Datasets:

saikat02004

/

criteria_4

like 0

"An experimental drug appears to reduce the risk of bone fractures in postmenopausal women with osteoporosis better than a placebo and the currently available drug a new study finds. In this phase trial funded by the drugs maker Radius Health fewer women on the injectable drug abaloparatide had spine fractures . percent than women receiving a placebo . percent and slightly fewer than those taking a similar injectable drug teriparatide Forteo . percent. If this gets approved and there is no reason to think it wont this will be the second drug available for the treatment of highrisk osteoporosis said lead researcher Dr. Paul Miller of the Colorado Center for Bone Research. Forteo has been in use for the past years he said. Abaloparatide works differently from Forteo and improves bone density more than Forteo Miller said. Women taking abaloparatide also had fewer other types of fractures . percent than those who got a placebo . percent and slightly fewer than those on Forteo . percent the researchers found. Miller said many spine fractures are painless. Patients are often unaware they have happened until a doctor measures their height and finds they are up to an inch shorter than before he said. Abaloparatide and Forteo are synthetic peptides that help grow and strengthen bone Miller said. Along with building bone density they are the only ones that increase bone quality he said. Bone quality is an important aspect of bone strength the ability to withstand a break Miller said. He predicts that when abaloparatide is on the market it will compete with Forteo driving down the price of both drugs. I am hoping that having a second drug available that it will help reduce the cost he said. Forteo costs about a month if you dont have insurance. Even if a patient is insured monthly copays can range from to . Forteo is covered by Medicare Miller said. The report was published Aug. in the Journal of the American Medical Association. A study based on U.S. Census data estimated that more than million women between the ages of and have osteoporosis. A yearold woman has a percent lifetime risk of fracture due to low bone density. For the study Miller and colleagues randomly assigned nearly postmenopausal women with osteoporosis to receive daily injections of abaloparatide Forteo or a placebo for months. Their average age was . Among the nearly women who completed the trial increases in bone mineral density were greater with abaloparatide than placebo the researchers found. In addition fewer cases of hypercalcemia abnormally high levels of calcium in the blood occurred among women taking abaloparatide percent than Forteo percent. Hypercalcemia can weaken bones cause kidney stones and interfere with heart and brain function. There were no differences among the groups in other serious side effects such as nausea and heart palpations Miller said. Dr. Caroline Messer director of the Center for Pituitary and Neuroendocrine Disorders at Lenox Hill Hospital in New York City is eager for further research. There needs to be a large headtohead trial between Forteo and abaloparatide she said to really see which drug is better. Everybody is going to want to know if this is inferior or superior to Forteo she said adding that this is an early study. It shows more bone building and fewer fractures than Forteo but whether it will replace that drug is still up in the air. An editorial accompanying the study said which drug is selected may be less important than identifying and starting an approved treatment. The bar is high for any preventive treatment in the efforts to prevent a fracture that may or may not ever occur prescribers do not want to prescribe a therapy that causes a new problem. The way forward for fracture prevention involves not only the development of better therapies . . . and easier delivery systems but also improved adoption of existing osteoporosis therapies for patients with prior fractures and minimization of adverse effects particularly those associated with longterm use the editorial said. The editorial was cowritten by Dr. Anne Cappola of the Perelman School of Medicine at the University of Pennsylvania Philadelphia associate editor of JAMA and Dr. Dolores Shoback of the University of California San Francisco. More information To learn more about osteoporosis visit the American College of Rheumatology http SOURCES Paul Miller M.D. Colorado Center for Bone Research Lakewood Colo. Caroline Messer M.D. director Center for Pituitary and Neuroendocrine Disorders Lenox Hill Hospital New York City Aug. Journal of the American Medical Association"

"The U.S. Food and Drug Administration approved Intrarosa prasterone to treat women experiencing moderate to severe pain during sexual intercourse dyspareunia a symptom of vulvar and vaginal atrophy VVA due to menopause. Intrarosa is the first FDA approved product containing the active ingredient prasterone which is also known as dehydroepiandrosterone DHEA. During menopause levels of estrogen decline in vaginal tissues which may cause a condition known as VVA leading to symptoms such as pain during sexual intercourse. Pain during sexual intercourse is one of the most frequent symptoms of VVA reported by postmenopausal women said Audrey Gassman M.D. deputy director of the Division of Bone Reproductive and Urologic Products DBRUP in the Office of Drug Evaluation III in the FDAs Center for Drug Evaluation and Research CDER. Intrarosa provides an additional treatment option for women seeking relief of dyspareunia caused by VVA. Efficacy of Intrarosa a oncedaily vaginal insert was established in two week placebocontrolled clinical trials of healthy postmenopausal women to years of age who identified moderate to severe pain during sexual intercourse as their most bothersome symptom of VVA. Women were randomly assigned to receive Intrarosa or a placebo vaginal insert. Intrarosa when compared to placebo was shown to reduce the severity of pain experienced during sexual intercourse. The safety of Intrarosa was established in four week placebocontrolled trials and one week openlabel trial. The most common adverse reactions were vaginal discharge and abnormal Pap smear. Although DHEA is included in some dietary supplements the efficacy and safety of those products have not been established for diagnosing curing mitigating treating or preventing any disease. Intrarosa is marketed by Quebecbased Endoceutics Inc. The FDA an agency within the U.S. Department of Health and Human Services protects the public health by assuring the safety effectiveness and security of human and veterinary drugs vaccines and other biological products for human use and medical devices. The agency also is responsible for the safety and security of our nations food supply cosmetics dietary supplements products that give off electronic radiation and for regulating tobacco products."

"A bonestrengthening drug given by IV every months greatly lowered the risk of fracture in certain older women a large study found. The results suggest these medicines might help more people than those who get them now and can be used less often too. Broken bones are a scourge of aging. A hip fracture can start a long decline that lands someone in a nursing home. The risk is most common in women after menopause. According to a study a bonestrengthening drug given intravenously every months greatly lowered the risk of fracture in certain older women. Nam Y. Huh The Associated Press file photo But who should use drugs called bisphosphonates is debatable. Theyre recommended for people with severely brittle bones called osteoporosis but their value is less clear for millions of others with moderate bone loss. Yet thats the group in whom per cent of fractures occur and the new results suggest they also may benefit from treatment said Dr. Ian Reid of the University of Auckland in New Zealand. He led the study reported Monday at an American Society for Bone and Mineral Research meeting in Montreal and published by the New England Journal of Medicine. Estrogen keeps bones strong they weaken after menopause when levels of that hormone drop. It often gets worse after and women of that age are advised to have a bone mineral density scan a lowdose Xray to estimate bone strength. If osteoporosis is found treatment usually is Fosamax Boniva or generic versions of these drugs which help prevent bone from being lost faster than the body is able to renew it. Some people dont stick with the pills or endure digestive side effects so the medicines also can be given by IV usually once a year. However concern about some rare side effects have limited their use along with a lack of evidence that they might help before bone loss becomes severe. The study involved women average age with moderate bone loss. One quarter had previously had a fracture. They were assigned to get a Novartis drug sold as Reclast in the United States and Aclasta elsewhere or a placebo IV solution every months. After six years women in the drug group had broken a bone versus of those on placebo a per cent lowered risk. The drug also cut in half the risk of a vertebral fracture when bone compression causes part of the spine to collapse. For every women like this treated for six years one fracture was prevented a ratio that some experts said makes treatment worth considering. Two rare problems are tied to bisphosphonates deterioration of the jawbone and unusual leg fractures. No cases of either occurred but the study wasnt big enough to rule out this risk. Other results stood out Fewer women in the drug group were found to have cancer versus in the placebo group. However the study was not designed to test for this so other factors such as a family history of cancer may have influenced those numbers. Deaths and heart attacks also were fewer in the drug group but the difference was so small it could have occurred by chance alone. Still doctors said these were encouraging signs also seen in some earlier research. It now raises the question should we be doing additional studies to look for cancer and heart benefits from these drugs said Dr. Michael Econs an Indiana University professor who is president of the bone society. Novartis supplied the drug but had no role in the study a New Zealand government health agency sponsored it. Reid consults for the company and other drugmakers. An IV infusion of generic Reclast costs to depending on insurance and other factors several doctors said. Other bisphosphonates may give similar benefits but we cant be certain of that Reid said. The benefits also cant be assumed to extend to women under or to men said Dr. Clifford J. Rosen of Maine Medical Center Research Institute and an editor at the medical journal. Gauging a patients risk and need for treatment should focus on age and previous broken bones not just the bone mineral density score Rosen said. But if youre at high risk and youre going to be treated this is the kind of therapy you probably should get he said."

"Debbie Spina is a supervisor for the radiology department at the Hospital for Joint Diseases at the NYU Langone Medical Center in New York City. But when CBS News met her this spring she was a patient who was about to undergo sameday hip replacement surgery. The yearold had been having hip pain for the past two years because of arthritis. She had heard a lot of positive feedback from people who had undergone hip replacement surgery https at her hospital. A big attraction for her was the possibility of going home right after the surgery. The option to go home the same day and have that family around me was something that I wanted to do said Spina. She believed she would be able to recuperate more comfortably at home and get back on her feet faster. At most hospitals hip replacement https patients can expect a one to threenight hospital stay. Total hip replacement surgery is increasingly common with more than procedures done every year in the U.S. The surgery is meant to restore range of motion and help relieve arthritic pain. The procedure consists of removing the patients worn out ball and socket joint and inserting an artificial socket. On the femur side a stem is inserted into the bone and a ball is on the tip of it. NYU Langone Medical Center said it became the first academic medical center in New York City to implement a sameday hip replacement program in . Dr. Roy Davidovitch director of NYU Langones Hip Center said he performs around hip replacements a year and approximately percent of those patients will go home the same day. Davidovitch said patients are happier going home sooner. Nothing beats the comfort of your own home for recovery. And to be quite honest if the pain is controlled and the patient is healthy and medically completely stable there is no reason for them to be in the hospital. It really doesnt make sense. There are two common surgical approaches for a total hip replacement anterior which involves entering surgically through the front of the hip and posterior or entering surgically through the side or buttocks. According to research done by the American Academy of Orthopaedic Surgeons http there are no significant differences between either approach in recovery outcomes six months after surgery. Davidovitch favors the anterior approach which he believes has a faster and less painful recovery period in the short term because doctors dont have to cut through muscles or tendons to get to the hip like in the posterior approach. He does agree that in the long term both procedures have the same outcomes for patients. But its not the surgical approach alone that allows some of his patients to go home the same day its a combination of what happens before during and after surgery. At NYU Langone patients have to do whats called prehab. Before the surgery they work with an occupational and physical therapist to learn information on the procedure learn exercises to do after the surgery and how to properly move around while they are recovering. During the surgery Davidovitch uses a shortacting spinal anesthetic that lasts about hours and when closing the wound he injects a cocktail of medications to help with the inflammation and pain. Patients can be up and walking usually within three hours after the surgery. But they must have someone around the first night they are spending at home postsurgery. The people who are against the whole idea for sameday discharge for hip replacement are concerned about the very rare instances where somebody could develop a blood clot that goes to the lung or a fracture of some sort said Davidovitch. The rates of blood clots or pulmonary emboli is exceedingly low. And in general if a patient is identified as a high risk or a higher risk we dont send them home the same day. Davidovitch makes it clear that this kind of surgery is not onesizefitsall. Patients are screened first to make sure they dont have risk factors like obesity chronic liver disease or cardiac problems https Those who have risk factors must plan on staying overnight in the hospital not going right home. However not every surgeon is embracing the sameday trend. Douglas E. Padgett M.D. chief of the joint replacement service at Hospital for Special Surgery in New York is a lot more conservative about who he believes is the optimal patient for going home the same day. The number of patients that are going home at this point in time in our institution is somewhere between one and two percent. So its a relatively small percentage of patients that are going directly home said Padgett. Padgett has seen an increase in the number of hip replacement patients and a decrease in their age some are as young as their s and s. He said his department performs the most hip replacements of any institution in the U.S. doing about a year. While he is not against patients going home the same day he cautions that total joint replacement is a major procedure and doctors need to be careful to avoid sending patients home too soon. While I recognize there is no place like home should there be the need for urgent or medical care the question is will that be available to the patient when theyre in the setting of their own home Padgett said. Debbie Spina met all the requirements to go home the same day. Her surgery lasted about an hour which is the average time for her type of procedure. After the the operation she was able to move around but felt dizzy and nauseous. The occupational and physical therapists waited until evening to try and get her to go up and down steps and walk around which patients must be able to do before they are discharged. But Spina didnt feel well enough so she actually ended up spending the night. Even though her sameday discharge didnt go as planned Spina felt good the following morning and was able to do her exercises and leave the hospital. After her recovery is complete she has a few goals shed like to reach. I had walked prior to this four miles every morning Id like to do that. And Id like to improve my golf game if possible Spina said while smiling. Davidovitchs goal is for patients to return to their normal level of activity as quickly as possible. And with many people wanting to maintain active lifestyles well into their s and beyond he expects to see even greater demand for hip replacement surgery and the sameday option. In general I see this growing to about percent of my practice he said."

"By substituting a healthy gene for a defective one scientists were able to partially restore the hearts ability to pump in heart failure patients researchers report. This is the first time gene therapy has been tested and shown to improve outcomes for patients with advanced heart failure study lead author Dr. Donna Mancini professor of medicine and the Sudhir Choudhrie professor of cardiology at Columbia University College of Physicians and Surgeons in New York City said in a university news release. The therapy works by replenishing levels of an enzyme necessary for the heart to pump more efficiently by introducing the gene for SERCAa which is depressed in these patients. If these results are confirmed in future trials this approach could be an alternative to heart transplant for patients without any other options she added. Mancini presented the results Monday at the annual meeting of the American Heart Association AHA in Chicago. The gene for SERCAa raises levels of the enzyme back to where the heart can pump more efficiently. The enzyme regulates calcium cycling which in turn is involved in how well the heart contracts the researchers said. Heart failure is a defect in contractility related to calcium cycling explained Dr. Robert Eckel past president of the AHA and professor of medicine at the University of Colorado Denver. The study authors hope that if replicated in larger trials the genetherapy treatment could actually delay or obviate the need for heart transplants in patients with heart failure. There are a lot of treatments for heart failure but at some point patients stop responding and then the prognosis is poor said Dr. Rita Redberg AHA spokeswoman and professor of medicine at the University of California San Francisco. After that the only option is a transplant. For this phase study patients with advanced heart failure were randomly chosen to receive either the gene therapy through cardiac catheterization or a placebo. At both six months and a year later the patients who had received the new gene saw their risk for death cardiac transplantation worsening heart failure and hospitalization decline by half. Results were even more heartening at higher doses where participants had an percent decrease in risk for death cardiac transplant hospitalizations and other outcomes the study authors said. Redberg cautioned that the study was still preliminary and requires more investigation. And research presented at meetings isnt subjected to the same level of scrutiny as studies published in peerreviewed journals. The study was funded by the Celladon Corp. of La Jolla Calif. More information The American Heart Association has more on heart failure http_UCM__Article.jsp. SOURCES Rita Redberg M.D. professor of medicine University of California San Francisco and spokeswoman American Heart Association Robert Eckel M.D. professor of medicine University of Colorado Denver and past president American Heart Association study abstract Nov. American Heart Association annual meeting Chicago"

"Among older adults with an unstable ankle fracture the use of a modified casting technique known as close contact casting a molded belowknee cast with minimal padding resulted in similar functional outcomes at months compared with surgery and with fewer wound complications and reduced intervention costs according to a study appearing in the October issue of JAMA. The number of older adults sustaining ankle fractures is increasing. Treatment of unstable fractures is either surgical or nonsurgical using externally applied casts. Neither method yields an entirely satisfactory outcome in older adults. Traditional casting techniques are associated with poor fracture alignment and healing as well as plasterrelated sores. Surgery is often complicated by poor implant fixation bone healing wound problems and infection. A modified casting technique has been developed close contact casting which uses minimal padding compared with traditional casting and achieves fracture reduction by distributing contact pressure by close anatomic fit. Keith Willett M.B.B.S. F.R.C.S. of the University of Oxford United Kingdom and colleagues randomly assigned adults older than years with acute unstable ankle fracture to surgery n or casting n . Casts were applied in the operating room under general or spinal anesthesia by a trained surgeon. Among the adults average age years percent women who were randomized percent completed the study. Nearly all participants percent received assigned treatment of percent who initially received casting later converted to surgery. At months casting resulted in measures of ankle function equivalent to that with surgery. Infection and wound breakdown were more common with surgery percent vs percent as were additional operating room procedures percent vs percent. Radiologic malunion abnormal healing of a fracture was more common in the casting group percent vs percent for surgery. Casting required less operating room time compared with surgery. There were no significant differences in other secondary outcomes quality of life pain ankle motion mobility and patient satisfaction. Close contact casting was delivered successfully for most participants substantially reducing the number of patients requiring invasive surgical procedures at the outset and additional operations during a month period the authors write. The researchers add that close contact casting may be an appropriate treatment for older adults with unstable ankle fracture. doi.jama.. the study is available preembargo to the media at the For the Media website Editors Note Please see the article for additional information including other authors author contributions and affiliations financial disclosures funding and support etc. Editorial Close Contact Casting vs Surgery for Unstable Ankle Fractures The results reported by Willett et al demonstrate that most unstable ankle fractures in older patients can be treated with a cast without the need for surgery writes David W. Sanders M.D. M.Sc. F.R.C.S.C. of Western University London Ontario Canada in an accompanying editorial. However many patients who were initially treated by casting subsequently required repeat casting or surgery. Further studies are needed to help identify which patients will not benefit from casting. Although close contact casting may be unfamiliar to some orthopedic surgeons it can avoid surgery for older patients with ankle fractures yet result in equivalent functional outcomes. This technique is worth considering when treating this challenging clinical problem. doi.jama.. the study is available preembargo to the media at the For the Media website Editors Note The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. To place an electronic embedded link to these articles in your story These links will be live at the embargo time httpjama.jamanetwork.comarticle.aspxdoi.jama.. httpjama.jamanetwork.comarticle.aspxdoi.jama.."

"Many migraine sufferers could have fewer less severe headaches if they took preventive medicines but few eligible patients do say doctors releasing updated treatment guidelines Monday. Not everyone with migraines needs prevention medicine. Not everyone with migraines needs prevention medicine. The guidelines list seven prescription medicines and one herbal remedy backed by strong evidence and include many other treatments that might work for some patients. Migraine is one of the most disabling conditions known to man but patients need to know that there is hope says Stephen Silberstein a neurologist at Thomas Jefferson University in Philadelphia and lead author of the guidelines from the American Academy of Neurology httpcontent.usatoday.comtopicstopicAmericanAcademyofNeurology and the American Headache Society. They were presented at an academy meeting and published in the journal Neurology. Medicines backed by the strongest evidence include antiseizure drugs divalproex sodium sodium valproate and topiramate blood pressure drugs metoprolol propranolol and timolol and for menstrualrelated migraines a medicine called frovatriptan the guidelines say. They also cite strong support for the herbal remedy butterbur and include a longer list of prescription and nonprescription therapies patients can consider. More about migraines Migraines are not ordinary headaches. They cause throbbing pain often on one side of the head and can come with nausea vomiting and sensitivity to light and sound. Visual disturbances or other warning signs called auras may precede the headaches. Migraines are three times more common in women than men. In some susceptible people stress bright lights lack of food or sleep hormonal changes or other triggers may play roles. Source National Institute of Neurological Disorders and Stroke These preventive treatments usually are used daily. The guidelines do not look at the options patients have once symptoms begin. Not everyone with migraines needs prevention medicine. But nearly have headaches that are so frequent at least once a week severe or hardtotreat that they qualify Silberstein says. Studies find that just to use the treatments. Why so few One reason is that its hard to persuade people to take medicines on days when they feel fine says Elizabeth Loder a neurologist at Brigham and Womens Hospital in Boston. Silberstein adds that some patients have not been properly diagnosed or made aware of their options. Still others try the treatments and decide they dont work or have unacceptable side effects. You have a lot of gunshy patients because of a lot of bad experiences says Michael John Coleman founder of the patient group MAGNUM also known as the National Migraine Association. Many spend months or years taking medicines that dont work and make them miserable he says. Thats what happened to Emily Guzan a lawyer from Pittsburgh who was diagnosed with migraine in . She was given a prescription for Topamax topiramate and it was a real nightmare she says. She kept having headaches bad enough to land her in an emergency room once a month and suffered nightmares an altered sense of taste an unwanted pound weight loss and memory problems all of which she attributes to the drug. She tried some other medications but for now shes given up on all of them and says shes getting better results with diet yoga and other lifestyle changes. Finding the right medication for the right patient can take a lot of trial and error and careful dosing Silberstein says. But about will get relief he says defined as a headache reduction of at least after trying three or four drugs alternative remedies and lifestyle changes. Even hardtotreat patients may eventually respond to something Loder says so she urges frustrated patients to keep trying. The life toll that poorly controlled headaches take is really underappreciated she says. You dont get back the time you lost at work or the time you lost with your children. Coleman of Alexandria Va. also urges fellow sufferers to keep working with their doctors His own migraines took years to control. This is not a cookiecutter disease and there is no magic bullet but there is hope."

"An inhaler that protects the lungs against air pollution has been developed by scientists and could help the many millions of people affected by toxic air to avoid its worst effects. The inhaler delivers a molecule first found in bacteria in the Egyptian desert which stabilises water on the surface of the lung cells to form a protective layer. It is expected to be available as an inexpensive overthecounter product. Outdoor air pollution is a global health crisis that kills over million people a year https and it has long been linked to lung and heart disease and strokes. But research is also uncovering new impacts on health including degenerative brain diseases such as Alzheimers https mental illness https_btn_tw and this week diabetes http Advertisement The impact of air pollution costs tn a year https according to a World Bank report published last week. In the UK at least people a year die prematurely https from air pollution with a crossparty committee of MPs calling it a public health emergency https But the governments plans to tackle the issue were heavily criticised this week https just as alerts were issued for extreme air pollution across much of northern England. A day later it was announced that more ambitious plans for London from Mayor Sadiq Khan were overwhelmingly backed by the public https Vehicles are a key contributor to air pollution but a year after the VW emissions scandal broke most new diesel cars still emit far more toxic nitrogen oxides https on the road than the official labbased limit. Action to clean up air is urgently needed across the world but cutting emissions for vehicles and other sources will take years meaning ways to reduce the harm in the meantime could be vital. The new inhaler has been developed by German medical devices company Bitop http and is based on a molecule called ectoine discovered in the s in a desert bacterium which uses the compound to conserve water in C heat. It is quite an inert molecule that does one main thing which is bind water which stabilises cell membrane tissues against physical or chemical damage said Dr Andreas Bilstein at Bitop. It supports the natural barrier. When inhaled this helps prevent the damage caused by air pollution particles that can lead to asthma chronic obstructive pulmonary disease COPD and lung cancer Bilstein said Damage cannot occur as strongly and there is less inflammatory response and so disease progression is reduced. The perfect situation is that the patient inhales in the morning and evening at home. The inhaler has been tested in three small groups of patients particularly at risk from air pollution due to asthma COPD and bronchitis with the positive results due to be published soon Bilstein said. Ectoine does not interact with cell receptors so it is classed as a medical device rather than a drug. This means large clinical trials are not required for official approval and the inhaler could be on sale soon at an estimated cost of a month after Bitop selects a marketing partner. A version of the product for use in nebulisers will be available this year in Germany and Poland while an ectoinebased nasal spray for allergy relief is already available https Bilstein said the inhaler could be useful around the world as particulate air pollution is not just a European problem Especially in Asia China in particular the demand for such a product is even higher. I was in New York last week and the air was also not very clean. The protective effect of ectoine was discovered by Prof Jean Krutmann and colleagues at the Leibniz Research Institute for Environmental Medicine while investigating whether the molecule could protect skin against sun damage. Bitop funded a series of studies now published httpjournals.plos.orgplosonearticleid.journal.pone. in prominent http scientific journals httperj.ersjournals.comcontent. The point that it can prevent the lung inflammation induced by ultrafine particles is established there is no more doubt Krutmann said. Antioxidants can also provide some protection but there has been controversy over the effectiveness of such food supplements he said Personally I think it is much better to eat lots of vegetables and fruit rather than taking any supplements. Dr Richard Russell a consultant respiratory physician in the NHS and medical advisor to the British Lung Foundation who was not involved in the research said the inhaler was both credible and promising Ectoine is a beautifully elegant molecule and it clearly works by helping water to stabilise giving you a film of water in times of stress. The work that has been published thus far in credible internationally recognised journals show that this stuff has positive properties protecting against triggered inflammation he told the Guardian. Russell who also lectures at Imperial College and Oxford University said it might also be useful for the treatment of asthma COPD and other lung diseases not only prevention. It could potentially do so much more. It is actually quite exciting and there is clearly a lot more to come from this story. Krutmann said slashing air pollution remained paramount. It is very nice to be able to protect people against the detrimental effects but this should not be used as an argument that we can now stop working on reducing particulate air pollution. The best thing is that we have clean air because then we dont need any prophylactic treatment. But on the other hand we have to be realistic and in many countries you cannot just switch traffic overnight to electric cars and do other drastic things. It will take many more years especially in countries like China and I think there is an ethical need to provide something to the general population to protect them he said."

"A study shows that not all good fats are the same when it comes to protecting your health. For decades the message about fats has been relatively simple reduce the amount of oils and fats you eat from animal and dairy products less red meat and cheese and substitute them with healthier fats from plants or fish olive oil httptopics.time.comoil omega fatty acids. The difference came down to the specific type of fats that make up these foods animal and dairy fats tend to be saturated which means all of the free bonds available in a chain of carbon atoms are bound to hydrogen atoms while plant fats are unsaturated meaning some of carbon atoms have double bonds with each other. Saturated fats are more likely to build up within artery walls and form plaques that can trigger heart attacks httptopics.time.comheartattacks. But in the latest study on fats published in the BMJ researchers found convincing evidence that not all plant fats are created equal and that linoleic acid or omega fatty acids may be associated with a higher risk of early death from any cause as well as increased risk of heart disease httptopics.time.comheartdisease and death from heartrelated conditions. The study is actually a reanalysis of data that had not been included in the original publication of results from the Sydney Diet Heart Study a trial that was conducted from to . For more than three years researchers at the time followed men aged to years old who had a history of heart disease about half were told to replace the saturated fats they consumed from animal and dairy sources with omega linoleic acid which is commonly found in safflower oil or margarines made from it. The other half were not told to change their diet in any way. When that study was published in researchers noted an increased risk of early death from any cause among the omega group but did not break down the data by what caused the deaths. MORE Study Good Fats Even Better for the Heart Than We Thought httphealthland.time.comstudygoodfatsevenbetterfortheheartthanwethought So Dr. Christopher Ramsden a clinical investigator at the National Institutes of Health who was interested in understanding the effects of linoleic acid on heart health contacted one of the original authors and reviewed data that had not been included in the study. This information involved deaths from heartrelated causes and the new analysis showed that the omega group had a higher risk of dying during the study period from heart disease compared with among the control group. The American Heart Association AHA currently recommends that people replace to of their daily saturatedfat intake with foods containing unsaturated fats such as canola and olive oils. The AHA further breaks down the unsaturatedfat advice by suggesting that people devote about to of their daily calories to foods containing linoleic acid. The recommendation is based on a review of the available data. MORE Study Eating Omegas May Help Reduce Alzheimers Risk httphealthland.time.comeatingomegasmayhelpreducealzheimersrisk The latest results however raise questions about that advice. Ramsden says the findings provide some refined understanding of unsaturated fats which come in different chemical forms that may have varying benefits or risks. I wouldnt necessarily say that the current advice is necessarily completely wrong he says. What happened is that in the s all polyunsaturated fats were considered the same. They were grouped together under one mechanism of being able to lower bloodcholesterol levels. Then over the ensuing decades it became clear as science progressed that there were multiple types of polyunsaturated fats and these compounds potentially have distinct biochemical and health effects. There has been some evidence to suggest that omega fatty acids for example may trigger inflammation a condition that is linked to an increased risk of heart problems while omega fatty acids found in deepwater fish like salmon tend to inhibit inflammatory reactions. Ramsden says the results highlight the need to study dietary ingredients in more detail rather than lumping them together and assuming they have the same effect on the body. MORE Can Olive Oil Help Prevent Stroke httphealthland.time.comcanoliveoilhelppreventstroke Recognizing that need the AHA says it is considering reevaluating all its dietary recommendations and will make the issue of polyunsaturated fats part of this assessment. Reviewing the dietary advice as a whole is important says Alice Lichtenstein a spokesperson for the association since changes in one area could have unexpected and potentially harmful effects on other eating habits. When health organizations advised people to lower their intake of saturated fats for example many replaced the fats with carbohydrates which can increase risk of diabetes and lead to higher levels of another type of fat in the blood triglycerides. One of the things we learned is that we need to look at the whole picture says Lichtenstein. Just looking at one individual component puts undue emphasis on that component and may lead to unanticipated consequences. We need to look at dietary patterns rather than individual nutrients or individual food components. Whether the association will change its advice about consuming linoleic acid isnt clear yet but Ramsden says the results of the latest study could have important implications for the way people eat if they want to stay hearthealthy."

"British scientists conducting earlystage research have found that a potential new drug from GlaxoSmithKline could treat mixedlineage leukemiaMLL the most common form of leukemia in babies. Signage is pictured on the company headquarters of GlaxoSmithKline in west London July . REUTERSToby Melville In a study published in the journal Nature scientists from the British drugmaker collaborating with the charity Cancer Research UK CRUK and Cellzome AG found that the experimental drug called IBET mimics a chemical tag which is key to preventing the process of activating the leukemia genes. This ... is an exciting new avenue for drug discovery which we hope will be useful for other types of cancer in addition to MLLleukaemias said Tony Kouzarides of the Wellcome TrustCRUK Gurdon Institute at Cambridge University who coled the study. Kevin Lee head of epigenetics discovery research at GSK who also worked on the study said he too was excited about the findings although it will probably be many years before the drug could potentially reach the market. Even though this is still labbased ... it validates the idea of developing small molecules against epigenetic switches he said in an emailed comment. It is important to remember we will need to be successful on a number of additional steps before we can move this from the lab to testing this compound in humans. MLL leukemia is thought to account for up to percent of cases of acute leukemia in children below two years old and up to one in cases in adults. Most patients dont respond well to standard leukemia treatments and often the cancer comes back. The disease is caused when a gene called MLL gets fused to another gene. This disrupts the normal function of MLL by creating a new fusion protein that behaves wrongly switching on genes that drive the development of leukemia. Kouzaridess team found that in the disease the MLLfusion proteins are targeted to leukemiacausing genes by proteins from the BET family which recognize certain chemical tags on chromatin the scaffold on which DNA is arranged. Using IBET to treat leukaemias in mice and human cancer cells in a lab the researchers found that the chemical could halt the disease paving the way for more research to be done in firststage or socalled Phase I human trials. We urgently need better ways to treat children with more aggressive forms of leukemia such as MLL said Lesley Walker CRUKs director of information. Although this research is only in the lab at the moment we hope it will move quickly toward clinical trials in patients. Leukemia is the most commonly diagnosed cancer in children and accounts for a around a third of all cancers diagnosed in children. According to Cancer Research UK eight out of children with leukemia in Britain now survive for five years or more compared with one in in the late s. Editing by Sugita Katyal Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Millions of people visit the websites of the Mayo Clinic American Cancer Society and the Centers for Disease Control and Prevention among others seeking authoritative health information. But are they receiving it When it comes to learning about the differences in risk among certain types of nicotine products many government websites are actually misleading or underinforming the public according to two researchers who analyzed the content of numerous health websites. This information quarantine in turn helps explain the woeful lack of public knowledge about relative risks violating basic consumer rights as well as the public health principles of individual rights and health literacy the researchers say. Writing in the International Journal of Drug Policy http Lynn Kozlowski of the University at Buffalo and David Sweanor of the University of Ottawa point out that many websites omit information showing that products such as ecigarettes smokeless tobacco and snus are far less harmful than traditional cigarettes. Public health ethics always has a concern to avoid any net harm to population health explains Kozlowski professor of community health and health behavior at UB and the papers lead author. The fear has been that much safer tobacco and nicotine products like snus smokeless tobacco and vape will possibly cause a net loss to public health because more people will use these products and these products may lead to cigarette use. This fear however is not based on actual evidence and cannot be used to suppress or otherwise keep the public uninformed of what is clearly known about the lower risks of these products adds Kozlowski PhD one of the worlds leading researchers on smoking behavior. An information quarantine functions similarly to a medical quarantine think of your favorite zombie movie or television show in which the infected person is secluded from everyone else to protect the overall public. In order to justify a quarantine there has to be clear evidence that the need to protect population health should overrule personal autonomy. In the case of providing information on differential health risks of nicotine products The evidence to date does not come close to establishing that there would be a loss to public health from making this information widely available from credible sources Kozlowski says. Kozlowski and Sweanor reviewed several major health websites including the CDC Mayo Clinic American Cancer Society Substance Abuse and Mental Health Services Administration and the National Cancer Institute and found three types of examples of information on smokeless tobacco but notomodest efforts to inform consumers of the significantly lower risks compared to cigarettes for lifelong users the researchers write. In fact they found that the Mayo Clinic perpetuated a misrepresentation discovered in erroneously informing visitors that smokeless tobacco was as dangerous as cigarettes. The day after the article was released the Mayo Clinic removed the headline replacing it with the still misleading statement that smokeless tobacco was not a safe product. People can only make as good a decision as the information available to them allows said Sweanor an adjunct professor in the University of Ottawas Faculty of Law who has spearheaded the development of worldleading tobacco control initiatives in Canada since the early s. The public is dramatically misinformed about the relative risks of substitutable tobacco and nicotine products. The risk differentials are huge but this is simply not known by a vast majority of those whose lives are at risk adds Sweanor. England has an example of a website Action on Smoking and Health ASH that gets it right on vaping the researchers said. A briefingDownload pdf http_.pdfqcigarettes posted on the site specifically states Compared to tobacco products electronic cigarettes are significantly safer. In their paper the researchers note that information on comparative risks is common for other products and activities like overthecounter medicines and even safety ratings of vehicles. They argue that the U.S. Food and Drug Administration FDA which regulates the sale of tobacco products isnt doing its part to inform consumers of important differences in harm among tobacco products. To illustrate their point Kozlowski and Sweanor use the example that if one type of alcoholic beverage caused in regular users to die prematurely as is the case with smoking traditional cigarettes while another caused massively fewer deaths consumers would want to know which product was the safer alternative. It would be scandalous even criminal to keep such facts from consumers the researchers write. Yet such facts are being kept from adult consumers of legal tobacconicotine products either by not informing or actively misinforming consumers. It is as if tobacco consumers were blindfolded and not allowed to see dramatic differences in harm from different products."

"A new device worn like a visor can detect emergent largevessel occlusion in patients with suspected stroke with percent accuracy report clinical investigators at the Medical University of South Carolina MUSC Mount Sinai the University of Tennessee Health Sciences Center and elsewhere in an article published online on March in the Journal of Neurointerventional Surgery. Patients with largevessel occlusions can then be routed to a Comprehensive Stroke Center with endovascular capabilities. In contrast a standard physical examination achieved only to percent accuracy in identifying patients with largevessel occlusion who could benefit from endovascular therapy. The volumetric impedance phase shift spectroscopy VIPS device Cerebrotech VisorTM Cerebrotech Medical Systems Pleasanton CA works by sending lowenergy radio waves through the brain that change frequency when passing through fluids. Such waves are reflected back through the brain and then detected by the device. When a patient is having a severe stroke the brains fluids will change producing an asymmetry in the radio waves detected by the VIPS device. The greater the asymmetry the more severe the stroke. Endovascular therapy within hours is the standard of care for emergent largevessel occlusion but the chance of achieving a good outcome decreases by approximately percent for each hour that passes before treatment. The researchers hope that the device will save valuable time especially important in stroke where time is brain when it is deployed with emergency medical personnel in the field. This is because the accuracy of the device simplifies the decision made by emergency personnel about where to take patients first according to Raymond D. Turner M.D. professor of neurosurgery and chief of the Neuroscience Integrated Center of Clinical Excellence at MUSC. Turner served as principal investigator for MUSC in the VIPS for the NonInvasive Detection of Hemispheric Bioimpedance Asymmetry in Severe Brain Pathology VITAL study reported in the article. Transfer between hospitals takes a lot of time said Turner. If we can give the information to emergency personnel out in the field that this is a largevessel occlusion that should change their thought process in triage as to which hospital they go to. In the study the VIPS device was deployed with emergency medical personnel in regions served by five Comprehensive Stroke Centers equipped with the endovascular capabilities to treat largevessel occlusions that underlie severe stroke. Their goal was to use the device to accurately identify severe stroke and then compare the results to established physical examination methods practiced by emergency personnel such as the Prehospital Acute Stroke Severity Scale. Both healthy participants and patients with suspected stroke were evaluated by emergency personnel using the VIPS device. Three readings were taken and averaged a process that takes about seconds. Patients were also later evaluated by neurologists who provided definitive diagnoses using neuroimaging. Compared to the neurologists diagnoses the device displayed percent specificity the ability to detect the difference between patients with severe stroke and those with other conditions such as mild stroke or healthy participants with no brain pathology. This places the VIPS device above standard physical examination tools used by emergency personnel that display specificity scores between and percent. The VIPS device is made by Cerebrotech Medical Systems which paid consultants to analyze the neuroimaging data independently. The neuroimaging data was needed to teach the VIPS device which radio waves were indicative of stroke. Yet the consultants did not have access to the VIPS radio wave data during their review of the images thereby eliminating the potential of the consultants to choose data that might artificially inflate the devices accuracy. It is also not clear how the device would work for patients with cranial implants as metal interferes with the devices operating radio frequencies. The devices success may be found in its ability to give emergency personnel a clear answer as to whether a patient is experiencing a severe stroke. The VIPS device requires very little training to operate compared to that required to learn standard emergency examination skills thereby reducing the possibility of human error during emergency diagnosis. In their next steps the researchers are undertaking the VITAL . study to determine if the VIPS device can use complex machine learning algorithms to teach itself how to discriminate between minor and severe stroke without the help of neurologists. If so the VIPS device could have widespread clinical implications helping emergency personnel decide whether to take a patient to a comprehensive stroke center or a primary stroke center for treatment. Turner likens the use of the VIPS device in detecting severe stroke to the use of electrocardiography ECG to definitively detect acute myocardial infarction. He predicts that the device has the potential to be used widely by emergency personnel but also to appear in other public spaces. This could potentially be something like a defibrillator said Turner. You can find out if a patient is having a stroke just like you can put a defibrillator on a patient to see if theyre having a heart attack. This study was funded by Cerebrotech Medical Systems. About MUSC Founded in in Charleston The Medical University of South Carolina is the oldest medical school in the South. Today MUSC continues the tradition of excellence in education research and patient care. MUSC educates and trains more than students and residents and has nearly employees including approximately faculty members. As the largest nonfederal employer in Charleston the university and its affiliates have collective annual budgets in excess of . billion. MUSC operates a bed medical center which includes a nationally recognized Childrens Hospital the Ashley River Tower cardiovascular digestive disease and surgical oncology Hollings Cancer Center a National Cancer Institute designated center Level I Trauma Center and Institute of Psychiatry. For more information on academic information or clinical services visit musc.edu. For more information on hospital patient services visit muschealth.org."

"Antiinflammatory drugs similar to those used to treat conditions such as rheumatoid arthritis and psoriasis could in future be used to treat some cases of depression concludes a review led by the University of Cambridge which further implicates our immune system in mental health disorders. Researchers from the Department of Psychiatry at Cambridge led a team that analysed data from clinical trials involving the use of anticytokine drugs to treat a range of autoimmune inflammatory diseases. By looking at additional beneficial sideeffects of the treatments the researchers were able to show that there was a significant antidepressant effect from the drugs compared to a placebo based on a metaanalysis of seven randomised controlled trials. Metaanalyses of the other types of clinical trials showed similar results. When we are exposed to an infection for example influenza or a stomach bug our immune system fights back to control and remove the infection. During this process immune cells flood the blood stream with proteins known as cytokines. This process is known as systemic inflammation. Even when we are healthy our bodies carry trace levels of these proteins known as inflammatory markers which rise exponentially in response to infection. Previous work from the team found that children with high everyday levels of one of these markers are at greater risk of developing depression and psychosis in adulthood suggesting a role for the immune system particularly chronic lowgrade systemic inflammation in mental illness. Inflammation can also occur as a result of the immune system mistaking healthy cells for infected cells and attacking the body leading to autoimmune inflammatory diseases such as rheumatoid arthritis psoriasis and Crohns disease. New types of antiinflammatory drugs called anticytokine monoclonal antibodies and cytokine inhibitors have been developed recently some of which are now routinely used for patients who respond poorly to conventional treatments. Many more are currently undergoing clinical trials to test their efficacy and safety. The team of researchers carried out a metaanalysis of these clinical trials and found that the drugs led to an improvement in the severity of depressive symptoms independently of improvements in physical illness. In other words regardless of whether a drug successfully treated rheumatoid arthritis for example it would still help improve a patients depressive symptoms. Their results are published today in the journal Molecular Psychiatry. Dr Golam Khandaker who led the study says Its becoming increasingly clear to us that inflammation plays a role in depression at least for some individuals and now our review suggests that it may be possible to treat these individuals using some antiinflammatory drugs. These are not your everyday antiinflammatory drugs such as ibuprofen however but a particular new class of drugs. Its too early to say whether these anticytokine drugs can be used in clinical practice for depression however adds Professor Peter Jones coauthor of the study. We will need clinical trials to test how effective they are in patients who do not have the chronic conditions for which the drugs have been developed such as rheumatoid arthritis or Crohns disease. On top of this some existing drugs can have potentially serious side effects which would need to be addressed. Dr Khandaker and colleagues believe that antiinflammatory drugs may offer hope for patients for whom current antidepressants are ineffective. Although the trials reviewed by the team involve physical illnesses that trigger inflammation and hence potentially contribute to depression their previous work found a connection between depression and baseline levels of inflammation in healthy people when someone does not have an acute infection which can be caused by a number of factors such as genes and psychological stress. About a third of patients who are resistant to antidepressants show evidence of inflammation adds Dr Khandaker. So antiinflammatory treatments could be relevant for a large number of people who suffer from depression. The current approach of a onesizefitsall medicine to treat depression is problematic. All currently available antidepressants target a particular type of neurotransmitter but a third of patients do not respond to these drugs. We are now entering the era of personalised medicine where we can tailor treatments to individual patients. This approach is starting to show success in treating cancers and its possible that in future we would use antiinflammatory drugs in psychiatry for certain patients with depression. The research was mainly funded by the Wellcome Trust with further support from the National Institute for Health Research NIHR Cambridge Biomedical Research Centre. Reference Kappelmann N et al. Antidepressant activity of anticytokine treatment a systematic review and metaanalysis of clinical trials of chronic inflammatory conditions. Molecular Psychiatry Oct DOI .mp.."

"Current models require users to test a drop of blood twice daily to calibrate or adjust the monitor. The pain of finger sticks and the cost of testing supplies discourage many people from keeping close tabs on their blood sugar which is needed to manage insulin use and adjust what they eat. Abbotts new FreeStyle Libre Flash Glucose Monitoring System approved Wednesday by the Food and Drug Administration uses a small sensor attached to the upper arm. Patients wave a reader device over it to see the current blood sugar level and changes over the past eight hours. Most of the million Americans with diabetes use standard glucose meters which require multiple finger pricks each day and only show current sugar level. Moreaccurate continuous glucose monitoring devices are used by about Americans. But most dont do the finger pricks to calibrate them and may get inaccurate readings said Dr. Timothy Bailey who helped test FreeStyle Libre. Were able to lower blood sugar safely with this technology said Bailey director of the Advanced Metabolic Care and Research Institute in California. He receives consulting fees from various diabetes device makers. Toohigh blood sugar levels can damage organs and lead to heart attacks strokes blindness and amputations. Very low blood sugar can cause seizures confusion and loss of consciousness. Abbotts device was approved for adults with Type or Type diabetes and should be available in pharmacies within months. The company based near Chicago did not disclose the price of the reader or the sensors. Abbotts system cant be used with an insulin pump a device worn against the skin that allows users to inject insulin as needed but the company is planning improvements to eventually enable that. Rival Medtronic this spring launched a device in which the insulin pump automatically responds to blood sugar changes recorded by the sensor and either withholds or injects insulin as needed."

"People with stage III colon cancer who regularly eat nuts are at significantly lower risk of cancer recurrence and mortality than those who dont according to a new large study led by researchers at Yale Cancer Center. The findings were published today in the Journal of Clinical Oncology. The study followed participants in a clinical trial for a median of . years after they were treated with surgery and chemotherapy. Those who regularly consumed at least two oneounce servings of nuts each week demonstrated a improvement in diseasefree survival and a improvement in overall survival. Further analysis of this cohort revealed that diseasefree survival increased by among the subgroup of nut consumers who ate tree nuts rather than peanuts said Charles S. Fuchs M.D. director of Yale Cancer Center and senior author of the study. Tree nuts include almonds walnuts hazelnuts cashews and pecans among others. In contrast peanuts are actually in the legume family of foods. These findings are in keeping with several other observational studies that indicate that a slew of healthy behaviors including increased physical activity keeping a healthy weight and lower intake of sugar and sweetened beverages improve colon cancer outcomes said Temidayo Fadelu M.D. a postdoctoral fellow at DanaFarber Cancer Institute and lead author of the paper. The results highlight the importance of emphasizing dietary and lifestyle factors in colon cancer survivorship. Additionally the researchers emphasized the study highlighted connections between biological mechanisms that worsen disease not just in colon cancer but in certain chronic illnesses such as type diabetes. Many previous studies have reported that nuts among other health benefits may help to reduce insulin resistance a condition in which the body has difficulty processing the insulin hormone. Insulin resistance leads to unhealthy levels of sugar in the blood and is often a predecessor to type diabetes and related illnesses. Earlier research among patients with colon cancer has revealed worse outcomes among those with lifestyle factors such as obesity lack of exercise and a diet with high levels of carbohydrates that heighten insulin resistance and quickly raise levels of blood sugar. These studies support the hypothesis that behaviors that make you less insulinresistant including eating nuts seem to improve outcomes in colon cancer Fuchs said. However we dont know yet what exactly about nuts is beneficial. Nuts also might play a positive role by satisfying hunger with less intake of carbohydrates or other foods associated with poor outcomes Fuchs noted. Patients may not be eating nuts due to concerns about the high fat content said Fuchs. For example a oneounce serving of about almonds holds about calories including grams of fat. People ask me if increasing nut consumption will lead to obesity which leads to worse outcomes he said. But whats really interesting is that in our studies and across the scientific literature in general regular consumers of nuts tend to be leaner. Dietary changes can make a difference. An earlier analysis of diets in the same patient cohort by Fuchs and his colleagues found a significant link between coffee consumption and reduced recurrence and mortality in colon cancer. When Fuchs advises his patients about lifestyle choices first and foremost I talk about avoiding obesity exercising regularly and staying away from a highcarbohydrate diet he said. Then we talk about things like coffee and nuts. If you like coffee or nuts enjoy them and if you dont there are many other helpful steps you can take. Overall we are working to apply the same rigorous science to the understanding of diet and lifestyles in the colon cancer patient population that we apply to defining new drugs Fuchs said. Cocorresponding authors on the paper are Jeffrey Meyerhardt M.D. of DanaFarber and Ying Bao M.D. of Brigham and Womens Hospital. Lead funding for the research was provided by the National Cancer Institute. Support also came from private sponsors including Pfizer Oncology and the International Tree Nut Council Nutrition Research Education Foundation. The private sponsors did not participate in the design conduct or analysis of the study or in review or approval of the paper."

"UNC researchers say the results from the multisite phase and trials of brexanolone injection are not only promising but could change the way postpartum depression PPD is treated. Brexanolone injection works differently than existing antidepressant medications and if approved by the U.S. Food and Drug Administration FDA later this year will be the first new class of antidepressants in decades and the first drug specifically indicated for PPD. With current antidepressant SSRIs selective serotonin reuptake inhibitors it could take four to six weeks to get a treatment response. In the brexanolone trials we saw patients starting to feel better within days said the trials academic principal investigator Samantha MeltzerBrody https MD MPH director of Perinatal Psychiatry Program at the UNC School of Medicine. David Rubinow MD chair of the Department of Psychiatry at the UNC School of Medicine and a coauthor of the paper says time is especially crucial for new mothers experiencing postpartum depression because the weeks and months following birth are a critical period for motherinfant bonding. Common symptoms of PPD a mood disorder in women that can be triggered by fluctuations in reproductive hormones include low mood feeling overwhelmed anxious and ruminating thoughts potential withdrawal from the baby and her family and suicidal thoughts in the most severe cases. PPD is one of the most common complications of pregnancy with between and percent of mothers worldwide experiencing it. Having a drug developed specifically for postpartum depression is a gamechanger for womens health said MeltzerBrody. With our latest results we believe that brexanolone if approved could provide relief for women with a range of postpartum severity. The paper published in The Lancet includes a new integrated analysis of results from three doubleblind placebocontrolled trials that took place at sites in the U.S. including UNCs Perinatal Psychiatry Unit. Eligible women were aged years old and were six months postpartum or less at screening. They also had to be experiencing moderate to severe postpartum depression which was assessed by the Hamilton Depression Rating Scale HAMD. The integrated analysis looked at results of the trials which randomized women to receive a doubleblinded hour infusion of either brexanolone injection gkghr or placebo. A unique dose group of brexanolone gkghr in one of the studies was not included in the integrated efficacy analysis but was included in integrated analyses of safety. Brexanolone injection gkghr was administered to women with moderate or severe PPD who also were evaluated throughout the infusion after the infusion stopped and then periodically for up to days. Another women were administered a placebo and evaluated during the same timeframe. The first statistically significant reduction in depression severity with brexanolone injection relative to placebo was observed as early as hours after dosing. At the end of the hour infusion the average reduction in patients Hamilton Rating Scale for Depression HAMD or depression severity score was . points for women in the brexanolone injection gkghr group versus . in the placebo group p.. The reduction of symptoms in the patients receiving brexanolone injection was maintained throughout the last study visit at Day . The most common of subjects adverse events following during brexanolone injection administration were headache dizziness and somnolence. This is a very different model for how we treat depression. Having a drug approved to treat PPD that works quickly and effectively yet is also durable would be a huge step forward for psychiatry in general MeltzerBrody said. Brexanolone injection is an allosteric modulator of both synaptic and extrasynaptic GABA receptors. In postpartum depression the GABA pathway may play a key role in regulating hormones that researchers believe can lead to PPD. Sage Therapeutics is the developer of brexanolone injection and sponsor of the trials. A New Drug Application is currently under review by the FDA and brexanolone injection has been granted Breakthrough Therapy Designation. The FDA has assigned a Prescription Drug User Fee Act target date of December ."

"Indiana University researchers have found that magnesium intake may be beneficial in preventing pancreatic cancer. Their study Magnesium intake and incidence of pancreatic cancer The VITamins and Lifestyle study recently appeared in the British Journal of Cancer. Pancreatic cancer is the fourth leading cause of cancerrelated death in both men and women in the United States. The overall occurrence of pancreatic cancer has not significantly changed since but the mortality rate has increased annually from to according to the National Cancer Institute. Pancreatic cancer is really unique and different from other cancers said study coauthor Ka He chair of the Department of Epidemiology and Biostatistics at the IU School of Public HealthBloomington. The fiveyear survival rate is really low so that makes prevention and identifying risk factors or predictors associated with pancreatic cancer very important. Previous studies have found that magnesium is inversely associated with the risk of diabetes which is a risk factor of pancreatic cancer. But few studies have explored the direct association of magnesium with pancreatic cancer of those that did their findings were inconclusive said Daniel Dibaba a Ph.D. student at the School of Public HealthBloomington who led the IU study. Using information from the VITamins and Lifestyle study Dibaba and the other coauthors analyzed an enormous trove of data on over men and women ages to looking at the direct association between magnesium and pancreatic cancer and whether age gender body mass index nonsteroidal antiinflammatory drugs use and magnesium supplementation play a role. Of those followed participants developed pancreatic cancer. The study found that every milligramsperday decrease in magnesium intake was associated with a percent increase in the occurrence of pancreatic cancer. The study also found that the effects of magnesium on pancreatic cancer did not appear to be modified by age gender body mass index or nonsteroidal antiinflammatory drug use but was limited to those taking magnesium supplements either from a multivitamin or individual supplement. For those at a higher risk of pancreatic cancer adding a magnesium supplement to their diet may prove beneficial in preventing this disease Dibaba said. While more study is needed the general population should strive to get the daily recommendations of magnesium through diet such as dark leafy greens or nuts to prevent any risk of pancreatic cancer. In addition to He and Dibaba other contributors included Pengcheng Xun a faculty member in IUs Department of Epidemiology and Biostatistics Kuninobu Yokota of The Jikei University School of Medicine in Tokyo Japan and Emily White of the University of Washington in Seattle."

"For patients with advanced inoperable stage lung cancer concurrent chemotherapy and the specialized radiation treatment proton therapy offers improved survival compared to historical data for standard of care according to a new study from The University of Texas MD Anderson Cancer Center. The research published in JAMA Oncology reported an overall survival OS of . months. In contrast the historical OS rate with standard of care concurrent chemotherapy and traditional radiation was months at the time when the study was designed. The findings are the final results of the single institution Phase II study and represent the longest followup to date of stage lung cancer patients who have received proton therapy said Joe Y. Chang M.D. professor Radiation Oncology and the studys corresponding author. Lung cancer is the leading cause of cancer death in both men and women in the U.S. According to the American Cancer Society more than people will be diagnosed and will die from the disease in with the majority of patients still being diagnosed when the disease is in an advanced stage. Advanced lung cancer patients with inoperable disease traditionally have been treated with concurrent chemotherapy and conventional photon radiation therapy. However the therapy can be very difficult for patients due to associated toxicities and because many patients are also dealing with comorbidities explained Chang. Proton therapy is an advanced type of radiation treatment that uses a beam of protons to deliver radiation directly to the tumor destroying cancer cells while sparing healthy tissues. Protons enter the body with a low radiation dose and stop at the tumor matching its shape and volume or depth. They deposit the bulk of their cancerfighting energy right at the tumor thereby reducing the dose to cardiopulmonary structures which impacts the toxicity functional status quality of life and even survival for patients explained Chang. With our study we hypothesized that proton therapy would offer a survival benefit to patients and reduce treatmentassociated toxicities which can be very serious he said. The study opened at MD Anderson in in this research Chang and his colleague report on the studys fiveyear results. For the prospective Phase II trial patients with inoperable Stage III nonsmallcell lung cancer were enrolled. The studys primary endpoint was OS. The researchers hypothesized that the median OS would increase from historical data of months on standard therapy to months. Secondary endpoints included distant metastasis and local and regional recurrence rates. Toxic effects of treatment in both the acute and late settings also were analyzed. Median follow up was . months for all patients and . months for alive patients. At five years the median OS was . months and the corresponding fiveyear OS was percent. Median progressionfree survival was . months with a fiveyear progressionfree survival of percent. In sum patients experienced a relapse with distant sites representing percent of all recurrences. Local and regional recurrence rates were low percent and percent respectively. Among the acute and late toxic effects diagnosed in patients were esophagitis pneumonitis and cardiac arrhythmia. Of note said Chang no patients developed the most severe or grade five toxicities as seen in patients who receive standard of care. Chang noted his study is not without limitations. Of greatest significance the study was designed more than a decade ago. While the studys survival recurrence rates and toxic effects are still favorable when compared to rates associated with the most advanced traditional photon radiation therapy intensity modulated radiation therapy IMRT technology to diagnose and stage the disease as well all treatment modalities have significantly improved. When the study opened PET imaging had just been approved for lung cancer staging. The image quality was poor and didnt include a CT component in most facilities across the country said Chang. Obviously the technology has improved dramatically over the last decade and has made a significant impact on diagnosis and staging. Also delivery of both the conventional intensitymodulated radiation therapy IMRT and proton therapy IMPT have improved thereby reducing side effects for both treatment modalities. For example MD Anderson proton therapy patients with advanced lung cancer now can receive IMPT. The technique uses an intricate network of magnets to aim a narrow proton beam at a tumor and paint the radiation dose onto it layer by layer. Healthy tissue surrounding the tumor is spared and side effects are even more reduced than earlier proton delivery said Chang. A Phase II trial studying IMPT and concurrent chemotherapy is underway. Chang also noted the advancements in cancer biology and immunotherapy and that both are important areas of research focus in combination with proton therapy. In addition to Chang other authors on the allMD Anderson study include Stephen Hahn M.D. Ritsuko Komaki M.D. Pamela K. Allen Ph.D. Zhongxing Liao M.D. Steven H. Lin M.D. Ph.D. Daniel Gomez M.D. James Welsh M.D. Melenda Jeter M.D. James Cox M.D. Michael OReilly M.D. Ming Li M.D. and Wencheng Zhang M.D. all of Radiation Oncology John V. Heymach M.D. Ph.D. and Charles Lu M.D. both of ThoracicHead and Neck Medical Oncology Ronald X. Zhu Ph.D. Xiaodong Zhang Ph.D. Heng Li Ph.D. Radhe Mohan Ph.D. all of Radiation Physics and Ara A. Vaporciyan M.D. Thoracic and Cardiovascular Surgery. Vivek Verma M.D. now at the University of Nebraska Medical Center also contributed to the study."

"The latest advances in Alzheimers disease involve people who dont appear to show any signs of cognitive decline yet. Experts now believe that the biological processes behind the neurodegenerative condition begin years if not decades before memory problems and confusion become noticeable. At the annual Alzheimers Association International Conference https researchers say they have found a series of substances in saliva that can distinguish between people who experience normal aging those with mild cognitive dementia MCI which in some cases can lead to Alzheimers and in other cases not and Alzheimers disease. Presenting at the meeting Shraddha Sapkota a graduate student in neuroscience at University of Alberta and her colleagues described how they carefully analyzed the saliva of a group of volunteers participating in an aging study. Some had been diagnosed with Alzheimers and some with MCI while others did not have any neurological conditions. By comparing their saliva components the scientists found that each of the three groups showed slightly different patterns of compounds which could form the basis of a relatively easy and noninvasive way to determine which people are at higher risk of developing more serious degenerative brain conditions. The results arent conclusive enough yet for doctors to start using them to distinguish people who are more likely to develop Alzheimers but thats the goal says Sapkota. Ideally for example isolating those with MCI might help doctors to focus in on a group of patients who might be at higher risk of developing Alzheimers and therefore might need more intensive and regular testing."

"Both men and women have utilized many resources to combat baldness but now a former NASA scientist is using lasers to regrow hair. Dr. Tamim Hamid is the CEO and inventor of Theradome a helmet that he said uses cold lasers to promote hair growth by stimulating the base of the hair follicle. He based his helmet off the findings of Endre Mester a Hungarian physician who accidentally discovered that lasers can grow hair in mice in . This has been sitting dormant for many many years until about . We discovered that the same wavelength of nanometers was able to stimulate hair on humans as well Hamid told FoxNews.com. To further explain how light grows hair Hamid said the laser light stimulates the mitochondria at the base of the hair follicle which is where the stem cells that grow hair are located. Once the hair follicle is reactivated using light energy the hair reverses the miniaturization process which was induced by the hormone DHT. The challenge that Hamid faced was putting this technology into something that was wearable and easy to use. Board certified dermatologist Dr. Eric Schweiger who has not worked on Theradome told FoxNews.com that there have been other products that use low level laser technology to grow hair but Theradome is the first of its kind to be wearable. It doesnt require anything from the patient apart from wearing the helmet for minutes two times a week. The major benefit of therdome is you wear it as a cap and you dont have to hold it up to your scalp. I think that will increase compliance Schweiger said. Hamid said that Theradome has helped tens of thousands of people. One of those is Sabra Hardy who suffers from alopecia areata an autoimmune disease that left her with huge bald spots on either side of her head. I was using creams that were developed for the coats of animals when they had problems with their coat. I was using oils developed for animals that were dangerous to use and smelled really bad Hardy said. Her hair loss was costly and painful. She spent hundreds of dollars on wigs and was getting steroid injections in her scalp for nearly two years with no signs of progress until she started using Theradome. According to the Theradome website percent of subjects saw positive results after weeks of treatment and they reported a percent increase in hair growth. Schweiger said that Theradome is safe for someone who wants another option in conjunction with other conventional baldness remedies and that its effectiveness should be studied more over time. For patients who are looking for an additional therapy its not unreasonable to use. I think well know more as time goes on Schweiger said. As far as the products safety Schweiger said that since the lights are low energy and are not UV he is confident that Theradome is safe. Theradome is FDA cleared and costs . Patients should always see their physician before trying any new treatments."

"A new study is raising questions about the ageold belief that a calorie is a calorie. Research from a new study funded by the National Institutes of Health finds that dieters were more successful maintaining weight on a lowcarb diet than they were on a lowfat diet. The research finds that dieters who were trying to maintain their weight loss burned significantly more calories eating a lowcarb diet than they did eating a lowfat diet. But some experts say these findings are very preliminary. The study funded by the National Institutes of Health httpcontent.usatoday.comtopicstopicOrganizationsGovernmentBodiesNationalInstitutesofHealth was designed to see if changing the type of diet people consumed helped with weight maintenance because dieters often regain lost weight. So scientists had obese participants ages to lose to of their initial body weight about pounds. After their weight had stabilized each participant followed one of three different diets for four weeks. Participants were fed food that was prepared for them by diet experts. The dieters were admitted to the hospital four times for medical and metabolic testing. Heres a look at the three types of diets used in the new study A lowfat diet which is about of calories from fat from carbohydrates from protein. It emphasizes wholegrain products and fruits and vegetables and cuts way back on oils nuts fatty meats and other highfat foods. A lowcarb diet similar to the Atkins diet with only of calories from carbohydrates from protein from fat. This diet emphasizes beef fish chicken eggs cheese some vegetables and fruits while slashing the consumption of breads pasta potatoes rice cakes cookies and starchy vegetables. A lowglycemic index diet similar to a Mediterranean diet is made up of vegetables fruit beans healthy fats olive oil nuts and mostly healthy grains oldfashioned oats brown rice. It gets about of daily calories from carbohydrates from fat and from protein. Source Journal of the American Medical Association The diets had the same number of calories but the fat protein and carbohydrate content varied. Those diets A lowfat diet which was about of calories from fat and emphasized wholegrain products and fruits and vegetables. A lowcarb diet similar to the Atkins diet with only of calories from carbohydrates. It emphasized fish chicken beef eggs cheese some vegetables and fruits while eliminating foods such as breads pasta potatoes and starchy vegetables. A lowglycemic index diet similar to a Mediterranean diet made up of vegetables fruit beans healthy fats olive oil nuts and mostly healthy grains oldfashioned oats brown rice. These foods digest more slowly helping to keep blood sugar and hormones stable after the meal. Findings published in this weeks Journal of the American Medical Association Participants burned about calories more a day on a lowcarb diet than they did on a lowfat diet. Thats the amount youd burn off in an hour of moderate intensity physical activity without lifting a finger says senior author David Ludwig httpcontent.usatoday.comtopicstopicDavidLudwig director of the New Balance Foundation Obesity Prevention Center at Boston Childrens Hospital. Participants burned calories more on the lowglycemic index diet than the lowfat diet. Thats about an hour of light physical activity he says. The reason for the lowcarb advantage is unclear he says. We think the lowcarb and lowglycemic index diets by not causing the surge and crash in blood sugar dont trigger the starvation response. When the body thinks its starving it turns down metabolism to conserve energy he says. The authors note a downside to the lowcarb diet It appears to raise some risk factors for heart disease. Ludwig says that restricting carbohydrates over the long term may be hard for many people. If youre trying to lose weight you can get a jump start with a lowcarb diet but over the long term a lowglycemic index diet may be better than severely restricting carbohydrates. The lowglycemic index diet seems to be the happy medium says Cara Ebbeling associate director of the Obesity Prevention Center. It didnt slow metabolism as much as the lowfat diet and it didnt seem to have some of the negative effects on cardiovascular disease risk. On a lowglycemic index diet you would avoid highly processed carbs such as white bread white rice many snack foods prepared breakfast cereals sugary desserts and sugary beverages she says. Experts had different responses to the findings. George Bray an obesity researcher at Pennington Biomedical Research Center in Baton Rouge who has also studied this topic and who wrote the accompanying editorial in JAMA says that other studies show that you can do well on any diet as long as you stick to it. Adherence is the major key for weight loss and maintenance. There is no magic in any diet. Eric Westman a Duke University httpcontent.usatoday.comtopicstopicOrganizationsSchoolsDukeUniversity researcher who has conducted several studies on the lowcarb diet and is coauthor of The New Atkins for a New You says this study documents that the lower the carbohydrates the better the metabolic effects. People burn more calories if they eat fewer carbohydrates. Marion Nestle httpcontent.usatoday.comtopicstopicMarionNestle a nutrition professor at New York University httpcontent.usatoday.comtopicstopicOrganizationsSchoolsNewYorkUniversity says longer studies conducted among people in their own environments not with such controlled meals have shown little difference in weight loss and maintenance between one kind of diet and another. More research is needed to show that interesting results like these are applicable in real life she says. In the meantime if you want to lose weight eat less."

"Warfarin is a blood thinner that is commonly prescribed to patients to prevent lifethreatening blood clots. Despite its longtime use warfarin remains tricky to dose because a persons genetic makeup influences how the drug is processed in the body. Too much warfarin can cause internal bleeding too little warfarin fails to prevent blood clots. Now a new study led by Washington University School of Medicine in St. Louis shows that dosing warfarin Coumadin and others is safer producing fewer adverse events such as hemorrhage when key elements of a patients genetic makeup are considered. The research published Sept. in the Journal of the American Medical Association reports results from the clinical trial known as GIFT Genetics Informatics Trial of Warfarin to Prevent Deep Venous Thrombosis. Physicians have been prescribing warfarin since the Eisenhower administration said first author Brian F. Gage MD a professor of medicine at Washington University School of Medicine in St. Louis. Its a widely used anticoagulant but it causes more major adverse events than any other oral drug. Thousands of patients end up in the emergency department or hospital because of warfarininduced bleeding. But we continue to prescribe it because it is highly effective reversible and inexpensive. So our goal is to make warfarin safer. GIFT showed that precisionmedicine based on clinical factors and three genes improves the safety of initiating warfarin therapy. Patients in the trial were randomly assigned to one of two groups. One group received warfarin dosing based on standard factors such as age height and weight the second group was dosed based on these clinical factors plus genetic variants. Participating sites in the trial included Washington University School of Medicine Hospital for Special Surgery in New York Intermountain Healthcare University of Utah and Rush University Medical Center. Of the patients who were dosed in the traditional manner experienced at least one adverse event . percent. Of the patients whose warfarin dosing was guided by genetic testing experienced an adverse event . percent. Compared with patients receiving traditional warfarin dosing patients dosed with the genetic approach had a percent reduction in adverse events which was statistically different. The adverse events were bleeding formation of blood clots in the veins and warfarin overdoses. No patient died during the trial. Earlier studies looking at whether genetic testing could improve warfarin dosing had produced conflicting results. However these studies were smaller and considered fewer genes than GIFT. GIFT enrolled patients age and older at high risk of blood clots because they underwent hip or kneereplacement surgeries. Unlike prior studies GIFT took into account genetic variants in three genes for days of warfarin therapy. Genetic variants were assessed on a commercial platform called GenMarkDx. Variants in one gene affect vitamin K recycling. Variants in another gene affect warfarin sensitivity. Variants in the third gene alter warfarin metabolism in the liver and can cause an overdose if the dose is not adjusted soon enough. There are additional genetic variants that may help to guide warfarin dosing especially among patients with African ancestry Gage said. In the future we hope to quantify how these variants affect warfarin. Gage also noted how healthcare costs relate to dosing warfarin in a genetically guided manner. Although genetic testing is more expensive than clinical dosing the cost is falling he said. In our study we estimated that genetic testing costs less than per person which is less than one month of a newer anticoagulant. This work was supported by the National Heart Lung and Blood Institute NHLBI and the National Center for Advancing Translational Sciences NCATS of the National Institutes of Health NIH grant numbers RHL and ULTR the Centers for Medicare and Medicaid Services grant number CAGN and GenMarkDx which supplied instrumentation. Gage BF Bass AR Lin H Woller SC Stevens SM AlHammadi N Li J Rodriguez Jr. T Miller JP McMillin GA Pendleton RC Jaffer AK King CR DeVore B PorcheSorbet R Napoli L Merritt K Thompson AM Hyun G Anderson JL Hollomon W Barrack RL Nunley RM Moskowitz G DavilaRoman V and Eby CS for the GIFT investigators. Effect of genotypeguided warfarin dosing on clinical events and anticoagulation control among patients undergoing hip or knee arthroplasty the GIFT randomized clinical trial. Journal of the American Medical Association. Sept. . Washington University School of Medicines employed and volunteer faculty physicians also are the medical staff of BarnesJewish and St. Louis Childrens hospitals. The School of Medicine is one of the leading medical research teaching and patientcare institutions in the nation currently ranked seventh in the nation by U.S. News World Report. Through its affiliations with BarnesJewish and St. Louis Childrens hospitals the School of Medicine is linked to BJC HealthCare."

"A Japanese drug company is offering up a big claim Shionogi Co. says it has an experimental pill that can kill the flu virus https within a single day according to news reports. In a clinical trial a single dose of the drug made by the pharmaceutical company eliminated the virus from peoples bodies in a median time of hours The Wall Street Journal https_emailexperimentaldrugpromisestokillthefluvirusinadaylMyQjAxMTIMDEyMTgxOTEWj reported. Both Japanese and American flu patients were included in the trial. The experimental drug worked three times faster than another antiviral drug Tamiflu https the company told the Journal. things you can do right now to help prevent the flu https The drug uses a different approach to fight the flu than other medications. The flu virus https spreads through the body by invading cells. Once inside a cell it hijacks the cells machinery forcing the cell to make copies of the virus. Then the newly copied viruses break out of the cell spreading to other cells nearby and repeating the process. Existing drugs including Tamiflu work to block these viral copies from escaping the cell the Journal reported. The experimental drug however kicks into action earlier working to block the virus https from hijacking cells in the first place the Journal said. Japanese drug regulators could approve the drug for use in Japan by early March the Journal reported. The drugmaker plans to apply for approval in the U.S. this summer however the drug likely wouldnt be available here until next year."

"A daily drink combining several nutrients appears to help people with early Alzheimers disease improve their memory a new study suggests. As Alzheimers progresses patients lose their memory as synapses connections between brain cells deteriorate according to background information included in the study. The new drink called Souvenaid may actually stimulate the growth of new synapses said the drinks inventor Massachusetts Institute of Technology scientist Dr. Richard Wurtman. But more research is needed before the drink could be made available to the public. And even then consumers should exercise caution said William Thies vice president for medical and scientific affairs at the Alzheimers Association. Nutricia a division of Dannon sponsored the study. MIT has a patent on Souvenaid and Nutricia has the exclusive license on the patent. Existing data now suggests that it may be possible to receive something that will sustain cognition in people with Alzheimers disease with a limited concern about side effects Wurtman said. Previous experiments in animals showed that giving them the three compounds included in the drink increased the production of synapses improving brain function he said. For the new study nearly early Alzheimers patients in Europe drank either Souvenaid or a placebo for six months. During the first three months of the study patients in both groups showed improved memory. After that however patients taking the placebo had a decline in memory. In contrast patients taking Souvenaid continued to show improved memory on tests used to assess Alzheimers patients. Whether Souvenaid will slow the progression of Alzheimers isnt known. There is however a longer trial going on that might answer that question Wurtman said. I dont think it has any effect on the fundamental diseases process but well see he said. The report was published in the July online edition of the Journal of Alzheimers Disease. The drink combines three ingredients choline uridine and omega fatty acids. Choline is a B vitamin found in meats nuts and eggs and omega fatty acids are found in fish eggs flaxseed and meat from grassfed animals. Uridine which is produced by the liver and kidneys is also found in some foods as a part of RNA which helps make protein in the body. These nutrients along with other proteins are essential for making braincell membranes that form synapses. To be effective all three compounds must be given together the researchers said. Nearly all patients drank the nutrient cocktail consistently throughout the study and there were no serious side effects the researchers reported. To show the drinks effect on the brain patients underwent electroencephalography EEG throughout the trial. During the study the brains of those taking the drink shifted from patterns of dementia to more normal ones the researchers found. Since EEG patterns reflect the activity of synapses this result suggests that synaptic function increased with treatment the researchers said. An earlier study found that patients with more advanced Alzheimers did not benefit from Souvenaid most likely because brains cells had already been lost so new synapses couldnt develop Wurtman said. There are as yet no plans to market Souvenaid so the cost hasnt been established company spokesman William Green said. Souvenaid is a test product in development which is still undergoing clinical trials Green said. No plans for the introduction of Souvenaid to the market either in Europe or the U.S. have been confirmed. It is probable that any introduction would take place first in Europe. An ongoing study will evaluate the product over two years. If it appears to have a positive effect then it may be something that could benefit patients even before definitive symptoms of Alzheimers appear Wurtman said. Thies of the Alzheimers Association is very cautious about the benefits of Souvenaid. Medical foods do not have a requirement for FDA premarket approval but they do have a requirement for having a scientific foundation and some evidence of efficacy he said. But they dont have the kind of data we would find for a medication. That makes it difficult to make a clearcut statement about the value of the product he said. There isnt a clear diet that prevents you from getting Alzheimers disease or improves your memory Thies said. In addition medical foods for Alzheimers most likely wont be covered by insurance he said. You are making a judgment without the protections you have when dealing with a medication Thies said. Youre going to be making a decision using your own funds and we would advise anybody to make sure they understand what the product offers and make sure they understand what its going to cost. More information For more about Alzheimers disease visit the Alzheimers Association http SOURCES Richard Wurtman M.D. professor emeritus of brain and cognitive sciences Massachusetts Institute of Technology Boston William Thies Ph.D. vice president medical and scientific affairs Alzheimers Association Chicago William Green spokesman Nutricia July Journal of Alzheimers Disease online"

"The U.S. Food and Drug Administration today approved Noctiva desmopressin acetate nasal spray for adults who awaken at least two times per night to urinate due to a condition known as nocturnal polyuria overproduction of urine during the night. Noctiva is the first FDAapproved treatment for this condition. Todays approval provides adults who overproduce urine at night with the first FDAapproved therapeutic option to help reduce the number of times a night they wake up to urinate said Hylton V. Joffe M.D. M.M.Sc. director of the Division of Bone Reproductive and Urologic Products in the FDAs Center for Drug Evaluation and Research. It is important to know that Noctiva is not approved for all causes of nighttime urination so patients should discuss their symptoms with their health care provider who can determine the underlying cause of the nighttime urination and whether Noctiva is right for them. Nocturia wakening at night to urinate is a symptom that can be caused by a wide variety of conditions such as congestive heart failure poorly controlled diabetes mellitus medications or diseases of the bladder or prostate. Before considering Noctiva health care providers should evaluate each patient for possible causes for the nocturia and optimize the treatment of underlying conditions that may be contributing to the nighttime urination. Because Noctiva is approved only for adults with nocturia caused by nocturnal polyuria health care providers should confirm overproduction of urine at night with a hour urine collection if one has not been obtained previously. Health care providers should also be mindful of underlying conditions that can cause nocturia but that make treatment with Noctiva unsafe such as excessive drinking of fluids or symptomatic congestive heart failure. Noctiva is taken daily approximately minutes before going to bed. It works by increasing the absorption of water through the kidneys which leads to less urine production. Noctivas efficacy was established in two week randomized placebocontrolled trials in patients years of age and older with nocturia due to nocturnal polyuria. Although these trials showed a small reduction in the average number of nighttime urinations with Noctiva compared to placebo more patients treated with Noctiva were able to at least halve their number of nighttime urinations and patients treated with Noctiva had more nights with one or fewer nighttime urinations. Noctiva is being approved with a boxed warning and a Medication Guide because it can cause low sodium levels in the blood hyponatremia. Severe hyponatremia can be lifethreatening if it is not promptly diagnosed and treated leading to seizures coma respiratory arrest or death. Health care providers should make sure the patients sodium level is normal before starting Noctiva and should check sodium levels within one week and approximately one month after starting treatment and periodically thereafter. The lower Noctiva dose is recommended as the starting dose for those who may be at risk for hyponatremia such as the elderly. Noctiva should not be used in patients at increased risk of severe hyponatremia such as those with excessive fluid intake those who have illnesses that can cause fluid or electrolyte imbalances certain patients with kidney damage and in those using certain medicines known as loop diuretics or glucocorticoids. Noctiva should also not be used in patients with symptomatic congestive heart failure or uncontrolled hypertension because fluid retention can worsen these underlying conditions. Use of Noctiva should be discontinued temporarily in patients with certain nasal conditions such as colds or allergies until those conditions have resolved. Noctiva is also not recommended for the treatment of nocturia in pregnant women. Nocturia is usually related to normal changes in pregnancy that do not require treatment with Noctiva. Noctiva should not be used in children. The most common side effects of Noctiva in clinical trials included nasal discomfort cold symptoms nasopharyngitis nasal congestion sneezing high or increased blood pressure back pain nose bleeds bronchitis and dizziness. Although there are other FDAapproved medications that also contain desmopressin none of those medications are approved to treat nocturia. Noctiva is manufactured by Renaissance Lakewood LLC for Milford Pennsylvaniabased Serenity Pharmaceuticals LLC. The FDA an agency within the U.S. Department of Health and Human Services protects the public health by assuring the safety effectiveness and security of human and veterinary drugs vaccines and other biological products for human use and medical devices. The Agency also is responsible for the safety and security of our nations food supply cosmetics dietary supplements products that give off electronic radiation and for regulating tobacco products."

"Braeburn Pharmaceuticals and Camurus today announce top line results of a multipledose pivotal Phase study assessing the blockade by CAM of subjective opioid effects of multiple randomized hydromorphone challenges in adults with opioid use disorder. A key objective of medicationassisted treatment for opioid use disorder is to reduce or eliminate the use of illicit opioids. The results from the present Phase study demonstrate that CAM blocks effectively the subjective effects of opioid challenges with hydromorphone including limiting drug liking. This study provides clinical proof of concept that CAM will be an effective treatment for opioid use disorder said Behshad Sheldon President and CEO of Braeburn Pharmaceuticals The current opioid crisis demands innovation and CAMs novel technology is now one step closer to providing physicians and patients with a different approach to treating this deadly chronic disease. The primary endpoint was met for both CAM doses demonstrating blockade of the subjective effects of hydromorphone as measured by the Drug Liking Visual Analog Scale. Furthermore CAM was well tolerated across the course of treatment. The study results show that CAM provides rapid and extended blockade of opioid effects said Fredrik Tiberg President and CEO of Camurus. The results also confirm the dose selection in the current Phase program and the potential of CAM as a future treatment alternative for patients with opioid use disorder from initiation to longterm maintenance. The current study demonstrated that weekly injections of CAM produced significant and robust opioid blockade a critical mechanism of efficacy for medications treating opioid dependence. CAM has the potential to alter the current treatment paradigm for opioid dependence said Sharon Walsh Ph.D Professor of Behavioral Science and Director of the Center on Drug and Alcohol Research University of Kentucky Because of its long acting properties CAM may decrease patient and physician burden improve access to treatment and obviate public health concerns about illicit diversion of buprenorphine. We were pleased to be involved in the development of CAM and are hopeful that it will serve as another safe and effective therapeutic option for patients with opioid use disorder. The ability of CAM to produce a longlasting and robust blockade of hydromorphoneinduced Drug Liking is especially encouraging said Sandra D. Comer Ph.D Professor of Neurobiology Columbia University. Importantly the fact that CAM will be given in the clinic by health providers should address concerns about diversion of buprenorphine for illicit use. We feel that this medication with its ease of administration and flexible dosing capabilities could significantly improve management of patients. About the Phase Trial The Phase study was a threecenter randomized doubleblind inpatient study to evaluate the degree of subjective opioid blocking efficacy of CAM qw in nontreatmentseeking participants with moderatetosevere opioid use disorder. After screening participants were randomized to different CAM qw onceweekly injections for two weeks. During this period four challenge sessions were conducted with a randomized hydromorphone dose to determine subjective liking score based on a visual analogue scale. Additional information on the design of the trial can be found at http . About CAM The investigational CAM buprenorphine subcutaneous injection products for treatment of opioid use disorder are being developed as onceweekly and oncemonthly formulations each with multiple doses to cover all phases of treatment from initiation through maintenance. The CAM products are designed for administration by healthcare personnel to ensure proper delivery that minimizes the risks of diversion abuse misuse and accidental exposure. The CAM products have been evaluated in three Phase clinical trials which evaluated the safety and tolerability as well as pharmacokinetic and pharmacodynamic properties of the products in a total of individuals opioiddependent patients and healthy volunteers under naltrexone blockage. Four more trials including two Phase studies are currently ongoing. CAM is also being developed for treatment of chronic pain. About Braeburn Pharmaceuticals Braeburn Pharmaceuticals an Apple Tree Partners company is a pillfree pharmaceutical company delivering precision medicine in neuroscience. In September the Food and Drug Administration FDA accepted for review Braeburns New Drug Application for its lead candidate Probuphine a sixmonth buprenorphine implant for treatment of opioid addiction. The Agency set May as the target date for action. Longacting therapeutic treatment options can be essential to improving patient outcomes and facilitating recovery in these conditions which are often complicated by stigma and present significant public health challenges. Braeburns investigational product pipeline consists of longacting implantable and injectable therapies for serious neurological and psychiatric disorders including opioid addiction pain and schizophrenia. Candidates include Probuphine a sixmonth buprenorphine implant for treatment of opioid addiction CAM weekly and monthly subcutaneous injection depot formulations of buprenorphine for treatment of opioid addiction and pain a risperidone sixmonth implant for treatment of schizophrenia and a novel molecule ATI for treatment of schizophrenia. More information on Braeburn can be found at http About Camurus Camurus is a Swedish researchbased pharmaceutical company committed to developing and commercialising innovative and differentiated medicines for the treatment of severe and chronic conditions. New drug products with bestinclass potential are conceived based on the proprietary FluidCrystal drug delivery technologies and an extensive RD expertise. Camurus clinical pipeline includes products for treatment of cancer endocrine diseases pain and addiction developed inhouse and in collaboration with international pharmaceutical companies. The companys share is listed on Nasdaq Stockholm under the ticker CAMX. For more information visit http Media contacts Fredrik Tiberg President CEO Tel fredrik.tibergcamurus.com mailtofredrik.tibergcamurus.com http Sherry Feldberg MSLGROUP Boston braeburnpharmamslgroup.com mailtobraeburnpharmamslgroup.com Logo httpphotos.prnewswire.comprnhLOGO Logo httpphotos.prnewswire.comprnhLOGO SOURCE Braeburn Pharmaceuticals Camurus Related Links http"

"A new pill may help in the fight with cystic fibrosis. A study funded in part by Vertex Pharmaceuticals http the drug ivacaftor pronounced eye va kaf tor caused patients with a specific type of cystic fibrosis to improve lung function gain weight and fight other aspects of the disease. This is the first time that we have a therapy that is directed at the cause of cystic fibrosis says Dr. Michael Konstan httpcf.case.eduKonstan.html the chair of the Department of Pediatrics at Rainbow Babies and Childrens Hospital http Cleveland and one of the authors of the study. There is no cure for this disease and existing treatments just help alleviate some of the symptoms. This is a big deal says Robert Beall http the president and CEO of the Cystic Fibrosis Foundation http The fact is it is obviously going to make a very big difference in the lives of patients. Cystic fibrosis is a genetic disease that causes problems with the balance of salt going in and out of cells. A sticky mucus clogs organs particularly the lungs and liver. It can also cause digestive problems. About new cases are diagnosed each year according to the Cystic Fibrosis Foundation and the average person with the disease dies before age . Ivacaftor works for people with the GD mutation of cystic fibrosis. Konstan says that only about of the people with the disease have this specific mutation. It really is a major milestone in the treatment of cystic fibrosis he says. Even thought it only affects a small percentage of patients the hope is there that we can finally do something about this disease. The study published in the New England Journal of Medicine http looked at people who got the drug. Those taking ivacaftor saw improvements within two weeks which continued for the nearly yearlong trial. Drug recipients could blow out more than more air from their lungs compared with patients who were not taking the drug and were about half as likely to have a pulmonary exacerbation or a worsening of their lung disease that often requires hospitalization. On average patients taking the drug grew more and put on more weight than the placebo group according to the study and had lower sweat chloride an indicator of the disease. Beall says the improved lung function helped patients double their ability to walk and one patient even started going the gym for the first time. We have an incredible proof of concept Beall says. He points to other research under way with ivacaftor combined with another drug that could help people with the most common mutation of cystic fibrosis. That trial is ongoing and the treatment is at least four or five years away from approval but if it works Beall says it could help of the people with cystic fibrosis. In an editorial accompanying the study Dr. Pamela Davis httpcasemed.case.eduaboutbrief_bio.cfmdirectory_id of Case Western University paraphrased Winston Churchill This study is also a great victory in the war against genetic diseases and marks the end of the beginning for the treatment of the cystic fibrosis defect. Ivacaftor has been submitted to the FDA for approval and could be available next year according to Konstan. When it goes on sale it will be sold under the brand name Kalydeco pronounced kuhLYEdehkoh."

"Note A media teleconference with researchers and patients from Johns Hopkins and New York University will be held on Wednesday Nov. from a.m. to p.m. ET. To participate U.S.based media may call international media should dial . The access code is . Phone lines open at a.m. and all media should place speakers on mute unless posing a question. Reporters wishing to ask a question should email their name and outlet to david.marchnyumc.org mailtodavid.marchnyumc.org during the briefing so they may be placed in a queue the moderator will call on individual media members to ask a question in the order names and outlets were received. In a small doubleblind study Johns Hopkins researchers report that a substantial majority of people suffering cancerrelated anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin the active compound in hallucinogenic magic mushrooms. The researchers cautioned that the drug was given in tightly controlled conditions in the presence of two clinically trained monitors and said they do not recommend use of the compound outside of such a research or patient care setting. The Johns Hopkins team released its study results involving adult patients concurrently with researchers from New York University Langone Medical Center who conducted a similarly designed study on participants. Both studies are published in the Journal of Psychopharmacology on Dec. . The Johns Hopkins group reported that psilocybin decreased clinician and patientrated depressed mood anxiety and death anxiety and increased quality of life life meaning and optimism. Six months after the final session of treatment about percent of participants continued to show clinically significant decreases in depressed mood and anxiety with about percent showing symptom remission into the normal range. Eightythree percent reported increases in wellbeing or life satisfaction. Some percent of participants reported the experience as one of the top five meaningful experiences in their lives and about percent reported the experience as one of the top five spiritually significant lifetime events. The most interesting and remarkable finding is that a single dose of psilocybin which lasts four to six hours produced enduring decreases in depression and anxiety symptoms and this may represent a fascinating new model for treating some psychiatric conditions says Roland Griffiths Ph.D. http professor of behavioral biology in the Departments of Psychiatry and Behavioral Sciences and of Neuroscience at the Johns Hopkins University School of Medicine. He notes that traditional psychotherapy offered to people with cancer including behavioral therapy and antidepressants can take weeks or even months isnt always effective and in the case of some drugs such as benzodiazepines may have addictive and other troubling side effects. Griffiths says his teams new study grew out of a decade of research at Johns Hopkins on the effects of psilocybin in healthy volunteers which found that psilocybin can consistently produce positive changes in mood behavior and spirituality when administered to carefully screened and prepared participants. The study was designed to see if psilocybin could produce similar results in psychologically distressed cancer patients. A lifethreatening cancer diagnosis can be psychologically challenging with anxiety and depression as very common symptoms says Griffiths. People with this kind of existential anxiety often feel hopeless and are worried about the meaning of life and what happens upon death. For the study the investigators recruited participants diagnosed with lifethreatening cancers most of which were recurrent or metastatic. They were chosen from a total of individuals reached through flyers web advertisements and physician referrals. Most participants had breast upper digestive GI genitourinary or blood cancer and each had been given a formal psychiatric diagnosis including an anxiety or depressive disorder. Half of the participants were female with an average age of . Ninetytwo percent were white percent were AfricanAmerican and percent were Asian. Each participant had two treatment sessions scheduled five weeks apart one with a very low psilocybin dose or milligrams per kilograms taken in a capsule and meant to act as a control placebo because the dose was too low to produce effects. In the other session participants received a capsule with what is considered a moderate or high dose or milligrams per kilograms. To minimize expectancy effects the participants and the staff members supervising the sessions were told that the participants would receive psilocybin on both sessions but they did not know that all participants would receive one high and one low dose. Blood pressure and mood were monitored throughout the sessions. Two monitors aided participants during each session encouraging them to lie down wear an eye mask listen to music through headphones and direct their attention on their inner experience. If anxiety or confusion arose the monitors provided reassurance to the participants. In addition to experiencing changes in visual perception emotions and thinking most participants reported experiences of psychological insight and often profound deeply meaningful experiences of the interconnectedness of all people. The researchers assessed each participants mood attitude about life behaviors and spirituality with questionnaires and structured interviews before the first session seven hours after taking the psilocybin five weeks after each session and six months after the second session. Immediately after the sessions participants completed questionnaires assessing changes in visual auditory and body perceptions feelings of transcendence changes in mood and more. Structured clinical interviews such as the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale and patient questionnaires like the Beck Depression Inventory and the StateTrait Anxiety Inventory assessed depression and anxiety. Other questionnaires assessed quality of life death acceptance meaningful existence optimism and spirituality generally defined as a search for the meaning of life and a connection to something bigger than ones self. To measure the changes in attitudes moods and behavior over time the researchers administered a questionnaire that assessed negative or positive changes in attitudes about life mood and behavior. With regard to adverse effects Griffiths says percent of participants were nauseated or vomited and onethird of participants experienced some psychological discomfort such as anxiety or paranoia after taking the higher dose. Onethird of the participants had transient increases in blood pressure. A few participants reported headaches following the session. Before beginning the study it wasnt clear to me that this treatment would be helpful since cancer patients may experience profound hopelessness in response to their diagnosis which is often followed by multiple surgeries and prolonged chemotherapy says Griffiths. I could imagine that cancer patients would receive psilocybin look into the existential void and come out even more fearful. However the positive changes in attitudes moods and behavior that we documented in healthy volunteers were replicated in cancer patients. Up to percent of people with cancer suffer from a mood disorder according to the National Comprehensive Cancer Network. Anticipating wide interest in the psilocybin research from scientists clinicians and the public the journal solicited commentaries to be copublished with the study results written by luminaries in psychiatry palliative care and drug regulation including two past presidents of the American Psychiatric Association a past president of the European College of Neuropsychopharmacology the former deputy director of the U.S. Office of National Drug Control Policy and the former head of the U.K. Medicines and Healthcare Products Regulatory Authority. In general the commentaries were supportive of the research and of using these drugs in a clinical setting as tools for psychiatry. Additional authors included Matthew Johnson Michael Carducci Annie Umbricht William Richards Brian Richards Mary Cosimano and Margaret Klinedinst all of The Johns Hopkins University. The study was funded by grants from the Heffter Research Institute the RiverStyx Foundation William Linton the Betsy Gordon Foundation the McCormick family the Fetzer Institute George Goldsmith Ekaterina Malievskaia and the National Institute on Drug Abuse RDA."

"Spinal manipulation and home exercise are more effective at relieving neck pain in the long term than medications according to new research. People undergoing spinal manipulation therapy for neck pain also reported greater satisfaction than people receiving medication or doing home exercises. We found that there are some viable treatment options for neck pain said Gert Bronfort vice president of research at the WolfeHarris Center for Clinical Studies at Northwestern Health Sciences University in Bloomington Minn. What we dont really know yet is how to individualize these treatments for each particular patient. All are probably still viable treatment options but what we dont know is what each particular patient will need Bronfort said adding that its possible a combination of treatments might be helpful too. Results of the study are published in the Jan. issue of the Annals of Internal Medicine. Funding for the study was provided by the U.S. National Center for Complementary and Alternative Medicine. Neck pain is an extremely common problem. About threequarters of adults report having neck pain at some point in their lives according to background information in the study. Neck pain is responsible for millions of health care visits each year and it can have a negative impact on quality of life. Spinal manipulation is one type of treatment thats offered for neck pain and it can be administered by chiropractors physical therapists osteopaths and other health care providers according to the study. But there isnt much evidence for treating neck pain with spinal manipulation. There also isnt a great deal of information on how effective medications or home exercise programs are for treating neck pain the researchers noted. Bronfort and colleagues thought that spinal manipulation might prove to be more effective than medications or home exercise therapy. To test their hypothesis they recruited people between the ages of and who had neck pain. Their neck pain had no known cause such as a trauma or pinched nerve and the patients been experiencing the pain for between two and weeks when the study began. The study volunteers were randomly selected for one of three treatment groups. One group received spinal manipulations over a week period. Each individual was allowed to choose the number of spinal manipulations they felt they needed. The second group received medications both over the counter and prescription depending on their needs. Firstline medications included nonsteroidal antiinflammatory medications or acetaminophen Tylenol. If people didnt get relief from these drugs narcotic pain medications and muscle relaxants were offered. The third group was assigned two onehour sessions of home exercise. The goal of the homeexercise program was to improve movement in the neck area. Participants were instructed to do the exercises six to eight times per day. At the th week percent of people receiving spinal manipulation reported at least a percent reduction in pain compared with percent of those on medication and percent doing home exercises. Also at week of people receiving spinal manipulation percent reported feeling a percent reduction in pain compared with percent on medications and percent doing home exercises. At one year percent of those receiving spinal manipulation said they felt a percent reduction in pain versus percent of those on medications and percent of those doing home exercises. For me as an ER doctor this study offers an interesting perspective said Dr. Robert Glatter an attending physician in emergency medicine at Lenox Hill Hospital in New York City. Its a small study but it found that home exercises and spinal manipulation were effective. So should we be referring to physical therapists osteopaths or chiropractors from the ER This study shows that basically neck pain will get better on its own said Dr. Victor Khabie chief of the departments of surgery and sports medicine at Northern Westchester Hospital in Mount Kisco N.Y. It wouldve been good if they had a notreatment group too he added. Everyone heals differently. There are different pathways to healing and whether you feel youre better off with chiropractic home exercises or medications this study shows that all three are basically just as effective. Whatever your pathway to healing in about six to eight weeks you should start to feel better said Khabie. He also noted that its important for anyone receiving spinal manipulation to know that there are rare but serious risks that can occur with neck manipulations. All three experts said anyone experiencing neck pain needs to have it evaluated to make sure there isnt a serious or correctable cause of the pain. This is especially true if youve been in a car accident or if you have any neurological symptoms such as repeatedly dropping things or if you have pain radiating down your arm. More information Learn more about neck pain its causes and treatment from the U.S. National Library of Medicine http SOURCES Gert Bronfort D.C. Ph.D. vice president and professor research WolfeHarris Center for Clinical Studies Northwestern Health Sciences University Bloomington Minn. Robert Glatter M.D. attending physician emergency medicine Lenox Hill Hospital New York City Victor Khabie M.D. codirector Orthopedic and Spine Institute and chief surgery and chief sports medicine Northern Westchester Hospital Mt. Kisco N.Y. Jan. Annals of Internal Medicine"

"Alex Pierce took up distance running with great enthusiasm a couple of years ago. Then she developed knee pain so severe that she could not climb stairs. So Pierce a doctoral student in food science went to see physical therapist Matt Briggs at The Ohio State Wexner Medical Center in Columbus. He performed deep massages suggested changes in her running form and taught her how to exercise her thigh and gluteal muscles to better protect her knees. She believes all of that helped. But Pierce like a growing number of patients had another treatment she is convinced helped even more. Its called dry needling and it involves the insertion of thin nonmedicated solid needles into muscles or connective tissues. Proponents say it can reduce pain and improve movement. Pierce has had the procedure more than half a dozen times and believes it is one reason she will be able to run her fourth marathon in November. This has kind of changed my life she says. Testimonials like that are a big reason dry needling has caught on with some physical therapists athletes and other patients Briggs says. But testimonials are not scientific proof. And there Briggs says is where dry needling is lacking. While some studies have shown promise he says the quality of the evidence is not strong. Thats why Briggs and his colleagues are starting a study looking at dry needling in runners knee the condition that has plagued Pierce. Their goal and the goal of other researchers now looking at dry needling is to produce results rigorous enough to show whether it really works. For now heres what consumers should know Is this acupuncture Physical therapists say it is not though superficially it may look the same says Justin Elliott vice president of government affairs for the American Physical Therapy Association http For one thing he says dry needling as performed by a physical therapist is not rooted in ancient Chinese medicine theres no talk about redirecting the bodys energy flow by placing needles at certain points in the body. Instead needles are placed directly in problem areas. Elliott says dry needling also is practiced by some chiropractors naturopathic physicians and nurses which puts it outside the realm of any one specialty. Acupuncturists beg to differ. What is being called dry needling is clearly a form of acupuncture and should be done only by professionals extensively trained in that discipline says Thomas Burgoon a West Chester Pa. physician who is president of the American Academy of Medical Acupuncture http He says many acupuncturists do exactly what the physical therapists describe with the same kind of needles. Burgoons group has persuaded some states to bar physical therapists from the practice. How might it work One theory is that the needles cause tight muscles to twitch then relax. The needles may also increase blood flow or set off nerve responses that alter pain perception Briggs says. Another possibility Its a placebo effect an improvement triggered by the expectation that a treatment will work rather than by the treatment itself. To look for that possibility the Ohio State study will compare patients who get the real needle treatment to those poked with sham needles that dont pierce the skin. Mark Crislip an infectiousdisease doctor in Portland Ore. who recently wrote about dry needling for ScienceBased Medicine https a website critical of alternative medicine says the version practiced by physical therapists doesnt come with the mystical baggage that accompanies acupuncture. But he says it may well be a theatrical placebo. What do published studies say Its a mixed bag Elliott says. In a review httpfileCUserskpainterDownloadsDryNeedlingResourcePaper.pdf the physical therapy association rated the evidence for dry needling a out of based on the best studies. A formal analysis http_acupunctureanddryneedlingforlowbackpain of trails on acupuncture and dry needling for chronic lower back pain was published by the Cochrane research group in . It found they may be useful additions to standard treatment. But it said higher quality studies were needed. What are the risks Needling can produce minor bleeding and some soreness but in trained hands and with the use of sterile needles and gloves its a very safe procedure Briggs says. In rare cases deep needling can lead to a punctured lung or injuries to nerves and blood vessels and acupuncturists fear nonspecialists will be more likely to make such mistakes Burgoon says. Will insurers pay for this Many will not. Charges for patients can range from to per session says Edo Zylstra CEO of KinetaCore a company that offers intensive threeday weekend courses in dry needling to physical therapists. Do all physical therapists offer this No. The physical therapy association tells members in seven states to steer clear because of recent court or regulatory decisions or language in existing licensing laws. They are California Florida Hawaii Idaho New York South Dakota and Washington. And most of the nations licensed physical therapists are not trained in the technique. About have taken courses in dry needling in the past few years Zylstra says."

"There may soon be a new tool in the fight against childhood obesity http Prebiotics reduce body fat in children who are overweight or obese by altering their gut microbiota according to new research published in Gastroenterology http the official journal of the American Gastroenterological Association AGA http Prebiotics are nondigestible food ingredients such as fiber that act as fertilizers to help stimulate the growth of good bacteria already in the gut different from probiotics which introduce new bacteria into the system. This is a welldesigned trial that demonstrates how a prebiotic could potentially help combat one of the most prevalent and costly conditions afflicting children in the developed world overnutrition by targeting the gut microbiome said Geoffrey A. Preidis MD PhD a member of the AGA Center for Gut Microbiome Research and Education http scientific advisory board. It is promising to see this evidence that alteration of the gut microbiota can be used to restore health. As a clinician I hope that continued research into prebiotics will lead to a new strategy for the treatment of obesity. Method For this study researchers from the University of Calgary Alberta Canada performed a doubleblind placebocontrolled trial with participants. Participants included children to years old who were classified as overweight or obese th percentile of body mass index but otherwise healthy. Participants were randomly assigned to groups given either the prebiotic fiber oligofructoseenriched inulin or a placebo once daily for weeks. The prebiotic was provided as a white powder mixed in water. Powdered fiber mixed in a water bottle taken once a day is all we asked the children to change and we got what we consider some pretty exciting results it has been fantastic added Raylene A. Reimer PhD RD professor and researcher in the Faculty of Kinesiology at University of Calgary who led the study. Results Based on fourmonth intervention data the annual projected body weight increase in the prebiotic group would be kilograms . pounds within the expected healthy range whereas the projected increase in the placebo group was kilograms . pounds almost triple the expected yearly weight increase. Thus supplementation with the prebiotic improved outcomes in children who were overweight or obese. Importantly the researchers show that the prebiotic induced specific gut bacterial shifts compared to placebo. Why is this important This is the first randomized controlled study to assess comprehensive changes in gut microbial composition with prebiotic intervention in children who are overweight and obese. Excess weight in childhood tends to persist into adulthood and is an early risk factor for obesityassociated morbidity and mortality highlighting the importance of early intervention. Whats next The metabolic and microbial findings from this study provide a foundation for a larger clinical trial in the pediatric population. Prebiotics are inexpensive and noninvasive and therefore a plausible dietary treatment in the overweight and obese pediatric population. Resources What is Obesity http_for_patientsobesitywhatisobesity Grant Support This work was supported by grants from the BMO Financial Group Endowed Research Fund in Healthy Living Alberta Childrens Hospital Foundation Alberta Childrens Hospital Research Institute and the Canadian Institutes of Health Research MOP. Clinicaltrials.gov no NCT. Reference Nicolucci A.C. Hume M.P. Martnez I. Mayengbam S. Walter J. Reimer R.A. Prebiotic Reduces Body Fat and Alters Intestinal Microbiota in Children With Overweight or Obesity. Gastroenterology doi .j.gastro... http About the AGA Institute The American Gastroenterological Association is the trusted voice of the GI community. Founded in the AGA has grown to more than members from around the globe who are involved in all aspects of the science practice and advancement of gastroenterology. The AGA Institute administers the practice research and educational programs of the organization. http About Gastroenterology Gastroenterology the official journal of the AGA Institute is the most prominent scientific journal in the specialty and is in the top percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system including the liver and pancreas as well as nutrition. The journal is abstracted and indexed in Biological Abstracts Current Awareness in Biological Sciences Chemical Abstracts Current Contents Excerpta Medica Index Medicus Nutrition Abstracts and Science Citation Index. For more information visit http Like AGA http and Gastroenterology http on Facebook. Follow us on Twitter AmerGastroAssn http AGA_Gastro httpstwitter.comAGA_Gastro New Check out our videos on YouTube http Join AGA on LinkedIn http"

"Checkups during pregnancy tend to focus around the waist. But theres growing debate about which motherstobe should have a gland in their neck tested too. Numerous studies since have found that an underactive thyroid httpsmedicalxpress.comtagsthyroid can raise a womans risk of miscarriage premature birth or a lower IQ for her baby even if its so mildly sluggish that she feels no symptoms. The problem While serious cases are treated with a hormone pill so far theres little evidence that treating the milder cases makes a difference. So guidelines about who should be tested vary widely. Now a peek at prenatal testing httpsmedicalxpress.comtagsprenataltesting from one of the countrys largest medical labs suggests that nearly a quarter of pregnant women httpsmedicalxpress.comtagspregnantwomen are getting the simple thyroid blood test httpsmedicalxpress.comtagsbloodtest regardless of whether they have symptoms. Researchers at Quest Diagnostics examined records for half a million pregnant women. Of those who got tested a higherthanexpected number percent had an underactive thyroid. Thats fivefold higher than some previous estimates httpsmedicalxpress.comtagsestimates partly because the way in which the condition is diagnosed has changed recently says the study published by the Journal of Clinical Endocrinology Metabolism. The vast majority of those women were in the gray zone with milder cases where no one knows for sure if a diagnosis helps or wastes money on testing and thyroid medication. The finding adds pressure for science to settle this longrunning controversy. We still dont have perfect answers says Dr. Elizabeth Pearce a wellknown endocrinologist at Boston Medical Center where a recent survey found widespread prenatal thyroid testing. But if its my patient in my office or its me or my family member Im going to treat every time. Obstetricians seem more wary. There are studies on both sides of the fence says Dr. Dena Goffman of New Yorks Montefiore Medical Center which tests only women at high risk. If you dont know what to do with the results you probably shouldnt order the test she said. The unassuming thyroid a small bow tieshaped gland nestled in the front of the neck plays a big role in good health for everyone. It produces hormones that regulate metabolism and can affect almost every type of tissue in the body. About million Americans are estimated to have a malfunctioning thyroid that if serious enough can contribute to heart disease bonethinning osteoporosis and infertility. An overactive thyroid called hyperthyroidism speeds up bodily functions causing such symptoms as weight loss nervousness anxiety and increased heart rate and vision problems. Much more common is an underactive thyroid called hypothyroidism. It slows body functions causing such problems as fatigue weight gain depression constipation and dry skin. It even can contribute to high cholesterol according to the National Institutes of Health. Thyroid problems increase with age but they affect far more women than men and pregnancy httpsmedicalxpress.comtagspregnancy puts extra stress on the gland. Having enough thyroid hormones is important for fetal brain development especially during the first trimester when the fetus depends solely on the mother for them. The hormones also play a role in avoiding miscarriage or premature birth httpsmedicalxpress.comtagsprematurebirth. Mothers also may harbor immune system cells called antibodies that subtly attack the gland and likewise are linked to miscarriage and prematurity. Italian researchers found that treating those women lowered their risk of encountering this problem. There is broad agreement that women with overt hypothyroidism a seriously underactive gland should be treated most likely given a onceaday hormone pill long known to be safe in pregnancy. But it takes blood testing to diagnose overt disease because even those women dont always report the vague symptoms. Those blood tests are sure to uncover women with mild hypothyroidism too the people in the socalled gray zone. Some research has raised questions about whether mild cases really pose a pregnancy risk and preliminary results from a large British study recently found no overall IQ benefit to the resulting children if their mothers had been treated. But the damage might already have been done by the time treatment began late in the first trimester notes Bostons Pearce. In the U.S. doctors are anxiously awaiting a similar National Institutes of Health study results arent expected until . Whats the advice until then The American College of Obstetricians and Gynecologists recommends testing only pregnant women who have thyroid symptoms have had previous thyroid problems or have similar autoimmune diseases such as Type diabetes those considered at risk for overt disease. The American Thyroid Association goes further. Last summer it advised also testing all pregnant women age and older and those with enlarged thyroids previous pregnancy problems or those who are obese says Pearce who coauthored the guidelines. Most guidelines cite the lack of evidence for treating mild cases. The thyroid association does urge treatment if those women harbor the worrisome antibodies. A final tip Pregnant women should check that their prenatal vitamins contain iodine important for proper thyroid function Pearce says. Not all do. Most Americans get enough iodine from dairy products bread seafood and iodized table salt. But women httpsmedicalxpress.comtagswomen need extra during pregnancy. Explore further BMC conducts high rates of thyroid testing in pregnant women study finds httpsmedicalxpress.comnewsbmchighthyroidpregnantwomen.html"

"Doctors are experimenting with new technology that could give them a more complete view of the large intestine than ever before improving the odds of finding potentially cancerous growths earlier. Dr. Arie Kaufman of SUNY Stony Brook demonstrated the virtual colonoscopy for CBS New Yorks Dr. Max Gomez. Well have both the computer and the doctors working in tandem to find polyps and find cancers Kaufman said. He added it could lead to better and earlier detection of colon polyps. Virtual colonoscopy screening uses CT scans to create color D images of the colon the final portion of the large intestine. Special computer animation enables a doctor to view the organ in remarkable detail. Regular colonoscopy physically examines the colon by inserting a lighted probe into the intestine and requires a sedative. Both have made early detection and treatment https more precise. This next step in virtual colonoscopy called immersive colonoscopy projects D images of the colon large enough to fill the walls of a room. Doctors can then walk through the colon and explore many different angles. We have the side view and the back view said Kaufman. This will allow the physician to view percent of the surface including lesions which are hidden behind folds maybe seen on the side and back walls. Such highly specific screening may allow doctors to detect more abnormal growths https called polyps when they are as small as . mm so they can be removed before they become fullblown cancer tumors. For the patient a virtual colonoscopy https is low risk but does involve additional exposure to radiation. It may need to be followed with the physical colonoscopy later as well. Colonoscopies are recommended for adults age and over to help detect early signs of colorectal cancer. Colorectal cancer is the second leading cause of death among the combined group of men and women who have cancer according to the National Institutes of Health http The CDC http says colonoscopy may also be recommended for people experiencing stomach pain aches or cramps that dont go away unexplained weight loss and blood in the stool. More routine DNA tests https and stool sampling https which show signs of bleeding caused by irregular growths can also help detect colon polyps and indicate that the need for a full colonoscopy. The CDC says colonoscopy could reduce the number https of colorectal cancer cases by as much as percent. This new wave of radiologybased colonoscopy could improve those odds further."

"Countless people often men with enlarged prostates need to visit the bathroom during the night. But help could soon be at hand in the form of a nasal spray new research suggests. A spritz of a synthetic hormone already used by bedwetting kids might benefit older people struggling with the problem called nocturia. Nocturia is very common in patients over years old and can cause significant problems by causing loss of sleep and injury due to falls said study lead author Dr. Jed Kaminetsky. The millions of people with nocturia wake up two or more times a night to urinate. Besides an enlarged prostate Kaminetsky said common causes are bladder problems poor circulation and obesity. Kaminetsky is a clinical assistant professor of urology at NYU Langone Medical Center in New York City. In the United States theres no approved drug to treat the problem the study authors said. The new drug while promising is of concern because of its potential to lower blood sodium levels in the elderly one doctor said. Meanwhile another researcher suggested that exercise might help stave off nocturia. Known as SER the nasal spray contains desmopressin a lowdose synthetic version of the naturally occurring hormone vasopressin. Vasopressin an antidiuretic reduces urine production. SER appears to delay urine production for four to six hours during sleep said Kaminetsky and wears off by morning when patients awaken and start to drink fluids. He is scheduled to present his teams research Sunday in San Diego at a meeting of the American Urological Association. The research was funded by the sprays manufacturer Serenity Pharmaceuticals. Desmopressin is commonly used to treat bedwetting among children ages and up the study authors pointed out. To assess its potential in adults the study team enlisted nearly men and women and older who had a history of nocturia. For three months participants were randomly assigned to use either the desmopressin spray two doses were tried or a nonmedicinal spray a placebo. Patients kept threeday urination diaries and filled out qualityoflife questionnaires. Desmopressin spray prompted a significant decrease in the frequency of nightly bathroom trips compared with the untreated group Kaminetsky said. On average patients reported at least two fewer episodes a night. The treatment group also experienced a significant increase in the length of time they could sleep before awakening to urinate. That uninterrupted sleep period extended to more than four hours Kaminetsky said. The researchers also found that those in the higherdose spray group experienced a significant improvement in overall quality of life compared with the untreated group. Though SER is still considered investigational Kaminetsky said the U.S. Food and Drug Administration is reviewing the findings with a possible decision late this year. Dr. Tomas Griebling a professor of urology at the University of Kansas described the study results as promising but added a note of caution. Other researchers have examined the utility and safety of desmopressin for the treatment of nocturia in the past he said. However there have been concerns about safety particularly in elderly patients. Griebling said the American Geriatrics Society includes desmopressin in the Beers Criteria for potentially inappropriate medications for older adults primarily because of concerns about resulting low blood sodium levels. But the lower doses used in this study . or . mcg may help to improve the overall safety profile particularly for geriatric patients he said. Additional research will be needed to fully answer this question in the future. The study team said two of the higherdose patients developed significantly low blood sodium levels hyponatremia as did one person taking the placebo. Dr. Julien Dagenais a urologist at Brigham and Womens Hospital in Boston explored nocturia from another angle. He analyzed physical activity data reported by more than men and women aged and older in a U.S. health and nutrition survey conducted between and . People who reported higher levels of exercise were less likely to suffer from nocturia Dagenais found. This suggests that the antiinflammatory impact of routine exercise may minimize nocturia he said. These findings will also be presented at the American Urological Association meeting. Data and conclusions presented at meetings are usually considered preliminary until published in a peerreviewed journal. More information Theres more on nocturia at the National Association for Continence http SOURCES Jed Kaminetsky M.D. clinical assistant professor department of urology NYU Langone Medical Center New York City Tomas L. Griebling M.D. MPH senior associate dean for medical education and professor urology and faculty associate Landon Center on Aging University of Kansas School of Medicine Kansas City American Urological Association meeting San Diego May"

"Researchers have discovered a new class of drug that has the potential to help cancer patients who no longer respond to existing therapies. The drug may not become available to patients for a number of years yet but researchers believe that if clinical trials are successful it could be used to tackle a variety of treatmentresistant cancers. Patients with breast cancer for example frequently become resistant to existing hormonebased treatments leading to the disease becoming fatal. In a bid to come up with new forms of treatment that work in a distinct way from established ones chemists biologists and clinicians at Imperial College London collaborated on creating a new drug the properties of which are reported in the journal Molecular Cancer Therapeutics. The team of scientists at Imperial was funded by Cancer Research UK. The drug was then developed by Imperial in collaboration with Emory University in the USA. Early labbased tests of ICEC were successful in targeting resistant breast cancers and indicated minimal side effects. ICEC was then licenced to Carrick Therapeutics who developed it into a molecule named CT which they have taken to earlystage clinical trials in less than two years. The first patient was given the drug in November as part of Carricks a Phase I clinical trial to assess its safety and how well it can be tolerated. The trial is still ongoing so results are not available yet. Professor Charles Coombes from the Department of Surgery Cancer said Treatmentresistant tumours represent a significant threat for patients as once a cancer stops responding to treatments there is increasingly little clinicians can do. Drugs such as these could help to shift the balance back in favour of the patients potentially providing a new option to patients for who existing treatments no longer work. Professor Tony Barrett from the Department of Chemistry said This work is the result of extensive collaboration between chemists biologists and clinicians which has helped to bring a new treatment from discovery to clinical testing in record time streamlining the process. The drug targets an enzyme called CDK involved in directing cells through their lifecycle which consists of growth DNA replication and cell division. CDK is also involved in the process of transcription a vital step in gene expression the creation of proteins to carry out cell functions. Particular cancers such as treatmentresistant breast cancers have a unique dependence on transcription meaning targeting CDK may be particularly effective. By inhibiting transcription ICEC shuts down the ability of the cancer to spread. As well as breast cancers cancers such as acute myeloid leukaemia and smallcell lung cancer are particularly transcriptiondependent so ICEC may work well for these too especially where they have become resistant to other treatments. The discovery of the drug was spurred by an initial meeting between Professor Anthony Barrett from the Department of Chemistry and oncologist Professor Charles Coombes from the Department of Surgery Cancer. Professor Simak Ali also from the Department of Surgery Cancer was working on understanding the action of CDK in treatmentresistant breast cancer. Professors Coombes and Ali suggested CDK as a drug target leading the collaboration to attempt to design a molecule that would inhibit its action. From early attempts a large collaborative team was eventually founded for drug discovery from bench to bedside directed by Dr Matthew Fuchter in the Department of Chemistry. Possible compounds for CDK inhibition were modelled using computational drug design aided by collaboration with Emory University. Ultimately a candidate molecule called ICEC suppressed tumour growth in a wide range of cancer types in lab tests. In addition laboratory studies showed ICEC worked better in combination with traditional hormone therapies for estrogen receptor positive breast cancer cells which have not yet become resistant. It is this molecule in oral pill form that was taken forward by Carrick as CT and is currently in Phase I clinical trials. If the Phase I trial proves successful the compound must pass further stages of trial over the next few years before it becomes available to patients. Early funding for the study came from the Engineering and Physical Sciences Research Council EPSRC and a major contribution of wholeproject funding was from Cancer Research UK. Licensing of the technology to Carrick Therapeutics was led by Cancer Research UKs Commercial Partnerships Team and Imperial Innovations the Technology Transfer Office of Imperial with support from Emory University. Dr Iain Foulkes Cancer Research UKs executive director of research and innovation said Its exciting to see how Cancer Research UKs partnerships with both academia and industry are bringing urgently needed new tests and treatments to patients. Drug resistance continues to be a major challenge across many cancer types so its vital that we explore new ways to tackle tumours that have stopped responding to standard therapies. We hope that this promising new class of drug will offer more options to patients who have few left available to them and help more people survive their cancer."

"Heres a bit of good news for folks who enjoy sitting in a superheated room and sweating profusely Finnish researchers say regular sauna bathing may help men to live longer. The study which was published Monday in JAMA httpjama.jamanetwork.comjournal.aspx is the latest in a series of papers to explore the potential cardiovascular health benefits of chilling out in a room heated to degrees Fahrenheit. Our results suggest that sauna bathing is a recommendable health habit wrote Dr. Jari Laukkanen a cardiologist a the Institute of Public Health and Clinical Nutrition University of Eastern Finland. The only catch is nobody can explain exactly why this is the case. Further studies are warranted to establish the potential mechanism that links sauna bathing and cardiovascular health wrote Laukkanen and his colleagues. The researchers based their conclusion on a database of of Finnish men who have had their health tracked since . Study participants were all aged to with a median age of . Those men who enjoyed a sauna two or three times a week had a lower risk of experiencing a fatal episode of coronary heart disease or cardiovascular disease compared to those who took just one sauna a week according to researchers. The apparent health benefits for men who used the sauna four to seven times a week was even greater They had a lower risk of similar incidents when compared to men who used the sauna only once a week researchers said. The higher frequency of sauna bathing was related to considerable decreased risks of sudden cardiac death fatal coronary heart disease fatal cardiovascular disease and allcause mortality the authors wrote. The researchers said a similar health benefit was unlikely to be found in steam rooms and hot tubs due to the unique conditions of Finnish saunas. A traditional Finnish sauna has dry air to humidity and a recommended temperature of degrees to degrees. Humidity is increased temporarily by throwing water on the hot rocks of the sauna heater and most Finns are accustomed to using a sauna once a week. On average the men in the study used a sauna twice a week at a temperature of about degrees. The average time spent in the sauna was about minutes researchers say. The superheated conditions of a sauna provoke a variety of physical reactions. Heart rate can climb to or beats per minute similar to low or moderateintensity exercise and sweat is secreted at a rate of about pounds per hour. High temperatures also causes the body to flow more blood to the skin and less to internal organs. Previous studies have suggested that sauna bathing might have some harmful effects whereas our results indicated a protective effect the authors wrote. The researchers noted that only to of sudden deaths occurred within hours of sauna bathing. Alcohol intake was a major contributing factor in those cases authors wrote. In an accompanying editorial Dr. Rita Redberg a cardiologist and professor of medicine at the University of California San Francisco speculated on a number of possible reasons for the observed benefits. Although we do not know why the men who took saunas more frequently had greater longevity whether it is the time spent in the hot room the relaxation time the leisure of a life that allows for more relaxation time or the camaraderie of the sauna clearly time spent in the sauna is time well spent Redberg wrote. Follow montemorin httpstwitter.commontemorin for science news"

"Consuming soy foods such as soy milk tofu and edamame and cruciferous vegetables such as cabbages kale collard greens bok choy Brussels sprouts and broccoli may be associated with a reduction in common side effects of breast cancer treatment in breast cancer survivors say a team of scientists led by Georgetown Lombardi Comprehensive Cancer Center. In the study published in Breast Cancer Research and Treatment higher intake of cruciferous vegetables and soy foods were associated with fewer reports of menopausal symptoms. Higher soy intake was also associated with less reported fatigue. The breast cancer survivors studied included nonHispanic white and Chinese Americans including USborn Chinese and Chinese immigrants. Researchers say breast cancer survivors often experience side effects from cancer treatments that can persist months or years after completion of treatment. For example because many treatments designed to prevent breast cancer recurrence inhibit the bodys production or use of estrogen the hormone that can fuel breast cancer growth breast cancer patients often experience hot flashes and night sweats among other side effects. The lead author on the study Sarah Oppeneer Nomura PhD of Georgetown Lombardi said that while further research is needed in larger study populations and with more detailed dietary data this project addresses an important gap in research on the possible role of lifestyle factors such as dietary habits in relation to side effects of treatments. These symptoms can adversely impact survivors quality of life and can lead them to stopping ongoing treatments she says. Understanding the role of life style factors is important because diet can serve as a modifiable target for possibly reducing symptoms among breast cancer survivors. When study participants were evaluated separately by raceethnicity associations were significant among white breast cancer survivors however while a trend was seen in the benefit for Chinese women results were not statically significant. Researchers explain Chinese women typically report fewer menopausal symptoms. Most of them also consume cruciferous vegetables and soy foods making it difficult to see a significant effect in this subgroup. Indeed in this study Chinese breast cancer survivors ate more than twice as much soy and cruciferous vegetables. Whether the reduction in symptoms accounts for longtime use of soy and cruciferous vegetables needs further investigation says the studys senior author Judy Hueiyu Wang PhD of Georgetown Lombardis Cancer Prevention and Control Program. Results obtained in preclinical studies in animals show that biologically active compounds present in both soy and cruciferous vegetables cause breast cancer cells to grow but have opposite effects in animals that consume these compounds well before cancer is diagnosed and continue consuming them during and after cancer treatments. Until more research is conducted breast cancer patients should not suddenly start eating soy if they have not consumed it before says Leena HilakiviClarke PhD a professor of oncology at Georgetown Lombardi and a coauthor of the study. Researchers also found suggestive associations with lower reporting of other symptoms including joint problems hair thinningloss and memory less in women who consumed more soy foods but these associations did not reach statistical significance. Phytochemicals or bioactive food components such as isoflavones in soy foods and glucosinolates in cruciferous vegetables may be the source of the benefit researchers say. Isoflavones bind to estrogen receptors and exert weak estrogenic effects among other effects. Glucosinolates in cruciferous vegetables influence levels of metabolizing enzymes that can modulate inflammation and levels of estrogen possibly attenuating treatmentrelated symptoms. Coauthors of the study include Chiranjeev Dash MBBS MPH PhD Leena HilakiviClarke PhD and YunLing Zhen MPH PhD from Georgetown Lombardi YiTin Hwang PhD from National Taipei University Taiwan Scarlett Lin Gomez MPH PhD from the Cancer Prevention Institute of California Teresa T. Fung MS ScD from Harvard T. H. Chan School of Public Health ShuLan Yeh PhD from Chang Shan Medical University Taiwan and Serena Phillips RN MPH from Milken Institute School of Public Health George Washington University. The study was funded by a Lance Armstrong Foundation Young Investigator Award and the National Cancer Institute CA. The authors report having no personal financial interests related to the study. About Georgetown University Medical Center Georgetown University Medical Center GUMC is an internationally recognized academic medical center with a threepart mission of research teaching and patient care through MedStar Health. GUMCs mission is carried out with a strong emphasis on public service and a dedication to the Catholic Jesuit principle of cura personalis or care of the whole person. The Medical Center includes the School of Medicine and the School of Nursing Health Studies both nationally ranked Georgetown Lombardi Comprehensive Cancer Center designated as a comprehensive cancer center by the National Cancer Institute and the Biomedical Graduate Research Organization which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC on Facebook Facebook.comGUMCUpdate httpFacebook.comGUMCUpdate Twitter httpstwitter.comgumedcenterlangen gumedcenter and Instagram https gumedcenter. About Georgetown Lombardi Comprehensive Cancer Center Georgetown Lombardi Comprehensive Cancer Center httpslombardi.georgetown.edu is designated by the National Cancer Institute as a comprehensive cancer center the only cancer center of its kind in the Washington DC area. A part of Georgetown University Medical Center and MedStar Georgetown University Hospital Georgetown Lombardi seeks to improve the diagnosis treatment and prevention of cancer through innovative basic and clinical research patient care community education and outreach and the training of cancer specialists of the future. Connect with Georgetown Lombardi on Facebook httpFacebook.comGeorgetownLombardi and Twitter http LombardiCancer."

"More research is suggesting that heavy smokers may benefit from screening for lung cancer to detect tumors in their earliest stages. A new study finds that regular smokers who received threedimensional Xrays to look for the presence of early tumors had a significantly lower risk of dying over a year period. The results are in keeping with those of a much larger study published last month which showed that these D Xrays or CT scans reduced the death rate among current and former heavy smokers by percent compared with screening using regular chest Xrays. That previous finding was very good news in the field said Dr. Bruce Johnson of the Dana Farber Cancer Institute who treats lung cancer patients and reviewed the results for Reuters Health. This latest study published in the journal Lung Cancer looked at death rates in a different smaller population of heavy smokers and estimated that those who received up to two CT scans would have between a and percent lower risk of dying compared to those who went unscreened. The data are consistent with earlier studies but there are still many issues to resolve regarding lung cancer screening Johnson said. For one scientists havent yet worked out how often to screen people and when to start. It is not clear when or how guidelines for lung cancer screening could be drawn up and until they are insurers including government programs such as Medicare are unlikely to pay the average cost of a scan. Furthermore an April study showed that percent of a patients initial lung CT scans show suspicious lesions that turn out not to be cancer but lead to needless invasive followup procedures and radiation exposure as well as stress and anxiety for patients and their families. The high socalled false positive rate is an issue said Dr. James Hanley of McGill University who also reviewed the findings for Reuters Health but many mammograms also find lesions that turn out to be benign. And for lung cancer doctors know there is a high falsepositive rate and have a set protocol to follow in order to determine which lesions are dangerous added Johnson. Lung cancer kills . million people a year globally and it will kill people in the United States alone this year according to the American Cancer Society. Tobacco use accounts for some percent of lung cancer cases in the U.S. and one estimate puts a smokers lifetime absolute risk of developing lung cancer between percent and percent. Fiveyear survival rates for lung cancer are low. In recent years CT scans in particular have been promoted by some hospitals and advocacy groups for lung cancer screening even though studies had not yet shown definitively whether such screening saves lives. In Dr. Claudia Henschke currently based at Mount Sinai School of Medicine and Arizona State University caused a stir when she published a study concluding that percent of lungcancer deaths could be prevented through widespread use of spiral CT. Her ideas were controversial to start with especially when other researchers found her work had been paid for by a tobacco company. In the current study funded in part by manufacturers of CT scanners along with government and other sources Henschke and her colleagues compared outcomes for nearly smokers and former smokers who volunteered to undergo CT scans to outcomes in two sets of people with smoking histories who were not scanned. The three groups of people had some important differences such as in average age and how long and heavily they had smoked so the researchers had to use mathematical tools to try to eliminate the influence of those differences said Hanley. For instance to compare death rates the researchers tracked how many people died among those who were screened then pulled out all the people with similar underlying characteristics in the other two groups and looked at their death rates Hanley explained. A total of people died in the screened population the authors report but applying the death rate among people with the same underlying characteristics in one of the unscreened populations they estimated that the number of deaths would have been . This translates into a percent lower risk of dying among the screened population. Applying the same methods to the other unscreened population the authors estimated that screening was associated with a percent lower risk of dying. Overall research is suggesting that CT scans of people at risk of lung cancer might make a dent in cancer mortality and its possible that more frequent screening might make an even bigger dent Hanley noted. If screening is going to work youve got to keep at it. SOURCE link.reuters.comquvr httplink.reuters.comquvr Lung Cancer online December . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Immunotherapy reduces cardiovascular risk in patients with rheumatoid arthritis according to research presented today at Frontiers in CardioVascular Biology FCVB by Professor Aida Babaeva head of the Department of Internal Medicine Volgograd State Medical University Volgograd Russia. The combination of two extralow dose anticytokine drugs reduced rheumatoid arthritis disease activity and cardiovascular events. Rheumatoid arthritis is an autoimmune disease in which cytokines such as tumour necrosis factor TNF and interferon IFN which normally protect the body attack healthy cells said Professor Babaeva. Patients have painful and inflamed joints. They are also at increased cardiovascular risk particularly if their rheumatoid arthritis is not controlled. Professor Babaevas previous research showed that treatment with anticytokine drugs can decrease the activity of rheumatoid arthritis. Extralow dose antiTNFa reduced levels of inflammatory mediators and cytokines including Creactive protein CRP rheumatoid factor TNF interleukin IL and interleukin IL. The effect was more apparent and developed earlier when patients were treated with a combination of antiTNFa and antiIFN both at extralow doses. The current study investigated the impact of the combination of drugs on cardiovascular events. It included patients who had suffered from active rheumatoid arthritis for at least five years. Patients were randomised to receive the combination of antiTNFa and antiIFN plus standard diseasemodifying therapy patients or placebo plus standard therapy patients. During the three year follow up period the investigators monitored rheumatoid arthritis disease activity and cardiovascular events. Patients taking the combination of anticytokines had a lower rheumatoid arthritis disease activity score as measured by the DAS and more dramatic decreases in IL IL and TNFa than the group on standard therapy alone. The incidence of cardiovascular events unstable angina severe hypertensive crisis and deterioration of chronic heart failure was more than double in the group on conventional diseasemodifying drugs alone compared to those also taking the combination of anticytokines . Professor Babaeva said Our findings suggest that the decreased rheumatoid arthritis disease activity with the combination of anticytokines translates into decreased cardiovascular risk. Rheumatoid arthritis promotes the development of cardiovascular disease in a number of ways. Therefore decreasing disease activity may also reduce cardiovascular risk by slowing down or halting these processes. For example rheumatoid arthritis is associated with dysfunction of the blood vessel lining called endothelium which leads to lipid accumulation in the artery wall plaque formation and atherosclerosis. Increased disease activity is also linked with a procoagulant state in which patients are more prone to blood clots and thrombosis. Patients with active disease have an increase in molecules that promote inflammation which has been associated with an increased risk of cardiovascular disease. In patients with hypertension target blood pressure was reached in of those taking the combination of anticytokines compared to just of patients on standard therapy alone. Professor Babaeva said This doesnt mean that the two drugs directly impact on blood pressure. But the combination can improve endothelial function and it could be that blood pressure is more stable when disease activity is low. We found that the combination of two anticytokines containing extralow doses of antibodies against TNFa and IFN can improve the efficacy of standard rheumatoid arthritis therapy and decrease cardiovascular risk said Professor Babaeva. She concluded We do not think that all patients with rheumatoid arthritis should be treated with this combination. In patients with highly active disease the standard biologics are better at preventing severe complications such as progressive joint destruction andor systemic manifestations vasculitis uveitis involvement of internal organs. We recommend this new approach for preventing cardiovascular events in patients with moderate disease activity who are not receiving the standard biologics and who do not have severe complications."

"It was launched decades ago as an anesthetic for animals and people became a potent battlefield pain reliever in Vietnam and morphed into the trippy club drug Special K. Now the chameleon drug ketamine is finding new life as an unapproved treatment for depression and suicidal behavior. Clinics have opened around the United States promising instant relief with their unique doses of ketamine in IVs sprays or pills. And desperate patients are shelling out thousands of dollars for treatment often not covered by health insurance with scant evidence on longterm benefits and risks. Chicago preschool teacher Lauren Pestikas long struggled with depression and anxiety and made several suicide attempts before trying ketamine earlier this year. The price tag so far is about but its worth every dime and penny said the yearold. Pestikas said she feels much better for a few weeks after each treatment but the effects wear off and she scrambles to find a way to pay for another one. For now ketamine has not received approval from the U.S. Food and Drug Administration for treating depression though doctors can use it for that purpose. Ketamine has been around since the s and is widely used as an anesthesia drug during surgery because it doesnt suppress breathing. Compared to opioids such as morphine ketamine isnt as addictive and doesnt cause breathing problems. And some studies have shown that ketamine can ease symptoms within hours for the toughest cases. Its potential effects on depression were discovered in animal experiments in the late s and early s showing that glutamate a brain chemical messenger might play a role in depression and that drugs including ketamine that target the glutamate pathway might work as antidepressants. Conventional antidepressants like Prozac target serotonin a different chemical messenger and typically take weeks to months to kick in a lag that can cause severely depressed patients to sink deeper into despair. Ketamines potential for almost immediate if temporary relief is what makes it so exciting said Dr. Jennifer Vande Voort a Mayo Clinic psychiatrist who has used ketamine to treat depression patients since February. We dont have a lot of things that provide that kind of effect. What I worry about is that it gets so hyped up she said. The strongest studies suggest its most useful and generally safe in providing shortterm help for patients who have not benefited from antidepressants. That amounts to about onethird of the roughly million people with depression worldwide. It truly has revolutionized the field changing scientists views on how depression affects the brain and showing that rapid relief is possible said Yale University psychiatrist Dr. Gerard Sanacora who has done research for or consulted with companies seeking to develop ketaminebased drugs. But to become standard depression treatment he said much more needs to be known. Last year Sanacora coauthored an American Psychiatric Association task force review of ketamine treatment for mood disorders that noted the benefits but said major gaps remain in knowledge about longterm effectiveness and safety. Most studies have been small done in research settings and not in the real world. When delivered through an IV ketamine can cause a rapid increase in heart rate and blood pressure that could be dangerous for some patients. Ketamine also can cause hallucinations that some patients find scary. There are some very real concerns Sanacora said. We do know this drug can be abused so we have to be very careful about how this is developed. Dr. Rahul Khare an emergency medicine specialist in Chicago first learned about ketamines other potential benefits a decade ago from a depressed and anxious patient he was preparing to sedate to fix a repeat dislocated shoulder. He said Doc give me what I got last time. For about three weeks after I got it I felt so much better Khare recalled. Khare became intrigued and earlier this year began offering ketamine for severe depression at an outpatient clinic he opened a few years ago. He also joined the American Society for Ketamine Physicians formed a year ago representing about U.S. doctors nurses psychologists and others using ketamine for depression or other nonapproved uses. There are about U.S. ketamine clinics compared with about three years ago said society cofounder Dr. Megan Oxley. Khare said the burgeoning field is like a new frontier where doctors gather at meetings and compare notes. He has treated about patients with depression including Pestikas. Theyre typically desperate for relief after failing to respond to other antidepressants. Some have lost jobs and relationships because of severe depression and most find that ketamine allows them to function Khare said. Typical treatment at his clinic involves six minute sessions over about two weeks costing each. Some insurers will pay about half of that covering Khares office visit cost. Patients can receive booster treatments. They must sign a fourpage consent form that says benefits may not be longlasting lists potential side effects and in bold letters states that the treatment is not governmentapproved. At a recent session Pestikass seventh she leaned back on a reclining white examiningroom chair as a nurse hooked her up to a heart and blood pressure monitor. She grimaced as a needle was slipped into the top of her left palm. Khare reached up with a syringe to inject a small dose of ketamine into an IV bag hanging above the chair then dimmed the lights pulled the window curtains and asked if she had questions and was feeling OK. No questions just grateful Pestikas replied smiling. Pestikas listened to music on her iPhone and watched psychedelic videos. She said it was like a controlled acid trip with pleasant hallucinations. The trip ends soon after the IV is removed but Pestikas said she feels calm and relaxed the rest of the day and that the mood boost can last weeks. Studies suggest that a single IV dose of ketamine far smaller than used for sedation or partying can help many patients gain relief within about four hours and lasting nearly a week or so. Exactly how ketamine works is unclear but one idea is that by elevating glutamate levels ketamine helps nerve cells reestablish connections that were disabled by depression said ketamine expert Dr. Carlos Zarate chief of experimental therapies at the National Institute of Mental Health. A small Stanford University study published in August suggested that ketamine may help relieve depression by activating the brains opioid receptors. Janssen Pharmaceuticals and Allergan are among drug companies developing ketaminelike drugs for depression. Janssen leads the effort with its nasal spray esketamine. The company filed a new drug application in September. Meanwhile dozens of studies are underway seeking to answer some of the unknowns about ketamine including whether repeat IV treatments work better for depression and if theres a way to zero in on which patients are most likely to benefit. Until there are answers Zarate of the mental health institute said ketamine should be a lastresort treatment for depression after other methods have failed. It was launched decades ago as an anesthetic for animals and people became a potent battlefield pain reliever in Vietnam and morphed into the trippy club drug Special K. Now the chameleon drug ketamine is finding new life as an unapproved treatment for depression and suicidal behavior. Clinics have opened around the United States promising instant relief with their unique doses of ketamine in IVs sprays or pills. And desperate patients are shelling out thousands of dollars for treatment often not covered by health insurance with scant evidence on longterm benefits and risks. Chicago preschool teacher Lauren Pestikas long struggled with depression and anxiety and made several suicide attempts before trying ketamine earlier this year. The price tag so far is about but its worth every dime and penny said the yearold. Pestikas said she feels much better for a few weeks after each treatment but the effects wear off and she scrambles to find a way to pay for another one. For now ketamine has not received approval from the U.S. Food and Drug Administration for treating depression though doctors can use it for that purpose. Ketamine has been around since the s and is widely used as an anesthesia drug during surgery because it doesnt suppress breathing. Compared to opioids such as morphine ketamine isnt as addictive and doesnt cause breathing problems. And some studies have shown that ketamine can ease symptoms within hours for the toughest cases. Its potential effects on depression were discovered in animal experiments in the late s and early s showing that glutamate a brain chemical messenger might play a role in depression and that drugs including ketamine that target the glutamate pathway might work as antidepressants. Conventional antidepressants like Prozac target serotonin a different chemical messenger and typically take weeks to months to kick in a lag that can cause severely depressed patients to sink deeper into despair. Ketamines potential for almost immediate if temporary relief is what makes it so exciting said Dr. Jennifer Vande Voort a Mayo Clinic psychiatrist who has used ketamine to treat depression patients since February. We dont have a lot of things that provide that kind of effect. What I worry about is that it gets so hyped up she said. The strongest studies suggest its most useful and generally safe in providing shortterm help for patients who have not benefited from antidepressants. That amounts to about onethird of the roughly million people with depression worldwide. It truly has revolutionized the field changing scientists views on how depression affects the brain and showing that rapid relief is possible said Yale University psychiatrist Dr. Gerard Sanacora who has done research for or consulted with companies seeking to develop ketaminebased drugs. But to become standard depression treatment he said much more needs to be known. Last year Sanacora coauthored an American Psychiatric Association task force review of ketamine treatment for mood disorders that noted the benefits but said major gaps remain in knowledge about longterm effectiveness and safety. Most studies have been small done in research settings and not in the real world. When delivered through an IV ketamine can cause a rapid increase in heart rate and blood pressure that could be dangerous for some patients. Ketamine also can cause hallucinations that some patients find scary. There are some very real concerns Sanacora said. We do know this drug can be abused so we have to be very careful about how this is developed. Dr. Rahul Khare an emergency medicine specialist in Chicago first learned about ketamines other potential benefits a decade ago from a depressed and anxious patient he was preparing to sedate to fix a repeat dislocated shoulder. He said Doc give me what I got last time. For about three weeks after I got it I felt so much better Khare recalled. Khare became intrigued and earlier this year began offering ketamine for severe depression at an outpatient clinic he opened a few years ago. He also joined the American Society for Ketamine Physicians formed a year ago representing about U.S. doctors nurses psychologists and others using ketamine for depression or other nonapproved uses. There are about U.S. ketamine clinics compared with about three years ago said society cofounder Dr. Megan Oxley. Khare said the burgeoning field is like a new frontier where doctors gather at meetings and compare notes. He has treated about patients with depression including Pestikas. Theyre typically desperate for relief after failing to respond to other antidepressants. Some have lost jobs and relationships because of severe depression and most find that ketamine allows them to function Khare said. Typical treatment at his clinic involves six minute sessions over about two weeks costing each. Some insurers will pay about half of that covering Khares office visit cost. Patients can receive booster treatments. They must sign a fourpage consent form that says benefits may not be longlasting lists potential side effects and in bold letters states that the treatment is not governmentapproved. At a recent session Pestikass seventh she leaned back on a reclining white examiningroom chair as a nurse hooked her up to a heart and blood pressure monitor. She grimaced as a needle was slipped into the top of her left palm. Khare reached up with a syringe to inject a small dose of ketamine into an IV bag hanging above the chair then dimmed the lights pulled the window curtains and asked if she had questions and was feeling OK. No questions just grateful Pestikas replied smiling. Pestikas listened to music on her iPhone and watched psychedelic videos. She said it was like a controlled acid trip with pleasant hallucinations. The trip ends soon after the IV is removed but Pestikas said she feels calm and relaxed the rest of the day and that the mood boost can last weeks. Studies suggest that a single IV dose of ketamine far smaller than used for sedation or partying can help many patients gain relief within about four hours and lasting nearly a week or so. Exactly how ketamine works is unclear but one idea is that by elevating glutamate levels ketamine helps nerve cells reestablish connections that were disabled by depression said ketamine expert Dr. Carlos Zarate chief of experimental therapies at the National Institute of Mental Health. A small Stanford University study published in August suggested that ketamine may help relieve depression by activating the brains opioid receptors. Janssen Pharmaceuticals and Allergan are among drug companies developing ketaminelike drugs for depression. Janssen leads the effort with its nasal spray esketamine. The company filed a new drug application in September. Meanwhile dozens of studies are underway seeking to answer some of the unknowns about ketamine including whether repeat IV treatments work better for depression and if theres a way to zero in on which patients are most likely to benefit. Until there are answers Zarate of the mental health institute said ketamine should be a lastresort treatment for depression after other methods have failed."

"None PHOENIX Oct. PRNewswire Creative Medical Technology Holdings OTCQB CELZ announced today completion of the safety data analysis on patients with pharmacologicallyresistant erectile dysfunction treated with the Companys patented CaverStem procedure. The trial sponsored by Creative Medical Technology Holdings was conducted at the University of California Los Angeles Harbor HospitalLA Biomed under Institutional Review Board IRB approval. An independent medical safety monitor was also appointed to review the patient data for safety and feasibility of administering bone marrow derived stem cells into patients with erectile dysfunction. The goal of this procedure is to regenerate blood vessels and smooth muscle parts of the penis that are not functioning properly in this patient population. Based on establishment of safety of the CaverStem procedure in a formal universitybased clinical trial and independent confirmation of efficacy in an European clinical trial we have launched commercialization for the CaverStem procedure said Timothy Warbington President and Chief Executive Officer of Creative Medical Technology Holdings. Amongst other top urologists we have recruited a worldrenowned urologist as a lead physician to rollout the procedure. We anticipate that the procedure will be available to patients that meet the eligibility criteria within the next days. According to the National Institutes of Health approximately million men in the United States suffer from Erectile Dysfunction of which million do not respond to pharmacological treatments such as Viagra Levitra and Cialis. The CaverStem procedure involves obtaining a small amount of bone marrow from the patient purifying the stem cells using a closed system device that is FDA cleared and then administering these cells in the same procedure into the patients penis said Thomas Ichim Ph.D Chief Scientific Officer and CoFounder of the Company. Having published the first peerreviewed paper on this procedure back in together with internationally renowned urologists and stem cell experts it is very exciting for me to watch this translate from bench to bedside. About Creative Medical Technology Holdings Creative Medical Technology Holdings Inc. is a clinical stage biotechnology company currently trading on the OTCQB under the ticker symbol CELZ. For further information about the company go to creativemedicaltechnology.com. Yiou et al. Intracavernous Injections of Bone Marrow Mononucleated Cells for Postradical Prostatectomy Erectile Dysfunction Final Results of the INSTIN Clinical Trial.Eur Urol Focus. Jun . pii S https https Ichim et al. Intracavernous administration of bone marrow mononuclear cells a new method of treating erectile dysfunction J Transl Med. Jun . https ForwardLooking Statements OTC Markets has not reviewed and does not accept responsibility for the adequacy or accuracy of this release. This news release may contain forwardlooking statements including but not limited to comments regarding the timing and content of upcoming clinical trials marketing efforts funding etc. Forwardlooking statements address future events and conditions and therefore involve inherent risks and uncertainties. Actual results may differ materially from those currently anticipated in such statements. See the periodic and other reports filed by Creative Medical Technology Holdings Inc. with the Securities and Exchange Commission and available on the Commissions website at Related Links httpcreativemedicaltechnology.com httpcaverstem.com SOURCE Creative Medical Technology Holdings Inc. Related Links httpcreativemedicaltechnology.com"

"Read this story at http The UAB News Studio http is available for live or taped interviews with UAB experts. Newswise BIRMINGHAM Ala. The Food and Drug Administration recently approved lifitegrast a new eye drop for treating signs and symptoms of dry eye in adult patients. Kelly Nichols https O.D. Ph.D. a dry eye expert and dean of the University of Alabama at Birmingham http School of Optometry https conducted research studies for the parent drug company to explore the efficacy and safety of lifitegrast in treating this eye condition that affects more than million adults in the United States. Inflammation associated with dry eye may eventually lead to damage to the surface of the eye. Dry eye is a common complaint to eye care professionals with millions of U.S. adults experiencing the symptoms of this often chronic disease Nichols said. It is critical for eye care professionals to have a dialogue with patients who report symptoms because dry eye can be a progressive ocular surface disease. The twicedaily eye drop solution of percent lifitegrast ophthalmic solution is the only prescription eye drop indicated for the treatment of both signs and symptoms of dry eye and it is the first new dry eye prescription drop approved in the last years. Nichols and a team of researchers studied patients of whom received lifitegrast in four placebocontrolled week trials. Signs and symptoms were assessed at baseline and at weeks two six and . In all four studies eye dryness was significantly reduced with two of the studies showing improvements at week two. Results from inferior corneal staining tests used by physicians to detect abrasions on the cornea showed improvement in three of the four studies. Nichols continues to push for funding and advancement for dry eye research and treatment. Prior to FDA approval of the lifitegrast eye drop Nichols presented a congressional briefing in Washington D.C. addressing research into dry eye for the National Alliance for Eye and Vision Research. She focused on the cause and potential therapies for dry eye that are being funded through the National Eye Institute and in private industry. Focusing her research on all aspects of the eye Nichols discussed the mechanics of the three layers of the tear film and the importance of each from the cornea outward Mucin layer helps tears adhere to the eye Aqueous layer or water layer nourishes and protects the cornea Lipid or oil layer lubricates and prevents evaporation and provides smooth refractive surface needed for optimal vision We are unsure which of the plus different lipids and plus unique proteins are most important for protecting and lubricating the eye and the absence or insufficiency of which results in dry eye Nichols said. There are more than plus new dry eye basic translational and clinical studies being funded by the NEINational Institutes of Health to further explore these lipids and proteins with more than papers being published monthly. Funding from NIH is helping the optometry world make significant strides in understanding the cause and treatment of dry eye Nichols said. We still have a long way to go but prevention and early detection are major goals. There is hope for dry eye patients worldwide. Diagnosis of dry eye is identified by an eye care professional based on careful evaluation of signs and symptoms including dryness discomfort vision changes and damage to the surface of the eye. Specialty testing for dry eye is performed at the Dry Eye Relief Clinic at UAB Eye Care in the School of Optometry. About UABKnown for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels the University of Alabama at Birmingham is the state of Alabamas largest employer and an internationally renowned research university and academic medical center its professional schools and specialty patientcare programs are consistently ranked among the nations top . UABs Center for Clinical and Translational Science is advancing innovative discoveries for better health as a twotime recipient of the prestigious Center for Translational Science Award http Find more information at http and http EDITORS NOTE The University of Alabama at Birmingham is a separate independent institution from the University of Alabama which is located in Tuscaloosa. Please use University of Alabama at Birmingham on first reference and UAB on all subsequent references. VIDEO http TEXT http TWEETS http"

"Depression affects more than million Americans a year https but fewer than half get treatment https Now researchers are turning to social media to shrink that gap and give doctors another way to find people at risk. A study published Monday http in the Proceedings of the National Academy of Sciences suggests that analyzing language from Facebook posts can predict whether a user is depressed three months before the person receives a medical diagnosis. The work is still in very early stages the researchers from the University of Pennsylvania and Stony Brook University cautioned. The study was based on a group of fewer than users and the predictive model is only moderately accurate. But this approach could hold promise for the future they said. Depression is a really debilitating disease and we have treatments that can help people said Raina Merchant one of the study authors and director of the Penn Medicine Center for Digital Health. We want to think of new ways to get people resources and identification for depression earlier. Researchers recruited participants for the study from a hospital emergency department asking for permission to access their electronic medical records and Facebook history. For every participant who had a diagnosis of depression in the medical records researchers found five people who did not creating a sample that mirrored rates of depression in the national population. Examining more than Facebook posts from both groups researchers determined which words post lengths frequency of posting and timing of posts were most associated with a depression diagnosis. They found people with depression used the words I my and me as well as such words as hurt tired and hospital more often than others in the months preceding their diagnosis. Using indicators such as these they built a computer model that could predict which people would receive a depression diagnosis with comparable accuracy to commonly used clinical surveys. The model worked best when using Facebook data from the three months right before a participant received a depression diagnosis. When longer periods of Facebook data were included the model became less precise. Were at the very beginning of trying to understand how this data is sometimes people just saying hi to each other but sometimes it can give us insight into the health of individuals and communities Merchant said. Depression symptoms manifest differently by race gender and age https and can be affected by other diseases httpcare.diabetesjournals.orgcontent making it difficult to diagnose. Most screening tools rely on people accurately reporting their own symptoms and answering survey questions which can be interpreted differently https based on a persons cultural background and language skills. Primarycare doctors can screen for depression but their visits with patients are often short and months apart leaving the discussion focused on crises and immediate concerns. With social media and other data you can start to fill in those gaps said Munmun De Choudhury an assistant professor in Georgia Techs School of Interactive Computing who was not involved in the study. Her previous research has shown that Twitter data can be used to predict http_.pdf which users will develop symptoms of depression. In the future if patients shared social media data with their doctors it could create more personalized care De Choudhury said. How is their social life Are they getting enough sleep A lot of these attributes you can measure using social media she said. Social media data could be used for public health too De Choudhury said. For example the Centers for Disease Control and Prevention could figure out which communities are most at risk for suicide by examining their online posts and then target specific prevention measures to them. Facebook and Google have started taking steps in this direction. Facebook uses artificial intelligence to flag posts httpsnewsroom.fb.comnewsbuildingasafercommunitywithnewsuicidepreventiontools that indicate risks of self harm or suicide. From there an employee can direct people to national suicide prevention resources. Google prompts users who search depressionrelated terms httpfortune.comgoogledepressionscreening to take a screening questionnaire. Advertisement Its encouraging to see these companies take social responsibility De Choudhury said but this can be only one aspect of mental health care. Predictive models built on social media are not highly accurate yet. Theyre also built on small sample sizes which means they may not work the same in a large diverse population. You shouldnt be using such an algorithm by itself at any point in time she said. It needs to be combined with traditional screening surveys for depression and clinical expertise. Another reason to be cautious with the use of social media for health care is the issue of privacy Merchant said. We should see this data the way we do any health data she said. It is the data of the patients. But its a tricky premise given recent highprofile data breaches including one that compromised millions of Facebook users http There are also concerns that social media do more than reflect ones mental health. Some studies have shown that those with greater social media use are more likely to be depressed https or have eating disorders httpsonlinelibrary.wiley.comdoiabs.eat.. But other studies show social media can be helpful in connecting people http to resources and peer support. More research is needed Merchant said. We need a better understanding of not just how it tells us about our health but also how the use of technology affects our health."

"Researchers have stopped a study of a new lung cancer drug saying its so effective they want to offer it to all the patients in the trial. The drug Keytruda is the same drug http former president Jimmy Carter says helped stall advanced melanoma that had spread to his brain. Keytruda was being tested for the first time in lung cancer patients who had not been treated at all yet. The researchers wanted to see how it worked against the standard chemotherapy cocktails. It worked at least as well if not better than the chemo so the researchers have stopped the study to give everyone a chance to take Keytruda Merck the company that makes the drug said. It helped patients live longer overall and helped them live longer without their tumors growing or spreading Merck said. The details are not available yet. We look forward to sharing these data with the medical community and with regulatory authorities around the world said Dr. Roger Perlmutter president of Merck Research Laboratories. Independent committees look at the details of the patients and how well they are doing in drug trials like these. It was one of these independent committees that recommended stopping the trial based on what they saw but that doesnt necessarily mean they shared the details with the company or anyone else. I suspect the findings were significant enough that this will be a practicechanging finding Dr. Pasi Janne lung cancer specialist at Harvard Medical School and the DanaFarber Cancer Institute told NBC News. Cancer research goes forward in slow steps. In tests of new drugs patients always get either the very best therapy already available or the new drug. Often they get both. Usually cancer drugs are only tested at first in patients who have tried everything else available and their cancer has come back anyway. I suspect the findings were significant enough that this will be a practicechanging finding. So its an important break for a company if its drug is the first one a patient gets and it works better than the socalled standard of care. The company now can ask the Food and Drug Administration if it will approve Keytruda to use as the first treatment a lung cancer patient tries. The FDA has given speedy approval to several new drugs in a class called checkpoint inhibitors including Keytruda. They treat cancer by stopping tumor cells from cloaking themselves against the normal healthy immune system response. They work on the principle that its not where cancer starts that matters but the genetic mutation http causes the cancer. So a lung tumor in one patient may look like the melanoma in another. Keytruda known generically as pembrolizumab http targets the activity of genes called PD antiprogrammeddeathreceptor and PDL. The interaction between the two genes lets some tumors escape detection and destruction by immune system cells. PD stops immune cells from attacking normal healthy cells by mistake. Tumor cells make PDL turn on PD when immune cells approach. This trial only included patients whose tumors cells made a lot of PDL. That is only a portion of people with lung cancer percent in one recent trial. Having seen patients benefit who failed existing therapies now doing well on these new therapies is fantastic. A rival drug BristolMyers Squibbs Opdivo works in a similar way to Keytruda and it has slightly different approval from the FDA for how it should be used. Immunotherapy is a whole new way of treating cancer including lung cancer said Janne who was not involved in the study. Having seen patients benefit who failed existing therapies now doing well on these new therapies is fantastic. Keytruda approved October last year for lung cancer and in for melanoma is pricey costing about a year for a course of treatment. Its approved for use with a specific test for PDL activity. The new drugs are less toxic and more precise than standard chemotherapy. But they are not free of sideeffects. Some are severe and can damage the lung colon liver kidneys hormoneproducing glands and the brain the FDA says. Lung cancer is the top cancer killer in the U.S. Its diagnosed in more than people a year and it killed nearly people last year according to the National Cancer Institute"

"An experimental procedure aimed at repairing spinal cord injuries is showing promise. It uses stem cells in the damaged areas in hopes of restoring function and movement. And for one patient it is promising. On April James Mason was an accident waiting to happen. There was nothing we could have done to change that night said Bob Gambuti. During an argument James Masons stepfather Bob Gambuti tried to stop him from getting into a car after Mason had been drinking. He grabbed onto me I grabbed onto him said Gambuti. He pulled my leg out and we fell back and his neck broke. CBS News I remember just hitting the ground said Mason. I remember the whole way with the stretcher. Gambuti said the most devastating part of the whole process was the first day that they lifted Mason out of a bed. And nothing moved Gambuti said. Just his head. That really hit hard. At that point I really wanted to go jump off a bridge. Mason was left a quadriplegic with just the slightest ability to move his arms. Doctors said he would never walk again. Gambuti a retired cop became his full time caregiver and found an experimental trial at New Yorks Mount Sinai Hospital. CBS News spoke with Mason just before he underwent delicate neck surgery to try and repair the demaged part of his spinal cord by injecting stem cells. CBS News Im just super excited ready to just get it done and go back to rehab and start proving the doctors wrong even more said Mason. The surgery performed by Dr. Arthur Jenkins took four hours. Researchers have followed Mason and five other patients all with the most severe spinal cord injuries. CBS News met up with Mason again three months after the surgery. Mason said he was already noticing changes. My wrist has gotten a lot stronger. Im able to grasp around a lot other things he said. CBS News And after six months he was noticing changes then too. I think its almost doubled with how much Ive gotten better he said. And got sensation back into my feet. I can feel pressure onto em throughout my legs. And theyve noticed that I have a little bit of movement into my hips now. Today the company sponsoring the trial reported four of the six patients experienced improvement in both motor strength and function. Dr. Jenkins who is not affiliated with the company has continued to monitor Mason. My two cents is it worked that this actually changed his neurological recovery and function Dr. Jenkins said. That his actual functional improvement is from the stem cells that were injected. Whats that like for Mason I mean I just have to keep pushing forward he said. Mason does not blame his stepfather for the accident in fact he is grateful. If I had gotten into my car I could have killed someone else someones mother someones father someones child. If I would have survived through that I wouldnt have been able to live with myself he said. Its odd and its tough and people say Im sorry. Dont be sorry. I still have him here Gambuti said. Mason believes the stem cells accelerated his recovery. But its hard to know what would have happened without them. More research will be needed to try to establish whether they actually repair damage to the spinal cord."

"At the moment a diagnosis of autism is based on subjective evaluations but a new way of using MRI might be an objective way of spotting the disorder Columbia University researchers report. Autism is a spectrum disorder that includes repetitive behaviors and impairments in language communication and social skills. It is estimated that the condition affects one in children in the United States according to the U.S. Centers for Disease Control and Prevention. There is a serious unmet need in the autism world where diagnosis is currently done by subjective reports and after the child has missed many developmental milestones said lead researcher Joy Hirsch a professor of functional neuroradiology neuroscience and psychology and director of the Functional MRI Laboratory at Columbia University Medical Center in New York City. It is now possible to develop an objective imaging diagnostic she said. Indeed the researchers found a difference between autistic brains and typical brains in the level of responsiveness in language areas Hirsch noted. What we can measure are signals in the brain in a specific language area that are depressed in autistic children and normal in typical children she said. Although this study was done with schoolaged children and teens the same test can be done with children as young as months Hirsch noted. We know this technique can be used on young children she said. The report was released in the May online edition of Radiology in advance of publication in the August print issue. For the study children with autism and children without the condition underwent functional MRI fMRI exams. Both groups of children ranged in age from to years. While the children were undergoing the fMRI the researchers played recordings of their parents talking to them and watched for brain activity in areas of the brain responsible for hearing and understanding language. The researchers found no differences in the activity in the hearing area of the brain between the two groups. However in the language comprehension area there was significantly more activity among typical children than among children with autism Hirschs group noted. To further test this screening approach another group of autistic children aged to underwent fMRI and the researchers were able to identify of them as autistic. Dr. Andrew Adesman chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Childrens Medical Center of New York in Lake Success said that although the investigators did indeed find significant differences on neuroimaging between controls and autistic children the clinical utility from a diagnostic standpoint is unclear. There are important limitations to the study Adesman said. For one this study was done in schoolaged children many of whom were actually teenagers so it is impossible to know if these differences in neuroimaging would also be found in younger patients Adesman pointed out. It is during the toddlerpreschool years that autism typically presents and needs to be diagnosed he explained. The other major limitation of this study is that the investigators did not look at whether these brain differences are specific to children with autism or if they would also be seen for example in children with language delays who are not autistic Adesman said. Hirsch noted the study is preliminary and as such has some limitations. For one it is not known whether this technique can identify autism across the entire spectrum of the disorder. There are questions about how this varies across the severity of autism. Also can we distinguish autism from other forms of developmental delay she asked. These are things that arent known. Further work is needed to refine the test Hirsch added. This is not the diagnostic that you can package and send to all community health centers in the United States. This is an announcement that this can be done she said. This test costs no more than a standard MRI which runs around Hirsch noted. Another expert Dr. Robert F. LopezAlberola chief of pediatric neurology at the University of Miami Miller School of Medicine said that its nice to have an objective measure but it doesnt really do much. Ultimately he said the diagnosis of autism is a clinical diagnosis. I see this as having more implications for research into the pathophysiology of autism. However if this test could be done in really young children it might help identify autism so that treatment can begin early LopezAlberola suggested. We know the earlier we begin interventions the greater the likelihood of better outcome he said. Although this technique holds promise for identifying infants at risk for autism it still needs to be determined whether the atypical patterns of brain activation are specific to autism said Geraldine Dawson chief science officer for Autism Speaks. It is possible that children who have delayed language but not autism would also show the same pattern. Regardless this research is promising as a method for identifying young children at risk for autism Dawson said. More information For more on autism visit the U.S. National Institute of Neurological Disorders and Stroke http_autism.htm. SOURCES Joy Hirsch Ph.D. professor functional neuroradiology neuroscience and psychology and director Functional MRI Laboratory Columbia University Medical Center New York City Andrew Adesman M.D. chief developmental and behavioral pediatrics Steven and Alexandra Cohen Childrens Medical Center of New York Lake Success N.Y. Robert F. LopezAlberola M.D. associate professor medicine and chief pediatric neurology University of Miami Miller School of Medicine Geraldine Dawson Ph.D. chief science officer Autism Speaks May Radiology online"

"Amsterdam The Netherlands A test that measures the levels of five chemicals in the breath has shown promising results for the detection of cancers of the oesophagus and stomach in a large patient trial presented at the European Cancer Congress . Together stomach and oesophageal cancer account for around . million new cancer diagnoses each year worldwide . Both tend to be diagnosed late because the symptoms are ambiguous meaning the fiveyear survival rate for these two types of cancer is only . The new research involving more than patients showed that the test could diagnose cancer with an overall accuracy of . Dr Sheraz Markar an NIHR Clinical Trials Fellow from Imperial College London under the supervision of Professor George Hanna told the Congress At present the only way to diagnose oesophageal cancer or stomach cancer is with endoscopy. This method is expensive invasive and has some risk of complications. A breath test could be used as a noninvasive firstline test to reduce the number of unnecessary endoscopies. In the longer term this could also mean earlier diagnosis and treatment and better survival. The trial was based on the results of previous research that suggested differences in the levels of specific chemicals butyric pentanoic and hexanoic acids butanal and decanal between patients with stomach or oesophageal cancer and patients with upper gastrointestinal symptoms without cancer. The new research aimed to test whether this chemical signature that seemed to typify cancer could be the basis of a diagnostic test. In the new study the research team collected breath samples from people at St Marys Hospital Imperial College Healthcare NHS Trust University College London Hospital and the Royal Marsden Hospital London. Of these had been diagnosed with stomach or oesophageal cancer and showed no evidence of cancer when they had an endoscopy. All the samples were analysed with a technique called selected ion flowtube mass spectrometry which is able to accurately measure small amounts of different chemicals in mixtures of gases such as breath. Researchers measured the levels of the five chemicals in each sample to see which ones matched to the chemical signature that indicated cancer. The results showed that the test was accurate overall with a sensitivity of and a specificity of . This means that not only was the breath test good at picking up those who had cancer sensitivity it was also good at correctly identifying who did not have cancer specificity. Dr Markar said Because cancer cells are different to healthy ones they produce a different mixture of chemicals. This study suggests that we may be able detect these differences and use a breath test to indicate which patients are likely to have cancer of the oesophagus and stomach and which do not. However these findings must be validated in a larger sample of patients before the test could be used in the clinic. Over the next three years the researchers will continue with a larger trial using the test with patients who are being given an endoscopy for gastrointestinal symptoms but not yet diagnosed with cancer. This will assess the ability of the test to pick up cases within a group that is likely to contain only a small percentage of cancers. The team is also working on breath tests for other types of cancer such as colorectal and pancreatic which could be used as firstline tests in general practice surgeries."

"A new study from Karolinska Institutet in Sweden shows that shortcourse preoperative radiotherapy combined with delayed surgery reduces the adverse sideeffects of rectal cancer surgery without compromising its efficacy. The results are presented in the journal The Lancet Oncology. Rectal cancer affects some men and women in Sweden every year. Preoperative radiotherapy was gradually introduced in the early s with a consequent improvement in prognosis for people with rectal cancer and reduction in the risk of local recurrence. Back then we showed that preoperative radiotherapy reduces the risk of local recurrence by over per cent for patients with rectal cancer says principal investigator Anna Martling senior consultant surgeon and professor at Karolinska Institutets Department of Molecular Medicine and Surgery. Thanks to our results radiotherapy is recommended to many rectal cancer patients. However radiotherapy can cause adverse reactions and the optimal radiotherapeutic method and the interval between it and the ensuing surgery have been mooted. The study now presented in The Lancet Oncology is based on the claim that the adverse effects of rectal cancer treatment can be reduced by administering more but lower doses of radiation for a longer time or by increasing the interval between radiotherapy and surgery. These hypotheses have now been tested in a study in which rectal cancer patients were randomly assigned to three different treatment arms Standard therapy i.e. shortcourse x Gy radiotherapy with direct surgery within a week. Delayed surgery with shortcourse x Gy radiotherapy followed by surgery after weeks. Delayed surgery with longcourse x Gy radiotherapy followed by surgery after weeks. The results of the study show that patients with delayed surgery develop fewer complications with equally good oncological outcomes. It also showed that there is no difference between longcourse and shortcourse radiotherapy other than that the former considerably lengthens the time for treatment. The results of the study will give rise to improved therapeutic strategies fewer complications with a sustained low incidence of local recurrence and better survival rates for rectal cancer patients says Professor Martling. The results can now be immediately put to clinical use to the considerable benefit of the patients. Eighteen Swedish hospitals took part in the study which was financed by the Swedish Research Council and the Cancer Society in Stockholm and through the regional ALF agreement between Stockholm County Council and Karolinska Institutet. Researchers from the universities in Lund Uppsala and Linkping also contributed to findings. Publication The Stockholm III Trial on optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer a randomised controlled trial Johan Erlandsson Torbjrn Holm David Pettersson ke Berglund Bjrn Cedermark Calin Radu Hemming Johansson Mikael Machado Fredrik Hjern Olof Hallbk Ingvar Syk Bengt Glimelius Anna Martling The Lancet Oncology online February DOI httpdx.doi.org.S"

"A perfect sleeping pill one that gets people to fall asleep faster and for a longer period of time with no side effects is still a dream. Such a magic pill could potentially solve many problems. Millions of Americans dont get enough sleep. In a recent http survey the Centers for Disease Control and Prevention found that percent of Americans are sleeping fewer than seven hours per night the recommended healthy amount. Good sleep doesnt just boost our feelings of wellbeing. Theres a growing scientific consensus that it protects us against heart disease diabetes and obesity. In sleep labs participants who have their sleep cycles severely thrown off for just three weeks can start to appear http prediabetic on blood tests. If you doubt the importance of sleep consider this Scientists now believe that cycles of restfulness and alertness are core organizing principles of all life on Earth. Even the tiniest singlecell organisms contain the genetic coding httplearn.genetics.utah.educontentinheritanceclockgenes for a circadian rhythm. Of course there are many prescription sleep aids on the market unfortunately they arent very effective and can be addictive and dangerous. So many httpsnccih.nih.govresearchstatisticsNHISnaturalproductsmelatonin prefer to walk into a corner drug store and buy an alternative for just thats marketed as safe and all natural. Its melatonin and unlike other chemicals http sold as nutrition supplements in America theres some scientific evidence to back up its claims. But like all sleep drugs melatonins story is complicated. Despite the fact its a chemical that our bodies naturally produce during sleep how melatonin actually works and what its best for is worth a good hard look. What is melatonin Melatonin was originally discovered in the s when a dermatology lab thought it played a role in skin pigmentation. The researchers all took a massive dose of their newfound chemical expecting their skin to lighten. But they just got sleepy. What scientists eventually realized about melatonin is this Its the hormone that tells the body when it is nighttime. Its made in the pineal gland a pineconeshaped structure located deep in the brain. In lower vertebrates like the frog the pineal is in fact a third eye its a lightdark receptor Dick Wurtman a MIT cognitive scientist who help discover melatonins function in humans says. Scientists once assumed that it had served a function in mammals but had become a vestigial https organ bound to disappear in a few million years Wurtman says. In this animation the pineal gland is highlighted in red. Life Science Databases Wikimedia Commons In the s Wurtman and his team at MIT found that light does still reach the pineal in mammals through the eyes and controls the release of melatonin. During the day melatonin is inhibited by light. At night it flows into the bloodstream unless were around bright http light or blue light http which suppress the release of melatonin and keep us up. When it does reach the bloodstream melatonin acts as a messenger. How the body responds to the message depends on the animal. Rats for instance are nocturnal so melatonin may play a role in keeping them awake. In humans and other daydwelling creatures it prepares the body for rest and helps maintain that rest throughout the night. In humans melatonin is thought to promote sleep in two ways. . The exact pathway isnt well understood but its believed melatonin broadly suppresses the areas of the brain involved in wakefulness. Melatonin may also play http a role in lowering body temperature which is needed for sleep. . Melatonin helps set the overall pace of the master circadian clock in the body. Scientists have shown that when people are given httppress.endocrine.orgdoifull.jc. melatonin in the afternoon their body clocks can be tricked into thinking its later and they get sleepier sooner. This can be handy if youre suffering from jet lag and your body thinks its still in an earlier time zone. More on this later. So how well does melatonin work When assessing melatonin there are a couple of big questions researchers are asking Does it help people with insomnia fall asleep faster Does it help people stay asleep Does it help people sleep in new time zones Is it helpful for people adjusting to new shifts at work And does it reliably shift a persons body clock to a new phase The studies that have been done on these questions have tested a wide range of doses on many different populations which makes direct comparisons among studies very difficult and limits what we can really learn from them. But the meta analyses of melatonin that do exist does find some evidence that it can be helpful in regard to most of the above questions. Patty Deuster a research scientist at Uniformed Services University of the Health Sciences was the senior author on a systematic review httpsnutritionj.biomedcentral.comarticles. on melatonin. She and her team amassed a total of randomized placebocontrolled studies on healthy people with or without a diagnosis of insomnia. The effect of melatonin for insomnia was positive but weak says Deutster. More studies with greater number of participants are needed. Her review found weak positive findings for sleep onset staying asleep and jet lag. The evidence for shift workers and shifting the body clock were inconclusive. However the experts with whom I spoke said melatonin should be taken in the late afternoon to have the best chance at shifting the biological clock. Deusters report only looked at phaseshifting studies when melatonin is given at night. International health organizations have analyzed melatonin research as well. In Europe melatonin is only available by prescription in some countries. In the European Food Safety Authority which regulates melatonin conducted an overview http_outputfilesmain_documents.pdf of the evidence on melatonin and concluded this Melatonin helps reduce the time to fall asleep. That might be true but not all researchers agree that melatonin can make a meaningful difference. Philip Gehrman a sleep researcher and clinician at the University of Pennsylvania says The research is pretty clear that melatonin is a lousy sleeping pill. A meta review http looked at this question more closely analyzing placebocontrolled studies of otherwise healthy people with insomnia. It found on average melatonin decreased the time it took to fall asleep compared to placebo by . minutes it increased the time spent asleep by . minutes and increased sleep efficiency a ratio of time spent lying bed versus time sleeping by . percent. Meanwhile a metaanalysis http found that a type of prescription sleeping pill called benzodiazepines httpsen.wikipedia.orgwikiBenzodiazepine got people to sleep minutes faster on average. Nonbenzodiazepines like Ambien get people to sleep about . minutes faster. And once youre asleep these drugs only increase the time spent asleep by or so minutes. https Dont forget that these drugs can be addicting and can kill a person in high enough doses. Melatonin may work best for jet lag and in people who have low melatonin When a person is jet lagged their bodys clock is off from the clock of their destination. This can make it hard to sleep. Melatonin may be particularly helpful for jet laggers because it can both help change a persons internal clock to match local time and it can help them sleep after a long restless flight. In the Cochrane Library conducted a systematic review of melatonins ability to help a person readjust to a new sleep schedule after jet lag at doses as small as . milligrams. Melatonin is remarkably effective in preventing or reducing jet lag and occasional shortterm use appears to be safe the review concluded httponlinelibrary.wiley.comdoi..CDabstract especially when used after eastward flights. Eight of the ten trials found that melatonin taken close to the target bedtime at the destination pm to midnight decreased jetlag from flights crossing five or more time zones. Melatonin also seems to work much better for certain individuals. If your sleep problem results from a deficiency of the hormone melatonin then melatonin will be very effective for your sleep problem Wurtman says. If sleep problems stem from anxiety for instance it will be less effective. Frank Scheer who studies chronobiology at Harvard agrees An oral dose of melatonin has the best chance to make someone sleepy when internal melatonin levels are low. In healthy subjects if you give subjects melatonin in the middle of the day it will help them sleep during the middle of the day he says. If I give melatonin to you during the night when melatonin levels are higher and youre healthy melatonin wont have any effect on sleep. Scheer also notes that melatonin doesnt follow a typical doseresponse curve. That means taking a higher dose of melatonin doesnt necessarily result in more sleepiness. People tend to produce less melatonin as they age so the hormone may be more suited httpweb.mit.edudick to treating the insomnia thats the result of aging. Melatonin also been shown to be much more effective for people with delayed sleep phase http a condition where a persons biological clock is permanently out of sync with the rest of the world. Are there side effects Deusters review looked at the reporting of adverse effects across all studies and found nothing serious. The most commonly reported side effect was drowsiness which is kind of the point of taking melatonin and headache. But Scheer says there are some cases where melatonin can have adverse effects. For some people with a particular genetic variant melatonin impairs http the bodys ability to process blood glucose. Its not harmless he says. The risks of longterm use have also not been assessed. There are no clear studies beyond six months of duration on melatonins use Scheer says. When to take melatonin Researchers have never done a systematic review of whether the timing of melatonin matters for people who want to get to sleep faster. The ones I talked to also disagreed on when to take it depending on whether they thought melatonin was better for sleep promotion or circadian clock resetting. According to Gehrman melatonins ability to shift the circadian clock is stronger than its ability to promote immediate sleep. Therefore instead of taking it at bed time you take it several hours before bedtime he says. This can advance the biological clock around a half hour every day. Scheer agrees that taking melatonin in the late afternoon or early evening will result in the largest phase advance meaning the next day your body clock will be slightly earlier. Exposure to sunlight in the morning helps too he says and may be even more effective than melatonin or should be used in addition to melatonin when pushing the clock forward. Wurtman however doesnt recommend taking melatonin several hours before bed. He says melatonins albeit weak ability to promote sleep on the spot means that people should take it shortly before bed. Overall Scheer says the ideal time for any individual to take it is hard to predict. Melatonin is not simple to use as a consumer he says adding that many primary care physicians may not know about its subtleties. Another reason for caution Melatonin isnt well regulated Voxs Julia Belluz has done extensive reporting http on the murky regulations of dietary supplements in America. Basically she finds the dietary supplement aisle is a minefield. Supplements dont always contain what they say they do and they can have harmful additives. Thats why its important make sure the brand of melatonin you buy has its contents verified by a third party like USP http According to Wurtman the fact that we treat melatonin as a dietary supplement is unmitigated bullshit. None of our bodies natural melatonin comes from diet. In the case of melatonin the lax regulations means it can be sold in massive completely unnecessary doses. At the drug store its easy to pick up a milligram httpsgo.redirectingat.comidXxsurlhttpAFF per pill bottle of melatonin. But this is likely overkill. Many of the studies on melatonin find that it works just as well at small doses around one milligram or less as it does in high doses. Plus theres a chance a huge dose will desensitize your brain to the hormone. If you present to your brain blood levels of melatonin that are way way higher than any that occur normally you desensitize the brains receptors to melatonin Wurtman says. You become less and less and less responsive. The bottom line according to the experts Start with a small dose and see if it works for you. And finally Know that a pill may never fully combat the reasons why Americans are sleeping poorly. There are myriad ways the modern world conspires against good sleep Stress at home and work noisy neighborhoods spending too little time in bright daylight drinking too much caffeine working odd shifts not getting enough exercise spending too much time with smartphones late at night and the list goes on."

"A national sickle cell disease study involving Medical University of South Carolina researchers found that for some children with sickle cell disease the drug hydroxyurea is as effective as blood transfusions to reduce blood flow speeds in the brain. Increased blood flows are a major risk factor for stroke in these children. Study findings were published Dec. in The Lancet and were presented at the American Society of Hematology meeting. It was a privilege to be a part of this welldesigned and executed study. Russell Ware presented the results at the ASH meeting and years ago almost to the day I presented the STOP study results to the same meeting said Robert J. Adams M.D. study principal investigator MUSC professor of neurosciences and director of the South Carolina Stroke Center of Economic Excellence. That study showed how effective transcranial Doppler risk stratification followed by regular red cell transfusions in those with high risk blood flow can be in the prevention of stroke httpsmedicalxpress.comtagsstroke in these children httpsmedicalxpress.comtagschildren. This became known as the STOP protocol and its wide adoption has been associated with a sharp drop in ischemic strokes in children with sickle cell disease httpsmedicalxpress.comtagssicklecelldisease. The drawback of indefinite transfusions however was a limitation to wider use of the STOP protocol. This study shows that some children can be moved from transfusion to medication after at least a year. The combined understanding and evidence from these two studies brings us closer to achieving the National Institutes goal of a stroke free generation in sickle cell disease. Standard treatment for children with sickle cell disease who are at high risk of stroke consists of regular blood transfusions. Children who receive regular blood transfusions are then at risk for iron overload. Chelation or ironreduction therapy is needed for those receiving transfusions. The National Institutes of Health NIHsupported study sought to answer whether hydroxyurea would provide the same benefit as blood transfusions given these additional treatment impacts. Hydroxyurea is the only drug approved by the Food and Drug Administration to treat sickle cell disease. The Transcranial Doppler with Transfusions Changing to Hydroxyurea TWiTCH study was stopped early due to positive preliminary results in November . Researchers from clinical sites supported by the NIHs National Heart Lung and Blood Institute NHLBI recruited and studied children ages to years old and divided them into two groups one that received transfusions and one that was transitioned from transfusions to daily doses of hydroxyurea. No child should ever have to face the prospect of suffering through a stroke said Gary H. Gibbons M.D. director of the NHLBI. Our institute is striving to achieve a strokefree generation of children living with sickle cell disease. Studies like this are vital for moving us toward this worthwhile goal. Study authors indicated that the findings suggest that hydroxyurea could be effective at reducing risk of stroke for other patient populations though this was not a primary goal of the study. Explore further Successful outcome prompts early end to sickle cell anemia clinical trial httpsmedicalxpress.comnewssuccessfuloutcomepromptsearlysickle.html"

"Scientists using brain https scanning technologies say they have been able to predict with accuracy which children with dyslexia https will be able to improve reading skills over a period of a few years. Researchers say their findings reveal activity in specific brain https regions during reading that could eventually lead to new treatments for people with dyslexia. At this time we cannot say which treatment type will each child benefit from study researcher Fumiko Hoeft MD PhD an imaging expert at Stanford University tells WebMD in an email. But with more research and if researchers combine it with intervention studies then we should be able to identify brain https patterns that are predictive of responding to one type of intervention or another. She says in a news release that the study gives us hope that we can identify which children might get better over time and that the findings represent a huge step forward. The discovery of brain https regions involved in the learning disorder may provide a mechanism for enduring improvement that promotes relatively successful reading development according to the study published in the Dec. issue of the Proceedings of the National Academy of Sciences. Study Suggests Interventions to Help Dyslexics Learn to Read Dyslexia is a learning disability https that impairs a persons ability to read and affects to of children in the U.S. About of youths with dyslexia develop adequate reading skills by the time they are adults. But until now what happens in the brain that permits improvement has not been known the researchers say. Brain imaging studies in the past have shown greater activation of specific brain regions in children and adults with dyslexia while they are performing readingrelated tasks. In particular an area known as the interior frontal gyrus seems to be hyperactivated in dyslexic people. Hoeft and colleagues set out to determine whether neuroimaging could predict which children with dyslexia would gain improvement in reading skills using functional magnetic resonance imaging https fMRI which shows oxygen use by areas in the brain and diffusion tensor magnetic resonance imaging DTI which shows connections between brain areas. Study Involves Youths With Dyslexia and Normal Readers For the study the researchers enrolled children with dyslexia and without all between ages and and evaluated their reading skills using standardized tests. They used the two types of brain imaging fMRIs and DTIs observing the brains of the youths while they read. Then . years later they reevaluated reading performance. They found that no behavioral measure including standardized reading and language tests reliably predicted reading gains. But the children with dyslexia who showed greater activation in the right inferior frontal gyrus showed greater improvement over the . years from the studys start. The scientists also examined white matter connected to the right frontal region and children in whom this was better organized also showed improvement. Predicting Learning Improvement May Lead to New Treatments Using these techniques the researchers say they were able to predict with significant accuracy future reading gains in youths with dyslexia. The reason this is exciting is that until now there have been no known measures that predicted who will learn to compensate Hoeft says in a news release. By understanding whats going on in the brains of these children scientists may now be better equipped to develop interventions that focus on brain regions involved and thus help adolescents learn to read faster. Coauthor Bruce McCandliss PhD of Vanderbilt University says in a news release that insights from the brain scans may be crucial for new educational research on how to best meet the individual needs of struggling readers. He tells WebMD in an email that the findings could be used to investigate the possibility that brain activity patterns and structural differences hold clues as to how to match treatment approaches to the particular needs of such children. Alan E. Guttmacher MD director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development says the study creates insights into how certain people with dyslexia learn to compensate for reading difficulties. Understanding the brain activity associated with compensation may lead to ways to help individuals with this capacity draw upon their strengths he says. Similarly learning why other individuals have difficulty compensating may lead to new treatments to help them overcome reading disability. Hoeft says the findings suggest brain imaging can help determine which kinds of treatments are likely to work. She also suggests that the study may show that youths with dyslexia use right brain frontal regions to compensate for reading problems rather than the areas in the left side of the brain as typical readers do."

"Oramed Pharmaceuticals Inc. NASDAQ ORMP httpstudio.financialcontent.comprnewsPageQuoteTickerORMP today announced positive topline results from its Phase IIb study designed to evaluate the safety and efficacy of its oral insulin capsule ORMD in patients with type diabetes. The studys primary objective a significant reduction of weighted mean nighttime glucose was successfully achieved. This demonstration of safe and effective oral insulin delivery represents a transformative event in the treatment of type diabetes said Nadav Kidron Oramed CEO. We are delighted with the results and look forward to moving into Phase III trials. This US based double blind day randomized study of adult type diabetic patients showed a statistically significant decrease in the primary endpoint pooled nighttime glucose mean percentage change of . from runin between placebo and active cohorts p.. The study additionally demonstrated a good safety profile with no drug related serious adverse events. These are very impressive results that confirm the efficacy of orally delivered intestinally absorbed insulin said Dr. Michael Berelowitz Head of Orameds Scientific Advisory Board. The promise of this more physiological delivery system for insulin is the inhibition of hepatic glucose production which was clearly demonstrated via the significant reduction in nighttime glucose levels in patients who received ORMD. The Company plans to present and publish more comprehensive data in the future. Conference Call today May at am Eastern Time Oramed will host a conference call to discuss the study results. Interested parties may access the call at US or UK. Conference ID About the Phase IIb Oral Insulin Study The doubleblind randomized Phase IIb study of patients with type diabetes was initiated on June and was conducted at clinical sites in the United States under an IND that was approved by the FDA. The study was designed to generate data to assess the safety and efficacy of multiple oral bedtime doses of ORMD in adult patients with type diabetes mellitus who are inadequately controlled with diet and metformin. The study was comprised of three arms placebo ORMD mg and ORMD mg. Patients were dosed before bedtime and their nighttime glucose levels hours post dose were continuously monitored. For more information on the study which does not form a part of this press release see httpsclinicaltrials.govctshowNCTtermoramedrank About ORMD ORMD has the potential to create a new paradigm in the treatment of diabetes by oral delivery of insulin at an earlier stage of treatment potentially slowing disease progression and delaying or even eliminating latestage complications. Orally administered insulin is expected to enhance patient compliance. In addition intestinally absorbedoral insulin mimics insulins natural location and gradients in the body by first passing through the liver before entering the bloodstream. About Oramed Pharmaceuticals Oramed Pharmaceuticals is a platform technology pioneer in the field of oral delivery solutions for drugs currently delivered via injection. Established in Orameds Protein Oral Delivery PODTM technology is based on over years of research by scientists at Jerusalems Hadassah Medical Center. Oramed is seeking to revolutionize the treatment of diabetes through its proprietary flagship product an orally ingestible insulin capsule ORMD http The Company completed multiple Phase II clinical trials under an Investigational New Drug application with the U.S. Food and Drug Administration. In addition Oramed is developing an oral GLP analog capsule ORMD http For more information the content of which is not part of this press release please visithttp Forwardlooking statements This press release contains forwardlooking statements within the meaning of the Private Securities Litigation Reform Act of and other federal securities laws. Words such as expects anticipates intends plans believes seeks estimates and similar expressions or variations of such words are intended to identify forwardlooking statements. For example we are using forwardlooking statements when we discuss our Phase IIb study that the demonstration of safe and effective oral insulin delivery represents a transforming event in the treatment of type diabetes when we discuss moving into Phase III trials when we discuss ORMD and its potential to create a new paradigm in the treatment of diabetes by oral delivery of insulin or when we discuss revolutionizing the treatment of diabetes with our products. These forwardlooking statements are based on the current expectations of the management of Oramed only and are subject to a number of factors and uncertainties that could cause actual results to differ materially from those described in the forwardlooking statements including the risks and uncertainties related to the progress timing cost and results of clinical trials and product development programs difficulties or delays in obtaining regulatory approval or patent protection for our product candidates competition from other pharmaceutical or biotechnology companies and our ability to obtain additional funding required to conduct our research development and commercialization activities. In addition the following factors among others could cause actual results to differ materially from those described in the forwardlooking statements changes in technology and market requirements delays or obstacles in launching our clinical trials changes in legislation inability to timely develop and introduce new technologies products and applications lack of validation of our technology as we progress further and lack of acceptance of our methods by the scientific community inability to retain or attract key employees whose knowledge is essential to the development of our products unforeseen scientific difficulties that may develop with our process greater cost of final product than anticipated loss of market share and pressure on pricing resulting from competition laboratory results that do not translate to equally good results in real settings our patents may not be sufficient and finally that products may harm recipients all of which could cause the actual results or performance of Oramed to differ materially from those contemplated in such forwardlooking statements. Except as otherwise required by law Oramed undertakes no obligation to publicly release any revisions to these forwardlooking statements to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events. For a more detailed description of the risks and uncertainties affecting Oramed reference is made to Orameds reports filed from time to time with the Securities and Exchange Commission."

"An implanted combination cardiac resynchronization device and defibrillator reduces deaths from mild heart failure by compared with a defibrillator alone researchers reported Sunday. The report is the second one indicating that such combination devices which are about the size of a cellphone can save the lives of many of the million Americans with heart failure and many surgeons are already using them for that purpose. About of heart failure patients have the milder form of the disease for which the new study was conducted. The condition requires frequent hospitalizations and costs the U.S. healthcare system an estimated billion per year according to the American Heart Assn. Heart failure occurs when the muscles of the heart weaken and the ventricles fail to coordinate properly or synchronize reducing the ability of the organ to move blood throughout the body. In the most severe cases patients become so weak that they are bedridden or suffer a variety of symptoms such as shortness of breath buildup of fluid in the lungs and other organs confusion and fatigue. Patients with mild heart failure typically have few or no symptoms but both groups have an equally high risk of atrial fibrillation erratic heartbeats or death. A defibrillator applies a small electrical shock to the heart to halt the erratic heartbeats and restore normal function. Cardiac resynchronization therapy delivers a regular small electrical signal to the heart to maintain regular beating increasing the ejection fraction the amount of blood pushed into the cardiovascular system with each beat. The device has leads going to both ventricles to ensure that they are synchronized. Such devices are approved in the United States for treating patients with severe heart failure. Last year U.S. researchers reported that httparticles.latimes.comsepsciencesciheart a combination device manufactured by Boston Scientific reduced the death rate by for patients with moderate heart failure in a study of about patients. In September the Food and Drug Administration gave the company approval to market the device for this indication. In the new study Dr. Anthony S. L. Tang of the Ottawa Heart Institute and his colleagues studied mild heart failure patients at centers in Canada Australia Europe and Turkey. About half were given an implantable defibrillator manufactured by Medtronic Inc. of Minneapolis and half a combination device manufactured by the same company. The patients were followed for months. Tang reported at a Chicago meeting of the American Heart Assn. and in a report published online in the New England Journal of Medicine that the team observed a reduction in deaths in the patients treated with the combination device and a reduction in deaths and heart failurerelated hospitalizations. Fourteen patients had to be treated with the device to prevent one death. Complications were about twice as common with the combination device primarily because connecting the leads to the ventricles takes longer and requires a higher skill level. The extra leads also increase the possibility of infections. The study gives us reason for renewed enthusiasm about heart failure treatment said Dr. Clyde Yancy of the Baylor University Medical Center the immediate past president of the American Heart Assn. There has been a dearth of significant trials in mild heart failure for some time.... Whats good is that when we compare this to the other two studies we see some consistency of response. Dr. Alfred Bove a professor emeritus at Temple Medical School and an immediate past president of the American College of Cardiology noted that many surgeons are already installing the devices in patients with mild heart failure and only connecting the defibrillators not hooking up the second function until it is needed. The new study he said supports the idea that doing this works."

"One day years ago after a long walk with his dog along the Hudson River in Manhattan Marc Stecker noticed he was limping. Not long after he was diagnosed with multiple sclerosis. Fast forward now and my entire right side is pretty much paralyzed and my left side is weakening Stecker says. In CCSVI vascular changes like stenosis narrowing or reflux in valves can lead to reduced blood drainage from the brain. Cleveland Clinic Center for Medical Art PhotographyCleveland Clinic Center for Medical Art Photography Stecker is now confined to a wheelchair from where he writes a blog http about his disease called Wheelchair Kamikaze. More than a year ago Stecker started writing about a theory Italian physician Paolo Zamboni proposed in called chronic cerebrospinal venous insufficiency or CCSVI. Its been thought that multiple sclerosis is caused by a misguided immune system that attacks the nerves of the brain and spinal cord and can lead to muscle weakness paralysis and death. However Zamboni suggests that the disease instead is the result of blocked blood veins leading to inflammation which in turn causes the immune system to attack nerves in the brain and spinal cord. Zamboni proposed that treating it may be as simple as opening them up. Stecker was hopeful. Because my disease is so aggressive I have been very willing to be equally aggressive in trying to combat it Stecker says. The Liberation Procedure To clear the veins his doctor tried opening them with a tiny balloon. Zamboni calls it the liberation procedure but it is actually a common technique known as angioplasty when its used to open clogged arteries not veins. Article continues after this message from our sponsor A Brief History Of Multiple Sclerosis In Augustus DEste http the grandson of Englands King George III began documenting his illness which would one day be identified as multiple sclerosis. Since DEstes day researchers have learned how to better treat the disease but have not yet found a cure. Here is a timeline of some key events along the way. Scientists identify multiple sclerosis as a distinct condition. Myelin http which insulates nerve fibers is discovered. In MS the body erodes the myelin which damages nerve fibers and interrupts brain signals. Using a microscope James Dawson examines the brains of people who died from MS. He is able to describe in depth the damage done by the disease. Researchers use a hormone typically made by the pituitary gland to treat the symptoms of MS. The MRI is first used to help diagnose MS reducing diagnosis time from seven years to six months after the first symptom. Doctors begin using a drug called Beta interferon b to reduce disease flareups. Paolo Zamboni proposes httpjnnp.bmj.comcontent.full the theory Chronic Cerebrospinal Venous Insufficiency. From the National Multiple Sclerosis Society http At first I was very skeptical. But anecdotal reports started coming through of almost miraculous results from it.So I decided you know hey it was worth a shot Stecker says. But it didnt work. Although the doctor who treated him in New York found a significant blockage he was unable to correct it Stecker says. Still some would say Stecker was lucky. Many desperate patients have spent their life savings flying overseas to have the procedure only to have it fail a few months later. Others elect to have tiny metal tubes known as stents placed in the veins to hold them open and have suffered serious complications including lifethreatening blood clots. Several patients have even died as a result. Stecker says if he had it to do over again he would have waited for more research. But he says he was eager to try something that offered him the first real glimmer of hope for a cure. CCSVI equals hope and a lot of MS patients just are completely devoid of hope Stecker says. People dont want to have MS. They want to go back to who they used to be. You know along comes this theory that offers an easytounderstand solution so its very very very seductive. Growing Public Controversy Its so seductive in fact that Canadians and Americans with MS have been flocking overseas to get the liberation procedure. Something that many researchers find very troubling. Robert Zivadinov of the Buffalo Neuroimaging Analysis Center in New York says that not only is the procedure unsafe and costly to many patients it is impeding necessary research. Even if the treatment is not useful for patients with MS I dont think that we can abandon the idea of vascular involvement in MS Zivadinov says. And I think this merits very detailed understanding of what is going on. What is going on is still a bit of a mystery. Critics argue that although Zambonis original research suggests a vascular cause for MS other studies dont. These discrepancies and growing public controversy prompted the National Multiple Sclerosis Society in the U.S. and the Multiple Sclerosis Society of Canada to take Zambonis claims seriously. They funded a number of independent studies to investigate the relationship between CCSVI and MS. Robert Fox a neurologist at the Cleveland Clinic currently oversees one of the studies funded by an MS Society grant. He says part of the confusion comes from variations in how CCSVI is measured. Thats absolutely one of the potential problems in the previous studies Are the techs who got negative results did they just not know how to do the ultrasound in the way that Dr. Zamboni described doing the ultrasound And thats a very important issue Fox says. Fox says he sent his technicians to a special training to learn how to properly measure the veins because its not something most technicians ever do. Bigger Than Multiple Sclerosis Meanwhile in Buffalo Zivadinov says his research on CCSVI already shows a clear picture emerging. CCSVI is not the cause of MS but might be a consequence or a contributing factor to progression and I think that has to be studied Zivadinov says. Studying how the vascular system is involved in neurologic disease is an entirely new concept Zivadinov says. One that may have an impact beyond any single disease. What professor Zamboni discovered in terms of veins is something much bigger than multiple sclerosis Zivadinov says. We need to understand the role of the venous system in the pathology of central nervous diseases and aging. Zamboni himself says that even if it turns out hes wrong coming to a greater understanding of the disease would be the big reward both for him and thousands of MS patients."

"In a bid to make cancer immunotherapy more effective researchers report they have succeeded in halting the progress of aggressive melanoma in its tracks at least briefly in seven patients treated with an army of cloned cancerfighting immune cells. In one of those patients the treatment resulted in complete remission of his metastatic melanoma and evidence that his immune system stands ready to fight any return of the cancer after three years. The study published Monday in the Proceedings of the National Academies of Science contributes to hopes that a tumorfighting strategy called immunotherapy can slow halt or even reverse the growth of a range of cancers and do so with fewer dangerous side effects. Immunotherapy is one of medicines most promising and most problematic approaches to cancer treatment. It aims to charge up the patients immune system to attack cancer cells and halt their outofcontrol growth. The approach outlined in the new study by researchers from the Fred Hutchinson Cancer Research Center in Seattle identifies several ways to make it better said Dr. Cassian Yee the studys senior author. The key is to identify specific cancerfighting cells already circulating in the blood of patients and make thousands of copies of them in the lab. This type of adoptive immunotherapy could be effective against a wide range of cancers Yee said. His research group is making plans to try the technique on patients with advanced ovarian cancer and sarcomas rare tumors that arise from connective tissue in bones and muscle. Several independent researchers said the study results were promising. But they also noted that the trial involved only patients and said the therapy was less effective than in other published trials. Someday cellbased therapy will be mainstream in cancer therapy said Dr. Jeff Miller of the University of Minnesotas cell therapy core laboratory. Each article that shows clinical activity is giving us a piece of the puzzle that will make it safer and more effective he said. Immunotherapy usually starts with clinicians harvesting immune system cells called T cells that have attached themselves to a tumor in an effort to attack. They then coax the cells to multiply either in the lab or in the body and let them loose in the bloodstream so they can attack cancer wherever they find it. Yees team tried to do this more precisely. The researchers hoped that by choosing T cells more selectively and cloning only those judged most likely to vanquish their foe the treatment would be more effective. Sorting through the bodys vast and diverse population of T cells to select just the right ones is a painstaking process. But Yee bet that the extra effort would pay off with better results and fewer side effects. Researchers drew blood from patients and scoured it to find the rare type of immune cell a melanomaspecific cytotoxic T lymphocyte cell that specifically homes in on proteins expressed by the cancer. Then they put their harvest as few as a few hundred cells into a test tube and cloned them creating millions. The last step was to infuse the resulting army of cancerfighting clones back into the patient. In six of the patients in the trial the melanoma stopped progressing for to weeks. Another patient was declared in remission because his cancer ceased to spread and after several months disappeared altogether. Three years later researchers continue to detect the presence of the cloned cells they infused into the patient yearold high school history teacher Gardiner Vinnedge of North Bend Wash. For six years Vinnedge endured painful rounds of chemotherapy only to have his melanoma return. The immunotherapy allowed him to return to work three weeks after treatments began. The only side effect he said was a raging rash that lasted for three days. My back my legs were just covered with a hot red rash Vinnedge said. It meant the treatment was working the war was on between my T cells and the melanin in my skin. Now he says he is optimistic he may live to see retirement age though hes not sure hell ever stop teaching. For immunotherapy to work the manufactured T cells must survive for the months it takes to reach a tumor and dismantle it as well as to round up migrating cancer cells and kill them. Currently the T cells have limited staying power and often die off before their work is done. Doctors give them a boost by administering a growth factor called interleukin. But at high doses it can cause dangerously low blood pressure breathing problems kidney failure and heart arrhythmias. Yees group showed that by choosing T cells more selectively patients can get by with much lower doses of interleukin making the treatment less toxic. The researchers also discovered another way to reduce their dependence on interleukin by selecting the most youthful T cells which survived the longest when infused into patients. Dr. Patrick Hwu of the MD Anderson Cancer Center in Houston said the study adds to the wealth of what we know about using the bodys immune system to fight cancer. But immunotherapy pioneer Dr. Steven A. Rosenberg was highly critical of the methods and results. Cloned cells dont work said Rosenberg who heads the National Cancer Institutes tumor immunology section. In larger immunotherapy trials that used cultured cancerfighting immune cells taken from patients tumors Rosenberg and his colleagues achieved durable and complete regression in as many as as patients with advanced metastatic melanoma. These results he said are inferior."

"MaryAnn Anselmo feared for the worst when she was diagnosed with a brain tumor called a glioblastoma in late . You start doing research on that type of tumor and youre saying Oh my God youre history. Its like a death sentence says Anselmo now . Only for her it wasnt. Anselmos successful treatment shows how precision medicine tailoring therapy to each patients genetic needs is beginning to transform cancer care. At first the outlook seemed grim. Although Anselmos surgeon was able to surgically remove most of her tumor she couldnt tolerate traditional chemotherapy that was the planned second step and had to discontinue it. The chemo failure was the latest in a string of personal setbacks. The year before she was diagnosed with brain cancer shed lost her son to suicide. Weeks after that she was almost killed in a car crash outside a local mall. Her cancer was discovered after she had a dizzy spell and her husband Joseph insisted she return to the hospital to have it checked out. After all that Anselmo and her husband werent ready to give up on her cancer fight. Hed read about advances in targeted therapies drugs that go after cancer cells at the molecular level. The family sent samples of her tumor samples for genetic testing to several leading cancer hospitals. Memorial Sloan Kettering Cancer Center where she was being treated also did its own sequencing. They all found the same thing. Anselmos tumor had a BRAF mutation http common in skin cancer but very unusual for a brain tumor. Her oncologist David Hyman http at Memorial Sloan Kettering enrolled Anselmo into a new kind of drug trial. Called a basket trial http_r the study is designed to include people whose tumors have the same kind of genetic fingerprint regardless of where in the body the tumors are found. Knowing more about the genetic mutations of a tumor enables doctors to find a potentially effective drug much more quickly and accurately. Its like youre in a parking lot Hyman says. And you have a key to one of the cars in the parking lot. And so one option is just to go to each car and try to open the lock. The other is to know that its the third car on the right. What were doing now is were saying OK this key fits that lock. And were only going straight to that car. Today Anselmo is doing well. Shes been in the clinical trial for a year now and continues to take Zelboraf or vemurafenib http generically daily. The pills have kept her cancer from growing. There are side effects of course. Shes lost some peripheral vision though shes been able to compensate. And Zelboraf is expensive though its free to Anselmo because shes taking it as part of a study. Now she can focus again on the things she loves like singing. Anselmo a jazz singer who performed under the stage name Mariel Larsen before her illness is planning a comeback. Shes back in training with her longtime vocal coach. As this kind of genetic sequencing of tumors has become faster and cheaper more patients have access to this technology. More doctors are taking advantage of the information to treat patients with a targeted approach. We took a disease where nothing really works for any length of time and weve given her a year of life and hopefully much more where shes been much better Hyman her oncologist says. Still he cautions that the targeted treatments cant be considered cures. At some point the drug that is keeping Anselmos cancer at bay could stop working. Every patient is different in how long it works he says. We all have patients that have been on these drugs for years. But I dont know I mean I think if I was being honest eventually our expectation would be that it would stop working. Theres no way to predict when. But in the meantime patients like Anselmo are grateful to have time they wouldnt have had otherwise. After all the misfortunes shes been through it would be easy to think Anselmo has been incredibly unlucky. But she doesnt see it that way. No she says after rehearsing for her comeback show Im the luckiest. Our series is produced with member station WNYC and with Ken Burns Presents Cancer The Emperor of All Maladies http which will air on PBS starting March . Check your local listings for broadcast times."

"Yoga does the body good and according to a new study it may ease the mind as well. Yoga has also become such a cultural phenomenon that it has become difficult for physicians and consumers httptopics.time.comconsumers to differentiate legitimate claims from hype researchers from Duke University Medical Center write in their study published http_Disorders_and_Psychosomatic_Research.fpsyt..abstract in the journal Frontiers in Psychiatry. In order to explore the widely held belief that practicing yoga can relieve mental stress httptopics.time.comstress the team reviewed more than studies on the effect of yoga and mental health. Most individuals already know that yoga produces some kind of a calming effect. Individually people feel better after doing the physical exercise says lead study author Dr. P. Murali Doraiswamy a professor of psychiatry and medicine at Duke University Medical Center. Mentally people feel calmer sharper maybe more content. We thought its time to see if we could pull all the literature together to see if theres enough evidence that the benefits individual people notice can be used to help people with mental illness. MORE Yoga Can Help Stroke Survivors Regain Their Balance httphealthland.time.comyogacanhelpstrokesurvivorsregaintheirbalance Their findings suggest that yoga does in fact have positive effects on mild depression httptopics.time.comdepression and sleep problems and it improves the symptoms of psychiatric disorders like schizophrenia and ADHD among patients using medication. The researchers focused on studies that recorded the effects of practicing yoga on mentalhealth issues ranging from depression schizophrenia ADHD sleep complaints and eating disorders to cognitive problems. They found positive effects of the mindandbody practice for all conditions with the exception of eating disorders and cognition. Those studies involved too few participants or produced conflicting results to draw any meaningful conclusions. Some of the studies included in the analysis even suggested that yoga might affect the body in ways similar to antidepressants and psychotherapy. For instance yoga may influence brain chemicals known as neurotransmitters boosting levels of feelgood agents like serotonin lower inflammation reduce oxidative stress and produce a healthier balance of lipids and growth factors just as other forms of exercise do. MORE We Tried This Aerial Vinyasa or UpsideDown Yoga httphealthland.time.comwetriedthisaerialvinyasaorupsidedownyoga Embracing yoga as a complementary treatment for mental disorders is not uncommon. Yoga is a feature in many veterans centers throughout the country backed by research http_highlightsyoga.cfm funded by the Department of Veterans Affairs. The Huffington Post reported http_n_.html that many troops use yoga as a form of treatment for PTSD for example with companies like Warriors at Ease httpwarriorsatease.com training instructors in yoga techniques specifically catered to those in the military. A study published httpajot.aotapress.netcontent.abstract earlier this month of activeduty troops found daily yoga eased anxiety and improved sleep. The researchers say theres enough evidence to warrant a larger study on the effects of yoga on mental health and it should be considered as part of treatment for more disorders. Many millions of Americans are doing yoga and many millions of Americans have mental illnesses and are popping psychiatric pills daily. Despite all of this the vast majority of studies looking at the benefits of yoga are all small studies. We did not come across a single study where there was a coordinated effort done by some large agency to really conduct a large national study says Doraiswamy. MORE Does Yoga Really Drive People Wild with Desire httphealthland.time.comdoesyogareallydrivepeoplewildwithdesire But while the research is promising yoga likely wont be a panacea for mental illness. Nor should patients try to replace their medications with the practice. What we are saying is that we still need to do further largescale studies before we are ready to conclude that people with mental illnesses can turn to yoga as a firstline treatment says Doraiswamy. We are not saying throw away your Prozac and turn to yoga. Were saying it has the promise and potential. If a large national study were done it could turn out that yoga is just as good and may be a low cost alternative to people with unmet needs. In the meantime he says it doesnt hurt to add yoga to existing treatments so patients can take advantage of any potential benefits."

"Going for a jog on a treadmill can predict how long youre going to live a large new study suggests. Researchers from Johns Hopkins Medicine looked at standard treadmill stress test results for more than subjects ages to . After age and sex the two best predictors of whether the patient would be alive in ten years was how highly activated their metabolism was and how fast their heart would beat during the test. . Billion Young People at Risk of Losing Their Hearing WHO Says httpabcnews.go.comHealthbillionyoungpeoplerisklosinghearingstoryid Ebola Survivor Nina Pham Suing Hospital to Be Voice for Other Nurses httpabcnews.go.comHealthebolasurvivorninaphamsuinghospitalvoicenursesstoryid Scientists Make a Million Dollar Bet Who Will Die Last httpabcnews.go.comHealthantiagingscientistsmakemilliondollarbetdiestoryid Metabolism was calculated using metabolic equivalent of tasks or METs a measure of how much energy someone expends during a task. The higher MET level achieved the more likely it was the subject would last another decade. The closer someone came to reaching their maximum heart rate as they ran the less likely they were to die within ten years compared to someone who only reached about percent of their maximum heart rate during the test. Maximum heart rate was determined by subtracting the subjects age from a formula thats been used for decades by exercisers and doctors alike. Dr. Jennifer Ashton ABC News medical contributor explained the science behind the test on Good Morning America httpabcnews.go.comtopicsentertainmenttvgoodmorningamerica.htm. In medicine we usually base predictions of survival on the absence or presence of a disease state she said. Whats new here is that there is now a fancy equation doctors can use to compare the chances of survival for one yearold woman against another yearold woman. Rather than being viewed as morbid experts should be able to use this information to motivate people to change their behavior Ashton said. Everyone can improve their survival score by exercising more often and pushing it a little harder when they do she added. This is in your power to change and improve your numbers. You can actually change your own destiny she said."

"Much of the debate over when to start having mammograms has focused on lives saved but new research suggests that early screening might also translate into smaller tumors and less aggressive breast cancer treatments. There are multiple benefits of mammography in terms of early detection. Not only do we save lives but we reduce the likelihood of needing more aggressive treatment said study author Dr. Elisa Port. She directs the Dubin Breast Center at Mount Sinai and is chief of breast surgery at Mount Sinai Hospital both in New York City. Currently the U.S. Preventive Services Task Force recommends that biennial screenings start at age for most women while the American Cancer Society advises that annual screenings begin at age . Earlier guidelines had suggested annual screenings begin at age . Port noted that screening guidelines tend to be based on the ability of mammograms to save lives and how often they give a false positive result. But isnt there some benefit to getting tested earlier like needing fewer lymph nodes removed and not needing chemotherapy I think its safe to say that most women if they could be assured the same survival would choose not to get more aggressive therapies she said. Ports study included more than women diagnosed with breast cancer at the Dubin Breast Center. All of the women were older than . The women were separated into two groups. One group had a mammogram within the months before their breast cancer diagnosis. The other group had a screening months or more before their diagnosis. The second group also included women who had never had a mammogram. Women in the second group were percent more likely to need chemotherapy. They were also percent more likely to need surgery to remove the whole breast mastectomy and percent more likely to need lymph nodes removed. And the women who were screened earlier had smaller tumors. Port also looked at the to yearold age group and found those who had never had a mammogram were much more likely to need chemotherapy. They were also more likely to have larger tumors by millimeters on average and to need a mastectomy than those in the months or less group. But only women fell into the never had a mammogram group. However the study did not prove a causeandeffect link between earlier mammograms and smaller tumors and less aggressive treatment. And Dr. Len Lichtenfeld deputy chief medical officer for the American Cancer Society noted that this was an observational study that only looked at the experience of one institution. Still the observations are consistent with what we have seen with the value of early detection. Clearly the earlier a breast cancer is diagnosed the less treatment that will be required. But this study doesnt tell us about longterm outcomes or what transpired over a long period of time he said. Also because of the nature of the study and the small sample size in the young age group subanalysis Lichtenfeld said that this cannot be interpreted as a study telling us what age to start mammograms. The study is to be presented Thursday at the American Society of Breast Surgeons meeting in Orlando Fla. Findings presented at meetings are typically viewed as preliminary until published in a peerreviewed journal. More information Learn more about mammography screening guidelines from the American Cancer Society https SOURCES Elisa Port M.D. director Dubin Breast Center at Mount Sinai and chief breast surgery Mount Sinai Hospital New York City Len Lichtenfeld M.D. deputy chief medical officer American Cancer Society May presentation American Society of Breast Surgeons meeting Orlando Fla."

"In findings that could pry open a door closed for nearly half a century researchers have found that psilocybin a hallucinogen long used in traditional healing rituals eases the depression and soothes the anxiety of patients contending with serious illness and the prospect of imminent death. In two separate studies published httpjop.sagepub.com Thursday researchers report that trial subjects who received a single moderatetolarge dose of psilocybin got substantial and lasting relief from their profound distress. Among cancer patients who participated in the two trials as many as in continued to feel measurably less hopeless and demoralized six months after taking the drug than they had upon their recruitment. And even years later many reported they had gained and retained a profound sense of peace and meaning from the experience. Of cancer patients who got psilocybin in a trial httpjop.sagepub.comcontent.full conducted at New York Universitys Langone Medical Center rated it as among the most meaningful events of their life. This drug saved my life and changed my life said Dinah Bazer a Brooklyn N.Y. woman who was administered a single dose of psilocybin at a New York treatment center in . In the wake of treatment for ovarian cancer Bazer said her anxiety at the prospect of its return was eating her alive. Under the influence of a single high dose of psilocybin Bazer said Wednesday she became volcanically angry as she visualized her cancer as a dark mass bearing down on her. With an epithet she then saw herself throwing it off. I was bathed in Gods love for hours after that said Bazer who describes herself as an atheist. When the psilocybins hallucinatory effects wore off she said two years of intense anxiety were simply gone. This is a groundbreaking result said Dr. George Greer medical director of the Heffter Research Institute httpsheffter.org the nonprofit organization that funded the two trials. Greer suggested that the existential anxiety of the terminally ill is only one of many conditions that psilocybin may one day treat. Others may include treatmentresistant depression addiction to cocaine alcohol or tobacco obsessivecompulsive disorder and demoralization in longterm survivors of HIV he said. Johns Hopkins University psychiatrist Dr. Roland R. Griffiths http the lead author of one of the two studies httpjop.sagepub.comcontent.full said the enduring relief provided by a single dose of psilocybin makes such treatment more akin to surgery than it does to the plodding laborintensive treatments that remain the mainstay of his profession. I really dont think we have any models in psychiatry that look like the effects demonstrated in the two trials said Griffiths. Something occurs and its repaired and its better going forward very plausibly for more than six months he added. In that sense its a new model. The publication of the two early trials in the Journal of Psychopharmacology marks an American return to research on the therapeutic use of hallucinogenic drugs after a hiatus of years. In the s and s hallucinogenic drugs such as lysergic acid diethylamide LSD and psilocybin which is found naturally in certain mushrooms were widely used in U.S. biomedical research and in psychotherapy practices. But in as the psychedelic drugs gained a broad counterculture following in the United States the U.S. government declared any use of the drugs illegal. By the s that ended all American research on their potential therapeutic benefits. In recent years a small clutch of American researchers including the authors of the two new papers have argued that such prohibitions might be preventing the discovery of better treatments for widespread and pressing psychiatric problems including depression addiction and posttraumatic stress disorder PTSD. With PTSD epidemic among U.S. combat veterans and drug addiction a national scourge American officials have indicated a new willingness to allow research to proceed on psychedelic and other drugs long classified as having no legitimate medical use. On Tuesday the Food and Drug Administration gave its blessing to conducting largescale clinical trials of an experimental medication methylenedioxymethamphetamine better known as the party drug ecstasy. Like LSD and psilocybin ecstasy appears to hold promise as an adjunct to psychotherapy in the treatment of PTSD. If the resulting Phase trials of ecstasy demonstrate their effectiveness the next step could be FDA approval of ecstasy as a prescription drug. The newly published trials of psilocybin are not quite so far advanced. Both studies were considered Phase clinical trials in which the safety and dosing regimens of a potential medication are still being tested. But both were considered to be doubleblind placebo trials the goldstandard of medical research in which subjects are left to guess whether they have gotten the active study drug or an inactive lookalike. In one of the trials researchers used a very low dose of psilocybin much lower than that required to induce hallucinations as a placebo. In the other they used the dietary supplement niacin. In each trial all of the subjects got a high dose of psilocybin in one of two sessions. So all in the end experienced the full effects of the drug. All subjects in both trials had been diagnosed with cancer and with existential anxiety or depression resulting from the illness and the likelihood of an early death. Participants were extensively prepared for the expected effects of the psilocybin. To minimize adverse reactions researchers closely monitored the subjects while they were under the influence of the drug or the placebo. Afterwards psychotherapists encouraged the subjects to write down and reflect upon the experience. Immediately after as well as five weeks after their first session subjects who got the psilocybin first looked much better than did those who got the placebo first. A wide range of standardized measures of depression anxiety and quality of life showed that these subjects were less hopeless less demoralized and less anxious. Six months out of those in the trial conducted at New York UniversityLangone reported their life satisfaction andor wellbeing had been improved by the experience. In the larger of the two trials conducted at Johns Hopkins University psilocybin produced large and significant increases in measures of quality of life life meaning death acceptance and optimism effects that were sustained at six months. Psilocybins side effects meanwhile were pretty tame. In the two trials about of subjects experienced nausea or vomiting when getting a high dose and about in experienced some form of transient psychological discomfort. Many subjects heart rates and blood pressure rose but none to a dangerous extent. The potential use of psilocybin in patients diagnosed with lifethreatening diseases comes at a moment when medical care at the end of life is a subject of growing concern among patients and physicians. Research finds its still common for dying patients to get painful and futile procedures. Palliative and hospice care both aimed at easing the discomfort of the seriously ill are growing specialties in American hospitals. An increasing number of patients meanwhile are demanding the right to die with a physicians help. As states debate these physicianassisted suicide bills they should consider the implications of finding an effective treatment for the existential distress of the dying said Dr. Craig D. Blinderman http a palliative care specialist at Columbia University Medical CenterNew York Presbyterian Hospital. It would seem to me before we get to that point we should explore approaches like psilocybin and hopefully not consider physicianassisted suicide as their only option said Blinderman who was not involved in either of the two studies published Thursday. But finding drugs like psilocybin effective is by no means the final hurdle to their widespread availability. None are currently in production and no forprofit pharmaceutical company would likely invest millions of dollars to bring to market a pill intended effectively for onetime use. Dr. Greer said that in addition to incubating the next generation of researchers to explore the healing effects of psychedelic compounds the New Mexicobased Heffter Institute is pondering a future in which specialized psychiatric clinics have routine access to psilocybin for treating patients. The institute is laying plans to scale up the production and distribution of a synthetic form of psilocybin that could make such treatments available at low cost to patients who could benefit from the drug he said."

"Hot water treatment may help improve inflammation and blood sugar glucose levels in people who are unable to exercise according to a new study. The findings httpsdoi.org.japplphysiol.. are published ahead of print in the Journal of Applied Physiology. Physical stress such as exercise can cause the shortterm elevation of inflammatory markers. After exercise the level of an inflammatory chemical IL rises. In a process called the inflammatory response this activates the release of antiinflammatory substances to combat unhealthily high levels of inflammation known as chronic lowgrade inflammation. Recent research has shown that raising body temperature augments the inflammatory response and provides a rationale for identifying exercise alternatives that reduce lowgrade inflammation in the body. Previous studies have also found a connection between a spike in body temperature and nitric oxide production a substance that aids blood flow and helps carry glucose throughout the body. Researchers studied markers of inflammation and blood sugar and insulin levels in a group of sedentary overweight men. The volunteers participated in both hotwater immersion and ambient room temperature control trials separated by at least three days. The researchers took blood samples before and after the participants rested in an degree F room for minutes. After the rest period the participants either remained seated in the room or entered a hotwater bath for minutes. In the hot water trial the volunteers sat immersed up to their necks in degree F water. The research team measured the mens heart rate blood pressure and body temperature every minutes throughout both the control and immersion conditions. Blood samples were taken again two hours after each session. The researchers found that a single hotwater immersion session causes the elevation of Il levels in the blood and increased nitric oxide production but did not change the expression of heat shock protein another protein suggested to be important for health. However a twoweek treatment period in which the men participated in daily hotwater baths showed a reduction of fasting blood sugar and insulin levels as well as improved lowgrade inflammation at rest. The men reported a level of discomfort during the hot water immersion trial which could be due to the high temperature of the water or the length of time they were required to remain immersed. The researchers acknowledge that these conditions may make it difficult for people to commit to this type of alternative treatment. However the positive results of decreased inflammation and improved insulin sensitivity suggest that hotwater immersion may improve aspects of the inflammatory profile and enhance glucose metabolism in sedentary overweight males and might have implications for improving metabolic health in populations unable to meet the current physical activity recommendations the researchers wrote. Read the full article The acute and chronic effects of hot water immersion on inflammation and metabolism in sedentary overweight adults httpsdoi.org.japplphysiol.. published ahead of print in the Journal of Applied Physiology https NOTE TO JOURNALISTS To schedule an interview with a member of the research team please contact the communicationstheaps.org mailtocahrefAPS Communications Office or . Find more research highlights in the APS Press Room http Physiology is the study of how molecules cells tissues and organs function in health and disease. Established in the American Physiological Society APS was the first U.S. society in the biomedical sciences field. The Society represents more than members and publishes peerreviewed journals with a worldwide readership."

"A yearold heart patient with dangerously high levels of cholesterol that could not be adequately reduced by statin drugs now has nearnormal cholesterol levels thanks to a new class of drugs that grew out of work done by UT Southwestern Medical Center researchers. Two of these drugs in a category known as PCSK inhibitors were approved by the Food and Drug Administration last summer for use by some individuals with extremely high cholesterol levels. If you take the core patients who are at highest risk it makes you appreciate how important this drug class is said Dr. Amit Khera httphttpprofiles.utsouthwestern.eduprofile Director of the Preventive Cardiology Program and Associate Professor of Internal Medicine at UT Southwestern. Frank Brown of Dallas grandfather of six and the owner of Franks Wrecker Service in Dallas has familial hypercholesterolemia an inherited condition that causes high levels of cholesterol especially lowdensity lipoprotein LDL cholesterol or bad cholesterol. High levels of LDL cholesterol are strongly associated with heart disease. Mr. Brown with a history of two heart attacks had been aggressively treated with multiple drugs to reduce his cholesterol levels but they remained stubbornly high. When I first met Mr. Brown he had a strong family history of heart disease he had a cholesterol level that was ridiculously high with an LDL of and he was having chest pains said Dr. Amit Khera who is Mr. Browns cardiologist. Dr. Khera who holds the Dallas Heart Ball Chair in Hypertension and Heart Disease at UT Southwestern was treating Mr. Brown with three cholesterollowering medications a statin which is a class of drugs that works by blocking a substance the body needs to make cholesterol ezetimibe a drug that blocks absorption of cholesterol in the intestine and colesevelam which sequesters bile acids. Even with this trio of medicines Mr. Browns LDL cholesterol level hovered around . The two PCSK inhibitors approved by the FDA last year were developed as a result of research done by UT Southwestern geneticists Dr. Helen Hobbs httphttpprofiles.utsouthwestern.eduprofile and Dr. Jonathan Cohen httphttpprofiles.utsouthwestern.eduprofile. Using data from the Dallas Heart Study a populationbased study that gathered extensive medical data on Dallas residents the two researchers showed that certain mutations to the gene that codes for the protein PCSK lead to low levels of cholesterol in the blood. FurtherDr. Hobbs and Dr. Cohen found a woman who had inherited not one but two of these mutations in the PCSK gene one mutation from each parent. This woman had stunningly low levels of LDL cholesterol. While anything below is considered good her LDL cholesterol level was just . Crucially this woman was in good health suggesting that therapies aimed at blocking PCSK would not only be effective but also safe. Their research led to the development by drug companies of evolocumab and alirocumab the two approved PCSK inhibitors which are delivered by monthly or semimonthly injections. Dr. Hobbs Director of the Eugene McDermott Center for Human Growth and Development holds the Eugene McDermott Distinguished Chair for the Study of Human Growth and Development the Philip OBryan Montgomery Jr. M.D. Distinguished Chair in Developmental Biology and the Dallas Heart Ball Chair in Cardiology Research. Dr. Cohen Professor of Internal Medicine and with the McDermott Center holds the C. Vincent Prothro Distinguished Chair in Human Nutrition Research. Mr. Brown had been part of a clinical trial testing the safety and effectiveness of one of the new PCSK inhibitors and when the drugs were approved Dr. Khera began working to get Mr. Brown approved by his insurance to be on the new regimen. In the world of cholesterol patients most are wellcontrolled with statins and they should stay on those said Dr. Khera. But Mr. Brown is the perfect patient for PCSK inhibitors. We knew he could tolerate it because hed been in a clinical trial he knew how to administer the injections and he was very highrisk. Wed exhausted the other options in trying to control his cholesterol. Two months after he started his biweekly injections of the new drug Mr. Browns LDL cholesterol level was down to not quite normal which is or less but an almost percent reduction from the level it had been for years. Its a good sign for Mr. Brown who looks forward to many more years of running his business watching Dallas Cowboys games and spending time with his grandchildren. There are many more Frank Browns out there patients who cant control their cholesterol with the standard drugs said Dr. Khera. Its wonderful to have this option to offer this special set of patients. About UT Southwestern Medical CenterUT Southwestern one of the premier academic medical centers in the nation integrates pioneering biomedical research with exceptional clinical care and education. The institutions faculty includes many distinguished members including six who have been awarded Nobel Prizes since . The faculty of almost is responsible for groundbreaking medical advances and is committed to translating sciencedriven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in about specialties to more than hospitalized patients and oversee approximately . million outpatient visits a year. This news release is available on our home page at http To automatically receive news releases from UT Southwestern via email subscribe at http"

"When women take a supplement of the omega fatty acid DHA during pregnancy their babies have fewer cold symptoms and shorter illnesses new research indicates. At month and months of age about percent of babies exposed to docosahexaenoic acid DHA in the womb experienced cold symptoms compared to about percent of the babies whose mothers were given a placebo supplement while they were pregnant. The data suggested that for most of the symptoms we looked at duration of symptoms was less when mothers received DHA. And in the case of colds the probability of a cold was slightly less. The effects seemed to be strongest early on after birth said study senior author Usha Ramakrishnan an associate professor in the Hubert Department of Global Health at the Rollins School of Public Health at Emory University in Atlanta. Ramakrishnan said its probably too soon to recommend routine use of DHA supplements for pregnant women because the findings werent dramatic. But she added that the supplements did appear to be safe for pregnant women to take. Results of the study will be published online on Aug. and are scheduled to appear in the September issue of Pediatrics. The research was funded by the U.S. National Institutes of Health and the March of Dimes Foundation. Omega fatty acids are a class of nutrients considered essential for neural and retinal development during pregnancy. They are often obtained through diet by eating fish. But concerns about mercury contamination in fish have led to recommendations that advise pregnant women to limit their fish consumption. Pregnant women are also advised to avoid certain fish such as swordfish altogether. Therefore the current study looked at DHA supplements derived from algae. Ramakrishnan said there are no concerns about mercury contamination in DHA from algae. More than Mexican women were included in the study. Half were randomly selected to be in the treatment group while the other half received a daily placebo pill. The treatment group received milligrams of DHA each day beginning when they were between and weeks pregnant. Treatment continued at least until the birth of the baby. Ramakrishnan said Mexican women tend to be deficient in DHA much like many American women are. The babies were assessed at and months of age and the mothers completed questionnaires about their babies health. To aid their recall the mothers were also asked to keep a diary recording any illness symptoms. Babies in the DHA group had a percent drop in the odds of having a combination of cold symptoms at month compared to babies whose mothers were given a placebo. Also at month babies whose mothers had gotten the DHA supplement had percent shorter duration of cough percent less time with phlegm and percent shorter duration of wheezing. At months babies in the DHA group were also sick percent less time. And at months the babies whose mothers had DHA had shorter duration of fever runny nose and breathing problems. At times however babies in the DHA group experienced longer duration of rashes and vomiting the study authors noted. Ramakrishnan said that its likely that DHA boosts infants immune response. Dr. Jennifer Wu an obstetrician and gynecologist at Lenox Hill Hospital in New York City said Weve been recommending DHA intake in pregnant women for brain and nervous system development and this study suggests another good reason to take DHA. Wu recommended that women who are thinking about becoming pregnant should start prenatal vitamins and DHA supplements about three months before pregnancy and then continue them throughout the pregnancy. If youre not taking them ahead of time you may miss out on proper nutrition she added. More information Learn more about omega fatty acids including DHA and infant health from the March of Dimes http_omega.html. SOURCES Usha Ramakrishnan Ph.D. associate professor Hubert Department of Global Health Rollins School of Public Health and director graduate program in Nutrition and Health Sciences division of Biological and Biomedical Sciences Emory University Atlanta Ga. Jennifer Wu M.D. obstetriciangynecologist Lenox Hill Hospital New York City September Pediatrics"

"New research offers hope for the first pill to treat a common problem in young women fibroids in the uterus. The growths can cause pain heavy bleeding and fertility problems and they are the leading cause of hysterectomies. In two studies a lower dose of a morning after contraceptive pill stopped the bleeding and shrank the fibroids. It worked as well as shots of a hormoneblocking drug that has unpleasant side effects. This is very very good news. The results are better than we expected said research leader Dr. Jacques Donnez of SaintLuc hospital at the Catholic University of Louvain in Brussels. Hes now testing intermittent longterm use of the pill to see if that could help women avoid surgery. The pill is called Esmya and it is awaiting marketing approval in Europe. Its a lowdose version of an emergency birth control pill called ella that came on the market in the United States about a year ago. The new fibroid pill still needs to be tested in the U.S. and wont be available anytime soon. Fibroids are benign growths in the uterus that are common in women during their childbearing years mostly in their late s and s. They usually go away after menopause. Treating fibroids isnt easy. Removing the uterus is the only cure other treatments include surgery to remove them or procedures to shrink them with ultrasound or pellets that cut off their blood supply. With the discovery that the hormone progesterone as well as estrogen promotes fibroid growth scientists have been looking at a class of drugs that can block progesterones effect on the uterus. Donnez and his colleagues in several European countries tested Esmya made by Swissbased PregLem. Their findings are in Thursdays New England Journal of Medicine. The two studies involved about premenopausal women whose fibroid symptoms were serious enough that surgery was planned. One study compared two doses of Esmya with a dummy pill for three months. The second tested Esmya against a monthly hormoneblocking shot that shrinks fibroids but causes hot flashes and with longterm use can thin bones.. Women in that study got a daily Esmya pill and a dummy shot each month or a hormone shot and a dummy pill. In both studies Esmya stopped the bleeding and shrank fibroids in most patients and worked as well as the shot but with fewer side effects. Menstrual bleeding was controlled in over percent of the women on Esmya many within a week compared to percent of those who took a dummy pill. At the end of the three months only about half of the participants went ahead with any kind of fibroid surgery. That allowed the researchers to observe whether improvements lasted over the next six months. They did for many of the Esmya patients while fibroids started growing after a month in the group that got the hormone shot. Donnez is now studying whether Esmya could be used longterm given periodically if symptoms return until menopause when fibroids usually disappear. That means some women depending on their age might avoid having surgery at all said Donnez. He does between six and hysterectomies a week for fibroids. Despite newer less invasive alternatives the rate of hysterectomies remains high Dr. Elizabeth Stewart a professor of obstetrics and gynecology at Mayo Clinic wrote in an editorial in the journal. Theres a need for good medical treatments and the new research represents an important step in that direction. Its amazing to me that so many women have uterine fibroids and yet the treatments we have available are pretty few and far between she said. The new pill is awaiting final European approval as a treatment before surgery following a recommendation from the European Medicines Agency in December. In the U.S. and Canada Esmya will be developed by Watson Pharmaceuticals Inc. which also sells prescription ella the contraception pill that helps prevent pregnancy for up to five days after sex. Watson spokesman Charlie Mayr said the company will soon start a study of the fibroids pill in the United States but it will be several years before it is ready for government review. It will seek approval in Canada early this year he said. Drugmaker PregLem paid for the latest studies. The researchers included company employees Donnez and others have been on its scientific advisory board."

"Surgery to remove the primary tumor in women diagnosed with stage IV breast cancer followed by the standard combination of therapies adds months to the patients lives compared with standard therapy alone an international clinical trial led by a University of Pittsburgh Cancer Institute UPCI professor revealed. The results of the phase III randomized controlled trial will be presented Saturday at the American Society of Clinical Oncology ASCO annual meeting in Chicago. The study was selected for the societys Best of ASCO an effort to condense the research most relevant and significant to oncology into a twoday program to increase global access to cuttingedge science. Our findings will change the standard of care for women newly diagnosed with stage IV breast cancer said principal investigator Atilla Soran M.D. M.P.H. clinical professor of surgery University of Pittsburgh School of Medicine and breast surgical oncologist with UPMC CancerCenter. Weve shown that surgery to remove the primary tumoreither through lumpectomy or mastectomyfollowed by standard therapy is beneficial over no surgery. Dr. Soran began the trial in ultimately recruiting a total of women newly diagnosed with stage IV breast cancer from institutions. Half the women received standard therapy which avoids surgery and consists of a combination of chemotherapy hormonal therapy and targeted therapy while the other half first had surgery to remove their primary breast tumor followed by the standard therapy. At about months after diagnosis the women who received the surgery plus standard therapy lived an average of nine months longer than their counterparts who received standard therapy alone. Nearly percent of the women who received surgery lived to five years after diagnosis compared with less than percent of the women who did not receive surgery. The trial also showed that surgery in younger women with less aggressive cancers resulted in longer average survival than in women with more aggressive cancers that had spread to the liver or lungs. Our thinking is similar to how you might approach a battle against two enemies said Dr. Soran. First you quickly dispatch one armythe primary tumorleaving you to concentrate all your efforts on battling the second armyany remaining cancer. This research was primarily funded by the Turkish Federation of Societies for Breast Diseases. The study received scientific advisement from UPMC and assistance with statistical analysis from epidemiologists at the University of Pittsburgh Graduate School of Public Health. About UPCI As the only NCIdesignated comprehensive cancer center in western Pennsylvania UPCI is a recognized leader in providing innovative cancer prevention detection diagnosis and treatment biomedical research compassionate patient care and support and communitybased outreach services. Investigators at UPCI a partner with UPMC CancerCenter are worldrenowned for their work in clinical and basic cancer research. http"

"New research suggests that Opdivo a drug that works with the immune system to fight melanoma is more effective than the current standard of care for patients whove had surgery to remove advanced tumors. The international study was funded by Opdivos maker BristolMyers Squibb and included more than patients with stage III and stage IV melanoma. Patients were treated at medical centers across countries. All underwent surgery for their cancer before they began treatment with either Opdivo nivolumab or Yervoy ipilimumab the drug thats the current standard of care. Both drugs are immunotherapies which work by boosting the immune systems ability to spot and destroy tumor cells. After a year of treatment percent of patients in the Opdivo group were alive without any recurrence of the disease compared with percent of those treated with Yervoy. And at months the rate was percent for Opdivo and percent for Yervoy the findings showed. According to the Skin Cancer Foundation metastatic melanoma accounts for only about percent of skin cancer cases but causes the majority of skin cancer deaths. Our results demonstrate that Opdivo is more effective in treating patients with stage III and IV melanoma cutting the risk of relapse by a third lead researcher Dr. Jeffrey Weber professor of medicine at NYU School of Medicine said in a university news release. Results like this will change how we practice medicine. Hopefully physicians will embrace the use of Opdivo in these highrisk patients as adjuvant therapy added Weber who also helps direct NYUs Perlmutter Cancer Center in New York City. One cancer surgeon who reviewed the findings was impressed. Based on this study it appears that patients with advanced melanoma who have their disease completely removed by surgery should go on to receive additional therapy with Opdivo said Dr. Gary Deutsch. He is a surgical oncologist at Northwell Healths Imbert Cancer Center in Bay Shore N.Y. Not only did these patients have a better survival outcome at one year but they had only onethird the side effects compared to Yervoy Deutsch said. The study found that patients taking Opdivo had fewer severe side effects than those taking Yervoy at percent versus percent. Five percent of patients on Opdivo had to stop treatment due to side effects compared with percent of those on Yervoy. The most common side effects for both drugs were fatigue and diarrhea. Weber added that the safety of Opdivo is very promising. The study is scheduled for presentation Monday in Madrid Spain at the annual meeting of the European Society for Medical Oncology. It was also published online Sept. in the New England Journal of Medicine. Both Opdivo and Yervoy are already approved by the U.S. Food and Drug Administration to treat advanced metastatic melanoma. In some patients the drugs are used in combination. Dr. Michele Green is a dermatologist at Lenox Hill Hospital in New York City. She said any advance in the care of aggressive melanomas is welcome news for patients. It is amazing that there is now an alternative that is superior to conventional chemotherapy for advanced metastatic disease Green said after reviewing the new study findings. With these advanced melanomas that have high risks of recurrences and have poor outcomes it is vital to look at alternative treatments. The future in cancer treatments lies in immunotherapy and other targeted options. More information The U.S. National Cancer Institute has more on melanoma https SOURCES Gary B. Deutsch M.D. surgical oncologist Northwell Healths Imbert Cancer Center Bay Shore N.Y. Michele Green M.D. dermatologist Lenox Hill Hospital New York City NYU School of Medicine news release Sept."

"After his accident doctors said Ian Burkhart would never move his hands again. But scientists have now developed a system that has enabled him to regain movement and do everyday things like swipe a credit card and play Guitar Hero but only in a lab so far. Ian Burkhart shouldnt be able to move his hands at all. The yearold from Dublin Ohio was in an accident six years ago that left his arms and legs paralysed. But now thanks to computer software that decodes his thoughts and sends the signal to his hands hes been able to pick up small objects swipe a credit card and even play Guitar Hero albeit in a science lab. This is the first time a person with paralysis has regained movement in their hands and individual fingers using signals from their brain. Details of the system that allows him to do this developed by scientists at Ohio State University and Battelle Memorial Institute are published httpnature.comarticlesdoi.nature in the journal Nature today. The study builds on previous work in which humans have been able to move computer cursors and robotic arms using their own brain signals and a study http in which monkeys with paralysed arms were able to move them again thanks to a similar intervention. It was the summer after his freshman year of college when Burkhart lost the ability to move his arms and legs. I was years old really independent and I didnt think anything like this would happen in my life that would slow me down and set me back this much Burkhart said during a press briefing. I dove into a wave that then pushed me down into a sandbar the water wasnt as deep as I thought. I was lucky to have friends with me who were able to pull me out of the water and get medical attention. The injury in his spinal cord means he doesnt have any movement below his elbow so he is missing the fine motor movement in his hands that would allow him to grasp or pick up objects. Burkharts thoughts and brain signals work in the same way as they did before the accident but his spinal cord injury means they never reach his hand leaving him unable to move it. He has some residual movement in his shoulders and can use those working shoulder muscles to move his arms about. Thats how I do pretty much everything in my daily life when Im not hooked up to the system he says. The system works by bypassing Burkharts spinal cord injury. A device implanted in his brain records signals from neurons that fire when he thinks about a movement picking up a cup for example. This signal is passed to a computer that decodes it and the resulting instruction is then sent to a sleeve he wears on his forearm that stimulates the muscles that move his wrist and fingers. In June in the early stages of the trial Burkhart moved his hand again for the first time after his accident. It was a flicker of hope knowing that this was something that was working knowing I will be able to use my hand again he said. After three sessions a week for over a year he is able to use the system to do things he couldnt do on his own like pick up a mug and pour its contents into another container swipe a credit card and play Guitar Hero. So far hes been able to make isolated finger movements and six different hand and wrist movements. To test how useful this would be in a normal situation the scientists had Burkhart pick up a container empty its contents into a jar then pick up a stick and stir the contents of the jar. It was a struggle at first but by the end of the trial he was able to complete the action three out of five times in a minute period. The setup currently requires a minute training period at the beginning of every session. Burkhart watches videos of different hand movements hes going to perform that day and thinks about the movements so the computer learns what the brain signals for each movement looks like. The machine is actually learning and Ian is learning how to refine his thought patterns Chad Bouton http lead author on the paper said in a press briefing. So the machine and the person are learning together and after that minute period theres a dramatic improvement its been really amazing to watch. Initially wed do a short session and Id feel completely mentally fatigued and exhausted said Burkhart. But just like anything with more and more practice its become easier. This technology is possible because theres about years of basic neuroscience that has been looking at how signals in the brain encode information about movement Dr Andrew Jackson http a neuroscientist at Newcastle University who was not involved with the work told BuzzFeed News. What were seeing now is all of that basic research which was driven by purely scientific questions coming to fruition in terms of enabling new treatments but theres still a lot we need to learn. There are still many challenges to be overcome to bring this work out of the lab and into the lives of the millions of people who are paralysed. We have to be realistic about this theres still quite a long way towards turning this into something that would be feasible for widespread use in large numbers of people Jackson said. For starters the device that records the brain signals will need to be much smaller so its fully implanted under the paralysed persons skin. One of the directions the field is moving towards Jackson said is to develop implanted devices that can be positioned under the skin and communicate wirelessly or route signals to the muscles completely under the skin. Burkhart swipes a credit card during the study. Our understanding of how brain signals change will also be crucial to making this technology usable on a large scale. The recordings we get from these electrodes in the brain can be quite unstable from day to day Jackson said. Thats why the device requires training every time Burkhart uses it. What wed really like is a system thats plug and play and will work daily without needing to be recalibrated. That could come from better electrode designs or looking for different signals that are more stable. Dr Jonas Zimmerman httpsvivo.brown.edudisplayjz a neuroscientist at Brown University in the US who was also not involved with the study echoed Jacksons point. Brain signals change from day to day even hour to hour the signals may be different depending on context am I trying to lift a full or an empty glass do I watch someone draw or do I want to draw myself and brain signals change while we learn a new task he told BuzzFeed news. We need to understand a lot more about the brain before we will make really meaningful improvements in this direction. It will be years until a paralyzed patient will be able to control neural prostheses independently from caregivers but there is nothing that should make this improvement impossible."

"For older women undergoing mastectomy for breast cancer directtoimplant DTI breast reconstruction provides good outcomes in a singlestep procedure httpsjournals.lww.complasreconsurgFulltextDirect_to_Implant_Breast_Reconstruction_in_Women..aspxPRIDPRS_PR_DTI_ while avoiding some of the inconvenience and risks of staged approaches to breast reconstruction reports a study in the February issue of Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg the official medical journal of the American Society of Plastic Surgeons http ASPS. The DTI approach is a powerful tool for breast reconstruction in elderly patients comments ASPS Member Surgeon Andrea Moreira MD of the Cleveland Clinic. The researchers believe the DTI technique may expand the options for older women who are less likely to undergo breast reconstruction. Good Results with DTI Breast Reconstruction in Women over Directtoimplant breast reconstruction has emerged as a singlestage approach to immediate breast reconstruction after mastectomy. So far however most studies of DTI have focused on younger women. Half of all breast cancers occur in women over yet only four to percent of these women undergo reconstruction Dr. Moreira and coauthors write. Most studies of breast reconstruction in older women have focused on multiplestep techniques such as tissue expander implant TEI reconstruction. The researchers identified women over age who underwent DTI reconstruction at the Cleveland Clinic between and . They identified a total of breasts reconstructed by DTI in patients all with at least days followup and most with one year of followup Patient characteristics and outcomes were compared to those of breasts with TEI reconstruction in patients. The women undergoing DTI reconstruction were older . versus . years and had a higher body mass index compared to the TEI group. Both DTI and TEI were safe and effective options for breast reconstruction. Complication rates were similar between groups including blood and fluid collections hematoma and seroma infection unplanned surgery and failed reconstruction. However DTI had some important advantages. Women in the DTI group were less likely to be readmitted to the hospital and spent fewer total days in the hospital. In the year after surgery was completed women in the DTI group made an average of . office visits compared to about visits in the TEI group. The DTI group also spent fewer days with a surgical drain in place average about days compared to days in the and had fewer total days in the hospital. Thats an important consideration as drains require antibiotic treatment to prevent infection in addition to causing discomfort for the patient. The authors note some important limitations of their studyparticularly the fact that it was a review study of one hospitals experience with a relatively new procedure. Dr. Moreira and colleagues write These reported cases include our learning curve patients as we familiarized ourselves with appropriate patient selection and surgical technique. The researchers emphasize that DTI isnt an option for every patient depending on breast shape and other factors. Despite these limitations their experience suggests that complications of the DTI approach in older women are similar to those of the more commonly used TEI technique. Dr. Moreira adds In appropriately selected cases DTI reconstruction is a viable alternative to staged techniques requiring multiple surgeries. Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg is published by Wolters Kluwer. Click here to read DirecttoImplant Breast Reconstruction in Women Older than Years A Retrospective Analysis of Complication Rate and Overall Outcomes. httpsjournals.lww.complasreconsurgFulltextDirect_to_Implant_Breast_Reconstruction_in_Women..aspxPRIDPRS_PR_DTI_ DOI .PRS. About Plastic and Reconstructive Surgery For more than years Plastic and Reconstructive Surgery http has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons Plastic and Reconstructive Surgery brings subscribers uptotheminute reports on the latest techniques and followup for all areas of plastic and reconstructive surgery including breast reconstruction experimental studies maxillofacial reconstruction hand and microsurgery burn repair and cosmetic surgery as well as news on medicolegal issues. About ASPS The American Society of Plastic Surgeons http is the largest organization of boardcertified plastic surgeons in the world. Representing more than physician members the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than percent of all boardcertified plastic surgeons in the United States. Founded in the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. About Wolters Kluwer Wolters Kluwer N.V. AEX WKL is a global leader in information services and solutions for professionals in the health tax and accounting risk and compliance finance and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services. Wolters Kluwer reported annual revenues of . billion. The company headquartered in Alphen aan den Rijn the Netherlands serves customers in over countries maintains operations in over countries and employs people worldwide. Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and the organization visit http follow WKHealth httpstwitter.comwkhealth or Wolters_Kluwer httpstwitter.comWolters_Kluwer on Twitter like us on Facebook https follow us on LinkedIn https or follow WoltersKluwerComms on YouTube http For more information about Wolters Kluwers solutions and organization visit http follow us on Twitter httpstwitter.comwolters_kluwer Facebook https LinkedIn https and YouTube http"

"Dieters who go vegetarian not only lose weight more effectively than those on conventional lowcalorie diets but also improve their metabolism by reducing muscle fat a new study published in the Journal of the American College of Nutrition has found. Losing muscle fat improves glucose and lipid metabolism so this finding is particularly important for people with metabolic syndrome and type diabetes says lead author Dr. Hana Kahleov Director of Clinical Research at the Physicians Committee for Responsible Medicine in Washington DC. Seventyfour subjects with type diabetes were randomly assigned to follow either a vegetarian diet or a conventional antidiabetic diet. The vegetarian diet consisted of vegetables grains legumes fruits and nuts with animal products limited to a maximum of one portion of lowfat yoghurt per day the conventional diabetic diet followed the official recommendations of the European Association for the Study of Diabetes EASD. Both diets were restricted by kilocalories per day compared to an isocaloric intake for each individual. The vegetarian diet was found to be almost twice as effective in reducing body weight resulting in an average loss of .kg compared to .kg for the conventional diet. Using magnetic resonance imaging Dr. Kahleov and colleagues then studied adipose fatstorage tissue in the subjects thighs to see how the two different diets had affected subcutaneous subfascial and intramuscular fat that is fat under the skin on the surface of muscles and inside muscles. They found that both diets caused a similar reduction in subcutaneous fat. However subfascial fat was only reduced in response to the vegetarian diet and intramuscular fat was more greatly reduced by the vegetarian diet. This is important as increased subfascial fat in patients with type diabetes has been associated with insulin resistance so reducing it could have a beneficial effect on glucose metabolism. In addition reducing intramuscular fat could help improve muscular strength and mobility particularly in older people with diabetes. Dr. Kahleov said Vegetarian diets proved to be the most effective diets for weight loss. However we also showed that a vegetarian diet is much more effective at reducing muscle fat thus improving metabolism. This finding is important for people who are trying to lose weight including those suffering from metabolic syndrome andor type diabetes. But it is also relevant to anyone who takes their weight management seriously and wants to stay lean and healthy."

"Gentle yoga classes may help people with type diabetes take off a small amount of weight and steady their blood sugar control a small study suggests. People perform yoga during a gathering calling for world peace at Ibirapuera Park in Sao Paulo August . REUTERSNacho Doce The study of middleaged and older adults found that those who added yoga classes to standard diabetes care shed a handful of pounds over three months. Meanwhile their average blood sugar levels held steady in contrast to the nonyogapracticing control group whose blood sugar levels rose. The findings reported in the journal Diabetes Care do not suggest that yoga should replace other forms of exercise for people with type diabetes a disease commonly associated with obesity. To really lose weight and rein in blood sugar morevigorous exercise would work better according to Shreelaxmi V. Hegde of the Srinivas Institute of Medical Science and Research Center in Mangalore India. Among the study participants who took yoga classes several times a week the average BMI a measure of weight in relation to height declined from . to .. A BMI between and is considered overweight. In our study the effect of yoga on BMI body mass index and blood sugar control was marginal Hegde the lead researcher on the work told Reuters Health in an email. But she added it should be noted that yoga controlled the blood sugar levels which otherwise rose in the control group. In addition to that the study found signs of socalled oxidative stress declined in the yoga group. Oxidative stress refers to a situation where levels of reactive oxygen species or free radicals damaging byproducts of energy use in cells rise beyond the bodys capacity to neutralize them. Longterm oxidative stress is believed to contribute to a host of chronic diseases. In this study Hegdes team measured participants blood levels of certain chemicals that reflect oxidative stress. They found that on average the yoga groups levels of the chemicals dipped by percent. The significance of that is not clear. Hegde said that if such a decline in oxidative stress were sustained over time it might lower the chances of diabetes complications which include heart and kidney disease nerve damage and damage to the blood vessels of the eyes. Further longterm studies are needed to see whether that is the case the researchers say. According to Hegde yoga may curb oxidative stress because it stimulates the parasympathetic nervous system the part of the nervous system that basically acts as a brake against the gas pedal of the sympathetic nervous system. There are caveats. The yoga used in this study was a gentle form Hegde said and parts of the practice were adapted for people who had additional health problems certain poses were avoided in people who had heart disease for example. In the real world yoga classes vary widely. Some are vigorous workouts involving complicated poses that would not be appropriate for older adults with chronic health conditions. Older adults with diabetes can look for yoga classes designed specifically for older people and those with chronic medical conditions. In the U.S. hospitals and local community centers are increasingly offering such classes. SOURCE bit.lyqJGXZ httpbit.lyqJGXZ Diabetes Care online August ."

"A team of Cleveland Clinic researchers in collaboration with Nestl Research Center conducted one of the largest controlled studies of its kind on whole grains and concluded that a diet rich in whole grains may significantly lower the risk of cardiovascular disease in overweight and obese adults under the age of . The findings published in the Journal of Nutrition today suggest that whole grains can be a key regulator of blood pressure and could provide an effective nutritional strategy to reduce cardiovascularrelated deaths and disorders. Heart disease and strokes are a leading cause of death in the United States. This research shows that eating whole grains reduces the risk of heart disease said John Kirwan Ph.D. principal investigator and director of the Metabolic Translational Research Center which is part of Cleveland Clinics Endocrinology Metabolism Institute. Researchers conducted a doubleblind randomized controlled crossover trial. In the study a group of overweight and obese adults followed a whole grain diet intervention or a refined grain diet control for two eightweek periods. The diets were exactly the same except for their content of whole grains or refined grains. At the beginning and end of each diet period participants spent three days undergoing metabolic testing in a clinical research setting. Participants taking antihypertensive medication were instructed to maintain medication usage throughout the study. While on the whole grain diet participants saw a threefold improvement in diastolic blood pressure the lowest pressure when your heart relaxes between beats compared to the refined grain diet. This improvement equates to reducing the risk of death from heart disease by almost onethird and the risk of death from a stroke by twofifths. The uniqueness of this study is that each of the participants consumed both diets said Kirwan. This level of control can only be performed for small numbers and provides the essential empirical data that cannot be obtained from large observational studies. These evidencebased data demonstrate the effect of diet on cardiovascular disease outcomes particularly diastolic blood pressure. Blood pressure is typically recorded as two numbers. Systolic is the top number that measures the pressure in the arteries when the heart beats. Diastolic is the bottom number which measures the pressure in the arteries when the heart muscle is resting between heartbeats. Hypertension or high blood pressure is a common obesityrelated condition that affects about percent of U.S. adults and it is a major risk factor for cardiovascular disease. Before age an elevated diastolic blood pressure is associated with increased cardiovascular disease risk. As they age people with elevated diastolic blood pressure are at a higherthanaverage risk of developing elevated systolic blood pressure. Overall there were substantial reductions in body weight fat loss systolic blood pressure total cholesterol and LDL cholesterol during both diet periods but these differences were due to the people changing their normal dietary habits to carefully controlled diets. This collaborative research began in . It was supported by an investigatorinitiated grant from Nestl NIH National Center for Research Resources Grant ULRR and NIH Grant T DK. Nestl Product Technology Center Solon and Cereal Partners Worldwide provided the study meals and foods. About Cleveland Clinic Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland Ohio it was founded in by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs including coronary artery bypass surgery and the first face transplant in the United States. U.S.News World Report consistently names Cleveland Clinic as one of the nations best hospitals in its annual Americas Best Hospitals survey. Among Cleveland Clinics employees are more than fulltime salaried physicians and researchers and nurses representing medical specialties and subspecialties. The Cleveland Clinic health system includes a acre main campus near downtown Cleveland nine community hospitals more than northern Ohio outpatient locations including fullservice family health centers and three health and wellness centers and locations in Weston Fla. Las Vegas Nev. Toronto Canada Abu Dhabi UAE and London England. In there were . million outpatient visits hospital admissions and surgical cases throughout the Cleveland Clinic health system. Patients came for treatment from every state and countries. Visit us at http Follow us at http Editors Note Cleveland Clinic News Service is available to provide broadcastquality interviews and Broll upon request."

"Acupuncture can help alleviate the oftendebilitating hot flashes that afflict many breast cancer patients new Italian research says. Noting that hot flashes are a fact of life for many women with breast cancer the investigators found that pairing lifestyle advice with weekly acupuncture sessions dramatically improved the womens quality of life. Acupuncture together with enhanced selfcare for three months is effective in reducing hot flashes in women with breast cancer said study author Giorgia Razzini a clinical trial project manager in the oncology unit of Ospedale di Carpi Carpi Hospital in Bologna Italy. And because hormone treatment for breast cancer typically makes the hot flash experience even worse Razzini added acupuncture could be a useful tool for helping such patients stay on their therapy and improve their quality of life. Razzini and colleagues published their findings online March in the Journal of Clinical Oncology. In the study the Italian team focused on breast cancer patients who had reported moderate or worse hot flashes while undergoing treatment at five cancer hospitals and one primary health care center in northern Italy between and . The patients whose average age was were randomly split into two groups. One group of patients was offered a threemonth regimen of selfcare advice on diet exercise and psychological support. The second group of was offered the same advice in the same time frame along with halfhour weekly sessions of traditional acupuncture. All of the participants kept hot flash diaries. At the end of the threemonth period and for up to six months thereafter daily hot flash experiences were assessed for changing severity and frequency. The result by the end of the treatment period those in the acupuncture group were found to have hot flash scores that were percent lower than those in the nonacupuncture group. The finding continued to hold up for a halfyear after the acupuncture sessions ended. Those in the acupuncture group also seemed to have a generally higher overall quality of life in terms of both physical and mental health with no serious side effects the study authors said. So why does acupuncture seem to work Razzini cited several reasons including acupunctures ability to prompt blood vessel dilation in the patients nervous system while stimulating the release of endorphins a neurotransmitter that interacts with brain cells involved in the regulation of pain and emotion. It also triggers the release of the stress hormone norepinephrine as well as the mood regulator serotonin. Razzini didnt know how much American patients might have to pay for such treatment but added Compared to other effective treatments such as antidepressants acupuncture should be less expensive and for sure more safe and feasible. Dr. Courtney Vito a breast oncologic surgeon at the City of Hope Comprehensive Cancer Center in Duarte Calif. was pleased that a serious issue in breast cancer treatment is getting a closer look. Anyone who treats breast cancer struggles with this problem in their practice because the hot flashes that some women experience with antihormonal treatment can be profound she said. Almost all women experience them. For some its a moderate situation but for others its a really significant problem. Some women I would say probably about percent have such severe hot flashes that they even refuse to take medications that can cut their risk for cancer or cancer recurrence by percent simply because they cant handle the hot flashes Vito explained. And Ive actually had patients who have had acupuncture with good success so Im not surprised by the finding she added. But it is heartening that we now have scientific proof that this can work. Which in the end may help to encourage insurance companies to their expand coverage so this can become an affordable option for all patients in need. More information Theres more on cancer and hot flashes at the U.S. National Cancer Institute http SOURCES Courtney Vito M.D. breast oncologic surgeon and assistant clinical professor City of Hope Comprehensive Cancer Center Duarte Calif. Giorgia Razzini Ph.D. clinical trial project manager oncology unit Ospedale di Carpi Bologna Italy March Journal of Clinical Oncology"

"A daily supplement of pharmaceutical grade chondroitin is as good as celecoxib Celebrex at relieving arthritic knee pain and doesnt have dangerous side effects researchers say. Dr. JeanYves Reginster of Liege State University in Belgium and colleagues recruited people over age with knee osteoarthritis from five European countries and randomly assigned them to take mg of the extrapure chondroitin sulfate Chondrosulf mg of celecoxib Celebrex or a placebo every day for six months. Those who took chondroitin sulfate or celecoxib had similar levels of pain relief at the end of the study and in both groups the improvement was greater than for those taking just a placebo according to the report in Annals of the Rheumatic Diseases. Reginster told Reuters Health the findings are in line with earlier studies showing pharmaceuticalgrade chondroitin sulfate could significantly decrease the progression of knee osteoarthritis over a period of three years. He stressed that pharmaceuticalgrade chondroitin is not the same as overthecounter supplements which are made differently and cant get into the joint in high enough concentrations to combat the causes of cartilage degradation and pain. European regulatory bodies recommend pharmaceuticalgrade chondroitin sulfate as well as pharmaceuticalgrade glucosamine sulfate as firstline treatments for osteoarthritis Reginster said by email because of the side effects associated with celecoxib and other nonsteroidal inflammatory drugs NSAIDs including stomach ulcers bleeding liver and kidney problems. Dr. Michael Shepard of Hoag Orthopedic Institute in Orange California noted that the study had a relatively low number of participants and that most U.S. studies of this type would run two years rather than six months. In addition U.S.based studies of chondroitin have had mixed results said Shepard who wasnt involved in the study. Some have found the supplements to be as effective as ibuprofen also an NSAID and some have found that chondroitin sulfate is no more effective than placebo he told Reuters Health. I tell my patients buyer beware Shepard said in an email. I tell them about the mixed results of chondroitin in the literature. I tell them to try chondroitin for one month as a trial and if they like it and feel better with it then keep taking it. If chondroitin doesnt work for them he suggests taking an NSAID periodically and to be aware of the side effects. If you are going to stay on an NSAID for a prolonged period then you need regular follow up with your doctor Shepard cautioned. Dr. Rachel Wolfe of Wake Forest Baptist Medical Center in WinstonSalem North Carolina agreed that chondroitin is reasonable to try for some people especially those with contraindications to NSAIDs. However it should not replace other therapy such as quad strengthening exercises and weight loss which we know will provide benefit. It should be used in conjunction with these measures said Wolfe who wasnt involved in the study. Chondroitin is not a miracle pill but if it allows people to feel less pain and be more active thereby losing weight and strengthening muscles then I think there may benefit Wolfe told Reuters Health by email. Studies like this highlight that medicine is still an art we do not have perfect answers and we have to individualize for each patient. The study was sponsored by IBSA Institut Biochimique SA a pharmaceutical company based in Lugano Switzerland that makes the chondroitin sulfate supplements used in the test. SOURCE bit.lyrcPLh httpbit.lyrcPLh Annals of the Rheumatic Diseases online May ."

"Its still very early but scientists say a test based on a patients saliva might someday help detect Alzheimers disease. Saliva is easily obtained safe and affordable and has promising potential for predicting and tracking cognitive decline but were in the very early stages of this work and much more research is needed study author Shraddha Sapkota a neuroscience graduate student at the University of Alberta in Canada said in a news release from the Alzheimers Association. The study was to be presented Sunday at the Alzheimers Association International Conference in Washington D.C. Experts note that studies presented at medical meetings are typically considered preliminary until published in a peerreviewed journal. In the study Sapkotas team tested the saliva of people with Alzheimers disease people with whats known as mild cognitive impairment a decline in memory and thinking thats sometimes a precursor to dementia as well as people whose mental skills were normal for their age. They found that the saliva of people with Alzheimers had different levels of certain substances compared to the saliva of healthy people or those with mild cognitive impairment. Experts agreed that the findings held promise but much more research will be needed. This is a very preliminary study with a small number of subjects and the results are far from conclusive said Dr. Allison Reiss head of the Inflammation Section at WinthropUniversity Hospital in Mineola N.Y. She believes the current study lacks information on possible confounding factors things such as coexisting illnesses medications hydration state tobacco use and multiple other variables that could influence whats found in the saliva samples. There are many gaps in the evidence Reiss said. It is uncertain whether the strength and consistency of the relationship between these metabolites in saliva and Alzheimers risk will be maintained in a large multicenter study. Still Dr. Paul Wright chair of neurology at North Shore University Hospital in Manhasset N.Y. said the research is still in its infancy but very promising. If a saliva test lives up to its promise one advantage is the ease of obtaining a sample he said. But that convenience also brings its own problems Wright added. People might ask for a test even when they dont show any signs of dementia and this may result in anxiety and depression if there is a false positive result he said. For that reason larger studies are needed to corroborate and validate their findings Wright said. More information The U.S. National Institute on Aging has more about Alzheimers disease https SOURCES Paul Wright M.D. chair neurology North Shore University Hospital Manhasset N.Y. and Long Island Jewish Medical Center New Hyde Park N.Y. Allison Reiss M.D. head Inflammation Section WinthropUniversity Hospital Mineola N.Y. Alzheimers Association news release July"

"German researchers who used a bone marrow transplant to treat a cancer patient with the AIDS virus have declared him cured of the virus a stunning claim in a field where the word cure is barely whispered. The patient who had both HIV infection and leukemia received the bone marrow transplant in from a donor who had a genetic mutation known to give patients a natural immunity to the virus. Nearly four years after the transplant the patient is free of the virus and it does not appear to be hiding anywhere in his body Thomas Schneider of Berlin Charite hospital and colleagues said. Our results strongly suggest that cure of HIV has been achieved in this patient they wrote in the journal Blood. AIDS researchers have rejected the approach on any kind of scale for patients with HIV. A bone marrow transplant is a lastditch treatment for cancers such as leukemia. It requires destruction of a patients own bone marrow itself a harrowing process and then a transplant from a donor who has a nearexact blood and immune system type. Months of recovery are needed while the transplant grows and reconstitutes the patients immune system. Its not practical and it can kill people said Dr. Robert Gallo of the Institute of Human Virology at the University of Maryland who helped discover the human immunodeficiency virus that causes AIDS. It is possibly a cure thats for sure you wont know for absolute sure until the person dies and undergoes extreme PCR genetic analysis of postmortem tissue. Sponsored ADVERTISING The mutation affects a receptor a cellular doorway called CCR that the AIDS virus uses to get into the cells it infects. Since the s scientists have known that some people mostly of Northern European descent have the mutation and are rarely infected with HIV. They are uninfectable virtually Gallo said. Some researchers are working on the idea of gene therapy to treat or try to cure HIV but the technology is still in experimental stages. I dont want to throw cold water on an interesting thing but thats what it is an interesting thing Gallo said. Schneiders team has been following the patient taking samples from his colon liver spinal fluid and brain as he developed various conditions that justified the tests. They tested all these samples for evidence of the virus which can be difficult to detect unless it is actively infecting cells. All these places are suspected reservoirs where HIV can hide out for years to rebound in patients who stop taking drugs that suppress the infection. This patient appears to have a fully functioning immune system they found which appears genetically identical to cells from the donor not the patients own immune cells. Schneiders team found no evidence of HIV anywhere. From these results it is reasonable to conclude that cure of HIV infection has been achieved in this patient they wrote. The AIDS virus infects million people globally and has killed more than million since the pandemic began in the s. Cocktails of strong drugs can suppress the virus keeping patients healthy and reducing the chance they will infect others but there is no vaccine."

"Labor is an intensely strenuous activity with the uterine muscle contracting every few minutes to reposition a baby through the pelvis and down the birth canal. Even low levels of dehydration can seriously compromise normal physiological function yet recent studies looking at hydration in laboring women via the rates of intravenous IV fluid showed conflicting results. By pooling the data of several studies Thomas Jefferson University http researchers showed that a higher rate of IV fluids not only decreased csection rates but also shortened the overall length of labor by one hour as well as shortened the pushing phase. The results were published online as an accepted article https in Acta Obstetricia et Gynecologica Scandinavica. The results are compelling and strongly argue for a change in practice says Vincenzo Berghella M.D. the Director of Maternal Fetal Medicine and Professor in the Department of Obstetrics and Gynecology at the Sidney Kimmel Medical College at Thomas Jefferson University. We have already begun changing practice at Jefferson http to give women more fluids in labor to allow them to have the best chance of delivering vaginally. Dr. Berghella and colleagues compiled data from seven small clinical trials that collectively included a total of women. Of those about half or women received IV fluids at a rate of milliliters per hour and the other half women received fluids at the lower rate of milliliters per hour. General practice in the United States is to administer IV fluids at milliliters per hour during labor. With the data pooled the researchers could see a clear difference in outcomes for women in the two groups. Women getting the faster fluid rate milliliters per hour were less likely to get a cesarean section. The higher fluid rate also reduced the overall time of labor by an average of minutes and shortened the pushing phase by nearly minutes on average. Weve known that its important for women to stay well hydrated during pregnancy and labor. This study suggests that IV fluids could help women maintain hydration at appropriate levels reduce the likelihood of csection and decrease length of labor says Dr. Berghella. Recently we also showed that letting women eat more liberally in labor httpblogs.jefferson.eduatjeffinthenewsnewstudyshowseatingduringlaborcanbesafeforwomen especially in early labor has benefits including shorter labor and no identifiable risks. Today approximately one in three births in the United States occurs via csection despite an increased attention by national and international obstetric societies on safely reducing the practice. This study and others are providing evidence for changes in obstetric practice that could help safely reduce csection rates. Drs. Ehsanipoor Saccone Seligman PierceWilliams and Ciardulli were the coinvestigators with Dr Berghella. The authors report no conflicts of interest. Article reference R.M. Ehsanipoor. et al. Intravenous Fluid Rate for Reduction of Cesarean Delivery Rate in Nulliparous Women A Systematic Review and Metaanalysis. Acta Obstetricia et Gynecologica Scandinavica. doi .aogs.. . About Jefferson http Jefferson through its academic and clinical entities of Thomas Jefferson University and Jefferson Health including Abington Health and Aria Health is reimagining health care for the greater Philadelphia region and southern New Jersey. Jefferson has people dedicated to providing the highestquality compassionate clinical care for patients educating the health professionals of tomorrow and discovering new treatments and therapies to define the future of care. With a university and hospital that date back to today Jefferson is comprised of six colleges nine hospitals outpatient and urgent care locations and a multitude of physician practices throughout the region serving more than inpatients emergency patients and . million outpatients annually."

"When Sierra Riddle stormed into the conference room at Denvers child protective services office the director of the agency was seated there along with her sons team of doctors top administrators from the Childrens Hospital Colorado oncology department and lawyers. She recalls looking one of the physicians in the eye defiant. Im done with this shit she remembers saying. Im done with you guys bullying us. Then she took out a bag and dumped the contents on the table nine months of cancer drugs prescribed to her son Landon who was at the time. He had been diagnosed more than a year before with an aggressive form of leukemia and undergone months of grueling treatment. But his mother was now refusing to follow his doctors orders. Listen Heres all this chemo you told CPS he cannot live without and if I didnt give it to him he would relapse and die. But Landon who underwent only one year of cancer treatment instead of the recommended four was still alivethriving in facteven though hed stopped taking that massive pile of drugs prescribed for him. Thats why his mother had called this meeting. She implored the CPS directorwhom by then she knew by first nameto restrain the oncologists who had threatened to take her child away and put him in foster care. Riddle believes the doctors wanted to prove she was a neglectful abusive mother but she knew she could convince the world that the hospital was wrong about her sons treatment. Due to HIPAA patient privacy laws Childrens Hospital Colorado was unable to comment on Landons case for this story. Landons cancer diagnosed in September had put Riddle in a situation thats any parents worst nightmare She had to watch him undergo lifesaving treatment that appeared to be killing him. Riddle says she was left with no choice but to defy his doctors orders. In January nearly four months after Landons initial diagnosis the two went from Utah to Colorado where Riddle purchased an alternative treatment fraught with complicated politics and plenty of skepticismespecially when it comes to saving the life of a preschooler with a potentially fatal disease. At the time Colorado was one of only about a dozen states in the U.S. that had legalized medical cannabis. It also allowed sick children to access the drug under professional guidance. Landon became the youngest patient in the U.S. at that time to receive a medical marijuana card. Riddles decision to treat her child with cannabis landed the family in the center of a contentious national debate as well as on primetime television with CNNs chief medical correspondent Sanjay Gupta. In Utah all cannabis is illegal so when their story went public she and Landon had to move permanently to Colorado so he could continue to have access to the drug. Even now at he still needs to take cannabis to cope with the longterm effects of chemotherapy and radiation she says. By the time of that showdown with CPS and Landons doctors in Denver Riddle had stopped giving her son all of the drugs prescribed by the hospital the chemo opiates and benzos. The latter twowhich included OxyContin morphine and Ativanwere prescribed to help Landon cope with the side effects of cancer treatment. None of them helped she says or they made him feel worse. But when Landon started the cannabis oil his health miraculously improved. She was willing to do whatever it took to keep him on cannabis. A Key in the Lock As laws that permit medical cannabis have expanded nationwide states in the country now permit some form of cannabis use for medical purposes cancer patients increasingly use the drug to alleviate the harsh symptoms of chemotherapy such as nausea anxiety loss of appetite and insomnia. But theres also an emerging body of research that suggests marijuana might be effective as a treatment for cancer on its own or in conjunction with standard therapies. When Riddle made the decision to give her son cannabis the information on its safety and efficacy was and still is limited to anecdotal accounts a handful of case reports and lab studies published in obscure medical journals. Initially her hope was that the drug would lessen the side effects. But Riddle soon heard that certain compounds in cannabiscannabinoidshave been shown to induce cancer cell death. The theory seemed to be especially promising for leukemia at least according to studies done on cancer cells in test tubes and on mice injected with human leukemia cells. But at that point there wasnt any evidence it would work for humans. There still isnt. While cannabis is legal in many U.S. states the drug is still classified by the Drug Enforcement Administration as a Schedule narcotic along with heroin and cocaine which make it very difficult for scientists to conduct clinical trials on people. However that may change as other nations such as Israel take the lead and fund marijuana research. Landon Riddle carries bags of marijuana buds as his mother Sierra Riddle stands behind him in their home in Colorado on July . The two had to move from Utah to Colorado permanently after their story went public. Ryan David Brown for Newsweek Related Stories The findings so far from published lab studies suggest cannabidiol CBD one of more than cannabinoids present in the plant targets certain pathways in leukemia. The evidence indicates that leukemia cells have a high number of cannabinoid receptorsprimarily the receptor CB. The proteins on the cell membrane receptors recognize the chemical compound CBD. The shape of the receptor mirrors the shape of the compound enabling the CBD to land and attach to the cell. Its like a key in the lock says Dr. Bonni Goldstein medical director of CannaCenters in Los Angeles and the medical adviser to Weedmaps.com a resource for people seeking specialists to oversee their medical cannabis treatment. When compounds such as cannabidiol bond to receptors it causes the cell to die. Further studies are needed to verify that CBD could potentially kill leukemia says Robert McKallip an associate professor of immunology at Mercer University School of Medicine who conducted some of the earliest research on the antileukemia properties of compounds found in cannabis. McKallip suggests cannabis could be used along with other treatments for leukemia. Combined with other targeted therapies which again specifically target the leukemia you give it a onetwo punch and hopefully reduce side effects and improve efficacy of treatment he says. Riddle isnt a doctor but she theorizes that while the chemo initially cleared Landons cancer its the cannabis that has kept his disease from coming back. Oncologists who treat pediatric patients often tell families that when the fiveyear mark passes their child is in the clear. Its been nearly five years since Riddle sat in that conference room meeting Landon is still cancerfree. Riddle says that once he hits the fiveyear mark this fall hell set a precedent for pediatric leukemia patients in the U.S. and maybe even worldwide. Hes Dying Riddle a single mother was willing to do whatever it would take to rid Landon of the cancer in his blood that had spread to his brain and formed a tumor in his chest the size of a large grapefruit. She desperately wanted to trust the doctors at the Huntsman Cancer Institute in Salt Lake City where her son was diagnosed at age and who admitted to her that they werent sure they could save his life. She knew the leukemia treatment protocols are backed by decades of research. But they are infamously rough for a child and drag on for years. First there would be several months of aggressive inpatient chemo and other therapies for whats known as remission reduction. After that even when blood work showed the disease had entered remission Landon would need years of chemo and monitoringcalled consolidationto make sure his body wasnt harboring leukemia cells. This aggressive approach is one of the main reasons pediatric leukemia depending on its more specific classification has at least an to percent survival rate. The Leukemia Lymphoma Society estimates that nearly kids will be diagnosed in the U.S. with some form of leukemia in . For most of the kids who go through the entire course of treatment the illness turns out to be a mere blip on the screen of childhood. Riddle hoped the same would be true for her son. But Landon appeared to be among a small percentage of children with leukemia for whom the treatment was unbearable excruciating. The chemo caused him to vomit up to times a day which made it difficult for him to speak because his esophagus was burned and closed up. The chemo had compromised his immune system so severely that he caught every bug in the hospital just about every strain of stomach viruses influenza and the common cold. He eventually developed numbness tingling pain and weakness neuropathy in his feet and ankles and was no longer able to walk. Within the first days of treatment Landon lost half his body weight. He stopped eating for more than a month. He needed blood and platelet transfusions. Doctors kept adding prescription after prescription to alleviate the side effects of treatmentnarcotics antidepressants antianxiety drugs prescriptions for pain. The sad thing is they didnt seem to help Landon she says. At this point they kept telling us we have to keep going. I said Hes dying. Its very apparent that hes dying. Landon began to refuse chemotherapy and turn into a little psychopath says Riddle. He kicked and screamed when nurses forced pills into his mouth so eventually everything needed to be administered with an IV. The chemo actually has healed a lot of kids but it almost killed me he says. Landon Riddle poses at home in Colorado on July . Ryan David Brown for Newsweek Most children with leukemia go into remission within the first days of treatment which was why Landons doctors insisted on several more years of chemotherapy says Riddle. By the time Landon was nearing the end of his first stage of treatment Riddle says her son was on the brink of death. The doctors told her to bring him home for a twoweek break from chemo adding that they would arrange to send a hospice nursean ominous hint that Landon was about to die. A plea for help posted on Facebook by Riddles mother Wendy led the family to a group of brothers in Denver the Stanleys who were cultivating cannabis for medicinal purposes and had made the news for a strain they called Charlottes Web. Riddle and her mother had seen the story about Charlotte Figi a yearold girl with Dravet syndrome a rare type of epilepsy that was unresponsive to standard treatment. She had up to seizures per day. But the seizures stopped when she began taking CBD oil supplied by the brothers. The Stanleys visited the Riddles in Utah to educate them about Tetrahydrocannabinol THCthe psychoactive chemical in the plantand CBD. She decided to start Landon on cannabis. But to do that the family would need to leave Utah where all cannabis is illegal. So Riddle and Landon moved in with the brothers for about a year says Joel Stanley the CEO of the company that is now known as CW Hemp https It was just so sad to see someone that young and that small going through such harsh treatment Stanley says of Landon. He also had elements of what I know a lot of folks would call chemo brain. He would get very frustrated and very angry all normal because his little body was just being invaded by this intense medication and rounds of chemotherapy treatment. Throughout that year Riddle and her son traveled back and forth from Colorado to Utah so he could continue chemo but this time with the aid of cannabis to make treatment more bearable. That meant Riddle had the drug on hand and Landon was under its influence while in Utah which made mother and son both felons. Nearly all of the children the brothers had worked with by then were refractory epilepsy patients. The Stanleys had gotten their start a few years before with adults who wanted to manage cancer and Landon was their first pediatric cancer patient. Riddle began her son on Charlottes Web CBD oil and eventually added THC. As Riddle titrated the THC dosing she slowly weaned her son off the narcotics prescribed for him by his doctors in Utah. Stanley says the combination of CBD oil and THC helped Landon deal with the side effects of chemotherapy and based on limited existing lab research made it more likely that the cannabis could kill the cancer as well. If the cannabinoids do in his body what they have proven to do in petri dishes and in mice why not throw the book at them By then CNN had started to follow Landons story. The network planned to broadcast the segment after he and his mother had returned to Utah packed up their car with their possessions and drove to their new home in Colorado where Landon could continue to take cannabis. But CNN aired a promotion for the premiere of the episode before they had left for Colorado. The oncologist at the hospital in Utah who oversaw Landons treatment granted them discharge anyway and told Riddle she better leave the state immediately. Riddle says she was shocked to find that the doctors at the childrens hospital in Denver werent on her side. She says the hospital called CPS on her more than a dozen times when it became aware that she was no longer complying with treatment. That is why she ended up in that conference room with a cannabis researcher who was there to explain why the drug could help patients like Landon. He was the only person in the medical field she could find who would speak on her behalf. It was a big slap in the face that not a single doctor would come forward to help us she says. They were all afraid of losing their medical license. They were afraid of the government. They were afraid of what it would look like if they came forward in the name of cannabis. In the end CPS supported Riddle. Results from blood tests a bone marrow biopsy and spinal tap proved Landon no longer had leukemia not even the microscopic kind she says. Riddle says the CPS director called the hospital and ordered it to have Landons chemo port removed and discharge him from the hospital. Today Landon is still coping with the impact of his treatment. In addition to digestive problems he has posttraumatic stress disorder and anxiety. The cannabis vape pen helps with that says Riddle. She says the cranial radiation he had to endure caused some neurological deficits and Landon says he worries that hell be sick forever. But theres so much good news here. Hes alive and he and his mother are no longer just medical marijuana refugees. Theyre also activists. Along with other parents she helped draft a bill and pass a state law that allows Landon and other children like him with chronic illnesses to take cannabis at school. Since the drug is federally illegal it had been illegal at school. Thats no longer the case in Colorado. Theyve testified in California on behalf of a medical marijuana caregiver whose home was raided by the federal government helping the man avoid a year jail sentence. The mother and son have also traveled back to Utah to appear at a state congressional hearing for a medical marijuana bill thats been shot down twice which means they wont be going home anytime soon. At public appearances Riddle does most of the talking but she says as Landon has grown up he has become more aware of his health problems stemming from his cancer treatment. And also angrier. Eventually hell be the one telling the story and Ill just be the one supporting him."

"Dominic Gessler lifts two squirming mice from their cages. Sherri Epstein flinches but Gessler coaxes her to hold out her hands. He places the small animals in her palms and they skitter in tiny circles tickling her skin. Now says Gessler. Which one used to have Canavan disease A few miles away at Epsteins home in Worcester Massachusetts a young woman lies in bed her thin limbs bent and still her curly red hair splayed across a pillow. This is Rachel Epsteins yearold daughter born with Canavan diseasea debilitating fatal brain disorder. As a newborn Rachel opened her mouth as if to scream but made no sound. As an infant she never moved in her sleep. When Rachel failed to lift her head by six months of age an early intervention therapist suspected she had cerebral palsy. Epstein wishes it had been so. Instead Rachel had inherited a mutated version of a gene called ASPA from each of her parents. Without a healthy copy of that gene her cells could not produce a protein needed to break down acid in the brain. So the acid built up then slowly ate away at the insulation protecting Rachels neurons turning her white matter into a sponge pocketed with fluidfilled sacs. As a result Rachel does not talk she cannot see or control her limbs or other bodily functions she has seizures and will likely not live to adulthood. There is no treatment and no cure for Canavan disease. Yet standing in a room at the University of Massachusetts Medical School Epstein holds a mouse that once had the same symptoms as Rachelbut now runs effortlessly over her outstretched fingers. Weeks before the mouse was treated with a single intravenous injection of a gene therapy drug developed in the lab of Gesslers doctoral adviser microbiologist Guangping Gao. The drug is the fruit of Gaos year career in gene therapy. Gao did not always believe the drug would ever make it out of the laboratory because the field of gene therapy has been plagued with seemingly insurmountable obstacles including the deaths of test subjects. Over the past five years however there has been a resurgence of gene therapy in neuroscience. Scientists now argue it is our best and perhaps only chance at curing many diseases of the brain. And attuned to the multibilliondollar potential of this new class of drugs large pharmaceutical companies including Novartis Shire AstraZeneca and GSK are joining the fray. More than biotech companies are currently developing viral gene therapies while others are working to directly edit genes. Gene therapies are coming along fast and furious. Theyre going to earn their place says Kevin Starr cofounder of Third Rock Ventures a venture capital firm invested in three gene therapy companies. We are probably in the greatest innovative period of understanding human disease and how to make cures ever. A FedEx Truck to the Brain The concept of gene therapy is straightforward beautiful even Fix an illness caused by a faulty gene by replacing or supplementing a healthy new copy of the gene. In other words use genes as medicine. For example one of the earliest human tests of gene therapy was in when two young girls with severe combined immunodeficiency SCID received repeated infusions of their own white blood cells modified to fix a defective gene. It workedwith continued treatments both children showed signs of a restored immune system and went on to lead normal lives. Gao first met a Canavan patient in at a party celebrating his discovery of the gene and mutations that caused the disorder. A family wheeled over their yearold with Canavan disease to the young scientist who realized that the boy had donated tissue to his research project. Id held his DNA in my hands. I had found what was wrong with his DNA recalls Gao then a Ph.D. student. Yet he had no way to fix it. At that moment I knew what I would do for the rest of my lifefind a cure for the disease says Gao. And other than gene therapy there was no other way. Gene therapy is wellsuited for treating inherited brain diseases. First most drugs cant get through the brains formidable bloodbrain barrier but something small like a virus with a healthy gene tucked inside can do it. Additionally the brain is a closed compartment so the risks of gene therapy are minimizedother parts of the body the liver or the lungs say are undisturbed. In the early s Gao was a student without a lab of his own. So he sought out James Wilson at the University of Pennsylvania a rising star in the field of gene therapy. For the next years Gao would work for Wilson engineering new and better viruses for the therapies called viral vectors. These molecular FedEx trucks can be loaded with healthy versions of genes and deliver them to the correct location in the body. Gao was in the right place at the right time. By more than gene therapy clinical trials were approved in the U.S ranging in illnesses from cancer to blood disorders to graftversushost disease. Wilson eagerly moved from the lab into human trials starting with five studies utilizing a modified version of an adenovirus a common virus known to cause respiratory infections in people. One of those trials enrolled a teenager named Jesse Gelsinger. Gelsinger suffered from a genetic liver condition kept under control with pills and diet but he volunteered for the study to help find a cure for infants with a fatal form of his disorder. When Gelsinger received the gene therapy in September the adenoviral vector triggered a violent immune response that damaged his liver and shut down his lungs. Four days after the injection he was dead. His death shuttered gene therapy funding and research in the United States. Europeans continued on buoyed by an announcement in that gene therapy had cured a group of children with SCID. But within a few years five of them had developed leukemia from the treatment. One died and scientists fled the field. Gao who was not directly involved in the clinical trial that led to Gelsingers death doesnt like to talk about it now saying only that he doesnt blame Wilson. Gao kept his head down and quietly continued to work on other types of safer viral vectors. The most promising candidate was adenoassociated virus AAVa virus that grows in the presence of adenovirus but is a completely different type. AAVs are not quite as efficient as adenoviruses at getting genes into human cells but they are much safer The human immune system barely notices the viruss outer coat or dress as Gao calls it. And AAVs do not integrate into the genome of human cells which is what caused leukemia in some of the SCID patients. In Gao struck out on his own taking a job as director of a brandnew gene therapy center at UMass. The paint on his office walls was still wet when Sherri Epstein walked in. A parttime administrative assistant in the building next door Epstein had seen Gaos appointment in a local newspaper. Epstein introduced herself and told Gao about Rachel and her previous attempt at gene therapy. Five years earlier doctors running the firstever Canavan gene therapy trial drilled six tiny holes into Rachels skull inserted thin catheters and delivered their drug to parts of her brain. It was safe but it didnt work. Not long after that initial meeting Epstein brought Rachel to visit the lab. Once again Gao was standing in front of a desperate parent and dying child. At the time only one gene therapy had been commercially approved in the world a cancer drug in China. Regulators in the U.S. and Europe were highly skeptical of the safety and efficacy of such treatments. Gao knew he had to be careful and was determined to not repeat the errors of his predecessors by rushing into human trials. Instead he spent the next eight years methodically producing a novel gene therapy for Canavan disease. He has spent over million in federal and university research funds developing and testing it in hundreds of mice with the disease. Gaos graduate student Seemin Ahmed initiated the lab work in and accomplished a proofofconcept with a firstgeneration gene therapy that could partially rescue the disease based on AAV an ideal AAV vector to get into the brain. The AAV therapy is so good at slipping into the brain that one can deliver the drug intravenously into the blood and it passes through the bloodbrain barrier to penetrate all areas of the brain. No drilling into the skull required. Gessler a young German scientist studying to be a neurosurgeon joined the project in and has since built on Ahmeds work optimization the therapy with an improved gene construct that produces times as many copies of the needed protein as earlier versions. Gessler will never forget the first time he tested the optimized therapy in a live animal. He injected it into a young sick mouse hunched over with no control over its muscles. When Gessler returned to assess the results he couldnt find the mouse. He worried he had mislabeled a cage. He hadnt. The mouse was there acting just as healthy as the control mice. Today the treatment has cured Canavan disease in two different strains of mice engineered to have the disease. A dozen freezers line the long hallway in Gaos laboratory each filled to the brim with preserved tissues and viruses. We have the therapy. We are ready says Gao grinning like a schoolchild. The last barrier is financial but not impossible to overcome. Gao estimates it will require million to million to launch the first human clinical trialsbut the potential profits are already attracting biotech attention. Two companies which Gao declined to name have approached him about getting involved in the effort. Making the BillionDollar Bet The office of Voyager Therapeutics in Cambridge Massachusetts epitomizes a trendy startup glass doors whiteboard walls minimalist orangeaccented dcor and a communal area with free drinks and snacks. It smells like caffeine and money. But unlike tech startups this office is flanked on either side by laboratories full of microscopes and viruses. The company is developing gene therapies for a handful of central nervous system disorders including Parkinsons Huntingtons and Lou Gehrigs disease. Voyager CEO Steven Paul has worked in the pharmaceutical industry developing drugs for brain disorders for over years and witnessed the tribulations of gene therapy. Hes ardent that now is finally the right time. Investors agree. Venture firms have invested more in gene therapy since than they did during the whole previous decade and therapies for the brain far and away lead the pack according to Dow Jones VentureSource. Last February when Voyager was just a year old it inked a deal with Genzyme for million up front and up to million in future milestone payments including for the companys severe brain disease programs. Voyager followed that with million in investor financing in April and an million initial public offering in November. Philadelphiabased Spark Therapeutics developing gene therapies for rare eye diseases accumulated million in funding after going public in just two years and scoring a sizable licensing deal with Pfizer. Cambridgebased Bluebird Bio ended last year with a whopping million in cash and cash equivalents. In the Magazine https It used to be that Big Pharma wasnt interested in rare diseases Companies thought these markets were too small says Paul. But with the right price tag even a therapy sold to only a few hundred patients can make billions. Glybera the first Europeanapproved gene therapy sparked pricing debates when it debuted at . million per shot. While insurance companies and health care providers struggle to figure out what they are willing and able to recommend and pay for theres no doubt a market exists. Gene therapy investments have become so abundant that some academics are turning from government support toward venture capital. R. Jude Samulski who developed the first AAVs for gene therapy back in the s recently founded a biotech company in North Carolina Bamboo Therapeutics to tap into that revenue stream. It is developing therapies for rare genetic diseases that result in progressive nerve death including Duchenne muscular dystrophy Canavan disease Friedreichs ataxia and giant axonal neuropathy. The company expects to begin human trials as soon as next year. Europe is beginning to see a trickle of gene therapy approvals including a green light in April for a treatment of type of SCID. The U.S. field waits on an influx of positive clinical data. Gene therapy will have a product in the U.S. approved by the FDA within two years says Gao. For sure. That will mostly likely be a treatment for the eyes this past October Spark had a Phase III win when a gene therapy to correct an inherited form of blindness successfully restored vision to the maximum possible benefit in patients according to the company. It plans to seek FDA approval for the treatment this year. Bluebird is also in latestage development of a gene therapy for the Lorenzos Oil disease adrenoleukodystrophy which like Canavans targets white matter in the brain. The therapy LentiD is performed on cells outside of the body The company removes blood stem cells from bone marrow of a patient treats them with a gene therapy in a dish then washes out the virus tests the genemodified cells and reinfuses them into the patients body. For all the recent improvements gene therapy will not be a cureall. For instance the approach is less likely to improve diseases where more than one gene is implicated or the cause is not known. In conditions like Parkinsons disease and Alzheimers disease for example the approach may lead to symptomatic relief but not a cure. And the risks have not entirely dissipated. You always have to think of benefit versus risk with any therapy says Paul. We pick diseases where the risk of not treating is very bad. Most children with Canavan disease die before age though some survive into their s and s. While Gao and Gessler believe their therapy will be most effective in newborn infants who test positive for the mutation they also cant forget Rachel and other older Canavan patients. With them in mind Gessler recently decided to test whether the therapy might also work for older mice. How long could he wait after a mouse had developed the disease to treat and still rescue it Gessler administered the therapy in sick teenage mice weeks old in human time adult mice weeks and mature mice weeks. Then he waited nervously. On a cold bright day in February I catch up with Gessler in Gaos sixthfloor corner office. He is smiling. We just got the oneyear data for the sixweektreated mice Gessler says. They are completely normal. After meeting with Gessler I travel an hour north to a pediatric nursing home where Rachel now livesa utilitarian brick building tucked behind Main Street in a quaint Massachusetts town. Rachel is lying in bed beneath a purple blanket a unicorn pillow at her feet. An episode of Friends plays in the background. Epstein is painting Rachels nails when I arrive. She adjusts the TV monitor closer to Rachels face. Shes legally blind but I think she understands everything says Epstein. She eventually asks about Gesslers experiments treating older mice a hint of hope in her voice. Epstein is not desperateshe has accepted Rachels lot in lifebut like any parent she will always desire the best for her child. I tell her about the recent mouse results and she smiles. The sun outside is setting and Epstein returns to painting her daughters nails a bright bubble gum pink."

"People with multiple sclerosis have long said that smoking marijuana helps ease their painful muscle cramping. And a new clinical trial suggests they are not just blowing smoke. The study published Monday found that for MS patients with muscle spasticity a few days of marijuana smoking brought some relief. But the big caveat researchers say is that its not clear that the downsides of pot smoking are worth it. Some people with MS are already using medical marijuana to treat certain symptoms including spasticity when the muscles in the legs or arms contract painfully in something akin to a charley horse. There is some science behind the idea The body naturally produces cannabinoids the group of chemicals found in marijuana. And studies have suggested the cannabinoid receptors on our cells help regulate muscle spasticity. But the evidence that pot smoking actually helps with spasticity has been anecdotal. Weve heard from patients that marijuana helps their spasticity but I think a lot us thought Well its probably just making you feel good said Dr. Jody CoreyBloom the lead researcher on the new study. I think this study shows that yes marijuana may help with spasticity but at a cost said CoreyBloom of the University of California San Diego. The cost her team found is that smoking caused fatigue and dizziness in some users and generally slowed down peoples mental skills soon after they used marijuana. But its not clear if that would have any longterm consequences CoreyBloom said. About people in the United States have MS a chronic disease in which the protective coating around nerve fibers starts breaking down. The new study reported in the Canadian Medical Association Journal included MS patients with muscle spasticity that had failed to get better with standard medication. CoreyBlooms team had each patient smoke marijuana or placebo joints which looked smelled and tasted like the real thing but lacked the active ingredient in marijuana known as THC. Each patient smoked marijuana once a day for three days and used the placebo cigarette once a day on three separate days. Before and after each treatment an independent rater assessed the patients muscle spasticity. Overall the study found measures of spasticity dropped an average of three points about percent on a point scale when patients smoked marijuana but didnt change after they smoked the placebo. The issue of treating spasticity is certainly an important one said Nicholas LaRocca vice president of healthcare delivery and policy research at the National MS Society. Spasticity is a big problem for many people with MS and the current medications dont necessarily work for everyone said LaRocca who was not involved in the new study. But smoking marijuana does not appear to be a longterm solution because of the cognitive effects he told Reuters Health. People with MS are already at some risk of cognitive changes LaRocca pointed out so the potential for lasting effects from longterm marijuana smoking is a concern. However LaRocca said researchers are developing cannabinoidbased medications for MS. That includes a cannabinoid mouth spray called Sativex that has been approved in the UK Canada Spain and New Zealand to treat MSrelated spasticity. Research into cannabinoids and spasticity should continue LaRocca said because medications may be able to harness the benefits of specific cannabis compounds without the side effects linked to smoking pot. Both LaRocca and CoreyBloom said there were limitations to the current study. Blinding people as to whether they are on marijuana or a placebo is tough since the drug creates a high feeling. In this study of patients were able to correctly guess whether they were using marijuana or a placebo at each of their six visits with the researchers. And the rest often guessed correctly. Its pretty clear that the patients were not really blinded LaRocca said. What effects that might have had on the results is unclear. CoreyBloom said that should not have influenced the spasticity findings since an independent researcher who didnt know whether patients were smoking marijuana or the placebo rated spasticity using a standard scale. But another limitation she pointed out is that the study looked at the effects and side effects of marijuana over only a few days. We cant say anything about longterm effects CoreyBloom told Reuters Health. For now LaRocca recommended that people with spasticity see a doctor experienced in treating MS. And if youre on an antispasticity medication and its not working well enough or the side effects are too much tell your doctor he said. For some people a change in the medication dose might help. SOURCE bit.lyqBMku httpbit.lyqBMku Canadian Medical Association Journal online May . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"For the first time researchers at Fred Hutchinson Cancer Research Center http have found that weight loss in combination with vitamin D supplementation has a greater effect on reducing chronic inflammation than weight loss alone. Chronic inflammation is known to contribute to the development and progression of several diseases including some cancers. Results of the randomized controlled clinical trial which involved more than overweight postmenopausal women who had insufficient levels of vitamin D at the beginning of the study are published online ahead of the July print issue of Cancer Prevention Research httpcancerpreventionresearch.aacrjournals.orgcontentearly.CAPR.full.pdfhtmlsiddbdeafafbcdad a journal of the American Association for Cancer Research. We know from our previous studies http that by losing weight people can reduce their overall levels of inflammation and there is some evidence suggesting that taking vitamin D supplements can have a similar effect if one has insufficient levels of the nutrient said lead and corresponding author Catherine Duggan Ph.D. a principal staff scientist in the Public Health Sciences Division at Fred Hutch. However it has not been known whether combining the two weight loss and vitamin D would further boost this effect. Its the first study to test whether adding vitamin D augments the considerable effect of weight loss on inflammatory biomarkers she said. To explore this question Duggan and colleagues recruited healthy overweight older women who had lowerthanrecommended levels of vitamin D less than ngmL. The women then took part in a month diet and exercise program including minutes of moderatetovigorous exercise five days a week. Half of the study participants were randomly selected to receive IU of vitamin D daily for the duration of the yearlong trial and the other half received an identicalappearing placebo or dummy vitamin. Biomarkers of inflammation were measured at the beginning and end of the study. The researchers then compared changes in these levels between the two groups. At the end of the study all of the participants had reduced levels of inflammation regardless of whether they took vitamin D which highlights the importance of weight loss in reducing inflammation Duggan said. However those who saw the most significant decline in markers of inflammation were those who took vitamin D and lost to percent of their baseline weight. These study participants had a percent reduction in a proinflammatory cytokine called interleukin or IL as compared to those in the placebo group who saw a . percent reduction in IL. The researchers found similar results among women in the vitamin D group who lost more than percent of their starting weight. While IL has normal functions in the body elevated levels are associated with an increased risk of developing certain cancers and diabetes and may be implicated as a cause of depression Duggan said. We were quite surprised to see that vitamin D had an effect on an inflammation biomarker only among women who lost at least percent of their baseline weight Duggan said. That suggests vitamin D can augment the effect of weight loss on inflammation. Vitamin D is a steroid hormone that has multiple functions beyond its widely recognized role in regulating calcium levels and bone metabolism. Vitamin D receptors are found in more than cell types and the research focus around this nutrient recently has shifted from bone health to vitamin Ds effect on cancer cardiovascular health and weight loss among other health issues. Inflammation occurs when the body is exposed to pathogens such as bacteria or viruses which puts the immune system in overdrive until the attack ceases and the inflammatory response abates. Overweight or obese people however exist in a state of chronic inflammation. This sustained upregulation of the inflammatory response occurs because fat tissue continually produces cytokines molecules that are usually only present for a short time while the body is fighting infection for example. It is thought that this state of chronic inflammation is protumorigenic that is it encourages the growth of cancer cells she said. There is also some evidence that increased body mass dilutes vitamin D possibly by sequestering it in fat tissue. Weight loss reduces inflammation and thus represents another mechanism for reducing cancer risk Duggan said. If ensuring that vitamin D levels are replete or at an optimum level can decrease inflammation over and above that of weight loss alone that can be an important addition to the tools people can use to reduce their cancer risk. Duggan encourages women to speak to their health care providers about measuring their levels of vitamin D to determine the most appropriate dosage. The Breast Cancer Research Foundation Susan G. Komen for the Cure National Institutes of Health Seattle Cancer Consortium Breast Cancer Specialized Program in Research Excellence Fred HutchinsonUniversity of Washington Cancer Consortium and Safeway Foundation funded the research. Editors note To obtain a copy of the Cancer Prevention Research paper Effect of vitamin D supplementation in combination with weight loss on inflammatory biomarkers in postmenopausal women a randomized controlled trial or to arrange an interview with corresponding author Catherine Duggan please contact Kristen Woodward in Fred Hutch media relations kwoodwarfredhutch.org mailtokwoodwarfredhutch.org or . Fred Hutch years of cures At Fred Hutchinson Cancer Research Center httpfhcrc.orgen.html home to three Nobel laureates interdisciplinary teams of worldrenowned scientists seek new and innovative ways to prevent diagnose and treat cancer HIVAIDS and other lifethreatening diseases. Fred Hutchs pioneering work in bone marrow transplantation led to the development of immunotherapy which harnesses the power of the immune system to treat cancer with minimal side effects. An independent nonprofit research institute based in Seattle Fred Hutch houses the nations first and largest cancer prevention research program as well as the clinical coordinating center of the Womens Health Initiative and the international headquarters of the HIV Vaccine Trials Network. Private contributions are essential httpssecure.convio.netfhcrcsiteDonationdf_id.donationform for enabling Fred Hutch scientists to explore novel research opportunities that lead to important medical breakthroughs. For more information visit fredhutch.org http or follow Fred Hutch on Facebook https Twitter https or YouTube httpplus.google.comfredhutchvideos."

"An international team of researchers has successfully deployed a Zika virus vaccine to target and kill human glioblastoma brain cancer stem cells which had been transplanted into mice. In a study published this week in mBio an openaccess journal of the American Society for Microbiology the team shows that a live attenuated version of the Zika virus could form the basis of a new treatment option for this fatal brain cancer. Glioblastoma kills about adults in the US each year and is currently incurable because patients experience a high recurrence rate of their cancer even after the standard treatments of surgery radiation and chemotherapy. Scientists suspect this recurrence is due to cancer stem cells called glioblastoma stem cells GSCs which hide out in nearby brain tissue even after the combination of therapies. During the Zika epidemic we learned that the virus preferentially infects neural progenitor cells in the fetus and causes the devastating microcephaly seen in babies born to infected mothers says PeiYong Shi a virologist at University of Texas Medical Branch in Galveston. He coled the current study with tumor biologist Jianghong Man of the National Center of Biomedical Analysis in Beijing and virologist ChengFeng Qin of the Chinese Academy of Military Medical Sciences in Beijing. We made the connection that perhaps Zika virus could also specifically infect the GSCs because these cells have similar properties to neural stem cells says Man. In previous work Shi and his collaborators at Washington University in St. Louis showed that Zika virus did indeed attack and kill GSCs grown in the lab dish and in a mouse model of glioblastoma. In addition the Zika virus was much less efficient at attacking the differentiated healthy brain cells. image transmission electron micrograph of Zika virus NIAID If we could find a way to specifically target those GSCs that are the source of recurrence then that might provide an option to prevent recurrence or even a cure says Qin. The teams first objective was to determine if there was a safe way to use Zika virus in patients to attack the cancer cells. Shis lab has developed a promising liveattenuated Zika vaccine candidate called ZIKVLAV that had been shown to be safe nonvirulent and effective in protecting against infection in mice and nonhuman primates. The ZIKVLAV has a small deletion from the viral genome that prevents it from replicating itself efficiently. When the team injected this ZIKVLAV into the brains of mice they saw no health effects on the mice no weight loss and no behavioral abnormalities such as loss of appetite depression lethargy or selfinjury. The mice also functioned normally in tests for anxiety and motor function. Next the team wanted to show whether the ZIKALAV could work to infect and kill human patientderived GSCs in a mouse model. So they mixed GSCs from two different human patient donors with the ZIKALAV and injected the mixture into the brains of mice. Mice that got the injection of the GSCs only rapidly developed tumors. Mice that got the ZIKVLAV injected as well saw a significant delay in tumor development. Coimplanting the virus along with the GSCs also prolonged the median survival time of the treated mice to around days compared to around days for the untreated mice who received GSCs alone. Qin says that perhaps in the future patients would be given the Zika vaccine at the same time as surgery to let the viruses hunt down the GSCs and eliminate them. Finally the team investigated the cellular mechanisms that the modified Zika virus used to kill the GSCs. They took GSCs treated with the ZIKVLAV and those GSCs not treated and sequenced all the RNA messages being expressed in these two cell populations. Comparing those profiles the team found that in the treated cells the virus triggered a strong antiviral response in the cells which induced inflammation and eventually cell death. Next the team will work with clinicians to develop safety tests of the ZIKVLAV in glioblastoma patients. They may also modify the Zika virus further to make it an even more potent cancer cell killing machine. For example Man explains the researchers could add an immune modulator as a cargo in the viral genome. Then once such a virus infects a cancer cell and kills it the immune modulator would be released to alert and activate the patients systemic immune system against the remaining cancer cells. As a virologist I see that we should take advantage of the bad side of viruses says Shi. They should have a role to play in cancer treatment. The American Society for Microbiology is the largest single life science society composed of more than scientists and health professionals. ASMs mission is to promote and advance the microbial sciences. ASM advances the microbial sciences through conferences publications certifications and educational opportunities. It enhances laboratory capacity around the globe through training and resources. It provides a network for scientists in academia industry and clinical settings. Additionally ASM promotes a deeper understanding of the microbial sciences to diverse audiences."

"City of Hope patient Susan Young has had a remarkable response to a potentially revolutionary new treatment a combination of the p cancer vaccine and a drug that blocks a specific canceraiding protein. The yearold came to City of Hope in August from UC Davis with advanced triplenegative breast cancer that had metastasized to her bones and skin. She had exhausted all of her chemotherapy options and this experimental treatment was her last hope. The only other option was hospice. At least to percent of her body was covered by lesions inflammation and thickened purplish skin said Yuan Yuan M.D. breast cancer oncologist at City of Hope who treated Young. Six weeks into her treatment the skin lesions were gone her itchiness went away. Its quite a dramatic response. So dramatic in fact that Yuan refers to Young as her miracle patient. This in some ways is pretty unprecedented. This patient is at a late stage of her disease. There are no treatments available that would have done the same thing said Don J. Diamond Ph.D. chair of the Department of Experimental Therapeutics at City of Hope. Young received a combination of the p vaccine and the drug pembrolizumab. Diamond developed the vaccine and has been studying its effectiveness in clinical trials at COH since . He currently is testing it on ovarian cancer and other solid tumors such as pancreatic and gastrointestinal masses. Ive responded great. Im feeling good said Young who has received six of seven pembrolizumab infusions each of which takes about a halfhour and all three p vaccine injections. My skin has cleared up. I think the prognosis is going to be good now. Teaching the immune system to fight The most frequent mutation across all cancers occurs in a gene called p which contributes to cells becoming oncogenic when they produce a mutant form of the p protein p gene mutations are present in about of malignancies. Diamonds vaccine boosts the immune response to many different mutant forms of p. The researchers tested this vaccine known as pMVA in a clinical trial and found it to be safe in patients with advanced gastrointestinal cancers. However patients whose T cells had preexisting high levels of a protein named PD a molecule that instructs immune cells to shut down responded poorly to the antip vaccine. In a subsequent laboratory study the COH researchers showed that these patients immune cells could be reactivated by treatment with a PD inhibitor that is a biosimilar to the clinical drug called pembrolizumab. Together the vaccine and the drug potentially could form a potent team to reactivate the immune system to quickly clear out cancer cells. Before Young the combination had been tried on patients with recurrent solid tumors such as nonsmall cell lung cancer melanoma renal cell carcinoma and many other cancer types. So far while Diamond has noted an immune response in patients given the combination treatment in clinical trials he has not seen a clinical benefit. That is until he met Young. We have treated a number of different types of patients with the combination but nothing is even in the same universe as this he said. A shocking response Young who tested positive for the p mutation has been fighting breast cancer for eight years and has undergone one chemo after another Yuan said. Referred to City of Hope by her physician at Davis she began responding to the experimental treatment right away Yuan said her skin tumors disappearing and the latest biopsies showing no cancer. The purple thickened skin has faded away the skin color has normalized. Shes healed basically she said. Its such a promising early response. Its quite unusual she added. We have two drugs here so its hard to dissect which drug did what but we do think the vaccine played a key role. It was shocking to me said Diamond. What we have noticed is that her immune response to p has been increasing as time goes on. It was of tremendous magnitude in the last blood draw. The next step will be to take bone and CT scans to see if the cancer is disappearing internally as well as externally which Young will receive in a couple of weeks. Even now though Young is extremely happy with the results Yuan said. Her psychological wellbeing has improved. Her appetite is better shes more functional. She went through a lot. It will be very interesting to follow up. I couldnt look at myself. It was really hard Young said of the skin lesions she had endured for five years. They started to go away after the third treatment she said. Even the marks where it was climbing up my neck are all gone.Further study needed What Diamond is hoping for now is funding for a full clinical trial so that he can test the combination in advanced triplenegative breast cancer patients who test positive for p. A couple of major drug companies have already expressed interest in his vaccine he said. What we would like is to have women come here from all over the country and the world to receive this vaccine formula so that we can test this combination Diamond said. If it happened once maybe it will happen twice. But weve got to get these patients in. Following the success in Young the formula has recently been given to two other triple negative breast cancer patients at City of Hope. Its too early to gauge the response although the entire breast team is very excited about this Diamond said. We saw this phenomenal response in this patient. I am very encouraged by the findings so I think theres a story to come. Everything is turning around for me Young said. I was very frightened when I started out. Im not that frightened anymore. I know it still can turn for me but I think Im going to be the miracle that Dr. Yuan wants."

"Getting your tonsils out used to be just part of childhood a rite of passage for children in the s and s. Then it fell out of favor. But tonsillectomy is back. Today the most common reason for the surgery is sleep disordered breathing a broad diagnosis that includes sleep apnea and snoring. About percent of elementaryschoolage children snore. Doctors say snoring can cause bedwetting behavior problems short stature and poor school performance. Thats a far cry from the s and s when tonsillectomy was used to fight frequent sore throats. Back then it was the most popular surgery in the United States. In the s sitcom Leave It to Beaver http Beaver Cleaver was so impressed by his dads tales of ice cream and pretty nurses that he schemed to have his tonsils out even though he didnt need it. Turning Point For Tonsillectomies It was becoming unacceptable to just take tonsils out because they were there or you had a few infections. People were growing up with their tonsils. Richard Rosenfeld an ear nose and throat doctor at SUNY Downstate in Brooklyn N.Y. The tonsils are two glands that sit at the base of the tongue and are part of the bodys immune system. The premise of tonsillectomies back in their heyday was that tonsils get infected themselves and no longer help fend off germs. Then doctors started noticing that kids were still getting sore throats even after having their tonsils taken out. But it wasnt until clinical trials were completed in the early s that there was proof that tonsillectomy really only helped children with severe recurrent throat infections. It was becoming unacceptable to just take tonsils out because they were there or you had a few infections says Richard Rosenfeld an ear nose and throat doctor at SUNY Downstate in Brooklyn N.Y. People were growing up with their tonsils. Article continues after this message from our sponsor But growing up with tonsils can create another problem snoring. Lisa Moran of Takoma Park Md. remembers what it sounded like when her son Tyler Scorza now age slept. It was loud Moran says. You could hear him through he closed door down the hall snoring and he would occasionally stop breathing. At first Tylers pediatrician thought hed outgrow the snoring. But he wasnt sleeping well and often didnt have any energy. The doctor recommended a head XRay and the radiologist said that though Tylers adenoids were enlarged they werent that bad. By then Tyler had been dealing with this for almost three years. He started getting frequent nasal infections. So his parents took him to an ear nose and throat doctor. He said sure the adenoids are swollen. But the real problem is the tonsils Moran recalls. He showed us on the Xray that there was a tiny passage between the tonsils and the back of his throat very small. Enlarged tonsils and adenoids are the most common cause of sleepdisordered breathing in children. So the doctor recommended tonsillectomy. Complications From Surgery But Tylers parents were worried about the surgery. Its usually done as an outpatient procedure now but with general anesthesia. Thats never without some risk. Your child is under says Moran completely under. This is not a local. Other complications include pain after surgery and the risk of bleeding about percent of people have complications that require readmission to the hospital. Despite hundreds of studies theres still surprisingly little research on whether tonsillectomy really helps reduce the risk of sore throats. The operation continues to be controversial. Whats A Sleep Study Sleep studies are a way for doctors to diagnose sleep disorders like apnea by observing patients overnight while they sleep. During a sleep study the patient is connected to an array of sensors monitoring brainwaves eye movements heart rate breathing and bloodoxygen levels. This information called a polysomnogram lets doctors see whether the patient has stopped breathing and for how long. Apnea in adults happens when seconds pass without breathing for children its a disruption of two cycles of inhaling and exhaling. Some patients can also use portable sleep monitors to record whats happening in their sleep as an alternative to the sleep study but that approach is not as comprehensive. Many sleep disorders can be diagnosed without costly sleep studies which can run anywhere from to severalthousand dollars. More children are undergoing sleep studies as awareness of the condition particularly in children rises. The American Academy of Sleep Medicine http says about percent of children have obstructive sleep apnea. Before a sleep study is ordered doctors typically ask for medical and sleep histories http and a physical exam. Eliza Barclay No less a personage than President Obama dissed tonsillectomy when he was stumping for health care overhaul in July . In a prime time news conference http_doctors_taking_tonsils_out_for_money_instead_of_diagnosing_it_as_allergies.html Obama said that doctors may think You know what I make a lot more money if I take this kids tonsils out. Rosenfeld disputes Obamas claim saying insurers usually pay a surgeon to for tonsil surgery. Sleep Study Before Tonsillectomy The picture is further clouded because not all children with big tonsils have sleepdisordered breathing or frequent throat infections. Because of that in the American Academy of Pediatrics httpaappolicy.aappublications.orgcgicontentfullpediatrics recommended that children have a sleep study before surgery is considered. About tonsillectomies are performed in the United States each year. Obviously parents could use some help in deciding whether surgery is needed. In January the American Academy of Otolaryngology issued its first guidelines on tonsillectomy http in children. With sore throats the ENTs recommend waiting and treatment with antibiotics if needed unless a child has more than seven infections in a year. Theyd recommend surgery if a child has five or more throat infections a year for two years or three or more in three years. There have been very few randomized studies on the effects of tonsillectomy for sleepdisordered breathing. Most of the researchers have asked parents or children whether they noticed improvements and looked at a single measure like behavior or quality of life. Still the ENTs recommend tonsillectomy for sleepdisordered breathing saying it reduces symptoms in most children. Tylers family decided to go ahead with the surgery they went to the hospital at a.m. and Tyler was home by noon. The doctors said he would be out of school for a week but a throat infection kept him home a second week. His classmates sent him getwell cards. A year later Tyler is feeling great. And his snoring is gone. Completely gone his mom says. You can hear a pindrop quiet when he sleeps. Tyler still hears snoring at night he says. But he knows that the culprit is not him or the family dog. Its Dad."

"Cutting the cord is a momentous event in a babys life. For nine months the developing fetus is attached to its mother by the umbilical cord. Then moments after birth that cord is severed. Now research suggests there may be benefits to keeping mom and baby attached a few minutes longer. Those benefits researchers say likely have to do with iron. Waiting a few minutes before clamping the umbilical cord allows more ironrich blood from the placenta to reach the newborn. Iron deficiency occurs in about one in six American babies and its more common among those clamped quickly said Ola Andersson a neonatologist and pediatrician at Uppsala University in Sweden who led a study published today in JAMA Pediatrics. Babies who are anemic often appear tired and pale. His previous research has shown that babies whose cords were clamped a few minutes later than usual were less likely than others to have irondeficiency anemia when they were months old. The benefits of those extra few minutes may last a long time. In the new study Andersson found that healthy fullterm newborns whose umbilical cords were left attached for three extra minutes had better fine motor control when they reached preschool than those clamped immediately. Some yearold boys who were clamped later even appeared to have better social skills. Iron is essential to the developing brain he said and deficiencies during early months perhaps linked to early clamping could affect nerve and muscle control making it harder for the child to later control a pen or interact comfortably with peers. Anderssons study marks the first time researchers have followed children to see whether the clamping makes a difference later in life. In he published a study of healthy fullterm babies showing that those clamped later fared better the new study of of those children extends those findings by nearly four years. Boys showed more benefit than girls probably because they are more likely to be irondeficient Andersson said. Immediate clamping started about years ago out of concern that leaving the delivered infant attached to the placenta could rob the mother of too much blood. But those doctors overestimated the benefit to the mother and didnt look at the impact their change had on the babies said Heike Rabe a researcher at Brighton and Sussex Medical School and University Hospitals in the United Kingdom who wrote an editorial accompanying the study. For babies born at fullterm we should trust nature more than we do now she said. Rabe has published reviews showing that delaying clamping for seconds or squeezing the umbilical cord to get the blood out faster is also better for premature babies. Many countries and professional organizations including the American Congress of Obstetricians and Gynecologists have called on obstetricians to delay cord clamping in premature babies when feasible. There was not enough evidence before to extend that recommendation to fullterm babies but Rabe thinks this study should tip the balance in favor of delay. Kjersti Aagaard vice chair of obstetrics and gynecology at Baylor College of Medicine and Texas Childrens Hospital is more skeptical. She said the decision about when to clamp should be made between the doctor and parents depending on the delivery the health of the baby and the mothers condition. The most important thing for parents to be talking with their provider about is how will we adapt to the delivery as it emerges she said."

"As a new school year approaches many parents are hoping for a breakthrough for their children Higher grades better behavior and fewer talks with exasperated teachers. Tutors counseling stern lectures and good oldfashioned wishful thinking are all possibilities. But some moms and dads also try to give their kids a nutritional edge in the classroom with the help of supplements. Many supplements promise to boost young brains with doses of docosahexaenoic acid or DHA an omega fatty acid thats naturally found in cell membranes throughout the body. DHA is particularly abundant in the nervous system and it seems to help brain cells communicate with one another. Commonly found in prenatal vitamins and infant formulas DHA is also showing up in products specifically aimed at gradeschool children. BrainStrong a product from Amerifit thats widely advertised on TV has a gummy formula for children ages to . Each dose has milligrams of DHA along with a full days supply of vitamins A C E and B. According to the instructions children should chew one gummy each day. Its sold at many drugstores and grocery stores with a price tag of about for a bottle of gummies. BrainStrong gets its DHA from Martek Biosciences Corp. which harvests the fatty acid from algae. Martek Biosciences makes a supplement of its own called lifesDHA Kids Softgel. The label says its Great for Kids and has a picture of two young people jumping for joy to drive home the message. Each softgel contains milligrams of DHA without any other added nutrients. The label specifies that the product is intended for children older than . The instructions say to take one softgel every day with a meal. You can buy a bottle of softgels online for about . The claims The TV ad for BrainStrong in which the narrator speculates that a young girl wrapping herself in toilet paper may become a fashion designer and a boy playing with his pudding may become a food critic says that DHA is a nutrient essential for proper brain development. The ads tagline is BrainStrong Nourish their potential. The BrainStrong website doesnt make any specific claims that it will make kids any smarter but it does say that DHA is brain nutrition and that DHA ensures that the brain retina heart and other parts of the nervous system develop and function properly from infancy through adulthood. The website for lifesDHA simply says that its a supplement for brain eye and heart health. Cassie FranceKelly a spokeswoman for Martek Biosciences says DHA is as important for the brain as calcium is for the bones. The bottom line is that kids need it but they dont get enough of it in their diets she says. The bottom line Undoubtedly DHA is an important nutrient for the brain and other organs of the body says Usha Ramakrishnan an associate professor of global health at Emory University in Atlanta who specializes in childhood nutrition. From time to time she has purchased DHAenhanced milk for her own child who is now . Ramakrishnan says that although the evidence isnt exactly airtight there is reason to believe that DHA supplements could help some children perform better in the classroom especially if their minds have a tendency to wander. Children who get adequate DHA as infants and toddlers a crucial period of brain development seem to have more focus in later years she explains so its reasonable to suspect that supplements could help older kids too. Its not something that will make you smarter she says. But it may help you pay attention and get more out of school. Still Ramakrishnan says parents shouldnt expect any dramatic improvements. If it were a whopping effect there would be a lot more studies she says. One of the few clinical trials of DHA supplements in schoolage children included nearly kids from Australia and Indonesia. The study published in the American Journal of Clinical Nutrition found that giving kids a supplement containing mg of DHA every day for a year slightly improved verbal learning and memory scores but didnt seem to affect overall intelligence or the ability to pay attention. A study of children ages to found that taking a supplement containing mg of DHA every day for weeks had almost no measurable effect on thinking skills or academic performance. As reported in the journal Research in Developmental Disabilities the children receiving the DHA actually had slightly worse reports from teachers than the children taking a placebo. Even with such uncertainty DHA supplements may be worth a try for schoolage kids says John Colombo a DHA researcher and director of the Schiefelbusch Institute for Lifespan Studies at the University of Kansas in Lawrence. Colombo says his own children now and have been taking mg DHA supplements Neuromins which also uses DHA from Martek for years. Its impossible to know if it made them better students Colombo says. But it almost certainly didnt hurt. Theres no downside to it he says."

"People who have narrowed carotid arteries in the neck and show no symptoms may be at risk for stroke and not know it but a simple ultrasound test can identify the problem a new study suggests. This condition known as asymptomatic carotid stenosis is caused by plaque buildup in the arteries that carry blood from the heart to the brain. This can cause less blood to reach the brain and in rare cases may also trigger a stroke if plaque breaks off and becomes lodged in the small vessels in the brain. Only a small minority of patients with carotid stenosis will suffer a stroke said lead researcher Dr. Raffi Topakian from the Academic Teaching Hospital WagnerJauregg in Linz Austria. The problem is identifying the patients at the highest risk for stroke he said. Most patients with carotid stenosis can be managed with medications such as cholesterollowering drugs blood pressurelowering drugs and blood thinners such as aspirin he added. But those at highest risk may need a surgical procedure called an endarterectomy which clears the carotid arteries of plaque. We found with two ultrasound methods we could differentiate the patients who are at very low risk of suffering a stroke lower than percent per year from patients at high risk of stroke higher than percent per year Topakian said. The patients who are at high risk are candidates for surgery he said. Endarterectomy is not recommended for most people with carotid stenosis since the problem can be managed with drugs and there are risks including stroke with the procedure Topakian said. Those who would benefit from the ultrasound test are people with known carotid stenosis who are fit for surgery Topakian said. If they are too sick or frail for surgery it makes no sense to do the ultrasound he said. In addition people at high risk for stroke are also candidates for ultrasound Topakian said. This would include people with high cholesterol high blood pressure or heart disease he said. This test could be a good tool to identify the right patients for surgery Topakian said. Of course anyone with symptomatic carotid stenosis is a candidate for immediate surgery Topakian said. Warning signs include transient ischemic attacks TIAS or ministrokes which cause no permanent damage but are often followed by a stroke within a few days. The report was published in the Aug. online edition of Neurology. For the study a research team led by Topakian followed people with asymptomatic carotid stenosis for two years. Each participant had an ultrasound to see if there were signs that a stroke might occur. These included tiny blood clots which pass into the brain and a type of plaque called echolucent plaque which is fattier than other plaque and linked with an increased risk for stroke. Among those in the study percent had the fattierthannormal plaque percent had signs of blood clots and percent had both the fattier plaque and blood clots the researchers found. In addition over the two years of the study people had TIAs. Moreover people with the fattier plaque were more than six times more likely to have a stroke than those people without the plaque and those with the fattier plaque and clots had a risk that was times higher Topakians team found. Nonetheless some experts said that research suggests that patients with no symptoms are better off without the surgery. Dr. Lars Marquardta professor of surgery at the University of ErlangenNuremberg in Germany and coauthor of an accompanying journal editorial said surgery for people with asymptomatic carotid steno sis is done too frequently. Marquardt noted that the risks associated with the surgery are a lot higher than leaving the stenosis as it is and starting aggressive medical treatment. Patients with symptomatic carotid stenosis dont get the surgical procedure early enough and patients with asymptomatic carotid stenosis have too many surgical interventions Marquardt said. When treating asymptomatic carotid stenosis Marquardt doesnt think the case has been made for distinguishing between high and lowrisk patients. Right now the work done by Topakians group is still experimental he said. Another expert Dr. Larry B. Goldstein director of the Duke University Stroke Center said that what remains uncertain is whether surgical intervention would result in an overall improvement in strokefree survival. It is also unclear how optimal medical management lifestyle changes in addition to antiplatelet medication and statins would affect overall stroke and cardiovascular risk and strokefree survival he said. Both the U.S. Preventive Services Task Force and the American Heart Association currently recommend against general population screening for asymptomatic carotid artery stenosis Goldstein noted. More information For more information on stroke visit the U.S. National Library of Medicine http SOURCES Raffi Topakian M.D. Academic Teaching Hospital WagnerJauregg Linz Austria Lars Marquardt M.D. Ph.D. professor surgery University of ErlangenNuremberg Germany Larry B. Goldstein M.D. director Duke University Stroke Center Durham N.C. Aug. Neurology online"

"Switching to public transport or cyclingwalking to get to work might help shed the pounds Strengthens case for incentivising walking or cycling to boost population health say researchers Switching from driving to work to using public transport walking or cycling might help commuters shed weight within a couple of years suggests res earch published online in the Journal of Epidemiology Community Health . Given that car use is high the findings strengthen the case for incentivising walking or cycling to boost population health suggest the researchers. They base their findings on t he responses of people to three waves of the British Household Panel Survey BHPS in and . The BHPS is a long term annual study of a representative sample of adult Britons which began in . At each time point respondents described their usual main mode of transport for their daily commute and provided details of their height and weight BMI in and in . The researchers used a series of analyses to see if changes in mode of transport were linked to changes i n weight over a two year period. In the first analysis which included respondents people had stopped driving to work and were either walking orcycling or taking public transport . The switchers tended to be younger and less likely to have access to a car than those who continued to drive. Those who chose to walk or cycle instead tended to have a lower household income and a shorter commute which became shorter still after making the switch while those who opted for public transport were significantly more likely to be more highly educated. Switching from a car to walking cycling or public transport was associated with a statistically significant average reduction in BMI of . kgm after taking account of other influential fac tors equivalent to a difference of around kg a person on average. The longer the commute the stronger was the association with a reduction in BMI of . kgm equivalent to a weight loss of around kg associated with journeys of more than minu tes and . kgm associated with journeys of more than minutes equivalent to weight loss of around kg on average. In the second analysis which included people switched from active to passive travel. Some stopped walkingor cycling an d switched from public transport usually a bus or coach to the car. Once again the switchers tended to be younger than those who continued with their mode of transport. Those who stopped walking or cycling to work were significantly less likely than those who stopped using public transport to be in a managerial or professional post. They also tended on average to have a shorter commute which lengthened after the switch. Those who had previously used public transport on the other hand had a short commute after the switch. But switching to a car was associated with a significant weight gain of around kg per person or . kgm after taking account of other influential factors. This is an observational study so no definitive conclusions can be drawn about cause and effect. Nevertheless the analysis of individual level changes in BMI over time between the two groups of switchers using data from a nationally representative survey strengthens their findings say the researchers. If a la rger proportion of commuters were able to abandon their cars for a more physically active commute this could help drive down the average population BMI they suggest. Combined with other potential health economic and environmental benefits associated with walking cycling and public transport these findings add to the case for interventions to promote the uptake of these more sustainable forms of transport they write. Research Impact of changes in mode of travel to work on changes in body mass index evidence from the British Household Panel Survey httpjech.bmj.comlookupdoi.jech About the journal The Journal of Epidemiology Community Health is one of more than specialist journals published by BMJ. The title is the official journal of the Society of Social Medicine. httpjech.bmj.com"

"Advanced stage liver tumors may be safely treated through imageguided injections of an immunotherapy approved for melanoma according to a study presented today at the Society of Interventional Radiologys Annual Scientific Meeting. Researchers found that talimogene laherparepvec TVECa genetically modified version of the herpes viruscan be safely administered into active cancer in the liver and stimulate the immune system to destroy cancer cells throughout the body. Advanced stage liver tumors including ones that have spread from other locations have limited treatment options because the patients can be in poor health further the complex structure of the organ can make it difficult to target with standard approaches said Steven S. Raman M.D. professor of radiology surgery and urology at the David Geffen School of Medicine University of California Los Angeles and lead author of the study. This minimally invasive treatment offers patients a novel way to directly and indirectly attack the cancer cells. Using imageguided needle injections researchers at centers in the United States Switzerland and Spain treated advancedstage cancer patients with liver metastases including those with cirrhosis. Patients were given escalating doses of TVEC up to the maximum FDAapproved dose for melanoma. Injection volume was based on lesion size. Researchers found the patients tolerated the treatment well with expected side effects including temporary flulike symptoms. As part of the study researchers will follow patients for up to two years and new trials to investigate the effectiveness of the drug in treating advanced cancer in the liver are being planned. Additional investigation is also planned to test the therapy in combination with a checkpoint inhibitor to activate a stronger immune response. Imageguided treatments have expanded the options available for patients with liver cancer from innovative approaches to biopsies to resections to chemo said Raman. This is an exciting way to look to the future but patients living with advanced liver cancer should understand that this treatment will not be available for several years except through clinical trials. The authors note several limitations of the current study including the preliminary nature of the results as well as the number of patients tested. Amgen the pharmaceutical company that makes TVEC was a sponsor of the trial. Abstract Early safety from a phase multicenter openlabel clinical trial of talimogene laherparepvec TVEC injected into liver tumors. S. Raman M. Pless A. Cubillo A. Calvo R. Hecht C. Liu E. Chan J. Chesney A. Prat David Geffen School of Medicine University of California Los Angeles CA Department of Oncology Kantonsspital Winterthur Winterthur Switzerland HM Universitario Sanchinarro CIOCC Madrid Spain Hospital General Universitario Gregorio Maran Madrid Spain Amgen Inc. Thousand Oaks CA James Graham Brown Cancer Center University of Louisville Louisville KY Hospital Clnic University of Barcelona Barcelona Spain. SIR Annual Scientific Meeting March . This abstract can be found at sirmeeting.org https_releasessirmeeting.org About the Society of Interventional Radiology The Society of Interventional Radiology is a nonprofit professional medical society representing more than practicing interventional radiology physicians trainees students scientists and clinical associates dedicated to improving patient care through the limitless potential of imageguided therapies. SIRs members work in a variety of settings and at different professional levelsfrom medical students and residents to university faculty and private practice physicians. Visit sirweb.org. The Society of Interventional Radiology is holding its Annual Scientific Meeting March at the Los Angeles Convention Center in Los Angeles Calif. Visit sirmeeting.org https_releasessirmeeting.org."

"A computerized brain training program cut the risk of dementia among healthy people by percent U.S. researchers said on Sunday in reporting an analysis of the results of a year study. The preliminary findings presented at the Alzheimers Association International Conference in Toronto are the first to show that any kind of intervention could delay the development of dementia in normal healthy adults. To date cognitive psychologists and neuroscientists have largely rejected evidence that computerbased cognitivetraining software or brain games have any effect on cognitive function. The new findings would be quite promising if they hold up through peer review and publication in a scientific journal said Dr. John King an expert in social research at the National Institute of Aging. The institute is part of the National Institutes of Health which funded the study. King worked on the original clinical trial on which the new analysis is based. The study known as Active examined the effects of cognitive training programs on healthy older adults. Participants were divided into three groups. One got training for memory improvement one for reasoning and one with computerized training in speedofprocessing. In the speed training which emphasized visual perception individuals were asked to identify objects on a screen quickly. The program got harder with each correct answer. Participants had onehour training sessions conducted in a classroom setting over five weeks. Some received four additional booster sessions one year after the original training and four more two years after that. Scientists measured cognitive and functional changes immediately and at one two three five and years after the training to see if it affected how participants performed daily tasks. Results of that study published in found modest benefits in the reasoning and speedofprocessing groups but not memory. Sponsored The new analysis was by Dr. Jerri Edwards of the University of South Florida whose mentor Dr. Karlene Ball of the University of Alabama at Birmingham sold her rights to the program to Posit Science. Edwards also was a paid consultant for the company for part of . The program is now incorporated in Posit Sciences BrainHQ.com brain training program. Edwards did a secondary analysis of the year data looking at the time it took individuals to develop dementia. She found that the group that did speed training showed percent less risk of dementia relative to the control group while the memory and the reasoning interventions offered no such benefit. People who completed or more speed training sessions were at percent less risk for developing dementia over the years of the study Edwards said. At first blush thats kind of a big deal Mayo Clinic Alzheimers expert Dr. Ronald Petersen said. This may even be clinically relevant. In a group of nearly neuroscientists and cognitive psychologists led by researchers at Stanford Universitys Center on Longevity and the Berlin Max Planck Institute for Human Development signed a letter saying there was little evidence of such results from brain games. The letter was in response to heavy marketing by companies touting the benefits of their programs based on scant scientific data. Edwards said she was frustrated with the scientific debate which is one reason she agreed to present her findings before they were published. Im sick of our studies being ignored she said. King said the training offered in the program was slightly different from the current Posit Science offering and that it was unclear whether speed training would help people who are already at risk for dementia. Its a promising result from an interesting data set he said. I do think we will know more after the paper is reviewed."

"Even after decades of battling one of the worlds biggest killers the treatment of cancer is still an inexact science. Successful methods such as chemotherapy work by killing the cancer cells but they also destroy healthy tissue. Health practitioners have been searching for a magic bullet that goes straight to the source of the cancer and everything from monoclonal antibodies which carry cancer drugs direct to cancer cells to straight surgery to cut out tumors have been used with varying degrees of success. In Belgium engineer and nuclear physicist Yves Jongen is pioneering a new therapy that targets cancers with proton radiation a therapy that offers precision and minimal side effects. I started to designing equipment for proton therapy of cancer that was a radically new idea Jongen told CNN. Encased in a twometre thick concrete bunker that serves as a radiation shield one of Jongens cyclotron machines produces proton beams to treat cancer patients. In this space we accelerate the protons and we give them a higher and higher velocity until they reach two thirds of the speed of light thats km per second and this acceleration takes place in the shape of a spiral he said. It does a lot less collateral damage to the patient thats the great thing about proton therapy Yves Jongen Thats needed if you want to be able to penetrate one foot into the body of a patient. Once the proton beam has been generated its piped into a treatment room where patients receive a powerful dose of targeted radiation that kills only those cancerous cells. It does a lot less collateral damage to the patient Jongen said. Thats the great thing about proton therapy. While proton therapy is a giant step forward its not yet the magic bullet that clinicians are looking for. So far it is not effective against all types of cancer. There are a number of cancers which are not localized he said. If you look at leukemia which is cancer of the blood cells there is nowhere to shoot its all through the body. The other drawback is that the cyclotron is not cheap. Each system and the bunker needed to house it doesnt leave much change from million. Currently there are just operational particle therapy facilities worldwide http with a total of treatment rooms. As the fame of the process has started to spread some people have been taking desperate measures to get treatment. One British couple last year even sparked an international manhunt httpedition.cnn.comworldeuropeukbraincancerboyfoundindex.html after they removed their son from hospital without doctors permission to get to a proton center in Prague in the Czech Republic. Proton treatment is limited on Britains National Health Service. Just one center in the north of the country offers proton therapy for certain types of eye tumors. Other centers however are currently in development. While the proton therapy market is expected to more than double by with an estimated proton therapy rooms Jongens Brusselsbased company IBA is working on a smaller and cheaper model they hope will make proton therapy more accessible. It would be much less expensive making it more possible for a hospital to afford it a smaller system can already treat a relatively large number of patients per year. At the moment fewer than of cancer patients are treated with proton therapy but Jongen is hopeful that smaller and cheaper machines will be the game changer. I have a number of letters from parents of young kids saying if it had not been for this treatment we would have lost our kid he said. Thats something I really cherish. When I feel a bit depressed for whatever reason I go back to those letters and they are very exciting."

"Video commentary from researchers and broll are available at httpbcove.mettyxtcl. A media teleconference with researchers and patients will also be held on Wednesday Nov. from a.m. EST to p.m. EST. To participate U.S.based media can call international media should dial . The access code is . Phone lines open at a.m. and all media should place speakers on mute unless posing a question. Reporters wishing to ask a question should email their name and outlet to david.marchnyumc.org mailtodavid.marchnyumc.orgsubjectNewswiseArticleReporterFollowupbccreportersnewswise.com during the briefing so they may be placed in a queue the moderator will call on individual media to ask a question in the order names and outlets were received. Newswise When combined with psychological counseling a single dose of a mindaltering compound contained in psychedelic mushrooms significantly lessens mental anguish in distressed cancer patients for months at a time according to results of a clinical trial led by researchers at NYU Langone Medical Center. Published in the Journal of Psychopharmacology online Dec. the study showed that onetime treatment with the hallucinogenic drug psilocybin whose use required federal waivers because it is a banned substance quickly brought relief from distress that then lasted for more than six months in percent of the study subjects monitored based on clinical evaluation scores for anxiety and depression. The NYU Langoneled study was published side by side with a similar study from Johns Hopkins. Study results were also endorsed in accompanying editorials from leading experts in psychiatry addiction and palliative care. Our results represent the strongest evidence to date of a clinical benefit from psilocybin therapy with the potential to transform care for patients with cancerrelated psychological distress says study lead investigator Stephen Ross MD director of substance abuse services in the Department of Psychiatry at NYU Langone. If larger clinical trials prove successful then we could ultimately have available a safe effective and inexpensive medication dispensed under strict control to alleviate the distress that increases suicide rates among cancer patients says Ross also an associate professor of psychiatry at NYU School of Medicine. Study coinvestigator Jeffrey Guss MD a clinical assistant professor of psychiatry at NYU Langone notes that psilocybin has been studied for decades and has an established safety profile. Study participants he says experienced no serious negative effects such as hospitalization or more serious mental health conditions. Although the neurological benefits of psilocybin are not completely understood it has been proven to activate parts of the brain also impacted by the signaling chemical serotonin which is known to control mood and anxiety. Serotonin imbalances have also been linked to depression. For the study half of the participants were randomly assigned to receive a . milligrams per kilogram dose of psilocybin while the rest received a vitamin placebo milligrams of niacin known to produce a rush that mimics a hallucinogenic drug experience. Approximately half way through the studys monitoring period after seven weeks all participants switched treatments. Those who initially received psilocybin took a single dose of placebo and those who first took niacin then received psilocybin. Neither patients nor researchers knew who had first received psilocybin or placebo. Guss says The randomization placebo control and doubleblind procedures maximized the validity of the study results. One of the key findings was that improvements in clinical evaluation scores for anxiety and depression lasted for the remainder of the studys extended monitoring period specifically eight months for those who took psilocybin first. All patients in the study mostly women age to who are or were patients at the Perlmutter Cancer Center of NYU Langone had either advanced breast gastrointestinal or blood cancers and had been diagnosed as suffering from serious psychological distress related to their disease. All patients who volunteered to be part of the study were provided with tailored counseling from a psychiatrist psychologist nurse or social worker and were monitored for side effects and improvements in their mental state. Coinvestigator Anthony Bossis PhD a clinical assistant professor of psychiatry at NYU Langone says patients also reported postpsilocybin improvements in their quality of life going out more greater energy getting along better with family members and doing well at work. Several also reported variations of spirituality unusual peacefulness and increased feelings of altruism. Our study showed that psilocybin facilitated experiences that drove reductions in psychological distress says Bossis. And if its true for cancer care then it could apply to other stressful medical conditions. Bossis cautions that patients should not consume psilocybin on their own or without supervision by a physician and a trained counselor. He also says Psilocybin therapy may not work for everyone and some groups such as people with schizophrenia as well as adolescents should not be treated with it. Both the NYU Langone and Johns Hopkins studies were principally funded by the Heffter Research Institute a nonprofit scientific institution with the principal mission of helping to design review and fund studies on the use of psilocybin for a wide range of ailments Ross previously served as a board member. Additional funding for the NYU Langone study was provided by the National Center for Advancing Translational Sciences part of the National Institutes of Health UL TR. The drug used in the study was manufactured by Organix Inc. in Woburn Mass. Besides Ross Guss and Bossis other NYU researchers involved in this study are Gabrielle AginLiebes BS Tara Malone MA Alexander Belser MPhil Krystallia Kalliontzi MSc Barry Cohen PhD Sarah Mennenga PhD James Babb PhD Zhe Su MS MA Patricia Corby DDS and Brian Schmidt MD PhD. Media Inquiries David MarchJim Mandlerdavid.marchnyumc.org mailtodavid.marchnyumc.orgsubjectNewswiseArticleReporterFollowupbccreportersnewswise.comjim.mandlernyumc.org mailtojim.mandlernyumc.orgsubjectNewswiseArticleReporterFollowupbccreportersnewswise.com"

"In the first analysis of how to treat patients on anticoagulants who suffer a major bleeding event a clinical practice that routinely gives doctors pause while also evaluating a new drug University of Pittsburgh researchers aim to provide muchneeded guidance to clinicians trying to balance the risks of stroke versus bleeding when determining the best treatment. The analysis published today in the journal Stroke determined that resuming anticoagulation therapy after a person suffers a major bleeding event was associated with a higher likelihood of strokefree survival than discontinuing anticoagulation. Furthermore restarting therapy with the new oral anticoagulant dabigatran was associated with a lower risk of recurrent hemorrhage in these cases than the old standby drug warfarin. People take anticoagulants to avoid blood clots when they have a risk for stroke or heart attack but the downside is that these medications increase a persons risk of severe bleedingsuch as in the brain or gutbecause the blood isnt clotting as well as it otherwise might. If a patient who is on an anticoagulant to avoid a stroke has a major bleeding event doctors are faced with a catch Discontinue the anticoagulant to avoid future bleeding but again place their patient at increased risk of stroke or resume the anticoagulant to continue avoiding a stroke but then have to worry about another bleeding event said lead author Inmaculada Hernandez Pharm.D. Ph.D. an assistant professor in Pitts School of Pharmacy who completed this work as a doctoral student at Pitts Graduate School of Public Health. It causes a lot of uncertainty for physicians especially because patients at highest risk of recurrent bleeding also are at highest risk of stroke said coauthor Yuting Zhang Ph.D. associate professor of health policy and management at Pitt Public Health and Hernandezs doctoral dissertation committee chair. The Pitt research team obtained data from to for a random sample of Medicare beneficiaries. They then followed nearly people who had filled prescriptions for the anticoagulants warfarin which has been used as a medication since and dabigatran which was approved by the U.S. Food and Drug Administration in . More than of those people suffered a major bleeding event while using one of the drugs. About half of those people resumed one of the two anticoagulants a few months after the bleeding while the others did not. The risk of dying from any cause or having a stroke was to percent higher in patients who discontinued anticoagulation therapy compared to those who resumed it. People who took dabigatran after their initial bleeding event had nearly half the risk of another major bleeding event within one year compared with those who took warfarin. Our results should encourage clinicians to seriously consider resuming anticoagulation among patients who survived a major bleeding event particularly if the source of bleeding was identified and addressed said senior author Samir Saba M.D. associate professor of medicine and associate chief of cardiology at UPMC Heart and Vascular Institute. They should also take into account that the benefittorisk ratio of posthemorrhage use of anticoagulation is not the same for all medications. Additional authors on this research are Maria M. Brooks Ph.D. of Pitt Public Health and Paul K.L. Chin Ph.D. of the University of Otago in New Zealand. This research was funded by the Commonwealth Foundation Agency for Healthcare Research and Quality grant R HS and National Institute of Mental Health grant R MH. Dr. Hernandez was supported by a fellowship from La Caixa foundation. About the University of Pittsburgh Graduate School of Public Health The University of Pittsburgh Graduate School of Public Health founded in and now one of the topranked schools of public health in the United States conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases HIVAIDS cancer and other important public health problems. For more information about Pitt Public Health visit the schools Web site at http http"

"Government and other scientists are proposing a new way to define Alzheimers disease basing it on biological signs such as brain changes rather than memory loss and other symptoms of dementia that are used today. The move is aimed at improving research by using more objective criteria like brain scans to pick patients for studies and enroll them sooner in the course of their illness when treatments may have more chance to help. But its too soon to use these scans and other tests in routine care because they havent been validated for that yet experts stress. For now doctors will still rely on the tools theyve long used to evaluate thinking skills to diagnose most cases. Regardless of what tests are used to make the diagnosis the new definition will have a startling effect Many more people will be considered to have Alzheimers because the biological signs can show up to years before symptoms do. The numbers will increase dramatically said Dr. Clifford R. Jack Jr. a Mayo Clinic brain imaging specialist. There are a lot more cognitively normal people who have the pathology in the brain who will now be counted as having Alzheimers disease. He led a panel of experts working with the Alzheimers Association and the National Institute on Aging that updated guidelines on the disease published Tuesday in Alzheimers Dementia The Journal of the Alzheimers Association. About Alzheimers About million people worldwide have dementia and Alzheimers is the most common form. In the U.S. about . million have Alzheimers under its current definition which is based on memory problems and other symptoms. About onethird of people over who show no thinking problems actually have brain signs that suggest Alzheimers Jack said. There is no cure current medicines such as Aricept and Namenda just temporarily ease symptoms. Dozens of hopedfor treatments have failed and doctors think one reason may be that the studies enrolled patients after too much brain damage had already occurred. By the time that you have the diagnosis of the disease its very late said Dr. Eliezer Masliah neuroscience chief at the Institute on Aging. What weve realized is that you have to go earlier and earlier and earlier just as doctors found with treating cancer he said. Another problem as many as percent of people enrolled in Alzheimers studies based on symptoms didnt actually have the disease they had other forms of dementia or even other medical conditions. That doesnt give an accurate picture of whether a potential treatment might help and the new definition aims to improve patient selection by using brain scans and other tests. Better tests Many other diseases such as diabetes already are defined by measuring a biomarker an objective indicator such as blood sugar. That wasnt possible for Alzheimers disease until a few years ago when brain scans and spinal fluid tests were developed to do this. They measure certain forms of two proteins amyloid and tau that form plaques and tangles in the brain and signs of nerve injury degeneration and brain shrinkage. The guidelines spell out use of these biomarkers over a spectrum of mental decline starting with early brain changes through mild impairment and Alzheimers dementia. What to do People may be worried and want these tests for themselves or a family member now but Jack advises Dont bother. Theres no proven treatment yet. You might find a doctor willing to order them but spinal fluid tests are somewhat invasive and brain scans can cost up to . Insurance usually does not pay because theyre considered experimental outside of research. A large study is underway now to see whether Medicare should cover them and when. Anyone with symptoms or family history of dementia or even healthy people concerned about the risk can consider enrolling in one of the many studies underway. We need more people in this presymptomatic stage to see if treatments can help stave off decline Masliah said."

"People struggling with irritable bowel syndrome IBS might feel better with antidepressants or psychotherapy a recent study suggests. People with IBS typically suffer from chronic abdominal pain gas diarrhea and constipation. While some people improve with customized diets that avoid certain foods that trigger symptoms this approach doesnt help everyone and some emerging research suggests that the condition may also be influenced by processes in the brain. For the current analysis researchers examined data from trials that compared the effects of antidepressants or psychotherapy either alone or in combination versus placebo treatments or usual management in people with IBS. Rates of no relief were highest with placebo treatments. People were percent less likely to have no relief from antidepressants and percent less likely to get no relief from psychotherapy the study found. One component of IBS is increased sensitivity to the functions of the bowels simply summarized this means either the nerves taking messages from the bowel to the brain are more sensitive or that the brain is more attentive or reacts in a more emotional manner to the normal messages arising in the bowel or both said Dr. Michael Camilleri a researcher at the Mayo Clinic College of Medicine and Science in Rochester Minnesota who wasnt involved in the current study. Since there are really no medications to reduce the nerve sensitivity some doctors give medications that modulate the function of the brain in the hope that this approach will reduce the ability to sense or emotionally react to the signals or messages arriving from the bowels Camilleri said by email. Psychiatric conditions including depression anxiety and somatisation physical symptoms thought to have psychological origins are common among people with IBS researchers note in the American Journal of Gastroenterology. Although the use of antidepressants is common among IBS patients psychotherapy is not the study authors note. One limitation of the current study is that the smaller studies used in the analysis had a wide variety of designs and methods for testing the success of treatment researchers note. Another drawback is that these studies werent designed to prove how antidepressants or psychotherapy might directly improve IBS symptoms. Still a psychological evaluation may make sense for IBS patients because its possible their symptoms might be a byproduct of untreated depression said Dr. Agnieszka KulakBejda a psychiatry researcher at the Medical University of Bialystok in Poland who wasnt involved in the study. Antidepressants may work better for certain types of IBS and the study findings also suggest that the type of medication may matter KulakBejda said by email. A family of medicines known as tricyclic antidepressants were more effective at relieving global symptoms of IBS the analysis found. But another family of medicines known as selective serotonin reuptake inhibitors SSRIs was better than a placebo for easing symptoms like pain and bloating and improving quality of life. The decision to use antidepressants as a form of therapy should be taken individually KulakBejda said. The decision should be made after considering all the pros and cons. Lead author Dr. Alexander Ford of the University of Leeds in the U.K. didnt respond to requests for comment. SOURCE go.nature.comQXSVK httpsgo.nature.comQXSVK The American Journal of Gastroenterology online September ."

"A twoweek course of the antibiotic rifaximin https Xifaxan https helps to relieve the symptoms of irritable bowel syndrome https IBS https and the relief lasts up to weeks after stopping the medication https according to new research. The major finding was that all IBS symptoms https improved says Mark Pimentel MD director of the GI Motility Program at CedarsSinai Medical Center Los Angeles who led the clinical trial https of the drug at Cedars. The study looked only at those IBS https patients with the nonconstipation https form he tells WebMD. For those with this type of IBS symptoms can include abdominal pain https bloating https and changes in bowel function such as diarrhea https IBS is considered a functional gastrointestinal disorder without a known physiologic cause with the symptoms recurring and often worsened by stress. Existing treatment options diet and lifestyle modification psychological therapy and other drugs do not help all people with the condition. With the new antibiotic treatment Pimentel tells WebMD many participants say they are improved improved that kind of results. The stool was more solid the diarrhea https goes away and the bloating is much less. That can translate to big changes in the lives of those with IBS estimated to affect about of adult Americans. With the drug treatment Pimentel says those with the IBS can enjoy social outings without the worry of having to run to the bathroom and having diarrhea. The drug is approved by the FDA only for travelers diarrhea https and hepatic encephalopathy a brain https disorder caused by chronic liver failure https Rifaximin for IBS Study Details Experts believe that those with IBS may have changes in their intestinal microorganisms leading them to consider targeting these gut microorganisms to treat the condition. They chose to study rifaximin because it is minimally absorbed and stays in the gut so they thought it might perform better than the antibiotics https widely absorbed by the body which have produced mixed results for IBS patients. Pimentel and colleagues conducted two parallel studies of the antibiotic. In both trials known as TARGET and TARGET they assigned IBS patients with mild to moderate diarrhea and bloating to take either a milligram dose of rifaximin or a placebo https three times a day for two weeks. The patients reported on their symptoms and were followed for weeks after the twoweek doses. For the two studies combined . of those taking the drug had adequate relief of their symptoms during the first four weeks after treatment but just . of those on placebo. While . of those on the drug had relief from bloating . of those in the placebo group did. The drug Pimentel says passes through the gut and gets rid of the bacteria in the small bowel that are believed to cause the problems. The studies were funded by Salix Pharmaceuticals Inc. which makes rifaximin. Pimentel serves as a consultant to Salix and serves on its scientific advisory board. He discovered the use of the antibiotic for IBS. CedarsSinai holds the patent and has licensed the rights to Salix. Salix has applied for FDA approval of the drug for the nonconstipation https form of IBS and IBSrelated bloating says Mike Freeman company spokesman. Rifaximin for IBS Second Opinion In an editorial published with the study results Jan Tack MD PhD a professor of medicine at University Hospital of the University of Leuven in Belgium writes that The TARGET studies have some attractive findings including the sustained benefits and short treatment course. It also seems to relieve the bloating which he calls one of the most challenging symptoms. But he has some caveats calling for more studies before the drug is widely used. In an email interview he says his main concern is antibiotic resistance so far not shown to be a problem in research studies and that the study followup needs to be longer. This issue is relatively easy to address with a longerterm followup study or a retreatment trial he tells WebMD. For now he suggests that the antibiotic be reserved for those patients in whom overgrowth of the small intestine bacteria has been confirmed or to limit treatment to a single cycle for those not responding to other medications. Tack has severed as a scientific adviser to companies evaluating IBS drugs. Another doctor Christine Frissora MD an associate professor of medicine at Weill Cornell Medical College of Cornell University says the results show promise. She was not involved in the studies but has been prescribing rifaximin for IBS patients with the nonconstipation form offlabel. Offlabel refers to uses that have not been approved by the FDA. As for the new study findings she says they wont change my practice but they will probably encourage other doctors to try it especially primary care doctors who may not yet know about this data. The patients who have diarrhea cramping urgency and frequency gas and bloating will be most likely to respond she says. It could also work she says in those with constipation. We just dont know yet. Pimentel says he is studying those patients now. Frissora reports research funding from Tioga Pharmaceuticals for a study of an IBS drug and serving on the speakers bureaus for Prometheus Therapeutics and Diagnostics Salix Pharmaceuticals and Takeda Pharmaceuticals North America."

"Weightloss surgery helps people drop a significant amount of weight and now a new study confirms that much of the weight appears to stay off for at least years. This study suggests that patients interested in bariatric surgery especially gastric bypass surgery should be able to lose a significant amount of weight and keep that weight off for a very long time said study researcher Matt Maciejewski. Hes a professor of medicine at Duke University School of Medicine in Durham N.C. While other research has found that weightloss surgery is the most effective treatment for obese patients there is less data on longlasting effects. The new study is notable because of the decadelong followup said Maciejewski who is also a research career scientist at Durham Veterans Affairs Medical Center. In the twopart study Maciejewskis team first looked at the results of about men and women who had gastric bypass surgery. The investigators compared weight changes in gastric bypass surgery patients to weight changes in more than obese veterans who had no weightloss surgery or formal weightloss treatment. Gastric bypass surgery involves making the stomach smaller and attaching the lower part of the small intestine directly to the stomach so much of the small intestine is bypassed. After surgery people feel much fuller faster. The surgery also appears to alter gut hormones gut bacteria and metabolism according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases NIDDK. At the studys oneyear mark those who had the bypass had lost percent of their starting weight but the nonsurgical patients had lost just percent. At years the researchers had weight information on of the nearly patients who had the gastric bypass. Only of them had regained so much weight that they were nearly back to their starting weight the rest kept off the weight. Compared to the nonsurgical group the bypass group weighed percent less than at the start of the study. Next the researchers compared three types of weightloss surgeries gastric bypass sleeve gastrectomy and adjustable gastric banding. In gastric banding a band is placed at the top of the stomach to create a small pouch that reduces the size of the stomach. In sleeve gastrectomy most of the stomach is removed leaving a bananashaped sleeve. As with gastric bypass surgery both of these procedures leave people feeling full faster according to NIDDK. After four years those who had gastric bypass lost nearly percent of their starting weight. People who had sleeve gastrectomy lost about percent and those with gastric banding lost about percent the researchers found. The average age of the men and women studied was about and threequarters were men. Most were white. The study was published online Aug. in JAMA Surgery. The study helps address a knowledge gap about longterm outcomes of bariatric surgery said Dr. Jon Gould chief of general surgery at the Medical College of Wisconsin in Milwaukee. The study shows that the gastric bypass procedure compared to sleeve gastrectomy or adjustable gastric banding produces more weight loss and it was sustained over the long term Gould said. He wrote a commentary to accompany the study in the same issue of the journal. Based on the new study findings Gould said I think a patient who is young and who has a long way to go may want to think about these results and all other things being equal might pick a gastric bypass for the longterm weight loss. The new finding he added validates his belief that the gastric bypass could be a durable procedure. Maciejewski acknowledged that the study has limitations. For example the study included mostly men so the findings may not apply to women. In addition women who undergo bariatric surgery are typically in their s through their s he said. In this study the average age of the men and women was . These results may not generalize to everyone he said. Another possible limitation was the loss of patients during the followup which could have affected the results the researchers noted. More information To learn more about bariatric surgery procedures visit the American Society for Metabolic and Bariatric Surgery httpsasmbs.orgpatientsbariatricsurgeryprocedures. SOURCES Matt Maciejewski Ph.D. research career scientist Durham Veterans Affairs Medical Center and professor of medicine Duke University School of Medicine Durham N.C. Jon Gould M.D. professor and chief of general surgery Medical College of Wisconsin Milwaukee Aug. JAMA Surgery online"

"Columbus OH. Good news for the millions of people who suffer from skin wounds that wont heal. A team of researchers at The Ohio State University has brought a potentially transformative solution to the problem by creating a portable adhesive patch that drives a continuous small electrical current to stimulate healing and reduce the risk of infection. Nearly million Americans have chronic wounds typically a result of diabetes obesity or other conditions that impact circulation costing the healthcare system nearly billion each year. The nonhealing wounds are painful can permanently damage nerves prevent mobility and in extreme cases cause infection that can lead to death. The patchs design significantly advances existing FDAapproved wireless electroceutical dressing WED that harnesses the bodys innate response to injury to help wounds heal. A wound naturally produces its own electrical fields that help reduce bacteria and promote cell regeneration however this function is likely impaired in chronic wounds said Sashwati Roy PhD an Associate Professor in the Department of Surgery at Ohio States College of Medicine. The prototype dressing mimics this physiological process and while it has proven to create an optimal environment where chronic wounds can heal we are always looking for new ways to keep pathogens under better control. Roy notes that chronic wounds are particularly susceptible to infection because bacteria which at times are free floating within a wound can sometimes mobilize creating colonies covered by a thick sticky coating called a biofilm. The immune system cannot penetrate the biofilm and antibiotics cant get in either causing constant inflammation and lowlevel infection that can further dampen the healing process. Now with support from Ohio States Center for Clinical and Translational Science CCTS researchers from both the College of Engineering and the College of Medicine are taking the technology to the next level. Working with a mechanical and aerospace engineering team led by Shaurya Prakash PhD and Vish Subramaniam PhD the scientists have optimized the bandages design and the amount of electrical current delivered. Like present WEDs the new prototype is flexible portable and selfcontained. Made of silk and silver the experimental dressing includes a selfcontained battery that delivers a continuous safe lowlevel electrical current to the injury. Were hoping this new design may allow electric fields and currents to penetrate more deeply into wounds and really get to where these biofilms may be hiding said Subramaniam chair of the Department of Mechanical and Aerospace Engineering at Ohio State. The destruction of the biofilm would enable antibiotics to start killing off bacteria reduce chronic inflammation and allow the bodys natural immune response to work more effectively. Bacteria are known to quickly acquire resistance against antibiotics but to our knowledge bacteria do not develop resistance against electroceuticals. To test the experimental design Roy and a team of scientists developed an animal model to mimic the skin function of a person suffering from metabolic syndrome obesity high blood pressure high blood sugar which mirrors the type of patient that typically develops chronic wounds. Animal models had skin injuries infected with Pseudomonas aeruginosa Staphylococcus aureus or Acinetobacter baumannii three different types of bacteria that commonly infect wounds and develop biofilms that are treatment resistant. Early results which were presented at the Wound Healing Societys Annual Meeting in April indicate that infected wounds covered by the experimental bioelectric dressing healed better and more quickly than those covered with a plain dressing that is commonly used in the care of wounds today. Scientists hypothesize that the electrical currents may disrupt bacteria in two ways by interrupting the production of chemical messages that instruct bacteria to develop biofilms and by weakening the molecular structure of existing biofilms potentially making them more susceptible to antibiotics or the bodys natural immune response. The teams next move is to focus on the bioelectric bandage as a treatment for chronic wounds in a patient population however the technology could also be used to treat acute injuries. Roy also notes that the U. S. Department of Defense is very interested in the dressing as a temporary measure to help prevent infection in soldiers wounded on the battle front. This technology has a long shelf life and is compact enough to be put into any field medical kit. It could be applied immediately to wounds help keep bacteria from mobilizing and start promoting healing until the soldier could be transported to a facility for more intensive medical care. The team already has interest from several industry partners and is hoping to begin testing the new technology in patients before the end of the year to determine optimal treatment duration and more about the healing effects of electrical fields on skin cells on a molecular level. Roys research team includes Shomita S. Steiner PhD Shaurya Prakash PhD Gayle Gordillo MD Vish Subramaniam PhD and Chandan K. Sen PhD. The Ohio State University Center for Clinical and Translational Science CCTS is funded by the National Institutes of Health NIH Clinical and Translational Science Award CTSA program ULTR KLTR TLTR The CTSA program is led by the NIHs National Center for Advancing Translational Sciences NCATS. The content of this release is solely the responsibility of the CCTS and does not necessarily represent the official views of the NIH."

"Most doctors opt for screening women for cervical cancer more often than guidelines suggest according to a new study. Researchers based at the Centers for Disease Control and Prevention CDC found that many primary care doctors would bring women back for cancer screening annually while recommendations generally call for a threeyear wait after normal tests. That means more costs to women and the healthcare system as well as a risk of unnecessary treatment for falsepositive test results with very little additional cancercatching benefit. Theres really no advantage to annual screening compared to screening every two or three years lead author Katherine Roland told Reuters Health. Guidelines from the American Cancer Society and other organizations recommend that women age and older are screened using Pap smears and tests for the human papillomavirus or HPV. If both tests are normal those guidelines call for a threeyear wait before the next screening. Thats because HPV which causes changes in the cervix that can lead to cancer may take a decade to progress to that point. No test is perfect said Philip Castle an HPV expert at the American Society for Clinical Pathology in Chicago. But he added a single negative HPV test is very good at ruling out disease. Even when doctors use just a Pap test Roland said a woman who has had a few normal tests in a row can go two or three years before her next screening. For the current study she and her colleagues sent out questionnaires to a representative sample of about officebased doctors and hospital departments around the country. They asked doctors and staff what tests they used for cervical cancer screening and presented them with three patient scenarios. In those scenarios a woman age to has had two consecutive normal Pap tests but no HPV tests two normal Paps and a negative HPV test or a negative HPV test but no recent Pap tests. In all of those cases guidelines recommend waiting three years before screening the patient again the authors explain in the American Journal of Obstetrics Gynecology. But for each scenario between percent and percent of doctors said they would bring the woman back in a year. And those extra tests arent harmless. Roland pointed to the extra costs women may incur to get childcare and make it to the doctors office plus the costs to a strained healthcare system of ordering more tests. And any extra screening increases the chance of getting a false positive result on a test meaning the test finds something that doesnt turn out to be cancer. In that case women would need more invasive tests to rule out disease Roland said and risk undue harm from those procedures. Some of it is dont go looking before you need to go looking because youll find stuff that youd rather not find said Castle who was not involved in the new study. Results from a survey of the same doctors have shown that many also give the HPV test alongside Pap smears to women under which is not recommended because HPV is common in young women and often goes away on its own see Reuters Health story of July . Castle said there could be a few reasons that doctors opt to screen women more often than is recommended. First they might not know about the guidelines. But women may also be used to annual testing and ask for it themselves. In addition Roland added some doctors might be afraid of missing very early cervical cancer and getting sued if they screen less frequently. But if doctors and hospitals want to rein in spending and limit unnecessary risks that attitude has to change researchers agreed. We need to shift toward the wellness visit as opposed to You have to come in here every year for a Pap Castle said. Women should talk to their doctors about screening especially if they think they are being screened too often researchers added. A woman should know what test is being used said Dr. Mona Saraiya a coauthor on the new study. Often a provider just does the HPV test without telling the patient. A woman should say What screening tests are you doing on me And if doctors want women to come back again next year women should ask them why Saraiya said. SOURCE bit.lyqdtM httpbit.lyqdtM American Journal of Obstetrics Gynecology online August . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Its hard to talk about carbs without talking about wheat and its hard to talk about wheat without talking about gluten. Gluten is not a carbohydrate its a mix of proteins found in wheat and its close relatives including spelt kamut and farro as well as in barley and rye. Its what gives bread its elasticity but it also sets off the immune system of people with celiac disease httpceliac.orgceliacdiseasewhatisceliacdisease damaging the small intestine and sometimes producing painful and unpleasant symptoms. Even some people who dont have celiac disease feel better when they dont eat wheat. They may assume that they have gluten sensitivity but some researchers believe that its not the gluten theyre sensitive to. Instead its fermentable oligosaccharides disaccharides monosaccharides and polyols or FODMAPS. Never was a group of molecules more desperately in need of an acronym. FODMAPs are a group of carbohydrates that dont get broken down and absorbed in the small intestine. Instead they pass through to the large intestine where they draw water into the gut and start to ferment httpcdhf.cabankdocument_enfodmaps.pdf. The process by which FODMAPs are broken down and fermented can cause gastrointestinal distress diarrhea bloating pain flatulence and constipation. http Wheat and rye are high in FODMAPs as are onions garlic apples stone fruit pistachios and many other foods. Research by Peter Gibson a professor of gastroenterology at Australias Monash University has found http that some people who believed they were glutensensitive were instead FODMAPsensitive. A lowFODMAP diet eased their symptoms as it does for about percent of people who suffer from irritable bowel syndrome a condition that causes abdominal pain and bowel changes. Gibson estimates that overall about percent of the population may be FODMAPsensitive. But theres a problem with a lowFODMAP diet. The fermentation that is painful to that percent is good for your gut because it stimulates growth of the kind of bacteria associated with digestive health. Following strictly the lowFODMAP diet is associated with changes in the microbiota that many would not equate with good health says Gibson who stresses that a lowFODMAP diet should be used to reduce specific symptoms not as a way to improve health. If your gut can handle FODMAPs foods that contain a lot of them can be very good choices partly because the fermentation helps your gut biome and partly because the way FODMAPs are digested means youre absorbing fewer calories than indicated on a FODMAPrich products label. Unless you have specific symptoms that a lowFODMAP diet alleviates Gibson says enjoy your FODMAPs Food list HighFODMAPs protein Legumes LowFODMAPs protein Meat fish chicken tofu HighFODMAPs vegetables Garlic onions asparagus artichokes sugar snap peas celery sweet corn LowFODMAPs vegetables Green beans carrots cucumbers lettuce tomatoes zucchini HighFODMAPs fruit and nuts Apples mangoes pears peaches plums watermelon cashews pistachios LowFODMAPs fruit and nuts Bananas oranges grapes almonds HighFODMAPs cereals grains breads pastas Wheat products barley rye LowFODMAPs cereals grains breads and pastas Glutenfree bread and pastas oats rice quinoa HighFODMAPs dairy products Soft cheeses cows milk cream ice cream yogurt LowFODMAPs dairy products Lactosefree milk and yogurt hard cheese"

"Every year falls affect approximately one in three older adults living at home with approximately one in falls resulting in serious injury. Even if an injury does not occur the fear of falling can lead to reduced activity and a loss of independence. Research has shown that vitamin D plays a key role in maintaining muscle integrity and strength and some studies suggest vitamin D may reduce the risk of falls. Homebound elderly a generally vulnerable population due to poor dietary intake and nutritionrelated health conditions as well as decreased exposure to sunlight are at increased risk for low vitamin D levels possibly leading to more falls. Researchers at Wake Forest Baptist Medical Center set out to evaluate the feasibility of delivering a vitamin D supplement through a MealsonWheels MOW program to improve the clients vitamin D levels and reduce falls. The study is published in the early online edition of the Journal of the American Geriatrics Society. Falls in homebound older people often lead to disability and placement in a nursing home said Denise Houston Ph.D. R.D. associate professor of gerontology and geriatric medicine at Wake Forest Baptist and lead author of the study. One or our aging centers goals is to help people maintain their independence and live safely at home for as long as possible. Participants in the MealsonWheels program in Forsyth County North Carolina were recruited to take part in a fivemonth singleblind randomized trial. Sixtyeight study participants received either a monthly vitamin D supplement of international units or placebo delivered with their MOW meal. The study included the participants history of falls and their fear of falling blood tests at the beginning and at end of the trial to measure hydroxyvitamin D biomarker for vitamin D in blood and a monthly diary recording falls during the trial period. At the beginning of this pilot study the research team found that more than half of the participants had insufficient concentrations of vitamin D in the blood less than ngml while less than a quarter had concentrations in the optimal range ngml or more. The study showed that the monthly vitamin D supplement was effective in increasing the concentrations of vitamin D in the blood from insufficient to sufficient levels in all but one of the people who received it and to optimal levels in all but five people. In addition people in the vitamin D group reported approximately half the falls of those in the control group. Although these initial findings are encouraging we need to confirm the results in a larger trial Houston said. The Wake Forest Baptist team currently is conducting a clinical trial to try to determine how vitamin D affects risk factors for falls such as balance and muscle strength and power. Funding for the study was provided by the Wake Forest Translational Science Institute and Center for Integrative Medicine and the Claude Pepper Older Americans Independence Center of Wake Forest Baptist. Coauthors are Janet Tooze Ph.D. Jamehl Demons M.D. Brooke Davis M.S. Rachel ShertzerSkinner M.A. Stephen Kritchevsky Ph.D. and Jeff Williamson M.D. of Wake Forest Baptist and Linda Kearsley B.S. Senior Services Inc. WinstonSalem."