Imaging reveals new results from landmark stem cell trial for stroke

Researchers led by Sean I. Savitz, MD, reported today in the journal Stem Cells that bone marrow cells used to treat ischemic stroke in an expanded Phase I trial were not only safe and feasible, but also resulted in enhanced recovery compared to a matched historical control group.

In addition, using serial diffusion tensor imaging, the repair of motor nerve tracts that extend from the brain through the spinal cord were captured for the first time in study participants, according to the team at The University of Texas Health Science Center at Houston (UTHealth).

“In the typical stroke injury, you can see the degeneration of the nerve tracts where it thins out,” said Savitz, director of the Institute for Stroke and Cerebrovascular Disease and professor of neurology with McGovern Medical School at UTHealth. “What surprised us was that after three to six months, we could see the tracts thicken up again in some patients. We do not typically see that same level of response in patients with such severe strokes but further research will be needed to determine if the return of the nerve tracts is because of the cell treatment or part of natural recovery.”

The team also reported that patients in the cell-treated group had a 1-point improvement in the Day 90 modified Rankin score, a 6-point scale considered the gold standard for rating stroke recovery and disability. The study patients were compared to a propensity score-based matched control group to estimate the improvement in effect size.

Farhaan S. Vahidy, PhD, MBBS, MPH, director of Population Health at the Institute for Stroke and Cerebrovascular Diseases and associate professor of neurology with McGovern Medical School at UTHealth, was first author of the paper and performed the analyses.

The pilot study, which began in 2009, was the first of its kind using a patient’s own bone marrow cells. Results from the first 10 patients were published in 2011 in the Annals of Neurology.

The latest paper included results from 25 patients, who received an intravenous dose of their own bone marrow cells within 72 hours after first symptoms of stroke. They were followed for one year after treatment and the results compared to a control group of 185 acute ischemic stroke patients who received conventional treatment only. No definite severe adverse events related to the procedures were seen in any of the 25 patients, the research showed.

The authors wrote that the regenerative potential of bone marrow mononuclear cells is attributed to various mechanisms that impact stroke recovery and is supported by extensive preclinical studies that Vahidy analyzed in a study published in the American Heart Association journal, Stroke, in 2016. The cells migrate to the site of injury and release proteins that decrease the inflammation hindering the healing process. Bone marrow cells are also easily amenable to autologous infusion, eliminating the need for immunosuppressive drugs.

“According to our findings, it is feasible to perform a bone marrow harvest and then infuse the cells in a wide range of stroke patients,” Savitz said. “Well-designed randomized clinical trials are needed to further assess safety and efficacy of this novel approach to enhance stroke recovery.”

The study was supported with grants from the National Institutes of Health (R21HD06098, T32NS04712), and the National Heart, Lung, and Blood Institute (N01-HB037163).

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Materials provided by University of Texas Health Science Center at Houston. Original written by Deborah Mann Lake. Note: Content may be edited for style and length.

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Child’s gluten intake during infancy, rather than mother’s during pregnancy, linked to increased risk of developing type 1 diabetes

New research presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, Spain (16-20 September) shows that a child’s intake of gluten at age 18 months is associated with a 46% increased risk of developing type 1 diabetes for each extra 10g of gluten consumed per day. There was no association found between the mother’s intake of gluten during pregnancy and type 1 diabetes in her child, conclude the authors who include Dr Nicolai Lund-Blix, Oslo University Hospital, and the Norwegian Institute of Public Health, Oslo, Norway.

A previous study from Denmark suggested that a high maternal gluten intake during pregnancy increased the risk of type 1 diabetes in the child. No studies have investigated the relation between the amount of gluten intake by both the mother during pregnancy and the child in early life and risk of developing type 1 diabetes in childhood. This new study examined the association between the maternal gluten intake during pregnancy, child’s gluten intake at age 18 months, and the risk of type 1 diabetes in the child in a Norwegian population-based nationwide study.

The study included 86,306 children in The Norwegian Mother and Child Cohort Study born from 1999 to 2009, followed up until April 2018. The outcome was clinical type 1 diabetes, ascertained in a nationwide childhood diabetes registry. Increased risk was calculated using statistical modelling for maternal gluten intake during pregnancy and child’s gluten intake at 18 months. The authors estimated the amount (g/day) of gluten intake from a semi-quantitative food frequency questionnaire at week 22 of pregnancy and from a questionnaire completed by the guardian when the child was 18 months old.

During a mean follow-up of 12.3 years, 346 children (0.4%) developed type 1 diabetes (incidence rate 32.6 per 100,000 person-years). The average gluten intake was 13.6 grams/day for mothers during pregnancy, and 8.8 grams/day for the child at 18 months of age. Maternal gluten intake in mid-pregnancy was not associated with the development of type 1 diabetes in the child. However, the child’s gluten intake at 18 months of age was associated with an increased risk of later developing type 1 diabetes, with risk increasing by 46% for each 10g per day increase in gluten intake.

The authors conclude: “This study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child. Our observations may motivate future interventional studies with reduced gluten intake to establish whether there is a true causal association between amount of gluten intake in the child’s early diet and type 1 diabetes in susceptible individuals.”

The authors discuss some possible reasons for the findings, saying: “There is some evidence that gluten intake may influence the gut microbiota and induce inflammation in so-called ‘leaky gut’ (increased absorption of dietary antigens and/or gut infections). These are plausible mechanisms, but the exact mechanism explaining our findings is not known. If anything, we believe that gluten works in combination with another environmental factors such as virus infections in predisposed children.”

In this Norwegian study, the main sources of gluten in the diet are cereal and bread. However, at this stage the authors say their study, together with existing evidence, is not enough to encourage people to avoid or reduce gluten intake.

They say: “We need confirmation from further studies, and ideally a randomised controlled trial (RCT) to determine any relationship between gluten intake and type 1 diabetes with certainty. Since our findings show the highest risk of developing T1D is in the group with the highest gluten consumption, it could be that simply reducing gluten intake would be enough to reduce risk and this is easier to achieve than complete avoidance. Based on experiences from patients with celiac disease, complete avoidance of gluten is hard but manageable, but this would probably not be necessary..”

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Materials provided by Diabetologia. Note: Content may be edited for style and length.

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Boris Johnson ‘glad’ about new father’s NHS confrontation

Boris Johnson says an angry exchange with the father of a sick child is “part of my job”.

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Vaginal birth and Caesarean: Differences in babies’ bacteria

New findings may help explain why some Caesarean babies are more at risk of certain diseases.

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Women Feel Better About Their Bodies Than They Used To

Though women are still more dissatisfied than men when it comes to their size, a new study reveals that women’s views of their bodies are softening over the years.

The study, presented Friday at the American Psychological Association’s 124th Annual Convention, researchers found that women’s feelings about how thin they are have improved significantly over time. Looking at data from more than 100,000 men and women over 31 years, they found that from 1981 to 2011, on average women’s dissatisfaction dropped 3.3 points.

Though the change may seem small, study author Bryan Karazsia, an associate professor of psychology at The College of Wooster, says that statistically the drop is “substantial.” The researchers also looked at data from over 23,800 men and women over 14 years who were asked about their satisfaction with their muscular build. Men were more likely than women to report feeling dissatisfied with their muscles and that trend remained stable over time.

“If you walk into a store and see mens mannequins, they are really large,” says Karazsia, speculating why the opinion has remained unchanged for men. “Men just don’t look like that.”

What might be responsible for women’s drop in body criticisms? The researchers don’t know for sure, but they have a few theories. One is that Americans in general are getting larger. More than two-thirds of adults are overweight or obese, and Karazsia says “because people are larger, people are seeing what’s around them and feel more normal and less concerned.”

It’s also possible that the depictions of women in media are changing. Karazsia cites the popularity of ads by Dove, a company known for soap and deodorant, which feature women of all different body sizes and races. “You are seeing more images in the media of body diversity,” says Karazsia. “As those ideals are shifting, I think people are becoming a little more critical of the extreme images they see and the media is embracing [the idea] that bodies of all shapes and sizes can still sell products.”

There is also a possibility that a new body ideal is replacing women’s desire to be thin. Though the researchers didn’t look at the trend specifically, Karazsia said colleagues wondered whether a trend toward being lean and toned rather than thin also had a role.

“I am optimistic that [this study] is good news,” says Karazsia. “I am a dad of young girls so when I saw these findings I thought it was hopeful.”

 

This article originally appeared on Time.com.

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Teens Are ‘Juuling’ At School. Here’s What That Means

The most popular product in the booming e-cigarette market doesn’t look like a cigarette at all.

The Juul, a trendy vape that resembles a flash drive and can be charged in a laptop’s USB port, accounted for 33% of the e-cigarette market as of late 2017, according to Wells Fargo data. The product is made for and legally available only to adults 18 and older, and its “growth appears to be due to growth with the 18 to 24 year old age group,” according to a Wells Fargo report.

But in many cases, media reports suggest, these devices are being used by kids and teenagers even younger than that — which has some parents, educators and medical professionals concerned. Each Juul cartridge—which lasts about 200 puffs—has as much nicotine as an entire pack of cigarettes. Here’s what to know about “Juuling,” the trend sweeping schools nationwide.

What do parents need to know about Juuling?

Although Juul products, like most e-cigarettes, are made and marketed as smoking alternatives, the device is increasingly popping up on high school and college campuses. The term “Juuling” usually refers to this recreational use.

Because of their sleek design and resemblance to USB drives, Juul products are easy for students to conceal and use in school — sometimes even in the middle of class. (Juuls also produce less smoke than many similar devices, making them even more discreet.) The problem has grown widespread enough that school districts in states including Kentucky, Wisconsin, California and Massachusetts have voiced their concerns and, in some cases, begun amending school policy to address the issue. Some college publications, including those at New York University and the University of Illinois, have also reported on the trend.

Ashley Gould, chief administrative officer at Juul Labs, says that the product was created by two former smokers specifically and solely to help adult smokers quit, and that the company has numerous anti-youth-use initiatives in place because “we really don’t want kids using our product.” Gould also notes that Juul uses age authentication systems to sell only to adults 21 and older online, though most of its sales take place in retail stores, where state laws may allow anyone 18 and older to purchase the devices.

The design, she adds, was not meant to make the device easier to hide.

“It was absolutely not made to look like a USB port. It was absolutely not made to look discreet, for kids to hide them in school,” Gould says. “It was made to not look like a cigarette, because when smokers stop they don’t want to be reminded of cigarettes.”

Are e-cigs safe?

While e-cigarettes contain fewer toxic substances than traditional cigarettes, the CDC warns that vaping may still expose people to cancer-causing chemicals. (Different brands use different formulations, and the CDC’s warning did not mention Juul specifically.)

It’s not clear exactly how e-cigarettes affect health because there’s little long-term data on the topic, says Dr. Michael Ong, an associate professor of general internal medicine and health services at the David Geffen School of Medicine at the University of California Los Angeles. “We just don’t have a lot of information as to what the harms potentially are going to be,” he says. “There likely would be health risks associated with it, though they’re not going to be the same as a traditional cigarette.”

Doctors do know, however, that each Juul pod contains nicotine equivalent to a pack of cigarettes. That’s troubling, because nicotine is “one of the most addicting substances that we know of,” Ong says. “Having access to that is certainly problematic,” Ong adds, because it may get kids hooked, which could potentially lead them to later take up cigarettes.

Juul’s products come in flavors including mango, fruit medley and creme brûlée — and the chemicals used to flavor vaping liquid may also be dangerous, Ong adds. “Even if the manufacturer doesn’t intend it to be something that’s kid-friendly, it’s kid-friendly,” he says. A 2016 study suggested that these flavoring agents may also cause popcorn lung, a respiratory condition first seen in people working in factories that make microwave popcorn.

Does Juuling help you quit smoking?

It’s not yet clear. Gould acknowledges that Juul doesn’t have great end-user data since its products are mostly sold in retail stores, but she says the company is actively researching the effectiveness of its devices.

Research about the efficacy of nicotine replacement therapy using tools such as e-cigarettes and nicotine gum is relatively inconclusive. A new study published in the Annals of Internal Medicine even found that smokers trying to quit may actually have less success if they use e-cigarettes.

“The literature has suggested that when you have nicotine replacement therapies, they work best if [people are] being advised by a professional,” Ong says. “When we provide things over the counter, we don’t see the benefits of cessation that we would have expected by making it widely available, and that’s probably the reason why: because people aren’t actually getting professional help.”

Correction: The original version of this story misstated the legal purchasing age for Juul. It is 18 in some states, not 21. The original version of this story also misstated Juul’s marketing strategy. The product is marketed as a smoking alternative, not a smoking cessation tool.

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Health24.com | Can sugar really weaken your immune system?

Reducing your sugar intake is a major struggle – and quitting it altogether is even harder. Most of us wouldn’t be able to go even a day without sugar, one of the reasons being that 74% of processed foods contain hidden sugars.

Brands that claim their products contain “zero refined sugar” are simply referring to the absence of white sugar. We need to know that ingredients ending in “-ose”, like glucose, fructose and sucrose are also sugar units and only have subtle differences in the way they’re digested and absorbed.  

There are, however, ways to reduce your daily intake without going cold turkey.

Read: I gave up sugar for 14 days and this is what happened

Sugar in its different forms

A previous Health24 article explains that sugar is a simple carbohydrate and comes in many different forms. In its simplest form, it is called a monosaccharide, which includes:

  • Glucose (occurs naturally in fruits and plant juices)
  • Fructose (occurs naturally in fruits, some root vegetables, cane sugar and honey)
  • Galactose (combines with glucose to form lactose) 

While consuming a small amount of sugar every day isn’t going to kill you, consuming too much added sugar puts you at risk for some deadly diseases. The World Health Organization (WHO) recommends that a person’s added sugar consumption per day should be no more than 10% of their total daily caloric intake. 

Can a sugar-overload crash your immune system?

But, apart from leading to, among other things, weight gain, blood sugar problems and an increased risk of heart disease, could the “root of all (nutritional) evil” also have an effect on your immunity? 

There is a widespread belief that sugar weakens the immune system, mainly based on a 1970s study where people donated blood before and after consuming large amounts of sugar. The researchers found that after a large dose of sugar, certain white blood cells (neutrophils) were less aggressive in destroying bacteria.

However, this belief is built on a shaky foundation as the study was never replicated or expounded. Nutritionist Monica Reinagel notes that while eating sugar may put your white blood cells into a temporary coma, it’s a little more complicated than that:

“To look at a petri dish full of neutrophils in a sugar-induced coma and say that ‘eating sugar suppresses immune response’ is a bit of an over-simplification,” she said.

A more recent study done on mice showed that an overconsumption of sugar and its effects on your immune system is dependent on the type of bug you’re fighting. While the consumption of sugar seemed to aid the mice in recovering from viral infections, it was unsuccessful in fighting bacterial infections.

Is it really worth it?

The bottom line is that, apart from the above risks, we are already aware of so many other downsides of consuming excessive sugar. According to Men’s Health, sugar can:

  • Double your risk of heart disease
  • Lead to obesity
  • Cause kidney stones
  • Cause tooth decay

The best advice is therefore to severely limit your added sugar intake. We also need to beware of “healthy” sugar substitutes such as honey and maple syrup, as the calories they contain are essentially the same as in sugar.

Image: iStock

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The information on Health24 is for educational purposes only, and is not intended as medical advice, diagnosis or treatment. If you are experiencing symptoms or need health advice, please consult a healthcare professional. See additional information.

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Health24.com | Even dolphins are threatened by antibiotic-resistant ‘superbugs’

Scientists have found one more way Flipper is a lot like people: The sharp rise in antibiotic resistance affecting humans is also happening to dolphins.

The discovery stems from a 13-year study of bottlenose dolphins in Florida’s Indian River Lagoon.

A ‘toxic cocktail’ of chemicals

“We’ve been able to provide a large database of information in order to continue learning from these impressive animals,” said Gregory Bossart, senior vice president and chief veterinary officer at the Georgia Aquarium, one of four partners in the new study.

The research, published in the journal Aquatic Mammals, follows a report last week that bottlenose dolphins in the English Channel harbour “a toxic cocktail” of chemicals, including some that have been banned for decades.

For the latest study, the researchers analysed antibiotic resistance in 733 samples of bacteria collected between 2003 and 2015 from 171 bottlenose dolphins in the lagoon on Florida’s eastern coast. Some of the bacteria are also a threat to humans.

In all, over 88% were resistant to at least one antibiotic, the researchers found. Resistance was highest to erythromycin (nearly 92%), followed by ampicillin (77%) and cephalothin (about 62%).

Similar to trends in people, resistance to ciprofloxacin among E. coli samples more than doubled during the study.

And rates of resistance in Pseudomonas aeruginosa – a cause of respiratory and urinary infections in people – were the highest recorded for any organism and increased over the period, the findings showed.

One of the biggest public health challenges

The researchers also reported significant increases in antibiotic resistance in Vibrio alginolyticus, a common marine bacterium that causes serious seafood poisoning.

Lead author Adam Schaefer said, “In 2009, we reported a high prevalence of antibiotic resistance in wild dolphins, which was unexpected. Since then, we have been tracking changes over time and have found a significant increase in antibiotic resistance in isolates from these animals.”

Schaefer is an epidemiologist at Florida Atlantic University (FAU) Harbor Branch Oceanographic Institute, in Boca Raton.

“Based on our findings, it is likely that these isolates from dolphins originated from a source where antibiotics are regularly used, potentially entering the marine environment through human activities or discharges from terrestrial sources,” he added in a FAU news release.

Antibiotic resistance is one of the biggest public health challenges worldwide. At least two million people a year in the United States get an antibiotic-resistant infection, and at least 23 000 of them die.

Few studies have examined long-term trends in antibiotic resistance in wildlife, according to the researchers.

In a separate study, published in the journal Scientific Reports, Belgian and French scientists reported high concentrations of industrial fluids and mercury in dolphins found off the northwest coast of France.

Many of the chemicals, including PCBs, have been banned since the 1970s and 1980s, but persist in the environment, where they can pass through the food chain, the researchers said.

Image credit: iStock

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Can you turn around the health of an entire town?

Three years on, how is a project aimed at transforming the health of people in Fleetwood faring?

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