New Zealand

Brain fertility control unraveled..

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In a landmark discovery, the final piece in the puzzle of understanding how the brain circuitry vital to normal fertility in humans and other mammals operates has been put together by University of Otago researchers.

Their new findings, which appear in the leading international journal Nature Communications, will be critical to enabling the design of novel therapies for infertile couples as well as new forms of contraception.

Sebastian_Kaulitzki_Fertility_shutterstock

The research team, led by Otago neuroscientist Professor Allan Herbison, has discovered the key cellular location of signalling between a small protein known as kisspeptin and its receptor, called Gpr54. Kisspeptin had earlier been found to be crucial for fertility in humans, and in a subsequent major breakthrough Professor Herbison showed that this molecule was also vital for ovulation to occur.

In the latest research, Professor Herbison and colleagues at Otago and Heidelberg University, Germany, provide conclusive evidence that the kisspeptin-Gpr54 signalling occurs in a small population of nerve cells in the brain called gonadotropin-releasing hormone (GnRH) neurons.

Using state-of-the-art techniques, the researchers studied mice that lacked Gpr54 receptors in only their GnRH neurons and found that these did not undergo puberty and were infertile. They then showed that infertile mice could be rescued back to completely normal fertility by inserting the Gpr54 gene into just the GnRH neurons.

Professor Herbison says the findings represent a substantial step forward in enabling new treatments for infertility and new classes of contraceptives to be developed.

“Infertility is a major issue affecting millions of people worldwide. It’s currently estimated that up to 20 per cent of New Zealand couples are infertile, and it is thought that up to one-third of all cases of infertility in women involve disorders in the area of brain circuitry we are studying.

“Our new understanding of the exact mechanism by which kisspeptin acts as a master controller of reproduction is an exciting breakthrough which opens up avenues for tackling what is often a very heart-breaking health issue. Through detailing this mechanism we now have a key chemical switch to which drugs can be precisely targeted,” Professor Herbison says.

As well as the findings’ benefits for advancing new therapies for infertility and approaches to controlling fertility, they suggest that targeting kisspeptin may be valuable in treating diseases such as prostate cancer that are influenced by sex steroid hormone levels in the blood, he says.

Professor Herbison noted that the research findings represent a long-standing collaborative effort with the laboratory of Professor Gunther Schutz at Heidelberg University, Germany.

The work was supported by the Health Research Council of New Zealand and the former Ministry of Science and Innovation.

Professor Herbison is Director of the University’s Centre for Neuroendocrinology, the world-leading research centre investigating how the brain controls fertility.

“We are delighted to have published this work in one of the top scientific journals and also to be able to maintain the leading role of New Zealand researchers in understanding fertility control,” he says.

 

Source: http://www.sciencealert.com.au

 

Is the STEM skills shortage overblown or even non-existent?

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With the rising emphasis on tech across the business landscape, STEM (science, technology, engineering and mathematics) skills appear to be in high demand. Yet, one analysis finds the alleged shortfall of these skills isn’t all it appears to be.

Robert Charette, writing in IEEE Spectrum,  says that despite the handwringing, “there are more STEM workers than suitable jobs.” He points to a study by the Economic Policy Institute that found that wages for U.S. IT and mathematics-related professionals have not grown appreciably over the past decade, and that they, too, have had difficulty finding jobs in the past five years. He lists a number of studies that refute the presence of a global STEM skills shortage. The U.S. Bureau of Labor Statistics, for one, estimates that there was a net loss of  370 000 science and engineering jobs in the U.S. in 2011.

There isn’t even agreement on what STEM jobs are, Charette points out. Even agencies of the U.S. government don’t agree. The U.S. Department of Commerce puts the number of STEM jobs at7.6 million, which “includes professional and technical support occupations in the fields of computer science and mathematics, engineering, and life and physical sciences as well as management,” he relates. The National Science Foundation, on the other hand, estimates there are 12.4 million STEM jobs, taking in health-care workers,  psychologists and social scientists. Other data from Georgetown University finds that a majority of STEM graduates actually leave the STEM field altogether after ten years.

Perhaps what is needed is more polymath skills — blending STEM with other disciplines such as business, law, or even the arts — to drive innovation and entrepreneurship. Building a software company takes more than programming abilities — it takes business savvy and vision.

STEM skills do have an important role in economic growth, Charette opines. “There is indeed a shortage — a STEM knowledge shortage.” While a STEM-based university degree isn’t necessary, “improving everyone’s STEM skills would clearly be good for the workforce and for people’s employment prospects, for public policy debates, and for everyday tasks like balancing checkbooks and calculating risks.”

Ironically, while many non-STEM jobs require some level of STEM skills, many STEM jobs themselves are being displaced. Many of the skills needed in today’s marketplace — from auto repair to graphic arts to accounting — call for computer proficiency, as they now entail work built on software. At the same time, many functions that may have required engineers and mathematicians are being automated — algorithms have replaced many high-level mental tasks and processes. Even computer programmers and operators are finding their jobs are being automated. Perhaps non-STEM professionals need more STEM, but STEM professionals need more liberal arts.

Carotid Stenting vs. Endarterectomy: Coming into.

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Findings from a large clinical trial and magnetic resonance imaging substudy strengthen the case for endarterectomy as the preferred treatment for carotid artery stenosis.

Although the use of percutaneous stenting for carotid artery stenosis is increasing, the procedure is FDA-approved only in patients at high risk for surgical complications. In direct comparisons with endarterectomy, stenting was associated with increased rates of periprocedural stroke, but questions remain about surgical complications, patient selection, timing of intervention, and operator experience. To address these issues, investigators from 50 centers in Europe, Australia, New Zealand, and Canada randomized 1713 patients with recently symptomatic carotid stenosis to undergo stenting or endarterectomy. Planned follow-up is 3 years; we now have results of an interim safety analysis.

At 120 days after randomization, the rate of disabling stroke or death was 4.0% in the stenting group and 3.2% in the endarterectomy group, a nonsignificant difference. However, the incidence of the primary endpoint — any stroke, death, or myocardial infarction (MI) — was 8.5% in the stenting group and 5.2% in the endarterectomy group (hazard ratio, 1.69; 95% confidence interval, 1.16–2.45; P=0·006). Cranial nerve palsy occurred in 1 patient in the stenting group compared with 45 in the endarterectomy group, and significantly fewer hematomas occurred in the stenting group than in the endarterectomy group.

In a substudy, 231 patients underwent preprocedural and postprocedural diffusion-weighted magnetic resonance imaging (DWI) to detect ischemic brain lesions. New postprocedural lesions were found in 50% of patients randomized to stenting and in 17% of those randomized to endarterectomy (odds ratio, 5.21; 95% CI, 2.78–9.79; P<0.001). Increasing DWI lesion volume was associated with subsequent symptomatic stroke. Moreover, DWI lesion rates were higher in centers where filter-based cerebral protection devices were used routinely during stenting than in centers where these devices were not routinely used.

COMMENT

Although longer-term follow-up results of this trial are yet to come, the evidence increasingly supports endarterectomy as the first choice for patients with symptomatic carotid stenosis who are suitable candidates for surgery. The elevated stroke risk associated with stenting is underlined by the striking increase in new ischemic lesions on DWI that appeared to be somewhat related to the use of cerebral protection devices. Whether periprocedural strokes have a greater impact on a patient’s quality of life than periprocedural MIs remains to be seen. Investigators from a U.S. trial (CREST) reported at a recent stroke meeting that stenting and endarterectomy were comparable in their trial, but we reserve judgment until their full published analysis is available.

Source: http://www.jwatch.org

 

Asthma genetic risk research could lead to future test

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Research into the genetic risks for asthma could lead to a test which predicts which children will never grow out of it, says a study in The Lancet.

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Scientists found that those at higher genetic risk of asthma were 36% more likely to develop serious, life-long asthma than those with lower risk.

But they said it was too soon to be used as a reliable clinical test.

Asthma UK says the findings could help identify people whose asthma could become severe.

Earlier studies had linked several genes to small increases in asthma risk.

This study, led by researchers from Duke University in North Carolina, identified 15 separate locations in the human genome which are associated with asthma.

Using this knowledge combined with data from a major New Zealand health study of more than 1,000 people since birth, the researchers were able to calculate the genetic risk score for 880 individuals.

They then tracked the development and progression of their asthma from early childhood through to their late 30s.

 “Start Quote

Genetic risk prediction for asthma is still in its infancy.”

Dr Daniel BelskyDuke University

Those with higher genetic risk scores were more likely to have severe asthma which continued into adulthood, and they more often developed problems with lung function.

They were also more likely to miss school or work and to be admitted to hospital because of their asthma.

At present, there are no tests that can predict which children will recover as they grow older.

Dr Daniel Belsky, a post-doctoral fellow at the Duke Institute for Genome Sciences and Policy, said it was too early to talk about a predictive test for severe asthma.

“Although our study revealed that genetic risks can help to predict which childhood-onset asthma cases remit and which become life-course-persistent, genetic risk prediction for asthma is still in its infancy.

“As additional risk genes are discovered, the value of genetic assessments is likely to improve.”

He said there was still a long way to go before genetic risk scores could be used routinely in medical practice.

But the study could lead to a better understanding of asthma and how to treat it, he said.

Leanne Reynolds, from the charity Asthma UK, said it was misleading to assume that some children ‘grow out’ of the condition.

“We know that some children with asthma no longer experience symptoms when they reach adulthood, however… the underlying tendency still remains and so symptoms can still return in later life.”

However, she said further research in this area would be welcomed.

“This could mean that in the future we’re able to identify those people whose asthma will put them at greatest risk so we can ensure they get the support they need.”

Source: BBC

 

 

No magic answer for Achilles tendinopathy.

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“Although they are trendy money spinners, best evidence shows little effectiveness”—An attention grabbing subheading to an editorial by Nic Maffulli in the BMJ commenting on an intriguing randomised controlled trial (RCT) from New Zealand on the use of autologus blood injections in treating Achilles tendinopathy. It doesn’t work.

Evidence based sports medicine was radical new thinking when Tom Best and I first began to think about it. Care of the athlete had evolved empirically. Few asked questions. For example, when our university research group first began to study ice, perhaps the most commonly used treatment in soft tissue injury, there was little quality evidence to inform treatment; the duration of each application, over what period of time, the temperature of the ice (melting iced water is 0 degrees Celcius),  if it mattered if you were fat or thin etc. Clinicians then began to ask about the evidence for the tests used in clinical examination, the effectiveness of prevention, the appropriate management of common conditions. Where we thought there was certainty, there was little evidence. This RCT on Achilles tendinopathy is an important trial because it asked serious questions about a treatment that had become commonplace yet seemingly evidence free.

Much of what we think is fact in sport is hype, based often on weak science, but mostly on extrapolation from observation. People in sport are forever looking for that extra added magic ingredient to set them apart. Complicit and gullible because they want to believe.  They follow the training programme, wear the headband, chase the logo the champions wear. It is no surprise that they take the drink, buy the supplement, wear the shoe, or do the exercise endorsed by champions. Ever susceptible, suggestible—looking for an easy way, its human nature.  So, it was no surprise to see the hype surrounding yet another product on the margin. This was the next big thing—an injection to cure one of the most common and troublesome injuries.

Its great to see good quality research and more is needed. But, research is expensive and its almost impossible to justify research in sports medicine when competing for funds with cancer, cardiology, and other core medical topics.  There is an evidence vacuum and in sports medicine there is huge pressure to do something. And, always someone looking for the magic answer.

Sourc: BMJ

 

 

Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial.

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Abstract

Objective To assess the effectiveness of two peritendinous autologous blood injections in addition to a standardised eccentric calf strengthening programme in improving pain and function in patients with mid-portion Achilles tendinopathy.

Design Single centre, participant and single assessor blinded, parallel group, randomised, controlled trial.

Setting Single sports medicine clinic in New Zealand.

Participants 53 adults (mean age 49, 53% men) with symptoms of unilateral mid-portion Achilles tendinopathy for at least three months. Participants were excluded if they had a history of previous Achilles tendon rupture or surgery or had undergone previous adjuvant treatments such as injectable therapies, glyceryl trinitrate patches, or extracorporeal shockwave therapy.

Interventions All participants underwent two unguided peritendinous injections one month apart with a standardised protocol. The treatment group had 3 mL of their own whole blood injected while the control group had no substance injected (needling only). Participants in both groups carried out a standardised and monitored 12 week eccentric calf training programme. Follow-up was at one, two, three and six months.

Main outcome measures The primary outcome measure was the change in symptoms and function from baseline to six months with the Victorian Institute of Sport Assessment-Achilles (VISA-A) score. Secondary outcomes were the participant’s perceived rehabilitation and their ability to return to sport.

Results 26 participants were randomly assigned to the treatment group and 27 to the control group. In total, 50 (94%) completed the six month study, with 25 in each group. Clear and clinically worthwhile improvements in the VISA-A score were evident at six months in both the treatment (change in score 18.7, 95% confidence interval 12.3 to 25.1) and control (19.9, 13.6 to 26.2) groups. The overall effect of treatment was not significant (P=0.689) and the 95% confidence intervals at all points precluded clinically meaningful benefit or harm. There was no significant difference between groups in secondary outcomes or in the levels of compliance with the eccentric calf strengthening programme. No adverse events were reported.

Conclusion The administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy.

 

What is already know on this topic

  • Several studies have suggested that the injection of autologous blood can be helpful in the treatment of various tendinopathies
  • Autologous blood injections are a relatively common treatment, despite a lack of high quality evidence supporting their use in the management of Achilles tendinopathy
  • The use of peritendinous autologous blood injections does not reduce pain or improve function in those with mid-portion Achilles tendinopathy when they are combined with an eccentric training programme.

What this study adds

Discussion

Summary of principal findings

To our knowledge, this is the first double blinded, randomised, controlled trial investigating the efficacy of autologous blood injections as a treatment for mid-portion Achilles tendinopathy in addition to a standardised eccentric training programme. Both groups showed a steady and clinically meaningful improvement in the mean VISA-A scores throughout the study. The addition of two peritendinous autologous blood injections administered one month apart, however, was unlikely to have resulted in additional clinically meaningful improvements in pain or in ability to return to activity.

Comparisons with the literature

The only other available published study investigating the use of autologous blood injections to treat Achilles tendinopathy concluded that injections produced a moderate improvement in symptoms.24 This previous study lacked blinding and allocation concealment, administered a variable number of injections, included participants with unilateral and bilateral symptoms, and had a high dropout rate. The sample size recruited for our study was large enough to preclude possible clinical benefits and harm and was also similar to that in other randomised trials that used the change in VISA-A score as the primary outcome measure (40-75 participants).24 28 29 The monitoring of eccentric training was also similar to that used by some other investigators,28 30 though others did not mention steps taken to monitor compliance.29 31 Good compliance probably contributes to a participant’s clinical improvement.25 Without accurate monitoring, any benefit attributable to the intervention might actually be caused by disparity between groups in the compliance with eccentric training or would at least increase the variation of the results. It is also likely that there would be increased variation in measurement between participants.

Explanations and clinical implications

The use of autologous blood injections to treat tendinopathy has become particularly popular in recent years, despite the apparent lack of quality evidence supporting their use.19 20 24 32 33 Our findings suggest that the application of autologous blood injections as described has no clear clinically beneficial effect, and based on this finding we cannot recommend their future use. There are, however, several other possible explanations for the outcome. Firstly, the needling process itself might have created sufficient bleeding in the control participants to induce a healing response. Secondly, administering injections closer together would have enhanced any potential benefit from maintaining a steady state effect of growth factors present in the blood.17 19 The lack of ultrasound guidance, or the injections being directed peritendinously rather than intratendinously, could have affected the outcome. From our experience however, most autologous blood injections administered in New Zealand are delivered peritendinously. Several reports of benefit from unguided injections in tendinopathy support this type of administration.24 32 33 34 35 36 There are also numerous studies indicating that peritendinous injections of differing substances can provide benefit in the treatment of Achilles tendinopathy.24 36 37 38 The intratendinous injection of platelet rich plasma, a derivative of whole blood, has been investigated in the treatment of mid-portion Achilles tendinopathy with mixed results to date.39 The proposed mechanism of action of autologous blood injections and platelet rich plasma is similar, but the former is cheaper as it does not require specific preparation and a smaller volume of blood is taken from participants. The negligible clinical effect of autologous blood injections in this study, and the mixed results of platelet rich plasma, suggest that these forms of injection therapy are not useful for the treatment of mid-portion Achilles tendinopathy. Eccentric training is already recognised as a good treatment option for Achilles tendinopathy,15 25 28 and both groups showed a clinical improvement as a result of the eccentric training component. It was therefore difficult to show an additive clinically meaningful effect of autologous blood injections. We did not use any type of substance in the injections in the control group, whereas most other studies used injections of normal saline28 40 41 42or local anaesthetic.43 44 There is recent evidence to suggest that higher levels of extracellular sodium suppress transient receptor potential V1 (TRPV1) activity, a non-selective cation channel present in nociceptors that helps to integrate pain perception.45We considered that injecting normal saline could itself result in reduced pain sensation, and as such, not strictly act as a control intervention. Indeed, the group allocation prediction analysis shows that participants were unable to determine which group that they had been randomised to, suggesting that with the use of our control intervention, we were able to maintain adequate blinding.

Strengths and limitations of the study

Strengths of this study were the high participation rate (95%) and low dropout rate (6%). The participants reflected a wide range of society with ages ranging from 27 to 76 and sex being evenly matched with 53% men and 47% women. There was, however, an under-representation of minority ethnic groups, with 91% of the participants identifying themselves as European and the 9% remaining as New Zealand Maori. A further strength was the use of the validated primary outcome measure, the VISA-A questionnaire, which was completed in the presence of the single blinded assessor. We also used daily monitoring of eccentric training compliance with a written log, which could have encouraged good compliance and showed that there were no differences between the groups in the eccentric training aspect of the management.

Future research

We conclude that the administration of unguided peritendinous autologous blood injections does not confer an additional benefit to rehabilitation outcomes resulting from a standardised eccentric training programme. Follow-up studies could involve the injections being given intratendinously under ultrasound guidance, a shorter time interval between injections, or an increase in the volume of injected blood. It would also be beneficial to have a third treatment group who undertake an eccentric training programme only, without injection. While such derivations would aid in estimation of the effect of the needling itself, it would be without blinding and therefore susceptible to placebo effects. A fourth treatment with autologous blood injections in the absence of eccentric training would help to determine whether any benefit is obtained from injections in isolation.

Source: BMJ

SUCCESS! Shell stops Arctic oil drilling for this year.

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For over six months, huge numbers of us have been pressuring Shell to stay out of the Arctic. Well this morning, company bosses announced they were scrapping their oil drilling programme for this year. It’s a huge victory for people power.

We started six months ago in New Zealand, when Lucy Lawless climbed and occupied Shell’s Noble Discoverer rig, as it started its long journey up to drill in the Arctic. As Lucy said, “six activists went up, but 133,000 came down“.

But that was only the beginning.

As thousands of you spread the word of the unparalleled insanity that is Arctic drilling, more and more people became involved.

When Penelope Cruz, Sir Paul McCartney and One Direction joined the growing voices calling out for Arctic protection it was obvious that this movement was going to keep growing.

And today together we’ve landed a major victory.

As one of the world’s biggest oil companies, Shell was set to lead the pack and spark the Arctic oil rush. But a few hours ago they admitted defeat for 2012.

With the eyes of two million people on them, Shell executives knew that any mistakes would be noticed. And today they admitted yet another one. A special dome which was designed to clean up after a spill has been damaged. That means the end of the project for this year.

By shining a light in the far frozen corners of this planet, together we’ve helped keep risky oil drilling out of the Arctic – for this year.

The significance of Shell stopping oil drilling is hard to overestimate. After sinking five billion dollars into its failing programme, other oil giants are now questioning the logic of Arctic drilling. Only a few days ago, the Norwegian company Statoil said it was going to wait and see how Shell gets on in the Arctic.

Well today’s news makes it totally clear: Shell’s Arctic misadventure is an expensive and risky mistake.

Thank you to the thousands of volunteers around the world on high streets, petrol stations, universities and places of work who’ve shown what a movement can do.

This is a huge step forward in our campaign, but we need to build on it to make sure we keep the Arctic protected from all oil drillers, for good.

If you’re one of the two million who’ve joined the campaign to save the Arctic – today is a time to celebrate what you’ve achieved against one of the most powerful corporations on the planet. If you’re not, please join now to make the movement even stronger: savethearctic.org

Source: savethearctic.org

http://www.greenpeace.org

 

Ways to curb falls in elderly.

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A large-scale international review involving University of Sydney researchers has shed light on falls in older people, revealing some interventions can effectively prevent falls in people over 65 and living in their own homes.

The review, published in the Cochrane Database of Systematic Reviews, included 159 trials involving more than 79,000 participants from Australia, the UK and New Zealand and was co-authored by the University of Sydney’s Professor Lindy Clemson, Faculty of Health Sciences and Associate Professor Cathie Sherrington, George Institute for Global Health.

The research was led by the University of Otago in New Zealand, and also involved researchers from the University of Hull and the University of Warwick in the UK.

“Falls have debilitating and isolating social consequences for older people, not to mention the increasing economic cost they present in our ageing population,” says Professor Clemson.

“Our review found a number of interventions can prevent older people from falling, with solutions as simple as wearing an anti-slip shoe device in icy conditions and as complex as surgical and drug treatments. We found multiple-component exercises for groups or individuals significantly reduced the risk of falls.”

In fact, three trials in the review found that interventions could save more money than they cost.

Falls affect approximately 30 percent of people over 65 living in the community. Around one in five falls requires medical attention, and one in ten results in a fracture.

“Falls can start a downward spiral of immobility, reduced confidence, and incapacity leading to institutionalisation, so it’s really important we tackle the issue to prevent as many falls as possible,” says Professor Clemson, who developed a program for falls prevention published in the British Medical Journal last month.

The Cochrane review found performing safety modifications and behaviour changes in the home to be particularly effective in falls reduction, especially for people with severe visual impairments and when the assessment was carried out by a qualified occupational therapist.

Some forms of medication changes and surgery also reduced falling, with people fitted for pacemakers for particular heart rate disorders (carotid sinus hypersensitivity) falling less often than those without the pacemakers. Women receiving cataract surgery on the first eye also had a reduced rate of falling, although removing the cataract from the second eye had no further effect.

According to the review, older people may be at an increased risk of falling while adjusting to new glasses or major changes in prescriptions. However, the risk reduced when people wearing multifocal glasses who took part in activities outside the home swapped their multifocals for two separate pairs of glasses for distance and close vision tasks.

Source: Science Alert