Thursday, March 21, 2013

How to Treat Burns With Running Water

The Research Report: How to Treat Burns With Running Water -
The Wall Street Journal by ANN LUKITS

Running cold tap water over accidental burns and scalds is generally accepted as the best way to cool the skin and prevent blistering. But a study in the Journal of Plastic, Reconstructive & Aesthetic Surgery suggests the reverse—that using warm instead of cold water, while counterintuitive, may be a more effective method of limiting tissue damage and restoring blood flow to burned areas.

Swiss researchers used a heated metal template to induce same-size burns on anesthetized rats in four places on each of their backs. (Pain medication was administered before and after the procedure.)

One group of rats was treated for 20 minutes with gauze soaked in water cooled to 62.6 degrees Fahrenheit. A second group received gauze containing water at 98.6 degrees.

A third group of control rats wasn’t treated. The burns and unburned spaces between the burns were tested after one hour, 24 hours, four days and seven days.

Within 24 hours, burn damage in the control rats had extended to underlying tissues, whereas the burned area didn’t immediately change in the rats treated with cold or warm water, researchers said. After four days, all the animals developed tissue damage, or necrosis, in the spaces between the burns, but the damage was significantly less in the rats treated with warm water.

Necrosis affected 65% of interspaces in warm-water rats, 81% in cold-water rats and 94% in controls. Normal blood flow, assessed with a laser probe, was only restored in warm-water rats.

Although the experiments were performed on rats, the researchers said the basic principles and mechanisms of burn progression are similar to those in humans.

While applying cold tap water to burns helps to cool the skin, it can be painful after 20 minutes and leads to abnormally low temperature in the skin, according to lead researcher Reto Wettstein, a plastic and reconstructive hand surgeon in Basel, Switzerland. Dr. Wettstein personally practices rapid cooling with cold water for about a minute and then switches to warm water to help restore circulation.

Caveat: The findings only apply to second-degree burns that don’t require surgery, researchers said. The study didn’t consider other complications associated with burns, such as shock and the potential for hypothermia.

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Saturday, March 16, 2013

That bright screen can keep you up at night

Bright Screens Could Delay Bedtime
Using a tablet or computer in the late evening disrupts the body's melatonin production

By Stephani Sutherland

If you have trouble sleeping, laptop or tablet use at bedtime might be to blame, new research suggests. Mariana Figueiro of the Lighting Research Center at Rensselaer Polytechnic Institute and her team showed that two hours of iPad use at maximum brightness was enough to suppress people's normal nighttime release of melatonin, a key hormone in the body's clock, or circadian system. Melatonin tells your body that it is night, helping to make you sleepy. If you delay that signal, Figueiro says, you could delay sleep. Other research indicates that “if you do that chronically, for many years, it can lead to disruption of the circadian system,” sometimes with serious health consequences, she explains.

The dose of light is important, Figueiro says; the brightness and exposure time, as well as the wavelength, determine whether it affects melatonin. Light in the blue-and-white range emitted by today's tablets can do the trick—as can laptops and desktop computers, which emit even more of the disrupting light but are usually positioned farther from the eyes, which ameliorates the light's effects. The team designed light-detector goggles and had subjects wear them during late-evening tablet use. The light dose measurements from the goggles correlated with hampered melatonin production.

On the bright side, a morning shot of screen time could be used as light therapy for seasonal affective disorder and other light-based problems. Figueiro hopes manufacturers will “get creative” with tomorrow's tablets, making them more “circadian friendly,” perhaps even switching to white text on a black screen at night to minimize the light dose. Until then, do your sleep schedule a favor and turn down the brightness of your glowing screens before bed—or switch back to good old-fashioned books.

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Wednesday, March 13, 2013

A little zap to the brain may ease depression

A Little Juice to the Brain Eases Depression by Crystal Phend on February 6, 2013
By Crystal Phend, Senior Staff Writer, MedPage Today
Published: February 06, 2013

Non-invasive, electric stimulation of the brain appears to help the initial phase of treatment in major depressive disorder, especially in combination with an antidepressant, a double-blind trial showed.

Six weeks of daily transcranial direct current stimulation sessions reduced depression scores roughly the same as sertraline (Zoloft, P=0.35), Andre R. Brunoni, MD, PhD, of the University of São Paulo, Brazil, and colleagues reported online in JAMA Psychiatry.

The two together brought scores down by an average 8.5 points more than sertraline alone on a depression rating scale, and by 5.9 points more than direct current stimulation alone (P=0.002 and P=0.03, respectively).

A 3-point difference on that Montgomery-Asberg Depression Rating Scale (MADRS) is considered clinically relevant.

“Noninvasive brain stimulation is becoming an established therapy for the treatment of depression,” Brunoni and colleagues wrote.

The weak electrical current applied across large electrodes on the scalp may work by boosting activity in an area of the brain known to be hypoactive in depression, with the advantage of not having the same adverse effects and contraindications as antidepressant drugs, the group pointed out.

The device also is relatively inexpensive, so it might be a “cost-effective alternative for regions with low resources where the prevalence of major depressive disorder is high, such as most developing nations,” they added.

However, the treatment is less practical than taking a pill, and it’s not clear how its results would hold up in the maintenance phase.

“Even if transcranial direct current stimulation becomes available for in-house use, it would still require 20- to 30-minute daily sessions for several weeks,” Brunoni’s group wrote.

Their Sertraline vs Electrical Current Therapy for Treating Depression Clinical Study (SELECT TDCS) compared in a two-by-two design treatment with 6 weeks of sertraline at 50 mg per day or placebo and 2-mA anodal left/cathodal right prefrontal transcranial direct current stimulation (30-minute sessions each weekday plus two extra sessions every other week) or sham.

It included 120 antidepressant-naive patients with moderate-to-severe major depressive disorder but no psychotic or bipolar component, seen at a single outpatient center in an academic setting in São Paulo. The cohort had a relatively low degree of refractoriness and short duration of the index episode.

The only thing that wasn’t better than inactive treatment at the end of the 6-week period was sertraline alone, with a mean difference of 2.9 points versus placebo (P=0.20).

The explanation may have been that 50 mg per day was a low dose for some participants, though there have been negative trials with sertraline in major depressive disorder, the researchers pointed out.

Transcranial direct current stimulation improved MADRS score by 5.6 points over sham (P=0.01).

The combination of the two appeared to work fastest, as that was the only group with a significant change in score at week two. Factorial analysis suggested that the initial effect was driven primarily by the electric stimulation treatment.

The two appeared to be additive rather than synergistic.

Clinical response with at least a 50% reduction in baseline MADRS score was significantly more common with transcranial direct current stimulation or combination treatment than with placebo (43% and 63% versus 17%).

Remission, with MADRS score falling to 10 points or less, occurred in 47% of the combo group and 40% of the electrical stimulation group, which were both significantly better than the 13% rate with placebo.

Sertraline alone induced remission in 30%, although this difference didn’t reach significance.

No negative cognitive effects were seen with transcranial direct current stimulation, though skin redness was more common at the end of week two.

Of the seven episodes of treatment-emergent mania or hypomania, five were in the combined treatment group, including one severe manic episode requiring pharmacologic intervention.

Mania or hypomania induction may be similar with transcranial direct current stimulation as with antidepressants, so such events need careful monitoring in future trials, Brunoni’s group noted.

Further research is needed into longer-term effects and into use in the inpatient setting, they added.

Their trial includes an open-label phase for sham nonresponders to cross over to 10 days of active transcranial direct current stimulation, as well as a 6-month follow-up phase for those who responded to active treatment in the first 6 weeks.

The study was funded by a grant from the São Paulo Research Foundation.

The researchers reported having no conflicts of interest to disclose. by Crystal Phend on February 6, 2013 • Report a text problem

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Friday, March 8, 2013

Keep Calm and Carry a Gizmo

Keep Calm and Carry a Gizmo -

Sergio Ruzzier for The Wall Street Journal

IT WAS A COOL 68 DEGREES in the car, yet my forehead was beading with sweat. I-405 was a slow-rolling conveyor belt of anxiety. My palms were hot. My mind raced. Was that BMW really going to cut me off again?

But I had a solution. I pulled over at the next exit and did what any nerd-in-the-know would do: I plugged a stress-management device into my iPhone, fired up a relaxation guide and let go.

With finger on sensor, I inhaled and exhaled while following a bouncing ball on the screen, “breathing from the heart,” as the instructions told me. Within 60 seconds, I felt calm and collected, ready to face the 33 miles of stop-and-go ahead. I slipped back into traffic, a monk. I was home before I knew it.

Normally, I find technology to be a source of stress: social networks make me feel like I have no life; my blood boils over the emails I read before bedtime; hours spent staring at a screen have turned my lower back into a tight band of doom. Sure, I turn to other outlets to release stress—exercise, meditation, single-malt scotch—but like an email newsletter from a travel site, it just keeps coming back. But what if the very gadgets causing my angst could be used to combat the stress they create? A handful of devices promise to do just that. They quantify your stress level by calculating your heart rate and the minute variations in the time between each beat, a measurement known as heart rate variability (HRV), which has been used to gauge the likelihood of mortality after a heart attack and to help assess certain psychiatric conditions. If the gadgets find that you should unwind, they’ll attempt to guide you to a more centered state through relaxation exercises. Some use simple animations that you follow with deep breaths. Others offer video with experts like Andrew Weil and Thich Nhat Hanh, who lead you through a short meditation or even a series of yoga poses. Gadgets that can lower my stress and teach me to calm down? I was in. Was it all too good to be true, though? Some of the language I read reeked of snake oil, and the devices and apps often assessed my stress level inconsistently. One might tell me I was calm, while another advised me that I needed to cool down, so take their readings with a grain of salt if you choose to hop on board. But if you’re like me, you just might come out the other side more mellow, with your gadgets looking less like stressors and more like digital therapists.

The emWave2 is the most complex of the devices that I looked at, but it was also the most accurate. It consists of a heart-rate sensor that clips onto your earlobe and an iPod-size device that can send your data to a Mac or Windows computer via USB. (The emWave2 also has an onboard thumb sensor that wasn’t nearly as accurate.) While you can use the emWave 2 without a computer, I found the PC-based experience to be more immersive.

Before I could begin using the emWave2, I had to install it—a procedure that was, ironically, pretty stressful. It required loading software and drivers from a CD-ROM (remember those?) and then restarting my computer, which modern software rarely does. Thirty minutes and two computer crashes later, the emWave2 was up and running. There I sat with the device pulsing blue light, a pile of documentation strewed about my desk, a wire hanging from my ear. My wife peeked in at me from the office door, eyebrow raised.

I fired up the emWave2 software, the device calibrated and I saw a graph of my HRV being drawn on my computer screen in real time. I was fascinated. And according to the device, I needed to chill. I ran a coaching program intended to help me build my “coherence”—focusing on my heart, breathing from my center, “activating” a positive feeling. I breathed in as a little ball on the screen floated up, out as it descended, and gazed upon images of serene mountain brooks. Although I was skeptical at first, I genuinely felt better by the end of it all.

If only the software could be brought up to date, I could see legions of strung-out geeks like me becoming addicted servants of this device. Wasn’t there a “Star Trek” episode about this? $229, F. Martin Ramin for The Wall Street Journal Zensorium Tinké Zensorium TinkéThe Tinké is a cute dongle that measures HRV, blood oxygen level and respiratory rate with a built-in thumb sensor. It connects to an iPhone, iPad or iPod Touch’s 30-pin connector (using the Tinké with newer Lightning-equipped iOS devices requires an adapter); an accompanying app processes your stats. From a design standpoint, the Tinké was the clear stand out: pretty, colorful and simple.

The Tinké was also easy to use. I plugged the device into the iPhone, downloaded the app, ran a quick calibration and was measuring my stress levels in minutes. The Tinké was especially convenient to use on the go, which is exactly when I needed it most, whether dealing with Los Angeles traffic or coming down after a gym session. Its portability is easily its best feature.

That said, the app’s interface is cramped, and it offers only one relaxation exercise, in which you follow expanding and contracting circles with your breath. Although it’s effective, the breadth of exercises offered by the other devices left me wishing for more here. The Tinké’s thumb sensor could be temperamental, too. To take an accurate reading, it requires that you exert constant, consistent pressure. I often found myself more concerned with holding the device properly than getting my breathing in line.

Because of this, I had a hard time trusting the unit. My “Vita” score—a measure of cardiorespiratory fitness compiled by assessing my blood-oxygen saturation levels and heart and respiratory rates—was constantly high and healthy. My “Zen Index,” on the other hand, never rose above 34, indicating that, despite my heart health, I was constantly stressed out. Even after doing multiple relaxation exercises and verifying my improved HRV with the emWave2, the Tinké’s reading didn’t budge past 34. Perhaps it was waiting for me to pass out from all the deep-breathing exercises it led me through.

Apart from its wonky readings on the Zen side, the Tinké’s simplicity provided me with the shortest route to relaxation. I found myself returning to the unit more than any other because it was so easy to take along. Carrying it in my pocket was a constant reminder to relax. $119, F. Martin Ramin for The Wall Street Journal (phone)

GPS for the Soul GPS for the SoulThis recently launched Huffington Post app for the iPhone 4, 4S and 5 uses HRV-sensing technology developed by HeartMath, the same company behind the emWave2. It requires no additional hardware; the app measures HRV with the iPhone’s camera and flash. It also has a stress-reducing price: free. I found the emWave2 and its earpiece to be the most accurate, the Tinké’s dongle less so. It was no surprise, then, that this sensorless app was the flakiest of all. Getting accurate readings with the app required placing my index finger gingerly over my iPhone’s camera lens and flash for 80 seconds. If I moved too much, the app would suggest that I rub my fingers together and start again. A few rounds of this was enough to elevate my stress level. But do you really need an app to tell you that you’re strung out? If not, GPS for the Soul truly shines. It features dozens of stress-relieving guides from various experts and wellness companies: A video with the Zen Buddhist monk Thich Nhat Hanh teaches you how to move mindfully; instructors from the Kripalu yoga center demonstrate the cat/cow pose; Dr. Andrew Weil leads you through a simple breathing exercise. I also appreciated that I could have the app remind me to “check-in.” I normally find it annoying when apps do this, but it was helpful to be reminded to de-stress in the middle of hectic days. Free, Explore More Keeping Fit, One Step at a Time
Bicyclists of a Feather Flock Together
A version of this article appeared January 5, 2013, on page D11 in the U.S. edition of The Wall Street Journal, with the headline: KeepCalmandCarryaGizmo.

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