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"An experimental psoriasis treatment performed significantly better than the commonly prescribed medication methotrexate in a new clinical trial. The drug briakinumab reduced psoriasis symptoms by at least percent in nearly percent of those taking it compared to just percent of those on methotrexate. But serious side effects were more common among the briakinumab users. Very high levels of response were observed and maintained throughout the study period said lead researcher Dr. Kristian Reich a professor of dermatology at the University of Gottingen and a managing partner at Dermatologikum Hamburg both in Germany. Results of the study are published in the Oct. issue of the New England Journal of Medicine. The study was funded by the drugs manufacturer Abbott Laboratories. Psoriasis affects about million Americans according to the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases NIAMS. The disease causes patches of thick red inflamed skin that have silvery scales. Psoriasis can affect any part of the body including the skin nails genitals and inside the mouth according to NIAMS. The current study included people with moderate to severe psoriasis. The study volunteers had had psoriasis for at least six months and the condition affected at least percent of their bodies. Nearly half of the study participants were randomly selected to receive injections of briakinumab at a dose of milligrams mg for the first and fourth week of the study and mg at week eight and every four weeks thereafter. The study lasted one year. The remaining volunteers were given between mg and mg of oral methotrexate weekly. After six months nearly percent of those in the briakinumab group had at least a percent improvement in the psoriasis areaandseverity index PASI a commonly used measurement to assess the severity of psoriasis. Slightly less than percent of those on methotrexate had a percent improvement in their PASI score according to the study. After a year about percent of those taking briakinumab had a percent improvement in their PASI score compared to almost percent for those on methotrexate according to the study. Briakinumab works by dampening the immune system response that causes psoriasis said Bruce Bebo director of research and medical programs for the National Psoriasis Foundation based in Portland Ore. More serious infections were seen in people taking briakinumab . percent vs. those taking methotrexate . percent. There were also two cases of cancer in people taking briakinumab and none in the methotrexate group. However the researchers said these differences werent statistically significant. Cancer risk is extremely hard to define and this study was not powered to detect any difference in the risk of developing a malignancy said Bebo. He said that in an earlier trial of briakinumab some unexplained major adverse cardiac events occurred. At the time Abbott withdrew its application for approval from the U.S. Food and Drug Administration pending further research. In the current study no serious cardiovascular events were reported. Of the increased infections and cancers Reich said Although these differences were not statistically significant they lead to questions regarding a favorable riskbenefit profile of the drug. Research on briakinumab is continuing. An ongoing threeyear trial involves people from the current study. For people living with psoriasis Bebo said the message from this study is that dramatic progress has been made from where we were just five years ago. More information Learn more about psoriasis treatments from the National Psoriasis Foundation http SOURCES Kristian Reich M.D. professor dermatology University of Gottingen and managing partner Dermatologikum Hamburg Germany Bruce Bebo Ph.D. director research and medical programs National Psoriasis Foundation Portland Ore. Oct. New England Journal of Medicine"

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

"Throughout her early s Shirley Kessel ran through a gamut of medications but none brought relief from her daily migraines. Special occasions werent spared On her wedding day Kessel suffered the worst headache of her life. I couldnt wait for the day to end said Kessel who now is and executive director of Miles for Migraine which raises money for research and education for the disease. Finally during her first pregnancy the chronic headaches abated. After the birth of her first daughter Kessels headaches subsided to one or two menstrual migraines per month. For years she got relief from triptans a fastacting class of drug developed in the s for migraine attacks. During perimenopause however her chronic headaches returned along with fatigue nausea light and noise sensitivity and ringing in her ears. Migraines affect an estimated million Americans httpmigraineresearchfoundation.orgaboutmigrainemigrainefacts and about three out of four people who suffer from them are women. The World Health Organization estimates million to million people worldwide experience chronic migraine defined as or more headaches per month over at least three months. Migraines also often have a genetic component. Along with her mother two of Kessels three daughters Julia and Sydney suffer from migraines. Sydney who is in college lost a year of high school to migraines which transformed her from an active social butterfly to a withdrawn and nauseated young woman who spent most of her time in bed. While a number of interventions exist many work only for a limited time. There are many medications for migraines including topiramate antidepressants blood pressure medications and Botox injections. But there hasnt been a new drug specifically designed for migraines since triptans. Thats likely to change. A new study recently in the New England Journal of Medicine http reports that fremanezumab an immunotherapy drug has been found to reduce the number of days that chronic migraine sufferers experienced headaches. The drug blocks the activity of a molecule called calcitonin generelated peptide or CGRP which spikes during migraine attacks. By blocking this peptide doctors hope to break the cycle of increasing inflammation and heightened pain sensitivity that contributes to migraine headaches. Its the first specific migraine drug said Stephen D. Silberstein director of the Jefferson Headache Center at Thomas Jefferson University Hospitals and lead author of the study. This therapeutic approach offers new hope for people whose migraines cannot be treated with existing medicine. Based on the promising phase III clinical trials the drug could be available later next year. Women get more migraines than men because of hormonal changes said Roderick Spears a physician and clinical associate of neurology at Penn Medicine. If you look at the statistics boys outpace girls with migraines until girls start to menstruate and you begin to have hormonal fluctuations said Spears. About twothirds of women with migraines will get some type of migraine around ovulation or menstruation. Its the cycle of rising and falling estrogen levels said Silberstein. During perimenopause when periods and estrogen levels are irregular headaches increase. Stable estrogen is better for migraines. He notes that sometimes as was true in Kessels case the second or third trimester of pregnancy brings a drop in migraines. Because of the hormonal connection some physicians prescribe lowdose estrogen patches or try IUDs that are progesteronebased to stem headaches said Spears. Other women use antiinflammatories like naproxen sodium or a longacting migraine medication Meanwhile Silberstein suggests preventive measures for those with migraines. First and foremost regular exercise meditation or biofeedback he said. Then there are medications. Prevention can also include doses of CoQ and riboflavin which have been shown to help. Another useful supplement is magnesium which has been clinically shown to prevent menstrual migraines said Spears. Lifestyle changes can also prove useful Spears recommends regulating sleep eating regular meals avoiding artificial sweeteners limiting caffeine intake and holding rescue medications to two days per week. As if the pain werent enough migraineurs as sufferers are known may also cope with stigma. Migraine in the th century had been considered a disease of neurotic women said Silberstein. But this is a neurological disease. Also some people have one attack every three months others have it every day. And if you have infrequent migraines it may not seem a big deal Silberstein said. And attitudes from the medical community may not help. I think this may be changing in health care said Spears but because migraine affects women more than men there is a stigma around the stereotype of a patient who comes in with multiple complaints calls frequently and wants to see the doctor frequently. Men on the other hand have been stereotyped as going to the doctor only when something he has is real. Another problem is that you cant see a migraine. If youre walking around with crutches or your arm in a sling you can see that but if you tell people your head hurts light bothers you or sounds bother you people dont really believe it Spears said. Its hard for people to understand what migraineurs are really going through. These days Kessel who lives in Lafayette Hill struggles to weather her headaches and looks toward the future for a cure. My lifestyle is not the same as other women my age she said. I may look completely normal. But thats not how I feel."

"Physicians have used the snarelike LARIAT device to close off a sac in the heart that is thought to be the source of harmful clots. But a new University of Pennsylvanialed study finds that this procedure is risky. In older patients with atrial fibrillation cardiologists increasingly are using a snarelike device to close off a small sac in the heart thought to be the source of clots that can cause stroke in those with the abnormal heart rhythm. But the U.S. Food and Drug Administration did not approve the Lariat device for that specific purpose and now a new University of Pennsylvanialed study says this approach though legal too often leads to urgent surgery and even death. Several area hospitals have used the device including one that is part of Penns own health system Pennsylvania Hospital though physicians there have stopped. Others that have tried it include Deborah Heart Lung Center in Browns Mills and Cooper University Health Care in Camden where physicians say it is a reasonable choice for strokeprone patients with limited options. In the study published Monday in JAMA Internal Medicine authors found that the procedure was reported to be successful in . percent of the cases they identified in the medical literature. Success meant physicians were able to close off the left atrial appendage a sac in the wall of the hearts left atrium not that there was any reduction in the rate of strokes. But urgent followup surgery was needed in seven patients or . percent of reported cases and one patient died. The study authors also searched an FDA database of adverse events associated with medical devices finding reports of five patients who died after undergoing a Lariat heart procedure and an additional who required urgent followup surgery. Senior author Jay Giri an assistant professor at Penns Perelman School of Medicine urged a formal study of the device before further use. The Lariat is an absolutely ingenious piece of engineering said Giri an interventional cardiologist. However ingenuity doesnt guarantee its safety and efficacy. Meanwhile the device made by SentreHEART Inc. of Redwood City Calif. is facing competition from a product specifically approved by the FDA to deal with this heart sac. Rather than cinching the sac shut the Watchman device is implanted in the sac to block clots from emerging. The Watchman made by Boston Scientific of Marlborough Mass. was cleared by the FDA in March after rigorous clinical trials. The FDA approved the Lariat in without such trials because its manufacturer told the agency that the product was substantially equivalent to other suturing devices on the market. But those other devices are not used to close off the left atrial appendage and SentreHEART is not allowed to promote the Lariat for that specific purpose either. In fact on the companys website description of the Lariat the only time the word heart appears is in the companys name. The company has filed for a patent to use the device for closing off the heart sac. Giri the study senior author said those facts have left little question that Lariat was designed with the heart in mind even though it was not specifically approved for that purpose. He referred to the process through which it was approved as a regulatory loophole. In a statement the company said that it agreed with the study authors that more research was warranted and that it was in the process of discussing clinical trials with the FDA. However it did not answer questions about whether the Lariat had been used for anything other than cardiac procedures. The way in which the FDA can approve devices as substantially equivalent to those already on the market called the k process has come under fire with other devices recently. Among them are duodenoscopes that have undergone numerous incremental changes and now are thought to pose a higher risk of transmitting bacteria. Physicians who use the Lariat to close off the left atrial appendage are said to be using the product offlabel a practice that is legal and can lead to innovation. It is unclear just how many times the Lariat has been used to close off the heart sac as it is designated with a general billing code that can refer to closing off the appendage with any of several techniques. In Pennsylvania cardiologists closed off a left atrial appendage times between Sept. and Aug. according to the Pennsylvania Health Care Cost Containment Council a state agency that tracks healthcare cost and quality. At Cooper cardiologist Phillip Koren said he and colleagues have used the Lariat on the left atrial appendage of about patients in the last six months. The closure was unsuccessful in a few of those cases but in those there have been no strokes said Koren deputy director of the Cooper Heart Institute. None of the patients suffered adverse events from the device. In patients with afib whose hearts pump blood less efficiently the appendage is thought to be a source of clots because blood can stagnate there. When such clots travel toward the brain that means stroke. Closing off the appendage with the Lariat delivered through catheters not an open incision involves placing magnets inside and outside the heart to serve as a guide for inserting the snare Koren said. It takes two hours and is performed after putting the patient under general anesthesia. At Cooper Koren said the procedure was recommended only in patients who were at high risk of stroke and who had difficulty with anticoagulant medication the usual course of treatment for preventing clots. He said Cooper also planned to start using the Watchman which he said might be easier to use. We are extremely excited that were on the cutting edge of new treatments for patients with atrial fibrillation Koren said. We always have to weigh the benefits and the risks. One of the authors of the new study Daniel McCormick of Pennsylvania Hospital also expressed enthusiasm when he first used the Lariat in January . Its terrific to be able to add another tool to our arsenal of treatments for atrial fibrillation McCormick said in a hospital blog post then. Titled Lasso It Up How a Rodeo Roping Technique Can Help Treat an Ageold Heart Ailment the post was illustrated with a drawing of a ropewielding cowboy on horseback. McCormick was not available to discuss his apparently changed opinion of the procedure but he and study coauthors concluded with the following Highquality randomized clinical trials examining the Lariat as a device for LAA exclusion should be obtained before its widespread use is adopted by the medical community."

"A minimally invasive procedure that cuts off the blood https supply to an enlarged prostate https may help when medications https fail and it appears to provide good symptom control without sexual dysfunction a new study shows. The procedure involves using a tiny catheter that is threaded through arteries https near the groin to reach the vessels that supply the prostate https with blood https These vessels are then blocked with particles the size of a grain of sand. A similar procedure is sometimes used to treat another kind of benign growth uterine fibroids https in women. It was my inspiration uterine fibroids https Its the same kind of growth says study researcher Joao Martins Pisco MD chief radiologist at Hospital Pulido Valente and director of interventional radiology at St. Louis Hospital both in Lisbon Portugal. The results are excellent. In a small pilot study most men were able to leave the hospital four to eight hours after the procedure which is called prostatic artery embolization PAE researchers report. PAE reduced the symptoms of frequency and urgency of urination without causing side effects like incontinence https sexual dysfunction retrograde ejaculation ejaculation into the bladder https or bleeding. Despite the promising results of this small trial experts said it was far too early to recommend PAE to patients. There are a lot of questions. We really dont know what the short and longterm success or complication rates are says Anthony Malizia Jr. MD president and director of the Malizia Clinic a nonprofit urology specialty center in Atlanta. We dont know how well these particles are localized to the prostate or if theyre going to the pelvis or other parts of the body. Malizia notes that in one serious complication reported in the study the particles appeared to migrate and kill a small part of the bladder https wall. The authors report that the dead tissue required surgical removal. The study was presented at the Society of Interventional Radiology annual meeting in Chicago. Living With Benign Prostatic Hypertrophy When the prostate normally a walnutsized gland grows in mid to late life it can clamp down on the urethra decreasing or shutting off the flow of urine and causing many sleep https trips to the bathroom. The condition is called benign prostatic hyperplasia https BPH httpsmen.webmd.comprostateenlargementbph and its estimated to affect as many as million American men. Medications can sometimes help but for some the problem requires a procedure to reduce the size of the prostate. The gold standard for treating BPH https is considered to be less invasive surgery called transurethral resection of the prostate TURP where under anesthesia doctors thread a heated wire loop up through the penis https and use it to cut and remove sections of the prostate. Side effects from TURP may include retrograde ejaculation bleeding incontinence https or leakage and difficulty having an erection. Experts say however that most men who could have erections before their procedure will be able to have them after. Surgery doesnt usually restore lost sexual function however. TURP is performed in of cases where treatment is needed but sometimes the prostate is too large and requires open surgery. Less commonly some centers are offering newer procedures using lasers to vaporize prostate tissue or microwave heat therapy to ablate tissue thats blocking the urethra. Looking at a Different Option For the trial researchers in Portugal enrolled men who ranged in age from to with severely enlarged prostates who had tried medications but still had not gotten relief from their symptoms after at least six months on the drugs. Overall . of procedures were considered to be technical successes meaning that doctors were able to seal off at least one out of four of the arteries that feed the prostate. An average of nine months after their procedures researchers reported that men had excellent improvement. Six men had slight improvement but needed no medications. And one had no improvement because the procedure couldnt be completed. Overall improvement on a scale that ranks symptom severity from to points was about points. On average the men started with a score of and improved to a score of researchers say. That would be a pretty impressive response to therapy and comparable to a lot of other things that have gained traction and become part of our armamentarium for treating BPH https says Stephen M. Schatz MD assistant professor at Brady Urological Institute at Johns Hopkins University School of Medicine who was not involved in the study. If the results are reproducible and real that represents something promising. There were eight clinical failures Pisco says meaning that the men only had slight or no improvement after their procedures. Despite the fact that more testing needs to be done to determine safety and longterm results Pisco says hes optimistic that this will turn out to be a good choice for many men. If the patients know about it PAE they dont want to be treated by surgery. They know about the complications Pisco says adding In two or three years this will be the first option I believe. Theres a lot of interest. This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

"Women who need breast surgery to remove an abnormality that cannot be felt also known as a nonpalpable breast lesion now may benefit from the convenience and comfort provided by an advanced new tissue locating technology offered at Rush University Medical Center. The SAVI SCOUT Radar Localization System helps to decrease the time a woman is in the operating room increase the success rates of lesion removal and reduce the amount of healthy breast tissue that is removed during the procedure. Rush began offering SAVI SCOUT which has been used in more than lumpectomy surgeries in July. SAVI SCOUT allows a radiologist to insert a radar wave reflector the size of a grain of rice in the patients breast up to days before surgery to mark the location of the lesion as shown with ultrasound or Xray https mammography https The reflector replaces the widespread current practice of inserting a thin hooked wire into the breast the same day as surgery. When there is an abnormality that we cant feel and are unable to biopsy we have to find that lesion in surgery said Dr. Andrea Madrigrano httpsdoctors.rush.edudetails assistant professor of surgery at Rush University Medical Center. SAVI SCOUT replaces a more inconvenient technique used since s Used since the s a hooked wire is placed in the breast through the skin to the abnormality using ultrasound or Xray guidance with local anesthesia. The wire is placed into the breast to help guide the surgeon in removing the abnormality later that day. Until now a patient would go to the imaging center to have the thin wire precisely placed in the breast. The woman would then be taken to the operating room area Madrigrano said. Wire localization requires a high degree of coordination between radiology and surgical scheduling which can lead to delays between placement of the wire and surgery often requiring a woman to wait long periods of time with the wire in her breast. Before surgery these patients are in a hospital gown and are walking around while this wire is in place which obviously is less than ideal for the patient Madrigrano said. The radar reflector is a replacement for the wire and is essentially a little marker. After the patient receives a local anesthetic it can be placed into the breast using an extremely thin needle under image guidance days or weeks prior to surgery. Because this important step is out of the way in advance it completely changes the patients day of surgery experience. Radar can target abnormality within mm sparing more healthy tissue Unlike mastectomy https which treats breast cancer by removing an entire breast lumpectomy https surgery also known as breastconserving surgery is used to remove only the tumor and a small amount of tissue surrounding the tumor. Using the SAVI SCOUT system technology which emits million radar pulses per second surgeons can target the affected tissue within millimeter of the reflector. When Madrigrano told me about it I thought it was an ingenious idea and Im glad it was developed said Nancy Morrissey who underwent lumpectomy surgery at Rush in July using the SAVI SCOUT technology. It made surgery go smoothly and I didnt have any pain before or after. When the marker was inserted near the lump it was similar to a biopsy. I was glad it was done a week before and not the same day as the lumpectomy surgery. I have been very impressed with the experience. According to Cianna Medical the company that created SAVI SCOUT percent of women return to work the next day after the SCOUT procedure. In addition to enhancing the patients surgical experience the more precise localization of the surgical site enable surgeons to plan the procedure better. That advantage may lead to less tissue needing to be removed and a better appearance of the breast after surgery. Ultimately this wireless technology has the potential to reduce surgical delays and more importantly will benefit patients by increasing comfort and satisfaction during a stressful time Madrigrano said."

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

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

"The bone drug zoledronic acid Zometa considered a potentially promising weapon against breast cancer recurrence has flopped in a new study involving more than patients. Zometa did not appear to prevent breast cancer from returning or to boost diseasefree survival overall. British researchers presented the disappointing findings Thursday at the San Antonio Breast Cancer Symposium in Texas. As a whole the study is negative study author Dr. Robert Coleman a professor of medical oncology at the University of Sheffield in England said during a Thursday news conference on the findings. There is no overall difference in recurrence rates or survival rates between patients who got the bone drug and those who did not except in older patients defined as more than five years after menopause. That was a possible bright spot in the results. In that population there is a benefit Coleman said. The older women had a percent improvement in recurrence and a percent improvement in overall survival over the fiveyear followup compared to those who didnt get the drug. There was tremendous hope that this drug approach would be a major leap forward Coleman noted. There have been other trials that suggest this is the case. In one previous study the use of the drug was linked with a percent improvement in survival and lowered recurrence in younger women with breast cancer. Other research has found that healthy women on bone drugs were less prone to develop breast cancer so experts were hoping the drugs had an antitumor effect. Zometa marketed by Novartis AG is used to relieve pain when cancers have spread to the bone in part by slowing bone erosion caused by the disease. It is given intravenously while other bisphosphonates such as Actonel Fosamax or Boniva can be taken orally. In the trial known as AZURE Adjuvant Treatment with Zoledronic Acid in State IIIII Breast Cancer Coleman and his colleagues evaluated breast cancer patients from participating centers all with stage II or III cancers but no evidence of metastases cancer that has spread beyond the original site. About half received the bone drugs plus standard therapy half just got standard therapy. The focus was on diseasefree survival. After five years about women in each group either died or had recurrences. When Colemans team looked at subgroups however they found the benefit among older women a finding they say warrants more study. The younger patients are getting no benefit Coleman said. If anything they are doing a little bit worse. In addition there were some troubling side effects among women taking Zometa including cases of osteonecrosis of the jaw a severe bone disease that can result in death of the jawbone. Dr. Sharon Giordano an associate professor of breast medical oncology at the University of Texas M.D. Anderson Cancer Center was not involved in the study but put it in perspective. Bisphosphonates have been used to treat osteoporosis as well as bone complications of breast cancer treatment she said. The role of bisphosphonates in preventing cancer recurrence has been less clear she said noting that multiple studies have had conflicting findings. As for the benefit found in postmenopausal women she said I would consider this hypothesisgenerating and not practicechanging. Other studies underway may provide a clearer answer she said. Since the current study was presented at a meeting its findings should be considered preliminary until published in a peerreviewed journal. Said Coleman Zoledronic acid cannot be routinely recommended for prevention of cancer returning but it remains a very good drug for patients where the cancer has already spread to the bone. Coleman disclosed receiving speaker fees from Novartis the researchers also received academic grant funding from the drug maker. More information For more information on bisphosphonates visit U.S. Food and Drug Administration http SOURCES Robert Coleman M.D. professor medical oncology University of Sheffield England Charon Giordano M.D. associate professor breast medical oncology University of Texas M.D. Anderson Cancer Center Houston Dec. presentation San Antonio Breast Cancer Symposium Texas"

"One single dose of cannabidiol a chemical extracted from cannabis decreases brain abnormalities in people with psychosis. According to a study published Wednesday by Kings College London https in JAMA Psychiatry cannidiboil also referred to as CBD acts in the brain to reduce psychotic symptoms. The chemical is a nonintoxicating compound found in cannabis. Researchers examined participants who were experiencing psychotic symptoms but had not yet been diagnosed with psychosis as well as healthy patients. Some subjects with symptoms were given placebo while others received a single dose of CBD. All the participants then underwent an MRI scan while performing a memory task that engages regions of the brain related to psychosis a press release stated. Results from the MRI scans showed that participants displaying psychotic symptoms had abnormal brain activity compared to healthy participants. However those that had received cannabidiol showed decreased abnormal activity compared to those who received the placebo. These results suggest that CBD can help readjust brain function to normal levels. The researchers arent entirely sure how CBD works in the brain to reduce psychotic symptoms but the results show that it has a therapeutic effect according to the press release. The mainstay of current treatment for people with psychosis are drugs that were first discovered in the s and unfortunately do not work for everyone Sagnik Bhattacharyya coauthor of the study said in the release. Our results have started unravelling the brain mechanisms of a new drug that works in a completely different way to traditional antipsychotics. A previous Kings College London study https also discovered that the chemical has antipsychotic effects and in June the U.S. Food and Drug Administration approved the first medication https made from cannabidiol to treat two rare forms of epilepsy. The researchers are now launching a larger study to investigate if cannabidiol can be used to treat young people who are at high risk of developing psychosis."

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

"A study published today in the prestigious New England Journal of Medicine offers the most indepth assessment yet of the safety and effectiveness of a hightech alternative to brain surgery to treat the uncontrollable shaking caused by the most common movement disorder. And the news is very good. The paper outlines the results of an international clinical trial led by Jeff Elias MD httpsuvahealth.comfindadoctorprofilejeffelias of the University of Virginia Health System httpsuvahealth.com that evaluated the scalpelfree approach called focused ultrasound for the treatment of essential tremor httpsneurosciences.uvahealth.comservicesparkinsonsmovementdisordersconditionsandtreatmentsessentialtremor ET a condition that afflicts an estimated million Americans. Not only did the researchers determine that the procedure was safe and effective they found that it offered a lasting benefit reducing shaking for trial participants throughout the month study period. This study represents a major advance for neurosurgery treatment of brain disease and specifically the treatment of ET Elias said. For the first time in a randomized controlled trial we have shown that ultrasound can be precisely delivered through the intact human skull to treat a difficult neurological disease. Pioneering Tremor TrialThe multisite clinical trial included participants with moderate to severe essential tremor a condition that often robs people of their ability to write feed themselves and carry out their normal daily activities. The trial participants all had tried existing medications without success. The mean age was and most had suffered with their tremor for many years. Seventyfive percent of participants received the experimental treatment using focused ultrasound guided by magnetic resonance imaging. The remaining percent underwent a sham procedure to act as the control group. They would later be given the opportunity to undergo the real procedure. Participants who received the treatment showed dramatic improvement with the beneficial effects continuing throughout the study period. The researchers employed a point scale to assess tremor severity and they found that mean tremor scores improved by percent at three months and percent at months. Participants reported major improvements in their quality of life. People who couldnt feed themselves soup or cereal could again do so. Participants who received the sham procedure on the other hand showed no significant improvements. The degree of tremor control was very good overall in the study but the most important aspects were the significant gains in disabilities and quality of life thats what patients really care about Elias said. The most commonly reported side effects were gait disturbances and numbness in the hand or face in most instances these side effects were temporary but some were permanent. FDA Approved Based on the clinical trial led by Elias the federal Food and Drug Administration has approved the focused ultrasound device manufactured by InSightec Inc. for the treatment of essential tremor. The device focuses sound waves inside the brain to create heat much like a magnifying glass focuses light. That heat can then be used to interrupt the troublesome brain connections responsible for the tremor. Elias can actually watch as patients tremor decreases and the realtime imaging allows him to zone in on exactly the right spot before making any permanent changes to the brain. The FDA approval means UVA can make the procedure available to eligible patients. UVA however is still working out the necessary logistics its not yet clear when Elias will begin treating patients. Because the approach is so new insurance plans will not yet cover the procedure though that may change in the coming months. The cost at UVA has not yet been determined. People interested in the procedure can learn more at uvahealth.comfocusedultrasound httpsneurosciences.uvahealth.comservicesfocusedultrasound. The site includes a list of frequently asked questions and will be updated as UVA prepares to make the treatment available. The procedure is not for everyone with essential tremor. It cant be used in patients who cannot undergo MRI imaging including those with implanted metallic devices such as a pacemaker. It is also not available for pregnant women people with heart conditions or very high blood pressure patients with kidney disease or clotting disorders patients on blood thinners patients with a history of strokes or brain tumors and people with substance abuse issues. There are other exclusions as well. Doctors at UVA will evaluate potential patients to determine their eligibility and then recommend the best course of treatment. Groundbreaking ResearchUVA is a world leader in focused ultrasound research. Elias and his colleagues are testing the capability of focused ultrasound to treat Parkinsons disease epilepsy brain tumors and benign breast tumors. The essential tremor research has been supported by InSightec the Focused Ultrasound Foundation and the BIRD USIsrael Binational Industry Research and Development Foundation. FOR REPORTERS Elias will be available for interviews today and hell be doing a Facebook Live broadcast at Eastern. To arrange an interview contact Alex Prevost at .. or ampgbvirginia.edu mailtoampgbvirginia.edusubjectNewswiseArticleReporterFollowupbccreportersnewswise.com. Highresolution images and video are available as well."

"kalo a privatelyheld pharmaceutical company today announced that EVZIO naloxone HCl injection Autoinjectors have been reported to help save more than lives. EVZIO was the first naloxone product specifically designed FDA approved and labeled for the emergency treatment of opioid overdose by individuals without medical training. EVZIO is an intelligent Autoinjection system that provides simple onthespot voice and visual guidance. In Baltimore we believe that naloxone should be a part of everyones medicine cabinet and everyones first aid kit. If we dont save lives today there is no chance for a better tomorrow said Baltimore City Health Commissioner Dr. Leana Wen. Having EVZIO available in Baltimore is helping us do everything possible to help prevent opioid overdose deaths in our community and across the country. The opioid epidemic is killing people each day the equivalent of a fully loaded airplane crashing each and every week. We cant stand by and hope that things change on their own said Spencer Williamson President and CEO of kalo. By empowering more patients to have access to this potentially lifesaving medicine we believe that EVZIO will help reduce the burden of opioid overdose in the United States. Since October we have received reports that EVZIO Autoinjectors have helped save an average of lives per week. People at an overdose scene may be very emotional so it really helps that EVZIO has audio instructions on how to administer this potentially lifesaving medication said Laurie Fugitt RN BSN cofounder of Georgia Overdose Prevention. It has already helped save many many lives in Georgia. The CabellHuntington Health Department is pleased to have EVZIO in our community said Dr. Michael Kilkenny Physician Director of the CabellHuntington Health Department in Huntington West Virginia. Following initial deployment of EVZIO on February we had a confirmed life saved on February th. Our community is in a crisis as a result of opioid overdoses and EVZIO has provided an outstanding tool to help combat the harmful effects and death resulting from heroin and opioid use. The Sarasota County Sheriffs Office SCSO has found the naloxone Autoinjector to be an outstanding addition to our first responder capabilities said Captain Charlie Thorpe. Deputies now have instant access to this potentially lifesaving tool since our field deployment in December . Opioid overdoses continue to plague communities nationwide. The SCSO recognizes this effective medical intervention as another way to help combat the opioid overdose threat to our community. About OpioidInduced Respiratory Depression OIRD and Overdose Opioid emergencies such as an accidental overdose are a growing public health epidemic. On average people die from opioids including prescription opioid analgesics and heroin everyday in the United States most occur outside of medical settings such as in a home. Approximately opioid overdose emergency department visits occur each year. Many communities throughout the United States are facing a devastating heroin epidemic. Additionally there are nearly two times the number of prescription opioidrelated deaths as compared to heroinrelated deaths. On average children five years old and younger are admitted to emergency departments each year due to accidental opioid exposure. Lifethreatening opioid emergencies result in respiratory andor central nervous system depression. OpioidInduced Respiratory Depression OIRD is the most important serious adverse effect of opioids as it can be immediately lifethreatening. In addition to the risk of an opioid overdose associated with an opioid use disorder there may be an increased risk of lifethreatening OIRD even when patients take a prescribed dose of an opioid as directed. For example taking high doses of opioids taking an opioid in combination with other drugs e.g. benzodiazepines or alcohol or if there is a history of certain medical conditions e.g. COPD severe asthma places individuals at significantly higher risk for lifethreatening OIRD. Seconds count when a lifethreatening OIRD event occurs. Without rapid intervention brain injury or death can occur in as little as minutes. Most lifethreatening OIRD emergencies occur in the home and are witnessed by family and friends who may be in the best position to intervene quickly. Naloxone is an opioid antagonist that displaces opioids from the receptors in the brain temporarily reversing the lifethreatening breathing problems that can occur during an opioid emergency. About EVZIO EVVzeeoh EVZIO naloxone HCl injection Autoinjector is an opioid antagonist indicated for the emergency treatment of known or suspected opioid overdose as manifested by respiratory andor central nervous system depression. EVZIO is intended for immediate administration as emergency therapy in settings where opioids may be present. EVZIO is not a substitute for emergency medical care. EVZIO is an intelligent Autoinjection system that provides simple onthespot voice and visual guidance. EVZIO is small easytocarry and easytouse to help patients and caregivers keep it on hand so they can take fast confident action administering EVZIO during an opioid emergency. Results averaged across two adequate and wellcontrolled usability studies demonstrate more than of users can correctly administer EVZIO without training and with training. Each EVZIO prefilled singleuse handheld Autoinjector delivers a single . mg dose of naloxone. Each EVZIO prescription comes with two Autoinjectors and a Trainer. For more information on EVZIO including full Prescribing Information visit http EVZIO IMPORTANT SAFETY INFORMATION EVZIO is contraindicated in patients known to be hypersensitive to naloxone hydrochloride or to any of the ingredients in EVZIO. The following warnings and precautions should be taken when administering EVZIO Due to the duration of action keep the patient under continued surveillance and repeated doses of naloxone should be administered as necessary while awaiting emergency medical assistance. Additional supportive andor resuscitative measures may be helpful while awaiting emergency medical assistance. Reversal of respiratory depression by partial agonists or mixed agonistsantagonists such as buprenorphine and pentazocine may be incomplete. Use in patients who are opioid dependent may precipitate acute abstinence syndrome. Patients with preexisting cardiac disease or patients who have received medications with potential adverse cardiovascular effects should be monitored in an appropriate healthcare setting. In neonates opioid withdrawal may be lifethreatening if not recognized and properly treated. The following adverse reactions have been identified during use of naloxone hydrochloride in the postoperative setting hypotension hypertension ventricular tachycardia and fibrillation dyspnea pulmonary edema and cardiac arrest. Death coma and encephalopathy have been reported as sequelae of these events. Excessive doses of naloxone hydrochloride in postoperative patients have resulted in significant reversal of analgesia and have caused agitation. Abrupt reversal of opioid effects in persons who were physically dependent on opioids has precipitated signs and symptoms of opioid withdrawal including body aches fever sweating runny nose sneezing piloerection yawning weakness shivering or trembling nervousness restlessness or irritability diarrhea nausea or vomiting abdominal cramps increased blood pressure and tachycardia. In the neonate opioid withdrawal signs and symptoms also included convulsions excessive crying and hyperactive reflexes. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http or call FDA. For full Prescribing Information visit httpevzio.compdfsEvzio PI.PDF httpevzio.compdfsEvzioPI.PDF. About kalo kuhLAYoh Kalo is a pharmaceutical company dedicated to building innovative solutions for serious and lifethreatening medical conditions. Our mission is to provide innovative solutions that empower patients to confidently take control of their medical conditions. We believe patients and caregivers are the experts on how their medical condition impacts their lives and are an integral part of our product development process. Each kalo product combines an established drug with an innovative delivery platform with the goal of achieving superiority and cost effectiveness. Kalo is a privatelyheld company headquartered in Richmond Virginia. For more information visit http Centers for Disease Control and Prevention. Increase in Drug and Opioid Overdose DeathsUnited States . http_cidmma_w. Accessed . World Health Organization. Community Management of Opioid Overdose. Geneva Switzerland WHO . Yokell et al. Presentation of Prescription and Nonprescription Opioid Overdoses to US Emergency Departments. JAMA Int. Med. . Burghardt L et al. Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings. Pediatrics. . Food and Drug Administration. FDA Blueprint for Prescriber Education for ExtendedRelease and LongActing Opioid Analgesics . Zedler B Xie L Wang L et al. Risk factors for serious prescription opioidrelated toxicity or overdose among Veterans Health Administration patients. Pain Med. . Bohnert A Valenstein M Bair MJ et al. Association between Opioid Prescribing Patterns and Opioid OverdoseRelated Deaths. . Gudin JA Mogali S Jones JD Comer SD. Risks Management and Monitoring of Combination Opioid Benzodiazepines andor Alcohol Use. Postgrad Med J. . Caplan LR Hurst JW Chimowitz MI. Cardiac arrest and other hypoxicischemic insults. In Clinical Neurocardiology. New York NY CRC Press . World Health Organization. Community Management of Opioid Overdose. Geneva Switzerland WHO . Straus M Ghitza U Tai B. Preventing deaths from rising opioid overdose in the US the promise of naloxone antidote in communitybased naloxone takehome programs. Subst Abuse Rehabil. . EVZIO Naloxone Hydrochloride Injection Autoinjector Data on File. Richmond VA Kaleo Inc. Contact Mark Herzog kalo mark.herzogkaleopharma.com mailtomark.herzogkaleopharma.com office Logo httpphotos.prnewswire.comprnhLOGO SOURCE kaleo Related Links http"

"Of course Hologic has done some selling of its own. The firm which markets itself as The Womens Health Company makes other products including a D digital mammography machine a test that assesses risk of preterm labor gynecological products including Adiana a permanent contraception technique and widely used equipment that measures bone density. But D mammography could become its flagship because for the moment it owns the entire market although other companies including powerhouse GE are developing their own D machines Hologic is the only one with FDA approval thus far. Of course given the sluggish economy and the continuing state of uncertainty around American health care persuading hospitals to upgrade may be challenging. So perhaps its not surprising that the companys PowerPoint presentation to the FDA included the unsubtle phrase huge breakthrough or that the first American patient to undergo D mammography Laura Lang a polished yearold Boston marketing executive and breast cancer survivor did so in front of a CBS camera crew last February. Indeed they do. Theyre catching on like well its not a slow burn. The device earned Food and Drug Administration approval on February and for a short time it was available only at MGH. Now it is available in at least nine states three of which have multiple sites and most of the several dozen hospitals around the United States that assisted with clinical trials are planning to buy systems too. The images arent the only selling point. The early data are compelling as well. In studies presented to the FDA radiologists reported a percent improvement in their ability to distinguish cancerous from noncancerous cases when they used the new system. If that sounds unimpressive consider that million women are screened each year any significant reduction in callbacks for additional testing would mean hundreds of thousands of women would be spared painful and expensive followup. Dr. Elizabeth Rafferty is trying not to lapse into rhapsodic cliches. I dont want to call it a magic bullet because that would oversell she says. Its not a panacea. Then five minutes later I dont want to say its catching on like wildfire. After a few minutes more though Rafferty cant help herself. She lets her enthusiasm loose. People have been waiting for it for a long time she says. Its a step but its a step by a person who has a stride of feet. It is a D mammography machine the Selenia Dimensions system one of which sits in the breast imaging clinic at Massachusetts General Hospital that Rafferty a radiologist runs. The machine which is made by the Bedford company Hologic and developed partly at MGH under Raffertys supervision produces images that are so vivid and clear they seem to speak out loud Hey right here This is a tumor If you look at enough of them you may become convinced that you dont need medical training to spot a case of breast cancer or distinguish a false positive on a mammogram from a true one. The distinction seems that clear. If you can tell the difference as a nonradiologist imagine how a radiologist feels says Rafferty. The images sort of sell themselves. Much of the criticism focused on the data the task force had used to make its decision which consisted largely of the results from prospective randomized clinical trials conducted in the United States. Trials like this are the gold standard of medical evidence. They are also expensive and timeconsuming and thus hard to come by. The most recent such trial looking at mammography and mortality in the United States was published in the s. A lot of the people on the task force are my friends and I have tremendous respect for them but this was a big point where we differed says Brawley. The standard type of mammography thats used all over the country today may very well be better than what was used in that trial. So the outcomes may be better too. The studies the task force had chosen to examine showed that screening beginning at age had little impact on mortality while at the same time generating a significant number of false positives. Those data were complete and comprehensive. But says Brawley they were outdated. The task force wasnt expecting a firestorm. That however was what it got. Breast cancer advocacy groups mutinied saying the guidelines would cause significant numbers of women to go undiagnosed for years some of them fatally. Politicians started giving scary speeches about rationing health care. Many radiologists including the MGH department as a whole rejected the new guidelines. Daniel Kopans a world leader in breast imaging he wrote the textbook of that name and a radiologist at MGH now says that the panel didnt understand mammography screening. Furthermore he adds the new guidelines had no biological or scientific reason behind them. The last time someone tried to improve the way American women are screened for breast cancer it turned into a national debacle. In November the US Preventive Services Task Force a governmentbacked group of doctors charged with making recommendations that often influence what insurers will pay for updated its guidelines for mammography. Previously it had advised women to begin annual or biannual screening at . The new guidelines pushed that age to emphasizing that starting earlier should be an individual choice. Debates about mammography are often so emotionally charged that this type of nuance goes missing. I think some of our rhetoric medicines in general and also that of advocates has made people think that every metastatic breast cancer is a failure of the woman to get a mammogram or of a doctor to read a mammogram correctly says Otis Brawley chief medical officer of the American Cancer Society and a professor at Emory Universitys School of Medicine in Atlanta. In reality yes mammography does save lives but it is far from perfect. Its not as good as many people think it is. So if the new D mammography isnt perfect just how good is it But the company and the rest of us should be careful not to overhype D mammography. As Rafferty says its not a panacea. The technology does come with costs financial and medical. A fully equipped D machine runs on average not including the annual service fee Hologic charges for maintenance and even hospitals that already own an upgradeable D system made by Hologic have to pay about to get it adapted for D use. There are also costs in the sense of risks Women who get a combo D and D mammogram the protocol that confers the most dramatic jump in benefits are exposed to twice as much Xray radiation as the norm albeit still an amount thats under the FDAs permitted limit. And no one yet knows if the new technique will actually save lives. Is Hologics D mammography machine likely to fare better There are reasons to think it will. Unlike MRI which requires an injection with contrast dye and an hour in the imaging machine it isnt an ordeal or at least its no worse than a conventional mammogram. Yes you still have to endure the dreaded clamp. And it seems to be more effective than its most similar precursor the D digital technique. Early data from Raffertys trial showed that the same group of women who did benefit from D digital benefited even more dramatically from D. Its worth noting that this is not a small group of people. Fifty percent of women are in what the American Cancer Society considers the intermediate zone of risk which overlaps considerably with the group that saw some benefit in DMIST. Perhaps more important even the women who didnt see any improvement in accuracy with D get a small boost with D over film. And D seems to be both more sensitive and more specific improvement in one area doesnt have to come at the cost of the other. But when the definitive trial of D digital techniques called DMIST was published in tracking nearly patients it didnt provide the answers that advocates had been expecting. Digital mammography did seem to perform more accurately than film in women who were younger than women who were pre or perimenopausal and women with dense breast tissue. But when all women were considered as a group that benefit disappeared. On the whole it turned out digital just didnt live up to the way it had been sold. When D digital mammography was introduced in doctors hoped it would vault over those problems. Well most of them. The cost concern was still present Digital mammography machines were five times as expensive as film ones. The marketing materials suggested it already had. An ad for GEs D digital system that ran during the Summer Olympics called it a major new breakthrough in the fight against breast cancer. Digital technology the thinking went would show nuances that film never could because it could render literally many more shades of gray. The problem however was that each time they introduced a new imaging tool for breast cancer they found that they could not advance on one front without taking a step backward on the other. First there was ultrasound says Rafferty. We did find more cancers but we also found so many false positives that it was untenable. Then there was MRI which had the same problem and it was times more expensive than mammography. Rafferty had already been running trials of D mammography for two years when the task forces guidelines came out. She understood its concern about false positives she was trying to address it herself albeit in a very different way. In fact technology developers had been trying in various ways for years to increase mammographys sensitivity its ability to flag possible cases of cancer while also increasing its specificity its ability to filter out the false positives. Theres an intuitive argument for why D mammography might be more accurate. The technique works a little like a CT scan does it takes pictures of the breast at slightly different angles then fuses them into a single synthesized image. If breast cancers were spherical in shape theyd look basically the same in all images or for that matter on a conventional D picture. But theyre very rarely shaped that way in reality. In the breast in particular cancer cells tend to creep out singlefile along the architecture of the body says Rafferty. And that makes some of them especially hard to see on a D mammogram. They look like distortions not blobs. Theres another thing about cancer that is much clearer on a D mammogram spicules or thin spidery tentacles emerging from the center of a tumor. D images when taken from the wrong angle are often too fuzzy to show them. In D however the spicules are visible in high resolution and seeing them is critical since they are a hallmark of malignancy. To Rafferty the existing data are persuasive enough. I own no stock in Hologic. I have no financial ties to them. And I was skeptical of this idea at first. You think to yourself it is that simple That elegant she says. But this really does address the fundamental flaw of mammography. I want every woman to have access to this technology. I got my sisters down here when it was approved. I was like Youre all going to get this Because in my heart I know its better. Andy Smith Hologics vice president of imaging science is similarly hopeful. Its expected to improve the cancer detection rate. It is going to reduce the recall rate he says referring to suspicious findings that require women to return for followup tests some of which turn out to be false alarms. And we will have more numbers on that within one to two years. This last part at least is very likely true. Mammography is heavily regulated and clinics are required to send their recall statistics the number of women they call back for second looks to the federal government. The data on whether D will save more lives than D may not be known immediately. But they will exist. However the most meaningful data the numbers that would show whether D mammography saves womens lives wont be available for decades. Only a prospective randomized trial with mortality as its endpoint can say for sure and thats how long it takes to conduct one. Smith knows that thats the reality. We are expecting a reduction in morbidity and mortality but we wont know that for a long time he says. You know this technology has only been approved for two months. By the time such data do come out mammography will surely have changed again. There are already efforts to augment it with contrast dyes to develop a complementary tool called a gamma camera and to augment imperfect human judgment by refining computer programs that can spot tumors as well as a radiologist might. What this means is that the next time the US Preventive Services Task Force or anyone else wants to take a hard look at mammography the data it has will once again be outdated. Its inevitable. ThreeD mammography may very well be more accurate than D. It may see more cancers and fewer impostors. But whether its truly a huge breakthrough by the metric that matters most is a question that cant currently be answered and that may be irrelevant by the time it can be. Rafferty may know in her heart that D is better. But right now at least thats the only way she truly can."

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

"Should people at high risk of heart attack https and stroke https eat dark chocolate https every day Maybe according to a new study from Australia. Dark chocolate https may be a pleasant and effective way of delivering important dietary components that can provide health benefits to the ever increasing numbers of people at increased risk of cardiovascular disease https says researcher Christopher M. Reid PhD professor of cardiovascular epidemiology and preventive medicine at Monash University in Australia. Reid and his team constructed a mathematical model to predict the longterm health effects of eating dark chocolate https daily in highrisk people. They did not study actual people eating actual chocolate https The researchers also computed whether it would be costeffective to spend money on a public education campaign about dark chocolates benefits. They found it would be. Several studies have found that dark chocolate with its heart https flavonols can lower blood pressure https and improve cholesterol https However Reid believes theirs is the first study to model the longterm effects of eating dark chocolate in reducing cardiovascular risk. The study is published in the journal BMJ. Chocolate to Prevent Heart Attacks Reids team first looked at the treatment effects linked with dark chocolate by evaluating studies already published. They computed the number of heart attacks https and strokes that would occur with and without the dark chocolate. They also looked at people from the Australian Diabetes https Obesity https and Lifestyle study. All had metabolic syndrome https but none had diagnosed heart disease https or diabetes https at the start. Metabolic syndrome increases the risk of heart disease https and stroke https It is diagnosed when three or more of the following factors are present high blood pressure https high triglycerides https low levels of good HDL cholesterol https high blood sugar https_assetscontrolled_contenthealthwisemedicaltestblood_glucose_medicaltest_hw.xml or a large waist size. Reids team looked at costs associated with the heart and stroke https problems. They used these cost figures to determine how much money could be spent each year to educate highrisk people about dark chocolate and still be costeffective. Their study looked longerterm than most years Reid says. Dark Chocolate to Prevent Heart Disease Stroke First the researchers plugged in the bestcase scenario of the people eating the recommended grams of dark chocolate . ounces or about two bars a day for years. This would prevent nonfatal and fatal heart attacks https and strokes per people over years according to the study model. With an adherence rate there would be fewer nonfatal and fewer fatal heart attacks and strokes per people over years. The estimates may be low Reid says. They found that it would be costeffective to spend per person per year on education. The education might include advertising educational campaigns or subsidies to pay for the chocolate Reid says. Other Experts Not Convinced The new model drew mixed reactions from U.S. chocolate researchers. Its overassuming the benefits says Eric Ding PhD nutritionist and epidemiologist at Harvard Medical School. He reviewed the findings. They are basing their estimates on heart disease https intermediate risk factors blood pressure and cholesterol https and not on actual heart disease events like heart attacks Ding tells WebMD. The researchers are ignoring some downsides he says. They are ignoring the dangers of too many calories and too much fat and sugar from the chocolate bar he says. Those at risk of heart attack and stroke should first focus on lifestyle Ding says. That includes weight loss https if needed exercising https regularly and not smoking https Joe Vinson PhD professor of chemistry at the University of Scranton and a longtime chocolate researcher likes the study even though it has limitations. Its all theoretical based on statistics he says. Even so he says Its wonderful news again on the health effects of dark chocolate for people who have a little higher risk of heart problems than the normal person. With their doctors approval people at risk of heart attacks or strokes could eat a bit of dark chocolate daily and monitor their weight https_assetscontrolled_contenthealthwisespecialweight_managementare_you_at_a_healthy_weight_special_aa.xml and blood pressure Vinson suggests. He recommends eating less than grams used in the model. He suggests about grams or about one chocolate bar daily. Reid suggests that the chocolate should be dark and at least cocoa. The research was supported by an Australian Research Council grant with SanofiAventis Australia."

"Palo Alto Health Sciences Inc. PAHS developer of the drugfree Freespira treatment for panic attacks and other symptoms of panic disorder today announced that another study has demonstrated clinically significant symptom improvement with of patients panic attack free one year after treatment. This latest study conducted as part of the VITAL Program at Allegheny Health Network in Pennsylvania also demonstrated a reduction in healthcare costs in patients with panic symptoms months after being treated with Freespira. A Symposium at the Anxiety and Depression Association of America ADAA Annual Conference in Washington DC focused on the impact of abnormal breathing patterns on anxietyrelated conditions and treatments as reported in five studies. Two studies reported nearly of Freespiratreated patients were panic attack free at months posttreatment. Two additional studies reported that patients with mixed anxiety disorders and low exhaled CO at baseline were less responsive andor discontinued treatment with Cognitive Behavioral Therapy or Acceptance Commitment Therapy. Early data from a fifth study reported on Freespira treatment for patients with PostTraumatic Stress Disorder PTSD. Ninety percent of patients in this study experienced a significant improvement in PTSD symptoms at two months and six months posttreatment. Symposium Chair David Tolin Ph.D. Director of Anxiety Disorders Center The Institute of Living and Adjunct Professor of Psychiatry Yale University School of Medicine commented Studies of the Freespira treatment have shown that this innovative approach to treating patients suffering from panic symptoms and panic attacks not only significantly reduces or eliminates these symptoms in approximately of patients but also results in meaningful reduction in health costs. Debra Reisenthel CEO of Palo Alto Health Sciences added Patients with panic symptoms and panic attacks have times higher medical costs than patients without panic due to higher utilization of medical resources including ED visits physician visits and prescription drugs. Freespira is both easy to use and effective. Once a licensed healthcare provider authorizes the treatment and after a single training session the patient uses Freespira at home performing two minute breathing sessions a day over a fourweek period after which the treatment is complete. The peerreviewed published multicenter Freespira clinical trial presented by Dr. Tolin demonstrated that of patients were panic attack free immediately after treatment and of patients were panic attack free months posttreatment. About Freespira Freespira is an FDAcleared drugfree fourweek athome treatment for panic attacks and other panic symptoms. Treatment is authorized and completed under the supervision of a licensed healthcare provider. Freespira is clinically proven to reduce or eliminate panic attacks and other symptoms of panic disorder a mental health condition in which debilitating anxiety leads to lifealtering avoidance behaviors. Individuals with panic chronically hyperventilate even when not experiencing a panic attack. This abnormal breathing pattern has been shown to exacerbate attacks. Freespira works by training the patient to stabilize respiration rate and exhaled carbon dioxide levels which reduces or eliminates panic attacks. About Palo Alto Health Sciences Inc. Palo Alto Health Sciences Inc. is a privately held digital therapeutic company revolutionizing behavioral healthcare with evidencebased noninvasive drugfree solutions. Their first product Freespira is an FDAcleared treatment for individuals suffering from panic disorder panic attacks and other symptoms of panic. In the United States over . million adults annually suffer from panic disorder panic attacks affect a total of million adults in the U.S. every year and are a common component of other anxiety disorders. Freespira is commercially available throughout the U.S. To learn more visit http or contact infopahealthsciences.com mailtoinfopahealthsciences.com. MEDIA CONTACT Michele Kong SOURCE Palo Alto Health Sciences Related Links httpfreespira.com"

"Postoperative cognitive dysfunction POCD a condition mostly observed in older patients following surgery under general anesthesia is characterized by impaired memory and concentration. The impairment may be temporary or permanent and incapacitating. The problem has become more frequent as the population ages and also as a growing number of older adults undergo surgical procedures made possible by more advanced medical technology. Data from the scientific literature suggest a rise in mortality from POCD in the first year after surgery under general anesthesia. The good news according to a Brazilian study published by the journal PLoS One is that two relatively simple measures can help to reduce the incidence of POCD administering a small dose of the antiinflammatory drug dexamethasone immediately before an operation and avoiding profound anesthesia during the operation. Opinions on the adequate depth of anesthesia and the risks of very profound anesthesia currently diverge. Excessively superficial anesthesia is known to incur a risk of patient recall of the procedure which is undesirable. Our findings confirm recent evidence that the deeper the anesthesiainduced hypnosis the higher the incidence of POCD. The literature points to a link with the systemic inflammatory response induced by surgical trauma damaging the central nervous system. If so the use of an antiinflammatory drug may have a protective effect said Maria Jos Carvalho Carmona a professor of anesthesiology at the University of So Paulos Medical School FMUSP and principal investigator for the study. The researchers evaluated patients aged between and who underwent surgery under propofolinduced general anesthesia at the Central Institute of Hospital das Clnicas FMUSPs teaching hospital in most cases for removal of gallstones. Preoperative assessment included a battery of tests to measure mental and cognitive status. Patients who failed to achieve a cutoff score were excluded. The remaining subjects were divided randomly into four groups. In the operating room deep anesthesia typical of major surgical procedures was induced in the first and third groups and more superficial anesthesia in the second and fourth. Only the third and fourth groups received dexamethasone. The depth of anesthesia was monitored using bispectral index BIS technology which processes electroencephalogram signals to measure druginduced unconsciousness. The researchers classified a BIS of as deep anesthesia and a BIS of as superficial anesthesia. In the fourth group superficial anesthesia with dexamethasone the incidence of POCD was . immediately after surgery but after six months the preoperative cognitive status was restored in all patients. The results reinforce recent evidence of the importance of avoiding deep anesthesia Carmona said. With regard to the use of dexamethasone more research is needed to confirm our finding preferably in multicenter trials but there are strong indications that it can be beneficial in many cases. The earliest trials with patients who developed POCD were performed after the s. Before that older patients were rarely subjected to major surgery and significant research in this field has only been conducted for approximately years. The causes of and risk factors for POCD are still being discussed she said. Little is said about rehabilitation or ways of helping patients recover preoperative cognitive function. One of the obstacles to reliable diagnosis and rehabilitation is a lack of practical and secure instruments for pre and postoperative cognitive assessment. The tests available today are either too time consuming or quick but unreliable Carmona said. This makes it hard to follow up on patients."

"Australian researchers have developed an experimental blood test they say is the first blood test capable of detecting melanoma an aggressive form of skin cancer in its early stages with a high degree of accuracy. The test could speed up the diagnosis process saving thousands of lives. Scientists at Edith Cowan University in Western Australia tested blood samples for the antibodies typically created by the immune system in response to melanoma and identified them with significant accuracy. Antibodies are easily accessible in the blood so it provides a fantastic test to identify an earlystage cancer said project lead Professor Mel Ziman leader of the universitys Melanoma Research Group on Monday. In the study httpcdn.cnn.comcnnimagesziman.melanoma.blood.test.pdf published Tuesday in the journal Oncotarget Zimans team screened blood samples from both melanoma patients and healthy volunteers. The researchers were able to identify people with melanoma with accuracy and people without a melanoma with accuracy. In order for it to be valued by clinicians we would need to get to accuracy in detection she said. So we are doing a clinical trial with participants to refine our test to get to this point. If further trials are successful Ziman estimates the test could be distributed internationally in up to five years. Patients who returned a positive result would still need a biopsy to confirm the blood test and determine how far the cancer had developed Ziman said. Multiple groups worldwide are working to develop blood tests that detect a range of cancers. A recent study httpsedition.cnn.comhealthcancerbloodteststudyindex.html showed promise for a test detecting tumors of the ovary liver stomach pancreas esophagus colorectum lung and breast while another study httpsedition.cnn.comhealthbloodtestcancerscreeningintlindex.htmlclaimed to detect cancers including accuracy for ovarian cancer. The Australian team believe theirs would be the first to detect melanoma. In the wrong place with the wrong skin color Melanoma cancers are dangerous abnormal growths on the surface of the skin caused by sun damage which can spread throughout the body if left untreated. They accounted for an estimated . of all cancer diagnoses worldwide https in . The World Health Organization http estimates that melanoma skin cancers occur globally each year. The problem is particularly serious in Australia where melanomas were the fourth most commonly diagnosed cancer in and cause about deaths a year according to the university. This is in large part due to high levels of UV exposure caused by the regions proximity to the ozone https hole over the Antarctic. Were in the wrong place with the wrong skin color. Weve had a lot of migrants from European nations so theyre fairskinned ... and we do have a very intense sun here Ziman said. If detected early skin cancers have a survival rate as high as the research team said but it drops to just if diagnosed late. Surgery to remove the growth is the most common form of treatment. Simpler detection Ziman said current methods of melanoma detection are expensive and invasive involving a trip to a clinician who must biopsy the lesion to discover whether it is cancerous. For potential sufferers in remote areas away from skin specialists diagnosis can be especially tricky he said making a simple blood test an easy alternative to identify those at risk. Over three years the research team identified a combination of types of antibodies that best signal the presence of a melanoma. Antibodies are the products of the bodys immune system created to battle not only bacteria and viruses but abnormal cancer cells Ziman said. Follow CNN Health on Facebook and Twitter See the latest news and share your comments with CNN Health on Facebook https and Twitter httpstwitter.comcnnhealth. Dr. Jodie Moffat head of early diagnosis at Cancer Research UK agreed that a test which finds melanoma earlier could help reduce deaths from the disease adding that melanoma can be more than skin deep and its much harder to treat when diagnosed at a late stage after it has spread. However she stressed the fact this new test has not undergone clinical trials. We need to know how accurate it is if it can save lives and how it could work in practice. So although a blood test to find skin cancer earlier is certainly exciting research in this field still has hurdles to overcome she said. In the meantime people can help spot skin cancer early by knowing whats normal for their skin said Moffat. In turn people should talk to a health professional about any unusual or lasting changes to a mole freckle or normal patch of skin. CNNs Meera Senthilingam contributed to this report"

"The investigational drug abaloparatideSC subcutaneous may help increase bone mineral density in postmenopausal women with osteoporosis and reduce their risk of vertebral and nonvertebral fractures new industrysponsored research suggests. The results of the prespecified subgroup analysis within the ACTIVE clinical trial will be presented Friday April at ENDO the annual meeting of the Endocrine Society in Boston. According to lead study author Felicia Cosman MD osteoporosis specialist and Medical Director of the Clinical Research Center at Helen Hayes Hospital Senior Clinical Director of the National Osteoporosis Foundation and Professor of Medicine at Columbia University who is a consultant to Radius Health Inc. in Waltham Massachusetts AbaloparatideSC increased bone mineral density in both the spine and hip and reduced the risk of vertebral and nonvertebral fractures consistently in postmenopausal women with osteoporosis regardless of their baseline patient characteristics including age bone mineral density and whether or not they had prior fractures. The researchers investigated patients enrolled in the randomized doubleblind comparative multicenter international phase ACTIVE trial to evaluate the efficacy and safety of micrograms of abaloparatideSC in preventing fractures in otherwise healthy ambulatory postmenopausal women with osteoporosis. Osteoporosis was defined broadly using both BMD criteria as well as recent history of nonvertebral fracture and confirmed prevalent vertebral fracture on xray. Overall patients between and years of age were randomized to one of three treatment arms for months doubleblind micrograms of abaloparatideSC blindmatched placebo or openlabel micrograms of subcutaneous teriparatide an FDAapproved prescription drug known to increase bone density and strength. At months abaloparatideSC significantly increased bone mineral density from baseline at the lumbar spine by . the total hip by . and the femoral neck by . compared with placebo. AbaloparatideSC also reduced new vertebral fractures by nonvertebral fractures by clinical fractures by and major osteoporotic fractures by compared with placebo after months of treatment. The drug also reduced major osteoporotic fractures by compared with teriparatide and increased bone density to a greater extent in the hip region compared with teriparatide. The authors found that the risk of new vertebral or nonvertebral fractures dropped consistently among the participants taking abaloparatideSC irrespective of their baseline risk factors and they found an increase in bone mineral density by abaloparatide in each of the baseline risk subgroups. The data suggest that abaloparatide appears to be an effective treatment for a broad group of postmenopausal women with osteoporosis. The study was funded by Radius Health Inc. Endocrinologists are at the core of solving the most pressing health problems of our time from diabetes and obesity to infertility bone health and hormonerelated cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormonerelated conditions. The Society which is celebrating its centennial in has more than members including scientists physicians educators nurses and students in countries. To learn more about the Society and the field of endocrinology visit our site at http Follow us on Twitter at TheEndoSociety and EndoMedia"

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

"Johnson Johnson said its drug Tremfya was found to be more effective than a rival medicine from Novartis AG in reducing the severity and affected area in adults with moderatetosevere plaque psoriasis in a latestage study. After weeks of therapy . percent of the participants treated with Tremfya showed percent improvement in disease symptoms as measured by the Psoriasis Area Severity Index compared with percent on Novartiss Cosentyx JJ said. JJ is positioning Tremfya as a better alternative to Cosentyx as it seeks to take market share away from Novartiss drug which was launched two years ago and is among the topselling treatments in the billion global psoriasis market. That market is expected to double to . billion by according to U.S. consultant Grand View Research. With . billion in sales in Cosentyx has become one of the top revenue earners for Novartis and is expected to make up for falling revenue from its blood cancer treatment Gleevec whose patent expired two years ago. On a media briefing following the release of JJs trial results Novartis said it expected the data to have limited clinical relevance and no impact on plans to expand the Cosentyx label. JJ also said Cosentyx demonstrated quicker effectiveness than Tremfya during the study. These results imply that Cosentyx remains a good option for moderatetosevere psoriasis patients that want to achieve more rapid skin clearance brokerage Jefferies wrote in a note following the results. We see Cosentyx secure as a mainstay psoriasis therapy. Psoriasis is a chronic condition that causes an overproduction of skin cells resulting in inflamed red lesions or plaques which can be itchy and painful. About . million Americans live with plaque psoriasis of which percent have moderatetosevere form of the disease JJ said. Tremfya first approved in July as a plaque psoriasis treatment in the United States is also being tested as a for psoriatic arthritis and Crohns disease. Shares of JJ closed up marginally at . U.S.listed shares of Novartis closed up . percent . Reporting by Manogna Maddipatla and Tamara Mathias and Aakash Jagadeesh Babu in Bengaluru Editing by Shounak Dasgupta and Sriraj Kalluvila"

"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."

"Christine Curtis of Sterling says she is a happy mom again crediting her recovery from debilitating depression to an expensive treatment that sends magnetic pulses into the brain. I cant put a price on it said Curtis who said she feels better than she has in a decade after completing days of the procedure called repetitive transcranial magnetic stimulation or rTMS. An increasing number of psychiatrists and hospitals as well as entrepreneurs opening rTMS centers around the country are betting that there are millions of people like Curtis discouraged by depression treatments that have proved unsuccessful and willing to pony up thousands of dollars for the possibility of relief. The treatment which has been approved by the Food and Drug Administration is covered by Medicare in five states but few private insurers pay for it routinely. While rTMS has ardent supporters its effectiveness is still debated and there is little evidence showing how long the results last. The technique has been shown to work better than a placebo but the proportion of patients who show complete relief ranges widely from as few as percent to as many as percent according to various studies. The debate has huge implications not just for many of the million Americans who suffer from major depression every year but also for businesses eyeing a potentially lucrative market and insurers weighing whether to cover it. About half of those million Americans seek relief through psychotherapy and prescription drug treatment according to an evaluation http_CER_.pdfby the federal Agency for Healthcare Research and Quality. But studies show that antidepressants provide complete cessation of symptoms only about a third of the time. Magnetic stimulation is aimed at patients with such treatmentresistant depression. Supporters say rTMS is worth the cost between and for the fourtosixweek treatment because it enables people such as Curtis to resume productive lives. Skeptics question the price tag in light of uncertain benefits. The majority of studies that evaluated rTMS failed to find evidence of an enduring treatment effect after the initial response ... and some ... failed to find any significant treatment effect concluded Health Plan of Nevada a UnitedHealthcare insurer which rejected coverage in March. With the nations healthcare spending expected to top . trillion this year the battle over paying for rTMS http demonstrates why it is so difficult to rein in healthcare costs. New technology is generally allowed into the market after studies show it is reasonably safe and more effective than placebos. But thats not the same as showing it works better than current approaches. Experts differ over whether its smart to cover new techniques if they havent proved superior to established methods. And they can also disagree over the medical research itself Was a study done well Were there enough patients enrolled Did it ask the right questions Insurers often call for more research while doctors and patients many desperate for help warn against delay. And costs are rarely discussed publicly. What did I have to lose In December when Curtis first had a magnetic coil placed on her scalp while a machine sent pulses into part of her brain she had already spent a decade trying seven different prescription medications in her battle with depression. Getting no relief but gaining weight and feeling sluggish and out of it because of the drugs side effects she eagerly agreed to the monthlong series of fivedayaweek treatments. Most patients have between four and six weeks of near daily sessions. Curtiss psychiatrist Niku Singh who is also the medical director at TMS NeuroHealth suggested that she try the procedure. I was all for it said Curtis whose insurance did not cover the treatment. Its a matter of nothing else had worked so what did I have to lose As the very first patient treated at the Tysons Corner facility which opened in December Curtis paid only because the center needed a test patient to meet the requirements of the device manufacturer. The fee is generally about but officials say they work with patients who cant afford that. Founders of the center compare rTMSs potential to that of the nowubiquitous laser eye clinics they aim to open a chain of centers nationally that will take walkins and accept referrals from physicians. Walkin patients without a doctor referral would be screened by the centers medical director to determine if they are in fact appropriate candidates for rTMS treatment. We looked at the Lasik model and said Can we do this with depression Can we do this with TMS said Bill Leonard president of the company. During a treatment a patient sits in a chair like one in a dentists office while an electromagnetic coil is placed against her head. The machine sends four seconds of magnetic pulses into the brain in second intervals making a woodpeckerlike tapping noise. The whole procedure takes about minutes and is monitored by a technician. Patients say it does not hurt. Studies have shown that side effects are few and generally minor such as headaches and scalp irritations. Singh said rTMS works by having the pulses stimulate a region of the brain that helps control mood researchers say the pulses help depression by activating the release of neurotransmitters such as serotonin norepinephrine and dopamine. Singh who owns two psychiatry practices in the region says he does not have an investment interest in TMS NeuroHealth. The use of rTMS for altering mood or affecting the brain has been studied since at least the early s. After reviewing data from a study of patients the FDA cleared the device http_docspdfK.pdfin for the treatment of major depression in adults who had failed to improve after at least one round of drug therapy. That study was funded by the devices manufacturer Neuronetics a company based in Malvern Pa. It found httpdepression.wustl.eduOReardonPivitaltrial.pdf that up to percent of patients treated with the device for six weeks became symptomfree about twice as many as those treated with a sham rTMS machine. Subsequent studies have shown a range of results with about a third of patients reporting complete relief. One study http of moderately treatment resistent patients funded by the National Institute of Mental Health found that rTMS was four times as likely to get patients symptomfree as was a sham procedure. Patients in that study were treated five times a week for three to five weeks. One key measure known as the number needed to treat found that one patient became symptomfree for every who were treated. Five percent of the patients in the sham group became symptomfree. Supporters such as those at TMS NeuroHealth say they are seeing better results than that among their patients who can continue taking antidepressants along with their treatment. Curtis for example still takes a daily antidepressant four months after completing her treatment but she has been able to sharply reduce the dosage. Curtis said she noticed no change in her depression at the very start of her rTMS treatment but she began feeling better after about two weeks of treatment. Im not up and down anymore she said. For patients who dont respond to prescription drugs and talk therapy the other major option is electroconvulsive therapy or ECT in which an electrical current is sent through the brain to deliberately cause a seizure. The procedure which is more widely used than rTMS requires two to three treatments a week for three to four weeks and is effective for many patients. But it requires anesthesia and sometimes causes memory loss or confusion. rTMS does not require anesthesia and its side effects are generally mild. A few small studies have looked at its effects on cognitive function and found either no effect or slight improvement according to the AHRQ analysis. The costs of ECT typically about for four weeks of thriceweekly treatments according to AHRQ data are covered by most private insurers as well as by Medicare and Medicaid. The cost is higher however if a patient must be admitted to the hospital. Comparable to drug therapy Linda Carpenter an associate professor of psychiatry and human behavior at Brown University who has conducted medical studies using rTMS for depressed patients says the treatment is effective for some patients possibly even better than simply trying another medication. But she says questions remain about how long the effects last and how often a patient should return for additional sessions. Whats the range of booster treatments people need she asks. Is it once a week or every couple of years Theres a huge range in my clinical experience. Carpenter a physician says research has not found any safety issues for patients returning for additional treatments but cost is a factor. Uncertainty about its longterm effectiveness is why most insurers do not routinely cover rTMS. Medicare also has mainly rejected coverage though in January the administrator of the programs New England region became the first to approve it citing the AHRQ report and an assessment httpcepac.icerreview.orgwpcontentuploadsFinalReportTRD_FINAL.pdf from an independent regional advisory board. That member panel voted to last year that studies of the treatment showed it to be as good as or better than usual care for depression. Six of the said it represented a reasonable value for its cost four saw it as a low value. The same panel voted to that rTMSs health benefit was equal to that of ECT. A similar coverage decision proposal is being considered by the Medicare office serving the Washington region. Even with limited insurance coverage about patients have had the treatment and the number of treatment centers has doubled to a total of about nationwise since according to reports by the devices maker. Centers include some big names such as Johns Hopkins in Baltimore and the Mayo Clinic in Rochester Minn. Still some are not convinced. The initial treatment with rTMS is Thats a lot of generic Prozac or Effexor which are costeffective antidepressants with long track records said Joel Rubinstein associate medical director of Harvard Pilgrim HealthCare an insurer that does not cover rTMS. Managed care has an obligation to a population. Youre shepherding a fixed amount of resources across a large population and trying to do it according to some sort of evidencebased system. Kaiser Health News http is an editorially independent program of the Henry J. Kaiser Family Foundation a nonprofit nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente."

"Routine mammographywidely recommended for breast cancer screeningmay also be a useful tool to identify women at risk for heart disease potentially allowing for earlier intervention according to a study scheduled for presentation at the American College of Cardiologys th Annual Scientific Session. Data from this study show for the first time a link between the amount of calcium in the arteries of the breastreadily visible on digital mammographyand the level of calcium buildup in the coronary arteries. Coronary arterial calcification or CAC is considered a very early sign of cardiovascular disease. Importantly the presence of breast arterial calcification also appears to be an equivalent or stronger risk factor for CAC than other wellestablished cardiovascular risk factors such as high cholesterol high blood pressure and diabetes. Earlier research had shown a link between breast arterial calcification and atherosclerotic diseaseeven heart attack stroke and other cardiovascular disease events but researchers said these data provide a more direct relationship between the extent of calcified plaque in the mammary and coronary arteries as well as a comparison to standard risk evaluation. Many women especially young women dont know the health of their coronary arteries. Based on our data if a mammogram shows breast arterial calcifications it can be a red flagan aha momentthat there is a strong possibility she also has plaque in her coronary arteries said Harvey Hecht M.D. professor at the Icahn School of Medicine and director of cardiovascular imaging at Mount Sinai St. Lukes hospital and lead author of the study. All told percent of the women who had evidence of breast arterial calcification on their mammogram were also found to have CAC as shown on a noncontrast CT scan of the chest. For women under years of age with CAC half also had breast arterial calcificationan important finding as very few would be thinking about or considered for early signs of heart disease. There were even fewer false positives among younger patients researchers said that if a younger woman had breast arterial calcification there was an percent chance she also had CAC. Notably breast arterial calcification also appeared to be as strong a predictor for cardiovascular risk as standard risk scores such as the Framingham Risk Score which underestimates womens risk and the Cholesterol Guidelines Pooled Cohort Equations which tends to overestimate risk Hecht said. When researchers added asymptomatic women with established CAD breast arterial calcification was more powerful than both risk assessment formulas which suggests the presence of subclinical atherosclerosis may be a more important indicator of heart disease than other risk factors. This information is available on every mammogram with no additional cost or radiation exposure and our research suggests breast arterial calcification is as good as the standard risk factorbased estimate for predicting risk Hecht said. Using this information would allow atrisk women to be referred for standard CAC scoring and to be able to start focusing on preventionperhaps even taking a statin when it can make the most difference. Multivariate analysis showed that early signs of a buildup of plaque in the coronary arteries were most strongly related to breast arterial calcification. While CAC was about two times as likely with advancing age or high blood pressure it was three times more likely with breast arterial calcification. The message is if a woman is getting a mammogram look for breast arterial calcification. Its a freebie and provides critical information that could be lifesaving for some women Hecht said adding he hopes these findings will prompt clinicians who rarely report breast arterial calcification to routinely report not just the presence or absence of breast arterial calcifications but also to estimate and note the amount. The more breast arterial calcification a women has the more likely she is to have calcium in her hearts arteries as well. If all it requires is to take a closer look at the images how can we ignore it he said. A total of women who had digital mammography and noncontrast CT scans within one year were included in the study. Of these or . percent were found to have evidence of breast arterial calcification. Mammograms were reviewed by a second radiologist who was blinded to the CAC results. Women with breast arterial calcification were more likely to be older have high blood pressure and chronic kidney disease and less likely smokers. Women with established cardiovascular diseases were excluded. Breast arterial calcification was evaluated on a scale from zero to by increasing severity and CAC was measured on the CT using a validated severity score. The overall accuracy of breast arterial calcification for the presence of CAC was percent and percent of those with CAC also had breast arterial calcification. To date there is no consensus on using CAC as a screening test though a very large outcome study of subjects is underway in the Netherlands. Mammography however is widely used and accepted and as Hecht said may provide an opportunity to risk stratify asymptomatic women by breast arterial calcification who might have calcium in the coronary arteries and ordinarily would not have been readily considered for cardiovascular screening. Heart disease is the leading cause of death among women yet breast cancer is often the most feared. Roughly million mammograms are performed annually in the U.S. Mammography is recommended annually for women over years of age by the American Cancer Society and every other year for women years old and women at high risk for breast cancer by the U.S. Preventive Service Task Force. Digital mammography is more sensitive to the presence of calcifications and is now available in percent of mammography units in the U.S. Another intriguing point that deserves additional study according to the researchers is that the nature of the atherosclerosis is different in breast arterial calcification and CAC making it unclear why one should be related to the other. Hecht stresses that these findings warrant further evaluation and validation in larger studies. Future prospective trials are needed to see what the prognostic significance of breast arterial calcification might be. Because the study involved women who received both mammography and CT scan for clinical indications these women may have been more likely than the average woman to have coexisting conditions although Hecht said these were unrelated to heart disease. This study is being published simultaneously online in JACC Cardiovascular Imaging. In an accompanying editorial in JACC Cardiovascular Imaging Khurram Nasir M.D. M.P.H. and John McEvoy from the Center for Healthcare Advancement and Outcomes at Baptist Health South Florida said that the report provides impetus to document breast arterial calcification in mammography reports to improve education of primary care and radiology providers on the link with heart disease and other actions to establish best practices for incorporating this research into care. Even by the conservative estimate of percent approximately million women nationwide undergoing screening mammography will exhibit breast arterial calcification with to million of them likely to have signs of premature coronary atherosclerotic disease the authors said. Whether the best use of breast arterial calcification is to trigger additional testing or to directly inform preventive treatment decisions either by flagging highrisk women to their providers or by reclassifying traditional heart disease risk estimates is worth further discussion. The study was funded in part by the Flight Attendants Medical Research Institute. The study Digital Mammography Screening for Coronary Artery Disease will be presented on April at a.m. CT a.m. ET p.m. UTC at the American College of Cardiologys th Annual Scientific Session in Chicago. The meeting runs April . The ACCs Annual Scientific Session which in will be April in Chicago brings together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow ACCMediaCenter httpstwitter.comaccmediacenterlangsv and ACC for the latest news from the meeting. The American College of Cardiology is a member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy standards and guidelines. The College operates national registries to measure and improve care offers cardiovascular accreditation to hospitals and institutions provides professional medical education disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. Laurie Margolies M.D. associate professor of radiology at the Icahn School of Medicine at Mount Sinai and coauthor of the study will be available to the media in an embargoed web briefing on Tuesday March at p.m. ET p.m. CT p.m. UTC. Eligible media should contact Shealy Molpus smolpusacc.org mailtosmolpusacc.org to receive access to the briefing. Hecht will present the study Digital Mammography Screening for Coronary Artery Disease on Sunday April at a.m. CT a.m. ET p.m. UTC in Poster Area South Hall A."

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

"Researchers say theyve been able to use nanoparticles to stop multiple sclerosis https MS in mice that are bred to have the disease. The particles are about times smaller than the thickness of a human hair https They are made from the same material thats used to create dissolving stitches https When researchers attach specific proteins to the particles they say theyre able to teach the body not to attack its own tissues. If the approach succeeds in human studies it may one day lead to more targeted treatments not only for multiple sclerosis https but also for other kinds of autoimmune disorders https including type diabetes https and rheumatoid arthritis https This technology could be very effective says Timothy Coetzee PhD chief research officer for the National Multiple Sclerosis https Society. What remains to be seen is whether the researchers have picked the right proteins that might turn off the disease in humans he says. Will these peptides actually induce tolerance in people We just dont know. Its rational but we wont know until we get it into people says Coetzee who was not involved in the research. The research is published in the journal Nature Biotechnology. The study was funded by grants from the National Institutes of Health the Myelin https Repair Foundation the Juvenile Diabetes httpsdiabetes.webmd.comguidediabetesoverviewfacts Foundation and the Australian government. Turning Down an Autoimmune Attack In multiple sclerosis the body attacks its own myelin. Like the insulation around electric wires myelin is a material that coats nerve fibers allowing them to effectively carry signals that power the body. Over time people with MS may develop a host of problems related to myelin damage including trouble with muscle coordination movement numbness pain and vision https problems. About of people with MS have the relapsingremitting form. The mice in this study were bred to have this type of MS. Researchers wondered if they could stop that process by making use of the bodys garbage disposal system. In addition to protecting the body from foreign invaders an important role of the immune system is getting rid of dead cells. When dead or dying cells pass through the spleen https big white blood cells https called macrophages gobble them up. As part of this process the macrophages send signals to other parts of the immune system letting them know that the dying cells arent dangerous just routine bits of trash that need to go. Years ago researcher Stephen D. Miller PhD an immunologist in the Feinberg School of Medicine at Northwestern University in Chicago figured that it might be possible to hijack this garbage removal system and get the body to recognize and then ignore proteins it was mistaking for threats. What weve done is simply tap into a system that the immune system was smart enough to evolve millions of years ago to get rid of dead and dying cells Miller says. Hes already tried the approach in humans using white blood cells https that were first collected and then killed. He then attached proteins to the dying cells and infused them into the body. In an early safety trial Miller says that approach appeared to be well tolerated. There were no side effects there was no retriggering of disease and we actually showed that immune responses in patients were decreased Miller says. But other immune responses such as protection against certain infections remained strong. That suggests that patients treated this way wouldnt see the kind of general immune suppression that happens with current treatments for autoimmune diseases. Testing Nanoparticles The problem with using whole cells however is that its time consuming and expensive. So Miller wondered if it might be possible to try the same thing with synthetic nanoparticles. First they tried tiny plastic beads. But since those dont break down in the body he asked his Northwestern colleague Lonnie Shea PhD who is a biomedical engineer for help finding another material that might be safer. They decided on polylactidecoglycolide or PLG. Its a material thats used to make sutures grafts and other things that are meant to slowly dissolve in the body. By first dissolving PLG and then spinning the watery solution very rapidly they were able to make tiny particles that could carry myelin proteins. When they infused these proteincoated particles into the mice they were able to both prevent the development of a mouse disease that mimics MS and to stop attacks in mice that already had the disease. We think this is actually a simpler option. You dont have to manipulate cells and put an antigen on them. This way you could have an offtheshelf product Shea says. Whats more the nanoparticles can be coated in many different kinds of proteins which means they could one day treat other kinds of autoimmune diseases and even problems like food allergies https There are just so many possible applications of this its fun to think about says Shea. First though the technology has to be tested in humans. Before that can happen Miller says they need to conduct more animal trials. If all goes well he thinks the first human studies might be two years away."

"Scientists have developed a spit test that could identify the men most at risk of developing prostate cancer. By testing a mans DNA researchers can look for genes linked to the disease which one in seven men in the Western world will be diagnosed with in their lifetime. Scientists in the U.K. and U.S. who helped piece together the study published in Nature Genetics https found new gene variants linked to prostate cancer. This was achieved by assessing the DNA of prostate cancer patients and men without the disease. The resulting test hones in on these and the existing known markers to pinpoint the percent of men who are at six times greater risk of developing the condition and the percent of men who have a threefold greater risk of developing the disease a study author told The Guardian https The new method is being trialed on men in doctors offices across London and is due to be expanded to next year according to BBC News https If it is found to be effective it could be an important tool for physicians. Although prostate cancer is the second leading cause https of cancer death in the U.S. after lung few risk factors have been found and it is difficult to accurately diagnose. Most men with prostate cancer do not experience symptoms. Doctors can use the prostatespecific antigen PSA blood test to detect protein produced by prostate and cancerous cells respectively. But as these antigens can be present in men without the cancer it carries a risk of returning a false positive httpsprostatecanceruk.orgprostateinformationprostatetestspsatest that can kickstart unnecessary lifechanging treatment. Rectal examinations and biopsies are also used to test for the disease. According to the American Cancer Society over new cases of prostate cancer are diagnosed each year and around people die of the disease https The condition is rare in those below the age of older men and AfricanAmericans are most at risk. The majority of cases are caught at around . Rosalind Eeles an author of the study at the U.K.based Institute of Cancer Research ICR who specializes in finding genetic variants that increase the risk of prostate cancer told The Guardian the team is excited by the test because it can be used by doctors to offer patients targeted screenings. Carl Alexander a spokesman from the charity Cancer Research UK said This study is an exciting example of how research can find clues in our genes to help us uncover those more likely to develop the disease. The next steps should be to understand how this research can be developed into tests that could identify men who might be more likely to develop aggressive cancers and how this could be rolled out to patients. Dr. Iain Frame the director of research at the charity Prostate Cancer UK highlighted that men with a family history of prostate cancer are twoandahalf times more likely to be diagnosed with the disease compared to a man with no family history. With Fathers Day fast approaching use it as an opportunity to ask your dad your brother your uncle your friends about their risk of prostate cancer. Its a conversation that could save their life he said."

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

"A new anticlotting drug called apixaban was better than warfarin at preventing stroke in patients with the heart rhythm disorder atrial fibrillation a new study found. Data from more than patients also found that apixaban was safer overall than warfarin and tended to cause less bleeding in the skull in patients who faced the highest risk of bleeding. The findings suggest that the current risk scoring systems for tailoring anticlotting anticoagulant treatment to individual patients may be less relevant when using apixaban for patients with atrial fibrillation who have at least one risk factor for stroke according to the Duke University Medical Center researchers. The benefits of apixaban are preserved regardless of the risk score used and regardless of the patient risk category study author and cardiologist Dr. Renato Lopes said in a Duke news release. With new oral anticoagulants such as apixaban we might not need risk scores to guide treatment decisions for stroke prevention in patients with atrial fibrillation. This may simplify how physicians make decisions and also improve patient care. Study coinvestigator Dr. Jack Ansell agreed. This analysis provides further support for the benefit of apixaban but given the very low risk of bleeding with apixaban it also suggests that the current stroke and bleeding risk scores may not be sensitive enough to tease out those patients with the very lowest risk of stroke who might benefit from apixaban therapy said Ansell who is chairman of the department of medicine at Lenox Hill Hospital in New York City and a consultant to BristolMyers Squibb and Pfizer the companies that are marketing the drug as Eliquis. The drug has not yet been approved by the U.S. Food and Drug Administration. The study was published online Oct. in The Lancet. Apixaban showed a percent relative reduction in the incidence of strokes or systemic embolisms clots when compared to warfarin a percent relative reduction in major bleeding and an percent relative reduction in overall mortality the researchers found. Atrial fibrillation affects more than . million people in the United States. In people with atrial fibrillation disorganized electrical activity causes ineffective contraction of the upper chambers of the heart. This increases the risk for blood clots that can cause stroke. Current practice guidelines permit the use of either anticlotting therapy with aspirin or warfarin. Aspirin is less effective than warfarin but carries a lower risk of bleeding for patients with atrial fibrillation and one risk factor for stroke. More information The U.S. National Heart Lung and Blood Institute has more about atrial fibrillation http SOURCES Jack Ansell M.D. chairman department of medicine Lenox Hill Hospital New York City Duke Medicine news release Oct."

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

"When Stephen Weber saw an ad seeking participants to help determine whether online games could improve brain function it was well a nobrainer. The Drexel senior would get paid for what sounded to him like playing Nintendo. Maybe it could even help him remedy his weakness in math he thought. So he signed up for a University of Pennsylvania study on the effects of Lumosity on brain activity and decisionmaking behavior. Theres much more at stake here than the fortunes of an industry whose revenue is expected to hit billion a year by . Or whether Weber can do math more easily in his head than using a calculator. Studies on brain games have offered mixed results. Some are promising but others indicate the games offer little more than recreation. Theres some evidence that brain games can improve cognitive functions says Caryn Lerman professor of psychiatry at the Perelman School of Medicine and deputy director of Penns Abramson Cancer Center. But the more important question she says is can we change the brain to change behavior Lerman is one of two principal investigators in the million study financed by the National Cancer Institute. She and her coinvestigator assistant psychology professor Joseph Kable say the institute wants to see whether brain circuits that are active when we display restraint can be stimulated by brain games. In other words could brain games help with healthy behaviors such as proper diet and avoiding smoking which explains the institutes interest. The trial involves adults ages to the range when adopting healthy behaviors does the most good. All are given a functional brain MRI to test areas such as working memory sustained inhibition and response inhibition. Half the subjects are then asked to play Lumosity a popular brain game five times a week for minutes. The other are given free video games not designed to stimulate the brain. A second brain MRI then follows. Our theory Lerman says is that if you activate these higher brain networks that are involved in executive control the brain will assert more topdown control over lower regions of the brain that drive people to these gratifying behaviors like unhealthy eating and smoking. Answers are expected in a year or less. Based on extensive research Lumositys website states the game improves memory attention processing speed and problemsolving skills so you can feel more confident in your abilities. A consensus statement last year by cognitive psychologists and neuroscientists found such claims highly questionable. The group assembled by the Stanford Center on Longevity and the Max Planck Institute for Human Development in Berlin stated Claims promoting brain games are frequently exaggerated and at times misleading. Practice a specific skill enough and you will get better at it the group said. But that doesnt mean general and lasting improvements of mind and brain. A Lumosity official asked that questions be submitted by email but then declined to respond to a request for independent studies supporting the companys claims. Arthur F. Kramer director of the Beckman Institute for Science and Technology at the University of Illinois was a signer of the consensus statement. He says that after decades of studies there is no evidence brief interventions like brain games translate into lasting effects in the real world. What does work he says is physical exercise such as running and walking. Jason Chein principal investigator at the Neurocognition Lab at Temple University is more optimistic. A study using two groups of Temple students in found memory training on a computerized program designed by the lab not only made the students better at playing the game but also appeared to enhance discipline and reading comprehension. Had he been asked Chein said he would not have signed the consensus statement. Its too negative and Im not sure it really reflects the scientific consensus. Still if computerized brain games are proved to work he said youd have to figure out why for whom and under what circumstances. Theres favorable evidence but we have a lot of investigation to do. Joseph Santos a Drexel University sophomore in Lermans study says since playing Lumosity he feels my memory is improving. I remember things I used to forget. Ive been doing somewhat better on exams. . . . My reactions are a little bit faster. Researchers say its common for test subjects to perceive improvements even if they arent measurable. Weber the Drexel senior in the study wasnt sure whether the brain games had made him any sharper. But neither Weber nor Santos will know for sure because research subjects generally dont get their individual results. Dawn MechanicHamilton clinical director of the Cognitive Fitness Program at the University of Pennsylvania says she has used a commercial brain game Brain HQ in her work with adults with mild cognitive impairment and has found it helpful in combination with classwork and individual coaching. But she doesnt see it as a magic bullet. If youre going to spend time doing other things that are cognitively challenging she says such as taking music lessons or learning a language then you shouldnt replace it with a computerized program. On the other hand she said brain games are likely better for you than a few hours of TV watching but even thats not clear. We just dont know a lot of stuff we need to she said. An April report from the Institute of Medicine puts brain games fairly low on the ladder of recommended ways to improve cognition or maintain abilities. Kramer says the entire field is far too complex for any one definitive trial. Walter R. Boot an assistant professor of psychology at Florida State University estimates it may be a decade before psychologists can know for sure whether brain games can be effective and if so in what ways and for which populations. Lerman hopes to bring the final answer a bit closer partly through using MRI scans to measure brain function before and after the subjects have played Lumosity or standard video games. We know what parts of the brain and what circuits light up when people are doing these exercises Lerman says. What we havent tested is whether a program of weeks changes the brain in a way thats sustainable and helps people change their behaviors. RX FOR YOUR BRAIN According to the Institute of Medicine the jury is still out on whether brain games improve cognitive health for people trying to stave off normal agerelated declines. In a recent report Cognitive Aging Progress in Understanding and Opportunities for Action the institute analyzed the best available evidence and came up with this prescription for cognitive health What Helps Exercise. Staying socially and intellectually active. Healthy diet. Getting good sleep. Keeping your heart healthy. What Hurts Depression. Hearing and vision loss. Some medications including antihistamines. Stress. Air pollution. Buyer Beware Brain games."

"In this Thursday May file photo a doctor holds Truvada pills at her office in San Francisco. Statins are proven to reduce the risk of heart attack and stroke yet as many as half of patients with prescriptions eventually stop taking the pills. A possible solution says a team of University of Pennsylvania researchers Pay the patients. And for those whose good pilltaking habits lead to lower levels of LDL bad cholesterol give their physicians a bonus as well. While the field of medicine has moved increasingly toward paying doctors for performance there has been little controlled research on whether it works. Studies of patients meanwhile have found that incentives can encourage healthy behaviors such as giving up cigarettes. But in a study of patients announced Sunday the Penn team reported that the most effective approach at least where statins are concerned may be to reward both patient and physician. In some respects it takes two to tango said lead author David A. Asch a professor at Penns Perelman School of Medicine. The study whose authors also included Penns Kevin Volpp and scientists from Harvard and the Geisinger Health System in Danville Pa. was published online in the Journal of the American Medical Association. Still to come is an analysis of whether the amounts paid in the study up to over the course of a year would be worth it in terms of avoiding the costs of treating a certain number of heart attacks and strokes. Treatment for a heart attack commonly runs into the tens of thousands of dollars not to mention the cost of the lost productivity and reduced quality of life. Asch said the team picked the figure based on rough estimates but said that it was in the realm of what would be reasonable. You can imagine that this might actually be worth it he said. The researchers compared four different approaches for distributing that sum. In one group patients at risk of heart disease earned an average of . every day they took a statin as measured by electronic pill bottles that transmitted a wireless signal when the lids were opened. In a second group only the doctors were eligible for bonus money paid out in two installments. The physicians could earn up to for each patient who lowered their cholesterol by a specified amount each quarter. In a third group both patients and doctors could get paid but they split the money getting up to half of the each. And in a fourth control group neither patient nor doctor got a bonus. Patients in all four groups lowered their LDL cholesterol numbers somewhat. But in the groups where only the patient or doctor earned bonuses the amounts of improvement were statistically no different from that in the nomoney group. The biggest drop in LDL cholesterol came in the group with both patient and doctor earning bonuses . points on average over the course of a year compared with a drop of . points in the nomoney group. Physicians not involved with the research said it was intriguing but urged further study. I think this is an important first step but it would be nice to replicate it in real life said Ohio State University cardiologist Martha Gulati. The fact that cholesterol levels dropped in all four patient groups was especially encouraging said Melissa Y. Wei a University of Michigan Medical School researcher who has studied why many patients stop taking statins. That suggests factors besides money were helping to encourage patient compliance she said. Asch the studys lead author agreed. For example all patients got the electronic pill bottles so they may have been better at taking pills because they felt they were being watched he said. But even in the study fewer than half of patients were taking their pills on a regular basis by the end. Why are patients so uncommitted Some may experience improvement and decide incorrectly that it is safe to stop taking the daily pills said Ohio States Gulati editor of the American College of Cardiologys CardioSmart magazine. Another reason she said is that a minority of patients suffer side effects from the drugs such as muscle pain. But in the Penn study the authors excluded any patients who had previously experienced side effects. Even if money helps the notion of paying people to do the right thing may rub some the wrong way. We shouldnt have to said Bobbi Cecco president of the Hackensack N.J. chapter of the Mended Hearts patient support group. But if thats what it comes down to . . . Wei the Michigan physician said she already is motivated to help her patients stick with their medicine. Financial incentives wouldnt change my values or patient care she said. I am also an idealist. Participants in the Penn study ranged in age from to and all were at risk of heart disease. At the start of the study they had an average LDL number of about which is considered high. But while the study was underway the leading medical societies moved away from asking patients to hit specific LDL targets. Now they are urged to take statins when indicated by an online calculator that takes a variety of risk factors into account. The Penn study did not explore specific elements of the patientdoctor interaction that could lead to better habits. Also unclear if money works how long would payments need to continue And who would pay Insurance Researchers followed the patients for an additional three months after the payouts stopped and did not see any backsliding Asch said. Beyond that who knows People wonder whether youre going to create good habits he said. Obviously it takes a physician to prescribe it and a patient to take it."

"Working through a selfhelp program online can prevent or delay major depression disorder in people who are vulnerable a study finds. Similar programs have been used to treat depression but this may be the first one tested to prevent it the researchers say. Online programs for mental health problems can be as effective as facetoface treatment and offer some advantages Low cost available at any time and customizable. But theyre not panaceas. In this experiment half of the participants were asked to do six halfhourlong exercises that were based on cognitive behavioral therapy and problemsolving therapy which are techniques commonly used for inperson therapy. In the cognitive behavioral therapy participants were asked to identify positive activities they used to engage in and then are asked to actively plan those activities again. At the next session participants reflect on their experiences. For the problemsolving therapy people were asked to create a list of the things that matter most to them in their lives and brainstorm on how to incorporate those things into daily life. They next were asked to categorize problems and worries into manageable and unmanageable the main focus in problemsolving therapy is to tackle those problems that are considered manageable. Article continues after this message from our sponsor Both cognitivebehavioral therapy and problemsolving therapy are intended to change negative thinking in order to alter mood and behavior. After completing each exercise participants in the intervention group received written individualized feedback from an online trainer. The trainers did not offer any therapeutic advice only motivation and encouragement to continue the exercises. Participants also could repeat the online sessions as often as they liked. The control group received information about depression but was under no obligation to read it. The study which was conducted by researchers from Leuphana University in Lueneburg Germany recruited people with subthreshold depression which is defined as having some symptoms of depression but not enough to be diagnosed with major depressive disorder. It was published httpjama.jamanetwork.comarticle.aspxarticleid Tuesday in JAMA the journal of the American Medical Association. Of the participants that began the study completed the telephone followup at the end of months. Twentyseven percent in the intervention group experienced depression compared with percent in the control group. It is unclear if the people who went on to develop major depressive disorder had experienced it before. Lead author Claudia Buntrock httpfox.leuphana.deportaldepersonsclaudiabuntrockdedafabebbbddaef.html a PhD candidate in clinical psychology at Leuphana says that because the study only tracked participants mental health over the course of months the longterm effectiveness of the intervention is unknown. Its also not clear if this kind of program could be scaled up. It took the trainers about minutes to provide feedback for each session and they also stayed in touch with participants via instant messaging Buntrock says. Other experiments http online therapy have found that people didnt continue it if it wasnt guided by an actual human. One reason could be that when people are depressed they can have a hard time getting motivated to do things. More studies are needed to evaluate the preventive effects of unguided webbased interventions on the onset of major depressive disorder Buntrock wrote in an email. Still Buntrock seems pleased with the results especially since the German insurance company BARMER GEK that sponsored the trial is now providing it to its customers. I was surprised by the big response to our study Buntrock wrote. And of course Im surprised about what happens now that a health insurance company offers the intervention to its members. Its a success story you might dream of when you start but it actually seeing to happen is a great feeling."

"In the latest research to test the concept of an artificial pancreas for the management of type diabetes British researchers report that they were able to improve blood sugar control and reduce the risk of dangerous low blood sugars overnight. An analysis of pooled data showed that the overall time that plasma glucose levels were in target increased by a median percent with the artificial pancreas said the studys lead author Roman Hovorka a principal research associate at the University of Cambridge in the United Kingdom. Hovorkas team is one of several working to produce an effective artificial pancreas also known as a closed loop system or closed loop delivery. An artificial pancreas combines existing diabetes management technology insulin pumps and continuous glucose monitors with a sophisticated computer algorithm that tells these devices what to do when blood sugar levels are rising or falling. The closed loop insulin delivery system for example computes insulin doses and administers them according to glucose levels detected by a sensor. The hope is that an artificial pancreas will closely mimic the way the human pancreas normally releases insulin in response to food or stress. An effective artificial pancreas has the potential to vastly improve the lives of people with type diabetes. Type diabetes is an autoimmune disease in which the bodys immune system mistakenly attacks the insulinproducing beta cells in the pancreas. The autoimmune attack destroys so many beta cells that someone with type diabetes can no longer produce the insulin the body needs. Insulin is a hormone thats essential for the body to use sugar as fuel. Without replacement insulin people with type diabetes couldnt survive. But replacing insulin isnt easy. While too little insulin can be deadly too much insulin can also cause serious problems and in the worst case coma and death. Replacing insulin is a delicate balancing act requiring constant blood sugar monitoring. Previous research suggests that in a hour period the average person with type diabetes spends about hours with blood sugar levels too high and about an hour a day with blood sugar levels too low according to Aaron Kowalski assistant vice president for treatment therapies at the Juvenile Diabetes Research Foundation. The current study included people with type diabetes and challenged an artificial pancreas prototype in two different reallife scenarios. The first trial was meant to mimic a night of eating at home while the second trial was designed to simulate an evening out including drinking alcohol which can unpredictably lower blood sugar levels. For the eatingin portion of the randomized study of the study volunteers were assigned to consume a mediumsized meal grams of carbohydrates at p.m. and then another half were placed on the artificial pancreas program during the night while the other half maintained their standard insulin pump therapy. Several weeks later the participants came back for another meal and switched overnight regimens. The second arm of the trial simulated a meal out. The other volunteers were given a larger meal grams of carbohydrate at p.m. and were dispensed white wine along with their meal. As with the other trial half were managed with the artificial pancreas while the others used conventional insulin pump therapy. Both groups were monitored twice overnight in each study. For the eatingin scenario overnight closed loop delivery increased the time plasma glucose levels were in target by a median percent said Hovorka. For the eating out scenario the average time good blood sugar control was increased was percent on average. And when combined the average increase in blood sugar control was percent according to the study. Of greater concern to most people with type diabetes is the ability to avoid low blood sugars while theyre sleeping. The study found no serious low blood sugar events after midnight. There were four instances of severe hypoglycemia but the researchers attributed three of them to insulin administered prior to the start of the study in the evening. Results were published online in the British Journal of Medicine on April . Although an accompanying journal editorial noted that the artificial pancreas is still in its infancy some experts were cheered by the findings. This study is more good news and were seeing an evolution of more and more sophistication in this closed loop study said Kowalski. What were doing now is pressing these systems in real situations with the goal of getting to the next step of testing at home he added. Hovorka said his team is working on developing a home trial now and hopes to begin home trials by the end of the year. More information Learn more about type diabetes from the Nemours Foundation httpkidshealth.orgparentmedicalendocrinetype.html. SOURCES Roman Hovorka Ph.D. principle research associate University of Cambridge U.K. Aaron Kowalski Ph.D. assistant vice president for treatment therapies Juvenile Diabetes Research Foundation online British Medical Journal April"

"A minimally invasive implant procedure is highly effective in reducing pain and disability for patients with sacroiliac joint SIJ dysfunction reports a clinical trial in the November issue of Neurosurgery http official journal of the Congress of Neurological Surgeons http published by Wolters Kluwer http The randomized controlled trial shows superior outcomes in patients undergoing minimally invasive sacroiliac joint SIJ fusion using triangular titanium implants compared to nonsurgical management according to the new research overseen by Dr. Daniel J. Cher of SIBONE Inc. in San Jose Calif. The study was sponsored by SIBONE manufacturer of the SIJ implants. Good Pain Relief and Other Outcomes with Implant Treatment for SIJ Dysfunction The study included patients with low back pain caused by confirmed SIJ dysfunction treated at US spine surgery clinics. The SIJ connects the central sacrum and lateral ilium bones of the pelvis. SIJ disruption or osteoarthritis is a common pain condition estimated to cause to percent of cases of chronic low back pain. Trial subjects had severe SIJ pain with an average pain score of on a topoint scale. Average pain duration was longer than six years and about twothirds of subjects were taking opioid narcotic medications. Many had previously received many nonsurgical SIJ treatments and many had a history of prior spinal surgery. Twothirds of subjects were randomly assigned to undergo minimally invasive SIJ fusion. In this procedure triangular titanium implants were placed through a small incision to stabilize and fuse the SIJ. Procedures were unilateral in most cases but some subjects underwent bilateral treatment. The remaining subjects received nonsurgical treatments such as physical therapy steroid injections andor radiofrequency ablation of sacral nerve root lateral branches. Pain and other outcomes were compared at baseline and at and months. At months subjects in the nonsurgical group had the option to cross over to the implant procedure. Based on reduction in pain and absence of complications at months treatment was rated successful in percent of subjects assigned to the SIJ implant procedure compared to percent with nonsurgical treatment. Average pain score decreased to in the surgical group versus in the nonsurgical group. Seventythree percent of subjects undergoing the implant procedure had clinically significant reduction in disability scores compared to just percent in the nonsurgical group. After one year subjects assigned to SIJ fusion still had significant reductions in pain and disability as well as improved quality of life. Thirtyfive subjects from the nonsurgical group opted to undergo the implant procedure with similarly good results. There were only a few complications related to the SIJ implant procedure. Sacroiliac joint dysfunction is a common cause of disabling pain in the lower back buttocks or groin. Many different surgical and nonsurgical treatments have been used for this condition despite a lack of highquality evidence for their effectiveness. The minimally invasive SIJ implant approach evaluated in this trial has been cleared by the US Food and Drug Administration. The study is the first randomized controlled trial to directly compare the results of surgical and nonsurgical treatment for SIJ dysfunction. The results show clinically and statistically important improvements in clinical outcomes for patients undergoing the SIJ implant procedure according to Dr. Cher and colleagues with profound differences between the surgical and nonsurgical groups. The implant procedure is minimally invasive has few complications and produces significant and lasting improvements in pain disability and quality of life. The authors note some important limitations of the trial including the lack of longterm outcomes in the nonsurgical group due to the high crossover rate. They plan further analyses including twoyear followup CT scans and a costeffectiveness comparison of SIJ fusion versus nonsurgical treatment. Click here to read Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion Using Triangular Titanium Implants vs Nonsurgical Management for Sacroiliac Joint Dysfunction Month Outcomes. httpjournals.lww.comneurosurgeryFulltextRandomized_Controlled_Trial_of_Minimally_Invasive..aspx Article Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion Using Triangular Titanium Implants vs Nonsurgical Management for Sacroiliac Joint Dysfunction Month Outcomes doi .NEU. About Neurosurgery Neurosurgery http the Official Journal of the Congress of Neurological Surgeons http is your most complete window to the contemporary field of neurosurgery. Members of the Congress and nonmember subscribers receive pages per year packed with the very latest science technology and medicine not to mention fulltext online access to the worlds most complete uptotheminute neurosurgery resource. For professionals aware of the rapid pace of developments in the field Neurosurgery is nothing short of indispensable. About Wolters Kluwer Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal business tax accounting finance audit risk compliance and healthcare rely on Wolters Kluwers market leading informationenabled tools and software solutions to manage their business efficiently deliver results to their clients and succeed in an ever more dynamic world. Wolters Kluwer reported annual revenues of . billion. The group serves customers in over countries and employs over people worldwide. The company is headquartered in Alphen aan den Rijn the Netherlands. 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"National guidelines help doctors decide how to treat high blood pressure. But tailoring those guidelines to better fit individuals could prevent many more heart attacks and strokes say developers of a computer model that makes those calculations. Their study published Monday in the Annals of Internal Medicine estimated the effects of using individualized guidelines to make decisions on treating high blood pressure. It found that the tailored approach could prevent percent more heart attacks and strokes than the simpler general recommendations used now. Currently U.S. guidelines recommend treatment if blood pressure rises above mm Hg or above mm Hg if a person has diabetes or chronic kidney disease. Doctors generally add their own judgment to that decision as well. If for instance a person has slightly elevated blood pressure but is otherwise at low risk for heart problems then lifestyle changes might be enough. But the new study looked at a more sophisticated way of estimating individual patients needs. Researchers used a computerbased risk calculator that took into account a persons age cholesterol levels family history of heart disease and any diabetes diagnosis. It also factored in whats known about different types of patients responses to various blood pressure medications. The researchers then used data from a longterm study of Americans to estimate the effects of applying the individualized guidelines. Overall they found the tailored method could prevent percent more heart attacks and strokes than national guidelines if healthcare costs were kept the same. If on the other hand the number of heart attacks and strokes prevented were kept the same the individualized guidelines would accomplish that result at a percent cost savings versus the national guidelines. The goal of using the risk calculator is the same as the physicians desire to take into account the whole patient when discussing treatment options with patients said lead researcher Dr. David M. Eddy. The problem with the oldfashioned way he told Reuters Health in an email is that there are many pieces of information about a patient to consider. It is impossible for the human brain to digest it all and estimate accurately the patients risks or how they would benefit from treatments he said. According to Eddy risk calculators like the one in the study could eventually help doctors give patients real numbers. A doctor might tell you for example what your risk is of developing diabetes in the next years and how much you could cut that risk if you lose a certain amount of weight and keep it off. Eddy is a founder of Archimedes Inc. a San Franciscobased company that has developed a computerbased mathematical model to aid in healthcare decisions. The calculator used in this study is a simplified version of that model. Eddy said that the calculator or others like it could be integrated into electronic health records. A patients information could be automatically fed to the calculator and the results would then be displayed on a computer for the doctor and patient to discuss. A researcher not involved in the work said it was a nice study that is a first step toward showing that tailored guidelines could have benefits. This shows that there might be better ways for physicians to choose who gets treated and who does not said Dr. Douglas K. Owens of the VA Palo Alto Health Care System in California who wrote an editorial published with the study. General guidelines like those for treating high blood pressure are kept fairly simple so they are easy to remember Owens told Reuters Health in an interview. Doctors ideally then adapt those guidelines to individual patients situations. However Owens said its hard to do all of that in your head. This gives them a tool. Now the looming questions are how to implement risk calculators in doctors practices and Owens said whether that benefits patients health in the real world. The general theme is that we can do better and we may have an opportunity to improve patients health outcomes Owens said. Thats the hope. He said he thinks electronic health records will be key to putting individualized guidelines into practice. And right now there is a way to go before most doctors will have those systems in place. A recent government survey found that the percentage of U.S. doctors using electronic health records is on the rise but still fairly low. About onequarter of surveyed doctors said they had basic electronic medical record systems in their offices. Only about percent had a fully functional system that included extensive information on patients medical history. SOURCE bit.lyanXRm httpbit.lyanXRm Annals of Internal Medicine online May . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

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

"Breast cancer patients who double the length of time that they take a common medication can sharply reduce their risk of death according to a new study thats predicted to influence medical practice. The study involved an estrogenblocking pill called tamoxifen a standard therapy for the roughly twothirds of breast cancer patients whose tumors are sensitive to estrogen. Taking tamoxifen for five years after diagnosis reduces breast cancer mortality by about onethird. In the new study women with early tumors who took tamoxifen for years cut their risk of dying from breast cancer by another compared to women who stopped after five years. In absolute terms of women on tamoxifen for years died of breast cancer within five to years after diagnosis compared to of those who stopped at five years. Overall women who take tamoxifen for a decade cut their risk of dying from breast cancer nearly in half compared with those who dont take it at all says study coauthor Richard Gray of the University of Oxford in the United Kingdom. Thats significant given that tamoxifen is used by hundreds of thousands of women worldwide says Gray whose study was presented Wednesday at the annual San Antonio Breast Cancer Symposium. Oxford funded the study which included more than women from countries While tamoxifen delays tumor growth in some women it appears to cure others Gray says. This is a dream come true for women says V. Craig Jordan a researcher who led tamoxifens development but who wasnt involved in the new study. Its very exciting. Tamoxifen which has been used for decades is far cheaper than most new chemotherapies and biological drugs which cost thousands of dollars a month. A generic version costs about a month in the USA according to Susan G. Komen for the Cure. In the U.K. tamoxifen costs only a month. In India its cents a pill says Jordan scientific director at Georgetowns Lombardi Comprehensive Cancer Center. Jordan says the new findings will quickly change care for some patients. Younger women with more aggressive tumors may want to extend their tamoxifen use says Jennifer Litton an assistant professor at M.D. Anderson Cancer Center in Houston who wasnt involved in the study. Tamoxifen is the only hormonal option for women before menopause Litton says. Doctors may not want to change the care of older patients however she says. Thats because postmenopausal women have the option of tamoxifen or another class of hormonal therapies called aromatase inhibitors or AIs. These drugs are slightly more effective than tamoxifen although they dont work before menopause Litton says. Because the study didnt include AIs doctors cant say how whether tamoxifen would benefit women whove taken them Litton says. Other researchers are conducting trials comparing five versus years of AIs although these results wont be out for several years. Gray noted that tamoxifen has risks. In his study doubling the length of treament also doubled the risk of endometrial cancer which affects the uterine lining to about . However because this cancer is very treatable death rates were low . of those on tamoxifen for years died of endometrial cancer compared to . of those taking it for five years. Doctors saw no increase in strokes which has long been a concern with tamoxifen Gray says. Breast cancer survivors have mixed reactions to the results. Some women will be glad to have another treament option says breast cancer survivor Lillie Shockney administrative director of the Johns Hopkins Cancer Survivorhip Program in Baltimore. Patients get very nervous when they stop any hormonal therapy because they feel like now they arent doing anything says Shockney . The opportunity to do something might be appealing despite the side effects. Shockney says shed like to see research on other ways to prevent recurrences such as weight loss. If someone lost pounds would that do as much as another five years on tamoxifen Shockney asks. Some patients may be reluctant to prolong their use of a drug that causes so many side effects says Boston breast cancer survivor Alicia Staley. Studies show that only of women take tamoxifen for five years Litton says. Some switch to an AI although these drugs can also cause problems such as joint pain and osteoporosis. Staley say she tamoxifen gave her many many side effects including severe hot flashes. Dry eyes joint pain weight gain you name it I had it she says. After years Staley and her doctor stopped the drug to regain a measure of quality of life. For Shockney tamoxifen took a heavy toll on her marriage causing dryness that made sex unbearably painful. Patients and their partners need to have honest talks with doctors about how extended treatment will affect their relationship she says. If we are going to look at giving women tamoxifen for years by golly we better get the partners involved Shockney says. Yet Shockney says her husband of nearly years would have wanted her to do everything possible to survive. If someone said to my husband I know this has been a rough road for you and a big impact on your sex life but if she stays on it another five years. it could affect her survival he would have said Please please take the pill."

"A new noninvasive test to detect precancerous polyps and colon tumors appears to be more accurate than current noninvasive tests such as the fecal occult blood test Mayo clinic researchers say. The search for a highly accurate noninvasive alternative to invasive screens such as colonoscopy or sigmoidoscopy is a Holy Grail of colon cancer research. In a preliminary trial the new test was able to identify percent of precancerous polyps and percent of fullblown cancers the researchers reported. Dr. Floriano Marchetti an assistant professor of clinical surgery in the division of colon and rectal surgery at University of Miami Sylvester Comprehensive Cancer Center said the new test could be an important adjunct to colon cancer screening if it proves itself in further study. Obviously these findings need to be replicated on a larger scale he said. Hopefully this is a good start for a more reliable test. Dr. Durado Brooks director of colorectal cancer at the American Cancer Society agreed. These findings are interesting he said. They will be more interesting if we ever get this kind of data in a screening population. The studys lead researcher remained optimistic. There are new cases of colon cancer each year in the United States treated at an estimated cost of billion noted Dr. David A. Ahlquist professor of medicine and a consultant in gastroenterology at the Mayo Clinic in Rochester Minn. The dream is to eradicate colon cancer altogether and the most realistic approach to getting there is screening he said. And screening not only in a way that would not only detect cancer but precancer. Our test takes us closer to that dream. Ahlquist was scheduled to present the findings of the study Thursday in Philadelphia at a meeting on colorectal cancer sponsored by the American Association for Cancer Research. The new technology called the Cologuard sDNA test works by identifying specific altered DNA in cells shed by precancerous or cancerous polyps into the patients stool. If a DNA abnormality is found a colonoscopy would still be needed to confirm the results just as happens now after a positive fecal occult blood test FOBT result. To see whether the test was effective Ahlquists team tried it out on more than frozen stool samples from patients with and without colorectal cancer. The test was able to detect . percent of colorectal cancers and . percent of polyps bigger than centimeter. Polyps this size are considered precancers and most likely to progress to cancer Ahlquist said. The sensitivity of the test is much better than what has been seen in other stool screening tests the ACS Brooks added. But showing that in a small group of samples is very different from demonstrating that in a population where only a small number of individuals are going to have polyps of that size. Then we will know if this is a big step forward he said. According to Ahlquist Cologuard is the first noninvasive test to detect precancerous polyps he added. In addition the test is the only one that is able to identify cancer in all locations throughout the colon something which other tests either cant or dont do well Ahlquist said. One more advantage patients do not need to do any special preparation before taking the test something that other tests require he added. Ahlquist noted that the test still needs to be refined. We learned there are still some bugs and we can make the test even better he said. Cologuard is not yet available for sale. Clinical trials comparing the test with colonoscopy are slated to start next year. Ahlquist hopes that the test will be approved and available within two years. Ahlquist noted that the cost of the test has not yet been established. It is expected to cost more than a fecal occult blood test but far less than a colonoscopy. A fecal occult blood test can cost as little as while a colonoscopy can total . Another benefit is that it would probably need to be done once every three years while the fecal occult blood test is usually done yearly. Savings over time on a more accurate test done fewer times could justify the higher cost of the Cologuard test Ahlquist said. In two other presentations at the meeting researchers have linked key gene variants to the risk for colon cancer and also to the prognosis of the disease. In one study researchers found that people who have long telomeres the small strips of DNA that cover the ends of chromosomes have a percent increased risk of developing colon cancer. Even for people their age their telomeres were longer than youd expect for healthy people lead researcher Dr. Lisa A. Boardman an associate professor of medicine at the Mayo Clinic said in a statement. This suggests that there may be two different mechanisms that affect telomere length and that set up susceptibility to cancer she said. In the other study a research team led by Kim M. Smits a molecular biologist and epidemiologist in the GROWSchool for Oncology and Developmental Biology at Maastricht University Medical Center in the Netherlands uncovered a surprise when it came to a gene variant on the KRAS gene called the G variant. This variant long linked to poorer outcomes in advanced colorectal cancer actually predicted a better prognosis in earlystage colon cancer. You would intuitively think that the G variant would be associated with a poorer prognosis as it is in latestage colorectal cancer but that is not the case Smits said in a statement. Experts point out that studies presented at scientific meetings do not have to pass the rigorous peer review of studies published in reputable journals. More information For more information on colon cancer visit the American Cancer Society http SOURCES David A. Ahlquist M.D. professor of medicine Mayo Clinic Rochester Minn. Durado Brooks MD director of colorectal cancerAmerican Cancer Society Floriano Marchetti M.D. assistant professor of clinical surgery Division of Colon and Rectal Surgery University of Miami Sylvester Comprehensive Cancer Center Oct. presentation Special Conference for Colorectal Cancer Biology American Association for Cancer Research Philadelphia"

"Acupuncture is a safe and effective alternative to pain medications for some emergency room patients a new study reports. While acupuncture is widely used by practitioners in community settings for treating pain it is rarely used in hospital emergency departments said study lead investigator Marc Cohen. He is a professor in the School of Health and Biomedical Sciences at RMIT University in Melbourne Australia. The study billed as the worlds largest randomized controlled trial of acupuncture in the emergency department included patients. The study participants were seen at four Australian emergency departments for acute low back pain migraines or ankle sprains. Patients who said their level of pain was at least on a point scale received one of three treatments acupuncture alone acupuncture with painkillers or painkillers alone. One hour after treatment less than percent of all patients had significant pain reduction meaning at least a point decline on the point scale. More than percent still had a pain rating of at least the findings showed. But two days later most patients were satisfied. Overall nearly percent of acupunctureonly patients said they would probably or definitely repeat their treatment compared with about percent in the combined group and percent who took painkillers alone. Emergency nurses and doctors need a variety of painrelieving options when treating patients given the concerns around opioids such as morphine which carry the risk of addiction when used longterm Cohen said in a university news release. The study results suggest acupuncture would be especially beneficial for patients who cant use standard painrelieving drugs because of other medical conditions Cohen added. But he noted that more research is needed because some patients remained in pain no matter what treatment they received. The study was published June in the Medical Journal of Australia. More information The U.S. National Institutes of Health has more on acupuncture httpsnccih.nih.govhealthacupuncture. SOURCE RMIT University news release June"

"Researchers report some of the most encouraging results yet for treating lung cancer with the latest immunebased treatments most of which have been approved to treat other types of tumors. In three papers presented at the American Association for Cancer Research annual meeting http and published simultaneously in the New England Journal of Medicine http lung cancer experts found innovative ways to weaken lung tumors to improve peoples chances of surviving the disease. There is definitely a high unmet need says Patrick Forde assistant professor of oncology and associate member of the BloombergKimmel Institute for Cancer Immunotherapy at Johns Hopkins of the lack of effective treatments for lung cancer. Currently more than half of people who are treated even at early stages of the disease can expect the cancer to return and chemotherapy typically leads to only a improvement in peoples chances of living five years but an up to chance of being exposed to serious toxicities. a group of immunebased cancer drugs called checkpoint inhibitors httptime.comcancertreatmentimmunotherapy which are designed to rip away the molecular cloak behind which cancer cells hide from the immune system. The medications target a protein called PD its related PDL or CTLA which protect the bodys cells from being killed by immune cells httptime.comimmunotherapypembroclinicaltrialscancer because tumors are normal cells growing out of control they take advantage of this molecular security blanket to avoid getting detected by immune cells. A series of checkpoint inhibitor drugs first approved in initially for treating melanoma expose the tumor cells to the immune system. Based on their success in treating skin cancers scientists are now studying this group of drugs in a number of other cancers including tumors in the lung. In one study called CheckMate researchers tested whether a combination of two of these checkpoint inhibitor drugs could keep tumors from growing better than the standard treatment of chemotherapy in people with advanced non small cell lung cancer NSCLC. Nearly people were randomly assigned to receive either the combination of the immunebased drugs or the traditional chemotherapy treatment. After nearly a year the lung cancer in people taking the immunotherapy was less likely to have progressed than among people getting chemotherapy. Whats more say the studys authors doctors may also figure out which people are most likely to respond to the twodrug combination of nivolumab Opdivo https and ipilimumab Yervoy https and which are not. In the study he and his colleagues found that people whose tumors had more mutations enjoyed the longest time period during which their cancers did not progress. Currently lung cancer treatments rely heavily on chemotherapy but doctors are shifting toward a more customized and precise way of treating each persons disease in order to improve their chances of survival. For example newer targeted therapy drugs home in on specific genetic mutations that are responsible for driving a persons cancer. Doctors can also determine if a persons lung cancer is genetically vulnerable to the checkpoint inhibitor drugs tested in the current study. Putting together everything that doctors currently know about lung tumors more than half of people with lung cancer can avoid chemotherapy and get more precisionbased treatments says Dr. Matthew Hellmann of the Memorial Sloan Kettering Cancer Center MSKCC lead author of the study. In addition a year after treatment three times more people on immunotherapy were doing well compared to those who just got chemotherapy. The results could play a role in changing standard treatments for people diagnosed with advanced NSCLC by making a strong case for starting people immediately on the immunotherapy combination rather than giving them chemotherapy first as many doctors currently do. While nivolumab is approved for treating metastatic NSCLC for example that indication calls for using it if the disease continues to progress either during or after chemotherapy. This combination of nivolumab and ipilimumab showed that the paired drugs could be more effective when begun as the first treatment instead of chemotherapy. There may also be other ways to improve outcomes for people with advanced NSCLC. In another study researchers found that combining standard chemotherapy with another immunebased checkpoint inhibitor pembrolizumab Keytruda httptime.comcancerimmunotherapypembro helped them live nearly four months longer on average than people treated with just chemotherapy. People getting the combination of immunotherapy and chemotherapy were less likely to die after . months than people receiving chemotherapy alone. The magnitude of benefit was unexpected and great to see says Dr. Leena Gandhi associate professor of medicine at NYU Langone Medical Center and coauthor of the study. Pembrolizumab is already approved for treating about to of people with advanced NSCLC who have a certain genetic profile that makes their cancer vulnerable to the drug but this latest study expands that population to many more people who may benefit from the immunotherapy if the medication is combined with chemotherapy. The results are even more encouraging for people with early stage lung cancer. In a third small study of people diagnosed with early stage disease researchers led by a team at Johns Hopkins and MSKCC found that giving people two doses of nivolumab before surgery to remove lung tumors shrunk those tumors drastically and lowered chances of relapse thanks to its ability to jump start the immune system to fight the cancer. When the scientists analyzed the tumors they had cut out they found that in about half of the people treated with nivolumab the growths showed significant destruction by immune cells meaning that nivolumab had unmasked the tumors as foreign and allowed the immune systems killer cells to attack them. And when the scientists studied the blood of the people receiving the immunotherapy they discovered a close match between the types of immune cells in the blood and certain targets on the tumor cells suggesting that nivolumab had released the immune system to pump out the appropriate cells it needed to tackle the cancer. We expected to see some response but I dont think we expected to see a significant response says Forde. To give you some idea of how significant that is with chemotherapy we normally see the same degree of response around of the time. Forde says that the strong response seen in people at the beginning of the disease could suggest that immunotherapies might be useful in retraining the immune system to fight cancer for long periods of time possibly even a lifetime. The Holy Grail is to have a relatively nontoxic therapy that could potentially use the bodys own immune system to prevent recurrence he says. And while our study is only with patients the early indications from this study are very positive. Taken together the results could fundamentally change the way lung cancer is treated significantly improving peoples ability to both hold off lung cancer for longer periods of time as well as live longer with the disease."

"Phone support can help ease postpartum depression a small study suggests offering an option for mothers who are unable or unwilling to seek therapy in person. In the study women with postpartum depression received telephone counseling from other women who had previously suffered from the disorder and recovered. The new moms found that the conversations helped relieve symptoms. Postpartum depression is a problem for one in seven women and many of them dont get help because theres a stigma and they dont have time and its expensive said study leader Dr. Nicole Letourneau a professor and research chair in parentinfant mental health at the University of Calgary. Training peer counselors to do phone counseling is an effective lowcost and nonstigmatizing way for new moms to get the help they need. Particularly for firsttime mothers postpartum depression can be hard to distinguish from the stress and fatigue that come with caring for a new infant around the clock Letourneau said. Symptoms can include sadness insomnia difficulty concentrating and making decisions feelings of shame or guilt as well as difficulty bonding with the baby or thoughts about harming the baby. To assess the effectiveness of phone counseling for easing these symptoms Letourneau and colleagues identified mothers with symptoms of major depression within months after delivery and offered them up to weekly peer support calls. The average mom with depression was about years old. Most had symptoms of depression before they got pregnant and many had previously been treated with medication or professional counseling. The women who volunteered as peer counselors attended an eighthour training course and received reference materials about postpartum depression. They also had nurses available for phone consults if they had concerns about anything the moms said during their conversations. By midway through the study new moms had received at least one call from a peer counsellor. On average the women spoke more than eight times and the calls typically lasted about minutes the researchers reported in the Journal of Advanced Nursing. Over the second half of the study mothers had at least one phone conversation with a peer counsellor. On average they spoke about three times. Mothers who left the study said they no longer needed support sought counseling from mental health professionals or didnt have time for the phone calls. While all of the mothers were depressed at the start of the study at midpoint only percent were at risk for depression and this declined to percent at the end. Furthermore at midpoint percent of the mothers had low depression scores this percentage rose to percent at end. Even though the small study had several women drop out and lacked a control group of moms who received different treatment the results are consistent with previous research that has proven peer counseling works said Dr. Ruta Nonacs a psychiatrist at the Center for Womens Mental Health at Massachusetts General Hospital in Boston. It is a very powerful experience to be able to talk to a woman who has gone through the same thing and come out the other side said Nonacs who wasnt involved in the study. A lot of firsttime moms wonder whats normal whats depression and what to do with the fact that they feel overwhelmed and alone and like their experience looks nothing like the happy moms they see smiling in all of the baby food and diaper commercials. Because postpartum depression is the most common complication of childbirth it makes sense to explore peer counseling and other interventions that can reach women in rural or suburban areas where access to mental health professionals may be limited said Dr. Samantha MeltzerBrody director of the perinatal psychiatry program at the Center for Womens Mood Disorders at the University of North Carolina at Chapel Hill. Most people in the world have access to a telephone said MeltzerBrody who wasnt involved in the study. This study while small suggests that peer phone counseling could be a very effective widespread public health intervention. SOURCE bit.lyMPlxUu httpbit.lyMPlxUu Journal of Advanced Nursing online February . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Medical researchers in Britain have successfully treated six patients suffering from the bloodclotting disease known as hemophilia B httphealth.nytimes.comhealthguidesdiseasehemophiliaboverview.htmlinlinenytclassifier by injecting them with the correct form of a defective gene a landmark achievement in the troubled field of gene therapy. Hemophilia B which was carried by Queen Victoria and affected most of the royal houses of Europe is the first wellknown disease to appear treatable by gene therapy a technique with a year record of almost unbroken failure. I think this is a terrific advance for the field said Dr. Ronald G. Crystal http a gene therapist at Weill Cornell Medical College. After all the hype in the early s I think the field is really coming back now. Gene therapy has had minor successes http in very rare diseases but suffered a major setback in with the death of a patient http in a clinical trial at the University of Pennsylvania. Another gene therapy trial treated an immune deficiency but caused cancer in some patients http The general concept of gene therapy replacing the defective gene in any genetic disease with the intact version has long been alluring. But carrying it out in practice usually by loading the replacement gene onto a virus that introduces it into human cells has been a struggle. The immune system is all too effective at killing the viruses before the genes can take effect. The success with hemophilia B reported online Saturday in The New England Journal of Medicine http embodies several minor improvements developed over many years by different groups of researchers. Continue reading the main story https_rrefhealth ADVERTISEMENT Continue reading the main story https_rrefhealth The delivery virus carrying a good version of the human gene for the clotting agent known as Factor IX was prepared by researchers at St. Jude Childrens Research Hospital http in Memphis. The patients had been recruited and treated with the virus in England by a team led by Dr. Amit C. Nathwani httpsiris.ucl.ac.ukresearchpersonalindexupiACNAT of University College London researchers at the Childrens Hospital of Philadelphia http monitored their immune reactions. Hemophilia B is caused by a defect in the gene for Factor IX. Fatal if untreated the disease occurs almost only in men because the Factor IX gene lies on the X chromosome of which men have only a single copy. Women who carry a defective gene on one X chromosome can compensate with the good copy on their other X chromosome but they bequeath the defective copy to half their children. About one in of newborn boys have the disease with about patients in the United States. Dr. Nathwani and his team reported that they treated the patients by infusing the delivery virus into their veins. The virus homes in on the cells of the liver and the gene it carries then churns out correct copies of Factor IX. A single injection enabled the patients to produce small amounts of Factor IX enough that four of the six could stop the usual treatment injections of Factor IX concentrate prepared from donated blood. The other two patients continued to need concentrate but less frequently. Treating a patient with concentrate costs a year with a possible lifetime cost of million but the single required injection of the new delivery virus costs just Dr. Katherine P. Ponder httphematology.wustl.edufacultyponderponderBio.html of the Washington University School of Medicine in St. Louis notes in her commentary in The New England Journal of Medicine calling the trial a landmark study. The patients have continued to produce their own Factor IX for up to months said Dr. Edward G. D. Tuddenham director of the Hemophilia Center http_nav_idsel_left_navtab_id at the Royal Free Hospital in London. One patient a geologist had a good response at first but his level of Factor IX has declined to percent of normal the level at which the disease kicks in. We attribute this to the fact that he had an inflammation and although we treated it promptly we should have been quicker off the mark Dr. Tuddenham said. The patient cannot be injected again with the same virus because his immune system is now primed to attack it. Hes very philosophic about it but hes a scientist and his motivation is to help the science Dr. Tuddenham said. Twenty more patients will be treated to assess the best dose of the virus the goal being the highest dose that does not set off an immune system attack Dr. Tuddenham said. We are pretty close to the sweet spot he said. If all goes well a genetic treatment for hemophilia B could be available for widespread use in a couple of years. In a trial in a patient injected with a corrective gene produced his own Factor IX but only for weeks. The designer of that treatment Dr. Katherine A. High of Childrens Hospital of Philadelphia said the new therapy had worked because the delivery virus had been made more efficient and because the research team had treated the patients with steroids httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicssteroidsindex.htmlinlinenytclassifier to suppress immune system attacks on the virus. I think its incredibly exciting and I say that even though these people are my competitors she said. Dr. High is listed as a coauthor of the report because her laboratory helped monitor the patients and provided proof for regulators that the virus would not insert its human gene into the patients sperm and make the change hereditary. A serious problem with other delivery viruses is that they insert themselves randomly into chromosomes sometimes disrupting a gene. The virus used by Dr. Nathwanis team known as adenoassociated virus generally stays outside the chromosomes so it should not present this problem. Still patients will need to be monitored for liver cancer httphealth.nytimes.comhealthguidesdiseasehepatocellularcarcinomaoverview.htmlinlinenytclassifier a small possibility that has been observed in mice. I dont think its a showstopper but its a critical safety issue that has to be assessed Dr. High said. Patients have little or no immunity httphealth.nytimes.comhealthguidesspecialtopicimmuneresponseoverview.htmlinlinenytclassifier to the adenoassociated virus which infects rhesus monkeys. The virus has a propensity for making liver cells its target which is good for the therapy because these cells are the natural producers of Factor IX. However liver cells do not live forever and slowly replenish themselves possibly limiting how long the therapy will last. About percent of hemophilia cases are of the type known as hemophilia A httphealth.nytimes.comhealthguidesdiseasehemophiliaaoverview.htmlinlinenytclassifier which is caused by defects in a different bloodclotting agent Factor VIII. Researchers have focused on hemophilia B in part because the Factor IX gene is much smaller and easier to work with."

"A blood test for different types of cancers could one day help doctors screen for the disease before patients show symptoms researchers at the worlds largest gathering of oncologists have said. The test called a liquid biopsy https screens for cancer by detecting tiny bits of DNA released by cancer cells into blood. The test had particularly good results for ovarian and pancreatic cancers though the number of cancers detected was small. Researchers hope the test will become part of a universal screening tool that doctors can use to detect cancer in patients. This is potentially the holy grail of cancer research to find cancers that are currently hard to cure at an earlier stage when they are easier to cure said Dr Eric Klein lead author of the research from Cleveland Clinics Taussig Cancer https Institute. We hope this test could save many lives. The study by a research team that also included scientists from Stanford University was presented at the annual conference of the American Society of Clinical Oncologists in Chicago. Simon Stevens the chief executive of NHS England said new techniques such as cancer blood tests could unlock enormous survival gains as well as dramatic productivity benefits in the practice of medicine. Now as the NHS marks its th anniversary we stand on the cusp of a new era of personalised medicine that will dramatically transform care for cancer and for inherited and rare diseases said Stevens. The research scrutinised the cases of more than people of whom were cancerfree at the time of the study with no diagnosis and of whom had been newly diagnosed with a disease. The test was most accurate for diagnosing pancreatic ovarian liver and gallbladder cancers correctly finding the diseases in at least four out of five patients. The blood test found lymphoma and myeloma with slightly less accuracy at and and bowel cancer in two out of three patients. Lung cancer https was detected in of patients. Head and neck cancer was detected in of patients. Researchers said their results showed promise in the approach of blood screenings for cancer but noted further clinical development was needed. The number of patients in whom cancers were detected was small. For example although the test detected ovarian cancer with accuracy only ovarian cancers in total were detected. Nevertheless researchers aim to develop a tool that could be used by for all people regardless of their family history. Potentially this test could be used for everybody said Klein. Prof Nicholas Turner from the Institute of Cancer Research in London described the findings as really exciting and as a possible universal screening tool. Far too many cancers are picked up too late when it is no longer possible to operate and the chances of survival are slim he said. The goal is to develop a blood test such as this one that can accurately identify cancers in their earliest stages. Klein added It is several steps away and more research is needed but it could be given to healthy adults of a certain age such as those over to see if they have early signs of cancer."

"Prenatal testing to detect Down syndrome is carried out with amniocentesis or chorionic villus sampling. Both are invasive tests that carry about a risk of miscarriage. Researchers said Tuesday however that they were developing a simple maternal blood test that can detect Down syndrome with a high rate of accuracy and greatly reduce the number of cases requiring an invasive test. Down syndrome occurs in about in births. The new DNA sequencing technology relies on finding small bits of fetal DNA in the mothers blood something that has been difficult to do until now. In the study pregnant women at high risk for having a baby with Down syndrome were tested. Using the new technology researchers found they could rule out Down syndrome in of cases sparing the women from further testing. The blood test did not produce false negative results showing the fetus did not have the disorder when in fact the condition was present. Currently women in the United States are offered a blood test combined with an ultrasound test called the combined test to assess the risk of Down syndrome in pregnancy. The combined test still leaves an estimated to of women in need of invasive testing. The new blood test which is conducted in the first trimester could be used after the combined test or even as a firsttier test said the study authors from the Institute of Health Sciences in Hong Kong."

"LCPN a novel oral testosterone undecanoate formulation has been shown to be safe and efficacious for the treatment of hypogonadal patients according to a study being presented during the th Annual Scientific Meeting of the American Urological Association AUA. American Urological Association The research will be highlighted by study authors during a special press conference to be moderated by Tobias S. Khler MD MPH FACS AUA spokesperson and associate professor of Surgery at Southern Illinois University on May at a.m. PT in the San Diego Convention Center. Testosterone therapy is used to treat men with clinically diagnosed testosterone deficiency serum T levels ngdL also known as hypogonadism. It is often administered as a gel patch injection or implant pellet. There is currently no oral form of testosterone therapy approved for use in the United States by the Federal Drug Agency however researchers from Houston TX and Torrance CA have been evaluating the longterm safety and tolerability of LPCN a novel oral testosterone undecanoate formulation for the treatment of low testosterone. Throughout a week study period a total of hypogonadal men were randomized either to LPCN or T gel active control. Of the men were randomized to LPCN and were randomized to active control. Following a week efficacy phase men continued to receive their assigned treatment for up to weeks. They returned at weeks and for safety assessments which included an evaluation of adverse events clinical laboratory tests and physical examinations. Results showed LPCN was well tolerated and had a favorable safety profile in the longterm management of hypogonadal patients No hepatic cardiac or drugrelated serious adverse events were reported The most common drugrelated adverse events for LPCN and T gel . percent were acne . percent vs. . percent respectively headache . percent vs. . percent respectively weight increase . percent vs. percent respectively hematocrit increase . percent vs. percent respectively liver enzyme level increase . percent vs. percent respectively fatigue . percent vs. . percent respectively and hypertension . percent vs. . percent respectively Lipid parameters i.e. cholesterol LDL HDL and TG were comparable between treatment groups at Week Androgenic parameters including hematocrit hemoglobin platelet prothrombin and prostatespecific antigen PSA showed no significant differences in change from baseline to end of study between treatments Based on the results of this study we might be closer than ever to having an oral form of therapy to treat the millions of men with hypogonadism said Dr. Khler. Making sure an oral treatment is safe and effective for men and for the children and partners at risk for inadvertent testosterone transference is the top priority and what weve found so far has shown were on the right track. About the American Urological Association The th Annual Meeting of the American Urological Association takes place May at the San Diego Convention Center in San Diego CA. Founded in and headquartered near Baltimore Maryland the American Urological Association is a leading advocate for the specialty of urology and has more than members throughout the world. The AUA is a premier urologic association providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education research and the formulation of health policy. Related Links http"

"Women who have had breast cancer should consider annual screening with breast MRI in addition to an annual mammogram new research indicates. Currently the American Cancer Society recommends annual breast MRI plus mammography for women at very high risk for breast cancer such as those with a known genetic mutation known as BRCA or those with a very strong family history. But it takes no position on MRI imaging for women who have had breast cancer saying there is not enough evidence to recommend one way or the other. Studying the effectiveness of MRI screening on all three groups of women Dr. Wendy DeMartini an assistant professor of radiology at the University of Washington Medical School said MRI imaging found proportionally more cancers in women who had been treated for breast cancer than in the women considered at very high risk. Women in the personal history group who had MRI were also less likely to be recalled for additional testing and less likely to have a biopsy for a false positive finding she said. DeMartini was scheduled to present the findings Sunday at the annual meeting of the Radiological Society of North America in Chicago. For the study her team reviewed initial breast MRI exams of women conducted from January to June . Of these had a genetic or family history had a personal history of breast cancer that had been treated. Overall the MRI detected of cancers DeMartini said. With the MRI screen we found cancer in just over percent of women with a personal history which was double that found in those with a genetic or family history she said. However still more research is needed to clarify the role of MRI in this population she said. The findings are impressive said Dr. Robert Smith director of cancer screening for the American Cancer Society. While the society recommends neither for nor against MRI imaging for those with a personal history of breast cancer he said it regularly reviews study findings to determine if the guidelines need updating. There are some tumors that dont show up on mammography as well as they do on MRI he explained. MRI highlights angiogenesis the formation of new blood vessels especially those that feed cancerous tissues. Until more research is in what should a woman with a personal history of breast cancer do She should talk to her doctor Smith said. He doesnt see a downside to getting an MRI except perhaps an increased risk of false positives and perhaps a need to pay out of pocket. More information To learn more about breast cancer screening visit the American Cancer Society http SOURCES Wendy DeMartini M.D. assistant professor breast imaging University of Washington and Seattle Cancer Care Alliance Seattle Robert Smith M.D. American Cancer Society Atlanta Ga. Nov. presentation Radiological Society of North America annual meeting Nov. Chicago"

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

"A treatment for obesity could be on the horizon as scientists have discovered an antibody that reduces body fat. In trials on mice the antibody was found to increase bone mass and reduce adipose tissue fatand while human studies are some way off the findings could lead to new treatments for weight loss and osteoporosis. The antibody discovered targets folliclestimulating hormone FSH found in the pituitary gland. Ten years ago scientists started looking at the hormones made in the pituitary gland to see how they act on certain targets. They found some of these hormones had an effect on bone mass. From this they created an antibody to see if it could be used to prevent bone loss in miceand in they showed it could. As a result they started considering it as a potential treatment for osteoporosis particularly in postmenopausal womena period when women lose bone mass fairly quickly. But scientists also realized it could have other uses. Mone Zaidi from the Icahn School of Medicine at Mount Sinai New York is one of the authors on the latest study into how the antibody triggers weight loss. Osteoporosis and obesity are fairly closely linked in several ways he tells Newsweek. Women when they undergo menopause lose bone and gain body fat. So we thought maybe there was a connectionthat FSH could have direct effects on adipose tissue. In the study published in Nature httpnature.comarticlesdoi.nature scientists injected the antibody into mice that had had their ovaries removed mimicking menopause and mice that had been fed on a highfat diet. In both cases the antibody caused significant weight loss and gains in bone mass. Zaidi says they looked at the adipose tissue in different areas of the body including under the skin and around the vital organs. In all compartments it was fat reduced by around this level. Its a fairly dramatic effect. Mice also showed increased oxygen consumption higher levels of physical activity and more heat production in beige fat which dissipates energy around the body. But how do mice models translate to human treatments Mice a fairly close genetic match to Humans and Zaidi is hopeful there will be similar effects in humans. Their next step is to humanize the antibody so it can be tested without triggering an immune response. We would then hopefully go to the next phase of preclinical testing which would be to look at side effects toxicology etc. After that we would go into primates and larger animals. That would then leadif all goes wellto the first human trials in three to four years. At present the researchers are focusing on the adiposity rather than bone loss for drug development I think obesity is a more prevalent diseasebut osteoporosis at the tail end can be tagged on. Also to do trials for osteoporosis takes a very long time Zaidi says. Eventually he hopes to end up with an injected drug that gets rid of fat and increases bone mass. Thats the ideal situation he says. It could be a unique obesity drug. But it could also be a unique drug because it lowers body fat and makes bones stronger. And the population that could be most benefited by this could be postmenopausal women. Commenting on the research Tim Speckor Professor of Genetic Epidemiology at Kings College London U.K. says Its a nice mouse study that seems to workwhether it works in humans is another matter."

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

"Merck NYSEMRK known as MSD outside the United States and Canada today announced that the U.S. Food and Drug Administration FDA has approved ZEPATIER elbasvir and grazoprevir for the treatment of adult patients with chronic hepatitis C virus HCV genotype GT or GT infection with or without ribavirin RBV following priority review by the FDA. ZEPATIER pronounced ZEPahteer is a oncedaily fixeddose combination tablet containing the NSA inhibitor elbasvir mg and the NSA protease inhibitor grazoprevir mg. The FDA previously granted two Breakthrough Therapy designations to ZEPATIER for the treatment of chronic HCV GT infection in patients with end stage renal disease on hemodialysis and for the treatment of patients with chronic HCV GT infection. Breakthrough Therapy designation is given to investigational medicines for serious or lifethreatening conditions that may offer substantial improvement over existing therapies. Across multiple clinical studies ZEPATIER achieved high rates of sustained virologic response ranging from to percent in GTinfected patients and to percent in GTinfected patients. Sustained virologic response is defined as HCV RNA levels measuring less than the lower limit of quantification at weeks after the cessation of treatment SVR indicating that a patients HCV infection has been cured. ZEPATIER is not for use in patients with moderate or severe hepatic impairment ChildPugh B or C. ZEPATIER also is not for use with organic anion transporting polypeptides B OATPB inhibitors e.g. atazanavir darunavir lopinavir saquinavir tipranavir cyclosporine strong cytochrome P A CYPA inducers e.g. carbamazepine phenytoin rifampin St. Johns Wort and efavirenz. If ZEPATIER is administered with RBV healthcare professionals should refer to the prescribing information for RBV as the contraindications warnings and precautions adverse reactions and dosing for RBV also apply to this combination regimen. Continued innovation is needed to help address the worldwide epidemic of chronic hepatitis C virus infection said Dr. Roger M. Perlmutter president Merck Research Laboratories. Our clinical program was designed to study a broad range of patients infected with the hepatitis C virus including difficulttotreat patients such as those with stage or chronic kidney disease. The approval of ZEPATIER is a testament to Mercks unwavering commitment to improving therapy for patients with hepatitis C virus infection and we are eager to bring this innovation to patients and physicians in the United States. ZEPATIER was approved with a treatment duration of or weeks depending on HCV genotype prior treatment history and for patients with GTa infection the presence of certain baseline NSA polymorphisms. A week oncedaily regimen is recommended for the vast majority of patients for whom ZEPATIER is indicated. Mercks broad clinical trial program supporting the efficacy of ZEPATIER included six studies in patients with chronic HCV GT or GT infection. These studies assessed the rate of sustained virologic response weeks after the completion of treatment with ZEPATIER SVR. The clinical development program for ZEPATIER enrolled diverse groups of HCV GT and GTinfected patients including treatmentnave patients and those who had failed prior therapy with peginterferon alfa PegIFN and RBV as well as patients suffering with meaningful comorbidities and health complications such as compensated cirrhosis and HIV coinfection. GTinfected patients with severe renal impairment on hemodialysis and those who previously failed therapy with PegIFN and RBV in combination with an HCV NSA protease inhibitor boceprevir simeprevir or telaprevir also were studied. The following table provides a summary of clinical data that contributed to the efficacy assessment of ZEPATIER. The primary endpoint in each study was SVR. Please see section entitled Summary of Study Designs below for additional study design information including treatment arms and baseline characteristics. Clinical Studies Supporting Efficacy of ZEPATIER elbasvir and grazoprevir Clinical Trials Population SVR nN Treatment Regimen and Duration GT CEDGE TN double blind placebo controlled TN cirrhosis ZEPATIER weeks CEDGE COINFXN openlabel single arm TN cirrhosis HIV coinfection CSURFER double blind placebo controlled TNTEa cirrhosis severe renal impairment CEDGE TEd openlabel comparative TEb cirrhosis HIV coinfection ZEPATIER weeks ZEPATIER RBV weeks CSALVAGE openlabel single arm TEc cirrhosis ZEPATIER RBV weeks GT CSCAPE openlabel CEDGE TN CEDGE COINFXN TN without cirrhosis TN cirrhosis TN cirrhosis HIV coinfection ZEPATIER weeks CEDGE TE TEb cirrhosis ZEPATIER RBV weeks TE treatmentexperienced TN treatmentnave. a Failed prior IFN or PegIFN RBV. b Failed prior PegIFN RBV. c Failed prior PegIFN RBV HCV NSA protease inhibitor PI boceprevir simeprevir or telaprevir. d CEDGE TE treatment outcomes for ZEPATIER with RBV for weeks n or without RBV for weeks n not shown because these regimens are not recommended in PegIFN RBVexperienced GT patients. Selected Safety Information about ZEPATIER elbasvir and grazoprevir Elevations of alanine transaminase ALT to greater than times the upper limit of normal ULN occurred in of subjects generally at or after treatment week . These late ALT elevations were typically asymptomatic and most resolved with ongoing or completion of therapy. Healthcare professionals should perform hepatic lab testing on patients prior to therapy at treatment week and as clinically indicated. For patients receiving weeks of therapy additional hepatic lab testing should be performed at treatment week . Patients should be instructed to consult their healthcare professional without delay if they have onset of fatigue weakness lack of appetite nausea and vomiting jaundice or discolored feces. Healthcare providers should consider discontinuing ZEPATIER if ALT levels remain persistently greater than times ULN. ZEPATIER should be discontinued if ALT elevation is accompanied by signs or symptoms of liver inflammation or increasing conjugated bilirubin alkaline phosphatase or international normalized ratio. Recommended Dosage Regimens and Durations for ZEPATIER elbasvir and grazoprevir The dosing regimens and durations for treatment with oncedaily ZEPATIER for chronic HCV GT or GT infection in patients with or without cirrhosis HIV coinfection or renal impairment are as follows Patient Population Treatment Duration GTa Treatmentnave or PegIFNRBVexperienced without baseline NSA polymorphisms ZEPATIER weeks GTa Treatmentnave or PegIFNRBVexperienced with baseline NSA polymorphisms ZEPATIER with RBV weeks GTb Treatmentnave or PegIFNRBVexperienced ZEPATIER weeks GTa or GTb PegIFNRBVPIexperienced ZEPATIER with RBV weeks GT Treatmentnave ZEPATIER weeks GT PegIFNRBVexperienced ZEPATIER with RBV weeks Patients who have failed treatment with PegIFN RBV. NSA resistanceassociated polymorphisms at amino acid positions or . Patients who have failed treatment with PegIFNRBV HCV NSA PI boceprevir simeprevir or telaprevir. For GTainfected PegIFNRBVPIexperienced patients with one or more baseline NSA resistanceassociated polymorphisms positions or the optimal ZEPATIERbased treatment regimen and duration of therapy has not been established. In patients with GTa infection some hepatitis C viruses may contain mutations that can confer resistance to treatment. These are called resistanceassociated polymorphisms also referred to as resistanceassociated variants RAVs. GTa infection accounts for percent of U.S. HCV cases. To help as many patients as possible to achieve SVR testing for NSA resistanceassociated polymorphisms positions or is recommended for GTainfected patients prior to starting treatment with ZEPATIER to determine the optimal dosage regimen and duration. In clinical trials of ZEPATIER percent of GTainfected U.S. study participants had these NSA resistanceassociated polymorphisms at baseline. A week regimen of ZEPATIER with RBV is recommended for GTainfected patients with these baseline NSA polymorphisms as described in the above table. This approval provides patients and physicians with an additional treatment option that has the potential to cure many patients with chronic hepatitis C in the United States said Dr. Ira Jacobson site chair department of medicine Mount Sinai Beth Israel New York. ZEPATIER is a oncedaily singletablet directacting antiviral that has demonstrated high cure rates in genotype and in genotype including treatmentnave and treatmentexperienced patients with or without compensated cirrhosis and those with chronic kidney disease. The company anticipates that ZEPATIER will be available for shipping to wholesalers within seven business days. Chronic hepatitis C is a potentially devastating illness that can cause serious longterm health consequences for patients including reduced liver function liver failure or liver cancer said Michael Ninburg executive director Hepatitis Education Project Seattle. Today chronic hepatitis C is a curable condition for many patients and we are fortunate to have multiple therapeutic tools that can mitigate its impact. Selected Safety Information about ZEPATIER elbasvir and grazoprevir continued The concomitant use of ZEPATIER with certain drugs may lead to possible clinically significant adverse reactions from greater exposure to ZEPATIER or concomitant drugs. Coadministration of ZEPATIER is not recommended with certain strong CYPA inhibitors e.g. ketoconazole or the cobicistatcontaining regimens of elvitegravircobicistatemtricitabinetenofovir disoproxil fumarate or alafenamide. Healthcare professionals should not exceed atorvastatin mgdaily or rosuvastatin mgdaily when given with ZEPATIER. If ZEPATIER is given with fluvastatin lovastatin or simvastatin healthcare professionals should give the lowest statin dose necessary and closely monitor for statinassociated adverse events. If ZEPATIER and tacrolimus are coadministered frequent monitoring of tacrolimus whole blood concentrations changes in renal function and tacrolimusassociated adverse events is recommended. The concomitant use of ZEPATIER and certain drugs may cause significant decrease of elbasvir and grazoprevir plasma concentrations which may lead to reduced therapeutic effect of ZEPATIER and possible development of resistance. Coadministration of ZEPATIER is not recommended with moderate CYPA inducers e.g. nafcillin bosentan etravirine modafinil. In subjects receiving ZEPATIER for weeks the most commonly reported adverse reactions of all intensity greater than or equal to in placebocontrolled trials were fatigue headache and nausea. In subjects receiving ZEPATIER with RBV for weeks the most commonly reported adverse reactions of moderate or severe intensity greater than or equal to were anemia and headache. Pricing Designed to Enable Broad Patient Access to ZEPATIER elbasvir and grazoprevir The latest innovations in chronic HCV treatment that have become available over the past three years now including ZEPATIER provide the U.S. with an unprecedented opportunity to significantly reduce the burden of HCV. The scientific community believes that control of HCV infection may be possible and is actively working to achieve that goal by . A significant medical need remains it is estimated that less than one in five patients with chronic HCV infection are currently treated with thousands of new cases each year. ZEPATIER which received two Breakthrough Therapy designations for GT patients with end stage renal disease on hemodialysis and for GT patients and was thereafter approved by the FDA following priority review offers a highly effective option for a broad range of adult patients with chronic HCV GT or GT infection. Public reports indicate that net prices for the most commonly used directacting antiviral regimens are substantially lower than the list prices. However the majority of patients with chronic HCV have not yet been treated in some cases due to cost constraints. After considering these factors Merck has established a list price of for a week regimen which the company believes to be in the range of net prices for other commonly used HCV directacting antiviral regimens at weeks of therapy. Merck anticipates that this price as well as our comprehensive access strategy to seek broad coverage across commercial and public segments will help broaden and accelerate patient access to treatment and move us closer to our shared goal of reducing the burden of chronic HCV in the U.S. Mercks decadeslong commitment in chronic hepatitis C and infectious diseases overall has been to both scientific innovation and access said Robert McMahon president U.S. Market Global Human Health Merck. We are embracing this opportunity to partner with payers and physicians to enable as many appropriate patients to be treated as possible as quickly as possible. Financial Assistance Programs for Those Who Need Help With the Cost of Their Medicine Merck also anticipates that the list price of ZEPATIER will result in lower outofpocket medication costs for some patients. Lower outofpocket costs alone do not necessarily reflect a cost advantage in the outcome of the condition treated because there are other variables that affect relative costs. The direct outofpocket costs to patients will vary depending on an individuals insurance plan. Privately insured patients who have difficulty affording the copay set by their insurance plan may be eligible for significant copay assistance and may pay as little as for each prescription. Maximum savings are limited and terms and conditions apply. Information is available at http Merck anticipates that the website for ZEPATIER will be accessible within hours of FDA approval. Merck also offers assistance to patients who cannot afford ZEPATIER through Mercks yearold Patient Assistance Program. The Merck PAP provides certain Merck medicines free of charge to eligible patients. The Merck PAP for ZEPATIER is designed primarily for the uninsured who without our assistance could not afford their medication. Additionally for those patients whose insurance plan covers ZEPATIER but who still cannot afford their medication a request for an exception may be made if they meet certain financial medical andor insurance criteria. For more information about the Merck PAP please visit http or call the Merck Patient Assistance Program at . Summary of Study Designs Clinical Trials for GT HCV CEDGE TN was a randomized doubleblind placebocontrolled trial in treatmentnave patients with GT or GT infection with or without cirrhosis. Patients were randomized in a ratio to ZEPATIER for weeks immediate treatment group N or placebo for weeks followed by openlabel treatment with ZEPATIER for weeks deferred treatment group N. Among patients with GT infection randomized to the immediate treatment group the median age was years range to of the patients were male were white were black or African American were Hispanic or Latino mean body mass index was kgm had baseline HCV RNA levels greater than IU per mL had cirrhosis had nonCC ILB alleles CT or TT and had GTa and had GTb chronic HCV infection. CEDGE COINFECTION COINFXN was an openlabel singlearm trial in treatmentnave HIVHCV coinfected patients with GT or GT infection with or without cirrhosis. Patients received ZEPATIER for weeks N. Among patients with GT infection the median age was years range to of the patients were male were white were black or African American were Hispanic or Latino mean body mass index was kg per m had baseline HCV RNA levels greater than IU per mL had cirrhosis had nonCC ILB alleles CT or TT and had GTa had GTb and had GTOther chronic HCV infection. CSURFER was a randomized doubleblind placebocontrolled trial in patients with GT infection with or without cirrhosis with chronic kidney disease CKD Stage eGFR mLmin. m or CKD Stage eGFR mLmin. m including patients on hemodialysis who were treatmentnave or who had failed prior therapy with IFN or PegIFN RBV therapy. Patients were randomized in a ratio to one of the following treatment groups elbasvir mg once daily grazoprevir mg once daily for weeks N immediate treatment group or placebo for weeks followed by openlabel treatment with elbasvir grazoprevir for weeks N deferred treatment group. In addition patients received openlabel elbasvir grazoprevir for weeks intensive pharmacokinetic PK group. Patients randomized to the immediate treatment group and intensive PK group had a median age of years range to of the patients were male were white were black or African American were Hispanic or Latino had baseline HCV RNA levels greater than IUmL had cirrhosis and had nonCC ILB alleles CT or TT. CEDGE TE was a randomized openlabel comparative trial in patients with GT or GT infection with or without cirrhosis with or without HCVHIV coinfection who had failed prior therapy with PegIFN RBV therapy. Patients were randomized in a ratio to one of the following treatment groups ZEPATIER for weeks N ZEPATIER RBV for weeks N ZEPATIER for weeks N or ZEPATIER RBV for weeks N. Among patients with GT infection the median age was years range to of the patients were male were white were black or African American were Hispanic or Latino mean body mass index was kgm had baseline HCV RNA levels greater than IUmL had cirrhosis had nonCC ILB alleles CT or TT and had GTa had GTb and had GTOther chronic HCV infection. CSALVAGE was an openlabel singlearm trial in patients with GT infection with or without cirrhosis who had failed prior treatment with boceprevir simeprevir or telaprevir in combination with PegIFN RBV. Patients received elbasvir mg once daily grazoprevir mg once daily RBV for weeks N. Patients had a median age of years range to of the patients were male were white were black or African American were Hispanic or Latino mean body mass index was kgm had baseline HCV RNA levels greater than IUmL had cirrhosis and had nonCC ILB alleles CT or TT had baseline NS resistanceassociated substitutions. Clinical Trials for GT HCV The efficacy of ZEPATIER in patients with GT chronic HCV infection was demonstrated in CEDGE TN CEDGE COINFXN CEDGE TE and CSCAPE. CSCAPE was a randomized openlabel trial which included treatmentnave patients with GT infection without cirrhosis. Patients were randomized in a ratio to elbasvir mg once daily grazoprevir mg once daily for weeks N or elbasvir mg once daily grazoprevir mg once daily RBV for weeks N. In these combined studies in patients with GT infection were treatmentnave of the patients were male were white were black or African American had cirrhosis and had HIVHCV coinfection. About Merck Todays Merck is a global health care leader working to help the world be well. Merck is known as MSD outside the United States and Canada. Through our prescription medicines vaccines biologic therapies and animal health products we work with customers and operate in more than countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to health care through farreaching policies programs and partnerships. For more information visit http and connect with us on Twitter httpstwitter.comMerck Facebook http YouTube http and LinkedIn https ForwardLooking Statement of Merck Co. Inc. Kenilworth NJ USA This news release of Merck Co. Inc. Kenilworth NJ USA the company includes forwardlooking statements within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of . These statements are based upon the current beliefs and expectations of the companys management and are subject to significant risks and uncertainties. There can be no guarantees with respect to pipeline products that the products will receive the necessary regulatory approvals or that they will prove to be commercially successful. If underlying assumptions prove inaccurate or risks or uncertainties materialize actual results may differ materially from those set forth in the forwardlooking statements. Risks and uncertainties include but are not limited to general industry conditions and competition general economic factors including interest rate and currency exchange rate fluctuations the impact of pharmaceutical industry regulation and health care legislation in the United States and internationally global trends toward health care cost containment technological advances new products and patents attained by competitors challenges inherent in new product development including obtaining regulatory approval the companys ability to accurately predict future market conditions manufacturing difficulties or delays financial instability of international economies and sovereign risk dependence on the effectiveness of the companys patents and other protections for innovative products and the exposure to litigation including patent litigation andor regulatory actions. The company undertakes no obligation to publicly update any forwardlooking statement whether as a result of new information future events or otherwise. Additional factors that could cause results to differ materially from those described in the forwardlooking statements can be found in the companys Annual Report on Form K and the companys other filings with the Securities and Exchange Commission SEC available at the SECs Internet site http Please see Prescribing Information for ZEPATIER elbasvir and grazoprevir at http_circularszzepatierzepatier_pi.pdf and the Patient Information for ZEPATIER at http_circularszzepatierzepatier_ppi.pdf"

"Data from a clinical trial has shown that how people respond to treatment for Bipolar Disorder may be influenced by their weight and the overall quality of their diet including whether they are eating a diet high in foods thought to contribute to general inflammation. These are early results but if replicated may mean that treatment of some mental health problems could benefit from the inclusion of dietary advice. This is presented at the ECNP Conference in Barcelona. Bipolar Disorder which used to be called manic depression is characterised by episodes of mood swings between being very up or very down with periods in between the two extremes. The fact that there are two opposite sets of symptoms means that finding an effective treatment is difficult. While current medications are useful they are better at targeting mania symptoms the up phase leaving a lack of effective treatment for people experiencing depressive episodes. Now a group of Australian German and American scientists have shown those who have a high quality diet a less inflammatory diet andor a low BMI Body Mass Index may respond better to an addon nutraceutical treatment provided as part of a clinical trial. If we can confirm these results then its good news for people with Bipolar Disorder as there is a great need for better treatments for the depressive phase of Bipolar Disorder said lead researcher Melanie Ashton of Deakin University in Australia. A total of participants were randomly assigned to take a combination of nutraceuticals compounds derived from foods such as vitamins or minerals that treat or prevent a disease or disorder including the antiinflammatory amino acid nacetylcysteine NAC or NAC alone or a placebo a dummy pill for weeks. Participants received the study medication in addition to any stable treatments they were already receiving. Researchers measured BMI at the beginning of the study and then measured depression and how a person is able to function in their day to day life. Researchers also rated whether a participant was improving and if so how much over the next weeks. Participants filled in a questionnaire about what they usually eat over the year and researchers calculated a diet quality score where good diets included a healthy diet with lots of fruit and vegetables whereas poorerquality diets had more saturated fat refined carbohydrates and alcohol. These types of diets were then categorised as either antiinflammatory or proinflammatory based on foods that affect inflammation. Melanie Ashton continued We found that people who had a betterquality diet a diet with antiinflammatory properties or a lower BMI showed better response to addon nutraceutical treatment than did those who reported a lowquality diet or a diet including foods that promote inflammation or who were overweight. What this means if these results can be repeated in a larger trial is that treatment for Bipolar Disorder would need to take into account what a person eats and their weight. There are some points we need to note about this study. This is a randomised controlled trial but what we found were exploratory outcomes in other words it wasnt the main result that we were testing. Our result is statistically significant but because the study wasnt specifically designed to test the effect of diet quality inflammatory diets and BMI on drug response in general it is necessary to see the work replicated in a larger study before any firm conclusions can be formed. Commenting Professor Eduard Vieta Barcelona said This is interesting work which holds out the possibility that patients with Bipolar Disorder may benefit from a balanced diet. However it is an early study and we need more research before we can think whether this might affect clinical practice. Professor Vieta was not involved in this work it is an independent comment."

"Can a single ingredient swap make an impact on health According to the recently released Dietary Guidelines for Americans small shifts in food choices can make a big difference including a shift from solid fats to oils like the oil in fresh avocados. On the heels of this advice a new metaanalysis considered the best evidence and an unbiased overview of the body of knowledge on a specific topic published in the Journal of Clinical Lipidology adds to the growing body of research that supports the use of avocados in lieu of solid fats and foods that have higher saturated fat content to significantly change lipid profiles. The research Impact of avocadoenriched diets on plasma lipoproteins A metaanalysis conducted at the University of the Pacific and independently funded looked at unique avocado studies with participants assessing the impact of avocados on cholesterol levels. Researchers found avocado consumption to . per day significantly reduced total cholesterol TC bad low density lipoprotein cholesterol LDLC and triglycerides TG when they were substituted for sources of saturated fat. Additionally avocado consumption did not impact good high density lipoprotein cholesterol HDL. However the optimal amount of avocado and frequency of use needs further evaluation along with the nutritional similarities and differences between other different MUFA sources. Larger trials looking at the impact of avocados on major adverse cardiovascular events are warranted. See conclusion of study Interestingly our results indicate that even healthy subjects with a relatively normal baseline TC to mgdL LDLC to mgdL and TG to mgdL had significant reductions says Sachin Shah PharmD corresponding author and expert in cardiovascular health. As we head into American Heart Health Month February its important to remind people that they have the power to help control their risk factors for developing heart disease by exercising regularly knowing cholesterol levels and keeping them under control and maintaining a healthy weight. Cardiovascular disease is responsible for one out of every four deaths it is the number killer of American women and men and it is a leading cause of disability. Fresh avocado as part of a balanced diet and as a cholesterolfree substitute for solid fats can help be part of the solution for maintaining normal cholesterol levels says Nikki Ford PhD Director of Nutrition Hass Avocado Board. Beyond their naturally good fats avocados are also a delicious way to boost fiber percent of DV and fruit intakes both of which are under consumed in American diets. The Hass Avocado Board HAB continues to be a leader in educating health professionals and consumers on the benefits of avocados. HAB recently created a series of simple quick to prepare interactive meal makeovers https to show people how to make small shifts in their diets by substituting fresh avocados for other foods or ingredients higher in saturated fats. This study supports the body of research showing the many benefits that fresh avocados have to offer when consumed in everyday healthy eating plans says Emiliano Escobedo Executive Director HAB. Through our nutrition research program established in we are committed to increase awareness and improve understanding of the unique benefits of avocados to human health and nutrition. Clinical studies are currently underway to investigate the relationship between avocado consumption and risk factors for heart disease diabetes support of weight management and healthy living. To view the abstract or the published article visit http About the Hass Avocado Board The Hass Avocado Board HAB is an agriculture promotion group established in to promote the consumption of Hass Avocados in the United States. A member board representing domestic producers and importers of Hass Avocados directs HABs promotion research and information programs under supervision of the United States Department of Agriculture. Funding for HAB comes from Hass avocado producers and importers in the United States. In HAB established a nutrition research program to increase awareness and improve understanding of the unique benefits of avocados to human health. For a comprehensive collection of published nutrition and scientific literature authoritative reports and other articles on or related to avocados their nutrients and eating patterns that include them visit avocadonutritioncenter.com. For tips and recipes visit LoveOneToday.com https_sourceloveoneredirectutm_mediumloveonetodayutm_campaignLOT or follow HAB on Facebook https Twitter httpstwitter.comHassAvocados Pinterest https and YouTube https"

"Low back pain is second only to cold symptoms when it comes to complaints that send people to the doctor. Sooner or later back pain seems to get most of us. Now a study httpannals.orgcontentI in the July issue of the Annals of Internal Medicine shows that massage is an effective treatment for lower back pain. In some cases researchers report the benefits of massage lasted for six months or longer. Researchers headed by epidemiologist Daniel Cherkin a senior investigator at Group Health Research Institute in Seattle enrolled people with chronic low back pain and no identifiable reason for the pain. Study participants were randomly assigned to one of three treatments. One group received fullbody relaxation massage. A second received targeted deep tissue massage. The third group got the usual care medication and physical therapy. In relaxation massage often referred to as Swedish massage a variety of maneuvers are used to promote a feeling of relaxation throughout the body and muscles. Structural massage commonly referred to as deep tissue massage targets specific pain related tissues ligaments and joints. After weeks the results were dramatic Nearly twothirds of the patients who received either type of weekly massage said their back pain was significantly improved or gone altogether. Only about onethird of patients receiving the usual care experienced similar relief. We found that both types of massage were equally effective in helping people improve their function and diminish their symptoms Cherkin says. He says massage relieved the pain for six months or more. Im So Very Lucky Peggy OBrienMurphy was among the study participants. In her late s a retired state employee OBrien Murphy tried just about everything to get rid of the pain in her lower back. The massage therapy finally seemed to do the trick. Im so very lucky she says. Prior to the study OBrienMurphy says she had found herself increasingly debilitated by back pain. At one point she says she could hardly get out of a chair. It was really bad she says. In fact I was pulling myself up the stairs by the banister. It was difficult getting into the car. And she could no longer walk the hills where she lives. For an active person this was devastating. So when she came upon an ad in her HMOs newsletter Group Health Cooperative in Seattle she jumped at the chance to take part in the massage study. After just two or three sessions with massage therapist Loretta Lanz OBrienMurphy said she felt better. After each session she walked around the block standing straighter and walking further each time. By the end she felt back to normal with a spring to my walk and some energy in it For OBrienMurphy the massagetherapy experience has been lifechanging She has traveled to China where she walked all over without problems and shes already planning her next trips. No one knows exactly how massage works to relieve pain says Dr. Richard Deyo of Oregon Health Sciences University who also took part in the study. It may be that it helps with relaxation of muscles that are tense Deyo says. But it may also be there are simply more generalized effects of relaxation in the caring and attention and someone laying hands on that may all be important. Researchers say future studies should look more closely at the benefits of massage and focus on costbenefit analysis. As for OBrienMurphy she remains free of back pain but not without some effort on her part. Other studies have shown that building strong and flexible muscles can help prevent back pain. OBrienMurphy never exercised before. But now she does weight training muscle stretches and aerobic exercise activities all shown to help prevent recurrence of lower back pain. Web Resources American Massage Therapy Association http National Certification Board of Massage Therapists http"

"U.S. regulators have approved a new more effective vaccine to prevent painful shingles https which is caused by the chickenpox virus https Drugmaker GlaxoSmithKline said the Food and Drug Administration approved it late Friday. It will be the second shingles vaccine in the U.S. market. Merck launched the first one in . Studies paid for by Glaxo found it prevents shingles in about percent of people. Mercks is about percent effective. Both versions are for adults and older. The U.S. Centers for Disease Control and Prevention though recommends vaccination for those or older partly because it loses effectiveness over time. Anyone whos had chickenpox nearly everyone over harbors the varicellazoster virus that causes the disease. The virus can resurface decades later triggering painful sores on one side of the body. About to percent of those who get shingles also develop debilitating nerve pain that can last for months even years. About onethird of people who have had chickenpox get shingles. Thats about million Americans a year. But once someone has recovered from shingles it rarely reoccurs. Chickenpox was a very common childhood illness until a Merck vaccine was introduced two decades ago its now part of routine childhood shots https GlaxoSmithKline PLC said the price of its shingles vaccine called Shingrix will be for the required two shots. Merck Co.s oneshot Zostavax costs . Most insurance plans cover it. The two vaccines are made differently. Glaxos is genetically engineered and includes an ingredient that boosts effectiveness. In addition to preventing shingles it also reduces the risk of nerve pain by nearly percent. Glaxo studies also show it retains about percent of its effectiveness for four years and followup studies indicate it lasts years longer according to Dr. Leonard Friedland Glaxos vaccines director for North America. Mercks vaccine uses a live but weakened virus so it cant be used by people with compromised immune systems. It reduces risk of shingles by half and risk of nerve pain by percent according to the CDC. One study found it doesnt prevent shingles after eight years. More research is being done. Glaxo is testing its vaccine against Mercks. Meanwhile Merck has been testing a different vaccine on cancer patients and people with compromised immune systems."

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

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

"A new analysis of evidence used by a U.S. advisory panel to roll back breast cancer screening guidelines suggests it may have ignored evidence that more frequent mammograms save more lives U.S. researchers said on Tuesday. Researchers at the University of Colorado and University of Michigan studied some of the same risk models used by the U.S. Preventive Services Task Force USPSTF to issue controversial breast screening guidelines in . Those guidelines recommended against routine mammograms for women in their s and said women in their s should get mammograms every other year instead of every year. In the new analysis the team found that annual mammograms starting at age save more women from breast cancer than mammograms done every other year in women and older. It is not a small difference said Dr. Mark Helvie of the University of Michigan Health System who worked on the study published in the February issue of the American Journal of Roentgenology. His team calculated that a woman who gets a yearly mammogram starting at age cuts her risk of dying from breast cancer by percent compared to a percent reduction in risk if a woman followed the task force recommendations. When they were issued the task forces guidelines contradicted years of messages about the need for routine breast cancer screening starting at age kicking off a fury of protest among breast cancer experts and advocacy groups who argued the recommendation of fewer screenings would confuse women and result in more deaths from breast cancer. They were meant to spare women some of the worry and expense of extra tests needed to distinguish between cancer and harmless lumps. But Helvie and colleague Edward Hendrick of the University of Colorado wrote that the USPSTF chose to ignore the science available to them and overemphasized the potential harms of screening mammography to the serious detriment of U.S. women who follow their flawed recommendations. Dr. Carol Lee who chairs the American College of Radiologys Breast Imaging Commission said the new study highlights the risk of setting policy based on the conclusions of one group of scientists. She said breast mammograms have contributed significantly to reducing deaths from breast cancer a fact that should not be ignored in favor of mathematical models. Its like a weather man using a computer model to see what the weather is rather than looking outside the window Lee said in a telephone interview. Many groups including the American Cancer Society have stuck by their longstanding recommendations of a yearly breast exam for women starting at age stressing that the breast Xrays have been proven to save lives by spotting tumors early when they are most easily treated. Breast cancer is the secondleading cause of cancer death among U.S. women after lung cancer. It kills people globally every year and is diagnosed in close to . million people around the world. Editing by Cynthia Osterman Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Heres another reason for getting a second medical opinion Biopsy specialists frequently misdiagnose breast tissue potentially leading to tooaggressive treatment for some women and undertreatment for others a study suggests. The results indicate that pathologists are very good at determining when invasive cancer is present in breast tissue but less adept at making the right diagnosis with less serious conditions or when biopsied tissue is normal. The study involved U.S. pathologists and breast biopsy specimens. Their diagnoses were matched against those of three experts. It was an experiment and may not reflect what happens outside a research setting but the authors say the results highlight the challenges of accurately interpreting tissue under a microscope. The study was published in Tuesdays Journal of the American Medical Association. About . million breast biopsies are performed each year nationwide typically after radiologists spot something suspicious on a mammogram. Tissue is withdrawn through a needle or from a surgically removed growth and examined under a microscope. Previous research has shown that interpreting mammograms can also be tricky and lead to under or overtreatment. Among the new studys findings Pathologists correctly diagnosed abnormal precancerous cells about half the time no better than a coin toss said lead author Dr. Joann Elmore a University of Washington researcher. Treatment for this condition typically includes frequent monitoring and sometimes medication. About a third of these cases were misdiagnosed as not worrisome or normal while percent were deemed more suspicious or cancer. Since as many as U.S. women each year are diagnosed with this condition the results suggest many may be getting inappropriate treatment Elmore said. Pathologists mistakenly found something suspicious in percent of normal tissue. They had similar trouble with a condition called DCIS percent of these cases were misdiagnosed as less serious while percent were mistaken for invasive cancer. DCIS involves abnormal cells confined to a milk duct and is diagnosed in about U.S. women each year. Cases have increased because of rising mammogram use and it can sometimes spread so usual treatment is surgery and radiation. As a woman I would probably want to get a second opinion with a diagnosis of abnormal precancer or DCIS Elmore said. A JAMA editorial notes that the study lacks information on patient outcomes so theres no proof that the experts made the correct diagnosis. Also pathologists werent allowed to consult with colleagues when they were uncertain about findings while in the real world those consultations happen frequently said editorial coauthor Dr. David Rimm a Yale University pathology professor who also interprets biopsies. Still he said the results are troubling and highlight that pathology is an imperfect science. Rimm said he has been asked to offer a second opinion and that patients make those requests though their primary care physicians. The editorial says the results should be a call to action for pathologists and breast cancer scientists to improve and refine definitions of breast tissue abnormalities."

"When you learn your child has brain cancer or another aggressive tumor youre intensely focused on the immediate present. Which course of treatment what combination of surgery chemotherapy or radiation httpshealth.usnews.comhealthnewspatientadvicearticlesradiationevolvingchoicesincancertreatment will best help your child survive But with most kids living long past httpshealth.usnews.comhealthnewspatientadvicearticlescancersurvivortakingonnewmeaningforpatients their cancer diagnosis its also important to consider how treatments they undergo now may affect them later httpshealth.usnews.comhealthnewsbestchildrenshospitalsarticlesisurvivedchildhoodcancernowwhat even as adults. One choice some parents may face is whether to seek a newer type of radiation called proton beam therapy instead of conventional Xray radiation to potentially reduce harmful side effects in their developing child. Proton beam therapy is considered a big advance in cancer therapy by some experts. Others however hesitate to get caught up in the early hype without more longterm evidence. Even so people are traveling far and wide so their children can receive proton therapy from the handful of centers where its offered. Four leading radiation oncologists httpshealth.usnews.comdoctorslocationindexradiationoncologists explained to U.S. News what parents should understand about proton therapy and its possible benefits See Concerns Parents Have About Their Kids Health httpshealth.usnews.comhealthnewspatientadviceslideshowsinnovationsincancertherapy. Proton beam therapy is a form of radiation that may reduce late side effects compared with conventional Xray radiation. The pinpoint beam and lack of exit dose which is unneeded radiation as the conventional Xray beam passes beyond the tumor and through the body on its way out the other side spares healthy normal tissue in developing areas such as the brain heart and lungs. Childhood brain cancer is considered one of the most evidencebased uses for proton therapy. It may prevent late effects such as hearing loss or reduced ability to do well in school. However at least for now proton therapy does not offer a higher possibility of cure than traditional Xray radiation. The brain is the most common area for kids to develop cancerous tumors that require radiation treatment says Dr. Torunn Yock director of pediatric radiation oncology at Massachusetts General Hospital httpshealth.usnews.combesthospitalsareamamassachusettsgeneralhospital and an associate professor at Harvard Medical School. Because the pediatric brain is still growing and developing if you irradiate the brain during this process it wont continue to grow and develop as it normally would she says. And this over time leads to slowing of development which shows up as drops in neurocognitive testing. The younger the child the more potential exists for stunted development Yock says. A yearold is very different from a yearold in terms of brain development so the adverse consequences are much greater in the yearold. Clearly theres an advantage to not irradiating healthy brain tissue she says. For instance avoiding the brains vision and auditory centers may save children from loss or impairment of sight or hearing. See Innovations in Cancer Therapy httpshealth.usnews.comhealthnewspatientadviceslideshowsinnovationsincancertherapy. Proton beam therapy allows doctors to give the same dose as with traditional radiation while reducing the dose and complications to normal healthy tissue says Dr. Sameer Keole medical director of the proton beam therapy program at Mayo Clinic in Arizona httpshealth.usnews.combesthospitalsareaazmayoclinic. It also allows the use of a higher dose than traditional Xray radiation also called photon radiation to treat resistant tumors while still protecting surrounding tissue. With traditional radiation to the brain the radiation scatters. That collateral radiation exposes large amounts of brain to low doses of radiation says Dr. Thomas Merchant chair of radiation oncology at St. Jude Childrens Research Hospital httpshealth.usnews.combesthospitalsareatnstjudechildrensresearchhospital in Memphis Tennessee. Even lower doses of radiation can be harmful he adds. In November the new St. Jude Red Frog Events Proton Therapy Center the worlds only protontherapy center dedicated solely to the treatment of children began treating kids with aggressive cancers including brain tumors and Hodgkin lymphoma. There are certain brain tumors in children where we have to treat the entire brain and spine Merchant says. If we give proton therapy we dont have exit radiation into the chest and abdomen that you have when you treat someone with conventional radiation. That may reduce longterm side effects in the heart and lungs. With the newest form of proton therapy called pencilbeam scanning which conforms or shapes the highestdose radiation to the targeted tumor its possible to reduce the margin area around the tumor exposed to radiation Merchant says. That method which is used by St. Jude may eventually have the potential to reduce the risk of secondary cancers. See Essential Items to Pack in Your Childs Hospital Bag httpshealth.usnews.comhealthnewspatientadviceslideshowsessentialitemstopackinyourchildshospitalbag. Dr. Anita Mahajan a professor and chief of pediatric radiation oncology at the University of Texas MD Anderson Cancer Center httpshealth.usnews.combesthospitalsareatxuniversityoftexasmdandersoncancercenterrankings says when she describes proton therapy to parents she emphasizes that proton therapy is radiation. The biggest difference she explains is that the subatomic particle the proton stops where the oncologists need it to. It has to get in but we can stop it from coming out. That ability to avoid other organs is important. For instance if were treating a young child for pelvic rhabdomyosarcoma a muscle and connective tissue cancer one of the things we might be able to do is avoid the growth plates in the femurs Mahajan says. That might give you less problem with growth asymmetry of the legs as they get older. Future fertility is a factor httpshealth.usnews.comhealthnewspatientadvicearticlespreparingforababyaftercancer in cancer treatment planning. In cases involving radiation around the pelvic area its sometimes possible to avoid the ovaries in a young girl or the testes in a boy. Spaceship Hamster Wheel A proton is a positively charged atomic particle. In proton therapy a powerful machine called a particle accelerator speeds protons up to reach a high energy level. The technology is massive three stories high and weighting upward of tons requiring special housing within a treatment facility to contain the equipment and deliver the proton beams. A rotating device called a gantry releases protons to the tumor from different angles. You can take a quick virtual tour httpnationalpress.orgtopicvirtualtourofprotonbeamcancertreatmentsttmmVideo of proton beam therapy at the Mayo Clinic in Arizona. In the treatment room patients are positioned on a table or in a specialized chair. CT or MRI scans are taken before each treatment to ensure accurate positioning. Some children need sedation to sleep through the treatment while others who can remain still may stay awake. Patients may need immobilization devices to keep them in the proper precise position for every protonbeam treatment. With brain cancer patients usually wear a customfitted mask to maintain their position. Parents can accompany children to the treatment room and see them settle in before treatment begins Mahajan says. A child life specialist httpshealth.usnews.comhealthnewshealthwellnessarticlesfactsaboutchildlifespecialists is part of the team to help children and families cope with the entire patient experience. While the treatment itself is painless side effects can include skin problems like swelling dryness blistering or peeling similar to traditional radiation. Fatigue nausea and vomiting are side effects as well and are also due to other treatments patients receive like chemotherapy. Meg McQuillan of Riverside Connecticut recalls her sons introduction to proton beam therapy three years ago when he was treated at Mass General for a type of brain tumor called medulloblastoma. He and fellow patients named the device the spaceship hamster wheel. Young people take the treatment process in stride Keole says. Kids are tough he says. Sometimes theyre a lot tougher than adults. By and large they have a great attitude. Cost and Access There are operating proton beam centers in the U.S. http according to the National Association for Proton Therapy unevenly distributed throughout the country. Only a portion exist in the context of a pediatricfocused cancer program. Between and pediatric patients get proton radiation therapy each year according to Yocks rough estimate. With a typical treatment course lasting six weeks families face the disruption of traveling to a childrens hospital httpshealth.usnews.combesthospitalspediatricrankingscancer with a proton therapy center finding lodging and making arrangements for other children at home. Proton therapy costs roughly twice as much as traditional Xray radiation. The average cost for a full course of proton radiation treatment is estimated at . Creating a new proton center is a huge investment. If you look at simply the upfront costs it will be three to four times more expensive than photons Yock says. It is absolutely intensive in terms of people and equipment needed and the quality assurance and the engineers and the physicists. Its a huge team thats required to run it safely with good quality control. Yock coauthored a study published in December in the journal Cancer which compared the costeffectiveness of proton radiation therapy versus traditional radiation among kids with medulloblastoma. The study which used models to measure longterm side effects and related costs in treatment workforce participation and quality of life found that proton therapy was costeffective. As Mahajan says If we can prevent some neurocognitive deficits endocrine issues growth issues skeletal deformities those are going to help that child be more productive in society and need fewer medical interventions down the road. Insurance usually covers the cost of proton therapy when a cancer is considered curable Yock says Ninetyeight percent of the time we are successful with arguing to get a pediatric patient treatment she says. We dont take the recommendation to give radiation lightly Merchant says. Patients are carefully evaluated to determine the course of treatment. Its so important for the parents as well as the child to know what theyre getting into he adds. One thing we do is compare treatment plans using proton or conventional or photon radiation and choose the best plan. And in most cases the proton plan looks better."

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

"A brain tumor appears as a malformed blob on a brain scan shining white among the surrounding gray tissuea certain and devastating diagnosis. Doctors can begin treatment immediately trying to save the most important organ in the body. The brain however is also vulnerable to many more much less visible ailments. Consider the case of Allie Orlando a yearold social service coordinator who has received a plethora of diagnoses since she first saw a psychologist at . First it was generalized anxiety disorder. Next she was told she had depression. Then when she was it was settled She suffered from borderline personality disorder. But when Orlando traveled out of state for college she began seeing a new psychologist who strongly disagreed with her borderline diagnosis. Meanwhile she continued to struggle and entered the hospital for suicidal ideation her sophomore year. The doctors there agreed Borderline wasnt the right diagnosis and maybe she should stop taking the meds she had been prescribed. I was just frustrated because the stigma attached to borderline is very strong Orlando says. She had been open about her diagnosis in high school but felt the borderline label may have scared some people off. She recalled her boyfriend at the time searching the web for her diagnosis and saying Oh God no. After that she kept quiet about her diagnosis worried it would drive friends away. Im sure it also affected what meds I was prescribed. It took a few years to find the right formula of meds. While the doctors recommended some medication that helped it was a matter of trial and error since Orlando still doesnt have a concrete diagnosis today. Research Into Biological Markers The problem is that mental health diagnosis has essentially remained unchanged for years relying on symptoms and clinical interviews. Mental disorders lack what most other health diagnoses rely on biological markers. A tumor seen on a scan bacteria identified by a throat culture a fracture captured on an Xray Theyre all clear signs something is wrong. Mental health disorders are difficult to diagnose even by the most welltrained wellmeaning psychiatrists because all they have to go on are questions and sometimes answers. Diagnosis is really asking lots and lots of questions about their patients experience looking at patients answers both from what they say and how they say it says Dr. Michael Dulchin an assistant professor of psychiatry at the New York University Medical Center. The uncertainty can lead to dangerous misdiagnoses. Without such signs to confirm their diagnosis patients with mental illnesses are often burdened by the perception that they somehow have something less real than most other ailments. For years researchers searched in vain for concrete signs in the brain that could tell them the difference between for example bipolar and depression. Now some believe the key may be realizing that mental illnesses are not necessarily contained in the brain Biomarkers may be found throughout the entire body. Dr. Sabine Bahn a professor of neurotechnology at Cambridge University leads a team researching this premise. As a Ph.D. student she investigated the postmortem brains of psychiatric patients and was surprised to find differences in glucose regulation processes and certain parts of cell production in the brains of schizophrenia patients. Bahns team then looked at the cerebrospinal fluid of earlystage schizophrenia patients who had not yet taken any medication and again saw abnormalities in glucose handling. Bahn says it was a revelation that such changes could be spotted in the blood of patients in such early stages of the disease. What if her team began to think it could come up with a blood test for schizophrenia Having this kind of tool would be invaluablewith the current interviewbased methods of diagnosis subtle symptoms of schizophrenia are missed until too late delaying treatment by months or even years. Armed with her previous research Bahn and her team detailed a panel of blood biomarkers http in individuals who have an increased risk of schizophrenia but have no visible symptoms yet. The test says Bahn can accurately predict whether someone will develop schizophrenia over the next two years. Bahns finding is one of several recent advancements toward a comprehensive system of biological mental health diagnostic tools. One group of researchers for example recently worked backward to take on the problematic overlap between depression and bipolar disordermany bipolar patients are initially and incorrectly diagnosed with depression. The team took urine samples http from patients who had been diagnosed with one of the two disorders and looked for differences between the two groups. The results published in the Journal of Proteome Research showed that different metabolites differentiated the two groups. Another team of scientists identified differences in the throat bacteria http of schizophrenic and healthy people. Previous research had suggested tentative links between immune disorders which are influenced in part by microbes in the body and schizophrenia the new study published in PeerJ furthered the possibility that differences in oral bacteria could be associated with the disorder. Challenging to Bring to Market Despite these exciting preliminary findings there arent yet any biological tests for mental illness widely used in medical practice. In some cases the reason is primarily financial. The problem with schizophrenia is that although about percent of the population suffers from schizophrenia the number of new patients per year is quite low at . percent says Bahn. As the development costs of a test are very high there is a risk that the test will not be commercially viable. For severe mental illnesses like schizophrenia its also the case that even if a test made it through development and hit the market it may not be successfully integrated into psychiatric practice. Thats because Dulchin says if a patient comes in with schizophrenia symptoms that a doctor knows can be alleviated with drugs the doctor is not likely to deny that patient treatmentno matter what a biological test says. Those working on these sorts of tests see them being implemented in a different setting entirely when a patient comes into their internist seeking treatment for other conditions. Psychiatric disorders often present with other diseases such as diabetes and some immune disorders says Bahn. If there was a blood test for depression it could just become part of a standard paneland thus help achieve earlier diagnoses and in turn earlier treatment across the board. But if biological tests for mental illness do come to fruition even those already living with a condition could benefit. I think if this biological aspect was attached to it then people would see that stigmatizing someone for their depression is as ridiculous as stigmatizing someone for their diabetes Orlando says. People often need concrete tangible facts and thats what scares them about mental illness and what causes the stigmatizationthey just dont understand it."

"Johnson and Johnson will partner with Massachusetts General Hospital to develop and market a blood test that could find a single cancer cell circulating in a persons blood the company said Monday. Researchers hope the test will be used by oncologists as a diagnostic tool aimed at discovering as early as possible if a cancer has spread as well as by researchers in coming up with new drug therapies. Dr. Mehmet Toner director of the BioMicroElectroMechanical Systems Resource Center in Massachusetts Generals Center for Engineering in Medicine says while it will take at least five years before the test is on the market its another step toward personalized medicine and the implications for patients are significant. It is very big. It has the potential to turn cancer into a chronic disease because we can monitor patients individually and respond with treatment to the genetic makeup of their cancer. Toner says the test is like a liquid biopsy and targets almost all solid cancers cancers found in solid organs like the breast or prostate. The cancer cells it finds would be analyzed and their genetic makeup determined which would be useful in monitoring patients and targeting therapies to the individual. Veridex a Johnson and Johnson company announced the partnership in a statement saying it involves Ortho Biotech Oncology Research and Development a unit of Johnson and Johnson Pharmaceutical Research and Development. This new technology has the potential to facilitate an easytoadminister noninvasive blood test that would allow us to count tumor cells and to characterize the biology of the cells said Robert McCormack Veridexs head of technology innovation and strategy. Harnessing the information contained in these cells in an invitro clinical setting could enable tools to help select treatment and monitor how patients are responding. Veridex launched the first commercial test using circulating tumor cell technology in the company said. It describes circulating tumor cells as cancer cells that have detached from a tumor and are found at very low levels in the bloodstream. Capturing and counting those cells can provide information to patients and doctors about prognoses with certain types of metastatic cancers the statement said. The value of capturing and counting CTCs is evolving as more research data is gathered about the utility of these markers in monitoring disease progression and potentially guiding personalized cancer therapy the Veridex statement said. Toner said you are likely to find just one circulating tumor cell in to billion blood cells. In fact a tube of blood taken during an annual exam would only have a few CTCs. The challenging goal of sorting extremely rare circulating tumor cells from blood requires continuous technological biological and clinical innovation to fully explore the utility of these precious cells in clinical oncology Toner said. We have developed and continue to develop a broad range of technologies that are evolving what we know about cancer and cancer care. The American Cancer Society said the new research is exciting but its important to remember its just another step in the scientific process. Researchers have been working on this and similar technologies for some time and others have predicted a day when we will be able to diagnose cancers before they are otherwise visible by current techniques said Dr. Len Lichtenfeld the groups deputy chief medical officer. It is appropriate to view announcements such as the one today with enthusiasm but recognize that we must temper that excitement with the realization that there is still much research to be done to determine the true impact of this test on the treatment of patients with cancer."

"The use of mammograms has dipped since a medical task force made controversial recommendations that women in their s may not need to get breast cancer screenings every year according to one of three small studies to be presented Monday. The studies related to this topic will be presented at the American Roentgen Ray Society annual meeting. They do not appear in peerreviewed journals. The studies suggest that fewer physicians are recommending annual mammograms for women in their s fewer patients in that age group are getting screened and that tumors found through routine mammography are more likely to be detected in early stages of cancer. The studies examined the impact of the controversial guidelines issued by the U.S. Preventive Services Task Force a federal advisory board. Who decides about mammograms Inside the task force httpedition.cnn.comHEALTHbreast.cancer.task.force.uspstfindex.html In November the group stated that yearly mammograms should not be automatic at age and that physicians should discuss their risks and benefits with their patients. It recommended routine mammography screenings every two years for women ages to . The benefit in to yearold women is pretty small said Dr. Virginia Moyer chair of the task force about annual mammograms. There is a real but rather modest benefit. There are also risks and they are greater in younger women than older women. Mammograms are less effective in detecting growths in younger women whose breasts may be denser. The screening gets better with older women because breast tissues change over time. As a result some women experience false positives anxiety and unnecessary biopsies because of mammograms according to data. Roughly of women in their s detect breast cancer through mammography. Should I get a mammogram httpedition.cnn.comHEALTHexpert.q.abrawley.mammogramsindex.html The benefit is modest enough it needs to be an individual decision Moyer said about mammograms for women in their s. This contradicted advice from cancer groups such as the American Cancer Society and Susan G. Komen for the Cure which told women and older to get screened every year. It sparked immediate outcry from such groups and cancer survivors who say routine mammograms for women younger than can save lives. Oncedropping U.S. breast cancer rates now stable httpthechart.blogs.cnn.comoncedroppingusbreastcancerratesnowstable Suspicious growths caught in regularscreening mammograms are more likely to be in early stages and therefore more treatable said Dr. Donna Plecha division chief of mammography at University Hospitals at Case Medical Center in Ohio. She reviewed records of biopsies samples of suspicious growths in breasts from women in their s during to at her hospital. Of the biopsies from screening mammography patients had cancer. These cancers were more treatable because they were caught in earlier stages Plecha said. Although of those biopsies turned out to be noncancerous some may show us the patient is at higher risk of breast cancer she said. I havent met many patients who dont appreciate us being thorough to trying to find the cancers at an early stage Plecha said. I would still recommend screening mammograms starting at age of because cancers caught earlier would be more curable. Breast cancer IDd more accurately by docs who see more scans httppagingdrgupta.blogs.cnn.combreastcanceriddmoreaccuratelybydocswhoseemorescans Plechas findings were not surprising to Moyer. Its obvious that annual screenings would catch cancers before they progress she said. The study presumes that catching earlier stages for women between the ages of would translate into fewer breast cancer deaths. The data that we have suggests that in a thousand will benefit from mammograms in the age she said. There are whole lots of assumptions that are not supported by the data they presented. The task force did not say dont get mammograms Moyer said. It might make women not want to get the test she said. This is a decision that should belong to the woman with appropriate info on hand. In another study Dr. Lara Hardesty section chief of breast imaging at the University of Colorado Hospital examined survey results from fewer than internists gynecologists family practitioners and nurse midwives. She found that fewer clinicians were recommending annual mammograms after the task forces guidelines were issued. Before the guidelines recommended yearly mammograms for women in the to yearold range. After the guidelines that rate decreased to and of the clinicians reported they were discussing the risks and benefits of screening with patients. That decrease Hardesty said is a statistically significant difference but it also showed more doctors were discussing mammograms with patients. Hardesty also found that there were fewer mammograms among women in their s after the guidelines were issued. Among patients and older mammograms increased slightly from patients to . It was unclear why mammograms in the s decreased while older womens mammograms increased slightly. Hardesty offered this hypothesis Older women are used to having annual mammograms because theyve done it for years. Meanwhile younger women may feel as though they dont have to get this screening. Although the task force concluded that the net benefit of mammography in the s is small Hardesty said If youre the one person we find your cancer its the world to you."

"Advising patient with chronic sinus congestion to use nasal irrigation a popular nonpharmacologic treatment improved their symptoms but steam inhalation did not according to a randomized controlled trial published in CMAJ Canadian Medical Association Journal. More than million people in the United States and about . million Canadians suffer from chronic rhinosinusitis or sinus infection and experience compromised quality of life. To alleviate symptoms steam inhalation and nasal irrigation are widely suggested as an alternative to common treatment with antibiotics which are often not effective and contribute to antibiotic resistance. Researchers from the United Kingdom conducted a randomized controlled trial on the effectiveness of advice from primary care physicians to use nasal irrigation andor steam inhalation for chronic sinusitis. The study involved patients from primary care practices in England who were randomly assigned to of advice strategies usual care daily nasal and saline irrigation supported by a demonstration video daily steam inhalation or combined treatment with both interventions. We have found that even a very brief intervention of a video showing patients how to use saline nasal irrigation can improve symptoms help people feel they do not need to see the doctor to manage the problem and reduce the amount of overthecounter medication they need to use said Dr. Paul Little Primary Care and Population Sciences Unit University of Southampton Southampton United Kingdom. Patients who were instructed to use nasal irrigation showed improvement at and months as measured by the Rhinosinusitis Disability Index. Steam inhalation did not appear to alleviate symptoms of sinusitis. We found potentially important changes in other outcomes in particular fewer participants in the nasal irrigation group than in the noirrigation group had headaches used overthecounter medications and intended to consult a doctor in future episodes write the authors. Although there was no significant difference in either physician visits or antibiotic use as might be expected over only a month followup period our findings concerning consultations are important in the longer term given antibiotic use increases the risk of antimicrobial resistance. Since the impact was less than in previous studies that had used more intensive coaching about nasal irrigation the authors suggest that further research is needed to understand how much coaching of patients is required."

"On a scale of to lower back pain httpshealth.usnews.comwellnessarticleshowtostayoffthebackpaintreatmentcarousel can register somewhere between I need an aspirin to please jack me up with morphine. Those suffering from such discomfort might feel moderate to mild pain that is not debilitating. In severe cases they could feel like a giant electrified claw has claimed the lower part of their back tearing into each nerve in that part of the body. The smallest of movements getting up from a chair walking or even coughing can feel torturous. Maybe the lower back is as stiff as hardened concrete and as sensitive as an exposed nerve. A simple lumbar support device or back brace can provide shortterm relief research shows according to an analysis of studies published in the September issue of the Annals of Physical Rehabilitation Medicine journal. While these devices wont cure the underlying condition theyre simple and relatively inexpensive. In the metaanalysis researchers concluded that lumbar support devices are useful for improving function and reducing pain among those suffering from subacute back pain which means its past the acute stage which is sudden and short in duration but not longlasting enough to be chronic httpshealth.usnews.comhealthnewspatientadvicearticlesrecoveringfromchronickneehipandbackpainwithoutsurgery. See Items That Help Protect Your Health httpshealth.usnews.comwellnessslideshowsitemsthathelpprotectyourhealth. Lumbar support devices provide enough compression and support for the lower back to allow healing to occur says Christopher Cousins http a physical therapist based in the District of Columbia. The compression on the abdomen means theres less pressure on your lower back discs ligaments muscles and spine. Lumbar devices typically fit around your waist and are secured with Velcro. They often have a steel or plastic plate attached to the section that would press against the patients lower back to provide support some have overtheshoulders straps. Most overthecounter lumbar support devices cost between and and theyre available at many drug stores Target and WalMart plus online without a a prescription. Custommade lumbar support devices which are contoured to the natural curvature of the patients spine cost from a few hundred dollars to about Cousins says. httpshealth.usnews.comhealthnewsblogseatrunarticlesthebestyogaposesyoucandoatyourdeskThe Best Yoga Poses You Can Do at Your Desk httpshealth.usnews.comhealthnewsblogseatrunarticlesthebestyogaposesyoucandoatyourdesk Colleagues awkward stares not included. Jake PanasevichApril People who suffer mild to moderate subacute back pain httpshealth.usnews.comhealthnewspatientadvicearticlesbemindfulintreatinglowerbackpain should put on a back brace as soon as their discomfort sets in says Scott Bautch http a chiropractor in Wasau Wisconsin and president of the American Chiropractic Associations council on occupational health. You want to give yourself bracing so you can move Bautch says. Inactivity or immobilization is the worst thing for a back. You want to remain active and a brace can help you do that. Some studies have shown that wearing a lumbar support device could lead to negative effects such as skin lesions muscle wasting gastrointestinal disorders higher blood pressure and higher heart rates. Those issues are rare and typically occur with people who wear a back brace for an extended period of time for more than the week or two most experts recommend Bautch says. If a back brace fits well is worn properly that is its not too snug and is not overused it shouldnt create any health problems Bautch says. During the course of his year career Bautch says hundreds of his patients have worn lumbar support devices. None of them developed any problems aside from a handful who had minor skin irritation where part of the brace rubbed their body Bautch says. He remedied that issue by having his patients wear an undershirt between the lumbar support device and their skin. See Ways to Cope With Back Pain httpshealth.usnews.comhealthnewspatientadviceslideshowswaystocopewithbackpain. Searing subacute back pain is caused by an array of conditions including a herniated disc in which the soft jellylike center inside the disc pushes out through a tear in its tough exterior and irritates nerves. A herniated disc can cause sciatica a painful condition that affects the back hips and legs and is caused by the compression of a spinal nerve root in the lower back. Spinal discs degenerate with age and a herniated disc can occur without a physical injury says Dr. Neel Anand http director of spine trauma at CedarsSinai Medical Center httpshealth.usnews.combesthospitalsareacacedarssinaimedicalcenter in Los Angeles. Think of your disc like your car tire its going to wear out Anand says. Before getting a lumbar support device for your lower back pain experts recommend these steps . If you have severe pain see a physician quickly. If your back pain or stiffness is so bad you cant move without tremendous discomfort see a doctor as soon as possible Bautch says. If your pain and stiffness are that severe a back brace may not be of much immediate use he says adding that it may be helpful once the pain and stiffness subside to a tolerable level where you can move. Moderate to mild lower back pain often subsides after five days or so but if your discomfort persists beyond that or worsens see a doctor adds Dr. Megan Cortazzo http_.html medical director of clinical documentation improvement and health information management at the University of Pittsburgh Medical Center httpshealth.usnews.combesthospitalsareapaupmcuniversityofpittsburghmedicalcenter. A doctor can test for and rule out serious potential causes such as kidney stones httpshealth.usnews.comwellnessarticlespassyourkidneystonebyridingarollercoaster an abdominal aneurysm httpshealth.usnews.comhealthcarebesthospitalsarticlesabdominalaorticaneurysmwhenitssurgerytime and cancer httpshealth.usnews.combesthospitalsrankingscancer Cortazzo says. Doctors can order an array of tests such as an Xray MRI or CT scan to arrive at the correct diagnosis which will help lead to the most effective treatment plan she says. The goal of most treatment regimens is strengthening the patients core muscles supporting the spine so the pain doesnt recur. Treatment could include physical therapy a stretching routine yoga or Pilates httpshealth.usnews.comhealthnewsblogseatrunhowpilatesbenefitsrunners. Many people also find chiropractic adjustments httpshealth.usnews.comwellnessarticlestheprosandconsofseeingachiropractor helpful says Robert Hayden httpiriscitychiro.com a chiropractor based in Griffin Georgia. . Find a lumbar support device that fits you. Once youve been diagnosed look for a lumbar support device that fits the natural curvature of your spine says Dr. Jeremy Smith https an orthopedic spine surgeon at the Hoag Orthopedic Institute in Irvine California. Try on a few at the store before buying one he advises. If you buy the device online you can return it if it doesnt fit. It needs to naturally contour and fit kind of like a glove so all surface areas are in contact with your back. It should help remind you to keep good posture Smith says. The device should be snug but not too tight. It shouldnt constrict your breathing. ADVERTISING inRead invented by Teads https_sourceinreadutm_mediumcreditsutm_campaigninventedbyteads . Dont become reliant on your back brace. Patients should wear a back brace for no longer than a few days to two weeks at the most Bautch says. Longer than that and your muscles start to adapt and get accustomed to the brace which means they can lose strength which can lead to more injuries he adds. If you use the back brace for more than two weeks you can become bracedependent. A lumbar support device can be useful in the short term but strengthening the core muscles that support your back is important in the long run Bautch says. See Seemingly Innocent Symptoms You Shouldnt Ignore httpshealth.usnews.comhealthnewspatientadviceslideshowsseeminglyinnocentsymptomsyoushouldntignore. . Learn your capacity. Figure out your physical limits to avoid reinjuring your back both when youre wearing a back brace and after youve stopped using it says Robert Shapiro http a physical therapist and certified orthopedic manual therapist based in Huntington New York. Youre not Superman when youre wearing your brace he says. Exceeding your physical boundaries could cause a recurrence of low back pain httpshealth.usnews.comhealthnewspatientadvicearticlesbackpainnaturalwaystogetrelief. You have to learn what your limits are and not to exceed them Shapiro says. You may be able to lift a box of books but shoveling snow may cause pain. Your physical limits may change as you exercise and strengthen your core."

"Men can take birth control shots to prevent pregnancy in their female partners according to a new study published in the Endocrine Societys Journal of Clinical Endocrinology Metabolism. Researchers are still working to perfect the combination of hormonal contraceptives to reduce the risk of mild to moderate side effects including depression and other mood disorders. While women can choose from a number of birth control methods men have few options to control their own fertility. Available methods for men include condoms vasectomies and withdrawal. Better birth control options are needed for men. In percent of all pregnancies worldwide were unintended according to the Guttmacher Institute https The study found it is possible to have a hormonal contraceptive for men that reduces the risk of unplanned pregnancies in the partners of men who use it said one of the studys authors Mario Philip Reyes Festin MD of the World Health Organization in Geneva Switzerland. Our findings confirmed the efficacy of this contraceptive method previously seen in small studies. The prospective Phase II single arm multicenter study tested the safety and effectiveness of injectable contraceptives in healthy men ages to . The participants had all been in monogamous relationships with female partners between the ages of and for at least a year. The men underwent testing to ensure they had a normal sperm count at the start of the study. The men received injections of milligrams of a longacting progestogen called norethisterone enanthate NETEN and milligrams of a longacting androgen called testosterone undecanoate TU for up to weeks to suppress their sperm counts. Healthcare professionals gave the men two injections every eight weeks. Participants initially provided semen samples after eight and weeks in the suppression phase and then every weeks until they met the criteria for the next phase. During this time the couples were instructed to use other nonhormonal birth control methods. Once a participants sperm count was lowered to less than millionml in two consecutive tests the couple was asked to rely on the injections for birth control. During this period known as the efficacy phase of the study the men continued to receive injections every eight weeks for up to weeks. Participants provided semen samples every eight weeks to ensure their sperm counts stayed low. Once the participants stopped receiving the injections they were monitored to see how quickly their sperm counts recovered. The hormones were effective in reducing the sperm count to millionml or less within weeks in of the participants. The contraceptive method was effective in nearly percent of continuing users. Only four pregnancies occurred among the mens partners during the efficacy phase of the study. Researchers stopped enrolling new participants in the study in due to the rate of adverse events particularly depression and other mood disorders reported by the participants. The men reported side effects including injection site pain muscle pain increased libido and acne. Twenty men dropped out of the study due to side effects. Despite the adverse effects more than percent of participants reported being willing to use this method of contraception at the conclusion of the trial. Of the reported adverse events nearly percent were found to be unrelated to the contraceptive injections. These included one death by suicide which was assessed not to be related to the use of the drug. Serious adverse events that were assessed as probably or possibly related to the study included one case of depression one intentional overdose of acetaminophen and a man who experienced an abnormally fast and irregular heartbeat after he stopped receiving the injections. More research is needed to advance this concept to the point that it can be made widely available to men as a method of contraception Festin said. Although the injections were effective in reducing the rate of pregnancy the combination of hormones needs to be studied more to consider a good balance between efficacy and safety. The study Efficacy and Safety of an Injectable Combination Hormonal Contraceptive for Men will be published online at httppress.endocrine.orgdoi.jc. ahead of print. Other authors of the study include Hermann M. Behre of Martin Luther University of HalleWittenberg in Halle Germany Michael Zitzmann of the University of Mnster in Mnster Germany Richard A. Anderson of The University of Edinburgh in Edinburgh United Kingdom David J. Handelsman of the University of Sydney and Concord Hospital in Sydney Australia Silvia W. Lestari of the University of Indonesia in Jakarta Indonesia Robert I. McLachlan of Monash Medical Centre in Melbourne Australia M. Cristina Meriggiola of the University of Bologna in Bologna Italy Man Mohan Misro of the National Institute of Health Family Welfare in New Dehli India Gabriela Noe of the Instituto Chileno de Medicina Reproductiva in Santiago Chile Frederick C. W. Wu of Manchester Royal Infirmary in Manchester U.K. Ndema A. Habib and Kirsten M. Vogelsong of the World Health Organization of Geneva Switzerland and Marianne M. Callahan Kim A. Linton and Doug S. Colvard of CONRAD East Virginia Medical School a reproductive health organization based in Arlington VA. The research was cosponsored and funded by UNDPUNFPAUNICEFWHOWorld Bank Special Program of Research Development and Research Training in Human Reproduction in Geneva Switzerland and CONRAD using funding from the Bill Melinda Gates Foundation and the U.S. Agency for International Development. The injectable hormones were provided by Schering AG which has since merged with Bayer Pharma AG. For more information on mens health visit the Endocrine Societys centennial website. Endocrinologists are at the core of solving the most pressing health problems of our time from diabetes and obesity to infertility bone health and hormonerelated cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormonerelated conditions. The Society which is celebrating its centennial httpescentennial.orgcalendarjune in has more than members including scientists physicians educators nurses and students in countries. To learn more about the Society and the field of endocrinology visit our site at http Follow us on Twitter at TheEndoSociety httpstwitter.comTheEndoSocietyref_srctwsrcEgoogleCtwcampEserpCtwgrEauthor and EndoMedia httpstwitter.comendomedia."

"Researchers at the Kennedy Institute and Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford working with clinicians at NHS Lothian have found that injection of the antiTNF drug adalimumab into Dupuytrens disease nodules results in the reduction of the cell characteristics responsible for progression of Dupuytrens disease. Based on their laboratory data that tumour necrosis factor TNF drives the development of myofibroblasts the cell type that causes Dupuytrens disease the research team explored the effect of an antiTNF drug injected directly into the Dupuytrens nodule tissue. The results so far are very promising. Our data have shown that a concentrated formulation of adalimumab injected directly into the diseased tissue may be effective in targeting the cells responsible for Dupuytrens disease said Jagdeep Nanchahal MD PhD University of Oxford Professor of Hand Plastic and Reconstructive Surgery who led the study. This brings new hope to people who suffer from this disabling condition who currently have to wait for their situation to be deteriorate watching their hand lose function until it is bad enough for surgery. And then theres the lengthy recovery ahead a less than ideal situation to find yourself in. This randomised trial phase a recruited patients with Dupuytrens disease who were scheduled to have surgery in Edinburgh to remove diseased tissue in their hand. Two weeks prior to surgery they received a single injection of varying doses of the antiTNF drug or placebo. The tissue removed during surgery which is usually discarded was then analysed in the laboratory. The team found that adalimumab at a dose of mg formulated in .ml reduces expression of the fibrotic markers smooth muscle actin SMA and type I procollagen at weeks post injection suggesting this drug could be used to stop the growth of disease causing myofibroblast cells. They also found the drug to be safe and well tolerated. The findings are published on line in the journal EBioMedicine https published by The Lancet. Dupuytrens disease is a common condition of the hand that affects of the UK population and causes the fingers to curl irreversibly into the palm. There is currently no NICE approved treatment for early disease and typically people are told to return to their GP once their fingers become so bent that their hand function is impaired. The antiTNF drug adalimumab Humira is currently licensed in the EU for the treatment of a number of conditions including rheumatoid arthritis Crohns disease and ulcerative colitis and overall has an excellent safety profile. We are delighted to have received further funding from the Wellcome Trust and Department of Health to test whether adalimumab will work for patients with early stage Dupuytrens disease said Professor Sir Marc Feldmann coauthor and former director of the Kennedy Institute. In conjunction with Professor Sir Ravinder Maini Sir Marc identified TNF as a therapeutic target in patients with rheumatoid arthritis. The Kennedy Institute has a long history of successfully translating laboratory findings to the clinic said Professor Fiona Powrie Director of the Institute. This type of work requires close collaboration between laboratory scientists clinical trialists and clinician scientists over many years. The researchers are continuing to investigate the use of this drug to treat Dupuytrens disease in a phase b trial called the RIDD trial which is currently running in Oxford and Edinburgh. The research was funded by the Health Innovation Challenge Fund which is a collaboration between the Wellcome Trust and the Department of Health. Funding for the drug was provided by Therapeutics. The trial was run by the UKCRC accredited Oxford Clinical Trials Research Unit OCTRU Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford."

"In the first analysis of how to treat patients on anticoagulants who suffer a major bleeding event a clinical practice that routinely gives doctors pause while also evaluating a new drug University of Pittsburgh researchers aim to provide muchneeded guidance to clinicians trying to balance the risks of stroke versus bleeding when determining the best treatment. The analysis published today in the journal Stroke determined that resuming anticoagulation therapy after a person suffers a major bleeding event was associated with a higher likelihood of strokefree survival than discontinuing anticoagulation. Furthermore restarting therapy with the new oral anticoagulant dabigatran was associated with a lower risk of recurrent hemorrhage in these cases than the old standby drug warfarin. People take anticoagulants to avoid blood clots when they have a risk for stroke or heart attack but the downside is that these medications increase a persons risk of severe bleedingsuch as in the brain or gutbecause the blood isnt clotting as well as it otherwise might. If a patient who is on an anticoagulant to avoid a stroke has a major bleeding event doctors are faced with a catch Discontinue the anticoagulant to avoid future bleeding but again place their patient at increased risk of stroke or resume the anticoagulant to continue avoiding a stroke but then have to worry about another bleeding event said lead author Inmaculada Hernandez Pharm.D. Ph.D. an assistant professor in Pitts School of Pharmacy who completed this work as a doctoral student at Pitts Graduate School of Public Health. It causes a lot of uncertainty for physicians especially because patients at highest risk of recurrent bleeding also are at highest risk of stroke said coauthor Yuting Zhang Ph.D. associate professor of health policy and management at Pitt Public Health and Hernandezs doctoral dissertation committee chair. The Pitt research team obtained data from to for a random sample of Medicare beneficiaries. They then followed nearly people who had filled prescriptions for the anticoagulants warfarin which has been used as a medication since and dabigatran which was approved by the U.S. Food and Drug Administration in . More than of those people suffered a major bleeding event while using one of the drugs. About half of those people resumed one of the two anticoagulants a few months after the bleeding while the others did not. The risk of dying from any cause or having a stroke was to percent higher in patients who discontinued anticoagulation therapy compared to those who resumed it. People who took dabigatran after their initial bleeding event had nearly half the risk of another major bleeding event within one year compared with those who took warfarin. Our results should encourage clinicians to seriously consider resuming anticoagulation among patients who survived a major bleeding event particularly if the source of bleeding was identified and addressed said senior author Samir Saba M.D. associate professor of medicine and associate chief of cardiology at UPMC Heart and Vascular Institute. They should also take into account that the benefittorisk ratio of posthemorrhage use of anticoagulation is not the same for all medications. Additional authors on this research are Maria M. Brooks Ph.D. of Pitt Public Health and Paul K.L. Chin Ph.D. of the University of Otago in New Zealand. This research was funded by the Commonwealth Foundation Agency for Healthcare Research and Quality grant R HS and National Institute of Mental Health grant R MH. Dr. Hernandez was supported by a fellowship from La Caixa foundation. About the University of Pittsburgh Graduate School of Public Health The University of Pittsburgh Graduate School of Public Health founded in and now one of the topranked schools of public health in the United States conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases HIVAIDS cancer and other important public health problems. For more information about Pitt Public Health visit the schools Web site at http http"

"UPDATE Click here to read the latest statement from the Victor Chang Institute. https OVERVIEW One of Australias greatest discoveries in pregnancy research Vitamin B can potentially treat molecular deficiencies which cause miscarriages and birth defects Discovery promises to reduce miscarriages and birth defects Findings expected to change the way pregnant women are cared for A blockbuster world first breakthrough at Sydneys Victor Chang Cardiac Research Institute is expected to prevent recurrent miscarriages and multiple types of birth defects in one of Australias most significant discoveries in pregnancy research. Crucially Australian scientists have also demonstrated a potential cure in the form of a common dietary supplement. This historic discovery is expected to forever change the way pregnant women are cared for around the globe. Every year . million babies are born with a birth defect worldwide and one in four pregnant women suffer a miscarriage in Australia. In the vast majority of cases the cause of these problems has remained a mystery. Until now. This breakthrough led by Professor Sally Dunwoodie from the Victor Chang Institute has identified a cause of recurrent miscarriages as well as heart spinal kidney and cleft palate problems in newborn babies. The ramifications are likely to be huge. This has the potential to significantly reduce the number of miscarriages and birth defects around the world and I do not use those words lightly says Professor Dunwoodie. The landmark study found that a deficiency in a vital molecule known as NAD can prevent a babys organs from developing correctly in the womb. Nicotinamide adenine dinucleotide NAD is one of the most important molecules in all living cells. NAD synthesis is essential for energy production DNA repair and cell communication. Environmental and genetic factors can disrupt its production which can cause a NAD deficiency. World first research at the Victor Chang Institute has found that this deficiency can be particularly harmful during a pregnancy as it can cripple an embryo when it is forming. Now after years of research our team has also discovered that this deficiency can potentially be cured and miscarriages and birth defects prevented by taking a common vitamin Professor Dunwoodie revealed. At the heart of the paramount discovery is the dietary supplement vitamin B also known as niacin. Scientists at the Victor Chang Institute have discovered simply boosting levels of this nutrient during pregnancy can potentially prevent recurrent miscarriages and birth defects. Vitamin B is required to make NAD and is typically found in meats and green vegetables as well as vegemite. However a recent studyi found that despite taking vitamin supplements at least a third of pregnant women have low levels of vitamin B in their first trimester which is the critical time in organ development. By the third trimester vitamin B levels were low in of pregnant women. This indicates pregnant women may require more vitamin B than is currently available in most vitamin supplements. Using a preclinical mouse model scientists at the Victor Chang Institute investigated the effect of vitamin B on developing embryos. The results were astounding. Before vitamin B was introduced into the mothers diet embryos were either lost through miscarriage or the offspring were born with a range of severe birth defects. After the dietary change both the miscarriages and birth defects were completely prevented with all the offspring born perfectly healthy. This discovery is akin to the revolutionary breakthrough made last century that confirmed folic acid supplementation can prevent spina bifida and other neural tube defects in babies. As a result consumption of folic acid has been adopted by expectant mothers worldwide and the addition of folate to our food supply has led to a decrease in the number of babies born with neural tube defects. According to the Executive Director of the Victor Chang Cardiac Research Institute Professor Robert Graham the implications are profound. Just like we now use folate to prevent spina bifida Professor Dunwoodies research suggests that it is probably best for women to start taking vitamin B very early on even before they become pregnant. This could change the way pregnant women are cared for around the world said Professor Graham. We believe that this breakthrough will be one of our countrys greatest medical discoveries. Its extremely rare to discover the problem and provide a preventive solution at the same time. Its actually a double breakthrough said Professor Graham. The next step will be to develop a diagnostic test to measure NAD levels. This will enable doctors to identify those women who are at greatest risk of having a baby with a birth defect and ensure they are getting sufficient vitamin B. The findings have been released today by the New England Journal of Medicine the most prestigious clinical research publication in the world. http This study would not have been possible without the generous support of the Chain Reaction Foundation httpchainreaction.org.au the Key Foundation and the National Health and Medical Research Council https STATISTICS in pregnant women will suffer a miscarriage . million babies are born with a serious birth defect worldwide every year . million children under five die from serious birth defects annually Congenital heart disease is the most common form of birth defect affecting in babies babies are born with a heart defect in Australia every week babies will undergo heart surgery in Australia every week Heart defects account for of deaths in children under five REFERENCE Baker H DeAngelis B Holland B GittensWilliams L Barrett T Jr. Vitamin Profile of Gravidas during Trimesters of Pregnancy. Journal of the American College of Nutrition . MEDIA CONTACTS Media Manager g.glovervictorchang.edu.au mailtog.glovervictorchang.edu.auMedia Coordinator l.alexandrouvictorchang.edu.au mailtol.alexandrouvictorchang.edu.au"

"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"

"Amgen Inc said its potent cholesterol fighter Repatha significantly reduced the risk of heart attacks strokes and death in patients with heart disease according to initial results of a large eagerlyanticipated trial released on Thursday. The data should pave the way for greater acceptance by health insurers and pharmacy benefit managers who have been rejecting about percent of prescriptions written for the expensive medicine despite multiple appeals by physicians. An Amgen sign is seen at the companys office in South San Francisco California in this October file photo. REUTERSRobert GalbraithFiles No new safety problems cropped up in the patient study called Fourier Amgen said. It also said Repathas effect on mental function was similar to placebo likely alleviating concerns that it might impair cognition in some patients. The trial was widely expected to be positive especially after a smaller study presented in November showed Repatha therapy led to regression of arteryclogging plaque an underlying cause of heart disease. These results show unequivocally the connection between lowering LDL cholesterol with Repatha and cardiovascular risk reduction even in a population already treated with optimized statin therapy Amgen research chief Sean Harper said in a statement. Details on the magnitude of benefit will be revealed in midMarch at the American College of Cardiology meeting in Washington D.C. Industry analysts have been looking for a percent to percent reduction of major adverse heart events. Repatha with a list price of more than a year was approved based on its ability to dramatically lower bad LDL cholesterol in patients who require more intensive therapy on top of widelyused statins such as Lipitor or who are unable to tolerate statins. But those who control budgets wanted concrete proof that the drug could actually reduce the risk of heart attacks and death before making it easier for patients to get the medicine. Repatha and a rival drug from Regeneron Corp and Sanofi have had endured anemic sales as a result. Amgen reported just million in thirdquarter sales. The company said Repatha would be well on its way to becoming a billion seller if all prescriptions written had been filled. The primary and secondary goals of the study are composites of several adverse outcomes. At the heart meeting in March researchers will also provide details on risk reduction for each of the components such as nonfatal heart attack nonfatal stroke and heartrelated death. The primary goal also included need for a new arteryclearing procedure and hospitalization for angina. Reporting by Bill Berkrot Editing by Alan Crosby Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

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

"Agitation and aggression are common in Alzheimers patients and there is no known safe and effective treatment. Now researchers report that a combination drug already in use for treating certain neurological problems may be a better remedy. Dextromethorphan is a cough suppressant commonly found in overthecounter cough medicines and quinidine is a drug used to control heart rhythm disorders. In combination they are used to treat pseudobulbar affect a neurological disorder involving involuntary crying or other emotional displays. The scientists randomized Alzheimers patients to a week course of dextromethorphanquinidine and to placebo. Researchers then rated them using a wellvalidated scale that measures aggression and agitation. The study is in the Sept. issue of JAMA httpsjama.jamanetwork.comarticle.aspxarticleid. Aggression scores declined to . from . in the dextromethorphanquinidine group and to . from . in those who took a placebo. Then the researchers rerandomized those who did not respond to placebo to receive either drugs or placebo and found similar encouraging results for the drug combination. Fiftyfive percent of the people who were on drugs had a percent reduction in their agitation said the lead author Dr. Jeffrey L. Cummings director of the Cleveland Clinic Lou Ruvo Center for Brain Health. Thats a lot when a patient is striking and hitting and cussing. There are no currently approved treatments for agitation and were very enthusiastic about this finding."

"U.S. Stem Cell Inc. OTC USRM httpstudio.financialcontent.comprnewsPageQuoteTickerUSRM a leader in the development of proprietary physicianbased stem cell therapies and novel regenerative medicine solutions today announced it has demonstrated successful inhuman results in repairing meniscus tear after autologous stem cell therapy from adipose or fat tissue. Results are published http in the scientific publication the Journal of Medical Cases and is authored by USRM Chief Science Officer Dr. Kristin Comella and colleagues Dr. Scott Greenberg httpsdrmagaziner.comdrscottgreenberg of the Magaziner Center for Wellness and Dr. Laura Ross httprossorthopedics.comdrross.htm of Ross Orthopedic. The ability to provide this kind of therapy to Americans can be life changing said Dr. Comella. Use of ones own healing cells to help repair damaged tissue rather than having to cut open or manipulate the damaged area to try to reduce pain and restore function is the most elegant form of regenerative medicine we have today. Meniscal injuries are the most common knee injury in the United States with an annual average of incidence of per according to a article in the Journal of Orthopedics httpsjeoesska.springeropen.comarticles.sz. Approximately patients each year are surgically treated often arthroscopically for meniscal injuries. The paper outlines the case study of a yearold male with a chronic meniscus injury. During the month followup period the patient reported a reduction in pain and an improvement in knee function. Figure a shows a tear at baseline on the posterior horn of the medial meniscus while Figure b taken months after the first injection shows complete resolution of the tear. The healed tear could not be penetrated by the probe. The arthroscopic images showing resolution were also consistent with quality of life improvements for the patient including a reduction in pain and resumption of normal activities. The patient experienced very little downtime and was able to resume normal activities in less than week. Dr. Comella who has more than years experience is recognized worldwide by her peers as an innovator and world leader in the development and clinical practice of stem cell httpusstemcell.comtopfunctionalandintegrativemedicaldoctors products and therapies. USRM has been a part of more than stem cell procedures in the past years for a variety of indications including orthopedic autoimmune degenerative and neurological diseases. U.S. Stem Cell Inc. httpusstemcell.com is an emerging leader in the regenerative medicine cellular therapy industry specializing in physician training and certification and stem cell products including its lead product Adipocell as well as veterinary stem cell training and stem cell banking and creation and management of stem cell clinics. To managements knowledge USRM has completed more clinical treatments than any other stem cell company in the world. ForwardLooking Statements Except for historical matters contained herein statements made in this press release are forwardlooking statements. Without limiting the generality of the foregoing words such as may will to plan expect believe anticipate intend could would estimate or continue or the negative other variations thereof or comparable terminology are intended to identify forwardlooking statements. Forwardlooking statements involve known and unknown risks uncertainties and other factors which may cause our actual results performance or achievements to be materially different from any future results performance or achievements expressed or implied by the forwardlooking statements and represent our managements beliefs and assumptions only as of the date hereof. Except as required by law we assume no obligation to update these forwardlooking statements even if new information becomes available in the future. The Companys business and the risks and uncertainties of the business are described in its filings with the Securities and Exchange Commission which can be found at sec.gov httpsec.gov. Media Contact U.S. Stem Cell Inc. NW th Street Suite Sunrise Fl Phone .. Email usstemcellusstemcell.com mailtousstemcellusstemcell.com SOURCE U.S. Stem Cell Inc. Related Links httpusstemcell.com"

"To place an electronic embedded link to this study in your story Links will be live at the embargo time httparchpedi.jamanetwork.comarticle.aspxdoi.jamapediatrics.. JAMA Pediatrics Breastfeeding for six months or longer was associated with a lower risk of childhood leukemia compared with children who were never breastfed or who were breastfed for a shorter time according to an article published online by JAMA Pediatrics. Leukemia is the most common childhood cancer and accounts for about percent of all childhood cancers. Still little is known about its cause. Breast milk is meant to exclusively supply all the nutritional needs of infants and current recommendations include exclusively breastfeeding for the first six months of life to optimize growth development and health. Efrat L. Amitay Ph.D. M.P.H. and Lital KeinanBoker M.D. Ph.D. M.P.H. of the University of Haifa Israel reviewed the evidence in studies on the association between breastfeeding and childhood leukemia. In a review of all studies the authors found breastfeeding for six months or longer was associated with a percent lower risk compared with no breastfeeding or breastfeeding for a shorter period of time. A separate analysis of studies found that ever being breastfed compared with never being breastfed was associated with an percent lower risk of childhood leukemia. The authors suggest several biological mechanisms of breast milk may explain their results including that breast milk contains many immunologically active components and antiinflammatory defense mechanisms that influence the development of an infants immune system. Because the primary goal of public health is prevention of morbidity health care professionals should be taught the potential health benefits of breastfeeding and given tools to assist mothers with breastfeeding whether themselves or with referrals to others who can help. The many potential preventive health benefits of breastfeeding should also be communicated openly to the general public not only to mothers so breastfeeding can be more socially accepted and facilitated. In addition more highquality studies are needed to clarify the biological mechanisms underlying this association between breastfeeding and lower childhood leukemia morbidity the study concludes. JAMA Pediatr. Published online June . doi.jamapediatrics... Available preembargo to the media at httpmedia.jamanetwork.com. Editors Note Please see article for additional information including other authors author contributions and affiliations etc."

"Scientists still havent discovered a cure for the common cold httpshealth.nytimes.comhealthguidesdiseasecommoncoldoverview.htmlinlinenytclassifier but researchers now say zinc httpshealth.nytimes.comhealthguidespoisonzincoverview.htmlinlinenytclassifier may be the next best thing. A sweeping new review of the medical research on zinc shows that sniffing sneezing httpshealth.nytimes.comhealthguidessymptomssneezingoverview.htmlinlinenytclassifier coughing and stuffyheaded cold sufferers finally have a better option than just tissue and chicken soup. When taken within hours of the first runny nose httpshealth.nytimes.comhealthguidessymptomsnasaldischargeoverview.htmlinlinenytclassifier or sore throat httpshealth.nytimes.comhealthguidessymptomssorethroatoverview.htmlinlinenytclassifier zinc lozenges tablets or syrups can cut colds httpshealth.nytimes.comhealthguidesdiseasecommoncoldoverview.htmlinlinenytclassifier short by an average of a day or more and sharply reduce the severity of symptoms according to the Cochrane Database of Systematic Reviews https a respected medical clearinghouse. In some of the cited studies the benefits of zinc were significant. A March report https in The Journal of Infectious Diseases for example found that zinc lozenges cut the duration of colds to four days from seven days and reduced coughing to two days from five. While the findings are certain to send droves of miserable cold sufferers to the drugstore in search of zinc treatments the study authors offered no guidance on what type of zinc product to buy. The authors declined to make recommendations about the optimal dose formulation or duration of zinc use saying that more work was needed before they could make recommendations. Over all it appears that zinc does have an effect in controlling the common cold said Dr. Meenu Singh the reviews lead author and a professor in the department of pediatrics httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicspediatricsindex.htmlinlinenytclassifier at the Postgraduate Institute of Medical Education and Research in Chandigarh India. But there still needs to be consensus about the dose. Zinc experts say that many overthecounter zinc products may not be as effective as those studied by researchers because commercial lozenges and syrups often are made with different formulations of zinc and various flavors and binders that can alter the effectiveness of the treatment. A lot of preparations have added so many things that they arent releasing zinc properly said Dr. Ananda Prasad professor in the department of oncology at Wayne State University School of Medicine in Detroit and an early pioneer of research into zinc as an essential mineral. Two of Dr. Prasads studies were included in the Cochrane report. The public is confused because people have used the wrong dose they have used the wrong sort of zinc or they have not started the treatment within hours of onset he said. Even so the new report gives credence to the longdebated theory that zinc can be an effective treatment for colds. While its not certain how the mineral curbs colds it appears to have antiviral properties that prevent the cold virus from replicating or attaching to nasal membranes. The first study to show that zinc might be a useful treatment for the common cold was published in but the research was criticized for its poor methods. Since that study more trials of zinc for colds have been conducted of them showed it to be a useful treatment while seven of them showed no benefit according to the review. Although a majority of trials have shown some benefit from zinc many of them have been criticized for failing to mask the treatment meaning the participants most likely knew they were using zinc which may have skewed the results. At the same time many of the trials that showed no benefit from zinc have been criticized for using formulations that may have contained ingredients that blunted the effectiveness of zinc. The Cochrane reviewers selected studies that enrolled a combined participants. The studies were all considered to have good methodological quality with a low risk of bias but they were far from perfect. All the studies compared zinc use with a placebo but in several studies the zinc users complained about the taste of lozenges suggesting that some people may have known that they were using zinc rather than a placebo. Even so when the data was pooled the effect shown was strong. The review found that not only did zinc reduce the duration and severity of common cold symptoms but regular zinc use also worked to prevent colds leading to fewer school absences and less antibiotic httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsantibioticsindex.htmlinlinenytclassifier use in children. People who used zinc were also far less likely to have a cold that lasted more than seven days. The studies used various forms and doses of zinc including zinc gluconate or zinc acetate lozenges and zinc sulfate syrup and the dose ranged from to milligrams a day. Several studies in the Cochrane review used zinc acetate lozenges from the Web site ColdCure.com httpscoldcure.com created by George Eby the researcher who wrote the first zinc study in . Dr. Prasad said his studies have used zinc acetate lozenges from ColdCure.com that contained about milligrams of zinc. Study participants took a lozenge every three to four hours during the day for four consecutive days resulting in a daily dose of to milligrams a day he said. Some cold sufferers have been wary about using zinc since the Food and Drug Administration httpstopics.nytimes.comtopreferencetimestopicsorganizationsffood_and_drug_administrationindex.htmlinlinenytorg warned consumers to stop using Zicam nasal sprays and swabs which contain zinc after numerous reports that some users lost their sense of smell after using the product. The Cochrane report did not review any studies of nasal zinc products."

"Researchers in Europe say a fermented dairy product containing a specific bacterium known as a probiotic did not relieve constipation in children https more than a dairy product without a probiotic. The finding is significant the researchers say because probiotics https have helped some adults with constipation https It seemed logical that probiotics live microorganisms that are often called friendly or good bacteria might work for children. But in a new study the kids who consumed the fermented dairy product did no better based on number of stools produced than youngsters in a comparison group. The study examined children with constipation https for at least two months with a defecation rate of less than three times per week. About half were given the probiotic product twice daily for three weeks children in the comparison group were given a dairy product without the probiotic. Study Results In the study the fermented dairy product that contained B lactis strain DN increased stool frequency but not significantly more than the dairy product without a probiotic given to the comparison group according to researchers in the Netherlands and Poland. Even though it is common practice to give probiotics to children to help them with constipation problems study researcher Merit M. Tabbers MD PhD a pediatric gastroenterologist at Emmas Childrens Hospital Academic Medical Center in Amsterdam the Netherlands tells WebMD that there is not yet enough evidence to support a general recommendation about the use of probiotics in the treatment of functional childhood constipation. But because constipation is a common problem in young children more research is in the works. Probiotics are indeed also given in the Netherlands and elsewhere by caregivers because constipation is in the majority of patients difficult to treat and a longlasting problem Tabbers tells WebMD via email. Approximately of all children followed for six to months are found to recover and were successfully taken off laxatives https Probiotics in Adults Tabbers says a study in another hospital even showed that despite intensive medical and behavioral therapy of patients who developed constipation before the age of years continued to have severe complaints of constipation infrequent painful defecation andfecal incontinence https beyond puberty. Sandra Fryhofer MD an internal medicine specialist in Atlanta who was not involved in the study says constipation can be uncomfortable for children and for that reason it is not unreasonable that parents seeking a safe and natural remedy might turn to probiotics for relief. For children who are constipated the first step of treatment consists of education dietary advice and behavioral modifications Tabbers tells WebMD. If not effective laxatives are prescribed. Tabbers says although there is a lack of placebo https research showing the effectiveness of probiotics over placebo their use in clinical practice is widely accepted. The researchers say that studies on adults have shown that the same fermented dairy product that contains B lactis DN seems to have some effect in improving constipation. They conclude that constipation in children differs considerably from that in constipated adults with regard to its prevalence onset etiology symptoms treatment and prognosis. The researchers say that future studies should focus on whether the consumption of this probiotic product could be more effective in children with a short history of constipation. Two of the researchers Catherine Perrin PhD and Nolwenn Crastes are employees of Danone Research which supplied products used in the study. No other potential conflicts were reported. The study is published in the May issue of Pediatrics."

"A painless urine test https could soon help doctors tell when a high prostate https antigen PSA https level means a dangerous cancer https or when its a sign of a more benign condition that may not need further treatment a new study shows. The test looks for a genetic mistake thats present in about half of all cases of prostate cancer https This mistake a case of two genes that come together and fuse doesnt appear to occur anywhere else in the body or even in precancerous conditions making it a highly specific marker for the disease. When the genes fuse says study researcher Scott A. Tomlins MD PhD a pathologist at the University of Michigan Health System in Ann Arbor its a lot like flipping a switch. And that gene when its turned on can cause cancer https Refining PSA Test Results This would be done for men who have been identified as having an elevated PSA Tomlins says. Currently doctors are split over the value of PSA testing for prostate cancer https Thats because PSA can be elevated even when cancer https is not present for example when the prostate is inflamed as in the case of prostatitis https or enlarged as in benign prostatic hyperplasia https BPH httpsmen.webmd.comprostateenlargementbph. Yet high PSA levels over four typically lead to a biopsy which can cause discomfort anxiety https and in rare cases lead to complications like infections. Biopsies https are also expensive costing somewhere between and . Researchers say that right now when PSA levels are elevated its up to patients and their doctors to figure out what to do next. There really arent very good tools to utilize to help make that decision Tomlins says. We wanted to see if our urine markers could be useful in that situation. Testing for Prostate Cancer Biomarkers For the study which is published in the journal Science Translational Medicine researchers tested the urine of men with elevated PSA levels who had gone on to have needle biopsies or surgery to remove their prostates. The test uses strands of artificially created oligonucleotides the building blocks of DNA and RNA which are built to match the code of the fused gene which is called TMPRSSERG. To increase the accuracy of the test researchers also looked for another gene called prostate cancer antigen or PCA which is also found in urine. The two tests together appeared to generate both sensitive and specific results. Sensitive means its unlikely that the test would miss a case of cancer. Specific means that the test is unlikely to be positive if cancer isnt really present. Based on the levels of PCA and TMPRSSERG detected the men were given numerical scores that were classified as being high medium or low. Those scores were then compared to the biopsy results. The men in the highest group have a risk of cancer on biopsy of about and those in the lowest group have a risk of cancer of about says Tomlins. Researchers then narrowed their analysis to see how the urine test scores matched the mens Gleason score which helps doctors gauge how aggressive a cancer may be. What weve found is that your risk of having an aggressive cancer if youre in the high group is about and if youre in the low group the risk of having an aggressive cancer is only about Tomlins says. The company that developed the test GenProbe helped to pay for the study and several authors said they had a personal financial interest in the technology. This is great science says J. Stephen Jones MD chairman of the department of regional urology at the Cleveland Clinic in Ohio. Now that the researchers have validated the test further studies in larger more diverse populations will be important to understand how it is best used. The real key is using this or any test to help drive decisions says Jones who was not involved in the research If it helps me to know who to biopsy or not biopsy thats massively valuable information."

"Scientists report another step in the use of stem cells to help treat people with debilitating heart failure. In an early study of patients Japanese researchers used patients own muscle stem cells to create a patch that was placed on the heart. Over the next year the patients generally showed small improvements in their symptoms including the ability to walk without becoming breathless and fatigued. However experts cautioned that while the results are encouraging theres a lot of work left ahead before stem cells can be used to treat heart failure. Theyve shown that this approach is feasible said Dr. Eiran Gorodeski a heart failure specialist at the Cleveland Clinic in Ohio. But its not clear whether the stemcell tactic was actually effective said Gorodeski who was not involved in the study. Thats because the study didnt include a comparison group that did not receive stem cells. So its possible Gorodeski explained that the modest symptom improvements would have happened anyway. All of the patients were on standard medications and some had heart devices implanted. Stem cells are primitive cells that mature into the various cells that make up the bodys tissues. In the past years or so scientists have tried to use the cells to help repair some of the damage seen in heart failure. Heart failure is a progressive disease where the heart muscle is too damaged to efficiently pump blood throughout the body. It often arises after a heart attack. Symptoms of heart failure include fatigue breathlessness and swelling in the limbs. The condition cannot be cured although medications and implantable devices can treat the symptoms. In the new study the researchers used stem cells from the patients own thigh muscle to create a patch they placed on the heart. Thats in contrast to many past studies where researchers have injected stem cells often from patients bone marrow into the heart. The patch tactic could have some advantages said senior researcher Dr. Yoshiki Sawa of Osaka University. He said animal research suggests that cells in sheet form survive for a longer period compared to injections. To test the safety of the approach Sawas team recruited patients who had debilitating symptoms despite standard heart failure therapies. The scientists extracted stem cells from each patients thigh muscle then cultured the cells so that they formed a sheet. The sheet was placed on each patients heart. The tactic appeared safe the researchers said and there were signs of symptom improvements over the next six months to a year. Why would stem cells from the thigh muscle affect the heart Its not clear Sawa acknowledged. The stem cells dont grow into new heart muscle cells. Instead Sawa explained they seem to produce chemicals called cytokines that can promote new blood vessel growth in damaged areas of the heart. The theory he said is that hibernating cells in the heart muscle can then function better. Still its too soon to know what the new findings mean said Gorodeski. This type of trial called phase is designed to look at the safety and feasibility of a therapy Gorodeski said. It takes laterphase trials where some patients receive the treatment and others do not to prove that a therapy actually works. Those trials are underway Sawa said. Other studies are further along. Last year researchers reported on a trial testing infusions of stem cells taken from the bone marrow of patients with severe heart failure. Patients who received the therapy were less likely to die or be hospitalized over the next year versus those given standard treatment only. But the study was small and the stem cells had only a minor impact on patients heart function. So its not clear why the stemcell patients fared better Gorodeski said. For now he stressed all stemcell therapies for heart failure remain experimental. Theres no cell therapy that we can offer patients right now Gorodeski said. The message for patients he added is that heart failure can be treated and researchers are looking for innovative ways to improve that treatment. The study was published April in the Journal of the American Heart Association. More information The American Heart Association has more on heart failure http_UCM__Article.jsp. SOURCES Yoshiki Sawa M.D. Ph.D. professor cardiovascular surgery Osaka University Graduate School of Medicine Osaka Japan Eiran Gorodeski M.D. M.P.H. staff cardiologist assistant professor medicine Cleveland Clinic Ohio April Journal of the American Heart Association online"

"Up until the Mona Lisa Touch Laser there has not been a successful nonmedication alternative treatment option for vaginal dryness httpshealth.usnews.comwellnesshealthbuzzarticlesdontputthisinyourvaginadoctorssay also known at vulvovaginal atrophy or VVA. Women in menopause or those who cannot take estrogen including our breast cancer survivors httpshealth.usnews.comwellnessagingwellarticleswhatarethetypesofbreastcancer often suffer in silence when their vagina decides to completely dry up and lose its moist and supple lining causing disruptive symptoms. It can affect your ability to do everyday activities such as exercise and engage in sexual contact and intercourse due to pain and discomfort. Symptoms of VVA include dryness burning irritation itching urinary incontinence and urinary frequency. These symptoms are mainly caused by a condition called vaginal atrophy which is due to menopause httpshealth.usnews.comhealthnewshealthwellnessslideshowschangeswomengothroughinmenopause or perimenopause or occurs after child birth. See LittleKnown Things That Happen to Your Body After Giving Birth httpshealth.usnews.comhealthnewshealthwellnessarticleslittleknownthingsthathappentoyourbodyaftergivingbirth. Women with VVA report the following percent of women report vaginal atrophy negatively impacts their lives. percent failed to recognize vaginal atrophy as a chronic condition httpshealth.usnews.comhealthnewspatientadvicearticleswhattoknowaboutpelvicorganprolapse. percent report they did not consult a gynecologist for finding a solution. percent only recognized the common symptoms of vaginal atrophy. Estrogen is the best treatment option for VVA since it rehydrates the vagina and restores lubrication and pH balance in the vagina. Unfortunately this is not always an appropriate option especially if you have breast cancer or are unable or unwilling to be on estrogen. Other medication options include Osphena vaginal estrogen steroid and testosterone creams and lubrications or moisturizers. See The Fertility Preservation Diet How to Eat If You Want to Get Pregnant httpshealth.usnews.comhealthnewshealthwellnessslideshowsthefertilitypreservationdiethowtoeatifyouwanttogetpregnant. The Mona Lisa Touch Laser Treatment or MLLT is one of the newest kids on the block to combat vaginal atrophy. There are other types of vaginal lasers but they dont have the same track record Food and Drug Administration support and longterm studies as the MLLT. An Italianbuilt laser device the Mona Lisa Touch Laser holds tremendous promise in treating a vagina that has been transformed in menopause httpshealth.usnews.comwellnessslideshowswhattoeatanddrinkduringmenopause or via cancer treatment side effects httpshealth.usnews.comhealthnewspatientadvicearticlesgettingthebetterofchemobrain. Once youve had a pelvic exam to assure youre an appropriate candidate a physician trained in the use of the Mona Lisa which is actually a small vaginal laser inserts the device into the vagina during three minute sessions six weeks apart. Many women report positive changes after just the first minute treatment which involves removing the dried skin inside that vagina stimulating collagen and blood flow production and allowing vaginal revival. The end result is a vagina makeover a new lease on a vagina if you will with more elasticity and natural lubrication of the tissue inside the vagina. Although it may sound too good to be true the results are proving to be a game changer in the way vagina atrophy is being treated without hormones which is a relief to many women and their partners. See Things No One Tells You About Breastfeeding httpshealth.usnews.comhealthnewshealthwellnessslideshowsthingsnoonetellsyouaboutbreastfeeding. Mona Lisa is ideal for women who cant take estrogen due to a personal or family history of breast cancer httpshealth.usnews.comwellnessagingwellarticleswhatfactorsmayincreasemyriskofbreastcancer or for those who are unhappy with the side effects associated with hormone replacement therapy httpshealth.usnews.comhealthcareforbetterarticlesmenopausalhormonetherapycontroversyoropportunity. Still there is a painful part of the procedure the cost. It runs about a session and is most likely not covered by insurance."

"Age is just a number. But for men that number says a lot about whats going on in their bodies. Starting at about age men start producing less testosterone the hormone that helps spark sex drive build muscle and stoke energy ambition and aggression. In short it helps men feel manly. For all of the talk about male menopause the loss of testosterone isnt anything like the hormonal nose dive that women go through. Instead of essentially disappearing all at once testosterone levels usually decline by about every year although they can drop more dramatically especially if a man becomes ill. Men diagnosed with unusually low levels of testosterone are sometimes treated with prescription testosterone injections patches or creams. Men who want to regain the levels of their younger days without a prescription may be interested in a different route overthecounter products that promise to boost testosterone naturally. TestoJack a supplement from NOW Foods contains a blend of herbs including Eleutherococcus senticosus Tribulus terrestris and Eurycoma longifolia along with zinc magnesium and vitamin B among other ingredients. Users are instructed to take two capsules once or twice a day. Its available at many healthfood stores and you can expect to pay roughly to for a bottle of capsules. HGH Up a widely available supplement from Applied Nutriceuticals contains among other ingredients the herbs Chlorophytum borivillanium Mucuna pruriens and Huperzia serrata along with green tea magnesium and a vitamin B complex. Users are instructed to take five capsules every day on an empty stomach three in the morning and two in the afternoon. A bottle of capsules costs about . The claims The NOW website says TestoJack supports male reproductive function and healthy testosterone levels. The tribulus in the product is said to be especially helpful for virility. Despite the suggestive name of the product NOW doesnt claim that TestoJack actually increases testosterone says Neil Levin the companys nutrition education manager. It supports healthy testosterone levels he says. According to the label HGH Up promotes radical increases in growth hormone and testosterone production. The website says that it can provide the physiological benefits comparable to that of fully hormonal products while minimizing potential side effects. Though the product is marketed mainly to weightlifters and bodybuilders it has a growing following among older men looking for rejuvenation says Don Orrell president of Applied Nutriceuticals. For an older man who has low testosterone there is absolutely no downside to taking this he says. Orrell notes that the way in which the product boosts testosterone is a bit of a mystery thats the magic pixie dust part he says but he has no doubt that it works. The anecdotal evidence is overwhelming he adds. The bottom line Dr. John Morley a testosterone expert and director of geriatrics at St. Louis University says that theres not a lot of scientific evidence for any supplement that claims to boost or promote testosterone. And for him thats a real problem. These sorts of products have been around forever he says. As far as I know none of them have been proven to work in a carefully controlled trial. Some of the individual ingredients in these products have been tested with lessthanimpressive results. In a study in the Journal of Strength and Conditioning Research Australian researchers found that giving rugby players daily doses of Tribulus terrestris for five weeks had no effect on their testosterone levels. Chlorophytum one of the ingredients in HGH Up has long been used as a supposed aphrodisiac for men. A search of the medical literature uncovers a single study suggesting that it may have testosteronelike effects including enhanced sex drive and stronger erections but the study was conducted on rats not humans. Morley often prescribes testosterone for men who have a significant deficit of the hormone a condition called hypogonadism. The prevalence of this condition is controversial it depends on how one measures testosterone and defines normal levels but Morley estimates that to of middleaged men dont have enough testosterone to feel their best sexually and otherwise. Even among these men about onethird dont respond to testosterone treatment. In other words testosterone is hardly a surefire remedy against the ravages of aging. Overthecounter testosterone products may carry hidden dangers. A study in Clinical Cancer Research found that two men taking a supplement called Teston developed unusually aggressive fastgrowing prostate cancer. Lab tests showed that the product contained hormones including testosterone that werent on the label a common issue with nonprescription products. The manufacturer quickly pulled it from the market. The problem with these sorts of supplements is that they dont have to meet the regulations of the Food and Drug Administration says Dolores Lamb a coauthor of the Teston study and professor of urology at Baylor College of Medicine in Houston. A man who thinks hes short on testosterone shouldnt be looking in a health food store for answers Morley says. He needs to go to a doctor to get checked out."

"In a Canadian first a medical team has implanted a wireless device inside a heart failure patient permitting clinicians to monitor the patients cardiovascular status virtually and in realtime and proactively adjust treatment to prevent costly potentially unnecessary hospitalization. Heart failure is an epidemic that commonly leads to hospitalization says Dr. Heather Ross scientific lead at the Ted Rogers Centre for Heart Research and cardiologist Peter Munk Cardiac Centre University Health Network. Hospitalization is often necessary when patients start to retain fluid develop congestion and experience shortness of breath. This technology is a way to directly measure how much fluid is in a patient allowing us to intervene before they develop symptoms of congestion before they end up in hospital. This is a big gamechanger. Funded by the Ted Rogers Centre for Heart Research the device called CardioMEMS HF System was successfully implanted by interventional cardiologists at the Peter Munk Cardiac Centre in March . The system features a small butterflylike sensor that then sits inside the pulmonary artery of a heart failure patient. When the patient lies on an accompanying antennaequipped pillow device the sensor provides important data including the patients lung pressure readings to clinicians via a secure website. Never before have we had the ability to obtain a patients accurate lung pressure data while they are outside the hospital said Meredith Linghorne nurse practitioner Peter Munk Cardiac Centre. Traditionally weve relied on a patient describing symptoms and by then they may have already progressed to the point of hospitalization. With this device we can see warning signs days in advance and adjust treatment accordingly. The most rapidly rising cardiovascular disease in Canada heart failure affects close to one million Canadians and an estimated million people globally. In Canada heart failure patients stay an average of almost days for each hospital admission accounting for . million hospital stays a year. These patients live an average of . years after diagnosis and cost the Canadian healthcare system more than billion annually. About onequarter of these patients return to hospital within three months while approximately per cent return to hospital within six months. The CardioMEMS HF System is designed to monitor heart failure patients whose condition is serious but who are not so ill that the technology cannot improve their outcome. The first Canadian patient implanted with the heart monitor will be among patients within the Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre to be fitted with the device over the next nine months. Produced by Abbott the CardioMEMS HF System is approved in the United States by the Food Drug Administration FDA and is currently awaiting approval by Health Canada. Video interview Dr. Heather Ross cardiologist and Meredith Linghorne nurse practitioner. https ABOUT THE TED ROGERS CENTRE FOR HEART RESEARCH The Ted Rogers Centre for Heart Research aims to develop new diagnoses treatments and tools to prevent and individually manage heart failure Canadas fastest growing cardiac disease. Enabled by an unprecedented gift of million from the Rogers family the Centre was jointly conceived by its three partner organizations the Hospital for Sick Children University Health Network and the University of Toronto. Together they committed an additional million toward the Centre representing a million investment in basic science translational and clinical research innovation and education in regenerative medicine genomics and the clinical care of children and adults. It is addressing heart failure across the lifespan. http trogersresearch ABOUT THE PETER MUNK CARDIAC CENTRE The Peter Munk Cardiac Centre is the premier cardiac centre in Canada. Since it opened in the Centre has saved and improved the lives of cardiac and vascular patients from around the world. Each year approximately patients receive innovative and compassionate care from multidisciplinary teams in the Peter Munk Cardiac Centre and the Centre trains more cardiologists cardiovascular surgeons and vascular surgeons than any other hospital in Canada. The Centre is based at the Toronto General Hospital and the Toronto Western Hospital members of University Health Network. http"

"You smoked for years. Maybe you still do. Now that Medicare promises to begin covering lung cancer screening http should you sign up Thats a difficult question. The eligibility requirements seem fairly clearcut You can receive an annual lowdose CT scan if you are to years old have a smoking history of at least pack years meaning that you smoked a pack a day for years or two packs a day for and so on and still smoke or quit only within the past years. More than million Americans will be eligible for screening the United States Preventive Services Task Force http an independent volunteer panel of national experts has estimated though many of those millions arent yet Medicare recipients. But screening will not help everyone who is eligible experts warn. Like any medical test or procedure it will subject some patients to harm. How do you make a blanket coverage decision about something thats a good idea for some people and not so good for others said Dr. Michael Gould a pulmonologist and senior research scientist at Kaiser Permanente Southern California and a nonvoting member of Medicares coverage advisory committee. That committee voted last year against covering the procedure saying it found insufficient evidence of benefit. A few months earlier the preventive services task force had come to precisely the opposite conclusion and recommended annual screening httpannals.orgarticle.aspxarticleid which made coverage mandatory for private insurers but not for Medicare. Overriding its own advisory committee Medicare approved coverage http but decided to require a first a counseling and shared decisionmaking visit with a physician or other medical professional before reimbursement for a scan. Because the followup testing is invasive biopsies and such and lung cancer has such serious mortality and morbidity risks we wanted to ensure that Medicare beneficiaries were informed said Dr. Patrick Conway chief medical officer at the Centers for Medicare and Medicaid Services http Lung cancer overwhelmingly caused by smoking still causes more deaths than any other cancer http in part because it is hard to detect at more curable stages. Unlike lumps in breasts for example nothing in your lungs allows you to sense the presence of a nodule or mass said Dr. Douglas Arenberg director of the lung cancer screening program at the University of Michigan Medical School. With treatment usually surgery percent to percent of patients with Stage lung cancer and half of those with Stage survive for at least five years. But most lung cancer is diagnosed when the disease is more advanced leading to lousy overall mortality rates Just percent of all lung cancer patients survive for five years. Pulmonologists have tried for years to find ways to detect lung cancer earlier. Experiments using ordinary chest Xrays proved disappointing. Then in researchers running the National Lung Screening Trial http involving smokers and former smokers ages to reported encouraging findings Patients who received a lowdose CT scan annually for three years were percent less likely to die of lung cancer http over an average of . years than those tested with Xrays. Those results led to the preventive services task forces endorsement and eventually to Medicares approval. Were covering evidencebased preventive services for beneficiaries which will save lives Dr. Conway said. How many lives While the overwhelming number of people with lung cancer are or were smokers most smokers dont develop lung cancer. So although a percent reduction in mortality sounds impressive it represents a small number of people. In the national trial those screened with chest Xrays had about a . percent chance of dying from lung cancer http during the study period in the CT scan group it was about . percent. For every thousand people screened with a lowdose CT three fewer died of lung cancer. Lay people struggle to grasp these kinds of numbers. They look at me and say Doc just tell me what to do Dr. Arenberg said. Or they give a howcanithurt shrug and opt in Maybe theyll be among the three in saved. The problem is testing can cause harm too httpannals.orgarticle.aspxarticleid. First a high proportion of those tests will trigger a false alarm. CT scans cant distinguish well between small nodules that arent dangerous and those that become lethal. In the national trial close to percent of participants got positive results from at least one of their three CT scans but more than percent of these nodules werent cancerous. False positives usually require additional scans over several years to determine whether nodules are malignant. Meanwhile you have to be willing to live with that uncertainty Dr. Gould said. Worse some positive results require more invasive followup particularly biopsies which also have risks though low ones. Twenty to percent of the time a biopsy causes a pneumothorax http or collapsed lung which usually heals on its own but occasionally requires hospitalization. Biopsies can also produce false negatives or dangerous bleeding. For older people the odds shift somewhat. Their cancer risk rises with age so the scan will detect more lung cancer httpannals.orgarticle.aspxarticleid according to an analysis of the national trial participants over age . But their rate of false positives rose too making invasive diagnostic procedures more likely. At older ages these procedures may not be trivial. Elayne Green a retiree in Boca Raton Fla. learned this in when she was . Because shed smoked for years before hypnosis helped her stop at her health care provider recommended lung cancer screening. She agreed and paid out of pocket. She wouldnt meet Medicare eligibility requirements now. The CT scan found a hot spot she was told. Regular followup screenings felt like a guillotine over my head she said. So Mrs. Green had diagnostic surgery called wedge resection which found no cancer but caused considerable pain. I couldnt wear a brassiere for three months she recalled. Among the to yearolds getting CT scans in the national trial moreover many had other serious health problems heart disease diabetes hypertension pulmonary disease which probably contributed to only percent surviving five years compared with percent among those under age . Researchers call it competing mortality httparchinte.jamanetwork.comarticle.aspxarticleid. Finding lung cancer is a hollow victory if patients endure testing and treatment then die of another illness before the cancer would have killed them. Most older adults especially smokers have multiple chronic diseases. If I find a teensy lung cancer in a yearold with heart disease I may not have done him any favor Dr. Arenberg said. In fact if screening finds cancer some seniors wont withstand the surgery usually a lobectomy http_index.html_rmoduleinline that may cure it. The postsurgical death rate in the national trial was just percent but that involved major medical centers with specialized radiologists and surgeons the ideal setting. Nationally deaths from this operation run two to four times higher and they increase with the patients age. And the trial provides no information on screening results for those older than . So those required shared decisionmaking visits with doctors will involve lots of very individual questions and judgments. Researchers are developing decision aids to guide physicians and consumers beginning to struggle with lung cancer screening. A University of Michigan team has put a helpful one online at shouldiscreen.com http And Medicare has established a registry to see how well largescale screening works. But it is worth remembering that however effective it is screening cant ward off disease. It only finds the damage already done. The only way to prevent lung cancer or reduce your risk Dr. Gould said is to stop smoking."

"Annual incidence rate of developing a primary malignant brain tumor httpshealth.usnews.comhealthnewspatientadvicearticlesharnessingtheimmunesystemtocombataggressivebraintumors is n population and the lifetime risk is . percent. In addition metastases from systemic cancer to the brain are times more common than primary malignancy of the brain. Brain tumors can develop in both males and females and at any age though theyre more common in adults. The most common type of primary malignant brain tumors is malignant glioma. Brain tumors are diagnosed with clinical symptoms as well as advance imaging modalities of the brain such as computed tomography or magnetic resonance imaging. Conventional surgery is usually the first step to have tissue diagnosis and decrease the burden of tumor. However its not a cure for malignant brain tumors and is usually followed by other types of adjuvant treatments such as radiation andor chemotherapy. Not all brain tumors are amenable to conventional surgery for multiple reasons such as location in deep parts of the brain with limited surgical access or being adjacent to critical structures. In addition in some conditions increased risk of morbidity is seen after surgery like in recurrent tumors with prior radiation or surgery. These patients especially in the recurrent setting have limited treatment options httpshealth.usnews.comhealthnewspatientadviceslideshowsinnovationsincancertherapy. Focused highdose radiation like stereotactic radiosurgery is useful in brain metastasis and could be used as initial treatment. However radiosurgery is not useful for malignant primary brain tumors like gliomas and even in metastasis it does have variable degree of failure based upon the size of tumor and prescribed radiation dose. Patients who are suffering from deep seated or recurrent primary brain tumors as well as those with brain metastases who failed radiation httpshealth.usnews.comhealthnewspatientadvicearticlesradiationevolvingchoicesincancertreatment have limited options and may benefit from alternative treatments like laser ablation. Laser ablation is a minimally invasive treatment modality for brain tumors that uses laser technology to increase the temperature of tumor and subsequently kill tumor cells. It also might have a role in enhancement of chemotherapy httpshealth.usnews.comhealthnewspatientadvicearticleseatingonchemotipstoovercometasteandweightchallenges and radiation therapy effects by disruption of repair mechanisms in tumor cells and increase the permeability of blood vessels of brain. Unlike conventional surgery it doesnt need extensive surgical exposure. Actually it works through a small stab incision in the skin and a small hole in the skull. Laser probe will be inserted using intraoperative navigation and controlled firing of the laser will cause an increase in the temperature of tumor and eventually destruction of tumor cells. Although this technology has been around for decades new technical advancements like specific MRthermometric scans during surgery have an almost realtime measurement of brain temperature and control of the extension of treatment field which allows the robotic probe driver to change direction and the depth of laser probe during surgery to have complete coverage of the tumor. Plus a completely newly designed laser probe with a builtin cooling system prevents excessive temperature of the probe during surgery which has made a resurgence of this treatment modality for intracranial applications in recent years. Since five years ago when the NeuroBlate System was approved by the Food and Drug Administration hundreds of patients with brain tumors httpshealth.usnews.combesthospitalsrankingsneurologyandneurosurgery who used to be considered inoperable underwent this procedure successfully with promising outcomes. Its especially crucial for patients with brain tumors in difficulttoaccess locations as well as for those who have experienced failure of prior radiation treatment. Being a relatively new procedure NeuroBlate doesnt yet qualify as a standard treatment for brain tumors. However initial results have been promising and further studies are on the way. For patients with a malignant brain tumor having more quality time with family and friends httpshealth.usnews.comhealthnewspatientadvicearticlesrobitussinforbraincancerpartii is sometimes all that they can wish for. NeuroBlate might be a ray of hope in their gray sky."

"Just rip off the bandage dive into the freezing water close your eyes and take it. For cigarette smokers who waver at the edge of a decision to quit and consider strategies to ease the transition a new study finds that the allin approach is more likely to work than wading in slowly. In a clinical trial that pitted wouldbe quitters who stopped smoking altogether on quit day against those directed to wean themselves off the butts over two weeks researchers found that those who went cold turkey were more likely than gradual taperers to succeed in quitting for four weeks and for six months. The differences werent overwhelming at four weeks . of the gradualists were no longer smoking compared to of the doitnowers. At six months . of the gradualists and of those who stopped smoking on quit day were former smokers. But in a group of this size those differences are considered statistical proof that quitting abruptly is a superior strategy to tiptoeing into the decision. The study http was published in the Annals of Internal Medicine on Monday. Those numbers also underscore a somewhat depressing truth among cigarette smokers wishing to quit Failure is common. Most studies have shown that roughly oneinfour quitters who use medicines to aid in their effort is able to remain abstinent for six months and many who make it that far subsequently relapse. Successful quitters tend to have one thing in common Most of them tried to quit many times before succeeding. The study was conducted in Great Britain where participants included people who smoked at least cigarettes a day or who had diminished lung capacity consistent with regular smoking. To participate subjects had to agree to quit within two weeks of enrollment. They were then assigned to either an abruptquit or gradualquit group. Enrollees in the gradualquit group did get to choose whether in the twoweek period over which they were to stop smoking they would taper their daily cigarettes observe smokefree periods or smoke on a schedule. While they followed those gradualquit patterns they wore nicotine patches and got fastacting nicotine products including gum tablets lozenges and sprays. At a nurse visit one week before their finalquit day the gradualists had reduced their cigarette consumption on average by just short of the goal. By quitday they had reduced on average by short of the goal. The abruptquitters were issued nicotine patches which they wore for the two weeks leading up to their quit day. After that they were issued nicotinereplacement products to ease their withdrawal. And despite being told not to alter their smoking patterns as their quitday approached they did decrease their smoking by an average of . After the twoweek period was up and cessation began in both conditions both groups experienced withdrawal symptoms and urge intensities that were roughly the same. The provision not only of nicotinereplacement products but of schedules structure and professional encouragement for gradual quitters likely optimized those participants likelihood of success the researchers said. And yet their success rates still fell well below those of abruptquitters. The latest finding falls in line with other research on quitting. It may be that those who choose to quit gradually are not as committed to quitting as are those willing to take the plunge but since participants here were randomized to their condition this study suggests that different levels of motivation might not fully explain the different rates of success. The researchers acknowledge that this is hardly the last word on the best way to quit. In a large population of smokers the gradual approach might feel kinder and gentler to many smokers and prompt more to attempt quitting more often. Quitting gradually is at least sometimes successful. So over time and in a large population getting more people to try might result in greater reductions in smoking than abrupt quitting they acknowledge. Heres what the American Cancer Society http says about quitting and the oftendiscouraging statistics The truth is that quit smoking programs like other programs that treat addictions often have fairly low success rates. But that doesnt mean theyre not worthwhile or that you should be discouraged. Your own success in quitting and staying that way is what really counts and you have some control over that. Even if you dont succeed the first few times keep trying. You can learn from your mistakes so that youll be ready for those pitfalls next time."

"Patients with the most lethal form of acute myeloid leukemia AML based on genetic profiles of their cancers typically survive for only four to six months after diagnosis even with aggressive chemotherapy. But new research indicates that such patients paradoxically may live longer if they receive a milder chemotherapy drug. Treatment with the less intensive drug decitabine is not a cure. But surprisingly AML patients whose leukemia cells carried mutations in a nefarious cancer gene called TP consistently achieved remission after treatment with decitabine. Their median survival was just over a year. The study by a team of scientists at Washington University School of Medicine in St. Louis is published Nov. in The New England Journal of Medicine. In AML treatment involves intensive chemotherapy to try to kill the patients leukemia cells and put the cancer into remission. If successful a followup bonemarrow transplant can offer a possible cure but this course of treatment is recommended only for patients with a high risk of relapse because the procedure can cause severe complications even death. Whats really unique here is that all the patients in the study with TP mutations had a response to decitabine and achieved an initial remission said the studys senior author Timothy J. Ley MD the Lewis T. and Rosalind B. Apple Professor of Medicine noting that in AML TP mutations have been correlated with an extremely poor prognosis. With standard aggressive chemotherapy we only see about to percent of these patients achieving remission which is the critical first step to have a chance to cure patients with additional therapies. The findings need to be validated in a larger trial Ley added but they do suggest that TP mutations can reliably predict responses to decitabine potentially prolonging survival in this ultra highrisk group of patients and providing a bridge to transplantation in some patients who might not otherwise be candidates. In an accompanying editorial Elihu Estey MD an AML expert at the University of Washington Medical Center and Fred Hutchinson Cancer Research Center in Seattle noted that AML is not one disease but many each driven by different genetic mutations. The results of the current trial he said point to the inevitable need to replace large cancer clinical trials evaluating homogeneous drug treatments with smaller trials that involve subgroups of patients with treatments targeted to their specific mutations. The current study involved patients treated with decitabine at the Siteman Cancer Center at Washington University School of Medicine and BarnesJewish Hospital and at the University of Chicago. The patients either had AML a cancer of the bone marrow or myelodysplastic syndrome MDS a group of blood cancers that often progresses to AML. This year an estimated people living in the U.S. will be diagnosed with AML and at least deaths will be attributed to the disease. Decitabine often is given to older patients with AML or MDS because it is less toxic than standard chemotherapies. But fewer than half of patients who get the drug achieve an initial remission so the researchers wanted to determine whether specific mutations in the patients cancer cells could predict their responses to treatment. To find out they sequenced all the genes in patients cancer cells or analyzed select cancer genes. They also conducted standard tests to look for broken missing or rearranged chromosomes. Then the researchers correlated these molecular markers with treatment response to identify subgroups of patients likely to benefit from decitabine. Among the patients in the study percent achieved a remission with decitabine. But remarkably all patients whose leukemia cells carried TP mutations went into remission. Patients also were likely to respond to decitabine if they were deemed to have an unfavorable risk prognosis based on extensive chromosomal rearrangements in their cancer cells many of these patients also had TP mutations. Indeed percent of patients with an unfavorable risk achieved remission compared with percent of patients who had more favorable prognoses. The challenge with using decitabine has been knowing which patients are most likely to respond said coauthor Amanda Cashen MD an associate professor of medicine who led an earlier clinical trial of decitabine in older patients with AML. The value of this study is the comprehensive mutational analysis that helps us figure out which patients are likely to benefit. This information opens the door to using decitabine in a more targeted fashion to treat not just older patients but also younger patients who carry TP mutations. First author John Welch MD PhD an assistant professor of medicine added Its important to note that patients with an extremely poor prognosis in this relatively small study had the same survival outcomes as patients facing a better prognosis which is encouraging. We dont yet understand why patients with TP mutations consistently respond to decitabine and more work is needed to understand that phenomenon. Responses to decitabine are usually shortlived however with remissions typically lasting for about a year. Decitabine does not completely clear all the leukemia cells that carry TP mutations and these cells invariably become resistant to the drug leading to relapse. Remissions with decitabine typically dont last long and no one was cured with this drug Ley explained. But patients who responded to decitabine live longer than what you would expect with aggressive chemotherapy and that can mean something. Some people live a year or two and with a good quality of life because the chemotherapy is not too toxic. Roughly percent of AML patients carry TP mutations in their leukemia cells. Among patients in the study with such mutations median survival was . months which is not significantly different from the . months survival seen in patients without the mutations and is longer than the typical four to sixmonth survival observed in such patients treated with more aggressive therapies. Decitabine was approved by the FDA in as a treatment for MDS but oncologists often prescribe it offlabel as a treatment for AML particularly in older patients. AML typically strikes in a persons mids the average age of people in the current study was . Were now planning a larger trial to evaluate decitabine in AML patients of all ages who carry TP mutations Welch said. Its exciting to think we may have a therapy that has the potential to improve response rates in this group of highrisk patients. The research is supported by an AMLSPORE grant and the Genomics of AML Program Project grant both from the National Cancer Institute at the National Institutes of Health NIH grant numbers P CA and P CA. Welch J Petti A Miller C Fronick C OLaughlin M Fulton R Wilson R Baty J Duncavage E Tandon B Lee YS Wartman L Uy G Ghobadi A Tomasson M Pusic I Romee R Fehniger T StockerlGoldstein K Vig R Oh S Abboud C Cashen A Schroeder M Jacoby M Heath S Luber K Janke M Hantel A Khan N Sukanova M Knoebel R Stock W Graubert T Walter M Westervelt P Link D DiPersio J and Ley T. TP and decitabine in acute myeloid leukemia and myelodysplastic syndromes. The New England Journal of Medicine. Nov. . Washington University School of Medicines employed and volunteer faculty physicians also are the medical staff of BarnesJewish and St. Louis Childrens hospitals. The School of Medicine is one of the leading medical research teaching and patientcare institutions in the nation currently ranked sixth in the nation by U.S. News World Report. Through its affiliations with BarnesJewish and St. Louis Childrens hospitals the School of Medicine is linked to BJC HealthCare. Siteman Cancer Center ranked among the top cancer treatment centers by U.S. News World Report also is one of only a few cancer centers in the U.S. to receive the highest rating of the National Cancer Institute NCI. Comprising the cancer research prevention and treatment programs of BarnesJewish Hospital and Washington University School of Medicine in St. Louis Siteman is Missouris only NCIdesignated Comprehensive Cancer Center and the states only member of the National Comprehensive Cancer Network."

"A new study finds that individuals struggling with obesity who are not candidates for weightloss surgery can benefit substantially from nonsurgical endoscopic sleeve gastroplasty according to research presented at Digestive Disease Week DDW http the largest international gathering of physicians researchers and academics in the fields of gastroenterology hepatology endoscopy and gastrointestinal surgery. Patients who underwent ESG a procedure performed through the mouth with an endoscope to accordion the stomach by suturing pleats to reduce its size achieved greater weight loss than laparoscopic banding but less weight loss than laparoscopic sleeve gastrectomy surgery. Patients who received treatment endoscopically had shorter hospital stays and lower costs than those who had laparoscopic surgery. Obesity continues to be a problem in America and it is an epidemic rapidly spreading around the world said Reem Z. Sharaiha MD MSc assistant professor of medicine at Weill Cornell Medicine and attending physician at New YorkPresbyterianWeill Cornell Medical Center the studys lead author. Our research the first to compare these treatments demonstrates that endoscopic sleeve gastroplasty is safe and effective in helping patients lead healthier lives. It should be considered as another tool available to clinicians and patients in the fight against obesity. Dr. Sharaiha followed patients who underwent ESG patients laparoscopic sleeve gastrectomy patients or laparoscopic banding . During the oneyear followup period patients went to an academic bariatric center of excellence as part of their treatment. At oneyear followup patients who chose laparoscopic sleeve gastrectomy surgery achieved the greatest percent total body weight loss at . percent compared to . percent for endoscopic sleeve gastroplasty patients and . percent for laparoscopic banding patients. Researchers found that patients who received endoscopic treatment had lower complications percent than those who received surgical treatment percent for laparoscopic sleeve gastrectomy and percent for laparoscopic banding. Dr. Sharaiha noted that these findings do not suggest that endoscopic sleeve gastroplasty will replace the two surgical treatments as weightloss interventions. Instead these results show that endoscopic sleeve gastroplasty is another possibility that patients and healthcare providers should consider when discussing options. While endoscopic sleeve gastroplasty is performed with an endoscopic device through the mouth laparoscopic sleeve gastrectomy involves a small surgical incision in the belly to place a tube in the abdomen allowing doctors to reduce the stomachs volume. With laparoscopic banding doctors insert a tube through an incision in the belly to place a band around the stomach restricting food intake. The team also reported that endoscopic sleeve gastroplasty patients customarily left the hospital on the same day of treatment while laparoscopic sleeve gastrectomy patients stayed for about three days and laparoscopic banding patients for a day and a half. When examining cost researchers reported endoscopic sleeve gastroplasty resulted in the lowestcost with an average institutional procedure cost of compared to for laparoscopic sleeve gastrectomy and for laparoscopic banding. For years patients seeking weightloss interventions had limited options because they could not tolerate or did not want surgery or it was not even an option for them added Dr. Sharaiha. Our research shows that endoscopic sleeve gastroplasty can be the treatment theyve been looking for. Its less invasive than surgery and helps them reach their health goals. Obesity is associated with heart disease stroke diabetes and some cancers and researchers estimate that it is the secondleading cause of preventable death after tobacco use. The Centers for Disease Control and Prevention CDC estimates that more than one in three U.S. adults is obese having a body mass index of or more. The CDC estimated the medical cost of obesity in the U.S. at approximately billion in . Globally the World Health Organization estimates that more than million people were obese in . Dr. Reem Z. Sharaiha will present data from the study Endoscopic Sleeve Gastroplasty Laparoscopic Sleeve Gastrectomy and Laparoscopic Band for Weight Loss How Do They Compare abstract on Saturday May at a.m. CT in S of McCormick Place. For more information about featured studies as well as a schedule of availability for featured researchers please visit http Dr. Sharaiha did not have any disclosures for DDW research. Digestive Disease Week DDW is the largest international gathering of physicians researchers and academics in the fields of gastroenterology hepatology endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases AASLD the American Gastroenterological Association AGA Institute the American Society for Gastrointestinal Endoscopy ASGE and the Society for Surgery of the Alimentary Tract SSAT DDW takes place May at McCormick Place Chicago. The meeting showcases more than abstracts and hundreds of lectures on the latest advances in GI research medicine and technology. More information can be found at http"

"For most of her life Fran Friedman struggled with compulsive eating. At years old she was foot and weighed pounds. Thats when she opted for bariatric surgery. The surgery http worked. Friedman who is now and lives in Los Angeles lost pounds. It was a miracle Friedman says not to feel hungry. It was the first time in my life that Ive ever lost a lot of weight and was able to maintain it. Friedman kept the weight off for almost years. But then to her dismay she started to gain it back. I thought I was cured she says. I thought I could eat like regular people. Shes not alone says Dr. Rabindra Watson http Assistant Clinical Professor at the University of California Los Angeles Division of Digestive Diseases. About one in three patients regain significant amounts of weight a few years after surgery to reduce the size of the stomach pouch. Bariatric surgery shrinks the stomach to about the size of an egg so people feel full from eating very little food. The problem is that over the years the stomach stretches and when that happens Watson says Patients are able to eat more at one sitting and they feel hungrier more often. At the same time hormonal changes that reduce the appetite and take effect immediately after the surgery begin to decline. Watson says we dont know for sure but its possible the body begins to adapt to those changes which is why the weight loss is reversed over time. For Fran Friedman it meant a pound weight gain and a bout of depression. The reality hits she says. Do I want to go back to where I was or do I want to maintain this level of quality of life So Friedman opted for a less invasive procedure to make her stomach smaller again. Its called Transoral Outlet Reduction httpgastro.ucla.edusite.cfmid or TORe for short. Its one of several procedures designed to help people maintain the benefits of bariatric surgery. This procedure involves inserting an endoscope through the mouth into the stomach while the patient is under anesthesia. It costs http to and insurance coverage varies. Article continues after this message from our sponsor If the stomach pouch has stretched new sutures are put in place to once again reduce the size of the stomach. After the surgery Watson says patients report feeling fuller and less hungry and they ultimately gain greater control over what they are eating. And research http conducted over the past decade suggests it works. There are no significant side effects to the surgery and patients can return to work the day after they have the procedure. For Friedman it did the trick. She has lost pounds since her second surgery. And now she says with the help of a support group she is recommitted to watching what she eats and how much she exercises. She wants to lose another pounds. And more importantly she wants to keep the weight off."

"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."

"THE QUESTION Memory wanes as mild cognitive impairment or Alzheimers disease sets in. Might insulin a drug used for diabetes help THIS STUDY randomly assigned adults with mild cognitive impairment or mild to moderate Alzheimers disease to be given via nasal spray or milligram doses of insulin detemir Levemir a manmade insulin that is longer acting than natural insulin or a placebo daily for three weeks. Standardized tests given at the start and end of the study showed that working memory sometimes thought of as shortterm memory improved for those given milligrams of insulin but not for those given the smaller dose or the placebo. Also among those in the milligram group people carrying what is sometimes called the Alzheimers gene APOEe showed more improvement than noncarriers. WHO MAY BE AFFECTED People in the early stages of dementia. Some research has suggested a link between lower levels of insulin in cerebrospinal fluid and the formation of plaques often found in the brain tissue of people with Alzheimers. Memory loss is often the first sign of dementia which in later stages can interfere with such things as the ability to solve problems control emotions or do such daily tasks as eating and dressing. CAVEATS The study involved a relatively small number of participants and lasted a short time a larger and longer study would be needed to adequately test effectiveness and safety. FIND THIS STUDY February issue of the Journal of Alzheimers Disease For an early version of the study abstract click on Contents then Volume No. in press and search for insulin. LEARN MORE ABOUT dementia at ninds.nih.govdisorders and The research described in Quick Study comes from credible peerreviewed journals. Nonetheless conclusive evidence about a treatments effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind THE QUESTION Memory wanes as mild cognitive impairment or Alzheimers disease sets in. Might insulin a drug used for diabetes help THIS STUDY randomly assigned adults with mild cognitive impairment or mild to moderate Alzheimers disease to be given via nasal spray or milligram doses of insulin detemir Levemir a manmade insulin that is longer acting than natural insulin or a placebo daily for three weeks. Standardized tests given at the start and end of the study showed that working memory sometimes thought of as shortterm memory improved for those given milligrams of insulin but not for those given the smaller dose or the placebo. Also among those in the milligram group people carrying what is sometimes called the Alzheimers gene APOEe showed more improvement than noncarriers. WHO MAY BE AFFECTED People in the early stages of dementia. Some research has suggested a link between lower levels of insulin in cerebrospinal fluid and the formation of plaques often found in the brain tissue of people with Alzheimers. Memory loss is often the first sign of dementia which in later stages can interfere with such things as the ability to solve problems control emotions or do such daily tasks as eating and dressing. CAVEATS The study involved a relatively small number of participants and lasted a short time a larger and longer study would be needed to adequately test effectiveness and safety. FIND THIS STUDY February issue of the Journal of Alzheimers Disease http For an early version of the study abstract click on Contents then Volume No. in press and search for insulin. LEARN MORE ABOUT dementia at ninds.nih.govdisorders http and http The research described in Quick Study comes from credible peerreviewed journals. Nonetheless conclusive evidence about a treatments effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician."

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

"Blood drawn from expectant mothers could offer parents an earlier sneak peek at their babys sex than methods currently used in the U.S. researchers said Tuesday. The test may be particularly valuable for families that harbor sexlinked genetic disorders like hemophilia they add. Because such disorders mostly strike boys knowing that the baby is a girl could spare the mother diagnostic procedures such as amniocentesis that carry a small risk of miscarriage. It could reduce the number of invasive procedures that are being performed for specific genetic conditions said Dr. Diana Bianchi of Tufts University School of Medicine who worked on the new study. But other researchers voiced concerns saying it could be misused to terminate a pregnancy if the baby isnt of the desired sex. What you have to consider is the ethics of this said Dr. Mary Rosser an obstetrician and gynecologist at the Montefiore Medical Center in New York. If parents are using it to determine gender and then terminate the pregnancy based on that that could be a problem she told Reuters Health. Remember gender is not a disease. The test looks for small pieces of the male sex chromosome in the mothers blood which would mean she is carrying a baby boy. Some European hospitals already rely on the method called cellfree fetal DNA although its not available from doctors in the U.S. What they are finding in England is that many women are not going on to have the invasive tests Bianchi told Reuters Health. In those procedures doctors either extract a small amount of the fluid that surrounds the fetus amniocentesis or they take a sample of the placenta chorionic villus sampling. Between one in and one in mothers miscarry as a result according to Bianchi. In a fresh look at the medical evidence for the blood test she and her colleagues analyzed earlier studies that included more than pregnancies. They found parents could trust the test . percent of the time when it said theyd have a boy and . percent of the time when it indicated a girl. That leaves some room for error which could be important if parents are making medical decisions based on the results such as whether or not to get an invasive procedure to look for genetic disorders. However the current noninvasive alternative an ultrasound done at the end of the first trimester isnt always good at spotting a babys sex Bianchis team reported in the Journal of the American Medical Association. And the blood test is reliable as early as seven weeks into the pregnancy whereas ultrasound is not. Bianchi said one study had estimated the blood test costs about pounds in the UK about all included. While its available over the Internet she said her team had only looked at hospitalbased test performance. I dont know why it is not being incorporated in the US she said. Rosser however chalked that up to the ethical issues it raises. It is a great test that can be part of our armamentarium of noninvasive testing that we use she said. But it should only be used by families that are at risk for sexlinked diseases. Bianchi said she owns stock in Verinata Health a company that is developing cellfree fetal DNA tests for Down syndrome although that company had no role in the new study. The American College of Medical Genetics did not respond to requests for comment on the DNA tests. SOURCE bit.lyHWZ httpbit.lyHWZ Journal of the American Medical Association August . This story has been corrected in paragraph to show said disorders mostly strike boys not only strike boys Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"For years research has shown that babies born by cesarean section are more likely to develop health problems. Now a groundbreaking study suggests that not all Csections are equally risky. The research looked at all fullterm firstborn births in Scotland over a year period and tracked the babies longterm health. It is one of the largest and longest studies to explore how planned Csections differ from other deliveries. Surprisingly the data showed more health problems among babies born by planned Csection than among those delivered by emergency Csection or vaginal birth even though the planned surgery is done under more controlled conditions. The finding suggests that the arduous experience of labor that exhausting sweaty utterly unpredictable yet often strangely exhilarating process may give children a healthy start even when its interrupted by a surgical birth. The new findings published in JAMA this month https are important because the number of babies born by Csection has increased tremendously. In the United States nearly one in three https babies are born by Csection. Cesarean births that had no medical indication increased to . percent of lowrisk women in up from . percent of such women in https Dr. Mairead Black the University of Aberdeen obstetrician who led the study said that as cesarean births had increased in Scotland and worldwide the researchers wondered what if anything children born by Csection are missing out on. Our thinking was If a baby is born naturally it comes into contact with bacteria from the mother which might help with immune system development Dr. Black said. Even attempted labor may provide some exposure to bacteria she said. But babies delivered by a planned Csection which is usually scheduled to take place well before the first pang of labor may miss out entirely. When you dont wait for labor to begin on its own you cut short all kinds of physiological changes and preparations for birth that are taking place toward the end of pregnancy said Carol Sakala the director of the nonprofit Childbirth Connection https programs at the National Partnership for Women Families. What is the effect of cutting off those processes so casually on such a large scale Studies have consistently found that children born by Csection are at higher risk for health problems like obesity httpsjournals.plos.orgplosonearticleid.journal.pone.and allergies https Csection birth has also been associated with a higher risk for Type httpslink.springer.comarticle.Fsz diabetes. The Scottish study took advantage of the small countrys rich trove of linked birth and medical databases to track the longterm health of babies. Nearly percent were born by planned Csection and percent were delivered by emergency surgery. The remaining were vaginal births. The researchers compared a range of health outcomes among the babies including asthma irritable bowel syndrome obesity Type diabetes early death and cancer. Over all the differences between a scheduled Csection and an emergency Csection were slight. However the data do begin to shed light on why babies born through vaginal birth may have fewer health risks than babies born by Csection. The biggest difference between babies born by scheduled and unscheduled Csection appeared in risk for Type diabetes. The results showed that babies born by planned Csection had a percent higher risk of Type diabetes compared with babies born by emergency Csection after adjusting for differences among the mothers. All of the babies born by Csection were slightly more likely to use an asthma inhaler at age . percent of planned Csection babies and . percent of unscheduled Csection babies wound up using an inhaler compared with . percent of vaginally born babies. Asthma hospitalization rates were also higher for babies born by planned Csection with a statistically significant increase of percent over vaginally born babies. Although all of the Csection babies were more likely to be obese at age the differences were not statistically significant after adjusting for differences among the mothers. There were no significant differences in cancer and irritable bowel disease among any of the types of births. No one knows exactly why labor may be protective but the spontaneous onset of labor prompts fluid to clear from a babys lungs said Dr. Aaron Caughey who helped draw up guidelines https for the American College of Obstetricians and Gynecologists that urged providers to let women spend more time in labor and avoid an unnecessary Csection. The step is just one of a cascade of physiological changes that take place in mother and baby during the labor process including surges in stress hormones and reproductive hormones like oxytocin that may help the fetus adapt during labor preserve blood flow to the organs and keep the baby alert and prepared for breastfeeding. During labor a newborn absorbs maternal microbes into its mouth and gastrointestinal tract said Dr. Josef Neu a neonatologist at the University of Florida who has written about Csection babies and the hygiene hypothesis. The theory is that maternal microbes train the infants immune system so it doesnt overreact or become destructive and precipitate autoimmune disorders like Type diabetes. Its an education process that says Calm down youre going to be seeing this antigen again you dont have to be so aggressive Dr. Neu said. Dr. Neu said the broadspectrum antibiotics prescribed to the mother before a surgical delivery were another concern the antibiotics can be transmitted to the baby through breast milk if not before birth decreasing the diversity of natural bacteria. The findings are a reminder that although Csections are appropriate in some circumstances they are a poor substitute for labor. Childbirth and labor are a physiological process that weve evolved to over millions of years Dr. Caughey said. Its been really welldesigned by evolution."

"A breath test to detect stomach and esophageal cancers shows promise researchers say. The test measures five chemicals in the breath. It was percent accurate in detecting these cancers in more than patients the new study found. Each year . million cases of cancer of the stomach and esophagus the tube leading from the throat to the stomach are diagnosed worldwide. Both tend to be diagnosed at a late stage and the fiveyear survival rate for the two cancers is percent the researchers said. Findings from the study were presented Monday at the European Cancer Congress ECC. At present the only way to diagnose esophageal cancer or stomach cancer is with endoscopy. This method is expensive invasive and has some risk of complications study author Dr. Sheraz Markar said in an ECC news release. Markar is from Imperial College London in England. With endoscopy a flexible tube is threaded down a sedated patients throat to the stomach to view the digestive tract. A breath test could be used as a noninvasive firstline test to reduce the number of unnecessary endoscopies. In the longer term this could also mean earlier diagnosis and treatment and better survival Markar said. Because cancer cells are different to healthy ones they produce a different mixture of chemicals. This study suggests that we may be able detect these differences and use a breath test to indicate which patients are likely to have cancer of the esophagus and stomach and which do not he explained. Markar added that the test needs to be validated in a bigger group before it could be used on patients. The researchers said they are planning a larger trial of the breath test over the next three years. Study results presented at meetings are generally considered preliminary until theyve been published in a peerreviewed journal. More information The U.S. National Cancer Institute has more on stomach cancer https SOURCE European Cancer Congress news release Jan."

"Silicone breast implants were pulled off the market in amid concerns that leaks from the implants could lead to cancer or autoimmune disease. Five years ago revamped products returned to the market. But now the Food and Drug Administration has evaluated the safety of the second generation of silicone implants and the results are mixed. An FDA report released in late June says silicone implants are generally safe. But complications from implants are frequent things like hardening of the skin around the implant ruptured wrinkled or lopsided implants scarring pain and infection. As many as half of patients will need to have additional surgeries or have the implants removed in the first decade. It also turns out that the longer a woman has the implants the more likely she is to experience these complications. Ruptured Implants Can Require Surgery Take Kate Marion. She had silicone implants for breast augmentation in her late s. Just shy of two decades later she noticed something unusual. When I was crossing my left arm across my body for instance to put lotion on my right arm I would make a little noise from my armpit the way little boys do when they stick their hand in their armpit and pump their arm up and down Marion says. A little tooty noise. Article continues after this message from our sponsor An MRI showed both her implants had burst. Her doctor immediately recommended removing them which she did. Marion hasnt suffered any apparent harm from her ruptured implants and she even confesses to having an occasional twinge of regret that she didnt have them replaced when she had the old ones removed. But ultimately she decided she didnt want to go through more surgery. There is a huge deficiency of longterm data at a time when we know that the longer these devices are in the more problems...occur. Sid Wolf with the nonprofit watchdog group Public Citizen Well how long would these next ones last I would be in my s when I had to do this again and who wants to have surgery unnecessarily when you are something says Marion. Although the longterm effects of silicone in the body are still uncertain many plastic surgeons dont see the leaking of modern implants as a health concern. The actual silicone thats within the implants is inert. So if the silicone gel leaks it doesnt travel through the body it doesnt cause systemic problems. So the MRI is really detecting a cosmetic concern says New York City plastic surgeon Matthew Schulman. Oily Silicone Versus Gel But there have been more serious outcomes. Annette Knecht got silicone implants in following a double mastectomy. For years afterward she felt ill suffered multiple bouts of pneumonia had trouble breathing and pain in her chest. Doctors reassured her it wasnt her implants. We had a CT scan done and it showed OK everything looked fine so we didnt worry about it says Knecht. But no one ever told her to get an MRI something the FDA now recommends that women with silicone implants get every few years. As it turned out Knechts implants had leaked a biopsy found silicone in her lymph nodes and in her lungs. She is currently disabled and awaiting a lung transplant all she says for vanity. Were about four generations removed from those implants says Schulman the plastic surgeon. He explains that implants have undergone big changes since the early s when Knecht received hers. Back then they contained a runny liquid silicone. The silicone implants of today are what we call a cohesive gel its essentially like a jelly. So the jelly may ooze a little bit but it will not run out like an oil says Schulman. Sid Wolf of the nonprofit watchdog group Public Citizen is among critics who point out that the data in the FDA report sample just a fraction of the nearly women who receive breast implants each year. Moreover that data are limited to just the last two or three years not enough Wolf says to make any real claims about the longterm safety of the implants. There is a huge deficiency of longterm data at a time when we know that the longer these devices are in the more problems ... occur says Wolf. Thousands Still Choosing Silicone Still there are plenty of satisfied customers among the nearly women who receive breast implants each year. Not only have the number of women choosing breast implants for augmentation risen by nearly percent in the last decade Schulman says that in his practice percent of them are choosing silicone over saline. Whats more he says few of them follow the recommendations to get routine MRIs to screen for leaks. Schulman says that the rates of complications for silicone implants are roughly the same as for saline though he feels these complications can be minimized by choosing an experienced surgeon. Still he warns his patients that no procedure is without risks and additional surgeries are a very real possibility. Your young breast implants dont last forever says Schulman. They may leak they may rupture you may decide you want a different size. So you have to at least expect that sometime in your life you are going to need a reoperation. And if you are percent against having another surgery related to these implants then its something you should reconsider."

"The active ingredient in pot that gets you high can calm agitation in people with advanced Alzheimers disease a small new study suggests. Canadian researchers found that a form of synthetic THC significantly decreased agitation in a small group of Alzheimers patients working even better than the drugs now used. This is the first clinical trial to show that a cannabinoid can decrease agitation said lead researcher Krista Lanctot a senior scientist at Sunnybrook Health Sciences Center in Toronto. However many study patients suffered from sedation due to the drug noted Keith Fargo director of scientific programs and outreach at the Alzheimers Association. We would love to see this study done in a larger group of people to see if it continues to be effective in a larger group and how worried we need to be about this sedation side effect Fargo said. Agitation is a frequent symptom of advanced Alzheimers Lanctot explained. Doctors struggle to control it through offlabel use of drugs like antipsychotics and anticonvulsants. Agitated patients yell scream pace and wander she said. They also can become physically aggressive striking out at people and hurting themselves or others. Youre going to find one in five outpatients with it. But when you get to the longterm care facilities about percent of inpatients will have agitation Lanctot said. Its actually a big treatment challenge. The drugs we have now do not work very well and theyre associated with an increase in mortality. The offlabel drugs used to treat Alzheimers are indeed a bit dodgy. For example only one person out of five to treated with antipsychotics actually experiences a decrease in agitation Lanctot said. And for every nine to people helped one will die. But Lanctot and her colleagues suspected that cannabinoids might help control agitation given that natural cannabinoids in the brain decrease as Alzheimers enters its advanced stages. We know cannabis has several effects that might be good for people with agitation Lanctot said. It has a calming effect. It helps with weight loss because it helps with appetite. Its also used for pain. The synthetic THC drug nabilone is approved in Canada for treating nausea and vomiting caused by chemotherapy. It comes in capsule form. Its a milder form of TCH compared to wholeleaf marijuana Lanctot said. We hoped it wouldnt have the side effects associated with cannabis but would have the calming effects. During the clinical trial patients with moderate to severe Alzheimers disease received nabilone for six weeks to treat their clinically significant agitation followed by six weeks with an inactive placebo. We had a significant decrease in agitation. The decrease we saw was larger than is seen with the currently used medications Lanctot said. Patients underwent significant overall improvement in their other behavioral symptoms and had small benefits in their brain function and nutrition during the study. Their caregivers also reported reduced levels of stress according to Lanctot. These benefits came with a downside though. About percent of patients experienced sedation with nabilone compared with percent for placebo the findings showed. Lanctot and Fargo do not recommend that relatives or friends of those with agitated Alzheimers provide them medical marijuana to ease their suffering. This trial tested a synthetic analog of THC. Its not THC and its certainly not wholeplant marijuana Fargo said. Theres virtually no data on wholeplant marijuana whether or not its effective or safe in people with Alzheimers disease. A form of synthetic THC is available in the United States called dronabinol and sold under the trade name Marinol Lanctot said. Its used as an appetite stimulant for people with AIDS and an antinausea remedy for chemotherapy patients. Marinol is now being tested for its usefulness in treating Alzheimers symptoms Lanctot said. People interested in trying it should reach out to one of the big clinical trials Johns Hopkins is one of the centers testing Marinol. We wouldnt want to change clinical practice based on one study Lanctot added. The study was to be presented Tuesday at the Alzheimers Association meeting in Chicago. Research presented at medical meetings is considered preliminary until published in a peerreviewed journal. More information The Alzheimers Society has more about cannabis and Alzheimers disease https SOURCES Krista Lanctot Ph.D. senior scientist Sunnybrook Health Sciences Center Toronto Canada Keith Fargo Ph.D. director scientific programs and outreach Alzheimers Association July Alzheimers Association annual meeting Chicago"

"Adding seaweed to processed foods such as frozen pizzas hot dogs and dried pasta will reduce cardiovascular diseases concludes a new scientific article. One suggestion is to replace of the flour in pizza dough with dried and granulated seaweed. According to the World Health Organization WHO cardiovascular diseases are the number one cause of premature death globally. Ironically many of the pathologies leading to premature death from cardiovascular diseases are not only widespread but they are preventable. One way to prevent cardiovascular diseases is to avoid obesity and eat healthy leaving the responsibility with the individual consumer. But the responsibility should also be shared by society argues University of Southern Denmark professor of biophysics Ole G. Mouritsen who has authored several books on seaweed as food. Professor Mouritsen is the coauthor of an article in the journal Phycologia reviewing existing knowledge on the health effects of different seaweed species. In the article the authors offer suggestions to how both individual consumers and the food industry can use seaweed to make our everyday meals healthier. Certain substances in seaweed may be important for reducing cardiovascular diseases. We think this knowledge should be available for society and also be put to use says Mouritsen. Seaweed salt is healthier salt Many seaweed species have a variety of health benefits. They contain among other things beneficial proteins antioxidants minerals trace elements dietary fiber and polyunsaturated fatty acids. Seaweeds content of potassium salts does not led to high blood pressure unlike the sodium salts typically encountered in the processed food. An important feature is also that the seaweed has umami the fifth basic taste which is known to promote satiety and hence regulate food intake in addition to reduce the craving for salt sugar and fat. It is difficult to determine how much seaweed a person should consume to benefit from its good qualities. grams of dried seaweed per day is my estimate says Professor Mouritsen. He and the coauthors suggest that seaweed should be added fast food thus making this type of food healthier. It can even enhance the flavor of the food they argue. For example dried and granulated seaweed can replace some of the flour when producing dry pasta bread pizza snack bars etc. Seaweed is also good in meat products It is also possible to add seaweed to meat products and thereby provide the consumer with an increased intake of dietary fiber and antioxidants or maybe the aim is lower cholesterol levels. In the article Professor Mouritsen and his coauthors describe a study in which a group of overweight but otherwise healthy men were asked to taste bread with added dried seaweed from the species Ascophyllum nosodum. The mens reaction was that the bread tasted acceptable as long as the seaweed content was kept under . By eating bread containing of dried seaweed the overweight men ingested more dietary fiber . g more fiber per. g than when they ate the control wholemeal bread. Another effect was that they consumed . less energy in the hour period after eating the seaweed enriched bread. We know that many people have difficulty distinguishing between healthy and unhealthy food. By adding seaweed to processed foods we can make food healthier. In many cases we also get tastier food and it may also help reduce the risk of cardiovascular diseases the authors believe. HOW TO GET THE HEALTH BENEFITS FROM SEAWEED Seaweed contains only few calories but is still rich in rich in essential amino acids dietary fibers minerals trace elements vitamins and polyunsaturated fats. You can easily add up to dried seaweed to a dough without losing its ability to raise. Dried seaweed can be stored for months or years without loss of flavor and nutritional value. Dried seaweed can be added to food as powder granulate or pieces in pastries egg dishes mashed potatoes dressings or sprinkled on vegetables or fish dishes. Powders and granulates can be used as a salt substitute. Hijiki contains arsenic which is carcinogenic and therefore some national food authorities recommend that you do not eat it. Despite these warnings you can buy dried hijiki in many stores. Some species may contain large amounts of iodine. Never eat seaweed that is washed up on the beach. Contact Professor Ole G. Mouritsen head of Centre for Biomembrane Physics MEMPHYS at University of Southern Denmark head of center Taste For Life President of the Danish Academy of Gastronomy. Email ogmmemphys.sdu.dk mailtoogmmemphys.sdu.dk. Tel . Ref Cornish Critchley Mouritsen. A role for dietary macroalgae in the ameliorating ration of certainement Risk Factors Associated with cardiovascular disease. Phycologia . November . Photo Serving of seaweed crackers Birgitte SvennevigSDU."

"The cancer drug that former president Jimmy Carter says made his melanoma seemingly disappear has helped about percent of similar patients survive for as long as three years oncologists said Wednesday. The drug called Keytruda takes a new approach to treating cancer by stopping tumor cells from cloaking themselves against the normal healthy immune system response. New data about to be released to a meeting of cancer specialists shows that percent of the patients who have been taking the drug are still alive three years later. That compares to about percent of patients given the standard therapy interleukin the American Society for Clinical Oncology ASCO says. That means percent of patients are not living that long but its still far more than the usual month survival with advanced melanoma. It is definitely a huge benefit over what we have seen in the past said ASCO president Dr. Julie Vose a specialist in blood cancers at the University of Nebraska Medical Center. For some of those patients it is likely that their cancer never will come back. Melanoma is the deadliest form of skin cancer. It will be diagnosed in more than Americans this year according to the American Cancer Society and it will kill . Rates are rising in part because tanning became fashionable. Melanoma is easy to cure when caught early but it is often hard to tell if a mole or freckle has turned cancerous. Carter for example was only diagnosed http the tumors had spread to his brain last fall. Thats Stage IV cancer and its almost always deadly at that stage. But Carter has remained well enough to continue teaching his weekly Sunday school classes and said this past Sunday hed just traveled to London. He says theres no trace of his cancer now. In the past patients with this type of melanoma he has metastases to the brain you dont even see responses to therapy Vose told NBC News. This is something really different than what we have seen in the past. Other people are having similar experiences. For the trial Caroline Robert of Gustave Roussy and ParisSud University in France and colleagues treated patients with advanced melanoma. These are patients whose disease cannot be surgically removed cannot be cured by surgery and usually the majority of these patients have disease that involved vital organs said Dr. Stephen Hodi a melanoma specialist at the DanaFarber Cancer Institute who worked on the study. Seventyfive percent of them had already been given other cancer treatments including Yervoy known generically as ipilimumab. On average the patients lived two years and percent of them are still alive three years later. About percent of these patients have whats called a complete remission meaning there is no trace of their tumors. That doesnt mean a cure its too soon to say that but it does mean months or years of cancerfree life that they otherwise could not have hoped for. And of the patients or percent have stopped taking the drug after their tumors went away. Virtually all of them are still in remission. This is huge in the melanoma community said Tim Turnham executive director of the Melanoma Research Foundation. Its difficult to know at what point you call it a cure. For the patient though it means they are cancerfree and for some of those patients it is likely that their cancer never will come back Turnham told NBC News. When this study was started the average life expectancy of someone with advanced melanoma was months and now were seeing that a large percentage of people are living at least three years. Keytruda known generically as pembrolizumab http targets the activity of genes called PD antiprogrammeddeathreceptor and PDL. The interaction between the two genes lets some tumors escape detection and destruction by immune system cells. PD stops immune cells from attacking normal healthy cells by mistake. Tumor cells make PDL turn on PD when immune cells approach. Keytruda an engineered immune protein called a monoclonal antibody disrupts this signal and lets the immune cells attack the tumor cell. The drug works far better in patients whose tumors express more PD meaning they have a lot of PD activity so the drug will optimally be used jointly with a test for PD. There are sideeffects including fatigue itchiness and rash. It was bad enough for percent of patients that they stopped taking it. In a matter of a few years these therapies have truly transformed the outlook for patients with melanoma and many other hardtotreat cancers. The Food and Drug Administration gave Keytruda accelerated approval for melanoma i http . Its got breakthrough therapy designation for Hodgkins lymphoma and colon cancer and got accelerated approval for lung cancer. In a matter of a few years these therapies have truly transformed the outlook for patients with melanoma and many other hardtotreat cancers said Dr. Don Dizon an oncologist at Massachusetts General Hospital and a spokesman for ASCO. Keytrudas being tested in other cancer types now. Earlier Wednesday the FDA gave accelerated approval to a drug that works in a similar way. It approved Tecentriq known generically as atezolizumab for use in patients with advanced bladder cancer. Like Keytruda Tecentriq is a monoclonal antibody. It goes straight to PDL so its target is slightly different. FDAs approval was made on the basis of a trial that showed percent of patients with advanced bladder cancer who had high levels of PDL activity saw their tumors disappear compared to . percent of patients on other treatments. Another percent had a partial response meaning their tumors shrank a little compared to . percent on standard treatment. The drugs must be infused and they are pricey. Keytruda costs about a month or a year."