Exercises to Strengthen Back Muscles
(but check with your doctor first)

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0424-1


A minimally invasive interventional radiology treatment—that safely and effectively uses oxygen/ozone to relieve the pain of herniated disks—will become standard in the United States in the next few years, predict researchers at the Society of Interventional Radiology’s 34th Annual Scientific Meeting. In a related study, the interventional radiologists examined just how ozone relieves the pain associated with herniated disks.

Society of Interventional Radiology, April 23, 2009 — Back pain is the most common cause of job-related disability and a leading contributor to missed work. While the pain of herniated disks can be severe, it can ease over time, and many people may no longer feel the need for medical care. However, in some, the pain from herniated (or ruptured or slipped) disks is intolerable or persists. “Having a herniated disk can affect how you perform everyday activities and can cause severe pain that influences almost everything you do; however, you don’t have to undergo invasive surgery,” noted Kieran J. Murphy, M.D., interventional neuroradiologist and vice chair and chief of medical imaging at the University of Toronto in Toronto, Ontario, Canada.

Oxygen/ozone therapy involves injecting a gas mixture of oxygen and ozone into a herniated disk. The treatment can limit pain and inflammation by reducing the disk’s volume. Currently, open diskectomy and microdiskectomy (both involving removal of disk material through an incision) are the standards in surgical treatment for herniated disk.

“Oxygen/ozone treatment of herniated disks is an effective and extremely safe procedure; interventional radiologists use imaging to guide a needle to inject oxygen/ozone into injured disks. The estimated improvement in pain and function is impressive when we looked at patients who ranged in age from 13 to 94 years with all types of disk herniations,” explained Murphy. “Equally important, pain and function outcomes are similar to the outcomes for lumbar disks treated with surgical diskectomy, but the complication rate is much less (less than 0.1 percent),” he added. “In addition, the recovery time is significantly shorter for the oxygen/ozone injection than for the diskectomy,” said Murphy. “The spine is a stunningly beautiful piece of engineering, or, as our engineers say, the spine is like a complex electromechanical system. And the interventional radiology oxygen/ozone treatment takes a minimalist approach. It’s all about being gentle,” said Murphy.

“Ozone shrinks disk volume; this is why it provides pain relief,” said Murphy, whose second study explored the mechanism of why oxygen/ozone treatment works. The bones (vertebrae) that form the spine in the back are cushioned by small, spongy disks. When these disks are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disk is damaged, it may bulge or break open. “There are millions of people with back pain who suffer and who can’t work because of their pain. Undergoing invasive surgical diskectomy puts you on a path where you may be left with too little disk. Taking out a protruding disk may lose the shock absorption that naturally resides between them in the spine,” said Murphy, who predicts this procedure will become standard in the United States within the next five years.

Researchers conducted a meta-analysis of various results published for oxygen/ozone treatment in regards to pain relief, reduction of disability and risk of complications. More than 8,000 patients from multiple centers in multiple locations were included in the study. The estimated mean improvement for patients after treatment based on the 10-point visual analog scale (VAS), a standard tool for rating the disabling effects of back pain, was a change of 3.9 (with 0 being no pain and 10 representing worst pain experienced). The estimated mean improvement was 25.7 percent for the Oswestry Disability Index (ODI), which measures one’s ability to manage everyday life-such as washing, dressing or standing (with 61 percent or higher representing back pain that has an impact on all aspects of daily living. The improvement scores for VAS and ODI outcomes are well above both the minimum clinically important difference and the minimum (statistically significant) detectable change, indicating that the improvement in pain and function is a real change that can be felt by the patient.

Much research in oxygen/ozone treatments has been done by interventional radiologists in Italy, said Murphy, indicating that as many as 14,000 individuals have received this treatment abroad over the past five years. The mechanism of action in relieving low back pain is complex; however, the primary effect is a volume reduction due to ozone oxidation. Researchers discovered that a simple incompressible fluid model predicted that reducing disk volume by 0.6 percent results in an intradiscal pressure reduction of 1 psi (pounds per square inch). Thus a very small change in volume creates a large change in disc pressure, which reduces the applied pressure on the nerve and relieves pain. This model confirmed that a minimalistic alternative to a diskectomy, such as oxygen/ozone treatment, is capable of relieving the pain caused by a herniated disk without causing irreparable damage.

new

New imaging technology discovers that silent heart attacks may be more common, and more deadly, than previously thought, according to U.S. researchers..

PLoSMedicine.org, April 24, 2009 — Some studies estimate that these often painless heart attacks, also known as unrecognized myocardial infarctions, affect 200,000 people in the United States each year.

But Dr. Han Kim of Duke University in North Carolina suspects the numbers may be far higher.

“No one has fully understood how often these heart attacks occur and what they mean, in terms of prognosis,” Kim, whose study will appear next week in the Public Library of Science journal PLoS Medicine, said in a statement.

Doctors usually can tell whether a patient has had a recent heart attack by looking for signature changes on a test of the heart’s electrical activity called an electrocardiogram and by checking for certain enzymes in the blood.

For a heart attack that might have occurred in the past, doctors look for changes on an electrocardiogram called a Q-wave, a marker for damaged tissue.

But not all silent heart attacks result in Q-waves.

“Those are the ones we haven’t been able to count because we’ve never had a good way to document them,” Kim said.

To spot these, Kim and colleagues used a new type of magnetic resonance imaging technology called delayed enhancement cardiovascular magnetic resonance, which is especially adept at finding damaged heart tissue.

They studied 185 patients with coronary artery disease but no record of heart attacks who were scheduled to have a test to look for possible blockages in their heart arteries.

They found that 35 percent of the patients had evidence of a prior heart attack. And they found that these so-called non-Q-wave heart attacks were three times more common than silent heart attacks with Q-waves.

They also found that after two years of follow up, people who had suffered a silent, non-Q-wave heart attack had an 11-fold higher risk of death from any cause and a 17-fold higher risk of death due to heart problems, when compared to patients who did not have any heart damage.

Kim said currently people who have had silent heart attacks are treated like other patients with heart disease.

But given the findings, he said new studies should look at the best way to care for these patients.

Heart disease is the No. 1 cause of death in the United States, followed by cancer and stroke.

The article an be found at http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000060

British Medical Journal   A simple measurement of resting pulse predicts coronary events in women independently of physical activity and common risk factors, such as smoking and alcohol consumption, finds a study published on the British Medical Journal website.

Previous studies have shown that resting heart rate predicts coronary events in men. But, for women, the relationship between heart rate and coronary events or stroke remains uncertain.

So researchers in the USA assessed resting heart rate in 129,135 postmenopausal women with no history of heart problems. Risk factors that might be expected to affect heart rate, such as high blood pressure, high cholesterol levels, smoking and alcohol intake were taken into account at the start of the study. The women were monitored for an average of 7.8 years, during which time all hospital stays and coronary events were recorded.

During the study period, 2,281 coronary events (heart attacks and coronary deaths) and 1,877 strokes occurred.

Women with the highest resting heart rate (more than 76 beats per minute) were significantly more likely to suffer a coronary event than women with the lowest resting heart rate (62 beats per minute or less).

Further analysis showed that this association was independent of physical activity, did not differ between white and minority women, or those with or without diabetes, but was stronger in women 50-64 years of age than among women 65 years or older.
There was no such relationship between resting heart rate and stroke.

Resting heart rate is a simple, inexpensive measurement that independently predicts heart attacks and coronary deaths, but not stroke, in postmenopausal women, say the authors. Although the strength of this association is less than cigarette smoking or diabetes, it may be large enough to be clinically meaningful, they conclude.

fruit

Can a grape-enriched diet prevent the downhill sequence of heart failure after years of high blood pressure?

University of Michigan Health System, April 23, 2009 — A University of Michigan Cardiovascular Center study suggests grapes may prevent heart health risks beyond the simple blood pressure-lowering impact that can come from a diet rich in fruits and vegetables. The benefits may be the result of the phytochemicals – naturally occurring antioxidants – turning on a protective process in the genes that reduces damage to the heart muscle.

The study, performed in laboratory rats, was presented at the 2009 Experimental Biology convention in New Orleans.

The researchers studied the effect of regular table grapes (a blend of green, red, and black grapes) that were mixed into the rat diet in a powdered form, as part of either a high- or low-salt diet. Comparisons were made between rats consuming the grape powder and rats that received a mild dose of a common blood pressure drug. All the rats were from a research breed that develops high blood pressure when fed a salty diet.

After 18 weeks, the rats that received the grape-enriched diet powder had lower blood pressure, better heart function, and fewer signs of heart muscle damage than the rats that ate the same salty diet but didn’t receive grapes.

Rats that received the blood pressure medicine, hydrazine, along with a salty diet also had lower blood pressure, but their hearts were not protected from damage as they were in the grape-fed group.

“There are the small changes that diet can bring, but the effect of grape intake on genes can have a greater impact on disease down the road,” said E. Mitchell Seymour, M.S., who led the research as part of his doctoral work in nutrition science at Michigan State University. He manages the U-M Cardioprotection Research Laboratory, which is headed by U-M cardiac surgeon Steven Bolling, M.D.

Heart cells, like other cells in the body, make an antioxidant protein called glutathione, which is one of our first defenders against damaging oxidative stress. High blood pressure causes oxidative stress in the heart and lowers the amount of protective glutathione. However, intake of grapes actually turned on glutathione-regulating genes in the heart and significantly elevated glutathione levels.

This may explain why the hearts of grape-fed animals functioned better and had less damage.

Although the current study was supported in part by the California Table Grape Commission, which also supplied the grape powder, the authors note that the commission played no role in the study’s design, conduct, analysis or the preparation of the journal article for publication. Seymour also receives funding from the National Heart, Lung and Blood Institute, part of the National Institutes of Health, through a National Research Service Award.

Bolling said the latest results take research on the health benefits of grapes “a step further” by examining the mechanisms impacted by antioxidant-rich grapes.

The rats in the study were from a strain called Dahl rats, which have been specially bred to all be susceptible to salt-induced hypertension. The animals are similar to Americans who have elevated blood pressure related to diet, and who develop heart failure over time because of prolonged hypertension.

Each group of 12 rats was fed the same weight of food each day with powdered grapes making up 3 percent of the diet (by weight) for rats that received grapes as part of either a low-salt or high-salt diet. The rats that received hydrazine were fed it through their water supply in a dose that has been previously shown to be effective in reducing blood pressure.

Such naturally occurring chemicals have already been shown in other research, including previous U-M studies, to reduce other potentially harmful molecular and cellular activity in the body.

In all, the researchers say, the study further demonstrates that a grape-enriched diet can have broad effects on the development of hypertension and the risk factors that go with it. Whether the effect can be replicated in humans, they say, remains to be seen.

0424-2

Scientists in Germany found that adding zinc, titanium or aluminum to a length of spider silk made it more resistant to breaking or deforming. They used a process called atomic layer deposition, which not only coated spider dragline silks with metal but also caused some metal ions to penetrate the fibres and react with their protein structure.

Photograph by: Strdel, AFP/Getty Images

0424-3

Spider silk is already tougher and lighter than steel, and now scientists have made it three times stronger by adding small amounts of metal.

ScienceDaily.com, April 23, 2009, by Ben Hirschler – The technique may be useful for manufacturing super-tough textiles and high-tech medical materials, including artificial bones and tendons.

“It could make very strong thread for surgical operations,” researcher Seung-Mo Lee of the Max Planck Institute of Microstructure Physics in Halle, Germany, said in a telephone interview.

Lee and colleagues, who published their findings in the journal Science, found that adding zinc, titanium or aluminum to a length of spider silk made it more resistant to breaking or deforming.

They used a process called atomic layer deposition, which not only coated spider dragline silks with metal but also caused some metal ions to penetrate the fibers and react with their protein structure.

Lee said he next wanted to try adding other materials, including artificial polymers like Teflon.

The idea was inspired by studies showing traces of metals in the toughest parts of some insect body parts. The jaws of leaf-cutter ants and locusts, for example, both contain high levels of zinc, making them particularly stiff and hard.

Spider silk has long fascinated scientists but producing it in commercial quantities is difficult because spiders kept in captivity tend to eat each other.

As a result, researchers have looked at alternative ways of producing silk without spiders, by duplicating their spinning technique.

Approaches being tried include deriving fiber from the milk of transgenic goats with an extra spider-silk gene and adapting silk produced by other insects, such as silkworms.

GoogleNews.com, April 21, 2009, by Maggie Fox – New stem cell guidelines released on Friday by the National Institutes of Health would limit federal funding of the research to embryos left over at fertility clinics and prohibit federal funding of research on embryos made by cloning or certain other methods.

“We are likely to increase greatly the number of human embryonic stem cells available for federal funding,” acting NIH director Raynard Kington said a telephone briefing.

“This is a remarkable development that promises to speed the research that one day may fundamentally change the way we do (medical) research,” he added.

“There can be no question that these guidelines will greatly expand scientific opportunity.”

The guidelines would restrict funding of work on cells made using certain more experimental methods, such as creating stem cells from a human egg only or by cloning via somatic cell nuclear transfer.

They also would prohibit funding of work on embryos created specifically for research purposes, with the aim of directing the money toward work with cells from fertility clinic embryos donated by parents.

The NIH guidelines also cover informed consent by parents and limit the use of federal tax money to create certain human-animal hybrids.

The guidelines apply only to research using federal funds and would not affect what scientists do using private funds or even state funds.

U.S. legislation called the Dickey Amendment forbids the use of federal funds for the creation or destruction of human embryos for research. The NIH guidelines affect labs that use cells that someone else would have created.

In 2001, then-President George W. Bush limited the use of federal funds to stem cell lines that existed as of that moment. He vetoed several congressional attempts to override the decision.

In March, President Barack Obama reversed this decision and left it to the NIH to decide how and whether to fund human embryonic stem cell research. These guidelines are now available for public comment before they become policy.

country

Europe, led by Switzerland, leads the way as the U.S. falls.

Forbes.com, April 21, 2009, by Andy Stone — The declining health of Mother Earth has drawn growing attention over the last two decades, with countries coming together to fight a range of environmental threats, from declining fishing stocks to global warming.

Witness the Kyoto Protocol, the first widely adopted set of environmental protection guidelines, which emerged during the 1990s and took effect in 2005. Kyoto led to the development of the first large-scale emissions trading market, Europe’s Greenhouse Gas Emission Trading Scheme, which puts caps on carbon dioxide pollution. A similar carbon market, the Regional Greenhouse Gas Initiative, began operating at the start of this year in 10 Eastern U.S. states.

In spite of nearly universal support for a cleaner globe (the U.S. was one of only a few countries that failed to adopt Kyoto), it’s mainly the rich nations that enjoy pristine environments, according to the Environmental Performance Index (EPI). Columbia University’s Center for International Earth Science Information Network and Yale University’s Center for Environmental Law and Policy developed the index to highlight the cleanest countries, and give laggards the opportunity to benchmark efforts to improve their own environments and the health of their citizens.

Switzerland tops the list with an overall EPI score of 95.5 out of 100, while European countries account for 14 of the top 20 environmental performers. Europe has the infrastructure to provide clean drinking water and treat waste water, lowering the likelihood that Europeans will suffer from waterborne disease. Europe scores consistently well in EPI’s environmental health ranking, which measures the effects of pollution on human health.

A second broad measure, ecosystem vitality, measures the health of fisheries, the amount of greenhouse gases a country pumps into the air and how well it preserves the diversity of its plants and animals. On this measure, the performance of developed countries diverges. Scandinavia, with its low population and vast open spaces, enjoys pristine forests and relatively little air pollution.

The U.S., once a leader in environmental protection, has failed to keep pace. “Starting 25 years ago, the United States started to fall behind in relative terms. Before that time, Europe always had dirtier air and drinking water,” says Mark Levy, associate director of Columbia University’s earth science center.

Then-President George H. W. Bush signed the last significant American air quality legislation in 1990, an amendment to the Clean Air Act. The U.S. scores a meager 63.5 on the ecosystem vitality scale, vs. an average score of 74.2 for the world’s richest nations. The U.S.’ overall EPI score is 81, putting it in 39th place on the list.

Improved science has led to a better understanding of the linkage between pollution and human health. “The science that’s come out has shown that the harder you look for air-pollution-related health problems, the more you find,” says Levy. “Scientists have recommended that environmental regulations be tightened. Europe has done that, but the U.S. has been stuck.”

Countries are also handicapped according to their locations, with sub-Saharan African countries suffering from scant and poor-quality water, and Asian countries affected by depleted fishing stocks. Switzerland’s weakest marks come in agriculture, in part because farmers in the mountainous country have a tendency to overwork their limited crop land.

A few developing nations break into the top 10 of the rankings. Costa Rica has a per-capita gross domestic product of $11,600, but ranks fifth overall as it protects its forests and rich biodiversity, both lures for ecotourists.

Another Latin American country, Colombia, ranks ninth overall. The country carefully guards its coffee plantations, a source of lucrative exports. Ironically, the presence of guerrillas and drug lords also makes the countryside hard to develop, even as developers rapidly cut down rainforest in neighboring Brazil.

EPI researchers caution that the information used to develop the scale often comes from local sources and can be of less-than-ideal quality, especially in developing countries. They ranked