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Research Roundup

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March 15, 2011, Volume 57, No. 25

Antidepressant Use: Reducing Hot Flashes

Peri-menopausal and postmenopausal women who took the antidepressant medication escitalopram—brand name Lexapro®—experienced a reduction in the frequency and severity of hot flashes as compared to women who received a placebo according to a study led by Penn’s School of Medicine. The study was published in the January 19 issue of the Journal of the American Medical Association.

“Our findings suggest that among healthy women who were not depressed or anxious, a 10 to 20 milligram dose of escitalopram—which is well below the dosage level for psychiatric use—provides a non-hormonal, off-label option that is effective and well-tolerated in the management of menopausal hot flashes,” said Dr. Ellen W. Freeman, research professor of obstetrics and gynecology and principal investigator of the national, multi-site study.

At the end of the study after eight weeks, participants showed a significant decrease in hot flash frequency and intensity in the escitalopram group compared to the placebo group—55 percent vs. 36 percent. The three-week study participant follow-up also showed that hot flashes increased after cessation of escitalopram but not after cessation of placebo, further proving the drug’s effectiveness. Dr. Freeman and her colleagues note that while the reduction in hot flash frequency and severity seems modest, the study participants perceived these improvements as “meaningful,” greatly improving their quality of life and reinforcing their desire to continue the treatment.

Sideline Test: Detecting Athletes’ Concussions in Minutes

A simple test performed at the sideline of sporting events can accurately detect concussions in athletes, according to a study by researchers at Penn’s School of Medicine. Current sideline tests can leave a wide amount of brain function untested following a concussion. Penn researchers showed that this simple test adds to current methods and accurately and reliably identifies athletes with head trauma. The study appears online in the journal Neurology.

The one-minute test, called the King-Devick test, involves the athlete reading single digit numbers displayed on index-sized cards. Any increase (worsening) in the time needed to complete the test suggests a concussion has occurred, particularly if the delay is greater than five seconds compared to the individual’s baseline test time. The test captures impairments of eye movement, attention, language and other symptoms of impaired brain function. Tests of rapid number naming such as the King-Devick test are objective and capture many aspects of function. This may help coaches and athletic trainers determine whether players should be removed from games or not.

“This rapid screening test provides an effective way to detect early signs of concussion, which can improve outcomes and hopefully prevent repetitive concussions,” said the study’s senior author, Dr. Laura Balcer, professor of neurology, ophthalmology and epidemiology. “If validated in future studies, this test has the potential to become a standard sideline test for athletes.”

As emphasized by the study’s lead author and staff member in the department of neurology, Kristin Galetta, “Concussion is a complex type of brain injury that is not visible on the routine scans we do of the brain, yet is detectable when we measure important aspects of brain function, such as vision. The K-D test is only one test on the sidelines, though, and the diagnosis of concussion requires a combination of tests and input of medical professionals.”

Math Research: Plenty of Time for Evolution

A new mathematical model has offered even more evidence of the correctness of evolutionary theory. Dr. Herbert Wilf, Thomas A. Scott Emeritus Professor of Mathematics, and Dr. Warren Ewens, emeritus professor of biology, say their model directly challenges the long-standing contention among some doubters that evolution couldn’t have happened because the small changes in species outlined by the theory would have taken too much time to be completed.

According to Dr. Wilf, the understanding of evolution reached in the paper can best be illustrated by thinking about the two different ways a hacker might try to break into a computer. Suppose that a computer’s password is 12 letters long. Simple math dictates that because there are 12 characters in the password and 26 letters in the alphabet, there are approximately 10,000,000,000,000,000 (26 to the 12th power) possible iterations of the password.

One way to hack this password would be to guess a random string of 12 letters and keep doing so until the right combination was found. That process, however, would take an extremely long time.

A better strategy, Dr. Wilf said, would be to use a “spy” after each guess. The spy could tell the hacker which, if any, of the 12 letters were correct. If, for instance, the spy told the hacker that two of the 12 letters were correct, it would leave only 10 letters to be discovered. Extrapolate that spying-and-guessing process over the entire hack attempt, and it’s clear that the amount of time required would be greatly reduced. In the case of evolution, the hacker is evolution itself. The password is the string of codons that describes, for example, a butterfly. And the spy is natural selection.

“If, when we guess the full string of letters [for a new species], one of the letters is correct—for instance, one that describes correctly the eyes of a butterfly—then that letter has survival value,” he said.

“It will not be discarded as future mutations take place because the intermediate creatures are seeing very well, and they will live and reproduce. So although it seems at first glance that the process of random mutations will take a very long time to produce a higher organism, thanks to the spying of natural selection, the process can go very rapidly.”

School-Based Program: Reducing Sexual Behaviors in South African Teens

A school-based, six-session program targeting sexual risk behaviors has proven effective in reducing rates of self-reported unprotected sex and sex with multiple partners among South African sixth-graders, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The study was led by Dr. John B. Jemmott III, professor of communication in psychiatry and the Kenneth B. Clark Professor of Communication at Penn’s School of Medicine and Annenberg School for Communication and Dr. Loretta S. Jemmott, the van Amerigen Professor of Psychiatric Mental Health Nursing at Penn’s School of Nursing, and done in collaboration with colleagues at the US Centers for Disease Control and Prevention and the University of Fort Hare in South Africa, among others.

“Future research with more sexually experienced adolescents will have to explore whether such interventions can have an effect on condom use and STDs, including HIV,” said Dr. John Jemmott.

Nine schools were randomly assigned to participate in the HIV/STD intervention, which was designed to teach students how to avoid HIV and other STDs, enhance beliefs supporting abstinence and condom use, and increase the skills and self-confidence needed to choose less risky behaviors. The health-promotion intervention focused on physical activity, diet, and other behaviors linked to non-communicable diseases, such as heart disease, diabetes and cancer. The 1,057 participating children (average age 12.4) were asked about sexual behaviors before and three, six and 12 months after the intervention.

Averaged over the three follow-ups, a significantly smaller percentage of students in the HIV/STD risk reduction group than the health promotion group reported having unprotected vaginal intercourse (2.2 percent vs. 4.2 percent), having vaginal intercourse at all (4.8 percent vs. 7.2 percent) or having multiple sexual partners (1.8 percent vs. 3.2 percent).

Effective Blood Test for Ectopic Pregnancy

Scientists at the Wistar Institute and Penn’s School of Medicine have discovered protein markers that could provide physicians with the first reliable blood test to predict ectopic pregnancies. Their findings were published in the February 16 online issue of the Journal of Proteome Research. In a related study of clinical samples, published recently in the journal Fertility and Sterility, the researchers found that one of the proteins—ADAM12—showed a nearly 97 percent correlation with ectopic pregnancy.

Ectopic pregnancies occur when a woman’s fertilized egg develops outside of the uterus, most often in the fallopian tubes. As the embryo grows, the tube could rupture, which results in the loss of the embryo and threatens the life of the mother. Ectopic pregnancies are the leading cause of death in the first trimester of pregnancy. Currently, diagnosis of ectopic pregnancy relies on the use of ultrasound and there is no single proven blood test.

According to Dr. David W. Speicher, professor and co-leader of Wistar’s Molecular and Cellular Oncogenesis Program and director of the Center for Systems and Computational Biology, in the current study they describe a group of proteins that, “with further refinement, could make a simple blood test for ectopic pregnancy.” Dr. Speicher and his team collaborated with Dr. Kurt T. Barnhart, professor of obstetrics and gynecology at Penn’s School of Medicine, associate director of Penn Fertility Care and director of clinical research for the department of obstetrics & gynecology.

This current study demonstrates the power of proteomics, or the study of the sum total of proteins that the body is making at a given time, in understanding the state of health or disease in people. Proteomics provides researchers an “unbiased” approach to the discovery of biomarkers, proteins in this case, which could be used to signal the presence of a particular clinical disorder or disease such as ectopic pregnancy.

 

Almanac - March 15, 2011, Volume 57, No. 25