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Wednesday, March 13, 2013
US renews waivers in Iran oil sanction program
WASHINGTON (AP) ? The United States is renewing waivers for Japan and 10 European countries for their efforts in the Iran oil sanction program.
Secretary of State John Kerry announced the waivers Wednesday, saying the international community remains committed to maintaining pressure on the Iranian regime until it fully addresses concerns about its nuclear program.
Wednesday's action means the 11 countries have been given a reprieve from the part of the sanctions requirements that cuts off countries from the U.S. financial system.
Kerry noted in a statement that European Union countries have a full embargo on Iranian crude and said Japan has significantly reduced the volume of its purchases.
Kerry has to reconfirm compliance every six months.
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Fewer adverse events with 'double kissing' crush stent than culotte
Mar. 10, 2013 ? Patients with a type of coronary lesion linked with poor prognosis fared significantly better with the stent technique known as double kissing crush than with culotte stenting, according to data from the DKCRUSH-III trial presented today at the American College of Cardiology's 62nd Annual Scientific Session.
DKCRUSH-III is the first head-to-head comparison of double kissing (DK) crush and culotte stent techniques in coronary artery disease. The study focused on bifurcation lesions, which involve a main branch and a smaller side branch forking off a major artery.
DK crush and culotte are two-stent procedures named for their configurations. The culotte technique places stents in the main artery and the side branch, overlapping them in the main vessel before the branch forks, akin to pants legs that meet at the seat. The DK crush technique extends a small piece of the branch stent into the main artery, where it is squeezed against the main artery's wall. This approach introduces two points where the balloons used in stenting inflate in the artery and connect for a "double kiss."
Bifurcation lesions are Y-shaped trouble spots, which account for about 15 percent of lesions treated with coronary stents. Bifurcation lesions present technical problems associated with higher rates of recurrent blockage at the treated site known as restenosis and lower rates of long-term favorable outcome. High morbidity and mortality are connected with a subset called unprotected left main coronary artery (ULMCA) disease. Approximately two-thirds of significant ULMCA disease involves the distal bifurcations. Such lesions magnify the challenge for the interventional cardiologist, who threads balloon-tipped catheters and stents through major arterial pathways and then must veer off to reach these smaller side channels. The best treatment for this lesion type has been a matter of debate.
"Angiographic follow-up at eight months found 12 cases of in-stent restenosis in the side branch with DK crush and 22 with culotte [6.8 percent vs. 12.6 percent]," said Jun-Jie Zhang, MD, an interventional cardiologist in the cardiovascular department of Nanjing First Hospital, Nanjing Medical University, in Nanjing, China. "Thus, we have to say that DK crush is superior to culotte stenting."
The multicenter study randomly assigned patients with ULMCA distal bifurcation lesions to treatment with DK crush (210 patients) or culotte (209 patients) stenting. At one year, major adverse cardiac events occurred in 6.2 percent of the DK crush patients and 16.3 percent of the culotte patients. The culotte approach had markedly higher rates of repeat intervention at the target lesion and the target vessel: 6.7 percent target lesion vs. 2.4 percent, and 10.5 percent target vessel vs. 4.3 percent. Clotting at the stent site was low in both groups.
"Although this trial did not include a bypass surgery group to contrast with the stenting techniques, the promising results achieved by DK crush were comparable with those after coronary artery bypass," Dr. Zhang said.
The study will extend clinical follow-up for participating patients to five years, and further research through the DKCRUSH-V study is ongoing.
DKCRUSH-III was funded by the Jiangsu Provincial Outstanding Medical Program.
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Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/vi27VXIXtRQ/130311101800.htm
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Tuesday, March 12, 2013
Mummy CT scans show preindustrial hunter gatherers had clogged arteries
Monday, March 11, 2013
Like nearly 4.6 million Americans, ancient hunter-gatherers also suffered from clogged arteries, revealing that the plaque build-up causing blood clots, heart attacks and strokes is not just a result of fatty diets or couch potato habits, according to new research in the journal The Lancet.
The researchers performed CT scans of 137 mummies from across four continents and found artery plaque in every single population studied, from preagricultual hunter-gatherers in the Aleutian Islands to the ancient Puebloans of southwestern United States.
Their findings provide an important twist to our understanding of atherosclerotic vascular disease, which is the leading cause of death in the developed world: while modern lifestyles can accelerate the development of plaque on our arteries, the prevalence of the disease across human history shows it may have a more basic connection to inflammation and aging.
"This is not a disease only of modern circumstance but a basic feature of human aging in all populations," said Caleb Finch, USC University Professor, ARCO/ Kieschnick Professor of Gerontology at the USC Davis School of Gerontology, and a senior author of the study. "Turns out even a Bronze Age guy from 5,000 years ago had calcified, carotid arteries," Finch said, referring to Otzi the Iceman, a natural mummy who lived around 3200 BCE and was discovered frozen in a glacier in the Italian Alps in 1991.
With Gregory Thomas of Long Beach Memorial, Finch was part of a team that previously showed Egyptian mummies had calcified patches on their arteries indicative of advanced atherosclerosis (from the Greek arthero, meaning "gruel" and scler, meaning "hard").
But ancient Egyptians tended to mummify only royalty or those who had privileged lives. The new study led by Thomas and Randall Thompson of Saint Luke's Mid America Heart Institute examined mummies from four drastically different climates and diets ? and from cultures that mummified regular people, including ancient Peruvians, Ancestral Puebloans, the Unangans of the Aleutian Islands and ancient Egyptians.
"Our research shows that we are all at risk for atherosclerosis, the disease that causes heart attacks and strokes ? all races, diets and lifestyles," said Thomas, medical director of the MemorialCare Heart & Vascular Institute, Long Beach Memorial. "Because of this we all need to be cautious of our diet, weight and exercise to minimize its impact. The data gathered about individuals from the pre-historic cultures of ancient Peru and the Native Americans living along the Colorado River and the Unangan of the Aleutian Islands is forcing us to think outside the box and look for other factors that may cause heart disease."
Overall, the researchers found probable or definite atherosclerosis in 34 percent of the mummies studied, with calcification of arteries more pronounced in the mummies that were older at time of death. Artherosclerosis was equally common in mummies identified as male or female.
"We found that heart disease is a serial killer that has been stalking mankind for thousands of years," Thompson said. "In the last century, atherosclerotic vascular disease has replaced infectious disease as the leading cause of death across the developed world. A common assumption is that the rise in levels of atherosclerosis is predominantly lifestyle-related, and that if modern humans could emulate pre-industrial or even pre-agricultural lifestyles, that atherosclerosis, or at least its clinical manifestations, would be avoided. Our findings seem to cast doubt on that assumption, and at the very least, we think they suggest that our understanding of the causes of atherosclerosis is incomplete, and that it might be somehow inherent to the process of human aging."
The international team of researchers will next seek to biopsy ancient mummies to get a better understanding of the role chronic infection, inflammation and genetics in promoting the prevalence of atherosclerosis.
"Atherosclerosis starts very early in life. In the United States, most kids have little bumps on their arteries. Even stillbirths have little tiny nests of inflammatory cells. But environmental factors can accelerate this process," Finch said, pointing to studies that show larger plaques in children exposed to household tobacco smoking or who are obese.
###
University of Southern California: http://www.usc.edu
Thanks to University of Southern California for this article.
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Political strife undermines HIV treatment
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Public release date: 12-Mar-2013[ | E-mail |
Share ] Contact: David Orenstein
david_orenstein@brown.edu
401-863-1862
Brown University
Recent history in Kenya informs research
PROVIDENCE, R.I. [Brown University] As Kenyan citizens negotiated the tensions following the March 4 nationwide elections, memories of the violence that followed the December 2007 vote weighed heavily for many reasons. Among those in any nation with an HIV epidemic, argue authors of a new paper in AIDS Reviews, should be the long-term damage that political conflict can do to public health by disrupting treatment and thereby promoting resistance to antiretroviral drugs and treatment failure.
"It's the long-term consequences that make this a bigger issue," said lead author Marita Mann, who began studying the rise of drug resistant HIV in the wake of Kenya's 2007 strife when she was a Brown University Master of Public Health student. She is now a doctoral student at the University of Washington. "First there are the patients who are affected themselves during the conflict and may be resistant to treatment later on, but this also may lead to transmitted resistance that will be a bigger problem in the epidemic."
This time around in advance of the elections, Mann said, some Kenya health workers gave their patients extra supplies of medicine and papers that would help them transfer to another clinic in case they were displaced by new violence. In 2007, more than 1,000 Kenyans died and about 300,000 were displaced.
But many policymakers and health officials in HIV- and strife-ridden nations have not recognized the link between disrupted treatment and the potential for increased treatment failure and viral resistance, said senior author Dr. Rami Kantor, associate professor of medicine at Brown University and an infectious diseases physician at The Miriam Hospital in Providence.
The paper seeks to make that link clear by explaining how an unplanned treatment interruption can lead to increased viral drug resistance and treatment failure and by describing the research needed to mitigate the effects of treatment interruption in future conflicts.
The paper provides an overview, but the underlying concern is neither prospective nor hypothetical. In data they have presented at an international HIV conference but not yet published, Mann, Kantor, and colleagues from the AMPATH academic medical collaboration in Kenya found that after the 2007 violence, treatment in subjects whose drug regimens were interrupted by the conflict failed significantly more often than treatment in subjects who did not suffer a conflict-related disruption.
How conflict breeds resistance
HIV mutates often and research shows that as little as a single amino acid change can lead to drug resistance, the authors write. Modern "highly active" antiretroviral therapy (HAART) fights HIV with a potent mix of several drugs that attack the virus in multiple ways, successfully suppressing its replication in most patients.
When violence erupts, staying on those delicately balanced medications can become impossible. Drugs may no longer get to the clinic, patients and health care workers can become displaced, travel to the clinic can become unsafe, and patients can become profoundly depressed by the horror and tragedy around them.
After an unplanned treatment interruption takes place, the multipronged attack of HAART falls apart in an insidious fashion. Some drugs stay in the patient's system longer than others, leaving only a partial therapy in place. That partial therapy fails to stop the virus, instead encouraging the evolution of resistant strains. When full HAART resumes, the virus is better prepared to resist it.
Different variants of the virus will show differences in their likelihood of evolving resistance after an unplanned treatment interruption, the researchers predict.
What can be done
Mann said the steps her colleagues in Kenya took in advance of this year's elections providing extra medicine and clinic transfer papers were good ones to take at the level of an individual clinic, assuming they have extra doses of medicine on hand.
Similarly, Kantor said, "In the 2007 conflict AMPATH did a great job to do as much as possible to address the potential issues that we're raising and made great efforts to reach patients to resume care as soon they could, despite the post-conflict displacement and chaos. AMPATH has undertaken similar efforts and preparations for this month's Kenyan elections, including managing treatment stocks, on-call staff, logistical support, and participating in regional and national coordination."
But in the paper, the authors point out that neither health care providers nor officials have much of a rigorous knowledge base to refer to in managing unplanned treatment interruptions. And many officials do not consider or plan for the problem at all.
To better inform and prepare providers and officials, not only in Kenya but in other strife-prone nations with high rates of HIV infection, authors call for further research and attention to planning.
"Research is therefore needed to determine optimal ART stopping and restarting strategies for patients who find themselves in situations of unplanned interruptions," the authors write. "An additional strategy should encompass implementation of contingency treatment plans in developing countries addressing factors like consistent drug supplies, improved patient follow-up, education for healthcare providers, implementation of viral load monitoring and resistance testing and availability of multiple treatment regimens."
And if political leaders and their opponents happen to need one more reason to forgo violence, they can consider how it appears to worsen the HIV pandemic among their constituents.
###
In addition to Mann and Kantor, the paper's other authors are Mark Lurie, assistant professor of epidemiology at Brown, and Dr. Sylvester Kimaiyo at Moi University School of Medicine in Eldoret, Kenya, and program manager of AMPATH.
Kantor, who is research director of the Brown-Kenya program led by Dr. Jane Carter, was supported for this research by a grant from the National Institutes of Health International Epidemiological Databases to Evaluate AIDS program (U01-AI069911); grant R01-AI66922; and the Brown/Lifespan/Tufts Center for AIDS Research (P30-AI042853).
Mann was also supported by the Brown University Framework in Global Health Program. Additional collaborators on this research include Dr. Lameck Diero, Dr. Nathan Buziba, Dr. Wilfred Emonyi, Emmanuel Kemboi, Fidelis Mambo, and Mary Rono from Eldoret, Kenya; Dr. Kara Wools Kaloustian and Dr. John Sidle from Indiana University; Allison DeLong from Brown; and Leeann Schreier, in Kantor's lab.
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Public release date: 12-Mar-2013[ | E-mail |
Share ] Contact: David Orenstein
david_orenstein@brown.edu
401-863-1862
Brown University
Recent history in Kenya informs research
PROVIDENCE, R.I. [Brown University] As Kenyan citizens negotiated the tensions following the March 4 nationwide elections, memories of the violence that followed the December 2007 vote weighed heavily for many reasons. Among those in any nation with an HIV epidemic, argue authors of a new paper in AIDS Reviews, should be the long-term damage that political conflict can do to public health by disrupting treatment and thereby promoting resistance to antiretroviral drugs and treatment failure.
"It's the long-term consequences that make this a bigger issue," said lead author Marita Mann, who began studying the rise of drug resistant HIV in the wake of Kenya's 2007 strife when she was a Brown University Master of Public Health student. She is now a doctoral student at the University of Washington. "First there are the patients who are affected themselves during the conflict and may be resistant to treatment later on, but this also may lead to transmitted resistance that will be a bigger problem in the epidemic."
This time around in advance of the elections, Mann said, some Kenya health workers gave their patients extra supplies of medicine and papers that would help them transfer to another clinic in case they were displaced by new violence. In 2007, more than 1,000 Kenyans died and about 300,000 were displaced.
But many policymakers and health officials in HIV- and strife-ridden nations have not recognized the link between disrupted treatment and the potential for increased treatment failure and viral resistance, said senior author Dr. Rami Kantor, associate professor of medicine at Brown University and an infectious diseases physician at The Miriam Hospital in Providence.
The paper seeks to make that link clear by explaining how an unplanned treatment interruption can lead to increased viral drug resistance and treatment failure and by describing the research needed to mitigate the effects of treatment interruption in future conflicts.
The paper provides an overview, but the underlying concern is neither prospective nor hypothetical. In data they have presented at an international HIV conference but not yet published, Mann, Kantor, and colleagues from the AMPATH academic medical collaboration in Kenya found that after the 2007 violence, treatment in subjects whose drug regimens were interrupted by the conflict failed significantly more often than treatment in subjects who did not suffer a conflict-related disruption.
How conflict breeds resistance
HIV mutates often and research shows that as little as a single amino acid change can lead to drug resistance, the authors write. Modern "highly active" antiretroviral therapy (HAART) fights HIV with a potent mix of several drugs that attack the virus in multiple ways, successfully suppressing its replication in most patients.
When violence erupts, staying on those delicately balanced medications can become impossible. Drugs may no longer get to the clinic, patients and health care workers can become displaced, travel to the clinic can become unsafe, and patients can become profoundly depressed by the horror and tragedy around them.
After an unplanned treatment interruption takes place, the multipronged attack of HAART falls apart in an insidious fashion. Some drugs stay in the patient's system longer than others, leaving only a partial therapy in place. That partial therapy fails to stop the virus, instead encouraging the evolution of resistant strains. When full HAART resumes, the virus is better prepared to resist it.
Different variants of the virus will show differences in their likelihood of evolving resistance after an unplanned treatment interruption, the researchers predict.
What can be done
Mann said the steps her colleagues in Kenya took in advance of this year's elections providing extra medicine and clinic transfer papers were good ones to take at the level of an individual clinic, assuming they have extra doses of medicine on hand.
Similarly, Kantor said, "In the 2007 conflict AMPATH did a great job to do as much as possible to address the potential issues that we're raising and made great efforts to reach patients to resume care as soon they could, despite the post-conflict displacement and chaos. AMPATH has undertaken similar efforts and preparations for this month's Kenyan elections, including managing treatment stocks, on-call staff, logistical support, and participating in regional and national coordination."
But in the paper, the authors point out that neither health care providers nor officials have much of a rigorous knowledge base to refer to in managing unplanned treatment interruptions. And many officials do not consider or plan for the problem at all.
To better inform and prepare providers and officials, not only in Kenya but in other strife-prone nations with high rates of HIV infection, authors call for further research and attention to planning.
"Research is therefore needed to determine optimal ART stopping and restarting strategies for patients who find themselves in situations of unplanned interruptions," the authors write. "An additional strategy should encompass implementation of contingency treatment plans in developing countries addressing factors like consistent drug supplies, improved patient follow-up, education for healthcare providers, implementation of viral load monitoring and resistance testing and availability of multiple treatment regimens."
And if political leaders and their opponents happen to need one more reason to forgo violence, they can consider how it appears to worsen the HIV pandemic among their constituents.
###
In addition to Mann and Kantor, the paper's other authors are Mark Lurie, assistant professor of epidemiology at Brown, and Dr. Sylvester Kimaiyo at Moi University School of Medicine in Eldoret, Kenya, and program manager of AMPATH.
Kantor, who is research director of the Brown-Kenya program led by Dr. Jane Carter, was supported for this research by a grant from the National Institutes of Health International Epidemiological Databases to Evaluate AIDS program (U01-AI069911); grant R01-AI66922; and the Brown/Lifespan/Tufts Center for AIDS Research (P30-AI042853).
Mann was also supported by the Brown University Framework in Global Health Program. Additional collaborators on this research include Dr. Lameck Diero, Dr. Nathan Buziba, Dr. Wilfred Emonyi, Emmanuel Kemboi, Fidelis Mambo, and Mary Rono from Eldoret, Kenya; Dr. Kara Wools Kaloustian and Dr. John Sidle from Indiana University; Allison DeLong from Brown; and Leeann Schreier, in Kantor's lab.
[ | E-mail | Share ] ?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Source: http://www.eurekalert.org/pub_releases/2013-03/bu-psu031213.php
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Cybersecurity threatens US-China relations: WH official
Carolyn Kaster / AP file
National security adviser Tom Donilon speaks during the daily news briefing at the White House in Washington on Thursday, May 17, 2012.
By Andrew Rafferty, Staff Writer, NBC News
?
Chinese leaders must address cybersecurity threats emanating from their country on ?an unprecedented scale? or risk weakening the economic relationship between Beijing and the United States, White House national security adviser Tom Donilon said Monday.
?U.S. businesses are speaking out about their serious concerns about sophisticated, targeted theft of confidential business information and proprietary technologies through cyberintrusions emanating from China on an unprecedented scale,? said Donilon.? ?The international community cannot afford to tolerate such activity from any country.?
The remarks, delivered to The Asia Society in New York, are the first by a White House official to specifically name China as a threat to U.S. cybersecurity.
Though Donilon focused mainly on the danger to U.S. businesses, he did acknowledge the risk such an attack could pose to U.S. national security.? He said that the issue has become ?a key point of concern and discussion with China at all levels of our governments? and that President Barack Obama has vowed to do what is necessary to protect America?s interests against cyberattacks. ?
During last month?s State of the Union address, Obama highlighted how vulnerable America?s financial institutions, power grid and air traffic control systems could be to an attack.? The president, who has signed an executive order to help address those concerns, called on Congress to pass comprehensive legislation that would better secure online networks to help protect against attacks.
The president never mentioned China during his high-profile address.
But on Monday, Donilon was much more direct, detailing three requests for Beijing, including recognition of the severity of the problem, ?serious steps? to address it and establishing guidelines of acceptable norms in the digital realm. ??
?Both countries face risks when it comes to protecting personal data and communications, financial transactions, critical infrastructure, or the intellectual property and trade secrets that are so vital to innovation and economic growth,? said Donilon.
James Lewis, a cybersecurity expert at the Center for Strategic and International Studies, said Donilon?s remarks indicate an aggressive shift in how the administration deals with China. It is a pivot, Lewis said, that comes as more and more data pours in pointing to China as the biggest culprit behind cyberattacks.
?The atmosphere has just changed; the data is overwhelming,? he said.
Lewis said protecting digital institutions is more diplomatically framed as an economic issue instead of a security one to avoid stirring threats of military action. Still it is significant the debut of the administration?s sterner policy came from the president?s top security adviser, he said. ??
A report released in February by a private security firm found a Chinese military unit hacked more than 140 businesses, mostly inside the United States.? It?s a claim the Chinese government denies.
Media giants The New York Times and Wall Street Journal say they had been hacked for months and through an investigation with the FBI, traced the intrusions back to China.? The Wall Street Journal said the hacking was aimed at monitoring the newspaper?s China reporting, a claim that the spokesman for the Chinese foreign ministry called ?irresponsible.?
White House spokesman Jay Carney said cybersecurity will be one of the priorities the president addresses with congressional leaders when he visits Capitol Hill this week.
And the United States is not alone. European countries have suspected China has infiltrated their computer systems as well.? Nations could retaliate with sanctions against Beijing.
?It?s become a problem that China can?t ignore without harming their economy,? said Lewis.
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Monday, March 11, 2013
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