The JackB

"When you're in jail, a good friend will be trying to bail you out. A best friend will be in the cell next to you saying, 'Damn, that was fun'." Groucho Marx

Medicine

Study Links Diet Soft Drinks With Cardiac Risk

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MONDAY, July 23 (HealthDay News) — Drinking more than one soda a day — even if it’s the sugar-free diet kind — is associated with an increased incidence of metabolic syndrome, a cluster of risk factors linked to the development of diabetes and cardiovascular disease, a study finds.

The link to diet soda found in the study was “striking” but not entirely a surprise, said Dr. Ramachandran Vasan, study senior author and professor of medicine at Boston University School of Medicine. There had been some hints of it in earlier studies, he said.

“But this is the first study to show the association in a prospective fashion and in a large population,” Vasan said.

That population consisted of more than 6,000 participants in the Framingham Heart Study, which has been following residents of a Massachusetts town since 1948. When the soda portion of the study began, all participants were free of metabolic syndrome, a collection of risk factors including high blood pressure, elevated levels of the blood fats called triglycerides, low levels of the artery-protecting HDL cholesterol, high fasting blood sugar levels and excessive waist circumference. Metabolic syndrome is the presence of three or more of these risk factors.

Over the four years of the study, people who consumed more than one soft drink of any kind a day were 44 percent more likely to develop metabolic syndrome than those who didn’t drink a soda a day.

That sound you hear is the collective groaning of Diet Coke addicts all over the world.

He Is Not Really Dead

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The latest issue of Newsweek has an interesting article called Back From the Dead. Some of you may be aware that I spent seven years working as a CPR and First Aid Instructor so these sorts of articles are of interest to me.

This is a story about what happens when your heart stops: about new research into how brain cells die and how something as simple as lowering body temperature may keep them alive—research that could ultimately save as many as 100,000 lives a year. And it’s about the mind as well, the visions people report from their deathbeds and the age-old questions about what, if anything, outlives the body. It begins with a challenge to something doctors have always been taught in medical school: that after about five minutes without a pulse, the brain starts dying, followed by heart muscle—the two most voracious consumers of oxygen in the body, victims of their own appetites. The emerging view is that oxygen deprivation is merely the start of a cascade of reactions within and outside the cells that can play out over the succeeding hours, or even days. Dying turns out to be almost as complicated a process as living, and somehow, among its labyrinthine pathways

I find this to be fascinating. Not unlike so many others I have wondered what happens when you die. Where does your mind go? Do you feel any pain? Do you have any understanding of what is happening? Do you go off into the next whatever with the words, sounds and noises of those that were around you?

Becker’s interest in mitochondria reflects a new understanding about how cells die from loss of circulation, or ischemia. Five minutes without oxygen is indeed fatal to brain cells, but the actual dying may take hours, or even days. Doctors have known for a long time that the consequences of ischemia play out over time. “Half the time in cardiac arrest, we get the heart going again, blood pressure is good, everything is going along,” says Dr. Terry Vanden Hoek, director of the Emergency Resuscitation Center at the University of Chicago, “and within a few hours everything crashes and the patient is dead.” It took some time, though, for basic research to supply an explanation. Neumar, working with rats, simulates cardiac arrest and resuscitation, and then examines the neurons at intervals afterward. Up to 24 hours later they appear normal, but then in the next 24 hours, something kicks in and they begin to deteriorate. And Dr. James R. Brorson of the University of Chicago has seen something similar in neural cells grown in culture; deprive them of oxygen and watch for five minutes, or even much longer, and not much happens. “If your car runs out of gas, your engine isn’t destroyed, it just needs fuel,” he says.

Cell death isn’t an event; it’s a process. And in principle, a process can be interrupted. The process appears to begin in the mitochondria, which control the cell’s self-destruct mechanism, known as apoptosis, and a related process, necrosis. Apoptosis is a natural function, destroying cells that are no longer needed or have been damaged in some way. Cancer cells, which might otherwise be killed by apoptosis, survive by shutting down their mitochondria; cancer researchers are looking for ways to turn them back on. Becker is trying to do the opposite, preventing cells that have been injured by lack of oxygen from, in effect, committing suicide.

It’s a daunting problem. “We’re asking the questions,” says one leading researcher, Dr. Norm Abramson of the University of Pittsburgh. “We just haven’t found the answers.” Until recently, the conventional wisdom was that apoptosis couldn’t be stopped once it was underway. It proceeds by a complex sequence of reactions—including inflammation, oxidation and cell-membrane breakdown—none of which seems to respond to traditional therapies. Becker views cell death in cardiac arrest as a two-step process, beginning with oxygen deprivation, which sets up the cell for apoptosis; then the heart starts up again and the patient gets a lungful of oxygen, triggering what is called reperfusion injury. The very substance required to save the patient’s life ends up injuring or killing him.

I truly do not fear death. How can I fear it? I don’t really know anything about it. Don’t misunderstand, I don’t want to die. When I said that I want to live for a thousand years it is because I have so many interests. There is so much to do and so very little time.

To quote my grandfather I’ll fight for every last breath because I can and because I am. It doesn’t have to make sense to you, but it does to me.

My children are a huge part of my interest in living. It is not just because I can’t imagine not being there for them but because I am intensely curious about who they are going to become. When they grow up who will they be. What will they do and with whom?

Anyway, I think that the article is quite interesting. Give it a read.

Walgreens- Unfair Pricing

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Over at the Freakonomics blog they have a post that is quite disturbing.

Many of his patients, he explained, must pay for their drugs out-of-pocket, and yet even the generic drugs at pharmacy chains like Walgreens, Eckerd, and CVS could cost them dearly.

So Wolf began snooping around and found that two chains, Costco and Sam’s Club, sold generics at prices far, far below the other chains. Even once you factor in the cost of buying a membership at Costco and Sam’s Club, the price differences were astounding. Here are the prices he found at Houston stores for 90 tablets of generic Prozac:

Walgreens: $117

Eckerd: $115

CVS: $115

Sam’s Club: $15

Costco: $12

Those aren’t typos. Walgreens charges $117 for a bottle of the same pills for which Costco charges $12.

I was skeptical at first. Why on earth, I asked Wolf, would anyone in his right mind fill his generic prescription at Walgreen’s instead of Costco?

His answer: if a retiree is used to filling his prescriptions at Walgreens, that’s where he fills his prescriptions — and he assumes that the price of a generic drug (or, perhaps, any drug) is pretty much the same at any pharmacy. Talk about information asymmetry; talk about price discrimination.

Read the whole story.

Chest presses, not breaths, help CPR

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In a different life I spent a number of years teaching CPR and First AID .

Chest compression — not mouth-to-mouth resuscitation — seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.

A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday’s issue of the medical journal The Lancet.

More than a year ago, the
American Heart Association revised CPR guidelines to put more emphasis on chest presses, urging 30 instead of 15 for every two breaths given. Stopping chest compressions to blow air into the lungs of someone who is unresponsive detracts from the more important task of keeping blood moving to provide oxygen and nourishment to the brain and heart.

Another big advantage to dropping the rescue breaths: It could make bystanders more willing to provide CPR in the first place. Many are unwilling to do the mouth-to-mouth part and become flummoxed and fearful of getting the ratio right in an emergency.

Sudden cardiac arrest — when the heart suddenly stops beating — can occur after a heart attack or as a result of electrocution or near-drowning. It’s most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.

In the new study, researchers led by Dr Ken Nagao of Surugadai Nihon University Hospital in Tokyo analyzed 4,068 adult patients who had cardiac arrest witnessed by bystanders. Of those, 439 received chest compressions only from bystanders, and 712 received conventional CPR — compressions and breaths.

Any CPR attempt improved survival odds. However, 22 percent of those who received just chest compressions survived with good neurological function compared with only 10 percent of those who received combination CPR.

Click here to read the whole story.

Regrow Lost Limbs

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This article is pretty cool.

NEW YORK – Researchers are trying to find ways to regrow fingers — and someday, even limbs — with tricks that sound like magic spells from a
Harry Potter novel.There’s the guy who sliced off a fingertip but grew it back, after he treated the wound with an extract of pig bladder. And the scientists who grow extra arms on salamanders. And the laboratory mice with the eerie ability to heal themselves.

This summer, scientists are planning to see whether the powdered pig extract can help injured soldiers regrow parts of their fingers. And a large federally funded project is trying to unlock the secrets of how some animals regrow body parts so well, with hopes of applying the the lessons to humans.

Take a look at this:

Up to about age 2, people can consistently regrow fingertips, says Dr. Stephen Badylak, a regeneration expert at the University of Pittsburgh. But that’s rare in adults, he said.

Spievack, however, did have a major advantage — a brother, Alan, a former Harvard surgeon who’d founded a company called ACell Inc., that makes an extract of pig bladder for promoting healing and tissue regeneration.

It helps horses regrow ligaments, for example, and the federal government has given clearance to market it for use in people. Similar formulations have been used in many people to do things like treat ulcers and other wounds and help make cartilage.

The summer before Lee Spievack’s accident, Dr. Alan Spievack had used it on a neighbor who’d cut his fingertip off on a tablesaw. The man’s fingertip grew back over four to six weeks, Alan Spievack said.

Lee Spievack took his brother’s advice to forget about a skin graft and try the pig powder.

Soon a shipment of the stuff arrived and Lee Spievack started applying it every two days. Within four weeks his finger had regained its original length, he says, and in four months “it looked like my normal finger.”

Spievack said it’s a little hard, as if calloused, and there’s a slight scar on the end. The nail continues to grow at twice the speed of his other nails.

“All my fingers in this cold weather have cracked except that one,” he said.

All in all, he said, “I’m quite impressed.”

For the full story please click here.