Datasets:

saikat02004

/

criteria_8

like 0

"If you spend all day sitting on your rear end then you might want to schedule some time for a brisk walk just make sure you can spare at least an hour. Scientists analyzing data from more than million people found that it takes about to minutes of moderate intensity exercise to undo the damage of sitting for at least eight hours a day. Not exercising and sitting all day is as dangerous as being obese or smoking they found. And the added risk of parking yourself in front of a television for hours or more a day after sitting at the office is so high even the hour of exercise is not enough to reverse the damage. We cannot stress enough the importance of getting exercise whether its getting out for a walk at lunchtime going for a run in the morning or cycling to work said Ulf Ekelund of the Norwegian School of Sports Sciences in Norway one of the study authors in a statement. It has been long suspected that sitting a lot at work or at home is not healthy. Previous studies have found that prolonged sitting can raise the chances of heart disease various cancers and an earlier death. In the new research experts combed through papers with data on factors including how long people spend sitting their physical activity levels and their televisionwatching habits. The majority of studies included people older than age . All except one were done in the U.S. Western Europe and Australia. Researchers found that people with the highest levels of moderate physical activity to minutes daily erased the higher risk of death linked to being seated for more than eight hours a day. But even that exercise regime was not enough to counter the hazards of also watching more than five hours of television a day. The paper was published online Wednesday in the journal Lancet. Lars Bo Andersen who coauthored an accompanying commentary called the new research very convincing explaining that too much sitting increases the risk of problems including diabetes and heart disease because it can make insulin levels spike and might slow the bodys metabolism. Andersen said that watching lots of television was probably even worse than sitting at the office all day because it likely includes other unhealthy habits. A lot of people dont just watch TV they eat fatty snacks at the same time said Andersen of Sogn and Fjordane University College in Norway. Andersen said that some cultures make it easier than others to squeeze in an hour of exercise every day noting that in Denmark and much of Scandinavia about half of all people either cycle or walk to work. But he said that getting the recommended amount of physical activity shouldnt be overly arduous and doesnt necessarily mean going to the gym for an intense workout. If you are walking and can feel yourself getting a little warm and your breathing is a little heavier thats enough he said. You dont have to be sweaty and out of breath to get the benefits. Copyright The Associated Press http All rights reserved. This material may not be published broadcast rewritten or redistributed."

"Elekta EKTAB.ST today announced new data demonstrating stereotactic body radiation therapy SBRT is a safe treatment option for earlystage lung cancer patients aged or older. The results which were based on data from more than patients across five institutions that comprise the Elekta Lung Research Group are available online and will be published in the July print issue of International Journal of Radiation Oncology Biology Physics http The study evaluated safety and efficacy outcomes of patient reports collected in a multiinstitutional database. Patients were treated with SBRT for earlystage lung cancer between and and followed for a median of . years. The cohort included patients under years of age patients ages to years and patients aged years or more which included patients aged years or more. The median age was years range to . Study results show no significant differences among the three age groups with respect to year local recurrence regional recurrence distant metastases or the incidence of grade or higher toxicity. Causespecific survival was similar among all three age groups . to . percent. Twoyear overall survival was lower in older patients which is likely related to other medical issues. Older patients are often not considered for radiation therapy due to concerns about their ability to tolerate treatment. The results of our study clearly support the use of SBRT for elderly patients especially those who may not be able to tolerate longer courses of radiotherapy or more invasive treatment options says Meredith Giuliani MBBS FRCPC MEd a radiation oncologist in the Cancer Clinical Research Unit at Princess Margaret Cancer Centre University Health Network in Toronto and lead study author. Radiation oncologists need to work closely with our peers in other parts of the medical community to ensure that patients with diagnosed or suspected earlylung cancer are evaluated for potential treatment with SBRT regardless of age. This study is the largest series of its type to evaluate SBRT outcomes in patients aged years and older says Joel Goldwein MD Senior Vice President Medical Affairs for Elekta. In addition to providing important support for using SBRT to treat earlystage lung cancer in elderly patients these findings highlight the value of multiinstitutional collaborations and large data sets that can provide statistically meaningful answers to critical questions about treatment outcome and guide clinical decision making. The Elekta Lung Research Group ELRG is an international collaboration of physicians and physicists that is evaluating clinical outcomes in earlystage nonsmall cell lung cancer patients. To date they have accumulated data on close to such patients and identified medical and technical factors that affect tumor control and toxicity. Their collective experience is among the largest multinational series of patients treated with imageguided SBRT to date. The ELRG includes participants from William Beaumont Hospital in Royal Oak Michigan Princess Margaret Cancer Centre Thomas Jefferson University in Philadelphia Pennsylvania JuliusMaximilians University of Wrzburg in Wrzburg Germany and The Netherlands Cancer InstituteAntoni van Leeuwenhoek hospital in Amsterdam The Netherlands. Disclosure This research was partially supported by Elekta through a research grant with all institutions being members of the Elekta Lung Research Group. This work and these data however are the intellectual property of the individual group members and their sponsoring institutions. The authors declare no other conflicts of interest. The following files are available for download httpmb.cision.comMain.pdfPDF SOURCE Elekta"

"A new study finds that a noninvasive electromagnetic brain stimulation technique helps obese people lose weight partly by changing the composition of their intestinal bacteriathe socalled gut microbiota. Results of the technique called deep transcranial magnetic stimulation dTMS will be presented Sunday at ENDO the Endocrine Societys th annual meeting in Orlando Fla. This study expands on the researchers previous finding that dTMS reduced food cravings and induced weight loss in obese individuals. Unlike deep brain stimulation dTMS does not need an operation or implantation of electrodes. Instead an electromagnetic coil is placed on the scalp and sends magnetic pulses to stimulate specific deep regions of the brain. Currently approved in the U.S. for treating major depression dTMS is being studied in some countries for the treatment of other neuropsychiatric disorders especially addiction. We need new safe and effective therapies for obesity said principal investigator Livio Luzi M.D. professor and head of endocrinology at the IRCCS Policlinico San Donato and the University of Milan in Milan Italy. Despite numerous preventive and therapeutic interventions none has stopped obesity from reaching epidemic proportions. An underlying cause of obesity may be an impaired gut microbiota composition an imbalance in the complex mix of beneficial and harmful microorganisms that inhabit the digestive tract. Luzi said scientists now know that an impaired gut microbiota can alter the brains signals for appetite and satiety or fullness. He and his coworkers studied whether dTMS could improve the gut microbiota composition in obese persons and if so by what underlying mechanisms. In their study funded by the Italian Ministry of Health the investigators recruited three men and women ages to with obesity as shown by a body mass index BMI of to kgm. They randomly assigned the study subjects to two groups for five weeks to receive sessionsthree times per weekof either dTMS to the insula and prefrontal cortex deep in the brain or a sham stimulation as a control. Before and at the end of treatment subjects provided stool samples for microbiota analysis. The research team also measured blood levels of glucose sugar insulin pituitary gland hormones and neurotransmitters such as norepinephrine. Pituitary hormones play a key role in regulating appetite and recent research shows that norepinephrine and other neurotransmitters affect microbiota composition Luzi said. After five weeks of treatment subjects receiving dTMS lost more than percent of their body weight and more than percent of their fatsignificantly more than controls did Luzi reported. Results of the fecal analysis demonstrated that after five weeks dTMStreated subjects had greatly increased quantities of several beneficial bacterial species with antiinflammatory properties such as are found in healthy people. The control group however had no clinically relevant alterations in their microbiota composition Luzi said. He also reported that changes in the abundance of other bacterial species correlated with improvement of metabolic and hormonal parameters including glucose insulin several pituitary hormones and norepinephrine. These changes suggest a beneficial effect of dTMS on both weight loss and change in microbiota composition Luzi said. Our research shows the innovative ability of dTMS in exerting antiobesity effects through alteration of the gutbrain axis. Endocrinologists are at the core of solving the most pressing health problems of our time from diabetes and obesity to infertility bone health and hormonerelated cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormonerelated conditions. The Society has more than members including scientists physicians educators nurses and students in countries. To learn more about the Society and the field of endocrinology visit our site at http Follow us on Twitter at TheEndoSociety httpstwitter.comtheendosocietylangen and EndoMedia httpstwitter.comEndoMedia."

"Lovers of Indian food give yourselves a second helping Daily consumption of a certain form of curcumin the substance that gives Indian curry its bright color improved memory and mood in people with mild agerelated memory loss according to the results of a study conducted by UCLA researchers. The research httpsdoi.org.j.jagp... published online Jan. in the American Journal of Geriatric Psychiatry examined the effects of an easily absorbed curcumin supplement on memory performance in people without dementia as well as curcumins potential impact on the microscopic plaques and tangles in the brains of people with Alzheimers disease. Found in turmeric curcumin has previously been shown to have antiinflammatory and antioxidant properties in lab studies. It also has been suggested as a possible reason that senior citizens in India where curcumin is a dietary staple have a lower prevalence of Alzheimers disease and better cognitive performance. Exactly how curcumin exerts its effects is not certain but it may be due to its ability to reduce brain inammation which has been linked to both Alzheimers disease and major depression said Dr. Gary Small director of geriatric psychiatry at UCLAs Longevity Center and of the geriatric psychiatry division at the Semel Institute for Neuroscience and Human Behavior at UCLA https and the studys first author. The doubleblind placebocontrolled study involved adults between the ages of and years who had mild memory complaints. Participants were randomly assigned to receive either a placebo or milligrams of curcumin twice daily for months. All subjects received standardized cognitive assessments at the start of the study and at sixmonth intervals and monitoring of curcumin levels in their blood at the start of the study and after months. Thirty of the volunteers underwent positron emission tomography or PET scans to determine the levels of amyloid and tau in their brains at the start of the study and after months. The people who took curcumin experienced significant improvements in their memory and attention abilities while the subjects who received placebo did not Small said. In memory tests the people taking curcumin improved by percent over the months. Those taking curcumin also had mild improvements in mood and their brain PET scans showed significantly less amyloid and tau signals in the amygdala and hypothalamus than those who took placebos. The amygdala and hypothalamus are regions of the brain that control several memory and emotional functions. Four people taking curcumin and two taking placebos experienced mild side effects such as abdominal pain and nausea. The researchers plan to conduct a followup study with a larger number of people. That study will include some people with mild depression so the scientists can explore whether curcumin also has antidepressant effects. The larger sample also would allow them to analyze whether curcumins memoryenhancing effects vary according to peoples genetic risk for Alzheimers their age or the extent of their cognitive problems. These results suggest that taking this relatively safe form of curcumin could provide meaningful cognitive benefits over the years said Small UCLAs ParlowSolomon Professor on Aging. The papers authors in addition to Small are Prabha Siddarth Dr. Zhaoping Li Karen Miller Linda Ercoli Natacha Emerson Jacqueline Martinez KoonPong Wong Jie Liu Dr. David Merrill Dr. Stephen Chen Susanne Henning Nagichettiar Satyamurthy SungCheng Huang Dr. David Heber and Jorge Barrio all of UCLA. The study was supported by the Ahmanson Foundation the Marshall and Margherite McComb Foundation the McMahan Foundation Bob and Marion Wilson the Fran and Ray Stark Foundation Fund for Alzheimers Disease Research the U.S. Department of Energy and the National Institutes of Health. Theravalues Corp. provided the curcumin and placebos for the trial as well as funds for laboratory testing and for Smalls travel to present preliminary findings at the Alzheimers Association International Conference. SEE ORIGINAL STUDY http"

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

"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."

"In a firstofitskind study researchers demonstrate a benefit in overall survival among epithelial ovarian cancer EOC patients receiving generic heart medications known as betablockers. Survival was shown to be greatest among those prescribed firstgeneration nonselective betablockers. According to The University of Texas MD Anderson Cancer Center investigators the drugs block the effects of stress pathways involved in tumor growth and spread. With further research they may also prove beneficial in conjunction with other treatment regimens and across other cancer types. Published today in the journal CANCER the findings are the result of a multiinstitutional retrospective analysis of the medical records of women with ovarian cancer treated between and . Researchers compared overall survival among patients with documented betablocker use during chemotherapy and those without. Among the patients who received betablockers . percent received betaadrenergic receptor selective agents SBBs and the remaining patients received nonselective beta antagonists NSBBs. The research team found For patients receiving any betablocker the median overall survival was . months versus months for nonusers. Median overall survival based on betablocker receptor selectivity was . months for those receiving NSBBs versus months for those receiving SBBs. Even among patients with hypertension a longer median overall survival was observed among users of NSBBs compared with nonusers months versus . months. This study builds on a large body of research by principal investigator Anil Sood M.D. professor in Gynecologic Medical Oncology and Cancer Biology at MD Anderson. It showed that stress hormones fuel progression of ovarian and other cancers and that betablockers among the most proven drugs in cardiovascular medicine might be a new way to stifle that effect. Betablockers treat a variety of conditions such as heart disease highblood pressure glaucoma and migraines. They target a receptor protein in heart muscle that causes the heart to beat harder and faster when activated by stress hormones Sood said. Our research has shown that the same stress mechanisms impact ovarian cancer progression so these drugs could play a new role in cancer treatment. According to Sood the usefulness of betablockers was unclear until now. The ability to show improved survival using nonselective agents which inhibit a specific stress pathway is the culmination of years of research into ovarian cancer biology and pathogenesis. He added that betablocker users in the study presented at a higher stage of disease had an increased average BMI and were more likely to be hypertensive. All these factors were associated with decreased survival yet those who received betablockers had either equivalent or improved overall survival. Further examination revealed that NSBB users had improved overall survival regardless of the presence of such prognostic factors or comorbidities. This was not true for patients who took SBBs. Although further study is needed these results highlight the importance of adrenergic receptor ADRB a signaling pathway important to ovarian carcinogenesis and targeted by NSBBs versus the ADRB pathway targeted by SBBs. Ovarian cancer is the th most deadly cancer among women accounting for more deaths than any other female reproductive system cancer. An estimated new cases are diagnosed and some women die from the disease each year in the U.S. according to the American Cancer Society. Future trials will seek to identify patients who would benefit most from betablocker use and the best betablocker for a specific tumor type based on adrenergic receptor expression. Then they potentially could be used as an adjuvant therapy during surgical recovery and chemotherapy to decrease tumor growth delays in wound healing and metastasis. Betablockers may also reduce cancerrelated psychological distress in newly diagnosed patients according to the study authors. There are currently two clinical trials one led by MD Anderson evaluating the combination of chemotherapy and propranolol a type of NSBB on cancer biology and on stress modulators in patients with newly diagnosed EOC. According to Sood the preliminary data from these feasibility trials will be used to design prospective randomized clinical trials examining NSBBs on patient outcomes. The stratification of patients by betablocker use and selectivity in this study makes it unique among all other studies examining the impact of these drugs on cancer. It also builds on the mounting evidence that betablockers may become a key treatment component for many patients in the future said Sood. Portions of this study were supported by National Institutes of Health grants CA CA CA PCA UCA UCA UCA and CA an Ovarian Cancer Research Fund program Project Development Grant the Department of Defense grants OC WXWJ and OC the Betty Ann Asche Murray Distinguished Professorship the RGK Foundation the Gilder Foundation the BlantonDavis Ovarian Cancer Research Program and a Gynecologic Cancer FoundationSt. Louis Ovarian Cancer Awareness grant. One of the researchers has acted as a paid consultant for Incyte Pharmaceuticals and received research funding from Egen Pharmaceuticals. Other researchers contributing to this study include Robert L. Coleman M.D. Alpa M. Nick M.D. Pedro T. Ramirez M.D. Lois M. Ramondetta M.D. Diana Urbauer Jack L. Watkins all from MD Anderson Susan K. Lutgendorf Ph.D. from University of Iowa Sanjeev Kumar M.B. B.S. from the Mayo Clinic Koji Matsuo M.D. from Mercy Medical Center Kathryn Squires M.D. and Premal H. Thaker M.D. M.S. from Washington University School of Medicine."

"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."

"Cognitive behavioral therapy which traditionally includes regular and often weekly visits to a clinician is recommended by the American College of Physicians and other organizations for treatment of chronic insomnia. For military personnel internetdelivered cognitive behavioral therapy appears to be an effective alternative to meeting regularly with a therapist although it is about half as effective as traditional methods according to results of a study conducted by Daniel Taylor University of North Texas professor of psychology and director of UNTs Sleep Health Research Laboratory. Taylor received a . million grant from the U.S. Department of Defense for the study which was affiliated with the STRONG STAR Consortium a federally funded network of national experts seeking the best ways to treat behavioral health problems impacting post service members and veterans. The study was published in SLEEP the official journal of the Sleep Research Society. Chronic insomnia is defined by the Diagnostic and Statistical Manual of Mental Disorders as sleeping poorly at least three nights a week for a month or longer despite adequate opportunity for a full nights sleep. It is a significant problem in the military said Taylor who noted that military personnel often develop insomnia because of rapidly changing schedules and deployments that keep them constantly on alert. Chronic insomnia is a strong risk factor for posttraumatic stress disorder depression and substance abuse absenteeism and occupational accidents Taylor said. Treatment of insomnia may not only improve sleep in these soldiers but also improve these other conditions he said. About percent of deployed military personnel take sleep medications which are effective for shortterm treatment of insomnia in civilian populations. For deployed military personnel the side effects such as grogginess slowed cognitive processing and slowed reaction time can be dangerous Taylor said. One hundred soldiers at Fort Hood who had chronic insomnia were recruited for Taylors study. All completed one week of sleep monitoring by keeping sleep diaries and wearing activity monitors. One third of the participants met with clinicians at Fort Hood for cognitive behavioral therapy for insomnia once a week for six weeks while another third received the therapy via the Internet once a week for six weeks. Both the inperson and Internet therapy had the exact same content with the Internet lessons presented as audio recordings accompanied by visual graphics and animations. A third control group of participants was contacted by the researchers every other week during the six weeks but did not receive cognitive behavioral therapy. Taylor discovered that the study participants who received inperson cognitive behavioral treatment for their insomnia reported significantly greater improvements in sleep quality as determined by the sleep diaries and activity monitors than those who received the Internet therapy. Both groups had greater improvements in sleep quality than those who did not receive cognitive behavioral therapy. He noted that that cognitive behavioral therapy is a multifaceted intervention that can be difficult to administer without the benefit of a therapist. Additional training in the therapy for behavioral health providers in all branches of the military is needed he said. In a previous study of civilians with insomnia Taylor and his research team discovered that cognitive behavioral therapy led to significant improvements in sleep efficiency with the research subjects use of sleep medication declining from . percent before therapy to percent afterward although the subjects werent required to stop taking their medication. Kristi Pruiksma a STRONG STAR collaborating investigator and clinical psychologist served as a clinician on Taylors study. She said the benefits of the online therapy include easy access to the treatment and flexibility in times for completing the sessions which is really helpful for those juggling work and family demands. The online program can also be done from home rather than at a military behavioral health clinic which some service members may avoid due to concerns about stigma said Pruiksma an assistant professor of psychiatry at the University of Texas Health Science Center at San Antonio UT Health San Antonio. Successful treatment has a real impact on patients daily lives. An important next step will be to figure out who is able to achieve good benefits from the online program and who is likely to need additional assistance from a therapist she said."

"GenomeDx Biosciences today announced that a study featured on the cover of Urology demonstrates that Decipher Prostate Cancer Classifier significantly influenced treatment recommendations following prostate surgery reducing disagreement between urologists and radiation oncologists and has the potential to enhance personalization of patient care. Decipher is a Medicarecovered genomic test capable of predicting tumor aggressiveness in men following prostate surgery. The study titled Impact of a Genomic Classifier of Metastatic Risk on Postprostatectomy Treatment Recommendations by Radiation Oncologists and Urologists http was published in this months issue of Urology. Conflicting treatment recommendations by different specialists looking at the same disease can be highly confusing for patients and is a problem for the health care system in general said Paul Nguyen M.D. of DanaFarberBrigham and Womens Cancer Center and Harvard Medical School. The Decipher tests tendency to make the two specialties more concordant in their treatment recommendations provides significant value toward standardizing care for patients. The study was designed to evaluate how the Decipher Prostate Cancer Classifier which predicts the risk of metastasis after prostatectomy would impact adjuvant treatment recommendations made by urologists and radiation oncologists. These two specialties often disagree on which patients should receive radiation therapy following surgery and when. Using clinical information alone observation rather than adjuvant radiation therapy was recommended in of decisions made by urologists and of decisions by radiation oncologists P .. The Decipher test results altered and of treatment recommendations made by urologists and radiation oncologists respectively. Decipher results indicating genomic high risk resulted in intensification of treatment whereas genomic low risk resulted in less aggressive recommendations. The Decipher results increased agreement in treatment recommendations between urologists and radiation oncologists as the odds of a recommendation for adjuvant treatment by urologists vs radiation oncologists increased from . CI .. to . CI .. after results of the Decipher test were made available. It is notable that while the Decipher test significantly influenced treatment decisions it did not increase the total number of people receiving adjuvant therapy suggesting that it helped ensure that the ones selected for adjuvant therapy are the ones most likely to benefit from it said Doug Dolginow M.D. chief executive officer of GenomeDx. As genomic tests like Decipher become used more routinely in urologic cancer patient care they will have a greater impact on treatment recommendations in clinical practice and allow for better personalization of therapy. The Decipher test used in this study has been previously described in multiple blinded independent validation studies in men at high risk of recurrence at the time of prostatectomy. Researchers found that of the clinically highrisk men would be reclassified as low risk based on the Decipher test and have only a . risk of metastasis at years after surgery. In addition the of the patients with the highest risk based on Decipher had a nearly fold higher risk of distant metastases by years. The test provided a more accurate and precise estimate of a patients risk of recurrence. Use of this test therefore has the potential to assist clinicians to better direct utilization of secondary therapy after surgery. About Decipher The Decipher Prostate Cancer Classifier is a highly validated and commercially available genomic test for men with intermediate and high risk prostate cancer. Decipher predicts cancer aggressiveness by looking for a unique genomic signature comprised of a validated series of biomarkers associated with metastatic disease. Adding truly unique information to the treatment decisionmaking process Decipher generates a risk result that is completely independent and distinct from PSA Gleason score and other clinical risk factors. Clinical studies from leading cancer centers published in over a dozen medical journals demonstrate that Decipher can accurately predict metastatic disease which men may benefit from radiation therapy following prostate surgery and can lead to significant costsavings for healthcare systems. Decipher was developed in partnership with the Mayo Clinic. Decipher is covered by Medicare and multiple private insurance plans in the US. Learn more at http and follow Decipher on Twitter DecipherTest http and on Facebook. About GenomeDx Biosciences GenomeDx Biosciences is focused on transforming cancer patient care by putting usable genomic information in the hands of patients and their physicians. GenomeDx is developing and commercializing Decipher a highly validated genomic test for predicting metastatic disease in men with prostate cancer. In partnership with leading medical centers the company has assembled the largest genomic catalogue of prostate cancer tumors in the world representing billions of data points and more than years of prostate cancer research expertise. Using advanced cloudbased bioinformatics GenomeDx mines the genomic data to develop proprietary tests that address key clinical questions in cancer patient management. GenomeDx has partnered to share genomic data with leading clinicianscientists worldwide to collaboratively enrich the knowledge and understanding of urologic cancers for the goal of improving global cancer patient care. GenomeDx is based in San Diego California and Vancouver British Columbia. Learn more at http and follow us on Twitter at Twitter GenomeDx http Facebook LinkedIn httpca.linkedin.comcompanygenomedxbiosciencesinc. and YouTube http Media Contact for GenomeDx Biosciences Ian Stone Canale Communications iancanalecomm.com mailtoiancanalecomm.com SOURCE GenomeDx Biosciences Related Links httpgenomedx.com"

"About million Americans have sleep apnea httpshealth.nytimes.comhealthguidesdiseasesleepapneaoverview.htmlinlinenytclassifier which causes repeated awakenings and pauses in breathing during the night sometimes resulting in loud snoring httpshealth.nytimes.comhealthguidessymptomssnoringoverview.htmlinlinenytclassifier and gasps for air. For decades the standard treatment has been continuous positive airway pressure. A mask worn at night pushes air into the nasal passages enabling easier breathing. C.P.A.P. reduces and in some cases completely prevents episodes of apnea httpshealth.nytimes.comhealthguidessymptomsbreathingslowedorstoppedoverview.htmlinlinenytclassifier. The new device has two small plugs that create just enough air pressure to keep the airways open at night.Credit Joseph A. Golish M.D. But the mask is like something from a bad science fiction movie big bulky and obtrusive. Many patients simply refuse to wear it or rip it off while asleep. Studies show that about half of all people prescribed C.P.A.P. machines stop using them in one to three weeks httpsarchinte.amaassn.orgcgicontentfull. For a lot of people out there the C.P.A.P. machine turns into a doorstop said Dr. Joseph Golish the former chief of sleep medicine at the Cleveland Clinic and now a professor with the MetroHealth System in Cleveland. C.P.A.P. is very effective in the sleep lab. But when people go home theres a good chance they wont use it and the success rate of an unused C.P.A.P. machine is absolutely zero. Now an alternative form of C.P.A.P. is gaining popularity a patch that fits over the nostrils. Called Provent the patch holds two small plugs one for each nostril that create just enough air pressure to keep the airways open at night. It is far less intrusive than the traditional C.P.A.P. machine. It is also more expensive and it doesnt work for every patient. Share your thoughts. Join in the discussion. httpswell.blogs.nytimes.comtreatingsleepapneawithoutthemask Approved by the Food and Drug Administration in Provent has spread mostly by word of mouth. But it has caught on fast. Its manufacturer Ventus Medical says it has shipped one million of the devices in the past months up from a half million total in the two years prior. Doctors say it has given them a new weapon in the battle against sleep apnea and many patients who struggled with C.P.A.P. call it a godsend. Bob Bleck who owns a computer networking firm in Ohio struggled with poor sleep and chronic fatigue httpshealth.nytimes.comhealthguidesdiseasechronicfatiguesyndromeoverview.htmlinlinenytclassifier for decades. But it was only a year and a half ago that he finally went to a sleep clinic prodded by his wife who worried about his heavy snoring. The diagnosis was severe sleep apnea. Tests showed that in a typical night Mr. Bleck awoke or stopped breathing times an hour. His doctor prescribed a C.P.A.P. machine and Mr. Bleck hated it. I had this constricted feeling he said. It would be incorporated into these dreams where I was tied up like in the movie Alien. It was more difficult to sleep with that thing on than to just get through the night with the apnea. Mr. Bleck got rid of the machine after he discovered Provent. After I started using it I noticed a difference right away he said. My symptoms subsided dramatically. Provent works like a traditional C.P.A.P. machine but is only a fraction of the size. When people with apnea fall asleep their throat muscles collapse constricting the airway and causing the body to fight for air. C.P.A.P. machines use mild air pressure to keep the airway from constricting. Provent does too but in a different way. The device contains two pinholesize valves one over each nostril. The valves let air in easily most people breathe through their nostrils while asleep but there is resistance as the user exhales. That resistance creates a backpressure in the airways dilating the muscles that would otherwise collapse in the middle of the night. In the morning the patch is removed a new one is used every night. Last year in a large study of apnea sufferers published in the medical journal Sleep https and subsidized by Ventus researchers found that those who used Provent devices over a threemonth period saw their apnea episodes fall sharply compared with people who were given a sham or placebo device. A followup study tracked people over the course of a year and had similar results. But not everyone finds that Provent alleviates their apnea. In interviews sleep specialists said that a third or more of patients do not end up using it. It works like a champ in some people and doesnt work on other people said Dr. Nancy Appelblatt an ear nose and throat surgeon in Sacramento who has prescribed it to about patients. All sleep apnea is not created equal. Some people for example breathe through the mouth at night not the nostrils. In those people Provent typically doesnt work. Nor will it work very well in someone who has severe nasal allergies httpshealth.nytimes.comhealthguidesdiseaseallergicrhinitisoverview.htmlinlinenytclassifier and has a blocked nose at night said one of the leaders of the Provent studies Dr. Meir H. Kryger a professor at Yale Medical School and founder of the National Sleep Foundation. Unlike C.P.A.P. Provent is not covered by Medicare and most major insurers though some doctors say they expect that will change in the near future. In the meantime a day supply of the patches costs to . Dr. Lee A. Surkin a cardiologist and sleep medicine specialist in Greenville N.C. said patients typically start with a day trial pack that costs .. He has prescribed Provent to about of his patients. The No. reason people dont continue it is the outofpocket expense he said. For now Dr. Kryger and others say that C.P.A.P. will continue to be the gold standard and certainly the first option for patients with severe apnea. But for the roughly percent of patients in whom C.P.A.P. fails Provent may be a reliable alternative. Dr. Surkin said some patients use C.P.A.P. at home but take their pocketsize Provent patches with them when they travel to avoid the hassle of lugging a machine through airports. To me its a miracle said Joyce Nemoga . Ms. Nemoga who lives in Baldwin Harbor N.Y. has moderate apnea that caused her to snore and gasp in her sleep. She tried C.P.A.P. but could not sleep comfortably with the device. Every time you turn over you have to take the hose with you she said. I tried it for six months and I dont think I had one full night of sleep the whole time. A doctor suggested Provent and Ms. Nemoga saw quick results. Im just so happy that I found it she said."

"The gene responsible for cystic fibrosis httpshealth.nytimes.comhealthguidesdiseasecysticfibrosisoverview.htmlinlinenytclassifier was discovered in . Now years later a drug that tries to compensate for the genetic defect might be nearing the market. Vertex Pharmaceuticals https announced Wednesday morning that the drug VX https improved lung function in people with cystic fibrosis in a latestage clinical trial. The drug also reduced the frequency of disease exacerbations that required treatment with antibiotics httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsantibioticsindex.htmlinlinenytclassifier. The caveat is that VX is designed to counter one specific genetic mutation that accounts for about percent of cases of cystic fibrosis. Vertex is working on another drug for the most common mutation but that one is further behind in development. Still the news is expected to be greeted favorably by doctors and patients and by Wall Street. Ive been doing clinical trials for years in C.F. and these are amazing results Dr. Bonnie W. Ramsey https_Bonnie.html a lead investigator in the trial said in an interview. Dr. Ramsey a professor of pediatrics httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicspediatricsindex.htmlinlinenytclassifier at the University of Washington httpstopics.nytimes.comtopreferencetimestopicsorganizationsuuniversity_of_washingtonindex.htmlinlinenytorg was briefed on the results by Vertex. The results were announced by a press release httpsinvestors.vrtx.comreleasedetail.cfmReleaseID and have not been peer reviewed by experts. About Americans and people worldwide have cystic fibrosis a disease caused by defects in a gene responsible for the transport of chloride ions across cell membranes. People with the disease tend to have very thick mucus in their lungs which leads to infections and lung damage. Many do not live past age . Two inhaled antibiotics and one drug that loosens mucus are approved to treat cystic fibrosis but nothing that directly improves chloride ion transport. In the trial those who received VX gained . percentage points more on a lung function test after weeks than those getting a placebo a difference that statistically was highly significant. Patients continued to take either drug or placebo for another weeks and the improvement was sustained. Lung function the primary endpoint of the trial was measured by how much a person could exhale in one second a standard test. Investors had been expecting around a percentage point improvement. In a note to clients Tuesday evening before the results were known an analyst at ISI Group Mark Schoenebaum https said that an improvement of percent would be a home run that could lead to million in annual sales for the drug. Dr. Ramsey who has received research grants from Vertex said that some patients could perceive a percentage point change in lung function. She said other results of the trial were encouraging. These included fewer exacerbations of the disease in those who got the drug fewer selfreported respiratory symptoms and a gain in weight which is good for people with cystic fibrosis who often have digestive problems. The saltiness of their sweat a measure used to diagnose the disease was markedly reduced suggesting that the drug was having an effect on chloride ion transport. The trial involved people age and older all with at least one copy of the particular mutation known as GD. The main side effects Vertex said were headache httpshealth.nytimes.comhealthguidessymptomsheadacheoverview.htmlinlinenytclassifier upper respiratory tract infections nasal congestion httpshealth.nytimes.comhealthguidessymptomsnasalcongestionoverview.htmlinlinenytclassifier rash and dizziness httpshealth.nytimes.comhealthguidessymptomsdizzinessoverview.htmlinlinenytclassifier. Vertex said it hoped to apply in the second half of the year for approval of VX in the United States and Europe. The company is awaiting results of a second trial of the drug this one in younger children. Vertex has not said how much it will charge for VX. But since there are only about Americans who are candidates for the drug the price is likely to be tens of thousands of dollars a year. Vertex based in Cambridge Mass. was founded in coincidentally the same year the cystic fibrosis gene was discovered. It has not yet had a big commercial success and had a . billion net loss in the last five years. The company is hoping that by late May it will win approval to sell a new type of drug for hepatitis C httpshealth.nytimes.comhealthguidesdiseasehepatitiscoverview.htmlinlinenytclassifier which analysts expect will be a blockbuster. The long time needed to develop a drug for cystic fibrosis is a lesson for those expecting a quick payout from the sequencing of the human genome which was completed a decade ago. It is not enough to know the gene behind a disease. It can take years of research to determine how a mutation actually causes a disease and then to design a drug that corrects the problem. Vertex received million in financial support from the Cystic Fibrosis Foundation one of the first nonprofit disease groups to give money to companies. These results are highly encouraging Robert J. Beall president of the foundation said in a statement Wednesday. They provide scientific evidence that support our longstanding belief that targeting the underlying defect of C.F. may have a profound effect on the disease."

"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."

"Alzheimers disease can be heartbreaking to watch and frustrating to treat. Most medicines on the market do little more than delay the inevitable mental decline. But a new drug called Dimebon appears to stop and perhaps even reverse the symptoms of the cruel and degenerative disease according to a new study published in the journal Lancet today. I was pleasantly surprised to see the effect on cognitive function on memory on activities of daily living that not only were clearly significant but seemed to increase over time said Dr. Sam Gandy former chairman of the Alzheimers Association Medical and Scientific Advisory Council. Dimebon wasnt designed to treat Alzheimers disease. Far from it. Its an antihistamine that was supposed to treat allergies. But a study that tracked mild to moderate Alzheimers patients for a year and found that at six months those taking Dimebon three times a day showed significant improvement in mental tests and cognitive functioning while those placed on the placebo kept deteriorating. A year into the study the Dimebon group was still improving while those without the drug were declining rapidly. Whats most encouraging for researchers is that current Alzheimers drugs lose their effectiveness after three or six months. But Dimebon still worked after at least a year and seemed to be improving with time. For those five million Americans living with Alzheimers disease memories tend to be lost first and then its victims lose the ability to care for themselves. Currently there is no cure for Alzheimers so eventually they lose their lives. Those with Alzheimers in the moderate to severe stages often lose the ability to complete daily tasks such as dressing themselves walking and eating. Karen Henes of CrotononHudson N.Y. was diagnosed with Alzheimers just a year ago and already complains of some such symptoms. I would like to just go see my grandchildren. I cant Henes said. Im not responsible enough just to drive. I cant always remember what to do. Its really sad. Her husband Michael expressed equal frustration with the disease. Life with Karen is so frustrating. It has already changed he said. She writes down all her appointments and she still doesnt remember them. On a daytoday basis its a struggle. Dimebon has been shown to improve patient memory and skills and to help on small daily tasks like using the telephone shopping and remembering the grocery list. Doctors havent yet figured out exactly how the drug works. Researchers think that the drug affects the mitochondria or the energy powerhouses of the brain cells. There are two major classes of Alzheimers drugs and researchers think that Dimebon performs both functions. Alzheimers patients families and doctors tend to be skeptical of new drugs because so many have fallen short over the years. Dr. Gandy cautioned that the new study was small. Dimebon must go through more clinical tests. And even if theyre a success it will be at least two years before Dimebon is approved for treatment by the Federal Drug Administration. This is promising but its not marketed anywhere in the world right now and it hasnt been approved in any country said Dr. Rachelle Doody the studys principal investigator and Effie Marie Cain chair in Alzheimers disease research at Baylor College of Medicine. This is coming along she told ABC News. Its coming along pretty quickly relative to other agents but this drug and all the others are not cures for the disease. Alzheimers patients like Henes are optimistic. I cant wait. I am so excited about the possibility Henes said. If I can stay the way I am now until a drug that comes along I will be a lucky person. To learn more about participating in the Phase III clinical trials of Dimebon visit this site http or call ...."

"For patients whose high blood pressure cannot be controlled despite taking several medications a short burst of radio waves at the nerves around the kidneys may do the trick a small new study says. The treatment was effective for at least six months. The findings could be a significant step in treating people with resistant hypertension which is a major risk factor for heart attack and stroke the researchers said. The technique called catheterbased renal denervation is minimally invasive. In it doctors use a catheter inserted through the artery in the groin which sends radio waves burning away nerve tissue around the arteries that feed the kidneys. The procedure destroys nerves that help control and filter salt in the body and may be overactive in patients with high blood pressure. The U.S. Food and Drug Administration has not yet approved its use. The study was funded by medical device maker Medtronic. The findings were published Dec. in the journal Circulation. This is a very promising approach for managing medicationresistant hypertension said Dr. Gregg Fonarow a spokesman for the American Heart Association and professor of cardiology at the University of California Los Angeles. High blood pressure is a major contributor to heart attack stroke heart failure and kidney failure said Fonarow who was not involved in the study. Despite the availability of a number of effective medications many patients with hypertension have not achieved adequate control of their blood pressure. There is thus an important but currently unmet need for additional therapies to effectively control hypertension. For the study an international team lead by Dr. Murray Esler professor and senior director of the Baker IDI Heart and Diabetes Institute in Melbourne Australia assigned patients to renal denervation and compared them to patients who had already had the procedure. All the patients suffered from drugresistant hypertension. Their systolic blood pressure the top number in a bloodpressure reading remained dangerously high at millimeters of mercury mmHg or above despite having taking three or more drugs to control blood pressure the researchers noted. Eslers team found that more than percent of those who had denervation treatment before had a drop in systolic blood pressure of at least mmHg after six months and almost percent maintained the reduction at months. The patients in this phase of the study had similar results to the initial group. Almost percent of these patients saw a reduction in systolic blood pressure of mmHg or more six months after treatment. Fonarow noted In all reductions in systolic bloodpressure levels on the order of to mmHg were achieved and maintained without any loss in efficacy. The procedure is safe as well as effective the study authors said. Participants kidneys were not damaged or functionally impaired Esler said in a journal news release. We also found no ill effects on longterm health from the procedure. Whether this technique might be useful in treating less severe high blood pressure hasnt yet been tested. If it is applicable it could mean patients need not take bloodpressure drugs Esler suggested. Another expert however said that scenario is likely overoptimistic. Hypertension is a hard disease to treat because there are so many things that go into getting blood pressure under control said Dr. Varinder Singh chairman of cardiology at Lenox Hill Hospital in New York City. Theres lifestyle and diet there is getting to the right doses of medications there are adherence issues. So anything that will help patients get their goals is exciting. Even with this technique people will most likely still have to take bloodpressure medications Singh said. You may have to take less medication and you may have to take lower doses of medication but we all expect that patients will still have to take some medication he said. Singh also noted that although this procedure is used in other countries it is not yet approved in the United States. Fonarow added While this study demonstrates that renal denervation provides sustained reduction of blood pressure up to one year and appears safe additional studies with longerterm followup are needed. According to the American Heart Association more than million adults in the United States have high blood pressure which is blood pressure higher than mmHg. Among these adults about percent have resistant hypertension which means that even taking three or more medications to control their blood pressure it remains higher than mmHg. More information To learn more about hypertension visit the U.S. National Library of Medicine http SOURCES Gregg Fonarow M.D. spokesman American Heart Association and professor of cardiology University of California Los Angeles Varinder Singh M.D. chairman of cardiology Lenox Hill Hospital New York City American Heart Association news release Dec. Circulation"

"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."

"An experimental therapy involving stem cell https injections from the patients own blood https is showing promise in the treatment of people with chest pain https that is not responsive to drugs angioplasty https or surgery. Results from a pivotal study of the treatment were reported today in the American Heart https Association AHA journal Circulation Research. Patients with untreatable angina https who received the injections of CD stem cells https in key areas of the heart had significantly fewer chest pain episodes and significantly better performance on exercise https tests than patients who got placebo https injections. Treating Angina Drugs angioplasty https and coronary artery bypass graft https CABG surgery are the main treatments for angina chest pain caused by blocked coronary arteries https About Americans have angina that persists despite available treatments. These are patients who have been on drugs and may have had multiple angioplasties or CABG surgeries AHA President Gordon Tomaselli MD tells WebMD. Their activities are severely restricted by their chest pain and right now we have little to offer them. The new treatment came from the discovery about a decade ago that CD stem cells stimulate the formation of new blood https vessels study researcher Douglas W. Losordo MD of Chicagos Northwestern University tells WebMD. Coronary artery disease https involves not only the blockage of major arteries but the death of small vessels or capillaries of the heart muscle he says. This treatment targets these small vessels that have been damaged. The stem cells have shown the ability to repair and replace them in animal models. The approach also showed promise in a pilot study involving fewer than patients. The newly reported study included patients with severe angina treated at medical centers across the country. Chest Pain Relief Study participants received one of three treatments lowdose CD injections highdose injections or placebo. Patients were given a drug for several days to increase the number of CD stem cells in the blood. Blood was collected and processed to collect the stem cells and then using a catheter threaded into the heart the researchers injected the CD cells into areas of the muscle that had been identified as oxygendeprived areas. The patients received such injections during a single catheterization procedure. Among the major findings Six months after the procedure patients treated with the stem cells had an average of seven attacks of angina a week compared to close to in the placebo group. At months the lowdose stem cell patients were having around six chest pain episodes a week compared to in the placebotreated patients. Exercise https tolerance test scores were also better in the stemcelltreated patients. The lowdose stem cell patients had improvements of seconds compared to seconds in the placebotreated patients. Patients in both active treatment portions of the study used less nitroglycerin https to treat angina attacks than patients in the placebo group but the difference was small. About one in three patients had elevations of a cardiac enzyme that is associated with heart attacks https While the elevations did not appear to be clinically significant Losordo says the researchers will continue to closely monitor cardiac enzymes https_assetscontrolled_contenthealthwisemedicaltestcardiac_enzyme_studies_medicaltest_hw.xml in patients who receive the treatment. Improvements in Quality of Life Losordo says the improvements in the stemcelltreated patients were life altering for many patients. To put it in human terms patients who might have been able to sit and watch TV without symptoms could now walk at a normal pace without chest pain and someone who could walk at a slow pace might be able to ride a bike he says. The study was funded by Illinoisbased medical device manufacturer Baxter Healthcare https which hopes to market the machine that collects the stem cells. A phase III study expected to involve around medical centers in the U.S. is in the planning stages. There is an emerging notion that our bodies even the bodies of patients with significant disease contain this natural biology that can heal Losordo says. We are just beginning to understand and exploit this preinstalled mechanism for selfrepair. Tomaselli says the study shows that the approach is both safe and feasible in patients with significant coronary disease. The results are pretty undeniable he says. The stem cell treated patients had improvements in angina frequency and improvements in exertion times. The next step is to prove the treatment is clinically useful."

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

"A simple safe relatively inexpensive hormone treatment might help some highrisk pregnant women carry their babies longer a new study http suggests while improving the outlook for their infants. Such a treatment has been long sought. Even better the newest one would appear unlikely to cost a dose unless drug makers are slow learners. Federal researchers working with colleagues at medical centers found that administering vaginal progesterone to women with a short cervix a risk factor for premature delivery cuts the rate of delivering before weeks by . The reduction applies only to women with a short cervix between centimeter and centimeters not for women at high risk for other reasons. But for these women few medications have been found effective at keeping a baby in the womb longer. Physicians led by the National Institute of Child Health and Human Development in Bethesda Md. assigned women with a short cervix to receive daily applications of either a progesterone gel or a placebo gel between the th and rd weeks of pregnancy. Fewer women who got the progesterone treatment delivered early. versus . in the placebo group the team reported online httponlinelibrary.wiley.comdoi.uog.pdf in the journal Ultrasound in Obstetrics and Gynecology. Further there were indications the hormone might help the babies too. Fewer babies born to mothers given progesterone had respiratory distress syndrome a lung disorder common to premature infants versus .. The data set isnt very large of women given progesterone delivered early compared with of women given a placebo. And of course the trial was funded by the maker of the progesterone gel to be marketed as Prochieve. But giving progesterone gel to women with short cervical length would appear to prevent one premature birth and a progesterone gel the company already sells Crinone is FDA approved for women in some fertility treatments. The researchers used about worth of the strength of Crinone in each dose. Thus the findings are promising especially when few drugs can keep a pregnant woman from delivering early. One new drug httparticles.latimes.comfebhealthlahefdamakena also progesteronebased is marketed for women who have already had a spontaneous preterm birth. That drug Makena http was the subject of considerable controversy recently after its manufacturer boosted the price from per dose to per dose before finally lowering it to . Makena an injectable is administered weekly. RELATED Drug maker lowers price of Makena pregnancy drug to per dose http If the progesterone gel is as effective as the study suggests women would likely find the price tolerable. But probably not at a dose."

"Each year nearly three times as many Americans die from suicide as from homicide. More Americans kill themselves than die from breast cancer. As Dr.Thomas Insel http longtime head of the National Institute of Mental Health prepared to step down from his job in October he cited the lack of progress in reducing the number of suicides as his biggest disappointment. While the homicide rate in the U.S. has dropped percent since the early s the suicide rate is higher than it was a decade ago. That to me is unacceptable Insel says. It hasnt been for lack of trying. The U.S. has a national suicide hotline http and there are suicide prevention programs in every state. Theres screening educational programs and midnight walks to raise awareness. Yet over the past decade or so the national suicide rate has increased. In the suicide rate was . per people. In it was .. An effort that began in Detroit in to treat the most common cause of suicide depression is offering hope. With a relentless focus on finding and treating people with depression the Henry Ford Health System http has cut the suicide rate among the people in its insurance plan dramatically. The story of the health systems success is a story of persistence confidence hope and a strict adherence to a very specific approach. That approach saved the life of a woman who prefers to be known only by her first name Lynn. She agreed to share her medical history on the condition that we not use her full name to protect her privacy. Lynn whos now in her mids has had bipolar disorder http also known as manicdepressive illness for nearly years. The depressive part of her illness is like the pain of having a cancer she says. About years ago she started getting irresistible urges to take her own life and she started making serious attempts at times almost monthly. When I was in the depths of depression I was being pulled and sucked into this black tunnel she says. I was desperately trying to grab onto something to stop from being sucked in. Sometimes she couldnt find anything to hang on to. Those are the times when I finally let go and attempted suicide she says. The program that saved Lynn almost didnt get off the ground. Fifteen years ago suicide prevention care at Henry Ford like in many places was mostly reactive. When patients came in talking about suicide health providers took notice. But little was done to find people before they reached that point. Some of the health providers in the psychiatric division decided they could do better. So they applied to a foundation for a grant to provide something they called perfect depression care for the patients in the health system. The goal zero suicides. The mental health division failed to win the grant but the health system went ahead with the proposed changes anyway. The plan it developed is intensive and thorough an almost cookbook approach. Primary care doctors screen every patient with two questions How often have you felt down in the past two weeks And how often have you felt little pleasure in doing things A high score leads to more questions about sleep disturbances changes in appetite thoughts of hurting oneself. All patients are questioned on every visit. If the health providers recognize a mental health problem patients are assigned to appropriate care cognitive behavioral therapy drugs group counseling or hospitalization if necessary. On each patients medical record providers have to attest to having done the screening and they record plans for any needed care. Therapists involve patients families and ask them to remove guns or other means of suicide from their homes. Clerks are trained to make sure that patients who need followup care dont leave without an appointment. Patients themselves come up with safety plans. Lynn has two copies one by her nightstand and one in her kitchen. Each lists things she can do when she feels depression coming on. She could sit on her balcony or do some drawing or painting. The list includes her therapists phone numbers. And theres a reminder that the feeling will pass it has before. Before the zero suicide plan went into effect says psychiatrist Doree Ann Espiritu http acting head of the zero suicide program at Henry Ford you might make a contract with a patient where the patient agrees not to commit suicide. Studies show it doesnt work very well she says. Today providers are trained to be comfortable asking their patients about suicidal thoughts. There is a fear among clinicians that if you ask questions about suicide you are giving the patient an idea that this could be an option says Espiritu and if you ask about guns or pills that you are giving them some hints on how they can carry out a plan. The Henry Ford therapists are trained to break that barrier. For Lynn the key was persistence her therapists and her own. I recall one time with my psychiatrist who kept trying to encourage me and help me find ways of coping and I can remember saying I dont believe theres hope I dont see it I dont feel it I need you to hold on to that for me because its not there she recalls. Her therapists never gave up. There is no question that the message I got from Day is that they knew they could help me and they would help me Lynn says. Over the years shes been in group therapy day treatment and when things got bad the emergency room. The Henry Ford approach is catching on. A stream of visitors from U.S. health insurers and from the United Kingdom have made site visits. The Suicide Prevention Resource Center http has run two zero suicide training academies for teams from health care systems based on the Henry Ford principles. Other health systems have adapted the plan including Group Health Cooperative https Seattle and the behavioral health provider Centerstone https in Tennessee. Espiritu started work at Henry Ford just as the program was starting and she remembers the initial staff meetings There was a lot of How can you do this How can you aim for zero How can you expect your clinicians to be perfect and follow this protocol Some people didnt think it could be done she says or even attempted. Still the health system went ahead and the rewards were nearly immediate. Henry Ford epidemiologist Brian Ahmedani http the numbers. In for those being actively treated for a mental health problem or substance abuse we had a rate of zero per hundred thousand he says. Its crept up to per per year but thats still percent lower than it was when the program began. The rate is five per in the organizations general population which is well below the national average and has remained steady despite an increasing rate of suicide statewide. Theres reason to think a fullbore effort to treat depression could reduce health costs because untreated depression is associated with higher medical bills for chronic illnesses such as diabetes and hypertension. But there are training costs involved and the Henry Ford system has had to keep its staffing up to be able to provide care for people who need it. Officials at Henry Ford say they havent analyzed the costs. But Centerstone https has. The behavioral health provider in Nashville implemented the Henry Ford approach for nearly patients whod already made a suicide attempt. Reductions in emergency room visits and hospitalizations over the course of a year resulted in savings of more than . Why push for zero rather than just a reduction Because if you say were OK with five a year one of those might be your brother or your friend says Espiritu. We aim for zero because it reminds all of us of what we would want for ourselves. Maybe it is not possible she says. But it is a goal. And as for Lynn she doesnt consider herself cured. She says with the treatment shes received at Henry Ford shes learned to live even thrive with bipolar disease. And shes alive. That she says makes her a big success story."

"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."

"Theres another type of prescription drugs besides opioid painkillers thats involved in thousands of drug overdose deaths in the US every year. The drugs are benzodiazepines which are widely known by their brand names Xanax and Valium and commonly prescribed to help treat anxiety. These drugs were involved in nearly overdose deaths in according to federal data https But theres a catch Such overdoses seem to be very closely tied to the opioid epidemic http with the majority of benzodiazepine overdose deaths involving both benzodiazepines and opioids. A new study http published in BMJ looked at just how much the concurrent use of these two drugs increases the risk of overdose versus the risk of only using opioids. Drawing on a huge sample of nearly patients who were continuously enrolled in private health insurance plans from and researchers compared those who were prescribed just opioids versus those who were prescribed both and what their additional risk of an emergency room visit or inpatient admission was in the period they were prescribed both. The study found that among all opioid users concurrent use of benzodiazepines more than doubled the risk of an emergency room or inpatient visit for a drug overdose. The study also found that eliminating concurrent benzodiazepine and opioid use could reduce the risk for an opioid overdoserelated emergency room or inpatient visit by percent. If that reduced risk applies to overdose deaths as well eliminating concurrent opioid and benzodiazepine use could have prevented up to opioid painkillerrelated overdose deaths in . Keith Humphreys a drug policy expert at Stanford University and one of the authors of the study said this reveals an underappreciated policy lever for reducing drug overdoses making sure patients prescribed to opioids arent also prescribed to benzodiazepines and vice versa. Even if we didnt change opioid prescribing at all the data here suggest that we could cut overdoses dramatically just by getting prescribers to not put people on a benzodiazepine at the same time Humphreys said. Yet the study suggests the opposite has happened. From to coprescriptions to opioids and benzodiazepines among the studied pool of patients increased from percent to percent a nearly percent jump. For some patients eliminating these coprescriptions could involve some tough tradeoffs. If someone genuinely suffers from pain and anxiety doctors and patients will need to work out which condition is more important to treat and which one can be treated with alternatives to avoid a potentially deadly overdose. Hopefully while keeping in mind that theres no httpannals.orgarticle.aspxarticleID good http scientific http evidence http that opioids can treat chronic pain so opioids arent the right treatment for chronic pain in the first place. There are some caveats to the study. For one emergency room visits and inpatient admissions for opioid overdoses likely arent a perfect onetoone proxy for overdoses that didnt involve a trip to a doctor. The study also only looked at legally prescribed opioid painkillers and benzodiazepines missing the effects of concurrent use of illegally obtained pills or drugs. And since the research relied on patients who were continuously insured throughout the study period its possible the findings dont exactly apply to people with spottier coverage. Although sensitivity analyses in the study for people who had lapses in insurance produced similar results. Finally since the study looked at correlation not causation its possible that it missed some other factor driving up overdose deaths among concurrent benzodiazepine and opioid users perhaps for whatever reason these users may be more likely to misuse their drugs. Still its well established https that benzodiazepine and opioids compound each others overdose risk. So its not really controversial to conclude that simultaneously using opioids and benzodiazepines dramatically increases the risk of drug overdose or conversely that stopping the concurrent use of these two drugs could reduce the risk of overdose. Given that the opioid epidemic has quickly turned into the deadliest drug crisis in US history http its important and potentially lifesaving for doctors and policymakers to at least consider the studys findings. For more on the opioid epidemic read Voxs indepth explainer http the abridged explainer http or the maps and charts explainer http"

"A fiveyear study shows that Stereotactic Body Radiation Therapy SBRT to treat prostate cancer offers a higher cure rate than more traditional approaches according to researchers at UT Southwestern Medical Center Harold C. Simmons Comprehensive Cancer Center. The study the first trial to publish fiveyear results from SBRT treatment for prostate cancer found a . percent cure rate with SBRT a noninvasive form of radiation treatment that involves highdose radiation beams entering the body through various angles and intersecting at the desired target. It is a stateoftheart technology that allows for a concentrated dose to reach the tumor while limiting the radiation dose to surrounding healthy tissue. The high cure rate is striking when compared to the reported fiveyear cure rates from other approaches like surgery or conventional radiation which range between to percent while the side effects of this treatment are comparable to other types of treatment said Dr. Raquibul Hannan Assistant Professor of Radiation Oncology and lead author for the study. What we now have is a more potent and effective form of completely noninvasive treatment for prostate cancer conveniently completed in five treatments. Conventional treatment options for early stage prostate cancer include Prostatectomy the surgical removal of the prostate gland which can be done with minimally invasive techniques and robotic assistance Brachytherapy in which doctors implant numerous small radioactive seeds about the size of a grain of rice into the prostate gland using multiple large needles inserted through the skin in the operating room. Once implanted the seeds release their radioactivity directly into the prostate gland and External beam radiation which involves to treatments administered over two or more months five days a week. The current form of radiation is treatments given over nine weeks. In contrast the SBRT therapy we used allows the delivery of highly focused radiation in only five treatments allowing patients to return to their normal lives more quickly said senior author Dr. Robert Timmerman Director of the Annette Simmons Stereotactic Treatment Center at UT Southwestern and Professor and Vice Chairman of the Department of Radiation Oncology. SBRT is both more convenient and has increased potency. UT Southwestern served as the lead site for the multiinstitutional clinical trial which involved firsttime prostate cancer patients diagnosed with stage I or stage II low and intermediate risk prostate cancer. A total of patients were treated prospectively and followed for five years with only one patient experiencing a recurrence of his cancer. The findings are published in the European Journal of Cancer. Terry Martin of McKinney Texas about an hour outside Dallas said the fewer number of treatments was a compelling advantage when he was evaluating treatment options. I live minutes away from UT Southwestern. The difference between being treated five times versus times is enormous said Mr. Martin a retired airline pilot. I felt that I was back to normal just days after finishing treatment. In addition to shorter treatment times researchers found that side effects were not necessarily different compared to other forms of prostate cancer treatment. In the short term the side effects of SBRT can include urinary issues urgency frequency and burning and rectal irritation which are often temporary and reverse within four weeks of treatment. Researchers found a small risk of longerterm urinary and rectal complications which is also comparable to conventional treatments. Decrease in erectile function was seen in percent of patients fewer than with conventional radiation or surgery said Dr. Hannan. To reduce the side effects associated with SBRT current clinical trials at UTSW are using a unique and biodegradable rectal spacer gel to protect the rectum. UTSW is currently the only accredited site in Texas at which this spacer gel can be used. Other clinical trials at the UTSW Department of Radiation Oncology are seeking to expand the application of SBRT to highrisk Stage III prostate cancer patients. Our hope is that the high potency of this form of treatment will significantly improve treatment of these patients says Dr. Hannan the principal investigator of the highrisk prostate SBRT trial. UT Southwestern has been a leader in pioneering use of SBRT. Dr. Timmerman Director of ImageGuided Stereotactic Radiation Therapy Medical Director of Radiation Oncology and holder of the Effie Marie Cain Distinguished Chair in Cancer Therapy Research has served as the lead investigator in several national trials designed to evaluate the efficacy and safety of SBRT to treat other types of cancer including cancer in the lung liver and spine. A range of clinical trials of SBRT therapy are under way at Simmons Cancer Center including new investigations evaluating use of SBRT for cancers in the breast and larynx. Since UT Southwestern has trained more than physicians and peers interested in implementing SBRT in their clinical practice. Simmons Cancer Centers arsenal of stereotactic radiotherapy technology includes the cuttingedge Gamma Knife CyberKnife Agility Vero SBRT and TrueBeam technologies. The SBRT study for prostate cancer was supported by a grant from the U.S. Department of Defense. Additional UTSW researchers involved in the study include Dr. Yair Lotan Professor of Urology and holder of the Helen J. and Robert S. Strauss Professorship in Urology and Dr. XianJin Xie Professor of Clinical Science. The Harold C. Simmons Comprehensive Cancer Center is the only NCIdesignated Comprehensive Cancer Center in North Texas and one of just NCIdesignated Comprehensive Cancer Centers in the nation. The Simmons Cancer Center includes major cancer care programs with a focus on treating the whole patient with innovative treatments while fostering groundbreaking basic research that has the potential to improve patient care and prevention of cancer worldwide. In addition the Centers education and training programs support and develop the next generation of cancer researchers and clinicians. The Simmons Cancer Center is among only U.S. cancer research centers and the only cancer center in North Texas to be named a National Clinical Trials Network Lead Academic Participating Site a prestigious designation by the NCI designed to bolster clinical cancer research for adults and to provide patients access to cancer research trials sponsored by the NCI where promising new drugs often are tested. About UT Southwestern Medical Center UT Southwestern one of the premier academic medical centers in the nation integrates pioneering biomedical research with exceptional clinical care and education. The institutions faculty has included six who have been awarded Nobel Prizes since . The faculty of almost is responsible for groundbreaking medical advances and is committed to translating sciencedriven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in about specialties to more than hospitalized patients and oversee approximately . million outpatient visits a year. This news release is available on our home page at http To automatically receive news releases from UT Southwestern via email subscribe at http"

"Researchers are hoping that by using a common tool for measuring of brain activity in a new way they may be one step closer to identifying whether a child is a greater risk for autism. We havent diagnosed autism at this point says William Bosl Ph.D. lead author and a research scientist at Childrens Hospital Boston http But he says by using an electroencephalogram httpkidshealth.orgparentgeneralsickeeg.html and new sophisticated computer programs to analyze the EEGs he and his coauthors were able to correctly identify with accuracy which babies were at higher risk for autism and which were not. Scientists have known for quite some time now that the earlier a child with autism gets therapy the easier it is to improve language and behavioral skills. In the American Academy of Pediatrics http that all children be screened for autism at the ages of months and months. Here researchers are trying to find markers for autism before a child begins showing signs of autism. In a new study published Tuesday in the journal BMC Medicine scientists studied infants. babies had a brother or sister with known autism which means they themselves are at an increased risk for the neurodevelopmental disorder that affects about one in children according to the Centers for Disease Control and Prevention http The sibling of a child with a confirmed diagnosis of autism has a in chance of also developing the disorder. These infant siblings were compared with infants with no known family history of autism. The babies were given EEGs at and months of age. Researchers strapped a net of electrodes all over a babys head while it was sitting in its moms lap and a research assistant was blowing bubbles to hold the childs attention. The electrodes measured actual firings of neurons. The EEG technique is much easier to use because the baby can be awake and moving and wiggling around says Dr. Geraldine Dawson chief science officer for the advocacy group Autism Speaks http which partially funded this research. Other brain imaging technologies like magnetic resonance imaging would require a baby to be asleep or sedated because they have to be completely still while the test is being done. Nobody wants to sedate a healthy infant says Dawson. Bosl explains that the new computer algorithms that he developed were able to analyze results of the EEG much better than in the past. He said that judging by the differences in brain activity he and his colleagues could detect which babies were in the highrisk group. They say they were nearly accurate when the boys were months old. They were most accurate with baby girls at age months. Overall the biggest differences in brain activity were seen at months which is much earlier than when a child typically shows behavioral problems associated with autism. The differences in brain activity were smaller as the babies got older. Doctors and scientists not connected to the study are intrigued by the results but caution that this is very early research and not something concerned parents can be looking for as a screening tool for their babies any time soon. Sarah Paterson Ph.D. is the director of the neuroimaging lab at the Center for Autism Research at Childrens Hospital of Philadelphia http She is also looking for early signs of autism as part of the Infant Brain Imaging Study http but her work focuses on differences in brain structure. Paterson says that if the results out of Boston can be confirmed Its very exciting because finding an early sign for autism is really the holy grail. But she cautions that a lot more work needs to be done. This study needs to be replicated by their lab and independent scientists she says. Dr. Max Wiznitzer says the researchers have found a really fascinating technique that offers a different way to look at the brain. Wiznitzer a pediatric neurologist at Rainbow Babies Childrens Hospital http Cleveland Ohio notes that what the study cant tell us is what the differences in brain activity between the two groups of babies actually mean. He too is hopeful that further research will provide more concrete information. Bosl says the first children enrolled in his study are now at and years old which is the age when autism usually is diagnosed. This will now allow the researchers to evaluate them for autism and then look back at the brain activity patterns of the children who do fit the clinical criteria for autism. Bosl acknowledges that if this is very early research but he believes if the results are confirmed it may lead to a safe and inexpensive way to detect autism which would allow intervention before any autistic behaviors appear. Itll change the field if this works says Bosl. He hopes to expand the number of babies in his study to . The only thing slowing us down right now is funding."

"Preliminary findings suggest a drug used to treat another disease might also reduce painful flareups in gout patients starting new medication regimens. In a new study the proteininhibitor drug rilonacept Arcalyst appeared to markedly lower the risk of gout flareups during the first few months of treatments aimed at lowering uric acid levels. While effective in lowering the risk for gout attacks in the longterm uric acidlowering treatment can initially boost the risk for flareups as it breaks up and releases the uric acid crystal deposits at the source. To reduce deposits of crystals in the joints we advise patients to initiate treatment with medications that lower levels of uric acid in the blood study author Dr. H. Ralph Schumacher Jr. a professor of medicine at the University of Pennsylvania School of Medicine said in a journal news release. Gout a debilitating and painful form of inflammatory arthritis now affects upwards of . million Americans according to the release. Flareups which involve excruciating joint pain redness swelling and warmth can last days or weeks. The researchers wanted to learn if rilonacept could lower this shortterm risk for by neutralizing a specific target protein interleukin or IL before it initiates inflammation. They looked at gout patients in U.S. study centers who had a history of gout flareups and high levels of uric acid. All were placed on a chronic uricacid lowering regimen of the standard drug allopurinol. About half were also given an initial doubledose injection of rilonacept milligrams followed by a single dose for weeks. The other half received sugar pills. Rilonacept patients were less likely to have flareups with percent experiencing flareups threemonths into the study compared with percent among the nonrilonacept group the researchers found. Welltolerated drugs that reduce the risk of gout flares when initiating uricacid lowering therapy could make patients more likely to continue important longterm treatments that control gout Schumacher said in the release. And this trial provides wellcontrolled evidence that this IL blocker is effective in preventing acute gout flares in this setting he added. Rilonacept appears safe and well tolerated and could increase patient adherence to longterm uratelowering therapy. The study appeared online Jan. in the journal Arthritis Rheumatism. Dr. Michael A. Becker a professor emeritus of medicine at the University of Chicago described the findings as very promising. However he cautioned that the high cost of rilonacept will most likely curtail its use. This is a very expensive drug he said. And insurance will be an issue. So I think you will have to carefully justify its use and define the universe of patients who are likely to be treated with it. But there are a number of patients who cant take a less expensive alternative such as nonsteroidal antiinflammatory drugs because of their kidney function or ulcer disease Becker noted. So for this population of patients who cant tolerate cheaper medications rilonacept may be a necessary indication. More information For more on gout visit the U.S. National Library of Medicine http SOURCE Michael A. Becker professor emeritus medicine University of Chicago Arthritis Rheumatism news release Jan."

"A new analysis published today in JAMA Cardiology has found that timely and broad adoption of Entresto sacubitrilvalsartan by all eligible heart failure patients with reduced ejection fraction HFrEF could prevent or postpone more than deaths each year in the US alone. This analysis based on an application of the results of PARADIGMHF to published heart failure statistics is the first to quantify the possible impact of Entrestos potential benefit in reducing death. Heart failure is a chronic condition that contributes to more than deaths in the US every year. About half of people with heart failure have HFrEF. This new analysis estimates that as many as deaths in HFrEF patients annually could be prevented or postponed with optimal use of Entresto with sensitivity analyses demonstrating a range of to . Further the study suggests that delaying routine use of Entresto in clinical practice could have a substantial negative effect on patients given the expected riskbenefit profile as it could result in failure to prevent tens of thousands of deaths. These findings demonstrate the significant survival benefits Entresto could offer to those living with HFrEF if patients in the group defined by the authors were given access to treatment. The study authors stated that nearly of HFrEF patients . million people may be candidates for treatment with Entresto. Heart failure is a lifethreatening condition and despite available medicines about half of patients diagnosed with heart failure die within years. According to the study authors these findings may substantially impact the national health of the HFrEF population offering significant clinical benefit in preventing or postponing death when applied in clinical practice. This expert analysis adds to the already compelling case for the treatment of heart failure patients with reduced ejection fraction with Entresto said Fabrice Chouraqui president of Novartis Pharmaceuticals Corporation. In addition to survival benefits the study also recognizes other treatment effects of Entresto particularly in reducing HF hospitalizations. Coupled with the recent Class I recommendation the strongest endorsement in the focused update to the US HF Guideline these findings underscore the potential of Entresto as a standard therapy for chronic HFrEF patients. In a separate analysis published in the same issue of JAMA Cardiology researchers used data from the PARADIGMHF trial to model the health consequences and costeffectiveness of Entresto over a year time period. They compared Entresto to the ACEinhibitor enalapril and found Entresto was associated with more than a year longer average survival time and that it was costeffective compared to enalapril when these medications were used with other standard of care therapies. For every patients treated with Entresto vs. enalapril potentially . HF hospital admissions could be averted per each year alive in the model. In addition Entresto increased life expectancy at an incremental costeffectiveness ratio consistent with other highvalue widely accepted cardiovascular interventions such as implantable cardioverter defibrillators ICDs and cholesterollowering statins before they became generic. About Heart Failure Heart failure is a debilitating and lifethreatening condition which impacts nearly million Americans and is the leading cause of hospitalization among Americans over the age of . About half of people with heart failure have heart failure with reduced ejection fraction HFrEF. Reduced ejection fraction means the heart does not contract with enough force so less blood is pumped out. Heart failure presents a major and growing healtheconomic burden that currently exceeds billion in the United States which accounts for both direct and indirect costs. About Entresto Entresto is a twiceaday medicine that reduces the strain on the failing heart. It does this by enhancing the protective neurohormonal systems Natriuretic Peptide system while simultaneously inhibiting the harmful effects of the overactive reninangiotensinaldosterone system RAAS. Other heart failure medicines only block the harmful effects of the overactive RAAS. Entresto contains the neprilysin inhibitor sacubitril and the angiotensin receptor blocker ARB valsartan. Entresto is indicated in the US to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure NYHA Class IIIV and reduced ejection fraction. Entresto is usually administered in conjunction with other heart failure therapies in place of an Angiotensin Converting Enzyme ACE inhibitor or an angiotensin II receptor blocker ARB. Entresto filmcoated tablets are available in three dosage strengths mg mg and mg sacubitrilvalsartan. These doses are referred to as mg mg and mg in the clinical trial literature including the New England Journal of Medicine publication of the results of PARADIGMHF. The target treatment dose of Entresto is mg twice daily. Novartis is committed to providing patients with affordable access and resources through Entresto Central. For more information please call ENTRESTO or visit http Please visit http for Entresto full Prescribing Information. IMPORTANT SAFETY INFORMATION Entresto can harm or cause death to an unborn baby. Patients should talk to their doctor about other ways to treat heart failure if they plan to become pregnant. If a patient gets pregnant while taking Entresto she should tell her doctor right away. Patients are not to take Entresto if they are allergic to sacubitril or valsartan or any of the ingredients in Entresto have had an allergic reaction including swelling of the face lips tongue throat or trouble breathing while taking a type of medicine called angiotensinconverting enzyme ACE inhibitor or angiotensin II receptor blocker ARB or take an ACE inhibitor medicine. Patients are not to take Entresto for at least hours before or after they take an ACE inhibitor medicine. Patients should talk with their doctor or pharmacist before taking Entresto if they are not sure if they take an ACE inhibitor medicine. Patients are not to take Entresto if they have diabetes and take a medicine that contains aliskiren. Before they take Entresto patients should tell their doctor about all of their medical conditions including if they have kidney or liver problems are pregnant or plan to become pregnant are breastfeeding or plan to breastfeed. Patients should either take Entresto or breastfeed. They should not do both. Patients should tell their doctor about all the medicines they take including prescription and overthecounter medicines vitamins and herbal supplements. They should especially tell their doctor if they take potassium supplements or a salt substitute nonsteroidal antiinflammatory drugs NSAIDs lithium or other medicines for high blood pressure or heart problems such as an ACE inhibitor ARB or aliskiren. Entresto may cause serious side effects including serious allergic reactions causing swelling of the face lips tongue and throat angioedema that may cause trouble breathing and death. Patients are to get emergency medical help right away if they have symptoms of angioedema or trouble breathing. Patients are not to take Entresto again if they have had angioedema while taking Entresto. People who are black or who have had angioedema may have a higher risk of having angioedema if they take Entresto. Entresto may cause low blood pressure hypotension. Patients are to call their doctor if they become dizzy or lightheaded or they develop extreme fatigue. Entresto may cause kidney problems or an increased amount of potassium in the blood. The most common side effects were low blood pressure high potassium cough dizziness and kidney problems. Please see full Prescribing Information including Boxed WARNING available at http Patients are encouraged to report negative side effects of prescription drugs to the FDA. Visit http or call FDA. Disclaimer The foregoing release contains forwardlooking statements that can be identified by words such as could potential call for accelerate possible suggests expected may compelling endorsement potentially growing committed or similar terms or by express or implied discussions regarding potential new indications or labeling for Entresto or regarding potential future revenues from Entresto. You should not place undue reliance on these statements. Such forwardlooking statements are based on the current beliefs and expectations of management regarding future events and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize or should underlying assumptions prove incorrect actual results may vary materially from those set forth in the forwardlooking statements. There can be no guarantee that Entresto will be submitted or approved for any additional indications or labeling in any market or at any particular time. Nor can there be any guarantee that Entresto will be commercially successful in the future. In particular managements expectations regarding Entresto could be affected by among other things the uncertainties inherent in research and development including unexpected clinical trial results and additional analysis of existing clinical data unexpected regulatory actions or delays or government regulation generally the companys ability to obtain or maintain proprietary intellectual property protection general economic and industry conditions global trends toward health care cost containment including ongoing pricing pressures unexpected safety quality or manufacturing issues and other risks and factors referred to in Novartis AGs current Form F on file with the US Securities and Exchange Commission. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forwardlooking statements contained in this press release as a result of new information future events or otherwise. About Novartis Novartis Pharmaceuticals Corporation researches develops manufactures and markets innovative medicines aimed at improving patients lives. We offer a broad range of medicines for cancer cardiovascular disease endocrine disease inflammatory disease infectious disease neurological disease organ transplantation respiratory disease eye and ear care and skin conditions. The companys mission is to improve peoples lives by pioneering novel healthcare solutions. Located in East Hanover NJ Novartis Pharmaceuticals Corporation is an affiliate of Novartis AG which provides innovative healthcare solutions that address the evolving needs of patients and societies. Headquartered in Basel Switzerland Novartis offers a diversified portfolio to best meet these needs innovative medicines eye care and costsaving generic pharmaceuticals. Novartis is the only global company with leading positions in these areas. In the Group achieved net sales of USD . billion while RD throughout the Group amounted to approximately USD . billion USD . billion excluding impairment and amortization charges. Novartis Group companies employ approximately fulltimeequivalent associates. Novartis products are available in more than countries around the world. For more information please visit http Novartis is on Twitter. Sign up to follow Novartis at httptwitter.comnovartis. References . Fonarow GC Hernandez AF Solomon SD et al. Potential Mortality Reduction with Optimal Implementation of Angiotensin Receptor Neprilysin Inhibitor Therapy in Heart Failure. JAMA Cardiol. . doi.jamacardio.. . Yancy CW Jessup M Bozkurt B Butler J Casey Jr DE Colvin MM Drazner MH Filippatos G Fonarow GC Givertz MM Hollenberg SM Lindenfeld J Masoudi FA McBride PE Peterson PN Stevenson LW Westlake C ACCAHAHFSA Focused Update on New Pharmacological Therapy for Heart Failure An Update of the ACCFAHA Guideline for the Management of Heart Failure httpscontent.onlinejacc.orgarticle.aspxarticleid Journal of the American College of Cardiology doi .j.jacc.... . Gaziano TA Fonarow GC et al. CostEffectiveness Analysis of SacubitrilValsartan versus Enalapril in Heart Failure Patients with Reduced Ejection Fraction in the United States. JAMA Cardiol. . doi.jamacardio.. . Mozaffarian D Benjamin EJ Go AS et al. Heart Disease and Stroke Statistics Update A report from the American Heart Association. Circulation. ee. doi .CIR.. . Owan TE Hodge DO Herges RM et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. . . Roger VL Weston SA Redfield MM et al. Trends in heart failure incidence and survival communitybased population. JAMA. . Levy D Kenchaiah S Larson MG et al. Long term trends in the incidence and survival with heart failure. N Engl J Med. . . Weir LM Pfuntner A Maeda J et al. HCUP facts and figures statistics on hospitalbased care in the United States . Rockville MD Agency for Healthcare Research and Quality . . Ejection Fraction Heart Failure Measurement. American Heart Association Website.http_UCM__Article.jsp. Published March . Accessed March . . Heidenreich PA Albert NM Allen LA et al. Forecasting the impact of heart failure in the United States a policy statement from the American Heart Association. Circ Heart Fail. . . Entresto Prescribing Information. . Yancy CW Jessup M Bozkurt B et al. ACCFAHA guideline for the management of heart failure A report of the American College of Cardiology FoundationAmerican Heart Association task force on practice guidelines. Circulation. ee. For Novartis multimedia content please visit http For questions about the site or required registration please contact journalisthelpthenewsmarket.com mailtojournalisthelpthenewsmarket.com. SOURCE Novartis Pharmaceuticals Corporation Related Links http"

"Women who take bone drugs for several years have a slightly increased chance of suffering an unusual type of thigh fracture according to a large Canadian study. The findings add to earlier concern over the medicines called bisphosphonates whose U.S. labels have been required since October to include a warning about the thighbone fracture risk. However researchers stress the drugs are effective at preventing fractures of the hip or spine which are much more common in elderly people with the bonethinning disease osteoporosis. And the actual risk of having one of the unusual fractures was low said Laura Y. ParkWyllie of St. Michaels Hospital in Toronto who worked on the new study. Women with osteoporosis who are at high risk of fractures should not stop taking their treatment she told Reuters Health. Bone drugs include Mercks Fosamax Roches Boniva Novartiss Reclast and Warner Chilcotts Actonel. Some million Americans currently suffer from bone thinning according to the National Osteoporosis Foundation. The majority are postmenopausal women. ParkWyllie and colleagues tapped into data on more than Ontario women at least years old who had taken the bone drugs. Their findings appear in the Journal of the American Medical Association. Overall women suffered the unusual type of thighbone fracture after starting the bone drugs and nearly had typical hip fractures. The risk of a thighbone fracture differed depending on how long the women had been taking the medicine. After taking bone drugs for five years about one in women went on to suffer a thigh fracture over the next year. That works out to nearly three times the risk of those whod taken the drugs for roughly three months or less after accounting for other risk factors. On the other hand longer treatment was tied to a percent decrease in hip fractures which along with wrist and spine fractures affect about half of all people with osteoporosis. There are several alternative ways to treat osteoporosis including hormone treatment for women. And one preliminary study published along with the Canadian findings in JAMA hints that the common heart medication nitroglycerin might also boost bone health. So far however the cheap and effective bisphosphonate bone drugs remain the most popular treatment option. But some experts worry that negative media coverage might have led to more fractures and possibly deaths by dissuading patients from taking the drugs. The bad news is that overstating the levels of risk of side effects with these drugs which the media have been doing for some time now has led people to stop the drugs when they should be taking them said Dr. Ethel S. Siris who heads the Toni Stabile Osteoporosis Center at Columbia University in New York. Apart from atypical fractures the most serious side effect of the bone drugs is bone death or osteonecrosis of the jaw. But thats a very rare problem experts say which only affects about one in people on bisphosphonates. If youre taking the drugs and youve been on them for a while but arent sure if youre at high risk you should ask your doctor about it ParkWyllie advised. The U.S. Preventive Services Task Force a federal expert panel recommends screening all women over for osteoporosis. SOURCE bit.lyHWZ httpbit.lyHWZ JAMAJournal of the American Medical Association online February . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Almost two million Americans have severe heart failure and for them even mundane tasks can be extraordinarily difficult. With blood flow impeded throughout their bodies patients may become breathless simply walking across a room or up stairs. Some must sleep sitting up to avoid gasping for air. Drugs may help to control the symptoms but the disease takes a relentless course and most people with severe heart failure do not have long to live. Until now there has been little doctors can do. But on Sunday researchers reported that a tiny clip inserted into the heart sharply reduced death rates in patients with severe heart failure http In a large clinical trial doctors found that these patients also avoided additional hospitalizations and described a drastically improved quality of life with fewer symptoms. The results reported at a medical meeting in San Diego and published simultaneously in the New England Journal of Medicine were far more encouraging than heart specialists had expected. Its a huge advance said Dr. Howard Herrmann the director of interventional cardiology at the University of Pennsylvania which enrolled a few patients in the study. It shows we can treat and improve the outcomes of a disease in a way we never thought we could. If the device is approved by the Food and Drug Administration for treatment of severe heart failure as expected then insurers including Medicare most likely will cover it. Like the Science Times page on Facebook. httpon.fb.mepaTQh Sign up for the Science Times newsletter. httpnyti.msMbHaRU In heart failure the organ itself is damaged and flaccid often as a consequence of a heart attack. The muscle pumps inefficiently and in an attempt to compensate the heart enlarges and becomes misshapen. The enlarged organ tugs apart the mitral valve which controls blood flow from the left atrium into the left ventricle. The distorted valve functions poorly its flaps swinging apart. Blood that is supposed to be pumped into the body backs up into the heart and lungs. A vicious cycle ensues The heart enlarges so the mitral valve leaks. The leaky mitral valve makes the heart enlarge even more as it tries to compensate and heart failure worsens. In the new study a device called the MitraClip was used to repair the mitral valve by clipping its two flaps together in the middle. The clip is made by Abbott which funded the study outside experts reviewed the trial data. The result was to convert a valve that barely functioned into one able to regulate blood flow in and out of the heart. Until today researchers were not sure that fixing the mitral valve would do much to help these patients. A smaller study in France with similar patients failed to find a benefit for the MitraClip https But that research included many patients with less severe valve problems the procedure was not performed as adeptly and the patients medications were not as well optimized as in the new study. In the new trial patients with severe heart failure in the United States and Canada were randomly assigned to receive a MitraClip along with standard medical treatment or to continue with standard care alone. Among those who received only medical treatment were hospitalized for heart failure in the ensuing two years. Sixtyone died. In contrast just who got the device were hospitalized for heart failure during the period and died. The results have left leading researchers unexpectedly optimistic. The trial sends a very very powerful message said Dr. Gilbert Tang a heart surgeon at Mount Sinai Medical Center which enrolled a patient in the trial. This is a game changer. This is massive said Dr. Mathew Williams director of the heart valve program at NYU Langone Health which had a few patients in the study. Estimates of how many heart failure patients in the United States are like those in the trial range from . million to . million Dr. Williams said. But he adds the number who might ultimately be treated will be less than the number who could be treated. The device itself costs about not counting the cost of the hospital and doctors a surgeon an interventional cardiologist and an echocardiologist among others all in the operating room. Cardiologists said the study was impeccably executed. The doctors inserting the device first had to demonstrate their expertise doing so. An independent group of experts ascertained that patients medical care was optimal all too often heart failure patients do not receive ideal treatment. Patients with severe heart failure often are gravely ill too sick to have openheart surgery to have mitral valves replaced. Its not worth the risk said Dr. Gregg Stone of Columbia University Medical Center and NewYorkPresbyterian Hospital the studys principal investigator. Dr. Stone reported no relevant conflicts but said that Columbia University gets royalties from the sale of the MitraClip. But the new procedure is much less invasive than openheart surgery. A cardiologist threads the device to the heart through a blood vessel in the groin. Once it reaches the heart the MitraClip is guided to the valve and the device is used to clip the two flaps together. Not every cardiologist is equipped to insert the clip. These are difficult procedures that require training and dedication Dr. Herrmann said. During the procedure for example a tiny echocardiogram camera is placed into the patients esophagus behind the heart to show where the catheter with the clip is going. Doctors must watch an Xray screen and an echocardiogram as they guide the clip to the mitral valve. When the clip arrives you have to see where you are grasping to get a good result Dr. Tang said. The device is already approved by the F.D.A. for patients too frail for surgery but whose hearts are fine except for a mitral valve that does not function properly. Advertisement Cardiologists predicted the F.D.A. would quickly approve the device for patients with severe heart failure as well. It already is used in Europe for these patients but there had been no rigorous studies showing it helped. The new trial promises to alter prospects for many people with severe heart failure who had relatively few options. This will change how we treat these patients Dr. Williams said. Its possible he added that many would fare even better with the valve repair procedure if they were not so frail when they got it. Maybe we need to start intervening earlier he said."

"A fiveminute neck scan could predict a persons risk of developing dementia a full decade before symptoms emerge researchers have said. The test which analyzes the pulse of blood vessels in the neck could become part of routine testing for cognitive decline according to the study http by scientists at University College London UCL who presented their work Sunday at the American Heart Associations annual scientific conference. A group of almost patients aged had ultrasounds on their necks in before having their cognitive functions monitored for up to years from to . Why wellness retreats are tourisms next big thing In Asia the huge growth in highclass wellness retreats is changing the landscape of medical treatment and tourism. People with the most intense pulses which pointed to a greater and more irregular blood flow were up to more likely to suffer reduced cognitive functions the research found because the strength with which blood traveled into their brains caused damage to the brains network of blood vessels. Pulses become more intense when arteries near the heart are worn down usually by lifestyle factors such as poor diet and drug use and can no longer cushion the blood flow coming from the heart. If you can detect the risk in people in midlife it really gives an impetus to those people to change their lifestyle said Dr. Scott Chiesa postdoctoral researcher at UCL. Whats good for the arteries is good for the brain he added in summary of his findings. Dementia is not an inevitable cause of aging. How you live your life... has a real impact on how quickly your condition can decline. If the findings are confirmed by larger studies they could vastly improve the ability to detect dementia in middle age. And the scans would be well set up for routine testing according to Chiesa. Its very easy to do and its very quick to do. When healthy arteries around the heart can regulate the blood being pumped from the organ ensuring that it flows smoothly and at a constant rate to the brain. But damage to the arteries means blood flows more aggressively and irregularly through vessels and into the brain which can damage its network of blood vessels and cells. Over time the researchers believe this led more frequently to cognitive decline in participants in the study. What we do know is that the blood supply in the brain is incredibly important and that maintaining a healthy heart and blood pressure is associated with a lower risk of developing dementia said Carol Routledge Director of Research at Alzheimers Research UK who was not involved in the research. Vascular dementia is directly caused by reduced blood flow to the brain and this can also play a role in the development of Alzheimers disease studies have found. Those two conditions make up the vast majority of cases of dementia. Dementia is an umbrella term used to describe symptoms related to the loss of brain function. Alzheimers disease and vascular dementia make up the vast majority of cases. Around million people suffer from dementia worldwide according to the World Health Organization http with numbers projected to rise to million by . In the United States the condition is the sixth biggest cause of death among all adults according to the US Centers for Disease Control and Prevention while in the UK it has overtaken heart disease as the leading cause of death according to the Office for National Statistics. Promising findings The studys findings have been met with cautious optimism by dementia organizations. Getting a diagnosis of dementia can be time consuming and quite frustrating for many people so its promising that earlier indicators of cognitive decline are in development said Paul Edwards Director of Clinical Services at Dementia UK. But he added that focus should also be paid to dementia sufferers after their diagnosis saying The elephant in the room is the lack of support for people and their families once they get a diagnosis of dementia. There is currently no cure for dementia though medication can be used to temporarily treat its symptoms. Often a diagnosis is made and then people are sent home with no information no followup appointments and no clue about what is going to happen next. Previous studies this year have linked dementia risk to lifestyle factors such as alcohol consumption https and fitness level https but its effects remain largely incurable. More research is needed to determine whether neck scans should become a part of routine testing for dementia. While these findings are interesting as the full data from this research is yet to be published it is difficult to assess how useful this kind of scan could be said Routledge. Routledge added that current evidence shows that not smoking only consuming alcohol within recommended limits staying active monitoring cholesterol levels and eating a balanced diet can all help with the health of the heart and brain."

"The makers of POM Wonderful pomegranate juice say that the drink improves blood flow and heart health prevents and treats prostate cancer and works percent as well as Viagra whatever that means. All for about four bucks a bottle. Those impressive claims helped the company rack up million in sales in . They also earned the disapproval of the Federal Trade Commission FTC. Last month the agency sued POM Wonderful for making false and unsubstantiated health claims and is asking the company to remove the claims from its ads. A percent juice drink that contains antioxidants and no added sugar POM is just one of many beverages that bill themselves as promoting better health. VitaminWater kombucha tea coconut water and various brands of juice drinks made from acai goji berry and mangosteen have all used health claims in their marketing and some like POM have been the subject of scrutiny and legal action. The FTC along with the Food and Drug Administration FDA has been cracking down on food and beverage makers for allegedly overselling the health benefits of their products. In alone the FDA warned companies that they were providing misleading nutritional information on their packaging or making overly specific health claims. Health.com dietbusting foods you should never eat http Not all of the products were drinks but the beverage category stands out says Bruce Silverglade director of legal affairs at the Center for Science in the Public Interest a consumer advocacy group based in Washington D.C. At first blush it seems that beverage products are certainly a large proportion of food products that make bogus healthrelated claims. Drinks such as POM have become increasingly popular with consumers in recent years thanks in part to public health campaigns against soda that have been prompted by the obesity epidemic. The trend is away from traditional soda pop toward products claiming to provide magical health benefits Silverglade says. Are the health claims true Yes and no. The federal government doesnt require companies to vet health claims with the agency before plastering them on product packaging as long as the claims are accompanied by a disclaimer about their uncertainty. But that doesnt mean the claims are invented most are based in research. The research is often funded by the manufacturers however and industryfunded research can be prone to bias. A study found that research on health drinks that was funded entirely by beverage companies was between four and eight times more likely to find a favorable result than research with no industry support. If a cell phone company told you they tested all the models and their model came out the best would you believe it Probably not says Dr. Lenard Lesser M.D. one of the coauthors of that study and a researcher at UCLA. The same is true with nutrition research but the stakes are higher because were putting our bodies at risk. Wheres the line between research and marketing httpedition.cnn.comHEALTHcompany.funded.researchindex.html Sounds great hard to believe However farfetched the claims may sound POM is standing behind them. Two weeks before the FTC publicly announced its lawsuit POM preemptively sued the FTC claiming that preapproval of ads featuring health claims violates the companys right to free speech. But are shoppers really convinced that POM can unclog their arteries cure cancer and lead to hotter sex There seem to be more than a few believers out there. I started drinking POM after reading the studies two years ago my triglycerides were almost one of POM Wonderfuls fans breathlessly posted on Facebook after the FTC announced its lawsuit. Working out everyday drinking POM and eating healthy they are now less than . Forget what the Feds say I believe A triglycerides level of is still nearly three times higher than whats considered normal. Most health beverage drinkers arent as enthusiastic as the realtor from Alaska who posted the above testimonial. Quinton Ma a yearold marketing coordinator at Gawker Media in New York City started to drink VitaminWater as a middle schooler because it seemed like a healthy alternative to soda. I figured that if they were selling something that I could get extra vitamins from it couldnt hurt to drink Ma says. Once I learned they were really just cleverly marketed sugar waters I stopped. Health.com You are what you drink httpeating.health.comnewresearchyouarewhatyoudrinkcnnyes But the fact is even when people dont buy the health claims they often still buy the beverage. Thats the paradox of products such as POM Silverglade says The health claims on these products strain the imagination yet studies have repeatedly shown that health claims sell food. Thats because these claims however improbable they may seem distract shoppers from the real nutritional information and hook consumers with buzzwords like antioxidant. This phenomenon is known as a health halo an aura of healthfulness attached to a product based on labels like lowfat allnatural or made with whole grains that seduces consumers into overeating. According to a study by the FTC this halo effect can even lead people to overlook warning statements about the high sodium content of a product for example. A healthy halo develops around products like these says Frances LargemanRoth R.D. Health magazines senior food and nutrition editor. The healthconscious consumer incorporates them into their lifestyle thinking that theyre doing a world of good for themselves. Health.com Food label knowhow mistakes even savvy shoppers make httpeating.health.commistakesshoppersmakecnnyes Ceating a health halo The makers of POM Wonderful have spent million on scientific research on POM products and pomegranates. According to the FTCs complaint the studies POM has funded do not substantiate the companys claims and a closer look at the research seems to bear that out. One of the most prominent claims that POM can decrease arterial plaque by percent was taken from a single pilot study that included just people and was funded by the makers of POM. Another claim that POM drinkers experience a percent improvement in blood flow was taken from another POMfunded study that included just people and only lasted for three months. These days its possible for a food company to pay just about anybody to conduct a study says Silverglade. Michael Aviram Ds.C. a cholesterol researcher at Rambam Medical Center in Haifa Israel defended his studies on pomegranates many of them funded by POM by noting that they were published in very prestigious peer reviewed journals including the American Journal of Clinical Nutrition and Atherosclerosis. Dr. Harley Liker M.D. a physician at UCLA Medical Center who has also led research funded by POM directed all inquiries to a POM spokesman. A grocery store is a designed marketing environment to get people to buy things says Lesser. Lots of products are going to try to use health claims from research often from their own industry just to sell a product. Health.com health products you probably dont need http Iffy health claims dont mean that products like pomegranate juice should be avoided at all costs says Keri Gans R.D. a spokesperson for the American Dietetic Association. As long as consumers limit themselves to ounce servings and products with no added sugar juice can be an excellent source of vitamins and other nutrients Gans says. But its not going to solve any of your health issues she adds. The bottom line is that consumers shouldnt believe everything they read on labels. If they focus on consuming an overall wellbalanced diet they might not need to focus so much on finding a product that makes false promises Gans says."

"Patrick Hetzner tried diets and exercise just about everything short of stomach stapling to lose weight. Nothing worked. Five months ago he tried something new a stomach pacemaker that curbed his appetite. Since having it implanted Hetzner a yearold Munich mailman has knocked off more than kilos pounds from his earlier weight of kilos pounds. Hetzner got the device as part of a clinical trial. Since being approved by Britain last month the device is available for sale across the European Union. It works a bit like a cardiac pacemaker and consists of a stimulator and a sensor surgically implanted onto the stomach. The stimulator sends out electrical pulses meant to trick the stomach and brain into thinking the body is full. Hetzner said the pulses kick in a few minutes after he starts eating or drinking. He said they make him feel full after finishing about half the amount of food he would normally eat. It feels like a little pressure on my stomach or a tickle but its not a bad feeling he said in a telephone interview. Advertisement Its been like a little guide to help me change my life he said. So far about patients in two studies have received the device from U.S. pacemaker manufacturer Intrapace. Only about half of those have had the pacemaker for at least a year and most lost about percent of their weight and kept it off. Other stomach pacemakers are on the market but most are used to relieve symptoms like nausea and vomiting not to fight obesity. Appetite is partly controlled by signals sent from nerves around the stomach to the brain the stomach pacemaker taps into that communication system sending a message to the brain that the body is full after a relatively small amount of food is consumed. If you can stimulate the nerves going from the stomach to the brain that should indeed have an effect in reducing food intake said Stephen Bloom an obesity expert at Imperial College in London who is not connected to Intrapace or the clinical trials. Bloom however questioned whether the device would work longterm as people might eventually get used to the electrical pulses and keep eating anyway. Doctors familiar with the pacemaker say there will always be ways for patients to eat and work around the system. We could make the stomach pacemaker work so people feel like theyre going to throw up but we dont want that said Thomas Horbach chief of surgery at Stadtkrankenhaus Schwabach near Munich who led one of the trials. If you take away all the responsibilities from the patient they will not change on their own. As an additional benefit the sensor tracks when patients eat drink or exercise so patients can chart their progress. Intrapace has also created an online network for patients to trade weight loss advice and share experiences. Other surgical approaches to weight loss come with serious side effects. People who have their stomach stapled or have a gastric band must eat smaller amounts of mostly lowfat foods because their stomachs cant accommodate or process large volumes. If they overeat they will feel nauseous vomit or suffer from other problems. The most serious side effect seen in the pacemaker has been an infection linked to surgery. In Britain the pacemaker costs about pounds including the keyhole surgery used to implant it. Intrapace President Chuck Brynelsen said thats comparable to other weight loss surgeries. The device is authorized for sale across the EU though the company is first targeting weight loss clinics in Britain Germany and Spain. It also plans to submit the device for approval in the U.S. once it has more data and hopes it will be available there in . The pacemaker hasnt yet been implanted commercially in Europe but Intrapace is in talks with clinics interested in offering it. Brynelsen said the battery in the device lasts about five years and it will be up to patients how long they want to keep the pacemaker. We dont know if patients will see the stomach pacemaker as a bridge to recovery or whether this is a crutch they will need for the longer term he said. Some experts said the pacemaker did not address peoples underlying reasons for overeating. The problem with these devices is they assume people are rational and that they eat because theyre hungry said Stephan Rossner a professor in the obesity unit at Karolinska University Hospital. A lot of obese patients eat because theyre depressed they cant sleep at night or they have nobody to have sex with he said. So whatever you insert into their stomach they can outeat that device because its other things that drive them to consume. Hetzner said he intends to keep the stomach pacemaker for about four years. I dont want to backslide he said adding he would recommend the device to others. I want to be sure I can stick with it and that my body adapts to this new way of eating. ___ Online http"

"After three years teens with severe obesity who underwent stomach reduction surgery to lose weight also significantly improved their heart health. A study published httpdoi.org.peds. Monday in Pediatrics shows that blood pressure cholesterol inflammation and insulin levels all improved particularly among those who lost the most weight. The potential impact of such risk reduction translates into a reduced likelihood of developing significant heart disease later in life including atherosclerosis heart failure and stroke says study author Marc Michalsky http surgical director of the Center for Healthy Weight and Nutrition at Nationwide Childrens Hospital in Columbus Ohio in an email. This study serves to reinforce the benefits of bariatric surgery as a safe and effective treatment strategy that should be considered sooner rather than later. Younger adolescents in the study showed bigger improvements in their cholesterol and inflammation levels than the older teens. Even participants who had normalrange blood pressure triglycerides or cholesterol levels before surgery saw improved measures. Nearly a third http of all children and teens are overweight or obese in the U.S. and an estimated to percent have severe obesity. The greater a persons obesity the greater their risk of high blood pressure heart disease Type diabetes and organ damage. The findings are important because many of the participants in this study likely already had some level of cardiac damage such as thickened arteries or heart walls says Geetha Raghuveer http a pediatric cardiologist at Childrens Mercy Kansas City in Missouri who was not involved in the study. If you have very high blood pressure or lipids cholesterol or diabetes you do see cardiovascular changes even at a very young age Raghuveer says. They may not be having a heart attack or stroke in their teens and s but theyre closer to having those in their s and s. Article continues after this message from our sponsor Among teens in the study of them underwent a RouxenY gastric bypass procedure httpasmbs.orgpatientsbariatricsurgeryproceduresbypass underwent a vertical sleeve gastrectomy httpasmbs.orgpatientsbariatricsurgeryproceduressleeve and received an adjustable gastric banding httpasmbs.orgpatientsbariatricsurgeryproceduresband. The study authors had no part in which procedures the teens received. They collected data from the five participating medical centers for their observational study and decisions about procedures depended on each centers clinical practices. The teens ages to when the study began had a body mass index BMI between and with half over . Medical providers use BMI the ratio of a persons weight to height to estimate body fat http_wtrisk.htm. A BMI over is considered overweight over is obese. The obesity classification with the highest risks of health problems is a BMI of or higher. The risk factors measured in the study included elevated blood pressure above mgHg high cholesterol high insulin levels in the blood and abnormally high levels of Creactive protein http_vascular_instituteclinical_servicescenters_excellencewomens_cardiovascular_health_centerpatient_informationhealth_topicsc_reactive_protein.html an indicator of inflammation in the body. The higher a persons insulin levels are the more likely they are to have or develop insulin resistance which can increase blood sugar levels and diabetes risk. High insulin levels may also contribute to increased blood pressure and increase the risk of atherosclerosis http_UCM__Article.jsp.WkASOZNo when fat clogs the arteries. Three years after surgery teens who underwent a gastric bypass had a percent drop in their BMI similar to the percent drop in those who had the sleeve gastrectomy. Those with the gastric band had an percent drop in BMI. Before surgery only percent of the teens had no cardiac risk factors at all but three years later just over half of them percent had no risk factors. Just percent had all four cardiac risk factors before their surgeries but none had all of them three years later. In fact the majority of the participants percent had only one or no risk factors three years after their surgeries. The proportion of participants with two or three risk factors also dropped substantially. One of the surprises was that almost all patients benefited as a result of the surgery says M. James Lenhard httpdoctors.christianacare.orgdetails the medical director of Christiana Care Health Systems Diabetes Metabolic Diseases Center in Wilmington Del. who was not involved in the study. The average BMI three years after surgery was still considered very obese he says. And yet they still had significant improvements in cardiovascular risk factors Lenhard says. The results were impressive. The studys biggest limitation is its very selective population. Most of the participants were female most were white and most received the gastric bypass. Children of color have the greatest risk of obesity heart disease and Type diabetes but its not clear whether they would see the same improvement with these procedures. Lenhard expects the odds are very good that they would and Raghuveer would be cautiously optimistic that the findings would be similar regardless of sex or ethnicity. The population also included only teens with the greatest obesity who were also unsuccessful trying other weight loss methods. Severe obesity is notoriously difficult to treat with anything other than surgery Lenhard says. The results of this study suggest that performing surgery at a BMI even lower than would provide even better outcomes. An estimated adolescents undergo metabolic or bariatric surgeries each year the study notes but families should only consider such procedures after exhausting other treatment options. This is not a procedure you would consider for any obese patient who walks through the door Raghuveer says. It would be considered for the highly obese and those not responding to any behavioral modifications physical activity or calorie restriction. Before undergoing bariatric surgery teens and their families receive extensive counseling Michalsky says. Teens considering bariatric surgery should have a frank discussion with their family and primary care provider and seek detailed information from wellestablished bariatric surgery centers that are specifically dedicated to treating adolescents he adds. All three procedures carry the same risks as any surgical procedure such as infections blood clots and bleeding Lenhard said and a common risk of sleeve gastrectomy is bleeding where the stomach is reconnected httpmedlineplus.govencyarticle.htm. People who have a gastric bypass often have nutritional and vitamin deficiencies Lenhard said. And gastric banding has low effectiveness and a risk of the band slipping down the stomach. Getting longer term data is important too. Three years is a good followup time for this type of study and it has many more participants than similar studies. However three years is not a long time overall in the life of a child Raghuveer says. Id be curious what happens to these kids at years years later. Michalsky says the study is ongoing and they expect to continuing gathering information for years to come. Ideally public health efforts should aim for better obesity prevention including parent education and interventions when children are toddlers and preschoolers according to Raghuveer. A generational divide has left fewer families knowing how to fix meals she says and more families need to learn to cook and avoid packaged foods and microwave dinners. The big question is how do we prevent obese kids from getting to this point where they would need an invasive surgical procedure Raghuveer says. The bigger message should be that we should get to a point in society where we are not managing obesity but we are preventing obesity."

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

"An easy twominute vision test administered on the sidelines after a young athlete has hit his or her head can help to reliably determine whether the athlete has sustained a concussion according to a new study of student athletes https some as young as . The test is so simple and inexpensive that any coach or parent potentially could administer it the studys authors believe and any league afford to provide it as a way to help evaluate and safeguard players. Those of us who coach or care for young athletes know by now that an athlete who falls or collides with something during play or seems dazed dizzy loses consciousness or complains of head pain should be tested for a concussion which occurs when the brain is physically jostled within the skull. But most of us are clueless about how to test young athletes. The most commonly recommended sideline test is the Standardized Assessment of Concussion a multipart examination during which athletes are asked to name the date describe how they feel memorize and recall lists of words and do jumping jacks and other tests of coordination. Ideally this assessment should be administered and evaluated by a medical professional. But while the sidelines of college and professional games are crowded with doctors and certified athletic trainers few high schools and youth leagues have those resources. Most of the time concussion testing in youth sports falls to volunteer coaches or parents with little if any medical experience. That situation prompted researchers at New York Universitys Langone Concussion Center https to begin wondering recently whether there might be other easier diagnostic tools to check young players for concussions. Their thoughts soon turned to vision. About percent of the brains pathways are tied in some to way to vision and visual processing said Dr. Steven Galetta chairman of neurology at N.Y.U. Langone Medical Center and senior author of the study which was published in The Journal of NeuroOphthalmology https Eye tests can tell evaluators a great deal about how well someones brain is working. But for the most part visual tests have not been part of the standard protocol for sideline concussion testing of young athletes. However the N.Y.U. researchers knew that in recent years trainers working with athletes in sports such as boxing and mixed martial arts where concussions are common had begun supplementing the Standardized Assessment with a simple vision exam known as the KingDevick test during which someone reads slightly jumbled lines of numbers printed on three cards as quickly as possible. See below for more information. The KingDevick test measures rapid eye movement visual tracking and related cognitive responses and is a reliable indicator of cognitive problems. If an injured adult reads the numbers more slowly after a head impact than in baseline testing he or she is considered to have sustained a concussion. The test requires no medical training. But it had not been evaluated for use in young athletes. So the N.Y.U. researchers decided to test it. They recruited young hockey and lacrosse players between the ages of and and collegians from the same sports. These athletes all completed a baseline Standardized Assessment of Concussion exam during preseason and walked as fast as possible along a narrow foot long strip of athletic tape to measure their balance. They also completed the KingDevick test. Then they went out to play. During their subsequent competitive seasons athletes hit their heads and were put through the full battery of sideline concussion tests by parents or coaches under the supervision of N.Y.U. medical personnel. Fourteen agematched uninjured athletes in the same sports completed the same tests to serve as controls. Neurologists later confirmed that the injured athletes had sustained concussions. Then the N.Y.U. researchers compared how well the various sidelines tests had done at pinpointing the brain injury. The Standardized Assessment of Concussion had performed rather miserably correctly identifying only two of the concussed athletes missing and finding that three of the uninjured control athletes had supposedly sustained a concussion since their scores had declined compared with their baseline almost certainly the studys authors believe because these young athletes were physically tired. The KingDevick test did much better correctly assessing concussion in percent of the young injured players and inaccurately identifying it in only one. The pacealongthetape test was also relatively accurate. Ten of the injured athletes were slower now but so were five of the unhurt players. Overall the KingDevick test had by far the greatest accuracy and lowest risk of false positives. The upshot Dr. Galetta believes is that parents and coaches should absolutely consider familiarizing themselves with the KingDevick test and administering it to young athletes before the season starts then having those baseline numbers and the test itself handy on the sidelines. If an athlete hits his or her head and is then slower than baseline by even a fraction of a second at reading off the numbers Dr. Galetta said it is very probable he or she has a concussion and needs to be taken from play and seen by a doctor. It is still too early to say however whether the KingDevick test can replace other more conventional concussion evaluations for young athletes including the standardized assessment despite its shortcomings in this study Dr. Galetta cautioned. For now he says it probably should be used in conjunction with other tests. How to Administer the KingDevick Concussion Test During preseason use a stopwatch to time the athlete as he or she reads off the numbers on each line from left to right as quickly as possible. The cards should be read in order. This establishes a baseline time. For the greatest precision you might want to have athletes perform the test twice and use their best reading. During the season if an athlete is suspected of sustaining a concussion have him or her repeat the test on the sidelines. If the time is slower even by a small amount he or she probably has a concussion according to neurologists. Interestingly uninjured athletes are almost always faster at reading the numbers during games or practices because physical exertion sharpens the kind of visual performance being tested."

"When symptomfree people have heart scans to look for clogged arteries they can end up with overtreatment and side effects researchers said Monday. In a study published in the Archives of Internal Medicine they found people who had the scans were much more likely to be put on medications and undergo surgery than those who chose standard health screening. The scans called coronary computed tomography angiography or CCTA produce a detailed image of the heart that reveals cholesterol buildups in the coronary arteries. If they get big enough such buildups may cut the blood flow and cause a heart attack. So in theory treating them early on might help stave off some the more than . million heart attacks a third of them fatal that occur every year in the U.S. Yet theres no evidence that treating people based on heart scan results does any good said Dr. John McEvoy of Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore who led the new study. By contrast its well known that the scans expose patients to a high dose of Xrays which can increase their likelihood of developing cancer. And the dyes used to enhance the images cause kidney damage in a significant portion of people. Testing might lead to more harm than good McEvoy told Reuters Health adding that heart scans may cost or more. His team looked at Korean patients who chose to get a heart scan as part of a health screening program at Seoul National University Bundang Hospital. The researchers compared those patients to closely matched individuals who opted to forgo the scans not currently recommended by guidelines and just get the standard health checkup. More than a fifth of the patients who got scanned had cholesterol buildups in their arteries also called atherosclerosis. Three months later these individuals were using cholesterollowering statins percent of the time and bloodthinning aspirin percent of the time. In those who tested negative for atherosclerosis or didnt get scanned less than percent used the medications. People who got scans also had more additional tests and major heart procedures. The researchers expected that if the extra drugs and procedures were actually helpful the treated people would have a lower rate of serious heart problems in the future. But after another months there was no such difference. There was just one event in the people who had CCTA one case of hospitalization for chest pain and one in the people who didnt a heartrelated death. Currently whether a patient gets statin or aspirin is based on risk factors such as their age and how much cholesterol is in their blood. Both drugs have side effects notably joint problems and bleeding ulcers. Although the study cant prove that getting a scan caused the extra medication use the gap could not be explained by differences in risk factors for heart disease such as cholesterol levels or smoking. In an editorial Dr. Michael S. Lauer of National Heart Lung and Blood Institute in Bethesda Maryland said the new study serves as a reminder of the downsides of screening. Physicians cannot easily ignore diagnoses made with screening tests because it is impossible for them to determine whether their patients have real disease or pseudodisease Lauer notes. Therefore physicians prescribe tests medications procedures or even surgical procedures all of which carry inherent risks. McEvoy agrees. With these new imaging techniques we are left with the dilemma of what to do with the results he said. Even when screening helps predict health problems down the road Lauer adds that doesnt mean treatments are necessarily beneficial. Overdiagnosis is threatening to become an increasingly important public health problem because of the enthusiasm for and proliferation of unproven screening tests Lauer writes. McEvoy said there have been several reports of doctors doing CCTA heart scans in healthy patients although the practice is currently discouraged by the American Heart Association. According to McEvoy doctors should focus on patients lifestyle and traditional risk factors such as smoking and obesity. SOURCE bit.lylEEptL httpbit.lylEEptL and bit.lykBzXJ httpbit.lykBzXJ Archives of Internal Medicine online May ."