Making the cut
Surgery trumps physical therapy, steroid injections, and drugs in relieving pain from a slipped vertebra and a narrowing spinal canal, according to the latest paper from the seven-year, $21-million Spine Patient Outcomes Research Trial. "We suspected surgery produced better results, but we had little objective data to support that," said James Weinstein, D.O., M.S., chair of orthopaedics at Dartmouth and lead author of the study, published in the New England Journal of Medicine. "We can now discuss much more fully the surgical and non-surgical options available to our patients so that they can make an informed choice."

Function junction
Hunting for better ways to combat cancer, a DMS team examined the expression patterns of 241 microRNAs (miRNAs) in 59 cancer cell lines. Since miRNAs regulate gene expression and protein production, knowing how they function is "essential . . . for designing effective strategies for cancer prevention and treatment," note Arti Gaur, Ph.D., and her coauthors in Cancer Research. Understanding miRNAs may also offer insight into how a "limited number of genetic alterations . . . result in the profound physiologic changes that characterize all malignant tissues."

Aging well
A new fountain of youth for yeast was reported by DMS biochemists in the journal Cell. Previously, the best known way to prolong life in yeast, as well as more complex organisms, was by calorie restriction. But Charles Brenner, Ph.D., and colleagues have found a new vitamin that prolongs life in yeast. "If we could do this in humans," he says, "we would be able to provide some of the benefits of calorie restriction, which are pretty striking in model organisms." The findings may one day help people with neurodegenerative diseases and other conditions associated with aging.

Needlepoint
Administering vaccinations against measles, mumps, rubella, and chicken pox may soon be easier in developed and developing nations alike. Pediatric researchers at Dartmouth recently evaluated a combination vaccine that only needs to be refrigerated, not frozen, and found it to be just as good as its frozen counterparts. Adopting the refrigerator-stable formulation "will lessen the burden of distribution and storage on pediatric practices, increase the ease of vaccine administration, and allow additional global expansion of current recommendations throughout the world," the authors wrote in the journal Pediatrics.

Walkabout
Elderly men, but not women, who live in pedestrian-friendly neighborhoods have lower rates of depression, found a study led by a new DMS faculty member. Even after taking into account factors such as income, education, age, ethnicity, smoking status, and chronic diseases, the association persisted. "One consequence of a poorly walkable neighborhood may be more depressive symptoms, particularly in older men," wrote Ethan Berke, M.D., M.P.H., in the Journal of the American Geriatrics Society. So, the authors wondered, should clinicians suggest that "older patients . . . live, if possible, in more-walkable areas?"

High sign
Higher malpractice awards and premiums go hand in hand with higher Medicare spending, note DMS health-policy analysts. In a state-by-state comparison of Medicare data from 2000 to 2003, they found that rising liability costs were associated with increases in physician services. "Our estimates do not imply that [the association is due to] 'defensive medicine,'" the authors wrote in Health Affairs. But they identified an especially strong link between higher liability costs and more imaging procedures, which are "often believed to be driven by physicians' fears of malpractice."

Using national data from 10,061 people patch tested for allergens, a DHMC resident found that children and adults show allergic reactions at similar rates—but to different substances.

Who decides where elective surgery is performed? A recent Dartmouth study of 500 Medicare patients found that in 31% of cases, the doctor was the primary decision-maker.

DMS geneticists explained in the journal Science how cells' circadian clocks sense light and thus pace their daily cycle. It's a mechanism that has implications for mental illness and cancer.