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". Both acupuncture and Alexander Technique prove effective for longterm relief of chronic neck pain Abstract http Free summary http URL live when embargo lifts In a randomized controlled trial both acupuncture and the Alexander Technique led to longterm significant reductions in neck pain and associated disability compared with usual care alone. The study is published in Annals of Internal Medicine. Chronic neck pain is a leading cause of disability. Usual care for neck pain generally consists of prescribed medications and visits to physical therapists and other health care professionals. In addition persons with chronic neck pain often seek complimentary care to manage their condition such as acupuncture or the Alexander Technique. Acupuncture is a procedure in which patients have thin needles inserted into specific points on the body to relieve pain and the Alexander Technique is an educational process that teaches people how to avoid unnecessary muscular and mental tension in everyday activities. Researchers sought to determine the clinical effectiveness of acupuncture or Alexander Technique lessons compared with usual care for persons with chronic nonspecific neck pain. Patients were randomly assigned to acupuncture sessions or onetoone Alexander Technique lessons plus usual care or usual care only. Neck pain was assessed by the Northwick Park Questionnaire NPQ at and months. The researchers found that acupuncture and the Alexander Technique lessons both led to a significant reduction in neck pain at months compared with usual care alone. Both interventions had a high rate of acceptability and greater adherence was associated with better pain outcomes. Over time both interventions resulted in a greater increase in selfefficacy than did usual care and these improvements were associated with better NPQ outcomes. Note For an embargoed PDF please contact Cara Graeff. To speak with the lead author Dr. Hugh MacPherson please contact David Garner at david.garneryork.ac.uk mailtodavid.garneryork.ac.uk or ."

"New research finds that eating an avocado per day as part of an overall diet rich in healthy fats may help cut the bad kind cholesterol known as LDL. Researchers at Pennsylvania State University recruited overweight participants who agreed to try three different types of cholesterollowering diets. Their study httpjaha.ahajournals.orgcontente.abstract was published Wednesday in the Journal of the American Heart Association. One was a lowfat diet that included lots of fruits lowfat dairy poultry whole grains and small amounts of red meat. The other two diets were moderately high in fat with about percent of total calories consumed per day coming from fat. The types of foods and meals were similar to the lowfat diet but included more nuts and oils. One of the moderately highfat diets included a daily serving of one avocado. In one sample meal plan lunch was chicken salad with half an avocado and dinner included turkey tacos with another half an avocado. The diets were similar in terms of macronutrients like protein and fats and calories. The only difference between the two was the avocado the other diet had the same amount of fat from other sources. At the end of the study the researchers found that the avocado diet led to significant reductions in LDL cholesterol compared with the other two diets. To put the difference in perspective the avocado diet decreased LDL cholesterol about milligrams per deciliter of blood. Compare that with a decrease of about mgdL for the lowfat diet and about a mgdl drop from the moderatefat diet. I was surprised to see the added benefit of the avocado Penny KrisEtherton httpnutrition.hhd.psu.edudirectoryBio.aspxidPennyKrisEtherton a nutrition scientist at Penn State and the lead author of the study tells us. Its something in the avocado other than just the fat composition she says. She says shed like to do followup research to look at the bioactive compounds in avocados which may explain the added reduction in LDL cholesterol in the study participants. Its also possible that the fiber in avocados plays a role in the cholesterollowering effect she says. Article continues after this message from our sponsor But one caveat for anyone who loves guacamole When its served up with chips the calories can add up. A mere halfcup of guacamole has about calories all on its own. KrisEthertons study was funded in part by the National Center for Research Resources part of the National Institutes of Health. It was also supported by a grant from the Hass Avocado Board an industry group that the researchers say had no role in the design of the study or the interpretation of the data. We asked KrisEtherton if she would have published the results had there been no positive findings for the avocado. Oh absolutely she told us. The agreement was to publish no matter the results. And given the reduction in funds available for research its become increasingly common for researchers to carry out these kinds of industrysupported studies."

"Breast cancer is the second most common cancer in women after skin cancer and occurred in women in the United States in . Breast cancer afflicts in women in their lifetime and in die from this disease. Although a number of randomized trials demonstrate the clear benefits of mammography screening in women up to age on reducing mortality data are sparse in women over the age of especially minorities. In percent of breast cancer deaths occurred in the more than million women who are between the ages of to years. In a new study published in the American Journal of Medicine Charles H. Hennekens M.D. senior author and first Sir Richard Doll Professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University indicates that black and white women ages to years who had an annual mammogram had lower year breast cancer mortality than corresponding women who had biennial or noirregular mammograms. Among elder women the American Cancer Society and the United States Preventive Services Task Force recommend regular mammography for ages to . Although many guidelines rely on selfreports Hennekens and his collaborators from Baylor College of Medicine and Meharry Medical College used the Surveillance Epidemiology and End Results SEER program file linked to the Medicare administrative claims file which allowed them to identify screening mammography use from to from nonHispanic women black and white. These linked files also permitted them to explore breast cancer mortality differences between elderly black or white women who selfselected for regular annual or biennial mammography screening. The researchers selected as the lower age limit because Medicare coverage of the general population begins at age and the exposure of interest was regular mammography screening in the four years immediately preceding breast cancer diagnosis. Three mutually exclusive categories were defined no or irregular mammography biennial mammography and annual mammography. They looked at data from nonHispanic white or black women Hispanics were not included because Hispanic white women have substantially lower mortality than nonHispanic whites and the number of Hispanic blacks is small. The researchers also measured socioeconomic status looking at median household income the percentage of individuals living below the poverty level and whether or not they had a high school education. Other significant findings from the study show that White women who had died tended to be older to have a later stage diagnosis to have received chemotherapy and to have a higher socioeconomic status. White women who died were less likely to have undergone surgery and receive radiation therapy. Similar characteristics were seen in black women as in white women. to yearold women receiving regular annual screening mammography during the four years immediately preceding breast cancer diagnosis had consistently lower fiveyear and year risks of breast cancer mortality than women with no or irregular screening regardless of race. year risks were more than three times higher among white and more than two times higher among blacks aged to years with no or irregular screening compared with annual screening. Hennekens notes that further research is needed but that in the future the use of regular claimsbased surveillance for mammography as a source of data may offer some unique advantages over selfreports. From to according to Science Watch Hennekens was the third most widely cited medical researcher in the world and five of the top were his former fellows andor trainees. In Science Heroes ranked Hennekens No. in the history of the world for having saved more than . million lives which placed him two ahead of professor Jonas Salk ranked No. for the development of the polio vaccine. In he received the Fries Prize for Improving Health and in he received the Alton Ochsner Award for his pioneering work on smoking and health. In he was ranked the No. Top Scientist in the World based on his Hindex of . About Florida Atlantic University Florida Atlantic University established in officially opened its doors in as the fifth public university in Florida. Today the University with an annual economic impact of . billion serves more than undergraduate and graduate students at sites throughout its sixcounty service region in southeast Florida. FAUs worldclass teaching and research faculty serves students through colleges the Dorothy F. Schmidt College of Arts and Letters the College of Business the College for Design and Social Inquiry the College of Education the College of Engineering and Computer Science the Graduate College the Harriet L. Wilkes Honors College the Charles E. Schmidt College of Medicine the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan Healthy aging biotech coastal and marine issues neuroscience regenerative medicine informatics lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAUs existing strengths in research and scholarship. For more information visit http"

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

"Blood injections especially of plateletrich blood into the affected area help relieve the pain associated with tennis elbow where other treatment methods have failed according to a Greek study. A player returns the ball during the Monte Carlo Masters tennis tournament in Monaco April . REUTERSEric Gaillard Analogous blood injections in which the patients own blood is taken and then injected into a specific area of the body is used to help harness the healing power of blood to treat the degeneration of tendons. Plateletrich plasma PRP is blood that has been spun in a centrifuge to separate the blood cells. There is now a solution for patients suffering from unrelenting tennis elbow said Christos Thanasas from Henry Dunant Hospital Athens who led the study. Whole blood treatment is a god alternative in remote areas or in health systems that do not support financially the use of PRP he told Reuters Health in an email. Thanasas and his colleagues compared the effectiveness of single local injections of PRP under ultrasound guidance with autologous blood injections in patients with tennis elbow formally known as lateral elbow epicondylitis. Visual analog pain scores at weeks after the injections improved by a mean . points or . percent in patients who had the PRP injections compared to the autologous blood group a mean . points or . percent improvement. Both groups experienced more improvement at and months after the injections with no significant in pain scores between the treatments. The findings were published in The American Journal of Sports Medicine. PRP is probably the best treatment for chronic refractory lateral epicondylitis if it is used after classical types of treatment like rest braces nonsteroidal anti inflammatory drugs cortisone injections or physiotherapy have all failed Thanasas said. The last resort remains surgery. Thanasas added that further studies are needed to see how and when the PRP therapy is most effective adding that he and his colleagues are about to start trials of PRP therapy in which different concentrations of white blood cells are used to see how this affects the regeneration of tendons. Reporting by Will Boggs at Reuters Health editing by Elaine Lies Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"About one in three couples struggling with infertility httptime.commoneypagewaitingforbaby can trace their issues to poor quality semen and men are given all kinds of advice about ways to produce healthier sperm. Among the most dispensed eat a healthy diet keep a healthy weight avoid alcohol and tobacco and stay away from certain medications such as blood pressure and depression drugs. Now researchers publishing in the journal Reproduction have found that another lifestyle changeexercise httptime.comthenewscienceofexerciseiidsrlinkmay also help improve sperm quality. In the study Behzad Maleki at JustusLiebig University in Germany and his colleagues recruited sedentary middleaged men and randomly assigned them to one of three exercise regimens or to no exercise and followed them for six months. They wanted to see what effect different types of exercise and different intensity activity had on sperm quality and count. One group exercised at moderate levels continuously by walking or jogging on a treadmill while another followed the same protocol but at a higher intensity. Another group did high intensity exercise on the treadmill but in short interval bouts. Compared to the control group that didnt exercise all of the men who followed a physical activity program showed improvements in a variety of measures of their sperm. After six months they showed less DNA damage healthier sperm shape and lower levels of metabolic stress factors. They also showed higher numbers of sperm precursors. This fits reasonably well with what we thought about the effects of exercise says Dr. Peter Schlegel vice president of the American Society of Reproductive Medicine and chairman of urology at New York PresbyterianWeill Cornell Medical Center. But this is a much better done study than almost anything thats been done before on the subject. He notes that most previous studies did not randomly assign people to exercise groups and compare the outcome on sperm quality but rather recorded sperm measures among men who reported their exercise habits after the fact. In the current study the men in the moderate intensity continuous activity program showed the most improvements compared to men in the other two more intense groups. While its not entirely clear why part of the reason may have to do with the fact that extreme exercise generates body heat which can be detrimental to sperm health for marathoners and people training at intense levels finding ways to dissipate body heat is a major concern. Schlegel also says that regular exercise can improve circulation and make the blood vessels healthier which may benefit the testes an organ thats sensitive to and requires good blood flow. Exercise may also be working in other ways to enhance reproductive health since all of the men who exercised lost weight reduced their amount of body fat and improved their fitness levels. Fat tissue has been linked to higher levels of damaging metabolic stress compounds so losing weight and becoming more fit may create more hospitable conditions for sperm and improve its quality and volume. There are already plenty of reasons to exercise httptime.comexercisefitnessworkoutsiidsrlink and now better quality sperm is one more worth noting."

"Multiple sclerosis patients may eventually benefit from a novel treatment that takes aim at the abnormal behavior of a specific type of immune cell preliminary research suggests. The errant behavior of the cells in question known as B cells is viewed as key to the development of this chronic and disabling nervous system disease commonly called MS. The new therapys potential is only in the early stages of exploration cautions an international study team comprised of researchers from the United States Canada Switzerland and the Netherlands in the report published in the Nov. online edition of The Lancet. But initial indications suggest that the new antibody drug called ocrelizumab successfully targets these renegade cells with hopeful results a significant reduction in diseaserelated inflammatory brain lesions. Our findings show that ocrelizumab rapidly suppresses inflammatory activity noted the study authors led by Dr. Ludwig Kappos from the University Hospital Basel Switzerland in a journal news release. Describing the targeting of B cells as an innovative therapeutic approach Kappos and his colleagues reported that in testing among patients the drugs impact on lesions was rapid and pronounced. Whats more to date the treatment appears to be safe. The study authors noted that MS is a progressively debilitating disease that attacks an individuals central nervous system disrupting the normal brain spinal cord and optic nerve function. A classic characteristic of the disease is inflammation which takes the form of brain lesions. The immune systems T cells have long been implicated in disease progression but the notion that B cells may also play a major role is relatively new. With this new potential target in mind researchers configured ocrelizumab to specifically focus on a protein CD found on the surface of certain B cells. To test the drug Kappos and his team recruited patients aged to seeking MS treatment in centers in countries. The patients were divided into four groups treated with a low dose of ocrelizumab milligrams a high dose of ocrelizumab mg a wellknown MS inflammation treatment known as intramuscular interferon betaa or a sugar pill placebo. After weeks some of the doses were adjusted. The result at week all of the patients receiving either dose of ocrelizumab fared better in terms of lesion count than either the placebo or standard treatment groups. The number of active lesions had dropped percent more among the mg group compared with those getting a placebo. Similarly those in the mg group experienced a percent bigger drop in lesions. Whats more relapse rates were much lower among those taking the new drug in contrast to those taking a placebo. The investigators further noted that even eight months after treatment launch no serious adverse effects were directly attributable to the new drug. That said Dr. Moses Rodriguez a professor of neurology and immunology at the Mayo Clinic in Rochester Minn. disputed the premise that ocrelizumab is shaping up as anything new and innovative. In fact theres nothing novel about this at all he said. There is another drug called rituximab thats been in early trials for MS for years. And all this new drug is attempting to do is replicate the same that rituximab already does. And I see no major advantage of this drug versus that older drug. Its not better or worse. Its the same Rodriguez noted. So bottomline I would not sell this as a major breakthrough in MS cautioned Rodriguez. Its not. Funding for the study was provided by F. HoffmannLa Roche and Biogen Idec. Inc. More information For more on multiple sclerosis visit the U.S. National Library of Medicine http SOURCES The Lancet news release Oct. Moses Rodriguez M.D. professor neurology and immunology Mayo Clinic Rochester Minn."

"A chemical found in marijuana known as tetrahydrocannabinol or THC has been found to potentially slow the process in which mental decline can occur in up to percent of HIV patients says a new Michigan State University study. Its believed that cognitive function decreases in many of those with HIV partly due to chronic inflammation that occurs in the brain said Norbert Kaminski lead author of the study now published in the journal AIDS. This happens because the immune system is constantly being stimulated to fight off disease. Kaminski and his coauthor Mike Rizzo a graduate student in toxicology discovered that the compounds in marijuana were able to act as antiinflammatory agents reducing the number of inflammatory white blood cells called monocytes and decreasing the proteins they release in the body. This decrease of cells could slow down or maybe even stop the inflammatory process potentially helping patients maintain their cognitive function longer Rizzo said. The two researchers took blood samples from HIV patients who reported whether or not they used marijuana. Then they isolated the white blood cells from each donor and studied inflammatory cell levels and the effect marijuana had on the cells. The patients who didnt smoke marijuana had a very high level of inflammatory cells compared to those who did use Kaminski said. In fact those who used marijuana had levels pretty close to a healthy person not infected with HIV. Kaminski director of MSUs Institute for Integrative Toxicology has studied the effects of marijuana on the immune system since . His lab was the first to identify the proteins that can bind marijuana compounds on the surface of immune cells. Up until then it was unclear how these compounds also known as cannabinoids affected the immune system. HIV which stands for human immunodeficiency virus infects and can destroy or change the functions of immune cells that defend the body. With antiretroviral therapy a standard form of treatment that includes a cocktail of drugs to ward off the virus these cells have a better chance of staying intact. Yet even with this therapy certain white blood cells can still be overly stimulated and eventually become inflammatory. Well continue investigating these cells and how they interact and cause inflammation specifically in the brain Rizzo said. What we learn from this could also have implications to other brainrelated diseases like Alzheimers and Parkinsons since the same inflammatory cells have been found to be involved. Knowing more about this interaction could ultimately lead to new therapeutic agents that could help HIV patients specifically maintain their mental function. It might not be people smoking marijuana Kaminski said. It might be people taking a pill that has some of the key compounds found in the marijuana plant that could help. Michigan State University has been working to advance the common good in uncommon ways for more than years. One of the top research universities in the world MSU focuses its vast resources on creating solutions to some of the worlds most pressing challenges while providing lifechanging opportunities to a diverse and inclusive academic community through more than programs of study in degreegranting colleges."

"University of Louisville announced today results from the Soft Tissue Ablation Registry STAR demonstrating that irreversible electroporation IRE with the NanoKnife System in combination with chemotherapy doubled the overall survival rate of locally advanced Stage III pancreatic cancer patients to nearly months. The data was presented at the American Surgical Association annual meeting in San Diego. Locally advanced pancreatic cancer is Stage III cancer that has not yet spread. Pancreatic cancer has one of the highest mortality rates of all cancers and is expected to climb from the fourth leading cause of cancerrelated death in the U.S. to the second by . Ninety four percent of pancreatic cancer patients will die within five years of diagnosis and of patients die within the first year of diagnosis. The STAR data adds to the growing body of evidence that IRE ablation may represent a new treatment paradigm for patients with locally advanced pancreatic cancer said Robert Martin M.D. Ph.D. F.A.C.S. director of the Division of Surgical Oncology and Professor Department of Surgery University of Louisville James Graham Brown Cancer Center. This new analysis of IRE could help change the standard of care for Stage III pancreatic cancer patients whose only treatment options until now were chemotherapy or a combination of chemoradiation therapy which will only stabilize the disease and not destroy the tumor. With IRE these patients now have a surgical treatment option to augment their treatment plan. The NanoKnife IRE system is a tool that destroys cancerous cells by subjecting them to a series of short electrical pulses using highvoltage direct current that does not injure surrounding cells blood vessels and other vital structures. IRE overcomes rapid growth of the tumor by killing all malignant cells at once so they cannot continue to grow and spread. The NanoKnife IRE system is approved by the U.S. Food and Drug Administration for the surgical ablation of soft tissue. It is not approved for use in specific cancers. About STAR STAR was a retrospective analysis of IRE performed on consecutive patients diagnosed with locally advanced Stage III pancreatic cancer LAPC at six centers in the U.S. The centers that collaborated on the study included University of Louisville Louisville KY Henry Ford Hospital Detroit MI Cleveland Clinic Cleveland OH Piedmont Hospital Atlanta GA Swedish Medical Center Denver CO and Cancer Treatment Centers of America Atlanta GA. From July to October patients with radiographic Stage III LAPC were treated with IRE and monitored under a multicenter prospective IRBapproved registry. Perioperative day outcomes local failure and overall survival were recorded and compared to standard of care data for Stage III LAPC. All patients underwent induction chemotherapy with percent receiving chemoradiation for a median of months range prior to IRE. IRE was successfully administered to all patients. Nineteen percent sustained complications with a median grade of range . Median length of stay was days range with a median followup of months. Six patients had local recurrence. Median overall survival in both groups was . months. About the University of Louisville Physicians Group and The James Graham Brown Cancer Center The James Graham Brown Cancer Center is a key component of the University of Louisville Health Sciences Center. As part of the regions leading academic research and teaching health center the cancer center provides the latest medical advances to patients often long before they become available in nonteaching settings. The JGBCC is a part of KentuckyOne Health and is affiliated with the Kentucky Cancer Program. It is the only cancer center in the region to use a unified approach to cancer care with multidisciplinary teams of physicians working together to guide patients through diagnosis treatment and recovery. For more information visit our web site http or call . Related Links http"

"A new test can accurately predict within minutes if an individual has Ebola Virus Disease EVD according to new research published in The Lancet. The study is the first to show that a pointofcare EVD test ReEBOV Antigen Rapid Test Corgenix is faster than and as sensitive as a conventional laboratorybased molecular method used for clinical testing during the recent outbreak in Sierra Leone. This new rapid diagnostic test RDT could cut back on the lengthy process usually required to confirm if a patient has EVD help identify case contacts and ultimately curb the spread of Ebola. Currently diagnosis of EVD requires a full vial of venous blood to be shipped to a laboratory with a high level of biosafety and staff expertise for testing by realtime reverse transcription polymerase chain reaction RTPCR. This method poses substantial risks to the healthcare workers responsible for blood collection transport and testing and efforts to contain the Ebola epidemic in west Africa have been hampered by this slow and complex diagnostic test. Laboratory results can sometimes take days to return. Delays like this result not only in the failure to diagnose and treat Ebolainfected patients but also in individuals without Ebola being admitted to holding units where they may be subsequently infected with the virus explains Dr Nira Pollock senior author and Associate Medical Director of the Infectious Diseases Diagnostic Laboratory at the Boston Childrens Hospital USA. This new test on the other hand is capable of detecting the Ebola virus in just a small drop of blood tested at the bedside and could help us in the fight against Ebola. In this study the researchers compared the diagnostic accuracy of the new RDT against the benchmark RTPCR test altona Diagnostics being used for clinical diagnosis in the field reference laboratory run by Public Health England at Port Loko in Sierra Leone. suspected Ebola patients admitted to two treatment centres in Sierra Leone run by the Ministry of Health and Sanitation of Sierra Leone and supported by the nongovernmental organisation Partners In Health during February were tested by both RDT performed on a fingerstick blood sample at the pointofcare and by standard RTPCR performed on plasma in the laboratory. Both RDT on whole blood and RTPCR on plasma were also performed on samples in the laboratory. The RDT detected all confirmed cases of EVD that were positive by RTPCR in both pointofcare patients and laboratory testing patients with sensitivity of identifying all patients with EVD as per the benchmark method and a specificity of identifying patients who didnt have EVD. Surprisingly the findings also revealed that the standard altona RTPCR test under the conditions deployed in the field was itself an imperfect reference standard. The altona RTPCR assay failed to detect a small number of EVD cases that tested positive by both RDT and by an alternative RTPCR test Trombley all with relatively low amounts of virus. Both the RDT and altona assays failed to detect a small number of EVD cases that tested positive by the Trombley test all with very low amounts of virus. The authors caution that given the limitations of the performance of the altona RTPCR reference test in patients with low levels of the virus in their blood more research is needed to assess how the new RDT will perform in patients very early in the course of EVD. According to coauthor Dr Jana Broadhurst from Partners In Health Boston USA This test could have an immediate impact on patient care and infection control by reliably detecting patients well into their illness who are likely to be highly infectious. Earlier test results would improve triage of patients enabling staff to focus on those most likely to have Ebola and reducing the opportunity for infection of nonEbola suspects. Although the RDT requires refrigeration this is already available in many health centres in endemic areas particularly those that store vaccines and other medical products. Writing in a linked Comment Dr Nahid Bhadelia from Boston University School of Medicine and Boston Medical Center Boston USA says This study validates the accuracy of the ReEBOV RDT in patients who are well into their illness...suggesting it could be used to triage this subset of patients if RTPCR is not available particularly in those with a high index of clinical suspicion for a differential diagnosis...the data presented provide crucial information about the point ofcare function of this rapid diagnostic test such as ease of use quality of samples taken at the bedside and the concordance with venous samples...the results raise caution regarding the performance of the widely used altona RTPCR assay which the authors suggest might have underperformed because of laboratory specific technical and performance factors. NOTES TO EDITORS This study was funded by a gift from the Abundance Foundation Stephen Kahn. Corgenix provided the test kits. Quotes direct from authors and cannot be found in text of Article."

"Researchers are using highenergy waves similar to those used to make microwave popcorn to destroy inoperable lung tumors https In a preliminary study the technique called microwave ablation eliminated lung tumors in of patients. Eight months later none of the tumors had come back. Tumors shrank or stopped growing in the other nine patients says study researcher Claudio Pusceddu MD a specialist in radiation https and oncology at Oncological Hospital in Cagliari Italy. During microwave ablation radiologists place a thin microwave antenna directly into the tumor. An electromagnetic wave then agitates water molecules in the surrounding tumor tissue producing friction and heat that eventually destroy the tumor. The procedure which costs about takes about an hour and the patient is typically kept overnight in the hospital for observation. U.S. researchers say the technique certainly shows promise. But more patients have to be followed for far longer to see if they stay in remission they say. The findings were presented here at the annual meeting of the Radiological Society of North America. Microwave Ablation for Lung Cancer About Americans are living with lung cancer https according to the American Cancer https Society. Standard treatment options include surgery chemotherapy https and radiation. Researchers are looking at a number of ways of destroying tumors with heat from radiofrequency waves or by freezing it for example. It remains to be seen which of these newer techniques if any will keep cancer https from coming back says American Society of Clinical Oncology spokesman Gregory Masters MD a medical oncologist at the Helen F. Graham Cancer https Center in Newark Del. Masters tells WebMD that in one study cancer stopped growing for a year or more in twothirds of patients who underwent microwave ablation. But we need to follow them for five or seven years. Pusceddu says that the major advantage of microwave ablation is that it works quickly to heat tumor cells to high temperatures. As a result it can be used to destroy larger tumors than other ablation techniques he says. None of the patients in the study suffered major complications. Eight had temporary trouble breathing https due to a partially collapsed lung https but all got better on their own within a week. In addition to lung tumors microwave ablation is being studied for the treatment of liver https kidney https and bone cancers. These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

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

"What National Institutes of Health scientists developing a rapid practical test for the early diagnosis of prion diseases have modified the assay to offer the possibility of improving early diagnosis of Parkinsons disease and dementia with Lewy bodies. The group led by NIHs National Institute of Allergy and Infectious Diseases NIAID tested cerebral spinal fluid samples including from people with Parkinsons disease from people with dementia with Lewy bodies and controls including of whom had Alzheimers disease. The test correctly excluded all the controls and diagnosed both Parkinsons disease and dementia with Lewy bodies with percent accuracy. Importantly test results were available within two days compared to related assays that require up to days. The group conducted the tests using RealTime QuakingInduced Conversion RTQuIC an assay developed and refined over the past decade at NIAIDs Rocky Mountain Laboratories. Scientists from the University of California San Diego University of Verona in Italy Indiana University School of Medicine Indianapolis and the Case Western Reserve University School of Medicine Cleveland collaborated on the project. The research findings were published in Acta Neuropathologica Communications. Multiple neurological disorders including Parkinsons disease and dementia with Lewy bodies involve the abnormal clumping of a protein called alphasynuclein into brain deposits called Lewy bodies. The pathological processes in these diseases resembles prion diseases in mammal brains. Like prion diseases Parkinsons disease and dementia with Lewy bodies result in progressive deterioration of brain functions and ultimately death. Parkinsons disease is about times more common than prion diseases affecting up to million people in the United States with new cases diagnosed each year. Lewy body dementia affects an estimated . million people in the United States according to the Lewy Body Dementia Association. Early and accurate diagnoses of these brain disorders is essential for developing treatments and identifying patients eligible for clinical trials. The diseases typically progress for years before symptoms appear and once they do distinguishing one disease from another can be difficult. The NIAID group continues to adapt the RTQuIC assay to detect additional types of neurological diseases with greater accuracy using the least invasive patient sample possible whether that is blood skin nasal brushings or other samples. The group also has trained many international colleagues to use and advance the test. Article B Groveman et al. Rapid and ultrasensitive quantitation of diseaseassociated asynuclein seeds in brain and cerebrospinal fluid by aSyn RTQuIC. Acta Neuropathologica Communications DOI .s . Who Byron Caughey Ph.D. a senior investigator in NIAIDs Laboratory of Persistent Viral Diseases is available to comment on this study. Contact To schedule interviews please contact Ken Pekoc kpekocniaid.nih.gov link sends email mailtokpekocniaid.nih.gov. This research was supported in part by NIH funding awards ZIA AI AGO and PHS PAG. NIAID conducts and supports researchat NIH throughout the United States and worldwideto study the causes of infectious and immunemediated diseases and to develop better means of preventing diagnosing and treating these illnesses. News releases fact sheets and other NIAIDrelated materials are available on the NIAID website http About the National Institutes of Health NIH NIH the nations medical research agency includes Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic clinical and translational medical research and is investigating the causes treatments and cures for both common and rare diseases. For more information about NIH and its programs visit https"

"An injection of Botox works about as well as a surgically implanted device to help women with very severe incontinence researchers reported Tuesday. Its good news for women with severe urge incontinence who can choose between treatments based on preference said Dr. Cindy Amundsen of Duke University who led the study. What we have learned from the study is the treatments are both good and it will just help inform physicians and patients who are trying to make a decision between these two therapies Amundsen said. We are actually not surprised that there isnt a big difference between the two because both therapies are effective at relaxing the overactive bladder muscles. Women can choose between a surgical procedure which is more expensive at first versus regular Botox injections which are less costly and less invasive but which could add up over time Amundsen said. The team studied women with severe incontinence who could not be helped with drugs or other treatments. The women in the study had to suffer at least six episodes of incontinence over three days. The Botox injections freed percent of the women in the study of incontinence compared to percent who had a nerve stimulator implant Amundesen and colleagues reported in the Journal of the American Medical Association. Fortysix percent in the onabotulinumtoxinA Botox group and percent in the sacral neuromodulation group had at least a percent reduction in the number of episodes of urgency incontinence they added. Incontinence may sound funny but its no joke the researchers said. The prevalence of this disruptive condition is common and increases with age from percent of women older than years to percent older than years in the United States they wrote. And according to the National Institutes of Health between percent and percent of all women have some degree of urinary incontinence. Women experience urinary incontinence twice as often as men the National Institute of Diabetes and Digestive and Kidney Diseases part of the NIH says on its website. Pregnancy childbirth menopause and the structure of the female urinary tract account for this difference. The researchers at nine medical centers did a head to head comparison of a single Botox injection to the implanted medical device assigning women to randomly get one or the other treatment. The women were asked to keep diaries for six months. Both treatments calm down the nerves responsible for signaling the bladder to empty. On average both treatments cut the number of accidents Botox by almost four times a day and the nerve stimulator by about three times a day. But both groups of women reported equal satisfaction and more women in the Botox group got urinary tract infections percent versus percent in the surgery group. Amundsen said its not clear why but her team is studyingthis to find out. Theyre also studying the cost difference. Most women who get either treatment have insurance that pays Amundsen said. The treatments are both good and it will just help inform physicians and patients who are trying to make a decision between these two therapies. Incontinence is embarrassing and troubling to men and women alike who are often unwilling to even tell a doctor. They end up staying close to home and avoiding travel shopping and visits. There are different types of incontinence. This study covered urge incontinence but theres also stress incontinence which is caused by pressure on the bladder. Overflow incontinence is caused when the bladder never really empties. That can be a problem for men with enlarged prostates. Doctors usually try to start people off with lifestyle treatment such as weight loss drinking less caffeine and alcohol and avoiding lifting heavy objects. Exercises to strengthen the pelvic floor muscles can help as can bladder training to accustom the body to urinating at regular times. Medications can help as well although they often have unpleasant side effects http_caretincontinencedrugslinkedmemoryproblems such as extremely dry mouth."

"The new drug sold as Xofluza is about as effective as Tamiflu in shortening flu symptoms and is expected to work against drugresistant strains. CreditGenentech via Associated Press the first new flu drug in years won approval Wednesday from the Food and Drug Administration. The new antiviral generically known as baloxavir marboxil but sold under the brand name Xofluza is a single dose treatment. It is for use only in those aged or more the F.D.A. said and should be taken only in the first two days after symptoms like fever aches and sniffles appear. The pill will cost according to a spokeswoman for Genentech which will sell Xofluza in this country. Genentech will offer coupons that lower the price to for patients with health insurance and to about for the uninsured. Flu season has already begun and last years was one of the most lethal in decades about Americans died of flu or its consequences https the Centers for Disease Control and Prevention said earlier this month. The new drug is no miracle cure and it is not approved for young children who are one of the most vulnerable groups so the C.D.C. still strongly recommends that every American over the age of six months get a flu shot as soon as possible. Advertisement Several other antiflu drugs exist the bestknown of which is oseltamivir sold as Tamiflu but none cure the illness quickly. Also the influenza virus mutates very rapidly and has split into many strains that circulate simultaneously each winter and several have evolved resistance to older drugs. Having safe and effective treatment alternatives is critical said Dr. Scott Gottlieb the F.D.A. commissioner in a statement https This novel drug provides an important additional treatment option. Like the Science Times page on Facebook. httpon.fb.mepaTQh Sign up for the Science Times newsletter. httpnyti.msMbHaRU Xofluza works in a new way by blocking an enzyme the virus needs to copy itself. So at least in theory circulating flu strains resistant to earlier drugs should not have any resistance to it. It has been shown to work against both A and B strains which circulate each year and it is expected to work against dangerous bird flus known to occasionally infect humans such as the A strains of both HN and A HN. Advertisement However it is virtually inevitable that resistance to Xofluza will evolve as more people use it. To prevent that doctors treat several diseases including H.I.V. and tuberculosis with cocktails of three or four different drugs but that is not the norm for flu treatment. Xofluza was invented by Shionogi a Japanese company that also created the statin Crestor. It does not cure a bout of flu as rapidly as for example antibiotics clear susceptible bacterial infections. But it may alleviate some symptoms and shorten the time that patients feel sick said Dr. Debra Birnkrant the F.D.A.s director of antiviral products. Xofluza was approved after two clinical trials in patients. In both trials those treated with it recovered more quickly than those who got a placebo. In one trial there was no difference between Xofluza and Tamiflu. Tamiflu which is sold by Roche Genentechs parent company is now available cheaply as a generic drug. It requires two pills a day for five days. Xofluzas most common side effects were diarrhea and bronchitis the F.D.A. said. Further research is underway to see whether it is safe and effective in children and whether it lowers rates of hospitalization and death. In June the F.D.A. granted Shionogi and Genentech priority review status https_trialsfdagrantspriorityreviewgenentechsbaloxavirmarboxilinfluenza.html expediting the approval process because it was considered an important drug. Sign up for Science Times Well bring you stories that capture the wonders of the human body nature and the cosmos. Donald G. McNeil Jr. is a science reporter covering epidemics and diseases of the worlds poor. He joined The Times in and has reported from countries."

"Acupuncture may help reduce the severity of hot flashes and other symptoms of menopause according to a small study. The research included postmenopausal women with about half receiving traditional Chinese acupuncture twice a week and the others given sham acupuncture treatments. After weeks the women in the traditional acupuncture group had significantly less severe hot flashes and mood swings than those whod gotten the fake treatment. There were no differences between the two groups in terms of vaginal dryness and urinary tract infection. The beneficial effects of traditional acupuncture according to the researchers did not appear to be associated with changes in levels of hormones that trigger menopause and its associated symptoms. The findings were published online March in Acupuncture in Medicine. Though the researchers acknowledged that they did not monitor how long symptom relief lasted they suggested that traditional acupuncture may offer an alternative for women who cant or dont want to use hormone replacement therapy to ease menopause symptoms. More information The U.S. National Womens Health Information Center has more about treating menopause symptoms httpwomenshealth.govmenopausetreatment. SOURCE Acupuncture in Medicine news release March"

"Research published today in Scientific Reports shows that light from RayVios nm ultraviolet UV LED is more efficient than sunlight at producing vitamin D in skin samples. Tyler Kalajian and his research team led by Dr. Michael F. Holick Ph.D. M.D. and supported by Boston University School of Medicine and a Boston University Ignition Award found that skin samples exposed to RayVios UV LED for just . minutes produced more than twice as much vitamin D as samples exposed to . minutes of sunlight. We tested ultraviolet LEDs from different sources and at different wavelengths. RayVios nm LED showed the most significant potential for vitamin D production in the shortest amount of time said Dr. Holick a Professor of Medicine Physiology and Biophysics at Boston University School of Medicine and endocrinologist at Boston Medical Center. This study will lead to a new generation of technology that can be labeled as photopharmacology in which the use of LEDs with targeted wavelengths can cause specific biologic effects in human skin to help treat and prevent chronic illnesses. Vitamin D deficiency is associated with osteoporosis rickets and other metabolic bone diseases and is more prevalent in northern and southern latitudes where sunlight is limited for a significant part of the year. This device for making vitamin D is ideally suited for patients with fat malabsorption syndromes including inflammatory bowel disease and gastric bypass surgery. The research shows that RayVios UV LEDs could be used for treating patients that are vitamin D deficient. A vitamin D producing UV LED device could be used on skin areas that experience less exposure to sunlight such as upper legs and arms and abdomen and back thus minimizing risk for developing nonmelanoma skin cancer. The UV LED device also emits a much narrower band of UVB light and thereby decreasing likelihood of skin damage that can occur when the skin is exposed to higher wavelengths of UV radiation. The potential of digital UV technology for phototherapy is enormous said Dr. Robert C. Walker RayVios CEO. Dr. Holicks research with our UVB LEDs demonstrates the potential for new applications that can potentially improve and save hundreds of thousands of lives. About Vitamin D Two forms of vitamin D are important to humans vitamin D produced by plants yeast and mushrooms and vitamin D produced by skin when exposed to sunlight or the appropriate wavelength of ultraviolet light. U.S. alone seventyfive percent of teens and adults are vitamin D deficient. Thanks to the work of the research team and the pioneering work of the Boston University Photonics Center on UV LEDs we may soon see innovative treatment options like simple integration with a wearable device could aid millions of people. Coauthors on the paper all from Boston University are T.A. Kalajian A. Aldoukhi A.J. Veronikis K. Persons and M.F. Holick."

"MEDIA CONTACT Ashley Yum ashley.yumasco.org mailtoashley.yumasco.org PATIENT AND CAREGIVER INQUIRIES Contact Cancer.Net https ASCO Perspective This is one more example of how immunotherapy is making steady gains against a number of cancers. Immunotherapy has been shown to be effective in other types of lung cancer and now were seeing encouraging improvements in advanced squamous lung cancer which historically has been very difficult to treat said ASCO Expert David Graham MD FASCO. CHICAGO Initial findings from a randomized phase III clinical trial show that patients with advanced squamous nonsmallcell lung cancer NSCLC benefit more from initial treatment with PDL targeted immunotherapy atezolizumab Tecentriq and chemotherapy than from chemotherapy alone had a reduced risk of disease worsening or death compared with those who received chemotherapy alone. At months cancer had not worsened in twice as many patients who received atezolizumab plus chemotherapy compared to those who only received chemotherapy. This benefit was observed across all PDL expressing subgroups. The findings will be featured in a press briefing today and presented at the American Society of Clinical Oncology ASCO Annual Meeting http Until now there have been few treatment advances for squamous nonsmallcell lung cancer. Our findings may provide a new potential treatment option for this type of cancer said lead study author Robert M. Jotte MD PhD Medical Director and CoChair USON Thoracic Committee Rocky Mountain Cancer Centers in Denver CO. We used to think that chemotherapy just knocked down the patients immune system and that it would be irrational to combine it with immunotherapy but growing research including this study shows that chemotherapy can help trigger the immune response to the tumor helping the immunotherapy treatment work better. Squamous NSCLC which accounts for of NSCLCs is very difficult to treat. Fewer than of people with advanced squamous NSCLC survive a year after diagnosis and less than survive five years. Recent studies have also found a benefit of combining immunotherapy with chemotherapy in nonsquamous lung cancer. Given those findings along with the results from this trial a rapid change in clinical practice is expected noted Dr. Jotte. About the Study The IMpower trial enrolled patients with stage IV squamous NSCLC. Tumors were tested for PDL expression but patients were included in the trial regardless of tumor PDL expression level. Patients with EGFR or ALK gene changes in the tumor received targeted treatments before starting therapy on this trial. The study participants were randomly assigned to one of three treatment groups. Outcomes for only two of the groups however are being reported in this presentation Atezolizumab plus chemotherapy carboplatin and nabpaclitaxel patients Chemotherapy carboplatin and nabpaclitaxel patients Outcome data for the third treatment group which received atezolizumab with a slightly different chemotherapy regimen carboplatin and paclitaxel are not yet available. Key Findings In this study of all patients regardless of PDL expression had a reduced risk of disease worsening or death compared with those who received chemotherapy alone. Importantly there was a doubling of progressionfree survival PFS benefit with this combination at months cancer had not worsened in . patients receiving immunotherapy and chemotherapy compared to of those receiving chemotherapy alone. Improved progressionfree survival was observed in all groups of patients who received immunotherapy and chemotherapy including those with PDLnegative tumors and liver metastases. Overall survival data are not yet mature. This is the first phase III trial of an immunotherapybased combined modality treatment to show a significant improvement in progressionfree survival in advanced squamous NSCLC according to the authors. Although the difference between treatment groups is modest a statistically significant improvement shows that overall people with advanced squamous lung cancer can benefit when immunotherapy is added to standard treatment according to the authors. Although the rate of severe side effects was higher with the combined modality treatment than with chemotherapy alone vs. it had a manageable safety profile consistent with known safety risks of the individual therapies. The most common side effects of atezolizumab included skin rash colitis and low thyroid hormone. At this interim analysis a statistically significant overall survival OS benefit was not observed median OS was months for atezolizumab plus chemotherapy vs. . months for chemotherapy alone. Researchers are continuing to follow patients and anticipate a subsequent analysis later this year. Next Steps More research is needed to determine which patients benefit the most from the addition of immunotherapy to standard chemotherapy. The researchers will explore tumor PDL expression and other molecular markers such as tumor mutational burden TMB that may predict whether a patient will benefit from this treatment regimen. This study received funding from F. HoffmannLa Roche Ltd. Study at a Glance Disease Squamous NSCLC Trial Phase Type Phase III Randomized Global countries Multicenter Patients on Trial allcomer PDL unselected chemotherapynave patients with stage IV squamous NSCLC Intervention Tested Atezolizumab plus chemotherapy vs. chemotherapy alone Primary Finding mPFS . months with atezolizumab plus chemotherapy vs. . months with chemotherapy alone Secondary Findings month PFS . with atezolizumab plus chemotherapy vs. with chemotherapy alone View the full abstract httpsmeetinglibrary.asco.orgrecordabstract. For your readers Guide to NonSmall Cell Lung Cancer https Cncer de pulmn clulas no pequeas https Understanding Immunotherapy https Qu es la inmunoterapia https View the disclosures httpsam.asco.orgsitesam.asco.orgfilesAMCCCDisclosureReport.pdf for the ASCO Annual Meeting News Planning Team. ATTRIBUTION TO THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY ANNUAL MEETING IS REQUESTED IN ALL COVERAGE. About ASCO Founded in the American Society of Clinical Oncology Inc. ASCO is committed to making a world of difference in cancer care. As the worlds leading organization of its kind ASCO represents nearly oncology professionals who care for people living with cancer. Through research education and promotion of the highestquality patient care ASCO works to conquer cancer and create a world where cancer is prevented or cured and every survivor is healthy. ASCO is supported by its affiliate organization the Conquer Cancer Foundation. Learn more at http explore patient education resources at http and follow us on Facebook Twitter LinkedIn and YouTube."

"An experimental Alzheimers disease drug gantenerumab may help lower levels of amyloid plaque in the brains of people with the disease an early clinical trial indicates. The new study which appears online Oct. in the Archives of Neurology is among the first to show the effects of an antiamyloid drug in humans with Alzheimers disease but experts caution that while promising more research is needed before this drug can be deemed safe or effective. And in what may turn out to be an equally important caveat experts also say that its by no means certain that reducing levels of amyloid plaque would stave off memory loss and the other mental declines associated with the disease because the role of the plaque in Alzheimers isnt fully understood. Alzheimers disease is the most common form of dementia. Symptoms including serious memory loss confusion and mood changes develop gradually and worsen with time. Recently many strides have been made in diagnosing Alzheimers disease earlier but doctors have been stymied by a lack of effective treatments to stop or slow the course of the disease. Its long been known that a protein fragment called betaamyloid builds up in the spaces between nerve cells in the brains of people with Alzheimers disease. The new drug gantenerumab targets these amyloid proteins by priming the bodys immune system to recognize them as invaders. Of people with mildtomoderate Alzheimers disease those who received two to seven infusions of the experimental drug every four weeks showed marked reductions in the amount of plaque in their brains via imaging tests that were conducted several months after their treatments. By contrast amyloid load increased among people who were randomized to receive the placebo. The new drug was given at either or milligrams mg doses. The higher dose yielded greater reductions in amyloid levels the study showed. People who were given the mg doses saw a nearly percent reduction in the amount of amyloid and those given the mg doses saw a percent reduction. The new study was conducted and funded by the drugs manufacturer F. HoffmannLaRoche Ltd. in Basel Switzerland. The big question is whether or not reducing amyloid levels has any effect on the symptoms or progression of Alzheimers disease said Dr. Patrick Lyden chief of neurology at CedarsSinai Medical Center in Los Angeles. There is a growing concern that amyloid is a guilty bystander but not the actual culprit in the brains of people with Alzheimers disease and taking away the bystander may not help the patient he said. There are approximately one dozen therapies including vaccines for Alzheimers disease that are currently in the pipeline Lyden noted. They are all extremely exciting and promising in animals he said. This is the first one to show a preliminary result in people but we have a huge way to go to make sure it is safe and improves symptoms. Many in the Alzheimers research community are awaiting these drugs with bated breath but none are ready for prime time he said. The leading theory of Alzheimers disease is that an imbalance in the production or clearance of the amyloid plaque in the brain initiates a cascade of events that lead to dementia explained Dr. Neelum Aggarwal an associate professor of neurological sciences at Rush Alzheimers Disease Research Center at Rush University Medical Center in Chicago. Accumulation of the plaques cause a variety of cellular responses inflammation neuronal death and thus any potential treatment that can alter these processes would be beneficial she said. The hope is that gantenerumab or other drugs like it will not only prevent amyloid from accumulating in the brain but also slow down the cognitive impairment that occurs in people with Alzheimers disease she added. That said these experimental drugs carry the potential for serious side effects including causing the immune system to go haywire. The main issue that remains for this type of drug development is managing the immune response Aggarwal said. Other side effects include a potentially fatal fluid buildup in certain areas of the brain. This is problematic in that use of these treatments may carry a very high risk for neurologic complications thus necessitating heightened monitoring and diminishing its applicability as a treatment for a larger patient population such as the Alzheimers disease population she said. If any of these drugs make it through the pipeline it also needs to be determined who will get them including whether the drugs will be given to prevent Alzheimers in patients at highrisk of the disease or to treat it once its started. The need for a drug to delay the onset or slow progression of Alzheimers disease cant be underestimated Aggrawal said. In the United States alone there are . million people with Alzheimers disease and the numbers are expected to increase to million by when approximately three of every five people over the age of will have Alzheimers disease she said. More information For more information about Alzheimers disease signs symptoms and treatments visit the Alzheimers Association http SOURCES Neelum Aggarwal M.D. associate professor neurological sciences Rush Alzheimers Disease Research Center Rush University Medical Center Chicago Patrick Lyden chief neurology CedarsSinai Medical Center Los Angeles Oct. Archives of Neurology online"

"A minimally invasive treatment can help restore fertility in women with uterine fibroids according to a new study published online in the journal Radiology. Uterine fibroids abnormal masses of fiber and muscle tissue in the wall of the uterus are considered one of the most common causes of infertility and complications related to pregnancy. Previous research has found that one out of every four women with fibroids has problems related to fertility. The standard treatment option for such women is myomectomy or surgical removal of the fibroids. However myomectomy is not always possible or effective and can result in major complications including hysterectomy according to study coauthor Joo Martins Pisco M.D. Ph.D. from the Department of Interventional Radiology at Saint Louis Hospital in Lisbon Portugal. Uterine fibroid embolization UFE is a less invasive option that involves injection of an embolic agent typically made up of very small beads into the uterine arteries to block the blood supply to the uterus and fibroids. As the fibroids die and begin to shrink the uterus fully recovers. UFE can be performed in patients with a prior myomectomy or in vitro fertilization IVF. Despite its less invasive nature UFE has yet to be fully embraced in the medical community as a fertilitypreserving treatment for women with symptomatic fibroids due to concerns that the procedure may cause inadequate blood flow to the endometrium or lining of the uterus and the ovaries. For the new study Dr. Pisco and colleagues assessed pregnancy rates in women with uterine fibroids who were unable to conceive and who underwent either conventional or partial UFE. In conventional UFE all uterine artery branches are embolized. However the partial procedure requires treatment of only the small vessels to the fibroids leaving the corresponding larger vessels unaffected. Partial UFE may help reduce the risks of infertility associated with conventional UFE. After an average followup of almost six years of the women or . percent had become pregnant one or more times and gave birth to a total of babies. It was the first pregnancy for more than percent of the women who gave birth. The procedures had a clinical success rate of approximately percent for fibroidrelated symptoms. Complication rates were . percent for partial UFE and . percent for conventional UFE. The procedure was repeated in patients whose fibroids had not been fully treated as shown by MRI and of those patients subsequently got pregnant. Our findings show that UFE is a fertilityrestoring procedure in women with uterine fibroids who wish to conceive and pregnancy following UFE appears to be safe with low morbidity Dr. Pisco said. Women who had been unable to conceive had normal pregnancies after UFE and similar complication rates as the general population in spite of being in a highrisk group. Dr. Pisco suggested that UFE may become the firstline treatment for women with fibroids who wish to conceive particularly for those with numerous or very large fibroids. Such patients have a fibroid recurrence rate of more than percent after myomectomy making UFE an important option. The researchers are continuing the treatments and compiling data. Since the time of writing there were additional pregnancies. In our study there are now almost newborns following UFE Dr. Pisco said. Our next step will be a randomized study comparing the results of partial and conventional UFE. Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization. Collaborating with Dr. Pisco were Marisa Duarte M.D. Tiago Bilhim M.D. Ph.D. Jorge Branco M.D. Ph.D. Fernando Cirurgio M.D. Marcela Forjaz M.D. Lcia Fernandes M.D. Jos Pereira M.D. Nuno Costa M.D. Joana B. M. Pisco M.D. and Antnio G. Oliveira M.D. Ph.D. Radiology is edited by Herbert Y. Kressel M.D. Harvard Medical School Boston Mass. and owned and published by the Radiological Society of North America Inc. httppubs.rsna.orgjournalradiology RSNA is an association of over radiologists radiation oncologists medical physicists and related scientists promoting excellence in patient care and health care delivery through education research and technologic innovation. The Society is based in Oak Brook Ill. RSNA.org httpRSNA.org For patientfriendly information on uterine fibroid embolization visit RadiologyInfo.org httpRadiologyInfo.org."

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

"Patients with castration resistant prostate cancer CRPC usually have a poor prognosis. In part this is due to the cancers ability to resist antiandrogen therapy. A University of Colorado Cancer Center study published today May in Oncotarget shows that combining a CPTA inhibitors with antiandrogen therapy increases the cancers sensitivity to the antiandrogen drug enzalutamide. This is a huge development for men with CRPC that previously did not have many options says Isabel Schlaepfer PhD CU Cancer Center member assistant professor in the Division of Medical Oncology and senior author of the study. There is a critical need for improved therapies for this specific cancer type. Most cells use the energy of glucose sugar. Some prostate cancers evolve to use energy from lipids fat. Previous work shows that metabolizing lipids helps prostate cancer escape antiandrogen therapy. However there are many steps involved in lipid metabolism and researchers have been working to break prostate cancers ability to harness this energy source. In this study the researchers focused on the CPTA enzyme. CPTA helps facilitate the entry of long chain fatty acids into the cells mitochondria for oxidation. This oxidation is vital to lipid metabolism and has been shown to aid cancer cell survival resistance to radiation oxidative stress and activation of oncogenic signaling pathways. We had to find a way to block this pathway so that the cancer would not be able to burn lipid in the mitochondria to acquire energy to resist therapy explains Schlaepfer. In fact we are already able to block the action of the CPTA enzyme. The drug ranolazine is a fat oxidation inhibitor that earned FDA approval in to treat angina. When Schlaepfer and colleagues experimented with fat burning inhibitors and antiandrogens in cancer cell lines they found that the addition of ranolazine to antiandrogen therapy made tumors more sensitivity to the antiandrogen drug enzalutamide. This finding may have a huge impact on patients with CRPC that had very few options before says Schlaepfer. Since the drugs are clinically safe a clinical trial can be designed in patients for whom enzalutamide is prescribed."

"Yale Cancer Center researchers have developed a vaccine strategy that reduces the risk of flu infections in cancer patients at highest risk for influenza. The findings were presented Dec. at the th annual meeting of the American Society of Hematology in Orlando Florida. Patients with cancers of the immune system like multiple myeloma are especially susceptible to common infections and a bout of the flu can lead to serious illness and even death. Even though patients with multiple myeloma and other plasma cell disorders may receive an annual flu vaccine studies show that a onetime flu shot does not offer adequate immune response. The Yale researchers developed a strategy that entailed offering patients a highdose flu vaccine followed by a second highdose booster shot one month later. The highdose vaccine Fluzone HighDose was approved in by the FDA as a single dose for adults over . The booster strategy lowered the flu infection rate among patients to versus an expected rate of and it improved protection against all flu strains covered by the vaccine in of patients said the studys first author Andrew Branagan M.D. a postdoctoral associate in medicine hematology. Using an approved flu vaccine in a novel dosing schedule yielded promising results for a group patients at high risk for infection Branagan said. We hope to confirm these results in a larger prospective randomized trial that is underway now at Yale during the flu season. We suspect this strategy could benefit other cancer patient populations. This study was supported by the Arthur R. Sekerak Cancer Research Fund a Yale Cancer Center philanthropic fund."

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

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

"A firstofitskind drug targeting a fused gene found in many types of cancer was effective in percent of pediatric patients tested researchers at UT Southwesterns Simmons Cancer Center announced. Most cancer drugs are targeted to specific organs or locations in the body. Larotrectinib is the first cancer drug to receive FDA breakthrough therapy designation for patients with a specific fusion of two genes in the cancer cell no matter what cancer type. The research appears in The Lancet Oncology. In some cancers a part of the TRK gene has become attached to another gene which is called a fusion. When this occurs it leads to the TRK gene being turned on when its not supposed to be and that causes the cells to grow uncontrollably. Whats unique about the drug is it is very selective it only blocks TRK receptors said lead author Dr. Ted Laetsch Assistant Professor of Pediatrics and with the Harold C. Simmons Comprehensive Cancer Center. More information Lancet Oncology paper News release on NEJM paper Larotrectinib targets TRK fusions which can occur in many types of cancer. While the TRK fusions occur in only a small percentage of common adult cancers they occur frequently in some rare pediatric cancers such as infantile fibrosarcoma cellular congenital mesoblastic nephroma and papillary thyroid cancer said Dr. Laetsch who leads the Experimental Therapeutics Program ETP in the Pauline Allen Gill Center for Cancer and Blood Disorders at Childrens Health in Dallas. Every patient with a TRK fusionpositive solid tumor treated on this study had their tumor shrink. The nearly universal response rate seen with larotrectinib is unprecedented Dr. Laetsch said. Among them was yearold Briana Ayala of El Paso who aspires to a career in fashion design. In Briana was found to have a rare tumor in her abdomen wrapped around her aorta the largest artery in the body. Surgeons in her hometown said it would be too dangerous to operate so her family brought Briana to Childrens Health in Dallas where UT Southwestern Professor of Surgery Dr. Stephen Megison had to remove portions of her aorta while removing most of the tumor. But the cancer started to grow again and no further treatments were available. Dr. Laetsch sent her tumor for genetic testing and found that Brianas cancer had the TRK fusion meaning the new drug might help. Briana enrolled in the phase clinical trial of larotrectinib and began taking the drug twice a day. Within weeks her pain and the swelling in her abdomen diminished and scans showed her tumors had shrunk significantly. Nearly two years later Briana is back in school and playing with her dog Goofy and the familys seven parakeets. Shes also been able to pick up her sketch pad and her dreams of a New York City fashion career. These are the kind of amazing responses weve seen with larotrectinib said Dr. Laetsch and this is why Im so excited about it. The results of the larotrectinib trial in adult patients a percent response rate were published last month in the New England Journal of Medicine. The TRKfusion mutation can be present in many types of cancers including lung colon thyroid and breast cancer as well as certain pediatric tumors. TRK short for tropomyosin receptor kinase is a gene that plays a key role in brain and nervous system development and has a limited role in nervous system functions such as regulating pain in later life. Larotrectinib belongs to a class of molecules known as kinase inhibitors which work by cutting back on the enzymatic activity of a key cellular reaction. The selectivity of the drug means it does not cause the severe side effects associated with many traditional cancer treatments and none of the patients with TRK fusions had to quit the study because of a druginduced side effect. Equally important the response was longlasting for most patients. For some of the targeted drugs in the past many patients responded initially but then resistance developed quickly. To date the response to this drug seems to be durable in most patients said Dr. Laetsch who investigates the use of tumor molecular profiling to guide therapy in UT Southwesterns Pediatric Hematology and Oncology Division. A next step in the research is a clinical trial involving a similar drug for those patients who developed resistance. Dr. Laetsch will be the national leader for that clinical trial in children. The larotrectinib research was supported by Loxo Oncology Inc. the National Institutes of Health the Cancer Prevention and Research Institute of Texas the National Center for Advancing Translational Sciences and Alexs Lemonade Stand Foundation. Dr. Laetsch is a paid consultant for Loxo Oncology Inc. The Harold C. Simmons Comprehensive Cancer Center is the only NCIdesignated Comprehensive Cancer Center in North Texas and among just U.S. cancer research centers to be designated by the NCI as a National Clinical Trials Network Lead Academic Participating Site. UT Southwestern Medical Center is recognizing its th year this year. 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 received six Nobel Prizes and includes members of the National Academy of Sciences members of the National Academy of Medicine and Howard Hughes Medical Institute Investigators. The faculty of more than is responsible for groundbreaking medical advances and is committed to translating sciencedriven research quickly to new clinical treatments. UT Southwestern physicians provide care in about specialties to more than hospitalized patients emergency room cases and oversee approximately . million outpatient visits a year."

"Soon you can seek mental health advice on your smartphone as quickly as finding a good restaurant. A novel suite of speedy miniapps called IntelliCare resulted in participants reporting significantly less depression and anxiety by using the apps on their smartphones up to four times a day reports a new Northwestern Medicine study. The apps offer exercises to destress reduce selfcriticism and worrying methods to help your life feel more meaningful mantras to highlight your strengths strategies for a good nights sleep and more. Most apps designed for mental health typically offer a single strategy to feel better or provide too many features that make them difficult to navigate. Users may get bored or overwhelmed and may stop using the apps after a few weeks. But participants robustly used the IntelliCare interactive apps as many as four times daily or an average of times for eight weeks of the study. They spent an average of one minute using each app with longer times for apps with relaxation videos. The participants who completed the research study reported that they experienced about a percent decrease in the severity of depressive and anxiety symptoms. The shortterm studyrelated reductions are comparable to results expected in clinical practice using psychotherapy or with that seen using antidepressant medication. The study will be published Jan. in the Journal of Medical Internet Research. We designed these apps so they fit easily into peoples lives and could be used as simply as apps to find a restaurant or directions said lead study author David Mohr professor of preventive medicine and director of the Center for Behavioral Intervention Technologies at Northwestern University Feinberg School of Medicine. Some of the participants kept using them after the study because they felt that the apps helped them feel better Mohr said. There were many apps to try during the study so there was a sense of novelty. Participants had access to the IntelliCare apps from Google Play and received eight weeks of coaching for the use of IntelliCare. Coaching included an initial phone call plus two or more text messages per week over the eight weeks. In the study participants were enrolled and of them completed the study. The preliminary study did not include a control arm so its possible that some people who enrolled in the trial would have improved anyway partly because they may have been motivated to try something new Mohr said. He now has launched a larger trial recruiting participants with a control arm. Some of the IntelliCare apps include Daily Feats designed to motivate you to add worthwhile and rewarding activities into your day to increase your overall satisfaction in life. Purple Chill designed to help you unwind with audio recordings that guide you through exercises to destress and worry less. Slumber Time designed to ease you into a good nights rest. My Mantra designed to help you create motivating mantras to highlight your strengths and values. Using digital tools for mental health is emerging as an important part of our future Mohr said. These are designed to help the millions of people who want support but cant get to a therapists office. More than percent of Americans have significant symptoms of depression or anxiety each year but only around percent of people with a mental health problem get adequate treatment. The IntelliCare algorithm recommends new apps each week to keep the experience fresh provide new opportunities for learning skills and avoid user boredom. Although the apps are not validated each one was designed by Northwestern clinicians and based on validated techniques used by therapists. IntelliCare is a national research study. Individuals can download the apps free with no financial obligation. But Northwestern researchers hope participants will provide confidential feedback via four weekly questions that will be used to further develop the system. The data will help the system make even better recommendations and provide more personalized treatment. People also may enroll in a study in which they will be paid to provide even more feedback. Some also will have access to an IntelliCare coach via text messaging and phone calls who are available to support them in using the apps. We now have evidence these approaches will likely work Mohr said. They are designed to teach many of the same skills therapists teach patients. Different apps are expected to work for different people. The goal is to find whats right for you. Other Northwestern authors include Kate Tomasino Emily Lattie Hannah Palac Mary J Kwasny Kenneth Weingardt Leland R Bardsley Lauren Caccamo Colleen StilesShields and Stephen Schueller. Rebecca Rossom a researcher with HealthPartners Institute also was a study coauthor. The study was supported by grant R MH from the National Institute of Mental Health of the National Institutes of Health."

"More than a million Americans will undergo hip or knee replacement httpshealth.usnews.comhealthnewspatientadvicearticlespatientoutcomeoptimizationhowtobestmanagejointreplacementrisksandgetbackonyourfeet this year. Doing their due diligence many will select topnotch orthopedic surgeons httpshealth.usnews.comdoctorslocationindexorthopedicsurgeons and some will even evaluate the company that makes their implant. Now researchers in Canada and some highly regarded orthopedic specialists at U.S. hospitals say mounting evidence and clinical experience shows that patients and doctors should consider one more aspect of care often left out of the conversation Whether its appropriate to use a drug called tranexamic acid or TXA which is increasingly being viewed as a way to enhance joint replacement surgery by reducing blood loss during these procedures. A study published last month in the Canadian Journal of Anesthesiology found that administering TXA intravenously to patients undergoing hip and knee replacement surgery reduced the rate of blood transfusion during those procedures by more than percent without increasing the length of a patients hospital stay or adverse events such as heart attack stroke httpshealth.usnews.comhealthnewspatientadvicearticlesassessingtheriskforheartattacksandstrokeshowacoronaryarterycalciumscoremayhelpandwhoneedsthetest or blood clot. The practice of medicine is now catching up to the research on TXA says Dr. Charles BushJoseph an orthopedic surgeon at Rush University Medical Center in Chicago. Here at Rush weve been using it for a number of years. Surgeons administer the drug to prevent the breakdown of clots or act as a clot stabalizer and thereby reduce bleeding and the likelihood a blood transfusion will be needed during surgery. Though blood transfusions are generally considered safe they still carry risks ranging from allergic reactions httpshealth.usnews.comhealthnewspatientadvicearticlesareallergyautoinjectorneedleslongenoughforobesepatients to exceedingly rare bloodborne infections. TXA is widely known as a potential lifesaver such as on battlefields where its used to slow blood loss among soldiers httpshealth.usnews.comhealthnewspatientadvicearticleswhenservicemembersneedmentalhealthhelp injured in combat. Back in the civilian world clinicians at medical centers including Saint Marys Hospital one of Mayo Clinics hospitals in Rochester Minnesota also administer the drug to stop patients bleeding in cases ranging from automobile crashes to farming accidents says Dr. Donald Jenkins medical director for the hospitals Level I Trauma Center. Jenkins says doctors at St. Marys and elsewhere at Mayo use the drug during elective joint replacement surgery as well and he says the positive results that Canadian researchers found reflect their experience. It supports our practice. We have been using TXA for these precise operations for many years with what we thought was good success Jenkins says. I would have been very surprised had these results come out some other way. He estimates that the cost of the drug administered during surgery is less than and a Canadian researcher puts the price of TXA at per patient there. That compares with upwards of or more for a single blood transfusion Jenkins says. But despite TXAs ability to reduce the need for transfusions the latest figures show TXA is used in only about in joint replacement surgeries. Researchers at St. Michaels Hospital in Toronto describe the drug studied in more than patients who underwent hip and knee replacement there as underutilized at hospitals elsewhere in Canada and the U.S. In a statement Dr. Greg Hare an anesthesiologist at St. Michaels and one of the founders of St. Michaels Centre of Excellence for Patient Blood Management wrote Other hospitals and surgical centres should consider making TXA mandatory for similar surgeries because it can improve quality of care decrease the need for blood transfusions and even save money. Even so the Canadian research team still calls for ongoing surveillance of the drug to make sure its use doesnt increase adverse events. All experts say individual risk factors should be considered in determining whether its appropriate to use the drug thats also sometimes used in nonorthopedic surgeries to slow blood loss from trauma to cardiac operations. We use it very judiciously in our older patient population who would be at increased risk of stroke and heart attack because of underlying cardiovascular disease Jenkins says. Because of the risks associated with the drug which range from the formation of a blood clot in a vein deep in the body or deep vein thrombosis to heart attack BushJoseph says some surgeons at Rush remain leery and dont use it. However previous research finds a low complication rate when used to slow blood loss during joint replacement procedures. And BushJoseph says most orthopedic surgeons at the medical center do use it for elective hip replacements. Both he and Jenkins say TXA use is discussed with patients along with other aspects of surgery httpshealth.usnews.comhealthnewspatientadvicearticlespersonalizedjointshowsurgeryischangingforthebetter. I would say its an element of the informed consent BushJoseph says adding that most patients seem to be in favor of it since it reduces the likelihood theyll need a blood transfusion. Jenkins adds that patients interested in knowing whether the drug might be appropriate for their case should feel comfortable broaching the subject with clinicians handling their care. In the elective surgical setting the patient has the opportunity not to only meet with the orthopedic surgeon and their team but the anesthesia team as well he says. Certainly the conversation about TXA would be part of that discussion with the patient."

"Sometimes she glares at the painting of Jesus in her dining room. I just let it loose said Mary Kleiss at her Royal Oak home. I look at that picture and I say You get down here and put on your boxing gloves and lets get this over with. I am so damned angry. Her son Regis was diagnosed two and a half years ago with Lou Gehrigs disease amyotrophic lateral sclerosis or ALS. It is he writes as if God is torturing me. The disease kills with stunning efficiency deadening its victims peripheral nerves withering muscles and in a final assault shutting down their ability to breathe. An estimated people have it at any given time are diagnosed yearly. Most die within years. There is no cure. The disease has reduced Regis Kleiss a formerly thickbodied shot and discus thrower and captain of the track team at Dondero High School to a bony echo of himself. Paralyzed except for some minor movement of his head he will spend his final days on a feeding tube. ALS leaves its victims minds intact. Its a miserable damned disease his mother said. Now a clinical trial overseen by the University of Michigan may provide hope. It is cuttingedge and audacious work the only ALS trial so far in which neural stem cells are injected directly into a patients spinal cord. So far patients have undergone the procedure two of them twice as the FDA monitors its safety. One patient showed a remarkable improvement for a while though UMs Dr. Eva Feldman who heads the research cautions not to read too much into that. The other showed no improvement. The trail is tentative and early. But when the rest of a persons life has been compressed to an expectancy of two to five years it is hope nonetheless. The trial has been based in Atlanta since but UM has requested approval from the U.S. Food and Drug Administration to expand it and move it to the University of Michigan in Ann Arbor. The trial involves injecting million stem cells into the spine. The ancestry of the cells dates to the spinal cord of an aborted fetus in . The cells are different from the embryonic stem cells that were the subject of a controversial ballot proposal in Michigan in when voters approved lifting the ban on embryonic stem cell research. Feldman and others theorize that these new cells act as nursemaids to damaged nerve cells sending out repair signals and somehow halting the progression of the disease. The procedure worked in rats. It has been shown to be safe in pigs. If the FDA approves moving the trial to Ann Arbor Michigan patients will have access to an experimental treatment that not only might offer insight into a disease that kills an estimated Americans a day but also push back the battle lines against other neurodegenerative diseases such as Parkinsons and Alzheimers or Huntingtons. Read the entire story here http For patients We appreciate your interest in our stem cell trial and as this article mentions we are working to bring it to Michigan. However we are not at this time able to accept patient applications. Please check this site monthly for any updates."

"With the widespread availability of marijuana in recent years thanks to its legalization in a growing number of states there has been increasing concern about the longterm health consequences on teens who might be able to get easier access to it illegally. A study published by the American Psychological Association http in the journal Psychology of Addictive Behaviors this week should alleviate some of the worst fears. Researchers from the University of Pittsburgh Medical Center and Rutgers University studied males from adolescence to their mids. The participants fell into four groups those with no use or low use of marijuana early chronic users those who only smoked during their teens and those who began using it later and continued using the drug. The early chronic users smoked a great deal a peak of more than days per year on average when they were years old. The researchers found no links to physical or mental health issues including depression psychotic symptoms or asthma in any group even those with very high use. They controlled for cigarette smoking other drug use access to health insurance and other factors. What we found was a little surprising lead author Jordan Bechtold a research fellow at the University of Pittsburgh Medical Center said in a statement. Based on other studies in the past that seemed to allude to marijuana use and later development of psychotic symptoms such as delusions or hallucinations the researchers had thought they might find some associations to disease or other health conditions. But there were none. They also found no link to a wide range of other health issues cancer asthma respiratory problems depression anxiety allergies headaches or high blood pressure. Bechtold said the researchers wanted to help inform the debate about legalization of marijuana but that this is a very complicated issue and one study including his own should not be taken in isolation and should be viewed in context of other studies on teenagers marijuana use. One major limitation of the study is that it ends when the men are in their s which may be too early for decrements in health to emerge the authors acknowledge. Therefore continued data collection and longer followups are needed. Update The studys findings generated significant controversy along with requests for supplemental analysis according to the editors of the Psychology of Addictive Behaviors. In a lengthy clarification issued in December the journal said that by applying different models to look at the data they confirmed that there did not appear to be any link between marijuana use and health issues. However the reanalysis regarding psychotic disorders contradicted the earlier conclusions that there indeed appeared to be a higher risk of psychotic disorders among marijuana users in the study versus nonusers that approached statistical significance when using a more liberal test."

"Taking high doses of selenium may help slightly lower cholesterol levels but its still not recommended in the United States where most people get plenty of the mineral according to the authors of a new study. Still the finding is reassuring because previous research had linked high selenium with higher cholesterol levels said study author Dr. Eliseo Guallar from the Johns Hopkins Bloomberg School of Public Health in Baltimore. The picture of seleniums health benefits or possible health risks has been anything but clear. Last week a review of prior studies suggested that selenium probably doesnt help prevent cancer but might be linked to an increased diabetes risk at high doses see Reuters Health story of May . We dont really know where we are Guallar told Reuters Health. In a sense its a necessary micronutrient and we need it but we might be in a situation where we have enough we might even have too much. Selenium is found in meat bread and some nuts. Its also available in supplement form and costs about for a months supply. The Institute of Medicine recommends U.S. adults consume micrograms of selenium per day. Guallar and his colleagues wanted to look specifically at the link between selenium and cholesterol. They recruited about older adults in the UK to take one of three different doses of selenium daily or micrograms or a placebo pill with no selenium. Researchers measured participants cholesterol levels at the beginning of the study and after six months on the selenium supplements or placebo. Their results are published in Annals of Internal Medicine. Participants had an average starting cholesterol of about milligrams per deciliter of blood. A healthy cholesterol level is less than mgdL according to the American Heart Association while to mgdL is considered borderline high. In the groups taking and micrograms of selenium daily total cholesterol dropped an average of . mgdL and . mgdL respectively compared to the group taking a placebo pill. Taking the highest dose of selenium was not linked to decreases in total cholesterol but it was the only dose associated with an increase in HDL good cholesterol. The authors reported no serious side effects associated with selenium during the study. While Guallar said the results are good news in showing that high selenium intake is probably not a risk for high cholesterol he wanted to add a note of caution. ADVERTISING The finding is not generalizable to other patients he said. In a population like the U.S. where selenium levels are adequate theres no reason to take extra selenium in supplements. The question of the link between selenium and health outcomes Guallar said is a very interesting story thats still developing. SOURCE bit.lyatTzv httpbit.lyatTzv Annals of Internal Medicine online May . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"A new study published in the Journal of Nutrition suggests that consuming servings of walnuts per week cup per serving was associated with reduced risk of developing impairments in physical function which helps enable older women to maintain independence throughout the aging process. This paper emphasized that overall diet quality rather than individual foods may have a greater impact on reducing risk of physical function impairments. Specifically diet quality traits most associated with reduced rates of incident physical impairment were higher intake of fruits and vegetables lower intake of sugarsweetened beverages trans fat and sodium and moderate alcohol intake. Among food components the strongest relations were found for increased intakes of oranges orange juice apples pears romaine or leaf lettuce and walnuts. Theres a lot of research that looks at specific health conditions in aging such as diabetes and heart disease but less attention to research on quality of life and ability to maintain independence with aging said Dr. Francine Grodstein ScD professor of medicine at Brigham and Womens Hospital and Harvard Medical School. The simple message from this study is that eating an overall healthy diet including certain foods such as walnuts and other whole foods may help women with the ability to do key everyday tasks as they age like carrying groceries or dressing themselves. The researchers looked at data from women in the Nurses Health Study which tracked women for over years. Between and the women were asked questions about their physical function including their ability to perform basic activities of daily living. This new paper prospectively examined the association between the dietary habits of the participants and subsequent impairment in physical function. Diet was assessed using the Alternative Healthy Eating Index AHEI a measure of diet quality that incorporates foods and nutrients predictive of chronic disease risk based on scientific evidence. These results add to the large body of evidence that outline the many benefits of a healthy diet for women. Additional research is needed to better understand how diet and lifestyle choices can help maintain our health and wellbeing as we age said Dr. Grodstein. There are numerous possible active properties in walnuts that may be contributing factors in providing health benefits. Walnuts are unique among nuts in that they are primarily composed of polyunsaturated fat grams per ounce which includes alphalinolenic acid ALA the plantbased omega fatty acid. They are the only nut to contain a significant amount of ALA with . grams per one ounce serving. Some study limitations should be considered. The sample only included women so these results may not be generalizable to men. Additionally participants were not assigned to eat walnuts or other foods and were just asked about their dietary choices. It is also possible that subjects may have misreported their dietary intake since this information was collected by questionnaires. In addition because this is an observational study residual confounding cannot be ruled out i.e. that other lifestyle habits which are more common in adults who eat walnuts could contribute to the study findings and thus the results should be interpreted with caution. This research was supported in part by the California Walnut Commission CWC. The CWC has supported healthrelated research on walnuts for more than years. While the CWC does provide funds andor walnuts for various projects the actual studies are conducted independently by researchers who design the experiments interpret the results and write the manuscripts. About California Walnut Commission The California Walnut Commission established in is funded by mandatory assessments of the growers. The Commission is an agency of the State of California that works in concurrence with the Secretary of the California Department of Food and Agriculture CDFA. The CWC is mainly involved in health research and export market development activities. For more industry information health research and recipe ideas visit http NonDiscrimination Statement The California Walnut Commission CWC prohibits discrimination in all programs and activities on the basis of race color national origin age disability sex marital status familial status parental status religion sexual orientation genetic information political beliefs reprisal or because all or part of an individuals income is derived from any public assistance programs. Persons with disabilities who require alternative means for communication of program information Braille large print audiotape etc. should contact the CWC offices at . To file a complaint of discrimination write to USDA Director Office of Civil Rights Independence Avenue S.W. Washington D.C. or call voice or TDD. CWC is an equal opportunity employer and provider. The California Walnut Commission offices are located at Parkshore Dr. Ste. Folsom CA Resources . Hagan KA Chiuve SE Stampfer MJ Katz JN Grodstein F. Greater Adherence to the Alternative Healthy Eating Index Is Associated with Lower Incidence of Physical Function Impairment in the Nurses Health Study published online ahead of print May . J Nutr. doi .jn.."

"A noninvasive scan might someday help doctors track the progress of prostate cancer and help guide treatment researchers report. The imaging tool known as a prostate cancerspecific radiotracer has so far only been tested successfully in mice. But a team from Memorial SloanKettering Cancer Center in New York City said the technology could help identify cases where prostate cancer has spread to the bone. Radiotracers work by injecting a small amount of a compound tagged with a radionuclide into patients. Using positron emission tomography also known as a PET scan doctors are then able to better visualize tumors and tumor spread. In studies involving mice with prostate cancer the researchers had the radiotracer hone in on prostatespecific antigen PSA the same prostate cancer marker used in the PSA test. They found that the PSA gravitated to tissues containing prostate cancer that had already grown resistant to standard hormonebased therapies. The study also revealed the radiotracer could help identify cases where prostate cancer had spread to the bone. The researchers pointed out traditional bone scans are unable to differentiate between malignant and nonmalignant lesions. The findings were to be presented Saturday at the American Association for Cancer Research annual meeting in Chicago and are also being published in Cancer Discovery. If used on people the researchers claimed that the radiotracer might someday help doctors personalize treatment strategies for prostate cancer and better manage the disease. The ultimate goal is to be able to predict the response of patients to new and existing therapies at an early stage thereby personalizing their treatment and improving outcomes Michael J. Evans research fellow in the Human Oncology and Pathogenesis Program at Memorial SloanKettering Cancer Center explained in meeting news release. Encouraged by their findings the studys authors said they hope to begin a human trial next year. Two prostate cancer experts said the tool if borne out in patients could prove very useful. Dr. Michael Schwartz is director of laparoscopy and minimally invasive surgery at North ShoreLIJ Health System in Lake Success N.Y. He noted that as of now doctors typically rely on results of the PSA blood test andor standard diagnostic scans to help guide treatment decisions. Both methods have their limits and while this study is very preliminary if this radiotracer technology can prove to detect very early recurrence or metastasis in human patients it could become extremely useful in either the pre or posttreatment setting in selecting a treatment algorithm Schwartz said. It also may help reduce the need for biopsy of possible metastatic lesions. Dr. Erik Goluboff an attending urologist at Beth Israel Medical Center New York City agreed that this is an exciting study using a novel radiotracer to detect PSAexpressing tissues throughout the body. He believes that the new tools greatest strength would be in monitoring changes in PSA expression in tissues as a result of various treatments. If a treatment showed a marked change it could continue to be used in that patient hence personalized medicine. If a specific change did not occur that treatment could be abandoned and another tried instead. Since these changes could not be detected based on a PSA blood test alone this new test would be very helpful in determining early on which therapy to choose in a given patient. However Goluboff also noted that research from animalbased studies does not always pan out in humans and further larger studies are of course required to confirm these findings. More information The U.S. National Cancer Institute provides more information on prostate cancer. SOURCE Michael J. Schwartz M.D. director laparoscopy and minimally invasive surgery Arthur Smith Institute for Urology North ShoreLIJ Health System Lake Success N.Y. Erik T. Goluboff M.D. attending urologist Urologic Oncology Beth Israel Medical Center New York City The American Association for Cancer Research news release March"

"New clinical trial results provide evidence that highdose immunosuppressive therapy followed by transplantation of a persons own bloodforming stem cells can induce sustained remission of relapsingremitting multiple sclerosis MS an autoimmune disease in which the immune system attacks the central nervous system. ...these fiveyear results suggest the promise of this treatment for inducing longterm sustained remissions of poorprognosis relapsingremitting MS. Richard Nash M.D. Principal iInvestigator HALTMS study Five years after receiving the treatment called highdose immunosuppressive therapy and autologous hematopoietic cell transplant HDITHCT percent of trial participants had survived without experiencing progression of disability relapse of MS symptoms or new brain lesions. Notably participants did not take any MS medications after receiving HDITHCT. Other studies have indicated that currently available MS drugs have lower success rates. The trial called HALTMS was sponsored by the National Institute of Allergy and Infectious Diseases NIAID part of the National Institutes of Health and conducted by the NIAIDfunded Immune Tolerance Network link is external https ITN. The researchers published threeyear results https from the study in December and the final fiveyear results appear online Feb. in Neurology the medical journal of the American Academy of Neurology. These extended findings suggest that onetime treatment with HDITHCT may be substantially more effective than longterm treatment with the best available medications for people with a certain type of MS said NIAID Director Anthony S. Fauci M.D. These encouraging results support the development of a large randomized trial to directly compare HDITHCT to standard of care for this oftendebilitating disease. MS symptoms vary widely and may include motor and speech difficulties weakness fatigue and chronic pain. The most common form of MS is relapsingremitting MS which is characterized by periods of mild or no symptoms interspersed with symptom flareups or relapses. Over years the disease can worsen and shift to a progressive form. In HALTMS researchers tested the safety efficacy and durability of HDITHCT in volunteers aged to years with relapsingremitting MS who despite taking clinically available medications experienced active inflammation evidenced by frequent severe relapses and worsened neurological disability. The experimental treatment aims to suppress active disease and prevent further disability by removing diseasecausing cells and resetting the immune system. During the procedure doctors collect a participants bloodforming stem cells give the participant highdose chemotherapy to deplete the immune system and return the participants own stem cells to rebuild the immune system. The treatment carries some risks and many participants experienced the expected side effects of HDITHCT such as infections. Three participants died during the study none of the deaths were related to the study treatment. Five years after HDITHCT most trial participants remained in remission and their MS had stabilized. In addition some participants showed improvements such as recovery of mobility or other physical capabilities. Although further evaluation of the benefits and risks of HDITHCT is needed these fiveyear results suggest the promise of this treatment for inducing longterm sustained remissions of poorprognosis relapsingremitting MS said Richard Nash M.D. of Colorado Blood Cancer Institute and PresbyterianSt. Lukes Hospital. Dr. Nash served as principal investigator of the HALTMS study. If these findings are confirmed in larger studies HDITHCT may become a potential therapeutic option for patients with active relapsingremitting MS particularly those who do not respond to existing therapies said Daniel Rotrosen M.D. director of NIAIDs Division of Allergy Immunology and Transplantation. This work was sponsored by NIAID NIH and conducted by the ITN under award number AI and NIAIDfunded statistical and clinical coordinating centers under award number AI. The ClinicalTrials.gov identifier for the Phase study HighDose Immunosuppression and Autologous Transplantation for Multiple Sclerosis HALTMS is NCT httpsclinicaltrials.govctshowNCT. NIAID conducts and supports research at NIH throughout the United States and worldwide to study the causes of infectious and immunemediated diseases and to develop better means of preventing diagnosing and treating these illnesses. News releases fact sheets and other NIAIDrelated materials are available on the NIAID website https About the National Institutes of Health NIH NIH the nations medical research agency includes Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic clinical and translational medical research and is investigating the causes treatments and cures for both common and rare diseases. For more information about NIH and its programs visit https NIHTurning Discovery Into Health Reference RA Nash et al. Highdose immunosuppressive therapy and autologous HCT for relapsingremitting MS. Neurology DOI .WNL. ."

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

"For men who believe size matters and that their penises dont measure up success can be found in certain nonsurgical penile lengthening treatments a new study analysis by Italian researchers contends. Concerned that patients were seeking out unproven and potentially dangerous ways of lengthening the penis the researchers examined the medical literature to see whether popular nonsurgical methods had any scientific basis. In a review of five evidencebased surgical studies of men and six nonsurgical studies of men published between and the researchers found that penile extenders which stretch the organ over a period of months through traction were the most effective among noninvasive methods. But one expert cautioned that men are playing with fire if they tinker with their penis size simply for vanitys sake. Dr. Elizabeth Kavaler a urologist at Lenox Hill Hospital in New York City said functional issues resulting from conditions such as birth defects or prostate cancer surgery may warrant penile surgery but such cases are unusual. Its a very fragile organ to begin with Kavaler said and if you start to do all these things to it you can disfigure it... They should leave it alone. Study coauthor Dr. Paolo Gontero said urologists are constantly approached by men concerned about their penis size despite the fact that the majority are average with a flaccid length of to inches. However most men complaining of inadequate penile size do have associated sexual problems even if their penile dimensions fall within the normal range socalled dysmorphophobic penis said Gontero an associate professor of urology at the University of Turin. No study has however specifically addressed the extent and type of sexual bother in this patient category. Dysmorphophobia is a condition consisting of an imaginary flaw in the physical appearance the study noted. Writing in the April issue of the British Journal of Urology International Gontero and his colleagues found that penile extenders work better than techniques such as vacuum devices exercises and Botox injections and that psychological satisfaction is equally as important as any physical changes. A review of surgical techniques showed they increased phallus size an average of about a halfinch to inch but Gontero cautioned that the safest surgery which cuts the suspensory ligament of the penis to lengthen it often yields poor results. On the contrary more complex lengthening procedures are to be considered experimental and potentially dangerous he said. All procedures aimed to increase the penile girth should be considered unsafe leading to potentially poor cosmetic and functional results Gontero added. I have come across such cases that I had to reoperate in order to remove additive substances injected around the penis. The men studied ranged in age from to and were followed between three and months. More than of them used penile extenders with six experiencing minor problems such as bruising pain and itching. These devices yielded average flaccid length increases of between . inches and inch Gontero said and men achieving better results noted their satisfaction. Application of progressive and constant traction forces is a very oldfashioned technique used by the ancestors and currently by some tribal populations to elongate the penis or the neck he said. Gontero noted that cognitive behavioral therapy might help build confidence in some men. Longterm vacuum treatments did not appear effective producing no significant physical changes after six months Gontero said but did provide a degree of psychological satisfaction. He and his colleagues found no scientific evidence to support penilelengthening exercises. Dr. E. Douglas Whitehead director of New York Phalloplasty and associate clinical professor of urology at Albert Einstein College of Medicine in New York City said suspensory ligament surgery to increase penis length can be more effective when combined with stretching techniques. The human body even bone can be stretched he said. So stretching the penis when done long enough will work. If anything libido and desire are even better because you look better and feel better about yourself. More information For more about penis size visit Psychology Today http SOURCES Paolo Gontero M.D. associate professor urology University of Turin Italy Elizabeth Kavaler M.D. urologist Lenox Hill Hospital New York City E. Douglas Whitehead M.D. director New York Phalloplasty and associate clinical professor of urology Albert Einstein College of Medicine New York City April British Journal of Urology International"

"Each year thousands of Americans suffer a traumatic brain injury. In about . million TBIrelated https_the_facts.html emergency department visits hospitalizations and deaths occurred in the United States according to the Centers for Disease Control and Prevention. Most of these are what are called mild traumatic brain injuries or mTBIs httpsacrm.orgwpcontentuploadspdfTBIDef_English_.pdf head injuries that dont cause a coma. People with an mTBI typically get better within a few weeks but for as many as percent problems can linger for months or years. Many of these patients find themselves stuck with depression cognitive problems headaches fatigue and other symptoms. Known as postconcussion syndrome this phenomenon is often difficult to treat. Antidepressants can lift moods painkillers can ease headaches and physical therapy may ease dizziness but most researchers agree that these remedies dont heal the injury within the brain. Could oxygen do the trick A growing group of scientists and physicians say that hyperbaric treatment which exposes patients to pure oxygen at higherthannormal air pressure may work. These patients dont have enough oxygen to heal the injured parts of their brains said Shai Efrati a researcher and physician at Tel Aviv University in Israel and a leading hyperbaric scientist. Hyperbaric treatment massively increases the amount of oxygen available to the brain. But other researchers believe that the treatment has no merit and should not be recommended. People want to believe that hyperbaric can fix brain injuries and it cant said David Cifu a researcher at Virginia Commonwealth University in Richmond who has spent much of his career treating veterans with brain injuries. Compressed air has been used by doctors since the th century. In two German inventors first used pressurized pure oxygen to treat decompression sickness which occurs when undersea divers return to the surface too quickly. For the past years hyperbaric therapy has been approved by the Food and Drug Administration as a treatment for nonhealing wounds carbon monoxide poisoning burns and decompression sickness. Over the past decade doctors in the United States and internationally have begun using it to treat mTBIs. MTBIs include sportsrelated concussions and head injuries caused by traffic accidents. Also between and American service members suffered mild traumatic brain injuries according to the Department of Defense httpdvbic.dcoe.milfilestbinumbersWorldwideTotalsQQNov.pdf. Patients with an mTBI typically experience symptoms that include headache dizziness fatigue depression anxiety and cognitive impairment. Known as postconcussion syndrome PCS this phenomenon is difficult to treat. Doctors use antidepressants pain medications biofeedback and physical therapy but these strategies do not always work. The nature of the human brain makes it particularly susceptible to chronic injury. The organ requires large amounts of energy under normal circumstances and even more to heal when injured. And often the initial trauma damages blood vessels that supply the brain with oxygen. So just as the brain needs extra resources it faces an energy crisis. Often Efrati and others say injured brain cells dont die but may persist for years or decades alive but hobbled. Hyperbaric therapy he said can return them to full function even years after the injury. Oxygen is different because it has a direct biological effect on brain tissue said Paul G. Harch a physician in New Orleans who over the past three decades has used hyperbaric oxygen to treat hundreds of people with chronic brain injury as well as stroke. Patients typically receive between and hourlong hyperbaric treatments spread over two to three months. During each treatment they sit or lie inside a hyperbaric chamber which varies in size from a personsize tube to a large room that can hold several patients. While in the chamber patients breathe in pure oxygen typically pressurized to about twice the density of sealevel air in this environment the lungs take in about times as much oxygen as under normal conditions. Researchers say it remains unclear how hyperbaric oxygen affects injured brains. Efrati and others argue that it probably works through several biological pathways. The extra oxygen appears to trigger the healing of brain cells and switches on genes specifically related to brain repair. It increases the number of stem cells that migrate to sites of brain injury promotes the growth of new blood vessels in the brain and boosts the activity of mitochondria which provide energy to cells throughout the body. Scientists have linked increased mitochondrial activity to healing in many kinds of tissue. Efrati said the brain is no different from any other part of the body. Pressurized oxygen has the power to repair many kinds of tissue damage. A nonhealing wound in the leg and a nonhealing wound in the brain he said they are the same basic thing. Efrati came to the field accidentally. Eight years ago as director of research at Assaf Harofeh Medical Center in Tel Aviv he was asked to oversee the hospitals small hyperbaric chamber. He knew little about hyperbaric medicine and wasnt especially interested in it. But he soon noticed that pressurized oxygen seemed to have an unexpected effect. A patient had come for treatment of foot wounds that wouldnt heal a common symptom in diabetes. The man had also suffered a traumatic brain injury several years earlier which left him unable to speak more than a few words. The hyperbaric treatment healed his feet and also revived his ability to speak. Other patients with wounds and brain injuries had similar surprising results. He began to examine how hyperbaric treatment affects the brain and this work has become his focus. In . Efrati founded and now directs the Sagol Center for Hyperbaric Medicine and Research at Tel Aviv University and Assaf Harofeh where he oversees and collaborates with a range of scientists and manages a large hyperbaric treatment facility. As the use of hyperbaric therapy for brain injury has grown it has become increasingly controversial. Critics argue that it remains unproven and that desperate patients are wasting thousands of dollars the treatment typically costs between and per session and is rarely covered by insurance on a technique that rarely if ever helps. Between and Cifu oversaw three https studies httpjournals.sagepub.comdoiabs.url_verZ.rfr_idoriAridAcrossref.orgrfr_datcr_pubDpubmed for the Department of Veterans Affairs httpsinsights.ovid.compubmedpmid reportedly at a taxpayer cost of about million https of about activeduty service members with postconcussion syndrome. The studies found that hyperbaric treatment had little effect on their symptoms. Overall there is relatively little research on hyperbaric treatment for brain injury in part because pressurized oxygen cant be patented which limits its potential profitability. Its very difficult to get funding for studies on this topic Harch said. A few studies besides Cifus have looked at humans. In a paper published https in October Efrati and colleagues examined postconcussion syndrome patients who had received hyperbaric treatment. Using brain imaging the scientists found that after treatment the subjects had increased cerebral blood flow as well as more activity in brain areas that had previously been dormant. They say that this indicates that hyperbaric treatment triggered regeneration of nerve fibers and blood vessels in the brain. In addition tests showed that the subjects had improved memory and processing speed. In another study published in httpjournals.plos.orgplosonearticleid.journal.pone. researchers gave hyperbaric oxygen to patients with prolonged postconcussion syndrome. They found that many patients showed significant improvements in cognitive function and overall quality of life. While the research remains inconclusive some American doctors are using oxygen to treat chronic brain injuries. Ziad Mirza is one of them. For most of his career he dispensed hyperbaric treatment for hospitals around Baltimore. Two years ago he became chief medical officer for Hyperheal Hyperbarics a company with three clinics in the Baltimore area. Since then he said he has treated about a halfdozen braininjury patients with mostly positive results. One of these patients is Parisa Cook who in was found to have a tennis ballsize tumor in her brain. Surgeons removed it but the operation was not a complete success. Cook who lives in Baltimore began to suffer from debilitating symptoms She had problems with her shortterm memory she had constant headaches and couldnt concentrate her vision became blurry and dark and her hearing was altered so that all sounds were jumbled and very loud. Specialists told her the operation probably had caused collateral brain trauma. Over the course of a year she went to eight doctors and tried more than a dozen medications and a variety of other treatments. Nothing helped. A policy analyst for the Maryland Department of Health she worried that she would have to quit her job. She began to consider suicide. I felt completely hopeless she said. Then Cook read about hyperbaric oxygen treatment. She got in touch with Mirza and began treatments. After a single session she said her vision was no longer wobbly after sessions over a month she felt perfect. It was a complete she said. This treatment saved my life. Cooks primarycare doctor Sujay Pathak an internist in Baltimore first saw her in February. Her life was totally interrupted by this. She couldnt function Pathak said. But a few weeks after starting hyperbaric therapy in September she got suddenly and rather miraculously better Pathak said. Of course such anecdotes are not the same as rigorous scientific research. Efrati agreed that hyperbaric treatment requires more research. Definitely we need more science he said. We have a lot to learn. But we are seeing the results with our patients. It works again and again and again."

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

"For the first time doctors in Cleveland will stimulate the brain httptime.comawakebrainsurgery of a person disabled by stroke httptime.comriskssleepingtoomuch to help them regain function and independence. Someone has a stroke httptime.comworkinglonghoursstrokeheartdisease in the United States every seconds and it has become the leading cause of serious longterm disability among Americans. Thats why doctors at the Cleveland Clinic httpmy.clevelandclinic.org will test deep brain stimulation DBSa procedure in which electrodes are implanted in the brain to provide small electric pulses as a way to help people recover control of their movements. The hospital recently received the green light from federal authorities to start the first ever human trial of DBS for stroke httptime.comheartagehealth and plans to announce Tuesday that it will perform the procedure as soon as an initial patient is identified. Close to Americans have a stroke each year and estimates suggest about half of those people will be disabled from it. With physical therapy many people regain some motor function but the brain damage cannot be reversed and many still have profound movement problems. Despite advances in physical therapy and acute treatment of stroke there are still too many people who live with long term disabilities and new technologies are needed said Dr. Andre Machado the chairman of the Cleveland Clinic Neurological Institute who is leading the trial and will perform the procedures. DBS has been used to treat tremors associated with Parkinsons disease but Machado said the new approach if successful will achieve something novel. The big difference is that when we are treating the motor symptoms of Parkinsons disease were trying to make the symptom like a tremor go away he said. When we are treating stroke we are really trying to make movement come back. There is something inherently different about that. And inherently harder. DBS has never been used on humans as a way to regain a function. And experts arent even entirely sure why it works for Parkinsons in the first place. But for years Machado and his team have been studying the effects of DBS on rats. They found that rats with strokes who received DBS had more proteins in the brain that are associated with brain plasticityand twice as many synapses or connections between nerve cells compared to rats with strokes who did not undergo DBS. If all goes as planned Machado will insert the electrodes in the brain of someone severely disabled by stroke who has exhausted all other options without improvement. The electrodes will be placed on parts of the brain that communicate with the damaged region and surrounding areas. The electrodes will be attached to a wire that connects them to a battery pack located under the skin in the chestthe pack looks similar to a pacemaker. The stimulation will hopefully jumpstart the brains recovery process and help them gain more control while undergoing standard therapy. The team will focus on people who suffer ischemic strokes which is when blood flow to the brain is blocked. About of all strokes are this type. DBS is a type of brain surgery and comes with risks like bleeding infection and need for more surgeries. Since the procedure is experimental there may be some unknown risks as well. Depending on how the first procedure goes the hospital will enroll more people into its trial. If ultimately successful DBS could become a treatment used in tandem with physical rehabilitation. The goal of this therapy is not to replace physical training but rather to boost the effects Machado said. The proposition here is to make that recovery greater."

"A new study gives depression sufferers much hope if only they can get their doctors to look at this study. Ketamine infusion therapy the controversial treatment for depression has been resisted by many physicians due to concerns about shortlived benefits risks of addiction and the lack of large scale studies. In contrast this retrospective study of over three years of clinical experience shows lasting benefits for many patients with no apparent risk of addiction. Through a handful of ketamine infusions directed by Theodore Henderson MD PhD refractory depression symptoms can be relieved significantly and persistently. Evidence points to the regeneration of brain cells as a critical mechanism for the relief of depression as published in peerreviewed journal Neural Regeneration Research February issue. The study Practical application of the neuroregenerative properties of ketamine real world treatment experience http addresses key points in the controversy surrounding the use of intravenous ketamine for the treatment of depression. Its findings stand in direct contrast to warnings from the American Psychiatric Association APA. While controversial in academic settings Dr. Henderson said his direct experience supports a different strategy for multipleinfusion treatment regimens and his clinical experience shows ketamine can invoke longlasting effects often with less than six infusions. The wealth of clinical experience from treating hundreds of patients with ketamine has supplanted the preliminary data that emerged from the initial openlabel and small doubleblinded studies said Dr. Henderson who is a board certified psychiatrist specializing in diagnosing and treating complex conditions based in Denver Colorado. He is also the cofounder of NeuroLuminance Ketamine Infusion Centers. Patients in the study completed the Quick Inventory of Depressive Symptoms QIDSSR among other scales and showed persistent positive response to the ketamine infusions treatments. What is a Ketamine Infusion Ketamine is a dissociative anesthetic in use since s. Intravenous administration over a prolonged period of time is key to its persistent antidepressant benefit. Depression is associated with neuron loss reduced synapse numbers and dearborization of dendrites. Ketamine appears to potently induce mechanisms which reverse these neurodegenerative processes. Citing over published scientific research studies the new research article also reviews the molecular mechanisms by which ketamine invokes a robust activation of the brains own repair mechanisms. Another conclusion Dr. Henderson highlights is ketamine infusions can relieve refractory depression symptoms persistently perhaps for years. Activation of brainderived neurotrophic factor BDNF appears to have an important role in the antidepressant effects of ketamine. BDNF induces synaptogenesis dendritic arborization improved neuronal health and neurogenesis. These processes likely underlie the persistent benefits of ketamine. Dr. Hendersons findings challenge the oftheld beliefs that ketamine must be given frequently to have any benefit and that ketamine has no longlasting benefit. Dr. Henderson stated Misconceptions about ketamine abound among psychiatrists particularly related to possible chemical dependence problems. However the neurobiological basis of its benefit for depression has nothing to do with causing addictive risk. Our patients get better after a few infusions and from there treatments can be discontinued. The study also challenges concerns about neurotoxicity and a recent hypothesis that patients must experience hallucinations during ketamine infusion in order to have an antidepressant benefit. Please visit NeuroLuminance http or call for more information."

"A single breath may be all it takes to identify the return of lung cancer after surgery according to a study posted online today by The Annals of Thoracic Surgery. Exhaled breath contains thousands of volatile organic compounds VOCs that vary in composition and pattern depending on a persons health status. A subset of four VOCscalled carbonyl compounds because of their carbon basehave been discovered in the exhaled breath of lung cancer patients. Being able to identify this lung cancer signature through a simple breath test has emerged as one of the most promising ways to diagnose the disease. Now the test is being used to monitor for disease recurrence. Erin M. Schumer MD MPH Victor van Berkel MD PhD and colleagues from the University of Louisville analyzed breath samples collected before and after surgery from lung cancer patients and compared their carbonyl VOCs levels with samples from healthy patients. The researchers found a significant decrease in overall carbonyl VOC levels following surgery in fact three of the four carbonyl VOCs normalized after surgery matching levels in the control group. The rapid normalization of almost all of the four compounds after surgery provides strong evidence that they are directly produced by the tumor environment said Dr. Schumer. This study confirms that the technology is accurate. Lung cancer is the leading cause of cancer death. The American Cancer Society ACS estimates that more than Americans will be diagnosed with lung cancer this year and more than lung cancer patients will diethat translates to lung cancer deaths per day in the United States. Dr. Schumer said those grim statistics underscore the need for early detection We hope that breath analysis will allow us to diagnose patients with primary or recurrent lung cancer long before they suffer from symptoms when we have more options for treating them giving them the best chance for cure. Currently lung cancer patients are followed after surgery with chest computed tomography CT scans which can be inconvenient expensive and expose the patient to radiation. We hope that the breath analysis can serve as the primary screening tool for cancer recurrence and a CT scan ordered only if the breath test suggests that there has been a change said Dr. van Berkel. How the Breath Test WorksThe process of breath analysis is relatively simple. The patient blows a single breath into a specialized balloon. The balloon is then connected to a pump that pulls the breath over a small microchip smaller than a quarter trapping the chemicals. The microchip is sent to the lab where the chemicals are analyzed within hours. Breath collection can be performed in the doctors office. The pump is reusable the balloon microchip and lab test together cost around all supporting the increasing acceptance of breath tests as a costeffective easytoperform noninvasive and rapid option for the diagnosis of lung cancer. The great potential with breath analysis is detecting lung cancer at any point both as a primary screening tool and to follow patients after disease has been treated said Dr. van Berkel. The technology is pretty robust. Our next step is getting approval from the FDA. Schumer E Black M Bousamra M Trivedi J Li M Fu X van Berkel V. Normalization of Exhaled Carbonyl Compounds Following Lung Cancer Resection. Ann Thoracic Surg DOI .j.athoracsur.... Note This work was supported by the Coulter Foundation V Foundation National Science Foundation and Bill and Melinda Gates Foundation. In addition Drs. Bousamra van Berkel and Fu disclose a financial relationship with Breath Diagnostics Inc. For a copy of The Annals article contact Jennifer Bagley at or jbagleysts.org. Founded in The Society of Thoracic Surgeons is a notforprofit organization representing more than cardiothoracic surgeons researchers and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart lung and esophagus as well as other surgical procedures within the chest. The Societys mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education research and advocacy. The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association. It has a year impact factor of . the highest of any cardiothoracic surgery journal worldwide."

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

"A surgical technique called EDAS encephaloduroarteriosynangiosis significantly decreases the rate of stroke recurrence and death for patients with severe atherosclerosis of the brain arteries according to findings of a Phase IIa clinical trial presented today at the World Stroke Congress in Montreal. Atherosclerotic disease in which plaque buildup narrows the brain arteries is one of the most common causes of strokes https Neurosurgeons performing EDAS reroute arteries from the scalp and the membranes that cover the brain and place these arteries under the skull near areas of the brain at risk of stroke. Over time new blood vessels form creating fresh pathways for blood and oxygen to reach the brain. The trial led by Nestor R. Gonzalez MD httpbio.csmc.eduviewNestorGonzalez.aspx professor of Neurosurgery and director of the Neurovascular Laboratory at CedarsSinai enrolled patients with severe brain atherosclerosis also known as intracranial atherosclerotic disease or ICAD who showed symptoms of either a recent stroke or a ministroke called a transient ischemic attack https These patients received EDAS surgery along with intensive medical management which included diet and lifestyle changes blood thinners and other medications to control blood pressure cholesterol and blood sugar levels. After one year . percent of the patients treated with the surgery experienced another ischemic stroke or died compared with . percent of patients in a matched control group who received only intensive medical management. Two of the EDAS patients had small wound openings that required additional surgical interventions but there were no intracranial hemorrhages or other serious adverse events the researchers reported. Our findings in this intermediatestage trial are promising for applying EDAS surgery to intracranial atherosclerotic disease said Gonzalez said. Previously EDAS has been used for moyamoya disease a rare cerebrovascular disorder that affects younger patients. Gonzalez said the new trial addressed a serious medical need. Even under the best current treatments ICAD carries high rates of recurrent stroke and death compared with other causes of stroke he said. Developing new therapeutic strategies is crucial for ICAD patients. Current ICAD therapiesin addition to intensive medical managementinclude bypass surgery to connect a blood vessel from outside the brain to a vessel inside the brain as well as angioplasty with stenting which involves inflating a tiny balloon inside a cerebral artery to open it up and placing a stent device inside the artery. Despite advances in medical care annual rates of recurrent stroke and death are remain high at percent or more for ICAD patients according to published research. Gonzalez said his team is working with the stroke prevention working group of the National Institutes of Health to develop a proposal for a Phase III randomized clinical trial across multiple institutions to further test the effectiveness of EDAS as compared with intensive medical management. While this Phase IIa trial selected patients from previous studies as the control group the Phase III study would enroll new ICAD patients for both the control and experimental groups he explained. This clinical trial moves us significantly closer to preventing strokes and death in highrisk populations said Keith Black MD httpbio.csmc.eduviewblack.aspx professor and chair of the Department of Neurosurgery. As a nationally renowned physicianinvestigator Dr. Gonzalez personifies the dedication of CedarsSinai to translating the most advanced research into new cures. Besides Gonzalez the trial involved other investigators from the stroke centers https of CedarsSinai and UCLA. Funding Research reported in this publication was supported by the National Institutes of Neurological Disorders and Strokes of the National Institutes of Health under award number KNSA."

"Using gene therapy German researchers report that they managed to correct a malfunctioning gene responsible for WiskottAldrich syndrome a rare but devastating childhood disorder that leads to prolonged bleeding from even minor hits or scrapes and also leaves these children vulnerable to certain cancers and dangerous infections. However one of the kids in the study developed acute Tcell leukemia apparently as a result of the viral vector that was used to insert the healthy gene. The boy is currently on chemotherapy the study authors noted. This is a very good first step but its a little scary and we need to move to safer vectors said Dr. Mary Ellen Conley director of the Program in Genetic Immunodeficiencies at St. Jude Childrens Research Hospital in Memphis Tenn. The study shows proofofprinciple that gene therapy with stem cells in a genetic disorder like this has strong potential added Paul Sanberg a stem cell specialist who is director of the University of South Florida Center of Excellence for Aging and Brain Repair in Tampa. Neither Conley nor Sanberg were involved in the study which is scheduled to be presented Sunday at the annual meeting of the American Society of Hematology in Orlando Fla. According to Conley children mostly boys with WiskottAldrich syndrome WAS are born with an inherited genetic defect on the X chromosome that affects the number and size of platelets and makes the children remarkably susceptible to easy bleeding and infections including different types of cancer. Bone marrow transplants are the main treatment for the disorder which if they succeed basically cure the patient. They grow up go to college and they cause problems said Conley. But theyre not an easy group of patients to transplant. Even if a good match is found transplant recipients can go on to have more problems with infections such as graftversushost disease in which the body basically rejects the foreign elements. One of the longlasting complications is the kids couldnt do this they couldnt do that they see themselves as different Conley said. Transplants are getting better but we need better therapy theres no question. In this study the researchers inserted a healthy gene capable of producing WAS protein into hematopoietic stem cells the granddaddy cells that give rise to different blood cells then transferred these stem cells back into the patient using a viral vector. A viral vector is a virus that has been modified to deliver foreign genetic material into a cell. In fact the experiment was largely successful with cells now able to produce WAS protein resulting in increased platelet counts and improvement of some immunesystem cells. This is a first step that says you can correct the disease but I think most people would look at it and say the risk of leukemia is something and that lets see if we can avoid that said Conley whose team at St. Jude is working on a therapy involving a different type of vector. Its a good start but I think we have better things coming down the road. In other news from the conference another group of German researchers have determined that people who donate peripheral blood stem cells or bone marrow to help save a life dont face any heightened risk of cancer. Previously there had been some concern that drugs needed to get the stem cells out of the bone marrow and into the bloodstream where they could be accessed might pose a risk of leukemia. The study was based on questionnaires returned from more than donors which also showed the donors tended to be in good health and were willing to donate again. Another study found that the drug rituximab Rituxan used to treat rheumatoid arthritis and forms of leukemia and lymphoma could greatly reduce graftversushost disease in stem cell transplant recipients. More information The National Marrow Donor Program has more on WiskottAldrich syndrome http_Disease_TreatLrn_about_DiseaseImmune_SystemWAS_and_Txindex.html. SOURCES Mary Ellen Conley M.D. director program in genetic immunodeficiencies St. Jude Childrens Research Hospital Memphis Tenn. Paul Sanberg Ph.D. D.Sc. distinguished professor neurosurgery and director University of South Florida Center of Excellence for Aging and Brain Repair Tampa Dec. presentations American Society of Hematology annual meeting Orlando Fla."

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

"Patients with newly diagnosed advanced lung cancer who received an immunotherapy drug plus standard chemotherapy lived significantly longer than those who got chemo alone according to a new study that is expected to change the way such patients are treated. The report was one of several highly anticipated studies on immunotherapy and lung cancer presented Monday at the annual meeting of the American Association for Cancer Research in Chicago. The studies simultaneously were published by the New England Journal of Medicine on a day that some experts called the Super Bowl of lung cancer immunotherapy. The reports underscore the increasingly important firstline role that immunotherapy https_story.htmlutm_term.afa which unleashes the immune system to destroy cancer cells is taking against the deadliest cancer. Immunotherapy is rapidly in combination with other treatments and on its own dramatically changing the standard of care for lung cancer said Leena Gandhi an oncologist at NYU Langone Health who led the study on the immunotherapychemotherapy combination called Keynote. Instead of chemo being the backbone on which to improve immunotherapy is now the backbone on which we build. Lung cancer is the secondmostcommon malignancy https_story.htmlutm_term.afaaf in the United States after breast cancer. The American Cancer Society estimates that people will be diagnosed with the disease this year and will die of it. Most patients diagnosed with advanced lung cancer disease that has spread beyond its original site initially receive chemotherapy which provides only marginal benefit. But the disease is so lethal that many patients dont survive long enough to try second or thirdline treatments so researchers are trying to develop and use more effective approaches earlier. The trial that grabbed much of the spotlight Monday is a randomized effectiveness study that involved more than untreated patients with advanced nonsquamous nonsmall cell lung cancer a common type of the disease. The patients did not have cancercausing mutations. One group was treated only with chemo while the other got an immunotherapy drug called Keytruda https_story.htmlutm_term.efec plus chemo. Some of the results had been released previously but not specific details.After a median followup time of . months Gandhi said the patients in the combination group were percent less likely to die compared with patients in the chemoonly arm. For the first time adding another drug has significantly impacted the longterm outlook for those patients she said. Scientists who werent involved in the study agreed that it was highly significant. H. Jack West an oncologist at Swedish Medical Center in Seattle said It is literally practicechanging immediately. Roy Herbst an oncologist at Yale Cancer Center said that most lung cancer patients now will be offered immunotherapy in some form much earlier than before. Still he said the approach was not a cure and there is a lot of room for improvement. The estimated proportion of patients in the combination therapy group who were alive and whose disease had not gotten worse at a year was about percent about double the proportion for the chemoonly group. Last May the Food and Drug Administration approved the Keytrudachemo combination based on an earlystage trial. But many doctors did not adopt it because the trial was small and didnt initially show a survival benefit Gandhi said. Experts said it was especially significant that the study showed that patients benefited from the Keytrudachemo combination regardless of the levels of a protein called PDL found on their cancer cells. Researchers already had known https_story.htmlnoredirectonutm_term.adea that patients with high levels of the protein were more likely to respond to immunotherapy. Last week in a related development Merck which makes Keytruda reported that a different trial showed that the medication prolonged survival even when used alone compared with chemo. Experts said they will have to see more details before they can determine whether the medication is better used alone or with chemo. In a second study published Monday researchers used two other immunotherapy medications Opdivo and Yervoy both made by BristolMyers Squibb to treat newly diagnosed patients with advanced nonsmall cell lung cancer with a high number of mutations in their tumors. The patients experienced a significantly longer period during which their disease did not worsen compared with people who received only chemotherapy said Memorial Sloan Kettering Cancer Center oncologist Matthew Hellmann who led the study. He said the results established the doubleimmunotherapy combination as a firstline treatment for patients with a high tumor mutational burden but that it was too early to know whether the treatment leads to longer survival. And he said the trial showed that tumor mutational burden is a reliable way to predict who will benefit from the medications. Another study published Monday used immunotherapy in a different way for patients with earlystage lung cancer. Researchers at Johns Hopkins and Memorial Sloan Kettering gave patients two doses of Opdivo the first a month before surgery the second two weeks before the operation to try to stimulate antitumor activity and reduce the risk of relapse. Nine of the patients who got Opdivo had a major pathologic response a sharp reduction in the number of cancer cells found in the tumors removed by surgery. Drew Pardoll director of Hopkins BloombergKimmel Institute for Cancer Immunotherapy said that it is too early to know whether the findings will translate into longer survival. But if future studies show that he added then immunotherapy might be used to augment or even replace chemo typically given before surgery."