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Tuesday, August 8, 2017

Morning Rounds by Megan Thielking

Happy Tuesday, everyone! Here's what you need to know this morning about health and medicine. 

Life expectancy low, infant mortality high in Appalachia 

There are striking health disparities among individuals in Appalachia compared to the rest of the country — and some of those disparities are growing. White women in wealthier parts of the country live 13 years longer than black men in high-poverty parts of the region, according to new data published in Health Affairs. The new study also found that infant mortality in Appalachia was 16 percent higher than the national average in 2013, even though in the early 90s the two were relatively even. Now, the authors of the new research say, health officials need to come up with specific plans to address what’s driving those disparities, including higher rates of smoking and obesity in the region.

Alzheimer's deaths are creeping up in number

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(hyacinth empinado / stat)

The death rate from Alzheimer’s disease in the U.S. is creeping up, according to new numbers out from the CDC this morning. There were just over 31 deaths due to Alzheimer’s disease per 100,000 people in the past year, up from 29 the year before. And while that might seem like a small difference, it’s worth noting — the increase translates to thousands more deaths from Alzheimer’s in the past year. CDC officials tell me that the increase might be due in part to increased awareness about the disease and, in turn, increased reporting of Alzheimer’s deaths.

A doctor’s murder leaves a city with no easy answers

Dr. Todd Graham wasn’t yet halfway through his workday in his Mishawaka, Ind., office when a new patient came in complaining of chronic pain. He told her opioids weren’t the appropriate treatment, but her husband, Michael Jarvis, was at the appointment and he insisted. When Graham held his ground, Jarvis grew irate. Graham just kept seeing patients, which many of his peers say they would’ve done, too. Two hours later, Jarvis, who dealt with his own issues with addiction, returned and shot and killed Graham. The murder has forced doctors to rethink how they prescribe opioids and law enforcement to rethink how they’ve approached addiction. Read my story from Mishawaka here.

Lab Chat: A cell-converting chip aims to treat disease

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an arm model shows off the cell-converting chip. (ohio state university wexner medical center)

Regenerative medicine researchers have created a little chip that's able to reprogram skin cells into other cells in less than a second. It worked well in a mouse model, and now they’re testing the technology in pigs. Here’s what Chandan Sen of Ohio State University told me about the work, published in Nature Nanotechnology

How does the device work?

Our goal was to try to achieve direct cellular conversion in the body without using a viral vector, because once that’s introduced into the body, it will affect almost everything in its way. We open a small window on the cell surface, no more than 2 percent of the cell’s surface, and through that we insert DNA or RNA. It takes a fraction of a second and then the chip comes off.

How did it work when you tested it?

We tested it on a loss of blood in the leg in mice. We rescued the leg with the chip, which reprogrammed skin cells to form blood vessels. And in another case, we had a stroke-injured brain and we grew new nerve cells by using the skin as a bioreactor. The beauty of using the skin as a bioreactor is that it has already been under immune surveillance the entire time and the body is more likely to accept the cells.

Telehealth sounds great. But the price can be too high

There's been a lot of hype over telemedicine's potential to narrow the distance between patients and clinicians in rural communities, but South Dakota's efforts to use it serve as a cautionary tale. Although the state uses telehealth technology in hospitals and nursing homes, getting those devices into patients' homes is "very cost prohibitive for us right now," South Dakota state representative Jean Hunhoff tells STAT. In part, that's because patients can't just use Skype to chat with their doctors — the technology used in a patient's home has to be compatible with the systems and software used in clinicians' offices. Another barrier: In the most rural parts of South Dakota, the internet can be too slow in patients' homes. 

Immune cells sacrifice themselves as a warning signal

Scientists at the University of California, San Diego, have made a new discovery about how the immune system fends off strep bacteria. It's been known that group A streptococcus bacteria — which cause strep throat and other illnesses — are covered with M proteins, which help the bacteria attach to human tissues and overcome the immune system. Now, scientists have found that when immune cells called macrophages spot M proteins, they sacrifice themselves as an early warning to the rest of the immune system. That triggers pathways that destroy M proteins and increase inflammation — which in some cases can do more damage than the infection itself. The finding could help scientists develop better strep vaccines and treatments that target M proteins to stop excessive inflammation in strep infections and toxic shock syndrome. 

What to read around the web today

  • Braving cancer amid the chaos in Syria. New York Times Magazine
  • Experimenting with drugs while terminally ill. WAMU
  • 'A number' of athletes dealing with stomach illness at world championships in London. Associated Press

More reads from STAT

The latest from STAT Plus

  • ‘Doctors are getting shot’: Navigating the perils of pain pill prescribing in the midst of an opioid crisis. 
  • MyoKardia drug improves blood flow in patients with serious, inherited form of heart disease. 

Thanks for reading! More tomorrow,

Megan

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