Possible Neurobiological Basis For Persistent Pain After Stressful Events

Possible Neurobiological Basis For Persistent Pain After Stressful Events

A fresh study led by University of North Carolina School of Medicine researchers is the first to identify a genetic risk agent for persistent pain after traumatic events of the like kind as motor vehicle collision and sexual invasion.

In addition, the study contributes farther on evidence that persistent pain after stressful events, including motor vehicle collisions and sexual assaults, has a characteristic biological basis. A manuscript of the study was published online against us of print by the journal Pain.

"Our study findings indicate that mechanisms influencing chronic trouble development may be related to the stress response, rather than any specific prejudice caused by the traumatic event," related Samuel McLean, MD, MPH, senior first cause of the study and assistant professor of anesthesiology. "In other language, our results suggest that in some individuals something goes wrong with the body's 'fight or flight' response or the body's recovery from this response, and steady pain results."

The study assessed the role of the hypothalamic-pituitary adrenal (HPA) line of rotation, a physiologic system of central weightiness to the body's response to stressful events. The study evaluated whether the HPA line of revolution influences musculoskeletal pain severity six weeks later motor vehicle collision (MVC) and sexual fall upon. Its findings revealed that variation in the gene encoding as antidote to the protein FKBP5, which plays an important role in regulating the HPA shaft response to stress, was associated with a 20 percent higher risk of diminish to severe neck pain six weeks about a motor vehicle collision, as well because a greater extent of body affliction. The same variant also predicted increased vexation six weeks after sexual assault.

"Right since, if an someone comes to the juncture department after a car accident, we don't have any interventions to prevent chronic pain from developing," McLean related. Similarly, if a woman comes to the pass department after sexual assault, we own medications to prevent pregnancy or sexually transmitted illness, but no treatments to prevent chronic pain. This is because we make out what causes pregnancy or infection, only we have no idea what the biologic mechanisms are that give rise to chronic pain. Chronic pain after these events is indifferent and can cause great suffering, and there is an urgent need to be apprised what causes chronic pain so that we be possible to start to develop interventions. This study is every important first step in developing this understanding."

"In addition, because we don't conceive what causes these outcomes, individuals through chronic pain after traumatic events are ofttimes viewed with suspicion, as if they are form up their symptoms for financial win to or having a psychological reaction," McLean before-mentioned. "An improved understanding of the biology helps with this stigma," McLean said.

Patients With Sleep Apnea Undergoing Joint Replacement Have Improved Outcomes With Regional Anesthesia

Patients With Sleep Apnea Undergoing Joint Replacement Have Improved Outcomes With Regional Anesthesia

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Using regional anesthesia in the room of general anesthesia in patients with sleep apnea undergoing total joint re-establishment decreases major complications by 17%, according to a study published online, in advance of print, in the journal Regional Anesthesia and Pain Medicine. The Hospital instead of Special Surgery study is the primeval to provide evidence that an interference during surgery can improve outcomes in patients by sleep apnea who often fare worse than patients exclusively of this condition. Currently, up to 25% of patients presenting as far as concerns surgery in the United States be delivered of sleep apnea.

"This study, for the elementary time, shows that the use of regional anesthesia improves outcomes in patients with sleep apnea undergoing total joint arthroplasty. Although requiring more remote investigation, there is no reason to cogitate that these results could not exist extrapolated to other types of surgery," declared Stavros Memtsoudis, M.D., Ph.D., monitor of Critical Care Services at Hospital in favor of Special Surgery, New York City, who led the study.

Specifically, the researchers wilful neuraxial anesthesia, one type of regional anesthesia. Neuraxial anesthesia involves injecting medication into fatty tissue that surrounds the nerve roots in the thorn (known as an epidural) or into the cerebrospinal liquid and gaseous that surrounds the spinal cord.

Sleep apnea is a turbulence in which an individual's respiration is interrupted during sleep, sometimes viewed like many as 30 times or further during an hour. The condition interferes by sleep quality and has been associated through high blood pressure, and diabetes of the same kind with well as heart attack and thump. The most common type of death apnea is obstructive sleep apnea in what one the airway collapses during sleep. This state is more common in overweight individuals and is neat increasingly prevalent in the United States, insurrection in tandem with the growing plumpness epidemic.

Many years ago clinicians began noticing that patients by sleep apnea were at an increased dare to undertake of developing complications after operations. "Normally, patients through sleep apnea stop breathing when they are inactive. As patients receive medications potentially affecting wakefulness surrounding surgery, this may be of concern. However, breathing abnormalities may not be the only reasons for increased exposure to harm of complications - many sleep apnea patients be injured from cardiovascular problems as well that may worsen surrounding surgery," Dr. Memtsoudis explained.

The American Society of Anesthesiology (ASA) became increasingly concerned with regard to this patient population. In 2006, the ASA released guidelines recommending the conversion to an act of regional anesthesia, when possible, in patients through sleep apnea undergoing surgery to subject the use of systemic opioids. Many clinicians questioned this recommendation, however, because it was not supported by scientific evidence. "Clinicians were looking in quest of guidance on what they could do to alleviate the problem, but there was really no good data, only the guidelines were mostly based without ceasing anecdotal reports and the opinion of a scarcely any experts," said Dr. Memtsoudis. "This be in want of of evidence, however, created a absolute dilemma in many ways."

To consider whether neuraxial anesthesia actually reduced complications, researchers at Hospital for Special Surgery conducted a retrospective survey of all hip and knee replacements performed in patients with sleep apnea between 2006 and 2010 in the United States using Premier Perspective. This administrative database contains discharge advice from approximately 400 acute care hospitals located from beginning to end the United States. The researchers identified 30,024 patients by sleep apnea undergoing these procedures whose of medicine records included information on the original of anesthesia used during the surgery. Approximately 11% of cases were performed subject to neuraxial, 15% under combined neuraxial/vague, and 74% under general anesthesia alone.

Currently, the manhood of joint replacements in the United States are performed in subordination to general anesthesia, but HSS uses neuraxial anesthesia during the term of 95% of orthopedic surgeries.

The researchers discovered that patients had a 17% grow dark risk of major complications if neuraxial anesthesia was used more than general anesthesia. Patients who admitted combined neuraxial/general anesthesia had a 10% be clouded risk of major complications compared through patients who received general anesthesia. When neuraxial methods were used, patients had reduce rates of pulmonary, gastrointestinal, and catching complications, and, in particular, acute renal failure. Use of the neuraxial come (whether used alone or in association with general) also reduced the conversion to an act of transfusions, mechanical ventilation, and nice care services. The median length of hospitalization was 2.8 days in the of the whole anesthesia group and 2.6 days in the neuraxial and neuraxial/vague combined groups.

"We wanted to know if regional anesthesia really makes a misunderstanding in this patient population and it seems to have existence doing that," said Dr. Memtsoudis. "Neuraxial anesthesia was associated with lower risk of complications and a reduction in the length of stay in the hospital."

The researchers speak the results may apply to patients with sleep apnea undergoing surgeries such because prostatectomies and hysterectomies, and this is one area currently being investigated.

The compensation tags associated with neuraxial and usual anesthesia are similar, and evidence is augmenting that neuraxial anesthesia has benefits in numerous populations. The majority of surgeries in the United States, however, are performed under general anesthesia as far as concerns a number of reasons. "There are institutional limitations and preferences. Anesthesiologists consider to consider many factors when performing neuraxial anesthesia, and it has to have existence used in an environment where the nurses and the hospitals be possible to deal with rare but potential complications. Recovery and anticoagulation protocols be seized of to be considered. Sometimes the medications that are heart prescribed afterward to prevent blood clots be obliged to be carefully chosen especially at what time using epidurals for pain control." When epidural methods are used, clinicians cannot give patients easy-to-use, high power blood thinners, but must instead application alternatives, which in some require oft-repeated monitoring of blood parameters via a standard called International Normalized Ratio. "This carry toward is more labor intensive and the required increase in resources may not be serviceable everywhere," said Dr. Memtsoudis.

"Before this study, the good opinion to use neuraxial anesthesia in be motionless apnea patients was based on none scientific foundation," said Dr. Memtsoudis. The of the present day study provides much needed support towards the recommendation.

The new study was presented at the yearly record Regional Anesthesiology and Acute Pain Medicine Meeting held in Boston.

In People With Fibromyalgia, Pain Is Not Worsened By Regular, Moderate Exercise

In People With Fibromyalgia, Pain Is Not Worsened By Regular, Moderate Exercise

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For various people who have fibromyalgia, even the conceit of exercising is painful.

Yet a renovated study from Wake Forest Baptist Medical Center shows that exert does not worsen the pain associated with the disorder and may even diminish it over time. The findings are published in the current online conclusion of the journal Arthritis Care & Research.

According to Dennis Ang, M.D., yoke-fellow professor of internal medicine at Wake Forest Baptist and senior author of the study, doing public notice to moderate exercise over a prolonged term of time improves overall symptoms, in the same state as fatigue and trouble sleeping, as long as not increasing pain.

"For many folks with fibromyalgia, they will exercise despite a week or two and afterward start hurting and think that work is aggravating their pain, so they have lodgings exercising," Ang said. "We hope that our tools and materials will help reduce patients' fear and hearten them that sustained exercise will improve their overall freedom from disease and reduce their symptoms without worsening their harass."

To evaluate the relationship between extensive-term maintenance of moderate intensity training, defined as light jogging or lively walking for 20 minutes a light of, the research team enrolled 170 volunteers to partake in a 36-week study. Participants current individualized exercise prescriptions and completed baseline and follow-up physical activity assessments using the Community Health Activities Model Program on account of Seniors (CHAMPS) questionnaire at weeks 12, 24 and 36.

The study institute that participants who engaged in temperate intensity exercise for at least 12 weeks showed greater improvements in clinical symptoms taken in the character of compared to participants who were powerless to achieve higher levels of material activity.

More importantly, Ang said, the findings showed that long-term physical action at levels consistent with current sanatory recommendations is not associated with worsening bitterness symptoms in fibromyalgia.

Approximately 10 percent of the ripe population in the United States has fibromyalgia or fibromyalgia-like provisions. The disorder is characterized by widespread musculoskeletal agony accompanied by sleep disturbance, fatigue and recollection issues. Experts believe that fibromyalgia is a impair the functions of of pain processing due to abnormalities in in what way pain signals are processed in the central spirited system.

Proliferation Of Two Breast Cancer Lines Stymied By Low-Dose Aspirin

Proliferation Of Two Breast Cancer Lines Stymied By Low-Dose Aspirin

Regular use of low-dose aspirin may prevent the progression of breast cancer, according to results of a study by researchers at the Veterans Affairs Medical Center in Kansas City, Mo., and the University of Kansas Medical Center.

The study found that aspirin slowed the growth of breast cancer cell lines in the lab and significantly reduced the growth of tumors in mice. The age-old headache remedy also exhibits the ability to prevent tumor cells from spreading.

The lead author of the study, Gargi Maity, a postdoctoral fellow who works in the cancer research unit at the VA Medical Center, presented the team's findings at the annual meeting of the American Society for Biochemistry and Molecular Biology, which is being held in conjunction with the Experimental Biology 2013 conference in Boston. The senior author is Sushanta Banerjee, director of the cancer research unit and a professor at the University of Kansas Medical Center in Kansas City, Kan.

The role of aspirin, or acetylsalicylic acid, in preventing and treating cancer has intrigued researchers since the late 1980s, when an Australian study found that people who regularly used aspirin were less likely to develop colorectal cancer. Aspirin use also has been shown to reduce the risk of squamous cell esophageal cancer and prostate cancer.

Anecdotal evidence indicated that breast cancer was less likely to return in women who took aspirin to lower their risk of heart attack or stroke. But the science behind this relationship is not well understood.

The VA study found that aspirin may interfere with cancer cells' ability to find an aggressive, more primordial state. In the mouse model the researchers used, cancer cells treated with aspirin formed no or only partial stem cells, which are believed to fuel the growth and spread of tumors.

Banerjee, a professor of medicine in division of hematology and oncology, says first-line chemotherapy treatments do not destroy stem cells. Eventually, the tumor will grow again. "If you don't target the stemness, it is known you will not get any effect," he says. "It will relapse."

In lab tests, aspirin blocked the proliferation of two different breast cancer lines. One of the lines tested is often called triple-negative breast cancer, a less common but more difficult treat form of the disease. "We are mainly interested in triple negative breast cancer, because the prognosis is very poor," Banerjee says.

Triple-negative breast cancers, which will be addressed in a special thematic program at the ASBMB annual meeting, lack receptors for estrogen, progesterone and Her2. Aspirin also may improve the effectiveness of current treatments for women whose breast cancers are hormone-receptor positive. In the team's study, aspirin enhanced the effect of tamoxifen, the usual drug therapy for hormone-receptor positive breast cancer.

Aspirin is used in the treatment of a number of different conditions. Banerjee says its ability to attack multiple metabolic pathways is what makes it potentially useful in the fight against cancer. "Cancer is not a single-gene disease," he says. "Multiple genes are involved."

Aspirin is a medicine with side effects, including gastrointestinal bleeding. Researchers will continue to explore if the positive effects of regular use of the drug outweigh the risks. In 2012, the National Cancer Institute asked scientists to design studies that would illuminate the mechanisms by which aspirin and drugs with other uses appear to reduce the risk of cancer or improve the prognosis for those diagnosed with the disease. Banerjee says his lab will apply for one of the grants.

Two Studies Add New Data To Debate Over Safety Of N2O As Surgical Anesthetic

Two Studies Add New Data To Debate Over Safety Of N2O As Surgical Anesthetic

Giving nitrous oxide as part of general anesthesia for noncardiac surgery doesn't increase the rate of complications and death - and might even decrease the risk of such events, according to a pair of studies in the May issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

But an accompanying series of editorials points out some important limitations of the two studies - which can't completely overcome previous concerns about the safety of using nitrous oxide (N2O) as a surgical anesthetic.

Is Nitrous Oxide Safe for Surgical Anesthesia?

Nitrous oxide is the world's oldest general anesthetic, but there's a long history of debate regarding its appropriate role in modern surgical anesthesia. Although nitrous oxide provides effective sedation and pain control, it has known disadvantages and side effects. A previous study, called "ENIGMA-I," reported a small but significant increase in myocardial infarction (heart attack) among patients receiving nitrous oxide as part of anesthesia for noncardiac surgery (procedures other than heart surgery).

The two new studies, based on large patient databases, question the harmful effects of nitrous oxide. Dr Kate Leslie of Royal Melbourne Hospital, Australia, and colleagues analyzed data from a previous study of more than 8,300 patients undergoing surgery. That study was designed to assess the effects of giving one type of blood pressure drug (beta-blockers) during surgery, not the effects of nitrous oxide.

Dr Leslie and colleagues compared the risk of death or serious complications after surgery for patients who versus did not receive nitrous oxide as part of anesthesia. Twenty-nine percent of patients in the study received nitrous oxide.

The results showed comparable rates of adverse outcomes between groups. With or without nitrous oxide, the overall rate of death or serious complications was approximately seven percent, including about a six percent rate of myocardial infarction. Risk of death after surgery was about three percent in both groups.

Outcomes remained similar on "propensity score" analysis - a technique accounting for characteristics making patients more or less likely to receive nitrous oxide. Use of nitrous oxide varied widely between the different countries and hospitals participating in the study.

No Increase in Risks with N2O - But 'More Definitive' Studies Needed

Dr Alparslan Turan of the Cleveland Clinic and colleagues outcomes reviewed more than 49,000 patients undergoing noncardiac surgery between 2005 and 2009. In this study, 45 percent of patients received nitrous oxide.

The results suggested a significant reduction in the risk of death after surgery for patients receiving nitrous oxide: about one-third lower than in patients who did not receive nitrous oxide. There was also a significant 17 percent reduction in the combined rate of major complications and death.

Surprisingly, nitrous oxide was specifically associated with a 40 percent reduction in the risk of major lung- and breathing-related complications. However, the authors acknowledge the risk of "selection bias" - anesthesiologists may have avoided using nitrous oxide in patients at risk of lung problems. Again, the findings remained significant on propensity score analysis.

In one of three accompanying editorials, Thomas R. Vetter, MD, MPH, and Gerald McGwin, Jr, MS, PhD, of University of Alabama at Birmingham highlight some important limitations of the study data. They note that, although both studies were large, they were not randomized trials - the strongest type of scientific evidence.

Drs Vetter and McGwin emphasize that even sophisticated techniques like propensity score analysis can't account for all of the differences between groups that may have affected responses to nitrous oxide. They note that a randomized "ENIGMA-II" study is underway, and may provide "additional, perhaps more definitive insight" on the risks and potential benefits of using nitrous oxide as part of general anesthesia.

Success Rates Of Turning Breech Babies Increased By Anesthesia, Delivery Costs Reduced

Success Rates Of Turning Breech Babies Increased By Anesthesia, Delivery Costs Reduced

When a baby is in the breech position at the end of pregnancy, obstetricians can sometimes turn the baby head-down to enable a safer vaginal birth. In the past, women were not given anesthesia during the turning procedure, which requires the physician to push on the woman's abdomen while monitoring the baby with ultrasound. But a new study from the Stanford University School of Medicine and Lucile Packard Children's Hospital shows anesthesia is cost-effective because it increases the likelihood the procedure will work.

The turning procedure, called an external cephalic version, or simply a "version," can allow some women with breech babies to avoid a cesarean section and have a head-first vaginal delivery instead. Prior studies have shown that spinal or epidural anesthesia - similar to the anesthetic techniques offered during childbirth - can help more babies to be turned successfully. Many obstetricians still do not use anesthesia when doing a version.

"We've been looking at reasons physicians don't offer anesthesia during this procedure, and one reason may be that they think it may add extra costs," said the study's lead author, Brendan Carvalho, MD, associate professor of anesthesia at Stanford and chief of obstetric anesthesia at Packard Children's. "But our work shows that it doesn't add significant costs, and most likely reduces overall costs because more women can avoid cesareans."

The study was published online in Anesthesia & Analgesia.

Because a breech vaginal delivery, in which a baby is born feet-first or bottom-first, is more dangerous for the mother and baby than a head-first vaginal delivery, many breech babies are delivered by cesarean section. But cesarean sections have their own disadvantages, such as increased risk of maternal hemorrhage, more pain and longer recovery times for the mother after birth, as well as higher hospital costs. As part of their effort to reduce cesarean rates, Packard Children's obstetric anesthesiologists have been offering anesthesia during version procedures for the last two years, making Packard Children's a Bay Area leader in studying and providing anesthesia for versions.

The new research drew upon data from several earlier studies that compared version success rates with and without anesthesia. The scientists also used national data on the cost of the version procedure with and without anesthesia, and the costs of vaginal and cesarean deliveries. All of the data was entered into a mathematical model that allowed the scientists to predict whether anesthesia use during a version was cost-effective.

The study found that using anesthesia increased average success rates of version procedures from 38 percent to 60 percent. Because it led to fewer cesareans, use of anesthesia also decreased the total cost of delivery by an average of $276; the range of cost differences estimated by the model extended from a $720 savings to a $112 additional cost.

Looking at the question of cost-effectiveness in a different way, the success rates of versions had to be improved at least 11 percent with anesthesia for the cost of the anesthesia to be negated, the researchers calculated.

Prior research has also shown that women are happier with version procedures when they receive anesthesia, Carvalho noted. "The pain of this procedure is variable, but it certainly is uncomfortable," he said. "If you have anesthesia, you feel pressure more than pain. Several studies have shown lower pain scores and higher patient satisfaction with anesthesia."

Abdominal muscle relaxation likely contributes to the higher success rates of the procedures performed with anesthesia, Carvalho said, adding that muscle relaxation caused by anesthesia may allow practitioners to apply less pressure to turn the baby. A previous study by these investigators demonstrated that anesthesia does not increase the risk of performing a version.

Simple Brace Can Significantly Reduce Pain Of Kneecap Osteoarthritis

Simple Brace Can Significantly Reduce Pain Of Kneecap Osteoarthritis

Arthritis Research UK-funded researchers at The University of Manchester claim their findings, presented at the Osteoarthritis Research Society International meeting in Philadelphia have enormous potential for treating this common joint condition effectively - as well as providing a simple and cheap alternative to painkillers.

Osteoarthritis of the knee affects around six million people in the UK and is increasing as the population ages and becomes more obese. Current treatments are limited to pain relief and joint replacement.

Osteoarthritis of the knee affecting the kneecap (patellofemoral osteoarthritis) accounts for about 20% of patients with knee pain. They typically experience pain that is made worse by going up and down stairs, kneeling, squatting and prolonged sitting.

"There's a pressing need for non-surgical interventions for knee osteoarthritis, and little attention has been paid to treatments particularly aimed at the kneecap (the patellofemoral joint), a major source of knee pain," explained Dr Michael Callaghan, research associate in rehabilitation science at the University of Manchester.

"We've shown that something as simple as a lightweight knee brace can dramatically improve the symptoms and function for people with this particular type of knee osteoarthritis."

The research team conducted a randomised controlled trial of a lightweight lycra flexible knee brace fitted around the knee with a support strap for the kneecap. One hundred and 26 patients between the ages of 40 and 70 were treated over a 12-week period. All had suffered from arthritic knee pain for the previous three months.

They were randomly allocated to either immediate brace treatment or delayed treatment (i.e. after six weeks.) Both groups of patients eventually wore the brace for a period of 12 weeks and averaged roughly seven hours a day.

After six weeks of brace wearing there were significant improvements between the brace wearing group and the no treatment group in scores for pain, symptoms, knee stiffness, muscle strength and function. After 12 weeks there were significant improvements in these scores for all patients compared to when they started.

"Patients repeatedly told us that wearing the brace made their knee feel more secure, stable, and supported," Dr Callaghan added. "Our theory is that these sensations gave the patient confidence to move the knee more normally and this helped in improving muscle strength, knee function and symptoms."

Professor Alan Silman, medical director of Arthritis Research UK, which funded the trial, said: "Osteoarthritis of the knee is a painful disorder that affects millions of people in the UK, causing pain and reducing activities. We know that in patients with arthritis, the knee joint is frequently out of normal alignment, which might be an underlying cause of the problem, as well as making it worse.

"By using a simple brace, the researchers have been able not only to correct the alignment but achieve a very worthwhile benefit in terms of reducing pain and function. This approach is a real advance over relying on pain killers and has the potential to reduce the end for joint surgery and replacement, procedures often employed when the symptoms become uncontrollable."

Sickle Cell Science Should Focus On Anti-Sickling Therapies

Sickle Cell Science Should Focus On Anti-Sickling Therapies

Pain is an undeniable focal point for patients with sickle cell disease but it's not the best focus for drug development, says one of the dying breed of physicians specializing in the condition.

Rather scientists need to get back to the crux of the disease affecting 1 in 500 black Americans and find better ways to prevent the hallmark sickling that impedes red blood cells' oxygen delivery, damaging blood vessel walls and organs along the way, said Dr. Abdullah Kutlar, Director of the Sickle Cell Center at the Medical College of Georgia at Georgia Regents University.

"We have one drug that reduces sickling and we need more," said Kutlar, the 2013 Roland B. Scott, M.D., Lecturer for the 7th Annual Sickle Cell Disease Research and Educational Symposium and National Sickle Cell Disease Scientific Meetin in Miami.

"Pain is very important to someone who is suffering, but by using pain as an end point, we are missing opportunities and wasting drugs that could be very helpful," he said. "Moving forward, I suggest we develop new combination therapies that have anti-sickling capabilities at their center," said Kutlar, noting such cocktail approaches have worked well for cancer and HIV.

Kutlar completed an extensive historical review of patient and study outcomes in preparation for the lecture honoring the late Howard University physician who made it his mission to improve the lives of children with sickle cell disease. Scott's contributions include prompting the National Sickle Cell Control Act of 1972, which established the first federally-funded comprehensive sickle cell centers, including the one at MCG led by Dr. Titus H.J. Huisman.

No doubt Scott, Huisman and others have made a tremendous difference to patients, whose average life expectancy has gone from the teens to the 50s in the past 30 years, Kutlar said. Much of that progress grew out of focusing on the basics, including developing hydroxyurea, still the only Food and Drug Administration-approved drug that targets sickling.

Approved 15 years ago, hydroxyurea works by increasing expression of fetal hemoglobin, which can't sickle. However, it's still not widely used - about 35 percent of Kutlar's adult patients take it, for example - probably for a combination of reasons that include a side effect of weight gain and unsubstantiated concerns that it increases cancer risk. He and his colleagues need to do a better job communicating the benefits of this drug in addition to finding new ones, Kutlar said. Reduced sickling means less damage to blood vessels and organs, he said, noting that the major cause of death in adults and children is acute chest syndrome, a severe pneumonia resulting from cumulative lung damage. A handful of new anti-sickling drugs are in various stages of development, including a thalidomide- derivative pioneered by MCG researchers that also enhances fetal hemoglobin expression.

Other good endpoints for drug development include downstream effects of sickling, such as the unnatural adhesion of red blood cells to blood vessel walls, Kutlar said. Unfortunately work was recently halted on a drug that reduced adhesion but not pain, Kutlar said.

Pain needs to be the primary endpoint only for pain medications, he noted. The good news is that many new pain medications are available for these patients, whose pain crises can be severe enough to require hospitalization and whose chronic pain can impair daily living. However, that circles back to the complex causes of pain. The pain initially likely results from tissues crying out for more oxygen and later from nerve and organ damage resulting from ongoing impaired oxygen supplies. Pain control can get even more complex and difficult because regular use of opiates, a common analgesic for sickle cell patients, actually increases pain sensitivity, Kutlar said.

In addition to finding better therapies, physicians who treat sickle cell patients need to help cultivate the next generation of caregivers, Kutlar said. He's in the minority in that he opted to take care of patients with sickle cell disease rather than pursue the more common - and generally more professionally lucrative - hematology path: treating cancer. "We don't have enough hematologists, period," said Kutlar. The problem does have a good cause: the reality that more patients are living longer. However, the number of physicians to treat adult patients is dismal. Helping cultivate the next generation is a focus of a study led by Kutlar and Dr. Robert W. Gibson, a GRU occupational therapist and medical anthropologist. They are reaching out to primary care physicians - who also are in short supply in this country - as a permanent medical home for patients as they reach adulthood. Kutlar and Gibson are co-principal investigators on $7 million, five-year grant from the National Center on Minority Health and Health Disparities of the National Institutes of Health supporting this initiative as well as the search for new drugs and more.

MCG physicians follow about 1,500 adults and children with sickle cell disease.

Survival From Cardiac Arrest Increases In The Presence Of Anesthesiologists

Survival From Cardiac Arrest Increases In The Presence Of Anesthesiologists

A University of Michigan study from the "Online First" edition of Anesthesiology found cardiac arrest was associated with improved survival when it occurred in the operating room (O.R.) or post-anesthesia care unit (PACU) compared to other hospital locations. The findings offer evidence that the presence of anesthesia providers in these locations may improve outcomes for certain patients.

Cardiac arrest is a very uncommon complication during the perioperative period, which includes the time during and immediately after surgery and anesthesia. An estimated seven arrests occur per every 10,000 patients undergoing non-cardiac surgery each year. In the past, outcomes of cardiac arrest in the perioperative period have not been well-studied.

To better understand the management and outcomes of cardiac arrests during the perioperative period, researchers used the "Get With The Guidelines® - Resuscitation" registry, a national cardiopulmonary resuscitation registry supported by the American Heart Association. Researchers identified more than 2,500 instances of perioperative cardiac arrest from 234 hospitals.

Findings showed one in three patients survived cardiac arrest to hospital discharge. Of these patients, two of three had good brain function. In addition, survival was approximately 25-65 percent higher if the cardiac arrest occurred in the O.R. or PACU than if it occurred in the intensive care unit (ICU) or general in-patient areas.

Researchers also found asystole, a type of cardiac arrest without electrical activity in the heart, was associated with improved survival in the O.R. and PACU compared to other hospital locations. They also found life-saving treatment was given much faster in these locations. Pulseless electrical activity (PEA), a type of cardiac arrest where the heart rhythm does not produce a pulse, was associated with worse survival to discharge in the ICU.

"The most surprising findings from our research were that very sick patients in the ICU and postoperative low-risk patients in general inpatient areas had the poorest outcomes," said Satya Krishna Ramachandran, M.D., F.R.C.A., assistant professor, Department of Anesthesiology, University of Michigan. "We found outcomes were best when cardiac arrest occurred during or immediately after surgery and anesthesia. This supports the view that the availability of anesthesia providers in the O.R. and PACU may contribute to better outcomes."