The journey of a marathon sleeper

A marathon sleeper who got away left some clues for Emory and University of Florida scientists to Read more

A push for reproducibility in biomedical research

At Emory, several scientists are making greater efforts to push forward to improve scientific research and combat what is being called “the reproducibility crisis.” Guest post from Erica Read more

Exosomes as potential biomarkers of radiation exposure

Exosomes = potential biomarkers of radiation in the Read more

World Alzheimer’s Day – brain health tips from Emory

Today is World Alzheimer’s Day 2009 and Emory’s Alzheimer’s Disease Research Center is part of an effort nationwide to address this disease through research and state-of-the-art care for patients.

Allan Levey, MD, PhD, chair of Emory’s Department of Neurology and an Alzheimer’s researcher and clinician, says millions of baby boomers are entering late adulthood and experts expect the number of patients with Alzheimer’s disease to increase drastically over the next several decades. Prevention and early detection are extremely important, he says.

Emory’s Center is a National Institute on Aging funded center focused on clinical trials and research for Alzheimer’s disease. It is the only comprehensive program in Georgia and one of only 32 nationwide.

Levey, who directs the Center, offers the tips for good brain health:

Stay socially active
Remaining socially engaged in activities that stimulate the mind and body can reduce stress levels and help maintain healthy connections among brain cells.

Stay active, say experts

Stay active, say experts

Be physically active
Exercising your body regularly is vital for maintaining good blood flow to the brain and encouraging the growth of new brain cells.

Stay mentally active
Your brain needs mental stimulation to allow it to function at its peak. Research shows that keeping the brain active helps increase its vigor and may strengthen brain cells and the connections between them, and may even generate new ones.

Protect your head
Injury to the head can increase your risk of dementia as you get older. Make sure you wear a helmet when you ride a bike, skate, ski or engage in any activity where you may injure yourself.

Eat brain healthy foods
The brain, like the heart, needs the proper balance of nutrients, including protein and sugar, to optimally function. According to current research, certain foods appear to protect brain cells so increase your intake of these protective foods.

Levey says scientists are finding more clues that high blood pressure, high cholesterol and diabetes may increase a person’s risk of getting Alzheimer’s disease. He says to keep your weight in a healthy range, lower your cholesterol if it is high and maintain control of your blood glucose and blood pressure.

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National Cholesterol Month: Check your numbers

Emory’s Cheryl Williams, RD, LD, clinical nutritionist for the Emory Heart & Vascular Center and Emory HeartWise Cardiac Risk Reduction Program, says you should make it a priority to know your cholesterol levels and learn how what you eat can impact cholesterol and your heart’s health.Williams heart

Since diets high in saturated fat and trans fat have been linked to chronic disease, specifically, heart disease, this knowledge could save your life.

During National Cholesterol Month Williams notes in her blog for the Atlanta Journal-Constitution’s “Doctor Is In” that eating too many fatty foods – especially those high in saturated fat and trans fat – is the primary cause of high cholesterol. Thin, active people may not be aware of how much bad fat they consume, she says.

According to Williams, “Saturated fats are derived primarily from animal products and are known to raise cholesterol levels. They are found in common foods like butter, cheese, whole milk, pork and red meat. Lower-fat versions of these foods usually contain saturated fats, but typically in smaller quantities than the regular versions. Certain plant oils, like palm and coconut oils, are another source of saturated fats. You may not use these oils when you cook, but they are often added to commercially baked foods, such as cookies, cakes, doughnuts and pies.

Even more detrimental to cholesterol levels are trans fats, artificially created during food processing when liquid oils are converted into solid fats — a process called hydrogenation. Many fried restaurant foods and commercially baked goods contain trans fats, as well as vegetable shortening and stick margarine. Read labels and avoid foods that contain partially or fully hydrogenated oils.”

For more tips from Williams about managing for healthy cholesterol levels, visit ajc.com. To learn more about heart disease from Laurence Sperling MD, director of the Emory HeartWise Cardiac Risk Reduction Program, watch videos on health.com.

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Delivering nutrition to critical care patients

Emory clinical nutrition expert Thomas Ziegler, MD, has a case report article in the Sept. 10 issue of the New England Journal of Medicine.

The case report describes a woman with diabetes who needed surgery because of loss of blood flow to abdominal organs. While she is in intensive care after surgery, it becomes clear that a feeding tube leading from her nose to her stomach is not working. That makes her a good candidate for parenteral nutrition, or bypassing the digestive system and delivering nutrients directly into her blood.

Malnutrition is common in patients who are critically ill and often worsens with prolonged hospitalization. Some patients can’t eat normal food or benefit from a feeding tube into the stomach.

Thomas Ziegler, MD, Director, Center for Clinical and Molecular Nutrition, Department of Medicine

Thomas Ziegler, MD, Director, Center for Clinical and Molecular Nutrition, Department of Medicine

Yet few well-designed clinical trials studying parenteral nutrition have been conducted, Ziegler writes. He also notes that there is considerable debate over when parenteral nutrition is appropriate during critical care and how to administer it.

Ziegler’s own research has shown the beneficial effects of the amino acid glutamine, which must be added fresh to feeding formulas, for some critical care patients.

Several of the questions Ziegler outlines in his article will be issues investigators at Emory’s new Center for Critical Care will tackle. Recently, Timothy Buchman, MD, PhD, joined Emory to lead the critical care team.

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Pancreatic cancer: Front and center

With the sad news today of the death of actor Patrick Swayze, the public is again focused on pancreatic cancer and searching for more information on this aggressive cancer.

Recently, David Kooby, MD, Emory Winship Cancer Institute, and an assistant professor, Department of Surgical Oncology, authored a blog for the Atlanta Journal-Constitution’s “Doctor Is In” on this topic.

Emory Winship Cancer Institute

Emory Winship Cancer Institute

The following is an excerpt from the blog:

Pancreatic cancer is an aggressive malignancy that begins in the cells of the duct (or tube) running along the length of the pancreas. Each year about 42,000 new cases of pancreatic cancer are diagnosed and more than 35,000 people die from this cancer. A diagnosis of pancreatic cancer is usually made after discovery of a mass or a dilated duct in the pancreas.

Pancreatic cancer can be difficult to diagnose. Patients often come in for a doctor’s visit with non-specific symptoms such as abdominal or back pain or weight loss. Some patients will develop jaundice (yellowing of the skin) as a result of the tumor blocking the duct draining bile from the liver

No one knows the exact causes of pancreatic cancer, although some risk factors are known through research that has been done.

According to the National Cancer Institute, the following are risk factors for development of pancreatic cancer:

  • Age — The likelihood of developing pancreatic cancer increases with age. Most pancreatic cancers occur in people over the age of 60.
  • Smoking — Cigarette smokers are two or three times more likely than nonsmokers to develop pancreatic cancer.
  • Diabetes mellitus — Pancreatic cancer occurs more often in people who have diabetes than in people who do not.
  • Being male — More men than women are diagnosed with pancreatic cancer.
  • Being African-American — African-Americans are more likely than Asians, Hispanics or whites to get pancreatic cancer.
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Voles and the neurochemistry of social behavior

A new study has shown that prairie voles may be a useful model in understanding the neurochemistry of social behavior. By influencing early social experience in prairie voles, researchers hope to gain greater insight into what aspects of early social experience drive diversity in adult social behavior.

VolesPrairie voles are small, highly social rodents that often form stable, life-long bonds between mates. In the wild, there is striking diversity in how offspring are reared. Some pups are reared by single-mothers, some by both parents (with the father providing much of the same care as the mother) and some in communal family groups.

Researchers Todd Ahern, a graduate student in the Emory Neuroscience Program, and Larry Young, PhD, professor of psychiatry and behavioral sciences at the Yerkes National Primate Research Center and Emory School of Medicine, compared pups raised by single mothers (SM) to pups raised by both parents (BP) to determine the effects of these types of early social environments on adult social behavior.

The study showed SM- and BP-reared animals experienced different levels of care during the neonatal period and that these differences significantly influenced bonding social behaviors in adulthood. Pups raised by single mothers were slower to make life-long partnerships, and they showed less interest in nurturing pups in their communal families.

Researchers also found differences in the oxytocin system. Oxytocin is best known for its roles in maternal labor and suckling, but, more recently, it has been tied to prosocial behavior, such as bonding, trust and social awareness. Very simply, altering their early social experience influenced adult bonding.

Further studies will look at the altered oxytocin levels in the brain to determine how these hormonal changes affect relationships.

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Healthy aging on the Emory front

Emory’s Center for Health and Aging is addressing health care issues affecting the rapidly growing senior population in the United States through research, clinical care, community outreach and education.

One of the greatest challenges now facing the health care system in the United States is the rapid growth of the numbers of aging adults. It will have an unprecedented impact on the delivery of medical care, including supply of and demand for health care workers.

It is expected that the supply of health care providers may decrease at a time huge numbers of workers retire or reduce their working hours. And older adults consume a disproportionate share of American health care services, resulting in greater demand for services.

There are compelling demographic reasons to study aging. According to U.S. census records, a wave of 2.7 million Americans will turn 65 by 2011, and each succeeding year the swell gets higher until it peaks in 2025 with 4.2 million new 65-year-olds. By 2030, when the youngest boomers have become seniors, the number of Americans 65 and older is expected to be more than 70 million – nearly twice as many as in 2005, according to a report by the National Academies’ Institute of Medicine

Ted Johnson, MD

Ted Johnson, MD, MPH

Led by Theodore (Ted) Johnson II, MD, MPH, the Center benefits from well-established and successful programs in clinical care, aging research and education at Emory’s Wesley Woods Center, one of the nation’s few campuses devoted to the health and well being of older adults.

Wesley Woods is one of the nation’s most comprehensive centers for aging-related research, care and quality of life, serving more than 30,000 elderly and chronically ill patients each year through outpatient clinics, a hospital, skilled nursing care facility and residential retirement facility. In addition, Emory is affiliated with the Atlanta Veterans Affairs Medical Center, which has an extensive array of geriatric clinical, research and training programs.

The health care implications for seniors in Georgia and the U.S. are tremendous, according to Johnson. He says that the sheer numbers of older adults will place strains on our healthcare system and the family and professional caregivers who help them.

Johnson,who heads Emory’s Division of Geriatric Medicine and Gerontology, notes that it’s the cumulative effect of that surge – plus the fact that people are living far longer than ever before – that poses a looming crisis for the health care system.

For a glimpse of aging care and research at Emory: dementia research, Alzheimer’s DETECT device, diagnosing memory loss, preventing heart failure, disease prevention through nutrition, aging and fitness, and more about health initiatives at Emory Healthcare.

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Helping stem cells find their new homes

The idea that doctors could use stem cells to treat diseases ranging from amyotrophic lateral sclerosis (ALS) to stroke, spinal cord injury and heart disease has stimulated excitement and research funding over the last decade.

One critical obstacle is getting the stem cells to survive in the harsh environment of injured tissue and turn into the right kind of cell where they are needed. In both laboratory experiments and clinical trials, most of the stem cells usually die a few days after transplantation.

Exposing stem cells to reduced levels of oxygen may actually help protect them from the stressful process of being transplanted into the heart, according to recent research.

Shan Ping Yu and Ling Wei, who moved their laboratories about a year ago to Emory’s Department of Anesthesiology, were the first to show the effects of “hypoxic preconditioning.” Wei says the low oxygen strategy is a continuation of previous collaboration with Comprehensive Neurosciences Center director Dennis Choi. There, they had used the tactic of overexpressing BCl2, a gene that counteracts cell death, but the new approach avoids permanently altering the genes in stem cells, which may have long-term adverse effects.

Effects on mesenchymal stem cells' ability to implant into heart tissue. In D, the stem cells were exposed to low oxygen but in C they were not. Blue shows all cell nuclei, while green shows implanted stem cells. Yellow indicates the activation of an enzyme that leads to cell death.

Effects on mesenchymal stem cells' ability to implant into heart tissue in rats. In D, the stem cells were exposed to low oxygen but in C they were not. Blue shows all cell nuclei, while green shows implanted stem cells. The greater presence of yellow in C, a couple days after transplantation, displays the activation of an enzyme that leads to cell death. From the Journal of Thoracic and Cardiovascular Surgery.

In a way, this is consistent with the work of former Emory investigator Marie Csete, who showed that stem cells are happier and healthier in oxygen concentrations that reflect the levels they experience in the body: between 2 and 5%.

To achieve their protective effects, Yu and Wei are using oxygen concentrations of 0.5%. For comparison, room air has about 20% oxygen.

In an editorial, Yu, Wei and graduate student Molly Ogle discuss how they have been exploring whether inhibitors of enzymes that sense levels of oxygen in cells could have the same protective effects as exposure to low oxygen. Yu also reports that his group is studying how low oxygen helps stem cells home to target tissues better. Their hypothesis is that low oxygen stimulates cells’ motility — their ability to migrate into the right place. Wei’s research has shown that lower oxygen helps more stem cells to turn into neuronal cells.

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Study looks at teenage brain and risk-taking

A new study using brain imaging to study teen behavior indicates that adolescents who engage in dangerous activities have frontal white matter tracts that are more adult in form than their more conservative peers.

The brain goes through a course of maturation during adolescence and does not reach its adult form until the mid-twenties. A long-standing theory of adolescent behavior has assumed that this delayed brain maturation is the cause of impulsive and dangerous decisions in adolescence. The new study, using a new form of brain imaging, calls into question this theory.

In order to better understand the relationship between high risk-taking and the brain’s development, Emory University and Emory School of Medicine neuroscientists used a form of magnetic resonance imaging (MRI) called diffusion tensor imaging (DTI) to measure structural changes in white matter in the brain. The study’s findings are published in the Aug. 26, 2009 PLoS ONE.

“In the past, studies have focused on the pattern of gray matter density from childhood to early adulthood, says Gregory Berns, MD, PhD, principal investigator and professor of Psychiatry and Neuroeconomics at Emory University and director of the Center for Neuropolicy. “With new technology, we were able to develop the first study looking at how development of white matter relates to activities in the real world.”

Gray matter is the part of the brain made up of neurons, while white matter connects neurons to each other. As the brain matures, white matter becomes denser and more organized. Gray matter and white matter follow different trajectories. Both are important for understanding brain function.

Berns suggests that doing adult-like activities requires sophisticated skills.

“Society is a lot different now than it was 100 years ago when teens were expected to go to work and raise a family,” says Berns. “Now, adolescents aren’t expected to act like adults until they are in their twenties, when they have finished their education and found a career. Listen to Berns discuss the changing definition of adulthood.

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A shift in how geneticists study complex diseases

An Emory project studying schizophrenia genetics is a good example of how geneticists are shifting from examining small, common mutations to “rare variants” when studying complex diseases.

From studies of twins, doctors have known for a long time that heredity plays a big role in causing schizophrenia. But dissecting out which genes are the most important has been a challenge.

Three landmark studies on schizophrenia genetics published this summer illustrate the limitations of “genome wide association” studies. New York Times science reporter Nicholas Wade summarized the results in this way:

“The principal news from the three studies is that schizophrenia is caused by a very large number of errant genes, not a manageable and meaningful handful.”

The limitations from this type of study comes from the type of markers geneticists are looking at, says Steve Warren, chair of the human genetics department at Emory.

Genome wide association studies usually follow SNPs — single nucleotide polymorphisms. This is a one-letter change somewhere in the genetic code that is found in a fraction of the population. It’s not a big change in the genome, and in many cases, it will have a small effect on disease risk.

Researchers looking for the genes behind complex diseases such as schizophrenia and autism are starting to shift their efforts away from genome wide association studies, Warren says.

Think of a SNP like a misspelling of a word in a certain place in a book, he says. In contrast, the “rare variants” geneticists are starting to study more intensively are more like printers’ errors or missing pages. The rapid sequencing technology that allows scientists to investigate these changes easily is just now coming on line, he says.

One example of these rare variants is DiGeorge syndrome, a deletion that gets rid of dozens of genes on one copy of chromosome 22. Children who have this chromosomal alteration often have anatomical changes to their heart and palate. But it also substantially increases the risk of schizophrenia – to about 25% lifetime risk. That’s a lot more than any of the SNPs identified this summer.

Working with several Emory colleagues, researcher Brad Pearce is planning to examine the genes missing in DiGeorge syndrome in several groups of patients: people with DiGeorge, patients with “typical” schizophrenia and people at high risk of developing schizophrenia.

An article in this spring’s Emory Health describes genetic research on autism. Several of the researchers mentioned there, such as geneticist Joe Cubells and psychiatrist Opal Ousley, are involved in this schizophrenia project as well, because deletions on chromosome 22 also lead to an increased risk of autism.

Pearce’s project is funded through American Recovery and Reinvestment Act money from the NIH.

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Manage stress to your advantage

Recently Charles Raison, MD, assistant professor, Emory Department of Psychiatry and Behavioral Sciences, wrote a blog for the Atlanta Journal-Constitution on stress. As clinical director of the Emory Mind-Body Program and director of the Behavioral Immunology Program, he has been studying stress.

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Raison says stress is everywhere today, both in our private and public lives, but also relentlessly in print, with discussion after discussion regarding what it is and what can be done to ease it.

He notes that you should think of stress like a sandwich. One trick for dealing with stress is to try to stay in the middle of the stress sandwich in the meat of life – the optimal challenge. The basic idea, he comments, is that you see what’s in front of you as a challenge, neither boring nor threatening, difficult enough to keep you fully engaged, easy enough for you to accomplish your goals.

You can read more by Raison by visiting the Atlanta Journal-Constitution Doctor Is In blog online.

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