Fraudulent Data May Have Led to Use of Risky Treatment in ICUs

By Amanda Gardner
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Studies loaded with fraudulent data may have encouraged the use of a treatment for patients in intensive care units that now appears to do more harm than good, new research shows.

At issue is hydroxyethyl starch, an intravenous solution sometimes used to replace lost blood volume in critically ill patients. According to a new review article in the Feb. 20 issue of the Journal of the American Medical Association, the starchy solution may instead boost their risk of death or kidney failure.

"Almost certainly, what is happening is that some of the starch molecules leak out of blood vessels into the kidney itself so the kidney doesn't work as efficiently," said Dr. David Taylor, chairman of pulmonary and critical care medicine at Ochsner Health System in New Orleans. He was not involved in the new review.

Luckily for American patients, hydroxyethyl starch is not commonly used in the United States, Taylor said. But the new analysis serves as a cautionary tale on how fraudulent data can end up endangering patients' lives.

As Taylor explained it, critically ill patients often develop leaky vessels, and so quickly require intravenous fluids to keep their blood pressure stable and to improve organ function.

One such fluid is simple saline or salt water, known as crystalloid solution. This is the cheapest fluid available, but it tends to leak out of blood vessels, which means it can also leak into the lungs, under the skin and into various organs.

As a result, researchers have spent considerable time and effort trying to find less leaky alternatives to saline. The protein albumin, derived from human blood, is commonly used after cardiac surgery, when the risk of fluid collecting in the lungs is high, Taylor explained. Although albumin is less leaky than saline, it is more expensive.

Hydroxyethyl starch is similar to albumin, but it contains starch molecules, which are less likely to leak out of the blood vessels than saline.

Still, many researchers had reservations about using a starch-based solution from the beginning, Taylor said.

"If you have salt water and it leaks out, you just get some salt into the tissue and it goes away with a little bit of time," he explained. On the other hand, "if you have starch in the tissue it's not so easy to get starch out of there, and many people were worried about the possibility of complications."

It turns out there was even more reason to be suspicious of any alleged benefits of hydroxyethyl starch. In 2011, investigators discovered that the lion's share of research on the treatment that was conducted by German anesthesiologist Dr. Joachim Boldt was fraudulent and had to be retracted.

So the author of the current paper wondered: Would the purported benefits of hydroxyethyl starch hold up once Boldt's data was excluded?

Led by Dr. Ryan Zarychanski, of the University of Manitoba in Winnipeg, Canada, the team pooled data from 38 previous studies on the issue, including those by Boldt.

That analysis concluded that patients who received hydroxyethyl starch did not fare any better than other types of fluid.

But when the Boldt studies were excluded from the mix, hydroxyethyl starch was actually associated with an increased risk of death, kidney failure and need for dialysis among patients, the new research found.

It's impossible to gauge how many patients were damaged by Boldt's falsified research, but this new study highlights "how the inclusion or exclusion of the Boldt papers associated with research misconduct can shift the balance toward harm," said Dr. Massimo Antonelli, author of an editorial accompanying the new study.

"It showed also how the worldwide administration of starches for volume replacement therapy have caused the increase of acute renal failure and affected mortality," said Antonelli, a professor of intensive care and anesthesiology at the Catholic University-A.Gemelli University Hospital in Rome.

He added that a task force of the Surviving Sepsis Campaign, an organization devoted to reducing death from sepsis, recently issued guidelines warning against using starches for fluid replacement.

"These findings will reinforce [those] recommendations," he said.

Taylor stressed, however, that it would still be helpful to find alternatives to both albumin and saline.

A person in the intensive care unit (ICU) can have 1-2 liters more of fluid going into their body than out, said Taylor. Each liter weighs 1 kilogram, or 2.2 pounds.

"It's possible to gain anywhere from 8-10 pounds in fluid [in the ICU] so it would be a great to have an alternative to 10 pounds of weight," he said. However, a starch solution "is not a good alternative because it increases the risk of dying or needing dialysis," Taylor said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: David Taylor, M.D., chairman, pulmonary and critical care medicine, Ochsner Health System, New Orleans; Massimo Antonelli, M.D., professor, intensive care and anesthesiology, Catholic University-A. Gemelli University Hospital, Rome; Feb. 20, 2013, Journal of the American Medical Association

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Health Tip: Eating for Healthier Teeth

(HealthDay News) -- Most parents know the importance of brushing and flossing, but what you eat also is crucial to maintaining good dental health.

The Academy of Nutrition and Dietetics offers this advice to help preserve a child's dental health:

Kids should eat foods rich in calcium, such as dairy foods, dark and leafy green vegetables, and almonds.They should also eat phosphorous-rich foods, such as eggs, fish and lean meats.And they should eat vitamin C-rich foods, such as citrus fruits, potatoes, tomatoes, spinach and broccoli.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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Cold and Flu Sufferers Should Ease Back Into Fitness Routine

TUESDAY, Feb. 19 (HealthDay News) -- Although physical activity can help boost your immune system, people who are sick should tone down their workout or skip it altogether, experts advise.

"Regular exercise is a great way to reduce stress and sleep better at night. This helps boost your immune system. However, vigorous exercise and extreme conditioning can have a negative impact on your health if you're sick," Joe Berg, a personal trainer and fitness specialist at Loyola Center for Health, said in a Loyola University news release.

"When fighting a viral illness, it's best to keep your exercise session short and not as intense. If you have a fever or stomach bug it might be best to hold off," Berg added.

For those recovering from an illness, it's best to ease back into a workout routine slowly. Berg recommends starting small with some light aerobics, such as walking and cycling at an easy pace as well as body weight squats, push-ups and planks. In the plank exercise, you rest your weight on your forearms with your elbows directly beneath your shoulders, keeping your body in a straight line from your head to your feet.

"These exercises cover the major muscles of the body and when performed in moderation, can help boost your immune system," explained Berg.

For people worried about being exposed to germs at the gym, Valerie Walkowiak, medical integration coordinator at the Loyola Center for Fitness, pointed out that heading outside or working out at home may be a good way to stay healthy and fit during the cold and flu season.

"Weather permitting, it's always great to just get out of the house and walk or run to get in some cardio exercise. Just make sure you wear the proper clothes to keep warm. This includes layers of clothing, a hat, scarf, gloves and appropriate shoes," said Walkowiak.

When the weather makes exercising outdoors impossible, there are ways people can work out at home -- even if they don't have special equipment. Walkowiak said you can get your heart rate up without leaving the house by climbing the stairs, jogging in place or doing jumping jacks. She added that a home-based circuit training routine can be created by alternating two to three minutes of these cardio exercises with 30 to 60 seconds of strength-training moves, such as push-ups, squats, seated rows or heel raises.

"You don't have to have dumbbells, bands or tubing to get in some strength training at home. Try using household items to add resistance such as soup cans, gallon jugs of water or your own body weight," Walkowiak noted.

In order to target all the muscle groups, Walkowiak recommended doing the following exercises:

Chest, shoulder and triceps: do push-ups on the floor or against a wallBack, rear shoulders and biceps: try seated or standing row exercises using soup cans Legs, glutes and core: perform squats, sit-to-chair stands or lunges Calfs: do heel raises on the edge of a step Core: do planks, abdominal crunches, abdominal twists and leg raises Biceps: do bicep curls using soup cansTriceps: using a soup can or weighted object do kickbacks or over presses

Anyone who does go to the gym should remember to wipe down machines and wash their hands often, the experts advised.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Loyola University Health System, news release, Feb. 14, 2013

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Fluorescent Tracer 'Lights Up' Brain Tumor for Surgery

By Barbara Bronson Gray
HealthDay Reporter

TUESDAY, Feb. 19 (HealthDay News) -- Neurosurgeons report that they harnessed the power of fluorescent light to illuminate a brain tumor so the entire growth could be removed.

A report describes a case in which a patient with glioblastoma swallowed a pill, called 5-ALA, and was taken to surgery about four hours later. The medication attached itself to tumor cells, causing them to glow brightly. Once the skull was opened, the doctors focused a blue light on the tumor, which gave the cancerous cells a pink glow, so the surgeons could differentiate malignant tissue from healthy tissue.

"This is a very, very good thing," said study author Mitchel Berger, chairman of neurosurgery at the University of California, San Francisco. "In this case, we just happened to notice we could see evidence of the tumor spreading along the way of the ventricles [a communicating network of brain cavities], which showed we could see tumor dissemination."

The authors noted that the best way to extend survival is to remove as much of the brain tumor as possible. The research is published in the Feb. 19 issue of the Journal of Neurosurgery.

It's not always easy to see precisely where a tumor has spread in the brain. Some types of tumors can be particularly difficult to identify and remove, even with the benefit of MRI and surgical microscopes.

The use of fluorescence appears to be more effective than MRI technology, at least in this case, because the glow allows surgeons to see microscopic remnants of the tumor and areas of the cancer that might be mistaken for edema, or swelling, Berger explained. "This is an inexpensive way to identify high-grade tumors," he said.

Glioblastomas are a fast-growing type of tumor that usually occurs in adults and affects the brain more often than the spinal cord, according to the U.S. National Cancer Institute.

Why do tumor cells respond differently to the fluorescent drug than the body's other cells do? Their metabolism involves porphyrin, which has a tremendous ability to absorb light, Berger explained. Porphyrin is an organic compound, like the pigment in red blood cells. The pill used in the case report is derived from porphyrin.

The report focused on the case of a 56-year-old man who had undergone resection of a glioblastoma located in the right occipital lobe of his brain in 2005. Several years later, when symptoms reappeared, an MRI scan showed three distinct, new sites of tumor in the patient's right temporal lobe.

In surgery, when the surgeons viewed the fluorescent tumor cells, they could tell rather than being a new tumor, the cancer had spread from its original location on the right side of the brain through a pathway along the wall of the right ventricle. The researchers found that the use of 5-ALA during surgery enabled them to see the actual pathway of the tumor as it had spread.

The use of 5-ALA changed the patient's prognosis. "Multi-centric disease worsens the prognosis," Berger explained.

While the technique has been used in Europe for several years, the U.S. Food and Drug Administration has not approved the use of 5-ALA in the United States. Any surgeons using 5-ALA do so with limited permission from the FDA, Berger noted. The medication, 5-ALA, is manufactured by DUSA Pharmaceuticals.

Dr. Michael Schulder, vice chairman of the department of neurosurgery at North Shore University Hospital in Manhasset, N.Y., explained that "while the FDA considers 5-ALA a drug, which would require a lengthy process for approval, neurosurgeons see it as a surgical aid, which would take far less time to get the OK."

While Schulder said he thinks 5-ALA probably will add about six months to the anticipated survival of patients with high-grade gliomas, he said that attempts to improve the ability to remove these tumors will only go so far. "In the end, however helpful the use of 5-ALA or similar compounds may be in the surgical removal of brain cancers, it won't be the answer. The treatments will have to be biological to truly have an impact on survival, and ultimately, on a cure."

Schulder said he thinks it would be possible for fluorescence to be used in other types of surgeries, if surgeons could become comfortable using a surgical microscope with the benefit of a special light (something neurosurgeons are accustomed to using). He noted that he also thinks the technique might apply to some spinal surgeries, where visualizing the spinal cord is critical.

Schulder said he thinks the use of fluorescence in cancer surgery is promising. "It's a very important concept: if you can see a tumor better, you can remove it without affecting healthy tissue."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Mitchel Berger, M.D., professor and chairman, neurosurgery, department of neurological surgery, University of California, San Francisco; Michael Schulder, M.D., vice chairman, department of neurosurgery, North Shore University Hospital, Manhasset, N.Y.; Feb. 19, 2013, Journal of Neurosurgery

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Injuries Rising Among Young Dancers

TUESDAY, Feb. 19 (HealthDay News) -- A new study finds that 113,000 children and teens were treated for injuries related to dancing from 1991 to 2007, and the annual number of injuries grew by more than a third over that period.

Sprains and strains, or both, were most common, causing 52 percent of injuries, followed by falls, responsible for 45 percent of dance-related mishaps.

The study looked at dance injuries among children and young adults aged 3 to 19. All were treated in U.S. emergency rooms.

"Adolescents are still growing into their bodies and as such often develop imbalances that can lead to injury," said Eric Leighton, an athletic trainer in sports medicine at Nationwide Children's Hospital, in a hospital news release. "It's critical that intervention and injury prevention be made available to them to address balance, strength and functional body control deficits as they grow."

According to the study, the annual number of dance-related injuries grew from 6,175 injuries in 1991 to nearly 8,500 injuries in 2007. Forty percent of injuries occurred in dancers aged 15 to 19.

"We believe this could be due to adolescent dancers getting more advanced in their skills, becoming more progressed in their careers and spending more time training and practicing," Kristin Roberts, lead study author and a senior research associate at the Center for Injury Research and Policy at the hospital, said in the news release. "We encourage children to keep dancing and exercising. But it is important that dancers and their instructors take precautions to avoid sustaining injuries."

Senior author Lara McKenzie, principal investigator at the Center for Injury Research and Policy, added: "Safety precautions such as staying well-hydrated, properly warming up and cooling down, concentrating on the proper technique and getting plenty of rest can help prevent dance-related injuries."

The study appears in the February issue of the Journal of Physical Activity and Health.

-- Randy Dotinga
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Nationwide Children's Hospital, news release, Feb. 11, 2013

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CommScope Completes Acquisition of Argus Technologies

CommScope, a global leader in infrastructure solutions for communications networks, has completed its acquisition of Argus Technologies, a leading producer of innovative antenna solutions for wireless applications. Terms of the agreement are not being disclosed.

Argus, headquartered near Sydney, Australia, provides a wide array of high-performance, high technology antennas for base stations, stadiums and venues, and other wireless applications. The acquisition enables CommScope to broaden its antenna solutions portfolio, deepen its research and development capabilities, strengthen its global market presence and accelerate its growth in the wireless market.

“We welcome the Argus team to CommScope and are excited about our future together as we help customers evolve their networks to new technologies and address challenges presented by today’s data hungry, on-the-go society,” said Randy Crenshaw, executive vice president and chief operating officer, CommScope.

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Nordic Train Passengers Stay Connected with CommScope Coverage Solutions

Trains and rail systems – among the most complex environments for providing wireless network services – are fast becoming priorities for providing reliable coverage because of consumers’ expectation for constant connectivity. CommScope, which through its Andrew Solutions portfolio already has provided connectivity solutions to rail systems throughout the world, now has supplied new coverage and capacity solutions for trains and train tunnels in multiple Nordic countries, enabling commuter access to reliable wireless communications.

“Challenging RF environments such as train cars and tunnels require dedicated coverage systems for supporting wireless signals,” said Phil Sorsky, vice president, wireless sales, Europe, CommScope. “Devising the engineering and product solutions that enable wireless communications in such difficult environments is a specialty of CommScope.”

Wireless operators are faced with many challenges in providing service along railways, including tunnels and stations that block or restrict signals, high-speed trains that complicate cellular hand-offs, and smartphone users who expect constant access to data services while onboard. Such demands typically require dedicated coverage and capacity solutions to ensure access for commuters and sufficient network capacity for operators.

Wireless operators in Denmark and Finland are utilising the Node AM digital repeater from CommScope, a global leader in infrastructure solutions for communication networks, for in-train deployments. Meanwhile, one operator in Norway is deploying CommScope’s ION™-M distributed antenna system (DAS) and Node A digital repeater platform for wireless coverage in train tunnels.

In Denmark, CommScope supplied its Node AM in-train repeaters for use by wireless operators with three RF cards in each repeater supporting the 900MHz, 1,800MHz and 2,100MHz bands. Thanks to the Node AM’s flexible design, each repeater can easily be extended to support LTE in the 800 MHz band. Node AM in-train repeaters are placed in each train car to effectively manage access to RF signals for passengers.

CommScope also is supplying Node AM repeaters for use by wireless operators in Finland. There, each repeater has two RF cards – one combined card supporting the standard 900MHz band and GSM-R and one card for UMTS in the 2,100MHz band.

“Multi-operator, multi-frequency band, and multi-technology standard are common scenarios when working on train projects such as these,” said Sorsky. “CommScope’s extensive history in bringing wireless coverage and capacity to rail systems, sports stadiums, and other challenging areas helps us manage such complexity.”

CommScope’s work in Norway has involved supplying RF equipment for installation in train tunnels, not inside the train cars. The company’s ION-M DAS and Node A digital repeater platform bring wireless signals into the tunnels, making access for train passengers possible. CommScope’s coverage and capacity solutions currently support CDMA in the 450MHz, 900MHz, 1,800MHz and 2,100MHz bands, and are also easily extended to LTE 800MHz.

ION is an easy-to-scale, fibre-based coverage and capacity solution for indoor and outdoor applications, available in multiple power levels with a unique multi-band, multi-operator platform. CommScope’s off-air repeaters include a full line of pico and micro class RF enhancers and macro class digital nodes. CommScope’s repeaters provide RF signals for wide area coverage through antennas and are self-diagnosing, self-adaptive and available in multiple power classes.

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