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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"

"In the first study of its kind researchers found realworld massage therapy to be an effective treatment for chronic low back pain. Niki Munk an assistant professor of health sciences in the School of Health and Rehabilitation Sciences at Indiana UniversityPurdue University Indianapolis and one of the cofirst authors of the study said that the studys findings are important given the large number of people who suffer low back pain in the U.S. Low back pain leads all disorders in years lost to disability in the U.S. Most patients improve rapidly but onethird report persistent back pain and percent develop chronic low back pain with significant physical limitations. More than percent of those who participated in the study experienced clinically meaningful improvements in their low back pain with disability according to Munk. The study can give primary care providers the confidence to tell patients with chronic low back pain to try massage if the patients can afford to do so Munk said. Generally massage is not covered by insurance Medicaid or Medicare. Previous studies of the effectiveness of massage were conducted in controlled research situations. In this study patients were referred by a physician to a massage therapist. The massage therapist designed and provided a series of massages at no cost to the patient in a clinical treatment environment mimicking the experience of people who choose to seek massage therapy in the real world. The study also looked at different characteristics associated with patients being more likely or less likely to experience clinically meaningful change from massage. Among the studys findings Adults in the babyboom and older generations tended to be much more likely to experience clinically meaningful changes. Obese patients experienced significant improvements but those improvements were not retained over time. Patients who were taking opioids experienced improvements in their pain from disability in some cases but were two times less likely to experience clinically meaningful change compared to those who were not taking opioids. While the study results are promising much more work needs to be done Munk said The fact of the matter is that chronic lower back pain is very complex and often requires a maintenancetype approach versus a shortterm intervention option. Additional investigation is needed to replicate the results of the initial study and to conduct a costbenefit analysis of massage therapy Munk said. Massage is an outofpocket cost she said. Generally people wonder if it is worth it. Will it pay to provide massage to people for an extended period of time Will it help avoid back surgeries for example that may or may not have great outcomes These are the types of analyses that we hope will result from this study. The study RealWorld Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain Results of a Repeated Measures Cohort Study was published online March in the journal Pain Medicine."

"An investigational drug called pridopidine seems an effective and safe treatment for people with the progressive movement disorder Huntingtons disease researchers report. Huntingtons patients have an imbalance in the signaling chemical dopamine. The new drug stabilizes dopamine signaling in areas of the brain that control movement and coordination. According to the study authors this is the first drug shown to improve patients loss of ability to move their muscles voluntarily. The only drug currently approved for Huntingtons is tetrabenazine which treats only involuntary movements and can cause serious side effects. The results of the phase clinical trial conducted by Spanish researchers led by Dr. Justo Garcia de Yebenes of the department of neurology Hospital Ramon y Cajal in Madrid appear in the Nov. online edition of The Lancet Neurology. The study included Huntingtons disease patients from eight European countries. The participants took either pridopidine milligrams once daily or mg twice daily or a placebo for weeks. After six months of treatment patients taking the higher dose of pridopidine showed improvements in motor function specifically in eye and hand movements involuntary muscle contractions dystonia and gait and balance compared with patients taking the placebo. More than percent of the patients taking the higher dose of the drug showed a significant benefit according to the researchers. Side effects among patients taking the drug were similar to the placebo group. Pridopidine has the potential to complement available treatments by improving a different range of motor deficits. Its lack of severe sideeffects . . . suggests that pridopidine might be useful even for those patients who are treated at sites that are not centers of excellence for Huntingtons disease the researchers concluded. One U.S. neurologist agreed that the drug seems promising against a disease with few treatment options. There has been a great deal of attention for this drug as it is one of the few molecules that in preliminary studies was found to have some efficacy in Huntingtons disease said Dr. Alessandro Di Rocco professor in the department of neurology and chief of the division of movement disorders at NYU Langone Medical Center in New York City. However this is the first large study to show evidence of a positive result in treating the motor symptoms of this devastating disease. And though the compound is apparently well tolerated without significant side effects the benefit is modest and limited to the motor symptoms of the disease and it is unknown how long the improvement observed could last he added. Still pridopidine does not get at the underlying cause of Huntingtons disease Di Rocco said. Unfortunately Huntingtons is a progressive disease and this drug is not a treatment of the disease itself but only improves some of its symptoms he explained. Nevertheless it is a welcome addition because there is very little else yet available to treat the symptoms. The challenge for scientists and clinicians is to discover therapies that actually slows or halts the progression of the disease. Another expert agreed that new treatment options for patients are sorely needed. A welltolerated drug that produces even small benefits for patients with Huntingtons disease would be a very welcome addition to the currently available treatments for this debilitating disorder Andrew Feigin from The Feinstein Institute for Medical Research in New York City wrote in an accompanying commentary. The study was funded by European pharmaceuticals company NeuroSearch AS. More information We Move has more about Huntingtons disease http SOURCES Alessandro Di Rocco M.D. professor department of neurology and chief division of movement disorders NYU Langone Medical Center New York City The Lancet Neurology news release Nov."

"Bariatric surgery is probably the most effective intervention we have in health care says Laurie K. Twells a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weightloss surgerys ability to reverse the often devastating effects of being extremely overweight on health and quality of life. I havent come across a patient yet who wouldnt recommend it Dr. Twells said in an interview. Most say they wish theyd done it years sooner. She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying and failing to lose weight and keep it off. And the reason is not a lack of willpower http_rmoduleinline. These patients have lost hundreds of pounds over and over again Dr. Twells said. The weight that it takes them one year to lose is typically back in two months often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate an effect not seen after bariatric surgery which permanently changes the contours of the digestive tract. In reviewing studies https that followed patients for five to years after weightloss surgery Dr. Twells and colleagues found major longlasting benefits to the patients health and quality of life. Matched with comparable patients who did not have surgery those who did fared much better physically emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility pain daily activities social interactions and feelings of depression and anxiety among other factors that can compromise wellbeing. Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type diabetes it nearly always puts the disease into remission and slows or prevents the lifethreatening damage it can cause to the heart and blood vessels. Even in the small percentage of patients who ultimately lose little weight after surgery significant metabolic benefits persist according to findings at the Cleveland Clinic. In a study of obese diabetic patients https who had not lost a lot of excess weight five to nine years after surgery a modest weight loss of just to percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities Dr. Stacy Brethauer and colleagues reported. For the two most popular surgical techniques the gastric bypass and the gastric sleeve the metabolic benefits are independent of weight loss Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However the gastric band procedure which is reversible lacks these benefits unless patients achieve and maintain significant weight loss he said. Furthermore as a study last year of surgical patients https at the Veterans Affairs Medical Center in Durham N.C. found those who underwent bariatric surgery had lower overall death rates up to years later than comparable patients who did not have weightloss surgery. Experts in the field regard the reluctance of some medical insurers including Medicaid programs in many states to cover the cost of bariatric surgery as a pennywise poundfoolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical price tag of bariatric surgery sometimes even millions of dollars more. Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially the latest longterm research has shown otherwise. In a decadelong followup of veterans httpjamanetwork.comjournalsjamasurgeryfullarticle who underwent gastric bypass a mere . percent returned to within percent of their initial weight years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of percent of gastric bypass patients a task too challenging for most clinics. The study by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery found that years later more than percent of surgical patients lost more than percent of their starting weight and about percent had lost more than percent. Gastric bypass an operation called RouxenY resulted in a somewhat greater weight loss at years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band LapBand surgery which has fallen out of favor in the last two or three years Dr. Maciejewski said. Bariatric surgery regardless of the method used is also much safer nowadays than it was even a decade ago said Dr. Jon C. Gould a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary httpjamanetwork.comjournalsjamasurgeryfullarticle on the V.A. study. However he noted the surgery is vastly underutilized to the detriment of patients health and the nations health care costs. Less than percent who would qualify for bariatric surgery are actually getting it Dr. Gould said. Although the vast majority have health coverage insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesityrelated health conditions and are taking a slew of medications to control them. For example he said to be covered for bariatric surgery Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure. He cited a further deterrent to bariatric surgery a perception that its dangerous and doesnt work beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions. Given the welldocumented safety and effectiveness of bariatric surgery it is now increasingly being performed in people whose obesity is less severe those with a body mass index B.M.I. of or perhaps even less but who have a metabolic disorder like Type diabetes related to their weight. In recent years the profession has promoted what Dr. Gould calls centers of excellence where or more bariatric operations are usually done in a year. Practitioners at these centers learn from experience share their knowledge and push for quality improvements he said. Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery which have combined forces to promote quality control. While experts agree that money would be better spent on prevention than treatment Dr. Twells pointed out that we have yet to find a way to prevent obesity and people whose health is compromised by their weight deserve to be treated by the most effective method we have."

"Remarkable thats how researchers are describing the results of a new study done on mice displaying traits associated with Alzheimers disease. The deletion of just a single enzyme saw the near total reversal of the deposition of amyloid plaques found in brains of those with Alzheimers improving cognitive functions in the mouse subjects according to the study from researchers at the Cleveland Clinic published Feb. in the Journal of Experimental Medicine. These promising research findings center around deleting a gene that produces an enzyme called BACE which helps make the betaamyloid peptides that accumulate abnormally in the brains of people with Alzheimers disease. Studies have shown that stopping or reducing that enzymes activity dramatically reduces production of betaamyloid peptides which are toxic to the brain and lead to the symptoms including memory loss associated with Alzheimers. By using BACE inhibitors to gradually lower the enzymes levels researchers saw reduced neuron loss and better brain function in the mice offering hope for human subjects down the line according to the study. However researchers urge caution with the results as many Alzheimers discoveries seem to hold true in mice then fail in people. Cleveland Clinic researcher Riqiang Yan Ph.D. an author on the study told ABC News that in the mouse model the gene that produces the enzyme was deleted completely stopping the enzymes production. But in humans its unlikely that BACE inhibitors would totally halt the enzymes production Yan said. Nonetheless five BACE inhibitors are being tested in human subjects currently Yan added. BACE inhibitors are still hopeful for AD patients if they have no unwanted side effects or can be tolerated for longterm use Yan said. Yan added researchers are currently in phase II and in some cases phase III clinical trials for the various compounds. Dr. JaySheree Allen is a family medicine resident physician at the Mayo Clinic in Minnesota and a resident at the ABC News Medical Unit."

"More than years after the gene behind cystic fibrosis http_Genomeposterschromosomecftr.shtml was identified a pill that could fix the problem in some people is getting closer to reality. The experimental medicine taken twice a day goes by the code name VX. Now there are some promising results from a study httpclinicaltrials.govctshowNCTtermvxrank in people with a specific genetic mutation that affects about four percent of cystic fibrosis patients. Lung function got percentage points better on average in people who got the drug compared with those taking a placebo. The improvement at six months was still present almost a year after the studys start. That much improvement is a big deal for CF patients Robert Beall http president of the Cystic Fibrosis Foundation told Shots. It is larger than any other clinical intervention weve ever had in cystic fibrosis. Beall said there were no significant side effects. The foundation has championed the development of drugs including VX and has provided million to Vertex http to get the medicine this far. If the drug makes it to market the foundation will receive royalties from sales. This pill for people with the GD mutation http of the cystic fibrosis gene helps a defective protein in cell membranes httpghr.nlm.nih.govgeneCFTR do a better job moving things around. Lisa Jarvis has more details httpcenblog.orgthehaystackvertexunveilsexcitingdataforcysticfibrosisdrug on that at the Haystack blog. But a key takeaway is that the medicine gets at a root cause of cystic fibrosis in some people rather than just relieving their symptoms. Article continues after this message from our sponsor Now to be perfectly clear all we know about the latest data is from press releases. And the drug hasnt been submitted for review by the Food and Drug Administration though Vertex expects to do that later this year. But these results even with plenty of caveats suggest the drug is on the right track. Vertexs shares jumped percent Wednesday as investors figured VX looks even better than theyd expected. Wow wrote Dr. Mark Schoenebaum http a biotech and drug analyst ISI Group in a note to investors. The effectiveness of VX looks best case he wrote. Ultimately the drug might be used by around patients worldwide if approved and Schoenebaum expects it would be command a very high price perhaps a year."

"Detailed Results of Phase Trial Presented at the American College of Gastroenterology Annual Scientific Meeting . of Patients Treated Using the Lead Formulation of Novel Prep Achieved a Colonoscopy Rating of Excellent or Good Compared to . of Those Using Standard Prep Products in Colonoscopistblinded Trial Phase Study Planned to Initiate in Early More Patientfriendly Palatable Prep Could Help Increase Patient Acceptance of Colonoscopies for Colorectal Cancer Screening Newton MA October Detailed results from a Phase study of a novel colonoscopy prep ECP under development by ColonaryConcepts LLC show the investigational treatment to be at least as effective and safe as two currently available colonoscopy prep formulations while offering a much higher level of patient satisfaction and preference than standard preps. The investigational prep is designed to be goodtasting with no fasting and lower fluid requirements than standard preps. It consists of nutritionally balanced bars and beverages incorporating the standard purgative active ingredient PEG which a patient consumes during the hours prior to colonoscopy. Results from the randomized singleblind study will be presented today at the American College of Gastroenterology Annual Scientific Meeting being held in Las Vegas NV by principal investigator Douglas K. Rex M.D. Distinguished Professor of Medicine Indiana University School of Medicine. Approximately of those who ought to have a colonoscopy avoid the procedure and the top reason cited for their avoidance is the prep said Dr. Rex. Results from this study show that this innovative investigational product performed as well as or better at colon cleansing than two currently available colonoscopy prep formulations. Moreover the higher levels of patient satisfaction reported by those who used the lead ECP formulation in the trial suggest this new approach to colonoscopy prep may have a positive impact on patient willingness to undergo this potentially lifesaving colorectal cancer screening procedure. The study tested six formulations of ECP using different doses of the active ingredients integrated within different meal kit menus randomized against two U.S. Food and Drug Administrationapproved active comparators. The primary outcome was the proportion of subjects with an endoscopic visibility rating of excellent or good based on the Aronchick scale. Secondary endpoints included segmentbysegment endoscopic visibility based on the Ottawa scale as well as safety tolerability and reports of patient experience. Fiftyone patients were treated with ECP and with active comparators. In the top three most effective formulations of ECP . of of patients had a rating of excellent or good. With ColonaryConcepts lead formulation . of of patients had a rating of excellent or good with of colon segments rated as excellent or good on the Ottawa scale. For the comparator products . of had a rating of excellent or good. There were no serious adverse events across any of the treatment groups. The proportion of patients reporting being satisfied or extremely satisfied with the experience of using the lead ECP formulation was nearly double that for those using the standard preps . versus .. We are very pleased with the efficacy and safety results of this study which clearly support advancing this product to a Phase trial said Corey A. Siegel M.D. M.S. a cofounder of ColonaryConcepts and Director of the Inflammatory Bowel Disease Center at the DartmouthHitchcock Medical Center and Associate Professor of Medicine at The Geisel School of Medicine at Dartmouth. The ECP approach allows patients to eat solid food bars and drink palatable lowvolume beverages a patientfriendly design that participants in the study clearly favored over conventional preps comments Dr. Siegel. Patients participating in the study were nearly four times more likely to recommend ECP to their friends and family as compared to the standard colonoscopy prep. Colonoscopy is still recognized as the gold standard the best way to catch this cancer at an early stage. The medical community has called for an increase in colorectal cancer screening overall both through the recent recommendations of the Cancer Moonshot Blue Ribbon Panel and the National Colorectal Cancer Roundtables call for screening by said Joshua Korzenik M.D. a cofounder of ColonaryConcepts and Faculty Member at Harvard Medical School and the Director of the Brigham and Womens Hospital Crohns and Colitis Center. By making the preparation for the procedure easier we believe ECP can lower patient resistance to colonoscopies and thus can help attain these important public health goals. About ColonaryConcepts LLC ColonaryConcepts LLC is headquartered in Newton MA and is committed to developing patientcentric innovations that improve gastrointestinal health. The company currently has two product candidates in clinical development ECP which is expected to enter Phase clinical trials in early and the Cbar a novel product candidate for chronic constipation which is currently being studied in a Phase b clinical trial. ColonaryConcepts physicianled product development team includes Boardcertified gastroenterologists food scientists pharmaceutical development experts culinary research chefs and product design strategists. For more information about ColonaryConcepts LLC please visit http Media Contact Joan E. Kureczka Bioscribe Inc. Email Joanbioscribe.com mailtoJoanbioscribe.com Ph .. ColonaryConcepts Michael Allio .. michael.alliogmail.com mailtomichael.alliogmail.com Herb Stern .. infocolonaryconcepts.com mailtoinfocolonaryconcepts.com"

"Vitamin D supplements may slow or prevent lowgrade prostate cancer from progressing a small new study suggests. Vitamin D decreases inflammation in tissues and inflammation is a driver of cancer explained Bruce Hollis the studys lead researcher and a professor of pediatrics biochemistry and molecular biology at the Medical University of South Carolina in Charleston. For the study researchers randomly assigned men who elected to have their prostate removed to receive either international units IU of vitamin D or an inactive placebo daily for days before their operation. When the prostate gland was examined after their surgery researchers found that many who received vitamin D had improvements in their prostate tumors while the tumors in the placebo group remained the same or got worse. In greater than percent of those taking it vitamin D actually made the cancer better said Hollis. Hollis reported that in some cases the tumor shrank and in others the cancer went away. However the study was small and results from a larger trial arent expected for several years he added. Doctors often recommend a watch and wait period for men with lowgrade or less aggressive prostate tumors. But many patients and their families arent comfortable waiting and opt to have surgery before its deemed medically necessary. These findings suggest that taking vitamin D might help reduce the need for such radical treatment. But Dr. Anthony DAmico chief of radiation oncology at Brigham and Womens Hospital in Boston said that this study was too small to reach any definitive conclusion about the value of vitamin D in fighting prostate cancer. Its premature to make any conclusions he said. The findings also need to be replicated in a much larger number of patients DAmico said. DAmico stressed that men should not start taking vitamin D supplements in hopes of slowing or curing prostate cancer. Vitamin D known as the sunshine vitamin is produced by the body when its exposed to sun. Its also found in fortified dairy products and fatty fish. The study results were scheduled for presentation Monday at the annual meeting of the American Chemical Society in Denver. Data and conclusions presented at meetings are usually considered preliminary until published in a peerreviewed medical journal. More information For more about prostate cancer visit the American Cancer Society. SOURCES Bruce Hollis Ph.D. professor pediatrics biochemistry and molecular biology Medical University of South Carolina Charleston S.C. Anthony DAmico M.D. Ph.D. chief radiation oncology Brigham and Womens Hospital Boston March presentation American Chemical Society meeting Denver Last Updated Mar"

"An ibuprofen patch that delivers the painkiller directly through the skin to the site of pain at a consistent dose for up to hours has been developed by UK researchers. Scientists at the University of Warwick and spinoff company Medherant say their TEPI patch could revolutionize the transdermal drug delivery market. University of Warwick research chemist Professor David Haddleton told Reuters that the polymer matrix in the patch acts as a reservoir for the drug capable of releasing between five and ten times the amount of drugs used in gels and patches currently on the market for periods of six hours hours and even hours. What we do is dissolve the active ibuprofen for example into the adhesive so we can have quite a high loading so up to percent of the adhesive will be the ibuprofen said Haddleton. When thats placed on the skin just like an elastoplast then the drug will actually diffuse across the skin into the body at the site of the pain and then relieve the pain in the same way as current gels and creams. Were controlling the dosage and were keeping it there for a prolonged period of time. The patches could help treat conditions like chronic back pain neuralgia and arthritis without the need to take potentially damaging doses of the drug orally. The team says that popular ibuprofen gels make it difficult to control dosage and can be easily rubbed off. Although TEPI patch remains highly tacky and adheres well to skin it is not uncomfortable to peel off unlike many traditional plasters. According to Andrew Lee cofounder of Medherant weve only been in the lab about months but in the months weve essentially assessed about percent of the drugs that are currently available as either creams or patches. Weve tested them in our polymers with very good results weve been able to get increased loadings of drugs in the polymer and weve shown almost across the board that we can get a steady release rate of that drug from the polymer as well. The team says TEPI patches could go on sale within three years and Medherant is working with some large unnamed pharmaceutical companies to get them ready for market. Haddleton says the technology has exciting potential for other medications such as opioid painkillers. Whats important is to be able to extend the range of drugs that are available by patches because at the moment were limited to about different drugs and there are thousands of drugs out there and only about are used in patches at the moment which is limited by the technology of the adhesive essentially he said. Lee told Reuters that many commercial patches do not contain pain relief agents at all and merely sooth the body with a warming effect. He said Medherants technology would eliminate most side effects created by oral medication. One of the interesting areas that we plan to explore in partnership with large companies is actually using our platform technology to include other drugs that previously maybe havent been suitable for topical or transdermal delivery or drugs which may have not got through the regulatory filings because for instance they might have caused stomach irritation or other side effects when taken orally said Lee. The TEPI patch incorporates new adhesive technology developed by global adhesive company Bostik. Lee believes ibuprofen strips could be useful for sports participants helping alleviate conditions such as tendonitis and repetitive strain injuries. Nutrition companies have also shown an interest in adapting Medherants technology for transmitting minerals and vitamins through the skin. Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"For the first time scientists have shown that probiotics beneficial live bacteria and yeasts taken as dietary supplements can improve cognitive function in humans. In a new clinical trial scientists show that a daily dose of probiotic Lactobacillus and Bifidobacterium bacteria taken over a period of just weeks is enough to yield a moderate but significant improvement in the score of elderly Alzheimers patients on the MiniMental State Examination MMSE scale a standard measure of cognitive impairment. Probiotics are known to give partial protection against certain infectious diarrheas irritable bowel syndrome inflammatory bowel disease eczema allergies colds tooth decay and periodontal disease. But scientists have long hypothesized that probiotics might also boost cognition as there is continuous twoway communication between the intestinal microflora the gastrointestinal tract and the brain through the nervous system the immune system and hormones along the socalled microbiotagutbrain axis. In mice probiotics have indeed been shown to improve learning and memory and reduce anxiety and depression and OCDlike symptoms. But prior to the present study there was very limited evidence of any cognitive benefits in humans. Here the researchers from Kashan University of Medical Sciences Kashan and Islamic Azad University Tehran Iran present results from a randomized doubleblind controlled clinical trial on a total of women and men with Alzheimers between and years of age. Half of the patients daily received ml milk enriched with four probiotic bacteria Lactobacillus acidophilus L. casei L. fermentum and Bifidobacterium bifidum approximately billion bacteria per species while the other half received untreated milk. At the beginning and the end of the week experimental period the scientists took blood samples for biochemical analyses and tested the cognitive function of the subjects with the MMSE questionnaire which includes tasks like giving the current date counting backwards from by sevens naming objects repeating a phrase and copying a picture. Over the course of the study the average score on the MMSE questionnaire significantly increased from . to . out of a maximum of in the group receiving probiotics but not in the control group from . to .. Even though this increase is moderate and all patients remained severely cognitively impaired these results are important because they are the first to show that probiotics can improve human cognition. Future research on more patients and over longer timescales is necessary to test if the beneficial effects of probiotics become stronger after longer treatment. In a previous study we showed that probiotic treatment improves the impaired spatial learning and memory in diabetic rats but this is the first time that probiotic supplementation has been shown to benefit cognition in cognitively impaired humans says Professor Mahmoud Salami from Kashan University the senior author of the study. Treatment with probiotics also resulted in lower levels of triglycerides Very Low Density Lipoprotein VLDL highsensitivity CReactive Protein hsCRP in the blood of the Alzheimer patients and likewise a reduction in two common measures called Homeostatic Model Assessment HOMAIR and HOMAB of insulin resistance and the activity of the insulinproducing cells in the pancreas. These findings indicate that change in the metabolic adjustments might be a mechanism by which probiotics affect Alzheimers and possibly other neurological disorders says Salami. We plan to look at these mechanisms in greater detail in our next study. Walter Lukiw Professor of Neurology Neuroscience and Ophthalmology and Bollinger Professor of Alzheimers disease at Louisiana State University who reviewed the study but was not involved in the research said This early study is interesting and important because it provides evidence for gastrointestinal GI tract microbiome components playing a role in neurological function and indicates that probiotics can in principle improve human cognition. This is in line with some of our recent studies which indicate that the GI tract microbiome in Alzheimers is significantly altered in composition when compared to agematched controls and that both the GI tract and bloodbrain barriersbecome significantly more leaky with aging thus allowing GI tract microbial exudates e.g. amyloids lipopolysaccharides endotoxins and small noncoding RNAs to access Central Nervous System compartments. The study is published in the openaccess journal Frontiers in Aging Neuroscience."

"The U.S. Food and Drug Administration today approved Trulance plecanatide for the treatment of Chronic Idiopathic Constipation CIC in adult patients. No one medication works for all patients suffering from chronic gastrointestinal disorders said Julie Beitz M.D. director of the Office of Drug Evaluation III in the FDAs Center for Drug Evaluation and Research. With the availability of new therapies patients and their doctors can select the most appropriate treatment for their condition. According to the National Institutes of Health an estimated million people are affected by constipation. Chronic idiopathic constipation is a diagnosis given to those who experience persistent constipation and for whom there is no structural or biochemical explanation. Trulance taken orally once daily works locally in the upper GI tract to stimulate secretion of intestinal fluid and support regular bowel function. The safety and efficacy of Trulance were established in two week placebocontrolled trials including adult participants. Participants were randomly assigned to receive a placebo or Trulance once daily. Participants in the trials were required to have been diagnosed with constipation at least six months prior to the study onset and to have less than three defecations per week in the previous three months as well as other symptoms associated with constipation. Participants receiving Trulance were more likely to experience improvement in the frequency of complete spontaneous bowel movements than those receiving placebo and also had improvements in stool frequency and consistency and straining. Trulance should not be used in children less than six years of age due to the risk of serious dehydration. Trulance should be avoided in patients six years of age to years of age. The safety and effectiveness of Trulance have not been established in patients less than years of age. Trulance should not be used in patients with known or suspected mechanical gastrointestinal obstruction. The most common and serious side effects of Trulance was diarrhea. Patients may experience severe diarrhea. If severe diarrhea occurs patients should stop taking Trulance and contact their health care provider. Trulance is manufactured by New York New Yorkbased Synergy Pharmaceuticals Inc. The FDA an agency within the U.S. Department of Health and Human Services protects the public health by assuring the safety effectiveness and security of human and veterinary drugs vaccines and other biological products for human use and medical devices. The agency also is responsible for the safety and security of our nations food supply cosmetics dietary supplements products that give off electronic radiation and for regulating tobacco products."

"Two studies published Tuesday lend support to controversial new cholesterol httphealth.nytimes.comhealthguidesnutritioncholesteroloverview.htmlinlinenytclassifier guidelines that could vastly increase the number of Americans advised to take cholesterollowering drugs called statins. One study suggests that the new guidelines are better at identifying who is truly at risk of a heart attack and should be given statins than the older guidelines are. The other suggests that treating people based on the new guidelines would be costeffective even with the tremendously increased use of statins. The new studies are not large clinical trials that will definitively settle the matter of whether to expand drug treatment to millions more people in hopes of preventing cardiovascular disease the leading killer of Americans. But they could help dispel some of the criticism of the new guidelines and strengthen the position of those who contend treatment should be extended to more people. There is no longer any question as to whether to offer treatment with statins for patients for primary prevention and there should now be fewer questions about how to treat and in whom said an editorial httpjama.jamanetwork.comarticle.aspxarticleid that accompanied the publication of the studies in JAMA a journal of the American Medical Association. The editorial was written by Dr. Philip Greenland of Northwestern University who is also a senior editor of JAMA and Dr. Michael S. Lauer of the National Heart Lung and Blood Institute. Advertisement A study http published last year estimated that million American adults or almost half those age to would be advised to take statins under the new guidelines compared with . million or . percent under the old ones. In actuality about one in four adults of that age now take statins according to the Centers for Disease Control and Prevention http The guidelines httpscirc.ahajournals.orgcontentearly.cir...a issued by two leading cardiology societies in November move away from trying to lower cholesterol to particular target levels. Instead patients are urged to consider statins if they have an overall risk of . percent of developing a heart attack or stroke httphealth.nytimes.comhealthguidesdiseasestrokeoverview.htmlinlinenytclassifier in the next years. The risk can be calculated using an online tool httptools.cardiosource.orgASCVDRiskEstimator that considers such factors as gender age race total cholesterol httphealth.nytimes.comhealthguidestestcholesteroltestoverview.htmlinlinenytclassifier systolic blood pressure httphealth.nytimes.comhealthguidestestbloodpressureoverview.htmlinlinenytclassifier and smoking status. The guidelines were contested http almost as soon as they were announced. Critics said that the online calculator greatly overstated http a patients risk of developing a heart problem and that new guidelines would lead millions of additional people to take statins exposing them to potential side effects such as muscle pain httphealth.nytimes.comhealthguidessymptomsmuscleachesoverview.htmlinlinenytclassifier or damage with little to gain. That debate continues with the release of the new studies. These two articles indicate that the new guidelines allow you to treat more people and provide better results at a reasonable cost said Dr. Harlan Krumholz a cardiologist at Yale who was not involved in the studies. But some say the studies have too many shortcomings to be persuasive. I dont think they are terribly informative and I dont think they change our thinking said Dr. Steven E. Nissen the chairman of cardiovascular medicine at the Cleveland Clinic. One of the new studies httpjama.jamanetwork.comarticle.aspxarticleid looked at people who were not taking statins and who underwent a test for calcium httphealth.nytimes.comhealthguidestestserumcalciumoverview.htmlinlinenytclassifier in their coronary arteries from to as part of the longrunning Framingham Heart Study. The authors determined which of those participants would have been eligible for statins under the new guidelines and under the old guidelines. Because it is known what happened to those people over the ensuing nine years the researchers could determine which of the guidelines did a better job in predicting who would develop cardiovascular problems a proxy for who would benefit from taking a statin. As expected many more people were eligible for statins under the new guidelines percent of the study participants compared with only percent under the old guidelines. Among the people eligible for statins under the old guidelines . percent had a heart attack or stroke or died from coronary disease over the ensuing nine years. Among those eligible for statins under the new guidelines the figure was . percent almost as high. That suggests that the new guidelines do not lead to treatment of many more people who do not need statins. The people who are new on statins seem to have the same riskbenefit from statins as the ones that are eligible under the old guidelines said the senior author of the study Dr. Udo Hoffmann the chief of cardiovascular imaging at Massachusetts General Hospital. The study was paid for by the National Institutes of Health. Also only percent of participants deemed ineligible for statins under the new guidelines had a heart attack or stroke over nine years compared with . percent of those ineligible under the old guidelines. So the new guidelines over all did a better job in discriminating between those who should and should not get statins. Critics said the study did not really test if using statins helped these people. They also said the study was too small for sweeping conclusions. Among other things virtually all the participants were white. The other study httpjama.jamanetwork.comarticle.aspxarticleid found that treating patients who have a . percent risk of heart attack or stroke over the next decade the threshold for statin use under the new guidelines was costeffective even though more people would be treated. Under a more generous definition of costeffectiveness it would even be costeffective to give statins to people who have a greater than percent risk of heart attack or stroke over the next years a scenario under which twothirds of adults to would be taking the drugs. Its good value for money said the lead author Ankur Pandya an assistant professor of health decision science at the Harvard T.H. Chan School of Public Health. The study also funded by the N.I.H. was based on a computer simulation of a representative population of American adults. Like all such studies the conclusions depend on the assumptions made and data chosen. The cholesterol guidelines issued in do not appear to have altered medical practice much yet. Dr. Michael Blaha director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease said that an unscientific survey conducted for the American College of Cardiology found the adoption of the guidelines was highly variable and not nearly what the guideline writers would have hoped for. Among primary care physicians the new advice has no doubt been even slower to catch on. One sign is that there was no big increase in prescriptions for statins in according to IMS Health a health care information company. The most widely used statins are the generic equivalents of Lipitor httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicslipitor_drugindex.htmlinlinenytclassifier and Zocor httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicszocor_drugindex.htmlinlinenytclassifier."

"Cannabidiol which is found in marijuana plants reduced the number of convulsive seizures in children with a severe and often fatal epilepsy disorder according to research published Wednesday in the New England Journal of Medicine http_home. Among children taking cannabidiol the decrease in the frequency of convulsive seizures http which involve a loss of consciousness stiffened muscles and jerking movements was percentage points greater than the decrease in seizures among children taking a placebo. The study was a randomized doubleblind placebocontrolled human trial which is considered the gold standard test for any new medicine. Cannabidiol also called CBD https is one of more than active cannabinoid chemicals in the marijuana plant which is classified as a Schedule I controlled substance. Unlike tetrahydrocannabinol or THC it does not produce a high. GW Pharmaceuticals a company that is developing cannabidiol medicines helped subsidize the study. After years of cannabis use for epilepsy ... we finally have solid evidence said Dr. Orrin Devinsky lead author of the study and director of NYU Langones Comprehensive Epilepsy Center. His own previous research http indicates that cannabis was used as early as B.C. in Sumeria to treat epilepsy neurologists of the Victorian period used Indian hemp which is rich in cannabidiol for the same purpose. Despite the generally positive results most study participants reported side effects that included vomiting fatigue diarrhea and some liver issues. CBD is an effective drug for this type of rare epilepsy but was not a panacea or cureall for these children Devinsky httpnyulangone.orgdoctorsorrindevinsky said. What is Dravet syndrome A total of patients with Dravet syndrome ranging in age from nearly to years old were randomly assigned to receive either an oral solution of cannabidiol or a placebo for a week period. Dravet syndrome is a severe childhoodonset epilepsy that causes multiple kinds of seizures developmental delays speech and language problems behavioral issues and movement and balance problems said Brandy Fureman vice president of research and new therapies at the Epilepsy Foundation. She was not involved in the new study. Epilepsy is a neurological disorder that disrupts electrical communication between neurons in the brain. Considered a spectrum disorder different epilepsy syndromes are defined by clusters of symptoms or features and treated accordingly. Existing epilepsy medications usually dont work for patients with Dravet so up to of these children die from seizures before age years Devinsky explained. Within the study individual participants experienced convulsive seizures at a rate ranging from four per month on average to per month. During the week study frequency of convulsive seizures decreased from an average of . to . per month in the cannabidiol group compared with . to . in the placebo group. On average the change in seizure frequency amounted to a decrease for the cannabidiol group patients compared with a roughly decrease among the placebo group. Five percent of the children became entirely seizurefree during the week study. Overall parents in the cannabidiol group felt that they witnessed significantly greater positive changes in their children than parents in the placebo group. However there was a downside. Most of the cannabidiol patients reported side effects though threequarters of the placebo group patients did as well. Nine out of cannabidiol group patients dropped out of the study eight of them because of side effects compared with just three of the placebo group patients. Tiredness somnolence or fatigue was most common others were decreased appetite diarrhea and vomiting Devinsky explained. Based on the overall results Devinsky believes CBD should be evaluated for epilepsy types beyond Dravet syndrome which is caused by a genetic mutation and affects about one in to children in the United States. Wayne Hall httpresearchers.uq.edu.auresearcher professor and director of the Centre for Youth Substance Abuse Research at the University of Queensland in Australia also believes the findings are sufficiently encouraging to warrant further research of cannabidiol that focuses on related forms of epilepsy. Critically important for the epilepsy community No one study decides an issue the sample size is still relatively small because this is a rare syndrome and so hard to study large numbers of cases and the duration of treatment so far has been relatively short Hall who was not involved in the research wrote in an email. Still Hall said the research which carefully measured safety and efficacy for a substantial number of children showed clear evidence of benefits in reducing seizure frequency and severity over the duration of the trial. Dr. Brenda Porter httpsprofiles.stanford.edubrendaporter associate professor of neurology at Stanford School of Medicine said shes glad to see data coming out. Porter is not one of the researchers behind this study though she too has published papers on cannabidiol as a treatment for epilepsy. Interestingly it looks similar to our other seizure medications in terms of efficacy and tolerability Porter said. So sadly not a home run for most patients but another tool in our treatment regimen. The marijuana plant is classified as a Schedule I controlled substance. Scientific researchers studying cannabidiol must meet federal security requirements and follow federal practices. Some scientists have said these federal requirements have slowed research supporting medicinal benefits of the plant. Porter believes the study may open the door to having more thoughtful discussions with our patients about the efficacy and the side effects of cannabidiol. Hopefully the FDA will see this as a sign it should be moved off of Schedule I. If it stays on Schedule I we will have trouble getting it to our patients when it does become available. The Controlled Substances Act classifies marijuana as a Schedule I drug https meaning it has no currently accepted medical use and a high potential for abuse. Changing the schedule of a drug falls to the Drug Enforcement Administration or the Department of Health and Human Services. An interested party such as a drug company may also petition for the process to begin. The Food and Drug Administration and the National Institute of Drug Abuse provide guidance to the DEA when reviewing scientific evidence on which to base a schedule change. Dr. David Gloss director of clinical neurophysiology at CAMC Health System in Charleston West Virginia believes the new study is very important because theres a lot of people using cannabidiol for all kinds of stuff. Gloss coauthored a review of cannabinoids for the Cochrane Library http which publishes systematic reviews of medical research. He was not involved in the new research. He noted that generating more evidence of effective use is a good thing. Already there is existing medical evidence http of efficacy for narrow neurologic conditions said Gloss who hopes that when enough evidence is available the classification of cannabidiol as a Schedule I drug might be reconsidered and changed. Join the conversation The University of Queenslands Hall believes that boundaries between medical use of cannabinoids and the recreational use of cannabis by adults should not be blurred. If future clinical trials confirm these promising results then appropriate regulation will enable the drug to be safely used for medical purposes he said. The Epilepsy Foundations Fureman said before publication of this trial much of the clinical evidence about CBDs effects on peoples seizures was uncontrolled and anecdotal. She added that the new study is critically important for the epilepsy community which believes a CBDbased medical product would be a firstinclass therapeutic option. On the need for more scientific research all these experts agree. As Devinsky said natural substances are not necessarily safe and effective. They need to be evaluated rigorously."

"The Maryland Proton Treatment Center MPTC is now offering deeptissue external thermal therapy in combination with highprecision protonbeam radiotherapy as a potential way to boost survival chances for certain cancer patients. MPTC is the only center in the world to offer these two treatments at the same facility an advantage to patients because these therapies are typically given within an hour of each other. Research has shown that thermal therapy can be especially useful in difficulttoreach cancers in the abdomen and pelvic region. Studies have found that adding thermal therapy to standard treatments can significantly shrink tumors and can improve survival for some patients. External thermal therapy or hyperthermia in the range of up to F. sensitizes tumor cells to chemotherapy and radiation therapy. In addition heat has been shown to enhance antitumor immune response. We are very pleased to be able to offer deeptissue thermal therapy which can be combined with standard radiation therapy as well as protonbeam therapy to enhance the cancerkilling effects of the radiation says Zeljko Vujaskovic MD PhD a professor of radiation oncology and director of the Division of Translational Radiation Sciences DTRS in the Department of Radiation Oncology at the University of Maryland School of Medicine UMSOM. Early research suggests that adding thermal therapy to protonbeam therapy may be associated with an even greater benefit than when combined with standard radiation therapy and we are excited to be at the forefront of making this combination therapy available to cancer patients says Dr. Vujaskovic an internationally recognized expert in hyperthermic oncology. Proton therapy is a precise form of radiation therapy that deposits all of its energy within the tumor and allows for less irradiation of noncancerous tissue. MPTC which is affiliated with the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center UMGCCC at the University of Maryland Medical Center is the only proton treatment center in Maryland. Radiation oncologists at UMGCCC already use external thermal therapy to treat a range of cancers but do not currently use it for cancers that are deeper in the body. According to Dr. Vujaskovic the new deeptissue thermal therapy equipment which is made by Pyrexar will be used to treat cancers of the abdominal and pelvic region including cancer of the bladder rectum cervix ovaries pancreas and connective tissue which are known as sarcomas. Patients would typically receive the thermal therapy two times a week for an hour before or after they receive standard photon radiation or protonbeam therapy. The system heats the tumor tissue to F. with internal and external probes that enable doctors to continuously monitor the temperature. A waterfilled applicator is placed over the area to be treated and noninvasive radio frequency energy is directed at the tumor. The heat causes the blood vessels in the tumor to dilate bringing more oxygen into the tumor which makes cancer cells more vulnerable to radiation therapy. The acquisition of the deeptissue thermal therapy system was made possible by donations from Jack and Emily Howell and the Middendorf Foundation Inc. Within the Department of Radiation Oncology and throughout our cancer center we strive to make every available tool in the cancerfighting toolbox available to our patients says William F. Regine MD FACR FACRO the Isadore Fannie Schneider Foxman Endowed Chair and Professor of radiation oncology at UMSOM and chair of radiation oncology at UMGCCC. By continuing to develop a comprehensive thermal oncology program we are giving patients more effective treatment options and therefore another reason to hope for better outcomes. The Maryland Proton Treatment Center has achieved another milestone by becoming the first center to offer both deepthermal therapy and proton therapy says E. Albert Reece MD PhD MBA Executive Vice President for Medical Affairs at UM Baltimore and the John Z. and Akiko K. Bowers Distinguished Professor and dean at UMSOM. This achievement is a testament to Dr. Vujaskovics considerable expertise in hyperthermic oncology and leadership in developing an outstanding thermal oncology program at the University of Maryland. Its this type of innovation that sets MPTC apart from other proton treatment centers. About the University of Maryland School of Medicine Commemorating its th Anniversary the University of Maryland School of Medicine was chartered in as the first public medical school in the United States. It continues today as one of the fastest growing toptier biomedical research enterprises in the world with academic departments centers institutes and programs and a faculty of more than physicians scientists and allied health professionals including members of the National Academy of Sciences and a distinguished recipient of the Albert E. Lasker Award in Medical Research. With an operating budget of more than billion the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide researchintensive academic and clinicallybased care for more than . million patients each year. The School has over students residents and fellows and nearly million in extramural funding with more than half of its academic departments ranked in the top among all public medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland Baltimore campus the School of Medicine has a total workforce of nearly individuals. The combined School and Medical System University of Maryland Medicine has a total budget of billion and an economic impact of nearly billion on the state and local community. The School of Medicine faculty which ranks as the thhighest public medical school in research productivity is an innovator in translational medicine with active patents and startup companies. The School works locally nationally and globally with research and treatment facilities in countries around the world. Visit medschool.umaryland.edu httpmedschool.umaryland.edu About the Maryland Proton Treatment Center The Maryland Proton Treatment Center MPTC offers proton therapy a highly advanced and precise form of radiation therapy that can increase radiation dose to tumor while decreasing dose to healthy surrounding tissue to the BaltimoreWashington region and beyond. It is a highly effective treatment for a wide range of localized tumors such as those found in the brain base of the skull head and neck area eye tumors tumors of the esophagus lung prostate liver breast spinal cord as well as gastrointestinal malignancies. It is also an important treatment option for children with cancer. At MPTC each treatment room is equipped with the most advanced form of pencil beam proton therapy which essentially paints the radiation onto the tumor while stopping precisely at the site of the tumor. Proton therapy is performed on an outpatient basis and is a welltolerated noninvasive treatment that can reduce side effects. It can be used in conjunction with other modalities of cancer treatments such as chemotherapy and surgery. MPTC offers a robust clinical trial program to all its patients to further evidencebased medicine. MPTC has been patientcentered from the beginning with a focus on accessibility and affordability. The center was designed to be a regional resource providing the same training privileges and clinical guidelines to physician groups across the region that work sidebyside with MPTC faculty and staff thus improving efficiency and affordability. MPTC offers free concierge services to ensure a seamless patient experience and a successful reconnection back to their referring physician. One of the goals of MPTC is to remain costneutral to insurance providers meaning patients pay the same for proton treatment as they would for other more conventionally available intensitymodulated treatments at the University of Maryland Medical Center. http"

"GSK LSENYSE GSK httpstudio.financialcontent.comprnewsPageQuoteTickerGSK today announced the publication of detailed results from a randomised phase III study ZOE of its investigational shingles vaccine Shingrix showing efficacy in adults aged years and older that is maintained for at least four years. The results were published in the New England Journal of Medicine NEJM. The study from which headline results were reported in October showed that the twodose candidate shingles vaccine had efficacy confidence interval compared to placebo in people over years old. Vaccine efficacy was maintained across the various age groups included in the study ranging between in people aged years confidence interval and in those aged years and above confidence interval . The high efficacy is in line with the results of the ZOE trial a study in people over years old which was presented and published last year showing a efficacy confidence interval . A pooled analysis of data from both trials showed the vaccine demonstrated efficacy against shingles confidence interval in adults aged years and older compared to placebo. This efficacy was maintained with an reduction in the risk of shingles confidence interval in the fourth year after vaccination. The risk of serious adverse events potential immunemediated diseases or deaths observed in ZOE was similar in people receiving Shingrix and placebo. The most commonly reported local adverse reaction was pain at the injection site and the most frequently reported systemic adverse reaction was fatigue. The majority of injection site and systemic reactions occurred within seven days of vaccination with most lasting days and generally were mildtomoderate in intensity. In addition a pooled analysis of data from the ZOE and ZOE trials showed that the candidate vaccine effectively reduced the risk of subsequent chronic neuropathic pain also known as postherpetic neuralgia PHN which is the most common and often severe complication of shingles. The candidate vaccine was shown to be confidence interval efficacious in preventing PHN in people aged years and older and efficacious confidence interval in people aged years and over. Dr Emmanuel Hanon Senior Vice President Vaccines Research and Development GSK said This is the first time that such high efficacy has been demonstrated in a vaccine candidate for older people and it is remarkable as we know that these people frequently have an agerelated weakening of their immune system. If approved this candidate vaccine could be an important tool for the prevention of shingles and the pain associated with it which would significantly impact the health and quality of life of so many people. Anthony Cunningham Executive Director of the Westmead Institute for Medical Research in Australia and Principal Investigator of the ZOE study said These data show that this investigational vaccine maintains high efficacy against herpes zoster in people over and years of age the age groups who are most affected by the disease. Importantly it also prevents a common and feared complication of herpes zoster prolonged pain or post herpetic neuralgia in these groups. Based on these and the previously reported ZOE data GSK expects to start submitting regulatory applications for the candidate vaccine for the prevention of shingles in people years and above later this year. About Shingrix Shingrix is a nonlive adjuvanted subunit HZsu candidate vaccine to help prevent herpes zoster and its complications. The candidate vaccine combines glycoprotein E a protein found on the varicella zoster virus VZV that causes shingles with an adjuvant system ASB which is intended to enhance the immunological response to the antigen. Additional trials to evaluate the ability of Shingrix to help prevent shingles are ongoing in healthy people aged and older and in adults with compromised immune systems. These studies will provide additional information with respect to the efficacy and safety profile of the candidate vaccine as well as its ability to stimulate immune responses in other populations and in specific circumstances. Notes to editors The name Shingrix is not yet approved for use by regulatory authorities in most countries including the US Food and Drug Administration FDA. About the ZOE trial The ZOE ZOster Efficacy in adults aged years and over NCT study is a randomised observerblind placebocontrolled saline solution multicentre multinational North America Europe Latin America AsiaPacific phase III trial involving more than adults aged years and older. Two doses were given intramuscularly two months apart. The study which started in August in parallel with the ZOE trial includes subjects in the age ranges and years. The primary objective of ZOE is overall vaccine efficacy against shingles in people years and over compared to placebo. The coprimary objectives of the pooled analysis over both studies are the assessment of overall vaccine efficacy in reducing the risk of developing shingles and PHN in people aged years and over using pooled data from both ZOE and ZOE studies. About the ZOE trial The ZOE ZOster Efficacy in adults aged years and over NCT study is a randomised observerblind placebocontrolled saline solution multicentre multinational North America Europe Latin America AsiaPacific phase III trial involving adults aged years and older. The study started in August . Two doses were given intramuscularly two months apart. The primary objective of this study is the overall vaccine efficacy against shingles in people aged years or older compared to placebo. The study includes subjects in the age ranges and years. About the phase III study programme Involving more than subjects globally the phase III programme for GSKs candidate shingles vaccine evaluates its efficacy safety and immunogenicity. In addition to older adults the candidate vaccine is being evaluated in immunocompromised patient populations including solid and haematological cancer patients haematopoietic stem cell and renal transplant recipients and HIVinfected people. About shingles Shingles typically presents as a painful itchy rash that develops on one side of the body as a result of reactivation of latent chickenpox virus varicella zoster virus VZV. Anyone who has been infected with VZV is at risk of developing shingles with age and altered immune system being recognised as the main risk factors. Complications from shingles can include PHN the most common complication scarring vision complications secondary infection and nerve palsies.PHN is often defined as a localized pain of significant intensity persisting at least days after the appearance of the acute shingles rash. Data from many countries indicate that older adults aged and over are at highest risk for shingles as more than of older adults have been infected with wild type VZV. A persons risk for shingles increases sharply after years of age. Risk of complications including PHN and hospitalisation also increase with age. The individual lifetime risk of developing shingles is approximately one in three for people in the USA however for individuals aged and over this risk increases to one in two people. References . Cunningham et al. N Engl J Med . Efficacy of the herpes zoster subunit vaccine in adults years of age or older. . Lal et al. N Engl J Med Efficacy of an Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults . Shingles Herpes Zoster Clinical Overview. US Centers for Disease Control and Prevention. Accessed at http on Sept . . Cohen et al. N Engl J Med Clinical practice Herpes zoster. . The GSK proprietary AS adjuvant system contains QS Stimulon adjuvant licensed from Antigenics Inc a wholly owned subsidiary of Agenus Inc. NASDAQ AGEN httpstudio.financialcontent.comprnewsPageQuoteTickerAGEN MPL and liposomes GSK one of the worlds leading researchbased pharmaceutical and healthcare companies is committed to improving the quality of human life by enabling people to do more feel better and live longer. For further information please visit http"

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

"Blood tests that indicate prostatespecific antigen PSA levels are rising rapidly over time are of little use in detecting aggressive prostate cancer and should not be done a new study indicates. PSA is a protein produced by cells of the prostate gland. High levels of PSA can be a marker for prostate cancer although its far from a perfect screening tool experts say. Men with both high and low levels of PSA can have cancer or not have cancer. The thought was that since high PSA levels are correlated with prostate cancer rapidly rising levels of PSA called PSA velocity from one year to another would also be an indicator of prostate cancer. However the new study found that PSA velocity doesnt add any useful information beyond what physicians can already tell from other methods of prostate cancer screening including the onetime PSA level test and digital rectal exams. Current screening guidelines that recommend biopsies for men who have high PSA velocity but no other signs of prostate cancer such as a suspected abnormality during a digital rectal exam or high PSA level during a single test are leading to many unnecessary biopsies the researchers said. We found there was no strong association between PSA velocity and prostate cancer and virtually none with aggressive prostate cancer said study author Andrew Vickers of Memorial SloanKettering Cancer Center in New York City. The velocity didnt add anything more to detecting aggressive prostate cancers. The study is published online Feb. in the Journal of the National Cancer Institute. The whole issue of prostate cancer screening including the PSA test the digital rectal exam and PSA velocity has been controversial said Dr. Otis Brawley chief medical officer of the American Cancer Society ACS. Part of the difficulty is while current screening methods are good at detecting cancer they cant distinguish between aggressive lifethreatening prostate cancers and those that are slowgrowing and relatively benign. And many prostate cancers are just that of little risk to men during their lifetimes Brawley said. Current ACS prostate screening cancer guidelines recommend that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment according to the ACS. As for PSA velocity the ACS doesnt have a position on what PSA velocity warrants a biopsy. But the National Comprehensive Cancer Network and American Urological Association guidelines do recommend biopsies based on high PSA velocities even in the absence of an elevated PSA or a suspicious digital rectal exam according to background information in the study. And many internal medicine and primarycare doctors in part because of fears of litigation do order biopsies based on fastrising PSA levels Brawley said. Its something that has become almost a community standard. If a guy has a PSA of . last year and a year or so later youve repeated it and its . because it has increased by a factor of he gets sent to biopsy Brawley said. In the study researchers used data on more than men in their s and s who took part in a drug trial for a prostate cancer prevention drug. The men in the study were all from the placebo arm meaning they had not received the drug. As part of the trial all of the men agreed to have a biopsy at the end of the trial needed or not. Researchers did find a statistical association between PSA velocity and the chances of a biopsy coming back cancerous. But when they factored in other things that can influence risk including a family history of the disease being older being black PSA level and results of a digital rectal exam there was virtually no association between PSA velocity and biopsy outcome. PSA velocity measurement is not useful Brawley said. Grace LuYao a cancer epidemiologist at the Cancer Institute of New Jersey who wrote an accompanying editorial said she agreed with the authors conclusions that PSA velocity does not seem to be a good predictor of prostate cancer. In addition tracking PSA levels overtime can also cause anxiety to men who often worry if their PSA level has suddenly shot up. According to the data PSA velocity does not add any value but it may add more anxiety LuYao said. More information The National Cancer Institute http has more on the PSA test. SOURCES Andrew Vickers Ph.D. associate attending research methodologist department of epidemiology biostatistics Memorial SloanKettering Cancer Center New York City Otis Brawley M.D. chief medical officer American Cancer Society Grace LuYao Ph.D. M.P.H. cancer epidemiologist The Cancer Institute of New Jersey Feb. Journal of the National Cancer Institute online"

"A breakthrough study led by the University of Sydneys Brain and Mind Centre and Royal Prince Alfred Hospital has revealed unique molecules in the blood of people with Multiple Sclerosis MS that could become definitive diagnostic biomarkers of the worlds most common neurologic disability in young adults. Published today in Scientific Reports the discovery identifies tiny dysregulated microRNA molecules that correctly diagnose MS and discriminate between patients at different disease stages all in a simple blood test. Currently there is no definitive test for MS. Diagnosis and disease monitoring relies on several parameters including clinical examination MRI cerebrospinal fluid assessment and electrophysiology. MS is a chronic disease so current diagnostic and monitoring tests are costly and still have limited utility to discriminate between different stages of the disease. Key findings In addition to identifying biomarkers that distinguish healthy people from those with MS the researchers identified nine unique microRNA molecules that differentiate between two MS subtypes relapsingremitting MS RRMS and progressive MS. Relapsingremitting MS RRMS affects percent of people and often evolves into a secondary progressive form of MS. percent of people with MS are diagnosed with a progressive form of the disease from the outset known as primary progressive MS. The team also validated eight out of nine microRNA molecules in an independent group of progressive MS cases confirming the reproducibility of the findings. This is the first demonstration that microRNAs associated with circulating exosomes in blood are informative biomarkers not only for the diagnosis of MS but in predicting disease subtypes with a high degree of accuracy said Associate Professor Michael Buckland Head of the Department of Neuropathology at RPA Hospital and the Brain and Mind Centre University of Sydney. The research was made possible through the generosity of patients at the Brain Mind Centres multidisciplinary Multiple Sclerosis Clinic a collaborative service offered by Royal Prince Alfred Hospital and the University of Sydney. The research was funded by an Incubator grant from MS Research Australia. This blood test may allow people with MS to begin treatment earlier and identify the most appropriate treatment for their condition said Dr Matthew Miles CEO MS Research Australia. This in turn may lead to fewer relapses and a slower loss of brain volume resulting in slowing or potentially halting progression of the disease for the person living with MS. It will also help remove the uncertainty surrounding which sub type of the disease an individual has and therefore be a catalyst for better outcomes for all people with MS. About the science Multiple Sclerosis MS is a chronic inflammatory demyelinating disease of the central nervous system CNS. The research team assessed the utility of microRNAs miRNA in serum blood exosomes as biomarkers of MS disease. MicroRNA are small noncoding RNA that control many genes and processes vital for cellular life such as metabolism development and the immune system. They are called miRNA because they are very short only letters long. Science has so far identified about human miRNAs. Exosomes are nanosized particles shed by almost all cell types in the body and are packed with microRNAs and other types of small RNA. The research team has shown previously that some microRNAs are selectively packaged into exosomes for release from the cell. Exosomes are tiny packages released by both healthy and diseased cells in the body. They circulate in blood and can be purified in their millions from a single vial of blood. Dubbed the biological equivalent of tweeting the exosomes circulate throughout the body and can deliver their cargo of information to multiple cells in almost realtime. In inflammatory diseases such as MS there is a significant increase in circulating exosome concentrations. In studying the blood exosomes of healthy volunteers and patients with MS the research team identified a molecular signature of MS that not only correctly diagnoses MS but also discriminates between patients with different stages of disease Associate Professor Buckland said. Exosomes released by brain cells circulating in the blood so they offer an easily accessible way to monitor diseases of the brain. We are only now starting to wake up to their enormous potential as clinical tests. Given exosomes can cross the bloodbrain barrier it is likely that some of the circulating exosomes in MS patients come from affected central nervous system cells or the associated inflammatory milieu. The researchers hypothesised that physiological changes associated with MS and its progression is reflected in differences in serum exosomal microRNAs. Using next generation sequencing and integrative bioinformatics they found that serum exosome microRNA profiles not only distinguish MS from healthy controls but also distinguish relapsingremitting MS RRMS from progressive MS with high accuracy. Associate Professor Michael Buckland is Head of the Molecular Neuropathology at the University of Sydney and Head of the Department of Neuropathology at Royal Prince Alfred Hospital."

"WhatA research paper published in The Lancet Infectious Diseases reported that the human papillomavirus HPV vaccine is safe and efficacious across a wide age range of women. The international study found that it protects against HPV infection in women older than years. Vaccination programs worldwide currently target routine vaccination of women years and younger. The study recruited women in countries across four continents. Cosette Wheeler PhD at The University of New Mexico Comprehensive Cancer Center was the lead author of the report. WhyThe human papillomaviruses cause cancer of the cervix anus and middle throat. Five types of HPV account for about percent of all invasive cervical cancer cases. HPV vaccines are expected to prevent most of these cancer cases. Many countries routinely vaccinate girls and boys years and younger although vaccination rates in the United States remain low. In the US only about percent of girls and percent of boys receive the threedose vaccination series. The earlier the vaccine is given the more efficacious it can be. This study focused on the benefit of vaccinating women years and older. Infection with HPV can take place at any time throughout adulthood and women in this age group may have already been exposed to HPV. The study showed that women in this age group were still protected from HPV infections. The scientists followed each woman for four to seven years. They found that the vaccine protected the women against HPV infections during the followup period and that the women were protected from many types of HPV across a broad age range. These study results are essential to new approaches in cancer prevention particularly those that are investigating combined approaches of cervical screening and vaccination in adult women. WhoCosette Wheeler PhD is a UNM Regents Professor in the Departments of Pathology and Obstetrics and Gynecology at the University of New Mexico Health Sciences Center. She holds the Victor and Ruby Hansen Surface Endowed Chair in Translational Medicine and Public Health. Her New Mexico research group has contributed for over years to understanding the molecular epidemiology of human papillomaviruses HPV in cervical precancer and cancer among Native American Hispanic and nonHispanic women of the southwest and on a global basis. She has overseen a number of largescale multidisciplinary populationbased projects that have ultimately enabled advances in primary HPV vaccines and secondary cervical cancer prevention Pap and HPV tests. Dr. Wheeler has authored over peerreviewed articles a number in top tier journals. In Sciencewatch Thomson Reuters httpsciencewatch.comanasthpvjulHPVWheler ranked her global citation contributions over the past decade th in human papillomavirus contributions and in the top in the field of clinical medicine. WhenThe paper Efficacy safety and immunogenicity of the human papillomavirus ASadjuvanted vaccine in women older than years year followup of the phase doubleblind randomised controlled VIVIANE study was published in the June online edition of The Lancet Authors are Cosette M Wheeler S Rachel Skinner M Rowena Del RosarioRaymundo Suzanne M Garland Archana Chatterjee Eduardo LazcanoPonce Jorge Salmern Shelly McNeil Jack T Stapleton Cline Bouchard Mark G Martens Deborah M Money Swee Chong Quek Barbara Romanowski Carlos S Vallejos Bram ter Harmsel Vera Prilepskaya Kah Leng Fong Henry Kitchener Galina Minkina Yong Kuei Timothy Lim Tanya Stoney Nahida Chakhtoura Margaret E Cruickshank Alevtina Savicheva Daniel Pereira da Silva Murdo Ferguson Anco C Molijn Wim G V Quint Karin Hardt Dominique Descamps Pemmaraju V Suryakiran Naveen Karkada Brecht Geeraerts Gary Dubin and Frank Struyf for the VIVIANE Study Group. ContactDorothy Hornbeck JKPR dhornbeckjameskorenchen.com Michele Sequeira UNM Cancer Center msequeirasalud.unm.edu About the UNM Comprehensive Cancer CenterThe University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institutedesignated Cancer Center in a mile radius. One of the premier cancer centers nationwide the UNM CCC has more than boardcertified oncology physicians forming New Mexicos largest cancer care team. It treats about percent of adults and virtually all the children in New Mexico diagnosed with cancer more than people from every county in the state in more than clinic visits each year. Through its partnership with the New Mexico Cancer Care Alliance an exemplary national model for cancer health care delivery the UNM CCC offers access to more than clinical trials to New Mexicans in every part of the state. Annual research funding of almost million supports the UNM CCCs cancer scientists. Working with partners at Los Alamos and Sandia National Laboratories Lovelace Respiratory Research Institute and New Mexico State University they have developed new diagnostics and drugs for leukemia breast cancer ovarian cancer prostate cancer liver and pancreatic cancer brain cancer and melanoma. Learn more at http SEE ORIGINAL STUDY https"

"The proportion of older adults with agerelated vision loss is estimated to be as high as one in three over the age of . In Canada thats roughly . million people. Many of these individuals turn to adaptive devices designed to magnify objects and text but these devices can be prohibitively expensive unifunctional and bulky. Enter the iPad a technological device thats relatively cheap serves many purposes is smaller than most books and according to new research from Concordia University in Montreal is just as effective a visual aid as traditional devices. A study recently described in Good Times Magazine provides the first experimental evidence that the Apple iPad is as good as technology traditionally used in reading rehabilitation for individuals with visual impairment. And that could help with stigmatization of the elderly and disabled. For the study the Concordiabased research team recruited participants who ranged in age from to . A little over half the participants had agerelated macular degeneration a disease characterized by the deterioration of the small central portion of the retina that is normally responsible for fine detailed vision tasks such as reading. The researchers used questionnaires and tests to gauge participants visual ability and then compared the Apple iPad versus two traditionally used magnification devices to see if reading rates varied across devices. Unsurprisingly we found that most participants found it hard to read small and medium text while nearly a quarter of them reported that reading large text was much easier says Elliott Morrice an MA student in Concordias Department of Psychology and the studys first author. What was interesting to note was that it didnt matter what technology was used to do the magnification an iPad worked just as well as a traditional device like a closed circuit television system CCTV he says. When we took previous experience into account we found that participants who had used iPads before read on average words per minute faster than those who were using the iPad for the first time. But there were no significant differences in the reading rates of participants who had previous experience using the CCTV compared to the reading rates of firsttime CCTV users. Another benefit is that many older adults feel stigmatized by using the traditional devices because they identify them as having an impairment or disability. Tablet computers offer many of the same benefits while being socially acceptable says Aaron Johnson the studys senior author and an associate professor in the psychology department and a member of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal CRIR. Whats more compared to the devices currently used by those with low vision iPads are multifunctional allowing the user to go online check email make video calls and they cost less than the traditional devices he says. This cost saving can be both to the individual and if appropriate to the insurance companies that may provide individuals with assistive devices. Partners in research This work was supported in part by the Vision Health Research Network the Fonds de recherche du Qubc Sant the Antoine Turmel Foundation CRIR and the MABMackay Foundation. The studys third coauthor is JulieAndre Marinier from the Centre de recherche interdisciplinaire en radaptation du Montral mtropolitain and cole doptomtrie at the Universit de Montral. Walter Wittich is a member of CRIR an assistant professor in lcole doptomtrie at Universit de Montral and an affiliated faculty member of the Department of Psychology at Concordia University. Related linksDepartment of Psychology https de recherche interdisciplinaire en radaptation du Montral mtropolitain http doptomtrie at the Universit de Montral http Rehabilitation Centre http"

"The U.S. Food and Drug Administration today approved Nuplazid pimavanserin tablets the first drug approved to treat hallucinations and delusions associated with psychosis experienced by some people with Parkinsons disease. Hallucinations or delusions can occur in as many as percent of patients with Parkinsons disease at some time during the course of their illness. People who experience them see or hear things that are not there hallucinations andor have false beliefs delusions. The hallucinations and delusions experienced with Parkinsons disease are serious symptoms and can lead to thinking and emotions that are so impaired that the people experiencing them may not relate to loved ones well or take appropriate care of themselves. Hallucinations and delusions can be profoundly disturbing and disabling said Mitchell Mathis M.D. director of the Division of Psychiatry Products in the FDAs Center for Drug Evaluation and Research. Nuplazid represents an important treatment for people with Parkinsons disease who experience these symptoms. An estimated Americans are diagnosed with Parkinsons disease each year according to the National Institutes of Health and about one million Americans have the condition. The neurological disorder typically occurs in people over age when cells in the brain that produce a chemical called dopamine become impaired or die. Dopamine helps transmit signals between the areas of the brain that produce smooth purposeful movement like eating writing and shaving. Early symptoms of the disease are subtle and occur gradually. In some people Parkinsons disease progresses more quickly than in others. As the disease progresses the shaking or tremor which affects the majority of people with Parkinsons disease may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes hallucinations and delusions difficulty in swallowing chewing and speaking urinary problems or constipation skin problems and sleep disruptions. The effectiveness of Nuplazid was shown in a sixweek clinical trial of participants. Nuplazid was shown to be superior to placebo in decreasing the frequency andor severity of hallucinations and delusions without worsening the primary motor symptoms of Parkinsons disease. As with other atypical antipsychotic drugs Nuplazid has a Boxed Warning alerting health care professionals about an increased risk of death associated with the use of these drugs to treat older people with dementiarelated psychosis. No drug in this class is approved to treat patients with dementiarelated psychosis. In clinical trials the most common side effects reported by participants taking Nuplazid were swelling usually of the ankles legs and feet due to the accumulation of excessive fluid in the tissue peripheral edema nausea and abnormal state of mind confused state. Nuplazid was granted breakthrough therapy designation http for the treatment of hallucinations and delusions associated with Parkinsons disease. Breakthrough therapy designation is a program designed to expedite the development and review of drugs that are intended to treat a serious condition and where preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapy on a clinically significant endpoint. The drug was also granted a priority review. The FDAs priority review http program provides for an expedited review of drugs that offer a significant improvement in the safety or effectiveness for the treatment prevention or diagnosis of a serious condition. Nuplazid is marketed by Acadia Pharmaceuticals Inc. of San Diego California. The FDA an agency within the U.S. Department of Health and Human Services protects the public health by assuring the safety effectiveness and security of human and veterinary drugs vaccines and other biological products for human use and medical devices. The agency also is responsible for the safety and security of our nations food supply cosmetics dietary supplements products that give off electronic radiation and for regulating tobacco products."

"A drug already used safely to treat Parkinsons disease restless leg syndrome and other movement disorders also could delay or prevent the most common cause of blindness affecting more than million older Americans agerelated macular degeneration AMD. Researchers have discovered that patients who take the drug LDOPA are significantly less likely to develop AMD and if they do get AMD its at a significantly older age according to the study published online Nov. in the American Journal of Medicine. The retrospective study was led by researchers at Marshfield Clinic Research Foundation University of Arizona Medical College of Wisconsin University of Miami Essentia Health Stanford University and University of Southern California. Research points to this as a pathway to regulate and prevent this most common cause of blindness in adults said Murray Brilliant Ph.D. director Marshfield Clinic Research Foundation Center for Human Genetics Marshfield Wisconsin. Imagine telling patients we potentially have medication that will allow them to see and continue enjoying life their family and perform every day activities as they age. That is very powerful. AMD the No. cause of legal blindness in adults over is a progressive eye condition affecting as many as one in three adults. The disease attacks the macula of the eye where the sharpest central vision occurs causing central blindness. This vision is used to drive read recognize faces and perform daily tasks. AMD spares the peripheral vision leaving dim images or black holes at the center of vision. LDOPA is a natural byproduct of pigmentation and is made in a layer of cells in the back of the eye that functions to promote health and survival of retinal tissues. Researchers asked the question if people taking LDOPA as a medicine are protected from AMD. The obvious question was if the LDOPA no longer produced was supplemented via pill form does it have the potential to serve as a preventive medicine against AMD Brilliant said. We need more research but this first step is promising. Albinism research leads to hope This work grew out of research using albino mouse models. Mice as well as humans who have albinism or lack of pigmentation have profound vision loss and changes in the eye structure especially the macula the ovalshaped area near the center of the retina associated with a persons ability to see clearly. Race and ocular pigmentation are known risk factors for developing AMD indicating darker pigmentation may protect from the disease as it occurs much much more frequently in the white population than black or Hispanic populations. This led to the hypothesis that those with darker pigmentation may have greater LDOPA signaling in the RPE. To test this researchers examined health records of Marshfield Clinic patients looking for those with AMD those taking LDOPA and those with both LDOPA and AMD. They then determined the age patients developed AMD. According to national statistics the average age at which individuals are given LDOPA is the average age of AMD diagnosis is . In those people who got LDOPA before being diagnosed with AMD their AMD diagnosis occurred eight years later than those without LDOPA. These provocative results were then confirmed in a much larger data set of million patients where similar results were observed and the study expanded to include prevention and delay of wet AMD the most devastating form of the disease. In all the groups examined data suggests LDOPA may prevent or delay AMD. This study suggests an intriguing link between patients taking LDOPA and a lower incidence and delayed onset of AMD said Paul A. Sieving M.D. Ph.D. director of the National Eye Institute. Showing that LDOPA causes this protective effect will require further investigation but if confirmed could lead to new drugs or combination therapies for AMD that target DOPAresponsive cells in the retina. The next step in this research is to perform a clinical trial to determine the ability of this drug to prevent AMD. Results suggest a new path forward in our fight against AMD that may even include a strategy to prevent those at risk of the disease from ever developing it said Brian McKay Ph.D. associate professor Department of Ophthalmology and Vision Science University of Arizona. In the end LDOPA may not be the drug that ends the disease but the pathway identified is likely to be a key observation as the search for a cure continues. This research titled Mining Retrospective Data for Virtual Prospective Drug Repurposing LDOPA and Agerelated Macular Degeneration was supported by National Center for Advancing Translational Sciences National Human Genome Research Institute Research to Prevent Blindness Bright Focus Foundation The Edward N. Della L. Thome Memorial Foundation Wisconsin Genomics Initiative National Eye Institute Marshfield Clinic and University of Arizona. Marshfield Clinic provides patient care research and education with more than locations in northern central and western Wisconsin making it one of the largest comprehensive medical systems in the United States."

"Allergan plc NYSE AGN httpstudio.financialcontent.comprnewsPageQuoteTickerAGN today announced that it has been granted marketing authorization from the U.S. Food and Drug Administration FDA for TrueTear Intranasal Tear Neurostimulator the first and only FDAcleared device developed to temporarily increase tear production during neurostimulation in adult patients. TrueTear is a handheld stimulator with daily disposable tips that is inserted into the nasal cavity to induce the production of tears. There have been two clinical studies showing positive safety and effectiveness of the device in the increase of tear production completed with aqueous deficient dry eye adult patients. TrueTear represents a technological breakthrough for eye care professionals as it delivers an effective noninvasive and drugfree way to temporarily increase tear production said David Nicholson Chief RD Officer at Allergan. As an innovator in eye care we are continually looking for new products to offer through our portfolio and TrueTear represents the next step forward. The new advancement is an addition to Allergans current eye care portfolio. Last May Allergan announced positive results from two pivotal trials for TrueTear that showed an increase in tear production upon nasal neurostimulation in adults with aqueous tear deficiency. In clinical trials TrueTear demonstrated increased tear production upon stimulation of the nasal cavity said John Sheppard M.D. M.M. Sc. professor of Ophthalmology Eastern Virginia Medical School and president of Virginia Eye Consultants. Interestingly neurostimulation has been used as an approach for a wide variety of disorders for more than years. TrueTear is the first of its kind to provide a temporary increase in tear production in this way. About the Studies Study is a prospective randomized controlled doublemasked multicenter crossover trial in which participants used an active device and two control applications. The primary effectiveness endpoint of increased tear production during intranasal application as measured by Schirmer score compared to both controls was met. Study is a prospective singlearm multicenter openlabel clinical trial in which participants used TrueTear to stimulate tear production for days. The primary effectiveness endpoint of increased tear production as measured by Schirmer score during application of the device compared with basal Schirmer score at Day was met. Secondary endpoints of increased tear production as measured by Schirmer score during application of the device compared with basal Schirmer score at Days and were also met. The direct clinical benefit of temporarily increasing tear production as a therapy for patients with dry eye disease was not assessed as part of these clinical trials. All devicerelated adverse events were mild in nature. There were no devicerelated serious adverse events. ABOUT TRUETEAR INDICATION TrueTear provides a temporary increase in tear production during neurostimulation in adult patients. IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS Do not prescribe TrueTear to patients with a cardiac pacemaker implanted or wearable defibrillator or other implanted metallic or electronic device within head or neck a known hypersensitivity to the hydrogel device material or chronic or recurrent nosebleeds or bleeding disordercondition that can lead to increased bleeding. WARNINGS Do not apply stimulation around electronic monitoring equipment eg cardiac monitors ECG alarms in the bathshower while driving operating machinery during activity in which sneezingwatery eyes may cause risk areas other than the nose within feet of shortwave or microwave therapy equipment around flammable anesthetics mixture air oxygen or nitrous oxygen. Persistent use on irritated nasal tissue may cause injury. Safetyeffectiveness not established for longer than months or for treating aqueousdeficient dry eye disease. Safety not established in pregnancy patients under years of age patients with nasal or sinus surgery including nasal cautery or significant trauma severe nasal airway obstruction or vascularized polyp active severe systemic or chronic seasonal allergies rhinitis or sinusitis requiring treatment untreated nasal infection and disabling arthritis neuropathy severe dexterity impairment or limited motor coordination. PRECAUTIONS Consult patients to discontinue use if pain discomfort or numbness in the nose persists after adjusting for high levelslong sessions to remove studs nose rings or other nose jewelry before use to not use prescription eye medications or nasal sprays minutes before or after using TrueTear. Suspected or diagnosed heart disease patients should follow doctors precautions. Keep away from children. ADVERSE EVENTS Nasal pain discomfort or burning . transient electrical discomfort . nosebleed . nasal congestion . headaches . trace blood dot heme in nostril . facial pain . sore eye . sinus pain . periorbital pain . runny nose . nasal ulcers . and lightheadedness .. Caution Federal law restricts this device to sale by or on the order of a licensed physician. For the full Directions for Use please call . Please call to report an adverse event. About Allergan plc Allergan plc NYSE AGN httpstudio.financialcontent.comprnewsPageQuoteTickerAGN headquartered in Dublin Ireland is a bold global pharmaceutical company and a leader in a new industry model Growth Pharma. Allergan is focused on developing manufacturing and commercializing branded pharmaceuticals devices and biologic products for patients around the world. Allergan markets a portfolio of leading brands and bestinclass products for the central nervous system eye care medical aesthetics and dermatology gastroenterology womens health urology and antiinfective therapeutic categories. Allergan is an industry leader in Open Science the Companys RD model which defines our approach to identifying and developing gamechanging ideas and innovation for better patient care. This approach has led to Allergan building one of the broadest development pipelines in the pharmaceutical industry with midtolate stage pipeline programs in development. Our Companys success is powered by our more than global colleagues commitment to being Bold for Life. Together we build bridges power ideas act fast and drive results for our customers and patients around the world by always doing what is right. With commercial operations in approximately countries Allergan is committed to working with physicians healthcare providers and patients to deliver innovative and meaningful treatments that help people around the world live longer healthier lives every day. For more information visit Allergans website at http ForwardLooking Statement Statements contained in this press release that refer to future events or other nonhistorical facts are forwardlooking statements that reflect Allergans current perspective of existing trends and information as of the date of this release. Except as expressly required by law Allergan disclaims any intent or obligation to update these forwardlooking statements. Actual results may differ materially from Allergans current expectations depending upon a number of factors affecting Allergans business. These factors include among others the difficulty of predicting the timing or outcome of FDA approvals or actions if any the impact of competitive products and pricing market acceptance of and continued demand for Allergans products difficulties or delays in manufacturing and other risks and uncertainties detailed in Allergans periodic public filings with the Securities and Exchange Commission including but not limited to Allergans Annual Report on Form K for the year ended December and Quarterly Report on Form Q for the quarter ended September certain of such periodic public filings having been filed under the Actavis plc name. Except as expressly required by law Allergan disclaims any intent or obligation to update these forwardlooking statements. CONTACTS Investors Karina Calzadilla Media Mark Marmur Suzanne Jacobson SOURCE Allergan plc Related Links http"

"Doctors can use a patients abdominal CT scans to also check for signs of the boneweakening disease osteoporosis according to a new study. The researchers who published their findings in the Annals of Internal Medicine on Monday compared patients CT scans to their dualenergy Xray absorptiometry DXA which is traditionally used to diagnose osteoporosis. What we found is that there is pretty good correlation said the studys lead author Dr. Perry Pickhardt professor of radiology at the University of Wisconsin School of Medicine and Public Health in Madison. The idea say the researchers is doctors can use patients CT scans that are ordered for another reason such as looking for tumors to also check for signs of osteoporosis. That may spare the patients from additional testing and additional costs. In an editorial accompanying the study however experts wrote that using CT scans to gauge bone density could lead to some people being incorrectly diagnosed particularly if people at low risk are tested. In this study the average age was about years old six years younger than the age at which the U.S. Preventive Services Task Force a governmentbacked panel recommends all women begin being screened for osteoporosis. The disease affects over million Americans over . The panel also suggests younger women at an increased risk for bone fractures should be screened but theres no recommendation for men of any age. Despite DXA scans being safe and cost effective Pickhardt and his colleagues say the test is underused. CT scans however are considered overused with more than million performed in the U.S. during . INCIDENTALOPOROSIS For the new study the researchers analyzed test results from patients who had both types of scans performed within six months of each other over a year period to see if their CT scans showed osteoporosis as well as the DXAs. Overall about percent of the people were diagnosed with osteoporosis about percent were diagnosed with some boneweakening and about percent were healthy based on their DXAs. Sponsored The researchers then found that their ability to accurately diagnose those same patients with osteoporosis from a CT scan depended on what threshold for bone density they used. Dr. Sumit Majumdar who wrote an editorial accompanying the new study said a lower threshold for bone density would catch most cases of osteoporosis and limit incidentaloporosis incorrect osteoporosis diagnoses discovered while doctors were looking for something else. At the lower threshold the researchers found percent of those diagnosed with osteoporosis were misdiagnosed. Pickhardt said the screenings would have to target the right groups of people to prevent overdiagnosis. Obviously its something we need to worry about but if you apply it to a population thats suitable for diagnosis you wouldnt run that risk he said. CT v. DXA Majumdar a professor of medicine at the University of Alberta in Canada said CT scans are better tests but stomach scans dont include the hip like a DXA would. A DXA can cost a couple hundred dollars while a CT scan can cost about . Both involve radiation. ADVERTISING Dr. Beatrice Hull from the Center for Osteoporosis and Bone Health at the Medical University of South Carolina in Charleston told Reuters Health that shed want her patients to have a DXA scan even with a diagnosis from a CT scan. I dont think at this point this one test is going to prevent further testing. I think it will identify patients who are at a higher risk and need more testing said Hull who wasnt involved with the new research. SOURCE bit.lyZwiu httpbit.lyZwiu Annals of Internal Medicine online April . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

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

"Hospitals can improve patient care and reduce costs associated with coronary angioplasty if cardiologists perform more of these procedures through an artery in the wrist and if they take steps to discharge such patients on the same day according to a new study led by Washington University School of Medicine in St. Louis. Coronary angioplasty is a procedure in which arteries are opened to increase blood flow to the heart. The research published Feb. in JACC Cardiovascular Interventions suggests that the lower costs of the wrist approach largely are due to the fact that patients experience fewer complications and can be discharged earlier compared with procedures that access the heart through the larger deeper artery in the groin. The researchers estimated that shifting standard practice by percent to the wrist approach along with sameday discharge could save the United States million per year. We have unequivocal evidence and data that show better outcomes when we access the hearts coronary arteries and perform angioplasty through a blood vessel in the wrist rather than through the femoral artery in the groin said first author Amit P. Amin MD an assistant professor of medicine. The femoral artery is the traditional route but when we go in through a vessel in the wrist we see less bleeding fewer complications less pain and discomfort higher patient satisfaction shorter hospital stays and lower costs. Patients may undergo coronary angioplasty also called percutaneous coronary intervention PCI to alleviate chest pain or shortness of breath. Such symptoms suggest the coronary arteries that deliver blood to the heart are blocked or narrowed and oxygen delivery to the heart muscle is reduced. Interventional cardiologists insert a small tube into an artery in the wrist or the groin which can be used to view the narrowed heart artery deliver an inflatable balloon to open up the narrowed section and possibly deliver a stent to hold the vessel open. Using the National Cardiovascular Data Registry CathPCI Registry the researchers analyzed data from almost Medicare patients who underwent PCI and were eligible for sameday discharge. Despite the fact that all of these patients were capable of leaving the hospital the same day as their procedures only about percent of these patients actually were discharged without having stayed overnight. We have seen that it is very safe to send these patients home the same day said Amin who treats patients at BarnesJewish Hospital. We use riskprediction models to predict their risks ahead of time and we plan ahead to mitigate any issues so we can facilitate a sameday discharge. This is really about patient care. We want to outline healthcare pathways that provide the best care for patients. The analysis demonstrated an average cost of for the wrist approach with sameday discharge compared with for the groin approach with at least one night of hospitalization resulting in a cost savings of about for outpatients who get the wristaccess procedure. Independent of the length of stay the wrist approach costs about less than the groin approach on average. The investigators estimated that if a hospital performing of these procedures annually shifted percent of these patients to the wristaccess with sameday discharge approach the hospital would save million over that period. Expanding that practice to hospitals nationwide might save the United States million in healthcare spending per year. Healthcare costs for the patients who receive PCI each year in the U.S. are estimated to be billion. Of the studys patient population receiving PCI percent received the procedure in which doctors used wrist access. According to Amin improved technology has allowed wrist access to become a viable route to the coronary arteries even for complex cases and should be considered for more patients. The traditional way has been to go through the bigger femoral artery that is a straight pathway to the heart Amin said. Unfortunately that artery is also deep. Its associated with more bleeding complications. In contrast the wrist artery is small and is associated with fewer complications. The minor challenge is in the difficulty of navigating a smaller more twisting path of an artery through the wrist. But with advances we have in technology and equipment those challenges are rapidly decreasing. This work was supported by a grant from Vita Solutions a subsidiary of The Medicines Company for whom Amin has provided consultation and by the National Institutes of Health NIH grant numbers ULTR KLTR TLTR and KMCA. Amin also reported consulting for Terumo. Coauthors from other institutions reported receiving grant funding from or providing consultations to the National Institutes of Health the American College of Cardiology Foundation Eli Lilly Amorcyte Gilead Genentech UnitedHealthcare Amgen Janssen Health Outcomes Sciences Blue Cross Blue Shield of Kansas City Edwards Lifesciences Medtronic St. Jude Medical Abbott Vascular Saint Lukes Hospital Foundation of Kansas City partially funded by Merck Boston Scientific Biomet Daiichi Sankyo AstraZeneca and Bellerophon. Amin AP Patterson M House JA Giersiefen H Spertus JA Baklanov DV Chhatriwalla AK Safley DM Cohen DJ Rao SV Marso SP. Costs associated with access site and sameday discharge among Medicare beneficiaries undergoing percutaneous coronary intervention. JACC Cardiovascular Interventions. Feb. . Washington University School of Medicines employed and volunteer faculty physicians also are the medical staff of BarnesJewish and St. Louis Childrens hospitals. The School of Medicine is one of the leading medical research teaching and patientcare institutions in the nation currently ranked sixth in the nation by U.S. News World Report. Through its affiliations with BarnesJewish and St. Louis Childrens hospitals the School of Medicine is linked to BJC HealthCare."

"EPA and DHA omegas reduce the risk of coronary heart disease CHD according to results of a new comprehensive metaanalysis published in the Mayo Clinic Proceedings. Among randomized controlled trials RCTs there was a statistically significant reduction in CHD risk in higher risk populations including percent in those with high triglycerides and percent in those with high LDL cholesterol. A nonstatistically significant percent risk reduction among all populations in RCTs a finding supported by a statistically significant percent reduced risk of CHD among prospective cohort studies. What makes this paper unique is that it looked at the effects of EPA and DHA on coronary heart disease specifically which is an important nuance considering coronary heart disease accounts for half of all cardiovascular deaths in the U.S. said Dr. Dominik Alexander lead author and Principal Epidemiologist for EpidStat. The percent reduced risk among RCTs coupled with an percent risk reduction in prospective cohort studies which tend to include more reallife dietary scenarios over longer periods tell a compelling story about the importance of EPA and DHA omegas for cardiovascular health. Additional study details include The study reviewed randomized controlled trials RCTs and prospective cohort studies with and subjects respectively. The study examined outcomes such as myocardial infarction sudden cardiac death and coronary death. The study compared the results of RCTs which explore interventions under strict clinical conditions to those of prospective cohort studies that are observational and followed larger populations for longer periods of time. There are important public health implications related to reducing the risk of coronary heart disease and therefore we are encouraged by the results of this comprehensive analysis said Dr. Harry Rice Vice President of Regulatory and Scientific Affairs for the Global Organization for EPA and DHA Omegas GOED which funded the study. Its also important that the observed risk reductions were even stronger in patient populations with elevated triglycerides and LDL cholesterol levels two risk factors that affect more than one quarter of the American population. The results confirm that increasing omegas is a healthy lifestyle intervention that can contribute towards reductions in CHD risk added Adam Ismail Executive Director of GOED. Remember that increasing omega intakes is basically just improving the quality of ones diet slightly like reducing the amount of sodium or increasing your dietary fiber. It is a simple inexpensive and achievable change that most consumers need to make to optimize their health. An accompanying editorial in Mayo Clinic Proceedings also acknowledges the importance of the study. The metaanalyses of Alexander and colleagues suggests that omega fatty acid intake may reduce risk of adverse CHD events especially among people with elevated levels of TGs or LDLC....omega fatty acid intake of at least gram of EPADHA per day either from seafood or supplementation as recommended by the American Heart Association continues to be a reasonable strategy said the authors. Study authors did point out that further clinical trials looking specifically at CHD outcomes may continue to provide a better understanding of the promising beneficial relationship between EPADHA and CHD risk. Current RCTs have varying durations different baseline CHD status for study participants and utilize several methods for patient selection and randomization. Future studies should Increase patient populations to account for dropout rates in longer trials. Extensively detail how subjects are diagnosed to create uniform diagnostic criteria. Be appropriately powered to detect an effect in current clinical conditions. Measure baseline omega intake or status of study participants to determine the extent to which it confounds results. The study was supported by a grant from GOED which played no role in study design in the collection analysis and interpretation of data in the writing of the report or in the decision to submit the article for publication."

"Its somewhat of a littleknown adverse effect of having breast cancer but studies suggest that approximately to of women with breast cancer report persistent hot flashes. Nocturnal hot flashes are among the most problematic because they can contribute to poor sleep. A new study shows that electroacupuncture may be effective in providing some relief. The study is being published online in Menopause the journal of The North American Menopause Society NAMS. Compared with women who undergo natural menopause women with breast cancer are at a greater risk of experiencing hot flashes partially as a result of the premature menopause that results from chemotherapy and surgery as well as estrogen deficiency caused by the use of breast cancer treatments such as tamoxifen and aromatase inhibitors. It is estimated that by the year there will be nearly six million breast cancer survivors in the United States. Researchers analyzed data from a randomized controlled trial involving breast cancer survivors experiencing bothersome hot flashes. They compared the benefits of using electroacupuncture the application of a pulsating electric current to prescribing gabapentin an antiseizure medication frequently prescribed to treat sleep disturbances related to hot flashes. The study showed electroacupuncture to be comparable to if not better than gabapentin in helping to reduce hot flash severity and frequency and improving overall sleep quality including falling asleep faster and fewer sleep disruptions. Although it is not exactly understood how acupuncture affects sleep it has been shown to affect a number of neurotransmitters associated with sleep such as serotonin and melatonin. Poor sleep is particularly bothersome for breast cancer survivors experiencing nighttime hot flashes because it has been shown to increase levels of pain fatigue depression and anxiety. Although electroacupuncture produced significant sleep improvements researchers noted that sleep quality for the participants was still not as good as it should be implying that more research is necessary to explore possible combinations of pharmacologic and nonpharmacologic treatments. This study shows that for women who need or choose to avoid medications electroacupuncture may be an option because it has minimal risks but blinded controlled trials are needed says Dr. JoAnn Pinkerton NAMS executive director. Funding for the study was provided in part by a grant from the National Institutes of HealthNational Cancer Institute Cancer Center. Founded in The North American Menopause Society NAMS is North Americas leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging. Its multidisciplinary membership of leaders in the fieldincluding clinical and basic science experts from medicine nursing sociology psychology nutrition anthropology epidemiology pharmacy and educationmakes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate unbiased information about menopause and healthy aging. To learn more about NAMS visit http"

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

"A UCLAled study has found that a treatment that uses a bacterialike agent in combination with an immunotherapy drug could help some people with advanced melanoma an aggressive form of skin cancer live longer. The research showed that using the immunotherapy drug pembrolizumab and the experimental agent SD a sequence of nucleic acids that mimics a bacterial infection altered the microenvironment around the tumor in a way that enabled the immune system to more effectively attack the cancer. The research was an earlystage study conducted to test the side effects and best dosage of a potential new combined therapy and the findings were published httpcancerdiscovery.aacrjournals.orgcontentearly.CD today in the journal Cancer Discovery. Pembrolizumab which is marketed under the brand name Keytruda works by blocking a protein called PD which interferes with immune system function. Blocking PD with pembrolizumab enables the immune system cells to better attack the cancer. While pembrolizumab has been a significant advancement for treating people with a variety of advanced or metastatic cancers a majority of metastatic melanoma tumors are still resistant to the drug. We have found that the reason patients with metastatic melanoma do not initially respond to immunotherapy with an antiPD is that their immune system was not ready said Dr. Antoni Ribas the studys lead author a professor of medicine at the David Geffen School of Medicine at UCLA and director of the UCLA Jonsson Comprehensive Cancer Center httpscancer.ucla.edu Tumor Immunology Program. So we thought What if we change that by injecting the therapy drug into the metastatic lesions and change the microenvironment of the cancer Its like having a pile of wood but not having a match to light it. With this new approach SD is the match that starts the fire. The researchers found that SD not only directs T cells to cancer cells but it also makes the microenvironment more hospitable for the T cells so that they can better kill the cancer cells. All people in the study had an advanced stage of inoperable or metastatic melanoma. Nine were receiving an immunotherapy treatment for the first time as part of the study. Seven of those nine had a positive response to the drug combination including two for whom the tumors disappeared completely. The other people in the study had previously received a type of immunotherapy before the study. Of them two had a partial response meaning parts of the tumors shrank but the tumors did not go away completely. Five more showed some reduction in the tumors but the other participants did respond to the therapy. The results of the study suggest that the combination of pembrolizumab and SD could provide an alternative treatment for people with melanoma whose tumors have not responded or would be unlikely to respond to other therapies. For all patients with advanced cancer immunotherapy using PD inhibitors has really changed the face of cancer treatment. Unfortunately this therapy still only works in a subset of patients said Dr. Deborah Wong assistant clinical professor of medicine at the Geffen School of Medicine and an oncologist at the Ronald Reagan UCLA Medical Center who was also an author of the paper. This particular combination has been especially gratifying because not only does the SD therapy drug induce tumor shrinkage at the actual site where its injected but its working in conjunction with pembrolizumab to shrink tumors outside of the ones were directly injecting. The study highlights the need for more research into combination therapies like this one because many people with cancer do not respond to immunotherapy or experience a reoccurrence of their tumors after treatment. We are really starting to understand the science of how immunotherapies work in patients said Ribas who is also the director of the Parker Institute for Cancer Immunotherapy Center at UCLA. By understanding that we can find more ways to make that therapy more active. One way is by combining the therapy with another agent that can overcome the resistance that some cancers have to these therapies. The study was funded by Dynavax Technologies Corp. which provided SD. Merck Co. provided pembrolizumab. Ribas research is funded by the Parker Institute for Cancer Immunotherapy and the National Institutes of Health."

"Nobody looks forward to having a cavity drilled and filled by a dentist. Now theres an alternative an antimicrobial liquid that can be brushed on cavities to stop tooth decay painlessly. The liquid is called silver diamine fluoride or S.D.F. Its been used for decades in Japan but its been available in the United States under the brand name Advantage Arrest for just about a year. The Food and Drug Administration cleared silver diamine fluoride http for use as a tooth desensitizer for adults and older. But studies show it can halt the progression of cavities http and prevent them http and dentists are increasingly using it offlabel for those purposes. Knox Urschel had a liquid treatment silver diamine fluoride brushed on a decaying tooth. Studies have shown that the antimicrobial liquid can halt the progression of cavities and prevent them.CreditCaitlin OHara for The New York Times The upside the great one is you dont need to drill and you dont need an injection said Dr. Margherita Fontana a professor of cariology at the University of Michigan. Advertisement Silver diamine fluoride is already used in hundreds of dental offices. Medicaid patients in Oregon are receiving the treatment and at least dental schools have started teaching the next generation of pediatric dentists how to use it. Dr. Richard Niederman the chairman of the epidemiology and health promotion department at the New York University College of Dentistry said Being able to paint it on in seconds with no noise no drilling is better faster cheaper. I would encourage parents to ask for it he added. Its less trauma for the kid. The main downside is aesthetic Silver diamine fluoride blackens the brownish decay on a tooth. That may not matter on a back molar or a baby tooth that will fall out but some patients are likely to be deterred by the prospect of a dark spot on a visible tooth. Until more insurers cover it patients also have to cover the cost. Still its relatively inexpensive. Dr. Michelle Urschel an anesthesiologist was happy to pay to have Dr. Jeanette MacLean a pediatric dentist in Glendale Ariz. paint over a cavity that her son Knox had recently developed. Editors Picks A cavity that had to be drilled cost . The liquid was very affordable Dr. Urschel said. The noninvasive treatment may be ideal for the indigent nursing home residents and others who have trouble finding care. And many anxious dental patients want to dodge the drill. But the liquid may be especially useful for children. Nearly a quarter of to yearolds have cavities according to the Centers for Disease Control and Prevention httpwell.blogs.nytimes.comuntreateddentaldecayisfallingamongchildren. Some preschoolers with severe cavities must be treated in a hospital under general anesthesia http even though it may pose risks to the developing brain. S.D.F. gives us an opportunity to decrease the number of toddlers with cavities going to the O.R. said Dr. Arwa Owais an associate professor of pediatric dentistry at the University of Iowa httpsclinicaltrials.govctshowNCT. Dr. Laurence Hyacinthe a pediatric dentist in Harlem used silver diamine fluoride on eight uncooperative children whose parents wanted to delay a trip to the operating room. Dr. MacLean said People assume that parents will reject it because of poor aesthetics. But if it means preventing a child from having to be sedated or having their tooth drilled and filled there are many parents who choose S.D.F. she added. After Dr. MacLean treated Knox she gave him a sticker.CreditCaitlin OHara for The New York Times After Dr. MacLean treated Knox she gave him a sticker.CreditCaitlin OHara for The New York Times Alejandra Bujeiro was delighted that her yearold daughter Natalia didnt have to have two cavities filled in the back of her mouth. Instead Dr. Eyal Simchi https a pediatric dentist in Elmwood Park N.J. brushed silver diamine fluoride on the decay. Two front teeth however were drilled. Next time Ms. Bujeiro said shed opt for silver diamine fluoride. I would use it in baby teeth even if its in front she said. As for the discoloration You cant see it too much. Advertisement Silver diamine fluoride has another advantage over traditional treatment It kills the bacteria that cause decay. A second treatment applied six to months after the first markedly arrests cavities studies have shown. S.D.F. reduces the incidence of new caries and progression of current caries by about percent said Dr. Niederman who is updating an evidence review of silver diamine fluoride published in . Fillings by contrast do not cure an oral infection. Theres nothing that goes on in an operating room that treats the underlying problem said Dr. Peter Milgrom a professor of pediatric dentistry at the University of Washington who was instrumental in receiving F.D.A. clearance for silver diamine fluoride and has a financial stake in Advantage Arrest. Thats why some children must have dental treatment under anesthesia twice. Bacterial infections also cause acne but a dermatologist doesnt take a scalpel and cut off your pimples said Dr. Jason Hirsch a pediatric dentist in Royal Palm Beach Fla. Yet thats how dentistry has approached cavities. Dr. Hirsch has a Facebook page called SDF Action https where dentists can discuss individual cases. Knox getting a highfive from Dr. MacLean after being treated with silver diamine fluoride. The cost of the treatment . By comparison a filling would have run .CreditCaitlin OHara for The New York Times Knox getting a highfive from Dr. MacLean after being treated with silver diamine fluoride. The cost of the treatment . By comparison a filling would have run .CreditCaitlin OHara for The New York Times In January Oregon became the first state to reimburse Medicaid providers for treating cavities with silver diamine fluoride. Its a completely new paradigm that offers significant savings said Dr. Bruce W. Austin the dental director of the Oregon Health Authority http You need only a drop to treat five teeth and it comes out to pennies per tooth said Dr. Scott L. Tomar a University of Florida dentistry professor who treats some Medicaid patients. Toddlers in lowincome families sometimes have to wait a year for fillings in an operating room. The new alternative is a huge deal said Dr. Tomar the chairman of the oral health section https of the American Public Health Association. Advertisement Silver diamine fluoride also may help nursinghome residents who often experience severe cavities if their teeth arent routinely brushed httpwell.blogs.nytimes.cominnursinghomesanepidemicofpoordentalhygiene. Transporting and treating frail patients assuming they can afford to see a dentist can be difficult. But now some patients can be quickly treated where they live. Still silver diamine fluoride is no silver bullet. Patients with mouth sores or a silver allergy cant use it. Severe cavities huge holes that trap food and plaque still require fillings. At dental conferences Dr. Tomar and Dr. Fontana lecture about the treatment. They ask audiences if they are using it so far just a few hands go up."

"When the results of a test wouldnt change how doctors manage a patients care most say its not worth doing. But new tests for breast cancer risk mutations beyond the wellknown BRCA genes would offer actionable information for many women and their doctors a new study finds. The BRCA and BRCA gene mutations put women at high risk for breast ovarian and other cancers but mutations of other genes are believed to confer extra risk as well. Earlier this year genetic experts argued against testing for a wider panel of breast cancerrelated gene mutations until they are proven to be valid and useful in clinical practice see Reuters story of May here reut.rsTvOoDf httpreut.rsTvOoDf. Theres a lot of controversy even among experts said the senior author of the new study Dr. Leif W. Ellisen of Massachusetts General Hospital Cancer Center in Boston. For years atrisk women have only been tested for BRCA and but many companies now offer multigene panels for or other genes Ellisen told Reuters Health. Are patients better off getting these much broader tests he said. Does it actually change what you would tell them to do in terms of screening prevention or risk management According to the new results at least for some women it would change their clinical management he said. Several of the authors of the new paper disclosed that they receive research funding consult for or are employed by genetic testing companies like Myriad Genetics and Invitae Corporation. Between and the study team did panel tests for or genes on women who were referred for hereditary breast or ovarian cancer gene testing but had tested negative for BRCA mutations. Most of the women had a personal history of breast or ovarian cancer already. The researchers found that women or percent of the total group did have potentially harmful mutations in other genes. Of those women had mutations carrying low to moderate risk of breast or ovarian cancer eight had mutations associated with Lynch syndrome which increases colon and ovarian cancer risk and three had highrisk breast cancer genes. Including another patients who were referred into the study at a late stage there were women positive for nonBRCA mutations. Of those the researchers decided that would have been considered for additional screening or prevention measures based on their results. And for many family testing would be recommended for firstdegree relatives according to the report in JAMA Oncology. Even among all appropriate candidates who are sent for genetic testing only nine percent will test positive for the BRCA mutations so an additional four percent who have nonBRCA mutations is a significant number Ellisen said. Often these additional women do not have a high risk of breast or ovarian cancer but some do have a high risk of colon or uterine cancer and would be referred for additional screening he said. Multigene testing is not more expensive than testing for the BRCA mutations alone he said. Though these results indicate that additional genetic screening is clinically useful some genetic test results will be uncertain and it can be psychologically difficult for patients to deal with this uncertainty Ellisen said. We do not advocate for broad populationbased screening he said. The interpretation of these tests is not a simple colorbynumbers thing. The vast majority of uncertain genes will be benign but a misinterpretation could lead a patient to a drastic unnecessary surgical procedure he said. Many cancer genetics experts have again urged caution characterizing the use of multigene testing in the clinical setting as premature Dr. Elizabeth M. Swisher of the University of Washington Medical Center in Seattle writes in a commentary accompanying the new paper. Yet thousands of women and their physicians are ignoring this advice ordering a wide selection of multiplex tests daily Swisher writes. The train has left the station and is unlikely to return so it is important to assess how useful this additional testing can be she concludes. SOURCE bit.lyLeE httpbit.lyLeE and bit.lyLpLj httpbit.lyLpLj JAMA Oncology online August ."

"New research indicates that dietary soy products are safe and even beneficial for women diagnosed with breast cancer. Published early online in CANCER a peerreviewed journal of the American Cancer Society the findings may help resolve controversies over soys potential link to breast cancer outcomes. Soy foods are considered among the healthiest for human consumption but their estrogenlike properties have raised concerns of a potential increased risk of breast cancer. This is because in hormone receptorpositive cancer the most common form of the disease there are some concerns that high estrogen levels help cancer cells grow and spread though this remains controversial. Isoflavonesthe component of soy that has estrogenlike propertieshave been shown to slow the growth of breast cancer cells in laboratory studies and epidemiological analyses in East Asian women with breast cancer found links between higher isoflavone intake and reduced mortality however other research has suggested that the estrogenlike effects of isoflavones may reduce the effectiveness of hormone therapies used to treat breast cancer explained Fang Fang Zhang MD PhD of the Friedman School of Nutrition Science and Policy at Tufts University. Because of this disparity it remains unknown whether isoflavone consumption should be encouraged or avoided for breast cancer patients. To provide some clarity Dr. Zhang and her colleagues looked at the relationship between dietary intake of isoflavones and death from any cause in American and Canadian women diagnosed with breast cancer. Over a median followup of nine years women with breast cancer who consumed high amounts of isoflavones had a percent lower risk of dying than women who consumed low amounts. This decrease was largely confined to women with hormone receptornegative tumors and women who were not treated with antiestrogen therapy such as tamoxifen which blocks the effects of estrogen. In contrast to some previous research high levels of isoflavone intake were not associated with greater mortality among women receiving hormonal therapy. Based on our results we do not see a detrimental effect of soy food intake among women who were treated with endocrine therapy said Dr. Zhang. For women with hormone receptornegative breast cancer soy food products may potentially have a protective effect. Women who did not receive endocrine therapy as a treatment for their breast cancer had a weaker but still statistically significant association. More than percent of all new breast cancer cases with known estrogen and progesterone receptor status are receptornegative and they have poorer survival rates than hormone receptorpositive cases. Whether lifestyle factors can improve survival after diagnosis is an important question for women diagnosed with this more aggressive type of breast cancer. Our findings suggest that survival may be better in patients with a higher consumption of isoflavones said senior author Esther John PhD of the Cancer Prevention Institute of California. The investigators noted that they examined only naturally occurring dietary isoflavones not isoflavones from supplements. How isoflavones from foods interact with breast cancer cells is unclear but research has shown that they have antioxidant antiinflammatory antiangiogenic and other effects that could influence tumor survival and growth. In an accompanying editorial Omer Kucuk MD of the Winship Cancer Institute of Emory University noted that the United States is the number soy producer in the world and is in a great position to initiate changes in health policy encouraging soy intake. We now have evidence that soy foods not only prevent breast cancer but also benefit women who have breast cancer. Therefore we can recommend women to consume soy foods because of soys many health benefits he wrote. Additional information NOTE The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the Cancer News Room upon online publication. For more information or to obtain a PDF of any study please contact Dawn Peters US sciencenewsroomwiley.com mailtosciencenewsroomwiley.com Follow us on Twitter WileyNews httpstwitter.comWileyNews Full Citation Dietary Isoflavone Intake and AllCause Mortality in Breast Cancer Survivors the Breast Cancer Family Registry. Fang Fang Zhang Danielle E. Haslam Mary Beth Terry Julia A. Knight Irene L. Andrulis Mary Daly Saundra S. Buys and Esther M. John. CANCER Published Online March DOI .cncr.. URL Upon Publication httpdoi.wiley.com.cncr. Author Contact Siobhan Gallagher of the Tufts University Public Relations Office at Siobhan.gallaghertufts.edu mailtoSiobhan.gallaghertufts.edu or . Editorial Soy Foods Isoflavones and Breast Cancer. Omer Kucuk. CANCER Published Online March DOI .cncr.. URL Upon Publication httpdoi.wiley.com.cncr. About the Journal CANCER is a peerreviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology course and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online at httpwileyonlinelibrary.comjournalcancer. Follow us on Twitter JournalCancer httpstwitter.comJournalCancer and Facebook https About Wiley Wiley a global company helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific technical medical and scholarly journals combined with our digital learning assessment and certification solutions help universities learned societies businesses governments and individuals increase the academic and professional impact of their work. For more than years we have delivered consistent performance to our stakeholders. The companys website can be accessed at http"

"Women who undergo mammograms every two years instead of every year have fewer falsepositive results but the tradeoff is a slightly higher risk of being diagnosed with latestage breast cancer new research finds. After years biennial mammograms reduced the risk of falsepositives by about onethird and over a lifetime that would accumulate said Rebecca Hubbard lead author of a study published in the Oct. issue of Annals of Internal Medicine and funded by the U.S. National Cancer Institute. But the increase in breast cancer diagnoses wasnt statistically significant she said. And breast cancer stage was only analyzed in women who actually developed cancer. On the other hand among roughly women screened between and and followed for a decade more than half who received annual mammograms were called back at least once because of a falsepositive result and to percent were recommended to get a biopsy. Fewer women about percent who had biennial screening were called back because of a falsepositive while . percent were referred for a biopsy. Having a previous mammogram for comparison purposes sliced the rate of falsepositives in half. For the study researchers used data from NCIs Breast Cancer Surveillance Consortium. Women undergoing onceyearly mammograms need to be prepared for possible call backs and being prepared may reduce the anxiety around such an event the authors stated. This is the latest volley in an ongoing debate about when to start mammography screening in women. In the U.S. Preventative Services Task Force USPSTF a governmentsponsored organization startled the world by recommending that women start mammograms at age instead of and then only once every two years rather than once a year. The move released an outcry in the medical community leading to this and other studies to try to determine the best timing for mammograms the only screening tool shown to reduce deaths from breast cancer. The new study gives a nod in the direction of the UPSTF recommendations but practitioners arent necessarily ready to let go of the longstanding onceayear recommendation. Hubbard an assistant investigator with Group Health Research Institute in Seattle Wash. said she definitely wouldnt make a specific recommendation for individual women. I feel its really an individual choice where a woman needs to think about her own risk tolerance and also their own breast cancer risk. This gives women more information as to what the risks and benefits of mammography are added Dr. Stephanie Bernik chief of surgical oncology at Lenox Hill Hospital in New York City. Its a personal choice as to whether or not you absolutely have to screen at . As breast surgeons were still going to advocate that mammograms start at . A second study in the same journal issue looked at more than U.S. women screened from to and found that newer digital mammography and older film mammography were similarly accurate in finding cancer in women ages through . But in premenopausal women in their s who tend to have denser breast tissue digital mammography performed better. Again though the risk of falsepositives was higher than with film mammography. There was a tradeoff here as well said Hubbard who was also an author of this study. In general in women aged to the two modalities performed pretty equivalently but in younger women the sensitivity of digital mammography was a little bit better so it found more cancers but there was also a bigger decrease in specificity resulting in more falsepositives. More information The U.S. National Cancer Institute has more on mammography http"

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

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

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

"Researchers have identified two new biological markers of cystic fibrosis CF a genetic disease which affects children and young adults leaving them with lifelong health complications including digestive problems and persistent lung infections. The findings published in the journal ACS Central Science shed new light on the underlying mechanisms of CF and could lead to improved prognosis and better therapies for a disease which is quite variable affecting different children in different ways say researchers. There are chemical signatures in sweat that tell us an infant has CF says Philip BritzMcKibbin lead author of the study and a professor in the Department of Chemistry and Chemical Biology at McMaster University. We set out to discover whether there were chemical indicators detected in sweat that could complement the gold standard for CF diagnosis the sweat chloride test. The test is commonly used in universal newborn diseasescreening programs and measures the concentrations of salt. Elevated sweat chloride confirms that an infant actually has CF. But there are some obstacles that complicate clinical decisionmaking explains BritzMcKibbin because sweat chloride can result in ambiguous diagnoses in some borderline cases and does not reveal how the disease might progress for individual patients. Sweat contains lots of information related to human health that researchers have not fully analyzed and we found some unexpected chemicals associated with CF he says. Using a specialized technique developed at McMaster scientists collected and analyzed sweat samples from infants in CF clinics at the McMaster Childrens Hospital and the Hospital for Sick Children in Toronto. They identified several unknown chemicals beyond chloride that were consistently associated with babies who had CF including two different drug and environmental compounds the infants secreted in sweat at much lower concentration levels. Testing for these biomarkers could be done in cases in which the chloride sweat test result is unclear say researchers. The biomarkers also point to other underlying mechanisms that contribute to the progression of CF and could lead to better therapeutic interventions earlier in life. The easier it is to detect CF the earlier it can be diagnosed and the better peoples chances are at living a longer healthier life says Joanna Valsamis Chief Healthcare Research and Advocacy Officer at Cystic Fibrosis Canada. CF Canada invests heavily in research that aims to improve the lives of people living with CF and findings such as those from Dr. BritzMcKibbin are crucial to our understanding of the disease. In Canada one in every children are diagnosed with CF. But life expectancy rates have risen dramatically in recent decades with the median age of survival now over years due to better treatments to improve lung function better nutrition and lung transplants. Further benefits are expected with the advent of newborn screening programs that have resulted in early detection. The research was funded in part by Cystic Fibrosis Canada. Since CF Canada has invested more than million in leading CF research and care."

"Every year in Europe three million people are admitted into hospitals for suspected mild traumatic brain injury mTBI cases. Yet of these patients will be able to return home safely as no trauma has been detected. Today the only reliable diagnosis is the CT Scan which is only available in some hospitals and in addition to being expensive exposes patients to radiations. Researchers from the University of Geneva UNIGE in collaboration with the Hospitals of Barcelona Madrid and Seville have developed a small device PointofCare Test POCT that analyses the level of proteins in the blood and allows using a single drop of blood to diagnose the possibility of a mild traumatic brain injury. This discovery described in PLOS ONE will not only relieve emergency departments free patients from often long waits but also save on costly medical examinations. Falling whilst skiing tumbling down the stairs or getting hit on the head can cause symptoms such as blurred vision vomiting loss of consciousness or memory for about minutes. There is then a risk of mild cerebral trauma which represents more than of brain injuries admitted to hospitals. But is there really a brain lesion Or are these symptoms merely the consequence of the violence of the shock of which will ultimately only leave a bump behind Today the injured patients have to go to the emergency rooms of hospitals equipped with a CT Scan an expensive examination that sends Xrays to the brain to detect the presence or absence of brain trauma. As their case is not a priority it often takes a long time for the majority of patients to return home without risk of sequelae except for bad memories. Find biomarkers for light traumas We wondered if it was possible to isolate certain proteins whose presence in the blood increases in the event of mild traumatic brain injury explains JeanCharles Sanchez professor at the Department of Internal Medicine of Specialties and the Biomarkers Centre of the Faculty of Medicine of the UNIGE. Our idea was to find a way to do a quick examination that would allow during a boxing or American football match for example to determine whether the athlete can return to the field or if his condition requires hospitalization. The opposite of the CT Scan an exam that lasts a long time and cannot be done anywhere he adds. During a shock on the head some brain cells are damaged and release the proteins they contain increasing their level in the blood. Scientists at UNIGE and Spanish hospitals then compared the blood of patients admitted for mild traumatic brain injury but diagnosed as negative with that of patients actually suffering from a brain lesion. Using proteomic analyses which can quantify thousands of proteins simultaneously and observe variations in their levels in the blood they gradually isolated four molecules indicating the presence of a brain injury HFABP Interleukin SB and GFAP. We have noticed that the HFABP level alone makes it possible to confirm that there is no risk of trauma in one third of patients admitted after a shock enthuses JeanCharles Sanchez. The rest of the patients will have to undergo a CT scan to confirm the diagnosis. TBIcheck the light brain trauma detector It was still necessary to develop a device that could be used everywhere quickly and simply and that could be available in pharmacies or sports halls. When a person has an accident in the mountain few practices can do a CT Scan notes the Geneva researcher. His team has developed a rapid diagnostic test POCT called TBIcheck inspired by the principle of pregnancy testing by placing a single drop of blood on the well of a small cm plastic case the patient knows within minutes whether there is a risk of mild trauma namely whether or not his HFABP level is higher than . nanograms per millilitre of blood. If a lane appears the injured person must go to a hospital for a CT scan if there is nothing he can go home safely JeanCharles Sanchez says. In case of doubt when reading the result a small reader the Cube Reader can be installed on TBIcheck. It will display the word positive or negative and send the result to the patients or caregivers smartphone via Bluetooth. No more doubts Commercialization planned for beginning These results patented by UNIGE and awarded the Prix de lInnovation Academy in December will be marketed from by ABCDx a startup founded four years ago by JeanCharles Sanchez of UNIGE and Joan Montaner of Vall dHebron Hospital in Barcelona coauthors of this study. Today our research shows that the results are even more accurate when we combine HFABP and GFAP levels continues JeanCharles Sanchez. We are currently preparing an even more effective TBIcheck which will allow of patients to be sent home but which requires an increase in the sensitivity of the test that receives the blood. ABCDxs ultimate goal is to bring to market biomarkers capable of diagnosing brain trauma stroke and aneurysms. Biomarkers are a mine of information on patients state of health it is up to us to decode them concludes the Geneva researcher."

"A dizzying number of factors can conspire against sexual desire as midlife approaches depression medications illness career worries financial pressures marriage troubles young children in the home or an empty nest the sense that life is half over and then theres testosterone. Usually we think of testosterone as a hormone that men have in abundance. But testosterone plays a big role in setting the pace for a womans sex drive as well. And both men and women experience a natural drop in testosterone that can cause libido to ebb in midlife. Testosterone levels peak in the mids for both men and women. For women who have about to the amount of testosterone that men have testosterone levels taper off slowly until they plateau around the age of . For men testosterone levels continue to wane into their s. By the time women reach menopause their testosterone levels are about half of what they were in their s. Mens testosterone levels decrease by about per year and then drop faster as they approach older age. Testosterone treatment for men and women can help restore the hormone to a level that will push the sexual accelerator. But how often you feel like jumping in the sack is tied to so many complex biological and lifestyle factors experts say that its important to make sure youre treating the appropriate issues. If you have a serious illness or depression those should be addressed separately. And a number of things can go wrong with testosterone treatment. Testosterone use is very widespread but its misused a lot says Dr. Glenn Braunstein an endocrinologist and chairman of the department of medicine at CedarsSinai Medical Center in Los Angeles. Inaccurate diagnoses can result simply because blood draws were done at the wrong time of day. In men testosterone levels peak in the morning and dip in the afternoon so if doctors rely on a single blood test done in the afternoon they may misdiagnose the source of the problem Braunstein says. Men have a number of options for treating low testosterone including the topical gels Testim and AndroGel. These prescription drugs deliver the hormone from the skin into the bloodstream. Testosterone patches and injections are also available. The wellknown Viagra and its counterparts on the other hand dont have any effect on libido rather they improve erectile function. Getting and maintaining an erection requires generation of nitric oxide which aids in engorgement of blood vessels. But when nitric oxide levels drop too quickly the erection is lost. Viagra which is made only for men inhibits the breakdown of nitric oxide to keep an erection from waning prematurely. Patients whose testosterone levels are low may not benefit fully from taking Viagra until levels of the key hormone are increased Braunstein says. Yet in some cases testosterone can help both libido and erectile function though its not entirely clear why that is so. The observation has been that you may not get an adequate response to Viagra unless you add testosterone back Braunstein says. But he notes we do not want men who are otherwise normal in regards to testosterone to run out and get it because they want a better effect from Viagra. The Food and Drug Administration has not approved any testosterone treatments for women though a topical gel called LibiGel is in advanced clinical trials. To fill the void doctors sometimes resort to prescribing offlabel treatments for women such as low doses of the gels approved for men says Sheryl Kingsberg a clinical psychologist and chief of obstetricsgynecology behavioral medicine at University Hospitals Case Medical Center in Cleveland. But Kingsberg emphasizes that other factors such as exercise fatigue sleep deprivation stress cardiovascular disease and obesity cannot be overlooked when trying to restore or maintain sex drive. All of those things absolutely affect overall health and sexual health she says. The converse is true as well. Studies show that having a healthy sex life can improve health and wellbeing. And for women who reach menopause and assume their best days are behind them Kingsberg has two words No way. Its important for postmenopausal women to know that the quality of a relationship has been shown to be a much better predictor of sexual health and sexual satisfaction than age and menopausal status she says. And another reason to keep ones libido in good working order Without it a relationship can really suffer she says. Bad sex does way more to subvert an otherwise good relationship than good sex does to promote an average one. READ MORE Midlife and What to Do About It http"

"Sick with depression Harriet Bruce spent her days lying in bed for months at a time. Pills didnt work. Neither did psychotherapy. Then she agreed to a transcranial magnetic stimulation. The new treatment pushes powerful magnetic currents into the front of the brain the part that controls emotions. These days Bruce awakens before her alarm goes off and dives into projects including monster tasks she once dreaded. I have a room in my house in which I had stacked boxes from when we moved years ago that I wanted to get to but I couldnt do it the Centerville woman said. But Ive been working on that. Transcranial magnetic stimulation once considered an experimental treatment for depression is gaining acceptance since it came on the market four years ago. Beginning Saturday Medicare will cover the treatments when other therapies have failed. This week specialty insurance administrator Magellan Behavioral Health Inc. issued medical necessity guidelines for TMS treatment and will provide coverage effective Jan. . Doctors who use the NeuroStar TMS Therapy system say treatments are more effective than medications with far fewer side effects. Its an alternative to electroconvulsive therapy shock treatments for patients who have not responded to drugs or psychotherapy. But TMS is expensive. It can cost as much as for a minute session and require multiple treatments. The total bill can range between and . The cost however is less than an extended hospital stay. We had several patients who were headed toward the hospital who had this treatment and were able to avoid that said Dr. Scott West a psychiatrist who pioneered the treatment in Nashville and onehalf years ago. The NeuroStar system resembles a dentists chair. A patient sits in the chair while a magnetic pulse emitter transmits energy from a levered arm a process similar to undergoing dental Xrays. The device makes a clicking noise while delivering the magnetic pulses. When this large magnet pulses repetitively it causes an electromagnetic field which then passes through the skull and stimulates the brain tissue itself said West explaining a cascading effect that results in the interior nerve fibers connecting better. Dr. Michelle Cochran purchased her TMS system about months ago. The devices cost around Cochran said who has treated patients with the therapy. Most people are not scared of it she said. It sounds sort of creepy and weird when you think about it but for the most part it is safer in general than taking a medicine. Youve got less seizure risk than taking a medicine. Youve got less side effects than taking a medicine. Both Cochran and West cite high patient response rates. A clinical trial funded by the National Institutes of Health revealed a significant effect of treatment when patients received TMS treatment. It compared outcomes of patients who actually received the magnetic pulses against patients in a sham group who sat down in the treatment chair for fake sessions. Depressed patients who received the real TMS treatment had remission rates four times higher than those in the sham group. However insurers including UnitedHealthcare and BlueCross BlueShield of Tennessee remain reluctant to embrace the treatment. UnitedHealthcares medical policy for TMS says it is unproven for treating depression. Generally speaking just because a device procedure or medication has been approved or is deemed to be safe by some entities does not mean that it is automatically covered BlueCross BlueShield spokeswoman Kelly Allen said. Quality and safety are our first priority in setting our medical policy but those have to be balanced with affordability. Cochran does not accept Medicare and has chosen to be an outofnetwork provider. West is a Medicare provider. Said West Typically when Medicare starts to cover something the excuse of experimental and investigational is no longer valid."

"With just a drop of blood doctors may one day be able to detect pancreatic cancer in its early stages before it has become deadly a new study suggests. An international team of researchers was able to identify percent of patients with latestage pancreatic cancer as well as those with earlier stage disease by looking for a protein in the blood that is made in abundance by tumor cells. That protein turns up in tiny virussized particles called exosomes which are excreted by all of the bodys cells according to the study published in Nature. But by good fortune the protein turns up in exosomes only when there is cancer so its presence could be an early and testable marker for the disease. Its rare to discover pancreatic cancer early said study coauthor Dr. Raghu Kalluri professor and chairman of the department of cancer biology at the MD Anderson Cancer Center. People dont feel any symptoms that make them want to go to the clinic until their cancer is stage or stage he added. Using this test we were percent accurate at identifying all cancer patients. In Americans will be diagnosed with pancreatic cancer according to estimates by the National Cancer Institute. And an estimated will die from the disease. It is the most deadly cancer with just . percent surviving five years. For perspective over the course of a lifetime . percent of Americans will develop pancreatic cancer. While quite promising the new findings will need to be verified and validated by other studies experts told NBC News. And even if it passes muster it will take some time before a test could be developed to screen for the disease. Kalluri and his colleagues examined serum samples from patients with pancreatic cancer patients with breast cancer and healthy volunteers. They found levels of the protein in exosomes correlated with the severity of the disease so there was more in patients with more advanced disease. It was not present in the healthy volunteers. Even more promising are the findings from the seven patients with early pancreatic cancer that were detectable through their protein levels. Further levels dropped when patients had surgery to remove their tumors so the marker could also be used to follow the progression of the disease Kalluri said. Kalluri says that a screening test might be available in as little as a year. But he said this is just a speculation based on the current strength of the study."

"A new drug appears to be effective for shrinking uterine fibroids https and controlling the heavy menstrual bleeding they often cause according to new research from Europe. In one study the drug ulipristal acetate proved to be much more effective than a placebo https for shrinking the nonmalignant uterine tumors. In another ulipristal acetate was found to be as effective as monthly injections of the drug Lupron for reducing heavy bleeding in women with uterine fibroids https Both studies appear in the Feb. issue of The New England Journal of Medicine. Ulipristal acetate is the active chemical in the emergency contraceptive sold in the U.S. as Ella but the daily doses taken by the fibroid patients in the studies were much smaller than those in the contraceptive. If trials now under way in the U.S. prove positive New Jerseybased Watson Pharmaceuticals Inc. and Swissbased PregLem hope to market ulipristal acetate as a fibroid treatment under the trade name Esmya says Watson spokesman Charlie Mayr. in Women Have Fibroid Symptoms Uterine fibroids are the most common indication for the close to hysterectomies performed each year in the U.S. About in women in their childbearing years have symptoms related to fibroids such as heavy periods https and related iron deficiency https abdominal pain https and fertility https problems according to figures from the National Institutes of Health. Surgery is the most common uterine fibroid treatment but many women want a nonsurgical treatment option says researcher Jacques Donnez MD PhD of SaintLuc Catholic University of Louvain in Brussels Belgium. Lupron improves symptoms and shrinks uterine fibroids but it does not make them go away. It works by blocking the production of estrogen https the hormone that fuels fibroids and many women who take it develop hot flashes https and other symptoms of menopause https In one of the newly published studies women with excessive bleeding caused by uterine fibroids who took ulipristal acetate for three months had similar improvements in bleeding as patients who got monthly injections of Lupron with significantly fewer side effects. Drug Controlled Bleeding Shrank Fibroids Moderate to severe hot flashes were reported in about of the women treated with ulipristal acetate and of women who took Lupron. In another study ulipristal acetate was compared to placebo in fibroid patients with heavy bleeding and anemia https Treatment with the drug for weeks controlled uterine bleeding in around of patients. In both studies significant reductions in fibroid size were seen during treatment with ulipristal acetate and for some time after. This was a surprise Donnez says. We know that when patients stop taking leuprolide https acetate their symptoms return quickly but this does not appear to be the case with ulipristal acetate. He says this could mean that the newer drug may help patients avoid surgery entirely. It may be that women can go on and off this drug intermittently taking it for a few months when symptoms return he says. Still Too Many Hysterectomies Elizabeth A. Stewart MD a professor of obstetrics and gynecology at the Mayo Clinic in Rochester Minn. says it remains to be seen if the drug is safe for longterm intermittent use. If it is Stewart agrees that ulipristal acetate could help many patients with symptomatic fibroids avoid surgery. She says there are good alternatives to hysterectomy https for the treatment of fibroids but many patients never hear about them. Fibroid patients need to understand their options so they can at least consider them she tells WebMD. There will still be some women who choose hysterectomy but many others may not."

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

"A saliva test may someday be able to diagnose a concussion and predict how long symptoms last according to a study published Monday httpjamanetwork.comjournalsjamapediatricsfullarticle.jamapediatrics.. in the JAMA Pediatrics. A concussion https_symptoms.html is one type of traumatic brain injury caused by a bump blow or jolt to either the head or the body. Though not lifethreatening these injuries to the brain can be serious and cause symptoms of headache or pressure in the head nausea vomiting dizziness balance problems double or blurry vision sluggishness confusion memory problems and difficulty concentrating. In their study Penn State College of Medicine researchers found five small molecules called microRNAs in saliva with real potential for identifying concussive symptoms in children teens and young adults. MicroRNAs influence protein activities throughout the body and they are easily measured in biofluids including blood cerebrospinal fluid and saliva according to the authors. Dr. Steve Hicks senior author of the study and an assistant professor of pediatrics at Penn State College of Medicine said the five microRNAs in saliva could predict with approximately accuracy which concussed children would have symptoms one month later. In comparison standard survey measures that are typically used in clinics were approximately accurate. The study was funded in part by Quadrant Biosciences a biotech company that hopes to bring a saliva test for concussion to market in the next to months Hicks said. Concussions affect mostly children In there were about . million https_the_facts.html traumatic brain injuryrelated ER visits hospitalizations and deaths in the US according to the Centers for Disease Control and Prevention. Nearly twothirds https of concussions take place in children and teens Hicks and his coauthors noted. Although most patients symptoms disappear within two weeks onethird of children and teens may experience prolonged symptoms of concussion. Its frustrating for both parents and physicians that we cant accurately and objectively predict how long a childs concussion symptoms might last what those symptoms are likely to consist of and when it might be safe for them to return to sports or school said Hicks who as a practicing pediatrician has routinely cared for kids with concussions. For the study Hicks and his coauthors looked at patients between the ages of and with an average age of . MicroRNA expression was measured in saliva spit into a cup by the patients who had been injured mostly in sports or car accidents when they arrived at Penn State Hershey Medical Center for an evaluation. Of the had prolonged symptoms and had shortterm symptoms of mild traumatic brain injury. Levels of five microRNAs accurately identified patients with prolonged symptoms in the study. Even more the five saliva biomarkers were more accurate than the Standardized Concussion Assessment Tool a questionnaire currently used to help make a diagnosis of mild traumatic brain injury. The questionnaire httpbjsm.bmj.comcontentbjsports.full.pdf is not a standalone tool but one used in conjunction with an assessment made by a medical professional. It notes that an athlete may have a concussion even if their score is normal. We found three microRNAs that were highly associated with specific symptoms one month after injury such as headache fatigue and memory difficulties Hicks said. He added that creating an actual test for use by doctors will require collaboration on the part of researchers. Fortunately the technology required to measure saliva RNA is already employed in medicine we use it to check patients for upper respiratory viruses in our hospitals and clinics every day Hicks said. Modifying this approach for patients with concussions could potentially provide a rapid objective tool for managing brain injury. The new research represents an advance in the science of sportrelated concussions according to an editorial https.jamapediatrics.. published alongside the study in JAMA Pediatrics. Way too early to know However the editorial authors Dr. William P. Meehan III of Micheli Center for Sports Injury Prevention at Boston Childrens Hospital in Massachusetts and Dr. Rebekah Mannix of Brain Injury Center at Boston Childrens Hospital noted that the relatively small sample size in this study requires largerscale studies to determine the reliability of the results. For example they noted that the use of nonsteroidal antiinflammatory medications is common among those with more severe injury. In the study those who had used antiinflammatory medications were the ones with longerterm symptoms. Possibly then the drugs may be a potential confounding variable they wrote meaning that medication may influence test results and symptoms adding an element of confusion to the study and its possible interpretation. Still the findings are promising representing potential biomarkers for the diagnosis recovery and prognostic assessment of a sportrelated concussion. Dr. Jeffrey Kutcher a neurologist and National Director of The Sports Neurology Clinic at The CORE Institute said that work like this is important because it does provide potential for tests that can be helpful in the clinical setting. I think the main caveat is this is way too early to know what this type of tool can do for us added Kutcher who was not involved in the new research. The main reason is that theres a difference between simply having a brain that experiences force and being concussed. The saliva biomarker may be showing that neurons experienced force and not that a there is a concussion with which the brain cannot perform its typical functions within a normal range he said I would hesitate to assign too much potential groundbreaking science. Follow CNN Health on Facebook and Twitter See the latest news and share your comments with CNN Health on Facebook https and Twitter httpstwitter.comcnnhealth. Other biomarkers including blood are being investigated as potential concussion tests he said though nothing is at this stage or beyond this. There are also tools that look at the electrical networks that brains form he said disclosing that he is consulting for a company working on one such technology. A patient undergoes an electroencephalogram while doing a cognitive task and the EEG records how the brain responds. By actually measuring the brain network activity directly you can look at really what is the functional health of the brain he said. In addition some scientists are exploring functional MRI techniques to look at the metabolic function of different areas of the brain to gain insight into concussion he said. Hicks said he and his colleagues are collaborating with others to examine saliva biomarkers in adult athletes and members of the armed services. Because the markers we identified in this study are not correlated with patient age we are hopeful they may be applied in adult populations as well he said."

"Alyssa Gold had planned on getting married by age and having kids by age but life worked out differently. Instead at age she was single and successful and about to start an MBA program. But her dreams of having a family were real and she began to be concerned as she got older about her chances of having a baby. I knew starting a family was a few years off said Gold. I was very careerminded and very focused and had relationships throughout my s and early s but still wasnt in that forever relationship. Women are born with a finite number of eggs they start out with roughly one to two million in their ovaries. Once a woman hits puberty the number drops to and by age the amount decreases by percent. In her mids Alyssa worried how many eggs she had left. Turns out theres a simple blood test that could tell her. For years its been a staple in fertility clinics its officially called the AntiMllerian hormone AMH test. Some doctors are now offering it as an option to healthy women to assess what they call their ovarian reserve. Its now being called the baby deadline test. There are some young healthy women who are living their lives in shape and taking very good care of themselves who might not know that their reserve strength of their ovaries is lower than it should be. said Dr. Joshua Hurwitz a reproductive endocrinologist and infertility specialist with Reproductive Medical Associates of Connecticut. Its a question of having the knowledge and awareness of keeping your options open. The test is a simple blood analysis that usually costs less than . It measures the amount of AMH circulating in a womens bloodstream. This hormone is released by follicles in the ovaries and predicts the amount of possible eggs a woman has. The higher the result the more eggs the lower the result the fewer eggs. The test doesnt measure the quality of the eggs and its not a guarantee of fertility. The test has traditionally been offered to women who are struggling to get pregnant and helps assess the possible next steps such as getting pregnant sooner or freezing eggs. For Alyssa Gold the AMH test was a wakeup call. At her regular gynecology visit Gold took the AMH test and received news she didnt wanted to hear but it helped her take the next right step for her. I took the AMH test and Im glad I did because the results were not what I was hoping them to be said Gold. My tests were really below normal and that was an indicator to me that I needed to move ahead with taking control of my fertility at that time and doing something which was egg freezing. Gold finished her graduate studies and soon after met her future husband. She is now happily married and at age thinking about starting a family soon. Shes grateful to the Baby Deadline Test for giving her that option. Completely fortunate that I was able to get the information and make that decision that there is this medical technology out there to help me in that way said Gold. If I had waited until I met my husband and we were trying now to have a child it would be a very different story. Even the best AMH level in the world is not a guarantee for someone going forward or even right now but they are good indicators for fertility said Hurwitz. Theres no way you should lose hope theres so many things we can do these days and starting early enough we can use this information to keep options open no matter what the result is youre going to be okay."

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

"At age Angelica Lopez is helping to break a sound barrier for deaf children. Born without working auditory nerves she can detect sounds for the first time and start to mimic them after undergoing brain surgery to implant a device that bypasses missing wiring in her inner ears. Angelica is one of a small number of U.S. children who are testing whats called an auditory brainstem implant or ABI. The device goes beyond cochlear implants that have brought hearing to many deaf children but that dont work for tots who lack their hearing nerve. When the ABI is first turned on she isnt going to be hearing like a yearold. Shell be hearing like a newborn audiologist Laurie Eisenberg of the University of Southern California tells parents. She outlined the research Friday at a meeting of the American Association for the Advancement of Science. The children dont magically understand and use those sounds. Its going to take a lot of work Eisenberg cautioned. Angelica cried when her ABI first was switched on scared by the sounds. But five months later her mother says the youngster uses sign language to identify some sounds that was a cough thats a dog barking. And shes beginning to babble like hearing babies do as therapists work to teach her oral speech. Its just so awesome to hear her little voice said Julie Lopez of Big Spring Texas who enrolled her daughter in the study at USC where researchers say shes progressing well. Many children born deaf benefit from cochlear implants electrodes that send impulses to the auditory nerve where theyre relayed to the brain and recognized as sound. But the small fraction born without a working hearing nerve cant make that brain connection. The ABI attempts to fill that gap by delivering electrical stimulation directly to the neurons on the brainstem the nerve normally would have targeted. Heres how it works The person wears a microphone on the ear to detect sound and a processer changes it to electrical signals. Those are beamed to a stimulator under the skin which sends the signals snaking through a wire to electrodes surgically placed on the brainstem. The Food and Drug Administration approved the device in specifically for adults and teenagers whose hearing nerves had been destroyed by surgery for a rare type of tumor. It doesnt restore normal hearing but can help to varying degrees. Then about a decade ago an Italian surgeon started trying the ABI in deaf children whose younger brains are more flexible and might better adapt to this artificial way of delivering sound. Now spurred by some successes abroad the first U.S. studies in young children are underway at a handful of hospitals. Hearing specialists are watching the work closely. There are children who are not being helped in any other way said Dr. Gordon Hughes of the National Institutes of Health which is funding Eisenbergs study. And cochlear implants proved theres a critical time window when the brain is very receptive to auditory stimulation and can develop speech communication in ways that are surprisingly good if the stimulation is started early enough. The studies are small each enrolling to children. Ages vary the Los Angeles study will implant starting at age while some others try earlier. Children then receive intensive therapy to learn to hear. The studies must prove safety since the ABI requires delicate brain surgery in healthy children. Were talking about real surgery to go into a deep area of the brain said Dr. Marc Schwartz a neurosurgeon with the House Clinic and Huntington Medical Research Institutes in Los Angeles who is part of the USC study. This is a precise operation that requires exacting technique. In skilled hands complications appear rare said Robert Shannon a USC professor of otolaryngology who helped develop the device. Postsurgery stimulator complications can include nonauditory sensations such as tingling of the face or throat. Next questions include who are the best candidates and what benefit to expect if children really will develop speech as well as with cochlear implants and hear well enough to talk on a phone. Scientists know far more about how to stimulate the inner ear than the brain directly Shannon noted. What were giving to these kids is something very different than what any normal system would be getting he explained. To untangle that scrambled pattern the brain is picking up the slack. Its covering our tracks."

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

"In the FDA warned the public that the use of common antidepressants like Prozac and Paxil late in pregnancy could put a baby at risk https for respiratory failure. Many women with depression https faced a difficult decision continue their medication during pregnancy potentially putting their child at risk or jeopardize their own mental health by going off the drugs. The FDA advisory pointed to a single study showing a sixfold increased risk of a condition called persistent pulmonary hypertension https in newborns whose mothers were taking antidepressants. But now a new largescale study finds that the risk is negligible much lower than previously believed reports CBS Bostons Dr. Mallika Marshall httpboston.cbslocal.comantidepressantsduringpregancyposelowrisktounbornbabystudyfinds. Researchers at Brigham and Womens Hospital in Boston looked at . million pregnant women nationwide and found that those taking popular antidepressants called SSRIs did not appear to be at significantly increased risk of having a baby with pulmonary hypertension. The risk increase of taking antidepressants late in pregnancy if present is much more modest than previous studies have found says Krista Huybrechts Ph.D. an epidemiologist at Brigham and Womens Hospital. So for women with severe debilitating depression that is not responsive to other nonpharmacological treatments this should be reassuring information. Its certainly reassuring news for Dr. Katherine Economy a maternal fetal medicine specialist at the Brigham who cares for many pregnant women on antidepressants. They take them because they have a disease that impacts their daily life Economy says. And for many women they cannot get through their daily activities getting out of bed taking a shower and preparing food for themselves. So for many of these women these medications are lifesaving and lifealtering. Dr. Economy warns patients about the potential risks like withdrawal in the newborn and a small risk of heart defects but says for many women the worst time to stop their medications is at the end of pregnancy when postpartum depression becomes a concern. My basic message is that overall there may be some slight risks associated with the medication but in balancing risks and benefits for most women I would suggest they stay on their medication she said."

"Despite several safe drug therapies available to help smokers quit threequarters report relapsing within six months of a quit attempt. University of Pennsylvania researchers Rebecca Ashare and Heath Schmidt saw potential for a permanent cessation solution in a class of FDAapproved medications used to improve cognitive impairments from Alzheimers disease. In a study consisting of a rat trial and a human trial Ashare and Schmidt studied the effects of two acetylcholinesterase inhibitors or AChEIs called galantamine and donepezil on overall nicotine intake. The rat component showed that pretreating the rodents with an AChEI decreased their nicotine consumption. Consistent with these effects clinical trial participants taking the AChEI not the placebo smoked . fewer cigarettes daily a percent decrease and noted feeling less satisfied with the cigarettes they did smoke. Were very interested in screening potential efficacy of antiaddiction medications in our models said Schmidt a professor in Penns School of Nursing and Perelman School of Medicine. For this study we looked at potential smokingcessation medications. The research itself took a translational approach what Ashare a professor in Penn Medicines psychiatry department calls bidirectional. In other words the preclinical data informed the clinical study and vice versa. At Penns Center for Interdisciplinary Research on Nicotine Addiction work on smoking cessation has been ongoing since . Specifically research from Caryn Lerman CIRNAs director and the Mary W. Calkins Professor in Psychiatry concluded that people who quit smoking often report a decrease in whats commonly called their executive functions. They feel fuzzy. Theyre forgetful Ashare said. Those deficits are related to their ability to quit smoking. It was this clinical aspect of smoking cessation we thought would be useful to take further. Thats when they turned to the acetylcholinesterase inhibitors. In the brain the neurotransmitter called acetylcholine is important to cognitive functions like learning and shortterm memory. When nicotine enters the body it binds to the same receptors in the brain that acetylcholine binds to resulting in smokings rewarding and reinforcement effects. Acetylcholinesterase inhibitors increase acetylcholine levels in the brain and in effect substitute nicotines effects. Schmidt had successfully employed such a model with other addictive substances like cocaine. He divided a group of rats into galantamine and donepezil cohorts. To mirror voluntary drug taking in humans the rats selfadministered nicotine using a lever pushed at will. Once nicotinetaking stabilized the rats were pretreated with one of the two AChEIs. For both drugs we were able to show a reduction in total nicotine selfadministered Schmidt said however there was a caveat. We know from the literature that upward of percent of patients will report nausea and vomiting when taking these drugs and this will limit their compliance he said. We had seen that these drugs reduced nicotine selfadministration but we wanted to make sure it wasnt because the rats were sick. Unlike humans who can verbally report when they dont feel well and whose bodies react to nausea rats lack the reflex to vomit. In previous research Matthew Hayes who has appointments in Penn Medicine and Penn Nursing had shown that in rats kaolin clay consumption coats the stomach like an antacid and quells any ill effects. Collaborating with Hayes Schmidt offered the animals kaolin clay then compared how much they ate normally and with the addition of the AChEIs. At the doses shown to reduce nicotine selfadministration the AChEIs did not make our animals sick Schmidt said. The findings sparked the CIRNA clinical trial which has to date studied smokers ages to . People who were interested in quitting smoking signed on for days. For the first two weeks they continued to smoke but also took either galantamine or a placebo. Before the trial began researchers assessed the smokers cognitive function to get a baseline. Participants followed the regimen for two weeks and then were asked to not smoke for one full day. Two more assessments took place after the two weeks on the cigarettedrug combination and again after that initial smokefree day. Finally the researchers asked the study subjects to do their best to not smoke for seven straight days a time during which the participants still took either galantamine or a placebo. That weeklong period is a proxy for longerterm cessation. The ability to quit smoking the first week after you make a quit attempt is highly predictive of longterm success Ashare said. Shes still actively recruiting for the trial with an aim of people total. Once the trial reaches that number shell dig into overall quit data. What shes learned so far that smokers who used the FDAapproved galantamine smoked fewer cigarettes per day and enjoyed them less is promising particularly given that those who dont smoke during that first crucial week are times more likely to quit smoking permanently. Our goal in investigating these different repurposed medications is not to replace the medications that are already available she said. We know that theyre effective. Our goal is to target different populations of smokers who may be more likely to experience these cognitive deficits. Theres no data to suggest that a clinician treating a smoker should prescribe one of these AChEIs now. But Ashare and Schmidt are forging a path and if it leads where they think it might it could provide smokers yet another option to help them quit. Ashare and Schmidt published their work in the Nature journal Translational Psychiatry."

"The irony isnt lost on Bryan Moore and probably not on the driver who slammed into his car on April shattering the lower legs of one of the most highprofile personalinjury attorneys in Denver. But appreciation of lifes weird turns doesnt translate into physical rehabilitation which is where a NASAinspired machine dubbed the AlterG AntiGravity Treadmill comes in. Its a stateoftheart device that allows people with lowerbody injuries to walk and even run in a simulated lowgravity environment. For Moore whose Bulldog lawfirm advertisements adorn area billboards its a godsend. From an orthopedic standpoint I got hurt worse than . percent of my clients Moore said during a recent rehab session with the AlterG. But this machine is miraculous. Actually its rooted in science The concept of using advanced differential air pressure technology for weight support was conceived by Robert Whalen a NASA researcher who was studying the biomechanics of exercise in space. The first version arrived in developed by the namesake company in Fremont Calif. A secondgeneration commercial version came out in October . A recent morning found Moore gearing up for his twiceweekly minute workout on the machine during his regular therapy session at The Suites at Holly Creek a retirement community and assistedliving facility in Centennial where he spent several weeks before returning to his practice. He was assisted by Jennifer Lo Holly Creeks director of rehabilitation. At the AlterG is expensive but the technology is simple. Compressed air is pumped into a plastic chamber over the treadmill creating lift. The patient is sealed from the waist down inside the chamber and a computer panel allows patients to take up to percent of their body weight off their joints. So a pound man can wind up effectively feeling like he weighs only pounds a real boon when youre trying to rehab shattered shins as Moore is. Gearing up At first glance Moore looked like he was gearing up for a deepsea dive. Step was getting into a pair of neoprene shorts topped with a stiff reinforced fabric that encircled his waist. This ring contained a zipper that when Moore stepped onto the treadmill was attached to another zipper forming a seal. Air was pumped in and Lo programmed the AlterG to let Moore walk at percent of his pound body weight. His legs were effectively supporting a pound man. Moore who still limps badly months after the accident started walking with alacrity no trace of hobbling at all. The thing about this machine is that when patients get in here and offload their weight by or percent they can resume their normal gait Lo said. And theyre not just working their legs theyre getting a cardio workout too. As Moore walked on the treadmill he marveled at what it allows him to do. Im walking as fast as I did before the accident said Moore . Im walking as normal as I did a year ago. When his session ended the machines whirring stopped and the plastic bubble encasing his lower body deflated. Moore stepped onto the carpeted floor and took a few halting steps toward the leg brace he wears. Now here I am back in real life he said. There are only a few of the pound units in the area. The Suites at Clermont Park uses them. Ditto for Mountain View Physical Therapy in Evergreen Azura Senior Living in Boulder and the Life Care Center of Littleton. Mountain Views AlterG is available to the general public and athletes sometimes rent time on it to do speed work and interval training. Knee back rehab We use it a lot for patients doing postsurgical rehab for their knees and backs says Valerie Gluth a physical therapist and Mountain Views owner. It lets people walk with a normal gait so they dont develop bad habits that lead to other orthopedic problems. A limp is easy to develop and hard to get rid of. Elite distant runners such as Dathan Ritzenhein and Shannon Rowbury have used the AlterG and professional sports teams such as the Los Angeles Lakers and Englands Manchester United soccer club have used the machines. Theyre also used at Walter Reed Army Medical Center to treat injured soldiers and at the Olympic Training Center in Colorado Springs. The AlterG treadmill is an excellent rehabilitation device Rowbury said. It was a huge asset to me when I was recovering from a stress fracture in my hip because it allowed me to reintroduce running in a safe lowimpact environment. I could gradually build up my strength so that when my bone was healed enough to tolerate fullbody weight running my muscles were strong enough to support me. The machines are also used to help obese patients not just for training but in giving them incentive by showing them how their feet and knees would feel better if they lost say pounds. I think theyre going to be everywhere with rehab units and with recreational and elite athletes too said Lo who is a trail runner and competitive ultra marathoner in her off hours."

"Bottom Line The investigational anticancer therapeutic abemaciclib which targets CDK and CDK showed durable clinical activity when given as continuous singleagent therapy to patients with a variety of cancer types including breast cancer nonsmall cell lung cancer NSCLC glioblastoma and melanoma according to results from a phase I clinical trial. Journal in Which the Study was Published Cancer Discovery a journal of the American Association for Cancer Research. Senior authors Amita Patnaik MD associate director of clinical research at South Texas Accelerated Research Therapeutics in San Antonio Texas and Geoffrey I. Shapiro MD PhD director of the Early Drug Development Center at the DanaFarber Cancer Institute in Boston. Background In February the U.S. Food and Drug Administration FDA approved the CDK inhibitor palbociclib Ibrance for use in combination with the aromatase inhibitor letrozole for treating postmenopausal women with estrogen receptorpositive HERnegative advanced breast cancer. The oral CDK inhibitor abemaciclib is a very different molecule from palbociclib with distinct attributes that contribute to its discrete therapeutic effects in particular its singleagent activity according to Shapiro. For example abemaciclib has greater selectivity for CDK compared with palbociclib which may explain why it does not affect white blood cell counts as severely allowing it to be taken on a continuous schedule without treatment holidays he said. Abemaciclib also penetrates the central nervous system whereas palbociclib does not raising the possibility that it could be used to treat primary or metastatic brain tumors he added. How the Study Was Conducted and Results Patnaik Shapiro and colleagues enrolled patients with a variety of types of advanced cancer in the phase I clinical trial designed to evaluate the safety and preliminary efficacy of abemaciclib. In the dose escalation phase the researchers determined that the maximum tolerated dose was milligrams mg every hours the doselimiting toxicity was grade fatigue. In the expansion phase singleagent abemaciclib was administered to patients with breast cancer with NSCLC with glioblastoma with melanoma and with colorectal cancer. Among these patients the most common treatmentrelated adverse events were fatigue diarrhea nausea vomiting anorexia weight loss kidney dysfunction and decreased red and white blood cell counts. Radiographic responses were observed for some patients with breast cancer NSCLC and melanoma. Among the patients with hormone receptorpositive breast cancer had a partial response with four of the responders having continued prior endocrine therapy and an additional patients had stable disease. Among the patients with NSCLC two had a partial response and had stable disease one patient who had a partial response and who had stable disease were known to have KRASmutant NSCLC. Among the patients with melanoma one had a partial response and six had stable disease. Three of the patients with glioblastoma had stable disease with two of them continuing to receive treatment without disease progression for and cycles respectively. Author Comment These data show that abemaciclib is an oral drug that can be taken on a continuous schedule and achieve durable clinical activity against multiple tumors including breast and lung cancers said Shapiro. The results of the trial supported the FDA decision to grant breakthrough therapy designation to abemaciclib previously known as LY for patients with refractory hormone receptorpositive advanced or metastatic breast cancer added Patnaik. Limitations Patnaik explained that because this study included patients with different types of cancer confirmatory clinical trials in specific patient populations are necessary to precisely define the role of abemaciclib in cancer care. Multiple clinical trials have already been initiated to evaluate abemaciclib as a treatment for certain groups of patients with breast cancer and NSCLC as well as children with primary brain tumors and adults with brain metastases she noted. Funding Disclosures The study was funded by Eli Lilly and Company. Patnaik has received research funding from Lilly. Shapiro served on an advisory board for Lilly during the conduct of the study reports receiving personal fees from Lilly GI Therapeutics Vertex Pharmaceuticals and grants from Lilly for work other than reported here and is an investigator on several trials using other CDK inhibitors including palbociclib and ribociclib. Follow us Cancer Research Catalyst httpblog.aacr.org Twitter AACR and Facebook http About the American Association for Cancer Research Founded in the American Association for Cancer Research AACR is the worlds first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR membership includes more than laboratory translational and clinical researchers population scientists other health care professionals and patient advocates residing in countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention biology diagnosis and treatment of cancer by annually convening more than conferences and educational workshops the largest of which is the AACR Annual Meeting with nearly attendees. In addition the AACR publishes eight prestigious peerreviewed scientific journals and a magazine for cancer survivors patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the Scientific Partner of Stand Up To Cancer the AACR provides expert peer review grants administration and scientific oversight of team science and individual investigator grants in cancer research that have the potential for nearterm patient benefit. The AACR actively communicates with legislators and other policymakers about the value of cancer research and related biomedical science in saving lives from cancer. For more information about the AACR visit http To interview Amita Patnaik or Geoffrey I. Shapiro contact Julia Gunther at julia.guntheraacr.org mailtojulia.guntheraacr.org or ."

"A nonsurgical treatment could improve quality of life for patients with knee pain due to osteoarthritis according to new research presented today at the Society of Interventional Radiologys Annual Scientific Meeting. In the first U.S. clinical trial on geniculate artery embolization GAE a minimally invasive imageguided treatment that blocks key arteries in the knee to reduce inflammation and pain resulted in a majority of study participants achieving significant pain reduction and improvements in range of motion avoiding more invasive measures. A majority of our patients with osteoarthritis of the knee saw significant pain reduction not only just a few days after the procedure but a month after as well making this an accessible treatment for patients looking to improve their quality of life without surgery said Sandeep Bagla M.D. director of interventional radiology at the Vascular Institute of Virginia and lead author of the study. We are very encouraged by the results and the implications for the millions suffering from this common yet debilitating condition. Interventional radiologists perform GAE for knee pain by inserting catheters through a pinholesized incision blocking the very small arteries or capillaries within the lining of the knee reducing the inflammation caused by osteoarthritis. As an outpatient treatment GAE does not require open surgery or physical therapy and takes minutes to perform. This prospective multicenter clinical trial evaluated patients with severe osteoarthritis pain. Each patients pain and disability were measured along two scales with evaluations before and after the treatment. The treatment was successfully completed in all patients with no adverse events. One month later researchers followed the progress of eight patients and found that GAE significantly decreased pain mm on the Visual Analog Scale reduced stiffness and increased physical function . on the Western Ontario and McMaster University Osteoarthritis Index. Together the scales represent an percent improvement in function compared with preprocedure conditions. This procedure could have a significant impact in the treatment of osteoarthritis pain as a whole said Bagla. The current mainstay of treatment in patients who have arthritis are pain medications which come with significant side effects and risks. But GAE provides another option for patients struggling with pain and may even allow patients to avoid the painful recovery of knee surgery and the need for the kind of opioid pain medications associated with the dangerous epidemic in the United States. This study builds on the growing international research around GAE and osteoarthritis. While preliminary data shows that the treatment does work and is feasible it has only been used in a clinical trial setting. The study has completed enrollment of patients and final results are expected in summer . A second randomized controlled clinical trial began in February and will provide further data on what types of patients are the best candidates for this treatment and how it could move toward clinical practice. Abstract Geniculate Artery Embolization GAE for Osteoarthritis OArelated Knee Pain Interim Results from a Multicenter US Trial. S. Bagla R. Piechowiak T. Hartman J. Orlando A. Isaacson Vascular Institute of Virginia Woodbridge VA UNC Chapel Hill Chapel Hill NC University of North Carolina Chapel Hill. SIR Annual Scientific Meeting March . This abstract can be found at sirmeeting.org http About the Society of Interventional Radiology The Society of Interventional Radiology is a nonprofit professional medical society representing more than practicing interventional radiology physicians trainees students scientists and clinical associates dedicated to improving patient care through the limitless potential of imageguided therapies. SIRs members work in a variety of settings and at different professional levelsfrom medical students and residents to university faculty and private practice physicians. Visit sirweb.org http The Society of Interventional Radiology is holding its Annual Scientific Meeting March at the Los Angeles Convention Center in Los Angeles Calif. Visit sirmeeting.org http"

"About percent of patients with moderate to severe psoriasis saw their disease completely or almost completely cleared with a new drug called ixekizumab according to three large longterm clinical trials led by Northwestern Medicine. The results of these phase III trials were compiled in a paper published in the New England Journal of Medicine. This group of studies not only shows very high and consistent levels of safety and efficacy but also that the great majority of the responses persist at least weeks said Dr. Kenneth Gordon a professor of dermatology at Northwestern University Feinberg School of Medicine and first author of the paper. Affecting about percent of the worlds population psoriasis is an immunemediated inflammatory disease that causes itchy dry and red skin. It is also associated with an increased risk for depression heart disease and diabetes among other conditions. Ixekizumab works by neutralizing a pathway in the immune system known to promote psoriasis. To test the drugs efficacy over time and to help clinicians determine whether its benefits outweigh any risks the three studies enrolled a total of adult patients at more than study sites in countries. All participants had moderate to severe psoriasis which is defined as covering percent or more of the body. Patients were randomly assigned to receive injections of ixekizumab at various doses or a placebo over a period of more than a year. The investigators assessed whether the drug reduced the severity of psoriasis symptoms compared to the placebo and evaluated safety by monitoring adverse events. By the th week . to . percent of patients has their psoriasis classified as clear or minimal compared to . of patients on the placebo. By the th week . to . percent of patients had maintained their improvement. Based on these findings we expect that percent of patients will have an extremely high response rate to ixekizumab and about percent will be completely cleared of psoriasis Gordon said. Ten years ago we thought complete clearance of this disease was impossible. It wasnt something we would even try to do. Now with this drug were obtaining response levels higher than ever seen before. Adverse events associated with ixekizumab included slightly higher rates of neutropenia low white blood cell count yeast infection and inflammatory bowel disease compared to the placebo. The safety of therapy longer than weeks will need to be monitored in the future. The drug has been approved by the Food and Drug Administration since the trials were completed. This research was funded by Eli Lilly and Company the manufacturer of ixekizumab. Dr. Gordon is a paid consultant for Eli Lilly and Company."

"Four years ago University of Pennsylvania researchers published early but electrifying results. An experimental Tcell therapy eradicated endstage leukemia in two patients and put a third in remission. Soon after that pharmaceutical giant Novartis partnered with Penn aiming to commercialize the breakthrough. Since then a more modest picture of success has emerged in treating the blood cancer a type called chronic lymphocytic leukemia CLL that usually strikes in middle age or later. Walter J. Urba httpsoregon.providence.orgphysiciandirectoryuurbawalterj director of research at Providence Cancer Center httpsoregon.providence.orgourservicespprovidencecancercenter in Portland Ore. wrote an editorial four years ago cautioning that only wider testing would show whether Penns impressive initial results were an authentic advance for CLL. Last week Urba said Penns Tcell therapy remains very exciting despite the costs and toxic side effects. Everything we do in oncology is a riskbenefit balance Urba said. I suspect that over time well have better Tcell therapies maybe given with other immune therapies. Indeed Penn and other centers have begun testing nextgeneration T cells in more blood malignancies including lymphomas and against the ultimate biological challenge solid tumor cancers. For Penns very first Tcell patient Bill Ludwig the pace of progress is thrilling humbling and yet a bit of a letdown. The retired corrections officer from Bridgeton N.J. was losing his decadelong battle with CLL when he agreed to try the novel therapy in August . I didnt hesitate because I had no options left he recalled last week. And also these people at Penn had been so wonderful to me and my family for years. I felt obligated to say yes. Did I ever think it would be successful Not in a million years. He suffered catastrophic side effects as his immune system went into overdrive and his body struggled to eliminate seven pounds worth of dead cancer cells. I was in intensive care with all my major organs shutting down he said. My lower extremities were twice the size they should have been. They called my wife and said Hes not going to see the sunrise. They were wrong. I was a skeleton when I walked out a month later he said. But I walked out being told they couldnt find any cancer cells in my body. When youve already accepted your fate to have it degrees changed its unnerving. Ludwig and his wife have since bought a recreational vehicle and traveled the country seen grandchildren graduate high school and welcomed three greatgrandchildren. Still he cant help feeling disappointed that the phenomenal early success of the therapy was just that. When two out of three are successful you think maybe it will be out of or out of . I figured if they can cure me they can cure everyone. He corrected himself Theyve never said cured. But cancerfree works for me."

"In just four months highdoses of vitamin D reduce arterial stiffness in young overweightobese vitamindeficient but otherwise still healthy AfricanAmericans researchers say. Rigid artery walls are an independent predictor of cardiovascular related disease and death and vitamin D deficiency appears to be a contributor says Dr. Yanbin Dong geneticist and cardiologist at the Georgia Prevention Institute at the Medical College of Georgia at Augusta University. So researchers looked at baseline and again weeks later in AfricanAmericans ages all of whom had some degree of arterial stiffness taking varying doses of the vitamin best known for its role in bone health. In what appears to be the first randomized trial of its kind they found that arterial stiffness was improved by vitamin D supplementation in a doseresponse manner in this population they write in the journal PLOS ONE. Overweightobese blacks are at increased risk for vitamin D deficiency because darker skin absorbs less sunlight the skin makes vitamin D in response to sun exposure and fat tends to sequester vitamin D for no apparent purpose says Dong the studys corresponding author. Participants taking international units more than six times the daily IUs the Institute of Medicine currently recommends for most adults and children received the most benefit says Dr. Anas Raed research resident in the MCG Department of Medicine and the studys first author. The dose now considered the highest safe upper dose of the vitamin by the Institute of Medicine reduced arterial stiffness the most and the fastest . percent in four months. It significantly and rapidly reduced stiffness Raed says. Two thousand IUs decreased stiffness by percent in that timeframe. At IUs arterial stiffness actually increased slightly . percent and the placebo group experienced a . percent increase in arterial stiffness over the timeframe. They used the noninvasive gold standard pulse wave velocity to assess arterial stiffness. Reported measures were from the carotid artery in the neck to the femoral artery a major blood vessel which supplies the lower body with blood. The American Heart Association considers this the primary outcome measurement of arterial stiffness. When the heart beats it generates a waveform and with a healthy heart and vasculature there are fewer and smaller waves. The test essentially measures the speed at which the blood is moving and in this case fast is not good Raed says. When your arteries are more stiff you have higher pulse wave velocity which increases your risk of cardiometabolic disease in the future says Raed. The varying doses as well as the placebo participants took were all packaged the same so neither they or the investigators knew which dose if any they were getting until the study was complete. Both placebo and supplements were given once monthly rather than daily at home at the GPI to ensure consistent compliance. Dong was also corresponding author on a study published in in the journal BioMed Central Obesity that showed in this same group of individuals both and IUs restored more desirable vitamin D blood levels of nanograms per milliliter. The upperlimit dose restored healthy blood level quicker by eight weeks and was also better at suppressing parathyroid hormone which works against vitamin Ds efforts to improve bone health by absorbing calcium they reported. While heart disease is the leading cause of death in the United States according to the Centers for Disease Control and Prevention blacks have higher rates of cardiovascular disease and death than whites and the disease tends to occur earlier in life. The authors write that arterial stiffness and vitamin D deficiency might be potential contributors. While just how vitamin D is good for our arteries isnt completely understood it appears to impact blood vessel health in many ways. Laboratory studies have shown that mice missing a vitamin D receptor have higher activation of the reninangiotensinaldosterone system says Raed. Activation of this system increases blood vessel constriction which can contribute to arterial stiffness. Vitamin D also can suppress vascular smooth muscle cell proliferation activation of garbageeating macrophages and calcification formation all of which can thicken blood vessel walls and hinder flexibility. Vitamin D also reduces inflammation an underlying mechanism for obesity related development of coronary artery disease says Raed. Now its time to do a largerscale study particularly in highrisk populations and follow participants progress for longer periods Dong and Raed say. A year would give us even more data and ideas Raed adds. Dong notes that pulse wave velocity and blood pressure measures are complimentary but not interchangeable. We think maybe in the future when you go to your physician he or she might check your arterial stiffness as another indicator of how healthy you are Raed says. There were no measurable differences in weight or blood pressure measurements over the week study period. The Institute of Medicine currently recommends a daily intake of IUs of vitamin D for those age and older. For adolescents and adults they recommend IUs as the upper daily limit was a previous upper limit. More than percent of Americans the majority of whom spend their days indoors have vitamin D insufficiency or deficiency. Dong an expert in vitamin D and a professor in the MCG Department of Population Health Sciences says about minutes daily in the young sun between a.m. and p.m. but before your skin starts to get pink is the best source of vitamin D. Foods like milk milk products like cheese and yogurt fatty fish like mackerel and sardines some greens like kale and collards and fortified cereals also are good sources. The researchers say a vitamin D supplement is an inexpensive and safe option for most of us."

"Many heart doctor will tell you that one of the best ways to keep your heart healthy is to include more healthy oils httptime.complantssciencehealthierdietbestclimate such as omega fatty acids httptime.comfishoilomegaantidepressants found in fish in your diet. Studies have shown that people in parts of the world who eat more fish have lower rates of heart disease and fewer heart attacks though the same cant necessarily be true of those who take supplementssee this piece Fish Oil Is Hugely PopularBut Should You Take It httpstimeinc.slack.comfilesaliceparkFWFVKZUZcstl____article.pdf for more on that. One thing that has been less clear is what role fish oil plays in people who have already had a heart attack. Can omega fat provide similar benefit Researchers led by Dr. Raymond Kwong at Brigham and Womens Hospital wanted to find out so they took advantage of more sophisticated imaging techniques that can provide detailed pictures of the heart and how its changing in the days and weeks after a heart attack. For the study published in the journal Circulation they studied nearly people who recently had a heart attack who were randomly assigned to take g of omega fatty acids or a placebo pill for six months. Thats a high dose a oz. portion of salmon contains anywhere from half a gram to g of omega. Every two months the volunteers came in for an MRI of their heart to track how much the muscle was changing. Normally after a heart attack part of the heart is starved of oxygen and that portion never recovers. The remaining healthy tissue starts to compensate for the compromised tissue but has to work harder to maintain the hearts normal pumping function. Over time this overworking can lead to scar tissue and start to restrict even the healthy tissues ability to do its job. Kwong and his team found that people taking the high dose of omega fats showed less of this decline in heart function than those taking placebo. Whats more the people who showed the highest blood levels of the omega fats people absorb it at different rates showed the greatest reduction in scarring compared to those with the lowest levels. The effects remained strong even after the researchers accounted for the fact that all of the people were taking standard heart disease treatment drugs including cholesterollowering statins and blood pressure medications. The omega fatty acids seem to be preventing scarring of the otherwise healthy muscle that now has to overwork because of the heart attack says Kwong. Based on analysis of their blood samples the people taking omega supplements also showed lower levels of inflammatory markers httptime.cominflammationhealtheffects which suggests that the fish oil may be working by reducing inflammation following a heart attack. Its the first encouraging strategy for protecting the heart after a heart attack the more remaining healthy tissue that can be saved the stronger the heart will be. Kwong says that the findings are only the first step toward considering whether omega fatty acid supplements should be part of every emergency heart attack response. The g is a high dose previous studies in which people were given g of fish oil were more inconsistent. Most of the people also started taking the supplements two to four weeks after their heart attack. Might they have benefit more if they had started taking the supplements sooner How much omega is needed to start remodeling the heart in a beneficial way These are questions Kwong and others hope to answer with more studies. Kwong collected blood samples from the volunteers and will be studying them for hints about how omega fatty acids are working in the body after a heart attack. To say every heart attack patient should be taking omega fatty acids right away is a bit premature he says. But I do think its logical that our results hold promise and may reduce bad outcomes in patients after a heart attack."