Datasets:

saikat02004

/

criteria_6

like 0

"Patients with depression often struggle through weeks or months of trialanderror to find the right antidepressant. Now the burgeoning field of pharmacogenomics how genes affect a persons response to drugs is helping more patients avoid debilitating and alltoocommon side effects of psychiatric medications. Sarah Ellis will never forget her darkest days battling depression and the series of prescriptions the Sioux Falls South Dakota mother of three endured. I tried every medicine Ellis said. I wondered if I would ever find something that works. One prescription gave her a rash for two years and the antianxiety medication Clonazepam Klonopin affected her balance. She was also prescribed selective serotonin reuptake inhibitors SSRIs a class of drugs including Prozac which are used to treat anxiety and depression but they made me feel like I was losing my mind Ellis told NBC News. More than in American ages and older are struggling with depression according to the Centers for Disease Control and Prevention. And many more are suffering from sometimes severe side effects like weight gain nausea sleepiness and sexual problems. At least adverse drug reactions linked to antidepressants were reported to the Food and Drug Administrations Adverse Event Reporting System between and . Its unclear how many patients have had to stop or chosen to stop treatment for depression due to side effects. Ellis tried different combinations of depression medications. Finally her psychiatrist suspicious that her body might process medication differently than most recommended a genetic test to see why Ellis wasnt responding to the prescriptions. Once the genetic testing became available it provided Sarah with more than just physical relief says Dr. Matthew B. Stanley of the Avera Medical Group in Sioux Falls South Dakota. It gave us an answer that this was her physiology and her genetics and not something in her head. The Avera Institute for Human Genetics AIHG in Sioux Falls South Dakota is among several institutions exploring the role of pharmacogenomics the science of how our inheritance and genetic makeup influences the way we metabolize medications. One piece of the puzzle AIHGs pharmacogenomics research has led to the development of Genefolio a genetic test that uses an individuals unique DNA to predict how that individual will respond to medications. The test offered by Avera is and is often covered by insurance. Research pharmacist Krista Bohlen director of personalized pharmaceutical medicine at the Avera Institute for Human Genetics believes that genetics play a large role in how different individuals react to certain medications but cautions doctors and patients against relying solely on this method for answers. According to a study conducted by the Mayo Clinic that looked at one genetic test similar to many used in hospitals GeneSight Psychotropic symptoms of depression were reduced by percent compared to treatments prescribed without genetic testing. While the results are striking this technology is not a guarantee of complete resolution of depressive symptoms or medication side effects. Pharmacogenomics is one piece of the puzzle Bohlen told NBC News. We look at it as a tool to help the physician. They can couple their expert opinions with information from the patient like their symptoms and family history to look more closely at one class of drug over another. Sarah Ellis is sideeffect free and in great spirits now.Courtesy Sarah Ellis The Genefolio test confirmed gene variants within Ellis DNA that made her more susceptible to certain side effects with newer classes of medications so Stanley prescribed an older class of antidepressant and experimented with a lower dose. It worked for Ellis. My energys been really great she says. I feel like I can accomplish what I want to accomplish. This was definitely worth it."

"Can a single ingredient swap make an impact on health According to the recently released Dietary Guidelines for Americans small shifts in food choices can make a big difference including a shift from solid fats to oils like the oil in fresh avocados. On the heels of this advice a new metaanalysis considered the best evidence and an unbiased overview of the body of knowledge on a specific topic published in the Journal of Clinical Lipidology adds to the growing body of research that supports the use of avocados in lieu of solid fats and foods that have higher saturated fat content to significantly change lipid profiles. The research Impact of avocadoenriched diets on plasma lipoproteins A metaanalysis conducted at the University of the Pacific and independently funded looked at unique avocado studies with participants assessing the impact of avocados on cholesterol levels. Researchers found avocado consumption to . per day significantly reduced total cholesterol TC bad low density lipoprotein cholesterol LDLC and triglycerides TG when they were substituted for sources of saturated fat. Additionally avocado consumption did not impact good high density lipoprotein cholesterol HDL. However the optimal amount of avocado and frequency of use needs further evaluation along with the nutritional similarities and differences between other different MUFA sources. Larger trials looking at the impact of avocados on major adverse cardiovascular events are warranted. See conclusion of study Interestingly our results indicate that even healthy subjects with a relatively normal baseline TC to mgdL LDLC to mgdL and TG to mgdL had significant reductions says Sachin Shah PharmD corresponding author and expert in cardiovascular health. As we head into American Heart Health Month February its important to remind people that they have the power to help control their risk factors for developing heart disease by exercising regularly knowing cholesterol levels and keeping them under control and maintaining a healthy weight. Cardiovascular disease is responsible for one out of every four deaths it is the number killer of American women and men and it is a leading cause of disability. Fresh avocado as part of a balanced diet and as a cholesterolfree substitute for solid fats can help be part of the solution for maintaining normal cholesterol levels says Nikki Ford PhD Director of Nutrition Hass Avocado Board. Beyond their naturally good fats avocados are also a delicious way to boost fiber percent of DV and fruit intakes both of which are under consumed in American diets. The Hass Avocado Board HAB continues to be a leader in educating health professionals and consumers on the benefits of avocados. HAB recently created a series of simple quick to prepare interactive meal makeovers https to show people how to make small shifts in their diets by substituting fresh avocados for other foods or ingredients higher in saturated fats. This study supports the body of research showing the many benefits that fresh avocados have to offer when consumed in everyday healthy eating plans says Emiliano Escobedo Executive Director HAB. Through our nutrition research program established in we are committed to increase awareness and improve understanding of the unique benefits of avocados to human health and nutrition. Clinical studies are currently underway to investigate the relationship between avocado consumption and risk factors for heart disease diabetes support of weight management and healthy living. To view the abstract or the published article visit http About the Hass Avocado Board The Hass Avocado Board HAB is an agriculture promotion group established in to promote the consumption of Hass Avocados in the United States. A member board representing domestic producers and importers of Hass Avocados directs HABs promotion research and information programs under supervision of the United States Department of Agriculture. Funding for HAB comes from Hass avocado producers and importers in the United States. In HAB established a nutrition research program to increase awareness and improve understanding of the unique benefits of avocados to human health. For a comprehensive collection of published nutrition and scientific literature authoritative reports and other articles on or related to avocados their nutrients and eating patterns that include them visit avocadonutritioncenter.com. For tips and recipes visit LoveOneToday.com https_sourceloveoneredirectutm_mediumloveonetodayutm_campaignLOT or follow HAB on Facebook https Twitter httpstwitter.comHassAvocados Pinterest https and YouTube https"

"A procedure used to relieve chest pain in hundreds of thousands of heart patients each year is useless for many of them researchers reported on Wednesday. Their study focused on the insertion of stents tiny wire cages to open blocked arteries. The devices are lifesaving when used to open arteries in patients in the throes of a heart attack. But they are most often used in patients who have a blocked artery and chest pain that occurs for example walking up a hill or going up stairs. Sometimes patients get stents when they have no pain at all just blockages. Heart disease is still the leading killer of Americans people have heart attacks each year and stenting is a mainstay treatment in virtually every hospital. More than heart patients worldwide have stents inserted each year to relieve chest pain according to the researchers. Other estimates are far higher. Several companies including Boston Scientific Medtronic and Abbott Laboratories sell the devices and inserting them costs from to httphealth.costhelper.comstents.html at hospitals in the United States. The new study http published in the Lancet stunned leading cardiologists by countering decades of clinical experience. The findings raise questions about whether stents should be used so often or at all to treat chest pain. Its a very humbling study for someone who puts in stents said Dr. Brahmajee K. Nallamothu an interventional cardiologist at the University of Michigan. Dr. William E. Boden a cardiologist and professor of medicine at Boston University School of Medicine called the results unbelievable. Dr. David Maron a cardiologist at Stanford University praised the new study as very well conducted but said that it left some questions unanswered. The participants had a profound blockage but only in one artery he noted and they were assessed after just six weeks. We dont know if the conclusions apply to people with more severe disease Dr. Maron said. And we dont know if the conclusions apply for a longer period of observation. For the study Dr. Justin E. Davies a cardiologist at Imperial College London and his colleagues recruited patients with a profoundly blocked coronary artery and chest pain severe enough to limit physical activity common reasons for inserting a stent. All were treated httpswe.tlxMlsGYBfor six weeks with drugs to reduce the risk of a heart attack like aspirin a statin and a blood pressure drug as well as medications that relieve chest pain by slowing the heart or opening blood vessels. Then the subjects had a procedure a real or fake insertion of a stent. This is one of the few studies in cardiology in which a sham procedure was given to controls who were then compared to patients receiving the actual treatment. In both groups doctors threaded a catheter through the groin or wrist of the patient and with Xray guidance up to the blocked artery. Once the catheter reached the blockage the doctor inserted a stent or if the patient was getting the sham procedure simply pulled the catheter out. Sign up for Science Times Well bring you stories that capture the wonders of the human body nature and the cosmos. Jim Stevens a lawyer in Troy Mich. was about to have a stent put in but the new study gave his cardiologist pause. He advised against inserting the stent and Mr. Stevens concurred.CreditSean Proctor for The New York Times Neither the patients nor the researchers assessing them afterward knew who had received a stent. Following the procedure both groups of patients took powerful drugs to prevent blood clots. The stents did what they were supposed to do in patients who received them. Blood flow through the previously blocked artery was greatly improved. When the researchers tested the patients six weeks later both groups said they had less chest pain and they did better than before on treadmill tests. But there was no real difference between the patients the researchers found. Those who got the sham procedure did just as well as those who got stents. Cardiologists said one reason might be that atherosclerosis affects many blood vessels and stenting only the largest blockage may not make much difference in a patients discomfort. Those who report feeling better may only be experiencing a placebo effect from the procedure. All cardiology guidelines should be revised Dr. David L. Brown of Washington University School of Medicine and Dr. Rita F. Redberg of the University of California San Francisco wrote in an editorial published with the new study. Clinical guidelines in the United States say stenting is appropriate for patients with a blocked artery and chest pain who have tried optimal medical therapy meaning medications like those given to the study patients. But those guidelines were based on studies in which patients simply said they felt better after having stents inserted. It was impressive how negative it was Dr. Redberg said of the new study. Since the procedure carries some risks including death stents should be used only for people who are having heart attacks she added. Stents came into wide use in the s and became the treatment of choice because they were less invasive than bypass surgery. But there have long been questions about their effectiveness. A large federally funded study https with Dr. Maron as a coprincipal investigator which does not have an untreated control group is now underway to determine whether medications can be just as effective as stenting or coronary bypass in preventing heart attacks. In another large study http led by Dr. Boden also without an untreated control group found stents did not prevent heart attacks or deaths from heart disease. The explanation researchers said was that atherosclerosis is a diffuse disease. A few arteries might be blocked today and then reopened with stents. But tomorrow a blockage might arise in another artery and cause a heart attack. Relieving chest pain though seemed a different goal to many cardiologists. After all the heart is a muscle and if a muscle is starved for blood it aches. Many patients have coronary arteries that are to percent blocked. Surely opening those vessels should make the patients feel better. Mr. Stevens was on the operating table to receive a stent through his wrist when his cardiologist Dr. Brahmajee K. Nallamothu had second thoughts and ended the procedure.CreditSean Proctor for The New York Times The idea that stenting relieves chest pain is so ingrained that some experts said they expect most doctors will continue with stenting reasoning that the new research is just one study. Even Dr. Davies hesitated to say patients like those he tested should not get stents. Some dont want drugs or cant take them he said. Stenting is so accepted that American cardiologists said they were amazed ethics boards agreed to a study with a sham control group. But in the United Kingdom said Dr. Davies getting approval for the study was not so difficult. Neither was it difficult to find patients. There are many people who are open to research and if you tell them you are exploring a question people agree he said. Nonetheless it took him three and a half years to find the subjects for his study. Ethics boards at many American hospitals probably would resist since giving such patients fake procedures flies in the face of guidelines Dr. Boden said. Placebo effects can be surprisingly powerful said Dr. Neal Dickert Jr. a cardiologist and ethicist at Emory University. A few years ago researchers at the insistence of the Food and Drug Administration did a study http to test an invasive procedure to treat high blood pressure. The control group got a sham procedure. The method was becoming popular in Europe but the study found that blood pressure dropped just as much in those who had the fake treatment. Dr. Dickert said he hoped the new stent study will show cardiologists that they need to do more studies with sham procedures. This may turn out to be an important moment he said. But getting them underway in the United States may not be easy. Ethics boards at hospitals and universities are likely to resist as are patients. Its not just up to us said Dr. David Goff director of cardiovascular sciences at the National Heart Lung and Blood Institute. Still the results of the new research have at least one heart specialist rethinking his practice. Dr. Nallamothu got an advance look at the new paper on Tuesday. Coincidentally he had a patient Jim Stevens a lawyer in Troy Mich. scheduled to receive a stent that day. Mr. Stevens had a blocked artery but the new report gave Dr. Nallamothu second thoughts. I took him off the table he said. He explained to Mr. Stevens and his wife that he did not need a stent. I was surprised Mr. Stevens said. But I feel better not needing it."

"Instead of shrinking as expected as part of the normal aging process the memory center in the brains of seniors maintained their size and in men grew modestly after two years in a program that engaged them in meaningful and social activities new Johns Hopkins Bloomberg School of Public Healthled research suggests. At the same time those with larger increases in the brains volume over two years also saw the greatest improvements on memory tests showing a direct correlation between brain volume and the reversal of a type of cognitive decline linked to increased risk for Alzheimers disease. The research published online in Alzheimers Dementia The Journal of the Alzheimers Association studied participants in the Baltimore Experience Corps a program that brings retired people into public schools to serve as mentors to young children working with teachers to help them learn to read in understaffed school libraries. Someone once said to me that being in this program removed the cobwebs from her brain and this study shows that is exactly what is happening says study leader Michelle Carlson PhD an associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health. By helping others participants are helping themselves in ways beyond just feeding their souls. They are helping their brains. The brain shrinks as part of aging but with this program we appear to have stopped that shrinkage and are reversing part of the aging process. For the study Carlson and her colleagues randomized men and women to either participate in the Experience Corps or not . They took MRI scans of their brains at enrollment and then again after and months. They also conducted memory tests. Participants were an average of . years old predominantly AfricanAmerican were in good health came from neighborhoods with low socioeconomic status and had some college education. The control arm of the study those not involved in Experience Corps exhibited agerelated shrinkage in brain volumes. Typically annual rates of atrophy in adults over age range from . percent to two percent. The men who were enrolled in Experience Corps however showed a . percent to . percent increase in brain volumes over the course of two years. Though not statistically significant women appeared to experience small gains as compared to declines in the control group of one percent over months. Carlson notes that many cognitive intervention studies last one year or less. One strength of this study she says is that the participants were followed for two years which in this case was long enough to see changes that wouldnt have been detected after just one year. The researchers were particularly interested in the results considering that people with less education and who live in poverty are at greater risk for cognitive decline. Carlson says its not entirely clear which elements of Experience Corps account for the improved memory function and increased brain volumes. She says the program increases involvement in so many different kinds of activities that retired people may not have engaged in otherwise. Participants need to get out of bed walk to the bus and walk up and down stairs inside the schools. They work in teams. They work with young people. They share their knowledge and know they are doing good in the world. They engage in problem solving and they socialize in ways they wouldnt have if they stayed at home. Were not training them on one skill like doing crossword puzzles she says. Were embedding complexity and novelty into their daily lives something that tends to disappear once people retire. The same things that benefit us at contact with others meaningful work are certain to benefit us as we age. Experience Corps is a national program however it can be costly and isnt available everywhere. But Carlson says she believes finding purpose and civic engagement may forestall some of the damage of aging on the brain. Impact of the Baltimore Experience Corps Trial on cortical and hippocampal volumes was written by Michelle C. Carlson Julie H. Kuo YiFang Chuang Vijay Varma Greg Harris Marilyn Albert Kirk I. Erickson Arthur F. Kramer Jeanine M. Parisi QianLi Xue Erwin Tan Elizabeth K. Tanner Alden Gross Teresa E. Seeman Tara Gruenewald Sylvia McGill George W. Rebok and Linda P. Fried. The study was supported by the Johns Hopkins Neurobehavioral Research Unit the National Institutes of Healths National Institute on Aging P AG the Alzheimers Drug Discovery Foundation and the Johns Hopkins Epidemiology and Biostatistics of Aging Research Fellowship NIA TAG."

"A hormone called DHEA and mostly secreted by the adrenal glands may be able to help women who are going through menopause and could also give them better sex lives a study found on Tuesday. Italian researchers writing in the journal of the International Menopause Society Climacteric said they had found the first robust evidence that low doses of DHEA can help sexual function and menopausal symptoms suggesting it may one day become an alternative to hormone replacement therapy HRT. But they stressed that the trial was small so far larger studies are needed to confirm the results. We must bear in mind that this is a pilot study with a small sample Anna Fenton coeditor of Climacteric said in commentary on the work. We cant yet say that this study means that DHEA is a viable alternative to HRT but ... we should be looking to do larger studies to confirm these initial results. DHEA or dehydroepiandrosterone is a natural steroid hormone mostly made in the adrenal glands and has a variety of therapeutic uses. HRT which is a combination of the hormones oestrogen and progesterone is an approved treatment for women going through the menopause who often experience unpleasant symptoms such as hot flushes night sweats loss of sex drive and mood swings. But sales of HRT drugs have fallen sharply since a large study in found higher rates of ovarian cancer breast cancer and strokes in women who took the pills and the search has since been on for alternatives. American researchers said in January that the antidepressant Lexapro made by drugmaker Forest Laboratories significantly cut the number and severity of hot flushes in menopausal women and other antidepressants including GlaxoSmithKlines Paxil and the Pfizer drugs Prozac and Effexor also have been found to be effective. For this trial a team of researchers led by Andrea Genazzani of the University of Pisa followed a group of postmenopausal women with troubling symptoms. Over a year women took vitamin D and calcium took DHEA took standard HRT and took a synthetic steroid called tibolone which is used to alleviate menopausal symptoms. The womens menopausal symptoms sexual interest and activity were measured using a standard questionnaire that explores factors such as satisfaction with frequency of sex vaginal lubrication orgasm and sexual partner. After months all the women on hormone replacements had improvements in menopausal symptoms but those taking vitamin D and calcium did not show any significant improvement. At the start of the trial all groups had similar sexual activity but after the year those taking calcium and vitamin D scored an average of . on the questionnaire scale while those taking DHEA had a score of . showing that those on DHEA had more sexual interest and activity. The results for the HRT group were similar and both the HRT DHEA groups showed a higher level of sexual intercourse in comparison to the control group the researchers said. Genazzani said the results showed DHEA has potential especially for those women who may have problems in taking more conventional HRT. But this is a small study a proof of concept. What we need to do now is to look at a larger study to confirm that these initial results are valid she added. Reporting by Kate Kelland Editing by Jon LoadesCarter Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Men who have a low prostatespecific antigen PSA score when theyre first tested may not need to be screened annually and probably dont need to undergo a biopsy a new study suggests. Dutch researchers presenting the findings at the Genitourinary Cancers Symposium in Orlando Fla. said that few men with a PSA below . ngml were likely to develop prostate cancer and die of the disease. PSA can identify those at low risk of prostate cancer and once you have done that you can remove almost percent of men in the age group to from undergoing biopsies said study senior author Monique Roobol an epidemiologist in the department of urology at Erasmus University Medical Center in Rotterdam. For this study about men aged to in the Rotterdam area were screened with those having PSA scores at or above the cutoff of . sent for biopsies and additional screenings every four years. Eighty percent of men in the group had PSA levels below that threshold. In this group of men the higher the PSA level at baseline the more likely the person was to develop prostate cancer and to die of the disease. Only . percent of men with PSA scores below . were diagnosed with prostate cancer with only . percent dying of the disease. This compares with . percent of those with scores from percent to . percent developing a malignancy and . percent dying of the disease. This gives us some confidence that annual PSA screening is going to soon become a thing of the past said Dr. Nicholas J. Vogelzang chair of the Developmental Therapeutics Committee of US Oncology who moderated the teleconference. A low PSA particularly those in men who have less than . and probably those less than . certainly could be considered for substantially longer intervals of PSA screening... Personalization of PSA screening is clearly underway. A second study also being presented at the symposium found that a drug already used to treat enlarged prostate gland may delay the progression of lowrisk early prostate cancer among men who choose a waitandsee approach to treatment. In comparison to men with lowrisk earlystage prostate cancer who took a placebo men randomized to receive Avodart saw their chance of progression significantly reduced by approximately percent said study author Dr. Neil Fleshner head of urology at the University Health Network and Love Chair in Prostate Cancer Prevention at Princess Margaret Hospital both in Toronto. Men with lowrisk prostate cancer who want to have a period of observation should consider using this drug. But the maker of Avodart dutasteride GlaxoSmithKline is unlikely to apply for new approval to market the drug for what is essentially prevention meaning it would be used offlabel in this context he added. A final study of almost patients found that surgeons needed to perform procedures known as roboticassisted laparoscopic radical prostatectomies RALP to become adept at the procedure. In comparison with typical laparoscopic surgery RALP offers surgeons threedimensional vision and such improvements as better magnification and hand tremor filtering. We recommend that this operation should not be done by all urologists in small community hospitals but should be focused and concentrated on high volume centers of excellence... in order to achieve best possible results for patients said study author Dr. Prasanna Sooriakumaran a visiting fellow in urology at the Weill Cornell Medical College in New York. The procedure is not as easy as manufacturers make it out to be and enthusiasm in the U.S. needs to be tempered in terms of which hospitals should be buying the equipment and which surgeons should be doing these sorts of operations he added. One caution though is that the study only looked at three surgeons performing RALP. More information The National Cancer Institute has more on prostate cancer http SOURCES Feb. teleconference with Nicholas J. Vogelzang M.D. chair and medical director Developmental Therapeutics Committee US Oncology Monique Roobol Ph.D. epidemiologist department of urology Erasmus University Medical Center Rotterdam the Netherlands Neil Fleshner M.D. head urology University Health Network and Love Chair in Prostate Cancer Prevention Princess Margaret Hospital Toronto Prasanna Sooriakumaran M.D. Ph.D. visiting fellow urology Weill Cornell Medical College New York City Feb. presentations Genitourinary Cancers Symposium Orlando Fla."

"The race to develop a safe and effective vaccine against the Zika virus got one step closer Thursday when a team of researchers reported positive results in the latest round of testing in monkeys. Three experimental vaccines being developed by researchers at Harvards Beth Israel Hospital and the Walter Reed Army Institute of Research had already shown promise in mice but monkeys are a much better model of how the medicines will work in humans. All three of the vaccines were found to be safe and protected the monkeys against infection with the virus according to the report published in Science. The urgency for a vaccine to protect against Zika infection has intensified as the virus spreads rapidly across Latin America and the Caribbean. This week an unprecedented travel advisory was given for southern Florida after more than a dozen people were diagnosed with Zika after being bitten by homegrown mosquitoes. Zika virus is most dangerous to pregnant women because it can cause severe birth defects in babies if they are infected in the womb. Right now just one of those three vaccines will be progressing to clinical trials. That vaccine dubbed ZPIV for purified inactivated Zika virus uses a more traditional vaccine approach and depends on dead virus particles. Striking results To develop the vaccine researchers kill the virus with chemicals leaving behind harmless proteins that the body can learn to recognize as foreign invaders. Using those proteins as targets the immune system can then produce antibodies to latch onto live virus particles and destroy them. This kind of vaccine is much safer than ones that depend on live virus particles to foster immunity. The researchers gave monkeys an initial dose of ZPIV and then a booster four weeks later. Then the monkeys were exposed to active forms of the virus. In tests afterwards the monkeys showed antibodies against Zika and no detectable virus in their blood or urine meaning that the protection from the vaccine was complete. Monkeys that got a sham vaccine developed no antibodies. The results were striking said study coauthor Dr. Dan Barouch a professor of medicine at Beth Israel Deaconess Medical Center and Harvard Medical School. The findings published today substantially increase our optimism for the potential for the development of a Zika vaccine for humans. Beyond that this is a promising vaccine candidate that can be easily produced in large quantities said coauthor Col. Nelson Michael an Army doctor who specializes in flaviviruses such as Zika and dengue. Testing in people by October To continue the development of the vaccine the researchers will be partnering up with the largest pharmaceutical company solely devoted to vaccines Sanofi Pasteur. The researchers hope to test the vaccine in people by October Barouch said. The two other experimental vaccines described in the new report also sparked an immune response in monkeys. Both of these vaccines depend on new technology in which scientists learn the exact DNA of proteins on the surface of the virus and then create copies to be put in a vaccine. One vaccine had just the manmade proteins in it the other wrapped a common cold virus around the proteins. The proteincold virus vaccine was especially effective sparking a significant immune response after just one dose. Cautiously optimistic Another experimental vaccine developed by researchers at the National Institutes of Health is a bit further along. Trials of that vaccine in people which is also based on manmade copies of virus proteins began on August when the first study volunteer was given a vaccination through a needle free injector said Dr. Anthony Fauci head of the National Institute for Allergy and Infectious Diseases. Results are expected by December and if they are promising a bigger phase II trial will be launched in Zika endemic countries That puts the project ahead of schedule since the original launch of the phase I trials was expected to start in September Fauci said. Still with many years of experience in vaccine development behind him Fauci said youre never overconfident of the clinical results. But we are optimistic that this new DNA Zika is a viable platform Fauci said. So were cautiously optimistic. And if problems turn up there are the three potential vaccine described in the new study. Its always good to have multiple different vaccine candidates in both clinical and preclinical testing Barouch said. That increases the chance that we will have at least one if not more than one that works in the end."

"An experimental approach in which penile nerve tissue is frozen to knock out overactive nerves helped men with premature ejaculation https last three times longer. Researchers tested the technique on men who hadnt been helped by standard treatments. They lasted an average of seconds before ejaculation or nearly two minutes over the three months they were followed compared with seconds before treatment. Thats about what you see with standard drug therapy says researcher J. David Prologo MD assistant professor of interventional radiology at Case Western Reserve Universitys School of Medicine in Cleveland. A time to ejaculation of more than two minutes is normal he tells WebMD. Its supporters say the technique or a similar one involving heat therapy could someday become a standard treatment for the condition. But other experts tell WebMD that questions about the longterm consequences remain. Also unknown whether men would opt for the treatment. The findings were presented here at the annual meeting of the Radiological Society of North America. Prologo consults for Galil Medical which funded the study. Common Sex Problem for Men Premature ejaculation affects to of men making it among the most common forms of male sexual dysfunction worldwide. Treatment options include certain antidepressants https such as Celexa https citalopram https Paxil https paroxetine Prozac https fluoxetine https and Zoloft https sertraline https as well as anesthetic ointments and cream and behavioral therapies. But many men arent helped by the treatments Prologo says. The new technique involves inserting a tiny hollow needle into the skin https near the belly button. Using computerized imaging for guidance the doctor snakes it down to one of the two dorsal penile nerves. Overactivity of these nerves has been implicated as a cause of premature ejaculation. Then we knock out the nerve by freezing it Prologo says. Its not painful though some men feel a cold sensation he says. The procedure takes about minutes and men can go home the same day. While still experimental Prologo estimates the cost at . Repeat Injections May Be Needed After the procedure men were asked five questions relating to their sexual satisfaction. All improved on at least one sexualrelated symptom. There were no side effects from the procedure. However three men reported their erections werent as firm afterward for reasons Prologo cant explain. Unknown is how long the treatment will last. In the third month of the study some men started ejaculating more quickly again. Prologo says repeat injections may be necessary and he is following the men for six months to see what happens. Paula Novelli MD clinical assistant professor of radiology at the University of Michigan in Ann Arbor says that could be a problem. How many times can you repeat it before you do damage she says. Novelli moderated the session at which the findings were presented. Prologo says he doesnt think there will be longterm problems because only one of two nerves is destroyed. Still he is testing a similar but less aggressive technique that uses heat to decrease the activity of overactive penile nerves without destroying them. The researchers plan a study comparing one or both techniques to placebo https in larger numbers of men. These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

"Of course Hologic has done some selling of its own. The firm which markets itself as The Womens Health Company makes other products including a D digital mammography machine a test that assesses risk of preterm labor gynecological products including Adiana a permanent contraception technique and widely used equipment that measures bone density. But D mammography could become its flagship because for the moment it owns the entire market although other companies including powerhouse GE are developing their own D machines Hologic is the only one with FDA approval thus far. Of course given the sluggish economy and the continuing state of uncertainty around American health care persuading hospitals to upgrade may be challenging. So perhaps its not surprising that the companys PowerPoint presentation to the FDA included the unsubtle phrase huge breakthrough or that the first American patient to undergo D mammography Laura Lang a polished yearold Boston marketing executive and breast cancer survivor did so in front of a CBS camera crew last February. Indeed they do. Theyre catching on like well its not a slow burn. The device earned Food and Drug Administration approval on February and for a short time it was available only at MGH. Now it is available in at least nine states three of which have multiple sites and most of the several dozen hospitals around the United States that assisted with clinical trials are planning to buy systems too. The images arent the only selling point. The early data are compelling as well. In studies presented to the FDA radiologists reported a percent improvement in their ability to distinguish cancerous from noncancerous cases when they used the new system. If that sounds unimpressive consider that million women are screened each year any significant reduction in callbacks for additional testing would mean hundreds of thousands of women would be spared painful and expensive followup. Dr. Elizabeth Rafferty is trying not to lapse into rhapsodic cliches. I dont want to call it a magic bullet because that would oversell she says. Its not a panacea. Then five minutes later I dont want to say its catching on like wildfire. After a few minutes more though Rafferty cant help herself. She lets her enthusiasm loose. People have been waiting for it for a long time she says. Its a step but its a step by a person who has a stride of feet. It is a D mammography machine the Selenia Dimensions system one of which sits in the breast imaging clinic at Massachusetts General Hospital that Rafferty a radiologist runs. The machine which is made by the Bedford company Hologic and developed partly at MGH under Raffertys supervision produces images that are so vivid and clear they seem to speak out loud Hey right here This is a tumor If you look at enough of them you may become convinced that you dont need medical training to spot a case of breast cancer or distinguish a false positive on a mammogram from a true one. The distinction seems that clear. If you can tell the difference as a nonradiologist imagine how a radiologist feels says Rafferty. The images sort of sell themselves. Much of the criticism focused on the data the task force had used to make its decision which consisted largely of the results from prospective randomized clinical trials conducted in the United States. Trials like this are the gold standard of medical evidence. They are also expensive and timeconsuming and thus hard to come by. The most recent such trial looking at mammography and mortality in the United States was published in the s. A lot of the people on the task force are my friends and I have tremendous respect for them but this was a big point where we differed says Brawley. The standard type of mammography thats used all over the country today may very well be better than what was used in that trial. So the outcomes may be better too. The studies the task force had chosen to examine showed that screening beginning at age had little impact on mortality while at the same time generating a significant number of false positives. Those data were complete and comprehensive. But says Brawley they were outdated. The task force wasnt expecting a firestorm. That however was what it got. Breast cancer advocacy groups mutinied saying the guidelines would cause significant numbers of women to go undiagnosed for years some of them fatally. Politicians started giving scary speeches about rationing health care. Many radiologists including the MGH department as a whole rejected the new guidelines. Daniel Kopans a world leader in breast imaging he wrote the textbook of that name and a radiologist at MGH now says that the panel didnt understand mammography screening. Furthermore he adds the new guidelines had no biological or scientific reason behind them. The last time someone tried to improve the way American women are screened for breast cancer it turned into a national debacle. In November the US Preventive Services Task Force a governmentbacked group of doctors charged with making recommendations that often influence what insurers will pay for updated its guidelines for mammography. Previously it had advised women to begin annual or biannual screening at . The new guidelines pushed that age to emphasizing that starting earlier should be an individual choice. Debates about mammography are often so emotionally charged that this type of nuance goes missing. I think some of our rhetoric medicines in general and also that of advocates has made people think that every metastatic breast cancer is a failure of the woman to get a mammogram or of a doctor to read a mammogram correctly says Otis Brawley chief medical officer of the American Cancer Society and a professor at Emory Universitys School of Medicine in Atlanta. In reality yes mammography does save lives but it is far from perfect. Its not as good as many people think it is. So if the new D mammography isnt perfect just how good is it But the company and the rest of us should be careful not to overhype D mammography. As Rafferty says its not a panacea. The technology does come with costs financial and medical. A fully equipped D machine runs on average not including the annual service fee Hologic charges for maintenance and even hospitals that already own an upgradeable D system made by Hologic have to pay about to get it adapted for D use. There are also costs in the sense of risks Women who get a combo D and D mammogram the protocol that confers the most dramatic jump in benefits are exposed to twice as much Xray radiation as the norm albeit still an amount thats under the FDAs permitted limit. And no one yet knows if the new technique will actually save lives. Is Hologics D mammography machine likely to fare better There are reasons to think it will. Unlike MRI which requires an injection with contrast dye and an hour in the imaging machine it isnt an ordeal or at least its no worse than a conventional mammogram. Yes you still have to endure the dreaded clamp. And it seems to be more effective than its most similar precursor the D digital technique. Early data from Raffertys trial showed that the same group of women who did benefit from D digital benefited even more dramatically from D. Its worth noting that this is not a small group of people. Fifty percent of women are in what the American Cancer Society considers the intermediate zone of risk which overlaps considerably with the group that saw some benefit in DMIST. Perhaps more important even the women who didnt see any improvement in accuracy with D get a small boost with D over film. And D seems to be both more sensitive and more specific improvement in one area doesnt have to come at the cost of the other. But when the definitive trial of D digital techniques called DMIST was published in tracking nearly patients it didnt provide the answers that advocates had been expecting. Digital mammography did seem to perform more accurately than film in women who were younger than women who were pre or perimenopausal and women with dense breast tissue. But when all women were considered as a group that benefit disappeared. On the whole it turned out digital just didnt live up to the way it had been sold. When D digital mammography was introduced in doctors hoped it would vault over those problems. Well most of them. The cost concern was still present Digital mammography machines were five times as expensive as film ones. The marketing materials suggested it already had. An ad for GEs D digital system that ran during the Summer Olympics called it a major new breakthrough in the fight against breast cancer. Digital technology the thinking went would show nuances that film never could because it could render literally many more shades of gray. The problem however was that each time they introduced a new imaging tool for breast cancer they found that they could not advance on one front without taking a step backward on the other. First there was ultrasound says Rafferty. We did find more cancers but we also found so many false positives that it was untenable. Then there was MRI which had the same problem and it was times more expensive than mammography. Rafferty had already been running trials of D mammography for two years when the task forces guidelines came out. She understood its concern about false positives she was trying to address it herself albeit in a very different way. In fact technology developers had been trying in various ways for years to increase mammographys sensitivity its ability to flag possible cases of cancer while also increasing its specificity its ability to filter out the false positives. Theres an intuitive argument for why D mammography might be more accurate. The technique works a little like a CT scan does it takes pictures of the breast at slightly different angles then fuses them into a single synthesized image. If breast cancers were spherical in shape theyd look basically the same in all images or for that matter on a conventional D picture. But theyre very rarely shaped that way in reality. In the breast in particular cancer cells tend to creep out singlefile along the architecture of the body says Rafferty. And that makes some of them especially hard to see on a D mammogram. They look like distortions not blobs. Theres another thing about cancer that is much clearer on a D mammogram spicules or thin spidery tentacles emerging from the center of a tumor. D images when taken from the wrong angle are often too fuzzy to show them. In D however the spicules are visible in high resolution and seeing them is critical since they are a hallmark of malignancy. To Rafferty the existing data are persuasive enough. I own no stock in Hologic. I have no financial ties to them. And I was skeptical of this idea at first. You think to yourself it is that simple That elegant she says. But this really does address the fundamental flaw of mammography. I want every woman to have access to this technology. I got my sisters down here when it was approved. I was like Youre all going to get this Because in my heart I know its better. Andy Smith Hologics vice president of imaging science is similarly hopeful. Its expected to improve the cancer detection rate. It is going to reduce the recall rate he says referring to suspicious findings that require women to return for followup tests some of which turn out to be false alarms. And we will have more numbers on that within one to two years. This last part at least is very likely true. Mammography is heavily regulated and clinics are required to send their recall statistics the number of women they call back for second looks to the federal government. The data on whether D will save more lives than D may not be known immediately. But they will exist. However the most meaningful data the numbers that would show whether D mammography saves womens lives wont be available for decades. Only a prospective randomized trial with mortality as its endpoint can say for sure and thats how long it takes to conduct one. Smith knows that thats the reality. We are expecting a reduction in morbidity and mortality but we wont know that for a long time he says. You know this technology has only been approved for two months. By the time such data do come out mammography will surely have changed again. There are already efforts to augment it with contrast dyes to develop a complementary tool called a gamma camera and to augment imperfect human judgment by refining computer programs that can spot tumors as well as a radiologist might. What this means is that the next time the US Preventive Services Task Force or anyone else wants to take a hard look at mammography the data it has will once again be outdated. Its inevitable. ThreeD mammography may very well be more accurate than D. It may see more cancers and fewer impostors. But whether its truly a huge breakthrough by the metric that matters most is a question that cant currently be answered and that may be irrelevant by the time it can be. Rafferty may know in her heart that D is better. But right now at least thats the only way she truly can."

"Starting your day off with an egg may help curb your appetite better than cereal new research suggests. In a small study it took longer for people who ate eggs for breakfast https to show signs of hunger https than it did for those who had a bowl of readytoeat cereal. Scientists suspect that egg protein may be better at making people feel full longer compared to the protein found in wheat. For people hoping to shed some pounds changing the type of protein in the diet rather than the amount of it is an idea the researchers think deserves more study as a weight loss strategy. This study shows that diets with higher protein quality may enhance satiety leading to better compliance and success of a weight loss diet https researcher Nikhil Dhurandhar PhD says in a news release. He is an associate professor in the department of infection and obesity https at the Pennington Biomedical Research Center in Baton Rouge La. One large egg has about calories and it contains about grams of protein grams of fat and milligrams of cholesterol https The research was funded by the American Egg Board and will be presented at theth European Congress on Obesity https in Lyon France. Eggs vs. Cereals In the study researchers tracked overweight or obese people giving them either a breakfast https containing eggs or cold cereal for one week. Although the breakfasts offered different protein foods the meals themselves were equally matched in terms of calories carbohydrates protein and fat. Its unclear how the eggs were prepared how many were served or what other foods were included in the breakfast meals. On the first and last day of the test week people were given a buffet lunch to eat. On those days researchers measured how hungry httpsfit.webmd.comkidsfoodrmqrmquizhungerwhatisit or full participants felt before and after breakfast and lunch and they recorded how many calories were consumed at the buffet. They also took blood https samples to determine levels of ghrelin a hungerstimulating hormone and PYY a hormone that signals fullness. Participants then got a twoweek break from the research followed by a second test week where they received the other breakfast food not had during the first week. Researchers found that people who had eggs in the morning felt fuller before lunch and they also ate less food from the buffet compared to those who had cereal. Egg eaters also had lower levels of ghrelin and higher amounts of PYY during the three hours between breakfast and lunch. This suggests they felt less hungry and more satisfied between meals. Longterm weight loss trials to compare the manipulation of protein quality without increasing protein quantity should be explored Dhurandhar says. This study will be presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

"Montmorency tart cherries may play a role in improving gut health suggests a firstofits kind human trial of nine adults combined with a parallel laboratory study published in the Journal of Nutritional Biochemistry https An international team of scientists found that Montmorency tart cherries helped to positively impact the gut microbiome a collection of trillions of bacteria and other microbes that live in the intestinal tract. The microbiome has been the focus of multiple studies in recent years due to its potential role in maintaining digestive health as well as its impact on immunity heart health blood sugar control weight management and even brain health. The gut microbiome holds great promise especially related to personalized nutrition although the research is still evolving and larger longterm human intervention studies are needed. However the new study does suggest that Montmorency tart cherries can be added to the list of gutfriendly foods. While previous studies on Montmorency tart cherries have ranged from heart health and exercise recovery to sleep this is the first study to explore the potential gut health benefits. The researchers speculate that it may be due to the polyphenols anthocyanins and other flavonoids in Montmorency tart cherries the varietal of tart cherries grown in the U.S. Polyphenols in plantbased foods are broken down by microbes to stimulate growth of good bacteria. Montmorency tart cherries were a logical food to study due to their unique composition of polyphenols including chlorogenic acids said principal investigator Franck Carbonero PhD assistant professor in the Department of Food Science at the University of Arkansas. Our results suggest that the unique polyphenol mixture in tart cherries may help positively shape the gut microbiome which could potentially have farreaching health implications. Research Methodology Researchers conducted both human and laboratory experiments to determine the impact of Montmorency tart cherries on the microbiome. In the human trial nine healthy adults years old drank ounces of Montmorency tart cherry juice from concentrate daily for five days. These individuals were nonsmokers and had not taken antibiotics which can affect the microbiome in the weeks prior and during the study. Using stool samples the participants microbiome was analyzed before and after the dietary intervention and food frequency questionnaires were used to evaluate their overall diet. The laboratory experiments were set up to mimic the conditions within the human digestive system specifically the stomach small intestine and three regions of the colon to study how polyphenols are broken down and absorbed. This process of breakdown and absorption can have a significant impact on the bodys ability to use the beneficial bioactive compounds in plantbased foods. The researchers tested U.S.grown Montmorency tart cherries European tart cherries sweet cherries apricots and isolated polyphenols in each simulated region of the digestive tract. They analyzed changes in the mix of bacteria and how these bacteria helped digest the polyphenols over time. Study Results In the human trial the microbiome was positively altered primarily measured by the increase in good bacteria after just five days of drinking Montmorency tart cherry concentrate although there were strikingly different responses due to the participants initial microbiome composition. Individuals who ate a more Western diet low in fruits vegetables and fiber potentially had a lower ability to metabolize polyphenols thereby reducing bioavailability and any potential health benefits in the tart cherries. Remarkably in these subjects instead of Bifidobacterium Collinsella were the beneficial polyphenoldegrading bacteria stimulated. The individuals who ate a more plantbased diet with higher intakes of carbohydrates and fiber responded with an increase in Bacteroides and Bifidobacterium presumably because of the specific combination of polysaccharides and polyphenols. While more research is needed these results suggest individuals consuming a more plantbased diet may have a mix of gut bacteria that responds more positively andor rapidly to tart cherry consumption. Individuals consuming a more Western diet that is lower in carbohydrates and fiber may have a lowerdifferent ability to metabolize polyphenols thereby altering bioavailability and any potential health benefits. The laboratory experiments found that pure polyphenols characteristics of tart cherries increased the amount of Bifidobacterium. However when concentrated juices were fermented this bifidogenic effect appeared to be leveled out by the larger increase of polysaccharides utilizing bacteria. Somewhat surprisingly Carbonero said chemistry analyses showed that tart cherries polyphenols were not completely converted to smaller phenolic metabolites suggesting that the full diversity of bacterial species in the human gut is required for efficient breakdown of the polyphenols in tart cherries. While the dietary intervention was based on a limited number of human volunteers and more research is needed to support these conclusions the results help build the foundation for future research and suggest Montmorency tart cherries can play a role in positively shaping the microbiome and maintaining gut health. Montmorency tart cherries are the most common variety of tart cherries grown in the U.S. and are available yearround in dried frozen canned and juice forms including juice concentrate which was the form used in this human trial. Montmorency tart cherry juice concentrate can be mixed with water or other juices. It can also be consumed straight from the bottle or used as an ingredient in recipes such as smoothies and other beverages. This study was made available online in April ahead of peerreview and publication this month. Source MaytaApaza AC Pottgen E De Bodt J et al. Impact of tart cherries polyphenols on the human gut microbiota and phenolic metabolites in vitro and in vivo. Journal of Nutritional Biochemistry. . Cherry Marketing Institute The Cherry Marketing Institute a notforprofit organization funded by U.S. tart cherry growers and processors provided financial support for the study. The funders had no role in the study design data collection and analysis decision to publish or preparation of the manuscript. CMIs mission is to increase the demand for Montmorency tart cherries through promotion market expansion product development and research."

"The cancer drug that former president Jimmy Carter says made his melanoma seemingly disappear has helped about percent of similar patients survive for as long as three years oncologists said Wednesday. The drug called Keytruda takes a new approach to treating cancer by stopping tumor cells from cloaking themselves against the normal healthy immune system response. New data about to be released to a meeting of cancer specialists shows that percent of the patients who have been taking the drug are still alive three years later. That compares to about percent of patients given the standard therapy interleukin the American Society for Clinical Oncology ASCO says. That means percent of patients are not living that long but its still far more than the usual month survival with advanced melanoma. It is definitely a huge benefit over what we have seen in the past said ASCO president Dr. Julie Vose a specialist in blood cancers at the University of Nebraska Medical Center. For some of those patients it is likely that their cancer never will come back. Melanoma is the deadliest form of skin cancer. It will be diagnosed in more than Americans this year according to the American Cancer Society and it will kill . Rates are rising in part because tanning became fashionable. Melanoma is easy to cure when caught early but it is often hard to tell if a mole or freckle has turned cancerous. Carter for example was only diagnosed http the tumors had spread to his brain last fall. Thats Stage IV cancer and its almost always deadly at that stage. But Carter has remained well enough to continue teaching his weekly Sunday school classes and said this past Sunday hed just traveled to London. He says theres no trace of his cancer now. In the past patients with this type of melanoma he has metastases to the brain you dont even see responses to therapy Vose told NBC News. This is something really different than what we have seen in the past. Other people are having similar experiences. For the trial Caroline Robert of Gustave Roussy and ParisSud University in France and colleagues treated patients with advanced melanoma. These are patients whose disease cannot be surgically removed cannot be cured by surgery and usually the majority of these patients have disease that involved vital organs said Dr. Stephen Hodi a melanoma specialist at the DanaFarber Cancer Institute who worked on the study. Seventyfive percent of them had already been given other cancer treatments including Yervoy known generically as ipilimumab. On average the patients lived two years and percent of them are still alive three years later. About percent of these patients have whats called a complete remission meaning there is no trace of their tumors. That doesnt mean a cure its too soon to say that but it does mean months or years of cancerfree life that they otherwise could not have hoped for. And of the patients or percent have stopped taking the drug after their tumors went away. Virtually all of them are still in remission. This is huge in the melanoma community said Tim Turnham executive director of the Melanoma Research Foundation. Its difficult to know at what point you call it a cure. For the patient though it means they are cancerfree and for some of those patients it is likely that their cancer never will come back Turnham told NBC News. When this study was started the average life expectancy of someone with advanced melanoma was months and now were seeing that a large percentage of people are living at least three years. 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. Keytruda an engineered immune protein called a monoclonal antibody disrupts this signal and lets the immune cells attack the tumor cell. The drug works far better in patients whose tumors express more PD meaning they have a lot of PD activity so the drug will optimally be used jointly with a test for PD. There are sideeffects including fatigue itchiness and rash. It was bad enough for percent of patients that they stopped taking it. In a matter of a few years these therapies have truly transformed the outlook for patients with melanoma and many other hardtotreat cancers. The Food and Drug Administration gave Keytruda accelerated approval for melanoma i http . Its got breakthrough therapy designation for Hodgkins lymphoma and colon cancer and got accelerated approval for lung cancer. In a matter of a few years these therapies have truly transformed the outlook for patients with melanoma and many other hardtotreat cancers said Dr. Don Dizon an oncologist at Massachusetts General Hospital and a spokesman for ASCO. Keytrudas being tested in other cancer types now. Earlier Wednesday the FDA gave accelerated approval to a drug that works in a similar way. It approved Tecentriq known generically as atezolizumab for use in patients with advanced bladder cancer. Like Keytruda Tecentriq is a monoclonal antibody. It goes straight to PDL so its target is slightly different. FDAs approval was made on the basis of a trial that showed percent of patients with advanced bladder cancer who had high levels of PDL activity saw their tumors disappear compared to . percent of patients on other treatments. Another percent had a partial response meaning their tumors shrank a little compared to . percent on standard treatment. The drugs must be infused and they are pricey. Keytruda costs about a month or a year."

"In an early study an experimental stem cell procedure helped teens httpsteens.webmd.comdefault.htm with type diabetes httpsdiabetes.webmd.comguidediabetesoverviewfacts stay off of insulin https injections for about . years on average. The study was very small and the procedure is not ready for widespread use. We now have a unique approach with some positive findings but its still early. We need to better understand the biology behind the treatment and follow patients for longterm side effects Robert E. Ratner MD chief scientific and medical officer of the American Diabetes https Association tells WebMD. This is the latest of several stem cell studies to show promising results for the treatment of type diabetes https Ratner notes. In the new study of teens with type diabetes https who got an experimental treatment using their own stem cells https went into remission and did not need insulin https injections for an average of about . years. The cocktail treatment combines stem cell therapy with drugs that suppress the bodys immune system. In type diabetes https the immune system attacks and destroys insulin https cells within the pancreas https The experimental treatment is called autologous nonmyeloablative hematopoietic stem cell transplantation HSCT. It aims to kill the destructive immune system cells and replace them with immature stem cells https not programmed to destroy insulinproducing cells. First patients are given drugs to stimulate production of blood https stem cells. The blood https stem cells are then removed from the body and frozen. Then patients are hospitalized and given drugs to kill the destructive immune system cells. The harvested blood stem cells are then put back into the patient. Eight teens who took part in the study have remained insulinfree for two years on average. One patient has gone without insulin injections for . years. All our patients considered the treatment to be worthwhile and beneficial though some patients experienced side effects study head Weiqiong Gu MD of Ruijin Hospital in Shanghai tells WebMD. As a result of the immunesystem suppressing drugs most of the patients in Gus study experienced side effects including low white blood cell counts fever nausea https vomiting https hair loss https and suppression of bone marrow. Most of those side effects disappeared within two to four weeks and unlike in previous studies of the experimental therapy none of the patients developed infections pneumonia https low sperm https counts or organ damage. One woman became pregnant https by natural means a year after transplantation and delivered a healthy girl Gu says. Still patients have to be followed for years to ensure they do not develop known longterm complications of immunesuppressing drugs including tumors and infertility https Gu says. The findings were presented here at the annual meeting of the American Diabetes https Association and appear in the July issue of the journal Diabetes Care."

"Strobe lighting has been shown to reduce levels of the toxic proteins seen in Alzheimers disease in findings that raise the tantalising possibility of future noninvasive treatments for the disease. The study in mice found that exposure to flickering light stimulated brain waves called gamma oscillations that are known to be disturbed in Alzheimers patients. Boosting this synchronous brain activity appeared to act as a cue for the brains immune cells prompting them to absorb the sticky amyloid proteins that are the most visible hallmarks of the disease in the brains of people with Alzheimers. The authors caution that a big if remains over whether the findings would be replicated in humans and whether cognitive deficits as well as visible symptoms of the disease would be improved. If humans behave similarly to mice in response to this treatment I would say the potential is just enormous because its so noninvasive and its so accessible said LiHuei Tsai director of the Picower Institute for Learning and Memory at MIT and the papers senior author. Alzheimers research has faced a number of major setbacks most recently the failure of Eli Lilys drug trial https after promising results in rodents did not translate into clinical improvements for patients. The latest intervention scientists predict should be quicker and cheaper to confirm in humans than pharmaceuticals which typically take more than a decade to develop and assess for safety before the clinical efficacy is even examined. The study published on Wednesday httpnature.comarticlesdoi.nature in the journal Nature hinges on the observation that Alzheimers patients show a loss of synchronised brain activity known as gamma oscillations which is linked to attention and memory. To restore the activity the scientists first used mice that had been genetically engineered such that the neurons that generate gamma activity in the brain were sensitive to light. The technique known as optogenetics allowed the scientists to artificially cause groups of neurons to fire in unison by pulsing light into the brains of the mice. After an hour of stimulation the researchers found a roughly reduction in the levels of beta amyloid proteins in the hippocampus the brains memory centre. Closer inspection showed that the amyloid had been taken up by microglia the brains immune cells. In a healthy brain microglia act as chemical rubbish collectors surveying the local environment clearing up unwanted compounds but in Alzheimers these cells can lose this function and switch into an inflammatory state in which they secrete toxic compounds instead. Strengthening gamma oscillations appeared to switch the microglia back into a productive state. Next the scientist showed that gamma oscillations could also be stimulated noninvasively in the visual brain region simply by exposing the mice to a flickering light. At Hz the flicker of the light is barely discernible and would be not offensive at all for a person to have in the background. After being given one hour of flickering light each day for a week the scientists saw a reduction of harmful amyloid plaques in the brains of the mice. Ed Mann an associate professor of neuroscience at the University of Oxford said I was surprised and its exciting that such a simple stimulus can target a molecular pathway and have such an effect in an hour. Questions remain however about whether boosting gamma oscillations and sweeping amyloid plaques out of the visual brain region would help with memory which is centred in the hippocampus or broader cognitive abilities. David Reynolds chief scientific officer at Alzheimers Research UK said It is conceivable that changing brain cell rhythms could be a future target for therapies but researchers will need to explore how light flickering approaches could not only reduce amyloid in the visual area of the brain but in those areas more commonly affected in Alzheimers. The authors suggest that it may be possible to take a multisensory approach using a combination of flashing lights and vibrating chairs. Tsai and Ed Boyden a colleague at MIT and coauthor have started a company called Cognito Therapeutics to pursue tests in humans. There are people with dementia in Britain and this figure is expected to reach million by . Earlier this year dementia overtook heart disease https as the leading cause of death in England and Wales."

"Women who want to quit smoking may find it easier if they time their efforts just right. A new study finds hormone fluctuations that occur over the course of a womans menstrual cycle may impact her ability to kick the cigarette habit. According to small study http conducted by researchers at the University of Montreal women are more likely to crave cigarettes and have trouble quitting when in the follicular phase of their monthly cycle. This is the time right after her period and before ovulation. While overall more men than women smoke cigarettes https women and girls take less time to become dependent after initial use and have more difficulties quitting the habit the researchers write in their study. One of the factors contributing to these differences may be that women crave cigarettes more than men and that their desire to smoke is influenced by hormonal fluctuations across the menstrual cycle. The study which was published in Psychiatry Journal involved women and men who were all chronic smokers but otherwise healthy. None of the study participants were enrolled in a smoking cessation program or were trying to quit. Researchers asked each participant to smoke one cigarette to minutes before undergoing an fMRI or brain scan. They were asked to view photos both related and unrelated to smoking. After undergoing the brain scans they viewed the photos a second time and reported on a scale from zero to if the pictures triggered cigarette cravings. The researchers tested of the female participants twice to assess how their response changed at a different point in their menstrual cycle. The brain scans showed that during the follicular stage cigarette imagery activated five areas of the brain which the researchers say are linked to higherlevel cravings. However during the luteal phase after a woman ovulates and before her period only one area of the brain was activated by images of cigarettes and smoking https During the luteal phase estrogen and progesterone levels are at their highest which may help a woman keep addictive cravings at bay and reduce feelings of cigarette withdrawal. Previous studies have found womens monthly hormone fluctuations can affect everything from food cravings and digestive problems to joint pain and a whole host of other health issues. This result emphasizes the need for genderspecific programs to quit smoking https as well as taking into consideration a menstrual cycle phase during addiction treatment in women the researchers conclude. They called for more studies to help understand all the factors that contribute to sex and gender differences in smoking."

"Preliminary experiments in a handful of people suggest that it might be possible to reverse Type diabetes using an inexpensive vaccine to stop the immune system from attacking cells in the pancreas. Research in mice had already shown that the tuberculosis vaccine called BCG prevents T cells from destroying insulinsecreting cells allowing the pancreas to regenerate and begin producing insulin again curing the disease. Now tests with very low doses of the vaccine in humans show transient increases in insulin production researchers will report Sunday at a San Diego meeting of the American Diabetes Assn. The Massachusetts General Hospital team is now gearing up to use higher doses of the vaccine in larger numbers of people in an effort to increase and prolong the response. The findings contradict an essential paradigm of diabetes therapy that once the insulinsecreting beta cells of the pancreas have been destroyed they are gone forever. Because of that belief most research today focuses on using vaccines to prevent the cells destruction in the first place or on using beta cell transplants to replace the destroyed cells. The new findings however hint that even in patients with longstanding diabetes the body retains the potential to restore pancreas function if clinicians can only block the parts of the immune system that are killing the beta cells. The results are fascinating and very promising said immunology expert Dr. Eva Mezey director of the adult stemcell unit at the National Institute of Dental and Craniofacial Research. But Mezey noted that the results had been achieved in only a small number of patients and that they suggest the vaccinations would have to be repeated regularly. The key player in the diabetes study is a protein of the immune system called tumor necrosis factor or TNF. Studies by others have shown that if you increase levels of TNF in the blood it will block other parts of the immune system that attack the body especially the pancreas. To raise TNF levels Dr. Denise Faustman of Massachusetts General Hospital and her colleagues have been working with the BCG vaccine known formally as Bacille CalmetteGuerin. BCG has been used for more than years in relatively low doses to stimulate immunity against tuberculosis. More recently it has been used in much higher doses to treat bladder cancer. Faustman first reported her findings in mice in a paper in the Journal of Clinical Investigation but scientists reviewing her findings for that journal were so skeptical that she was not allowed to refer to regeneration of the pancreas in the paper. Instead she was told to say restoration of insulin secretion by return of blood sugar to normal. In she published a report in the journal Science in which she was able to use the word regeneration but that finding was met by an explosion of skepticism she said. Nonetheless by six international labs had duplicated the mouse experiments she said. We needed to move forward into humans. In the human trial Faustman and her colleagues studied six patients who had been diagnosed with Type diabetes for an average of years. They were randomly selected to receive either two doses of BCG spaced four weeks apart or a placebo. Careful examination of those receiving the vaccine showed a decline of T cells that normally attack the pancreas. It also revealed a temporary but statistically significant elevation of an insulin precursor called Cpeptide an indication that new insulin production was occurring. If this is reproducible and correct it could be a phenomenal finding said Dr. Robert R. Henry of UC San Diego who chaired the scientific program at the meeting. It suggests that once the destructive immune response is controlled the body has the capability to produce more insulin he said. One of the patients receiving a placebo also showed a similar elevation of Cpeptide but that patient coincidentally became infected by EpsteinBarr virus which is known to induce production of TNF. The concentrations of BCG that the team used were much lower than they would have liked but were the highest the Food and Drug Administration would permit Faustman said. She said she is now negotiating with the agency to use higher levels which should produce a more pronounced effect and to enroll more people. The research is funded by philanthropists primarily the Iacocca Family Foundation."

"If you had a history of suffering from migraines and could prevent the debilitating headaches by swallowing a few pills youd do it wouldnt you Actually odds are you wouldnt. Neurologists say that only about onethird of those who could benefit by migrainepreventing medication actually use it. Preventive treatment involves taking a seizure drug and a betablocker every day to reduce the frequency severity and duration of migraines. Neurologists estimate http_ipsecsha that about of people who suffer from migraines stand to benefit with such a regimen and studies suggest that as many as half of migraines can be prevented with drugs according to Dr. Stephen D. Silberstein a neurologist at the Jefferson Headache Center at Thomas Jefferson University in Philadelphia. Silberstein was the lead author of new migraine treatment guidelines http presented Monday at the annual meeting of the American Academy of Neurology in New Orleans. It would seem that migraineurs would be eager to stop these headaches before they start. In a summary of the guidelines http written for patients and their families this is how migraines are described Migraine is a condition that involves recurring headaches. Each headache may last from four hours to two days. It can cause throbbing pain in the head. Other symptoms may include nausea upset stomach vomiting and extreme sensitivity to light or sound. Most people with migraine have attacks that happen repeatedly. Yuck. People whose migraines are infrequent or mild may not be able to prevent them with drugs the guidelines say. But for those who can the best seizure drugs are divalproex sodium Depakote sodium valproate Depakote Depakene Stavzor and topiramate Topamax or Topiragen. Betablockers are usually taken to treat high blood pressure heart arrhythmias and other cardiovascular conditions though metoprolol Lopressor or Toprol propranolol Inderal and timolol Blocadren can also help with migraines. The authors also noted that frovatriptan Frova which is used to treat migraine symptoms can also help prevent menstrual migraines. These medications are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity Silberstein and colleagues wrote in the new guidelines which were based on a review of publications. In addition an herbal remedy derived from a family of plants called Petasites or butterbur was found to be effective according to the review. The review identified a handful of drugs that are probably effective and should be considered for migraine prevention. These include the antidepressants amitriptyline Elavil Endep or Vanatrip and venlafaxine Effexor the beta blockers atenolol Senormin or Tenormin and nadolol Corgard and for menstrual migraines naratriptan Amerge and zolmitriptan Zomig. People need to keep in mind that all drugs includingoverthecounter drugsand complementary treatments can have side effects or interact with other medications which should be monitored Silberstein said in a statement. Five of the six coauthors of the new guidelines including Silberstein disclosed that they receive research funding speaking fees and other payments from drug companies. The guidelines will be published in Tuesdays edition of the journal Neurology. They were developed in conjunction with the American Headache Society. You can read the new guidelines here http or check out the patientfriendly summary here http Return to the Booster Shots blog."

"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"

"Cancer patients undergoing chemotherapy may be able to avoid the accompanying muscle loss and malnutrition by taking fish oil supplements that contain omega fatty acids new research suggests. The finding is based on a small study involving just lung cancer patients. Nevertheless it raises hope that a simple noninvasive intervention might go a long way towards countering the fatigue poorer prognosis and impaired quality of life that can result from chemoinduced muscle mass loss. Fish oil may prevent loss of weight and muscle by interfering with some of the pathways that are altered in advanced cancer study author Dr. Vera Mazurak of the University of Alberta in Edmonton Canada said in a news release. This holds great promise because currently there is no effective treatment for cancerrelated malnutrition. Mazurak and her colleagues report their observations in the Feb. online edition of Cancer. To explore the therapeutic potential of fish oil supplements the authors offered cancer patients undergoing an initial week chemotherapy regimen a daily dose of . grams of a particular omega fatty acid called eicosapentaenoic EPA. While these patients took fish oil supplements throughout their chemotherapy treatment a second group of patients underwent the same regimen minus the fish oil. The results continual muscle and fat measurements revealed that the group that took no fish oil supplementation lost an average of just over pounds the supplement group lost no weight. Whats more blood analyses revealed that those in the fish oil group who had the biggest bump in bloodstream EPA concentrations also had the greatest muscle mass gains. Specifically nearly percent of those in the fish oil group either kept their prechemo muscle mass or gained muscle. By comparison less than percent in the nonsupplement group kept their original muscle mass. Total fat tissue measurements were unaffected by fish oil supplementation the team noted and no side effects were observed. The authors concluded that fish oil supplementation appears to be a safe and effective way to prevent malnutrition among cancer patients and may ultimately prove to be of benefit for other groups of people such as elderly patients who also face a significant ongoing risk for muscle loss. Lona Sandon a registered dietitian and assistant professor of clinical nutrition at the University of Texas Southwestern Dallas reacted with cautious optimism to the findings. Malnutrition is a big concern with cancer patients undergoing chemotherapy and radiation she noted. Because first of all they do have wasting from the cancer itself which is very metabolically active and eats up your energy stores. And then with chemotherapy there is some inflammation thats detrimental to the heart and muscle as it can cause muscle breakdown. And preservation of lean muscle tissue we know leads to better outcomes. So certainly this does seem to be promising Sandon said. And other similar studies have looked at omega and muscle preservation and have also suggested that fish oil can act to prevent inflammation caused by both disease and hardcore medications like chemotherapy agents. But I would caution that the amount of pure concentrated fish oil supplement the people in this study were given is a lot she added. Much much more than any recommended dietary allowance along the lines of two to three servings of fish per week. But she said I would say this is certainly worthy of continuing research and exploration. But meanwhile people should definitely not go out and start consuming huge amounts of fish oil. More information For more on chemotherapy visit the American Cancer Society http SOURCE Cancer Feb. news release Lona Sandon dietitian and assistant professor clinical nutrition University of Texas Southwestern Dallas"

"Postoperative cognitive dysfunction POCD a condition mostly observed in older patients following surgery under general anesthesia is characterized by impaired memory and concentration. The impairment may be temporary or permanent and incapacitating. The problem has become more frequent as the population ages and also as a growing number of older adults undergo surgical procedures made possible by more advanced medical technology. Data from the scientific literature suggest a rise in mortality from POCD in the first year after surgery under general anesthesia. The good news according to a Brazilian study published by the journal PLoS One is that two relatively simple measures can help to reduce the incidence of POCD administering a small dose of the antiinflammatory drug dexamethasone immediately before an operation and avoiding profound anesthesia during the operation. Opinions on the adequate depth of anesthesia and the risks of very profound anesthesia currently diverge. Excessively superficial anesthesia is known to incur a risk of patient recall of the procedure which is undesirable. Our findings confirm recent evidence that the deeper the anesthesiainduced hypnosis the higher the incidence of POCD. The literature points to a link with the systemic inflammatory response induced by surgical trauma damaging the central nervous system. If so the use of an antiinflammatory drug may have a protective effect said Maria Jos Carvalho Carmona a professor of anesthesiology at the University of So Paulos Medical School FMUSP and principal investigator for the study. The researchers evaluated patients aged between and who underwent surgery under propofolinduced general anesthesia at the Central Institute of Hospital das Clnicas FMUSPs teaching hospital in most cases for removal of gallstones. Preoperative assessment included a battery of tests to measure mental and cognitive status. Patients who failed to achieve a cutoff score were excluded. The remaining subjects were divided randomly into four groups. In the operating room deep anesthesia typical of major surgical procedures was induced in the first and third groups and more superficial anesthesia in the second and fourth. Only the third and fourth groups received dexamethasone. The depth of anesthesia was monitored using bispectral index BIS technology which processes electroencephalogram signals to measure druginduced unconsciousness. The researchers classified a BIS of as deep anesthesia and a BIS of as superficial anesthesia. In the fourth group superficial anesthesia with dexamethasone the incidence of POCD was . immediately after surgery but after six months the preoperative cognitive status was restored in all patients. The results reinforce recent evidence of the importance of avoiding deep anesthesia Carmona said. With regard to the use of dexamethasone more research is needed to confirm our finding preferably in multicenter trials but there are strong indications that it can be beneficial in many cases. The earliest trials with patients who developed POCD were performed after the s. Before that older patients were rarely subjected to major surgery and significant research in this field has only been conducted for approximately years. The causes of and risk factors for POCD are still being discussed she said. Little is said about rehabilitation or ways of helping patients recover preoperative cognitive function. One of the obstacles to reliable diagnosis and rehabilitation is a lack of practical and secure instruments for pre and postoperative cognitive assessment. The tests available today are either too time consuming or quick but unreliable Carmona said. This makes it hard to follow up on patients."

"Millions of Americans take baby aspirin every day to prevent a heart attack or stroke. If they are at high risk of heart disease theyre doing the right thing according to draft recommendations http issued Monday by the U.S. Preventive Services Task Force. The independent panel also said that taking lowdose aspirin daily for at least years may protect against colorectal cancer at least in people who are already taking it to prevent heart attacks and stroke. Adults between the ages of and who have a percent or greater risk of having a heart attack or stroke in the next years benefit the most from taking about milligrams of aspirin every day the panel says. But the potential benefit is smaller for adults between the ages of and . And its unknown for adults under or over . People should talk with their health care provider to find out if they have health problems that would justify taking aspirin according to Dr. Douglas Owens httpsmed.stanford.eduprofilesdouglasowens a professor of medicine at Stanford University and a member of the task force. For example uncontrolled high blood pressure or high cholesterol obesity age and diabetes can all increase heart disease risk. Because heart attacks are caused by clots in the arteries of the heart aspirin can help prevent heart attack and it can also help prevent strokes that are caused by blood clots Owens says. Several groups including the American Heart Association offer online calculators http_UCM__Article.jsp to help people figure out their risk which along with discussion with a health care provider can help determine whether daily aspirin might be useful. However there is a caveat. Daily aspirin can cause bleeding in the stomach and brain. And Owens says that people with medical conditions like ulcers kidney problems liver problems or bleeding disorders are more vulnerable as are people who take bloodthinning drugs and NSAIDs. These new recommendations arent final and are open to public comment. Concerns have been raised about whether aspirin is really effective enough when so many other medicines are available to help control heart disease risk. One physician with major concerns is Steven Nissen httpmy.clevelandclinic.orgstaff_directorystaff_displaydoctorid chairman of cardiovascular medicine at the Cleveland Clinic in Cleveland Ohio. I think that millions of Americans are taking aspirin some of them are really the worried well he says. If people dont have a significantly increased risk of having a heart attack or stroke over the next decade Nissen says they may be causing more harm than benefit. And while many medical groups recommend daily aspirin to lower heart disease risk not all federal agencies agree. The Food and Drug Administration actually issued a warning http against routinely taking aspirin to prevent heart disease in people without significantly high risk. Nissen worries that many people are mistaking their actual heart disease risk. With all the good therapies better blood pressure control better cholesterol control all the things we do in modern medicine he says over the last couple of decades weve had nearly a percent reduction in the rate of cardiovascular disease. People who dont really need to should not be taking aspirin every day says Nissen. Its just not prudent or safe he says noting that bleeding in the abdomen or brain is extremely dangerous and can be fatal. Nissen does agree with the general consensus that taking low dose aspirin is beneficial for people who have had a heart attack or stroke. But for pretty much everyone else assessing actual heart disease risk in consultation with your doctor is crucial to deciding whether to take aspirin every day."

"Heart failure patients have weakened hearts but researchers say an experimental drug used for the first time in humans may repair heart cells and improve heart function. According to the results of a small phase trial a single intravenous infusion of the drug cimaglermin was safe and at high doses improved heart function for at least three months. Right now we have many therapies that we use for heart failure and these patients in the study were on all of those therapies and still had significant heart dysfunction said lead researcher Dr. Daniel Lenihan. Hes a professor of medicine and director of Vanderbilt Universitys heart clinical research program in Nashville. People with heart failure often take a combination of drugs Lenihan said. These include medications to lower blood pressure and diuretics to help remove excess fluid that builds up as a result of the hearts labored pumping ability. In addition some people have implanted defibrillators or pacemakers. Even with all these options the death rate among these patients is unacceptably high Lenihan said. Heart failure a condition where the heart cant pump enough blood to meet the bodys needs is among the leading causes of death worldwide. A significant number of heart failure patients dont respond well to current treatments particularly those patients whose left lower heart chamber which pumps blood into the arteries is weak Lenihan said. Cimaglermin acts as a growth factor for the heart helping it repair itself following injury Lenihan said. Specifically it binds to the HER and HER receptors on the surface of heart cells that are important for cellular repair and survival he explained. Researchers have tried using stem cells to repair heart muscle in much the same way he said but these efforts have not been effective. You dont see any sustained effect he added. A phase trial like this one is designed to see if a new drug is safe not to test its effectiveness. Before cimaglermin could be used to treat patients it must prove its worth in a series of progressively larger and challenging trials and then be approved by the U.S. Food and Drug Administration. The process can take several years. Based on these preliminary findings larger trials are being planned Lenihan said. This drug although still in an experimental phase might be an important way to improve heart function in patients with heart failure he said. For the study Lenihan and his colleagues randomly assigned patients to get an infusion of cimaglermin or a placebo. Compared with patients who received a placebo patients given a high dose of cimaglermin had a sustained increase in the hearts ability to pump blood. The improvement lasted days with the maximum increase in heart function reached in days the researchers found. The most common side effects were headache and nausea directly after receiving the drug. One patient who received the highest dose of cimaglermin developed abnormal liver function which cleared up over a twoweek period Lenihan said. The study was funded by Acorda Therapeutics the maker of cimaglermin and the report was published online Dec. in the journal JACC Basic to Translational Science. Dr. Nanette Bishopric is a professor of medicine at the University of Miami Miller School of Medicine and the author of an accompanying journal editorial. There havent been breakthrough treatments for heart failure for a long time she said. Cimaglermin however may be such a drug she said. Its a remarkable thing that you could give a drug once and have it affect heart function three months later its really extraordinary she said. Every drug currently used to treat heart failure has to be given daily or several times a day to get it to work Bishopric said. And when you stop taking it it stops working she said. Despite the encouraging results of this first trial a lot more testing will be needed before cimaglermin can be considered a standard treatment for heart failure Bishopric said. These findings need to be replicated in larger trials and you have to be able to predict whether improved heart function from cimaglermin will help people live longer and feel better she noted. More information For more on heart failure visit the American Heart Association http_UCM__SubHomePage.jsp. SOURCES Daniel J. Lenihan M.D. professor medicine and director heart clinical research program Vanderbilt University Nashville Nanette Bishopric M.D. professor medicine University of Miami Miller School of Medicine Dec. JACC Basic to Translational Science online"

"Women who take part in exercise diet programs or a combination of the two during pregnancy can prevent excessive weight gain according to a fresh review of past research. The review incorporates dozens of new studies to update a previous review that did not find enough evidence to support the use of diet and exercise during pregnancy. After including the new studies the new review found highquality evidence to show diet exercise or both can reduce the risk of excessive weight gain during pregnancy write the researchers in The Cochrane Library. Other benefits may include a lower risk of cesarean delivery excessive birth weight and respiratory problems in the newborn particularly for highrisk women receiving combined diet and exercise interventions add the researchers led by Benja Muktabhant of Khon Kaen University in Thailand. The U.S. Institute of Medicine says the amount of weight women should gain during pregnancy varies depending on their nonpregnancy weight. For example a normalweight woman should gain between and pounds while an overweight woman should gain between and pounds. Obese women should gain even less. Gaining too much weight is tied to an increased risk of complications for both mother and child according to the researchers who completed the review for The Cochrane Collaboration an international organization that evaluates medical research. For the new review the researchers examined data from randomized controlled trials which are considered the gold standard of medical research. They were able to combine data from trials involving a total of pregnant women. The women were randomly assigned to a diet exercise a combination of the two or standard care. The diets and exercise programs varied but could include lowglycemic diets and unsupervised exercise. Women who took part in diet exercise or combination programs were about percent less likely than women in standardcare groups to gain too much weight while pregnant the researchers report. The women who took part in diet exercise and combination programs were also less likely to develop high blood pressure during pregnancy compared to those in the standard care group. There was no clear benefit among the women in the diet and exercise groups when the researchers looked at other complications such as cesarean delivery but it did look like there may be some benefit they write. While the new study generally did not show fewer complications in the diet and exercise group Dr. Loralei Thornburg told Reuters Health that its good that there was no increase in complications. This was very reassuring that there wasnt an increased risk of preterm birth with moderate exercise said Thornburg a highrisk pregnancy expert at the University of Rochester Medical Center in New York. Most people gain more weight than they probably should during pregnancy Thornburg who was not involved with the review told Reuters Health. She said women who gain too much weight may not be able to lose it after the baby is born. Then during the next pregnancy the woman is already heavier and that may increase the risk of complications. In the next pregnancy if you dont get it off you may go from obese to very obese Thornburg said. ADVERTISING She cautioned however that women should check with their doctors before starting a diet and exercise program during pregnancy. SOURCE bit.lyClYDc httpbit.lyClYDc The Cochrane Library online June . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Patients receiving cancer treatment could increase their chance of survival by up to and help stop their cancer from spreading by taking a lowdose of aspirin new research suggests. In a systematic review of the available scientific literature a team from Cardiff Universitys School of Medicine found a significant reduction in mortality and cancer spread by patients who took a lowlevel dose of aspirin in addition to their cancer treatment average study followup length over years. There is a growing body of evidence that taking aspirin is of significant benefit in reducing some cancers said Professor Peter Elwood who led the research published in the journal PLOS ONE. Whilst we know a lowdose of aspirin has been shown to reduce the incidence of cancer its role in the treatment of cancer remains uncertain. As a result we set out to conduct a systematic search of all the scientific literature. The teams review looked at all of the available data including five randomised trials and forty two observational studies of colorectal breast and prostate cancers. Professor Elwood said Our review based on the available evidence suggests that lowdose aspirin taken by patients with bowel breast or prostate cancer in addition to other treatments is associated with a reduction in deaths of about together with a reduction in the spread of the cancer. The results from six studies of other cancers also suggest a reduction but the numbers of patients were too few to enable confident interpretation. A mutation known as PIKCA was present in about of patients and appeared to explain much of the reduction in colon cancer mortality by aspirin. One of the concerns about taking aspirin remains the potential for intestinal bleeding. Thats why we specifically looked at the available evidence of bleeding and we wrote to all authors asking for further data. In no study was serious or lifethreatening bleeding reported. As a result of the review the team say their study highlights the need for randomised trials to establish the evidence needed to support lowdose aspirin as an effective additional treatment of cancer. Professor Elwood added While there is a desperate need for more detailed research to verify our review and to obtain evidence on less common cancers wed urge patients diagnosed with cancer to speak to their doctor about our findings so they can make an informed decision as to whether or not they should take a lowdose aspirin as part of their cancer treatment. This is not the only significant study Professor Elwood led research examining ways to improve peoples health. In Elwoods team reported the very first randomised trial of aspirin in the prevention of vascular mortality in the British Medical Journal. Professor Elwood also led a major study which monitored the health habits of men over a year period and found that exercise significantly reduces the risk of dementia. The study was the longest of its kind to probe the influence of environmental factors in chronic disease. The study identified five healthy behaviours as being integral to having the best chance of leading a diseasefree lifestyle taking regular exercise nonsmoking a healthy bodyweight a healthy diet and a low alcohol intake."

"A new study bolsters the case that daily aspirin may help protect against cancer although the effect seems weaker than previously thought. An aerial view shows an administration building of the German Bayer AG chemical company in Leverkusen wrapped as giant Aspirin box. And the final chapter on the popular but controversial drug has yet to be written experts say because like earlier research the new work has considerable limitations. News about the cancer potential of aspirin use has been really encouraging lately said Dr. Michael Thun of the American Cancer Society who worked on the study. Things are moving forward but it is still a work in progress. Medical guidelines in the U.S. already urge people to take low doses of aspirin to prevent heart disease if the predicted benefits outweigh the risk of side effects or if they have already suffered a heart attack. Whether those recommendations should be broadened to include cancer prevention is still up in the air however. Earlier this year an analysis of previous clinical trials showed that people on aspirin were less likely to die of cancer than those not on the medication with a percent drop in cancer deaths observed from five years onwards. The new report published Friday in the Journal of the National Cancer Institute is based on reallife observations instead of experiments. It includes a decades worth of data from more than men and women in the U.S. most over and all of them nonsmokers. People who said they took daily aspirin whether baby or adult strength had a percent lower risk of dying from cancer than nonusers overall Thun and his colleagues found. For men the difference came out to fewer cancer deaths a year per people for women the number was . The effect was strongest for gastrointestinal cancers such as colon cancer and stomach cancer. But it didnt seem to matter whether people had been on aspirin for more or less than five years. Because the study wasnt a clinical trial its hard to know if the findings can be chalked up to aspirin or if something else is at play. Still Thun said the results would favor broadening the aspirin guidelines to include cancer prevention based on an individual riskbenefit assessment. But he added that it will take scientists a few years to mull over all of the existing evidence. LONGSTANDING CONTROVERSY Other researchers are more skeptical. Dr. Kausik Ray of St. Georges University of London who has studied aspirin said the new study did not look at overall death rates or side effects such as serious stomach bleeds. This is not a drug without side effects so what you have to look at is net benefit he told Reuters Health. Earlier this year Rays team published an analysis of previous aspirin trials showing the medication did not prevent deaths from heart disease or cancer and was likely to cause more harm than good. One of the problems with the new study as well as with previous aspirin trials he said is something called detection bias. People who develop stomach bleeding from aspirin are likely to get their bowels checked out by a doctor. As a result doctors may find and remove tumors or precancerous polyps which could prolong the patients life the idea behind colon cancer screening. So far most aspirin trials have been designed to test the drugs effect on heart disease. Ray called for trials that specifically check people for new cancers at given intervals to weed out the selection bias marring the previous research. I dont think we have enough hard evidence suggesting everybody should be taking aspirin Ray said. When it comes to cancer the governmentbacked U.S. Preventive Services Task Force agrees. It discourages the use of aspirin to stave off colorectal cancer in people at average risk for the disease. SOURCE Journal of the National Cancer Institute August ."

"A treatment for obesity could be on the horizon as scientists have discovered an antibody that reduces body fat. In trials on mice the antibody was found to increase bone mass and reduce adipose tissue fatand while human studies are some way off the findings could lead to new treatments for weight loss and osteoporosis. The antibody discovered targets folliclestimulating hormone FSH found in the pituitary gland. Ten years ago scientists started looking at the hormones made in the pituitary gland to see how they act on certain targets. They found some of these hormones had an effect on bone mass. From this they created an antibody to see if it could be used to prevent bone loss in miceand in they showed it could. As a result they started considering it as a potential treatment for osteoporosis particularly in postmenopausal womena period when women lose bone mass fairly quickly. But scientists also realized it could have other uses. Mone Zaidi from the Icahn School of Medicine at Mount Sinai New York is one of the authors on the latest study into how the antibody triggers weight loss. Osteoporosis and obesity are fairly closely linked in several ways he tells Newsweek. Women when they undergo menopause lose bone and gain body fat. So we thought maybe there was a connectionthat FSH could have direct effects on adipose tissue. In the study published in Nature httpnature.comarticlesdoi.nature scientists injected the antibody into mice that had had their ovaries removed mimicking menopause and mice that had been fed on a highfat diet. In both cases the antibody caused significant weight loss and gains in bone mass. Zaidi says they looked at the adipose tissue in different areas of the body including under the skin and around the vital organs. In all compartments it was fat reduced by around this level. Its a fairly dramatic effect. Mice also showed increased oxygen consumption higher levels of physical activity and more heat production in beige fat which dissipates energy around the body. But how do mice models translate to human treatments Mice a fairly close genetic match to Humans and Zaidi is hopeful there will be similar effects in humans. Their next step is to humanize the antibody so it can be tested without triggering an immune response. We would then hopefully go to the next phase of preclinical testing which would be to look at side effects toxicology etc. After that we would go into primates and larger animals. That would then leadif all goes wellto the first human trials in three to four years. At present the researchers are focusing on the adiposity rather than bone loss for drug development I think obesity is a more prevalent diseasebut osteoporosis at the tail end can be tagged on. Also to do trials for osteoporosis takes a very long time Zaidi says. Eventually he hopes to end up with an injected drug that gets rid of fat and increases bone mass. Thats the ideal situation he says. It could be a unique obesity drug. But it could also be a unique drug because it lowers body fat and makes bones stronger. And the population that could be most benefited by this could be postmenopausal women. Commenting on the research Tim Speckor Professor of Genetic Epidemiology at Kings College London U.K. says Its a nice mouse study that seems to workwhether it works in humans is another matter."

"Artificial intelligence can be used to spot Alzheimers six years before a patient would normally be diagnosed a study shows. Doctors used the selflearning computer to detect changes in brain scans too subtle for humans to see. The system was able to identify dementia in patients an average of six years before they were formally diagnosed. British AI expert Prof Noel Sharkey from the University of Sheffield said of the findings This is exactly the sort of task that deep learning is cut out for finding highlevel patterns in data. Although the sample sizes and test sets were relatively small the results are so promising that a much larger study would be worthwhile. Boffins from the University of California trained the computer using more than scans from patients. The scans measure brain activity by tracking the uptake of a radioactive liquid injected into the blood. Research has linked the development of Alzheimers to particular changes in certain brain regions but these can be difficult to spot. The Alzheimers algorithm was able to teach itself to recognize patterns in brain scans that indicated disease. As a final test it was given a set of scans from patients it had never studied before. It proved to be percent accurate at detecting Alzheimers disease many years before the patient was later diagnosed. Dr Jae Ho Sohn who worked on the project said We were very pleased with the algorithms performance. It was able to predict every single case that advanced to Alzheimers disease. Early detection of Alzheimers could open the door to new ways of slowing down or even halting the progression of the disease. Dr Carol Routledge from Alzheimers Research UK said The diseases that cause dementia begin in the brain up to years before any symptoms start to show presenting a vital window of opportunity for us to intervene before widespread damage occurs. This study highlights the potential of machine learning to assist with the early detection of diseases like Alzheimers but the findings will need to be confirmed in much larger groups of people before we can properly assess the power of this approach. The research is published in the latest issue of the journal Radiology. Click for more from The Sun. https"

"Millions of people suffer from asthma. Many report having poor control of their symptoms. Fortunately new research shows there is a simple antidote minutes of exercise a day yearround. In a study recently published in BMJ Open Respiratory Research experts from Concordia University the Hpital du SacrCoeur de Montral and several other institutions analyzed the exercise habits of participants who had been diagnosed with asthma. Results were overwhelmingly clear those who engaged in optimal levels of physical activity on a regular basis were nearly twoandahalf times more likely to have good control of their symptoms compared with those who did no exercise. The workout doesnt have to be strenuous. Were not talking about running marathons here says Simon Bacon the studys lead author and a professor in the Department of Exercise Science at Concordia. Just minutes a day of walking riding a bike doing yoga anything active really can result in significant reduction of asthma symptoms. Traditionally people with the condition have been discouraged from exercising because of a belief that it triggers shortness of breath and attacks. Bacon explains that simple precautionary measures can be taken to avoid the discomforts that can be caused by physical activity. The issue of exerciseinduced bronchospasm is real but if you use your releaver medication blue puffer before you exercise and then take the time to cool down afterwards you should be okay he says. Even if you have asthma theres no good reason not to get out there and exercise. Thats a message Bacon hopes resonates. Within his sample group of individuals a whopping reported doing no physical activity. Only said they engaged in the optimal minutes a day. Those numbers reflect the population in general says Bacon who is also director of the Centre de radaptation JeanJacquesGauthier at Hopital du SacrCoeur. Forty per cent of people dont exercise at all he says. We need to keep in mind that doing something is better than nothing and doing more is better than less. Even the smallest amount of activity is beneficial. Its something to keep in mind during winter months when fitness levels tend to drop along with the temperature and cold air provides another trigger for asthma symptoms. Our study shows that those who were able to engage in physical activity on a regular basis yearround benefit most says Bacon. If necessary he suggests finding an indoor place to move whether its the gym a staircase or a shopping mall. Its all about being creative and finding environments where the cold doesnt become an issue. Could a prescription for exercise be the result of this study Bacon is hopeful. It would be great to see physicians recommending physical activity to patients with asthma alongside traditional pharmacological treatments he says. Partners in research Funding support for this study was provided by grants from the Social Sciences and Humanities Research Council Fonds de recherche du Quebec Sante the Canadian Institutes of Health Research and the Michel Auger Foundation of Hopital du SacreCoeur de Montreal. Institutions involved are Hpital du SacrCur de Montral Concordia University Universit de Montreal Universit de Quebec en Outaouais Universit de Montpellier and Universit de Quebec Montreal. Related links Cited study httpbmjopenrespres.bmj.comcontente.abstract Department of Exercise Science https Simon Bacon https Hopital du SacrCur Montral http Media contact Cla Desjardins Senior advisor media relations University Communications Services Concordia University Phone ext. Email clea.desjardinsconcordia.ca mailtoclea.desjardinsconcordia.ca Web http Twitter CleaDesjardins"

"Copenhagen Denmark July Researchers from the Department of Nutrition Exercise and Sports at the University of Copenhagen today announced the findings from a weight loss biomarker study published in the American Journal of Clinical Nutrition AJCN. The study Pretreatment fasting plasma glucose and insulin modify dietary weight loss success results from randomized clinical trials found that fasting blood sugar andor fasting insulin can be used to select the optimal diet and to predict weight loss particularly for people with prediabetes or diabetes. The research analyzed data from three diet clinical trials which collectively looked at more than individuals Diet Obesity and Genes DiOGenes the OPUS Supermarket intervention SHOPUS and the Nutrientgene interactions in human obesity NUGENOB. The findings suggest that for most people with prediabetes a diet rich with vegetables fruits and wholegrains should be recommended for weight loss and could potentially improve diabetes markers. For people with type diabetes the analysis found that a diet rich in healthy fats from plant sources would be effective for achieving weight loss. These diets could also be effective independent of caloric restriction. Two simple biomarkers with a large effect Recognizing fasting plasma glucose as a key biomarker enables a new interpretation of the data from many previous studies which could potentially lead to a breakthrough in personalized nutrition said Arne Astrup M.D. Head of Department of Nutrition Exercise and Sports at University of Copenhagen. The beauty of this concept is its simplicity. While we are looking into other biomarkers it is quite amazing how much more we can do for our patients just by using those two simple biomarkers. We will continue to participate in and support research to explore additional biomarkers such as gut microbiota and genomics approaches which may offer more insights and help to more effectively customize the right diet for specific individuals. The latest findings as reported in AJCN have garnered international support with further analysis conducted by researchers from the University of Colorado Tufts University and Centro de Investigacin Biomdica en Red de Fisiopatologa de la Obesidad y Nutricin CIBER OBN. Presented at the American Diabetes Associations th Scientific Sessions on June the additional research includes an examination of patients in the Prevencion Dieta Mediterranea PREDIMED Study a Randomized Trial of a LowCHO Diet for Obesity CHO Study and The Healthy Weight for Living Study. The different studies six in total employed a variety of nutrition strategies including caloric restriction and ad libitum diets varying the contributions of carbohydrate and fat and increasing fiber intake. The study was inspired by a finding in an early trial of Gelesis a novel hydrogel which demonstrated pronounced weight loss in people with prediabetes. The latest findings as published in AJCN concluded that a personalized nutritional approach based on an individuals biomarkers will lead to improved weight loss and maintenance success. The University of Copenhagen will continue to collaborate with the studys authors and other experts to advance this research and help find solutions for people around the world who struggle with weight loss. About the University of Copenhagen With over students and more than employees the University of Copenhagen is the largest institution of research and education in Denmark. The purpose of the University to quote the University Statute is to conduct research and provide further education to the highest academic level. Approximately one hundred different institutes departments laboratories centres museums etc. form the nucleus of the University. The Department of Nutrition Exercise and Sports conducts research education innovation and dissemination of information in nutrition human physiology and sports at the highest international level and incorporates the humanities as well as health and social sciences."

"A simple blood test may one day offer a safe way to detect Down syndrome during pregnancy researchers say. In a small study an experimental blood test identified a gene mutation associated with Down syndrome with percent accuracy according to the Cyprus scientists. Down syndrome is a common birth defect with one Down syndrome birth in every births in all populations said lead researcher Philippos Patsalis chief executive medical director of the Cyprus Institute of Neurology and Genetics in Nicosia. This is due to an extra chromosome and that leads to physical and mental impairment. With our method we identify all normal and all Down syndrome pregnancies Patsalis said. Currently Down syndrome is diagnosed using one of two invasive procedures amniocentesis or chorionic villus sampling. Because these tests while percent accurate carry a percent to percent risk of miscarriage only about one in pregnant women opts for them he said. The new test eliminates the risk of miscarriage Patsalis said. It also can identify Down syndrome in the th week of pregnancy early enough for a woman to end her pregnancy if she chooses Patsalis said. Although Down syndrome varies in severity it usually causes some intellectual impairment and distinguishing facial features. Heart defects and other health problems are also common according to the March of Dimes. Older mothers are more likely to give birth to Down syndrome babies. People with Down syndrome also known as Trisomy carry three copies of chromosome instead of two. For the study published online March in Nature Medicine Patsalis and his colleagues took blood samples from pregnant women and mothers of Down syndrome and healthy babies. In each case the test quickly pinpointed the chromosomal variation identifying Down syndrome cases and normal fetuses the study authors said. If larger clinical trials confirm the results the test could become standard practice Patsalis said. The cost is much lower than the invasive procedures he said. We estimate we can introduce this to clinical practice in a couple of years. Dr. Brian Skotko clinical fellow in genetics at Childrens Hospital Boston and a spokesman for the National Down Syndrome Society said this study has widespread implications for the incidence of Down syndrome. With this new test women will know if their baby has Down syndrome even before they look pregnant Skotko said. So they will be able to make a very personal decision without anyone realizing it he said. Noting that most of his Down syndrome patients say they lead fulfilling lives Skotko said The overwhelming majority of family members say they cant imagine their life without their family member with Down syndrome. More information For more information on Down syndrome visit the U.S. National Library of Medicine http SOURCES Philippos Patsalis Ph.D. chief executive medical director The Cyprus Institute of Neurology and Genetics Nicosia Brian Skotko M.D. clinical fellow in genetics Childrens Hospital Boston spokesman National Down Syndrome Society March Nature Medicine online"

"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."

"Taking nonsteroidal antiinflammatory drugs NSAIDs which include medicine cabinet staples such as aspirin Motrin and Aleve appears to significantly lower the risk for developing several major forms of skin cancer a new Danish study reveals. Whats more the apparent protective impact of both prescription and nonprescription NSAIDs on skin cancer risk seems to be stronger the longer someone takes them. Overthecounter NSAIDs are used to control pain fever and swelling. NSAIDs also include prescription medicines called COX enzyme inhibitors such as Celebrex celecoxib. Our study showed that users of common painkillers known as NSAIDs have a lower risk of the three major types of skin cancer including malignant melanoma basal cell carcinoma and squamous cell carcinoma said study lead author Sigrun Alba Johannesdottir at the department of clinical epidemiology at Aarhus University Hospital in Aarhus Denmark. The greatest effect she noted was found for squamous cell carcinomas and malignant melanoma especially when these painkillers were taken frequently and over a long time period. The study appears in the May online issue of the journal Cancer. The authors noted that prior work supported the notion that NSAIDs may offer some measure of protection against cancer most notably colorectal cancer by specifically impeding the cancercausing activities of COX cyclooxygenase enzymes. However the team suggested that past investigations into how NSAIDs may affect skin cancer risk in particular had key design problems that undercut efforts to nail down any NSAIDskin cancer connection. For the new study the researchers analyzed prescription databases and health information registries including the Danish Cancer Registry and the Danish Civil Registration System. The team focused on diagnostic and death records concerning nearly cases of squamous cell carcinoma about cases of basal cell carcinoma and nearly cases of malignant melanoma diagnosed between and when the patients were at least years old. In turn prescription histories were gathered for both the cancer patient group and almost healthy Danes. Records covered the use of both low and highdose aspirin ranging from milligrams to milligrams socalled nonselective NSAIDs such as ibuprofen Advil and naproxen Aleve and both older and newer types of COX inhibitors. Researchers noted the number of prescriptions issued per patient and their length of use with shortterm use defined as fewer than seven years. The result The relative risk for squamous cell carcinoma was found to have dropped by percent among those Danes who had filled more than two NSAID prescriptions compared to those who had filled two or less. Similarly malignant melanoma risk fell by nearly as much percent among those filling more than two NSAID prescriptions. However the same dynamic was generally not seen with regards to basal cell carcinoma. But taking NSAIDs for long periods of time and at relatively high doses was associated with a reduced risk between and percent specifically for basal cell cases that manifested in skin regions that typically experience relatively little sun exposure areas other than the neck or head. On that front longterm users and those who took NSAIDs at relatively higher doses appeared to benefit from the strongest protective effect suggesting that when it comes to skin cancer risk reduction more NSAID use is better. The researchers pointed out that the NSAIDcancer connection could be affected by a range of lifestyle factors they did not account for such as an individuals specific skin type or sun exposure patterns. But Johannesdottir added that we hope that our finding will inspire more research on skin cancer prevention. Also the potential cancerprotective effect should be taken into account when discussing benefits and harms of NSAID use she noted. However other studies need to detail the association further and to examine benefits versus risks she cautioned. Meanwhile the most important prevention against skin cancer remains sun protection. Meanwhile Dr. William Ting a private practice dermatologist in San Ramon Calif. praised the study despite agreeing that many factors are at play when it comes to skin cancer formation. Now we have a better understanding that inflammation also plays a significant role in cancer formation and even skin cancers he said. And this exciting article gives physicians and consumers a relatively simple way of diminishing ones risk of skin cancer by doing what most of us are doing already for heart health Ting added. Ting also advised that people consult with their doctor before starting on any blood thinner. While the study found an association between skin cancer risk and NSAIDs it did not prove a causeandeffect relationship. More information For more on NSAIDs and cancer visit the U.S. National Cancer Institute. SOURCES Sigrun Alba Johannesdottir department of clinical epidemiology Aarhus University Hospital Aarhus Denmark William Ting M.D. F.A.A.D. private practice dermatologist Advanced Dermatology Care San Ramon Calif. May Cancer online"

"About people in the United States suffer from a stroke each year. Of those who survive about percent will be left disabled making the cardiac event a major cause of adult disability. While there are therapies to help improve patients mobility theyre only effective within the first few hours of an event. Recently researchers from the Stanford University School of Medicine have made it their mission to improve these outcomes. They hypothesized that injecting stem cells into the brains of chronic stroke patients would increase their survival rates. And in a clinical trial testing the technique researchers found injections can safely improve patients motor function. What surprised us most was the remarkable recovery some patients had Dr. Gary Steinberg professor and chair of neurosurgery at Stanford told Medical Daily While we had hoped for that we didnt really expect it. Patients recover from strokes over the first six months and then theres very little recovery after that. You know they go to rehab and theres not much more more they can recover usually. For the study Steinberg and his team recruited patients who had suffered their first and only stroke six months to three years prior to the trial. Each patient had a small hole drilled through their skulls in order for researchers to be able to inject stem cells taken from the bone marrow of two donors directly into parts of their brains that were damaged from stroke. After patients were sent home researchers continued to monitor their health through blood tests clinical evaluations and brain imaging. Results showed that the implanted stem cells didnt survive very long in the brain disappearing about one to two months after injections however patients still showed significant motor recovery at six and months postsurgery. Some of the patients bound to wheelchairs were even able to walk again. The recovery some patients showed was not just minimal it was significant said Steinberg who has researched stem cell therapies for more than years. It wasnt just someone who couldnt move their thumb now being able to move their thumb it was more profound than that. The types of stem cells used called mesenchymal stem cells can differentiate into a variety of cell types. In other words they are the precursors to muscle fat bone and tendon tissue. Past research http has shown that these cells can be used to treat the effects of hypoxicischemic encephalopathy brain damage caused by loss of oxygen. In Steinbergs study it did not cause problems by differentiating into unwanted tissues or forming tumors. And even when the stem cells came from an unrelated donor the participants did not experience a strong immune reaction. Although more than percent of patients reported suffering headaches afterward the researchers said it was probably due to the surgical procedure rather than the stem cells themselves. Furthermore there were no lifethreatening effects linked to the procedure used to administer them. Motor improvement was also independent of the severity of the stroke patients conditions an important detail considering older adults tend to respond less to treatment the researchers said. In addition to setting the stage for an expanded trial of the procedure the promising results also change our notion of what happens after a stroke Steinberg explained. The findings suggest that strokedamaged areas of the brain once thought to be dead or irreversible can actually be resurrected. Source Steinberg G Kondziolka D Wechsler L et al. Clinical Outcomes of Transplanted Modified Bone MarrowDerived Mesenchymal Stem Cells in Stroke A Phase a Study. Stroke. ."

"A phase study of children ages years with attention deficithyperactivity disorder ADHD has shown that a delayedrelease longacting formulation of the stimulant methylphenidate when taken in the evening led to significant improvement in ADHD symptoms and functional impairment first thing the next morning compared to a placebo. Children taking the delayedrelease stimulant did not have to wait for a morning dose to take effect and also benefited from improved symptoms later in the afternoon and evening according to the study results published in Journal of Child and Adolescent Psychopharmacology a peerreviewed journal from Mary Ann Liebert Inc. publishers. The article is available free on the Journal of Child and Adolescent Psychopharmacology website. The article entitled Efficacy and Safety of HLD DelayedRelease and ExtendedRelease Methylphenidate in Children with AttentionDeficitHyperactivity Disorder httponline.liebertpub.comdoifull.cap.. is coauthored by Steven Pliszka MD from The University of Texas Health Science Center at San Antonio and colleagues from Massachusetts General Hospital Boston MA Westside Medical Family Practice Clinton UT University of Tennessee Health Science Center Memphis TN Meridien Research Maitland and Bradenton FL Childrens Development Center Winter Park FL Ironshore Pharmaceuticals Development Grand Cayman Cayman Islands and Mount Sinai Medical Center New York NY on behalf of the HLD Study Group. The drug formulation which consists of two layers of microbeads with an inner drugloaded core delays release of the active ingredient for hours and then provides controlled extended release designed to cover the early morning into the evening. The medication was well tolerated with the main adverse effects of appetite suppression and insomnia being those commonly reported for other formulations of methylphenidate. Developing new formulations of effective medications for patients with ADHD improves the lives of children with the disorder says Harold S. Koplewicz MD EditorinChief of the Journal of Child and Adolescent Psychopharmacology and President of the Child Mind Institute in New York. About the Journal Journal of Child and Adolescent Psychopharmacology is an authoritative peerreviewed journal published bimonthly in print and online. The Journal is dedicated to child and adolescent psychiatry and behavioral pediatrics covering clinical and biological aspects of child and adolescent psychopharmacology and developmental neurobiology. Complete tables of content and a sample issue may be viewed on the Journal of Child and Adolescent Psychopharmacology website http About the Publisher Mary Ann Liebert Inc. publishers is a privately held fully integrated media company known for establishing authoritative peerreviewed journals in many promising areas of science and biomedical research including Cyberpsychology Behavior and Social Networking Games for Health Journal and Violence and Gender. Its biotechnology trade magazine GEN Genetic Engineering Biotechnology News was the first in its field and is today the industrys most widely read publication worldwide. A complete list of the firms journals books and newsmagazines is available on the Mary Ann Liebert Inc. publishers website http"

"Among nonsmokers who had diabetes those who took the diabetes drug metformin had a decrease in lung cancer risk according to a study in Cancer Prevention Research a journal of the American Association for Cancer Research by Lori Sakoda PhD MPH research scientist at the Kaiser Permanente Division of Research in Oakland California. Some laboratory studies and a number of observational studies suggest that metformin may prevent cancer but the data from human studies however are conflicting explained Sakoda. The researchers conducted this study to further clarify the association between metformin use and lung cancer risk. Sakoda and colleagues conducted a retrospective cohort study of diabetic patients percent men years or older who completed a healthrelated survey between and . Information on their diabetes medications was collected from electronic pharmacy records. About percent of them were everusers of metformin defined as those who filled two or more prescriptions within a sixmonth period. During years of followup patients were diagnosed with lung cancer. Of them were nonsmokers and were current smokers. Metformin use was not associated with lower lung cancer risk overall however the risk was percent lower among diabetic patients who had never smoked and the risk appeared to decrease with longer use. Nonsmokers who used metformin for five years or longer had a percent reduction in lung cancer risk but this finding was not statistically significant. Metformin use for five or more years was associated with a percent decrease in the risk for adenocarcinoma the most common type of lung cancer diagnosed in nonsmokers and an percent increase in the risk for smallcell carcinoma a type of lung cancer often diagnosed in smokers but neither of these findings were statistically significant. In an interview Sakoda said Metformin use was not associated with lung cancer risk when we looked at all patients with diabetes. However our results suggest that risk might differ by smoking history with metformin decreasing risk among nonsmokers and increasing risk among current smokers. Our results suggesting that the risk associated with metformin might differ by smoking history were unexpected. Additional large wellconducted studies are needed to clarify whether metformin may be used to prevent lung or other cancers particularly in specific subpopulations such as nonsmokers. This study was funded by the National Institutes of Health. Sakoda declares no conflicts of interest. Assiamira Ferrara Charles Quesenberry Jr. and Laurel Habel coauthors on this study have received research funding from Takeda to Kaiser Foundation Research Institute for a study of pioglitazone and cancer and from Sanofi through a subcontract from University of North Carolina to Kaiser Foundation Research Institute for a study of insulin glargine and cancer. Habel has received additional research funding from Genentech to Kaiser Foundation Research Institute for a study of HERpositive breast cancer including risk of cardiotoxicity following trastuzumab. Follow us Cancer Research Catalyst httpblog.aacr.org Twitter AACR and Facebook http For AACR information visit Fast Facts About the American Association for Cancer Research Founded in the American Association for Cancer Research AACR is the worlds oldest and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR membership includes more than laboratory translational and clinical researchers population scientists other health care professionals and cancer advocates residing in countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention biology diagnosis and treatment of cancer by annually convening more than conferences and educational workshops the largest of which is the AACR Annual Meeting with over attendees. In addition the AACR publishes eight peerreviewed scientific journals and a magazine for cancer survivors patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the Scientific Partner of Stand Up To Cancer the AACR provides expert peer review grants administration and scientific oversight of team science and individual grants in cancer research that have the potential for nearterm patient benefit. The AACR actively communicates with legislators and policymakers about the value of cancer research and related biomedical science in saving lives from cancer. For more information about the AACR visit http"

"When Kelly Hidleburgs confounding case of anemia was traced to heavy bleeding due to uterine fibroids she faced the same tough choice that confronts thousands of American women every year. She could have her uterus or just the fibroids surgically removed or she could try one of several newer procedures aimed at shrinking the usually benign but troublesome tumors. At she could try waiting a few years to see whether menopause with its natural decline in hormones would solve the problem. Hidleburgs options were even more limited however because she didnt want to have surgery with a long recovery time that would take her away from work and family. And even with iron supplements her anemia was so severe that waiting out the fibroids wasnt looking good either. But then her gynecologist Minda Green suggested another option a new tool that requires no incision and uses heat to damage the fibroids which then shrink. Though the tool is still being tested what Hidleburg heard sounded too good to pass up. With this option I had a better chance of recovery and going back to work more quickly said Hidleburg who lives in Olney. Last month the mother of two grown children underwent the outpatient procedure at Hahnemann Hospital without a hitch and returned home the same day. A few days later she was back at work as a Philadelphia correctional officer. Sonata which stands for sonographyguided transcervical ablation a device made by Californiabased Gynesonics shows promise as an addition to the arsenal of ways to treat a condition that is common but that has defied easy solutions. This is probably the most minimally invasive surgical procedure you can do said Green an assistant professor in Drexel Universitys College of Medicine who is coinvestigator in the devices trial at Drexelaffiliated Hahnemann. Thats hugely important. . . . You can get back to work and life. Thats what women want. Sonata uses a probe that is inserted through the cervix into the uterus. The probe not only allows the doctor to see the fibroid using ultrasound but it also has a radiofrequency device at the tip. The doctor hits a foot pedal to send energy through the probe to heat the fibroid shrinking it over time. The body absorbs the dead tissue so it does not have to be surgically removed. The tool is also being tested at other sites in the United States including Cooper University Hospital and Christiana Care Health System. Fibroids are muscular tumors usually benign that grow in the wall of the uterus. They can affect up to percent of women by the time they reach age but in most cases the fibroids cause no symptoms. Sometimes symptoms are mild enough that women can be treated with hormone therapy or can wait them out until menopause. But for some women significant fibroids can mean profuse bleeding cramping and pain from the pressure they can exert. They also can pose problems during childbirth and in rare cases can even affect fertility. An estimated onefourth of all women with fibroids require treatment according to the National Uterine Fibroids Foundation. Hidleburg lost so much blood during her heavy menstrual cycles that she was extremely anemic. Of her five fibroids four were deep in the uterine wall. The options Hundreds of thousands of hysterectomies are performed each year in the U.S. mostly to treat uterine fibroids making the procedure the most common choice. But this is major surgery that can mean a lengthy recovery time increasing demand for alternatives from hormone therapy to more complicated procedures. Though hysterectomies are not performed as frequently as they once were their rates are widely considered to be too high. Another option is to have just the fibroids removed a procedure known as myomectomy. But that also is an invasive procedure requiring an incision and longer recovery time. And unlike a hysterectomy there is no guarantee that fibroids wont grow back after myomectomy. Power morcellation a technique that cuts up the uterus or just the fibroids for removal through tiny incisions seemed to be the answer for some promising swifter recovery times than the traditional open hysterectomy. But in some cases the FDA estimates one in the device disseminates an undiagnosed cancer that preoperative screening tests cannot reliably detect. The FDA has advised physicians and hospitals not to use it except in rare cases. Sonata is not the first procedure aimed at shrinking fibroids without surgery though it is touted as less invasive. In uterine artery embolization UAE an interventional radiologist uses a catheter in the groin to deliver small particles that block blood flow to the fibroids. But some women including Hidleburg turn it down because it can be painful while the fibroids shrink. Other options include Acessa a therapy which employs laparoscopic radiofrequency waves to destroy the tissue. Also tested at Hahnemann it was approved in and heats the fibroid but requires two small incisions and uses multiple tools unlike the allinone Sonata probe. ExAblate is an MRIguided technology that uses magnetically focused energy to eliminate the tissue. It can take hours and shrinks fibroids less than percent studies indicate. While the list of options looks long each has its drawbacks according to gynecologists. The market is not overcrowded by any means says Erin Carey an assistant professor at the University of North CarolinaChapel Hill and division director of minimally invasive gynecology surgery who is not involved in the Sonata trial. Theres huge room for growth. Dipak Delvadia a Drexel assistant professor of obgyn who is a principal investigator for the trial said it was appropriate for fibroids in the uterine wall that are between and centimeters. Weve been trying to get to these types of fibroids and tumors for a long time in a minimally invasive way he said. In the OR During the procedure Hidleburg was under general anesthesia though Sonata can be used in an office setting with partial sedation according to Gynesonics. Green who under Delvadias supervision was performing the procedure for the first time guided the probe through the cervix to the uterus where she could see a clear D image of the fibroids. Then Green deployed the electrodes which reach degrees Fahrenheit being careful to ablate or heat as much of the fibroid as possible without harming surrounding tissue. The system calibrates how long the ablation will take depending on the fibroids location and characteristics. Hidleburgs first fibroid required minutes and seconds. Then Green was on to treat the next one. Compared with the Acessa procedure which requires the physician to manipulate multiple devices Sonata is much easier Green said afterward. She also noted that the procedure doesnt require a radiologist. Sonata was approved in Europe a few years ago and has been getting positive reviews so far here. But because its still under investigation in the U.S. its not covered by insurance patients such as Hidleburg who participate in a trial are treated for free. If insurance doesnt pay for Sonata no one is going to get it said Jay Goldberg a professor at Einstein Medical Center and director of its Philadelphia Fibroid Center. He notes that ExAblate which typically isnt covered by insurance can cost tens of thousands of dollars out of pocket one reason it is not often used. Sonatas manufacturer declined to say what the procedure might cost once the trials are complete and it is approved. The company has said one advantage of Sonata is that it is simpler to perform putting it within reach of more doctors. But Goldberg notes that such minimally invasive procedures require a lot of skill to perform safely. You need a really experienced surgeon he says. Will it translate to the average obgyn Fibroids rarely are malignant but UNCs Carey noted that because tissue is not removed with the Sonata method it cannot be biopsied to be certain. Carey also wants to know more about Sonatas potential impact on fertility. The trial targets women who do not want future pregnancies so that question will not be put to rest in the trial although the procedure anecdotally does not appear to hurt fertility according to Gynesonics medical director David Toub. If confirmed through additional studies that it doesnt affect fertility Carey says that would make Sonata a gamechanger. This is what would elevate the product. Meanwhile Hidleburg is happy with her choice which she said was painfree and allowed her to get back to her routine quickly. Everything went well she says. It was in and out."

"The U.S. Food and Drug Administration FDA said it had approved Adamas Pharmaceuticals Incs treatment for a side effect caused by a commonly prescribed Parkinsons drug sending the shares of the drugmaker soaring in aftermarket trading. The companys shares were up . percent at . after the bell on Thursday. A majority of patients diagnosed with Parkinsons are treated with levodopa whose use often leads to dyskinesia involuntary movements that are nonrhythmic purposeless and unpredictable. Parkinsons disease is a debilitating disorder in which brain cells progressively die causing patients to experience tremors rigidity extreme slowness of movement impaired balance and difficulties in swallowing and speaking. Adamas Gocovri previously ADS is the first drug cleared by the FDA to control levodopainduced dyskinesia LID. The longacting therapy is taken oncedaily at bedtime. An estimated percent of levodopatreated patients about people in the United States suffer from LID the company said. Fluctuating levels of levodopa result in erratic periods of muscular control and involuntary movements throughout the day disrupting activity at least half a dozen times a day. As Parkinsons progresses patients are dyskinetic just after taking levodopa but increasingly exhibit off time or worsening symptoms as it wears off. These patients have little recourse other than opting for deep brain stimulation a surgical procedure that involves blocking electrical signals from targeted areas in the brain. With Gocovri which targets both dyskinesia and off time patients will be able to reclaim about . hours of their day CEO Gregory Went said in an interview ahead of the decision. About people are diagnosed with Parkinsons in the United States each year according to the National Institutes of Health. The main ingredient of Gocovri amantadine has been available in the market as an antiviral drug for several decades. The company said the drug is expected to be available in the fourth quarter and formally launched in January . Adamas is also testing the drug to treat walking impairment in patients with multiple sclerosis."

"Study in adults with treatmentresistant depression marks the first time an antidepressant has achieved superiority in a clinical trial for major depressive disorder that included a newly initiated oral antidepressant in both the control and placebo groups Study in elderly patients is the first large clinical trial in treatmentresistant depression in this population Results demonstrate the potential of esketamine nasal spray to address a significant unmet need for the more than percent of people suffering from major depressive disorder who do not respond to two or more currently available antidepressants News provided by Janssen Pharmaceutical Companies of Johnson Johnson https May ET Share this article javascriptvoid javascriptvoid javascriptvoid javascriptvoid javascriptvoid javascriptvoid TITUSVILLE N.J. May PRNewswire The Janssen Pharmaceutical Companies of Johnson Johnson today announced the results from two Phase clinical studies of the investigational compound esketamine nasal spray in patients with treatmentresistant depression. These studies will be presented at the American Psychiatric Association Annual Meeting taking place May in New York NY. Data from a study in adults with treatmentresistant depression showed that flexibly dosed esketamine nasal spray plus a newly initiated oral antidepressant demonstrated a statistically significant clinically meaningful rapid reduction of depressive symptoms as compared to placebo nasal spray plus a newly initiated oral antidepressant. The study defined treatmentresistant as patients who had not responded to two or more currently available antidepressants of adequate dose and duration in the current episode of depression. Data from a second study in elderly patients aged and older with treatmentresistant depression which is the first study of its kind showed treatment with flexibly dosed esketamine plus a newly initiated oral antidepressant demonstrated clinically meaningful effects compared to placebo nasal spray plus a newly initiated oral antidepressant. However the study narrowly missed statistical significance for its primary efficacy endpoint. If approved by the U.S. Food and Drug Administration FDA esketamine would be one of the first new approaches to treat refractory major depressive disorder available to patients in the last years. With about percent of patients with major depression failing to respond to currently available antidepressants treatmentresistant depression represents a major public health need said Husseini K. Manji MD Global Head Neuroscience Therapeutic Area Janssen Research Development LLC. The positive Phase results for esketamine nasal spray in adults with treatmentresistant depression are exciting particularly as they mark the first time an antidepressant has achieved superiority versus an active comparator in any clinical trial for major depressive disorder. What makes this even more significant is that the response was rapid and this milestone was achieved in patients deemed to be treatmentresistant. We are also pleased with the clinically meaningful outcomes for esketamine nasal spray in elderly patients a population that often has greater disability and lower response rates. Theres a critical need for new rapidly acting and effective treatment options for people with major depressive disorder who do not respond to existing therapies said Mathai Mammen M.D. Ph.D. Global Head Janssen Research Development LLC. Janssen is fully committed to exploring the newest science in the area of mood disorders and bringing these discoveries to patients in need. Click to Tweet httpsctt.ecPLxd Janssen announces new Phase data re. treatmentresistant depression httppo.stMUWqV Results of the Study in Adults with TreatmentResistant Depression In the Phase study of adults with treatmentresistant depression patients were randomized to flexibly dosed esketamine nasal spray mg or mg added to a newly initiated oral antidepressant or placebo nasal spray added to a newly initiated oral antidepressant. Primary Efficacy Endpoint The primary efficacy endpoint change from baseline in the Montgomerysberg Depression Rating Scale MADRS total score demonstrated the statistically significant clinical improvement in patients depressive symptoms for esketamine nasal spray plus an oral antidepressant at day Least Squares Mean Difference Standard Error from placebo nasal spray plus a newly initiated oral antidepressant . . Confidence Interval CI . . onesided p.. Secondary and Other Efficacy Endpoints The first key secondary endpoint onset of clinical response by hours postdose that is maintained through day numerically favored esketamine nasal spray plus an oral antidepressant vs. placebo nasal spray plus an oral antidepressant but did not meet statistical significance sided p.. The other two key secondary endpoints Sheehan Disability Scale SDS a subjectreported outcome measure widely used and accepted for assessment of functional impairment and associated disability and Patient Health Questionnaire PHQ a selfreport scale assessing depressive symptoms could not be formally evaluated since onset of clinical response was not statistically significant. Among other endpoints response rate was notable with . responding in the esketamine group vs. in the placebo group at days response improvement in MADRS from baseline. Remission rate MADRS total score at day was . and . for the esketamine and placebo groups respectively. The most common treatmentemergent adverse events reported in the esketamine group were metallic taste nausea vertigo dizziness headache drowsiness dissociation blurred vision paraesthesia tingling sensation and anxiety. The most common treatmentemergent adverse events reported in the placebo group were metallic taste and headache. Results of the Study in Elderly Patients with TreatmentResistant Depression Janssen conducted a separate Phase study in elderly patients with treatmentresistant depression. Elderly populations with major depressive disorder are historically hard to treat and often have comorbidities and longstanding depression. To improve tolerability patients were given a lower starting dose mg of esketamine nasal spray flexibly dosed at mg mg or mg plus a newly initiated oral antidepressant or placebo nasal spray plus a newly initiated oral antidepressant. Primary Efficacy Endpoint Although statistical significance for the primary endpoint for the overall patient population studied was narrowly missed results favored the esketamine nasal spray plus a newly initiated oral antidepressant group median unbiased estimate of the difference from placebo nasal spray plus a newly initiated oral antidepressant . CI . . onesided p.. To put this into context an analysis of placebocontrolled data from three prior studies conducted by Duru and Fantino determined that a minimum change in MADRS of . was clinically meaningful. In addition the average difference is between points for currently approved antidepressants vs. placebo. Safety results were consistent with previous studies of esketamine in younger adult populations. The most common treatmentemergent adverse events reported in the esketamine group were dizziness nausea headache fatigue increased blood pressure vertigo and dissociation. There were no treatmentemergent adverse events reported in of patients in the placebo group. Esketamine nasal spray has an acceptable safety and tolerability profile based on the adverse event data from both Phase studies. Adverse events and associated symptoms were seen predominately on the day of dosing and were generally transient and resolved on the day of dosing. These findings represent two of the five Phase studies that comprise Janssens treatmentresistant depression program with esketamine nasal spray. The results from these studies will inform regulatory filings for esketamine nasal spray in treatmentresistant depression for which Janssen has received Breakthrough Therapy Designations from the U.S. FDA. Data from other Phase studies will be presented later in . About the Studies In both Phase studies esketamine or placebo was provided in disposable nasal spray devices containing l of solution i.e. two sprays and administered under the supervision of a health care professional. A bittering agent was added to placebo to simulate the taste of esketamine to help mask the treatment assignment. The study in adults with treatmentresistant depression was a Phase doubleblind activecontrol flexibly dosed multicenter study using blinded raters conducted at sites in Czech Republic Germany Poland Spain and the United States from August to November . The study enrolled adults with moderatetosevere nonpsychotic recurrent or persistent depression and history of nonresponse to antidepressants in the current episode of depression with one of them assessed prospectively. Nonresponders were randomized to flexiblydosed esketamine nasal spray or mg twice weekly plus a newly initiated oral antidepressant N or placebo nasal spray plus a newly initiated oral antidepressant N. The primary efficacy endpoint change from baseline to day in MADRS total score was assessed among patients who received dose of nasal spray and oral study medication by mixedeffects model using repeated measures using a onesided significance level of .. .. For further information about this study visit the ClinicalTrials.gov httpsclinicaltrials.govctshowNCTtermNCTrank website. The study in elderly patients with treatmentresistant depression was a Phase doubleblind multicenter activecontrolled study. Patients years of age were randomized to either esketamine nasal spray plus a new oral antidepressant N or placebo nasal spray plus a new oral antidepressant N. The primary endpoint was the change in the MADRS total score from day baseline to day . Statistical analysis employed mixedeffects model repeated measures MMRM with a weighted combination test to account for an interim analysis for sample size reestimation using a onesided significance level of .. For further information about this study visit the ClinicalTrials.gov httpsclinicaltrials.govctshowNCTtermNCTrank website. About Esketamine Esketamine nasal spray is an investigational compound being studied by Janssen Research Development LLC as part of a global development program. Esketamine is a noncompetitive NmethylDaspartate NMDA receptor antagonist also known as a glutamate receptor modulator thought to help restore synaptic connections in brain cells in people with major depressive disorder. It has a novel mechanism of action meaning it works differently than currently available therapies for depression. Esketamine received Breakthrough Therapy Designations from the U.S. FDA in November for treatmentresistant depression and in August for the indication of major depressive disorder with imminent risk for suicide. About Major Depressive Disorder Major depressive disorder affects nearly million people of all ages globally and is the leading cause of disability worldwide. Individuals with depression including major depressive disorder experience continuous suffering from a serious biologically based disease which has a significant negative impact on all aspects of life including quality of life and function. Although currently available antidepressants are effective for many patients about one third of patients do not respond to treatment and are thought to have treatmentresistant depression. About the Janssen Pharmaceutical Companies of Johnson Johnson At the Janssen Pharmaceutical Companies of Johnson Johnson we are working to create a world without disease. Transforming lives by finding new and better ways to prevent intercept treat and cure disease inspires us. We bring together the best minds and pursue the most promising science. We are Janssen. We collaborate with the world for the health of everyone in it. Learn more at http Follow us at http and http Cautions Concerning ForwardLooking Statements This press release contains forwardlooking statements as defined in the Private Securities Litigation Reform Act of regarding product development and the potential benefits of esketamine. The reader is cautioned not to rely on these forwardlooking statements. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or known or unknown risks or uncertainties materialize actual results could vary materially from the expectations and projections of Janssen Research Development LLC andor Johnson Johnson. Risks and uncertainties include but are not limited to challenges and uncertainties inherent in product research and development including the uncertainty of clinical success and of obtaining regulatory approvals uncertainty of commercial success competition including technological advances new products and patents attained by competitors challenges to patents manufacturing difficulties and delays changes in behavior and spending patterns or financial distress of purchasers of health care products and services changes to applicable laws and regulations including global health care reforms and trends toward health care cost containment. A further list and description of these risks uncertainties and other factors can be found in Johnson Johnsons Annual Report on Form K for the fiscal year ended January including in Exhibit thereto and the companys subsequent filings with the Securities and Exchange Commission. Copies of these filings are available online at http http or on request from Johnson Johnson. None of the Janssen Pharmaceutical Companies or Johnson Johnson undertakes to update any forwardlooking statement as a result of new information or future events or developments. . National Institute of Mental Health. Sequenced Treatment Alternatives to Relieve Depression STARD Study. Available at http_edn http Accessed May . . The clinical relevance of changes in the MontgomeryAsberg Depression Rating Scale using the minimum clinically important difference approach. Available at https Accessed May . . Khin NA https_uid et.al. Exploratory analyses of efficacy data from major depressive disorder trials submitted to the US Food and Drug Administration in support of new drug applications Journal of Clinical Psychiatry. April . Available at https Accessed May . . Johnson Johnson Press Release. Esketamine Receives Breakthrough Therapy Designation from U.S. Food and Drug Administration for Major Depressive Disorder with Imminent Risk for Suicide. Available at https Accessed May . . World Health Organization. Depression. Available at http Accessed May . . Thase ME. Update on partial response in depression. J Clin Psychiatry. suppl ."

"A Veterans Affairs database study of more than patients found that men whose low testosterone was restored to normal through gels patches or injections had a lower risk of heart attack stroke or death from any cause versus similar men who were not treated. The study also found that men who were treated but did not attain normal levels did not see the same benefits as those whose levels did reach normal. The study was published online Aug. in the European Heart Journal. The findings may sway the ongoing debate over testosterone therapys benefits and risks especially for the heart. Studies over the past few years have yielded mixed results although part of that might stem from differing patient populations and research methods. For example the new VA study excluded men with a history of heart attacks or strokes although it did include those with existing heart disease. A muchcited VA database study that was published in JAMA in looked specifically at men with coronary artery disease about percent of the total study group of around men had suffered a prior heart attack. So far the medical community lacks results from any definitive clinical trial that might provide clear guidance. Meanwhile the Food and Drug Administration issued guidance earlier in advising clinicians about the overuse of testosterone therapy and pointing to a possible increased risk of heart attack and stroke. The new VA study is likely to draw attention because of its large size and relatively long followup period. Dr. Rajat Barua the papers corresponding author says the study is also noteworthy because of its finding that administering the right dose is critical Treating low T but not restoring levels to normal doesnt appear to impart much benefit at least in terms of cardiovascular risk. Testosterone isnt prescribed with the goal of improving heart health but that is a consideration in many cases. It is the first study to demonstrate that significant benefit is observed only if the dose is adequate to normalize the total testosterone levels Barua and his coauthors wrote. Patients who failed to achieve the therapeutic range after testosterone replacement therapy did not see a reduction in heart attack or stroke and had significantly less benefit on mortality. Barua is with the Kansas City Mo. VA Medical Center. Hes also an assistant professor of medicine at the University of Kansas. The study team looked at national data on more than men with documented low testosterone all age or above who received care in VA between and . The researchers divided the men into three clinical groups those who were treated to the point where their total testosterone levels returned to normal Group those who were treated but without reaching normal Group and those who were untreated and remained at low levels Group . Importantly all three groups were propensity matched so the comparisons would be between men with similar health profiles. The researchers took into account a wide array of factors that might affect cardiovascular and overall risk. They included for example age body mass index various chronic diseases LDL cholesterol levels and the use of aspirin beta blockers and statins. The average followup across the groups ranged from . to . years. The sharpest contrast emerged between Group those who were treated and attained normal levels and Group those whose low testosterone went untreated. The treated men were percent less likely to die during the followup period percent less likely to suffer a heart attack and percent less likely to have a stroke. The differences between Group and Group those who were treated but did not attain normal levels were similar but less pronounced. Little difference emerged between Groups and except for a slight benefit in survival for those who were treated. Barua and colleagues say they dont know the exact reasons for testosterones apparent benefits for the heart and overall survival. The mechanisms for these effects remain speculative they write. Possible explanations they say could involve body fat insulin sensitivity lipids blood platelets inflammation or other biological pathways. More research is needed they say to clarify how testosterone affects the cardiovascular system. While the new study results do seem to advocate for testosterone replacement therapy Barua stresses the need for appropriate screening selection dosing and followup of patients to maximize the benefit of testosterone therapy. The authors also caution that offlabel use remains a concern. In other words doctors should not write a prescription simply because an older man is complaining of symptoms such as low energy and low sex drive. According to the FDA Testosterone products are FDAapproved only for use in men who lack or have low testosterone levels in conjunction with an associated medical condition. Examples of these conditions include failure of the testicles to produce testosterone because of reasons such as genetic problems or chemotherapy. ... None of the FDAapproved testosterone products are approved for use in men with low testosterone levels who lack an associated medical condition."

"Men who eat lots of tomatoes and tomatobased products may have a lower risk for stroke https a new study suggests. Tomatoes are rich in the antioxidant https lycopene. Men who had the highest levels of lycopene in their blood https were less likely to have a stroke https compared with men who had the lowest levels of the antioxidant in their blood https The lowered risk was even greater for strokes caused by blood clots https in the brain https called ischemic strokes. These are the most common type of stroke https Men who had the highest lycopene levels were less likely to have this kind of stroke than men with the lowest levels. The findings appear in the Oct. issue of Neurology. The new study included slightly more than men from Finland aged to . Researchers measured the level of lycopene in their blood when the study began and followed the men for about years. During that time men had a stroke. This study adds to the evidence that a diet high in fruits and vegetables https is associated with a lower risk of stroke says researcher Jouni Karppi PhD of the University of Eastern Finland in Kuopio. The results support the recommendation that people get more than five servings of fruits and vegetables https a day which would likely lead to a major reduction in the number of strokes worldwide according to previous research. Other studies have shown that high lycopene levels may be linked to a reduced risk of certain cancers. Cooked tomatoes tend to have a greater effect on blood levels of lycopene than raw tomatoes or tomato juice. Tomatoes are not the only food that is rich in this antioxidant. Other sources include pink grapefruit watermelon and guava. Healthy Diet Lowers Stroke Risk Lycopene seems to have some beneficial effects when in the form of fruits and vegetables https says Deepak Bhatt MD. He is the director of the Integrated Interventional Cardiovascular Program at Brigham and Womens Hospital in Boston. The benefits likely only apply to whole foods not individual supplements https_AssetsscopemapsWebMDConsumerPagesVitaminsandSupplementsLifestyleGuide_ecedpage_VitaminsandSupplementsLifestyleGuide_eced.xml of lycopene. Eat more fruits and vegetables to reduce your risk of stroke is a safe conclusion he says. The new study only included men but the same benefits likely extend to women. Although eating more vegetables is good advice the study looked at lycopene levels in blood not at how many tomatoes the men ate says Daniel Labovitz MD. He is the director of the Stern Stroke Center at Montefiore Medical Center in New York City. Whats more the study just showed a link. It was not designed to say whether or not eating more tomatoes can lower stroke risk. There is no reason to think that tomatoes are bad but we havent proven that they are special either he says. One of the best ways to lower stroke risk is to eat a healthy diet that is rich in fruits and vegetables and to exercise https regularly. Lifestyle changes are better than any pill we can prescribe. Rafael Ortiz MD is less cautious in his interpretation of the study. I would definitely recommend an increased intake of fruits and vegetables especially tomatoes to decrease your chances of stroke he says. He is the director of the Center for Stroke and NeuroEndovascular Surgery at Lenox Hill Hospital in New York City. The study also shows that smokers tended to have the lowest blood levels of lycopene. Smoking https is a major risk factor for stroke."

"Overweight people could be given help with the discovery that a drug used for sleep disorder could also reduce the impulse for food. There are many factors that cause obesity but there is a growing weight of evidence that shows obesity is not just caused by a behavioural disorder such as a lack of selfcontrol but that many overweight people are physically addicted to foods rich in fat and sugar. When we eat food that tastes good we get a powerful release of dopamine in the pleasurereward section of the brain but food addicts have been found to have a deficiency in a certain type of dopamine so that their sense of reward and pleasure is diminished thus they have to eat more to reach the same level of pleasure as anybody else. Scientists have also found impulsive behaviour is a factor in leading to food addiction and Ivo Vlaev of Warwick Business School plus Myutan Kulendran Laura Wingfield Colin Sugden and Ara Darzi of Imperial College London discovered that a drug called Modafinil usually used for narcolepsy shift work disorder and excessive daytime sleepiness can reduce impulsivity and thus food addiction. We found Modafinil which is already on the market did reduce peoples impulsive behaviour said Professor Vlaev. It has been shown to reduce impulsiveness in a variety of disorders such as alcohol dependence schizophrenia and ADHD. Food addicts suffer from the same neurobiological conditions so we believe it will help food addicts as well and our initial tests have backed up that theory. This could have important implications for people who are obese. There is mounting evidence to show that there is a substantial number of obese people who are food addicts because they have an inability to control their impulsive actions and this drug has shown it can give them more control which will help overweight people lose weight and so improve their health. Food addicts know they need to lose weight but the desire for more food is overwhelming leading to a spiral of depression that can lead to psychological issues as well as health problems. The drug which is sold under a wide variety of brand names around the world was one of two drugs tested by researchers the other being Atomoxetine. Both drugs have been used for impulsive conditions including ADHD. In the paper Pharmacological manipulation of impulsivity A randomized controlled trial published in Personality and Individual Differences the scientists conducted a series of trials on men aged between and with taking a placebo Atomoxetine and Modafinil. The tests revealed that those who had taken Modafinil had a significantly reduced level of impulsiveness whereas Atomoxetine produced no difference compared to the placebo group. Modafinil was found to have an effect on impulsivity in healthy individuals and so would be able to have an even bigger effect on food addicts who are lacking in certain types of dopamine said Professor Vlaev. This drug could be a real help to those people struggling to control their desire for food even though they know they should lose weight. The drug improves selfcontrol which is a key factor in determining obesity so our hypothesis is that this drug should help in treating the disease. For a copy of the paper email Ashley.potterwbs.ac.uk mailtoAshley.potterwbs.ac.uk To interview Ivo Vlaev contact Email Ivo.Vlaevwbs.ac.uk mailtoIvo.Vlaevwbs.ac.uk Warwick Business School is the largest department of the University of Warwick and is triple accredited by the leading global business education associations the first in the UK to attain this accreditation. Offering the full portfolio of business education courses from undergraduate through to MBAs and with a strong Doctoral Programme WBS is the complete business school."

"Early heart disease ran in Rick Del Sontros family and every time he went for a run he was scared his heart would betray him. So he did all he could to improve his odds. He kept himself lean stayed away from red meat spurned cigarettes and exercised intensely even completing an Ironman Triathlon. I had bought the dream if you just do the right things and eat the right things you will be O.K. said Mr. Del Sontro whose cholesterol and blood pressure are reassuringly low. But after his sister just years old found out she had advanced heart disease Mr. Del Sontro then and the president of Zippy Shell a selfstorage company went to a cardiologist. An Xray of his arteries revealed the truth. Like his grandfather his mother his four brothers and two sisters he had heart disease. One brother Michael has not received a diagnosis of the disease. Now he and his extended family have joined an extraordinary federal research project that is using genetic sequencing to find factors that increase the risk of heart disease beyond the usual suspects high cholesterol high blood pressure smoking and diabetes. The aim is to see if genetics can explain why heart disease strikes apparently healthy people. The hope is that a family like Mr. Del Sontros could be a Rosetta stone for heart disease that their arteries profound but mysterious propensity to clog could reveal forces that do the same in millions of others. We dont know yet how many pathways there are to heart disease said Dr. Leslie Biesecker who directs the study Mr. Del Sontro joined. Thats the power of genetics. To try and dissect that. Researchers have long known that a family history of early death from heart disease doubles a persons risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age or a mother or sister before age . Scientists are studying the genetic makeup of each member of the Del Sontro family searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA. Until very recently such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and timeconsuming that it was impractical to take on for an entire family. Analyzing the deluge of data would have been overwhelming. But costs have plunged and data analysis has advanced. Rick Del Sontro keeps himself lean and watches his diet but despite his efforts he has heart disease like many in his family.CreditBrendan Hoffman for The New York Times With the right family you may need only one family said Dr. Robert C. Green httppcpgm.partners.orgaboutusleadershipfaculty of Harvard Medical School who studies genetics and medicine and is not involved in the study. Beyond Risk Factors Control of cardiovascular disease is one of medicines great success stories. Over the past years heart disease death rates have steadily dropped percent from their peak in the s. But doctors still rely mostly on risk factors discovered decades ago cholesterol levels blood pressure diabetes smoking obesity and a sedentary lifestyle. Risk factors are part of the canon now in medicine said Dr. Gary H. Gibbons the director of the National Heart Lung and Blood Institute http We use them every day. Still people arrive at the hospital every day with heart attacks. And heart disease is still the leading killer of men and women. Each year nearly people in the United States die of heart disease. Though the average age for a first heart attack has steadily risen it is now for men and for women many die much younger. And many had no obvious risk factors. What researchers ask are they missing The old method of inquiry into heart disease was to start with basic laboratory research test a hypothesis in animals develop a drug and then test it in humans. That approach led to some expensive failures. Researchers now want to use human genetics. We need to understand disease biology in humans said Dr. Elias Zerhouni a former director of the National Institutes of Health and now president for global research and development at Sanofi. The tools are here. But the greatest challenge is to figure out how to prevent heart disease in the first place. And that is where the Del Sontro family comes in. A Familys Grim Secret Mr. Del Sontro had been more or less in denial about his familys heart disease problem until one of his sisters Robin Ashwood found out she had it. One Saturday morning about six years ago she was running on a treadmill when her arms began to feel sore as if she had done a tough workout with weights. She ended her workout and the pain went away. But it came back later that day while she was shopping with her younger sister Tina Del Sontro. Ms. Del Sontro pressed her sister to go to an emergency room asking Do you really want to die on the floor of Sams Club The family history of heart disease is dire. Their grandfather had a severe heart attack when he was . Their mother started having severe chest pains at . And toward the end of their mothers life she was popping nitroglycerin pills like Tic Tacs Mr. Del Sontro said. She had openheart surgery three times and died on the operating table at . Robin Ashwood one of Mr. Del Sontros sisters found out she had extensive heart disease even though her electrocardiograms had come back normal. Six of her seven siblings also have heart disease despite not having any of the traditional risk factors.CreditBrendan Hoffman for The New York Times So Ms. Ashwood went to a nearby emergency room. Doctors took her blood pressure. It was elevated she says and she was terrified. They did an electrocardiogram. It was normal. They told her she was fine. Advertisement But she recalled that her mothers electrocardiogram had been fine too and she died of the disease. She called her cardiologist the next day. But he blew me off she said. He told me it was probably a stomach problem. Still fearful she coldcalled cardiologists offering to pay for a consultation if a doctor would just look at her medical record and family history. Dr. Leslie R. Fleischer in Pensacola Fla. where Ms. Ashwood was living at the time took her on. He threaded a catheter through a blood vessel from her groin to her heart and shot dye into the coronary arteries to make them visible on Xrays. He saw extensive heart disease. One coronary artery was almost completely blocked and the others were partly blocked. I have been doing this for years Dr. Fleischer said. So I am not surprised. I am just sad. He inserted a stent a small wire cage into an artery that was percent blocked. And he warned Ms. Ashwood that all her siblings should get tested. Tina Del Sontro went first. She was but tests showed she had heart disease too. Her doctor told her a heart attack was in her future saying she recalls Its not if it is going to happen its when. So Rick went to a general practitioner who told him he had nothing to worry about. Then his brother Peter at the time saw a cardiologist and days later had emergency double bypass surgery. Shaken Rick decided he too should see a cardiologist. Dr. Edward Bodurian in Chevy Chase Md. first suggested a heart scan to look for calcification in his arteries a sign of blockages. The scan showed potential problems so Dr. Bodurian performed the same catherization test that had detected Ms. Ashwoods disease. It revealed the grim news about his blocked arteries. Most people who have this test can leave the hospital quickly. Doctors insert a plug in the hole in the groin where the catheter is inserted to stop the bleeding. But Mr. Del Sontro had so little body fat that a plug would not stay in place. So he had to lie flat on his back for hours in Suburban Hospital which happened to be across the street from the National Institutes of Health. While Mr. Del Sontro was lying there someone came by he never got the persons name and told him there was a study starting at the National Institutes of Health that you might find relevant. It was the one Dr. Biesecker was directing to find new causes of heart disease. I keep waiting for the day when I have shortness of breath Mr. Del Sontro said while at home in Washington with his yearold son Nico and his yearold daughter Siena.CreditGreg Kahn for The New York Times This serendipitous encounter led to his familys participation in the study. Seeking the Mutation Dr. Bieseckers project had a specific goal to recruit people a quarter with no heart disease and a quarter each with mild moderate and severe forms of the disease. The hope was that by comparing the genes of people with varying degrees of severity the researchers might discover genetic alterations that would reveal why heart disease occurs. They made some interesting observations about gene mutations that were already known to cause heart diseases but the Del Sontros offered the possibility of discovering an entirely new genetic pathway to heart disease. Now eight family members have joined the study and Dr. Biesecker is searching for more. Even so finding the tiny troublemaking genetic glitches in the familys genes is an intimidating task. There are genes in each persons DNA and each gene is can be made up of a string of hundreds of DNA letters and can harbor variations. Most of the variations are meaningless. In the entire DNA which contains genes and regions that control genes there are six billion DNA letters to check. To figure out what DNA changes might be important the researchers are comparing the DNA sequences of Rick Del Sontro and his family with those of others in the study looking for genetic changes that occur in every member of the Del Sontro family who has heart disease but that are not generally found in healthy people. Dr. Biesecker acknowledged that there was no guarantee of success. He and his colleagues know the gene mutation in the Del Sontro family must be rare. Otherwise lots of people would have early heart disease but no obvious risk factors. To keep the focus on truly rare mutations the researchers are excluding those that are present in both members of the Del Sontro family and percent or more of the other study participants. That strategy alone Dr. Biesecker said has eliminated the vast majority of candidate genes. The researchers are now searching for culprits among genes that remain a search that could take years. Or the change might be in a poorly understood region of DNA that controls genes rather than in a gene itself. Researchers ignorance of these control regions and what many of them do might doom the effort. So the researchers are hoping the Del Sontro familys heart disease is caused by a mutated gene. Our main job is to find the gene Dr. Biesecker said. Still Mr. Del Sontro is preparing for the worst. He has life insurance and longterm care insurance. I keep waiting for the day when I have shortness of breath he said. When his heart disease was first diagnosed four and a half years ago Mr. Del Sontro now told his cardiologist he wanted to run one more Bay to Breakers race a centuryold kilometer race in San Francisco. His doctor told him absolutely not saying You are the kind of guy we will read about who dies during the race of a massive heart attack. Mr. Del Sontro could still exercise his cardiologist said but no more than minutes a day. Mr. Del Sontro is all too aware that the cause of his heart disease is a mystery but he worries that if he fails to eat right and exercise he might make his illness even worse. So he left for the gym before dawn on a recent chilly morning. He lifted weights using dumbbells and bars moving quickly from exercise to exercise. Fortyfive minutes later sweating he was done. His disease casts a dark shadow not just on him but on his entire family. At dinner one recent evening at their yellow brick townhouse in the Georgetown neighborhood in Washington his wife Pura admitted to worrying but said We dont talk about it a lot. She served Indian takeout saffron rice tandoori chicken eggplant. Tall slender and elegant in skinny jeans and a long beige sweater she ate sparingly and drank a Coke Zero. Mr. Del Sontro drank only water and took small portions. Their yearold daughter Siena said she was afraid she had inherited her fathers heart problems. He reassured her that scientists would surely have found a treatment by the time she grew up. I hope it doesnt hurt she told him. Her shy yearold brother Nico slipped away from the dinner table."

"Two personalized cancer vaccines have been found to be safe and effective at treating people with melanoma scientists have announced. Cancer vaccines that are personalized to the patientdesigned to help the immune system identify tumors as foreign bodies and destroy themhave been considered as a potential treatment for a number of years. But working out the unique mutations of each persons cancer a timeconsuming and complicated process must first be identified before a vaccine can be developed for them. In two studies published in the journal Nature researchers have shown promising results from Phase I clinical trials. While they are very small scaleone was on six participants the other the findings mean researchers can move ahead with the vaccines which could potentially lead to new more effective cancer treatments. In the first study httpnature.comarticlesdoi.nature scientists led by Catherine Wu developed a vaccine for people who had been treated for melanoma with surgery but who had received no other treatment. They sequenced the DNA from the tumors then created a personalized vaccine that contained neoantigens targets for the immune response for predicted mutations. Six patients were given a full series of vaccinations including five priming injections and two booster vaccinations. Four of the six had no recurrence of the disease after months. In the other study httpnature.comarticlesdoi.nature by Ugur Sahin and colleagues tested a personalized vaccine based on RNA an essential link in the production of proteins encoded by DNA. They used a similar approach to Wu and her team to identify the mutations then tested the vaccine on people who were being treated for melanoma. All participants were found to have a boosted immunity against the antigens specific to their tumors. Eight were still tumor free after months. Both vaccines were deemed safe and are expected to be taken forward for further research. These vaccines are not necessarily the future of personalized cancer treatment. Cornelius Melief from the Leiden University Medical Center Netherlands said in an accompanying News Views article that controlled randomized Phase II clinical trials will be needed to work out if the vaccines are effective. He added however that the studies confirm the potential of cancer vaccines. Elizabeth Williams from the School of Biomedical Sciences at Queensland University of Technology tells Newsweek the two studies describe tantalizing complementary and consistent results in Phase trials in melanoma patients using vaccines. The vaccines are personalized for each individuals tumours by harnessing technologies that enable the comprehensive analysis of the molecular fingerprint of the tumour she says. The data shows that it is a safe and well tolerated strategy that stimulates relevant antitumor immune responses. However the treatment has its downsides As the vaccine therapies are designed and generated specifically for each individual there is a lag time from enrollment to commencement of treatmentapproximately four monthswhich may be too long from some patients with advanced cancer. As technologies and processes continue improve this is likely to be reduced she continues. It is still unknown whether these vaccines will extend the survival of cancer patients or whether they are more effective than other recently developed immunotherapies. Additional clinical trials will be required to determine the utility of these individualised neoepitope vaccines. Catherine Pickworth science communication officer at Cancer Research UK said The promising results from these two small earlystage studies show that personalized cancer vaccines designed to treat skin cancer are safe to use and that for some patients they can successfully harness the power of the bodys own immune system to kill cancer cells. The next step will be to test these personalized vaccines in larger clinical trials to see if they are better than existing treatments if they improve survival and what their longterm side effects could be."

"If you find yourself hospitalized youve got a one in five chance of needing a urinary catheter raising your risk for a urinary tract infection. Now researchers report that a new program shows it might be possible to reduce both catheter use and its associated infections. Catheterassociated urinary tract infections are common and costly patient safety problems said lead researcher Dr. Sanjay Saint. He is a professor of internal medicine at the University of Michigan in Ann Arbor. Roughly such infections occur in hospitals each year in the United States costing about million the researchers pointed out. Although about percent of hospitalized patients get a urinary catheter onethird of the time they arent needed Saint said. He believes that patients can play a role in reducing catheter use. A lot of patients and families dont realize that there are problems with a urinary catheter so they may request them because they think it will allow patients to stay in bed Saint said. Unfortunately there are side effects with a catheter. And Ive seen patients who have gotten up in the middle of the night and they trip and fall on the tubing he explained. Patients and families should request that a catheter not be put in and if there is one there the patient should ask every day whether it is still needed Saint suggested. For the study Saint and his colleagues tried the new program in hospitals. After months of using the program infection rates among hospital patients in general wards dropped by onethird while catheter use had dropped about percent. But there was no drop in infections or catheter use in intensive care units ICUs the study findings showed. Hospitalacquired urinary tract infection rates rose nationwide during the same time period Saint noted. The program Saint helped develop called the bladder bundle includes protocols checklists training and informationsharing that help doctors and nurses reduce catheter use and prevent infections. Included in the program are Daily checks to see if a catheter is still needed. Using other options to collect urine such as bedpans. Training for managing urinary catheters. Use of infectioncontrol techniques for catheter placement and maintenance. Feedback to the medical team about catheter use and infection rates. The researchers found that catheter infection rates in the new program dropped percent overall in general wards nonICU. The findings were published June in the New England Journal of Medicine. Dr. Susan Huang a professor of infectious disease at the University of California Irvine wrote an editorial accompanying the study. She said While weve known the correct care processes for managing urinary catheters we havent been able to reliably reduce catheterrelated infections. An intervention that focuses on changing the culture in hospitals to make them more responsive to the problem of infection control one that involves rallying around a focused problem and ensuring teambased solutions is integral to improving infection control in hospitals she said. As for improving infection control in intensive care units Huang said further analysis may help us understand why this intervention didnt work. This program can reduce urinary infections in hospitals if a team is assembled to ensure adoption of best practices and to rapidly correct reasons for failing to comply with these processes she added. More information Visit the U.S. Centers for Disease Control and Prevention http_utiuti.html for more on urinary tract infections. SOURCES Sanjay Saint M.D. M.P.H. professor internal medicine University of Michigan Ann Arbor Susan Huang M.D. M.P.H. professor infectious disease University of California Irvine June New England Journal of Medicine"

"A new dietary review of observational and controlled studies finds plantbased vegetarian diets especially vegan diets are associated with lower levels of total cholesterol including lower levels of HDL and LDL cholesterol compared to omnivorous diets. The metaanalysis appears as an online advance in Nutrition Reviews. The study authorsYoko Yokoyama Ph.D. M.P.H. Susan Levin M.S. R.D. C.S.S.D. and Neal Barnard M.D. F.A.C.C.reviewed observational studies and clinical trials which met their inclusion criteria. They find A plantbased vegetarian diet is associated with total cholesterol thats . mgdL lower in observational studies. In clinical trials a plantbased diet lowers total cholesterol by . mgdL. In observational studies a plantbased vegetarian diet is associated with a . mgdL reduction in LDL cholesterol and a . mgdL reduction in HDL cholesterol compared to control groups following an omnivorous diet. In clinical trials a plantbased vegetarian diet lowers LDL cholesterol by . mgdL and reduces HDL cholesterol by . mgdL compared to control groups following an omnivorous lowfat calorierestricted or a conventional diabetes diet. A plantbased vegetarian diet is not associated with statistically significant changes in triglyceride levels in observational studies or in clinical trials. The authors predict the strong correlation between vegetarian diets and lower cholesterol levels may be due to the association a plantbased diet has with a lower body weight a reduced intake of saturated fat and an increased intake of plant foods like vegetables fruits legumes nuts and whole grains which are naturally rich in components such as soluble fiber soy protein and plant sterols. The study authors hypothesize that the greater risk reduction for total HDL and LDL cholesterol levels observed in the longitudinal studies is likely due to longterm adherence to plantbased eating patterns and changes in body composition. The immediate health benefits of a plantbased diet like weight loss lower blood pressure and improved cholesterol are well documented in controlled studies says study author Susan Levin M.S. R.D. C.S.S.D. Our goal with studying plasma lipids throughout the lifespan is to capture the net risk reduction of using a vegetarian diet to control lipid levels. We hope to empower patients with new research about the longterm cardiovascular health benefits of a vegetarian diet which include a reduced risk of a heart attack stroke and premature death. Charles Ross D.O. a member of the nonprofit Physicians Committee and a former emergency department physician has firsthand experience with putting a plantbased diet into practice. Dr. Ross is in his late s takes no medications and lowered his previously high total cholesterol from mgdL to a healthy mgdL after adopting a wholefood plantbased diet in . Within the first month of making the dietary change he effortlessly lost pounds. Within a year Dr. Ross traded a year career of practicing emergency medicine for a new career path lifestyle medicine. After . years of making the career switch he continues to host free biweekly nutrition classes for his primary care patients and the community. More than people have enrolled to learn how to lose weight eliminate the need for medications to treat type diabetes hypertension and elevated cholesterol and to simply feel better. His former hometown of Roseburg Ore. is now a Blue Zones community. He is a parttime instructor at the College of Osteopathic Medicine of the Pacific Northwest and hopes to set an example for future physicians. I no longer work for a living notes Dr. Ross who now resides in Westfir Ore. I wake up every day eager to hear about how a plantbased diet and a healthful lifestyle is changing and saving lives in our community. What Ive found is that if you want your patients to make significant health changes you have to make them yourself. The prescription started to spread soon after my family coworkers neighbors and friends heard about my experience. For clinicians concerned about spending extra time in and outside of the exam room the study authors encourage timestrapped health care providers to refer patients to registered dietitians who can help with the transition to a plantbased vegetarian diet. The Dietary Guidelines for Americans highlights a healthy vegetarian diet as one of three healthful eating plans to follow. The study authors also note hyperlipidemia or elevated cholesterol and triglycerides is often underdiagnosed and undertreated. A percent increase in the prevalence of treatment for hyperlipidemia can prevent deaths each year. Taking small steps like those proposed by the National Cholesterol Education Program Adult Treatment Panel which include assessing heart disease risk making lifestyle and dietary recommendations and assessing the need for future followup appointments and pharmaceutical interventions could prevent approximately heart attacks cases of coronary heart disease and save almost billion in medical costs each year. To make any form of health care work and to truly power economic mobility we have to get healthy says Levin. The first place to start is by building meals around nutrientpacked plantbased foods which fit into nearly every cultural template taste preference and budget. To request a copy of the study or to request an interview with a study author please contact Jessica Frost at . Founded in the Physicians Committee for Responsible Medicine is a nonprofit organization that promotes preventive medicine conducts clinical research and encourages higher standards for ethics and effectiveness in research."

"For years research has shown that babies born by cesarean section are more likely to develop health problems. Now a groundbreaking study suggests that not all Csections are equally risky. The research looked at all fullterm firstborn births in Scotland over a year period and tracked the babies longterm health. It is one of the largest and longest studies to explore how planned Csections differ from other deliveries. Surprisingly the data showed more health problems among babies born by planned Csection than among those delivered by emergency Csection or vaginal birth even though the planned surgery is done under more controlled conditions. The finding suggests that the arduous experience of labor that exhausting sweaty utterly unpredictable yet often strangely exhilarating process may give children a healthy start even when its interrupted by a surgical birth. The new findings published in JAMA this month https are important because the number of babies born by Csection has increased tremendously. In the United States nearly one in three https babies are born by Csection. Cesarean births that had no medical indication increased to . percent of lowrisk women in up from . percent of such women in https Dr. Mairead Black the University of Aberdeen obstetrician who led the study said that as cesarean births had increased in Scotland and worldwide the researchers wondered what if anything children born by Csection are missing out on. Our thinking was If a baby is born naturally it comes into contact with bacteria from the mother which might help with immune system development Dr. Black said. Even attempted labor may provide some exposure to bacteria she said. But babies delivered by a planned Csection which is usually scheduled to take place well before the first pang of labor may miss out entirely. When you dont wait for labor to begin on its own you cut short all kinds of physiological changes and preparations for birth that are taking place toward the end of pregnancy said Carol Sakala the director of the nonprofit Childbirth Connection https programs at the National Partnership for Women Families. What is the effect of cutting off those processes so casually on such a large scale Studies have consistently found that children born by Csection are at higher risk for health problems like obesity httpsjournals.plos.orgplosonearticleid.journal.pone.and allergies https Csection birth has also been associated with a higher risk for Type httpslink.springer.comarticle.Fsz diabetes. The Scottish study took advantage of the small countrys rich trove of linked birth and medical databases to track the longterm health of babies. Nearly percent were born by planned Csection and percent were delivered by emergency surgery. The remaining were vaginal births. The researchers compared a range of health outcomes among the babies including asthma irritable bowel syndrome obesity Type diabetes early death and cancer. Over all the differences between a scheduled Csection and an emergency Csection were slight. However the data do begin to shed light on why babies born through vaginal birth may have fewer health risks than babies born by Csection. The biggest difference between babies born by scheduled and unscheduled Csection appeared in risk for Type diabetes. The results showed that babies born by planned Csection had a percent higher risk of Type diabetes compared with babies born by emergency Csection after adjusting for differences among the mothers. All of the babies born by Csection were slightly more likely to use an asthma inhaler at age . percent of planned Csection babies and . percent of unscheduled Csection babies wound up using an inhaler compared with . percent of vaginally born babies. Asthma hospitalization rates were also higher for babies born by planned Csection with a statistically significant increase of percent over vaginally born babies. Although all of the Csection babies were more likely to be obese at age the differences were not statistically significant after adjusting for differences among the mothers. There were no significant differences in cancer and irritable bowel disease among any of the types of births. No one knows exactly why labor may be protective but the spontaneous onset of labor prompts fluid to clear from a babys lungs said Dr. Aaron Caughey who helped draw up guidelines https for the American College of Obstetricians and Gynecologists that urged providers to let women spend more time in labor and avoid an unnecessary Csection. The step is just one of a cascade of physiological changes that take place in mother and baby during the labor process including surges in stress hormones and reproductive hormones like oxytocin that may help the fetus adapt during labor preserve blood flow to the organs and keep the baby alert and prepared for breastfeeding. During labor a newborn absorbs maternal microbes into its mouth and gastrointestinal tract said Dr. Josef Neu a neonatologist at the University of Florida who has written about Csection babies and the hygiene hypothesis. The theory is that maternal microbes train the infants immune system so it doesnt overreact or become destructive and precipitate autoimmune disorders like Type diabetes. Its an education process that says Calm down youre going to be seeing this antigen again you dont have to be so aggressive Dr. Neu said. Dr. Neu said the broadspectrum antibiotics prescribed to the mother before a surgical delivery were another concern the antibiotics can be transmitted to the baby through breast milk if not before birth decreasing the diversity of natural bacteria. The findings are a reminder that although Csections are appropriate in some circumstances they are a poor substitute for labor. Childbirth and labor are a physiological process that weve evolved to over millions of years Dr. Caughey said. Its been really welldesigned by evolution."

"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."

"An international phase trial has found that the drug regorafenib improved survival in patients with advanced hepatocellular carcinoma HCC a form of liver cancer giving people who previously had no other options a better chance at survival. Results from the study which included researchers at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai were recently published online in The Lancet http The trial funded by Bayer included sites in countries. About percent of HCC cases are diagnosed at advanced stages a point when HCC is particularly difficult to treat. This trial provides evidence that regorafenib is the first systemic treatment for patients whose HCC progressed during treatment with sorafenib the only other drug with proven clinical benefit. This study tested regorafenibs effectiveness as a secondline therapy on patients previously treated with sorafenib of whom were given a placebo. Regorafenib a multikinase inhibitor significantly improved overall survival from . months on placebo to . months with regorafenib. Two patients treated with regorafenib had their tumor shrink to an undetectable level according to the study. This study represents a breakthrough in the management of hepatocellular carcinoma since it provides evidence for clinical benefits in an area that was an unmet medical need said Josep M. Llovet MD founder and Director of the Liver Cancer Program and Professor of Medicine and Liver Diseases at the Icahn School of Medicine at Mount Sinai. Regorafenib has shown it can improve survival in patients with advanced hepatocellular carcinoma progressing on sorafenib. Previously no treatment was available for these patients. Dr. Llovet was a member of the clinical trials steering committee and Charissa Chang MD Assistant Professor of Medicine and Liver Diseases at the Icahn School of Medicine was principal investigator of the Mount Sinai testing site. The success of this trial opens the field for testing drugs in thirdline treatment of HCC and provides a rationale to test regorafenib as a firstline treatment or in combination with therapies administered directly into the tumor or diseased liver in patients in an earlier stage of HCC according to Dr. Llovet. In this trial regorafenib was welltolerated with manageable adverse events according to the paper in Lancet. In January Bayer announced that the U.S. Food and Drug Administration FDA had granted priority review status for Stivarga regorafenib as a secondline systemic treatment for patients with hepatocellular carcinoma. This research was also presented during the European Society of Medical Oncologys World Congress on Gastrointestinal Cancer in June. Liver cancer is the secondleading primary cause of cancerrelated deaths worldwide."

"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."

"Theres still no cure for the common cold but there may be a way to shorten its misery A new study suggests that higher doses of zinc lozenges in certain formulations may cut the length of colds by more than percent. Researcher Dr. Harri Hemila of the University of Helsinki in Finland reviewed placebocontrolled trials examining the effect of zinc lozenges on cold infections. Three of them found that zinc acetate in daily doses of more than milligrams mg shortened colds duration by percent on average. Five trials using zinc salts other than acetate in daily doses greater than mg shortened colds by an average of percent while another five using less than mg per day produced no effect. Much of the variation in the published study findings can be explained by the daily dose of zinc administered in the zinc lozenges said Hemila who funded the research himself. When focusing on those studies which have used large daily doses of zinc there is strong evidence that zinc lozenges shorten the duration of colds. The study is published in The Open Respiratory Medicine Journal. Despite the popularity of zinc supplements controversy over their effectiveness has continued since a muchpublicized study first suggested a coldlimiting effect. Allowing the lozenge to dissolve instead of swallowing it seemed to provide a therapeutic effect. Since then more than a dozen studies have been carried out but data on the trace minerals effectiveness has been mixed. All of the trials examined by Hemila compared zinc lozenges to placebos. While surprised to note how strong the correlation was between daily doses of zinc and its effect on colds duration he said he and his colleagues still dont know why it seems to work. In the evidencebased medicine framework we are primarily interested in the question whether there is an effect and how great whereas the mechanism of the effect is a secondary issue he said. No prior studies showed zinc lozenge use even up to mg per day might cause harm aside from bad taste or constipation Hemila said and the most recent trial on zinc acetate indicated no significant differences between zinc and placebo groups in adverse effects even though the daily zinc dose was mg. Dr. Lisa Winston an epidemiologist at San Francisco General Hospital praised the study as a pretty good synthesis of the data although she noted that the trials Hemila reviewed involved small numbers of participants. Its an area of controversy and question . . . but I dont think the evidence is strong enough nor do I think the author is suggesting that we can base clinical practice on it said Winston also an associate professor in the University of CaliforniaSan Francisco Department of Medicine. I would tell my patients we still dont have a cure for the common cold and we dont know if zinc works. More information The U.S. National Library of Medicine has more about the common cold http SOURCES Harri Hemila M.D. Ph.D. researcher department of public health University of Helsinki Finland Lisa Winston M.D. associate professor University of California San Francisco Department of Medicine and vice chief inpatient medical services and hospital epidemiologist San Francisco General Hospital The Open Respiratory Medicine Journal"

"The latest outcomes measuring the impact of CDCs national tobacco education campaign are as strong as those achieved in its first year and suggest that three years into the campaign the ads were still having a significant impact. More than . million smokers attempted to quit smoking because of the nineweeklong Tips From Former Smokers Tips campaign. An estimated Americans quit smoking for good as a result of the campaign. The survey results are published in the March release of the journal Preventing Chronic Disease. Unlike the campaign which aired for consecutive weeks the campaign aired in two phases from February to April and from July to September . Phase of the campaign ran ads primarily from the and campaigns Phase contained new ads. Those new ads featured people and their struggles with smokingrelated health issues including cancer gum disease premature birth and stroke caused by smoking combined with HIV. About percent of U.S. adult cigarette smokers who were surveyed reported seeing at least one television ad from Phase of the campaign. CDCs Tips campaign has helped at least smokers quit smoking for good since said CDC Director Tom Frieden M.D. M.P.H. Tips is also extremely costeffective and a best buy saving both lives and money. With a yearround campaign we could save even more lives and money. Tips the first federally funded antismoking paid media campaign features former smokers talking about their smokingrelated illnesses. Smokingrelated diseases cost the United States more than billion a year including nearly billion in direct health care costs and more than billion in lost productivity. The Tips campaign is an important counter measure to the million that the tobacco industry spends each hour on cigarette advertising and promotion said Corinne Graffunder Dr.P.H. director of CDCs Office on Smoking and Health. The money spent in one year on Tips is less than the amount the tobacco industry spends on advertising and promotion in just days. The most recent Surgeon Generals Report The Health Consequences of Smoking Years of Progress called for airing effective messages such as the Tips ads with high frequency and exposure for months a year for a decade or more. Cigarette smoking is the leading preventable cause of disease and death in the United States killing about Americans each year. For every American who dies from a smokingrelated disease about more suffer at least one serious illness from smoking. And while the percentage of American adults who smoke is at the lowest level since the CDC began tracking such data there are still an estimated million adult smokers in the U.S. Surveys show about percent of all smokers want to quit and research shows quitting completely at any age has significant health benefits. Tips ads encourage smokers to call QUITNOW or to visit http to view the personal stories from the campaign. The website includes detailed assistance developed by the National Cancer Institute to support smokers trying to quit. For more information on the Tips campaign including profiles of the former smokers other campaign resources and links to the ads visit http"

"Obese patients who swallowed balloon capsules that helped them eat less lost an average of pounds roughly two times more weight than patients who just dieted and exercised researchers report. The capsule was inflated with gas via a catheter when it reached the stomach. As many as three balloons were placed over three months and all of the balloons were removed after six months. The balloons made patients feel full the researchers explained. In addition to the balloons patients followed a moderate diet and behavior modification program. Whether the weight loss will last over the long term isnt known said lead researcher Dr. Aurora Pryor director of the Bariatric and Metabolic Weight Loss Center at Stony Brook University in New York. The study lasted a year but we dont know what happens after that Pryor said. If they are able to stick to their newfound lifestyle with their diet and exercise program they could maintain their weight loss she said. The longterm results are dependent on patients keeping their motivation to stay with their diet and exercise programs. The balloon treatment will be available starting in January but the cost hasnt been announced Pryor said. The device called the Obalon Balloon System was approved in September by the U.S. Food and Drug Administration. An advantage of the balloons is that patients have no downtime and can go back to work the same day the researchers said. There is no sedation or recovery time when the balloons are placed but there is sedation when the balloons are removed so you wouldnt want to go back to work after that Pryor added. Pryor believes balloons are a better option for patients who are candidates for weight loss surgery but dont want surgery. For people who want to lose some weight but dont feel they are heavy enough for surgery or theyre afraid of surgery this is a really good next step to help them jump start their weight loss she suggested. The findings were to be presented Friday at the annual meeting of the American Society for Metabolic and Bariatric Surgery and the Obesity Society in New Orleans. Research presented at meeting is considered preliminary until published in a peerreviewed journal. One weightloss expert expressed some doubts about the findings. I still question the efficacy of balloons said Dr. Mitchell Roslin chief of obesity surgery at Lenox Hill Hospital in New York City. While there is potentially easier insertion that does not require sedation I still doubt after removal there will be weight loss he said. Roslin said patients who have other treatments that restrict their ability to eat such as bands and bypass operations that reduce the size of the stomach often regain lost weight over time. As time goes on weight loss will be about lifestyle changes he said. The only argument for the balloon is that it starts the lifestyle changes Roslin said. It may make it easier to become motivated he said. But I believe that few will maintain weight loss two years after any balloon. For the study Pryor and her colleagues randomly assigned nearly obese patients to receive a real or sham device. All patients also had minutes of lifestyle therapy every three weeks. After six months patients with the Obalon balloons had them removed. During the time patients had the balloons and for six months after the researchers monitored their weight loss. The investigators also followed those who had not received the balloon therapy. People treated with the balloons lost an average of percent of their weight compared to less than percent for those who received the sham device the researchers found. Six months after the balloons were removed nearly percent maintained the weight loss they achieved during treatment Pryor said. As for side effects one patient had a bleeding stomach ulcer while taking high doses of pain pills after a knee replacement. Most patients percent suffered from stomach cramps and nausea which nearly percent said were mild or moderate. The results were also presented at a medical meeting in May. One health and nutrition expert noted that a balloon does not equal a lifestyle change. A gastric balloon may help with weight loss but will do nothing to improve diet quality and overall health said Dr. David Katz. He is director of the YaleGriffin Prevention Research Center in Derby Conn. and president of the American College of Lifestyle Medicine. The role for such technologybased approaches to weight control should be a small one he said. Such devices may be alternatives to bariatric surgery in some cases. But they should not distract us from the far better solution at the population level practices programs and policies that make eating well and being active a cultural norm Katz said. More information Visit the U.S. Centers for Disease Control and Prevention https for more on obesity. SOURCES Aurora Pryor M.D. professor surgery and director Bariatric and Metabolic Weight Loss Center Stony Brook University N.Y. Mitchell Roslin M.D. chief obesity surgery Lenox Hill Hospital New York City David Katz M.D. M.P.H. director YaleGriffin Prevention Research Center Derby Conn. and president American College of Lifestyle Medicine Nov. presentation Obesity Week New Orleans"

"Aspirin https already linked in some studies to a lower risk of developing colon cancer https may also cut the risk of dying of prostate cancer https by more than half a large study suggests. Researchers stress the findings are preliminary and that men with the cancer https should not reach for the aspirin bottle in an attempt to improve their health. But if the findings are confirmed patients who are taking aspirin for other reasons may see an added benefit says study head Kevin Choe MD a radiation https oncologist at the University of Texas Southwestern Medical School in Dallas. The findings were released at a news briefing held in advance of the annual meeting of the American Society for Radiation Oncology ASTRO in San Diego. Blood ClotCancer Link Studies have shown that people with cancer https are more prone to blood clots https and that people with blood clots are at increased risk of cancer https Also lab and animal studies suggest drugs that anticlotting drugs like aspirin may interfere with cancer growth and spread. So Choe and colleagues hypothesized that anticlotting drugs may lower the risk of dying among men with prostate cancer https The study involved men with localized cancer whose disease had not spread beyond the prostate gland https of the men were taking anticlotting medications https aspirin Lovenox Plavix andor warfarin https By years after diagnosis of men not taking one of these medications had died from prostate cancer vs. of those who took an anticlotting medication. The risk that cancer spread was also reduced by anticlotting medications from to . Also of men who didnt take anticlotting medications had a recurrence of their cancer compared with of men who did take them. Men who took aspirin gained the greatest benefit Choe says. Harvard Medical Schools Anthony Zietman MD president of ASTRO tells WebMD that the findings are intriguing. However they need to be confirmed and the optimal dose timing and duration of use needs to be worked out he says. Aspirin and other anticlotting medications carry risks of their own chiefly bleeding Zietman says. We have to be sure the benefits outweigh the risks before we recommend this to patients. This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

"When doctors saw the report on Bill Ludwigs bonemarrow biopsy they thought it was a mistake and ordered the test repeated. But the results came back the same His lethal leukemia had been wiped out by an experimental treatment never before used in humans. We were hoping for a little improvement remembered the yearold retired New Jersey corrections officer who had battled the disease for a decade. He and his oncologist both broke down when she delivered the good news in . Nobody was hoping for zero cancer. The pioneering therapy administered to Ludwig and a few other adults at the University of Pennsylvania hospital paved the way for clinical trials with children. Sixyearold Emily Whitehead who was near death became the first pediatric recipient in . Like Ludwig she remains cancerfree. Such results are why the treatment is on track to become the first gene therapy approved by the Food and Drug Administration. An FDA advisory committee will decide Wednesday whether to recommend approval of the approach which uses patients own genetically altered immune cells to fight blood cancers. If the panel gives the nod the agency probably will follow suit by the end of September. That would open the latest chapter in immunotherapy https_term.ef a true living drug said Penn scientist Carl June who led its development. The CAR Tcell treatment manufactured by the drug company Novartis initially would be available only for the small number of children and young adults whose leukemia does not respond to standard care. Those patients typically have a grim prognosis but in the pivotal trial testing the therapy in almost a dozen countries percent of patients went into remission. A year later twothirds remained so. And childhood leukemia is just the start https_term.ceafa for a field that has attracted intense interest in academia and industry. Kite Pharma of Santa Monica Calif. has applied for FDA approval to treat aggressive nonHodgkins lymphoma and a similar Novartis application is close behind. Researchers also are exploring CAR Tcell therapys use for multiple myeloma and chronic lymphocytic leukemia the disease that afflicted Ludwig. They are also tackling a far more difficult challenge using the therapy for solid tumors in the lungs or brain for example. The excitement among doctors and researchers is palpable. Were saving patients who three or four years ago we were at our wits end trying to keep alive said Stephen Schuster the Penn oncologist who is leading a Novartis lymphoma study. That study and a Kite trial have shown that the treatment can put about onethird of adults with advanced disease those who have exhausted all options into remission. Yet along with the enthusiasm come pressing questions about safety cost and the complexity of the procedure. It involves extracting white blood cells called T cells the foot soldiers of the immune system from a patients blood freezing them and sending them to Novartiss sprawling manufacturing plant in Morris Plains N.J. There a crippled HIV fragment is used to genetically modify the T cells so they can find and attack the cancer. The cells then are refrozen and sent back to be infused into the patient. Once inside the persons body the Tcell army multiplies astronomically. Novartis has not disclosed the price for its therapy but analysts are predicting to for a onetime infusion. Brad Loncar whose investment fund focuses on companies that develop immunotherapy treatments hopes the cost does not prompt a backlash. CART is not the EpiPen he said. This is truly pushing the envelope and at the cutting edge of science. The biggest concerns however center on safety. The revvedup immune system becomes a potent cancerfighting agent but also a dangerous threat to the patient. Serious side effects abound raising concerns about broad use. Treating patients safely is the heart of the rollout said Stephan Grupp of Childrens Hospital of Philadelphia who as director of the hospitals cancer immunotherapy program led early pediatric studies as well as Novartiss global trial. The efficacy takes care of itself but safety takes a lot of attention. One of the most common side effects is called cytokine release syndrome which causes high fever and flulike symptoms that in some cases can be so dangerous that the patient ends up in intensive care. The other major worry is neurotoxicity which can result in temporary confusion or potentially fatal brain swelling. Juno Therapeutics a biotech firm in Seattle shut down one of its CAR Tcell programs after five patients died of brain swelling. Novartis has not seen brain swelling in its trials company officials said. To try to ensure patient safety Novartis is not planning a typical product rollout with a drug pushed as widely and aggressively as possible. The company instead will designate to medical centers to administer the treatment. Many of them took part in the clinical trial and all have gotten extensive training by Grupp and others. Grupp said he and his staff learned about the side effects of CAR Tcell therapy and what to do about them through terrifying experiences that began five years ago with Emily Whitehead. The young girl who had relapsed twice on conventional treatments for acute lymphoblastic leukemia was in grave condition. Grupp suggested to her parents that she be the first child to get the experimental therapy. I said Surely this has been tried on kids somewhere else in the world recalled her father Thomas Whitehead of Philipsburg Pa. But Steve said Nope some adults got it but that was a different kind of leukemia. After she received the therapy Emilys fever soared her blood pressure plummeted and she ended up in a coma and on a ventilator for two weeks in the hospitals intensive care unit. Convinced his patient would not survive another day a frantic Grupp got rushed lab results that suggested a surge of the protein Interleukin was causing her immune system to relentlessly hammer her body. Doctors decided to give Emily an immunosuppressant drug called tocilizumab. She was dramatically better within hours. She woke up the next day her seventh birthday. Tests showed her cancer was gone. The approval of CAR Tcell therapy would represent the second big immunotherapy advance in less than a decade. In the FDA cleared the first agent in a new class of drugs called checkpoint inhibitors. It has approved five more since then. There are big differences between the two approaches. The checkpoint inhibitors are targeted at solid tumors such as advanced melanoma https_term. and lung https_story.htmlutm_term.fefbfaf and bladder cancer while CAR Tcell therapy has been aimed at blood disorders. And although checkpoint inhibitors are off the shelf with every patient getting the same drug CAR Tcell therapy is customized to an individual. Many immunotherapy experts think the greatest progress against cancer will be achieved when researchers figure out how to combine the approaches. For the Penn team the CAR Tcell story goes back decades starting at the thenNational Naval Medical Center in Bethesda Md. where June and a postdoctorate fellow named Bruce Levine worked on new HIV treatments. In the process they figured out a way to turbocharge T cells to make them more powerful and plentiful. The pair moved to Philadelphia in and dove into cancer research. Two years later Junes wife died of ovarian cancer something he has credited as spurring him to work even harder in the field. In the years that followed researchers across the country including at the Memorial Sloan Kettering Cancer Center in New York and Fred Hutchinson Cancer Research Center in Seattle racked up an array of tantalizing discoveries involving T cells. Fastforward to when Ludwig who lives in Bridgeton N.J. became Penns first patient to receive CAR Tcell therapy. Two other men got the treatment not long after. One is still in remission the other relapsed and died. But after those three patients the Penn researchers ran out of money for more treatments. To try to raise interest and funding they decided to publish the results of their work. The article that appeared in the New England Journal of Medicine in August created a firestorm June said one that brought them new resources. David Porter a Penn oncologist working with June was on vacation in western Maryland and had to stop at a Kohls to buy a dress shirt for the immediate TV interviews. The pediatric trial opened the following spring with Emily. Six months later Penn licensed its technology to Novartis in exchange for financial support which included a new oncampus cellmanufacturing facility. With FDA approval seeming imminent the researchers who were so instrumental in the therapys development and testing are almost giddy. Grupp is especially pleased that the advance will be available first to children. Usually everything is developed first for adults he noted recently and children are an afterthought."

"A rising PSA level isnt such a good predictor of prostate cancer after all and can lead to many unnecessary biopsies says a large new study. Most men over get PSA blood tests but theyre hugely problematic. Too much PSA or prostatespecific antigen only sometimes signals prostate cancer is brewing it also can mean a benign enlarged prostate or an infection. And screening often detects small tumors that will prove too slowgrowing to be deadly. Yet theres no sure way to tell in advance who needs aggressive therapy. On the other hand some men have cancer despite a normal PSA count of or below. So for PSAs that are rising yet still in the normal range some guidelines urge doctors to consider a biopsy. How quickly the PSA number rises is something that patients and doctors worry a lot about said Dr. Andrew Vickers of Memorial SloanKettering Cancer Center. Men show up here with a PSA of and we say Why are you here And they say Well I used to be a and my doctors worried. Am I going to die So SloanKettering researchers studied whether considering PSA velocity adds value to the biopsyornot decision in those otherwise lowrisk men and concluded it doesnt. This is a really important study said Dr. Otis Brawley of the American Cancer Society who wasnt part of the research. A lot of doctors are going to stop looking at a PSA rise of and ordering biopsies. Vickers team tracked men whod taken part in a huge prostate cancer prevention study and whod received a biopsy at the studys end regardless of their PSA level. Just having a rising PSA if nothing else was considered was associated with a slightly higher risk of having cancer although not the more worrisome aggressive kind. But the PSA level alone not its rise was a much better predictor of a tumor reported Vickers a statistician who specializes in prostate cancer. Focusing on PSAs rise instead triggered many more biopsies with close to in men who would get one concluded the study published Thursday in the Journal of the National Cancer Institute. That compares with in men who are biopsied for a high PSA level alone noted Dr. Grace LuYao of the University of Medicine and Dentistry of New Jersey in an accompanying editorial. Theres an important public health message here which is for men not to worry about changes in their PSA if their overall PSA level is low Vickers said."

"Researchers have found evidence that a natural fruit extract is capable of dissolving calcium oxalate crystals the most common component of human kidney stones. This finding could lead to the first advance in the treatment of calcium oxalate stones in years. Jeffrey Rimer associate professor of chemical engineering at the University of Houston was lead author of the study published Aug. in the online edition of Nature. The work offers the first evidence that the compound hydroxycitrate HCA is an effective inhibitor of calcium oxalate crystal growth that under certain conditions is actually able to dissolve these crystals. Researchers also explain how it works. The findings are the result of a combination of experimental studies computational studies and human studies Rimer said. Kidney stones are small hard mineral deposits that form inside the kidneys affecting up to percent of men and seven percent of women. High blood pressure diabetes and obesity can increase the risk and the reported incidence is on the rise. Preventive treatment has not changed much over the last three decades. Doctors tell patients who are at risk of developing stones to drink lots of water and avoid foods rich in oxalate such as rhubarb okra spinach and almonds. They often recommend taking citrate CA in the form of potassium citrate a supplement that can slow crystal growth but some people are unable to tolerate the side effects. The project grew out of preliminary work done by collaborator John Asplin a nephrologist at Litholink Corporation who suggested HCA as a possible treatment. HCA is chemically similar to CA and is also available as a dietary supplement. HCA shows promise as a potential therapy to prevent kidney stones the researchers wrote. HCA may be preferred as a therapy over CA potassium citrate. In addition to Rimer and Asplin authors on the paper include Giannis Mpourmpakis and his graduate student Michael G. Taylor of the University of Pittsburgh Ignacio Granja of Litholink Corporation and Jihae Chung a UH graduate student working in Rimers lab. The headtohead studies of CA and HCA determined that while both compounds inhibit the growth of calcium oxalate crystals HCA was more potent and displayed unique qualities that are advantageous for the development of new therapies. The team of researchers then used atomic force microscopy or AFM to study interactions between the crystals CA and HCA under realistic growth conditions. According to Rimer the technique allowed them to record crystal growth in real time with nearmolecular resolution. Chung noted that the AFM images recorded the crystal actually shrinking when exposed to specific concentrations of HCA. Rimer suspected the initial finding was an abnormality as it is rare to see a crystal actually dissolve in highly supersaturated growth solutions. The most effective inhibitors reported in the literature simply stop the crystal from growing. It turned out that Chungs initial finding was correct. Once they confirmed it is possible to dissolve crystals in supersaturated solutions researchers then looked at reasons to explain why that happened. Mpourmpakis and Taylor applied density functional theory DFT a highly accurate computational method used to study the structure and properties of materials to address how HCA and CA bind to calcium and to calcium oxalate crystals. They discovered HCA formed a stronger bond with crystal surfaces inducing a strain that is seemingly relieved by the release of calcium and oxalate leading to crystal dissolution. HCA was also tested in human subjects as seven people took the supplement for three days allowing researchers to determine that HCA is excreted through urine a requirement for the supplement to work as a treatment. While Rimer said the research established the groundwork to design an effective drug questions remain. Longterm safety dosage and additional human trials are needed he said. But our initial findings are very promising he said. If it works in vivo similar to our trials in the laboratory HCA has the potential to reduce the incidence rate of people with chronic kidney stone disease."

"A new nonsurgical treatment for lowrisk prostate cancer can effectively kill cancer cells while preserving healthy tissue reports a new UCLled phase III clinical trial in patients. The trial was funded by STEBA Biotech which holds the commercial license for the treatment. The new treatment vasculartargeted photodynamic therapy VTP involves injecting a lightsensitive drug into the bloodstream and then activating it with a laser to destroy tumour tissue in the prostate. The research published in The Lancet Oncology found that around half of patients treated with VTP went into complete remission compared with . in the control group. These results are excellent news for men with early localised prostate cancer offering a treatment that can kill cancer without removing or destroying the prostate says lead investigator Professor Mark Emberton Dean of UCL Medical Sciences and Consultant Urologist at UCLH. This is truly a huge leap forward for prostate cancer treatment which has previously lagged decades behind other solid cancers such as breast cancer. In almost everyone with breast cancer was given a radical mastectomy but since then treatments have steady improved and we now rarely need to remove the whole breast. In prostate cancer we are still commonly removing or irradiating the whole prostate so the success of this new tissuepreserving treatment is welcome news indeed. At the moment men with lowrisk prostate cancer are put under active surveillance where the disease is monitored and only treated when it becomes more severe. Radical therapy which involves surgically removing or irradiating the whole prostate has significant longterm side effects so is only used to treat highrisk cancers. Radical therapy causes lifelong erectile problems and around one in five patients also suffer from incontinence. By contrast VTP only caused shortterm urinary and erectile problems which resolved within three months and no significant sideeffects remained after two years. In the trial only of patients treated with VTP needed radical therapy compared with of patients in the control arm who were under active surveillance. The chances of cancer progressing to a more dangerous stage were three times lower for patients on VTP and the treatment doubled the average time to progression from months to months. The trial involved treatment sites from ten different European countries most of which were performing VTP for the first time. The fact that the treatment was performed so successfully by nonspecialist centres in various health systems is really remarkable says Professor Emberton who is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. New procedures are generally associated with a learning curve but the lack of complications in the trial suggests that the treatment protocol is safe efficient and relatively easy to scale up. We would also expect the treatment to be far more precise if we repeated it today as technology has come a long way since the study began in . We can now pinpoint prostate cancers using MRI scans and targeted biopsies allowing a much more targeted approach to diagnosis and treatment. This means we could accurately identify men who would benefit from VTP and deliver treatment more precisely to the tumour. With such an approach we should be able to achieve a significantly higher remission rate than in the trial and send nearly all lowrisk localised prostate cancers into remission. We also hope that VTP will be effective against other types of cancer the treatment was developed for prostate cancer because of the urgent need for new therapies but it should be translatable to other solid cancers including breast and liver cancer. The VTP therapy approach was developed by scientists at the Weizmann Institute of Science in Israel in collaboration with STEBA Biotech and the European phase I II and III trials were all led by UCL. The drug used in the procedure WST is derived from bacteria at the bottom of the ocean. To survive with very little sunlight they have evolved to convert light into energy with incredible efficiency. This property has been exploited to develop WST a compound that releases free radicals to kill surrounding cells when activated by laser light. One of the first people to be treated with VTP was UCLH patient Gerald a man in his sixties who took part in the latest trial under the care of Professor Emberton. He says When I was diagnosed with early prostate cancer I had the option of active surveillance but I didnt want to wait until it got worse so when I was offered a place on the trial I signed up straight away. Some men prefer to delay treatment but I couldnt live with the fear of the cancer spreading until it either couldnt be treated or needed a treatment that would stop me living a normal life. The treatment I received on the trial changed my life. Im now cancerfree with no sideeffects and dont have to worry about needing surgery in future. I feel so lucky to be in this position. Ive met other men who had surgery they had to stay in hospital for days whereas I could go home the next day and one suffered from terrible incontinence which he found very distressing. I had some minor sideeffects for a few weeks after the operation but Im back to normal now. I am incredibly grateful to Professor Mark Emberton and his team for the excellent care that I received and I hope that other patients will be able to benefit from this treatment in future. The VTP treatment is currently being reviewed by the European Medicines Agency EMA so it is likely to be a number of years before it can be offered to patients more widely."

"What would happen if screening for male infertility was just about as easy as taking a pregnancy test in your home bathroom Thats the question researchers at Brigham and Womens Hospital and Massachusetts General Hospital tried to answer when they went about developing a smartphonebased test that men could use to test their semen https in the comfort of their homes. The test delivered impressive results identifying abnormal semen samples with approximately percent accuracy according to the researchers who published their findings httpstm.sciencemag.orgcontenteaai Wednesday in the journal Science Translational Medicine. Infertility affects up to percent of the male population worldwide. Though its as common as female infertility it often goes unrecognized due to factors like cultural stigma the high cost and time required for testing and access to laboratory facilities. As things stand now men have to provide samples in these specific rooms in hospitals under so much stress and embarrassment the studys principal investigator Hadi Shafiee PhD told CBS News. His teams new approach aims to change that with a simple and inexpensive athome test option. The smartphonebased test involves several distinct parts one a disposable device on which to place the sample including a disposable microchip that handles the sample two an optical attachment that connects to a smartphone three an app that guides the user through each step of testing. The researchers say the optical attachment could be created by Dprinting and the device would only cost about . The testing kit also includes a tiny weight scale that connects wirelessly to the testing app and measures the total number of sperm swimming in the sample. The researchers tested the device on clinical semen specimens in Massachusetts including both trained and untrained users in their trial. The accuracy of this approach was very similar to that of computerassisted laboratory analysis even when it was performed by untrained users with no clinical background they wrote in the study. The app is similar to a fitness tracker in a sense in that it stores any history of previous semen samples as well. The apps user experience is hard to forget users can see vivid moving images of their sperm right on the screen. Though the system is in the prototyping stage it could eventually shake up the world of fertility testing by allowing men to evaluate their sperm in their own homes and helping health centers with fewer resources offer easy cheap testing. In addition the developers say it could also potentially be used by men who have had a vasectomy to monitor their progress at home following surgery. Currently theyre required to make office visits to a urologist for several months to ensure that the operation was successful. Shafiees team plans to continue refining the test and then file for approval from the Food and Drug Administration FDA. Several other homebased tests are already on the market but Boston researchers say their version can analyze additional aspects of the sample checking how well the sperm move known as motility as well as their concentration. Male infertility https has a range of root causes from low or abnormal sperm production to blockages to illness."

"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"

"Scientists are inching closer to a drug that may protect peanut allergy sufferers from potentially lifethreatening complications that can occur due to accidental consumption. While the drug is not being hailed as a cure for peanut allergy it has proven successful in building up patients tolerance to peanuts over time lessening the potential for lifethreatening complications. Were excited about the potential to help children and adolescents with peanut allergy protect themselves against accidentally eating a food with peanut in it said allergist Stephen Tilles MD ACAAI former president study coauthor and consulting advisor for Aimmune Therapeutics according to EurekAlert. Our hope when we started the study was that by treating patients with the equivalent of one peanut per day many would tolerate as much as two peanuts. We were pleased to find that two thirds of people in the study were able to tolerate the equivalent of two peanuts per day after nine to months of treatment and half the patients tolerated the equivalent of four peanuts. FDA WARNS AGAINST HONEY PACIFIERS AFTER TEXAS INFANTS HOSPITALIZED WITH RARE ILLNESS https The results which were presented Sunday at the College of Allergy Asthma and Immunology Annual Scientific Meeting and published in the New England Journal of Medicine were based on study participants ranging in age from to years old. All participants who mostly fell between ages and had a peanut allergy but one third received a placebo while the rest were given a peanut protein powder that increased in dose over time. Participants ingested the peanut protein under the supervision of a boardcertified allergist as part of a process called an oral food challenge OFC. Reactions from the oral challenges at the end of the study were much milder than prior to treatment Tilles said according to EurekAlert. On average the participants were able to tolerate a fold higher dose of peanut at the end of the study than they did at the beginning. In addition the symptoms caused by the fold higher dose at the end of the study were milder than the symptoms on the lower dose at the beginning of the study. EXPERTS CHILDREN AT RISK OF LEAD POISONING IN CHATTANOOGA https With FDA approval this drug would mark the first treatment available by prescription for peanut allergies. The studys authors noted that patients would need to stay on the drug in order to receive protection against the allergy. This is not a quick fix and it doesnt mean people with peanut allergy will be able to eat peanuts whenever they want Jay Lieberman MD vice chair of the ACAAI Food Allergy Committee and study coauthor said according to EurekAlert. But it is definitely a breakthrough. The hope would be to have a treatment available in the second half of . If that happens people who receive and are able to tolerate this treatment should be protected from accidental exposures."

"Researchers from Hebrew SeniorLifes Institute for Aging Research University of Western Australia University of Sydney and Edith Cowan University have discovered that bone density scans typically used to determine fracture risk could also be an aid in identifying cardiovascular disease. The study was recently published in the Journal of Bone and Mineral Research. Researchers analyzed the bone density scans of over older women from Australia for the presence of calcium deposits in the large artery in the abdomen called the aorta. They graded the severity of these calcium deposits using scans done for osteoporosis screening. They then followed the women for almost years to determine the occurrence of cardiovascular disease within the cohort. We found that that the presence of calcifications increased the likelihood of having cardiovascular disease such as heart attacks and even the likelihood of cardiovascular deaths and mortality in general. Said Coauthor Douglas P. Kiel M.D. M.P.H. Director Musculoskeletal Research Center at Hebrew SeniorLifes Institute for Aging Research. Our study highlights the fact that having a bone density test not only tells women about their risk of fracture but also their long term risk for cardiovascular disease. This makes bone density testing even more useful in screening. About Institute for Aging Research Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of agerelated disease and disability lead to the prevention treatment and cure of disease advance the standard of care for older people and inform public decisionmaking. The Musculoskeletal Center within IFAR studies conditions affecting bone muscle and joint health with aging. About Hebrew SeniorLife Hebrew SeniorLife an affiliate of Harvard Medical School is a national senior services leader uniquely dedicated to rethinking researching and redefining the possibilities of aging. Based in Boston the nonprofit nonsectarian organization has provided communities and health care for seniors research into aging and education for geriatric care providers since . For more information about Hebrew SeniorLife visit http follow us on Twitter H_SeniorLife like us on Facebook or read our blog."

"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."

"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."

"In a study to be presented on Feb. at p.m. EST at the Society for MaternalFetal Medicines annual meeting The Pregnancy Meeting in Atlanta researchers will present findings from a study titled Highflavanol chocolate to improve placental function and to decrease the risk of preeclampsia a double blind randomized clinical trial. In light of previous studies showing conflicting results regarding the role of chocolate consumption during pregnancy and the risk of preeclampsia this study set out to evaluate the impact of highflavanol chocolate. Researchers conducted a singlecenter randomized controlled trial of women with singleton pregnancy between and weeks gestation who had doublenotching on uterine artery Doppler. The pregnant women selected were randomized to either highflavanol or lowflavanol chocolate. A total of grams of chocolate was consumed daily for weeks and women were followed until delivery. Uterine artery Doppler pulsatility index was at baseline and weeks after randomization. Preeclampsia gestational hypertension placenta weight and birthweight were also evaluated. The result was that there was no difference in preeclampsia gestational hypertension placental weight or birthweight in the two groups however the uterine artery Doppler pulsatility index a surrogate marker of blood velocity in the uterine placental and fetal circulations in both groups showed marked improvement that was much greater than expected in general population. This study indicates that chocolate could have a positive impact on placenta and fetal growth and development and that chocolates effects are not solely and directly due to flavanol content explained Emmanuel Bujold M.D. one of the researchers on the study who will present the findings. Dr. Bujold and Dr. Sylvie Dodin principal investigator of the trial are with the Universit Laval Qubec City Canada. A copy of the abstract is available at http and below. For interviews please contact Vicki Bendure at Vickibendurepr.com mailtoVickibendurepr.com cell. The Society for MaternalFetal Medicine est. is the premiere membership organization for obstetriciansgynecologists who have additional formal education and training in maternalfetal medicine. The society is devoted to reducing highrisk pregnancy complications by sharing expertise through continuing education to its members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy and expanding research funding and opportunities for maternalfetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternalfetal medicine are shared and discussed. For more information visit http Abstract Highflavanol chocolate to improve placental function and to decrease the risk of preeclampsia a double blind randomized clinical trial Authors Emmanuel Bujold Asma Babar Elise Lavoie Mario Girard Vicky Leblanc Simone Lemieux LionelAnge Poungui Isabelle Marc Belkacem Abdous Sylvie Dodin Universit Laval Qubec City QC Canada Centre de recherche du CHU de Qubec Qubec City QC Canada Objective Previous studies showed conflicting results regarding the role of chocolate consumption during pregnancy and the risk of preeclampsia. We aimed to evaluate the impact of highflavanol chocolate in a randomized clinical trial. Study Design We conducted a singlecenter randomized controlled trial including women with singleton pregnancy between and weeks gestation who had doublenotching on uterine artery Doppler. The pregnant women selected were randomized to either highflavanol HFC or lowflavanol chocolate LFC. A total of g of chocolate was consumed daily for weeks and women were followed until delivery. Uterine artery Doppler pulsatility index UtA PI reported as multiple of medians MoM adjusted for gestational age was assessed at baseline and weeks after randomization. Preeclampsia gestational hypertension placenta weight and birthweight were also evaluated. Results One hundred twenty nine women were randomized at a mean gestational age of . . weeks with a mean UtA PI of . . MoM. Although adjusted UtA PI significantly decreased from baseline to weeks in the groups . the difference between the groups was not significant p.. At weeks we observed no significant difference between HFC and LFC groups in the rate of preeclampsia . vs . p. and gestational hypertension . vs . p.. Placental weight vs grams p. and birthweight vs grams p. were comparable between the two groups. Conclusion Compared with lowflavanol chocolate daily intake of g of highflavanol chocolate did not improve placental function placental weight and the risk of preeclampsia. Nevertheless the marked improvement of the pulsatility index observed in the chocolate groups might suggest that chocolate effects are not solely and directly due to flavanol content."

"Children with attention deficit hyperactivity disorder https ADHD https should be offered a special ADHD diet https to see if eliminating certain foods might reduce their symptoms Dutch researchers say. The diet studied known as the restricted elimination diet RED can work the researchers say because they believe ADHD symptoms https in some children might be affected by eating specific foods. I am of the opinion that every child deserves this diagnostic intervention researcher Lidy Pelsser PhD of the ADHD https Research Centre in Eindhoven the Netherlands tells WebMD. In the study published in The Lancet of children who stuck with the diet did respond by having fewer symptoms. In five weeks of trying the diet Pelsser says parents will know if their child is responding or not if not they can move on to other treatments. Continue Reading Below you might like U.S. experts had some caveats saying that the results of the study which included children should be repeated in other populations to see if the findings hold up. About ADHD ADHD affects about to of U.S. schoolaged children according to the American Psychiatric Association but other sources put the figures higher. The disorder is marked by inattention hyperactivity and impulsive behavior. Some children with ADHD https also have oppositional defiant disorder https ODD in which they express hostility and rebelliousness toward authority figures. Experts arent sure of the cause of ADHD https but theorize that both genetic and environmental factors play a role. Specific foods or ingredients are thought by some to be linked to the symptoms. Besides dietary restriction medication https and behavior therapy are used to treat children with ADHD https In RED foods that are thought to trigger symptoms are eliminated the foods are reintroduced if they do not trigger symptoms. Positive Response to ADHD Diet Pelsser and colleagues assigned children diagnosed with ADHD ages to either to five weeks of the ADHD diet https or to five weeks of following a healthy diet with instructions on how to do so. The ADHD diet was individualized for each child eliminating foods that might cause problems. The diet was restricted to certain foods including rice meat vegetables pears and water along with other foods such as potatoes fruits and wheat. In the ADHD diet group of children finished the first phase. In that group of children or responded favorably by having fewer symptoms. Overall of or responded favorably. Not only ADHD but also ODD symptoms characterized by stubbornness temper tantrums https and provocative behavior which were present in of the children decreased significantly Pelsser tells WebMD. When the offending foods were reintroduced symptoms returned in those who had responded favorably the researcher says. While previous studies have found a link between foods and ADHD symptoms the researchers say the studies were typically small or only included children known to have a tendency to allergies https their study is more applicable to the population as a whole. The restricted diets must be supervised by experts Pelsser tells WebMD and five weeks is enough time to determine if it will work. If the diet works to reduce symptoms Pelsser says the children wont need medication. The children responding favorably to the RED do not meet the criteria for ADHD or ODD anymore. Consequently there is no need for medication. In a second phase of the study the researchers looked at the theory of whether eating foods that induce high levels of immunoglobulin G IgG antibodies is linked to symptoms of ADHD as some believe. Those who support this theory suggest blood https tests to evaluate IgG levels might be useful. After challenging the children with highIgG and lowIgG inducing foods the researchers found no association between IgG blood https levels and behavioral effects concluding that IgG blood tests to identify foods triggering ADHD symptoms is not advisable. Second Opinion The high response rate is very surprising to Eugene Arnold MD professor emeritus of psychiatry https at Ohio State Universitys Nisonger Center Columbus who reviewed the study findings for WebMD. Arnold says he is open to parents who want to try the ADHD diet provided it is supervised by experts who can help the parents. There is a risk of malnutrition if you dont pay attention to the balance of nutrients https But the results need to be duplicated in another study with different children he says to see if the results hold up. He cautions parents not to try out the diet for long periods. If there is no improvement in two to five weeks forget it Arnold says. The diet effort tends to work better in younger children ages to or so he says in part because parents have more control over the diets of younger children than those of older ones. If parents decide to give the ADHD diet a try their involvement is crucial agrees Jaswinder Ghuman MD associate professor of psychiatry and pediatrics at the University of Arizona who wrote a commentary to accompany the study. It is very difficult to carry out she says of the diet. It can be time consuming and more expensive than other diets experts say. She too is surprised by the high response rate to the ADHD diet. But she adds that these are interesting findings and it does present an alternative treatment option for the children."

"Tenyearold Alexis Carey has a rare but intractable form of epilepsy Dravet Syndrome. The genetic disease causes severe and multiple seizures which often leave parents guessing if the terror of watching their child seize up will pass or turn fatal. Her Boise Idaho family learned that oil extracted from marijuana had helped other children and wanted to see if it would help Alexis too. Parent to parent when youre in a small community and people that you know are all having success thats no longer anecdotal Clare Carey her mother said. Thats hope. But Idahos stringent marijuana laws do not allow for medicinal use. The family began lobbying lawmakers to decriminalize the oil almost two years ago. Now theyve got some legislative backers and an upcoming hearing as Idaho joins a larger movement to loosen laws to allow the use of marijuana extract oil. Twelve states have legalized the oil while still banning medical marijuana. Virginia legalized the oil Feb. . In Utah lawmakers have given initial approval to let those with chronic and debilitating diseases consume edible marijuana products while still banning smoking. Marijuana extract oil first received attention when a Colorado family fought and won for access for their daughter who also had Dravet Syndrome. It is similar to hemp oil which is legal in Idaho and can be bought in grocery stores. With no known cure for Dravet Syndrome children are often prescribed a cocktail of medications to counter the seizures. However the heavy drugs often come with sideeffects that can permanently damage a childs developing liver kidneys and other organs. Proponents of cannabidiol oil a nonpsychotropic extract of marijuana argue that it reduces the amount and length of seizures in children. Over time Carey hopes that the oil would also reduce the number of medications her daughter relies on. Like any parent you never give up hope that you can get complete seizure control she said. Children die from Dravet by any one of the seizures. Alexis could have a seizure that may not stop we never really know. Alexis began having seizures when she was two months old. But even in her mom says a lack of awareness of the disease led to many doctors not automatically suspecting it could be a rare genetic disorder. It wasnt until Alexis lost all speech and potty control when she was that doctors determined she had Dravet Syndrome Carey said. Since then Alexis parents have put her on a variety of diets and medications to help reduce the seizures but the disease is tricky to manage. Dravet Syndrome often causes a variety of different kinds of seizures but medications typically target one particular type. Alexis seizures usually occur at night which means one of her parents regularly sleep with her and monitor her sleep patterns. During the day Alexis requires constant supervision. While most yearolds freely run and jump around Alexis walks albeit sometimes unstably and with help going up and down stairs. Carey says working with Idahos Republicancontrolled Legislature has been easier than anticipated. Lawmakers who resisted the idea at first blush have warmed up to the idea she said. This year the bill is endorsed by Republicans Sen. Curt McKenzie and Rep. Tom Leortscher. Both are chairs of the legislatures State Affairs Committees panels that often get tossed controversial legislation and have a high bar for clearance. The measure unanimously passed the Senate committee during its introduction hearing which means it now goes on to a full hearing in front of the committee. Yet the bill must survive a Statehouse that approved a resolution in vowing never to legalize marijuana for any purpose."

"Researchers have taken another step in the hunt to find a treatment for an aggressive likelytorecur form of breast cancer. In a study published in the Jan. online edition of the New England Journal of Medicine the experimental drug iniparib not only shrank tumors and increased the time they took to progress but also surprised researchers by prolonging survival in women with whats known as triplenegative breast cancer. This type of breast cancer lacks receptors for estrogen and progesterone and doesnt have large quantities of HERneu protein which the most successful cancer therapies target. This means that many currently available drugs simply wont affect it. We were surprised at the results because triplenegative breast cancer is very difficult to treat said study lead author Dr. Joyce OShaughnessy. The big big surprise was survival added OShaughnessy who nevertheless stressed that the trial was small and preliminary. The findings were enough to generate the interest of Dr. Lisa A. Carey the coauthor of an accompanying editorial. It is early but its really exciting because its a new class of drugs. It isnt that often that we have a completely new approach to treating cancer said Carey medical director of the University of North Carolina Breast Center in Chapel Hill. This is a new book. Weve just opened it up. Iniparib inhibits a pathway that helps repair DNA researchers call it the polyADPribose polymerase PARP pathway. If this chain is interrupted cancer cells dont have the necessary tools to repair themselves. PARP inhibitors work by preventing the cells from repairing damage to their DNA Carey explained. A similar drug in fact has shown benefit in patients with BRCA or BRCA mutations predisposing them to breast and ovarian cancer. In this study patients with triplenegative breast cancer were randomized to receive a commonly used welltolerated chemotherapy regimen gemcitabine and carboplatin or to receive chemo plus iniparib. More than onehalf of the women responded to the combination treatment meaning the tumor volume decreased versus only about onethird of those receiving chemo alone. Women receiving iniparib plus chemo lived an average of . months compared to just . months in the chemoalone group. This may not seen like very long in either group but for this serious a cancer it is impressive the researchers noted. This was a phase trial. OShaughnessy who is codirector of breast cancer research at BaylorSammons Cancer Center US Oncology and Texas Oncology in Dallas said the results of a larger about patients phase trial should be available within one to three months. The whole field is still preliminary and we have to be careful not to overhype the results as were waiting on the results of the phase trial she said. Phase was quite positive but we really dont know if this is going to end up benefiting patients until we get to phase . In her editorial accompanying the study Carey agreed. Both excitement and caution are appropriate in interpreting the trial she wrote. Some clear drawbacks should be noted. Among them she said were the small size of the study group imbalances at baseline favoring the iniparib group and the unconventional chemotherapy regimen. But caveats notwithstanding she concluded the results may herald improved therapy for an underserved subgroup of patients with breast cancer. OShaughnessy added that the drug was extremely well tolerated by patients. It didnt seem to add any appreciable toxicity to chemotherapy. In the meantime she pointed out a woman walking through a clinic door who is diagnosed with triplenegative breast cancer shouldnt panic. If its only in the breast or lymph nodes we cure most triplenegative cancers. But when it recurs and becomes metastatic its very difficult to treat she explained. The study was funded by BiPar Sciences a subsidiary of SanofiAventis which makes the drug. More information The U.S. National Cancer Institute has more on breast cancer http SOURCES Joyce OShaughnessy M.D. codirector breast cancer research BaylorSammons Cancer Center US Oncology and Texas Oncology Dallas Lisa A. Carey M.D. medical director University of North Carolina Breast Center Chapel Hill Jan. New England Journal of Medicine online"

"For the millions of Americans with chronic low back pain a silver bullet to alleviate the condition has yet to be identified a new study suggests. Reviewing studies comparing spinal manipulative therapy SMT to other treatments such as medication exercise or physical therapy researchers from the Netherlands found that SMT appears to be no better or worse than other options at relieving back pain longterm. The analyses indicated that SMT which involves manual manipulation of the spine and surrounding muscles has only a shortterm impact on pain relief although it eases pain faster than other treatments. In short no single therapy is better than another although some individuals are likely to have more success with one therapy than another said study author Sidney Rubinstein a research fellow at VU University Medical Center in Amsterdam. Current studies are focusing on which subjects are more likely to benefit from spinal manipulation exercise or other therapies he added. Spinal manipulation should be considered a viable treatment option for those with nonspecific chronic low back pain. The study was recently published in the journal Spine. More than patients were included in the compilation of results which the study authors said were sparse in data indicating participants overall recovery quality of life and ability to return to work. The studies also varied in quality with only nine of considered low in bias according to background information accompanying the study. In all evaluations patients were randomly assigned to SMT or another comparison treatment including active treatments such as exercise or inactive placebo treatments. About twothirds of the studies were not included in a previous review published in and all patients had suffered from lower back pain for weeks or longer. While chiropractors often perform SMT on patients it is also administered by physical therapists and osteopaths. But which treatment is right for any patient depends not only on their specific pain but their doctors recommendations and their own comfort level with various options said Stephen Perle a spokesman for the American Chiropractic Association. The cost of SMT sessions varies widely depending on the region Perle said. Nobody has the answer at this time Perle said. I guess people in almost every profession like to say We have a compelling treatment and it will work almost every time but thats just not the case. With low back pain there are many reasons people dont get better added Perle also a professor of clinical sciences in the College of Chiropractic at the University of Bridgeport in Connecticut. So the finding was not unexpected. An unrelated study of patients with low back pain published July in Annals of Internal Medicine suggested that massage may be better than medication or exercise for shortterm pain relief. Seattle researchers found that those who received either relaxation massage or structural massage which involved manipulation of muscles and ligaments had less pain and better functioning for up to a year compared to those getting usual medical care which included medication and physical therapy. More information The U.S. National Institute of Neurological Disorders and Stroke has more information about low back pain. SOURCES Sidney Rubinstein D.C. Ph.D. research fellow Institute for Research in Extramural Medicine VU University Medical Center Amsterdam the Netherlands Stephen M. Perle D.C. spokesman American Chiropractic Association and professor clinical sciences College of Chiropractic University of Bridgeport Conn. June Spine"

"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."

"German researchers say theyre a step closer to developing an electronic nose that can distinguish between people who have heart failure https and those who dont. The device has gas sensors that detect various odorous molecules in sweat. Specially developed software divides patients into groups depending on the pattern of molecules detected. We saw two distinct patterns one of which correlated with heart failure says study leader Vasileios Kechagias a PhD candidate at the University Hospital Jena. The goal of the project is to develop a simple accurate noninvasive and reproducible method for early identification of chronic heart failure he tells WebMD. Million Have Heart Failure in U.S. More than million Americans have heart failure which occurs when the heart muscle loses its ability to pump enough blood throughout the body. http Fluid can back up into the lungs https leaving people short of breath. The new study involved people with heart https failure so severe that they were comfortable only at rest people with less severe heart failure and healthy people. The electronic nose correctly identified of the people who had heart failure and of people that didnt have the condition. Still that means that of cases would have been missed and of people would have been told they had a lifethreatening condition when they didnt. The new device was about that accurate at differentiating between severe and less severe heart failure patients. The findings were presented here at the European Society of Cardiology Congress . Frank Ruschitzka MD of Zurich University Hospital tells WebMD that ideas that at first seem crazy can turn out to be lifesaving. We need people to swim against the stream. Someone had the idea to put three leads in a device and pace the heart the pacemaker https now saves millions of lives he says. Still much more work is needed before we will know if the electronic nose will make it to the clinic says Ruschitzka who moderated a news briefing to discuss the findings. The researchers are now testing more than patients and trying to identify the odorous molecules unique to heart failure patients Kechagias says."

"Up to half of women with advancedstage ovarian cancer might be cured compared to the current per cent survival rate argues Dr. Steven Narod senior scientist at Womens College Research Institute who calls for a new standard of treatment for women with latestage ovarian cancer. Based on an analysis of existing evidence published in an opinion article in the Nature Reviews Clinical Oncology journal on January Dr. Narod argues that to achieve a cure rather than simply delay progression or reoccurrence of the disease women should be first treated with aggressive surgery to remove all clinicallydetectable cancer cells followed by targeted chemotherapy to the abdomen intraperitoneal chemotherapy. The possibility of a per cent cure rate would be a significant improvement over the current per cent survival rate resulting from more conventional treatment options offered to patients which consist of a combination of different methods including chemotherapy before surgery postoperative chemotherapy delivered intravenously to the whole body as opposed to localized into the abdomen and surgery that leaves minimal residual disease in the abdomen rather than removing all visible cancer cells. Dr. Narod who is also a Tier Canada Research Chair in Breast Cancer recommends that doctors should consider adopting a standard model of care for all women diagnosed with advancedstage ovarian cancer Chemotherapy should be offered after the surgery rather than before. Chemotherapy before surgery might provide a false assurance that theres no more residual cancer whereas microscopic tumour may remain after the surgery leading to cancer recurrence and possibly death. The surgery should be aggressive in an attempt to remove all visible signs of the tumour and to avoid leaving any residual disease. The goal is to have no cancer visible to the naked eye of the surgeon after the surgery. Surgery should be followed by intraperitoneal or localized chemotherapy delivered to the abdomen. Localized chemotherapy works best if theres no residual cancer after the initial surgery. It is the combined effect of surgery and chemotherapy that works best. For decades women have been treated with a combination of treatment options resulting in poor prognosis for most women with advancedstage ovarian cancer but there are many survivors as well said Dr. Narod senior scientist at Womens College Research Institute. Women need support to endure surgery and the rigours of intraperitoneal chemotherapy but should be encouraged to do so whenever possible considering the potential survival benefits said Narod. We should offer all women the possibility of a cure."

"Medical marijuana can provide relief from symptoms from dozens of health conditions with minimal negative side effects according to new research. Two studies published recently in the journals Frontiers in Pharmacology https and Medicine http found that patients with health conditions such as chronic pain and insomnia saw statistically and clinically significant therapeutic benefits when they used medical cannabis according to a press release httpnews.unm.edunewsinnovativestudyshowsmedicalcannabiseffectiveintreatingawiderangeofhealthconditions from the University of New Mexico. Researchers from the university https studied data obtained through the Releaf App. This app developed by several of the studies authors is the largest repository of userentered information on the consumption and effect of cannabis use in the United States the release states. It has almost entries. The app httpsreleafapp.com is designed to record how using marijuana corresponds to changes in the intensity of symptoms and any side effects a person experiences. It helps track and learn which types of cannabis dosing and ingestion methods work best. The study published in Frontiers in Pharmacology found that users suffering from different health conditions with symptoms ranging from seizures to depression reported a mean reduction in symptoms of . to . points on a zero to point scale after consuming cannabis in various forms including concentrates and topicals. People using the drug to treat anxiety and depressionrelated symptoms reported more relief than people with pain symptoms. In the second study researchers examined how cannabis buds treated insomnia. Cannabis users on the Releaf App experienced a reduction of symptom severity of an average . points on a zero to point scale. According to the study people who consumed the drug via pipes and vaporizers experienced greater relief of symptoms and those who vaped experienced fewer negative effects. According to the release data from the app showed that an overall percent of cannabis users suffering from a variety of health conditions reported that the intensity of their symptoms was reduced after consuming the drug. Additionally use of marijuana was associated with nonserious side effects. If the results found in our studies can be extrapolated to the general population cannabis could systematically replace multibillion dollar medication industries around the world. It is likely already beginning to do so Jacob Vigil coauthor of the studies said in the release. Because many prescription medications have negative side effects medical marijuana has been gaining popularity especially among older patients and those with significant health conditions the release states. Marijuana has been studied as potential treatment for a number of health conditions including posttraumatic stress disorder cancer chronic pain and epilepsy."

"Doctors should consider radiosurgery earlier for patients with severe facial pain according to a new study in the International Journal of Radiation OncologyBiologyPhysics the Red Journal the official journal of the American Society for Radiation Oncology ASTRO. In the research radiosurgery helped improve the quality of life for patients with trigeminal neuralgia and reduced their depression which is often exacerbated by the side effects of other treatments. The authors from Cleveland Clinic in the US say considering radiosurgery earlier on could make a big difference to patients lives. Trigeminal neuralgia TN is a very painful nerve disorder that causes an electrical shock feeling in the face usually in older people. Some things can trigger it like chewing or even the wind blowing but attacks can be random. On a scale of patients often describe the pain as off the scale. TN is commonly treated with antiepileptic medications. While this can reduce the pain it makes patients drowsy and tired and they report feeling drunk. This has an impact on their quality of life and frequently causes depression as it stops them from driving working or even just leaving the house. According to the new study radiosurgery which is normally a second line treatment to be used following the medication helps improve quality of life and reduce depression in patients with TN. By considering it earlier as a treatment option doctors could help improve the lives of patients with TN more quickly. We knew radiosurgery results in pain relief but we didnt know if the patients actually felt better said Dr. Samuel Chao corresponding author of the study. I think people go and see their neurologist and get the pain under control with medication but they dont realize how lousy this can make them feel. Using radiosurgery earlier on allows patients to get off the medications improving their quality of life by allowing them to return to activities they used to do. Radiosurgery is a method for physically treating the nerve using radiation with stereotactic radiosurgery doctors can focus beams of radiation on a single point. It is noninvasive so doesnt require the healing time of traditional surgery. Treatment takes less than an hour and requires no anesthetic. However it is often overlooked or delayed as a treatment because there is a lack of capability and experience with the method. Research has shown that radiosurgery reduces pain for of patients but the broader impact on their lives remained unknown. In the new study Dr. Chao Dr. Kotecha and his colleagues prospectively collected data from patients they treated with radiosurgery using two questionnaires EuroQOL Dimension and Patient Health Questionnaire . They asked questions about the patients pain and facial numbness their health and their ability to take care of themselves. The researchers analyzed patients answers before treatment and at each followup appointment and found that patients reported an improved quality of life and lower rates of depression after radiosurgery. Importantly the benefit of treatment was strongly driven by improvements in pain and discomfort as well as selfcare. Pain and the medication to stop the pain make it difficult for people with TN to go outside and live life explained Dr. Chao. With radiosurgery we can reduce pain improve quality of life and decrease depression people can go out and enjoy life without worrying they will have a random attack. Giving options empowers the patient to be more aware of themselves and manage their own condition. The team plans to analyze the impact of other treatment options and carry out a costbased analysis to establish the best treatment options for TN. Notes for editors The article is Stereotactic Radiosurgery for Trigeminal Neuralgia Improves PatientReported QualityofLife and Reduces Depression httpsdoi.org.j.ijrobp... by Rupesh Kotecha Jacob A. Miller Sujith Modugula Gene H. Barnett Erin S. Murphy Chandana A. Reddy John H. Suh Gennady Neyman Andre Machado and Sean Nagel. It appears in International Journal of Radiation OncologyBiologyPhysics available online April published by Elsevier. Copies of this paper are available to credentialed journalists upon request please contact Name at Email address or Phone number add country code. About International Journal of Radiation OncologyBiologyPhysics International Journal of Radiation Oncology Biology Physics IJROBP known in the field as the Red Journal is the official journal of the American Society for Radiation Oncology ASTRO. It publishes original laboratory and clinical investigations related to radiation oncology radiation biology medical physics and both education and health policy as it relates to the field. This journal has a particular interest in prospective clinical trials outcomes research and large database interrogation as well as reports of highimpact innovations in single or combined modality treatment tumor sensitization normal tissue protection including both precision avoidance and pharmacologic means brachytherapy particle irradiation and cancer imaging. About Elsevier Elsevier is a global information analytics company that helps institutions and professionals progress science advance healthcare and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management RD performance clinical decision support and professional education including ScienceDirect Scopus ClinicalKey and Sherpath. Elsevier publishes over digitized journals including The Lancet and Cell more than ebook titles and many iconic reference works including Grays Anatomy. Elsevier is part of RELX Group a global provider of information and analytics for professionals and business customers across industries. http"

"Anxiety disorders plague more than one in four http adolescents between the ages of and and many of them are treated with antidepressants and other medications to try and help them live a relatively healthy childhood. But a team of researchers from the University of Cincinnati set out to explore other treatment options that focus more on the mind and less on pharmaceutical solutions. Their study httponline.liebertpub.comdoi.cap.. published in the Journal of Child and Adolescent Psychopharmacology recruited nine participants who were diagnosed with anxiety disorders between and years of age. These conditions included generalized social and separation anxiety disorder as well as having a parent with bipolar disorder. Over the course of weeks each participant underwent functional magnetic resonance imaging fMRI scans while they practiced mindfulnessbased cognitive therapy https a wide range of theraputic techiniques that include meditation yoga and learning how to pay nonjudgmental attention to ones life. These integrative approaches expand traditional treatments and offer new strategies for coping with psychological distress said the studys coauthor Sian Cotton director of the UCs Center for Integrative Health and Wellness in a statement http_releasesuocassc.php. Mindfulnessbased therapeutic interventions http promote the use of meditative practices to increase presentmoment awareness of conscious thoughts feelings and body sensations in an effort to manage negative experiences more effectively. Children who are at a high risk for bipolar disorder http or other anxiety disorders such as the participants often have poor coping skills when confronted by stress and only a lucky few get help. According to the Anxiety and Depression Association of America http percent of children with a diagnosed anxiety disorder and percent of those diagnosed with depression do not receive treatment. Some mental health professionals have suggested that mindfulness exercises http can help bridge the treatment gap and there is some encouraging if early evidence showing that these techniques can be used to prevent relapses of depression or anxiety. Cotton noted the anxiety of their patients was significantly reduced following treatment and the more mindfulness they practiced the less anxious they felt. Both findings reaffirm the potential that mindfulness therapy could bring to the table. If nothing else it might allow people who would be reluctant to take medication more treatments to choose from. Increasingly patients and families are asking for additional therapeutic options in addition to traditional medicationbased treatments that have proven effectiveness for improved symptom reduction. Mindfulnessbased therapies http for mood disorders is one such example with promising evidence said Cotton adding the university is both studying and implenting these therapies. After the week experiment Cotton and his colleagues found mindfulness therapy increased neural activity in a part of the brain that plays in a role in processing cognitive and emotion information known as the cingulate. The therapy was also able to increase brain activity in the insula a part of the brain that helps monitor how the body feels psychologically. This raises the possibility that treatmentrelated increases in brain activity during emotional processing may improve emotional processing in anxious youth who are at risk for developing bipolar disorder said fellow coauthor Dr. Jeffrey Strawn a professor in UCs Department of Psychiatry and Behavioral Neuroscience as well as director of the Anxiety Disorders Research Program in a statement http_releasesuocassc.php. The path from understanding the effects of psychotherapy on brain activity to the identification of treatment response is a challenging one and will require additional studies of emotional processing circuits. Source Strawn JR Cotton S Luberto CM et al. Neural Function Before and After MindfulnessBased Cognitive Therapy in Anxious Adolescents at Risk for Developing Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology. ."

"Nacetylcysteine when combined with group cognitive behavioral therapy CBT reduced symptoms of posttraumatic stress disorder PTSD cravings and depression significantly more than CBT alone in veterans with cooccurring PTSD and substance use disorder a particularly difficulttotreat population according to the findings of a randomized controlled pilot trial conducted by researchers at the Medical University of South Carolina MUSC and the Ralph H. Johnson VA Medical Center. This trial is the first to use NAC as a pharmacotherapy for PTSD and a broad range of SUDs. The results were published online ahead of print on October by the Journal of Clinical Psychiatry. The National Center for PTSD estimates that seven to eight percent of Americans will have PTSD at some point in their life. The numbers are even worse for veterans it is estimated for example that percent of Vietnam veterans will have experienced PTSD at some point in their life. Approximately to percent of veterans with PTSD also have a substance use disorder SUD. Addiction goes along with virtually every psychiatric disorder at a higher percentage than it does in the general population said Peter W. Kalivas Ph.D. the senior author on the article and chair of the Department of Neuroscience at MUSC. People who are prone to psychiatric disorders are also prone to addiction. Currently there are no wellexplored pharmacological treatments for patients with cooccurring PTSDSUD. Although selective serotonin reuptake inhibitors have been approved by the FDA for treatment of PTSD pharmacological treatments for cooccurring PTSDSUD have yielded suboptimal results. Groundbreaking basic science research by Kalivas has shown that levels of glutamate transporters are decreased in SUDs and that administration of the antioxidant Nacetylcysteine can help restore those levels and guard against relapse in animal models of SUD. Because evidence suggests that SUDs and PTSD share overlapping neurobiological pathways Sudie E. Back Ph.D. lead author on the article hypothesized that NAC treatment with CBT would be a novel approach to treat cooccurring PTSD and SUD. Back is a professor in the Department of Psychiatry and Behavioral Sciences at MUSC and a staff psychologist at the Ralph H. Johnson VA Medical Center. In the eightweek randomized controlled trial led by Back and Kalivas veterans with PTSD and SUD all of whom were receiving cognitive behavioral therapy CBT for their SUD were randomized to either mgday of NAC or placebo. The average age of the veterans was years and many were veterans of the Vietnam War. To be included veterans had to have abstained from substance use for at least seven days. Of the veterans enrolled in the trial completed it a very high rate for this difficulttotreat population. Veterans in the NACtreated group showed a reduction in PTSD symptoms compared with a reduction in the placebo group on the ClinicalAdministered PTSD Scale CAPS which assesses trauma history and symptom severity. The threshold CAPS score for diagnosis of PTSD is . As a group the NACtreated veterans were below diagnostic level for PTSD at the end of treatment said Back. For PTSD these are some of the best outcomes we have seen in the literature for a medication. Craving and depression were also reduced in the NACtreated group. The amount of craving was reduced by and the frequency of craving by in the NAC group compared with and in the placebo group. Craving is a key component of substance use in relapse said Back. If you have a medication that can really reduce craving that will go a long way to helping people stay clean and sober. Depression gauged using the Beck Depression Inventory was reduced in the NAC group vs. in the placebo group. Veterans in the study had low rates of substance use during the trial and the study found little effect of medication on use perhaps due to the fact that all participants were receiving SUD treatment and exhibiting low levels of use. This finding could also be due to the relatively limited number of participants or to the chronic nature of the participants PTSD. This is a tough patient population with SUD to work with. said Kalivas. We have Vietnam vets that have had PTSD for to years. This is not an easytoturnaround population. Although these early promising findings show that NAC reduced PTSD symptoms craving and depression NAC should not be used as a monotherapy or substitute for evidencebased behavioral treatment but instead be seen as an adjunct therapy that enhances it. We would not advocate using it instead of therapy said Back. But this could be something to help prevent relapse when used alongside a behavioral treatment. NAC is available over the counter and does not cause side effects at the doses used in the study but it degrades quickly when stored is contraindicated in patients with asthma and can cause nausea at higher doses and so should always be obtained and administered under a physicians supervision. The next steps in Backs research are to run a longerterm trial of NAC in veterans with PTSD and SUD and to use MRS magnetic spectroscopy to better explore the effect of NAC on glutamate levels in patients with PTSD and SUD. 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 in six colleges Dental Medicine Graduate Studies Health Professions Medicine Nursing and Pharmacy 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 with an annual economic impact of more than . billion and annual research funding in excess of million. 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 Institutedesignated center Level I Trauma Center Institute of Psychiatry and the states only transplant center. In U.S. News World Report named MUSC Health the number one hospital in South Carolina. For more information on academic programs or clinical services visit musc.edu httpmusc.edu. For more information on hospital patient services visit muschealth.org httpmuschealth.org. About the Ralph H. Johnson VA Medical Center Located in historic downtown Charleston South Carolina the Ralph H. Johnson VA Medical Center is a tertiary care teaching hospital providing the highest level quality care from cardiology to neurology to primary and mental health care for Veterans along the South Carolina and Georgia coast. The Ralph H. Johnson VA achieved a Star rating according to VAs Strategic Analytics for Improvement and Learning Value SAIL model. The SAIL rating ranks the Charleston VA in the top percent of VA medical centers nationwide for quality of care and efficiency. The Charleston VA is also ranked in the top th percentile according to the Healthcare Effectiveness Data and Information Set HEDIS. HEDIS is an independent review that measures performance of percent of Americas health plans and facilities in both the public and private sector on dimensions of care and service. The Ralph H. Johnson VA Medical Center is a center of excellence for robotic surgery and orthopedics and is the first VA National TeleMental Health Hub providing care for Veterans across the U.S. The bed hospital includes six community based outpatient clinics a bed nursing home womens health and the full range of inpatient and outpatient care including medical and surgical intensive care. The VAMC provides more than outpatient visits and approximately inpatient stays annually. With more than employees Charleston VA has an annual budget of million research funding of more than million and more than principal investigators participating in approximately research studies. For more information visit http"

"To the tantalizing delight of chocolate lovers everywhere a number of recent studies employing various methods have suggested that compounds in cocoa called flavanols could benefit cardiovascular health. Now a systematic review and metaanalysis of randomized controlled trials RCTs of cocoa consumption reveals some further pieces of supporting evidence. The metaanalysis in the Journal of Nutrition an assessment of the combined evidence from all RCTs focused on whether consumption of flavanolrich cocoa products was associated with improvements in specific circulating biomarkers of cardiometabolic health as compared to consuming placebos with negligible cocoa flavanol content. In all volunteers were involved in these trials. Our metaanalysis of RCTs characterizes how cocoa flavanols affect cardiometabolic biomarkers providing guidance in designing large definitive prevention trials against diabetes and cardiovascular disease in future work said corresponding author Dr. Simin Liu professor and director of the Center for Global Cardiometabolic Health at Brown University who worked with epidemiology graduate student and lead author Xiaochen Lin. We found that cocoa flavanol intake may reduce dyslipidemia elevated triglycerides insulin resistance and systemic inflammation which are all major subclinical risk factors for cardiometabolic diseases. Liu noted some limitations in the trials. All studies were small and of short duration not all of the biomarkers tracked in these studies changed for the better and none of the studies were designed to test directly whether cocoa flavanol consumption leads to reduced cases of heart attacks or type diabetes. But taking into account some of these heterogeneities across studies the teams metaanalysis summarizing data from trials found potential beneficial effects of flavanolrich cocoa on cardiometabolic health. There were smalltomodest but statistically significant improvements among those who ate flavanolrich cocoa product vs. those who did not. The greatest effects were seen among trial volunteers who ate between and milligrams of flavanols a day based on their cocoa consumption. They saw significant declines in blood glucose and insulin as well as another indicator of insulin resistance called HOMAIR. They also saw an increase in HDL or good cholesterol. Those consuming higher doses saw some of the insulin resistance benefits and a drop in triglycerides but not a significant increase in HDL. Those with lower doses of flavanols only saw a significant HDL benefit. In general Lin said where there were benefits they were evident for both women and men and didnt depend on what physical form the flavanolrich cocoa product was consumed in dark chocolate vs. a beverage for example. The treatment groups of the trials included in our metaanalysis are primarily dark chocolate a few were using cocoa powderbased beverages Lin said. Therefore the findings from the current study apparently shouldnt be generalized to different sorts of chocolate candies or white chocolates of which the content of sugarfood additives could be substantially higher than that of the dark chocolate. The authors therefore concluded Our study highlights the urgent need for large longterm RCTs that improve our understanding of how the shortterm benefits of cocoa flavanol intake on cardiometabolic biomarkers may be translated into clinical outcomes. In addition to Lin and Liu the studys other authors are Isabel Zhang Alina Li from Brown University JoAnn Manson Howard Sesso and Lu Wang from Brigham and Womens Hospital. The authors acknowledge funding from the National Institutes of Health including the National Heart Lung and Blood Institute the American Heart Association and Pfizer. Coauthors at Brigham and Womens also noted receiving funding from Mars Symbioscience a research segment of Mars Inc. which makes chocolate products."

"Some cancer patients who take cholesterollowering statins may live longer than those not on these heart medications a study from Britain suggests. While it did not prove a causeandeffect connection the study of nearly million cancer patients found that those taking statin drugs such as Lipitor and Crestor appeared to have a percent lower risk of dying from lung cancer a percent lower risk of dying from breast cancer a percent lower risk of dying from prostate cancer and a percent lower risk of dying from colon cancer. We need to further investigate the reasons for patients with high cholesterol having improved mortality in four of the most common cancers said senior researcher Dr. Rahul Potluri a clinical lecturer at Aston University School of Medicine in Birmingham. Potluri cautioned however that this study cant prove that statins actually extended life in cancer patients. At this time people without high cholesterol should not be taking statins in the hope of warding off cancer or living longer with cancer he said. People with high cholesterol should be taking statins to lower their cholesterol and reduce their cardiovascular risk he said. We cannot however recommend statins for cancer prevention without a positive clinical trial. For the study Potluri and colleagues collected data on nearly million patients listed in a clinical database from January to March . The database includes information on cancer and other medical conditions including high cholesterol. Data on deaths was obtained from the U.K. Office for National Statistics. Among the patients in the study nearly had lung cancer had breast cancer had prostate cancer and had colon cancer the researchers found. After adjusting for factors that might play a role in dying such as age gender ethnicity and common causes of death the researchers found those taking statins lived longer than those who were not taking them. The results were to be presented Friday at the European Society of Cardiology meeting in Florence Italy. Research presented at meetings is considered preliminary until published in a peerreviewed medical journal. One expert doesnt think sufficient evidence exists yet to take statins to prevent or treat cancer. Regardless of whether or not a person has cancer statin use should be discussed with a health care provider said Eric Jacobs strategic director of pharmacoepidemiology at the American Cancer Society. There is little evidence that statins affect cancer risk or survival but clear evidence that they can help some people lower risk of heart attacks and strokes he said. More information Visit the American Heart Association http_UCM__Article.jsp for more on statins. SOURCES Rahul Potluri M.D. clinical lecturer Aston University School of Medicine Birmingham England Eric Jacobs Ph.D. strategic director pharmacoepidemiology American Cancer Society July presentation European Society of Cardiology meeting Florence Italy"

"A change in diet can improve the lives of those diagnosed with a common but hardtotreat gut disorder. Thats the result of research by the University of Michigan Health System presented at Digestive DiseaseWeek that studied for the first time in the United States the result of following a carefully controlled diet to improve the symptoms and quality of life for those with irritable bowel syndrome. This is the only methodically rigorous clinical trial to show that dietbased therapy can not only improve symptoms but also quality of life in patients with IBS says UM assistant clinical professor and gastroenterologist Shanti Eswaran M.D. who researches the role of diet and food in functional bowel diseases such as IBS. Irritable bowel syndrome can be highly debilitating if not virtually paralyzing and affect work sleep and personal and family relationships. Most treatments initially rely on medications that are often expensive usually ineffective and frequently cause unwelcome side effects. And unfortunately there is no cure. Many practitioners and patients have turned to diet as a possible treatment but many of the dietary recommendations have not been backed by clinical trials.The study the largest of its kind measured the degree of relief from low FODMAP a frequently recommended diet which stands for Fermentable OligoDiMonosaccharides and Polyols. This diet excludes many compounds found in wheat certain fruits and vegetables garlic onions and sugar substitutes. Over a sixweek process registered dietitians educated and monitored the progress of more than IBS patients. Roughly half followed a prescribed low FODMAP diet and half were a control group that used a commonsense regimen cutting down on large meals binges and known irritants such as caffeine and alcohol. The results were impressive More than percent of the patients on the low FODMAP diet had major improvement of their abdominal pain compared with percent of the control group. There was also more improvement of other bothersome symptoms compared to the control group bloating diarrhea and stool urgency. Eswaran collaborated with William Chey M.D. professor of internal medicine Kenya Jackson Sivaram G. Pillai Samuel W. Chey and Theresa HanMarkey M.S. R.D. at the University of Michigan on the study abstract published in Gastroenterology. At four weeks the proportion of patients with a meaningful improvement in IBS quality of life was significantly higher in the low FODMAP group compared to the control group percent versus percent. While the results are highly encouraging for IBS sufferers there are a few important caveats Eswaran says. Because of the many unknowns about the chemical causes and triggers of IBS the list of bad foods is exhaustive and elusive and help from a dietician is highly recommended. LowFODMAP is not a new treatment but we are now convinced that it really works she says. Our next step will be to more precisely determine the underlying chemistry of how and why particular foods can yield dramatically different results for different people. Meanwhile we strongly recommend that IBS patients work with their physician and a registered dietitian to navigate the LowFODMAP diet to take control of their IBS symptoms. Eswaran received funding to conduct the research from the University of Michigan Nutritional and Obesity Center and Prometheus Diagnostics."

"Theres fresh evidence pointing to a troubling link between commonly used osteoporosis drugs and a rare type of thighbone fracture. When a hip bone breaks because of osteoporosis http the fracture usually involves either the ball at the top of the femur or the narrow neck just below the ball. The unusual fractures that may be associated with certain osteoporosis drugs called bisphosphonates http occur lower on the bone. Ironically thats where the femur the longest bone in the body is usually strongest. These unusual fractures can occur suddenly without any trauma such as a fall. And they can be complex breaks that are difficult to fix and slow to heal. In the study httpjama.amaassn.orgcontent.abstract published in current issue of JAMA researchers looked at of these fractures in more than Ontario women who had taken bisphosphonates. Women who had taken the drugs for five years or longer had nearly a three times higher risk of suffering atypical fractures compared with women who had only transient exposure to such drugs. Thats called the relative risk http and it seems alarming. But the absolute risk of these unusual fractures is still pretty low fractures per year for every people taking bisphosphonates for five years or longer. That is longterm users have a risk of about a tenth of percent. Moreover the study verified that longterm use of bisphosphonate drugs reduces the risk of typical osteoporosis fractures by percent. Thats obviously a lot more benefit than risk. The big message really is the number of typical hip fractures is much much larger than the number of unusual thigh fractures says Dr. Gillian Hawker http of St. Michaels Hospital in Ontario an osteoporosis specialist and study author. So although we believe there is an increased risk of these unusual fractures it doesnt outweigh the benefit of taking osteoporosis drugs. Merck which makes Fosamax http the original and leading bisphosphonate drug criticizes the new study. The company said in a statement to Shots that women who had atypical fractures were different from those who didnt. For instance they started out with a history of more fractures so the comparison isnt valid. Merck believes that the results must be interpreted with caution and should not be overstated says the companys statement. Still the accumulating evidence that there is a risk of these serious unusual fractures associated with bisphosphonates is getting a lot of attention http in the medical community. Last fall the Food and Drug Administration issued http a safety update urging doctors and patients to be on the lookout for the problem. Often the FDA says an atypical fracture is preceded by pain in the thigh apparently from a small stress fracture that signals bone weakness. Although it is not clear if bisphosphonates are the cause these unusual femur fractures have been predominantly reported in patients taking bisphosphonates the FDA says. The concern is heightened by another even rarer possible side effect osteonecrosis http of the jaw. Basically it means that part of the jawbone dies. Some reports including one published http earlier this month in the Journal of Dental Research have found a higher risk of the jaw problem in dental patients taking bisphosphonates. Again Merck disputes the connection. Earlier this month it convinced http_.html a New Jersey jury that Fosamax did not cause one womans jaw problems. Amid all the debate many specialists are wondering if women on bisphosphonates should take a holiday from the drug from time to time. The idea is that perhaps theyd get the osteoporosis benefit without the risks of osteonecrosis and unusual fractures. You could do five years on five years off Dr. Clifford Rosen http a bone specialist at Maine Medical Center tells Shots. Some people are doing three on and three off. But at some point should these patients start taking the drug again I dont think anybody knows Rosen says. The thought is you would have to put them back on at some time."

"Breastconserving surgery for early stage breast cancers may result in better survival than mastectomy according to a new study. For those with early stage breast cancer lumpectomy is just as effective if not more effective than mastectomy said researcher Dr. Shelley Hwang chief of breast surgery at Duke Cancer Institute in Durham N.C. There are lots of women who think the more treatment they do the better they will do she said. This refutes that. The findings published online Jan. in the journal Cancer are especially strong for women over with hormonesensitive cancers the researchers found. Earlier research had also concluded that the two procedures are similarly effective but Hwangs is a more realworld study. Hwangs team looked at years of data from the California Cancer Registry following more than women with early stage breast cancer stages or between and . Ages ranged from to . More than half percent had lumpectomy and radiation while percent had mastectomy complete breast removal alone. Hwang compared lumpectomy and radiation with mastectomy alone not mastectomy plus radiation. We wanted to look at early stage disease and those patients typically dont get radiation after mastectomy she said. The researchers tracked the womens progress for a median of more than nine years half followed longer half less. During that time more than women died nearly percent of them from breast cancer. The others died of other causes. For the first three years after treatment those who had a mastectomy had a higher risk of dying from heart disease and other ailments than those who had lumpectomy. This may indicate that the women who underwent lumpectomy were generally healthier Hwang said. Over the entire followup those who underwent lumpectomy were more likely to survive the breast cancer. The group that benefited the most who had the biggest difference in breast cancer survival were those women over with estrogenreceptor positive disease Hwang said. This means their cancer depends on estrogen to grow. Among those women the lumpectomy group had a percent lower risk of death from breast cancer and a percent lower risk of death from any cause than those who had a mastectomy. Not all women with early stage breast cancers can have a lumpectomy Hwang said. In this procedure just the tumor and some healthy tissue are removed sparing the rest of the breast. Among the exceptions are those whose cancers are too large or those who have different cancers in the same breast. The percent of women with early breast cancers choosing a mastectomy has risen recently after a dip in previous years. Hwang and others suspect that women told they could safely opt for lumpectomy were still afraid to try it. The new research which was funded by the U.S. National Cancer Institute suggests that if a lumpectomy is possible it may actually increase survival Hwang said. The findings may reverse the mastectomy trend said Dr. Laura Kruper codirector of the breast oncology program at the City of Hope Comprehensive Cancer Center in Duarte Calif. who was not involved in the study. The study is scientifically sound in many ways Kruper said. They broke it down by year of diagnosis and by age category she said. They looked at socioeconomic status and they kept it early stage. Dr. Wendy Woodward section chief for breast radiation oncology at the University of Texas MD Anderson Cancer Center in Houston said that for women with early cancers the study clearly reiterates there is no detriment to cancer control in having a lumpectomy and radiation for breastconserving surgery candidates. But Woodward added I am not sure the study convinces us that lumpectomy and radiation is better for breast cancer survival but it may be. The study was observational Hwang stressed. It found a link or association but could not provide causeandeffect proof that the breastconserving treatment is more effective than mastectomy in early stage breast cancer. Hwang believes the study does arm women with valuable information. However I dont want women who chose mastectomy to think they did the wrong thing Hwang said. At the end of the day personal preference trumps everything else. I fully support the patients options to choose the best treatment for themselves. More information To learn more about lumpectomy visit the American Cancer Society. SOURCES E. Shelley Hwang M.D. M.P.H. chief breast surgery Duke Cancer Institute Durham N.C. Wendy Woodward M.D. Ph.D. section chief for breast radiation oncology and associate professor University of Texas MD Anderson Cancer Center Houston Laura Kruper M.D. M.P.H. director Cooper Finkel Womens Health Center and codirector breast oncology program City of Hope Comprehensive Cancer Center Duarte Calif. Cancer Jan."

"More bad news on the prostate cancer front A widely used test http_Clinical_Stage.html thats supposed to help doctors and patients predict the outcome of most prostate cancers is basically worthless. Thats according to a study httponlinelibrary.wiley.comjournal.ISSN just published in the journal CANCER. The new study discrediting the test coupled with persistent questions http_cancer_screening_talk.html about how useful prostate screening is for most men anyway add up to a whole lot of discussion points patients should take to their doctors. The test in question is called clinical staging. It relies on certain signs doctors use to classify how advanced an individual patients cancer is that is what stage its in. It includes criteria like whether the doctor can feel a nodule through rectal examination and whether a tumor is detected through a test called transrectal ultrasound. Ten years ago the American College of Surgeons Commission on Cancer http that doctors should use these types of clinical staging tests to help decide how to treat cancers. Our findings question the utility of our current staging system for localized prostate cancer says Dr. Adam Reese httpurology.ucsf.eduresidencyresCurrent.html of the University of California at San Francisco lead author of the study. To begin with doctors err in using this prostate test percent of the time. When these errors occur the study says doctors most often conclude the cancer is less serious than it really is. Article continues after this message from our sponsor But even when researchers allowed for these errors they found the test doesnt predict how patients ultimately do. Dr. Gerald Andriole http of Washington University who was not involved in the study told Shots he wasnt surprised by the results. Recently he says urologists have begun to realize these criteria are not adequate. But this is the first study that quantifies the magnitude of the inadequacy. Even so Andriole says the findings may not make too much difference in the real world. Before treatment recommendations are made doctors put most prostate tumors through other tests too like the Gleason score http_GleasonScore.html and they look at the percentage of biopsies that are positive for cancer cells. I use all those parameters to tell a patient what his chances of a good outcome are Andriole says. Still both study author Reese and Andriole say the new study may serve as a wakeup call to those who are overrelying on the clinical staging system. They say whats really needed is a set of tests that classify prostate tumors by what genes are turned on or off in the cells. Once this is sorted out doctors treating prostate cancer will be less like the blind men who try to guess what kind of creature theyre dealing with when they grasp the elephants trunk or tail."

"A traditional Chinese herbal treatment may reduce fever from HN swine flu influenza just as well as the prescription medication Tamiflu a new study suggests. For thousands of years Chinese herbs have been used to treat influenza study coauthors Dr. Chen Wang and Dr. Bin Cao of Beijing ChaoYang Hospital Capital Medical University in China said in an email. The pandemic influenza gave us the opportunity to evaluate a standard Chinese herb formula designed to target the flu they added. Cao and Wang who specialize in infectious diseases and clinical microbiology said the herbal recipe known as maxingshiganyinqiaosan MY is easily accessible throughout China and much less expensive than Tamiflu oseltamivir. However finding the medicine in the United States is difficult if not impossible given that it contains the stimulant ephedra. The United States has banned or restricted the sale of ephedra products because of concerns about possible complications such as heart attack stroke and even death related to its use as a weightloss supplement. The authors discuss their findings in the Aug. issue of the Annals of Internal Medicine. The HN swine flu pandemic sparked influenza cases around the globe resulting in nearly deaths the authors said. Per World Health Organization WHO recommendations in most instances Tamiflu was the treatment of choice where it was available. However it is often out of reach in less developed parts of the world such as rural China where traditional herbal medicines are a likely default treatment. The MY flu preparation is composed of herbs ephedrae zhimu qinghao shigao yinhua huangqin chaoxingren lianqiao bohe zhebeimu niubangzi and gancao. To compare the relative effectiveness of MY and Tamiflu in treating HN influenza the authors focused on previously healthy patients who were diagnosed with a very mild form of the illness. The men and women were relatively young with an average age of . They were being treated in different medical facilities across four Chinese provinces during the height of the pandemic between July and November of to prevent spreading the flu not because their symptoms were severe. Within hours of the onset of symptoms the patients were assigned to one of four fiveday treatment groups. One group was given milligrams of Tamiflu twice a day in capsule form a second group received milliliters of MY four times a day in liquid form a third group took the same dosages of Tamiflu and MY together and a fourth group received no treatment. All of the herbs were screened for quality and the MY mixture was deemed to meet Chinese safety standards. The results Both MY and Tamiflu were effective at eliminating fever whether administered on their own or in combination. All three approaches helped to resolve fever sooner than no intervention whatsoever the authors said noting it appeared that fever dissipated fastest when MY and Tamiflu were given together. However none of the treatment methods appeared to be superior in terms of overall viral control and side effects were minimal in all cases. Even though the ephedracontaining herbal is not readily available in the United States the MY herbal formula is available in many countries besides China including Korea Japan India and Germany the study authors noted. Duffy MacKay vice president of scientific and regulatory affairs at the Council for Responsible Nutrition which represents the dietary supplement industry believes that fears over ephedras use as a weightcontrol agent have overlooked its more traditional and much safer role as a medicine against lung inflammation. MacKay said that in China traditional medicine is seamlessly integrated into everyday medical practice. Here in the U.S. we do things differently he said. We have our prescription drugs on the one hand and then we have dietary supplements on the other. But MacKay continued it should also be understood that these two treatments actually work very differently. Tamiflu works to stop viral replication. But the herbal formula is working on symptoms to help people become more comfortable. And those are two very different goals he noted. So our advice MacKay added is that because HN can be very serious its very important to see your doctor. And once youre under the care of your licensed physician theres certainly a lot of things in the world of botanicals that might help. More information For more on the flu and traditional medicine visit the U.S. National Center for Complementary and Alternative Medicine httpnccam.nih.govhealthfluD_GTF.pdf. SOURCES Chen Wang M.D. Ph.D. and Bin Cao M.D. department of infectious diseases and clinical microbiology Beijing ChaoYang Hospital Beijing Institute of Respiratory Medicine Capital Medical University Beijing Duffy MacKay N.D. vice president scientific and regulatory affairs Council for Responsible Nutrition Washington D.C. Aug. Annals of Internal Medicine"

"Tiny pellets could treat arthritic knee pain delaying the need for knee replacement surgery a small study has found. Microparticles inserted into small blood vessels around the knee helped reduce the pain and improve function in eight arthritis sufferers according to clinical trial results. The results were presented Monday at the Society of Interventional Radiologys annual meeting in Los Angeles. Patients overall were able to improve their physical function in the knee after the procedure and there were no adverse events related to this treatment said lead researcher Dr. Sandeep Bagla. Bagla is director of interventional radiology at the Vascular Institute of Virginia in Woodbridge. Boston Scientific maker of the microparticles funded the study. Much of the pain that comes from knee arthritis actually stems from inflammation in the lining of the knee joint also called the synovium Bagla said. In fact small blood vessels created by degenerative arthritis feed this inflammation by increasing blood flow to the lining. To treat this Bagla and his colleagues decided to try blocking those tiny blood vessels using microparticles spheres about a tenth of a millimeter in size made from a synthetic gellike material. The microparticles are inserted using a catheter run through a pinholesized incision in a procedure that lasts between and minutes Bagla said. Its an outpatient procedure and no physical therapy is required before or after this procedure he said. The small pilot study the first U.S. clinical trial of this procedure involved patients with moderate to severe arthritis pain. Only had undergone the procedure by the time of Mondays annual meeting and only eight had made it to the onemonth followup Bagla said. Those eight patients averaged a point decrease in pain as measured on a point visual scale used to estimate pain Bagla said. They started with an average baseline of which means their pain was brought down to manageable levels he said. Physical function of their knee also improved based on an index used to judge the effects of osteoarthritis Bagla added. Overall the two scales represented an percent improvement in function the researchers concluded. Bagla said no side effects are expected because the procedure only blocks additional blood flow to the knee rather than cutting it off altogether. You dont normally have this degree of increased blood supply to this lining. Were not blocking normal blood vessels to the knee or leg or bone or cartilage he said. Final results from this clinical trial are expected to be released this summer. Researchers are already kicking off a second larger trial to better understand how the procedure works and which patients it might benefit Bagla said. They think it will be most appropriate for people between ages and who arent ready to go through knee replacement or people who are on chronic pain medication for their knee arthritis Bagla said. Perhaps we can demonstrate and prove patients do not need to be on these medications and can alternatively go through a minimally invasive procedure like this to reduce their knee pain Bagla said. Dr. Suresh Vedantham president of the Society of Interventional Radiology called the new procedure very promising given that it focuses on the inflamed knee lining that causes the pain. This therapy is very welltargeted to that particular mechanism and certainly it should be investigated further said Vedantham who wasnt involved with the study. Hes a professor of radiology and surgery at the Mallinckrodt Institute of Radiology at Washington University in St. Louis. Research presented at medical meetings is typically considered preliminary until it is published in a peerreviewed journal. More information The Arthritis Foundation has more about knee pain https SOURCES Sandeep Bagla M.D. director interventional radiology Vascular Institute of Virginia Woodbridge Suresh Vedantham M.D. professor radiology and surgery Mallinckrodt Institute of Radiology Washington University of St. Louis Society of Interventional Radiology annual meeting March Los Angeles"

"Men may one day have a birthcontrol option other than the condom or vasectomy if early research on a new contraceptive gel pans out. Preliminary findings suggest that when applied to the skin the gel dramatically lowers sperm counts thus also lowering though not eliminating the risk for pregnancy. This is the first time that a combination of testosterone and a synthetic progestin called Nestorone has been tested as a gel that could be applied topically. Previous research involved administering the combination by injection or via a patch said study senior author Dr. Christina Wang a professor of medicine at Los Angeles Biomedical Research Institute. The combination contraceptive needs to undergo further testing before it is commercially available. Although men have sometimes received a bad rap for not being willing to assume responsibility for birth control Dr. Joseph Alukal an assistant professor of urology at NYU Langone Medical Center in New York City thinks this reputation may be somewhat undeserved. I think men would use it more than is realized said Alukal who was not involved in the new research. Plenty of guys are concerned about unwanted pregnancy almost as much as women. Unfortunately condoms and vasectomy have remained the only commercially available contraception options for men. The results of the study funded by the U.S. National Institutes of Child Health and Human Development were presented at the recent Endocrine Society annual meeting held in Houston. According to Wang the gel was applied in two spots the testosterone component on the arm and the progestin component on the abdomen. The gels were applied every day for six months. The study conducted in conjunction with the University of Washington involved men who were assigned to receive one of three types of gels one gel containing both testosterone plus a gel containing one of two doses of the synthetic progestin or a gel containing testosterone on its own plus a placebo gel with no progestin. Up to percent of the men who received the combination formulas saw their sperm concentrations plunge to less than million sperm per milliliter versus just percent of those receiving only testosterone. Normal sperm concentration is more than million sperm per milliliter according to the Mayo Clinics website. Up to percent of men receiving the drug combination in the study saw their concentrations drop to no sperm at all versus only percent of men taking testosterone alone. The testosteroneprogestin combination works by shutting off the hormones that control production of sperm in the testes Wang explained. One important and unanswered question is what the longterm side effects of this regimen might be. The answer said Wang is We just dont know. Thats apart from mildtomoderate acne or an increase in acne which was seen in about percent of participants. A new formulation currently being developed that contains half the amount of testosterone might decrease or eliminate that problem Wang speculated. Another question is how reversible this would be in terms of restoring sperm counts Alukal said. In addition to planning more studies on this combination protocol Wang is also in early phases of testing the male hormone dimethandrolone which is more potent than testosterone. Because the new study was presented at a medical meeting the data and conclusions should be viewed as preliminary until published in a peerreviewed journal. More information Theres more on contraception at the American College of Obstetricians and Gynecologists http_Patients. SOURCES Christina Wang M.D. professor of medicine Los Angeles Biomedical Research Institute Joseph P. Alukal M.D. assistant professor of urology NYU Langone Medical Center New York City presentation Endocrine Society annual meeting June Houston"

"A leukemia drug might also effectively treat severe asthma a smallscale clinical trial suggests. Gleevec imatinib reduced the twitchiness of airways making them less likely to reflexively constrict when exposed to an allergen or asthma trigger said senior researcher Dr. Elliot Israel. We showed we could decrease the amount of airway twitchiness by a third Israel said. Thats a substantial change and that was significant compared with the placebo group. Israel is director of the respiratory therapy department at Brigham and Womens Hospital in Boston. The drug also improved overall airway function an effect researchers hadnt expected Israel said. People whose severe asthma isnt controlled despite use of highdose steroid medications are at risk of declining lung function and poor quality of life the researchers said in background notes. But this powerful cancer drug cant be recommended for them on the basis of this small study Israel and other specialists noted. Gleevec fights leukemia by blocking a specific receptor on cancerous white blood cells inhibiting their ability to multiply and spread Israel said. That same action also affects mast cells a type of white blood cell distributed throughout the body that promotes inflammation and causes allergic reactions Israel said. For example mast cells in the skin are responsible for hives while mast cells in the lungs have been associated with severe asthma he said. By blocking the signal that helps keep mast cells alive we were hoping to reduce the number of these cells Israel said. By doing that we hoped to produce improvements beyond the maximal therapy that these patients with severe asthma are on. Israel and his colleagues recruited severe asthma sufferers for the study. All received topnotch asthma treatment and were randomly assigned to take either Gleevec or a placebo pill once daily during the month trial. Blood tests showed that Gleevec did reduce mast cell activity in patients Israel said. Further allergy challenge tests showed a decrease in airway reactivity among patients taking Gleevec the researchers reported. Airways became less likely to close off after exposure to an allergen. Physical examinations showed that people taking Gleevec actually experienced a slight overall widening of their airways Israel added. There was a small but significant improvement in the airway narrowing in these patients which we didnt expect because we didnt think the mast cells were necessarily promoting that airway narrowing all the time Israel said. Sideeffects were not as severe as expected he added. One person dropped out because of a sharp decline in white blood cells which bounced back after the drug was discontinued. Another person dropped out because of leg cramps associated with the drug. All in all we were expecting a significantly greater pattern of sideeffects and we didnt see it Israel explained. According to Dr. Len Horovitz a pulmonary specialist with Lenox Hill Hospital in New York City This drug represents a new mechanism for the immune modulation of severe asthma. Horovitz was not involved with the study. It has been a while since a new approach and treatment for severe asthma has emerged Horovitz said. Further studies will be needed to assess its utility in moderate asthma. Pulmonologist Dr. Theodore Maniatis is medical director of Staten Island University Hospital in New York City. He sounded a more cautionary note. This is a very early work that in no way should encourage asthmatics Maniatis said. While it is a very interesting study for pulmonologists and immunologists it is a very small study. Until now this immunemodulating drug has been used only for cancer and is toxic he added. It will take years of study to determine the usefulness of this drug in treatment. Israel agreed that further clinical trials are needed. Before you go out and recommend this be used in general you really want to repeat this in a larger population with greater numbers he said. It likely will be three to four years before Gleevec could be approved for asthma treatment Israel estimated. If proven effective Gleevec might provide a relatively inexpensive new treatment for asthma patients. Two generic versions of the drug were launched last year which could make it less pricey than newwave asthma drugs headed for the market Israel added. The study was published May in the New England Journal of Medicine. More information For more on asthma visit the U.S. National Heart Lung and Blood Institute https SOURCES Elliot Israel M.D. director respiratory therapy department and director clinical research pulmonary and critical care medicine division Brigham and Womens Hospital Boston Len Horovitz M.D. pulmonary specialist Lenox Hill Hospital New York City Theodore Maniatis M.D. medical director Staten Island University Hospital New York City May New England Journal of Medicine"

"Pour some more of that EVOO on your plate a study finds that eating more olive oil could be linked with lower stroke risk in older people. Medical records of people and older who lived in three French cities were examined by researchers to determine how their olive oil consumption affected their chances of having a stroke. The participants had no history of stroke at the beginning of the study. Olive oil is a component of the Mediterranean diet which is rich in healthy fats like olive oil and nuts plus whole grains fruits vegetables fish and chicken. Red meat and wine are consumed in moderate amounts and regular physical activity is part of the regimen as well. Other studies have linked the Mediterranean diet with a lower risk of heart disease but scientists are still assessing the roles various portions of the diet and lifestyle play. In this study participants were surveyed about how much olive oil they consumed About used none were moderate users cooking with it or using it as a dressing or with bread and about were intensive users using it in cooking and as a dressing or with bread. In an average . years of followup strokes occurred. Those who were intensive users had a lower stroke risk compared to those who never used olive oil. Researchers arrived at that number after adjusting for such factors as body mass index other stroke risk factors diet and physical activity. The results were statistically significant for ischemic stroke caused by blockage of an artery to the brain but not hemorrahagic stroke caused by the rupture of a blood vessel. The authors noted that the findings could be used to make dietary recommendations for older people at risk for stroke. The study was published online Wednesday in the journal Neurology."

"Laser pretreatment to soften cataracts https appears to be making cataract surgery safer two new studies suggest. There certainly seems to be a benefit to using the laser says American Academy of Ophthalmology AAO spokesman James Salz MD clinical professor of ophthalmology at the University of Southern California in Los Angeles. He reviewed the findings for WebMD. If you have a technique to soften the cataract there appears to be less chance of damage to the eye https Salz says. The research was presented here at the AAO annual meeting. Standard vs. Laser Cataract Surgery More than . million cataract surgeries are performed annually in the U.S. One in three mostly older Americans will have the surgery at some point in their lives. The surgery is performed to remove the natural lens of the eye https after it has become clouded over time. A permanent artificial lens is then implanted to replace the natural lens and provide appropriate vision https correction for each patient. Currently most aspects of cataract surgery including the initial incision and the breakup and removal of the clouded lens from the lens capsule are performed manually by the surgeon. An ultrasound https instrument with a vibrating needle is used to break up the cataracts https and a vacuum sucks them out. The new studies looked at using the socalled femtosecond laser to deliver nearinfrared light to fragment the cataract into tiny segments prior to removal. The idea is that all the surgeon will have to do is remove the pieces with a vacuum says researcher Mark Packer MD of Oregon Health and Sciences University in Portland. Ideally you wont need ultrasound or at least youll need less ultrasound. Thats important because ultrasound can cause collateral damage to the eye https he says. It can hinder recovery and cause clouding of the cornea https which is the clear outer layer of the eye. Although approved by the FDA the femtosecond laser procedure is not widely used in the U.S. according to the American Academy of Ophthalmology. Laser Cataract Surgery Requires Less Energy One new study led by William Culbertson MD of the Bascom Palmer Eye Institute at the University of Miami involved patients. All had the femtosecond laser procedure in one eye and standard manual cataract surgery in the other. Lens fragmentation involved using the laser to make the incision and split the lens into sections and soften it by etching crosshatch patterns on its surface prior to use of ultrasound and removal. The lasertreated eyes required less ultrasound energy to achieve cataract removal than the conventionally treated eyes. Also surgeons made fewer movements in eyes that received laser pretreatment compared to manual standard surgery. Intuitively if we use less energy and fewer movements inside the eye we will have fewer complications less inflammation and swelling of the eye and faster recovery of vision https Culbertson tells WebMD. Because such problems are relatively rare however we need thousands and thousands of patients to prove this he says. The laser pretreatment adds about five to seven minutes to the usual to minute cataract surgery Culbertson says. The study involved the most common types of cataracts https those graded . Culbertson says that these findings may not apply to higher grade harder cataracts. Laser Cataract Surgery Causes Less Cell Damage Packer and colleagues assessed laser cataract surgery in terms of loss of endothelial cells on the inside surface on the cornea as counted after the procedure. Packer consults for LensAR which makes the laser used in the study. Endothelial cells are a barometer of the health of the eye Packer says. They preserve the corneas clarity and they dont regenerate he says. When laser lens fragmentation was used in eyes there was no loss of endothelial cells the study showed. In contrast there was to cell loss in eyes that received standard treatment. Laser Cataract Surgery Other Advantages Other research has shown other advantages to laser surgery as well Packer says. Incisions are always precisely the same. Thats hard when we use our hands to perform the surgery he says. Also the laser allows doctors to perform more precise standardized capsulotomies which is the opening and removal of part of the lens capsule to make room for the new lens. This reduces the chance that a lens will later become displaced. Laser Cataract Surgery Who Will Pay The big issue is who is going to pay Salz says. The laser costs about on top of the ultrasound probe. The government Medicare https wont pay unless we prove thats the only way to do the surgery and clearly thats not true since standard surgery works he says. Packer says he envisions surgical centers or hospitals that have surgeons doing lots of cases investing in the laser. These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

"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"

"UPDATE Click here to read the latest statement from the Victor Chang Institute. https OVERVIEW One of Australias greatest discoveries in pregnancy research Vitamin B can potentially treat molecular deficiencies which cause miscarriages and birth defects Discovery promises to reduce miscarriages and birth defects Findings expected to change the way pregnant women are cared for A blockbuster world first breakthrough at Sydneys Victor Chang Cardiac Research Institute is expected to prevent recurrent miscarriages and multiple types of birth defects in one of Australias most significant discoveries in pregnancy research. Crucially Australian scientists have also demonstrated a potential cure in the form of a common dietary supplement. This historic discovery is expected to forever change the way pregnant women are cared for around the globe. Every year . million babies are born with a birth defect worldwide and one in four pregnant women suffer a miscarriage in Australia. In the vast majority of cases the cause of these problems has remained a mystery. Until now. This breakthrough led by Professor Sally Dunwoodie from the Victor Chang Institute has identified a cause of recurrent miscarriages as well as heart spinal kidney and cleft palate problems in newborn babies. The ramifications are likely to be huge. This has the potential to significantly reduce the number of miscarriages and birth defects around the world and I do not use those words lightly says Professor Dunwoodie. The landmark study found that a deficiency in a vital molecule known as NAD can prevent a babys organs from developing correctly in the womb. Nicotinamide adenine dinucleotide NAD is one of the most important molecules in all living cells. NAD synthesis is essential for energy production DNA repair and cell communication. Environmental and genetic factors can disrupt its production which can cause a NAD deficiency. World first research at the Victor Chang Institute has found that this deficiency can be particularly harmful during a pregnancy as it can cripple an embryo when it is forming. Now after years of research our team has also discovered that this deficiency can potentially be cured and miscarriages and birth defects prevented by taking a common vitamin Professor Dunwoodie revealed. At the heart of the paramount discovery is the dietary supplement vitamin B also known as niacin. Scientists at the Victor Chang Institute have discovered simply boosting levels of this nutrient during pregnancy can potentially prevent recurrent miscarriages and birth defects. Vitamin B is required to make NAD and is typically found in meats and green vegetables as well as vegemite. However a recent studyi found that despite taking vitamin supplements at least a third of pregnant women have low levels of vitamin B in their first trimester which is the critical time in organ development. By the third trimester vitamin B levels were low in of pregnant women. This indicates pregnant women may require more vitamin B than is currently available in most vitamin supplements. Using a preclinical mouse model scientists at the Victor Chang Institute investigated the effect of vitamin B on developing embryos. The results were astounding. Before vitamin B was introduced into the mothers diet embryos were either lost through miscarriage or the offspring were born with a range of severe birth defects. After the dietary change both the miscarriages and birth defects were completely prevented with all the offspring born perfectly healthy. This discovery is akin to the revolutionary breakthrough made last century that confirmed folic acid supplementation can prevent spina bifida and other neural tube defects in babies. As a result consumption of folic acid has been adopted by expectant mothers worldwide and the addition of folate to our food supply has led to a decrease in the number of babies born with neural tube defects. According to the Executive Director of the Victor Chang Cardiac Research Institute Professor Robert Graham the implications are profound. Just like we now use folate to prevent spina bifida Professor Dunwoodies research suggests that it is probably best for women to start taking vitamin B very early on even before they become pregnant. This could change the way pregnant women are cared for around the world said Professor Graham. We believe that this breakthrough will be one of our countrys greatest medical discoveries. Its extremely rare to discover the problem and provide a preventive solution at the same time. Its actually a double breakthrough said Professor Graham. The next step will be to develop a diagnostic test to measure NAD levels. This will enable doctors to identify those women who are at greatest risk of having a baby with a birth defect and ensure they are getting sufficient vitamin B. The findings have been released today by the New England Journal of Medicine the most prestigious clinical research publication in the world. http This study would not have been possible without the generous support of the Chain Reaction Foundation httpchainreaction.org.au the Key Foundation and the National Health and Medical Research Council https STATISTICS in pregnant women will suffer a miscarriage . million babies are born with a serious birth defect worldwide every year . million children under five die from serious birth defects annually Congenital heart disease is the most common form of birth defect affecting in babies babies are born with a heart defect in Australia every week babies will undergo heart surgery in Australia every week Heart defects account for of deaths in children under five REFERENCE Baker H DeAngelis B Holland B GittensWilliams L Barrett T Jr. Vitamin Profile of Gravidas during Trimesters of Pregnancy. Journal of the American College of Nutrition . MEDIA CONTACTS Media Manager g.glovervictorchang.edu.au mailtog.glovervictorchang.edu.auMedia Coordinator l.alexandrouvictorchang.edu.au mailtol.alexandrouvictorchang.edu.au"

"An estimated percent of Americans have food allergies http and the Centers for Disease Control and Prevention has concluded that allergies are a growing https public health concern. But diagnosing allergies can be tricky and kids can outgrow them too. Now a new study https sheds light on the effectiveness of a test called a food challenge https to determine whether a person can tolerate a food they once reacted to. Jula Cieciuch a fifthgrader who lives in Telluride Colo. recently took a food challenge to find out if she was still allergic to eggs. When she passed she was ecstatic. After years of avoiding all foods with eggs she was a bit shocked. For so long it was You cant eat this. You cant eat this Jula says. I was very emotional Shes also outgrown allergies to walnuts and almonds. Its a huge relief ... it has really opened up her diet a lot her mom Kendall Cieciuch told us. Once you can eat eggs you can eat cakes and breads and frittatas and lots of other baked goods. Article continues after this message from our sponsor Jula is still allergic to some foods including milk and cashews so she still needs to be careful. But Kendall says every time shes crossed a food off her allergy list it makes life a little easier. Jula Cieciuchs story is not uncommon. About to percent of children with an egg allergy will outgrow it. And about percent of kids outgrow peanut allergies. In Julas case her allergists at National Jewish Health in Denver Colo. repeated the standard allergy blood tests last summer. Thats when they realized she may have outgrown her egg allergy. The blood test measures the levels of a certain type of antibody immunoglobulin E IgE httpkidshealth.orgenparentstestimmunoglobuline.html. The higher the level the more likely a person is to have an allergic reaction. Julas blood revealed a drop in antibody count. But the only way to confirm that it was safe for Jula to eat egg was to take the food challenge test. Basically the test entails eating small quantities of the foods youve been allergic to. The testing is done under medical supervision. What they do is give you a really small dose like a crumb basically explains Jula. Then after minutes or so if you dont have any reaction you can take a dose thats a little bigger. If you can eat an entire egg you pass. A new study published https in the Annals of Allergy Asthma Immunology illuminates just how many people come to find out they can eat foods theyve long avoided. Researchers studied the results of about food challenges. The tests were done in adults and children whom doctors suspected had become tolerant to foods theyd once reacted to. We found that percent of the patients challenged had mild or moderate allergic reactions explains study author Carla Davis https an allergist and director of the Food Allergy Program at Texas Childrens Hospital. If the symptoms were treated with just Benadryl or another antihistamine they were considered mild or moderate. She says percent of the reactions were more serious requiring treatment with epinephrine. But the vast majority of patients percent did not have an allergic reaction. In other words they tolerated the food just fine. She says the results arent that surprising since allergists had classified these patients as lowrisk for reacting to the foods they were being tested for. I think the results are very encouraging Bruce Lanser https a pediatric allergist who directs the Pediatric Food Allergy Program at National Jewish Health in Denver told us. He was not involved in the study but he says the findings mirror what he sees in his clinical practice. We know a certain percentage will outgrow their allergies Lanser says. And the last thing I want to miss is the opportunity to get a food into a kids diet. He says many of the patients in the study may have outgrown their allergy just like Jula did. But its also possible some of them never truly had a food allergy. As weve reported http people sometimes misinterpret the symptoms of a condition such as lactose intolerance for a food allergy. Lanser says it can be tricky to diagnose food allergies. Thats because the two main tests doctors use the blood test and the skin prick test only reveal part of the story. Both tests only measure sensitization he explains. All they can tell us is how likely you are to react when you eat the food. And thats where the oral food challenge comes in. Its become the gold standard test to rule out an allergy. So if you or your child tested positive for a food allergy years ago you may want to consider seeing an allergist again."

"A new animal study from Beth Israel Deaconess Medical Center Harvard Medical School led by Dr. Christos Mantzoros indicates that a diet containing walnuts may slow colorectal tumor growth by causing beneficial changes in cancer genes. This is the first study that evaluates whether walnut consumption can cause changes to microribonucleic acids miRNA the nucleotides that are involved in altering gene expression. miRNA are the focus of much research in the growing field of epigenetics or the study of how genes may be changed by environmental factors. Our research demonstrates that a walnut diet causes significant changes in the expression profile of miRNAs in localized colorectal cancer tissue and that a walnut diet incorporates protective fatty acids in the colonic tumor either through its direct effects or through additive or synergistic effects of multiple other compounds present in walnuts said Dr. Mantzoros. While future studies are needed were optimistic of the role of miRNAs as biomarkers of disease and prognosis and may demonstrate a potential therapeutic target for colorectal cancer treatment. Researchers conducted the randomized study with two groups of mice. One group was fed the equivalent of two servings ounces per day of walnuts for humans while the second group received a similar control diet with no walnuts. After days researchers found that in walnutfed mice key miRNA that may affect cancer cell inflammation vascularization blood supply and proliferation were positively engaged. The tumors of mice fed the walnutcontaining diet were found to have times the amount of total omega fatty acids including plantbased alphalinolenic acid ALA in the tissue compared to the mice fed the control diet. The study results found that a smaller tumor size was associated with greater percentage of omegas in tumor tissues suggesting that ALA may provide a protective benefit. Tumor growth rate was also significantly slower in the walnut group compared to the control group. As this study was conducted on animals results cannot yet be implied for humans. ALA is an essential fatty acid critical to various body processes and is known to reduce inflammation. Walnuts are the only nut that contain a significant source of alphalinolenic acid ALA . grams per ounce. Walnuts also contain a variety of antioxidants . mmolounce and numerous vitamins and minerals. Colorectal cancer is the third most common type of cancer worldwide and is second to only lung cancer as the leading cause of death in Western Countries. Diet has been shown to be a modifiable risk factor in preventing many types of cancer including colorectal cancer. It is estimated that percent of colorectal cancer in men and percent in women can be prevented by diet and other lifestyle changes. An article detailing these findings Dietary Walnut Suppression of Colorectal Cancer in mice mediation by miRNA patterns and fatty acid incorporation has been published in the Journal of Nutritional Biochemistry. This study was supported from a grant by the American Institute for Cancer Research and the California Walnut Commission. About California Walnut Commission The California Walnut Commission established in is funded by mandatory assessments of the growers. The Commission is an agency of the State of California that works in concurrence with the Secretary of the California Department of Food and Agriculture CDFA. The CWC is mainly involved in health research and export market development activities. For more industry information health research and recipe ideas visit . NonDiscrimination Statement The California Walnut Commission CWC prohibits discrimination in all programs and activities on the basis of race color national origin age disability sex marital status familial status parental status religion sexual orientation genetic information political beliefs reprisal or because all or part of an individuals income is derived from any public assistance programs. Persons with disabilities who require alternative means for communication of program information Braille large print audiotape etc. should contact the CWC offices at . To file a complaint of discrimination write to USDA Director Office of Civil Rights Independence Avenue S.W. Washington D.C. or call voice or TDD. CWC is an equal opportunity employer and provider. The California Walnut Commission offices are located at Parkshore Dr. Ste. Folsom CA Resources . World cancer research fundamerican institute for cancer research. Food nutrition physical activity and the prevention of cancer A globalperspective. AICR . . Platz EA Willett WC Colditz GA et al. Proportion of colon cancer risk that might be preventable in a cohort of middleaged us men. Cancer Causes Control. . . Tsoukas MA Ko BJ Witte TR Dincer F Hardman WE Mantzoros CS. Dietary walnut suppression of colorectal cancer in mice Mediation by miRNA patterns and fatty acid incorporation. J Nutr Biochem. Apr . Epub ahead of print"

"Like many breast cancer survivors yearold Lisa Elliot was prescribed tamoxifen a hormone therapy drug used to prevent the disease from returning. But after a year on the antiestrogen medication she started experiencing menopauselike side effects. One of the symptoms that was the worst for me that nobody ever mentioned was the vaginal atrophy part of it Elliot told FoxNews.com. That was really detrimental to my life way more so than hot flashes were. Vaginal atrophy often occurs after menopause when a womans estrogen levels decrease which leads to a thinning of the vaginal wall. Some studies estimate it can affect up to percent of postmenopausal women. Symptoms include vaginal dryness irritation itchiness painful intercourse and frequent urination. Elliotts symptoms started to impact her daytoday life to the point where sitting in a chair felt extremely uncomfortable. Sex with her boyfriend also became terribly painful and even caused disputes in her relationship she said. It was probably one of the reasons why that relationship didnt continue. To be in your late twenties early thirties and say to your partner Im sorry we cant ever have sex ever again its just too painful theres a lot of distrust that develops Elliott said. It was a question of Well are you not attracted to me Is there somebody else And that wasnt the case at all. Despite the dire conditions only to percent of postmenopausal women seek treatment. Estrogen replacement therapy is commonly used to cure the condition but it is not recommended for all patients. Since many breast cancers are fed by estrogen these drugs are not safe for women like Elliott. Doctors may also propose vaginal moisturizers and lubricants to help but when these overthecounter options were ineffective for Elliott her doctors suggested the MonaLisa Touch a laser treatment. This is a unique fractional carbon dioxide laser thats been utilized for many many years in the face and in the neck to revitalize that skin Dr. Mickey Karram the director of urogynecology at The Christ Hospital in Cincinnati Ohio told FoxNews.com. The therapeutic laser has been available in Italy for several years but it was only recently approved by the U.S. Food and Drug Administration FDA. The skin becomes more lubricated the actual skin surface thickens becomes less sensitive and becomes more pliable. It basically restores everything that you would see in that vaginal canal when the woman had normal circulating estrogen Karram who authored the first U.S. clinical trial on the treatment said. During the procedure the laser probe is inserted into the vagina and releases photon energy to the skin to stimulate the production of collagen. It initiates a process that starts to produce more cells that are important for that skin to be revitalized. And most of that is around collagen and a material called glycogen and these fibroblasts that get circulated Karram said. Once the process gets going within days usually a woman feels theres more lubrication. The laser technology is administered by a trained obstetrician or gynecologist takes about five minutes and does not require anesthesia. Women receive three laser sessions spaced six weeks apart and once yearly afterward. Some experts do warn that further longterm efficacy and safety tests need to be done. To date there has not been a placebo controlled trial or headtohead trials with any other treatments but those studies are in the process of being completed Karram said. Karrams initial U.S. studies have shown some encouraging results with patients showing to percent improvement of all symptoms. In my patients were basically cured and felt that all of their symptoms had resolved. Two of the patients had a few residual symptoms but had significant improvement he said. After a session women may experience some spotting as a potential side effect and doctors do tell patients to avoid sexual intercourse for at least to hours after. The officebased procedure itself however is seemingly painless Karram said. The insertion of the laser does hurt a little bit its like getting a pap smear Elliott said. But the lasering itself doesnt. It feels just fine. And in fact right afterwards you feel fine too theres no residual pain. Elliott admitted she was skeptical of how effective the laser treatment would be but after completing her three sessions she is more than happy she tried it. I feel amazing. I feel like I did before the atrophy before the tamoxifen before all of the bad stuff Elliott said. Today I have a confidence that I didnt have for a very long time because I know that I can be sexually active with somebody that I care about and I dont have to worry about being broken. The MonaLisa Touch therapy can cost up to and it is not covered by insurance. For more information visit SmileMonaLisa.com http"

"Medtronic Inc a manufacturer of pacemakers heart stents and spine products has developed a device to tackle another common health problem erectile dysfunction. The medical device maker said it completed an initial feasibility study of men average age of who suffered from erectile dysfunction ED. After three months the results were promising the company said. The stent a tiny wire mesh tube similar to those used to prop open heart arteries was placed in the internal pudendal artery which supplies blood to the penis. The stent was delivered using a catheter threaded up to the pelvis where the pudendal artery is located. It was placed in the artery opening the vessel and allowing for better blood flow. ED is largely a vascular disease and thats why Medtronic was interested in this said Dr. Jason Rogers of UC Davis Medical Center one of the researchers of the companysponsored trial. There are an estimated million men in the United States who have ED and million worldwide. Rogers said up to percent of men discontinue drug therapy which includes Viagra Levitra and Cialis either because it did not work or because they could not tolerate side effects including lowering of blood pressure. He also noted that men who take certain drugs for heart disease cannot use the popular pills. Theres a real unmet clinical need Rogers said. Initial findings showed twothirds of men who underwent the to hour procedure improved by at least points on the point Internal Index of Erectile Dysfunction scale he said. There were no adverse events reported up to three months later but Rogers acknowledged that risks may become evident much later. This is still investigational and requires more research. It is the inception of an entirely new way of treating ED that has never been seen before he said. Rogers said it could be several years before Medtronic undertakes a much larger latestage trial. Medtronic shares gained . percent to close at . on Wednesday. Reporting by Debra Sherman in Chicago editing by Matthew Lewis Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"A fruitbased micronutrient and fiberdense supplement bar the CHORIbar conceived by Drs. Bruce Ames and Mark K. Shigenaga at Childrens Hospital Oakland Research Institute CHORI was shown in clinical trials to improve metabolism in overweightobese OWOB otherwise healthy adults in ways that are consistent with reduced risk of type diabetes and cardiovascular disease. Consumption of the bar for two months also reduced chronic inflammation and initiated a reduction in weight and waist circumference. Decreased inflammation and improved weight and weight distribution can lower the risk of many chronic diseases. These effects occurred without requiring that participants make any change in their current diet or other lifestyle practices other than to eat two CHORIbars each day for two months. The CHORIbar is not just another nutrition bar. It is a serious intervention to improve health. Its composition is therefore complex and required a number of years and a series of clinical trials to develop. The publication describing this work appeared online today April at The FASEB Journal http The bar was developed over the past years by a team of scientists led by Drs. Bruce N. Ames and Joyce C. McCann at CHORI in collaboration with the United States Department of Agriculture USDA. Most people do not eat an optimally nutritious diet particularly the obese. This results in unhealthy metabolism which not only diminishes vigor but increases future risk of many diseases. While poor diets contain much that is not healthy e.g. too much salt sugar they also are missing or deficient in a number of important components e.g. vitaminsminerals omega fatty acids fiber necessary for healthy metabolism. The CHORIbar is intended to fill these gaps with components present in the bar in normal dietary amounts. Considerable evidence in the scientific literature including Drs. Ames and McCanns work on vitamins and minerals supports the idea that simply supplying missing or deficient dietary ingredients will improve metabolism . Development of the CHORIbar has also been guided by Dr. Mark Shigenagas insights into the importance of a healthy gut supported by optimal nutrition for disease prevention. Because of the strong flavors associated with some vitamins and minerals CHORI partnered with the United States Department of Agriculture to produce a tasty bar. Formulation development was guided by over small clinical trials to ensure that beneficial properties of the bar were retained. Most early trials were two weeks in length and involved primarily lean individuals most of whom benefited by increased HDL cholesterol. Results presented in this publication are compiled from twomonth clinical trials that also included a significant number of overweightobese individuals. These trials were conducted over a year period using very similar bar formulations. These trials employed a simple economical design in which participants acted as their own controls i.e. change in metabolic markers was measured before and after eating the bar. Healthy metabolism is like a complex smoothrunning machine. Unhealthy metabolism is like an old machine with many rusted out joints. There is no magic bullet ingredient in nutrition oiling one joint is not going to allow the rusted out machine to run. The CHORIteam thinks the broad scale improvements observed with the CHORIbar may be the result of oiling multiple joints by the complex nutrient mixture. They are currently conducting experiments to better understand which ingredients in the bar are most important in the complex mixture for the observed effects. The increasing prevalence of obesity is taking a huge toll on public health. Conventional approaches that encourage weight loss by improving dietary habits reducing caloric intake and modifying activity can be successful but prove difficult for many to initiate and sustain. The CHORIbar is intended as a nontraditional means to positively impact the obesity epidemic by initiating a healthier metabolism without requiring sudden drastic behavioral changes. It may therefore assist in weight loss programs by beginning a process of favorable metabolic change. Improved metabolism resulting from eating the bar is also associated with a number of reports of feeling better though this observation has not yet been formally tested which the CHORI team predicts will help people transition to improved lifestyle habits. The power of nutrientrich properly formulated foodbased supplements such as the CHORIbar to move dysregulated metabolism in a healthy direction may help reverse obesityassociated conditions and thereby reduce the risk of future chronic diseases. The full potential of foodbased supplements to do the work of some drugs without their negative side effects is just beginning to be seriously investigated. About UCSF Benioff Childrens Hospital Oakland UCSF Benioff Childrens Hospital Oakland formerly Childrens Hospital Research Center Oakland is a premier notforprofit medical center for children in Northern California and is the only hospital in the East Bay devoted to pediatrics. UCSF Benioff Childrens Hospital Oakland affiliated with UCSF Benioff Childrens Hospital San Francisco on January . UCSF Benioff Childrens Hospital Oakland is a national leader in many pediatric specialties including cardiology hematologyoncology neonatology neurosurgery orthopedics pulmonology and sports medicine. The hospital is one of only five ACS Pediatric Level I Trauma Centers in the state and has one of largest pediatric intensive care units in Northern California. UCSF Benioff Childrens Hospital Oakland has licensed beds over physicians in specialties more than employees and a consolidated annual operating budget of more than million. UCSF Benioff Childrens Hospital Oakland is also a leading teaching hospital with an outstanding pediatric residency program and a number of unique pediatric subspecialty fellowship programs. UCSF Benioff Childrens Hospital Oaklands research arm Childrens Hospital Oakland Research Institute CHORI is internationally known for its basic and clinical research. CHORI is at the forefront of translating research into interventions for treating and preventing human diseases. CHORI has members of its investigative staff a budget of about million and is ranked among the nations top ten research centers for National Institutes of Health funding to childrens hospitals. For more information go to http and http References McCann J. C. Shigenaga M. K. MietusSnyder M. L. Lal A. Suh J. H. Krauss R. M. Gildengorin G. L. Goldrich A. M. Block D. S. Shenvi S. V. McHugh T. H. Olson D. A. and Ames B. N. A multicomponent nutrient bar promotes weight loss and improves dyslipidemia and insulin resistance in the overweightobese Chronic inflammation blunts these improvements. The FASEB Journal in press March . MietusSnyder M. L. Shigenaga M. K. Suh J. H. Shenvi S. V. Lal A. McHugh T. Olson D. Lilienstein J. Krauss R. M. Gildengoren G. McCann J. C. and Ames B. N. A nutrientdense highfiber fruitbased supplement bar increases HDL cholesterol particularly large HDL lowers homocysteine and raises glutathione in a wk trial. FASEB J . CHRCOCHORI . Pending United States patent application no. owned by Childrens Hospital Research Center Oakland California. Ames B. N. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. PNAS . Ames B. N. Prevention of mutation cancer and other ageassociated diseases by optimizing micronutrient intake. J Nucleic Acids pli. doi.. McCann J. C. and Ames B. N. Vitamin K an example of triage theory is micronutrient inadequacy linked to diseases of aging Am J Clin Nutr . McCann J. C. and Ames B. N. Adaptive dysfunction of selenoproteins from the perspective of the triage theory why modest selenium deficiency may increase risk of diseases of aging. FASEB J ."

"In a longterm study of the latest treatment for peanut allergy scientists in Australia report that an immunebased therapy helped children allergic to peanuts eat them without reactions for four years. The study published in the journal Lancet Child Adolescent Health http follows up on children enrolled in an earlier study of an immunotherapy treatment which combined probiotics with small doses of peanuts that were designed to gradually train the childrens immune systems httptime.compeanutallergiesprevention to accept the peanut allergen rather than treat it as something foreign. Previous studies have suggested httptime.comhowtopreventpeanutallergy that methods like these could be effective in reducing youngsters allergic sometimes dangerous anaphylactic shock reactions to peanuts. The Australian team added probiotics to further enhance the guts ability to accept the peanuts and not trigger an immune reaction. Compared to of children who didnt get any treatment of those receiving the combination therapy significantly reduced their allergic reactions to peanuts. MORE Babies Should Eat Eggs and Peanuts Early to Avoid Food Allergies httptime.compeanutsfoodallergy In the followup which tracked the children for four years after they were treated with the combination therapy of those who got the combination probiotic and peanut therapy were comfortable eating peanuts compared to only of those who did not get the treatment. Fewer children in the treated group had an allergic reaction to the peanuts and they also showed smaller reactions to skin prick tests with peanut allergen. The results are encouraging allowing the children who were treated to eat peanuts without fear of an allergic reaction. But it may be too early to call this a cure. The researchers believe that adding probiotics to the peanut allergens may be important in improving the childrens tolerance to the food but Dr. Anna NowakWegrzyn an associate professor of pediatrics at Icahn School of Medicine at Mt. Sinai Hospital who was not involved in the study notes that the researchers didnt compare the effect of the probiotics themselves they only compared children who received the probiotics along with immune therapy to those who didnt get any treatment at all. It makes sense that the probiotics may enhance the immunotherapys effect since probiotics are beneficial bacteria in the gut where food allergens are processed. I think there is certainly a suggestion but not hard proof that the probiotics make a difference says NowakWegrzyn. The question for me would be if there is a difference between patients who were treated with both immunotherapy in the form of low doses of peanuts and probiotics and those who were treated with just immunotherapy. That may have to wait for another study. But the new findings provide even more evidence that using peanuts to treat peanut allergy and to retrain the immune system to be less allergic can be effective"

"Older people who eat baked or broiled fish at least once a week may be boosting their brain https health. In a new study imaging scans showed that regular fisheaters were less likely to have brain cells die off in the area of the brain responsible for shortterm memory recalling a phone number that was just heard for example. And people who ate baked or broiled fish at least weekly and didnt lose brain cells were much less likely to develop Alzheimers https disease or mild mental impairment says Cyrus Raji MD PhD of the University of Pittsburgh School of Medicine. Several studies have linked a diet https rich in certain fish to a reduced risk of Alzheimers disease. This benefit is thought to come from the omega fatty acids in fish although studies of fish oil supplements https_assetscontrolled_contenthealthwisespecialDietary_SupplementsTopic_Overview.xml have produced disappointing results in people who already have Alzheimers. The new study is the first to establish a direct relationship between fish consumption brain structure and Alzheimers risk Raji says. More fish more brain less Alzheimers he tells WebMD. Eating Fish for Brain Health As many as . million Americans may have Alzheimers disease an incurable progressive brain disease https that slowly destroys memory. People with mild mental impairment have memory loss https greater than expected by normal aging but to a lesser extent than in Alzheimers disease. The study involved people average age with no memory problems in . All filled out food questionnaires asking how much fish they ate and how they prepared it. There were people who ate fish at least weekly most of whom ate it one to four times a week. Imaging scans of the brain were taken at the start of the study and an average of about seven years later. What we found Raji says is that if you dont eat fish brain cells die off and developed Alzheimers disease or mild impairment over the next five years. On the other hand only of people who ate fish weekly and whose brain cells were preserved developed Alzheimers or mild impairment. The researchers tried to take into account other risk factors for memory loss that could affect the results including age gender education obesity and physical activity https Still the association between fish brain volume and dementia https remained. But it is possible that other lifestyle factors such as eating less meat could have also contributed to the association between eating fish and brain health. William Thies PhD chief medical and scientific officer of the Alzheimers Association says the findings support the groups recommendation to eat a diet rich in coldwater fish that contain beneficial omega fatty acids. These fish include halibut mackerel salmon trout and tuna. But its still not clear how much fish would have to be eaten to have a detectable benefit he tells WebMD. Not all fish is healthy Raji says. Some fish contain toxins that could raise the risk of dementia. And fried fish has no benefit for preserving memory he says. The Environmental Protection Agency recommends that pregnant https women nursing mothers and children avoid eating shark swordfish king mackerel or tilefish and limiting albacore tuna to ounces per week because of concern about levels of mercury in these fish. These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

"A dozen years ago a patient told plastic surgeon Bahman Guyuron that her forehead lift made her feel fabulous. Sure she looked better. But the wrinklesmoothing operation also endedher migraine headaches something that decades of drugs and lifestyle changes had failed to do. After a similar case of serendipity Guyuron became intrigued by the possibility that he had stumbled on a new way to help some of the million hapless Americans who suffer from migraines. He surmised that the cosmetic surgery had freed nerves that were being pinched and pained by muscles in the brow. The idea was unorthodox but not farfetched. Botox which paralyzes muscles by blocking nerve signals was then being tested for migraines. In the U.S. Food and Drug Administration approved it for prevention of chronic migraines the frequent relentless headaches that afflict percent of migraineurs. Guyuron chair of plastic surgery at University Hospitals Case Medical Center in Cleveland went on to identify four common trigger sites and publish studies showing that in selected patients surgical decompression of nerves in one or more of these sites provides lasting migraine relief. He has also taught plastic surgeons around the world none in the Philadelphia area to perform the outpatient operation which costs an average of and is not covered by many insurers. Yet neurologists the specialists who traditionally treat migraines generally remain not just skeptical of surgery but disapproving. Neurology journals have declined to publish Guyurons submissions. I know most of the headache experts in the country and they dont support migraine surgery said neurologist Stephen Silberstein director of Thomas Jefferson Universitys Headache Center one of the nations leading programs. I certainly wouldnt recommend it or say insurance should cover it at this point. Neither would the American Headache Society whose board includes Jefferson neurologist William Young. Last week following Boston media stories about migraine surgery the headache society issued a warning No convincing or definitive data show its longterm value it may cause irreversible side effects and it can be extremely expensive. Most importantly said the release it may not work. For decades scientists thought migraines were caused by blood vessels in the brain that suddenly constricted and then widened like garden hoses being stomped on. Better brainimaging technologies suggested this theory was too simple. Abnormal nerve activity neurochemicals bloodvessel changes possibly muscle spasms in the neck and of course genetics are all believed to play a role. As any sufferer can attest the excruciating result is pulsating pain usually with nausea vomiting and sensitivity to light and sound. It can be set off by an idiosyncratic list that includes foods stress hunger dehydration fatigue odors loud noises hormone changes weather conditions basically living. Migraines can also transform as doctors call it from episodic to chronic defined as more than days a month. It wouldnt be unusual for me to have a migraine for a whole week said Tara Pezze a school librarian in the Pittsburgh suburb of North Huntington. You learn how to function but youre going through life almost in a haze. I would be afraid to go out with my friends afraid to exercise. It took over my life. After transformation the nervous system doesnt fully recover between attacks so the pain never fully remits explained neurologist Richard Lipton director of Montefiore Medical Centers Headache Center in New York City. Its a chronic change in the brain. The first line of treatment is an evergrowing arsenal of pharmaceuticals most not approved for migraine including overthecounter and prescription analgesics triptans ergotamines antiseizure drugs antidepressants cardiovascular drugs and opioid painkillers. For migraines that are focused at the back of the head newer treatments include shots to numb the occipital nerves at the nape of the neck or an implantable device that stimulates those nerves. Botox given every three months is injected into neck and forehead muscles. Nothing works for everyone said Teri Robert of Washington W.Va. whose migraine odyssey inspired an educational book and her website helpforheadaches.com. Many patients make matters worse by overusing medications as Pezze said she did thus setting up a vicious rebound cycle More meds lead to more headaches which lead to more meds and so on. When addictive opioids such as Vicodin and OxyContin are in the mix the consequences can be disastrous. Pezze never resorted to opioids but by the time she sought help from Guyuron in she was desperate He could have sawed my arm off. I was willing to do anything he suggested. Guyuron a graduate of Tehran University Medical School in Iran trained in surgery plastic surgery and craniofacial surgery at academic medical centers in the United States and Canada. In he combed his patient files to turn up dozens whose forehead lifts coincidentally eased migraines. He theorized that their headaches had involved irritation of the end branches of the trigeminal nerve the primary nerve supplying sensation in the face. This was not a novel idea a neurologist had posited it decades earlier but Guyuron built on it. Dissecting cadavers in an anatomy lab he identified four sites of likely nervebranch irritation the forehead the temples the back of the neck and the sinuses. In three out of these four trigger sites the nerve passes through muscle to get to the surface of the head Guyuron explained. As the muscle contracts it can hurt the nerve. In the fourth site the sinuses Guyuron suspected that the culprit was little bony projections inside the nose called turbinates. He developed techniques to free up the nerves removing bits of muscle or bone through small incisions hidden in the crease of the eye or the hairline. Sometimes he inserted a pad of fat to shield the nerve. From the beginning the one to threehour surgery was limited to migraineurs who had been diagnosed by a neurologist failed conventional therapies and got relief from Botox. Guyuron injected the paralytic over a period of three months to identify trigger sites. He published small studies in plastic surgery journals that showed the operation worked for least percent of patients. Side effects good and bad included occasional neck stiffness forehead skin numbness loss of frown lines and improvement in breathing. Neurologists faulted the studies for not having untreated control groups. So Guyuron conducted a clinical trial the most rigorous design in which patients were randomly assigned to migraine surgery or a sham procedure. Of those who underwent the real thing percent said their migraines were eliminated compared with percent in the control group. Headache pain frequency and duration were reduced by at least half in percent of surgery patients compared with percent of controls a difference too big to occur by chance. The most common complication was slight hollowing of the temple. Neurologists were largely unimpressed. Silberstein still believes the benefits may be a placebo effect. If you believe strongly enough that something works it works he said. Im not convinced that its more than a sham procedure. Placebo effect Guyuron countered is shortlived. Last year he reported that relief persisted in of patients followed for five years. Commenting on that study neurologist Alexander Mauskop director of the New York Headache Center in New York City told medscape.com that surgery is controversial and obviously headache specialists dont think its appropriate for plastic surgeons to be treating headache patients. There are exceptions. I think what Guyuron does is very helpful to a subgroup of migraineurs said Lipton the Montefiore neurologist. Its not a miracle cure by any means but it makes physiological sense for a subgroup. Surgery is an arrow in the quiver. In Pezzes case that arrow hit a bullseye. Not that she rushed it. For two years Guyuron treated her with Botox. The shots worked but she lived in fear knowing what would happen as the drug wore off. Finally in she had surgery. It took her two more years to stop being afraid. I just kept waiting for the pain to come and it didnt she said. In the past four years Ive had two migraines. I know it sounds corny and cheesy but surgery has absolutely changed my life."

"Eating three or more servings of blueberries and strawberries each week may help reduce a womans risk of heart attack a large new study suggests. The study included nearly young and middleaged women who took part in the Nurses Health Study II. The women completed questionnaires about their diet every four years for years. During the study period participants had heart attacks. Women who ate the most blueberries and strawberries were percent less likely to have a heart attack compared to women who ate berries once a month or less. This held true even among women who ate a diet rich in other fruits and vegetables. This benefit was independent of other heart risk factors such as advancing age high blood pressure family history of heart attack body mass index exercise smoking and caffeine and alcohol intake. The findings appear online Jan. in the journal Circulation. The study cant say specifically what about the berries seemed to result in a lower risk of heart attack among these women or that there was a direct causeandeffect link between eating the berries and lowered heart attack risk. But blueberries and strawberries contain high levels of compounds that may help widen arteries which counters plaque buildup the researchers said. Heart attacks can occur when plaque blocks blood flow to the heart. Berries were the most commonly consumed sources of these substances in the U.S. diet and they are one of the best sources of these powerful bioactive compounds said study lead author Aedin Cassidy. These substances called anthocyanins a flavonoid are naturally present in red and bluecolored fruits and vegetables so they are also found in high amounts in cherries grapes eggplant black currants plums and other berries. Men are likely to benefit from eating berries as well although this study included only women said Cassidy who is head of the department of nutrition at Norwich Medical School at the University of East Anglia in England. Although more research is needed to confirm these benefits these data are important from a public health perspective because these fruits can be readily incorporated into the habitual diet the study concluded. Dr. Suzanne Steinbaum a preventive cardiologist at Lenox Hill Hospital in New York City noted that this was a huge study that followed women for a long period of time. Women who ate three or more servings of strawberries and blueberries per week decreased their heart attack risk by onethird. This is pretty compelling. Steinbaums advice to both women and men is to include berries in their diet and make them part of their daily fruit and vegetable fill. One serving of blueberries or strawberries equals about one cup. Dana Greene a nutritionist in Boston regularly tells her patients to consume more fruits and vegetables including berries. They are so good for you Greene said. Besides flavonoids berries also are loaded with other nutrients including vitamin C potassium and folate. I tell all patients to make sure that half of their plate is filled with fruits and vegetables especially richly colored ones like blueberries and strawberries Greene said. Berries can also help people lose weight and maintain that loss because they feel fuller faster. There is no downside. The study was funded by the U.S. National Institutes of Health and the U.K. Biotechnology and Biological Sciences Research Council. More informationf What does a heart attack look like in women Find out at the American Heart Association http_UCM__Article.jsp. SOURCES Aedin Cassidy Ph.D. head department of nutrition Norwich Medical School University of East Anglia England Suzanne Steinbaum D.O. preventive cardiologist Lenox Hill Hospital New York City Dana Greene M.S. R.D. nutritionist Boston Jan. Circulation online"

"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."

"Minimally invasive surgery for a burst appendix appears to be more successful and less costly in the long run than the traditional operation a new study hints. Using the gentler technique called laparoscopy a surgeon makes small cuts in the abdomen before inserting a tiny camera inside then performing the operation by watching a television monitor. Doctors say this type of operation hurts patients less afterward than the conventional open method which involves one long incision in the abdomen of up to inches. But experiments comparing the two kinds of procedure have yielded mixed outcomes and some experts remain unconvinced that laparoscopy is worth its higher upfront cost. The new study in the Annals of Surgery doesnt settle that question. But it does suggest that laparoscopy could actually save thousands of dollars for some patients when all costs including physician fees hospital fees and readmissions are considered. You really want to look at the total cost because thats what society has to pay said Dr. Dmitry Oleynikov who heads the Center for Advanced Surgical Technology at Nebraska Medical Center in Omaha and led the new study. Overall this study shows benefit from laparoscopy on every aspect including cost he told Reuters Health. Appendix removals are one of the most common surgeries in the U.S. with some procedures done every year Oleynikov added. Sponsored With his colleagues he looked back at some such surgeries done at dozens of academic medical centers in the U.S. roughly open procedures and laparoscopic ones. For uncomplicated cases of appendicitis in which the appendix is still intact the tabs for the two surgeries came out about the same at just over . People who had the laparoscopic procedures also had lower death rates at . percent versus . percent fewer readmissions and a slightly shorter stay at the hospital. When the appendix had burst however the open surgery racked up a considerably higher bill. On average it cost compared to for the laparoscopic surgery. Yet again the patients who had laparoscopy fared much better than those who had conventional surgery. In healthy individuals the death rate is very small for all groups of patients. But when you become sicker laparoscopy is better said Oleynikov. Substantial savings could be seen if open surgery is done in a laparoscopic fashion. But he acknowledged that the study has major limitations. First it looks only at academic medical centers. And second its not a randomized controlled trial which means the patients being compared could be different in important ways explaining at least part of the outcomes of the two types of surgery. Indeed those who had laparoscopy were younger and usually had less severe disease which could have biased the results in favor of the minimally invasive procedure. SOURCE bit.lyoOWUTt httpbit.lyoOWUTt Annals of Surgery online July ."