Tiny Organelles Called Primary Cilia Hold The Key To Combat Inflammation

Main Category: Arthritis / Rheumatology
Also Included In: Immune System / Vaccines
Article Date: 10 May 2012 – 1:00 PDT

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Scientists from Queen Mary, University of London have found a new therapeutic target to combat inflammation.

The research, published in the journal Cellular and Molecular Life Sciences, revealed tiny organelles called primary cilia are important for regulating inflammation. The findings could lead to potential therapies for millions of people who suffer from arthritis*.

Dr Martin Knight who led the research at Queen Mary’s School of Engineering and Materials Science said: “Although primary cilia were discovered more than a century ago, we’re only beginning to realise the importance they play in different diseases and conditions, and the potential therapeutic benefits that could be developed from manipulating cilia structure and function.”

The researchers investigated the role of primary cilia in inflammation. They took cartilage cells and exposed them to a group of inflammatory proteins called cytokines, specifically interleukin-1 (IL-1), to see whether there were any changes to the primary cilia.

“When we exposed the cells to IL-1, in just three hours the primary cilia showed a 50 per cent increase in length,” he said.

“But what was most interesting was when we treated cells to prevent this elongation of the cilium. The cartilage cells had a greatly reduced response to the inflammatory proteins and were therefore not as inflamed. This suggests a brand new therapeutic target for inflammation.”

Co-author Dr Angus Wann, said this is the first time primary cilia have been suggested as a target for novel therapies to reduce the effects of inflammation.

“If we can work out how to better manipulate the primary cilium, we could potentially attenuate or even prevent inflammation,” he said.

* 8 million people in the UK suffer from arthritis. The research could also benefit others who suffer from illnesses which cause inflammation.

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Autoimmunity In Rheumatoid Arthritis Tempered By Regulatory Immune Cell Diversity

Main Category: Arthritis / Rheumatology
Also Included In: Immune System / Vaccines
Article Date: 10 May 2012 – 1:00 PDT

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Untangling the root cause of rheumatoid arthritis has been a difficult task for immunologists, as decades of research has pointed to multiple culprits in our immune system, with contradictory lines of evidence. Now, researchers at The Wistar Institute announce that it takes a diverse array of regulatory T cells (a specialized subset of white blood cells) to prevent the immune system from generating the tissue-specific inflammation that is a hallmark of the disease. Regulatory T cell diversity, the researchers say, provides a cumulative protective effect against rheumatoid arthritis. When that diversity is not present, it allows the immune system to attack joints.

The Wistar scientists presented their findings*, developed in a mouse model of rheumatoid arthritis, in the Journal of Immunology. Defining the immune mechanisms involved in rheumatoid arthritis could point to new therapies for the disease.

“Our results show, surprisingly, that suppressing the immune response against a single target will not shut down the inflammatory response that causes rheumatoid arthritis,” said Andrew J. Caton, Ph.D., senior author and professor in The Wistar Institute Cancer Center’s Tumor Microenvironment and Metastasis program. “Instead, an array of inflammation-stimulating antigens may be involved in causing the disease, since our study shows that an array of regulatory T cells is required to temper the immune system’s attack on joints.”

Rheumatoid arthritis (RA) is an autoimmune disorder that occurs as the immune system attacks the synovium, the membrane that lines all the joints of the body. It is a common disorder that causes uncontrolled inflammation – resulting in pain and swelling – around the joints. It is thought that approximately one percent of the adult population, worldwide, suffers from rheumatoid arthritis. RA has shown to be exacerbated by drinking and smoking, and the disease can lead to an overall increased risk of death.

While the exact cause of RA is unknown, the Caton laboratory and others have shown that a variety of white blood cells called regulatory T cells (or Tregs) are a necessary component to either restrain (or encourage) the immune system’s inflammatory response. Tregs are activated as molecules on their surface membranes called T cell receptors interact with “friendly” or “self” molecules – a way for the immune system to recognize friend from foe. Mismanagement of these Tregs, which normally serve to restrain the immune system from over-reacting to healthy tissue, could then lead to runaway inflammation.

In this study, the researchers sought to examine how T cell receptors affect the ability of Tregs to suppress arthritis in a mouse that had been bred to express a “self” molecule that drives arthritis. They showed that an array of Tregs given to the mice effectively stops arthritis. Unexpectedly, however, Tregs that are specific for the surrogate “self” molecule do not prevent arthritis.

“We find that the Treg responsible for recognition of the disease-initiating self antigen are sufficient for stopping arthritis, but a diverse repertoire of Tregs are very effective,” Caton said. “All of these Tregs, together, influence other components of the immune system which serves to slow down the inflammatory process that causes RA.”

According to Caton, their findings also point to a possible answer of why the immune system targets the membranes that line joints. Tregs influence other types of T cells to produce a substance known as IL-17, and these cells often travel through the body’s lymphatic system where they then drain out into the joints.

“The big unanswered question of RA is ‘why are joints targeted?'” Caton said. “Of all the tissues in the body, of all the places our immune system could attack, this question remains.”

“One idea is that the immune system isn’t deliberately attacking joints in patients with rheumatoid arthritis,” Caton said, “but the joint inflammation is a side effect of the natural tendency of these cells to accumulate in these areas of the body.”

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Recommendations By AMA Committee On Doctor Fees Set By Medicare Are Followed 9 Times Out Of 10

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 09 May 2012 – 1:00 PDT

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To calculate physicians’ fees under Medicare – which in turn influence some state and private payers’ decisions on how they will pay doctors — the Centers for Medicare and Medicaid Services (CMS) relies on the recommendations of an American Medical Association advisory panel. A study led by Miriam Laugesen, PhD at Columbia University’s Mailman School of Public Health, found that the Medicare and Medicaid agency closely followed the committee’s recommendations on the fees physicians are paid, which are based on an assessment of time and effort associated with various physicians’ services.

The findings are reported in the May issue of Health Affairs.

The analysis by Dr. Laugesen, Mailman School Assistant Professor of Health Policy and Management, and colleagues at UCLA and the University of Illinois, shows that for services provided between 1994 and 2010, CMS agreed with 87.4% of the recommendations of the committee, known as RUC or the Relative Value Update Committee. The study looked at 2,768 reimbursable services. When the agency differed with these recommendations, it tended to recommend lower fees for certain radiology and medical specialty services.

In recent years primary care doctors have expressed concerns that the AMA committee, which includes representatives from 31 physicians’ organizations, has too little representation from their ranks and is partly responsible for the increasing pay gap between primary care doctors and specialists. While the current study did not directly examine this issue, it did find that CMS’s decisions are less likely to lower fees for evaluation and management services, which account for a large percentage of primary care providers’ income, than for fees of medical specialists.

“This is encouraging for providers in primary care and other specialties that bill the greatest proportion of these services,” said Dr. Laugesen, who is the principal investigator. “However, it does not explain why there has been no reduction in the income gap between primary care providers and specialists.”

Recommendations on physician payments are based on several factors, including the amount of time a procedure takes, the technical skill and mental judgment required, as well as the stress that the physician experiences – a factor related to patient risk. Medicare and Medicaid payments are adjusted for geographical differences in costs based on where the provider is located.

If policy makers or physicians want to change the update process but keep the Medicare fee schedule in its current form, the authors suggest that Congress and CMS make some long-term investments in the agency’s ability to undertake research and analysis of issues such as how the effort and time associated with various physician services is determined. Such an investment, they write, “could pay dividends throughout the health care system.”

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Poorer Neighborhoods More Likely To Have Scarce Primary Health Services

Editor’s Choice
Main Category: Primary Care / General Practice
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 08 May 2012 – 13:00 PDT

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According to a study published in the latest issue of Health Services Research, blacks and lower income Hispanics are more likely to live in neighborhoods with few or no primary care physicians.

Lead author Darrell J. Gaskin, Ph.D., deputy director of the Hopkins Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health explained:

“What this says to us is that we really need to encourage physicians to locate in these areas.”

According to research, minorities, the poor and those living in inner cities and rural areas, as well as those who are uninsured are more likely to have an irregular source of medical care, compared with those who do not.

Gaskin explained that primary-care physicians are vital as they are “our first line of defense in the health-care system. They deliver most of our preventive and routine services in terms of checkups and initial acute-care services and do the initial diagnosis to let patients know if they need a higher level of care.”

In order to find out which zip codes in U.S. metropolitan areas – which can include rural neighborhoods – had a shortage of primary-care physicians, the team examined data from the U.S. Census and American Medical Association from 2000 and 2006. The researchers defined a shortage of primary-care physicians as 1 physician per 3,500+ people, or no physician at all.

The researchers found that blacks and Hispanics were more likely to live in areas with few or no primary-care physicians (25.6% and 24.3%, respectively) than whites or Asians (13.2% and 9.6% respectively). Although areas with primarily black or Hispanic residents were more likely to have a shortage of primary care physicians, the researchers found that the disparity disappeared for Hispanics after controlling for socioeconomic factors.

Results from the study indicated the availability of a primary care physician was positively linked with segregation of Asians, as well as certain groups of Hispanics. According to the team, foreign-trained doctors may help reduce shortages in Asian and some Hispanic neighborhoods, as they may be seeking places where patients speak their languages.

According to the researchers, the cost to financially sustain a practice in black neighborhoods may be a reason for the shortage and not racism and bigotry. They explain that in these neighborhoods, more black patients are uninsured or covered by Medicaid.

Stephen B. Thomas, Ph.D., director of the University of Maryland Center for Health Equity, explained:

“In many ways, it confirms that being black matters. You cannot make a living as a solo practitioner, particularly in primary care, if you’re serving a population that lacks the ability to pay.”

Gaskin explained that solutions to solving the shortages include expanding health insurance coverage to individuals without insurance, as well as increasing doctors’ reimbursement from the government to practice in areas with shortages. In addition, he states that it can be an extremely expensive proposition for a physician to treat the poor who use Medicaid for medical expenses.

Gaskin said:

“You can’t pay physicians less for a service under Medicaid and expect them to want to practice in that kind of area. We’re talking about areas where doctors won’t be able to practice because they just can’t sustain themselves.”

Written By Grace Rattue

Copyright: Medical News Today

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A quick note about feeding pumps

Our Enteralite Infinity feeding pump by Moog (formerly a maker of fine synthesizers) went on the fritz. For several weeks, adjusting, poking, prodding, duct-taping, etc. took an average 30-45 minutes per feeding to ensure the bag and pump were properly aligned and calibrated to allow the feeding system to work as designed.

I finally called our med-tech company rep and complained. He brought over a pump called “Kangaroo Joey” and every feeding since has worked like clockwork. Pour the formula in the bag, thread tub through pump, hook tube to Luke, press start. Every time.

If you’re having problems with your enteralite infinity, I strongly suggest switching over to the Kangaroo Joey.

Multi-Center Study Reveals That Eye Color May Indicate Risk For Serious Skin Conditions

Main Category: Dermatology
Also Included In: Melanoma / Skin Cancer;  Arthritis / Rheumatology
Article Date: 08 May 2012 – 1:00 PDT

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Eye color may be an indicator of whether a person is high-risk for certain serious skin conditions. A study, led by the University of Colorado School of Medicine, shows people with blue eyes are less likely to have vitiligo. It then follows, according to scientists, that people with brown eyes may be less likely to have melanoma. Vitiligo is an autoimmune skin disease in which pigment loss results in irregular white patches of skin and hair. Melanoma is the most dangerous kind of skin cancer.

The study is published online by the journal Nature Genetics. It looked at almost 3,000 people with vitiligo of Non-Hispanic European ancestry, identifying 13 new genes that predispose to vitiligo. Among the vitiligo patients, approximately 27 percent had blue/gray eyes, 43 percent had tan or brown eyes and 30 percent had green or hazel eyes, which is significantly different from the normal distribution of eye color where approximately 52 percent of Americans of Non-Hispanic European ancestry have blue/gray eyes, 22 percent have green/hazel eyes, and 27 percent have tan or brown eyes.

Richard Spritz, MD, is director of the Human Medical Genetics and Genomics Program at the CU School of Medicine, the coordinating center for the research. Spritz said the study primarily looked at vitiligo but also has implications for melanoma.

“Genetically, in some ways vitiligo and melanoma are polar opposites. Some of the same genetic variations that make one more likely to have vitiligo make one less likely to have melanoma, and vice-versa,” said Spritz. “Vitiligo is an autoimmune disease, in which a person’s immune system attacks their normal pigment cells. We think that vitiligo represents over-activity of a normal process by which one’s immune system searches out and destroys early cancerous melanoma cells.”

People with vitiligo are at higher risk for various other autoimmune diseases, such as thyroid disease, type 1 diabetes, rheumatoid arthritis and lupus. Vitiligo patients’ close relatives also are at higher risk for these same diseases, even if they don’t have vitiligo. Spritz said this means there must be some genes that push towards these autoimmune diseases in general, while other genes and environmental triggers determine which autoimmune disease occurs and when. So, as scientists learn about the genetics of vitiligo, they also are learning about the genetics of these other autoimmune diseases.

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Surgical Instruments Forging 101

The quality, finish, and functionality of a surgical instrument is greatly affected by the quality of forging used. Die making and forging are perhaps amongst the most important and basic processes that help create world class medical devices. Having said that, what is forging anyways?

Forging is a method of shaping metal by applying pressure. There are various methods of forging but in surgical instruments manufacturing industry drop forging technique is the most commonly used. In this type of forging, stainless steel of various grades is heated to a certain temperature and placed between two dies. One of the dies is dropped on the heated metal with pressure causing the metal to expand into the die cavity that is already precisely carved in the shape of the desired instrument. Normally, multiple hits through various dies is required before the forging process is considered complete.

The quality, precision, and finish of the die, along with the quality of stainless steel used will greatly affect the standard of the surgical instrument under manufacturing. For more informative articles on surgical instruments, don’t forget to sign up to our blog.

My First Blog Post / An Introduction

Hello world. My name is Joey Graham and I’m the Director of Operations and Administration for Gulf Medical Services (www.gulfmed.com), a mid-sized durable medical equipment (DME)/ home medical equipment (HME) company that operates in the Florida panhandle and Southern Alabama. We sell and rent medical equipment to people and we bill their insurance for it. I’m also the Vice President and CFO for Best Bet Rentals, Inc. (www.bestbetrentals.com). Best Bet is a start-up company that specializes in the cash sales / internet side of the home medical equipment industry. Where Gulf Medical focuses on treating sickness, Best Bet focuses on health and life.

I also have a Masters of Business Administration that I earned from the University of West Florida, College of Business, an AACSB accredited business school. I started working at Gulf Medical the summer after I graduated from high school and continued working there throughout college. During my first two years when I was working towards an Associate’s degree, I was driving Gulf Medical’s trucks delivering medical equipment as a Service Technician. I also worked the office as a Customer Service Representative. Then, when I started work on my Bachelor’s degree, I relocated to the corporate office and worked the Billing and Collections Dept. Finally, when I began my Master’s program, I was promoted to the Executive Assistant to the President. All of this groomed me for my current position – I’m the #2 guy in the company, over nearly every department and manager. I like to say that I earned my real-world MBA at Gulf Medical at the same time that i earned my academic MBA from UWF.

Why am I writing this blog? To pass on the knowledge that I gain every day working at both Gulf Medical and Best Bet. I want to share about new and old home medical products as well as insurance coverage of medical equipment. I’ll be answering questions about what products best help you cope with various medical conditions. I’ll also address specific insurance guidelines for medical equipment to help you know when you should seek to have your health insurance pay for your medical equipment, and when you should just buy it yourself and skip the hassle. For example, some medical equipment requires so much testing to keep you “qualified” for insurance coverage, that its often more cost effective for you to just buy it outright rather than pay the copays and deductibles for all the office visits and tests, all of which may end up saying that you’re not qualified.

So, its good to meet you world. I hope we’ll have a long and fulfilling relationship. I’m always open to meeting new people and helping answer questions, so feel free to contact me at joey@bestbetrentals.com if you have any questions, concerns, or comments for me. I’m also available on LinkedIn.

Kindest Regards,
Joey Graham
HME Executive

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How to Buy Durable Medical Equipment from Medical Supply Store

In the field of medical supplies innumerable people have been benefited down the years. Medical equipment field is a rapidly advancing day by day. This implies a tremendous scope of developing better and improved machines for betterment of healthcare and medicine as a science.

medical supply store

Often it is not possible under financial considerations to carry out the long- term treatment of a patient in an official medical facility like a hospital. The patient is taken care of by a family member or any other person not a qualified medical professional in their knowledge of nursing. It is also referred to as Durable Medical Equipment or DME in medical parlance as it is manufactured to withstand regular and repeated use easily.

Visible and recognizable apparatuses and devices like the wheelchair, bath lifts, defibrillator, mobility accessories, mobility scooters, rolling walkers, scooter wheelchair lifts, wheelchair stair climbers, walk in baths, vertical platform lifts, stair lifts and toilet seat lifts are mostly required as home equipment. Such devices can only be used on a doctor’s recommendation and approval and can only be purchased from a doctor’s prescription online.

People nowadays can even opt for medical supplies at online medical supply store. There are many medical supply store who have their own websites and they sell medical equipments to needy people at an affordable price without compromising with the quality. However, there are risks associated with it. You can take advice and tips from your doctor for that particular equipment or tool. Without going by conventional way, one can even take various helps like doctor or a neighbor or relative who has the experience of procuring medical supplies for treatment. Do not go by contentious advertisements of these medical suppliers.

Be careful before opting to buy durable medical equipment online. Take a look about manufacturing and expiry date if any are attached with medical kit. You should always ask your medical supplier online for proper cash receipt; keep the receipt with yourself in case you need replacement of your purchased product. You can also challenge supplier with such receipts if they supply you obsolete products to you. Beware of duplicate products or second hand (old) products as these can be dangerous too for your body and life.

People with impaired mobility can now live a more normal life by means of durable medical equipment. This is specially designed to give assistance to people who are suffering from injuries and diseases that constrict their movements and give them a hard time carrying out their everyday activities.

Medical equipment supplies offers all inclusive range of bath Lifts, lift chairs, durable medical equipment, medical equipment, medical supply store, medical supply and various other equipment’s for medical purpose usage.

Juvenile Idiopathic Arthritis Linked To Higher Bacterial Infection Rates

Editor’s Choice
Main Category: Arthritis / Rheumatology
Also Included In: Pediatrics / Children’s Health
Article Date: 04 May 2012 – 10:00 PDT

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According to an observational study published in Arthritis Rheumatism, children with juvenile idiopathic arthritis (JIA) have higher rates of hospitalized bacterial infection compared with those without JIA.

The study demonstrates that the risk of infection in JIA patients was considerably higher with use of high-dose glucocorticoids (steroids). However, methotrexate (MTX) and tumor necrosis factor alpha (TNF) inhibitors did not increase the risk of infection in these pediatric patients.

Arthritis is an inflammation of the joints that is usually accompanied by pain, stiffness and swelling and can lead to disability.

There are numerous forms of arthritis, but JIA is a chronic arthritis disease that attacks young patients. According to the American College of Rheumatology (ACR) JIA affects almost 300,000 children in the U.S. JIA is commonly treated with immunosuppressant therapies like steroids, MTX, and TNF inhibitors. However, it remains uncertain how these drugs affect the risk of infection.

Dr. Timothy Beukelman from the University of Alabama at Birmingham, USA and his team decided to compare bacterial infection incidence in children with and without JIA. Using Medicaid data from 2000 to 2005, they identified 8,479 JIA patients with 13,003 person-years of follow-up and a group of 360,489 children with attention-deficit hyperactivity disorder (ADHD) for comparison. To determine exposure to MTX, TNF inhibitors and oral steroid medications, the team used pharmacy claims and diagnoses on hospital discharges in order to identify infections.

The team observed that 42% of JIA patients used MTX and 17% used TNF inhibitors to manage their disease. They noted that JIA patients who were currently not taking MTX or TNF inhibitors had an elevated rate of bacterial infection compared to ADHD patients. The results remained unchanged even after adjusting for steroid use.

Dr. Beukelman explains:

“Patients with JIA who were not currently treated with MTX or TNF inhibitors had a 2-fold increase in hospitalized bacterial infection rates compared to children without arthritis. This finding suggests the inflammatory or autoimmune process may predispose children to infection regardless of therapy.”

The rate of infection linked to MTX or TNF inhibitors was similar amongst children with JIA. After the team adjusted for MTX and TNF inhibitor use in children with JIA, the team discovered that high-dose steroid use, i.e. 10 mg or more of prednisone per day resulted in more than double the rate of subsequent infection compared to those who did not take steroids.

Dr. Beukelman says in a concluding statement:

“A steroid-sparing treatment strategy may reduce the risk of serious infection in children with JIA.”

Written By Petra Rattue

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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Rates of Hospitalized Bacterial Infection Associated with Juvenile Idiopathic Arthritis and Its Treatment
Timothy Beukelman, Fenglong Xie, Lang Chen, John W Baddley, Elizabeth Delzell, Carlos G Grijalva, James D Lewis, Rita Ouellet-Hellstrom, Nivedita M Patkar, Kenneth G Saag, Kevin L Winthrop and Jeffrey R Curtis
Arthritis and Rheumatism , May 2012, DOI: 10.1002/art.34458

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