"We need to think about veterans who live in rural settings as a special population," explains DMS psychiatrist William Weeks, M.D. Weeks and colleagues at the White River Junction, Vt., Veterans Affairs Outcomes Group conducted the first nationwide comparison of the health status of rural versus urban VA patients. The study, published in the American Journal of Public Health, found that rural veterans are in much poorer health then their suburban and urban counterparts. The authors had some advice for policy makers: establish more clinics in rural areas and coordinate VA services with Medicare.
Water, water, everywhere . . .
A new federal standard for arsenic in drinking water—set to take effect in 2006—is 10 parts per billion. That may still be too high, according to a team of DMS researchers that has been examining the effects of arsenic on rat cells. Led by physiologist Jack Bodwell, Ph.D., the team published its findings in Chemical Research in Toxicology. The researchers described how arsenic disrupts hormone signaling and regulation— causing reproductive problems and other abnormalities—and confirmed that even concentrations of arsenic well below the new standard can cause such problems.
Changing view of MS
The "recognition of new 'players' " in the causes and progression of multiple sclerosis (MS) has been one of the biggest changes in MS research in recent years, according to a literature review by two Dartmouth neurologists. MS is predominantly an autoimmune disorder, they explain, but "recent studies have challenged this existing paradigm, supporting the role of other immune cells and factors (even nonimmune)." They concluded that the future of MS therapy is
in novel approaches that target "a multifaceted spectrum of immune activity." The paper was published in Frontiers in Bioscience.
In a review of the published research on glucocorticoids (GCs)—steroids with metabolic and anti-inflammatory effects—a DMS team found a big gap between the literature and clinical practice. "It seems clear that the long-held clinical view that GCs act solely as anti-inflammatory agents needs to be reassessed," the authors wrote. "Varying doses of GCs do not lead simply to varying degrees of inflammation suppression, but rather GCs can exert a full range of effects from permissive to stimulatory to suppressive." The paper appeared in the journal of the Scandinavian Society of Anaesthesiology and Critical Care Medicine.
Building muscle is usually good—but not in your arteries. In fact, according to Michael Simons, M.D., chief of cardiology at DHMC, the growth of smooth muscle along the lining of arteries is the most common cause for the failure of stents—mesh tubes that reopen blocked blood vessels. A team led by Simons reported in Circulation that smooth muscle can proliferate in arteries after mechanical injury, such as from angioplasty or stenting. So stents coated with smooth muscle inhibitors are the treatment of choice, the authors concluded.
Two recent studies show promise for combating pancreatic cancer, one of the most aggressive and deadly cancers. In a trial led by Murray Korc, M.D., chair of medicine, researchers injected a protein "sponge" into mice with human-derived pancreatic tumors. "The protein sponge completely suppressed pancreatic tumor
growth," Korc reported. "In all the tumors tested, there was a marked decrease in blood vessel formation, which is very exciting." The other study—led by a postdoctoral fellow in Korc's lab, Nicole Boyer Arnold, Ph.D.—described a pathway that is responsible for pancreatic cancer's ability to become resistant to traditional chemotherapy.
Zinc plays a critical role in the blinding disease retinitis pigmentosa, according to a group of researchers from DMS. The team determined that a zinc deficiency can cause malformation of a light-receptor protein called rhodopsin, which is essential for vision but is dysfunctional in those with the disease. The discovery reveals a possible "pharmacological approach for the treatment of select retinitis pigmentosa mutations," wrote the paper's authors. Their report was the "Paper of the Week" in the Journal of Biological Chemistry. Since the disease affects an estimated one million people worldwide, the public health implications of the work are promising.
Another look at Botox
In addition to treating wrinkles, severe underarm sweating, and certain neurological disorders, Botox may also be a safe and effective treatment for gastroparesis—a debilitating gastric disorder that causes nausea and vomiting and often affects diabetics. The finding came from a small study led by DHMC gastroenterologist Brian Lacy, M.D., Ph.D. The eight subjects were all type I diabetics. Before the treatment can be added to the list of Botox's approved uses, however, a double-blind, placebo-controlled trial is in order. Annual research funding to Dartmouth Medical School has increased by 58% since fiscal year 2001. For more on the most recent fiscal year's research income, see page 19 in this issue.
The DMS COOP Project, a network of private physicians established in 1972 to do practice-improvement studies, is the oldest practice-based primary-care research network in the U.S.
DMS researchers William Wade, Ph.D., and Ronald Taylor, Ph.D., are making progress on identifying a vaccine for cholera, according to papers in recent issues of Infection and Immunity.
On December 1, World AIDS Day, Dartmouth received $2 million to combat pediatric AIDS. The funds are going to a collaborative project run by DMS and Muhimbili University in Tanzania.
Annual research funding to Dartmouth Medical School has increased by 58% since fiscal year 2001. For more on the most recent fiscal year's research income, see page 19 in this issue.
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