DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING AUGUST 23, 2020.
Monthly Archives: August 2020
PATIENT EDUCATION: THE “2020 WEEKLY CROSSWORD PUZZLE CHALLENGE” (AUG 22)
STANFORD: RESEARCHERS FIND WAY TO “REGROW” NEW CARTILAGE IN JOINTS
The Stanford researchers figured out how to regrow articular cartilage by first causing slight injury to the joint tissue, then using chemical signals to steer the growth of skeletal stem cells as the injuries heal. The work was published Aug. 17 in the journal Nature Medicine.
“Cartilage has practically zero regenerative potential in adulthood, so once it’s injured or gone, what we can do for patients has been very limited,” said assistant professor of surgery Charles K.F. Chan, PhD. “It’s extremely gratifying to find a way to help the body regrow this important tissue.”
STANFORD MEDICINE (Aug 17, 2020): Researchers at the Stanford University School of Medicine have discovered a way to regenerate, in mice and human tissue, the cushion of cartilage found in joints.
Loss of this slippery and shock-absorbing tissue layer, called articular cartilage, is responsible for many cases of joint pain and arthritis, which afflicts more than 55 million Americans. Nearly 1 in 4 adult Americans suffer from arthritis, and far more are burdened by joint pain and inflammation generally.
COMMENTARY
Stanford has come up with a Promising new approach to the surgical treatment of osteoarthritis. Unfortunately for the suffering public, this approach is still in the rodent experimental stage.
The pain of osteoarthritis is caused by the LOSS of the CARTILAGE which insulates the bone of the joints. The wonderful cartilage coating prevents the pain which would result from the rubbing of bone on bone. The best solution in osteoarthritis would be to replace the cartilage, and I have no doubt that this will be possible some day.
STEM CELLS is the theoretical method most commonly imagined when it comes to replacing lost tissue.. Brain cells, cardiac muscle cells, and pancreatic islet cells are some of the research areas. The development of stem cells from the cells of the Patient herself (iSCs) obviates the need for immunosuppression, which plagues allographs ( stem cells or organs from other humans).
Recently, in situ transformation of neighboring cells has been described, which sidesteps the need to introduce any cells. For instance the transformation of astrocytes (a type of brain cell) into neuronal stem cells of the dopamine lineage would be a great boon to Parkinson’s disease.
The Stanford method somewhat resembles this last-mentioned technique. An injury is created where the cartilage is desired. Like any injury, bleeding, clotting, and cell infiltration follows, destined to form a scar. However, the researchers added BMP-2, which in this milieu causes the pro-fibroblasts to head toward the bone (osteoblast) lineage. Since cartilage forms first in a tissue destined to be bone, they then added a VEGF antagonist, which interrupts the transformation in the desired cartilage stage. Both BMP-2 and anti-VEGF have already been approved for use, facilitating the development of this attractive therapy.
The researchers have even identified an excellent potential Patient Population: Osteoarthritis patients scheduled for surgical removal of the first metacarpal articulation with the wrist. They could do their procedure on this area, and if there is no benefit, They could just go ahead with the original plan of removal. The thumb happens to be one of my most painful arthritic areas.
I will most interestedly follow their research.
–Dr. C.
Dr. C’s Medicine Cabinet: Benefits Of “Nootkatone”
INSECTS are mainly pests. Except for the very commercially valuable Pollinators, Honeybees, the other useful insects, like ladybugs, dragonflies and spiders are beneficial because they eat other insects. It is very exciting, then, to hear about a pleasantly-smelling insect repellent that is quite harmless to Humans.
NOOTKATONE, after you get used to its ugly spelling, has an aromatic, Grapefruit-like smell. It was discovered while researching the CEDAR family. We all know of the association between Cedar and storage. One of my prized possessions was a Cedar chest for storing our families ski clothes.
Whenever I hear of a non-toxic chemical that repels and sometimes kills mosquitos, ticks, bedbugs and fleas, and yet is so harmless as to be used in perfumes, I like to hear of a proposed MECHANISM OF ACTION.
Nootkatone is thought to work by stimulating octopamine receptors, which insects use to make their muscles work. The muscles just keep on contracting and the insects die. The only problem is that Nootkatone is mainly a repellant, and a weaker insecticide.
Another good quality of Nootkatone is that the effect lasts several hours, in contrast to citronella and the other plant oils. Interestingly, the substance was isolated from grapefruit some 25 years ago, while looking for a repellant for the tick of Lyme disease.
Anaplasmosis and Rocky mountain spotted fever are 2 other tick-transmitted diseases present in America. Nootkatone is particularly effective against ticks, and is now EPA-approved.
–Dr. C.
THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #8: GOUT (GOUTY ARTHRITIS)
If you develop severe big toe pain in the middle of the night, and it is so tender that you can’t even stand the pressure of the sheet on it, you may have GOUT, an increasingly common form of ARTHRITIS.
And you would be in famous company: King Henry Vlll, Isaac Newton, and Benjamin Franklin all had Gout. There is even a famous dialogue between Franklin and his Tormentor.
Gout is caused by a buildup of URIC ACID in the bloodstream. This buildup can be caused by eating too much nucleic-acid-containing foods, like meats, “sweetbreads” and shellfish, and drinking too much alcohol, especially beer.
Reduced Clearance of Uric acid in the kidneys may contribute, and may be responsible for some of the familial tendencies of gout. The uric excess acid in the blood stream gets into joint tissues, most famously the big toe, although ankles, knees and other joints may be involved.
When deposited in joint tissues, the uric acid crystals attract inflammatory cells, which secrete their Interleukins and produce all of the symptoms of painful, red and swollen joints.
Risk factors include Obesity, diabetes, and the usual suite of problems of the METABOLIC SYNDROME. Just look at a picture of Henry Vlll with a mug of beer in one hand, and a leg of mutton in the other, and your big toe will start to hurt.
Dietary regulation is one of the best ways of reducing PURINE AND PYRIMIDINE intake and consequently the metabolic BYPRODUCT, Uric Acid, in the circulation.
There are DRUGS, called uricosurics, which will cause the kidneys to Clear more Uric acid, and other drugs, such as thiazide diuretics, which will reduce clearance and excretion of gout’s causative agent.
Yes, UNHEALTHFUL EATING CAN BE PAINFUL.
–DR. C
Technology: SCIENTISTS DEVELOP SMARTPHONE APP TO DETECT “DIABETES” (UCSF)
Overall, the algorithm correctly identified the presence of diabetes in up to 81 percent of patients in two separate datasets. When the algorithm was tested in an additional dataset of patients enrolled from in-person clinics, it correctly identified 82 percent of patients with diabetes.
In the Nature Medicine study, UCSF researchers obtained nearly 3 million PPG recordings from 53,870 patients in the Health eHeart Study who used the Azumio Instant Heart Rate app on the iPhone and reported having been diagnosed with diabetes by a health care provider. This data was used to both develop and validate a deep-learning algorithm to detect the presence of diabetes using smartphone-measured PPG signals.
Among the patients that the algorithm predicted did not have diabetes, 92 to 97 percent indeed did not have the disease across the validation datasets. When this PPG-derived prediction was combined with other easily obtainable patient information, such as age, gender, body mass index and race/ethnicity, predictive performance improved further.
Telehealth: Older Adults increase Use Of Virtual Visits from 4% To 26% (2020)
From 2019 to 2020, there was a substantial increase in the proportion of older adults who reported that their health care providers offered telehealth visits. In May 2019, 14% of older adults said that their health care providers offered telehealth visits, compared to 62% in June 2020.
Similarly, the percentage of older adults who had ever participated in a telehealth visit rose sharply from 4% in May 2019 to 30% in June 2020. Of those surveyed in 2020, 6% reported having a telehealth visit prior to March 2020, while 26% reported having a telehealth visit in the period from March to June 2020.
Over the past year, some concerns about telehealth visits decreased among adults age 50–80 whether or not they had a telehealth visit. Older adults’ concerns about privacy in telehealth visits decreased from 49% in May 2019 to 24% in June 2020, and concerns about having difficulty seeing or hearing health care providers in telehealth visits decreased from 39% in May 2019 to 25% in June 2020. Concerns about not feeling personally connected to the health care provider decreased slightly (49% to 45%).
PATIENT EDUCATION: THE “2020 WEEKLY CROSSWORD PUZZLE CHALLENGE” (AUG 16)
DR. C’S PODCAST: WEEKLY MEDICAL NEWS (AUG 16)
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING AUGUST 16, 2020.
TOP NEW BOOKS ON AGING: “EXERCISED” BY DANIEL E. LIEBERMAN – “EXTENDING LONGEVITY” (HARVARD)
HARVARD MAGAZINE (SEPT – OCT 2020): From the book EXERCISED: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman, to be published on September 8, 2020 by Pantheon Books:
‘….many of the mechanisms that slow aging and extend life are turned on by physical activity, especially as we get older. Human health and longevity are thus extended both by and for physical activity.’
The graph breaks total energy expenditure (TEE) into two parts: active energy expenditure, and resting metabolism. Resting metabolism remains elevated for hours even after exercise ceases, burning additional calories in a phase known as excess post-exercise oxygen consumption (EPOC).
Exercise is like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner. The modest stresses caused by exercise trigger a reparative response yielding a general benefit.
In order to elucidate the links between exercise and aging, I propose a corollary to the Grandmother Hypothesis, which I call the Active Grandparent Hypothesis. According to this idea, human longevity was not only selected for but was also made possible by having to work hard during old age to help as many children, grandchildren, and other younger relatives as possible survive and thrive. That is, while there may have been selection for genes (as yet unidentified) that help humans live past the age of 50, there was also selection for genes that repair and maintain our bodies when we are physically active.
Daniel E. Lieberman is a paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology. He is best known for his research on the evolution of the human head and the evolution of the human body.
Read full excerpt from article
COMMENTARY
Daniel Lieberman, a Cultural Anthropologist from Harvard, makes the case that paleolithic hunter-gatherers Grandparents were helpful, in fact necessary to their families, and evolved to be active into old age. They did not evolve to sit in front of the TV, and modern men pay a penalty if they do.
INACTIVITY at ANY AGE is bad. If you put 20 year olds to bed, both weight and blood pressure go up. The book addresses a conundrum. Free radicals are bad. Exercise runs O2 through the mitochondria, which produces free radicals.
But EXERCISE REDUCES FREE RADICALS. A metaphor is introduced: you spill some tomato juice on the floor. But you clean it up, and the floor becomes cleaner than it was before. You exercise, the muscles suffer some microtears and injury. The REPAIR RESTORES the muscles to better than before, maybe with some extra mitochondria.
The Bodies MECHANISMS are MEANT TO BE USED. DIET is meant to supply the body energy and units for repair, EXERCISE is meant to use that energy, and keep the mechanism lubricated, and SLEEP is meant to allow for time to accomplish repair.
Sleep, Diet and Exercise can all be reconciled by recourse to Paleolithic man, whose activities imprinted our modern bodies.
Doctors Without Waiting Rooms 