Thursday, January 2, 2014

Hydrocephalus: sensors monitor cerebral pressure

If the pressure in a patient's brain is too high, physicians implant a system in the head that regulates the pressure. A sensor can now measure and individually adjust brain pressure. The sensor system is approved for use as a long-term implant.

Urinary incontinence, a shuffling gait, and deteriorating reasoning skills are all indicators pointing to a Parkinsonian or Alzheimer type disease. An equally plausible explanation is hydrocephalus, commonly known as "water on the brain." With this diagnosis, the brain produces either too much cerebral fluid, or it cannot "drain off" these fluids with adequate sufficiency. The consequence: Pressure in the brain rises sharply, resulting in damage. A shunt system – a kind of silicon tube that physicians into the patient's brain, provides relief. It draws off superfluous fluid from there, for example, into the abdominal cavity. The heart of this shunt system is a valve: If the pressure increases above a threshold value, then the valve opens; if it declines again, then the valve closes.
In rare cases, over-drainage may occur. The cerebral pressure lowers too much, the cerebral ventricles are virtually squeezed out. Until now, physicians could only detect and verify such over-drainage through elaborate and costly computer and magnetic resonance tomography.

Cerebral pressure measurable anytime
With a new kind of sensor, things are different: If it is implanted into the patient's brain with the shunt system, the physicians could read out brain pressure using a hand-held meter: within seconds, anytime and without complex investigation. Researchers at the Fraunhofer Institute for Microelectronic Circuits and Systems IMS in Duisburg, working jointly with Christoph Miethke GmbH and Aesculap AG, engineered these .

If the patient complains of discomfort, then the physician merely needs to place the hand- held meter outside, on the patient's head. The device sends magnetic radio waves and supplies the sensor in the shunt with power- the implant is "awakened," measures tem- perature and pressure in the cerebral fluid, and transmits these data back to the handheld device. If the pressure on the outside of the desired area, the physician can set the valve on the shunt system from the outside as needed, and individually adjusted to the patient. "The sensor is an active implant, which also takes over measurement functions, in contrast to a stent or a tooth implant," says Michael Görtz, head of pressure sensor technology at IMS.

The implant must be biocompatible; the body cannot reject it. Researchers had to ensure that the body also would not attack the implant. "The defense response behaves just like an aggressive medium, that would even dilute the silicon of the electronics over the course of time," explains Görtz. Miethke therefore completely encases the implant into a thin metal casing. "We can still supply it with power from the outside through the metal casing, measure cerebral pressure through the housing and transmit the recorded data outside, through the metal to the reader," Görtz explains. To do so, the correct metal had to be found. The coating may not be thicker than the walls of a soft drink can – in other words, much thinner than one millimeter. The researchers even developed the handheld reading device, together with the electronics, through which it communicates with the sensor.

The sensor is ready for serial production, and was already approved by Miethke. The company has already initiated the market launch of the system. "The sensor sets the basis for the further development through to theranostic implants – a neologism derived from the words "therapy" and "diagnostic." In a few years, the sensor could then not only record cerebral pressure and develop a diagnosis on the basis of this, but also properly adjust the pressure independently, immediately on its own and thus, take over the therapy process," says Görtz.

Monday, December 23, 2013

Can a Father's Diet Affect His Newborn's Health?

Can a Father's Diet Affect His Newborn's Health?
Fathers, like mothers, might need to watch their folic acid levels.
We've known for a long time that women who do not get enough folic acid in their diets from the very first weeks of pregnancy are at increased risk of having children with birth defects of the brain and spine, including spina bifida.

Now, however, comes the surprising news that low folic acid levels in fathers can also increase the risk. This isn't actually new; the link has been known for a while. But it's been hard to understand how this could work.
Mothers provide the environment for the developing fetus, including not only the roof over its head, so to speak, but the complex bath of chemicals in which it swims during pregnancy. It makes sense that altering that chemical soup—with a deficiency of folic acid, for example—would have consequences for the fetus. But the father's only direct connection with the fetus is a single tiny sperm cell. How could his diet have anything to do with the fetus?

In a new study in the journal Nature Communications, researchers at McGill University in Montreal say they've found a possible explanation. Diet can't alter the DNA in the sperm, but it can alter something else, leaving a telltale signature that can disrupt proceedings weeks later in the womb.

A man's diet, it turns out, alters the epigenetics of his sperm. The genes in the sperm carry all the hereditary characteristics that we're familiar with—eye color, height, and so forth. But the proper operation of those genes requires that they be turned on or off appropriately. Epigenetic markings are small molecules that can attach to genes and control whether or not they are turned on.

The McGill researchers now suggest that the link between fathers' folic acid levels and their children's risk of birth defects might be a consequence of diet altering these epigenetic markings in his sperm.

Does this mean men contemplating having children should take folic acid supplements? There’s no way yet to know. Researchers must do more work to establish with certainty what is going on, and at this point they have no way of predicting how much folic acid is enough to reduce the risk—if, indeed, further studies prove that the risk is real.

Nevertheless, the study is yet one more examples of how important fathers are in the lives of their children--often in ways, such as this, that no one could have predicted. This one came out too late for inclusion in my book Do Fathers Matter? What Science is Telling Us About the Parent We’ve Overlooked, (due out for Fathers Day, 2014), but you will see many similar studies there, including a more complete explanation of epigenetics and its role in many aspects of children’s health.

This is perhaps one of the most exciting new areas of research regarding fathers, and I’m following it closely and will be blogging on it here in the weeks and months to come.

CDC report shows danger at Camp Lejeune

The horror of Camp Lejeune, already one of the worst cases of drinking water contamination in American history, continues to grow. So does the shame of the U.S. Marine Corps.

Last week, the U.S. Centers for Disease Control and Prevention confirmed a long-suspected link between toxic chemicals in drinking water at the base and an increased risk of birth defects and childhood cancer.
The contamination stretches back decades, with exposure ending in 1987, when the Marine Corps closed the last of contaminated wells at the base.

Based on a survey of the parents of more than 12,000 children born at Lejeune between 1968 and 1985, the CDC concluded that pregnant women who drank tap water at the base were four times more likely to have babies with serious birth defects such as spina bifida. The study also found a slightly elevated risk for childhood cancers such as leukemia.

The study is limited in its findings. Researchers told The Associated Press that they were able to confirm only 52 cases of specific illnesses related to chemical exposure at Lejeune based on medical records. The cause can't be definitely shown for other birth defects and cancer diagnoses.

But the CDC study is the latest evidence of widespread health problems linked to leaks from a fuel depot at the base and a dry cleaner outside the base.

Although some of the contaminants were addressed in federal regulations dating to 1963, the Marine Corps repeatedly downplayed health problems at Lejeune over the years and didn't take action until 1985.

By that time, an estimated 1 million Marines and their families had been exposed.

Last year, President Barack Obama signed legislation expanding health care resources for those individuals. (Information on compensation claims for Lejeune veterans and their families can be found at the Department of Veterans Affairs website at

The compensation covers 15 health problems, including multiple forms of cancer. More than 80 men with connections to Lejeune have been diagnosed with a rare form of breast cancer.

For the Marine Corps and the VA, the mission remains much as it was before last week's news. They need to expedite claims and continue reaching out to veterans and their families and to any civilians who may have been exposed to carcinogens at the base.

Research also should continue on the extent of contamination. Among other things, the government needs to delve deeper into reports of problems related to storage of DDT and other insecticides in a building later used as a day care.

The government also must explore further when the contamination began. The legislation covers exposure beginning in 1957, but some research indicates at least one carcinogen may have been present as early as 1948.

Last week's CDC report was difficult but welcome news for Lejeune veterans and family members who've fought many years for answers.

The Marine Corps, the VA, the president and Congress need to continue working to address those concerns.

The loss of human life and the suffering cannot be reversed. But the Marine Corps can ensure it doesn't leave behind the men and women whose health was damaged at Lejeune.

Birth Defects Linked To Contaminated Marine Base Water

Birth Defects Linked To Contaminated Marine Base Water

By Sara Jerome
Contaminated water at a U.S. Marine Corps base in North Carolina may be a cause of neural tube defects (NTDs) in some children, according to a long-awaited study.

The study from the Centers for Disease Control found "associations between TCE and benzene in Camp Lejeune drinking water and NTDs," the report said.

Survey participants reported "35 NTDs, 42 oral clefts, and 29 childhood hematopoietic cancers," the study said. CDC "made extensive efforts to obtain medical information from health providers to confirm reported cases.  ATSDR was able to confirm 15 NTDs, 24 oral clefts, and 13 cancers."

The effects were observed "in children born from 1968 to 1985 whose mothers were exposed to contaminated drinking water in their residences at Camp Lejeune."

The study also observed "weaker associations" between "first trimester exposure to PCE, vinyl chloride, and 1,2- DCE," and childhood hematopoietic cancers such as leukemia.

According to the Associated Press, "a prior CDC study cited a February 1985 level for trichloroethylene of 18,900 parts per billion in one Lejeune drinking water well — nearly 4,000 times today's maximum allowed health limit of 5 ppb. Testing also found high levels of benzene, a fuel additive."

The contamination was caused by "a leaky on-base fuel depot and an off-base dry cleaner," the report said.
In the nearly 30 years since the contamination was first publicly disclosed, "military officials have repeatedly issued public statements downplaying health risks from drinking the tainted water prior to the closure of the most contaminated wells," the AP said.

The base kept using the wells for years even after tainted water was discovered, the AP reported. "The most highly contaminated wells were closed in 1984 and 1985, after a round of more extensive testing found dangerous concentrations of toxins associated with degreasing solvents and gasoline."

Lejeune spokeswoman Captain Maureen Krebs said in a statement published by Reuters that the Marine Corps has supported attempts to study the effects of the tainted water.

"These results provide additional information in support of ongoing efforts to provide comprehensive science-based answers to the health questions that have been raised," she said.

A law passed last year attempted to help those affected by the water. The law provides "medical care to former Marines and their dependents who were exposed to the contaminated wells between 1957 and 1987. The law covers 15 conditions including miscarriage, female infertility, leukemia, non-Hodgkin's lymphoma and several other forms of cancer," an editorial in Star News Online said.

People With Spinal Cord Injuries Prone To Premature Death: WHO Report

People With Spinal Cord Injuries Prone To Premature Death: WHO Report

12/3/2013 6:13 AM ET 
People with spinal cord injuries are two to five times more likely to die prematurely, with worse survival rates in low- and middle-income countries, says a new report by the World Health Organization (WHO).
As many as 500,000 people suffer a spinal cord injury each year, it is estimated. 

The report, titled "International perspectives on spinal cord injury," summarizes the best available evidence on the causes, prevention, care and lived experience of people with spinal cord injury.

The report was developed in association with the International Spinal Cord Society and Swiss Paraplegic Research, and launched on the occasion of the International Day of Persons with Disabilities, which falls on December 3.

Males are most at risk of spinal cord injury between the ages of 20-29 years and 70 years and older, while females are most at risk between the ages of 15-19 years and 60 years and older. Studies report male to female ratios of at least 2:1 among adults.

Up to 90 percent of spinal cord injury cases are due to traumatic causes such as road traffic crashes, falls and violence. Variations exist across regions. For example, road accidents are the main contributor to spinal cord injury in the African Region (nearly 70 percent of cases) and the Western Pacific Region (55 percent of cases) and falls the leading cause in the South-East Asia and Eastern Mediterranean Regions (40 percent of cases). Non-traumatic spinal cord injury results from conditions such as tumors, spina bifida, and tuberculosis. A third of non-traumatic spinal cord injury is linked to tuberculosis in sub-Saharan Africa.

Most people with spinal cord injury experience chronic pain, and an estimated 20-30 percent show clinically significant signs of depression. People with spinal cord injury also risk developing secondary conditions that can be debilitating and even life-threatening, such as deep vein thrombosis, urinary tract infections, pressure ulcers and respiratory complications.
Spinal cord injury is associated with lower rates of school enrollment and economic participation. Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to socio-economic participation, with a global unemployment rate of more than 60 percent. Spinal cord injury carries substantial individual and societal costs.

Many of the consequences associated with spinal cord injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social and policy environments that exclude people with spinal cord injury from participation in their communities. Full Implementation of the Convention on the Rights of Persons with Disabilities is urgently required to address these gaps and barriers.

"Spinal cord injury is a medically complex and life-disrupting condition," notes Dr. Etienne Krug, Director of WHO's Department of Violence and Injury Prevention and Disability. "However, spinal cord injury is preventable, survivable, and need not preclude good health and social inclusion," according to him.
Essential measures for improving the survival, health and participation of people with spinal cord injury are detailed in the report. 

by RTT Staff Writer

Tuesday, August 13, 2013

Bone Marrow Cells Used in Bladder Regeneration


A new approach to bladder regeneration is capitalizing on the potential of two distinct cell populations harvested from a patient's healthy bone marrow, a new study reports.

The Northwestern Medicine® research, which will be published February 18 in the Proceedings of the National Academy of Sciences by lead author Arun K. Sharma, research assistant professor in urology at Northwestern University Feinberg School of Medicine and colleagues, is an alternative to contemporary tissue-engineering strategies. The bone marrow cells are being used to recreate the organ's smooth muscle, vasculature, and nerve tissue.

"We are manipulating a person's own disease-free cells for bladder tissue reformation," said Sharma, a member of the Institute for BioNanotechnology in Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago Research Center. "We have used the spina bifida patient population as a proof of concept model because those patients typically have bladder dysfunction. However, this regeneration approach could be used for people suffering from a variety of bladder issues where the bone marrow microenvironment is deemed normal."

In end-stage neurogenic bladder disease -- an illness often associated with spinal cord diseases like spina bifida -- the nerves which carry messages between the bladder and the brain do not work properly, causing an inability to pass urine. The most common surgical option, augmentation cystoplasty, involves placing a "patch" derived from an individual's bowel over a part of the diseased organ in order to increase its size. The current "gold standard," the procedure remains problematic because the bowel tissue introduces long-term complications like the development of electrolyte imbalance and bladder cancer.

Because Sharma's procedure does not use bowel tissue, it offers the benefits of augmentation without the association of long-term risks. His technique combines stem and progenitor cells from a patient's bone marrow with a synthetic scaffold created in the lab of Guillermo Ameer, ScD, professor of biomedical engineering at McCormick School of Engineering and Applied Science and of surgery at Feinberg. The scaffold takes the place of the traditional patch.

"We decided to use material that has the ability to be tailored to simulate mechanical properties of the bladder," said Sharma, director of pediatric urological regenerative medicine at Lurie Children's. "Using the elastomer created by Dr. Ameer and the bone marrow stem and progenitor cells, I believe that we have developed a technique that can potentially be used in lieu of current bladder augmentation procedures. However, further study is needed."

Follow-up to landmark spina bifida study could influence future treatment


HOUSTON — Almost 10 years ago, the Management of Myelomeningocele (MOMS) study began comparing two approaches to treatment for a serious form of spina bifida: prenatal surgery versus the standard postnatal repair.

This breakthrough study, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and published by the New England Journal of Medicine in 2011, found that children whose spina bifida defects were repaired surgically before birth were more likely to walk without the assistance of orthotics or devices.  NICHD is one of the Institutes of the National Institutes of Health.

Now, a follow-up study, also funded by NICHD and informally known as MOMS2, is being conducted to determine whether prenatal repair done in the original study influenced the adaptive behavior of these children, now 5 to 9 years of age, compared with those who underwent postnatal repair.

One of the effects in question is the brain development of these children. Jenifer Juranek, Ph.D., a neuroimaging expert with the Texas Fetal Center and the Children’s Learning Institute at The University of Texas Health Science Center at Houston (UTHealth), is performing high-resolution magnetic resonance imaging (MRI) brain sequences on 177 of the children from the original study to investigate if those who underwent prenatal surgery experienced greater structural modification in their brains than those infants who underwent postnatal surgery.

The follow-up brain imaging protocol was set up by Juranek at each of the three original MOMS study sites: Vanderbilt University in Nashville, Tenn., The Children's Hospital of Philadelphia, and the University of California at San Francisco. Each follow-up image will be analyzed and quantified by Juranek for such key development indicators as brain volume, matter integrity, synaptic pruning (i.e., when excess connections between cells are eliminated) and myelination, which enables nerve cells to transmit information faster and allows for more complex brain processes.

“Researchers have demonstrated that many neurodevelopmental disorders like spina bifida may be linked to poorly-timed cellular events during brain development. These events lead to specific structural and functional brain development,” said Juranek. “With this follow-up study, researchers can evaluate the impact different intervention strategies have on brain structure, function and behavior.”

The results of the MOMS2 study could influence future surgical procedures for babies diagnosed with myelomeningocele, says KuoJen Tsao, M.D., associate professor of pediatric surgery at UTHealth Medical School and a co-director of the Texas Fetal Center.

“The MOMS study gave us data that goes two or three years out from surgery, but we know there is a lot of development beyond that,” said Tsao. “We know there are certain short-term outcomes, but there may be some long-term neurological effects we don’t know about. What’s most exciting about the MOMS2 study is they are going to follow these patients at school age.”

One common risk associated with myelomeningocele is the buildup of fluid inside the skull that leads to brain swelling. This swelling is repaired with shunts inserted into the brain to relieve pressure. The original MOMS study found that prenatal surgery reduced the need for shunts, which may improve long-term brain development.

“Once you put in a shunt you have risks,” said Juranek. “Getting into the center of brain isn’t easy. If you put in a shunt, you are likely to cut through gray and white matter, both of which are responsible for certain brain functions.”

Tsao added, “The important thing about the MOMS2 study is it will answer questions that we are asking now. That’s where Dr. Juranek’s work is very important.”

Other follow-up testing will look at other development factors such as attention, executive function and fine and gross motor skills.