Genome-wide screen of learning in zebrafish identifies enzyme important in neural circuit

Implications for understanding underlying molecular genetics of human neuropsychiatric disorders, according to Penn study

Researchers at the Perelman School of Medicine at the University of Pennsylvania describe the first set of genes important in learning in a zebrafish model in the journalNeuron this week. “Using an in-depth analysis of one of these genes, we have already revealed an important relevant signaling pathway,” says senior author Michael Granato, PhD, a professor of Cell and Developmental Biology. “The proteins in this pathway could provide new insights into the development of novel pharmacological targets.”Over the last 20 years, zebrafish have become great models for studying development and disease. Like humans, zebrafish are vertebrates and over 80 percent of human genes bearing disease descriptions are also present in zebrafish. As such, this animal model has become increasingly popular to study human diseases such as cardiovascular conditions or tumor formation.

Read the rest of the article at http://www.medicalnewstoday.com/releases/291338.php.

One in 4 patients who visited emergency department for chest pain did not receive follow-up care

Patients with multiple health issues and who are at higher risk of adverse events are less likely to receive follow-up care from a physician after visiting an emergency department for chest pain, reports a study published in CMAJ(Canadian Medical Association Journal).Chest pain is one of the most common reasons people visit emergency departments, with about 500 000 visits every year in Canada alone.The study looked at 56 767 patients with chest pain who visited an emergency department in Ontario between April 2004 and March 2010. Of these, 42 535 (75%) were seen by a primary care physician or cardiologist within 30 days after discharge, and 14 232 (25%) did not receive follow-up care. Patients with multiple illnesses such as heart disease, kidney disease and dementia, and rural residency were less likely than others to receive follow-up care in the following month. Patients who had visited a primary care physician or cardiologist in the preceding year were more likely to see a physician after discharge.”We initially thought that emergency department physicians would risk stratify patients such that those with more medical and cardiac comorbidities would receive more physician follow-up care,” writes Dr. Dennis Ko, a senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and an interventional cardiologist at the Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, with coauthors. “However, patients with more medical comorbidities in our cohort were less likely to receive physician follow-up postdischarge.”

Read the rest of the article at  http://www.medicalnewstoday.com/releases/289784.php.

Improved survival with earlier intervention for common form of heart attack

Changes in the treatment of the most common form of heart attack over the past decade have been associated with higher survival rates for men and women regardless of age, race and ethnicity, according to a UCLA-led analysis.

But the study also suggests that there is room for improvement in how current treatment guidelines are applied among specific patient groups.

The researchers reviewed records for 6.5 million people who were treated for heart attacks between 2002 and 2011. The analysis was among the first and largest national studies to assess the impact of the trend toward more aggressive care for patients who experience the type of heart attack known as non-ST elevation myocardial infarction, or NSTEMI.

Their findings are reported in the current online edition of the peer-reviewed Journal of the American Heart Association.

“The substantial reductions in in-hospital mortality observed for NSTEMI patients nationwide over the last decade reflect greater adherence to evidence-based, guideline-directed therapies,” said Dr. Gregg C. Fonarow, the study’s senior author and UCLA’s Eliot Corday Professor of Cardiovascular Medicine and Science.

“Nevertheless, there may be further opportunities to improve care and outcomes for patients with NSTEMI, who represent the greater proportion of patients presenting with myocardial infarction,” said Fonarow, who also is director of the Ahmanson-UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA.

Heart attacks are broadly classified into two types. The more severe form, ST-elevation myocardial infarction (STEMI), involves complete blockage of an artery supplying blood to the heart muscle. The less severe type, NSTEMI, involves partial or temporary blockage of the artery. Studies in the U.S. and Europe have found that although the incidence of STEMI heart attacks is declining, the number of NSTEMI heart attacks increased in the past decade.

Guidelines issued in 2012 by the American College of Cardiology and American Heart Association recommended initiating cardiac catheterization in high-risk NSTEMI patients within 12 to 24 hours after the patient arrives at the hospital. This strategy had been evolving since 2009 following publication of the Timing of Intervention in Acute Coronary Syndromes trial. Previously, the recommendation was to begin catheterization in high-risk NSTEMI patients within 48 hours.

Fonarow and his colleagues examined trends in the use of cardiac catheterization for people who had been hospitalized after suffering an NSTEMI, within 24 hours and within 48 hours of presentation, seeking to determine whether changes in their care may have resulted in better outcomes.

The researchers analyzed publicly available records from the Nationwide Inpatient Sample, the largest U.S. database of hospitalized individuals. Of the 6.5 million patients whose records they examined, 3.98 million were admitted to hospitals with NSTEMI diagnoses.

The study tracked the proportion of those patients who underwent cardiac catheterization each year, and their outcomes – how many died in the hospital, the average length of their hospital stays, and the cost of hospitalization. They found that as the trend toward earlier intervention in NSTEMI patients took hold – with doctors beginning treatment within 24 hours after patients arrived at the hospital, rather than within 48 hours – the rate of in-hospital death declined from 5.5 percent in 2002 to 3.9 percent in 2011. Improvements were found for men and women, older and younger patients, and across all races and ethnic groups.

In addition, the average length of patients’ hospital stays decreased during the decade-long study, from 5.7 days to 4.8 days. NSTEMI patients who underwent cardiac catheterization within the first 24 hours had the shortest average stays.

Although more NSTEMI patients in all demographic groups received early cardiac catheterization as the study progressed, there were still significant differences across age, gender, and racial and ethnic groups in how frequently early intervention was used. Men, for example, were more likely to receive earlier catheterization than women.

“Despite the improvement, there are significant differences in the age-, gender-, and ethnicity-specific trends in the use of invasive management of NSTEMI, and these findings may help guide further improvements in care and outcomes for male and female patients of all ages, races and ethnicities,” said New York Medical College’s Dr. Sahil Khera, the study’s first author. “Further efforts are needed to enhance the quality of care for patients with NSTEMI and to develop strategies to ensure more equitable care for patients with this type of heart attack.”

http://www.medicalnewstoday.com/releases/280651.php

 

 

Moderate exercise reduces female stroke risk

SAN DIEGO – Moderate exercise significantly reduced the risk of stroke in women and seemed to offset much but not all of the increased stroke risk in postmenopausal women on hormone therapy, a large retrospective study found.

A self-reported history of moderate-to-strenuous physical activity in the prior 3 years was associated with a roughly 20%-30% lower risk for stroke in an analysis of data on 133,479 women in theCalifornia Teachers Study who had been followed every 4-5 years since 1995 by questionnaire, Sophia S. Wang, Ph.D., and her associates reported.

They linked the data set with hospitalization data during 1996-2010 to identify 2,416 ischemic strokes and 710 hemorrhagic strokes in the cohort that were validated by a review of medical records.

The strongest reduction in stroke risk was seen in women who reported moderate physical activity such as brisk walking, recreational tennis, golf, volleyball, or cycling on level streets. Women who reported in 1995-1996 questionnaires that they had engaged in moderate activity in the prior 3 years were 12%-22% less likely to develop a stroke, depending on the amount of activity each week, compared with inactive women who reported less than a half-hour per week of moderate activity.

“You don’t have to climb a mountain” to gain the stroke-reducing benefits of exercise, Dr. Wang said in an interview at the International Stroke Conference. And the fact that people tend to overreport how much they exercise when surveyed makes the findings “particularly robust,” she said.

Indeed, reports of strenuous activity were not significantly associated with lower stroke risk. Strenuous activity included swimming laps, aerobics, running, calisthenics, jogging, basketball, racquetball, or cycling on hills. Risk levels ranged from an increase of 3% to a reduction of 18% with strenuous activity, compared with inactive women.

Because most women who exercised strenuously also reported moderate activity, the investigators combined those two activity categories and again found approximately a 20% reduction in stroke risk that clearly was being driven by the benefits of moderate activity, said Dr. Wang of Beckman Research Institute at the City of Hope, Duarte, Calif. Stroke risk reductions ranged from 15%-23% in the combined activity analysis for the 1995-1996 surveys.

Surveyed again in 2005-2006, women who reported moderate or strenuous activity in the prior 3 years were 12%-20% less likely to develop a stroke, compared with inactive women, she said at the meeting, sponsored by the American Heart Association.

More than 5 hours of activity wasn’t more beneficial than fewer hours, she added. Stroke reduction benefits seemed greatest with 3.5-5 hours of activity per week, which was associated with a 23% risk reduction in the earlier survey and a 29% reduction in the later survey. With more than 5 hours, the risk reduction was 17% and 27%, respectively.

In inactive postmenopausal women, current hormone use was associated with a 59% higher risk for stroke and former hormone use was associated with a 16% increased risk, compared with postmenopausal women who didn’t use hormones, Dr. Wang said. However, the elevated stroke risk with hormone use fell in women who exercised, compared with those who didn’t.

In current hormone users, stroke risk was 37% higher in women who reported 0.51-3.5 hours of moderate or strenuous activity per week and 29% higher in women who reported more than 3.5 hours of activity per week, compared with non-hormone users. In former hormone users, stroke risk was 15% higher in those who reported 0.51-3.5 hours of activity per week and 5% higher in those who exercised more than 3.5 hours per week, compared with non-hormone users.

Because of smaller numbers of women in the subset analyses of postmenopausal hormone use, these differences between groups did not reach statistical significance, Dr. Wang said.

She and her associates plan further studies related to these findings, including whether or not activity levels may help prevent stroke in women who’ve already had a stroke, she said.

Dr. Wang and her colleagues reported having no financial disclosures. The National Institute of Neurological Disorders and Stroke funded the study.

 

http://www.ecardiologynews.com/single-view/moderate-exercise-reduces-female-stroke-risk/e98ae0e5d5e6180cf80efe5de44a9e8c.html

 

Picture courtesy of heart.arizona.edu