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"The red berries of a weed found in the southern United States contain an compound that can disarm a deadly superbug according to research published Friday. Researchers from Emory University and the University of Iowa found that extracts from the Brazilian peppertree which traditional healers in the Amazon have used for hundreds of years to treat skin and softtissue infections have the power to stop methicillinresistant Staphylococcus aureus MRSA infections in mice. The study was published in Natures Scientific Reports. http Cassandra Quave an Emory University scientist who studies how indigenous people use plants in healing practices said researchers pulled apart the chemical ingredients of the berries and tested them in mice infected with these superbug strains. The mice got injections containing the bacteria with or without the plant extracts. Those that didnt receive the extracts developed skin lesions. But in the other mice the extracts a mixture of chemicals prevented skin lesions from forming. Instead of destroying the bacteria the ingredients in the fruit weakened the bacteria by preventing them from producing the toxins it uses as weapons to damage tissue. The extracts from the fruit repress a gene that allows the bacterial cells to communicate with one another. It weakens the bacteria so the mouses own defenses work better to clear the infection she said. The plant extracts didnt harm the skin tissues or the normal healthy bacteria found on skin. The discovery may hold the potential for new ways to treat and prevent antimicrobialresistant infections an enormous global problem that was the focus of a rare highlevel United Nations summit https_term.beaaad last fall. MRSA has become a serious threat to human health in it was responsible for more than invasive infections and more than deaths in the United States according to federal statistics. Antimicrobial resistance refers to infections that have evolved the ability to withstand drugs that ought to stop them. The medicines include antibiotics which act on bacteria as well as drugs to fight fungal https viral or parasitic infections. Fighting bacteria with drugs designed to kill them helps fuel the problem of antibiotic resistance if stronger bacteria can survive and evolve to become superbugs. But instead of always setting a bomb off to kill an infection there are situations where using an antivirulence method may be just as effective while also helping to restore balance to the health of the patient said Quave. Researchers say the red berries of this weedy species the Brazilian peppertree contain an extract that can disarm a deadly superbug. Photo Emory University Plants have been used repeatedly in traditional medicine over the centuries and knowledge about their use is passed down from generation to generation which points to their efficacy she said. People dont save that knowledge over centuries if something doesnt work she said. Were trying to answer the question Does this work against bacteria and how does it work and is it safe to use The Brazilian peppertree a shrubby tree native to South America is an invasive species throughout the southern United States particularly in Florida where its sometimes called the Florida holly or broadleaf peppertree and is considered a noxious weed. The woody plant has long been a staple in Brazilian traditional medicine. Its leaves and bark are used to treat wounds ulcers burns and skin infections Quave said. Less is known about the plants fruit which was used traditionally as topical poultices for infected wounds and ulcers. From an ecological standpoint Quave said it makes sense that invasive weeds have a chemical advantage that may help protect them from diseases so they can spread more easily in a new environment. But she said the average person shouldnt try to use the weed to make their own medicine. Not everything that is natural is safe she said. Her lab at Emory is doing additional research to confirm the safest and most effective way of using the plant extract. Researchers would still need to conduct preclinical trials to test its medicinal benefits."

"In the past multiple sclerosis patients were advised not to exercise for fear of exacerbating the illness. However it is now known that physical training can relieve many of the symptoms including the excessive fatigue and mobility impairments that are often seen. New research now shows that resistance training may protect the nervous system and thus slow the progression of the disease. This is the main finding of a study conducted by a research partnership between Aarhus University Aarhus University Hospital the University of Southern Denmark and the University Medical Center HamburgEppendorf that has just been published in Multiple Sclerosis Journal. The study shows that resistance training has a number of positive effects on the brain which go beyond what can be achieved through effective disease specific medication. Over the past six years we have been pursuing the idea that physical training has effects on more than just the symptoms and this study provides the first indications that physical exercise may protect the nervous system against the disease says one of the researchers behind the study Associate Professor Ulrik Dalgas from the Department of Public Health at Aarhus University. For the past years we have known that physical exercise does not harm people with multiple sclerosis but instead often has a positive impact on for example their ability to walk their levels of fatigue their muscle strength and their aerobic capacity which has otherwise often deteriorated. But the fact that physical training also seems to have a protective effect on the brain in people with multiple sclerosis is new and important knowledge says Ulrik Dalgas. In the study the researchers followed people with multiple sclerosis for six months. Half of the group engaged in resistance training twice a week while the other half continued to live their lives normally without systematic training. Prior to and following the sixmonth period the test subjects had their brains MRscanned and the researchers could see that there was a tendency for the brain to shrink less in those patients who undertook resistance training. Among persons with multiple sclerosis the brain shrinks markedly faster than normal. Drugs can counter this development but we saw a tendency that training further minimises brain shrinkage in patients already receiving medication. In addition we saw that several smaller brain areas actually started to grow in response to training says Ulrik Dalgas. The researchers behind the study are still unable to explain why training has a positive effect on the brain in people with multiple sclerosis. A bigger and more indepth ongoing study will help to clarify this and may also lead to improved treatment options says Ulrik Dalgas. However he stresses that the aim is not to replace medication with physical training. Phasing out drugs in favour of training is not realistic. On the other hand the study indicates that systematic physical training can be a far more important supplement during treatment than has so far been assumed. This aspect needs to be thoroughly explored says Ulrik Dalgas. It is not yet clear whether all people with multiple sclerosis can benefit from this type of exercise as it has not been sufficiently tested in the more severely affected patients. Therefore Ulrik Dalgas is not recommending that all multiple sclerosis patients throw themselves into intensive physical training regimes without first seeking professional advice. Facts Multiple sclerosis is an incurable disease of the central nervous system. There are about twice as many women as men with multiple sclerosis. Eighty per cent of people with multiple sclerosis live with the disease for more than years. The disease is found in both aggressive and more benign forms. The cause of the illness is unknown but both genetic and environmental factors play a role. Source http"

"Yoga does the body good and according to a new study it may ease the mind as well. Yoga has also become such a cultural phenomenon that it has become difficult for physicians and consumers httptopics.time.comconsumers to differentiate legitimate claims from hype researchers from Duke University Medical Center write in their study published http_Disorders_and_Psychosomatic_Research.fpsyt..abstract in the journal Frontiers in Psychiatry. In order to explore the widely held belief that practicing yoga can relieve mental stress httptopics.time.comstress the team reviewed more than studies on the effect of yoga and mental health. Most individuals already know that yoga produces some kind of a calming effect. Individually people feel better after doing the physical exercise says lead study author Dr. P. Murali Doraiswamy a professor of psychiatry and medicine at Duke University Medical Center. Mentally people feel calmer sharper maybe more content. We thought its time to see if we could pull all the literature together to see if theres enough evidence that the benefits individual people notice can be used to help people with mental illness. MORE Yoga Can Help Stroke Survivors Regain Their Balance httphealthland.time.comyogacanhelpstrokesurvivorsregaintheirbalance Their findings suggest that yoga does in fact have positive effects on mild depression httptopics.time.comdepression and sleep problems and it improves the symptoms of psychiatric disorders like schizophrenia and ADHD among patients using medication. The researchers focused on studies that recorded the effects of practicing yoga on mentalhealth issues ranging from depression schizophrenia ADHD sleep complaints and eating disorders to cognitive problems. They found positive effects of the mindandbody practice for all conditions with the exception of eating disorders and cognition. Those studies involved too few participants or produced conflicting results to draw any meaningful conclusions. Some of the studies included in the analysis even suggested that yoga might affect the body in ways similar to antidepressants and psychotherapy. For instance yoga may influence brain chemicals known as neurotransmitters boosting levels of feelgood agents like serotonin lower inflammation reduce oxidative stress and produce a healthier balance of lipids and growth factors just as other forms of exercise do. MORE We Tried This Aerial Vinyasa or UpsideDown Yoga httphealthland.time.comwetriedthisaerialvinyasaorupsidedownyoga Embracing yoga as a complementary treatment for mental disorders is not uncommon. Yoga is a feature in many veterans centers throughout the country backed by research http_highlightsyoga.cfm funded by the Department of Veterans Affairs. The Huffington Post reported http_n_.html that many troops use yoga as a form of treatment for PTSD for example with companies like Warriors at Ease httpwarriorsatease.com training instructors in yoga techniques specifically catered to those in the military. A study published httpajot.aotapress.netcontent.abstract earlier this month of activeduty troops found daily yoga eased anxiety and improved sleep. The researchers say theres enough evidence to warrant a larger study on the effects of yoga on mental health and it should be considered as part of treatment for more disorders. Many millions of Americans are doing yoga and many millions of Americans have mental illnesses and are popping psychiatric pills daily. Despite all of this the vast majority of studies looking at the benefits of yoga are all small studies. We did not come across a single study where there was a coordinated effort done by some large agency to really conduct a large national study says Doraiswamy. MORE Does Yoga Really Drive People Wild with Desire httphealthland.time.comdoesyogareallydrivepeoplewildwithdesire But while the research is promising yoga likely wont be a panacea for mental illness. Nor should patients try to replace their medications with the practice. What we are saying is that we still need to do further largescale studies before we are ready to conclude that people with mental illnesses can turn to yoga as a firstline treatment says Doraiswamy. We are not saying throw away your Prozac and turn to yoga. Were saying it has the promise and potential. If a large national study were done it could turn out that yoga is just as good and may be a low cost alternative to people with unmet needs. In the meantime he says it doesnt hurt to add yoga to existing treatments so patients can take advantage of any potential benefits."

"A multidisciplinary team of researchers has developed a new diagnostic test that can change the medical landscape by making it possible for patients to quickly determine if they are infected with an illness using a simple paper test sensitive enough to detect markers of various illnesses using minute amounts of blood sweat or other biological material. The test developed by biochemists engineers and chemists at McMaster University features an allinclusive patch of reactive material or reagent printed on paper that changes colour to indicate the presence of a biological marker for a specific bacterium virus or even cancer. Its a very simple device that anyone can use says Yingfu Li a professor of Biochemistry and Biomedical Sciences at McMaster and one of the authors of a new paper in the German chemistry journal Angewandte Chemie. Theres a huge need for this type of technology. Li explains that the platform can be manufactured cheaply and easily formulated to detect biological markers for a huge range of illnesses. Only a tiny sample of blood sweat or other fluid is required since the test works by detecting and amplifying the target DNA or RNA sequence in a sample. A single molecule of the target can be multiplied thousands of times producing a visible result. Conceivably a user could swab a doorknob or dip it in a toilet bowl to test for Ebola for example. The test is the latest in a series of related developments to emerge from the Biointerfaces Institute whose mission is to create useful new substances that combine biological agents and physical materials. The new test involves printing of all required components needed to amplify a DNA or RNA target directly on paper says the institutes director John Brennan. The user only needs to add the sample to the paper and wait a few minutes for a color to develop. The test material is suspended in pullulan a naturally derived polymeric sugar that is also the platform for the familiar Listerine breath strips. Pullulan allows the testing materials to remain viable for months until used. The new test which could be commercialized quickly the researchers say can diagnose infections even before patients feel symptoms. During cold season for example patients could save trips to the doctor and exposing the public by testing themselves at home. The test can also quickly differentiate between illnesses that share similar symptoms such as headache fever or diarrhea permitting a quick diagnosis and earlier treatment. Because it is portable inexpensive and requires no other equipment the technology which can be printed on paper by an inkjet printer could be used in many environments such as homes and airports and in remote locations. Research funding was provided by the Natural Sciences and Engineering Research Council of Canada Ontario Centres of Excellence and ProLab Diagnostics Inc. SEE ORIGINAL STUDY httponlinelibrary.wiley.comdoi.anie.full"

"The Food and Drug Administration approved a new drug on Tuesday to treat serious cases of eczema. The drug called Dupixent is a twiceamonth injection under the skin. Patients can do it at home. Itll cost a year but the drugs makers Regeneron Pharmaceuticals and Sanofi have stressed thats the wholesale price and make a point of saying there will be programs to help people pay for it. Its approved for people with atopic dermatitis a catchall term for itchy skin caused by allergy. It can be very unpleasant. The cause of atopic dermatitis is a combination of genetic immune and environmental factors. In atopic dermatitis the skin develops red scaly and crusted bumps which are extremely itchy the FDA says. Scratching leads to swelling cracking weeping clear fluid and finally coarsening and thickening of the skin. There are many treatments out there now from simple skin lotions to steroid creams and immune suppressant drugs like tacrolimus. But none of these works for everybody and the immune suppressant drugs can raise the risk of cancers such as lymphoma. People with moderate to severe atopic dermatitis cope with intense sometimes unbearable symptoms that can impact them for most of their lives. Dupixent is for the hardcore cases that arent helped by anything else. Its a monoclonal antibody a targeted immune system drug that inactivates two inflammatory compounds called interleukin or IL and IL. By binding to this protein Dupixent is able to inhibit the inflammatory response that plays a role in the development of atopic dermatitis the FDA said in a statement. Known generically as dupilumab the drug can cause serious allergic reactions and eye inflammation. The most common side effects include injection site reactions cold sores in the mouth or on the lips and eye and eyelid inflammation including redness swelling and itching the FDA notes. The agency gave it both priority review and breakthrough therapy status speeding it through the approval process. Studies of about people showed Dupixent injections resulted in clear skin or nearly clear skin for about twothirds of those who tried it and it reduced itching sharply in percent. People with moderate to severe atopic dermatitis cope with intense sometimes unbearable symptoms that can impact them for most of their lives Julie Block president and CEO of the National Eczema Association said in a statement provided by the company. Of the adults with uncontrolled moderate to severe atopic dermatitis in the United States it is estimated that are most in need of new treatment options Regeneron said. In a nod to the sensitivity around drug prices the company stressed that there is no single price for the drug. The Wholesale Acquisition Cost WAC of Dupixent in the United States is annually. Actual costs to patients payers and health systems are anticipated to be lower as WAC pricing does not reflect discounts rebates or patient assistance programs http it said."

"Whether youre an athlete or a whitecollar worker most Americans have suffered minor to severe knee pain at some point especially as they age even everyday wear and tear can damage a healthy set of knees. According to the Centers for Disease Control and Prevention CDC nearly in people may develop symptomatic knee osteoarthritis by the age of . While there are several types of treatments to help such as physical therapy surgery and medications there are still no guarantees. Essie Jarrett of Brooklyn N.Y. has undergone knee surgery nine times to treat her chronic knee pain. I had surgery but the pain it wasnt getting better it was getting worse Jarrett told FoxNews.com. And no matter what they tried on me it didnt work. Nothing worked. Frustrated with living a life in pain Jarrett turned to Dr. Halland Chen httpdrhalland.com a knee specialist in New York City who offered a new nonsurgical treatment known as the iovera system. The iovera works in a very novel fashion. It actually harnesses the power of focus cold therapy Chen told FoxNews.com. The iovera treatment uses a handheld device with nitrous oxide canisters to freeze short needle probes to negative degrees. Once injected into the skin the cold therapy kills away targeted sensory nerves around the knee which prevents the nerve from sending pain signals. Within to minutes weve frozen away the nerve and the patient will know immediately if they have good results Chen said. Chen says he typically sees people with arthritis or those who have had total knee replacements and still struggle with residual pain. The iovera treatment is cleared by the FDA and is designed to provide temporary pain relief for up to six months after a single session. The interesting thing that makes it very safe is one of the reasons why it doesnt last forever because youre not permanently damaging or killing off the nerves the nerves do regenerate and grow back over time Chen said. Even though the procedure does not correct or cure a patients knee problem Chen says it allows them to regain function and mobility so they can get through physical therapy and regain strength. And as for the pain you might feel during the treatment patient Charles Bradshaw said it didnt hurt at all. No discomfort at all its easier than getting a tattoo Bradshaw who recently received the iovera treatment told FoxNews.com. For comfort local anesthesia is applied to the area before treatment. Its been three months since I had the treatment my knee is fine and it doesnt hurt. And I do so much moreso much more. I go out a lot I play with my grandkids. Everything that I had trouble doing before I do it now Jarrett said. Most insurance companies do not cover the procedure and payment can cost around per treatment. For more information visit ioverahealth.com httpioverahealth.com.index.php."

"Electroencephalogram EEG a test that shows the electrical activity of the brain might be used to spot autism in children a new study suggests. The study conducted by researchers at Harvard University Medical School looked at the synchronization of brain activity across different brain regions as measured by EEG. These scientists used sensors to record electrical brain activity across many different regions on the scalp explained Geraldine Dawson chief science officer at the advocacy group Autism Speaks. They then looked at the extent to which brain activity from one region was synchronized with brain activity from another region a phenomenon known as EEG coherence said Dawson who was not involved in the research. Synchronization between different brain regions indicates that those regions are functioning in a coordinated rather than independent fashion in other words they are functionally connected and communicating with each other she said. In the new study Dr. Frank Duffy and Dr. Heidelise Als compared EEG measurements of nearly children with and without autism. They found that the two groups had widespread differences in terms of brain connectivity. EEG revealed that the children with autism had a reduced short range connectivity indicating poor function of local brain networks. This was especially true in the left hemisphere regions of the brain responsible for language. The children with autism also had increased connectivity between brain regions that were farther apart which might be a mechanism developed to compensate for reduced short range connectivity the researchers said. The research was conducted at Boston Childrens Hospital and was published online June in the journal BMC Medicine. The use of EEGbased testing may help diagnose autism in children and may improve early detection in infants leading to more effective treatments and coping strategies the researchers said. What was unique about this study is the very large number of children studied Dawson noted. Consistent with many previous studies using EEG and functional MRI with both children and adults with autism these investigators found that overall children with autism show reduced coordination coherence across brain regions. She said the findings are important because they help us understand why individuals with autism have difficulty with complex behaviors such as social interaction and language. As childrens brains develop the different brain regions become increasingly connected allowing for the acquisition of complex behaviors that require coordination across different brain regions. Language for example requires coordination across the auditory visual and motor brain regions as well as the participation of the prefrontal cortex she said. This reduced functional connectivity in the brain helps us understand impairments associated with autism she added. The hope is that early behavioral intervention can help mitigate these functional impairments helping to form the connections that natural develop in typical children. Another expert agreed. Although autism is still principally a clinical diagnosis this study ... may allow for a new approach to classifying children with autism and may even assist in the early identification of affected children at a younger age said Dr. Andrew Adesman chief of developmental and behavioral pediatrics at the Steven Alexandra Cohen Childrens Medical Center of New York in New Hyde Park NY. The number of children diagnosed with autism in the United States has recently increased to one in . More information The U.S. National Institute of Neurological Disorders and Stroke has more about autism http_autism.htm. SOURCES Geraldine Dawson Ph.D. chief science officer Autism Speaks Andrew Adesman MD chief of developmental behavioral pediatrics Steven Alexandra Cohen Childrens Medical Center of New York New Hyde Park NY BMC Medicine news release June"

"Doctors are experimenting with new technology that could give them a more complete view of the large intestine than ever before improving the odds of finding potentially cancerous growths earlier. Dr. Arie Kaufman of SUNY Stony Brook demonstrated the virtual colonoscopy for CBS New Yorks Dr. Max Gomez. Well have both the computer and the doctors working in tandem to find polyps and find cancers Kaufman said. He added it could lead to better and earlier detection of colon polyps. Virtual colonoscopy screening uses CT scans to create color D images of the colon the final portion of the large intestine. Special computer animation enables a doctor to view the organ in remarkable detail. Regular colonoscopy physically examines the colon by inserting a lighted probe into the intestine and requires a sedative. Both have made early detection and treatment https more precise. This next step in virtual colonoscopy called immersive colonoscopy projects D images of the colon large enough to fill the walls of a room. Doctors can then walk through the colon and explore many different angles. We have the side view and the back view said Kaufman. This will allow the physician to view percent of the surface including lesions which are hidden behind folds maybe seen on the side and back walls. Such highly specific screening may allow doctors to detect more abnormal growths https called polyps when they are as small as . mm so they can be removed before they become fullblown cancer tumors. For the patient a virtual colonoscopy https is low risk but does involve additional exposure to radiation. It may need to be followed with the physical colonoscopy later as well. Colonoscopies are recommended for adults age and over to help detect early signs of colorectal cancer. Colorectal cancer is the second leading cause of death among the combined group of men and women who have cancer according to the National Institutes of Health http The CDC http says colonoscopy may also be recommended for people experiencing stomach pain aches or cramps that dont go away unexplained weight loss and blood in the stool. More routine DNA tests https and stool sampling https which show signs of bleeding caused by irregular growths can also help detect colon polyps and indicate that the need for a full colonoscopy. The CDC says colonoscopy could reduce the number https of colorectal cancer cases by as much as percent. This new wave of radiologybased colonoscopy could improve those odds further."

"For the millions of Americans with chronic low back pain a silver bullet to alleviate the condition has yet to be identified a new study suggests. Reviewing studies comparing spinal manipulative therapy SMT to other treatments such as medication exercise or physical therapy researchers from the Netherlands found that SMT appears to be no better or worse than other options at relieving back pain longterm. The analyses indicated that SMT which involves manual manipulation of the spine and surrounding muscles has only a shortterm impact on pain relief although it eases pain faster than other treatments. In short no single therapy is better than another although some individuals are likely to have more success with one therapy than another said study author Sidney Rubinstein a research fellow at VU University Medical Center in Amsterdam. Current studies are focusing on which subjects are more likely to benefit from spinal manipulation exercise or other therapies he added. Spinal manipulation should be considered a viable treatment option for those with nonspecific chronic low back pain. The study was recently published in the journal Spine. More than patients were included in the compilation of results which the study authors said were sparse in data indicating participants overall recovery quality of life and ability to return to work. The studies also varied in quality with only nine of considered low in bias according to background information accompanying the study. In all evaluations patients were randomly assigned to SMT or another comparison treatment including active treatments such as exercise or inactive placebo treatments. About twothirds of the studies were not included in a previous review published in and all patients had suffered from lower back pain for weeks or longer. While chiropractors often perform SMT on patients it is also administered by physical therapists and osteopaths. But which treatment is right for any patient depends not only on their specific pain but their doctors recommendations and their own comfort level with various options said Stephen Perle a spokesman for the American Chiropractic Association. The cost of SMT sessions varies widely depending on the region Perle said. Nobody has the answer at this time Perle said. I guess people in almost every profession like to say We have a compelling treatment and it will work almost every time but thats just not the case. With low back pain there are many reasons people dont get better added Perle also a professor of clinical sciences in the College of Chiropractic at the University of Bridgeport in Connecticut. So the finding was not unexpected. An unrelated study of patients with low back pain published July in Annals of Internal Medicine suggested that massage may be better than medication or exercise for shortterm pain relief. Seattle researchers found that those who received either relaxation massage or structural massage which involved manipulation of muscles and ligaments had less pain and better functioning for up to a year compared to those getting usual medical care which included medication and physical therapy. More information The U.S. National Institute of Neurological Disorders and Stroke has more information about low back pain. SOURCES Sidney Rubinstein D.C. Ph.D. research fellow Institute for Research in Extramural Medicine VU University Medical Center Amsterdam the Netherlands Stephen M. Perle D.C. spokesman American Chiropractic Association and professor clinical sciences College of Chiropractic University of Bridgeport Conn. June Spine"

"Some cancer patients who take cholesterollowering statins may live longer than those not on these heart medications a study from Britain suggests. While it did not prove a causeandeffect connection the study of nearly million cancer patients found that those taking statin drugs such as Lipitor and Crestor appeared to have a percent lower risk of dying from lung cancer a percent lower risk of dying from breast cancer a percent lower risk of dying from prostate cancer and a percent lower risk of dying from colon cancer. We need to further investigate the reasons for patients with high cholesterol having improved mortality in four of the most common cancers said senior researcher Dr. Rahul Potluri a clinical lecturer at Aston University School of Medicine in Birmingham. Potluri cautioned however that this study cant prove that statins actually extended life in cancer patients. At this time people without high cholesterol should not be taking statins in the hope of warding off cancer or living longer with cancer he said. People with high cholesterol should be taking statins to lower their cholesterol and reduce their cardiovascular risk he said. We cannot however recommend statins for cancer prevention without a positive clinical trial. For the study Potluri and colleagues collected data on nearly million patients listed in a clinical database from January to March . The database includes information on cancer and other medical conditions including high cholesterol. Data on deaths was obtained from the U.K. Office for National Statistics. Among the patients in the study nearly had lung cancer had breast cancer had prostate cancer and had colon cancer the researchers found. After adjusting for factors that might play a role in dying such as age gender ethnicity and common causes of death the researchers found those taking statins lived longer than those who were not taking them. The results were to be presented Friday at the European Society of Cardiology meeting in Florence Italy. Research presented at meetings is considered preliminary until published in a peerreviewed medical journal. One expert doesnt think sufficient evidence exists yet to take statins to prevent or treat cancer. Regardless of whether or not a person has cancer statin use should be discussed with a health care provider said Eric Jacobs strategic director of pharmacoepidemiology at the American Cancer Society. There is little evidence that statins affect cancer risk or survival but clear evidence that they can help some people lower risk of heart attacks and strokes he said. More information Visit the American Heart Association http_UCM__Article.jsp for more on statins. SOURCES Rahul Potluri M.D. clinical lecturer Aston University School of Medicine Birmingham England Eric Jacobs Ph.D. strategic director pharmacoepidemiology American Cancer Society July presentation European Society of Cardiology meeting Florence Italy"

"For younger patients with severe damage to the rotator cuff muscles a reverse shoulder replacement provides lasting improvement in shoulder function according to a study in The Journal of Bone Joint Surgery httpjbjs.org. The journal is published in partnership with Wolters Kluwer http In the absence of treatment alternatives reverse total shoulder arthroplasty RTSA is a justifiable treatment for patients with a massive irreparable rotator cuff tear before the age of according to the report by Christian Gerber MD of the University of Zurich and colleagues. Despite a substantial risk of complications most patients are satisfied with the outcomes of RTSA at followups of a decade or longer. Stable LongTerm Results of RTSA in Patients Younger than The researchers analyzed the longterm outcomes of RTSA in patients average age years. All had massive irreparable tears of the rotator cuff muscles causing shoulder pseudoparalysiswith little no ability to lift the arm. This group of patients typically gets limited benefit from shoulder replacement with conventional implants which rely on the rotator cuff muscles to provide shoulder movement. The RTSA techniqueusing an implant in which the natural locations of the shoulder ball and socket are reverseduses other muscles to move the shoulder providing an alternative when the rotator cuff is severely damaged or destroyed. When first introduced RTSA was performed mainly in elderly patients who placed low demands on the shoulder. With refinements in technique and components in more recent years the procedure has been used in younger more active patients. But there are concerns about how well the results of RTSA will hold up over time in this group of patients. The new study focused on longterm outcomes of RTSA in patients under age . The patients underwent followup examination between eight and years after surgery average . years. Three patients had RTSA in both shoulders for a total of procedures. Compared to their preoperative status most patients had substantial longterm improvement after RTSA. The average Constant scorea standard assessment accounting for shoulder motion strength daily activities and painat the time of finalfollowup improved from to out of a possible . Patients ratings of subjective shoulder value improved from percent to percent compared to percent for a normal shoulder. Shoulder movement and strength increased while pain decreased. The improvement was similar for patients with and without prior shoulder surgery. However complications occurred in percent of the shoulders. Further surgery was required in six shoulders in two cases the RTSA procedure was considered a failure. When complications occurred longterm shoulder functioning was not as good but even with the high complication rate percent of patients rated their satisfaction level as excellent or good. The results alleviate concerns that the clinical benefits of RTSA might not hold up over time in younger more active patients. Despite its high complication rate Dr. Gerber and colleagues conclude that RTSA provides substantial and lasting improvement in shoulder function and pain in a group of patients with limited treatment options. Click here to read Reverse Total Shoulder Arthroplasty for Massive Irreparable Rotator Cuff Tears Before the Age of Years LongTerm Results. httpjournals.lww.comjbjsjournalAbstractReverse_Total_Shoulder_Arthroplasty_for_Massive..aspxPRIDJBJS_PR_ Article DOI .JBJS.. About The Journal of Bone Joint Surgery The Journal of Bone Joint Surgery httpjbjs.org JBJS has been the most valued source of information for orthopaedic surgeons and researchers for over years and is the gold standard in peerreviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide The Journal publishes evidencebased research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do from the science of the content published to the customer service we provide. JBJS is an independent nonprofit journal. About Wolters Kluwer Wolters Kluwer N.V. AEX WKL is a global leader in information services and solutions for professionals in the health tax and accounting risk and compliance finance and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services. Wolters Kluwer reported annual revenues of . billion. The company headquartered in Alphen aan den Rijn the Netherlands serves customers in over countries maintains operations in over countries and employs people worldwide. Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and the organization visit http follow WKHealth httpstwitter.comwkhealth or Wolters_Kluwer httpstwitter.comWolters_Kluwer on Twitter like us on Facebook https follow us on LinkedIn https or follow WoltersKluwerComms on YouTube http"

"A study that tracked tens of thousands of midlife and older men for more than years has found that vigorous exercise and other healthy lifestyle habits may cut their chances of developing a lethal type of prostate cancer by up to percent. While most prostate cancers are clinically indolent meaning they do not metastasize and are nonlifethreatening a minority of patients are diagnosed with aggressive disease that invades the bone and other organs and is ultimately fatal. Lead author Stacey Kenfield ScD of UCSF and a team of researchers at UCSF and Harvard focused on this variant of prostate cancer to determine if exercise diet and smokefree status might have lifesaving benefits. In the study published today Nov. in the Journal of the National Cancer Institute the researchers analyzed data from two U.S. studies the Health Professionals FollowUp Study that tracked more than males ages to from to and a second the Physicians Health Study that followed more than males ages to from to . To gage the effects of lifestyle habits the researchers developed a score based on the results of the health professionals survey then applied it to the physicians study. They assigned one point for each affirmative response to questions about regular intense exercise that induced sweating body mass index BMI under tobaccofree status for a minimum of years high intake of fatty fish high intake of tomatoes and low intake of processed meat. To reduce error participants had to be free of diagnosed cancer at the start of the study and a fouryear lag was imposed to rule out those who unknowingly had lethal prostate cancer which was determined by evidence of prostate cancer death or metastasis to the bones or other organs excluding the lymph nodes. Cases were confirmed through medical records and pathology reports and cause of death was determined by death certificate and medical record and secondarily by next of kin. Vigorous activity trumps other lifestyle factors The researchers identified cases of lethal prostate cancer in the health professionals group and cases in the physicians group. Participants with to points in the health professionals group had a percent decreased risk of lethal prostate cancer and a percent decreased risk was observed in the physicians group for the same comparison. For dietary factors alone men with three points versus those with zero points had a percent decreased chance of developing lethal prostate cancer in the health professionals group. In the physicians group this decrease was percent. While there were fewer cases and less detailed data collected in the physicians study the score was similar in both populations indicating the potential benefit of healthy lifestyle habits in warding off lethal prostate cancer said the authors. We estimated that percent of lethal prostate cancer cases would be prevented in the United States if men over had five or more of these healthy habits said Kenfield assistant professor in the Department of Urology at UCSF Medical Center and formerly of the Department of Medicine at Harvard Medical School in Boston where the study was initiated. Its interesting that vigorous activity had the highest potential impact on prevention of lethal prostate cancer. We calculated the populationattributable risk for American men over and estimated that percent of lethal prostate cancer would be reduced if all men exercised to the point of sweating for at least three hours a week Kenfield said. The researchers also calculated that lethal prostate cancer among American men over would be cut by percent if they consumed at least seven servings of tomatoes per week and that percent would be spared this diagnosis if they consumed at least one serving of fatty fish per week. Reducing intake of processed meats would cut the risk by percent they reported. In contrast the populationattributed risk for smoking was percent largely because the majority of older American men are longterm nonsmokers. Lifestyle changes also prevent heart disease diabetes This study underscores the ongoing need for more effective prevention measures and policies to increase exercise improve diet quality and reduce tobacco use in our population said senior author June M. Chan ScD from the departments of Urology and Epidemiology and Biostatistics at UCSF. It takes cooperation and effort from multiple areas like insurance companies employers policy makers and city planners to figure out how to creatively support and encourage more exercise into most busy adults working day. These lifestyle habits align with other recommendations to prevent diabetes and heart disease. About one man in seven will be diagnosed with prostate cancer during his lifetime making it the most frequently diagnosed cancer in the United States excluding nonmelanoma skin cancer. According to the American Cancer Society in there will be approximately cases of prostate cancer and approximately deaths. This study was supported by grants from the Prostate Cancer Foundation and the National Institutes of Health. Coauthors are Erin Van Blarigan ScD of the departments of Urology and Epidemiology and Biostatistics at UCSF Howard Sesso ScD MPH Edward Giovannucci MD ScD Meir Stampfer MD DrPH and Julie Batista ScD all of Harvard T.H. Chan School of Public Health Harvard Medical School and Brigham and Womens Hospital Mary Kathryn Downer and Jaquelyn Jahn both of Harvard T.H. Chan School of Public Health and Brigham and Womens Hospital. About UCSF UCSF is a leading university dedicated to transforming health worldwide through advanced biomedical research graduatelevel education in the life sciences and health professions and excellence in patient care. Founded in as a medical college UCSF now includes topranked graduate schools of dentistry medicine nursing and pharmacy a graduate division with worldrenowned programs in the biological sciences a preeminent biomedical research enterprise and toptier hospitals UCSF Medical Center and UCSF Benioff Childrens Hospitals. Please visit http"

"A national sickle cell disease study involving Medical University of South Carolina researchers found that for some children with sickle cell disease the drug hydroxyurea is as effective as blood transfusions to reduce blood flow speeds in the brain. Increased blood flows are a major risk factor for stroke in these children. Study findings were published Dec. in The Lancet and were presented at the American Society of Hematology meeting. It was a privilege to be a part of this welldesigned and executed study. Russell Ware presented the results at the ASH meeting and years ago almost to the day I presented the STOP study results to the same meeting said Robert J. Adams M.D. study principal investigator MUSC professor of neurosciences and director of the South Carolina Stroke Center of Economic Excellence. That study showed how effective transcranial Doppler risk stratification followed by regular red cell transfusions in those with high risk blood flow can be in the prevention of stroke httpsmedicalxpress.comtagsstroke in these children httpsmedicalxpress.comtagschildren. This became known as the STOP protocol and its wide adoption has been associated with a sharp drop in ischemic strokes in children with sickle cell disease httpsmedicalxpress.comtagssicklecelldisease. The drawback of indefinite transfusions however was a limitation to wider use of the STOP protocol. This study shows that some children can be moved from transfusion to medication after at least a year. The combined understanding and evidence from these two studies brings us closer to achieving the National Institutes goal of a stroke free generation in sickle cell disease. Standard treatment for children with sickle cell disease who are at high risk of stroke consists of regular blood transfusions. Children who receive regular blood transfusions are then at risk for iron overload. Chelation or ironreduction therapy is needed for those receiving transfusions. The National Institutes of Health NIHsupported study sought to answer whether hydroxyurea would provide the same benefit as blood transfusions given these additional treatment impacts. Hydroxyurea is the only drug approved by the Food and Drug Administration to treat sickle cell disease. The Transcranial Doppler with Transfusions Changing to Hydroxyurea TWiTCH study was stopped early due to positive preliminary results in November . Researchers from clinical sites supported by the NIHs National Heart Lung and Blood Institute NHLBI recruited and studied children ages to years old and divided them into two groups one that received transfusions and one that was transitioned from transfusions to daily doses of hydroxyurea. No child should ever have to face the prospect of suffering through a stroke said Gary H. Gibbons M.D. director of the NHLBI. Our institute is striving to achieve a strokefree generation of children living with sickle cell disease. Studies like this are vital for moving us toward this worthwhile goal. Study authors indicated that the findings suggest that hydroxyurea could be effective at reducing risk of stroke for other patient populations though this was not a primary goal of the study. Explore further Successful outcome prompts early end to sickle cell anemia clinical trial httpsmedicalxpress.comnewssuccessfuloutcomepromptsearlysickle.html"

"Sharon Belvins nightmare with cancer began in when she was just . Belvin was an avid runner but said she suddenly found she couldnt climb the stairs without a lot of difficulty breathing. Eventually after months of fruitless treatments for lung ailments like bronchitis she was diagnosed with melanoma a very serious skin cancer. It had already spread to her lungs and the prognosis was grim. She had about a chance of surviving the next six months. Yeah that was the turning point of life right there she says. What Belvin didnt know at the time was that a revolutionary treatment for melanoma had begun testing in clinical trials. An immunologist named Jim Allison httpfaculty.mdanderson.orgJames_AllisonDefault.aspSNID now at the University of Texas MD Anderson Cancer Center had figured out that if the immune system was tweaked just right it could do a better job of killing the cancer than the usual treatments. Joe Palca worked for Allison http early in both mens careers. Allisons treatment was still experimental but if it worked it had the potential to save Belvins life. Its a new modality for treating cancer Dr. Samuel Broder https a former director of the National Cancer Institute says now of Allisons pioneering research. It used to be there were three basic treatment options for cancer surgery radiation and chemotherapy or some combination of those three. Its fair to say theres now a fourth option. Allisons long search for this new kind of treatment one that has since become a lifesaver for some cancer patients began around a decade before Belvin got sick when Allison was running a lab at the University of California Berkeley. At the time he was what you could call a research scientists research scientist. He was fascinated by certain powerful cells of the immune system T cells. A subset of white blood cells T cells travel around the body and can protect us against just about anything Allison says. T cells do recognize cancer cells but not in a way that can eliminate the disease. Allison had been studying T cells for years and thought that by tinkering with one key molecule on the outside of these cells he could enhance their response to cancer enough to eradicate the illness. He and one of his grad students ran an experiment to test the tweaked T cells on cancerous tumors in mice and the initial results astounded them. The T cells seemed to be doing just what Allison had hoped they would do shrink the tumors and kill the cancer. Allison repeated the experiment with more mice over his winter break. After a few tense days the tumors again disappeared. These mice were cured Allison says. Cancer cured Ive been doing this sort of stuff for years and Id never seen anything like that Allison says. And I thought If we could do that in people this is going to be amazing. Allison tried to persuade drugmakers to create a human version of the treatment that had worked in mice. He thought they would jump at the chance to try a new approach. But the biotech companies he met with didnt bite. In those days most firms were focused on drugs that would target tumors directly and Allison was asking them to try something very different. This was targeting the immune system not the cancer he says. We werent trying to kill the cancer cells. We were letting the T cells kill the cancer cells. Thanks but no thanks the companies told him. I got very depressed Allison says. He was sure this was the most important work of his career but he had to get others on board. Eventually a scientist attending one of Allisons research talks was intrigued enough to contact a pal at the biotech firm Medarex. The company had recently developed technology that could make a human version of Allisons therapy and was willing to give it a try. It took a decade but eventually Allisons big idea was ready for testing in people. A clinical trial to study the drug now called ipilimumab http or Ippy for short was set up at Memorial Sloan Kettering Cancer Center in New York City. Allison decided he wanted to be part of this next chapter in the testing of immunotherapy so he packed up his California lab and moved it to Sloan Kettering. As it happens Belvin was also in New York a patient of Dr. Jedd Wolchok https at Sloan Kettering. By the fall of Belvin had run through all the treatment options available to her. Nothing had worked to control the melanoma it continued to spread dangerously throughout her body. Belvin remembers feeling sick and depressed and says she wasnt even paying much attention when Wolchok walked into the exam room and suggested one last treatment. Sharon we have an opportunity to participate in a clinical trial here. Its something you should consider Wolchok told her. Belvin says she signed up without hesitation. After just four injections of Ippy across three months her cancer was nearly gone. And at Belvins followup appointment a year later Wolchok delivered news that was hard for her to take in Sharon you no longer have cancer. And in the next breath Belvin recalls he goes Oh the guy who invented this is upstairs. Do you want to meet him Yes of course I want to meet him she told her doctor. Wolchok called Allison who was working nearby and told him to drop everything and come to the clinic a part of the hospital Allison had rarely seen. Though the research scientist couldnt imagine why Wolchok was in such a rush he quickly figured it out as he opened the door and was greeted by Belvin with a huge hug. Belvin says she tried not to tackle him. It was hard to control myself she says. I owe this man my life. Belvin was the first recipient of the immunotherapy that Allison had ever met. It really meant a lot he says. It reminded me what its all about at the end of the day. That was in today Sharon Belvin is still cancerfree. Ippy is now sold under the brand name Yervoy by BristolMyers Squibb which bought Medarex in . Meanwhile Jim Allison has become a bit of a celebrity in the cancer research world. Among other honors he was a recipient of the prestigious Lasker Award http for his achievements in medical science. Hes become wellknown among patients too. Now and again Allison fields calls from patients yearning to learn from the master himself what it will take to cure their disease. Allison cant really answer them. Each case is different and using a patients own cells to destroy tumors wont work in every patient or in every type of cancer. Still the approach offers promise to some people that other therapies cant and has transformed the way doctors think about cancer treatment. It might be too early to say were going to cure cancer Allison says but were going to cure certain types of cancers. Weve got a shot at it now."

"Media Advisory To contact Daniel E. Hall M.D. M.Div. M.H.Sc. email Sheila Tunney at sheila.tunneyva.gov mailtosheila.tunneyva.gov. Related material Also available at the For the Media website httpmedia.jamanetwork.com the commentary A Call for Frailty Screening in the Preoperative Setting by Anne M. Suskind M.D. M.S. and Emily Finlayson M.D. M.S. of the University of California San Francisco. To place an electronic embedded link to this study in your story This link will be live at the embargo time httpjamanetwork.comjournalsjamasurgeryfullarticle.jamasurg.. JAMA Surgery In a study published online by JAMA Surgery Daniel E. Hall M.D. M.Div. M.H.Sc. of the Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh and colleagues examined the effect of a Frailty Screening Initiative FSI on death and complications by comparing the surgical outcomes of patients treated before and after implementation of the FSI. As the U.S. population ages the number of operations performed on elderly patients will likely increase. Frailty predicts postoperative mortality and illness more than age alone thus presenting opportunities to identify the highestrisk surgical patients and provide tailored clinical care to improve their outcomes. This study included patients average age years from a Veterans Affairs medical center who presented for major elective noncardiac surgery. Preoperative frailty was assessed with the Risk Analysis Index RAI a item questionnaire and the records of all frail patients as determined by a certain RAI score were flagged for administrative review by the chief of surgery or designee before the scheduled operation. On the basis of this review clinicians from surgery anesthesia critical care and palliative care were notified of the patients frailty and associated surgical risks if indicated perioperative plans were modified based on team input. The researchers found that overall day mortality decreased from . percent of patients to . percent of patients after FSI implementation. Improvement was greatest among frail patients . percent to . percent although mortality rates also decreased among the robust patients . percent to . percent. The magnitude of improvement among frail patients increased at and days. The ultimate cause of the survival benefit is likely multifactorial including changes in preoperative decision making intraoperative management and postoperative rescue the authors write. This study reveals the feasibility of facilitywide frailty screening in elective surgical populations. It also suggests the potential to improve postoperative survival among the frail through systematic administrative screening review and optimization of perioperative plans. The absolute reduction in day mortality among frail patients was more than percent with improvement remaining robust even after controlling for age frailty and predicted mortality. JAMA Surgery. Published online November .doi.jamasurg... This study is available preembargo at the For The Media website httpmedia.jamanetwork.com. Editors Note This investigation was supported by a grant from the U.S. Department of Veterans Affairs Veterans Health Administration Office of Research and Development Health Services Research and Development. Please see the article for additional information including other authors author contributions and affiliations financial disclosures etc."

"People struggling with irritable bowel syndrome IBS might feel better with antidepressants or psychotherapy a recent study suggests. People with IBS typically suffer from chronic abdominal pain gas diarrhea and constipation. While some people improve with customized diets that avoid certain foods that trigger symptoms this approach doesnt help everyone and some emerging research suggests that the condition may also be influenced by processes in the brain. For the current analysis researchers examined data from trials that compared the effects of antidepressants or psychotherapy either alone or in combination versus placebo treatments or usual management in people with IBS. Rates of no relief were highest with placebo treatments. People were percent less likely to have no relief from antidepressants and percent less likely to get no relief from psychotherapy the study found. One component of IBS is increased sensitivity to the functions of the bowels simply summarized this means either the nerves taking messages from the bowel to the brain are more sensitive or that the brain is more attentive or reacts in a more emotional manner to the normal messages arising in the bowel or both said Dr. Michael Camilleri a researcher at the Mayo Clinic College of Medicine and Science in Rochester Minnesota who wasnt involved in the current study. Since there are really no medications to reduce the nerve sensitivity some doctors give medications that modulate the function of the brain in the hope that this approach will reduce the ability to sense or emotionally react to the signals or messages arriving from the bowels Camilleri said by email. Psychiatric conditions including depression anxiety and somatisation physical symptoms thought to have psychological origins are common among people with IBS researchers note in the American Journal of Gastroenterology. Although the use of antidepressants is common among IBS patients psychotherapy is not the study authors note. One limitation of the current study is that the smaller studies used in the analysis had a wide variety of designs and methods for testing the success of treatment researchers note. Another drawback is that these studies werent designed to prove how antidepressants or psychotherapy might directly improve IBS symptoms. Still a psychological evaluation may make sense for IBS patients because its possible their symptoms might be a byproduct of untreated depression said Dr. Agnieszka KulakBejda a psychiatry researcher at the Medical University of Bialystok in Poland who wasnt involved in the study. Antidepressants may work better for certain types of IBS and the study findings also suggest that the type of medication may matter KulakBejda said by email. A family of medicines known as tricyclic antidepressants were more effective at relieving global symptoms of IBS the analysis found. But another family of medicines known as selective serotonin reuptake inhibitors SSRIs was better than a placebo for easing symptoms like pain and bloating and improving quality of life. The decision to use antidepressants as a form of therapy should be taken individually KulakBejda said. The decision should be made after considering all the pros and cons. Lead author Dr. Alexander Ford of the University of Leeds in the U.K. didnt respond to requests for comment. SOURCE go.nature.comQXSVK httpsgo.nature.comQXSVK The American Journal of Gastroenterology online September ."

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

"Its notoriously hard to treat depression in kidsthe antidepressants we rely on to treat adults seem to be less effective and more dangerous when used on younger minds. New research out of Oxford http helps confirm this and then some The researchers metaanalysis on how commercially available antidepressants compare with a placebo showed that just one of the antidepressants examined was significantly better than a placebo in treating depression in children and adolescents. The only drug to pass the test was fluoxetine sold in the U.S. under the trade name Prozac. It outperformed all other antidepressants in both efficacy and tolerability a term that researchers use to mean how often patients had to quit the drug due to negative side effects. Prozac is also the only antidepressant approved by the Food and Drug Administration to treat depression in people under . Thats because the FDA has deemed that Prozac has demonstrated benefits that outweigh one of the suspected downsides of antidepressants in kids and teens disrupting brain development. Dr. Andrea Cipriani psychiatrist and lead author on the study says these are concerns that practicing psychiatrists confront daily. From a clinical point of view we tend to be very cautious when prescribing medication to children and adolescents because of the unknown effects on the developing brain he said. Theres good reason for this. Researchers have long worried about the effects of psychoactive drugs on people whose brains are still developing. Back in researchers at Harvard Medical School released a study http that sought to answer questions about the safety of certain drugs and chemicals including antidepressants in adolescents. The study which used rats in lieu of human children found evidence that reward pathways are severely altered following exposure to drugs that affect the brain. Research on how antidepressants actually affect human childrens brain development is extremely hard to come by given the limited numbers of actual children on antidepressants and the complications of gaining consent to study them. But other research on antidepressants suggest they negatively affect brain plasticity http and memory http that would be problematic while the brain is still developing. And theres another major problem with the use of many antidepressants in children They may increase suicidal thoughts and behavior. Since the FDA has advised http that antidepressants not be prescribed to individuals under due to the increased risk in suicidality especially during the early phases of treatment. Dr. Mina Fazel child psychiatrist at the Oxford University Childrens Hospital says Its complicated because youre giving antidepressants when youre very worried about that young persons mood. Essentially the moment when it seems most necessary to prescribe the drugs may also be the moment when the patient is most at risk of suicide. Untangling this cause and effect has thus far eluded researchers though there is some evidence http to suggest that antidepressants spark a chemical reaction in the brain that does in fact increase the risk of suicide. So far the FDA is erring on the side of caution. A comment attached to the Oxford paper written by Dr. Jon Jureidini a child psychiatrist at the Womens and Childrens Hospital in Adelaide Australia goes even further in decrying the use of antidepressants in kids. Only if the discounted benefit outweighs the boosted harm should the treatment be prescribed he writes. For antidepressants in adolescents this equation will rarely favor prescribing in younger children almost never. To be clear Jureidini believes there is almost never a justification for prescribing antidepressants to children or adolescents. I called him to be sure. Theyre not better than nothing he said and theres quite clear evidence that theyre more dangerous than nothing. He arrived at this conclusion after applying the customary dose of skepticism doctors are taught to apply when translating research findings to clinical practice. His wariness of antidepressants being prescribed for kids Prozac included is further bolstered by the theory that these drugs dont work well in children because they werent designed for children. They were designed for adults and adults have very different physiological states than adolescents. The Oxford paper notes that percent of children ages and nearly percent of teenagers ages suffered from major depressive disorder the psychiatric term for what is colloquially known as depression. Given the U.S. population that works out to more than a million children and adolescents. The disease manifests differently in kids Whereas adults might report feeling apathetic unmotivated unfocused and just plain sad children with this disorder tend to be irritable and aggressive and as a result have trouble navigating social situations with adults and peers. That means that one of the first battles in treating depression in kids is recognizing it in the first place. Of course having an effective intervention once it is recognized would help. If theres an upside to be found in how ineffective antidepressants likely are for kids its that pharmacological solutions are not the recommended first line of defense anyway. Guidelines from the psychiatric associations in most countries recommend that doctors first try psychotherapy or talk therapy which is has been shown to work at least by participants own assessment of their depression levels its very hard to test therapy against a placebo for obvious reasons. Methods such as cognitive behavioral therapy in which psychiatrists help patients overcome destructive behaviors and thought patterns and interpersonal therapy which focuses more on the effect depression has on relationships seem to be equally effective http in treating depression particularly in adolescents. Of course this is a highcost intervention in terms of both dollars and time invested and it may not always be readily available http_hrmentalhealth_oct.pdfbut the upside is that there is no reason to believe it is harmful. Like in nearly all areas of science biomedical or otherwise our understanding is limited and further research is required to find out more about both potential treatment options. Adolescent depression is particularly difficult since gaining consent to study interventions in children is more complicated than it is in adults. If we are to answer these big unknowns regarding the safety of antidepressants in young patients critical because therapy and medication are more effective together than in isolation http_psychologicaltherapiesversusantidepressantmedicationaloneandincombinationfordepressioninchildrenandadolescents we need more data."

"Cancer experts said Tuesday that the actress and filmmaker Angelina Jolie Pitt was wise to have had her ovaries and fallopian tubes removed last week because she carries a genetic mutation BRCA that significantly increases the risk of ovarian cancer a disease so difficult to detect that it is often found only at an advanced untreatable stage. They also said Ms. Jolie Pitts decision to discuss her own choices so frankly will encourage women in similar situations to consider their own options. BRCA mutations cause about to percent of breast cancers and to percent of ovarian cancers among white women in the United States. It is unclear how common the mutations are in other racial and ethnic groups. Prophylactic removal of ovaries and fallopian tubes is strongly recommended in women before age in BRCA and BRCA mutation carriers said Dr. Susan Domchek executive director of the University of Pennsylvanias Basser Research Center which specializes in BRCA mutations. There is no effective screening for ovarian cancer and too many women with advanced stage ovarian cancer die of their disease. Writing for The New York Timess OpEd page http_rmoduleinline Ms. Jolie Pitt said she had expected to have her ovaries and fallopian tubes removed a procedure called a laparoscopic bilateral salpingooophorectomy but that a cancer scare made her decide to undergo the procedure sooner. Her mother aunt and grandmother died of cancer. To my relief I still had the option of removing my ovaries and fallopian tubes and I chose to do it she wrote. Two years ago she ignited a worldwide discussion about options for women at high risk for breast cancer when she wrote that she had had both breasts removed because BRCA the same genetic mutation that prompted her surgery last week increased her risk of breast cancer. Several doctors said that for women in similar situations they generally recommend that ovaries be removed before breasts but the cost is that women who do so go into early menopause and can no longer bear children. However removing the ovaries substantially decreases a womans risk of developing breast cancer. Also breast cancer is generally more detectable and treatable than ovarian cancer. Were really quite pushy about oophorectomy Dr. Domchek said. And we talk about mastectomy as an option. Experts said that some details mentioned by Ms. Jolie Pitt might not apply to all women with such mutations or might be characterized differently by doctors. For example Ms. Jolie Pitt wrote that she was advised to have the surgery about years before the age at which her mother was first diagnosed which was . But doctors said a better rule of thumb is between ages and ideally after a woman has finished having children but before her cancer risk rises sharply. https_idactionclickmoduleeditorContentpgtypeArticleregionCompanionColumncontentCollectionTrending Ms. Jolie Pitt also said she had a yearly test for the CA protein to monitor the possibility of ovarian cancer. She noted that her doctor said the test missed a high percentage of cancers. Some experts said they had stopped such tests because they miss so many cancers and have not been shown to improve survival rates. Weve basically said theres no data to support it and were recommending the surgery said Dr. Kenneth Offit chief of the clinical genetics service at Memorial Sloan Kettering Cancer Center. He added In the end what she did is fine. She got to the right place. She had ovarian surgery done within the window of time. Ms. Jolie Pitts decision not to remove her uterus was consistent with what experts recommended. There is no research showing that having a BRCA mutation puts women at risk for uterine cancer said Dr. Jamie BakkumGamez a gynecologic oncologist at the Mayo Clinic. Dr. Jamie BakkumGamez and other experts endorsed her decision to take hormone replacement therapy an estrogen patch and a progesterone intrauterine device to counteract symptoms of surgeryinduced menopause. Ms. Jolie Pitt who has six children three adopted wrote that she knows these decisions are far harder for women who still want to get pregnant and that she had learned they might have options to remove their fallopian tubes but keep their ovaries. Experts cautioned that the evidence is still slim on whether fallopian tube removal is effective at preventing ovarian cancer. Shira Krance who has a BRCA mutation had a double mastectomy two years ago and said she has considered whether to have the fallopian tubes removed before her ovaries. Doctors will give you a lot of options but nobody will tell you what to do said Ms. Krance who lives in Valley Cottage N.Y. and has two young children. Its scary the idea of not being around when your children grow up. Thats the worst thing and Im going to do everything I can to avoid that. Ethel Zelenske a BRCA carrier who lives in Baltimore had her tubes and ovaries removed in . A few years later she was diagnosed with peritoneal cancer a condition that Dr. Offit said each year occurs in about half of a percent of women who have had their ovaries removed. Ms. Zelenske was treated but had a recurrence of the peritoneal cancer two years ago. My doctors have told me that I will always be in treatment said Ms. Zelenske who like many other women welcomed Ms. Jolie Pitts public disclosure. I really love that she said knowledge is power because I say that all the time."

"A team of researchers from Cleveland Clinic Louis Stokes Cleveland VA Medical Center Kaiser Permanente Northwest and other clinical sites have demonstrated that a new blood test known as IsoPSA detects prostate cancer more precisely than current tests in two crucial measures distinguishing cancer from benign conditions and identifying patients with highrisk disease. By identifying molecular changes in the prostate specific antigen PSA protein the findings published online last month by European Urology suggest that once validated use of IsoPSA may substantially reduce the need for biopsy and may thus lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer. The research team led by Cleveland Clinics Eric Klein M.D. conducted a multicenter prospective study of men scheduled for prostate biopsy at five academic and community centers in the U.S. enrolled between August and December . Despite criticism PSA has transformed the landscape of early detection screening and management of prostate cancer in the last few decades said Dr. Klein chair of Cleveland Clinics Glickman Urological Kidney Institute. Unfortunately PSA is tissuespecific but not cancerspecific leading to overdiagnosis and overtreatment of biologically insignificant cancers which is widely recognized as a key limitation in its clinical utility. The study directly compared the clinical performance of a new test based on PSA called IsoPSA to PSA itself with patients already scheduled for prostate biopsy. IsoPSA proved significantly superior to PSA in two key indications discriminating between prostate cancer and benign conditions and identifying patients with highgrade disease. The former indication is potentially useful for using IsoPSA for screening by primary care physicians while the second is helpful for urologists in identifying patients who would benefit from curative intent therapy and other applications. The results show that if validated and adopted clinically IsoPSA could significantly reduce the rate of unnecessary biopsies by almost percent. The methodology used in the IsoPSA assay represents a significant departure from conventional ways to define biomarkers in blood and may be applicable to improving other cancer biomarkers said Dr. Klein. Due to its inherent simplicity requiring only a blood draw and presenting information to the physician in familiar context using a single number just like PSA itself we are quite hopeful in IsoPSAs future utility after further validation studies said Mark Stovsky M.D. coauthor and staff member Cleveland Clinic Glickman Urological Kidney Institute. The IsoPSA test was developed by Cleveland Diagnostics a company cofounded by Cleveland Clinic in which it has financial interest. Dr. Klein has no personal financial interest in the company. Dr. Stovsky has a leadership position Chief Medical Officer and investment interest in Cleveland Diagnostics Inc. About Cleveland Clinic Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland Ohio it was founded in by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs including coronary artery bypass surgery and the first face transplant in the United States. U.S. News World Report consistently names Cleveland Clinic as one of the nations best hospitals in its annual Americas Best Hospitals survey. Among Cleveland Clinics employees are more than fulltime salaried physicians and researchers and nurses representing medical specialties and subspecialties. Cleveland Clinics health system includes a acre main campus near downtown Cleveland regional hospitals more than northern Ohio outpatient locations including fullservice family health centers and three health and wellness centers and locations in Weston Fla. Las Vegas Nev. Toronto Canada Abu Dhabi UAE and London England. In there were . million outpatient visits hospital admissions and surgical cases throughout Cleveland Clinics health system. Patients came for treatment from every state and countries. Visit us at clevelandclinic.org httpclevelandclinic.org. Follow us at twitter.comClevelandClinic httptwitter.comClevelandClinic. News and resources available at newsroom.clevelandclinic.org httpnewsroom.clevelandclinic.org."

"isit an urban park in China any given morning or late afternoon and youre likely to find elderly people engaged in a slow elegant dance their arms and legs lifting and circling in unison. Tinny traditional music might be playing from a batteryrun cassette player. The seniors are focused and at ease in their daily ritual and its soothing to watch them. The movement is tai chi an ancient martial art turned exercise and a study httparchinte.amaassn.orgcgicontentfull out this week in Archives of Internal Medicine says it may help people suffering from heart failure http feel better about life. In a quality of life questionnaire the researchers gave out those who practiced tai chi scored significantly higher than those who hadnt been doing the movement. The tai chi group also reported an improvement in mood. Heart failure is a tough disease to live with the shortness of breath and low energy that can come because the heart cant pump enough blood make physical activity unappealing. Historically patients with chronic systolic heart failure were considered too frail to exercise http_big_fat_lie_of_exercise.html and through the late s avoidance of physical activity was a standard recommendation the studys authors write. Article continues after this message from our sponsor The Chinese developed tai chi thousands of years ago but it has recently piqued the interest of Western medicine as an alternative mindbody therapy to treat disease. According to a Harvard Medical School newsletter http_Womens_Health_WatchMayThehealthbenefitsoftaichi tai chi is increasingly seen as a form of medication in motion. Its been shown to be useful in treating a wide range of diseases from breast cancer to Parkinsons. The National Institutes of Health httpnccam.nih.govhealthtaichiintroduction.htm has also jumped on board and is funding a variety of studies on tai chi for chronic disease. The Archives of Internal Medicine study is the first large clinical trial to look at whether a tai chi program can do anything for people with heart failure. The researchers recruited people with the chronic condition from heart clinics in Boston. About half were randomly assigned to receive a week tai chi exercise program. The other half got a heart health education program. The tai chi program started off with some traditional warmup exercises of arm swinging gentle stretches breathing and visualization techniques. Then patients learned five simple movements designed to release tension in the body increase awareness of breathing and relax the body and mind. Patients got an instructional video tape and were encouraged to practice at home at least times a week. The study authors say theres a usually a strong relationship between depression and heart failure so the fact that tai chi helped cheer people up was an especially good sign."

"Treatment with a HERtargeted therapeutic cancer vaccine provided clinical benefit to several patients with metastatic HERpositive cancers who had not previously been treated with a HERtargeted therapeutic according to data from a phase I clinical trial presented at the Fourth CRICIMTEATIAACR International Cancer Immunotherapy Conference Translating Science into Survival held Sept. Oct. . Among evaluable patients who had received more than the lowest dose of the vaccine six percent had clinical benefit. One patient with ovarian cancer had a complete response that lasted weeks one patient with gastroesophageal cancer had a partial response that lasted weeks and four patients two with colon cancer one with prostate cancer and one with ovarian cancer had stable disease. Immunotherapy marshals the exquisite specificity of the immune system to destroy cancer and some types may have potentially fewer side effects than traditional chemotherapy said Jay A. Berzofsky MD PhD chief of the Vaccine Branch at the Center for Cancer Research National Cancer Institute National Institutes of Health Bethesda Maryland. We are using a vaccine approach to generate an immune response to HER which is found at high levels on and drives the growth of several types of cancer including breast ovarian lung colorectal and gastroesophageal cancers. Our results suggest that we have a very promising vaccine for HERoverexpressing cancers continued Berzofsky. We hope that one day the vaccine will provide a new treatment option for patients with these cancers. The patients vaccines are individually customized by Berzofsky and colleagues using their own immune cells isolated from their blood. The bloodderived immune cells are modified in several ways in the laboratory. The final product which is administered intradermally between the layers of the skin comprises patientderived dendritic cells genetically modified with an adenovirus to produce parts of the HER protein. Preclinical studies which were previously published in the AACR journal Cancer Research showed that this type of vaccine could eradicate large established tumors as well as lung metastases in mice. In the dose escalation portion of the phase I clinical trial patients were injected with the vaccine on weeks and after enrollment in the study. Among the six patients who received the lowest dose of the vaccine million dendritic cells per injection no clinical benefit was seen. Among the patients who received either million or million dendritic cells per injection six had clinical benefit. Adverse reactions were predominantly injectionsite reactions that did not require treatment. No cardiotoxicity was seen. Based on the current safety and clinical benefit data the dose of the vaccine was increased to million dendritic cells per injection and the trial opened to patients who have previously been treated with a HERtargeted therapeutic including patients with breast cancer said Berzofsky. Moving forward we would like to investigate whether we can increase the proportion of people who benefit from treatment with the vaccine by combining it with checkpoint inhibitor therapy he added. According to Berzofsky the main scientific limitation of the study is that it is a relatively small phase I clinical trial with no placebo control. However the approach is sufficiently promising to warrant additional trials. This study was supported by intramural funds from the National Cancer Institute. Berzofsky declares no conflicts of interest."

"Exposing sleeping people to a series of short flashing lights at night might help them adjust more quickly to time zone changes according to a new U.S. study. In experiments the technique which is based on the way nonvisual parts of the brain respond to light was much more effective than sustained bright light similar to that from devices sometimes used to combat sleep disorders or seasonal depression. Jet lag itself is really a nuisance syndrome as it is selfresolving said senior author Jamie Zeitzer assistant professor of psychiatry and behavioral sciences at the Stanford University School of Medicine in California. Zeitzer was on the committee that removed jet lag as a disease from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM the guide that psychiatrists use to diagnose mental illnesses. However the treatments that are developed for jet lag can be used for less prevalent though far more significant societal problems including delayed sleep in teens in whom we have an ongoing clinical trial using the flash technique and shift workers who try to flip between a night time schedule for work and a day time schedule for leisure he told Reuters Health by email. The study included people of whom were exposed to a series of twomillisecond light flashes with changing intervals while sleeping and eight of whom were exposed to minutes of continuous bright light. A series of flashes similar to a camera flash delivered every seconds over a minute period delayed sleepiness by two hours compared to a minute delay for those exposed to continuous light for an hour according to the results published in the Journal of Clinical Investigation. In essence using the night before you traveled from California to N.Y. would move your circadian system twothirds of the way there before you even left Zeitzer said. Arriving in New York you would be synced to the local time after one day he said. The circadian clock is the central conductor of the many clocks that are found in nearly all tissues of your body Zeitzer said. This clock remains synchronized with the external day through regular exposure to light. Nighttime flashes change the timing of the circadian clock he said. For moving your system to a later time such as would be necessary when traveling EasttoWest light during the first few hours of the night is ideal he said. For moving your system to an earlier time such as would be necessary when traveling WesttoEast light during the last few hours of the night is ideal. The night flashes require special technology and equipment beyond just a smartphone which are still in development Zeitzer said. In a previous study the short flashes of light at night did not interrupt sleep or reduce its quality he added. This is one of the real advantages of this system you can change circadian timing while you sleep without interfering with sleep he said. Mistiming light therapy can make jet lag worse cautioned Anna WirzJustice professor emeritus at the Center for Chronobiology at the University of Basel in Switzerland who was not part of the new study. As for frequent flyers trying this themselves it is far too early neither the methodology is available outside research nor any guidance about safety nor tests of simulated jet lag in an appropriate realistic protocol WirzJustice told Reuters Health by email. SOURCE bit.lynYsDhD httpbit.lynYsDhD Journal of Clinical Investigation online February . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Scientists have found an unexpected use for virtual reality headsets to help pinpoint people who may later develop Alzheimers disease. https The devices widely used by computer gamers display images that can be used to test the navigational skills of people thought to be at risk of dementia. Those who do worse in the tests will be the ones most likely to succumb to Alzheimers later in life scientists now believe. By identifying potential patients far earlier than is possible at present researchers hope it should then become easier in the long term to develop treatments aimed at halting or slowing their condition. It is usually thought memory is the first attribute affected in Alzheimers said project leader Dennis Chan a neuroscientist based at Cambridge University. But difficulty with navigation is increasingly recognised https as one of the very earliest symptoms. This may predate the onset of other symptoms. By pinpointing those who are beginning to lose their navigational skills we hope to show that we can target people at a much earlier stage of the condition and one day become far more effective in treating them. The discovery that loss of navigational skills was associated with Alzheimers disease was made several years ago by Chan and colleagues based at several centres in the UK. These studies used tablet computers to test navigational tasks. But now scientists plan to take their tests to a new level with the use of the virtual reality sets in which wearers are immersed in simulated environments through which they must navigate. Around people aged between and will be recruited to take part in the study. Some will have a gene that puts them at risk of the condition or will come from a family with a history of Alzheimers. Not all will be destined to be affected by the disease however. Chans project aims to find out who will. Wearing virtual reality headsets participants will be asked to navigate their way towards and then remember details of a series of different environments. We will make a note of those who have particular problems and see if these are the ones who are at higher risk of developing Alzheimers explained Chan. The aim of the study is very simple can we detect changes in brain function before people are aware that they have them Researchers recently pinpointed the significance of a tiny area of the brain known as the entorhinal cortex which acts as a hub in a widespread brain network that controls navigation. This now appears to be the first part of the brain that succumbs to Alzheimers. The entorhinal cortex is the first brain region to show degeneration when you get Alzheimers and that is where we shall be focusing our research said Chan whose work is funded by the Alzheimers Society. The goal of the work is to help people as they develop the disease. To date drug trials for Alzheimers have been applied when people have already got dementia by which time considerable damage to the brain has already occurred Chan told the Observer. If we can develop drugs and administer them earlier for instance before the disease has spread beyond the entorhinal cortex then this would have the potential to prevent the onset of dementia."

"Half of children with sleep apnea who also wet the bed might stop their bedwetting if their tonsils or adenoids are removed new research suggests. Obstructive sleep apnea OSA is marked by interruptions in breathing while asleep it is common among children with enlarged tonsils or adenoids. Exactly how sleep apnea results in bedwetting is not fully understood but hormonal changes may play a role. However half of the children in this latest study who had sleep apnea and were bedwetters stopped wetting the bed after they had their tonsils or adenoids removed. Children in the study were aged to and were followed for just under one year after their surgery on average. Those who did not stop wetting the bed after the surgery were more likely to be born prematurely be male be obese or have a family history of bedwetting the investigators noted. Premature birth was the greatest predictor of continued bedwetting after surgery. If they havent seen an ear nose and throat specialist see one to see if the child who wets the bed has OSA that can be cured by tonsil or adenoid removal said study author Dr. Yegappan Lakshmanan chief of pediatric urology at Childrens Hospital of Michigan in Detroit. The findings were to be presented Monday at the annual meeting of the American Urological Association AUA in Washington D.C. Research presented at medical meetings should be viewed as preliminary until it has been published in a peerreviewed medical journal. There are many other causes of bedwetting Lakshmanan said. About to million children are bedwetters and the causes fall into three main groups bladder issues sleeprelated problems and the kidneys he explained. The children in this study wet the bed due to sleeprelated problems. So why werent they all cured Bedwetting is multifactorial even within these groups and eventually we should be able to pinpoint the cause for every single child Lakshmanan said. There are several potential causes of bedwetting and sleep apnea is clearly one of them said Dr. Lane S. Palmer chief of pediatric urology at the Cohen Childrens Medical Center in New Hyde Park N.Y. There are secondary positive effects of this tonsil or adenoidremoving surgery but I dont know that I would jump to have my childs tonsils or adenoids out as a primary treatment for bedwetting he said. Children with sleep apnea and bedwetting should see an otolaryngologist first. This study really underscores the fact that children who have other issues with sleep should be looked at for bedwetting because anything that depresses sleep at night can lead to bedwetting said AUA spokesman Dr. Anthony Atala a urologist at Wake Forest University in WinstonSalem N.C. If a child has bedwetting pay close attention to their sleep patterns and observe them while they are asleep and you can see whether they are breathing at a regular pace and if not seek additional help Atala said. Children with sleep apnea can be difficult to rouse which may cause the bedwetting said Dr. Dennis Kitsko an otolaryngologist at the Childrens Hospital of Pittsburgh. But not every child with sleep apnea will wet the bed and not every bedwetter will have sleep apnea. Still snoring in children is abnormal said Dr. Linda Dahl an ear nose and throat doctor at Lenox Hill Hospital in New York City. Children snore because their tonsils and adenoids are enlarged and they end up getting other behaviors that go along with sleep apnea including bedwetting she explained. There are many ancillary benefits that you may not attribute to removing large tonsil and adenoids such as putting an end to bedwetting Dahl added. More information Find out more about bedwetting and its treatment at the Nemours Foundation httpkidshealth.orgkidhealth_problemsbladderenuresis.html. SOURCES Yegappan Lakshmanan M.D. chief pediatric urology Childrens Hospital of Michigan Detroit Lane S. Palmer M.D. chief pediatric urology Cohen Childrens Medical Center New Hyde Park N.Y. Anthony Atala M.D. urologist Wake Forest University Medical Center WinstonSalem N.C. Dennis Kitsko M.D. otolaryngologist Childrens Hospital of Pittsburgh Linda Dahl M.D. ear nose and throat specialist Lenox Hill Hospital New York City May presentation American Urological Association annual meeting Washington D.C."

"Worcester Mass. When the standard malaria medications failed to help critically ill patients the attending physician in a Congo clinic acted under the compassionate use doctrine and prescribed a notyetapproved malaria therapy made only from the dried leaves of the Artemisia annua plant. In just five days all people fully recovered. This small but stunningly successful trial offers hope to address the growing problem of drugresistant malaria. Details of the cases are documented in the paper Artemisia annua dried leaf tablets treated malaria resistant to ACT and i.v. artesunate case reports by an international team lead by Pamela Weathers PhD professor of biology and biotechnology at Worcester Polytechnic Institute WPI who has pioneered the use of dried leaves of Artemisia annua DLA as a malaria therapy. To our knowledge this is the first report of driedleaf Artemisia annua controlling ACTresistant malaria in humans the authors of the Phytomedicine http paper note adding that more comprehensive clinical trials on patients with drugresistant malaria are warranted. Successful treatment of all ACTresistant cases suggests that DLA should be rapidly incorporated into the antimalarial regimen for Africa they added and possibly wherever else ACT resistance has emerged. Watch a video https_cfeatureyoutu.be about research at WPI related to this study. The report documents the experiences of patients in the North Kivu province of the Democratic Republic of Congo who showed symptoms of malaria and were originally treated with the recommended medication artemisininbased combination therapy ACT which blends artemisinin a chemical extract from Artemisia annua with one or more other drugs that attack the malaria parasite in different ways. The patients ranging in age from months to years did not respond to the standard ACT treatment and all lapsed into severe malaria defined by symptoms that can include loss of consciousness respiratory distress convulsions and pulmonary edema. One patient a fiveyearold child became comatose. All were then treated with intravenously administered artesunate the frontline medication for severe malaria but again they showed no improvement. As a last resort doctors turned to driedleaf Artemisia DLA a therapy developed and extensively studied by Weathers and her team at WPI. After five days of treatment with tablets made from only the dried and powered leaves of Artemisia which has been prepared and analyzed using methods developed by Weathers and postdoctoral fellow Melissa Towler all patients fully recovered. Laboratory tests showed they had no parasites remaining in their blood. Weathers noted more than other drugresistant patients also have been successfully treated with DLA tablets. These patients were dying Weathers said. So to see percent recover even the child who had lapsed into a coma was just amazing. Its a small study but the results are powerful. According to the World Health Organization WHO more than million people contracted malaria in and some died with young children and pregnant women being particularly vulnerable. Caused by a mosquitoborne parasite the illness is reported in nearly countries and threatens nearly half of the worlds population. ACT the current recommended therapy is expensive to produce and is in short supply in areas hit hardest by the disease. In addition while the combination therapy is designed to be less prone to the drug resistance that has rendered previous antimalarial agents ineffective increasingly the malaria parasite is showing signs of resistance to ACT particularly in Southeast Asia. Weathers began her research on artemisinin and Artemesia annua also known as sweet wormwood more than years ago. In recent years she has turned her attention to the use of DLA as an alternative to conventional antimalarial drugs. Noting that Artemisia annua which is classified as a generally regarded as safe GRAS herb has been consumed by humans and used as an herbal therapy for thousands of years often in the form of a tea she became intrigued by the potential for using the dried plant rather than just a chemical extract as a malaria treatment. A study she published in Photochemistry Reviews in was the first to demonstrate that dried leaves of the Artemisia annua plant delivers times more artemisinin to the blood than does the drug based on the chemical extract of the plant. In a paper published in PLOS ONE the following year Weathers and her team showed that not only does DLA have antimalarial properties it is more effective in knocking out the parasite and reduced the level of parasite infection more completely in mice. In a study in the Proceedings of the National Academy of Sciences the WPI researchers with colleagues at the University of Massachusetts Amherst showed that dried Artemisia leaves cured rodents infected with malaria strains that were known to be resistant to artemisinin. And in an experiment that accelerated the evolution of the malaria parasite by passing it through up to generations of mice the parasite showed no signs of resistance to DLA. Weathers says the superior performance of DLA in comparison to ACT as well as its ability to kill drugresistant parasites and avoid the resistance trap itself is likely due to the synergistic effects of a complex array of phytochemicals contained in the plants leaves several of which are also known to have antimalarial properties and others of which may act both to enhance the absorption of artemisinin into the bloodstream and bolster its effectiveness against malaria. In effect the dried leaves constitute a robust natural combination therapy one whose benefits far surpass those of ACT and other combination drugs. We have done a lot of work to understand the biochemistry of these compounds which include a number of flavonoids and terpenes so we can better understand the role they play in the pharmacological activity of the dried leaves Weathers said. The more we learn the more excited we become about the potential for DLA to be the medication of choice for combatting malaria worldwide. Artemisia annua is known to be efficacious against a range of other diseases including other tropical maladies and certain cancers so in our lab we are already at work investigating the effectiveness of DLA with other diseases. Another advantage of DLA over conventional malaria treatments is its low cost and the relative simplicity of its manufacture Weathers said. While the processes for manufacturing ACT is costlier and requires a higher degree of expertise producing DLA tablets can be accomplished with simpler equipment and a modest amount of training. Growing Artemisia annua and producing and testing the tablets Weathers noted are ideal local business that can provide jobs in impoverished areas and greatly expand access to antimalarial therapy. In fact she has already established a supply chain in Africa that includes growing and harvesting highproducing cultivars in East Africa along with GMP Good Manufacturing Practice processing operations in Uganda where the leaves are dried pulverized and homogenized where the powder is compacted into tablets and where the tablets are tested to verify their dosage. This supply chain helped produce the tablets used to treat the patients in the Democratic Republic of Congo. This simple technology can be owned operated and distributed by Africans for Africans Weathers said. About Worcester Polytechnic Institute Founded in in Worcester Mass. WPI is one of the nations first engineering and technology universities. Its academic departments offer more than undergraduate and graduate degree programs in science engineering technology business the social sciences and the humanities and arts leading to bachelors masters and doctoral degrees. WPIs talented faculty work with students on interdisciplinary research that seeks solutions to important and socially relevant problems in fields as diverse as the life sciences and bioengineering energy information security materials processing and robotics. Students also have the opportunity to make a difference to communities and organizations around the world through the universitys innovative Global Projects Program. There are more than WPI project centers throughout the Americas Africa AsiaPacific and Europe."

"Approximately percent of men will be diagnosed with prostate cancer at some point in their lifetimes according to the National Institutes of Health. Radiation therapy traditionally has been a primary treatment for the cancer but onefourth of men have a recurrence of prostate cancer within five years after the therapy. Now a University of Missouri School of Medicine researcher has found that a complex procedure to remove the prostate achieves excellent longterm survival for men after radiation therapy has failed. Prostate cancer unfortunately is a common cancer and more than men are estimated to have died from the disease in said Naveen Pokala M.D. an assistant professor in the Division of Urology at the MU School of Medicine and lead author of the study. By studying a national database of prostate cancer cases we found that a procedure known as salvage radical prostatectomy can greatly increase a mans chance of survival when traditional radiation therapy has failed to eradicate the cancer. Using the Surveillance Epidemiology and End Results SEER program database Pokala and his research team studied patients who underwent a salvage radical prostatectomy surgery after unsuccessful radiation treatments. Looking at survival rates the researchers found that . percent of men were still alive years later and . percent of men were still alive years later. During a salvage radical prostatectomy the prostate gland and surrounding tissue are surgically removed to keep the cancer from spreading. The procedure is challenging because tissue that surrounds the prostate is scarred during radiation treatment making it difficult for the surgeon to identify and cut out tissue that needs to be removed. If the cancer is localized a highly skilled surgeon can remove the gland and surrounding tissue using a robotic minimally invasive technique or through an open surgery. Because radical prostatectomy is a complex surgery there can be a reluctance to undergo the procedure Pokala said. However this study shows that it is a viable treatment option. This can bring a renewed hope and peace of mind to men living with prostate cancer. The study Survival Outcomes in Men Undergoing Radical Prostatectomy after Primary Radiation Treatment for Adenocarcinoma of the Prostate recently was published by Clinical Genitourinary Cancer a peerreviewed journal on the detection diagnosis prevention and treatment of genitourinary cancers."

"Weekly sessions of noninvasive repetitive transcranial magnetic stimulation provided sufficient longterm pain relief in percent of patients with central poststroke pain and delivered longterm relief for patients who continued for one year according to a study presented at the International Neuromodulation Society th World Congress by Masahito Kobayashi MD PhD of the Department of Neurosurgery Saitama Medical University Department of Neurology Institute of Brain and Blood Vessels Mihara Memorial Hospital in Saitama Japan. Of patients in the openlabel series patients achieved satisfactorytoexcellent pain relief. Pain relief was sustained in six patients who continued treatment for one year. All patients received repetitive transcranial magnetic stimulation rTMS to their primary motor cortex once a week for at least weeks. Satisfactory relief was considered a percent reduction in pain scores patients and excellent relief pain reduction of percent or more patients. Overall patients who had severe strokecaused dysesthesias such as uncomfortable numbness or prickling experienced less relief than patients without severe dysesthesias suggesting possible neural circuit damage was inhibiting response to treatment. The study participants had all been treated medically after a blood clot or bleed in one side of the brain unilateral ischemic or hemorrhagic stroke. Several weeks into their recovery they had begun to experience severe hand or leg pain as a consequence of brain damage from the stroke. Such central poststroke pain can be extremely disabling and difficult to treat impacting general functioning mood and overall quality of life. Since the s Japan has been an active center of research into the study of electrical motor cortex stimulation EMCS to treat poststroke pain using surgically implanted devices. The study reported at the INS th World Congress builds on observations that electrical motor cortex stimulations effectiveness in relieving central poststroke pain can be predicted by rTMS suggesting the techniques share similar painrelief mechanisms. However Kobayashi and colleagues point out in their peerreviewed online publication of this study Repetitive Transcranial Magnetic Stimulation Once a Week Induces Sustainable LongTerm Relief of Central Poststroke Pain Neuromodulation Technology at the Neural Interface httponlinelibrary.wiley.comdoi.ner.abstract April https that there has still been controversy about the efficacy of rTMS in poststroke pain. Kobayashi said in comparison to EMCS his impression is rTMS efficacy seemed almost the same without requiring surgery. In a review https suggested that there is probable efficacy a level A recommendation for shortterm rTMS treatment of neuropathic pain including central poststroke pain but did not speak to longterm efficacy. Since pain relief from rTMS increases a few days after treatment weekly treatment sessions were selected to try to sustain pain relief at treatment intervals that could be maintained on an outpatient basis. Kobayashi believes neurologists would especially have an interest in this method which is also attractive due to its low sideeffect profile. None of the patients reported any serious side effects from weekly sessions of trains of second Hz rTMS at percent of the active motor threshold. Two patients reported transient slight scalp discomfort after rTMS. In addition to the potential of rTMS in pain relief there has been growing research into noninvasive stimulation to augment progress in physical rehabilitation soon after stroke. It is believed that the stimulation aids in plasticity the ability of the brain to gradually form new neural connections to take on functions previously performed by damaged areas. A first phase of the study assessed whether rTMS had a treatment effect on pain. In it the research team randomly assigned six patients to receive either sham or active rTMS one week and the other treatment the next measuring pain scores before and after each session. Once that phase had shown that rTMS did reduce the patients pain an openlabel treatment phase began. In this second phase the patients underwent weekly rTMS sessions. The patients pain scores were measured just before each weekly session. Data were collected for eight years ending in . Kobayashi said that some patients really hoped to continue rTMS after the study because their pain worsened after rTMS treatment sessions were over and almost all the patients said that after the study ended their pain increased to the level before rTMS. He added that the remaining question to answer is whether the level of the patients severe uncontrollable pain would continue to decrease if rTMS continued for several years. https Kobayashi M. Fujimaki T. Mihara B. and Ohira T. Repetitive Transcranial Magnetic Stimulation Once a Week Induces Sustainable LongTerm Relief of Central Poststroke Pain. Neuromodulation Technology at the Neural Interface. doi .ner. https Lefaucheur JP AndrObadia N Antal A Ayache SS Baeken C Benninger DH Cantello RM Cincotta M de Carvalho M De Ridder D Devanne H Di Lazzaro V Filipovic SR Hummel FC Jskelinen SK Kimiskidis VK Koch G Langguth B Nyffeler T Oliviero A Padberg F Poulet E Rossi S Rossini PM Rothwell JC SchnfeldtLecuona C Siebner HR Slotema CW Stagg CJ VallsSole J Ziemann U Paulus W GarciaLarrea L. Evidencebased guidelines on the therapeutic use of repetitive transcranial magnetic stimulation rTMS. Clin Neurophysiol. Nov. doi .j.clinph.... Epub Jun . Review. PubMed PMID . About the International Neuromodulation SocietyThe International Neuromodulation Society INS is a nonprofit medical society that unites clinicians scientists and engineers to share scientific knowledge about all aspects of neuromodulation in order to encourage best medical practice. Founded in and based in San Francisco CA the INS presents uptodate information about the full breadth of neuromodulation therapies through an interactive website at http chapter scientific meetings the MEDLINEindexed journal Neuromodulation Technology at the Neural Interface httponlinelibrary.wiley.comjournal.ISSN and its biennial world congress."

"In a remarkably rapid translation of laboratory research findings into a treatment with the potential to benefit patients UC San Francisco scientists have successfully completed a Phase II clinical trial showing that an FDAapproved antihistamine restores nervous system function in patients with chronic multiple sclerosis MS. In light of previous laboratory studies of the antihistamine compound at UCSF the researchers said the drug most likely exerted its effect by repairing damage MS had inflicted on myelin an insulating membrane that speeds transmission of electrical signals in the nervous system. The drug tested in the trial clemastine fumarate was first identified as a candidate treatment for MS in by UCSFs Jonah R. Chan PhD Debbie and Andy Rachleff Distinguished Professor of Neurology vice chief of the Division of Neuroinflammation and Glial Biology and senior author of the new study. First approved by the U.S. Food and Drug Administration FDA in for allergies the drug has been available over the counter in generic form since . The researchers said that the Phase II results published online on October in The Lancet are the first in which a drug has been shown to reliably restore any brain function damaged by a neurological disease in human patients. To the best of our knowledge this is the first time a therapy has been able to reverse deficits caused by MS. Its not a cure but its a first step towards restoring brain function to the millions who are affected by this chronic debilitating disease said the trials principal investigator Ari Green MD also Debbie and Andy Rachleff Distinguished Professor of Neurology chief of the Division of Neuroinflammation and Glial Biology and medical director of the UCSF Multiple Sclerosis and Neuroinflammation Center. Chan and Green are codirectors of the UCSF SmallMolecule Program for Remyelination and both are members of the UCSF Weill Institute for Neurosciences. The new results are particularly notable Chan said because patients in the trial had suffered from MS symptoms caused by injury to myelin for years. People thought we were absolutely crazy to launch this trial because they thought that only in newly diagnosed cases could a drug like this be effective intuitively if myelin damage is new the chance of repair is strong. In the patients in our trial the disease had gone on for years but we still saw strong evidence of repair. MS is an autoimmune neurodegenerative disorder that affects nearly . million people worldwide. The disease strikes when the immune system attacks myelin layers of fatty insulating membrane that surround nerve fibers. Unlike the rubber insulation around wires however myelin helps electrical signals in neurons move faster and more efficiently. As myelin damage continues over the course of the disease neurons progressively lose their ability to reliably transmit electrical signals resulting in progressive loss of vision weakness walking difficulties and problems with coordination and balance. Current MS treatments aim to prevent the immune system from doing further harm but none have been shown to repair damaged myelin. In both his research and in subsequent studies with a mouse model of MS however Chan and colleagues had demonstrated that clemastine fumarate promotes myelin regeneration and restores neural function promising preclinical results that inspired the new study known as the ReBUILD trial. Because the visual system is often one of the first and most prominent parts of the brain to be affected in MS and because there are wellestablished tools to measure the speed of neural transmission in the areas of the brain devoted to vision the research team used a method known as visual evoked potentials or VEPs to assess clemastines therapeutic effects in the trial. The fivemonth Phase II trial enrolled patients with relapsing but generally longstanding MS whose VEPs reflected preexisting deficits in neural transmission. The researchers showed flickering patterns on a screen to participants and used electrodes placed over the brains visual areas at the back of the head to gauge how long it took for the flickering signal presented to the eye to generate an electrical response that could be detected by the electrodes. The time from presentation of the pattern to the detection of the VEP is a measurement of how long it took for the signal to travel via nerve fibers from the retina at the back of the eye to the visual areas at the back of the brain. To enhance the power of their study the researchers used a crossover design they divided the patient population in two and gave the drug blinded to both participant and researcher to one group and a placebo to the other for days then they switched between the two groups giving a placebo to the first group and the drug to the other for the next days. This flipflop technique gave the researchers the ability to compare patients to themselves a form of control that increased the statistical power of the study by nearly an order of magnitude Green said. During the periods when each group was taking the drug the neural signal from the eye to the back of the brain was significantly accelerated over the baseline measurements taken before the patients began the study. The effect persisted in the group that had switched to placebo suggesting that durable repair of myelin had been induced by the drug. Although the research team could not directly observe evidence of rebuilding of myelin in trial participants using magnetic resonance imaging MRI Chan and Green said that this reflects a weakness of current MRI techniques as a tool for this purpose rather than evidence that myelin regeneration did not take place. We still dont have imaging methods that have been proven to be able to detect remyelination in humans said Chan. That myelin increases the speed of neural transmission is one of the most wellestablished concepts in neurobiology and combined with the clear evidence from Chans preclinical research showing that clemastine fumarate promotes myelin formation myelin regeneration is the only plausible explanation for the VEP results the authors said. This is the first step in a long process Green said. By no means do we want to suggest that this is a cureall. We want to groundtruth myelination metrics were designing the crucible thats going to be used to test any future method for detecting remyelination. The work was funded through generous support from the Rachleff Family. In addition to Green and Chan authors all at UCSF include Jeffrey M Gelfand MD MAS Bruce A Cree MD PhD MAS Carolyn Bevan MD W. John Boscardin PhD Feng Mei PhD Justin Inman Sam Arnow Michael Devereux Aya Abounasr Hiroko Nobuta PhD Alyssa Zhu Matt Friessen PhD Roy Gerona PhD Hans Christian von Bdingen MD PhD Roland G Henry PhD and Stephen L Hauser MD. UC San Francisco UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research graduatelevel education in the life sciences and health professions and excellence in patient care. It includes topranked graduate schools of dentistry medicine nursing and pharmacy a graduate division with nationally renowned programs in basic biomedical translational and population sciences and a preeminent biomedical research enterprise. It also includes UCSF Health which comprises three topranked hospitals UCSF Medical Center and UCSF Benioff Childrens Hospitals in San Francisco and Oakland and other partner and affiliated hospitals and healthcare providers throughout the Bay Area."

"New technology that tracks the eye movements of patients may be a more accurate measure of brain injury than any other diagnostic measurements currently in use according to a study published in the journal Concussion http Dr. Uzma Samadani who recently joined Hennepin County Medical Center httpshcmcnews.orginternationallyrecognizedneurosurgeondruzmasamadanijoinshcmc in collaboration with researchers at the Steven and Alexandra Cohen Veterans Center at NYU Langone Medical Center developed the technology that can serve as a biomarker for concussion by tracking patients eye movements as they watch music videos. The eye tracking technology works by having patients watch a music video for seconds while eye movements are measured using a tracking camera. Videos used in the study ranged from Disneys Puss in Boots to Wavin Flag by KNaan. Multiple measures of each eyes movement followed by comparisons of their positions over time are used to distinguish between normal subjects and those with concussion. In the work led by Uzma Samadani MD PhD Charles Marmar MD and Eugene Laska PhD the investigators built a classifier based on emergency room patients with brain injury and uninjured healthy control subjects of similar age. A classifier is a mathematical model that converts a patients eye movement measures into a prediction of the concussive status of the individual. They then tested the models on a dataset of subjects of whom had concussions and found that the eye tracking test had an optimal sensitivity of and specificity of . Typically a classifier produces a score and a subject is classified as having a concussion if the score exceeds a predefined threshold value. The accuracy of a biomarker is measured by plotting the probability of a true versus false positivity at each possible threshold value and the Area Under the Curve AUC is computed. A perfect biomarker has an AUC of . while a worthless marker no better than the chance toss of a coin has an AUC of .. Most tests used clinically have AUCs greater than .. For example serum troponin the most commonly performed blood test for heart attacks has an AUC ranging in various studies from . to .. In this study the eye tracking based classifier had an AUC of . and a crossvalidated AUC of .. According to Dr. Samadani the major challenge for any technology proposed as a biomarker for concussion is first defining concussion. When doctors look for a biomarker for heart attack it is relatively easy to check the accuracy of a potential candidate because they can perform a cardiac catheterization and confirm that the heart vessel is blocked and an attack has occurred. There is no analogous capability with brain injury there is no gold standard diagnostic no blood test and no imaging study for definitively concluding that a patient has experienced a concussion. We use symptom severity scales and standardized cognitive examination assessments but the imperfect nature of these may result in incorrect subject classification. Potentially eye tracking may be more accurate than it appears because of its objective appraisal of a complicated process of coordination that may be impaired. The investigators defined concussion as trauma to the head with a normal CT computed tomography scan of the brain symptom severity score of or greater on SCAT testing and standardized assessment of concussion SAC score less than . The symptom severity score measures the selfreported severity of concussion symptoms ranging from headache to dizziness and irritability. The SAC measures orientation memory and concentration capabilities which have some variability even among uninjured healthy control subjects. In an accompanying editorial http that also appears in the journal Dr. Samadani proposes that eye tracking will help diagnose and classify brain injury and concussion particularly in patients with elevated pressure inside their skulls and disruption of pathways in the brain that control eye movements. The ultimate goal for brain injury said Dr. Samadani is to achieve the same level of diagnostic capability and care as currently exists for other medical conditions. Right now when someone comes in to the emergency room with chest pain doctors perform an EKG blood test imaging and treatment. With brain injury we need to be able to achieve the same level of care to assess all aspects of the problem rigorously classify and treat accordingly. We already know that there is much more to brain injury than what is seen on a CT scan. Eye tracking tells us how well the brain is working regardless of how it looks and represents the beginning of a solution to this problem. It is noninvasive inexpensive and extremely quick. Testing does not require reading nor language skills which makes it useful for multiple patient populations. Commenting further on the study was Dr. David Cifu the Herman J. Flax M.D. Professor and Chair of Rehabilitation at Virginia Commonwealth University Senior TBI Specialist with the U.S. Department of Veterans Affairs and Principal Investigator of the VADepartment of Defense Chronic Effects of NeuroTrauma Consortium. This innovative research by Samadani and colleagues highlights a novel approach to objectively and rapidly support the diagnosis of acute concussion using a novel technique of assessing eye tracking. This publication may represent the first step in the development of a more exacting method of diagnosing and monitoring recovery from traumatic brain injury. Computerized assessment of eye tracking may represent the first truly useful biomarker of TBI. Brain injury is the number one cause of death and disability in Americans under age according to the U.S. Centers for Disease Control and Prevention. Every year . million people suffer from a traumatic brain injury in the United States. Of those die and require hospital admission. Internationally it is a leading cause of death in India and China where access to radiographic diagnostics is also limited. Dr. Samadani http_P_ is the Rockswold Kaplan endowed chair for traumatic brain injury at Hennepin County Medical Center and an Associate Professor of Neurosurgery at the University of Minnesota. Dr. Marmar is the Lucius N. Littauer Professor and Chair of the Department of Psychiatry at NYU Langone Medical Center and Director of its Cohen Veterans Center httpnyulangone.orglocationscohenveteranscenter. Dr. Laska is a statistician at the Nathan Kline Institute for Psychiatric Research and a Research Professor of Psychiatry at the NYU School of Medicine http Other coauthors of this study include Meng Li MA Meng Qian PhD Robert Ritlop M Eng Radek Kolecki MS Marleen Reyes BA Lindsey Altomare BA Je Yeong Sone Aylin Adem Paul Huang MD Douglas Kondziolka MD Stephen Wall MD and Spiros Frangos MD. Technology described in this paper has been licensed to Oculogica Inc. a neurodiagnostic startup company in which NYU Dr. Samadani and Robert Ritlop have an equity interest. The work was supported in part by the Steven Alexandra Cohen Veterans Center http for the Study of PostTraumatic Stress and Traumatic Brain Injury at NYU Langone."

"The largest analysis to date of amyloid plaques in peoples brains confirms that the presence of the substance can help predict who will develop Alzheimers and determine who has the disease. Two linked studies published Tuesday in JAMA also support the central early role in Alzheimers of beta amyloid the protein that creates plaques. Data from nearly people on five continents shows that amyloid can appear to years before symptoms of dementia httphealth.nytimes.comhealthguidesdiseasedementiaoverview.htmlinlinenytclassifier that the vast majority of Alzheimers patients have amyloid and that the ApoE gene known to increase Alzheimers risk greatly accelerates amyloid accumulation. The findings also confirm that amyloid screening by PET scan or cerebral spinal fluid test can help identify people for clinical trials of drugs to prevent Alzheimers. Such screening is increasingly used in research. Experts say previous trials of antiamyloid drugs on people with dementia failed because their brains were already too damaged or because some patients not screened for amyloid may not have had Alzheimers. The papers indicate that amyloid imaging is important to be sure that the drugs are being tested on people who have amyloid said Dr. Roger Rosenberg the director of the Alzheimers Disease Center at the University of Texas Southwestern Medical Center at Dallas who wrote an editorial httpjama.jamanetwork.comarticle.aspxarticleid about the studies. Advertisement Dr. Samuel Gandy an Alzheimers researcher at Mount Sinai Hospital who was not involved in the research said doctors can feel fairly confident that amyloid is due to Alzheimers. But he and others cautioned against screening most people without dementia because there is not yet a drug that prevents or treats Alzheimers and amyloid scans are expensive and typically not covered by insurance. Dr. Gandy also said that findings that amyloid could appear as early as age suggested that any medications to prevent the disease must be especially safe because well be exposing people to a drug for decades when they are healthy. The researchers scrutinized data from numerous studies. One analysis httpjama.jamanetwork.comarticle.aspxarticleid involved people without dementia who had normal cognitive functioning or subjective cognitive impairment a sense of memory loss httphealth.nytimes.comhealthguidessymptomsmemorylossoverview.htmlinlinenytclassifier despite normal memory tests or mild cognitive impairment or M.C.I. a condition often considered a precursor to Alzheimers. About percent of M.C.I. patients had no amyloid possibly indicating their problems were linked to other dementias. With M.C.I. the first thing you think of is Alzheimers because if you hear hoofbeats youd think of horses not zebras Dr. Rosenberg said. Lo and behold you do a PET scan and a third of the time its negative the M.C.I. is something else like vascular disease or a neurodegenerative state that will not go on to Alzheimers. https_id Of people without dementia those with more education were more likely to have amyloid than lesseducated people. Rik Ossenkoppele a neuropsychologist at Vrije Universiteit Medical Center in Amsterdam who led the research with Willemijn Jansen and Pieter Jelle Visser said this suggested that lesseducated people developed dementia sooner leaving fewer in studies of healthier people. He and others said this supported the cognitive reserve theory that more educated people have more brain pathways to compensate longer for cognitive decline. The second study httpjama.jamanetwork.comarticle.aspxarticleid of people with Alzheimers or other dementias frontotemporal vascular or dementia with Lewy bodies found that percent of Alzheimers patients had amyloid. Dr. Ossenkoppele said that for the patients who did not have it the amyloid test could have been wrong or the patients could have had another dementia or possibly several diseases making amyloid less prominent. In other dementias amyloid was present but in fewer people. More people with those dementias had amyloid as they aged but in Alzheimers httphealth.nytimes.comhealthguidesdiseasealzheimersdiseaseoverview.htmlinlinenytclassifier patients amyloid presence decreased as they grew older. We dont know why amyloid goes down with age in Alzheimers said Dr. John Hardy a neuroscientist at University College London who was not involved in the research. It could be that the number of nerve cells is going down and amyloid is produced by nerve cells. The research showed the ApoE gene had a bigger effect than some people expected Dr. Ossenkoppele said. Even when people had one copy of a rarer ApoE gene that protects against Alzheimers they were still at high risk of having amyloid if they had the ApoE gene."

"A team of researchers from the University of Miami Miller School of Medicine has shown that the IPortal Neuro Otologic Test which uses the headmounted goggle that gauged eye movement through video cameras and computers can successfully diagnose concussion with percent specificity and percent sensitivity. These findings illustrate how use of the IPortal goggle can better identify oculomotor vestibular and reaction time OVRT differences between those with mild traumatic brain injury mTBI and nonaffected individuals. Mild traumatic brain injury is typically diagnosed through physical exam findings. However to best manage mTBI researchers have felt it critical to develop objective tests to substantiate the diagnosis. With these findings it appears the IPortal goggle may be a solution. Michael Hoffer M.D. an otolaryngologist and concussion expert at UHealth the University of Miami Health System and lead investigator has been using the goggle for two years recruiting study participants from the emergency rooms of University of Miami Hospital and two military hospitals. Control subjects were recruited from volunteers at the locations where the study was being conducted. Another benefit for this research was that this next generation test has the considerable advantage of not requiring baseline testing said study coauthor Carey Balaban Ph.D. of the University of Pittsburgh. The goal was to identify OVRT performance metrics that differentiated between mTBI and control groups and to create a model that could accurately evaluate mTBI neurologic status in patients. The results of the trial met the expectations of Hoffer and his team of researchers. This is the first paper demonstrating an objective method of diagnosing mTBI that relies on physiologic parameters said Hoffer who is professor of otolaryngology at the University of Miami Miller School of Medicine. This work opens the door for site of injury testing and access to physiologic tests for athletes of all ages. Mild traumatic brain injury is a public health issue. Since the development of the goggle researchers have hoped that the technology used by the goggle in a research setting could be translated to the sidelines of all sports from professional leagues to amateur and little leagues. The research findings published by PLOS ONE help support their objective. It is not inconceivable that in the near future you will see the IPortal goggle used on every sideline in America Hoffer said. With accurate and timely diagnosis which is possible through this technology patients could receive better treatment faster. Its one of many developments that are needed to begin to curb the concussion epidemic."

"Longterm followup of participants in clinical trials of a generic vaccine to reverse advanced type diabetes finds significant clinical benefits including restoration of nearnormal blood sugar levels. Three years after receiving two administrations of the bacillus CalmetteGurin BCG vaccine four weeks apart all members of a group of adults with longstanding type diabetes showed an improvement in HbAc to near normal levels improvement that persisted for the following five years. The study from a Massachusetts General Hospital MGH research team published in npj Vaccines http also reports that the effects of BCG vaccine on blood sugar control appear to depend on a totally novel metabolic mechanism that increases cellular consumption of glucose. This is clinical validation of the potential to stably lower blood sugars to near normal levels with a safe vaccine even in patients with longstanding disease says Denise Faustman MD PhD director of the MGH Immunobiology Laboratory https principal investigator of BCG clinical trials http at MGH and senior author of the npj Vaccines report. In addition to the clinical outcomes we now have a clear understanding of the mechanisms through which limited BCG vaccine doses can make permanent beneficial changes to the immune system and lower blood sugars in type diabetes. Faustman will also present fiveyear followup results of a separate group of BCG clinical trial participants with longstanding type diabetes on Saturday June at the th Scientific Sessions of the American Diabetes Association in Orlando. Used for almost a century to prevent tuberculosis BCG has been known for more than years to boost production of a cytokine called tumor necrosis factor TNF which may be beneficial in autoimmune diseases both by eliminating the autoreactive T cells that attack an individuals tissues in the case of type diabetes pancreatic islets and by inducing production of regulatory T cells Tregs that could prevent an autoimmune reaction. Faustmans team first reported in that inducing TNF production could cure type diabetes in mice but since TNF dosing is toxic in humans clinical trials have utilized BCG for its ability to elevate TNF levels safely. Initial clinical trial results published in a PLOS One https paper reported that two doses of BCG spaced four weeks apart led to reductions in autoreactive T cells an increase in Tregs and what turned out to be a transient increase in insulin production. But by the end of that short week trial there was no reduction in HbAc the established measure of blood sugar levels over time. An extension and expansion of that trial with long term followup the current results are based on data from human study participants with type diabetes who participated in the BCG clinical trials and who contributed blood samples for mechanistic studies. Regular monitoring of clinical trial participants found that HbAc levels of those receiving BCG had dropped by more than percent at three years after treatment and by more than percent at four years. That reduction was maintained over the next four years with treated participants having an average HbAc of . close to the . considered the threshold for diabetes diagnosis and with no reports of severe hypoglycemia. Participants in the placebo group and in a comparison group of patients receiving no treatment experienced consistent HbAc elevations over the same eightyear time period. In investigating how BCG administration produces its beneficial effects the research team identified a mechanism never previously seen in humans in response to treatment with any drug a shifting of the process of glucose metabolism from oxidative phosphorylation the most common pathway by which cells convert glucose into energy to aerobic glycolysis a process that involves significantly greater glucose consumption by cells. The researchers also found that BCG could reduce blood sugar elevations in mice that were caused by means other than autoimmune attack raising the possibility that BCG vaccines could also be beneficial against type diabetes. Mihai G. Netea PhD professor in the Department of Internal Medicine at Radboud University Medical Center in the Netherlands says of this study The clinical effects and the proposed mechanism demonstrated are exciting and add to the emerging consensus that the BCG vaccine can have a lasting and valuable impact on the immune system. We know and this study shows that BCG vaccination induces epigenetic reprogramming at the chromatin architecture level and functional alterations indicative of a permanent change in immunity. The MGH trials and other larger prevention and intervention trials underway around the globe may lead to a major shift in the prevention and treatment of infections and autoimmunity. Netea was not involved in the current study. The MGH teams findings set the stage for further testing of BCG administration including the FDAapproved phase study currently underway testing multiple BCG doses in a large group of participants with longstanding type diabetes. That trial is fully enrolled and there are seven additional BCG clinical trial groups currently recruiting or enrolling at MGH with a pediatric trial in the planning stages. The MGH BCG clinical trial program is entirely funded by private philanthropy from individuals and family foundations including the Iacocca Foundation. Additional information about clinical trials including information for potential participants and financial supporters is available at http or by emailing DiabetesTrialpartners.org mailtoDiabetesTrialpartners.org. The lead author of the npj Vaccines paper is Willem M. Khtreiber PhD MGH Immunobiology Laboratories. Additional coauthors are Lisa Tran Taesoo Kim Michael Dybala Brian Nguyen Sara Plager Daniel Huang Sophie Janes Audrey Defusco and Danielle Baum MGH Immunobiology and Hui Zheng PhD MGH Biostatistics. Massachusetts General Hospital founded in is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute http conducts the largest hospitalbased research program in the nation with an annual research budget of more than million and major research centers in HIVAIDS cardiovascular research cancer computational and integrative biology cutaneous biology genomic medicine medical imaging neurodegenerative disorders regenerative medicine reproductive biology systems biology photomedicine and transplantation biology. The MGH topped the Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious Foster G. McGaw Prize for Excellence in Community Service. In August the MGH was once again named to the Honor Roll in the U.S. News World Report list of Americas Best Hospitals."

"Mapping blood flow in the brain of athletes using an advanced form of ultrasound may make it easier to more accurately recognize concussions according to a study released today that will be presented at the American Academy of Neurologys th Annual Meeting https in Vancouver Canada April to . There is growing evidence that concussions can change the blood flow in the brain said study author Robert Hamilton PhD cofounder of Neural Analytics in Los Angeles Calif. and a member of the American Academy of Neurology. While such changes may be detected with MRI we believe there may be a less expensive and portable way to measure these changes with a transcranial Doppler TCD device. More than one million athletes experience a concussion each year in the United States. TCD uses ultrasound to map blood flow activity in the brain. Traditionally it has measured variables like the speed and variability pulse of blood flowing through the arteries. But those measurements havent been enough to accurately detect concussion. For this study researchers used an advanced version of TCD ultrasound to get a more complete picture of just how the blood moves through the middle cerebral artery one of the three major arteries in the brain. Researchers compared a group of high school athletes in contact sports who had been recently diagnosed with a concussion to a control group of high school student athletes from both contact and noncontact sports. Examples of collision sports included in the study were football soccer basketball hockey water polo and lacrosse. The noncontact sports included were cheerleading cross country cycling tennis and track. Both the control and concussion groups were approximately percent female. Each of the concussed athletes had their brain blood flow measured with the advanced ultrasound headset within an average of six days after the injury. They were also given a general concussion evaluation and had their blood pressure checked. The study found that the advanced version of TCD ultrasound was able to differentiate between healthy and concussed athletes percent of the time. This is in contrast to traditional TCD ultrasound measurements like change in cerebral blood flow reactivity which differentiated between the two percent of the time average blood flow speed which differentiated percent of the time and blood flow resistance which differentiated percent of the time. This research suggests that this advanced form of ultrasound may provide a more accurate diagnosis of concussion said Hamilton. While more research is needed the hope is such a tool could one day be used on the sidelines to help determine more quickly whether an athlete needs further testing. This important work provides insight into a tool that may yet prove useful in the recognition and management of concussion said Jeffrey Kutcher MD FAAN with the The Sports Neurology Clinic in Brighton Michigan. The potential of having an accessible technology that detects a physiological change following brain trauma is very exciting. However what these detected blood flow changes mean to a patients clinical care is still unclear. This is an important area of research. Testing of the TCD technique at the sideline at the time of injury will be an important next step to determine its ultimate utility said Randolph S. Marshall MD MS with Columbia Presbyterian Medical Center in New York and a member of the American Academy of Neurologys Science Committee. The study was supported by the National Institutes of Health and the National Science Foundation. Learn more about concussion at http where you can access the AANs Sports Concussion Guideline QuickCheck app and other resources. The American Academy of Neurology an association of neurologists and neuroscience professionals 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 brain injury Parkinsons disease and epilepsy. For more information about the American Academy of Neurology visit http or find us on Facebook http Twitter httptwitter.com Google httptinyurl.comvzda and YouTube http SOURCE American Academy of Neurology Related Links http"

"Taking extra vitamin D and calcium doesnt seem to prevent bonethinning in older men according to Australian researchers. However exercise did boost bone mineral density a proxy for bone strength their report shows. Despite the findings people still need to get enough calcium and vitamin D to reduce the risk of osteoporosis or bone thinning said Dr. Mone Zaidi an osteoporosis researcher at the Mount Sinai School of Medicine in New York who was not involved in the study. Its like the four legs of the stool vitamin D and calcium exercise medications if a person is losing bone and the fourth leg is telling people how to prevent fractures Zaidi said. More than million people in the US are affected by osteoporosis. Its most common in older women but about seven percent of white men and five percent of black men are affected according to the American College of Physicians. In the new study published in the Journal of Clinical Endocrinology and Metabolism Robin M. Daly from the University of Melbourne Australia and colleagues randomly assigned men aged to to an exercise program drinking milk fortified with calcium and vitamin D doing both or doing nothing. They measured the mens bone density before and after the study which took place over months but they didnt look at fractures. At the end of the study men who exercised had higher bone density than those who had supplemented their diet with milligrams of calcium and international units IU of vitamin D per day. Adding the supplements to the exercise program provided no extra benefit hinting that the men already had enough vitamin D and calcium in their diets to be able to boost their bone strength through exercise alone. The recommended daily intake of vitamin D is IU in adults up to age and IU for older people according to the National Institutes of Health NIH. A month supply of vitamin D supplements can be bought for less than and many multivitamins contain the recommended daily dose of vitamin D. As for calcium the NIH advises mg per day for men ages and then mg per day for men older than . To build bone density weightbearing exercise is needed such as running or weightlifting according to the NIH. In animal studies a lack of vitamin D has been linked to several diseases such as multiple sclerosis and some types of cancer. However there isnt enough data to say if vitamin D can help treat or prevent these diseases Zaidi said. To reduce the risk of bone weakening the NIH recommends not smoking drinking less alcohol and exercising more. Zaidi said that both vitamin D and calcium are extremely important for human health so people should follow the previous vitamin D and calcium recommendations. Youve got to have it to build a wall he said. Adding more might not strengthen the wall but you have to take enough to keep the wall strong. Otherwise it might fall apart. SOURCE bit.lyitDqs httpbit.lyitDqs The Journal of Clinical Endocrinology and Metabolism online January . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Palbociclib a new oral drug whose efficacy in combating breast cancer has been demonstrated alone and in combination with endocrine therapy also has potential to combat other types of cancer according to a literature review and additional original research httponcology.jamanetwork.comarticle.aspxarticleid conducted by experts at the Abramson Cancer Center ACC in the University of Pennsylvania published this month in JAMA Oncology. Palbociclib targets the rapid division of tumor cells by inhibiting the activity of the enzymes CDK and CDK which propel cell division and increase in number in most cancers. It is the first CDK inhibitor to be approved for the treatment of breast cancer. All living cells undergo cell division and palbociclibs unique capacity to halt the cell division process also known as the cell cycle therefore has potentially broad applicability said the studys lead author Amy S. Clark MD MSCE an assistant professor of HematologyOncology at Penns Perelman School of Medicine and ACC. Pairing palbociclib with other anticancer therapies such as endocrine therapy chemotherapy and targeted therapy can create a powerful combinatorial effect with real promise for addressing a variety of cancers. For example amplification of CDK is reported in a high percentage of melanomas and esophageal cancers. Targeted therapy uses medication and other interventions to more accurately identify and attack cancer cells usually while doing no or little damage to normal cells. This drug has minor effects on normal cells other than neutrophils white blood cells said the studys senior author Peter J. ODwyer MD a professor of HematologyOncology at Penn and director of the Developmental Therapeutics Program at the ACC. In tumors it can cause shrinkage or more commonly arrest of growth. As we discover new functions for the CDK target of this medicine we are likely to use it in combinations to make other anticancer agents work better. In addition to inhibiting the cell cycle palbociclib has been shown for example to alter several recently described noncell cycle functions of CDK a finding expected to expand its therapeutic role ODwyer added. Assessing relevant publications in the literature as well as interpreting their own continuing studies the allPenn team found that in addition to its safety and effectiveness in fighting certain types of breast cancer early trials of palbociclib have shown promise of effectiveness in cases of lymphoma sarcoma and teratoma tumors that while rare often afflict younger patients. A phase trial showed that among patients with previously treated mantlecell lymphoma palbociclib resulted in one complete response and two partial responses. Although median progressionfree survival was four months five patients had progressionfree survival greater than one year. Another phase trial with sarcoma patients treated with palbociclib showed a progressionfree survival of percent at weeks. Also combining palbociclib with other anticancer agents is feasible and early results in myeloma and some solid tumors have led to more definitive studies. In both breast and other cancer trials palbociclib has been shown to be safe with oncedaily dosing and its main adverse effect is reversible neutropenia an abnormally low count of neutrophils a type of white blood cell that helps fight infections. The lower their neutrophil count the more vulnerable patients are to infectious diseases. In such cases the drug is temporarily discontinued and reintroduced at a lower dose. Other side effects included fatigue percent nausea percent diarrhea percent constipation percent and rash percent. At the recommended doses evidence of the desired drug effect in tumors has been obtained using novel PET imaging at Penn. These tools can help to individualize patient therapy going forward. Other Penn coauthors are Thomas B. Karasic MD Angela DeMichele MD MSCE David J.Vaughn MD Mark OHara MD Rodolfo Perini MD Paul Zhang MD Priti Lal MD Michael Feldman MD PhD and Maryann Gallagher RN. The study was funded by Pfizer Inc and the National Institutes of Health P CA."

"There is a group of metastatic breast cancers that has the HER gene amplified the cells have many copies of it which leads to enhanced activity of the product enzyme a tyrosine kinase. HER has been established as a therapeutic target in breast cancer and breast cancers in which the HER gene is not amplified do not in general respond to HERdirected therapeutic approaches. A few years ago when the research teams of Dr. Matthew Ellis and others carried out a molecular characterization of breast cancer tumors they found a new mutation in HER that was different from gene amplification but also resulted in tyrosine kinase being constantly activated. In this particular activation mechanism the cells develop a subtle mutation within the functional part of the HER gene that activates the enzyme said Ellis professor and director of the Lester and Sue Smith Breast Center part of the National Cancer Institutedesignated Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine. The mutation locks the enzyme into an on position. Ellis and his colleagues developed a preclinical model to study this new HER mutation and discovered that the enhanced enzymatic activity could trigger tumor formation. Furthermore these tumor cells were sensitive to an experimental drug neratinib. With this information in hand the researchers took the next step. We launched a phase II clinical trial of neratinib in patients with metastatic breast cancer carrying a HER mutation Ellis said. Finding patients that are positive for a HER mutation required a national collaboration because we had to screen hundreds of patients to identify the to percent that have a tumor driven by a HER mutation. The results of the clinical trial were encouraging in that about percent of the patients treated with neratinib had a meaningful clinical response showing significant disease stabilization or regression. Neratinib was well tolerated by most patients. This is the first time we had a reasonable number of patients treated for HER mutations in whom we could estimate the response rate. The number of patients who could potentially benefit from this new treatment approach is estimated to be in the thousands. The researchers estimate that as many as patients are likely to be living with metastatic breast cancer today in the United States. Based on the estimate that the new mutation is present in to percent of cases the researchers calculated that approximately to patients with metastatic breast cancer carry a HER mutation and are therefore potential candidates for neratinib treatment. Circulating tumor DNA analysis a promising diagnostic tool To identify the patients in this study who carried the new HER mutation the researchers required tissue from the tumor a biopsy from which they could extract and sequence the genetic material to determine the presence of the HER mutation. This task turned out to be a major challenge because for to percent of the patients the researchers did not have sufficient material to make the diagnosis. To assist in our ability to identify patients with HER mutationpositive tumors we conducted circulating tumor DNA analysis Ellis said. The tumors DNA is released into the human bloodstream and we were able to determine the presence of the mutation in blood samples from the patients. Importantly the circulating tumor DNA results were highly concordant with the tumor sequencing results and they were much easier to determine. Notably the blood test was sensitive enough that we could use it as a tool to determine eligibility for the clinical trial. In addition to bringing to the table a novel treatment for metastatic breast cancer carrying a HER mutation the researchers have tested the value of the circulating tumor DNA as a diseasemonitoring marker. A circulating tumor DNAbased blood test also could therefore be potentially used to monitor tumor progression and to determine whether patients are responding or not to treatment after just one month of therapy Ellis said. Ellis also is a McNair Scholar at Baylor. Read all the details of this study the full list of contributors and their financial support in Clinical Cancer Research."

"A treatment traditionally used on patients with certain cancers is being tried on a small number of people with multiple sclerosis http with remarkable results according to a professor involved in the research. The treatment destroys patients faulty immune systems through chemotherapy and then rebuilds them using stem cells previously harvested from their blood. Doctors at Royal Hallamshire hospital in Sheffield stress that the treatment so far given to about patients over three years is not suitable for everyone with the disease which attacks nerves in the brain and spinal column. The hospital is part of an international trial also involving patients in the US Sweden and Brazil to see whether the treatment can benefit those with relapsing remitting multiple sclerosis https a form that involves flareups of symptoms such as loss of vision fatigue muscle problems and difficulties with balance that can last from a few days to a few months. These will be followed by periods where symptoms are mild or disappear altogether. Most people with MS https there are thought to be more than in the UK are diagnosed with this form and although drugs may help slow progression there is currently no cure. Consultant hematologist John Snowden said The immune system is being reset or rebooted back to a time point before it caused MS ... The treatment has traditionally been used to treat bone and blood cancers. Basil Sharrack a consultant neurologist at Sheffield teaching hospitals NHS foundation trust said The new treatment is showing some remarkable results in the small number of patients we have treated so far. It is important to stress however that this treatment is only suitable for patients with relapsing remitting multiple sclerosis disease who have had two or more significant relapses in the past months failed to respond to standard drug treatment and who have had the illness for at least years. One patient who has undergone the treatment known as autologous haematopoietic stem cell transplant HSCT told the BBCs Panorama http that he had made incredible progress. Steven Storey who was diagnosed with MS in said I went from running marathons to needing hour acute care. At one point I couldnt even hold a spoon and feed myself. Within a few days of the transplant he was able to move his toes and after four months could stand unaided although he still needs a wheelchair. Its been incredible Storey said. I was in a dire place but now I can swim and cycle and I am determined to walk. Holly Drewry was when she was diagnosed with MS and her condition deteriorated after she gave birth to her daughter Isla. Within a couple of months I got worse and worse she said. I couldnt dress or wash myself I didnt even have the strength to carry my daughter. She had needed a wheelchair before her transplant but after the treatment she walked out of hospital. Drewry whose MS is described by doctors as dormant said Its been a miracle. I got my life and my independence back and the future is bright again in terms of being a mum and doing everything with Isla. Two years after the treatment she has had no relapses and there was no evidence of active disease on her scans. Paul Kirkham another patient who has undergone the treatment at a cost of about said It does knock you out. Id rather have done rounds with Mike Tyson. Richard Burt of Northwestern University in Chicago who carried out the first HSCT for MS in and is coordinating the international trials told the BBC There has been resistance to this in the pharmaceutical and academic world. This is not a technology you can patent and we have achieved this without industry backing. Emma Gray the head of clinical trials at the MS Society https said Ongoing research suggests stem cell treatments such as HSCT could offer hope and its clear that in the cases highlighted by Panorama theyve had a lifechanging impact. However trials have found that while HSCT may be able to stabilise or improve disability in some people with MS it may not be effective for all types of the condition. We want people to be aware that HSCT is an aggressive treatment that comes with significant risks. It needs to be carried out at an accredited centre or as part of a clinical trial. The MS Society has recently funded a study looking into the impact of HSCT on the immune system and wed like to see larger trials in this area. They would help us learn more about the safety and long term effectiveness of the treatment and who could benefit from it."

"A new smartphone app called WoundCare is successfully enabling patients to remotely send images of their surgical wounds for monitoring by nurses. The app was developed by researches from the Wisconsin Institute of Surgical Outcomes Research WiSOR Department of Surgery University of Wisconsin Madison with the goal of earlier detection of surgical site infections SSIs and prevention of hospital readmissions. The study results appear as an article in press https on the website of the Journal of the American College of Surgeons ahead of print. SSIs are the most common hospitalacquired infection and the leading cause of hospital readmission following an operation. Due to the prevalence off SSIs the WiSOR research team decided to see if postoperative wound monitoring could be effectively achieved by having patients upload photos through the WoundCare app and answer a few brief questions to gather information not easily captured through images. Patients cannot identify infections and frequently ignore or fail to recognize the early signs of cellulitis or other wound complications study authors wrote. This drawback leads to the common and frustrating scenario where patients present to a routine scheduled clinic appointment with an advanced wound complication that requires readmission with or without reoperation. However the complication may have been amenable to outpatient management if detected earlier. Forty vascular surgery patients were enrolled in the study. There was an overall data submission rate of . percent among participants and submissions were reviewed within an average of . hours. During the study seven wound complications were detected and one false negative was found. We set out to come up with a protocol where patients could become active participants in their care and allow us to be in closer communication and monitor their wounds after they leave the hospital said lead study author and general surgery resident Rebecca L. Gunter MD. . This approach allows us to intervene at an earlier time rather than waiting for patients to come back in after the problem has already developed past the point of being able to manage it on an outpatient basis. Patients were enthusiastic about the apps ease of use and the reassurance they felt having their wounds regularly monitored. The nurse practitioners responsible for reviewing the submitted images attested to the value of the photos and patient satisfaction although they also noted it was difficult to find time to review the submitted images on top of an already heavy clinical workload. Study authors note that the success and sustainability of a postdischarge woundmonitoring protocol requires a dedicated transitional care program and not simply adding a task to the current staff workload. This protocol also has a costsavings component in addition to the patient safety and satisfaction aspects. Study authors note that SSIs are the most expensive hospitalacquired infection costing an average of nearly per woundrelated readmission and an estimated billion annually. If you could imagine saving the cost from the number of patients whose readmission you were able to prevent that result could provide significant savings to the health system Dr. Gunter said. Although capturing specific numbers related to costsavings was not part of this study Dr. Gunter said it is an important area of focus for future studies. A limitation to telemedicine protocols that call for the use of smartphones is that not every patient has the necessary technology or knowledge to upload images on their own. The WiSOR research team addressed this issue by having participants undergo tailored training to learn to use the WoundCheck app. They provided each patient with an iPhone S and an accompanying visual reference guide to further assist in using the phone and app. Dr. Gunter said they were very successful in giving patients knowledge and access to technology so they could participate in the study. She said this is a model easily adaptable to other medical centers whether through providing participants with a phone having a rotating supply of phones at the hospitals for patients to borrow or relying on a patients personal device. We have demonstrated that a population of complex and highrisk patients many of whom are older adults and novice smartphone users can complete this protocol with high fidelity and satisfaction the researchers concluded. Study coauthors from the University of Wisconsin Madison include Sara FernandesTaylor PhD Shahrose Rahman BS Lola Awoyinka MPH Kyla M. Bennett MD Sharon M. Weber MD FACS Caprice C. Greenberg MD MPH FACS and K. Craig Kent MD FACS. FACS designates that a surgeon is a Fellow of the American College of Surgeons. Support for this study came from the Agency for Healthcare Research and Quality AHRQ R HS. Dr. Gunter is supported by the National Institutes of Health NIH T HL. This study was presented at the th Annual Academic Surgical Congress Las Vegas Nev. February . Citation Feasibility of an ImageBased Mobile Health Protocol for Postoperative Wound Monitoring. Journal of the American College of Surgeons. Available at http Wiseman JT Guzman AM FernandesTaylor S et al. General and vascular surgery readmissions a systematic review. J Am Coll Surg .e. Weber DJ SickbertBennett EE Brown V et al. Completeness of surveillance data reported by the National Healthcare Safety Network an analysis of healthcareassociated infections ascertained in a tertiary care hospital . Infect Control Hosp Epidemiol . Lewis SS Moehring RW Chen LF et al. Assessing the relative burden of hospitalacquired infections in a network of community hospitals. Infect Control Hosp Epidemiol . About the American College of Surgeons The American College of Surgeons is a scientific and educational organization of surgeons that was founded in to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than members and is the largest organization of surgeons in the world. For more information visit http"

"Epilepsy https patients who have not responded to standard drug treatments may benefit from a new therapy that delivers high frequency bursts of electrical stimulation called microbursts to the brain. Rush University Medical Center in Chicago is the first health care provider in the world to provide this treatment known as microburst vagus nerve stimulation. The treatment is akin to a heart pacemaker. A surgeon places an electronic pulse generator under the skin in the chest and attaches it to the left vagus nerve which runs down the side of the body from the stem of the brain through the neck and chest to the abdomen. The device sends regular electrical pulses through the vagus nerve to the brain to prevent epileptic seizures from occurring. The stimulators settings can be changed according to each patients needs using a special programming wand with no additional surgery needed. Dr. Rebecca ODwyer httpsdoctors.rush.eduDetails_ga.... assistant professor of neurology at Rush is participating in a nationwide clinical study of the initial safety and effectiveness of microburst vagus nerve stimulation in patients who have drugresistant epilepsy. She enrolled the first patient in the entire study on February . At the Rush Epilepsy Center https we regularly collaborate with members of the neurosurgery and neuroradiology department in our research endeavors. We look forward to the results of this study and hope we can bring relief to more people with epilepsy ODwyer said. Rush was the first hospital in Chicago to offer epilepsy patients the original vagal nerve stimulator which uses mild pulses of electricity after the U.S. Food and Drug Administration approved it in as an adjunctive treatment for drugresistant epilepsy. We are now exploring how higher frequency bursts delivered to the vagus nerve will affect epilepsy that does not respond to traditional therapies said ODwyer. The study consists of two groups of patients with epilepsy enrolling up to patients in total at approximately sites in the United States. The first group will include patients with primary generalized tonicclonic seizures. The second group will consist of patients with partial onset seizures including complex partial seizures with or without secondary generalization. Each patient will participate in the study for a minimum of months. The study will measure the percent change in seizure frequency and occurrence of stimulationrelated adverse events in comparison to a patients baseline. Activation of various areas of the brain in response to stimulation will be assessed using functional magnetic resonance imaging or fMRI. Patients also will be evaluated to assess changes from baseline in seizure severity quality of life antiepileptic drug use suicidality and adverse events. To be considered for enrollment in the study or for information contact The Rush Epilepsy Center at ."

"Bottom Line For adults coming to the emergency department for arm or leg pain due to sprain strain or fracture there was no difference in pain reduction after hours with ibuprofenacetaminophen vs three comparison opioidacetaminophen paracetamol combinations. Why The Research Is Interesting The United States is facing an opioid epidemic with almost individuals dying from opioid overdoses since . Despite the epidemic opioid analgesics remain a firstline treatment for moderate to severe acute pain in the emergency department. The combination of ibuprofen and acetaminophen may represent an effective nonopioid alternative. Who patients ages to years with moderate to severe acute extremity pain in two urban emergency departments were randomly assigned to receive mg ibuprofen and mg acetaminophen mg oxycodone and mg acetaminophen mg hydrocodone and mg acetaminophen or mg codeine and mg acetaminophen When July to August What Study Measures The betweengroup difference in decline in pain two hours after taking the study drugs. How Study Design This was a randomized clinical trial RCT. Randomized trials allow for the strongest inferences to be made about the true effect of an intervention such as a medication or a procedure. However not all RCT results can be replicated because patient characteristics or other variables in realworld settings may differ from those that were studied in the RCT. Authors Andrew K. Chang M.D. M.S. of Albany Medical College Albany New York and coauthors Results After hours pain was less in all participants without any important difference in effect between the four groups. Study Limitations The results apply only to pain after two hours. About in patients required additional medication to control their pain. Study Conclusions There were no important differences in pain reduction after hours with ibuprofenacetaminophen or opioidacetaminophen combination pills in emergency department patients with acute extremity pain. The findings suggest that ibuprofenacetaminophen is a reasonable alternative to opioid management of acute extremity pain due to sprain strain or fracture but further research to assess longerterm effect adverse events and dosing is warranted. Related material The following related elements also are available on the For The Media website The editorial Opioid vs Nonopioid Acute Pain Management in the Emergency Department by Demetrios N. Kyriacou M.D. Ph.D. Senior Editor JAMA Chicago Northwestern University Feinberg School of Medicine Chicago. For more details and to read the full study please visit the For The Media website. doi.jama.. Editors Note Please see the article for additional information including other authors author contributions and affiliations financial disclosures funding and support etc. Want to embed a link to this study in your story Link will be live at the embargo time httpjamanetwork.comjournalsjamafullarticle.jama.."

"Researchers say they have taken a big step towards developing a test that can tell people if they have cancer long before the first symptoms show up. The blood test detected the majority of cancers in people with four of the biggest cancer killers breast colon lung and ovarian cancer the team at Johns Hopkins University said. The test is a long way from being used to screen for cancer but the study shows a way to get there the team reported in the journal Science Translational Medicine. There is a lot of excitement about liquid biopsies but most of that has been in latestage cancer or in individuals where you already know what to look for said Dr. Victor Velculescu professor of oncology and pathology at the Johns Hopkins University Kimmel Cancer Center. The surprising result is that we can find a high fraction of earlystage patients having alterations in their blood said Velculescu who led the study team. It was not a slam dunk but the test found cancer in the blood of more than half the patients who had been diagnosed with stage cancer. It was even more accurate in finding latestage cancers but the goal would be to catch cancer in its earliest easiesttotreat stage. There were no false positives in people who did not have cancer they said. Thats important said Dr. Wyndham Wilson of the National Cancer Institute because there is no point detecting cancer in people if the cancer is not going to actually cause trouble. You dont want to go screening people for hallmark cancer mutations unless you absolutely know that when you find it that there is a tumor there and that it is a tumor that needs to be treated said Wyndham who was not involved in the study. Sometimes earlystage tumors or precancerous growths just go away attacked by the immune system or because they dont thrive for other reasons. Several different liquid biopsies are already on the market used to help track whether cancer treatments are working. But theres nothing yet that can detect cancer in someone who has not yet been diagnosed. Its easy to find tumor mutations if you know what to look for. The challenge was to develop a blood test that could predict the probable presence of cancer without knowing the genetic mutations present in a persons tumor Velculescu said. Velculescus team developed an approach called targeted error correction sequencing TECSeq for short. We have used this approach to examine cancerrelated genes the team wrote in their report. The method involved deep sequencing sequencing DNA times over to look for mutations in DNA from tumor cells that floats in the blood. Cancer patients had more of this DNA in their blood the team found. They identified percent of the patients with stage I cancer four out of eight colon cancer patients and percent of colon cancer patients with stage II III or IV disease. They got a positive in percent of the lung cancer patients with stage I disease percent of ovarian cancer patients with stage I disease and percent of breast cancer patients with stage I disease. While thats good its not a great result. The test still missed a large percentage of cancers and will need much improvement Velculescu said. It will also have to be tried in larger groups of patients and patients with different cancers. The first goal would be to try it in people at high risk of cancer but no symptoms yet such as smokers or people with cancercausing gene mutations like BRCA mutations Velculescu said. Wyndham said it will be important to study such tests in large groups of people who have not had cancer diagnosed to see if it can truly be used to screen asymptomatic people for cancer. And then it will have to be shown that using the test allows doctors to intervene sooner and help people. Catching cancer in its earliest stages could save many lives. Cancer is the No. killer overall in the United States. The survival difference between late stage and early stage disease in these cancers would account for more than a million lives each year worldwide Velculescu said. The genetic sequencing is also expensive right now on the order of several thousand dollars for the repeats the team did. But costs are coming down steadily he said. Velculescu said Johns Hopkins had patented this test and Velculescu is himself the founder of a company that does liquid biopsies for advanced cancer patients called Personal Genome Diagnostics. The U.S. Food and Drug Administration has been very skeptical http blood tests that claim to diagnose disease http people have symptoms. The agency has chastised a company called Pathway Genomics http over its liquid biopsy test http saying the company had not shown the test worked as advertised. Its also warned other gene testing companies http finally gave andMe the goahead http to market its home DNA test which does not include any cancer screening in April. Cancer screening is still often a tricky issue. Currently colon cancer can be detected very early with colonoscopies http and even stopped before precancerous growths get out of control. But colonoscopies are uncomfortable and carry a small risk of injury. Mammograms can detect early breast cancer http Pap smears can detect cervical cancer http or precancerous changes and a type of specialized chest xray called a spiral CT http detect lung cancer. Theres a debate over the usefulness of screening for prostate cancer http but blood tests and physical exams can indicate some men at high risk"

"The U.S. Food and Drug Administration today permitted marketing of the first blood test to evaluate mild traumatic brain injury mTBI commonly referred to as concussion in adults. The FDA reviewed and authorized for marketing the Banyan Brain Trauma Indicator in fewer than months as part of its Breakthrough Devices Program https Most patients with a suspected head injury are examined using a neurological scale called the point Glasgow Coma Scale followed by a computed tomography or CT scan of the head to detect brain tissue damage or intracranial lesions that may require treatment however a majority of patients evaluated for mTBIconcussion do not have detectable intracranial lesions after having a CT scan. Availability of a blood test for concussion will help health care professionals determine the need for a CT scan in patients suspected of having mTBI and help prevent unnecessary neuroimaging and associated radiation exposure to patients. Helping to deliver innovative testing technologies that minimize health impacts to patients while still providing accurate and reliable results to inform appropriate evaluation and treatment is an FDA priority. Todays action supports the FDAs Initiative to Reduce Unnecessary Radiation Exposure from Medical Imagingan effort to ensure that each patient is getting the right imaging exam at the right time with the right radiation dose said FDA Commissioner Scott Gottlieb M.D. A bloodtesting option for the evaluation of mTBIconcussion not only provides health care professionals with a new tool but also sets the stage for a more modernized standard of care for testing of suspected cases. In addition availability of a blood test for mTBIconcussion will likely reduce the CT scans performed on patients with concussion each year potentially saving our health care system the cost of often unnecessary neuroimaging tests. According to the U.S. Centers for Disease Control and Prevention in there were approximately . million TBIrelated emergency department visits hospitalizations and deaths in the U.S. Of these cases TBI contributed to the deaths of nearly people. TBI is caused by a bump blow or jolt to the head or a penetrating head injury that disrupts the brains normal functioning. Its severity may range from mild to severe with percent of TBIs that occur each year being assessed as mTBIs or concussions. A majority of patients with concussion symptoms have a negative CT scan. Potential effects of TBI can include impaired thinking or memory movement sensation or emotional functioning. A blood test to aid in concussion evaluation is an important tool for the American public and for our Service Members abroad who need access to quick and accurate tests said Jeffrey Shuren M.D. director of the FDAs Center for Devices and Radiological Health. The FDAs review team worked closely with the test developer and the U.S. Department of Defense to expedite a blood test for the evaluation of mTBI that can be used both in the continental U.S. as well as foreign U.S. laboratories that service the American military. The Brain Trauma Indicator works by measuring levels of proteins known as UCHL and GFAP that are released from the brain into blood and measured within hours of head injury. Levels of these blood proteins after mTBIconcussion can help predict which patients may have intracranial lesions visible by CT scan and which wont. Being able to predict if patients have a low probability of intracranial lesions can help health care professionals in their management of patients and the decision to perform a CT scan. Test results can be available within to hours. The FDA evaluated data from a multicenter prospective clinical study of individual blood samples from adults with suspected mTBIconcussion and reviewed the products performance by comparing mTBIconcussion blood tests results with CT scan results. The Brain Trauma Indicator was able to predict the presence of intracranial lesions on a CT scan . percent of the time and those who did not have intracranial lesions on a CT scan . percent of the time. These findings indicate that the test can reliably predict the absence of intracranial lesions and that health care professionals can incorporate this tool into the standard of care for patients to rule out the need for a CT scan in at least onethird of patients who are suspected of having mTBI. The Brain Trauma Indicator was reviewed under the FDAs De Novo premarket review pathway a regulatory pathway for some low to moderaterisk devices that are novel and for which there is no prior legally marketed device. The FDA is permitting marketing of the Brain Trauma Indicator to Banyan Biomarkers Inc. The FDA an agency within the U.S. Department of Health and Human Services protects the public health by assuring the safety effectiveness and security of human and veterinary drugs vaccines and other biological products for human use and medical devices. The agency also is responsible for the safety and security of our nations food supply cosmetics dietary supplements products that give off electronic radiation and for regulating tobacco products."

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

"Patients who need to be rehospitalized within a month after major surgery have a lower risk of death over the next two months if they return to the hospital where they had the surgery rather than going to a different facility according to a new study. Most clinicians or surgeons feel like if you take the time to do a big operation on someone you know the area operated on how the operations went if there were complications lead author Dr. Benjamin S. Brooke of the University of Utah School of Medicine in Salt Lake City told Reuters Health by phone. Doctors who did not perform the surgery wont have that context which may explain part of the survival benefit of returning to the original hospital he said. He and his team analyzed Medicare claims data from to on patients readmitted to the hospital within days after major surgeries including coronary artery bypass surgery removal of the colon or pancreas and hip or knee replacement. More than nine million patients underwent one of such surgeries during the study period and between six and percent depending on the surgery were readmitted to the hospital within a month. More than half the time patients were readmitted or transferred to the hospital where they had the surgery. Those who returned to the original hospital were percent less likely to die within three months of surgery than those admitted to a different hospital as reported in The Lancet. Patients readmitted after surgery almost always have a postoperative complication either medical or surgical Drs. Justin B. Dimick and David C. Miller both of the University of Michigan wrote in an editorial. Patients readmitted at the original hospital also tended to be readmitted one to two days earlier than those who ended up at different hospitals. It might be harder for patients to get appropriate care at the other hospitals where they dont have a preexisting relationship with a surgeon and so treatment might be delayed Dimick and Miller wrote. If you are a surgeon or clinician who takes care of this person its intuitive that going back to that surgeon would influence how well they do Brooke said. For complex operations some patients will fly to prestigious hospitals from several hundred miles away he said. If these patients have complications weeks later they end up going to a local hospital not the one where they had surgery. A lot of big Fortune companies contract with bigger hospitals for patients undergoing major surgery Brooke said noting the WalMart has contracted with the Cleveland Clinic. Even if they live in the same city where they had their surgery they might have to call an ambulance to pick them up and the ambulance drivers dont understand how important it is to take them to the same hospital he said. Ambulance drivers and emergency department doctors should make every effort to get a patient who has had major surgery back to their original hospital he said. A lot of readmissions are patients who have time to be transferred or triaged if they are not bleeding to death or having a heart attack he said. Patients should try to stay in the immediate vicinity of their surgical hospital for at least a week Brooke said. SOURCE bit.lyGjDe httpbit.lyGjDe and bit.lyGuHRgA httpbit.lyGuHRgA The Lancet online June . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"The latest advances in Alzheimers disease involve people who dont appear to show any signs of cognitive decline yet. Experts now believe that the biological processes behind the neurodegenerative condition begin years if not decades before memory problems and confusion become noticeable. At the annual Alzheimers Association International Conference https researchers say they have found a series of substances in saliva that can distinguish between people who experience normal aging those with mild cognitive dementia MCI which in some cases can lead to Alzheimers and in other cases not and Alzheimers disease. Presenting at the meeting Shraddha Sapkota a graduate student in neuroscience at University of Alberta and her colleagues described how they carefully analyzed the saliva of a group of volunteers participating in an aging study. Some had been diagnosed with Alzheimers and some with MCI while others did not have any neurological conditions. By comparing their saliva components the scientists found that each of the three groups showed slightly different patterns of compounds which could form the basis of a relatively easy and noninvasive way to determine which people are at higher risk of developing more serious degenerative brain conditions. The results arent conclusive enough yet for doctors to start using them to distinguish people who are more likely to develop Alzheimers but thats the goal says Sapkota. Ideally for example isolating those with MCI might help doctors to focus in on a group of patients who might be at higher risk of developing Alzheimers and therefore might need more intensive and regular testing."

"You dont need to go to a doctor in person for lifestyle counseling that can lower your blood pressure. Online lifestyle counseling works well too according to research presented Saturday at the American College of Cardiologys httpabstractsonline.compp th Annual Scientific Session and Expo in Washington. Systolic blood pressure the higher number in blood pressure readings declined more for participants in the study who received Webbased lifestyle counseling than for those who were part of a Webbased control intervention the study found. Over the month period systolic blood pressure of people in the Webbased lifestyle counseling group decreased by mmHg while it decreased by mmHg for the other group. The study also measured changes in risk scores of developing heart disease and stroke in the next years diastolic blood pressure dietary changes smoking cessation cholesterol levels excluding the good cholesterol HDL and pulse pressure which is the difference between the higher and lower diastolic numbers on the blood pressure reading. Results showed some genderbased disparities. Women in the treatment group had an average diastolic blood pressure reduction of mmHg while men in the same group had an average mmHg reduction. The electronic counseling eCounseling intervention had an effect similar to that of adding an additional bloodpressurelowering medication said Robert P. Nolan the lead author of the study a senior scientist at the Peter Munk Cardiac Center at the University Health Network and an associate professor at the University of Toronto. The randomized doubleblind study included participants with an average age of of whom percent were women. The participants were divided into two groups one of which received weekly emails with generic information about healthy living that is good for the heart and for reducing high blood pressure and the other group received weekly emails with links to interactive tools and online multimedia such as videos of people diagnosed with high blood pressure who made lifestyle changes. These tools were carefully chosen to increase in knowledge about and motivation to maintain a hearthealthy lifestyle. In the eCounseling intervention we tried to replicate the experience of going through facetoface lifestyle counseling for a year Nolan said. High blood pressure affects in every adults in the United States according to a fact sheet https by the Centers for Disease Control and Prevention. In high blood pressure was the major cause behind deaths in the United States. Reduction in high blood pressure has added health benefits because it can potentially reduce the likelihood of heart attacks strokes chronic heart failure and kidney disease. Engaging patients in such a way could be a very powerful tool in promoting behavioral change Nolan said. I am so happy to see this on the agenda for three main reasons. In part most of the studies here today show what to do not how to achieve it said Eric Peterson a professor at Duke University School of Medicine and an associate editor of the Journal of the American Medical Association during the conference. Secondly we only look at the tradeoff between efficacy and safety but your study is looking more at efficacy and effectiveness and practicality issues that are also very important. And finally this is a very real world study. The study was received well by the audience. No one should die of hypertension. The study is very useful in telling and confirming that we should talk to the patients no matter how we do it said Bernard Wong a cardiologist based in Hong Kong. One of the caveats of the study was that participants were highly motivated people looking for ways to cope with and decrease their blood pressure. Participants were also largely white and welleducated with most having a postsecondary education so the results of the study might not be generalize well to other groups."

"As we age managing healthy weight may become more difficult due to a slowing metabolism however help may come from a fiery source the capsicum pepper. A recent paper Capsaicinoids Enhance Metabolic Rate in Normal Healthy Individuals using a Novel Metabolic Tracker Breezing DeviceAn Open Label Placebo Controlled Acute Study published in the journal Obesity Open Access discussed the findings of the Metabolic Rate MR Study which demonstrated that an extract from red hot peppers boosted metabolic rate Chen et al. . Because capsaicinoids the component of hot peppers that gives them heat are hot it was imperative that we use an ingredient which the subjects could tolerate said Vijaya Juturu Ph.D. F.A.C.N. one of the lead researchers on the MR Study. Since Capsimax is made using a proprietary beadleting technology OmniBead which coats the capsicum extract releasing it only when it reaches the intestines where it is absorbed without discomfort we were able to deliver beneficial levels of capsaicinoids to our subjects which made the MR Study possible. The MR Study was a placebocontrolled crossover open label study with healthy adults examining the effects of either mg capsaicinoids from mg of Capsimax or placebo on resting energy expenditure heart rate and blood pressure. Resting energy expenditure is the amount of energy required by the body during resting conditions and accounts up to of the calories you burn each day and so increasing this amount can aid in managing weight. The study showed that supplementing with this low dose of Capsimax increased metabolic rate which calculated to an equivalent to burning an extra calories per day. Moreover though resting energy expenditure varies with each individual this increase would yield almost lb. of fat lost over days. Aging is inevitable but that doesnt mean we cant be active participants in our weight management as we age said Abhijit Bhattacharya President of OmniActive Health Technologies Ltd. producers of Capsimax. Capsimax is supported by multiple studies with findings showing safety increased lipolysis and satiety and improved healthy body composition. Now with the publication of the MR Study there is yet another demonstrated benefit of Capsimax as a natural stimulantfree approach to weight management sports nutrition and a healthy lifestyle as we age. For more information on the MR Study or Capsimax please contact Sara Zoet at s.zoetomniactives.com mailtos.zoetomniactives.com. About Capsimax Proprietary Capsimax is made using OmniBead Beadlet Technology to encapsulate the beneficial heat of concentrated highlyactive natural capsicum in a controlledrelease coatingdelivering effective levels of capsaicinoids without the oral and gastric burning sensation of unprotected red hot peppers. In studies clinicallytested stimulantfree Capsimax was shown to significantly help improve body composition promote thermogenesis and lipolysis decrease appetite accelerate metabolism and increase resting energy expenditure. About OmniActive Health Technologies Inc. OmniActive Health Technologies http offers a range of quality ingredients that are innovative and scientifically validated to address complex challenges for customers in the dietary supplement food and beverage space using technologydriven sustainable solutions with application support within a global regulatory framework. OmniActives core products include carotenoids plant extracts and specialty functional ingredients. The company develops IPprotected sciencebacked branded ingredients from natural sources using cutting edge technologies. OmniActive leverages international RD strengths to deploy an array of state of the art manufacturing technologies in extraction purification isolation and delivery of nutritional actives. Clinical research geared towards demonstrating efficacy and claim substantiation is the cornerstone of OmniActives RD activities. The companys centers of excellence are located in North America and India whereas its cGMP and HACCP systemcompliant manufacturing operations are located at multiple FDA inspected sites in India. Whether looking for a new ingredient to add to a finished product or technology to enhance an existing ingredient OmniActive delivers unmatched innovation. Capsimax and OmniBead are trademarks of OmniActive Health Technologies Ltd."

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

"The breast surgery and reconstructive team at The Valley Hospital http in Ridgewood NJ is taking the lead in providing new and progressive advances in breast cancer surgery. Valley was the first hospital in northern New Jersey where an innovative technique called prepectoral placement of a tissue expander was utilized during breast reconstruction surgery following a mastectomy. The procedure results in diminished postoperative pain quicker recovery time improved mobility and an excellent aesthetic outcome for patients. The technique has the potential to be a gamechanger says Tzvi Small M.D. Director of the Department of Plastic and Reconstructive Surgery at The Valley Hospital who performed the breast reconstruction procedure on Hasbrouck Heights resident Vanessa Burt . This variation of a standard technique used during breast reconstruction will revolutionize the postoperative recovery in patients who meet certain criteria for the procedure notes Dr. Small. Here at Valley we are proud to offer this option for our patients and are excited about its potential for vastly improving patient care for women with breast cancer. The technique involves placing tissue expanders interim implants under the skin on top of a womans pectoralis muscles after her breast tissue has been removed. After a recovery period of approximately two months during which the womans chest skin heals blood supply replenishes and the expanders are gradually inflated to stretch the skin the patient returns for an outpatient surgical procedure to replace the tissue expanders with permanent breast implants. In addition to exceptional cosmetic results the technique is likely to improve clinical outcomes as evidenced by ongoing research that shows women who undergo this procedure experience less pain and a shorter recovery period. Over the past decade there have been dramatic improvements in breast reconstruction that utilize various types of surgical innovations implants and biologic tissue notes Dr. Small. It is very rewarding as a reconstructive surgeon to continuously refine these procedures for our patients. Ms. Burt chose the Valley breast surgery team after carefully researching her treatment options for DCIS ductal carcinoma in situ a diagnosis that is often debated among clinicians as to whether it should be classified as breast cancer at all. In DCIS abnormal cells have not spread beyond the milk ducts into adjacent breast tissue or lymph nodes. After consulting with several breast surgeons and reconstructive surgeons Ms. Burt opted for a nipplesparing mastectomy performed by breast surgeon Tihesha Wilson M.D. Assistant Medical Director of Valleys Breast Center http Immediately following in the operating room Dr. Small performed the breast reconstruction. This was a long journey says Ms. Burt a publicist for the San Franciscobased Fat Wreck Chords music company. Dr. Wilson was more than patient with me as I first chose active surveillance for one year and then decided to undergo a double mastectomy when another area of DCIS was identified in November . I am also grateful for Dr. Smalls willingness to look outside the box and for his determination to perform my reconstruction in a way that would give me the best results with the least amount of recovery time. I want to also commend the pathologists at Valley who were exceptional in their diagnostic results. Dr. Wilson and Laura Klein M.D. Medical Director of the Breast Center have extensive experience in performing nipplesparing mastectomy a technically demanding surgery that is performed within aesthetically appealing minimally invasive incisions. With expertise in minimally invasive oncoplastic breast surgery Dr. Wilson has also studied complementary medicine and provides her patients with a holistic integrative approach to breast care. Its important to listen to each womans needs and then to decide together what is the best approach to treatment so that in the end the cancer will be gone and the woman can move on with her life says Dr. Wilson. The Valley Breast Center http provides comprehensive diagnostic surgical and support services using a multidisciplinary approach. The Breast Center is designated by the National Accreditation Program of Breast Centers a program of the American Cancer Society. Valleys Breast Imaging Center has been named a Breast Imaging Center of Excellence by the American College of Radiology."

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

"In a report on what is believed to be the first small clinical trial of its kind researchers at the Johns Hopkins Kimmel Cancer Center say they have safely used immune cells grown from patients own bone marrow to treat multiple myeloma a cancer of white blood cells. Results of the trial involving a particular type of tumortargeting T cell known as marrowinfiltrating lymphocytes MILs are described in the May issue of Science Translational Medicine. What we learned in this small trial is that large numbers of activated MILs can selectively target and kill myeloma cells says Johns Hopkins immunologist Ivan Borrello M.D. who led the clinical trial. MILs he explains are the foot soldiers of the immune system and attack foreign cells such as bacteria or viruses. But in their normal state they are inactive and too few in number to have a measurable effect on cancer. Previous laboratory research by Borrello and his colleagues showed that activated MILs could selectively target and kill myeloma cells taken from patients and grown in laboratory culture flasks. For the clinical trial the Johns Hopkins team enrolled patients with newly diagnosed or relapsed multiple myeloma although three of the patients relapsed before they could receive the MILs therapy. The scientists retrieved MILs from each patients bone marrow grew them in the laboratory to expand their numbers activated them with microscopic beads coated with immune activating antibodies and intravenously injected each of the patients with their own cells. Three days before the injections of expanded MILs patients received high doses of chemotherapy and a stem cell transplant standard treatments for multiple myeloma. One year after receiving the MILs therapy of the patients had at least a partial response to the therapy meaning that their cancers had shrunk by at least percent. Seven patients experienced at least a percent reduction in tumor cell volume and lived on average . months without cancer progression. The remaining patients had an average of . progressionfree months following MILs therapy. None of the participants had serious side effects from the MILs therapy. The overall survival was . months for those with less than percent disease reduction but this number has not yet been reached in those with better responses. The average followup time is currently more than six years. Borrello notes that several U.S. cancer centers have conducted similar experimental treatments known as adoptive T cell therapy but says the Johns Hopkins team is believed to be the only one to use MILs. Other types of tumorinfiltrating cells can be used but they are usually less plentiful in patients tumors and may not grow as well outside the body says Borrello. In nonbloodbased tumors such as melanoma only about onehalf of patients have T cells in their tumors that can be harvested and only about onehalf of those harvested cells can be grown. Typically immune cells from solid tumors called tumorinfiltrating lymphocytes can be harvested and grown in only about percent of patients who could potentially be eligible for the therapy. But in our clinical trial we were able to harvest and grow MILs from all patients says Kimberly Noonan Ph.D. a research associate at the Johns Hopkins University School of Medicine. Noonan says the small trial helped her and her colleagues learn more about which patients may benefit from MILs therapy. For example they were able to determine how many of the MILs grown in the lab were specifically targeted to the patients tumor and whether they continued to target the tumor after being infused. Additionally the scientists found that patients whose bone marrow before treatment contained a high number of certain immune cells known as central memory cells also had better response to MILs therapy. Patients who began treatment with signs of an overactive immune response did not respond as well. Noonan says the research team has used these data to guide two other ongoing MILs clinical trials. Those studies she says are trying to extend antitumor response and tumor specificity by combining the MILs transplant with a Johns Hopkinsdeveloped cancer vaccine called GVAX and the myeloma drug lenalidomide which stimulates T cell responses. The researchers say the trials also have shed light on new ways to grow the MILs. In most of these trials you see that the more cells you get the better response you get in patients. Learning how to improve cell growth may therefore improve the therapy says Noonan. Kimmel Cancer Center scientists are also developing MILs to treat solid tumors such as lung esophageal and gastric cancers as well as the pediatric cancers neuroblastoma and Ewings sarcoma. Experts report there are more than new cases of multiple myeloma and more than deaths each year in United States. It is the second most common cancer originating in the blood. Other Johns Hopkins scientists who contributed to the research include Carol Ann Huff Janice Davis M. Victor Lemas Susan Fiorino Jeffrey Bitzan Anna Ferguson Amy Emerling Leo Luznik William Matsui Jonathan Powell Ephraim Fuchs Gary L. Rosner C. Epstein Lakshmi Rudraraju Richard F. Ambinder Richard J. Jones and Drew Pardoll. Funding for the study was provided by the Commonwealth Fund P CA P CA and the Baca and Morisi Funds. Media Contacts Vanessa Wasta wastajhmi.edu mailtowastajhmi.edu Amy Mone amonejhmi.edu mailtoamonejhmi.edu"

"Giving school children access to chilled selfserve water https may help chip away at childhood obesity https a new study of more than one million New York City school students suggests. The study published in JAMA Pediatrics analyzed data collected from elementary and middle schools across New York City some with and some without water jets. The large clear electrically cooled jugs with a push lever for fast dispensing were placed in school cafeterias about percent of schools during the and the school years. Schools with water dispensers saw a modest weight drop among students according to the study by researchers from NYU Langone Medical Center New York Universitys Institute for Education and Social Policy and the Center for Policy Research at Syracuse Universitys Maxwell School of Citizenship and Public Affairs. We associated these water dispensers with almost a one percentage point reduction in the likelihood of being overweight https for boys and a little over a half a percentage point reduction for girls said lead researcher Brian Elbel an associate professor of population health and health policy at NYU School of Medicine. Even a small straightforward relatively inexpensive policy intervention was associated with a small but statistically significant drop Elbel told CBS News. Water jets also were linked with a decrease in the amount of halfpints of milk students bought which could be a potential mechanism of weight reduction the researchers found. Modern water dispensers may be more effective than oldfashioned water fountains since water quality and cleanliness may deter kids from using older fountains and theyre not as efficient at serving large numbers of children experts noted in an accompanying editorial. The editorial entitled Power of a Simple Intervention to Improve Student Health Just Add Water said the studys findings are significant. Sometimes a very simple intervention https can have a powerful effect wrote Lindsey Turner of Boise State University in Idaho and Erin Hager from the University of Maryland School of Medicine in Baltimore. The study by Schwartz and colleagues in this issue of JAMA Pediatrics adds to a growing body of evidence supporting the importance of providing drinking water https access in schools. In this study the findings demonstrate that water access in schools can promote healthy weight outcomes among students Turner and Hager said."

"Updated Almost sixty years since the FDA approved the pill for birth control in women a male version may finally be on the horizon. Researchers have developed a prototype male pill that appears to be safe in a monthlong trial. More attractive to many men than a longacting injection or topical gelboth of which are in developmentthe prototype pill offers a major step forward in male contraception Stephanie Page a professor at the University of Washington in Seattle and senior investigator on the study said in a statement https The oncedaily prototype pill suppressed certain hormones to the low levels youd expect to see with effective longerterm contraceptives results from an ENDO the Endocrine Societys annual meeting in Chicago abstract show http The prototype pilldimethandrolone undecanoate DMAUis somewhat similar to the combined female pill which contains estrogen and a steroid hormone. Rather than estrogen DMAU uses a male hormone like testosterone. Currently available forms of testosterone can exit the body too quickly for use in a oncedaily pill. The undecanoate in DMAU however is a longchain fatty acid that can slow the drugs journey out of the body Page said. Eightythree men took various doses of DMAU or a placebo for a month. Researchers analyzed the mens hormones and cholesterol with blood tests at the start and end of the study. They found testosterone and two hormones needed for the production of sperm were notably suppressed in men who took the highest dose of DMAU. While some subjects on all doses experienced mild weight gain and decreases in socalled good HDL cholesterol DMAU appeared safe. All participants passed safety tests including liver and kidney health checks. Despite having low levels of circulating testosterone very few subjects reported symptoms consistent with testosterone deficiency or excess Page said. There were no significant changes in mood or sexual function but a minority of participants did experience decreased libido during the study. Page has high hopes for the results calling them unprecedented in the development of a prototype male pill. Longerterm studies are the next step toward a oncedaily male contraceptive pill she said. The study was funded by the National Institutes for Health https This article has been updated to include more information on DMAU."

"Mayo Clinic researchers have found that an oral drug apixaban used to treat blood clots in patients undergoing cancer therapy is safe and effective. The drug was associated with fewer major bleeding events and fewer recurrent blood clots compared to lowmolecular weight heparin. Their findings were presented at the annual meeting of the American Society of Hematology by Robert McBane II M.D. a Mayo Clinic cardiologist. Nearly in patients with cancer will develop a clot in the veins referred to as either a deep vein thrombosis or pulmonary embolism says Dr. McBane. Clotting events can be deadly with pulmonary embolism being the second most common cause of death in cancer patients. While twicedaily injections of lowmolecularweight heparin has been the traditional treatment of choice for cancer patients who suffer a venous clot Dr. McBane notes that there are numerous limitations to this therapy. These injections can be painful and cause considerable bruising at the injection site. Injections are expensive at nearly per day. And cancer patients may experience low platelet counts and be at risk for a clotting disorder called heparininduced thrombocytopenia. Dr. McBane noted that cancer and cancer treatment can be associated with kidney injury which can limit the drugs use further. Finally Dr. McBane says there isnt is a good antidote for this medication should a bleeding problem arise. More recently a number of new blood thinners called direct oral anticoagulants have become available says Dr. McBane. As a class these drugs have a number of advantages including oral delivery lack of interactions with foods or other medications and the lack of a need for monitoring drug levels. He says these qualities make this class of drug much easier to use than the traditional blood thinners. However it was unclear whether these drugs could be used safely in cancer patients until now. Dr. McBane says quality of life surveys which were taken monthly throughout the sixmonth trial showed that patients markedly preferred oral apixaban over injectable dalteparin. We are hopeful that this medication will also improve medication compliance in cancer patients requiring blood thinner therapy. About Mayo Clinic Cancer Center As a leading institution funded by the National Cancer Institute Mayo Clinic Cancer Center conducts basic clinical and population science research translating discoveries into improved methods for prevention diagnosis prognosis and therapy. For information on cancer clinical trials call the Clinical Trials Referral Office at tollfree. About Mayo Clinic Mayo Clinic is a nonprofit organization committed to clinical practice education and research providing expert comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network"

"When Heidi Imhof started losing her hair at she also started losing sleep. Ms. Imhof a lawyer was afraid that blowdrying her straight dark hair would hasten the shedding so she got up two hours early to shower and apply mousse and volumizers. When her hair finally airdried shed pull it back hoping to hide the bald patches on her scalp. I was desperate she said. The hair thickening shampoo Nioxin didnt help. Neither did Rogaine. Then she heard about Harklinikken http a Danish company offering a customized hair extract thats given only to those who pass a fairly rigorous selection process. Ms. Imhof who lives in Land OLakes Fla. was skeptical. The companys before and after photos seemed too good to be true. But she went for a consultation and made the cut. Harklinikkens products are not available to anyone with autoimmune illnesses like alopecia or baldness from scarring or anyone who is unlikely to see at least a percent increase in growth. Skin Deep https Tips and trends for hair makeup and more. Laura Harriers Awards Season Beauty SecretsJan. https How SkinCare Companies Are Tackling Issues Faced by Women of ColorDec. https This Winter Dont Just Sit by a Crackling Fire. Smell Like It Too.Dec. https Felicity Jones on Becoming Ruth Bader GinsburgDec. https After three months of applying the amonth serum Ms. Imhof was so excited by the results that she overcame her embarrassment about the subject and posted her own beforeandafter photos on Facebook. You cant see holes in my hair anymore she said. Harklinikken hair clinic in Danish inspires great loyalty. Four out of five users come as referrals from satisfied customers said Lars Skjoth the companys founder and chief scientist. The results are certainly compelling. After four months of daily application that is working the teacolored tonic into the hair section by section then letting it sit on the scalp for six hours most users regain at least percent of lost density and some as much as percent according to company figures. Harklinikken does not advertise but the yearold multinational company is beginning an aggressive expansion into the . billion hairloss market in the United States meaning youre likely to hear a lot more about it. A New York clinic opened in June inside the Core Club http in Midtown you dont need to be a member to get an appointment and in August Harklinikken consultations became available at some Womens Care Florida obstetrics and gynecology clinics. Roughly percent of the companys active users are female. Mr. Skjoth said the plan is to have a presence in every state in the next two years. The company recently opened outposts in Tampa Fla. and Beverly Hills Calif. Panos Vasiloudes a Tampa dermatologist and Harklinikkens medical director said the company has doubleblind placebocontrolled studies it hopes to publish next year in peerreviewed journals. Such studies are the one thing some dermatologists say they need to recommend the product to patients. For now Maryanne Senna a dermatologist and the director of the Hair Academic Innovative Research Unit at Massachusetts General Hospital in Boston said the best she can tell patients who ask and a lot of them do is that Harklinikken wont do any harm. Dont get me wrong I really want it to work said Dr. Senna who also teaches at Harvard Medical School. There arent a lot of options and Id love to be able to say to my patients This is something you can try that is worth the money. But I cant do that yet. Harklinikkens formula refined over years is derived from plants and cows milk. Thats the most Mr. Skjoth will say about it. In the s clients mixed it with Rogaine Mr. Skjoth said and then we took the Rogaine part away and started focusing on the actual liquid. Small studies have shown the efficacy of various plantderived ingredients mostly in mice. But two potential explanations for Harklinikkens success have little to do with its formula. One is how much emphasis the company places on compliance the major stumbling block in the efficacy of any treatment said Dr. Senna an author of studies on the subject. Prospective users are questioned about their ability to stick to a regimen because the extract must be applied every day and they are told that the more conscientious they are the better. Users are also reminded and encouraged with regular checkins. Clients must also use the companys shampoo conditioner and styling products forsaking all others a psychological as well as a financial buyin Dr. Senna said. Mr. Skjoth who has a masters degree in nutrition and chemistry but is not a doctor said this is because other products may clog the scalp causing hair loss. Hair changes about as fast as grass grows which is to say its extraordinarily slow and not visible to anyone checking impatiently in the mirror every day. But during regular followup appointments Harklinikken uses hightech equipment to photograph and magnify the scalp and count new hairs and active follicles which motivates users to adhere to the regimen. Too many people give up on treatments like Rogaine and lowlevellight devices before theyve had a chance to work Dr. Senna said. Its also possible that some of Harklinikkens users are women whose hair would have grown back even if theyd done nothing. Many women who arrive in a dermatologists office with prior diagnoses of female pattern hair loss actually have whats called telogen effluvium. Thats a period of acute shedding of hair meaning up to percent of hair three months after a triggering event like pregnancy significant weight loss or starting or stopping hormone medications. Once that hair has stopped shedding it does regrow at a rate of about a centimeter a month said Dr. Senna who suffered from the condition after each of her pregnancies. She shares photos of herself with patients to show she can sympathize. In one her entire frontal hairline clearly is growing back in. If Id used a treatment I would have thought it was a miracle drug she said. Users of the extract say that one of the strengths of Harklinikken is that it doesnt claim to be a miracle. It wasnt Youre going to get a full head of hair said Jon Centella of Apollo Beach Fla. who started seeing peach fuzz after four months. It was Well give you percent and thats what made me comfortable enough to give it a shot."

"The disease is characterized by an itching oozing rash that can cover almost all of the skin. The constant itch to say nothing of the disfigurement can be so unbearable that many patients consider suicide. There has never been a safe and effective treatment. On Saturday the results of two large clinical trials of a new drug offered hope to the estimated . million adult Americans with an uncontrolled moderatetosevere form of the disease atopic dermatitis which is a type of eczema. Most patients who got the active drug dupilumab instead of a placebo reported that the itching began to wane within two weeks and was gone in a few months as their skin began to clear. Nearly percent of participants getting the drug saw all or almost all of their rash disappear. For some relief was almost instantaneous. I knew immediately I was on the drug and not the placebo said Daniela Velasco an event planner in Playa del Carmen Mexico. Within a couple of weeks the ugly red rash that had covered percent of her body was almost gone. Even better she said for the first time I didnt feel any itch at all. Before entering the trial Mrs. Velasco had seen doctors about the disease and tried dozens of drugs and treatments to no avail. To participate in the study she spent more than to fly to Mount Sinai in New York on a regular basis and stay in hotels. She realized she might get a placebo but also knew that when the study ended everyone including the placebo patients would be able get the drug if the trial was successful. The drug blocks two specific molecules of the immune system that are overproduced in patients with this and some other allergic diseases. The only side effects were a slight increase in conjunctivitis an inflammation of the outer membrane of the eye and swelling at the injection site. This is a landmark study said Dr. Mark Boguniewicz an atopic dermatitis expert at National Jewish Health and the University of Colorado School of Medicine who was not involved with the study. For us in atopic dermatitis we are entering a new era. The studies http lasting weeks and involving nearly people were published in the New England Journal of Medicine. Daniela Velascos arms left and top and legs below right before the treatment with dupilumab.CreditEmma GuttmanYassky Daniela Velascos arms left and top and legs below right before the treatment with dupilumab.CreditEmma GuttmanYassky Dr. George D. Yancopoulos the president and chief scientific officer at Regeneron which in partnership with Sanofi makes the drug said he expects the Food and Drug Administration to rule on dupilumab by March . The drugs brand name will be Dupixent. The agency has given the drug breakthrough status httpnewsroom.regeneron.comreleasedetail.cfmReleaseID which provides expedited development and review of drugs for serious or lifethreatening diseases. Editors Picks Dr. Yancopoulos declined to speculate on dupilumabs price saying only that it will be consistent with the value of the drug. It is a biologic the most expensive type of drug and is injected every two weeks. Atopic dermatitis experts said they have longed for a safe and highly effective treatment. In desperation some prescribed other drugs offlabel like powerful immunosuppressants or high doses of steroids which are far from ideal because even if they helped their side effects can be severe kidney failure with immunosuppressants bone loss and even psychotic breaks with highdose steroids. Patients are miserable Dr. Boguniewicz said. Our patients and families havent slept through the night not for days or weeks but for months or years. Many doctors provide no treatments other than perhaps creams and ointments that do not stop the itching or soothe the red and weeping rash said Dr. Jonathan I. Silverberg of Northwestern Universitys Feinberg School of Medicine and a principal investigator in one of the studies. Many sufferers can relate to the plight of the defense lawyer played by John Turturro in the HBO series The Night Of http He suffers from http atopic dermatitis that started on his legs and his feet and later spread to his neck and head. Like so many patients he tries treatment after treatment bleach baths covering the rash in Crisco and wrapping it with plastic wrap steroids Chinese medicine. He scratches it with chopsticks and disgusts people near him. But all to no avail. Such experiences explain the excitement over the new drug although researchers say they would like to see longerterm data. What we are seeing are some really impressive efficacy numbers Dr. Silverberg said. But efficacy alone is not enough. It is the safety profile that is the real key. Everything we are seeing really looks great. Sign up for Science Times Well bring you stories that capture the wonders of the human body nature and the cosmos. Dr. Jon M. Hanifin a professor of dermatology at Oregon Health and Science University and founder of the National Eczema Association agreed. While not a principal investigator in the study Dr. Hanifin did oversee the care of some patients enrolled in it. Herb Bull at a friends home in Westfield N.J. He said the new drug saved his life.CreditBryan Anselm for The New York Times Herb Bull at a friends home in Westfield N.J. He said the new drug saved his life.CreditBryan Anselm for The New York Times Its wonderful he said. We walk in the room and patients are smiling. These patients are the worst of the worst. Their life was destroyed. Dr. Yancopoulos was inspired in part to develop the drug because his father had severe atopic dermatitis which he developed shortly after he got lung cancer at . More so than the cancer and the chemo this rash and its horrible itch started dominating his life and ruining its quality Dr. Yancopoulos said. Heres a guy with Stage IIIB lung cancer basically a death sentence and he is more concerned and miserable about his skin and his itch. One participant in the trial Lisa Tannebaum a yearold harpist in Stamford Conn. was so thrilled that she wrote a letter to Regeneron suggesting they use her before and after photographs in advertisements. She developed a severe form of the disease years ago and tried everything imaginable in conventional and alternative medicine without relief specialized diets immunosuppressive drugs special clothing bleach baths. She even had the gold fillings removed from her teeth on the theory that they may be causing an allergic response but to no avail. It was like every day I had poison ivy and fire ants on myself she said. You dont sleep at all. You cant go out you have staph infections all the time because the skins protective barrier is broken by the rash. I couldnt drive my kids to school because the itching was so bad I couldnt put my hands on the steering wheel. Now she is performing again and will be playing her harp at Carnegie Hall on Oct. https Herb Bull a retired Merck scientist in Westfield N.J. had mild atopic dermatitis for years until three years ago when it took a turn for the worse. The rash covered his entire body. Sleep was impossible itching a constant torment. Even walking was difficult. Advertisement He had weeping lesions all over his body said his doctor Dr. Emma GuttmanYassky a principal investigator in the trial and professor of dermatology and immunology at the Icahn School of Medicine at Mount Sinai. I thought I might as well give up and die Mr. Bull said. It took months for the drug to work he said but when it did the change was miraculous. His rash and the itching went away. The new drug Mr. Bull said saved my life."

"When U.S. Marine Chris Merkle returned from his last tour of duty in Afghanistan his family was thrilled to have him back. Interested in Add as an interest to stay up to date on the latest news video and analysis from ABC News. Add Interest But for Merkle the welcome home was also accompanied by some dark problems. He couldnt sleep. He was irritable and had anger issues. He would avoid certain stressful situations like driving in traffic. And he would stay on high alert in the classroom. And then soon theyre like Youre not the same Merkle recalled of what his family told him. They start to notice that youre not really enjoying the parties of our friends. You only get really excited when youre going to visit former Marines and the people you used to hang out with. Merkle served three tours in Iraq httpabcnews.go.comtopicsnewsiraq.htm and four in Afghanistan. Readjusting to being a civilian was tough he said and he was finding it difficult to function. There was almost years of deploying back and forth back and forth there was this void this monster in the room thats not talked about until finally it came out. It was like You need to see somebody. Something is going on with you. While Merkle was a patient at the VA he heard of a clinical psychologist named Skip Rizzo at the University of Southern California Institute of Creative Technologies. Merkle was trying traditional oneonone therapy and said that at the time it wasnt really taking that well. He was looking for an alternative and heard about Skips research that used a new and unexpected way to treat posttraumatic stress disorder with virtual reality. Finding the Next full episodes will release Tuesdays on ABCNews.com and ABC News mobile apps. The entire series is available now on ABC News apps on Apple TV httpabcnews.go.comtopicsnewstechnologyappletv.htm Roku and Xbox httpabcnews.go.comtopicsentertainmentvideogamesxbox.htm One. Nearly million adults suffer from PTSD httpabcnews.go.comtopicslifestylehealthposttraumaticstressdisorder.htm during a given year according to the National Center for PTSD. The condition can occur after someone has been exposed to a significant stressor and often includes symptoms such as avoidance hypervigilance anger issues and mood swings. One common method for treatment is called exposure therapy. The patient recounts their trauma visualizing it in their imagination and narrates it to a clinician. By repeatedly confronting and processing the trauma the brain can start to reduce the level of anxiety httpabcnews.go.comtopicslifestylehealthmentalhealth.htm and response to those memories. Thats exactly the approach Rizzo uses with virtual reality therapy. My mission is to drag psychology kicking and screaming into the st century Rizzo said noting that virtual reality offers a unique opportunity for clinicians and clients alike to be immersed in the environment that evokes the original trauma rather than relying on the patients imagination. Rizzo has created virtual worlds for patients and clinicians can add custom elements including helicopters clouds smallarms fire and missiles. The first thing to keep in mind is that we are never going to replicate an exact simulation of what the patient went through Rizzo said. But we really dont need to. Merkle explained how the virtual reality experience works. Your brain assumes OK this must be where were at and it fills in the blanks. And as youre talking through it you feel like youre physically there. Each session lasts for about an hour and a half and the patient speaks about their experience with a clinician as they go through the virtual simulation. For Merkle virtual reality allowed him to start unlocking memories and work through his trauma. So it really allowed me to open the door and begin my healing process he said. Im still a work in process obviously but Im so far forward leaps and bound beyond where I would have been without virtual reality."

"Orlando Fla Researchers at Orlando Health detected evidence of concussions in patients up to days after their injury using a simple blood test according to a new study published in JAMA Neurology. The discovery could greatly expand the window for diagnosing concussions especially in patients who experience a delayed onset of symptoms. Symptoms of a concussion or a mild to moderate traumatic brain injury can be subtle and are often delayed in many cases by several days said Linda Papa MD MSC an emergency medicine physician and NIH funded researcher at Orlando Health and lead author of the study. This could provide doctors with an important tool for simply and accurately diagnosing those patients particularly children and making sure they are treated properly. Its estimated nearly a quarter of a million children are treated in hospitals each year for concussions from playing sports an average of nearly a day. Almost all concussions in children are diagnosed only by symptoms which are either observed like vomiting or loss of balance or symptoms reported by the child like blurred vision or headaches. Neither scenario gives doctors and objective way to determine the severity of the injury. If patients are not diagnosed properly and treated appropriately it could lead to longterm problems said Papa. Untreated or undertreated traumatic brain injuries like concussions can lead to prolonged bouts with headaches dizziness memory loss and depression. This test could take the guesswork out of making a diagnosis by allowing doctors to simply look for a specific biomarker in the blood. The biomarker Papa analyzed is known as a glial fibrillary acidic protein GFAP. These proteins are found in glial cells which surround neurons in the brain and when an injury occurs the GFAP are released. What makes them unique is that they pass the bloodbrain barrier and enter the bloodstream making them easy to detect with this particular test. Not only were they present in the bloodstream we were able to detect measurable levels of GFAP up to a week after the injury said Papa. Researchers analyzed nearly patients for years. When crosschecked with scans the blood test was able to detect mild to moderate traumatic brain lesions with up to percent accuracy in patients years and older. The blood test also indicated which patients were in need of lifesaving neurosurgery. This suggests that the blood test could be used by clinicians for up to a week after injury to detect brain injury. This is important because many patients with concussion may not seek medical attention for days after injury. The blood test could also dramatically cut down on the need for computerized tomography CT scans. Currently CT scans are the most precise way to diagnose brain lesions but are expensive and are associated with radiation exposure. Physicians really want to minimize the amount of CTs in patients especially children who are a lot more sensitive to radiation and the side effects that can come with it. Fortunately this simple blood test appears to give us nearly the same information as a CT scan. In fact in a previous study published last fall Papa and her team at Orlando Health tested both. They analyzed children within hours of sustaining a concussion or mild to moderate traumatic brain injury. The results showed that the blood test was able to detect brain injuries with percent accuracy nearly as effective as stateofthe art CT scans. This could ultimately change the way we diagnose concussions not only in children but in anyone who sustains a head injury said Papa. We have so many diagnostic blood tests for different parts of the body like the heart liver and kidneys but theres never been a reliable blood test to identify trauma in the brain. We think this test could change that she said. BROLL SOUND BITES WEB ELEMENTS HIRES STILL PHOTOS Including HD video available for freeunrestricted use by the news media httpbit.lyRzOAs Courtesy Orlando Health For assistance in downloading or if you have any questions contact drewmediasourcetv.com mailtodrewmediasourcetv.com or call .. About Orlando Health Orlando Health is a . billion notforprofit health care organization and a communitybased network of physician practices hospitals and outpatient care centers throughout Central Florida. The organization is home to the areas only Level One Trauma Centers for adults and pediatrics and is a statutory teaching hospital system that offers both specialty and community hospitals. Nearly physicians have privileges at Orlando Health which is also one of the areas largest employers with more than employees who serve nearly million Central Florida residents and more than international patients annually. Additionally Orlando Health provides more than million in support of community health needs. More information can be found at http"

"the US Food and Drug Administration FDA cleared for marketing in the United States the first cooling cap to reduce alopecia in female breast cancer patients undergoing chemotherapy. Hair loss is a common side effect of certain types of chemotherapy commonly associated with the treatment of breast cancer. Hair may fall out entirely gradually in sections or may become thin. Hair loss due to cancer treatment is usually temporary but minimising or relieving these kinds of side effects are considered important to overall treatment. The Dignitana DigniCap Cooling System is indicated to reduce the frequency and severity of alopecia during chemotherapy in breast cancer patients in which alopeciainducing chemotherapeutic agents and doses are used. It is a computercontrolled system that circulates cooled liquid to a headworn cooling cap during chemotherapy treatment. The cooling cap is covered by a second cap made from neoprene which holds the cooling cap in place and acts as an insulation cover to prevent loss of cooling. The cooling action is intended to constrict blood vessels in the scalp which in theory reduces the amount of chemotherapy that reaches cells in the hair follicles. The cold also decreases the activity of the hair follicles which slows down cell division and makes them less affected by chemotherapy. The combined actions are thought to reduce the effect chemotherapy has on the cells which may reduce hair loss. DigniCap may not work with some chemotherapy regimens. Interested patients should talk with their doctors. The efficacy of the cooling system was studied in stage I and stage II women with breast cancer who were undergoing chemotherapy using recognised chemotherapy regimens that have been associated with hair loss. The data from this study may also be applied to some stage III and IV breast cancer patients because they may have a benefitrisk profile comparable to the patients enrolled in this study. The primary endpoint was a selfassessment of hair loss by the women using standardised photographs at one month threesix weeks after the last chemotherapy cycle. More than of patients treated with the DigniCap reported losing less than half their hair. Prevention of hair loss in these patients may be a significant benefit to their quality of life and the risk of the chemotherapy drug missing an isolated grouping of the breast cancer cells in the scalp because of the cold cap is extremely rare. The most common side effects of the cooling system include coldinduced headaches and neck and shoulder discomfort chills and pain associated with wearing the cooling cap for an extended period of time. The FDA reviewed data for DigniCap cooling system through the de novo classification process a regulatory pathway for some low to moderaterisk devices that are novel and not substantially equivalent to any legally marketed device. The DigniCap Cooling System is manufactured by Dignitana Inc. in Lund Sweden."

"Experts rightfully caution against relying on miracle diet drugs but a new study offers a novel approach that bears watching. Researchers at the Salk Institute for Biological Studies http La Jolla Calif. reported Monday that they have developed a compound that tricks the metabolism into responding as if a meal has been eaten causing it to burn fat to make room for new calories. Better yet the drug fexaramine works only in the intestine never entering the bloodstream. That makes it much safer than say systemic stimulants that also rev up the heart and other parts of the body and cause strong side effects according to the research. Anyone remember fenphen http For now the new approach has been demonstrated only in mice according to the research published Monday in the journal Nature Medicine http But Ronald Evans director of the institutes Gene Expression Laboratory and lead author of the new study said in an interview that if it shows the same promise in primate studies clinical trials on humans could begin in a couple of years. We described a new type of therapy that targets the known genetic switch in our bodies that is linked to eating and metabolic control Evans said. The drug or the pill is taken orally and it tricks the body into thinking youve eaten a meal. Yet the mice showed no reduction in appetite and continued to eat the same amount of food the study showed. The paper suggests that the drug may one day offer a nonsurgical alternative to vertical sleeve gastrectomies that have become popular in the battle against morbid obesity. More than a third of the U.S. population is considered obese. Nearly years ago Evanss lab worked to identify the molecular switch that turns on a whole series of bodily responses to eating including digestion absorption the transfer of nutrients by the bloodstream and increased blood circulation to name a few. In mice at least fexaramine turns on that switch and sets off the same cascade of reactions without any side effects Evans said. Other researchers are working on similar approaches he said but this drug so far passes harmlessly out of the intestine after doing its work. We can get that whole process of what a meal does without actually having the meal he said. The study also found other benefits. The drug contributed to development of brown fat which helps burn calories http and relieves inflammation of cells in various tissues which is the result of chronic obesity. It also reduced resistance to insulin httpdiabetes.niddk.nih.govdmpubsinsulinresistance the hormone that helps cells absorb the glucose they use for energy. Many Type diabetics become resistant to insulin and have to inject additional amounts. But dont expect to be popping fexaramine any time soon. In the meantime basic weight loss advice remains the same fewer calories in more calories expended by physical activity."

"Many more stroke victims than previously thought can be saved from disability or death if doctors remove blood clots that are choking off circulation to the brain a new study has shown. These striking results will have an immediate impact and save people from lifelong disability or death Dr. Walter J. Koroshetz director of the National Institute of Neurological Disorders and Stroke said in a statement. I really cannot overstate the size of this effect. The key finding is that there is often more time than doctors realized in which brain cells can still be rescued by a procedure to remove the clot https Traditional guidelines have set a limit of six hours after stroke symptoms begin and said after that it would be too late to help. The study showed that the time window could be expanded to hours. However the findings do not apply to every stroke victim. The researchers used a special type of brain imaging to identify the patients who still had live brain tissue that could be saved if the blood supply was restored. Only about half the patients who were screened qualified for treatment known as thrombectomy which uses a mechanical device to pull clots out of a blood vessel. Advertisement The study involving patients at hospitals in the United States was stopped early because patients who had clots removed fared so much better than those who did not. Ninety days after treatment percent of the thrombectomy patients were well enough to be functionally independent as opposed to percent of those who did not have the procedure. The death rates were percent in the thrombectomy group and percent in those whose clots were not removed. The results were published http on Wednesday in The New England Journal of Medicine. The study was paid for by the National Institutes of Health and led by researchers from Stanford University. The Stanford team said it expected the study would lead the American Heart Association to change the guidelines for stroke treatment extending the time window for thrombectomy. It is not uncommon for strokes to begin during sleep and some of those patients miss out on treatment because it is not clear what time the stroke began. Medical practice has been to set the beginning of the time window as the last moment they were known to be well and if they have slept most of the night the sixhour window may be over by the time they wake up. New guidelines may allow such patients to be treated. About people a year suffer strokes in the United States and percent of those are caused by clots the same type treated in this study. Symptoms include speech difficulty arm weakness and facial drooping. Experts urge patients or their families to call immediately so that treatment can be started as soon as possible."

"Cognitive behavioural therapy has significant positive effects on a mothers mental health income employment and parenting skills even seven years after the birth of the child according to the first study of its kind. The international research project https the impact of depression on pregnant mothers and their babies led by Professor Sonia Bhalotra from the Institute for Social and Economic Research at the University of Essex could have major implications for public policy. More than million people worldwide report episodes of depression at a global cost of around bn in . Between and of women in the countries in the Organisation for Economic Cooperation and Development suffer from perinatal depression and in poorer countries. Cognitive behavioural therapy CBT is a talking therapy that can help a person manage problems by changing how they think and behave. The NHS website explains that it is based on the concept that your thoughts feelings physical sensations and actions are interconnected and that negative thoughts and feelings can trap you in a vicious cycle. CBT encourages people to see their problems in a more positive way by breaking them down into smaller parts. While studies have highlighted the shortterm benefits of CBT until now question marks have been raised about whether it can have longterm effects. The study one of the largest randomised control trials to be held in the developing world followed women diagnosed with depression midpregnancy in communities in rural Pakistan https Within a year more than half of the women in a control group were still depressed whereas only a quarter of the mothers who had been treated with CBT reported depression. Returning to the women and their children seven years later researchers found that the treated mothers were still significantly less likely to be depressed than the control group. The first group were also more likely to be employed and have control over household spending. There were also big improvements in their parenting style. The study found that women who had least social support such as those who were not living with or near their mother or motherinlaw benefited most from the therapy intervention both in the short and long term. These findings on the longerterm benefits at seven years posttreatment are really exciting Bhalotra said. This is an important study for the impact on mothers with depression but there are global implications for the treatment of all human beings suffering from depression. We have seen that CBT has changed how many of the treated women live their lives now their mental health has improved their financial situation and their empowerment over their lives and undoubtedly the way they interact with their children."

"Surgery to remove the primary tumor in women diagnosed with stage IV breast cancer followed by the standard combination of therapies adds months to the patients lives compared with standard therapy alone an international clinical trial led by a University of Pittsburgh Cancer Institute UPCI professor revealed. The results of the phase III randomized controlled trial will be presented Saturday at the American Society of Clinical Oncology ASCO annual meeting in Chicago. The study was selected for the societys Best of ASCO an effort to condense the research most relevant and significant to oncology into a twoday program to increase global access to cuttingedge science. Our findings will change the standard of care for women newly diagnosed with stage IV breast cancer said principal investigator Atilla Soran M.D. M.P.H. clinical professor of surgery University of Pittsburgh School of Medicine and breast surgical oncologist with UPMC CancerCenter. Weve shown that surgery to remove the primary tumoreither through lumpectomy or mastectomyfollowed by standard therapy is beneficial over no surgery. Dr. Soran began the trial in ultimately recruiting a total of women newly diagnosed with stage IV breast cancer from institutions. Half the women received standard therapy which avoids surgery and consists of a combination of chemotherapy hormonal therapy and targeted therapy while the other half first had surgery to remove their primary breast tumor followed by the standard therapy. At about months after diagnosis the women who received the surgery plus standard therapy lived an average of nine months longer than their counterparts who received standard therapy alone. Nearly percent of the women who received surgery lived to five years after diagnosis compared with less than percent of the women who did not receive surgery. The trial also showed that surgery in younger women with less aggressive cancers resulted in longer average survival than in women with more aggressive cancers that had spread to the liver or lungs. Our thinking is similar to how you might approach a battle against two enemies said Dr. Soran. First you quickly dispatch one armythe primary tumorleaving you to concentrate all your efforts on battling the second armyany remaining cancer. This research was primarily funded by the Turkish Federation of Societies for Breast Diseases. The study received scientific advisement from UPMC and assistance with statistical analysis from epidemiologists at the University of Pittsburgh Graduate School of Public Health. About UPCI As the only NCIdesignated comprehensive cancer center in western Pennsylvania UPCI is a recognized leader in providing innovative cancer prevention detection diagnosis and treatment biomedical research compassionate patient care and support and communitybased outreach services. Investigators at UPCI a partner with UPMC CancerCenter are worldrenowned for their work in clinical and basic cancer research. http"

"A pioneering drug developed to treat women with inherited cancers can also benefit men with advanced prostate cancer a major new clinical trial concludes. The trial is a milestone in cancer treatment as the first to show the benefits of precision medicine in prostate cancer with treatment matched to the particular genetic characteristics of a mans tumour. Olaparib the worlds first drug to reach the market targeted against inherited cancer mutations was found to benefit as many as a third of patients with prostate cancer including many who did not inherit cancer genes but whose tumours had acquired defects in DNA repair. An international consortium of researchers led by experts at The Institute of Cancer Research London and The Royal Marsden NHS Foundation Trust publish the trials findings in the New England Journal of Medicine today Wednesday. The trial called TOPARPA received support from a wide range of funders including Cancer Research UK the Prostate Cancer Foundation Stand Up To Cancer Prostate Cancer UK and the Movember Foundation. There was also support from the InvestigatorSponsored Study Collaboration between AstraZeneca and The NIHR Biomedical Research Centre at The Royal Marsden and the ICR the NIHR Cancer Research Network and Experimental Cancer Medicine Centre ECMC funding to the ICR and Royal Marsden and several other ECMC sites. In the trial men with treatmentresistant advanced prostate cancer received olaparib and of them or per cent responded as defined by a set of clinical criteria. Olaparib stopped prostate cancer growth generating lasting falls in prostate specific antigen PSA levels falls in circulating tumour cell counts in the blood and radiological responses on CT scans and MRI. The clinical trial found that up to per cent of men with advanced prostate cancer had tumours with defects in their systems for repairing DNA detected by genomic testing and that these responded particularly well to olaparib. Of the patients with detectable DNA repair mutations responded very well to olaparib accounting for the large majority of those who benefited from the drug. Most of these men who all had terminal prostate cancer with limited treatment options had disease control lasting much longer than expected in this group of patients. The results have led on to the start of TOPARPB a second part of this trial in which only men whose prostate cancers have detectable DNA repair mutations will receive olaparib. If the results are successful olaparib could become a standard treatment option for men with advanced prostate cancer and DNA repair mutations. The development of olaparib which is now owned by AstraZeneca was underpinned by scientific research carried out with funding from Cancer Research UK at The Institute of Cancer Research ICR and the University of Cambridge and clinical trials led by the ICR and The Royal Marsden and other institutions in the UK and overseas. It has had particularly strong results in phase III trials in patients who inherited mutations to the BRCA genes many of whom had breast or ovarian cancer. The drug a type of treatment called a PARP inhibitor was licensed last year for women with ovarian cancer and inherited BRCA mutations but so far has not been approved for use on the NHS by NICE or the Cancer Drugs Fund. Trial chief investigator Professor Johann de Bono Head of Drug Development at The Institute of Cancer Research London and The Royal Marsden NHS Foundation Trust said Our trial marks a significant step forward in the treatment of prostate cancer showing that olaparib is highly effective at treating men with DNA repair defects in their tumours. It also proves the principle that we can detect prostate cancers with specific targetable mutations using genomic sequencing to deliver more precise cancer care by matching treatment to those men most likely to benefit. I hope it wont be long before we are using olaparib in the clinic to treat prostate cancer or before genomic stratification of cancers becomes a standard in this and other cancers. Study coleader Dr Emma Hall Deputy Director of the Cancer Research UKfunded Clinical Trials and Statistics Unit at The Institute of Cancer Research London which coordinated the study said This phase II clinical trial combined a highly targeted cancer drug with cuttingedge genomic sequencing. We showed that a subset of men whose tumours had mutations in their DNA repair machinery responded particularly well to treatment with olaparib. The next trial includes only men with these mutations in their tumours with the aim of proving that olaparib is highly effective for them. Dr Aine McCarthy science information officer at Cancer Research UK said Even though the number of men surviving prostate cancer is increasing its still the second most common cause of cancer death in UK men. This is partly because the disease is so hard to treat once it has spread around the body. This trial is exciting because it could offer a new way to treat prostate cancer by targeting genetic mistakes in cancers that have spread. The hope is that this approach could help save many more lives in the future. Howard R. Soule PhD executive vice president and chief science officer of the Prostate Cancer Foundation said TOPARPA is significant because it exploits the genetic similarities of prostate breast and ovarian cancers said. We are excited about this pioneering study because it demonstrates the tremendous crossover and wider applications in the research on these diseases. Dr. William Nelson covice chair of the SUC Scientific Advisory Committee and director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore Maryland said Understanding the link between prostate cancer and DNA repair mutations is incredibly important for patients and their families. We can identify prostate cancer patients who will benefit from drugs like olaparib and also help men and their families better understand their genetic risk of metastatic prostate cancer just as women with BRCA mutations do for breast and ovarian cancer. Notes to editors For more information contact Henry French on henry.frenchicr.ac.uk mailtohenry.frenchicr.ac.uk. For enquiries out of hours please call . The Institute of Cancer Research London is one of the worlds most influential cancer research institutes. 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 cancer centres 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 leads the world at isolating cancerrelated genes and discovering new targeted drugs for personalised cancer treatment. As a college of the University of London the ICR 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. 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. The Prostate Cancer Foundation PCF is the worlds leading philanthropic organization funding and accelerating prostate cancer research. Founded in PCF has raised more than million and provided funding to more than research programs at nearly cancer centers and universities. The PCF global research enterprise now extends to countries. PCF advocates for greater awareness of prostate cancer and more efficient investment of governmental research funds for transformational cancer research. Its efforts have helped produce a fold increase in government funding for prostate cancer. For more information click here. About the Movember Foundation The Movember Foundation is a global charity raising funds and awareness for mens health. These funds deliver breakthrough research and support services to allow men to live longer healthier happier lives. Since millions have joined the mens health movement raising more than million and funding over programs through impact investments focusing on four key areas prostate cancer testicular cancer poor mental health and physical inactivity. Movember is fully accredited by the Better Business Bureau and for the past three years has been named a Top best NGO by The Global Journal. For more information please visit Movember.com. Movember is a registered c charity."

"Any pet owner will tell you that their animal companions comfort and sustain them when life gets rough. This may be especially true for people with serious mental illness a study finds. When people with schizophrenia or bipolar disorder were asked who or what helped them manage the condition many said it was pets that helped the most. When Im feeling really low they are wonderful because they wont leave my side for two days one study participant with two dogs and two cats They just stay with me until I am ready to come out of it. Another person said of their pet birds If I didnt have my pets I think I would be on my own. You know what I mean so its its nice to come home and you know listen to the birds singing and that you know. Many people with serious mental illness live at home and have limited contact with the health care system says Helen Brooks a mental health researcher at University of Manchester in the United Kingdom and the lead author on the study which was published Friday httpsbmcpsychiatry.biomedcentral.comarticles.s in the journal BMC Psychiatry. So theyre doing a lot of the work of managing their conditions. Article continues after this message from our sponsor Brooks says Many felt deep emotional connections with their pet that werent available from friends and family. Brooks and her colleagues interviewed people with serious longterm mental illnesses. Twentyfive of them considered their pets to be a part of their social network. The scientists asked who they went to when they needed help or advice where they gained emotional support and encouragement and how they spent their days. The participants were then given a diagram with three consecutive circles radiating out from a square representing the participant. They were asked to write the people places and things that gave them support into the circles with the circles closest to the center being the most important. Sixty percent of the people who considered pets to be a part of their social networks placed them in the central most important circle the same place many people put close family and social workers. percent placed pets in the second circle. This study participant had a limited social network so he placed his birds in the closest social circle in his life along with his social worker and gardening group. Helen BrooksUniversity of Manchester The interviews with participants are poignant and reveal the struggle and isolation that can come with mental illness. I think its really hard when you havent had a mental illness to know what the actual experience is like said one participant. Theres like a chasm deep chasm between us ... Other people are on one side of it and were on the other side of it. Were sending smoke signals to each other to try and understand each other but we dont always we dont always understand. People with mental illnesses often see their social groups shrink and find themselves alienated from their friends. For many of these people says Brooks animals can break through the isolation. They give affection without needing to understand the disorder. Pets dont look at the scars on your arms one participant said. They dont question where youve been. The pets provided more than just emotional support and companionship participants said. The animals also could distract them from their illness even from severe psychosis. One study participant placed birds in his closest social circle. When he was hearing voices he said that they help me in the sense you know Im not thinking about the voices Im just thinking of when I hear the birds singing. Another participant said that merely seeing a hamster climbing the bars on the cage and acting cute helped with some difficult situations. And having to take care of pets keeps people from withdrawing from the world. They force me the cats force me to sort of still be involved said one participant. Another said that walking the dog helped them get out of the house and with people. That surprised me you know the amount of people that stop and talk to him and that yeah it cheers me up with him. I havent got much in my life but hes quite good yeah. The routine these pets provide is really important for people says Brooks. Getting up in the morning to feed them and groom them and walk them giving them structure and a sense of purpose that they wont otherwise have. Many of the study participants are unemployed because of their illness she notes. Having a pet that was well taken care of was a source of pride for them. Mark Longsjo the program director of adult services at McLean Southeast http an inpatient mental facility in Middleborough Mass. says that the interviews in the study reflect his professional experiences. We have so many patients come through and we always ask them about their support system. Sometimes its family members sometimes its friends but its very common to hear about pets. When he does patient intake surveys Longsjo says that he includes pets in their risk assessments. Patients with pets often say the animals help keep them from following through on suicidal thinking because they know their pets depend on them. The social workers at McLean also incorporate pets into their aftercare planning encouraging patients to make walking and grooming their pets a part of their routine. I think theres significant value in considering the common everyday pet to be as important as the relationships one has with ones family in the course of their treatment says Longsjo. He feels this study is important because although theres a lot of work looking at the benefits of trained therapy animals http they can be expensive and out of the reach of many patients. Brooks hopes that more health workers will consider incorporating pets into care plans for people with mental illness. Many of her participants said that sometimes it felt like their pets could sense when they needed help the most and were able to provide it just like the owners took care of them. As one person in the study said When he comes up and sits beside you on a night its different you know. Its just like he needs me as much as I need him."

"Blindfolded would you know the smell of your mom a lover or a coworker Not the smells of their colognes or perfumes not of the laundry detergents they use the smells of them Each of us has a unique odorprint made up of thousands of organic compounds. These molecules offer a whiff of who we are revealing age genetics lifestyle hometown even metabolic processes that underlie our health. Ancient Greek and Chinese medical practitioners used a patients scent to make diagnoses. Modern medical research too confirms that the smell of someones skin breath and bodily fluids can be suggestive of illness. The breath of diabetics sometimes smells of rotten apples https experts report the skin of typhoid patients like baking bread httpsjamanetwork.comjournalsjamadermatologyarticleabstract. But not every physicians nose is a precision instrument and dogs https while adept at sniffing out cancer get distracted. So researchers have been trying for decades to figure out how to build an inexpensive odor sensor for quick reliable and noninvasive diagnoses. The field finally seems on the cusp of succeeding. Youre seeing a convergence of technology now so we can actually run largescale clinical studies to get the data to prove odor analysis has real utility said Billy Boyle cofounder and president of operations at Owlstone http a manufacturer of chemical sensors in Cambridge England. Mr. Boyle an electronics engineer formed the company with two friends in to develop sensors to detect chemical weapons and explosives for customers including the United States government. But when Mr. Boyles girlfriend and eventual wife Kate Gross was diagnosed with colon cancer in his focus shifted to medical sensors with an emphasis on cancer detection. Ms. Gross died at the end of . That she might still be alive if her cancer had been detected earlier Mr. Boyle said continues to be a big motivator. Owlstone has raised . million to put its odor analysis technology into the hands of clinicians. Moreover Britains National Health Service is funding a subject clinical trial httpsclinicaltrials.govctshowNCT to test Owlstones sensor to diagnose lung cancer. The sensor is a silicon chip stacked with various metal layers and tiny gold electrodes. While it looks like your mobile phones SIM card it works like a chemical filter. Editors Picks The molecules in an odor sample are first ionized given a charge and then an electric current is used to move only chemicals of diagnostic interest through the channels etched in the chip where they can be detected. You can program what you want to sniff out just by changing the software Mr. Boyle said. We can use the device for our own trials on colorectal cancer but it can also be used by our partners to look for other things like irritable bowel disease. The company also is conducting a subject trial in collaboration with the University of Warwick to detect colon cancer from urine samples and is exploring whether its chips can help determine the best drugs for asthma patients by sorting through molecules in their breath. A similar diagnostic technology is being developed by an Israeli chemical engineer Hossam Haick who was also touched by cancer. My college roommate had leukemia and it made me want to see whether a sensor could be used for treatment said Mr. Haick a professor at TechnionIsrael Institute of Technology http in Haifa. But then I realized early diagnosis could be as important as treatment itself. His smelling machine uses an array of sensors composed of gold nanoparticles or carbon nanotubes. They are coated with ligands molecular receptors that have a high affinity for certain biomarkers of disease found in exhaled breath. Once these biomarkers latch onto the ligands the nanoparticles and nanotubes swell or shrink changing how long it takes for an electrical charge to pass between them. This gain or loss in conductivity is translated into a diagnosis. Sign up for Science Times Well bring you stories that capture the wonders of the human body nature and the cosmos. We send all the signals to a computer and it will translate the odor into a signature that connects it to the disease we exposed to it Mr. Haick said. With artificial intelligence he said the machine becomes better at diagnosing with each exposure. Rather than detecting specific molecules that suggest disease however Mr. Haicks machine sniffs out the overall chemical stew that makes up an odor. Its analogous to smelling an orange Your brain doesnt distinguish among the chemicals that make up that odor. Instead you smell the totality and your brain recognizes all of it as an orange. Mr. Haick and his colleagues published a paper in ACS Nano httppubs.acs.orgdoiabs.acsnano.b last December showing that his artificially intelligent nanoarray could distinguish among different diseases with up to percent accuracy. There were a total of participants in the trial but the sample sizes for each disease were quite small. And the machine was better at distinguishing among some diseases than others. In the United States a team of researchers from the Monell Chemical Senses Center https and the University of Pennsylvania received an grant https_releasesmonell_center_grant_ovarian_cancer_odor_diagnostic in February from the Kleberg Foundation to advance work on a prototype odor sensor that detects ovarian cancer in samples of blood plasma. The team chose plasma because it is somewhat less likely than breath or urine to be corrupted by confounding factors like diet or environmental chemicals including cleaning products or pollution. Instead of ligands their sensors rely on snippets of singlestrand DNA to do the work of latching onto odor particles. We are trying to make the device work the way we understand mammalian olfaction works said Charlie Johnson director of the NanoBio Interface Center http at the University of Pennsylvania who is leading the fabrication effort. DNA gives unique characteristics for this process. In addition to these groups teams in Austria Switzerland and Japan also are developing odor sensors to diagnose disease. I think the fact that youre seeing so much activity both in commercial and academic settings shows that were getting a lot closer said Cristina Davis a biomedical engineer and professor at the University of California Davis who also is helping to develop an odor sensor to diagnose disease. My estimate is its a three to fiveyear time frame before such tools are available to clinicians she added. The researchers may be competing intensely but all see possibilities for saving lives. Theres a lot of good work going on out there Mr. Johnson said. It will be interesting to see who comes out on top. Correction May An earlier version of this article misstated when Kate Gross died. It was Dec. not last year. Correction May An article on Tuesday about odor detection to diagnose disease misspelled the name of a foundation that awarded a grant to advance work on a prototype odor sensor that detects ovarian cancer in samples of blood plasma. It is the Kleberg Foundation not Kleburg."

"Scientists have announced the development of a highly accurate and reliable technique for diagnosing prostate cancer. The Dundee Universitybased team say they have used an ultrasound process called shear wave elastography SWE to detect prostate tumours. The method is noninvasive and cheaper than current detection techniques. Prostate cancer has become the most common cancer in men in the UK. One in eight men will develop the condition at some point in their lives with more than new cases being diagnosed every year. Men aged or over men with a family history of prostate cancer and black men https are at greatest risk of developing the condition. Current diagnosis of prostate cancer is extremely inefficient leading to unnecessary treatments for many patients said the Dundee University teams leader Professor Ghulam Nabi. Our new method is far more accurate and also allows us to identify the difference between cancerous and benign tissue in the prostate without the need for invasive surgery. The prostate is a small gland in the male reproductive system and is normally about the shape and size of a walnut. Current methods for determining if a prostate has become cancerous include a physical examination of the prostate known as a digital rectal examination or DRE MRI scans a biopsy or tests https to determine levels of the chemical prostatespecific antigen PSA in the blood. Each carries problems. PSA results can be unreliable a DRE is not good at identifying which cancers are benign and which need treatment MRI scans cannot always give a definitive answer while a biopsy carries a risk of infection and is expensive. The new method aims to get round the problems by targeting the prostate with ultrasound. Cancerous tissue is stiffer than normal tissue so shear waves are slowed as they pass through a tumour. We have been able to show a stark difference in results between our technology and existing techniques such as MRI added Nabi. The technique has picked up cancers which MRI did not reveal. We can now see with much greater accuracy what tissue is cancerous where it is and what level of treatment it needs. This is a significant step forward. The trial tests involved around patients. Now we need to use this on a wider scale to build more data but there is clearly the potential to really change the way we manage prostate cancer Nabi said. SWE technology is already used in diagnosing breast cancer and liver diseases. However to make it applicable to prostate cancer a special probe had to be developed by the team. The technique now needs to be tested in a much larger number of men to confirm just how well it can detect the aggressive cancers while also ruling out those who do not have prostate cancer said Simon Grieveson head of research funding at Prostate Cancer UK which funded the Dundee project with support from the Movember Foundation. With an average of one man dying every minutes from prostate cancer in the UK the need for a more reliable test that can identify dangerous forms of the disease earlier is greater than ever. In the past few years a number of celebrities have revealed that they had been diagnosed with prostate cancer and have joined campaigns to raise awareness of the disease including Michael Parkinson Ian McKellen and most recently Stephen Fry https the comedian and former rector of Dundee University who this year described how he had surgery to deal with a prostate tumour. This breakthrough comes at a time when prostate cancer is being pushed to the forefront of our consciousness in the UK not least because of the disturbing upward trend in its prevalence said Fry. It is therefore doubly exciting to hear of the new techniques in diagnostic imaging. Number of cases of prostate cancer diagnosed every year in the UK The number of men who die each year from the disease in Proportion of UK men who will get prostate cancer in their lifetime"

"A far less expensive alternative proved roughly as effective as Genentechs costly drug Lucentis in preserving or improving vision in elderly people with a common eye disease according to two people familiar with the results of a closely watched clinical trial. A clear showing of equivalence between the two drugs could lead to greater use of the less expensive drug Avastin which is also made by Genentech saving Medicare hundreds of millions of dollars a year or more. However some researchers said there are some complicating factors both in the trial data and in other studies that would favor Lucentis. The data is going to be interpreted many different ways said one investigator in the trial who spoke under condition of anonymity but would not provide any trial results. Revealing trial results before they are published or presented at a conference is considered a violation of scientific protocol. Genentech developed Lucentis to treat the wet form of agerelated macular degeneration the most common cause of severe vision loss in the elderly. While Avastin which is a cancer drug has not been approved for use in treating macular degeneration it has the same mechanism of action as Lucentis. And Avastin costs only about per injection into the eye compared to roughly for Lucentis. Many eye doctors already are using Avastin offlabel to treat macular degeneration and many say it appears to work just as well as Lucentis. But there has never been a definitive trial to compare the two drugs. So the National Eye Institute part of the National Institutes of Health sponsored a randomized trial involving patients. Results are scheduled to be presented Sunday at the annual meeting of the Association for Research in Vision and Ophthalmology in Fort Lauderdale Fla. The results will also be published in The New England Journal of Medicine. Some . million Americans have advanced forms of agerelated macular degeneration and the number is expected to increase as baby boomers age. In Medicare paid for injections of Avastin to treat macular degeneration and injections of Lucentis according to a study led by Dr. Philip Rosenfeld of the University of Miami. Yet Medicare paid only million for the Avastin compared to million for the smaller number of Lucentis injections. Investigators in the National Eye Institute trial had a daylong meeting on Tuesday in Chicago to learn the results. But they were sworn to secrecy. But two people familiar with the data who spoke on condition of anonymity said that injections of Lucentis and Avastin every four weeks resulted in vision changes after one year that were essentially the same. The result was largely expected. Under the rules of the trial patients treated with Avastin could read on average of up to five fewer letters on an eye chart than those treated with Lucentis and Avastin would still be considered noninferior. It is believed the results were closer than five letters however. Still doctors will be looking closely at details of the data. One person said Avastin was less effective than Lucentis in decreasing the thickness of the retina suggesting that Avastin might not prove as effective in preserving vision over a period beyond one year. Patients in the trial are being followed for a second year. Safety of the two drugs will also be closely watched. However experts say that with only patients the trial will be able to detect only major differences in safety. Another part of the trial compared injecting the drugs as needed depending on the course of the patients disease rather than on a strict monthly schedule. One source said Avastin was slightly inferior to Lucentis but the other said the results of the two drugs were the same. The trial comparing the two drugs is of the type known as a comparative effectiveness study. Such studies are being encouraged under the new health reform law though this one started before the law was enacted. Genentech which is owned by Roche has already mounted a preemptive counterattack aimed at nullifying any results of the federal trial that would shift more patients to Avastin. The company sponsored a study looking at records of nearly Medicare recipients with agerelated macular degeneration. The study found that those who received Avastin had an percent higher risk of dying and a percent higher risk of hemorrhagic stroke than those getting Lucentis according to an abstract of the study posted on the Web site of the upcoming ophthalmology conference where the results will be presented. Genentech arranged for the lead investigator of this study Dr. Emily W. Gower of Johns Hopkins University to brief Congressional staffers on the results on Tuesday. If this finding is considered valid it could render the results of the National Eye Institute trial somewhat moot by raising safety questions about Avastin. Once you plant that seed of doubt in patients minds its very difficult to overcome that said one retina specialist who spoke on condition of anonymity. I would say it changes the landscape. However experts have not been able to scrutinize the data of this study. One obvious potential flaw is that people who get the cheaper Avastin are more likely to be poor and uninsured and might therefore have worse health to begin with than those who get Lucentis. The study tried to correct for this but whether it did so adequately is a subject of debate. Roche sells Lucentis in the United States and Novartis in other countries. Sales of the drug for each company were about . billion last year."

"Developing a vaccine to stop HIV is thought to be among the most daunting challenges in medicine for one big reason The virus is extraordinarily genetically diverse even more so than the flu. So its difficult to think about how a single shot might work against all the different HIV subtypes circulating around the world. But scientists may be inching toward a vaccine that could tackle HIVs genetic diversity and prevent the virus from taking hold in people. Researchers from the National Institutes of Health and Johnson Johnson at the International AIDS Society conference http in Paris Monday morning presented data on a clinical trial of whats called the Adenv mosaic vaccine. The mosaic vaccine was developed using a computer algorithm to analyze HIV data from around the world and select a range of HIV sequences to include in a shot. Its called a mosaic because it involves taking pieces of different viruses and sticking them together to generate immune responses that can cover a broad range of HIV subtypes. One of the great challenges for development of HIV vaccine is viral diversity said Dan Barouch a lead researcher on the vaccine and director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston. The mosaic strategy is one way to attempt to deal with the global virus diversity. A word of caution though Were only in the early phase of human testing and the vaccine could ultimately fail to prevent the virus from spreading among people. But so far the HIV community is carefully watching the Ad vaccine research because the approach seems quite promising. The mosaic approach seems promising in very early clinical research In the years of the HIV epidemic only four HIV vaccine concepts have been tested in humans. The mosaic strategy is the fifth concept and one of only two HIV vaccines thats currently part of clinical trials of efficacy in humans. The other is the HVTN HIV vaccine candidate https now underway in Thailand. In the study of the Ad mosaic vaccine called the APPROACH trial volunteers in the United States Rwanda Uganda South Africa and Thailand were randomly assigned to receive one of seven experimental vaccines or a placebo. The mosaic vaccine was the best tolerated and also capable of generating antiHIV immune responses in all the people who received the shots. Before this studies of the mosaic vaccine in rhesus monkeys showed a percent efficacy rate meaning percent of monkeys that got the shot were protected from the virus. With HIV to percent is about the efficacy range researchers hope for. Interestingly in the early human study the immune response was comparable to the rhesus monkey one which gave the researchers hope that the vaccine might be similarly effective in people. We need more human studies of this HIV vaccine But we still dont know if the vaccine will protect humans from the virus since the studies so far have only looked at safety and immune responses not efficacy. And many medicines that look promising in animals and safe in humans dont pan out in clinical trials focused on efficacy. I wouldnt use the word excited too much said Anthony Fauci director of the NIHs National Institute of Allergy and Infectious Diseases. Its a step forward toward getting another candidate into trial that could have some promise. Its too soon to say if and when the mosaic vaccine might work to prevent the virus from spreading in humans he added. As for next steps if the researchers continue to see promising data on the mosaic vaccine from another ongoing study a larger human efficacy trial will move forward toward the end of the year in southern Africa involving some healthy HIVnegative women. Deaths from AIDS have halved since but theres still a ton of work to be done Weve made remarkable progress against HIV around the world. In as HIV prevalence http was peaking around the world the United Nations established UNAIDS http the first global health body focused on a single disease. In the UN Security Council convened an unprecedented meeting to address the outofcontrol AIDS crisis. This led to a massive concentration httpone.org.s.amazonaws.comimagesAIDSReportEnglish.pdf of resources into HIVAIDS research and triggered global and coordinated efforts to stem the disease. Researchers and doctors figured out how to get people tested and diagnosed quickly and uncovered effective treatments that allowed those with HIV to live long relatively healthy lives. Public health officials also waged awareness campaigns about prevention reminding people to practice safe sex with condoms and get tested and that early HIV treatment can save lives. Recently researchers even discovered http a pill to prevent HIV. Deaths from AIDS have halved to million since and UNAIDS http_Data_book_ estimates almost million people now have access to treatment. Some of that access is now in jeopardy however given that President Donald Trump has proposed cutting million from a key US government AIDS program called PEPFAR in the budget. An HIV vaccine has long been elusive. The other HIV vaccine in human testing the HVTN candidate https is a newer version of the only other HIV vaccine to show any efficacy in humans called RV. In a trial on the RV percent of people who got the vaccine did not develop HIV too small a number to be useful. But with the new HVTN trial researchers hope some tweaks to the vaccine might boost the efficacy rate. A safe and effective HIV vaccine would be a powerful tool to reduce new HIV infections worldwide and help bring about a durable end to the HIVAIDS pandemic Fauci said in a statement. By exploring multiple promising avenues of vaccine development research we expand our opportunities to achieve these goals."

"For infants with congenital malformations of the ear a treatment system called EarWell can gently reshape the earavoiding the pain and cost of later surgery reports a study in the March issue of Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg the official medical journal of the American Society of Plastic Surgeons http ASPS. But treatment must begin earlypreferably within the first three weeks after birth according to the study by ASPS Member Surgeon H. Steve Byrd MD and colleagues of Pediatric Plastic Surgery Institute Dallas. Dr. Byrd comments The EarWell system is effective in eliminating or reducing the need for surgery in all but the most severe congenital ear malformations. Nonsurgical Treatment Avoids Later Consequences of Infant Ear Malformations The researchers review their experience with nonsurgical correction of congenital ear malformations in infants. The EarWell system is a relatively simple technique for molding and reshaping the ear taking advantage of the increased malleability of the ear cartilage in newborns. For best results treatment should start within the first three weeks after birth or correspondingly later in infants born prematurely. The technique and length of EarWell treatment varies according to the type and severity of the infants ear deformity. Dr. Byrd and colleagues present a classification system and technical details for plastic surgeons to follow in evaluating the best treatment for specific types of malformations. For most infants in the study both ears were treated for a total of ears. Ninetyeight percent of infants had relatively mild constrictedtype ear deformities. EarWell treatment started at an average age of days and continued for days including an average of six followup visits to the plastic surgeons office. EarWell treatment was highly successful in correcting or reducing the severity of congenital ear malformations. Results were judged good to excellent in percent of ears with one simple deformity and percent with more complex mixed deformities. About percent of ears with constricted malformations were graded as having no deformity after treatment. Complications consisted mainly of skin injuries that healed without further problems. In eight cases treatment had to be stopped because of an allergic reaction to the adhesive tape used. While the EarWell system is not new the report is the largest study of congenital ear malformations treated with this approachincluding a standardized approach to treatment and assessment of the results. The results strongly support its use especially in infants with deformities and lesssevere malformations. But lack of awareness of this nonsurgical alternative is a key limiting factor. The opportunity for early treatment can be hampered by a failure to convince pediatricians that the majority of misshapen newborn ears do not selfcorrect Dr. Byrd and coauthors write. They also point out that EarWell is highly successful in the treatment of prominent earsa condition that commonly goes unnoticed by parents and pediatricians but is likely to get worse as the child grows. While we can operate on ears later in the patients life waiting not only increases the surgerys difficulty and expense but may expose the child to teasing bullying and loss of selfesteem comments EditorinChief Rod J. Rohrich MD in a featured video on the Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg website. If your baby has any type of ear deformity plastic surgeons can help with or without surgery. Discuss nonsurgical ear molding alternatives with your pediatrician and consult with a boardcertified plastic surgeon...the earlier the better Plastic and Reconstructive Surgery httpjournals.lww.complasreconsurg is published by Wolters Kluwer http Click here to read Classification of Newborn Ear Malformations and their Treatment with the EarWell Infant Ear Correction System. httpjournals.lww.complasreconsurgFulltextClassification_of_Newborn_Ear_Malformations_and..aspx Article Classification of Newborn Ear Malformations and their Treatment with the EarWell Infant Ear Correction System doi .PRS. About Plastic and Reconstructive Surgery For more than years Plastic and Reconstructive Surgery http has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons Plastic and Reconstructive Surgery brings subscribers uptotheminute reports on the latest techniques and followup for all areas of plastic and reconstructive surgery including breast reconstruction experimental studies maxillofacial reconstruction hand and microsurgery burn repair and cosmetic surgery as well as news on medicolegal issues About ASPS The American Society of Plastic Surgeons http is the largest organization of boardcertified plastic surgeons in the world. Representing more than physician members the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than percent of all boardcertified plastic surgeons in the United States. Founded in the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. About Wolters Kluwer Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal business tax accounting finance audit risk compliance and healthcare rely on Wolters Kluwers market leading informationenabled tools and software solutions to manage their business efficiently deliver results to their clients and succeed in an ever more dynamic world. Wolters Kluwer reported annual revenues of . billion. The group serves customers in over countries and employs over people worldwide. The company is headquartered in Alphen aan den Rijn the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam WKL and are included in the AEX and Euronext indices. Wolters Kluwer has a sponsored Level American Depositary Receipt program. The ADRs are traded on the overthecounter market in the U.S. WTKWY. Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization visit http httpwolterskluwer.com follow WKHealth httpstwitter.comwkhealth or Wolters_Kluwer httpstwitter.comWolters_Kluwer on Twitter like us on Facebook https follow us on LinkedIn https or follow WoltersKluwerComms on YouTube. https"

"Researchers at the University of Colorado Anschutz Medical Campus have found that high doses of vitamin D reduce the incidence of acute respiratory illness ARI in older longterm care residents. The findings of the clinical trial published today in the Journal of the American Geriatrics Society could help reduce one of the leading causes of serious illness debilitation and death among patients in nursing homes and other longterm care facilities. After studying these patients for a year we found a percent reduction in acute respiratory illness among those who took higher doses of vitamin D said the studys lead author Adit Ginde MD MPH professor of emergency medicine at the University of Colorado School of Medicine. Vitamin D can improve the immune systems ability to fight infections because it bolsters the first line of defense of the immune system. Ginde said in older people that first line of defense is often impaired. But vitamin D can reinforce it and prevent illnesses like pneumonia influenza and bronchitis. It may also prevent infections and exacerbations of Chronic Obstructive Pulmonary Disease COPD like emphysema. At the same time Ginde found that those who received higher doses of vitamin D also saw an increase in falls. The falls were lower in those given smaller doses rather than higher monthly doses of vitamin D. The clinical trial the first to examine vitamin Ds impact on respiratory infections in nursing home residents looked at patients with an average age of over a month period. Of those received high doses of vitamin D or units monthly averaging units daily. And received lower doses averaging between units daily. Those with higher doses saw ARIs cut nearly in half. They also had over double the incidence of falls the study said. This finding requires a confirmatory trial including whether high daily doses of vitamin D rather than high monthly doses makes patients less likely to fall Ginde said. But Ginde said the primary finding that vitamin D can reduce ARI is a major step forward in treating these dangerous infections. This is a potentially lifesaving discovery Ginde said. There is very little in a doctors arsenal to battle ARI especially since most are viral infections where antibiotics dont work. But vitamin D seems able to potentially prevent these infections. He cautioned that the study is not definitive proof that vitamin D can prevent ARI but it suggests that it can and at little risk to the patient. If our results are confirmed by a larger trial high dose vitamin D ideally using daily dosing to minimize fall risk has the potential for substantial public health benefit through ARI prevention for the large and growing population of long term care residents Ginde said. The study coauthors include Patrick Blatchford PhD Keith Breese MA Lida Zarrabi MPH Sunny Linnebur PharmD Jeffrey Wallace MD MPH and Robert Schwartz MD. All are from the University of Colorado Anschutz Medical Campus."

"A commonlyprescribed multiple sclerosis MS infusion medication linked to a rare but serious side effect is safer to use when dosing intervals are extended according to a new study led by MS specialists NYU Langone Health. The new research showed that extending dosing of natalizumab from every weeks to every to weeks significantly reduced the risk of developing progressive multifocal leukoencephalopathy PML a rare but potentially fatal brain infection. The authors presented their findings February at the Americas Committee for Treatment and Research in Multiple Sclerosis ACTRIMS Forum in San Diego. The findings could influence how neurologists prescribe the medication. Neurologists have been looking for safer ways to administer natalizumab infusions to their patients but there hasnt been clear data on whether decreasing dosing frequency improves safety says first study author Lana Zhovtis Ryerson MD httpsnyulangone.orgdoctorslanazhovtisryerson assistant professor of neurology at NYU School of Medicine and an attending neurologist at NYU Langones Multiple Sclerosis Comprehensive Care Center httpsnyulangone.orglocationsmultiplesclerosiscomprehensivecarecenter. Our safety findings are clinically and statistically significant and we believe that extending the dosing schedule of natalizumab is practice changing and may save lives. Natalizumab a monoclonal antibody is used to prevent MS relapses improve quality of life and slow worsening disability. The medication is indicated to be prescribed in milligram infusion doses every weeks. Taking the medication longer than two years however may increase risk PML which is caused by the John Cunningham virus JCV. There have been PML cases reported worldwide as of January with a global incidence rate of . per PML cases in people treated with natalizumab. Patients who test JCV antibodypositive are typically either told to not to start natalizumab or have had treatment stopped after two years when risk was deemed to be too high. The new study however reports safety data through up to months or years when the extended dosing regimens were applied with risk reduction for PML as high as percent. How the Study Was Conducted Researchers reviewed data on all patients who have been exposed to JCV who are enrolled in TOUCH the U.S. Food and Drug Administrationmandated Risk Evaluation and Mitigation Strategy REMS program for natalizumab that requires manufacturers to document all uses of a medication to ensure that the benefits of a drug outweigh its risks. Since the optimal extended dose schedule is not known researchers chose to look at the data in multiple ways with the primary definition looking at extended dose history in the last months the secondary definition looking at extended dose occurring at any time in the dosing history and for tertiary definition looking primarily at how extended dose history affects PML risk. The results showed clinically and statistically significant risk reductions with all definitions. The new study did not look at drug efficacy comparing extended to standard doses. However previous research led by Dr. ZhovtisRyersons group found extending the dose up to weeks did not negatively affect the medications efficacy in a retrospective sample of people. The authors are planning prospective efficacy studies of extended dose natalizumab. Natalizumab is manufactured by Biogen Idec and Elan and sold under the name Tysabri. Biogen provided the researchers access to their data and statistical support. Other infusion diseasemodifying therapies approved to treat MS include the drugs alemtuzumab and ocrelizumab. Oral and injectable medications are also prescribed. The study was carried out in collaboration with Biogen and academic collaborators from NYU School of Medicines Division of Biostatics University of Alabama at Birmingham School of Medicine and Rocky Mountain Multiple Sclerosis Clinic in Utah. In addition to Dr. ZhovtisRyerson Ilya Kister MD associate professor of neurology Judith D. Goldberg professor of population health and environmental medicine and Xiaochun Li PhD research scientist of biostatistics were coauthors at NYU Langone Health. Other coauthors include Dr. John Foley Dr. Ih Chang Professor Gary R. Cutter Dr. Ryan Metzger Dr. Evan Riddle Dr. Bei Yu Dr. Zheng Ren Dr. Christophe Hotermans Dr. PeiRan Ho and Dr. Nolan Campbell."

"More research is suggesting that heavy smokers may benefit from screening for lung cancer to detect tumors in their earliest stages. A new study finds that regular smokers who received threedimensional Xrays to look for the presence of early tumors had a significantly lower risk of dying over a year period. The results are in keeping with those of a much larger study published last month which showed that these D Xrays or CT scans reduced the death rate among current and former heavy smokers by percent compared with screening using regular chest Xrays. That previous finding was very good news in the field said Dr. Bruce Johnson of the Dana Farber Cancer Institute who treats lung cancer patients and reviewed the results for Reuters Health. This latest study published in the journal Lung Cancer looked at death rates in a different smaller population of heavy smokers and estimated that those who received up to two CT scans would have between a and percent lower risk of dying compared to those who went unscreened. The data are consistent with earlier studies but there are still many issues to resolve regarding lung cancer screening Johnson said. For one scientists havent yet worked out how often to screen people and when to start. It is not clear when or how guidelines for lung cancer screening could be drawn up and until they are insurers including government programs such as Medicare are unlikely to pay the average cost of a scan. Furthermore an April study showed that percent of a patients initial lung CT scans show suspicious lesions that turn out not to be cancer but lead to needless invasive followup procedures and radiation exposure as well as stress and anxiety for patients and their families. The high socalled false positive rate is an issue said Dr. James Hanley of McGill University who also reviewed the findings for Reuters Health but many mammograms also find lesions that turn out to be benign. And for lung cancer doctors know there is a high falsepositive rate and have a set protocol to follow in order to determine which lesions are dangerous added Johnson. Lung cancer kills . million people a year globally and it will kill people in the United States alone this year according to the American Cancer Society. Tobacco use accounts for some percent of lung cancer cases in the U.S. and one estimate puts a smokers lifetime absolute risk of developing lung cancer between percent and percent. Fiveyear survival rates for lung cancer are low. In recent years CT scans in particular have been promoted by some hospitals and advocacy groups for lung cancer screening even though studies had not yet shown definitively whether such screening saves lives. In Dr. Claudia Henschke currently based at Mount Sinai School of Medicine and Arizona State University caused a stir when she published a study concluding that percent of lungcancer deaths could be prevented through widespread use of spiral CT. Her ideas were controversial to start with especially when other researchers found her work had been paid for by a tobacco company. In the current study funded in part by manufacturers of CT scanners along with government and other sources Henschke and her colleagues compared outcomes for nearly smokers and former smokers who volunteered to undergo CT scans to outcomes in two sets of people with smoking histories who were not scanned. The three groups of people had some important differences such as in average age and how long and heavily they had smoked so the researchers had to use mathematical tools to try to eliminate the influence of those differences said Hanley. For instance to compare death rates the researchers tracked how many people died among those who were screened then pulled out all the people with similar underlying characteristics in the other two groups and looked at their death rates Hanley explained. A total of people died in the screened population the authors report but applying the death rate among people with the same underlying characteristics in one of the unscreened populations they estimated that the number of deaths would have been . This translates into a percent lower risk of dying among the screened population. Applying the same methods to the other unscreened population the authors estimated that screening was associated with a percent lower risk of dying. Overall research is suggesting that CT scans of people at risk of lung cancer might make a dent in cancer mortality and its possible that more frequent screening might make an even bigger dent Hanley noted. If screening is going to work youve got to keep at it. SOURCE link.reuters.comquvr httplink.reuters.comquvr Lung Cancer online December . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Results published today in The Journal of the Prevention of Alzheimers Disease JPAD describe analyses of Phase data for the investigational amyloidtargeted drug tramiprosate in patients with Mild to Moderate Alzheimers disease AD. These efficacy analyses evaluated patient subgroups based on the number of e alleles of apolipoprotein E APOE a major genetic risk factor in up to percent of patients with AD. The published results showed a genedose effect at the high dose of tramiprosate mg twice daily with patients with two APOE alleles APOE homozygotes showing the largest clinical benefit those with one APOE allele APOE heterozygotes showing an intermediate benefit while APOE noncarriers showed no benefit from tramiprosate. The results published in JPAD are the first evidence from a large clinical trial to associate efficacy of an amyloidtargeted agent with APOE status in AD patients. The manuscript titled Clinical Benefits of Tramiprosate in Alzheimers Disease Are Associated with Higher Number of APOE Alleles The APOE GeneDose Effect is featured in the advanced online publication of The Journal of the Prevention of Alzheimers Disease JPAD with lead authors from Alzheon Inc. a biopharmaceutical company focused on treatments for neurodegenerative and neuropsychiatric disorders. Based on the analyses in the publication Alzheon is developing ALZ an optimized oral prodrug of tramiprosate and has refined the design of the pivotal clinical trial to evaluate ALZ as a potential diseasemodifying agent in symptomatic AD patients who are APOE homozygotes. Anton P. Porsteinsson MD Professor of Psychiatry at the University of Rochester School of Medicine and Dentistry and Director of the Alzheimers Disease Care Research and Education Program at the University of Rochester in Rochester NY and an investigator in the North American Phase clinical trial commented The geneticallydefined population of APOE carriers has an fold increased risk of developing AD and has more rapidly progressive disease usually becoming symptomatic a decade earlier than noncarriers of the APOE genotype. These analyses with tramiprosate in the APOE subgroups are compelling and suggest a meaningful clinical benefit on top of the existing symptomatic AD treatments in Alzheimers patients who are in great need of new treatments. We can apply these insights about the therapeutic response of APOE carriers to refine patient selection and potentially improve the success rate of new Alzheimers medicines. The efficacy and safety analyses with tramiprosate published in JPAD reveal a therapeutic effect in patients who are carriers of APOE after segmenting them from the larger nongeneticallydefined study population in the Phase clinical program involving more than AD patients in North America and Europe. In the overall Mild and Moderate AD study population with baseline MMSE of and any APOE genotype the North American study did not demonstrate a significant benefit with either of two tramiprosate doses mg BID and mg BID compared to placebo during the week study period. As a result the European study was terminated before completion and the results were not previously published. To our knowledge this is the first time that the clinical benefits of an amyloidtargeted agent have been associated with the number of APOE alleles in Alzheimers patients. This new insight shows how we can apply a precision medicine approach in AD and develop this drug for the right patients namely patients with the APOE genotype which carries the highest risk as well as the earliest onset and faster disease progression said Martin Tolar MD PhD Founder President and CEO of Alzheon. These newlypublished findings form the basis for the design of our Phase program and further support our companys commitment to advance ALZ into pivotal studies in APOE homozygous AD patients who represent up to of AD patients. We are preparing to advance ALZ a promising new treatment for Alzheimers disease into confirmatory clinical studies in . The observed genedose effects of tramiprosate in APOE carriers are consistent with the prevalence of amyloid pathology in AD patients. Amyloid imaging in AD clinical trials has shown the highest prevalence of positive amyloid scans in APOE homozygotes and the lowest prevalence in APOE noncarriers. As one of the few orallyadministered amyloidtargeted agents tramiprosate blocks the aggregation of beta amyloid monomers into toxic oligomers and was developed to show efficacy in patients with amyloid pathology and an accurate diagnosis of AD. Efficacy Results in APOE Homozygous Patients from the JPAD Phase Analyses The published results showed the largest clinical benefit in the Alzheimers APOE homozygous AD patients who represent approximately percent of patients in the study. APOE homozygous patients who received the high dose of tramiprosate showed efficacy benefit compared to placebo on both cognitive and functional measures in the Phase analyses. The effects on the ADAScog cognitive outcome were significant at Week LS means difference from placebo . nominal p . and Week . nominal p . and corresponded to percent and percent benefit from tramiprosate compared to placebo. These effects were supported by functional benefits on the CDRSB that showed a positive trend at Week LS means difference from placebo . nominal p . and were numerically in favor of tramiprosate at Week . nominal p .. APOE homozygous AD patients are especially challenging since they are known to have the highest burden of amyloid pathology in cerebral cortex and blood vessels which explains their susceptibility to ARIAE with some amyloidtargeted treatments. In these new subgroup analyses the high dose of tramiprosate showed promising clinical effects in APOE homozygous AD patients already receiving maximal standard of care and this dose was not associated with any events of vasogenic edema said Susan Abushakra MD Chief Medical Officer of Alzheon and lead author on the JPAD publication. Replication of these findings in Alzheons planned Phase study would provide a meaningful therapeutic advance for AD patients with the APOE genotype and we are now preparing to carry forward these results into the development of ALZ. Safety Results from the JPAD Phase Analyses The safety profile of tramiprosate in AD patients across the two studies was favorable and similar in the APOE carriers and noncarriers. The main adverse events were gastrointestinal nausea vomiting and weight loss which were mild or moderate in severity. New ARIAE safety analyses were reported in the JPAD publication. Brain magnetic resonance imaging MRI evaluations in patients were conducted during the Phase studies and did not reveal any events of vasogenic brain edema ARIAE or amyloidrelated imaging abnormalitiesedema on either dose of tramiprosate. Vasogenic edema or brain swelling is a side effect observed in clinical studies with some injectable antiamyloid antibodies which requires MRI monitoring and can occasionally be serious. About Tramiprosate and the New Prodrug ALZ In Alzheon obtained the license to tramiprosate and the associated portfolio of drug compounds along with the historical clinical dataset and applied new insights to the existing data. This led to the development of an optimized oral amyloidtargeted drug candidate ALZ. Alzheon developed ALZ as a novel oral prodrug of tramiprosate designed to improve the pharmacokinetic and gastrointestinal tolerability profile while retaining tramiprosate as the active agent in ALZ. Phase studies in more than subjects including healthy elderly showed that ALZ provides consistent plasma levels of tramiprosate with very low intersubject variability. The rate of nausea and vomiting was also lower than with tramiprosate tablets. ALZ at the dose of mg provided equivalent systemic plasma exposures to tramiprosate mg tablets. Alzheon is advancing ALZ into pivotal Phase studies in the geneticallydefined APOE homozygous patients with Alzheimers disease. About Apolipoprotein E Apolipoprotein E or APOE is a gene that provides a predictive window into an individuals Alzheimers disease prognosis. APOE encodes for a protein called apolipoprotein E which combines with fats to form lipoproteins that can be moved throughout the body. In the brain apolipoprotein E helps shuttle cholesterol to neurons to support their normal function. There are three forms or alleles of the APOE gene called e e and e. The e allele has been found to correlate with high risk of developing Alzheimers disease. People who inherit one copy of the e allele APOE heterozygotes have an increased chance of developing the disease those who inherit two copies of the allele APOE homozygotes are at even greater risk and tend to have more aggressive disease. The e allele is significantly overrepresented in the Alzheimers disease population compared to the general population up to percent of Alzheimers patients carry one or two copies of the e allele compared to about percent of the general population. About Alzheon Alzheon Inc. is committed to developing innovative medicines by directly addressing the underlying pathology of devastating neurodegenerative disorders. Our lead Alzheimers clinical candidate ALZ is a Phase ready firstinclass small molecule oral inhibitor of amyloid aggregation and neurotoxicity hallmarks of Alzheimers disease. ALZ is a novel prodrug that builds on the safety and efficacy profile of the active compound tramiprosate which has been evaluated in clinical trials involving over Alzheimers patients. Our clinical expertise and technology platform is focused on developing drug candidates using a precision medicine approach based on individual genetic and biological information to advance therapies with the greatest impact for patients. Ward et al. Neuroepidemiology Sevigny et al. Nature Abushakra et al. J Prev Alz Dis . Advanced online publication http Aisen et al Arch Med Science Degenhardt et al. Psychosomatics Sperling et al. Alzheimers Dementia"

"A new study could change the way doctors treat patients at high risk for skin cancer https It doesnt involve any highpriced new pharmaceuticals the key may be an overthecounter vitamin supplement that costs less than a month. Researchers found that a form of vitamin B called nicotinamide could help reduce the chance of skin cancer https recurring in patients whove had it before. Another popular form of Vitamin B called niacin was not used in this study. For the study researchers in Australia looked at nearly people who had had at least two nonmelanoma skin cancers. They found patients who took vitamin B twice a day cut their chances of developing new skin cancers by percent. Thats a dramatic number Dr. David Agus director of USCs Norris Westside Cancer Center told CBS This Morning. It could make a major impact. Dr. Jae Jung a dermatologist at City of Hope cancer center in Duarte California agreed. If you can reduce the new skin cancer rates for these patients it would be an enormous benefit she told CBS News. How does it work Sunlights ultraviolet UV rays https can damage the DNA in skin cells https increasing the risk for skin cancer. Researchers say vitamin B gives skin cells an energy boost turns back on the immune system in Aguss words helping them repair the damage. Nearly million people are treated for skin cancer in the U.S. each year and the Skin Cancer Foundation says out of Americans will develop skin cancer in their lifetime https The two most common forms of the disease basal cell carcinoma and squamous cell carcinoma can usually be treated successfully. The most dangerous type melanoma occurs in about people in the U.S. each year and kills more than . One patient who could benefit from the vitamin treatment is Charity Wiese who has been diagnosed with skin cancer more than two dozen times in the last five years. She said shes had quite a few on the top of my head a few on the back of my head one behind each ear even though she tries to stay out of the sun. Wiese had leukemia as a teenager and underwent radiation therapy which put her at high risk for skin cancer later in life. Wiese thinks the vitamin study sounds promising. I am absolutely willing to try it and hope for the best she said. Doctors involved in the study are excited by their findings on vitamin B nicotinamide. Its safe its almost obscenely inexpensive and its already widely commercially available Dr. Diona Damian the senior author of the study and a professor of dermatology at the University of Sydney told HealthDay httpconsumer.healthday.comcancerinformationmiscancernewsvitaminsupplementmayhelppreventskincancer.htmlutm_expid.pIVhUrQRK_MJ_OqjLag.utm_referrerhttpAFFconsumer.healthday.comF. But she said more reserach is needed to see if everyone benefits from it. Its not something wed recommend at this stage for the general population Damian said. She also noted that the benefits appear to wear off when patients stop taking the supplements. Results of the study are being presented at the annual meeting of the American Society of Clinical Oncology later this month."

"Many migraine sufferers could have fewer less severe headaches if they took preventive medicines but few eligible patients do say doctors releasing updated treatment guidelines Monday. Not everyone with migraines needs prevention medicine. Not everyone with migraines needs prevention medicine. The guidelines list seven prescription medicines and one herbal remedy backed by strong evidence and include many other treatments that might work for some patients. Migraine is one of the most disabling conditions known to man but patients need to know that there is hope says Stephen Silberstein a neurologist at Thomas Jefferson University in Philadelphia and lead author of the guidelines from the American Academy of Neurology httpcontent.usatoday.comtopicstopicAmericanAcademyofNeurology and the American Headache Society. They were presented at an academy meeting and published in the journal Neurology. Medicines backed by the strongest evidence include antiseizure drugs divalproex sodium sodium valproate and topiramate blood pressure drugs metoprolol propranolol and timolol and for menstrualrelated migraines a medicine called frovatriptan the guidelines say. They also cite strong support for the herbal remedy butterbur and include a longer list of prescription and nonprescription therapies patients can consider. More about migraines Migraines are not ordinary headaches. They cause throbbing pain often on one side of the head and can come with nausea vomiting and sensitivity to light and sound. Visual disturbances or other warning signs called auras may precede the headaches. Migraines are three times more common in women than men. In some susceptible people stress bright lights lack of food or sleep hormonal changes or other triggers may play roles. Source National Institute of Neurological Disorders and Stroke These preventive treatments usually are used daily. The guidelines do not look at the options patients have once symptoms begin. Not everyone with migraines needs prevention medicine. But nearly have headaches that are so frequent at least once a week severe or hardtotreat that they qualify Silberstein says. Studies find that just to use the treatments. Why so few One reason is that its hard to persuade people to take medicines on days when they feel fine says Elizabeth Loder a neurologist at Brigham and Womens Hospital in Boston. Silberstein adds that some patients have not been properly diagnosed or made aware of their options. Still others try the treatments and decide they dont work or have unacceptable side effects. You have a lot of gunshy patients because of a lot of bad experiences says Michael John Coleman founder of the patient group MAGNUM also known as the National Migraine Association. Many spend months or years taking medicines that dont work and make them miserable he says. Thats what happened to Emily Guzan a lawyer from Pittsburgh who was diagnosed with migraine in . She was given a prescription for Topamax topiramate and it was a real nightmare she says. She kept having headaches bad enough to land her in an emergency room once a month and suffered nightmares an altered sense of taste an unwanted pound weight loss and memory problems all of which she attributes to the drug. She tried some other medications but for now shes given up on all of them and says shes getting better results with diet yoga and other lifestyle changes. Finding the right medication for the right patient can take a lot of trial and error and careful dosing Silberstein says. But about will get relief he says defined as a headache reduction of at least after trying three or four drugs alternative remedies and lifestyle changes. Even hardtotreat patients may eventually respond to something Loder says so she urges frustrated patients to keep trying. The life toll that poorly controlled headaches take is really underappreciated she says. You dont get back the time you lost at work or the time you lost with your children. Coleman of Alexandria Va. also urges fellow sufferers to keep working with their doctors His own migraines took years to control. This is not a cookiecutter disease and there is no magic bullet but there is hope."

"A vaccine https for breast https and ovarian cancer https that has spread to other parts of the body shows promise according to a preliminary study of patients. One woman who got the investigational vaccine https now has no Xray evidence of cancer says study researcher James Gulley MD PhD. In January it will be four years for her he tells WebMD. As exciting as that is he says a lot of work needs to be done to prove whether this can be effective for more patients. Gulley is director and deputy chief of the clinical trials https group at the Laboratory of Tumor Immunology and Biology National Cancer https Institute. Results of the vaccine were not as good in the other patients. For them the median time before the cancer https progressed was about two months. That time frame is not anything to write home about Gulley says. Overall however the limited success in some patients and the complete success in one is good news he says. It gives us encouragement that we may be on to something here. The study funded by the National Cancer https Institute is published in Clinical Cancer Research. Testing the Vaccine Gulleys team enrolled patients with breast cancer https and with ovarian cancer https They ranged in age from to . The patients had already undergone a variety of treatments but the cancer was progressing. Twenty one of the had undergone three or more chemotherapy https regimens. The patients received injections of the investigational PANVAC vaccine given monthly until the disease worsened. The vaccine targets two proteins mucin MUC and carcinoembryonic antigen https CEA Gulley says. Both are overexpressed in many cancer cells. The vaccine is designed to have your bodys immune system recognize and attack tumor cells making CEA and MUC Gulley says. The patient with no evidence of cancer had breast cancer https and was the youngest in the study at . The cancer had gone to her liver https and to her lymph nodes in her chest Gulley says. After the vaccine the cancer began to shrink. At months it was completely gone and remained gone. As far as we can tell there is no radiographic evidence of disease. Among the breast cancer https patients overall however the median time half more half less before the cancer progressed was . months. The median overall survival was . months. Four had stable disease defined as the cancer neither growing nor shrinking. Among the ovarian cancer patients the median time to progression was two months and the median overall survival was months. Three had stable disease. The followup was up to months. Side effects were mild Gulley says. Most common was a reaction at the injection site which was temporary. Two patients had musculoskeletal pain. One had anemia https Some got fevers https he says which were relieved with fever reducers. Interpreting the Findings The question is why did we see this result in one patient he says. All we can get from this trial are hints. The woman who remains diseasefree had a previous treatment with a different treatment vaccine. That might have primed her immune system Gulley speculates. She also had only one regimen of chemotherapy perhaps keeping her immune system stronger. Ideally the vaccine may need to be given earlier in the course of the disease he says. Further research should focus on predicting which patients would benefit most. The PANVAC vaccine is one of several cancer vaccines being studied. It is a therapeutic or treatment vaccine given after the disease occurs. Other cancer vaccines being studied are preventive or prophylactic. They are meant to prevent cancer in those who are cancerfree. Much more research is needed on the PANVAC vaccine for breast https and ovarian cancer Gulley says. Its difficult at this point to predict costs. However he expects costs will not approach those for Provenge the pricey treatment vaccine for prostate cancer https approved by the FDA in . Provenge costs for the onemonth threedose treatment. Medicare https covers it. PANVAC is an offtheshelf vaccine Gulley says. Its been developed at the National Cancer Institute. Its easier to make and logistically much simpler than the prostate cancer https vaccine which requires manipulation of the blood https with each patient. Second Opinion The study results show the promise and the frustration of developing therapeutic vaccines says Vincent K. Tuohy PhD professor at the Lerner College of Medicine and an immunologist at the Cleveland Clinic Lerner Research Institute. He is developing a preventive vaccine for breast cancer. He reviewed the study findings for WebMD. The encouraging observation from Gulleys study he says is the durable resolution of breast cancer in one patient. On the other hand he says the study shows the difficulty in prompting immune responses from patients whose cancer has spread and who have already had chemotherapy. There are many ways that mature tumors can turn off the immune response directed against them Tuohy tells WebMD. He agrees that the vaccine may work better in certain patients including those who have had fewer chemotherapy regimens and that giving the vaccine earlier is better."

"A study coordinated by the MUSC Health Weight Management Center shows the scales tipping in Weight Watchers favor instead of standard care when it comes to helping people with Type diabetes. Patrick ONeil Ph.D. directs the Weight Management Center and led the site study. Results were published November in the Obesity Journal. While the Weight Management Center has a high success rate at helping patients lose weight to fight diabetes many people with the condition dont live near a specialized program and need help thats readily available. ONeil said because Weight Watchers has centers all over the country including sites in small towns with limited or no medical facilities its program could help meet this need if combined with diabetesspecific counseling. Thats why he said it was important for MUSC to be involved in the study which was funded by a grant from the commercial weight loss program Weight Watchers. Promoting healthy communities is part of MUSCs mission. The multisite studys results were statistically and clinically significant ONeil said. The Weight Watchers people were significantly better off than people who received standard care. They achieved better control of their blood sugar and lost more weight he said. They still had diabetes but many were able to reduce the amount of medication they were taking. The studys participants were all overweight or obese and under a doctors care for uncontrolled Type diabetes. Half got standard care a session of nutrition counseling with a registered dietitian and written materials. The other half went to Weight Watchers meetings had access to Weight Watchers online materials and had two phone consultations and followup email contact with certified diabetes educators who told them how to modify the Weight Watchers plan to help with their diabetes. Participants had four followup visits related to the study and continued to see their regular doctors for medical management of their diabetes. After a year people in the Weight Watchers group had an average weight loss of about percent of their starting weight compared to percent for the standard care group. The Weight Watchers group also had a bigger improvement in a measure of longterm control of their blood sugar which can reduce the risk for serious problems related to Type diabetes. Left uncontrolled the condition can damage blood vessels and nerves putting people at risk of having a heart attack or stroke. It can also cause eye problems kidney damage and even lead to amputations. Risk factors for Type diabetes include Being overweight Not getting enough exercise Being or older Having a family member with Type diabetes Certain racial and ethnic groups are more at risk including AfricanAmericans and Hispanics. Unlike Type diabetes which is caused by an immune reaction Type diabetes develops over the course of years. So incremental improvements such as the ones seen in the MUSCled study are important. It wasnt a huge overwhelming difference ONeil said. But it was scalable meaning it could be applied to the whole population. The whole population of people with Type diabetes includes more than million Americans. Its by far the more common form of diabetes and can lead to about in medical costs. Diabetes is a growing problem. ONeil said the rate jumped from about percent to percent between and . Weight loss is seen as a good way to slow its progression. The MUSC Health Weight Management Center takes a scientific approach to weight loss focusing on changes in activity levels behavior thinking diet and support systems. ONeil said its important to help people not blame them. The Weight Watchers study is new evidence of what that help might include when it comes to a side effect of weight gain Type diabetes. You do have some power and control he said. You can lose some weight and lower your blood sugar and may even be able to change your medications. Thats no small feat in treating diabetes."

"Restaurants office parties potlucks meals while traveling theyre a minefield for people with celiac disease and gluten sensitivity who can suffer from stomach pain and upset swollen joints and other debilitating health problems when they ingest even a little bit of gluten. The maker of a new handheld glutendetecting device hopes to help make eating outside of a glutensensitive individuals https own kitchen safer and easier. The company SensorLabs has started taking preorders for the device it calls Nima which can test food for gluten and get rapid results said cofounder and chief technology officer Scott Sundvor. Nima is not FDAapproved and its not intended for medical use but the company intends it as a consumer tool to use when dining out Sundvor said. One of the things that we wanted to make sure we distinguish is that we dont see ourselves as a medical device Sundvor told CBS News. So we do not need FDA clearance for the device because we are not using it to diagnose or manage disease. Were simply providing a product to help people know whats in their food and guide their habits. Glutenfree diners can place a sample of food into a capsule or test pod and then insert the capsule into a black triangular device that basically acts like a mini chemistry test. In about two minutes Sundvor said Nima can tell if the food sample has parts per million or more of gluten. A smiley face means its OK a frowning face means it doesnt pass muster. As a point of reference the U.S. Food and Drug Administration requires manufacturers who choose to put a gluten free label https on food packaging to meet the same parts per million of gluten standard. Gluten is a protein found in wheat barley and rye. People with celiac disease experience an immune reaction when they eat gluten that can lead to intestinal damage and impact the health of other organs if its not managed well. It can cause stomach pain a swollen belly acid reflux diarrhea skin problems and other symptoms. The National Institute of Diabetes and Digestive and Kidney Diseases estimates that about in Americans has celiac disease but many people dont know they have the condition. Glutensensitive people experience similar symptoms to those with celiac disease and improve when they eliminate gluten from their diets https Nima is triangular and relatively dainty about three and a half inches tall by three inches wide and a little less than an inch thick. Small enough to fit into your pocket along with your keys and mobile phone or a small clutch said Sundvor. Nima was first conceived when Sundvor and company cofounder Shireen Yates met about two years ago and realized they both had gluten intolerance and other food issues. We met at MIT through mutual friends. She was getting her MBA and Id gotten my engineering degree from there. We had this shared experience Shireen has several food allergies and I also have several food intolerances. We both just had these issues where wed eat out and get sick or feel uncomfortable Sundvor said. Shireen had the idea Why cant I just test my food and figure out whats in it So we started talking about the idea and we researched the market and realized its something we could make happen. It costs to preorder a tester plus three onetimeuse pods and . for a refill pack of pods prices will increase later this month according to the companys website. The company plans to deliver the product by the middle of next year after theyve tested it more thoroughly Sundvor. Marilyn Grunzweig Geller chief executive officer of the Celiac Disease Foundation said she is not familiar with the new glutensensing device and was unable to comment on it directly. Certainly an FDAapproved device that could help people determine if they were accidentally ingesting gluten could go a long way to helping people and would be useful. However she adds I would never comment on a device thats not FDAapproved. She said shes anecdotally aware of a number of treatments for celiac disease and has heard of gluten sensors but is skeptical. As for Nima Sundvor said Were doing a huge amount of testing and one thing we want to be sure of before we start shipping is that were . percent accurate. He said they have received Nima prototypes and he and his girlfriend who has celiac disease are already trying it out. The company also aims to create similar versions that could test for peanut and dairy allergens among other problematic ingredients. A Nima app is in the works too that he says will let users share information about restaurants and log their results."

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

"Americans suffering from muscle pain are used to taking a pill or rubbing in a cream to help soothe their aches. But a new form of pain relief seems to be catching on analgesics delivered through a medicated patch placed directly where it hurts. The U.S. Food and Drug Administration approved the countrys first overthecounter painrelieving transdermal patches in . But the patches marketed under the brand name Salonpas are nothing new. Theyve been sold in various countries in Asia since the s according to their manufacturer the Japanese firm Hisamitsu Pharmaceutical. Salonpas is the Western world catching up with Asia said Dr. Rick Rosenquist a professor of anesthesia and director of pain medicine at the University of Iowa Carver College of Medicine and chairman of the American Society of Anesthesiologists committee on pain medicine. If you are an Asian kid youve had these placed on you since time immemorial he said. Its just now starting to hit more mainstream in the United States. Theyre gaining more acceptance. Before the FDA action painrelieving patches were available in the United States only by prescription said Dr. John Dombrowski director of the Washington Pain Center in Washington D.C. Their active ingredients include such medications as lidocaine capsaicin and nonsteroidal antiinflammatory drugs or NSAIDs. The active ingredients in Salonpas are methyl salicylate and menthol common components of painrelieving gels and creams such as Bengay. Pain patches have a number of benefits Rosenquist and Dombrowski said not the least of which is convenience. With a patch you put it on and forget about it rather than having to remember to take pills Dombrowski said. The patches also deliver their medicine directly to the site of a persons pain. This may eliminate some of the side effects that come with taking pills. For instance some analgesics are likely to cause an upset stomach unless theyre taken with food. Obviously patches get around that he said. Its a very clever way of getting the medications right where they need to be. And because patches release their medication slowly into the body through the skin people also should get more consistent pain relief than they do with pills. On the other hand people have to be sure to carefully follow instructions for using the patches to avoid overdose. The main downside to pain patches however apparently comes from their effect on the skin. Some people may find themselves allergic to either the active ingredient in a patch or the adhesive used to keep the patch on the body. You need to pay attention when you put them on to see if you have any kind of skin reaction to the compounds that are contained in the patch Rosenquist said. Both doctors said that they expect more overthecounter pain patches to hit the market if the popularity of Salonpas continues to grow. Future overthecounter options they predicted could include reduceddosage versions of the NSAIDdelivering patches now available through prescription. Success begets success Dombrowski said. If this does very well other drug companies will say I want a piece of this action. More information The U.S. National Institute of Neurological Disorders and Stroke has more about pain http_paindetail_chronic_pain.htm. SOURCES Rick Rosenquist M.D. professor anesthesia and director Center for Pain Medicine and Regional Anesthesia Carver College of Medicine University of Iowa Iowa City Iowa John Dombrowski M.D. director Washington Pain Center Washington D.C."

"Targeted magnetic pulses to the brain were shown to reduce craving and substance use in cocaineaddicted patients. The results of this pilot study published in the peerreviewed journal European Neuropsychopharmacology suggest that this may become an effective medical treatment for patients with cocaine addiction although a larger trial is needed to confirm the initial findings. Cocaine use is widespread in the Western World. Last year . million young Europeans aged to used cocaine and the US National Institute on Drug Abuse estimates that . million Americans suffer from cocaine addiction. There is no effective drug treatment for cocaine addiction with behavioural therapies being the main element of any treatment regime. Now a group of researchers working in Italy and the USA have shown in a preliminary clinical study that cocaine use can be reduced by treatment with rTMS repetitive Transcranial Magnetic Stimulation. As author Dr Antonello Bonci Scientific Director National Institute on Drug Abuse and Adjunct Professor John Hopkins University Baltimore said Despite the fact that more than million people worldwide suffer from cocaine use disorders there are no effective neurobiological treatments for patients with this devastating condition. The practical work was conducted by team of scientists led by Dr Luigi Gallimberti from the University of Padova Medical School Italy who enrolled patients who were seeking treatment for cocaine addiction at the hospital clinic. The participating patients were randomized to receive either rTMS or standard symptomrelieving medications. The experimental group received one rTMS session per day for five days and then once a week for the following three weeks for a total of TMS sessions over days. Those in the control group received pharmacological treatment for symptoms associated with cocaine addiction such as depression anxiety and sleep problems. The study indicated the safety of rTMS in patients with cocaine addiction. There was significantly less craving and there were a significantly higher number of cocainefree urine drug tests in the rTMS compared to the control group. In addition patients in the experimental group showed no relapse to cocaine use whereas only patients in the control group showed a similar positive result the results are adjusted for patients who dropped out of the trial. Dr Bonci said rTMS is a noninvasive and very safe therapeutic approach which is used with other mental health and neurological conditions such as depression and neuropathic pain. Our study suggests that rTMS may also represent a new treatment for patients with cocaine use disorder. At the end of the first days of the experiment the experimental group was given the option of continuing the treatment whereas those in the control group were given the possibility of receiving the same rTMS treatment as the experimental group for days. Results further confirmed the beneficial effects of rTMS in helping patients to maintain abstinence from cocaine. Dr. Bonci continued We consider this study promising but preliminary. We need to replicate the work in a bigger group of patients using shamTMS as the control condition. As far as we know this work represents the first clinical report indicating that rTMS treatment results in significant reduction in cocaine use. It is also important to emphasize that in this study patients were seeking treatment for their cocaine addiction in a hospital setting the group studied albeit small was a real world sample. We have continued to follow patients from the trial and the improvement seems to be sustained over time up to months although we dont have any hard data on that yet. It is important that this is taken forward to a larger trial. We decided to target an area of the brain involved in decision making the dorsolateral prefrontal cortex DL PFC. This was because previous animal studies from our lab had shown that compulsive cocaineseeking was associated with hypoactivity in the prelimbic cortex which is a brain area that shares similar behavioural roles to the DL PFC. Importantly we had found that increasing the activity in the prelimbic cortex could significantly reduce cocaine selfadministration. Commenting European Neuropsychopharmacology editor Dr Andreas MeyerLindenberg Mannheim said This study represents a creative approach to a disorder that is notoriously difficult to treat in the real world. These pilot data also show that biological treatments nowadays reach far beyond medications and that new neuroscience methods may be used for targeted changes in brain regions relevant for complex mental disorders."

"This story is part of an occasional series http As more women postpone motherhood into their s even s theyre hitting that ageold constraint the biological clock. Now technology is dangling the possibility that women can stop that clock at least for a while. In a Manhattan office building on a recent evening two dozen women all in their s and s sit in folding chairs balancing cellphones and glasses of wine. Theyre gathered for a seminar called Take Control of Your Fertility. Dr. Alan Copperman of Reproductive Medicine Associates of New York http wastes no time laying out this harsh reality By the time a woman hits her s percent of her eggs are abnormal. The chances of a typical yearold getting pregnant in any given month Ten percent. Unless that is she gets pregnant with her younger eggs eggs she had frozen years before. Copperman explains the procedure introduces someone who has gone through it and takes a flurry of questions. Afterward women crowd a counter to set up appointments with Coppermans clinic which offers egg freezing. Sally Montgomery is among the youngest here and the most upbeat. Her mom had trouble conceiving so she wants to be proactive. Article continues after this message from our sponsor Im your typical New Yorker she says. Im single Im bouncing around and Id like the opportunity to have a family so I just figured Why not I dont think its a guarantee but its a nice insurance policy and I think it takes some of the pressure off. Others though slip out quietly. One yearold says she wishes shed learned about egg freezing earlier. Esther Montoro a yearold photographer looks a little stunned. I think its fantastic she says but I think its so incredibly expensive. The whole process a week of hormones plus the procedure to collect the eggs runs to . And because it takes to eggs for a reasonable shot at success some may need to do this several times. Plus there are annual storage fees. Then when youre ready to use your eggs youll need in vitro fertilization another pricey procedure. All told costs can easily exceed money Montoro doesnt have. I guess theres a big assumption that most women that need to do this are career successful rich women she says. And Im not Technological Advances In his office later Copperman empathizes and says he hopes the procedure eventually becomes easier and cheaper. Still he says freezing eggs offers many women the biggest game changer since the birth control pill years ago. Women began to have reproductive choices he says. They got to decide when not to get pregnant. This technology has the potential to help women decide when they can get pregnant. Clinics in the U.S. have long frozen fertilized eggs or embryos. But eggs alone are more delicate and prone to damage. Over the years egg freezing has been offered mainly to cancer patients facing radiation but success rates were pretty dismal. Of late though the technology has exploded thanks to scientific leaps including a flashfreeze method called vitrification. In Coppermans lab you can hear the sizzle as a tiny tube is plunged into liquid nitrogen. Snap freeze snap thaw he says. And whats really impressive is that when it comes out it comes out looking just like it went in. Ironically much of this research was pioneered in Italy and Spain where Catholic influence discouraged the creation of too many embryos leaving fertility researchers with unused eggs instead. With the better survival rate from vitrification and other new freezing methods more and more clinics are now offering what they call fertility preservation. Meanwhile the early adopters are starting to come back and use their eggs. First Wave Of Babies In a New York high rise monthold Camden squeals in delight as she bounces in her walker. Shes here thanks to eggs her mom froze several years ago. My best friend and I made a pact together that at age if we were both still single we were going to have a child on our own says Robyn Ross. When that time came Ross decided she wasnt ready for single motherhood. Instead she froze eggs. Within a year she fell in love and soon got married. Her husband Mark Cohen says he wasnt at all put off by the fact that his new love had her eggs in the freezer. As it turned out his sperm was weakened by earlier cancer treatment so conceiving their baby in a lab was the perfect solution. And this is our miracle baby Cohen says planting a kiss on Camden. We are one little happy family. Ross has already evangelized to her younger sister. I made her promise me that if shes still single by the age of she would freeze her eggs she says. The younger the better. Now before you run out to a fertility clinic there is a big note of caution. The Society for Assisted Reproductive Technology http which sets industry guidelines still considers egg freezing experimental. If the question were just Does egg freezing and thawing work to achieve a pregnancy I think were close says Dr. Eric Widra a member of the societys executive council. But only to babies in the world have been born using frozen eggs. So far theyre fine no abnormalities. Still Widra would like a largerscale longerterm track record. Its not clear when or if a bigscale study might happen. But Widra says women need to understand that success rates will never be percent. Its an insurance policy that you may or may not actually ever need he says. And its an insurance policy that if you do need may not pay out. And yet even Widra agrees that egg freezing has appeal if it can help avoid the anguish of infertility. At Shady Grove Fertility http the Washington D.C. clinic where he practices he offers it to his own patients. The Challenge Of Setting An Age Limit Its quite a concept Put your eggs in deep freeze and disconnect from that nagging biological clock. But until when How old is too old to use your younger eggs There should be guidelines I think that are more clearly defined says Dr. Geoffrey Sher who heads the Sher Institutes for Reproductive Medicine httphaveababy.com and is based in Las Vegas. He says many clinics suggest a cutoff of the average age of menopause. After that pregnancy can be riskier and the large age gap raises complicated social issues. But the limit is tricky to impose. Sher remembers one couple who wanted to use donor eggs to conceive. The husband was his wife . Sher hesitated. And she said Thats discriminatory. If my husband was my age and I was his age you wouldnt hesitate. And she had a point Sher says. The woman was healthy. And the uterus doesnt decline like eggs do in some cases it can actually be coaxed back into working order. Shers ethics board said OK. And she went ahead and had a baby at years of age without any problems whatsoever Sher says. I get a postcard from them at Christmas every year. The bigger challenge Sher and others say is reaching out to younger women getting them to take action before its too late. They envision a time when society considers freezing eggs an act not of desperation but of empowerment. This story was produced for broadcast by Marisa Penaloza."

"Merck KGaA said that its immunotherapy Bavencio jointly developed with Pfizer delayed the progression of kidney cancer when used in combination with Pfizers Inlyta drug in a latestage study. The drug combination led to longer progressionfree survival in patients with advanced renal cell carcinoma RCC when compared with a control group on older Pfizer drug Sutent the German drugmaker said in a statement on Tuesday. The trial will continue to show whether Bavencio plus Inlyta also prolongs patients lives. While the company said the benefit was statistically significant they did not specify the duration of progressionfree survival. A detailed analysis would be submitted for presentation at a medical congress it added. Reporting by Ludwig Burger Editing by Maria Sheahan Our StandardsThe Thomson Reuters Trust Principles httpthomsonreuters.comenaboutustrustprinciples.html"

"U.S. researchers are closing in on an accurate test for autism a finding that could lead to earlier diagnosis and treatment. An autistic child peers from between curtains at the Consulting Centre for Autism in Amman March . REUTERSAli Jarekji The test which uses conventional magnetic resonance imaging or MRI machines detected percent of individuals with a highfunctioning form of autism they reported on Thursday. These results are the best yet in the search for a biological basis in terms of being able to distinguish those with and without the disease said Nicholas Lange of Harvard Medical School who directs the Neurostatistics Laboratory at McLean Hospital in Belmont Massachusetts. He said the findings published in the journal Autism Research were very preliminary but if confirmed in several more and larger studies they might replace current subjective tests now used to diagnose the disorder. And he said they might also lead to better management and treatment of people with autism a complex and mysterious brain disorder usually first diagnosed in early childhood. Autism is characterized by difficulties in social interaction communication and understanding other peoples emotions and behavior. For the study researchers at McLean and a team led by Dr. Janet Lainhart the University of Utah used an MRI that was tuned to pick up microscopic features of the brains wiring a technique known as diffusion tensor imaging. You dont need any fancy equipment. This is performed around the world Lange said in a telephone interview. The team did scans of this type on the brains of people with autism and people without. They found that the brain circuitry is significantly different in those with autism compared to people with normal brain function specifically in areas of the brain that are engaged in language and social and emotional functioning. By measuring six aspects of the brains circuitry the test was able to correctly pick out people who had been diagnosed with autism with percent accuracy. A repeat study using two different sets of subjects showed the same high level of performance. Lange said the findings should help make the process of diagnosing autism more scientific because it would rely on a test rather than a subjective assessment. And it may also offer an early diagnosis which could help affected children get earlier intervention when it is most likely to do some good. The basis of autism in the brain is very deep. There may be very little that one can actually change about the disorder for an individual with a severe case Lange said. However it has been shown that in the early stages of development individuals have been aided by intense oneonone caring to help them with language social function with their peers and also with emotional problems he said. Autism disorders are diagnosed in one in children in the United States and affect four times as many boys as girls. Editing by Cynthia Osterman Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"An experimental drug appears to reduce the risk of bone fractures in postmenopausal women with osteoporosis better than a placebo and the currently available drug a new study finds. In this phase trial funded by the drugs maker Radius Health fewer women on the injectable drug abaloparatide had spine fractures . percent than women receiving a placebo . percent and slightly fewer than those taking a similar injectable drug teriparatide Forteo . percent. If this gets approved and there is no reason to think it wont this will be the second drug available for the treatment of highrisk osteoporosis said lead researcher Dr. Paul Miller of the Colorado Center for Bone Research. Forteo has been in use for the past years he said. Abaloparatide works differently from Forteo and improves bone density more than Forteo Miller said. Women taking abaloparatide also had fewer other types of fractures . percent than those who got a placebo . percent and slightly fewer than those on Forteo . percent the researchers found. Miller said many spine fractures are painless. Patients are often unaware they have happened until a doctor measures their height and finds they are up to an inch shorter than before he said. Abaloparatide and Forteo are synthetic peptides that help grow and strengthen bone Miller said. Along with building bone density they are the only ones that increase bone quality he said. Bone quality is an important aspect of bone strength the ability to withstand a break Miller said. He predicts that when abaloparatide is on the market it will compete with Forteo driving down the price of both drugs. I am hoping that having a second drug available that it will help reduce the cost he said. Forteo costs about a month if you dont have insurance. Even if a patient is insured monthly copays can range from to . Forteo is covered by Medicare Miller said. The report was published Aug. in the Journal of the American Medical Association. A study based on U.S. Census data estimated that more than million women between the ages of and have osteoporosis. A yearold woman has a percent lifetime risk of fracture due to low bone density. For the study Miller and colleagues randomly assigned nearly postmenopausal women with osteoporosis to receive daily injections of abaloparatide Forteo or a placebo for months. Their average age was . Among the nearly women who completed the trial increases in bone mineral density were greater with abaloparatide than placebo the researchers found. In addition fewer cases of hypercalcemia abnormally high levels of calcium in the blood occurred among women taking abaloparatide percent than Forteo percent. Hypercalcemia can weaken bones cause kidney stones and interfere with heart and brain function. There were no differences among the groups in other serious side effects such as nausea and heart palpations Miller said. Dr. Caroline Messer director of the Center for Pituitary and Neuroendocrine Disorders at Lenox Hill Hospital in New York City is eager for further research. There needs to be a large headtohead trial between Forteo and abaloparatide she said to really see which drug is better. Everybody is going to want to know if this is inferior or superior to Forteo she said adding that this is an early study. It shows more bone building and fewer fractures than Forteo but whether it will replace that drug is still up in the air. An editorial accompanying the study said which drug is selected may be less important than identifying and starting an approved treatment. The bar is high for any preventive treatment in the efforts to prevent a fracture that may or may not ever occur prescribers do not want to prescribe a therapy that causes a new problem. The way forward for fracture prevention involves not only the development of better therapies . . . and easier delivery systems but also improved adoption of existing osteoporosis therapies for patients with prior fractures and minimization of adverse effects particularly those associated with longterm use the editorial said. The editorial was cowritten by Dr. Anne Cappola of the Perelman School of Medicine at the University of Pennsylvania Philadelphia associate editor of JAMA and Dr. Dolores Shoback of the University of California San Francisco. More information To learn more about osteoporosis visit the American College of Rheumatology http SOURCES Paul Miller M.D. Colorado Center for Bone Research Lakewood Colo. Caroline Messer M.D. director Center for Pituitary and Neuroendocrine Disorders Lenox Hill Hospital New York City Aug. Journal of the American Medical Association"

"The patient turned over the summer and was already having symptoms that made her neurologist wonder whether she had Alzheimers disease the deadly mindkilling dementia that usually attacks far older people. She and her husband went to the Adler Institute for Advanced Imaging in Jenkintown on a recent morning after tests over the last year failed to explain her worsening symptoms. She was going to try yet another a newly approved test developed by a Philadelphia biotech firm. It uses a PET scanner and a radioactive tracer Amyvid that binds to amyloid one of the hallmark proteins that accumulate in the brains of Alzheimers patients. Until recently the only sure way to know whether people had Alzheimers was to examine their brains after death. The Food and Drug Administration approved the test in April. It is both a sign of the future of dementia treatment enabling doctors to identify people at risk for a dread disease even before they have symptoms and an example of the challenging economic and medical issues new technology so often raises. The test is costly and possibly confusing. There is now no good longterm Alzheimers treatment. The diagnosis could subject patients to discrimination by employers and insurers let alone intense anxiety. Claudia Kawas a geriatric neurologist at the University of California Irvine said a patient strode into her office soon after the FDA approved the procedure and asked for the Alzheimers test. In one hand he held an article about the approval of Amyvid. In the other he had a document from a righttodie group. If the test was positive he told her he would get his affairs in order and kill himself within days. Although she thinks the test can be useful she was glad her center didnt have it. She says she wouldnt have it done on herself though shes noticing some memory changes. The information I think wouldnt help me in any way she said. The Adler patient who asked that her name not be used is a former college English major who is having trouble finding words thinking clearly and understanding even slightly complicated reading material. On a recent shopping excursion her sister found her wandering aimlessly. Shes having memory spatial and balance problems and has given up driving. Alzheimers would be unusual at her age but an earlier PET scan showed a pattern suggestive of the disease. The new test would support that diagnosis or rule it out. The patient and her husband who met on her st birthday and became engaged six weeks later want to know what to tell their children how to face their future however bleak it may be. Still the woman hoped their search for a diagnosis would not end with this test. Alzheimers at this age is a pretty scary endeavor. Radiologist Lee Adler told her the test which combines a CT and PET scan would take about minutes. She had to lie perfectly still on a table her head immobile between two wedges. It would be quiet. Adler who began doing the test as part of research in told her the absence of amyloid would mean she didnt have Alzheimers. Its presence is more complicated. Some people with amyloid in their brains think normally. Some may be at higher risk for Alzheimers but its too soon to know whether amyloid is a sign of what experts are calling preclinical disease. Patients with mild cognitive impairment often a precursor to dementia along with amyloid deposits may be at higher risk. We can exclude the diagnosis Adler said but not make it. The woman climbed onto the scanner and waited for the test to begin. Rajan Agarwal an Abington Memorial Hospital radiologist did the countrys first three commercial Amyvid scans in June and has had no referrals since. Adler also has done three. Though doctors think the test can be a blockbuster PETNET a Siemens subsidiary that distributes the tracer said it had made commercial doses for this region since June. The tracer is made individually for each patient on test day at sites around the country then delivered within a hour radius. In this region its mixed in North Wales. Lack of coverage for the test is the biggest barrier to it here. Medicares decision on coverage which often sets the standard for private insurers is due by July. Doctors dont know what causes Alzheimers. Amyloid and tau in the brain are the proteins that define the diagnosis but its still unclear whether amyloid causes symptoms or defends against the disease. Drugs that target it have been disappointing so far. Doctors say Amyvid is likely to be most useful when people have symptoms but the diagnosis is uncertain. It would help doctors decide between say Alzheimers and frontotemporal dementia. Negative Amyvid results can spur doctors to seek other explanations and avoid prescribing useless drugs that have side effects. Recent studies involving Amyvid which is made by Avid Radiopharmaceuticals an Eli Lilly Co. subsidiary have shown that a surprising number of patients thought to have Alzheimers didnt. A paper in the October issue of Annals of Neurology noted that of patients diagnosed with Alzheimers by expert physicians had negative PET scans for amyloid. One emerging lesson said Jason Karlawish an Alzheimers expert at the University of Pennsylvania is that Alzheimers may be more than one disease or variant. In an article published in the fall in the journal Alzheimers Dementia a group of international experts who gathered at Penn over the summer said other biomarkers were being tested in clinical trials from imaging compounds to analyses of blood and cerebrospinal fluid. Laws prohibiting the use of biomarkers in insurance or employment decisions may also be in order until their clinical value is fully understood they said. For now one of the most obvious benefits of biomarkers is that they can help researchers put patients in the right clinical trials. That raises the odds that a drug meant to treat Alzheimers is being tested on people with the disease. Dementia experts know changes associated with Alzheimers begin decades before its diagnosed. When there is a treatment it almost certainly will make sense to start early before the disease causes extensive brain damage. Then demand for tests like Amyvid will skyrocket. The race is on here between the biomarkers and the therapeutics said Rise Sperling a Harvard University Alzheimers expert. In Jenkintown Adlers patient emerged from her scan. It was lovely she said. Adler told the couple he could see that the womans brain had not atrophied. Good news. Later the patient who did not want her name used until she knows whats wrong with her learned the test had been negative. Shes left with the mystery but glad to rule out Alzheimers. Its actually a relief she said because that would have been the worstcase scenario."

"A yearold heart patient with dangerously high levels of cholesterol that could not be adequately reduced by statin drugs now has nearnormal cholesterol levels thanks to a new class of drugs that grew out of work done by UT Southwestern Medical Center researchers. Two of these drugs in a category known as PCSK inhibitors were approved by the Food and Drug Administration last summer for use by some individuals with extremely high cholesterol levels. If you take the core patients who are at highest risk it makes you appreciate how important this drug class is said Dr. Amit Khera httphttpprofiles.utsouthwestern.eduprofile Director of the Preventive Cardiology Program and Associate Professor of Internal Medicine at UT Southwestern. Frank Brown of Dallas grandfather of six and the owner of Franks Wrecker Service in Dallas has familial hypercholesterolemia an inherited condition that causes high levels of cholesterol especially lowdensity lipoprotein LDL cholesterol or bad cholesterol. High levels of LDL cholesterol are strongly associated with heart disease. Mr. Brown with a history of two heart attacks had been aggressively treated with multiple drugs to reduce his cholesterol levels but they remained stubbornly high. When I first met Mr. Brown he had a strong family history of heart disease he had a cholesterol level that was ridiculously high with an LDL of and he was having chest pains said Dr. Amit Khera who is Mr. Browns cardiologist. Dr. Khera who holds the Dallas Heart Ball Chair in Hypertension and Heart Disease at UT Southwestern was treating Mr. Brown with three cholesterollowering medications a statin which is a class of drugs that works by blocking a substance the body needs to make cholesterol ezetimibe a drug that blocks absorption of cholesterol in the intestine and colesevelam which sequesters bile acids. Even with this trio of medicines Mr. Browns LDL cholesterol level hovered around . The two PCSK inhibitors approved by the FDA last year were developed as a result of research done by UT Southwestern geneticists Dr. Helen Hobbs httphttpprofiles.utsouthwestern.eduprofile and Dr. Jonathan Cohen httphttpprofiles.utsouthwestern.eduprofile. Using data from the Dallas Heart Study a populationbased study that gathered extensive medical data on Dallas residents the two researchers showed that certain mutations to the gene that codes for the protein PCSK lead to low levels of cholesterol in the blood. FurtherDr. Hobbs and Dr. Cohen found a woman who had inherited not one but two of these mutations in the PCSK gene one mutation from each parent. This woman had stunningly low levels of LDL cholesterol. While anything below is considered good her LDL cholesterol level was just . Crucially this woman was in good health suggesting that therapies aimed at blocking PCSK would not only be effective but also safe. Their research led to the development by drug companies of evolocumab and alirocumab the two approved PCSK inhibitors which are delivered by monthly or semimonthly injections. Dr. Hobbs Director of the Eugene McDermott Center for Human Growth and Development holds the Eugene McDermott Distinguished Chair for the Study of Human Growth and Development the Philip OBryan Montgomery Jr. M.D. Distinguished Chair in Developmental Biology and the Dallas Heart Ball Chair in Cardiology Research. Dr. Cohen Professor of Internal Medicine and with the McDermott Center holds the C. Vincent Prothro Distinguished Chair in Human Nutrition Research. Mr. Brown had been part of a clinical trial testing the safety and effectiveness of one of the new PCSK inhibitors and when the drugs were approved Dr. Khera began working to get Mr. Brown approved by his insurance to be on the new regimen. In the world of cholesterol patients most are wellcontrolled with statins and they should stay on those said Dr. Khera. But Mr. Brown is the perfect patient for PCSK inhibitors. We knew he could tolerate it because hed been in a clinical trial he knew how to administer the injections and he was very highrisk. Wed exhausted the other options in trying to control his cholesterol. Two months after he started his biweekly injections of the new drug Mr. Browns LDL cholesterol level was down to not quite normal which is or less but an almost percent reduction from the level it had been for years. Its a good sign for Mr. Brown who looks forward to many more years of running his business watching Dallas Cowboys games and spending time with his grandchildren. There are many more Frank Browns out there patients who cant control their cholesterol with the standard drugs said Dr. Khera. Its wonderful to have this option to offer this special set of patients. About UT Southwestern Medical CenterUT Southwestern one of the premier academic medical centers in the nation integrates pioneering biomedical research with exceptional clinical care and education. The institutions faculty includes many distinguished members including six who have been awarded Nobel Prizes since . The faculty of almost is responsible for groundbreaking medical advances and is committed to translating sciencedriven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in about specialties to more than hospitalized patients and oversee approximately . million outpatient visits a year. This news release is available on our home page at http To automatically receive news releases from UT Southwestern via email subscribe at http"

"Tammy Wade knew she had to try something else to lose weight when she stepped on the scale and saw the number pounds. Wade of McCalla Ala. is only feet inches tall. She had tried everything. Nothing worked. I had problems with my feet and ankles and they were saying I was borderline diabetic Wade says. Im like well I gotta do something you know. So I needed really did need to lose the weight. So Wade volunteered to help test Qnexa http an experimental drug pending before the Food and Drug Administration. She quickly noticed a big difference. I didnt feel ravenous and I didnt want to snack all day long she says. Over the next year Qnexa http Wade slowly drop about pounds and keep it off for another year. It makes you feel so much better Wade says. Your back dont hurt your feet dont hurt. But the FDA rejected Qnexa http in because of concerns about side effects especially possible heart problems and birth defects. Article continues after this message from our sponsor FDA Briefing Documents Released Update Feb. a.m. The FDA posted a page review of the possible risks and benefits of Qnexa on the agencys website http The review noted continued concerns that Qnexa can increase the risk for several possible side effects including increased heart rate birth defects and thinking problems such as memory lapses and confusion. But the agency also noted Qnexa does appear to help many people lose at percent of their body weight In addition it was somewhat reassuring that the drug also appears to produce some health benefits beyond weight loss including lower blood pressure. Among the questions the agency plans to ask an advisory committee meeting Feb. to review the drug is whether Vivus Inc. which makes Qnexa should conduct a study better assessing the drugs affect on the heart before the drug is approved. In its own page review Vivus called Qnexa a significant advancement in the medical treatment of obesity and detailed the potential benefits of the drug. The company also outlined a plan to minimize the chances that women of childbearing age would take it. Qnexas rejection came amid a flurry of failed attempts by drug companies to win approvals of new weightloss drugs. The setbacks put a spotlight on how the FDA handles these drugs. Even though obesity is at epidemic levels the FDA hasnt approved any new weightloss medicines since . We have twothirds of all Americans who are overweight or obese and the costs are nearing billion a year says Christine Ferguson http a health policy professor at George Washington University. The sheer magnitude of the problem really requires us to address it more aggressively and thoughtfully than we have. Ferguson has been helping to organize a series of meetings involving public health experts antiobesity advocates government officials and others to try to figure out what the FDA should do. We actually have this huge gap says Joe Nadglowski http of the Obesity Action Coalition who has been participating in the meetings. We go from Weight Watchers to bariatric surgery. And the fact that there isnt ... medical treatments for obesity including pharmaceuticals really is a challenge considering how big the problem is in this country. Part of whats going on is that the FDA has gotten a lot more cautious about approving new drugs in general after some serious drugsafety problems such as heart problems linked to the painkiller Vioxx. The FDA has been especially tough on weightloss drugs because of previous problems with those drugs such as the diet drug cocktail fenphen. Theres been a long history with obesity drugs that weve had to take off the market. You recall the fenphen episode where a significant number of people got heartvalve defects says Janet Woodcock http a top FDA official. Woodcock argues that the agency has to be extracareful with weightloss drugs because chances are it wont just be obese people taking them. When youre talking about a drug where it could go into literally tens of millions of Americans there has to be attention to safety Woodcock says. What might look like a rare problem now could turn into another public health disaster she says. But some say the agencys aversion to accepting any risks is outdated. They say the FDA wrongly still tends to view weightloss drugs as diet pills something frivolous and used primarily for cosmetic purposes. We are not talking about medications to help someone lose five pounds to fit into their prom dress or wedding dress. Were talking about medications to help those who are struggling with the health impact of obesity Nadglowski says. So Nadglowski and others are pushing the FDA to take into consideration whether the risks of new drugs may be outweighed by their benefits beyond weight loss such as reducing the risk for heart disease diabetes and other complications of obesity. Woodcock says officials realize they may have to think about things differently. As the FDA works through this many are watching how the agency handles Qnexa. An FDA advisory panel is scheduled to review Qnexa again on Feb. . Barbara Troupin of Vivus http the company that is developing Qnexa says the drug appears to do a lot more than just help people lose weight. We see decreases in blood pressure. We see decreased rates of progression to diabetes. We see improvements in sleep apnea. We see improvements in quality of life. Pretty much all of our data shows significant benefits she says. Vivus hopes the FDA will agree that those benefits will outweigh some of the risks including the concerns about birth defects. The company is submitting new data it says show that the risk is lower than had been feared. Vivus also has a plan to minimize the chances that pregnant women will take it. Some see Qnexa as a test of the FDA trying to recalibrate how it weighs risks and benefits for weightloss drugs. For her part Wade just wants to be able to start taking it again. Shes gained back half of the weight she lost. I need to lose more pounds again she says. And I need the help."

"Menstrual cramps are the bane of many women but new research suggests that a form of vitamin D may one day be added to the meager list of pain relievers for the sometimes disabling condition. A small study in Italy found that a single high dose of cholecalciferol also known as vitamin D was linked to a marked reduction in menstrual cramps with the largest benefits observed in women reporting the most pain at the beginning of the study. U.S. experts cautioned that its too early to recommend vitamin D to those experiencing cramps estimated to occur in at least half of all reproductiveage women because the study didnt delve into possible longterm risks of taking high doses. Its provocative in the fact that the results are pretty amazing said Dr. Robert Graham an internist and vitamin D expert at Lenox Hill Hospital in New York City. But the dose given is a lot more than conventionally given for any condition. The study was published Feb. in the Archives of Internal Medicine. In the study Italian women were split into two groups one receiving a single oral dose of IUs of vitamin D and the other getting a placebo five days before the expected start of their menstrual periods. After two months average pain scores dropped percent for women assigned vitamin D treatment while no difference in pain was reported in the placebo group. Also the women who took vitamin D reported no need to use nonsteroidal antiinflammatory drugs NSAIDS such as the pain reliever ibuprofen to manage their pain in the twomonth study period while percent of those assigned to placebo reported using an NSAID at least once. Menstrual cramps known by the medical name dysmenorrhea typically begin just before or at the start of a womans menstrual period and can last several days. Experts attribute the pelvic pain to prostaglandins a hormonelike substance that contributes to the contraction and relaxation of muscles and blood vessels. Vitamin D apparently helped hamper prostaglandin production in study participants easing their pain said Dr. Jill Rabin chief of obstetrics and gynecology at Long Island Jewish Medical Center in New Hyde Park N.Y. The vitamin is also known to have antiinflammatory effects Rabin added. The bottom line is it looked like it worked said Rabin also head of urogynecology at the hospital. It was a very welldone study but my comment is it was one study. It asks more questions than it answers which is the sign of a good trial. The IU dose of vitamin D given in the study also far exceeds the daily intake of IUs recommended for American women of reproductive age both Graham and Rabin said. And since the study period lasted only two months there was no way to tell whether such a high dose produced any toxic longterm effects. Currently used methods of controlling menstrual cramps include NSAIDs and among those with severe pain birth control pills. But both have potential risks NSAID users can experience stomach or kidney troubles for example while birth control pills are linked to blood clots in certain women. The cost of vitamin D supplements would be roughly comparable with both of these remedies. Vitamin D use has also been widely studied as a possible preventive for many other conditions including heart disease certain cancers and autoimmune disorders. The Italian study participants all had blood levels of vitamin D measuring in the lowest percent of normal at the studys outset although the researchers didnt report the womens blood levels afterward. Experts wondered if women with higher blood levels would experience such dramatic cramp relief as observed in the study. Graham and Rabin agreed that much larger trials should be done before they would recommend vitamin D use to any of their patients for cramp relief. From a symptomatic standpoint its something to be considered but more studies are needed to see the risks and benefits Graham said. Studies like this are starting to show that vitamin D is ubiquitous in receptors in our bodies . . . but it needs further explanation. More information To find out more about painful menstrual periods head to the U.S. National Library of Medicine http SOURCES Robert Graham M.D. internist Lenox Hill Hospital New York City Jill Rabin M.D. chief obstetrics and gynecology and head urogynecology Long Island Jewish Medical Center New Hyde Park N.Y. Feb. Archives of Internal Medicine"

"Its a Catch with potentially deadly consequences People trying to overcome addiction cant get treatment for their pain because the most powerful pain medicines also carry an addiction risk. And so their pain continues to get in the way of their addiction recovery or they seek pain relief in the same addictive substances theyre trying to avoid. But a new study shows the potential for patients to break out of that cycle through a nondrug approach that combines behavioral therapy and social support to help them manage their pain. The lowcost approach grounded in psychological theories of pain could help address the nations epidemic of addictions to opioid painkillers and illicit drugs. Veterans who received this painfocused care while also being treated for addiction found that the intensity of their pain decreased their ability to function increased and their alcohol use went down compared to veterans who received a lessfocused approach. However the two groups had similar rates of drug use. Just weekly sessions of the approach called ImPAT for Improving Pain during Addiction Treatment had an effect that lasted up to a year in veterans who took part according to the new results published in the journal Addiction by a team from the VA Ann Arbor Healthcare Systems Center for Clinical Management Research and University of Michigan Medical Schools Addiction Center. The researchers have already launched a followup study in a larger group of nonveterans in a residential addiction treatment program. And the studys authors note that the ImPAT approach has the potential to be easily and inexpensively adopted by addiction treatment centers and groups worldwide through team members trained in standard psychological techniques. Caught in the middle These results highlight the need for addiction treatment programs to offer a multifaceted approach that doesnt only address substance use but also the other factors that might be driving substance use including pain says Mark Ilgen Ph.D. the studys lead author and a VA and UM psychologist specializing in addiction research. Weve shown that its possible to improve pain outcomes in people with addiction and even have some spillover effects on their substance use. Addiction treatment programs often have patients who suffer from chronic pain but offer few options to treat them Ilgen says. To make matters worse Past studies of psychosocial approaches for pain have often excluded people with drug or alcohol problems addiction treatment programs do not usually have providers trained in pain care and many pain specialists will not treat people who also have addiction. So patients are caught in the middle. All patients in the study most of them men in their s and s were receiving outpatient addiction treatment in a CBTbased nonabstinence setting at the Ann Arbor VA. Half were randomly assigned to ImPAT sessions the other half to support groups of peers led by a therapist where pain and addiction could be discussed. Combination approach ImPAT combines elements of cognitive behavioral therapy with another psychosocial approach called acceptance and commitment therapy. While the two approaches arent usually used together they are often used in pain treatment settings but those clinics and programs dont often accept people who also acknowledge they have addiction issues. Ilgen and his colleagues hope their results will help bring the techniques into addiction treatment settings where the cognitive behavioral therapy approach is often used. The ImPAT technique seeks to use integrated approaches both to help patients focus less on their pain and more on other aspects of life. This includes techniques to help people adapt to their pain find ways to distract themselves from their pain and think of ways to function in the face of pain. We want to take the focus off pain and put it onto functioning and finding pleasurable ways to spend time Ilgen says. Theres also a strong link between depression and pain. Pain is responsive to mood and mood is responsive to social support. In an editorial accompanying the new paper another addiction and pain specialist William C. Becker Ph.D. of Yale University and the Connecticut VA notes that the new results are even more impressive because ImPAT was compared with another psychosocial approach. The newly published study did show that one in five veterans randomly assigned to ImPAT or the comparison approach did not actually attend any sessions likely because of delays in getting the sessions going. The larger ongoing study based in an abstinencebased treatment facility in Michigan and funded by the National Institute on Drug Abuse has largely avoided that issue by decreasing the delay between study recruitment and the start of the treatment groups Ilgen says. The study in veterans was planned just before the rapid rise in and increased awareness of opioid painkiller addiction issues in the U.S. While opioid addiction was one of the issues faced by veterans in the study most had issues with multiple substances. The sharp rise in opioid addiction in recent years often among people who started taking the painkillers as treatment for acute or chronic pain has made the search for effective nondrug pain treatment options even more urgent Ilgen notes. Longterm use of opioids can sometimes lead to a hypersensitivity to pain so there may actually be a causal link between use of these medications and pain he notes. We need to study psychological pain management approaches in opioiddependent patients including those receiving addiction therapies such as buprenorphine. In the meantime he notes people struggling with addiction who want to seek relief from pain should explore the full range of treatment options that have been shown to work in nonaddicted patients including physical therapy exercise and psychotherapy as well as antidepressant medications. And while existing prescription guidelines do not explicitly prohibit the use of opioid painkillers in people with pain who have substance use disorders these guidelines recommend only using opioids sparingly and under close supervision he says. In addition to Ilgen an associate professor in the UM Department of Psychiatry and member of the UM Institute for Healthcare Policy and Innovation the study team included Addiction Center director Frederic Blow Ph.D. as well as Amy S. B. Bohnert Ph.D. Stephen Chermack Ph.D. Carly Conran Mary Jannausch M.S. and Jodie Trafton. Blow Bohnert and Chermack are all members of the VA CCMR and IHPI. The study was funded by the Veterans Health Administrations Health Services Research and Development Service Reference Addiction Volume Issue pages August . doi.add. httponlinelibrary.wiley.comdoi.add.abstract Editorial httponlinelibrary.wiley.comdoi.add.abstract"

"Physicians should consider blood testing of female adolescents for iron deficiency within a few years of starting menses according to two studies by Penn State College of Medicine researchers. The researchers used data from more than women to years old who took part in the National Health and Nutrition Examination Survey NHANES between and . As part of the survey female participants had blood testing for iron deficiency as well as hemoglobin testing to identify anemia. Women are typically tested some time in their teens for anemia the severe form of iron deficiency using a quick and affordable hemoglobin test. However iron deficiency can develop years before anemia and can be missed by hemoglobin testing alone. If you think about your car you have to run your gas tank all the way down before the red light goes on and thats similar to the way were screening for iron deficiency said Deepa L. Sekhar physician and associate professor of pediatrics. Were basically waiting until their red light goes on. You have to be really low on your iron storage before youre going to flag as anemic. Iron deficiency without anemia has been associated with lower standardized math scores attention deficit disorder and restless leg syndrome in children and adolescents. Among irondeficient adolescent women there is a future risk of maternal iron deficiency and negative effects on infant health. Blood tests for iron deficiency without anemia have been developed but they are more costly and difficult to obtain in the doctors office compared to hemoglobin testing for anemia. Sekhar and colleagues hoped to determine risk factors for iron deficiency without anemia that could pinpoint which women could benefit most from this more costly testing. In the first study when the researchers analyzed the NHANES study data percent of females who were to years old had iron deficiency without anemia. The researchers then looked at potential iron deficiency risk factors in this group including the age when they started menstruating as well as their race and ethnicity poverty status food insecurity tobacco or nicotine use dietary information body mass index BMI and physical activity. All of these factors have been associated with iron deficiency anemia in women in prior studies. However the only risk factor significantly associated with iron deficiency without anemia in young women in this study was having had a period for more than three years. The research was recently published in the journal PLOS ONE. In a second study the researchers next looked at whether a specially developed questionnaire could better predict iron status. Questions were included on depression poor attention and daytime sleepiness symptoms which all have been associated with iron deficiency or iron deficiency anemia but were not captured in the prior NHANES analyses. This questionnaire was compared to the currently recommended four iron deficiency anemiarisk questions in the Bright Futures Adolescent Previsit Questionnaire a survey recommended for physician use by the American Academy of Pediatrics. Ninetysix female adolescents participated in this study published in The Journal of Pediatrics. The Bright Futures questions alone did not predict iron deficiency or anemia. Yet the researchers risk assessment questionnaire was equally poor. Taken together the studies suggest that risk factors and assessments should not be used to determine which young women should receive testing for iron deficiency. The questions arent predictive Sekhar said. I think we need to establish the optimal timing for an objective assessment of adolescent iron deficiency and anemia. Sekhar believes the appropriate age may be years old when most females will have been menstruating for at least three years. In addition to timing further research will be needed to determine which blood test for iron deficiency without anemia is accurate costefficient and practical for routine doctors office use. This test should be given with hemoglobin testing to catch all young women on the spectrum of iron deficiency Sekhar said. Iron deficiency can be corrected with dietary changes and supplementation Sekhar added. Other researchers on the study in PLOS ONE were Laura E. MurrayKolb in the Department of Nutritional Sciences Allen R. Kunselman in the Department of Public Health Sciences Carol S. Weisman in the Departments of Public Health Sciences and Obstetrics and Gynecology and Ian M. Paul in the Departments of Pediatrics and Public Health Sciences all at Penn State. This research received of federal funding from The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health grant number KHD which funded percent of the project. MurrayKolb and Paul also worked on the study in The Journal of Pediatrics along with Eric W. Schaefer a biostatistician in the Department of Public Health Sciences. Nongovernment funding from Sackler Institute for Nutrition Science of the New York Academy of Sciences provided percent of funding for this research project."

"New research boosts hope that a highly anticipated experimental class of cholesterol drugs can greatly lower the risk for heart attacks death and other heartrelated problems. The government will decide this summer whether to allow two of these drugs on the market. People taking one of these drugs had half the risk of dying or suffering a heart problem compared to others who were given usual caretypically one of the statin drugs such as Lipitor or Zocor doctors found. Many people cannot tolerate statins or get enough help from them so new medicines are badly needed. The results are really impressive and very encouraging for the new drugs said one independent expert Dr. Judith Hochman of NYU Langone Medical Center. The studies were published online Sunday by the New England Journal of Medicine and discussed at an American College of Cardiology conference in San Diego. They are fresh analyses from older studies designed to look at how much the drugs lower cholesterol so they can only suggest that the drugs also lower heart problems not prove that point. Definitive studies will take about two more years so the federal Food and Drug Administration will be deciding the drugs fates with only results like this in hand. The drugs are evolocumab which Amgen wants to call Repatha and alirocumab which Regeneron Pharmaceuticals and Sanofi have named Praluent. They lower LDL or bad cholesterol more powerfully and in a different way than existing drugs by blocking PCSK a substance that interferes with the livers ability to remove cholesterol from the blood. Side effects remain a question though especially on thinking confusion and memoryproblems the FDA has already voiced concern about and asked the companies to track. The problems affected only or percent of patients and may be temporary but they were twice as common among people taking one of the new drugs and need to be closely monitored as studies continue said Dr. Anthony DeMaria a University of California at San Diego heart specialist and past president of the American College of Cardiology. As a patient facing potential side effects the last one I want is one that affects the brain he said. Dr. Eric Topol a cardiologist at Scripps Clinic in La Jolla California said the new results show an unquestionable signal of a potential safety issue. More side effects typically turn up once a drug is approved and used in a wider population he said. Two other heart expertsDrs. Neil Stone and Daniel LloydJones of Northwestern University in Chicagowrote in the medical journal that it would be premature to endorse these drugs for widespread use until the definitive studies are done in a couple of years. Other drugs that initially seemed good failed when put to the most rigorous test they wrote. Still the results so far suggest that the drugs appear to be on track to be important new medicines they wrote. Dr. Clyde Yancy cardiology chief at Northwestern University in Chicago and a former American Heart Association president agreed. Science has revealed a brand new approach to treating cholesterol and there is reasonable enthusiasm it will be a big boon to patients he said. Tags Pharmaceuticals https Supply Chain https Technology https"

"One day years ago after a long walk with his dog along the Hudson River in Manhattan Marc Stecker noticed he was limping. Not long after he was diagnosed with multiple sclerosis. Fast forward now and my entire right side is pretty much paralyzed and my left side is weakening Stecker says. In CCSVI vascular changes like stenosis narrowing or reflux in valves can lead to reduced blood drainage from the brain. Cleveland Clinic Center for Medical Art PhotographyCleveland Clinic Center for Medical Art Photography Stecker is now confined to a wheelchair from where he writes a blog http about his disease called Wheelchair Kamikaze. More than a year ago Stecker started writing about a theory Italian physician Paolo Zamboni proposed in called chronic cerebrospinal venous insufficiency or CCSVI. Its been thought that multiple sclerosis is caused by a misguided immune system that attacks the nerves of the brain and spinal cord and can lead to muscle weakness paralysis and death. However Zamboni suggests that the disease instead is the result of blocked blood veins leading to inflammation which in turn causes the immune system to attack nerves in the brain and spinal cord. Zamboni proposed that treating it may be as simple as opening them up. Stecker was hopeful. Because my disease is so aggressive I have been very willing to be equally aggressive in trying to combat it Stecker says. The Liberation Procedure To clear the veins his doctor tried opening them with a tiny balloon. Zamboni calls it the liberation procedure but it is actually a common technique known as angioplasty when its used to open clogged arteries not veins. Article continues after this message from our sponsor A Brief History Of Multiple Sclerosis In Augustus DEste http the grandson of Englands King George III began documenting his illness which would one day be identified as multiple sclerosis. Since DEstes day researchers have learned how to better treat the disease but have not yet found a cure. Here is a timeline of some key events along the way. Scientists identify multiple sclerosis as a distinct condition. Myelin http which insulates nerve fibers is discovered. In MS the body erodes the myelin which damages nerve fibers and interrupts brain signals. Using a microscope James Dawson examines the brains of people who died from MS. He is able to describe in depth the damage done by the disease. Researchers use a hormone typically made by the pituitary gland to treat the symptoms of MS. The MRI is first used to help diagnose MS reducing diagnosis time from seven years to six months after the first symptom. Doctors begin using a drug called Beta interferon b to reduce disease flareups. Paolo Zamboni proposes httpjnnp.bmj.comcontent.full the theory Chronic Cerebrospinal Venous Insufficiency. From the National Multiple Sclerosis Society http At first I was very skeptical. But anecdotal reports started coming through of almost miraculous results from it.So I decided you know hey it was worth a shot Stecker says. But it didnt work. Although the doctor who treated him in New York found a significant blockage he was unable to correct it Stecker says. Still some would say Stecker was lucky. Many desperate patients have spent their life savings flying overseas to have the procedure only to have it fail a few months later. Others elect to have tiny metal tubes known as stents placed in the veins to hold them open and have suffered serious complications including lifethreatening blood clots. Several patients have even died as a result. Stecker says if he had it to do over again he would have waited for more research. But he says he was eager to try something that offered him the first real glimmer of hope for a cure. CCSVI equals hope and a lot of MS patients just are completely devoid of hope Stecker says. People dont want to have MS. They want to go back to who they used to be. You know along comes this theory that offers an easytounderstand solution so its very very very seductive. Growing Public Controversy Its so seductive in fact that Canadians and Americans with MS have been flocking overseas to get the liberation procedure. Something that many researchers find very troubling. Robert Zivadinov of the Buffalo Neuroimaging Analysis Center in New York says that not only is the procedure unsafe and costly to many patients it is impeding necessary research. Even if the treatment is not useful for patients with MS I dont think that we can abandon the idea of vascular involvement in MS Zivadinov says. And I think this merits very detailed understanding of what is going on. What is going on is still a bit of a mystery. Critics argue that although Zambonis original research suggests a vascular cause for MS other studies dont. These discrepancies and growing public controversy prompted the National Multiple Sclerosis Society in the U.S. and the Multiple Sclerosis Society of Canada to take Zambonis claims seriously. They funded a number of independent studies to investigate the relationship between CCSVI and MS. Robert Fox a neurologist at the Cleveland Clinic currently oversees one of the studies funded by an MS Society grant. He says part of the confusion comes from variations in how CCSVI is measured. Thats absolutely one of the potential problems in the previous studies Are the techs who got negative results did they just not know how to do the ultrasound in the way that Dr. Zamboni described doing the ultrasound And thats a very important issue Fox says. Fox says he sent his technicians to a special training to learn how to properly measure the veins because its not something most technicians ever do. Bigger Than Multiple Sclerosis Meanwhile in Buffalo Zivadinov says his research on CCSVI already shows a clear picture emerging. CCSVI is not the cause of MS but might be a consequence or a contributing factor to progression and I think that has to be studied Zivadinov says. Studying how the vascular system is involved in neurologic disease is an entirely new concept Zivadinov says. One that may have an impact beyond any single disease. What professor Zamboni discovered in terms of veins is something much bigger than multiple sclerosis Zivadinov says. We need to understand the role of the venous system in the pathology of central nervous diseases and aging. Zamboni himself says that even if it turns out hes wrong coming to a greater understanding of the disease would be the big reward both for him and thousands of MS patients."

"A cancer drug for patients with certain types of leukemia and lymphoma can also prevent reactions to some of the most common airborne allergies according to a recent Northwestern Medicine study. The promising data from this pilot study could have greater implications for adults with food allergies. The cancer patients who were allergic to allergens such as cat dander and ragweed saw their allergic skin test reactivity reduced by to percent in one week and this persisted with continued use of the drug for at least one to two months. The findings were published in the Journal of Allergy and Clinical Immunology in May. It almost completely knocked out the patients skin test and blood cell allergic reactivity said senior author Dr. Bruce Bochner the Samuel M. Feinberg Professor of Medicine at Northwestern University Feinberg School of Medicine. This FDAapproved drug ibrutinib is currently on the market as a successful and lesstoxic alternative to chemotherapy for patients with chronic lymphocytic leukemia and mantle cell lymphoma. In this recent study Bochner and his team performed traditional allergy skin tests and the basophil activation test a related allergy test using blood cells on cancer patients before they had taken ibrutinib and again after one week and after one to two months of taking it. A rather unlikely pairing cancer and allergies Bochner thought to test if a cancer drug could prevent allergic reactions by collaborating with Feinbergs oncology department. He knew that the generally welltolerated cancer drug was successful in blocking a protein inside a cell called Brutons Tyrosine Kinase BTK. BTK plays a crucial role in B cell activation growth and maturation and mast cell and basophil activation the latter two cells being responsible for immediate allergic reactions. Bochner teamed up with Northwestern oncologist Dr. Leo Gordon and colleagues to test if this BTK inhibitor could shut down an enzyme inside cells that is involved when you have an allergic reaction. Ibrutinib is considered a game changer in these two types of cancers said Gordon the Abby and John Friend Professor of Cancer Research at Feinberg. We understood that it might have some biologic effects in what Bruce is interested in so we were happy to participate in his study. Its an interesting repurposing of that drug. While the study was small only two patients qualified out of about that were screened for allergies the implications are much larger for later phases of this study. Bochner and his colleagues Drs. Anne Marie Singh and Melanie Dispenza are now testing how successful the drug is at targeting allergies to food such as tree nuts and peanuts. Preventing or lessening the severity of an allergic reaction to a food youve ingested that youre allergic to is kind of the holy grail of food allergy treatment Bochner said. I dont know if this or similar drugs will ever make it possible for a peanutallergic person to eat peanut butter and jelly sandwiches but were excited to use this approach to teach us how to lessen the risks of food allergy reactions. Currently the study is being expanded to adults with food allergy to see if their skin test and basophil activation test responses show a similar reduction with just a few doses of ibrutinib and how long such benefits might last. If the results are favorable the next step would be to get funding to actually test whether taking a BTK inhibitor will improve the ability of foodallergic adults to eat foods theyre allergic to. The hope is that drugs like BTK inhibitors will protect people with food allergies from having anaphylaxis or at least increase how much of that food they can eat without reacting Bochner said. Maybe theyll increase from being able to eat just one peanut to before they react. Or maybe theyll be able to eat a full meals worth of peanuts. We want to know if this would safely change their actual ability to eat foods that they currently need to avoid."

"Combining two drugs that target an aggressive type of breast cancer known as HERpositive appears to work better than using either drug alone researchers report. The dualdrug approach greatly boosted the chances of eliminating microscopic signs of early cancer by the time a woman was due to have surgery said researcher Dr. Jose Baselga chief of hematologyoncology at Massachusetts General Hospital Cancer Center and a professor of medicine at Harvard Medical School. The study was published online Jan. in The Lancet. The two drugs are Tykerb lapatinib and Herceptin trastuzumab. Using both together resulted in a percent response compared with a percent response in women given Herceptin alone. Those given Tykerb alone had a percent response. What we observed was a massive improvement in response Baselga said. GlaxoSmithKline the maker of Tykerb helped fund the study. Lapatinib was approved for advanced breast cancer in Baselga said. The question we had was what is the efficacy if we give it in earlystage breast cancer prior to surgery Baselga and his colleagues conducted a trial treating women from countries. All had HERpositive breast cancers. All had tumors larger than about threefourths of an inch. In HERpositive breast cancer test results are positive for a protein called human epidermal growth factor receptor which promotes cancer cell growth. In the study women got Tykerb Herceptin and the other both drugs. All had the drug regimen before surgery with Taxol paclitaxel a standard chemotherapy added after six weeks. After more weeks of treatment the women had surgery. At that point researchers evaluated who had better responses. The women continued the treatments for one more year allowing researchers to follow them and see how the approaches affected survival. Baselga stressed that the study looked only at women with earlystage HERpositive breast cancers and that the drug Tykerb is approved now only for advanced breast cancers. The study is well done and important said Dr. Len Lichtenfeld deputy chief medical officer for the American Cancer Society. The two drugs he said affect the same pathway but do it in a different way. While the combination showed a better response rate there is also an increased level of side effects he noted. While no major heart problems occurred those on Tykerb alone or the twodrug combination had more diarrhea. Liverenzyme alterations were also more frequent when Tykerb was used. GlaxoSmithKline notes that liver toxicity with the drug may be severe and that deaths have been reported although the cause of the deaths has not been determined. The important question however has not been answered yet Lichtenfeld said. Thats the effect on overall survival in using the twodrug approach. The researchers are continuing to evaluate that. Cost is another consideration Tykerb runs about a month wholesale and retail prices could be higher. In another study published online Jan. in The Lancet Oncology researchers from Germany reported that Tykerb is less beneficial than Herceptin as a singledrug therapy. They assigned women with HERpositive breast cancer to get standard chemotherapy plus Herceptin or Tykerb. They looked to see which drug was better at eliminating invasive cancer in the breast and metastatic cells in the lymph nodes. While percent of those in the Herceptin group had this response percent of the Tykerb group did. The study was funded by drug makers GlaxoSmithKline Roche and SanofiAventis. Baselga reports receiving honoraria from Roche other coauthors report receiving speaking fees or honoraria from GlaxoSmithKline and fees from other drug companies. More information To learn more about breast cancer including HERpositive cancers visit the American Cancer Society http SOURCES Jose Basegla M.D. Ph.D. chief hematologyoncology Massachusetts General Hospital Cancer Center and professor medicine Harvard Medical School Boston Len Lichtenfeld M.D. deputy chief medical officer American Cancer Society Jan. The Lancet The Lancet Oncology online"

"Two bloodbuilding drugs injected soon after birth may give tiny preemies a lasting longterm edge boosting brain development and IQ by age a firstofitskind study found. The study was small but the implications are big if larger longer studies prove the drugs help even the playing field for these atrisk children the researchers and other experts say. Babies who got the medicine scored much better by age on measures of intelligence language and memory than preemies who didnt get it. The medicine groups scores on an important behavior measure were just as good as a control group of yearolds born on time at a normal weight. The results are super exciting said Dr. Robin Ohls the lead author and a pediatrics professor at the University of New Mexico. She said its the first evidence of longterm benefits of the drugs when compared to no bloodboosting treatment. Even though the treated youngsters didnt do as well as the normalweight group on most measures their scores were impressive and suggest greater brain development than the other preemies Ohls said. They scored about points higher on average on IQ tests than the untreated kids but about points lower than the normalweight group. On tests measuring memory and impulsive behavior the treated kids fared as well as those born at normal weight. Heres how those differences would show up in a preschool setting The untreated group would be the kids who struggle a little in class while those who got the medicines would do OK but not as well as those born at a normal weight said Dr. Michael Schreiber a prematurity expert at the University of Chicagos Comer Childrens Hospital. Survival of extremely tiny preemies has improved dramatically in the past years but treatment for medical problems and developmental delays linked with prematurity has not kept pace Schreiber said. He was not involved in the study. He said larger studies including more diverse patient populations are needed to determine if the drugs can help a broader range of preemies. The study involved children most white or Hispanic born more than a month premature and weighing less than pounds at hospitals in New Mexico Utah and Colorado. Two dozen normalweight children were also included. Results were published Monday in Pediatrics. Shortly after birth the preemies were randomly assigned to receive injections of either erythropoeitin EPO three times weekly darbepoetin once a week for several weeks or no treatment. The drugs build red blood cells and are approved to treat anemia caused by cancer treatment or resulting from other conditions. Preemies lack the ability to make new red blood cells and often need frequent blood transfusions to replace blood taken for lab tests. The drugs are now sometimes used to try to reduce their need for transfusions in doses similar to the ones studied. The drugs can increase endurance by boosting oxygen levels in the blood and have been implicated in some sports doping scandals."

"High dose stereotactic body radiotherapy SBRT for men newlydiagnosed with low or intermediaterisk prostate cancer results in shorter treatment times low severe toxicity and excellent cancer control rates according to research presented today at the th Annual Meeting of the American Society for Radiation Oncology ASTRO. The study is the first large multiinstitutional study of SBRT in prostate cancer with longterm followup. Although prostate tumors generally respond well to radiation therapy RT the possibility of radiation exposure to healthy tissue in the genitourinary GU and gastrointestinal GI systems can be of concern. SBRT is an advanced technique that precisely targets high doses of RT to the tumor in a small number fractions simultaneously avoiding surrounding tissue and reducing toxicity to noncancerous cells. The technique has become the standard of care for many nonsurgical lung cancer patients as it limits exposure to the heart and surrounding lungs. When treating tumors in the prostate SBRT avoids the adjacent bladder sex organs and rectum. Singleinstitution studies on the use of SBRT as the primary treatment for prostate cancer have illuminated the treatment as a costeffective and faster alternative to IMRT said Robert Meier MD lead author of the study and a radiation oncologist at Swedish Medical Center in Seattle. Our study is the first to contribute multicenter data that support the use of SBRT as frontline therapy for men with prostate cancer. A total of men with newly diagnosed prostate cancer were enrolled in the trial at community regional and academic hospitals across the U.S. Eligible patients had either lowrisk disease CS TTa Gleason PSA n or intermediaterisk disease CS TcTb with either Gleason and PSA or Gleason and PSA . All of the men received SBRT via a nonisocentric robotic platform with an RT dose to the prostate of Gy administered in five treatment sessions of Gy each. Intermediate risk patients received a dose of . Gy to the seminal vesicles. Concurrent and adjuvant androgen ablation therapy were prohibited among study participants. Primary outcomes included GU and GI toxicities and relapsefree survival RFS. Researchers measured toxicity using the National Cancer Institutes Common Terminology Criteria for Adverse Events CTCAE version .. Biochemical failure was assessed using the ASTROconsensus and the nadir definitions. Overall survival OS was measured as a secondary outcome for the study. Actuarial OS and RFS were calculated with the KaplanMeier statistical method. Median followup was months. At five years following SBRT percent of patients were free from prostate cancer progression. In lowrisk patients the cancer control rates was superior to historical controls. Specifically in the lowrisk group the fiveyear RFS rate was . percent which is superior to the percent historical comparison DFS control rate p .. Actuarial fiveyear OS was . percent for the entire cohort. Actuarial fiveyear nadir RFS was . percent for all patients representing . percent of lowrisk and . of intermediaterisk patients. Actuarial fiveyear ASTRO RFS was . percent and . percent for low and intermediaterisk groups respectively. Fewer than two percent of all patients experienced serious side effects in the five years following SBRT. Five grade three GU side effects were reported in four of the study participants. There were no reported grade four or five toxicities nor any grade three GI toxicities. Between half and twothirds of patients experienced less serious side effects with rates of and percent for grade one GU and GI toxicities and rates of and percent for grade two GU and GI toxicities respectively. These side effects were usually temporary. Our results illustrate how advanced technology has radically improved our ability to target cancer said Dr. Meier. After following patients for more than five years we found that serious side effects from a brief course of SBRT were uncommon and that cancer control rates were very favorable compared to historical data. Our trial confirms that SBRT may be preferable to other treatment approaches for newlydiagnosed cases of prostate cancer including more aggressive disease. The abstract FiveYear Outcomes from a MultiCenter Trial of Stereotactic Body Radiotherapy for Low and IntermediateRisk Prostate Cancer will be presented in detail during a scientific session at ASTROs th Annual Meeting at a.m. Eastern time on Monday September . To speak with Dr. Meier or obtain a copy of the abstract please contact ASTROs media relations team onsite at the Boston Convention and Exhibition Center September through by phone at or by email at pressastro.org mailtopressastro.org. ATTRIBUTION TO THE AMERICAN SOCIETY OF RADIATION ONCOLOGY ASTRO ANNUAL MEETING REQUESTED IN ALL COVERAGE. This news release contains updated data from the study authors. ABOUT ASTROS ANNUAL MEETINGASTROs th Annual Meeting the nations premier scientific meeting in radiation oncology will be held September at the Boston Convention and Exhibition Center in Boston. The Annual Meeting is expected to attract more than attendees from across the globe including oncologists from all disciplines and members of the entire radiation oncology team. Led by ASTRO president David C. Beyer MD FASTRO the meeting will feature keynote addresses from Kathleen Sebelius former U.S. Secretary of Health and Human Services Thomas James Lynch Jr. MD Chair and CEO Massachusetts General Physicians Organization and Jason Ragogna general manager SMS and Safety Alliances Corporate Safety Security and Compliance Delta Air Lines Inc. The Presidential Symposium Prostate Cancer Defining Value and Delivering It highlights the meetings theme of Enhancing Value Improving Outcomes and will feature recent practicechanging studies and current developments in valuebased care for prostate cancer. ASTROs fourday scientific meeting will feature a record number of abstracts including oral presentations posters and digital posters in more than educational sessions and scientific panels for diseasesite tracks. For more information about ASTROs th Annual Meeting visit http For press registration and news briefing information for ASTROs th Annual Meeting visit http ABOUT ASTROASTRO is the premier radiation oncology society in the world with more than members who are physicians nurses biologists physicists radiation therapists dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology the Society is dedicated to improving patient care through professional education and training support for clinical practice and health policy standards advancement of science and research and advocacy. ASTRO publishes three medical journals International Journal of Radiation Oncology Biology Physics http Practical Radiation Oncology http and Advances in Radiation Oncology http developed and maintains an extensive patient website RT Answers http and created the Radiation Oncology Institute http a nonprofit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO visit http"

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