“Shoulder Function Not Fully Restored After Surgery: Henry Ford Hospital Study (Medical News Today)” plus 2 more

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• Shoulder Function Not Fully Restored After Surgery: Henry Ford Hospital Study (Medical News Today)
• Reducing Pain In Hospitalized Patients Using Non-Drug Techniques (Medical News Today)
• Study shows potential for using algae to produce human therapeutic proteins (PhysOrg)

Shoulder Function Not Fully Restored After Surgery: Henry Ford Hospital Study (Medical News Today) Posted: 08 Mar 2010 05:26 AM PST Main Category: Bones / Orthopaedics Also Included In: Rehabilitation / Physical Therapy Article Date: 08 Mar 2010 - 2:00 PST email to a friend   printer friendly   view / write opinions Shoulder motion after rotator cuff surgery remains significantly different when compared to the patient's opposite shoulder, according to Henry Ford Hospital researchers. In the study, researchers used X-rays providing a 3D view of motion of the arm bone in relation to the shoulder blade, to compared motion in the shoulders of 14 patients who had arthroscopic surgical repair of tendon tears and no symptoms in their other shoulders. Researchers analyzed the motion of both shoulders at three, 12 and 24 months after surgery, looking at changes in shoulder motion and shoulder strength. "Although patient satisfaction is generally very high after surgical repair of a torn rotator cuff, the data suggest that long-term shoulder function - in particular, shoulder strength and dynamic joint stability - may not be fully restored in every patient," says Michael Bey, Ph.D., director of the 3,000-sq.-ft. Herrick Davis Motion Analysis Lab at Henry Ford Hospital. Dr. Bey presented the results Saturday at the Orthopaedic Research Society's annual meeting in New Orleans. "We found that the motion pattern of the repaired shoulder is significantly different than the patient's opposite shoulder," says Dr. Bey. "These differences in shoulder motion seem to persist over time in some patients." According to the American Academy of Orthopaedic Surgeons, rotator cuff tears are a common cause of pain and disability among adults, especially among those over age 40. The rotator cuff is comprised of four muscles and several tendons that create a covering around the top of the upper arm bone. The rotator cuff holds the bone in and enables the arm to rotate. The rotator cuff can be torn from a single injury but most tears result from overuse of the muscles and tendons over years. Those at especially high risk are those who engage in repetitive overhead motions. Common treatments include anti-inflammatory medication, steroid injections, physical therapy and surgery. Dr. Bey explains that the study findings suggest that restoring normal joint mechanics may not be necessary in order to achieve a satisfactory clinical outcome. "Our study suggests that surgery may restore normal shoulder strength but doesn't necessarily restore normal shoulder motion," says Dr. Bey. "It could be, however, because the shoulder pain goes away, there is value in surgery." The study was done using a high-speed biplane X-ray system, one of only three in the country, which allows researchers to measure the position of bones and joints in the body during motion to within half a millimeter. "The biplane X-ray system allows us to investigate subtle nuances of shoulder function that cannot be detected with conventional laboratory techniques," explains Dr. Bey. Next steps for Henry Ford researchers include looking at physical therapy vs. surgery, and investigating improved or different techniques for treating rotator cuff tears. Dr. Bey is also presenting results from another study at the conference which looks at the condition of the shoulder prior to surgery. "What further complicates our understanding of rotator cuff tears is that we have also shown that there are subtle yet important differences in shoulder function between the dominant and non-dominant shoulder of healthy volunteers," says Dr. Bey. "These ongoing studies are aiding in our understanding of both the origin and treatment of rotator cuff tears." Funding: National Institutes of Health and Henry Ford Hospital. Source: Maria Seyrig Henry Ford Health System Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction.

Reducing Pain In Hospitalized Patients Using Non-Drug Techniques (Medical News Today) Posted: 08 Mar 2010 05:25 AM PST Main Category: Pain / Anesthetics Also Included In: Public Health;  Complementary Medicine / Alternative Medicine Article Date: 08 Mar 2010 - 2:00 PST email to a friend   printer friendly   view / write opinions Non-traditional therapies relieve pain among a wide range of hospitalized patients as much as 50 percent, according to a first-of-a-kind study in the Journal of Patient Safety. The study shows that an inpatient integrative medicine program can have a significant impact on pain in an environment where pain management continues to be a major challenge, and traditional medications can have negative consequences. "Roughly 80 percent of patients report moderate to severe pain levels after surgery," says Gregory Plotnikoff, M.D., one of the study's authors and medical director of the Penny George Institute for Health and Healing at Abbott Northwestern Hospital. "We struggle to provide effective pain control while trying to avoid the adverse effects of opioid medications, such as respiratory depression, nausea, constipation, dizziness and falls." The study included 1,837 cardiovascular, medical, surgical, orthopedics, spine, rehabilitation, oncology, and women's health patients at Abbott Northwestern between January 1, 2008, and June 30, 2009. They scored their pain verbally on a zero-to-ten scale before and after treatments. The treatments included non-pharmaceutical services: mind body therapies to elicit the relaxation response, acupuncture, acupressure, massage therapy, healing touch, music therapy, aromatherapy, and reflexology. The study, "The Impact of Integrative Medicine on Pain Management in a Tertiary Care Hospital" was published March 5 in the Journal of Patient Safety. "Earlier studies narrowly focused on whether specific integrative therapies manage pain in either cancer or surgical patients," says Jeffery A. Dusek, Ph.D., research director for the George Institute. "Our real-world study broadly shows that these therapies effectively reduce pain by over 50 percent across numerous patient populations. Furthermore, they can be clinically implemented in real time, across, and under the operational and financial constraints within an acute care hospital." Dusek says future research will focus on defining appropriate intervention doses, duration of pain relief, and developing profiles of which patients are most likely to respond to nonpharmacologic treatments. Reductions in total hospitalization costs, medication use and adverse events will be quantified in future prospective research using the electronic medical record. "I think we will find that integrative approaches to pain management during the hospital stay will improve patient satisfaction and outcomes, and we will see cost savings from patients using fewer drugs and experiencing fewer adverse events," said Lori Knutson, RN, BSN, HN-BC, executive director of the George Institute. The George Institute's inpatient program employs 21 integrative medicine practitioners, including six registered nurses, board-certified in their specialty areas such as oncology and cardiovascular, and also board-certified in holistic nursing; six licensed Asian medicine practitioners; eight certified massage therapists, with an emphasis on acute care massage, and one certified music therapist. Inpatient integrative services provided to patients are based on physician and nursing referrals, are supported by philanthropy and provided at no additional cost to the patient. Source: Gloria O'Connell Allina Hospitals & Clinics Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction.

Study shows potential for using algae to produce human therapeutic proteins (PhysOrg) Posted: 08 Mar 2010 11:54 AM PST That's the conclusion of a study, published online this week in Plant Biotechnology Journal, which sought to determine whether seven diverse human therapeutic proteins could be produced in Chlamydomonas reinhardtii, a green alga used widely in biology laboratories as a genetic model organism, much like the fruit fly Drosophila and the bacterium E. coli. "What surprised us was that of the seven genes chosen, four expressed proteins at levels sufficient for commercial production," said Stephen Mayfield, a professor of biology at the University of California, San Diego who headed the study, which involved scientists at The Scripps Research Institute, San Diego biofuel company Sapphire Energy and ProtElix, a protein engineering company in Hayward, CA. The scientists reported in their paper that all of the algal-produced proteins in their study showed biological activity comparable to the same proteins produced by traditional commercial techniques. And because algae cells can be grown cheaply and quickly, doubling in number every 12 hours, they noted that algae could be superior to current biological systems for the production of many human therapeutic proteins. "Currently, human therapeutic proteins are primarily produced from either bacteria or mammalian cell culture," they said. "Complex mammalian proteins and monoclonal antibodies are primarily produced by the culture of transgeneic mammalian cells, while simpler proteins are generally produced by E. coli." "Due to high capital and media costs, and the inherent complexity of mammalian cell culture, proteins produced by mammalian cell culture are very expensive," they added. "Bacterial production is generally more economical in terms of media components, but bacteria are often inefficient at producing properly folded complex proteins, requiring a denaturation and renaturation step that adds significant costs to bacterial protein production." The scientists said the percentage of human proteins produced in their algal cultures that were properly folded in three dimensions was comparable to the fraction produced by mammalian cell cultures and much better than that produced by bacterial systems. And because algae generate their energy from sunlight and have relatively simple nutrient needs, they said the costs for using them at large scale to commercially produce human proteins should be much lower than for mammalian cell culture, which require expensive fermentation facilities. To conduct their study, the scientists picked seven proteins that were either currently being used as standard treatments for diseases or are now undergoing human clinical trials. They include human interferon β1, which is used to treat Multiple Sclerosis and costs patients from $1,600 to $2,000 for a one month supply; human erythropoietin or EPO, used to increase red blood production in patients undergoing chemotherapy; and human proinsulin, a hormone with a multi-billion dollar market used to treat Type 1 diabetes. Two other proteins were human vascular endothelial growth factor or VEGF, used to treat patients suffering from pulmonary emphysema, and high moblility group protein B1 (HMGB1), which activates immune cells and is being investigated for its potential to enhance other cancer therapies. The remaining two proteins were domains 10 and 14 of human fibronectin, which are being investigated for their ability to mimic certain kinds of antibodies. Mayfield and his colleagues at The Scripps Research Institute demonstrated two years ago that they could produce a mammalian serum amyloid protein from algae and, last year, demonstrated success producing a human antibody. Both of these proteins had biological activities similar to the real proteins from mammalian cells. Enlarge UC San Diego researchers found this alga, seen from the neck of this flask, can also produce human therapeutic proteins. Credit: Credit: Beth Rasala, UCSD "That was the proof of concept," said Mayfield. "It showed us that the system works—that we could produce complex mammalian proteins in algae. What we did in this next study was to say, 'Let's take seven diverse human therapeutic proteins and see if we can express them in algae and report the good and the bad.'" The scientists found that in algae they were able to produce VEGF, HMGB1 and domain 14 of human fibronectin at levels above one percent of total soluble protein, levels sufficient for easy purification. Domain 10 of human fibronectin could also be produced from algae at these levels when fused to the protein M-SAA, which they had previously used to increase the accumulation of other proteins. Human proinsulin could be produced by algae, but only at lower levels, the study showed, while human interferon β1 and EPO were not produced by algae. "What our results show is that algae are a robust platform for the production of human therapeutic proteins," said Mayfield. "While not every protein can be produced in algae, a good fraction can, just like in any other system. You can get expression of about 25 percent in bacteria and about 40 to 50 percent in mammalian cells, so we're in the same ball park as these other systems." What makes algae particularly attractive compared to bacterial and mammalian systems, the scientists say, is its ability to produce proteins cheaply and at very large scale. With algae currently being produced at about $3 per kilogram at commercial scale, the researchers estimate that making recombinant protein would cost about 60 cents per gram prior to purification. "This is about the same cost estimates for the least expensive protein expression systems presently available, and considerably cheaper than mammalian cell culture," they said in their paper. With expected improvements in the ability to express proteins in algae, "and the continued reduction in algal biomass cost associated with the large scale efforts to use algae for biofuel production, we anticipate at least a ten-fold reduction in the costs over the next few years, which should make algal protein production the least expensive platform available. This reduced cost of goods, coupled with an ability to rapidly scale production in inexpensive bioreactors, suggests that algae may become an economically superior platform for therapeutic protein production in the future." In a separate, but related effort, Mayfield and his colleagues are using various species of algae to investigate ways of generating renewable forms of transportation fuel from algae that could eventually be competitive with the cost of gasoline. Five Filters featured article: Chilcot Inquiry. Available tools: PDF Newspaper, Full Text RSS, Term Extraction.

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