Day: 09/10/2016

First robotic eye surgery

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British surgeons have successfully performed the world’s first robotic operation inside the eye, potentially revolutionising the way such conditions are treated. The procedure was carried out at John Radcliffe hospital in Oxford. “With a robotic system, we open up a whole new chapter of eye operations that currently cannot be performed,” said the Surgeon Robert MacLaren.

British surgeons hail successful procedure to remove membrane 100th of a millimetre thick from retina

Professor Robert MacLaren operating
Professor Robert MacLaren praised the success of the world’s first robotic operation inside the eye. 

British surgeons have successfully performed the world’s first robotic operation inside the eye, potentially revolutionising the way such conditions are treated.

The procedure was carried out at John Radcliffe hospital in Oxford, where surgeons welcomed its success.

On completing the operation, Professor Robert MacLaren said: “There is no doubt in my mind that we have just witnessed a vision of eye surgery in the future.

“Current technology with laser scanners and microscopes allows us to monitor retinal diseases at the microscopic level, but the things we see are beyond the physiological limit of what the human hand can operate on.

“With a robotic system, we open up a whole new chapter of eye operations that currently cannot be performed.”

The procedure was necessary because the patient had a membrane growing on the surface of his retina, which had contracted and pulled it into an uneven shape. The membrane is about 100th of a millimetre thick and needed to be dissected off the retina without damaging it.

Surgeons normally attempt this by slowing their pulse and timing movements between heart beats, but the robot could make it much easier. Experts said the robot could enable new, high-precision procedures that are beyond the abilities of the human hand.

The surgeons used a joystick and touchscreen outside the eye to control the robot while monitoring its progress through the operating microscope. This gave medics a notable advantage as significant movements of the joystick resulted in tiny movements of the robot.

This is the first time a device has been available that achieves the three-dimensional precision required to operate inside the human eye.

Speaking at his follow-up visit at the Oxford eye hospital, Father Beaver said: “My sight is coming back.

“I am delighted that my surgery went so well and I feel honoured to be part of this pioneering research project.”

MacLaren said: “This will help to develop novel surgical treatments for blindness, such as gene therapy and stem cells, which need to be inserted under the retina with a high degree of precision.”

The robotic eye surgery trial involves 12 patients undergoing operations with increasing complexity. In the first part of the trial, the robot is used to peel membranes off the delicate retina without damaging it.

If this part is successful, as has been the case so far, the second phase of the trial will assess how the robot can place a fine needle under the retina and inject fluid through it.

Experts said this could lead to use of the robot in retinal gene therapy, a new treatment for blindness which is currently being trialled in a number of centres around the world.

Wrong-site surgery and checklist (non)compliance

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At one hospital, a skin incision was made in the right groin of a patient who was to have had a left orchiectomy. Fortunately the error was discovered, and the skin was closed. The correct testicle was removed. To his credit, the surgeon told the patient and his wife what happened immediately after the operation.

An investigation found that the patient’s groin had not been marked. The time out did not prevent the error because the OR team did not verify the operative site as the protocol mandates. In other words, they had gone through the motions.

The hospital was fined $75,000.

The other California case did not turn out as well. Instead of removing a cancerous left kidney, surgeons did a right nephrectomy. The error was not discovered until the pathology report was reviewed. A number of assumptions and misunderstandings contributed to this error for which the hospital was fined $100,000.

Both hospitals made the usual system and protocol corrections that are precipitated by any state investigation. But these were human errors and will likely happen again. The existing policies were adequate. They simply were not followed.

Another case that occurred in July but recently just surfaced is from Florida. A surgeon performed a vascular procedure on the wrong leg. Apparently, a nurse anesthetist noticed the error during the case and spoke up, but the surgeon didn’t stop. He finished the wrong leg and then did the correct leg too.

When the patient awoke, the surgeon asked her to sign a consent form for the wrong leg and told her that she had needed that surgery anyway.

The hospital failed to report the error for two weeks.

In the Orlando Sentinel article, a hospital spokesman said, “We have policies in place, and training in place, but the system broke down because of the human element.” I think he was admitting that the incorrect procedure was the result of a human error, but I’m not sure.

A state inspection found many issues, and the hospital has been threatened with termination of its Medicare and Medicaid provider agreement.

 

It appears that operating room checklists, for all their promise, are not working out as well as they should.

Two recent papers looking at three distinct hospital settings, have found that checklist use and completeness are less than ideal.

At Scott and White Memorial Hospital in Texas, researchers found that OR checklists were used 94% of the time, but 54% contained inaccurate data and 15% were not fully completed. Compliance with the “time out” portion of the checklist was found in 77.8% of cases.

The paper appeared on line in the Journal of the American College of Surgeons.

In a Medscape report on the study, the senior author was interviewed and said that some of the hospital’s surgeons did not “buy in” to the concept.

Dr. Atul Gawande, commenting on the paper, wondered if scrubbing 94% of the time would be acceptable and speculated that using the checklist was not the norm in that institution. Gawande also suggested that one-on-one contact with every surgeon might be the way to improve checklist use.

A paper from the UK published in BMJ Open looked at OR checklists in two hospitals in the UK and one in sub-Saharan Africa. Staff from all three were interviewed extensively.

The authors found that the rate of checklist use was better in the UK hospitals than the one in Africa, but like the Texas study, checklists were not used 100% of the time. Accuracy was also inconsistent. Completeness was noted to be variable especially in Africa, and there were many lapses in performance of checklist components.

An OR nurse in the African hospital said, “Even though training on the checklist was given for surgeons, they don’t use it, they don’t believe in this bit of paper, because mostly they said, ‘we don’t mistake the identity of the patient, it doesn’t happen that we get the wrong patient.'”

An anesthetist in the UK said, “We’re trying to prevent what are usually rare errors, rare mistakes, you know, the majority of the things on that checklist are done most of the time without the checklist, but every now and then […] you forget to check if you’re operating on the right leg and not the left leg, and that’s rare, but on very rare occasions it then leads to a disaster.”

What have we learned here?

We have a long way to go until the checklist becomes a real factor in preventing errors.

Surgeons should reflect and admit that this sort of mistake should never occur. Until we accept this and lead the way, these stories will continue to make us all look bad.

First of its Kind Study Finds Virtually No Driving Impairment Under the Influence of Marijuana

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As cannabis prohibition laws crumble seemingly by the day, it’s allowing more research to be performed on this psychoactive substance that has long been a part of the human experience.

The first study to analyze the effects of cannabis on driving performance found that it caused almost no impairment. The impairment that it did cause was similar to that observed under the influence of a legal alcohol limit.

Researchers at the University of Iowa’s National Advanced Driving Simulator carried out the study, sponsored by National Highway Traffic Safety Administration, National Institute of Drug Abuse, and the Office of National Drug Control Policy

“Once in the simulator—a 1996 Malibu sedan mounted in a 24-feet diameter dome—the drivers were assessed on weaving within the lane, how often the car left the lane, and the speed of the weaving. Drivers with only alcohol in their systems showed impairment in all three areas while those strictly under the influence of vaporized cannabis only demonstrated problems weaving within the lane.

Drivers with blood concentrations of 13.1 ug/L THC, or delta-9-tetrahydrocannabinol, the active ingredient in marijuana, showed increased weaving that was similar to those with a .08 breath alcohol concentration, the legal limit in most states. The legal limit for THC in Washington and Colorado is 5 ug/L, the same amount other states have considered.”

As expected, there was impairment in all areas when alcohol and cannabis were mixed. But cannabis itself, when taken in moderate amounts, seems to cause no significant driving impairment.

In fact, some would argue that it makes them drive safer or slower.

The study’s findings further illuminate the fact that alcohol is a much more dangerous drug than cannabis, and somehow the former is legal while the latter is not.

With cannabis being decriminalized across the country, law enforcement will be getting their “rules and regulations” in place for the driving masses. They should be based on science and not Reefer Madness mentalities.

Another important finding should deter any attempts to deploy instant roadside tests for THC-blood levels.

“The study also found that analyzing a driver’s oral fluids can detect recent use of marijuana but is not a reliable measure of impairment.

“Everyone wants a Breathalyzer which works for alcohol because alcohol is metabolized in the lungs,” says Andrew Spurgin, a postdoctoral research fellow with the UI College of Pharmacy. “But for cannabis this isn’t as simple due to THC’s metabolic and chemical properties.”

Cheese triggers same part of brain as hard drugs, study finds

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Casein is the reason why you can’t put down the brie.

Cheese contains a chemical found in addictive drugs, scientists have found.

The team behind the study set out to pin-point why certain foods are more addictive than others.

Using the Yale Food Addiction Scale, designed to measure a person’s dependence on, scientists found that cheese is particularly potent because it contains casein.

The substance, which is present in all dairy products, can trigger the brain’s opioid receptors which are linked to addiction.

The authors also found that processed foods were more associated with addictive behaviour, with fatty foods being the most difficult to put down.

In addition, they found that the top-ranking foods on the addiction scale were those containing cheese.

To make their findings, researchers asked 120 undergraduates to answer the Yale Food Addiction Scale, and were asked to choose between 35 foods of varying nutritional value, TechTimes reported.

A second part to the study involved 384 people who were presented with the same items of food, but in a hierarchical linear order.

Researchers behind the study published in the Public Library of Science One journal found that fat was linked to problematic eating whether or not participants were addicted to food.

Erica Schulte, one of the study’s authors, told Mic: “Fat seemed to be equally predictive of problematic eating for everyone, regardless of whether they experience symptoms of ‘food addiction.”

Infection and OR staff hair

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We had an independent nurse evaluate us for upcoming JCAHO inspection. We ‘failed’ due to not covering facial hair and chest hair with scrub attire and in addition were told folks with hairy arms needed long-sleeve scrub tops. Of course this comes from the all powerful AORN. Being an evidence-based person at heart, I began to look for some evidence regarding covering up (that is how I stumbled onto your blog). Do you have any knowledge of evidence based practice regarding hair covering and infection rates?

Great question. Where do they come up with these things? Chest hair? Arm hair? Long-sleeve scrub tops?

For the record, I am against wound infections. I would do any reasonable thing to try to prevent them.

I suspect your independent nurse evaluator may have over-interpreted the rules. My distaste for the Joint Commission (by the way, don’t ever say “JCAHO” again) runs deep, but I don’t think even they have thought of those wrinkles to the hair issue.

It is possible though as the JC and the AORN seemed to be obsessed with hair.

I assume long sleeve scrub tops would be for the circulating nurse only. If the surgeon and the scrub tech wore long sleeves, they wouldn’t be able to properly wash their hands and arms.

Regarding the chest hair, are we talking male or female staff? (Just kidding.)

As far as I know, there is not one shred of evidence linking hair on the head, face, chest or arms of OR staff to patient infections. This is after an exhaustive search of PubMed, CDC, and holding nothing back, I even crowd-sourced the question on Twitter.

In case some readers missed my post on the ritual of clipping the hair of patients before surgery, the link is here. The post was about rules that people make up without any justification to drive us all crazy.

I have collected several such rules from other frustrated readers. Here they are.

  • No forced-air warming until patient is draped.
  • No briefcases in the OR.
  • No one may enter the room without the circulator’s permission.
  • No room warming as it may cause condensation on surgical instruments. (Condensation causes infections? And children and burn victims who may become hypothermic in a cold room be damned!)
  • Remove masks every time you leave the OR. And no letting them hang down with just the lower tie done.
  • Masks must be worn by anyone in the scrub sink area even if that person is not scrubbing but just walking by.
  • All OR personnel must wear long sleeves because of the potential for “shedding skin.”
  • Patient hair on the operative site must be clipped in an area other than the operating room.

But the independent nurse reviewer has spoken. I’m betting that long sleeve scrub tops and chest hair police will soon appear in your OR.

Deadly Mycotoxins Found In Breakfast Cereals

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Deadly Mycotoxins Found In Breakfast Cereals

It’s been estimated that mycotoxins infect around 25% of the world’s cereal crop.  Mycotoxins include over 300 toxic compounds produced when certain molds or fungi infect crops.

A new study shows that breakfast cereals can be a significant source of these toxins. Researchers in Pakistan collected 237 breakfast cereal samples and analyzed them for 3 different types of mycotoxins.  They tested for aflatoxins (AFs), ochratoxin A (OTA), and zearalenone (ZEA).  They found these toxins in about half the breakfast cereals tested.[i]

Aflatoxins Cause Liver Disease and Liver Cancer

Aflatoxins are potent mycotoxins that cause liver disease and liver cancer in humans and animals.  The molds causing aflatoxin infect cereals and nuts.

Aflatoxin is classified into a number of subtypes. The most important ones are B1, B2, G1 and G2.

According to the Pakistan study, 41% of breakfast cereal samples were found contaminated with AFs.  Of the contaminated samples, 8% were above the European Union’s maximum safe levels for total AFs.

And 16% were above the EU’s limit for AFB1.  In fact, unlike most other mycotoxins, there is no tolerable daily intake (TDI) for aflatoxin B1 because it is carcinogenic. The highest levels of AFB1 and total AFs were found in semolina.

An earlier 2012 Pakistan study of cereals found 38% were contaminated with four types of AFs.  And 21% of processed foods intended for infants contained AFB1 levels above the EU’s maximums.[ii]

And just last year the European Food Safety Authority issued a technical report entitled Aflatoxins (sum of B1, B2, G1, G2) in cereals and cereal-derived food products. A total of 2,183 food samples were collected between 2007 and 2012.  The EFSA found 10% of the products contained one of the four most common aflatoxins.  Of those, 6 cereal and milling products were above the maximum EU limits as were 2 breakfast cereal samples.

Aflatoxin is associated with both acute and chronic toxicity.  It causes acute liver damage, liver cirrhosis, and liver cancers. Chronic toxicity has been linked to eating peanuts and cereals.[iii]

Aflatoxin was discovered some 30 years ago in England following a poisoning outbreak causing 100,000 turkey deaths. Among mycotoxins known to cause human disease, aflatoxins have been studied most.

Ochratoxin A Is Toxic to Kidneys and a Probable Human Carcinogen

Ochratoxin A (OTA) is a mycotoxin formed during the storage of crops.  Contamination has been reported in cereals, coffee, vine fruits (grapes), and nuts.

OTA is toxic to the kidneys (nephrotoxic) and the immune system.  It’s also been classified as a probable human carcinogen.

In the Pakistan study, about 48% of the breakfast cereal samples were found contaminated with OTA.  Of those, 30% were found to be above the EU maximum. The highest levels of OTA were also found in semolina products.

Zearalenone (ZEA) Mycotoxin Disrupts Hormones

Zearalenone (ZEA) mycotoxins originate in grains such as corn, barley, oats, wheat, rice and sorghum.[iv]  They’ve even been found in beer.  But animal products containing the toxin are also affected.  ZEA can be found in grain-fed meat, eggs and dairy products.

In Pakistan, 53% of the breakfast cereal samples were found contaminated with ZEA.  Of those, 8% were above the permissible EU limit.  Cornflakes had the highest ZEA contamination levels.

A groundbreaking 2011 study found ZEA in the urine of 78.5% of New Jersey girls sampled. The girls (aged 9 and 10 years) who tested positive for the ZEA toxin “tended to be shorter and less likely to have reached the onset of breast development.”[v] The researchers also found an association between the young girls’ ZEA urinary levels and their intake of commonly contaminated sources such as beef and popcorn.

Research from 30 years ago had shown the estrogenic properties of mycotoxins.  Young female piglets fed mycotoxin-contaminated grains showed abnormal sexual development.

How To Protect Yourself From Mycotoxins

Mycotoxins form while cereal crops are growing or in post-harvest storage.  The contamination is nearly impossible to eliminate.  They may not be completely removed by cleaning.  And they are not killed during cooking or processing so they frequently make their way into final products.

Whether mycotoxins pose a serious health risk depends on how toxic a particular strain is, how much contamination is present, and how much of the contaminated product is consumed.

It affects both conventionally grown and organic grains.[vi]  And GMO grains may be particularly susceptible.  A recent study revealed Roundup herbicide enhances the growth of aflatoxin-producing fungi.  It’s been suggested that GMOs may be responsible for an alarming increase in fungal toxins in U.S. corn supplies.

Reducing mycotoxin risk may require a move away from cereal grains altogether and toward other vegetarian options such as leafy greens.

Also, regularly eating healthy spices may boost your resistance to the toxins’ effects.  Garlic has been found to reduce the adverse effects of zearalenone toxicity.  Another study found turmeric, curcumin, garlic, and ellagic acid (found in pomegranate) significantly inhibited damage from the aflatoxin B1 strain.  Researchers suggested that antioxidant food additives may be useful in ameliorating aflatoxin-induced mutagenicity and carcinogenicity.[vii]

This is a great reason to add healthy seasonings to your cooking.  Regular use of herbs and spices may well protect us from a range of dangerous pathogens in the food supply.

Aflatoxins: Poisons Hiding in Plain Sight

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There’s a good chance these toxins are lurking in your child’s lunchbox—and they are some of the most poisonous natural compounds known to humankind. Find out how to eliminate them from your home and from your body.

Many of us who have studied whole-food and holistic nutrition have heard of aflatoxins in peanut butter. They’re one of the prime reasons many of us have kicked peanut butter to the curb and starting started using almond butter instead (or, peanut butters from climates where aflatoxins are not present.) All this said, the conversation over aflatoxins is far too often cut short – and the hazards of these toxins are grossly underestimated.

Think about it — If you noticed mold growing on your bread, you would toss it out, right? What if the mold on that bread was invisible? Further, what if that invisible mold was one of the most carcinogenic, toxic naturally occurring substances known to humankind? This scenario is not far from the truth. The deadly mycotoxin called aflatoxin is disturbingly common in our foods today.

As alarming as it sounds, even apparently healthy foods can kill you. Aflatoxins are among the most poisonous natural compounds on the planet, and aflatoxicosis is what happens if you ingest enough. Aflatoxin B1 (the most common aflatoxin) is the most potent naturally occurring liver carcinogen known to humankind.[1][2][3]

That’s right – multiple sources now refer to Aflatoxins as the MOST deadly naturally occurring toxin.

It’s estimated that about 4.5 billion people are exposed to aflatoxins each year in developing countries, although the numbers are largely unmonitored and on the rise.[4] People consuming normal-appearing corn, peanuts, or grain have become critically ill and even died from acute aflatoxin poisoning, which can cause life-threatening hemorrhage, liver damage, pulmonary edema, convulsions and brain damage.

The strength of the aflatoxin blow depends on factors such usage, level and duration of exposure, immune status and overall health.

Acute aflatoxicosis in humans is relatively rare, but the more chronic, lower-level exposure is probably more prevalent than reports would suggest because the symptoms are difficult to recognize. Chronic exposure is a significant concern due to its insidious nature and potential long-term effects, which include immunosuppression, cirrhosis, and liver cancer. There are at least 13 different species of mold that produce 20 different aflatoxins, with aflatoxin B1 considered the most toxic. Aflatoxins affect nearly every system of the body, as the following list shows:[5]

  • Respiratory: Pulmonary edema, cancer
  • Cardiovascular: Heart inflammation
  • Neurological: Reduced oxygen flow, headache, neuron death, encephalopathy, impaired memory, insomnia, disorientation, loss of coordination; tumors in both central and peripheral nervous system
  • Gastrointestinal: Liver damage, liver cancer, vital hepatitis, parasite infestation
  • Urinary: Kidney damage and tumors
  • Reproductive and Developmental: infertility, teratogenic, abnormal growth and development in children
  • Endocrine: Tumors and cancer
  • Blood: Blood and bone cancers
  • Immune: Immunosuppression, autoimmune reactions and allergies
  • Other: Mitochondrial malfunction, interference with protein and RNA synthesis, apoptosis (cell death)

Aflatoxins Are Everywhere

Aflatoxins are poisonous compounds produced by certain strains of the fungi Aspergillus flavus and A. parasiticus, which grow when temperature and humidity conditions are favorable. The highest levels are typically found in foods from warmer regions with greater climatic variation. However, aflatoxin-producing molds show an affinity for multiple types of crops and can grow under a broad-range of moisture and temperature conditions.

Although aflatoxicosis is a greater problem in developing nations, it nevertheless remains a significant concern in North America.[6][7] According to the Food and Agriculture Organization (FAO), about 25 percent of the world’s crops are affected by mycotoxins — including aflatoxins — and scientists warn that extreme weather and drought cycles are increasing their prevalence.[8] Fortunately, scientists are developing innovative ways to reduce aflatoxins, such as UC Davis researchers who are using benign fungi to displace Aspergillus from pistachio trees.[9]

Aflatoxins can be found in variety of foods you may already have in your pantry. According to the US Food and Drug Administration’s 2012 Bad Bug Book:[6]

“In the United States, aflatoxins have been identified in corn and corn products, peanuts and peanut products, cottonseed, milk, and tree nuts such as Brazil nuts, pecans, pistachio nuts, and walnuts. Other grains and nuts are susceptible but less prone to contamination.”

Contamination is most common in the southeastern US in peanuts and corn products, but it shows up in other grainsand legumes as well, including quinoa,coffee beans, cocoa beans, soybeans, spices, dairy, dried fruit and wine. Aspergillus typically gains a foothold during harvest and increases in storage. Improper food drying is a major factor in its growth.

Unfortunately, aflatoxins are very stable and can survive relatively high temperatures without degradation — which means they can’t always be destroyed by cooking or processing. For example, one study found that roasting green coffee at 180 degrees Celsius for 10 minutes reduced aflatoxin levels only by 50 %.[10] The one exception may be that corn processed using traditional methods (such as corn tortillas) may significantly reduce aflatoxin levels due to the alkaline conditions.[11]

Therefore, these toxic agents not only present a problem in raw foods but in processed foods as well — the most notable example being peanut butter – but you can also ingest aflatoxins by consuming the meat or dairy of animals who consumed aflatoxin-contaminated feed.

The aflatoxin levels in many of these foods is extremely small. However, it’s important to realize that ALL toxins add to your overall detox load. International Food Policy Research Institute cautions that consuming even tiny amounts of aflatoxin may have a cumulative effect.

Sadly, even our house pets are at risk for aflatoxin poisoning. Contamination is more common in processed dog food than cat food because commercial dog foods contain more corn products. A recent survey of premium pet food in Brazil found 22 percent to contain aflatoxin B1, and a full 93 percent contained other dangerous mycotoxins.[12] In dogs and cats, acute aflatoxicosis is a medical emergency with clinical signs such as severe vomiting with bloody diarrhea, anorexia, fever, sluggishness, discolored urine, and jaundice.

Regulators Do NOT Require Foods to Be Aflatoxin-Free

While there is some governmental inspection, the food industry is largely responsible for doing its own monitoring for aflatoxin contamination. Government regulators acknowledge aflatoxin exposure is a public health concern, but they do allow it to be present at low levels. FDA allows aflatoxin up to 20 parts per billion, whereas only 15 parts per billion is tolerated by Canada and Australia. However, FDA’s restrictions do not apply to foods produced and sold in the same state, only to those crossing state lines.

FDA allows much higher levels of aflatoxin in animal feed — up to 300 parts per billion. And with the lack of any federal inspection requirement, actual levels in animal feed may be much higher, which increases the chances some of these toxins will pass through to your meat and dairy products.

From Mold’s Point of View, Peanut Butter is the BEST FOOD EVER

We started out this conversation focusing on peanut butter. Aflatoxin-producing molds are extremely common in the soils where peanuts are grown. When it comes to aflatoxin contamination, peanut butter is notoriously the worst — or from the mold’s perspective, the best food ever.[13]

In the US, more than 99 percent of peanut farms use conventional farming practices, which includes the use of fungicides. Be careful: Organic peanut butters may contain even more aflatoxin than inorganic brands because fungicide is not used in their production. I am not trying to dissuade you from buying organic peanut butter, because pesticide levels in conventionally raised peanuts can be very high due to their soft, permeable shells — and you certainly don’t want that. Just be aware that in this case, the organic label does not protect you.

The most problematic source of peanut butter contamination appears to be the “grind-your-own” variety offered in various nutrition stores. Unless the peanut grinding machines are thoroughly cleaned every day, they can become Aspergillus breeding grounds. Once the machines are contaminated, molds and mycotoxins pass right into your peanut butter, and their levels only increase during storage.

You may want to do a little research before buying your next jar of peanut butter. I’ve included some pointers in next section. For more information about peanuts and peanut butter, refer to my own Peanut FAQ page.

Twelve Tips for Reducing Your Aflatoxin Exposure

What can you do to reduce the aflatoxins in your child’s PB&J? The type of peanuts and where they are grown make a difference. Proper storage is also important. That said, it is nearly impossible to avoid all aflatoxin exposure in today’s world, so it’s important to make detoxification part of your ongoing health routine. I have included some tips about aflatoxin below. (For more about detoxification, check out my eBook, Real Detox, and join experts like Sayer Ji on The Detox Project, which is free and online September 26 through October 3, 2016.)

  1. Valencia peanuts are grown mostly in New Mexico where mold levels are lower due to the drier climate, so look for organic peanut butters made from Valencia peanuts exclusively (not, “Valencia and ‘other’ peanuts).
  2. A representative with Justin’s reported that they test all of their own nut butters to ensure aflatoxin levels are below 10 parts per billion (according to KerryAnn Foster of Intentionally Domestic). Justin’s nut butters do not appear to be certified organic but the website reports they are GMO-free.
  3. Whole Foods advertises its 365 Organic Everyday Value Peanut Butter’s aflatoxin levels to be between zero and 10 parts per billion, verified by testing.
  4. Consider giving “jungle peanuts” a try, an heirloom variety from the Amazon rainforest. Jungle peanuts are sold as raw nuts and raw nut butters. They are reportedly higher in nutrition and typically touted as aflatoxin-free. However – they aren’t cheap! (You get what you pay for.)
  5. Regardless of what peanut butter you choose, always store it in the refrigerator.
  6. If you grind your own, wash your grinder thoroughly.
  7. In general, whole nuts tend to be less contaminated than nut pieces or butters. If your nuts taste sour, bitter or otherwise funky, toss them out.
  8. Some studies show that soaking and fermenting your nuts and grains can significantly lower their aflatoxin levels, as well as mitigating the toxic effects. Lactic acid during fermentation seems to bind to aflatoxins and cuts off mold’s energy supply.[14]
  9. Studies show chlorophyll may effectively block absorption of aflatoxin, so have your peanut butter with a side of greens.[15]
  10. Optimize your glutathione levels, as glutathione helps the body with aflatoxin detoxification, among other things.
  11. Activated charcoal will absorb some mycotoxins, but for aflatoxins, animal studies show bentonite or montmorillonite clay are superior to activated charcoal.[16]
  12. Other plant agents that may be useful for detoxification include milk thistle,[17] marshmallow root, dandelion root, and extract of the leaves of Adhatodavasica Nees, an Ayurvedic medicinal plant.

UC Irvine Accidentally Invents a Battery that Lasts Forever

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What do Viagra, popsicles, Corn Flakes, Ivory soap, the kitchen microwave, and champagne have in common? They were all discovered by accident. Add ultra-long-lasting nanowire batteries to that list, thanks to a team of researchers at the University of California Irvine. The average laptop battery is rated anywhere from 300 to 500 charge cycles – completely full to completely empty to completely full again – longer if you don’t use it all up before recharging. The UCI nanobattery endured 200,000 charge cycles over three months “with 94–96% average Coulombic efficiency.” It was effectively still brand new at the end of the experiment.

Let’s go conservative and say the average laptop battery lasts for 1,000 charge cycles, its capacity noticeably diminished after about two years. If that laptop had UCI’s nanobattery it would easily last for 400 years (if 1,000 cycles = two years, 200,000 cycles = 400 years). That’s long enough for that laptop to share a name with, but be far less useful than, an actual brick. If UCI can apply its findings to commercial uses, there’s a revolution coming throughout the electronic landscape.

The advance happened when UCI doctoral candidate Mya Le Thai “was playing around” in the lab and coated a set of gold nanowires in manganese dioxide, then applied a “Plexiglas-like” electrolyte gel. Under normal circumstances, nanowires – highly conductive but thousands of times thinner than a human hair – are useless after no more than 8,000 charge cycles because their fragility causes them to crack during charge and discharge loads. At the end of three months, however, the researchers found the nanowires in Thai’s gel-coated battery still intact. They suspect that the gel “plasticizes the metal oxide in the battery,” imbuing the nanowires with flexibility, which equals longevity. Thai said, “The coated electrode holds its shape much better.” The school published its findings in the American Chemical Society journal Energy Letters.

UC Irvine Battery
We’re a long way from an immortal, practical battery, though. In 2007 scientists at Stanford came up with a nanowire configuration that got a nanobattery through 40,000 charge cycles. The lead researcher said at the time that manufacturing needed “one or two different steps, but… it’s a well understood process.” Nine years later we’re still carrying charging bricks and fighting over public USB ports.

European Surgeons Vote on Global Recommendations for Inguinal Hernia

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A Mix of Consensus And Controversy on Recommendations
Rotterdam, Netherlands—Let the voting begin. The bustling auditorium at the 2016 International Congress of the European Hernia Society (EHS) quieted as more than 200 surgeons logged onto the EHS website to cast their votes on 50 global statements and recommendations for managing groin hernias.

Although surgical societies including the EHS have created guidelines for inguinal hernia surgery in the past, this marks the first attempt at world guidelines.

“The main goal of these guidelines is to improve patient outcomes and standardize care worldwide,” Maarten Simons, MD, general surgeon in the Department of Surgery at Onze Lieve Vrouwe Gasthuis Hospital, in Amsterdam, told the audience at the “Consensus Meeting” session.

Existing guidelines, which often reflect the values and practices of a particular region, have not yet achieved this goal. The current body of literature on inguinal hernia repair still shows wide variations in surgical practice and patient outcomes, with estimates for recurrence and chronic pain as high as 15%, depending on the analysis, surgeon and institution.

“We ideally want recurrences below 5% and chronic pain below 1%,” Dr. Simons said. “But that’s difficult to achieve with so many different meshes and prosthetic devices, and the variability in the way they are used.”

In 2014, a group of 50 experts from seven hernia societies worldwide joined forces and established the HerniaSurge Group to create a set of recommendations for all hernia surgeons based on the best available evidence.

“This was a herculean effort by many people,” said Robert J. Fitzgibbons, MD, the Harry E. Stuckenhoff Professor and Chairman of Surgery at Creighton University School of Medicine, in Omaha, Neb., who helped draft the guidelines.

Over six months, these surgeons divided themselves into groups dedicated to subtopics ranging from technique and mesh preferences, to anesthesia and prophylactic antibiotic practices, to education and training requirements. After combing through more than 3,500 articles, the international cohort ultimately whittled down the evidence to 50 essential statements and recommendations, which were subsequently graded by level of evidence (very low, low, moderate or high) and recommendation strength (weak or strong).

At the 2016 EHS congress, members of the HerniaSurge Group unveiled a draft of the guidelines for the first time. The purpose of the session was to engage a larger community of surgeons in the process and to vote on each guideline.

“Today is all about the consensus,” Dr. Simons said.

Marc Miserez, MD, PhD, a general surgeon at University Hospital Gasthuisberg in Leuven, Belgium, approached the microphone to begin reading the guidelines. Dr. Miserez indicated that a consensus would be reached if 70% or more voters agreed with the recommendation as well as its strength and level of evidence.
The first guideline—“Clinical examination alone is recommended for confirming the diagnosis of an evident groin hernia”—passed that threshold with 80% of voters agreeing on the recommendation, the strength as “strong” and the level of evidence as “low.”
A handful of other recommendations achieved a strong consensus:

92% agreed, recommendation strong, evidence low: “In patients with primary bilateral hernias a laparo-endoscopic approach is recommended provided expertise is available.”
91% agreed, recommendation strong, evidence high: “Although most patients will develop symptoms and need surgery, watchful waiting for minimal or asymptomatic inguinal hernias is safe since the risk of hernia complications is low and can be recommended.”
83% agreed, recommendation strong, evidence moderate: “A mesh-based repair technique is recommended for patients with symptomatic inguinal hernias.”
83% agreed, recommendation strong, evidence low: “Nerve anatomy awareness and recognition during surgery is recommended to reduce the incidence of chronic post-herniorrhaphy pain.”
81% agreed, recommendation strong, evidence moderate: “In laparo-endoscopic inguinal hernia repair, TAPP [transabdominal preperitoneal] and TEP [total extraperitoneal] have comparable outcomes; hence it is recommended that the choice of the technique should be based on the surgeon’s skills, education and experience.”
79% agreed, recommendation strong, evidence low: “Hernia surgeons should be aware of the clinical characteristics of the meshes they use.”
74% agreed, strong, very low: “It is recommended that surgeons tailor treatments based on expertise, local/national resources, and patient- and hernia-related factors.”
But several recommendations proved more controversial. About 22% of the audience disagreed that a laparoscopic technique should be recommended in male patients with a primary unilateral inguinal hernia; 26% of voters did not concur that day-case laparoscopic inguinal hernia repair with minimal use of disposables is cost-effective; and more than 36% disagreed that general or local anesthesia is preferred over regional in patients 65 years of age and older.

After the voting ended, the panel circled back to address these more divisive recommendations. One surgeon in the audience, for instance, noted that day-case surgery may not be a financially attractive option in certain hospitals due to local insurance practices. Another surgeon explained that, in Sweden, universities teach the Lichtenstein approach, and, thus, the recommendation to use a laparoscopic technique may not be feasible in that environment.

Even the watchful waiting recommendation, with its 91% consensus and high level of evidence, may not apply universally. Neil Smart, MD, a consultant colorectal surgeon at the Royal Devon and Exeter Foundation NHS Trust, in Exeter, England, noted that in the United Kingdom, policymakers have directed general practitioners to practice watchful waiting in an effort to cut costs. But this strategy has backfired. Dr. Smart has seen patients, who were initially rejected for a surgical consult, receive approval only after the situation had become dire and required emergency surgery.

“The cost of one late inguinal hernia surgery, including hospital stay and complications, could have paid for many repairs if we’d operated sooner,” said Dr. Smart, who also is honorary senior lecturer at the University of Exeter Medical School. “Just because there are guidelines, doesn’t mean they are right or appropriate for everyone.”

Guy Voeller, MD, professor of surgery at the University of Tennessee Health Science Center, in Memphis, questioned the value of world guidelines as well. “I understand why we need to have some common ground in hernia surgery, but I think hernia guidelines are a mistake,” Dr. Voeller said. “There is no algorithmic approach to medicine.”

According to Dr. Simons, between 15% and 30% of surgeons will choose not to follow guidelines because the recommendations do not apply to their daily practice or conflict with their professional autonomy and judgment.

Dr. Fitzgibbons also expects that not all recommendations will be universally accepted. Take the recommendation that mesh repair is superior to tissue repair. “In expert centers, like the Shouldice Hospital [in Thornhill, Ontario], surgeons achieve as good results with tissue repair,” Dr. Fitzgibbons said. “That is why I suggested qualifying this recommendation to ‘in the average general surgeons’ hands.’”

Although the HerniaSurge Group tried to consider the feasibility and usefulness of each recommendation for different countries, it was impossible to account for every political nuance or cultural variation. “As such, it is important to understand that these are just guidelines based on the strongest evidence to date and cannot be considered rules,” Dr. Fitzgibbons said.

Alfredo Carbonell, DO, professor of surgery at the University of South Carolina School of Medicine Greenville, and co-director of the Hernia Center at the Greenville Health System, sees the value in guidelines as a reference for clinical practice but believes the recommendations may not be widely adopted in the United States. “I think guidelines are generally useful for informing clinical practice, particularly for hernia surgery where many questions remain unanswered,” Dr. Carbonell said. Young surgeons especially may be looking for advice on best practices. “But surgeons in the U.S. tend to do what they’re going to do, and may not necessarily wait for guidelines to adopt a new technique.”

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Both Drs. Carbonell and Voeller expressed concern that the guidelines may create issues from a legal standpoint. “Guidelines can give lawyers ammunition and be a way for payors and administrators to police how we practice medicine,” Dr. Voeller said. “Attorneys love to whip out guidelines and treat them as law, but rarely understand that guidelines only inform, not dictate, practice.”

Dr. Fitzgibbons clarified that the world guidelines are not designed for government agencies, insurance companies or other regulatory bodies. “In the final version, we will put a disclaimer to reiterate that these guidelines are for surgeons, not third parties,” he said.

Still, even when it’s published, this set of guidelines will not represent the last word on inguinal hernia repair. “It is important to recognize that these guidelines will be continually updated as new data emerges,” Dr. Fitzgibbons said.

Given that surgical practices, health policies and regional resources vary significantly from location to location, the question remains: Will surgical practice actually improve with world guidelines?

“Some surgeons say yes; some say no,” Dr. Simons said. “I can’t say for certain because we don’t have evidence to confirm either way.”

In the future, the HerniaSurge Group will continue to seek consensus on the 50 key statements and recommendations from surgeons in other countries and incorporate feedback from surgeons in different specialties. The group will aim to publish the final version in 2017.

7 Facts About Depression That Will Blow You Away

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7 Facts About Depression That Will Blow You Away

What you think you know about depression is probably a myth.  Kelly Brogan, MD exposes the truth behind common misconceptions related to depression.

A silent tragedy in the history of modern health care is happening right now in America, but no one is talking about it. We have been told a story of depression: that it is caused by a chemical imbalance and cured by a chemical fix—a prescription. More than 30 million of us take antidepressants, including one in seven women (one in four women of reproductive age). Millions more are tempted to try them to end chronic, unyielding distress, irritability, and emotional “offness”—trapped by an exhausting inner agitation they can’t shake.

It is time, even according to leaders in the field, to let go of this false narrative and take a fresh look at where science is leading us. The human body interacts in its environment with deep intelligence. Your body creates symptoms for a reason. Depression is a meaningful symptom of a mismatch, biologically, with lifestyle—we eat a poor diet, harbor too much stress, lack sufficient physical movement, deprive ourselves of natural sunlight, expose ourselves to environmental toxicants, and take too many drugs. Inflammation is the language that the body speaks, expressing imbalance, inviting change. We usually suppress these symptoms with medication but that is like turning off the smoke alarm when you have a fire going on. Let’s get the facts straight:

1. Depression is often an inflammatory condition

Depression is often a manifestation of irregularities in the body that often starts far away from the brain and is not associated with so-called “chemical imbalances.” The medical literature has emphasized the role of inflammation in mental illness for more than twenty years (unfortunately, it takes an average of 17 years for the data that exposes inefficacy and/or a signal of harm, to trickle down into your doctor’s daily routine; a time lag problem that makes medicine’s standard of care “evidence-based” only in theory and not practice). Not a single study has proven that depression is caused by a chemical imbalance in the brain. That’s right: there has never been a human study that successfully links low serotonin levels and depression. Imaging studies, blood and urine tests, post-mortem suicide assessments, and even animal research have never validated the link between neurotransmitter levels and depression. In other words, the serotonin theory of depression is a total myth that has been unjustly supported by the manipulation of data. Much to the contrary, high serotonin levels have been linked to a range of problems, including schizophrenia and autism.  So if you think a chemical pill can save, cure, or “correct” you, you’re dead wrong. That is about as misguided as putting a bandage over a nail stuck in your foot and taking aspirin. It’s absolutely missing an opportunity to “remove the splinter” and resolve the problem from the source.

2. Antidepressants have the potential to irreversibly disable the body’s natural healing mechanisms

Despite what you’ve been led to believe, antidepressants have repeatedly been shown in long-term scientific studies to worsen the course of mental illness—to say nothing of the risks of liver damage, bleeding, weight gain, sexual dysfunction, and reduced cognitive function they entail. The dirtiest little secret of all is the fact that antidepressants are among the most difficult drugs to taper from, more so than alcohol and opiates. While you might call it “going through withdrawal,” we medical professionals have been instructed to call it “discontinuation syndrome,” which can be characterized by fiercely debilitating physical and psychological reactions. Moreover, antidepressants have a well-established history of causing violent side effects, including suicide and homicide. In fact, five of the top 10 most violence-inducing drugs have been found to be antidepressants.