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October 06, 2015

In Research

Patients prefer relief from lower back pain over improved mobility

man gripping aching lower backA new study in the journal Neurology examines the question of quality of life for individuals with a common form of lower back pain called lumbar spinal stenosis. The findings show that, when asked to choose between treatments that reduced pain or would help them stand or walk, patients overwhelmingly chose pain relief.

“There has long been a debate in the medical community over striking the right balance between pain relief and physical function,” says lead author John Markman, director of the Translational Pain Research Program in the Department of Neurosurgery. “While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief.”

There is compelling evidence that surgery provides relief and improves mobility for patients with lumbar spinal stenosis, however, many patients outlive the benefit or are not candidates for surgical treatment. Epidural steroid injections also may provide short-term relief of pain.

Researchers surveyed 269 patients with chronic back pain and difficulty standing and walking. The researchers asked patients about their priorities, specifically, whether they prefer a treatment that reduced their pain or one that would allow them to walk further. Study participants overwhelmingly (79 percent) chose reduced pain over improved mobility—no matter how much the condition impaired their ability to stand and walk.

“Even the patients who could not stand long enough to pick up a letter from their mail box or wash the dishes after dinner chose pain relief,” Markman says.
The research is an example of the new standards for pain relief that are being created based on input from patients. 


Research on women’s cancers lacking in poor countries

Low- and middle-income countries see millions of cases of breast and cervical cancer each year, but much of the research on the diseases is based in wealthier countries that have far greater resources and treatment options available, according to a review of existing research published by the CDC’s Global and Territorial Health Research Network. The network’s coordinating center is based at the University.

The research disparity translates into gaps in understanding the cancers, since they may behave differently based on patients’ geography, culture, and local medical practices. Recommendations and protocols based on research conducted outside of low- and middle-income countries may or may not be practical or even possible.

“We’re talking about many countries in sub-Saharan Africa, Latin America, Asia, Southeast Asia—in other words, most of the world,” says Timothy Dye, professor and associate chair of obstetrics and gynecology and principal investigator of the CDC’s Global and Territorial Health Research Network Coordinating Center. Dye is corresponding author of the review, published in PLoSOne.

“We’re arguing for more research to be done in low- and middle-income countries so prevention and treatment strategies there can be more evidence-based,” Dye says. “Better research on breast and cervical cancer in low- and middle-income countries would help develop more effective prevention programs as well.”

The authors also stress the importance of evaluating implementation of breast and cervical cancer interventions on the ground.

“The best hope for improving cancer control in low- and middle–income countries is to make sure that what we think works toward prevention and control, actually works in the settings and circumstances faced around the world,” Dye says.


Immune cells take cue from animal kingdom

Much like birds fly in flocks to conserve energy, dolphins swim in pods to mate and find food, and colonies of ants create complex nests to protect their queens, immune cells engage in coordinated behavior to wipe out viruses like the flu. That’s according to a new study published in the journal
Science by researchers at the School of Medicine and Dentistry.

The findings indicate, for the first time, how immune cells work together to get to their final destination—the site of an injury or infection. The body is expansive, and viruses or bacteria can take hold in any number of locations. How do immune cells, specifically the ones that are responsible for killing foreign invaders, know where to go?

Scientists discovered that cells called neutrophils—the “first responders” of the immune system–are the key. They arrive at the site of injury within an hour of infection and leave a chemical “trail” of sorts behind them. Killer immune cells called T-cells use the trail to find the site of injury and subsequently destroy invaders.

In fact, when scientists removed neutrophils (or their trails) from the equation, T-cells didn’t find the site of injury as quickly or easily; they were more dispersed, fewer made it to the site of injury, and the ones that did were less effective at fighting the infection. 

“Immune cells team up and share information to get their job done, much like many types of animals take part in collective behaviors to benefit the group as a whole,” says Minsoo Kim, the study’s lead author and associate professor of microbiology and immunology at the school’s David H. Smith Center for Vaccine Biology and Immu­nology.

“Understanding how immune cells collaborate to arrive at the site of an infection will lead to new ways to control and improve the body’s response to all types of illnesses,” says David Topham, coauthor and the Marie Curran Wilson and Joseph Chamberlain Wilson
Professor of Microbiology and Immunology.


Brain damage during stroke may point to source of addiction

of the brain called the insular cortex may hold the key to treating addiction. Scientists came to the conclusion after finding that smokers who suffered a stroke in the insular cortex were far more likely to quit smoking and experience fewer and less severe withdrawal symptoms than those with strokes in other parts of the brain.

“These findings indicate that the insular cortex may play a central role in addiction,” says Amir Abdolahi, lead author of the studies. “When this part of the brain is damaged during stroke, smokers are about twice as likely to stop smoking, and their craving and withdrawal symptoms are far less severe.”

Abdolahi is a clinical research scientist at Philips Research North America and conducted the research while an epidemiology doctoral student in the Department of Public Health Sciences at the School of Medicine and Dentistry.

Recent studies have hinted that the insular cortex may also play an important role in the cognitive and emotional processes that facilitate drug and tobacco use.

The authors of the current set of studies—which appear in the journals Addiction and Addictive Behaviors—tested the theory in a somewhat unique fashion: by determining whether smokers whose insular cortex had been damaged during a stroke are more likely to quit smoking.

The findings open the door for researchers to explore therapies that could target the area of the brain and disrupt its role in addiction, potentially with new drugs or other techniques such as deep brain stimulation or transcranial magnetic stimulation. Researchers also speculate that, in addition to smoking, the role of the insular cortex could apply to other forms of addiction.  


Researchers use laser to levitate nanodiamonds in a vacuum

green glowing speck between lensesResearchers have, for the first time, levitated individual nanodiamonds in vacuum. The research team is led by Nick Vamivakas, assistant professor of optics and of physics and astronomy, who thinks the work will make extremely sensitive instruments for sensing tiny forces and torques possible, as well as a way to physically create larger-scale quantum systems known as macroscopic Schrödinger Cat states.

In the paper, published in Nature Photonics, the researchers from the Institute of Optics say it is the first step toward creating a “hybrid quantum system.”

In a previous paper, the researchers had shown that nanodiamonds could be levitated in air using a trapping laser. The new paper shows that it can be done in vacuum, which the researchers say is “a critical advance over previous nanodiamond optical tweezer experiments performed in liquids or at atmospheric pressure.”

Nanodiamonds trapped at atmospheric pressure are continuously agitated by collisions with the air molecules around them. Trapping the diamonds in vacuum removes the effect of all these air molecules. “This allows us to exert mechanical control over them,” says Levi Neukirch, lead author of the paper and a PhD student in Vamivakas’s group. “They turn into little harmonic oscillators.”


Extreme preemies have better chance of survival

Extremely premature babies considered to be on the cusp of viability are much more likely to survive and evade illness today than they were 20 years ago, according to a study published in the Journal of the American Medical Association. The increase in positive outcomes is likely due to improvements in medical treatments for the babies and their mothers over the past two decades, researchers say.

The study was conducted between 1993 and 2012 and included nearly 1,100 infants from Rochester, Buffalo and surrounding areas. It found increases in survival rates of infants born 23 or 24 weeks into a pregnancy. While babies born at that early stage of pregnancy still have many health problems after birth, babies born as little as a one week later (between 25 and 28 weeks) experienced a decrease in several illnesses that typically occur in extremely premature infants.

“Survival, particularly among the smallest and least mature infants, continues to improve,” says Carl D’Angio, a study author and professor of pediatrics and of medical humanities and bioethics at the School of Medicine and Dentistry. D’Angio, who treats premature infants at Golisano Children’s Hospital, is the principal investigator of a combined University of Rochester–University at Buffalo research site that enrolled patients in the study.

The continuing improvement in survival among the least mature infants may be due, in part, to the significant increase in the use of corticosteroids to speed up lung development in the fetuses of mothers at risk of delivering early. In 1993, less than a quarter of mothers who delivered extremely premature infants received the steroids; the number jumped to 87 percent in 2012.

Mothers at risk of delivering at 22 to 24 weeks of pregnancy were also much more likely to have a cesarean delivery and to be treated with antibiotics during pregnancy in recent years than they were at the beginning of the study. Cesarean deliveries may minimize the trauma of birth, which may boost a baby’s chance of survival. Prenatal antibiotics are meant to prevent transmission of infections between mom and baby; however, there were no changes in rates of infection over the course of the study. The findings suggest a progressive increase in physicians’ ability to treat extremely premature infants who are near “the limit of viability,” researchers say.


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