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"A study that tracked tens of thousands of midlife and older men for more than years has found that vigorous exercise and other healthy lifestyle habits may cut their chances of developing a lethal type of prostate cancer by up to percent. While most prostate cancers are clinically indolent meaning they do not metastasize and are nonlifethreatening a minority of patients are diagnosed with aggressive disease that invades the bone and other organs and is ultimately fatal. Lead author Stacey Kenfield ScD of UCSF and a team of researchers at UCSF and Harvard focused on this variant of prostate cancer to determine if exercise diet and smokefree status might have lifesaving benefits. In the study published today Nov. in the Journal of the National Cancer Institute the researchers analyzed data from two U.S. studies the Health Professionals FollowUp Study that tracked more than males ages to from to and a second the Physicians Health Study that followed more than males ages to from to . To gage the effects of lifestyle habits the researchers developed a score based on the results of the health professionals survey then applied it to the physicians study. They assigned one point for each affirmative response to questions about regular intense exercise that induced sweating body mass index BMI under tobaccofree status for a minimum of years high intake of fatty fish high intake of tomatoes and low intake of processed meat. To reduce error participants had to be free of diagnosed cancer at the start of the study and a fouryear lag was imposed to rule out those who unknowingly had lethal prostate cancer which was determined by evidence of prostate cancer death or metastasis to the bones or other organs excluding the lymph nodes. Cases were confirmed through medical records and pathology reports and cause of death was determined by death certificate and medical record and secondarily by next of kin. Vigorous activity trumps other lifestyle factors The researchers identified cases of lethal prostate cancer in the health professionals group and cases in the physicians group. Participants with to points in the health professionals group had a percent decreased risk of lethal prostate cancer and a percent decreased risk was observed in the physicians group for the same comparison. For dietary factors alone men with three points versus those with zero points had a percent decreased chance of developing lethal prostate cancer in the health professionals group. In the physicians group this decrease was percent. While there were fewer cases and less detailed data collected in the physicians study the score was similar in both populations indicating the potential benefit of healthy lifestyle habits in warding off lethal prostate cancer said the authors. We estimated that percent of lethal prostate cancer cases would be prevented in the United States if men over had five or more of these healthy habits said Kenfield assistant professor in the Department of Urology at UCSF Medical Center and formerly of the Department of Medicine at Harvard Medical School in Boston where the study was initiated. Its interesting that vigorous activity had the highest potential impact on prevention of lethal prostate cancer. We calculated the populationattributable risk for American men over and estimated that percent of lethal prostate cancer would be reduced if all men exercised to the point of sweating for at least three hours a week Kenfield said. The researchers also calculated that lethal prostate cancer among American men over would be cut by percent if they consumed at least seven servings of tomatoes per week and that percent would be spared this diagnosis if they consumed at least one serving of fatty fish per week. Reducing intake of processed meats would cut the risk by percent they reported. In contrast the populationattributed risk for smoking was percent largely because the majority of older American men are longterm nonsmokers. Lifestyle changes also prevent heart disease diabetes This study underscores the ongoing need for more effective prevention measures and policies to increase exercise improve diet quality and reduce tobacco use in our population said senior author June M. Chan ScD from the departments of Urology and Epidemiology and Biostatistics at UCSF. It takes cooperation and effort from multiple areas like insurance companies employers policy makers and city planners to figure out how to creatively support and encourage more exercise into most busy adults working day. These lifestyle habits align with other recommendations to prevent diabetes and heart disease. About one man in seven will be diagnosed with prostate cancer during his lifetime making it the most frequently diagnosed cancer in the United States excluding nonmelanoma skin cancer. According to the American Cancer Society in there will be approximately cases of prostate cancer and approximately deaths. This study was supported by grants from the Prostate Cancer Foundation and the National Institutes of Health. Coauthors are Erin Van Blarigan ScD of the departments of Urology and Epidemiology and Biostatistics at UCSF Howard Sesso ScD MPH Edward Giovannucci MD ScD Meir Stampfer MD DrPH and Julie Batista ScD all of Harvard T.H. Chan School of Public Health Harvard Medical School and Brigham and Womens Hospital Mary Kathryn Downer and Jaquelyn Jahn both of Harvard T.H. Chan School of Public Health and Brigham and Womens Hospital. About UCSF UCSF is a leading university dedicated to transforming health worldwide through advanced biomedical research graduatelevel education in the life sciences and health professions and excellence in patient care. Founded in as a medical college UCSF now includes topranked graduate schools of dentistry medicine nursing and pharmacy a graduate division with worldrenowned programs in the biological sciences a preeminent biomedical research enterprise and toptier hospitals UCSF Medical Center and UCSF Benioff Childrens Hospitals. Please visit http"

"Pregnant women are at higher risk for serious illness and complications including death from influenza. For expectant mothers hospitalized with flu early treatment with the influenza antiviral drug oseltamivir may shorten their time in the hospital especially in severe cases suggests a new study published in The Journal of Infectious Diseases and available online. The findings also underscore the importance of flu vaccination for this risk group. Treating pregnant women who have influenza with antiviral drugs can have substantial benefit in terms of reducing length of stay in the hospital said Sandra S. Chaves MD MSc of the Centers for Disease Control and Prevention CDC and senior author of the study. CDC recommends treatment of suspected cases of flu among pregnant women with antiviral drugs as soon as possible without waiting for test results to confirm influenza. The earlier you treat the better chances you have to modify the course of the illness. Past studies have suggested that flu antiviral therapy is safe and beneficial for pregnant women. The current study based on data from a nationwide flu surveillance network including states focused on pregnant women hospitalized with laboratoryconfirmed flu over four recent flu seasons from to . During the study period pregnant women were hospitalized with flu. Sixtythree of these patients or about percent had severe illness. After adjusting for underlying medical conditions vaccination status and pregnancy trimester the researchers found that early treatment with the antiviral drug oseltamivir was associated with a shorter hospital stay. Among pregnant women with severe flu illness who were treated early within two days of the start of symptoms the median length of stay was about five days shorter compared to hospitalized pregnant women with severe flu illness who were treated later . days vs. . days. Pregnant women hospitalized with less severe illness who were treated early also had a shorter hospital stay than those treated later but the difference was not as great. In the study pregnant women hospitalized with severe flu illness were half as likely to have been vaccinated as women hospitalized with milder illness percent vs. percent. CDC recommends annual flu vaccination for everyone months of age and older including pregnant women during any trimester of their pregnancy. Earlier studies have suggested that immunization during pregnancy may protect not only the mother from flu but also her newborn baby during the first months of life. All pregnant women should receive annual influenza vaccination to prevent influenza and associated complications for themselves and their infants the study authors wrote. A related editorial commentary by Alan T. N. Tita MD PhD and William W. Andrews PhD MD of the University of Alabama at Birmingham accompanies the new study in The Journal of Infectious Diseases. Overall considering the accumulating evidence of fetal benefit and safety influenza vaccination of pregnant and postpartum women should be a public health priority in accordance with national recommendations the commentary authors wrote. Prompt initiation of antiviral therapy if infection occurs preferably within two days of suspected or confirmed influenza infection is encouraged. Fast Facts Among pregnant women hospitalized with severe flu who were treated early with an antiviral medication the median length of their hospital stay was about five days shorter compared to similar patients treated later. Pregnant women who were hospitalized with severe cases of flu illness were half as likely to have been vaccinated as women with nonsevere illness. Annual vaccination against flu is recommended for everyone months of age and older including pregnant women who are at high risk of serious flu illness and complications. Editors Note The study authors and editorial commentary authors affiliations acknowledgments and disclosures of financial support and potential conflicts of interests are available in the study and the commentary which are embargoed until a.m. EST on Thursday Feb. . For an embargoed copy of the study and the commentary please contact Emily Zaideman ezaidemanpcipr.com mailtoezaidemanpcipr.com. Published continuously since The Journal of Infectious Diseases is the premier global journal for original research on infectious diseases. The editors welcome major articles and brief reports describing research results on microbiology immunology epidemiology and related disciplines on the pathogenesis diagnosis and treatment of infectious diseases on the microbes that cause them and on disorders of host immune responses. The journal is an official publication of the Infectious Diseases Society of America IDSA. Based in Arlington Va. IDSA is a professional society representing nearly physicians and scientists who specialize in infectious diseases. For more information visit http Follow IDSA on Facebook and Twitter."

"Heart scans for patients with chest pains could save thousands of lives in the UK research suggests. The lifesaving scans helped to spot those with heart disease so they could be given treatments to prevent heart attacks. Researchers say current guidelines should be updated to incorporate the scans into routine care. The SCOTHEART study tracked more than patients who were referred to a hospital clinic with symptoms of angina a condition that restricts the blood supply to the heart. Half of the patients were given a scan called a computed tomography angiogram or CTA in addition to standard diagnostic tests. After receiving the scan the number of patients suffering a heart attack within five years dropped by per cent the study found. The number of patients undergoing additional procedures increased within the first year but had levelled out by the end of the fiveyear period. This suggests that including the scans in routine care would not lead to a surge in costly tests or additional heart surgery the researchers say. Patients who are at risk of a heart attack are frequently diagnosed with a test called an angiogram. This involves inserting tubes into the body and heart to check the flow of blood and identify any obstructions that could pose a heart attack risk. CTA scans enable doctors to look at the blood vessels from the outside the body without the need to insert tubes into the heart. The scans are cheaper quicker and safer than angiograms. The study had previously found that around a quarter of patients had their diagnoses reclassified after receiving the scan prompting new treatments in many cases. This is the first study to look at the impact of the scans on longterm survival rates. Lead researcher Professor David Newby of the BHF Centre for Cardiovascular Science at the University of Edinburgh said This relatively simple heart scan ensures that patients get the right treatment. This is the first time that CT guided management has been shown to improve patient outcomes with a major reduction in the future risk of heart attacks. This has major implications for how we now investigate and manage patients with suspected heart disease. The research is published in the New England Journal of Medicine and is being presented at the European Society of Cardiology Annual Congress in Munich. The study was funded by the Chief Scientist Office of the Scottish Government and the British Heart Foundation."

"You might not want to rush into knee surgery. Physical therapy can be just as good for a common injury and at far less cost and risk the most rigorous study to compare these treatments concludes. Therapy didnt always help and some people wound up having surgery for the problem called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who had arthroscopic surgery right away researchers found. Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that youll do quite well said one study leader Dr. Jeffrey Katz a joint specialist at Brigham and Womens Hospital and Harvard Medical School. He was to discuss the study Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. Results were published online by the New England Journal of Medicine. A meniscus is one of the crescentshaped cartilage discs that cushion the knee. About onethird of people over have a tear in one and arthritis makes this more likely. Usually the tear doesnt cause symptoms but it can be painful. When that happens its tough to tell if the pain is from the tear or the arthritis or whether surgery is needed or will help. Knee surgery for a torn meniscus is done about half a million times each year in the U.S. The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home which experts say is key to success. After six months both groups had similar rates of functional improvement. Pain scores also were similar. Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up often because they felt therapy wasnt helping them. Yet they ended up the same as those who got surgery right away as well as the rest of the physical therapy group who stuck with it and averted an operation. There are patients who would like to get better in a fix me approach and surgery may be best for them said Elena Losina another study leader from Brigham and Womens Hospital. However an Australian preventive medicine expert contends that the studys results should change practice. Therapy is a reasonable first strategy with surgery reserved for the minority who dont have improvement Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal. As it is now millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit and the costs are substantial she wrote. Surgery costs about compared with to for a typical course of physical therapy Katz said. One study participant Bob OKeefe of suburban Boston was glad to avoid surgery for his meniscus injury three years ago. I felt better within two weeks on physical therapy he said. My knee is virtually normal today. He still does the recommended exercises several times a week. Robert Dvorkin had both treatments for injuries on each knee several years apart. Dvorkin director of operations at the Coalition for the Homeless in New York City had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain. Then several years ago he hurt his left knee while exercising. I had been doing some stretching and doing some pushups and I just felt it go pop. he recalls. I was limping. It was extremely painful. An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Dvorkin said it worked like a charm he avoided surgery and recovered faster than from his first injury. The treatment involved two to three hourlong sessions a week including strengthening exercises balancing and massage. He said the sessions werent that painful and his knee felt better after each one. Within a month I was healed Dvorkin said. I was completely back to normal."

"A new surgical tool that uses light to make sure surgeons removing cancerous tumors got it all was found to correlate well with traditional pathologists diagnoses in a clinical study showing that the tool could soon enable reliable realtime guidance for surgeons. The interdisciplinary research team led by Stephen Boppart a University of Illinois professor of electrical and computer engineering and of bioengineering performed the study on patients with breast cancers at the Carle Foundation Hospital in Urbana Illinois. The results appear in the journal Cancer Research. One difficult but crucial determination for surgeons and tissue pathologists is figuring out where a tumor ends. A solid tumor may be easily identifiable but the tissue around the main body of the tumor known as the margin may contain cancerous cells as well. Because of this excess tissue surrounding the tumor is typically removed but the question lingers of whether any cancer cells remain to reemerge later as tumors. In almost all solidtumor surgeries theres a question of margins said Dr. Boppart who also is a medical doctor. Typically surgeons will remove the tissue mass that contains the tumor and will send it to the lab. The pathologist will process section and stain the tissue then examine the thin sections on microscope slides. They look at the structure of the cells and other features of the tissue. The diagnosis is made based on subjective interpretation and often other pathologists are consulted. This is what we call the gold standard for diagnosis. The new device is a handheld probe based on a technology called optical coherence tomography OCT that uses light to image tissue in real time. Cancer cells and normal tissue scatter light differently because they have different microstructural and molecular features Boppart said so OCT gives physicians a way to quantitatively measure the cellular feature of a tumor. Surgeons can pass the OCT wand over a section of tissue and see a video on a screen with no special chemical stains or lengthy tissue processing required. In many cases you cant tell the difference between cancer cells and normal tissue with the naked eye but with OCT theyre very different said Boppart who also is affiliated with the Beckman Institute for Advanced Science and Technology at the U. of I. In the clinical study surgeons treated patients according to the standard surgical procedure but OCT data were collected from the margin of the tumor cavity and the margin of the removed tissue mass during surgery so that the results could be compared later. The study found that the OCT device analysis identified the differences between normal and cancerous tissue with percent sensitivity and percent specificity. They also found that the way that OCT spotted cancer in the removed tissue was closely correlated with the results from the postoperative pathology reports which often came days later. For the first time this study demonstrates the use of OCT for imaging tumor margins within the tumor cavity in the patient during surgery Boppart said. It is likely better to check to see if any residual tumor cells might be left behind rather than checking the tissue mass that was taken out. Then the surgeon can intervene immediately. The researchers will continue clinical studies with the OCT device looking at other types of solidstate tumors. Diagnostic Photonics a startup company Boppart cofounded that also collaborated on the study is commercializing the OCT probe technology for broader use. Ultimately new technological innovations like this in medicine and surgery are going to improve our health care and save lives. Thats when this work will be most rewarding Boppart said. The National Institutes of Health supported this work. Editors notes Editors note To reach Stephen Boppart call email boppartillinois.edu mailtoboppartillinois.edu. The paper Realtime imaging of the resection bed using a handheld probe to reduce incidence of microscopic positive margins in cancer surgery is available online at httpcancerres.aacrjournals.orgcontent.full."

"Two new drugs have been found to prolong the lives of people with advanced melanoma httphealth.nytimes.comhealthguidesdiseasemelanomaoverview.htmlinlinenytclassifier representing what researchers say is notable progress against the deadly skin cancer httphealth.nytimes.comhealthguidesdiseaseskincanceroverview.htmlinlinenytclassifier after decades of futility. The drugs represent success in two new approaches to combating cancer httphealth.nytimes.comhealthguidesdiseasecanceroverview.htmlinlinenytclassifier one by attacking a specific genetic mutation that accelerates tumor httphealth.nytimes.comhealthguidesdiseasetumoroverview.htmlinlinenytclassifier growth the other by unleashing the bodys immune system to fight the disease This is an unprecedented time of celebration for our patients Dr. Lynn M. Schuchter a melanoma specialist at the University of Pennsylvania told reporters Sunday in Chicago at the annual meeting of the American Society of Clinical Oncology where the results were presented. The drugs do not cure melanoma except perhaps in rare cases. But experts said they might add two to several months to the expected lifespans of people with advanced melanoma. Right now people with metastatic melanoma meaning it has spread to distant organs typically live to months. In one trial percent of patients taking the experimental drug vemurafenib pronounced vemyooRAFenib were still alive after six months compared with percent of those getting an older chemotherapy httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicschemotherapyindex.htmlinlinenytclassifier drug dacarbazine. Using another statistical measure the risk of dying was reduced percent. The effect was so marked that the trial was stopped early for ethical reasons so that patients in the control group could be offered the new drug. Because of that researchers do not yet know the median survival. You dont need to wait for percent of patients to die to conclude that one drug is much better than the other said Dr. Antoni Ribas of the University of California Los Angeles who was an investigator in the trial and has been a consultant to the developer of the drug. The other new drug ipilimumab pronounced ipeeLIMyoomab when combined with dacarbazine extended median survival to . months compared with . months for those who received dacarbazine alone. After three years . percent of those who got that new drug were alive compared with . percent of those in the control group. The results of both trials were published online by The New England Journal of Medicine http in addition to being presented here. To be sure more than half of patients with metastatic melanoma would not be helped all that much by either drug. Experts say more needs to be done especially since melanoma affects more young adults than many other types of cancer. Even if the new drugs allow patients with metastatic melanoma to live two years Two years is nothing when youre said Dr. Anna C. Pavlick head of the melanoma program at New York University. Still doctors and patient groups welcomed the progress because until now treatment of melanoma that had spread beyond the skin to distant organs was terrible even by routine cancer standards said Dr. Vernon K. Sondak chairman of cutaneous oncology at the Moffitt Cancer Center in Tampa Fla. Also the number of melanoma cases has been rising unlike for many other types of cancer. Doctors say that is because of unprotected sun exposure years ago the proliferation of tanning salons and perhaps more attention to detecting the disease. Photo There were about new cases of melanoma and about deaths last year in the United States up from cases and deaths in according to the American Cancer Society http Particularly fast increases have occurred among people older than and among women to years old. Vemurafenib is the latest socalled targeted therapy which inhibits the effects of genetic mutations that spur tumor growth and spread. In particular the drug counters the effect of a mutation in a gene called BRAF that was discovered in to be common in melanomas. The drugs name comes from VE mutation in RAF. The drug which is taken orally twice a day would be used only by the roughly half of melanoma patients whose tumors httphealth.nytimes.comhealthguidesdiseasetumoroverview.htmlinlinenytclassifier have this mutation. The drug significantly shrinks tumors in about half of these patients or about a quarter of all melanoma patients. Get the best of Well with the latest on health fitness and nutrition delivered to your inbox every week. Top of Form Bottom of Form Top of Form It was developed by Roche and Plexxikon a biotechnology company in Berkeley Calif. that was recently acquired by Daiichi Sankyo of Japan. The drug is expected to be approved by the Food and Drug Administration within a few months. Ipilimumab the other new drug releases a brake on the bodys immune system allowing it to more effectively attack the tumor. Developed by BristolMyers Squibb httptopics.nytimes.comtopnewsbusinesscompaniesbristol_myers_squibb_companyindex.htmlinlinenytorg it was approved in March and is sold under the name Yervoy. A series of articles in The New York Times last year httptopics.nytimes.comtopnewshealthseriestarget_cancerindex.html followed the development of vemurafenib then known as PLX and recounted how some patients close to death seemed to make miraculous recoveries. The effect however typically lasts only about seven months before the cancer starts to grow again though some patients benefit for more than two years. S. Taylor Chance a yearold real estate agent in Rancho Cucamonga Calif. has been taking vemurafenib in a clinical trial since March . If it werent for the trial I wouldnt be here she said. It has not been all good. Ms. Chance said the drug caused such extreme pain at one point that I called in the children and said Im done I cant do this any more. But she had her dose reduced and took other medications for the pain. In the trial sponsored by Roche and led by Dr. Paul B. Chapman of the Memorial SloanKettering Cancer Center in New York percent of participants had to stop taking the drug or lower the dose because of side effects including rash and joint pain httphealth.nytimes.comhealthguidessymptomsjointpainoverview.htmlinlinenytclassifier. Many patients get minor skin cancers that can be removed by dermatologists. The trial of ipilimumab paid for by BristolMyers involved patients with latestage melanoma. Last year at this conference researchers presented results of a trial showing a survival advantage for patients who had undergone a previous treatment. The new trial of this drug by contrast involved patients who were getting treated for the first time. While the extension of median survival of two months from about months to about months was less than some experts expected researchers said the real benefit was that a small number of patients perhaps to percent could live a long time. Because it unleashes the immune system ipilimumab can have serious side effects. In the latest trial a big one was liver damage. A course of treatment of ipilimumab costs . The price of vemurafenib has not been announced but is expected to be at least tens of thousands of dollars per year. Doctors are eager to try the two drugs together. Roche and BristolMyers said Thursday that they would conduct such tests."

"The U.S. Food and Drug Administration yesterday granted accelerated approval to the checkpoint inhibitor Bavencio avelumab for the treatment of patients with metastatic Merkel cell carcinoma MCC httpsmerkelcell.org including those who have not received prior chemotherapy. Avelumab is the first FDAapproved treatment https for metastatic MCC and the first disease that the drug has ever been approved to treat. A rare and aggressive form of skin cancer MCC is times less common than melanoma but on average it is about three times more likely to be deadly. Until now there were no systemic therapies approved by the Food and Drug Administration for this cancer and no approved therapies once the cancer had spread. Tom Judd http who lives near Portland Oregon knows what it is like to be diagnosed with a deadly cancer for which there is no approved drug. After being diagnosed with MCC in his cancer jumped from a small pimple on his nose throughout his body growing until it interfered dangerously with organ function. By early the disease had nearly killed him despite surgery radiation and chemotherapy. Then he enrolled in a clinical trial and received his first of many infusions of the new immunotherapy drug avelumab. Within six weeks of that first infusion more than onethird of the cancer throughout his body was gone and today more than percent of his tumor mass has disappeared. Because of the data from this clinical trial avelumab brand name Bavencio has become the first systemic therapy approved by the FDA for MCC and the first treatment of any kind approved for metastatic MCC. Dr. Paul Nghiem http affiliate investigator of the Clinical Research Division at Fred Hutch and the George F. Odland Endowed Chair in Dermatology at the University of Washington School of Medicine is a senior investigator on the clinical trial that led to the FDA approval and the senior author on the Lancet Oncology httpthelancet.comjournalslanoncarticlePIISfulltext article httpthelancet.comjournalslanoncarticlePIISfulltext that preceded the approval. He is a leading expert on MCC and a pioneer of immunotherapy for the disease. The approval as a first and secondline therapy is a really big deal said Nghiem. His team foundational work on the role of immune cells in MCC paved the way for immunotherapy trials in the disease including one he leads of another immunotherapy drug with a similar mechanism of action Mercks Keytruda whose results were published last year and changed the field overnight https A practicing physician he treats patients with MCC and other skin cancers at Seattle Cancer Care Alliance Fred Hutchs clinical care partner. He is a consultant for EMD Serono Inc. and receives funding from BristolMyers Squibb to perform biomarker studies in MCC clinical trials. At Fred Hutchinson Cancer Research Center http home to three Nobel laureates interdisciplinary teams of worldrenowned scientists seek new and innovative ways to prevent diagnose and treat cancer HIVAIDS and other lifethreatening diseases. Fred Hutchs pioneering work in bone marrow transplantation led to the development of immunotherapy which harnesses the power of the immune system to treat cancer with minimal side effects. An independent nonprofit research institute based in Seattle Fred Hutch houses the nations first and largest cancer prevention research program as well as the clinical coordinating center of the Womens Health Initiative and the international headquarters of the HIV Vaccine Trials Network. Private contributions are essential httpssecure.convio.netfhcrcsiteDonationidbdf_idmfc_prefT.donationform for enabling Fred Hutch scientists to explore novel research opportunities that lead to important medical breakthroughs. For more information visit fredhutch.org http or follow Fred Hutch on Facebook https Twitter httpstwitter.comHutchinsonCtr or YouTube https_main."

"Every year many U.S. women get the grim news that they have breast cancer. In alone according to the American Cancer Society more than http were given that diagnosis. Each one very likely came as a devastating blow both to the patient and to her family. But what if some of these cases are preventable What if there was a medication that could at least reduce a womans risk of developing breast cancer Such drugs already exist. The Breast Cancer Prevention Trial published results http in indicating that women who took one of those drugs tamoxifen were half as likely to develop breast cancer as similar women who did not take the drug. Other medications including raloxifene httpen.wikipedia.orgwikiRaloxifene and a class of drugs called aromatese inhibitors httpformularyjournal.modernmedicine.comformularyjournalcontenttagsaromataseinhibitorguidelineaddsaromataseinhibitorbreastcancepagefull do much the same thing though the Food and Drug Administration has not yet approved aromatese inhibitors for this use http Studies estimate httpjnci.oxfordjournals.orgcontent.full that more than million American women at high risk for breast cancer could benefit from taking a preventive drug. But few women are opting for this protection which goes by the name chemoprevention. A study found exceptionally low rates of usage. In part this may be because many doctors are not even discussing this option with their patients. A small study http in the Journal of Womens Health found that only percent of internal medicine family medicine and gynecology physicians reported having recommended or prescribed these medications to women who might benefit from them. The low uptake of these medications is a missed opportunity says Heidi Nelson a professor of medical informatics and clinical epidemiology at the Oregon Health Science University in Portland. Many highrisk women ... could reduce their risks for invasive cancer by approximately to percent. On the other hand these drugs dont suit everyone and they are not without risks of their own. Because some of the side effects are serious such as blood clots in the legs and in the lungs and in the case of tamoxifen uterine cancer only women who are deemed to be at high risk for the disease should consider them. But there are conflicting views on who meets that high risk definition A bit about the drugs Chemoprevention should not be confused with chemotherapy. Although both involve taking drugs chemoprevention medications are taken with the goal of avoiding breast cancer altogether and the subsequent need for chemotherapy later. And they work on the body differently. Chemotherapy kills off cells healthy ones as well as cancercous ones. The chemoprevention drugs by contrast work by blocking estrogen a hormone known to promote the growth of cancer cells in breast tissue. Chemoprevention drugs are called SERMs or selective estrogen receptor modulators and two have been approved specifically for breast cancer prevention tamoxifen which was developed to treat breast cancer after its onset and only later was found to have a preventive benefit and raloxifene which was designed to treat osteoporosis. A study http in the Lancet analyzed data for more than women taking tamoxifen or other SERM drugs. The researchers found an overall percent reduction in new cases of breast cancer years after women took these drugs compared with women who took a placebo. The effect was even larger during the first five years of the study. Investigators working for the U.S. Preventive Services Task Force an independent group of scientists and clinicians funded by the government echoed these results. After looking at multiple trials of tamoxifen and raloxifene the task force noted http that these drugs reduced new cases of breast cancer significantly from cases per women in the control groups to cases per women in the treatment groups. Nelson one of the lead authors of the analysis is confident that these results show a true benefit. Others are more cautious. Kenneth Lin a family physician at Georgetown University who worked on developing the task forces SERM guidelines notes that while SERMs may have reduced new cases they have not been shown to reduce breast cancer mortality in any study or metaanalysis. One possible explanation he says is that these drugs are effective at preventing nonlethal cancers rather than the more serious ones. Not used enough Given that these drugs seem to offer some protection why are they not in widespread use Serious side effects is one reason. Beyond blood clots and uterine cancer other known reactions to the drugs include strokes cataracts bone pain hot flashes nausea and vaginal dryness. For some women the risk of such side effects may be worth taking depending on their particular odds of developing breast cancer. Those odds can be figured by using a commonly used calculator http often called the Gail model that estimates a womans chances of having breast cancer in a fiveyear period and over a lifetime. But this is where it gets more complicated. While many experts agree that women at high risk should consider the medications they do not agree on what Gail score should trigger that consideration. The studies that served as the basis for the FDA approval of the drugs along with recently released guidelines httpjco.ascopubs.orgcontentearlyJCO....full.pdf from the American Society of Clinical Oncology ASCO set the threshold at a fiveyear Gail score of . percent. The Preventive Services Task Force however recommended a threshold of percent. At that point the panel said http women are likely to have more benefit than harm from using tamoxifen or raloxifene. ASCOs lower cutoff worries some experts. At the . percent highrisk threshold Georgetowns Lin says every woman age and older would be considered highrisk. That might lead to a situation in which millions of women would be encouraged unnecessarilyto consider this therapy along with its potential harmful effects. Starting a conversation Kala Visvanathan the lead author of the ASCO recommendations and a faculty member at the Johns Hopkins School of Medicine said the cutoffs provide only a rough estimate of risk. It is important to realize she adds that as the risk increases the benefits tend to be greater. This is an evolving field and our goal is to better discern who is at high and low risk of breast cancer and develop a greater range of prevention strategies. An individual risk analysis should prompt conversation between doctor and patient about the potential benefits and the risk of the therapy. Both the ASCO and the task force guidelines recommend such a conversation. The discussion should include the specific risks and benefits associated with each chemopreventive agent according to ASCO. The task force similarly recommends that clinicians engage in a shared informed decision making with women and said that clinicians should offer to prescribe these drugs. Many risk factors increase a womans chances of having side effects. These factors include older age obesity having a history of a blood clot history of any cancer immobility history of certain autoimmune conditions history of using estrogen or oral contraceptives and history of some form of heart disease. Insured women with a high risk for breast cancer and a low risk for side effects who try this therapy will not incur outofpocket costs because this treatment was included in the Affordable Care Act as mandated nocharge preventive care. So what should a woman do Most important become familiar with your family history know your risk factors and discuss them with your primarycare physician. Age and family history cannot be controlled but lifestyle changes including eating a healthful diet exercising not smoking and not overconsuming alcohol are eminently doable and can reduce your risk. These basic tenets of leading a healthy lifestyle http have been shown to be important factors in breast cancer prevention. Visvanathan and her colleagues are hopeful that more women will be aware of this option. A discussion on the use of preventive agents needs to become part of routine care in women at high risk she says. We should begin to implement preventive strategies based on what we already know. Mishori is an associate professor of family medicine at the Georgetown University School of Medicine and director of the Health Media fellowship. Seliby is a family physician and the Health Media fellow at Georgetown University School of Medicine."

"GALVESTON Texas Researchers from The University of Texas Medical Branch at Galveston http found that testosterone replacement therapy may slow disease progression of chronic obstructive pulmonary disease. The paper httpjournals.sagepub.comdoifull. is currently available in Chronic Respiratory Disease httpjournals.sagepub.comhomecrd. Chronic obstructive pulmonary disease or COPD is predicted by the World Health Organization to be the thirdleading cause of illness and death internationally by . Low testosterone is common in men with COPD and may worsen their condition. Men with COPD have shortness of breath and often take steroidbased medications for an extended time both of which increase their risk of low testosterone. Previous studies have suggested that testosterone replacement therapy may have a positive effect on lung function in men with COPD said Jacques Baillargeon UTMB professor in preventive medicine and community health. However we are the first to conduct a large scale nationally representative study on this association. The goal of the study was to find out whether testosterone replacement therapy reduced the risk of respiratory hospitalizations in middleaged and older men with COPD. Using the Clinformatics Data Mart a database of one of the largest commercially insured populations in the U.S. Baillargeon and colleagues examined data of men aged to with COPD who began testosterone replacement therapy between and . They also used the national Medicare database to study data from men with COPD aged and older who initiated testosterone replacement therapy between and . We found that testosterone users had a greater decrease in respiratory hospitalizations compared with nonusers. Specifically middleaged testosterone replacement therapy users had a . percent greater decrease in respiratory hospitalizations compared with nonusers and older testosterone replacement therapy users had a . percent greater decrease in respiratory hospitalizations compared with nonusers said Baillargeon. The findings suggest that testosterone replacement therapy may slow the progression of disease in men with COPD. Other authors include UTMBs Dr. Randall Urban Wei Zhang Mohammed Zaiden Zulqarnain Javed Melinda SheffieldMoore YongFang Kuo and Dr. Gulshan Sharma. The University of Texas Medical Branch Office of Marketing and Communications University Boulevard Suite . Galveston Texas UTMB Newsroom utmbnews httpstwitter.comutmbnews ABOUT UTMB HEALTH Texas first academic health center opened its doors in and today has three campuses four health sciences schools three institutes for advanced study a research enterprise that includes one of only two national laboratories dedicated to the safe study of infectious threats to human health and a health system offering a full range of primary and specialized medical services throughout Galveston County and the Texas Gulf Coast region. UTMB is a part of the University of Texas System and a member of the Texas Medical Center"

"The American Academy of Pediatrics on Monday announced its first major shift on circumcision in more than a decade concluding that the health benefits of the procedure clearly outweigh any risks. There is clear evidence that supports the health benefits of circumcision said Susan Blank who led the member task force that formulated the new policy httppediatrics.aappublications.orgcgidoi.peds. being published in the journal Pediatrics. The statement and accompanying technical report httppediatrics.aappublications.orgcontente marks the first revision of the organizations position since when the academy backed away from circumcision. At that time the group which represents about pediatricians nationwide concluded that there was no clear evidence for or against circumcising newborns. The group affirmed that position in . Since then the popularity of circumcision in the United States has declined. Only about percent of newborn males are circumcised. The academys task force spent seven years combing through the latest research analyzing more than a thousand studies. Their conclusion For starters Blank says circumcision helps baby boys pretty much immediately. The health benefits of male circumcision include a drop in the risk of urinary tract infection in the first year of life by up to percent she says. Article continues after this message from our sponsor But theres a much bigger reason to do it Blank said. Circumcised males are far less likely to get infected with a long list of sexually transmitted diseases. It drops the risk of heterosexual HIV acquisition by about percent. It drops the risk of human papillomavirus HPV herpes virus and other infectious genital ulcers she says. It also reduces the chances that men will spread HPV to their wives and girlfriends protecting them from getting cervical cancer. Weve reviewed the data and you know we have gone through them with a finetooth comb and the data are pretty convincing she says. Critics however were not convinced. They liken the procedure to female genital mutilation. We have no right as parents or as physicians or adults to strap them down and chop off a normal part of their body. To do that is a human rights violation and an ethical travesty says Georgeanne Chapin httpintactamerica.orggchapin of the anticircumcision group Intact America http Chapin and other critics argue that the scientific evidence is questionable. For one thing the studies about HIV have only been done in Africa where AIDS is much more common among heterosexuals. Theyre cherrypicking their evidence she says. They act as though theres this huge body of literature. Its all the same couple of studies that have been regurgitated and reprogrammed. Over the past years all kinds of medical benefits have been proposed as resulting from cutting off the foreskin and they have all been disproven. Critics also question the safety of the procedure saying too many boys are damaged for life by botched circumcisions. But many experts say the academy is making the right call. They dismiss any comparison to female genital mutilation as grossly misleading and say male circumcision is about as safe as any procedure could be. Some think the academys position is long overdue and that the group should have gone even further and more forcefully recommended circumcision. I think that all healthy newborn babies should be circumcised says Edgar Schoen http_qualifications.html a professor emeritus at the University of California San Francisco. I feel about newborn circumcision the way I do about immunization Its a potent preventive health procedure that gives you a health advantage. For its part the pediatricians group hopes the new recommendations will encourage more parents to circumcise their sons and more insurance plans to pay for it. As Shots reported last week a lot of state Medicaid programs have stopped covering http_sthdl circumcision. Those families who choose circumcision should have access to circumcision. Cost should not be a barrier Blank says. The federal Centers for Disease Control and Prevention http has been promising for years now to issue the governments first guidelines about circumcision. But the CDC keeps delaying it and still has not said when that will happen."

"A small clinical trial using gold nanoparticles that act as tumorseeking missiles on a mission to remove prostate cancer has begun at The University of Texas Health Science Center at Houston UTHealth. It is the first trial of its kind in the world. The nanoparticles or nanoshells are made of small layers of silica glass formed into a sphere and wrapped in a thin layer of gold. The shells seek out and saturate cancerous cells and their advanced vibrational properties are then harnessed to cause the tumorous tissue to pulse with extreme temperature when light is applied through a laser specifically designed to excite the particles. The oscillation kills the cancer cells while preserving the healthy tissue avoiding the nerves and urinary sphincter. This procedure is the first in the world that is precise enough to potentially avoid negative ramifications like urinary incontinence or sexual impotency. This therapy could be lifechanging for men diagnosed with prostate cancer and Im honored to be among the first doctors the U.S. Food and Drug Administration approved to put it to the test said Steven Canfield M.D. chair of the division of urology at McGovern Medical School at UTHealth who recognized the possibility of the nanoparticles to treat prostate cancer and helped developed the trial to test the theory. Prostate cancer begins when cells in a mans prostate gland mutate and start to grow uncontrollably. Other than skin cancer prostate is the most common cancer in American men with an estimated out of men diagnosed. The American Cancer Society estimates men died from the disease in alone. Treatment options have traditionally included radical prostatectomy which is the removal of the prostate gland and some of the tissue around it radiation therapy and cryotherapy among others. These methods carry the potential to have a negative impact on urinary function and sexual performance. The side effects of current prostate cancer treatments can be extremely traumatic. This new technology holds the potential to eliminate those lifealtering effects while still removing the cancer tissue and reducing hospital and recovery time Canfield said. In fact the first patient in the trial was actually riding a bike within a week of his treatment. The fusion of MRI and ultrasound imaging technology that we use to accurately identify and diagnose the cancer combined with the extreme precision of the gold nanoshells in targeting the diseased cells allows us to be incredibly accurate at obliterating them. I am excited as we continue tracking the progress of this groundbreaking improvement to prostate cancer care. Doug Flewellen the first patient in Texas to receive the new method of care says for him the procedure was a nobrainer. No man wants to go through radical removal and I knew active monitoring could have potentially aggravated the cancer Flewellen said. The side effects of traditional treatment were not worth it to me and I wasnt afraid to try the most cuttingedge technology. Looking back the experience was even better than I was expecting and I hope to see nanoparticle therapy advance into an option for anyone diagnosed with prostate cancer in the future. The gold nanoparticles were invented by Naomi Halas the head of Rice Universitys Laboratory for Nanophotonics. Canfield worked closely with Halas and Nanospectra Biosciences the company where the shells are licensed to incorporate the stateoftheart technology into the trial that is also underway at the Icahn School of Medicine at Mount Sinai and the University of Michigan to test the efficacy of the therapy. To see the requirements and learn more about the trial visit httpsclinicaltrials.govctshowNCT. About UTHealth Established in by The University of Texas System Board of Regents http The University of Texas Health Science Center at Houston UTHealth is Houstons Health University and Texas resource for health care education innovation scientific discovery and excellence in patient care. The most comprehensive academic health center in the UT System http the U.S. Gulf Coast region UTHealth is home to Jane and Robert Cizik School of Nursing httpsnursing.uth.edu John P. and Kathrine G. McGovern Medical School httpsmed.uth.edu and schools of biomedical informatics httpssbmi.uth.edu biomedical sciences httpsgsbs.uth.edu dentistry httpsdentistry.uth.edu and public health httpssph.uth.edu. UTHealth includes The University of Texas Harris County Psychiatric Center httpshcpc.uth.edu as well as the growing clinical practices UT Physicians https UT Dentists httpsdentistry.uth.edupatients and UT Health Services httpsuthealthservices.com. The universitys primary teaching hospitals are Memorial HermannTexas Medical Center http Childrens Memorial Hermann Hospital httpchildrens.memorialhermann.org and Harris Health Lyndon B. Johnson Hospital https For more information visit http"

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

"Taking fish oil supplements during pregnancy might translate into healthier growth in children during their first six years of life a new study suggests. This study highlights the fact that in utero exposure can have a profound effect on the fetus that lasts through childhood said Dr. Jennifer Wu an obstetriciangynecologist from Lenox Hill Hospital in New York City. For the past decade the importance of fish oil and the omega fatty acids have been stressed to patients explained Wu who was not involved in the study. The use of fish oil in the latter part of the pregnancy has an impact on bone and muscle mass. Though these children are larger they do not have increased rates of obesity Wu added. In the study the researchers followed pregnant women in Denmark who took either fish oil or olive oil supplements daily from week of their pregnancy until one week after they gave birth. The children were assessed times between birth and the age of years. Those whose mothers took the fish oil supplements during pregnancy sustained a higher body mass index BMI from the age of to years. However the higher BMI was not due to a higher percentage of fat but rather to higher percentages of lean muscle and bone mass the researchers found. At age children whose mothers took fish oil supplements while pregnant had a grams higher total mass grams higher lean mass and grams higher bone mineral content than children whose mothers who took olive oil during pregnancy the findings showed. The body composition at age years in children given fish oil supplementation was characterized by a proportional increase in lean bone and fat mass suggesting a general growthstimulating effect the researchers who were led by Hans Bisgaard from the University of Copenhagen wrote in the report. However the findings only showed an association and did not prove that fish oil pills caused healthier growth in children. According to Dr. Jill Rabin cochief of the division of ambulatory care Womens Health ProgramsPCAP Services at Northwell Health in New Hyde Park N.Y. In pregnancy and beyond adequate intake of fish is important for normal human development and this paper certainly adds to the literature. But Rabin who was not involved in the study did add a few caveats about the findings. The population studied was relatively homogenous and the body mass findings were not the object of the study wheezing or asthma in children was the primary objective growth was a secondary finding Rabin explained. Certainly however this solid paper adds to the literature and paves the way for additional research on this interesting topic. The report by Bisgaard and colleagues was published online Sept. in the BMJ. More information The American Academy of Pediatrics has more on healthy growth https SOURCES Jennifer Wu M.D. obgyn Lenox Hill Hospital New York City Jill Rabin M.D. cochief division of ambulatory care Womens Health ProgramsPCAP Services Northwell Health New Hyde Park N.Y. BMJ news release Sept."

"Among men under with early stage prostate cancer those who have the prostate gland removed are less likely to die than those who adopt a watchful waiting approach according to a new longterm study out of Europe. But the findings are not likely to be practicechanging said Dr. Richard E. Greenberg chief of urologic oncology at Fox Chase Cancer Center in Philadelphia who was not involved with the study. This is relatively early stage disease and it shows what we would expect it to show that those who have more years to live have better survival if treated aggressively he said. Men with prostate cancer face a confusing maze of options today including not only surgery but hormone therapy different kinds of radiation therapy and even simply foregoing medical treatment while monitoring the cancer closely watchful waiting also known as active surveillance. Watchful waiting is often recommended when a man is not expected to die of the cancer and would like to avoid the risk of the debilitating side effects associated with prostate cancer treatment. These may include incontinence and erectile dysfunction surgery erectile dysfunction and secondary cancers radiation therapy nausea breast growth liver problems hormonal therapy and weakness hair loss fluid retention chemotherapy. The data presented in the May issue of the New England Journal of Medicine is a year followup of a study for which threeyears of followup had previously been reported. The earlier study also found that undergoing a radical prostatectomy lowered the risk of the cancer spreading as well as the death rate from prostate cancer or any other cause. The researchers Drs. Anna BillAxelson and Lars Holmberg of University Hospital Uppsala and colleagues enrolled nearly men with early prostate cancer under the age of who were randomly selected either to undergo a radical prostatectomy or to stay in watchful waiting mode. After an average followup of about years . percent of the men who had undergone surgery had died versus . percent in the watchful waiting group a percent reduced risk. The benefit was primarily seen among men younger than and the authors estimated that seven men under the age of and over the age of would need to be treated to save one life. There was also a benefit in men whose tumors had lowrisk characteristics. Men whose cancer had moved outside of the prostate gland and who underwent removal of the prostate had a seven times higher risk of dying than men whose tumors hadnt spread. Radical prostatectomy can come with a price including erectile dysfunction urinary incontinence and even bowel incontinence although these effects are not as common as techniques improve. A nervesparing radical prostatectomy for example may be able to prevent erectile dysfunction. Also the men in this study were diagnosed only after they had symptoms unlike the majority of men in the United States Greenberg said. The advantage of screening is that men are more likely to be cured of cancer but they also have a greater chance of not succumbing to the consequences of the surgical complications whether those be erectile dysfunction or urinary incontinence Greenberg said. Also he said erectile dysfunction can also be a factor of aging and can be treated in most cases. But much remains to be known about how best to treat different types of prostate cancer. The management of early stage prostate cancer continues to require further randomized controlled studies which are underway to determine the true benefit of treatment versus expectant management said Dr. Marc Danziger an attending urologist at Lenox Hill Hospital in New York City who was not involved with the study. Currently the potential benefit and side effects of treatment needs to be addressed on an individual basis in relation to the risk stratification of disease patient desires health status and risk tolerance Danziger added. More information The U.S. National Cancer Institute has more on prostate cancer treatments http SOURCES Richard E. Greenberg M.D. chief urologic oncology Fox Chase Cancer Center Philadelphia Marc D. Danziger M.D. attending urologist Lenox Hill Hospital New York City May New England Journal of Medicine"

"Taking soy to relieve hot flashes https has received mixed reviews over the years. Now researchers who took another look at published studies find that soy supplements https_AssetsscopemapsWebMDConsumerPagesVitaminsandSupplementsLifestyleGuide_ecedpage_VitaminsandSupplementsLifestyleGuide_eced.xml may help at least over time. Soy has been touted as an alternative treatment to hormone replacement therapy https after HRT was linked to an increased risk of breast cancer https For many women with symptoms and especially with concerns about hormone replacement therapy https trying soy for six to weeks to see if it relieves their symptoms could be a first line of treatment says Melissa Melby PhD a professor of medical anthropology at the University of Delaware. The study is published in Menopause https The Journal of The North American Menopause https Society. Two coauthors not including Melby have ties to the soy industry. The study had no industry funding. Although all the studies looked at soy supplements https Melby says that getting soy from food is a better bet. What this study shows is that ingesting soy isoflavones will help you she says. I personally think foods containing soy are better. Soy for Hot Flashes Another Look Melby looked for published studies of soy for hot flashes in the medical literature through midDecember . All the studies compared the soy to a placebo https More than women were in the studies which included the U.S. and nine other countries. The studies continued for six weeks up to a year and included different amounts of soy supplements https The researchers pooled the results of the individual studies to come up with their findings. Soy supplements with higher amounts of the isoflavone called genistein were more than twice as good at reducing hot flash frequency than those with low amounts Melby found. If you prefer to get your soy from food Melby suggests two servings of soy foods per day. That is roughly equal to two glasses of soy milk ounces of tofu or half a cup of edamame. Soy for Hot Flashes Second Opinion The new analysis leaves a lot unanswered says Silvina Levis MD a professor of medicine and director of the osteoporosis https center at the University of Miami. In her own research published in in the Archives of Internal Medicine she found no effects on menopausal symptoms when women took mg of soy isoflavones for two years. I think this study does not provide answers to women says Levis who reviewed the findings. Because the studies vary greatly in their methods and the preparations used she says we still dont know who are women who will benefit. Another expert Penny KrisEtherton PhD RD a distinguished professor of nutrition https at Pennsylvania State University calls the results very impressive. KrisEtherton who reviewed the findings but did not participate in the study noted some limitations though. Most of the women were white. We do not know if the effects of soy products would elicit similar effects in women of different ethnicity she says. The results vary she says and it doesnt appear to be a quick fix. In the studies of longer duration she says the effects were greater."

"Exhausted shift workers may be safer driving home at night when theyre exposed to bright light before they hit the road a small study suggests. To test the effect of light therapy on driving researchers did a series of three experiments with adults. In two scenarios participants spent a night being sleepdeprived in a lab and then spent minutes in dim or bright light before a driving test. For a third test people got a good nights sleep at home and then went to the lab for minutes of bright light exposure before a driving test. After sleep deprivation in the lab five people exposed to dim light therapy got in car accidents during the driving simulations. None of the people who slept at home crashed and neither did any of the sleepdeprived people who got bright light therapy before getting behind the wheel the study found. We experience severe sleepiness toward the end of the night shift and this may overlap with our commute time said senior study author Dr. Ralph Mistlberger of Simon Fraser University in British Columbia Canada. Sleep deprivation makes this worse of course and together with the clock this conspires to impair our ability to sustain attention to task e.g. driving and avoid distraction and react quickly to external stimuli like traffic lights brake lights in front of you road signs etc Mistlberger added by email. Bright light is alerting Mistlberger said. Sleepiness is a leading risk factor for automobile accidents because it can make drivers less vigilant slow reaction times and dull cognitive abilities researchers note in Sleep Medicine. Shift workers with chronic sleep deprivation also face an increased risk of accidents. Strategies like drinking coffee or soda napping before a drive or blasting music or rolling down the windows in the car may help increase alertness behind the wheel but none of these strategies is foolproof. For the current study researchers wanted to see if bright light might help reduce driving impairments related to sleep deprivation. They found participants had lower body temperatures after spending a sleepdeprived night in the lab as well as longer reaction times and increased sleepiness. Exposure to bright light didnt appear to improve reaction times or sleepiness. But light was associated with better driving. Beyond its small size other limitations of the study include the reliance on lab conditions for sleep deprivation and light exposure which may not match what shift workers would experience on the job the authors note. There is evidence that the use of bright light at the office or even at home directly prior to beginning the work shift may be beneficial in preventing sleep deprivationrelated motor vehicle collisions said Russell Griffin a researcher at the University of Alabama at Birmingham who wasnt involved in the study. That said there is not enough evidence to date to fully suggest the use of bright light therapy to avoid collision Griffin added by email. The proven way to avoid the effects of sleepiness on the road is to consistently get enough sleep said Dr. Flaura Koplin Winston a researcher at the University of Pennsylvania and the Childrens Hospital of Philadelphia who wasnt involved in the study. Drowsy driving is perhaps the most underrecognized cause of serious crashes and sadly the evidence is not there on how to counter it Winston said by email. More research is needed on the potential of bright light therapy to make exhausted drivers safer said Dr. Donald Redelmeier a researcher at the University of Toronto who wasnt involved in the study. But there are still things drivers can do now to stay safer on the road. Safety strategies while driving can include minimizing distractions stopping at stop signs respecting speed limits yielding rightofway buckling a seatbelt signaling all turns and not driving after drinking alcohol Redelmeier said. SOURCE bit.lyghLalo httpbit.lyghLalo Sleep Medicine online November . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Breastfeeding is not only good for babies there is growing evidence it may also reduce the risk for stroke in postmenopausal women who reported breastfeeding at least one child according to new research in Journal of the American Heart Association the Open Access Journal of the American Heart AssociationAmerican Stroke Association. Stroke is the fourth leading cause of death among women aged and older and is the third leading cause of death among Hispanic and black women aged and older according to the study. Some studies have reported that breastfeeding may reduce the rates of breast cancer ovarian cancer and risk of developing Type diabetes in mothers. Recent findings point to the benefits of breastfeeding on heart disease and other specific cardiovascular risk factors said Lisette T. Jacobson Ph.D. M.P.A. M.A. lead author of the study and assistant professor in the department of preventive medicine and public health at the University of Kansas School of MedicineWichita. This is among the first studies to examine breastfeeding and a possible relationship to stroke risk for mothers as well as how such a relationship might vary by ethnicity. Researchers analyzed data on participants in the Womens Health Initiative observational study a large ongoing national study that has tracked the medical events and health habits of postmenopausal women who were recruited between and . All women in this analysis had delivered one or more children and percent reported ever having breastfed. Among these women percent breastfed for onesix months percent for seven months and percent for or more months. At the time of recruitment the average age was . years and the followup period was . years. After adjusting for nonmodifiable stroke risk factors such as age and family history researchers found stroke risk among women who breastfed their babies was on average percent lower in all women percent lower in black women percent lower in Hispanic women percent lower in white women and percent lower in women who had breastfed for up to six months. A longer reported length of breastfeeding was associated with a greater reduction in risk. If you are pregnant please consider breastfeeding as part of your birthing plan and continue to breastfeed for at least six months to receive the optimal benefits for you and your infant Jacobson said. Our study did not address whether racialethnic differences in breastfeeding contribute to disparities in stroke risk. Additional research should consider the degree to which breastfeeding might alter racialethnic differences in stroke risk Jacobson said. Because the study was observational it couldnt establish a causeandeffect relationship between breastfeeding and lower stroke risk meaning that it is possible some other characteristic that distinguishes between women who breastfeed and those who dont is the factor changing the stroke risk. However because the Womens Health Initiative is large researchers were able to adjust for many characteristics and the effects of breastfeeding remained strong Jacobson said. Breastfeeding is only one of many factors that could potentially protect against stroke. Others include getting adequate exercise choosing healthy foods not smoking and seeking treatment if needed to keep your blood pressure cholesterol and blood sugar in the normal range Jacobson said. The study was also limited by the relatively small number of strokes that occurred during the followup period just . percent of the women experienced a stroke during the study period and . percent reported having had a stroke prior to the study and by the Womens Health Initiatives exclusion of women who had already had severe strokes at the time of recruitment. Currently the American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for six months with continuation of breast feeding for one year or longer. For babies health the American Heart Association recommends breastfeeding for months with transition to other additional sources of nutrients beginning at about four six months of age to ensure sufficient micronutrients in the diet. Frontiers The Heartland Institute for Clinical and Translational Research and the Wichita Center for Graduate Medical EducationKansas Bioscience Authority funded the study. The WHI was supported by the National Health Lung and Blood Institute. Coauthors are Erinn M. Hade Ph.D. Tracie C. Collins M.D. M.P.H. M.H.C.D.S. Karen L. Margolis M.D. M.P.H. Molly E. Waring Ph.D. Linda V. Van Horn Ph.D. R.D. Brian Silver M.D. Maryam Sattari M.D. M.S. Chloe E. Bird Ph.D. Kim Kimminau Ph.D. Karen Wambach Ph.D. and Marcia L. Stefanick Ph.D. Author disclosures are on the manuscript. Additional Resources Available multimedia including photos and an audio interview are on the right column of the release link httpsnewsroom.heart.orgnewsbreastfeedingmayhelpprotectmothersagainststrokepreviewceddcddbff After Aug. view the manuscript online. Story on previous JAHA study June Breastfeeding may reduce a mothers heart attack and stroke risk Follow AHAASA news on Twitter HeartNews httpstwitter.comheartnewslangen For updates and new science from JAHA follow JAHA_AHA httpstwitter.comjaha_ahalangen Follow the researcher on Twitter ltj_ http_ Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the associations policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals. Foundations and corporations including pharmaceutical device manufacturers and other companies also make donations and fund specific association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https About the American Heart Association The American Heart Association is devoted to saving people from heart disease and stroke the two leading causes of death in the world. We team with millions of volunteers to fund innovative research fight for stronger public health policies and provide lifesaving tools and information to prevent and treat these diseases. The Dallasbased association is the nations oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved call AHAUSA visit heart.org http or call any of our offices around the country. Follow us on Facebook and Twitter."

"The supplement Aged Garlic Extract can reverse the buildup of deadly plaque in arteries and help prevent the progression of heart disease according to a new study scheduled for publication in the Journal of Nutrition. The research conducted at LA BioMed found a reduction in the amount of lowattenuation plaque or soft plaque in the arteries of patients with metabolic syndrome who took Aged Garlic Extract. Metabolic syndrome is characterized by obesity hypertension and other cardiac risk factors. This study is another demonstration of the benefits of this supplement in reducing the accumulation of soft plaque and preventing the formation of new plaque in the arteries which can cause heart disease said Matthew J. Budoff MD an LA BioMed lead researcher. We have completed four randomized studies and they have led us to conclude that Aged Garlic Extract can help slow the progression of atherosclerosis and reverse the early stages of heart disease. The study involved patients aged to years who had been diagnosed with metabolic syndrome. All the participants underwent screening at the beginning of the study to measure the total coronary plaque volume as well as dense calcium noncalcified plaque and lowattenuation plaque. The screening was conducted using Cardiac Computed Tomography Angiography CCTA a noninvasive imaging technology that accurately measures calcium deposits and plaque buildup in the arteries. Following evaluation the participants were given either a placebo or a dose of milligrams of Aged Garlic Extract every day. A followup screening conducted a year after the initial screening found those who had taken Aged Garlic Extract had slowed total plaque accumulation by reduced soft plaque and demonstrated regression less plaque on followup for lowattenuation plaque. Other LA BioMed researchers who participated in the study were Suguru Matsumoto Rine Nakanishi Dong Li Anas Alani Panteha Rezaeian Jeby Abraham Michael A. Fahmy Christopher Dailing Ferdinand Flores and Sajad Hamal. Sach Prabhu from Mercy Medical Center in Merced CA Alexander Broersen from Leiden University Medical Center in the Netherlands and Pieter H. Kitslaar from Leiden University Medical Center and Medis Medical Imaging System both in the Netherlands also participated. Funding for the study was provided by Wakunaga of America Co. Ltd. the producer of Kyolic Aged Garlic Extract. Dr. Budoff also has received honoraria from Wakunaga. About LA BioMed Founded in LA BioMed is one of the countrys leading nonprofit independent biomedical research institutes. It has approximately principal researchers conducting studies into improved diagnostics and treatments for cancer inherited diseases infectious diseases illnesses caused by environmental factors and more. It also educates young scientists and provides community services including prenatal counseling and childhood nutrition programs. LA BioMed is academically affiliated with the David Geffen School of Medicine at UCLA and located on the campus of HarborUCLA Medical Center. For more information please visit http"

"In a remarkably rapid translation of laboratory research findings into a treatment with the potential to benefit patients UC San Francisco scientists have successfully completed a Phase II clinical trial showing that an FDAapproved antihistamine restores nervous system function in patients with chronic multiple sclerosis MS. In light of previous laboratory studies of the antihistamine compound at UCSF the researchers said the drug most likely exerted its effect by repairing damage MS had inflicted on myelin an insulating membrane that speeds transmission of electrical signals in the nervous system. The drug tested in the trial clemastine fumarate was first identified as a candidate treatment for MS in by UCSFs Jonah R. Chan PhD Debbie and Andy Rachleff Distinguished Professor of Neurology vice chief of the Division of Neuroinflammation and Glial Biology and senior author of the new study. First approved by the U.S. Food and Drug Administration FDA in for allergies the drug has been available over the counter in generic form since . The researchers said that the Phase II results published online on October in The Lancet are the first in which a drug has been shown to reliably restore any brain function damaged by a neurological disease in human patients. To the best of our knowledge this is the first time a therapy has been able to reverse deficits caused by MS. Its not a cure but its a first step towards restoring brain function to the millions who are affected by this chronic debilitating disease said the trials principal investigator Ari Green MD also Debbie and Andy Rachleff Distinguished Professor of Neurology chief of the Division of Neuroinflammation and Glial Biology and medical director of the UCSF Multiple Sclerosis and Neuroinflammation Center. Chan and Green are codirectors of the UCSF SmallMolecule Program for Remyelination and both are members of the UCSF Weill Institute for Neurosciences. The new results are particularly notable Chan said because patients in the trial had suffered from MS symptoms caused by injury to myelin for years. People thought we were absolutely crazy to launch this trial because they thought that only in newly diagnosed cases could a drug like this be effective intuitively if myelin damage is new the chance of repair is strong. In the patients in our trial the disease had gone on for years but we still saw strong evidence of repair. MS is an autoimmune neurodegenerative disorder that affects nearly . million people worldwide. The disease strikes when the immune system attacks myelin layers of fatty insulating membrane that surround nerve fibers. Unlike the rubber insulation around wires however myelin helps electrical signals in neurons move faster and more efficiently. As myelin damage continues over the course of the disease neurons progressively lose their ability to reliably transmit electrical signals resulting in progressive loss of vision weakness walking difficulties and problems with coordination and balance. Current MS treatments aim to prevent the immune system from doing further harm but none have been shown to repair damaged myelin. In both his research and in subsequent studies with a mouse model of MS however Chan and colleagues had demonstrated that clemastine fumarate promotes myelin regeneration and restores neural function promising preclinical results that inspired the new study known as the ReBUILD trial. Because the visual system is often one of the first and most prominent parts of the brain to be affected in MS and because there are wellestablished tools to measure the speed of neural transmission in the areas of the brain devoted to vision the research team used a method known as visual evoked potentials or VEPs to assess clemastines therapeutic effects in the trial. The fivemonth Phase II trial enrolled patients with relapsing but generally longstanding MS whose VEPs reflected preexisting deficits in neural transmission. The researchers showed flickering patterns on a screen to participants and used electrodes placed over the brains visual areas at the back of the head to gauge how long it took for the flickering signal presented to the eye to generate an electrical response that could be detected by the electrodes. The time from presentation of the pattern to the detection of the VEP is a measurement of how long it took for the signal to travel via nerve fibers from the retina at the back of the eye to the visual areas at the back of the brain. To enhance the power of their study the researchers used a crossover design they divided the patient population in two and gave the drug blinded to both participant and researcher to one group and a placebo to the other for days then they switched between the two groups giving a placebo to the first group and the drug to the other for the next days. This flipflop technique gave the researchers the ability to compare patients to themselves a form of control that increased the statistical power of the study by nearly an order of magnitude Green said. During the periods when each group was taking the drug the neural signal from the eye to the back of the brain was significantly accelerated over the baseline measurements taken before the patients began the study. The effect persisted in the group that had switched to placebo suggesting that durable repair of myelin had been induced by the drug. Although the research team could not directly observe evidence of rebuilding of myelin in trial participants using magnetic resonance imaging MRI Chan and Green said that this reflects a weakness of current MRI techniques as a tool for this purpose rather than evidence that myelin regeneration did not take place. We still dont have imaging methods that have been proven to be able to detect remyelination in humans said Chan. That myelin increases the speed of neural transmission is one of the most wellestablished concepts in neurobiology and combined with the clear evidence from Chans preclinical research showing that clemastine fumarate promotes myelin formation myelin regeneration is the only plausible explanation for the VEP results the authors said. This is the first step in a long process Green said. By no means do we want to suggest that this is a cureall. We want to groundtruth myelination metrics were designing the crucible thats going to be used to test any future method for detecting remyelination. The work was funded through generous support from the Rachleff Family. In addition to Green and Chan authors all at UCSF include Jeffrey M Gelfand MD MAS Bruce A Cree MD PhD MAS Carolyn Bevan MD W. John Boscardin PhD Feng Mei PhD Justin Inman Sam Arnow Michael Devereux Aya Abounasr Hiroko Nobuta PhD Alyssa Zhu Matt Friessen PhD Roy Gerona PhD Hans Christian von Bdingen MD PhD Roland G Henry PhD and Stephen L Hauser MD. UC San Francisco UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research graduatelevel education in the life sciences and health professions and excellence in patient care. It includes topranked graduate schools of dentistry medicine nursing and pharmacy a graduate division with nationally renowned programs in basic biomedical translational and population sciences and a preeminent biomedical research enterprise. It also includes UCSF Health which comprises three topranked hospitals UCSF Medical Center and UCSF Benioff Childrens Hospitals in San Francisco and Oakland and other partner and affiliated hospitals and healthcare providers throughout the Bay Area."

"A new biologic agentthe most potent of its kind so faris showing early promise as part of a potential new strategy for treating HIV. The drug known as may also offer a new way to prevent viral infection in people who are at high risk to acquire HIV the virus that causes AIDS. The drug belongs to a class of molecules called broadly neutralizing antibodies which are naturally found in HIVinfected people whose immune systems have a rare ability to fight off the virus. These antibodies are a major area of study in the laboratory of Rockefeller University investigator Michel Nussenzweig http who is Zanvil A. Cohn and Ralph M. Steinman Professor and head of the Laboratory of Molecular Immunology. Marina Caskey an Assistant Professor of Clinical Investigation leads clinical studies on these antibodies. This was the first human trial of says Till Schoofs an Instructor in Clinical Investigation in Nussenzweigs lab. The antibody binds to a different part of the virus than the other antibody weve studied. In addition its one of the most potent broadly neutralizing antibodies described to date. Today HIV is typically treated with antiretroviral therapy a drug regimen that became available in the s. Although it has been a lifesaver for people infected with the virus antiretroviral medications have significant drawbacks they can cause severe side effects and patients have to take them for life. This is why researchers continue to look for other ways to control the virusand broadly neutralizing antibodies could prove to be part of an alternate treatment strategy. The study of an earlystage clinical trial included individuals who were infected with HIV and who were not. The purpose was to determine whether the antibody was safe and whether it had antiviral activity in humans. The majority of the people in the trial were enrolled at The Rockefeller University Hospital while some of the HIV infected participants received the antibody at the University of Cologne in Germany. It has been challenging to find trial participants with high levels of the virus here in New York Caskey says so our collaboration with the University of Cologne has been very valuable. The investigators found that among HIVinfected people who received the highest dose of showed a rapid decline in the amount of virus. Although these patients were found to have some resistant virus in their blood further research in the lab showed that those viruses were still sensitive to other broadly neutralizing antibodies including BNC httpnewswire.rockefeller.edunewantibodydrugcontinuestoshowpromisefortreatmentofhiv that target different parts of the pathogen. The results were published in January in Nature Medicine. Caskey Schoofs and their team also analyzed the uninfected participants blood samples and found that may be an effective way to prevent infection in people who are exposed to the virus. Currently people who do not have HIV but are at substantial risk of getting itbecause they have multiple sexual partners for example or an HIVinfected partnercan receive antiviral medications to prevent disease a strategy called preexposure prophylaxis PrEP. But just like the antiviral medications used to treat infection PrEP can have severe side effects and must be taken daily to be effective which poses significant challenges to adequate compliance. Based on our findings we think these types of antibodies could be a viable substitute for the drugs currently used in PrEP says Caskey. But to clearly demonstrate that these antibodies have an advantage over the pill thats currently used we would need to test them in large numbers of people and show that they remain active for a prolonged period of time in the body. In an effort to accomplish this the investigators are looking into modified variants of the antibodies with prolonged activity so that they would need to be given less often in the PrEP setting. And they are already moving forward with new clinical studies using together with BNC with the hope that combining two antibodies targeting different parts of HIV will be more effective than either antibody on its own."

"Physicians from Carolinas HealthCare Systems Neurosciences Institute and Levine Cancer Institute are among the authors of a study that was accepted for publication by the Journal of the American Medical Association JAMA. The study released on July shows that patients with the most common form of brain tumor can be treated in an effective and substantially less toxic way by omitting a widely used portion of radiation therapy. These results will allow tens of thousands of patients with brain tumors to experience a better quality of life while maintaining the same length of life. Anthony L. Asher MD FACS medical director at Carolinas HealthCare Systems Neurosciences Institute and the senior author on the report and as well as Stuart H. Burri MD chairman department of radiation oncology at Levine Cancer Institute began their research on this subject over years ago in Charlotte North Carolina. Along with Dr. Paul Brown at Mayo Clinic they spearheaded an international multiinstitutional randomized trial that will ultimately improve the standard of care for patients with a specific type of brain tumor brain metastases by reducing the toxicity of their treatment without reducing the effectiveness. Typical therapies for these types of brain tumors include surgery whole brain radiation therapy and focused radiation also known as stereotactic radiosurgery. We discovered that whole brain radiation added to focused radiation in the treatment of brain metastases in other words cancer that travels to the brain reduces the number of new brain tumors over time however patients receiving the whole brain radiation had significantly more difficulties with memory and complex thinking than patients who only had the focused radiation says Dr. Asher. Whole brain radiation patients also reported worse quality of life compared with patients who only received the focused radiation adds Dr. Burri. Interestingly the data showed that the addition of whole brain radiation produced no improvement in survival. According to the American Cancer Society in there will be approximately . million new cancer cases diagnosed in the United States. Almost one in four of those patients about will experience spread of their cancers to the brain. In contrast and patients will be newly diagnosed with breast and primary lung cancers respectively each year. Brain metastases are not only extremely common they are also a major source of disability in society says Dr. Asher. Because of their location these tumors often produce severe neurological symptoms such as headaches weakness or problems with speech and information processing thereby compromising both daily function and quality of life in cancer patients. According to Dr. Asher there are two primary objectives in cancer care To improve survivalTo maintain or improve quality of life for patientsThe first and highest rule of medical care is do no harm says Dr. Asher. Consistent with that obligation when it isnt possible to extend survival with various therapies its absolutely essential that we work to reduce or eliminate any possibility that quality of life will be compromised by treatments. Another way to state that principle for cancer care is that when two cancer therapies produce similar survival its important to understand which therapy offers patients a better quality of life. In this study although whole brain radiation decreased the number of new brain tumors over time its addition to focused radiation interestingly did not result in a survival benefit over focused radiation alone. Furthermore whole brain therapy was associated with considerably worse quality of life. In the past clinicians who treated patients with brain tumors seldom used sophisticated techniques like neurocognitive tests to evaluate patients daily function in response to various therapies said Dr. Burri. Without those tests we might have incorrectly concluded that whole brain radiation was a better option for patients because it made their scans look better at least in the short term. However the data from our study shows that clinicians can no longer simply rely on the results of traditional lab tests or scans to assess the value of care we have to understand the total impact of cancer therapies on our patients. Drs. Asher and Burri emphasize that the real importance of this study is its potential to make us think differently about what really matters in cancer therapy. The trial authors concluded that the benefit of adding whole brain radiation was outweighed by its risks in patients with one to three newly diagnosed brain metastases. This is a very relevant finding as over patients still receive whole brain radiation in the United States each year and the majority of patients with brain metastases have a limited number typically three or less of brain lesions. Drs. Asher and Burri along with their coinvestigators now recommend that patients with one to three brain metastases should no longer receive routine whole brain radiation therapy and should be treated with focused therapy alone to better preserve cognitive function and quality of life. Having the research published in JAMA is validation of more than a decade of work says Dr. Burri. It is deeply satisfying to have developed an important scientific project work in close collaboration with other investigators to obtain support from the National Cancer Institute then carry the to carry the trial to completion with publication of impactful results in one of the leading medical journals in the world. Drs. Asher and Burri are now working on a new method of focused therapy for tumors that have spread to the brain that combines radiation and surgery. The technique was pioneered at Levine Cancer Institute and they are looking to expand and further validate the approach with the National Cancer Institute. About Carolinas HealthCare System Carolinas HealthCare System carolinashealthcare.org one of the nations leading and most innovative healthcare organizations provides a full spectrum of healthcare and wellness programs throughout North and South Carolina. Its diverse network of care locations includes academic medical centers hospitals freestanding emergency departments physician practices surgical and rehabilitation centers home health agencies nursing homes and behavioral health centers as well as hospice and palliative care services. Carolinas HealthCare System works to enhance the overall health and wellbeing of its communities through high quality patient care education and research programs and numerous collaborative partnerships and initiatives. R Anthony L. Asher MD FACS medical director at Carolinas HealthCare Systems Neurosciences Institute and the senior author on the report and L Stuart H. Burri MD chairman department of radiation oncology at Levine Cancer Institute spearheaded an international multiinstitutional randomized trial that will ultimately improve the standard of care for patients with a specific type of brain tumor brain metastases by reducing the toxicity of their treatment without reducing the effectiveness.Video httporiginqps.onstreammedia.comoriginmultivu_archivePRNAENRCarolinasHealthCareSystem.mp http_archivePRNAENRCarolinasHealthCareSystem.mpPhoto httpphotos.prnewswire.comprnh http"

"Dermira Inc said its experimental topical therapy for excessive underarm sweating was successful in two latestage studies bringing it one step closer to providing an easytouse therapy for the often embarrassing condition. While the function of sweating is to prevent overheating those affected sweat even when the body does not need cooling. Existing therapies for excessive underarm sweating also called axillary hyperhidrosis offer limited effectiveness and can be expensive. The first line of defense are antiperspirants. Next patients can try costlier alternatives such as botox injections a device called miraDry that delivers electromagnetic energy to decompose sweat glands or laser therapy to destroy them. Sufferers can also opt for localized surgery like liposuction to remove or injure sweat glands. Oral medicines can be used to systemically limit sweating. For instance a class of drugs called anticholinergics are commonly used offlabel for this purpose but they are linked with the risk of dementia. Based on the most recent estimates about . million Americans have some form of excessive sweating including palms feet underarms or head and about half of this population suffer from the underarm form said Dermira spokeswoman Erica Jefferson in an interview ahead of the data readout. The Menlo Park Californiabased companys shares were up percent at . in extended trading on Wednesday. About twothirds of the total enrolled in the two trials for the companys topical treatment DRM were treated with wipes containing DRM while the rest were not. In the first trial a significant improvement in the severity of sweating was seen in . percent of the patients treated with the drug compared with . percent patients in the control group on a scale designed by the company. In the second trial a significant improvement was seen in . percent of the drugtreated patients compared with . percent in the control group. Dermira said it had expected to apply for marketing approval for the drug in the second half of subject to completion of the drugs longterm safety trial. Reporting by Natalie Grover and Shailesh Kuber in Bengaluru Editing by Maju Samuel Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"The American Heart Association httpabcnews.go.comtopicslifestylehealthamericanheartassociation.htm has changed the definition of hypertension for the first time in years moving the number from the old standard of to the newly revised . The change is outlined in the American Heart Association Hypertension Practice Guidelines an extensive report by experts without relevant ties to the pharmaceutical industry. The changes are expected to drastically impact adult Americans revising the hypertension threshold downward will increase the percent of U.S. adults living with high blood pressure httpabcnews.go.comtopicslifestylehealthhighbloodpressure.htm from percent to percent nearly half of the adult population. It will also disproportionately affect younger people by tripling the number of men under and doubling the number of women under with the diagnosis. American Heart Association The American Heart Association has changed the definition of hypertension for the first time in years moving the number from mm Hg to mm Hg. more httpsabcnews.go.comHealthmillionamericanshighbloodpressureguidelinesstoryid The new guidelines reflect years of research which have shown that people within the new range of blood pressure defined as hypertension have doubled their risk of cardiovascular problems in the future such as heart attacks or strokes. As such health care professionals should be identifying these patients and helping to initiate interventions to bring down blood pressure. How to lower your blood pressure without medication httpabcnews.go.comHealthlowerbloodpressuremedicationstoryid While the new guidelines significantly increase the number of Americans with a diagnosis of hypertension they do not suggest a proportionate increase in treating with medication. The number of Americans with hypertension who are recommended for medical treatment would increase by only . million adults or percent more than were previously recommended. Medication will be recommended for patients with previous cardiovascular events such as heart attack httpabcnews.go.comtopicslifestylehealthhearthealth.htm or significant cardiovascular risk factors httpabcnews.go.comtopicslifestylehealthriskfactors.htm determined by factors such as age blood tests and having other medical conditions that increase risk of heart attack. The study authors recommend lifestyle changes including exercise httpabcnews.go.comtopicslifestylehealthcardiovascularexercise.htm diet modifications and weight loss httpabcnews.go.comtopicslifestylehealthdietandweightloss.htm as the first step to reducing high blood pressure. Getty Images The American Heart Association has changed the definition of hypertension for the first time in years moving the number from mm Hg to mm Hg. more httpsabcnews.go.comHealthmillionamericanshighbloodpressureguidelinesstoryid Doctors in the guidelines stress the importance of using two separate blood pressure readings on two different occasions to diagnose hypertension. They recommend that those with hypertension use approved blood pressure monitors at home. Writing down these readings at home can help tell the difference between people with truly abnormal blood pressure and those with whitecoat syndrome with high blood pressure only under stress like at the doctors office. High blood pressure increases the risk of cardiac problems and strokes and is sometimes called the silent killer because so many adults live with high blood pressure and dont know it. To help understand the new hypertension guidelines and how they affect managing your health see your healthcare professional."

"People who cram all their exercise into one or two sessions at the weekend benefit nearly as much as those who work out more frequently researchers say. A study of more than adults in England and Scotland found that weekend warriors lowered their risk of death by a similar margin to those who spread the same amount of exercise over the whole week. The findings will reassure people who find it hard to make time for a daily exercise routine and opt instead to break a sweat once or twice a week in the hope of keeping fit. Millions of people enjoy doing sport once or twice a week but they may be concerned that they are not doing enough said Gary ODonovan a physical activity researcher and author on the study at Loughborough University. We find a clear benefit. Its making them fit and healthy. The UKs National Health https Service recommends that to ward off an early death people should spend minutes a week performing moderate exercise or minutes a week doing vigorous exercise. As a rule of thumb moderate exercise can be done while maintaining a conversation whereas during vigorous exercise talking at the same time is too hard. In the study those who met the physical activity target by exercising through the week had a lower risk of death than the inactive adults with cardiovascular deaths down and a lower risk of cancer death. But the weekend warriors also saw substantial health benefits if they met the physical activity target too. Their overall risk of death was lower than the sedentary adults with the risk of cardiovascular and cancer deaths lower by and respectively. Weekend warriors are people who meet the recommended volume of physical activity each week through only one or two sessions. There are doing a large proportion of vigorous exercise and that makes you fitter than moderate exercise said ODonovan. Men and women benefited equally according to the study published in the Journal of the American Medical Association Internal Medicine httpdx.doi.org.jamainternmed... The results are based on medical data gathered for adults aged and above between and . Nearly of the study participants died in the period. For those who have resolved to get fit in the New Year ODonovan recommends to start with moderate exercise such as brisk walking and then to set realistic incremental goals to boost confidence without running the risk of setbacks due to injury. A middle aged or older person should do as much as weeks of moderate exercise before introducing vigorous exercise he said. Ulf Ekelund at the Norwegian School of Sport Sciences in Oslo said the study emphasised what researchers have found time and again that even a small amount of regular exercise wards off death. In the study those who exercised a little had a lower risk of death than those who did no exercise at all. The novel finding is that it appears the duration and possibly the intensity of leisure time physical activity is more important than the frequency Ekelund said. My take home message is that the greatest risk reduction and the greatest gain for the individual and for public health is if those who are physically inactive take up some activity he added."

"Children in rural Nepal whose mothers were given iron and folic acid supplements during pregnancy were smarter more organized and had better fine motor skills than children whose mothers did not get them U.S. researchers said on Tuesday. A store worker walks past rows of herbal vitamin and mineral pill products at a pharmacy in this file photo. REUTERSDavid Gray They said ensuring that pregnant women get this basic prenatal care could have a big effect on the educational futures of children who live in poor communities where iron deficiency is common. Iron is essential for the development of the central nervous system said Parul Christian an expert in international health at the Johns Hopkins University Bloomberg School of Public Health whose study appears in the Journal of the American Medical Association. Iron deficiency is the most common and widespread nutritional disorder in the world affecting billion people according to the World Health Organization. Early iron deficiency can interfere with nerve development biochemistry and metabolism hampering both intellectual and fine motor development. Christians team studied schoolage children whose mothers had been in a clinical trial in which some got iron and folic acid supplements and other nutrients while they were pregnant. About percent of the children aged to were enrolled in school. We had the opportunity to follow the offspring of women who had participated in a randomized trial of iron and folic acid and other micronutrients to assess neurocognitive function and outcomes Christian said in a telephone interview. What we showed is prenatal iron and folic acid supplementation had a significant impact on the offsprings intellectual level and motor ability and ability during school age which was a very exciting finding she said. It had an impact across a range of function including intellectual function executive function and fine motor function factors that could affect a childs later academic success Christian said. She said many children in poor communities would benefit from better prenatal programs that include the lowcost nutritional supplements. These results speak to a large swath of people residing in that part of the world. Iron and folic acid deficiency are very common she said. The World Health Organization estimates that in developing countries every other pregnant woman is anemic and about percent of preschool children are anemic. The study was funded by the National Institutes of Health and the Bill Melinda Gates Foundation. Ford and VW are exploring closer cooperation as trade frictions force carmakers to rethink where they build cars for Europe the United States and China and as software companies prepare to launch their own selfdriving cars. A global alliance is expected to be announced one source said adding that the pact will be unveiled next Tuesday. The scope of the alliance is still being determined the sources said as talks about cooperation in the area of electric and autonomous cars continue. Talks are going well said a second source who declined to be named. Volkswagen is reviewing whether to invest in Fords autonomous vehicles division while Ford executives are considering licensing Volkswagens MEB electric vehicles platform the second source said. Ford and VW had no immediate comment. In June Ford and VW unveiled a pact in commercial vehicles including vans adding that they were investigating several joint projects. U.S. China could settle immediate trade issues Ross In December VW CEO Herbert Diess said We are in quite advanced negotiations and dialog with Ford Corporation to really build up a global automotive alliance which also would strengthen the American automotive industry. At the time Ford Executive Chairman Bill Ford Jr told reporters that talks with Volkswagen about an alliance were going very well The auto show runs from January to January . Reporting by Jan Schwartz in Hamburg and Ben Klayman in Detroit Writing by Edward Taylor Editing by Joe White Georgina Prodhan and Elaine Hardcastle Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Measuring blood levels of the recently discovered hormone irisin may improve diagnosis rates of teenagers with polycystic ovary syndrome according to research presented today at the th Annual European Society for Paediatric Endocrinology Meeting. The findings may reduce the number of unnecessary treatments prescribed to otherwise healthy girls. Polycystic ovary syndrome PCOS is a common endocrine disorder affecting up to of women. Women with PCOS are more likely to suffer from irregular periods have excessive levels of male hormones and may have difficulty in conceiving due to irregularities in the ovaries. Doctors are cautious when diagnosing PCOS in teenagers because the symptoms can be confused with normal pubertal changes. Having tools that make diagnoses more accurate can reduce unnecessary treatment for otherwise healthy teenagers at a critical stage in their lives. The cause of PCOS is unknown and there is currently no cure for the condition. Previous studies have associated high levels of irisin a newly discovered hormone which is released from muscles and regulates energy metabolism with PCOS in adults. In this study Greek researchers from Aghia Sophia Childrens Hospital in Athens compared the hormones of teenagers with PCOS with healthy teenagers of the same age and BMI. They found that teenagers with PCOS had significantly higher irisin levels compared to the control group and that this was associated with higher levels of the male sex hormone testosterone a key marker of PCOS. The findings suggest that irisin could be a marker for PCOS allowing the condition to be diagnosed more easily. Teenagers who get an early diagnosis of PCOS can sooner start to deal with the physical and psychological symptoms caused by this lifelong condition said lead researcher Dr Flora Bacopoulou. Whether its through counselling or medication girls can manage their symptoms and decrease the risk of further complications such as fertility problems hirsutism excessive hair growth and type diabetes. The group will next focus on confirming their results and investigate the biological role of irisin in PCOS. If high irisin levels in teenagers with PCOS is established this could lead to the development of treatments for PCOS. Lifestyle changes and different exerciserelated signals that regulate the secretion of irisin could provide a potential option for the management of PCOS. The potential of irisin as a meaningful drug target in PCOS is very promising said Dr Bacopoulou."

"A minimally invasive procedure in which pulses of energy from a probe are applied directly to nerve roots near the spine is safe and effective in people with acute lower back pain that has not responded to conservative treatment according to a study being presented today at the annual meeting of the Radiological Society of North America RSNA. Lumbar disk herniation is a common often debilitating condition that affects the disks that act as cushions between the vertebrae of the lower spine. Herniation occurs where the jellylike material in the center of the disk bulges through a tear in the disks tough exterior layer and puts pressure on the roots of the nerves. Herniated disks are often the source of sciatica or pain that radiates downward from the lower back into the leg. Conservative treatment options for herniated disks range from overthecounter pain medications to injections of corticosteroids directly into the affected area of the spine. Those who dont respond may require surgery. In some cases the entire disk must be removed and the vertebra fused together for stability. An alternative technique CTguided pulsed radiofrequency pRF applies energy through an electrode under CT guidance to the portion of the nerve responsible for sending pain signals. Pulsed radiofrequency creates a nerve modulation significantly reducing inflammation and its associated symptoms said study senior author Alessandro Napoli M.D. Ph.D. professor of interventional radiology at Sapienza University of Rome in Italy. Dr. Napoli and colleagues studied the approach in patients with back pain from lumbar disk herniation that had not responded to prolonged conservative treatment. In patients the pRF treatment was delivered directly under CT guidance to the root of the nerve. The treatment was applied for minutes. For comparison a group of patients received one to three sessions of CTguided steroid injection on the same anatomical target with no pRF. The oneyear outcomes demonstrated that CTguided pRF was superior to the injectiononly strategy. Patients who received pRF saw greater overall improvement in pain and disability scores during the first year. Relief of leg pain was faster in patients assigned to pRF and they also reported a faster rate of perceived recovery. The probability of perceived recovery after one year of followup was percent in the pRF group compared with percent in the injection only group. Given our study results we offer pulsed radiofrequency to patients with herniated disk and sciatic nerve compression whose symptoms do not benefit from conservative therapy Dr. Napoli said. The results of the study are superior to those typically reported for usual care strategies and injections and may help a substantial number of patients with sciatic disk compression to avoid surgery Dr. Napoli added. The use of pRF also could improve outcomes for patients set to receive corticosteroid injections. We learned that when pulsed radiofrequency is followed by steroid injection the result is longer lasting and more efficacious than injection only Dr. Napoli said. The effect of pulsed radiofrequency is fast and without adverse events. Today therapy for spine disorders allows for definitive treatment of symptoms and conditions using different techniques and technologies. Of the different therapies available pulsed radiofrequency is among the least invasive Dr. Napoli said. Treatment lasts minutes and one session was enough in a large number of treated patients. Coauthors are Roberto Scipione M.D. Fabrizio Andrani M.D. Susan Dababou Cristina Marrocchio Michele Anzidei M.D. and Carlo Catalano M.D. Note Copies of RSNA news releases and electronic images will be available online at RSNA.orgpress httpspress.rsna.orgtimssnetmediarsnanewsroom.cfm beginning Monday Nov. . RSNA is an association of over radiologists radiation oncologists medical physicists and related scientists promoting excellence in patient care and health care delivery through education research and technologic innovation. The Society is based in Oak Brook Ill. RSNA.org https Editors note The data in these releases may differ from those in the published abstract and those actually presented at the meeting as researchers continue to update their data right up until the meeting. To ensure you are using the most uptodate information please contact us. For patientfriendly information on imageguided therapies visit RadiologyInfo.org https"

"Eating for two is exciting but comes with a lot of baggage weight gain uncontrollable cravings for ice cream and pickles and constant concern over whether your growing baby is getting all the nutrients it needs httpshealth.usnews.comhealthnewsblogseatrunthebestandworstfoodstoeatduringpregnancy to name a few. Now findings published in Applied Physiology Nutrition and Metabolism http reveal that most women arent getting enough omega fatty acids healthy fats found in fish walnuts avocados and supplements. Specifically they arent getting enough DHA docosahexaenoic acid an omega long chain polyunsaturated fatty acid omega LCPUFA thats critical to a babys brain development. DHA is primarily obtained by eating fish and other seafood. For the study researchers from Canadas University of Alberta studied women during and after pregnancy to monitor their intake of omega LCPUFAs. These include DHA EPA eicosapentaenoic acid and DPA docosapentaenoic acid. DHA is believed to be the biggest player in neurological health and is the primary structural fat found in the brain. The American Dietetic Association recommends that healthy adults including pregnant and lactating women get at least milligrams per day of omega LCPUFAs. Meanwhile the International Society for the Study of Fatty Acids and Lipids advises that pregnant httpshealth.usnews.comhealthnewsblogseatrunwhyiodineisimportantduringpregnancy and lactating women consume at least mg of DHA per day. The researchers found that only percent of women during pregnancy httpshealth.usnews.comhealthnewshealthwellnessarticleswhatnottosaytoapregnantwoman and percent of women threemonths postpartum were meeting those DHA recommendations. The Power of DHA Omega s are needed for the infants brain and nervous system to develop properly says contributing study author Catherine Field a registered dietitian and professor of nutrition at the University of Alberta. Also the membranes of every cell in a persons body contain omega fatty acids. They are needed for the cell to grow and function. After all during pregnancy and breastfeeding httpshealth.usnews.comhealthnewsblogseatrunwhattoeatwhilebreastfeeding babies are doing at lot of growing. Whats more during pregnancy omega fatty acids are required for moms body to produce more red blood cells so that she can provide enough nutrients and oxygen to her growing baby. These fatty acids also help the placenta grow and function as needed Field says. Its this placenta that omega fatty acids including DHA diffuse across to reach the baby and spur brain development says Dr. Vincenzo Berghella past president of the Society for MaternalFetal Medicine as well as professor and director of the division of MaternalFetal Medicine at Thomas Jefferson University in Philadelphia. Not surprisingly low intake of DHA in moms is linked to babies with lower cognitive development often associated with crying and poor sleep as well as lower IQs and attention deficit disorders Field says. Whats more her previous research in both animals and humans shows that DHA intake during breastfeeding impacts infants immune system development which may explain why babies who receive low amounts of DHA through breast milk have an increased risk of asthma and allergies. She also notes that DHA supplementation may help prevent preterm labor httpshealth.usnews.comhealthnewspatientadvicearticleswhatyoucandotopreventprematurebirth preeclampsia and postpartum depression. However whether DHA benefits more than babies brain health isnt conclusive. Data from observational studies and from randomized controlled trials suggest that omega during pregnancy could be associated with several benefits such as lower risk of preterm birth preeclampsia and other obstetrics complications. However there are contradicting results Berghella says. In fact Berghellas review http of randomized controlled trials found that omega supplementation during pregnancy was not associated with decreases in risk. However the review did find that women with singlechild pregnancies no multiples had a percent lower risk of stillbirth or early infant death if they began supplementation by weeks into their pregnancies. How to Get More DHA Sushis one thing but during pregnancy you shouldnt lay off seafood entirely Berghella says. The American Congress of Obstetricians and Gynecologists recommends that pregnant and breastfeeding women eat at least two servings of fish or shellfish about to ounces every week. But take care to choose lowmercury options such as shrimp salmon and catfish. The group recommends avoiding shark swordfish king mackerel and tilefish and limiting white tuna consumption to ounces per week. Hitting those recommendations will get you approximately mg of DHA per week Berghella says. While thats not exactly mg per day if you average your intake out over the course of a day week you still hit recommended amounts. In the University of Alberta study seafood fish and seaweed products contributed to percent of womens omega LCPUFA intakes from food. The biggest source salmon. Good thing as a study published in The Lancet http found that children born to mothers who reported no seafood intake had the greatest risk of behavioral problems and poor scores on early developmental and IQ tests. If you dont eat seafood DHA supplements can help says Dr. Gabriele Saccone of the University of Naples Federico IIs department of neuroscience and Berghellas collaborator. But if you do take supplements opt for fishoil varieties httpshealth.usnews.comhealthnewsblogseatrunhowtochooseafishoilsupplement since DHA from fish may be more beneficial than getting it from vegetarian supplements according to Saccone. And no worries they are low in mercury. Even if you are eating some seafood just not quite two servings per week a fishoil supplement could still help. In the current study women who took a supplement were times more likely to get mg of DHA per week during pregnancy and lactation compared to those who went supplementfree. Apart from taking supplements Field also recommends eating foods enriched with DHA such as milk and eggs. Wondering about avocados walnuts and olive oil While they are all filled with omega fatty acids they arent of the DHA variety. These plant sources httpshealth.usnews.combestdietbestplantbaseddiets of omegas contain ALA alphalinolenic acid which while good for you has a hard time converting into DHA so that it can really benefit babys brain development httpshealth.usnews.comhealthnewsblogseatrunbestfoodstoeatduringpregnancy Berghella says. In North Americans and Europeans only about percent of all ALA consumed becomes EPA or DHA Field says. The bottom line When a smiley face shows up on your pregnancy test its time to hit the fish market. But if youve got a sensitive pregnancy belly you might want to send your partner shopping for the pungent fare."

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

"By middle age the lenses in your eyes harden becoming less flexible. Your eye muscles increasingly struggle to bend them httparchopht.jamanetwork.comarticle.aspxarticleid to focus on this print. But a new form of training brain retraining really may delay the inevitable agerelated loss of closerange visual focus so that you wont need reading glasses. Various studies say it works though no treatment of any kind works for everybody. The increasing difficulty of reading small print that begins in middle age is called presbyopia http from the Greek words for old man http and eye http Its exceedingly common and despite the Greek etymology women experience it too. Every five years the average adult over loses the ability to see another line http on the eye reading charts used in eye doctors offices httpsen.wikipedia.orgwikiLogMAR_chart. By presbyopia affects an estimated percent httparchopht.jamanetwork.comarticle.aspxarticleid of adults in North America. Over age its nearly universal http Its why my middleaged friends are getting fitted for bifocals or graduated lenses. There are holdouts of course who view their cellphones and newspapers at arms length to make out the words. The decline in vision is inconvenient but its also dangerous causing falls http and auto accidents http Bifocals or graduated lenses can help those with presbyopia read but they also contribute http to falls and accidents because they can impair contrast sensitivity the ability to distinguish between shades of gray and depth perception httppss.sagepub.comcontentearly. Im . I dont need to correct my vision for presbyopia yet but I can tell its coming. I can still read the The New York Times print edition with ease but to read text in somewhat smaller fonts I have to strain. Any year now I figured my eye doctor would tell me it was time to talk about bifocals. Or so I thought. Then I undertook a monthslong strenuous regimen designed to train my brain to correct for what my eye muscles no longer can manage. The approach has been reported http in the news media http and perhaps youve heard of it. Its based on perceptual learning the improvement of visual performance as a result of demanding training on specific images. Some experts have expressed skepticism http that it can work but a number of studies provide evidence http that it can improve visual acuity contrast sensitivity and reading speed. The training involves looking at images called Gabor patches httpneuroanatody.comwhatsinagaborpatch in various conditions. Gabor patches optimally stimulate the part of the brain responsible for vision http A great deal of the training involves trying to see Gabor patches placed between closely spaced distracting flankers. In training the flanker spacing is varied the target contrast is turned way down and the images are flashed on a screen for fractions of a second to the point that one can barely see the target. A screenshot of a Gabor patch from the GlassesOff app tutorial.CreditGlassesOff Do this and similar exercises hundreds of times over multiple sessions weekly continue for months and gradually presbyopia lessens a number http of studies show http One study also http examined functions of the eye itself and found none of these improvements were because of changes in the eye. Theyre all in the brain. Various smartphone apps say they offer this kind of visionimproving training I used one called GlassesOff http the only one I found that was backed by scientific studies. Perceptual learning can improve the vision of people who already see quite well and those with other conditions. For example a study http tested the approach in young adults around age . Compared with a control group of young adults the treatment group increased letter recognition speed. Similar training is an effective component http in treating amblyopia httpsweb.archive.orgwebhttpoptometry.berkeley.edupdfsberkoptmagazine_sml.pdf also called lazy eye httpsnei.nih.govhealthamblyopiaamblyopia_guide which is the most frequent cause of vision loss in infants and children affecting percent of the population httpsweb.archive.orgwebhttpoptometry.berkeley.edupdfsberkoptmagazine_sml.pdf. It may also improve vision in those with mild myopia http nearsightedness. It should be acknowledged that some researchers involved in many of these studies have financial ties to GlassesOff. However other studies with no commercial links http obtained similar results and several scientists I spoke to including those without ties to GlassesOff thought the science behind the app was credible. One study published in Psychological Science httppss.sagepub.comcontentearly trained collegeaged adults and older adults around age with Gabor patch exercises for . hours per day for seven days. After training the older adults ability to see lowcontrast images improved to the level that the collegeage ones had before training. Scientists dont know exactly how perceptual learning relieves presbyopia but they have some clues based on how our brain processes visual information. After first taking in raw data of an image through the eye different sets of neurons in the brain process it as separate features http like edges and colors. Then the brain must coordinate activity across sets of neurons to assemble these features into recognizable objects like chairs faces letters or words. Reading at our normal pace the brain has only about milliseconds http to do this work until the eyes automatically move onto the next letter or word. Once they do so were taking in more information from whatever the eyes focus on next. If we havent yet processed the prior set of information we cant understand it. Visual processing time is challenged and slowed by noisy images low contrast or closely spaced information like small fonts. There is a bottleneck in the brain http as it attempts to build and then comprehend the image. Therefore enhancing and speeding up the ability to process image components through perceptual learning improves a wide range of vision functions. Whats surprising is that this is possible in adult brains. Neuroplasticity the ability of the brains processing functions to change to acquire new skills is most strongly associated with childhood. Its still more pronounced in children than adults but for some skills including vision httpsbooks.google.combooksidpuYSsGsClpgPPdqFahleCM.CPoggioCT..PerceptuallearningpgPR the brain is more malleable than once thought. The training with GlassesOff is long and challenging. I found it fun initially perhaps because it was new. But weeks into it I began to dread the monotonous labor. Yet after a couple of months the app reports I can read fonts nearly one third the size I could when I started and much more rapidly. According to feedback from GlassesOff my vision after training is equivalent to a man about years younger than my age. If I reach the age at which almost everyone needs corrective lenses http to read and still dont need reading glasses I may conclude that the training has paid off. As apps go GlassesOff is not cheap. I paid . for three months of use long enough to get me through the initial program. Upon completion I was invited to pay another . per year for maintenance training. Its a nice option but the hard work and price probably mean that the bifocals market will remain strong."

"Patients undergoing cancer treatment confront a number of welldocumented side effects. Chemotherapy and other cancer therapies can wreak havoc on the taste buds and olfactory senses depriving recipients of the intricate interplay between taste and smell that is critical to grasping flavors and enjoying foods. Over time taste and smell abnormalities TSA can lead to a loss of appetite and anorexic behaviors compromising patients ability to recuperate from the disease. In a new paper published in the journal Food Function httppubs.rsc.orgencontentarticlepdfFOCFOB Virginia Tech College of Agriculture and Life Sciences researchers Susan Duncan and Aili Wang investigated the feasibility of lactoferrin a highly bioactive protein found in saliva and milk as a treatment for TSA. Their findings could bring relief to millions of patients undergoing cancer treatment. The underlying molecular mechanisms of TSA are not wellunderstood said Duncan associate director of the Virginia Agricultural Experiment Station and a professor in the Department of Food Science and Technology. The prevailing symptom described by patients undergoing chemotherapy is a persistent metallic flavor or aftertaste with or without food intake. This can last for hours weeks or even months after the completion of treatments. As a consequence cancer patients suffer poor appetite weight loss depression and diminished nutrition all of which are detrimental to recovery. Although TSA is widespread and a frequent complaint of cancer patients until now there have been no established therapies that reliably prevent or treat this problem. Our research shows that daily lactoferrin supplementation elicits changes in the salivary protein profiles in cancer patients changes that may be influential in helping to protect taste buds and odor perception said Duncan. By suggesting lactoferrin as a dietary supplement we can reduce TSA for many patients restoring their ability to enjoy foods during a time in which nutrition can play a key role in their recovery. This research could help us develop TSAtargeted biomarkers and strategies for improving quality of life during chemotherapy. Cancer patients and their supporting family and friends may again find comfort in enjoying a meal together. The transdisciplinary team including William Ray Department of Biochemistry Andrea Dietrich of the Charles E. Via Jr. Department of Civil and Environmental Engineering in the College of Engineering and Glenn Lesser from Wake Forest Baptist Medical Center previously identified the role of lactoferrin a specific milk protein in diminishing the metallic flavor stimulated by chemotherapy medications. The substance is wellknown as a firstline defense aiding the bodys immune response but little is known about its ability to impact salivary proteins. Their most recent study builds on the previous body of work through the application of lactoferrin supplements in treating taste and smell abnormalities. The teams findings will make it possible for cancer patients to taste foods properly and to enjoy a healthier appetite enabling more optimal nutrition during a critical period of recovery. Lactoferrin supplementation also enhances the expression of salivary immune proteins which may help reduce oxidative stress and resulting side effects. Oral infections such as thrush also may be diminished."

"Every year when Morton Pollner had his checkup he worried that doctors would find something on his lung. For years they didnt. Then his luck ran out. My reaction was Well you smoked for years. You got away with it for another years and this is it. I thought it was a death sentence he says. Pollner who lives in Monroe N.Y. was when he was diagnosed with lung cancer. Like many patients his age he didnt expect there would be any effective treatment. Lung cancer is the second most common cancer in men and women. And it is mainly a disease of older people. Only about percent of lung cancer patients are under and the average age http at diagnosis is about . Older patients are frequently not offered curative treatment like surgery because they and their families and even their doctors often think they wont be able to tolerate it. So they are referred for supportive care to control symptoms rather than surgery to remove the cancer. But many patients can survive and even thrive after surgery says Dr. Prasad Adusumilli https a thoracic surgeon at Memorial Sloan Kettering Cancer Center in New York. He was senior author of a study httpascopubs.orgdoifull.JCO... published in the Journal of Clinical Oncology in October. The study looked at more than patients with Stage nonsmall cell lung cancer who had surgery to remove their tumor. About percent of the patients were years old or older and about percent were at least . And he found that a surprising number of these older patients did quite well. One year after surgery more people had died from other causes than died from lung cancer. And after five years almost out of patients were alive and cancer free. They did well and beat their lung cancer Adusumilli says proving that when it comes to surgery for early stage lung cancer age should not be a limiting factor. This was the case for Morton Pollner who is one of Adusumillis patients. His cancer had not spread and Adusumilli told him there was a good possibility the cancerous tissue could be completely removed and he could go back to leading a normal life. That was seven years ago. Today Pollner is cancer free and enjoying life. Whatever I get from here on its like gravy he says. Surgery isnt the answer for all older lung cancer patients according to Dr. Len Lichtenfeld httppressroom.cancer.orglenlichtenfeld deputy chief medical officer of the American Cancer Society. Patients with heart or other health problems may not be candidates. At the same time he says its important to recognize that patterns of aging have changed over the past two decades. Seventy today is not the same as it was years ago Lichtenfeld says. Older adults are more functional both physically and mentally than ever before and he says the medical community needs to adjust its thinking about what treatments older cancer patients can tolerate. We shouldnt allow numerical age to be the deciding factor Lichtenfeld says."

"According to a new study women experiencing difficulty with time management attention organization memory and problem solving often referred to as executive functions related to menopause may find improvement with a drug already being used to treat attention deficit hyperactivity disorder ADHD. The study led by researchers at the Perelman School of Medicine at the University of Pennsylvania is the first to show that lisdexamfetamine LDX improved subjective and objective measures of cognitive decline commonly experienced in menopausal women. Results of the study are published online today in the journal Psychopharmacology. Reports of cognitive decline particularly in executive functions are widespread among menopausal women said lead author C. Neill Epperson MD professor of Psychiatry and Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Center for Womens Behavioral Wellness. There are approximately million postmenopausal women living in the US alone and with the average age of onset occurring at the great majority of those women will live in the postmenopausal state for at least onethird of their lives. Therefore promoting healthy cognitive aging among menopausal women should be a major public health goal. The Pennled team administered a oncedaily dose of LDX for four weeks to healthy nonADHDdiagnosed women between the ages of and experiencing difficulties with executive functions as a result of midlife onset menopause and as measured using the Brown Attention Deficit Disorder Scale BADDS. All participants served as their own controls by being randomly assigned to crossover to a placebo for an additional four weeks. The researchers found a percent overall improvement in executive functions for women receiving LDX compared to a percent improvement when taking placebo medication. There were also significant improvements in four out of the five subscales for women taking LDX organization and motivation for work attention and concentration alertness effort and processing speed and working memory and accessing recall. While psychostimulants such as LDX are primarily marketed for the treatment of ADHD they have been successful in treating cognitive complaints in some patients including postmenopausal women. They work by promoting the release of dopamine which is impaired in ADHD and other disorders characterized by executive function problems. Although we observed that shortterm use of LDX was well tolerated and effective in several subjective and objective areas longterm studies of menopausal women receiving LDX are needed similar to those conducted for ADHD patients said Epperson. It is also important for clinicians to confirm that a womans complaints of worsening memory are in the executive function domains are temporally related to the transition to menopause and are not indicative of some other pathological cognitive impairment before prescribing a trial of LDX. In addition to Epperson other Penn coauthors are Sheila Shanmugan Deborah R. Kim Sarah Mathews Kathryn A. Czarkowski Jeanette Bradley Dina H. Appleby Claudia Iannelli and Mary D. Sammel. This project was funded in part by Shire Pharmaceuticals the National Institute of Mental Health the National Institute on Aging and the National Institute on Drug Abuse. Penn Medicine is one of the worlds leading academic medical centers dedicated to the related missions of medical education biomedical research and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania founded in as the nations first medical school and the University of Pennsylvania Health System which together form a . billion enterprise. The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past years according to U.S. News World Reports survey of researchoriented medical schools. The School is consistently among the nations top recipients of funding from the National Institutes of Health with million awarded in the fiscal year. The University of Pennsylvania Health Systems patient care facilities include The Hospital of the University of Pennsylvania recognized as one of the nations top Honor Roll hospitals by U.S. News World Report Penn Presbyterian Medical Center Chester County Hospital Penn Wissahickon Hospice and Pennsylvania Hospital the nations first hospital founded in . Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners a partnership between Good Shepherd Rehabilitation Network and Penn Medicine. Penn Medicine is committed to improving lives and health through a variety of communitybased programs and activities. In fiscal year Penn Medicine provided million to benefit our community. Disclaimer AAAS and EurekAlert are not responsible for the accuracy of news releases posted to EurekAlert by contributing institutions or for the use of any information through the EurekAlert system."

"A new study calls into question the value of removing blood clots from a patients heart arteries during angioplasty a procedure to open blocked arteries. Although manually removing clots has become common medical practice this study of more than heart attack patients found no benefit in terms of reducing death heart attack or heart failure in the six months after the procedure. Removing clots appears to have increased the risk of stroke in the month after clots were removed the Canadian researchers report. There has been some controversy about removing blood clots during the treatment of heart attacks said lead researcher Dr. Sanjit Jolly an associate professor of cardiology at McMaster University in Hamilton Ontario. A study in suggested that removing clots during an angioplasty might save lives he said. Guidelines changed based on this study Jolly noted. Another trial in however suggested that removing clots was not beneficial he added. In this latest trial researchers found that routinely removing clots was not beneficial Jolly said. Jolly isnt sure why removing clots causes additional problems. It is possible that parts of the clot break off and travel elsewhere in the heart or brain he said. This is an unexpected finding and we want to confirm this in other studies Jolly said. Jolly said there are mechanical methods of removing clots which were not tested in this study. Whether these methods would have produced better results isnt clear. The jury is out on that. It needs to be tested in large trials he said. However preliminary results from small trials of mechanical clot removal have not been promising Jolly noted. Jolly said the lesson from his teams trial is that clot removal should be used only as a rescue treatment when an angioplasty fails to clear an artery. As a routine therapy clot removal is not beneficial and could have some significant downsides he said. The results of the study were published online March in the New England Journal of Medicine to coincide with a planned presentation of the findings at the American College of Cardiologys annual meeting in San Diego. For the study Jolly and colleagues randomly assigned patients undergoing an angioplasty after a heart attack to have clots manually removed or to not have them removed. Among all the patients . percent who had clots removed and percent of those who didnt died had another heart attack or developed heart failure in the days after the procedure. In the days after the procedure . percent of the patients who had clots removed suffered a stroke as did . percent of those who only had angioplasty Jollys team found. Dr. Gregg Fonarow a professor of cardiology at the University of California Los Angeles said This is a very important and eagerly awaited clinical trial. A number of studies have suggested a benefit from manually removing clots during an angioplasty but this trial found no clinical benefits for doing so he said. These findings will likely have important implications for clinical practice Fonarow said. More information Visit the U.S. National Library of Medicine http for more on angioplasty. SOURCES Sanjit Jolly M.D. associate professor cardiology McMaster University Hamilton Ontario Canada Gregg Fonarow M.D. professor cardiology University of California Los Angeles March presentation American College of Cardiology annual meeting San Diego March New England Journal of Medicine online"

"An experimental breath test designed to quickly identify patients suffering from heart failure simply by analyzing the contents of a single exhaled breath has demonstrated promise in early trials a team of researchers says. The investigators stressed that their evaluation is based on a small group of participating patients and that more extensive research will have to be done to confirm their initial success. But by subjecting a patients breath to a rigorous but fast analysis of the hundreds of socalled volatile organic compounds contained therein the study team said it has so far been able to correctly diagnose heart failure among newly hospitalized patients with a percent accuracy. Every individual has a breath print that differentiates them from other people depending on whats going on in their body explained study lead author Dr. Raed Dweik a staff physician in the department of pulmonary allergy and critical care medicine with the Respiratory Institute at Cleveland Clinic. And that print can tell us a lot about a person what theyve been exposed to and what disease they have he added. Thats what makes the new field of breath testing so promising because it is nonintrusive so there is no risk involved Dweik said. And you can do it anywhere in a clinic in a hospital anywhere. The findings were published March in the Journal of the American College of Cardiology. The study authors pointed out that the most common reason American patients are admitted to a hospital is when there is a suspicion of heart failure a toughtotreat condition in which the hearts pumping action grows gradually weaker over time. Currently a diagnosis of heart failure comes from a variety of factors according to the U.S. National Heart Lung and Blood Institute. These include medical history and symptoms and a physical exam in which a doctor will listen to a patients heart and lung sounds and check ankles feet legs and abdomen for signs of fluid buildup. Blood tests and an electrocardiogram can help confirm that heart failure exists. In the new study to gauge how well the noninvasive breath test could identify heart failure the team collected exhaled breath samples from patients who had been admitted as inpatients to the Cleveland Clinic. Of those had been admitted with a primary diagnosis of acute decompensated heart failure while another patients had shown no signs of heart failure but did have other cardiovascular issues. A single breath sample was obtained from each of the patients within hours of admission as well as from an additional patients with acute decompensated heart failure as an independent point of comparison. Within two hours of collection all the samples were subject to the breath test analysis which relied upon mass spectrometry technology to scan the samples for their molecular and chemical compound content. Some of those compounds had been pegged as potential telltale signs of heart failure. The result The breath test correctly identified all the patients with heart failure clearly distinguishing them from those cardiac cases where heart failure was not an issue. Dr. Gregg Fonarow a professor of cardiology at the University of California Los Angeles said that if further research were able to establish its effectiveness a breathdriven tool for identifying heart failure would be a helpful diagnostic innovation but more so in a doctors office or clinic than in the hospital. If it is clear that it is highly reliable and specific and sensitive then yes it would be a welcome advance he said. But I would say it would be perhaps more helpful for primary care physicians in an outpatient setting because that is where its most challenging to identify heart failure. Today a diagnosis in that environment is based on a patients history and exam but symptoms for heart failure can easily overlap with a lot of other diagnoses. And the blood work that would be taken in a doctors office might not come back until the next day delaying identification he noted. So a breath test would be most useful in that kind of challenging situation Fonarow said. But in an emergency room while there are challenges as well bedside blood tests are much more readily drawn and quickly analyzed so you can often get the results in minutes. So there may be potentially less of a role for a breath test in that kind of setting. Study author Dweik added that the test is theoretically cheap. But of course were still early in the process of exploring its potential. This study is really a proof of concept. There is much more work that needs to be done to get it to the point where it would become widely available. More information For more on heart failure visit the U.S. National Heart Lung and Blood Institute http SOURCES Raed Dweik M.D. staff physician department of pulmonary allergy and critical care medicine Respiratory Institute at Cleveland Clinic Gregg C. Fonarow M.D. professor cardiology University of California Los Angeles March Journal of the American College of Cardiology"

"A new consumerfriendly test for colon cancer https once approved could persuade more Americans to undergo screening for the deadly cancer https according to researchers presenting their findings on the tests effectiveness at a cancer https conference in Philadelphia. At the same meeting other researchers reported that they have new clues about how DNA characteristics can help predict colon cancer risk. The research was presented at the American Association for Cancer https Researchs special conference Colorectal Cancer https Biology to Therapy. Screening for Colon Cancer Back Story One in every of us will have colon cancer in our lifetime says David Ahlquist MD professor of medicine and a consultant in gastroenterology at the Mayo Clinic in Rochester Minn. who presented his findings on the new colon cancer screening test. Although colon https cancer is the second leading cause of cancer death for men and women in the U.S. many adults dont undergo the screenings once they reach age or earlier for those with a family history Ahlquist told a news conference. Estimates of how many adults undergo screening vary but Ahlquist says probably only adhere to the screening schedule over time. One screening test the colonoscopy https in which a flexible lighted tube with a video camera is inserted to examine the colon requires dietary restriction and preparation of the colon. Patients must often take time off work and need transportation home from the procedure. Catching Colon Cancer The New Test The new test a nextgeneration stool test known as a DNA methylation test detects tumorspecific alterations or methylations in the DNA in the cells shed into the stool from cancerous or precancerous lesions. The test can be done at home without dietary restrictions or bowel preparation. At the meeting Ahlquist presented the results of the first clinical evaluation study which enrolled patients.We were pleased by the results of this first clinical study he says. The test found of precancerous tumors that were bigger than a centimeter less than a half inch and found of cancers. Ahlquist called the figure very high and adds It would be very hard to find a noninvasive approach that could get that range. The test also found tumors on both sides of the colon Ahlquist says a feat that is not always accomplished by colonoscopy https These results were encouraging he says. The detection rate was for cancers in stages I through III considered the most curable and percent for stage IV the most advanced. The test is better at detecting cancer in early stages he says because the cells can become less methylated in later stages. The focus of the test is to catch cancers early he says. We are targeting earlystage cancers and thats where the test does the best. The median age of the patients was half were older half younger. Positive test results would be followed up with colonoscopy. A clinical trial https of the new stool test is expected to start in he says and if all goes well the test could be available soon after that. Ahlquist and Mayo Clinic are working in collaboration with Exact Sciences Corp. of Madison Wis. to develop the test. DNA Clues to Colon Cancer In other research Lisa Boardman MD an associate professor of medicine at Mayo Clinic wanted to find out if people who develop colon cancer at a younger age than usual are biologically older. The median age of colon cancer diagnosis is according to the National Cancer Institute. To determine biological age Boardmans team focused on telomeres small strips of DNA that cover the end of chromosomes. Theyre similar to the protective cap on shoelaces Boardman says. Telomeres are a biologic time clock. As we age our telomeres will become shorter. She took DNA from the blood https of patients diagnosed with colon cancer all under when diagnosed. She compared the groups telomere lengths to those of agematched healthy patients. She didnt find what she expected We found that longer telomere length was associated with colorectal cancer in people under age . But in those over age those with the longest telomeres had the lowest chance of developing colorectal cancer she found. The implications she says may be that there are different types of colorectal cancer https in younger patients this in turn may drive different and more effective treatments. Colon Cancer Advances Perspectives Both findings are interesting says Anil Rustgi MD the T. Grier Miller professor of medicine and chief of gastroenterology at the University of Pennsylvania School of Medicine and a program chairman for the conference. He cautions that both the findings about telomeres and the results of the stool test study are in early stages. But both areas fill a need he tells WebMD. Very broadly speaking there is a need to develop biomarkers whether blood https based or stool based or both in order to identify patients who might be at increased risk for colon cancer. The detection rates for the new test appear promising but this was a very preliminary study that utilized samples from individuals who were known to have colon polyps https or cancer says Durado D. Brooks MD director of prostate https and colorectal cancers for the American Cancer Society who reviewed the findings. The performance may decrease considerably when the test is used in a large population of healthy individuals where only a small number of polyps or cancers may be present. 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."

"Omega fatty acids may lower the risk of breast cancer in postmenopausal obese women according to researchers. The protection likely comes from the fatty acids antiinflammatory effects said Dr. Andrea Manni httpsprofiles.psu.eduprofilesdisplay professor and division chief of endocrinology diabetes and metabolism Penn State College of Medicine httpmed.psu.edu. Obesity is a major breast cancer risk factor in postmenopausal women and scientists believe increased inflammation is an important underlying cause in this population. Omega fatty acids have an antiinflammatory effect so thats one of the reasons why we suspected it may be particularly effective in obese women Manni said. Some epidemiological data supports the idea that omegas protect against breast cancer but the findings have been inconsistent. Manni suspected that data from normalweight women obscured the results. Normalweight women have less inflammation than heavier women and are therefore less likely to benefit from antiinflammatory omegas he said. To tease apart the effects Mannis team working alongside researchers from Emory University and Colorado State University looked at the influence of prescription omega supplementation on breast density in different weight women. Breast density is a wellestablished biomarker for breast cancer risk and may be an independent risk factor as well. The higher the breast density the more likely the woman will develop breast cancer Manni said. The study included healthy postmenopausal women with high breast density detected by routine mammograms. The women either received no treatment the antiestrogen drug Raloxifene the prescription omega drug Lovaza or a combination of the two drugs. At the conclusion of the twoyear study the researchers found that increasing levels of omega in the blood were associated with reduced breast densitybut only in women with a body mass index above bordering on obesity. Although Lovaza contains both of the fatty acids DHA milligrams and EPA milligrams only DHA blood levels were associated with breast density reduction. The researchers plan to test the effect of DHA alone in obese subjects potentially in combination with weight loss in a future trial. The finding supports the idea that omegas and specifically DHA are preferentially protective in obese postmenopausal women Manni said. This represents an example of a personalized approach to breast cancer prevention. These findings may help to support future research looking at the direct effect of omega supplementation on breast cancer incidence in obese women. Manni added that with obesityrelated cancers on the rise the findings could have implications beyond breast cancer. The researchers also made a secondary discovery. Lovaza is an omega drug FDAapproved for the treatment of severe high triglycerides at the dose of milligrams daily. In the current study the combination of Lovaza and a half recommended dose of Raloxifene at milligrams was superior to the individual treatments in reducing triglycerides and LDL bad cholesterol and increasing HDL good cholesterol. Other investigators on this project were Narinder Sandhu and Carina Signori Department of Medicine Susann E. Schetter Department of Radiology Jason Liao and Ana Calcagnotto Department of Public Health Sciences John P. Richie Bogdan Prokopczyk and Neil Trushin Department of Pharmacology Cynthia DuBrock Penn State Hershey Cancer Institute Christopher Hamilton and Laurence M. Demers Department of Pathology Cesar Aliaga and Karam ElBayoumy Department of Biochemistry and Molecular Biology all at Penn State Milton S. Hershey Medical Center Terryl J. Hartman Emory University and John McGinley and Henry J. Thompson Colorado State University.Susan G. Komen for the Cure and Penn State Hershey Cancer Institute funded this research. GlaxoSmith Kline and Eli Lilly supplied Lovaza and Raloxifene respectively. About Penn State College of MedicineLocated on the campus of Penn State Milton S. Hershey Medical Center in Hershey Pa. Penn State College of Medicine boasts a portfolio of nearly million in funded research. Projects range from the development of artificial organs and advanced diagnostics to groundbreaking cancer treatments and understanding the fundamental causes of disease. Enrolling its first students in the College of Medicine has more than students and trainees in medicine nursing the health professions and biomedical research on its campus."

"A new study published in the American Journal of Clinical Nutrition found that consuming tree nuts such as walnuts may lower the risk of cardiovascular disease. After conducting a systematic review and metaanalysis of controlled trials one of the authors Michael Falk PhD Life Sciences Research Organization found that consuming tree nuts lowers total cholesterol triglycerides LDL cholesterol and ApoB the primary protein found in LDL cholesterol. These are key factors that are used to evaluate a persons risk of cardiovascular disease. Walnuts were investigated in of the trials more than any other nut reviewed in this study. Our study results further support the growing body of research that tree nuts such as walnuts can reduce the risk of cardiovascular diseases said Dr. Falk. Tree nuts contain important nutrients such as unsaturated fats protein vitamins and minerals. Walnuts are the only nut that provide a significant amount . grams per one ounce serving of alphalinolenic acid ALA the plantbased form of omegas. Beyond finding that tree nuts lower total cholesterol triglycerides LDL cholesterol and ApoB researchers also found that consuming at least two servings two ounces per day of tree nuts such as walnuts has stronger effects on total cholesterol and LDL. Additionally results showed that tree nut consumption may be particularly important for lowering the risk of heart disease in individuals with type diabetes. Of articles surveyed trials met eligibility criteria for this systematic review and metaanalysis totaling unique participants. Trials directly provided nuts to the intervention group rather than relying solely on dietary advice to consume nuts. The dose of nuts varied from to gday and most participants followed their typical diet. More than two decades of research has shown that walnuts may help lower cardiovascular risk factors by decreasing LDL bad cholesterol by and diastolic blood pressure by mmHg as well as reducing total cholesterol raising HDL cholesterol reducing inflammation as measured by Creactive protein and improving arterial function. These factors are major contributors to heart disease risk and reducing them is a critical step toward a healthier heart. In addition to providing omegas walnuts also deliver a convenient source of fiber grams per ounce and protein grams per ounce. Coauthors with Dr. Falk are Liana C. Del Gobbo PhD Robin Feldman MBA Kara Lewis PhD and Dariush Mozaffarian MD PhD. This study was supported in part by funds from The International Tree Nut Council Nutrition Research and Education Foundation. 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 http 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 Del Gobbo L. Falk M.C. Feldman R. Lewis K. Mozaffarian D. Effects of tree nuts on blood lipids apolipoproteins and blood pressure systematic review metaanalysis and doseresponse of controlled intervention trials. Am J Clin Nutr. doi .ajcn... KrisEtherton P. Walnuts decrease risk of cardiovascular disease a summary of efficacy and biologic mechanisms. J Nutr. .SS. Sabat J Fraser GE Burke K Knutsen SF Bennett H Lindsted KD. Effects of walnuts on serum lipid levels and blood pressure in normal men.N Engl J Med. . Banel HK Hu FB. Effects of walnut consumption on blood lipids and other cardiovascular risk factors a metaanalysis and systematic review. Am J ClinNutr. Jul. Zhao G Etherton TD Martin KR et al. Dietary alphalinolenic acid reduces inflammatory and lipid cardiovascular risk factors in hypercholesterolemic men and women. J Nutr ."

"For women older than who have been confused by conflicting advice on how frequently to get a mammogram some new science is here to guide their decisions. An ambitious research effort published http Monday in the Annals of Internal Medicine set out to tailor womens breast cancer screening practices to match their actual risk of breast cancer. It concludes that a womans breast density should influence the frequency with which she is screened for breast cancer in addition to such longrecognized breast cancer risk factors as age ethnicity personal history of abnormal breast findings and a family history of breast cancer. For a small slice of those women that makes a onceayear mammogram twice as often as the current standard the best bet. Underwritten by the National Cancer Institute the new study combined the datacollection efforts of breastcancer epidemiologists with three separate teams of cancer modelers. In the study women were separated into subcategories based on four levels each of individual risk and breast density. New research suggests womens breast cancer screening practices should match their actual risk of breast cancer. The research recommends that women older than with dense breast tissue who have higherthannormal risk of developing breast cancer should get annual mammograms. These women however represent a small minority of women in that age group less than of all women between and . Many women however could go as long as three years between mammograms without increasing their risk of death from breast cancer the study found. For women with average risk and low breast density the models showed that there was no difference in deaths averted from breast cancer whether they were screened every two years or every three years. Women who had a mammogram every three years however had fewer unnecessary followup procedures including biopsies. Accepted clinical guidelines recommend that women to get a mammogram every two years. These recommendations first proposed in by a federal task force urged women to discuss with their physicians whether more frequent screening might be in order. But they have continued to be controversial with some activist and medical groups that believe additional lives could be saved if more women got an annual mammogram. The latest study largely validates the controversial recommendations made by the U.S. Preventive Services Task Force in . But it also clarifies which women should or could depart safely from its recommendations. Only in the last decade or so have radiologists oncologists and womens health specialists begun to appreciate the role of breast density in a womans breast cancer risk. While radiologists have long warned that dense breast tissue made cancerous masses harder to spot mounting evidence has found that cancer is also more likely to gain a foothold in dense breast tissue. The latest effort is the first to produce a risk calculator httptools.bcscscc.orgBCyearRiskcalculator.htm that takes that into account and asks for a radiologists standardized assessment of breast density in its sixpoint questionnaire. Many states now require radiologists reading mammograms to assign and communicate to a woman and her physician this density measure called a Breast Imaging Reporting and Data System or BIRADS score. Overall the risk measure calculates a womans likelihood of developing breast cancer over five and years and compares it to normal risk. In devising their models the researchers updated assumptions that have cast doubt on the relevance of existing breastcancer risk calculators which relied on the experiences of women who got an earlier generation of screening mammograms and were more likely to die of breast cancer than is currently the case. Here teams of modelers from Erasmus University in the Netherlands Albert Einstein College of Medicine in New York and Harvard Pilgrim Healthcare assumed that women were getting digital mammograms which offer improved cancer detection rates at lower radiation dosages than earlier mammographic methods. They took into account improved rates of breast cancer treatment effectiveness and changing causes of mortality for women older than . They also took account of the fact that breast density decreases in older women. These models are very applicable to the populations we screen said UC San Francisco breastcancer specialist Dr. Karla Kerlikowske one of the lead authors of the new study. The practice of tailoring screening intervals to a womans breast cancer risk is already widespread in some European countries including Sweden the Netherlands and Spain. A Spanish study similar to the latest modeling effort found that implementing a general threeyear screening interval with yearly screening for highrisk women reduced overdiagnosis and caught more missed cancers. Some lesions detected in screening will never grow to become clinically significant and will not impact a womans life Kerlikowske said."

"An experimental treatment that involves spinal injections of ozone gas and steroids relieved pain https in over twothirds of people with back problems related to a herniated disc. This condition occurs when the cushions or discs that serve as shock absorbers for the spine become inflamed and bulge or break open. When inflamed discs press against nearby nerves. People with this condition can experience pain numbness and weakness in the back buttocks and legs. None of the people in this study had been helped by other nonsurgical therapies and supporters say the new therapy could become a standard treatment for such patients. But a back pain https specialist who spoke to WebMD says that further research is needed. In the study people reported no pain at six months. About another third reported less frequent episodes of low back pain maybe once a day says researcher Thomas Lehnert MD an assistant professor of radiology at Frankfurt University in Germany. Another reported only a little improvement with pain persisting. And had no improvement or their pain got worse. A few patients resorted to back surgery. Continue Reading Below you might like Still ozone therapy could even help many patients with unrelenting back pain to avoid surgery Lehnert tells WebMD. Before the treatment patients had tried everything without success and were considering an operation he says. Studies suggest that ozone therapy works by reducing inflammation shrinking herniated discs and relieving pressure on the nerves bringing pain signals to the brain https The steroid further reduces inflammation. Lehnert presented the findings here at the annual meeting of the Radiological Society of North America. Pain From Herniated Disc As many as of adults in the U.S. suffer from lower back pain https_assetscontrolled_contenthealthwisemajorLow_Back_PainTopic_Overview.xml at some point in their lives and for many the cause is a herniated disc. About of people with herniated discrelated pain will improve within two months without surgical treatment. Of those who dont improve only will need surgery. The vast majority improve with physical therapy steroid injections chiropractic https_assetscontrolled_contenthealthwisespecialChiropracticTopic_Overview.xml treatment etc. says A. Nick Shamie MD of UCLA Spine Center a spokesman for the American Academy of Orthopaedic Surgeons. Its possible ozone treatment will someday be one of those options Shamie tells WebMD. But because so many people with pain from herniated discs get better on their own it is hard to prove that treatments like ozone therapy actually work he says. And in this study its unknown whether it was ozone the steroids or a combination of the two that helped patients he says. Theres no way to be sure Lehnert says. A headtohead comparison of treatments is planned to answer that question. Ozone Therapy for Back Pain Ozone therapy was developed In Italy. Its been used to treat thousands of lower back pain patients mainly in Europe in recent years. Lehnert says he added the steroid to reduce inflammation because of the pain is due to inflammation in the herniated area. Using computer imaging for guidance the doctor guides the needle used to deliver the ozonesteroid treatment directly into the herniated disc. Patients require no more than a local anesthetic. While patients in the study only got one injection more may be needed he says. Importantly imaging studies showed patients disc volumes shrunk by to in the study. If you reduce the volume it wont be pushing against the nerve causing pain Lehnert says. There were no serious complications and no one had an allergic reaction https_assetscontrolled_contenthealthwisesymptomAllergic_ReactionTopic_Overview.xml. Some people complained of pain around the area in the back where the needle was injected it went away after a few days. In other studies there have been reports of increased pain and bleeding in the eyes Lehnert says. Jeffrey Peterson MD professor of radiology at the Mayo Clinic in Jacksonville Fla. says the technique is promising. Were already using similar procedures for steroid injections says Peterson who moderated the session at which the findings were presented. Whats different here is the medical ozone. 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."

"Women who get routine mammograms can lower their risk of dying from breast cancer by nearly half a new Dutch study suggests. Our study adds further to the evidence that mammography screening unambiguously reduces breast cancer mortality said Dr. Suzie Otto a senior researcher in the department of public health at Erasmus Medical Center in Rotterdam the Netherlands. The routine screening also lowered the chances of being diagnosed with an advanced cancer she said. The study appears online Dec. in the journal Cancer Epidemiology Biomarkers Prevention. Mammography screening including the best schedule and the best age to begin is being hotly debated in the United States and elsewhere. Some experts think women should start getting them at age . Other think women should discuss the pros and cons of the test at decide on an individual basis and start screens routinely at . Ottos study only looked at women aged and older. Otto tracked patients who died from breast cancer from to and another control patients matched by age and other measures. Among the women with breast cancer nearly percent of tumors were found at screening and about percent between screens. Nearly percent of these women had never had a mammogram. Advanced tumors were found in about percent of the patients who had never been screened but in just over percent of those who had mammograms. Women who underwent screening reduced their risk of dying from breast cancer by percent. Women aged to had the greatest risk reduction reducing the risk of dying from breast cancer by percent. The risk reduction in younger women aged to was smaller at percent but still considered substantial. The greater risk reduction in women aged to Otto said is probably a result of the longterm good effects of screening participation in the earlier target age group to before the upper age limit for screening was extended in the Netherlands from to . The study findings add to the body of evidence supporting the fact that mammography matters in improving detection and survival said Dr. Stephanie Bernik chief of surgical oncology at Lenox Hill Hospital in New York City. This study focuses on survival. The study however has some limitations Bernik noted. Its not clear for instance whether the women who died of cancer got less aggressive treatment or refused treatment. That could have affected survival of course. Mammography does lead to overtreatment in some cases Bernik acknowledged. Some cancers that are found on mammography may not have proven to be an issue in a womans lifetime. But there is no way to figure out which cancers will be a problem or not she said. More information To learn more about mammograms visit the U.S. Department of Health and Human Services http SOURCES Suzie Otto Ph.D. senior researcher department of public health Erasmus Medical Center Rotterdam the Netherlands Stephanie Bernik M.D. chief surgical oncology Lenox Hill Hospital New York City Dec. Cancer Epidemiology Biomarkers Prevention online"

"In an influential panel of medical experts ignited a nationwide uproar by suggesting that women needed fewer mammograms httphealth.nytimes.comhealthguidestestmammographyoverview.htmlinlinenytclassifier than had long been recommended. Instead of starting at age and being screened every year women with average risk of breast cancer httphealth.nytimes.comhealthguidesdiseasebreastcanceroverview.htmlinlinenytclassifier could safely begin at and be tested every other year the group said citing extensive data to support its advice. It also said that after there was not enough evidence to determine whether routine mammography was worthwhile. Outrage ensued from advocates for screening who said the advice would lead to delayed diagnoses and deaths. On Monday the same panel issued an update of its guidelines and it is sticking to its guns. The basic advice which applies to women with an average risk of breast cancer was unchanged. The recommendations are not immediately expected to affect insurance coverage. In December Congress passed a bill https requiring private insurers to pay for screening mammograms for women and over every one to two years without copays coinsurance or deductibles through . Advertisement But advocacy groups said they were worried about what will happen after . It would be great if screening could be covered forever said Carli Feinstein chief of staff for Bright Pink https a national group focused on prevention and early detection of breast and ovarian cancer httphealth.nytimes.comhealthguidesdiseaseovariancanceroverview.htmlinlinenytclassifier. The Susan G. Komen for the Cure foundation also expressed concerns about insurance payment and issued a statement saying that a lack of coverage would hit high risk and underserved women hardest particularly black women who are more prone than whites to aggressive types of breast cancer. The panel issuing the guidelines is the United States Preventive Services Task Force http an independent board of doctors and other experts appointed by the Department of Health and Human Services to evaluate screening tests counseling and medications intended to prevent disease or detect it early. Panel members are volunteers and consider only the scientific evidence in their evaluations not cost or insurance coverage. The mammography guidelines http along with four editorials and seven supporting articles were published on Monday in the Annals of Internal Medicine. The task force emphasized that it was not advising against screening for women under or over or against screening every year as opposed to every other year. Rather it says that women should choose for themselves but that its guidelines offer the best overall balance of benefits and risks. The task force also examined data for two subjects not included in its report and concluded that there was not enough evidence to recommend for or against either of them. One was additional testing such as M.R.I. httphealth.nytimes.comhealthguidestestmrioverview.htmlinlinenytclassifier or ultrasound httphealth.nytimes.comhealthguidestestultrasoundoverview.htmlinlinenytclassifier for women with dense breast tissue which makes it difficult to detect tumors with mammography. The other was screening with a newer test called D mammography or digital breast tomosynthesis. Breast cancer is the secondleading cause of cancer httphealth.nytimes.comhealthguidesdiseasecanceroverview.htmlinlinenytclassifier death in women in the United States after lung cancer. In there were about new cases of breast cancer and deaths. The highest incidence is in women aged to . Dr. Constance Lehman a professor of radiology at Harvard Medical School and director of breast imaging at Massachusetts General Hospital who is not on the task force said she was pleased to see that although its advice had not changed the group had placed more of an emphasis than before on the importance of womens having the freedom to decide how often to be screened and when to start. The guidelines state that from ages to screening will reduce the odds of dying from breast cancer with women to benefiting the least and those to benefiting the most. The task force said it concluded with moderate certainty that the benefit was moderate in women to and small in women to . For every women screened repeatedly over years four lives are saved in women to eight in women to in women to and in women to the task force found. The science supports mammography as an important tool in the fight against breast cancer said Dr. Michael LeFevre a former chairman of the task force and a professor of medicine at the University of Missouri. He noted that breast cancer deaths have decreased since mammography came into widespread use in the s though some of the decline he said was also due to better treatments. We believe the benefits increase with age. But there are harms and particularly in their s women have to make a decision for themselves. One potential harm is false positives in which a suspicious mammogram finding leads to more tests sometimes even biopsies but turns out to be harmless. The guidelines relied in part on a study of records http from women who had digital mammograms from to which found that false positives were common especially in younger women. Among those to who had regular screening for every women tested . had a false positive. Sign up for Science Times Well bring you stories that capture the wonders of the human body nature and the cosmos. Advertisement Another study httpannals.orgarticle.aspxarticleid in found that percent of women who had yearly mammograms starting at age had at least one false positive by the time they were . Being tested every other year instead of every year cut the rate of false positives significantly to about percent. Another potential risk is overdiagnosis meaning that some of the tiny cancers found in mammograms might never progress or threaten the patients life. But because there is now no way to be sure which cancers will turn dangerous they are treated anyway. Researchers agree that overdiagnosis occurs but they do not know how often. Dr. Therese Bevers medical director of the Cancer Prevention Center at the University of Texas MD Anderson Cancer Center in Houston said she thought the task force overemphasized the importance of drawbacks like false positives. Dr. Clifford A. Hudis the chief of breast cancer medicine at Memorial Sloan Kettering Cancer Center also expressed concern The harm of a missed curable cancer is something profound. The harm of an unnecessary biopsy httphealth.nytimes.comhealthguidestestbiopsyoverview.htmlinlinenytclassifier seems somewhat less to me. Leading medical groups offer different advice about screening that leaves women and their doctors to puzzle it out for themselves. The National Comprehensive Cancer Network http an alliance of prominent cancer centers recommends mammograms every year starting at age . The American College of Obstetricians and Gynecologists http recommends them every year or two from ages to and every year after that. In October one of the most influential groups the American Cancer Society dialed back its advice http Although for many years the society recommended mammograms once a year starting at age it now advises that screening start at continue yearly through and then shift to every other year. Recognizing the confusion the cancer society the cancer network and other groups will attend a private meeting in Washington on Jan. and to try to produce a single set of guidelines. Representatives from the preventive services task force will attend but the task force cannot sign onto consensus statements. It can change its advice only by issuing new guidelines Dr. LeFevre said."

"People who cant control cholesterol with diet exercise and statin drugs could soon have a new option. According to a new study a medication ancetrapib appears to simultaneously raise the level of HDL sometimes called good cholesterol and to lower the level of LDL or bad cholesterol. HDL cholesterol is not fully understood but essentially sucks cholesterol out of cells to be flushed from the body through the liver. The study was sponsored by Merck the drugs manufacturer. It was published in the New England Journal of Medicine httpscdf.nejm.orgservicesGetOnlineFirstPDF.aspxDOINEJMoa and results were to be presented Wednesday at a meeting of American Heart Association in Chicago. The socalled DEFINE trial involved patients with coronary heart disease or at high risk for it. All were taking statins to lower LDL cholesterol. Roughly half also received ancetrapib while half got a placebo. On average within weeks patients getting ancetrapib saw LDL levels drop by nearly percent compared with the placebo group while their HDL levels rose by percent. There were no significant side effects. If the same benefit were seen in all patients at risk of heart disease far from a sure thing it would translate to hundreds of thousands of fewer deaths and heart attacks over a fiveyear period according to Dr. Christopher Cannon the lead study author and a cardiologist at Brigham and Womens Hospital in Boston. Its an amazing result said Dr. Robert Eckel of the University of Colorado a past president of the American Heart Association. Its like a rocket that landed on Jupiter rather than the moon. Still Eckel warned its too soon to say whether ancetrapib would actually prevent disease over the long run. Theres ample reason for caution. A similar medication torcetrapib was considered promising four years ago but was shelved by Pfizer after studies found it actually raised blood pressure and the risk of heart problems and death. Dr. PK Shah cardiologist at the CedarsSinai Heart Institute said that hes encouraged by DEFINE but that some of the details give him pause. It appears to be safe and to not raise blood pressure Shah told CNN but its not a slamdunk. For one thing despite improved cholesterol levels patients did not see less inflammation in their blood vessels. Inflammation is a sign of damage from cholesterol. To try to provide final answers Merck is launching a study called REVEAL to follow people in several countries over four years. The first patients will be enrolled in April according to Dr. Rory Collins of Oxford University where the research will be overseen. Lee Davies a Merck spokesman said the company is not likely to seek FDA approval until those results are in most likely in . By then results will also be in on a large study of a similar drug httpclinicaltrials.govctshowNCT dalcetrapib made by Mercks competitor Roche."

"Stanford University scientists have described a new type of test that can detect genetic mutations in minute amounts of DNA released from cancer cells into the blood. The test which is called single color digital PCR requires only a fraction of a tube of blood and can detect as few as three mutationbearing molecules in a single reaction. According to the report httpdx.doi.org.j.jmoldx... in The Journal of Molecular Diagnostics httpjmd.amjpathol.org this highly sensitive test has the potential to be personalized to recognize mutations unique to any individual cancer. For monitoring patient tumors only a handful of blood tests are available which are limited to only several types of cancers. Nearly all cancer patients require monitoring by whole body imaging which can be costly complex and timeconsuming. In contrast molecular tests like the one we have developed will enable patients to be monitored at every visit and thus have the potential for quickly tracking cancer growth and spread. Moreover the tests rapid turnaround and relatively low cost especially compared to nextgeneration DNA sequencing provide a potential opportunity for universal monitoring of more patients than is currently done explained lead investigator Hanlee P. Ji MD Associate Professor in the Department of Medicine at Stanford University and Senior Associate Director of the Stanford Genome Technology Center. The report describes the use of the test to analyze samples from six patients. Five patients were previously diagnosed with colorectal cancer and one with cholangiocarcinoma. After generation of customized mutation detection assays the researchers were able to identify tumorderived circulating DNA from three out of six patients. In one patient the assay was able to show the presence of three different mutations. The three patients whose samples did not show elevated cancer DNA were undergoing active treatment at the time of collection. The singlecolor digital PCR test offers several advantages over other methods of circulating tumor DNA analysis compared to nextgeneration targeted sequencing and fluorescent probebased digital PCR assays. The main advantage is that the new technique does not rely on preamplification which can introduce errors and biases. This test is simple enough to set up and analyze without extensive training and therefore it can be implemented by anyone making it highly accessible to any laboratory. It has been truly motivating to work with a technology that will help transform the way that we monitor and treat individuals with cancer. I am excited to share our findings with the cancer research community noted lead author and researcher Christina Wood Bouwens of the Stanford Genome Technology Center and the Division of Oncology Department of Medicine Stanford University School of Medicine Stanford California."

"Imagine. A nick of the skin a flash of cold and minutes on an exam table. For thousands of women this may soon replace surgery as a treatment for breast cancer. Cryoablation using extreme cold to destroy diseased cells is potentially the first ever procedure to treat breast cancer tumors without the trauma of surgery. Following numerous limited studies a growing number of women are now being treated with the technique as part of a groundbreaking clinical trial involving leading breast cancer specialists across the country. Utilizing IceCure Medicals innovative IceSense cryoablation system the multicenter trial is examining cryoablation of certain types of breast cancer. Potentially it will usher in a new and gentler pathway for the treatment of a disease that affects one in every eight women annually. The benefits of cryoablation over traditional breast cancer surgery are significant. The procedure is typically performed in a physicians office under ultrasound guidance in less than minutes. It involves a small incision and placement of an IceSense nitrogencooled probe into the center of a tumor to freeze it from the inside out. The diseased cells then crack open and die. Eventually they are absorbed by the immune system and new cells take their place. By contrast surgical cancer removal often means several hours in the operating room complications of general anesthesia and weeks or months of recovery. Surgery also typically involves significant breast tissue damage and disfigurement due to large incisions and removal of sizable breast mass. Cryoablation however precisely targets the tumor site and involves insertion of only a slim probe. Therefore it boasts fast recovery time significantly improved cosmetic results and greater patient comfort overall. In fact most women are able to resume normal activities almost immediately following treatment. They experience minimal scarring and excellent cosmetic results. Physicians participating in the trial report that patients feel minimal discomfort and can watch the procedure on the ultrasound screen. Most are extremely relieved to avoid painful disfiguring surgery and long recovery times. For women with certain types of breast cancer cryoablation is showing promise as an alternative to surgery particularly for patients over age says Susan K. Boolbol MD Chief of the AppelVenet Comprehensive Breast Service Mount Sinai Beth Israel who is participating in the trial. For older patients the risks associated with invasive procedures and general anesthesia as well as the discomfort of long recoveries also makes this procedure particularly desirable. As our understanding of tumor biology grows the ability to offer treatment options other than surgery is important. There is growing awareness treatment should be based on individual tumor biology. We are excited to be participating in this trial where some breast cancer patients can be treated without surgery adds Richard Fine MD The West Comprehensive Breast Center Memphis TN another surgeon active in the cryoablation trial. Over the next years women and older will make up one of the fastest growing populations diagnosed with breast cancer. We are confident that the ICE trial can prove certain women can be successfully treated less aggressively than in the past. The option of a nonsurgical treatment has significant benefits for patients and the overall health care system. Cryoablation is wellestablished in the treatment of liver kidney prostate and other cancers. Its effectiveness in breast cancer has been proven in a number of smaller studies including a recent American College of Surgeons Oncology Group ACOSOG trial and extensive longterm ongoing unpublished studies in Japan. The ICE trial which began patient enrollment in October will significantly expand data on the technique as a treatment for breast cancer. Patents will be followed for five years to ensure they remain cancer free. Developed by IceCure Medical Caesarea IsraelMemphis TN specifically for breast applications the IceSense Cryoablation System has a long history of successful treatment of benign breast fibroadenomas. The ongoing refinement of the technology makes treatment more precise and extremely reliable. The IceSense device delivers a stable cycle of extremely cold temperatures and relies on a maneuverable disposable probe and compact high tech console. For the first time these advances make precise targeting of tumors extremely reliable. The ICE trial is recruiting and following women aged years and older diagnosed with certain tumor subtypes and measuring less than . centimeters in diameter. Developed by a diverse esteemed scientific advisory board the trial is underway at carefully selected sites throughout the United States. As a market leader in cryoablation treatment of breast disease IceCure will utilize its resources to provide clinical and technological support to sites in the cancer trial. CONTACT William Irby wirbyicecuremedical.com mailtowirbyicecuremedical.com Photo httpphotos.prnewswire.comprnh SOURCE IceCure Medical"

"Many more stroke victims than previously thought can be saved from disability or death if doctors remove blood clots that are choking off circulation to the brain a new study has shown. These striking results will have an immediate impact and save people from lifelong disability or death Dr. Walter J. Koroshetz director of the National Institute of Neurological Disorders and Stroke said in a statement. I really cannot overstate the size of this effect. The key finding is that there is often more time than doctors realized in which brain cells can still be rescued by a procedure to remove the clot https Traditional guidelines have set a limit of six hours after stroke symptoms begin and said after that it would be too late to help. The study showed that the time window could be expanded to hours. However the findings do not apply to every stroke victim. The researchers used a special type of brain imaging to identify the patients who still had live brain tissue that could be saved if the blood supply was restored. Only about half the patients who were screened qualified for treatment known as thrombectomy which uses a mechanical device to pull clots out of a blood vessel. Advertisement The study involving patients at hospitals in the United States was stopped early because patients who had clots removed fared so much better than those who did not. Ninety days after treatment percent of the thrombectomy patients were well enough to be functionally independent as opposed to percent of those who did not have the procedure. The death rates were percent in the thrombectomy group and percent in those whose clots were not removed. The results were published http on Wednesday in The New England Journal of Medicine. The study was paid for by the National Institutes of Health and led by researchers from Stanford University. The Stanford team said it expected the study would lead the American Heart Association to change the guidelines for stroke treatment extending the time window for thrombectomy. It is not uncommon for strokes to begin during sleep and some of those patients miss out on treatment because it is not clear what time the stroke began. Medical practice has been to set the beginning of the time window as the last moment they were known to be well and if they have slept most of the night the sixhour window may be over by the time they wake up. New guidelines may allow such patients to be treated. About people a year suffer strokes in the United States and percent of those are caused by clots the same type treated in this study. Symptoms include speech difficulty arm weakness and facial drooping. Experts urge patients or their families to call immediately so that treatment can be started as soon as possible."

"U.S. regulators have approved the first drug for treating a neurological syndrome that causes uncontrollable body movements that can also interfere with speech swallowing and breathing. The sometimesdisabling disorder tardive dyskinesia is caused by some widely used prescription medicines for psychiatric and gastrointestinal disorders. It can surface while patients are on those medicines or years after they stop. It affects about U.S. patients. The Food and Drug Administration on Tuesday approved Ingrezza developed by Neurocrine Biosciences for treating adult patients. The San Diegobased biotech company didnt disclose the drugs list price but said it will when it begins offering the onceaday capsule for sale in May. A second drug for the disorder from Israels Teva Pharmaceuticals is expected to win FDA approval in late August. Tardive dyskinesia causes repetitive involuntary movements including rapid eye blinking grimacing lipsmacking and rapid movements of the trunk arms and legs. It can be embarrassing for patients and lead to social withdrawal and job loss. The condition usually occurs after longterm use of drugs that block important receptors in the brain that help regulate mood movement and motor function. Those drugs include pills for schizophrenia and related psychiatric disorders including a newer generation of them that were touted as safer than older antipsychotic drugs. That claim led to the newer medicines being widely prescribed for depression bipolar disorder and other conditions. Patients taking certain drugs for acid reflux and other stomach disorders such as metoclopramide also have developed tardive dyskinesia. Until now treatment generally was limited to stopping or reducing the dosage of the psychiatric or stomach medication or switching to a different medication. However stopping the original medication doesnt halt tardive dyskinesia in most patients and doing so can destabilize schizophrenia patients according to Neurocrines chief executive Kevin Gorman. Ingrezza known chemically as valbenazine was tested on more than patients. In the final stage of testing percent of patients given a high dose of Ingrezza saw their movement symptoms decrease by at least half after six weeks compared to about percent of those getting dummy capsules Neurocrine reported. Gorman said study participants who kept taking it after the six weeks had additional improvement and after a year. A small percentage who stopped taking Ingrezza then found their tardive dyskinesia symptoms didnt return. Ingrezzas possible side effects were rare and include sleepiness heart rhythm problems restlessness dry mouth suicidal thoughts headaches and joint pain. The drug is also being tested in patients as a possible treatment for Tourettes syndrome."

"An app called Natural Cycles has become the first to be classified as a medical device for use as contraception. Natural Cycles https uses a womans body temperature and menstrual cycle data to tell her when she is fertile. On fertile days users must abstain from sex or use other protection such as condoms to prevent pregnancy. The app was approved as a class IIb medical device by Tv Sd a notified body in Sweden where it is based. But sexual health organisations are warning that being classed as a medical device does not guarantee that the app will effectively prevent pregnancy. Sexual health charity the FPA Fertility UK and the Faculty of Sexual and Reproductive Health of the Royal College of Obstetricians and Gynaecologists are jointly calling for more largescale independent trials to ensure that evidence for such apps is on a par with other rigorously tested methods of contraception. Natural Cycles is one of numerous apps that help women practise a method of contraception called natural family planning http also known as the fertility awareness method. Natural family planning involves monitoring your body for signs of ovulation like an increase in your temperature or a change in cervical mucus. The thing about the female egg is that it only lives for about hours. So if you could reliably know when youve ovulated as a woman and then you give that egg two or three days to die any time after that in the cycle you will not get pregnant because theres no egg to fertilise Dr Susan Walker a senior lecturer in sexual health at Anglia Ruskin University told BuzzFeed News. Taking your temperature is what sets Natural Cycles and other apps like it apart from standard periodtracking apps. Without temperature information an app can can guess at your ovulation day based on your average cycle length but cant be sure when you actually have ovulated and so you cant use it as a reliable form of birth control. You dont actually need an app to practise natural family planning although it does cut down on paperwork. Even so the FPA advises that natural family planning is most effective if youre taught how to do it by a specialist teacher and you monitor all three fertility indicators temperature menstrual cycle length and cervical secretions. But natural family planning is not for everyone. For starters it can only protect against pregnancy not STIs. And if youre considering ditching the Pill because remembering to take it each day is too much effort you probably wont like having to remember to take your temperature every morning. You really have to commit to it whether youre doing it the traditional way or youre using an app. You have to take your temperature every morning and record that because without all that data its not really any use to you Bekki Burbidge head of communications at the FPA told BuzzFeed News. Its not a method thats going to suit everybody. But for women like Natural Cycles cofounder Dr Elina Berglund who want an alternative to hormonal contraception its an option worth pursuing. Along with her husband and cofounder Dr Raoul Scherwitzl Berglund created the algorithm used in the app for personal use before deciding it was something she should share with the rest of the world. When it comes to contraception its all about choice. Its not like one solution will fit all women said Berglund. Our typical user is in a stable relationship a few years before wanting to have kids. At first she starts to use the app to prevent pregnancy and when shes ready to get pregnant she switches to plan and usually she gets pregnant quite quickly because the app already knows her body and cycle. To use the app you need a monthly or yearly subscription and a thermometer that you have to use to take your temperature each morning before you get out of bed. The app then tells you if youre likely to be fertile or not that day. And if the app gives you a red day meaning you could be fertile you have to abstain from sex or use another method of protection such as condoms. Berglund says typically women will start with green days days on which its safe to have sex on the app and that this number will go up as it learns more about them. The algorithm analyses womens body temperature and menstrual data and learns more and more from previous temperatures and previous cycles to know the unique woman she said. Natural Cycles published a paper http last year in the European Journal of Contraception and Reproductive Healthcare looking at how effective the app was at preventing pregnancy. The study involved over users of the app. When it comes to contraceptive effectiveness youll usually get two numbers rating how effective it is with perfect use and how effective it is with typical use. Perfect use is using the method exactly as instructed every time without fail. Typical use is closer to what the average persons experience might be for example with the Pill typical use will include people who occasionally forget to take it. Natural Cycles own analysis shows that with perfect use just . out of people will get pregnant in a year using the app as contraception with this number rising to in for typical use. When used perfectly the combined oral contraceptive pill aka the Pill results in about . pregnancies per women per year httppatient.infodoctorcombinedoralcontraceptivepillfirstprescription. With typical use that number rises to almost per . But the study has some drawbacks for one it was done by the team behind the app themselves so isnt independent and the data was analysed retrospectively. According to NHS Choices http The retrospective design means data was not collected to specifically answer this question and may not be fit for purpose. And most women included were aged between and so theres no evidence the results would apply to women outside that range. They certainly had lots of women in this study but what they will need to do is follow women up for a longer period of time because things change Walker said. Berglund told BuzzFeed News that the Natural Cycles team analyse the data they have internally every month. She said theyre also in the process of publishing an updated version of last years study this time with around women included in a peerreviewed journal I cant say too much about the numbers but its going in the right direction. Diana Mansour vice president for clinical quality at the Faculty for Sexual and Reproductive Healthcare said in a statement There are hundreds of apps which claim to help users plan or prevent a pregnancy these come in all manner of forms and some will be more effective than others. Without independent evaluation we cant say for certain which will be effective at achieving this. Women who wish to use fertility awarenessbased contraception are advised to receive guidance from a qualified teacher to learn how to effectively monitor the different indicators. Apps currently do not come with this teaching leaving room for misunderstanding and inaccurate use. If youre thinking about changing your method of contraception try the FPAs My Contraception Tool http or speak to your GP."

"A skin patch for the treatment of migraines and the intense waves of nausea that often accompany these debilitating headaches has been approved by the U.S. Food and Drug Administration. Called Zecuity the patch contains sumatriptan one of the most widely prescribed medications for migraines. According to Dr. Fawad Khan a neurologist with Ochsner Neuroscience Institute in New Orleans few drugs are approved for the treatment of acute symptomatic migraine. To complicate matters many migraine sufferers can also experience severe bouts of nausea and vomiting. Another expert described the problem this way. Ive had some patients where the nausea and vomiting was so bad they couldnt even swallow a pill said Nancy Waltman a nurse practitioner with the University of Nebraska Medical Center College of Nursing Lincoln Division. A nasal spray is available as is an injection but many patients arent comfortable with these options Khan and Waltman noted. Khan said the Zecuity patch is simple efficient and can deliver the exact amount of dosage with minimal variability. The patch is attached to the upper arm or thigh and when the patient pushes a button the drug is delivered through the skin. Zecuity which is batteryoperated delivers . milligrams of sumatriptan over the course of about five hours and can relieve nausea as well as reduce sensitivity to light and sound. NuPathe Inc. which makes Zecuity hopes to have the patch on the market later this year. Research involving patients ultimately led to the approval of Zecuity. One study found that percent of patients using the patch were headachefree after two hours compared with percent of those using an inactive placebo. About half achieved a reduction in their headache after two hours compared with percent of those using the placebo. And percent of patients using the patch were relieved of their nausea compared with percent of those in the placebo group according to a company news release. The most frequent side effects were pain at the site of application along with tingling itching warmth and discomfort. Patients with heart disease or who are using antidepressants known as selective serotonin reuptake inhibitors should also be careful when taking sumatriptans said Waltman who added that she thought the patches are wonderful. One concern though is cost Waltman cautioned. Its not clear how much the patches will cost but the class of medications known as triptans can be expensive as much as a month although sumatriptan now has a generic version Waltman said. In general though the more options that are available to migraine headache patients the better Waltman said. Migraine patients tend to be underdiagnosed and undertreated and inappropriately treated. NuPathe CEO Armando Anido told Bloomberg News We anticipate the product will be available for sale in the fourth quarter of this year. More information The U.S. National Library of Medicine has more about migraines http SOURCES Fawad Khan M.D. neurologist Ochsner Neuroscience Institute New Orleans Nancy Waltman Ph.D. nurse practitioner University of Nebraska Medical Center College of Nursing Lincoln Division NuPathe Inc. news release Jan. Bloomberg News Last Updated Jan"

"An estimated million people worldwide suffer from agerelated macular degeneration httpsnei.nih.govhealthmaculardegenarmd_facts AMD a serious eye condition marked by the death of lightsensitive cells in the retina. Doctors can slow macular degeneration with vitamins laser surgery stem cell treatments and even implantable miniature telescopes http But many sufferers ultimately go blind. In the FDA approved an artificial retina that could help restore limited vision to people with degenerative eye diseases. But the device relied on a sunglassmounted external camera https and a transmitter that relayed sight information to the retinal implant. Now researchers at the Italian Institute of Technology in Genoa and the University of California San Diego have crafted artificial retinas that can be implanted entirely inside the eye which offer hope to those with macular degeneration. The devices are only experimental prototypes with many years of additional research and development likely before they might be ready for commercial use. But Dr. Grazia Pertile http director of ophthalmology at the Sacred Heart Don Calabria in Negrar Italy and one of the Italian researchers said in a written statement that her teams device could be a turning point in the treatment of extremely debilitating retinal diseases. Shes not alone in that assessment. This is definitely a game changer Dr. Kapil Bharti an investigator at the National Eye Institute in Bethesda Maryland who is not involved with the research says. Previous versions of these work in a very very lowresolution range. Patients were practically still blind and incapacitated as far as everyday tasks were concerned. These promise that patients could become more independent. When healthy retinal cells transmit visual information to the brain. As these cells die off AMD sufferers lose their central vision. The new prosthesis is designed to be implanted onto the back wall of the eye where it absorbs light and transforms it into an electrical signal that stimulates the stillactive retinal cells to restore vision. When the prosthesis was tested in rats the animals pupils constricted in response to exposure to light. The researchers were unable to determine how well the rats were able to see if at all but they noted that the animals eyes continued to react to light more than six months after the implant was installed. We hope to replicate in humans the excellent results obtained in animal models Pertile said. The team will conduct human trials later this year. The findings were published in the journal Nature Materials. http The researchers in San Diego have taken a different approach to solving AMD that they think can restore vision to resolutions as sharp as a healthy eye. There engineers have partnered with Nanovision Biosciences Inc. to create a retinal implant that uses silicon nanowires https smaller than the width of a cell to sense light entering the eye and stimulate retinal neurons. Powered by a small wireless device this circular array of nanowires mimics densely packed retinal cells to help achieve functional vision says Gabriel A. Silva professor of bioengineering and ophthalmology at UC San Diego. We want to create a new class of devices with drastically improved capabilities to help people with impaired vision Silva said. The findings were reported in the Journal of Neural Engineering httpiopscience.iop.orgarticle.meta. Neither of the implants is able to restore color to vision yet and Bharti has questions about the durability of organic eye implants. But he says Those are things that can be easily worked out and can be done in the coming future. Overall this is very exciting."

"The nations most influential pediatricians group says the health benefits of circumcision in newborn boys outweigh any risks and insurance companies should pay for it. In its latest policy statement on circumcision a procedure that has been declining nationwide the American Academy of Pediatrics http moves closer to an endorsement but says the decision should be up to parents. Its not a verdict from on high said policy coauthor Dr. Andrew Freedman. Theres not a onesizefitsallanswer. But from a medical standpoint circumcisions benefits in reducing risk of disease outweigh its small risks said Freedman a pediatric urologist in Los Angeles. Recent research bolstering evidence that circumcision reduces chances of infection with HIV and other sexually spread diseases urinary tract infections and penis cancer influenced the academy to update its yearold policy. The groups old stance said potential medical benefits were not sufficient to warrant recommending routinely circumcising newborn boys. The new one says The benefits of newborn male circumcision justify access to this procedure for those families who choose it. The academy also says pain relief stronger than a sugarcoated pacifier is essential usually an injection to numb the area. The federal Centers for Disease Control and Prevention http.usa.govhJiQj has estimated circumcision costs range from about to nationwide. Coverage varies among insurers and several states have stopped Medicaid funding for circumcisions. The new policy was published online Monday in the journal Pediatrics httppediatrics.aappublications.org. It comes amid ongoing debate over whether circumcision is medically necessary or a cosmetic procedure that critics say amounts to genital mutilation. Activists favoring a circumcision ban made headway in putting it to a vote last year in San Francisco but a judge later knocked the measure off the city ballot ruling that regulating medical procedures is up to the state not city officials. In Germany Jewish and Muslim leaders have protested a regional court ruling in June that said circumcision amounts to bodily harm. Meantime a recent study projected that declining U.S. circumcision rates could add more than billion in health care costs in coming years because of increased illness and infections. Circumcision involves removing foreskin at the tip of the penis. The procedure can reduce germs that can grow underneath the foreskin and complications including bleeding and infection are rare the academy says. Despite the U.S. decline about half of baby boys nationwide still undergo circumcision or roughly million each year. The countrys overall rate is much higher than in other developed nations but U.S. rates vary by region and are higher in areas where it is a cultural or religious tradition including among Jews and Muslims. Psychologist Ronald Goldman director of an anticircumcision group the Circumcision Resource Center said studies show circumcision causes loss of sexual satisfaction a claim the academy said is not supported by the research it reviewed and can be psychologically harming. Goldman contends medical studies showing benefits are flawed and that the academys new position is out of step with medical groups in other developed countries. The American Congress of Obstetricians and Gynecologists took part in the research review that led to the new policy and has endorsed it. Circumcisions in hospitals are typically performed by obstetricians or pediatricians. The CDC also participated in the review and will consider the academys updated policy in preparing its own recommendations a CDC spokesman said. The agency has a fact sheet summarizing circumcisions potential health benefits and risks but no formal guidelines. The American Medical Association and American Academy of Family Physicians have neutral policies similar to the pediatrics academys previous position. Philadelphia social worker Shannon Coyne examined medical research on circumcision before her son was born last September and had a tough time making a decision. She learned that a relatives boy needed reconstructive surgery after a botched circumcision and that anothers son who wasnt circumcised developed urinary infections. Coyne said she and her husband ultimately decided against circumcision because she didnt want her baby to have what she considers cosmetic surgery without being able to consent. Her advice to other parents is just make an informed decision. Do your research be openminded. Some states have eliminated Medicaid coverage for circumcision a trend that could contribute to rising health care costs to treat infections if circumcision rates continue to decline according to a study published Aug. in Archives of Pediatrics Adolescent Medicine. Dr. Aaron Tobian a Johns Hopkins University assistant professor who coauthored the study said the academys updated policy is a very good step."

"Drinking plenty of water each day may have an unexpected benefit staving off urinary tract infections a new study reports. Young women plagued by UTIs who drank an additional cups of water each day were nearly half percent as likely as a control group to have another infection the study showed. The water group also reduced their use of antibiotics by roughly half or percent. Whats more the amount of time that passed before a womans next UTI and between recurrent infections was longer in the water group than in the control group. Women are more prone to UTIs than men partly due to their anatomy. A shorter urethra makes it easier for bacteria from rectum to enter the vagina and travel to the bladder. Study author Dr. Thomas Hooton said its thought that increasing fluid intake decreases UTI risk in two ways by preventing bacteria from adhering to the bladder and by reducing the overall concentration of bacteria that could cause an infection. Flushing bacteria out of the bladder its been known at least its been thought that it is protective. This study suggests that it is said Hooton clinical director of the division of infectious diseases at the University of Miami School of Medicine. Dr. Hunter Wessells who wasnt involved in the study called the additional fluid intake substantial leading to a corresponding increase in urine output. It is the urine output which is of course the key factor leading to the effect seen in the study said Wessells chair of the department of urology at the University of Washington School of Medicine in Seattle. Dr. Susan Bleasdale medical director of infection control at the University of Illinois at Chicago said the study may be a game changer for antibiotic stewardship programs aimed at reducing inappropriate antibiotic use. She cited a review estimating that million to million women a year will suffer from a UTI accounting for . billion antibiotic prescriptions a year. We might not even need to use antibiotics she said. The study conducted in Bulgaria involved healthy premenopausal women who had at least three UTIs in the past year. All reported low daily fluid intake. They drank roughly four cups of fluid per day including just cups of water a day. Half of the women in the study were asked to consume . liters of water or about cups each day in addition to their usual daily fluid intake. Specifically they were asked to begin drinking a liter water bottle at each meal and finish each bottle before the next meal. The remaining women served as a control group. They continued their usual fluid intake. The women were followed for a year with clinic visits at the beginning of the study as well as and months later. Researchers measured their water and fluid intake urine volume frequency and concentration and symptoms. They also called the women each month to assess compliance and counsel them to return to the clinic for evaluation and possible treatment if they were experiencing UTI symptoms. Overall the water group increased daily water intake by close to cups a day. Their total daily fluid intake including water and other beverages averaged nearly cups. By contrast the control groups total daily fluid intake was less than half of that. Hooton noted that its not clear exactly how much fluid intake must increase to deliver a benefit. Theres no magic in a literandahalf he said. Likewise he believes any increase in fluid not just water may be beneficial since fluids are mostly water. And while the study involved younger women he said older women who experience recurrent UTIs may benefit from increasing their daily fluid intake as well. Whether the advice would benefit women with normal urine output however is unclear Wessells noted. In addition the bother associated with the higher urine output and feasibility of implementing this water intake strategy across a range of occupations and ages requires further study as well he said. Researchers presented the findings Saturday at IDWeek the annual meeting of the Infectious Diseases Society of America the Society for Healthcare Epidemiology of America the HIV Medicine Association and the Pediatric Infectious Diseases Society. Research presented at meetings is generally considered preliminary until published in a peerreviewed publication. More information Visit the U.S. Centers for Disease Control and Prevention for more on UTIs https SOURCES Oct. media briefing with Thomas Hooton M.D. University of Miami clinical director division of infectious diseases University of Miami School of Medicine and Susan Bleasdale M.D. medical director infection control University of Illinois at Chicago Hunter Wessells M.D. professor and chair department of urology University of Washington Seattle Oct. presentation IDWeek San Diego"

"Treatment guidelines suggest that nearly half of those over age nearly million people in the United States at least consider a cholesterol httphealth.nytimes.comhealthguidesnutritioncholesteroloverview.htmlinlinenytclassifierlowering statin to reduce heart attack risk. But a new large study of people who had an inexpensive heart scan found that half of those who were statin candidates had no signs of plaque in their heart and very little chance of having a heart attack in the next decade. Some cardiologists say the results could go a long way toward helping patients make a more informed choice about whether to begin taking the drugs. The test is a CT scan httphealth.nytimes.comhealthguidestestctscanoverview.htmlinlinenytclassifier that looks for calcium httphealth.nytimes.comhealthguidestestserumcalciumoverview.htmlinlinenytclassifier in coronary arteries a signal that plaque is present. It used to be expensive about but now typically costs between and . Still it is generally not covered by insurance and so is not often used to assess risk. The Xray httphealth.nytimes.comhealthguidestestxrayskeletonoverview.htmlinlinenytclassifier dose is about that of a mammogram httphealth.nytimes.comhealthguidestestmammographyoverview.htmlinlinenytclassifier. Advocates for the scan say it should be used to derisk people. It can let those who do not want to take statins know whether their chance of a heart attack is actually extremely low. Maybe this is a tool to actually do less said Dr. Harlan M. Krumholz a Yale cardiologist and senior author of the paper httpcontent.onlinejacc.orgarticle.aspxarticleID published on Monday in the Journal of the American College of Cardiology. For those who have no objections to taking statins there is no need for a heart scan Dr. Krumholz said. But for those who are reluctant to take them he said I am willing to use this to refine their risk estimate. Others say the test can lead to an array of other medical problems some of which are gravely serious. The only reason to do things is to feel better or to live longer said Dr. Peter Libby a cardiovascular disease specialist at Harvards Brigham and Womens Hospital. With the scans he said that has yet to be established. Heart researchers have long known that plaques in coronary arteries start out as pimplelike bumps but get waxy and hard and filled with calcium as time passes. Calcium shows up as white flecks in CT scans. The hard plaques are not the dangerous ones it is the softer ones that rupture and cause a heart attack. But the amount of calcium in arteries can give a good idea of the presence or extent of coronary artery disease. Dr. Krumholz and Dr. Khurram Nasir a preventive cardiologist at Baptist Health South Florida who conceived the new study reasoned that research on heart scans had not been designed to help doctors make treatment decisions they face today. Current guidelines have vastly increased the number of people who are eligible to take statins. Many people though are reluctant to take them. So the investigators asked could a scan identify those whose actual risk is lower than what was calculated The study subjects were nearly men and women ages to and included blacks whites Hispanics and Asians who were recruited in through . According to todays guidelines half had risk scores high enough that a statin would be recommended or should be considered. But guidelines then were more conservative and in accordance with them the subjects did not take the drugs. All had heart scans and half had no calcium visible on the scans. The subjects were followed for years. It turned out that the actual incidence of heart attacks or disabling chest pain httphealth.nytimes.comhealthguidessymptomschestpainoverview.htmlinlinenytclassifier in those with zero calcium was half or less than what the risk calculator predicted. For example a person who according to the current risk calculator has a percent risk of a heart attack in the next decade should take a statin the guidelines say. But if that person has a calcium score of zero the actual risk turned out to be percent below the . percent threshold for recommending a statin according to the guidelines and below the percent risk for considering a statin. Dr. Nasir said he has been using the studys findings in his clinic. First he asks patients for whom statins are recommended according to the current guidelines if they would want to avoid taking the drugs if they turn out to have a calcium score of zero and an actual risk of less than percent. Most tell him that they would. He then sends them for a scan. But the study was observational not the highest level of evidence. The problem critics say is that there has never been a rigorous study randomly assigning people to a change in treatment based on a scan and demonstrating that the change improves outcomes. Dr. Libby of Harvard for one is leery. Although very few heart attacks may have occurred over a decade in people with no calcium he said noncalcified plaques may be developing that could cause trouble. And the time span for worrying about a heart attack is more than a decade he said. One problem with the scans is what doctors call incidentalomas unexpected incidental findings like lung nodules httphealth.nytimes.comhealthguidessymptomsnodulesoverview.htmlinlinenytclassifier. The new study reported such findings in percent of patients but radiologists have reported incidences in the double digits. All too often these findings start patients on a diagnostic odyssey getting tests and biopsies sometimes exploratory surgery only to find that there was nothing wrong. Routine heart scans of tens of thousands of people would uncover a not negligible number of incidentalomas Dr. Libby said. Then there will be the people with no symptoms of heart disease who turn out to have a high calcium score. Dr. Libby explains what often happens next The doctor suggests an angiogram httphealth.nytimes.comhealthguidestestarteriogramoverview.htmlinlinenytclassifier an Xray of the arteries. It shows one of the arteries is percent blocked. The cardiologist inserts a stent httphealth.nytimes.comhealthguidessurgerystentoverview.htmlinlinenytclassifier a wire cage to keep the artery open although many researchers doubt stents httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsstentsindex.htmlinlinenytclassifier will prevent heart attacks in symptomless people on todays medical therapy. Now the patient with the newly inserted stent has to take a powerful anticlotting drug and aspirin for at least the next year. Because the drugs make bleeding more likely the patient notices blood in his stool. Before he can have a colonoscopy httphealth.nytimes.comhealthguidestestcolonoscopyoverview.htmlinlinenytclassifier to check on the blood he has to stop the anticlotting drugs for a week. But without them he risks getting a clot at the site of the stent and having what could be a fatal heart attack. Now we have taken a healthy person asymptomatic and turned him or her into a patient Dr. Libby said. But others like Dr. Daniel Soffer a general internist at the University of Pennsylvania see a real benefit in using heart scans to derisk patients. All the other biomarkers get blown away compared to the calcium score he said adding that it is far and away the best marker of risk. The new study justifies to him a practice he began years ago of using scans with the belief that they could be better than a risk calculator for some patients. One of his patients Rena H. Barnett had a scan a decade ago. Her mother died of a heart attack and Mrs. Barnett knew her level of LDL cholesterol the bad kind was very high at . But she said statins and other cholesterollowering drugs made her depressed and made her muscles ache so much she could not get out of bed in the morning. She tried lowering her LDL level by becoming a vegetarian but it did not budge. Relaxation with yoga did not help. But when Mrs. Barnett had a heart scan she learned that her calcium score was zero. Five years later she had another scan. Zero again. For now Mrs. Barnett is not taking anything to lower her cholesterol levels. Its not that I feel good about it. It would be nice to have it lower she said. But her anxiety has lifted."

"The Food and Drug Administration httptopics.nytimes.comtopreferencetimestopicsorganizationsffood_and_drug_administrationindex.htmlinlinenytorg on Tuesday approved a new heart failure httphealth.nytimes.comhealthguidesdiseaseheartfailureoverview.htmlinlinenytclassifier drug from Novartis httptopics.nytimes.comtopnewsbusinesscompaniesnovartis_agindex.htmlinlinenytorg that has been shown to reduce death and hospitalizations from the condition. Excitement has been growing for the drug known as Entresto since the results of a large clinical trial were announced nearly a year ago showing a percent reduction in the risk of death from cardiovascular causes or hospitalization for worsening heart failure. In a somewhat unusual move for a pharmaceutical company Novartis has predicted that Entresto could eventually achieve more than billion in annual sales globally making it one of the worlds bestselling medications. This is one of those onceinadecade kind of breakthroughs to get a drug that extends life so substantially David Epstein the head of Novartiss pharmaceutical division said in an interview. More than five million Americans and an estimated million people worldwide suffer from heart failure in which the heart cannot pump blood adequately to the bodys organs often as a result of a heart attack or high blood pressure httphealth.nytimes.comhealthguidesdiseasehypertensionoverview.htmlinlinenytclassifier. Heart failure can cause shortness of breath httphealth.nytimes.comhealthguidessymptomsbreathingdifficultyoverview.htmlinlinenytclassifier fatigue and retention of fluids and is one of the leading causes of hospitalization if not the leading cause. Some heart failure specialists have said that Entresto which was known during its development as LCZ could replace the existing mainstay treatments for chronic heart failure which are drugs called angiotensinconverting enzyme ACE inhibitors or somewhat similar angiotensin II receptor blockers. Novartis said Entresto would cost about . a day or about for a year with two tablets taken daily. Mr. Epstein said the price was really quite reasonable given that some drugs for other diseases cost many times that amount and confer less benefit. He said the company could make the case that Entresto could save money over all by keeping people out of the hospital. That said the ACE inhibitors Entresto will be competing with are largely inexpensive generics so some health plans could conceivably be reluctant to pay for Novartiss product. Novartis is considering trying socalled risksharing with some health plans meaning it might charge more if the drug really does keep people out of the hospital and less if it doesnt. But such talks while encouraging are still in the early stages a Novartis spokesman said. Timothy Anderson pharmaceutical analyst at Sanford C. Bernstein Company said in a recent note that Entresto was likely to become a megabrand over time but that the initial uptake was likely to be on the slower side given the entrenched nature of offpatent ACE inhibitors. He said it was highly unusual that there were no major competitors for Entresto on the way giving it a long runway. In a clinical trial with more than participants patients were randomly assigned to take either Entresto or enalapril an ACE inhibitor. Patients in both groups of the study could also take other drugs such as beta blockers as their doctors saw fit. After about months . percent of those taking Entresto had either died from cardiovascular causes or had been hospitalized for worsening heart failure compared with . percent for those taking enalapril. That represented a relative risk reduction of percent using a measure known as the hazard ratio. Novartis said that about . million Americans would be eligible for the drug which was approved for patients with socalled Class II to Class IV chronic heart failure with socalled reduced ejection fraction. Novartis is sponsoring another study to see if the drug is effective for those with preserved ejection fraction which accounts for half of heart failure cases. The F.D.A. said that the main side effects were low blood pressure httphealth.nytimes.comhealthguidestestbloodpressureoverview.htmlinlinenytclassifier high blood potassium levels and kidney impairment. It said there were also cases of angioedema httphealth.nytimes.comhealthguidesdiseaseangioedemaoverview.htmlinlinenytclassifier an allergic reaction that usually results in swelling of the lips or face but can be life threatening if swelling interferes with breathing. Blacks and those with a previous history of the condition were at increased risk it said. Entresto is a combination of two drugs one of which is valsartan the active ingredient in the blockbuster drug that Novartis sells as Diovan but which now faces generic competition. The other ingredient sacubitril inhibits an enzyme known as neprilysin a new mechanism of action for a heart failure drug."

"Cardiac hybrid imaging with CT and nuclear stress testing is an excellent longterm predictor of adverse cardiac events like heart attacks in patients being evaluated for coronary artery disease according to a study published in the journal Radiology. Coronary artery disease is a leading cause of death and disability worldwide. Invasive coronary angiography ICA is considered the gold standard for determining the percent of stenosis or narrowing due to plaque in a coronary artery. However the degree of stenosis on ICA is not always an accurate predictor of heart attack risk because it gives no information on perfusion or the flow of blood into the heart muscle. Inadequate perfusion also known as ischemia is a potential danger to the patient. In lesions with less than percent narrowing one in five lesions still produce an ischemia said study coauthor Philipp A. Kaufmann M.D. professor and chair of nuclear medicine and director of cardiac imaging at University Hospital Zurich in Switzerland. Cardiac hybrid imaging combines coronary computed tomography angiography CCTA and myocardial perfusion imaging with single photon emission tomography SPECT to provide information on both stenosis and perfusion. The approach has shown promise in studies focusing on shortterm observations but information is lacking on longterm outcomes. The research team looked at patients who underwent hybrid imaging. During a median followup of . years a total of major adverse cardiac events including deaths were observed in the final study population. Patients with matched findingsstenosis of percent or more on CCTA with evidence of ischemia on SPECT in the area of the heart to which the blocked vessel was supplying bloodhad more than five times the risk of adverse events than those with normal findings. Patients with unmatched findings or evidence of ischemia but not in the area of the heart being fed by the stenotic artery had three times the risk. Major adverse cardiac event rates were . percent for matched findings and . percent for unmatchedconsiderably higher than the . percent rate for normal findings. The results show that cardiac hybrid imaging is an excellent longterm predictor of adverse cardiac events in patients evaluated for coronary artery disease. Dr. Kaufmann said that hybrid imaging findings could help guide treatment decisions such as whether or not a patient should have a revascularization procedure such as bypass or angioplasty. In patients with multiple lesions or complex coronary anatomy it is in many cases very difficult to correctly identify the culprit lesion he said. In a previous multicenter trial with hybrid imaging we were able to see that about one in five patients should be revascularized in another coronary artery than originally planned. The present study now documents the prognostic importance of the comprehensive assessment provided by hybrid imaging. The study supports CCTA use for an initial noninvasive evaluation of patients with known or suspected stable coronary artery disease. No additional imaging would be necessary if the results were normal. If a lesion was evident then clinicians could employ a nuclear scan to assess ischemia and take advantage of both modalities by fusing the results together to make a hybrid image. The strategy of direct referral to invasive coronary angiography without noninvasive imaging is obsolete Dr. Kaufmann said. Even after documenting coronary artery disease with coronary CT angiography we need further noninvasive evaluation before deciding upon revascularization versus medication. The researchers hope to run a trial to show that hybrid imaging can have a positive impact on patient outcomes. They are also looking at what they call triple hybrid imaging which combines the CCTASPECT hybrid with information on coronary artery shear stress. The shear stress information could help identify lesions that do not yet have an impact on ischemia but will in the future. Hybrid SPECT Perfusion Imaging and Coronary CT Angiography LongTerm Prognostic Value for Cardiovascular Outcomes. Collaborating with Dr. Kaufmann were Aju P. Pazhenkottil M.D. Dominik C. Benz M.D. Christoph Grni M.D. Michael A. Madsen M.D. Fran Mikulicic M.D. Elia von Felten M.D. Tobias A. Fuchs M.D. Beatrice Hirt Moch M.D. Julia Stehli M.D. Thomas F. Lscher M.D. Oliver Gaemperli M.D. and Ronny R. Buechel M.D. Radiology is edited by David A. Bluemke M.D. Ph.D. University of Wisconsin School of Medicine and Public Health Madison Wis. and owned and published by the Radiological Society of North America Inc. httpRSNA.orgradiology RSNA is an association of over radiologists radiation oncologists medical physicists and related scientists promoting excellence in patient care and health care delivery through education research and technologic innovation. The Society is based in Oak Brook Ill. RSNA.org httpRSNA.org For patientfriendly information on cardiac imaging visit RadiologyInfo.org httpRadiologyInfo.org."

"Surgery to remove the appendix called appendectomy is the goto treatment for patients with appendicitis and is one of the most common surgical procedures in the U.S. However antibiotic drugs could take the place of surgery for the many patients who have mild cases of appendicitis according to new research. Researchers in Finland studied more than adults who had uncomplicated appendicitis meaning their appendixes had not ruptured and they had no signs of infection or other problems in their abdomens. Half of the patients received an appendectomy which is the standard of care while the other half got an IV of antibiotics for three days followed by antibiotic pills for a week. The researchers found that of the patients who took antibiotics recovered from appendicitis and did not need surgery for at least a year afterward. The rest of the patients who went on to have another case of appendicitis and need an appendectomy did not have a higher rate of complications than the patients who initially received surgery. This is quite a radical change in the line of thinking because appendectomy has served patients well for over years said Dr. Paulina Salminen a surgeon at the Turku University Hospital in Finland and lead author of the study which was published on Tuesday in The Journal of the American Medical Association httpjama.jamanetwork.comarticle.aspxarticleid. An editorial accompanying the study added the time has come to consider abandoning routine appendectomy for patients with uncomplicated appendicitis. The findings suggest that for patients with uncomplicated cases who make up about of the patients diagnosed with appendicitis surgery may not be necessary Salminen said. However if the appendix has ruptured emergency surgery must be done because patients can develop deadly infections in the abdomen and antibiotics alone are not strong enough to treat them she added. Several previous studies have compared appendectomy with antibiotics http but most of them have relied on clinical examination to diagnose uncomplicated appendicitis. The current study relied on CT scans which are a more accurate way to diagnose the disease and to make sure only patients with simple cases are studied Salminen said. Still in both the current study and a study http that also used CT scans more than a quarter of patients who were treated with antibiotics for their welldiagnosed cases of simple appendicitis had a recurrence of appendicitis and ended up needing surgery. In contrast the failure rate was less than in the group that initially got an appendectomy in the current study. One patient died of heart disease in the week after surgery. The high failure rate of antibiotic therapy suggests that it is not ready for the clinic said Dr. Curtis Wray an associate professor of surgery at the University of Texas Health Science Center at Houston. I think we need to determine who are really the candidates for this type of nonoperative therapy Wray said. Part of the reason for the failure rate could be that the antibiotics did not clear up the obstruction in the appendix that was the root cause of the inflammation. More analyses need to be done to understand how this group differed from the other maybe they had more advanced appendicitis and thus to be able to predict who might not make a full recovery with antibiotics alone Wray said. If antibiotic therapy does become a viable alternative to appendectomy it would probably lead to a big cost savings Wray said. There are about appendectomies performed every year in the U.S. About of them are uncomplicated cases many of which could be good candidates for antibiotics. However as Wray pointed out it may take a little while for this nonsurgical option to be accepted by patients because appendectomy is considered the gold standard. In addition laparoscopic appendectomy is minimally invasive and patients usually go home the same day he added. Nevertheless Salminen said that surgery can cause several days of pain and missed work whereas patients would probably not experience pain following antibiotic therapy and would have a faster recovery. Because the study only looked at people between and it is not clear how effective antibiotic therapy would be in children the group that accounts for most cases of appendicitis. Other researchers are planning to do a similar study in children Salminen said. Salminen and her colleagues also did not include pregnant women in the study. You cant really do a CT scan on pregnant women so you cant really have the precise diagnosis so to be on the safe side those patients would probably have to undergo appendectomy she said. The study gave patients in the antibiotic group an IV of ertapenem once a day for three days and then prescribed a week of oral antibiotics levofloxacin and metronidazole. Every time you use antibiotics you have to think about the risk of developing antibiotic resistance especially because the antibiotics used here are very broad spectrum Salminen said. She added that future studies should look at whether lower doses of antibiotics and the use of more specific antibiotics that may be less likely to lead to resistance could also be effective in treating appendicitis."

"If mass mammography screening for breast cancer worked well fewer women would die from the disease. And yet a new study published in JAMA Internal Medicine httparchinte.jamanetwork.comarticle.aspxdoi.jamainternmed.. has found something that may seem counterintuitive More breast cancer screening didnt actually save lives. Screening did however lead to more overdiagnosis detecting cancers that would not have been fatal or even harmful. Related The problem with Taylor Swifts advice about cancer screening http The research led by Richard Wilson of Harvard University revealed that in more than US counties mammography screening programs were linked with more diagnoses of smaller breast cancers but not with fewer deaths or with fewer larger breast cancers which theoretically would be prevented by finding the disease early through screening. You can see this clearly in the chart below The number of diagnosed breast cancers rose with more screening yet the number of deaths from breast cancer years later remained stubbornly stable. Extent of screening breast cancer incidence and mortality in women years and older in US counties. JAMA Internal Medicine httparchinte.jamanetwork.comarticle.aspxdoi.jamainternmed.. To be clear Mass screening is different from using technologies like ultrasounds to diagnose people at risk of a disease or who have symptoms that require investigation. And not all mass screening programs are bad. Colorectal cancer screening for example has been shown to save lives as a result of early detection and the Pap test transformed cervical cancer into a treatable disease. But this isnt the first study to call into question the benefits of mammography and whether women are too often the victims of overdiagnosis. The trouble with overdiagnosis is that while the cancers doctors find wouldnt have harmed their patients the treatment and stress that result from the diagnosis probably will. We have to find a better way to screen women for breast cancer Overdiagnosis in thyroid cancer While the incidence of the disease increased after a screening program was instituted in South Korea the thyroid cancer mortality rate stayed the same. New England Journal of Medicine http The medical community has known http about overdiagnosis and overtreatment for years documenting the problem in a range of cancers in breast prostate lung and thyroid http which you can see in the chart above. This raises a tough question What should the medical community do about overdiagnosis In a related commentary httparchinte.jamanetwork.comarticle.aspxdoi.jamainternmed.. in the journal a pair of doctors from the University of Washington School of Medicine note that the estimates of overdiagnosis of breast cancer are frustratingly broad from less than percent to percent or more of women who get screened. In other words we dont actually know how bad the problem is. Sadly they write we are left in a conundrum. Women will increasingly approach their physicians with questions and concerns about overdiagnosis and we have no clear answers to provide. The authors of the newest study dont advocate no screening. Instead they note that the benefits of screening will probably be more favorable when screening is directed at people with a high risk of the disease such as those with a family history of breast cancer. The US Preventive Services Task Force httpscreeningforbreastcancer.org which analyzes the best available evidence to create guidelines for doctors now recommends biennial mammography screening for the general population in women ages to . For women under and over who arent at a high risk of breast cancer the benefits of mass screening are less clear. There are small things doctors can do that still dont happen often enough. For example most women arent told about the potential downsides of mammography screening even though theyre almost always briefed on the benefits. How to think about the benefits and harms of mammography. Harding Center for Risk Literacy Harding Center for Risk Literacy https For now its up to patients to talk to their doctors about their particular risk profiles and how to screen accordingly. We also need to remember that in medicine more often than not we generally overestimate the benefits and underestimate the harms http"

"Necator americanus the New World hookworm is as long and thin as a vermicelli noodle. It will slip under your skin and travel through the blood to your trachea where you will swallow it and give it a free ride to your small intestine. Upon arrival it will open its tiny jaw dig its teeth into your intestinal wall and begin to drink your blood. And it could be the key to making millions of people healthier. Writing in the journal Science Translational Medicine on Wednesday scientists report that a protein produced by hookworms eases the symptoms of asthma in mice and could one day be made into a pill to treat humans. The study is the latest from a surprising field of research into the potentially positive sides of parasites one of the most maligned groups in the animal kingdom. It began years ago when a gastroenterology surgeon approached parasitologist Alex Loukas httpsresearch.jcu.edu.auportfolioalex.loukas one of the senior authors on the new study. The doctor wanted to know whether there might be a connection between the dramatic success of deworming programs around the world and the rise of immune system problems like asthma and celiac disease. If you look at the data that comes in from immunological studies . . . where you remove the parasites thats where you see the highest incidence of autoimmune diseases and allergies said Severine Navarro httpsresearch.jcu.edu.auportfolioseverine.navarro the papers lead author and a senior research fellow in Loukass lab at James Cook University in Australia. Dear Science Why do we get allergies Whats the point of a runny nose https_term.bcb Many parasites have evolved the ability to hide from their hosts immune systems. When a hookworm crawls into a human it secretes chemicals that turn off the immune alarm bells and repair the tissue around it. It limits its consumption of blood to a few drops a day and doesnt leave its offspring scattered all over its hosts gut. Instead it thoughtfully plants them in the hosts poop to ensure an orderly exit from the body. Like a very conscientious cat burglar the hookworm knows its best served by not making a mess. Its almost symbiotic Navarro said because in order for it to survive and thrive it needs its host to be happy and healthy. Perhaps the adaptations that help the parasites stay hidden also benefit their host by reining in overactive immune systems. Thinking that they might be onto something the researchers found adults with celiac disease a serious genetic disorder that causes an autoimmune response to gluten who volunteered to have doctors infect them with a slimy slithery hookworm. It was important that the participants be adults because even relatively benign parasites can cause serious problems for children pregnant women and others. Navarro also warned people with autoimmune disorders that they should not attempt to infect themselves with a hookworm no matter how debilitating their illness might be. Parasites are no joke. For the dozen trial https participants the hookworm did improve their tolerance of gluten. It was an intriguing result but its difficult to scale that kind of study. Only so many people are willing to have a parasite put inside them for science. And because of the risks associated with parasites going around infecting people isnt a viable treatment option. Dear Science How many germs are actually on a toilet seat and should I care httpwpo.stzEH So Navarro and her colleagues isolated the active ingredient in hookworm spit a compound called AIP and injected it into asthmatic mice on a daily basis for five days. The animals asthma systems substantially declined and their airways became measurably less inflamed. These benefits persisted for weeks after the mice stopped getting the treatment I dont even know how much that is in mouse years Navarro said. The researchers also noticed that AIP seemed to have a calming effect on the bodys dendritic cells http a part of the immune system responsible for processing threats. It is basically rewiring the cells in that tissue into promoting very efficient regulatory T cells Navarro said describing the cells that help modulate the immune system. This suggests that AIP might also help humans since dendritic cells have the same function in us that they do in mice. Navarro said their next step is a phase one clinical trial which would test the effectiveness of an AIP pill. Should that work it has the potential to help the million people around the world who suffer from asthma. The compound might also be used to treat other autoimmune disorders like celiac disease inflammatory bowel disease and multiple sclerosis. This study would also suggest that humans lost something when we rid ourselves of the microbes and parasites that had evolved alongside us for tens of thousands of years. Theres a major school of thought that says that these parasites should be encountered early in life to contribute to the education of the immune system Navarro said. She wouldnt go so far as to call parasites good. Deworming campaigns and other public health efforts unquestionably have protected countless people from anemia malnutrition developmental disorders and potentially deadly infections. But what we need is to find whats good in them she said and try to restore that missing component."

"Doctors have been saying for years that what you eat can affect the health of your heart. Now theres growing evidence that the same is true for your brain. A new study by researchers at Rush University Medical Center in Chicago shows a diet plan they developed appropriately called the MIND diet may reduce the risk of developing Alzheimers disease https by as much as percent. Even those who didnt stick to the diet perfectly but followed it moderately well reduced their risk of Alzheimers by about a third. Diet appears to be just one of many factors that play into who gets the disease said nutritional epidemiologist Martha Clare Morris PhD the lead author of the MIND diet study. Genetics and other factors like smoking exercise and education also play a role. But the MIND diet helped slow the rate of cognitive decline and protect against Alzheimers https regardless of other risk factors. The study published in the journal Alzheimers Dementia looked at more than people between the ages of and who filled out food questionnaires and underwent repeated neurological testing. It found participants whose diets most closely followed the MIND recommendations had a level of cognitive function the equivalent of a person . years younger. The MIND diet breaks its recommendations down into brain healthy food groups a person should eat and five unhealthy food groups to avoid. It combines many elements of two other popular nutrition plans which have been proven to benefit heart health the Mediterranean diet https and the DASH https Dietary Approaches to Stop Hypertension diet. MIND stands for MediterraneanDASH Intervention for Neurodegenerative Delay. But the MIND diet also differs from those plans in a few significant ways and proved more effective than either of them at reducing the risk of Alzheimers. Click through to see which foods to eat and which ones to avoid for optimal brain health. https"

"Scientists have discovered that a commonly prescribed dementia drug could hold the key to helping prevent debilitating falls for people with Parkinsons. The research published today in The Lancet Neurology shows people with Parkinsons who were given the oral drug rivastigmine were less likely to fall and were considerably steadier when walking compared to those on the placebo. Parkinsons affects people in the UK and approximately seven million worldwide. of people with Parkinsons will fall at least once a year with over a third experiencing falls repeatedly resulting in fractures broken bones and hospital admissions . Parkinsons UK Research Fellow Dr Emily Henderson and principal researcher on the study based at the University of Bristol said With the degeneration of dopamine producing nerve cells people with Parkinsons often have issues with unsteadiness when walking. As part of the condition they also have lower levels of acetylcholine a chemical which helps us to concentrate making it extremely difficult to pay attention to walking. We already know that rivastigmine works to treat dementia by preventing the breakdown of acetylcholine however our study shows for the first time that it can also improve regularity of walking speed and balance. This is a real breakthrough in reducing the risk of falls for people with Parkinsons. Dr Henderson and her team at the University of Bristol studied people with Parkinsons who had fallen in the past year. Half the group were given rivastigmine capsules and the other half a placebo for an eight month period. Dr Arthur Roach Director of Research at Parkinsons UK which funded the study said People affected by Parkinsons their carers and health and social care professionals have said that preventing falls and improving balance is the biggest unmet need for people living with the condition other than finding a cure. Things that may be simple to us such as walking upstairs or getting up in the middle of the night to get a glass of water or go to the toilet are much harder and more dangerous when you could easily fall. You risk breaking bones and then needing an emergency hospital admission. This trial shows that there may be drugs already available being used for other purposes that can be tested to help treat Parkinsons. This takes us a step closer to improving the quality of life and finding better treatments for people with Parkinsons. Caroline Maxwell from Northamptonshire a participant on the study who was diagnosed with Parkinsons years ago said A few years ago I had a bad fall while carrying my sewing machine across the room leaving me in hospital for a week and really denting my confidence. Im at the stage where I would walk much better with a replacement joint but because I fall so frequently my surgeon is reluctant to operate. Falling on my replacement hip would put in an even worse situation than what Im in now. By potentially finding a treatment that helps to prevent falls Id be able to get a replacement hip and have the confidence to go shopping on my own without having to constantly rely on the goodness of strangers to pick me up when I fell. For more information on Parkinsons UK research and to donate visit parkinsons.org.ukresearch httpparkinsons.org.ukresearch. For media and interview enquiries Hanna Kilpin Senior Media PR Officer Research Parkinsons UK hkilpinparkinsons.org.uk mailtohkilpinparkinsons.org.uk . Out of hours Notes to editors . Rivastigmine for gait stability in patients with Parkinsons disease ReSPonD a randomised doubleblind placebocontrolled phase trial. Henderson E J et al. Lancet Neurology. January . httpdx.doi.org.S. . Recurrent Falls in Parkinson s disease A Systematic Review. Allen N E et al. Parkinsons Disease. . Priority setting partnership to identify the top research priorities for the management of Parkinsons disease. Deane K H O et al. BMJ Open. December . doi.bmjopen . Dr Emily Henderson Dr Arthur Roach and Caroline Maxwell are available for interview on request Parkinsons UK Every hour someone in the UK is told they have Parkinsons. It affects people in the UK which is around one in of the population. Parkinsons is a degenerative neurological condition for which there currently is no cure. The main symptoms of the condition are tremor slowness of movement and rigidity. Parkinsons UK is the UKs leading charity supporting those with the condition. Its mission is to find a cure and improve life for everyone affected by Parkinsons through cutting edge research information support and campaigning. For advice information and support visit http or call our free confidential helpline on . University of Bristol School of Social and Community Medicine More information about the University of Bristols School of Social and Community Medicine can be found at http"

"A special restrictive diet may significantly reduce symptoms of attentiondeficit hyperactivity disorder ADHD in young children a new study suggests. When children between the ages of and were placed on a diet containing no processed foods for five weeks ADHD symptoms diminished in percent of them. And when suspected trouble foods were reintroduced into the diet twothirds of the children experienced a relapse in symptoms. A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food wrote the study authors. We think that dietary intervention should be considered in all children with ADHD provided parents are willing to follow a diagnostic restricted elimination diet for a fiveweek period and provided expert supervision is available they concluded. Results of the study are published in the Feb. issue of The Lancet. ADHD is a common childhood disorder according to the National Institute of Mental Health NIMH. Children with ADHD have trouble paying attention focusing and can be hyperactive. Parents have long suspected that sugary foods might be a culprit in inducing symptoms but theres not a lot of evidence to support this theory according to the NIMH. However food additives and preservatives have recently been singled out as possibly having an effect on childrens behavior though the evidence isnt yet conclusive. Since some children have negative physical reactions to certain foods such as eczema asthma and gastrointestinal problems that affect different organ systems it has been suggested that foods may also affect the brain in a way that results in adverse behavior according to information in the study. To test this theory the researchers recruited children from Belgium and the Netherlands. The children were between the ages of and and all had been diagnosed with ADHD. Most of the children were boys. The children were randomly assigned to one of two groups. One group was placed on the restrictive elimination diet and the other group served as a control group and received advice on healthy eating. The restrictive diet began with a diet called the few foods diet which includes just rice meat vegetables pears and water. The researchers then complemented this diet with certain foods such as potatoes fruits and wheat. The restrictive diet lasted for five weeks. During the next four weeks kids in the restricted diet group received two food challenge diets in which certain foods were reintroduced into the diet. The researchers selected foods that were considered both low and highIgG foods. IgG is an antibody made by the immune system that some alternative medicine practitioners believe is linked to food hypersensitivities however IgG testing is controversial among many mainstream physicians and even some naturopaths according to background information in the study. Some complementary medicine practices test for IgG and recommend eliminating foods high in IgG explained Dr. Jaswinder Ghuman who wrote an accompanying editorial in the same issue of the journal. Fortyone children completed the restrictive phase of the diet. Of those percent had a reduction in their ADHD symptoms compared with no improvement in the controls. Nine children percent didnt respond to the diet. On an ADHD symptom scale that ranges from to points with a higher score indicating more severe symptoms the average reduction was points according to the study. Thirty children who had shown a response on the restrictive diet went on to the challenge test. Nineteen of those children had a relapse in symptoms on the challenge test. Whats more it didnt appear to matter if the children with challenged with a low or highIgG food. Measuring IgG levels in kids doesnt seem helpful Ghuman said but it does look as if the elimination diet may help some children. If parents have noticed that a childs behavior seems to get worse with certain foods it may be worth considering said Ghuman who is an associate professor of psychiatry and pediatrics at the University of Arizona in Tucson. But for this diet to work you have to be very consistent with it and you have to pay attention to nutrition. It should be done under the supervision of a primary care doctor and if possible a dietician she advised. Ghuman said that this study doesnt answer a number of questions such as whether or not the elimination diet reduces symptoms longterm. And she added that clinical practice shouldnt be changed based on the results of one study. Dr. Andrew Adesman chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Childrens Medical Center of New York in New Hyde Park echoed Ghumans concerns. Since none of the children stayed on the diet beyond five weeks it is hard to know if this dietary intervention offers sustained benefit he said adding Since it is more difficult to enforce restricted diets in older children this approach may not be suitable for the majority of older children with ADHD. Adesman also pointed out that this study is only applicable to children with ADHD not to children who had ADD without the hyperactivity component. More information Learn more about ADHD from the National Institute of Mental Health http SOURCES Jaswinder Kaur Ghuman M.D. associate professor psychiatry and pediatrics University of Arizona Tucson Andrew Adesman M.D. chief developmental and behavioral pediatrics Steven and Alexandra Cohen Childrens Medical Center of New York New Hyde Park Feb. The Lancet"

"Taking extra vitamin D and calcium doesnt seem to prevent bonethinning in older men according to Australian researchers. However exercise did boost bone mineral density a proxy for bone strength their report shows. Despite the findings people still need to get enough calcium and vitamin D to reduce the risk of osteoporosis or bone thinning said Dr. Mone Zaidi an osteoporosis researcher at the Mount Sinai School of Medicine in New York who was not involved in the study. Its like the four legs of the stool vitamin D and calcium exercise medications if a person is losing bone and the fourth leg is telling people how to prevent fractures Zaidi said. More than million people in the US are affected by osteoporosis. Its most common in older women but about seven percent of white men and five percent of black men are affected according to the American College of Physicians. In the new study published in the Journal of Clinical Endocrinology and Metabolism Robin M. Daly from the University of Melbourne Australia and colleagues randomly assigned men aged to to an exercise program drinking milk fortified with calcium and vitamin D doing both or doing nothing. They measured the mens bone density before and after the study which took place over months but they didnt look at fractures. At the end of the study men who exercised had higher bone density than those who had supplemented their diet with milligrams of calcium and international units IU of vitamin D per day. Adding the supplements to the exercise program provided no extra benefit hinting that the men already had enough vitamin D and calcium in their diets to be able to boost their bone strength through exercise alone. The recommended daily intake of vitamin D is IU in adults up to age and IU for older people according to the National Institutes of Health NIH. A month supply of vitamin D supplements can be bought for less than and many multivitamins contain the recommended daily dose of vitamin D. As for calcium the NIH advises mg per day for men ages and then mg per day for men older than . To build bone density weightbearing exercise is needed such as running or weightlifting according to the NIH. In animal studies a lack of vitamin D has been linked to several diseases such as multiple sclerosis and some types of cancer. However there isnt enough data to say if vitamin D can help treat or prevent these diseases Zaidi said. To reduce the risk of bone weakening the NIH recommends not smoking drinking less alcohol and exercising more. Zaidi said that both vitamin D and calcium are extremely important for human health so people should follow the previous vitamin D and calcium recommendations. Youve got to have it to build a wall he said. Adding more might not strengthen the wall but you have to take enough to keep the wall strong. Otherwise it might fall apart. SOURCE bit.lyitDqs httpbit.lyitDqs The Journal of Clinical Endocrinology and Metabolism online January . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"A study presented today that evaluated an investigational dosage of oncedaily ledipasvir mgsofosbuvir mg LDVSOF in children aged six to years infected with the Hepatitis C virus HCV found that of children n had undetectable levels of HCVRNA weeks after treatment. The study presented at The International Liver Congress in Amsterdam The Netherlands also showed that the fixeddose combination of LDVSOF was welltolerated and no patients experienced a serious adverse event considered related to the study drug. Around million people globally have chronic HCV infection including approximately million people in the EU. The prevalence of HCV infection in children varies from .. in the United States and Europe and up to .. in some developing countries. While directacting antivirals have been used to treat and cure adult patients with HCV until now children have been mainly treated for to weeks with pegylated interferon plus ribavirin RBV an older treatment which causes severe side effects. Directacting antivirals have transformed the treatment of adults with chronic HCV however studies of these new therapies in children are required said Dr Karen Murray University of Washington School of Medicine and Seattle Childrens Seattle United States and lead author of the study. These data establish the use of the oral directacting antivirals as an important treatment option in HCVinfected children aged six to years old. This ongoing openlabel study enrolled children aged between six and years with chronic HCV mostly genotype n. Children with HCV genotype infection received weeks of treatment n or weeks of treatment if they had cirrhosis and failed prior treatment with pegylated interferon plus RBV n genotype patients received LDVSOF plus RBV for weeks n genotype patients received LDVSOF for weeks n. Most children were male white treatment nave and vertically infected . Of the study population achieved a sustained virologic response weeks after treatment SVR one treatmentnave genotype patient with cirrhosis relapsed. No children discontinued the study due to side effects or had a severe or lifethreatening adverse event related to the study drug. The most common side effects reported in or more of patients were headache fever abdominal pain diarrhoea vomiting cough fatigue sore throat and nausea. This study is a breakthrough for the management of children aged six to years old with Hepatitis C demonstrating that the new DAA regimen is highly efficacious and more importantly safe in this group of HCVinfected children said Prof Frank Tacke University Hospital Aachen Germany and EASL Governing Board Member. About The International Liver Congress This annual congress is the biggest event in the EASL calendar attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present share debate and conclude on the latest science and research in hepatology working to enhance the treatment and management of liver disease in clinical practice. This year the congress is expected to attract approximately delegates from all corners of the globe. The International Liver Congress will take place from April at the RAI Amsterdam Amsterdam The Netherlands. About The European Association for the Study of the Liver EASL http Since its foundation in this notforprofit organisation has grown to over members from all over the world including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe having evolved into a major European Association with international influence with an impressive track record in promoting research in liver disease supporting wider education and promoting changes in European liver policy. Contact For more information please contact the ILC Press Office at Email ILCpressofficeruderfinn.co.uk mailtoILCpressofficeruderfinn.co.uk Telephone Onsite location reference Session title Parallel session Advances in the treatment of HCV Time date and location of session Friday April Hall Presenter Karen Murray United States of America Abstract Ledipasvirsofosbuvir ribavirin for or weeks is safe and effective in children years old with chronic hepatitis C infection PS Author disclosures Research funding from Gilead and NIH Merck stock ownership. References EASL Recommendation on Treatment of Hepatitis C . Available from http Last accessed April . World Health Organization. Global Alert and Response Hepatitis C. Available from http Last accessed April . Pawlowska M Malgorzata et al. Whats new in hepatitis C virus infections in children WJG. . Afdhal N et al. Ledipasvir and sofosbuvir for untreated HCV genotype infection. N Engl J Med. May . Afdhal N et al. Ledipasvir and sofosbuvir for previously treated HCV genotype infection. N Engl J Med. Apr . Kowdley KV et al. Ledipasvir and sofosbuvir for or weeks for chronic HCV without cirrhosis. N Engl J Med. May . Sulkowski MS et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. Jan . Jara P Hierro L. Treatment of Hepatitis C in children. Expert Rev Gastroenterol Hepatol. ."

"A diet rich in vitamin C could cut risk of cataract progression by a third suggests a study being published online today in Ophthalmology http the journal of the American Academy of Ophthalmology http The research is also the first to show that diet and lifestyle may play a greater role than genetics in cataract development and severity. Cataracts http occur naturally with age and cloud the eyes lens turning it opaque. Despite the advent of modern cataract removal surgery cataracts remain the leading cause of blindness globally. Researchers at Kings College London looked at whether certain nutrients from food or supplements could help prevent cataract progression. They also tried to find out how much environmental factors such as diet mattered versus genetics. The team examined data from more than pairs of female twins from the United Kingdom. Participants answered a food questionnaire to track the intake of vitamin C and other nutrients including vitamins A B D E copper manganese and zinc. To measure the progression of cataracts digital imaging was used to check the opacity of their lenses at around age . They performed a followup measurement on pairs of the twins about years later. During the baseline measurement diets rich in vitamin C were associated with a percent risk reduction for cataract. After years researchers found that women who reported consuming more vitamin Crich foods had a percent risk reduction of cataract progression. Genetic factors accounted for percent of the difference in cataract progression. Environmental factors such as diet accounted for percent. These results make the study the first to suggest that genetic factors may be less important in progression of cataract than previously thought. How vitamin C inhibits cataract progression may have to do with its strength as an antioxidant. The fluid inside the eye is normally high in vitamin C which helps prevents oxidation that clouds the lens. More vitamin C in the diet may increase the amount present in the fluid around the lens providing extra protection. Researchers noted that the findings only pertain to consuming the nutrient through food and not vitamin supplements. The most important finding was that vitamin C intake from food seemed to protect against cataract progression said study author Christopher Hammond M.D. FRCOphth professor of ophthalmology at Kings College London. While we cannot totally avoid developing cataracts we may be able to delay their onset and keep them from worsening significantly by eating a diet rich in vitamin C. Genetic and Dietary Factors Influencing the Progression of Nuclear Cataract http YonovaDoing et al. Ophthalmology article in press March . DOI .j.ophtha.... For a full copy of the study please contact the Public Relations Department at mediaaao.org mailtomediaaao.orgsubjectNewswiseArticleReporterFollowupbccreportersnewswise.com. For more information on cataracts visit the American Academy of Ophthalmologys EyeSmart public information website http About the American Academy of OphthalmologyThe American Academy of Ophthalmology is the worlds largest membership association of eye physicians and surgeons. A global community of ophthalmologists we are passionate about protecting sight and fighting preventable blindness. For more than years we have been educators innovators and advocates for the public and our profession to ensure the highestquality medical and surgical eye care. Our EyeSmart program is a preeminent source of eye health information for the public and empowers people to preserve their vision. For more information visit http About OphthalmologyOphthalmology the official journal of the American Academy of Ophthalmology publishes original peerreviewed clinicallyapplicable research. Topics include the results of clinical trials new diagnostic and surgical techniques treatment methods technology assessments translational science reviews and editorials. For more information visit http Global Data on Visual Impairments WHO"

"The Mediterranean diet includes lots of fish plenty of fruits and vegetables portions of whole grains and very little meat. This classic diet does not exclude a dinnertime glass of wine however sugary drinks fried food and sweets are not on the menu. Scientists believe this style of eating offers some protection against mental aging http and above all else it is heart healthy. A new study httphttpeurheartj.oxfordjournals.orgcontentearlyrecent of over people in countries explored the benefits of this diet for one special group those already diagnosed with heart disease. Surprisingly the results suggest it might be possible they can have their cake and eat it too. Participants eating a Mediterranean diet http showed a lower risk of heart attack and stroke the researchers discovered yet eating healthy food appeared to be more important than avoiding unhealthy foods identified as typical of a socalled Western diet such as French fries fatty red meats and yes even cake. Though diet names refer to regions they are not precise. Led by Professor Ralph Stewart from the University of Auckland New Zealand a team of researchers asked older adults with stable coronary artery disease to complete a lifestyle questionnaire. With an average age of each was a participant in GlaxoSmithKlines STABILITY drug trial created to learn whether the drug reduced the risk of heart attacks strokes and deaths. Participants lived in Western and Eastern Europe North and South America and the Asia Pacific region. They answered questions about their diet and reported how many times a week they consumed servings from separate food groups. Looking at their answers researchers gave them points in either the Mediterranean diet or Western diet category. Over nearly four years about percent of the study participants suffered either a heart attack or stroke or died. Those who ate more foods in the Mediterranean diet category http were . times less likely to experience one of these three events than people whose diets more closely resembled the Western standard. In fact every onepoint increase in a participants Mediterranean diet score was linked with a percent reduction in risk of heart attack stroke or death. Look at it this way if people ate the highest proportion of Mediterranean foods and ate the least there would be three fewer heart attacks strokes http or deaths among those who ate more foods from the Mediterranean diet. These findings held for every geographical region. Now heres the interesting part eating more foods thought to be less healthy those typical of Western diets did not link to an increase in heart attacks strokes or deaths. Eating more healthy foods was the key even if some unhealthy foods were also consumed along the way. According to Stewart the meaning behind the numbers is clear. Instead of avoiding unhealthy foods people with weak hearts might focus more on consuming healthy foods. That said Stewart notes his study has limitations including a lack of strict guidelines about portion size http and no measure of total calories. Longstanding American Heart Association guidelines recommend a diet primarily consisting of fruits vegetables fish and other whole foods with limited amounts of sodium sugar saturated fats and refined carbohydrates. Eat as you dare. Source Stewart RAH Wallentin L Benatar J et al. Dietary patterns and the risk of major adverse cardiovascular events in a global study of highrisk patients with stable coronary heart disease. European Heart Journal. ."

"The road to snuffing out cigarettes httpshealth.usnews.comhealthcarepatientadvicearticlesloweryourriskforlungcancerbyquittingsmoking once and for all can be a long one. I think the big thing for people to remember is that it usually takes multiple attempts to be successful at quitting smoking says Dr. Valerie Bonne httpdoctors.froedtert.comPhysicianDirectoryBonneValerieJ.htm a pulmonologist at Froedtert the Medical College of Wisconsin in Milwaukee who oversees the health systems smoking cessation program. So just because youve tried in the past and havent been successful doesnt mean you arent going to be successful in the future. In fact research published last year in BMJ Open an online open access journal found that for many smokers it may take or more quit attempts before they finally kick the habit httpshealth.usnews.comhealthnewshealthwellnessarticleshowdoiquitsmoking. Along with being persistent experts like J. Lee Westmaas https strategic director of tobacco control research at the American Cancer Society recommend trying lots of different approaches to smoke out the leading cause of preventable death. I would say use as many aids as you can he says. For those trying to quit one new quit aid on the horizon will be easily accessed with an internet connection and a smartphone tablet or computer tailored emails. Research led by Westmaas and published in May in the journal Tobacco Control looked at the effect of sending multiple emails to smokers during a quit attempt that were customized based on information provided by those individuals such as quit date their top two reasons for quitting top five triggers for smoking and intended use of cessation medications. The findings showed that approach yielded quit rates that were higher than for those who received a single nontailored email containing links to smoking cessation resources. Selfreported rates of abstinence from smoking at six months after enrollment in the randomized controlled trial were percent in the multiple email group compared with . percent in the single email group. See Ways to Live Healthier and Save Money Doing It httpshealth.usnews.comhealthnewshealthwellnessslideshowswaystolivehealthierandsavemoneydoingit. Whats more though smokers are encouraged to try different methods of quitting the research found the emails worked as a standalone approach. Westmaas says some emails were tailored based on whether study respondents planned to use nicotine replacement therapy httpshealth.usnews.comhealthproductstoprecsmokingcessationaids which has been found to be helpful for those seeking to quit smoking. Those study participants who werent planning to use NRT received an email explaining why use of NRT is actually a good thing he says. Those receiving multiple emails who planned on using NRT got messaging outlining all the different kinds of NRT. Interestingly though when we looked at whether or not people had used NRT our results were the same. So even when we controlled for use of NRT we still found an effect of the intervention he says that is receiving multiple tailored emails helped people quit smoking regardless. The intervention was effective whether or not you use nicotine replacement therapy. One of the studys limitations was that those who participated were generally welleducated. The majority were white and only percent reported a high school education or less suggesting the possibility that results may not necessarily be generalizable to less educated or other racial or ethnic groups the researchers wrote. They suggest that future research should examine how well tailored emails worked for these and other groups such as cancer survivors httpshealth.usnews.comhealthnewspatientadvicearticlescancersurvivortakingonnewmeaningforpatients or lesbian gay bisexual transsexual and intersex groups. At present the email program studied isnt available to the general public. But Westmaas says the American Cancer Society aims to make a similar program available soon. We hope that by the beginning of next year well have something ready he says adding that it could be earlier depending on the success of efforts to secure funding for the program. In the meantime those who wish to get support for quit attempts but prefer to receive it in a way that fits with an onthego lifestyle can opt to receive text messages to support a quit attempt as well like through smokefree.gov httpssmokefree.govsmokefreetxt a website created by the Tobacco Control Research Branch of the National Cancer Institute. NCI also offers QuitPal httpsmedlineplus.govmagazineissueswinterarticleswinterpgbackcover.html a free app for iPhone or iPad for a quit assist. The app has numerous interactive features such as tracking smoking habits with a calendar and providing tips to deal with cravings. httpshealth.usnews.comhealthnewshealthwellnessarticleshowtouseyoursmartphonetoquitsmoking It also allows users to connect with social media where they can see loved ones personalized video messages to support their progress. See Surprising Habits Killing Your Teeth httpshealth.usnews.comhealthnewshealthwellnessslideshowssurprisinghabitskillingyourteeth. The point however support is provided is to deliver it in a way that best suits the individual. It seems like people have preferences for how they want to receive information especially about quitting Westmaas says. While some gravitate toward group smoking cessation classes for example others prefer to talk oneonone with a counselor or on a smoking quitline like QUITNOW also affiliated with NCI. Others prefer less intrapersonal interaction and technology provides a way to reach more people trying to quit. Some people in rural areas httpshealth.usnews.comwellnessslideshowswaysrurallifeishazardoustoyourhealth may not have access to smoking cessation programs says Mary LeVasseur manager of community health and wellness at Lancaster General Health whos responsible for the health systems tobacco prevention and treatment programs. The email approach is not meant to replace other options for quitting Westmaas emphasizes but rather to provide an additional one. Experts point out in particular that medications and counseling in combination can be a powerful combination even more effective than either alone. However medications Chantix and Zyban are also associated with risks ranging from depressed mood hostility and aggression to suicidal thoughts httpshealth.usnews.comhealthcareforbetterarticlesstudyrevealsdepressionsuicidalthoughtsnotuncommoninairlinepilots. Most of the medication options and the nicotinereplacement options are fairly well tolerated and effective Bonne says. But experts say its important to keep doctors in the loop when issues arise to determine if medications or NRT should be stopped. See Things You Didnt Know About Lung Cancer httpshealth.usnews.comhealthnewspatientadviceslideshowsthingsyoudidntknowaboutlungcancer. If using NRT to break a tobacco addiction httpshealth.usnews.comwellnessarticlespopcornandcigarettessmokinginmovies talk with a health provider if you experience nausea dizziness weakness vomiting fast or irregular heartbeat mouth problems with the lozenge or gum or redness or swelling of the skin around an NRT patch that doesnt go away the Food and Drug Administration recommends. Taken by mouth the lozenges can cause a warm or tingling sensation and users are urged to seek medical attention right away if they experience a severe allergic reaction which may be marked by rash itching swelling of the mouth or difficulty breathing or other serious side effects. With any attempt to quit experts say its important to take stock of even small successes like not smoking for a short period even if it doesnt last. We look at tobacco dependence as a chronic disease. So thats the most important thing knowing that people go through many different cycles of abstinence and remission LeVasseur says. Thats not to say quitting for good isnt possible. Rather experts emphasize its important to take the long view Dont be discouraged and make as many quit attempts and use as many approaches as needed to kick the habit. Best Hospitals Honor Roll Rank Hospital Name Location Mayo Clinic httpshealth.usnews.combesthospitalsareamnmayoclinicRochester MN Cleveland Clinic httpshealth.usnews.combesthospitalsareaohclevelandclinicCleveland OH Massachusetts General Hospital httpshealth.usnews.combesthospitalsareamamassachusettsgeneralhospitalBoston MA Johns Hopkins Hospital httpshealth.usnews.combesthospitalsareamdjohnshopkinshospitalBaltimore MD UCLA Medical Center httpshealth.usnews.combesthospitalsareacauclamedicalcenterLos Angeles CA New YorkPresbyterian University Hospital of Columbia and Cornell httpshealth.usnews.combesthospitalsareanynewyorkpresbyterianuniversityhospitalofcolumbiaandcornellNew York NY UCSF Medical Center httpshealth.usnews.combesthospitalsareacaucsfmedicalcenterSan Francisco CA Northwestern Memorial Hospital httpshealth.usnews.combesthospitalsareailnorthwesternmemorialhospitalChicago IL Hospitals of the University of PennsylvaniaPenn Presbyterian httpshealth.usnews.combesthospitalsareapahospitaloftheuniversityofpennsylvaniaPhiladelphia PA NYU Langone Medical Center httpshealth.usnews.combesthospitalsareanynyulangonemedicalcenterNew York NY Hospital Ranking information as of May th Michael O. Schroeder https Staff Writer Michael O. Schroeder has been a health editor at U.S. News since . He writes health stories... Read more Tags health https patients https patient advice https smoking and tobacco https_and_tobacco lung cancer https_cancer"

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

"Eczema is the most common skin disease worldwide. People suffering from it often deal with a lifetime of painful symptoms. A new clinical trial is testing a natural treatment that researchers hope will provide a longterm solution for those dealing with the dry itchy and painful skin that comes with chronic eczema. The trial uses a cream containing beneficial bacteria to fight harmful bacteria on the skin. While it may seem counterintuitive to treat bacteria with more bacteria experts say this approach seeks to restore the natural microbial balance of healthy skin. There are over species of bacteria that all live in balance on healthy skin some that even produce natural antibiotics. However we know that eczema patients lack the beneficial bacteria needed to kill Staph aureus harmful bacteria that can worsen eczema said Donald Leung MD head of the Division of Pediatric Allergy Immunology at National Jewish Health. To fight harmful bacteria researchers isolate beneficial bacteria from our skin and grow it in a lab. It is then applied to eczema patients skin as a lotion twice a day for a week. Bacterial DNA from patients skin is then analyzed in a lab to determine if the cream effectively reduced the amount of bad bacteria present. Ideally we want to eliminate all staph aureus from the skin of eczema patients said Leung. What the cream does is help the skin gain back its natural balance and create that barrier needed to keep it healthy. Researchers hope that using the bacteriainfused cream will offer a longterm solution where other treatments fall short. Powerful antibiotics are commonly prescribed for eczema but they kill good bacteria on patients skin along with the bad. Creams containing corticosteroids are also often prescribed to eczema patients but they come with harsh side effects and patients usually cant tolerate them for long periods of time. The worst symptom of eczema is the itching and the scratching and the more you scratch the more it spreads. It can be very painful said Cassandra Rodriguez who has struggled with eczema all her life. Cassandra has tried just about every cream and medication on the market and says when she learned about the clinical trial she was on board to give it a try. The trial coordinator explained that its like a probiotic for your skin said Rodriguez. You hear all these things about good bacteria for your gut so it seemed like a promising idea to apply that same concept to the skin. Cassandras son also has eczema and shes hoping this research will lead to an effective treatment so that he wont have to suffer with the pain and embarrassment of the disease for as long as she has. Hes little now but dealing with eczema as a teen and an adult is really difficult said Rodriguez. If there were something on the market that could help him and help everyone suffering with eczema every day that would be amazing. Experts say there is more research to be done but that the goal of the trial is to discover the best combination of bacteria to clear eczema from the skin and then make it available to patients as a prescription cream. The next steps involve testing those different combinations ensuring theyre safe and conducting a longer trial to see if the benefits of bacterial cream can truly provide a permanent solution for eczema patients. About National Jewish Health National Jewish Health is the leading respiratory hospital in the nation. Founded years ago as a nonprofit hospital National Jewish Health today is the only facility in the world dedicated exclusively to groundbreaking medical research and treatment of patients with respiratory cardiac immune and related disorders. Patients and families come to National Jewish Health from around the world to receive cuttingedge comprehensive and coordinated care. To learn more visit njhealth.org http"

"Janet Jay is a cyborg. No shes not RoboCop or Darth Vader. But she shares a similarity with those characters Her alltoohuman body has been upgraded with a machine. A nextgeneration implant deep in Jays back stimulates her spinal cord overriding her bodys pain signals to give her some relief from the back pain that has plagued her for years. In an article https on Popular Sciences website Jay writes about her experience with pain and the nextgeneration way shes finding relief. She is hardly alone in her suffering. According to the National Center for Health Statistics httpsnccih.nih.govnewspress an estimated . million Americans or . percent of U.S. adults experience chronic pain. It can interfere with work and home life and leave patients debilitated disabled and depressed. So it makes sense that Jay jumped at the chance to experience longterm pain relief with the help of a spinalcord stimulator. Jay lays out the hows and whys of spinal stimulation and she paints a vivid picture of a life in agony a journey that has included skeptical doctors plenty of painkillers and unanswered questions about the future. She also describes her path to spinal stimulation how the device works with the body to shortcircuit pain and the many roadblocks to relief that patients face. Even for me the battle is not over Jay writes. Since this surgery Ive actually had another disc herniate complicating everything. My spine isnt cured and I still hurt all the time. But the pain is far more controlled and I can function much better at my current level of discomfort. As the human and financial costs of the opioid crisis rise spinal stimulation may become more popular even though its expensive. Jay says she was lucky Her insurance covered much of the sixfigure bill for the procedure."

"Exposure to bright light can raise testosterone levels and lead to greater sexual satisfaction in men with low sexual desire according to the results of a small scientific trial. Scientists at the University of Siena in Italy found that regular earlymorning use of a light box similar to those used to combat Seasonal Affective Disorder or SAD helped men increase testosterone and improved their sex lives. Andrea Fagiolini a professor who led the study and presented it at the European College of Neuropsychopharmacology conference in Vienna on Monday said the treatment may prove useful during the Northern hemispheres darker winter months. The increased levels of testosterone explain the greater reported sexual satisfaction he said. In the Northern hemisphere the bodys testosterone production naturally declines from November through April and then rises steadily through the spring and summer with a peak in October. Low sexual desire can affect significant numbers of men after the age of with studies finding that up to percent of men report problems. Fagiolinis team recruited men diagnosed with either hypoactive sexual desire disorder or sexual arousal disorder both characterized by a lack of interest in sex. After taking baseline readings they divided the men into two groups and gave one regular treatment with a bright light box while the control or placebo group was treated with a light box adapted to give out significantly less light. We found fairly significant differences Fagiolini said. Before treatment both groups averaged a sexual satisfaction score of around out of . But after treatment the group exposed to the bright light was scoring sexual satisfaction scores of around .. In contrast the control group only showed an average score of around . after treatment. Editing by Alexander Smith Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Daily aspirin https use long recommended for people at high risk of heart attack https may also reduce the risk of dying from cancer https according to new research. The benefit however may not be as great as believed says researcher Eric Jacobs PhD of the American Cancer https Society. A previous study by others found daily aspirin https reduced cancer https death risk by . In our analysis daily aspirin use was associated with about a lower risk of dying from cancer https overall Jacobs says. He describes that reduction as modest. Even so he says our results provide additional support for the potential benefit of daily aspirin for reducing cancer mortality. He found an association not cause and effect. Many other strategies will also reduce the risk of cancer he says. Among them engaging in regular physical activity https maintaining a healthy weight https and not smoking https cigarettes. Continue Reading Below you might like The new analysis is published in the Journal of the National Cancer Institute. Aspirin and Cancer Risk Study Details Jacobs analyzed information from more than people enrolled in a cancer prevention study. The men and women mostly white and older than age in reported their aspirin use over time. Nearly reported daily aspirin use in . They were followed for up to years. All who reported taking daily aspirin for any amount of time had the risk reduction he found. Most of the reduced risk was found for colorectal stomach https and esophageal cancers. The evidence for aspirins benefit is strongest for those cancers he says. As for the discrepancy between studies Jacob says that it just shows there is still considerable uncertainty about how much daily aspirin would help. Exactly how aspirin helps prevent cancer death is not known for sure Jacobs says. One possibility is that aspirin may prevent cancer the same way it helps prevent heart attacks https he says by blocking the activation of the blood https platelets which help the blood https to clot. We know platelets that are activated can release substances that help tumors grow and spread he says. A decision to take daily aspirin should be made only with a doctors guidance Jacobs says. Even lowdose aspirin can lead to problems such as serious gastrointestinal bleeding he says. Daily Aspirin and Cancer Death Risk Perspective The new study stands out because it shows that how long someone takes aspirin doesnt matter says John A. Baron MD professor of medicine at the University of North Carolina School of Medicine who wrote an editorial to accompany the research. Baron says that aspirins effects on cardiovascular disease https risk are nearly immediate but that the cancer benefits take longer. Its not clear exactly when those benefits kick in he says. Many ideas about how aspirin may be cancerprotective are discussed he says. The evidence for aspirin protecting against colorectal cancer https is strongest he agrees. Aspirin inhibits the production of substances found in colorectal cancer https cell both normal and cancerous cells he says. He also warns against taking daily aspirin without a doctors OK. Aspirin is a real drug. Its safe but its still a drug. In his editorial he writes that the benefits must be balanced against the risks particularly when the benefits for cancer risk are delayed whereas the risks are not. Baron is a consultant to Bayer and for studies of the side effects of aspirin use. He holds a use patient for the chemo https use of aspirin currently not licensed."

"A new treatment might open the door for more patients with advanced kidney disease to get a transplant a preliminary study suggests. Of the plus Americans waiting for a donor kidney about onethird are sensitized said Dr. Robert Montgomery director of the Transplant Institute at NYU Langone in New York City. Those patients face a tough situation They harbor immune system antibodies that are primed to attack a donor organ. The antibodies can form when a person is exposed to foreign tissue Montgomery explained. So a patient whos had a prior kidney transplant may be highly sensitized meaning they have a large number of the offending antibodies. It can also happen to patients whove had blood transfusion or ever been pregnant Montgomery said. Its almost impossible to find a compatible donor for those patients. But they might be able to receive a kidney from an incompatible donor if they first undergo an extensive desensitization process. That involves various treatments including IV drugs called immune globulin and rituximab that try to quash the antibodies that would attack the donor organ. Now the new research suggests a simple approach an infusion of a particular enzyme hours before the transplant could offer a better alternative. Researchers found that the treatment dubbed IdeS quickly wiped out the dangerous antibodies allowing all but one of patients to have a successful transplant. The findings were published in the Aug. issue of the New England Journal of Medicine. Funding for the study came from the company developing IdeS Hansa Medical. Montgomery who was not involved in the study said hes never seen anything like it. When you give this all of the antibodies are gone Montgomery said. Im hopeful that this will turn out to be a gamechanger. However he stressed many questions remain. Critically the enzyme does not banish the antibodies forever. They come back Montgomery said and the results of that comeback vary from patient to patient. In the study patients had an episode of antibodymediated rejection anywhere from two weeks to five months after their transplant. That means antibodies started to attack the new kidney. Those patients were all successfully treated with standard antirejection drugs according to the researchers. Still its not yet clear how the patients will fare in the long term said Dr. Julie Ingelfinger a professor at Harvard Medical School in Boston. Ingelfinger who wrote an editorial published with the study echoed Montgomerys cautious optimism. If larger longer studies bolster the current findings she said this could potentially be practicechanging. But Ingelfinger stressed only time will tell. Lead researcher Dr. Stanley Jordan agreed that more work is necessary. But the findings mark another step forward for patients like these according to Jordan who is medical director of the kidney transplant program at CedarsSinai in Los Angeles. Traditionally highly sensitized patients in need of a kidney have languished on waiting lists because its so hard to find a compatible donor. But in the past years or so desensitization has emerged as an alternative. Last year a landmark study proved that patients who receive transplants after desensitization live significantly longer than those who stay on dialysis. The outcomes have been good Jordan said. But he added theres clearly room for improvement. Ingelfinger agreed. The desensitization protocols now in use are timeconsuming and they dont always work she said noting that they can leave dangerous antibodies behind. Desensitization adds about to to the cost of the transplant according to the University of Wisconsins transplant center. The new approach is quite different Ingelfinger said. Patients receive one infusion of an enzyme called IdeS four to six hours before the transplant. The enzyme is derived from a strain of Streptococcus bacteria and it essentially chops up the antibodies that would attack the organ. Jordan acknowledged that the source sounds scary but stressed that patients do not receive the bacteria itself but an engineered version of the enzyme. In all U.S. and Swedish patients received an infusion of IdeS before their kidney transplant. All but one had a successful transplant and none had detectable antibodies immediately afterward. IdeS patients still received additional treatment including a week of immune globulin and rituximab infusions. And as with all transplants they needed standard antirejection drugs. Because IdeS so readily banishes the offending antibodies it might make transplants feasible for even the most highly sensitized patients Montgomery said. But the question remains he said Can it extend the survival of the donor kidney and ultimately patients lives IdeS is still experimental and the only way patients could receive it is through a clinical trial. It will be a few years before it could be more widely available Montgomery said. More information The National Kidney Foundation has more on kidney transplantation. https SOURCES Stanley Jordan M.D. medical director kidney transplant program CedarsSinai Medical Center Los Angeles Robert Montgomery M.D. director Transplant Institute and professor transplant surgery NYU Langone Medical Center New York City Julie R. Ingelfinger M.D. professor pediatrics Harvard Medical School Boston and deputy editor New England Journal of Medicine Aug. New England Journal of Medicine"

"New research has revealed that five different types of prostate cancer http exist. How will this discovery change the outlook of prostate cancer screening World renowned robotic prostate cancer surgeon http Dr. David Samadi evaluates. Discovering five different types of the disease httpsamadimd.comlatesthealthdifferenttypesofprostatecancer could change how theyre distinguished from one another and may even mean different treatments for each targeted to the individual patient said Dr. Samadi Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in New York City. New research has revealed that five different types of prostate cancer exist. How will this discovery change the outlook of prostate cancer screenings World renowned robotic prostate cancer surgeon Dr. David Samadi evaluates. Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist Dr. David Samadi for a consultation or second opinion. For men with a family history of the disease contact Dr. Samadi to learn more about your risk factors... Researchers analyzed men with prostate cancer. Among the group of participants tumor benign and germline samples were looked at. The researchers analyzed the samples and looked for genetic differences that made it so the researchers could categorize the study participants into groups regarding targeted treatments specific to their prostate cancer. What they found was more than minimal differences among the tumors. They concluded that five different types of prostate cancer were found based on genes. These genes demonstrated the risk of the disease progression which was more accurate than the currently used Gleason score test and PSA test. Prior research had shown six of the genes were linked to prostate cancer however researchers noted in the published study that it turns out the other genes had not been associated with prostate cancer until now. If five types of the disease exist how does this change popular medical opinion on prostate cancer screening http This may mean that each type of the disease needs its own approach to screening diagnosis treatment and even recurrence noted Dr. Samadi. While the findings need further research larger clinical trials could give better information on individualized treatment for each prostate cancer type. This could lead to a better quality of life and more effective treatment based on which prostate cancer a man is diagnosed with. Prostate Cancer http Key Statistics Prostate cancer is one of the leading causes of death among men. Other than skin cancer prostate cancer is the most common cancer in American men. About in men will get prostate cancer in their lifetime. Prostate cancer mainly occurs in older men about in cases are diagnosed in men aged or older. It is much rarer for men younger than years old to develop prostate cancer. The average age of diagnosis is about years old. In it is estimated that there will be more than deaths from prostate cancer. The researchers said the analysis in their study is better at forecasting how prostate cancer will advance compared to the current diagnostic tests being used for prostate cancer such as the prostate specific antigen test and the Gleason score. These findings could lead to more optimized diagnostic testing on all aspects of the prostate cancer diagnosis process and brings full circle the coming approach to cancer being an individual disease based very much on the patients individual genetic profile said Dr. Samadi. Get more of Dr. Samadis take on this study and its effect on the field of Prostate Cancer on Fox News Sunday Housecall https_bEkk. Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist Dr. David Samadi for a consultation or second opinion. For men with a family history of the disease contact Dr. Samadi to learn more about your risk factors and to get a baseline PSA blood test. Visit ProstateCancer.com http and call .. to set up your consultation. Photo httpphotos.prnewswire.comprnh SOURCE Dr. David Samadi Related Links http"

"Theres too little evidence to say definitively whether treating early localized prostate cancer with radiation is a better option than watchful waiting new research finds. In a study funded by the Agency for Healthcare Research and Quality AHRQ researchers from Tufts University reviewed the available literature on radiation and prostate cancer including randomized controlled trials and observational studies. They concluded there was insufficient evidence to say with certainty whether radiation treatment compared to watchful waiting is more likely to save lives. We just dont have sufficient information to say much of anything said Dr. Stanley Ip an assistant professor of medicine at Tufts University Medical Center. In part thats because researchers found no randomized controlled trials considered the gold standard of research that compared radiation therapy with watching waiting Ip said. Though there were observational studies those may be biased because men who opt to hold off on treatment may be those whose tumors are lower risk to begin with he said. The study is published in the June issue of the Annals of Internal Medicine. Watchful waiting which does not involve cancer treatment means having regular exams while keeping an eye on the tumor to see if it grows or spreads. It is usually recommended when doctors feel someones advanced age will allow them to outlive the generally slowmoving cancer or when someone has other conditions that are more likely to prove lethal. Men who are diagnosed with early prostate cancer meaning its confined to the prostate gland and has not spread are confronted with a bewildering array of options for treating it surgery radiation drugs to deprive the tumor of the hormone androgen that may drive its growth or watchful waiting. In AHRQ also commissioned a review of studies on other prostate cancer treatment options but that report could not draw conclusions on the best approach either. What all of these analyses have found is there is very limited data that allows us to determine which of these approaches in the best approach said Dr. Durado Brooks director of prostate cancer for the American Cancer Society. Brooks said more comparative effectiveness research which compares different kinds of treatments is needed. In the meantime what are men diagnosed with early prostate cancer to do Men and their doctors need to consider what the tumor looks like under the microscope which can help gauge how aggressive it may be. They should also consider age and overall health status including whether or not the patient has other conditions more likely to cause death than the prostate cancer. Finally patients and their doctors should weight the potential debilitating side effects of the treatments such as incontinence and erectile dysfunction against how comfortable the man is with holding off on treatment experts say. Men need to learn as much as they can about the possible outcomes and benefits of the various treatments and the potential side effects and choose which direction they are most comfortable with Brooks said. In the current review researchers found several trials that compared different doses of radiation and different types of radiation therapy including external beam radiation therapy in which a radiation is delivered through a beam through the skin or brachytherapy in which radioactive isotopes are delivered via injection into the prostate. For those methods too there was too little research to say with confidence which method was superior in preventing deaths from prostate cancer the researchers said. Retrospective studies however found that radiation treatments were associated with increased urinary or bowel problems compared with no treatment or no initial treatment. There was also moderate strength evidence that a higher external beam radiation was more effective than a lower dose. Taken together the review does point out that based on current evidence doctors should not be telling their patients that this form of radiation is better than that form Brooks said. Some of the distinctions being made are not really supported by the evidence. Proton beam therapy in particular is expensive but according to this report there isnt enough evidence to show its any better than other option. Radiation he noted may be the best option for men whose tumors have spread outside the gland since simply removing the prostate gland surgically is not likely to be as effective he said. The American Cancer Society estimates that in approximately men were diagnosed with prostate cancer and approximately men died of the disease. More information The National Cancer Institute http has more on prostate cancer. SOURCES Stanley Ip M.D. assistant professor medicine Tufts University Medical Center Boston Durado Brooks M.D. director prostate cancer American Cancer Society Atlanta June Annals of Internal Medicine"

"Infants who have a genetic profile linked with asthma risk could be protected against respiratory symptoms if they are breastfeed according to a new study. The study is presented today September at the European Respiratory Societys International Congress. Our study is the first to show that breastfeeding can modify the effect of asthmarelated genetic profiles on respiratory symptoms in the first year of life commented Dr Olga Gorlanova from the University Childrens Hospital Basel UKBB and the University of Basel Basel Switzerland. Genes that are associated with asthma risk are located on chromosome and called q. A recent study reported that children who possessed genetic variants on chromosome q had an increased risk of developing wheeze when combined with certain environmental exposures. It is already known that environmental factors have a modifying effect on specific genetic risk so the aim of this new study was to find out whether this could also be true for breastfeeding and this specific gene related to asthma with the respect to respiratory symptoms in early infancy. infants from the BaselBern Infant Lung Development birth cohort in Switzerland were included in the study. Researchers collected data on occurrence and severity of respiratory symptoms breastfeeding status and genotyping was performed. Findings revealed that during the weeks that infants were breastfed those carrying the asthma risk genotypes had a decreased relative risk of developing respiratory symptoms. When infants were not breastfed those carriers exhibited a trend towards an increased risk of respiratory symptoms. Dr Gorlanova said As research in this field progresses we are understanding more and more about the geneenvironment interaction for the development of asthma. Our study sheds light on how this interaction can be modified by breastfeeding. This is the first time that we were able to show the effect of the q variants on respiratory symptoms during the st year of life depending on breastfeeding status. Our results must be replicated in another cohort."

"For six years now life has been really good for James. He has a great job as the creative director of an advertising firm in New York City. He enjoys spending time with his wife and kids. And it has all been possible he says because for the past six years he has been taking a drug called ketamine https Before ketamine James was unable to work or focus his thoughts. His mind was filled with violent images. And his mood could go from ebullient to dark in a matter of minutes. Ketamine helped me get my life back says James who asked that we not use his last name to protect his career. Ketamine was developed as a human and animal anesthetic in the s. And almost from the time it reached the market it has also been used as a mindbending party drug. But ketamines story took a surprising turn in when researchers at the National Institutes of Health showed https that an intravenous dose could relieve severe depression in a matter of hours. Since then doctors have prescribed ketamine off label to thousands of depressed patients https who dont respond to other drugs. Article continues after this message from our sponsor And pharmaceutical companies are testing https several new ketaminerelated drugs to treat depression. Johnson Johnson expects to seek approval for its nasal spray esketamine https later this year though the approval would be limited to use in a clinical setting. Meanwhile doctors have begun trying ketamine on patients with a wide range of psychiatric disorders other than depression. And there is now growing evidence it can help people with anxiety bipolar disorder posttraumatic stress disorder and perhaps even obsessivecompulsive disorder. I think its actually one of the biggest advances in psychiatry in a very long time says Dr. Martin Teicher https an associate professor of psychiatry at Harvard Medical School and director of the Developmental Biopsychiatry Research Program at McLean Hospital. Ketamine may also offer new hope for people like James who have symptoms of several different psychiatric disorders. James had a happy childhood he says. But his thoughts were out of control. I always felt like I was crossing a freeway and my thoughts were just racing past me he says. He spent much of his childhood terrified of an unknown an ambiguous force out there. The fear was overwhelming he says. I literally slept with the cover over my head with just room to breathe through my mouth until I went to college. And there was something else about James his body temperature. I overheated constantly he says. I would wear shorts all year long. In my s in my apartment I would sleep with the windows open in the middle of the winter. In his late s James saw a doctor who told him he had attention deficit hyperactivity disorder. So he started taking stimulants. At first the pills helped him focus. Then they didnt no matter how many he took. Hed done well as an idea guy in the advertising industry. But now James was trying to work at home and it wasnt going well. ADHD pills will make you interested in anything he says. So I was putting the desk together and taking the desk apart. I was putting a laptop stand together and taking it apart. I was going in a massive downward spiral. James had always suffered from mood swings. But now they were rapid and extreme. And he couldnt stop thinking about gruesome scenarios like a murderer coming for his family. My wife took a summer off to be with me because she was scared of what was going to happen to me he says. She would go to work for a few hours then rush home. There would be times Id call her just screaming Please come home. I cant get through another minute. Eventually James found his way to Dr. Demitri Papolos httpbipolarchild.comaboutauthors an associate professor of clinical psychiatry at Albert Einstein College of Medicine. He was like a whirling dervish when he came into my office Papolos says. He was extremely fearful and scanning the environment all the time and he overheated at the drop of a hat. Papolos diagnosed James with a variant of bipolar disorder he calls the fear of harm phenotype. It typically appears in childhood and often doesnt respond to traditional psychiatric drugs. But Papolos has found that the condition does respond to ketamine. Its been transformational he says. In January Papolos published a study https of children with the problem. They inhaled a nasal mist containing ketamine about twice a week. Nearly all got dramatically better. Scientists still arent sure why ketamine works but theres evidence https that it encourages the brain to rewire to alter the connections between cells. That process has been linked to recovery from depression. And it may also explain why ketamine helps people who have symptoms associated with several different psychiatric disorders. I think its having multiple effects and that means its probably useful for multiple different disorders Teicher says. One of those effects involves a part of the brain involved in temperature regulation. And that could explain why patients like James usually stop overheating once they are taking ketamine. James started taking a ketamine nasal spray every other day. He says his response was dramatic. One day I turn to my wife and Im like I feel calm today. I dont know if its the sun coming in I dont know if its just the way were sitting here but I feel like I could go and sit at the computer and work. The next day James did sit down at his computer. A month later he was back at work."

"For years negative reports have surrounded artificial sweeteners claiming evidence of everything from being a carcinogen to causing cardiovascular disease. But now new research suggests a popular sugar substitute could lead to new treatments for some of the most common types of cancers. In findings presented at the National Meeting and Exposition of the American Chemical Society ACS a team of researchers from the University of Florida College of Medicine examined how saccharin the artificial sweetener that is the main ingredient in Sweet N Low Sweet Twin and Necta reacted with a protein found in aggressive cancer cells. The protein called carbonic anhydrase IX CA IX regulates pH in and around cancer cells allowing tumors to thrive and potentially metastasize to other parts of the body. It is found in a wide range of aggressive cancers including breast lung liver prostate pancreatic and kidney cancer. If you disrupt this pH balance via blocking CA IX activity you can stop these cancer cells from growing and proliferating study author Brian Mahon a graduate research assistant at the University of Florida told FoxNews.com. Mahon said the research stemmed from a study from the University of Florence in Italy that suggested saccharin would selectively block the activity of CA IX. He said his team led by University of Floridas Dr. Robert McKenna wanted to further investigate saccharins effect in treating cancer. It never ceases to amaze me how a simple molecule such as saccharin something many people put in their coffee every day may have untapped uses including as a possible lead compound to target aggressive cancers McKenna said. CA IX is not normally found in healthy human cells. McKenna said thats why its a prime target for anticancer drugs as they would cause little to no side effects to healthy tissue surrounding the tumor. Previous attempts to find an element that blocks CA IX without damaging other cells have been unsuccessful. Researchers used Xray crystallography to determine how saccharin binds to CA IX and are using that information to develop ways to finetune and improve its anticancer treatment potential. The goal is to develop drugs that could slow the growth of these cancers and potentially make them less resistant to chemo or radiation therapies. Currently saccharins effects are being tested on breast and liver cancer cells. This result opens up the potential to develop a novel anticancer drug that is derived from a common condiment that could have a lasting impact on treating several cancers McKenna said. Researchers warn the findings dont warrant adding large quantities of artificial sweeteners to your diet but they say their findings may offer promise for the development of an anticancer drug derived from an ingredient that ironically was once considered a possible carcinogen."

"Singing in a choir for just one hour boosts levels of immune proteins in people affected by cancer reduces stress and improves mood which in turn could have a positive impact on overall health a new study by Tenovus Cancer Care and the Royal College of Music published today in ecancermedicalscience has found. The research raises the possibility that singing in choir rehearsals could help to put people in the best possible position to receive treatment maintain remission and support cancer patients. The study tested members of five different choirs. Results showed that singing for an hour was associated with significant reductions in stress hormones such as cortisol and increases in quantities of cytokines proteins of the immune system which can boost the bodys ability to fight serious illness. Dr Ian Lewis Director of Research and Policy at Tenovus Cancer Care and coauthor of the research said These are really exciting findings. We have been building a body of evidence over the past six years to show that singing in a choir can have a range of social emotional and psychological benefits and now we can see it has biological effects too. Weve long heard anecdotal evidence that singing in a choir makes people feel good but this is the first time its been demonstrated that the immune system can be affected by singing. Its really exciting and could enhance the way we support people with cancer in the future. The study also found that those with the lowest levels of mental wellbeing and highest levels of depression experienced greatest mood improvement associated with lower levels of inflammation in the body. There is a link between high levels of inflammation and serious illness. Choir members gave samples of their saliva before an hour of singing and then again just after. The samples were analysed to see what changes occurred in a number of hormones immune proteins neuropeptides and receptors. Dr Daisy Fancourt Research Associate at the Centre for Performance Science a partnership between the Royal College of Music and Imperial College London and coauthor of the research said Many people affected by cancer can experience psychological difficulties such as stress anxiety and depression. Research has demonstrated that these can suppress immune activity at a time when patients need as much support as they can get from their immune system. This research is exciting as it suggests that an activity as simple as singing could reduce some of this stressinduced suppression helping to improve wellbeing and quality of life amongst patients and put them in the best position to receive treatment. Diane Raybould took part in the study and has been singing with the Bridgend Sing with Us choir since . Diane was diagnosed with breast cancer when she was aged . Her daughter was diagnosed with breast cancer at the same time and sadly passed away from the disease at just . Diane said Singing in the choir is about more than just enjoyment it genuinely makes you feel better. The choir leaders play a huge part of course but so does the support of the other choir members the inspirational programme and uplifting songs. The choir is a family simple as that. Having cancer and losing someone to cancer can be very isolating. With the choir you can share experiences openly and that is hugely important. Rosie Dow Head of Sing with Us at Tenovus Cancer Care and coauthor of the research added This research is so exciting as it echoes everything all our choir members tell us about how singing has helped them. Ive seen peoples lives transformed through singing in our choirs so knowing that singing also makes a biological difference will hopefully help us to reach more people with the message that singing is great for you mind body and soul. Following on from this research Tenovus Cancer Care is launching a two year study looking in more depth at the longitudinal effect of choir singing over several months. It will look at mental health wellbeing social support and ability to cope with cancer alongside measuring stress hormones and immune function amongst patients carers staff and people who have lost somebody to cancer. The full research paper can be found at httpecancer.orgjournal.php If you or someone you love has been affected by cancer Tenovus Cancer Care can offer help and support. To find out more call the Tenovus Cancer Care free Support Line on or visit tenovuscancercare.org.uk http For more information contact Ruth Taylor PR and Communications Manager on ruth.taylortenovuscancercare.org.uk mailtoruth.taylortenovuscancercare.org.uk. Research paper available on request About the research members of five choirs in Cardiff Bridgend Pontypridd Cwmbran and Swansea took part in the study across between June and July . The Centre for Performance Sciences is a partnership between the Royal College of Music London and Imperial College London. Tenovus Cancer Care runs Sing with Us choirs across England and Wales. For more information please visit http Notes to editor At Tenovus Cancer Care our aims are simple to help prevent treat and find a cure for cancer. In doing that we offer support advice and treatment information on prevention and funding for research to improve outcomes for people living with cancer. We do this where it is needed most right at the heart of the community. Tenovus Cancer Care free Support Line is open am pm days a year on . Keep up to date with Tenovus Cancer Care by following them on Twitter tenovuscancer http or Liking their page on Facebook http The Royal College of Music is currently home to undergraduate and postgraduate students from nations. International students constitute approximately of our student body. In the RCM was ranked by The Guardian as the leading Higher Education Institution in the UK for studying music. The Higher Education Statistics Agency HESA survey found that proportionally more RCM alumni who responded to the survey had moved to employment or further study within six months of graduation than graduates from any other UK conservatoire or UK university. Among RCM alumni are composers and performers such as Sir Hubert Parry Benjamin Britten Gustav Holst Sir Colin Davis David Helfgott Samuel ColeridgeTaylor Lord Lloyd Webber Dame Joan Sutherland Sir James Galway Ralph Vaughan Williams and Alfie Boe. Regular visitors to the RCM to teach and demonstrate are Bernard Haitink Vladimir Ashkenazy and Lang Lang. Our most recent honorary doctorates include Vladimir Jurwoski Dame Kiri Te Kanawa Sir Roger Norrington Bryn Terfel and Steve Reich. The Centre for Performance Science is a distinctive new partnership of the Royal College of Music and Imperial College London. The Centre takes a strongly interdisciplinary approach to investigating human performance in the arts business education medicine science and sport and draws upon worldleading expertise and stateoftheart facilities across the RCM and Imperial College. ecancermedicalscience is an openaccess journal that is free to read."

"Bottom Line For adults coming to the emergency department for arm or leg pain due to sprain strain or fracture there was no difference in pain reduction after hours with ibuprofenacetaminophen vs three comparison opioidacetaminophen paracetamol combinations. Why The Research Is Interesting The United States is facing an opioid epidemic with almost individuals dying from opioid overdoses since . Despite the epidemic opioid analgesics remain a firstline treatment for moderate to severe acute pain in the emergency department. The combination of ibuprofen and acetaminophen may represent an effective nonopioid alternative. Who patients ages to years with moderate to severe acute extremity pain in two urban emergency departments were randomly assigned to receive mg ibuprofen and mg acetaminophen mg oxycodone and mg acetaminophen mg hydrocodone and mg acetaminophen or mg codeine and mg acetaminophen When July to August What Study Measures The betweengroup difference in decline in pain two hours after taking the study drugs. How Study Design This was a randomized clinical trial RCT. Randomized trials allow for the strongest inferences to be made about the true effect of an intervention such as a medication or a procedure. However not all RCT results can be replicated because patient characteristics or other variables in realworld settings may differ from those that were studied in the RCT. Authors Andrew K. Chang M.D. M.S. of Albany Medical College Albany New York and coauthors Results After hours pain was less in all participants without any important difference in effect between the four groups. Study Limitations The results apply only to pain after two hours. About in patients required additional medication to control their pain. Study Conclusions There were no important differences in pain reduction after hours with ibuprofenacetaminophen or opioidacetaminophen combination pills in emergency department patients with acute extremity pain. The findings suggest that ibuprofenacetaminophen is a reasonable alternative to opioid management of acute extremity pain due to sprain strain or fracture but further research to assess longerterm effect adverse events and dosing is warranted. Related material The following related elements also are available on the For The Media website The editorial Opioid vs Nonopioid Acute Pain Management in the Emergency Department by Demetrios N. Kyriacou M.D. Ph.D. Senior Editor JAMA Chicago Northwestern University Feinberg School of Medicine Chicago. For more details and to read the full study please visit the For The Media website. doi.jama.. Editors Note Please see the article for additional information including other authors author contributions and affiliations financial disclosures funding and support etc. Want to embed a link to this study in your story Link will be live at the embargo time httpjamanetwork.comjournalsjamafullarticle.jama.."

"The older we get the more likely our circadian rhythms are disrupted. For example blood pressure BP not only tends to increase but as well become more irregular. Luckily as we show in our research melatonin helps to ameliorate both trends. senior respondents of a mean age of were studied during consecutive weeks. First week control data were collected for successive days. Over the next weeks the seniors were administered a low dose of melatonin . mg each day by night at p.m. On the third week data were monitored again. Melatonin significantly reduced BP. The hypotensive effect was dependent on time. The maximum systolic BP lowering effect of melatonin falls between and in the morning the time of the highest risk of heart attacks and strokes. Nighttime and morning BP decreased more profoundly on average . mm Hg for SBPDBP respectively. Moreover the higher the mean systolic BP was during the first week the more it dropped on the second week of melatonin administration. Melatonin also decreased the overall variability in BP. Melatonin ws effective in synchronizing disrupted circadian rhythms of BP heart rate and body temperature making these circadian rhythms smoother and less irregular. None of these effects was found in placebo treated seniors thus ruling out the possibility that rhythms could be improved just because of regular schedule and presence of medical personal who took measurements. In conclusion melatonin can be of great value for aged people suffering from hypertension as an adjuvant substance complementing basic medication as it is able to stabilize circadian BP heart rate profiles and their phase relationships. The improvement of circadian pacemaker functions may also provide a new strategy in the treatment of hypertension. Denis G. Gubin Gennady D. Gubin Ludmila I. Gapon and Dietmar Weinert Tyumen Medical University Odesskaya Tyumen Russia Reference Gubin D.G. et al. . Daily Melatonin Administration Attenuates AgeDependent Disturbances of Cardiovascular Rhythms Curr. Aging Sci. DOI ."

"Dear Julia How well do flu shots actually work Just about every influential public health figure urges people to get their flu shots each fall as a necessary precaution during influenza season. So over dinner I asked a couple of respected evidencebased medicine researchers what they thought of the vaccine. I was taken aback by their response. They basically laughed at the idea that the flu shot was particularly effective. This posed a conundrum. It seemed like there were two groups saying very different things. But after reviewing the research I think I understand whats going on here. Its true that flu vaccines dont work spectacularly well at least according to the best evidence we have and most of the evidence on flu vaccines is of poor methodological quality. But the downsides to getting a vaccine are extremely minimal and flu shots may still be helpful in reducing some illness and saving lives which is why public health experts say you should get vaccinated anyway. Why the flu vaccine isnt always effective The flu vaccine has been our main strategy for warding off seasonal flu for more than years. Seasonal influenza which surfaces as a respiratory illness is caused by influenza A and B viruses. The flu shot is designed to protect people against three or four strains of the A and B viruses that researchers believe will be most common that year leading to the nasty fevers headaches coughs and runny noses that make many people miserable in the fall and winter. The challenge however is that the flu virus is highly unstable mutating all the time. So this means drug companies cant just make one kind of vaccine thatll last a lifetime. Every year public health agencies essentially make educated guesses http on what strains and mutations will make the rounds. And thats not easy. In February the World Health Organization offers a prediction http based on surveillance and laboratory and clinical studies and then each country uses that prediction to approve vaccines in its jurisdiction. In the US the Food and Drug Administration makes that final call. The potential for error here can dramatically alter the effectiveness of the flu shot in a given season. If vaccine makers prepare for one combination of viruses and different ones end up circulating widely the vaccine wont work that well. This may help explain why the evidence on the effectiveness of flu shots is relatively mixed. The Cochrane Collaboration an independent nonprofit that reviews the evidence on medical questions has conducted two major metaanalyses looking at the results of lots of individual studies on whether the shot prevents flu in healthy children http and adults http In kids httponlinelibrary.wiley.comdoi..CD the highestquality evidence a randomized controlled trial suggests the vaccine works well enough On average if you give six kids under the age of a flu shot you can expect to prevent one case of the flu. For children under age the benefits are less clear the evidence the researchers found was scant and of the research that was available it seemed the efficacy of the shot was similar to placebo. In adults http however the vaccines effects are more modest. Depending on the season explained Tom Jefferson an author on these Cochrane reviews you need to vaccinate anywhere between and people to avoid one set of symptoms. In a good year when the WHO guesses correctly and the flu shot matches the strains in circulation you need to give adults flu shots on average to prevent one case of illness. In a year when the WHO guesses badly you need to vaccinate people to prevent one flu case. Jefferson pointed out that his Cochrane review on adults also found that flu vaccination rates have barely any effect on the number of sick days taken and no major impact on rates of hospitalization. So yes the flu vaccine can prevent illness but its hard to detect major effects on public health in the data. On the other hand the evidence suggests that theres no harm in getting a flu shot either. The metaanalyses found no evidence of serious side effects beyond the odd case of soreness at the injection site. That seems to be the same conclusion that other studies have drawn the flu vaccine is modestly helpful and doesnt hurt. In researchers analyzed http metaanalyses on the flu shot and concluded Most influenza vaccines have been shown to confer some protection against naturally acquired infection and no evidence for major harms has emerged. One key caveat here is that the evidence overall is pretty poor quality. Most of these analyses rely overwhelmingly on observational studies http where researchers observe and gather data on people who take the flu shot compared with those who dont. Because these arent experiments ideally wed have randomized controlled trials http theyre more prone to bias and therefore less reliable. In the case of the elderly the situation is particularly troublesome. As this Lancet study http points out because annual flu shots were recommended for the elderly since the s it has been unethical to conduct highquality randomized controlled trials where you give only one group the shot in order to compare it with another group that didnt get the vaccine. So as this Cochrane review http_vaccinesforpreventingseasonalinfluenzaanditscomplicationsinpeopleagedorolder notes its impossible to draw firm conclusions on the effectiveness of the flu vaccine for those over because the data is so biased and poor. Again though this doesnt mean we should throw away the vaccine. Stanford researcher John Ioannidis told me how he makes sense of this issue after reviewing the evidence Overall the flu vaccine is effective and it does save lives. I cannot put an exact figure to how many but it may well be millions of lives. Generally it is safe and rather cheap so even if the effectiveness is less than optimal sometimes overall it is a good deal. Why people still bother to get the shot Despite the limited evidence of effectiveness there are still good reasons why public health experts recommend the shot. For one in those years when the WHO guesses correctly which strains will circulate the shot tends to be a lot more helpful than some of these averages suggest. And the vaccine is overwhelmingly safe. Theres also little by way of alternatives. Beyond public health measures making sure you have good hand hygiene and avoiding the office when youre sick the flu shot is the best medical intervention we have for preventing infection. So theres little downside with at least some potential benefit. I personally continue to get the flu shot for this reason. As Roger Baxter the codirector of the Kaiser Permanente Vaccine Study Center http told me Flu vaccines are not a panacea and do not prevent all cases of flu even in the best years when there are no manufacturing problems and the match is perfect. He continued However the vaccines provide moderate protection and can prevent huge numbers of cases of this serious illness. Many studies have shown that the vaccines are very safe so the benefittorisk ratio is high and the cost is relatively low. Welcome to Dear Julia http a column where readers can submit everyday health questions. Which overthecounter painkillers http work best Is it better to run or walk http for exercise How much harm does frequent flying http to your body Julia Belluz will sift through the research and consult with experts in the field to figure out how science can help us live happier and healthier lives."

"Heterosexuals who are HIV negative can significantly reduce their risk of infection by taking a daily dose of an antiviral drug according to a new study by the Centers for Disease Control and Prevention. The study called TDF httpthechart.blogs.cnn.comtakingmedsbeforeexposurecutshivriskforheterosexualsPreexposuredrugsreducesriskofHIVinfectioninHeterosexuals followed uninfected heterosexual men and women between the ages of and years in Botswana Africa. Study participants took a tablet containing tenofovir disoproxil fumarate and emitricitabine TDFFTC whose brand name is Truvada http or a placebo. On average patients were followed for a year although some were followed for about three and a half years. The risk of infection was reduced overall but for participants who actually got the drugs that risk decreased by . Giving daily antiretroviral drugs to uninfected individuals to prevent the disease is called preexposure prophylaxis or PrEP http Previous studies have shown PrEP to be effective in reducing infection rates among the uninfected. Dr. Kevin Fenton director of the CDCs national Center for HIVAIDS Viral Hepatitis STD and TB Prevention called the news a milestone. It is clear we are not going to find one magic pill to solve the issue of HIV but by combining this approach with others we are beginning to get a better handle on combination packages. There is reason to be excited. The news comes at the same time a second study looking at PrEP in heterosexual couples in Kenya and Uganda also found significant reductions in infection rates. The Partners PrEP study http participants took either TDFFTC the drug tenofovirbrand name Viread or a placebo. Preliminary results showed both treatments significantly reduced transmission in couples where one partner was already infected with the virus. Patients who took tenofovir had fewer infections while those taking the combination drug had fewer infections than those who got the placebo. Just a few years ago the tool kit for HIV prevention was not very large says Dr. Jared Baeten the principal investigator of the Partners PrEP study at the University of Washington. Now we have a nice collection of really powerful strategies that work for the population at greatest risk in the world. This is really a game changer. We now have findings from two studies showing that PrEP can work for heterosexuals the population hardest hit by HIV worldwide Fenton said. Taken together these studies provide strong evidence the power of this prevention strategy. In fact an interim review of the Partners data on effectiveness was so compelling that the trial was stopped early and the placebo arm was discontinued. Clear evidence Baeten said that PrEP substantially reduces infection risk. At the same time he says there was no evidence of safety concerns. Patients taking the placebo will be put on one of the drugs. In the TDF study those taking the drug reported nausea vomiting and dizziness. An earlier PrEP trial the iPrEx study http looked at treatment in men who have sex with men. Infection rates dropped by in patients who consistently used PrEP. We are in a critical moment in HIV prevention research said Robert Grant M.D. M.P.H of the Gladstone Institutes and the University of California at San Francisco. He is the iPrEx protocol chair. iPrEx provided the first proof of an important new method of HIV prevention that can help slow the global toll of . million new HIV infections each year. Partners PrEP and the TDF study have now expanded that finding by demonstrating the effectiveness of PrEP in heterosexual women and men. Developing and deploying proven HIV prevention methods including PrEP microbicides vaginal gels clean needles medical male circumcision early treatment counseling testing condoms and suppressive therapy for pregnant women will all be key to slowing the global epidemic he said. The CDC says the next step is to fully review all the data and begin to develop guidelines for the use of these drugs in heterosexual men and women here in the U.S."

"Call them brain pacemakers tiny implants that hold promise for fighting tough psychiatric diseases if scientists can figure out just where in all that gray matter to put them. Deep brain stimulation or DBS has proved a powerful way to block the tremors of Parkinsons disease. Blocking mental illness isnt nearly as easy a task. But a push is on to expand research into how well these brain stimulators tackle the most severe cases of depression obsessivecompulsive disorder and Tourettes syndrome to know best how to use them before too many doctors and patients clamor to try. Its not a light switch cautions Dr. Michael Okun of the University of Florida. Unlike with tremor patients the psychiatric patients who respond to DBS tend to improve gradually sometimes to their frustration. And just because the tics of Tourettes fade or depression lightens doesnt mean patients can abandon traditional therapy. They also need help learning to function much as recipients of hip replacements undergo physical therapy says Dr. Helen Mayberg of Emory University. Once your brain is returned to you now you have to learn to use it she told the annual meeting of the American Association for the Advancement of Science. Roughly people around the world have undergone deep brain stimulation for Parkinsons or other movement disorders when standard medications fail says Okun among leading researchers who gathered at that meeting last week to assess the field. How does it work Surgeons implant a wire deep in the brain. Tiny electrical jolts running from a pacemakerlike generator near the collarbone up the neck to that electrode disable overactive nerve cells to curb the shaking. Scientists figured out which spot to target based on surgery that sometimes helps worstcase Parkinsons patients by destroying patches of brain tissue. But with deep brain stimulation the electrodes dont destroy that tissue. The electrical signals can be adjusted or even turned off if they dont help or if they cause neurological side effects. The surgery however does sometimes cause dangerous brain bleeding or infections. Psychiatric illnesses require a similar operation but surgeons must implant the electrode into a different spot in the brain. Theres the rub Its not clear which spot is best for which psychiatric disease. In fact two manufacturers Medtronic and St. Jude Medical have begun major studies of DBS effects on depression. Each places the implant in a different region based on promising pilot studies. And the Food and Drug Administration in approved Medtronics version for a small group of obsessivecompulsive patients who get no relief from todays treatments under a special program that lets devices for rare conditions sell before theres final proof that they work. Dr. Joseph Fins medical ethics chief at New York Presbyterian Hospital worries that may hurt efforts to get such proof. The more available the electrodes are the more people may seek to try the surgeries without enrolling in strict trials. How good is the evidence so far The researchers are pushing for a registry to track DBS recipients to better tell but overall theyre cautiously optimistic. Just over people with intractable obsessivecompulsive disorder have undergone DBS since says Dr. Benjamin Greenberg a Brown University psychiatrist who is heading a major study funded by the National Institute of Mental Health. About threefourths of the first few dozen patients studied significantly improved some as long as eight years. You still have a burden but you have a life is how he describes the improvement. These are people who try to relieve fears or anxiety with obsessive behavior such as washing their hands or checking locks repeatedly many of whom never got out of the house because their daily rituals consumed so much time Greenberg says.Theyd failed behavior therapy designed to teach that whatever they fear doesnt happen if they skip the ritual. But with the brain pacemaker somehow that behavior therapy starts working Greenberg says maybe by enabling their brains to better remember the lessons. One big hurdle The battery tucked near the collarbone tends to last less than two years. Changing it entails outpatient surgery one reason that about a third of studied patients stop getting zapped. So Greenberg just began testing a newer version that patients can recharge every few days. Results on about DBS patients with severe depression have been published so far and roughly half improve regardless of which of the two targeted brain regions is zapped says Emorys Mayberg who shares a patent licensed to St. Jude. Separately shes now studying what the successfully treated brains have in common that might help predict the best candidates hoping to ease a tremendous burden on the patients as they decide whether to try these experiments."

"Pivotal trial results for Merck Co Incs immunotherapy drug Keytruda show that it lengthened survival by three months or nearly percent for patients with advanced bladder cancer who had stopped responding to chemotherapy. The data to be presented next month at a meeting of the American Society of Clinical Oncology follow last weeks announcement that rival drug Tecentriq from Roche Holding AG did not improve survival when used as a secondline treatment for bladder cancer in a trial. The Merck drug is awaiting U.S. Food and Drug Administration approval but Tecentriq was approved by the agency last year contingent on verification of its clinical benefit. Roche in an emailed statement said it plans to discuss the data with health authorities but did not disclose the timing for the discussions. According to the FDA approval letter the company has until December to submit the full trial data to the agency. Merck filed in February for FDA approval of Keytruda for both initial and secondary treatment of advanced urothelial cancer the most common type of bladder cancer. Keytruda is already approved for treating melanoma lung cancer head and neck cancer and Hodgkin lymphoma. Merck announced in October that the secondline bladder cancer study met its main goal and was stopped early. The company is currently enrolling patients in a phase three trial of Keytruda combined with chemotherapy as an initial treatment for bladder cancer. In addition to Tecentriqs approval for bladder cancer patients whose disease has stopped responding to chemotherapy the FDA last month approved the Roche drug as an initial treatment for people with a specific type of advanced bladder cancer and in people whose cancer progressed despite at least one prior platinumcontaining chemotherapy. The agency has also granted contingent approval to AstraZeneca Plcs Imfinzi BristolMyers Squibbs Opdivo and Bavencio developed by Pfizer Inc and Merck KGaA as secondline bladder cancer treatments. All five drugs are part of a new class of treatments designed to unleash the bodys immune system to fight cancer by interfering with proteins known as PD or PDL that help malignant cells evade immune attack. Merck said data from an openlabel Phase trial of advanced bladder cancer patients showed median survival of . months for Keytruda patients and . months for patients given secondline chemotherapy. The studys median followup was . months. After months percent of Keytruda patients were alive compared with . percent of chemotherapy patients according to research published by ASCO. The study did not detect a difference in the length of time patients lived without their disease getting worse. Severe side effects were reported in . percent of the Keytruda patients compared with nearly half of the chemotherapy group. Reporting By Deena Beasley Editing by Bill Rigby and David Gregorio Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"University of Miami cardiologists last week reported success in a small preliminary human clinical trial of a new stem cell therapy they hope some day will routinely mend human hearts and reduce the need for lifelong medication even for transplants. Thats the Holy Grail the quest the whole field has been pursuing for close to a decade and this is evidence were on the right track said Dr. Joshua Hare director of the University of Miami Medical Schools Interdisciplinary Stem Cell Institute. Hes lead author of the study that appears in Thursdays peerreviewed Circulation Research Journal of the American Heart Association. Max Eaton the yearold directbuy franchise owner who was patient No. in the eightperson trial said Wednesday hes thankful he was part of the trial adding that he had just completed a .mile minute walk around his neighborhood in LauderdalebytheSea Fla. I feel very grateful he said. Almost certainly I would be deceased or in much worse shape had I not had the opportunity to be in this program. Hare stressed that the current trial is only a small runup phase of extensive testing that will take up to five years and involve dozens of hospitals and hundreds of patients before winning U.S. Food and Drug Administration approval for routine use. The trial was primarily about the safety of the procedure and all eight patients came through without significant side effects he said. The procedure also reduced the size of hearts swollen by previous heart attacks a condition called cardiomyopathy or simply heart failure. The reduction was up to percent while current therapies including medication and pacemakers typically reduce the size by only about percent he said. The reduction in swelling increases the hearts ability to pump blood he said. By implication it almost certainly improves the patients health although that was not directly measured in the small early study. In the study stem cells were taken from the patients own bone marrow and injected by catheter into scar tissue in the patients heart caused by an earlier heart attack. It worked in patients such as Eaton whose heart attack was years ago Hare said. The hope was that the immature adult stem cells would turn into heart muscle replacing the scar tissue. The study shed new light on a question of prime interest to cardiologists whether the injected stem cells actually transformed themselves into heart muscle or improved heart function in some other way. Some of the stem cells did become heart muscle Hare said they also triggered the heart to produce more of its own stem cells which became new heart muscle as well he said. The next step is two more nearterm studies. The first which started in is a doubleblind placebocontrolled study of patients designed further to test the safety of the procedure but primarily its efficacy or how well it works. Another study about to get underway will see whether bone marrow from a donor can work as well as the patients own bone marrow. Later researchers will conduct a study involving to hospitals and many hundreds of patients aimed at winning final FDA approval. Eatons part of the testing is finished. He says hes glad he took part even though it hasnt quite turned him into an Olympic runner. I still get chest pains at times. It depends on the time of year. I had my heart attack years ago in the fall. Thats when I get them he said. But he adds Im not ready to go. Ill keep going as long as I can enjoy whats to be enjoyed."

"Being a parent these days sometimes entails this hypocrisy Yes I know overuse of antibiotics is creating superbugs http_ST_N.htm that may soon conquer the universe. But please give some to my kid anyway. Now two http new studies http bolstered by an accompanying editorial http in the New England Journal of Medicine demonstrate what we parents have suspected for years When it comes to ear infections antibiotics are in order. Current practice guidelines for treating kids mild middleear infections or acute otitis media http call for watchful waiting to be followed by antibiotics only if symptoms worsen or dont cease. That sounds fine in theory but its a tough pill to swallow when its your own wee one whos wailing and writhing in pain. Ear infections hurt and waiting for them to run their course can be excruciating. Both of the studies in contrast to earlier research on which the watchful waiting approach has been based are considered welldesigned even if they are on the small side. Both show that antibiotics are more effective than placebos in relieving earinfection symptoms such as fever poor appetite decreased activity and irritability and suggested that their benefits warrant their being administered early on regardless of the seeming severity of a childs symptoms. Interestingly antibiotics were no more effective at reducing pain as reported by parents or children than placebos. One of the studies noted that while antibiotics specifically amoxicillin http paired with clavulanate shortened the duration of symptoms half the children on placebo eventually got better without the aid of those drugs. Still some of the placebogroup kids required rescue treatment when their symptoms grew markedly worse. The studies also noted that the use of antibiotics must be weighed against the risk of antimicrobial resistance to which prescriptions for childhood maladies such as ear infections are thought to contribute mightily and against antibiotics side effects which can include diarrhea and eczema. As it happens on Christmas Eve my daughter who at is wee no more woke up with a wicked pain in her ear. Her doctor took one quick look inside and wrote a prescription for Augmentin http a popular drug that combines amoxicillin with clavulanate potassium. By Christmas morning the pain had subsided. Did I feel guilty for potentially contributing to the development of a superbug The thought never crossed my mind. It doesnt tend to when youre worried about your kid and grateful when her pain goes away."

"U.S. regulators have approved the first drug aimed at women with advanced breast cancer caused by an inherited flawed gene. The Food and Drug Administration on Friday approved AstraZeneca PLCs Lynparza for patients with inherited BRCA gene mutations who have undergone chemotherapy. The drug has been on the market since for ovarian cancer and is the first in a new class of medicines called PARP inhibitors to be approved for breast cancer. PARP inhibitors prevent cancer cells from fixing problems in their DNA. Lynparza will cost per month without insurance according to AstraZeneca. The company is offering patients financial assistance. While there is currently no cure for metastatic breast cancer todays approval offers a new targeted option that may help to delay disease progression for these patients Dr. Susan M. Domchek at the University of Pennsylvanias Abramson Cancer Center said in a statement. Until recently cancer medicines targeted the disease based on where in the body it occurs. This is a new approach to target the underlying genetic causes of a cancer the FDAs Dr. Richard Pazdur said in a statement. The agency also approved a companion blood test from Myriad Genetic Laboratories Inc. for detecting BRCA mutations and determining which patients likely would benefit from Lynparza. About people each year are diagnosed with breast cancer and just over die from it according to the National Cancer Institute. About percent to percent of patients with hereditary breast cancers have a BRCA mutation. BRCArelated breast cancer often strikes younger people and is harder to treat than other breast cancers. The latest approval was based on a study of women with cancers that have spread beyond the breast and who had a BRCA gene mutation. Lynparza modestly delayed the time until cancer worsened months versus months for women given one of three commonly used chemotherapies. About half the study participants responded to Lynparza compared with about a quarter of those only treated with chemotherapy. Its unknown whether treatment increases survival. Possible side effects are less severe than for chemotherapy but serious problems can include blood and bone marrow cancers. Common side effects include nausea fatigue respiratory infections and blood count problems. Lynparza is marketed jointly by UKbased AstraZeneca and Merck Co. which is based in Kenilworth New Jersey."

"Beth McDaniels oncologist a bear of a man hugged her and twirled her around. Holy cow Beth Dr. John J. Gohmann exclaimed. For the first time since a rare cancer appeared eight years before her lymph nodes had shrunk to a normal size her skin was no longer bright red and inflamed and the itchiness that plagued her had subsided. Mrs. McDaniel the yearold wife of a retired corporate executive had gambled on the ultimate in personalized medicine an approach known as whole genome sequencing and it seemed to be paying off. Scientists had compared the entire genetic sequences of the tumor cells invading her body with those in her healthy cells searching for mutated tumor genes that could be thwarted by drugs approved for other cancers or even other diseases. That had led them to give her an expensive drug approved just a month earlier for melanoma patients. It had never been given to anyone with a blood cell cancer like hers. In theory the drug should have killed her. Instead it seemed to have halted or even reversed her cancer. But would it last And what would it mean if it did not In the end Mrs. McDaniels journey to the edge of genetics research turned out to be a decidedly mixed experience. It was hard much harder than anyone in her family had imagined to get the sequencing and analysis done. It was breathtaking to see the results which indicated that her cancer was driven by a strange gene aberration that could be attacked with a new drug. But it was heartbreaking to see how quickly her cancer recovered from the assault roaring back in a matter of weeks. Anthropomorphizing cancers as smart is just as sad as numerous attributions to deities which doggedly obstruct our extremely slow road to... Did the team make a difference for Mrs. McDaniel I am not qualified to answer that question but the work done and the knowledge gained... Mrs. McDaniels story offers a sobering look at the challenges for this kind of quest for a treatment even for someone like her who had both the means and the connections to get the intricate geography of her cancer charted. Her husband Roger McDaniel was a former chief executive of two companies involved in semiconductor manufacturing and the family could afford the approximately that the search would cost. They had expected to pay much more but to their astonishment Mrs. McDaniels insurance company covered almost all the drug costs. And the scientists who did the data analysis did not charge. From the start the family knew the odds were against Mrs. McDaniel but she thought she had little to lose. You cannot feel bad if this doesnt work or I die she told her son Timothy a molecular biologist. I would have died anyway. Scarlet Skin and Infections Beth McDaniels cancer began with itching all over her body. Then her skin turned scarlet and started becoming infected. In after she had spent more than a year going from specialist to specialist a dermatologist figured it out. Mrs. McDaniel then had Sezary syndrome a rare T cell lymphoma in which white blood cells become cancerous and migrate to the skin. All her doctors could tell her was that the disease was incurable that there was no standard treatment and that on average patients at her stage die within a few years. Of course I was shocked Mrs. McDaniel said in an interview last September. She wept that day as her husband drove her home. And she asked God to help her cope. Before cancer she had had a vibrant life hiking in the mountains traveling the world entertaining her wide network of friends. Her disease destroyed all of that. She could not even enjoy her luxuriant garden because sun on her inflamed skin was agony. Although there is no standard treatment for five years chemotherapy held her disease at bay. But in the summer of she got worse much worse with hundreds of tumors popping up under her skin. Some grew as large as kiwi fruits and split open. Her son Dr. McDaniel decided he would orchestrate the use of the most advanced techniques of gene sequencing and analysis to take on her cancer. Because of his job he works for Illumina a company that does DNA sequencing Dr. McDaniel had read scientific reports and gone to medical conferences where he heard talks on whole genome sequencing. He noticed that the patients all seemed to have rare cancers. Every time I heard one of those stories I thought Thats my mom he said. For now there are not many drugs that can target specific gene mutations in cancer cells. But the hope is that when more is known and more drugs are developed doctors will treat cancer by blocking several major genes at once. With several escape routes barred the cancer will not be able to break free of the drugs stopping its growth. FullTime Help From a Son In theory it seemed straightforward for Dr. McDaniel to help his mother. The technology for getting and analyzing DNA sequences has advanced greatly and the cost has plummeted. In fact Dr. McDaniel said the price of sequencing has dropped so fast that if the work were done today it would cost just instead of the it cost last year. The first obstacle was just getting a sample of Mrs. McDaniels cancer cells. One doctor told her the odds of success were so slim that she would be better off spending her money on a vacation. Another seemed interested but did not follow through. A third did two biopsies but was unable to get usable DNA. Finally Dr. McDaniel and his wife Gia decided he would make helping his mother a fulltime job. He took a leave of absence from Illumina and he Gia and their three young children moved from San Diego to Lexington Ky. I have not been a particularly humble person Beth McDaniel said. That humbled me. Dr. McDaniels parents had two homes in the Lexington area. One on a horse farm was vacant and he appropriated a bedroom on the second floor for his office. He treated his work like a regular job driving to the office each day from another house where he and his family were living. He dressed in his normal work clothes slacks and a collared shirt. Meanwhile his mothers cancer was erupting. She was covered in tumors almost like cobblestones said Dr. Fernando R. de Castro her dermatologist. They felt like marbles and pebbles all over her skin. Large ones on her arms and legs had burst open. We started talking about hospice. Mrs. McDaniel said she was not a vain person but with red lumps all over her face she was embarrassed to go out. She slept on a cooling pad and carried one with her to relieve the constant itching. Every evening around when the itching became most unbearable she would lay her head in her husbands lap as they watched TV in their great room and he would gently tickle her back for hours on end trying to ease her discomfort. The disease continued a relentless course until finally accepting what seemed the inevitable Mrs. McDaniel gave away her clothes planned her funeral and wrote notes to a few people she thought she had offended in her life asking them to forgive her. She believed we all believed she would die before we got the sequencing done Dr. McDaniel said. Then in January Dr. de Castro got a tissue sample from a tumor and for comparison with normal cells her saliva. He had removed a plug of tissue the size of a pencil eraser from one of the hundreds of tumors on Mrs. McDaniels skin frozen it in liquid nitrogen and shipped it overnight to the Mayo Clinic in Scottsdale Ariz. By April scientists at Illumina and TGen a nonprofit research institute had completed the genetic sequencing of the samples. Photo Next came the hard part the analysis. With time short Dr. McDaniel worked on it himself and recruited two small biotechnology companies and TGen to help. Three Billion Symbols in a Cell John Carpten an oncologist at TGen and David Craig are accustomed to working with gene sequence data but it is hard even for them to get used to the scale of such a project. The hard drive containing Mrs. McDaniels genetic data arrived in the mail it had too much data to send electronically. It took a full day just to pull this terabyte of information off the drive. Dr. Carpten explained that there were three billion symbols made from four letters A T G and C in just one cells DNA. If those letters were printed on paper they would fill a mediumsized elementary schools library. But there are unavoidable errors in sequencing so to be sure the data is correct researchers repeat the sequencing times libraries worth. They do this for the normal cells too another libraries worth. This kind of data though does not come in neat genetic words and sentences. Instead Dr. Craig said It looks like its been through a shredder. It is like putting together a jigsaw puzzle that has a billion pieces Dr. Carpten said. Finally they compared the sequences of normal cells and cancer cells. They found about differences most with no known significance for the disease. At last the work was done and on May Dr. McDaniel flew to TGen. The researchers noticed an intriguing aberration in Mrs. McDaniels cancer genes. But they were uncertain what it meant. It looked as if two genes had fused to each other in Mrs. McDaniels cancer cells. The result was that the cell growth signals in the cancer cells were reversed like crossed wires. The research team theorized that every time those cancer cells T cells of her immune system got a signal to stop growing they reacted as though they had gotten a signal to grow. And every time they got a signal to grow they responded by stopping their growth. If they were right the way to stop her cancers growth could be to signal it to grow. And that was what a new melanoma drug ipilimumab its trade name Yervoy was designed to do. It spurred the growth of normal T cells. But if the researchers were wrong the drug could kill her. They spent two hours at a whiteboard on Wednesday May trying to understand what the fusion really meant. Then Dr. McDaniel took the data home and asked a colleague at Illumina to try to fish out a handful of crucial genetic sequences that were buried among million others. On Sunday night May Dr. McDaniel had them and began trying to decipher them. By p.m. he had it figured out. The TGen scientists findings were real. The brake pedal had been wired to the accelerator Dr. McDaniel said. He worked all night found a paper by scientists who had deliberately fused those very genes and discovered that yes the genetically altered T cells had their growth signals reversed. At a.m. Dr. McDaniel sent an email to his collaborators. I was so tired at that point that believe it or not I had forgotten about the drug he said. He fell asleep and woke at a.m. rushing back to his computer. The melanoma drug he had forgotten in his exhaustion should hit that target. And that could stop his mothers cancer from growing. My jaw was just hanging open Dr. McDaniel said. The implications were so tantalizing that I didnt dare believe them. A Remarkable Turnaround Mrs. McDaniel had her first infusion on July and the result seemed remarkable. Her oncologist Dr. Gohmann was overwhelmed. Her son who had been terrified that he and the doctors might have made a terrible mistake was overjoyed. Mrs. McDaniel who had not left her house for several months except to see her doctors began going to movies and restaurants every day. On Sept. she and her husband went to the Heirloom Restaurant in the middle of horse country to celebrate their th wedding anniversary. She had given away so many of her clothes when she thought she was dying that she puzzled over what to wear. She had a favorite blouse that was loosefitting and comfortable but Mr. McDaniel recalled It was long gone. She could not drink wine with the medicines she was taking so she and her husband sipped iced tea in the quiet dining room. We reminisced but also talked about the future as we hoped it would be Mr. McDaniel said. But the reprieve lasted only weeks. By the end of September the cancer was back. Dr. McDaniel did not want to give up. Mrs. McDaniels tumor was sequenced again looking for a new mutation but there was nothing striking. As Dr. McDaniel sifted through the data he called his parents every day. They began calling him the governor hoping he would bring his mother another stay of execution. The doctors considered a less appealing target a mutated gene that T cells use to stop growing. Unpublished studies in mice suggested that a kidney cancer drug might stop the growth of T cells with this mutation. By then Mrs. McDaniels body was ravaged by the cancer and her treatments. She had entered hospice care with a hospital bed in her home and a nurse and an assistant to help. We had this shaky evidence based on the genome and on unpublished data Dr. McDaniel said. But the drugs side effects were mild and her family and doctors decided she should try it. If we do nothing she will be dead in one to six weeks Dr. McDaniel explained. Mrs. McDaniel took the drug on Nov. . But she was so ill that she was unable to get out of bed unable to drink from a straw. Her son Tim took his children to her bedroom one at a time so they could say goodbye. She wasnt talking but her eyes were open and she acknowledged each one with a weak chuckle Dr. McDaniel said. Three days later she briefly rallied. Her husband held her hand. She said I love you Mr. McDaniel said. She then repeated it twice more. I kissed her forehead and told her that I loved her. Those were our last words to each other. The next morning Nov. Mr. McDaniel woke early and went to his wifes room. Her breathing had become erratic. Worried he stepped out and asked the hospice nurse to call the doctor. In the seconds that I was absent she died Mr. McDaniel said. The team that tried to save her was heartbroken too and was left with a long list of whatifs. If you really look at it what did we buy her Dr. de Castro asked. Mrs. McDaniel was dying last January. Yet would she have survived as long even without the sequencing or the drugs Did the team make a difference I hope we did Dr. de Castro said but its hard to know.. Tuesday What a tumor holds in store"

"A new study finds young children with mild persistent asthma can tolerate acetaminophen without the worsening of asthma when compared with ibuprofen use. The study funded by the National Heart Lung and Blood Institutes NHLBI asthma network AsthmaNet appears in the August issue of the New England Journal of Medicine. Previous observational studies had suggested that acetaminophen use was associated with asthma symptoms says Kristie Ross MD MS Clinical Director Division of Pediatric Pulmonology AllergyImmunology and Sleep Medicine at University Hospitals Rainbow Babies Childrens Hospital UH Rainbow and coauthor on the study. Results from this randomized controlled study showed that in young children with mild asthma acetaminophen used as needed was not associated with increased asthma flares or more asthma symptoms. These findings can help us reassure parents of young children with asthma that they can continue to use acetaminophen on an as needed basis and as directed to treat pain and fever without concern that it will worsen asthma symptoms. Dr. Ross who is also an Associate Professor of Pediatrics at Case Western Reserve University School of Medicine was joined by UH Rainbow colleagues and study coauthors James Chmiel MD MPH Professor of Pediatrics and Ross Myers MD Assistant Professor of Pediatrics. To assess the impact of acetaminophen use on childrens asthma AsthmaNet investigators studied children aged to years old who had mild persistent asthma defined as symptoms on more than days out of a week but not daily. All children required daily inhaled treatments to manage their asthma. During the study caregivers used either acetaminophen commonly known as Tylenol or ibuprofen Advil Motrin whenever a child needed pain relief or had a fever. None of the study investigators children or caregivers knew which study drug each child was receiving. The study did not detect any worsening of asthma in the children treated with acetaminophen compared with those receiving ibuprofen. This was measured by asthma exacerbation rate the number of days of asthma control the need for rescue medications and unscheduled medical visits for asthma. They also did not find any significant differences in safety between the two drugs. AsthmaNet is a nationwide clinical research network created by the NHLBI in . The purpose of AsthmaNet is to develop and conduct multiple clinical trials that explore new approaches in treating asthma from childhood through adulthood. AsthmaNet studies are currently being conducted in states. In the United States more than million people are known to have asthma. The Division of Pediatric Pulmonology and AllergyImmunology at UH Rainbow is currently recruiting for a number of asthmarelated clinical trials. If you are interested in enrolling in a study or learning more about the opportunities please visit http About University Hospitals Rainbow Babies Childrens Hospital Internationally renowned UH Rainbow Babies Childrens Hospital is a fullservice childrens hospital and pediatric academic medical center with experts in medical divisions and surgical specialties who offer nationally ranked care not available at other institutions in the region including a center dedicated to adolescent and young adult cancer treatment and Northeast Ohios only singlesite provider of advanced maternal fetal medicine and neonatology services. As the primary pediatric affiliate of Case Western Reserve University School of Medicine and the only Level I Pediatric Trauma Center in the region UH Rainbow Babies Childrens Hospital offers access to novel therapies advanced technologies and clinical discoveries long before they are available nationwide. Rainbow pediatric specialists all of whom also serve on the faculty at the School of Medicine are engaged in todays most advanced clinical research and are widely regarded as the best in the nation and in some specialties the best in the world. Learn more at Rainbow.org. About Case Western Reserve University Case Western Reserve University is one of the countrys leading private research institutions. Located in Cleveland we offer a unique combination of forwardthinking educational opportunities in an inspiring cultural setting. Our leadingedge faculty engage in teaching and research in a collaborative handson environment. Our nationally recognized programs include arts and sciences dental medicine engineering law management medicine nursing and social work. About undergraduate and graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible. About the National Heart Lung and Blood Institute NHLBI NHLBI plans conducts and supports research related to the causes prevention diagnosis and treatment of heart blood vessel lung and blood diseases and sleep disorders. The Institute also administers national health education campaigns on women and heart disease healthy weight for children and other topics. NHLBI press releases and other materials are available online at http About the National Institutes of Health NIH NIH the nations medical research agency includes Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic clinical and translational medical research and is investigating the causes treatments and cures for both common and rare diseases. For more information about NIH and its programs visit http"

"Up to sixteen weeks of intermittent fasting without otherwise having to count calories helps fight obesity and other metabolic disorders. Such fasting already shows benefits after only six weeks. This is according to a study by KyoungHan Kim and Yun Hye Kim in the journal Cell Research which is published by Springer Nature. Intermittent fasting in mice helped to kickstart the animals metabolism and to burn fat by generating body heat. The research team was led by HoonKi Sung of The Hospital for Sick Children in Ontario Canada. Research has shown that our unhealthy eating habits and sedentary lifestyles are playing a major role in the development of lifestylerelated metabolic diseases such as diabetes heart disease and obesity. For this reason dietary interventions like intermittent fasting are gaining popularity to treat conditions such as obesity. The research team in this study wanted to better understand the reactions that interventions such as fasting trigger on a molecular level in the body. They exposed groups of mice to sixteen weeks of intermittent fasting. The recurring regimen saw the animals being fed for two days followed by one day without anything to eat. Their calorie intake was not adjusted otherwise. Four months later the mice in the fasting group weighed less than those in the control group who continued to eat the same volume of food. The lower body weight of the mice in the fasting group was not the only effect. The fasting regime helped lower fat buildup in the white fat by increasing the brownlike fat involved in burning energy and producing body heat of mice on the high fat diet. Their glucose and insulin systems also remained more stable. In a further experiment similar benefits were already seen after only six weeks of intermittent fasting. Through an analysis into the underlying biology involved the researchers found that such intermittent fasting tempers an immune reaction in fat cells. There are changes in certain gene pathways involved in the immune system and the bodys reaction to inflammation. A type of white blood cell known to play a role in fighting inflammation is triggered. Known as antiinflammatory macrophages these cells stimulate the fat cells to burn stored fats or lipids by generating heat. This happens during periods of intermittent fasting because there is an increase in vascular growth factor VEGF that help form blood vessels and activate antiinflammatory macrophage. Intermittent fasting without a reduction in calorie intake can be a preventative and therapeutic approach against obesity and metabolic disorders says KyoungHan Kim. Strikingly these fastingstimulated changes in the growth of vascular cells and subsequent immune alterations occur even after a single cycle of hour fasting and are completely reversed when mice start eating again adds Yun Hye Kim. Reference Kim KH. et al . Intermittent fasting promotes adipose thermogenesis and metabolic homeostasis via VEGFmediated alternative activation of macrophage Cell Research DOI .cr.. Note KyoungHan Kims current affiliation is the University of Ottawa Heart Institute Canada"

"When if ever are people just too old to benefit from cancer httphealth.nytimes.comhealthguidesdiseasecanceroverview.htmlinlinenytclassifier screening The question keeps arising and has never been satisfactorily answered. Now it has come up again in the context of a provocative new study on the popular P.S.A. httphealth.nytimes.comhealthguidestestpsaoverview.htmlinlinenytclassifier test for prostate cancer httphealth.nytimes.comhealthguidesdiseaseprostatecanceroverview.htmlinlinenytclassifier. The paper httpjco.ascopubs.orgcontentearlyJCO....abstractsideccbdccbafbcaa published in The Journal of Clinical Oncology finds that men in their s are being screened at nearly twice the rate of men in their s and men ages to are being screened as often as those years younger. That is mindboggling said the lead author Dr. Scott E. Eggener a University of Chicago urologist. What we were hoping was that young healthy men who were most likely to benefit would be screened at higher rates and that screening would tail off in older men. The American Cancer Society and the American Urological Society discourage screening for men whose life expectancy is years or less. The cancer is so slowgrowing that it can take that long for screening to show a benefit. The United States Preventive Services Task Force recently concluded that screening should stop at . Dr. Mary Barton scientific director for the group said it is more than just a lack of data that led to that conclusion. What data we do have for this group suggests it is a netharm situation she added. But although yearolds are much more likely than yearolds to have chronic illnesses and a limited life expectancy age should not be the deciding factor Dr. Eggener said. Health condition and life expectancy are far more important he said. There are yearolds that shouldnt be screened and yearolds that may benefit from it. The new study only included national data through the most recent year they were available but said Dr. Durado Brooks director of prostate and colorectal cancers for the American Cancer Society http there is no reason to believe it has changed significantly since . Doctors said there are several reasons screening seems to continue indefinitely as men age. They range from patient demands to malpractice fears to financial incentives and doctors own lack of understanding of the risks and benefits of screening. There are a lot of pressures said Dr. Gerald L. Andriole a urologic surgeon at Washington University. It is not all pure data that is promoting aggressive screening. Dr. Andriole is directing a National Cancer Institute study http of men that failed to find a screening benefit after years. The men were aged to when the study began. P.S.A. screening is controversial at any age. Screening proponents say the cancer institute study was flawed and point to a European study http of men aged to that showed a percent drop in the prostate cancer death rate with screening. Screening critics say the European study was flawed and add that there is a logical reason it has been hard to show a screening benefit. They note that prostate cancer is a common cancer found in most mens prostates on autopsy although often the men had no idea they had it. The cancer can be lethal but it usually grows so slowly that men die with it not because of it. For most men screening only has harms because it leads to biopsies and treatments with unpleasant side effects. And they say it might not help cure many deadly prostate cancers because those cancers may have already spread outside the prostate microscopically seeding other organs long before a P.S.A. test indicates a possible problem. A positive P.S.A. test usually leads to a biopsy httphealth.nytimes.comhealthguidestestbiopsyoverview.htmlinlinenytclassifier and then if cancer is found to a decision about whether to treat it. Nearly all men opt for treatment which includes surgery to remove the prostate or radiation to destroy the cancer. Side effects can include impotence httphealth.nytimes.comhealthguidessymptomserectionproblemsoverview.htmlinlinenytclassifier and incontinence. Even younger men should weigh the harms of screening says Dr. Lisa Schwartz of Dartmouth Medical School. You also have the potential to wreck their lives she said. One reason treatment is the most common choice is that it is hard to know if a cancer is lethal. Pathologists can distinguish between cancers that look particularly aggressive and those that do not but there is a real possibility that even if tissue obtained at a biopsy has only less aggressive tumor httphealth.nytimes.comhealthguidesdiseasetumoroverview.htmlinlinenytclassifier cells more aggressive cells might still be lurking in the prostate. But even with this uncertainty prostate cancer specialists say most men who are treated would not have died of prostate cancer and that is especially true for elderly men in particular those who are frail and have a limited life expectancy. Yet changing medical practice can be difficult. Anytime a practice becomes ingrained it is difficult to eradicate says Dr. Brooks. It is harder to get rid of an aberrant behavior than to adopt a new one. Dr. Andriole said the very concept of not screening is difficult. It is the hardest thing in the world not to look for a cancer and not to treat it he says. And doctors he added have many inducements to screen. They often are afraid they could be sued if they do not screen and a man is found to have a lethal cancer. And there are financial incentives. Urologists make money by finding ways to biopsy men and administer treatments Dr. Andriole said. Screening he added is promoted by hospitals httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicshospitalsindex.htmlinlinenytclassifier and industry. And he added many patients demand it. Dr. Brooks of the cancer society says he travels the country and talks to primary care doctors about screening and has learned that many have misconceptions about the tests benefits. They often dont appreciate the downside of screening Dr. Brooks said and they dont appreciate the delay in benefit. In addition Dr. Brooks said primary care doctors often overestimate the likelihood that early detection of prostate cancer will lead to survival benefits. Added to that Dr. Brooks said is the length of time it takes to discuss the pros and cons of screening with patients. Often it is easier to just order the test. Dr. Bruce Roth a professor of medicine at Washington University in St. Louis said that ideally a doctor should take a mans overall health into account and not just go by age in ordering P.S.A. tests. But if a man has been screened year after year it can be hard to suggest he stop because he may not live much longer. Some men say the cautions just do not apply to them. J. Allen Wheeler who is and lives in Portland Ore. said he had his most recent P.S.A. test in January. His doctor orders it routinely he says adding In all honestly its part of my physical. His doctor just does it thats the understanding between us. Mr. Wheeler who says his health is fairly good said he could not foresee a time when he would stop having the test. He would like to know if he has cancer he says although he may decide not to be treated. A yearold Connecticut man said he had the test because he was healthy and wanted to stay that way. I think I am going to live to be he said asking that his name be withheld to protect his privacy. A recent P.S.A. test found a small cancer and he does not want to take a chance that it will grow slowly and not cause him problems. I am thinking seriously of having the whole thing taken out he says. Hasta la vista. Correction April An article on Tuesday about the risks and benefits of prostate cancer screening for men in their s and s misstated the academic affiliation of Dr. Bruce Roth who said doctors should consider a mans overall health and not just his age in deciding whether to order the test. He is a professor of medicine at Washington University in St. Louis not at the University of Washington."

"An experimental drug called briakinumab appears to be more effective than a standard medication https for treating psoriasis https a new study shows. The study is published in the New England Journal of Medicine. It included psoriasis https patients who were assigned to get monthly injections of briakinumab or to take methotrexate https pills weekly. The result The thick red flaking skin https lesions that are characteristic of psoriasis https cleared up in about three times as many patients who got briakinumab as those who got methotrexate. This drug has had in this trial the highest efficacy we have ever seen with any biologic in psoriasis https before says study researcher Kristian Reich MD. Biologics are genetically engineered proteins derived from human genes. Reich a partner at Dermatologikum Hamburg and professor of dermatology venerology and allergology at GeorgAugustUniversity in Gottingen Germany says that after a year of therapy roughly of the patients in the briakinumab group had near or complete clearance of their skin lesions. Those same results were achieved by about to of patients in the methotrexate group. This is unheard of Reich tells WebMD. We in dermatology have never spoken about remission before. But with this drug the word remission is on the table. But as successful as the drug appears to be for some patients it may come with a significant risk. Patients taking briakinumab had more serious infections and more cancers than those taking methotrexate. We had amazing responses Reich says. Obviously the price that this comes with is the increased rate of serious infections and cancers. Abbott the company that makes briakinumab announced in January that it was withdrawing its bid to get the drug approved in the U.S. and Europe after regulators asked to see more robust proof that the medication was safe. At that time the company said it wanted to evaluate the next steps for briakinumab and might try for approval again at a later date. This is the single most effective drug weve had in psoriasis ever says Kenneth B. Gordon MD a dermatologist and clinical associate professor at the University of Chicagos Pritzker School of Medicine. Many of us were disappointed it was withdrawn because there would be a subset of patients who wouldnt respond to anything else and it would have been nice to have for them. Gordon was not involved in the current study but he has been involved in research of the drug and has been a paid consultant and investigator for Abbott. Causes of Psoriasis Psoriasis is caused by an overactive immune system that speeds up the growth cycle of the skin. In normal skin new cells surface about once a month. In psoriasis new cells surface in just three to four days. These cells build up into thick patches that have a silvery flaking crust. Psoriasis is thought to affect about of the population and its misery may go deeper than skin. Psoriasis is a systemic disease Gordon says. People with psoriasis also have higher risks of cardiovascular disease https diabetes https depression https and alcoholism https he says. So when people think of psoriasis as limited to the skin it really isnt laying credence to the severity of the disease and the overall health of the individual. Its very debilitating as well. Briakinumab helps stem the bodys overactive immune system by blocking two proteins that drive inflammation https A similar drug Stelara which also blocks the same two proteins was approved by the FDA in . In studies Stelara did not appear to be associated with as many adverse events Reich says perhaps because it is not as complete an inhibitor of the two proteins as briakinumab or because it is given at lower doses. Even if the drug is never approved Reich says the study is still important because it proves that highly effective treatment of psoriasis is possible. I take this briakinumab as ... a shining example of how far we can get with efficacy. On the other hand I hear the warning signal that is contained in the study that we need to make sure that the big benefit contained in the study is not putting the patient at risk he says. Other experts say the study is important because it provides some of the first information about how well methotrexate works. After six months the study showed about of patients who were taking weekly doses of methotrexate had at least a improvement in their skin symptoms. That number dropped to after a full year of treatment. Still fewer achieved complete clearance of their skin lesions. Serious adverse events occurred in . of patients on briakinumab compared to . of patients taking methotrexate group. There were a lot of people who thought methotrexate would work better than it does Gordon says. But because its a drug thats available cheaply as a generic he says methotrexate is an important treatment option."

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

"Obese children who cut sugar from their diets saw improvements in markers of heart disease after just nine days a study in Atherosclerosis found https For the study researchers evaluated children ages to who were obese and at high risk for heart disease and Type diabetes. The children were given food and drinks totaling the same number of calories fat protein and carbohydrates as their typical diets. The only change was their sugar intake The researchers swapped foods high in added sugars like pastries and sweetened yogurts for options like bagels and pizza. This lowered dietary sugar from percent to percent and fructose from percent to percent of total calories. After nine days the researchers found a percent drop in triglycerides a type of fat tied to heart disease a percent reduction in a protein called apoCIII that is tied to high triglyceride levels and large reductions in small dense LDL cholesterol a risk factor for heart disease. Though this study is small and shortterm it builds on this groups previous research implicating added sugars httpswell.blogs.nytimes.comcuttingsugarimproveschildrenshealthinjustdays as a contributor to metabolic disorders and heart disease. Sugar calories are not like other carbohydrate calories said Dr. Robert Lustig a coauthor of the study and professor of pediatrics at Benioff Childrens Hospital at the University of California San Francisco. Without changing total carbohydrate or fat or protein we were able to accomplish this enormous improvement in their cardiovascular risk factors unrelated to weight loss he said."

"MERCURY PE is the first prospective randomized trial to evaluate emergency department discharge in U.S. patients with lowrisk PE Results suggest opportunity to change hospital protocols for lowrisk PE management Lowrisk PE patients on XARELTO discharged early from the emergency department report it is less burdensome than inpatient standard of care TITUSVILLE N.J. June PRNewswire The Janssen Pharmaceutical Companies of Johnson Johnson today announced results from the MERCURY PE study which showed that people with lowrisk pulmonary embolism PE treated with XARELTO rivaroxaban and discharged from the emergency department had significantly reduced time in the hospital and a median savings of in per patient costs compared to standard of care inpatient treatment. Results from MERCURY PE which evaluated the benefits of treating patients with lowrisk PE with XARELTO and discharging them early from the emergency department to complete treatment at home were published in Academic Emergency Medicine httpsonlinelibrary.wiley.comdoiabs.acem.. Click to Tweet httpsctt.acRZka New study shows outpatient use of Janssen bloodthinner results in cost savings and reduces time in hospital for lowrisk PE patients httpsctt.acRZka Every year U.S. health care systems spend more than two billion dollars to manage patients with pulmonary emboli said principal study investigator W. Frank Peacock MD FACEP FACC Associate Chair and Research Director Emergency Medicine Baylor College of Medicine Houston TX. By avoiding hospitalizations that are not clinically necessary and transitioning patients with lowrisk PE to outpatient treatment with XARELTO weve seen significant cost savings which could help alleviate the burden on health care systems. Venous thromboembolism VTE includes deep vein thrombosis DVT a blood clot in a deep vein and PE a potentially lifethreatening condition that occurs when a blood clot travels to the lung. Of the approximately Americans who experience a VTE each yeari more than are diagnosed with PE in the emergency departmentii. Hospitals across the United States have varying protocols for managing PE but standard of care typically requires people to be admitted for treatment which drives up costs and substantially increases hospitalacquired conditions and infectionsiiiiv. While people with more severe PE have higher mortality rates the day mortality rate of lowrisk PE is less than one percentv. Click to Tweet httpsctt.acWcS Patients taking Janssen blood thinner say in a new study that outpatient treatment is less burdensome than the standard of care httpsctt.acWcS MERCURY PE met its primary efficacy endpoint with XARELTO leading to significantly reduced time in the hospital due to VTE or bleeding within days after randomization compared with the standard of care mean duration of . vs. . hours respectively CI p.. The mean difference of length of stay between the two groups was . hours. Of note there was no recurrence of VTE or VTErelated death or any significant differences in the bleedingrelated hospitalizations or physician visits within days from randomization in either group though this outcome should be interpreted with caution as the study was significantly underpowered to detect any such differences. Were proud to have pioneered this groundbreaking research which was the first prospective randomized trial to confirm the benefit of discharging patients with lowrisk PE early from the hospital and completing treatment at home said Paul Burton MD PhD FACC Vice President Janssen Scientific Affairs LLC. We expect that this XARELTO study will prompt physicians to reconsider how patients with lowrisk PE are managed. About MERCURYPE Patients with lowrisk PE were randomly assigned in a ratio to open label XARELTO or standard of care within hours of diagnosis. Patients randomized to XARELTO were discharged from the emergency department within hours and were instructed to take XARELTO mg twice daily for days then XARELTO mg once daily until the study was completed. Patients randomized to standard of care were treated per local hospital protocol which could include hospitalization and any U.S. Food and Drug Administrationapproved anticoagulant strategy including XARELTO. Researchers also made the following observations about XARELTO in this setting The mean length of initial and subsequent hospitalizations for any reason was shorter for patients who were discharged early on XARELTO within days from randomization compared to those receiving standard of care p. . hours vs. . hours respectively. There was no major bleeding in either group within days from randomization although two patients reported clinically relevant nonmajor bleeding one in each group. There were no deaths due to bleeding in the study. Overall early discharge on XARELTO was markedly less expensive than standard of care. The cost associated with the emergency room visit and any subsequent hospitalization at the time of PE diagnosis and the total costs were p. and p. less with XARELTO. MERCURY PE builds on prior research including a June study published in Academic Emergency Medicine httponlinelibrary.wiley.comdoi.acem.abstract showing that patients with lowrisk PE or DVT when prescribed XARELTO and immediately discharged had no recurrent events while on therapy. Additionally no major or clinically relevant bleeding events were observed. A companion study found patients with lowrisk PE or DVT who were prescribed XARELTO had significantly lower medical costs than those admitted and given standard treatment. The clinical and economic benefits demonstrated in the MERCURYPE trial have been confirmed in more than U.S. patients in a realworld study showing that XARELTO resulted in a significant oneday reduction in hospital length of stay and significantly lower total healthcare costs approximately . MERCURY PE Patient Satisfaction Results Patient satisfaction both with outpatient and inpatient care was also analyzed using Likert scales and the AntiClot Treatment Score ACTS. On the Likert scales most patients in both groups indicated they were very satisfied with their care but numerically more patients taking XARELTO preferred to receive outpatient care percent compared to slightly less than half of patients receiving inpatient standard of care . percent. The ACTS measured the patients perspective on the burden of treatment with more patients taking XARELTO reporting it was not at all burdensome compared to those receiving standard of care . percent vs. . percent. About MERCURY PE MERCURY PE was a randomized open label parallelgroup multicenter trial conducted at hospitals across the U.S. Adult patients who arrived at the emergency department with confirmed lowrisk PE defined by the absence of any Hestia criteria were eligible for enrollment. Of the patients randomized completed the study in the XARELTO group and in the standard of care group. Patients who did not complete the study were mainly lost to followup or adverse events. Analyses were conducted by intentiontotreat basis regardless of the anticoagulant used. The primary efficacy outcome was the total amount of time spent in the hospital in hours for VTE or bleeding events in the days after randomization. Hospital readmissions for reasons unrelated to VTE were excluded. The primary safety outcome was major bleeding within days. Secondary efficacy endpoints included day rates of newrecurrent VTE VTErelated death unplanned hospital or physician office visits for VTE or bleeding total length of initial or subsequent hospitalizations for any reason patientreported satisfaction and total costs of care. A secondary safety endpoint was clinically relevant nonmajor bleeding based on International Society on Thrombosis and Haemostasis ISTH definitions. MERCURY PE also had a few limitations including sample size study enrolled of a planned patients exclusion bias based on subjective evaluation of hemodynamic stability and ability to adhere to protocol and potential bias due to inability to blind patients to their admission status. About EXPLORER MERCURY PE is part of the EXPLORER program which is unmatched by any oral anticoagulant in the Factor Xa inhibitor class in its size scope and ambition. A collaborative effort between Janssen and its development partner Bayer EXPLORER seeks to generate important clinical evidence on the safety and efficacy of XARELTO and its potential role in addressing critical unmet medical needs. A number of the studies in the program are designed to seek additional indications or expand the label for XARELTO to benefit more patients in need of additional therapies for their cardiovascular disease. By the time of its completion more than patients will have participated in the EXPLORER clinical development program other completed and ongoing clinical trials investigative registries and noninterventional studies. WHAT IS XARELTO XARELTO rivaroxaban is a prescription medicine used to reduce the risk of stroke and blood clots in people with atrial fibrillation not caused by a heart valve problem. For patients currently well managed on warfarin there is limited information on how XARELTO and warfarin compare in reducing the risk of stroke. XARELTO is also a prescription medicine used to treat deep vein thrombosis DVT and pulmonary embolism PE and to reduce the risk of blood clots happening again in people who continue to be at risk for DVT or PE after receiving treatment for blood clots for at least months. XARELTO is also a prescription medicine used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had knee or hip replacement surgery. IMPORTANT SAFETY INFORMATION What is the most important information I should know about XARELTO rivaroxaban For people taking XARELTO for atrial fibrillation People with atrial fibrillation an irregular heart beat are at an increased risk of forming a blood clot in the heart which can travel to the brain causing a stroke or to other parts of the body. XARELTO lowers your chance of having a stroke by helping to prevent clots from forming. If you stop taking XARELTO you may have increased risk of forming a clot in your blood. Do not stop taking XARELTO without talking to the doctor who prescribes it for you. Stopping XARELTO increases your risk of having a stroke. If you have to stop taking XARELTO your doctor may prescribe another blood thinner medicine to prevent a blood clot from forming. XARELTO can cause bleeding which can be serious and rarely may lead to death. This is because XARELTO is a blood thinner medicine anticoagulant that reduces blood clotting. While you take XARELTO you are likely to bruise more easily and it may take longer for bleeding to stop. You may have a higher risk of bleeding if you take XARELTO and take other medicines that increase your risk of bleeding including o Aspirin or aspirincontaining products o Nonsteroidal antiinflammatory drugs NSAIDs o Warfarin sodium Coumadin Jantoven o Any medicine that contains heparin o Clopidogrel Plavix o Selective serotonin reuptake inhibitors SSRIs or serotonin norepinephrine reuptake inhibitors SNRIs o Other medicines to prevent or treat blood clots Tell your doctor if you take any of these medicines. Ask your doctor or pharmacist if you are not sure if your medicine is one listed above. Call your doctor or get medical help right away if you develop any of these signs or symptoms of bleeding Unexpected bleeding or bleeding that lasts a long time such as o Nosebleeds that happen often o Unusual bleeding from gums o Menstrual bleeding that is heavier than normal or vaginal bleeding Bleeding that is severe or you cannot control Red pink or brown urine Bright red or black stools looks like tar Cough up blood or blood clots Vomit blood or your vomit looks like coffee grounds Headaches feeling dizzy or weak Pain swelling or new drainage at wound sites Spinal or epidural blood clots hematoma People who take a blood thinner medicine like XARELTO and have medicine injected into their spinal and epidural area or have a spinal puncture have a risk of forming a blood clot that can cause longterm or permanent loss of the ability to move paralysis. Your risk of developing a spinal or epidural blood clot is higher if o A thin tube called an epidural catheter is placed in your back to give you certain medicine o You take NSAIDs or a medicine to prevent blood from clotting o You have a history of difficult or repeated epidural or spinal punctures o You have a history of problems with your spine or have had surgery on your spine If you take XARELTO and receive spinal anesthesia or have a spinal puncture your doctor should watch you closely for symptoms of spinal or epidural blood clots. Tell your doctor right away if you have back pain tingling numbness muscle weakness especially in your legs and feet or loss of control of the bowels or bladder incontinence. XARELTO is not for people with artificial heart valves. Do not take XARELTO if you Currently have certain types of abnormal bleeding. Talk to your doctor before taking XARELTO if you currently have unusual bleeding. Are allergic to rivaroxaban or any of the ingredients of XARELTO. Before taking XARELTO tell your doctor about all your medical conditions including if you Have ever had bleeding problems Have liver or kidney problems Are pregnant or plan to become pregnant. It is not known if XARELTO will harm your unborn baby. o Tell your doctor right away if you become pregnant during treatment with XARELTO. Taking XARELTO while you are pregnant may increase the risk of bleeding in you or in your unborn baby. o If you take XARELTO during pregnancy tell your doctor right away if you have any signs or symptoms of bleeding or blood loss. See What is the most important information I should know about XARELTO for signs and symptoms of bleeding. Are breastfeeding or plan to breastfeed. XARELTO may pass into your breast milk. You and your doctor should decide if you will take XARELTO or breastfeed. Tell all of your doctors and dentists that you are taking XARELTO. They should talk to the doctor who prescribed XARELTO for you before you have any surgery medical or dental procedure. Tell your doctor about all the medicines you take including prescription and overthecounter medicines vitamins and herbal supplements. Some of your other medicines may affect the way XARELTO works. Certain medicines may increase your risk of bleeding. See What is the most important information I should know about XARELTO How should I take XARELTO Take XARELTO exactly as prescribed by your doctor. Do not change your dose or stop taking XARELTO unless your doctor tells you to. Your doctor may change your dose if needed. If you take XARELTO for o Atrial Fibrillation Take XARELTO time a day with your evening meal. If you miss a dose of XARELTO take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time. o Blood clots in the veins of your legs or lungs Take XARELTO or times a day as prescribed by your doctor. For the mg and mg doses XARELTO should be taken with food. For the mg dose XARELTO may be taken with or without food. Take your XARELTO doses at the same time each day. If you miss a dose If you take the mg dose of XARELTO times a day a total of mg of XARELTO in day Take XARELTO as soon as you remember on the same day. You may take doses at the same time to make up for the missed dose. Take your next dose at your regularly scheduled time. If you take XARELTO time a day Take XARELTO as soon as you remember on the same day. Take your next dose at your regularly scheduled time. o Hip or knee replacement surgery Take XARELTO time a day with or without food. If you miss a dose of XARELTO take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time. If you have difficulty swallowing the XARELTO tablet whole talk to your doctor about other ways to take XARELTO. Your doctor will decide how long you should take XARELTO. Your doctor may stop XARELTO for a short time before any surgery medical or dental procedure. Your doctor will tell you when to start taking XARELTO again after your surgery or procedure. Do not run out of XARELTO. Refill your prescription for XARELTO before you run out. When leaving the hospital following a hip or knee replacement be sure that you have XARELTO available to avoid missing any doses. If you take too much XARELTO go to the nearest hospital emergency room or call your doctor right away. WHAT ARE THE POSSIBLE SIDE EFFECTS OF XARELTO See What is the most important information I should know about XARELTO Call your doctor for medical advice about side effects. You are also encouraged to report side effects to the FDA visit http or call FDA. You may also report side effects to Janssen Pharmaceuticals Inc. at JANSSEN . Please click here https for full Prescribing Information including Boxed Warnings and Medication Guide. Trademarks are those of their respective owners. Janssen and Bayer together are developing rivaroxaban. For more information about XARELTO visit http About the Janssen Pharmaceutical Companies 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 on Twitter at JanssenUS httpstwitter.comjanssenus. Janssen Pharmaceuticals Inc. and Janssen Scientific Affairs LLC are part of the Janssen Pharmaceutical Companies of Johnson Johnson. 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 presentation of new data and analyses regarding XARELTO rivaroxaban. 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 any of the Janssen Pharmaceutical Companies 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 manufacturing difficulties and delays competition including technological advances new products and patents attained by competitors challenges to patents product efficacy or safety concerns resulting in product recalls or regulatory action changes in behavior and spending patterns 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 descriptions of these risks uncertainties and other factors can be found in Johnson Johnsons Annual Report on Form K for the fiscal year ended December including in the sections captioned Item A. Risk Factors and Cautionary Note Regarding ForwardLooking Statements 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. Neither the Janssen Pharmaceutical Companies nor Johnson Johnson undertakes to update any forwardlooking statement as a result of new information or future events or developments. i Centers for Disease Control and Prevention. Venous thromboembolism blood clots Data and statistics. . Available at http ii Schissler AJ Rozenshtein A Schluger NW Einstein AJ. National trends in emergency room diagnosis of pulmonary embolism a crosssectional study. Respiratory Research . iii Kandilov A. Analysis report estimating the incremental costs of hospitalacquired conditions HACs. Centers for Medicare and Medicaid Services website. Available at https Last accessed May iv Wang L Baser O Wells P Peacock WF Coleman CI Ferman GJ Schein J Crivera C. Benefit of early discharge among patients with lowrisk pulmonary embolism. PLOS ONE e. httpsdoi.org.journal.pone. httpjournals.plos.orgplosonearticleid.journal.pone. v Kahler ZP Beam DM Kline JA. Cost of Treating Venous Thromboembolism With Heparin and Warfarin Versus Home Treatment With Rivaroxaban. Acad Emerg Med . Media contacts Sarah Freeman Mobile sfreemits.jnj.com mailtosfreemits.jnj.com Christina Chan Office Mobile cchanits.jnj.com mailtocchanits.jnj.com Investor contacts Johnson Johnson Joseph J. Wolk Office Lesley Fishman Office SOURCE Janssen Pharmaceutical Companies of Johnson Johnson Related Links http"

"Treating gum disease reduced symptoms of prostate inflammation called prostatitis report researchers from Case Western Reserve University School of Dental Medicine and the Departments of Urology and Pathology at University Hospitals Case Medical Center. Previous studies have found a link between gum disease and prostatitis a disease that inflames the gland that produces semen. Inflammation can make urination difficult. This study shows that if we treat the gum disease it can improve the symptoms of prostatitis and the quality of life for those who have the disease said Nabil Bissada chair of Case Western Reserves Department of Periodontics and the new studys corresponding author. The researchers reported their findings in the Dentistry article Periodontal Treatment Improves Prostate Symptoms and Lowers Serum PSA in Men with High PSA and Chronic Periodontitis httpomicsonline.orgopenaccessperiodontaltreatmentimprovesprostatesymptomsandlowersserumpsainmenwithhighpsaandchronicperiodontitis.phpaid. Naif Alwithanani a graduate student in the dental school led the investigation as part of his residency in periodontics. Bissada explained that gum disease not only affects the mouth but is a systemwide condition that can cause inflammation in various parts of the body. The dental school has previously found a link between gum disease and fetal deaths rheumatoid arthritis and heart disease. The new prostate study Researchers studied men years old and older. Each had had a needle biopsy within the past year that confirmed inflammation of the prostate gland and a blood test that showed elevated prostate specific antigen PSA levelspossible signs of inflammation and cancer. The men were assessed for symptoms of prostate disease by answering questions on the InternationalProstate Symptom Score IPSS test about their quality of life and possible urination issues. Researchers found of the participants had no or mild inflammation but had biopsyconfirmed malignancies. Two had both inflammation and a malignancy. The men also had to have at least teeth and were examined for signs of gum disease such as increased levels of inflammation and bleeding andor loose teeth due to attachment and bone loss. All the men had moderate to severe gum disease for which they received treatment. They were tested again for periodontal disease four to eight weeks later and showed significant improvement. During the periodontal care the men received no treatment for their prostate conditions. But even without prostate treatment of the men showed decreased levels of PSA. Those with the highest levels of inflammation benefited the most from the periodontal treatment. Six participants showed no changes. Symptom scores on the IPSS test also showed improvement. Bissada is now conducting followup research to support the first studys findings. He hopes to make periodontal treatment a standard part of treating prostate disease much like cardiac patients are often encouraged to visit their dentist before undergoing heart procedures and a dental checkup is advised for women who are pregnant or considering pregnancy. Case Western Reserve dental researchers Nishant Joshi Catherine Demko and Robert Skillicorn and University Hospitals Case Medical Center researchers Donald Bodner Lee Ponsky Sanjay Gupta and Gregory T. MacLennan contributed to the study."

"A small study suggests that deep brain stimulation which is currently being investigated as a treatment for general depression may also help patients with bipolar disorder. There are some caveats. The surgery necessary to allow deep brain stimulation is extremely expensive. And for now the research is preliminary so its too early to know for sure if the treatment is appropriate to be used for any kind of depression. Still the study suggests that brain stimulation not only just helps patients who havent been able to recover from depression but it seems to be associated with the absence of relapses. Theyre not only getting better theyre staying better said study coauthor Dr. Helen Mayberg a professor in both the departments of psychiatry and behavioral sciences and neurology at Emory University School of Medicine in Atlanta. In deep brain stimulation surgeons insert wires into the brain that allows a specific region to be continuously hit with an electronic pulse. The level of stimulation is controlled by a pacemakerlike device implanted in the chest. Deep brain stimulation has been around for more than years Mayberg said and is commonly used to treat Parkinsons disease. The cost of the surgery is about she said. Previous research by Mayberg and others suggested that deep brain stimulation had potential as a treatment for depression. The St. Jude Medical Neuromodulation company which has provided consulting fees to Mayberg and some of the other study authors is currently recruiting patients for a study that could pave the way for its approval as a treatment for depression Mayberg said. The new study which appears online Jan. in the Archives of General Psychiatry began with patients with depression and seven with bipolar disorder a condition that causes severe mood swings and is also known as manic depression. They all received deep brain stimulation for weeks after going through four weeks either with or without stimulation. Most of the patients continued to receive the treatment over two years although researchers temporarily turned it off in three of them as part of the study before realizing that doing so caused their depression to return. The researchers found that percent of patients went into remission after weeks percent of patients after one year. After two years of the patients still in the study seven patients percent were in remission. The number of patients who got better increased over time but its not quite clear as to why Mayberg said. The workings of deep brain stimulation as a whole are a mystery although Mayberg said it may work by changing the brains rhythms. Patients didnt suffer from side effects she noted. So whats next Dr. Samuel James Collier an assistant professor of psychiatry at the University of Texas Southwestern Medical Center at Austin predicted that even if deep brain stimulation turns out to be an effective treatment for depression itll be far from the first line of defense. Medications and ECT electroconvulsive therapy are clearly safer better tolerated and do not embody a large surgical risk Collier said. I cant think of a scenario where deep brain stimulation would be considered even remotely before medications and ECT were exhausted. Still he said its important to note that we seem to be making progress and hopefully those who are suffering the most can find solace in that and not give up hope. For now research continues. If patients are interested in deep brain stimulation treatment they should try to get into the study thats ongoing Mayberg said. More information For more about deep brain stimulation http visit the U.S. National Library of Medicine. SOURCES Helen S. Mayberg M.D. professor departments of psychiatry and behavioral sciences and neurology Emory University School of Medicine Atlanta Samuel James Collier M.D. assistant professor of psychiatry University of Texas Southwestern Medical Center at Austin Jan. Archives of General Psychiatry online"

"It takes up to years and billion for a new drug to make it through testing and earn approval from the U.S. Food and Drug Administration FDA. Before researchers try a compound on humans its tested at labs in petri dishes and on animals such as mice and monkeys. More often than not these studies produce mixed data that dont tell researchers much about whether it is safe and effective for humans. For some time scientists have been searching for ways to cut down on the cost and failure rate of drug testing. Researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University have developed a beautiful solution httpwyss.harvard.eduviewpage OrgansOnChips. The clear and flexible polymer microchips are lined with human cells. Each one represents a different human organ system such as lungs heart and intestines. The institutes goal is to create different organ systems that can be joined together by blood vessel channels to simulate human physiology on a microscale and provide a cheaper more reliable way to test new drugs. The sophisticated architecture of these organsonchipswhich are about the size of a thumb drivehas also earned the Wyss Institute recognition in the art world with a Design of the Year award from the Design Museum and placement in the Museum of Modern Arts permanent collection. The real power of this approach is that you have a window to the inner workings of life says Don Ingber founding director of the Wyss Institute and a professor of Vascular Biology and of Bioengineering at Harvard University. Anything you can ask at the molecular level we could do in our chips. In the team built and tested its first organoid chip to mimic the mechanical function of human lungs. It contains tiny channels separated by a porous membrane to create two distinct hollow passagewaysone lined with human lung cells and the other with capillary blood vessel cells. Air is suctioned through the side channels to emulate breathing. Ingber and his team introduced bacteria into the chips lung channel and white blood cells into the capillary channel. They observed that the white blood cells permeated the membrane and attacked the bacteria in the lung cell channelexactly what would happen in human lungs fighting off an infection. In another experiment the team at Wyss filled a chips lung cell channel with interleukin a chemotherapy drug known to cause pulmonary edema an accumulation of fluid in the lungs. When air entered the lung cell channel the channel filled with fluid and then blood clotsexactly what happens in the lungs of patients who develop this lifethreatening condition. This proved the chips could provide real world information to scientists studying the effects of new drug compounds. The project has received support from the National Institutes of Health and the FDA. The Defense Advanced Research Projects Agency also recently awarded the institute a million grant to create chips representing nearly all systems in the body. Ingber says some scientists are interested in using the chips to conduct research that would be unethical if performed on people such as studying the effects of gamma radiation on the human body. Of course the chips have limitations. We cant mimic consciousness we cant mimic compression on a joint says Ingber. Danilo Tagle associate director for special initiatives at the National Center for Advancing Translational Sciences a division of the NIH is spearheading a similar organonchip project. He suspects that in the beginning the chips will be used to complement and supplement animal studies but will eventually become routine practice. The chips will also provide researchers with information on dosing at a much earlier stage in drug studiesparticularly helpful because animals metabolize chemical substances at a different rate than humans. You can go forward with a candidate drug with greater assurance and confidence that it will have the desired effect on humans says Tagle. Biology is very complex. Incorporating the chips into drug testing could save millions of dollars and years of time on research. Some companies are already trying out the concept. Janssen Pharmaceuticals Company a subsidiary of Johnson Johnson is using a version of the chips to understand how blood clots in the lungs. The information is essential to reduce the risk for this side effect of oncology drugs. Though there still arent enough data to prove the chips are reliable enough to put rodents out of a job Ingber says its only a matter of time they hope to have them tested and ready for market in two years. The FDA has been very supportive he says. Theyve told us if they are as good as animals that they would consider accepting data provided by a drug company from one of these models rather than an animal model."

"FROM a marketing perspective theres something alluring about being a beauty outsider. Just ask Allison Slater the vice president for retail marketing at Sephora about the new antiaging skin care line Algenist featuring a star ingredient alguronic acid that scientists in San Francisco say they stumbled upon while researching microalgae. Retailing for to Algenist moisturizers serum and eye balm are already available at Sephora.com and will go on sale in the companys stores this week. When we saw it we thought it was so unique such innovation something our clients could really understand Mrs. Slater said of the line. The whole story about this being an unexpected discovery. Mrs. Slater added that it made sense to her that alguronic acid a compound that protects microalgae cells according to Algenists maker Solazyme could also protect middleaged faces from environmental assault. Think about how algae can live anywhere live in the coldest of places or the harshest of places and think about translating that to skin care she said. Dermatologists might not wholeheartedly share Sephoras enthusiasm. But a surprising story about a products genesis can be just as important for generating sales as the products demonstrable efficacy. Consider Crme de la Mer which like Algenist contains sea matter and also involves an enterprising scientist an aerospace physicist trying to heal scars he suffered in a lab accident. Its a slightly different story said Nica Lewis the head consultant of beauty innovation at Mintel a market research firm. But its still brainy scientist comes up with cosmetic product. According to Jonathan Wolfson the chief executive of Solazyme the alternativeenergy company that makes Algenist the product came about after a fortuitous suggestion roughly six years ago by Arthur Grossman a microalgae expert whos now an adviser to the brand. At first Solazyme executives had a good chuckle about the idea of getting into skin care Mr. Wolfson said. I really never thought Id be standing in a store like this he told a gathering of reporters during a preview at Sephora Fifth Avenue amid shiny display cases of primer and volumizing mascara. It may seem novel for a nonbeauty company to get into skin care but these days it really isnt Mrs. Lewis said. There are ingredient suppliers that provide ingredients to health care food and drink industries and cosmetic companies she said. In Japan food and health care companies have found cosmetic applications for their ingredients so they are creating skin care brands. For example Frutarom http a flavoringredient house based in Israel makes Alguard a purified polysaccharide shield from a red microalgae that it says protects skin from daily assaults and reduces roughness as well as the look of fine lines. There are more than algaederived ingredients used in cosmetics worldwide Mrs. Lewis said. The patentpending alguronic acid in Algenist is a single purified highly bioactive compound said Tony Day the vice president for research and development at Solazyme and therefore delivers much higher activity to the skin than products using only a microalgae extract. Studies conducted by an independent lab and commissioned by Algenist none of which have been published in a peerreviewed journal showed alguronic acid increased cell regeneration and the synthesis of elastin which gives skin that snapback youthful quality. This testing also demonstrated that alguronic acid provided protection against cell damage induced by ultraviolet rays and inhibited the enzymes that break down elastin. After reviewing press materials and Solazymes page patent application Dr. David McDaniel a dermatologist and the director of the Institute of AntiAging Research http in Virginia Beach Va. said he was impressed by the invitro testing of alguronic acid. In the petri dish their data seems to show some substantial benefits to their active ingredient he said. But he cautioned that invitro testing does not demonstrate how a final formulation works off the shelf. Dr. Dana Sachs an associate professor of dermatology at the University of Michigan Ann Arbor wrote in an email after looking at Algenists dossier that the claims on cell regeneration and elastin synthesis are based on in vitro models which is hard to extrapolate to in vivo and again no statistical significance is presented so this is a weak claim. Dr. Day who has a doctorate in biochemistry said that statistical significance was found but not included in press materials. And according to the company a study of women showed that after days of using the Algenist serum they had a percent decrease in wrinkles httphealth.nytimes.comhealthguidessymptomswrinklesoverview.htmlinlinenytclassifier as shown by silicone replicas of their faces. Dr. Ellen Marmur the chief of the division of dermatologic and cosmetic surgery httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsplasticsurgeryindex.htmlinlinenytclassifier at Mount Sinai Medical Center in Manhattan did say Algenist could fairly claim that alguronic acid offers protection against ultraviolet damage to cells and that she might use the product as a nice sun protection on top of S.P.F. protection. Algenist literature touts alguronic acids superiority to hyaluronic acid retinol httphealth.nytimes.comhealthguidesnutritionvitaminaoverview.htmlinlinenytclassifier and vitamin C httphealth.nytimes.comhealthguidesnutritionvitamincoverview.htmlinlinenytclassifier among other antiaging ingredients in encouraging elastin synthesis and cell regeneration. But Dr. McDaniel who does research into using plantderived products to lengthen the life of cells says he thinks the comparative data must be viewed with caution because the studies that yielded it are challenging to do accurately hard to interpret and not necessarily predictive of final products. Soon consumers will judge whether Algenist products are a breakthrough. In an unusual move Sephora is introducing the line in locations in countries all at once in a rollout coordinated with QVC. It was a brand nobody has ever heard of said Allen Burke the senior adviser for beauty strategy and development at QVC. We want to give it a lot of visibility all at the same time. But Mr. Burke knows that marketing has its limits. It can be the most interesting story in the world he said. But if it doesnt deliver its not a business that we can do."

"A small company started by a neuroscientist at the University of Rochester has moved closer to providing doctors with what he says is a simple computerbased tool to help detect early signs of Alzheimers disease or other forms of dementia. Cerebral Assessment Systems has received marketing approval from the U.S. Food and Drug Administration for Cognivue a cognitiveassessment tool that functions somewhat like a video game. A patient can perform the inexpensive and simple test while a timestrapped primarycare physician tends to other patients. The minute noninvasive examination can detect subtle lapses in the brains perceptual ability that may signal the early stages of mental decline http_story.htmlcaused by dementia. The federal governments approval to market the device comes as Alzheimers researchers everywhere step up the pursuit for easier and more inexpensive ways to identify dementia http_story.htmlin its earliest stages. Scientists are cautiously optimistic about progress toward finding treatments for Alzheimers disease http_story.html Look there is a latelife tsunami of latelife cognitive decline coming at us and healthcare providers are standing on the beach said Charles J. Duffy a neurology professor at the University of Rochester Medical Center who founded the company. What we are all about is making cognitive care part of primary care. More than million Americans have Alzheimers disease the leading cause of dementia. That number is expected to reach . million by according to the Alzheimers Association. With the United States shifting toward an older society the hope is that earlier detection can lead to earlier intervention to slow or arrest the disease perhaps through medications working their way to the market http_story.htmlor changes in lifestyle. In addition to Alzheimers a persons mental competency can be hindered by other conditions such as untreated diabetes thyroid conditions or toxic interactions among prescription medications. Duffy said his tool holds promise as a relatively inexpensive and easy way to test peoples memory and ability to think. With Cognivue patients sit before a video screen that shows a series of images such as a group of dots that move around and fluctuate in clarity. Using a rotaryshaped mouse called a manipulandum the patients try to follow the dots with a wedgeshaped cursor. The task becomes more difficult especially for people with early stages of dementia as the dots move around changing their direction speed and intensity. All perception is interpretive and so what were doing is measuring that process Duffy said. Other parts of the test challenge memory recall or the ability to recognize letters and shapes. Cerebral Assessment Systems device received de novo approval from the FDA a streamlined process for reviewing medical devices that appear to be new enough to have no equivalent and pose little risk. The Pittsford N.Y.based companys FDA application included data from a comparative study involving people recruited from communities for older adults. The subjects ranging in age from to were classified in three groups based on cognitive abilities normal mild cognitive impairment and impaired. Their performance on the Cognivue device was compared to their scores on an existing cognitive assessment test known as the St. Louis University Mental Status Examination SLUMS. The device would be available only for use by medical professionals as part of a more comprehensive assessment of cognitive function. It is not intended to be a standalone diagnostic tool and its effectiveness for people with less than years of education is not proven. Linda M. Rice a primarycare internist with about patients in her Rochester practice said that after a year of using the device in her clinic she is convinced of its worth. About half of her patients are older than and they often have questions about memory loss and their cognitive abilities. But her options for rating their performance involve administering the MiniMental State Exam MMSE http__b_handout.pdf also known as the Folstein test that uses a point questionnaire. The test which has been around since offers only a broad indication of cognitive abilities and fails to pick up borderline problems she said. You have to be pretty bad to do poorly on this exam she said. But the alternative involves referring patients for a battery of neuropsychiatric tests that can take hours to complete and cost or more. The computerbased tool created by Duffy has helped Rice to convince some patients that its time to stop driving and to start them on medications sooner to slow the progress of Alzheimers. I think its a really potentially valuable tool said Leslie Algase an internist who tends about patients in Rochester at least percent of whom are older than . Algase who said she has no financial ties to the company agreed to use the Cognivue in her practice about three years ago after meeting Duffy at a conference. Algase rates the device as about as accurate as the MMSE. But she said its more convenient and less timeconsuming to administer."