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Children with poor reading skills who underwent an intensive, six-month training program to improve their reading ability showed increased connectivity in a particular brain region, in addition to making significant gains in reading, according to a study funded in part by the National Institute of Mental Health (NIMH). The study was published in the Dec. 10, 2009, issue of Neuron.

“We have known that behavioral training can enhance brain function.” said NIMH Director Thomas R. Insel, M.D. “The exciting breakthrough here is detecting changes in brain connectivity with behavioral treatment. This finding with reading deficits suggests an exciting new approach to be tested in the treatment of mental disorders, which increasingly appear to be due to problems in specific brain circuits.”

For the study, Timothy Keller, Ph.D., and Marcel Just, Ph.D., both of Carnegie Mellon University, randomly assigned 35 poor readers ages 8–12, to an intensive, remedial reading program, and 12 to a control group that received normal classroom instruction. For comparison, the researchers also included 25 children of similar age who were rated as average or above-average readers by their teachers. The average readers also received only normal classroom instruction.

Four remedial reading programs were offered, but few differences in reading improvements were seen among them. As such, results for participants in these programs were evaluated as a group. All of the programs were given over a six month schooling period, for five days a week in 50-minute sessions (100 hours total), with three students per teacher. The focus of these programs was improving readers’ ability to decode unfamiliar words.

Using a technology called diffusion tensor imaging (DTI), the researchers were able to measure structural properties of the children’s white matter, the insulation-clad fibers that provide efficient communication in the central nervous system. Specifically, DTI shows the movement of water molecules through white matter, reflecting the quality of white matter connections. The better the connection, the more the water molecules move in the same direction, providing a higher “bandwidth” for information transfer between brain regions.

At the outset of the study, poor readers showed lower quality white matter than average readers in a brain region called the anterior left centrum semiovale. Six months later, at the completion of the intensive training, the poor readers showed significant increases in the quality of this region. Children who did not receive the training did not show this increase, suggesting that the changes seen in the remedial training group were not due to natural maturation of the brain.

In an effort to further pinpoint the mechanism underlying this change, the researchers deduced that a process called myelination may be key. Myelin is akin to electrical insulation, allowing for more rapid and efficient communication between nerve cells in the brain. However, the directional association between brain changes and reading improvements remains unclear — whether intensive training brings about increased myelination that results in improved word decoding skills, or whether improved word decoding skills leads to changes in reading habits that result in greater myelination.

“Our findings support not only the positive effects of remediation and rehabilitation for reading disabilities, but may also lead to improved treatments for a range of developmental conditions related to brain connectivity, such as autism,” noted Just.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the www.nimh.nih.gov.

Genetic testing of people who’ve suffered sudden unexplained death is an effective and cost-efficient way of identifying genetic mutations that may put surviving relatives at increased risk for potentially deadly heart rhythm disturbances, a new study suggests.

Genetic defects that can cause sudden cardiac death occur in 25 percent to 30 percent of victims of sudden unexplained death. The current recommended approach is for first-degree relatives of sudden unexplained death victims to undergo comprehensive cardiac testing.

In this study, U.S. researchers compared the results and costs of postmortem genetic/molecular autopsy testing in 146 sudden unexplained death cases and found that 40 of the victims (26.7 percent) had either a catecholaminergic polymorphic ventricular tachycardia mutation (18 people) or a long QT syndrome mutation (22 people). Both are known to cause sudden death.

The researchers then estimated the costs of testing the 584 relatives of the sudden unexplained death victims. The total cost of postmortem genetic testing, genetic confirmation testing of the 160 relatives of victims who tested positive for mutations, and cardiac tests for both relatives of mutation-positive and mutation-negative sudden unexplained death victims was $6.78 million.

In comparison, comprehensive cardiac testing for all 584 relatives of the sudden unexplained death victims, followed by directed genetic testing, would have been more than $7.7 million.

“With less than 150 sudden unexplained death cases, use of a cardiac channel molecular autopsy would be estimated to save almost $1 million indicating a much less expensive way of evaluating those left behind,” study co-author David Tester, a senior research technologist at Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minn., said in a news release.

“If you identify a mutation in a sudden unexplained death victim, you can do a simple genetic test in first-degree relatives to assess their risk and perform a disorder-directed clinical evaluation rather than a full clinical evaluation. If a relative is negative for the causative mutation, they may not need to undergo further clinical evaluation at all, and that saves money,” Tester explained.

The study was to be presented Sunday at the American Heart Association’s annual meeting in Orlando, Fla.

A hammer toe occurs when a toe bends over in a hammer-like or claw-like shape. Most common in the second toe, the condition can affect any toe.

A person can be born with a hammer toe, or it can develop over time, particularly from wearing shoes that are too small.

Early treatment may prevent the need for surgery. The U.S. National Library of Medicine offers this list of other potential treatment options:
Splinting the toe, which seems to work best for mild cases or among children.
Using foot manipulation, also an effective remedy for children.
Wearing properly fitted shoes that don’t squeeze the toes.
Wearing a protective pad or using a corrective foot device.
Exercising the toes. Speak to your doctor about what may work for you.

Tranexamic acid (Lysteda) has been approved by the U.S. Food and Drug Administration as the first non-hormonal drug to treat heavy menstrual bleeding, a medical condition called menorrhagia. It works to stabilize a protein that helps blood clot.

Some 3 million women in the United States report the condition each year, usually with no apparent cause, the FDA said in a news release.

Tranexamic acid has been used since the mid-1980s to reduce or prevent bleeding after tooth extraction in people with hemophilia, a genetic disorder caused by lack of a blood clotting factor.

Common side effects among people using Lysteda include headache, sinus and nasal symptoms, back or abdominal pain, muscle or joint pain, anemia and fatigue.

People who use Lysteda while also taking hormonal contraceptives may run the risk of increased blood clots, stroke or heart attack. So women who take a hormonal contraceptive should only use Lysteda if there is a strong medical need, the FDA stressed.

Lysteda is made by Kentucky-based Xanodyne Pharmaceuticals.

Heart attack patients arriving at the hospital typically receive the radiation equivalent of 725 chest X-rays from medical tests during that single hospital stay, new research shows.

The average exposure was 14.5 millisieverts (mSv), about one-third the annual maximum of 50 mSv allowed radiation workers and more than five times the amount of background radiation Americans get from just going about their business in any given year.

Although the amount may sound alarming, it’s not at all clear at this point whether these dosages actually increase health risk, particularly the likelihood of developing cancer, said the Duke University researchers, who plan to present their findings Monday at the American Heart Association’s annual meeting, in Orlando, Fla.

“We have to weigh the potential risk of radiation against the risk of not doing anything, and the risk would be very substantial, especially in these patients who were gravely ill,” said Dr. Thomas Gerber, a spokesman for the heart association and a professor of medicine and radiation at the Mayo Clinic, in Jacksonville, Fla. “It’s important to realize that nobody has ever been able to show scientifically that radiation at the levels used in medical imaging increase the risk of cancer. These are all theoretical concerns that are mathematically extrapolated from what happened in survivors of Hiroshima and Nagasaki who got so much more radiation.”

“The actual biological effects of radiation are an ongoing question,” added study author Dr. Prashant Kaul, a fellow in cardiovascular medicine at Duke. “The risks of causing cancer at the radiation dose levels we’re talking about is actually uncertain.”

The findings arrive in the context of several other recent studies that have shown that patients of all kinds are being exposed to large amounts of radiation from medical imaging procedures.

According to background information in this study, radiation exposure from medical imaging procedures exploded more than 700 percent between 1980 and 2006. One-third of these were cardiovascular procedures.

“Up to this point, we’ve been thinking about radiation as it relates to an individual imaging test. We think it’s appropriate to think of radiation dose per episode of care,” Kaul said.

More than 64,000 patients treated for heart attacks at one of about 50 university hospitals over a three-and-a-half year period underwent almost 277,000 procedures involving ionizing radiation. This represented an average of just over four imaging studies per person, with average cumulative radiation dose of 14.5 mSv.

Cardiac catheterization, one of the most important procedures used by cardiologists, represented at least half of the radiation exposure from all procedures, which was expected, Kaul said. Three-quarters of patients underwent this procedure, which is consistent with the guidelines.

“Also, about 50 percent of patients got CT scans, which is maybe a little higher than expected,” Kaul said. But the researchers don’t know why the patients were getting these chest, head or all-body scans so they can’t determine if they were necessary or not.

A head CT delivers 2 mSv, a body CT delivers 10 mSv and a chest scan delivers 7 mSv, he said. A diagnostic catheterization gives about 7 mSv and putting a stent into an artery adds another 8 mSv, on average.

“In the absence of definitive data, most authorities still recommend a conservative strategy following the ALARA [as low as reasonable achievable] principle,” Kaul stated. “We would like to increase awareness among physicians so when they’re ordering tests involving ionizing radiation, they’re thinking about this. At the end of the day, we want to be sure we’re ordering the right test for the right patient in a given clinical scenario.”

“You see, the potential risk of radiation differs in a patient with no symptoms who comes to the doctor for a regular check-up. For them, a stress test probably would not be meaningful but it’s also different if you’re a 20-year-old woman or an 80-year-old man,” Gerber added.

Using liposuctioned fat for breast augmentation may be a viable alternative to implants for some women, according to a new study.

The use of fat injections for breast augmentation has been the subject of ongoing debate because of a lack of research and worries that the fat may calcify and obscure mammograms, be mistaken for cancer or be re-absorbed by the body.

The study included 50 women, aged 17 to 63, who had 55 fat-grafting procedures (five women were grafted twice) to their breasts with fat taken from their upper thighs and other areas. The patients were followed-up for between nine months and five years, with an average follow-up of three years.

The researchers found that the grafts didn’t obscure mammography and that the women didn’t have any suspicious breast masses, nodules or lesions that might interfere with cancer detection.

Among the other findings:
Graft survival averaged 85 percent.
The average increase in breast volume at six to 12 months was 210 milliliters.
The procedure can be performed in 90 minutes.

The study was scheduled for presentation at the annual meeting of the American Society of Plastic Surgeons, held Oct. 23 to 27 in Seattle.

Another study scheduled for presentation at the meeting found that injecting fat into the breasts gives breast-lift patients a new option for improving breast size and shape, with a reduced risk of some of the complications associated with breast implants.

Many women who have breast lifts require some amount of augmentation to fill out their breasts. Breast implants are typically used in these cases.

This study included 46 women who received fat injections to their breasts after a breast lift. The fat was taken from the thigh, abdomen or other areas on the patient’s body. After one year, all of the women had a significant improvement in breast size and shape, with no abnormalities in mammograms, the researchers said.

In 2008, more than 307,000 breast augmentations and more than 92,000 breast lifts were performed in the United States, according to the American Society of Plastic Surgeons.

Psychiatric disorders and sexual trauma in women increase the risk of lower urinary tract symptoms, such as incontinence and overactive bladder, a new study finds.

U.S. researchers analyzed the answers in two questionnaires — the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 — completed by 121 female veterans referred to a specialized urology clinic for evaluation of lower urinary tract symptoms. The researchers also examined the women’s mental health, history of sexual trauma, age, race and obstetric history. The women were compared to a control group of 1,298 women.

Compared to those in the control group, the women in the lower urinary tract symptoms group had higher rates of psychiatric disorders (64.5 percent versus 25.9 percent) and sexual trauma (49.6 percent versus 20.1 percent). Further analysis revealed that women who were younger than 50 and had a history of miscarriage had higher Urogenital Distress Inventory-6 scores, while those with psychiatric disorders and a history of miscarriage had higher Incontinence Impact Questionnaire-7 scores.

“This is the first study to our knowledge to characterize the association of psychiatric comorbidities and sexual trauma with the type, severity and quality-of-life impact of lower urinary tract symptoms in women using validated surveys. The prevalence of psychiatric comorbidities and sexual trauma is high in women veterans presenting for evaluation of lower urinary tract symptoms,” wrote Dr. Adam P. Klausner, an associate professor and director of neurourology, female urology and voiding dysfunction at Virginia Commonwealth University Medical Center, and colleagues.

Hearts attacks have increased among middle-aged American women in the past two decades, but their chance of survival has improved, two new studies show.

“We found that men still have a higher prevalence than women, but what has happened is that the gap has narrowed,” said Dr. Amytis Towfighi, assistant professor of clinical neurology at the University of Southern California, lead author of one of two reports in the Oct. 26 issue of Archives of Internal Medicine. “For women it has increased, for men it has decreased.”

Her study used data from two national surveys conducted from 1988 to 1994 and 1999 to 2004. While 2.5 percent of the men and 0.7 percent of the women reported a history of heart attacks in the earlier survey, 2.2 percent of men and 1 percent of women reported heart attacks in the more recent survey.

The narrowing of the male-female difference is easily explained, Towfighi stated. “Very basically, the risk factors are being better controlled in men than in women.”

In men, levels of “bad” LDL cholesterol remained the same between the two surveys, while levels of “good” HDL cholesterol improved. Blood pressure levels improved, and fewer men smoked.

The improvements for women were marginal, with LDL cholesterol levels about the same. The only risk factor that improved in women was HDL cholesterol. Diabetes and obesity increased in men and women, the study found.

“We don’t know exactly what is going on in terms of risk factors being better controlled. Women aren’t checked as often,” Towfighi acknowledged.

Societal changes may play a role, she said.

With more women in the work force, she said, their rising rates of obesity and diabetes can be attributed to job demands that limit their ability to exercise and follow dietary rules.

It is no longer assumed that female hormones protect against heart disease, she said. Doctors are paying more attention to heart risk factors in women because “there is a red flag about women not being absolutely protected against heart disease in midlife, as we had thought, and we are aware that more effort must be made to reduce their risk,” Towfighi said.

The second study used information from a different data bank listing death rate trends from 1994 to 2006. It found a marked reduction in hospital deaths from heart attacks in all patients, especially among women. For women under 55, the risk of dying dropped by 53 percent, which was the greatest improvement noted. The least reduction, 33 percent, was seen in men under 55.

A detailed examination of cardiac risk factors showed that “women experienced less worsening than men,” said Dr. Viola Vaccarino, professor of medicine and director of the Emory Program in Cardiovascular Outcomes Research and Epidemiology, lead author of the report.

But changing attitudes about women and heart disease may also have had an effect, she said.

“Perhaps physicians are paying more attention to the detection and treatment of women with heart disease,” Vaccarino said. “It could be the same thing happening in the general public, with women getting more knowledgeable about this.”

“Basically, both studies show that there still is a gap between men and women,” said Dr. Nieca Goldberg, clinical associate professor of medicine at NYU Langone Medical Center and a spokeswoman for the American Heart Association. “They both show the importance of continuing to pay attention to women’s risk of cardiovascular disease and treatment of their heart attacks.”

The studies offer some good news for women, Goldberg said. “I’d like to think that’s because we have increased the awareness of women themselves. But these two important studies show the need to continue research about reducing women’s risk of cardiovascular disease.”

As women age, their dietary needs change. A healthy diet is always important, but even more so as women get older.

The American College of Obstetricians and Gynecologists suggests women should consume:
At least 1,500 milligrams daily of calcium, which may be found in dairy products and leafy green vegetables, or dietary supplements.
Eight milligrams of daily iron — needed to help produce red blood cells. Healthy sources of iron include fortified breakfast cereals, spinach and beans.
Limited intake of saturated and trans fats.
Limited intake of salt (sodium) and added sugars.
Plenty of fiber.

Scientists have assumed that people’s brains shrink as they age, but researchers now suspect that’s not the case.

A study in the September issue of Neuropsychology examines long-term Dutch research into aging brains, which used neurological tests and MRI scans to measure parts of the brain.

The researchers looked at data from 1994 to 2005 for two groups: 35 people who were cognitively healthy and 30 people who did not have dementia but experienced cognitive decline during the time period. Both groups averaged about 69 years old.

Those whose cognitive skills declined also had brain shrinkage. That suggested to the researchers that the brain may not shrink much among healthy, older people who don’t suffer from cognitive decline.

Scientists in the past had failed to screen out people whose brains had shrunk because of brain disease, they said.

In other words, simply growing older may not make the brain become smaller.

“If future longitudinal studies find similar results, our conception of ‘normal’ brain aging may become more optimistic,” the study’s lead author, Saartje Burgmans, a graduate student at Maastricht University in Holland, said in a news release from the American Psychological Association.