Archive for July 26th, 2012

MRSA cases in academic hospitals double in five years


ScienceDaily (July 26, 2012) — Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) doubled at academic medical centers in the U.S. between 2003 and 2008, according to a report published in the August issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

Researchers from the University of Chicago Medicine and the University HealthSystem Consortium (UHC) estimate hospitalizations increased from about 21 out of every 1,000 patients hospitalized in 2003 to about 42 out of every 1,000 in 2008, or almost 1 in 20 inpatients. “The rapid increase means that the number of people hospitalized with recorded MRSA infections exceeded the number hospitalized with AIDS and influenza combined in each of the last three years of the survey: 2006, 2007, and 2008,” said Michael David, MD, PhD, an assistant professor of medicine at the University of Chicago and one of the study’s authors.

The findings run counter to a recent CDC study that found MRSA cases in hospitals were declining. The CDC study looked only at cases of invasive MRSA — infections found in the blood, spinal fluid, or deep tissue. It excluded infections of the skin, which the UHC study includes.

MRSA infections, which cannot be treated with antibiotics related to penicillin, have become common since the late 1990s. These infections can affect any part of the body, including the skin, blood stream, joints, bones, and lungs.

The researchers attribute much of the overall increase they detected to community-associated infections — those that were contracted outside the healthcare setting. When MRSA first emerged it was primarily contracted in hospitals or nursing homes. “Community-associated MRSA infections, first described in 1998, have increased in prevalence greatly in the U.S. in the last decade,” David said. “Meanwhile, healthcare-associated strains have generally been declining.”

The study utilized the UHC database, which includes data from 90 percent of all not-for-profit academic medical centers in the U.S. However, like many such databases, the UHC data are based on billing codes hospitals submit to insurance companies, which often underestimate MRSA cases. For example, hospitals might not report MRSA cases that do not affect insurance reimbursement for that particular patient. In other cases, hospitals might be limited in the number of billing codes they can submit for each patient, which can result in a MRSA code being left off the billing report if it was not among the primary diagnoses.

David and his team corrected for these errors by using detailed patient observations from the University of Chicago Medical Center and three other hospitals. They looked at patient records to find the actual number of MRSA cases in each hospital over a three-year period. The team then checked the insurance billing data to see how many of those cases were actually recorded. They found that the billing data missed one-third to one-half of actual MRSA cases at the four hospitals. They used that rate of error as a proxy to correct the billing data from other 420 hospitals in the UHC database and arrive at the final estimates.

“I think this is still an underestimate of actual cases,” David said. “But we can say with some assurance that this correction gives us a more accurate lower bound for how many cases [of MRSA] there actually are. What’s clear from our data is that cases were on the rise in academic hospitals in 2003 to 2008.”

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Journal Reference:

  1. Michael Z. David, Sofia Medvedev, Samuel F. Hohmann, Bernard Ewigman, Robert S. Daum. Increasing Burden of Methicillin-Resistant Staphylococcus aureus Hospitalizations at US Academic Medical Centers, 2003? Infection Control and Hospital Epidemiology, August 2012 [link]

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Efficacy of transcranial magnetic stimulation for depression confirmed in new study


ScienceDaily (July 26, 2012) — In one of the first studies to look at transcranial magnetic stimulation (TMS) in real-world clinical practice settings, researchers at Butler Hospital, along with colleagues across the U.S., confirmed that TMS is an effective treatment for patients with depression who are unable to find symptom relief through antidepressant medications. The study findings are published online in the June 11, 2012 edition of Depression and Anxiety in the Wiley Online Library.

Previous analysis of the efficacy of TMS has been provided through more than 30 published trials, yielding generally consistent results supporting the use of TMS to treat depression when medications aren’t sufficient. “Those previous studies were key in laying the groundwork for the FDA to approve the first device for delivery of TMS as a treatment for depression in 2008,” said Linda Carpenter, MD, lead author of the report and chief of the Mood Disorders Program and the Neuromodulation Clinic at Butler Hospital. “Naturalistic studies like ours, which provide scrutiny of real-life patient outcomes when TMS therapy is given in actual clinical practice settings, are the next step in further understanding the effectiveness of TMS. They are also important for informing healthcare policy, particularly in an era when difficult decisions must be made about allocation of scarce resources.”

Carpenter explains that naturalistic studies differ from controlled clinical trials because they permit the inclusion of subjects with a wider range of symptomatology and comorbidity, whereas controlled clinical trials typically have more rigid criteria for inclusion. “As a multisite study collecting naturalistic outcomes from patients in clinics in various regions in the U.S., we were also able to capture effects that might arise from introducing a novel psychiatric treatment modality like TMS in non-research settings,” said Carpenter. In all, the study confirms how well TMS works in diverse settings where TMS is administered to a real-life population of patients with depression that have not found relief through many other available treatments.

The published report summarized data collected from 42 clinical TMS practice sites in the US, and included outcomes from 307 patients with Major Depressive Disorder (MDD) who had persistent symptoms despite the use of antidepressant medication. Change during TMS was assessed using both clinicians’ ratings of overall depression severity and scores on patient self-report depression scales, which require the patient to rate the severity of each symptom on the same standardized scale at the end of each 2-week period. Rates for “response” and “remission” to TMS were calculated based on the same cut-off scores and conventions used for other clinical trials of antidepressant treatments. Fifty-eight percent positive response rate to TMS and 37 percent remission rate were observed.

“The patient outcomes we found in this study demonstrated a response rate similar to controlled clinical trial populations,” said Dr. Carpenter, explaining that this new data validates TMS efficacy in treating depression for those who have failed to benefit from antidepressant medications. “Continued research and confirmation of the effectiveness of TMS is important for understanding its place in everyday psychiatric care and to support advocacy for insurance coverage of the treatment.” Thanks in part to the advocacy efforts of Dr. Carpenter, TMS was recently approved for coverage by Medicare in New England, and it is also now covered by BCBSRI. “Next steps for TMS research involve enhancing our understanding of how to maintain positive response to TMS over time after the course of therapy ends and learning how to customize the treatment for patients using newer technologies, so TMS can help even more patients.”

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The above story is reprinted from materials provided by Women & Infants Hospital, via EurekAlert!, a service of AAAS.

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Do ovaries continue to produce eggs during adulthood?


ScienceDaily (July 26, 2012) — A compelling new genetic study tracing the origins of immature egg cells, or ‘oocytes’, from the embryonic period throughout adulthood adds new information to a growing controversy. The notion of a “biological clock” in women arises from the fact that oocytes progressively decline in number as females get older, along with a decades-old dogmatic view that oocytes cannot be renewed in mammals after birth.

After careful assessment of data from a recent study published in PLoS Genetics, scientists from Massachusetts General Hospital and the University of Edinburgh argue that the findings support formation of new eggs during adult life; a topic that has been historically controversial and has sparked considerable debate in recent years.

Eggs are formed from progenitor germ cells that exit the mitotic cycle, thereby ending their ability to proliferate through cell division, and subsequently enter meiosis, a process unique to the formation of eggs and sperm which removes one half of the genetic material from each type of cell prior to fertilization.

While traditional thinking has held that female mammals are born with all of the eggs they will ever have, newer research has demonstrated that adult mouse and human ovaries contain a rare population of progenitor germ cells called oogonial stem cells capable of dividing and generating new oocytes. Using a powerful new genetic tool that traces the number of divisions a cell has undergone with age (its ‘depth’) Shapiro and colleagues counted the number of times progenitor germ cells divided before becoming oocytes; their study was published in PLoS Genetics in February this year.

If traditional thinking held true, all divisions would have occurred prior to birth, and thus all oocytes would exhibit the same depth regardless of age. However, the opposite was found — eggs showed a progressive increase in depth as the female mice grew older.

In their assessment of the work by Shapiro and colleagues — published recently in a PLoS Genetics Perspective article — reproductive biologists Dori Woods, Evelyn Telfer and Jonathan Tilly conclude that the most plausible explanation for these findings is that progenitor germ cells in ovaries continue to divide throughout reproductive life, resulting in production of new oocytes with greater depth as animals age.

Although these investigations were performed in mice, there is emerging evidence that oogonial stem cells are also present in the ovaries of reproductive-age women, and these cells possess the capacity, like their mouse counterparts, to generate new oocytes under certain experimental conditions. While more work is needed to settle the debate over the significance of oocyte renewal in adult mammals, Woods and colleagues emphasize that “the recent work of Shapiro and colleagues is one of the first reports to offer experimental data consistent with a role for postnatal oocyte renewal in contributing to the reserve of ovarian follicles available for use in adult females as they age.”

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Journal Reference:

  1. Woods DC, Telfer EE, Tilly JL. Oocyte Family Trees: Old Branches or New Stems? PLOS Genet, 2012 DOI: 10.1371/journal.pgen.1002848

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Modeling of new enzymes helps develop therapies for cocaine abuse


ScienceDaily (July 26, 2012) — Researchers from the University of Kentucky have designed and discovered a series of highly efficient enzymes that effectively metabolize cocaine. These high-activity cocaine-metabolizing enzymes could potentially prevent cocaine from producing physiological effects, and could aid in the treatment of drug dependency.

The results of this study by Chang-Guo Zhan et al are published in the journal PLOS Computational Biology.

The effectiveness of the enzymes’ work was evaluated through modeling cocaine pharmacokinetics, the study of the body’s action on administered external substances, such as cocaine, when the enzyme exists in the body. As there is no FDA-approved anti-cocaine medication, the medical and social consequences of cocaine abuse have made the development of anti-cocaine medication a high priority.

Administration of an enzyme to enhance cocaine metabolism has been recognized as a promising treatment strategy for overdose and abuse. A remarkable feature of the enzyme-based therapeutic approach is that one enzyme molecule can degrade many thousands of drug molecules per minute.

This pharmacokinetic modelling is a crucial step of enzyme-based therapy development for cocaine abuse. Furthermore, the general insights of the research should also be valuable for future development of an enzyme therapy for any addictive drug, as the general methodology of the modelling may be used to develop valuable models for evaluating the effectiveness of metabolic enzymes in detoxifying other drugs.

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Journal Reference:

  1. Zheng F, Zhan C-G. Modeling of Pharmacokinetics of Cocaine in Human Reveals the Feasibility for Development of Enzyme Therapies for Drugs of Abuse. PLoS Comput Biol, 2012 DOI: 10.1371/journal.pcbi.1002610

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Decoding the secrets of balance


ScienceDaily (July 26, 2012) — If you have ever looked over the edge of a cliff and felt dizzy, you understand the challenges faced by people who suffer from symptoms of vestibular dysfunction such as vertigo and dizziness. There are over 70 million of them in North America. For people with vestibular loss, performing basic daily living activities that we take for granted (e.g. dressing, eating, getting in and out of bed, getting around inside as well as outside the home) becomes difficult since even small head movements are accompanied by dizziness and the risk of falling.

We’ve known for a while that a sensory system in the inner ear (the vestibular system) is responsible for helping us keep our balance by giving us a stable visual field as we move around. And while researchers have already developed a basic understanding of how the brain constructs our perceptions of ourselves in motion, until now no one has understood the crucial step by which the neurons in the brain select the information needed to keep us in balance.

The way that the brain takes in and decodes information sent by neurons in the inner ear is complex. The peripheral vestibular sensory neurons in the inner ear take in the time varying acceleration and velocity stimuli caused by our movement in the outside world (such as those experienced while riding in a car that moves from a stationary position to 50 km per hour). These neurons transmit detailed information about these stimuli to the brain (i.e. information that allows one to reconstruct how these stimuli vary over time) in the form of nerve impulses.

Scientists had previously believed that the brain decoded this information linearly and therefore actually attempted to reconstruct the time course of velocity and acceleration stimuli. But by combining electrophysiological and computational approaches, Kathleen Cullen and Maurice Chacron, two professors in McGill University’s Department of Physiology, have been able to show for the first time that the neurons in the vestibular nuclei in the brain instead decode incoming information nonlinearly as they respond preferentially to unexpected, sudden changes in stimuli.

It is known that representations of the outside world change at each stage in this sensory pathway. For example, in the visual system neurons located closer to the periphery of the sensory system (e.g. ganglion cells in the retina) tend to respond to a wide range of sensory stimuli (a “dense” code), whereas central neurons (e.g. in the primary visual cortex at the back of the head tend to respond much more selectively (a “sparse” code). Chacron and Cullen have discovered that the selective transmission of vestibular information they were able to document for the first time occurs as early as the first synapse in the brain. “We were able to show that the brain has developed this very sophisticated computational strategy to represent sudden changes in movement in order to generate quick accurate responses and maintain balance,” explained Prof. Cullen. “I keep describing it as elegant, because that’s really how it strikes me.”

This kind of selectivity in response is important for everyday life, since it enhances the brain’s perception of sudden changes in body posture. So that if you step off an unseen curb, within milliseconds, your brain has both received the essential information and performed the sophisticated computation needed to help you readjust your position. This discovery is expected to apply to other sensory systems and eventually to the development of better treatments for patients who suffer from vertigo, dizziness, and disorientation during their daily activities. It should also lead to treatments that will help alleviate the symptoms that accompany motion and/or space sickness produced in more challenging environments.

The research was conducted by Corentin Massot a Postdoctoral fellow in the Department of Physiology, and Adam Schneider a Ph.D. Student in the Department of Physics.

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Journal Reference:

  1. Corentin Massot, Adam D. Schneider, Maurice J. Chacron, Kathleen E. Cullen. The Vestibular System Implements a Linear–Nonlinear Transformation In Order to Encode Self-Motion. PLoS Biology, 2012; 10 (7): e1001365 DOI: 10.1371/journal.pbio.1001365

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Light At Night Damage May Be Reversed


Editor’s Choice
Main Category: Depression
Also Included In: Psychology / Psychiatry;  Neurology / Neuroscience
Article Date: 26 Jul 2012 – 10:00 PDT

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A new study, published online in the journal Molecular Psychiatry, has revealed that although chronic exposure to dim light at night can lead to depressive symptoms in rodents, the symptoms are reversible by simply switching back to a normal light-dark cycle.

Researchers found that hamsters that were exposed to 4 weeks of light during the dark cycle at night displayed symptoms of depression, which disappeared around two weeks, after switching back to a normal day and night cycle. The researchers noted that changes in the hamsters brain, which occurred during the chronic light period, also reversed when they returned to a normal light cycle.

Leading researcher, Tracy Bedrosian, a doctoral student in neuroscience at Ohio State University, says that these study results add to existing evidence that chronic exposure to artificial light at night may have an influence on the growing rates of depression in humans during the past 5 centuries, adding: “The results we found in hamsters are consistent with what we know about depression in humans.”

The new study also offers some hope for those suffering from depression.

Bedrosian explained:

“The good news is that people who stay up late in front of the television and computer may be able to undo some of the harmful effects just by going back to a regular light-dark cycle and minimizing their exposure to artificial light at night. That’s what the results we found in hamsters would suggest.”

The study was a collaboration of Bedrosian, Zachary Weil, research assistant professor in neuroscience and Randy Nelson, professor of neuroscience and psychology, whose lab conducted previous studies in which he linked chronic exposure to light at night to depression and obesity in animal models.

The team discovered that one particular protein called tumor necrosis factor (TNF) that is present in the brain of hamsters, which is also present in humans, may play a key part in exposure to light at night can lead to depression. By blocking this protein, the team managed to prevent the hamsters from developing depressive-like symptoms – even when they were exposed to light at night.

The researchers conducted two experiments with female Siberian hamsters – with surgically removed ovaries – to ensure that the results were not distorted due to the production of hormones.

The first experiment exposed half of the hamsters to eight weeks in a standard light-dark cycle of 16 hours of light (150 lux) and 8 hours of total darkness each day, whilst the other hamsters were kept in 16 hours of daylight and 8 hours of dim light, i.e. 5 lux, for the first four weeks, which is similar to an on-switched television in a darkened room.

After eight weeks, the hamsters were returned to live under normal light cycle conditions for a period of either 1,2 or 4 weeks before testing began.

The animals were subsequently subjected to various behavior tests, which showed that hamsters exposed to chronic dim light at night were less active overall during their active period each day than those in standard lighting conditions.

The animals that experienced the dim light also displayed greater depressive symptoms compared with the other hamsters, which was observed by showing less interest in drinking sugar water they usually enjoy. However, the team observed that within two weeks of returning to a normal light cycle, the depressive-like symptoms in those in the dim light group were no different than that in hamsters that always had standard lighting and that the animals regained their normal levels of activity. The animals were sacrificed after the behavioral test and the researchers examined the animals’ hippocampus, the region in the brain that plays a key role in depressive disorders. The team discovered that the hippocampus of those that were exposed to dim light displayed various changed linked to depression, one of which was an increased expression of the gene that produces TNF.

TNF is a chemical messenger, which is activated during an injury or infection. It belongs to a large family of proteins called cytokines, which cause inflammation in an effort to repair the body’s injured or infected site. However, when the inflammation is constant it can be damaging, as seen in the hamsters that were exposed to dim light at night.

Nelson, who is a member of Ohio State’s Institute for Behavioral Medicine Research stated: “Researchers have found a strong association in people between chronic inflammation and depression. That’s why it is very significant that we found this relationship between dim light at night and increased expression of TNF.”

The team also discovered that hamsters in the dim light group had a considerably reduced density of dendritic spines, i.e. hair like growths on brain cells that transmit chemical messages between cells. Bedrosian stated that changes such as this have been associated with depression.

The team did discover though that in hamsters that were returned to a regular light-dark cycle after four weeks of dim light during the night were able to restore their TNF levels and even their density of dendritic spines to essentially normal levels.

Bedrosian commented: “Changes in dendritic spines can happen very rapidly in response to environmental factors.”

The second experiment involved testing TNFs importance in causing the negative effects those hamsters that were exposed to light at night. Some hamsters received a drug named XPro1595, a TNF inhibitor that negates the effects of some forms of TNF in the brain. The results demonstrated that those in the dim light group displayed no more depressive-like symptoms than standard-light hamsters if they were given XPro1595. The team points out that the drug was not able to prevent the reduction of dendritic spine density in those exposed to dim light.

Nelson concludes that these results add to existing evidence of TNFs potential role in causing depressive symptoms in hamsters exposed to dim light. He continues saying that the fact that XPro1595 did not affect dendritic spine density means that more research is necessary to gain further insight into the workings of TNF.

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Anxiety More Common in the Western World, Depression in East


Depression and anxiety affects evend society in the world, according to what is believed to be the world’s most comprehensive study of these mental disorders, conducted by researchers from the University of Queensland, Australia.ry country a

The researchers carried out two separate studies that focused on anxiety disorders and major depressive disorder (also called clinical depression). Researchers analyzed surveys of clinical anxiety and depression that had been conducted across 91 countries, involving more than 480,000 people.Anxiety More Common in the Western World, Depression in East

In Western societies, anxiety disorders were more commonly reported than in non-Western societies, including countries that are currently experiencing conflict.

About 10 percent of people in North America, Western Europe, Australia and New Zealand were experiencing clinical anxiety compared to approximately eight percent in the Middle East and six percent in Asia.

The opposite was true for depression, with those in Western countries least likely to feel depressed. Researchers found that depression was the lowest in North America and highest in certain areas of Asia and the Middle East.

Approximately nine percent of people experience major depression in Asian and Middle Eastern countries, such as India and Afghanistan, compared with about four percent in North and South America, Australia, New Zealand and East Asian countries including China, Thailand and Indonesia.

Study co-author Alize Ferrari said that the findings suggest that depression may be more common in parts of the world where conflict is occurring.  However, she emphasizes that it can be a difficult task to get hold of good quality data from low and middle income countries.

Amanda Baxter, who led the study, also added that researchers should use caution when comparing mental disorders across different societies and countries.

“Measuring mental disorders across different cultures is challenging because many factors can influence the reported prevalence of anxiety disorders,” said Baxter.

Source: The University of Queensland 

Person holding head with one hand photo by shutterstock.

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