eskdaill medical

T:01536 522633   121 Lower Street, Kettering, Northants, NN16 8DN.

NHS Direct Health News

NHS Choices: Behind the headlines   + / -  
last updated: Tue, 21 Oct 2014 21:29:14 GMT

 Tue, 21 Oct 2014 11:30:00 GMT Paralysed man walks again after pioneering surgery

"World first as man whose spinal cord was severed WALKS," the Mail Online reports. In pioneering research, transplanted cells have been used to stimulate the repair of a man's spinal cord.

The headlines are based on a scientific report describing a 38-year-old man whose spinal cord was almost completely severed in a knife attack. The man had completely lost feeling and movement below the injury and was paralysed from the chest down.

Researchers injected the man's damaged spinal cord with cells taken from parts of the brain involved in interpreting smell signals from the nose to the brain. This treatment was combined with a graft from one of the nerves in his lower leg to reconnect the stumps of spinal cord severed by the injury. 

After surgery, the man had improved trunk stability, partial recovery of the voluntary movements of the lower extremities, and an increase of muscle in one thigh, as well as improvements in sensation. According to an accompanying press release, the man is now able to walk using a frame.

While previous techniques have managed to "re-route" nerve signals around a damaged section of the spinal cord, this is the first time that damage to the cord has been directly repaired.

These results are very encouraging, but, as the researchers note, the findings will need to be confirmed in other patients with similar types of spinal cord injury.

 

Where did the story come from?

The study was carried out by researchers from Wroclaw Medical University, the Polish Academy of Sciences, Karol Marcinkowski Medical University, the Neurorehabilitation Center for Treatment of Spinal Cord Injuries AKSON in Poland, the Medical University of Warsaw, the University Clinical Hospital and the UCL Institute of Neurology in the UK.

It was funded by the Wroclaw Medical University, the Nicholls Spinal Injury Foundation and the UK Stem Cell Foundation.

The study was published in the peer-reviewed journal Cell Transplantation and has been made available on an open access basis, so it is free to read online.

The news was widely reported by both the UK and international media. Coverage was accurate, if uncritical. The lead author's claim that this research was "more impressive than man walking on the moon" seems to have been accepted without question by the media.

However, other experts are less impressed. For example, Dr Simone Di Giovanni, Chair in Restorative Neuroscience at Imperial College London, is reported by the Science Media Centre as saying, "One case of a patient improving neurological impairment after spinal cord knife injury following nerve and olfactory cell transplantation is simply anecdotal.

"Extreme caution should be used when communicating these findings to the public, in order not to elicit false expectations on people who already suffer because of their highly invalidating medical condition."

 

What kind of research was this?

This was a case report, which often report unusual medical findings in a single person. They often describe rare diseases, strange symptoms or untypical responses to treatment.

The results of this case report will need to be confirmed in a larger group of patients with similar types of spinal cord injury before such stem cell transplants can be said to be an effective treatment for spinal cord injuries.

Even if the treatment proves effective, it may not be safe in all cases. Because of its complexity, neurological surgery has a higher rate of complications than most other types of surgery.

 

What did the research involve?

The case report describes a 38-year-old man whose spinal cord was damaged in a knife attack, leading to his spinal cord being almost completely severed. The man had completely lost sensory (feeling) and motor (movement) function below the injury, resulting in paraplegic paralysis (where both legs and the lower body are paralysed).

The researchers removed one of his olfactory bulbs, the parts of the nervous system that normally transmit information on smell from the nose to the brain.

They then grew cells from the man's olfactory bulbs in the laboratory. They were interested in two cell types: olfactory ensheathing cells and olfactory nerve fibroblasts. Both of these cell types have been shown to mediate regeneration and the reconnection of severed axons (nerve cells).

The researchers transplanted the cultured cells by injection into the man's spine above and below the injury. 

To fully bridge the gap and reconnect the stumps of spinal cord severed by the injury, they also combined this treatment with a graft of small strips of nerve taken from one of the nerves in the man's lower leg (the sural nerve).

The man received intense neurorehabilitation through exercises and other interventions designed to help recovery from a nervous system injury or compensate for its effects.

 

What were the basic results?

The man seemed to have no adverse effects in the 19 months following the operation.

From five months after the operation, the man had improved neurological function. By 19 months after surgery, he had improved trunk stability (sometimes known as core stability), partial recovery of the voluntary movements of the lower extremities, and an increase in the muscle of one thigh, as well as improvements in sensation (feeling).

According to accompanying media reports, the man is now able to walk using a walking frame.

Interestingly, removal of one of the olfactory bulbs did not cause the man to permanently lose his sense of smell on one side, as might have been expected.

 

How did the researchers interpret the results?

The researchers conclude that to their knowledge, "This is the first clinical indication of beneficial effects of transplanted autologous bulbar cells."

 

Conclusion

Overall, these results demonstrate the first person with a severed spinal cord to have regained movement and sensation in his lower limbs following a cell transplant. Specifically, this involved a combination of cells taken from the olfactory bulb and a graft from nerve cells in the leg, which were used to reconnect the severed sections of spinal cord.

These results are very encouraging, but, as the researchers note, these will need to be confirmed in a larger group of patients with similar types of spinal cord injury.

Further research is also required into how best to access the olfactory bulb. In this study, it was accessed by craniotomy – a surgical operation where a bone flap is temporarily removed from the skull to access the brain. As the researchers also state, there remains a possibility that sources of other, more readily obtainable reparative cells may be discovered.

Though this treatment has given good recovery of movement and sensation, there has not yet been a full recovery in terms of bowel, bladder and sexual function. These functional effects of spinal cord injury can of course have an equally devastating effect on a person as loss of movement or sensation.

The results will undoubtedly give hope to many people affected by paralysis as a result of spinal cord injury. However, while very promising, there are still many steps to go until a new treatment is found that gives complete functional recovery from severe spinal cord injury.

Analysis by Bazian. Edited by NHS Choices
Follow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

World first as man whose spinal cord was severed WALKS: Fireman paralysed by knife attack recovers after UK scientists use nose cells to re-grow nerve cells in his spine. Mail Online, October 21 2014

Paralysed man walks again after cell transplant. BBC News, October 21 2014

Paralysed man Darek Fidyka walks again after treatment by British doctors on brink of 'cure'. The Independent, October 21 2014

Paralysed man Darek Fidyka walks again after pioneering surgery. The Guardian, October 21 2014

Paralysed man helped to walk again. The Daily Telegraph, October 21 2014

Paralysed man walks again: ‘It’s incredible — like being reborn’. The Times, October 21 2014

Links To Science

Tabakow P, Raisman G, Fortuna W, et al. Functional regeneration of supraspinal connections in a patient with transected spinal cord following transplantation of bulbar olfactory ensheathing cells with peripheral nerve bridging. Cell Transplantation. Published online October 21 2014

 Tue, 21 Oct 2014 10:29:00 GMT Smokers' homes 'as polluted as Beijing'

"Living with smoker 'as bad as living in polluted city'," BBC News reports. Scottish researchers have estimated that the level of fine particulate matter (PM2.5) in smokers' households is similar to those found in a heavily polluted city such as Beijing.

PM2.5 are tiny particles less than two and a half microns wide that are components of air pollution. Because of their size, they are able to penetrate the lungs' defences against external foreign bodies, potentially causing damage. They have been linked to chronic respiratory conditions such as asthma and even lung cancer.

Researchers found, on average, PM2.5 concentrations from smokers' homes were about 10 times higher than those found in non-smoking homes. If smoking households became non-smoking, most non-smokers would have their PM2.5 intake cut by more than 70%.

Over a lifetime, the researchers calculated that PM2.5 intake from living with a smoker could be equivalent to living in a heavily polluted city, and could have the health problems associated with such an environment. For example, there has been a dramatic rise in reported asthma cases in urban areas of China.

Ideally, if you smoke, you should quit now for the benefit of your health and the health of others. If you are unable or unwilling to do so, smoke outdoors, especially if you are sharing the house with children. Simply blowing the smoke out of a window will still lead to an increase in PM2.5. 

 

Where did the story come from?

The study was carried out by researchers from the University of Aberdeen and the Institute of Occupational Medicine in Edinburgh.

No funding was reported, but the study used data from other studies that had been funded by the Big Lottery Fund, the Irish Environmental Protection Agency and the Scottish School of Public Health Research.

It was published in the peer-reviewed public health journal Tobacco Control. This article was open-access, meaning it can be accessed and read for free.

The research was well reported by BBC News.

 

What kind of research was this?

This study brought together data from four previous cross-sectional studies that had measured PM2.5 concentrations in smoking and non-smoking households in Scotland. These concentrations were then used to model daily and lifetime PM2.5 intake.

Cross-sectional studies take data at one point in time, so they cannot prove cause and effect.

However, homes where there was likely to be a significant additional source of PM2.5 (for example, a coal or solid-fuel fire) were excluded from the analysis.

It is therefore probable that the tenfold difference seen between PM2.5 concentrations in smokers' and non-smokers' houses was a result of smoking.

 

What did the research involve?

The researchers used data from four studies conducted between 2009 and 2013, which had measured PM2.5 concentrations in a total of 93 smoking and 17 non-smoking households in Scotland. They combined this information with data on typical breathing rates and activity patterns.

Using this information, the researchers estimated:

  • daily PM2.5 intake
  • the percentage of total PM2.5 inhaled within the home environment
  • the percentage reduction in daily intake that could be achieved by switching to a smoke-free home

 

What were the basic results?

The researchers found:

  • the average PM2.5 concentration was 31 micrograms per cubic metre (µg/m3) in smoking homes
  • the average PM2.5 concentration was 3µg/m3 in non-smoking homes

From the modelling study, they estimated:

  • PM2.5 intake for a two-year-old child would be 34µg/day in a non-smoking home and 298µg/day in a smoking home. If a smoking home became a non-smoking home, PM2.5 intake would reduce by 79%.
  • PM2.5 intake for an 11-year-old child would be 45µg/day in a non-smoking home and 291µg/day in a smoking home. If a smoking home became a non-smoking home, PM2.5 intake would reduce by 76%.
  • PM2.5 intake for a 40-year-old would be 59µg/day in a non-smoking home and 334µg/day in a smoking home. If a smoking home became a non-smoking home, PM2.5 intake would reduce by 74%.
  • PM2.5 intake for a 70-year-old housebound adult would be 27µg/day in a non-smoking home and 479µg/day in a smoking home. If a smoking home became a non-smoking home, PM2.5 intake would reduce by 86%.

The researchers then estimated lifetime intake. They calculated the average lifetime intake of PM2.5 for people living in non-smoking households in Scotland is 0.76g, while the average lifetime intake for those living in a smoking household (but not smoking themselves) is more than seven times that amount, at 5.82g.

They calculated that some non-smokers living with a smoker will actually inhale more PM2.5 than non-smokers living in heavily polluted urban settings.

 

How did the researchers interpret the results?

The researchers concluded that, "Fine particulate pollution in Scottish homes where smoking is permitted is approximately 10 times higher than in non-smoking homes. Taken over a lifetime, many non-smokers living with a smoker inhale a similar mass of PM2.5 as a non-smoker living in a heavily polluted city such as Beijing.

"Most non-smokers living in smoking households would experience reductions of over 70% in their daily inhaled PM2.5 intake if their home became smoke-free. The reduction is likely to be greatest for the very young and for older members of the population because they typically spend more time at home."

 

Conclusion

This study has found that, on average, fine particulate pollution (PM2.5) concentrations from smoking households were about 10 times those found in non-smoking homes.

The combined results of the modelling studies suggested most non-smokers would have their PM2.5 intake cut by more than 70% if smoking households quit the habit.

Over a lifetime, the researchers calculated PM2.5 intake from living with a smoker could be the equivalent of living in a heavily polluted city.

The generalisability of these results depends on how representative the smoking and non-smoking homes were of the general population.

The researchers note there were wide differences in the PM2.5 concentrations measured in different studies, which they state is probably a result of differences in the populations the samples were drawn from.

They say it is possible smokers living with children restrict their children's exposure to secondhand smoke, so these results may not be generalisable.

In any case, there are many benefits to stopping smoking and there is no justification to subjecting children to the risks of smoke exposure, even if steps are taken to mitigate this.

Read more about how Cecelia Elliott, a young mother, managed to successfully quit smoking for the sake of her son.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Living with smoker 'as bad as living in polluted city'. BBC News, October 21 2014

Links To Science

Semple S, Apsley A, Ibrahim TA, et al. Fine particulate matter concentrations in smoking households: just how much secondhand smoke do you breathe in if you live with a smoker who smokes indoors? Tobacco Control. Published online October 20 2014

 Mon, 20 Oct 2014 12:00:00 GMT BMI tests 'miss' over a quarter of obese children

"Quarter of obese children missed by BMI tests," the Mail Online reports.

The headline was prompted by a review that combined the results of 37 studies in more than 50,000 children and found body mass index (BMI) is an imperfect way of detecting excess body fat.

The study estimated more than a quarter of children (27%) with excess body fat might not be classified as obese when using BMI measurements alone.

This may mean the missed children don't get the same support to achieve a healthy weight as those correctly identified as obese, and so remain at a higher risk of developing a range of weight-related diseases, such as type 2 diabetes.

BMI has long been known to be a relatively blunt tool in terms of accurately assessing body fat, as demonstrated in a similar study in 2012. However, this latest study puts a specific figure on the imperfection.

That said, BMI remains a very useful tool. It provides a reasonably accurate method to estimate obesity rates at a population level, taking just minutes to complete.

Other methods can be more resource and time consuming (hydrostatic weighing), or can have large margins of error if not done correctly (skin callipers).

Overall, this study adds to the evidence of BMI's "bluntness" by quantifying the possible impact of the inaccuracy.

If you are worried about your child's weight, contact your GP. They should be able to make a more detailed assessment.

 

Where did the story come from?

The study was carried out by researchers from the US and Czech Republic. No funding source was reported.

It was published in the peer-reviewed medical journal, Pediatric Obesity.

The Mail Online's coverage was broadly accurate, though if we were being really pedantic we would point out to the headline writers that 27% is not the same as 25%.

 

What kind of research was this?

This was a systematic review and meta-analysis of studies assessing the diagnostic performance of BMI to detect excess fat in children up to the age of 18.

systematic review seeks to identify and pool the results of all published material on a specific topic, and is an effective way of summarising lots of research evidence. A meta-analysis is a related statistical exercise, where the results of studies are pooled. 

Excess fat in people raises the risk of many weight-related diseases, such as diabetes and heart disease. Detecting excess fat in children helps identify those most at risk of damaging their health.

The researchers point out the ideal way of identifying obesity in children and adolescents has not been determined, although BMI is the most widely used screening tool.

This involves weighing and measuring the height of a young person to estimate their BMI. The BMI is then compared against standard cut-offs, which categorises the person as either underweight, a healthy weight, overweight or obese.

In England, this is the approach adopted by the NHS National Child Measurement Programme.

 

What did the research involve?

The researchers searched electronic medical databases for studies assessing the performance of BMI measurement compared with other measures of body fat in people less than 18 years of age.

They then pooled the individual study findings using a meta-analysis to give an overall estimate of how well BMI identified people with excess body fat.

All of the studies included had to compare measuring body fat using BMI with a different reference method, such as DEXA.

Study authors of relevant articles published on the topic were contacted to source additional relevant literature and supplement the electronic database searches.

The main analysis reported the sensitivity and specificity of using BMI to detect excess fat in males and females.

The analysis explored variation between the studies with regard to differences as a result of race, BMI cut-off, BMI reference criteria, and the reference standard for assessing fatness.

 

What were the basic results?

The analysis included 37 studies involving 53,521 patients. The average age in the studies ranged from 4 to 18 years.

The main finding was that commonly used BMI cut-offs showed a pooled sensitivity to detect high fatness of 0.73 (95% confidence interval [CI] 0.67 to 0.79) and a specificity of 0.93 (95% CI 0.88 to 0.96).

This means that BMI correctly identified children with high fat levels 73% of the time, and correctly identified children without high fat levels 93% of the time.

On the flip side, this means up to 27% (100% minus 73%) of children with high fat levels were not correctly identified using BMI, so 27% was the false positive rate.

There was moderate variation in the pooled results as a result of the confounders mentioned above.

 

How did the researchers interpret the results?

These results led the researchers to conclude that, "BMI has high specificity but low sensitivity to detect excess adiposity [body fatness] and fails to identify over a quarter of children with excess body fat percentage."

 

Conclusion

This systematic review and meta-analysis showed using BMI to detect excess body fat in children up to the age of 18 was not perfect. It estimated more than a quarter of children with excess body fat might not be classed as obese using BMI measurements alone.

This may mean they don't get the same help and support to achieve a healthy weight as those correctly identified, and so remain at a higher risk of developing a range of weight-related diseases.

BMI is known to be a far from perfect measure of body fatness, but is often a useful start, so the main conclusion of the research will be nothing new to many health professionals.

However, this study has put a specific figure on the imperfection: more than 25% are incorrectly given the all-clear when their weight may be harming their health.

England's current screening of children for excess body fat, the National Child Measurement Programme, uses BMI as its main measure, so this is very relevant to England's youth.

The way excess body fatness is assessed in this programme is regularly assessed, and this study may contribute to the evidence base considered at the next review of the methodology.

Measuring body fat in children on a large scale is a challenge, and the best way to do this is likely to be balancing accuracy with pragmatism. Some measures of body fat are time consuming to perform and, in the context of a busy school environment, this may be influential.

Overall, this study raises a known issue with using BMI to assess body fat in children, but adds to the evidence by quantifying the possible impact of the inaccuracy.

If you have any concerns about your child's weight, your GP will be able to assess whether their weight may be affecting their health and can offer help and support.

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Links To The Headlines

Quarter of obese children missed by BMI tests could be at risk of diabetes and heart disease, scientists warn. Mail Online, October 17 2014

Links To Science

Javed A, Jumean M, Murad MH, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis. Pediatric Obesity. Published online June 24 2014


 

 
A FedWeb Site