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Tips to Put a Stop to Early Aging

Dermatologists can’t stress it enough: How you treat your skin now will affect its future appearance. While it may seem silly to worry about wrinkles long before you have any, it’s true that preparation pays off.

According to dermatologists, more women in their twenties are asking for anti-aging tips. So, what can you do keep your skin looking young and healthy? Kiehl’s Since 1851, a company that specializes in skin and hair care formulas derived from natural ingredients, offers the following tips:

  • Rest up. There’s a reason “you look tired” and “you look great” aren’t synonymous. But did you know that the position in which you sleep can also affect your looks? If you sleep face-down, fluid can collect beneath your eyes. Try sleeping face-up with your head slightly elevated with pillows. If you do wake up with facial swelling, try tapping the skin beneath your eyes or applying a cold compress.
  • Apply vitamin C. Your skin contains more vitamin C than any other antioxidant, including the much-touted vitamin E. To keep vitamin C at an optimal level, make sure you are applying a skincare formula that contains plenty of vitamin C.
  • Reduce your sodium intake. You can make your doctor and your skin happy at the same time! When you eat too much sodium, you can cause your body to shift fluid into extracellular spaces, especially beneath your eyes. Avoid excess sodium intake to benefit both your health and your skin.

“Vitamin C helps keep skin even and bright, and it offers potent antioxidant protection from environmental stressors, such as pollution and sunlight,” said Dr. Adam Geyer, fellow of the American Academy of Dermatology, Instructor in Clinical Dermatology at Columbia University and Kiehl’s Brand Ambassador.

Two of Kiehl’s products, “Powerful-Strength Line-Reducing Concentrate” to improve tone and texture all over the face and “Line-Reducing Eye-Brightening Concentrate” formulated specifically for the eye area to boost radiance and minimize wrinkles, contain 10.5 percent vitamin C.

Unlike many retinol products, they won’t cause photosensitivity and irritation and are gentle enough for twice-daily use. Apply them after cleansing, both day and night to obtain the greatest results.

SOURCE: Kiehl’s

Deactivating A Cell Protein May Halt Progress Of Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that leads to inflammation and bone erosion in the joints. One of the hallmarks is swelling and pain caused by white blood cells flooding into the fluid around the joints. Now researchers have shown for the first time that the activation of a single protein on the surface of these cells could be the trigger for the disease.

The cell protein they investigated is toll-like receptor 5 (TLR5) that is found on myeloid – or marrow-derived – cells that migrate from the blood into affected joints.

“TLR5 does it all,” says one of the researchers, Shiva Shahrara, associate professor of rheumatology at the University of Illinois at Chicago College of Medicine.

She and her colleagues write about the study in the Journal of Immunology. They suggest the findings may lead to new drugs that target the cell protein and break the vicious cycle of inflammation and bone degradation in rheumatoid arthritis. Myeloid cells of rheumatoid arthritis patients have far more TLR5 receptors.

When they compared the myeloid cells from the joints of healthy people with those of rheumatoid arthritis sufferers, they found the myeloid cells from the arthritis patients had far more TLR5 on their surfaces.

One of the hallmarks of rheumatoid arthritis is swelling and pain caused by white blood cells flooding into the fluid around the joints. From previous work, they had already established that activation of the receptor leads to abnormal development of blood vessels in the joints of patients with rheumatoid arthritis.

In this latest work, they discovered the receptor also boosts the activity of TNF-alpha, an inflammatory molecule that summons even more myeloid cells into the joints, whereupon they change into osteoclasts, cells that cause bone erosion.

The researchers also carried out a series of experiments to show activating TLR5 triggers several disease processes. For example, they showed if myeloid cells with active TLR5 are placed next to joint fluid taken from rheumatoid arthritis patients, they migrate into the fluid, but switching TLR5 off reduces migration significantly.

In other experiments, the researchers showed that when the joint fluid of patients with rheumatoid arthritis contained myeloid cells with activated TLR5, this increased levels of TNF-alpha, and the myeloid cells of patients taking anti-TNF-alpha drugs have fewer TLR5 receptors. This suggests there is a positive feedback loop between TLR5 and TNF-alpha: when one increases, so does the other, as Prof. Shahrara explains:

“Not only do TLR5 and TNF-alpha regulate each other, but they work synergistically to attract more myeloid cells into the joint, where they are transformed into bone-eroding cells.”

In a final set of experiments, the team showed giving mice with rheumatoid arthritis an antibody to block TLR5 significantly reduced joint swelling and bone erosion compared to mice that did not receive the drug. The team suggests that blocking TLR5 with the antibody reduced myeloid cells migrating into the joints and turning into bone-eroding osteoclasts. Prof. Shahrara believes this means a drug that stops TLR5 activation could slow or even prevent the joint inflammation and bone erosion that occurs in later-stage rheumatoid arthritis. She suggests when the receptor is switched on, it triggers a “vicious feedback loop” that worsens the inflammation and bone erosion of rheumatoid arthritis.

“The receptor is a major driver of inflammation and bone degradation,” she explains. “Blocking this receptor could have significant therapeutic value in interrupting joint swelling and bone loss in patients with rheumatoid arthritis.”

Funds from the National Institutes of Health, the Department of Defense, the American College of Rheumatology and the Arthritis Foundation helped finance the study.

In June 2014, Medical News Today learned how researchers identified the T cells that drive rheumatoid arthritis. Using cutting-edge tetramer technology, the scientists studied how the disease starts, how current therapies may affect the immune response directed to the joint, and how to target these specific cells with drugs.

SOURCE: Medical News Today

Prof. Shahrara says it is as though something in the joint fluid attracts the myeloid cells when their TLR5 receptors are switched on. She suggests perhaps a protein that binds to the receptor is present in the fluid of joints affected by rheumatoid arthritis. Switched on TLR5 may trigger ‘vicious feedback loop’ of inflammation and erosion.

Telemedicine to Ensure 24/7 Access in Rural Germany

Using telecommunications to connect stroke experts to stroke patients in rural areas continued to improve and sustain stroke care, according to new research in the American Heart Association’s journal Stroke.

This is the largest and longest evaluation of telemedicine for stroke and took place in rural Bavaria, Germany.

With the tele-medical linked Stroke Units, patients in regional hospitals had around-the-clock access to consultations with vascular neurologists at stroke centers, including evaluation of brain imaging and patient examination via videoconferencing when needed.

Researchers reviewed the use of telemedicine for 10 years and found:

  • The number of patients receiving the clot-busting drug tissue plasminogen activator  for ischemic (clot-caused) stroke rose from 2.6 percent to 15.5 percent.
  • The median time between a patient’s arrival at a regional hospital until tPA was administered fell from 80 minutes to 40 minutes; exceeding American Heart Association/American Stroke Association’s “Target: Stroke” goal of treating at least 50 percent of patients within 60 minutes.
  • The median time between onset of stroke symptoms and receiving tPA fell from 150 minutes to 120 minutes.

“Cooperation within medical networks can be a huge benefit for patients. Telemedicine is a wonderful option to support the close cooperation of physicians from regional hospitals and tertiary stroke centers,” said Peter Müller-Barna, M.D., lead author and consultant in the department of neurology at the Agatharied Hospital in Hausham, Germany.

In 2003, TeleStroke Units were introduced to 12 regional hospitals lacking neurology and neurosurgery departments in Bavaria, Germany. Telemedicine linked them with two neurological stroke centers with vascular neurologists and other neurological experts. By 2012, there were 15 TeleStroke Units that had provided 31,864 consultations.

Between the first year of implementation and the end of 2012, the percentage of patients with stroke or mini-stroke who were treated at hospitals with telemedicine units rose from 19 percent to 78 percent.

“This illustrates the growing acceptance of the TeleStroke Units by emergency services personnel and general physicians, and also by the population and their political representatives. Still, the goal should be closer to 100 percent and we are now setting up further units in administrative districts that lack one,” Müller-Barna said.

“In my opinion, the improving thrombolysis rate and door-to-needle times can mostly be attributed to growing experience, practice and continuous quality management. The extended time window for thrombolysis also had an influence,” Müller-Barna said.

The researchers also found from 2003 to 2012, the proportion of patients transferred to stroke centers from regional hospitals fell from 11.5 percent to 7 percent.

“Telemedicine can accelerate the emergency transfer of patients in need of neurosurgery. At the same time, it helps avoid unnecessary transfers because expert vascular neurologists are involved in remote patient assessment by video examination and the interpretation of CT scans,” Müller-Barna said.

The benefits of TeleStroke Units should also be applicable in the United States in any region without direct access to a stroke unit or local stroke expertise, researchers said.

The use of telemedicine to ensure 24/7 access to consultation and care in rural areas is one of the major recommendations of the AHA/ASA in the organization’s  2013 policy statement on systems of care.

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Surgeons Create ‘New’ Knee Cartilage From Stem Cells In Hip

New knee operation that could prevent the development of arthritis

Surgeons in Southampton have pioneered a new knee operation that could prevent the development of arthritis – and extend sporting careers.

The procedure, which is currently being trialed at Southampton General Hospital, involves coating damaged cartilage with stem cells, taken from a patient’s own hip, and surgical glue.

Known as ABICUS – Autologous Bone Marrow Implantation of Cells University Hospital Southampton – the technique, if successful, will regenerate the remaining tissue and create a permanent, “like-for-like” replacement for the first time.

Cartilage is a tough, flexible tissue that covers the surface of joints and enables bones to slide over one another while reducing friction and acting as a shock absorber.

Damage to the tissue in the knee is common and occurs mainly following sudden twists or direct blows, such as falls or heavy tackles playing sports such as football and rugby, but can also develop over time through gradual wear and tear.

Around 10,000 people a year in the UK suffer cartilage damage serious enough to require treatment due to pain, ‘locking’ and reduced flexibility. If left untreated, it can progress to arthritis and severely impair leg movement.

Currently, the most commonly used procedure to repair the injury – microfracture – involves trimming any remaining damaged tissue and drilling holes in the bone beneath the defect via keyhole surgery to promote bleeding and scar tissue to work as a substitute.

However, the technique has variable results, with studies in the US suggesting the procedure offers only a short term benefit (the first 24 months after surgery), and does not lead to the formation of new cartilage.

Sports Medicine Research

Patients who undergo the ABICUS operation have the cartilage cut and tidied and undergo microfracture, but their cartilage tissue is then coated with a substance made up of bone marrow cells, platelet gel and hyaluronic acid.

During the 30-minute procedure, the bone marrow sample is spun in a centrifuge in the operating theatre to give a concentrated amount of the patient’s own stem cells.

These cells are then mixed with the gel and acid to create a ‘glue’ substance which is placed over the cartilage defect and allowed to set.

Gorav Datta, a consultant orthopaedic surgeon at Southampton General Hospital and the study’s principal investigator, said: “The development of this technique and the study we are conducting could revolutionise the treatment of common cartilage injury by creating a like-for-like, identical cartilage replacement for the first time.

“So far, treatments developed to combat the long-term problems associated with cartilage damage have had varied outcomes, resulting in knee pain for many people in older age and shortened careers for many amateur and professional sports players.”

He added: “At present, although the removal of damaged cartilage and microfracture surgery can provide a short-term solution, the chances, particularly for sports players, of developing arthritis in later life or requiring ongoing treatment remain high.”

The study at University Hospital Southampton NHS Foundation Trust will compare the results of 40 patients aged between 18 and 65 years, half who will undergo ABICUS and half microfracture alone.

Life’s Imprint On DNA Now Mappable In Single Cell

New technique maps life’s effects on our DNA: Powerful single-cell technique to study environmental effects on DNA

Researchers in the UK have developed a powerful new technique that uses a single cell to map the epigenetic marks that life leaves on our DNA. The development is considered a breakthrough because it will allow scientists to better understand the effect of environment on DNA, such as during the early life of the embryo, and in the development of diseases like cancer.

‘Epigenetic marks’ are chemical tags or proteins that mark DNA and act as a kind of cellular memory. They do not change the DNA sequence but record a cell’s experiences onto the DNA, which allows cells to remember an experience long after it has faded. Placing these tags is part of normal development; they tell genes whether to be switched on or off and so can determine how the cell develops. Different sets of active genes make a skin cell different from a brain cell, for example. However, environmental cues such as diet can also alter where epigenetic tags are laid down on DNA and influence an organism’s long-term health.

Dr Gavin Kelsey, from the Babraham Institute, said: “The ability to capture the full map of these epigenetic marks from individual cells will be critical for a full understanding of early embryonic development, cancer progression and aid the development of stem cell therapies.

“Epigenetics research has mostly been reliant on using the mouse as a model organism to study early development. Our new single-cell method gives us an unprecedented ability to study epigenetic processes in human early embryonic development, which has been restricted by the very limited amount of tissue available for analysis.”

Effects on our DNA

The research, published in Nature Methods, offers a new single-cell technique capable of analysing DNA methylation — one of the key epigenetic marks — across the whole genome. The method treats the cellular DNA with a chemical called bisulphite. Treated DNA is then amplified and read on high-throughput sequencing machines to show up the location of methylation marks and the genes being affected.

These analyses will help to define how epigenetic changes in individual cells during early development drive cell fate. Current methods observe epigenetic marks in multiple, pooled cells. This can obscure modifications taking place in individual cells at a time in development when each cell has the potential to form in a unique way. The new method has already revealed that many of the methylation marks that differ between individual cells are precisely located in sites that control gene activity.

Dr Gavin Kelsey, said: “Our work provides a proof-of-principle that large-scale, single-cell epigenetic analysis is achievable to help us understand how epigenetic changes control embryonic development. The application of single-cell approaches to epigenetic understanding goes far beyond basic biological research. Future clinical applications could include the analysis of individual cancer cells to provide clinicians with the information to tailor treatments, and improvements in fertility treatment by understanding the potential for epigenetic errors in assisted reproduction technologies.”

Prof Wolf Reik, a founder of the Wellcome Trust Sanger Institute Single Cell Genomics Centre, added: “This exciting new method has already given some remarkable insights into how much variation there is in the epigenetic information in embryonic stem cells. This may underlie the enormous plasticity these cells have to develop into many different cell types in the body.”

Missouri Law Creates New ‘Assistant Physician’ Designation

Signed last week by Governor Jay Nixon, the law creates the new position of “assistant physician.”

A controversial new law in Missouri will allow medical school graduates who haven’t yet passed their final credentialing exam to treat patients in under-served primary care settings. The law has encountered strong opposition from organized medicine.

Signed last week by Governor Jay Nixon, the law creates the new position of “assistant physician.” These doctors would be supervised on site by a collaborative physician for 30 days. After that, they could treat patients without direct supervision in settings 50 miles away and will be able to prescribe Schedule III, IV, and V drugs.

The assistant physician can provide only primary care services and only in medically under-served rural or urban areas of the state or in any pilot project areas, the law states. An assistant physician is defined as any medical school graduate who has passed the prescribed medical examinations and who has not entered into postgraduate residency training prescribed by rule of the State Board of Registration for the Healing Arts.

The Missouri State Medical Association (MSMA) helped draft the legislation and said it is necessary because a physician shortage especially in under-served areas has limited access to care. Missouri last year was listed by the federal government as 1 of the 10 most medically under-served states in the nation.

“This is a decent solution,” Jeffrey Howell, the MSMA’s general counsel and government relations director, told Medscape Medical News. “Patients in these areas aren’t getting any care now. Our attitude is that some care is better than no care. We hope this law will be a trailblazer for other states.”

Howell said the assistant physicians have graduated medical school and passed the first 2 sections of the licensing exam. They must be approved by the Missouri Board of Healing Arts and must find a physician willing to collaborate with them. It will likely take the board a year to promulgate regulations for assistant physicians.

medical school graduates

“Flawed Assumption”

Opposition from organized medicine was swift. Thomas Nasca, MD, CEO of the Accreditation Council for Graduate Medical Education, said the possibility of harm is striking.

“These are physicians with only rudimentary experience,” he told Medscape Medical News. “In Missouri, without direct supervision, they’d be able to manage patients with complex diabetes, congestive heart failure, arrhythmias, and malignancies. This doesn’t make sense.

“Physicians in the United States are not trained to enter practice upon graduation from medical school,” Dr. Nasca said. “They don’t have the skill sets required for independent practice. It’s a flawed assumption to suggest that novices are prepared to provide clinical care on their own in a rural area where any medical condition could present itself. This isn’t an emotional response. It’s a data driven response to a very bad idea.”

Despite recognizing the need to serve challenged areas, he doesn’t see this as the appropriate remedy. “I don’t underestimate the challenges we face in delivering care to rural populations and the urban poor. But to provide inadequate care is no solution. There is a dramatic difference between a medical school graduate and a doctor trained in a residency program. Why go back to the 1940s when doctors just out of medical school provided care without supervision? The idea that primary care is somehow simple is ludicrous,” Dr. Nasca said.

Motorized Device Helps People Walk

The U.S. Food and Drug Administration today allowed marketing of the first motorized device intended to act as an exoskeleton for people with lower body paralysis (paraplegia) due to a spinal cord injury. ReWalk is a motorized device worn over the legs and part of the upper body that helps an individual sit, stand, and walk with assistance from a trained companion, such as a spouse or home health aide.

According to the U.S. Centers for Disease Control and Prevention there are about 200,000 people in the United States living with a spinal cord injury, many of whom have complete or partial paraplegia.

“Innovative devices such as ReWalk go a long way towards helping individuals with spinal cord injuries gain some mobility,” said Christy Foreman, director of the Office of Device Evaluation, at the FDA’s Center for Devices and Radiological Health. “Along with physical therapy, training and assistance from a caregiver, these individuals may be able to use these devices to walk again in their homes and in their communities.”

ReWalk consists of a fitted, metal brace that supports the legs and part of the upper body; motors that supply movement at the hips, knees, and ankles; a tilt sensor; and a backpack that contains the computer and power supply. Crutches provide the user with additional stability when walking, standing, and rising up from a chair. Using a wireless remote control worn on the wrist, the user commands ReWalk to stand up, sit down or walk.

ReWalk is for people with paraplegia due to spinal cord injuries at levels T7 (seventh thoracic vertebra) to L5 (fifth lumbar vertebra) when accompanied by a specially trained caregiver. It is also for people with spinal cord injuries at levels T4 (fourth thoracic vertebra) to T6 (sixth thoracic vertebra) where the device is limited to use in rehabilitation institutions. The device is not intended for sports or climbing stairs.

Prior to being trained to use ReWalk, patients should be able to stand using an assistive standing device (e.g., standing frame), and their hands and shoulders should be able to support crutches or a walker. Patients should not use the device if they have a history of severe neurological injuries other than spinal cord injury, or have severe spasticity, significant contractures, unstable spine, unhealed limb fractures or pelvic fractures. Patients should also not use the device if they have severe concurrent medical diseases such as infection, circulatory conditions, heart or lung conditions, or pressure sores.

Patients and their caregivers must undergo training developed by the manufacturer to learn and demonstrate proper use of the device.

To assess safety and effectiveness of ReWalk, the FDA reviewed testing done to assess ReWalk’s durability, its hardware, software and battery systems, and other safety systems that help minimize risk of injury should the device lose balance or power.

The FDA also reviewed clinical data based on 30 study participants. The clinical tests assessed the participants’ ability to walk various distances, the amount of time needed to walk various distances, performance on various walking surfaces and slight slopes, and performance walking in areas where jostling might occur. Studies also assessed the risk of certain physical effects on the user. Additionally, observational data from 16 patients were also provided to support use of the device on various walking surfaces in the home and community with various levels of assistance from a trained companion. Risks associated with ReWalk include pressure sores, bruising or abrasions, falls and associated injuries, and diastolic hypertension during use.

The FDA reviewed the ReWalk through its de novo classification process, a regulatory pathway for novel, first-of-its-kind medical devices that are generally low-to moderate-risk. The FDA is requiring Argo Medical Technologies, Inc., the manufacturer of ReWalk, to complete a post-market clinical study that will consist of a registry to collect data on adverse events related to the use of the ReWalk device and prospectively and systematically assess the adequacy of its training program.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Eye Test May Be Able To Detect Alzheimer’s

Eye Test May Be Able To Detect Alzheimer’s Decades Before Onset

More than 5 million Americans currently have Alzheimer’s disease. That number is expected to increase dramatically in the decades ahead.

On Sunday, researchers announced the promising results of a study on a new test to pick up on the disease years – if not decades – in advance. And they’re looking for signs in an unusual place: the eye.

These bright dots are proteins called beta amyloids visible in the retina of a patient diagnosed with Alzheimer’s diseases.

Beta amyloids are typically found in the brain and have been known to be linked to Alzheimer’s.

Dr. James Galvin is a neurologist at New York University Langone Medical Center.

“What makes it unique is that the retina is actually an extension of the brain and so we think that a lot of the pathology that is occurring in the brain may also be occurring in the retina,” he said.

Eye Test for Alzheimer's

Australian researcher Shaun Frost tested 40 people using a liquid form of curcumin, the natural substance that makes curry yellow. Curcumin sticks to beta amyloids, allowing doctors to spot the proteins with a simple eye test.

Frost found that the test positively identified 100 percent of the participants who had Alzheimer’s.

Alzheimer’s so far is incurable, so why is it important to be able to detect it?

“Well, for several reasons. So we have medicines today that treat the symptoms of the disease, so you’d like to be able to pick up the disease as soon as possible, so you can start someone on an available medicine. But more importantly, in order to develop new therapies, we need to be able to identify people at the earliest stages,” said Galvin.

Currently, the disease is detected through spinal taps or PET scans, which are invasive, expensive and not readily available.

The developers of the eye test say it can predict the onset of Alzheimer’s 15 to 20 years before clinical diagnosis. The full study, involving 200 subjects, is expected to be completed earlier this year.

Paving The Way For Virus-Like Nanodevices That Diagnose Disease And Make Drugs

Mimicking viruses to target specific cells

Nanotechnology is a relatively new, but rapidly expanding field, where tiny devices and molecular-scale tools offer exciting possibilities for manipulating cells and their components. Now researchers, copying the tactics used by viruses to evade the immune system, have created the first nanodevices that survive the body’s immune defenses. The achievement supplies a missing piece to the puzzle of how to use nanodevices at the cellular level.

Scientists at Harvard’s Wyss Institute for Biologically Inspired Engineering in Boston, MA, say their DNA nanodevice has successfully completed its first pilot mission.

Writing in ACS Nano, they conclude the accomplishment provides “a platform for the engineering of sophisticated, translation-ready DNA nanodevices.”

Such “smart DNA nanorobots” could use logic to diagnose diseases like cancer earlier than current approaches can. They could also target drugs directly to chosen tumors, or even manufacture them on the spot.

Mimicking viruses to target specific cells
Senior author William Shih, an associate professor of Biological Chemistry and Molecular Pharmacology at Harvard Medical School, says:

“We’re mimicking virus functionality to eventually build therapeutics that specifically target cells.”

The researchers believe the same cloaking method could be used to make artificial containers or “protocells” that could detect toxins in drinking water, or pathogens in food.

DNA is mostly known for its role as a conveyor of genetic information. But the researchers behind this latest study are looking at it differently – they see DNA as a 3D building material. They take strands of DNA and program them to fold into shapes, reminiscent of the Japanese paper-folding art of origami.

Specifically, they use their nanoscale origami skills to create DNA devices that are increasingly complex in shape, and approaching the intricacy of the molecular machinery found in cells.

The team is effectively building tiny robots out of DNA. These DNA nanorobots are capable of several functions: they can sense their environment, work out how to respond, then do something useful like trigger a chemical reaction, perform a movement or generate a mechanical force.

Such devices are not new. For example, in 2012, researchers at the Wyss Institute reported how they devised origami DNA nanorobots that target cancer cells and deliver instructions that make them commit suicide.

Also that year, scientists at Massachusetts Institute of Technology revealed how they devised nano-factories that could make drugs at tumor sites. Their nanoparticles produce proteins when ultraviolet light shines on them.

How to make DNA nanorobots invisible to immune system?

However, what has been missing is a way for nanorobots to evade the immune system – or at least hide from it long enough to be able to do their job. When Prof. Shih and colleagues injected nanorobots into the bloodstream of mice, their immune systems quickly found and digested them.

Prof. Shih, who is also an associate professor of Cancer Biology at the Dana-Farber Cancer Institute, says, that led them to ask, “How could we protect our particles from getting chewed up?”

They found the answer in nature. A virus hides from the host immune system with the help of a cloaking device. The virus protects its genome inside a solid protein coat covered in an oily protein – a double layer of phospholipid – identical to that contained in membranes surrounding the host’s living cells.

Prof. Shih says they wondered if enclosing their nanodevice inside such an envelope would have a similar effect.

To arrive at such a solution they first folded the DNA into a virus-sized octahedron, then built in handles on which to hang lipids, which then directed the double-layer membrane to assemble around the octahedron.

Nanodevice coated with lipid bilayer looked just like enveloped virus

The coated nanodevice looked just like an enveloped virus when seen through an electron microscope.

The next stage was to show the enveloped device could evade the immune system and survive in the body. To do this the devices were first loaded with dye, then injected into mice. Using whole body imaging, the researchers could track the nanodevices by seeing which parts of the mice glowed.

They also dyed and injected uncoated devices into another group of mice. These only glowed in the bladder area, showing that their immune systems had broken them down quickly and their bodies were ready to excrete their remnants.

But the mice that were injected with enveloped nanodevices told a different story. Their whole bodies glowed for hours, showing that the nanodevices stayed in the bloodstream for about the same length of time as effective drugs.

To show that the enveloped devices had also evaded the immune system, the researchers measured levels of two immune-activating molecules. The levels were 100 times higher in the mice that received uncoated nanodevices compared to the ones that received coated ones.

The researchers foresee cloaked nanorobots doing things like activating the immune system to fight cancer, or suppressing it to stop it rejecting transplanted tissue. They say that the main point is being able to control the immune system.

The National Institutes of Health, the US Army Research Laboratory’s Army Research Office, and the Wyss Institute at Harvard University contributed funds for the study.

In February 2014, Medical News Today reported on a study that used nanoparticles to target inflammation-causing immune cells. Researchers at the University of Illinois at Chicago have developed a system for precisely targeting out-of-control immune cells without interfering with correctly functioning immune cells.

Medicare Proposes Dollar Figure For New Chronic-Care Code

A Proposal That Could Reduce Revenue for Surgeons

Medicare would begin to pay physicians $41.92 a month next year for managing a patient with two or more chronic diseases outside of face-to-face office visits, according to a proposed physician fee schedule for 2015 released last week by the Centers for Medicare & Medicaid Services (CMS).

Last year CMS authorized a new billing code for chronic-care management to compensate physicians for tasks such as developing a care plan, referring patients to colleagues, and working with home-care agencies that are inadequately reimbursed under current evaluation and management (E/M) payment codes. CMS scheduled the code to take effect in 2015, but did not assign a dollar amount to it.

The proposed fee schedule for 2015 shows physicians the money, down to the cents. If a medical practice had only 20 Medicare patients who qualified for the new chronic-care management fee, it would gain an extra $10,000.

Physicians would bill Medicare for chronic-care management using a new G code. It would apply to at least 20 minutes of management services over 30 days for a patient whose multiple chronic conditions are expected to last at least 12 months, or until death, and that represent a significant risk for death, functional decline, or acute exacerbation or decompensation. Chronic-care services must be available on a 24/7 basis, but a clinical staff member can provide them at the midnight hour on an “incident-to” billing basis without direct supervision.

In the proposed fee schedule for 2015, CMS backed off from earlier notions to limit the new fee to physicians who employ at least one nurse practitioner or physician assistant, or who operate a medical home. However, CMS continued to make a case for requiring physicians to use an electronic health record (EHR) system that is certified under the agency’s meaningful-use incentive program.

Budgeting Medicare

CMS conceived the new billing code for chronic-care management as a way to support financially beleaguered primary care physicians. Another provision in the Medicare’s proposed fee schedule for 2015, however, could reduce revenue for surgeons. CMS wants to stop paying surgeons a set fee for procedures that covers postoperative services — think office visits — during 10-day and 90-day global periods. The agency is proposing that surgeons instead bill postoperative services separately on a piecemeal basis during these time frames.

What helped prompt this change, CMS explained, were reports from the Office of Inspector General in the US Department of Health & Human Services indicating that most surgeons did not perform as many postoperative services as the global period called for. For example, the fee for a 90-day global period may assume 10 postoperative office visits, but the surgeon may conduct only six.

CMS said it wants to convert both 10-day and 90-day global periods into 0-day periods, which would bundle all preoperative and postoperative care on the day of the surgery together with the operation itself. The 10-day global period would be phased out in 2017, the 90-day global period in 2018.
In a small victory for digital healthcare, CMS also said that it wants to expand the list of reimbursable services delivered via telemedicine to include annual wellness visits, psychoanalysis, psychotherapy, and prolonged E/M services. The agency said this change would improve access to healthcare in rural areas.

SOURCE: Medscape