Saturday, May 9, 2015

The Muscle That Allowed Us to Evolve

The muscles connected to the ears of a human d...
The muscles connected to the ears of a human do not develop enough to have the same mobility allowed to many animals. (Photo credit: Wikipedia)


Some muscles get all the glory. But deep inside of us, a sheet of muscle does heroic work in obscurity. The diaphragm delivers oxygen to us a dozen times or more each minute, a half-billion times during an 80-year life.

“We are completely dependent on the diaphragm,” said Gabrielle Kardon of the University of Utah.

All mammals have a diaphragm. But no other animal has one. Before the evolution of a diaphragm, our reptile-like ancestors probably breathed the way many reptiles do today. They used a jacket of muscles to squeeze the rib cage.

Once the diaphragm evolved, breathing changed drastically. Mammals gained a more efficient means to draw in a steady supply of oxygen. The evolution of a diaphragm may have made it possible for mammals to then evolve a warm-blooded metabolism. Without a diaphragm, humans might not have been able to evolve giant – but oxygen-hungry – brains.  

Scientist suspect that the diaphragm evolved through a change in the way mammal embryos develop: Mutations caused certain embryonic cells to grow into a new muscle. Dr. Kardon and other researchers are trying to understand that shift and why the muscle sometimes fails to develop, with catastrophic consequences.

One in every 2,500 babies is born with a hole in its diaphragm. The baby’s liver, intestines and other abdominal organs can push up through this opening against the lungs, stunting their growth and restricting breathing. About a third of babies born with congenital diaphragmatic hernias die.

Scientists have found that mutations in certain genes can increase the risk of developing hernias. But they have struggled to figure out exactly how these genes build the diaphragm. Dr. Kardon and her colleagues developed new tools to get a closer look. They published the research in Nature Genetics.

The scientists engineered mice so that certain types of cells would glow inside mouse embryos. Then they tracked the cells as they multiplied and migrated.

The diaphragm begins as a pair of folds flanking the esophagus, they found. These folds then expand in two waves. “It’s beautiful, aesthetically,” said Dr. Kardon. In the first, the cells become connective tissue across the top of the liver.

In the second wave, cells form a second sheet sandwiched inside the membrane. “The muscle cells are kind of dumb, and they’re just following the connective tissue,” said Dr. Kardon.

The researchers then examined GATA4, a gene linked to diaphragmatic hernias. They engineered mouse embryos so they could shut down GATA4 in certain types of cells at certain points in development. In one trial, the scientists turned off GATA4 in the muscle cells in the diaphragm. In these cases, the mice formed diaphragms. When they shut down GATA4 in the connective tissue, the mice developed hernias. Connective tissue cells must be using GATA4 to lay down a chemical trail for muscle cells, Dr. Kardon concluded. They can still lay down the trail if they have one defective copy of the GATA4 gene.

Each time the connective tissue cells divide, there is a chance that a working copy of GATA4 may mutate, too. If that happens, the mutant cell and its descendants can’t lay down a trail, resulting in a gap in the sheet of muscle. As the liver pushes against the diaphragm, the pressure creates intense stress in the gap, causing the diaphragm to rupture.

John J. Greer, a biologist at the University of Alberta, said he was skeptical that this scenario could account for most hernias.

He noted that most medical cases of congenital diaphragmatic hernias occurred in the back left or right corners of the diaphragm. Dr.Kardon and her colleagues produced many hernias in the middle or front of the diaphragm of their mouse subjects.

Dr. Kardon countered that a lot of hernias occur in other parts of the diaphragm, but doctors fail to notice many of them, because the lungs sit at the back of the diaphragm, hernias there can be dangerous. Hernias elsewhere can be harmless.

“Because they don’t have serious medical consequences, they go un-noticed,” she said.

Clifford J. Tabin, a geneticist at Harvard Medical School, said that the new study offers a molecular explanation for how congenital diaphragmatic hernias occur. “I think it is a beautiful study and terribly important,” he said.

Taken from TODAY Saturday Edition, The New York Times International Weekly, 25 April 2015

Tuesday, May 5, 2015

Data With the Power To Help Heal Patients

A patient having his blood pressure taken by a...
A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

Steven Keating’s doctors view him as a citizen of the future.

A scan of his brain eight years ago revealed a slight abnormality – nothing to worry about, he was told, but worth monitoring. And monitor he did, reading and studying about brain structure, function and wayward cells, and obtaining a follow-up scan in 2010, which showed no trouble.

But he knew from his research that his abnormality was near the brain’s olfactory center. So when he started smelling whiffs of vinegar last summer, he suspected they might be “smell seizures.”

He pushed doctors to conduct an M.R.I., and three weeks later, surgeons in Boston removed a cancerous tumor the size of a tennis ball.

Mr. Keating, a 26-year-old doctoral student at the Massachusetts Institute of Technology’s Media Lab, has pushed and prodded to get his medical information, collecting about 70 gigabytes of his own patient data. His case points to what medical experts say could be gained if patients had full access to their medical information. Better-informed patients, they say, are more likely to take better care of themselves, comply with prescription drug regimens and even detect early-warning signals of illness, as Mr. Keating did.

“Today he is a big exception, but he is also a glimpse of what people will want: more and more information,” said Dr. David W. Bates, chief innovation officer at Brigham and Women’s Hospital.

 Some of the most advanced medical centers are starting to make medical data more available. Brigham and Women’s, where Mr. Keating had his surgery, is part of the Partners Healthcare Group, which has 500,000 patients with web access to some of the data in their health records including conditions and test results.

Other medical groups are beginning to allow patients online access to the notes taken by physicians, in an initiative called Open Notes. More than two-thirds of the patients reported having a better understanding of their health and medical conditions, adopting healthier habits and taking their medications as prescribed more regularly.

Nearly five million patients in America have been given online access to their notes.

As an articulate young scientist, Mr. Keating had a big advantage over most patients in obtaining his data. He knew what information to request, spoke the language of medicine and did not need help. The information he collected includes the video of his 10-hour surgery, dozens of medical images, genetic sequencing data and 300 pages of clinical documents. Much of it is on his website, and he has made his medical data available for research.

Still, he said he encountered a medical culture resistant to sharing data.

“The person with the least access to data in the system is the patient,” he said. “You can get it, but the burden is always on the patient. And it is scattered across many different silos of patient data.”

Since his diagnosis last summer, Mr. Keating has become an advocate for giving patients all the medical data they ask for.

An effort to accelerate the adoption of open technology standards in health care, the Argonaut Project, began in December.

One detail in a yearlong study of Open Notes underlines doctors’ concerns; 105 primary physicians completed the study, but 143 declined to participate.

Still, the experience of the doctors in the evaluation seemed reassuring. Only 3 percent said they spent more time answering patient questions outside of visits. Yet knowing that patients could read the notes, one-fifth of the physicians said they changed the way they wrote about certain conditions, like substance abuse and obesity.

Evidence of the benefit to individuals from sharing information rests mainly on a few studies so far. For example, 55 percent of the members of the epilepsy community on Patients Like Me, a patient network, reported that sharing information and experiences with others helped them learn about seizures, and 27 percent said it helped adhere to their medications.

Mr. Keating has no doubts. “Data can heal,” he said. “There is a huge healing power to patients understanding and seeing the effects of treatments and medications.”

Mr. Keating says he believes that people will increasingly want access to their medical data, especially younger people reared on social networks.

“This is what the next generation, which lives on data, is going to want,” Mr. Keating said.

Taken from TODAY Saturday Edition, The New York Times International Weekly, 02-May-2015

Saturday, May 2, 2015

Clean-up of 2010 Articles - Done!

English: Blogs on JoopeA
English: Blogs on JoopeA (Photo credit: Wikipedia)

Finally, I can say that the long process of cleaning up the articles up until 2010 is done. I guess in the process, there may have been slip ups of 2 or 3, but I suppose it is not more that 10, so I will still go through a 2nd or 3rd sweep, just to make sure everything is up to date, especially on the related articles.

And with the mobile-friendliness update that Google recently implemented, and required of blogs and websites, I was just glad that mine all passed without having to do any major change.

And as a user myself, I look at the blogs, and I see that some things can still be done to reduce data usage, like the categories or labels. Well, they seem to be extra baggage to me. I just might drop on a few other things, so the pages will also load faster. So much so for the AdSense and affiliate ads.

Let the money come when it comes.

Till then!

Friday, May 1, 2015

Mayweather-Pacquiao Match - The Fight of the Century


A day before the fight of the century, Pacquiao-Mayweather boxing match, the world is apprehensive of the much-awaited event.

Saturday night in Las Vegas, and that would be morning over at the Asian countries.

Who would win?

Facebook shows a blue-against-red mapping, and blue for Mayweather topics were concentrated in the US, while red for Pacquiao shows everywhere else - of course, except in countries where Facebook isn't a commodity.

Anyway, the question remains. Who will win?

That's a day away to find out.


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