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"Two new drugs using very different scientific approaches can extend survival among patients with the deadliest form of skin cancer offering the first new hope for real progress in many years. Advanced melanoma patients taking an experimental pill vemurafenib developed by Roche and Daiichi Sankyo were percent less likely to die than patients given chemotherapy according to a new trial presented on Sunday at a meeting of the American Society of Clinical Oncology in Chicago. Dr. Paul Chapman of Memorial SloanKettering Cancer Center in New York and the studys lead investigator called the results an unprecedented level of difference for patients with advanced melanoma who typically survive just eight months on current treatments. In a separate study presented at ASCO previously untreated people with advanced melanoma treated with BristolMyers Squibbs Yervoy or ipilimumab plus chemotherapy lived an average of two months longer than people who got chemotherapy alone. Yervoy works by spurring the immune system to fight off the cancer. Vemurafenib is designed for use in patients with tumors that have a mutation in a gene known as BRAF that allows melanoma cells to grow. About half of all melanomas have the genetic aberration. The Roche trial included patients with previously untreated inoperable latestage metastatic melanoma with the BRAF mutation. After a median three months of treatment vemurafenib patients also had a percent reduction in the risk of cancer progression compared to dacarbazine. This is a huge difference said Dr. Antoni Ribas an oncologist at the University of California Los Angeles who has studied vemurafenib. Even if it diminishes over time who cares Nearly half of patients treated with the Roche drug had tumor shrinkage compared with . percent with chemotherapy. Side effects included skin rashes and joint pain. About percent of patients developed a lowgrade skin cancer. More than people in the United States and worldwide are diagnosed with melanoma each year according to the American Cancer Society. The fiveyear survival rate for the aggressive cancer is just percent. Analysts on average have forecast annual vemurafenib sales of million by and expect Yervoy annual sales of . billion according to Thomson Pharma. ISI Group analyst Mark Schoenebaum said although the vemurafenib results look the most encouraging the findings are unlikely to make a difference for current sales estimates since virtually all eligible patients will be treated with both drugs either in sequence or in combination. MORE HELP FOR MELANOMA PATIENTS Roche expects U.S. and European regulators to decide on approval of its drug before the end of the year. BristolMyers Yervoy was approved in March for patients with inoperable or metastatic melanoma based on a previous study which showed the drug given alone extended survival by four months in patients who had failed other treatments. What was interesting about this study was not only was it the second one to show a benefit but that the improvement took place even in the presence of dacarbazine chemotherapy Dr. Jedd Wolchok of Memorial SloanKettering Cancer Center in New York who presented the study at the meeting said in a telephone interview. ADVERTISING We worried a lot that chemotherapy could be immunosuppressive Wolchok said noting that that might explain why the average survival benefit was two months instead of four. We dont know what dacarbazine did to the ipilimumab but we do know even in the presence of dacarbazine ipilimumab still produced a durable response and extended survival. Doctors said taken together the new studies offer new options for patients. This is really unprecedented time to have two new approaches to treat advanced melanoma said Dr. Lynn Schuchter of the University of Pennsylvania in Philadelphia a melanoma expert who moderated a panel discussion of the drugs. Once you finally understand what is driving the disease we can develop therapies that are more effective she said. She and others expect vemurafenib to be approved this year. Meanwhile doctors are already working out treatment strategies. For patients who are stable with slowgrowing tumors Chapman said he would start them off on ipilimumab. That is a drug that can take a while to work so if the person has time I would rather give him essentially two shots on goal rather than one. For advanced patients who need a quick response he would use vemurafenib first. Schuchter who was not involved with the studies said now the future is going to be to build upon this success and combine therapies. Cancer cells outwit us they are brilliant and figure out other pathways she said. BristolMyers and Roche announced earlier this week a collaboration to evaluate the combination of Yervoy and vemurafenib as a therapy for metastatic melanoma. Editing by Bill Trott and Marguerita Choy Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Its common for people who suffer from irritable bowel syndrome IBS to also struggle with depression. Now a small study published in the journal Gastroenterology http suggests that taking a probiotic supplement may provide relief from both conditions. The randomized placebocontrolled trial shows a connection between probiotics and mood improvement in people with IBS and depression or anxiety as well as changes in brain regions related to emotional processing. Most previous research httptime.comprobioticsdepression on this topic has been on healthy people without mood disorders. For the new research scientists from McMaster University in Canada recruited adults with IBS as well as mild to moderate anxiety or depression. They were followed for weeks half took a daily dose of the probiotic Bifidobacterium longum and half took a placebo. The probiotics were manufactured and provided by Nestle which also funded the study. Nestle was not involved in collection analysis or interpretation of study data. You Might Like Squatty Potty Toilet Stool How Toilet Posture Affects Your Health Women in the U.S. Are Having Fewer BabiesEspecially Here After six weeks twice as many people who took the probiotic had decreased depression scores compared to those who took the placebo versus . Results were similar after weeks as well. When people in the study were given functional MRI scans the researchers found that improved depression scores were associated with changes in activity of several brain areas involved in mood regulation. Those changes in brain activity support the notion that this probiotic has antidepressive properties the authors wrote in their paper. While their data did not show significant independent changes in anxiety constipation diarrhea or pain people who took the probiotic did report improvements in overall symptoms of IBS and in quality of life. One explanation for the improved mood in the group taking probiotics could be that because their physical symptoms feel better their mood gets better too. Thats why Dr. Roger McIntyre professor of psychiatry and pharmacology at the University of Toronto thinks the fMRI findings are the most interesting and important aspect of the new study they signal that the probiotics may really be working on the brain itself. MORE You Asked Should I Take Probiotics httptime.comprobioticsprobioticsupplementsiidsrlink We know that one part of the brain the amygdala tends to be red hot in people with depression and it seemed to cool down with this intervention says McIntyre who was not involved in the new research. It provides more scientific believability that something in the brain at a very biological level seems to be affected by this probiotic. No serious side effects related to the probiotic were reported suggesting that such a supplement could be a safe way to treat both stomach and moodrelated symptoms. Studies have looked at various types of probiotics for IBS patients the authors wrote and a recent review found that bifidobacteria seemed to work better for gastrointestinal symptoms than another common probiotic lactobacilli. Some experts believe that gut bacteria influence the brain and vice versa mainly through systemic inflammation http But in this study the researchers found no difference in inflammatory markers between the probiotic and the placebo group. McIntyre points out that the bowel communicates with the brain through other pathways as well including the metabolic and nervous systems. MORE Should I Eat Olives httptime.comolivesnutritionprobioticsiidsrlink The studys findings need to be confirmed in larger independent trials and McIntyre says he wouldnt yet recommend taking a probiotic for symptoms associated with mental disorders like depression or anxiety. Study coauthor Premysl Bercik associate professor of medicine at McMaster University says the formula used in the new research isnt commercially available anyway. The evidence at this point is promising says McIntyre but it is not sufficient to justify recommending to patients as a viable treatment strategy. But McIntyre says the results are encouraging. They seem credible to me and they might hint that there are other mechanisms besides just inflammation linking the GI tract to the brain he says."

"Although Vicks VapoRub http is often used to fight colds and congestion there has never been proof of how well it works. Now new research reported in the journal Pediatrics httppediatrics.aappublications.org finds the combination of camphor menthol and eucalyptus oils actually does ease cold symptoms and help children suffering from upperrespiratory infections sleep. In the study funded by an unrestricted research grant from Procter Gamble httpcnn.comHEALTHcompany.funded.researchindex.html makers of Vicks researchers took children between the ages of and with symptoms like cough congestion runny nose and restless sleep that lasted seven days or more. Only children with moderate cough and severe stuffy nose were eligible and those were divided into three groups. Some were treated with Vicks some with a placebo consisting of petroleum jelly and others got no treatment at all. Parents were surveyed the day before treatment about the severity of their childs symptoms. That night minutes before bedtime Vicks or petroleum jelly was rubbed onto the childs chest and neck. The next day parents were questioned about their childs symptoms overnight. Children in all three groups got better but those treated with the VapoRub saw the greatest improvement and parents in this group also had improved sleep the study found. The American Academy of Pediatrics http says the currently available oral cough and cold medications are not effective for children and have the potential for side effects said Dr. Ian Paul principal investigator and associate professor of pediatrics and public health sciences Penn State College of Medicine. This was based in part on some of the studies that we have conducted at Penn State. The current study shows that Vaporub is more effective than placebo. Paul is on Procter Gambles advisory board but holds no stock in the company and will not profit financially. Wheres the line between research and marketing http Twenty of the children in the vapor rub group suffered mild side effects including skin irritation and burning sensation of the eyes and nose. There were no side effects in the two other groups. Dr. Jennifer Shu a practicing pediatrician and CNNHealths Living Well expert uses Vicks for her family. I have found that when used properly it can be a good option for parents who want to relieve some cold symptoms in their children. Parents get frustrated with the FDA recommendations not to use cold medicines in kids under the age of because they are left with few options. Vicks is used topically on the skin its not ingested and is not included in these FDA guidelines. Shu says when used properly Vicks appears to be safe. But as with any product parents need to read the instructions carefully and keep medicines out of the reach of children. Vicks VapoRub is not recommend for children under the age of ."

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

"Taking cholesterollowering statin drugs such as Pfizers Lipitor and AstraZenecas Crestor could help prevent people dying from pneumonia according to a study by British scientists released on Tuesday. Researchers from the London School of Hygiene and Tropical Medicine found that the risk of death in the sixmonth period after being diagnosed with pneumonia was substantially lower among those who were already taking the cholesterollowering drugs than in those who were not. Previous studies have suggested statins which are also available as cheaper generics may be linked to better outcomes after bacterial infection. These findings suggest the pills may help protect against death in patients with pneumonia. Statins such as Lipitor Crestor and a generic called simvastatin are widely prescribed to lower socalled bad or LDL cholesterol a risk factor for heart disease and are credited with being among the most successful drugs in helping to prevent heart attacks and strokes. Separate research published in March found that lowering cholesterol levels could help the bodys immune system fight infections a finding that appears to be supported by Tuesdays study. Statins are safe cheap and an easy intervention in terms of delivery said Ian Douglas a lecturer in epidemiology at the LSHTM who led the research. Given the potential low number needed to treat to prevent a death suggested by this study we believe that a strong case exists for randomized trials of statins in people with serious infection to determine if a simple and practical intervention at the point of diagnosis of pneumonia has a beneficial effect. Douglass team whose research was published in the British Medical Journal used data from computerized medical records of doctors practices in Britain to identify statin users. They then matched each statin user who was aged over when first prescribed a statin between and with up to five nonstatin users for comparison. Patients with a record of pneumonia were followed for six months to see if they died and the researchers found that percent out of of statin users died compared with percent out of of nonstatin users. Douglas noted that since this study looked at patients who were already taking statins when they developed pneumonia a full randomized clinical trial was needed to find out whether starting a statin at the time of diagnosis has a similar effect. Reporting by Kate Kelland Editing by Will Waterman Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"School readiness isnt the only benefit young children can gain from Head Start. A new study finds that kids in the U.S. preschool program tend to have a healthier weight by kindergarten than similarly aged kids not in the program. In their first year in Head Start obese and overweight kids lost weight faster than two comparison groups of children who werent in the program researchers found. Similarly underweight kids bulked up faster. Participating in Head Start may be an effective and broadreaching strategy for preventing and treating obesity in United States preschoolers said lead researcher Dr. Julie Lumeng an associate professor at the University of Michigan Center for Human Growth and Development. Federally funded Head Start which is free for to yearolds living in poverty helps children prepare for kindergarten. The program is designed to build stable family relationships improve childrens physical and emotional wellbeing and develop strong learning skills. Health benefits including weight loss seem to be a byproduct of the program said Dr. David Katz director of the Yale University Prevention Research Center. This paper importantly suggests that some of the best strategies for controlling weight and promoting health may have little directly to do with either said Katz who wasnt involved in the study. Head Start might provide a structured supervised routine thats lacking in the home Katz suggested. Perhaps the program fosters better mental health in the children which in turn leads to better eating he said. Whatever the exact mechanisms by fostering wellbeing in one way we tend to foster it in others even unintended Katz said. The essence of this study is the holistic nature of social psychological and physical health. Almost onequarter of preschoolaged children in the United States are overweight or obese and obesity rates within Head Start populations are higher than national estimates the study authors noted. Because obesity in childhood tends to continue into adulthood experts worry that these children are at risk of future health problems. For the study Lumengs team collected data on more than Michigan preschoolage children between and . More than were in Head Start. Information on the others of whom were on Medicaid the publicly financed insurance program for the poor came from two primary health care groups. Whether those children were in another preschool program wasnt stated. At the studys start about onethird of the Head Start kids were obese or overweight compared to percent of those on Medicaid and less than percent of kids not on Medicaid. Even though children in the Head Start group began the observation period more obese equally overweight and moreunderweight than children in the comparison groups at the end of the observation period the initially obese and overweight Head Start children were substantially less obese andoverweight than the children in the comparison groups the authors wrote. Lumeng said an emphasis on good nutrition and exercise may partly explain the perceived Head Start advantage. Head Start programs must adhere to specific dietary guidelines she said. The children may be served healthier meals at Head Start than other children. In addition Head Start requires a certain amount of active play each day Lumeng said. Thus children attending Head Start may be getting more opportunities for physical activity than other children she explained. The daily routine might translate into less TV time and more regular sleep schedules she said. We know that better sleep is linked with less obesity she added. It also may be that when kids go to Head Start it reduces stress in the household and frees up time and resources at home to dedicate to healthier eating patterns she noted. The report was published Jan. online in the journal Pediatrics. More information For more on childhood obesity visit the U.S. Centers for Disease Control and Prevention http SOURCES Julie Lumeng M.D. associate professor University of Michigan Center for Human Growth and Development Ann Arbor Mich. David Katz M.D. M.P.H. director Yale University Prevention Research Center New Haven Conn. February Pediatrics"

"A Japanese drug company is offering up a big claim Shionogi Co. says it has an experimental pill that can kill the flu virus https within a single day according to news reports. In a clinical trial a single dose of the drug made by the pharmaceutical company eliminated the virus from peoples bodies in a median time of hours The Wall Street Journal https_emailexperimentaldrugpromisestokillthefluvirusinadaylMyQjAxMTIMDEyMTgxOTEWj reported. Both Japanese and American flu patients were included in the trial. The experimental drug worked three times faster than another antiviral drug Tamiflu https the company told the Journal. things you can do right now to help prevent the flu https The drug uses a different approach to fight the flu than other medications. The flu virus https spreads through the body by invading cells. Once inside a cell it hijacks the cells machinery forcing the cell to make copies of the virus. Then the newly copied viruses break out of the cell spreading to other cells nearby and repeating the process. Existing drugs including Tamiflu work to block these viral copies from escaping the cell the Journal reported. The experimental drug however kicks into action earlier working to block the virus https from hijacking cells in the first place the Journal said. Japanese drug regulators could approve the drug for use in Japan by early March the Journal reported. The drugmaker plans to apply for approval in the U.S. this summer however the drug likely wouldnt be available here until next year."

"MRI can detect the earliest signs of breast cancer recurrence and fastgrowing tumors. AddThis Sharing Buttons Share to Print Share to EmailShare to FacebookShare to TwitterShare to More Metastasis occurs when cells are shed from a primary cancer tumor and establish a new tumor at a distant site. For early detection of the metastasis with MRI the Lu Lab developed a probe that binds to fibrinfibronectin protein complexes in highrisk tumors. Fibronectin is expressed in highrisk cancer and not in normal tissue so MRI imaging is able to distinguish metastases from normal tissue. Researchers have shown that magnetic resonance imaging MRI can detect the earliest signs of breast cancer recurrence and fastgrowing tumors. Their approach detects micrometastases breakaway tumor cells with the potential to develop into dangerous secondary breast cancer tumors elsewhere in the body. The approach may offer an improved way to detect early recurrence of breast cancer in women and men. The work was completed at Case Western Reserve University CWRU Cleveland and was funded by the National Institute of Biomedical Imaging and Bioengineering NIBIB part of the National Institutes of Health. MRI has a wide array of diagnostic applications and shows promise in breast cancer detection and treatment monitoring said Richard Conroy Ph.D. director of NIBIB Division of Applied Science and Technology. The technique used by researchers in this study enables very early detection of metastatic spread which would allow adaptation of treatment more quickly and hopefully lead to better outcomes in the future. The study published online in the Aug. issue of Nature Communications was led by ZhengRong Lu Ph.D. CWRU M. Frank Rudy and Margaret Domiter Rudy Professor of biomedical engineering and an expert in molecular imaging for cancer and other diseases. We showed with this technique that we can detect very tiny tumors of just a few hundred cells Lu said adding that the study pushed imaging boundaries revealing smaller cancers than can be detected with current clinical imaging modalities. Our imaging technology has the potential to differentiate aggressive tumors from lowrisk tumors. These are two things that potentially can make a big impact on clinical practice and also management of cancer. Onethird of patients diagnosed with breast cancer eventually develop metastases in distant organs with an increased risk of death. Breast cancer has a high rate of metastasis to bone lung liver lymph nodes and the brain. Since small earlystage cancers are the most responsive to drug treatments screening is an important aspect of followup care for breast cancer patients and early detection is critical in tailoring appropriate and effective therapeutic interventions. While multiple imaging techniques including MRI are currently used in breast cancer detection and clinical management they are neither able to detect specific cancer types or early cancer growth. The earliest signs of cancer spread are called micrometastases. As the name implies they are often too small to be detected with standard screening. Dr. Lus team used a biochemical approach combined with MRI to detect molecular changes that signal micrometastases. To detect micrometastases Lu and his team used MRI imaging which uses a magnetic field and radio waves to produce images and combined it with a special chemical contrast solution. The contrast solution that the team developed contains a short piece of protein or peptide tagged with a minuscule magnet. They chose the peptide a chain of just five amino acids for its inclination to bind to protein matrix structures around cancer cells called fibrinfibronectin complexes. More importantly the fibronectin part of the complex is expressed during a cells transition to cancer and plays a role in cell growth migration and differentiation. Fibronectin is associated with highrisk breast cancer with poor prognosis. The researchers collected images depicting metastases where breast cancer had spread beyond the original tumors. Metal molecules within the contrast solution are magnetized during the MRI process and enhance the image wherever the molecules of solution bind with the targeted protein. The primary tumor sends signals to distant tissue and organs to prepare the soil for metastasis Lu said. By also binding with the magnetically tagged peptide the biomarker is enhanced generating enough signal for MRI detection of small highrisk cancer and micrometastases. The researchers tested the approach in mice into which they had introduced breast cancer cells. After a twoweek waiting period the researchers injected the contrast solution and performed MRI. The MRI imaging detected metastatic tumors including micrometastases in lung liver lymph node adrenal gland bone and brains of the mice. Analysis of images showed that the contrast used by the research team bound almost exclusively to the fibrinfibronectin complexes producing a strong and prolonged image enhancement of micrometastases and tumors compared with normal tissue. Using a microscopic imaging approach called cryoimaging and MRI the researchers verified that the MRI technique could detect micrometastases even observing bone micrometastases that were less than .mm the diameter of a very fine pencil lead. Prior to their study with this contrast agent Lus team had conducted studies to determine its clearance from the body after the imaging which is essential for safe clinical use. Their testing showed that the agent is readily cleared from the body and has a low level of retention in tissues. Therefore they expect it will be safe if ultimately developed for clinical use. The recurrence rates of some forms of breast cancer and the consequence of metastatic cancer make these efforts urgent and important said Lu adding that his research team also hopes to advance the approach for prostate cancer detection. We think this targeted approach holds great promise for earlier imaging of highrisk cancers in the clinic. It could also become useful as a noninvasive way to assess breast cancer treatment progress. The team plans to complete safety testing of the imaging agent during the next three years. They will then pursue human trials with this approach. This work was supported in part by NIH grants EB. About the National Institute of Biomedical Imaging and Bioengineering NIBIBs mission is to improve health by leading the development and accelerating the application of biomedical technologies. The Institute is committed to integrating the physical and engineering sciences with the life sciences to advance basic research and medical care. NIBIB supports emerging technology research and development within its internal laboratories and through grants collaborations and training. More information is available at the NIBIB website http About the National Institutes of Health NIH NIH the nations medical research agency includes Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic clinical and translational medical research and is investigating the causes treatments and cures for both common and rare diseases. For more information about NIH and its programs visit https NIHTurning Discovery Into Health Reference Molecular MRI of Breast Cancer Micrometastases Zhou Z Qutaish M Han Z Schur RM Liu Y Wilson DL Lu ZR. Nat Comms. Aug . Epub"

"Acupuncture https treatments to treat one type of lazy eye https proved as good as the traditional patching of the eye https used to help the eyes https work together according to a new study. Acupuncture https could potentially become an alternative treatment to occlusion patching therapy for ambylopia lazy eye https the researchers write. The study conducted in China is published in the Archives of Ophthalmology. U.S. experts familiar with the study call it interesting but say the treatment needs more study and wonder if it would catch on in the U.S. Acupuncture for Lazy Eye Vs. Patching Study Details While some previous research has found acupuncture for lazy eye effective the researchers couldnt find a study that directly compared acupuncture with conventional treatments such as patching. So Dennis Lam https MD a researcher at the Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong and his colleagues evaluated children ages to with the condition known as anisometropic amblyopia in which there is a difference in the degree of nearsightedness https or farsightedness https between the two eyes https They assigned children to the acupuncture group and they received five treatments a week. Acupuncturists used five different points in the head face hand and leg. The children were instructed to do an hour per day of nearvision https activities such as homework or computer work. Another children wore a patch over their normal eye for two hours daily a typical regimen and were also asked to do an hour of nearvision https activity a day. Acupuncture for Lazy Eye vs. Patching Results At weeks visual acuity with eyeglasses https improved by about . lines on the vision chart in the patched eyes and . lines in those who had acupuncture. An improvement of two lines or more occurred in nearly of those in the patching group but nearly of those in the acupuncture group. Ambylopia was evaluated as resolved in nearly of patched eyes but nearly of the acupuncture group. These results suggest that the treatment effect of acupuncture is equivalent to that of patching for anisometropic amblyopia in older children Lam writes. But at weeks the resolution rates were similar in the two groups of the patched group and of the acupuncture group. Acupuncture for Lazy Eye A Closer Look Lam cant explain exactly how the acupuncture for lazy eye might work. Acupuncture has been shown to increase blood https flow to the brain https and eye stimulating retinal nerve growth factors and leading to metabolic changes in the central nervous system https he writes. These actions may explain the effect on the amblyopia he speculates. Acupuncture vs. Patching Two experts who reviewed the study for WebMD but were not involved in it call the study scientifically sound but they note that it is small and that acupuncture is much more widely accepted in China than elsewhere. The amount of improvement here almost two lines on the eye chart is a lot says Michael Repka MD a professor of ophthalmology and pediatrics at the Johns Hopkins Unviersity School of Medicines Wilmer Eye Institute in Baltimore. However he notes it is an initial report and a single study. Some of the improvement could have come from wearing glasses he says. Theres a time commitment for this he says of the acupuncture. These kids went five days a week. He also cites expense and parent time to get the child to the acupuncturist as potential drawbacks. The patch is typically worn two hours a day can be worn at home and is inexpensive he says. The extra time to go to an acupuncturist may be a drawback agrees Matthew Gearinger MD an associate professor of ophthalmology and medicine at the Flaum Eye Institute at the University of Rochester School of Medicine. The fear of needles he says is probably not much of a problem with the older children studied. You can probably talk them into it he says. If a U.S. parent wanted to try acupuncture to help their childs anisometropic amblyopia Gearinger says he would probably agree with continued followup with an ophthalmologist."

"The U.S. Food and Drug Administration FDA on Friday expanded the use of Novartis AGs relapsing multiple sclerosis MS drug Gilenya to treat children and adolescents. MS is a chronic inflammatory autoimmune disease of the central nervous system that disrupts communication between the brain and other parts of the body and is among the most common causes of neurological disability in young adults. Gilenya is the first FDAapproved drug to treat pediatric patients suffering from relapsing MS the U.S. health regulator said. In a clinical trial percent of patients receiving Gilenya remained relapsefree after months of treatment compared to percent of those who were administered another MS drug. Gilenya was first approved by the FDA to treat adults with relapsing MS. Reporting by Mrinalini Krothapalli in Bengaluru Editing by Shounak Dasgupta Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Two new studies have documented the value of the BioZorb marker in improving the treatment of women who have breast cancer http The first study a peerreviewed article appearing in the World Journal of Surgery httplink.springer.comarticle.Fsy outlines how the threedimensional bioabsorbable marker provides more accurate targeting of the cancer tumor bed for radiation treatment when implanted during surgery. Breast surgeon Michael J. Cross lead author of the World Journal of Surgery study holds BioZorb a novel marker implanted in the tumor bed during breast cancer surgery. The article reports that the device provides clear visualization of the surgical site where the tumor was removed thereby improving communication between the surgeon and radiation oncologist. The study also noted that the device provides a helpful guide for posttreatment mammograms and other longterm followup to check for any cancer recurrence in these patients. A second study presented at the American Society for Radiation Oncology ASTRO annual conference describes the extra utility that BioZorb can provide by significantly reducing the amount of normal breast and surrounding tissues that are exposed to radiation treatment. The World Journal of Surgery article by lead author breast surgeon Michael J. Cross concluded that the D marker is an effective method for delineating the tumor bed with a significant utility for RT radiation therapy planning. In the course of this threeyear study Dr. Cross and colleagues also documented a favorable shift toward use of hypofractionated radiation treatment a shorter form of radiation associated with a substantial reduction in treatment costs. Through our experience with this marker weve observed that its use results in less radiation dose to the patient compared to whole breast radiation plus a better overall cosmetic outcome said Dr. Cross a nationally known breast surgeon at Breast Treatment Associates in Fayetteville Ark. We were also pleased to note in our research that there were no devicerelated complications in this group of patients and that none of them had a recurrence of cancer. The BioZorb device is placed during lumpectomy surgery http which removes the cancer and preserves the breast. It is the first and only device that identifies in a reliable way the D region where the tumor was removed. It is particularly effective because by suturing the implant to the tumor bed the surgeon can more precisely indicate to the radiation oncologist where the cancer was located. Dr. Cross notes that because of the markers unique configuration it can also assist with reconstructing the surgical region during the healing process. The implantable marker consists of a framework made of a bioabsorbable material that holds six titanium clips. The framework slowly dissolves in the body over the course of a year or more. The tiny marker clips stay in place so the surgical site can be viewed for longterm monitoring such as mammograms. As part of the research for the World Journal of Surgery study patients with earlystage breast cancer were prospectively implanted with the marker during reconstructive lumpectomy a method of oncoplastic surgery to remove the cancer while reconstructing the remaining breast to improve cosmetic outcomes. The average age of women in the study was years. The authors concluded that the marker was helpful for several different types of physicians involved in the care of women with breast cancer surgeons radiation oncologists who plan and oversee radiation treatment and radiologists who follow women after breast cancer treatment. The article also noted that there was a shift during the threeyear course of the study toward increasing use of hypofractionated radiation methods. These methods decrease the time it takes for patients to complete radiation treatment and are estimated to cut the cost of treatment by approximately . The authors said use of the marker facilitated their shift toward these shorter courses of radiotherapy. Use of the marker allowed physicians to be more confident in their targeting and rely less on ambiguous planning targets such as the seroma and surrounding tissue changes. Seroma is a collection of fluid that builds up in the area of tissue injury after surgery. While seromas have customarily been targeted for radiation treatment they do not always reflect where the cancer was and can overestimate the size of the target areas in need of radiation. By more precisely marking the tumor bed the article said BioZorb can reduce the amount of healthy tissue that would otherwise receive unnecessary radiation. The second recent study presented at the annual ASTRO conference in Boston described a collaborative approach between a radiation oncologist and breast surgeon. They studied the question of whether the marker could better identify the true lumpectomy cavity and thereby reduce the amount of tissue that is irradiated. The authors radiation oncologist William Hall M.D. and breast surgeon Cary Kaufman M.D. combined their analysis of cases in which BioZorb was used. They concluded that the tissue marker could significantly reduce radiation of healthy breast tissue an average of reduction as well as avoid irradiating inadvertent seromas that are more common with oncoplastic procedures. By providing better targeting they said the marker could also play a role in facilitating the use of external beam partial breast irradiation http_HallCollaborativeContouring.pdf. The process of delivering radiation treatment is substantially streamlined by having the D marker in place said Dr. Hall. The marker tells us where the tumor was and helps us determine appropriate forms of treatment whether with partial breast irradiation or standard whole breast irradiation and a boost dose at the end of the treatment process. Dr. Hall is a radiation oncologist in the Department of Radiation Oncology at PeaceHealth St. Joseph Medical Center Bellingham Wash. Dr. Kaufman is Medical Director of the Bellingham Regional Breast Center and past chairman of the National Accreditation Program for Breast Centers. Resources Infographic http_Infographic.jpg on BioZorb How the marker http works About Focal Therapeutics Focal Therapeutics is a medical device company based in Aliso Viejo Calif. The companys BioZorb marker is a proprietary bioabsorbable device that provides radiographic marking of soft tissue sites. The BioZorb device is placed at the time of surgical removal of tissue such as during breast surgery and the devices threedimensional array of marker clips has unique clinical utility for patient imaging. BioZorb has received k clearance from the U.S. Food and Drug Administration. The device is available in a range of sizes to accommodate a variety of clinical situations. For more information about the company call U.S. or email infofocaltherapeutics.com mailtoinfofocaltherapeutics.com. Contact Liz Dowling Dowling Dennis Public Relations Tel. Lizdowlingdennis.net mailtoLizdowlingdennis.net Photo httpphotos.prnewswire.comprnh SOURCE Focal Therapeutics"

"Once relaxation beverages consisted of alcohol chamomile tea and warm milk. Now the field includes a slew of new drinks promising a better nights sleep using such ingredients as melatonin valerian root and think turkey tryptophan. They have apt names such as Unwind iChill and Dream Water and offer such flavors as BerryBerry Tired Snoozeberry and Lullaby Lemon. Theyre the inverse of energy drinks. Consumers can wake up with Red Bull and then wind down with Slow Cow. But can consumers trust these fruity concoctions to give them their zs According to Steven M. Scharf director of the Sleep Disorders Center at the University of Maryland in Baltimore the answer is a resounding maybe. The issue is this Some of them probably have some biologic effect but they havent been as well studied as youd like Scharf says. Nobodys ever compared valerian root to the prescription sleep aid Ambien. The chief ingredient in many of these beverages is melatonin a hormone that induces sleepiness and helps coordinate the bodys biological clock. Its typically released by the pineal gland around p.m. secretion stops around or a.m. helping to trigger the body to wake up Scharf says. The body produces about threefourths of a milligram of melatonin a day. The manufacturer of the sleep aid Snoozn says its .ounce shots contain five milligrams of melatonin Unwind a relaxation blend has three milligrams per ounce can. Oral doses of melatonin havent worked much better at inducing sleep than a placebo in most studies Scharf says and a single concentrated shot of the stuff doesnt exactly mimic the bodys timerelease system. However a study published in January in the Journal of the American Geriatrics Society http found that a prebedtime cocktail of magnesium zinc and a fivemilligram dose of melatonin significantly improved sleep among a group of elderly Italian insomniacs. Jason Healy the head of InterMark Brands which markets Snoozn says he drinks his product on nights when he is stressedout or when he is traveling internationally. The back of the Snoozn bottle says the beverage will combat stress energy drinks and sleeplessness and takes about minutes to take effect. When it launches nationally in March Snoozn will be available in grocery and convenience stores and pharmacies like most of these drinks. We attack insomnia from two angles Healy says. Youve got to turn off all the stimulants and also get into a natural sleep cycle. Melatonin is used for the latter while ingredients such as valerian root and chamomile take care of the former Healy says. Both of those herbs are associated with soporific effects according to the Natural Medicines Comprehensive Database httpnaturaldatabase.therapeuticresearch.comhome.aspxcssND. Valerian root has properties that resemble the benzodiazepine class of medications such as Valium and Xanax but Scharf says he has no idea how they compare with standard sleeping pills because of the lack of comparative studies. Finding a niche Containers of relaxation drinks look similar to those of energy drinks. Many mimic the diminutive shape of the Hour Energy shot or the bright graphics and tall narrow can of Rockstar or Monster. Flavors range from a pleasant fruitflavored soda to just shy of cough syrup. Many relaxation beverages contain safety labels that warn consumers that they should neither drive or operate machinery after drinking them nor mix them with alcohol. Some say they arent intended for people younger than or for pregnant or nursing women a warning that the Food and Drug Administration has also made about melatonin. In January the FDA sent a warning letter to the Innovative Beverage Group which makes the relaxation beverage Drank saying the melatonin it uses is an unapproved food additive and not generally recognized as safe. Drank is still being sold with melatonin in it. In a statement Drank inventor Peter Bianchi says the safety of Dranks consumers remains a top priority and the company is working to modify the products packaging and marketing to reflect its classification as a dietary supplement. The FDA regulates conventional beverages ingredients and labeling claims more strictly than those of dietary supplements. Drank is still classified as a beverage. The relaxation drink market is tiny compared with the energy drink market says Garima Goel Lal a senior analyst at the consumer research firm Mintel. A Mintel survey found that percent of all functional beverage users said they were looking for beverages to release stress. A functional beverage the term is used for sport energy and relaxation drinks is a nonalcoholic drink that claims to have health benefits. The number of nonalcoholic beverages making relaxation claims continues to rise new ones came on the market in according to Mintel. The field is too young to identify the leaders and the losers Goel Lal says. Theyre trying to find a niche she says. Multiple choices Katherine Zeratsky a registered dietitian at the Mayo Clinic in Rochester Minn. has blogged about relaxation drinks. She says that people with certain health conditions such as high blood pressure should consult their physician before downing a can of Unwind or any of the other sleep beverages. A person can just go to the convenience store and purchase this Zeratsky says. Theres this perception that its safe and depending on the person it might not be a good choice."

"Legend has it that King Tut was fond of pomegranates and so were the ancient Persians. They surely enjoyed the fruit in its natural form not processed into pomegranate extract pills. These days a number of companies sell pomegranate supplements and say the pills are a more convenient way to benefit from the fruits potent antioxidants. The most aggressive of these manufacturers is POM Wonderful the company that also makes pomegranatebased juices teas and snack bars. Each of its Pomx Pills provides the same antioxidant power as ounces of Pom Wonderful pomegranate juice without the calories or grams of sugar the company says. The appeal of antioxidants stems from studies showing that diets high in antioxidantrich foods may be linked to a lower risk of cardiovascular disease some types of cancer and other health problems. Antioxidants neutralize dangerous molecules called free radicals that if left unchecked can damage cells. But claims that pomegranates in particular are good for the heart and prostate overstate the benefits of the fruit in any form and especially in pills says Dr. John Gordon Harold a cardiologist at the CedarsSinai Heart Institute in Los Angeles. If people want to take them thats fine but its not based on any scientifically valid information says Harold who is also a spokesman for the American Heart Assn. The AHA does not take positions on individual commercial products. For close to a decade now Pom Wonderful has touted what it claims are the fruits scientifically proven health benefits. The Los Angelesbased company has invested million in pomegranate research including studies on the fruits ability to improve cardiovascular and prostate health and erectile dysfunction. That marketing approach captured the attention of the Federal Trade Commission. Last year the agency filed a complaint against the company for making false and unsubstantiated claims that their products will prevent or treat heart disease prostate cancer and erectile dysfunction. Pom is fighting the charges. We disagree with the FTC and believe that the manner in which we have communicated the results of our scientific research is both truthful and appropriate the company said in a statement. Our scientific research which is worldclass shows that there are significant healthful benefits associated with drinking pomegranate juice. The company also chastised the agency for targeting a natural food product instead of focusing on manufactured and processed foods that make exaggerated health claims based on ingredients that have been added to the food in a laboratory. Pomegranates are inherently healthy. Indeed the pomegranate is probably the most wellstudied fruit we have says Dr. David Heber director of the UCLA Center for Human Nutrition and a recipient of Pom funding. Heber who has conducted more than a dozen studies on pomegranates says the fruit contains a powerful set of antioxidants including compounds called anthocyanidins and ellagitannins. While some of these are found in other redpigmented fruits and vegetables including strawberries and red cabbage other antioxidants such as punicalagins are found only in pomegranates and some rare herbs he says. It can be difficult to know precisely what parts of the fruit and which specific antioxidants are in commercial supplements because theyre not tightly regulated Heber says. Pom crushes the entire pomegranate skin rind and all to make its products the company says. Most of the evidence in favor of pomegranates health effects comes from laboratory and animal studies and most of them focus on the juice not the pills. A review of studies on pomegranate juice published this year in Complementary Therapies in Clinical Practice concluded that the beverage appeared to reduce blood pressure and slow the buildup of plaque in the arteries. But only five of the studies in the analysis were conducted in humans the rest involved mice or test tubes and they were small to boot. For instance a widely cited study showing a decline in blood pressure in people who drank . ounces of pomegranate juice daily for two weeks involved just participants. Theres less evidence to support the claim that pomegranate juice can prevent or treat prostate cancer. Animal research has been remarkably promising says Hasan Mukhtar a professor of cancer research at the University of Wisconsin Medical Science Center who has examined the juice in his own lab with funding from Pom in some cases. But human research on the subject is limited to a single clinical trial which lacked a proper placebo control he says. That trial published in Clinical Cancer Research showed that consuming ounces of pomegranate juice daily slowed the increase of prostate specific antigen a marker of prostate inflammation or cancer in men with prostate cancer."

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

"A drug used outside the U.S. to treat osteoporosis https may not only lessen the everyday pain associated with knee https osteoarthritis https but may even slow down the progression of osteoarthritis https researchers say. The drug is called strontium ranelate. In a threeyear study of more than people with knee osteoarthritis httpsarthritis.webmd.comstayingactivearthritisdefault.htmvidvdhzim digital Xrays revealed substantially less loss of cartilage in the joint space in those who took strontium ranelate every day compared with people who took a placebo https daily. In people with osteoarthritis https the cartilage in a joint wears away in some areas. The function of cartilage is to reduce friction in the joints and serve as a shock absorber. The wearing away of cartilage leads to pain and other symptoms. Nearly one in people have evidence of knee https osteoarthritis on an Xray. And nearly of women and of men age and older have joint pain https stiffness and other symptoms of knee osteoarthritis according to a large study. Study head JeanYves Reginster MD PhD presented the findings today at the American College of Rheumatology ACR Annual Meeting in Washington D.C. He is president and chair of the department of public health sciences at the University of Lige in Belgium. Strontium is a trace element found in seawater and soil. Its main dietary sources are Seafood Whole milk Wheat bran Meat Poultry Root vegetables In several European countries and Australia a form of strontium called Protelos strontium ranelate is available as a prescription drug for osteoporosis treatment https_treatment_care. Protelos is not approved in the U.S. But forms of the element such as strontium citrate are widely available as nutritional supplements https_AssetsscopemapsWebMDConsumerPagesVitaminsandSupplementsLifestyleGuide_ecedpage_VitaminsandSupplementsLifestyleGuide_eced.xml in supermarkets health food stores and online. But strontium supplements https cant just be substituted for Protelos says ACR spokesman Stanley Cohen MD a rheumatologist https at the University of Texas Southwestern Medical School in Dallas. They would have to be tested in another study. Strontium in Perspective Cohen notes that there are a variety of arthritis https medications https called diseasemodifying antirheumatic drugs DMARDs that work by curbing the underlying processes that cause certain forms of inflammatory arthritis https including rheumatoid arthritis https ankylosing spondylitis https and psoriatic arthritis https But finding a drug that can actually delay the progression of knee osteoarthritis is difficult he says. Several large trials of drugs that looked promising in early research failed to pan out. That makes this study potentially very exciting he says. But until the research has been reviewed by other doctors and published in a medical journal it is too soon to draw firm conclusions Cohen says. With no approved treatment to delay the progression of the disease current osteoarthritis treatments https focus on improving disease symptoms through a combination of medication physical therapy https and other nonpharmaceutical therapy. Strontium vs. Placebo The study involved people with knee osteoarthritis whose average age was . They were given a or gram dose of strontium or placebo daily. The people who took either dose of strontium had less cartilage loss compared to the placebo group. Both doses worked at a level that could significantly lower their risk of surgery within five years Reginster says. What we saw in this study is that to fewer patients taking strontium reached this surgery threshold compared with placebo he says. As for symptoms people taking the gram dose scored substantially higher than either of the other groups on pain related to everyday activities. Because the drug can raise the risk for deep vein thrombosis https when given in osteoporosis https patients with a history of DVT https were excluded from the study. As always people should talk to their doctors before taking a supplement to prevent or treat any disorder Cohen stresses. Several researchers reported financial ties to drug companies including Servier Laboratories a manufacturer of strontium ranelate. These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process in which outside experts scrutinize the data prior to publication in a medical journal."

"A new study from Karolinska Institutet in Sweden shows that shortcourse preoperative radiotherapy combined with delayed surgery reduces the adverse sideeffects of rectal cancer surgery without compromising its efficacy. The results are presented in the journal The Lancet Oncology. Rectal cancer affects some men and women in Sweden every year. Preoperative radiotherapy was gradually introduced in the early s with a consequent improvement in prognosis for people with rectal cancer and reduction in the risk of local recurrence. Back then we showed that preoperative radiotherapy reduces the risk of local recurrence by over per cent for patients with rectal cancer says principal investigator Anna Martling senior consultant surgeon and professor at Karolinska Institutets Department of Molecular Medicine and Surgery. Thanks to our results radiotherapy is recommended to many rectal cancer patients. However radiotherapy can cause adverse reactions and the optimal radiotherapeutic method and the interval between it and the ensuing surgery have been mooted. The study now presented in The Lancet Oncology is based on the claim that the adverse effects of rectal cancer treatment can be reduced by administering more but lower doses of radiation for a longer time or by increasing the interval between radiotherapy and surgery. These hypotheses have now been tested in a study in which rectal cancer patients were randomly assigned to three different treatment arms Standard therapy i.e. shortcourse x Gy radiotherapy with direct surgery within a week. Delayed surgery with shortcourse x Gy radiotherapy followed by surgery after weeks. Delayed surgery with longcourse x Gy radiotherapy followed by surgery after weeks. The results of the study show that patients with delayed surgery develop fewer complications with equally good oncological outcomes. It also showed that there is no difference between longcourse and shortcourse radiotherapy other than that the former considerably lengthens the time for treatment. The results of the study will give rise to improved therapeutic strategies fewer complications with a sustained low incidence of local recurrence and better survival rates for rectal cancer patients says Professor Martling. The results can now be immediately put to clinical use to the considerable benefit of the patients. Eighteen Swedish hospitals took part in the study which was financed by the Swedish Research Council and the Cancer Society in Stockholm and through the regional ALF agreement between Stockholm County Council and Karolinska Institutet. Researchers from the universities in Lund Uppsala and Linkping also contributed to findings. Publication The Stockholm III Trial on optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer a randomised controlled trial Johan Erlandsson Torbjrn Holm David Pettersson ke Berglund Bjrn Cedermark Calin Radu Hemming Johansson Mikael Machado Fredrik Hjern Olof Hallbk Ingvar Syk Bengt Glimelius Anna Martling The Lancet Oncology online February DOI httpdx.doi.org.S"

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

"A study presented today that evaluated an investigational dosage of oncedaily ledipasvir mgsofosbuvir mg LDVSOF in children aged six to years infected with the Hepatitis C virus HCV found that of children n had undetectable levels of HCVRNA weeks after treatment. The study presented at The International Liver Congress in Amsterdam The Netherlands also showed that the fixeddose combination of LDVSOF was welltolerated and no patients experienced a serious adverse event considered related to the study drug. Around million people globally have chronic HCV infection including approximately million people in the EU. The prevalence of HCV infection in children varies from .. in the United States and Europe and up to .. in some developing countries. While directacting antivirals have been used to treat and cure adult patients with HCV until now children have been mainly treated for to weeks with pegylated interferon plus ribavirin RBV an older treatment which causes severe side effects. Directacting antivirals have transformed the treatment of adults with chronic HCV however studies of these new therapies in children are required said Dr Karen Murray University of Washington School of Medicine and Seattle Childrens Seattle United States and lead author of the study. These data establish the use of the oral directacting antivirals as an important treatment option in HCVinfected children aged six to years old. This ongoing openlabel study enrolled children aged between six and years with chronic HCV mostly genotype n. Children with HCV genotype infection received weeks of treatment n or weeks of treatment if they had cirrhosis and failed prior treatment with pegylated interferon plus RBV n genotype patients received LDVSOF plus RBV for weeks n genotype patients received LDVSOF for weeks n. Most children were male white treatment nave and vertically infected . Of the study population achieved a sustained virologic response weeks after treatment SVR one treatmentnave genotype patient with cirrhosis relapsed. No children discontinued the study due to side effects or had a severe or lifethreatening adverse event related to the study drug. The most common side effects reported in or more of patients were headache fever abdominal pain diarrhoea vomiting cough fatigue sore throat and nausea. This study is a breakthrough for the management of children aged six to years old with Hepatitis C demonstrating that the new DAA regimen is highly efficacious and more importantly safe in this group of HCVinfected children said Prof Frank Tacke University Hospital Aachen Germany and EASL Governing Board Member. About The International Liver Congress This annual congress is the biggest event in the EASL calendar attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present share debate and conclude on the latest science and research in hepatology working to enhance the treatment and management of liver disease in clinical practice. This year the congress is expected to attract approximately delegates from all corners of the globe. The International Liver Congress will take place from April at the RAI Amsterdam Amsterdam The Netherlands. About The European Association for the Study of the Liver EASL http Since its foundation in this notforprofit organisation has grown to over members from all over the world including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe having evolved into a major European Association with international influence with an impressive track record in promoting research in liver disease supporting wider education and promoting changes in European liver policy. Contact For more information please contact the ILC Press Office at Email ILCpressofficeruderfinn.co.uk mailtoILCpressofficeruderfinn.co.uk Telephone Onsite location reference Session title Parallel session Advances in the treatment of HCV Time date and location of session Friday April Hall Presenter Karen Murray United States of America Abstract Ledipasvirsofosbuvir ribavirin for or weeks is safe and effective in children years old with chronic hepatitis C infection PS Author disclosures Research funding from Gilead and NIH Merck stock ownership. References EASL Recommendation on Treatment of Hepatitis C . Available from http Last accessed April . World Health Organization. Global Alert and Response Hepatitis C. Available from http Last accessed April . Pawlowska M Malgorzata et al. Whats new in hepatitis C virus infections in children WJG. . Afdhal N et al. Ledipasvir and sofosbuvir for untreated HCV genotype infection. N Engl J Med. May . Afdhal N et al. Ledipasvir and sofosbuvir for previously treated HCV genotype infection. N Engl J Med. Apr . Kowdley KV et al. Ledipasvir and sofosbuvir for or weeks for chronic HCV without cirrhosis. N Engl J Med. May . Sulkowski MS et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. Jan . Jara P Hierro L. Treatment of Hepatitis C in children. Expert Rev Gastroenterol Hepatol. ."

"Take a deep breath. How often do you hear someone give that advice for calming down Maybe you give it to yourself. You may be surprised to learn that a new biofeedback treatment for panic disorder suggests just the opposite. The athome treatment which uses a machine called Freespira that measures respiration rate and carbondioxide levels in exhaled breath trains patients to breathe slowly and shallowly with an emphasis on more complete exhalation than many of us are used to. A small early study found that percent of patients were panicfree a year after training with the device for a month. What weve learned from Freespira is that if you have a panic attack the last thing in the world you want to do is deep breathing said Carl Robbins a psychotherapist at the Anxiety and Stress Disorders Institute of Maryland who has used the device with patients. The theory behind the treatment is that improper breathing too fast or too deep triggers physical symptoms that spiral into fullblown panic attacks when anxious people worry that theyre having a heart attack or some other catastrophic problem. The fear causes even more hyperventilation leading to a vicious loop of physical symptoms and anxiety. Wow Alan J. Russell thought when he heard all this. Is that a big deal Russell a biological chemist who is chief innovation officer and executive vice president of Allegheny Health Network was in a position to go beyond the small studies that led the FDA to clear the device for use in . He runs VITAL an unusual program at Highmark Health the big Western Pennsylvania health provider and insurer. The program gathers information on treatments that are not yet ready for prime time in terms of classic reimbursement he said. Freespira is among the first three treatments the insurer is testing to decide whether they merit insurance coverage. VITAL Verification of Innovation by Testing Analysis and Learning is paying for of Highmarks million subscribers to try Freespira for panic symptoms. The program will then analyze whether the treatment works and reduces treatment costs. Currently no other insurance companies are covering Freespiras amonth price tag a barrier to widespread use. In this area only Marvin Berman a neurofeedback therapist who runs Quietmind Foundation in Plymouth Meeting offers the device to patients. He said a handful had used it with lasting results. Your brain is always looking for the more efficient way to do things he said. The whole dynamic becomes selfreinforcing. Six million people in the United States have panic disorder and million have episodes of panic. Seemingly out of the blue sufferers may experience sudden attacks of fear or feeling out of control. Physical symptoms include a racing or pounding heart chest pain sweating breathing problems tingling hands and chills. Such symptoms prompt repeated emergencyroom and primarycare visits. People with panic disorder can become so afraid of the attacks they stop doing things they think are triggers. In extreme cases they stop leaving their homes. It really starts to shrink the world in which people can operate said David Yusko a University of Pennsylvania psychologist who does not use Freespira. Their lives get reduced to safe zones. Patients typically are treated with cognitive behavioral therapy a type of talk therapy that focuses on changing dysfunctional thoughts as well as with antianxiety drugs and antidepressants. Learning to take slower breaths has long been part of panic disorder treatment. Yusko associate director of the Center for the Treatment and Study of Anxiety adds exposure therapy which helps people deal with their fears by facing them repeatedly. Finding skilled exposure practitioners is difficult he said but the combination of treatments is supereffective. He is skeptical that Freespira can outperform exposure therapy. Many people with panic disorder chronically hyperventilate or breathe too much. This can happen when they breathe deeply or too rapidly and it leads to an imbalance of oxygen and carbon dioxide in the blood. When carbon dioxide falls too low as it does when people hyperventilate it creates the symptoms that can send vulnerable people into a panic. The idea behind Freespira is to break the loop by retraining people to breathe properly a skill that most of us lose after infancy probably because we imitated our parents Berman said. First off breathe through your nose not your mouth. Pull the breath into your stomach not just the chest and let your belly expand. Exhale fully. Greg Tomita vice president of marketing for Palo Alto Health Sciences Inc. which markets Freespira said percent of patients with panic disorder in trials had low CO levels at baseline. Though the other percent had normal levels their breathing was erratic. Both were helped by breathing training. Freespiras FDA clearance was based on work by Alicia Meuret a psychologist at Southern Methodist University. She declined to discuss the company or her research for this article. David Tolin a psychologist at the Institute of Living in Hartford is now analyzing data from a multicenter trial that included patients of whom completed treatment. Two months after treatment percent of those who stayed in the study had a significant reduction in severity of panic disorder symptoms. The attacks had stopped for percent. Tolin said that was similar to results for cognitive behavioral therapy but that Freespira was much less timeconsuming than most of the behavioral therapies that we would use. Freespira measures respiration rate and CO through nasal tubes. Patients who are instructed to practice for minutes twice a day see how theyre doing on a computer tablet. Sound cues tell them when to inhale and exhale. Over four weeks their breathing rate declines to six breaths per minute. Getting it right while breathing evenly is not easy. Users are instructed to sip air as though it were a precious commodity. It is challenging said Tomita. It is not a relaxation exercise. Colleen Kistner of Fallston Md. who has suffered from frequent panic attacks for years participated a year ago in a test of Freespira. This is how she described her attacks I literally feel like Ive lost my breath. My chest is unbelievably tight. My hands go numb and tingly. I get very cold . . . and I feel completely disoriented and out of control. She has tried cognitive behavioral therapy exposure and medication. Kistner found using the machine was hard at first. The breathing felt weird and even made her a little panicky but she persevered. Soon she started sleeping better. She felt more focused. When shed feel nervous the machines breathing tone popped into her head like an annoying song hook. I think it calmed all of my system she said. She liked it so much that she begged to keep the machine. She used it twice when symptoms returned. She says she is panicfree now. I feel like I have my life back. A big question is why this would work. Is it the C or are patients benefiting from slower respiration a period of meditative stillness or the sense of control they get from seeing how their breathing changes We have a pretty good sense that breathing retraining works Tolin said but we have a million questions about why it works. Paul Lehrer a respiration expert at Rutgers University said that hyperventilation alone would create a host of disturbing symptoms that could trigger emotional reactions but that the pace and regularity of breathing were also important. No one breathes in perfect rhythm all day. We hold our breath when were concentrating. We take in more air when we exercise. Irregular breathing in the form of frequent sighing and yawning though brings in more air and can contribute to hyperventilation. Breathholding and the subsequent compensation also can lead to hyperventilation. Breathing at fiveandahalf to six beats per minute is typically the resonance frequency where breathing efficiency is maximized. When Lehrer studied Zen monks in Japan he found that was their breathing rate. Breathing at this frequency stimulates and strengthens reflexes that help control blood pressure pain anxiety and depression and improves physical functioning Lehrer said. An obvious question is whether the machine might be helpful for other anxious people. One study found that low C levels were common in those whose anxiety manifested itself in other ways. Tolin is now collecting respiratory data from everybody who comes to his clinic and is preparing for a controlled trial of people with anxiety. VITALs Russell is interested in that too. Were very excited to think about other uses for the device he said. For now though their study is focused like a laser on panic. Tolin said most of us need not worry about whether were breathing just right. His own CO is on the low end. A lot of us breathe wrong he said but I think for most of us its not a big deal. The body is pretty robust."

"Most heart attacks strike with no warning but doctors now have a clearer picture than ever before of who is most likely to have one says Dr. Arthur Agatston a Miami cardiologist and author of the bestselling South Beach diet books. Agatston says relatively new imaging tests give realtime pictures showing whether plaque is building up in key blood vessels alerting doctor and patient to an increased risk of a potentially deadly heart attack. Unless you do the imaging you are really playing Russian roulette with your life he said. Agatston invented one of the imaging tests the coronary calcium scan which looks at plaque in the arteries leading to the heart. Plaque in these arteries is a red flag for a potential heart attack. Agatston does not make any money from the coronary calcium scan. The other imaging test Agatston recommends is an ultrasound of the carotid artery looking at plaque in the main blood vessel leading to the brain. Plaque in the carotid artery is a sign of increased risk for a heart attack and stroke. American Heart Association Learn and live http Both tests are noninvasive and outpatient although the calcium scan does expose the patient to the equivalent of several months of normal background radiation. Dr. Arthur Agatston consults with Judy Willner about her checkup in his Miami office. One large federally funded study found the coronary calcium score a better predictor of coronary events like a heart attack than the traditional Framingham Risk Score which considers age cigarette smoking blood pressure total cholesterol and HDL the good cholesterol. Agatston thinks the coronary calcium scan should be routinely scheduled at age like a colonoscopy or earlier for people with family histories of heart disease. Most hospitals now offer the imaging tests some at less than for both and they are often covered by insurance. Cardiologists now generally use the calcium scan only for patients considered at intermediate risk for heart disease determined by traditional measures such as cholesterol blood pressure lifestyle and family history. Highrisk patients already receive such aggressive treatment as cholesterollowering statin medication but many doctors dont think lowrisk patients need to incur the expense or small dose of radiation that comes with a coronary calcium scan. There is a large group in the middle called intermediate risk which may be as much as of the population said Dr. Erin Michos a cardiologist at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University A good candidate for a coronary calcium scan she says would be a yearold man with slightly elevated cholesterol and a father who had a heart attack. Do you put this yearold who has this family history on a statin medication with potential expense and side effects for the next four decades of his life or do you further refine how far at risk he is she asked. A calcium score would answer that question she says. Theres a third test Agatston likes a blood test that looks at a patients LDL or bad cholesterol. LDL particles come in different sizes and patients with a lot of smallparticle LDL are more likely to build up plaque in their blood vessels Agatston says. Alternately patients with large LDL particles do not tend to accumulate plaque. There are a lot of little old ladies in their s with very high cholesterol who have squeaky clean vessels. They have very large particles and they dont get into the vessel wall Agatston says. These new tests give patients a chance to make major changes in their diet and lifestyle and give doctors an opportunity to treat them with medication. One of the bestkept secrets in the country in medicine is the doctors who are practicing aggressive prevention are really seeing heart attacks and strokes disappear from their practices. Its doable Agatston says."

"You may have seen it performed in real time on ABCs Good Morning America. Or maybe you caught actor Hugh Jackman telling David Letterman about having it. Or you may be among the legions of people who have personally undergone it. It is Mohs micrographic surgery the preferred treatment for the two most common types of skin cancer basal cell and squamous cell. Although rarely lifethreatening these tumors can become disfiguring without timely removal and they are being diagnosed at the staggering clip of more than four million a year. During Mohs surgery named for Frederic E. Mohs the Wisconsin surgeon who developed it in the s a thin disk of skin is cut out and while the patient waits examined under a microscope. This process is repeated until the entire malignancy and a border of healthy tissue have been removed. Compared to conventional excision cutting out the tumor plus a safety margin in one swoop Mohs spares more tissue produces better cosmetic results and has superior cure rates. Heres the rub Mohs is also more expensive and use soared percent from to Medicare data show. About a quarter of patients with nonmelanoma skin cancers are now treated with Mohs compared to percent in . In response to concerns about overuse Medicare has tightened rules and cut reimbursement rates for Mohs and medical groups have issued guidance about when to use it. Money definitely is a factor said Clifford Perlis director of Mohs and other dermatologic surgeries at Fox Chase Cancer Center. So theres a builtin controversy about when is Mohs appropriate. A related controversy involves who should do it. You can go to a dermatologist who like Perlis spent a year or more being trained to do Mohs which requires the surgeon to double as the pathologist the specialist who evaluates cells under a microscope. Or you can go to a dermatologist who took a fourday course on Mohs. Its no news that skin cancer is increasingly common. The factors include overexposure to the suns harmful rays an aging population the Earths thinning ozone layer maybe tanningbed use. Still the magnitude of the epidemic is shocking. The average annual number of adults treated for skin cancer jumped from . million in to . million in while the costs more than doubled from . billion to . billion according to a recent study by the U.S. Centers for Disease Control and Prevention. Melanoma the deadliest skin cancer is part of this upward trend. But it is nonmelanomas primarily basalcell and squamouscell lesions that account for almost percent of all skin malignancies. Early on these lesions may appear innocuous. Basal lesions often look like small sores red patches or shiny bumps and squamous cancers may start as scaly red patches open sores or wartlike growths. Usually nonmelanomas can be treated in a doctors office under a local anesthetic. Therapeutic options include topical drugs freezing or lasering. But when a biopsy confirms a nonmelanoma on a cosmetically important area Mohs is optimal. In expert groups including the American Academy of Dermatology and the American College of Mohs Surgery said the procedure was appropriate for nonmelanomas on the head and neck as well as those anywhere on the body that were recurrent or aggressive. Mohs is usually not necessary the groups say for lesions on the torso. To understand Mohs advantages consider that with traditional excision the surgeon has to estimate how extensively to cut in hopes of nabbing a safety margin of healthy tissue. If the pathologist finds cancer in that margin the patient has to return for a deeper excision. Worse the pathologist may conclude the surgery achieved clear margins when it actually didnt. This happens up to percent of the time studies show because random samples of the excised tissue are examined not the entire specimen. With Mohs in contrast each layer of removed tissue is frozen by a technician cut horizontally into micronthin slices and entirely examined under the microscope by the surgeon. This misses cancer only percent to percent of the time a cure rate of percent to percent studies show. Mohs also has a system for colorcoding and segmenting each disk of tissue so the surgeon can tell precisely where to cut deeper at the surgical site. For patients that means the smallest possible or no scar plus immediate repair of the surgical wound. Tina McDonnell of Palmyra went to Perlis just after Christmas for Mohs on her left ear. She is confident the results will be as good as on her nose where she has had two squamouscell lesions removed in the last decade. People cannot believe I had surgery on my nose said McDonnell operations director at the Ronald McDonald House in Philadelphia. You would never know. Thats not to suggest Mohs is magical. Deborah Edmiston a busy mother of six in Northeast Philadelphia put up with a raw flaky red spot on the corner of a nostril assuming it was just psoriasis. By the time it became painful in May the basalcell tumor was deep. Perlis removed it with Mohs but enlisted a plastic surgeon for the multistep reconstruction which is almost complete. Now I tell everybody Make sure you cover up and use your sunscreen said the fairskinned redhead. On average Mohs costs about per case compared to about for excision said Howard W. Rogers a Norwich Conn. dermatologist who sits on the public policy committee of the American College of Mohs Surgery. He believes Mohs is misperceived as expensive when its actually a bargain because a single payment is made to one doctor. With excision reimbursement is spread out to the surgeon pathologist and lab. Nonetheless beginning in the Centers for Medicare and Medicaid made changes that cut payments for Mohs percent to percent. Last year Medicares administrative contractor for Florida also proposed to limit reimbursement for Mohs to physicians who had completed a yearlong fellowship that included performing at least cases. The fellowship program was created in the s by the American College of Mohs Surgery. Such a restriction would be a blow to Florida dermatologists who took a considerably shorter route the fourday course offered by the American Society of Mohs Surgery. The society was founded in when demand for Mohs surgeons far outstripped the number being produced by the fellowship program. The proposed restriction was dropped amid backlash from medical groups. But it highlighted a controversy within the evolving field of Mohs Is the procedure just an arrow in the skincancer specialists quiver Or is Mohs a medical subspecialty by itself The latter said Cincinnati dermatologist Brett Coldiron president of the American Academy of Dermatology and an eminent Mohs surgeon. He envisions a time when Mohs surgeons will have to meet standards and pass a certification exam. The specialty is moving that way Coldiron said but you cant do it overnight or there will be an uproar. Meanwhile he advises patients to ask questions. Id tell patients to look at their doctors experience and ask how many cases theyve done Coldiron said. Ive done . WHERE TO FIND A MOHS SURGEON Heres a link to the American College of Mohs Surgery surgeon finder. These are all fellowshiptrained Mohs surgeons httpacms.execinc.comediboSurgeonFinder mmcculloughphillynews.com"

"Scientists are finding more pieces of the autism puzzle of with the help of MRI scans of brain circuitry according to a study published Thursday online in the journal Autism Research. By scanning the brain for minutes using magnetic resonance imaging researchers were able to measure six physical differences of microscopic fibers in the brains of males with confirmed highfunctioning autism and males without autism. The images of the brains helped researchers correctly identify those with autism with percent accuracy says Nicholas Lange an associate professor of psychiatry at Harvard Medical School and one of the study authors. No one has measured what we measured says Lange of the MRI test he and Dr. Janet Lainhart from the University of Utah developed. While previous studies using different types of scans have been able to identify people with autism Lange says no one has looked at it the brain the way we have and no one has gotten these type of results. Lange is quick to caution that this type of test is not yet ready for prime time. We do not want to give anyone false hopes that this is ready for the clinic yet. This method this test needs to be tried and confirmed with many more subjects outside our laboratory he says. Plus the research needs to be expanded to many more study participants and tried on younger people with autism and those who are not as highfunctioning as the subjects in this first trial. Using the MRI the study authors measured how the water in the brain flows along the axons or nerve fibers in the parts of the brain that control language social and emotional functioning. The scans revealed that the wiring of the brains of those with autism was disorganized compared with the brains of a typical person without autism. This is how they could determine which brains scans belonged those study participants with autism. The study included only males between the ages of and because they were part of a bigger research project at the University of Utah which is following males with autism for a longer period. The Centers for Disease Control and Prevention estimates in children in the United States have an autism spectrum disorder http boys are far more likely to have this neurological disorder that affects language and social behavior that number is about in . However future studies will include girls too. Currently theres no biologic test for autism so pediatricians look to see if a child is meeting certain developmental milestones as well as signs and symptoms of autism http The advocacy group Autism Speaks has posted videos to help parents see the signs of autism http The earlier a child has been identified as having autism the earlier behavioral therapies can be applied to lessen the impact of the disorder later in life. Lange believes this brain scans can be done on younger children as long as they can go to sleep in the scanner on their own without sedation because you cant move during the test. Carissa Cascio an assistant professor of psychiatry from Vanderbilt University School of Medicine who specializes in autism and neuroimaging believes these study results are important. But she cautions that using this method as a true diagnostic tool to detect autism in a child is a long way off. What this paper seems to be doing is taking the first steps towards parlaying what we are able to glean from brain imaging into potential diagnostic tools. Zachary Warren who is the director of the Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders TRIAD says since there are many types of autism it becomes very challenging to capture all these differences with one test. Still he believes this is new study can help pinpoint the earliest markers of concern in developing brains."

"Scientists in Britain have developed a type of HIV test using a USB stick that can give a fast and highly accurate reading of how much virus is in a patients blood. The device created by scientists at Imperial College London and the privatelyheld U.S. firm DNA Electronics uses a drop of blood to detect HIV then creates an electrical signal that can be read by a computer laptop or handheld device. The researchers say the technology although still in the early stages could allow patients to regularly monitor their virus levels in a similar way to diabetes patients checking their blood sugar levels. It could be particularly useful in remote settings to help HIV patients manage their treatment more effectively since current tests to detect virus levels take at least three days and involve sending a blood sample to a laboratory. Monitoring viral load is crucial to the success of HIV treatment. At the moment testing often requires costly and complex equipment that can take a couple of days to produce a result said Graham Cooke who coled the research from the Imperials department of medicine. We have taken the job done by this equipment which is the size of a large photocopier and shrunk it down to a USB chip. The test which uses a mobile phone chip requires a drop of blood to be placed onto a spot on the USB stick. Any HIV in the sample triggers an acidity change which the chip transforms into an electrical signal. This is sent to the USB stick which shows the result on a computer or electronic device. Published in the journal Scientific Reports results showed the stick test was percent accurate over blood samples and the average time to produce a reading was . minutes. Some million people worldwide are infected with the human deficiency virus HIV that causes AIDS and the majority of them live in subSaharan Africa. Current AIDS drugs called antiretrovirals reduce virus levels in a patients blood to near zero. But in some cases the drugs stop working sometimes because virus has developed resistance to them and the first sign of that would be a rise in a patients socalled viral load. Virus levels cant be detected by routine HIV tests which can only show whether or not a person has the virus. Editing by Raissa Kasolowsky Our StandardsThe Thomson Reuters Trust Principles httpthomsonreuters.comenaboutustrustprinciples.html"

"Britains people with bipolar disorder https should take lithium to help control their condition despite its reputation for dulling the senses a significant new study has found. Researchers claim that although the drug does carry some health risks its overall effectiveness especially its ability to reduce selfharm and suicide mean it should be much more widely used. The findings are contained in httpjournals.plos.orgplosmedicinearticleid.journal.pmed. the first study comparing the sideeffects of the four main moodstabilising drugs the NHS prescribes. They have prompted calls for a rethink about attitudes towards lithium given that only an estimated of those with bipolar disorder use it mainly because patients fear it will cause loss of personality weight gain and other problems. The lead author behind the research told the Guardian that widespread lithium stigma among patients is leading to them receiving the wrong treatment and ending up admitted to hospital unnecessarily because their condition is not as well controlled as it could be. Lithium is a drug with a bad reputation. It is seen by patients and some psychiatrists as a dangerous drug. People rightly have suspicions about it. Patients say that the downsides include emotional numbing feeling that you arent connected with your feelings as well as tremors said Dr Joseph Hayes a psychiatrist at University College London. But lithiums reputation is largely misplaced and based on the experiences of patients from the s to the s who were given too large a dose of the drug he added. The new research published in the medical journal PLOS Medicine found that the sideeffects of the moodstabilising alternatives used by most patients are either the same as or worse than lithium Hayes said. The paper cowritten by Hayes and four colleagues from UCL and Oxford University concluded that Lithium remains an important treatment for individuals with bipolar disorder. It accepts that there is clear evidence that its use is associated with a number of adverse events. However it adds These risks need to be offset with the potentially superior effectiveness and antisuicidal benefits of the drug compared to other treatment options. The researchers studied a nationally representative sample of patients across the UK who were treated for bipolar disorder between and . Of those had taken lithium had used valproate had been on olanzapine and had taken quetiapine. They experienced sideeffects including chronic kidney disease thyroid disease weight gain and high blood pressure. The researchers analysis bore out one of the two main criticisms of lithium but found the other to be baseless. They found that patients on lithium had a higher risk of suffering kidney function problems and developing hypothyroidism or hyperthyroidism and also hypercalcemia. However none of the drugs caused more severe kidney problems. Meanwhile lithium patients were less likely to put on weight than patients on the other drugs. While of those on the three other drugs were more likely to gain more than of their body weight just of those on lithium put on the same amount of extra pounds. Those on olanzapine added the most weight and experienced high blood pressure as a result. I think many patients are missing out quite commonly on the best available treatment Dr Joseph Hayes Separate research has shown that patients on the other three medications are more likely to harm themselves than those on lithium. Bipolar disorder https carries one of the highest rates of suicide of any mental illness alongside schizophrenia and alcohol and drug addiction. The very limited use of lithium is despite the National Institute for Health https and Care Excellence Nice advising in that it should be the standard treatment for bipolar disorder which is also known as manic depression and is characterised by manic highs and bouts of depression. That superseded its previous view outlined in that any of the four drugs were useful first lines of treatment for the condition which affects about one in people. Lithium stigma which includes some people in the psychiatric community leads to people using drugs that are less effective than lithium. To me as a doctor thats a big worry because my main aim is to help people to be well and if you arent doing that with the best available evidence then you are failing patients said Hayes. I think that many patients are missing out quite commonly on the best available treatment. That means that people end up in hospital more often than they need to and end up achieving less in their lives than they could do if they were on lithium. The high suicide rate with bipolar disorder should encourage greater use of lithium. There should be more sensible use of it. Stephen Buckley head of information at the charity Mind said We welcome research which adds to our understanding of treatments and medications for people experiencing mental health problems including bipolar disorder. But as with all areas of mental health there is still more research to be done. Different people will find that different treatments help with managing their mental health problems. This may be medication talking therapies or a mixture of both."

"People who are diagnosed with prediabetes can delay or prevent the disease if they change their lifestyle and lose a significant amount of weight. But heres the challenge How can people be motivated to eat healthier and move more Increasingly the answer might include digital medicine. Just telling people to do things doesnt work says Sean Duffy CEO of Omada Health https If it were easy there wouldnt be more than million adults https in the U.S. with prediabetes. Omada has rolled out a digital program delivered on smartphones and other devices that incorporates all the ingredients known to help people overhaul their habits. It includes ecoaching peer support education diet and exercise tracking and electronic nudging. Forget to weigh in or track your meals Youll get texts or emails reminding you to do it. Week by week we have lessons on different themes Duffy explains. Theyre interactive and theres little games to keep it dynamic. Participants are matched with a group of peers online and theyre led by a coach who they can text or email back and forth with. We call it the symphony effect Duffy says because there are multiple methods working together to help participants stay on track. Getting started Sometimes fear is a good motivator for losing weight. Don Speranza is in his late s and lives on a farm along the Columbia River in Washington state where he runs a bed and breakfast with his wife. Hes also the chef at the inn. Im immersed in food all day Speranza says. Article continues after this message from our sponsor Last year he received an email from his doctor at Kaiser Permanente with some test results. It was like a gut punch Speranza says. Based on his weight which had been crept up to pounds and the results of his bloodwork to test his glucose he was diagnosed with prediabetes. This means his blood sugar level was elevated but not yet high enough to be diagnosed with the condition. It was a real cometoJesus moment Speranza recalls. He knew that diabetes increased the risk of heart disease and can lead to many other complications including vision loss and amputations. When he signed up for the Omada program the first thing he received was a scale. He began to weigh himself daily. He also began to track what he was eating. Each day hed log his weight and meals and upload the data to a dashboard. His coach could see the data too and give him advice and encouragement. Oh my coach Speranza says. I cant sing her praises enough she was so responsive. Even though they never met in person they bonded. He took her advice and suggestions. He realized for instance that he ate too much of the wrong things. Homemade breads and croissants pasta and pizza Speranza ticks off the list of baked treats with a mix of reverence and resolve in his voice. Speranza realized he had to change his relationship with these foods. Temporarily he cut out all these refined carbohydrates. He had to train himself to resist all the treats he bakes for his guests. Instead he began to fill his plate with more protein vegetables and healthy fats. He raises animals on his organic farm so he eats pastured meats and a lot of salmon. Week by week Id make one or two little changes at a time Speranza says. It was a game changer. The weight began to fall off and he started to move more. His coach nudged him to switch up his morning routine. He says he was accustomed to sitting each morning for an hour or so just drinking coffee. Now Ill start the coffee he says but before he drinks it Ill go outside and walk. He tracks his movement withe a wearable electronic device. He began with steps logged during his morning walk but has now increased his steps significantly. And he rides a stationary bike too. Now I can almost keep up with my wife Speranza says with a laugh. Since last May he has lost about pounds to be exact but it fluctuates a bit and his blood sugar has returned to the normal range. He no longer has prediabetes. I feel so much better Speranza says. As a baker he buys flour in pound sacks. Now when I look at the sacks Im aghast to think thats what I was carrying around. Success is not automatic Not every Omada Health participant makes the progress theyre aiming for. After all pulling off these changes is difficult Im still on the journey to get to more optimal health says Lonny Northrup who lives in Utah. He lost weight while participating in the program but when he hit a plateau in his weight loss he felt stuck and he says he didnt get the personal support he would have liked from the program. For many days in a row I got an email saying Hey we noticed you didnt step on the scale he says. For some reason that didnt get escalated to the coach. So he says that was a disappointment. Overall he says he would recommend the Omada Health program to a friend. I got really good specific recommendations that worked for me and my lifestyle Northrup says. And he says the convenience of having the program delivered on a smartphone was key too. There is some evidence that these kinds of programs are working. A recent pilot study with Utahbased Intermountain Healthcare httpsintermountainhealthcare.org that included about people all of whom were at high risk of Type diabetes found that percent of the participants completed the Omada program and lost at least percent of their body weight. And about in participants lost percent of their body weight or more. Thats promising because theres evidence that a percent body weight loss cuts the risk https of developing diabetes by about percent. This is one of the most exciting things says Mark Greenwood a physician with Intermountain. Omada Health is not the only player in this space. The Centers for Disease Control and Prevention recognizes httpsnccd.cdc.govDDT_DPRPCity.aspxSTATEOTHCITYOTH many diabetes prevention lifestyle change programs delivered both inperson and online including Vida https which bills itself as a health transformation team that is data and techdriven. Additionally traditional players in the weight loss space such as Weight Watchers now offer some similar incentives https such as personal coaching. Greenwood says hed like to see many more patients try diabetes prevention programs. And he says hes pleased with the results of the pilot study of Omadas program. The data really does confirm that when you give people tools and help instead of just preaching to them it really does help."

"Shoulder instability is most common in the young athletic population bringing a focus to how these injuries are best treated. Research presented today at the American Orthopaedic Society for Sports Medicines AOSSM http Annual Meeting in Colorado Springs CO demonstrated that surgery after a firsttime shoulder dislocation lowered the reinjury risks and need for followup surgery when compared to those who were initially treated nonoperatively and experienced a repeat dislocation prior to surgery. The study examined patients at an average of months postsurgery. Of this group patients had experienced their first dislocation while had recurrent dislocations after being initially treated nonoperatively. After treatment with an arthroscopic bankart repair the postoperative dislocation rate in the firsttime injury group was compared to in those who did not have surgery after their initial injury. The average age of patients was years old. Deciding between a nonoperative program or going forward with surgery can be a challenging decision for medical professionals treating shoulder injuries in young athletes noted the studys lead author Tyler J. Marshall MD from Alabama Ortho Spine and Sports in Birmingham AL. However this study shows a substantial benefit for athletes undergoing surgery to prevent recurrent instability down the road. The research data was collected between and from eight fellowship trained surgical practices with patient ages ranging from to years old. Surveys given to patients during followups asked for information such as test for shoulder functionality whether patients returned to sport postoperative instability events and if further surgery was required on the shoulder. While young athletes and parents may be wary of surgery our study shows the advantages of this treatment approach commented Marshall. Physicians should counsel those with first time injuries on these benefits moving forward. The American Orthopaedic Society for Sports Medicine AOSSM is a global leader in orthopaedic sports medicine education research communication and fellowship and includes national and international sports medicine leaders. The Society works closely with many other sports medicine specialists including athletic trainers physical therapists family physicians and others to improve the identification prevention treatment and rehabilitation of sports injuries. AOSSM is also a founding partner of the STOP Sports Injuries http campaign to prevent overuse and traumatic injuries in kids"

"A new study finds young children with mild persistent asthma can tolerate acetaminophen without the worsening of asthma when compared with ibuprofen use. The study funded by the National Heart Lung and Blood Institutes NHLBI asthma network AsthmaNet appears in the August issue of the New England Journal of Medicine. Previous observational studies had suggested that acetaminophen use was associated with asthma symptoms says Kristie Ross MD MS Clinical Director Division of Pediatric Pulmonology AllergyImmunology and Sleep Medicine at University Hospitals Rainbow Babies Childrens Hospital UH Rainbow and coauthor on the study. Results from this randomized controlled study showed that in young children with mild asthma acetaminophen used as needed was not associated with increased asthma flares or more asthma symptoms. These findings can help us reassure parents of young children with asthma that they can continue to use acetaminophen on an as needed basis and as directed to treat pain and fever without concern that it will worsen asthma symptoms. Dr. Ross who is also an Associate Professor of Pediatrics at Case Western Reserve University School of Medicine was joined by UH Rainbow colleagues and study coauthors James Chmiel MD MPH Professor of Pediatrics and Ross Myers MD Assistant Professor of Pediatrics. To assess the impact of acetaminophen use on childrens asthma AsthmaNet investigators studied children aged to years old who had mild persistent asthma defined as symptoms on more than days out of a week but not daily. All children required daily inhaled treatments to manage their asthma. During the study caregivers used either acetaminophen commonly known as Tylenol or ibuprofen Advil Motrin whenever a child needed pain relief or had a fever. None of the study investigators children or caregivers knew which study drug each child was receiving. The study did not detect any worsening of asthma in the children treated with acetaminophen compared with those receiving ibuprofen. This was measured by asthma exacerbation rate the number of days of asthma control the need for rescue medications and unscheduled medical visits for asthma. They also did not find any significant differences in safety between the two drugs. AsthmaNet is a nationwide clinical research network created by the NHLBI in . The purpose of AsthmaNet is to develop and conduct multiple clinical trials that explore new approaches in treating asthma from childhood through adulthood. AsthmaNet studies are currently being conducted in states. In the United States more than million people are known to have asthma. The Division of Pediatric Pulmonology and AllergyImmunology at UH Rainbow is currently recruiting for a number of asthmarelated clinical trials. If you are interested in enrolling in a study or learning more about the opportunities please visit http About University Hospitals Rainbow Babies Childrens Hospital Internationally renowned UH Rainbow Babies Childrens Hospital is a fullservice childrens hospital and pediatric academic medical center with experts in medical divisions and surgical specialties who offer nationally ranked care not available at other institutions in the region including a center dedicated to adolescent and young adult cancer treatment and Northeast Ohios only singlesite provider of advanced maternal fetal medicine and neonatology services. As the primary pediatric affiliate of Case Western Reserve University School of Medicine and the only Level I Pediatric Trauma Center in the region UH Rainbow Babies Childrens Hospital offers access to novel therapies advanced technologies and clinical discoveries long before they are available nationwide. Rainbow pediatric specialists all of whom also serve on the faculty at the School of Medicine are engaged in todays most advanced clinical research and are widely regarded as the best in the nation and in some specialties the best in the world. Learn more at Rainbow.org. About Case Western Reserve University Case Western Reserve University is one of the countrys leading private research institutions. Located in Cleveland we offer a unique combination of forwardthinking educational opportunities in an inspiring cultural setting. Our leadingedge faculty engage in teaching and research in a collaborative handson environment. Our nationally recognized programs include arts and sciences dental medicine engineering law management medicine nursing and social work. About undergraduate and graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible. About the National Heart Lung and Blood Institute NHLBI NHLBI plans conducts and supports research related to the causes prevention diagnosis and treatment of heart blood vessel lung and blood diseases and sleep disorders. The Institute also administers national health education campaigns on women and heart disease healthy weight for children and other topics. NHLBI press releases and other materials are available online at http About the National Institutes of Health NIH NIH the nations medical research agency includes Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic clinical and translational medical research and is investigating the causes treatments and cures for both common and rare diseases. For more information about NIH and its programs visit http"

"Group Health researchers have found that bupropion marketed as Wellbutrin is the only antidepressant that tends to be linked to longterm modest weight loss. Previously Group Health researchers showed a twoway street between depression and body weight People with depression are more likely to be overweight and vice versa. These researchers also found that most antidepressant medications have been linked to weight gain. Prior research on antidepressants and weight change was limited to one year or shorter. But many people take antidepressantsthe most commonly prescribed medications in the United Statesfor longer than a year. So for up to two years the new study followed more than Group Health patients who started taking an antidepressant. The Journal of Clinical Medicine published it LongTerm Weight Change after Initiating SecondGeneration Antidepressants. Our study suggests that bupropion is the best initial choice of antidepressant for the vast majority of Americans who have depression and are overweight or obese said study leader David Arterburn MD MPH. Hes a senior investigator at Group Health Research Institute GHRI a Group Health physician and an affiliate associate professor in the University of Washington UW School of Medicines Department of Medicine. But in some cases an overweight or obese patient has reasons why bupropion is not for themlike a history of seizure disorderand it would be better for them to choose a different treatment option. Study findings We found that bupropion is the only antidepressant that tends to be linked to weight loss over two years Dr. Arterburn said. All other antidepressants are linked to varying degrees of weight gain. After two years nonsmokers lost an average of . pounds on bupropioncompared with gaining an average of . pounds on fluoxetine Prozac. So those who took bupropion ended up weighing pounds less than did those on fluoxetine. Unsurprisingly that difference wasnt seen in people who smoked tobacco. Bupropion is often used to help patients stop smoking. So smokers who take bupropion are likely to be trying to quitand coping with the weight gain that often accompanies attempts to quit smoking. Who should try which antidepressant A large body of evidence indicates no difference in how effectively the newer antidepressants improve peoples moods said Dr. Arterburns coauthor Gregory Simon MD MPH a Group Health psychiatrist GHRI senior investigator and research professor in psychiatry and behavioral sciences at the UW School of Medicine. So it makes sense for doctors and patients to choose antidepressants on the basis of their side effects costs and patients preferencesand now on whether patients are overweight or obese. Bupropion should be considered the firstline drug of choice for people who are overweight or obese Dr. Simon said. But patients should consult their doctor about which medication is right for them before making any changes including starting switching or stopping medication. Grant R MH from the National Institute of Mental Health funded this research. Drs. Arterburn and Simons coauthors are GHRI Senior Investigator Denise M. Boudreau PhD Research Project Management Director Emily O. Westbrook Programmer Analyst Mary Kay Theis and Andy Bogart Tamar Sofer PhD a biostatistician at the UW School of Public Health and postdoctoral research fellow at Harvard University and Sebastien Haneuse PhD an associate professor of biostatistics at the Harvard T.H. Chan School of Public Health who used to work at GHRI. Group Health Research Institute Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattlebased Group Health Cooperative a consumergoverned nonprofit health care system. Founded in Group Health Cooperative coordinates health care and coverage. The Institute has conducted nonproprietary publicinterest research on preventing diagnosing and treating major health problems since . Government and private research grants provide its main funding. Follow Group Health research on Twitter Facebook Pinterest LinkedIn or YouTube."

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

"For patients with high levels of socalled bad cholesterol doctors routinely reach for two remedies cholesterollowering statin drugs and a diet that cuts out foods high in saturated fat such as ice cream red meat and butter. But new research has found that when it comes to lowering arteryclogging cholesterol what you eat may be more important than what you dont eat. Released online Tuesday in the Journal of the American Medical Assn. the study found that incorporating several cholesterollowering foods such as soy protein and nuts into a diet can reduce bad cholesterol far more effectively than a diet low in saturated fat. In fact the authors assert levels of LDL the bad cholesterol can drop to half that seen by many patients who take statins sold under such names as Lipitor Crestor or Zocor. That could drive down a persons risk of fatal heart attack or stroke by the authors suggested. But this doesnt mean that people on statins should go dump their drugs for tofu said Cleveland Clinic cardiologist Dr. Steve Nissen who was not involved in the study. Dietary changes do not have nearly the research track record that statins have racked up for heart attack prevention he said. Patients dont want to take the medications and Im afraid that if you tell them theres a diet that works just as well then theyll do that instead he said. Nearly in Americans has a high overall cholesterol level which makes a person nearly twice as likely to suffer a heart attack or stroke as someone whose total cholesterol falls into a healthy range. Lowdensity lipoprotein LDL cholesterol is one component of this overall number. Last year statin and other lipidregulating drugs were the nations most commonly prescribed medications with more than million prescriptions dispensed according to the healthcare information firm IMS Health. The multicenter Canadian study tested a diet that contained a portfolio of cholesterolfighting foods such as soy protein nuts sticky fiber such as that found in oats and barley and plant sterols. Subjects were instructed to eat a handful of nuts such as almonds or walnuts every day and to substitute milk and meats with soy and tofu products as much as possible. One of the most potent cholesterolbusters in that mix plant sterols sometimes called stanols occurs in small amounts in many grains nuts vegetables legumes and fruits and also can be added to foods or taken as a dietary supplement. Plant sterols mimic LDL cholesterol particles in the gut preventing the absorption of those particles so that they pass through the body and are disposed of as waste. The subjects in the study which was coordinated by a team based at St. Michaels Hospital Toronto all suffered high cholesterol levels and were considered at elevated risk of coronary heart disease. The subjects each followed one of three diets an intensive portfolio diet a routine portfolio diet or a highfiber lowsaturatedfat diet rich in produce and whole grains which is commonly recommended to those who have had had a heart attack or need to lower their cholesterol. Among the subjects who completed the trial all three groups lost roughly an equal amount of weight between about pounds ounces and pounds ounces after six months. But those on one of the portfolio diets intensive or routine saw their LDL cholesterol levels decline between . and . after six months. Subjects on the lowsaturatedfat diet had on average a reduction in their LDL cholesterol in the same period. Dr. Walter Willett a nutrition and health expert at Harvard Universitys School of Public Health who was not involved in the study said that the trial was nicely done and that it underscored the fact that just focusing on reducing saturated and total fat is not the most effective diet for reducing heart disease risk factors or heart disease itself. The authors acknowledged that the components in the portfolio diet were wellknown for their cholesterolbusting properties. But their research is the first to test the relative effects of those dietary interventions in a realworld comparison and to gauge how readily people can understand and implement such a diet in everyday life. It was pretty easily done the scientists found. Subjects in the intensive group got as many as seven sessions of instruction and guidance while those in the routine group got one minute session plus a minute refresher but both groups realized roughly equal benefits. The researchers also found that the greater a subjects adherence to the portfolio diet the more dramatic on average was the LDL cholesterol reduction. But Cleveland Clinics Nissen stressed that researchers did not directly measure rates of coronary heart disease just LDL cholesterol so the health effects of the portfolio diet are not yet clear."

"Scientists are inching closer to a drug that may protect peanut allergy sufferers from potentially lifethreatening complications that can occur due to accidental consumption. While the drug is not being hailed as a cure for peanut allergy it has proven successful in building up patients tolerance to peanuts over time lessening the potential for lifethreatening complications. Were excited about the potential to help children and adolescents with peanut allergy protect themselves against accidentally eating a food with peanut in it said allergist Stephen Tilles MD ACAAI former president study coauthor and consulting advisor for Aimmune Therapeutics according to EurekAlert. Our hope when we started the study was that by treating patients with the equivalent of one peanut per day many would tolerate as much as two peanuts. We were pleased to find that two thirds of people in the study were able to tolerate the equivalent of two peanuts per day after nine to months of treatment and half the patients tolerated the equivalent of four peanuts. FDA WARNS AGAINST HONEY PACIFIERS AFTER TEXAS INFANTS HOSPITALIZED WITH RARE ILLNESS https The results which were presented Sunday at the College of Allergy Asthma and Immunology Annual Scientific Meeting and published in the New England Journal of Medicine were based on study participants ranging in age from to years old. All participants who mostly fell between ages and had a peanut allergy but one third received a placebo while the rest were given a peanut protein powder that increased in dose over time. Participants ingested the peanut protein under the supervision of a boardcertified allergist as part of a process called an oral food challenge OFC. Reactions from the oral challenges at the end of the study were much milder than prior to treatment Tilles said according to EurekAlert. On average the participants were able to tolerate a fold higher dose of peanut at the end of the study than they did at the beginning. In addition the symptoms caused by the fold higher dose at the end of the study were milder than the symptoms on the lower dose at the beginning of the study. EXPERTS CHILDREN AT RISK OF LEAD POISONING IN CHATTANOOGA https With FDA approval this drug would mark the first treatment available by prescription for peanut allergies. The studys authors noted that patients would need to stay on the drug in order to receive protection against the allergy. This is not a quick fix and it doesnt mean people with peanut allergy will be able to eat peanuts whenever they want Jay Lieberman MD vice chair of the ACAAI Food Allergy Committee and study coauthor said according to EurekAlert. But it is definitely a breakthrough. The hope would be to have a treatment available in the second half of . If that happens people who receive and are able to tolerate this treatment should be protected from accidental exposures."

"Researchers have discovered a new class of drug that has the potential to help cancer patients who no longer respond to existing therapies. The drug may not become available to patients for a number of years yet but researchers believe that if clinical trials are successful it could be used to tackle a variety of treatmentresistant cancers. Patients with breast cancer for example frequently become resistant to existing hormonebased treatments leading to the disease becoming fatal. In a bid to come up with new forms of treatment that work in a distinct way from established ones chemists biologists and clinicians at Imperial College London collaborated on creating a new drug the properties of which are reported in the journal Molecular Cancer Therapeutics. The team of scientists at Imperial was funded by Cancer Research UK. The drug was then developed by Imperial in collaboration with Emory University in the USA. Early labbased tests of ICEC were successful in targeting resistant breast cancers and indicated minimal side effects. ICEC was then licenced to Carrick Therapeutics who developed it into a molecule named CT which they have taken to earlystage clinical trials in less than two years. The first patient was given the drug in November as part of Carricks a Phase I clinical trial to assess its safety and how well it can be tolerated. The trial is still ongoing so results are not available yet. Professor Charles Coombes from the Department of Surgery Cancer said Treatmentresistant tumours represent a significant threat for patients as once a cancer stops responding to treatments there is increasingly little clinicians can do. Drugs such as these could help to shift the balance back in favour of the patients potentially providing a new option to patients for who existing treatments no longer work. Professor Tony Barrett from the Department of Chemistry said This work is the result of extensive collaboration between chemists biologists and clinicians which has helped to bring a new treatment from discovery to clinical testing in record time streamlining the process. The drug targets an enzyme called CDK involved in directing cells through their lifecycle which consists of growth DNA replication and cell division. CDK is also involved in the process of transcription a vital step in gene expression the creation of proteins to carry out cell functions. Particular cancers such as treatmentresistant breast cancers have a unique dependence on transcription meaning targeting CDK may be particularly effective. By inhibiting transcription ICEC shuts down the ability of the cancer to spread. As well as breast cancers cancers such as acute myeloid leukaemia and smallcell lung cancer are particularly transcriptiondependent so ICEC may work well for these too especially where they have become resistant to other treatments. The discovery of the drug was spurred by an initial meeting between Professor Anthony Barrett from the Department of Chemistry and oncologist Professor Charles Coombes from the Department of Surgery Cancer. Professor Simak Ali also from the Department of Surgery Cancer was working on understanding the action of CDK in treatmentresistant breast cancer. Professors Coombes and Ali suggested CDK as a drug target leading the collaboration to attempt to design a molecule that would inhibit its action. From early attempts a large collaborative team was eventually founded for drug discovery from bench to bedside directed by Dr Matthew Fuchter in the Department of Chemistry. Possible compounds for CDK inhibition were modelled using computational drug design aided by collaboration with Emory University. Ultimately a candidate molecule called ICEC suppressed tumour growth in a wide range of cancer types in lab tests. In addition laboratory studies showed ICEC worked better in combination with traditional hormone therapies for estrogen receptor positive breast cancer cells which have not yet become resistant. It is this molecule in oral pill form that was taken forward by Carrick as CT and is currently in Phase I clinical trials. If the Phase I trial proves successful the compound must pass further stages of trial over the next few years before it becomes available to patients. Early funding for the study came from the Engineering and Physical Sciences Research Council EPSRC and a major contribution of wholeproject funding was from Cancer Research UK. Licensing of the technology to Carrick Therapeutics was led by Cancer Research UKs Commercial Partnerships Team and Imperial Innovations the Technology Transfer Office of Imperial with support from Emory University. Dr Iain Foulkes Cancer Research UKs executive director of research and innovation said Its exciting to see how Cancer Research UKs partnerships with both academia and industry are bringing urgently needed new tests and treatments to patients. Drug resistance continues to be a major challenge across many cancer types so its vital that we explore new ways to tackle tumours that have stopped responding to standard therapies. We hope that this promising new class of drug will offer more options to patients who have few left available to them and help more people survive their cancer."

"Nitrous oxide the laughing gas used in many dental offices is catching on in labor and delivery. Actually nitrous is making a comeback in U.S. maternity circles. It has remained a staple of childbirth in Canada Australia and Britain Catherine Duchess of Cambridge the former Kate Middleton who welcomed her third royal baby Louis Arthur Charles last month reportedly has used it. But it basically disappeared in the United States in the s. American women preferred to be numbed below the waist with epidural anesthesia or at least that became the gold standard for pain relief. Now an estimated U.S. hospitals and birthing centers offer nitrous up from a handful less than a decade ago according to Porter Instrument in Hatfield maker of the leading nitrous oxide system. Midwives and others behind this resurgence emphasize that laughing gas is not anesthesia unlike epidurals or the other routine aid opioid painkillers. When nitrous is mixed with oxygen and inhaled through a face mask it makes many women not all feel less anxious more relaxed and better able to deal with suffering. The gas works by increasing pleasuresignaling brain chemicals such as dopamine. In labor half of the pain is feeling out of control said obstetriciangynecologist Laura Goetzl director of maternalfetal medicine at Temple University Hospital which began offering nitrous last month. Patients have been uniformly positive about having a choice. Some really liked it some didnt. It doesnt take the pain away but it creates a feeling of euphoria said midwife Julie Cristol clinical director of Lifecycle WomanCare and the Birth Center in Bryn Mawr which blazed the local trail by adding nitrous months ago. Holy Redeemer Hospital in Meadowbrook also began offering laughing gas for labor last August. Nitrous has numerous advantages proponents say. Its simple for the woman to selfadminister takes effect in less than a minute and wears off just as quickly when she removes the mask and resumes breathing air from the room. Its also safe for the baby doesnt slow down labor and can be used at any point including after the babys debut if a vaginal tear needs repair. Indifferent to the agony Labor pain is no laughing matter but women who use nitrous offer some funny reviews on blogs. I felt the contractions and pain but felt like I didnt really care Gemma James wrote on momshood https https If they had said they wanted to cut my leg off I would probably have agreed well perhaps not really. If your pain is at nitrous makes it about a so mainly a distraction wrote a woman on babycenter.com. But it worked well for me. Annette Fisher of Philadelphia also used the word distraction to describe her use of nitrous last month at Temple. Like many women who start with the gas she opted for an epidural when her pain intensified. The advantage she said was feeling fully aware of the birth of her daughter Amor not doped up or groggy as with her first two births. I didnt want the narcotic it basically knocks out the experience Fisher said. The gas was very helpful. Midwives began championing the reintroduction of nitrous about a decade ago. The American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists dont have official positions on its use. As midwives were always looking for lowtech options and there arent many for women in labor said certified nurse midwife Judith Bishop an emeritus professor of obgyn at the University of California San Francisco who has promoted nitrous. A reassuring safety record Nitrous comes with some caveats. It can cause nausea and dizziness. It also interacts with vitamin B so women with a deficiency of the nutrient shouldnt use the gas Goetzl said. But studies and generations of use worldwide have not found complications or longterm problems. Using nitrous to relieve labor pain is safe for the mother fetus and neonate Judith Rooks a certified nurse midwife and former government epidemiologist concluded in a medical literature review published in . Ironically about the same time the only company then making a labor nitrous system folded. Part of the system is a machine that scavenges any nitrous from the patients exhalation so other people in the room arent exposed to the gas. The setup also has a disposable face mask and tube. We acquired the rights to the system and brought it back in said Michael Civitello a Porter Instrument salesman. Since then two other manufacturers have joined the growing market. While the Philadelphia area is a tiny part of that market so far several more maternity hospitals are considering nitrous Civitello said. Bishop the San Francisco midwife said I think some hospitals see it as a marketing tool so if the neighboring hospital has it theyd better have it. Insurance plans however generally dont cover it. The Birth Center in Bryn Mawr charges patients to try nitrous and to use it at will during labor. Temple and Holy Redeemer do not charge patients. We essentially give it away for free Goetzl said. Its really just because you want women to be happier and have higher satisfaction."

"Much of the debate over when to start having mammograms has focused on lives saved but new research suggests that early screening might also translate into smaller tumors and less aggressive breast cancer treatments. There are multiple benefits of mammography in terms of early detection. Not only do we save lives but we reduce the likelihood of needing more aggressive treatment said study author Dr. Elisa Port. She directs the Dubin Breast Center at Mount Sinai and is chief of breast surgery at Mount Sinai Hospital both in New York City. Currently the U.S. Preventive Services Task Force recommends that biennial screenings start at age for most women while the American Cancer Society advises that annual screenings begin at age . Earlier guidelines had suggested annual screenings begin at age . Port noted that screening guidelines tend to be based on the ability of mammograms to save lives and how often they give a false positive result. But isnt there some benefit to getting tested earlier like needing fewer lymph nodes removed and not needing chemotherapy I think its safe to say that most women if they could be assured the same survival would choose not to get more aggressive therapies she said. Ports study included more than women diagnosed with breast cancer at the Dubin Breast Center. All of the women were older than . The women were separated into two groups. One group had a mammogram within the months before their breast cancer diagnosis. The other group had a screening months or more before their diagnosis. The second group also included women who had never had a mammogram. Women in the second group were percent more likely to need chemotherapy. They were also percent more likely to need surgery to remove the whole breast mastectomy and percent more likely to need lymph nodes removed. And the women who were screened earlier had smaller tumors. Port also looked at the to yearold age group and found those who had never had a mammogram were much more likely to need chemotherapy. They were also more likely to have larger tumors by millimeters on average and to need a mastectomy than those in the months or less group. But only women fell into the never had a mammogram group. However the study did not prove a causeandeffect link between earlier mammograms and smaller tumors and less aggressive treatment. And Dr. Len Lichtenfeld deputy chief medical officer for the American Cancer Society noted that this was an observational study that only looked at the experience of one institution. Still the observations are consistent with what we have seen with the value of early detection. Clearly the earlier a breast cancer is diagnosed the less treatment that will be required. But this study doesnt tell us about longterm outcomes or what transpired over a long period of time he said. Also because of the nature of the study and the small sample size in the young age group subanalysis Lichtenfeld said that this cannot be interpreted as a study telling us what age to start mammograms. The study is to be presented Thursday at the American Society of Breast Surgeons meeting in Orlando Fla. Findings presented at meetings are typically viewed as preliminary until published in a peerreviewed journal. More information Learn more about mammography screening guidelines from the American Cancer Society https SOURCES Elisa Port M.D. director Dubin Breast Center at Mount Sinai and chief breast surgery Mount Sinai Hospital New York City Len Lichtenfeld M.D. deputy chief medical officer American Cancer Society May presentation American Society of Breast Surgeons meeting Orlando Fla."

"A deceased donor kidney has been preserved and kept healthy outside the body in a device that mimics the bodys physiological functions and successfully transplanted into a human for the first time in North America. The technique unique solution and device are part of a Phase I clinical trial at Toronto General Hospital TG University Health Network UHN assessing the safety of the device with subsequent phases examining its efficacy. Kidneys are the most frequently transplanted solid organ but a continuing shortage of donor kidneys impacts wait times and quality of life of those waiting for a transplant. One way to address this gap by the transplant community worldwide has been to extend the criteria of those donor kidneys used for transplantation. But these extended criteria organs those from older donors or from donors who have two or more risk factors do not tolerate current cold storage methods for organ preservation well. This can result in greater injury to the kidney or in a sleepy kidney which functions poorly at the beginning requiring dialysis until it recovers days or weeks later. This early delayed function also impacts its longerterm survival. In Ontario about per cent of all transplanted kidneys are expanded criteria donor kidneys. This means donors are on average older than years or younger than years and likely have hypertension higher BMI body mass index diabetes or died due to stroke. Ex vivo organ perfusion is an innovative organ preservation technique that seeks to overcome the limitations of current cold storage method of preservation. Developed in the laboratory of UHN transplant surgeon Dr. Markus Selzner with the help of UHN transplant surgeons Drs. David Grant and Anand Ghanekar as well as Drs. Lisa Robinson and Darius Bagli from The Hospital for Sick Children SickKids it took four years to perfect the solution for the donor kidney and to modify the heartlung machine for use in the warm perfusion technique. This technology has advantages over the usual cold storage method in which a deceased donor kidney is cooled on ice to about four degrees Celsius with no oxygen slowing down its metabolism and inhibiting the repair process. The kidney cannot survive longer than hours in cold preservation. The new warm preservation technique avoids the damage of cold storage and instead allows the donor organ to improve and repair itself potentially leading to better outcomes for patients. Using a heartlung bypass machine with customized tubing adapted to the kidneys smaller blood vessels and a specially blended preservation solution of blood nutrients minerals amino acids oxygen glucose antibiotics and drugs surgeons nurses and perfusionists at TG prepared a deceased donor kidney in a transplant operating room to be placed in a warm preservation solution before transplantation into a patient in late November . The aim was to enhance kidney function minimize injury and avoid a sleepy kidney from an extended criteria kidney. About per cent of deceased donor kidneys do not work immediately requiring longer hospitals stays for the patients and dialysis. Zhao Xiao received the deceased donor kidney which was placed on the device for . hours at body temperature. I feel great says Xiao through an interpreter. He was able to get up and walk two day after his transplant. Xiao says he was happy to volunteer to become the first patient to receive a kidney that was improved by the new technology. This can make a difference to other patients so I am glad to be the first one helping them with my experience. As soon as the donor kidney was reattached to the patient it turned rubyred and started to pour out urine indicating that it was functioning well. It is a champion says an elated Dr. Selzner who has done about kidney transplants in the past years. It behaved like a normal kidney despite it being an extended criteria donor kidney. He points out blood tests within hours showed that the kidney was removing wastes and excess fluid from the blood normally. Since the kidney did not struggle after transplant there is a greater likelihood that its longterm outcome will be better he adds. This technique will change the landscape of organ donation by improving organ preservation allowing us to better assess and regenerate the donor organ on the device before we transplant it into a patient. We will know how healthy that organ is before the transplant operation says Dr. Markus Selzner coinvestigator of the clinical trial. Dr. Selzner a clinicianscientist at the Toronto General Hospital Research Institute and Associate Professor of Surgery at the University of Toronto previously modified the preservation solution and supervised the research on a successful warm perfusion technique for the deceased donor liver organ. Working on this project has been one of the most rewarding experiences of my professional career says Dr. Lisa Robinson Division Head of Nephrology at SickKids. It is exciting to see this work be transformed from an idea to experimental research and now to directly impacting patients. Even with the shortage of donor organs we have to decline some of our donor organs because of the damage they sustain in the retrieval process says Dr. David Grant Surgical Director of the MultiOrgan Transplant Program UHN. He is also coinvestigator of the clinical trial and transplanted the donor kidney which was on the modified heartlung bypass machine into the recipient. This new technology can help us answer the critical question Whats the best way to improve function and recover and repair the kidney before transplantation to get the best results for our patients Dr. Grant who is also Professor of Surgery at the University of Toronto emphasized that highimpact research projects such as this require strong collaborative teams including researchers surgical residents nurses Canadian Blood Services perfusionists colleagues at SickKids working together on experimental and clinical trials. UHN is one of the few places in the world where you can have a good idea and then find the right people to make something like this happen. Other collaborators on the research and clinical trial at UHN include Drs. Joseph Kim and Anand Ghanekar coleads of the kidney transplant program at UHN and transplant nephrologist Dr. Istvan Mucsi. Dr. Grant also praised the strong support and efforts of Trillium Gift of Life which coordinates organ and tissue donation across Ontario in helping to ensure that the transplant team could begin their clinical trials with this new technique. The technique of warm organ perfusion outside the body was pioneered by the Toronto Lung Transplant Program at TG in by Drs. Shaf Keshavjee and Marcelo Cypel to better treat repair and assess highrisk donor lungs outside the body. The lungs are placed in a protective dome in which a system continuously pumps a bloodless solution of oxygen proteins and nutrients into the injured donor lungs mimicking normal physiological conditions. This makes it possible for the injured cells to begin repairing themselves and sets the stage for more sophisticated repair techniques to be applied to donor lungs. Since there has been an unprecedented per cent increase in lung transplants at TG as a result of this system. At any point in time there are about patients waiting for a transplant in Ontario. About people wait for a kidney transplant across the province usually about four years. About five per cent of people on kidney waiting lists die every year. Research for the ex vivo kidney perfusion project was supported by the Canadian National Transplant Research Program CNTRP a national research network designed to increase organ and tissue donation in Canada and enhance the survival and quality of life of Canadians who receive transplants. Generous philanthropic support made through Toronto General Western Hospital Foundation has played and continues to play an integral role in the development of ex vivo technology and its impact on patients lives. About Toronto General Hospital Toronto General Hospital is a partner in University Health Network along with Toronto Western the Princess Margaret Cancer Centre Toronto Rehabilitation Institute and the Michener Institute of Education. The scope of research and complexity of cases at Toronto General Hospital have made it a national and international source for discovery education and patient care. It has one of the largest hospitalbased research programs in Canada with major research in transplantation surgical innovation cardiology infectious diseases genomic medicine and liver disease. Toronto General Hospital is a research and teaching hospital affiliated with the University of Toronto. http To download video and photos of the ex vivo kidney perfusion circuit and kidney transplant please visit BROLL Preparing ex vivo kidney circuit in the OR httpsdrive.google.comfiledQebXsGT_jrVgeBFIZijZrWqKAhQview Kidney transplant surgery httpsdrive.google.comfiledBCZuyALMmeMeUkZvyYRvbJZccEview Dr. Markus Selzner Clip httpsdrive.google.comfiledYlnRecrnGCfhRoHxHUGdJ_Fhview Clip httpsdrive.google.comfileduCovJHAOMUtKRpxZVtzzmIfunYZOview Photos httpsdrive.google.comopenidIUK_aXngLEac_AOTfUHqlUWrd Photo credit Courtesy of University Health Network"

"Taking soy to relieve hot flashes https has received mixed reviews over the years. Now researchers who took another look at published studies find that soy supplements https_AssetsscopemapsWebMDConsumerPagesVitaminsandSupplementsLifestyleGuide_ecedpage_VitaminsandSupplementsLifestyleGuide_eced.xml may help at least over time. Soy has been touted as an alternative treatment to hormone replacement therapy https after HRT was linked to an increased risk of breast cancer https For many women with symptoms and especially with concerns about hormone replacement therapy https trying soy for six to weeks to see if it relieves their symptoms could be a first line of treatment says Melissa Melby PhD a professor of medical anthropology at the University of Delaware. The study is published in Menopause https The Journal of The North American Menopause https Society. Two coauthors not including Melby have ties to the soy industry. The study had no industry funding. Although all the studies looked at soy supplements https Melby says that getting soy from food is a better bet. What this study shows is that ingesting soy isoflavones will help you she says. I personally think foods containing soy are better. Soy for Hot Flashes Another Look Melby looked for published studies of soy for hot flashes in the medical literature through midDecember . All the studies compared the soy to a placebo https More than women were in the studies which included the U.S. and nine other countries. The studies continued for six weeks up to a year and included different amounts of soy supplements https The researchers pooled the results of the individual studies to come up with their findings. Soy supplements with higher amounts of the isoflavone called genistein were more than twice as good at reducing hot flash frequency than those with low amounts Melby found. If you prefer to get your soy from food Melby suggests two servings of soy foods per day. That is roughly equal to two glasses of soy milk ounces of tofu or half a cup of edamame. Soy for Hot Flashes Second Opinion The new analysis leaves a lot unanswered says Silvina Levis MD a professor of medicine and director of the osteoporosis https center at the University of Miami. In her own research published in in the Archives of Internal Medicine she found no effects on menopausal symptoms when women took mg of soy isoflavones for two years. I think this study does not provide answers to women says Levis who reviewed the findings. Because the studies vary greatly in their methods and the preparations used she says we still dont know who are women who will benefit. Another expert Penny KrisEtherton PhD RD a distinguished professor of nutrition https at Pennsylvania State University calls the results very impressive. KrisEtherton who reviewed the findings but did not participate in the study noted some limitations though. Most of the women were white. We do not know if the effects of soy products would elicit similar effects in women of different ethnicity she says. The results vary she says and it doesnt appear to be a quick fix. In the studies of longer duration she says the effects were greater."

"When it comes to preventing blood clots after a knee replacement good old aspirin may be just as effective as newer more expensive drugs. That swap could help reduce the cost of caring for the nearly million Americans who have a knee fixed each year Michigan Medicine researchers say. After knee surgery theres a risk of blood clots in the legs or lungs. So its routine for patients to take clotpreventing drugs for some time afterward. Some doctors choose powerful anticlotting drugs like heparin Lovenox and rivaroxaban Xarelto but it hasnt been clear whether these expensive prescription drugs work any better than cheap readily available aspirin. Aspirin alone may provide similar protection compared to anticoagulation treatments says Brian R. Hallstrom M.D. an orthopaedic surgeon and associate chair for quality and safety at the University of Michigan Department of Orthopaedic Surgery. Hallstrom is the lead author of a new study published in JAMA Surgery that found few patients developed a blood clot after surgery and those patients on aspirin fared just as well as those on anticoagulants. Aspirin use growing During the twoyear study period from to aspirin use rose from percent to percent among the patients cared for by orthopaedic surgeons in the Michigan Arthroplasty Registry Collaborative Quality Initiative a statewide effort to give patients the best possible recovery and outcomes after hip and knee replacements. Since then the shift has become even more distinct Aspirin prescribing has risen to percent among Michigan surgeons says Hallstrom who is codirector of the initiative and a health services researcher at UMs Institute for Healthcare Policy and Innovation. Based on the experience of Michigan patients undergoing knee replacement the study may further the debate about the routine use of aspirin for clot prevention. A recent Canadian study looked at the issue but the analysis had a caveat Each of the more than clinical trial patients received rivaroxaban the first five days after surgery. After that they continued with the drug or switched to aspirin. The new UM study suggests patients may be adequately protected if they take aspirin alone from day one. This study is truly a realworld experience of what happened in Michigan when the majority of surgeons switched to aspirin Hallstrom says. The incidence of blood clots pulmonary embolus and death did not increase despite this dramatic change in practice. Shifting procedure and dialogue Over the past decade surgeons have turned away from powerful anticoagulants and toward aspirin used in addition to nondrug improvements such as compression devices for thwarting clots. These days most patients have a generally low risk of blood clots after knee replacement for a number of reasons. Those reasons include shorter surgical times less invasive procedures and use of regional anesthesia that allows early mobilization after surgery Hallstrom says. Some patients are even going home the same day. The most important way to prevent blood clots is getting moving says Hallstrom noting that people are at risk for blood clots when they sit or lie in one position for too long such as on an airplane or a hospital bed. Still pharmaceutical recommendations vary. The critical care specialists who make up the American College of Chest Physicians favor heparin to reduce the risk of blood clots while the American Academy of Orthopaedic Surgeons guidelines state that no one drug is better than another for preventing clots. Advantages of aspirin The UM study involved patients undergoing knee replacement surgery at any of the Michigan hospitals in the surgical quality group. Onethird of the patients took aspirin alone percent took only an anticoagulant and percent took an aspirinanticoagulant combination. Over three months just . percent of aspirin patients developed a serious blood clot. That was true for . percent of anticoagulant patients according to the Michigan study. This was not statistically different. So neither drug appeared better than the other but aspirin has some obvious advantages. Aspirin is easy to take and much less expensive Hallstrom says. Patients can get it over the counter for pennies while the other anticoagulants require monitoring injections frequent dose adjustments and are extremely expensive. The reported cost for a day supply of rivaroxaban is approximately to heparin is estimated at to . Although warfarin costs a few dollars for a day supply its cost approaches that of the other anticoagulants when doctor visits for monitoring are factored in Hallstrom says. In contrast aspirin costs approximately a month. The study suggests most patients can have just aspirin without increasing the risk for venous thromboembolism but doctors need to consider factors such as a patients history of clots obesity and ability to mobilize after surgery when determining the best measure for clot prevention Hallstrom adds."

"A small pilot study has found preliminary evidence that squirting insulin deep into the nose where it travels to the brain might hold early Alzheimers disease httphealth.nytimes.comhealthguidesdiseasealzheimersdiseaseoverview.htmlinlinenytclassifier at bay researchers said on Monday. It comes at a time when there are no effective ways to prevent or delay the progress of Alzheimers. And although the results are preliminary and must be viewed with caution it is a provocative study said Dr. Jason Karlawish an Alzheimers researcher and ethicist at the University of Pennsylvania. But he and other experts caution that a bigger and longer study is needed to see if the initial results hold up and whether there are adverse effects that might negate any benefits. Its important readers realize this is a pilot trial said Dr. P. Murali Doraiswamy an Alzheimers researcher at Duke University who was not part of the study. Its not ready for prime time. The study published online in the Archives of Neurology httparchneur.amaassn.orgcgicontentfullarchneurol.. included people a group small enough that the promising results could have occurred by chance. Researchers at the University of Washington divided the subjects into three groups. One got a placebo one got international units of aerosolized insulin a day and the third got international units a day. In the fourmonth study the group randomly assigned to receive intranasal insulin twice a day either improved slightly or remained the same in tests of memory and assessments of their ability to handle daytoday activities. The lower dose seemed more effective than the higher one. Those who received placebos got worse. A third also had scans to assess their brains use of glucose. One hallmark of Alzheimers disease is reduced metabolism in the brain which shows up on scans as less use of glucose the fuel for brain cells. In this assessment those getting insulin used more glucose in their brains those taking placebos used less. For years the studys principal investigator Suzanne Craft has studied insulins effects in Alzheimers. She is professor of psychiatry httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicspsychiatry_and_psychiatristsindex.htmlinlinenytclassifier at the University of Washington in Seattle and director of the memory disorders clinic at the Veterans Affairs Puget Sound Health Care System. Brain cells need insulin Dr. Craft said. And conditions in which the body makes too little insulin or is resistant to its effects diabetes httphealth.nytimes.comhealthguidesdiseasediabetesoverview.htmlinlinenytclassifier prediabetes even untreated highblood pressure httphealth.nytimes.comhealthguidestestbloodpressureoverview.htmlinlinenytclassifier are associated with an increased risk of Alzheimers. In addition she said beta amyloid a toxic protein that accumulates in the brain of Alzheimers patients seems to tie up insulin in the brain. So Dr. Craft reasoned perhaps if more insulin could be put into the brains of people with the degenerative brain disease their memories and ability to function might improve. The problem was to find a way to get more insulin to the brain but not to the body. The solution was a special device made by Kurve Technology that delivers a spray of insulin deep into the nose. From there the hormone travels along the path of nerves into the brain. The investigators first tried a single dose of insulin delivered via nasal spray to the brains of people with Alzheimers disease. Their memories improved temporarily. Then they tried giving insulin daily for three weeks. Again the hormone seemed to help. That led to the current study lasting four months. But Dr. Martha Daviglus of Northwestern University who led a panel last year that assessed published papers on preventing and treating Alzheimers urged caution. In her field cardiovascular medicine she has seen many exciting findings in small studies that fall apart in larger or longer ones. Now Dr. Craft wants to test insulin again in a much more extensive study. . In the meantime she cautions Alzheimers patients not to rush out and try to take insulin. It is too soon to say if the treatment is even safe she said. And patients would need a special device to get it deep into the nose. Kurves device is not yet on the market. The individual person will not be able to get this device Dr. Craft said. But she added if her study goes forward many will be able to participate in it."

"A new insomnia drug helped people get a bit more shuteye in a lab study researchers report. The drug known as suvorexant is being developed by Merck Research Laboratories which funded and conducted the study. The medication is not available yet but the U.S. Food and Drug Administration is reviewing it for possible approval the researchers said. In the United States about percent of people say they have chronic insomnia according to the U.S. Centers for Disease Control and Prevention. There are sleep aids on the market but they do not work for everyone and they can have side effects that include sleepwalking daytime drowsiness and confusion. Suvorexant works differently from those drugs zeroing in on specific brain chemicals involved in the ability to sleep explained study author Dr. William Herring executive director of clinical research at Merck. The study published online Nov. and in the Dec. print issue of the journal Neurology included healthy adults with primary insomnia which means it wasnt caused by an underlying physical or mental health problem. All of the patients spent four weeks on one of four doses of suvorexant and another four weeks on placebo pills. They had their sleep monitored in a sleep lab on their first night with each treatment and then came back again after four weeks. Overall Herrings team found people slept better with the drug although the improvement was not dramatic. At the outset when patients spent eight hours in bed they were typically asleep for percent of that time. One day on suvorexant boosted that by anywhere from percent to percent relative to the placebo. Between and fewer minutes were spent awake during those sleep periods. There was still a benefit four weeks later. One expert pointed out however that the benefit was small. The amount of additional sleep was not tremendous said Dr. Carl Bazil director of the division of epilepsy and sleep at New YorkPresbyterian HospitalColumbia University Medical Center. The effect was essentially comparable to what has been seen with other sleep medications said Bazil who was not involved in the research. But he said suvorexant is seen as a potentially important development in the world of sleep medicine because the drug blocks specific brain chemicals called orexins which help keep people awake. Standard sleep medications work more widely throughout the brain Bazil explained which is why they can have a host of side effects. The way suvorexant works makes a lot of sense Bazil said. The hope is that it will help some people who havent responded to other drugs and have fewer side effects. Its promising news Bazil added that there were no serious side effects in this study. The most common side effects were sleepiness reported by about percent of patients on the two higher doses of suvorexant headache reported by about percent dizziness and abnormal dreams percent. There are still many questions including whether the drug would benefit people with insomnia due to a health condition which doctors call secondary insomnia. The study also excluded adults aged or older an age group commonly affected by insomnia. But Herring said seniors were part of a larger month trial and Merck has submitted those results to the FDA. Another sleep specialist said the findings show some potential benefit from suvorexant but he cautioned insomnia sufferers against relying completely on any drug. Medication can be important said Dr. William Kohler who directs the Florida Sleep Institute in Spring Hill. But in the long run the best methods for treating insomnia are behavioral techniques. Kohler said cognitive behavioral therapy where people learn to change the thoughts and habits that affect their sleep quality is a proven way to manage insomnia. For most people he said medication should be a temporary treatment behavior change is the longterm fix. Bazil agreed I look at most people with insomnia as someone who developed bad sleep habits. A drug ideally used for a short time may help encourage sleep and get people on the right track Bazil said. But those bad sleep habits youve got to address them too he added. The problem Kohler noted is that we dont want to make behavior changes. We want to pop a pill. More information Learn more about insomnia and good sleep habits from the National Sleep Foundation http SOURCES Carl Bazil M.D. Ph.D. director division of epilepsy and sleep New YorkPresbyterian HospitalColumbia University Medical Center New York City William Kohler M.D. medical director Florida Sleep Institute Spring Hill Fla. William Herring M.D. Ph.D. Merck Sharp Dohme Corp. Whitehouse Station N.J. Dec. Neurology"

"While smoking is a public health scourge the nicotine in cigarettes may have some promise in treating another growing problem mild cognitive impairment MCI which can be a precursor to Alzheimers disease or other forms of dementia. A new study on nonsmokers found that six months of treatment with nicotine patches restored longterm memory performance to of normal while placebo patients experienced a decline in recall during the same treatment period. The randomized controlled trial included people mainly in their late s with mild cognitive impairment MCI. MCI falls somewhere between the normal senior moments that occur with aging and the more serious lapses in recall and orientation that are typical of dementia. People with MCI are aware of their deficits but are still able to function and complete their daily activities. Prior research has shown repeatedly that nicotine enhances memory and reaction time which is one reason smokers cite for sticking with their habit. About half the participants were former smokers. Attention memory and reaction time all improved in those given nicotine treatment on several objective tests and patients own ratings of their cognitive abilities and those of family members or other people close to them also showed improvement. Moreover nicotines positive effects did not seem to wane over time. However when clinical experts rated overall general change in the patients they did not see a significant difference between the two groups. MORE A Cheaper Way to Quit Smoking httphealthland.time.comacheaperwaytoquitsmoking Was the nicotine actually having an effect on memory Possibly. Intriguingly it appeared to be more effective among people with two copies of the APOE gene a genetic combination that increases risk for Alzheimers by a factor of or higher. People with Alzheimers disease have reduced numbers of nicotine receptors in their brains and while the research is conflicting some evidence suggests that the drug could protect these neurons. Other research httphealthland.time.com however suggests that nicotine might enhance the cancercausing properties of other substances. The authors conclude This initial study provides evidence for nicotineinduced cognitive improvement in subjects with MCI however whether these effects are clinically important will require larger studies. The study found no problematic side effects associated with the nicotine patch and none of the patients had withdrawal symptoms when it was stopped. However patients on nicotine did lose a few pounds which is a known side effect. The research was funded by the National Institute on Aging but some of the authors also receive pharmaceutical industry funding and one reported funding from Philip Morris. Patches were provided by the manufacturer Pfizer. The study http was led by Dr. Paul Newhouse of Vanderbilt University and published in Neurology. MORE Is Nicotine a Gateway to Cocaine Addiction and Cancer httphealthland.time.com"

"A new device worn like a visor can detect emergent largevessel occlusion in patients with suspected stroke with percent accuracy report clinical investigators at the Medical University of South Carolina MUSC Mount Sinai the University of Tennessee Health Sciences Center and elsewhere in an article published online on March in the Journal of Neurointerventional Surgery. Patients with largevessel occlusions can then be routed to a Comprehensive Stroke Center with endovascular capabilities. In contrast a standard physical examination achieved only to percent accuracy in identifying patients with largevessel occlusion who could benefit from endovascular therapy. The volumetric impedance phase shift spectroscopy VIPS device Cerebrotech VisorTM Cerebrotech Medical Systems Pleasanton CA works by sending lowenergy radio waves through the brain that change frequency when passing through fluids. Such waves are reflected back through the brain and then detected by the device. When a patient is having a severe stroke the brains fluids will change producing an asymmetry in the radio waves detected by the VIPS device. The greater the asymmetry the more severe the stroke. Endovascular therapy within hours is the standard of care for emergent largevessel occlusion but the chance of achieving a good outcome decreases by approximately percent for each hour that passes before treatment. The researchers hope that the device will save valuable time especially important in stroke where time is brain when it is deployed with emergency medical personnel in the field. This is because the accuracy of the device simplifies the decision made by emergency personnel about where to take patients first according to Raymond D. Turner M.D. professor of neurosurgery and chief of the Neuroscience Integrated Center of Clinical Excellence at MUSC. Turner served as principal investigator for MUSC in the VIPS for the NonInvasive Detection of Hemispheric Bioimpedance Asymmetry in Severe Brain Pathology VITAL study reported in the article. Transfer between hospitals takes a lot of time said Turner. If we can give the information to emergency personnel out in the field that this is a largevessel occlusion that should change their thought process in triage as to which hospital they go to. In the study the VIPS device was deployed with emergency medical personnel in regions served by five Comprehensive Stroke Centers equipped with the endovascular capabilities to treat largevessel occlusions that underlie severe stroke. Their goal was to use the device to accurately identify severe stroke and then compare the results to established physical examination methods practiced by emergency personnel such as the Prehospital Acute Stroke Severity Scale. Both healthy participants and patients with suspected stroke were evaluated by emergency personnel using the VIPS device. Three readings were taken and averaged a process that takes about seconds. Patients were also later evaluated by neurologists who provided definitive diagnoses using neuroimaging. Compared to the neurologists diagnoses the device displayed percent specificity the ability to detect the difference between patients with severe stroke and those with other conditions such as mild stroke or healthy participants with no brain pathology. This places the VIPS device above standard physical examination tools used by emergency personnel that display specificity scores between and percent. The VIPS device is made by Cerebrotech Medical Systems which paid consultants to analyze the neuroimaging data independently. The neuroimaging data was needed to teach the VIPS device which radio waves were indicative of stroke. Yet the consultants did not have access to the VIPS radio wave data during their review of the images thereby eliminating the potential of the consultants to choose data that might artificially inflate the devices accuracy. It is also not clear how the device would work for patients with cranial implants as metal interferes with the devices operating radio frequencies. The devices success may be found in its ability to give emergency personnel a clear answer as to whether a patient is experiencing a severe stroke. The VIPS device requires very little training to operate compared to that required to learn standard emergency examination skills thereby reducing the possibility of human error during emergency diagnosis. In their next steps the researchers are undertaking the VITAL . study to determine if the VIPS device can use complex machine learning algorithms to teach itself how to discriminate between minor and severe stroke without the help of neurologists. If so the VIPS device could have widespread clinical implications helping emergency personnel decide whether to take a patient to a comprehensive stroke center or a primary stroke center for treatment. Turner likens the use of the VIPS device in detecting severe stroke to the use of electrocardiography ECG to definitively detect acute myocardial infarction. He predicts that the device has the potential to be used widely by emergency personnel but also to appear in other public spaces. This could potentially be something like a defibrillator said Turner. You can find out if a patient is having a stroke just like you can put a defibrillator on a patient to see if theyre having a heart attack. This study was funded by Cerebrotech Medical Systems. About MUSC Founded in in Charleston The Medical University of South Carolina is the oldest medical school in the South. Today MUSC continues the tradition of excellence in education research and patient care. MUSC educates and trains more than students and residents and has nearly employees including approximately faculty members. As the largest nonfederal employer in Charleston the university and its affiliates have collective annual budgets in excess of . billion. MUSC operates a bed medical center which includes a nationally recognized Childrens Hospital the Ashley River Tower cardiovascular digestive disease and surgical oncology Hollings Cancer Center a National Cancer Institute designated center Level I Trauma Center and Institute of Psychiatry. For more information on academic information or clinical services visit musc.edu. For more information on hospital patient services visit muschealth.org."

"Stem cell transplants may halt the progression of aggressive multiple sclerosis MS in nearly half of those with the debilitating disease but picking the right patients for the treatment is key a new study suggests. Specifically younger patients with a relapsing form of MS who were not severely disabled and who hadnt found relief with other treatments fared better than others over five years the international team of researchers found. However in some cases the treatment proved fatal the researchers reported. Stem cell transplantation cannot be considered a cure for MS. However it can be considered a concrete option for patients showing aggressive MS who have not responded to approved treatments said study coauthor Dr. Riccardo Saccardi. Hes from the cell therapy and transfusion medicine unit at Careggi University Hospital in Florence Italy. Using patients own stem cells to reboot the immune system is a way to halt the advance of the disease. But the treatment can be risky because the patients immune system has to be wiped out before the stem cells are transplanted the researchers said. In fact nearly percent of the patients died shortly after receiving the transplant and those deaths were directly related to the transplant the researchers reported. Those deaths are a major concern one neurologist said because MS is not in itself lifethreatening. In effect those patients gambled with a treatment that could be fatal for a disease that isnt said Dr. Michael Racke a professor in the department of neurology at Ohio State University. Racke pointed out that stem cell transplants were first used to treat deadly diseases such as leukemia lymphoma and other cancers. There may be a population of MS patients that could be identified that might do well with transplant he said. Its important to select patients in such a way that they actually get well with the transplant. A trial that compares stem cell transplants with other therapies to see whether stem cell transplants can become a treatment for patients who have progressive MS is about to start added Racke who coauthored an editorial that accompanied the study. More than million people in the world suffer from MS in which the body attacks the central nervous system according to the National Multiple Sclerosis Society. MS can cause many symptoms including blurred vision loss of balance poor coordination slurred speech tremors numbness extreme fatigue problems with memory and concentration paralysis and blindness. These symptoms can come and go or persist and worsen over time. Most people are diagnosed between the ages of and although individuals as young as and as old as have developed the disease the society says. Medications can slow the progression of MS and help patients manage symptoms but theres no cure. To see how patients did over the long term after stem cell transplants Saccardi and colleagues followed patients from countries who received stem cell transplants between and . The researchers found that percent of the patients experienced progressionfree survival at five years after transplant. Within days of transplant however eight patients died nearly percent. Those deaths were related to the transplants Saccardi said. The researchers think these deaths were most likely due to the transplant technology used before which has since improved. The report was published online Feb. in the journal JAMA Neurology. Dr. Paul Wright is chair of neurology at North Shore University Hospital in Manhasset N.Y. and Long Island Jewish Medical Center in New Hyde Park N.Y. He said As neurologists battle with current therapies that are limited for progressive MS in younger patients this study provides a possible new avenue for treatment. More information Visit the National Multiple Sclerosis Society http for more on MS. SOURCES Riccardo Saccardi M.D. cell therapy and transfusion medicine unit Careggi University Hospital Florence Italy Paul Wright M.D. chair neurology North Shore University Hospital Manhasset N.Y. and Long Island Jewish Medical Center New Hyde Park N.Y. Michael Racke M.D. professor department of neurology Ohio State University Columbus Ohio Feb. JAMA Neurology online"

"Warfarin is a blood thinner that is commonly prescribed to patients to prevent lifethreatening blood clots. Despite its longtime use warfarin remains tricky to dose because a persons genetic makeup influences how the drug is processed in the body. Too much warfarin can cause internal bleeding too little warfarin fails to prevent blood clots. Now a new study led by Washington University School of Medicine in St. Louis shows that dosing warfarin Coumadin and others is safer producing fewer adverse events such as hemorrhage when key elements of a patients genetic makeup are considered. The research published Sept. in the Journal of the American Medical Association reports results from the clinical trial known as GIFT Genetics Informatics Trial of Warfarin to Prevent Deep Venous Thrombosis. Physicians have been prescribing warfarin since the Eisenhower administration said first author Brian F. Gage MD a professor of medicine at Washington University School of Medicine in St. Louis. Its a widely used anticoagulant but it causes more major adverse events than any other oral drug. Thousands of patients end up in the emergency department or hospital because of warfarininduced bleeding. But we continue to prescribe it because it is highly effective reversible and inexpensive. So our goal is to make warfarin safer. GIFT showed that precisionmedicine based on clinical factors and three genes improves the safety of initiating warfarin therapy. Patients in the trial were randomly assigned to one of two groups. One group received warfarin dosing based on standard factors such as age height and weight the second group was dosed based on these clinical factors plus genetic variants. Participating sites in the trial included Washington University School of Medicine Hospital for Special Surgery in New York Intermountain Healthcare University of Utah and Rush University Medical Center. Of the patients who were dosed in the traditional manner experienced at least one adverse event . percent. Of the patients whose warfarin dosing was guided by genetic testing experienced an adverse event . percent. Compared with patients receiving traditional warfarin dosing patients dosed with the genetic approach had a percent reduction in adverse events which was statistically different. The adverse events were bleeding formation of blood clots in the veins and warfarin overdoses. No patient died during the trial. Earlier studies looking at whether genetic testing could improve warfarin dosing had produced conflicting results. However these studies were smaller and considered fewer genes than GIFT. GIFT enrolled patients age and older at high risk of blood clots because they underwent hip or kneereplacement surgeries. Unlike prior studies GIFT took into account genetic variants in three genes for days of warfarin therapy. Genetic variants were assessed on a commercial platform called GenMarkDx. Variants in one gene affect vitamin K recycling. Variants in another gene affect warfarin sensitivity. Variants in the third gene alter warfarin metabolism in the liver and can cause an overdose if the dose is not adjusted soon enough. There are additional genetic variants that may help to guide warfarin dosing especially among patients with African ancestry Gage said. In the future we hope to quantify how these variants affect warfarin. Gage also noted how healthcare costs relate to dosing warfarin in a genetically guided manner. Although genetic testing is more expensive than clinical dosing the cost is falling he said. In our study we estimated that genetic testing costs less than per person which is less than one month of a newer anticoagulant. This work was supported by the National Heart Lung and Blood Institute NHLBI and the National Center for Advancing Translational Sciences NCATS of the National Institutes of Health NIH grant numbers RHL and ULTR the Centers for Medicare and Medicaid Services grant number CAGN and GenMarkDx which supplied instrumentation. Gage BF Bass AR Lin H Woller SC Stevens SM AlHammadi N Li J Rodriguez Jr. T Miller JP McMillin GA Pendleton RC Jaffer AK King CR DeVore B PorcheSorbet R Napoli L Merritt K Thompson AM Hyun G Anderson JL Hollomon W Barrack RL Nunley RM Moskowitz G DavilaRoman V and Eby CS for the GIFT investigators. Effect of genotypeguided warfarin dosing on clinical events and anticoagulation control among patients undergoing hip or knee arthroplasty the GIFT randomized clinical trial. Journal of the American Medical Association. Sept. . 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 seventh 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."

"If youre wondering why experts still cant agree on prostatecancer screening youre not alone. Just two months ago a major U.S. government panel said that basically no one should get screened for prostate cancer httphealthland.time.commenshouldforgopsatestingforprostatecancerpaneladvises claiming the simple blood test for prostatespecific antigen or PSA does more harm than good. Now a new study looks at government data httphealthland.time.comprostatecancerscreeningwhycantdoctorsagreeseer.cancer.gov and finds that without PSA testing the U.S. would have three times as many patients each year diagnosed with advancedstage prostate cancer and the vast majority of those cases would be fatal. Almost all men with clinically apparent metastases at initial diagnosis will die from prostate cancer urologist and study author Edward Messing told reporters as he explained the importance of his study. The new study reflects a broader divide in the medical community between public health experts who have largely turned away from PSA screening and many practicing clinicians who feel the test has helped their patients immensely. MORE Men Should Forgo PSA Testing U.S. Panel Advises httphealthland.time.commenshouldforgopsatestingforprostatecancerpaneladvises No one denies that PSA tests can help to catch prostate cancer early. But two issues are still unresolved. One is how well screening can actually work to prevent cancer deaths the other is what kind of negative effects screening brings httphealthland.time.comwhencancerscreeningdoesmoreharmthangood along with its benefits. On the first issue there is still some uncertainty. In the U.S. a large randomized trial found no mortality benefit http of screening. But an even larger randomized clinical trial in Europe http has found a benefit. In its latest results http published this spring the European study team said that men who undergo routine testing have significantly lower risk of prostatecancer death after years. Still the real crux of the debate on PSA testing is the second issue the possible negative effects of screening. No diagnostic test is accurate and if a PSA test comes back positive for prostate cancer the patient will usually be referred for a biopsy to confirm the diagnosis. That test can have side effects. Then if the patient does have cancer the available treatments http for it surgery radiation as well as other options also have side effects chief among them impotence incontinence and urinary incontinence. The same European trial that found lower cancer mortality with PSA testing also found that to save just one life through screening an extra men would need to be diagnosed with prostate cancer and treated http Many health experts think thats too much risky treatment to justify the results. So when the government advisory panel the U.S. Preventive Services Task Force recommends against routine PSA testing its making a judgment call. Its saying that for most men the albeit small risk of sexual dysfunction and urinary leakage from eventual treatment is not worth it given the even smaller chance that PSA testing could save your life. But that decision does remain a judgment call. It depends on how much you value certain qualityoflife measures versus how much you value having any life at all. MORE Surgery for Early Prostate Cancer Doesnt Save Lives httphealthland.time.comstudysurgeryforearlyprostatecancerdoesntsavelives As for the new paper this week which suggests that three times as many men would be diagnosed each year with metastatic prostate cancer if it werent for PSA testing that study is published in the journal Cancer and its numbers deserve a little explanation. To calculate the total number of metastatic cases wed get without screening the study takes todays population of the United States and applies the rates broken down by age and race of advancedstage prostate cancer that were observed before PSA testing was introduced that is the rates way back in . In other words it tells us what the current U.S. population would look like if today we faced the same risks that Americans faced in the s it finds wed have roughly U.S. men diagnosed with advancedstage prostate cancer each year compared to just today. But is going back in time years really the same thing that wed get if we abolished PSA testing today Who knows The rate of new diagnoses of all cancer types combined has been falling consistently http in recent years. However prostate cancer is one of the few cancers thats not strongly linked to smoking http and falling cigarette consumption over the past years is a major reason for falling cancer rates. It is however linked to obesity which has been on the rise since the s. One further fact to keep in mind is that PSA testing works to cut the number of newly diagnosed advancedstage cancers but it does so by increasing the number of cancers that are caught early. And as the debate over PSA testing shows us early diagnosis is only useful if early treatment can help patients live longer and healthier lives preventing progression to advancedstage cancer down the line but without increasing the risks of other health problems too much in the process. Thats what experts cant agree about. Many doctors do have very strong opinions though. As a patient if youre deciding whether to get a PSA test or whether not to get a PSA test remember you do have a right to your own opinion too. Theres no easy answer. MORE Prostate Cancer Screening What You Need to Kno httphealthland.time.comprostatecancerscreeningwhatyouneedtoknow"

"The first large headtohead comparison of two opioid addiction medications found that although they were equally effective in getting people off of high levels of opioids users had a significantly more difficult time starting a regimen of naltrexone compared with buprenorphine. Buprenorphine is commonly known by the the brand name Suboxone and naltrexone is sold under the brand name Vivitrol. The study published Tuesday in the Lancet http looked at patients with opioid addiction at eight inpatient treatment centers across the country for weeks. Half of the group was assigned to naltrexone and the other half to bupenorphine. Six percent of those enlisted to use buprenorphine were unable to start their treatment whereas of those assigned to naltrexone dropped out before starting the therapy. That hurdle is attributed to the fact that in order to start naltrexone a person has to have detoxed or not used opioids for several days whereas a user can transition from opioids to buprenorphine seamlessly. If youre currently opiatedependent ... naltrexone takes more work said Dr. Joshua Lee httpnyulangone.orgdoctorsjoshuadlee the lead author of the study who studies opioid addiction behavior and treatment at New York University. Once on either of the medications people fared equally well. They tend to stay on medications about the same rate. They report good outcomes avoiding heroin use Lee said. However both groups also reported similar challenges staying with the regimens Just of patients still used the drugs after weeks. What was important Lee said was for opioid addicts as well as treatment providers to understand that addiction isnt onesizefitsall. Much like you would expect if the doctor told you you have cancer or you have diabetes then there are different ways you could pursue treatment he said. The gold standard of addiction treatment Public health experts consider medicatedassisted treatment the gold standard of opioid addiction treatment. It combines medication with counseling to help addicts wean off of high opioid use. Public health experts say it can help solve the staggering opioid overdose epidemic. This year alone the CDC estimates that more than people https have died of drug overdoses most of them from opioids more than the number of American troops lost during the entire Vietnam War https Studies have found that using medicatedassisted treatments can reduce overdose mortality by half. http Methadone may be the bestknown form of medicatedassisted treatment but it requires patients to have the drug administered daily in a clinic. Two other options have become increasingly popular buprenorphine which can be taken outside a clinic and naltrexone which is administered monthly. Naltrexone has become become an increasingly popular choice among drug courts httpsndcrc.orgresourcedrugcourtpractitionerfactsheetextendedreleasenaltrexone. Some say thats because of the onceamonth administration and others say its because it requires that users completely detox before starting the regimen. Understanding addiction People need choices said Caleb BantaGreen httpsph.washington.edufacultyfac_bio.aspurl_IDBantaGreen_Caleb a professor at the University of Washingtons School of Public Health. BantaGreen who was not involved in the new study said that getting the right treatment means understanding addiction from a psychological as well as biological perspective. Legally prescribed opioid drugs like oxycodone and hydrocodone work in the same manner as illicit drugs like heroin. They all chemically bind to the opioid receptors in the brain to help dull pain and in some people provide euphoria. The body also produces natural opioids but the more narcotics a person takes the less opioids the body naturally produces. Without the opioids people can go into withdrawal all contributing to a cycle of dependency. To feel normal they need opiates on those receptors BantaGreen said. Buprenorphine and methadone which are opioids work by reducing peoples cravings. They bind to prevent withdrawal giving some opiate effect he said. On the other hand naltrexone works by chemically blocking those receptors which is why someone needs to detox before starting the regimen. Youre not getting an opiate effect BantaGreen explained. If a person takes an opioid while on naltrexone it is unlikely they will feel any opioid sensation. If a person is using opioids and takes naltrexone it can induce a feeling of withdrawal. It addresses craving in a different way. The person knows they cant use he said. So for example a person who is actively using opioids and cant manage the withdrawals may be better suited for buprenorphine while someone coming from a facility where he or she has detoxed and who doesnt want to use opioids may be better suited for naltrexone. What is key said Dr. Miriam Komaromy is meeting a patient where they are and understanding what best meets their needs. Addiction is an incredibly deadly disease said Komaromy an addiction specialist at the University of New Mexico Health Sciences Center. And as public policymakers prisons and drug courts play a larger role in treating addiction public health experts like Komaromy argue that it is imperative to look at evidencebased ways instead of having a moralistic view. BantaGreen says he talks to a lot of judges who are trying to understand addiction treatment. I say this a lot to judges You cant just offer one medication. Just like any other medication some people are going to feel right with one as opposed to the other. Clarification This story has been updated to reflect how naltrexone interacts with opioids."

"Roches Tecentriq immunotherapy combined with other drugs boosted lung cancer patients survival versus an older cocktail the Swiss company said as it seeks an edge on Merck and BristolMyers Squibb. Mixing Tecentriq with Avastin and carboplatin and paclitaxel boosted overall survival in firstline treatment of nonsquamous nonsmall cell lung cancer Roche said on Monday compared to patients who received only Avastin plus the two chemotherapies. The latest trial success follows Roches announcement last week about a separate study in which Tecentriq mixed with chemotherapies carboplatin and Abraxane boosted progressionfree survival compared with chemotherapy alone in firstline treatment of patients with advanced squamous nonsmall cell lung cancer. The Baselbased company which had previously announced Tecentriq Avastin and chemotherapy had reduced the risk of disease progression or death said on Monday it hopes for a quick approval from authorities for the cocktail. While Roche did not provide specific overall survival data the headline result helps its bid to catch up to betterestablished immunotherapies from Merck and BristolMyers Squibb and its shares rose about percent in early trading. We are pleased the IMpower study demonstrated a clinically meaningful survival benefit for people receiving their initial treatment for this type of advanced lung cancer said Sandra Horning Roches chief medical officer. She also said the survival benefit was observed across key subgroups including those with varying levels of a protein called PDL that can help tumors avoid detection. This could help Roche make the case that its cocktail is suitable for broad patients groups not just those with specific biomarkers. The worlds biggest maker of cancer drugs is counting on growing sales of Tecentriq which notched million Swiss francs in to help offset falling revenue from its older cancer medicines Avastin Rituxan and Herceptin whose patent expirations are exposing them to rivals cheaper copies. Analysts from Baader Helvea said its announcement completes an already robust set of data for regulators who now must sign off on Tecentriqs use as an initial treatment of lung cancer. We continue to see Roche efficacy more than sufficiently competitive to grant a percent market share in the indication translating in . billion francs Tecentriq peak sales and . billion francs in Baaders Bruno Bulic said. Facing biosimilar competition... we see Tecentriq sales coming timely to support Roches profitability going forward. Reporting by John Miller editing by Brenna Hughes NeghaiwiLouise HeavensAlexander Smith Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"A skin patch for the treatment of migraines and the intense waves of nausea that often accompany these debilitating headaches has been approved by the U.S. Food and Drug Administration. Called Zecuity the patch contains sumatriptan one of the most widely prescribed medications for migraines. According to Dr. Fawad Khan a neurologist with Ochsner Neuroscience Institute in New Orleans few drugs are approved for the treatment of acute symptomatic migraine. To complicate matters many migraine sufferers can also experience severe bouts of nausea and vomiting. Another expert described the problem this way. Ive had some patients where the nausea and vomiting was so bad they couldnt even swallow a pill said Nancy Waltman a nurse practitioner with the University of Nebraska Medical Center College of Nursing Lincoln Division. A nasal spray is available as is an injection but many patients arent comfortable with these options Khan and Waltman noted. Khan said the Zecuity patch is simple efficient and can deliver the exact amount of dosage with minimal variability. The patch is attached to the upper arm or thigh and when the patient pushes a button the drug is delivered through the skin. Zecuity which is batteryoperated delivers . milligrams of sumatriptan over the course of about five hours and can relieve nausea as well as reduce sensitivity to light and sound. NuPathe Inc. which makes Zecuity hopes to have the patch on the market later this year. Research involving patients ultimately led to the approval of Zecuity. One study found that percent of patients using the patch were headachefree after two hours compared with percent of those using an inactive placebo. About half achieved a reduction in their headache after two hours compared with percent of those using the placebo. And percent of patients using the patch were relieved of their nausea compared with percent of those in the placebo group according to a company news release. The most frequent side effects were pain at the site of application along with tingling itching warmth and discomfort. Patients with heart disease or who are using antidepressants known as selective serotonin reuptake inhibitors should also be careful when taking sumatriptans said Waltman who added that she thought the patches are wonderful. One concern though is cost Waltman cautioned. Its not clear how much the patches will cost but the class of medications known as triptans can be expensive as much as a month although sumatriptan now has a generic version Waltman said. In general though the more options that are available to migraine headache patients the better Waltman said. Migraine patients tend to be underdiagnosed and undertreated and inappropriately treated. NuPathe CEO Armando Anido told Bloomberg News We anticipate the product will be available for sale in the fourth quarter of this year. More information The U.S. National Library of Medicine has more about migraines http SOURCES Fawad Khan M.D. neurologist Ochsner Neuroscience Institute New Orleans Nancy Waltman Ph.D. nurse practitioner University of Nebraska Medical Center College of Nursing Lincoln Division NuPathe Inc. news release Jan. Bloomberg News Last Updated Jan"

"A special type of CT scan can detect lung cancer early enough to save some lives the National Cancer Institute announced Thursday the first evidence that a screening test may help fight the top U.S. cancer killer. At issue are controversial spiral CT scans where a rotating scanner views the lungs at various angles to spot growths when they are about half the size that a standard chest Xray can detect. Some previous studies have suggested that the earlier detection helps while other research concluded it may do more harm than good by spotting too many benign growths. The massive National Lung Screening Trial enrolled current or former smokers to try to settle the debate. It found percent fewer deaths from lung cancer among those screened with spiral CTs than among those given chest Xrays the NCI said Thursday a difference significant enough that it ended the study early. The actual number of deaths averted was fairly modest died in the spiral CT group over the eightyear study period compared with deaths among those who got chest Xrays. The NCI said it is not clear that all smokers should get the scans which are not riskfree. The best advice for avoiding lung cancer remains to quit smoking said NCI Director Dr. Harold Varmus. Still a validated approach that can reduce lung cancer mortality by even percent has the potential to spare very significant numbers of people from the ravages of this disease he said. About new lung cancers are diagnosed in the U.S. each year and the disease kills about people annually. It is most often diagnosed at advanced stages and the average fiveyear survival rate is just percent. Many smokers already had sought out spiral CTs even though the American Cancer Society hasnt recommended the test citing a lack of clear evidence that they work and most insurance doesnt cover the to cost. The scans arent riskfree They frequently mistake scar tissue from an old infection or some other benign lump for cancer leading to unnecessary biopsies or surgery that in turn can cause a collapsed lung infection or other problems. The NCI still is compiling rates of false alarms and other risks from the study. Nor is it clear if the study results are applicable to all smokers. The trial enrolled people ages to who were or had been very heavy smokers and gave them one scan a year for three years. While the spiral CTs emit less radiation than standard CT scans used to diagnose disease researchers also will analyze whether the radiation exposures from three scans changes a smokers lifetime risk of other radiationrelated cancers. Letters being mailed to study participants advise them to discuss with their doctors whether they should have additional scans or not."

"Nearly three decades have passed since the debate began about a series of symptoms that have come to be known as chronic fatigue syndrome http Its cause http is still unknown but over the years researchers have identified various brain immune system and energy metabolism irregularities involved. Some patients describe the syndrome as feeling like an unrelenting unremitting flu. Doctors say some treatments can help. Arthur Barsky http_barsky.aspx a psychiatrist at Brigham and Womens Hospital in Boston and a professor at Harvard Medical School says patients need to change how they experience symptoms typically pain insomnia and anxiety. When patients adopt a more positive attitude Barsky points out it often translates into greater confidence and more energy. A study http published this year in the Lancet found that a form of talk therapy as well as exercise offered relief for some patients. Researchers from the United Kingdom looked at cognitive behavior therapy http or CBT. In the study over patients with chronic fatigue syndrome were assigned to different treatments. All of them received medical care for symptoms like pain insomnia or anxiety. Article continues after this message from our sponsor Hear Joanne Silberners Report Medical Mystery Of Chronic Fatigue Syndrome Returns https Sept. One group got counseled about how to pace activities. Another took part in an exercise program. And a third received the cognitive behavioral talk therapy. The therapy and the exercise group improved the most reporting less fatigue insomnia and anxiety. Barsky says his patients do best when cognitive behavior therapy is also combined with gradually increased exercise. People need to begin to push themselves in the face of their fatigue because if you dont you become deconditioned and you get caught in a cycle which ... makes fatigue worse says Barsky. But he cautions against overdoing it. People should start with mild gentle exercise like clearing the table doing the dishes or taking the dog for a short walk. Then slowly build up to longer and more frequent walks he says. Lucinda Bateman http is a doctor at the Fatigue Consultation Clinic in Salt Lake City who specializes in chronic fatigue syndrome. Shes skeptical about the Lancet study pointing out that patients improved only moderately and not much more than those who were counseled about pacing themselves. Bateman suggests her patients pace themselves and try to do only as many activities as they can manage. She says some patients get caught in a push and crash cycle. When symptoms abate and they feel better they may go all out exercising doing errands and socializing. But soon that level of activity often comes to a crashing end and patients can relapse dramatically even becoming bedridden for several days or longer. Bateman takes also issue with CBTs implication that chronic fatigue syndrome is psychosomatic. We still dont know what exactly causes the syndrome. And like most professionals who treat patients Bateman eagerly awaits the day when science can finally pinpoint its cause."

"An herb widely used in traditional Chinese medicine might hold the key to a new osteoporosis therapy that could prevent bone loss without causing side effects. Using a compound derived from red sage UBC researchers have found a way to selectively block an enzyme called Cathepsin K CatK which plays a major role in the breakdown of collagen in bones during osteoporosis. The findings were published today in the Journal of Bone and Mineral Research. httponlinelibrary.wiley.comstore.bph.assetbph.pdfjsessionidAFEECDCACECD.ftvtjwgzdseeeafcfbdeadfaeb The development of osteoporosis drugs by pharmaceutical companies has focused heavily on blocking CatK in recent years said Dieter Brmme a professor in the faculty of dentistry and a Canada Research Chair in Proteases and Disease. All clinical trials to date have failed due to side effects ranging from stroke skin fibrosis and cardiovascular issues. Weve found a way to block CatK only in bone tissue that we think will prevent these other negative effects. The researchers tested a compound derived from red sage in human and mouse bone cells and a mouse model. They found that it prevented bone loss and increased the bone mineral density of the mice treated with the compound by per cent when compared with the control group. The study builds on previous research httponlinelibrary.wiley.comstore.bph.assetbph.pdfjsessionidAFEECDCACECD.ftvtjwgzdseeeafcfbdeadfaeb by Brmme and his team that looked at the effectiveness of red sage known as Danshen in Chinese and used to treat bone ailments in stopping the activity of CatK in limited ways. Enzyme blockers work like keys in locks. Most drugs in development have been so called active sitedirected inhibitors which act like master keys and lock the entire enzyme blocking both its diseaserelevant functions such as collagen degradation and its other normal functions. CatK is a multifunctional enzyme with important roles in other parts of the body and we think completely blocking it is what causes unexpected side effects in other drugs said Preety Panwar a research associate in the Brmme lab. Our compound only locks the collagen degrading CatK activity preventing the unregulated breakdown of collagen in bones without any other negative impacts. The treatment could also potentially be used to treat a variety of other bone and cartilage diseases such as arthritis and certain bone cancers. Osteoporosis is a global health problem that will affect one out of three women and one of out five men worldwide with a multibilliondollar pharmaceutical industry dedicated to finding treatments to stop its progression."

"The debate over coronary bypass surgery http versus stenting goes back decades. Studies have been inconclusive but doctors and patients have voted with their feet in favor of the lessinvasive procedure clearing clogged arteries and propping them open with tiny scaffolds called stents. U.S. doctors do at least two stenting procedures these days for every coronary bypass operation. Now the biggest collection of cases so far comes out in favor of surgery on the allimportant question of mortality. Four years after the procedure patients over who had coronary artery bypass surgeries called CABG or cabbages were almost percent less likely to die. Put another way percent of stented patients had died after four years compared with percent of surgery patients. Is that a big difference Well the studys lead author tells Shots that it might be enough to tip the balance a little bit but not overwhelmingly so. The National Heart Lung and Blood Institute which funded the study with new stimulus money from the American Recovery and Reinvestment Act is more bullish on the implications. We would hope a study as powerful as this one will inform decisionmakers to rethink the direction theyre going in the NHLBIs Dr. Michael Lauer httppublic.nhlbi.nih.govNewsroomhomeShowBio.aspxPID told Shots. He says its been worrying that so many doctors have been opting for stenting over surgery. Article continues after this message from our sponsor Study author Dr. William Weintraub http chief of cardiology at Christiana Care Health System in Newark Del. is presenting the data at the annual meeting of the American College of Cardiology in Chicago. The study also appears online http_home in the New England Journal of Medicine. It draws on data from more than patients across the nation who underwent CABG operations and nearly patients who had coronary stenting. They had blockages in either two or three coronary arteries but did not require emergency procedures. Although the prosurgery outcome is not a gamechanger Weintraub says it might cause some doctors and patients to consider surgery. And he says it supports those who now opt for CABGs. Its a very big deal to recommend coronary surgery to patients Weintraub says. I think doctors work very hard to weigh whats best for their patients. When doctors recommend surgery these data suggest that that decision is a good one. But Dr. Laura Mauri http_teamLaura_Mauri says in an accompanying editorial http_home that the new study cant settle any debates. Only studies that randomly assign comparable patients to surgery or stenting can do that. Mauri is an interventional cardiologist i.e. a specialist who does coronary stenting at Brigham and Womens Hospital inBoston. Weintraub notes its very difficult and expensive to do randomized studies on this question and to make the comparison groups truly comparable. And while such a study is being done the technology especially stenting technology changes. That can call into question the ultimate relevance of the findings. So the new data may be the best that doctors and patients in this situation can expect for the foreseeable future."

"Welltimed pulses from electrodes implanted in the brain can enhance memory in some people scientists reported http on Thursday in the most rigorous demonstration to date of how a pacemakerlike approach might help reduce symptoms of dementia head injuries and other conditions. The report is the result of decades of work decoding brain signals helped along in recent years by large Department of Defense grants https intended to develop novel treatments for people with traumatic brain injuries a signature wound of the Iraq and Afghanistan wars. The research led by a team at the University of Pennsylvania is published in the journal Current Biology. Previous attempts to stimulate human memory with implanted electrodes had produced mixed results Some experiments seemed to sharpen memory but others muddled it. The new paper resolves this confusion by demonstrating that the timing of the stimulation is crucial. Zapping memory areas when they are functioning poorly improves the brains encoding of new information. But doing so when those areas are operating well as they do for stretches of the day in most everyone including those with deficits impairs the process. We all have good days and bad days times when were foggy or when were sharp said Michael Kahana who with Youssef Ezzyat led the research team. We found that jostling the system when its in a lowfunctioning state can jump it to a highfunctioning one. Researchers cautioned that implantation is a delicate procedure and that the reported improvements may not apply broadly. The study was of epilepsy patients scientists still have much work to do to determine whether this approach has the same potential in people with other conditions and if so how best to apply it. But in establishing the importance of timing the field seems to have turned a corner experts said. Experts said the new report gives scientists a needed blueprint for socalled closedloop cognitive stimulation implanted electrodes that both monitor the functional state of memory areas moment to moment and deliver pulses only in the very microseconds when theyre helpful. The hope is that such sensitive timed implants could bolster thinking and memory in a range of conditions including Alzheimers and other dementias as well as deficits from brain injury. The cool thing about this paper is that they showed why stimulation works in some conditions and why it doesnt in others said Bradley Voytek an assistant professor of cognitive science and neuroscience at the University of California San Diego who was not involved in the work. It gives us a blueprint for moving forward. Justin Sanchez director of the biotechnologies office at the Pentagons Defense Advanced Research Projects Agency which has doled out some million to advance cognitive stimulation said To me this paper is one of the breakthrough moments on this problem to find locations in the brain to stimulate in this particular way to boost performance. The right hemisphere of a study participants brain. The electrodes are overlaid in blue and the one researchers targeted for stimulation is toward the right highlighted in yellow.CreditJoel Stein and Youssef Ezzyat The new study is the latest chapter in an extraordinary decadeslong collaboration among cognitive scientists brain surgeons and people with severe epilepsy being evaluated for an operation. The preoperative evaluation is a fishing expedition of sorts in which doctors sink an array of electrodes through the top of the skull and wait for a seizure to occur to see whether its operable. Many of the electrodes sit in or near memory areas and the wait can take weeks in the hospital. Cognitive scientists use this opportunity with patients consent to present memory tests and take recordings. This approach called direct neural recording and piggybacking entirely on the clinical placement of the electrodes has become the leading edge of research into the biology of human memory. This study used data from patients and had collaborators from institutions around the country including Emory University the University of Washington the Mayo Clinic and the University of California San Francisco. In a series of experiments the researchers had patients memorize lists of words and later after a distraction asked them to freely recall as many of the words as they could. All the while the scientists monitored a handful of hot spots in the brain which previous work had shown were strongly related to memory encoding. Before the stimulation tests the team determined the precise settings for each patients high and lowfunctioning states. Each participant carried out the wordmemorization tests repeatedly with different words every time some lists were memorized with brain stimulation and other lists with no stimulation which served as a control. The authors then examined memory performance based on whether stimulation arrived during low compared with highfunctioning brain states. The team then statistically analyzed the results and found that people scored slightly higher than usual on words when stimulation arrived during a low or foggy state and worse when the pulse arrived in a high state. The average enhancement effect was about to percent Dr. Kahana said. And when stimulation arrived in a good state the average was about to percent worse than usual. Dr. Doris Greenblatt a psychiatrist who participated in the trial at Emory said she sought the surgery because her epilepsy had long caused memory problems. Each seizure I had tore at the fabric of memory and it was as if my memories werent attached to anything Dr. Greenblatt said. She agreed to the memory testing for the study. It was a little humiliating to be honest she said of the testing. I would remember one or two items from a list of objects in a kitchen for instance then think Oh no what else was there She said she had no idea whether the electrodes in her brain were stimulating or not. All I can say is that it was exhausting and I worried about how I was doing. She had the surgery for her epilepsy a year ago with Dr. Robert Gross and has not had a seizure since her memory is also improved she said. The timed component in this study represented a clear break from previous approaches. In the Defense Department had funded another group testing stimulation in epilepsy patients directly to a brain area near the hippocampus which is crucial to memory formation. That approach did not take into account brain states the high and low function and it was not successful. To me said Dr. Voytek the new approach is a clear demarcation that the era of dumb stimulators is over."

"In an era when people talk about just about anything fecal incontinence is one of the few medical conditions that is so embarrassing so disturbing that people dont even tell their doctors about it. Sadly if sufferers talked theyd find out how common their problem is and learn that new help is available. In the last two years two new treatments for the debilitating condition have been approved. They dont cure everybody but can offer hope to people who are often so afraid theyll soil their pants in public that they wont leave home. Their lives revolve around their unreliable sphincters. Joshua Bleier a Pennsylvania Hospital colorectal surgeon is thrilled to be able to offer something helpful. He has been using a device similar to a heart pacemaker to improve function of pelvic floor muscles. I am amazed and so gratified by the fact that these people whose lives have just been hijacked and destroyed by their incontinence . . . theyre just rescued by this he said. Its the best feeling in the world. Henry Parkman director of the GI Motility Laboratory at Temple University Hospital said doctors call fecal incontinence the silent affliction. Even when they visit a specialist patients with it may say theyve come due to diarrhea. Doctors are learning that they have to ask. If you think that theres embarrassment attached to urinary incontinence that is just a shadow of the embarrassment surrounding fecal incontinence said Nancy Muller executive director of the National Association for Continence. The National Institute of Health estimates that million Americans have fecal incontinence. The incidence rises with age and experts estimate that percent of those over suffer from the condition. Its a key reason many elderly people wind up in nursing homes. While most of us associate the need for adult diapers with serious illness and dementia doctors said they treat middleaged people who are still working and healthy seniors without cognitive problems. That makes the emotional consequences all the more brutal. It can be devastating said Stephanie Moleski a gastroenterologist at Thomas Jefferson University Hospital. It affects selfconfidence personal image. It can lead to social isolation. Like parents with toddlers patients have to learn where all the public bathrooms are. Bleier said he had had patients who spent eight hours a day sitting on the toilet. The problem is more common in women than in men. Women can blame their children. Lengthy labor especially when deliveries required forceps or episiotomies is linked to incontinence immediately after the birth and years later when pelvic floor muscles weaken. Prostate cancer treatment is a risk factor for men. Nerve damage from diabetes can also cause incontinence. Stroke and neurological disease patients are at higher risk. Fecal incontinence can range from what doctors call leakage to full bowel movements. A yearold Bryn Mawr man was willing to talk about the problem that left him isolated depressed and afraid to leave his house but his wife vetoed use of his name because she thought it was too embarrassing. He first became incontinent a decade ago after radiation treatment for prostate cancer. His doctor suggested Kegel exercises which are used to strengthen the pelvic floor and they did the trick for a while. Three or four years ago the problem returned with a vengeance. Sometimes the man felt he was about to have a bowel movement but had too little warning. Other times he didnt feel the stool escape and discovered it later. He was still working so he would often have to race to the bathroom. He carried extra underwear and later adult diapers. Hed surreptitiously wash soiled underwear in the toilet wrap it in paper towels and dump it in the trash. He did the best he could with the odor. Nobody would say anything but I imagine I was not a very popular character at that time he said. He had to watch what he ate. Red meat was out and Mexican food caused an explosive discharge. I had some terrible messes he said. It was getting me down. It was very depressing. His worst experience came while driving his car. He felt the bowel movement starting but couldnt find a bathroom. I was holding it back as hard as I could but it just broke through like a dam he said. He turned around and headed home sitting in the mess the whole time. Then he had to clean everything up. It was very upsetting he said. You feel very helpless. His family knew what he was going through but nobody else. Those are the issues that you kind of sweat out as a human being he said. People dont realize that these little dramas are going on. The man one of Bleiers patients tried the pacemaker device known as a sacral nerve stimulator. It didnt completely get rid of the problem he said but it makes a big difference. Doctors typically first try dietary changes and Kegel exercises sometimes coupled with biofeedback. Jeffersons Moleski said another new treatment is Solesta a bulking agent that is injected beneath the lining of the anus narrowing the opening. According to the Food and Drug Administration the treatment reduced fecal incontinence episodes in half of the patients by percent six months after treatment but a sham procedure had the same effect for a third of patients. Moleski said the results are a lot better than previous options and its a less invasive approach than the pacemaker. Bleier said that in the past surgeons could only try to repair the sphincter but that was painful and would often fail after three to five years. He considers the new Medtronic pacemaker InterStim a significant advance. The device was initially approved for urinary incontinence and the company applied for the additional use after patients reported that it improved both kinds of incontinence. Bleier said there was some evidence that it could also help patients with chronic constipation. A Medtronic spokesman said InterStim uses the same technology as a heart pacemaker but paces at a different rate. While a heart pacemaker connects directly to heart muscle InterStim stimulates the sacral nerves. Bleier said the device which consists of a lead wire and a neurostimulator the size of a stopwatch is implanted on top of a buttock muscle. Patients dont feel it when they sit down and you cant see its imprint under a tight pair of pants. Patients can try the stimulation for two weeks with the pacemaker outside the body before deciding whether to have it implanted an outpatient procedure. Medicare pays about for the device and treatment. A Medtronic study of patients found that percent reported complete continence three years after insertion of the device. The Bryn Mawr man said the stimulator gives him more warning time to get to a bathroom and a greater sense of control. Its really quite a miracle he said. You dont have that cloud over your head all the time. Ive gotten quite a few phone calls Monday from people who read my article and wanted to contact the doctors I interviewed. Here are numbers where you can reach them Joshua Bleier a colorectal surgeon at Pennsylvania Hospital implants the sacral nerve stimulator. The number for his physician assistant is . The front desk is . Stephanie Moleski a gastroenterologist at Thomas Jefferson University Hospital is at . The number for Henry Parkman director of the GI Motility Laboratory at Temple University Hospital Medtronic maker of the sacral nerve stimulator InterStim gave me a list of local centers that are implanting the device. It is not a comprehensive list but here it is Pennsylvania Hospital Thomas Jefferson Health System Einstein Medical Center Christiana Hospital and Kennedy Health System."

"While the majority of morbidly obese patients who undergo gastric banding say they are generally satisfied years later almost percent are saddled with major complications while about half have to have their bands removed a small new Belgian study reveals. The finding comes on the heels of a recent study out of the University of California San Francisco that suggested gastric bypass surgery is superior to alternative surgical methods such as gastric banding for promoting weight loss andor eliminating type diabetes. The current observations stem from a research effort led by Dr. Jacques Himpens of the European School of Laparoscopic Surgery at the Saint Pierre University Hospital in Brussels whose team assessed the status of patients that had undergone the procedure known as laparoscopic adjustable gastric banding LABG more than a decade prior to the study launch. Himpens and his colleagues outline their findings in the March online issue and the July print issue of the Archives of Surgery. LAGB creates a small pouch by placing a constricting ring or band around the top portion of the stomach the smaller stomach size allows patients to feel full more quickly. Since its introduction in the banding approach has become a popular alternative to RouxenY gastric bypass surgery which involves the literal stapling of the stomach in order to redirect food past part of the small intestine to instigate reduced food absorption as well as a quicker sensation of satiety. But LAGB surgery has come under criticism in the past for involving a relatively high risk for complications including wound infection and injury to the spleen and esophagus and a poor prognosis in terms of longterm quality of life. It is also been reported that LAGB patients are likely to regain much of their lost weight years down the road. To explore satisfaction levels and the longterm complication history of gastric banding in Himpens and his team examined a pool of patients who had undergone the surgery between and . The results years or more later more than percent of the banding patients said they were satisfied with their experience. On average excess weight loss had been maintained at a level approaching nearly percent and quality of life appeared to be equal to that of patients who had not undergone the surgery. However percent of the patients had experienced serious complications including abnormal pouch expansion band erosion and band infection . Another percent experienced relatively minor complications. Almost percent had to have the bands entirely removed while percent needed to undergo subsequent surgery. The procedure appears to result in relatively poor longterm outcomes the researchers concluded. One in six of the patients ended up deciding to have a gastric bypass procedure and all of these patients demonstrated good outcomes following their subsequent surgery. Himpens said that patients should limit their expectations with respect to banding noting that all weightloss operations have a high failure rate. But he added that it is still defendable for surgeons to continue doing this. The high failure rate of the band gastroplasty in the long term is not that much worse than other procedures he noted. I therefore think patients will continue to ask for the procedure. But he cautioned that patients undergoing band surgery should do so knowing that they need to commit themselves to rigorous longterm followup. Meanwhile in a critique published alongside Himpens work Dr. Clifford W. Deveney a professor of surgery in the department of surgery at Oregon Health and Science University in Portland concluded that the current study does not shed a favorable light on the use of LAGB. The band has a spotty history Deveney said. Some groups have very good results with to percent weight loss. But other groups have either poor weight loss or complications or both. So I think he continued that the patient should be made aware of these facts and also that the weight loss is going to be less with the band than with a gastric bypass. And that itll take longer to achieve the weight loss because with gastric bypass most of the weight loss occurs over the first year while with a band it takes five to six years. Its also easier to cheat on the band he added. You can eat around the band and render it ineffective if youre not disciplined in following a healthy diet. With gastric bypass thats not as much of an issue. But all this is not to say that I think we shouldnt be doing bands. Its just not as good as bypass. Dr. Mitchell S. Roslin chief of bariatric surgery at Northern Westchester Hospital in Mount Kisco N.Y. said he was not surprised by the findings. I always tell my patients that bands are like going a diet with a seatbelt he said. And that theres bound to be a percent extraction rate of these bands per year that theyre in. Which actually comes to about the same percent of band removals these researchers observed among their patients. I think the problem with the bands is simply that having a fixed obstruction underneath your esophagus is not a natural occurrence Roslin noted. And also these bands make it more difficult to eat but they do not make every patient less hungry. So theres a big variability in treatment effect. Youll see patients who do great and patients who dont. Almost like a camel with two humps. So bands are easy to sell and very heavily marketed he added. But for many patients there are better options. More information For more on gastric banding visit the National Institutes of Health http SOURCES Jacques Himpens M.D. European School of Laparoscopic Surgery Saint Pierre University Hospital Brussels Belgium Clifford W. Deveney M.D. professor surgery department of surgery Oregon Health and Science University Portland Mitchell S. Roslin M.D. chief bariatric surgery Northern Westchester Hospital Mount Kisco N.Y. March Archives of Surgery online"

"In the wake of a widely publicized report advising against prostatespecific antigen PSA testing for prostate cancer a new study finds not screening would triple the number of U.S. men developing advanced cancer. Testing on the other hand might keep some men each year from receiving a diagnosis of latestage prostate cancer cancer that has spread and is far less curable the study finds. PSA testing for all its pluses and minuses and all that . . . permits you to catch the disease earlier said lead researcher Dr. Edward Messing chair of urology at the University of Rochester Medical Center in Rochester N.Y. These people are all going to die they are going to die incredibly expensively and die miserably he said referring to the many men whose diagnoses would be delayed by not testing. I dont know that all these people could be saved with PSA testing but many could he added. The report was published online July in the journal Cancer. Messing said the annual number of prostate cancer deaths dropped from about in the s to now. The only thing that can explain that is PSA early detection and treatment he said. Many cases of prostate cancer are not lifethreatening which is why testing is controversial. The U.S. Preventive Services Task Force USPSTF in May recommended against routine PSA screening saying too many nonlethal cancers were being treated aggressively exposing men who didnt need treatment to serious side effects such as impotence and urinary incontinence. But Messing disagreed with that advice. Condemning PSA testing wasnt a brilliant conclusion he said. For the new study Messings team compared information from the U.S. Surveillance Epidemiology and End Results database for the years to immediately before widespread PSA testing started to data from through . In the data cases of prostate cancer were diagnosed after the malignancy had spread to other parts of the body. Using these cases as a base the researchers constructed a model that used data of advanced cancer diagnosed in the s and predicted how many cases of advanced cancer would have been diagnosed in if PSA testing was not done. Their model showed instead of actual cases in about cases would have been diagnosed. But the USPSTF maintains the benefits of testing are overrated. The task force recommends against prostate cancer screening using the PSA test as the potential benefit does not outweigh the harms said Dr. Michael LeFevre covice chair of the task force and professor in the department of family and community medicine at the University of Missouri School of Medicine. As a result of treatments for PSAdetected prostate cancer one out of men screened in the United States develops a blood clot in his legs or lungs two will have a heart attack or stroke and up to are left impotent or with urinary incontinence LeFevre said. At best only one of these men who were screened avoids dying from prostate cancer for at least years LeFevre said. In addition about one in every men screened dies as a result of surgery to treat cancer detected by the PSA test. Still the task force recognizes that some men may continue requesting the PSA test and some physicians may continue offering it LeFevre said. Before getting this blood test which measures a protein in cells of the prostate gland men should learn about the pros and cons he said. The decision to start or continue screening should reflect an understanding of the possible benefits and known harms and should respect each individuals preferences. Messing advises men with a family history of prostate cancer or urinary symptoms to have a PSA test. Men with no family history or symptoms should discuss PSA testing with their doctor he added. Messing pointed out that screeningdetected cancer doesnt mean surgery chemotherapy or radiation treatment must follow. Most cases can be watched for some time he said. Dr. Otis Brawley chief medical officer for the American Cancer Society said over the past few years a number of studies have been published on the benefits and harms of PSA testing. None of these studies can be considered decisive other than in proving that there are some harms associated with treatment he said. The American Cancer Society still supports screening for certain men in consultation with a physician. Prostate cancer is the secondleading cause of cancer death among men in the United States. In more than new cases are expected to be diagnosed and men will die from the disease researchers say. More information For more information on prostate cancer visit the U.S. National Cancer Institute."

"Exelixis Incs cabozantinib experimental drug shrank bone malignancies from prostate cancer in percent of patients interim results from a midstage trial show. Of patients so far evaluated by bone scan had complete resolution and had partial shrinkage of metastatic bone lesions which can lead to bone fractures severe pain and eventual death. The disease remained stable in other patients or percent and worsened in three. The study results were reported on Monday at the American Society of Clinical Oncologys annual meeting. For the first time cabo is showing dramatic activity against both soft tissue and metastatic bone lesions said Exelixis Chief Executive Officer Michael Morrissey. Men with latestage prostate cancer usually die from bone disease. After weeks of treatment patients were randomly selected to receive either a placebo or cabozantinib. The drug reduced by percent the risk of disease progression or death. Excluding patients on placebo the median survival without disease progression was weeks. Side effects of cabozantinib included fatigue high blood pressure and hemorrhage. Morrissey said Exelixis planned to start a Phase prostate cancer trial in the second half of this year with a combined goal of reducing pain and bone malignancies. Cabozantinib also known as XL is an oral drug designed to limit blood supply to tumors and to block two segments of a pathway used by cancer cells to grow and spread. Other Phase data presented over the weekend showed that treatment with cabozantinib led to significant tumor shrinkage in percent of patients with metastatic ovarian cancer. But two ovarian cancer patients died from cabozantinibrelated side effects one from bowel fistula and one from intestinal perforation. Exelixis expects to have initial results around midyear from a pivotal trial of the drug as a treatment for thyroid cancer. Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"A novel class of antimicrobials that inhibits the function of a key diseasecausing component of bacteria could be effective in fighting methicillinresistant Staphylococcus aureus MRSA one of the major drugresistant bacterial pathogens according to researchers at Georgia State University. Their study showed that small molecule analogs that target the functions of SecA a central part of the general bacterial secretion system required for viability and virulence have potent antimicrobial activities reduce the secretion of toxins and can overcome the effect of efflux pumps which are responsible for multidrug resistance. Their findings indicate that targeting SecA is an attractive antimicrobial strategy against MRSA and may be several times more effective than the antibiotics now available for treating the infection. MRSA causes serious hospital and communityacquired infections. Healthcareassociated MRSA infections are typically linked to invasive procedures or devices such as surgeries intravenous tubing or artificial joints. Communityacquired MRSA often begins as a skin boil and is spread by skintoskin contact. Individuals at risk include competitive wrestlers child care workers and those living in crowded conditions. Weve found that SecA inhibitors are broadspectrum antimicrobials and are very effective against strains of bacteria that are resistant to existing antibiotics said Binghe Wang Regents Professor of Chemistry at Georgia State Georgia Research Alliance Eminent Scholar in Drug Discovery and Georgia Cancer Coalition Distinguished Cancer Scholar. He coled the study with Phang C. Tai Regents Professor of Biology at Georgia State who is an expert on the functions of SecA in bacteria. Their findings were published in the journal Bioorganic Medicinal Chemistry in November. Because of the widespread resistance of bacteria to antibiotics on the market there is an urgent need for the development of new antimicrobials. MRSA infection is caused by a type of Staphylococcus bacteria that has become resistant to many antibiotics used to treat ordinary staph infections according to the Mayo Clinic. In previous work the researchers developed novel small molecule SecA inhibitors active against the bacteria strains Escherichia coli and Bacillus subtilis by dissecting a SecA inhibitor called Rose Bengal RB. In this study they evaluated two potent RB analogs for their activity against MRSA strains. The RB analogs inhibited the ATPase activities of two SecA isoforms identified in S. aureus SaSecA and SaSecA as well as the SaSecAdependent proteinconducting channel. The inhibitors also reduced the secretion of three toxins from S. aureus and stopped three MRSA strains of bacteria from reproducing. The best inhibitor in this group SCA showed strong activity against MRSA Mu strain and an inhibitory effect on MRSA Mu that was twoto times more potent than all commonly used antibiotics including vancomycin the last resort option for treating MRSArelated infections. In a study recently published online in the journal ChemMedChem the researchers synthesized and evaluated another new class of triazolepyrimidine analogs as SecA inhibitors. This study also confirmed that SecA inhibitors have the potential for being broadspectrum antimicrobials can directly block virulence factor production and can null the effect of efflux pumps. Collaborators for the paper published in Bioorganic Medicinal Chemistry include Hsiuchin Yang Hao Zhang Krishna Damera YingHsin Hsieh Arpana Sagwal Chaudhary Jianmei Cui and Jinshan Jin of Georgia State. The study is funded by the National Institutes of Health and Georgia States Center for Biotechnology and Drug Design and Molecular Basis of Diseases Program. To read the study visit http The ChemMedChem study is available at httpdx.doi.org.cmdc.."

"A twoyear multicenter clinical study with patients with class IIIIV refractory angina randomized to low and high dose CD cells or placebo has revealed that patients who received either a high or low dose of CD a member of a family of proteins that have an impact on vascularassociated tissue cells had a significant reduction in angina frequency over patients who received placebo. The patients who were unresponsive to other treatments were considered to have no other options refractory. The researchers used intramyocardial delivery into the ischemic zone after D mapping to register both electrical and mechanical activities of the left ventricle. Outcomes from the ACTCMI study a twoyear phase II randomized doubleblind placebocontrolled clinical trial will be published in an upcoming cardiac issue of Cell Transplantation http There are an increasing number of patients with advanced coronary artery disease that are not amenable to surgical or percutaneous revascularization said study coauthor Dr. Timothy D. Henry of the CedarsSinai Heart Institute. These patients frequently have symptoms after having had standard therapies and are left with limited treatment options. Encouraging early clinical trials suggest that cell therapy is an attractive treatment option for these patients especially trials in which subjects were transplanted with autologous selfdonated CD cells. CD cells drew the attention of researchers for possible therapeutic testing because recent studies pointed to the importance of CD cell content in the bone marrow of patients with risk factors for coronary artery disease in predicting not only baseline but also future exercise capacity. According to the researchers the study demonstrated that CD cells have the ability to restore the microcirculation and improve myocardial tissue perfusion. All of the patients participating in the ACTCMI study saw significant improvement in both angina frequency and exercise at months and a trend toward decreasing major cardiac events. There was also a reduction in angina in the placebo group at six months but the effect was less prominent at and months reported the researchers. In addition there was a significant reduction in the time to first hospitalization in celltreated patients with a trend toward reduction in mortality as well. The results of our study are even more provocative given that the outcomes represent the effect of a single treatment wrote the researchers. Recent reports suggest that in patients with recurring symptoms repeated cell administration may replicate the initial positive results. The researchers concluded that for no option patients with class IIIIV angina refractory that was unresponsive to conventional medical therapy and who were not candidates for revascularization injection of CD cells resulted in persistent improvement in angina at two years posttreatment. Contact Timothy D. Henry S. San Clemente Blvd. Suite A Los Angeles CA. Email henrytcshs.org mailtohenrytcshs.org Tel Fax Citation Henry TD Schaer GL Traverse JH Povisc TJ Davidson C Lee JS Costa MA Bass T Mendelsohn F Fortuin FD Pepine CJ Patel AN Riedel N Junge C Hunt A Kereiakes DJ White C Harrington RA Schatz RA Losordo DW the ACTCMI Investigators. Autologous CD Cell Therapy for Refractory Angina year Outcomes from the ACTCMI StudyCell Transplant. Appeared or available online May This study scheduled to be published later this year in a special cardiovascular issue of Cell Transplantation is currently freely available online as an unedited early epub at http_Henry_et_al The CoEditorsinChief for CELL TRANSPLANTATION are at the Department of Neurosurgery and Brain Repair Morsani College of Medicine University of South Florida Tampa FL USA and the Center for Neuropsychiatry China Medical University Hospital TaiChung Taiwan. Contact Paul R. Sanberg at psanberghealth.usf.edu mailtopsanberghealth.usf.edu ShinnZong Lin at shinnzongyahoo.com.tw mailtoshinnzongyahoo.com.tw or Associate Editor Samantha Portis at celltransplantationgmail.com mailtocelltransplantationgmail.com"

"Despite the continued controversy surrounding the use of testosterone in men who have testosterone deficiency hypogonadism a new study has found that longterm use of testosterone therapy not only improves vigor and vitality but may reduce the risk of death due to cardiovascular CV disease. These findings appear online in the Journal of Cardiovascular Pharmacology and Therapeutics. Testosterone T is the primary male sex hormone. In men T plays a key role in the development of male reproductive tissues as well as promoting secondary sexual characteristics such as increased muscle and bone mass and growth of body hair. In addition T is essential for overall health and wellbeing and for the prevention of osteoporosis. Insufficient levels of circulating T in men contributes to frailty and bone loss. In the absence of large prospective placebocontrolled clinical trials of longer duration substantial evidence regarding the safety and risk of testosterone therapy TTh with regard to cardiovascular outcomes can only be gleaned from observational studies. To date there are limited studies comparing the effects of longterm TTh in hypogonadal men who were treated or remained untreated with T. Researchers at Boston University Schools of Medicine BUSM and Public Health BUSPH along with researchers in Germany established a registry to assess longterm effectiveness and safety of T in men. For this study they sought to compare its effects on a host of parameters obesity cholesterol levels diabetes liver function considered to contribute to cardiovascular disease. The researchers followed a group of men for eight years who had been on TTh and compared them with another group of men who remained untreated for the same time period. They found there were only two deaths in the TTh group and neither was related to CV events. In the nontreated control group there were deaths of which were related to CV events. Furthermore there were nonfatal myocardial infarctions and nonfatal strokes in the control group but none in the Ttreated group. According to the researchers longterm TTh in men with hypogonadism appears to be an effective approach to achieve sustained improvements in cardiometabolic function and reduces the risk of CV events. The low CV events observed in the Tgroup compared to the untreated control group strongly suggest that TTh is protective. We believe that the protective effect of T on the CV system provides clinicians with the opportunity to utilize this approach for secondary prevention for hypogonadal men with a history of CV events explained corresponding author Abdulmaged M. Traish PhD professor of biochemistry and urology at BUSM. Conflict of interest disclosure statement Contributing authors Dr. Farid Saad is a full time employee of Bayer Pharma. Dr. Ahmad Haider has received partial compensation for data entry from Bayer Pharma. Dr. Gheorghe Doros has received payment for statistical analysis from Bayer Pharma."

"Implantable devices designed to control heart rhythm and efficiency while preventing sudden death among heart failure patients are as effective at ensuring patient survival in realworld situations as they are in controlled study environments new research suggests. The finding is based on an analysis of nearly patients outfitted with either an implantable cardioverter defibrillator ICD a cardiac resynchronization therapy device CRT or a defibrillator combined with a CRT device a CRTD. The study authors noted that the observation is somewhat surprising given that some of the patients not enrolled in structured studies have already experienced a cardiac event and are therefore prescribed such devices to prevent a recurrence. This would suggest that realworld heart failure patients as a whole might be more vulnerable to fatal events than those tracked in a study setting. Im very encouraged that survival after defibrillator implant is as good as it is for as long as it is coauthor Dr. Leslie A. Saxon chief of the division of cardiovascular medicine at the University of Southern Californias Keck School of Medicine in Los Angeles said in a news release from the American Heart Association. Theres a lot of good news here she added. Saxon and her team reported their observations in the Nov. online edition of Circulation. Crunching the numbers the authors determined that percent of ICD patients survive one year out from device implantation. The same is true for percent of CRTD patients they noted. Five years out those figures dipped to percent for ICD patients and percent for CRTD patients. Among those outfitted with CRT devices alone oneyear survival was pegged at percent while fiveyear survival came in at percent the investigators found. The poorer prognosis for CRTonly patients was attributed to their older average age years and the fact that they may be relatively sicker overall. Patients today tend to receive CRT devices with defibrillators. The study team also found that patients whose implants were monitored remotely on a continual basis by a health facility network were about half as likely to die as patients who only had intermittent inperson assessments. Remote monitoring via telephone lines and online physician access is available for all ICD and CRTD devices the authors noted and enrollment in such programs is typically free with a cardiologists recommendation. Its highly likely the reason these patients did better is that they were receiving earlier diagnoses and they were also empowered to take charge of their own health care more Saxon said. I dont think theres any reason not to put a patient on it. Dr. Eric N. Prystowsky cardiologist and director of clinical electrophysiology at St. Vincent Medical Center in Indianapolis said that the findings are good news but cautioned against overinterpreting the data. These are very basic facts concerning simply who lived and died he noted. So we dont really know what it all means and its inappropriate to suggest that we could based only on this compilation of data. But Prystowsky continued this analysis does show two impressive things one that patients who are not superselected for a trial do well with these devices from a mortality standpoint and two that patients who had homemonitoring had better outcomes. Prystowsky added Now on the latter point again from this data we cant say exactly why that is. But at our facility we think it makes caring for a patient much easier. Physicians knowing things sooner will theoretically give a patient a better chance for quicker access to appropriate care. And that has to be good. So we think theres certainly no downside to remote monitoring and wherever possible its reasonable to want to do this. More information For more on implantable devices visit the American Heart Association http_UCM__Article.jsp. SOURCES American Heart Association news release Nov. Eric N. Prystowsky M.D. cardiologist director clinical electrophysiology St. Vincent Medical Center Indianapolis"

"Researchers from the University of Copenhagen and humanitarian organizations have conducted a large study in Burkina Faso in West Africa treating more than children with acute malnutrition. The study published Monday September in the open access medical journal PLOS Medicine showed that cornsoy porridge should be replaced with a lipidbased nutrient supplement LNS a fortified peanut butter. The results of the study can be used directly both in the treatment and prevention of acute malnutrition. Globally more than million children are affected by acute malnutrition. Those with the most severe acute malnutrition have more than ten times increased mortality and those surviving may have impaired development compared to children without malnutrition. But this can be prevented if children are treated early while they only have moderate acute malnutrition. LNS supports healthy growth Christian Fabiansen MD PhD and a team from the Department of Nutrition Sports and Exercise at the University of Copenhagen conducted the study in collaboration with a PhDstudent from the Institut de Recherche en Sciences de la Sant in rural Northern Burkina Faso where there was a high prevalence of acute malnutrition. Dr Fabiansen previously worked in humanitarian medical projects with Mdecins Sans Frontires MSF who also sponsored this work. The research was conducted in a malnutrition project run by the medical humanitarian organisation The Alliance for International Medical Action ALIMA and its Burkinabe partners Keoogo and SOS Mdecins. During the trial small children with moderate acute malnutrition were given either LNS or cornsoy porridge for weeks. The study found that children who received LNS experienced greater weight gain and the large majority of the weight gain was healthy lean tissue. Dr Fabiansen the main author of the paper appearing in PLOS Medicine today underscores the importance of the findings Previous studies of nutritional supplements have mainly looked at the effect on weight gain. It has been a concern that LNS with its very high fat content would result mainly in weight gain composed of fat. But by using a method based measurement of heavy water in the childs body we have found that LNS mainly increase lean mass that is muscles and organs which are important for immune function survival and development. Novel standard for research in malnutrition may save lives Professor Henrik Friis the senior author on the paper points to the importance of the collaboration between university researchers and humanitarian organizations It has been a new way to conduct research that we tested the effect of nutritional supplements used mainly by aid agencies employing very advanced research methods in remote rural areas where humanitarian organization are working and not at the university hospitals. The collaboration between researchers and humanitarian organizations means these findings can have immediate practical impact on field practice. The General Director of the Danish section of MSF Jesper H. Brix notes Acute malnutrition is still a major global health problem. So I hope we can use the results to provide the best possible treatment for more vulnerable children. If we can treat children with moderate acute malnutrition with the scientifically proven most effective food aid product and thereby prevent severe acute malnutrition then many lives can be saved Dr Susan Shepherd a paediatrician who heads ALIMAs Operational and Clinical Research says ALIMA is very proud of its participation in this study. Vulnerable children no matter where they live deserve the best medical and nutritional treatments available. Studies like Treatfood generate the evidence we need to make the best decisions with our patients. ALIMA is committed to developing more research partnerships in its humanitarian projects because this is how we will raise the quality of medical practice for all. Treatfood treating acute malnutrition University of Copenhagen Doctors Without Borders and ALIMA have collaborated on the project Treatfood which aims to improve products for children with acute malnutrition. The study was primarily funded by Danida MSFDenmark and MSFNorway and USAID via the World Food Programme. The main Treatfood results are presented in the paper Effectiveness of food supplements in increasing fatfree tissue accretion in children with moderate acute malnutrition A randomised factorial trial in Burkina Faso httpjournals.plos.orgplosmedicinearticleid.journal.pmed. published in the open access medical journal PLOS Medicine. Earlier peerreviewed articles from the study have appeared in the American Journal of Clinical Nutrition BMC Nutrition and Appetite. Facts about malnutrition Malnutrition in children can be chronic or acute. In acute malnutrition children are thin relative to their height or wasted. Approximately or mio children globally are affected by acute malnutrition. Of these have moderate and severe acute malnutrition. Acute malnutrition is more lifethreatening than chronic. In chronic malnutrition the children are short relative to their age or stunted. More than of children in the world have chronic malnutrition. Previous research has focused on treatment of severe acute malnutrition. WHO has called for research to identify the most optimal foods for treatment of children with moderate acute malnutrition."

"A combination of two BristolMyers Squibb drugs that help the immune system fight melanoma led to significantly greater tumor shrinkage than treatment with one of the medicines according to a midstage study presented on Monday. The combination of Yervoy and the newer Opdivo also reduced the risk of disease progression by percent compared with Yervoy alone through months of followup in previously untreated patients with advanced melanoma researchers found. The overall response rate defined as tumors that shrank by at least percent was percent for the patients who received the combination versus percent among the who got Yervoy alone. Twentytwo percent of those combination patients had a complete response meaning no sign of tumor. There were no complete responses with Yervoy alone. The response rates and the depth of responses are quite impressive Dr. Stephen Hodi director of the Melanoma Center at DanaFarber Cancer Institute and colead author of the study said in an interview. The median time it took for Yervoy patients to see their cancer worsen was . months. But after months more than half of the combination group had yet to see their disease worsen. Overall survival data was not yet available. Longer followup will be helpful to see the durability of these responses and what happens to patients who had complete responses said Hodi who presented data from the Checkpoint study at the American Association for Cancer Research meeting in Philadelphia. The results were published in the New England Journal of Medicine. Yervoy also known as ipilimumab had been the first immunotherapy to extend survival in patients with advanced melanoma the deadliest skin cancer. It works by taking the brakes off the immune system to more efficiently attack cancer. Opdivo nivolumab belongs to a promising new class of drugs called PD inhibitors that block a mechanism tumors use to hide from the immune system. In a separate group of patients with a mutation of the BRAF gene involved in cancer cell growth the overall response rate was percent for the combination. The complete response rate was percent. That compared with percent overall response rate and no complete responses for Yervoy alone. The combination of the two drugs also led to far higher levels of side effects such as colitis and inflammation of lung tissue at percent versus percent for Yervoy alone. Patients were also more likely to stop taking the combination of drugs. Most of the patients who stopped for toxicity continued to benefit said Fouad Namouni Bristols head of development for Yervoy and Opdivo."

"Eating a type of powdered food supplement based on a molecule produced by bacteria in the gut reduces cravings for highcalorie foods such as chocolate cake and pizza a new study suggests. Scientists from Imperial College London and the University of Glasgow asked volunteers to consume a milkshake that either contained an ingredient called inulinpropionate ester or a type of fibre called inulin. Previous studies have shown bacteria in the gut release a compound called propionate when they digest the fibre inulin which can signal to the brain to reduce appetite. However the inulinpropionate ester supplement releases much more propionate in the intestines than inulin alone. After drinking the milkshakes the participants in the current study underwent an MRI scan where they were shown pictures of various low or high calorie foods such as salad fish and vegetables or chocolate cake and pizza. The team found that when volunteers drank the milkshake containing inulinpropionate ester they had less activity in areas of their brain linked to reward but only when looking at the high calorie foods. These areas called the caudate and the nucleus accumbens found in the centre of the brain have previously been linked to food cravings and the motivation to want a food. The volunteers also had to rate how appealing they found the foods. The results showed when they drank the milkshake with the inulinpropionate ester supplement they rated the high calorie foods as less appealing. In a second part of the study which is published in July edition of the American Journal of Clinical Nutrition the volunteers were given a bowl of pasta with tomato sauce and asked to eat as much as they like. When participants drank the inulinpropionate ester they ate per cent less pasta than when they drank the milkshake that contained inulin alone. In a previous research study by the same team published in they found that overweight volunteers who added the inulinpropionate ester supplement to their food every day gained less weight over six months compared to volunteers who added only inulin to their meals. Professor Gary Frost senior author of the study from the Department of Medicine at Imperial said Our previous findings showed that people who ate this ingredient gained less weight but we did not know why. This study is filling in a missing bit of the jigsaw and shows that this supplement can decrease activity in brain areas associated with food reward at the same time as reducing the amount of food they eat. He added that eating enough fibre to naturally produce similar amounts of propionate would be difficult The amount of inulinpropionate ester used in this study was g which previous studies show increases propionate production by . times. To get the same increase from fibre alone we would need to eat around g a day. At the moment the UK average is g. Claire Byrne a PhD researcher also from the Department of Medicine explained that using inulinpropionate ester as a food ingredient may help prevent weight gain If we add this to foods it could reduce the urge to consume high calorie foods. She added that some peoples gut bacteria may naturally produce more propionate than others which may be why some people seem more naturally predisposed to gain weight. Dr Tony Goldstone cosenior author of the study from the Department of Medicine added This study adds to our previous brain imaging studies in people who have had gastric bypass surgery for obesity. These show that altering how the gut works can change not only appetite in general but also change how the brain responds when they see highcalorie foods and how appealing they find the foods to be. Dr Douglas Morrison author of the paper from the Scottish Universities Environmental Research Centre at the University of Glasgow commented We developed inulinpropionate ester to investigate the role of propionate produced by the gut microbiota in human health. This study illustrates very nicely that signals produced by the gut microbiota are important for appetite regulation and food choice. This study also sheds new light on how diet the gut microbiome and health are inextricably linked adding to our understanding of how feeding our gut microbes with dietary fibre is important for healthy living. The research was funded by the National Institute for Health Research Imperial Biomedical Research Centre and the Biotechnology and Biological Sciences Research Council"

"Psilocybin the psychedelic compound in magic mushrooms may one day be an effective treatment for patients with severe depression who fail to recover using other therapies scientists said on Tuesday. Mushrooms grow at the Highline Mushrooms farm Canadas largest mushroom grower in Leamington Ontario Canada April . REUTERSMark Blinch A smallscale pilot study of psilocybins use in cases of treatmentresistant depression showed it was safe and effective the British researchers said. Of patients given the drug all showed some decrease in symptoms of depression for at least three weeks. Seven continued to show a positive response at three months. Five remained in remission beyond the three months. Robin CarhartHarris who led the study at Imperial College Londons department of medicine said the results published in the Lancet Psychiatry journal were striking. Many patients described a profound experience he said and appeared to undergo a shift in the way they perceived the world. But we shouldnt get carried away with these results he told reporters at a briefing in London. This isnt a magic bullet. Were just learning how to do this treatment. Magic mushrooms grow worldwide and have been used since ancient times both for recreation and for religious rites. British researchers led by David Nutt a professor of neuropsychopharmacology at Imperial have been exploring the potential of psilocybin to ease severe forms of depression in people who dont respond to other treatments. The World Health Organization estimates that some million people worldwide are affected by depression a common mental disorder characterized by sadness loss of interest or pleasure tiredness feelings of guilt or low selfworth disturbed sleep and appetite and poor concentration. Many patients respond to treatment with anti depressants and cognitive behavioral therapy but around percent dont get better and are classed as having treatmentresistant depression. Psilocybin acts on the serotonin system suggesting it could be developed for treating depression. But hallucinogenic drugs can also cause unpleasant reactions including anxiety and paranoia so Nutts team wanted to find out if psilocybin can be given safely. The trial involved six men and six women aged between and all diagnosed with treatmentresistant depression. They all went through a full screening process before being allowed to participate and they were fully supported before during and after they received psilocybin. The patients were given psilocybin capsules during two dosing sessions seven days apart. Pappardelle Magic Mushroom Truffles prepared by chef Harlan Goldstein is shown at Gold restaurant in Hong Kong March . REUTERSAndy Ho Blood pressure heart rate and the selfreported intensity of the effects of psilocybin were monitored during each session and the patients were seen by a psychiatrist the next day and one two three and five weeks after the second dose. CarhartHarris said no serious side effects were reported during the study although all volunteers said they were slightly anxious before and during initial drug administration. Psychedelic drugs have potent psychological effects and are only given in our research when appropriate safeguards are in place he said. I wouldnt want members of the public thinking they can treat their own depressions by picking their own magic mushrooms. That kind of approach could be risky. Nutt said the results showed that psilocybin is safe and fast acting so may if administered carefully have value for these patients. Reporting by Kate Kelland editing by Larry King Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Two new drugs have been found to prolong the lives of people with advanced melanoma httphealth.nytimes.comhealthguidesdiseasemelanomaoverview.htmlinlinenytclassifier representing what researchers say is notable progress against the deadly skin cancer httphealth.nytimes.comhealthguidesdiseaseskincanceroverview.htmlinlinenytclassifier after decades of futility. The drugs represent success in two new approaches to combating cancer httphealth.nytimes.comhealthguidesdiseasecanceroverview.htmlinlinenytclassifier one by attacking a specific genetic mutation that accelerates tumor httphealth.nytimes.comhealthguidesdiseasetumoroverview.htmlinlinenytclassifier growth the other by unleashing the bodys immune system to fight the disease This is an unprecedented time of celebration for our patients Dr. Lynn M. Schuchter a melanoma specialist at the University of Pennsylvania told reporters Sunday in Chicago at the annual meeting of the American Society of Clinical Oncology where the results were presented. The drugs do not cure melanoma except perhaps in rare cases. But experts said they might add two to several months to the expected lifespans of people with advanced melanoma. Right now people with metastatic melanoma meaning it has spread to distant organs typically live to months. In one trial percent of patients taking the experimental drug vemurafenib pronounced vemyooRAFenib were still alive after six months compared with percent of those getting an older chemotherapy httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicschemotherapyindex.htmlinlinenytclassifier drug dacarbazine. Using another statistical measure the risk of dying was reduced percent. The effect was so marked that the trial was stopped early for ethical reasons so that patients in the control group could be offered the new drug. Because of that researchers do not yet know the median survival. You dont need to wait for percent of patients to die to conclude that one drug is much better than the other said Dr. Antoni Ribas of the University of California Los Angeles who was an investigator in the trial and has been a consultant to the developer of the drug. The other new drug ipilimumab pronounced ipeeLIMyoomab when combined with dacarbazine extended median survival to . months compared with . months for those who received dacarbazine alone. After three years . percent of those who got that new drug were alive compared with . percent of those in the control group. The results of both trials were published online by The New England Journal of Medicine http in addition to being presented here. To be sure more than half of patients with metastatic melanoma would not be helped all that much by either drug. Experts say more needs to be done especially since melanoma affects more young adults than many other types of cancer. Even if the new drugs allow patients with metastatic melanoma to live two years Two years is nothing when youre said Dr. Anna C. Pavlick head of the melanoma program at New York University. Still doctors and patient groups welcomed the progress because until now treatment of melanoma that had spread beyond the skin to distant organs was terrible even by routine cancer standards said Dr. Vernon K. Sondak chairman of cutaneous oncology at the Moffitt Cancer Center in Tampa Fla. Also the number of melanoma cases has been rising unlike for many other types of cancer. Doctors say that is because of unprotected sun exposure years ago the proliferation of tanning salons and perhaps more attention to detecting the disease. Photo There were about new cases of melanoma and about deaths last year in the United States up from cases and deaths in according to the American Cancer Society http Particularly fast increases have occurred among people older than and among women to years old. Vemurafenib is the latest socalled targeted therapy which inhibits the effects of genetic mutations that spur tumor growth and spread. In particular the drug counters the effect of a mutation in a gene called BRAF that was discovered in to be common in melanomas. The drugs name comes from VE mutation in RAF. The drug which is taken orally twice a day would be used only by the roughly half of melanoma patients whose tumors httphealth.nytimes.comhealthguidesdiseasetumoroverview.htmlinlinenytclassifier have this mutation. The drug significantly shrinks tumors in about half of these patients or about a quarter of all melanoma patients. Get the best of Well with the latest on health fitness and nutrition delivered to your inbox every week. Top of Form Bottom of Form Top of Form It was developed by Roche and Plexxikon a biotechnology company in Berkeley Calif. that was recently acquired by Daiichi Sankyo of Japan. The drug is expected to be approved by the Food and Drug Administration within a few months. Ipilimumab the other new drug releases a brake on the bodys immune system allowing it to more effectively attack the tumor. Developed by BristolMyers Squibb httptopics.nytimes.comtopnewsbusinesscompaniesbristol_myers_squibb_companyindex.htmlinlinenytorg it was approved in March and is sold under the name Yervoy. A series of articles in The New York Times last year httptopics.nytimes.comtopnewshealthseriestarget_cancerindex.html followed the development of vemurafenib then known as PLX and recounted how some patients close to death seemed to make miraculous recoveries. The effect however typically lasts only about seven months before the cancer starts to grow again though some patients benefit for more than two years. S. Taylor Chance a yearold real estate agent in Rancho Cucamonga Calif. has been taking vemurafenib in a clinical trial since March . If it werent for the trial I wouldnt be here she said. It has not been all good. Ms. Chance said the drug caused such extreme pain at one point that I called in the children and said Im done I cant do this any more. But she had her dose reduced and took other medications for the pain. In the trial sponsored by Roche and led by Dr. Paul B. Chapman of the Memorial SloanKettering Cancer Center in New York percent of participants had to stop taking the drug or lower the dose because of side effects including rash and joint pain httphealth.nytimes.comhealthguidessymptomsjointpainoverview.htmlinlinenytclassifier. Many patients get minor skin cancers that can be removed by dermatologists. The trial of ipilimumab paid for by BristolMyers involved patients with latestage melanoma. Last year at this conference researchers presented results of a trial showing a survival advantage for patients who had undergone a previous treatment. The new trial of this drug by contrast involved patients who were getting treated for the first time. While the extension of median survival of two months from about months to about months was less than some experts expected researchers said the real benefit was that a small number of patients perhaps to percent could live a long time. Because it unleashes the immune system ipilimumab can have serious side effects. In the latest trial a big one was liver damage. A course of treatment of ipilimumab costs . The price of vemurafenib has not been announced but is expected to be at least tens of thousands of dollars per year. Doctors are eager to try the two drugs together. Roche and BristolMyers said Thursday that they would conduct such tests."

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

"Even as treatment options for laryngeal cancer seemed to improve survival rates did not. For the most advanced patients percent survival was the norm whether patients had surgery to totally remove the voice box or alternative treatment with chemotherapy and radiation to try to avoid surgery. But the head and neck oncology team at the University of Michigan Comprehensive Cancer Center came up with a different approach Give patients a single dose of chemotherapy and see who responds to it. The responders can continue with combination chemotherapy and radiation. The nonresponders can be referred immediately for surgery. After a decade of using this approach researchers are reporting exceptional survival rates nearing percent even for the most advanced patients. The team published their outcomes in JAMA Otolaryngology Head and Neck Surgery. In trying to match the biology of the tumor to the treatment all of the patients get better outcomes says study author Gregory T. Wolf M.D. professor and chair emeritus of otolaryngology head and neck surgery at Michigan Medicine. This approach allows us to enhance quality of life for all of our patients. Many patients can spare their voice box by having chemotherapy and radiation. But thats only good if the treatment works. For patients who must go on to receive surgery by selecting them up front we can spare them the complications that may occur when the voice box is removed following multiple cycles of chemotherapy with radiation adds study author Francis Worden M.D. professor of hematologyoncology. The Michigan Medicine team first tested the idea in . They found that patients whose tumor shrunk by more than half after one round of chemotherapy were more likely to do well with chemotherapy and radiation and have an excellent chance of saving their voice box. If the tumor did not respond after that first dose patients would likely fail on the chemotherapy and would do better going straight to surgery. In a clinical trial they saw diseasespecific survival rates of percent in patients with advanced disease. This was unheard of. And it wasnt just those who responded to the chemotherapy. The nonresponders who were immediately referred for surgery had better outcomes too. We adopted the treatment approach and started offering it to all our laryngeal cancer patients Wolf says. As part of a Specialized Program of Research Excellence or SPORE grant the team was already maintaining longterm followup data on patients. Wolf suggested they look back and see if they were still maintaining such strong outcomes with this approach. The results surprised even him. Over years stage and laryngeal cancer patients were treated at Michigan Medicine with about half receiving the induction chemotherapy. The remainder elected to proceed straight to surgery or chemoradiation without the induction dose. Average disease specific survival at five years for the induction chemotherapy patients was percent equivalent to the results in patients with early stage disease and significantly better than the percent survival for patients who had chemoradiation without the induction strategy. This adds ammunition to the idea that we need to pick individual therapies more carefully. Both chemoradiation and surgery are difficult treatments with their share of challenging longterm effects. But if we tailor treatments to the individual biology of the tumor and characteristics of the patient well get the best results Wolf says. The study did find lower functional preservation of the larynx in the induction chemotherapy group compared to those who elected chemoradiation. Twothirds of the induction group achieved organ preservation while more than threequarters of the chemoradiation patients did. Wolf notes however that chemoradiation often severely damages the larynx which may cause problems with eating or swallowing years later. The induction approach can be done anywhere but requires intense collaboration among surgeons medical oncologists and radiation oncologists. All three must be involved to assess the patient and refer to the appropriate therapy. Even that single dose of chemotherapy can be debilitating and toxic for some patients. Wolf hopes future research will reveal a way to tailor treatment without the need for the induction chemotherapy. Additional authors Emily Bellile M.S. Avraham Eisbruch M.D. Susan Urba M.D. Carol R. Bradford M.D. Lisa Peterson M.S. Mark E. Prince M.D. Theodoros N. Teknos M.D. Douglas B. Chepeha M.D. Norman D. Hogikyan M.D. Scott A. McLean M.D. Jeffrey Moyer M.D. Jeremy M.G. Taylor Ph.D. Francis P. Worden M.D. Funding National Cancer Institute grants P CA and P CA and the Sinabaldo and Diane Tozzi Research Fund Disclosure None Reference JAMA Otolaryngology Head and Neck Surgery doi.jamaoto.. published online Feb. Resources University of Michigan Comprehensive Cancer Center http Michigan Medicine Cancer AnswerLine Michigan Health Lab http"

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

"Gastric bypass https weight loss surgery https often improves type diabetes httpsdiabetes.webmd.comguidediabetes_symptoms_types long before patients lose much weight https Now a new study from Duke University Medical Center and Columbia University may help explain why. When researchers compared patients who had gastric bypass surgery https to those who lost the same amount of weight by dieting https they found that the surgery patients had lower levels of amino acids that have been linked to insulin resistance https The study was small including just patients who had the surgery and patients who followed severely calorierestricted diets. And the patients in both groups had lost just a fraction of the weight they needed to lose at the time of the analysis. But researchers say the preliminary findings could one day lead to diabetes https treatments. Certainly weight loss https by any means improves type diabetes https but there is something else going on with gastric bypass surgery https study researcher Blandine Laferrere MD of Columbia Universitys St. Lukes and Roosevelt Hospital Center tells WebMD. Surgery puts the diabetes https into remission. Most of the research has focused on changes in gut hormones but we have shown that a decline in specific circulating amino acids also occurs. Surgery Improves Blood Sugar The study included obese https people with type diabetes https who had a BMI body mass index greater than . Patients who did not have gastric bypass surgery https were placed on strictly monitored calorie a day mealreplacement diets. All the participants had lost an average of about pounds at the time of the study. The surgery group did this in one month while the dieters took about two months to lose the weight. The analysis revealed that the surgery patients had much lower levels of several types of circulating branchedchain amino acids BCAA and the aromatic amino acids phenylalanine https Phe and tyrosine Tyr. They also had greater improvements in blood sugar https control. One month after surgery all of the gastric bypass patients were off all diabetes drugs. About half the dieters still needed treatment after losing the same amount of weight. In earlier research study coresearcher Christopher Newgard PhD and colleagues from the nutrition https and metabolism https center at Duke University showed that these amino acids were associated with insulin resistance and cardiovascular disease https In a news release Newgard noted that studies are needed to better understand how BCAA and the related metabolites influence diabetes risk. Laferrere says this understanding could lead to new diabetes treatments that are as effective as gastric bypass surgery. It would not be possible to offer this surgery to everyone with type diabetes she says. About million American adults have type diabetes and about of these surgeries are done each year. Gastric Bypass Surgery Risks vs. Benefits The American Diabetes Association ADA considers gastric bypass surgery an option for severely overweight https people with type diabetes who have BMIs of or more but less than half of patients with the disease are that heavy. Late last month the International Diabetes Federation which represents more than diabetes groups across the globe called for weight loss surgery https to be considered a treatment for type diabetes in certain patients with BMIs as low as . ADA Vice President for Clinical Affairs Sue Kirkman MD says while benefits of surgery appear to clearly outweigh the risks for patients who are morbidly obese and are not helped by other treatments this is not so clear for other patients. Like all surgeries there are risks she tells WebMD. The risks are the same no matter what the BMI but the benefits of surgery may not be as great for patients with lower BMIs. The study which appears in the journal Science Translational Medicine was funded by the ADA the National Institutes of Health and the drugmaker GlaxoSmithKline."

"I love my local YMCA for many reasons beyond my daily swim. Top of the list the friendships and conversations in the locker room that are frequent sources of valuable information connections and motivation. For example I recently overheard a discussion about Y members and friends of members who had experienced devastating attacks of shingles including one woman who nearly lost an eye and another who was left with unrelenting nerve pain. That was the push I needed to end my procrastination about getting the new shingles vaccine Shingrix which was approved by the Food and Drug Administration last October after studies involving people showed it to be far more effective at preventing this disease than the first shingles vaccine Zostavax which I had had a decade earlier. The Centers for Disease Control and Prevention recommends that people and older https including those previously immunized with Zostavax should now get the Shingrix vaccine. The process was surprisingly simple and less costly than I had anticipated https list price is for the twopart shot without insurance. All I needed was a prescription from my doctor. I took it to my local pharmacy where a staff pharmacist administered the vaccine. Ill get the second part the same way in May. My Medicare Part D insurance covered it with a copay for each part. The cost may be higher if the vaccine is administered in a doctors office so check first. Many millions of Americans especially those older than are susceptible to an eventual attack of shingles https caused by the very same virus that causes chickenpox. Once this virus varicella zoster infects a person it lies dormant for decades in nerve roots ready to pounce when the immune system is weakened say by stress medication trauma or disease. Onethird of Americans eventually get shingles but the risk rises with age and by age half of adults will have had at least one outbreak of shingles. Before the introduction of the chickenpox vaccine in in the United States some four million cases of chickenpox mostly in children occurred annually. While you may not remember whether you had chickenpox as a child chances are you did if you were never vaccinated against it. The chickenpox vaccine https is usually given in two doses with the first dose recommended at age to months and the second at age to . Those and older who were never vaccinated or had chickenpox should get two shots at least four weeks apart. Studies have indicated that more than percent of Americans aged and older have had chickenpox even if they dont remember it according to Dr. Rosanne M. Leipzig geriatrician at the Icahn School of Medicine at Mount Sinai in New York. The Centers for Disease Control and Prevention recommends that people and older get the new shingles vaccine whether or not they remember having had chickenpox as a child. Those who never had chickenpox but did get the vaccine for it may also be susceptible to shingles because the vaccine contains a weakened live virus. However the risk of shingles for those who had the chickenpox vaccine is much lower than for people who had the natural infection. If you are uncertain about your disease or vaccine history you can get a blood test to check for immunity to chickenpox though the result does not distinguish between protection via the disease or the vaccine. Thus if the result is positive Dr. Leipzig says youd be wise to get the shingles vaccine because you could be harboring the live virus. Lest you have doubts about the value of this vaccine consider the effects of shingles. It is a painful infection of a single sensory nerve on one side of the body that can occur almost anywhere but most commonly involves the torso or face. Initial symptoms of tingling or burning pain within days develop into a red bumpy rash and very painful blisters. The blisters heal in a week or two to form crusty scabs that eventually fall off. But for about percent of people shingles does not end there. Instead it leaves them with deep searing nerve pain a condition called postherpetic neuralgia or PHN that can last for months or years and has no treatment or cure. More than half the cases of PHN affect people over . Other possible complications of shingles include pneumonia hearing problems blindness and encephalitis. Thats not all. Although most people get shingles only once it can happen again especially if you have a weakened immune system which most everyone does with advancing age. If youre lucky you may detect the onset of shingles before the rash appears. Years ago when I went to bed with what had been a daylong gnawing irritation on one side of my back I awakened in the middle of the night with the thought I have shingles. First thing in the morning I got a prescription for the antiviral drug acyclovir which halted progress of the disease. Not willing to trust my luck a second time I got the new vaccine. Heres how it compares to its predecessor Zostavax which over all reduces the risk of shingles by percent and of PHN by percent. According to the C.D.C. Shingrix can protect percent of people in their s and s and percent of those in their s and s. It also reduces the risk of PHN by percent and it appears to be longer lasting than Zostavax which starts to lose its protection after three years. What makes Shingrix so much better is the inclusion of a substance called an adjuvant that boosts the bodys immune response to the vaccine. Another difference is that Zostavax contains a live weakened virus making it unsuitable for people with poor immunity whereas Shingrix contains a nonliving virus particle and may eventually be approved for those with compromised immunity who are especially susceptible to a severe case of shingles. I should tell you that the new vaccine is not exactly a walk in the park. The shot itself is painful and can cause a sore arm for a day or two. Some people develop immunerelated side effects like headache fever or an upset stomach that last less than three days according to the manufacturer GlaxoSmithKline. My only reaction beyond local soreness was an acid stomach for a day or two."

"New research provides evidence that an old drug may provide relief for people with advanced Parkinsons according to a study https today that will be presented at the American Academy of Neurologys th Annual Meeting https in Boston April to . When it comes to the treatment of Parkinsons disease the oral drug levodopa has long been considered the gold standard improving quality of life and longevity. But as the disease progresses the effects of the medication can partially wear off more quickly after each dose leaving people to experience off time which are periods of immobility related to temporary unresponsiveness to medication. Parkinsons symptoms such as slowness and muscle rigidity often make movement difficult. If a person with Parkinsons disease can reduce their off times that can have a great impact on their everyday life said study author Regina Katzenschlager MD of Danube Hospital affiliated with the Medical University of Vienna Austria. In some patients in the trial the insecurity of unpredictable periods of incapacity was completely alleviated. The drug apomorphine first produced in was first used to treat advanced Parkinsons disease in the United States in . Its use grew in the s when European doctors starting using subcutaneous infusions of the drug to treat fluctuations in mobility that could not be controlled by the pills. Despite its use in many countries of the world highlevel evidence from randomized blinded studies of its effectiveness and safety has up until now been lacking. In this phase III study researchers recruited people with advanced Parkinsons disease from centers in seven countries. Participants were randomly selected to receive either apomorphine subcutaneous infusion or a placebo saline infusion. The infusion was administered over a period of to hours each day via a small portable pump similar to the sort used in the treatment of type diabetes. The study found that those who were given apomorphine had a significantly greater reduction of off time than those who were given the placebo infusion with on average . hours less off time per day while those who received the placebo infusion had an average minutes per day reduction in off time. This improvement was apparent within the first week of treatment. At the same time for those who received apomorphine there was an increase of on time without the abnormal involuntary movements known as dyskinesias that are often observed with levodopa. Participants were also asked to evaluate how well they thought the treatment worked. Those who received apomorphine gave their treatment higher scores at week than those who received the placebo infusion. In the apomorphine group percent of patients felt improved compared to percent on placebo whereas percent worsened on apomorphine compared to percent on placebo. Apomorphine was generally well tolerated and there were no serious side effects. It is our hope that these findings confirming the efficacy of apomorphine infusion will encourage doctors in the United States to offer this treatment to their patients and assess its efficacy in their own clinical practice said Katzenschlager. The study was supported by Britannia Pharmaceuticals Ltd. the maker of apomorphine. Learn more about Parkinsons disease at httppatients.aan.com. The American Academy of Neurology is the worlds largest association of neurologists and neuroscience professionals with members. The AAN is dedicated to promoting the highest quality patientcentered neurologic care. A neurologist is a doctor with specialized training in diagnosing treating and managing disorders of the brain and nervous system such as Alzheimers disease stroke migraine multiple sclerosis concussion Parkinsons disease and epilepsy."

"One of the great publichealth success stories of the past couple of decades can be found in your cereal bowl. Since the Food and Drug Administration has required that breakfast cereals breads rice pasta and other grain products made with enriched flour come fortified with folic acid. When consumed by women before and during early pregnancy this B vitamin plays a critical role in preventing severe brain and spinal cord defects. Thanks to mandatory fortification the number of babies born in the U.S. with neural tube defects has dropped by roughly percent http or about babies a year since the s. The story of folic acid is one of the great public health stories of ever says Dr. R.J. Berry who works with the Division of Birth Defects and Developmental Disabilities of the Centers for Disease Control and Prevention in Atlanta. But theres one notable exception to this success story Hispanic women and researchers think the reason may lie in a staple of their diet tortillas. Under current FDA rules tortillas corn chips and other foods made with corn masa flour cant be fortified with folic acid. So a coalition of groups including the March of Dimes Foundation and the National Council of La Raza has petitioned the FDA to change its stance and allow corn masa flour to be fortified with folic acid. According to the March of Dimes about pregnancies in the U.S. are affected by neural tube defects each year. The rates are highest among Hispanics Latina women are roughly percent more likely to have a baby with a neural tube defect compared to nonLatina white women. The exact cause of this discrepancy isnt known. Researchers say http there may be genetic factors that predispose the children of some Hispanic women to neural tube defects. But they suspect diet is also a factor Part of the reason was that these groups just werent consuming the same level of wheat flour products. Instead they were consuming corn masa flour products because that was the staple grain in that diet says Cynthia Pellegrini senior vice president of public policy and government affairs at the March of Dimes. Vernica Zaragovia for NPR Research has shown that women who consume at least micrograms of folic acid daily have a significantly reduced risk of having a pregnancy affected by neural tube defects including spina bifida which can involve paralysis and anencephaly in which large parts of the brain are missing. The catch Folic acid is only protective if consumed in the earliest weeks of pregnancy. Most women by the time they know theyre pregnant theyve already passed that critical window says Dean Appling a biochemistry professor at the University of Texas at Austin. If they had a problem with folic acid it would be too late at that point to prevent the birth defect. Mandating fortification helps ensure that women are getting enough folic acid even before they know they need it. And studies http suggest that fortifying corn masa with folic acid could prevent an additional to cases of neural tube defects among babies born to Hispanic mothers each year. So why does the FDA currently ban dosing corn masa flour with folic acid It all has to do with nixtamalization http the process by which tough corn kernels are softened by soaking in an alkaline solution usually of slaked lime. The process which hails from ancient Mesoamerica whats now Mexico and Central America dates back thousands of years. It renders the corn more pliable for grinding into masa flour and gives the masa its distinctive aroma and flavor. But the FDA worries that this alkaline treatment could also affect the stability of added folic acid the agency told The Salt in a statement. The FDA is concerned that the breakdown of folic acid in corn masa flour could yield a substance that raises concerns about safety. The March of Dimes and others first petitioned the FDA to allow added folic acid in corn flour masa in . As part of its review the FDA asked the petitioning groups to study whether folic acid would stay stable in corn masa flour. The petitioners filed the results of that study in October. Michael Dunn the Brigham Young University food scientist who led the study cannot comment on the test results while theyre under FDA review but he has previously called them encouraging. As The Seattle Times has reported http Dunns early results suggested no loss of folic acid in fortified masa after three months of storage. The March of Dimes Pellegrini says she believes the FDA will respond to the results of Dunns study later this month. But the FDA might have more questions related to the study before making a final ruling."

"The Food and Drug Administration on Monday approved the first drug derived from marijuana which will be used to treat two rare and severe forms of childhood epilepsy. The drug called Epidiolex https_term.dafefa is an oral solution containing highly purified cannabidiol CBD which is one of scores of chemicals in the cannabis sativa plant commonly known as marijuana. The drug contains only trace amounts of the psychoactive element THC and does not induce euphoria. Epidiolex was approved for patients age and older who suffer from LennoxGastaut and Dravet syndromes. Both cause uncontrolled daily seizures and put patients at high risk for other physical and intellectual disabilities injury and early death. The disorders afflict fewer than people in the United States but experts expect Epidiolex to be prescribed for other types of epilepsy as well. The drug is the first treatment approved for Dravet syndrome. FDA Commissioner Scott Gottlieb said the approval was a reminder that advancing sound development programs that properly evaluate active ingredients contained in marijuana can lead to important medical therapies. The medication tested in three randomized placebocontrolled trials with more than patients was effective in reducing seizures the FDA said. Gottlieb noted that the action was not an approval of marijuana or all of its components but rather of one specific CBD medication for a particular use. The agency he added remains concerned about the proliferation and illegal marketing of unapproved CBDcontaining products with unproven medical claims. In April an advisory committee unanimously recommended https_term.eadb approval of the drug for the two types of epilepsy. The FDA previously cleared medications containing synthetic versions of THC for nausea for patients getting chemotherapy and for other uses but it had not approved any drug derived from the plant itself. Marijuana and its components including CBD are Schedule controlled substances meaning they are banned because they are thought to have a high abuse potential no medical value and serious safety implications. Now that Epidiolex is approved by the FDA cannabidiol is expected to be reclassified by the Drug Enforcement Administration within days. However it isnt clear whether such a reclassification would involve CBD products in general the CBD formulation used specifically in Epidiolex or something else. For those who have long argued that cannabis offers medical benefits the FDA approval represents a milestone a recognition that the plant is a rich source of compounds which have potential therapeutic activity Justin Gover chief executive of GW Pharmaceuticals the Londonbased company that developed the drug said in an interview last week. We are just scratching the surface of what could be a range of cannabisbased medications. The medication which will continue to be manufactured in Britain will be marketed by Greenwich Biosciences the U.S. subsidiary of GW Pharmaceuticals. The drugmaker is testing other CBD treatments for glioblastoma and schizophrenia. Shlomo Shinnar president of the American Epilepsy Society and a neurologist at Montefiore Medical Center in New York has said the drug will be a very valuable addition to the limited options for treating severe childhoodonset epilepsy. Shinnar said he will welcome approval of a medicine that had undergone stringent FDA review for safety and effectiveness. Many parents already are giving children unregulated CBD formulations that are available in medical marijuana dispensaries in the many states where such operations are legal. Some have said that they have no intention of switching to the new prescription CBD drug because the products theyre using are helping their children. Others said they are anxious to try an FDAapproved product."

"The most common treatment for urinary incontinence httpshealth.nytimes.comhealthguidessymptomsurinaryincontinenceoverview.htmlinlinenytclassifier is a daily dose of an anticholinergic medicine that alters the action of certain nerves. Botox httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsbotox_drugindex.htmlinlinenytclassifier injections are also used often in cases where the medicine does not work. Now a placebocontrolled study has found that the treatments are equally useful in reducing the frequency of episodes of incontinence but vary in side effects and longterm effectiveness https Researchers randomly assigned women with urinary incontinence to daily medicine and a placebo injection or a Botox injection and a daily placebo pill. The scientists writing online on Oct. in The New England Journal of Medicine found that both treatments significantly reduced incontinence episodes. Dry mouth was much more common in those who took the medicine urinary infections and incomplete emptying of the bladder were more common in those given Botox. Significantly those who took Botox were more likely to have their symptoms completely disappear. The medicine has to be taken daily while Botox is given in a single injection that is effective for about to months. These are both effective treatments said the lead author Dr. Anthony G. Visco an associate professor of obstetrics and gynecology at Duke. This gives patients the information to make an informed decision. Both are reasonable options."

"Singing in a choir for just one hour boosts levels of immune proteins in people affected by cancer reduces stress and improves mood which in turn could have a positive impact on overall health a new study by Tenovus Cancer Care and the Royal College of Music published today in ecancermedicalscience has found. The research raises the possibility that singing in choir rehearsals could help to put people in the best possible position to receive treatment maintain remission and support cancer patients. The study tested members of five different choirs. Results showed that singing for an hour was associated with significant reductions in stress hormones such as cortisol and increases in quantities of cytokines proteins of the immune system which can boost the bodys ability to fight serious illness. Dr Ian Lewis Director of Research and Policy at Tenovus Cancer Care and coauthor of the research said These are really exciting findings. We have been building a body of evidence over the past six years to show that singing in a choir can have a range of social emotional and psychological benefits and now we can see it has biological effects too. Weve long heard anecdotal evidence that singing in a choir makes people feel good but this is the first time its been demonstrated that the immune system can be affected by singing. Its really exciting and could enhance the way we support people with cancer in the future. The study also found that those with the lowest levels of mental wellbeing and highest levels of depression experienced greatest mood improvement associated with lower levels of inflammation in the body. There is a link between high levels of inflammation and serious illness. Choir members gave samples of their saliva before an hour of singing and then again just after. The samples were analysed to see what changes occurred in a number of hormones immune proteins neuropeptides and receptors. Dr Daisy Fancourt Research Associate at the Centre for Performance Science a partnership between the Royal College of Music and Imperial College London and coauthor of the research said Many people affected by cancer can experience psychological difficulties such as stress anxiety and depression. Research has demonstrated that these can suppress immune activity at a time when patients need as much support as they can get from their immune system. This research is exciting as it suggests that an activity as simple as singing could reduce some of this stressinduced suppression helping to improve wellbeing and quality of life amongst patients and put them in the best position to receive treatment. Diane Raybould took part in the study and has been singing with the Bridgend Sing with Us choir since . Diane was diagnosed with breast cancer when she was aged . Her daughter was diagnosed with breast cancer at the same time and sadly passed away from the disease at just . Diane said Singing in the choir is about more than just enjoyment it genuinely makes you feel better. The choir leaders play a huge part of course but so does the support of the other choir members the inspirational programme and uplifting songs. The choir is a family simple as that. Having cancer and losing someone to cancer can be very isolating. With the choir you can share experiences openly and that is hugely important. Rosie Dow Head of Sing with Us at Tenovus Cancer Care and coauthor of the research added This research is so exciting as it echoes everything all our choir members tell us about how singing has helped them. Ive seen peoples lives transformed through singing in our choirs so knowing that singing also makes a biological difference will hopefully help us to reach more people with the message that singing is great for you mind body and soul. Following on from this research Tenovus Cancer Care is launching a two year study looking in more depth at the longitudinal effect of choir singing over several months. It will look at mental health wellbeing social support and ability to cope with cancer alongside measuring stress hormones and immune function amongst patients carers staff and people who have lost somebody to cancer. The full research paper can be found at httpecancer.orgjournal.php If you or someone you love has been affected by cancer Tenovus Cancer Care can offer help and support. To find out more call the Tenovus Cancer Care free Support Line on or visit tenovuscancercare.org.uk http For more information contact Ruth Taylor PR and Communications Manager on ruth.taylortenovuscancercare.org.uk mailtoruth.taylortenovuscancercare.org.uk. Research paper available on request About the research members of five choirs in Cardiff Bridgend Pontypridd Cwmbran and Swansea took part in the study across between June and July . The Centre for Performance Sciences is a partnership between the Royal College of Music London and Imperial College London. Tenovus Cancer Care runs Sing with Us choirs across England and Wales. For more information please visit http Notes to editor At Tenovus Cancer Care our aims are simple to help prevent treat and find a cure for cancer. In doing that we offer support advice and treatment information on prevention and funding for research to improve outcomes for people living with cancer. We do this where it is needed most right at the heart of the community. Tenovus Cancer Care free Support Line is open am pm days a year on . Keep up to date with Tenovus Cancer Care by following them on Twitter tenovuscancer http or Liking their page on Facebook http The Royal College of Music is currently home to undergraduate and postgraduate students from nations. International students constitute approximately of our student body. In the RCM was ranked by The Guardian as the leading Higher Education Institution in the UK for studying music. The Higher Education Statistics Agency HESA survey found that proportionally more RCM alumni who responded to the survey had moved to employment or further study within six months of graduation than graduates from any other UK conservatoire or UK university. Among RCM alumni are composers and performers such as Sir Hubert Parry Benjamin Britten Gustav Holst Sir Colin Davis David Helfgott Samuel ColeridgeTaylor Lord Lloyd Webber Dame Joan Sutherland Sir James Galway Ralph Vaughan Williams and Alfie Boe. Regular visitors to the RCM to teach and demonstrate are Bernard Haitink Vladimir Ashkenazy and Lang Lang. Our most recent honorary doctorates include Vladimir Jurwoski Dame Kiri Te Kanawa Sir Roger Norrington Bryn Terfel and Steve Reich. The Centre for Performance Science is a distinctive new partnership of the Royal College of Music and Imperial College London. The Centre takes a strongly interdisciplinary approach to investigating human performance in the arts business education medicine science and sport and draws upon worldleading expertise and stateoftheart facilities across the RCM and Imperial College. ecancermedicalscience is an openaccess journal that is free to read."

"A study published Monday is pushing back against the notion that up to percent of Americans should be taking statin drugs to reduce the risk of heart disease. The study httpannals.orgaimarticledoi.M in the Annals of Internal Medicine argues that current medical guidelines havent adequately considered the risks from these widely used drugs. Some harms are mentioned but its entirely unclear how they were considered when coming up with the recommendations says Milo Puhan https a physician and epidemiologist at the University of Zurich and senior author of the new study. In our approach we very explicitly considered the harms. Its important to note that statin drugs httpsmedlineplus.govstatins.html are generally safe and harms are uncommon. On the other hand the benefits arent that great either. Anywhere from to healthy httpsascpt.onlinelibrary.wiley.comdoifull.cpt. people need to take a statin daily to prevent a single heart attack for five years so even small harms may outweigh the potential benefits the Swiss scientists say. The most common side effect of these drugs is muscle pain which usually goes away if patients stop taking the medicines. People taking statins are also at a higher risk of developing diabetes which is harder to reverse. Puhan also found that some statins were more effective than others with atorvastatin the generic name for Lipitor being the best of the bunch. He notes that physician guidelines dont generally compare the relative value of these drugs which are all available as inexpensive generics. He also finds that benefits fade compared with harms as people get older. The elderly do not benefit as much as previous studies might have thought he says. One size doesnt fit it all he concludes. Thats a very important message. Puhan says based on his assessment perhaps to percent of older adults should be taking statins far less than the or percent suggested by current medical guidelines. I think for me as a physician says Ilana Richman httpsmedicine.yale.educorepeopleilana_richman.profile an internist at the Yale School of Medicine this kind of data suggests that if we give more weight to the potential for adverse events then maybe its reasonable to hold off for lowerrisk patients. She cowrote an editorial httpannals.orgaimarticledoi.M about the paper and came away from it thinking that doctors need to spend more time talking about the plusses and minuses of statin treatment personalizing their recommendations more than they do now. She says its a challenge to convey these sophisticated concepts in the short amount of time doctors have to spend with their patients. Yet that kind of dialog is increasingly the expectation. In midNovember the American Heart Association and American College of Cardiology published new guidelines https calling for more nuanced conversations around who would most benefit from statins. Scott Grundy https a physician at the University of Texas Southwestern Medical Center who chaired the guidelines committee says the new recommendations urge people in this gray area to get a special kind of CT scan that looks for calcium deposits in heart arteries a signal for clogs that could cause trouble. If you have no coronary calcium then your chances of having a heart attack over the next years are very low he says. And it turns out that perhaps percent of people who are identified as candidates based on their risk factors such as cholesterol levels and age actually have clear heart arteries Grundy says. That means a lot of people are going to be treated unnecessarily if they dont have the calcium scan. But that test which Grundy says is available for about is controversial among some physicians. They worry that it will trigger overtreatment of conditions that the scan will pick up but which dont require urgent attention. And it is only useful as a screening test for people who havent had heart disease. Statins are routinely prescribed for people who have already had a heart attack or stroke. For those patients who werent included in the Swiss analysis the benefits are so clear its almost mandatory to be on a statin drug Grundy says. He disagrees with a lot of the particulars in the Swiss study. So does cardiologist Roger Blumenthal https who heads the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins. The harms analyzed in the paper can be dealt with by a smart clinician he says. Yet both the new guidelines and the latest study agree on an important point Doctors and patients should spend more time reviewing the benefits and risks of statins with attention paid to each persons particular circumstances."

"Children who eat fish at least once a week sleep better and have IQ scores that are points higher on average than those who consume fish less frequently or not at all according to new findings from the University of Pennsylvania published this week in Scientific Reports a Nature journal. Previous studies showed a relationship between omegas the fatty acids in many types of fish and improved intelligence as well as omegas and better sleep. But theyve never all been connected before. This work conducted by Jianghong Liu Jennifer PintoMartin and Alexandra Hanlon of the School of Nursing and Penn Integrates Knowledge Professor Adrian Raine reveals sleep as a possible mediating pathway the potential missing link between fish and intelligence. This area of research is not welldeveloped. Its emerging said Liu lead author on the paper and an associate professor of nursing and public health. Here we look at omegas coming from our food instead of from supplements. For the work a cohort of to yearolds in China percent boys and percent girls completed a questionnaire about how often they consumed fish in the past month with options ranging from never to at least once per week. They also took the Chinese version of an IQ test called the Wechsler Intelligence Scale for ChildrenRevised which examines verbal and nonverbal skills such as vocabulary and coding. Their parents then answered questions about sleep quality using the standardized Children Sleep Habits Questionnaire which included topics such as sleep duration and frequency of night waking or daytime sleepiness. Finally the researchers controlled for demographic information including parental education occupation and marital status and number of children in the home. Analyzing these data points the Penn team found that children who reported eating fish weekly scored . points higher on the IQ exams than those who said they seldom or never consumed fish. Those whose meals sometimes included fish scored . points higher. In addition increased fish consumption was associated with fewer disturbances of sleep which the researchers say indicates better overall sleep quality. Lack of sleep is associated with antisocial behavior poor cognition is associated with antisocial behavior said Raine who has appointments in the School of Arts and Sciences and Penns Perelman School of Medicine. We have found that omega supplements reduce antisocial behavior so its not too surprising that fish is behind this. PintoMartin who is executive director of Penns Center for Public Health Initiatives as well as the Viola MacInnesIndependence Professor of Nursing and a professor of epidemiology in Penn Medicine sees strong potential for the implications of this research. It adds to the growing body of evidence showing that fish consumption has really positive health benefits and should be something more heavily advertised and promoted she said. Children should be introduced to it early on. That could be as young as months as long as the fish has no bones and has been finely chopped but should start by around age . Introducing the taste early makes it more palatable PintoMartin said. It really has to be a concerted effort especially in a culture where fish is not as commonly served or smelled. Children are sensitive to smell. If theyre not used to it they may shy away from it. Given the young age of this study group Liu and colleagues chose not to analyze the details participants reported about the types of fish consumed though they plan to do so for work on an older cohort in the future. The researchers also want to add to this current observational study to establish through randomized controlled trials that eating fish can lead to better sleep better school performance and other reallife practical outcomes. For the moment the researchers recommend incrementally incorporating additional fish into a diet consumption even once a week moves a family into the high fisheating group as defined in the study. Doing that could be a lot easier than nudging children about going to bed Raine said. If the fish improves sleep great. If it also improves cognitive performance like weve seen here even better. Its a double hit. Funding for this research came from the National Institutes of HealthNational Institute of Environmental Health Sciences grants RES KES KES and P ES with additional support from the Intramural program of the National Institute on Alcohol Abuse and Alcoholism."

"MDxHealth SA OTC MDXHF.BR httpstudio.financialcontent.comprnewsPageQuoteTickerMDXHF.BR today announces that a new study validates the costeffectiveness of the SelectMDx for Prostate Cancer test a noninvasive urinebased liquid biopsy test that helps identify patients at increased risk of aggressive prostate cancer. The SelectMDx test can help predict the likelihood that clinically significant prostate cancer will be found by a biopsy. The study published in The Journal of Urology https led by researchers at the Vanderbilt University Medical Center was designed to elucidate the costeffectiveness of SelectMDx in a population of U.S. men with elevated PSA a marker of prostate cancer risk. Researchers analyzed the impact of utilizing the noninvasive diagnostic test prior to prostate biopsy. The primary objective was to characterize changes in health outcomes measured in qualityadjusted life years and a secondary objective was evaluating healthcare costs. The researchers found that incorporating SelectMDx resulted in an average gain of . life years or approximately days in full health gained at a costsavings of for each patient undergoing biopsy. Extrapolating these data to a conservative estimate of patients per year undergoing biopsy resulted in life years in full health gained with an annual cost saving of more than million for each cohort. This study demonstrated that routine use of SelectMDx to guide biopsy decisionmaking improves health outcomes and lowers healthcare costs associated with prostate cancer risk assessment in a population of U.S. men said Dr. Matthew Resnick from the departments of Urologic Surgery and Health Policy at Vanderbilt University Medical Center Nashville TN. We believe that this strategy improves the value of conventional risk assessment strategies through improvements in both quality and cost the numerator and denominator of the health care value equation. Every year . million men in the U.S. undergo a prostate biopsy.i Although a biopsy is the only way to diagnose prostate cancer the procedure is invasive and results in complications in percent of patients with percent hospitalized for infection within days.iiiiiiv Common complications from a prostate biopsy may include bleeding infection sepsisbacteremia urinary symptomsretention and sexual dysfunction. While biopsy is the only path to prostate cancer diagnosis no man wants to nor should have to go through the uncomfortable costly procedure if it can be avoided said Dr. Jan Groen Chief Executive Officer of MDxHealth. We developed SelectMDx to help reduce unnecessary biopsies and now we have the data to show how we can both improve outcomes and save the system money. The full paper is accessible via the online edition of The Journal of Urology. About SelectMDx for Prostate Cancer SelectMDx for Prostate Cancer is a proprietary urinebased molecular diagnostic test that offers a noninvasive liquid biopsy method to assess a mans risk for prostate cancer. SelectMDx helps identify men at increased risk of harboring aggressive potentially lethal prostate cancer who may benefit most from a prostate biopsy and earlier detection. The test helps to reduce the need for MRI procedures and invasive prostate biopsies by up to thereby improving quality of life and lowering healthcare costs per patient. SelectMDx is available in the US and all EU member states. Since the introduction of the SelectMDx test in mid over patients have been tested and commercial contracts have been signed with US based insurance companies. The test has been included in the European Association of Urology EAU clinical guidelines. About MDxHealth MDxHealth is a multinational healthcare company that provides actionable molecular diagnostic information to personalize the diagnosis and treatment of cancer. The companys tests are based on proprietary genetic epigenetic methylation and other molecular technologies and assist physicians with the diagnosis of urologic cancers prognosis of recurrence risk and prediction of response to a specific therapy. The Companys European headquarters are in Herstal Belgium with laboratory operations in Nijmegen The Netherlands and US headquarters and laboratory operations based in Irvine California. For more information visit mdxhealth.com http and follow us on social media at twitter.commdxhealth httpstwitter.commdxhealth facebook.commdxhealth httpstwitter.commdxhealth and linkedin.comcompanymdxhealth httpslinkedin.comcompanymdxhealth. For more information MDxHealth Kenneth Kami kenneth.kamimdxhealth.com mailtokenneth.kamimdxhealth.com CURA Strategies ThyAnn Nguyen thyann.nguyencurastrategies.com mailtothyann.nguyencurastrategies.com This press release contains forwardlooking statements and estimates with respect to the anticipated future performance of MDxHealth and the market in which it operates. Such statements and estimates are based on assumptions and assessments of known and unknown risks uncertainties and other factors which were deemed reasonable but may not prove to be correct. Actual events are difficult to predict may depend upon factors that are beyond the companys control and may turn out to be materially different. MDxHealth expressly disclaims any obligation to update any such forwardlooking statements in this release to reflect any change in its expectations with regard thereto or any change in events conditions or circumstances on which any such statement is based unless required by law or regulation. This press release does not constitute an offer or invitation for the sale or purchase of securities or assets of MDxHealth in any jurisdiction. No securities of MDxHealth may be offered or sold within the United States without registration under the U.S. Securities Act of as amended or in compliance with an exemption therefrom and in accordance with any applicable U.S. securities laws. NOTE The MDxHealth logo MDxHealth ConfirmMDx SelectMDx AssureMDx PredictMDx and UrNCollect are trademarks or registered trademarks of MDxHealth SA. All other trademarks and service marks are the property of their respective owners. i NCI Seer Data . http ii Gershman et al. Eur Uro iii Loeb et al. Eur Uro . iv Loeb et al. J Urol. . SOURCE MDxHealth Related Links http"

"Sylentis Pharmaceutical Company belonging to the PharmaMar Group has presented results from the clinical studies carried out with tivanisiran for the treatment of dry eye syndrome and that has enabled the startup of the Phase III Helix clinical trial. The presentation has taken place within the framework of the annual meeting of the Association for Research in Vision and Ophthalmology ARVO that has been held from the th of April to the rd of May in Honolulu Hawaii. The purpose if this meeting is to share the latest breakthroughs in research in the area of ophthalmology to contribute to the progress in basic science and also in cuttingedge clinical research. In this context Sylentis has participated at this event presenting the preclinical and clinical results of various compounds that are being developed for the treatment of ocular disorders. Among these the abstract Tivanisiran a new treatment for Dry Eye Disease that improved signs and symptoms in clinical trials Posterboard number B is highlighted the compound improving the ocular inflammatory parameters tear quality and a reduction in ocular pain associated with dry eye disease is also underlined. The novel mechanism of action of tivanisiran based on genetic silencing through RNA interference RNAi is targeted at the treatment of the signs and symptoms of this pathology making it a firm candidate for the treatment of dry eye disease. According to Ana Isabel Jimnez Director of RD at Sylentis we trust in our technology innovative in this field and we hope that tivanisiran will soon become a real alternative for the treatment of millions of people that suffer dry eye disease around the world. In this respect Jimnez points out that this is a significant step forward in the development of innovative drugs in different therapeutic areas through a novel technology of genetic silencing based on the RNA. Sylentis is a pioneer in RNAi research and is one of the few in Europe that applies this technology to the field of ophthalmology. It also continues with its research on new therapies for ophthalmological and inflammatory illnesses. It must be empathized that this pathology affects more than million in Spain between and of the population mostly women and almost of these being elderly . In this context the phase III Helix study is being carried out in more than hospitals in Spain Germany Estonia Portugal Slovakia and Italy in patients to evaluate the efficacy of this compound in the treatment of the sign and symptoms of dry eye syndrome. About RNA interference https About tivanisiran SYL Tivanisiran is a drug based on RNAi that is administered as preservativefree eye drops it selectively inhibits production of the transient receptor potential cation channel TRPV. These receptors are ion channels that mediate the transmission of ocular pain. Tivanisiran is a small synthetic doublestranded RNA oligonucleotide siRNA with a novel and highly selective mechanism of action. Nonclinical studies conducted by Sylentis with SYL have demonstrated it has high ability to inhibit this specific target and block the perception of ocular pain in animals. Tivanisiran is a product under development for the treatment of signs and symptoms related to dry eye syndrome and has the potential to be developed for other pathologies that cause ocular pain corneal lesions refractive surgery etc. . About RNA interference RNAi RNA interference RNAi is a natural cellular process that regulates the expression of certain genes providing a role in innate defense and development in animals and plants. This process is used to specifically silence genetic transcripts that encode proteincausing diseases. The therapeutic application of targeted siRNAs is booming given the specificity of gene silencing for a particular protein in a given tissue and the lack of side effects. This new approach to drug discovery is a promising technology that is rapidly moving in the translational research space . About dry eye syndrome Dry eye syndrome is a multifactorial disease of the tear film and ocular surface that produces symptoms of ocular discomfort eyesight disorders and tear film instability with potential damage to the ocular surface. Dry eye syndrome is accompanied by such symptoms as ocular pain itching stinging and irritation of the eye tissues. It is a characteristic disease of developed countries associated with pollution air conditioning the use of contact lenses refractive surgery and continued use of computers. Moreover the amount and quality of tears decrease with age. Prevalence is between and among people aged or over and it is more frequent in womeniii. Dry eye can be treated with cyclosporin drops or autologous serum but there is as yet no specific product for chronic treatment of the ocular pain related to dry eye syndrome oral analgesics or anaesthetics are used in general. However the main treatment consists of artificial tears in the form of drops gel or creams. Preservativefree eye drops have generally been found to offer the best longterm response. About Sylentis Sylentis a company of PharmaMar MSEPHM is a biotechnology company fully owned that develops innovative therapies harnessing the technology of posttranscriptional gene silencing or RNA interference RNAi. Sylentis has developed an approach to efficiently design RNAibased therapeutics that can be used to silence numerous diseasecausing genes. We currently have a robust therapeutic program in ophthalmology with two candidates under development in Phase II and III studies for glaucoma bamosiran and ocular pain SYL respectively. Sylentis is also developing new products for the treatment of several eye diseases such as ocular allergies and retina diseases. To know more about us please visit us at http"

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

"Study addresses key U.S. Food and Drug Administration FDA requirement keeping SHP on track for potential U.S. launch Topline data revealed SHP met primary endpoint showing ADHD symptom improvement in children and adolescents p. Key secondary endpoint also met showing higher proportion of patients were rated improved p. Data add to overall robust clinical development program for SHP Shire plc LSE SHP httpstudio.financialcontent.comprnewsPageQuoteTickerSHPNASDAQ SHPG httpstudio.financialcontent.comprnewsPageQuoteTickerSHPG today announces positive topline results from a fourweek Phase randomized doubleblind multicenter placebocontrolled doseoptimization safety and efficacy study SHP in children and adolescents aged years with AttentionDeficitHyperactivity Disorder ADHD. SHP triplebead mixed amphetamine salts MAS is an investigational oral stimulant medication being evaluated in the U.S. as a potential treatment for ADHD a therapeutic area with significant need for additional treatment options. The primary efficacy analysis of study demonstrated that SHP administered as a daily morning dose was superior to placebo on the change from baseline in ADHDRSIV ADHD rating scale total score with a Least Squares LS mean difference from placebo at Week of . CI . to . p. suggesting a significant improvement in ADHD symptoms. SHP was also superior to placebo in the key secondary efficacy analysis on the clinical global impression improvement scale CGII with an LS mean difference from placebo at Week of . CI . to . p. indicating a significantly higher proportion of patients were rated improved on the CGII rating scale. The CGII is a standardized assessment tool that allows clinicians to rate the severity of ADHD illness change over time and efficacy of medication. Treatmentemergent adverse events for SHP were decreased appetite headache insomnia irritability nausea weight decrease and dizziness. Adverse events were generally mild to moderate in severity and similar to those observed in previous SHP studies and with other amphetamine compounds. The completion of SHP addresses an FDA requirement to evaluate the safety and efficacy of SHP in children and adolescents prior to filing a Class resubmission of the medicine for FDA approval. We are pleased with the positive results of the SHP study said Philip J. Vickers Ph.D. Head of Research Development Shire. These results represent an important step toward a new treatment option for patients with ADHD. Shire looks forward to including these data as part of the FDA resubmission and is eager to continue advancing this clinical program. Dr. Matthew Brams M.D. Clinical Assistant Professor at Baylor College of Medicine and principal investigator for study added The study of SHP in children and adolescents is an essential next step to progressing the clinical program. Im excited about these positive data from SHP because of the benefit that this potential new treatment option may provide for patients with ADHD. Overall Robust SHP Clinical Development Program to Support Class Resubmission Including study and previous studies Shire now has a robust database of clinical studies evaluating SHP in more than subjects. Once the pharmacokinetic study and an additional safety and efficacy Phase trial in adults currently under way are complete later this year Shire plans to add these study results to its existing SHP data set to submit a Class resubmission for FDA approval of the medicine for treatment of ADHD. SHP remains on track for potential U.S. launch in the second half of . In previous adolescent and adult clinical studies SHP demonstrated a statistically significant difference versus placebo at hours post dosing with onset of action starting hours post dosing as measured by the Permanent Product Measure of Performance PERMP. PERMP was not measured in the SHP study. Protection for Shires ADHD Franchise Extends to There are patents supporting Shires overall ADHD franchise in the U.S. that extend to . With a launch planned for the second half of Shire expects that SHP following potential FDA approval will have three years of HatchWaxman exclusivity and at least three patents listed in the FDA Orange Book expiring as late as May . NOTES TO EDITORS Shire enables people with lifealtering conditions to lead better lives. Our strategy is to focus on developing and marketing innovative specialty medicines to meet significant unmet patient needs. We focus on providing treatments in Rare Diseases Neuroscience Gastrointestinal and Internal Medicine and we are developing treatments for symptomatic conditions treated by specialist physicians in other targeted therapeutic areas such as Ophthalmics. http ForwardLooking Statements Statements included herein that are not historical facts including without limitation statements concerning our announced business combination with Baxalta and the timing and financial and strategic benefits thereof our x ambition that targets billion in combined product sales by as well as other targets for future financial results capital structure performance and sustainability of the combined company the combined companys future strategy plans objectives expectations and intentions the anticipated timing of clinical trials and approvals for and the commercial potential of inline or pipeline products are forwardlooking statements. Such forwardlooking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize Shires results could be materially adversely affected. The risks and uncertainties include but are not limited to the following the proposed combination with Baxalta may not be completed due to a failure to satisfy certain closing conditions including any shareholder or regulatory approvals or the receipt of applicable tax opinions disruption from the proposed transaction with Baxalta may make it more difficult to conduct business as usual or maintain relationships with patients physicians employees or suppliers the combined company may not achieve some or all of the anticipated benefits of Baxaltas spinoff from Baxter International Inc. Baxter and the proposed transaction may have an adverse impact on Baxaltas existing arrangements with Baxter including those related to transition manufacturing and supply services and tax matters the failure to achieve the strategic objectives with respect to the proposed combination with Baxalta may adversely affect the combined companys financial condition and results of operations products and product candidates may not achieve commercial success product sales from ADDERALL XR and INTUNIV are subject to generic competition the failure to obtain and maintain reimbursement or an adequate level of reimbursement by thirdparty payers in a timely manner for the combined companys products may affect future revenues financial condition and results of operations particularly if there is pressure on pricing of products to treat rare diseases supply chain or manufacturing disruptions may result in declines in revenue for affected products and commercial traction from competitors regulatory actions associated with product approvals or changes to manufacturing sites ingredients or manufacturing processes could lead to significant delays an increase in operating costs lost product sales an interruption of research activities or the delay of new product launches the successful development of products in various stages of research and development is highly uncertain and requires significant expenditures and time and there is no guarantee that these products will receive regulatory approval the actions of certain customers could affect the combined companys ability to sell or market products profitably and fluctuations in buying or distribution patterns by such customers can adversely affect the combined companys revenues financial condition or results of operations investigations or enforcement action by regulatory authorities or law enforcement agencies relating to the combined companys activities in the highly regulated markets in which it operates may result in significant legal costs and the payment of substantial compensation or fines adverse outcomes in legal matters and other disputes including the combined companys ability to enforce and defend patents and other intellectual property rights required for its business could have a material adverse effect on the combined companys revenues financial condition or results of operations Shire is undergoing a corporate reorganization and was the subject of an unsuccessful acquisition proposal and the consequent uncertainty could adversely affect the combined companys ability to attract andor retain the highly skilled personnel needed to meet its strategic objectives failure to achieve the strategic objectives with respect to Shires acquisition of NPS Pharmaceuticals Inc. or Dyax Corp. Dyax may adversely affect the combined companys financial condition and results of operations the combined company will be dependent on information technology and its systems and infrastructure face certain risks including from service disruptions the loss of sensitive or confidential information cyberattacks and other security breaches or data leakages that could have a material adverse effect on the combined companys revenues financial condition or results of operations the combined company may be unable to retain and hire key personnel andor maintain its relationships with customers suppliers and other business partners difficulties in integrating Dyax or Baxalta into Shire may lead to the combined company not being able to realize the expected operating efficiencies cost savings revenue enhancements synergies or other benefits at the time anticipated or at all and other risks and uncertainties detailed from time to time in Shires Dyaxs or Baxaltas filings with the Securities and Exchange Commission SEC including those risks outlined in ITEM A Risk Factors in Shires and Baxaltas Annual Reports on Form K for the year ended December . All forwardlooking statements attributable to us or any person acting on our behalf are expressly qualified in their entirety by this cautionary statement. Readers are cautioned not to place undue reliance on these forwardlooking statements that speak only as of the date hereof. Except to the extent otherwise required by applicable law we do not undertake any obligation to republish revised forwardlooking statements to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events."

"Commonly used diabetes drugs such as metformin may help control lung cancer and may help prevent it U.S. researchers reported on Tuesday. An Xray of a chest showing a growth on the left side of the lung in an undated image. REUTERSNIHHandout Patients who had taken the drugs to control diabetes were much less likely to have lung cancer spread which is when it becomes most deadly the researchers told a meeting of the American College of Chest Physicians. Metformin an older and cheaper drug available generically had a more powerful effect than newer drugs called thiazolidinediones TZDs or glitazones the researchers said. Our study as well as other research suggests an association between metformin andor TZD use and the risk of developing lung cancer said Dr. Peter Mazzone of the Cleveland Clinic in Ohio who led the study. However unique to this study we have been able to report less advanced cancer in those who do develop cancer a decreased frequency of squamous cell and small cell carcinomas and improved survival when controlled for stage in people taking metformin andor TZDs. The team reviewed the medical records of lung cancer survivors with diabetes. Those who had taken either a metformin drug or a TZD were significantly less likely to have advanced lung cancer that had spread percent of those who took the drugs had tumors that had spread versus percent of those who had not. The initial trend we have seen is toward metformin being more protective than TZDs Mazzone said. TZDs include GlaxoSmithKlines Avandia known generically as rosiglitazone and rival drug Actos or pioglitazone made by Takeda Pharmaceutical Co Ltd. Mazzone said it may be possible one day to use metformin to prevent lung cancer in smokers. But Dr. David Gutterman president of the American College of Chest Physicians said more research would be needed before this could be proposed. This new information adds to the growing body of evidence that metformin may help prevent and inhibit the progression of lung cancer Gutterman said. Metformin is one of the most widely used drugs for type diabetes with million prescriptions written in the United States in the American College of Chest Physicians said in a statement. In May researchers reported an inhaled drug called iloprost approved to treat pulmonary hypertension might also prevent lung cancer. In April researchers said a natural supplement derived from food called myoinositol seems to stop the precancerous changes that lead to lung cancer. Lung cancer is the No. cancer killer globally killing . million people a year. Only percent of people diagnosed with lung cancer are still alive five years later in part because the disease usually spreads silently for years before it causes clear enough symptoms to be detected. Early stage lung tumors can often be removed surgically however. The World Health Organization estimates million people globally had diabetes in and predicts that number will nearly double by to million."

"Medimetriks in collaboration with Otsuka announces the successful completion of a Phase trial of MM previously known as OPA in Atopic Dermatitis AD MM is a topical phosphodiesterase PDE inhibitor under development for the treatment of AD Results showed a therapeutic benefit as measured by percentage change in EASI score and improvement in IGA score MM is expected to be the nd topical PDE inhibitor available in the US and may offer unique benefits for patients suffering from AD Medimetriks Pharmaceuticals Inc. today announces the publication of Phase results for MM previously referred to as OPA a novel topical nonsteroidal phosphodiesterase IV PDE inhibitor for the treatment of mildtomoderate atopic dermatitis. The successful results of the Phase trial of MM have been published by the Journal of the American Academy of Dermatology JAAD the leading peerreviewed journal in dermatology. The randomized doubleblind vehiclecontrolled study in patients showed that MM demonstrates a statistically significant effect on the primary endpoints versus vehicle as measured by improvement in IGA score Investigators Global Assessment and percentage change in EASI score Eczema Area and Severity Index. The mean percentage improvement in baseline EASI score was notable very early at week . vs. for vehicle p. and at week . vs. for vehicle p.. These effects were sustained through week of the study. MM was also associated with improvement in patientreported outcomes most notably rapid and sustained itch relief with Visual Analog Scale scores showing improvement from moderate to mild within the first week . mean change p.. MM a PDE inhibitor reduces inflammation in affected skin by inhibiting production of cytokines and chemical mediators that are believed to cause the signs and symptoms of atopic dermatitis. In particular MM exhibits highly selective inhibitory activity against PDE subtype B an enzyme that may play a significant role in inflammation. MM is expected to be the nd topical PDE inhibitor in the market after the potential approval of Anacor Pharmaceuticals crisaborole product. The results of the Phase study suggest that MM represents a potentially safe effective and welltolerated nonsteroidal treatment for mildtomoderate atopic dermatitis said Linda Stein Gold MD director of clinical research Department of Dermatology at Henry Ford Hospital and coauthor of the article. Based on the results of this study it appears that MM could address an important unmet need in dermatology. We are pleased that JAAD the most respected peerreviewed journal in dermatology published the Phase results said Bradley Glassman Chairman and Chief Executive Officer of Medimetriks. We believe these Phase results demonstrate compelling evidence of MMs capacity to be a leading topical PDE inhibitor and are aggressively developing MM for atopic dermatitis in the US. Atopic Dermatitis patients have few treatment options and Medimetriks is dedicated to addressing this important unmet need. The JAAD article discussing the Phase results can be found by visiting http About Atopic Dermatitis Atopic dermatitis AD is a chronic inflammatory skin condition characterized by red swollen and cracked skin with intense itching. The onset of AD occurs most commonly between and months of age with approximately of patients developing the condition in the first year of life and by years of age. The majority of affected individuals have resolution of disease during childhood although to of patients maintain the condition throughout their lives. A small percentage of the population develops first symptoms as adults. It has been estimated that approximately million people are living with AD in the U.S. and this disease accounts for up to of patient visits to dermatology offices. Current treatments for atopic dermatitis include topical corticosteroids and topical calcineurin inhibitors. Topical steroids are typically used as first line therapies and are effective antiinflammatory agents. However topical steroids may be associated with local and systemic side effects when used for extended periods of time including skin atrophy acne and telangiectasias locally and HPA axis suppression systemically. Topical calcineurin inhibitors TCIs are recommended as secondline treatment for people with atopic dermatitis who are at risk of steroidrelated side effects. TCIs carry boxed warnings about a possible association with skin malignancies and lymphoma although studies have not demonstrated a clear link. Their use can be limited by local adverse reactions such as burning and stinging. About MM Medimetriks has sole exclusive US rights to MM. Discovered by Otsuka MM is an investigational nonsteroidal topical antiinflammatory PDE inhibitor in development for the potential treatment of atopic dermatitis. MM is hypothesized to exert antiinflammatory action by inhibiting the production of cytokines and chemical mediators thought to cause the signs and symptoms of atopic dermatitis. In particular MM exhibits highly selective inhibitory activity against PDE subtype B which is an enzyme that may play a significant role in inflammation. About Otsuka Otsuka Pharmaceutical is a global healthcare company with the corporate philosophy Otsuka people creating new products for better health worldwide. Otsuka researches develops manufactures and markets innovative and original products with a focus on pharmaceutical products for the treatment of diseases and nutraceutical products for the maintenance of everyday health. In pharmaceuticals Otsuka is a leader in the challenging area of mental health and also has research programs on several underaddressed diseases including tuberculosis a significant global public health issue. These commitments illustrate how Otsuka is a big venture company at heart applying a youthful spirit of creativity in everything it does. Otsuka Pharmaceutical which employs approximately people worldwide is a wholly owned subsidiary of Otsuka Holdings Co. Ltd. the holding company for the Otsuka Group that is headquartered in Tokyo Japan. The Otsuka Group has business operations in countries and regions around the world with consolidated sales of approximately USD . billion in fiscal year . Otsuka welcomes you to visit its global website at https About Medimetriks Medimetriks Pharmaceuticals Inc. is a leading independent branded Dermatology company focused on the development licensing and commercialization of innovative prescription skincare brands. The Company is dedicated to addressing unmet physician and patient needs with unique therapies that advance patient care. For more information please visit http Media Contact David Addis Senior Vice President Brand Communication Medimetriks Pharmaceuticals Inc. daddismedimetriks.com mailtodaddismedimetriks.com extension SOURCE Medimetriks Pharmaceuticals Inc. Related Links http"

"ViewRay Inc. Nasdaq VRAY maker of the worlds first and only clinical MRIguided radiation therapy system announced today outcomes data presented during the recent Annual Meeting of the American Society for Radiation Oncology ASTRO. This data highlighted compelling early results using the companys MRIdian system for the treatment of inoperable locally advanced pancreatic cancer. Unlike any other system on the market today MRIdian allows clinicians to see the tumor and nearby softtissue anatomy throughout radiation treatments using realtime diagnostic MRvisualization. As a result MRIdians ontable adaptive radiation therapy allows doctors to respond to subtle anatomical changes observed on a daytoday basis and reshape the dose to better match the current contours of the tumor. By more accurately targeting the tumor and reducing treatment radiation dose to surrounding organs such as the duodenum small bowel stomach and liver a higher and potentially more effective radiation dose may be delivered without increasing the risks of side effects and complications for the patient. As featured in the ASTRO Scientific Session poster titled High Dose Adaptive MRI Guided Radiation Therapy Improves Overall Survival of Inoperable Pancreatic Cancer key data points and findings from the presentation include the following The study detailed a retrospective review of locallyadvanced pancreatic cancer patients treated with MRIdian at four institutions University of California Los Angeles University of Wisconsin VU University Medical Center Washington University. The authors examined survival and toxicity rates for two unique cohorts of patients. One sample received a higher biologically effective dose maxBED primarily enabled by MRIdian MRguided ontable adaptive radiotherapy. The other sample received a lower more conventional biologically effective dose maxBED using nonadaptive therapy. The cohort receiving a higher dose demonstrated a near doubling of median overall survival KaplanMeier estimated median overall survival of . months compared to . months. Patients treated with higher radiation doses reported no grade or higher toxicities percent. In comparison those patients receiving lower doses via nonadaptive treatments experienced . percent grade or higher toxicities. Highdefinition MR now enables oncologists to detect the slightest anatomical changes that occur from one day to the next and in realtime while the patient is being treated. Coupled with new adaptive radiation therapy software tools we create new customized plans in minutes all while the patient is on the treatment table said Percy Lee M.D. senior author and Associate Professor and Vice Chair of Education for the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA. The data presented at the ASTRO Annual Meeting suggests that higher radiation doses with adaptive MR guided radiation therapy may improve survival in pancreatic cancer while maintaining a very favorable toxicity profile. These outcomes warrant further investigations. The early results highlighted above along with other data obtained using MRIdian will be tested in a multicenter prospective singlearm clinical trial for inoperable locally advanced or borderline resectable pancreatic cancer. The trial will be conducted by ViewRays Clinical Cooperative Think Tank CT a group of MRIdian medical institutions focused on evidence gathering to support MRguided radiation therapy. For more information regarding this clinical trial please visit httpgo.viewray.compancreatic_cancer_trial_info. Presentations discussing the multiinstitutional poster in ViewRays ASTRO booth are available on the companys website at http_. About ViewRay ViewRay Inc. Nasdaq VRAY designs manufactures and markets the MRIdian radiation therapy system. MRIdian is built upon a proprietary highdefinition MR imaging system designed from the ground up to address the unique challenges and clinical workflow for advanced radiation oncology. Unlike MR systems used in diagnostic radiology MRIdians highdefinition MR was purposely built to deliver highprecision radiation without unnecessary beam distortion and consequently help to mitigate skin toxicity and other safety concerns that may otherwise arise when high magnetic fields interact with radiation beams. ViewRay and MRIdian are registered trademarks of ViewRay Inc. This press release contains forwardlooking statements. Statements in this press release that are not purely historical are forwardlooking statements. Such statements are subject to risks and uncertainties that could cause future results to differ materially from those referenced. Forward looking statements with respect to predicted improved survival described in the poster presentation and video are based on current expectations from the presented retroactive study and involve inherent risks and uncertainties about the potential health and medical benefits of MRguided Radiation Therapy for the treatment of patients with locally advanced pancreatic cancer. Further studies including the planned prospective multiinstitutional study referenced in this press release as well as patient data covering longer periods of time posttreatment could lead to different or contrary results from those expressed during ASTRO or in the poster presentation. Given these uncertainties the reader is advised not to place any undue reliance on any forwardlooking statements. Additional risk factors include among others the ability to raise the additional funding needed to continue to pursue ViewRays business and product development plans the inherent uncertainties associated with developing new products or technologies competition in the industry in which ViewRay operates and overall market conditions. These forwardlooking statements are made as of the date of this press release and ViewRay assumes no obligation to update the forwardlooking statements or to update the reasons why actual results could differ from those projected in the forwardlooking statements except as required by law. Investors should consult all of the information set forth herein and should also refer to the risk factor disclosure set forth in the reports and other documents ViewRay files with the SEC available at http"

"Instead of shrinking as expected as part of the normal aging process the memory center in the brains of seniors maintained their size and in men grew modestly after two years in a program that engaged them in meaningful and social activities new Johns Hopkins Bloomberg School of Public Healthled research suggests. At the same time those with larger increases in the brains volume over two years also saw the greatest improvements on memory tests showing a direct correlation between brain volume and the reversal of a type of cognitive decline linked to increased risk for Alzheimers disease. The research published online in Alzheimers Dementia The Journal of the Alzheimers Association studied participants in the Baltimore Experience Corps a program that brings retired people into public schools to serve as mentors to young children working with teachers to help them learn to read in understaffed school libraries. Someone once said to me that being in this program removed the cobwebs from her brain and this study shows that is exactly what is happening says study leader Michelle Carlson PhD an associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health. By helping others participants are helping themselves in ways beyond just feeding their souls. They are helping their brains. The brain shrinks as part of aging but with this program we appear to have stopped that shrinkage and are reversing part of the aging process. For the study Carlson and her colleagues randomized men and women to either participate in the Experience Corps or not . They took MRI scans of their brains at enrollment and then again after and months. They also conducted memory tests. Participants were an average of . years old predominantly AfricanAmerican were in good health came from neighborhoods with low socioeconomic status and had some college education. The control arm of the study those not involved in Experience Corps exhibited agerelated shrinkage in brain volumes. Typically annual rates of atrophy in adults over age range from . percent to two percent. The men who were enrolled in Experience Corps however showed a . percent to . percent increase in brain volumes over the course of two years. Though not statistically significant women appeared to experience small gains as compared to declines in the control group of one percent over months. Carlson notes that many cognitive intervention studies last one year or less. One strength of this study she says is that the participants were followed for two years which in this case was long enough to see changes that wouldnt have been detected after just one year. The researchers were particularly interested in the results considering that people with less education and who live in poverty are at greater risk for cognitive decline. Carlson says its not entirely clear which elements of Experience Corps account for the improved memory function and increased brain volumes. She says the program increases involvement in so many different kinds of activities that retired people may not have engaged in otherwise. Participants need to get out of bed walk to the bus and walk up and down stairs inside the schools. They work in teams. They work with young people. They share their knowledge and know they are doing good in the world. They engage in problem solving and they socialize in ways they wouldnt have if they stayed at home. Were not training them on one skill like doing crossword puzzles she says. Were embedding complexity and novelty into their daily lives something that tends to disappear once people retire. The same things that benefit us at contact with others meaningful work are certain to benefit us as we age. Experience Corps is a national program however it can be costly and isnt available everywhere. But Carlson says she believes finding purpose and civic engagement may forestall some of the damage of aging on the brain. Impact of the Baltimore Experience Corps Trial on cortical and hippocampal volumes was written by Michelle C. Carlson Julie H. Kuo YiFang Chuang Vijay Varma Greg Harris Marilyn Albert Kirk I. Erickson Arthur F. Kramer Jeanine M. Parisi QianLi Xue Erwin Tan Elizabeth K. Tanner Alden Gross Teresa E. Seeman Tara Gruenewald Sylvia McGill George W. Rebok and Linda P. Fried. The study was supported by the Johns Hopkins Neurobehavioral Research Unit the National Institutes of Healths National Institute on Aging P AG the Alzheimers Drug Discovery Foundation and the Johns Hopkins Epidemiology and Biostatistics of Aging Research Fellowship NIA TAG."

"Select patients age years and older with aortic stenosis AS can benefit from a relatively new minimally invasive surgery for aortic valve replacement according to an article in the September issue of the Annals of Thoracic Surgery. Key points Both transfemoral and transapical approaches to TAVR appear to be safe and effective for treatment of aortic stenosis in select patients age years and older. By months postsurgery most qualityoflife measures had stabilized at a level considerably better than baseline meaning patients quality of life was better than it was prior to surgery. Future studies are needed to address potential differences in outcomes between TF and TATAVR groups. As part of the PARTNERI trial Vinod H. Thourani MD from Emory University in Atlanta and colleagues from other institutions in the United States found that transcatheter aortic valve replacement TAVR is a safe and effective way to treat aortic stenosis in nonagenarians who qualify for the surgical technique. Historically extreme elderly patients can be at a very high risk for open surgery said Dr. Thourani. We still believe that for those year olds who are lowor intermediate risk surgical options may be a viable procedure. However with the advent of TAVR technology we can now offer these extreme elderly patients a treatment option that otherwise would have been highrisk or prohibitive. Aortic stenosis is the most common acquired valve disease in elderly patients and affects nearly of those over the age of according to the American Heart Association. The ability to safely treat AS patients has become increasingly important the US government predicts that the number of Americans over the age of will exceed million in the next years. For the study the researchers used two different approaches transfemoral TAVR TFTAVR which is the traditional approach performed via the groin and transapical TAVR TATAVR which is performed via the heart muscle. TATAVR is an alternative for patients who are medically ineligible for TFTAVR secondary to severe peripheral vascular disease. While the current study did not evaluate other alternative options for TAVR these techniques may include transaortic transcaval transcarotid or transsubclavian. In the largest series published to date between April and February nonagenarians underwent TAVR with TFTAVR and with TATAVR. We evaluated perioperative short and midterm outcomes following both TF and TATAVR explained Dr. Thourani. Compared with an agesexracematched US population the TAVR patients had a comparable risk of mortality and quality of life improved within months of the procedure. Our study shows that age alone should not preclude referral for TAVR in patients age years and older. The study also showed that the day stroke risk was . in TFTAVR patients and . in TATAVR patients. Major complications such as bleeding or vascular issues occurred in of TFTAVR patients and of TATAVR patients and more than of patients were discharged home after the procedure. Future studies are needed to address potential differences in outcomes between TF and TATAVR groups said Dr. Thourani but Im thrilled that were able to give elderly people the chance to continue enjoying life in their golden years. Many would not have had that option without TAVR. Notes for editors Thourani V Jensen H Babaliaros V Kodali S Rajeswaran J Ehrlinger J Blackstone E Suri R Don C Aldea G Williams M Makkar R Svensson L McCabe J Dean L Kapadia S Cohen D Pichard A Szeto W Herrmann H Devireddy C Leshnower B Ailawadi G Maniar H Hahn R Leon M Mack M. Outcomes in Nonagenarians Undergoing Transcatheter Aortic Valve Replacement in the PARTNERI Trial. Ann Thorac Surg . doi.j.athoracsur... Full text of the article is available to credentialed journalists upon request contact Cassie McNulty cmcnultysts.org mailtocmcnultysts.org at About The Annals of Thoracic Surgery The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association. Founded in The Society of Thoracic Surgeons is a notforprofit organization representing more than cardiothoracic surgeons researchers and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart lung and esophagus as well as other surgical procedures within the chest. The Societys mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education research and advocacy. About Elsevier Elsevier is a worldleading provider of information solutions that enhance the performance of science health and technology professionals empowering them to make better decisions deliver better care and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides webbased digital solutions among them ScienceDirect Scopus Elsevier Research Intelligence and ClinicalKey and publishes over journals including The Lancet and Cell and more than book titles including a number of iconic reference works. Elsevier is part of RELX Group plc a worldleading provider of information solutions for professional customers across industries. http"

"A new skin test for tuberculosis infection has proven safe easy to administer and accurate in two Phase III clinical trials according to research presented at the ATS International Conference. The test known as CTb combines the field friendliness of the PPDbased tuberculin skin test with the high specificity of interferon gamma release assays or IGRAs said lead researcher Morten Ruhwald MD PhD head of human immunology at Statens Serum Institut in Denmark which developed the test. The new test measures the bodys immune response to two TB antigens EAST and CFP. The test is administered like a tuberculin skin test TST and results are interpreted by measuring the size of the skin induration two or three days later. The TST is the most commonly used test to detect TB infection with about million tests worldwide each year according to the World Health Organization. The test is easy to administer but produces too many false positives to achieve the WHOs goal of reducing TB deaths by percent and new cases by percent by Dr. Ruhwald said. Introduced a decade ago IGRAs have high specificity producing few false positives but require blood samples and complicated lab work which has limited their widespread use. There is also a dramatic price difference between the two diagnostic tests. According to Dr. Ruhwald a TST costs about an IGRA is to times more expensive depending on setting. In the first clinical trial Dr. Ruhwald and colleagues conducted a doubleblinded study of CTb in participants enrolled at clinical trial sites in Spain. Participants all adults ranged in TB status from presumed uninfected through intermediate and high risk of latent TB to active disease. Researchers found Both CTb and the IGRA had a specificity of percent. CTb was highly concordant to IGRA in percent of study participants. The specificity of CTb unlike the TST was not impacted by the BCG vaccine the partially effective vaccine that many residents in the developing world receive. TST specificity in this group was only percent. The sensitivity of CTb was comparable to the IGRA in confirmed TB cases percent vs. percent indicating similar abilities to detect infection. In the second doubleblinded trial researchers were primarily concerned with testing how accurate CTb was in HIVpositive patients and in young childrenpopulations in which the accuracy of the TST and the IGRA is known to be compromised. The study conducted in South Africa enrolled participants including patients with HIV and children as young as days. Researchers found Among participants with HIV the ability of all three tests to detect TB infection was diminished though the CTb appeared more robust in HIVinfected participants with low CD T cell counts. Among children under CTb was comparable with the other two tests in identifying those infected. Dr. Ruhwald said another advantage of CTb is that the measurement of infection a mm or larger induration is universal across patients with different risk factors including HIV infection. With TST the size of the induration is often adjusted to increase its accuracy in measuring infection in different patient populations. Regulatory approval for CTb is currently being sought and Statens Serum Institute is actively seeking a commercial partner for marketing of CTb. The cost of a CTb test is to be determined however it is expected to be significantly less than an IGRA. Abstract Diagnostic Accuracy of the Novel CTb Skin Test for Latent M.tuberculosis Infection Results from Two Phase III Clinical Trials M. Ruhwald J.A. Cayla H. Aggerbaek K. Dheda P. Andersen Statens Serum Institut CopenhagenDK Public Health Agency of Barcelona BarcelonaES UCT Lung Institute Lung Infection Immunity Unit Cape TownZA Rationale Renewed emphasis on the detection and preventive treatment of M. tuberculosisinfected individuals at risk is required to reach the goals of the WHO post global tuberculosis strategy. Statens Serum Institut has developed a novel specific skin test CTb based on the antigens ESAT and CFP. CTb combines the field friendliness of the PPDbased Tuberculin Skin Test TST with the high specificity of the interferon gamma release assays IGRA. This presentation outlines the results from two recently completed phase III trials TESEC and . The results have not previously been published or presented. Methods The TESEC trial included participants from clinical trial sites in Catalonia Galicia and Basque Country Spain with various risk profiles of M.tuberculosis infection. The TESEC trial included participants with symptoms of TB and endemic controls from Cape Town South Africa. In both trials CTb and TST were administered in a doubleblinded fashion to one or the other forearm. Skin indurations were read to days later. A reading mm was considered positive for the TST and CTb cut off preset in phase II. Blood for IGRA testing Quantiferon QFTGIT was drawn prior to skin testing. Results The safety profile of CTb was acceptable and not different from TST. Test specificity was assessed in presumed unexposed Spanish controls. Here CTb had comparable specificity to QFTGIT both p. and there was no impact of BCG vaccination. By contrast previous BCG vaccination subverted TST specificity in BCG vaccinated compared to in BCG unvaccinated persons p.. Sensitivity of CTb and QFTGIT was comparable in patients with confirmed TB vs p.. In contacts mirroring the findings with QFTGIT there was a strong trend in increasing CTb test positivity with M. tuberculosis exposure figure . The impact of age and HIV infection on CTb TST and QFT reactivity was assessed in individuals with symptoms suspect of TB disease analysis is ongoing and will be included in the presentation. Discussion These phase III trial results demonstrate that CTb is safe has comparable diagnostic performance to QFTGIT and addresses the problem of false positive TST results in BCG vaccinated persons. The fieldfriendliness and high specificity offered by the CTb test could allow for improved targeted treatment of M. tuberculosisinfected persons in also in resourceconstrained settings where IGRAs are too complicated to implement."

"Eradicating cancer without damaging healthy tissue is the Holy Grail of cancer researchers. Wills Eye Hospital in Philadelphia is testing a novel lightactivated drug designed to do just that in the eye raising hopes for the first ocular melanoma treatment that would preserve patients vision. Sparing eyesight could encourage earlier detection and treatment thus reducing the chance of metastases the deadly spread that killed acclaimed author and neurologist Oliver Sacks in . A close up of the ophthalmic laser used to activate Aura Biosciences experimental drug. This could be a gamechanger if it works said Carol Shields an ocular oncologist at Wills Eye and Thomas Jefferson University. Thats still a big if. Shields treated the first patient a yearold man from Hazleton Pa. in March. A dozen patients in all will be treated at Wills and five other centers over the next two years and thats just the first of three clinical trials needed to win approval from the U.S. Food and Drug Administration. But if Aura Biosciences experimental therapy vanquishes the rare eye malignancy it could pave the way for a new class of exquisitely precise cancer therapies. In lab experiments the drugs artificial viral nanoparticles derived from groundbreaking technology pioneered at the National Cancer Institute have been shown to zero in on and bind to many types of malignant cells without harming normal cells. We decided to first focus on a cancer with medical need and no other drug option Auras founding CEO Elisabet de los Pinos said of ocular melanoma. But we think that our technology can be applied to other cancers including bladder and head and neck. A freckle in the eye Many people have a harmless freckle or nevus in their eyes formed by the same pigmentcarrying melanocytes that produce freckles in the skin. Just as in the skin the eye spots can turn malignant. Sun exposure is not clearly linked to ocular melanoma but fair skin and light eye color are risk factors. Carol shields When a benign freckle in the eye turns malignant it grows into an ocular melanoma a rare but potentially lifethreatening cancer. While the disease is rare with about new diagnoses and deaths in the United States each year it often goes undiagnosed until it affects vision. Sacks known for books including Awakenings and The Minds Eye in which he tells the story of his own cancer said his symptoms hit suddenly wiping out a triangular chunk of the vision in his right eye. Sacks decided to have a chip of radioactive iodine embedded in his eye to treat the tumor. It caused severe pain hallucinations and vision loss in the center of that eye. The radiation and later lasering ultimately left that eye blind. Carol shields The dark spot in the upper center region is a benign freckle formed by pigmented cells called melanocytes. Other ocular melanoma treatments including proton beams gamma knife and surgery to cut out the tumor also have damaging side effects. If these fail to control the cancer the eye must be removed. The first patient Ed Tuggle a maintenance supervisor for a food company never had symptoms. In his ophthalmologist spotted a tiny freckle during a routine eye exam. Last year the same doctor saw that the lesion had grown. Although it was still small about onetenth of an inch he sent Tuggle to Wills where Shields did a battery of tests and concluded that it was malignant. Patients with small tumors such as Tuggles often choose monitoring rather than immediate visiondamaging treatment. But holding off can be anxietyprovoking given that studies indicate up to percent of ocular melanomas metastasize. When Shields proposed another option Auras clinical trial Tuggle and his wife Daneen a nurse were eager. The actual procedure in early March was a breeze Tuggle recalled. Shields numbed his eye injected the drug and six hours later used a laser to activate the lightsensitive dye that is part of the therapy. His dose was purposely low intended more to test safety than effectiveness. Patients in the next trial will get multiple higher doses. Still a month after Tuggles injection Shields was pleased to find that the tumor had begun to atrophy. Based on animal studies it takes three or four months to gauge the response. Ive got a lot of faith said Tuggle who said he has had no side effects. In my mind its already worked. Wills Eye Hospital ocular oncologist Carol Shields puts a protective lens on patient Ed Tuggles eye in preparation for a laser treatment. The laser activates an experimental targeted cancer drug previously injected in his eye. A new way to target tumors De los Pinos a molecular biologist who previously worked in Eli Lilly Co.s oncology division founded Cambridge Mass.based Aura in with the goal of developing a highly targeted approach to cancer treatment. The first product candidate is built on decades of advances involving of all things the human wart virus human papillomavirus or HPV. In the s certain virulent strains of HPV were shown to cause cervical cancer. In the s scientists figured out how to make harmless empty HPV shells called viruslike particles to prime the immune system to ward off the real germ. Viruslike particles became the basis of Mercks groundbreaking cervical cancer prevention vaccine Gardasil approved in . More recently a team at the National Cancer Institute led by John T. Schiller and Douglas R. Lowy deciphered how HPV infects certain cervical cells in the first place. Physically disrupted cells overproduce a carbohydrate molecule that normally helps with wound healing. The virus binds to that molecule called heparan sulfate proteoglycans. Healthy intact cells meanwhile resist being bound. Using animal models the NCI researchers showed that viruslike particles behaved like the actual virus using the carbohydrate to attach to tumors. And not just in the cervix. In Schiller Lowy Auras de los Pinos and others published a study that showed viruslike particles can infect a broad range of cancer cell types including ovarian and lung by binding to the carbohydrate. Since viruslike particles are harmless on their own Auras are coupled with a lightsensitive dye. When activated by laser light the dye becomes toxic to the tumor cells membranes and if all goes as expected selectively kills the cancer. Although ocular melanoma is rare Shields has long urged people to get annual eye checks because finding it early is critical. Now she foresees a way to make early detection less dreadful. Were hoping this becomes a new alternative in the management of melanoma of the eye she said."

"A device that grabs and drags a blood clot out through the blood vessels should be used to treat certain stroke victims according to new guidelines issued by the American Heart Association. Nearly nine out of strokes are caused by a blood clot that blocks one of the arteries supplying blood to the brain the American Heart Association AHA said. Standard stroke treatment relies on powerful bloodthinning medications that break up the clot and restore blood flow to the brain. But when those drugs dont work doctors now can turn to a new catheterbased device that will physically remove the blood clot said Dr. William Powers lead author of the updated AHA guidelines and chair of neurology at the University of North Carolina at Chapel Hill. The tool called an endovascular stent retrieval device is made up of wire mesh that resembles a tiny ring of chicken wire Powers said. Skilled surgeons run the device up through a persons arteries via a catheter and then open it smack in the middle of a strokecausing blood clot. If you actually deploy or open one in the middle of a clot it smooshes out and the clot gets caught in the chicken wire and then you pull the whole thing out back through the artery Powers said. The new guidelines were published June in the journal Stroke. The AHA issued its updated guidelines based primarily on the results of six new clinical trials released within the past eight months Powers said. All of these studies showed that the device can safely and effectively stop a stroke by removing blood clots he added. A number of other medical societies have endorsed the AHAs new guidelines including the American Association of Neurological Surgeons and the Society of Vascular and Interventional Neurology. As with other stroke treatments time is of the essence. The procedure must start within six hours of the onset of a stroke which means that emergency teams and hospitals will have to move fast Powers said. The guidelines provide added incentive to quickly transfer stroke victims from a local hospital to a major stroke center capable of advanced treatment said Powers and Dr. David Kandzari director of interventional cardiology and chief scientific officer for the Piedmont Heart Institute in Atlanta. Local hospitals currently are urged to drip and ship people experiencing a major stroke essentially start an IV drip of the powerful clotbusting drug called tissue plasminogen activator tPA and then ship them by ambulance or helicopter to the nearest comprehensive stroke center for further treatment Kandzari said. Stent retrieval devices make that quick hospital transfer even more important since the gadgets provide a crucial backup for tPA but are more tricky to use. These are procedures performed by very specialized individuals Kandzari said. They are not regularly performed by cardiologists or radiologists or neurologists. Hospitals must make plans to get people to other centers that are capable of this catheterbased therapy he explained. Powers said I think whats going to happen is that we will develop systems of rapid triage and rapid transport. A lot of this at this point depends on logistics and manpower. The people who do this are specially trained. You need a lot of special training to get those catheters up into the brain and pull things out. The guidelines specifically recommend using a stent retrieval device for people who Didnt have any significant disability prior to their current stroke. Received tPA within . hours of their stroke onset and can start the procedure within six hours after stroke symptoms started. Are at least years old as clinical trials have not been conducted with children. Have imaging scans that show more than half of the brain on the side of the stroke is not permanently damaged. Have a clot blocking a large artery supplying blood to the brain. That last point is especially important because the stent retrieval device will not fit into the smaller blood vessels that branch out further into the brain Powers said. The major risk of using the device is that it could tear an artery and cause bleeding in the brain particularly since it will be used on people who have already received very potent blood thinners Kandzari said. But clinical trials have shown that the risk of brain bleeding for people who received tPA and then went through mechanical clot removal is no greater than for people who just receive the blood thinner Powers said. The outcomes were uniformly positive in all of the trials he said. Its really really good evidence. More information For more about stroke visit the National Stroke Association http SOURCES William Powers M.D. chair neurology University of North Carolina at Chapel Hill David Kandzari M.D. director interventional cardiology and chief scientific officer Piedmont Heart Institute Atlanta June Stroke"

"An immunotherapy drug has been hailed as a potential game changer after being found to greatly improve survival for patients with relapsed head and neck cancer a disease which is notoriously difficult to treat. Nivolumab became the first treatment to extend survival in a phase III clinical trial for patients with head and neck cancer in whom chemotherapy had failed and it did so with fewer sideeffects than existing therapeutic options. More than double the number of patients taking nivolumab were alive after one year as those treated with chemotherapy reported the major international trial published today Sunday in the New England Journal of Medicine. There are currently no other treatment options that improve the survival of patients with cisplatinresistant relapsed or metastatic head and neck cancers. This group of patients are expected to live less than six months. The trial was led in the UK by Professor Kevin Harrington of The Institute of Cancer Research London and The Royal Marsden NHS Foundation Trust and involved research organisations from around the world. It was funded by Bristol Myers Squibb. Of the patients in the trial with relapsed or metastatic head and neck cancer were allocated to receive nivolumab and to one of three different chemotherapies. UK patients received the chemotherapy drug docetaxel which is the only treatment approved for advanced head and neck cancer by NICE. After one year of the study per cent of patients treated with nivolumab were still alive compared with per cent for the comparator arm. Median survival for patients on nivolumab was . months compared with . months for chemotherapy. The survival benefit was more pronounced in patients whose tumours had tested positive for human papillomavirus HPV. These patients survived an average of . months with nivolumab and . months with chemotherapy. HPVnegative patients survived an average of . months with nivolumab and . with chemotherapy. Importantly fewer patients experienced serious sideeffects from taking nivolumab than with conventional treatment only per cent compared with per cent of patients who received chemotherapy. Patients given chemotherapy reported feeling physically socially and emotionally worse off whereas those who were given nivolumab remained stable during the course of treatment. Professor Harrington will be presenting some of the findings at the European Society for Medical Oncology Congress in Copenhagen simultaneously with publication. Nivolumab will still have to go through approval by the European Medicines Agency and NICE before it is available for head and neck cancer patients on the NHS. UK trial lead Professor Kevin Harrington Professor of Biological Cancer Therapies at The Institute of Cancer Research London and Consultant at The Royal Marsden NHS Foundation Trust said Nivolumab could be a real gamechanger for patients with advanced head and neck cancer. This trial found that it can greatly extend life among a group of patients who have no existing treatment options without worsening quality of life. Once it has relapsed or spread head and neck cancer is extremely difficult to treat. So its great news that these results indicate we now have a new treatment that can significantly extend life and Im keen to see it enter the clinic as soon as possible. Professor Paul Workman Chief Executive of The Institute of Cancer Research London said Nivolumab is one of a new wave of immunotherapies that are beginning to have an impact across cancer treatment. This phase III clinical trial expands the repertoire of nivolumab even further showing that it is the first treatment to have significant benefits in relapsed head and neck cancer. We hope regulators can work with the manufacturer to avoid delays in getting this drug to patients who have no effective treatment options left to them. Some of the data was presented at CEST today Sunday at the European Society for Medical Oncology Congress in Copenhagen. Notes to editors For more information please contact Claire Hastings on or claire.hastingsicr.ac.uk mailtoclaire.hastingsicr.ac.uk. For enquiries out of hours please call . About head and neck cancer There were around new cases of head and neck cancer and deaths in the UK in globally and more than half relapse within years. The Institute of Cancer Research London is one of the worlds most influential cancer research organisations. Scientists and clinicians at The Institute of Cancer Research ICR are working every day to make a real impact on cancer patients lives. Through its unique partnership with The Royal Marsden NHS Foundation Trust and benchtobedside approach the ICR is able to create and deliver results in a way that other institutions cannot. Together the two organisations are rated in the top four centres for cancer research and treatment globally. The ICR has an outstanding record of achievement dating back more than years. It provided the first convincing evidence that DNA damage is the basic cause of cancer laying the foundation for the now universally accepted idea that cancer is a genetic disease. Today it is a world leader at identifying cancerrelated genes and discovering new targeted drugs for personalised cancer treatment. A college of the University of London the ICR is the UKs topranked academic institution for research quality and provides postgraduate higher education of international distinction. It has charitable status and relies on support from partner organisations charities and the general public. The ICRs mission is to make the discoveries that defeat cancer. For more information visit http The Royal Marsden NHS Foundation Trust The Royal Marsden opened its doors in as the worlds first hospital dedicated to cancer diagnosis treatment research and education. The Head and Neck Unit at The Royal Marsden is one of the largest of its kind in Europe. Today together with its academic partner The Institute of Cancer Research ICR it is the largest and most comprehensive cancer centre in Europe treating over NHS and private patients every year. It is a centre of excellence with an international reputation for groundbreaking research and pioneering the very latest in cancer treatments and technologies. The Royal Marsden with the ICR is the only National Institute for Health Research Biomedical Research Centre for Cancer. First awarded the status in it was reawarded in . A total of million is being provided over five years to support pioneering research work and is being shared out over eight different cancer themes. The Royal Marsden also provides community services in the London boroughs of Sutton and Merton and in June along with the ICR the Trust launched a new academic partnership with Mount Vernon Cancer Centre in Middlesex. Since the hospitals charity The Royal Marsden Cancer Charity has helped raise over million to build theatres diagnostic centres and drug development units. Prince William became President of The Royal Marsden in following a long royal connection with the hospital."

"You wouldnt last very long without oxygen. But just as rust slowly eats away at a nail oxygen can age your body. As your cells use this vital element they produce free radicals unstable molecules that can damage your tissues and add wear and tear to your entire body including your skin. Many antiaging products promise youngerlooking skin through the power of antioxidants compounds that help neutralize free radicals before they can do any harm. Antioxidants such as vitamin E vitamin C and beta carotene show up in a lot of sunscreens and lotions. But if you want your antioxidants to go more than skin deep you might be interested in oral supplements. Proleva a supplement from Allmera Nutraceuticals contains antioxidants from several different sources including green tea acai berries goji berries and resveratrol a compound found in grape skins. Users are instructed to take two capsules once a day. You can buy a bottle of capsules on the company website for about . Vivida a supplement from LifesGood Inc. contains astaxanthin an antioxidant thats extracted from algae along with vitamin C. Other ingredients include silica from the horsetail plant and a marine extract from cod and other ocean fish. Users are instructed to take one tablet in the morning and one in the evening. A bottle of tablets costs about . The claims According to the company website Proleva is a fountain of youth that can give users youthful glowing skin. The site adds that healthy vibrant skin comes not from a cream but from within. The site also says that the supplement will improve memory enhance the immune system and speed healing but those are claims for another time. Ron Slavick the managing director of Allmera Nutraceuticals says many Proleva customers boast of their softer youngerlooking skin. You cant treat skin with lotions and potions he says. Healthy skin is a reflection of the health of the body. He believes that the natural plant extracts in Proleva work better than the artificially produced antioxidants found in most multivitamins. The website for Vivida says that the product nourishes skin from the inside to make it smoother firmer and healthier. LifesGood President Mark Holland says that antioxidants help take impurities away from the skin while softening fine lines and wrinkles. According to Holland the antioxidants work together with the marine extract to keep the skin moist and supple. The bottom line Over the years scientists have largely dashed the hopes that antioxidants could be the secret to good health and longer lives. Studies have failed to show that antioxidant supplements such as vitamin E and beta carotene can prevent heart disease cancer or other major diseases. Theres still some hope that antioxidants can help the skin but the results likely arent as dramatic as the companies suggest says Dr. Patricia Farris a fellow of the American Academy of Dermatology who has a cosmetic dermatology practice in Metarie La. These products are overhyped Farris says. Only a few studies show that you can improve the appearance of skin with any type of supplement. According to Farris some but not all studies suggest that antioxidants can help protect the skin from sun damage one of the major causes of wrinkles. But she notes that this would only prevent signs of aging not fix any problems that a person already has. I tell patients that antioxidants might help protect the skin but they wont repair the skin she says. Proponents of antioxidants can point to a few studies with encouraging results. For example a German study of adults published in in the journal Skin Pharmacology and Physiology found that volunteers taking supplements containing the antioxidants lutein selenium and lycopene among other things had measurably smoother skin after weeks. There were no such benefits for the subjects taking a placebo. The changes were assessed with a scanning device and its unclear if any benefits were visible to the naked eye. In an unpublished companyfunded study provided by Holland women who took Vivida reported generally positive results. After weeks said that their skin looked smoother and softer. These results werent confirmed by a dermatologist or anyone else and there was no control group for comparison. Plantbased nutrients deserve more study but the field is still in its infancy says Dr. David McDaniel an assistant professor of clinical dermatology at Eastern Virginia Medical School who runs a cosmetic dermatology clinic in Virginia Beach. Because products vary widely in their ingredients and their doses he cant recommend any particular product without evidence to back it up. Without welldesigned statistically valid trials Im a skeptic he says."

"In women who have had breast cancer annual mammograms help detect second breast cancers but theyre not as effective in women who have never had the disease new research suggests. Screening mammography does work well in women with a history of breast cancer so they should continue to get their annual screening mammogram said Diana Miglioretti senior investigator at Group Health Research Institute in Seattle and a coauthor of the new research. But they also need to remain vigilant because they are at increased risk of cancers not detected on mammography that show up between mammograms. In their study published in the Feb. issue of the Journal of the American Medical Association Miglioretti and her colleagues found that false positives and interval cancers were both higher in women with a history of breast cancer than in those without such history. False positives are an initial finding of cancer that turns out to be benign based on additional testing. Interval cancers are those found between mammograms either through additional tests or symptoms. The researchers evaluated years of data from screening mammograms in women with earlystage breast cancer and an equal number of mammograms in another women who had never had breast cancer. The women were matched on such factors as age and breast density a risk factor for cancer with higher density increasing risk. Within a year of the screening cancers were found in women with a breast cancer history and in those without. Mammograms had detected . percent of the cancers in women who had never had breast cancer and . percent in those who had previously had the disease. As for false positives percent of the women without a history of breast cancer were referred for biopsy but ended up being cancerfree compared with . percent of those with a breast cancer history. The interval cancer rate was . per screenings in those with a history and . per in those without the investigators found. Women with a history of breast cancer were also more likely to be called back for additional imaging or biopsies percent called back compared with . percent of the others. I think its mostly positive news Miglioretti said. Of the ones that are missed most of them are early stage. It points to the need she said for women to remain vigilant about screening after their breast cancer treatment and to report any symptoms to their doctor immediately. Dr. William Audeh medical director of the Samuel Oschin Cancer Center and the Wasserman Breast Cancer Risk Reduction Program at CedarsSinai Medical Center in Los Angeles described the findings as not at all surprising. He reviewed the study but was not involved in it. After surgery and radiation he said a womans breasts have changed and there is a greater chance that a radiologist will think that something is abnormal simply because of the changes. That helps explain the false positives Audeh said. And though mammography did not catch all cancers in the women with a breast cancer history the study still points out the value of the test he said. Robert Smith director of cancer screening for the American Cancer Society agreed. Despite poorer performance compared with women without a prior history of breast cancer overall screening mammography was effective at detecting the majority of breast cancer in women with a history at an early favorable stage with the majority of tumors being diagnosed as ductal carcinoma in situ or stage Smith said. A trend among cancer specialists Audeh said is to tailor followup for a woman who has had breast cancer. For those who have dense breasts and are younger than for example we can alternate mammograms with breast MRIs with one of the tests every six months he said. More information WomensHealth.gov has more on mammograms httpwomenshealth.govfaqmammograms.cfm. SOURCES Diana Miglioretti Ph.D. senior investigator Group Health Research Institute Seattle William Audeh M.D. medical oncologist and medical director Samuel Oschin Cancer Center and Wasserman Breast Cancer Risk Reduction Program CedarsSinai Medical Center Los Angeles Robert A. Smith Ph.D. director cancer screening American Cancer Society Atlanta Feb. Journal of the American Medical Association"

"Pembrolizumab an antibody drug already used to treat other forms of cancer can be effective in the treatment of the most common form of mesothelioma according to a new study led by investigators from the Perelman School of Medicine at the University of Pennsylvania. The study published this month in The Lancet Oncology is the first to show a positive impact from checkpoint inhibitor immunotherapy drugs on this disease. Malignant pleural mesothelioma is a rare and aggressive cancer that represents about percent of all malignant mesothelioma cases. Its primarily caused by the inhalation of asbestos a fiber commonly found in some forms of insulation vinyl floor tiles and other material. Tumors form in the pleura a thin membrane of cells that line the lungs and chest wall. Most patients survive less than a year. This poor prognosis is partially due to the fact that most patients are not diagnosed until they are already at a late stage of the disease. The standard firstline therapy treatment involves chemotherapy and currently there is no approved secondline therapy. There have been a lot of studies looking at different drugs but researchers have not seen positive results said the studys lead author Evan Alley MD PhD chief of Hematology and Medical Oncology at Penn Presbyterian Hospital. But weve found this new class of drugs checkpoint inhibitors seems to be more effective than whats been available in the past. Checkpoint inhibitors are a class of drugs designed to free the bodys immune system to fight back against cancer. Pembrolizumab in particular has been used to treat melanoma nonsmall cell lung cancer and in some cases head and neck cancers. Alley and his team presented data from KEYNOTE an ongoing trial involving different research sites in six different countries all looking at the effect of pembrolizumab on patients with advanced malignancies including malignant pleural mesothelioma. The study evaluated patients with pleural mesothelioma all of whom were over the age of and had either already been treated with chemotherapy or were unable to receive it. Patients who had already received another checkpoint inhibitor were not included in the study. Beginning with the first enrollees two years ago doctors gave each patient a dose of pembrolizumab every two weeks. The tumor reduced in size in of those patients. On average patients went about six months without their disease progressing and overall survival was about months. Fourteen patients passed away during the study while four were still undergoing treatment as of the studys writing. Most patients who receive a secondline therapy have a life expectancy of about six or seven months so to have four patients still ongoing at two years is very encouraging Alley said. The most common sideeffects reported were fatigue nausea loss of appetite and dry mouth. One great sign in this study is that none of the patients had to stop treatment because of sideeffects Alley said. Some had temporary stoppages but they were able to continue. The drug appears to be welltolerated. There are multiple studies going on right now to confirm these findings which the authors note is a necessary step before the drug can become a standard secondline therapy. This study provides evidence that some patients can have longterm disease control with this drug which we havent seen before Alley said. We need to better understand what we can do next to make immunotherapy more effective for more patients. Alley said there are already plans for trials that will test combination therapies which will utilize pembrolizumab in conjunction with other treatments. Those studies are expected to launch later this year including two at Penn. The study was funded by Merck which manufactures pembrolizumab. Alley has no personal financial relationship with Merck. Penn Medicine is one of the worlds leading academic medical centers dedicated to the related missions of medical education biomedical research and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania founded in as the nations first medical school and the University of Pennsylvania Health System which together form a . billion enterprise. The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past years according to U.S. News World Reports survey of researchoriented medical schools. The School is consistently among the nations top recipients of funding from the National Institutes of Health with million awarded in the fiscal year. The University of Pennsylvania Health Systems patient care facilities include The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center which are recognized as one of the nations top Honor Roll hospitals by U.S. News World Report Chester County Hospital Lancaster General Health Penn Wissahickon Hospice and Pennsylvania Hospital the nations first hospital founded in . Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners a partnership between Good Shepherd Rehabilitation Network and Penn Medicine. Penn Medicine is committed to improving lives and health through a variety of communitybased programs and activities. In fiscal year Penn Medicine provided . million to benefit our community."

"Getting your tonsils out used to be just part of childhood a rite of passage for children in the s and s. Then it fell out of favor. But tonsillectomy is back. Today the most common reason for the surgery is sleep disordered breathing a broad diagnosis that includes sleep apnea and snoring. About percent of elementaryschoolage children snore. Doctors say snoring can cause bedwetting behavior problems short stature and poor school performance. Thats a far cry from the s and s when tonsillectomy was used to fight frequent sore throats. Back then it was the most popular surgery in the United States. In the s sitcom Leave It to Beaver http Beaver Cleaver was so impressed by his dads tales of ice cream and pretty nurses that he schemed to have his tonsils out even though he didnt need it. Turning Point For Tonsillectomies It was becoming unacceptable to just take tonsils out because they were there or you had a few infections. People were growing up with their tonsils. Richard Rosenfeld an ear nose and throat doctor at SUNY Downstate in Brooklyn N.Y. The tonsils are two glands that sit at the base of the tongue and are part of the bodys immune system. The premise of tonsillectomies back in their heyday was that tonsils get infected themselves and no longer help fend off germs. Then doctors started noticing that kids were still getting sore throats even after having their tonsils taken out. But it wasnt until clinical trials were completed in the early s that there was proof that tonsillectomy really only helped children with severe recurrent throat infections. It was becoming unacceptable to just take tonsils out because they were there or you had a few infections says Richard Rosenfeld an ear nose and throat doctor at SUNY Downstate in Brooklyn N.Y. People were growing up with their tonsils. Article continues after this message from our sponsor But growing up with tonsils can create another problem snoring. Lisa Moran of Takoma Park Md. remembers what it sounded like when her son Tyler Scorza now age slept. It was loud Moran says. You could hear him through he closed door down the hall snoring and he would occasionally stop breathing. At first Tylers pediatrician thought hed outgrow the snoring. But he wasnt sleeping well and often didnt have any energy. The doctor recommended a head XRay and the radiologist said that though Tylers adenoids were enlarged they werent that bad. By then Tyler had been dealing with this for almost three years. He started getting frequent nasal infections. So his parents took him to an ear nose and throat doctor. He said sure the adenoids are swollen. But the real problem is the tonsils Moran recalls. He showed us on the Xray that there was a tiny passage between the tonsils and the back of his throat very small. Enlarged tonsils and adenoids are the most common cause of sleepdisordered breathing in children. So the doctor recommended tonsillectomy. Complications From Surgery But Tylers parents were worried about the surgery. Its usually done as an outpatient procedure now but with general anesthesia. Thats never without some risk. Your child is under says Moran completely under. This is not a local. Other complications include pain after surgery and the risk of bleeding about percent of people have complications that require readmission to the hospital. Despite hundreds of studies theres still surprisingly little research on whether tonsillectomy really helps reduce the risk of sore throats. The operation continues to be controversial. Whats A Sleep Study Sleep studies are a way for doctors to diagnose sleep disorders like apnea by observing patients overnight while they sleep. During a sleep study the patient is connected to an array of sensors monitoring brainwaves eye movements heart rate breathing and bloodoxygen levels. This information called a polysomnogram lets doctors see whether the patient has stopped breathing and for how long. Apnea in adults happens when seconds pass without breathing for children its a disruption of two cycles of inhaling and exhaling. Some patients can also use portable sleep monitors to record whats happening in their sleep as an alternative to the sleep study but that approach is not as comprehensive. Many sleep disorders can be diagnosed without costly sleep studies which can run anywhere from to severalthousand dollars. More children are undergoing sleep studies as awareness of the condition particularly in children rises. The American Academy of Sleep Medicine http says about percent of children have obstructive sleep apnea. Before a sleep study is ordered doctors typically ask for medical and sleep histories http and a physical exam. Eliza Barclay No less a personage than President Obama dissed tonsillectomy when he was stumping for health care overhaul in July . In a prime time news conference http_doctors_taking_tonsils_out_for_money_instead_of_diagnosing_it_as_allergies.html Obama said that doctors may think You know what I make a lot more money if I take this kids tonsils out. Rosenfeld disputes Obamas claim saying insurers usually pay a surgeon to for tonsil surgery. Sleep Study Before Tonsillectomy The picture is further clouded because not all children with big tonsils have sleepdisordered breathing or frequent throat infections. Because of that in the American Academy of Pediatrics httpaappolicy.aappublications.orgcgicontentfullpediatrics recommended that children have a sleep study before surgery is considered. About tonsillectomies are performed in the United States each year. Obviously parents could use some help in deciding whether surgery is needed. In January the American Academy of Otolaryngology issued its first guidelines on tonsillectomy http in children. With sore throats the ENTs recommend waiting and treatment with antibiotics if needed unless a child has more than seven infections in a year. Theyd recommend surgery if a child has five or more throat infections a year for two years or three or more in three years. There have been very few randomized studies on the effects of tonsillectomy for sleepdisordered breathing. Most of the researchers have asked parents or children whether they noticed improvements and looked at a single measure like behavior or quality of life. Still the ENTs recommend tonsillectomy for sleepdisordered breathing saying it reduces symptoms in most children. Tylers family decided to go ahead with the surgery they went to the hospital at a.m. and Tyler was home by noon. The doctors said he would be out of school for a week but a throat infection kept him home a second week. His classmates sent him getwell cards. A year later Tyler is feeling great. And his snoring is gone. Completely gone his mom says. You can hear a pindrop quiet when he sleeps. Tyler still hears snoring at night he says. But he knows that the culprit is not him or the family dog. Its Dad."

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

"A study finds that use of virtual colonoscopy a noninvasive way of scanning the colon for potentially cancerous growths is on the rise. Thats a bit of a surprise given that not all medical experts agree on whether the virtual screen is as reliable as a traditional colonoscopy in which doctors insert a scope with a small camera into the colon. Plus Medicare does not currently reimburse patients for routine screening with virtual colonoscopy but does cover evaluations with colonoscopy. Add to that the aggressive public awareness campaign for colonoscopy screening led by celebrities like Katie Couric who allowed TV cameras in as she got her first test and its clear why more people are familiar with the scope than with its virtual cousin. But in spite of those challenges Megan McHugh at the Health Research and Educational Trust in Chicago and her team report that about of hospitals in the U.S. now offer the screening test up from in . As its name implies virtual colonoscopy is way to survey the colon without actually using a scope. Patients lie in a CT scanner which takes a series of pictures from a variety of different angles and a computer compiles the snapshots in two different ways. The images can be viewed as two dimensional CT scans which display any possible abnormalities protruding from the lining of the colon. Or the images can be combined to generate a D view of the colon allowing the doctors to fly through the organ looking for any suspicious growths or protrusions. The prep for both the virtual and actual colonoscopy is the same the dreaded colon cleanse that many patients find is the worst part of the procedure. The night before the test they start drinking clear liquids and take agents to loosen their stools and empty their colon so any remaining debris isnt mistaken for a tumor during the screen. While the virtual colonoscopy does not require the sedation and insertion of a scope that colonoscopy does it involves exposure to a small amount of radiation. But according to Dr. Marc Gollub director of CT and gastrointestinal radiology at Memorial SloanKettering Cancer Center the radiation is much lower than a regular CT scan and has not been proven to be of any risk. Its similar to the exposure from cosmic radiation you might get on a long airplane flight. While a growing body of data suggest that virtual colonoscopy is as sensitive as colonoscopy in picking up potential tumors not all cancer experts agree that its a good alternative to the goldstandard scope. While the American Cancer Society the American College of Physicians and other gastroenterology experts recommend virtual screening every five years the U.S. Preventive Services Task Force a congressionally mandated but nonfederal independent group of medical experts concluded the evidence wasnt strong enough to justify Medicare coverage of the service. So which one is right for you Virtual colonoscopy is a good option for those who cant be sedated for colonoscopy or who simply cant tolerate the scope. In McHughs survey hospitals reported that these patients make up the bulk of their use. And given the relatively low cost of investing in the software and other equipment required to run a virtual scan more hospitals may be adding the option to their patient services. The virtual scan does involve radiation exposure and if doctors find an abnormality that needs to be removed youll have to undergo a colonoscopy anyway to avoid another colon cleanse consider scheduling a colonoscopy on the same day in case tumors need to be removed. But Gollub notes that only about of healthy adults getting regularly screened actually have tumors. Given the fact that more hospitals are offering virtual colonoscopy its worth discussing with your doctor. In the end its a matter of personal preference its less important how you get screened just that you do get screened."

"When a suspicious lesion shows up in the lungs on a CT scan the first thing your doctor wants to know is whether its cancerous. A specialist will pass a long thin bronchoscope http into your airway in the hope of grabbing a few cells of the growth so they can be examined under a microscope. But some of these lesions or nodules are deep in the small branches of the lungs out of reach of the bronchoscope which is about the diameter of a pen. Other times the results are inconclusive. That has left only two ways to determine whether the abnormality is cancerous inserting a needle through the chest wall and into the tumor or surgically opening a patients chest to find it and remove it if necessary. The first procedure carries a percent risk of collapsing a lung pneumothorax as well as infection. The second is serious surgery that requires general anesthesia and results in the loss of lung tissue. Both are inpatient procedures that carry the cost and other risks of hospitalizations. In about a third of the surgeries the growth turns out to be benign meaning the surgery was unnecessary. But now according to a study published Sunday in the New England Journal of Medicine http_home there appears to be a new much less invasive way of determining whether a growth is malignant. Researchers at Boston University have discovered that the thin epithelial cells that line the entire airway show changes that indicate whether a growth is malignant. With small brushes on the bronchoscope they can take some of those cells and using genomic testing that has been available only in recent years reach a conclusion. Breast cancers predicted to rise by percent by http The study released Sunday showed that the tests were about percent accurate on subjects. A private company has purchased the technology and is making it available to hospitals across the country. Even though lung cancer tends to develop deep in your lung all the cells that line your airway are exposed said Avrum Spira a professor of medicine at Boston University who led the research. They have changes in their genome. Spiras test focuses on messenger RNA the molecules that express genes instructions to cells. He called the technology a canary in the coal mine for lung cancer which kills about people in the United States each year. If the test is negative its accuracy will allow doctors to wait and watch a lesion. If it shows a malignancy a biopsy still would be needed to confirm the cancer. There will still be a small number of biopsies Spira said. But were going to reduce them significantly. Other research is being conducted to find markers for lung cancer though much of it focuses on substances that can be found in the blood Spira said. With the vast majority of lung cancer victims being smokers the epithelial cells show changes that could be tracked once the technology became available he said. The next logical question is whether those changes might be detected early enough to predict and prevent lung cancer. Spira said his team already is working on research to determine whether thats possible. Woman denied bank transaction after chemotherapy erases her fingerprints http The current advance was a long time in coming and shows the difficulty of bringing research from the lab to the consumer. Spira said the initial discovery was made years ago but he couldnt find any private group willing to put up the millions of dollars needed to conduct studies work through the government and academic regulatory process and bring his idea to market. Seven years ago he formed his own company raised venture capital and eventually proved that his idea worked. Now his company has been purchased by Veracyte which will take over the production and marketing of the Bronchial Genomic Classifier. We were adding seconds to a minute to the length of a bronchoscopy Spira said. . . . Even then the regulatory hurdles were significant. We got over them all but they were significant. Correction The original version of this post incorrectly named the company that is distributing the Bronchial Genomic Classifier. This version has been corrected."

"Nearly every American who has become a parent in the last decade has heard the slogan breast milk is best and has likely been encouraged to offer breast milk to newborns. Among other things breast milk contains natural sources of prebiotics small indigestible fiber molecules that promote the growth of good bacteria in the babys gut. Yet for many families breastfeeding is difficult or impossible. Fortunately modern infant formulas are getting closer to the real thing with the help of University of Illinois researchers. In a recent study from the Piglet Nutrition and Cognition Lab at U of I scientists worked with piglets to show prebiotics included in infant formula can enhance memory and exploratory behavior. When we provide prebiotics in formula our results confirm that we can not only benefit gut health which is known but we can also influence brain development says Ryan Dilger associate professor in the Department of Animal Sciences Division of Nutritional Sciences and Neuroscience Program at U of I. We can actually change the way piglets learn and remember by influencing bacteria in the colon. Piglets are widely considered a more informative model for human infants than mice and rats their digestive systems behavioral responses and brain development are remarkably similar to human infants. Therefore researchers are increasingly turning to piglets to test hypotheses in preclinical trials related to human health especially in the context of gut microbes and brain development. There hasnt been a lot of work looking at the gutbrain axis in humans but a lot of rodent work is showing those connections. This is taking it to an animal model that is a lot closer to human infants and asking if that connection still exists and if we can tease out possible mechanisms says Stephen Fleming lead author of the study and a doctoral student in the Neuroscience Program at U of I. In early Dilger and his colleagues worked with piglets to show that a combination of innovative formula components including prebiotics may play a role in brain development and behavior. In their new study the team concentrated solely on the effects of prebiotics. Starting on the second day of life piglets were given a cows milkbased infant formula supplemented with polydextrose PDX a synthetic carbohydrate with prebiotic activity and galactooligosaccharide GOS a naturally occurring prebiotic. When the piglets were days old Fleming took them through several learning memory and stress tests. After days blood brain and intestinal tissues were collected for analysis. The test for learning and memory gave piglets a chance to play with dog toys one theyd seen before and one brandnew toy. If they spent more time with the new toy that was an indication that the piglet recognized it as new and preferred it. This novel object recognition test improves on classic maze tests commonly used in rodent studies. If youre trying to test for memory this test is closer to what wed do with an infant. After all we dont generally train infants on mazes Fleming says. We know from previous research this test works for pigs but this is the first published example of using it in a nutrition context. Pigs fed PDX and GOS spent more time playing with new objects than pigs who didnt receive the prebiotic supplements. The preference for novel objects an indication of natural curiosity is a sign of healthy brain development and points towards positive development of learning and memory. When prebiotics are working the way they should good bacteria increase in abundance. One way to tell is by looking at metabolic endproducts volatile fatty acids VFAs excreted by bacteria during digestion of prebiotic fibers. Volatile fatty acids are a global indicator for whether prebiotics had an effect on the overall population of bacteria. For example we might want to see an increase in Lactobacillus and other beneficial bacteria that produce butyrate Dilger explains. Volatile fatty acid VFA concentrations in the colon blood and brain were changed in pigs receiving PDX and GOS compared with control pigs. Recent evidence suggests that bacterial VFAs could be getting into the blood and traveling to the brain where they could potentially affect mood and behavior. We found that yes VFAs are absorbed in the blood of pigs that were fed PDXGOS. And yes they do get into the brain Fleming explains. But when we looked at the relationship between these VFAs and the results of our behavior tests there did not appear to be a clear connection. Another surprise was a decrease in serotonin in brains of pigs fed the prebiotic. When you hear less serotonin theres an immediate reaction to say Well thats bad Fleming says. Not necessarily those pigs didnt show greater anxiety than control pigs during a stress test or poorer performance when given a learning and memory test. The researchers hypothesize that the prebiotics may alter levels of tryptophan serotonins amino acid precursor but its too early to say. Although more work is needed to tackle remaining questions the study adds to the growing body of research suggesting a strong and potentially modifiable link between the gut and the brain a link that makers of infant formula should strongly consider. There are so many ways we can alter the composition of the microbiota and they can have very strong benefits. Promoting good gut health remains a strong focus in the field of nutrition Dilger says. The article Dietary polydextrose and galactooligosaccharide increase exploratory behavior improve recognition memory and alter neurochemistry in the young pig is published in Nutritional Neuroscience. Fleming and Dilgers coauthors include Supida Monaikul Alexander Patsavas Rosaline Waworuntu and Brian Berg. The work was supported by Mead Johnson Nutrition."

"Acupuncture can help alleviate the oftendebilitating hot flashes that afflict many breast cancer patients new Italian research says. Noting that hot flashes are a fact of life for many women with breast cancer the investigators found that pairing lifestyle advice with weekly acupuncture sessions dramatically improved the womens quality of life. Acupuncture together with enhanced selfcare for three months is effective in reducing hot flashes in women with breast cancer said study author Giorgia Razzini a clinical trial project manager in the oncology unit of Ospedale di Carpi Carpi Hospital in Bologna Italy. And because hormone treatment for breast cancer typically makes the hot flash experience even worse Razzini added acupuncture could be a useful tool for helping such patients stay on their therapy and improve their quality of life. Razzini and colleagues published their findings online March in the Journal of Clinical Oncology. In the study the Italian team focused on breast cancer patients who had reported moderate or worse hot flashes while undergoing treatment at five cancer hospitals and one primary health care center in northern Italy between and . The patients whose average age was were randomly split into two groups. One group of patients was offered a threemonth regimen of selfcare advice on diet exercise and psychological support. The second group of was offered the same advice in the same time frame along with halfhour weekly sessions of traditional acupuncture. All of the participants kept hot flash diaries. At the end of the threemonth period and for up to six months thereafter daily hot flash experiences were assessed for changing severity and frequency. The result by the end of the treatment period those in the acupuncture group were found to have hot flash scores that were percent lower than those in the nonacupuncture group. The finding continued to hold up for a halfyear after the acupuncture sessions ended. Those in the acupuncture group also seemed to have a generally higher overall quality of life in terms of both physical and mental health with no serious side effects the study authors said. So why does acupuncture seem to work Razzini cited several reasons including acupunctures ability to prompt blood vessel dilation in the patients nervous system while stimulating the release of endorphins a neurotransmitter that interacts with brain cells involved in the regulation of pain and emotion. It also triggers the release of the stress hormone norepinephrine as well as the mood regulator serotonin. Razzini didnt know how much American patients might have to pay for such treatment but added Compared to other effective treatments such as antidepressants acupuncture should be less expensive and for sure more safe and feasible. Dr. Courtney Vito a breast oncologic surgeon at the City of Hope Comprehensive Cancer Center in Duarte Calif. was pleased that a serious issue in breast cancer treatment is getting a closer look. Anyone who treats breast cancer struggles with this problem in their practice because the hot flashes that some women experience with antihormonal treatment can be profound she said. Almost all women experience them. For some its a moderate situation but for others its a really significant problem. Some women I would say probably about percent have such severe hot flashes that they even refuse to take medications that can cut their risk for cancer or cancer recurrence by percent simply because they cant handle the hot flashes Vito explained. And Ive actually had patients who have had acupuncture with good success so Im not surprised by the finding she added. But it is heartening that we now have scientific proof that this can work. Which in the end may help to encourage insurance companies to their expand coverage so this can become an affordable option for all patients in need. More information Theres more on cancer and hot flashes at the U.S. National Cancer Institute http SOURCES Courtney Vito M.D. breast oncologic surgeon and assistant clinical professor City of Hope Comprehensive Cancer Center Duarte Calif. Giorgia Razzini Ph.D. clinical trial project manager oncology unit Ospedale di Carpi Bologna Italy March Journal of Clinical Oncology"

"An international phase trial has found that the drug regorafenib improved survival in patients with advanced hepatocellular carcinoma HCC a form of liver cancer giving people who previously had no other options a better chance at survival. Results from the study which included researchers at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai were recently published online in The Lancet http The trial funded by Bayer included sites in countries. About percent of HCC cases are diagnosed at advanced stages a point when HCC is particularly difficult to treat. This trial provides evidence that regorafenib is the first systemic treatment for patients whose HCC progressed during treatment with sorafenib the only other drug with proven clinical benefit. This study tested regorafenibs effectiveness as a secondline therapy on patients previously treated with sorafenib of whom were given a placebo. Regorafenib a multikinase inhibitor significantly improved overall survival from . months on placebo to . months with regorafenib. Two patients treated with regorafenib had their tumor shrink to an undetectable level according to the study. This study represents a breakthrough in the management of hepatocellular carcinoma since it provides evidence for clinical benefits in an area that was an unmet medical need said Josep M. Llovet MD founder and Director of the Liver Cancer Program and Professor of Medicine and Liver Diseases at the Icahn School of Medicine at Mount Sinai. Regorafenib has shown it can improve survival in patients with advanced hepatocellular carcinoma progressing on sorafenib. Previously no treatment was available for these patients. Dr. Llovet was a member of the clinical trials steering committee and Charissa Chang MD Assistant Professor of Medicine and Liver Diseases at the Icahn School of Medicine was principal investigator of the Mount Sinai testing site. The success of this trial opens the field for testing drugs in thirdline treatment of HCC and provides a rationale to test regorafenib as a firstline treatment or in combination with therapies administered directly into the tumor or diseased liver in patients in an earlier stage of HCC according to Dr. Llovet. In this trial regorafenib was welltolerated with manageable adverse events according to the paper in Lancet. In January Bayer announced that the U.S. Food and Drug Administration FDA had granted priority review status for Stivarga regorafenib as a secondline systemic treatment for patients with hepatocellular carcinoma. This research was also presented during the European Society of Medical Oncologys World Congress on Gastrointestinal Cancer in June. Liver cancer is the secondleading primary cause of cancerrelated deaths worldwide."