Mystery Surrounding The Death Of Two Sisters Nearly 50 Years Ago Solved By Researchers

Main Category: Bones / Orthopedics
Also Included In: Genetics;  Arthritis / Rheumatology;  Pediatrics / Children’s Health
Article Date: 31 Aug 2012 – 1:00 PDT

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Researchers at Mount Sinai School of Medicine have identified the genetic cause of a rare and fatal bone disease by studying frozen skin cells that were taken from a child with the condition almost fifty years ago. Their study, which details how the MT1-MMP gene leads to the disease known as Winchester syndrome, appears in the online edition of The American Journal of Human Genetics.

In 1969, Patricia Winchester, MD, a pediatric radiologist in New York City, was asked to diagnose two young sisters who were losing bone in their hands and feet, developing severe arthritis in their fingers and losing movement of their shoulders, elbows, hips and knees because of osteoporosis. The frozen skin cells that were recently studied by principal investigator, John Martignetti, MD, PhD, and his team of researchers in the Department of Genetics and Genomic Sciences at Mount Sinai, had been taken from one of the sisters. Ultimately, the disease rendered the girls incapable of moving without assistance, and proved fatal.

The cause of the disease has remained unknown until now, when the study’s lead authors, post-doctoral students, Rebecca Mosig, PhD and Brad Evans, PhD, zeroed in on the MT1-MMP gene.

“This gene encodes an enzyme that needs to be specifically positioned on the membranes of cells to function correctly,” explains Dr. Martignetti. “What we discovered is that these girls had a gene mutation which resulted in incorrect shuttling of the protein. Instead of being directed to the cell surface where it could interact with the outside environment, the mutant protein never reached its final, correct destination and remained trapped in the cell’s cytoplasm. Mislocalized, it lost its ability to function and the children developed severe arthritis and bone The enzyme lost its ability to interact with another disease-casuing protein, MMP-2. Dr. Martignetti’s team had previously identifed mutations in the MMP-2 gene as the cause of a similar group of bone disorders in children.

The researchers says this recent discovery should provide diagnostic clarity and insight into possible treatments for children with Winchester syndrome, and other bone disorders, and for people in the general population who have osteoporosis and arthritis.

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Potential New Type Of Diagnostic Imaging Technology Using Collagen-Seeking Synthetic Protein Could Lead Doctors To Tumor Locations

Main Category: Medical Devices / Diagnostics
Also Included In: Arthritis / Rheumatology;  Cancer / Oncology
Article Date: 31 Aug 2012 – 2:00 PDT

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Johns Hopkins researchers have created a synthetic protein that, when activated by ultraviolet light, can guide doctors to places within the body where cancer, arthritis and other serious medical disorders can be detected.

The technique could lead to a new type of diagnostic imaging technology and may someday serve as a way to move medications to parts of the body where signs of disease have been found. In a study published in the Aug. 27-31 Online Early Edition of Proceedings of the National Academy of Sciences, the researchers reported success in using the synthetic protein in mouse models to locate prostate and pancreatic cancers, as well as to detect abnormal bone growth activity associated with Marfan syndrome.

Video of Michael Yu discussing a synthetic molecule called collagen mimetic peptide:

The synthetic protein developed by the Johns Hopkins team does not zero in directly on the diseased cells. Instead, it binds to nearby collagen that has been degraded by various health disorders. Collagen, the body’s most abundant protein, provides structure and creates a sturdy framework upon which cells build nerves, bone and skin. Some buildup and degradation of collagen is normal, but disease cells such as cancer can send out enzymes that break down collagen at an accelerated pace. It is this excessive damage, caused by disease, that the new synthetic protein can detect, the researchers said.

“These disease cells are like burglars who break into a house and do lots of damage but who are not there when the police arrive,” said S. Michael Yu, a faculty member in the Whiting School of Engineering’s Department of Materials Science and Engineering. “Instead of looking for the burglars, our synthetic protein is reacting to evidence left at the scene of the crime,” said Yu, who was principal investigator in the study.

A key collaborator was Martin Pomper, a School of Medicine professor of radiology and co-principal investigator of the Johns Hopkins Center of Cancer Nanotechnology Excellence. Pomper and Yu met as fellow affiliates of the Johns Hopkins Institute for NanoBioTechnology. “A major unmet medical need is for a better non-invasive characterization of disrupted collagen, which occurs in a wide variety of disorders,” Pomper said. “Michael has found what could be a very elegant and practical solution, which we are converting into a suite of imaging and potential agents for diagnosis and treatment.”

The synthetic proteins used in the study are called collagen mimetic peptides or CMPs. These tiny bits of protein are attracted to and physically bind to degraded strands of collagen, particularly those damaged by disease. Fluorescent tags are placed on each CMP so that it will show up when doctors scan tissue with fluorescent imaging equipment. The glowing areas indicate the location of damaged collagen that is likely to be associated with disease.

In developing the technique, the researchers faced a challenge because CMPs tend to bind with one another and form their own structures, similar to DNA, in a way that would cause them to ignore the disease-linked collagen targeted by the researchers.

To remedy this, the study’s lead author, Yang Li, synthesized CMPs that possess a chemical “cage” to keep the proteins from binding with one another. Just prior to entering the bloodstream to search for damaged collagen, a powerful ultraviolet light is used to “unlock” the cage and allow the CMPs to initiate their disease-tracking mission. Li is a doctoral student from the Department of Chemistry in the Krieger School of Arts and Sciences at Johns Hopkins. Yu, who holds a joint appointment in that department, is his doctoral adviser.

Yu’s team tested Li’s fluorescently tagged and caged peptides by injecting them into lab mice that possessed both prostate and pancreatic human cancer cells. Through a series of fluorescent images taken over four days, researchers tracked single strands of the synthetic protein spreading throughout the tumor sites via blood vessels and binding to collagen that had been damaged by cancer.

Similar in vivo tests showed that the CMP can target bones and cartilage that contain large amounts of degraded collagen. Therefore, the new protein could be used for diagnosis and treatment related to bone and cartilage damage.

Although the process is not well understood, the breakdown and rebuilding of collagen is thought to play a role in the excessive bone growth found in patients with Marfan syndrome. Yu’s team tested their CMPs on a mouse model for this disease and saw increased CMP binding in the ribs and spines of the Marfan mice, as compared to the control mice.

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Erectile Dysfunction Linked to Increased Cardiovascular Risk

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Main Category: Cardiovascular / Cardiology
Also Included In: Erectile Dysfunction / Premature Ejaculation;  Heart Disease
Article Date: 30 Aug 2012 – 16:00 PDT

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According to a recent report by the Princeton Consensus (Expert Panel) Conference, men’s sexual function should be evaluated and taken into account when they are being tested for risk factors of cardiovascular problems.

Lead author of the study Dr. Ajay Nehra, vice chairperson, professor and director of Men’t Health in the Department of Urology at Rush University Medical Center in Chicago, worked with over 20 other experts to determine their findings.

The study explains that erectile dysfunction (ED) is a risk factor in men younger than 55 for eventual cardiovascular disease. In some men diagnosed with ED, a cardiovascular event may occur within 2 to 5 years.

Nehra explains:

“Any man with ED should be considered at a substantially higher increase cardiovascular risk until further testing can be done. Erectile dysfunction often occurs in the presence of silent, symptomatic cardiovascular disease; and hence this is an opportunity for cardiovascular risk reduction.”

The researchers recommend that men over 30 who suffer from ED should be evaluated closely for cardiovascular disease, because they believe that any man over 30 who has ED has a large risk for CVD (cardiovascular disease).

The experts determined that men who experience ED are at twice the risk of having cardiovascular disease than men who do not have ED. The younger then men are, the higher the risk of CVD.

Recent trials have shown that low testosterone levels may be associated with ED, CVD and cardiovascular death. Therefore, the team says men should also be tested to determine their testosterone levels.

Trials of over 500 patients have shown that low levels of testosterone result in a higher risk of mortality. Nehra continues: “Testosterone levels should be routinely measured. Men with testosterone levels less than 230 have higher risk for all cause and cardiovascular mortality.” These findings, along with advice for patients with ED and CVD were been published in Mayo Clinic Proceedings in the August 2012 issue.

The goal of the Princeton III meeting, which updated data presented at Princeton I and Princeton II meetings in 2000 and 2005, was to discover a method for optimizing sexual function in men and improving cardiovascular health in patients who have CVD.

Nehra commented:

“The conference focused on the predictive value of vascular erectile dysfunction in assigning cardiovascular risk in men of all ages, the objective being development of a primary approach to cardiovascular risk assessment in younger men with erectile dysfunction and no cardiovascular disease.”

The team’s approach adds to the 2010 American College of Cardiology/American Heart Association recommendation to screen asymptomatic adults at risk of cardiovascular disease. However, this did not involve men with ED. Other studies, including the Framingham Heart Study, only include minimum information about patients under the age of 40.

“Experts have been considering the connection between erectile dysfunction and cardiovascular disease for a while. Recent data and publications about the connection have become more consistent in linking the two”, said Nehra.

Evidence of ED being linked with CVD in men under the age of 40 is rapidly growing. One trial explained that men between the ages of 40 and 49 who had ED had a 50% higher likelihood of coronary artery disease than the men who did not have the disorder.

The team notes that it would be beneficial for the cardiovascular evaluations to involve looking at blood and urine tests and lifestyle habits, as well as history of family health to determine if risk factors are present in the patient. This will assist in deciding appropriate treatment.

Nehra said: “That means that doctors treating men for erectile dysfunction can play a critical role in helping monitor and start reducing a patient’s cardiovascular risk, even when the patient has no symptoms.”

The panel recommends evaluating whether men who have ED have cardiovascular health persistent with the physical action needed for sexual activity. This is more important for men who have a very high risk of developing CVD.

The report said: “Scientific evidence suggests that a comprehensive approach to cardiovascular risk reduction will improve overall vascular health, including sexual function.”

The Princeton III team recommends that doctors ask patients, especially men older than 30, if they have any symptoms of ED.

They conclude: “Identification of ED, particularly in men younger than 60, represents an important first step toward CVD detection and reduction.”

Written by Christine Kearney

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease.

Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FC.
Mayo Clinic Proceedings, August 2012

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Collaborative Care Facilitates Therapy Compliance For Patients With Knee Osteoarthritis Improves Function, Pain, And Quality Of Life

Main Category: Arthritis / Rheumatology
Also Included In: Pharmacy / Pharmacist;  Rehabilitation / Physical Therapy
Article Date: 30 Aug 2012 – 0:00 PDT

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Canadian researchers have determined that community-based pharmacists could provide an added resource in identifying knee osteoarthritis (OA). The study, published in Arthritis Care Research, a journal of the American College of Rheumatology (ACR), represents the first evidence supporting a collaborative approach to managing knee OA. Findings suggest that involving pharmacists, physiotherapists, and primary care physicians in caring for OA patients improves the quality of care, along with patient function, pain, and quality of life.

OA is the most prevalent form of arthritis where a progressive loss of articular cartilage in the joints causes joint pain and could lead to functional disability. Nearly 27 million Americans over the age of 25 have some form of OA according to the Centers for Disease Control and Prevention (CDC). Joints that receive repetitive impact such as fingers, hips, and knees are most often affected by OA. Medical evidence estimates that knee OA occurs in 10% of men and 13% of women over the age of 59. Prior research projects a 50% increase in OA prevalence over the next 10 to 20 years, with aging and obesity reported as the leading contributors to this increase.

“Many cases of knee OA go undiagnosed and patients often do not receive timely care to relieve pain, improve function and prevent disability,” said lead author Dr. Carlo Marra, PharmD, PhD, a Director with the Collaboration for Outcomes Research and Evaluation (CORE) and Professor of Pharmaceutical Sciences at the University of British Columbia in Vancouver, Canada. “Our study investigates a multidisciplinary intervention that involves pharmacists in the identification and patient care for those with knee OA.”

For this randomized, controlled trial, the team engaged 14 pharmacies to provide intervention therapy and 18 pharmacies to offer usual care (control). At least two pharmacists at each location were asked to identify and enroll participants 50 years or older who experienced knee pain or stiffness on most days of the last month and fulfilled other criteria such as having a body mass index (BMI) greater than 25 kg/m2, not participating in a formal exercise program in the previous 6 months, and difficulty with activities due to knee pain. The 73 patients in the intervention arm received OA screening questionnaires, education, pain medication management, physical therapy exercises, and primary care physician (PCP) communication. There were 66 participants in the control group who were given an educational pamphlet.

Patients in the intervention arm had a significantly higher quality of OA care (as measured by a quality indicator pass rate) than those in the control group. At three months and six months, participants in the intervention arm saw significantly greater improvement in their overall pain and function scores compared to those receiving usual care. Dr. Marra concludes, “Our findings suggest that pharmacists can effectively initiate interventions that address the gaps in OA patient care. With the rise in OA, collaborative care presents a novel approach in prevent and treating those with knee OA.”

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Full citation: “Pharmacist Initiated Intervention Trial in Osteoarthritis (PhIT-OA): A Multidisciplinary Intervention for Knee Osteoarthritis.” Carlo A. Marra, Jolanda Cibere, Maja Grubisic, Kelly A. Grindrod, Louise Gastonguay, Jamie M Thomas, Patrick Embley, Lindsey Colley, Ross T. Tsuyuki, Karim M. Khan, and John M. Esdaile. Arthritis Care and Research; Published Online: August 28, 2012 (DOI: 10.1002/acr.21763).
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Quality Measure For Stroke Care: Study Questions Validity

Main Category: Stroke
Also Included In: Public Health;  Medicare / Medicaid / SCHIP
Article Date: 29 Aug 2012 – 0:00 PDT

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One of the key indicators of the quality of care provided by hospitals to acute stroke victims is the percentage of patients who die within a 30-day period. A new study shows that the decisions made by patients and their families to stop care may account for as many as 40 percent of these stroke-related deaths, calling into question whether it is a valid measure of a hospital’s skill in providing stroke care.

The study, which appears in the journal Neurology, focuses on a quality measure proposed by the federal Centers for Medicaid and Medicare Services called the 30-day risk adjusted stroke mortality. While the measure is being developed as a part of federal health care reform, it is already commonly employed as an indicator of a hospital’s quality of care on websites that evaluate hospital performance.

“It is clear that a significant component of the overall mortality score as currently constructed does not tell the whole story and is predicated on the preference of patients and their families,” said University of Rochester Medical Center (URMC) neurologist Adam Kelly, M.D., lead author of the study.

The study evaluated cases of stroke patients admitted to Strong Memorial Hospital in Rochester, New York. The hospital is a part of the University of Rochester Medical Center and is certified by New York State and the Joint Commission as a stroke center. It has also received the highest level of recognition from the American Heart Association for stroke care.

In 2009, 436 people were admitted Strong Memorial with a diagnosis of ischemic stroke. Of that number, 37 (7.8 percent) either died within 30 days while in the hospital or were discharged to hospice care. Of that number, 36 patients died because of a decision by the patient or family – often in accordance with specific instructions contained in an advanced directive – to withhold or withdraw life-sustaining interventions, such as mechanical ventilation or artificial nutrition. This was often done after a trial period of these interventions to allow for potential neurological recovery.

The study authors then asked a panel of neurologists to review each case and indicate whether they believed that the patient would have survived longer than 30 days if every available medical intervention where employed on a continuous basis. The panel determined that 41 percent of the patients could have been kept alive, effectively reducing the hospital’s mortality rate by 3.2 percent.

“The decision to withdraw or withhold life-sustaining measures is one of most difficult and heart-wrenching choices that a patient and their family can make,” said Kelly. “The role of a physician is to help them understand the medical options before them and, ultimately, respect their desires and do what is in the best interest of the patient. Unfortunately, this method of calculating a hospital’s quality of stroke care appears to contradict this patient-centered approach.”

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Osteoarthritis Pain Targeted

Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics;  Seniors / Aging
Article Date: 23 Aug 2012 – 0:00 PDT

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The research relates to a family of molecules firstly discovered in Melbourne that applied to blood cell development. One of these, granulocyte macrophage colony-stimulating factor or GM-CSF, acts as a messenger between cells acting at a site of inflammation.

Professor John Hamilton has posed the question: could blocking GM-CSF action lead to a new treatment for inflammatory diseases? In experimental models of rheumatoid arthritis, Professor Hamilton and Dr Andrew Cook had previously shown that blocking GM-CSF function with an antibody suppressed the disease leading to clinical trials which are already showing patient benefit.

They have now shown, in a paper that has just appeared in the world’s top ranking arthritis journal, Annals of the Rheumatic Diseases, that GM-CSF depletion also suppresses pain in such models; they have also noted similar efficacy in an osteoarthritis experimental model.

“Without a doubt, quality of life and to be free from pain are important issues for people suffering with arthritis-related conditions” said Professor Hamilton.

Rheumatoid arthritis is a debilitating condition with the peak incidence being in people in their 30s and 40s. It is more common in women than in men.

“With our ageing population, the more common condition of osteoarthritis impacts more on our community and medical resources. A new therapy that can block such painful conditions would have massive benefits for health providers and governments in the future” said Dr Cook.

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Oral Drug Shows Clinical Response And Remission In Some Patients With Ulcerative Colitis

Main Category: Arthritis / Rheumatology
Also Included In: Crohn’s / IBD
Article Date: 16 Aug 2012 – 2:00 PDT

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An investigational drug currently under FDA review for the treatment of rheumatoid arthritis has now shown positive results in patients with moderate-to-severe ulcerative colitis, according to researchers at the University of California San Diego, School of Medicine. The study will appear in the August 16, 2012 issue of the New England Journal of Medicine (NEJM).

Results from the phase 2 clinical trial showed the drug Tofacitinib achieved clinical response and remission in certain patients suffering from ulcerative colitis – a chronic inflammatory disease of the colon where patients experience painful episodes of rectal bleeding and diarrhea combined with the urgent need to use the restroom.

“Ulcerative colitis causes severe bouts of illness that adversely affect a patient’s quality of life at home and work.” said William Sandborn, MD, chief of the Division of Gastroenterology at the UC San Diego School of Medicine and director of the Inflammatory Bowel Disease Center at UC San Diego Health System. “Oral treatment with Tofacitinib resulted in improvement and remission in some patients.”

Currently, there are limited types of drugs to treat ulcerative colitis. Drugs available are not universally effective and some require intravenous administration.

“This is a whole new class of drug that affects the number of proteins in the immune system that cause this type of inflammatory bowel disease (IBD),” said Sandborn.

There are about 600,000 to 700,000 patients suffering from ulcerative colitis in the United States. Half of these patients experience severe flare ups that in some cases could progress to surgery where the colon is completely removed.

“Patients with a more advanced case of ulcerative colitis need a potent and highly effective therapy,” said Sandborn. “The results of our study show Tofacitinib may provide a new approach to attacking this disease.”

One hundred and ninety four patients were part of the randomized trial, which was conducted at 51 centers in 17 countries. Eligible patients were at least 18 years of age, had a confirmed diagnosis of ulcerative colitis and had previously been treated with conventional therapy for the disease.

The patients were treated for eight weeks. They were given a dose of Tofacitinib twice daily, and benefits could be seen as early as two weeks. A flexile sigmoidoscopy was performed at the beginning and end of the trial, along with blood work and stool samples as a measurement of intestinal inflammation.

Among patients treated, the most commonly reported infections were influenza and nasopharyngitis – a respiratory infection with common-cold symptoms. Two patients developed an abscess, and in some cases, headaches were reported and the ulcerative colitis worsened.

“The goal of this study was to show that the oral inhibitor is effective in treating ulcerative colitis. The next phase of studies aim to confirm the efficacy and safety profile of the drug, will examine the long term or maintenance effect of Tofacitinib and confirm the results of this study,” said Sandborn.

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Researchers who also participated in this study include Subrata Ghosh, MD, University of Calgary; Julian Panes, MD, Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain; Ivana Vranic, PhD, Chinyu Su, MD, Samantha Rousell, MSc, and Wojciech Niezychowski, MD, all at Pfizer Inc.

The study was funded by Pfizer Inc.
University of California – San Diego

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Post-Injury Arthritis May Be Prevented By Stem Cell Therapy

Main Category: Arthritis / Rheumatology
Also Included In: Stem Cell Research
Article Date: 14 Aug 2012 – 0:00 PDT

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Duke researchers may have found a promising stem cell therapy for preventing osteoarthritis after a joint injury.

Injuring a joint greatly raises the odds of getting a form of osteoarthritis called post-traumatic arthritis, or PTA. There are no therapies yet that modify or slow the progression of arthritis after injury.

Researchers at Duke University Health System have found a very promising therapeutic approach to PTA using a type of stem cell, called mesenchymal stem cells (MSCs), in mice with fractures that typically would lead to them developing arthritis. Their findings could lead to a therapy that would be used after joint injury and before signs of significant osteoarthritis.

The scientists thought the stem cells would work to prevent PTA by altering the balance of inflammation and regeneration in knee joints, because these stem cells have beneficial properties in other regions of the body.

“The stem cells were able to prevent post-traumatic arthritis,” said Farshid Guilak, Ph.D., director of orthopaedic research at Duke and senior author of the study.

The study was published in Cell Transplantation.

The researchers also thought that a type of mice bred for their super-healing properties would probably fare better than typical mice, but they were wrong.

“We decided to investigate two therapies for the study, said lead author Brian Diekman, Ph.D., a postdoctoral researcher in the Guilak lab. “We thought that stem cells from so-called superhealer mice would be superior at providing protection, and instead, we found that they were no better than stem cells from typical mice. We thought that maybe it would take stem cells from superhealers to gain an effect as strong as preventing arthritis after a fracture, but we were surprised – and excited – to learn that regular stem cells work just as well.”

Certain people appear to fall into the superhealer category, too. They bounce back quickly and heal well naturally after a fracture, while other people eventually form cases of arthritis at the fractured joint, said Guilak, who is a professor of orthopaedic surgery and biomedical engineering.

“The ability of the superhealer mice to have superior healing after a fracture may go beyond the properties of their stem cells and be some beneficial factor, like a growth factor, that we don’t know about yet,” Guilak said.

The delivery of 10,000 typical or superhealer stem cells to the joint prevented the mice from developing PTA, unlike a control group that received only saline.

Diekman said the team looked at markers of inflammation and saw that the stem cells affected the inflammatory environment of the joint after fracture.

“The stem cells changed the levels of certain immune factors, called cytokines, and altered the bone healing response,” said Diekman, who is also with the Duke Department of Biomedical Engineering.

Guilak said that very few studies have purified stem cells to the degree they were purified for this study. They used mesenchymal stem cells, which are bone marrow cells not destined to become part of blood.

Diekman said that one of the challenges in the field is isolating and developing a system for sorting the specific cells they wanted, the mesenchymal stem cells, which form a very rare cell type in the bone marrow.

“We found that by placing the stem cells into low-oxygen conditions, they would grow more rapidly in culture so that we could deliver enough of them to make a difference therapeutically,” Diekman said.

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Hand Implants Not Fit For Purpose

Main Category: Arthritis / Rheumatology
Also Included In: Medical Devices / Diagnostics;  Bones / Orthopedics
Article Date: 13 Aug 2012 – 0:00 PDT

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Poorly-performing medical implants have hit the headlines recently, and the trend looks set to continue: the September issue of the Journal of Hand Surgery (JHS) homes in on the unacceptable performance of hand implants for osteoarthritis patients. Citing several recent studies, the editorial asks why these implants – which perform worse that certain hip replacement implants now deemed unacceptable – are still widely used. JHS is an online and print, orthopedic surgery journal published by SAGE.

The issue reports on a number of thumb arthroplasties – joint replacement operations at the base of the thumb – which are often used to treat arthritis. Orthopedic surgeons and the medical profession in general will be interested in research following up on outcomes for a range of implant brands used in this type of surgery. JHS names those that failed to make the grade, and recommends that they should be withdrawn.

Patients who have received a de la Caffiniere implant can expect good long term outcomes following their surgeries. However, those whose joints were replaced with the Moje, Elektra and Pi2 thumb CMC joint implants have less to celebrate, according to the latest follow-up research.

Editor-in-Chief, Grey Giddins, calls for people to readdress their opinions on using what is known and what is not necessarily the best, over what may be less known, but is ultimately performing better:

“We should make a stand as a profession and stop using implants with known poor outcomes unless other data is published to change our minds. Moreover, we should continue to be careful about being encouraged into using other new implants until adequate long term follow-up is available.”

Supported by notable research studies, the editorial suggests that failing Moje and Electra implants should be withdrawn, and while just one study on the Pi2 implant is insufficient to recommend withdrawal, the journal asks surgeons to use it with caution in future.

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Medicare Woes Mostly Rooted In Myth: Retirement Expert

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 12 Aug 2012 – 0:00 PDT

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Various misconceptions surrounding the continued viability of Medicare can be debunked or discredited, making it more important than ever for voters and policymakers to fully understand the program’s existing contours and limitations, according to a paper published by a University of Illinois expert on retirement benefits.

Law professor Richard L. Kaplan says Medicare has become one of the most controversial federal programs for numerous reasons, but misinformation has played a key role in fostering criticism of it.

“Medicare is an important and complicated program that has no counterpart in the American health care system, and its significance to Americans of all ages is impossible to overstate,” said Kaplan, the Peer and Sarah Pedersen Professor at Illinois.

“At the same time, its very size, cost and complexity make it a natural target for serious reform and cost reduction. Therefore, Medicare has become a lightning rod simply because it is eating up more federal resources every year.”

Among the myths that have sprouted, perhaps the most popular one is that Medicare is going bankrupt, Kaplan says.

“Medicare consists of several distinct components with differing mechanisms for financing its costs,” he said. “Medicare Parts B and D are financed by premiums paid by current-year enrollees and general tax revenues. These funds are generated in the current fiscal year.”

As long as the federal government receives tax revenues from any source and there are any enrollees in Medicare Parts B and D, those two programs can be funded, Kaplan says.

Medicare Part A, however, is a very different arrangement, because it collects payroll taxes paid by current workers and funnels those taxes to a “trust fund” that pays for its expenditures, Kaplan says.

“But money is fungible, and the federal government can spend whatever sums it wishes on whatever programs it deems worthy of funding,” he said. “After all, there is no ‘trust fund’ for the Defense Department, but the lack of a dedicated funding source has not prevented paying for wars in Iraq and Afghanistan.”

Another myth is that Medicare is not “means-tested” – that is, higher-income beneficiaries don’t pay more than lower-income beneficiaries for the same benefits.

“Medicare Part A has been means-tested from the very beginning, because a payroll tax necessarily means that you pay more if you earn more,” Kaplan said. “Since 2006, under legislation signed by President Bush, enrollees above a certain income threshold pay higher premiums for their Medicare Part B coverage, and a provision of the Affordable Care Act extends that treatment to Medicare Part D, the prescription drug program.

“One can argue that wealthy people should pay still more, but the point is that we already have means-testing in Medicare.”

Another popular myth is that Medicare is politically untouchable. Not true, says Kaplan.

“Both Democrats and Republicans have reduced Medicare’s budget in virtually every budget cycle for the last 20 years, mostly on the providers’ side, by reducing the amount Medicare pays to hospitals, nursing homes, home health care agencies, pharmacies and the like,” he said. “In fact, half of the financing for the Affordable Care Act comes from cuts to Medicare’s budget.”

Such budget cuts, however, are not painless to beneficiaries, Kaplan says.

“If health care providers decide that they are not going to take any new Medicare patients, there may be serious access issues,” he said. “We’ve seen that happen already with Medicaid, and it might soon happen with Medicare.”

As the baby boomer generation becomes direct beneficiaries as program enrollees, Kaplan says it is essential that would-be reformers undertake an informed discussion and analysis of proposals to control the future cost of Medicare.

“Only if the many myths that surround this program are debunked can the difficult decisions and inevitable policy trade-offs be developed that will maintain the program’s singular importance for older Americans,” he said.

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