The human brain is a wonderfully complex organ that has evaded understanding since the dawn of time … at least, until now. John Cleese, English actor and comedian, presents an in-depth yet succinct overview of how the brain works. Even more amazing is his ability to distill all this information into a 2-minute videocast, “All About The Brain”.

For an Einsteinian few, these ideas appear elegantly logical and simple. As for the majority of us, including myself, they represent concepts far too esoteric and advanced for mere minds to comprehend. If you feel Cleese’s words were like gobbledygook, then you belong in the latter group. It may have helped if I stayed awake more during neuroscience classes in medical school.

Dr. Rob Lamberts of the Musings of a Distractible Mind hosts this week’s grand rounds … through the eyes of a groundhog. Special guests for this week’s grand rounds include a llama and an iPad-touting [photoshopped] Steve Jobs. On The Wards makes a brief appearance as well with our low-carb vs. low-fat diet article:

What’s best, low carb or low fat diets? The blog On The Wards discusses the research on the subject. It turns out that they are the same. I am glad about that. Some woodchucks eat bugs and other yucky stuff, but I stick to the veggies to maintain my chuckish figure.

For those curious about the woodchuck — er, groundhog — references made by Dr. Lamberts, take a peek at the following Wikipedia article for some background information.

The “New & Interesting” series is a biweekly compilation of select research findings, news articles, and random tidbits in bullet-point format. The entries are highly abbreviated, but provide links to the original articles or abstracts if you desire to read further.

General Articles

• Reducing just 3 grams of salt from the diet of the average American could prevent up to 66,000 strokes, 99,000 heart attacks, and 92,000 deaths in the United States. This would also save $24 billion in health care costs per year. (Reuters)

• Raising ambulatory care copayments among elderly patients similarly increased rates of hospitalizations, length of stays, and total cost of care. (NEJM)

Technical Articles

• Reducing the rates of readmission in the geriatric population. A hospitalist and his colleagues at the Baylor University Medical Center performed a pilot project involving a care coordinator and clinical pharmacist performing telephone follow-up calls and home visits to geriatric patients recently discharged from the hospital. The team found that this approach reduced the rates of readmissions or emergency visits within 30 days after discharge. The population studied included geriatric patients pre-identified to be have high risk for readmission. (ACP Hospitalist)

• High doses (50 mg / day or more) of opioids for chronic non-cancer pain in the elderly were associated with a two-fold increased risk for developing a fracture. (J Gen Intern Med)

Low-carbohydrate diets were initially popularized by the late Dr. Robert Atkins, who published the fundamentals of this diet in his book Dr. Atkins’ New Diet Revolution. He also founded Atkins Nutritional to commercialize and further evangelize the low-carbohydrate diet. Following Dr. Atkins’s death, however, the popularity of the diet subsided and his company filed for Chapter 11 bankruptcy in 2005.

Despite its controversial nature, the low-carbohydrate diet may still have health benefits. A group at the Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center (Durham, North Carolina), recently published their findings in the Archives of Internal Medicine, where they compared the low-carbohydrate, ketogenic diet (LCKD) with a low-fat diet (combined with the weight-loss medication orlistat) regarding their effects on several health parameters: weight loss, blood pressure, cholesterol levels, and glycemic parameters.
Read more … »

Anthony Atala, director of the Wake Forest Institute for Regenerative
Medicine, presented a riveting TED talk in October 2009 (broadcasted
January 2010) about organ regeneration. Atala initially lays out the
current dilemma with organ transplantation: although the demand for
donor organs has multiplied several-fold over the years, the annual rate of transplantation has remained virtually unchanged due to a limited supply of organs. Atala adds, “Every 30 seconds, a patient dies from diseases that could be treated with tissue replacement.” His answer to the supply bottleneck? … grow “artificial” in the laboratory.

In 1996, natural biomaterials were used as a “bridge” to promote cell
growth and repair in a damaged urethral tube. This technology was
however limited by a maximum wound length (approximately 1 cm) where
the cells would regenerate. What about larger injuries? Atala provides the example of a bio-reactor strategy used to create a carotid artery. First, myocytes are grown in vitro and “exercised” using a linear oscillating device to develop muscle strands that are acclimated to contractile motion. These cells are then coated along a biodegradable tubular scaffold and incubated at 37 ^oC and 95% oxygen concentration to approximate the thermodynamics inside the human body. The internal wall of the tubular scaffold is coated with vascular endothelial cells. The end-product is a vascular vessel with external muscular and internal endothelial walls.

Similar principles can be applied to more complex organs. The Wake
Forest Institute for Regenerative Medicine has also been successful at
creating a bladder using an ovoid scaffold overlaid by human cells and
growth media. The process takes about 6-8 weeks for each
“manufactured” bladder. Atala adds that the Institute can also create
bladders of different sizes, joking that his attentive audience at the TED talk would probably prefer the XL version. Other organs produced by the Institute include heart valves, ears, and digits.

The next steps of active research involve the growth of significantly
more complex and highly-vascularized organs, such as the heart, liver,
and kidney. One project under study is the use of a modified desktop
inkjet printer to “print” solid organs through systematic layering of
cells. Another technique is to form new organs from autologous cells
using the collagen/vasculature infrastructure of donor organs. Mild
detergents are first used to remove the donor organ’s cell elements,
leaving a “skeleton” of collagen and retained vasculature. The organ
is then perfused and coated with the patient’s own cells. This concept
is interesting in that it would increase the supply of donor organs by
permitting the use of dysfunctional, but structurally preserved,
organs. Moreover, the use of autologous cells would theoretically
decrease the risk for rejection.

Although Atala was able to distill his talk to less than 20 minutes,
the immense resources invested into this research effort are by no
means diminutive. There have been 700 researchers over the past 20
years at the Wake Forest Institute for Regenerative Medicine and its
collaborating sites working on organ regeneration. The potential
impact of this research effort is similarly staggering, particularly
for the thousands of patients and their families who eagerly await the
phone call that an organ is available. On a more personal note, my first
patient to die during my residency training was on the liver transplant list, but unfortunately did not survive long enough to receive a replacement organ. While I cannot imagine the emotional duress his family endured, the event was painful for me as well. I eagerly look forward to the many advances stem cell and organ regeneration research may bring … as well as the countless lives they may save.