- UID
- 504111
- 在线时间
- 小时
- 注册时间
- 2010-1-19
- 最后登录
- 1970-1-1
- 主题
- 帖子
- 性别
- 保密
|
新的一期小分队开始了,期待大家的参与。一起提高,一起进步! 撒花~~ 坚持就是胜利!!
[计时1] About One Baby Born Each Hour Addicted to Opiate Drugs in U.S.
ScienceDaily (Apr. 30, 2012) — About one baby is born every hour addicted to opiate drugs in the United States, according to new research from University of Michigan physicians.
In the research published April 30 in the Journal of the American Medical Association, U-M physicians found that diagnosis of neonatal abstinence syndrome, a drug withdrawal syndrome among newborns, almost tripled between 2000 and 2009.
By 2009, the estimated number of newborns with the syndrome was 13,539 -- or about one baby born each hour, according to the study that U-M researchers believe is the first to assess national trends in neonatal abstinence syndrome and mothers using opiate drugs.
"Recently, the Centers for Disease Control and Prevention released a report which found that over the last decade sales for opiate pain relievers like OxyContin and Vicodin have quadrupled," says Stephen W. Patrick, M.D., M.P.H., M.S., lead author of the study and a fellow in the University of Michigan's Division of Neonatal-Perinatal Medicine.
"Although our study was not able to distinguish the exact opiate used during pregnancy, we do know that the overall use of this class of drugs grew by 5-fold over the last decade and this appears to correspond with much higher rates of withdrawal in their infants."
Patrick, a Robert Wood Johnson Clinical Scholar at the University of Michigan, says multiple factors are likely to blame for the dramatic spike in use of opiate pain relievers, from their potential overuse for chronic pain to illegal sales of these drugs on the street. Overall, the U-M study showed that the number of mothers using opiate drugs increased five times over the last decade.
"Opiate use in our country is becoming an epidemic. Too often our health system reacts to problems; instead, we must address opiate use as a public health issue. To do this, we must limit opiate pain reliever use through healthcare provider education and statewide systems that watch for abuses, like people going to multiple doctors to get opiate prescriptions," Patrick says. (345)
[计时2] Neonatal abstinence syndrome causes a wide array of symptoms including increased irritability, hypertonia, or heightened muscle tone, tremors, feeding intolerance, seizures, and respiratory distress. In addition, babies with the syndrome are more likely to be born with a low birthweight.
"You can often stand in the hallway and know which babies are experiencing withdrawal. They are irritable, their cries are different, and they appear uncomfortable," Patrick says.
The majority of the mothers of babies born with the syndrome were covered by Medicaid for health care costs. The average hospital bill for babies with the syndrome increased from $39,400 in 2000 to $53,400 in 2009, a 35 percent increase. By 2009, 77.6 percent of charges for babies with the syndrome were charged to Medicaid.
In Florida, where opiate pain reliever death now accounts for four times the number of deaths as illicit drugs, the number of newborns diagnosed with the syndrome has increase five-fold in the last six years. The Florida state House and Senate recently passed legislation to form a task force to evaluate the issue.
"Given that newborns with neonatal abstinence syndrome experience longer, often medically complex and costly initial hospitalizations, this study highlights the need for increased public health measures to reduce the number of babies exposed to opiate drugs," says Matthew M. Davis, M.D., M.A.P.P., associate professor in the Child Health Evaluation and Research Unit at the U-M Medical School, and associate professor of Public Policy at the Gerald R. Ford School of Public Policy. Davis is senior author on the paper and co-director of the Robert Wood Johnson Clinical Scholar Program at U-M.
"We hope that state leaders will call for more research into the data we've provided because the majority of hospital expenditures for this condition are shouldered by state Medicaid programs."
This work was supported by a grant from the Robert Wood Johnson Foundation Clinical Scholars Program. (313)
[计时3] Prenatal Exposure to Insecticide Chlorpyrifos Linked to Alterations in Brain Structure and Cognition
ScienceDaily (Apr. 30, 2012) — While chlorpyrifos is no longer registered for household use in the US, it continues to be widely used around the world, as well as on many food and agricultural products throughout the US.
Even low to moderate levels of exposure to the insecticide chlorpyrifos during pregnancy may lead to long-term, potentially irreversible changes in the brain structure of the child, according to a new brain imaging study by researchers from the Columbia Center for Children's Environmental Health at the Mailman School of Public Health, Duke University Medical Center, Emory University, and the New York State Psychiatric Institute. The changes in brain structure are consistent with cognitive deficits found in children exposed to this chemical.
Results of the study appear online in the April 30 PNAS.
The new study is the first to use MRI to identify the structural evidence for these cognitive deficits in humans, confirming earlier findings in animals. Changes were visible across the surface of the brain, with abnormal enlargement of some areas and thinning in others. The disturbances in brain structure are consistent with the IQ deficits previously reported in the children with high exposure levels of chlorpyrifos, or CPF, suggesting a link between prenatal exposure to CPF and deficits in IQ and working memory at age 7.
The study also reports evidence that CPF may eliminate or reverse the male-female differences that are ordinarily present in the brain. Further study is needed to determine the consequences of these changes before and after puberty, the researchers say.
Notably, the brain abnormalities appeared to occur at exposure levels below the current EPA threshold for toxicity, which is based on exposures high enough to inhibit the action of the key neurological enzyme cholinesterase. The present findings suggest that the mechanism underlying structural changes in the brain may involve other pathways. (318)
[计时4] According to the lead author, Virginia Rauh, ScD, Professor at the Mailman School of Public Health and Deputy Director of the Columbia Center for Children's Environmental Health, "By measuring a biomarker of CPF exposure during pregnancy, and following the children prospectively from birth into middle childhood, the present study provides evidence that the prenatal period is a vulnerable time for the developing child, and that toxic exposure during this critical period can have far-reaching effects on brain development and behavioral functioning."
"By combining brain imaging and community-based research, we now have much stronger evidence linking exposure to chlorpyrifos with neurodevelopmental problems," adds senior author Bradley S. Peterson, MD, Chief of Child & Adolescent Psychiatry, New York State Psychiatric Institute, and Director of MRI Research in the Department of Psychiatry, Columbia University Medical Center.
In the current study, the researchers used MRI to evaluate the brains of 40 New York City children, ages 5 to 11, whose mothers were enrolled prenatally in a larger cohort study. Researchers compared 20 children with high exposures to CPF with 20 children with lower exposures; all exposures occurred prior to the EPA ban on household use of the chemical in 2001. They found brain anomalies were associated with the higher exposure.
Since the 2001 ban, a drop in residential exposure levels of CPF has been documented by Robin Whyatt, DrPH, a co-author on the present study and Professor of Clinical Environmental Health Sciences and Co-Deputy Director of the Columbia Center for Children's Environmental Health at the Mailman School.
However, the chemical continues to be present in the environment through its widespread use in agriculture (food and feed crops), wood treatments, and public spaces such as golf courses, some parks, and highway medians. People near these sources can be exposed by inhaling the chemical, which drifts on the wind. Low-level exposure can also occur by eating fruits and vegetables that have been sprayed. Although the chemical is degraded rapidly by water and sunlight outdoors, it has been detected by the Columbia researchers in many urban residences years after the ban went into effect. (347)
[计时5] Faster-Ticking Clock Indicates Early Solar System May Have Evolved Faster Than We Thought
ScienceDaily (May 1, 2012) — Our solar system is four and a half billion years old, but its formation may have occurred over a shorter period of time than we previously thought, says an international team of researchers from the Hebrew University of Jerusalem and universities and laboratories in the US and Japan.
[attachimg=800,600]99853[/attachimg] Establishing chronologies of past events or determining ages of objects require having clocks that tick at different paces, according to how far back one looks. Nuclear clocks, used for dating, are based on the rate of decay of an atomic nucleus expressed by a half-life, the time it takes for half of a number of nuclei to decay, a property of each nuclear species.
Radiocarbon dating for example, invented in Chicago in the late 1940s and refined ever since, can date artifacts back to prehistoric times because the half-life of radiocarbon (carbon-14) is a few thousand years. The evaluation of ages of the history of earth or of the solar system requires extremely "slow-paced" chronometers consisting of nuclear clocks with much longer half-lives.
The activity of one of these clocks, known as nucleus samarium-146 (146Sm), was examined by Michael Paul, the Kalman and Malke Cooper Professor of Nuclear Physics at the Hebrew University of Jerusalem, as well as researchers from the University of Notre Dame and the Argonne National Laboratory in the US and from two Japanese universities.
146Sm belongs to a family of nuclear species which were "live" in our sun and its solar system when they were born. Events thereafter, and within a few hundred million years, are dated by the amount of 146Sm that was left in various mineral archives until its eventual "extinction."
146Sm has become the main tool for establishing the time evolution of the solar system over its first few hundred million years. This by itself owes to a delicate geochemical property of the element samarium, a rare element in nature. It is a sensitive probe for the separation, or differentiation, of the silicate portion of earth and of other planetary bodies. The main result of the work of the international scientists, detailed in a recent article in the journal Science, is a new determination of the half-life of 146Sm, previously adopted as 103 million years, to a much shorter value of 68 million years. The shorter half-life value, like a clock ticking faster, has the effect of shrinking the assessed chronology of events in the early solar system and in planetary differentiation into a shorter time span.
The new time scale, interestingly, is now consistent with a recent and precise dating made on a lunar rock and is in better agreement with the dating obtained with other chronometers.
The measurement of the half-life of 146Sm, performed over several years by the collaborators, involved the use of the ATLAS particle accelerator at Argonne National Laboratory in Illinois. (488)
[越障] Debate on diabetes drugs gathers pace
Petition unveils unnerving reports on potential carcinogenicity of GLP-1 mimics. Amy Maxmen 30 April 2012
A petition to ban the diabetes drug Victoza (liraglutide) has turned the spotlight onto studies that demonstrate its potential to cause pancreatic and thyroid cancer.
“We don’t just go after drugs casually,” says Sidney Wolfe, director of the health and research group at Public Citizen, a non-profit consumer-advocacy organization based in Washington DC, which sent the petition to the US Food and Drug Administration (FDA) on 19 April. “We only go after drugs when there is clear evidence of unique dangers or risks, and when there is no evidence of a unique clinical advantage.”
Public Citizen says that Victoza has a number of possible side effects; of those, critics are most concerned about pancreatic cancer. Once that cancer spreads, a patient stands just a 1.8% chance of surviving for longer than five years.
The petition rests in part on the work of Peter Butler, an endocrinologist at the University of California, Los Angeles. For some years, his work has been fuelling a debate on Victoza and other drugs in the same class — but until now, that debate has been confined to diabetes investigators.
Victoza, made by Novo Nordisk of Bagsværd, Denmark, was approved by the FDA in 2010. It is the second diabetes drug to mimic the activity of a hormone called glucagon-like peptide-1 (GLP-1), which stimulates the release of insulin from the pancreas and ultimately lowers concentrations of glucose in the blood.
In some people, drugs that mimic GLP-1 may inflame the pancreas, causing pancreatitis — a risk factor for pancreatic cancer. In 2009, the FDA ruled that such drugs must be labelled with a warning about pancreatitis; Victoza carries that warning, as do Byetta and Bydureon, formulations of the GLP-1 mimic exenatide, made by Amylin Pharmaceuticals of San Diego, California. Wolfe says his concern extends to other diabetes drugs that alter the GLP-1 pathway, but there was stronger evidence to make a case against Victoza.
Since 2009, Butler and his colleagues have discovered that such treatments might affect the pancreas by activating GLP-1 receptor proteins, which in turn stimulate proliferation of precancerous cells. His latest finding1 is that human and rodent pancreases contain lots of GLP-1 receptors in areas in which cancer is thought to originate, and mice that are genetically predisposed to pancreatic cancer develop the disease more quickly than usual in response to Byetta.
Butler hypothesizes that treatments based on GLP-1 might lead to pancreatic cancer in people with pancreatic abnormalities that might otherwise have remained dormant. Similarly, GLP-1 receptors inhabit thyroid tissue, which Butler says could account for cases of thyroid cancer that occurred during clinical trials of Victoza2.
“Butler has put together a hypothesis which is interesting and needs to be investigated,” says Edwin Gale, an endocrinologist at the University of Bristol, UK. “Pancreatitis may be just the tip of the iceberg, and it’s the iceberg that concerns me.”
Shaky data
On the basis of information plucked from the FDA’s adverse-event reporting database, Public Citizen counted 28 cases of pancreatic cancer reported between February 2010 and September 2011 among patients on Victoza, compared with just one case in a patient taking a diabetes drug that does not manipulate the GLP-1 pathway. And last year, Butler published a report in Gastroenterology3, in which he looked at FDA data from thousands of patients, and concluded that those taking Byetta developed pancreatic cancer 2.95 times as often as those on an unrelated diabetes medication.
Within days of Butler’s paper being posted online, Novo Nordisk wrote to the journal's editor-in-chief, criticizing the paper and its authors for publishing bad science. “If that article is taken out of context, it can do more harm than good if it’s picked up by the media, and people think, oh my god, this is dangerous and I need to get off this drug,” says Alan Moses, global chief medical officer for Novo Nordisk in Princeton, New Jersey.
Indeed, any conclusions drawn from the FDA’s adverse-event database are riddled with caveats. For example, the database does not indicate whether a patient was at particular risk for cancer before they took the drug. And because it has no information on healthy people, it is impossible for researchers to determine incidence rates accurately.
As for Butler’s rodent experiments, Moses argues that if pancreatic cancer were a risk, Novo Nordisk would have seen it in in-house animal studies. (A rare type of thyroid cancer did show up, prompting a warning on Victoza’s label.)
Butler says it is no wonder that Novo Nordisk bristles in response to his publications. “The global market for type 2 diabetes drugs is worth US$20 billion,” he says. “These drugs are the only ones that manufacturers have that are not off-patent, so if they disappear, they’d have nothing.” Global sales of Victoza reached $310 million last year.
Insufficient surveillance
Butler and others who use the FDA adverse event database admit that a strong case cannot be made with this information alone. Ideally, researchers would compare incidence of cancer in the thousands of patients taking Victoza or Byetta with that in those on non-GLP-1 diabetes drugs, but for now they can't, because comprehensive databases either don’t exist or can’t be accessed. Instead, Novo Nordisk has enrolled 9,000 people in a safety-monitoring study requested by the FDA.
Still, the study might not be large enough to detect pancreatic-cancer risks, according to Daniel Drucker, an endocrinologist at the University of Toronto in Canada. About 1 in 10,000 people in the United States develop pancreatic cancer each year, so the study would have to be enormous to reach statistical significance.“You need to follow close to a million people, controlled for as many variables as possible, to be able to have the statistical power to make any meaningful conclusin about possible changes in incidence rates of cancers like pancreatic cancer,” says Drucker, who consults for Novo Nordisk and other manufacturers of diabetes drugs. “It’s highly irresponsible to say on the basis of a mouse or rat study that a drug is safe or unsafe, and I wouldn’t use poor-quality case reports [from the FDA's adverse event database] to make assumptions either.”
Because there are other diabetes drugs on the market, Wolfe disagrees with waiting while thousands of people are followed for years. So far people have filled about 2 million prescriptions for Victoza in the United States; that number will increase rapidly if Novo Nordisk receives approval from the FDA to market liraglutide for obesity.
Butler agrees that waiting isn’t the only approach. “This story is a genie that’s escaped from the bottle because of Public Citizen, which is good because we need neutral people to repeat my experiments and to do other experiments,” he says. “I hope that I’m proven wrong because I’m not looking for people to get pancreatic cancer.”
(1146) |
本帖子中包含更多资源
您需要 登录 才可以下载或查看,没有帐号?立即注册
x
|