What is Life?
It is the flash of a firefly in the night.
It is the breath of a buffalo in the winter time.
It is the little shadow which runs across the grass
and loses itself in the Sunset."
Crowfoot on his deathbed, April 1890
Monday, November 11, 2013
Wednesday, November 6, 2013
Alzheimer's Protection
Some people do brain exercises to stave off this building epidemic...
Studies say fasting twice a week staves off Alzheimer's
By Makiko Kitamura / Bloomberg News
LONDON -- For the past year, Stuart Adams has been fasting twice a week. While he has lost 15 pounds, the real reason he's depriving himself is to stave off brain disorders including schizophrenia and Alzheimer's disease.
"There's a virulent strain of madness running through my family, and I reckoned my chances of going down that route were pretty high," said Mr. Adams, 43, a freelance translator and interpreter in London who learned of a possible link between Alzheimer's and diet while watching a BBC documentary last year. "Anything that could help with that was of great interest."
Because there is no cure for Alzheimer's, which afflicts more than 35 million people, any possibility of prevention holds huge potential.
Mr. Adams was inspired to try the diet last year after the BBC documentary called "Eat, Fast and Live Longer" cited a study in mice that suggested intermittent fasting could delay the onset of cognitive disorders.
The study was led by Mark Mattson, professor of neuroscience at Johns Hopkins University in Baltimore and senior investigator at the U.S. National Institute of Aging. Mr. Mattson is planning a new project to measure how fasting twice a week for two months affects human brain function and early signs of Alzheimer's.
While this and other similar diets are gaining in popularity even as they spawn a steady outpouring of new books on the subject, some experts have doubts.
"This is part of a never-ending carousel of diet books," said Kelly Brownell, former director of the Rudd Center for Food Policy and Obesity at Yale University and now dean of the Sanford School of Public Policy at Duke University.
"There will be some buzz and then the diet will go away, never to be heard of again."
Nonetheless, the studies and the books keep coming. Another examination into the fasting-dementia link will be led by Krista Varady, an associate professor of kinesiology and nutrition at the University of Illinois at Chicago. Her research focuses on alternating a normal diet with eating 500 or 600 calories every other day. Nutritionists recommend men consume about 2,500 calories a day and women 2,000 calories.
While research on fasting diets and dementia still has a long way to go, the early evidence is promising.
The mouse study led by Mr. Mattson found that intermittent fasting may have protected the function of brain cells, even if it didn't reduce levels of the plaque and tangles that are typical signs of Alzheimer's.
At the same time, fasting is increasingly seen as playing a role in the prevention of other diseases including breast cancer and diabetes.
That's paved the way for a flurry of how-to books including Ms. Varady's "The Every-Other-Day Diet," which goes on sale Dec. 24. Competing with that is "The Fast Diet" by science journalist Michael Mosley, who was behind the BBC documentary Mr. Adams watched, and lifestyle writer Mimi Spencer. Their regimen is known as the 5:2 diet.
There's also "The 2-Day Diet" by dietitian Michelle Harvie and Tony Howell, a professor of oncology at the University of Manchester in England. Their approach was developed specifically to help prevent breast cancer, for which obesity is a known risk factor.
Health experts say fasting diets can't substitute for eating healthy foods.
"In general, intermittent fasting is a good thing if it's done properly," said Dean Ornish, a professor of medicine at the University of California at San Francisco and a physician consultant to former President Bill Clinton. "But if you're already eating very healthily, then you may not need to do that."
In a study conducted with Mr. Mattson and published this year, they found the two-day diet led to greater drops in body fat and insulin resistance in women with high breast-cancer risk after three months, compared with a diet where calories are cut every day, suggesting that intermittent fasting is an easier approach to follow.
The bottom line, though, is that any fasting diet needs to be undertaken thoughtfully, including eating healthy foods on non-fasting days, Ms. Harvie said.
Link: http://www.post-gazette.com/news/healthscience/2013/11/03/Studies-say-fasting-twice-a-week-staves-off-Alzheimer-s/stories/201311030147
Prostate Diseases
2013 Annual Report on Prostate Diseases
Most men eventually develop some type of prostate problem, and
when they do there are usually no easy solutions. The three most common
prostate problems are benign prostatic hyperplasia (BPH), prostatitis,
and prostate cancer. Men with the same condition and symptoms might
opt for very different treatments — or choose to do nothing at all.
A number of exciting new treatment options have emerged for prostate diseases, including new medications and refined surgical techniques. But daunting challenges remain. A major disappointment has been in the area of chemoprevention — an approach that uses drugs or supplements to try to reduce risk of prostate cancer. Two leading contenders — 5-alpha reductase inhibitors and vitamin E supplements — not only don’t seem to prevent prostate cancer but actually may increase risk of developing it. And in a major development, the U.S. Preventive Services Task Force has recommended against routine prostate-specific antigen (PSA) screening — arguing that for most men screening does not save lives and causes more harm than benefit.
That’s why this unique publication is more than a primer on prostate conditions; it includes roundtable discussions with experts at the forefront of prostate research, interviews with patients about their treatment decisions, and the latest thinking on complementary therapies.
The goal of this publication is not to relate easy answers. Rather, our mission is to provide you with the information you need to understand the current controversies, avoid common pitfalls, and work with your doctor to make informed choices about your prostate health.
Prepared by the editors of Harvard Health Publications in consultation with Marc B. Garnick, M.D., Clinical Professor of Medicine, Harvard Medical School, and Hematology/Oncology Division, Beth Israel Deaconess Medical Center. 136 pages. (2013)
A number of exciting new treatment options have emerged for prostate diseases, including new medications and refined surgical techniques. But daunting challenges remain. A major disappointment has been in the area of chemoprevention — an approach that uses drugs or supplements to try to reduce risk of prostate cancer. Two leading contenders — 5-alpha reductase inhibitors and vitamin E supplements — not only don’t seem to prevent prostate cancer but actually may increase risk of developing it. And in a major development, the U.S. Preventive Services Task Force has recommended against routine prostate-specific antigen (PSA) screening — arguing that for most men screening does not save lives and causes more harm than benefit.
That’s why this unique publication is more than a primer on prostate conditions; it includes roundtable discussions with experts at the forefront of prostate research, interviews with patients about their treatment decisions, and the latest thinking on complementary therapies.
The goal of this publication is not to relate easy answers. Rather, our mission is to provide you with the information you need to understand the current controversies, avoid common pitfalls, and work with your doctor to make informed choices about your prostate health.
Prepared by the editors of Harvard Health Publications in consultation with Marc B. Garnick, M.D., Clinical Professor of Medicine, Harvard Medical School, and Hematology/Oncology Division, Beth Israel Deaconess Medical Center. 136 pages. (2013)
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why men have deep voices
Roar of the rutting stag: why men have deep voices
Saturday, October 05, 2013 4:06 PM
The behaviour of rutting stags helps explain why men have evolved descended larynges
It's the rutting season. From Richmond Park to the Isle of Rum, red deer hinds will be gathering, and the stags that have spent the past 10 months minding their own business in bachelor groups are back in town, with one thing on their minds. A mature male that has netted himself a harem is very dedicated. He practically stops eating, focusing instead on keeping his hinds near and his competitors at bay. If you're a red deer stag, one of the ways you make sure that your adversaries know you mean business – and that you're big – is roaring. And you don't let up. You can keep roaring all day, and through the night too, twice a minute, if necessary.
While female red deer prefer the deeper roars of larger stags, roaring also appears to be part of how stags size one another up, before deciding whether or not to get engaged in a full-on physical fight. Most confrontations are settled without locking antlers. In male red and fallow deer, the voicebox or larynx is very low in the throat – and gets even lower when they roar.
Strap-like muscles that attach to the larynx contract to drag it down towards the breastbone – lengthening the vocal tract and deepening the stag's roar.
Deepening the voice exaggerates body size.
Over generations, stags with deeper roars presumably had more reproductive success, so the position of the larynx moved lower and lower in the neck. When a red deer stag roars his larynx is pulled down so far that it contacts the front of his breastbone – it couldn't get any lower.
In human evolution, much is made of the low position of the larynx in the neck. So much, in fact, that it has been considered to be a uniquely human trait, and intrinsically linked to that other uniquely human trait: spoken language.
But if red and fallow deer also have low larynges, that means, first, that we're not as unusual as we like to think we are, and second, that there could be other reasons – that are nothing to do with speaking – for having a descended larynx.
The relative position of the larynx tends to be lower in men than in women, and as far as speaking goes, this may actually be a disadvantage. The human female vocal tract is capable of making a larger range of discrete vowel sounds than the male. It's safe to assume that the comparatively low position of the male voicebox hasn't evolved to improve the production of intelligible speech.
But when we listen to someone speaking, we gain far more information than is contained in just the words themselves. Even though we may not always be aware of it, we size people up by their voices. The deep human male voice, exaggerating body size just as it does in stags, could have come about because women found men with low voices more attractive – perhaps we could call this the "Barry White effect".
This isn't just idle speculation; a recent study from the University of Aberdeen found that women expressed a preference for deep voices. It also turned out that women tended to remember information better when they'd been told it by a man with a low voice.
But it could also be that men, like stags, have evolved low voices in order to deter sexual competitors. In support of this idea, it's been found that men modulate the pitch of their voices when they're in competition with one another, as revealed by a dating game, played in the interests of science, at the University of Pittsburgh. Male students were pitted against an unseen male rival in order to win a date. Each participant had a conversation with the adversary, so they had an opportunity to "size him up".
The results of those conversations were fascinating: participants who believed themselves to be more physically dominant than their rival lowered their voices. But students who thought they were less dominant raised their voices to a higher pitch. The men were sizing each other up, just like rutting stags. But they were also changing their voices in a way that suggests they were – without being aware of it – managing the confrontation to avoid conflict. A man who thought he was more dominant lowered his voice to emphasize his dominance and intimidate his competitor. A man who thought he was likely to lose the game, just by listening to his adversary, spoke in a higher voice: don't bother fighting me – you've won, mate.
The low voice of men, like stags, is a trait that probably evolved through sexual selection.
This isn't just about being attractive to the opposite sex, it's also about beating same-sex rivals. A deep voice may prove an advantage in both cases, helping a man to exclude other, apparently less dominant men, from the mating game, as well as making him more attractive to the opposite sex.
A win-win situation.
Unless, of course, you're a well-built man with a mellifluous tenor voice, who's bucked the trend, or a woman who prefers Justin Timberlake or John Lennon to Jim Morrison or Eddie Vedder.
This is biology, after all – variability is what makes it so interesting.
Evolution
Animal behaviour
Dating
Biology
Alice Roberts
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Link: http://www.theguardian.com/theobserver/new-review/discover/rss
Sunday, September 8, 2013
Saturday, August 31, 2013
Sunday, August 18, 2013
Wednesday, July 31, 2013
Fatigue in M.S.
by DR. KURT WOELLER on DECEMBER 5, 2012
Fatigue as defined by Webster’s medical dictionary is as follows:
- weariness or exhaustion from labor, exertion, or stress, and the temporary loss of power to respond induced in a sensory receptor or motor end organ by continued stimulation. Essentially, fatigue is the lack/loss of energy needed to maintain normal function – whether it is temporary or chronic.
According to estimates from the Centers for Disease Control approximately 25,000 million Americans suffer from severe fatigue (lasting longer than one month). We all experience fatigue from time to time, but the devastating problem of persistent fatigue is the inability to carry on normal daily activities essential for health, family and livelihood.
Fatigue is a significant problem in Multiple Sclerosis (MS).
What are the reasons for fatigue in MS?
Is fatigue in MS different than someone with classic Chronic Fatigue Syndrome or a person with another disease condition?
What can be done to help with fatigue in MS?
The list of medical problems that can lead to fatigue is quite lengthy. When a patient presents to a physician with complaint of fatigue the doctor will look for clinical signs of recent illness such as a virus. They may ask questions about sleep habits, diet, issues related to potential depression, unexpected loss of weight, and other associated complaints, such as weakness, headaches, etc. The doctor will usually perform some blood testing for thyroid function (a good reason everyone with MS should have their thyroid assessed via Thyroid Stimulating Hormone, Free T3 and Free T4 levels), anemia (either iron and/or vitamin B12 and folate), metabolic panel looking at electrolytes such as sodium, potassium, and chloride, blood sugar (to rule out hypoglycemia or diabetes), and a complete blood count (to evaluate immune function).
However, in MS a person’s fatigue is often not caused by anemia or blood sugar problems (although it is important to check).
The fatigue manifests at a much deeper level, in part from the cellular machinery called the mitochondria, as well as the associated immune dysfunction that defines the disease.
Mitochondria are our cells energy factories. They produce a tremendous amount of energy currency needed by the body, i.e. brain, heart, muscles to function properly.
Mitochondria receive nutrients from our diet, as well as oxygen from the air we breathe to burn fuel (proteins and fats) for energy production.
Deficits in certain nutrients like CoQ10 can leave the mitochondria vulnerable to malfunction.
Certain nutrients have been shown to help some people with fatigue such as L-Carnitine (helps to transport fat into the cell as a fuel source – 500mg to 1000mg daily), CoQ10 (supports the inner workings of the mitochondria – 200mg to 300mg daily), NADH (necessary for mitochondria activity – 5mg to 10mg daily), and Ribose (needed for energy production – 5g to 10 g daily).
Another possible link for fatigue in MS has to do with a deficiency of cyclic AMP (cAMP). cAMP is a cellular messenger responsible for a variety of functions such as stimulating myelin production (protective coating around nerve cells that is damaged in MS) and helping to maintain the blood brain barrier (damaged in MS which can lead to brain inflammation).
One brain structure responsible for cAMP production is the Pineal Gland. The pineal gland is best known for its role in sleep regulation through the production of melatonin. The pineal receives input from a chemical called Histamine 2 which has been found to be deficient in MS. Without adequate H2 people suffer many of the common problems seen in MS including fatigue, heat intolerance, digestive problems, symptoms of allergy, hormone imbalances, i.e. thyroid, poor sleep.
A therapy called Prokarin has shown benefit for many individuals with MS. Prokarin positively influences the histamine 2 system in the body with improvements in symptoms such as fatigue and weakness.
There is much to discuss with respects to these important biochemical systems and how they related to MS. I will discuss Prokarin therapy and other related topics seen in MS in future writings.
Dr. Kurt N. Woeller About the author: Dr. Kurt N. Woeller, D.O. is the medical director for Sunrise Complementary Medical Center in California, as well as two online patient-physician access websites – www.AskTheDoctor-MS.com and www.AutismActionPlan.com. He has been a complementary and integrative medical specialist since 1998 helping individuals with chronic illness including Multiple Sclerosis, Autism, Chronic Fatigue, Autoimmune Disorders, etc. who are interested in integrative (traditional and natural medicine) medical options for their condition. Dr. Woeller is available for Q&A’s regarding natural and complementary medicine options for Multiple Sclerosis at AskTheDoctor-MS. You can also learn more about Dr. Woeller’s consultation services, books, websites, etc. at Dr.Woeller.com.
Source: http://msrelief.com/2012/12/05/multiple-sclerosis-and-fatigue-why-are-you-so-tired/
All health and health-related information contained within this website are intended to be general in nature and does not reflect any and/or all treatment options. The web site is an educational tool and should not be used as a substitute for a visit with a health care professional.
Monday, July 29, 2013
Wednesday, July 17, 2013
The Crack-Up Book
by
Charles Barber
The Crack-Up Book
Posted: 06/26/2013 9:50 am
"In a real dark night of the soul, it is always three o'clock in the morning, day after day."
That is how F. Scott Fitzgerald described his mental state in a series of essays called
The Crack-Up, published in 1936, a few years before he died.
The Crack-Up was Fitzgerald's description of his own experience with depression and alcoholism, and obliquely, his wife Zelda's bipolar disorder.
Yet nowhere in the essays are such psychiatric terms used. Instead, Fitzgerald uses metaphor and poetry. He writes that he "cracked like an old plate," and lived in a state of emotional bankruptcy in a world of "dangerous mist" and "villainous feeling." He sums up the last, lost decade of his life: there had been "too much anger and too many tears."
Thankfully Fitzgerald was writing before the publication of the American Psychiatric Association's diagnostic manuals, the fifth edition of which, the DSM-5, was recently published. Had the DSMs existed, even a writer of Fitzgerald's stature would have been tempted to draw from symptom lists to describe his inner torment in The Crack-Up.
The DSMs have become victims of their own success. To be sure, the DSM-3, published in 1980, was a necessary step forward for the psychiatric world. Earlier manuals were steeped in unclear Freudianisms with little consistency in the language of even basic psychiatric diagnoses. Doctors, and perhaps more importantly, insurance companies, had no way to talk to one another. DSM-3 became quite unexpectedly a runaway success, a best seller. (The last version made $100 million for the APA.) But each successive edition seems to have gone haywire, adding over time, hundreds of new diagnoses. Which in turn has led to mass over-diagnosing and over-medicating.
A central problem is that the DSM's diagnoses are categorical, rather than dimensional. That is, to qualify for one of the 400 or so diagnoses in today's manual, one has to meet sharply drawn criteria. The DSMs have set up diagnosis as a light switch that is either on or off. But psychiatric conditions are not absolute and differ wildly in intensity from person to person. A dimensional perspective -- like that of a dimmer switch, as psychologist Simone Hoermann has put it -- more accurately reflects the realities of psychiatric suffering.
The result is a mass confusion between severe and persistent mental illness -- the truly mentally ill -- and the worried well. Millions of Americans are mistakenly walking around thinking they have a mental illness. One in ten of us in on antidepressants. Since the mass impact of the DSMs, psychiatry has been all off or on (mainly on), with no dimmers.
There are two ways out of this mess. The first is to ignore the DSM-5 entirely and wait until biological psychiatry can be used as a basis for a truly scientific diagnostic system. Thomas Insel, director of the National Institute of Mental Health, did as much recently when he said that NIMH would no longer use the DSM to guide research, favoring instead new categories based on neural circuits and cognitive functioning.
The second approach is to actually listen to patients as they tell their stories and describe what they are feeling. As William Osler, Canadian physician and a pioneer of modern medicine, said a century ago, "Listen to your patient. He is telling you the diagnosis." Besides, listening is good treatment. Research shows unequivocally that the more patients feel understood, the better their satisfaction with treatment. The better their satisfaction with care, the better their compliance and clinical outcomes.
I tell my students, if you want to learn about depression, don't read the DSM. Read The Crack-Up. If you want to understand grief, read Joan Didion's The Year of Magical Thinking. If you want to know about Post-Traumatic Stress Disorder, read Wilfred Owen's poetry about World War I. This is how Owen described shell-shocked soldiers (he was one himself) in "Mental Cases":
These are men whose minds the Dead have ravished
... their eyeballs shrink tormented
Back into their brains, because on their sense
Sunlight becomes a bloodsmear; night becomes blood-black ...
Until the biology catches up, we would do well to heed the lessons of the literary and, yes, psychiatric experts -- Fitzgerald and Owen: no categories, all dimension.
Source: http://www.huffingtonpost.com/charles-barber/the-crackup-book_b_3497782.html?utm_hp_ref=books&ir=Books
Charles Barber
The Crack-Up Book
Posted: 06/26/2013 9:50 am
"In a real dark night of the soul, it is always three o'clock in the morning, day after day."
That is how F. Scott Fitzgerald described his mental state in a series of essays called
The Crack-Up, published in 1936, a few years before he died.
The Crack-Up was Fitzgerald's description of his own experience with depression and alcoholism, and obliquely, his wife Zelda's bipolar disorder.
Yet nowhere in the essays are such psychiatric terms used. Instead, Fitzgerald uses metaphor and poetry. He writes that he "cracked like an old plate," and lived in a state of emotional bankruptcy in a world of "dangerous mist" and "villainous feeling." He sums up the last, lost decade of his life: there had been "too much anger and too many tears."
Thankfully Fitzgerald was writing before the publication of the American Psychiatric Association's diagnostic manuals, the fifth edition of which, the DSM-5, was recently published. Had the DSMs existed, even a writer of Fitzgerald's stature would have been tempted to draw from symptom lists to describe his inner torment in The Crack-Up.
The DSMs have become victims of their own success. To be sure, the DSM-3, published in 1980, was a necessary step forward for the psychiatric world. Earlier manuals were steeped in unclear Freudianisms with little consistency in the language of even basic psychiatric diagnoses. Doctors, and perhaps more importantly, insurance companies, had no way to talk to one another. DSM-3 became quite unexpectedly a runaway success, a best seller. (The last version made $100 million for the APA.) But each successive edition seems to have gone haywire, adding over time, hundreds of new diagnoses. Which in turn has led to mass over-diagnosing and over-medicating.
A central problem is that the DSM's diagnoses are categorical, rather than dimensional. That is, to qualify for one of the 400 or so diagnoses in today's manual, one has to meet sharply drawn criteria. The DSMs have set up diagnosis as a light switch that is either on or off. But psychiatric conditions are not absolute and differ wildly in intensity from person to person. A dimensional perspective -- like that of a dimmer switch, as psychologist Simone Hoermann has put it -- more accurately reflects the realities of psychiatric suffering.
The result is a mass confusion between severe and persistent mental illness -- the truly mentally ill -- and the worried well. Millions of Americans are mistakenly walking around thinking they have a mental illness. One in ten of us in on antidepressants. Since the mass impact of the DSMs, psychiatry has been all off or on (mainly on), with no dimmers.
There are two ways out of this mess. The first is to ignore the DSM-5 entirely and wait until biological psychiatry can be used as a basis for a truly scientific diagnostic system. Thomas Insel, director of the National Institute of Mental Health, did as much recently when he said that NIMH would no longer use the DSM to guide research, favoring instead new categories based on neural circuits and cognitive functioning.
The second approach is to actually listen to patients as they tell their stories and describe what they are feeling. As William Osler, Canadian physician and a pioneer of modern medicine, said a century ago, "Listen to your patient. He is telling you the diagnosis." Besides, listening is good treatment. Research shows unequivocally that the more patients feel understood, the better their satisfaction with treatment. The better their satisfaction with care, the better their compliance and clinical outcomes.
I tell my students, if you want to learn about depression, don't read the DSM. Read The Crack-Up. If you want to understand grief, read Joan Didion's The Year of Magical Thinking. If you want to know about Post-Traumatic Stress Disorder, read Wilfred Owen's poetry about World War I. This is how Owen described shell-shocked soldiers (he was one himself) in "Mental Cases":
These are men whose minds the Dead have ravished
... their eyeballs shrink tormented
Back into their brains, because on their sense
Sunlight becomes a bloodsmear; night becomes blood-black ...
Until the biology catches up, we would do well to heed the lessons of the literary and, yes, psychiatric experts -- Fitzgerald and Owen: no categories, all dimension.
Source: http://www.huffingtonpost.com/charles-barber/the-crackup-book_b_3497782.html?utm_hp_ref=books&ir=Books
Stem-Cell Transplants Erase HIV In Two Men
Stem-Cell Transplants Erase HIV In Two Men
Two cancer patients in Boston no longer show any evidence of HIV infection, researchers announce.
By Rose Pastore
Posted 07.03.2013
Atomic Model of an HIV Capsid Courtesy of TCBG-UIUC
Two men with HIV seem to have been cleared of the virus after receiving stem-cell transplants to treat their lymphoma, scientists announced Wednesday at an International AIDS Society conference in Kuala Lumpur. One of the men has now been off of antiretroviral therapy for 15 weeks; the other stopped taking HIV-suppressing drugs seven weeks ago.
Doctors have been unable to detect HIV infection in the two men since they received the stem-cell therapy, though it is too early to be certain that the virus has completely disappeared from their bodies, according to Timothy Henrich, a physician and researcher at Harvard Medical School and Brigham and Women's Hospital in Boston.
The cases of these two men differ from that of Timothy Ray Brown, the first person to be cured of HIV, in a significant way: The so-called Berlin patient received a bone-marrow transplant to treat leukemia in 2007, using stem cells from a donor with a rare genetic mutation that makes people resistant to HIV, Reuters reports. The stem cells transplanted into the two Boston patients did not have that genetic mutation.
These patients, one of whom was infected as an infant and the other during the early years of the AIDS epidemic, are also unlike the baby girl who was recently cured of HIV. The infant in Mississippi was treated with antiretroviral therapy hours after her birth, and her cure is considered a "functional cure" because, while the virus is no longer replicating in her body, some tests revealed...
Atomic Model of an HIV Capsid Courtesy of TCBG-UIUC
Two men with HIV seem to have been cleared of the virus after receiving stem-cell transplants to treat their lymphoma, scientists announced Wednesday at an International AIDS Society conference in Kuala Lumpur. One of the men has now been off of antiretroviral therapy for 15 weeks; the other stopped taking HIV-suppressing drugs seven weeks ago.
Doctors have been unable to detect HIV infection in the two men since they received the stem-cell therapy, though it is too early to be certain that the virus has completely disappeared from their bodies, according to Timothy Henrich, a physician and researcher at Harvard Medical School and Brigham and Women's Hospital in Boston.
The cases of these two men differ from that of Timothy Ray Brown, the first person to be cured of HIV, in a significant way: The so-called Berlin patient received a bone-marrow transplant to treat leukemia in 2007, using stem cells from a donor with a rare genetic mutation that makes people resistant to HIV, Reuters reports. The stem cells transplanted into the two Boston patients did not have that genetic mutation.
These patients, one of whom was infected as an infant and the other during the early years of the AIDS epidemic, are also unlike the baby girl who was recently cured of HIV. The infant in Mississippi was treated with antiretroviral therapy hours after her birth, and her cure is considered a "functional cure" because, while the virus is no longer replicating in her body, some tests revealed...
Sunday, July 14, 2013
Cancer - The Forbidden Cures
Massimo Mazzucco (born 20 July 1954 in Turin) is an Italian filmmaker who is known for producing documentary films such as The New American Century and Cancer -The Forbidden Cures.
Mazzucco is also the editor of luogocomune.net, an Italian news site known especially for discussing conspiracy theories regarding the September 11 WTC attacks.
http://en.wikipedia.org/wiki/Massimo_Mazzucco
Link: http://youtu.be/gWLrfNJICeM
Thursday, July 11, 2013
Saturday, June 29, 2013
Alcohol Addiction Relapse
Alcohol Addiction Relapse Might Be Thwarted By Turning Off Brain Trigger
By Jennifer O'Brien on June 23, 2013
Researchers at the Ernest Gallo Clinic and Research Center at UC San Francisco have been able to identify and deactivate a brain pathway linked to memories that cause alcohol cravings in rats, a finding that may one day lead to a treatment option for people who suffer from alcohol abuse disorders and other addictions.
.
In the study, researchers were able to prevent the addicted animals from seeking alcohol and drinking it, the equivalent of relapse.
“One of the main causes of relapse is craving, triggered by the memory by certain cues – like going into a bar, or the smell or taste of alcohol,” said lead author Segev Barak, PhD, at the time a postdoctoral fellow in the lab of co-senior author Dorit Ron, PhD, a Gallo Center investigator and UCSF professor of neurology.
“We learned that when rats were exposed to the smell or taste of alcohol, there was a small window of opportunity to target the area of the brain that reconsolidates the memory of the craving for alcohol and to weaken or even erase the memory, and thus the craving”he said.
The study, also supervised by co-senior author PatriciH. Janak, PhD, a Gallo Center investigator and UCSF professor of neurology, was published online on June 23 in Nature Neuroscience.
Neural Mechanism That Triggers Alcohol Memorya
In the first phase of the study, rats had the choice to freely drink water or alcohol over the course of seven weeks, and during this time developed a high preference for alcohol.
In the next phase, they had the opportunity to access alcohol for one hour a day, which they learned to do by pressing a lever. They were then put through a 10-day period of abstinence from alcohol.
Following this period, the animals were exposed for five minutes to just the smell and taste of alcohol, which cued them to remember how much they liked drinking it. The researchers then scanned the animals’ brains, and identified the neural mechanism responsible for the reactivation of the memory of the alcohol – a molecular pathway mediated by an enzyme known as mammalian target of rapamycin complex 1 (mTORC1).
They found that just a small drop of alcohol presented to the rats turned on the mTORC1 pathway specifically in a select region of the amygdala, a structure linked to emotional reactions and withdrawal from alcohol, and cortical regions involved in memory processing.
They further showed that once mTORC1 was activated, the alcohol-memory stabilized (reconsolidated) and the rats relapsed on the following days, meaning in this case, that they started again to push the lever to dispense more alcohol.
“The smell and taste of alcohol were such strong cues that we could target the memory specifically without impacting other memories, such as a craving for sugar,” said Barak, who added that the
In the first phase of the study, rats had the choice to freely drink water or alcohol over the course of seven weeks, and during this time developed a high preference for alcohol.
In the next phase, they had the opportunity to access alcohol for one hour a day, which they learned to do by pressing a lever. They were then put through a 10-day period of abstinence from alcohol.
Following this period, the animals were exposed for five minutes to just the smell and taste of alcohol, which cued them to remember how much they liked drinking it. The researchers then scanned the animals’ brains, and identified the neural mechanism responsible for the reactivation of the memory of the alcohol – a molecular pathway mediated by an enzyme known as mammalian target of rapamycin complex 1 (mTORC1).
They found that just a small drop of alcohol presented to the rats turned on the mTORC1 pathway specifically in a select region of the amygdala, a structure linked to emotional reactions and withdrawal from alcohol, and cortical regions involved in memory processing.
They further showed that once mTORC1 was activated, the alcohol-memory stabilized (reconsolidated) and the rats relapsed on the following days, meaning in this case, that they started again to push the lever to dispense more alcohol.
“The smell and taste of alcohol were such strong cues that we could target the memory specifically without impacting other memories, such as a craving for sugar,” said Barak, who added that the
Ron research group has been doing brain studies for many years and has never seen such a robust and specific activation in the brain.
Drug that Erases the Memory of Alcohol
In the next part of the study, the researchers set out to see if they could prevent the reconsolidation of the memory of alcohol by inhibiting mTORC1, thus preventing relapse.
When mTORC1 was inactivated using a drug called rapamycin, administered immediately after the exposure to the cue (smell, taste), there was no relapse to alcohol-seeking the next day.
Strikingly, drinking remained suppressed for up to 14 days, the end point of the study.
Strikingly, drinking remained suppressed for up to 14 days, the end point of the study.
These results suggest that rapamycin erased the memory of alcohol for a long period, said Ron.
The authors said the study is an important first step, but that more research is needed to determine how mTORC1 contributes to alcohol memory reconsolidation and whether turning off mTORC1 with rapamycin would prevent relapse for more than two weeks.
The authors also said it would be interesting to test if rapamycin, an FDA-approved drug currently used to prevent organ rejection after transplantation, or other mTORC1 inhibitors that are currently being developed in pharmaceutical companies, would prevent relapse in human alcoholics.
“One of the main problems in alcohol abuse disorders is relapse, and current treatment options are very limited.” Barak said.
The authors said the study is an important first step, but that more research is needed to determine how mTORC1 contributes to alcohol memory reconsolidation and whether turning off mTORC1 with rapamycin would prevent relapse for more than two weeks.
The authors also said it would be interesting to test if rapamycin, an FDA-approved drug currently used to prevent organ rejection after transplantation, or other mTORC1 inhibitors that are currently being developed in pharmaceutical companies, would prevent relapse in human alcoholics.
“One of the main problems in alcohol abuse disorders is relapse, and current treatment options are very limited.” Barak said.
“Even after detoxification and a period of rehabilitation, 70 to 80 percent of patients will relapse in the first several years. It is really thrilling that we were able to completely erase the memory of alcohol and prevent relapse in these animals. This could be a revolution in treatment approaches for addiction, in terms of erasing unwanted memories and thereby manipulating the brain triggers that are so problematic for people with addictions.”
The other co-authors of the paper are Feng Liu, PhD, Sami Ben Hamida, PhD, Quinn V. Yowell, BS, Jeremie Neasta, PhD, and Viktor Kharazia, PhD, all of the Gallo Center and UCSF Department of Neurology.
The study was supported by funds from the National Institute on Alcohol Abuse and Alcoholism and funds from the State of California for Medical Research on Alcohol and Substance Abuse administered through UCSF.
The UCSF-affiliated Ernest Gallo Clinic and Research Center is one of the world’s preeminent academic centers for the study of the biological basis of alcohol and substance use disorders. Gallo Center discoveries of potential molecular targets for the development of therapeutic medications are extended through preclinical and proof-of-concept clinical studies.
The other co-authors of the paper are Feng Liu, PhD, Sami Ben Hamida, PhD, Quinn V. Yowell, BS, Jeremie Neasta, PhD, and Viktor Kharazia, PhD, all of the Gallo Center and UCSF Department of Neurology.
The study was supported by funds from the National Institute on Alcohol Abuse and Alcoholism and funds from the State of California for Medical Research on Alcohol and Substance Abuse administered through UCSF.
The UCSF-affiliated Ernest Gallo Clinic and Research Center is one of the world’s preeminent academic centers for the study of the biological basis of alcohol and substance use disorders. Gallo Center discoveries of potential molecular targets for the development of therapeutic medications are extended through preclinical and proof-of-concept clinical studies.
Source: http://www.ucsf.edu/news/2013/06/107001/addiction-relapse-might-be-thwarted-turning-brain-trigger
WHO's pain ladder for adults
WHO's pain ladder for adults
WHO has developed a three-step "ladder" for cancer pain relief in adults.
If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used. To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand” This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective. In the case of cancer pain in children, WHO recommends a two step ladder. For further information see WHO Guidelines on the pharmacological treatment of persisting pain in children with medical illnesses at:
WHO guidelines on persisting pain in children
Source:
Home
One in three absences at work due to anxiety and stress
One in three absences at work due to anxiety and stress, official Government survey finds
Anxiety and stress are the most common reasons to be off work because of illness, accounting for more than a third of national absences, an official study has found.
Anxiety and stress are the most common reasons to be off work because of illness Photo: Alamy
By Christopher Hope, Senior Political Correspondent
10:00PM BST 26 Jun 2013
A major study of tens of thousands of individual GPs' sick notes found that 35 per cent of those surveyed were given for “mild to moderate mental health disorders”, such as depression, anxiety and stress.
The fit note replaced the sick note in April 2010 and was supposed to allow employees back more quickly by suggesting things they could do at work.
The fit note specifically allows doctors to state what tasks a patient can do at work rather than simply declare them unfit to work. The scheme was meant to help the Government tackle the annual £15billion sickness absence bill, saving £240million over the 10 years.
The notes are normally required by employers to provide evidence that they are sick on the seventh day of an employee's illness.
However employers have repeatedly said they were dissatisfied, saying the scheme has made little or no difference in helping employees return to work more quickly.
The unprecedented Government study examined 58,700 individual fit notes issued to 25,000 patients between October 2011 and January 2013.
It found that there is “some evidence that mild-to-moderate mental health disorders are a growing cause of sickness absence”.
It added that “the highest rates of fit notes being issued for mild-to-moderate mental health disorders were found in practices in the most socially deprived areas”.
The study also laid bare “significant variation” between doctors in the rate at which the notes were issued.
In one GP practice 23 per of all the notes that were issued were for “mild to moderate” disorders, compared to 54 per cent at another practice.
Half of the notes allowed patients to take up to a month off work, while a quarter were for between one month and three months.
Longer fit notes were generally issued for more severe disorders and illnesses. Just over one in 10 of those surveyed were pronounced “may be fit to work” by their GPs.
There was also a split between men and women, with male patients 72 per cent more likely to be given a long term sicknote lasting of more than four weeks.
Contrary to concerns from employers, the report found there was “some evidence that the introduction of the fit note is having a positive effect in reducing long-term sickness absence”.
Over the past five years the proportion of employers with no sickness absence among their workforce has increased from 40 per cent to 51 per cent of employers.
However employers have been reporting that longer-term absence is increasing because of surgery, back pain, stress, mental health and other problems.
A survey from the Engineering Employers Federation earlier this month said employers were blaming “the failure” of the fit note scheme on GPs.
The study found that only a quarter of 353 employers that the fit note scheme had resulted in employees being returned to work.
They reported that GPs were the second biggest barrier to helping somebody back to work, behind only the employees’ health condition.
The EEF said: “Medical professionals are still disengaged from the fit note process and need to be better engaged through effective training.”
A Department for Work and Pensions spokesman said: "Sickness absence is a burden to business, to the taxpayer and to the thousands of people who end up trapped on benefits when they could actually work.
"Supporting people with mental health problems to return to work more quickly will be an important part of the new independent health and work advisory service we are bringing in, which will save employers up to £160m a year in Statutory Sick Pay.”
Source: http://www.theglobeandmail.com/life/health-and-fitness/health/painkiller-diclofenac-risky-should-be-removed-from-market-researchers-say/article8508977/
Friday, June 28, 2013
"Born to Run" by Christopher McDougall
Uploaded on Oct 27, 2009
Full of incredible characters, amazing athletic achievements, cutting-edge science, and, most of all, pure inspiration, Born to Run is an epic adventure that began with one simple question:
Why does my foot hurt?
In search of an answer, Christopher McDougall sets off to find a tribe of the world's greatest distance runners and learn their secrets, and in the process shows us that everything we thought we knew about running is wrong.
Isolated by the most savage terrain in North America, the reclusive Tarahumara Indians of Mexico's deadly Copper Canyons are custodians of a lost art. For centuries they have practiced techniques that allow them to run hundreds of miles without rest and chase down anything from a deer to an Olympic marathoner while enjoying every mile of it.
Their superhuman talent is matched by uncanny health and serenity, leaving the Tarahumara immune to the diseases and strife that plague modern existence.
With the help of Caballo Blanco, a mysterious loner who lives among the tribe, the author was able not only to uncover the secrets of the Tarahumara but also to find his own inner ultra-athlete, as he trained for the challenge of a lifetime: a fifty-mile race through the heart of Tarahumara country pitting the tribe against an odd band of Americans, including a star ultramarathoner, a beautiful young surfer, and a barefoot wonder.
With a sharp wit and wild exuberance, McDougall takes us from the high-tech science labs at Harvard to the sun-baked valleys and freezing peaks across North America, where ever-growing numbers of ultrarunners are pushing their bodies to the limit, and, finally, to the climactic race in the Copper Canyons.
Born to Run is that rare book that will not only engage your mind but inspire your body when you realize that the secret to happiness is right at your feet, and that you, indeed all of us, were born to run.
Christopher McDougall visits Google's Mountain View, CA headquarters to speak as part of the Authors@Google series.
Category - People & Blogs
License - Standard YouTube License
Authors@Google: Christopher McDougall
Link: http://www.youtube.com/watch?v=Y_usxrvKvus
Thursday, June 27, 2013
The Tarahumara - A Hidden Tribe of Superathletes Born to Run
Uploaded on Jun 4, 2010
Nestled in northern Mexico and the canyons of the Sierra Madre Occidental is a small tribe of indigenous people known as the Tarahumara. They call themselves Rarámuri, loosely translated as "running people," "foot-runner," "swift of foot," or "he who walks well." They are known for evading the Spanish conquerors in the sixteenth century and keeping their cave-dwelling culture alive and secluded. They are also known for their long distance running and their superior health, not displaying the common health issues of "modern" societies.
A recent National Geographic study (Nov. 2008) states: "When it comes to the top 10 health risks facing American men, the Tarahumara are practically immortal: Their incidence rate is at or near zero in just about every category, including diabetes, vascular disease, and colorectal cancer...Plus, their supernatural invulnerability isn't just limited to their bodies; the Tarahumara have mastered the secret of happiness as well, living as benignly as bodhisattvas in a world free of theft, murder, suicide, and cruelty."
So what is the Tarahumara story and what can we learn from them? How can we use their history as an example for our own primal living? For some they may not be an example of what is considered primal, but they are one of the closest we can find in today's world.
http://liveprimal.com/2009/07/tarahum...
Category- Education
License - Standard YouTube License
Link: http://youtu.be/FnwIKZhrdt4
Saturday, June 22, 2013
Brain
European Journal of Neuroscience | Special Issue: Development And Plasticity Of Thalamocortical Systems http://goo.gl/vBY3r [EJN]
Brain Freeze
Why do we get Brain Freeze? [Sphenopalatine Ganglioneuralgia]
Have you ever wondered why you get “brain freeze” when you eat something cold such as ice cream or a milkshake? That sudden pain in your forehead is known in medicine as sphenopalatine ganglioneuralgia.
It is caused by having something cold touch the roof of the mouth (palate), or the total immersion in water that is generally below 15°C (or 10°C or even 5°C for some acclimated open water swimmers). It is believed to result from a nerve response causing rapid constriction and swelling of blood vessels or a “referring” of pain from the roof of the mouth to the head.
An ice cream headache is the direct result of the rapid cooling and rewarming of the capillaries in the sinuses. A similar but painless blood vessel response causes the face to appear “flushed” after being outside on a cold day. In both instances, the cold temperature causes the capillaries in the sinuses to constrict and then experience extreme rebound dilation as they warm up again.
In the palate, this dilation is sensed by nearby pain receptors, which then send signals back to the brain via the trigeminal nerve, one of the major nerves of the facial area. This nerve also senses facial pain, so as the neural signals are conducted the brain interprets the pain as coming from the forehead—the same “referred pain” phenomenon seen in heart attacks.
It is caused by having something cold touch the roof of the mouth (palate), or the total immersion in water that is generally below 15°C (or 10°C or even 5°C for some acclimated open water swimmers). It is believed to result from a nerve response causing rapid constriction and swelling of blood vessels or a “referring” of pain from the roof of the mouth to the head.
An ice cream headache is the direct result of the rapid cooling and rewarming of the capillaries in the sinuses. A similar but painless blood vessel response causes the face to appear “flushed” after being outside on a cold day. In both instances, the cold temperature causes the capillaries in the sinuses to constrict and then experience extreme rebound dilation as they warm up again.
In the palate, this dilation is sensed by nearby pain receptors, which then send signals back to the brain via the trigeminal nerve, one of the major nerves of the facial area. This nerve also senses facial pain, so as the neural signals are conducted the brain interprets the pain as coming from the forehead—the same “referred pain” phenomenon seen in heart attacks.
Brain-freeze pain may last from a few seconds to a few minutes. Research suggests that the same vascular mechanism and nerve implicated in “brain freeze” cause the aura (sensory disturbance) and pulsatile (throbbing pain) phases of migraines.
Find more interesting stories on the official Neuroscience Facebook page
Source: http://wisciblog.com/2012/05/29/why-do-we-get-brain-freeze-sphenopalatine-ganglioneuralgia/
How do we stop brain freeze? WikiHow explains.
Find more interesting stories on the official Neuroscience Facebook page
How do we stop brain freeze? WikiHow explains.Find more interesting stories on the official Neuroscience Facebook page
Source: http://wisciblog.com/2012/05/29/why-do-we-get-brain-freeze-sphenopalatine-ganglioneuralgia/
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Levity never hurts a person thus, this funny article is included here for your enjoyment.
Always laugh when you can. It is cheap medicine.
— Lord Byron
Tuesday, June 18, 2013
Top 25 Celebrity Doctors on Twitter Worth Following
Dr. Kelly Sennholz of Symtrimics named as
Top 25 Celebrity Doctors on Twitter Worth Following
Wichita, Kansas March 12, 2010 Lifestyle News
(PRLEAP.COM) What makes a physician popular on Twitter? Celebrity status might be gained through television shows, authorship or simply by being accessible to patients and to other medical professionals in the comfort of their homes.
In the our list of the top 25 celebrity doctors on Twitter who are worth following, you may learn that 'celebrity status' might be a combination of what that doctor knows as well as how he or she presents that information.
The following list is divided into two categories entitled, "Instantly Recognizable" and "Gaining a Name." The first category includes doctors who have over 75,000 followers.
The second category includes doctors who have 10,000-50,000 followers. Notice the gap in numbers between the two categories…we could not find doctors who had between 50,000 and 75,000 followers.
This gap might show that success is viral. After this list makes its rounds, a few of the doctors in the second category may end up in the first category. Some, like Dr. Andrew Weil - who has been on the cover of Time and is instantly recognizable outside Twitter - may work their way into the Twitter 'hall of doctor fame' with over 75,000 followers once people realize that he Twitters.
Each doctor on this list is worth following, as they all offer information to the medical profession as well as to patients. No matter if its in the field of nursing or in the field of social media, each doctor can show readers how to gain some popularity (and responsibility) for helping others.
The links within each category are listed alphabetically by the doctor's Twitter name and the links lead to their Twitter pages. From there, you can learn more about the doctor, including links to each doctor's Web site(s) and other specialties.
Instantly Recognizable
1. brianwmarshall: Dr. Brian Marshall is an occupational medicine director at Cleveland Clinic and emergency medicine physician who loves social media, Internet marketing and personal finance. He doesn't have a television show, nor has he authored a book. His popularity seems to come from his seemingly genuine interest in people and in life.
2. DeepakChopra: Dr. Chopra is a fellow of the American College of Physicians, a member of the American Association of Clinical Endocrinologists, Adjunct Professor at Kellogg School of Management and Senior Scientist with The Gallup Organization. Time magazine heralded Chopra credits him as 'the poet-prophet of alternative medicine.'
3. drdrew: Dr. Drew is a practicing internist and "addictionologist" with training in psychology. He's become hugely popular with his focus on sex addition and for the television show, "Celebrity Rehab," which chronicles the real life experiences of a group of celebrities as they make the life-changing decision to enter themselves into a drug, alcohol, and addiction treatment program.
4. DrOz: Dr. Mehmet Oz, cardiac surgeon, is an author and host of the The Dr. Oz Show. He's become wildly popular because viewers can share stories to become eligible to be on his show.
5. DrPhil: Through his many books and his daily syndicated television talk show, Dr. Phil McGraw has galvanized millions of people to "get real" about their behaviors.
6. mikeyoung: Mike Young, PhD, is out of Cary, North Carolina, and he's into CEO-human performance consulting and athletic developments. He is a sports scientist and researcher among other specialties, and he's made himself popular through his ability to help people connect fitness to success.
7. sanjayguptaCNN: Dr. Sanjay Gupta has made a name for himself through his shows and appearances on CNN. He is that broadcast network's chief medical correspondent and a neurosurgeon.
Gaining a Name
8. bengoldacre: Dr. Goldacre is becoming very well known for his "bad science" objectives, as he specializes in "unpicking dodgy scientific claims made by scaremongering journalists, dodgy government reports, evil pharmaceutical corporations, PR companies and quacks."
9. DoctorRobin: Dr. Robin A. Eckert is an academic and clinical leader in the emerging field of integrative medicine. She is an assistant clinical professor with the Department of Family Medicine at U.C. Irvine Medical Center, and she is founder and medical director of the Laguna Center for Integrative Medicine in Laguna Beach, California.
10. dougpmd: Dr. Doug Penta is an OB/GYN physician with interests in HPV, fibroids, PMS and recent anti-aging physiology.
11. DrAnthony: Dr. Anthony Casas, Jr. holds a PhD in I/O Psychology, Masters in HR & OD, and a Bachelors in Psychology and Sociology. He also has extensive experience in planning, negotiations, coaching and consulting start-up enterprises.
12. DrBermant: Dr. Michael Bermant is a plastic surgeon who operates out of Richmond, Virginia. He specializes in gynecomastia, liposuction, tummy tuck, belly button, otoplasty, rhinoplasty, breast & body surgical sculpture.
13. DrJennifer: Dr. Jennifer Howard is a psychotherapist, and she brings together her more than 20 years of experience, extensive training and expertise in mind-body psychology, meditation, and a variety of the healing arts.
14. drjoesDIYhealth: Dr. Joe is a medical doctor in Australia who prides himself in "actually talking about health." His strategy seems to be working.
15. DrJosephKim: Joseph Kim, MD, MPH, is an MIT engineer and technology advocate who offers a number of Web sites focused on medicine and technology.
16. DrWeil: Get daily information on integrative medicine, natural health and well being and tips for pesky problems that might be resolved without prescription medication through Dr. Andrew Weil's tweets.
17. FeliceDunas: Dr. Felice Dunas brings her patients, clients and audiences better health, happiness and quality of life through erotic and intimacy education, alternative medicine and marriage coaching.
18. JohnLLeRoyJrMD: Dr. John L. LeRoy, Jr. is a band-aid mini face lift specialist and board-certified plastic surgeon who focuses on cosmetic plastic surgery from Atlanta, Georgia.
19. kevinmd: Kevin Pho, M.D., is a leading voice in the social media movement, providing provocative commentary on breaking health and medical news on Twitter and at his blog.
20. KristieMcNealy: This doctor, located out of Denver, Colorado, focuses on health, nutrition and events, social media marketing and homeschooling.
21. Lissarankin: Lissa Rankin is an OB/GYN, artist and author of two books: What's Up Down There? and Encaustic Art. Located in Marin County, California, this doctor also is the found of Owning Pink, a "gutsy guide to getting your mojo back."
22. Mtnmd: Dr. Kelly Sennholz, located in both the Denver, Colorado and Beverly Hills, California areas, is a physician and "doctor of wellness," who assists people to live life to its fullest. She is the Chief Medical Officer for Symtrimics in Beverly Hills.
23. thenakeddoctor: Dr. Keith Scott-Mumby is a British alternative doctor and a long-time pioneer in natural healing. His books include Diet Wise and Cancer Confidential.
24. timlawler: Tim Lawler is a naval physician, who currently serves as a flight surgeon. He went to medical school at Kansas City University of Medicine and Biosciences in Kansas City, MO and enjoys educating others about various issues with life after college.
25. tomheston: Dr. Tom Heston cares a lot about his patients and blog readers in the Las Vegas area and beyond. He studied at the University of Berkley and Saint Louis University and is a Fellow at Johns Hopkins Hospital.
(PRLEAP.COM) What makes a physician popular on Twitter? Celebrity status might be gained through television shows, authorship or simply by being accessible to patients and to other medical professionals in the comfort of their homes.
In the our list of the top 25 celebrity doctors on Twitter who are worth following, you may learn that 'celebrity status' might be a combination of what that doctor knows as well as how he or she presents that information.
The following list is divided into two categories entitled, "Instantly Recognizable" and "Gaining a Name." The first category includes doctors who have over 75,000 followers.
The second category includes doctors who have 10,000-50,000 followers. Notice the gap in numbers between the two categories…we could not find doctors who had between 50,000 and 75,000 followers.
This gap might show that success is viral. After this list makes its rounds, a few of the doctors in the second category may end up in the first category. Some, like Dr. Andrew Weil - who has been on the cover of Time and is instantly recognizable outside Twitter - may work their way into the Twitter 'hall of doctor fame' with over 75,000 followers once people realize that he Twitters.
Each doctor on this list is worth following, as they all offer information to the medical profession as well as to patients. No matter if its in the field of nursing or in the field of social media, each doctor can show readers how to gain some popularity (and responsibility) for helping others.
The links within each category are listed alphabetically by the doctor's Twitter name and the links lead to their Twitter pages. From there, you can learn more about the doctor, including links to each doctor's Web site(s) and other specialties.
Instantly Recognizable
1. brianwmarshall: Dr. Brian Marshall is an occupational medicine director at Cleveland Clinic and emergency medicine physician who loves social media, Internet marketing and personal finance. He doesn't have a television show, nor has he authored a book. His popularity seems to come from his seemingly genuine interest in people and in life.
2. DeepakChopra: Dr. Chopra is a fellow of the American College of Physicians, a member of the American Association of Clinical Endocrinologists, Adjunct Professor at Kellogg School of Management and Senior Scientist with The Gallup Organization. Time magazine heralded Chopra credits him as 'the poet-prophet of alternative medicine.'
3. drdrew: Dr. Drew is a practicing internist and "addictionologist" with training in psychology. He's become hugely popular with his focus on sex addition and for the television show, "Celebrity Rehab," which chronicles the real life experiences of a group of celebrities as they make the life-changing decision to enter themselves into a drug, alcohol, and addiction treatment program.
4. DrOz: Dr. Mehmet Oz, cardiac surgeon, is an author and host of the The Dr. Oz Show. He's become wildly popular because viewers can share stories to become eligible to be on his show.
5. DrPhil: Through his many books and his daily syndicated television talk show, Dr. Phil McGraw has galvanized millions of people to "get real" about their behaviors.
6. mikeyoung: Mike Young, PhD, is out of Cary, North Carolina, and he's into CEO-human performance consulting and athletic developments. He is a sports scientist and researcher among other specialties, and he's made himself popular through his ability to help people connect fitness to success.
7. sanjayguptaCNN: Dr. Sanjay Gupta has made a name for himself through his shows and appearances on CNN. He is that broadcast network's chief medical correspondent and a neurosurgeon.
Gaining a Name
8. bengoldacre: Dr. Goldacre is becoming very well known for his "bad science" objectives, as he specializes in "unpicking dodgy scientific claims made by scaremongering journalists, dodgy government reports, evil pharmaceutical corporations, PR companies and quacks."
9. DoctorRobin: Dr. Robin A. Eckert is an academic and clinical leader in the emerging field of integrative medicine. She is an assistant clinical professor with the Department of Family Medicine at U.C. Irvine Medical Center, and she is founder and medical director of the Laguna Center for Integrative Medicine in Laguna Beach, California.
10. dougpmd: Dr. Doug Penta is an OB/GYN physician with interests in HPV, fibroids, PMS and recent anti-aging physiology.
11. DrAnthony: Dr. Anthony Casas, Jr. holds a PhD in I/O Psychology, Masters in HR & OD, and a Bachelors in Psychology and Sociology. He also has extensive experience in planning, negotiations, coaching and consulting start-up enterprises.
12. DrBermant: Dr. Michael Bermant is a plastic surgeon who operates out of Richmond, Virginia. He specializes in gynecomastia, liposuction, tummy tuck, belly button, otoplasty, rhinoplasty, breast & body surgical sculpture.
13. DrJennifer: Dr. Jennifer Howard is a psychotherapist, and she brings together her more than 20 years of experience, extensive training and expertise in mind-body psychology, meditation, and a variety of the healing arts.
14. drjoesDIYhealth: Dr. Joe is a medical doctor in Australia who prides himself in "actually talking about health." His strategy seems to be working.
15. DrJosephKim: Joseph Kim, MD, MPH, is an MIT engineer and technology advocate who offers a number of Web sites focused on medicine and technology.
16. DrWeil: Get daily information on integrative medicine, natural health and well being and tips for pesky problems that might be resolved without prescription medication through Dr. Andrew Weil's tweets.
17. FeliceDunas: Dr. Felice Dunas brings her patients, clients and audiences better health, happiness and quality of life through erotic and intimacy education, alternative medicine and marriage coaching.
18. JohnLLeRoyJrMD: Dr. John L. LeRoy, Jr. is a band-aid mini face lift specialist and board-certified plastic surgeon who focuses on cosmetic plastic surgery from Atlanta, Georgia.
19. kevinmd: Kevin Pho, M.D., is a leading voice in the social media movement, providing provocative commentary on breaking health and medical news on Twitter and at his blog.
20. KristieMcNealy: This doctor, located out of Denver, Colorado, focuses on health, nutrition and events, social media marketing and homeschooling.
21. Lissarankin: Lissa Rankin is an OB/GYN, artist and author of two books: What's Up Down There? and Encaustic Art. Located in Marin County, California, this doctor also is the found of Owning Pink, a "gutsy guide to getting your mojo back."
22. Mtnmd: Dr. Kelly Sennholz, located in both the Denver, Colorado and Beverly Hills, California areas, is a physician and "doctor of wellness," who assists people to live life to its fullest. She is the Chief Medical Officer for Symtrimics in Beverly Hills.
23. thenakeddoctor: Dr. Keith Scott-Mumby is a British alternative doctor and a long-time pioneer in natural healing. His books include Diet Wise and Cancer Confidential.
24. timlawler: Tim Lawler is a naval physician, who currently serves as a flight surgeon. He went to medical school at Kansas City University of Medicine and Biosciences in Kansas City, MO and enjoys educating others about various issues with life after college.
25. tomheston: Dr. Tom Heston cares a lot about his patients and blog readers in the Las Vegas area and beyond. He studied at the University of Berkley and Saint Louis University and is a Fellow at Johns Hopkins Hospital.
About Symtrimics:
The Symtrimics programs produce better procedural results and happier patients than other clinics without Symtrimics. The good news is, if you are committed to making positive changes in your lifestyle, Symtrimics and your physician will give you the tools and teach you how to reclaim your health and vitality.
The Symtrimics programs focus on the lifelong adoption of habits, which help to improve health, lengthen life, establish healthy weight, slow aging and assist with disease prevention. www.symtrimics.com
Symtrimics™ provides an integrated wellness and clinic-marketing platform, which consists of five Symtrimic programs. These include an integrated web based service, medical grade nutrition, exercise, social, coaching program focused on the life-long adoption of habits that have been proven to: improve health, lengthen life, secure weight loss, slow aging and prevent disease.
Contact :
Public Relations
Symtrimics, LLC
Beverly Hills, CA 90212
310-228-1192
pr@symtrimics.com
www.symtrimics.com
Source:
http://www.prleap.com/pr/150153/
Stacy Glatczak
Symtrimics
877-641-4828
This press release was distributed by prleap.com
Stacy Glatczak
Symtrimics
877-641-4828
This press release was distributed by prleap.com
MENTAL ILLNESS IN AMERICA
Woman in state of 'hysteria' (Wikimedia Commons).
STATES OF MIND
MENTAL ILLNESS IN AMERICA
Published: May 31, 2013
The American Psychiatric Association just released the 5th version of its Diagnostic and Statistical Manual (DSM) – a manual that says as much about how we view the mind today, as it does about particular mental conditions. Indeed, latest estimates suggest that more than 50% of Americans will suffer from a “mental disorder” at some point in their lifetime, making the once “abnormal” – well, normal.
So in this episode of BackStory, the American History Guys look back over the history of mental illness in America – exploring how the diagnostic line between mental health and madness has shifted over time, and how we’ve treated those on both sides of it.
We’ll hear how the desire of slaves to escape bondage was once interpreted as a psychological disorder, how a woman’s sleepwalking landed her in the state asylum, and how perspectives on depression altered in the 1970s. Plus, the Guys walk us through a mid-20th century quiz that promised to identify a new kind of mental “disorder” – our susceptibility to fascism.
Source: http://backstoryradio.org/shows/states-of-mind/
Thursday, June 13, 2013
Don't Let It Bring You Down, It's Only Castles Burning - Neil Young
1971 Don't Let It Bring You Down
Tuesday, June 11, 2013
Albert Einstein prescribes compassion for all living creatures and the whole of nature
A human being is a part of the whole, called by us the "Universe," a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest -- a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.
- Albert Einstein
Link: http://lifeunfoldsinmoments.blogspot.ca/2013/04/albert-einstein-prescribes-compassion.html
Marcel Proust WAS a neuroscientist?
Was Proust really a neuroscientist?
Psychologist and novelist Charles Fernyhough calls it “one of the most famous passages in modern literature” – the scene when the narrator in Marcel Proust’s À La Recherche Du Temps Perdu sips on tea thick with crumbs from a madeleine cake, and memories from his childhood come flooding back. It has become the archetypal depiction of what psychologists refer to as an “involuntary memory”.
This capacity for sensory experiences to trigger powerful memories, seemingly beyond our wilful control, has come to be known as a “Proustian moment” or a “Proustian memory”.
This capacity for sensory experiences to trigger powerful memories, seemingly beyond our wilful control, has come to be known as a “Proustian moment” or a “Proustian memory”.
Based on the madeleine episode and other scenes, Evelyne Ender wrote that Proust “anticipat[ed] later discoveries” in memory research.
Jonah Lehrer, in Proust was a Neuroscientist, wrote that “We now know that Proust was right about memory.”
But how realistic was Proust’s depiction of involuntary memory really? A new paper by Emily Troscianko compares the portrayal of the madeleine episode against the latest findings from the cognitive neuroscience of memory.
Here’s what Troscianko says Proust got right. One reason smells and tastes can be so evocative is because they are paired with a particular situation, often repeatedly (and also often outside of awareness), and then not experienced again for many years. This fits with the fact the Proustian narrator tasted a tea-soaked cake that he used to enjoy regularly at his aunt’s in Combray as a child, but which he had not tasted for a long time.
Another fact about memories that wash over us is that they tend to arrive when we’re tired or distracted. Again, this matches the madeleine episode, in which the narrator is “dispirited after a dreary day”.
Continue reading on Research Digest
Saturday, June 8, 2013
Anorexia And Bulimia
Anorexia And Bulimia May Stem From Altered Neural Circuitry
Main Category: Eating Disorders
Also Included In: Psychology / Psychiatry
Article Date: 06 Jun 2013 - 0:00 PDT
Anorexia And Bulimia May Stem From Altered Neural Circuitry
Anorexia nervosa and bulimia nervosa - disorders characterized by extreme eating behavior and distorted body image - are among the deadliest of psychiatric disorders, with few proven effective treatments.
A landmark study, with first author Tyson Oberndorfer, MD, and led by Walter H. Kaye, MD, professor of psychiatry at the University of California, San Diego School of Medicine, suggests that the altered function of neural circuitry contributes to restricted eating in anorexia and overeating in bulimia. The research, published in the early on-line edition of the American Journal of Psychiatry, may offer a pathway to new and more effective treatments for these serious eating disorders.
"It has been unknown whether individuals with anorexia or bulimia have a disturbance in the system that regulates appetite in the brain, or whether eating behavior is driven by other phenomena, such as an obsessional preoccupation with body image," said Kaye, director of the UCSD Eating Disorders Treatment and Research Program.
"However,this study confirms earlier studies by our group and others that establish a clear link between these disorders and neural processes in the insula, an area of the brain where taste is sensed and integrated with reward to help determine whether an individual hungry or full."
The UC San Diego study used functional MRI to test this neurocircuitry by measuring the brain response to sweet tastes in 28 women who had recovered from either anorexia or bulimia.
Relative to a cohort of 14 women who had never suffered from either disorder, those recovered from anorexia had significantly diminished, and those recovered from bulimia, significantly elevated responses to the taste of sucrose in the right anterior insula.
"One possibility is that restricted eating and weight loss occurs in anorexia because the brain fails to accurately recognize hunger signals," said Oberndorfer. "Alternately, overeating in bulimia could represent an exaggerated perception of hunger signals."
A recent complementary study that investigated brain structure in anorexia and bulimia nervosa (Frank et al 2013) similarly highlights that the insula could be an integral part of eating disorder pathology.
The researchers added that such studies could have very important implications for treatment, and that identifying abnormal neural substrates could help to reformulate the basic pathology of eating disorders and offer new targets for treatment.
"It may be possible to modulate the experience by, for example, enhancing insula activity in individuals with anorexia or dampening the exaggerated or unstable response to food in those with bulimia," said Kaye.
Studies indicate that healthy subjects can use real-time fMRI, biofeedback or mindfulness training to alter the brain's response to food stimuli.
For patients with anorexia who have an overly active satiety signal in response to palatable foods, the researchers suggest bland or even slightly aversive foods might prevent the brain's over stimulation.
Medications may also be found that enhance the reward response to food, or decrease inhibition to food consumption in the brain's reward circuitry.
Visit our eating disorders section for the latest news on this subject.
Citations:
MLA
University of California - San Diego. "Anorexia And Bulimia May Stem From Altered Neural Circuitry." Medical News Today. MediLexicon, Intl., 6 Jun. 2013. Web.
University of California - San Diego. (2013, June 6). "Anorexia And Bulimia May Stem From Altered Neural Circuitry." Medical News Today. Retrieved from
Please note: If no author information is provided, the source is cited instead.
Willful Modulation of Brain Activity in Disorders of Consciousness
N Engl J Med 2010; 362:579-589, DOI: 10.1056/NEJMoa0905370
In recent years, improvements in intensive care have led to an increase in the number of patients who survive severe brain injury. Although some of these patients go on to have a good recovery, others awaken from the acute comatose state but do not show any signs of awareness. If repeated examinations yield no evidence of a sustained, reproducible, purposeful, or voluntary behavioral response to visual, auditory, tactile, or noxious stimuli, a diagnosis of a vegetative state — or “wakefulness without awareness” — is made.
Some patients remain in a vegetative state permanently. Others eventually show inconsistent but reproducible signs of awareness, including the ability to follow commands, but they remain unable to communicate interactively. In 2002, the Aspen Neurobehavioral Conference Work Group coined the term “minimally conscious state” to describe the condition of such patients, thereby adding a new clinical entity to the spectrum of disorders of consciousness.6
There are two main goals in the clinical assessment of patients in a vegetative or minimally conscious state.
The first goal is to determine whether the patient retains the capacity for a purposeful response to stimulation, however inconsistent. Such a capacity, which suggests at least partial awareness, distinguishes minimally conscious patients from those in a vegetative state and therefore has implications for subsequent care and rehabilitation, as well as for legal and ethical decision making.
Unfortunately, the behavior elicited from these patients is often ambiguous, inconsistent, and constrained by varying degrees of paresis, making it very challenging to distinguish purely reflexive from voluntary behaviors.
Nevertheless, in the absence of an absolute measure, awareness has to be inferred from a patient's motor responsiveness; this fact undoubtedly contributes to the high rate of diagnostic errors (approximately 40%) in this group of patients.
The second goal of clinical assessment is to harness and nurture any available response, through intervention, into a form of reproducible communication, however rudimentary. The acquisition of any interactive and functional verbal or nonverbal method of communication is an important milestone. Clinically, consistent and repeatable communication demarcates the upper boundary of a minimally conscious state.
In this article, we present the results of a study conducted between November 2005 and January 2009 in which functional magnetic resonance imaging (MRI) was routinely used in the evaluation of a group of 54 patients with a clinical diagnosis of being in a vegetative state or a minimally conscious state. In light of a previous single-case study that showed intact awareness in a patient who met the clinical criteria for being in a vegetative state, our investigation had two main aims.
The first aim was to determine what proportion of this group of patients could also reliably and repeatedly modulate their functional MRI responses, reflecting preserved awareness.
The second aim was to develop and validate a method that would allow such patients to functionally communicate yes-or-no responses by modulating their own brain activity, without training and without the need for any motor response.
Methods
Patients
A convenience sample of 54 patients with severe brain injury, including 23 in a vegetative state and 31 in a minimally conscious state, underwent functional MRI as a means of evaluating their performance on motor and spatial imagery tasks.
Characteristics of the Patients., and the inclusion criteria are described in the Supplementary Appendix, available with the full text of this article at NEJM.org. Written informed consent was obtained from the legal guardians of all patients. The motor and spatial imagery tasks have been well validated in healthy control subjects10-12 and are known to be associated with distinct functional MRI activity in the supplementary motor area and the parahippocampal gyrus.
The method to detect functional communication was first tested for feasibility and robustness in 16 healthy control subjects (9 men and 7 women) with no history of a neurologic disorder. Once validated, the tasks were given to one patient
(Patient 23 in Table 1 and Figure 1Figure 1Mental-Imagery Tasks.), who had received a diagnosis of being in a permanent vegetative state 17 months after a traffic accident; this diagnosis was confirmed by a month-long specialized assessment 3.5 years after the injury. At the time of admission for functional MRI scanning (5 years after the ictus), the patient was assumed to remain in a vegetative state, although extensive behavioral testing after the functional MRI revealed reproducible, but inconsistent, responses indicative of a minimally conscious state. (The Supplementary Appendix includes detailed results and a description of the clinical assessment of this patient.)
Imagery Tasks
While in the functional MRI scanner, all patients were asked to perform two imagery tasks. In the motor imagery task, they were instructed to imagine standing still on a tennis court and to swing an arm to “hit the ball” back and forth to an imagined instructor. In the spatial imagery task, participants were instructed to imagine navigating the streets of a familiar city or to imagine walking from room to room in their home and to visualize all that they would “see” if they were there. First, two so-called localizer scanning sessions were conducted in which the patients were instructed to alternate 30-second periods of mental imagery with 30-second periods of rest. Each scan included five rest–imagery cycles. The beginning of each imagery period was cued with the spoken word “tennis” or “navigation,” and rest periods were cued with the word “relax.”
Communication Task
After the localizer scans had been obtained, all 16 control subjects and 1 patient underwent functional MRI during which they attempted to answer questions by modulating their brain activity, and a set of so-called communication scans were obtained. Before each of these imaging sessions, participants were asked a yes-or-no question (e.g., “Do you have any brothers?”) and instructed to respond during the imaging session by using one type of mental imagery (either motor imagery or spatial imagery) for “yes” and the other for “no.” The nature of the questions ensured that the investigators would not know the correct answers before judging the functional MRI data. Participants were asked to respond by thinking of whichever imagery corresponded to the answer that they wanted to convey. Communication scanning was identical to localizer scanning with the exception that the same neutral word “answer” was used to cue each response to a question (with “relax” used as the cue for rest periods). Cues were delivered once, at the beginning of each period. Three communication scans (with one question per scan) were obtained for each of the 16 healthy control subjects. To maximize statistical power, six communication scans (with one question per scan) were obtained for the patient.
Statistical Analysis
To determine whether the imagery tasks produced the expected activations in predefined neuroanatomical locations, two scans were compared for each participant: motor imagery and spatial imagery. The multiple localizer scanning sessions of the patient who also underwent communication scanning were averaged with the use of a fixed-effects model.
Answers provided during the communication scanning were assessed with the use of a two-step procedure. First, activity in the two regions of interest (the supplementary motor area and the parahippocampal gyrus) identified during the localizer scanning was quantitatively characterized (with the use of the average generalized linear model estimate for each region of interest).
Next, a similarity metric (described in the Supplementary Appendix) was computed to quantify how closely the activity in the regions of interest on each communication scan matched each localizer scan.
Results
Responses to the Imagery Tasks
Among the 54 patients, we identified 5 who could willfully modulate their brain activity (Figure 1). In all five of these patients, the functional MRI scans associated with motor imagery, as compared with spatial imagery, showed considerable activation in the supplementary motor area. In four of the five patients, the scans associated with spatial imagery, as compared with motor imagery, showed activation in the parahippocampal gyrus. Furthermore, the time course of activity within the two regions of interest was sustained for 30 seconds and was associated with the delivery of the verbal cues
These results closely match the pattern observed in the healthy control subjects (Figure 1, and the Supplementary Appendix). Four of the five patients were considered to be in a vegetative state (including Patient 4, who has been described previously10), and all five patients had a traumatic brain injury. (Table 1).
Responses to the Communication Task
Each of the 16 healthy control subjects underwent functional MRI to obtain three communication scans. For all 48 questions in the communication task, the correct answer was determined with 100% accuracy by comparing the activations shown on the communication scans with the activations shown on two localizer scans. In all subjects, the pattern produced in response to each question was quantitatively more similar to the pattern observed in the localizer scan for the imagery task that was associated with the factually correct answer; this answer was verified after the analysis.
Communication Scans. show this similarity in a healthy control. In this subject, the activation associated with the imagery period as compared with the rest period for question 1 resulted in extensive activation in the supplementary motor area and minimal activity in the parahippocampal gyrus
This pattern was almost identical to that observed in the activation associated with the motor imagery period as compared with the rest period in the motor localizer scan. Conversely, the imagery period as compared with the rest period for questions 2 and 3 was associated with extensive activation of the parahippocampal gyrus and, to a lesser extent, the supplementary motor area; these findings closely matched the activation seen in the spatial localizer scan. Similar patterns were observed in 9 of 16 control subjects. In the remaining seven control subjects, the distinction between tasks was even clearer; thus, a double dissociation was observed between activity in the supplementary motor area for motor imagery and activity in the parahippocampal gyrus for spatial navigation (see the Supplementary Appendix).
To assess whether such an approach could be used in a patient with impaired consciousness, one of the patients who had reliable responses during the two imagery tasks (Patient 23) was also asked six yes-or-no autobiographical questions and instructed to respond by thinking of one type of imagery (either motor imagery or spatial imagery) for an affirmative answer and the other type of imagery for a negative answer.
In this patient, the activity observed on the communication scan in response to five of the six questions closely matched that observed on one of the localizer scans (Figure 2A and 2C and Figure 3A and 3C). For example, in response to the question “Is your father's name Alexander?” the patient responded “yes” (correctly) with activity that matched that observed on the motor-imagery localizer scan (Figure 3A). In response to the question “Is your father's name Thomas?” the patient responded “no” (also correctly) with activity that matched that observed in the spatial-imagery localizer scan (Figure 3C).
The relative-similarity analysis confirmed, quantitatively, that the activity observed on the communication scans accurately reproduced that observed on the localizer scans within the bounds of normal variability for five of the six questions (Figure 4, and Tables A1 and A2 in the Supplementary Appendix). In addition, for those same five questions, the pattern produced always matched the factually correct answer. Only one question, the last one, could not be decoded. However, this was not because the “incorrect” pattern of activation was observed, but rather because virtually no activity was observed within the regions of interest.
Discussion
In this study, functional MRI was used to determine the incidence of undetected awareness in a group of patients with severe brain injuries. Of the 54 patients, 5 with traumatic brain injuries were able to modulate their brain activity by generating voluntary, reliable, and repeatable blood-oxygenation-level–dependent responses in predefined neuroanatomical regions when prompted to perform imagery tasks. No such responses were observed in any of the patients with nontraumatic brain injuries. Four of the five patients who were able to generate these responses were admitted to the hospital with a diagnosis of being in a vegetative state. When these four patients were thoroughly retested at the bedside, some behavioral indicators of awareness could be detected in two of them. However, the other two patients remained behaviorally unresponsive at the bedside, even after the functional MRI results were known and despite repeated testing by a multidisciplinary team. Thus, in a minority of cases, patients who meet the behavioral criteria for a vegetative state have residual cognitive function and even conscious awareness.14,15
We conducted additional tests in one of the five patients with evidence of awareness on functional MRI, and we found that he had the ability to apply the imagery technique in order to answer simple yes-or-no questions accurately. Before the scanning was performed, the patient had undergone repeated evaluations indicating that he was in a vegetative state, including a month-long specialized assessment by a highly trained clinical team. At the time of scanning, however, thorough retesting at the bedside showed reproducible but highly fluctuating and inconsistent signs of awareness (see the Supplementary Appendix), findings that are consistent with the diagnosis of a minimally conscious state. Nonetheless, despite the best efforts of the clinical team, it was impossible to establish any functional communication at the bedside, and the results of the behavioral examination remained ambiguous and inconsistent. In contrast, the functional MRI approach allowed the patient to establish functional and interactive communication. Indeed, for five of the six questions, the patient had a reliable neural response and was able to provide the correct answer with 100% accuracy. For the remaining question — the last question of the imaging session — the lack of activity within the regions of interest precluded any analysis of the results. Whether the patient fell asleep during this question, did not hear it, simply elected not to answer it, or lost consciousness cannot be determined.
Although the functional MRI data provided clear evidence that the patient was aware and able to communicate, it is not known whether either ability was available during earlier evaluations. It is possible that he was in a vegetative state when the diagnosis was received at 17 months and again 3.5 years after injury and subsequently regained some aspects of cognitive functioning. Alternatively, the patient may have been aware during previous assessments but unable to produce the necessary motor response required to signal his state of consciousness. If this was the case, then the clinical diagnosis of a vegetative state was entirely accurate in the sense that no behavioral markers of awareness were evident. That said, the diagnosis did not accurately reflect the patient's internal state of awareness and level of cognitive functioning at the time. Given that all previous assessments were based on behavioral observations alone, these two possibilities are indistinguishable.
Among 49 of the 54 patients included in this study, no significant functional MRI changes were observed during the imagery tasks. In these patients, it is not possible to determine whether the negative findings were the result of the low “sensitivity” of the method (e.g., failure to detect small effects), or whether they genuinely reflect the patients' limited cognitive abilities.
Some patients, for example, may have been unconscious (permanently or transiently) during scanning. Similarly, in some awake and aware patients who were in a minimally conscious state, the tasks may simply have exceeded their residual cognitive capabilities. Deficits in language comprehension, working memory, decision making, or executive function would have prevented successful completion of the imagery tasks.
However, positive results, whether observed with or without corroborative behavioral data, do confirm that all such processes were intact and that the patient must have been aware.
In summary, the results of this study show the potential for functional MRI to bridge the dissociation that can occur between behavior that is readily observable during a standardized clinical assessment and the actual level of residual cognitive function after serious brain injury.14-16
Thus, among 23 patients who received a diagnosis of being in a vegetative state on admission, 4 were shown to be able to willfully modulate their brain activity through mental imagery; this fact is inconsistent with the behavioral diagnosis.
In two of these patients, however, subsequent assessment at the bedside revealed some behavioral evidence of awareness, a finding that underscores the importance of thorough clinical examination for reducing the rate of misdiagnosis in such patients. Nonetheless, in the two remaining patients, no evidence of awareness could be detected at the bedside by an experienced clinical team, even after the results of the functional MRI examination were known.
This finding indicates that, in some patients, motor function can be so impaired that bedside assessments based on the presence or absence of a behavioral response may not reveal awareness, regardless of how thoroughly and carefully they are administered.
In patients without a behavioral response, it is clear that functional MRI complements existing diagnostic tools by providing a method for detecting covert signs of residual cognitive function17-20 and awareness.10
In addition, this study showed that in one patient with severe impairment of consciousness, functional MRI established the patient's ability to communicate solely by modulating brain activity, whereas this ability could not be established at the bedside.
In the future, this approach could be used to address important clinical questions. For example, patients could be asked if they are feeling any pain, and this information could be useful in determining whether analgesic agents should be administered.
With further development, this technique could be used by some patients to express their thoughts, control their environment, and increase their quality of life.
Supported by grants from the Medical Research Council (U.1055.01.002.00007.01 and U.1055.01.002.00001.01), the European Commission (Disorders and Coherence of the Embodied Self, Mindbridge, Deployment of Brain–Computer Interfaces for the Detection of Consciousness in Nonresponsive Patients, and Consciousness: A Transdisciplinary, Integrated Approach), Fonds de la Recherche Scientifique, the James S. McDonnell Foundation, the Mind Science Foundation, the Reine Elisabeth Medical Foundation, the Belgian French-Speaking Community Concerted Research Action, University Hospital of Liege, the University of Liege, and the National Institute for Health Research Biomedical Research Centre (Neurosciences Theme).
No potential conflict of interest relevant to this article was reported.
Dr. Monti and Ms. Vanhaudenhuyse contributed equally to this article.
This article (10.1056/NEJMoa0905370) was published on February 3, 2010, at NEJM.org.
We thank Daniel Gary Wakeman for his helpful discussions.
Source Information
From the Medical Research Council Cognition and Brain Sciences Unit (M.M.M., A.M.O.), the Impaired Consciousness Study Group, Wolfson Brain Imaging Centre, University of Cambridge (M.R.C.), and the Division of Academic Neurosurgery, Addenbrooke's Hospital (J.D.P.) — all in Cambridge, United Kingdom; and the Coma Science Group, Cyclotron Research Center, University of Liege (A.V., M.B., S.L.), and the Departments of Neurology (S.L., M.B.) and Neuroradiology (L.T.), University Hospital of Liege, Liege; and Fonds de la Recherche Scientifique, Brussels (A.V., S.L., M.B.) — all in Belgium.
Address reprint requests to Dr. Owen at the Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Rd., Cambridge CB2 7EF, United Kingdom, or at adrian.owen@mrc-cbu.cam.ac.uk.
Source: http://www.nejm.org/
Willful Modulation of Brain Activity in Disorders of Consciousness — NEJM
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa0905370#t=articleDiscussion
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