Following a cardiac arrest, emergency workers stabilize an unconscious patient’s heart as best they can. Sometimes cooling begins in the ambulance, but more often it’s initiated in the emergency room. Critical-care experts are increasingly relying on hypothermia, or cooling the body, which studies show can minimize organ damage. Two cooling methods:
Click below for slide show
Sources: Neurologist Richard Temes, Rush University Medical Center, Chicago; neurologist David Palestrant, Ceadars-Sinai Medical Center, Los Angeles; cardiologist John Erwin, Scott & White Heart and Vascular Institute, Texas A&M College of Medicine; Medivance; Philips Healthcare; The New England Journal of Medicine
Graphic by Frank Pompa, USA TODAY
GoogleNews.com, USAToday.com, March 29, 2010, by Mary Brophy Marcus – Two years ago this past October, Tawana Sample-Harris was like any other pregnant woman at nine months: ready to deliver. But when her water broke, she unexpectedly went into cardiac arrest and lost consciousness.
“I was actually dead for 43 minutes. They told me my tongue was hanging out of my mouth, my body started swelling, my organs started shutting down,” says Sample-Harris, 34, from her home in Aurora, Ill. As emergency staff at Rush University Medical Center in Chicago tried to restart her heart, her son, Carl Louis, was delivered by emergency C-section. But she remained in a coma.
Her doctors asked her family if they could try a relatively new treatment that would involve cooling Sample-Harris’ body to about 91 degrees F — about 7 degrees below normal body temperature. Called therapeutic hypothermia, it aims to slow brain-cell death and other organ demise that could lead to permanent neurological damage.
An uncertain outcome
But even as they cooled her, they held little hope that her brain would ever be the same again, says Richard Temes, medical director of the neurological intensive care unit at Rush.
“Generally nobody wakes up after a 40-minute cardiac arrest,” says Omar Lateef, director of critical care at Rush.
That was on a Friday. Two days later, after being cooled for 24 hours and gently rewarmed over another 12 hours, Sample-Harris woke up in her hospital bed, unaware of what had happened, and asked a nearby nurse for a telephone. She dialed her husband — her boyfriend at the time.
“I called him on his cellphone and I said ‘Hi, this is Tawana.’ And he said, ‘Tawana who?’ ” says Sample-Harris, laughing, who says her husband and relatives were in a nearby waiting room anticipating her death, trying to decide who would care for Carl Louis, who was born healthy despite the trauma his mother’s body had suffered.
Since 2005, when the American Heart Association issued recommendations and guidelines for inducing mild hypothermia in comatose survivors of cardiac arrest, the number of hospitals offering the treatment has climbed.
Almost 500 of about 5,000 hospitals across the country are doing it, says critical-care expert Vinay Nadkarni, the heart association’s spokesman for emergency cardiovascular care.
But most proponents of cooling say they’re surprised that the therapy hasn’t caught on faster.
“It’s growing, but the majority of hospitals are still not doing it. It’s less than 20% of patients,” says Nadkarni, who believes body cooling is one of the most exciting and promising interventions for the treatment of cardiac arrest over the past 50 years.
“For me, it’s been like witnessing resurrection,” says David Palestrant, director of neuro-critical care and the stroke program at Cedars-Sinai Medical Center in Los Angeles, whose “code cool” program has been up and running for six months.
“As a neurointensivist treating patients in the ICU, for years I had nothing to offer these patients,” Palestrant says. “Hypothermia is truly amazing. Patients who you know would have been severely impaired are now leaving the hospital and going on to normal lives.”
When the body suffers a cardiac arrest and the heart stops, blood flow ceases and the person technically dies, says Benjamin Abella, clinical research director at the Center for Resuscitation Science in the Department of Emergency Medicine at the University of Pennsylvania, where doctors have been using the technology since 2006.
How hypothermia works
Cooling should be done within 30 to 60 minutes of the arrest in these severe cases, says Scott Weingart, director of the emergency critical care division at Elmhurst Hospital and Mount Sinai School of Medicine in New York. He has been instrumental in establishing hypothermia centers in the city.
“If we get them early enough and everything is set up to provide optimal care, then we have a pretty good chance of making a good story happen,” Weingart says. But he says cooling is not a panacea, and not all patients will benefit.
Hypothermia can be induced externally or internally and can last 12 to 24 hours, and then the body is slowly rewarmed to a normal temperature.
Abella says he’s seeing a 40% to 50% survival rate at his medical center, a rate in line with studies that have analyzed the technique’s effectiveness.
“We have survivors who 20 years ago would be leaving the hospital severely crippled by brain injury,” he says.
Survivor Sample-Harris now has her hands full with work and her 2-year-old son. She says her mind feels as sharp as ever. Although she has some heart damage, it has not hindered her life.
“It feels like nothing happened,” Harris-Sample says. “I say to Carl Louis, ‘Mommy has a lot to tell you when you get old enough.’ “
USA TODAY/ GALLUP POLL
The new health care bill:
President Obama reaches for a pen to sign the health care bill Tuesday. A poll finds
increased support for the measure.
By Susan Page, USA TODAY, 03/29/10
WASHINGTON — More Americans now favor than oppose the health care overhaul that President Obama signed into law Tuesday, a USA TODAY/Gallup Poll finds — a notable turnaround from surveys before the vote that showed a plurality against the legislation.
By 49%-40%, those polled say it was “a good thing” rather than a bad one that Congress passed the bill. Half describe their reaction in positive terms — as “enthusiastic” or “pleased” — while about four in 10 describe it in negative ways, as “disappointed” or “angry.”
The largest single group, 48%, calls the legislation “a good first step” that needs to be followed by more action. And 4% say the bill itself makes the most important changes needed in the nation’s health care system.
“After a century of striving, after a year of debate, after a historic vote, health care reform is no longer an unmet promise,” Obama declared in a celebration at the Interior Department auditorium with members of Congress, leaders of advocacy groups and citizens whose personal stories were cited during the debate. “It is the law of the land.”
To be sure, the nation remains divided about the massive legislation that narrowly passed the House late Sunday. Minutes after Obama signed the bill in the East Room, attorneys general from 13 states — led by Bill McCollum of Florida — sued to block the law as unconstitutional. Virginia filed separately.
Nearly one-third of those surveyed, 31%, say the bill makes “the wrong types of changes,” and 8% say the health care system doesn’t need reform.
The poll of 1,005 adults Monday has a margin of error of +/—4 percentage points.
The findings show receptive terrain as the White House launches efforts to sell the plan, including a trip by Obama to Iowa on Thursday. “The political tides shifted with passage of the bill,” White House communications director Dan Pfeiffer says. “It’s easy to demonize something large and complex in theory; harder when it becomes law.”
No one gets overwhelmingly positive ratings on the issue, but Obama fares the best: 46% say his work has been excellent or good; 31% call it poor. For congressional Democrats, 32% call their efforts on health care excellent or good; 33% poor.
Congressional Republicans, all of whom voted against the bill, are viewed more negatively. Although 26% of those surveyed rate the GOP’s effort as excellent or good, 34% say it has been poor.
Republicans vow to stall a final package of fixes to the bill now being debated in the Senate.
In the new USA TODAY survey and one taken a month ago, the biggest shift toward support of the bill was among low-income Americans, minorities and those under 40. That has created a yawning age divide: A solid majority of seniors oppose the bill; a solid majority of those younger than 40 favor it.
Researchers at Columbia University use a bioreactor, left, to house and help cultivate material, right, that evolves into a bone.
The New York Times, March 29, 2010, by Anne Eisenberg – IF a lover breaks your heart, tissue engineers can’t fix it. But if sticks and stones break your bones, scientists may be able to grow custom-size replacements.
Gordana Vunjak-Novakovic, a professor of biomedical engineering at Columbia University, has solved one of many problems on the way to successful bone implants: how to grow new bones in the anatomical shape of the original.
Dr. Vunjak-Novakovic and her research team have created and nourished two small bones from scratch in their laboratory. The new bones, part of a joint at the back of the jaw, were created with human stem cells. The shape is based on digital images of undamaged bones.
Tissue-engineered bones have many implications, according to a leading figure in the field, Dr. Charles A. Vacanti, director of the laboratories for tissue engineering and regenerative medicine at the Brigham and Women’s Hospital in Boston. He has no connection to the Columbia work. “If your imaging equipment has sufficient high resolution, you can construct virtually any intricate shape you want — for example, the middle ear bone, creating an exact duplicate,” he said. “It’s a splendid example of tissue engineering at its best.”
Engineered bones are being tested in animals and in a few people, and may be common in operating rooms within a decade, said Rosemarie Hunziker, a program officer at the National Institute of Biomedical Imaging and Bioengineering, which sponsors research in the field, including that at Columbia.
“It’s a field that is attracting much interest from venture capitalists,” said Robert Langer, a professor at M.I.T. Dr. Langer has more than 750 patents issued or pending in tissue engineering and drug delivery systems, and is an adviser to many companies that have started businesses based on his work.
Scott Hollister, a professor at the University of Michigan, Ann Arbor, is a co-founder of Tissue Regeneration Systems, a company that is commercializing technology his group is developing for skeletal reconstruction in the face, spine and extremities.
Dr. Vunjak-Novakovic, who has filed a patent application through Columbia, said that her lab’s work had attracted considerable interest from investors, but that it was too soon to talk about commercial applications. “We are starting studies with large animals that will establish safety and feasibility before commercialization, “she said.
Dr. Vunjak-Novakovic, Dr. Warren L. Grayson and other members of the team used digital images of the joint to guide a machine that carved a three-dimensional replica, called a scaffold, from cleansed bone material. The team turned the bare scaffold into living tissue by putting it into a chamber molded to its exact shape, and adding human cells, typically isolated from bone marrow or liposuctioned fat. A steady source of oxygen, growth hormones, sugar and other nutrients was piped into the chamber, or bioreactor, so the bone would flourish.
“The cells grow rapidly,” Dr. Vunjak-Novakovic said. “They don’t know whether they are in the body or in a culture. They only sense the signals.”
Traditional bone grafts are typically harvested from other parts of the body, often a traumatic step, or made of materials like titanium that aren’t always compatible with host bones or cause inflammation, said Dr. Francis Y. Lee, a professor of clinical orthopedic surgery at Columbia’s College of Physicians and Surgeons. Dr. Lee also has no connection to Dr. Vunjak-Novakovic’s work.
“If we have an anatomically matching scaffold that can host bone cells,” Dr. Lee said, “this will provide a new way of reconstructing bone and cartilage defects.”
The design of the bioreactor is ingenious, said Dr. Vacanti of Boston, because it allows sources of nourishment and other fluids to permeate the pores of the scaffold as new bone grows within the pores. Often, cells make tissue mainly on the outside of a scaffold, while cells inside tend to die. But Dr. Vunjak-Novakovic’s bioreactor permits close observation and control of additives by the research team. “They can direct the flow and monitor the effect on the development of tissue,” Dr. Vacanti said.
PROFESSOR Hollister at Michigan is also working on creating bones of a jaw joint. But instead of using a bioreactor to grow them, he plans to use the human body as the incubator. The scaffold for the new bone, designed from a CT scan and printed directly using a laser system, is filled with cells from bone marrow or fat that are taken from the patient to prevent immune-system reactions. “Then we will let the patient’s body naturally heal and reconstruct the tissue as the implant is resorbed by the body,” he said.
Many of the components to generate good bones are in place, said David L. Kaplan, professor and chairman of the department of biomedical engineering at Tufts University. “The technology is here,” he said, “to control the size, shape and functional features of human tissue in the lab.”
The complex problems of keeping tissue alive and integrated when implanted in the body are also well on their way to being solved, Dr. Hunziker said. “We are starting to put the pieces of the puzzle together in various combinations to generate good bone,” she said, “and it’s all going to come together in a reasonable amount of time.”
ScienceDaily (Mar. 29, 2010) — Scientists at Oxford University have led a study that shows how simple diagnostic tests to identify which patients will respond to which cancer drugs can be developed, potentially ushering in a new era of personalized cancer medicine.
The Oxford researchers, with colleagues at the MD Anderson Cancer Center at the University of Texas, Houston, confirm their approach works in results published in the journal PNAS. They show that a specific protein can be used as a ‘biomarker’ to identify which patients with a rare type of non-Hodgkin lymphoma would benefit from a new class of cancer drug. ‘This is the first report of a biomarker that predicts how a patient’s cancer will respond to a cancer drug,’ says Professor Nick La Thangue of Oxford University, who led the research. ‘The presence or absence of the biomarker can now be used as a diagnostic test to identify which patients will benefit from this drug.
‘It’s one of the first examples of being able to personalize cancer medicine and tailor treatment for the individual patient,’ he adds.
Biomarkers also have implications for reducing the cost burden of introducing new cancer drugs on the NHS, as only the subset of patients that would see a benefit would receive the treatment.
‘New cancer drugs would be more likely to gain approval from the National Institute for Health and Clinical Excellence where biomarkers exist to identify the appropriate patient group,’ believes Professor La Thangue, as their analyses of how well the treatment works in relation to how much it costs the NHS would improve.
Cancer drug discovery and development has changed significantly with greater understanding of what goes wrong in biological processes within cancer cells. New drugs target a variety of these cellular processes, but they will often only be effective in a subset of patients according to the profile of their particular cancer.
For example, trastuzumab (Herceptin) is an effective drug against breast cancer but only among those patients with cancers that express the protein which the drug targets. Patients without that protein see no benefit from the drug.
A biomarker is something that can be measured to predict whether a particular cancer will respond to treatment with a particular drug. Simple diagnostic tests based on the level of biomarker present can then flag up patients that will respond to that drug.
Biomarkers can also be used to identify appropriate patient groups for clinical trials. This would improve the ability of the trial to determine a drug’s clinical benefits and increase the likelihood that new and effective drugs make it into clinics. Currently the failure rate for new drugs in development is estimated to be 80%.
The Oxford and Texas team focused on a new class of cancer drug called HDAC inhibitors because they stop the action of the protein histone deacetylase. SAHA (Vorinostat or Zolinza) was the first drug of this class to gain regulatory approval, and can be used in the treatment of a rare type of non-Hodgkin lymphoma known as cutaneous T-cell lymphoma, or CTCL.
The researchers used a whole-genome screen to identify those genes active in CTCL cells that govern whether the cancer cells respond to the drug SAHA or not. The screen works by silencing each gene in turn to assess its effect on how well the drug works. HR23B was found to determine the CTCL cells’ sensitivity to SAHA.
The scientists now report that HR23B works as a biomarker in a clinically relevant setting. The presence of HR23B in biopsies from patients with CTCL predicted who would respond to the treatment 71.7% of the time.
With this first demonstration of a predictive biomarker for a cancer drug, the approach using a whole-genome screen can be done again and again to find biomarkers for different cancers and different drugs. The hope is that the identification of new biomarkers can become routine.
The Oxford group has a patent on the whole-genome screen for identifying biomarkers and is looking at options for commercializing a biomarker kit using HR23B as a companion diagnostic test to go with the drug SAHA.
‘This new work validates our approach for identifying biomarkers,’ says Professor La Thangue. ‘It should be possible to find biomarkers for every drug on the market and every drug in development and truly personalize cancer medicine.
‘You can imagine in the future a biopsy will be taken of a patient’s tumor and screened for the presence of a hundred different biomarkers. They’ll then be given a cocktail of drugs that is tailored for the profile of their particular cancer,’ he adds.
March 29, 2010, by Gabe Mirkin MD – Researchers at Columbia University Medical Center used magnetic resonance imaging to show that even small rises in blood sugar levels can reduce blood flow to the dentate gyrus, the part of the brain that controls memory (Annals of Neurology, December 2008). This may give us the explanation for memory loss that occurs with aging and why exercise helps to prevent memory loss.
The brain gets more than 98 percent of its energy from a steady supply of sugar circulating in the bloodstream. When blood flow is reduced, the brain is deprived of its source of energy and oxygen, causing injury to brain cells.
When you eat, sugar goes from your intestines into your bloodstream. The rise in blood sugar calls out insulin that drives sugar from your bloodstream into cells, keeping blood sugar levels steady. However, with aging, the body starts to lose its fine ability to control blood sugar, and blood sugar levels can rise too high. However, you are protected when you exercise because contracting muscles draw sugar so rapidly from the bloodstream that your blood sugar level doesn’t rise very high and your pancreas doesn’t need to release very much insulin. This rapid withdrawal of sugar from the bloodstream by exercising muscles is dramatic during exercise and can last up to eighteen hours after you finish exercising.
Hundreds of other studies show that 1) exercise slows loss of memory with aging, 2) diabetes markedly increases risk for dementia, 3) diabetes damages the dentate gyrus, 4) exercise helps to prevent the rise in blood sugar after eating and the associated age-related loss of mental function, 5) regular exercisers suffer far less from age-related memory decline, 6) obesity markedly increases risk of age-related loss of mental function, and 7) exercise helps to prevent and treat obesity. This new study should encourage you to exercise to save your mind.
Read more by Gabe Mirkin MD………………
Gabe Mirkin, M.D. – A study from Brown University Medical School showed that Alzheimer’s disease may be another form of diabetes, and all the recommendations for avoiding diabetes may also protect your memory (Journal of Alzheimer’s Disease, November 2005).
Like the pancreas, the brain produces insulin. Professor Suzanne M. de la Monte showed that brain levels of insulin and insulin receptors fall during the early stages of Alzheimer’s and continue to drop progressively as the disease progresses. Other features of Alzheimer’s, such as cell death and tangles in the brain, could be caused by abnormalities in insulin functions.
Furthermore, lack of insulin lowers brain levels of the neurotransmitter acetylcholine, which is seen regularly in Alzheimer’s disease. This would explain why every factor known to increase risk for heart attacks also increases risk for Alzheimer’s disease. Even though these studies are preliminary, it is a good idea to reduce susceptibility to developing diabetes by markedly reducing your intake of sugar and flour; increasing your intake of fruits, vegetable, whole grains, beans, and nuts; avoiding weight gain and exercising regularly.
Read more by Gabe Mirkin MD…………….
By Gabe Mirkin MD – Recent research shows that a regular exercise program can help to prevent some of the loss of memory that comes with aging. A part of your brain called the hippocampus is the control station for memories that you store in other parts of the brain. Another brain structure called the prefrontal cortex is the central station that assembles data from other parts of your brain when you want to recall something from your past. Aging causes the brain to shrink and you lose synapses that transmit messages from one nerve to another.
Exercise causes the brain to produce a substance called Brain Derived Neurotropic Factor (BNDF) that strengthens old synapses and causes new one to grow (Proceedings of the National Academy of Sciences, May 2007). Researchers used MRIs of their human subjects to show that an exercise program of an hour a day, four days a week for three months caused new neurons to grow in the hippocampus. Several previous studies showed that exercise enlarges the hippocampus in rats and doubles or even triples the rate of the formation of new nerves. However, one way that rats differ from humans is that most of them like to run and need no encouragement to spend several hours a day on a treadmill.
There is also emerging evidence that physical activity may be protective against neurological disorders, including Alzheimer’s and other forms of dementia, Parkinson’s disease, strokes and spinal cord injuries. If you are not a regular exerciser, check with your doctor and get started.
Read more by Gabe Mirkin MD…………….
Gabe Mirkin, M.D. – You can tell if you are at high risk for diabetes if you store fat primarily in your belly. Pinch your belly; if you can pinch an inch, you are at increased risk and should get a blood test called HBA1C. Having high blood levels of triglycerides and low levels of the good HDL cholesterol that helps prevent heart attacks also increases your risk for diabetes.
When you eat sugar or flour, your blood sugar rises too high. This causes your pancreas to release insulin that converts sugar to triglycerides, which are poured into your bloodstream. Then the good HDL cholesterol tries to remove triglycerides by carrying them back into the liver, so having high blood levels of triglycerides and low blood levels of the good HDL cholesterol are both individual risk factors for diabetes.
High blood levels of insulin constrict arteries to raise blood pressure, so many people who have high blood pressure are also prediabetic. High insulin levels also constrict the arteries leading to your heart to cause heart attacks directly. People with insulin resistance have an increase in small, dense, low-density lipoprotein (LDL) cholesterol, which is more likely to cause heart attacks than the large, buoyant regular LDL cholesterol. High levels of insulin also cause clotting to increase your risk for heart attacks.
A study from Sweden showed that many people discover that they are diabetic only after they have had a heart attack. Researchers recorded blood sugar levels in men who had had heart attacks and then did sugar tolerance tests at discharge and three months later. They found that 40 percent had impaired sugar tolerance tests three months later. This suggests that 40 percent of people who have heart attacks are diabetic, even though they may not know it. The authors recommend that all people with heart attacks be tested for diabetes (1).
You can help to prevent diabetes and heart attacks by avoiding sugar and flour, exercising and eating lots of vegetables.