|| DukeMedNews || Bone Marrow Transplants for SCID

This week on Duke MedMinute: Dr. Rebecca Buckley, chief of Duke’s division of pediatric allergy and immunology, talks about using bone marrow transplantation to cure severe combined immune deficiency or SCID.

Tomorrow on the Newsline: Breaking news about existing drugs that can treat a type of fungus that attacks AIDS patients

Thursday on the Newsline: News from the Duke Primate Center

Suggested lead: Children with a disorder known as “bubble boy” disease are born without an immune system, and until recently, faced an early death from common infections. Now, researchers at Duke are using bone marrow transplants to help these tiny patients. Melinda Stubbee reports.

In Cut 1, Buckley says that babies born with the disorder can be given a healthy immune system if they receive a bone marrow transplant within three months of birth. They also have learned that these children need not have a perfectly matched donor, but can use a parent’s “half-matched” marrow. Furthermore, the babies do not need toxic pre-transplant chemotherapy, as is often thought and currently practiced.

Cut 1…survival rate…:11
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Buckley says early diagnosis of SCID is rare because doctors don’t routinely perform a test in newborns to count white blood cells. Such a blood test could pick up children with SCID as well as those with other serious immune deficiencies that would not be apparent until the child developed an infection. In Cut 2, Buckley says a simple blood test could allow them to treat, and most likely cure, SCID in a child for as little as 25-thousand dollars.

Cut 2…of birth…:18
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|| DukeMedNews || Everyday Stresses Can Damage the Heart

This week on Duke MedMinute: Elizabeth Gullette, research assistant in psychology at Duke, talks about a study published in the May 21 issue of the Journal of the American Medical Association. The study shows that such common emotions as tension, frustration and sadness trigger frequent and painless heart abnormalities that can lead to permanent heart damage. The researchers reported they have demonstrated a direct, cause-and-effect relationship between negative emotions and an increased risk of myocardial ischemia. This ischemia results from inadequate flow of blood to the heart and can be a precursor to heart attacks.

Suggested lead: The evidence that stress is bad for your heart continues to grow. Researchers at Duke University Medical Center report in this week’s Journal of the American Medical Association that even common emotions can trigger heart abnormalities. Melinda Stubbee has details.

Gullette describes the study’s main finding in Cut 1.

Cut 1…more than double…:18
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Gullette says this is the first time the degree of risk associated with stress has been documented, and the researchers were very surprised at the importance of negative emotions in triggering ischemia, as well as the size of the risk. She says only a minority of the patients they studied experienced chest pain, suggesting that patients were unaware that stress was affecting their hearts. In Cut 2, Gullette says those results present a good news/bad news scenario.

Cut 2…negative situations…:21
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In this study, 58 heart patients wore a portable electrocardiogram (ECG) monitor at home and at work and recorded in a diary their moods and symptoms three times an hour — during waking hours — for two days. The researchers the ECG data with diary information, and found that the episodes of ischemia were more than twice as likely to occur in the hour following emotional stress compared to the non-stress hours. They found that high levels of negative emotions were associated with a two- to three-fold increased risk for myocardial ischemia compared to low levels of these emotions

In addition to the higher risk for negative emotions, Gullette also found that heart patients had a 13 times higher risk of ischemia after heavy activity, and two times higher risk after moderate and light activity. Heavy activity, however, occurs relatively infrequently, while stress levels may fluctuate significantly over the course of the day. She says that behavior modification/stress management can help people with heart disease reduce their chances of having problems in the future.

|| DukeMedNews || Stress in Women

Background: Williams and his colleagues studied 152 women employed by a corporation in the Durham, N.C. area. Ninety-four women worked in customer service; the other 58 processed paperwork. The women were given confidential questionnaires measuring job stress and psychological factors. The workers reporting high levels of job strain showed higher levels of depression, anxiety, anger and hostility than their counterparts reporting lower levels of job strain. Those reporting strain also showed reduced levels of curiosity. Williams says because those factors can create health problems, any intervention that can reduce the stress associated with high job strain has the potential for immediate benefits in reduced use of costly medical services.

Suggested lead: A new study shows that if you’re a woman with a stressful job, you’re probably feeling the strain in ways that are harmful to your health. Melinda Stubbee reports.

SOQ…:60

Williams says they found that women workers who reported the highest levels of job strain in the work force they evaluated had a variety of other bad psychological and social characteristics including more hostility and anger, high levels of depression and anxiety and lower levels of social support.

Cut 1…job strain…:09 (Preview this in a AIFF or WAV file in 8 bit mono. For the full interview in high quality ISDN sound, call the newsline.)

In Cut 2 Williams explains what sort of health risks these high job stress women are more likely to face.

Cut 2…all causes…:20 (Preview this in a AIFF or WAV file in 8 bit mono. For the full interview in high quality ISDN sound, call the newsline.)

|| DukeMedNews || Low-Carbohydrate Diet Found Effective in Research Study

This week on MedMinute: Low-carbohydrate diet found effective in research study.

The debate about high-protein, low-carbohydrate diets such as the Atkins Diet continues among nutritionists and other medical experts. A new Duke study finds that such a diet led to sustained weight loss during a six-month period, but the study’s lead researcher says questions remain about the diet’s safety.

( Listen to this WAV file. )

The high-protein, low-carbohydrate diet, popularized by Dr. Robert Atkins, has been the subject of heated debate in medical circles for three decades. Is the diet an effective method of weight loss? Is it healthy? Now, preliminary findings of a new study at Duke University Medical Center show that a low-carbohydrate diet can indeed lead to significant and sustained weight loss. Dr. Eric Westman, associate professor of medicine, was principal investigator of the six-month study. “We found that 80 percent of the subjects stayed on the diet, which is remarkable for most diet programs. They lost an average of 10 percent of their original body weight, which again is a good amount of weight loss for a diet program.” Westman says researchers also found that subjects’ cholesterol levels improved, but he cautions that much more scientific research needs to be conducted. “While we’re impressed with the weight loss of this diet, we still are not sure about the safety of it. More studies need to be done to be confident about the safety of the diet.” The study, which appears in the current issue of The American Journal of Medicine, was funded by the Atkins Foundation.

|| DukeMedNews || Start Early To Prevent Osteoporosis

This week on MedMinute: Start Early To Prevent Osteoporosis

May is National Osteoporosis Awareness and Prevention Month, a good time to learn how Americans – especially women – can reduce their risk for developing this serious health condition. One key is to start exercising at a young age.

Listen to MedMinute audio

Grandmothers aren’t the only ones who should be concerned about osteoporosis. Girls as young as pre-teens are at an age when they can reduce future bone loss through regular, moderate exercise. This window of opportunity to “load our skeleton,” or increase bone mass, is brief – starting right around puberty and continuing through it, according to Dr. Kenneth Lyles, professor of medicine in the Division of Geriatrics at Duke University Medical Center.

“It is possible – and there’s plenty of clear data – that weight-bearing exercise for girls as they just start going into puberty is a very useful way to help them achieve their full skeletal potential.”

Advertising that shows pre-teens exercising or drinking a glass of milk can help make this age group aware of healthy habits that can reduce their risk of developing osteoporosis when they grow older.

“I think habits should be lifelong. Trying to get someone to do it who’s never done it before is a real problem. I think people should be encouraged to be physically active almost from the time they can walk. And I think it needs to be set by families.”

|| DukeMedNews || Brain Tumors and Drug Resistance

Background: The failure of chemotherapy to stop one type of aggressive brain tumor may be linked to a deficiency in a naturally occurring “fix-it” material in the cell, according to Duke medical center researchers. In a study reported in the July 15 issue of Cancer Research, Duke cancer and biochemistry specialists found that glioblastoma multiforme (GBM) tumors that had become resistant to chemotherapy drugs showed defects in the cellular mismatch repair system, a key factor in destroying cancer cells. The findings reinforce researchers’ beliefs that mismatch repair has broad impact on human tumor cell production.

While growing human GBM tumors in mice, the researchers treated the tumors with procarbazine, a drug commonly prescribed alone or in combination with other drugs in therapy for the brain cancer. Though procarbazine is a frontline drug treatment, most patients ultimately develop resistance to it and it ceases to check tumor growth. The tumors growing on mice developed resistance to the drug after nine treatments, giving the researchers a way to study the resistance mechanism.

Suggested lead: One of the most common and aggressive types of brain tumors is resistant to chemotherapy. And researchers at Duke University Medical Center say they think they know the reason why. Melinda Stubbee reports.

In Cut 1, Dr. Friedman says they grew the GBM tumors in mice and treated them with a common chemotherapy drug. He says they were surprised and delighted to see that the mice became resistant to the drug, and that gave them a chance to study that resistance mechanism.

Cut 1…in humans…:15
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A process called mismatch repair helps correct some of the disorder that occurs when cells go through changes. Friedman says what they found is that the resistant tumor cells have a mutation in mismatch repair, and that’s what they think leads to the resistance to certain drugs. In Cut 2, Friedman talks about what the discovery could lead to.

Cut 2…likely to work…:14
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|| DukeMedNews || Depression after a Heart Attack

Suggested lead: Recovery from a heart attack involves more than the physical rehabilitation; it can also require some psychological struggles. Tom Britt has more.

Cut 1…SOQ…:60 (Preview this in a WAV file in 16-bit mono.)

One of the typical reactions to a heart attack is depression. But how long that depression lasts might be sign of whether the patient is likely to have another, even more severe attack. James Blumenthal is a professor of medical psychiatry at Duke University Medical Center. He says physicians have only recently started to actively treat depression as part of the care for the heart attack itself. Research has shown that half of all heart attack patients suffer mild to serious depression.

“Another condition that frequently accompanies depression has to do with social isolation. People who feel that they don’t have people on whom they can depend, count on, confide in. Social isolation also appears to carry with it the significant increased risk for further heart complications.”

Blumenthal says the best treatment the family can give is to be supportive, and to work with the physician to encourage the heart attack patient to gradually ease back into an active lifestyle. I’m Tom Britt.

Blumenthal says being supportive is important in dealing with a recovering heart attack patient who shows signs of depression.

Cut 2…too long…:14 (Preview this in a WAV file in 16-bit mono.)

“Being a good listener, and also understanding that this is not an uncommon occurrence in heart attack patients — it’s not going to last forever, patients get over it — and that they’ll hopefully be back to normal before too long.”

|| DukeMedNews || Ovarian Cancer

Background: The scientists believe that constant ovulation, which causes cells in the ovary to divide, is likely to spontaneously damage DNA in those cells over time. That can result in mutations to a critical regulatory gene, known as p53, that normally stops cells from proliferating into cancer. The findings indicate that some women at risk for this type of cancer can protect themselves by reducing their ovulation cycles through birth control pills, pregnancy and breast-feeding.

Ovarian cancer is usually a fatal disease because it is usually found in its late stages, after it has spread beyond the ovaries. In 1996, about 27,000 new cases were diagnosed, and about 14,800 women died of the disease, according to the National Cancer Institute. Mean survival after detection is less than 3 years. Tumors that show evidence of p53 genetic mutation account for half of all ovarian cancer cases, and are considered the most aggressive form of ovarian cancer.

Suggested lead: Studies have shown that women who take birth control pills and have children have a reduced risk of getting ovarian cancer. And now, researchers at Duke University Medical Center say they’ve figured out why. Melinda Stubbee reports.

SOQ…:60

Berchuk says they believe that constant ovulation, which causes cells in the ovary to divide, is likely to spontaneously damage DNA in those cells over time. He says that can result in mutations to a critical regulatory gene, known as p53, that normally stops cells from proliferating into cancer.

Cut 1…p53 mutations…:13
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Berchuk says when a woman ovulates, the egg that is extruded from the ovary blows a hole in the surface of the ovary. The epithelial cells, where the cancer starts, line the surface of the ovary and they have to proliferate to fill in the hole.

Cut 2…ovarian cancer…:08
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In Cut 3, Berchuk says the Duke study is novel because it takes a “molecular epidemiology” approach to the disease, in order to link risk factors seen over a population of patients to alterations in the biology of the cell.

Cut 3…ovarian cancer…:20
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The study helps clear up the mystery of why it seems that some women, but not all, can protect themselves against ovarian cancer by suppressing ovulation, the investigators say. The lead author of the study is Joellen Schildkraut, assistant professor in community and family medicine and a researcher at Duke Comprehensive Cancer Center.

Berchuk says this is one of the first studies to show that ovarian cancer is really a collection of a number of different cancers. Each subgroup will have its own risk factors, which can help physicians tailor protective strategies and specific treatments.

|| DukeMedNews || Hepatitis and Liver Cancer

This week on Duke MedMinute: Randy Jirtle, professor of radiation oncology at Duke, talks about new research that shows how hepatitis leads to liver cancer.

Background: Hepatitis B and C infections slowly eat away at a person’s liver, severely damaging liver function and greatly increasing the risk of liver cancer. The Duke research demonstrates that once a hepatitis infection takes hold in the liver, even apparently healthy cells have lost one of two copies of a protective tumor suppressor gene, making them highly vulnerable to further genetic damage. Without a working copy of this suppressor gene, cancerous cell growth can’t be stopped. The discovery is particularly relevant because hepatitis, particularly hepatitis C, is responsible for about 85 percent of liver cancer cases in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 3.9 million Americans are infected with hepatitis C. Complications from hepatitis C are blamed for 10,000 deaths per year, but the CDC estimates the fatality rate could triple or quadruple within 15 years.

Suggested lead: Most people who get the hepatitis are vulnerable to liver cancer. And researchers at Duke University Medical Center say they now know the reason why. Melinda Stubbee reports on their recent finding, reported this week in the Proceedings of the National Academy of Sciences.

Jirtle says the finding demonstrates that hepatitis infection somehow favors survival of a subset of liver cells that are defective in a key cancer protective gene we know is an early marker for development of liver cancer

Cut 1..suppressor gene…:16 (Preview this in a AIFF or WAV file in 8 bit mono. For the full interview in high quality ISDN sound, call the newsline.

In Cut 2, Jirtle says this finding is a first step in understanding how the hepatitis virus damages the liver and greatly increases the chance of developing liver cancer. In addition, he says a test for the gene may help surgeons determine how much tissue surrounding cancerous liver lesions needs to be removed. Some of that “normal looking” tissue may already be on the path to cancer.

Cut 2…pre-malignant tissue…:16 (Preview this in a AIFF or WAV file in 8 bit mono. For the full interview in high quality ISDN sound, call the newsline.

|| DukeMedNews || Insight into Sperm Growth

Background: In a discovery that may help answer the eternal riddle of how an amorphous sac of stem cells in testes gives rise to sperm, Duke scientists have found a cell component that appears to guide potent reproductive cells to both self-renew and make mature differentiated cells. The finding, in the common fruit fly, may help explain how men continuously produce sperm, and why some stem cells in testicles and other parts of the body lose control, forming cancerous tumors.

Duke cell biologist Haifan Lin and his colleagues believe the cell structure or “organelle” orchestrates the formation of mature eggs from the progenitor stem cells in flies. This organelle, which Lin dubbed the “spectrosome,” appears to direct and help determine which cells remain stem cells and which become mature eggs by a process believed to be analogous to human sperm production.

Suggested lead: The formation of sex cells in flies may not sound very exciting. But a researcher at Duke University says his discovery of how they form could answer questions about cancer, infertility and anemia. Melinda Stubbee explains.

SOQ…:60

In Cut 1, Lin says his discovery was made by studying stem cells, which are potent cells thought to produce most of the specialized cells in the body, yet remain unchanged themselves. Perhaps as few as a couple of dozen stem cells, for example, give rise to all the varieties of white blood cells that constitute the immune system. Researchers estimate stem cells form or maintain up to 90 percent of the tissues in our bodies. Yet how these immortal cells work is one of the enduring mysteries of biology.

Cut 1…doing right things…:20 (Preview this in a AIFF or WAV file in 8 bit mono. For the full interview in high quality ISDN sound, call the newsline.

Lin says abnormal division of stem cells is also responsible for many forms of cancer, Mutations in germ stem cells in testicles account for some forms of testicular tumor formation, according to Lin. He believes an understanding of stem cell division and coordination will lead to a better understanding of the controls on cell growth and why some stem cells lose control to form cancers.

Cut 2…or infertility…:21 (Preview this in a AIFF or WAV file in 8 bit mono. For the full interview in high quality ISDN sound, call the newsline.