Monthly Archives: July 2016

Surgery is not good at all

The timing of an operation doesn’t affect a patient’s subsequent risk of complications or death, a new study finds.

For example, there’s no difference in death rates between elective surgery performed in the afternoon versus the morning or on Monday instead of Friday, the researchers said. Their findings should help to ease concerns that fatigue may lead to a higher rate of safety problems when operations are performed later in the day or week, they said.

The study included an analysis of the outcomes of more than 32,000 elective surgeries performed. The overall complication rate before discharge was 13 percent, and the overall risk of death within 30 days of surgery was 0.43 percent.

After the researchers adjusted for other factors, the risk of complications or death was not significantly different for patients who had surgery at different times of the day between 6 a.m. and 7 p.m. or week.

The time of year also had no impact on the risk of complications or death. This included July and August, when most new residents start working in teaching hospitals.

The study appears in the December issue of the journal Anesthesia & Analgesia.

“Elective surgery thus appears to be comparably safe at any time of the workday, any day of the workweek, and in any month of the year in our teaching hospital,” Dr. Daniel Sessler, of the Cleveland Clinic, and colleagues concluded in a journal news release.

Some previous studies have suggested that patients are at greater risk if they undergo late-day surgery.

How to Adopting Healthy Habits

unduhan-26Interested in adopting healthier habits? You have a better chance of success if you find a friend with similar traits to share the experience, a new study suggests.

Participants paired with others of similar body mass, age, fitness level and diet preferences were three times as likely to adopt healthy behaviors as those matched randomly in an Internet-based study conducted by a researcher from the Massachusetts Institute of Technology (MIT).

“I think the reality is, we as individuals may have less motivation to change on our own than if we’re surrounded by our peer group, even if we met on a social network site,” said Dr. Victor Fornari, director of child and adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y., who is familiar with the study. “We’re very influenced by the group phenomenon.”

The study is published in the Dec. 2 issue of the journal Science.

For the study, an online social network was created to promote health and fitness. Broken into small groups of “health buddies,” 710 participants were introduced to the idea of an online diet diary through a “dummy” participant who invited others to take part. Each participant was provided with a personalized, online “health dashboard” that displayed real-time information, such as daily exercise minutes, healthy behaviors and personal characteristics of the health buddies.

At the end of seven weeks, those who were matched with health buddies using the principle of “homophily” — the tendency of people to have similar friends — were far more likely to use the diet diary and take part in other healthy behaviors than participants whose buddies were assigned randomly. Not one obese individual signed up for the diet diary in the random networks, compared to more than 12 percent of obese participants in the similarly matched networks.

The results also suggest that the most effective social environment for increasing the willingness of obese people to adopt a behavior is one where they interact with others with similar health characteristics, the study said.

“I think it was a pretty brilliant study,” said Tricia M. Leahey, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University and Miriam Hospital’s Weight Control and Diabetes Research Center in Providence. “It’s neat that they’re actually starting to manipulate a social network in a way specific to homophily.”

Group therapy is also partially based on the premise that people can empathize better with others they relate to, said Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City.

“The question of whether people can benefit from role models that show how to move out of similar thinking is also part and parcel of the development of social networks,” Manevitz said. “We all need to be able to interact with people who can promote other senses of self, that you can take in and create within yourself.”

However, the current findings refute prior research. Leahey wrote a study published in January 2011 that indicated that overweight people tend to have more social contacts who are also overweight or obese.

“We can say, ‘Gee, if I’m in a network of relatively healthy individuals and become friends with someone who’s overweight or obese, we might be influenced by this one individual,'” she said. “So I guess it cuts both ways.”

Adult Stem Cells Advantages

unduhan-25Stem cell research is one of the most talked-about fields in modern medicine. It’s also one of the most misunderstood. Many people associate it with only embryonic stem cells, which are a source of much ethical debate, but there’s actually an entire world of data and inquiry that involves adult stem cells, which are found in our own bodies and may hold the key to treating some important health conditions.

Recent headlines, for example, have touted “major breakthroughs” in adult stem cell science and cardiovascular disease, and a number of high-profile celebrities, politicians, and athletes have undergone experimental stem cell treatments for pain and nerve damage. As more and more people seek out information about these procedures, here’s what you need to know.

Adult Stem Cells vs. Embryonic Stem Cells

Compared with the field of embryonic stem cell research, adult stem cell research is relatively new territory. For a long time, the medical community was interested primarily in embryonic stem cells, which are pluripotent, meaning they have the potential to generate any one of the 200 other cell types in the human body. Adult stem cells, conversely, are thought to be limited to forming types of cells based on their tissue of origin. For example, hematopoietic stem cells, found in bone marrow, give rise to blood cells, while adipose-derived stem cells, found in fat, give rise to adipocyte (fat) cells. Recent research has suggested that some types of stem cells may be able to transform into other cells via a process called transdifferentiation, but data – and scientific opinion – is mixed on this point.

Moreover, says Donald Kohn, MD, a scientist with the Broad Stem Cell Research Center at UCLA, “adult stem cells in general don’t have the ability to make more of themselves. When we take them from, say, the bone marrow, we can’t make more of them. The number we get out of the body is the most we have, and by the time we give them back [as in a transplant], we have less.” This, along with the fact that adult cells can be difficult to isolate from tissue, made pluripotent embryonic stem cells initially more compelling to researchers.

In recent years, however, scientists have shifted some of the focus to adult stem cells, partly out of necessity – federal and state legislation restricts funding for projects involving the creation, treatment, or destruction of embryos for research purposes – and partly because of new discoveries about the benefits of adult cells.

For one thing, Kohn says, there may be less risk of rejection with adult stem cells, since they’re often autologous, meaning they come from a person’s own body. “Embryonic stem cells don’t match your patient,” he explains. There’s a risk, as with any transplant, that the body won’t accept them.

Second, adult stem cells are readily available to everyone. We all have them inside of us – in our organs, bone marrow, blood, fat, etc. – so there’s a built-in (though limited) supply of donor material that matches our genetic makeup.

Finally, and perhaps most notably, adult stem cells don’t present the same ethical issues associated with embryonic stem cells, which, when harvested, result in the destruction of the embryo – a point of much controversy and debate in the medical, political, and religious sectors. Adult stem cells sidestep this problem because there’s no loss of human or potential human life.

Stem Cell Procedures in the News

Which is not to say, however, that adult stem cell research is immune to controversy.

Earlier this year, in July, Texas governor and Republican presidential hopeful Rick Perry raised some eyebrows – and red flags – when he underwent an experimental stem cell procedure to fuse part of his spine. The treatment, which was done outside of an approved clinical trial, involved liposuctioning fat from Perry’s body, separating and re-growing the stem cells from that fat, and then reinjecting the cells into Perry’s back and bloodstream in the hopes that they would form bone or cartilage. At the time, experts in the field balked at Perry’s decision to have the procedure, saying there was no scientific evidence to support its effectiveness – or, more importantly, its safety – and that by choosing to pursue an untested treatment, the politician risked blood clots, infection, even cancer cell growth.

“[Perry] went far outside mainstream medicine to treat his bad back – an irresponsible choice that endangered himself and anyone who might follow his lead,” wrote Arthur Caplan, PhD, director of the Center for Bioethics at the University of Pennsylvania, in a commentary for MSNBC. “The promise of adult stem cells may be fulfilled one day, but that day is not yet here.”

Caplan’s worry that high-profile procedures like Perry’s send the wrong message to patients is a concern shared by many in the stem cell research community. “When a highly visible celebrity/athlete chooses to undergo an untested/unproven therapy, and if they happen to get better without knowing whether the therapy is what caused the improvement, they encourage many other people to ignore scientific evidence and to substitute hope and blind trust for proof,” said Lawrence Goldstein, PhD, director of the University of California-San Diego Stem Cell Program, in an e-mail to ABCNews.com. “The downside is that many people might be hurt by subjecting themselves to a risky procedure, or a procedure with unknown risks, when there is no evidence of benefit to be gained.”

Dr. Goldstein’s statement was in response to news that Indianapolis Colts quarterback Peyton Manning had reportedly flown to Europe in September to take advantage of an unapproved stem cell procedure that he hoped would fix a nerveinjury in his neck. (It didn’t.) Other athletes who have had similarly controversial procedures to heal sports injuries include Yankees pitcher Bartolo Colon and football player Terrell Owens.

Most recently, actress Suzanne Somers revealed that she had undergone a new stem cell treatment to regrow her right breast after losing most of it to cancer more than a decade ago. Somers’ procedure, unlike others mentioned here, was part of an approved clinical trial and involved injecting stem cell-enriched fat into her breast to replace the damaged tissue. You can learn more about her treatmenthere.

The Current and Future State of Adult Stem Cell Research

Of course, not all stem cell procedures are as polarizing as those performed on Perry and Manning. Bone marrow stem cell transplants, using hematopoietic (blood) cells, have actually been used for decades – since about 1970 – as a treatment for certain genetic diseases and cancers, namely those affecting the blood, bone marrow, and lymphatic system. In fact, Everyday Health television show host and former Survivor winner Ethan Zohn had one in 2009 after he was diagnosed with and treated for a rare form of Hodgkin lymphoma.

Standard first line of treatment for both leukemia and lymphoma depends on a variety of factors but generally includes some amount of chemotherapy with or without radiation and/or surgery. In many cases, however – such as those in which the cancer comes back after a period of remission or is initially unresponsive to treatment – patients may require high-dose chemo, which destroys not only the cancer cells but also some of the individual’s healthy cells.

“Normally, we temper how much chemo we give so that we don’t damage the bone marrow too much,” Kohn says. “But with hematopoietic stem cell transplants, you can push up to the next level and give a lot more. Hopefully you wipe out the cancer – but you also wipe out normal bone marrow. So the stem cells are used to rescue you.”

In most cases, Kohn notes, the stem cells used are autologous (your own). Doctors extract them from your blood or bone marrow prior to administering the chemo, freeze them, and then reinject them into your bloodstream after treatment. Over time, they return to the bone, replacing the marrow and generating new blood cells.

In situations where an autologous transplant is not possible or has already been done, doctors may use cells from a donor whose tissue type matches the patient’s. This is riskier, because of the chance of rejection, but it’s not uncommon.

“Thousands of hematopoietic transplants are performed every year,” Kohn says. And other life-saving procedures may be on the way.