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

"Tofu is one soyfood that may help at least some women survive lung cancer better a study finds Soy foods long shown to help lower the risk of cancer may also help people survive at least some forms of cancer better researchers reported on Monday. They found that Chinese women who ate the most soy were also less likely to die of lung cancer the No. cancer killer across the world. The findings published in the Journal of Clinical Oncology lends support to the idea that adding soy foods to the diet can help people in multiple ways says Dr. Jyoti Patel a lung cancer specialist at Northwestern University in Chicago who was not involved in the study. It may be that we do need to change our diets a little bit and eat more of these soybased diets. The benefits may go beyond cardiac health Patel said in a telephone interview. For the study Gong Yang and colleagues at Vanderbilt University Medical Center Shanghai Cancer Institute and the National Cancer Institute looked at data from a large study of Chinese women called the Shanghai Womens Health Study. They pulled out the records of of the women who had lung cancer. The women had all filled out questionnaires that included details of what they normally ate. They did this twice when they enrolled in the study and two years later. Of the patients with lung cancer died during the three years of followup the researchers wrote. Initial analyses including all patients showed that higher intake of soy food was associated with better overall survival after adjusting for demographic and lifestyle characteristics and other nonclinical factor they wrote. Women who reported eating the least soy were . times as likely to die on average. Those who ate the most were about percent less likely to die. This finding along with our previous observation of an approximately percent reduction in risk of incident lung cancer associated with high intake of soy food provides further support for the role of soy food intake in lung cancer development and prognosis the researchers wrote. Most of the women in the study had never been smokers and theres a lot of evidence to suggest that lung cancer is a different disease in smokers versus nonsmokers. In Asian countries percent of women with lung cancer are never smokers Patel said. We dont know if there is an inherited susceptibility to it she added. There might be an infectious disease that causes some cases of lung cancer like the virus that causes cervical cancer or the bacteria that causes stomach cancer. Although the risks are probably different for American women for developing lung cancer I do think it is a call to action for more research about how we develop lung cancer Patel said. There are probably people in the U.S. who never smoked and who have lung cancer. Lung cancer kills Americans a year. Its diagnosed in women and men a year in the United States alone. It accounts for percent of all cancer deaths according to the American Cancer Society. Studies suggest that people who eat the most soy have a lower risk of heart disease and osteoporosis. Women may have fewer menopausal symptoms and perhaps a lower risk of some cancers. The Food and Drug Administration says soy products may carry a hearthealthy label saying that soy may reduce cholesterol when eaten as part of a diet that is low in saturated fat and cholesterol. It wouldnt be difficult to eat enough soy to be protected Patel noted. The high soy level patients were eating what the FDA has said is hearthealthy or grams of soy a day she said. Studies have shown that supplements containing soy protein dont have much health benefit. But foods such as soy milk tofu and edamame do. We think that consuming food in their whole forms is more important than the supplements Patel said. Some researchers have wondered whether Western people who eat more soy food are benefiting from the soy itself or because they perhaps use it as a substitute for meat and dairy foods. Patel says this study in China where soy is a normal part of the diet and where dairy foods are less commonly eaten suggests its the soy itself that adds the benefit. Soy and many other plant foods contain hormonelike substances called phytoestrogens. These may be affecting a cell compound called estrogen receptor beta she said. That compound interacts with another one called epidermal growth factor receptor or EGRF which is known to play a role in many cases on lung cancer. Lung cancer is the most common cause of cancer death. There are many neversmokers with lung cancer she said. People should consider eating a diet that is healthy. By all accounts one that includes soy decreases cardiac risks and could also affect lung cancer Patel concluded. How can people add soy to their diets A cup of vanilla soymilk poured over cereal provides grams of soy protein while an eightounce glass provides grams. A soy burger delivers grams of soy protein while ounces of tofu has . grams."

"Daily treatment with the antiviral drug tenofovir during the third trimester of pregnancy reduced the mothertochild transmission rate of hepatitis B httpsnyulangone.orgconditionshepatitisabc HBV from percent to percent according to the findings of a clinical trial led by researchers from NYU Langone Medical Center and published on June in the New England Journal of Medicine http_home. The study focused on the most common way that children become infected with hepatitis B an incurable viral infection that causes liver disease and cancer which is through infection during the perinatal period. Without intervention to percent of infants who are born to mothers infected with hepatitis B develop a chronic infection. The current standard of care is to provide vaccine and immune globulin to reduce transmission rates. Preventing mothertochild transmission is the most effective way to reduce the global burden of chronic hepatitis B infection and liver cancer says Calvin Pan MD http lead author of the study and a clinical professor of medicine at NYU Langone. We believe that these findings will not only save many lives but could also help to eradicate hepatitis B nationally and abroad. The study was conducted in five locations in China where HBV infection is endemic. Pan and colleagues enrolled pregnant women with a high viral load defined as one million copies of the virus per milliliter in a blood sample. Participants were randomly assigned to either a control group that received no antiviral therapy or to a second group that received a daily dose of milligrams of tenofovir in pill form beginning at or weeks of pregnancy and continuing until weeks after delivery. Treatment effectively reduced the viral load of the pregnant women says Pan. Before delivery percent of tenofovirtreated mothers had HBV loads below million copies per milliliter compared to percent of nontreated mothers. In terms of safety researchers found that tenofovir was well tolerated only one participant treated with tenofovir voluntarily withdrew from the study due to nausea. Among the children born during the study Pan and his colleagues found no significant differences between the tenofovirtreated group and the control group with regard to fetal development and infant growth. This study provides strong evidence on how best to care for women infected with hepatitis B during pregnancy and reduce the rate of disease transmission says Mark Pochapin MD httpsnyulangone.orgdoctorsmarkbpochapin the SholtzLeeds Professor of Gastroenterology and director of the Division of Gastroenterology and Hepatology http at NYU Langone. Based on the findings the investigators recommend that women be tested for HBV viral load at week of pregnancy. Those with a high viral load should receive tenofovir treatment starting at gestational week until delivery to reduce the risk of transmission to their infants. In addition infants should receive hepatitis B vaccine and immune globulin. Moving forward longer term observational studies are needed to confirm the safety of fetal exposure to tenofovir treatment says Pan. This research was supported by Gilead Sciences. Dr. Pans coauthors were Zhong Ping Duan at Beijing Youan Hospital Capital Medical University in Beijing Er Hei Dai and Bao Shen Zhu at Fifth Hospital of Shijiazhuang Hebei Medical University Shijiazhuang Shu Qing Zhang and Wen Jing Zhao at Hepatobiliary Disease Hospital of Ji Lin Province Changchun GuoRong Han and HongXiu Jiang at Second Affiliated Hospital of Southeast University Nanjing Yuming Wang at Institute for Infectious Diseases Southwest Hospital Third Military Medical University Chongqing Huai Bin Zou at Youan Hospital Capital Medical University Beijing and Huai Hong Zhang at Nanyang Center Hospital Nanyang Henan all for the China Study Group for the MothertoChild Transmission of Hepatitis B. Media Inquiries Rob Magyar Phone robert.magyarnyumc.org mailtorobert.magyarnyumc.org"

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

"Taking one or two baby aspirins a day for at least five years was tied to a lower risk of colorectal cancer in a study from Denmark. Bayer brand aspirin is seen on display at the Safeway store in Wheaton Maryland February . REUTERSGary Cameron Earlier studies had suggested that aspirin and nonsteroidal antiinflammatory drugs NSAIDs such as ibuprofen may help protect against colorectal cancer but it wasnt clear how much had to be taken and for how long to achieve those benefits. Now using data on more than individuals researchers have been trying to sort out the relationship between aspirin and NSAIDs duration of treatment and colorectal cancer rates. In general the risk of developing colorectal cancer varies with age race ethnicity and lifestyle. More than percent of cases are diagnosed in people older than according to the National Cancer Institute. An online risk calculator from the Centers for Disease Control and Prevention available here .usa.govDlscTL http.usa.govDlscTL indicates that in the U.S. for an average white or black woman in her late fifties the year risk of developing colorectal cancer is between and . percent and her lifetime risk is between and . percent. For an average black or white male of the same age the corresponding risks would be about . percent and . percent. In the new study from Denmark taking lowdose aspirin continuously for at least five years appeared to reduce the risk of colorectal cancer by and using nonaspirin NSAIDs for at least five years appeared to reduce it by . On the other hand merely having taken aspirin did not alter the colorectal cancer risk they reported in Annals of Internal Medicine. Sponsored Unless lowdose aspirin is taken continuously there is little protection against colorectal cancer Dr. Soren Friis from the Danish Cancer Society Research Center in Copenhagen told Reuters Health. Nonaspirin NSAIDs were also protective against colorectal cancer with consistent longterm use and there was some indication that even noncontinuous use of these agents may be marginally effective for the prevention of colorectal cancer Dr. Friis said. Aspirin and NSAIDs carry their own risks however. Longterm use can cause gastrointestinal bleeding for example so the potential reduction in colon cancer risk needs to be balanced against potential side effects the authors warn. The study had several limitations. For instance the researchers only had data for users who obtained their aspirin or NSAIDs from doctors prescriptions. They didnt include patients who made overthecounter purchases of the medicines. Also the researchers cant rule out the possibility that other factors may have increased participants risk for colorectal cancer such as obesity dietary habits alcohol use and family history of colorectal cancer. Dr. Friis emphasized that people should not start taking aspirin or NSAIDs on the basis of the new findings. Selfmedication with aspirin or nonaspirin NSAIDs is strongly discouraged due to the possibility of serious adverse events Dr. Friis said. The public should not take any medication regularly without consulting with a physician. Dr. Gurpreet Singh Ranger from Upper River Valley Hospital Waterville New Brunswick and Dalhousie Medical School in Halifax Nova Scotia Canada agreed with Dr. Friis. Low dose aspirin already taken regularly by millions reduces the risk of colorectal cancer he told Reuters Health by email. But before starting to take aspirin long term it is important to discuss the implications with your family doctor or specialist. SOURCE bit.lyilF httpbit.lyilF Annals of Internal Medicine online August ."

"A five week treatment with the synthetic hormone oxytocin significantly improved social emotional and behavioral issues among young children with autism according to University of Sydney research published today in Molecular Psychiatry. The study led by researchers at the Universitys Brain and Mind Centre is thought to be the first evidence of a medical treatment for social impairments in children with autism. It is also the first clinical trial investigating the efficacy tolerability and safety of intranasaladministered oxytocin in young children with autism. Autism is a group of complex brain developmental disorders characterized by impairments in social interaction communication and stereotypical and repetitive behaviours. The diagnosed incidence is estimated to be one in children and effective interventions remain limited. Behavioural therapies can improve social emotional and behavioural impairments but these are typically time consuming hours per week remain costly and show mixed outcomes. There is currently no medical treatment for these problems. In this new study children aged three to eight years of age received a twice daily course of oxytocin in the form of a nasal spray. We used some of the most widely used assessments of social responsiveness for children with autism said autism expert Associate Professor Adam Guastella of the Brain and Mind Centre. We found that following oxytocin treatment parents reported their child to be more socially responsive at home and our own blind independent clinician ratings also supported improved social responsiveness in the therapy rooms of the Brain and Mind Centre he said. Overall the nasal spray was well tolerated and the most common adverse events were thirst urination and constipation. This is the first time a medical treatment has shown this type of benefit for children with autism and findings reinforce outcomes from a longer sustained program of research by this team. Over the last years Brain and Mind Centre researchers have been documenting the benefits of oxytocin in humans revealing that it enhances eye gaze emotion recognition and memory across a range of populations. Study coauthor and codirector of the Brain and Mind Centre Professor Ian Hickie noted the new results were a critical first advance in the development of medical treatments for the social deficits that characterize autism. The potential to use such simple treatments to enhance the longerterm benefits of other behavioural educational and technologybased therapies is very exciting he said. Most recently the team has linked observed changes from treatment to brain changes associated with social circuitry. The next step in the research is to understand exactly how oxytocin changes brain circuitry to improve social behavior and to document how related treatments might be used to boost established social learning interventions. The researchers are seeking to further develop the potential of oxytocinbased interventions within the context of good multidisciplinary care for autism."

"Welcome to Dear Julia http a weekly column where readers can submit everyday health questions on anything from the science of hangovers to the mysteries of back pain. 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. Have a question Use our submission form httpsdocs.google.comformsdnBojnwSNqWYGlMzQcCOdoQdzaChMPOmNRRhKYtaviewform or ask juliaoftoronto httpstwitter.comjuliaoftoronto on Twitter. Whats the difference between Tylenol Advil and aspirin Which is the best to take for pain I used to take acetaminophen usually referred to by its brand name Tylenol for the occasional headache or sore muscle mostly because thats what we used in my house growing up. I didnt think much about whether it was more or less effective than any other type of overthecounter pain reliever and I suspect the same is true for many folks. Acetaminophen after all is the most popular httpard.bmj.comcontentearlyannrheumdis.full overthecounter painkiller worldwide. So I was surprised when I found out theres a huge gap between how pain researchers think about this drug and how the public does. More specifically every researcher I contacted for this piece said some variation of what Andrew Moore http a pain researcher at Oxford University told me Tylenol doesnt actually work that well for pain. To be more exact he said I cant imagine why anybody would take acetaminophen. Moore has done a number of systematic reviews on overthecounter pain medications looking at all the available evidence to figure out which ones work best for various problems. I asked him to describe the overall success rates for the most common three acetaminophen like Tylenol ibuprofen like Advil and aspirin. Like all good evidencebased medicine thinkers he was able to provide a very practical answer If youre talking about aspirin in doses of to mg or two tablets percent of people get relief from acute pain. For acetaminophen at doses of to mg about percent have a success. For ibuprofen in its normal formulation at something around mg or two tablets about percent have success. Now Moore was referring here to acute pain that strikes after a specific event like a surgery http_ibuprofenversusparacetamolacetaminophenforpainreliefaftersurgicalremovaloflowerwisdomteeth a cut or a burn but his message was simple Ibuprofen seems to work best followed by acetaminophen and then aspirin. For ongoing or chronic pain a sore lower back say or the kind of degenerative arthritis that typically develops with age ibuprofen still outperforms acetaminophen. WE FOUND THAT TYLENOL IS INEFFECTIVE ON BOTH PAIN AND DISABILITY OUTCOMES FOR LOW BACK PAIN A systematic review http of highquality evidence published in the BMJ found that acetaminophen didnt seem to help most sufferers of chronic low back pain and that it barely alleviates pain in people with osteoarthritis. As the researchers wrote We found that acetaminophen is ineffective on both pain and disability outcomes for low back pain in the immediate and short term and is not clinically superior to placebo on both pain and disability outcomes for osteoarthritis. A limitation of the study is that the evidence on acetaminophen was mainly for acute low back pain but as the University of Leedss Philip Conaghan httplmbru.leeds.ac.ukpeopleourpeopleprofessorphilipconaghan explained There is very little longterm data on chronic back pain and if a drug doesnt work in the acute problem it seems unlikely to work in the chronic phase though back pain may be even more complex than osteoarthritis pain. The study also noted that patients on acetaminophen are nearly four times more likely to have abnormal results on liver function tests compared with those taking oral placebo. Other studies like this welldesigned randomized control trial httpard.bmj.comcontent.short of people with knee pain have similar conclusions Acetaminophen doesnt perform as well as ibuprofen and its linked to higher rates of liver problems. Ibuprofen also has potential side effects more on that below. So what about the occasional headache What works best for that It turns out this is another fascinating problem area for pain researchers. Moore has looked at all the evidence for what he calls infrequent tension headaches and found it is surprising how poor the research is and how little it tells us. Either the outcomes in studies are badly defined the studies have too few participants to say anything concrete or many people in the studies actually seem to have chronic headaches as opposed to the ordinary ones the researchers are allegedly studying. Most people would say if you look at the data take an ibuprofen http_oralibuprofenacutetreatmentepisodictensiontypeheadacheadults tablet Moore said. Acetaminophen is just not a very good analgesic pain reliever yet its the goto drug because its thought to be safe. And thats where things get even more interesting Acetaminophen isnt actually that safe. We always thought acetaminophen was safe but there are increasing signals of accidental overdose in people who are regularly using it for chronic pain and some liver toxicity explained Conaghan httplmbru.leeds.ac.ukpeopleourpeopleprofessorphilipconaghan who has studied adverse events data httpard.bmj.comcontentearlyannrheumdis.fullrelated to this popular drug. Between and acetaminophen was the leading cause of acute liver failure http in the US. There are also hundreds of related deaths every year though keep in mind that millions of people take drugs with acetaminophen so these more extreme side effects are rare especially if youre only taking them in small doses occasionally. Still for the drugs minimal painkilling benefits the risks may not be worth it. Dont believe that just because something is overthecounter its safe Conaghan added. He advised people to see their doctor if theyre taking any of these painkillers for more than a few days particularly if theyre on other drugs already. Tylenol is an old drug obsolete and should be avoided altogether Kay Brune http a professor of pharmacology and toxicology at Germanys FriedrichAlexander University who has also studied the toxicity of painkillers was even more direct in his thoughts on acetaminophen Its an old drug obsolete and should be avoided altogether. Aspirin is safer than acetaminophen he said though to be used as a pain reliever it requires much higher doses which can have side effects like stomach upset. Aspirin also interferes with blood coagulation for days after taking it. If you take one gram of aspirin Brune explained youre at risk of bleeding for another four days. This is why aspirin has its place as a protective agent against strokes and heart attacks for people at a higher risk. Ibuprofen doesnt have these two problems its less toxic than the others in the doses that give people pain relief. But it has other side effects. Ibuprofen puts people at risk of bleeds in the gastrointestinal tract and kidney damage so its not free of risk said Brune. Using it in high doses also seems to raise blood pressure and increase the risk of heart attack and stroke one reason the Food and Drug Administration recently warned http_r people should only use ibuprofen and other nonsteroidal antiinflammatory drugs or NSAIDS like naproxen for short periods of time and in small amounts. I asked Brune about what hed suggest for the occasional headache or sore muscle. Taking mg of ibuprofen wont cause measurable harm he answered. Of all drugs we have available for most indications its also the most effective one. Is acetaminophen good for anything If the research community seems to have sided with ibuprofen for pain is acetaminophen good for anything Yes. There are some groups of people with health complications who shouldnt take ibuprofen. For example patients with kidney gastric cardiovascular or bleeding problems may need to avoid NSAIDS like ibuprofen so doctors might suggest Tylenol in these cases. Theres also some evidence that NSAIDS may increase the risk of psychosis and cognitive impairment in the elderly so doctors may avoid prescribing these drugs for older patients. And Tylenol is generally considered safer http than Advil or aspirin for pregnant women. Fever is another area where acetaminophen can help said Moore. According to one systematic review http_paracetamolfortreatingfeverinchildren acetaminophen seems to be safe for treating very young kids with fever and you can give children http as young as months old acetaminophen whereas you need to wait until kids are at least months old to safely treat them with ibuprofen. This may help to explain the popularity of drugs like Tylenol for kids. But a final caveat here If your child is older than months its not all that clear http that acetaminophen outperforms ibuprofen for reducing fevers and the same is true for adults. http So keep that in mind the next time you confront your medicine cabinet."

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

"A University of Manchester England engineering professor has invented a portable breast https scanner that could lead to more accurate tests for younger women without the need for Xrays. The scanner is based on radiofrequency technology which is able to quickly show malignant and benign tumors https when linked to a computer. It could be used in doctors offices. Radio Waves Radiofrequency or microwave technology for breast cancer https detection is not new but what Zhipeng Wu PhD from Manchesters School of Electrical and Electronic Engineering has achieved is the speed of results and portability. The patented realtime radiofrequency scanner uses computer tomography and works by using the same technology as a mobile phone but with only a tiny fraction of its power. Costs are reduced and the electronics fit into a case the size of a lunchbox. Continue Reading Below Current mammography https testing works well for detecting breast cancer https in women over with results of up to accuracy. The Manchester team says it is far less effective for younger women where the detection rate could be as low as for women under the age of . This group the team says accounts for of all breast cancer https cases. How It Works While mammography https works on breast https density radiofrequency looks at contrasts between normal and diseased breast tissues. The breast is placed in a scanner cup and an image appears on screen. Tumors or other abnormalities show up in red. Wu says in a news release The system we have is portable and as soon as you lie down you can get a scan its realtime. The realtime imaging minimizes the chance of missing a breast tumor during scanning. Wu says it will even work through a bra. Although there is still research to be done the system has great potential to bring a new way for breast cancer diagnosis https Reaction Carolyn Rogers clinical nurse specialist at Breast Cancer Care in the U.K. says in an emailed statement Evidence is needed to demonstrate the accuracy and uses of this device. The most effective screening tool for detecting breast cancer https is mammography and for women of all ages to remain breast aware reporting any changes to their doctor."

"People taking popular cholesterollowering drugs called statins may have a slightly lower risk than others of developing Parkinsons disease new research suggests. This effect may be even more pronounced among people younger than according to the study published in the March issue of Archives of Neurology. However the risk reduction was modest and may have been due to chance the authors said noting that more research is warranted especially because statins can cause adverse side effects. There is no clear verdict said Dr. Stuart Isaacson director of the Parkinsons Disease and Movement Disorders Center of Boca Raton who was not involved in the study. Right now we dont have any good evidence that there is anything we can do to reduce the risk of developing Parkinsons disease but research is ongoing added Isaacson also an associate professor of neurology at Florida International Universitys Herbert Wertheim College of Medicine in Miami. For the study researchers led by Dr. Xiang Gao of Brigham and Womens Hospital and Harvard University School of Public Health in Boston analyzed data on more than men and almost women enrolled in the Health Professionals Followup Study and the Nurses Health Study in . During years of followup people were diagnosed with Parkinsons disease. People taking cholesterollowering drugs especially those younger than were less likely to develop the neurological disorder than those not using cholesterol drugs the researchers found. Nearly one million people in the United States have Parkinsons disease a chronic and progressive movement disorder and no one knows what causes it. The researchers cant say exactly how or even if statins reduce the risk of Parkinsons. Its thought these drugs may have potent antiinflammatory effects which could protect the brain. The study had some limitations the authors acknowledged. For example only about percent of people who were taking drugs to lower cholesterol were actually on statins at the studys start. Dr. Roy Alcalay an assistant professor of neurology at Columbia University Medical Center in New York City said it is way too early to say that statins lower risk for Parkinsons disease. This is a promising avenue for future research said Alcalay an advisor for the Parkinsons Disease Foundation. But there is some good news he added. The data are compelling evidence that statins are not detrimental for people with or at risk of Parkinsons disease he said. There was a concern that statins could be harmful as they might lower the level of coenzyme Q in the blood. CoQ an antioxidant is thought to have benefits for people with Parkinsons disease. If you need to be on statins for your heart it is not going to increase your risk for Parkinsons Alcalay said. More information Learn more about Parkinsons disease and its symptoms at the Parkinsons Disease Foundation http_pd. SOURCES Stuart Isaacson M.D. director Parkinsons Disease and Movement Disorders Center of Boca Raton and associate professor neurology Florida International University Herbert Wertheim College of Medicine Miami Fla. Roy Alcalay M.D. assistant professor neurology Columbia University Medical Center New York City and advisor Parkinsons Disease Foundation March Archives of Neurology"

"A new pill may help glutenfree diners enjoy pizza pasta and other glutencontaining fare they regularly have to avoid during social gatherings. Researchers at the University of Alberta have developed a pill using egg yolk antibodies that helps coat gluten allowing it to pass from the body without doing any damage the Canadian Broadcasting Corporation CBC reported. http My friend is celiac. We havent had any entertaining with beers. So thats why I developed this pill for my friend Hoon Sunwoo an associated professor of pharmaceutical sciences at UAlberta told the CBC. http Celiac disease is an autoimmune disorder in the small intestine that makes patients sensitive to gluten. Patients would take Sunwoos pill five minutes before eating and have a onetotwo hour window of eating foods they typically avoid the CBC reported. http However Sunwoo warns the pill is neither a longterm solution for patients nor is it a cure for the disease just an aid to help improve quality of life. This is not treating the celiac disease or curing celiac disease he told local media. Its just to try to help them improve their quality of life so when they want to socialize with peers or friends. Researchers expect to begin clinical trials with the pill in CBC reported. http"

"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."

"Today marks a significant step forward in the prevention and treatment of leprosy as the Infectious Disease Research Institute IDRI and American Leprosy Missions announce the start of a Phase clinical trial in humans for a promising leprosy vaccine candidate the first vaccine developed specifically for leprosy. Characterized by the World Health Organization as a neglected tropical disease leprosy also known as Hansens disease is one of the most ancient diseases known to humankind and is caused by the bacteria Mycobacterium leprae. Nearly a quarter of a million people worldwide have leprosy which causes disfiguration of the skin and mucous membranes as well as progressive and incurable nerve damage. While drug therapy exists for leprosy it must be taken for many months has many side effects and often is given too late to reverse the permanent damage caused by the bacterial infection. A viable vaccine to prevent andor treat leprosy is the next step in the effort to bring this disease to an end. Scientists at IDRI along with national and international collaborators including the National Hansens Disease Program and the National Institute of Allergy and Infectious Diseases NIAID part of the National Institutes of Health with financial support from American Leprosy Missions have developed a promising leprosy vaccine candidate designed to help treat leprosy and prevent exposed individuals from developing disease and the resulting disabilities. Based on data generated in preclinical studies the vaccine candidate called LepVax has progressed to Phase I clinical testing in the United States the first stage of safety testing in human volunteers. The clinical trial is focused on safety as well as evaluating the immune response to the vaccine. While previous attempts have used vaccines primarily developed for other diseases this is the first totally defined vaccine candidate developed specifically for leprosy using the latest technologies and offering no less than those exposed to leprosy deserve said Steven Reed Ph.D. IDRI President CEO Founder. The leprosy vaccine program at IDRI has benefited greatly from what weve learned in the development of tuberculosis vaccine candidates over the past two decades. Although the bacteria that cause tuberculosis and leprosy are related leprosy vaccine development posed great challenges. This vaccine represents a unique accomplishment requiring the most advanced technologies in molecular biology and immunology and American Leprosy Missions has been there from the beginning. IDRI scientists have also developed two vaccine candidates for tuberculosis both in clinical stages of development. We are thrilled that after years and an investment of over . million made possible by our faithful donors and partners a leprosyspecific vaccine is beginning a Phase I clinical trial says Bill Simmons President and CEO of American Leprosy Missions. We believe this may be the most exciting breakthrough in leprosy treatment since multidrug therapy the current treatment for leprosy was launched in the s. We look forward to this vaccine improving the health outcomes of people diagnosed with leprosy. And it may be that this vaccine can lead to interruption of the transmission of leprosy all together. What a tremendous legacy this would leave for millions of people worldwide. The vaccine was developed through significant efforts in screening and identifying M. leprae proteins that trigger an effective immune response. IDRI scientists then produced a fusion of four leprosy proteins which is combined with IDRIs proprietary immunestimulating adjuvant GLASE. With recent developments in vaccine technology IDRI scientists can now induce protective responses even after infection meaning it could be possible to prevent disease development in people already infected with the leprosy bacterium. This generation of a vaccine to prevent and possibly treat leprosy is the result of years of research. The development has been complicated by the fact that the organism that causes leprosy cannot be grown in culture in the laboratory Reed explained. This is a unique example of a vaccine produced by totally synthetic methods. Reed added that without the foresight and support of American Leprosy Missions there would be no leprosy vaccine candidate. The vision and support of American Leprosy Missions has been tremendous as weve worked with them throughout the years moving from our work in developing a leprosy diagnostic to our current focus on a successful leprosy vaccine he said. The progress weve had to date would not have been possible without American Leprosy Missions financial support and guidance. Early results from the Phase I study should be available in and the partners are currently exploring mechanisms to advance the vaccine through laterphase clinical trials should results from the Phase I study clinical trial NCT support further evaluation. The vaccine candidate will serve as part of an overall strategy to end leprosy which will require detection prevention and treatment. IDRI had developed technology to enable a rapid affordable pointofcare diagnostic test which was funded by NIAID grant numbers RAIA and RAI. In addition to IDRI and American Leprosy Missions a variety of partners are taking part in efforts to eliminate leprosy including Novartis and the Novartis Foundation. Reed along with scientists from a variety of scientific organizations recently published Innovative tools and approaches to end the transmission of Mycobacterium leprae in The Lancet Infectious Diseases outlining what is needed to achieve this goal. Together with scientific government and NGO partners the Novartis Foundation develops and implements strategies to help interrupt leprosy transmission while Novartis donates the treatment for leprosy free of charge. About IDRI As a nonprofit global health organization IDRI Infectious Disease Research Institute takes a comprehensive approach to combat infectious diseases combining the highquality science of a research organization with the product development capabilities of a biotech company to create new diagnostics drugs and vaccines. Founded in IDRI has employees headquartered in Seattle with nearly partnerscollaborators around the world. For more information visit http About American Leprosy Missions American Leprosy Missions based in Greenville South Carolina is the oldest and largest Christian organization in the United States dedicated to curing and caring for people affected by leprosy and related diseases. It funds projects and partners in countries across Africa Asia and the Americas. During its more than year history American Leprosy Missions has provided holistic care to four million people around the world including medical treatment and training Christian outreach community development and vaccine research. For more information visit http SOURCE Infectious Disease Research Institute Related Links http"

"Lung ultrasound has been shown to be highly effective and safe for diagnosing pneumonia in children and a potential substitute for chest Xray according to a study conducted at the Icahn School of Medicine at Mount Sinai. Results are currently published in the medical journal Chest. To watch study author discuss this research click this link https Pneumonia is the leading cause of death in children worldwide according to the World Health Organization WHO. Symptoms include fever cough and rapid breathing. Chest Xray is considered the test of choice for diagnosing pneumonia in children but the WHO estimates threequarters of the worlds population does not have access to radiography. Investigators conducted a randomized controlled trial in the pediatric Emergency Department at The Mount Sinai Hospital comparing lung ultrasound to chest Xray in children from birth to years of age. The patients were randomly assigned into an investigational arm received a lung ultrasound and if the physician needed additional verification a chest Xray and a control arm received a chest Xray followed by a lung ultrasound. Researchers found a . percent reduction in chest Xrays in the investigational arm compared to no reduction in the control arm with no missed pneumonia cases and no increase in any other adverse events. The research team was led by James Tsung MD MPH Associate Professor in the Department of Emergency Medicine and Department of Pediatrics at the Icahn School of Medicine at Mount Sinai and former clinical fellow Brittany Pardue Jones MD whos currently Assistant Professor in the Department of Pediatrics at Vanderbilt University School of Medicine. Ultrasound is portable costsaving and safer for children than an Xray because it does not expose them to radiation says Dr. Tsung. Our study could have a profound impact in the developing world where access to radiography is limited. Furthermore the reduction in chest Xrays in the investigational arm resulted in an overall cost savings of and length of stay in the Emergency Department was decreased by minutes. In the era of precision medicine lung ultrasound may also be an ideal imaging option in children who are at higher risk for radiationinduced cancers or have received multiple radiographic or CT imaging studies says Dr. Tsung. As more and more handheld ultrasound machines come to market these results suggest that lung ultrasound has the potential to become the preferred choice for the diagnosis of pneumonia in children. Further research is needed to investigate the impact of lung ultrasound on antibiotic use and stewardship. About the Mount Sinai Health System The Mount Sinai Health System is an integrated health system committed to providing distinguished care conducting transformative research and advancing biomedical education. Structured around seven hospital campuses and a single medical school the Health System has an extensive ambulatory network and a range of inpatient and outpatient servicesfrom communitybased facilities to tertiary and quaternary care. The System includes approximately primary and specialty care physicians jointventure ambulatory surgery centers more than ambulatory practices throughout the five boroughs of New York City Westchester Long Island and Florida and affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is ranked as one of the nations top hospitals in Geriatrics CardiologyHeart Surgery and Gastroenterology and is in the top in five other specialties in the Best Hospitals issue of U.S. News World Report. Mount Sinais Kravis Childrens Hospital also is ranked in seven out of ten pediatric specialties by U.S. News World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked th nationally for Ophthalmology while Mount Sinai Beth Israel is ranked regionally. For more information visit http or find Mount Sinai on Facebook Twitter and YouTube."

"She had taken care of her husband for the last eight years of his life through his blindness through cancer and heart failure. After he died in she sold the Long Island house theyd loved and shared finding it too filled with memories and moved to their country home in upstate New York. Friends thought Anne Schomaker was coping well with her loss she recalled. I volunteered to get myself out and doing things to fill the gaps she said. I had many interests. She traveled and even tried dating again. But I wasnt really doing well said Ms. Schomaker . I had terrible pangs of sadness and despondency. I was missing my husband so badly. Even after seeing a therapist which helped she suffered from nightmares and couldnt bear to hear arias from their favorite operas. The pain just didnt go away she said. The death of someone beloved often brings deep sadness. Usually however the intense grief of early mourning begins to ebb as months pass and people alternate between continuing sorrow and a growing ability to rediscover lifes pleasures. What distinguished Ms. Schomakers suffering was its sheer duration. She had been mired in grief for nine years when she saw an announcement from Columbia University where researchers who had developed a treatment for complicated grief were seeking participants in a study. Maybe this new approach could help Ms. Schomaker thought. Complicated or prolonged grief can assail anyone but it is a particular problem for older adults because they suffer so many losses spouses parents siblings friends. It comes with bereavement said Dr. Katherine Shear httpsocialwork.columbia.edufacultykatherineshear the psychiatrist who led the Columbia University study. And the prevalence of important losses is so much greater in people over . In a review in The New England Journal of Medicine earlier this year Dr. Shear listed several symptoms characteristic of complicated grief http intense longing or yearning preoccupying thoughts and memories and an inability to accept the loss and to imagine a future without the person who died. Often mourners with these symptoms are convinced that had they done something differently they might have prevented the death. Severe and prolonged compared with typical reactions complicated grief impairs the mourners ability to function. Adapting to loss is as much a part of us as grief itself said Dr. Shear who directs the Center for Complicated Grief httpcomplicatedgrief.org at the Columbia University School of Social Work. With complicated grief something gets in the way of that adaptation she said. Something impedes the course of healing. How common is this prolonged grief An epidemiological study of more than people conducted in Germany in put the proportion at nearly percent and at percent among those over age http George A. Bonanno http director of the Loss Trauma and Emotion Lab http at Columbia University Teachers College said the real figure might be closer to to percent. Dr. Bonanno author of The Other Side of Sadness http What the New Science of Bereavement Tells Us About Life After Loss argues that resilience is the typical response to the death of loved ones. Yet he notes we always see a group of people who dont recover. The problem appears more likely when a death is sudden or violent when the person who died was ones spouse romantic partner or child and when the bereaved person has a history of depression anxiety or substance abuse. Defining this sort of grief has engendered some professional disagreement. What criteria distinguish complicated grief from depression or anxiety When does normal grief become prolonged Researchers disagree on even the conditions name. The American Psychiatric Association http in the latest version of its Diagnostic and Statistical Manual http of Mental Disorders declined to classify complicated grief as a mental disorder and instead included persistent complex bereavementrelated disorder in an appendix for further study. The fifth edition published in sets months as the point past which continued symptoms of intense grief may constitute a disorder although Dr. Shear and other researchers had proposed a threshold of six months. Some experts have argued that the available evidence doesnt support a clear distinction between longerthanaverage grieving and mental illness httpjournals.lww.comjonmdAbstractShould_Prolonged_Grief_Be_Reclassified_as_a_Mental..aspx. Does psychiatry need to continually label the range of normal human emotions as disorders Jerome C. Wakefield httpsocialwork.nyu.eduourfacultyfulltimejeromecwakefield.html a professor of social work and psychiatry at New York University said in an interview. By diagnosing complicated grief just six months after a death he said youll get a lot of normal people receiving treatment they dont need including drugs. Dr. Shear also worries about pathologizing normal emotions. But when a woman remains unable to leave her home or answer the phone four years after the death of her adult son as was true of one patient something has clearly gone wrong. If youre worried about what youre experiencing if youre not getting more engaged in life and people around you are saying Honey stop wallowing in it why not get some help Dr. Shear said. Complicated grief therapy developed by her center showed greater effectiveness among older adults than interpersonal psychotherapy in a clinical trial. Subjects including Ms. Schomaker were given a scale with statements measuring responses to loss like I think about this person so much that its hard for me to do the things I normally do and I feel that life is empty without the person who died. Their high scores indicated complicated grief. Close to half of the subjects average age had lost a spouse or partner and more than a quarter had lost a parent. More than three years had elapsed on average since the death. Most subjects reported that they had thought of suicide. They were randomly assigned to undergo weekly sessions of complicated grief therapy which focuses specifically on bereavement symptoms and incorporates memories photographs and recordings or interpersonal psychotherapy. Both treatments helped but in the group receiving complicated grief therapy more than percent were found much improved or very much improved httparchpsyc.jamanetwork.comarticle.aspxarticleidresultClick in the severity of their symptoms and impairment compared with percent in the standard psychotherapy group. A larger foursite study completed but not yet published showed similar effectiveness Dr. Shear said. To make its method more widely available the Center for Complicated Grief has published a manual and offers training workshops for therapists staff members consult with and answer questions from patients and therapists around the country. Darlyn Reardon of Ross Township Pa. for instance sought complicated grief therapy at the University of Pittsburgh Medical Center in . After her husband of years died of cancer it was like I lost my life too she said. Seven years passed and I didnt take care of myself she said. I didnt go to the doctor. I stopped going to church. We had a circle of friends and I stopped seeing them. I stopped everything. Ms. Reardon will always miss her husband John who was a firefighter. But she can take pleasure now in a regular movie and lunch with her cousin in an affectionate pug named Lovey in her teenage grandchildren. Ms. Schomaker too feels substantially recovered. A volunteer and museumgoer with an active social life she is grateful for the complicated grief therapy she received. It gets you thinking about your loss in a different way she said. It encourages you to move on because theres happiness ahead of you."

"In a finding that suggests the potential for practice change that would reduce the use of antibiotics in dermatology researchers in the Perelman School of Medicine at the University of Pennsylvania have found the diuretic drug spironolactone may be just as effective as antibiotics for the treatment of womens acne. The study published this month in the Journal of Drugs and Dermatology found patients who were originally prescribed spironolactone changed to a different drug within one year at almost the same rate as those who were prescribed antibiotics. The prescription change is a proxy for ineffectiveness since switching is often the result of treatment failure due to lack of efficacy side effects cost or other factors. Acne is one of the most common diseases in the world. It affects percent of people under the age of but it also regularly impacts adults. More than percent of women in the United States are treated for acne between the ages of and while more than percent are treated between the ages of and . Oral antibiotics are the most common systemic treatment for acne and when combined with the large patient population the result is that dermatologists prescribe the highest level of antibiotics per provider among all medical specialties according to the Centers for Disease Control a fact that contributes to concerns about increased resistance to antibiotics across all fields of medicine. Its clear that a safe alternative to oral antibiotics could have a huge benefit and our data show spironolactone may be that alternative said the studys lead author John S. Barbieri MD MBA Dermatology chief resident at Penn. David J. Margolis MD PhD a professor of Dermatology was the studys senior author. Spironolactone marketed under the name aldactone is currently approved to treat high blood pressure heart failure and conditions that cause people to retain fluid. It blocks the effects of male hormones like androgen meaning its not an option to treat acne in men. However those same antihormonal effects can help prevent acne outbreaks in women. As a result some dermatologists use it to treat female acne patients. Researchers compared data on women and girls taking spironolactone to who were prescribed antibiotics. Within a year . percent of spironolactone patients and . percent of antibiotic patients had switched to alternative treatments suggesting each treatment was working at almost the same rate despite the fact that tetracyclineclass antibiotics are prescribed five times as frequently. These numbers suggest dermatologists should consider spironolactone first instead of antibiotics when it comes to women with acne Barbieri said. In addition to the benefits for antibiotic stewardship Barbieri pointed to several studies showing longterm oral antibiotic use may be associated with antibiotic resistance lupus inflammatory bowel disease and even colon and breast cancer. This indicates spironolactone may have a better safety profile than oral antibiotics which is another factor that makes it such an appealing option Barbieri said. He also noted spironolactone is less expensive which may be relevant to patients with high deductibles or who are uninsured. Spironolactone is not approved for the treatment of acne by the U.S. Food and Drug Administration despite expert opinion supporting its use and Barbieri says the findings of this study should be confirmed by a randomized controlled trial that directly compares the two treatment options. 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 medical schools in the United States for more than 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 and Penn Presbyterian Medical Center which are recognized as one of the nations top Honor Roll hospitals by U.S. News World Report Chester County Hospital Lancaster General Health Penn Medicine Princeton Health Penn Wissahickon Hospice and Pennsylvania Hospital the nations first hospital founded in . Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners a partnership between Good Shepherd Rehabilitation Network and Penn Medicine and Princeton House Behavioral Health a leading provider of highly skilled and compassionate behavioral healthcare. Penn Medicine is committed to improving lives and health through a variety of communitybased programs and activities. In fiscal year Penn Medicine provided more than million to benefit our community."

"Details of a large heart safety study presented on Monday appear to give Merck and Cos diabetes drug Januvia a clean bill of health possibly setting the stage for a return to sales growth for the drugmakers biggest product. A view of the Merck Co. campus in Linden New Jersey March . REUTERSJeff Zelevansky Merck in April said the study called Tecos of patients with type diabetes and a history of heart disease demonstrated that adding Januvia to usual care did not increase major heart problems any more than adding a placebo removing a cloud that has been holding back sales of the medicine and the companys share price. Januvia an oral medication known chemically as sitagliptin that helps lower blood sugar levels had sales of about billion in plus another . billion for the related combination product Janumet On the studys main focus after about three years . percent of Januvia patients had experienced cardiovascular death nonfatal heart attack nonfatal stroke or hospitalization for unstable angina versus . percent in the placebo group. The detailed results also showed no increase in hospitalization for heart failure which had been a particular concern with DPP inhibitors the class to which Januvia belongs. There were such hospitalizations for Januvia and in the placebo group according to data also published in the New England Journal of Medicine. We can be reassured we can use this drug for glucose lowering without affecting the already high cardiovascular risk in people with type diabetes said Professor Rury Holman the studys lead investigator who presented the data at the American Diabetes Association meeting in Boston. For the heart failure concern raised by other agents in the class there is no difference with placebo he added. There was also no significant difference between Januvia and placebo in infections cancer kidney failure or severe hypoglycemia which is dangerously low blood sugar researchers reported. Acute pancreatitis a concern with some diabetes drugs was uncommon but higher with Januvia versus . That was not statistically significant. Numerically this is hardly a major risk just something we need to keep an eye on Holman said. Pancreatic cancers also uncommon were numerically fewer with Januvia versus . Death from any cause occurred in . percent of Januvia patients versus . percent for placebo. The Tecos heart safety study was conducted by an independent academic research collaboration between the University of Oxford Diabetes Trials Unit and the Duke University Clinical Research Institute. It was undertaken after heart safety concerns were raised over other diabetes medicines."

"A clinical trial among more than patients has found that the drug ranibizumab Lucentis is highly effective in treating proliferative diabetic retinopathy PDR a complication of diabetes that can severely damage eyesight. The results published by the Journal of the American Medical Association demonstrate the first major therapy advance for the condition in nearly years. Funded by the National Eye Institute NEI and conducted by the Diabetic Retinopathy Clinical Research Network DRCR.net the trial compared Lucentis injections with a type of laser therapy called panretinal photocoagulation which has remained the gold standard for PDR since the mids. Although laser therapy preserves central vision it can damage night and side vision so researchers have sought therapies that lack these side effects. The trial results provide crucial evidence for a safe and effective alternative to laser therapy against PDR said NEI Director Paul A. Sieving M.D. Ph.D. Patients who received Lucentis showed a little bit better central vision much less loss of their side vision and substantially less risk for surgery than patients who received laser treatment said Lloyd Paul Aiello M.D. Ph.D. director of the Beetham Eye Institute at Joslin Diabetes Center and Professor of Ophthalmology at Harvard Medical School. These findings will change the available treatment options for patients with PDR. Diabetic retinopathy damages blood vessels in the lightsensitive retina in the back of the eye. As the disease worsens blood vessels can swell and lose their ability to function properly. Diabetic retinopathy becomes proliferative when lack of blood flow in the retina increases production of a protein called vascular endothelial growth factor VEGF which can stimulate the growth of new abnormal blood vessels. These new vessels are prone to bleeding into the center of the eye sometimes requiring a surgical procedure called a vitrectomy to clear the blood. The abnormal blood vessels can also cause scarring and retinal detachment. Untreated PDR is associated with high risk of visual loss. Lucentis is among several drugs that block the effects of VEGF. Dr. Aiello and George King M.D. Chief Scientific Officer at Joslin Diabetes Center and Professor of Medicine at Harvard Medical School pioneered the study of VEGF in diabetic eye disease beginning in the early s. Their work followed a distinguished Joslin traditionthe basic laser photocoagulation technique was developed in the s by Dr. Aiellos father Lloyd M. Aiello M.D. and grandfather William P. Beetham M.D. About . million U.S. residents have diabetic retinopathy a leading cause of blindness among workingage Americans. Among these about . percent have progressed to PDR. The DRCR.net enrolled participants eyes with PDR in one or both eyes at clinical sites across the country. Eyes were assigned randomly to treatment with Lucentis or laser. About half of the eyes assigned to the laser group required more than one round of laser treatment. In the other group Lucentis was injected into the eye once per month for three consecutive months and then as needed until the disease resolved or stabilized. Because Lucentis is commonly injected to treat diabetic macular edema DMEa buildup of fluid in the center of the retinathe study permitted the use of Lucentis for DME in the laser group if necessary. Slightly more than half percent of eyes in the laser group received Lucentis injections to treat DME. About percent of eyes in the Lucentis group received laser therapy mostly for issues other than DME. At two years vision in the Lucentis group improved by an average of about half a line on an eye chart compared with virtually no change in the laser group. Participants treated with laser generally lost substantial peripheral vision but those given injections did not emphasized Jennifer Sun M.D. M.P.H. Associate Professor of Ophthalmology at Harvard Medical School and physician at the Beetham Eye Institute. This was a clear benefit associated with the antiVEGF medication said Dr. Sun who as the DRCR.net nationwide Protocol Working Investigator was instrumental in the studys development. Many of our patients who have laser treatment notice that they have more tunnel vision which can lead to difficulties as they go about activities of daily life. The use of antiVEGF treatment rather than laser for PDR could help prevent these symptoms. Additionally the need for vitrectomy surgery was lower in the Lucentis group of eyes than in the laser group of eyes. Overall the drugs benefits are particularly clear for people with both PDR and DME. We know that this drug will help treat both conditions at the same time so this is an especially appealing treatment alternative for these patients Dr. Aiello noted. Lucentis should be considered a viable treatment option for people with PDR especially for individuals needing antiVEGF for DME said Jeffrey G. Gross M.D. of the Carolina Retina Center in Columbia South Carolina who chaired the clinical study. The study also suggested that Lucentis may help prevent DME. Among people without this condition at the start of the study only percent of Lucentistreated eyes developed it compared with percent in the laser group. Scientists will follow up on that result as the DRCR.net continues to track patients for a total of five years. A separate clinical trial now getting underway will examine whether antiVEGF injections given at an earlier stage of diabetic eye disease can help prevent people from developing both DME and the sightthreatening PDR stage of the disease at all Dr. Aiello said. The trial reported today is a major study that may substantially change our approach to treatment of PDR summed up Dr. Sun. Laser still has a role in the treatment of PDR for some patients but antiVEGF therapy gives us another tool in our search for better vision outcomes in our patients with diabetes. About Joslin Diabetes Center Founded in Joslin Diabetes Center is worldrenowned for its deep expertise in diabetes treatment and research. Joslin is an independent nonprofit institution affiliated with Harvard Medical School and a federallydesignated Diabetes Research Center. Joslin is dedicated to finding a cure for diabetes and ensuring that people with diabetes live long healthy lives. We develop and disseminate innovative patient therapies and scientific discoveries throughout the world. Our mission is to prevent treat and cure diabetes. Our vision is a world free of diabetes and its complications. For more information visit http About Joslin Research Joslin Research comprises the most comprehensive and productive effort in diabetes research under one roof anywhere in the world. With plus facultylevel investigators Joslin researchers focus on unraveling the biological biochemical and genetic processes that underlie the development of type and type diabetes and related complications. Joslin research is highly innovative and imaginative employing the newest tools in genetics genomics and proteomics to identify abnormalities that may play a role in the development of diabetes and its complications. Joslin Clinic patients and others with diabetes have the option of participating in clinical trials at Joslin to help translate basic research into treatment innovations. Joslin has one of the largest diabetes training programs in the world educating M.D. and Ph.D. researchers each year many of whom go on to head diabetes initiatives at leading institutions all over the globe. For more information visit http"

"The results of a study presented today at the European League Against Rheumatism Annual Congress EULAR showed that in rheumatoid arthritis RA patients a good clinical response to maintenance treatment with a tumour necrosis factor inhibitor TNFi was maintained even when the dose was reduced by onethird. Reducing the TNFi dose by twothirds resulted in more flares exacerbations of symptoms and signs but these subsided when the higher dose of TNFi was restarted and did not adversely affect subsequent progression of any disability. In some cases however patients maintained a clinical response after stopping the TNFi altogether. The optimal management of RA involves achieving the lowest possible disease activity ideally remission and then maintaining this level of control said lead author Dr. James Galloway Department of Rheumatology Kings College Hospital NHS Foundation Trust UK. Findings from our study have shown that adopting a TNFi dose reduction strategy can still meet this objective with no compromise on symptom control for the patient and offering a more costeffective option by substantially reducing the high drug costs associated with TNFi maintenance therapy. RA is a chronic inflammatory disease characterised by joint inflammation and damage functional disability and significantly increased mortality. Early intervention using a conventional synthetic diseasemodifying antirheumatic drug DMARD such as methotrexate is critical in preventing structural joint damage and progressive loss of function. For those patients who either fail to respond or who develop an inadequate response to these drugs over time a biologic DMARD is an effective addon treatment option. The first choice of biologic therapy is usually a TNFi and currently identical dosing regimens of TNFi are used both to induce and then maintain a clinical response. Over the first six months of the study flares exacerbations of symptoms and signs occurred in of patients who stayed on the same TNFi dose compared to a similar figure of in those patients for whom the dose was reduced by onethird. A twothirds dose reduction increased the odds of a flare occurring by four times compared with a onethird dose reduction with flares occurring in of patients. Postdose reduction flares resolved when the original dose of TNFi was restarted. There were no significant differences in selfreported measures of disability Health Assessment Questionnaire score with either dose reduction strategy at six months. The OPTTIRA study is a month multicentre randomised controlled trial designed to evaluate if reducing TNFi doses of either etanercept or adalimumab caused a loss of response in RA patients who were also receiving a synthetic DMARD. To be eligible patients had to demonstrate stable low disease activity DAS less than . for over three months. Patients with serious concomitant illness or those taking highdose steroids more than mg prednisolone daily were excluded. Of the patients who reduced then stopped their TNFi after six months succeeded without flaring and their final mean DAS score after stopping treatment was . demonstrating low disease activity. Abstract Number SAT NOTES TO EDITORS For further information on this study or to request an interview with the study lead please do not hesitate to contact the EULAR congress Press Office in Room B of Fiera Roma during EULAR or on Email eularpressofficecohnwolfe.com mailtoeularpressofficecohnwolfe.com Onsite tel Twitter EULAR_Press httpstwitter.comeular_press Youtube Eular Pressoffice About EULAR The European League Against Rheumatism EULAR is an umbrella organisation which represents scientific societies health professional associations and organisations for people with rheumatic diseases throughout Europe. EULAR aims to promote stimulate and support the research prevention and treatment of rheumatic diseases and the rehabilitation of those it affects. With scientific member societies People with Arthritis and Rheumatism in Europe PARE organisations health professionals associations and corporate members EULAR highlights the importance of combating rheumatic diseases through both medical means and patient care. EULAR is set to be the biggest rheumatology event in Europe with around scientists physicians allied health professionals and related audiences in attendance from more than countries. Over the course of the congress there will be some oral and just under poster abstract presentations more than sessions lectures poster tours and invited speakers. To find out more about the activities of EULAR visit http"

"Important health tip for the summer Drink more wine A better protection against harmful sunburns might be a healthy dose of SPF sauvignon blanc suggests a new Spanish study http A compound found in grapes or grape derivatives may protect skin cells from skindamaging ultraviolet radiation report researchers http_releasesfsfgpa.php from the University of Barcelona and the Spanish National Research Council. The flavonoids found in grapes work to halt the chemical reaction that kills skin cells and causes sun damage. Heres what happens When UV rays hit your skin they activate reactive oxygen species or ROS which then oxidize big molecules like lipids and DNA. This activates particular enzymes that kill skin cells. But grapes flavonoids work to decrease the formation of the ROSs in skin cells that were exposed to UVA and UVB rays. The researchers led by Marta Cascante a biochemist at the University of Barcelona and director of the research project note that this finding may lead to better sunshielding drugs and cosmetics. The study was published in the Journal of Agricultural and Food Chemistry. Previously vino has also been found to fight Alzheimers ward off prostate cancer and even prevent cavities. Well drink to that."

"Anew gastric balloon that can be swallowed like a pill and then filledwhile in the stomach helped patients lose more than percent oftheir excess weight over four months according to new researchpresented here at ObesityWeek the largest international eventfocused on the basic science clinical application and prevention andtreatment of obesity. The weeklong conference is hosted by the AmericanSociety for Metabolic and Bariatric Surgery ASMBS and The ObesitySociety TOS. AllurionTechnologies the manufacturer of the device called Elipse whichis not yet commercially available is studyingwhat it says is the first procedureless gastric balloon inpatients with a body mass index BMI of or more. Thetreatment involves patients swallowing a capsule that quicklydissolves in the stomach to reveal a deflated gastric balloon inside.With a thin catheter attached to the device but long enough toremain outside the patients mouth a physician fills the balloonwith fluid mL to about the size of a grapefruit. The catheteris then removed while the balloon remains in the stomach for fourmonths. At that point a valve designed to open on its own allowsthe balloon to empty and be excreted naturally from the bodyeliminating the need for endoscopy or another procedure. Likeother gastric balloons the mechanism of action of Elipse is likelymultifactorial and includes increased satiety from the reduction ofavailable space in the stomach delayed gastric emptying and changesin hormones that control hunger and appetite saidRam Chuttani MD study coauthor and director of Endoscopy andchief Interventional Gastroenterology at Beth Israel DeaconessMedical Center in Boston. Our findings demonstrate that Elipseprovides individuals and their caregivers with a safe effective andnoninvasive weight loss intervention that does not require surgeryendoscopy or anesthesia. Researcherspresented interim results for the first patients of a multicenterstudy that showed individuals lost an average of pounds after fourmonths or percent of their excess weight. Patients also sawimprovements in triglycerides and hemoglobin Ac HgbAc levelsrisk factors for heart disease and diabetes. Similar to othergastric balloons the most common adverse events reported were nauseaand vomiting. NinhT. Nguyen MD immediate pastpresident of the ASMBS and vicechair UC Irvine Department ofSurgery and chief of gastrointestinal surgery who was not involvedin the study said the device is not a permanent solution to weightloss but has the potential to help those individuals who areoverweight or have obesity and are not candidates for bariatricsurgery. Newtreatment options are being studied and approved for the treatment ofobesity which is good news for our patients and the healthcareprofessionals involved in their treatment said Dr. Nguyen whowas not involved in the study. For many struggling with theirweight procedureless gastric balloon devices may serve as atreatment option that bridges the gap between weightloss drugs andsurgery. TheU.S. Food and Drug Administration FDA this year alone approved theOrberaIntragastric Balloon from Apollo Endosurgery and theReShapeIntegrated Dual Balloon System from ReShape Medical. Bothdevices are indicated for adults with BMIs between and whocould not lose weight through diet and exercise alone.The FDA also approved threeweightloss drugs since . Inaddition to Dr. Chuttani study authors of the abstract entitledThe First Procedureless Gastric Balloon A Prospective StudyEvaluating Safety Weight Loss Metabolic Parameters and Quality ofLife include Evzen Machytka MD PhDMartina Bojkova MD TomasKupka MD and Marek Buzga MSc PhD from the University of OstravaIoannis Raftopoulos MD Andreas Giannakou MD and Kandiliotis IoannisMD from the Iatriko Medical Center and Kathy Stecco MD Samuel LevyMD and Shantanu Gaur MD from Allurion Technologies. AboutObesity and Metabolic and Bariatric Surgery Accordingto the Centers of Disease Control and Prevention CDC more than million adults were obese in .https ASMBS estimates about million people have severe or morbidobesity. Individuals with a BMI greater than have a to percent increased risk of premature death compared to healthy weightindividuals as well as an increased risk of developing more than obesityrelated diseases and conditions including type diabetesheart disease and cancer.ii https https Metabolicbariatricsurgery has been shown to be the most effective and long lastingtreatment for morbid obesity and many related conditions and resultsin significant weight loss. The Agency for Healthcare Research andQuality AHRQ reported significant improvements in the safety ofmetabolicbariatric surgery due in large part to improvedlaparoscopic techniques.iv https risk of death is about . percenthttps the overall likelihood of major complications is about percent.vi https Aboutthe ASMBS TheASMBS is the largest organization for bariatric surgeons in thenation. It is a nonprofit organization that works to advance the artand science of bariatric surgery and is committed to educatingmedical professionals and the lay public about bariatric surgery asan option for the treatment of morbid obesity as well as theassociated risks and benefits. It encourages its members toinvestigate and discover new advances in obesity while maintaining asteady exchange of experiences and ideas that may lead to improvedoutcomes for morbidly obese patients. For more information visit http Dr.Chuttani holds an equity position in Allurion Technologies THEFIRST PROCEDURELESS GASTRIC BALLOON A PROSPECTIVE STUDY EVALUATINGSAFETY WEIGHT LOSS METABOLIC PARAMETERS AND QUALITY OF LIFE Evzen Machytka MD PhD RamChuttani MD Martina Bojkova MD Tomas Kupka MD Marek Buzga MScPhD Kathy Stecco MD SamuelLevy MD Shantanu Gaur MD Presented November"

"At it just didnt make sense that Daniel Sheiner was exhausted literally from the moment he woke up. It didnt get any better over the course of the day and I knew that was not normal Sheiner says. Sheiner is a software designer and programmer. His job suffered as a result of his fatigue. I would miss conversations Sheiner says. I would ask a question that had already been answered. Sheiner suspected he had sleep apnea because it ran in his family. But he was not overweight which is the biggest risk factor for the disorder some percent to percent of patients diagnosed with apnea have a body mass index or BMI over . A sleep study confirmed Sheiner had one of the worst cases of apnea his doctors had ever seen. After trying a number of different treatments his doctors finally tried a surgery using robots to treat his stubborn apnea with positive results. Gasping For Breath According to Erica Thaler an ear nose and throat surgeon at the Hospital of the University of Pennsylvania Sheiners sleep study found that he woke up about times every hour. That meant Sheiner stopped breathing for at least seconds about two times every minute. Article continues after this message from our sponsor Sleep apnea is a chronic and common sleep disorder. People with this condition stop breathing while sleeping. Like Sheiner they often find themselves suddenly and repeatedly gasping for breath during the night. Their airway is clogged sometimes because their tonsils and tonsilar tissue in the back of their throat are enlarged. This was exactly the case for Sheiner. Daniels obstruction was both at the level of the soft palate and at the back of the tongue Thaler says. He had very large tonsils but his tonsil tissue was also enlarged in the palate area and also at the back of his tongue. Sheiner was put on a nighttime breathing machine. In bed he wore a face mask which was connected to a tube that was connected to a device that pumped air into his nose and mouth. The Continuous Positive Airway Pressure machine or CPAP as it is often referred to works for about half of all patients who try it. It can be cumbersome Thaler says. But Sheiner was extremely committed to trying it. In fact he tried a number of different types of machines but none of them worked. Handing Surgery Off To Robots So Thaler suggested a type of robotic surgery currently used to remove cancerous tumors at the back of the throat. Thaler was starting to perform it on sleep apnea patients to remove tonsils and excess tissue. What the robot allows you to do is get into a small confined space without using hands Thaler says. Human hands are huge and robot hands are tiny and yet they can do exactly the same thing if you control them remotely. So about a year ago Thaler performed surgery on Sheiner removing both his tonsils and excess tissue. Sheiner is one of only about a halfdozen patients to have this robotic surgery for apnea. After surgery Sheiner says it was a whole new life. He had energy an ability to focus and get things done. I find myself solving problems much more quickly and more confidently. Hes exercising at the gym three times a week lifting weights. He is also starting to experiment with recipes and cooking something he had absolutely no energy or interest in doing before the surgery. Surgery Not For Everyone The surgery Sheiner had isnt right for everyone. Rashmi N. Aurora is a sleep specialist at Mount Sinai School of Medicine in New York. She is also chairwoman of the Standards of Practice Committee of the American Academy of Sleep Medicine http I wouldnt send a middleage obese man for surgery as their first option Aurora says. I would say lets lose the weight lets use CPAP and see a nutritionist lets avoid the alcohol and lets see how you do. The apnea can probably be taken care of with these noninvasive techniques she says and invasive surgery can be avoided. But when she sees a young thin person with severe apnea Aurora says surgery might be the answer. The upper airway starts with the nose and mouth and runs down to the vocal chords so theres a lot of room for obstruction to occur Aurora says. Some patients may require surgery to remove the uvula or the tonsils or excess tissue or all of them she says. Then theres surgery to remove blockage in the nasal passage. Oftentimes Aurora says patients need a series of surgeries to completely treat apnea. And even then success rates arent high theyre effective only to percent of the time. The only surgery proved effective more than percent of the time is a significant and highly invasive surgery. Maxillomandibular advancement or MMA involves literally slicing the jaw in half and moving it forward in order to widen the patients airway. For patients with recessed chins small jaws and airways narrowed by facial structure this might be the surgery for them. But it can take nearly a year to recover and many patients opt not to have it. The new CPAP machines are more sophisticated Aurora says. Theyre less cumbersome less noisy and can actually sense the magnitude of blockage and adjust air pressure being blown into the nose or mouth she says. Noninvasive measures are always the first lines of defense she says."

"The results debut the first HIV prevention tool specifically for women. But we need to be cautious of how much protection the ring can really offer experts say. Two groups of scientists presented results at an HIV conference on Monday suggesting that a vaginal ring could prevent HIV transmission in women. In both studies the ring lowered HIV cases by about though its effectiveness appears to be much better for women who used the ring consistently. The ring contains an antiretroviral medication called dapivirine which prevents HIV from making copies of itself. In the ring the drug is used as preexposure prophylaxis or PrEP slowly leaching out in the vagina and preventing the virus from taking hold in nearby cells. One of the new studies published today httpscdf.nejm.orgservicesGetOnlineFirstPDF.aspxDOINEJMoa in the New England Journal of Medicine tested the ring in more than women in four countries Malawi SouthAfrica Uganda and Zimbabwe over nearly two years. At the end of the study the group of volunteers who had used the dapivirine ring had fewer HIV infections than a control group who had a placebo ring with no drug the study found. Looking by age the researchers saw that the ring did not seem to help women younger than . But among women over the age of who used it new HIV cases went down by . The other study which has not yet been published but was presented on Monday at the Conference on Retroviruses and Opportunistic Infections meeting in Boston studied women in South Africa and Uganda. Like the other study in this one the ring had no visible effect in women younger than whereas new HIV cases dropped by in women over . These age differences are probably due in part to how the women used the drug the researchers say. Much like the contraceptive NuvaRing the dapivirine ring should be kept in every day and replaced once a month for maximum effectiveness. If used perfectly how much HIV protection could there be We dont know that yet Jared Baeten professor of global health medicine and epidemiology at the University of Washington and lead author on the study told BuzzFeed News. Adherence is also a big issue for the only other PrEP on the market a onceaday pill called Truvada. Initial trials http for the pill showed it led to a decrease in HIV infection rates overall. But its now known that when taken properly Truvada cuts new cases of HIV by at least http Because of its high effectiveness the CDC has since recommended http that in gay and bisexual men should be prescribed the drug to prevent the spread of HIV. The ring adds a new HIV prevention tool which some experts say will be particularly useful in African countries where women are at highest risk for HIV infection. More than half of the million people living with HIV worldwide are women and the vast majority http live in subSaharan Africa. A prevention tool like a ring could be used discreetly a woman would have control over it and it could allow her to keep herself safe from HIV without having to ask a male partner to take on prevention strategies Baeten said. That individual control of prevention is so powerful. The dapivirine ring has been in development for more than a decade and the the new studies are the first to show that it prevents HIV transmission. Still experts caution that the ring should not be a womans sole source of protection. There is absolute reason to celebrate. But is a lower number than any of us would like to see Mitchell Warren executive director of AVAC a global HIVprevention advocacy group told BuzzFeed News. We obviously always want higher numbers. But in infections were prevented overall and thats huge. Warren noted that other rings with antiretrovirals are also being developed as well as rings that could offer multipurpose protection against not only HIV but pregnancy. Like birth control the more types of HIV prevention the better experts say. For some women a pill every day might work really well. For others that may be not achievable Baeten said. Pills and rings should be sitting next to each other as options."

"Mindfulness meditation may help older adults get a better nights sleep a small study suggests. Researchers found that among older adults with sleep problems those who learned mindfulness practices started sleeping better within six weeks. In fact they did better than their counterparts who were given conventional lessons on good sleep habits the study authors said. Experts said the findings published online Feb. in the journal JAMA Internal Medicine are encouraging. On average the effects of the mindfulness program were comparable to whats been seen in studies of sleep medications and talk therapy said study leader David Black an assistant professor of preventive medicine at the University of Southern California in Los Angeles. According to Black that means older adults can feel comfortable opting for mindbody practices as a way to address moderate sleep problems. But he also emphasized the structured nature of the program tested in his study. From our results it is worth a try to engage in a structured mindfulnessbased intervention led by a certified teacher with extensive experience Black said. In general mindfulness practices encourage people to focus their attention on the present moment instead of the past or future and to take an objective look at their thoughts and emotions. Sleep problems Black explained both affect and are affected by the mind. When people have difficulty sleeping they often start to worry about it and that anxiety can worsen their sleep problems. On top of that poor sleep itself can lead to psychological distress such as depression symptoms Black said. There is a cyclical pattern here between wakefulness sleep disruption worry and mood he said. By learning nonjudgmental mindful awareness Black said people can begin to see their thoughts and feelings without reacting to them. In basic terms it helps them relax a necessary prerequisite for sleep Black noted. For the current study his team recruited older adults with moderate sleep problems based on their answers to a standard sleepquality questionnaire. It asked a range of questions including whether the person had problems falling asleep or staying asleep had difficulty breathing at night or felt drowsy during the day. Blacks team randomly assigned the participants to six weekly sessions of either sleep hygiene education or mindfulness training. The mindfulness group learned different meditation techniques as well as how to eat and move with more attention. The program Black said did not specifically address sleep a topic that might only stir anxiety in people who are already worried about a lack of sleep. By the end of the study the mindfulness group was showing a significant improvement shaving about three points on average from their scores on the sleepproblem scale. The group that received standard education lowered their scores by an average of point. The mindfulness group also showed greater improvements in depression symptoms and daytime fatigue the investigators found. Black said the benefits of mindfulness training were on par with whats been found in studies of sleep medications and cognitive behavioral therapy a form of talk therapy that is often helpful for insomnia for example. Cognitive behavioral therapy is highly effective said Adam Spira an associate professor at the Johns Hopkins School of Public Health in Baltimore. The problem Spira said is that behavioral therapy for sleep problems is not always easily found and even when its available the process takes some effort. What I found most interesting about this mindfulness approach is that its a nondrug option and its accessible to the community at large said Spira who wrote an editorial published with the study. Classes in meditation are available in many communities and there are books websites and CDs where people can learn mindfulness techniques. The course Blacks team studied is available online at httpmarc.ucla.edu. The caveat according to Spira is that this study tested that specific program. There is no guarantee that the course at your local senior center or a book would have the same chances of working. Still Spira said its a promising approach to older adults sleep problems and one thats needed. We definitely need a whole menu of treatment options he said. One major reason is that sleeping pills the most common current treatment are temporary fixes at best. Plus Spira said they can have side effects that are particularly dangerous for older people such as dizziness and balance problems that can lead to falls and problems with attention and memory. Then theres the fact that sleep issues become common as people age Spira said. Studies suggest that about half of adults age and up have insomnia or some other sleep disturbance and that can have consequences for their physical and mental health. There are still plenty of questions about the effects of mindfulness meditation on sleep quality. A key one is whether the benefits last. Spira said that with cognitive behavioral therapy there is evidence that peoples sleep keeps improving after their therapy sessions have ended. Itll be interesting to see whether people can learn mindfulness techniques then see durable effects he said. More information The National Sleep Foundation has more on sleep disorders httpsleepfoundation.orgsleepdisordersproblems. SOURCES David Black Ph.D. M.P.H. assistant professor preventive medicine University of Southern California Los Angeles Adam Spira Ph.D. associate professor department of mental health Johns Hopkins Bloomberg School of Public Health Baltimore Feb. JAMA Internal Medicine online"

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

"Cooking with heart https olive oil and using it for salad dressing may cut stroke https risk according to new research published online in Neurology. In the new study seniors who regularly used this healthy monounsaturated fat had a lower risk of stroke https compared to their counterparts who never used olive oil. This is the first study to suggest thatgreaterconsumption of olive oil may lower risk of stroke https in older subjects independently of other beneficial foods found in the Mediterranean diet https study author Cecilia Samieri PhD with the University of Bordeaux and the National Institute of Health and Medical Research in Bordeaux France says in an email. So what exactly is it about olive oil that may lower stroke risk There are several theories she says. It may be that people choose olive oil over saturated artery https fats. Moreover previous research found that the polyphenols from virgin olive oil account specifically for its ability to lower oxidized lowdensity lipoprotein LDL https or bad cholesterol https High cholesterol levels https are a known risk factor for stroke. The Study Researchers analyzed the medical records of people aged and older from three French cities who had no history of stroke. Participants were categorized based on their olive oil intake. Study participants mainly chose extra virgin olive oil which is widely available in France. During slightly more than five years of followup there were strokes. It is too early to issue any broad public health recommendations about the use of olive oil for stroke protection. These findings from an observational study should be confirmed by a randomized controlled trial Samieri says. Researchers also looked at the blood https levels of oleic acid in a subgroup of people and found that higher levels of oleic acid correlated with higher use of olive oil. Oleic acid the main monounsaturated fat found in olive oil is not a specific blood https marker for olive oil use and could be elevated as a result of eating other foods such as butter and duck fat. Too Early to Make Recommendations This is one of very few studies that looks at olive oil intake and risk for neurologic diseases including stroke Nikolaos Scarmeas MD of Columbia University in New York City says in an email. Maybe olive oil improves vascular risk factors such as hypertension https dyslipidemia diabetes https heart disease https obesity https which may in turn reduce stroke risk or it may be that olive oil is antiinflammatory or an antioxidant https Scarmeas writes an accompanying editorial. We do not know for sure and we do not know which particular aspect of olive oil is the most relevant to stroke he says. Following a healthy diet emerges as an important strategy for prevention of neurological disease but remains to be proved. Cathy A. Sila MD the George M. Humphrey II Professor of Neurology and the director of the Stroke Cerebrovascular Center at the Neurological Institute Case Medical Center of Case Western Reserve University School of Medicine in Cleveland Ohio says the benefits of diet and lifestyle choices in disease prevention are more important than ever given the rising costs of health care https She agrees with the study authors and editorialist that it is too early to make any recommendations about olive oil intake and stroke risk. She calls the findings intriguing but says they do not equate a randomized clinical trial https and should be used with appropriate caution in making broad recommendations. Suzanne Steinbaum MD director of women and heart disease https at Lenox Hill Hospital in New York says moderate use of olive oil in cooking and on bread may help protect against stroke in people older than . Olive oil is a healthy fat and it can reduce cholesterol https and inflammation and has been shown to help reduce the incidence of heart disease https she says. Now we see it may reduce stroke risk in people older than . Keeping blood pressure https controlled not smoking https exercising https regularly and eating a healthy diet that is low in salt and rich in fruits and vegetables https can also help reduce stroke risk she says."

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

"Bacteria live on everyones skin https and new research shows some friendly germs produce natural antibiotics that ward off their diseasecausing cousins. Now scientists are mixing the good bugs into lotions in hopes of spreading protection. In one early test those customized creams guarded five patients with a kind of itchy eczema https against risky bacteria that were gathering on their cracked skin researchers reported Wednesday. Its boosting the bodys overall immune defenses said Dr. Richard Gallo dermatology chairman at the University of California San Diego who is leading the work. We share our bodies with trillions of microbes that live on our skin in our noses in the gut. This community what scientists call the microbiome https plays critical roles in whether we stay healthy or become more vulnerable to various diseases. Learning what makes a healthy microbiome is a huge field of research and already scientists are altering gut bacteria to fight diarrheacausing infections. Wednesdays research sheds new light on the skins microbiome suggesting that one day it may be possible to restore the right balance of good bugs to treat skin disorders too. Its a really important paper said Dr. Emma GuttmanYassky of the Icahn School of Medicine at Mount Sinai Hospital in New York who wasnt involved with the new research. It does open a window for a potential new treatment. Healthy skin harbors a different mix of bacteria https than skin damaged by disorders such as atopic dermatitis the most common form of eczema. Those patches of dry red itchy skin are at increased risk of infections particularly from a worrisome germ known as Staphylococcus aureus. Gallos team took a closer look at how microbes in healthy skin might be keeping that bad staph in check. They discovered certain strains of some protective bacteria secrete two antimicrobial peptides a type of natural antibiotic. In lab tests and on the surface of animal skin those substances could selectively kill Staph aureus and even a drugresistant strain known as MRSA without killing neighboring bacteria like regular antibiotics do the team reported in the journal Science Translational Medicine. But those good bugs are rare in the skin of people with atopic dermatitis Gallo said. People with this type of eczema for some reason thats not quite known yet have a lot of bacteria on the skin but its the wrong type of bacteria. Theyre not producing the antimicrobials they need he explained. Would replenishing the good bugs help Theyre normal skin bacteria so we knew they would be safe Gallo noted. His team tested five volunteers with atopic dermatitis who had Staph aureus growing on their skins surface whats called colonization but didnt have an infection. Researchers culled some of the rare protective bacteria from the volunteers skin grew a larger supply and mixed a dose into an overthecounter moisturizer. Volunteers had the doctored lotion slathered onto one arm and regular moisturizer on the other. A day later much of the staph on the treated arms was killed and in two cases it was wiped out compared to the untreated arms Gallo said. Were encouraged that we see the Staph aureus which we know makes the disease worse go away he said. The study couldnt address the bigger question of whether exposure to the right mix of protective bacteria might improve atopic dermatitis itself cautioned Mount Sinais GuttmanYassky. Nextstep clinical trials are underway to start testing the effects of longerterm use."

"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"

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

"Taking aspirin regularly over several years may help prevent gastrointestinal cancers a new study suggests. There was a percent lower risk of cancers of the gastrointestinal tract especially in the colon and rectum among people taking aspirin said lead researcher Yin Cao a postdoctoral research fellow at the Harvard School of Public Health in Boston. But Cao doesnt think people should start taking aspirin to prevent cancer until more research is done. The results of ongoing research to develop more tailored treatment based upon a personalized assessment of risks and benefits is critical before recommending aspirin for preventing cancer she said. Moreover patients and their doctors need to consider the potential risks of taking aspirin including stomach bleeding Cao said. However if considered alongside the known benefits of aspirin in the prevention of heart attacks and strokes our data suggest the possibility that longterm regular aspirin use may have a significant benefit in prevention of the two leading causes of sickness and death in the U.S. and much of the world she said. The results of the study were to be presented Sunday at an American Association for Cancer Research meeting in Philadelphia. The data and conclusions should be viewed as preliminary until published in a peerreviewed journal. For the study Cao and her colleagues collected data on women enrolled in the Nurses Health Study in and men enrolled in the Health Professionals Followup Study in . The researchers collected data on aspirin use risk factors for cancer and diagnoses of cancer. After up to years of followup about women and men developed cancer the investigators found. Among men prostate cancer was excluded. Caos team found that men and women who took a regular dose of aspirin milligrams two times a week or more had a lower risk of cancer overall than people who did not regularly take aspirin. The reduced risk was largely due to fewer cases of gastrointestinal cancers including colon cancer rectal cancer and esophageal cancer. Regular aspirin use was not associated with a reduced risk of other cancers. Specifically no link was found between aspirin use and a lower risk of breast cancer advanced prostate cancer or lung cancer the researchers said. Moreover the benefit of aspirin in reducing overall cancer risk appeared to depend on how much one took. So the more aspirin taken the more the risk was reduced. Amounts ranged from less than one aspirin a week to or more the researchers said. Getting the biggest benefit from aspirin required taking it for at least years. The benefit was no longer seen within four years of stopping it the researchers found. And the study only showed an association between aspirin use and gastrointestinal cancer risk not a causeandeffect relationship. The association of aspirin with reduced cancer risk was the same for women and men regardless of race history of diabetes family history of cancer weight smoking regular use of other painkillers or taking multivitamins the study authors added. Eric Jacobs strategic director of pharmacoepidemiology at the American Cancer Society said the new study confirms the now wellestablished link between regular aspirin use and lower risk of developing certain cancers of the gastrointestinal tract cancers of the colon rectum and esophagus. Some though not all previous studies have indicated that aspirin might slightly lower risk of certain other cancers including breast cancer prostate cancer and lung cancer he added. Although aspirin is recommended for most people who have had a heart attack and has some benefits for cancer risk as well at this point the American Cancer Society does not recommend that people use aspirin specifically to prevent cancer because it is not clear that the benefits with respect to cancer outweigh the risks Jacobs said. While not common aspirin can cause serious even occasionally fatal stomach bleeding even at low doses he said. People who are uncertain about whether they should be using aspirin should talk to their health care provider who knows their personal medical history and can help weigh their individual risks and benefits Jacobs said. More information Visit the U.S. National Cancer Institute for more on aspirin and cancer risk. SOURCES Yin Cao postdoctoral research fellow Harvard School of Public Health Boston Eric Jacobs Ph.D. strategic director pharmacoepidemiology American Cancer Society April presentation American Association for Cancer Research meeting Philadelphia Last Updated Apr"

"Queensland University of Technology QUT researchers have identified a drug that could potentially help our brains reboot and reverse the damaging impacts of heavy alcohol consumption on regeneration of brain cells. Their studies in adult mice show that two weeks of daily treatment with the drug tandospirone reversed the effects of weeks of bingelike alcohol consumption on neurogenesis the ability of the brain to grow and replace neurons brain cells. The findings have been published in Scientific Reports https This is the first time tandospirone has be shown to reverse the deficit in brain neurogenesis induced by heavy alcohol consumption Tandospirone acts selectively on a serotonin receptor HTA The researchers also showed in mice that the drug was effective in stopping anxietylike behaviours associated with alcohol withdrawal and this was accompanied by a significant decrease in bingelike alcohol intake This is a novel discovery that tandospirone can reverse the deficit in neurogenesis caused by alcohol said study leader neuroscientist Professor Selena Bartlett from QUTs Institute of Health and Biomedical Innovation https We know that with heavy drinking you are inhibiting your ability to grow new neurons brain cells. Alcohol is specifically very damaging for neurons. Other studies in mice have shown that tandospirone improves brain neurogenesis but this is the first time it has been shown that it can totally reverse the neurogenic deficits induced by alcohol. This opens the way to look at if neurogenesis is associated with other substanceabuse deficits such as in memory and learning and whether this compound can reverse these. Professor Bartlett who is based at the Translational Research Institute said the discovery by study coauthors QUT postdoctoral research fellows Dr Arnauld Belmer and Dr Omkar Patkar came about serendipitously after research started in a different direction. It was surprising and exciting Dr Belmer said. This drug is relatively new and available only in China and Japan. It is commonly used there and shown to be highly effective in treating general anxiety and well tolerated with limited adverse effects. Professor Bartlett said researchers are constantly looking at new treatment strategies for alcohol abuse and addiction which is characterised by extended periods of heavy alcohol use binges and abstinence and anxiety and depression which contribute to relapse. This is not just another drug that shows promise in helping to reduce binge drinking she said. While it could possibly have that effect it might be able to help reboot the brain and reverse the deficits the alcohol abuse causes both the inhibition to the brains ability to regenerate and the behavioural consequences that come from what alcohol is doing to the brain like increases in anxiety and depression. The study by Professor Bartlett Dr Belmer Dr Patkar and Dr Vanessa Lanoue Queensland Brain Institute can be accessed here https"

"Scientists working for Googles parent company Alphabet have used artificial intelligence to determine a persons risk of having a heart attack from their retinal scan. The methoddetailed in a paper published on Monday in the Nature journal Biomedical Engineeringinvolves analyzing blood vessels in an area of the eye called the retinal fundus. The researchers from Verily formerly known as Google Life Sciences https developed the algorithm in the hope of making accurate assessments of patients cardiovascular health more quickly and easily than current methods. Training deeplearning models on data from more than a quarter of a million patients the scientists were able to predict the cardiovascular risk factors that were not previously thought to be present in retinal fundus images. The risk factors include the persons gender smoking status blood pressure and ageestimated to within four years of the patients actual age. Most cardiovascular risk calculators use some combination of these parameters to identify patients at risk of experiencing either a major cardiovascular event or cardiacrelated mortality within a prespecified time period such as years the paper https states. However some of these parameters may be unavailableWe therefore explored whether additional signals for cardiovascular risk can be extracted from retinal images which can be obtained quickly cheaply and noninvasively in an outpatient setting. Deeplearning networks have already been applied to produce algorithms capable of diagnosing diseases like melanoma and blindness caused by diabetes. Further tests are required before this latest method can be used within a clinical setting. The researchers concluded The opportunity to one day readily understand the health of a patients blood vessels key to cardiovascular health with a simple retinal image could lower the barrier to engage in critical conversations on preventive measures to protect against a cardiovascular event."

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

"When words on a menu seem small and blurry and reading the newspaper becomes a struggle these are often side effects of getting old. Presbyopia the natural aging process of the eye generally starts around age and worsens over time. There is no cure for the condition but many ophthalmologists say reading glasses contact lenses or even surgery can help correct your vision. But now a new app called GlassesOff claims it can help you see better without any glasses or magnifying devices. Dr. Christopher Starr httpweillcornell.orgcestarr a GlassesOff consultant and associate professor of ophthalmology at Weill Cornell Medical College in New York says the app improves the brains visual cortex which processes the images we see. It actually strengthens those connections in that part of the brain to help us better be able to identify and process a blurry image in front of our eyes Starr told FoxNews.com. The app works by using different gamelike exercises to train the brain to interpret blurry images accurately. Users are asked to finish three minute sessions per week for three months. Some gaming sessions ask users to identify fuzzy designs called Gabor patterns that flash on screen. And in other tests the app asks users to decide whether the letter E is facing up down right or left. Your eye is sending your brain a blurry image but because your brain has gone through this training its capable of processing much lower quality images Starr said. The company says the app is scientifically tested. In a small study published in Natures Scientific Reports httpsuripolat.files.wordpress.comsrep.pdf percent of participants gained the ability to read comfortably without glasses. But not all experts are sold on the apps training method. The proposed theory of explanation behind the GlassesOff technology seems to imply that the resolution of the captured image of the eye and its more central processing by the brain can be improved upon with learning. The idea that these low level changes can translate into higher visual performance that is clinically meaningful to a patient is yet to be demonstrated in any randomized clinical trial Dr. Barrett Katz a neuroopthamologist at New Yorks Montefiore Medical Center told FoxNews.com The app is free to download but the basic month program costs . The company suggests following their Ongoing Vision Care program in order to keep the benefits indefinitely. For the lifelong option you can subscribe for . a month or pay . for the year. For more information go to GlassesOff.com http"

"Using chest scans to screen for lung cancer in people whove never smoked and have no symptoms might help catch cancers early and decrease the diseases death toll suggests a new study from Japan. But experts say the findings likely dont apply in nonAsian countries where the majority of all lung cancers are found in people who smoke and where using computed tomography CT scans to screen for lung cancer in smokers has recently been a controversial topic. Moreover they warn that while regular screening might help doctors catch cancer earlier it also comes with a high price tag and added risks to patients. CT scanning uses Xrays and computers to produce a clearer image than traditional Xray techniques but CT also uses higher radiation doses to generate those images. Everybody agrees that CT does find the early stage lung cancer said Dr. Heidi Roberts a lung cancer researcher from Womens College Hospital Toronto who wasnt involved in the new study. Earlystage cancer is easier to treat and has a higher survival rate. The new study provides further evidence of that. Researchers led by Dr. Ryoichi Kondo of Shinshu University Hospital in Matsumoto looked back at outcomes for close to nonsmoking lung cancer patients whose cancer was caught by CT scan screening or by standard Xray screening another strategy for catching cancer early or when patients came into the doctor with lung symptoms. Most of the tumors found via CT scans were small whereas those found through Xray screening or in patients with symptoms were more often further advanced according to the findings published in the journal Lung Cancer. Five years after their diagnosis percent of people whose cancers were found through a CT scan were still alive compared to percent diagnosed with an Xray and percent of patients who had not been screened and whose symptoms led to discovery their disease. East Asian countries are more likely to regularly screen nonsmokers for lung cancer because biological differences seem to put Asians at a higher risk than other nonsmokers researchers explained. Nonsmokers without symptoms generally are not screened for lung cancer in the U.S. There and in Canada the lung cancer debate has centered around how often to screen smokers and until what age screening should be done Roberts said. In another study published by Kondo and colleagues this one looking at lung cancer screening in smokers fiveyear survival rates were also highest in those screened with CT scans. Thats consistent with the findings of the National Lung Screening Trial in the U.S. which in November released data published online in the New England Journal of Medicine last week showing that percent fewer middleaged heavy smokers died of lung cancer when they were screened annually with a CT scan compared to a standard less detailed chest Xray. Lung cancer kills more people in the U.S. than any other cancer over each year. The problem with frequent screening is not only its cost CT scans typically run a few hundred dollars each but that each scan exposes a person to radiation which also slightly increases cancer risks over time with repeated scans. And screening comes with an inherent risk of falsepositives scans which suggest a lung cancer that turns out not to be there. Dr. Christine Berg one of the leaders of the U.S. screening studies said that generally about a quarter of chest CT scans show some kind of abnormality but percent of those abnormal scans turn out not to be lung cancer. While doctors ruled out cancer those patients would have undergone further tests sometimes including biopsies which can cause complications including infection and bleeding. And for some patients if you really werent going to benefit from the screening...that complication is something you may not have faced Berg said. Those are some of the things I worry about. Her study showed that middleaged smokers would need to be screened with CT scans to prevent one death from lung cancer. The U.S. Preventive Services Task Force a federallysupported expert panel has said there isnt enough evidence for it to recommend screening for lung cancer in symptomfree people using CT scans or other methods. Berg and Roberts both told Reuters Health that more research is needed to see if there might be hints in the blood or genes of smokers that could tell doctors which had the highest risk for lung cancer and which would get the most out of routine CT screening. ADVERTISING We now have a technology that can detect lung cancer early enough to make some impact Berg said. But its not a home run and it clearly has these limitations. SOURCE bit.lyiLARSq httpbit.lyiLARSq Lung Cancer online June . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"A thorough review of dozens of studies led scientists to conclude that healthcare professionals should be telling their patients to have cranberry products as a first step in reducing recurrent UTIs. The comprehensive metaanalysis and assessment of human clinical trials published in the official journal of the American Urological Association The Journal of Urology assures practitioners and their patients that cranberry products are a low cost low risk and effective way to help prevent recurrent UTIs. To answer the question Can Cranberries Contribute to Reduce the Incidence of Urinary Tract Infections a total of studies showing results from nearly patients were considered. Authors found a statistically significant risk reduction in repeat UTIs overall but not significant for any particular subgroup. However patients with recurrent UTIs who ingested cranberry products and had undergone gynecological surgery experienced a significant reduction in UTIs. Our investigation supports that cranberry products can be a powerful tool to fight off frequent UTIs explains lead author Dr. ngelo Lus. While recommendations for dosage and duration of treatment require further study the efficacy of the medicinal properties of cranberry products has been wellestablished. The review explains that the medicinal properties of cranberries may be attributed to their unique polyphenol proanthocyanidins or PACs for short. Their ability to keep infectioncausing bacteria from sticking to the urinary tract walls may be the major reason for their effectiveness in limiting infection growth and recurrence. According to the authors scientists and practitioners continue to explore the use of alternative therapies in the prevention of common infections as part of the global movement to reduce antibiotic use and resistance. It is estimated that one third of women in the United States will get a UTI by the age of . Findings like this adds Dr. Luis give practitioners a viable inexpensive nonantibiotic option to help patients reduce the recurrence of an uncomfortable and potentially debilitating infection. As one of the oldest alternative therapies and U.S.born berries independent research such as this not only provides public health benefits it revitalizes the enthusiasm for cranberry products yearround. The industry appreciates the efforts of these researchers and takes pride in the healthy attributes that cranberry products provide to consumers around the world comments Terry Humfeld executive director of the nonprofit research and educationfocused organization The Cranberry Institute. This review was funded by Universidade da Beira Interior and bank SantanderTotta protocol postdoctoral research fellowship BIPDICIFCBSTUBI L. About the Cranberry Institute The Cranberry Institute is a notforprofit organization founded in to further the success of cranberry growers and the industry in the Americas through health agricultural and environmental stewardship research as well as cranberry promotion and education. The Cranberry Institute is funded voluntarily by Supporting Members that handle process and sell cranberries. Supporting Members are represented in national and international regulatory matters and research efforts are done on their behalf. For more information about the Cranberry Institute along with the health benefits of cranberries and current scientific research visit http References . Luis A Domingues F and Pereira L. Can cranberries contribute to reduce the incidence of urinary tract infections A systematic review with metaanalysis and trial sequential analysis of clinical trials. J Urol . . Foxman B Barlow R DArcy H Gillespie B and Sobel JD. Urinary tract infection selfreported incidence and associated costs. Ann Epidemiol"

"Drinking beet juice increases blood https flow to the brain https in older people a finding that suggests the dark red vegetable may fight the progression of dementia https a new study shows. Beet roots contain high concentrations of nitrates which are converted into nitrites by bacteria in the mouth https And nitrites help open blood https vessels in the body increasing blood flow and oxygen to places lacking in oxygen. Previous studies have shown that nitrites also found in high concentrations in celery cabbage and other leafy green vegetables like spinach widen blood vessels but researchers say this was the first to find that nitrites also increase blood flow to the brain https Blood Flow to the Brain There have been several very highprofile studies showing that drinking beet juice can lower blood pressure https but we wanted to show that drinking beet juice also increases perfusion or blood flow to the brain https Daniel KimShapiro PhD director of the Translational Science Center at Wake Forest University says in a news release. There are areas in the brain https that become poorly perfused as you age and thats believed to be associated with dementia and poor cognition. Researchers from the Translational Science Center looked at how dietary nitrates affected adults aged and older over a fourday period. On day one subjects reported to a laboratory after a hour fast completed a health status report and had either a high or lownitrate breakfast https The highnitrate breakfast https included ounces of beet juice. Then they were sent home with lunch dinner and snacks that conformed to their assigned diets. On the second day after another hour fast the participants returned to the lab and ate their assigned breakfasts. An hour later an MRI https scan recorded brain flow in each persons brain. And blood tests before and after breakfast confirmed nitrite levels in the body. On the third and fourth days researchers switched diets and repeated the process for each person. MRI scans showed that after eating a highnitrate diet the older adults had increased blood flow to the white matter of the frontal lobes which are the areas of the brain most commonly associated with the degeneration that leads to dementia and other cognitive conditions. Diets Rich in Fruits and Vegetables I think these results are consistent and encouraging that good diet consisting of a lot of fruits and vegetables https can contribute to overall good health says senior investigator Gary Miller PhD an associate professor in Wake Forests Department of Health and Exercise https Science. Because beet juice doesnt exactly taste like a sugary soda Wake Forest has worked with a company to create a new beet juice beverage that is tastier than plain beet juice and a news release says the university is investigating ways to market this beverage. The researchers say that their study and future ones like it may lead to interventions that could improve cognitive and physical functional health in older adults. The findings are published online in Nitric Oxide Biology and Chemistry the peerreviewed journal of the Nitric Oxide Society."

"During a traumatic divorce Ronni Shapiro of Westhampton Beach N.Y. became severely depressed and suicidal. Psychiatrists put her on different antidepressants that only aggravated her situation. Within three months I was on different medications Shapiro said. It was horrible. Eventually she learned about GeneSight a new type of genetic testing by Myriad Genetics meant to help avoid the painful trialanderror process many depression patients endure in the search for the right medicine. After a simple cheek swab her results showed that pretty much everything she had previously tried was in the significant gene interaction category meaning that based on her genetic makeup these medicines would adversely affect her or prove ineffective at normal doses. Guided by her results her doctor thought that Wellbutrin would be a more promising option. And though the test is better at saying what wont work than what will her doctors decision proved the right one. I cant tell you that I am footloose and fancyfree Shapiro said. I still suffer. But when I fall into those dark holes theres like a ladder that I can see to climb up as opposed to feeling helpless. As many as twothirds of people with depression arent helped by the first antidepressant they try leaving many to spend months after they are diagnosed without real help. READ MORE In despair from major depression I turned to a last resort Magnets http In May Myriad Genetics released the first largescale test httpsgenesight.comlandmarkstudyshowsgenesighttestledtosignificantimprovementinmentalhealthoutcomesforpatientswithmajordepressivedisorder of whether treatment guided by genetics pharmacogenomics would improve overall outcomes for patients with major depression. The study found that patients were percent more likely to respond to treatment when their medication selection was guided by the companys GeneSight test. The test uses a proprietary algorithm to analyze different genes to weigh their combined influence on patient response to more than psychotropic drugs. The patients colorcoded report would read Use as directed in green moderate genedrug interaction in yellow and significant gene interaction in red. Now another company Genomind in King of Prussia is offering free education http about its genetic test Genecept Assay at SavOn pharmacies in two Philadelphiaarea Acme Markets. Specially trained pharmacists may decide to counsel patients about the Genecept test if they see a pattern of unsuccessful treatment with medicine for depression anxiety andor obsessivecompulsive disorder. No magic solution But while genetic testing offers tools to better guide patients treatment it cannot tell doctors exactly which medicines will work or necessarily provide the key to enduring remission from depression. Vincent Sparks of Mullica Hill has benefited from genetic testing but his mental health issues have persisted. Having battled anxiety and depression most of his life Sparks was happy to find a genetic test to help his psychiatrist better direct his treatment. After taking the Genecept test he discovered that a combination of Prozac and Lamictal was a better genetic fit for him than previous medications. But Sparks continues to struggle. I have times where Im fairly level for a while but at times it seems like Im on a roller coaster Sparks said. Sometimes I wish I could just take out my brain and wash it. If I could just put it through the rinse cycle things would be better. Though imperfect the Genecept test has been shown in peerreviewed published studies httpsgenomind.comclinicalevidence to improve patient outcomes and reduce overall medical costs. In medicine in general this will be standard of care at some point said Dan Dowd Genomind vice president. Twenty years from now everyone will have some kind of pharmacological genetic test as part of their health record. GeneSights test is covered by Medicare for patients under the care of psychiatrists and who have failed to achieve satisfactory results with at least one antidepressant. The company has coverage with some commercial payers and is working to widen that coverage said Myriad Genetics spokesman Ron Rogers. The Genomind Genecept Assay is partly covered by Medicare and Medicaid. If the outofpocket cost for people with commercial plans is more than Genomind will contact the client before processing the test. The company also has a financial assistance program for uninsured patients. This is the beginning of personalized precision treatment said John Greden of the University of Michigan primary investigator of the GeneSight study. Onesize treatment will never fit all and were finally getting the tools not just to say that but to act on it. Knowledge is a good thing Michael Thase a psychiatry professor at the University of Pennsylvanias Perelman School of Medicine and director of Penns Mood and Anxiety program was another author of the GeneSight study. He stressed that although the test does not tell you exactly what will work it can indicate a host of medications that will be ineffective. I think knowledge is a good thing and having knowledge in improving the care of your patient is a good thing Thase said. john OReardon a Voorhees psychiatrist who treats patients with treatmentresistant depression and employs a form of neuromodulation called transcranial magnetic stimulation http TMS said that based on the results of the GeneSight study he may start using this genetic test in his practice. The absolute numbers for response percent and remission . percent dont seem that high but unfortunately that is what you get with increasing treatment resistance OReardon said about the GeneSight study. He was more impressed with the results patients experienced a half year out. By six months the response rate was up to percent and the remission rate was about percent which are excellent results he said. For Marina Goldman a Jenkintown psychiatrist in private practice the GeneSight study was interesting but really beside the point. Generally she thinks that TMS and electroconvulsive therapy ECT with their high success rates approximately percent to percent https for ECT and approximately percent httpspsychnews.psychiatryonline.orgdoifull.appi.pn..ppb for TMS offer more effective solutions for patients who have failed to respond to three or more antidepressants. At the same time Goldman presents genetic testing as an option to patients with treatmentresistant depression who are wary about trying TMS or ECT. Theres a big debate right now in the psychiatric literature and what theyre writing editorials about is that were waiting too long to refer patients out for neuromodulation Goldman said. With the genetic testing the chance of getting a response is about percent. Why not move to ECT where the chance is about percent for treatmentresistant patients"

"We have added an acknowledgement of several sources that Esther Gokhale used while developing her theories on back pain. These include physiotherapy methods such as the Alexander Technique http_FasenditGetAllCheckedAbstracts and the Feldenkrais Method httpfeldenkrais.com and the work of anthropologist Noelle PerezChristiaens. Back pain is a tricky beast. Most Americans will at some point have a problem with their backs. And for an unlucky third http treatments wont work and the problem will become chronic. Believe it or not there are a few cultures in the world where back pain hardly exists. One indigenous tribe in central India reported essentially none. And the discs in their backs showed http_highwire_article_pdf.fulltext.pdf little signs of degeneration as people aged. An acupuncturist in Palo Alto Calif. thinks she has figured out why. She has traveled around the world studying cultures with low rates of back pain how they stand sit and walk. Now shes sharing their secrets with back pain sufferers across the U.S. About two decades ago Esther Gokhale httpgokhalemethod.combiographyEsther_Gokhale_L_Ac_ started to struggle with her own back after she had her first child. I had excruciating pain. I couldnt sleep at night she says. I was walking around the block every two hours. I was just crippled. Gokhale had a herniated disc. Eventually she had surgery to fix it. But a year later it happened again. They wanted to do another back surgery. You dont want to make a habit out of back surgery she says. This time around Gokhale wanted to find a permanent fix for her back. And she wasnt convinced Western medicine could do that. So Gokhale started to think outside the box. She had an idea Go to populations where they dont have these huge problems and see what theyre doing. Added June So Gokhale studied findings from anthropologists such as Noelle PerezChristiaens http who analyzed postures of indigenous populations. And she studied physiotherapy methods such as the Alexander Technique http_FasenditGetAllCheckedAbstracts and the Feldenkrais Method httpfeldenkrais.com. And the original post continues ... Then over the next decade Gokhale went to cultures around the world that live far away from modern life. She went to the mountains in Ecuador tiny fishing towns in Portugal and remote villages of West Africa. I went to villages where every kid under age was crying because they were frightened to see somebody with white skin theyd never seen a white person before she says. Gokhale took photos and videos of people who walked with water buckets on their heads collected firewood or sat on the ground weaving for hours. I have a picture in my book of these two women who spend seven to nine hours everyday bent over gathering water chestnuts Gokhale says. Theyre quite old. But the truth is they dont have a back pain. She tried to figure out what all these different people had in common. The first thing that popped out was the shape of their spines. They have this regal posture and its very compelling. And its quite different than American spines. If you look at an Americans spine from the side or profile its shaped like the letter S. It curves at the top and then back again at the bottom. But Gokhale didnt see those two big curves in people who dont have back pain. That S shape is actually not natural she says. Its a Jshaped spine that you want. In fact if you look at drawings from Leonardo da Vinci or a Grays Anatomy http book from the spine isnt shaped like a sharp curvy S. Its much flatter all the way down the back. Then at the bottom it curves to stick the buttocks out. So the spine looks more like the letter J. The Jshaped spine is what you see in Greek statues. Its what you see in young children. Its good design Gokhale says. So Gokhale worked to get her spine into the J shape. And gradually her back pain went away. Then Gokhale realized she could help others httpgokhalemethod.com. She developed a set of exercises wrote a book http and set up a studio in downtown Palo Alto. Now her list of clients is impressive. Shes helped YouTube CEO Susan Wojcicki http and Matt Drudge of the Drudge Report http She has given classes at Google Facebook and companies across the country. In Silicon Valley shes known as the posture guru. Each year doctors in the Bay Area refer hundreds of patients to Gokhale. One of them is Dr. Neeta Jain http an internist at the Palo Alto Medical Foundation. She puts Gokhales method in the same category as Pilates and yoga for back pain. And it doesnt bother her that the method hasnt been tested in a clinical trial. If people are finding things that are helpful and its not causing any harm then why do we have to wait for a trial Jain asked. But theres still a big question looming here Is Gokhale right Have people in Western cultures somehow forgotten the right way to stand Scientists dont know yet says Dr. Praveen Mummaneni http a neurosurgeon at the University of California San Franciscos Spine Center. Nobody has done a study on traditional cultures to see why some have lower rates of back pain he says. Nobody has even documented the shape of their spines. Id like to go and take Xrays of indigenous populations and compare it to people in the Western world Mummaneni says. I think that would be helpful. But theres a whole bunch of reasons why Americans postures and the shape of their spines may be different than those of indigenous populations he says. For starters Americans tend to be much heavier. If you have a lot of fat built up in the belly that could pull your weight forward Mummaneni says. That could curve the spine. And people who are thinner probably have less curvature and thus a spine shaped more like J than than an S. Americans are also much less active than people in traditional cultures Mummaneni says. I think the sedentary lifestyle promotes a lack of muscle tone and a lack of postural stability because the muscles get weak. Everyone knows that weak abdominal muscles can cause back pain. In fact Mummaneni says stronger muscles might be the secret to Gokhales success. In other words its not that the Jshaped spine is the ideal one or the healthiest. Its what goes into making the Jshaped spine that matters You have to use muscle strength to get your spine to look like a J shape he says. So Gokhale has somehow figured out a way to teach people to build up their core muscles without them even knowing it. Yes I think thats correct Mummaneni says. Youre not going to be able to go from the S to the Jshaped spine without having good core muscle strength. And I think thats key here. So indigenous people around the world dont have a magic bullet for stopping back pain. Theyve just got beefy abdominal muscles and their lifestyle helps to keep them that way even as they age."

"If youre one of the estimated million Americans with osteoarthritis youre probably all too familiar with the feeling of aching swollen or stiff knees. Nonsteroidal antiinflammatory drugs such as ibuprofen may relieve those painful symptoms in most patients. But for others doctors may prescribe a more invasive treatment that involves injecting hyaluronic acid in to the knee called viscosupplementation. Now a new report questions the efficacy of this treatment for osteoarthritis in the knee. Hyaluronic acid is a lubricating fluid that is naturally found in the knee but degenerates over time in people with osteoarthritis. The effect of the injection used in viscosupplementation is to stimulate cells in the knee to increase production of hyaluronic acid. In a metaanalysis of reports that included data on more than patients with osteoarthritis in the knee researchers at the Institute of Social and Preventive Medicine at the University of Bern in Switzerland concluded that the treatment has minimal benefits and potential for harm. They write that because of increased risks for serious adverse events and local adverse events the administration of these preparations should be discouraged. Dr. John Richmond disagrees. He is the Chairman of the Orthopedics Department at New England Baptist Hospital and the previous Chair of the American Academy of Orthopaedic Surgeons AAOS working group on treatment of osteoarthritis in knees. We have an epidemic of osteoarthritis of the knee and we have limited treatment options says Dr. Richmond who was not affiliated with the analysis but who reviewed the same data it was based on. This needs to remain one of those limited treatment options and should be used appropriately by the physician giving it. The most common side effects patients undergoing viscosupplementation may endure are flareups where the knee becomes hot and swollen within hours after the injection and effusions where excessive joint fluid collects inside the knee. The researchers in Switzerland reviewed the existing studies and concluded that viscosupplementation was associated with an increase in these and other adverse events. Dr. Richmond who has independently reviewed the same research when the AAOS was drafting their recommendations to treat osteoarthritis of the knee argues that despite infrequent instances of those sideeffects viscosupplementation remains a solid treatment choice for some patients. This is most effective in relatively younger patients to to year olds and...in people with mild to moderate forms of the disease says Richmond. This is not a first line treatment but its a reasonable treatment in those people who have been appropriately screened. The authors of the study discourage patients from getting this treatment. However Richmond says patients considering viscosupplementation should discuss this as a treatment option with their doctor."

"Stimulating the brain with an implantable device may be safe and possibly helpful for some people with Alzheimers disease a small pilot study suggests. In what researchers described as a proof of concept treatment three Alzheimers patients had deep brain stimulation DBS wires implanted in the brain in areas related to skills like planning judgment and problemsolving. Over the next months or more the tactic appeared to be safe. And there were signals that it was slowing down two of the patients decline said lead researcher Dr. Douglas Scharre director of cognitive neurology at Ohio State Universitys Wexner Medical Center. Deep brain stimulation is already used to treat some cases of Parkinsons disease and certain other brain disorders. But its far too early to know whether it has value for people with Alzheimers Scharre stressed. This is not ready for prime time he said. Its not something patients can ask their neurologist for. Keith Fargo who directs scientific programs and outreach for the Alzheimers Association agreed. Its much too early for patients or caregivers to seek out DBS said Fargo who was not involved in the study. Instead he said these findings suggest that deep brain stimulation is a reasonable route to study in larger clinical trials. The results were published online Jan. in the Journal of Alzheimers Disease. Deep brain stimulation involves implanting electrodes in the brain then connecting them to a pulse generator placed under the skin of the chest. Sometimes called a brain pacemaker it delivers electrical pulses that alter the activity in specific brain circuits. The theory behind trying DBS for Alzheimers patients Scharre said is similar to the use it or lose it principle If key brain areas can be stimulated to form new connections among cells it might slow decline. Right now Scharre noted medications for Alzheimers target brain chemicals involved in memory. But Alzheimers impairs all kinds of mental functions including judgment planning and decisionmaking. And those issues have a huge impact on daily life for patients and their caregivers Scharre added. So the patients in his study received DBS for at least months to brain areas that regulate those mental skills. All three patients were in the earlier stages of Alzheimers and were on standard medications. After starting DBS all saw a general decline in their memory problemsolving and other skills. But they declined at a slower rate compared to similar patients whose information was taken from an Alzheimers research database. Two of the DBS patients declined at a meaningfully slower rate according to Scharre. That included one who actually showed some improvements. That patient was LaVonne Moore of Delaware Ohio. When she entered the study she was not preparing any meals. After two years of deep brain stimulation shed regained that skill and was better able to perform some other simple tasks like selecting her clothes and organizing outings. In a Ohio State news release her husband Tom Moore said her Alzheimers has progressed but more slowly than hed expected. LaVonne has had Alzheimers disease longer than anybody I know and that sounds negative but its really a positive thing because it shows that were doing something right Moore said. If DBS ever becomes an option for Alzheimers Scharre said it would not be for everyone. It would not be appropriate for example for people who are frail or have other serious medical conditions. In the pilot study side effects included hot flashes heart palpitations and burning sensations in the skin which were reversed by adjusting the DBS settings the researchers said. There is no larger trial in the works yet according to Scharre. Whats needed said Fargo is research that compares deep brain stimulation against a placebo device. On a broader level he noted this study highlights an important point Alzheimers disease is more than just amnesia. For caregivers Fargo said the problems with abilities like judgment and planning can actually be more challenging. So any new therapies that help address those issues would be welcome. More than million Americans have Alzheimers a number that could rise to million by according to the Alzheimers Association. More information The Alzheimers Association offers resources for caregivers https SOURCES Douglas Scharre M.D. director cognitive neurology Ohio State University Wexner Medical Center Columbus Keith Fargo Ph.D. director scientific programs and outreach Alzheimers Association Chicago Jan. Journal of Alzheimers Disease online"

"A new low dose three in one pill to treat hypertension could transform the way high blood pressure is treated around the world. A trial led by The George Institute for Global Health revealed that most patients per cent reached blood pressure targets with the Triple Pill compared to just over half receiving normal care. With high blood pressure the leading cause of disease burden worldwide its expected the findings published in JAMA will change guidelines globally. Dr Ruth Webster of The George Institute for Global Health said this was a major advance by showing that the Triple Pill was not only more effective than standard care it was also safe. Its estimated more than a billion people globally suffer from high blood pressure with the vast majority having poorly controlled blood pressure. Our results could help millions of people globally reduce their blood pressure and reduce their risk of heart attack or stroke. The researchers tested an entirely new way of treating hypertension by giving patients three drugs each at half dose in a single pill for early treatment of high blood pressure. Traditionally patients begin treatment with one drug at a very low dose which is increased over time with additional drugs added and increased in dosage to try to reach target. Dr Webster added Patients are brought back at frequent intervals to see if they are meeting their targets with multiple visits required to tailor their treatments and dosage. This is not only time inefficient its costly. We also know that many doctors and patients find it too complicated and often dont stick to the process. This new approach is much simpler and it works. The trial which was conducted in Sri Lanka enrolled patients with an average age of and blood pressure of mm Hg. Patients were randomly assigned to receive either the combination pill or usual care their doctors choice of blood pressure lowering medication. The Triple Pill consisted of the blood pressure medications telmisartan mg amlodipine . mg and chlorthalidone . mg. Compared with patients receiving usual care a significantly higher proportion of patients receiving the Triple Pill achieved their target blood pressure of or less with lower targets of for patients with diabetes or chronic kidney disease. At six months percent of participants in the Triple Pill group were still receiving the combination pill compared to the majority of patients in the usualcare group still receiving only one and only one third receiving two or more bloodpressurelowering drugs. Professor Anushka Patel Principal Investigator of the trial and Chief Scientist at The George Institute said this was big improvement. The World Heart Federation has set an ambitious goal that by there will be a per cent reduction in blood pressure levels globally. The Triple Pill could be a low cost way of helping countries around the world to meet this target. This study has global relevance. While the most pressing need from the perspective of the global burden of disease is lowand middleincome countries its equally relevant in a country like Australia where were still achieving only control rates for high blood pressure. The George Institute is now looking at strategies to maximise uptake of the study results. This includes examining the acceptability of the Triple Pill approach to patients and their doctors as well as costeffectiveness which will be important for governments and other payers to consider. The study was funded by the National Health and Medical Research Council of Australia as part of the Global Alliance for Chronic Disease. Video interview with Professor Anushka Patel httpsyoutu.beFIntpSVHM"