Breathe of life 

A revolutionary breath analysis machine is going on trial in a clinical environment for the first time and shows promise as a device that could be seen in every GP’s surgery as a standard means of diagnosis. 

The invention of Professor David Smith and Professor Patrik Spanel from Keele University’s Institute for Science and Technology in Medicine, in Staffordshire, UK is a revolutionary technique known as SIFT-MS, which works by measuring trace gases or metabolites present in the breath. 

It is so sensitive that it is capable of detecting a single molecule amid several billion molecules of air, infinitely more sensitive than a standard breathalyser used for alcohol testing. 

The technique has two major advantages over other ways of diagnosing illnesses: it is non-invasive, the patient simply breathes into a tube, making it particularly useful in paediatric medicine; and the results are available online and in real time, so the doctor can get a read out immediately. 

Initially it will be used to study the breath of patients with renal disease, and help to identify how effective their treatment is; another key area where it will be used is in the study of children with respiratory illnesses like asthma and cystic fibrosis. 

Prof Spanel said: “Already we can detect maybe 10 different metabolites present in breath of people, like ammonia, asotome, isoprene, or some metabolites that are a clear marker of some disease like hydrogen cyanide and even these can actually serve as valuable markers of various conditions when they are elevated outside the normal range.” 

The sheer size of the machinery required was one of the limitations in developing this technique in the past, but now its down to a manoeuvrable size, and they think it could be reduced further in the future to the equivalent of a shoe box which could make wider distribution possible. Prof Smith said: “A major move would be into primary care, that is in the GP’s surgery for screening the population for diseases such as diabetes, for example. 

A breath test for asitome for example will pick this up in its early stage. Imagine a small instrument in a GP’s surgery and any patient that came through could be measured whether they’re suspected or not of having this disease.” 



Asthma study
Imperial College London and Ludwig-Maximilians- Universität (LMU) Munich are to take the lead in a Euro11 million (£8 million) study to examine how genetics and environment influence the development of asthma in Europe. 

The GABRIEL project, funded through an EC Framework 6 grant, involves over 150 scientists from 14 European countries and Russia, using the latest research across a variety of disciplines, including genetics, epidemiology and immunology, to identify key factors in the development of asthma bronchiale.

The project will test genetic factors in over 40,000 subjects with childhood or adult asthma, with data from environmental factors such as tobacco smoke, air pollution, nutrition, allergen exposure and industrial agents.

Professor Bill Cookson, from Imperial College London, and co-ordinator of the study, said: “We hope this study will help us identify just how genes and the environment cause the development of asthma, identifying both risk and protective factors, with the long-term aim of preventing the illness.” 

Professor Erika von Mutius from LMU Munich and co-leader of the project added: “Previous studies have shown the causes of asthma are incredibly diverse with a huge number of genetic and environmental factors all potentially having an impact.

Traditionally it has been hard to analyse all the genetic and environmental information but the latest developments in areas such as genomics and bioinformatics now allow us to analyse this huge and complicated amount of data.” As well as looking at genetic and environmental interactions, GABRIEL will study the molecular basis for environmental factors which can increase the risk of industrial asthma.

It will also identify the agents which protect strongly against asthma in rural and farming communities and use genetics, genomics and proteomics to discover novel genetic and microbial factors that cause or protect against asthma. 



Dialysis exercise 

A new Queen’s, Canada, study suggests that patients who exercise while hooked up to dialysis show better results in clearing toxins and increasing overall physical stamina. 

A five-month, low-intensity exercise intervention study of dialysis patients was recently carried out by Rehabilitation Therapy professor Cheryl King- VanVlack, member of the Cardiac, Circulation and Respiratory (CCR) group at Queen’s, and a group of researchers from Queen’s and Kingston General Hospital. 

Results of the study, published in the May issue of the American Journal of Physical Medicine and Rehabilitation, show that exercise during the process of dialysis increases by 20% the removal of urea, one of the toxins collected in the body between dialysis sessions. 

This indicates that exercise during dialysis can enhance the treatment. 



Skin stem cells 

Researchers at The Hospital for Sick Children (SickKids), Toronto, Canada, and the University of Calgary have found that stem cells derived from adult skin can create neural cell types that can be transplanted into and function in mouse models of disease. 

This research is reported in the 14 June 2006 issue of The Journal of Neuroscience. SickKids researchers previously discovered what type of cells can be made from these stem cells (called skinderived precursors, or SKPs) based on the role played by neural-crest stem cells during embryogenesis. 

In addition to generating the peripheral nervous system, neural crest stem cells generate other tissues such as bone, cartilage, some types of muscle, and even part of the heart. 

In The Journal of Neuroscience paper, the research team found that SKPs can efficiently generate a type of glial cell, called Schwann cells, that can myelinate demyelinated axons (part of a neuron), and that have been shown to provide a good growth environment for injured central nervous system axons. These types of axons normally do not regenerate. 

“Schwann cells have been proposed as a cell type for treatment of nerve injuries, demyelination disorders such as multiple sclerosis, and even spinal cord injury,” said Dr Freda Miller, the study’s principal investigator, a senior scientist in Developmental Biology in the SickKids Research Institute, a professor of Molecular and Medical Genetics, and Physiology at the University of Toronto and Canada Research Chair in Developmental Neurobiology. 

“Our finding that we can efficiently generate and isolate these Schwann cells from SKPs raises the possibility that we could treat humans with Schwann cells derived from human skin stem cells, and perhaps even use the patient’s own skin to generate Schwann cells for treatment.” 



Siemens £300m deal 

Siemens has been awarded a contract to supply the latest medical technology to Barts Hospital and The Royal London Hospital for 35 years.

The deal, worth more than £300 million (US$547m), will involve Siemens supplying state-ofthe- art diagnostic and treatment technology in the radiology, cardiology and oncology departments of the two hospitals. 

Siemens will begin installing equipment in late 2009 and will be responsible for ensuring the hospitals have the latest technology until 2045. 

Barts will become a Cancer and Cardiac Centre of Excellence with the bulk of care provided in a new eight-storey, state-of-the-art facility. Most of the services currently provided at The London Chest Hospital in Bethnal Green will also move to Barts. 

Clinical services at The Royal London, including London’s leading trauma centre, the capital’s second biggest children’s hospital and one of Europe’s largest renal units, will be brought together in a new landmark 18-storey building. 

The redevelopment programme – Britain’s biggest hospital redevelopment – will transform The Royal London and Barts completely. 



Internet addiction 

The Internet – millions of people rely on it for everyday tasks. But when is the line crossed between average use and addiction? 

An article published in Perspectives in Psychiatric Care states: “The Internet has properties that for some individuals promote addictive behaviours and pseudointimate interpersonal relationships.” 

Nurse practitioners will soon find themselves faced with the issues of “Internet addicts” and their inability to get offline. While not yet defined as a true addiction, many are suffering the consequences of obsession with the online world, unable to control their use. 

From gaming to sexual and emotional relationships, the internet is taking over lives. More and more people will be confronted with consequences such as divorce and physical symptoms which will force them to seek both medical and psychological treatment. 

Some physical symptoms include “cyber shakes,” dry eyes, carpal tunnel syndrome and headaches. “A focus on the computer and lack of attention to daily reality is indicative of poor judgment and results on lowered grades in school, job loss, and indebtedness.” 

Recognising this as an addiction will allow for appropriate treatment. Subsequently, therapists will be faced with how to treat such technological addictions and their associated issues. 



Listerosis antibiotic 

A team of researchers working at the University of Bristol, UK, has found that the antibiotic, fosfomycin, can treat Listeria in the body, despite it being ineffective in laboratory conditions. Listeriosis is a deadly form of food poisoning. 

Their work is reported in Nature Medicine. Because it was not effective in the laboratory, this drug has never been considered for the treatment of listeriosis, in spite of it reaching the infection sites more effectively than other antibiotics. 

Professor Jose Vazquez- Boland who led the research group said: “Our results illustrate that antibiotic resistance in the laboratory does not always mean that the drug will not work in the infected patient. 

This work brings some optimism to the highly worrying problem of the increasing resistance to antibiotics.” The Listeria bacteria causes the food-borne disease, listeriosis. It often triggers a brain infection and kills up to 30% of those affected. 



Headache or TMJD? 

People whose recurrent headaches have been diagnosed as tension-related actually may be suffering from temporomandibular muscle and joint disorder, or TMJD, a study headed by a researcher from New York’s University at Buffalo’s (UB) School of Dental Medicine has shown. 

Results showed that examiners could replicate tension-headache symptoms in 82% of subjects by performing the clinical examination of the temporalis muscle, which is involved in TMJD.

Richard Ohrbach, DDS, PhD, UB associate professor in the Department of Oral Diagnostic Sciences, presented the study results at the American Association of Dental Research meeting held recently in Orlando, Florida, US. 

“Knowledge about the intersection between jaw pain and headache is not well established, and consequently, jaw pain may be ignored in the differential diagnosis,” Ohrbach added. 

“This can be most unfortunate for the individual, because TMJD can be very treatable, but if a jaw disorder is ignored, then treatment for the headache may not address all of the factors contributing to the headache.” 

The study is part of an US$8 million project to establish valid and reliable TMJD diagnostic criteria. Results will advance the field of TMJD research and aid clinicians in their practices. 



Hypertension 

On World Hypertension Day on 13 May, the results of a global hypertension survey were announced, uncovering alarming gaps between current and recommended hypertension management, and important insights into physician awareness of the importance of blood pressure goal achievement.

In response to the Close The Gap survey findings, the World Hypertension League (www.worldhypertensionleague.org) is supporting a call for better awareness of the importance of high blood pressure patients reaching the internationally- recognised goal of 140/90mmHg or lower. 

At the moment, around 50-70% of the one billion people with high blood pressure worldwide remain above this goal, leaving them at significant risk of coronary artery disease, heart failure, stroke, vascular and kidney damage. 

Dr Claude Lenfant, President of the World Hypertension League, commented on the survey findings: “Viewed simply, for every 20/10mmHg rise in blood pressure above this level, the risk of death from cardiovascular problems doubles. 

International guidelines have set a clear goal – every patient with hypertension needs to have their blood pressure reduced to 140mmHg or below”. The Close The Gap survey, conducted with 1,259 primary care physicians across 17 countries, compared physicians’ perceptions against the reality of current hypertension management. 

Encouragingly, the findings confirmed that most physicians are aware of the recommended blood pressure goal for hypertension patients (140/90mmHg), and that the vast majority (96%) know treating patients to blood pressure goal significantly reduces their risk of cardiovascular disease.

However, the survey also showed that over 40% of physicians would be satisfied to reduce patients’ blood pressure to an “acceptable level” only, rather than fully to the recommended goal. 

Examining physician views on treatment options, the survey revealed that physicians believe combination therapy would get more of their patients to goal, with 71% indicating they would give patients combination therapy if not reaching goal on monotherapy. 

However, recent studies show that fewer than 20% of uncontrolled monotherapy patients are switched to combination therapy during follow-up visits. Additionally, whilst the vast majority of physicians (96%) recognised hyperten sion is one of the most important cardiovascular conditions, only 54% cited it as one of the most challenging cardiovascular conditions to manage.

This suggests that some physicians may currently underestimate what is involved in successfully getting all hypertension patients to goal, and may help explain why the number of patients not at goal worldwide is so high. 



AIDS eastern Europe 

The first HIV/AIDS conference on Russia, eastern Europe and Central Asia held in Moscow concluded on 17 May with a call for greater leadership and commitment in mitigating the pandemic’s spread in the region. 

“The message was that there is considerable seriousness in terms of HIV/AIDS in the region,” Christoph Benn, External Relations Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said from Moscow. 

The epidemic continues to grow in eastern Europe and Central Asia, with the number of people living with HIV reaching 1.6 million in 2005. Uzbekistan, Central Asia’s most populous nation, has the highest recorded number of registered HIV/AIDS cases of the five Central Asian republics. 

In 1999, 28 people were diagnosed with the virus – in 2005, 2,016 new infections were reported, bringing the official total to 7,800. Unofficial estimates put the number of infections at around 10 times the official figure. 

The eastern European and Central Asian AIDS conference, attended by over 1,500 representatives from 47 countries, focused on combating AIDS-related stigma and discrimination in the region. 

“A couple of years ago, there was no real willingness [to address the pandemic],” Benn said. “There was discrimination and stigma. This has changed and we see discrimination to a lesser degree now. That is an encouragement, although, it still needs to be further tackled.” 



Cracking the virus code 

UK scientists have cracked one of the key biological processes used by viruses such as HIV and SARS when they replicate according to a paper published in the 11 May issue of the journal Nature. 

Viruses are able to interfere with the host cell processes that our bodies use to replicate cells, and protein synthesis is often one of their targets. For the first time, researchers at the Universities of Cambridge and Oxford have witnessed virus-induced “frameshifting” in action and have been able to identify the crucial role of particular elements. 

The research brings us another step closer to understanding the fundamental workings of these devastating viruses. The scientists have revealed the workings of the process known as ‘ribosomal frameshifting’ that forces a mis-reading of the genetic code during protein synthesis. 

The correct expression of most genes depends upon accurate translation of the ‘frame’ of the genetic code, which has a three nucleotide periodicity. Viruses such as HIV and SARS bring into the cell a special signal that forces the ribosome to back up by one nucleotide, pushing it into another ‘frame’ and allowing synthesis of different viral proteins. 

These are exploited by viruses and help them to survive and multiply. Dr Ian Brierley, the project leader at the University of Cambridge, said: “This collaborative project was set up with Dr Robert Gilbert’s team in Oxford to investigate the structure of a frameshifting ribosome using electron microscopy. 

The images we obtained give us an insight into how a virusencoded RNA pseudoknot can induce frameshifting and may be useful in designing new ways to combat virus pathogens that use this process.” 

                                  
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