is a high priority for patients with rheumatoid arthritis, so three researchers in Australia analysed existing study data to see whether two different classes of drugs can help. When looking at muscle relaxants, they discovered that neither the benzodiazepine agents, diazepam and triazolam, nor the non- benzodiazepine agent, zopiclone, reduce pain when taken for one to 14 days. However, even this short use was associated for both agents with drowsiness and dizziness.

When looking at neuromodulators, the researchers discovered weak evidence that using oral nefopam, topical capsaicin and oromucosal cannabis for one to seven days can reduce pain in patients with rheumatoid arthritis better than placebo. Each drug has its own set of side effects, but together they included nausea, sweating, dizziness, dry mouth light headedness, local burning and irritation. Accessibility to these medications is also an issue with nefopam not being widely available in many countries and cannabis use illegal in many parts of the world. These results are published in The Cochrane Library in two separate papers.

“Until further research is available, given the relatively mild nature of the adverse events, capsaicin could be considered as an add-on therapy for patients with persistent local pain and inadequate response or intolerance to other treatments. In view of the low quality of the evidence we found to support this option, some caution should be applied,” says lead researcher Bethan Richards, who works at the Institute of Rheumatology and Orthopedics, Royal Prince Alfred Hospital, Camperdown, Australia. “However, oral nefopam and oromucosal cannabis have more significant side effect profiles and the potential harms seem to outweigh any modest benefit achieved.”

Rheumatoid arthritis is a disease in which a people’s immune systems, which normally fight infection, attack the lining of their joints. This makes the joints swollen, stiff, and painful. The small joints of their hands and feet are usually affected first. There is currently no cure for rheumatoid arthritis, so the treatments aim to relieve pain and stiffness and improve their mobility.

Muscle relaxants can be used to treat anxiety and promote sleep, and some people believe they may also reduce pain by acting on the nerves that cause pain, but this remains controversial. Neuromodulators alter the way nerves communicate with each other and, consequently, alter the overall activity level of the brain. This may reduce the amount of pain felt by an individual.

The researchers looked for clinical studies that had compared these drugs with either other active treatments or placebos. After searching through the major clinical databases they found only a few, small trials. For muscle relaxants, they found six trials that had a total of 126 participants, and for the neuromodulators they found four trials that involved 141 participants. The data was further weakened because the procedures used in the trials ran the risk that the patients or those running the trials could have affected the findings.

“Given the large number of people with rheumatoid arthritis, and the debilitating affect that the disease has on their lives, it is disappointing that no high-quality studies have been carried out on these drugs in this patient group,” says Richards.

The researchers suggest that “to better assess the efficacy and safety of medications for pain management in patients with rheumatoid arthritis, large high quality, double-blind placebo-controlled trials are now required.”

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