Injecting Stem Cells into the Heart Could Stop Chronic Chest Pain

 

Stemming pain: Douglas Losordo of Northwestern University hopes that CD34+ stem cells, like this one shown here, can help treat patients with chest pain.
Credit: Northwestern University

 

 

 

Early research suggests that the treatment works by promoting blood vessel growth

 

 

MIT Technology Review, July 11, 2011, by Karen Weintraub  —  Patients with hard-to-treat chest pain reported feeling better, and could exercise longer, after doctors injected stem cells taken from their bone marrow into their heart, according to a new study in Circulation Research.

The early-stage research suggests that the cells were able to help heal tiny, damaged blood vessels that are often untouched by procedures like stents and angioplasty, says lead researcher Douglas Losordo of Northwestern University.

Losordo has been searching for more than a decade for ways to repair the heart using a patient’s own stem cells. He is by no means the only scientist on this quest, but Losordo is the only one using a particular stem cell, called CD34+, which is believed to promote blood vessel growth.

Richard Lee, a cardiologist at Brigham and Women’s Hospital in Boston and head of the cardiovascular program at the Harvard Stem Cell Institute, says Losordo’s research is novel because of his use of these cells, and because he is aiming his treatments at a group of people who have not been well helped by medicine so far.

The American Heart Association estimates that 850,000 Americans have lingering bouts of chest pain, a condition called refractory angina, which is not relieved by medication, angioplasty, or stenting. At the beginning of Losordo’s study, the 167 participants had 20 or more episodes of pain a week so severe that they had to stop what they were doing. Six months into the research, patients who received a low dose of the stem cells reported roughly seven attacks a week on average, while those who received a placebo treatment had 11.

The low-dose patients also were able to tolerate exercise for more than two minutes longer at the end of the study compared to the beginning, while those in the placebo arm could last just over a minute longer.

By harvesting a patient’s CD34+ cells from bone marrow, amplifying them, and injecting them directly into the damaged portion of the heart, Losordo says, he is circumventing natural steps that these people’s bodies might not be equipped to perform anymore. In animal studies, he found that the cells were naturally recruited to the heart after an injury to help repair damaged tissue. His research suggests that they secrete growth factors and immune molecules.

“These cells seem to represent one of the natural mechanisms for helping to repair damaged tissue,” he says. “We’re taking a preprogrammed repair mechanism and simply trying to leverage that in patients who have been damaged over the course of many years or decades.”

Lee compliments the thorough nature of Losordo’s work. “I think that this is a promising study, because it was so carefully done and because this patient population can be very incapacitated,” Lee says.

However, he offers three reasons for caution. First, patients in the placebo arm of the study also showed dramatic improvements. Second, although the procedure seemed generally safe, the patients’ hearts released an enzyme that is typically discharged when damage occurs. And third, patients receiving a lower dose of the stem cells fared as well or better than those receiving a higher dose.

“That really implies that we really don’t know what’s going on,” Lee says. “You like to see dose-dependence. If it’s the low-dose [that’s most effective], then you wonder, can we go lower and get the same effect? Have we missed the real benefit?” Other cell therapies for the heart suffer from similar shortcomings, Lee notes.

Losordo expects to start the final phase of clinical trials in a larger group of patients at the end of this year. Trials have already begun using CD34+ cells to help restore blood vessels in people at risk for amputation and in patients with artery blockages in their legs.

Photo: Dorothea Lange

 

 

By GINA KOLATA, The New York Times, July 11, 2011  —  When poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability, according to a new, large-scale study that provides the first rigorously controlled assessment of the impact of Medicaid.

 

While the findings may seem obvious, health economists and policy makers have long questioned whether it would make any difference to provide health insurance to poor people.

It has become part of the debate on Medicaid, at a time when states are cutting back on this insurance program for the poor. In fact, the only reason the study could be done was that Oregon was running out of money and had to choose some people to get insurance and exclude others, providing groups for comparison.

Some said that of course it would help to insure the uninsured. Others said maybe not. There was already a safety net: emergency rooms, charity care, free clinics and the option to go to a doctor and simply not pay the bill. And in any case, the argument goes, if Medicaid coverage is expanded, people will still have trouble seeing a doctor because so few accept that insurance.

Until now, the arguments were pretty much irresolvable. Researchers compared people who happened to have insurance with those who did not have it. But those who do not have insurance tend to be different in many ways from people who have it. They tend to be less educated and to have worse health habits and lower incomes, said Dr. Alan M. Garber, an internist and health economist at Stanford. No matter how carefully researchers try to correct for the differences “they cannot be completely successful,” Dr. Garber said. “There is always some doubt.”

The new study, published Thursday by the National Bureau of Economic Research, avoided that problem. Its design is like that used to test new drugs. People were randomly selected to have Medicaid or not, and researchers then asked if the insurance made any difference.

Health economists and other researchers said the study was historic and would be cited for years to come, shaping health care debates.

“It’s obviously a really important paper,” said James Smith, an economist at the RAND Corporation. “It is going to be a classic.”

Richard M. Suzman, director of the behavioral and social research program at the National Institute on Aging, a major source of financing for the research, said it was “one of the most important studies that our division has funded since I’ve been at the N.I.A.,” a period of more than a quarter-century.

In its first year of data collection, the study found a long list of differences between the insured and uninsured, adding up to an extra 25 percent in medical expenditures for the insured.

Those with Medicaid were 35 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital. Researchers were unable to detect a change in emergency room use.

Women with insurance were 60 percent more likely to have mammograms, and those with insurance were 20 percent more likely to have their cholesterol checked. They were 70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.

The insured also felt better: the likelihood that they said their health was good or excellent increased by 25 percent, and they were 40 percent less likely to say that their health had worsened in the past year than those without insurance.

The study is now in its next phase, an assessment of the health effects of having insurance. The researchers interviewed 12,000 people — 6,000 who received Medicaid and 6,000 who did not — and measured things like blood pressure, cholesterol and weight.

The study became possible because of an unusual situation in Oregon. In 2008, the state wanted to expand its Medicaid program to include more uninsured people but could afford to add only 10,000 to its rolls. Yet nearly 90,000 applied. Oregon decided to select the 10,000 by lottery.

Economists were electrified. Here was their chance to compare those who got insurance with those who were randomly assigned to go without it. No one had ever done anything like that before, in part because it would be considered unethical to devise a study that would explicitly deny some people coverage while giving it to others.

But this situation was perfect for assessing the impact of Medicaid, said Katherine Baicker, professor of health economics at the Harvard School of Public Health. Dr. Baicker and Amy Finkelstein, professor of economics at M.I.T., are the principal investigators for the study.

“Amy and I stumbled across the lottery in Oregon and thought, ‘This is an unbelievable opportunity to actually find out once and for all what expanding public health insurance does,’ ” Dr. Baicker said.

They had just a short window of time. Within two years, Oregon found the money to offer Medicaid to the nearly 80,000 who had been turned down in the lottery.

As an economist, Dr. Finkelstein was interested, among other things, in whether Medicaid did what all insurance — homeowner’s, auto, health — is supposed to do: shield people from financial catastrophe. Almost no one had even tried to investigate that question, she said.

“It is shocking that it is not even in the discourse,” Dr. Finkelstein said.

The study found that those with insurance were 25 percent less likely to have an unpaid bill sent to a collection agency and were 40 percent less likely to borrow money or fail to pay other bills because they had to pay medical bills.

Dr. Finkelstein said she had thought that the people were so poor to begin with that they just did not spend very much out of pocket on medical care when they did not have insurance. “Yet look at the results,” she said.

Dr. Baicker interviewed people for Part 2 of the study and was impressed by what she heard.

“Being uninsured is incredibly stressful from a financial perspective, a psychological perspective, a physical perspective,” she said. “It is a huge relief to people not to have to worry about it day in and day out.”

Photo: Dorothea Lange

 

 

 

Medscape.com, GoogleNews.com, July 11, 2011, WASHINGTON (Reuters) – Medicaid, a government health insurance program designed to help the poorest of the poor, is giving people unprecedented access to doctors and also improving their finances, a study co-authored by the Harvard School of Public Health has found.

The study, released on Thursday, showed that new recipients of Medicaid reported better physical and mental health and were less likely to go into debt to pay their medical bills.

The fate of Medicaid — the health program for people and families with low incomes and resources — has been hotly debated for its role in the ballooning U.S. deficit. The Obama administration’s healthcare overhaul passed last year requires all U.S. states to extend eligibility to millions more people by 2014.

The study followed health outcomes a year after a 2008 Medicaid expansion in Oregon, where 10,000 uninsured low-income adults won coverage through a lottery.

The results show that Medicaid helps poorer Americans well beyond the default safety net options that exist for people without coverage, according to the researchers from Harvard, the Massachusetts Institute of Technology, the National Bureau of Economic Research and Providence Health & Services.

“Some people wonder whether Medicaid coverage has any effect. The study findings make clear that it does,” Amy Finkelstein, professor of economics at MIT and co-principal investigator of the study, said in a statement.

“People reported that their physical and mental health were substantially better after a year of insurance coverage, and they were much less likely to have to borrow money or go into debt to pay for their care,” she said.

The study found that newly insured Medicaid recipients sought healthcare “substantially and statistically significantly” more than those who did not get the opportunity to apply for the program.

The lottery winners also spent less on out-of-pocket medical expenses, had less medical debt, were more likely to follow doctors’ recommendations on preventive care, buy medication and overall said they enjoyed better health.

An especially large impact was seen in broader access to care. Newly insured adults were 70% more likely to report regular clinic or office visits for primary care and 55% were more likely to say they visit a particular doctor.

Medicaid coverage also reduced the likelihood that participants would have to borrow money or miss paying other kinds of household bills to pay for their healthcare needs by 40%. The likelihood of having a medical bill sent to a collection agency dropped by 25%.

The researchers cautioned against extrapolating from their findings to estimate the broader impact of the new U.S. healthcare law given the relatively small sample population.

The study focused on 10,000 lottery winners and compared their outcomes with some of the 80,000 other applicants who were not selected for coverage. Oregon’s total population of about 3.8 million includes about 650,000 uninsured and about 200,000 low-income uninsured adults.

Researchers said they will continue to follow Medicaid lottery participants for another year and directly measure health outcomes such as changes in cholesterol levels, obesity and blood pressure.

The research group also included Katherine Baicker, former member of the Council of Economic Advisers under President George W. Bush, and Jonathan Gruber, who helped the Obama administration design the healthcare law as a paid technical consultant.

SOURCE: http://bit.ly/qbZE42

National Bureau of Economic Research 2011.

 

 

Dogs and Chocolate: Get the Facts

 

 

Most of us have heard that chocolate can make dogs sick. But how serious is the risk?

 

 

WebMD.com, July 11, 2011, by Salynn Boyles
WebMD Pet Health Feature
Reviewed by Katherine Snyder, DVM, DACVIM

 

 

If your canine companion is more family member than pet, you may be in the habit of sharing the foods your family loves with him.

Although some people foods are fine in moderation, this is definitely not the case with chocolate.

Chocolate can sicken and even kill dogs, and it is one of the most common causes of canine poisoning, veterinarians tell WebMD.

Veterinarian Michelle DeHaven says the worst case of chocolate poisoning she ever saw happened when some owners fed their eight-pound poodle a pound of chocolate on his birthday.

“We had to treat the dog with fluids and anti-seizure medication for five days,” says DeHaven, who practices in Smyrna, Ga. “Every time we stopped the meds he would start seizuring again. You wouldn’t feed a kid a pound of chocolate, but they fed it to a small dog.”

No amount of chocolate is OK for your dog to consume. Dark chocolate and baker’s chocolate are riskiest; milk and white chocolate pose a much less serious risk.

What Makes Chocolate Poisonous to Dogs?

Chocolate is made from cocoa, and cocoa beans contain caffeine and a related chemical compound called theobromine, which is the real danger.

The problem is that dogs metabolize theobromine much more slowly than humans, Denver veterinarian Kevin Fitzgerald, PhD, tells WebMD.

“The buzz we get from eating chocolate may last 20 to 40 minutes, but for dogs it lasts many hours,” he says. “After 17 hours, half of the theobromine a dog has ingested is still in the system.”

Theobromine is also toxic to cats, but there are very few reported cases of theobromine poisoning in felines because they rarely eat chocolate.

Dogs, on the other hand, will eat just about anything.

Even small amounts of chocolate can cause vomiting and diarrhea in dogs. Truly toxic amounts can induce hyperactivity, tremors, high blood pressure, a rapid heart rate, seizures, respiratory failure, and cardiac arrest.

Dogs and Chocolate: How Much is Too Much?

The more theobromine a cocoa product contains, the more poisonous it is to your dog.

Unsweetened bakers chocolate contains about 390 milligrams of theobromine per ounce — about 10 times more than milk chocolate and more than twice as much as semi-sweet chocolate. White chocolate contains very little theobromine.

According to the Merck Veterinary Manual, one ounce of milk chocolate per pound of body weight is potentially lethal.

But the real danger lies with dark chocolate. Merck warns that deaths have been reported with theobromine doses as low as 115 milligrams per kilogram (2.2 pounds) of body weight.

So 20 ounces of milk chocolate, 10 ounces of semi-sweet chocolate, and just 2.25 ounces of baking chocolate could potentially kill a 22-pound dog, Fitzgerald says.

Serious toxic reactions can occur with ingestion of about 100 to 150 milligrams of theobromine per kilogram of body weight.

 

 

 

 

That means:

  • A 9-pound dog could be expected to show symptoms of chocolate toxicity after eating 1 ounce of baking chocolate, 3 ounces of semi-sweet chocolate, or 9 ounces of milk chocolate.
  • A 27-pound dog might have such symptoms after eating 3 ounces of baking chocolate, 9 ounces of semi-sweet chocolate, and 27 ounces of milk chocolate.
  • A 63-pound dog might exhibit symptoms after eating 7 ounces of baking chocolate, 21 ounces of semi-sweet chocolate, or 63 ounces of milk chocolate.

“In 27 years of practice, I’ve seen two dogs die from eating chocolate,” says Fitzgerald, who appears regularly on Animal Planet’s hit show Emergency Vets. “Both were under 20 pounds, both were elderly and both ate baking chocolate in very large amounts.”

Although most people would not eat a 4-ounce bar of bitter-tasting baking chocolate, this is not true of dogs, he says.

“Dogs experience the world through tasting it, and they are gorgers,” he says. “Baking chocolate tastes good to them.”

Your Dog Ate Chocolate: Now What?

DeHaven, who owns Cumberland Animal Clinic in Smyrna, says she typically gets two to three calls a month from owners whose dogs have eaten chocolate.

When an owner calls, she asks how much and what kind of chocolate the dog has eaten and the dog’s weight.

“If a 60-pound golden retriever eats a bag of Hershey’s kisses, there isn’t too much to worry about,” she says. “The dog will probably have a stomachache, but not much else.”

After eating a potentially toxic dose of chocolate, dogs typically develop diarrhea and start vomiting.

If the dog isn’t vomiting on its own, the vet may advise inducing vomiting immediately to keep as much theobromine as possible from entering the system.

One method is giving the dog a one-to-one solution of hydrogen peroxide and water. But DeHaven says that treatment is now discouraged because it can cause esophageal ulcers.

She recommends syrup of ipecac, which induces vomiting.

When a dog shows signs of hyperactivity and agitation or is having seizures, the faster you get it to the vet the better. But there is no specific antidote for chocolate poisoning.

Fluids are typically given along with intravenous drugs to limit seizures and protect the heart.

Symptoms of theobromine poisoning generally occur within four to 24 hours after chocolate is consumed.

Cocoa Shell Mulch: A Little-Known Danger

Most people don’t realize it, but those increasingly popular cocoa shell mulches used for landscaping can also pose a serious risk to dogs in the same way that chocolate does.

Terry and Dawn Hall found out the hard way several years ago when their beloved 105-pound chocolate lab ‘Moose’ died after eating just eight ounces of cocoa shell mulch used to landscape their Minneapolis yard.

The death prompted the couple to contact Minnesota state senator Scott Dibble, who sponsored a bill to require cocoa mulch sellers to warn customers of the potential danger to dogs. His bill was approved by the Legislature, but vetoed by the governor.

“It is my understanding that theobromine can be removed from cocoa mulch pretty easily, and that some manufacturers do this and others do not,” Dibble tells WebMD. “But right now there is no way for the consumer to know if the mulch they are buying has been treated.”

 

 

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