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Anchor lead: Cured meats may be linked to the mania phase of bipolar disorder, Elizabeth Tracey reports

 

People who are hospitalized for mania are more than three times as likely to have consumed cured meats, which are high in nitrates, than those without the psychiatric disorder, research by Robert Yolken, a professor of neurovirology at Johns Hopkins, and colleagues has shown. Yolken notes that a lot more research is needed to prove causation, but genes are likely involved.

Yolken: There’s probably a genetic predisposition or some other predisposition but it is just a predisposition. One can have one gene or a set of genes and go through life without any problems but if one throws an environmental factor on top of that then one might get the disease. We’re just starting to understand really how genes and environment interact in terms of some of these disorders. That probably explains why most people don’t really have to be worried about these types of exposures because if they don’t have the genes they’re not going to have the effect and of course many people eat these products without any problems. I think we have to identify the people at risk.   :29

Yolken says that some vegetables are also high in naturally occurring nitrates, and that some link with the gut microbiome also seems likely. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A protein known as YAP may be important in both cancer and autoimmune disease, Elizabeth Tracey reports

Can inhibiting a protein known by the shorthand YAP help improve the effectiveness of immunotherapies against cancer? Yes, if results in animal models hold up in the clinic, a study by Fan Tan, a cancer immunology expert at Johns Hopkins, and colleagues has shown.

Tan: The role of the YAP in the immune system is relatively new.  :05

Turns out YAP is found in some regulatory immune cells in the body, already known to damp down the body’s immune response to tumors. When YAP is inhibited, and when immunotherapies are also used, enhanced tumor cell killing is possible.

Tan: So that’s why we think YAP is one of the potential target for the immunotherapy. :05

Tan notes that enhancing YAP may prove to be a promising target in managing autoimmune disease, where too much of an immune response is seen. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Blood transfusions increase someone’s risk for blood clots, but there are strategies in place to minimize risk, Elizabeth Tracey reports

Blood transfusions around the time of surgery increase someone’s risk of aberrant blood clots twofold, a study by Aaron Tobian and colleagues at Johns Hopkins has shown. Tobian’s previous study showed that a number of strategies are already in place to reduce transfusions and lower risk.

Tobian: We showed that red cell transfusions are down by about 15% over the last few years. There’s increased adherence to restrictive blood transfusion strategies, there’s increased conservation of blood during surgery, such as improved surgical techniques, improved pharmacotherapy, and there’s also been substantial advocacy among medical organizations to only transfuse blood when medically necessary.   :27

Tobian says the current study shows that the more transfusions someone gets the greater the risk, so if you are scheduled for elective surgery addressing this issue with your surgeon is a good idea. Some things can be done before your procedure that may reduce the need for transfusion. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Having a blood transfusion around the time of surgery may lead to blood clots, Elizabeth Tracey reports

Abnormal blood clotting known as venous thromboembolism can be a killer, if the clot travels to the brain, heart or lungs. Now a study by Aaron Tobian, a transfusion expert at Johns Hopkins, pinpoints just how risky blood transfusions used around the time of surgery can be with regard to blood clot formation.

Tobian: There’s an increasing number of studies that actually suggested red blood cell transfusions may have a role in the development of blood clots. In this study we aimed to assess whether red blood cell transfusion given before, during or after surgery was associated with increased blood clots within thirty days of the surgical procedure. In our study of more than ¾ of a million surgical patients, we actually found that red blood cell transfusion were associated with a twofold increased risk of a thrombotic event  :34

Tobian notes that  conservative strategies are already employed relative to transfusions, and that transfusions are generally safe. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When someone gets peer support, avoiding rehospitalization is more likely, Elizabeth Tracey reports

People who have been hospitalized for mental illness and had the support of someone in the community who had already had such an experience were more likely to remain out of the hospital, a recent study in the Lancet showed. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says she’s not surprised.

Davidson: Having that insight of that shared experience, that recognition particularly in addiction, where there’s so many physiological as well as psychological factors mitigating against recovery. So getting that commonality I think is really important. And it’s much the same as diversity. People want to see people like themselves, so it’s that ability to relate, and empathize, and to recognize that this, there’s someone here that’s providing a guidepost for you.   :30

Davidson says acting as a peer supporter is also beneficial for the person doing the supporting, so it’s a win-win. At Johns Hopkins, I’m Elizabeth Tracey.

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Program notes:

0:35 Jeremy Greene and state and federal advocacy

1:35 Focus on the patient in front of me

2:32 Became brand name only

3:22 Sherita Golden

4:22 Didn't real know how to treat

5:22 As front line clinicians we can share challenges

5:56 Lee Biddison

6:50 Feels unjust

7:50 Industrialized medicine

8:50 Start to move the needle on drug prices

9:50 Continue to speak about things that are problematic

11:08 End

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Anchor lead: If you don’t drink alcohol and you’re worried about Alzheimer’s disease, what should you do? Elizabeth Tracey reports

People who drink alcohol moderately in middle age seem to develop Alzheimer’s disease less often than those who don’t drink at all or who drink heavily. If you’re a teetotaler, does this mean you should start quaffing alcohol? Sevil Yasar, a neurologist at Johns Hopkins who wrote the editorial accompanying the study in the British Medical Journal says, not so fast.

Yasar: Definitely if you drink a lot, cut down. If you are an abstainer I would not recommend to my patients that you should start now to drink you know one glass of wine. I need more answers before I can do that. This is a population, they were in London, they were government employees so I’m sure they were better socioeconomics, maybe better social habits. How can I generalize it to everyone? The one and the best answer is doing a clinical trial.  :26

Yasar points out that such a trial should be free of any bias as a result of funding by the alcoholic beverage industry, and would need to follow a large number of participants over a long period of time. At Johns Hopkins, I’m Elizabeth Tracey.

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