Dr. Michael Schlitt, Neurosurgery

Ebola Hits the US

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Dr. Michael Schlitt ebola

A group of workers in West Africa dealing with an Ebola victim.

There has been a lot of talk about the spread of Ebola in West Africa, but most of this seems to have been restricted to Africa.  That is, until now.  The first case of Ebola has just been diagnosed by a person in the US, who had traveled between Liberia and Dallas, TX.  Although this patient didn’t display any symptoms upon leaving West Africa, symptoms revealed themselves 4 days after landing in Texas.  On September 26, two days after falling ill, the patient visited Texas Health Presbyterian Hospital.  Because of the patient’s recent trip to Liberia and symptoms, the Center for Disease Control and Prevention (CDC) recommended that they be isolated and tested for Ebola.

Thankfully, the CDC does know how to stop the further spread of Ebola, so there shouldn’t be too much to worry about.  Close contacts of the patients are currently under daily monitoring for 21 days following exposure.  Yesterday, Congressman Dr. Michael C Burgess of the North Texas Congressional district issued a statement that “the inevitable” had occurred.  While Ebola is pretty scary to think about, the US is significantly better equipped for disease control than West Africa, and therefore experts don’t believe that Ebola in the US won’t be on nearly the same scale that it was across the ocean.  Of course, it’s not impossible that there could be additional cases associated with the Texan patient, but the CDC is confident that they can contain this infection.

The Ebola virus is spread through direct contact with the bodily fluids of an infected person, and can’t be spread through casual contact or through the air.  Therefore, the CDC recommends that exposed people should be monitored for symptoms for 3 weeks.  Experts had previously concluded that Ebola would eventually make its way to the US, but experts insist that the US’ capacity to test and treat Ebola patients is excellent, and they don’t expect any “real transmission” in the US.  According to the CDC, the American public health and medical systems had previously been successful at containing similar outbreaks, pointing to five imported cases of viral hemorrhagic fever diseases similar to Ebola over the past 10 years that the US had contained without any transmission.

 

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Dr. Michael Schlitt, Neurosurgery

Brains Respond to Ads

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For quite some time now, media and marketing experts have long sought a reliable method of getting responses from the general population to future products and messages.  According to a recent study done by the City College of New York, (CCNY) in partnership with Georgia Tech, it looks like the brain responses of just a few individuals are a remarkably strong predictor.  By analyzing the brainwaves of 16 individuals as they watched mainstream TV content, researchers were able to accurately guess the preferences of large TV audiences, up to 90 percent in the case of Super Bowl commercials.  These findings appear in a paper entitled “Audience Preferences Are Predicted by Temporal Reliability of Neural Processing”, which was recently published in the latest edition of Nature Communications.

Mean Joe Coke

Now, measuring brainwaves allows people to determine how good commercials are.

Alternative methods such as self-reports are characterized by problems such as people conforming their responses to their own values and expectations.  However, brain signals measured through electroencephalography (EEG) can, in principle, alleviate this shortcoming by providing immediate physiological responses immune to such self-biasing.  According to Lucas Parra, the senior author of the report, explained that when two people watch a video, their brains respond similarly, but only if the video is engaging.  Popular shows and commercials draw our attention and make our brainwaves very reliable.

In the study, participants watched scenes from the TV show The Walking Dead, and then several commercials from the 2012 and 2013 Super Bowls.  EEG electrodes were then placed on their heads to capture brain activity.  The reliability of the recorded neural activity was then compared to audience reactions in the general population using publicly available social media data provided by the Harmony Institute and ratings from USA Today’s Super Bowl Ad Meter.  Brain activity among participants watching The Walking Dead predicted 40 percent of the associated Twitter traffic.  When brainwaves were in agreement, the number of tweets went up as well.  Brainwaves were also able to predict 60 percent of the Nielsen ratings that measure the size of a TV audience.

The study was even more accurate when comparing preferences for Super Bowl ads.  For instance, researchers saw very similar brainwaves from their participants as they watched a 2012 Budweiser commercial that featured a beer-fetching dog.  The general public voted the ad as their second favorite that year.  The study then found little agreement in the brain activity among participants when watching a GoDaddy commercial with a kissing couple, which was among the worst-rated Super Bowl ads in 2012.  The CCNY researchers collaborated with Matthew Bezdek and Eric Schumacher from Georgia Tech to identify which brain regions are involved and explain the mechanisms.  With functional magnetic resonance imaging (fMRI), they found evidence that brainwaves for engaging ads could be driven by activity in visual, auditory and attention brain areas.

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Dr. Michael Schlitt, Neurosurgery

The Dangers of Junk Food

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People have been talking about the dangers of smoking for a long time.  However, according to a recent article, unhealthy diets actually pose an even greater risk to global health, and governments should move to tax harmful food products.  In a statement issued on the opening of the annual summit of the World Health Organization (WHO), Belgian professor Olivier de Schutter called for efforts to launch negotiations on a global pact to tackle the obesity epidemic.  Just as the world worked together to tackle the spread of tobacco, he has called for a need to come together to regulate the wide sale of unhealthy foods.

Junk Food

While tasty, junk food like this is extremely harmful to health.

Back in 2005, a UN convention on tobacco control aimed at reducing deaths and health problems caused by the product went into force after a long series of negotiations under the umbrella of the WHO.  In a report to the rights council in 2012, de Schutter claimed that a similar accord on food should include taxing unhealthy products, regulating food high in saturated fats, salt and sugar while cracking down on the advertising of junk food.  It also called for an overhaul on the system of farm subsidies that make certain ingredients cheaper than others, and for support for local production so that consumers will have access to healthy, fresh and nutritious foods.

In a statement made yesterday, de Schutter said that any attempts to promote better diets and fight obesity will only work if the food systems underpinning them are put right.  While governments are focusing on increasing calories availability, they have often been indifferent on what kind of calories are being offered, at what price they’re being offered, to whom they’re made available and how they’re marketed.  Such measures are necessary, in the words of de Schutter, to make sure that people are protected from aggressive misinformation campaigns.

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Dr. Michael Schlitt, Neurosurgery

Cancer-Sniffing Dogs?

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Dogs have long been hailed for their noses, being used to sniff out bombs, drugs and everything in-between.  While humans have about 5 million different olfactory cells in our noses that detect different odors, dogs have approximately 200 million.  However, is it possible that dogs can sniff out prostate cancer as well?  According to a recent study published by Italian researchers, presented at the 109th Annual Scientific Meeting of the American Urological Association in Orlando, specially trained dogs were able to detect prostate cancer from urine samples with an astounding 98% accuracy.

Cancer Dog

A trained cancer-sniffing dog hard at work.

Last November, a spotlight feature from Medical News Today spoke about medical detection dogs, and how they can help alert a diabetic owner to high or low blood sugar levels through being trained to detect a specific scent in their breath or sweat, as well as how dogs are currently being used for detecting various different cancers.  According to one study, trained detection dogs were able to detect ovarian cancer in tissue and blood samples by sniffing out volatile organic compounds (VOCs).  Back in 2011, a study conducted by researchers at UK charity Medical Detection Dogs, such compounds could also be biomarkers of bladder cancer.  The authors of this study on prostate cancer note that back in 2010, a study revealed that specially trained dogs were able to smell VOCs released into urine from prostate cancer tumors.  However, this study only involved 33 patients.  Therefore, the Italian research team did a much larger version of this earlier study.

For this study, the team took two highly-trained dogs to see if they could detect prostate cancer-specific VOCs in the urine samples of 677 different participants.  Out of these, 320 of them had prostate cancer ranging from low-risk to metastatic, while 357 were healthy controls.  They discovered that the dogs could detect prostate cancer-specific VOCs in the urine samples with a combined accuracy of 98%.  Sensitivity to the compounds was an astounding 99% accurate, while specificity was 97% accurate.

According to Dr. Brian Stork, a urologist at West Shore Urology in Michigan, dogs are shaping up to be a promising approach to cancer detection.  While using dogs to identify cancer seems unorthodox, and so recently as ten years ago would have sounded ludicrous, “man’s best friend” very well could help save man’s life.  Earlier this year, Medical News Today reported on a study revealing that dogs could also provide new insight into Chiari malformation in humans, while other research published in Genome Biology showed that dogs could serve as a model for OCD in humans.

 

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Dr. Michael Schlitt, Neurosurgery

Henicraniectomy

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According to researchers, amongst stroke patients older than 60 with life-threatening brain edema, henicraniectomy cut the mortality rate by more than half compared with conservative treatment.  The 6-month survival rate without severe disability was 38% in the surgery group, compared to 18% among controls in a 112-patient randomized trial called DESTINY II, according to Werner Hacke, of the University of Heidelberg in Germany.  Overall 6-month survival was 70% with hemicreniectomy patients, as opposed to 33% of those treated conservatively, according to research in the March 20 issue of the New England Journal of Medicine.  Enrollment stopped early after interim analysis showed that the surgery significantly improved survival.

henicraniectomy

A henicraniectomy in progress.

The trial is the first to focus on older recipient of the procedure, in which about one-quarter of the skull is removed to relieve pressure on the brain following a stroke.  Earlier research found that it improved outcomes in younger patients, although its efficacy and safety in the main age group subject to strokes remained unclear.  In an accompanying editorial, Allan Ropper of Brigham and Women’s Hospital in Boston pointed out that survival was still not guaranteed after the procedure, and most patients receiving it still had significant disability.  He pointed out that half of the survivors in both treatment groups ended up with modified Rankin scores of 4, while about one-third of them had scores of 5.

According to Ropper, while these outcomes are bracing, they’re about the same with or without the operation, and it can be said that hemicraniectomy doesn’t increase the number of disabled patients.  The study also doesn’t provide support for previous claims that surgery improves functional outcome.  The investigators acknowledged that the improve surgical outcomes were driven almost exclusively by the reduction in mortality, although they also pointed out that most survivors in both groups reported being satisfied with their outcomes.  This led to Ropper commenting that people seemed content to just come out of the surgery alive.

Inclusion criteria for the trial were a diagnosis of acute middle cerebral artery infarction with onset less than 48 hours before treatment, 61 years or older, NIH Stroke Scale scores at recruitment of more than 14 in those with infarction in the nondominant hemisphere or more than 19 when infarction was in the dominant hemisphere and brain imaging results indicating that ischemia had affected at least two-thirds of the brain served by the middle cerebral artery.  Patients with significant pre-existing disabilities, lacking pupillary reflexes, Glasgow Coma Scale scores less than 6, hemorrhages or an estimated life expectancy of less than 3 years were excluded.  The average age of enrolled patients was 70, ranging up to 82, and were equally split between men and women.  Median NIH Stroke Scale scores at enrollment were around 20, with a range of 15 to 40.

A total of 49 subjects were randomized to hemicraniectomy and 63 to conservative treatment.  The latter consisted of usual ICU support with osmotherapy, sedation and ventilation.  hemicraniectomy involved the removal of skull bone at least 12 cm in diameter.  The primary outcome was modified Rankin score at 6 months.  Secondary outcomes included survival, NIH Stroke Scale score, quality of life scores from two instruments, Hamilton Depression Rating Scale score and adverse events such as surgical complications.

After 6 months, amongst those who underwent a hemicraniectomy, there were 6 deaths, 33% who had a 5 Rankin score, 28% with a 4 and 32% with a 3.  In the control group, there were 6 deaths, 70% had a 5 Rankin score, 13% had a 4 and 15% had a 3.  After a full year, an additional 6% of the control patients and 10% of the surgery group were dead.  The proportions of those with Rankin scores of 3 or 4 were about the same as they had been six months earlier.  Secondary outcomes for 1-year survivors were about the same in both groups, with large impairments in quality of life and persistent symptoms.  However, overt depression was rare, with no hemicraniectomy survivors showing Hamilton scores of 20 or higher, and only 17% of controls had scores in that range.

Family members gave consent for participation in the trial.  After the 1-year follow-up, Hacke and his colleagues asked the surviving patients themselves if they would have agreed to participate in the study.  63% of the hemicraniectomy patients and 53% of the controls gave their “retroactive consent” to this.

 

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Dr. Michael Schlitt, Neurosurgery

The Benefits of Chocolate

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There are many people out there whose weakness is chocolate.  However, according to a recent study presented at an American Chemical Society meeting, it turns out that bacteria in the stomach eat chocolate, which CHOCOLATEproduces anti-inflammatory compounds that are beneficial to the heart.  The naturally occurring antioxidants flavanols are found in cocoa products, but until now, scientists didn’t really know what happens to them in the lower gastrointestinal tract.  There have been many different health benefits linked to chocolate, but the exact reason for this has been unclear for a while.

Researchers from Louisiana State University tested three cocoa powders with a series of modified test tubes, which modeled the human digestive tract and simulated normal digestion.  According to one of the researchers, there are both “good” and “bad” microbes.  Good microbes, for example Bifidobacterium and lactic acid bacteria, feast on chocolate.  When you eat dark chocolate, they grow and ferment it, which in turn produces anti-inflammatory compounds.

John Finley, who led the study, explains that cocoa powder contains flavanol compounds of catechin and epicatechin, as well as a small bit of dietary fiber.  Even though both of these are poorly digested and absorbed, good microbes begin to process them once they enter the colon.  After subjecting the non-digestible materials to anaerobic fermentation, Finley says that he observed certain changes.  The fiber is fermented, and the large polyphenolic polymers are metabolized to smaller molecules, which in turn are more easily absorbed.  Then, these smaller polymers exhibited anti-inflammatory activity.  When these compounds decrease inflammation of cardiovascular tissue, it actually reduces the risk of stroke.

In addition, eating prebiotics along with the fiber in cocoa could improve somebody’s overall health by converting polyphenolics in the stomach into compounds that serve as anti-inflammatories.  Prebiotics are naturally found in foods, but are also available as dietary supplements.

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Dr. Michael Schlitt, Neurosurgeon

Medical and Recreational Marijuana in Washington

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Medical Dispensary

A shelf in a Washington medical marijuana dispensary.

This Tuesday, a group of 10 lawmakers in Washington proposed two bills aimed at curbing local marijuana bans.  These bills were written because of concerns that marijuana moratoriums would severely limit access to cannabis for recreational use, allowing the illegal cannabis trade to thrive.

One bill, HB 2322, would penalize any municipality in Washington that imposes a ban by making it ineligible to receive a cut of the state’s liquor licensing fees, estimated at a total of $49.5 million.  The other bill, HB 2144, is slightly softer.  Under this bill, Washington would provide local municipalities 30% of the state’s excise tax revenues on recreational cannabis sales.  According to the Center for Marijuana Science and Social Policy, at least 1.5 million Washington residents could be impacted by access restrictions, especially in the southern part of the state.

Under the I-502 law, recreational marijuana was legalized and municipalities retain authority to pass zoning regulations, which would effectively ban the sale of cannabis.  Local officials have final authority to grant licenses for operation after the business passed through the state’s licensing process.

Medical marijuana has been legalized in Washington since 1998.  People with these following conditions are eligible to use medical marijuana in the State of Washington: cachexia, cancer, HIV or AIDS, epilepsy (or other seizure disorders), glaucoma, chronic pain, Crohn’s disease, Hepatitis C and multiple sclerosis.  At the moment, Washington is the only state (apart from Colorado) that has legalized recreational use of marijuana.

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