Drug-coated stents may prevent complications of peripheral Arterial Disease

According to new research presented at the Society of Interventional Radiology’s 38th Annual Scientific Meeting in New Orleans, it seems that one of the most common complications of diabetes, namely PAD (peripheral arterial disease), can now be prevented by using drug-eluting stents. These stents enable blood flow in the arteries and prevent the installation of peripheral ischemia.

PAD, or peripheral arterial disease, refers to the blockage of an artery from the systemic circulation, such as the leg arteries. Because of diabetes or atherosclerosis,  these arteries become obstructed and gradually various signs and symptoms occur such as pain, cramps, tingling, burning, etc.. In some cases, occlusion may occur suddenly and the pain is acute and severe. Local consequences of ischemia (interruption of blood flow in an artery) refers to the loss of hairiness, low local temperature, atrophic nails and can go up to amputation.

Stents

Robert A. Lookstein, MD, FSIR, lead researcher and chief of interventional radiology at Mount Sinai Medical Center in New York, said the prevalence of PAD is on the increase due to aging population, diabetes and obesity. He said that patients with PAD that are not candidate for surgery may opt for minimally invasive procedures. Lookstein estimated that up to 20% of Americans age 65 of North or older suffer from this condition.

The most severe form of PAD is critical limb ischemia, which means that the arteries are almost completely blocked. Besides pain that occurs when walking, patients with PAD may also have different wounds that will not heal or heal very slowly. If left untreated, PAD can lead to amputation.

So far the results of this new method of treatment for critical limb ischemia have shown that stents are safe and effective. This form of therapy helps to relieve pain and prevent amputation. According to Lookstein, these special stents can maintain open arteries thus enable a good blood flow.

To verify the efficacy and safety of this new method of treatment, researchers conducted a retrospective study that included 107 patients with critical limb ischemia. They were evaluated and 171 drug-eluting stents were placed in blocked arteries. According to the study, their effectiveness was not constant during  the entire follow-up period: 90% were functional after 6 months, after a year-84% were open, and after 2 years only 70% were functional. There was no case of amputation in patients with critical limb ischemia treated in early stages. An alternative for patients who are not candidates for surgery is minimally invasive balloon angioplasty. But long-term success rate is low when small arteries are interested because of restenosis.

 The advantage of these new stents is that they prevent restenosis because the drug impregnated is released long time. Lookstein said that this new method is superior to balloon angioplasty. “It’s safe, it’s durable and the outcomes is spectacular. The vast majority of patients were able to avoid amputation and dramatically improve their quality of life,” he added.

Study finds that depression is due to abnormal connection between neurons

Researchers at the University of Maryland School of Medicine have made exciting new discoveries about the neurological mechanisms underlying depression. Latest studies show that this disorder is due to poor communication between neurons, suggesting a different perspective than what was previously thought about depression. The study results, published in Nature Neuroscience, reveal that, in depression, there is an abnormal transmission of excitatory signals between neurons. Depression is a mood disorder that manifests with sad, loss of energy and interest, anxiety, restlessness, and can even lead to suicide. Depression is common among American and World Health Organization estimates that by 2020, depression will become the second leading cause of disability in the world. According to statistics, between 2005 and 2008, one in 10 Americans were diagnosed and treated for depression.

Brain

Current treatment that is administered for this disorder aims to increase the level of serotonin in the brain: Prozac, Zoloft, Celexa. Although treatment is only effective in half the patients, it was long believed that the lack or the low level of serotonin, which is a neurotransmitter in the brain, is responsible for depression onset. But recent studies conducted by senior author led Scott M. Thompson, Ph.D., Professor and Interim Chair of the Department of Physiology at the University of Maryland School of Medicine, show that depression is actually based on other mechanisms. E. Albert Reece, MD, Ph.D., MBA, Vice President for Medical Affairs at the University of Maryland and John Z. and Akiko K. Bowers Distinguished Professor and Dean at the University of Maryland School of Medicine, said the research of Dr. Thompson, could alter the psychiatric medicine field because it comes with a different perspective on depression.

One of the findings of the study was that serotonin strengthens communication between neural cells. On this point, Dr. Thompson noted that serotonin amplifies excitatory interactions between brain cells in regions important in cognitive and emotional functions. To see what exactly is the role of serotonin in depression, the researchers experimented on rats and found that stress has no effect on the level of serotonin in the brains of mice depressed. It is known that sustained communication between neurons underlies memory and learning processes, and researchers hypothesis (according to which poor communication contributes to depression) explains why depressed people face a number of problems regarding concentrating or making decisions. “Although more work is needed, we believe that a malfunction of excitatory connections is fundamental to the origins of depression”, Dr.Thompson said.

Many women suffer from postpartum depression, study finds

According to a large-scale study conducted by researchers at Northwestern University, the number of women suffering from postpartum depression is incredibly high. It is the first time a complete psychiatric assessment is made among women diagnosed with postpartum depression. The study, involving nearly 10,000 women who recently born children in single obstetrical hospital, showed that there is a significant percentage of women who experienced episodes of major depression. Northwestern Medicine study lead author Katherine L. Wisner, MD, said that in the United States most women who suffer from depression are not diagnosed and treated early, even if they are at risk of psychiatric disorders. She added that it is a major health problem and the mental health of a pregnant woman affects not only physically but also emotionally the fetus.

Postpartum depression

The study showed that 14% of women were diagnosed with depression, and of these 826 have received full psychiatric assessments. Of the women screened positive for depression, over 19%  thought of harming themselves. It should be noted that suicide is the second most common cause of death in postpartum women. So, screening is important because it can save lives. It was also found that many women who had an episode of major depression or anxiety disorders also had an episode of depression before pregnancy.

The study also pointed out that among women with major depression, 22% were diagnosed with bipolar disorder, disorder  that was not identified by doctors in many cases. It is known that bipolar disorder is not easy to diagnose, especially if the person is in a manic phase. However, the postpartum period shows very high risk of developing new episodes of mania. Wisner said that this is very important because treatment with antidepressants alone can worsen bipolar disorder evolution. Another finding was that women who gave birth were much less likely to seek help than women who were in their first pregnancy.

There are several consequences of depression on both mother and newborn. It is already known that antepartum maternal stress is associated with preterm delivery and low infant birth weight, which in turn may affect cardiovascular system. Depression can cause a number of abuses such as alcohol or drug abuse, and also it may affect appetite, which has negative consequences not only on the fetus but also on the mother. “Depression during pregnancy increases the risk to a woman and her fetus,” Wisner said. “Depression is a physiological dysregulation disorder of the entire body.”

A breakthrough discovery in melanoma treatment

Researchers at the University of Utah are investigating a new way to stop melanoma, which is the most serious form of skin cancer, from spreading. It seems that by inhibiting the new target discovered (ARF6),  lung metastasis can be stopped. In recent decades, the incidence of melanoma has been increasing constantly so it has come to represent the sixth most common form of cancer in the United States. Although it is the least common of skin cancers, melanoma has the highest mortality rate and it is estimated that one of 50 individuals will develop melanoma during their lifetime. Prognosis depends very much on tumor stage. It is believed that if the tumor is less than 1 mm, the chances of survival at 5 years are approximately 90% but if the tumor has already metastasized in the body, the 5-year survival rate is less than 10%. Metastases can lead to multiple locations in the body such as the liver, lungs, brain, etc..

Lung Metastasis

Allie Grossmann, MD, Ph.D., molecular genetic pathology fellow at the University of Utah and co-first author on the study, said that metastases are those that are lethal in melanoma but their knowledge about the mechanisms underlying metastasis are limited. She added that by understanding these mechanisms of dissemination new therapeutic targets for the treatment of melanoma can be discovered .

Although much progress has been made lately regarding the treatment of this form of cancer, patients still have a poor prognosis. Grossmann and his team of researchers at the University of Utah have found a new molecular pathway involving ARF6, which is implicated in metastasis. Studies have shown that by blocking this signaling pathway using a small molecule known as SecinH3, can stop melanoma metastasis to the lung. Research to date shows that SecinH3 inhibits the whole cascade of metastasis, which is an unparalleled discovery in the treatment of melanoma. Moreover, it seems that ARF6 protein is involved not only in melanoma but also in other cancers such as glioblastoma and breast cancer, where invasion is promoted also by ARF6.

Odelberg Shannon, Ph.D., assistant professor of Internal Medicine and Neurobiology and Anatomy Navigen scientist, and a contributing author on the study, said that although SecinH3 is not available as cure for patients with melanoma, yet this molecule demonstrate that inhibition of ARF6 has therapeutic value in the treatment of melanoma.”Our findings are the first step toward developing potent therapies that may actually prevent or reduce melanoma metastasis,”  added Odelberg.

Melanoma is linked to Obesity Gene

A study published in Nature Genetics demonstrates that a major risk factor for malignant melanoma is obesity. Although it is the least common of all skin cancers, melanoma has the highest mortality rate of all skin cancers, that is responsible for approximately 80% of all skin cancer deaths. In UK melanoma is the fifth most common cause of death.
Malignant melanoma is a tumor that develops by proliferation of melanocytes, cells that are found between the two skin layers: epidermis and dermis. Among causative factors of melanoma, genetics has an important role. There are several melanoma associated genes: CDKN2A (p16), CDK4, RB1, CDKN2A (p19), PTEN/MMAC1. There are also mutations that run in families and in this case the risk of developing this type of skin cancer is higher. Melanoma can arise from preexisting lesions such as moles and signs that are suggestive for malignancy are systematized by ABCDE: asymmetry, irregular borders, change in color, diameter over 6 mm and elevation. Another important risk factor for melanoma, besides genetic factors, is exposure to sunlight. Studies have shown that sun exposure leads to skin immune system suppression, production of free radicals and DNA alteration.

Melanoma

Treatment of choice consists of surgical excision of melanoma with oncological safety margins and lymphadenectomy. Surgery is completed by chemotherapy and radiotherapy. The prognosis depends on many factors such as tumor stage (thickness), the invasion, type of melanoma, etc.. However survival at 5 years is less than 10%.

The study led by researchers at the University of Leeds is the first to reveal that could be a link between obesity and melanoma. To reach these conclusions, the researchers investigated 13,000 patients with melanoma and 60,000 healthy individuals worldwide. It seems that the FTO gene mutations lead to obesity and overeating and are associated with increased BMI (body mass index). A high BMI means obesity, and obesity is a risk factor for many diseases such as diabetes, heart disease, cancer and other types. Study author, Dr Mark Iles, Cancer Research UK scientist at the University of Leeds, said it is the first time this gene (FTO) that has already been associated with many diseases, has been involved in melanoma. He said it is possible that in the future to discover that this gene is involved in other diseases.
Dr Julie Sharp, Cancer Research UK’s senior science information manager, mentioned that this research may lead to the discovery of therapeutic targets and of new drugs for treating melanoma.

New generation of clot removal devices more effective in treating stroke patients

Stroke patients are treated at Stony Brook’s Cerebrovascular and Stroke Center (CCC) with a new range of devices for cerebral revascularization. Approved by the FDA in 2012 for treatment of acute ischemic stroke, the Solitaire Flow Restoration Device and the Trevo device proved more effective than first-generation clot removal device.
David Fiorella, MD, Ph.D., Professor of Clinical Neurological Surgery and Radiology at Stony Brook University School of Medicine and Co-Director of the CCC, said they have obtained promising results on these new devices. He said that in ischemic stroke, time is brain and every minute counts, in other words the chances of full recovery are higher if the patient is treated as soon as possible . He added that these new devices  help to quickly restore the blood flow in patients with stroke.

Stroke

Stroke is the leading cause of disability in adults in the United States and the fourth leading cause of death. Statistics show that on average every 4 seconds a stroke occurs and every 4 hours someone dies from a stroke. Given the high incidence of this disease, the development and introduction into clinical practice of new revascularization devices should become priorities for medical centers.

There are two types of stroke: ischemic stroke, occurring by blocking a blood vessel by a clot or ( platelet clot or thromboembolic clot ), or hemorrhagic, which appear by breaking a blood vessel. As with PCI, percutaneous coronary intervention, which applies to patients with acute myocardial infarction, revascularization of patients with stroke significantly improves their prognosis.

Although recent studies on the first generation of devices show that they do not significantly improve the prognosis of patients compared to standard drug therapy, Dr. Fiorella points out that these new devices are more efficient. In terms of effectiveness, studies are ongoing. These new revascularization devices are in fact expandable wire-mesh systems which collapses and enter the circulatory system with the use of microcatheters. They are then guided by cerebral circulation and are attached to the blood vessel affected;  when these devices are removed, they pull out the blood clot which obstructed the artery.

Dr. Fiorella said that endovascular therapy is especially effective in some patients with stroke. In addition, when stroke affects one of the main arteries of the brain, medications fail to open the occluded artery in 70-90% of cases. “In these cases where intravenous medications are ineffective or contraindicated, endovascular treatments using these new devices offer patients the most promise,” he said.

Virtual CT scan – The Best Alternative To colonoscopy

According to a study recently published in the Lancet, a new method to investigate colon cancer is CT colonography (CTC) or virtual colonoscopy. Unlike other imaging method of investigating diseases of the colon, like traditional X-ray test of barium enema, CTC is less invasive and provides more detailed and more accurate information.
Researchers made two trials in which were included more than 3,800 patients that were investigated either by barium enema or by CTC. The result of the study was that CTC is more effective in detecting precancerous polyps or colon cancer. Colon cancer is one of the most common malignancies of the digestive system and, what is important, is that it is one of the cancers that can be successfully cured if detected early.

Colonoscopy with biopsy is currently the gold standard for colon cancer diagnosis. This investigation involves endoscopic examination using a fiber optic camera  and thus offers the opportunity to view any lesion at the inside of the colon. Unlike barium enema, colonoscopy is more accurate because it offers the possibility of biopsy. In addition, there is the possibility of polyp resection which greatly decreases postoperative morbidity and complications that could occur after a colon surgery. Unlike colonoscopy, CTC is a method of imaging that uses X-rays to build a virtual three-dimensional image of the inside of the bowel.

Virtual CT Scan

Professor Steve Halligan, based at UCL and joint lead researcher, said that their study shows that CTC is more accurate than barium enema. But for the CTC to become basic investigation in the diagnosis of colon cancer, clinics must have,  in addition to CT scans, specialized radiologists in CTC.”These radiologists will need training in order to deliver the results we observed in our trials “, added Dr. Halligan.

The other study was conducted on 1,600 patients and the aim was to see which of the two investigations, CTC or colonoscopy, is more effective. Studies so far have shown that the two investigations have similar sensitivity in detecting colon cancer. Unlike colonoscopy, CTC has a disadvantage because it does not offer the possibility of biopsy and thus one cannot tell if the lesions are benign or malignant. Professor Wendy Atkin, based at Imperial College London and joint lead researcher, says that CTC detects unimportant lesions this is why guidelines are necessary to help doctors decide which patients will need further testing. He added that CTC is a viable option for patients who, for whatever reason, do not want to have a colonoscopy.

Stem cell therapy may be the new cure for myelin disorders

According to a study published in the journal Cell Stem Cell,  researchers at the University of Rochester Medical Center (URMC) have made progresses regarding a possible cure for myelin disorders, which include multiple sclerosis and pediatric leukodystrophies. Multiple sclerosis is an inflammatory neurological disease for which there is no treatment. It is a disease that occurs in young patients and is characterized by progressive demyelination of the nervous system. Multiple sclerosis can give any neurological deficit: ataxia (difficulty walking), muscle paralysis, paresthesia, muscle weakness, dysphagia (difficulty swallowing), optic neuritis, etc.. It is a chronic disease that develops in acute relapses, which are treated with corticosteroids, and remissions, but there are cases when neurological deficits no longer recover.

Stem cell Therapy

The pathogenic mechanism of this autoimmune disease consists in multiple attacks against the myelin, which is part of  nerve structure. It is not known what causes this autoimmune attack, although it is assumed that certain infections or intoxications are possible causes of multiple sclerosis. Myelin is a fatty material that has a role in nerve transmission, and therefore its loss leads to significant neurological deficits. It should be noted that loss of myelin also occurs in diseases other than multiple sclerosis, such as pediatric leukodystrophies which are some rare but fatal diseases.

Myelin is produced in the nervous system by some cells that are called oligodendrocytes, and the latter result from the proliferation of other cells called oligodendrocyte progenitor cell, or OPC. Researchers have long  figured that targeted cell-based therapy may be the key for myelin disorders. In other words, if healthy OPCS could be transplanted into diseased or injured brain, these cells would produce new myelin. However, there have been several obstacles that have prevented researchers to put their idea into practice. One of them was to find a suitable source for such cells. But even if experiments with cells derived from tissue-specific and embryonic stem cells have not been successful, researchers still managed to finally find a solution, that is induced pluripotent stem cells. The risk of rejection is practically insignificant because these cells are taken from the recipient’s own skin.

Now researchers at the University of Rochester Medical Center (URMC) are the first who have been able to purify OPCS from hiPSCs and the first who have transplanted these cells into mice with a hereditary leukodystrophy. It seems that OPCS make a new myelin and, what is more interesting, is that hiPSC-derived cells do this more efficiently than tissue-derived cells created using OPCS.

Scientists Reveal The Enzyme Responsible for the Mutations that Cause Breast Cancer

A new study that was recently published in the journal Nature, reveals the enzyme that is considered to be responsible for the majority of DNA mutations found in breast cancer. The research, which could represent a major breakthrough for breast cancer diagnosis and treatment, was conducted by a team from the University of Minnesota, United States. Breast cancer is a type of cancer that originates from the breast tissue. While breast cancer is the most common invasive cancer in women, male breast cancer is also possible. Almost 23% of all women diagnosed with cancer suffer from a form of breast cancer.

The lead author of the paper, associate professor Reuben Harris, suggests that their discovery could lead to an improvement in diagnosis and treatment of breast cancer. In the near future, scientists could develop drugs that would have an inhibitory effect on these mutations, thus preventing them from spreading and provoking the onset of breast cancer. The enzyme that Harris and his team discovered is named APOBEC3B. The discovery was made after Harris’ team discovered that APOBEC3B and other enzymes are responsible for the protection against viruses such as HIV-1. Currently there are 7 known APOBEC3 genes. The research team led by Harris managed to quantify the expression of these enzymes, revealing that one of the enzymes, specifically APOBEC3B, is over-expressed in patients with breast cancer.

Precedent cancer studies have shown that DNA mutations are quintessential for the onset of cancer. The current study reveals that APOBEC3B is responsible for the genetic mutations of cancerous cells involved in breast cancer. However, although the enzyme protects cells from various viral infections, such as the infection with HIV-1, it is also responsible for the mutations that lead to cancer. The research team agrees that further studies are needed in order to confirm the connection between the enzyme and the onset of breast cancer. Should these studies provide enough evidence in the matter, it could lead to the possibility of breast cancer being diagnosed through a routine blood test.

Future goals of Harris’ research team include the investigation for method to block the expression of APOBEC3B in order to prevent the genetic mutations that are associated. Some of his work on HIV is already showing promise for such future drugs. According to Harris, his team is already searching for links between age, elevated levels of APOBEC3B and numerous other risk factors that are already associated with breast cancer.