Laughter really is the best medicine (for leg ulcers)

Forget technology. The best prescription for patients with venous leg ulcers is good quality nursing care – and the occasional belly laugh!

A five-year study led from the University of Leeds has shown that ultrasound therapy does nothing to speed up the healing process of leg ulceration - contrary to what had been expected. Traditional methods of nursing care, which are cheaper and easier to deliver, work just as well, the authors conclude.

"The 'healing energy' of low-dose ultrasound can make a difference to some medical conditions but with venous leg ulcers, this is simply not the case," said Professor Andrea Nelson from the University of Leeds' School of Healthcare, who led the study.

"The key to care with this group of patients is to stimulate blood flow back up the legs to the heart. The best way to do that is with compression bandages and support stockings - not 'magic wands' - coupled with advice on diet and exercise. Believe it or not, having a really hearty chuckle can help too. This is because laughing gets the diaphragm moving and this plays a vital part in moving blood around the body."

Venous leg ulcers are common in people with varicose veins or mobility problems whose 'muscle pumps' in the feet and calves struggle to drive blood up to the heart. These ulcers can be painful and unsightly, having a significant negative impact on health and quality of life.

Although most leg ulcers will clear up with good nursing care, a significant proportion of the lesions will take 12 months or longer to heal. The older and larger ulcers become the harder they are to get rid of, hence the search for solutions that could speed-up the healing process.

A number of small studies had suggested that ultrasound could be the answer. Professor Nelson (University of Leeds), working with colleagues from the Universities of York and Teeside, and many NHS Trusts, have now shown that this is not the case.

The researchers concentrated on 'hard to heal' ulcers that had not cleared up after six months or longer. Drawing on patients from across the UK and Ireland, they found that adding ultrasound to the standard approach to care  - dressings and compression therapy - made no difference to the speed of healing or the chance of the ulcers coming back. Ultrasound also raised the cost of care per patient by almost £200.

"Rising levels of obesity mean that the number of people who suffer from legs ulcers is likely to grow," Professor Nelson said.  "We do need to find ways to helping those patients who ulcers won't go away, but our study shows that ultrasound is not the way to do that. We need to focus on what really matters, which is good quality nursing care. There really is no need for the NHS to provide district nurses with ultrasound machines. This would not be money well spent."

The study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (HTA).

Full details of the findings are published online today in advance of publication in the British Medical Journal and Health Technology Assessment.

Effects of tobacco

Health effects of tobacco

Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD), emphysema, and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer). Cigarette smoking increases the risk of Crohn’s disease as well as the severity of the course of the disease. It is also the number one cause of bladder cancer.
The World Health Organization estimate that tobacco caused 5.4 million deaths in 2004 and 100 million deaths over the course of the 20th century. Similarly, the United States Centers for Disease Control and Prevention describes tobacco use as “the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide.”
Rates of smoking have leveled off or declined in the developed world. Smoking rates in the United States have dropped by half from 1965 to 2006 falling from 42% to 20.8% in adults. In the developing world, tobacco consumption is rising by 3.4% per year.
Passive smoking presents a very real health risk. 603 000 deaths were attributable to second-hand smoke in 2004

head and torso of a male with internal organs shown and labels referring to the effects of tobacco smoking
Common adverse effects of tobacco smoking. The more common effects are in bold face.

Engineering Bacteria To make Anti-Cancer Drug

A complicated chemical pathway has to be configured into a microbe to produce Taxol drug
Making E. coli synthesise the intermediate baccatin III is the most realistic scenario

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Placitaxel, better known by the brand name Taxol, is a compound found in the bark of the Pacific yew tree, Taxus brevifolia, that has proved effective against a variety of cancers.
In the early 1990s, when the drug was just coming into use, the bark from over three trees was needed in order to extract just one gramme of Taxol.
These days, however, it is produced from plant cells grown in culture or by chemically processing a molecule found in the needles of the European yew tree.
Scientists are looking at another challenging option. Would it be possible to genetically engineer microbes to produce the drug? If so, production could be greatly increased and the cost of the medicine reduced.
Three decades back, scientists successfully engineered a bacterium to churn out insulin. This was achieved by introducing a gene for human insulin into the organism.
Instead of having to rely on insulin extracted and purified from animal tissue, large quantities of human insulin could be safely produced by simply growing the genetically altered bacterium.
To produce Taxol, however, a complicated chemical pathway has to be configured into a microbe. Many different genes are needed to make enzymes, each of which catalyse one step and must work like a factory assembly line to synthesise this complex molecule.
Recently in a paper published in the journal Science, a team led by Gregory Stephanopoulos of the Massachusetts Institute of Technology (MIT) reported efforts to produce precursors of Taxol using the bacterium Escherichia coli ( E. coli).
It was not simply a matter of introducing new genes into the microbe. Getting the organism to produce large quantities of the precursor molecules required careful optimisation of the entire pipeline.
First, the output from an endogenous pathway in the bacterium had to be increased, explained Parayil Kumaran Ajikumar, a post-doc in Prof. Stephanopoulos' laboratory and first author of the paper. For that, production of enzymes from four of eight genes in the pathway needed to be boosted. In addition, the output of this pathway had to be balanced with a new pathway with two plant-derived genes that then synthesised taxadiene, a precursor of Taxol.
For reasons that are not clear, if the two pathways were not balanced, the cell triggered the synthesis of indole, he told this correspondent. When indole accumulated inside the bacterium, it inhibited the production of taxadiene.
By balancing the two pathways, the scientists were able to create a strain of E. coli that produced 1,000 times more taxadiene than any other engineered microbial strain.
Then, by coaxing a plant gene to work in the bacterium, taxadiene was turned into taxadiene-5-alpha-ol. Their engineered strain proved capable of producing 2,400 times more of the latter molecule than had been possible with genetically modified yeast. Many more steps are needed before the bacterium is able to synthesise Taxol. The most realistic scenario, however, would be to get E. coli to synthesise the intermediate baccatin III and then use existing chemical methods, which are very efficient, to produce Taxol, observed Prof. Stephanopoulos in an email.
But, as the scientists noted in their paper, making E. coli that can synthesise baccatin III will be “a daunting task.” Several more steps, including some that have not been identified, would have to be effectively engineered into the bacterium.
“By mimicking nature, we can now begin to produce these intermediates that the plant makes, so people can look at them and see if they have any therapeutic properties,” said Dr. Stephanopoulos in a press release issued by the MIT.
Moreover, they can synthesise variants of these intermediates that may have therapeutic properties for other diseases.