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"Researchers at MD Anderson Cancer Center in Houston have identified a large and readily detectable molecule that circulates in the blood and has identified with perfect accuracy and no false positives the presence of pancreatic cancer in a small group of subjects. Searching blood samples of pancreatic cancer patients and controls for a distinctive molecule given off by the malignancy scientists were even able to distinguish subjects with benign pancreatic disease from those with earlystage cancer. The telltale sign of pancreas cancer was found in protein and nucleicacidfilled sacs called exosomes which circulate in the bloodstream. Spinning blood samples in a centrifuge researchers found they could break open those sacs and readily detect a protein called glypican which is overexpressed in breast and pancreatic cancers. The finding http offers the possibility for early detection of pancreatic cancer and help in designing potential curative surgical options the authors of the new research wrote. For a cancer that has already metastasized in four of five patients newly diagnosed earlier detection holds a strong promise of improving pancreatic cancers dismal survival rate they added. Pancreatic cancer is the deadliest of all common cancers in the United States. An estimated are diagnosed with the malignancy each year in the country usually when it has reached a very advanced stage and few treatment options are effective. Just of those diagnosed with this form of malignancy survive five or more years. Clotilde Thery a cancer researcher at Frances Institut Curie greeted the possibility with enthusiasm. The potential implications of such a test are huge Thery wrote in an editorial published alongside the study in the journal Nature. Although she said its findings need to be replicated in much larger groups she hailed the finding as clinically important. UC San Francisco cancer physician Alan Venook cautioned however that much more needs to be known about the telltale sign of cancer explored in the new research before its lifesaving properties can be established. The issue is can you detect these in patients that dont have advanced cancer Venook said. The answer is we dont know. The numbers tested by the MD Anderson researchers patients with pancreatic cancer five of whom had very early lesions with chronic pancreatitis and healthy controls arent nearly large enough to draw such conclusions. And getting a clear answer Venook said would probably require lengthy and expensive studies on very large populations. FOR THE RECORD June p.m. An earlier version of this article underreported the number of people tested for the glypican protein by the MD Anderson researchers. Participants with pancreatic cancer numbered not healthy controls numbered not those with chronic pancreatitis numbered not six. Dont get me wrong this is where we start. This is a very cool observation well worth following. But this is not a biomarker yet Venook said."

"Depression affects more than million Americans a year https but fewer than half get treatment https Now researchers are turning to social media to shrink that gap and give doctors another way to find people at risk. A study published Monday http in the Proceedings of the National Academy of Sciences suggests that analyzing language from Facebook posts can predict whether a user is depressed three months before the person receives a medical diagnosis. The work is still in very early stages the researchers from the University of Pennsylvania and Stony Brook University cautioned. The study was based on a group of fewer than users and the predictive model is only moderately accurate. But this approach could hold promise for the future they said. Depression is a really debilitating disease and we have treatments that can help people said Raina Merchant one of the study authors and director of the Penn Medicine Center for Digital Health. We want to think of new ways to get people resources and identification for depression earlier. Researchers recruited participants for the study from a hospital emergency department asking for permission to access their electronic medical records and Facebook history. For every participant who had a diagnosis of depression in the medical records researchers found five people who did not creating a sample that mirrored rates of depression in the national population. Examining more than Facebook posts from both groups researchers determined which words post lengths frequency of posting and timing of posts were most associated with a depression diagnosis. They found people with depression used the words I my and me as well as such words as hurt tired and hospital more often than others in the months preceding their diagnosis. Using indicators such as these they built a computer model that could predict which people would receive a depression diagnosis with comparable accuracy to commonly used clinical surveys. The model worked best when using Facebook data from the three months right before a participant received a depression diagnosis. When longer periods of Facebook data were included the model became less precise. Were at the very beginning of trying to understand how this data is sometimes people just saying hi to each other but sometimes it can give us insight into the health of individuals and communities Merchant said. Depression symptoms manifest differently by race gender and age https and can be affected by other diseases httpcare.diabetesjournals.orgcontent making it difficult to diagnose. Most screening tools rely on people accurately reporting their own symptoms and answering survey questions which can be interpreted differently https based on a persons cultural background and language skills. Primarycare doctors can screen for depression but their visits with patients are often short and months apart leaving the discussion focused on crises and immediate concerns. With social media and other data you can start to fill in those gaps said Munmun De Choudhury an assistant professor in Georgia Techs School of Interactive Computing who was not involved in the study. Her previous research has shown that Twitter data can be used to predict http_.pdf which users will develop symptoms of depression. In the future if patients shared social media data with their doctors it could create more personalized care De Choudhury said. How is their social life Are they getting enough sleep A lot of these attributes you can measure using social media she said. Social media data could be used for public health too De Choudhury said. For example the Centers for Disease Control and Prevention could figure out which communities are most at risk for suicide by examining their online posts and then target specific prevention measures to them. Facebook and Google have started taking steps in this direction. Facebook uses artificial intelligence to flag posts httpsnewsroom.fb.comnewsbuildingasafercommunitywithnewsuicidepreventiontools that indicate risks of self harm or suicide. From there an employee can direct people to national suicide prevention resources. Google prompts users who search depressionrelated terms httpfortune.comgoogledepressionscreening to take a screening questionnaire. Advertisement Its encouraging to see these companies take social responsibility De Choudhury said but this can be only one aspect of mental health care. Predictive models built on social media are not highly accurate yet. Theyre also built on small sample sizes which means they may not work the same in a large diverse population. You shouldnt be using such an algorithm by itself at any point in time she said. It needs to be combined with traditional screening surveys for depression and clinical expertise. Another reason to be cautious with the use of social media for health care is the issue of privacy Merchant said. We should see this data the way we do any health data she said. It is the data of the patients. But its a tricky premise given recent highprofile data breaches including one that compromised millions of Facebook users http There are also concerns that social media do more than reflect ones mental health. Some studies have shown that those with greater social media use are more likely to be depressed https or have eating disorders httpsonlinelibrary.wiley.comdoiabs.eat.. But other studies show social media can be helpful in connecting people http to resources and peer support. More research is needed Merchant said. We need a better understanding of not just how it tells us about our health but also how the use of technology affects our health."

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

"Breast cancers in women aged to that are diagnosed by mammograms have a better prognosis than those detected by doctors or the women themselves a new study indicates. They have an earlier diagnosis earlier stage better prognosis said study author Judith Malmgren an affiliated professor of epidemiology at the University of Washington School of Public Health and Community Medicine. She is also president of HealthStat Consulting Inc. in Seattle. The new study like previous ones reignites the ongoing debate about the best age to start routine mammograms and the best screening interval. It appears in the March issue of the journal Radiology. In the U.S. Preventive Services Task Force issued mammogram recommendations. It recommends women aged to who are at average risk for breast cancer have a mammogram done every two years. It also suggests that women aged to at average risk discuss the pros and cons with their doctors and decide on an individual basis if and when to start screening. Meanwhile other organizations including the American Cancer Society recommend women begin mammograms at age and continue to have them annually. Malmgren and her colleagues evaluated nearly women who had breast cancer. All were aged to when they were treated between and . The researchers looked at the method of diagnosis whether by mammogram or if the cancer was found by the doctor or the woman. They also took these into account the cancers stage at diagnosis type of treatment annual followup recurrence and survival. Over the year period the number of breast cancers diagnosed at very early stages increased percent while the number of more advanced cancers stage decreased by percent. Those whose cancers were detected by mammogram rose from percent in to percent in . The number of cancers detected by doctor or patients declined from percent in to percent in . Women whose cancers were detected by mammograms were more likely than the doctor or patientdetected cancers to have lumpectomy or other breastconserving surgery percent vs. percent. The women whose cancers were detected by mammograms were less likely to be given chemotherapy. While percent of women whose cancer was found on mammogram died during a followup period that ranged from one to years percent of those whose cancers were found by the doctor or the women died. When the researchers looked only at invasive cancers percent of the women whose cancer was found on mammogram survived without recurrence at five years percent of the other group did. I dont think the U.S. Preventive Services Task Force is looking at the whole picture Malmgren said. They are concentrating on the harms. Among them according to the guidelines are falsepositives which can lead to anxiety and unnecessary biopsies. Malmgren a breast cancer survivor says more focus should be placed on the benefit of early diagnosis because it often means less treatment is needed. There was a decrease found in cancers being diagnosed at later stages in those whose cancers were found on mammograms. Thats where the money is Malmgren said. Dr. Virginia Moyer chair of the U.S. Preventive Services Task Force and a professor of pediatrics at Baylor College of Medicine reviewed the study. The findings make sense she said. They found that cancers can be detected earlier by mammogram. A screening test if it cant find something earlier than by clinical presentation is a poor test she said. However she said the study does not provide support for all women aged to to have routine mammograms. When considering its recommendation the task force took all available evidence into account including published studies Moyer noted. The data from randomized trials and modeling show there is a very modest improvement in mortality with mammograms from to she said. Because it is so modest and there are risks people need to make their own decision Moyer said. More information To learn more about mammograms go to the U.S. National Cancer Institute. SOURCES Judith A. Malmgren Ph.D. affiliate professor epidemiology Washington University School of Public Health and president of HealthStat Consulting Inc. Seattle Virginia Moyer M.D. chairwoman U.S. Preventive Services Task Force and professor pediatrics Baylor College of Medicine Houston March Radiology"

"Allison MacMath had no medical training. But on a cold morning in February when a man beside her at the dog park suddenly collapsed to the snow she remembered a simple tip When giving CPR skip mouthtomouth and pump to the beat of an aptly named Bee Gees song. As she leaned against his chest she said she sang in her head but out loud at the hook Stayin alive. Stayin alive willing him to hear her. The mans wife comforted him with her own words. Mostly I love you Frank I love you MacMath remembered Saturday turning to Frank Norris the man whose life she helped save. She said it over and over. She loves you. She really loves you. The two traveled from Langhorne to Penn Medicine in Philadelphia to gather with others who suffered or saved someone from a sudden cardiac arrest. Advertisement They did so to offer support but also to spread awareness because they say too often life and death for someone having a cardiac arrest comes down to chance. If a bystander performs CPR while medics are on their way survival rates more than double doctors say. These guys are all alive today because of luck said Michele Schimers of the Minnesota Sudden Cardiac Arrest Survivors Network who came to Philadelphia to offer advice on starting a network here. We need to take luck out of the equation and give everyone a fair shot at surviving cardiac arrest. Benjamin Abella clinicalresearch director at Penns Center for Resuscitation Science said that means training more people in CPR. The need is especially acute he said in areas with high poverty or large minority populations where research shows CPR knowledge is very low. Everyone knows to call . . . . But most of the time we cant wait said Abella. Usually a cardiacarrest victims fate is sealed in those first five to minutes. Without intervention cardiac arrest is percent fatal doctors say. The condition kills about people each year in the United States an estimated in Philadelphia. Joseph Russell of the CPAT Network a group of former and current Philadelphia Fire Department EMTs has been educating Philadelphians about CPR for a decade. In the last year since a yearold at Andrew Jackson Elementary School died from a cardiac arrest when the school nurse wasnt on duty the group has trained more than School District employees in firstresponder skills. We have a long ways to go in the city he said. People tend to wait until the tragic situation happens. So somehow we have to get in the mindset for people to be more proactive and not wait for the disaster."

"For six years now life has been really good for James. He has a great job as the creative director of an advertising firm in New York City. He enjoys spending time with his wife and kids. And it has all been possible he says because for the past six years he has been taking a drug called ketamine https Before ketamine James was unable to work or focus his thoughts. His mind was filled with violent images. And his mood could go from ebullient to dark in a matter of minutes. Ketamine helped me get my life back says James who asked that we not use his last name to protect his career. Ketamine was developed as a human and animal anesthetic in the s. And almost from the time it reached the market it has also been used as a mindbending party drug. But ketamines story took a surprising turn in when researchers at the National Institutes of Health showed https that an intravenous dose could relieve severe depression in a matter of hours. Since then doctors have prescribed ketamine off label to thousands of depressed patients https who dont respond to other drugs. Article continues after this message from our sponsor And pharmaceutical companies are testing https several new ketaminerelated drugs to treat depression. Johnson Johnson expects to seek approval for its nasal spray esketamine https later this year though the approval would be limited to use in a clinical setting. Meanwhile doctors have begun trying ketamine on patients with a wide range of psychiatric disorders other than depression. And there is now growing evidence it can help people with anxiety bipolar disorder posttraumatic stress disorder and perhaps even obsessivecompulsive disorder. I think its actually one of the biggest advances in psychiatry in a very long time says Dr. Martin Teicher https an associate professor of psychiatry at Harvard Medical School and director of the Developmental Biopsychiatry Research Program at McLean Hospital. Ketamine may also offer new hope for people like James who have symptoms of several different psychiatric disorders. James had a happy childhood he says. But his thoughts were out of control. I always felt like I was crossing a freeway and my thoughts were just racing past me he says. He spent much of his childhood terrified of an unknown an ambiguous force out there. The fear was overwhelming he says. I literally slept with the cover over my head with just room to breathe through my mouth until I went to college. And there was something else about James his body temperature. I overheated constantly he says. I would wear shorts all year long. In my s in my apartment I would sleep with the windows open in the middle of the winter. In his late s James saw a doctor who told him he had attention deficit hyperactivity disorder. So he started taking stimulants. At first the pills helped him focus. Then they didnt no matter how many he took. Hed done well as an idea guy in the advertising industry. But now James was trying to work at home and it wasnt going well. ADHD pills will make you interested in anything he says. So I was putting the desk together and taking the desk apart. I was putting a laptop stand together and taking it apart. I was going in a massive downward spiral. James had always suffered from mood swings. But now they were rapid and extreme. And he couldnt stop thinking about gruesome scenarios like a murderer coming for his family. My wife took a summer off to be with me because she was scared of what was going to happen to me he says. She would go to work for a few hours then rush home. There would be times Id call her just screaming Please come home. I cant get through another minute. Eventually James found his way to Dr. Demitri Papolos httpbipolarchild.comaboutauthors an associate professor of clinical psychiatry at Albert Einstein College of Medicine. He was like a whirling dervish when he came into my office Papolos says. He was extremely fearful and scanning the environment all the time and he overheated at the drop of a hat. Papolos diagnosed James with a variant of bipolar disorder he calls the fear of harm phenotype. It typically appears in childhood and often doesnt respond to traditional psychiatric drugs. But Papolos has found that the condition does respond to ketamine. Its been transformational he says. In January Papolos published a study https of children with the problem. They inhaled a nasal mist containing ketamine about twice a week. Nearly all got dramatically better. Scientists still arent sure why ketamine works but theres evidence https that it encourages the brain to rewire to alter the connections between cells. That process has been linked to recovery from depression. And it may also explain why ketamine helps people who have symptoms associated with several different psychiatric disorders. I think its having multiple effects and that means its probably useful for multiple different disorders Teicher says. One of those effects involves a part of the brain involved in temperature regulation. And that could explain why patients like James usually stop overheating once they are taking ketamine. James started taking a ketamine nasal spray every other day. He says his response was dramatic. One day I turn to my wife and Im like I feel calm today. I dont know if its the sun coming in I dont know if its just the way were sitting here but I feel like I could go and sit at the computer and work. The next day James did sit down at his computer. A month later he was back at work."

"Human papillomaviruspositive oropharynx cancers cancers of the tonsils and back of the throat are on rise. After radiation treatment patients often experience severe lifelong swallowing eating and nutritional issues. However new clinical trial research shows reducing radiation for some patients with HPVassociated oropharyngeal squamous cell carcinomas can maintain high cure rates while sparing some of these late toxicities. We found there are some patients have very high cure rates with reduced doses of radiation said Barbara Burtness MD Professor of Medicine Medical Oncology Yale Cancer Center Disease Research Team Leader for the Head and Neck Cancers Program at Smilow Cancer Hospital and the chair of the ECOGACRIN head and neck committee. Radiation dose reduction resulted in significantly improved swallowing and nutritional status she said. The study published in the December issue of the Journal of Clinical Oncology showed that patients treated with reduced radiation had less difficulty swallowing solids percent versus percent of patients treated with standard doses of radiation or impaired nutrition percent versus percent of patients treated with regular doses of radiation. Today many younger patients are presenting with HPVassociated squamous cell carcinoma of the oropharynx said Dr. Burtness. And while traditional chemoradiation has demonstrated good tumor control and survival rates for patients too often they encounter unpleasant outcomes that can include difficulty swallowing solid foods impaired nutrition aspiration and feeding tube dependence said Dr. Burtness. Younger patients may have to deal with these side effects for decades after cancer treatment. We want to help improve our patients quality of life. The study included patients from ECOGACRIN Cancer Research Group sites who had stage three or four HPVpositive squamous cell carcinoma of the oropharynx and were candidates for surgery. Eligible patients received three courses of induction chemotherapy with the drugs cisplatin paclitaxel and cetuximab. Patients with good clinical response then received reduced radiation. Study results also showed that patients who had a history of smoking less than packs of cigarettes a year had a very high disease control compared with heavy smokers. Other authors on the paper include Shanthi Marur Johns Hopkins Medicine and Anthony Cmelak Vanderbilt University."

"For Carlton Davis the always seemed to come out as hte. Frequently having problems in school he once threw a typewriter out of his fourthfloor window at college after making the hte mistake yet again. Abby Schwartz can relate. She would often mix up the letters d and b sounding out certain words to make make sense of them. Things have gotten better but shell still make the occasional bd or flip. Davis now also still mixes up the digits of phone numbers. Reading would be slow. It wouldnt be enjoyable. I would lose my place said Abby of Lexington Massachusetts. There were times when I would yell at myself I cant do this. I cant do this. I cant do this. Abby and Davis like an estimated percent to percent of the population have struggled with dyslexia a condition that broadly speaking hinders a persons ability to interpret language. Scientists have recently made headway in understanding whats going on in the brain of a person with dyslexia which has not been well understood. New research suggests it may be possible to tell from a brain scan whether a dyslexic childs reading ability will improve over a few years. It goes along with the general trend of personalized medicine in which genetic tests brain scans and other tests can increasingly help predict the conditions for which a particular individual is at risk. And a separate recent study found that some dyslexics may have a heightened understanding of space despite an impairment in language. In dyslexia httpedition.cnn.comHEALTHlibrarydyslexiaDS.html also called developmental reading disorder http the brain doesnt properly recognize or process symbols. Children with this condition may find reading comprehension difficult because they dont connect sounds with letters and cant recognize words well. Celebrities http including Whoopi Goldberg Cher and Henry Winkler httpedition.cnn.comLIVINGmf.dyslexia.famous.celebritiesindex.html the Fonz have made their dyslexia publicly known and great artists such as Pablo Picasso are said to have had it. Some children with the disorder can compensate or read fairly normally but perhaps more slowly than their peers by adulthood. It is hard to know who will be able to improve reading skills over time and how much extra help is necessary. A study led by Fumiko Hoeft psychiatry researcher at Stanford University School of Medicine used brain imaging to answer this question. Her study followed children with dyslexia and children without dyslexia over a year period. The researchers found greater activation and connectivity in the brains right hemisphere among dyslexic children who showed greater improvement in reading after the years. They used functional magnetic resonance imaging fMRI to study this phenomenon. In general much of the language comprehension and processing that goes on in the brain happens in the left hemisphere but there is some right hemisphere involvement also. Hoefts study suggests that people with dyslexia who go on to read fairly normally are using a part of the right hemisphere in reading tasks more than the average person would. If made widely available this kind of brain scan could be an important complement to the assessments based on reading and behavior already available for diagnosing dyslexia Hoeft said. As this usage of fMRI becomes more useful and commonplace the high cost per scan would go down she said. Rebecca Branstetter psychologist who blogs at Notes from the School Psychologist httpstudentsgrow.blogspot.com says this dyslexia brain scan could provide useful information but it doesnt highlight environmental factors such as the quality of instruction in the childs classroom that could contribute to reading problems. Abbys father Edward Schwartz fears that this tool would just add to a childs anxiety about the testing process. The potential to alarm a child isnt worth it and he doesnt trust that this method would offer definitive information. The kids are much more likely to feel like theyre broken in some way Schwartz said. Abby he recalls didnt like it to be referred to as a learning disability. She was happy when people offered her alternative ways to think about it. Guillermo Tilley the father of yearold Nate who has dyslexia similarly would not want his son to have the fMRI. It would taint my interpretation of who Nate is and his struggle with dyslexia Tilley said. Of course the results of the study are only preliminary. Participants included children with dyslexia and children without dyslexia which is too small a sample size to prove anything although still respectable when it comes to neuroimaging studies. Another important limitation in the study is that some children in the study did receive tutoring or reading interventions to which they were not randomly assigned. A larger trial that controlled for remediations would offer more conclusive results. But this one found that receiving a remediation did not appear to affect improvement in reading abilities. Heres another insight about dyslexia men with the condition may have enhanced visualspatial abilities http_obArticleURL_udiBWPYXFS_user_coverDate_rdoc_fmthigh_origbrowse_originbrowse_zonerslt_list_item_srchdocinfo according to a study in the journal Learning and Individual Differences. This was another small study dyslexic volunteers and participants without the condition testing how people identify shapes navigate a virtual environment and do other tasks involving spatial reasoning. Davis a noted architect and writer in the Los Angeles area believes he fits that category. He gets thrown off by pure mathematics but hes good at anything involving spatial relationships and design. And those kinds of skills should be taken advantage of in school said Wendy Weiner principal of the artsfocused Conservatory Prep in Davie Florida and mother of a dyslexic child. If they can create projects instead of drawing a picture of a room if they can make a model of a room they will generally do it pretty much to scale because they can visualize things very clearly she said. Because of this Weiner said threedimensional letters and numbers perhaps made out of plastic or clay help a dyslexic child grasp the shapes better. Holding a upright in your hand youre less likely to view it sideways as a V she said. The most important intervention is a direct explicit teaching of phonics or how symbols correspond with sounds Branstetter said. The sooner it can be detected the better. A childs personality can also factor in Some persist despite frustration better than others. Parents should speak to their school psychologists about the best plan of action she said. For Abby a breakthrough moment came at age She started reading voraciously and today reads well above the seventhgrade level. Shed had good tutors and plenty of support from her parents but it also took selfconfidence for her to make herself read on her own she said. As for Davis hed never heard of dyslexia until a friend brought it up when he was and then went through training at a learning development center. Using computers for writing has helped him tremendously especially spellcheck. I know a lot of people who have trouble reading as I did when I was a kid are dyslexic he said. It is an issue that certainly holds back a lot of kids because of their inability to do certain things."

"First results from a human trial of an Ebola vaccine from GlaxoSmithKline show it is safe and generates an immune response scientists said on Wednesday but larger trials are needed to see if it protects and if a booster is needed. The vaccine is being developed by the U.S. National Institutes of Health NIH and GSK against the Zaire strain of Ebola the one circulating in West Africa and the first doses for a larger trial arrived in Liberia last week. That trial is the first of several midstage studies planned for West Africa and aims to test GSKs vaccine and one from Merck and NewLink. Johnson Johnson and Bavarian Nordic have a vaccine in earlystage clinical tests. The earlystage Phase I trial of GSKs vaccine was primarily designed to test safety but Adrian Hill who led the work at Oxfords Jenner Institute said it was encouraging that the shot also prompted responses from the immune system. The safety profile is pretty much as wed hoped and the immune responses are okay but not great he told Reuters. The data published in the New England Journal of Medicine were from healthy volunteers given the vaccine in Britain between Sept. and Nov. last year. The volunteers got one of three doses low medium or high and data from days after vaccination showed the shot was safe at these doses with only mild side effects. People typically experienced mild symptoms that lasted for one or maybe two days such as pain or reddening at the injection site and occasionally people felt feverish Hill said. However the antibody response was weaker than was found in a trial of the same Ebola vaccine in macaque monkeys in which the animals were also found to be protected. Hill said the lower antibody levels together with a lower response detected in the immune systems Tcells suggested to him that a booster may well be needed. Jeremy Farrar director of the Wellcome Trust charity which helped fund the trial said it provided good initial evidence that the GSK vaccine will be safe to use in people. However we still dont know whether it will provide protection against Ebola infection in a realworld situation he said. Thats why trials in West Africa of this and the other vaccines in development must begin as soon possible. Editing by Louise Ireland Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"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"

"An experimental Ebola vaccine was highly protective against the deadly virus in a major trial in Guinea according to results published today in The Lancet. The vaccine is the first to prevent infection from one of the most lethal known pathogens and the findings add weight to early trial results published last year. The vaccine called rVSVZEBOV was studied in a trial involving people in Guinea during . Among the people who received the vaccine no Ebola cases were recorded days or more after vaccination . In comparison there were cases days or more after vaccination among those who did not receive the vaccine. The trial was led by the World Health Organization together with Guineas Ministry of Health and other international partners. While these compelling results come too late for those who lost their lives during West Africas Ebola epidemic they show that when the next Ebola outbreak hits we will not be defenceless said Dr MariePaule Kieny WHOs Assistant DirectorGeneral for Health Systems and Innovation and the studys lead author . The vaccines manufacturer Merck Sharpe Dohme this year received Breakthrough Therapy Designation from the United States Food and Drug Administration and PRIME status from the European Medicines Agency enabling faster regulatory review of the vaccine once it is submitted. Since Ebola virus was first identified in sporadic outbreaks have been reported in Africa. But the West African Ebola outbreak which resulted in more than deaths highlighted the need for a vaccine. The trial took place in the coastal region of BasseGuine the area of Guinea still experiencing new Ebola cases when the trial started in . The trial used an innovative design a socalled ring vaccination approach the same method used to eradicate small pox. When a new Ebola case was diagnosed the research team traced all people who may have been in contact with that case within the previous weeks such as people who lived in the same household were visited by the patient or were in close contact with the patient their clothes or linen as well as certain contacts of contacts. A total of clusters or rings were identified each made up of an average of people. Initially rings were randomised to receive the vaccine either immediately or after a week delay and only adults over years were offered the vaccine. After interim results were published showing the vaccines efficacy all rings were offered the vaccine immediately and the trial was also opened to children older than years. In addition to showing high efficacy among those vaccinated the trial also shows that unvaccinated people in the rings were indirectly protected from Ebola virus through the ring vaccination approach socalled herd immunity. However the authors note that the trial was not designed to measure this effect so more research will be needed. Ebola left a devastating legacy in our country. We are proud that we have been able to contribute to developing a vaccine that will prevent other nations from enduring what we endured said Dr Keta Sakoba Coordinator of the Ebola Response and Director of the National Agency for Health Security in Guinea . To assess safety people who received the vaccine were observed for minutes after vaccination and at repeated home visits up to weeks later. Approximately half reported mild symptoms soon after vaccination including headache fatigue and muscle pain but recovered within days without longterm effects. Two serious adverse events were judged to be related to vaccination a febrile reaction and one anaphylaxis and one was judged to be possibly related influenzalike illness. All three recovered without any long term effects. It was not possible to collect biological samples from people who received the vaccine in order to analyse their immune response. Other studies are looking at the immune response to the vaccine including one conducted in parallel to the ring trial among frontline Ebola workers in Guinea. This both historical and innovative trial was made possible thanks to exemplary international collaboration and coordination the contribution of many experts worldwide and strong local involvement said Dr JohnArne Rttingen Specialist Director at the Norwegian Institute of Public Health and the chairman of the study steering group . In January GAVI the Vaccine Alliance provided US million to Merck towards the future procurement of the vaccine once it is approved prequalified and recommended by WHO. As part of this agreement Merck committed to ensure that doses of the vaccine are available for emergency use in the interim and to submit the vaccine for licensure by the end of . Merck has also submitted the vaccine to WHOs Emergency Use and Assessment Listing procedure a mechanism through which experimental vaccines medicines and diagnostics can be made available for use prior to formal licensure. Additional studies are ongoing to provide more data on the safety of the vaccine in children and other vulnerable populations such as people with HIV. In case of Ebola flareups prior to approval access to the vaccine is being made available through a procedure called compassionate use that enables use of the vaccine after informed consent. Merck and WHOs partners are working to compile data to support license applications. The rapid development of rVSVEBOV contributed to the development of WHOs RD Blueprint a global strategy to fasttrack the development of effective tests vaccines and medicines during epidemics. Also published in The Lancet embargo as above is a phase trial of a different Ebola vaccine candidate the recombinant adenovirus type Ebola vaccine. The trial was led by the Beijing Institute of Biotechnology and was conducted in Sierra Leone in . It involved healthy participants followed for months were given a high dose vaccine a lowdose and a placebo. The study found that the vaccine was safe and induced an immune response that peaked at days but decreased during the six months post injection. One serious adverse event was reported in an individual with a history of asthma. Further research on this vaccine is needed in order to assess its efficacy. NOTES TO EDITORS The rVSVZEBOV trial is funded by WHO with support from the Wellcome Trust the United Kingdom Department for International Development the Norwegian Ministry of Foreign Affairs to the Norwegian Institute of Public Health through the Research Council of Norway the Canadian Government through the Public Health Agency of Canada Canadian Institutes of Health Research International Development Research Centre and Department of Foreign Affairs Trade and Development and Mdecins Sans Frontires. The trial team includes experts from The University of Bern the University of Florida the London School of Hygiene and Tropical Medicine Public Health England the European Mobile Laboratories among others. The trial was designed by a group of experts including the late Professor Donald A. Henderson of John Hopkins University who led the WHO smallpox eradication effort by using the ring vaccination strategy. http VSVEBOV was developed by the Public Health Agency of Canada. The vaccine was licensed to NewLink Genetics who in turn licensed it to Merck Co. The vaccine works by replacing a gene from a harmless virus known as vesicular stomatitis virus VSV with a gene encoding an Ebola virus surface protein. The vaccine does not contain any live Ebola virus. Earlier trials have shown the vaccine to be protective in animals and be safe and produce an immune response in humans. Analysis only included cases occurring days after receiving the vaccine to account for the incubation period of the Ebola virus. Quotes direct from authors and cannot be found in the text of the Article."

"Cancer patients who have ovarian tissue removed and stored for later transplantation have a chance at a successful pregnancy a new study finds. Powerful chemotherapy and radiation treatments for cancer can impair a womans fertility. This new study shows that ovarian tissue transplants are safe and effective and pose little risk of the cancer coming back the Danish researchers said. This procedure is gaining ground worldwide as an optional fertility treatment for fertile female cancer patients who after cancer treatment most likely will be infertile said lead researcher Dr. Annette Jensen from the Laboratory of Reproductive Biology at Rigshospitalet in Copenhagen. With this procedure many women who survive cancer should be able to become pregnant and have healthy children Jensen said. Of women who had ovarian tissue frozen and transplanted in this study women or percent had a child she said. Many young cancer patients today can expect to live a normal lifespan. Their focus shifts from survival to qualityoflife explained senior researcher Dr. Claus Yding Andersen a professor of human reproductive physiology at the University of Copenhagen. Here fertility is very important to many young women he said. The tissue restores ovarian organ function and women regain menstrual cycles and sex hormone levels that will avoid menopause Andersen added. Dr. Avner Hershlag chief of the Center for Human Reproduction at North Shore University Hospital in Manhasset N.Y. called the new research innovative and exciting. Simultaneous advances in cancer treatment and reproductive medicine have made these scientific leaps possible he said. However Hershlag said he would like to see a pregnancy rate above percent. The pregnancy rate with frozen embryos is close to percent and results are getting better he said referring to another option for women hoping for a future pregnancy. It remains to be seen which method is better. The Danish report was published Oct. in the journal Human Reproduction. For the study the researchers reviewed the outcomes of transplantations of thawed ovarian tissue in Danish women. The investigators followed the women for years looking at ovarian function fertility and safety. The womens average age when the tissue was removed and frozen was nearly . Average age of the first transplant was . Thirtytwo of the women attempted pregnancy. Ten were successful and had at least one child children in all. Eight children were conceived naturally and six with the help of in vitro fertilization the researchers reported. Two women had abortions one because she was separating from her partner and the other because her breast cancer recurred. Another woman had a miscarriage the researchers said. For three of the mothers more than years had passed since the ovarian tissue transplantation. In six cases it was more than eight years. And for of the women transplantation had taken place more than five years earlier the researchers said. Although three women had a relapse of their cancer these relapses did not appear related to the tissue transplantation. And no cancer developed in the transplanted tissue Jensen said. So some of these women will still be able to have more children and avoid menopausal symptoms she said noting two more pregnancies have been reported to her laboratory since the studys publication. Not all women are eligible for ovarian tissue transplants however. In particular we have not performed transplants in patients who have suffered from leukemia because the ovarian tissue may harbor cancer cells Jensen said. More information For more on fertility and cancer treatments visit the American Cancer Society. SOURCES Claus Yding Andersen M.Sc. DM.Sc. professor human reproductive physiology University of Copenhagen Denmark Annette Jensen M.D. Laboratory of Reproductive Biology Rigshospitalet Copenhagen Denmark Avner Hershlag M.D. chief Center for Human Reproduction North Shore University Hospital Manhasset N.Y. Oct. Human"

"The immune checkpoint blockade drug nivolumab reduced tumor burden in . percent of patients with metastatic bladder cancer regardless of whether their tumors had a biomarker related to the drugs target according to clinical trial results from The University of Texas MD Anderson Cancer Center. The study will be presented Sunday June at the American Society of Clinical Oncology Annual Meeting. The response rate is better than weve seen for other potential secondline treatments and nivolumab is really welltolerated which is important because bladder cancer patients are a fragile group after frontline treatment with platinum chemotherapy said Padmanee Sharma M.D. Ph.D. professor of Genitourinary Medical Oncology at MD Anderson. Nivolumab unleashes an immune system attack on cancer by blocking activation of a protein called PD on T cells white blood cells that find and attack cells viruses or bacteria that have specific targets. PD acts as a brake or checkpoint to shut down activated T cells. PD is turned on by a ligand called PDL which is often found on cancer cells and other types of cells. The presence of PDL on a patients tumor has been considered a potential biomarker to guide treatment. The study found no significant difference in response rates between those with little to no PDL on their tumors percent and those with greater PDL expression percent. We can get good results without choosing to treat patients based on PDL status said Sharma who also is scientific director of MD Andersons immunotherapy platform and an investigator with the Parker Institute for Cancer Immunotherapy at MD Anderson. The platform is part of MD Andersons Moon Shots Program launched in to reduce cancer deaths by accelerating development of therapies prevention efforts and early detection from scientific discoveries. This Phase III clinical trial treated patients five . percent had complete responses percent had partial responses in which tumor burden shrinks by at least percent and . percent had stable disease. Thirty percent patients had disease progression. Treatmentrelated side effects included mainly lowgrade fatigue itching elevated lipase rash nausea joint pain and anemia. Grade or side effects occurred in . percent of patients. Two patients discontinued therapy because of adverse events related to the drug. At a median follow up of days . percent remained on treatment and . percent of patients survived for at least one year which Sharma noted is better than anything weve seen in the past. Overall survival will be analyzed in conjunction with the Phase II portion of this clinical trial which provides nivolumab or a combination of nivolumab plus the immune checkpoint inhibitor ipilimumab. The trial allows patients to cross over to the combination if nivolumab alone fails. Initial results from the Phase II portion of the trial will be presented later this year. Both nivolumab known as Opdivo and ipilimumab known as Yervoy were developed and marketed by BristolMyers Squibb which funded the clinical trial. Ipilimumab targets the CTLA checkpoint on T cells and was the first immune checkpoint inhibitor. It was based on the research of Jim Allison Ph.D. chair of Immunology executive director of the immunotherapy platform and director of the Parker Institute for Cancer Immunotherapy at MD Anderson. Ipilimumab was the first drug ever shown to extend the survival of patients with metastatic melanoma. Longterm follow up shows percent of those treated with the drug survive years or longer. Nivolumab has been approved by the U.S. Food and Drug Administration for advanced melanoma lung cancer kidney cancer and Hodgkin lymphoma. The fiveyear survival rate for those with metastatic melanoma treated with nivolumab is percent. The twoyear survival rate of patients treated with both drugs in combination is percent. Until May there were no drugs approved for secondline treatment of metastatic bladder cancer. The U.S. FDA approved atezolizumab which blocks PDL for these patients. Coauthors with Sharma who presented the data at ASCO are Petri Bono Helsinki University Hospital Helsinki Finland Joseph Kim Yale Cancer Center Pavlina Spiliopoulou Beatson West of Scotland Cancer Centre Glasgow Emiliano Calvo Centro Integral Oncolgico Clara Campal MadridSpain Rathi Pillai Emory Winship Cancer Institute Atlanta Patrick Ott Dana Farber Cancer Institute Boston Filippo DeBraud Istituto Nazionale dei Tumori Milan Italy Michael Morse Duke University Medical Center Durham N.C. Dung Le Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore Dirk Jaeger Heidelberg University Hospital Heidelberg Germany Emily Chan Vanderbilt University Nashville Tenn. Chris Harbison ChenSheng Lin Marina Tschaika Alex Azrilevich of BristolMyers Squibb and Jonathan Rosenberg of Memorial Sloan Kettering Cancer Center."

"Testing women for human papillomavirus HPV may catch more precancerous growths than standard cervical cancer screening does but more evidence is needed before the newer tests become routine a study published Monday concludes. The report in the Annals of Internal Medicine sums up a research review done for the U.S. Preventive Services Task Force USPSTF an expert medical panel supported by the federal government. The USPSTF is set to update its recommendations on cervical cancer screening which were last laid out in . At that time the task force recommended that sexually active women get regular Pap tests to screen for cervical cancer. But it said there was not enough evidence to recommend for or against newer types of testing including HPV tests and the liquidbased Pap tests that are now more often used than the oldfashioned version. During Pap tests cells are swabbed or scraped from the cervix for examination under a microscope to find cancer or possible precancerous changes. In the socalled liquidbased version the cells are placed in special preservative liquid designed to make the specimen easier to read those same cells can also be used for HPV testing unlike the cells collected with conventional Pap tests. Exactly what impact the new research review will have on the USPSTF recommendations is anyones guess. A draft of the guidelines will not be published until Wednesday when it will be available for public comment on the task force website here .usa.govxXexl http.usa.govxXexl. A lot of research has been done since the recommendations said Dr. Evelyn P. Whitlock a senior investigator with Kaiser Permanente Northwest in Portland Oregon who led the review. But there are still questions about the effects of HPV screening and more complete evidence is needed before it becomes widely used Whitlock and her colleagues write. HPV is a common virus that causes warts including genital warts. Usually the immune system clears the infection but persistent infection with certain strains of HPV leads to cervical cancer in some women. So in recent years tests for those highrisk HPV strains have been developed to help in screening for the disease. A few HPV tests are approved for use along with Pap tests for screening women age or older. The tests are not approved for younger women because they give doctors little information younger women commonly have HPV infections that go away on their own. It has not been clear exactly how HPV testing or liquidbased Pap tests measure up against standard Pap tests. In their review Whitlocks team examined four clinical trials including more than women that compared older Pap tests with the liquidbased version. They found that both tests had nearly the same sensitivity which refers to their ability to detect cancer or precancer. The tests also had the same specificity which can be used to measure how often a screening test produces falsepositive results. Across studies the falsepositive rate ranged between about six percent and percent for both conventional and liquidbased Pap tests. Its reassuring to know that they perform equivalently Whitlock told Reuters Health. In an interview she noted that the decision of whether to do a conventional or liquidbased Pap test is not the patients. It may not even be the doctors but may instead depend on whatever health system he or she is part of. Several other clinical trials in the review looked at HPV testing. In general Whitlocks team found HPV tests were more sensitive than conventional Pap tests but they were less specific meaning they had a higher falsepositive rate. In a trial of more than women for example HPV testing caught percent of potentially precancerous growths versus percent with Pap tests. But the falsepositive rate was percent compared with two percent with Pap testing. The problem with that higher falsepositive rate is that it could lead to needless biopsies and other tests or treatment to remove abnormallooking tissue. Its a tricky thing to get your mind around Whitlock said. It may seem that if a test is more sensitive it must be better. But its more subtle than that. Youre trying to make a tradeoff between sensitivity and specificity. Since cervical cancer screening is repeated over time whats needed is evidence of the longerterm effects of different tests according to Whitlock. How often for example does HPV testing lead to biopsies versus Pap testing And no one knows yet whether HPV testing actually catches cervical cancer at an earlier stage or reduces deaths from the disease compared with Pap tests. Clinical trials are ongoing Whitlock said. The state of the science will be changing relatively quickly so well have to keep looking at this. Right now the American Cancer Society ACS and other medical groups recommend that women start Pap tests at age or three years after they become sexually active whichever comes first. Those should be done every one to two years until age after age women whove had three normal Pap tests in a row can be screened less often every two to three years. Pap plus HPV testing done every three years is considered a reasonable option for women age and up according to the ACS. Whitlock called Pap testing one of the big public health success stories. Nationally the cervical cancer death rate dropped by percent between and and routine Pap testing is credited for most of that decline. But many women still do not get regular Pap screening Whitlock pointed out. Its thought that more than half of cervical cancer cases in the U.S. occur in women whove never been screened or havent been in the past five years. If more women received the screening that already exists that would be a huge step forward Whitlock said. An estimated U.S. women will be diagnosed with cervical cancer this year and nearly will die from the disease according to the ACS. SOURCE bit.lyatTzv httpbit.lyatTzv Annals of Internal Medicine online October . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html Sponsored"

"Its often prescribed for migraines httpshealth.usnews.comhealthnewspatientadvicearticlesmanagingmigraineduringpregnancy rheumatoid arthritis fever gout httpshealth.usnews.comhealthnewsblogseatrunhowtoeattocontrolgout and even postoperative pain. Now diclofenac could be a contender to help treat cancer httpshealth.usnews.comhealthnewspatientadvicearticlespreparingforababyaftercancer. The Repurposing Drugs in Oncology ReDO project published a clinical study this week in ecancermedicalscience httpecancer.orgjournalfullrepurposingdrugsinoncologyredodiclofenacasananticanceragent.php that the affordable generic nonsteroidal antiinflammatory drug or NSAID httpshealth.usnews.comhealthnewshealthwellnessarticleslongtermbabyaspirinothernsaidusemaylowercoloncancerrisk has cancerfighting properties. While researchers already suspected NSAIDs can help prevent cancer theyre only now beginning to explore the ways that they could actually help treat the disease. Its still somewhat surprising that there is still so much we dont understand about how many of the standard drugs we use every day like diclofenac work study author Pan Pantziarka member of the ReDO project and the Anticancer Fund said in a press release http But the more we learn the more we can see that these drugs are multitargeted agents with interesting and useful effects on multiple pathways of interest in oncology. Pantziarka and colleagues report that diclofenac may improve the immune system the effectiveness of chemotherapy httpshealth.usnews.comhealthnewspatientadvicearticlesgettingthebetterofchemobrain and radiation and the development of blood vessels. Previous studies have shown that the drug could reduce tumor size in fibrosarcoma colorectal cancer neuroblastoma ovarian cancer and several other cancers according to the press release. Treating cancer patients with diclofenac after surgery httpshealth.usnews.comhealthnewspatientadviceslideshowswaystoprepareforsurgery could also be beneficial the authors wrote in the study. After all its metastatic disease that most often kills patients not the original primary disease Pantziarka said in the release. There are currently other clinical trials underway testing the effectiveness of additional NSAIDs in cancer therapy according to the press release. How to Stop a Headache httpshealth.usnews.comhealthnewsblogseatrunhowtostopaheadache Immunotherapys Promise Against Cancer httpshealth.usnews.comhealthnewspatientadvicearticlesimmunotherapyspromiseagainstcancer"

"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"

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

"UCLA researchers have demonstrated for the first time that black tea may promote weight loss and other health benefits by changing bacteria in the gut. In a study of mice the scientists showed that black tea alters energy metabolism in the liver by changing gut metabolites. The research is published in the European Journal of Nutrition. The study found that both black and green tea changed the ratio of intestinal bacteria in the animals The percentage of bacteria associated with obesity decreased while bacteria associated with lean body mass increased. Previous studies indicated that chemicals in green tea called polyphenols are absorbed and alter the energy metabolism in the liver. The new findings show that black tea polyphenols which are too large to be absorbed in the small intestine stimulate the growth of gut bacterium and the formation of shortchain fatty acids a type of bacterial metabolites that has been shown to alter the energy metabolism in the liver. It was known that green tea polyphenols are more effective and offer more health benefits than black tea polyphenols since green tea chemicals are absorbed into the blood and tissue said Susanne Henning the studys lead author and an adjunct professor at the UCLA Center for Human Nutrition which is part of the David Geffen School of Medicine at UCLA. Our new findings suggest that black tea through a specific mechanism through the gut microbiome may also contribute to good health and weight loss in humans. The results suggest that both green and black teas are prebiotics substances that induce the growth of good microorganisms that contribute to a persons wellbeing she said. In the study four groups of mice received different diets two of which were supplemented with green tea or black tea extracts Lowfat highsugar Highfat highsugar Highfat highsugar and green tea extract Highfat highsugar and black tea extract After four weeks the weights of the mice that were given green or black tea extracts dropped to the same levels as those of the mice that received the lowfat diet throughout the study. The researchers also collected samples from the mices large intestines to measure bacteria content and liver tissues to measure fat deposits. In the mice that consumed either type of tea extract there was less of the type of bacteria associated with obesity and more of the bacteria associated with lean body mass. However only the mice that consumed black tea extract had an increase in a type of bacteria called Pseudobutyrivibrio which could help explain the difference between how black tea and green tea change energy metabolism. Dr. Zhaoping Li director of the UCLA Center for Human Nutrition chief of the UCLA Division of Clinical Nutrition and the studys senior author said the findings suggest that the health benefits of both green tea and black tea go beyond their antioxidant benefits and that both teas have a strong impact on the gut microbiome. For black tea lovers there may be a new reason to keep drinking it she said. The findings build on a UCLA study that demonstrated that both green tea and black tea helped prevent obesity in mice that consumed a highfat highsugar diet. The new study also concluded that both green tea and black tea have different effects on liver metabolism. According to Henning the molecules in green tea are smaller and can more readily be absorbed into the body and reach the liver directly while black tea molecules are larger and stay in the intestine rather than being absorbed. When black tea molecules stay in the intestinal tract they enhance the growth of beneficial bacteria and the formation of microbial metabolites involved in the regulation of energy metabolism. The study was funded by the National Institutes of Health and the UCLA Center for Human Nutrition."

"A daily aspirin to prevent cancer Maybe. A British study http offers compelling though not clinching evidence that the humble aspirin tablet can prevent death from a variety of cancers if you take the medicine long enough in middle age. Even a baby aspirin might be enough. Dont start popping aspirin every morning to fight tumors without talking to your doctor though. Yes scientists have already published strong evidence http suggesting aspirin can cut bowel cancer and deaths. The painkillers antiinflammatory properties and effects in damping down precancerous polyps may be involved. And the latest study published in The Lancet suggests aspirin could provide protection against a wide variety of tumors. They range from pancreatic cancer to the type of lung cancer that strikes nonsmokers httplungcancer.about.comodwhatislungcanceralungcancernonsmokers.htm. For some of these cancers the reduction in death was remarkable. Twenty years after people had started taking aspirin regularly and kept it up for at least five years their deaths from esophageal cancer httpheartburn.about.comcsarticlesaesophaguscancer.htm were reduced by percent compared to study subjects who got a placebo. Deaths from adenomatous lung cancer were cut percent those from colorectal cancer percent and those from prostate cancer percent. Still none of the big guns in cancer and prevention the National Cancer Institute the American Cancer Society or the U.S. Preventive Services Task Force are ready to advise healthy people to start taking aspirin to prevent cancer. But the latest batch of evidence deserves a closer look. It encompasses eight earlier studies that compared cancer deaths among more than people randomly assigned to get aspirin of different doses or placebo. And the researchers were able to gather more information about cancer deaths for up to years after those studies ended about nearly people. Article continues after this message from our sponsor For cancer prevention experts the British study is provocative and significant. This is definitely the first time that research has shown that longterm aspirin use can reduce the risk of deaths due to cancer Dr. Asad Umar of the National Cancer Institutes division of cancer prevention tells Shots. In fact Umar says no drug has been shown before now to prevent cancer deaths. This is definitely hypothesisgenerating for future studies Umar says. Massachusetts General Hospitals Dr. Andrew Chan http who studies the effect of aspirin on gastrointestinal cancers says the new study will feed a growing sense among experts that there is likely some potential anticancer effect of aspirin. Dr. Peter Rothwell an Oxford University neurologist who led the study tells Shots that aspirins effect on cancer is quite a lot bigger than its benefit in preventing heart attacks and strokes the reason millions of Americans already swallow a baby aspirin every day. So I think in the fullness of time preventing cancer will be seen to be the main reason for taking aspirin in healthy individuals Rothwell says. He started taking a daily dose of aspirin a couple of years ago as the results of his study emerged. It was looking as though there was something going on and I thought it was a sufficiently large benefit to be worth doing something about says the yearold researcher. Rothwell says the sensible time to start taking aspirin would be before the risk of cancer starts to rise at about . He says prophylactic aspirin is worth thinking about for people with a family history of early cancers. But aspirin carries risks. The biggest is stomach bleeding although it also raises the risk of brain hemorrhage. Daily aspirin doubles a persons gastrointestinal bleeding risk to about in every people a year. But Rothwell says this bleeding hazard is drowned out by the cancer benefit. Prof. Peter Elwood of the University of Cardiff who wasnt involved in the new study agrees. Theres a small risk of any of us having a gastric bleed Ellwood said at a Lancet press conference Monday. But when you inspect the datayou find that the mortality from the bleed is not increased. In other words aspirin seems to be increasing the lessserious bleeds he said. To be sure the U.S. Preventive Services Task Forces currently recommends against http taking aspirin to prevent colorectal cancer the type of cancer for which there is the largest body of scientific work. The benefits of daily lowdose aspirin can exceed the risks for many middleaged and older people when it comes to preventing heart attacks and strokes the task force says http So for those already taking prophylactic aspirin for this reason the possible anticancer effects are just icing on the cake. Other healthy people interested in taking aspirin to prevent cancer should consult their doctors experts say and possibly await further evidence. A final word about dose The new study didnt find any additional anticancer benefit for aspirin doses above milligrams a day the British dose for a baby aspirin. In the United States a baby aspirin weighs in at milligrams. However experts say more information is needed on the optimum dose for cancer prevention. Theres a little controversy about whether a baby aspirin dose is enough says Harvards Chan. We think that probably a standard adult aspirin dose of milligrams is more likely to be effective."

"Americas favorite dietary supplements multivitamins modestly lowered the risk for cancer in healthy male doctors who took them for more than a decade the first large study to test these pills has found. The result is a surprise because many studies of individual vitamins have found they dont help prevent chronic diseases and some have even caused problems. In the new study multivitamins cut the chance of developing cancer by . That is less effective than a good diet exercise and not smoking each of which can lower cancer risk by to cancer experts say. Multivitamins also may have different results in women younger men or people less healthy than those in this study. Its a very mild effect and personally Im not sure its significant enough to recommend to anyone although it is promising said Dr. Ernest Hawk vice president of cancer prevention at the University of Texas MD Anderson Cancer Center and formerly of the National Cancer Institute. At least this doesnt suggest a harm as some previous studies on single vitamins have he said. Hawk reviewed the study for the American Association for Cancer Research which is meeting in Anaheim Calif. where the study was to be presented on Wednesday. It also was published online in the Journal of the American Medical Association http About onethird of U.S. adults and as many as half of those over take them. They are marketed as a kind of insurance policy against bad eating. Yet no government agency recommends their routine use regardless of the quality of a persons diet says a fact sheet from the federal Office of Dietary Supplements httpods.od.nih.govfactsheetsMVMSHealthProfessional. Some fads such as the antioxidant craze over vitamins A and E and betacarotene backfired when studies found more health risk with those supplements not less. Many of those were single vitamins in larger doses than the of daily value amounts that multivitamins typically contain. Science on vitamins has been skimpy. Most studies have been observational they look at groups of people who do and do not use vitamins a method that cant give firm conclusions. Dr. J. Michael Gaziano of Brigham and Womens Hospital and VA Boston led a stronger test. Nearly male doctors who were or older and free of cancer when the study started were given monthly packets of Centrum Silver or fake multivitamins without knowing which type they received. After about years there were new cancers and some people had cancer more than once. For every men per year in the study there were cancers among multivitamin users and more than among those taking the placebo pills. That worked out to an lower risk of developing cancer in the vitamin group. Multivitamins made no difference in the risk of developing prostate cancer which accounted for half of all cases. They lowered the risk of other cancers collectively by about . There also was a trend toward fewer cancer deaths among multivitamin users but the difference was so small it could have occurred by chance alone. Side effects were fairly similar except for more rashes among vitamin users. The National Institutes of Health paid for most of the study. Pfizer Inc. supplied the pills and other companies supplied the packaging. The main reason to take a multivitamin is to correct or prevent a deficiency but there may be a modest benefit in reducing the risk of cancer in older men Gaziano said. Cancer experts said the results need to be confirmed by another study before recommending multivitamins to the public. These participants were healthier only smoked for example. For people who do want to take multivitamins doctors suggest Be aware that they are dietary supplements which do not get the strict testing required of prescription medicines. Ask your doctor before taking any. Vitamin K can interfere with common heart medicines and blood thinners and vitamins C and E can lower the effectiveness of some types of chemotherapy. For people having surgery some vitamins affect bleeding and response to anesthesia. Current and former smokers should avoid multivitamins with lots of betacarotene or vitamin A two studies have tied them to increased risk of lung cancer."

"A new blood https test may help pregnant https women who are at high risk for having a baby https with Down syndrome https avoid more invasive tests such as amniocentesis https and chronic villus sampling CVS. The blood https test analyzes components of genetic material from both the pregnant woman and her fetus https that is present in the mothers blood. It could help avoid up to of these screening procedures according to the study which appears in BMJ. While amniocentesis https and CVS can help definitively determine if an unborn baby has Down syndrome or trisomy these tests do carry a risk of miscarriage https and some women are unwilling to take this risk. These tests also screen for other less common fetal abnormalities and birth defects https such as trisomy and trisomy https Accuracy of Blood Test The new blood test would be used if a woman was considered at high risk for having a child with Down syndrome based on her age or other factors. The sequencing test could be used to rule out trisomy among highrisk pregnancies before proceeding to invasive diagnostic testing to reduce the number of cases requiring amniocentesis or CVS conclude study authors who were led by Dennis Lo of the Chinese University of Hong Kong in China. The new study included pregnant women who were at high risk for having a child with Down syndrome. Of these women were determined to be pregnant with a child with Down syndrome. There were no falsenegative results with the new test suggesting it can help avoid of followup invasive tests in women whose test shows that their baby does not have Down syndrome. In a year or two this test may be available but it wont replace existing technologies it will nudge its way into our armamentarium of available methodologies says Mark I. Evans MD director of Comprehensive Genetics in New York City and an obstetrician https at Mount Sinai School of Medicine also in New York City. Not Ready for Prime Time The bad news is that prenatal diagnosis is not just about Down syndrome he says. Down syndrome represents about of what we find and this new test can help with that but it may also give women a false sense of reassurance. Still he adds its an important step forward. The technology is likely prohibitively expensive and timeconsuming at this point he says. Its not ready for prime time but researchers are actively working on methods to increase its efficiency he says. Patients are very concerned about loss rates with aminocentesis and CVS and want reassurance about their pregnancies so we are always looking for a better test says Jennifer Wu an obstetriciangynecologist Lenox Hill Hospital in New York City. This test looks very promising but it is also very expensive While there are risks attached to amniocentesis and CVS screens these are minimized when the test is performed by a skilled obstetrician she says. The new test looks very promising says Cathy Sullivan a genetic counselor at the University of Texas Health Sciences Center in Houston. We are not quite there yet but it may become a real possibility for finding out real information without having to risk a pregnancy. For example If this comes back negative you dont need an amniocentesis but if it comes back positive we would probably still do an amniocentesis to confirm the results she says. While the new screen only looks for Down syndrome Sullivan says that some of the other trisomy birth defects can be more easily identified on an ultrasound https exam. Many babies with Down syndrome appear normal on an ultrasound she says. Joyce Fox MD the chief of medical genetics at Cohen Childrens Medical Center in New Hyde Park N.Y. definitely sees a role for a test such as the one described in the new study. For now the test just looks for Down syndrome but technology will advance to the point where noninvasive testing will encompass more of the less common genetic anomalies she says. For women who are concerned about losing a pregnancy as a result of an invasive test this is an excellent addition to our armamentarium of screening she says. It is not a diagnostic test for Down syndrome she says. It can help women put some of the information from other tests into context."

"The results of a study presented today at the European League Against Rheumatism Annual Congress EULAR showed that in rheumatoid arthritis RA patients a good clinical response to maintenance treatment with a tumour necrosis factor inhibitor TNFi was maintained even when the dose was reduced by onethird. Reducing the TNFi dose by twothirds resulted in more flares exacerbations of symptoms and signs but these subsided when the higher dose of TNFi was restarted and did not adversely affect subsequent progression of any disability. In some cases however patients maintained a clinical response after stopping the TNFi altogether. The optimal management of RA involves achieving the lowest possible disease activity ideally remission and then maintaining this level of control said lead author Dr. James Galloway Department of Rheumatology Kings College Hospital NHS Foundation Trust UK. Findings from our study have shown that adopting a TNFi dose reduction strategy can still meet this objective with no compromise on symptom control for the patient and offering a more costeffective option by substantially reducing the high drug costs associated with TNFi maintenance therapy. RA is a chronic inflammatory disease characterised by joint inflammation and damage functional disability and significantly increased mortality. Early intervention using a conventional synthetic diseasemodifying antirheumatic drug DMARD such as methotrexate is critical in preventing structural joint damage and progressive loss of function. For those patients who either fail to respond or who develop an inadequate response to these drugs over time a biologic DMARD is an effective addon treatment option. The first choice of biologic therapy is usually a TNFi and currently identical dosing regimens of TNFi are used both to induce and then maintain a clinical response. Over the first six months of the study flares exacerbations of symptoms and signs occurred in of patients who stayed on the same TNFi dose compared to a similar figure of in those patients for whom the dose was reduced by onethird. A twothirds dose reduction increased the odds of a flare occurring by four times compared with a onethird dose reduction with flares occurring in of patients. Postdose reduction flares resolved when the original dose of TNFi was restarted. There were no significant differences in selfreported measures of disability Health Assessment Questionnaire score with either dose reduction strategy at six months. The OPTTIRA study is a month multicentre randomised controlled trial designed to evaluate if reducing TNFi doses of either etanercept or adalimumab caused a loss of response in RA patients who were also receiving a synthetic DMARD. To be eligible patients had to demonstrate stable low disease activity DAS less than . for over three months. Patients with serious concomitant illness or those taking highdose steroids more than mg prednisolone daily were excluded. Of the patients who reduced then stopped their TNFi after six months succeeded without flaring and their final mean DAS score after stopping treatment was . demonstrating low disease activity. Abstract Number SAT NOTES TO EDITORS For further information on this study or to request an interview with the study lead please do not hesitate to contact the EULAR congress Press Office in Room B of Fiera Roma during EULAR or on Email eularpressofficecohnwolfe.com mailtoeularpressofficecohnwolfe.com Onsite tel Twitter EULAR_Press httpstwitter.comeular_press Youtube Eular Pressoffice About EULAR The European League Against Rheumatism EULAR is an umbrella organisation which represents scientific societies health professional associations and organisations for people with rheumatic diseases throughout Europe. EULAR aims to promote stimulate and support the research prevention and treatment of rheumatic diseases and the rehabilitation of those it affects. With scientific member societies People with Arthritis and Rheumatism in Europe PARE organisations health professionals associations and corporate members EULAR highlights the importance of combating rheumatic diseases through both medical means and patient care. EULAR is set to be the biggest rheumatology event in Europe with around scientists physicians allied health professionals and related audiences in attendance from more than countries. Over the course of the congress there will be some oral and just under poster abstract presentations more than sessions lectures poster tours and invited speakers. To find out more about the activities of EULAR visit http"

"New results from a clinical trial involving more than military veterans at high risk for keratinocyte carcinoma skin cancer provides evidence that using the generic skin cream fluorouacil percent for two to four weeks may reduce the risk of a squamous cell carcinoma SCC needing surgery by percent within a year. The finding that less than one months use of fluorouacil FU appeared to prevent cancer for up to a year is encouraging said lead author Dr. Martin A. Weinstock a professor of dermatology in the Warren Alpert Medical School of Brown University and chief of dermatology at the Providence Veterans Affairs Medical Center. The dose is the same as dermatologists currently employ to treat actinic keratosis. In a study Weinstock and coauthors showed the up to fourweek regimen of FU had a multiyear preventive benefit in reducing the number of actinic keratosis AK and the need for treatment. Earlier this year they also showed that the medicine prevents new AKs from emerging for two to three years. Meanwhile current means for preventing new carcinomas in highrisk patients sunscreen or oral medications cease to work as soon as they are no longer used. But in the new study FU appeared to provide prolonged protection after discontinuation and could be combined with sunscreen Weinstock said. In the absence of such a longlasting prevention option he said the typical approach to caring for patients with a history of prior carcinomas is to monitor for the next cancer and then remove it surgically an effective but imposing strategy often called wait and cut. People dont appreciate having stuff cut on their face a lot said Weinstock who led the trial funded by the U.S. Department of Veterans Affairs and conducted at a dozen V.A. hospitals around the country. They do it if there is a cancer there but we want to take a proactive approach where we can give them something to reduce their risk of getting new cancers. The new results are published in JAMA Dermatology. The VAKCC trial Between and the Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial randomly assigned veterans who each had at least two prior basal cell carcinomas BCCs or SCCs to either receive the FU cream or a cream just like it but without the active ingredient as an experimental control. All of the veterans were instructed to apply their cream twice a day to their face and ears for up to four weeks. They also received a SPF sunscreen and received education about skin cancer sunscreen and sun safety. The two groups were both almost exclusively white and male and they averaged years of age. The experimental and control groups were very similar along all other measured characteristics including their self reported degree of prior sun exposure and sunburn. Veterans typically have spent a large amount of time in the sun during their years of service. Both groups went to their V.A. center twice a year for two to four years for followup exams with a dermatologist. Neither the veterans nor the examining dermatologists knew who received FU and who received the placebo. Some reduced risks After the first year of the veterans in the control group developed a squamous cell carcinoma that required surgery but only five of the veterans who got FU did a statistically significant percent reduction in the risk according to the study. For the subsequent three years there was no longer a significant difference between the two groups in the number of patients who required surgical treatment for an SCC. For BCCs there was an percent reduced risk after the first year among the group that received FU but that difference was not statistically significant. In the second year BCC cases requiring surgery rose in the FU group but in years three and four and by the end of the study there was no significant overall difference in risk of developing a BCC requiring surgical treatment. After four years of all study the participants had developed at least one BCC and had developed at least one SCC. The study did show a significant decrease in the risk of needing Mohs surgery to treat a BCC in the first year. Mohs surgery is more effective but also more elaborate and expensive than a conventional procedure Weinstock said. In the studys first year BCCs were treated with Mohs surgery in participants in the control group but only BCCs were treated with the procedure among patients in the FU group. This suggests that using the FU can reduce the resources needed to treat these carcinomas Weinstock said. The cream does have common side effects including reddened more sensitive and often crusty skin effects that resolve when the application of the cream stops Weinstock acknowledged. After the studys first six months percent of the FU group rated the side effects as severe and percent rated them as moderate. But after six months and again at the end of the fouryear trial percent of participants in the FU group said theyd be willing to repeat the treatment if it proved effective in reducing skin cancer. In his clinical work Weinstock said that for particularly highrisk patients he has recommended FU treatment. Based on the study results it could be that patients need to renew their regimen with the cream every year. The most remarkable thing about this study is that now we have something to use that doesnt lose its effectiveness when you stop using it Weinstock said. But this is the first study of its type. Im hopeful there will be other studies that show other sorts of regimens that last longer and do a better job over time as science progresses. This is an important first step. He and colleagues are planning further studies including one to determine the costeffectiveness of FU treatment. In addition to Weinstock the new study has many authors from the VAKCC trial including at each of the studys sites Boston Bay Pines Fla. Chicago Ill. Palo Alto Calif. Atlanta Loma Linda Calif. Minneapolis Nashville Denver Durham N.C. Philadelphia and Miami."

"A new surgical tool that uses light to make sure surgeons removing cancerous tumors got it all was found to correlate well with traditional pathologists diagnoses in a clinical study showing that the tool could soon enable reliable realtime guidance for surgeons. The interdisciplinary research team led by Stephen Boppart a University of Illinois professor of electrical and computer engineering and of bioengineering performed the study on patients with breast cancers at the Carle Foundation Hospital in Urbana Illinois. The results appear in the journal Cancer Research. One difficult but crucial determination for surgeons and tissue pathologists is figuring out where a tumor ends. A solid tumor may be easily identifiable but the tissue around the main body of the tumor known as the margin may contain cancerous cells as well. Because of this excess tissue surrounding the tumor is typically removed but the question lingers of whether any cancer cells remain to reemerge later as tumors. In almost all solidtumor surgeries theres a question of margins said Dr. Boppart who also is a medical doctor. Typically surgeons will remove the tissue mass that contains the tumor and will send it to the lab. The pathologist will process section and stain the tissue then examine the thin sections on microscope slides. They look at the structure of the cells and other features of the tissue. The diagnosis is made based on subjective interpretation and often other pathologists are consulted. This is what we call the gold standard for diagnosis. The new device is a handheld probe based on a technology called optical coherence tomography OCT that uses light to image tissue in real time. Cancer cells and normal tissue scatter light differently because they have different microstructural and molecular features Boppart said so OCT gives physicians a way to quantitatively measure the cellular feature of a tumor. Surgeons can pass the OCT wand over a section of tissue and see a video on a screen with no special chemical stains or lengthy tissue processing required. In many cases you cant tell the difference between cancer cells and normal tissue with the naked eye but with OCT theyre very different said Boppart who also is affiliated with the Beckman Institute for Advanced Science and Technology at the U. of I. In the clinical study surgeons treated patients according to the standard surgical procedure but OCT data were collected from the margin of the tumor cavity and the margin of the removed tissue mass during surgery so that the results could be compared later. The study found that the OCT device analysis identified the differences between normal and cancerous tissue with percent sensitivity and percent specificity. They also found that the way that OCT spotted cancer in the removed tissue was closely correlated with the results from the postoperative pathology reports which often came days later. For the first time this study demonstrates the use of OCT for imaging tumor margins within the tumor cavity in the patient during surgery Boppart said. It is likely better to check to see if any residual tumor cells might be left behind rather than checking the tissue mass that was taken out. Then the surgeon can intervene immediately. The researchers will continue clinical studies with the OCT device looking at other types of solidstate tumors. Diagnostic Photonics a startup company Boppart cofounded that also collaborated on the study is commercializing the OCT probe technology for broader use. Ultimately new technological innovations like this in medicine and surgery are going to improve our health care and save lives. Thats when this work will be most rewarding Boppart said. The National Institutes of Health supported this work. Editors notes Editors note To reach Stephen Boppart call email boppartillinois.edu mailtoboppartillinois.edu. The paper Realtime imaging of the resection bed using a handheld probe to reduce incidence of microscopic positive margins in cancer surgery is available online at httpcancerres.aacrjournals.orgcontent.full."

"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."

"An experimental drug may help patients who cant tolerate statins lower their cholesterol a new Australian study suggests. The week phase clinical trial was conducted at international sites and included adults who suffered muscle problems when taking statins a class of cholesterollowering drugs that includes Crestor and Lipitor. They received injections of a placebo or different doses of AMG which is a human monoclonal antibody. Human monoclonal antibodies are naturally occurring human antibodies that are genetically altered in a laboratory cloned in large numbers and introduced into the patient to target disease sites. The patients who received AMG had percent to percent reductions in bad LDL cholesterol and did not experience significant musclerelated side effects said study leader Dr. David Sullivan of the Royal Prince Alfred Hospital in Australia and colleagues. The reductions in LDL cholesterol seen in these patients were comparable to those that occur in patients taking the highest doses of the most effective statins the researchers added. One expert found the results intriguing. The most interesting aspect of this study is use of a novel approach using monoclonal antibodies a subtype of antibodies in the management of elevated LDL cholesterol said Dr. Kenneth Ong acting chief of cardiology at the Brooklyn Hospital Center. In this phase study the results are certainly impressive and warrant further investigation Ong said. Of note is the reduction in the number of myalgias muscle pains for patients compared to the number of myalgias experienced by people taking statins. If larger trials and longer durations of observation confirm these initial findings many patients whose LDL cholesterol are otherwise untreated or undertreated could benefit. Another expert agreed. For those patients with elevated LDL who are intolerant to statins this provides a viable option said Dr. Suzanne Steinbaum a preventive cardiologist at Lenox Hill Hospital in New York City. More trials need to be done of this unique treatment she added. The study was published online Nov. in the Journal of the American Medical Association to coincide with a planned presentation at the American Heart Associations annual meeting in Los Angeles. More information The American Academy of Family Physicians has more about cholesterollowering drugs httpfamilydoctor.orgfamilydoctorendiseasesconditionshighcholesteroltreatmentcholesterolloweringmedicines.printerview.all.html. SOURCES Kenneth Ong M.D. acting chief cardiology The Brooklyn Hospital Center Suzanne Steinbaum M.D. preventive cardiologist Lenox Hill Hospital New York City Journal of the American Medical Association news release Nov."

"With little fanfare the Food and Drug Administration did something this week that its never done before The agency approved a single prescription drug pembrolizumab marketed by Merck as Keytruda for treatment of solid tumors in any organ so long as the malignancy bears a specific genetic signature. In the fastmoving field of cancer treatment the FDAs announcement https an important milestone close to two decades in the making. Increasingly cancer will no longer be identified categorized and treated by the organ it inhabits or in which it first gained its foothold. In a shift that is already underway cancers will be known by and treated for the common genetic mutations that nurture and sustain them. In clinical trial evidence cited by the FDA this week pembrolizumab induced complete or partial tumor shrinkage in about of patients with one of endstage malignancies. And for of those patients that response lasted six months or more. A trial reported earlier this year found that in of advanced cancer patients pembrolizumab stopped or reversed the progression of cancer and patients were still alive a year after starting the drug. All of those subjects of course had cancers with the genetic mutation that pembrolizumab is designed to target. In the treatment of patients with metastatic cancers that have failed all other treatments that record of success constitutes a home run said Dr. Bert Vogelstein of Johns Hopkins Universitys Kimmel Cancer Center. Vogelsteins research laid the groundwork for the discovery of pembrolizumabs broad cancerfighting powers. With the FDAs announcement drugs like pembrolizumab have also begun to change the way that physicians patients and government regulators think of cancer. No longer will they see all cancers of the lung breast colon brain liver pancreas and prostate as distinct from one another. Instead they will look for the common genetic mutations that give rise to cancers no matter where theyre found. And theyll treat those cancers with a drug that uses that common signature as a homing beacon either for the immune system or for targeted cancer drugs to attack. Its a key principle of whats called precision medicine the idea that cancer therapies should zero in on a tumors specific molecular fingerprint and not as most chemotherapies do harm healthy cells in the process of attacking malignant ones. In the cancers pembrolizumab treats the mutations occur in the complex of genes that govern DNA repair. Deficiencies in the DNAs mismatch repair system generate mutant proteins on the surface of cancer cells and pembrolizumab trains the immune system to attack those targets. The mutations that make pembrolizumab effective had already been found in melanoma nonsmallcell lung cancer head and neck cancer and Hodgkins lymphoma and the FDA had already approved the drug for those cancers before this week. But this weeks FDA approval goes further It makes clear that the drugs molecular targets are also common in colorectal endometrial and gastrointestinal cancers and less frequently present in cancers of the breast prostate bladder and thyroid gland. All told scientists believe about of advanced cancers bear the genetic signature that would make them treatable by Keytruda. The appearance of such a cancer workhorse will bring about profound changes on the cancer landscape not just for patients but for researchers and drug regulators as well. Organizations representing say people with pancreatic cancer will make common cause with groups that advocate for colorectal cancer patients. In cancer centers specialists in say melanoma will start in fact have already started treating patients with a range of other cancers. When drug companies and their academic partners set out to test the effectiveness of a prospective cancer drug theyll have to recruit trial subjects using a new and much less obvious criterion than theyve used in the past the genetic signatures their tumors bear. Even before the FDAs announcement this week all these processes were underway. The FDAs decision recognizes that fact said Dr. Svetomir Markovic an immunologist at the Mayo Clinic in Rochester Minn. who specializes in treating melanoma. But the decision also puts cancer physicians as well as insurers who will be called on to pay Keytrudas peryear price tag on notice that a new era is at hand said Markovic. The field of cancer medicine is changing at lightning speed he said. Physicians are having a hard time keeping up and I can only imagine that people who are regulating it are doing the same he added. But this decision by the FDA is really wonderful It has made it easier for us to secure treatment for our patients who may have run out of options that may help. Two other immunotherapy drugs have been approved for cancer treatment nivolumab marketed as Opdivo and ipilimumab Yervoy but neither has been shown to treat cancers across such a broad spectrum. Several other immunotherapy drugs are in early trials and could yet prove to be the sort of workhorse that pembrolizumab appears to be. In many ways were at the end of the beginning of immunotherapy Theres clear benefit but its still a minority of patients that get longterm benefit said Markovic of the Mayo Institute. We will get better at this. Markovic suggested that the newly recognized powers of pembrolizumab as well as the FDAs new openness to cancer drugs that blur traditional distinctions could prompt drug companies physicians and patient groups to take a second look at some abandoned cancer drugs. With a clearer idea of which patients they might help and a willingness to design and conduct innovative clinical trials some failures may look more promising he said. We just needed to take the first step in showing that this longbelieved theory that the immune system can kill cancer is true Markovic added. It indeed can."

"U.S. prisons are experimenting with a highpriced monthly injection that could help addicted inmates https stay off opioids after they are released but skeptics question its effectiveness and say the manufacturer has aggressively marketed an unproven drug to corrections officials. A single shot of Vivitrol given in the buttocks lasts for four weeks and eliminates the need for the daily doses common with alternatives such as methadone. But each shot costs as much as and because the drug has a limited track record experts do not agree on how well it works. Proponents say Vivitrol could save money compared with the cost of locking up a drug offender about a year for each inmate at the Sheridan Correctional Center miles southwest of Chicago. Dr. Joshua Lee of New York Universitys medical school said more evidence is needed to determine whether the medication can help substantial numbers of people and whether its worth paying for but the early results are encouraging. It sounds good and for some of us it feels like the right thing to do said Lee a leading researcher on the treatment. Vivitrol is emerging as the nation searches for ways to ease an opioid epidemic https that affects more than million Americans and an estimated percent of the U.S. prison population. Many experts view prisons where addictions human toll can be seen most clearly as a natural place to discover what works. Christopher Wolf had already served prison time for nonviolent crimes when he was ordered into treatment for a heroin addiction by a judge who suggested Vivitrol. Three months later the yearold from Centerville Ohio is clean and working full time as a cook. He now suggests the medication to other addicts https I dont have cravings Wolf said. I see how much better life is. It gets better really fast. Vivitrol targets receptors in the brains reward system blocking the high and extinguishing urges. In some programs prisoners get an injection before release then followup shots from any clinic. For decades researchers have recognized addiction as a relapsing brain disease with medication an important part of therapy. But most jails and prisons reject methadone and buprenorphine the other governmentapproved medications for opioid addiction because they are habitforming and can be abused. Just ask Joshua Meador an inmate at Sheridan who hopes to get into the Vivitrol program before his release in January. Before incarceration he abused both older treatment drugs. When given takehome doses of methadone for the weekend he would sell them for heroin. When Im on Vivitrol I cant get high he said. The drug has no street value or abuse potential. You couldnt design something better for the criminal justice system said David Farabee of the University of California at Los Angeles who leads a Vivitrol https study in a New Mexico jail. Theres been pushback with other medications people saying Were just changing one drug for another. That argument goes out the window when youre talking about a blocker like Vivitrol. Prison systems in Illinois Vermont Wyoming and Wisconsin are trying the drug on a small scale. Michigan is offering Vivitrol to parolees who commit small crimes if addiction is the reason for their new offense. The federal Bureau of Prisons ran a field trial in Texas and plans to expand the program to the Northeast next year. The drugs manufacturer hopes prisons will be the gateway to a larger market. Also known as extendedrelease naltrexone the medication won Food and Drug Administration approval for alcohol dependence in and in to prevent relapse in postdetox opioid users. The evidence for giving Vivitrol to inmates is thin but promising. In the biggest study sponsored by the National Institute on Drug Abuse about offenders most of them heroin users on probation or parole were randomly assigned to receive either Vivitrol or brief counseling and referral to a treatment program. After six months the Vivitrol group had a lower rate of relapse percent compared with percent. A year after treatment stopped there had been no overdoses in the Vivitrol group and seven overdoses including three deaths in the other group. The results published in March in the New England Journal of Medicine have been promoted by the drugmaker Irelandbased Alkermes as it markets Vivitrol to U.S. correctional systems. Yet addiction is stubborn. When the injections stopped many in the study relapsed. A year later relapse rates looked the same in the two groups. It does suggest six months wasnt enough said Lee the lead author. T.J. Voller was a Vivitrol success story until he wasnt. After Vivitrol was approved by the FDA Voller talked about getting the shot with The Associated Press and Dr. Sanjay Gupta in a CNN segment. The yearold was back at work and seemed proud of his recovery. But after months on Vivitrol he died of a heroin overdose https He was alone for the weekend and picked up that needle one last time said his mother Kathi Voller of Raynham Massachusetts. Advocates argue that inmates have a constitutional right to all FDAapproved addiction medications throughout their incarceration. Treatment should be offered from the moment they are brought into the system said Sally Friedman legal director of the New Yorkbased Legal Action Center which is looking for a test case to bring to court. Physicians have learned to be cautious about pharmaceutical company marketing said Andrew Kolodny senior scientist at the Heller School for Social Policy and Management at Brandeis University. Not so for criminal justice officials who may be too trusting Kolodny said. When the drug company sends someone in to give them a talk and buy them pizza they think theyre getting a scientific lecture he said. Alkermes spokeswoman Jennifer Snyder said the companys sales team helps educate corrections staff and community care providers only after they have shown interest in Vivitrol. Theres widespread agreement that counseling support groups and treatment for underlying problems such as depression are crucial for Vivitrol patients said Dr. Joseph Garbely of Pennsylvaniabased Caron Treatment Centers which supports medicationassisted treatment and prefers Vivitrol. The disease of addiction is a cunning baffling and powerful one Garbely said. And you need all hands on deck."

"Elevated levels of a group of five amino acids may predict the development of diabetes https years before any noticeable symptoms occur according to a new study. Researchers found that blood https tests that screened for these amino acids accurately predicted risk of type diabetes httpsdiabetes.webmd.comguidediabetes_symptoms_types in otherwise healthy adults as well as in those with traditional risk factors such as obesity https These findings could provide insight into metabolic pathways that are altered very early in the process leading to diabetes https says researcher Thomas Wang MD of Massachusetts General Hospitals Cardiovascular Research Center in a news release. They also raise the possibility that in selected individuals these measurements could identify those at highest risk of developing diabetes so that early preventive measures could be instituted. Researchers say metabolic abnormalities that eventually lead to type diabetes https can be present years before diabetes is diagnosed. For example insulin resistance https where the body does not use insulin https effectively occurs long before blood https sugars reach the level seen in type diabetes https Predicting Diabetes The study published in Nature Medicine followed healthy adults with normal blood sugars at the start of the study for years. During this period developed type diabetes. Researchers compared blood samples taken at the beginning of the study in participants who developed diabetes and similarly matched participants who did not. Specifically they screened for levels of various metabolites small molecules released into the bloodstream by metabolic activities. The results showed that elevated levels of five amino acids isoleucine leucine valine tyrosine and phenylalanine https were associated with the development of type diabetes. Researchers found that measuring combinations of these five amino acids rather than a single amino acid was a more accurate predictor of future diabetes risk. In addition in people closely matched for traditional risk factors for type diabetes such as obesity https or insulin resistance those with the highest levels of the three most predictive amino acids isoleucine phenylalanine and tyrosine had a five to seven times higher risk of developing type diabetes than those with the lowest levels. Researchers say several of these amino acids have also been associated with the development of diabetes in previous studies but further studies in larger numbers of people will be needed to confirm these results."

"Dialysis patients waiting for kidney transplants might safely accept an organ from a donor infected with hepatitis C virus HCV a new study finds. Using hepatitis Cinfected kidneys would expand the organ pool and save lives said lead researcher Dr. Peter Reese. Hes an associate professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia. There is a tremendous lack of kidneys for transplant he explained. Because of the opioid crisis there are many people who die from a drug overdose and have HCV and want to donate their organs. But these infected kidneys are discarded even though they are otherwise healthy. And many are from younger people Reese said. Of roughly a halfmillion patients in the United States who were on dialysis for latestage kidney disease in only received kidney transplants. This is partly due to organ shortages researchers have reported. And the average wait time for a noninfected kidney is more than two years compared to eight months for an HCVinfected kidney. New less toxic treatments for hepatitis C opened the door for transplanting infected kidneys and then successfully treating the infection Reese said. In a study of uninfected patients researchers found that transplanting infected kidneys and then treating recipients for HCV resulted in a percent cure rate. Half were evaluated six months after their transplant and the others a year after. And we found that these kidney transplants were working as well as kidney transplants from uninfected patients Reese said. The potential cost savings could be significant he added. Dialysis can cost more than a year according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Though some patients might not want to take the risk associated with an infected kidney others might consider it a good option given the high death rates for dialysis patients awaiting transplants the researchers suggested. The report was published online Aug. in the Annals of Internal Medicine. Dr. Adnan Sharif a consultant transplant nephrologist at Queen Elizabeth Hospital and University of Birmingham in the United Kingdom wrote an accompanying editorial. Sharif said the excellent shortterm outcomes and percent cure rate of HCV in organ recipients should prompt transplant centers to rethink use of HCVinfected kidneys. We must be bold in our approach to utilizing HCV kidneys he said. Sharif acknowledged however that using HCVinfected kidneys would represent a significant shift in our attitude to risk procurement of organs and counseling potential recipients appropriately about the risks albeit minimal. But the cost effectiveness of using these kidneys versus remaining on dialysis would be significant he noted. Another study published in the same journal in July reported similar success in transplants of HCVinfected kidneys into HCVinfected patients. About percent of dialysis patients have HCV the researchers said. Sharif said other organs from HCVinfected donors such as hearts and lungs might also be safely transplanted expanding those organs supply as well. Using such donors could lead to many lifesaving or enhancing transplants he said. More information To learn more about kidney transplants visit the National Kidney Foundation https SOURCES Peter Reese M.D. associate professor of medicine University of Pennsylvania School of Medicine Philadelphia Adnan Sharif M.D. consultant transplant nephrologist Queen Elizabeth Hospital and University of Birmingham U.K. Aug. Annals of Internal Medicine online"

"Cell and Gene Therapy Catapult and Aberdeen University are working on labgrown treatment that could help hundreds of thousands of people Julia Kollewe https Insulin shots could become a thing of the past for type diabetes patients thanks to a technology being developed by Cell and Gene Therapy Catapult a Londonbased notforprofit organisation and Aberdeen University. The preclinical results have encouraged CGT and Aberdeen University to create a spinout company called Islexa. It will manufacture labgrown islets the organoids responsible for insulin production by reprogramming donated pancreatic tissue. Only people with type diabetes in the UK https receive an islet transplant each year owing to a lack of donors and the difficulty of extracting islets from pancreatic tissue. Growing islets will significantly increase the number of patients who can receive the treatment Keith Thompson CGTs chief executive told the World Stem Cells and Regenerative Medicine congress in London on Wednesday. He will run Islexa with Michael Bennet from CGT and Anne Lewendon from Aberdeen University. If clinical trials are successful the technology means tens of thousands more people could live without the need for frequent insulin injections although it will take a few years until the treatment is available. About people in Britain have type diabetes a number set to more than double to by . Around the world million people have type diabetes. It is a lifelong condition that occurs when the pancreas does not produce any insulin while type diabetes https far more common especially as obesity rises around the world is a condition where the pancreas does not produce enough insulin or the bodys cells do not react to it. Prof Kevin Docherty from Aberdeen University said Donated islets are already effectively treating severe cases of type diabetes. Having a hugely expanded supply of labgrown islets will enable us to significantly extend this established clinical treatment. CGT was set up in and is based on the th floor of Guys hospital in London. It employs more than people and has government backing through Innovate UK but also gets private funding through partnerships. It is building a m cell therapy manufacturing centre in Stevenage. Islexa will use CGTs labs at Guys and facilities at Aberdeen University. They are looking for investors to take Islexa all the way as a fully fledged external company. The promising early results have given them the confidence to form a wider consortium with the Scottish Islet Transplant Programme the University of Edinburgh and the Scottish National Blood Transfusion Service. John Casey consultant transplant surgeon at the Royal Infirmary of Edinburgh and lead clinician for the islet transplantation programme in Scotland said Islet transplantation can transform the lives of patients with type diabetes and in some cases can result in longterm freedom from insulin injections with excellent glucose control."

"Eating a meal of seafood or other foods containing omega fatty acids at least once a week may protect against agerelated memory loss and thinking problems in older people according to a team of researchers at Rush University Medical Center and Wageningen University in the Netherlands. Their research findings were published in the May online issue of Neurology the medical journal of the American Academy of Neurology. The study was supported by the National Institute on Aging and the Judith Zwartz Foundation. The agerelated memory loss and thinking problems of participants in the study who reported eating seafood less than once a week declined more rapidly compared to those who ate at least one seafood meal per week. This study helps show that while cognitive abilities naturally decline as part of the normal aging process there is something that we can do to mitigate this process says Martha Clare Morris ScD a Rush nutritional epidemiologist and senior author of the paper. Four types of seafood five types of brain function The researchers followed people with a mean age of . years for an average of five years. At study enrollment none had signs of dementia. The participants were recruited from people already taking part in the Rush Memory and Aging Project a study of residents of more than retirement communities and senior public housing units across northern Illinois plus older adults identified through church groups and social service agencies. During the course of the study each person received annual standardized testing for cognitive ability in five areas episodic memory working memory semantic memory visuospatial ability and perceptual speed. The study group also completed annual food frequency questionnaires allowing the researchers to compare participants reported seafood intake with changes in their cognitive abilities as measured by the tests. The questionnaires included four types of seafood tuna sandwiches fish sticks fish cakes and fish sandwiches fresh fish as a main dish and shrimp lobster and crab. The participants were divided into two groups those who ate at least one of those seafood meals per week and those who ate less than one of those seafood meals per week. Participants in the higher seafood consumption group ate an average of two seafood meals per week. Those in the lower group ate an average of . meals per week. Making closer associations Seafood is the direct nutrient source of a type of omega fatty acid docosahexaenoic acid that is the main structural component of the brain. While epidemiologic studies have shown the importance of seafood and omega fatty acids in preventing dementia few prior studies have examined their associations with specific types of cognitive ability. In the new Neurology article the researchers report associations between seafood consumption and two of the areas of cognitive ability that they tested. People who ate more seafood had reduced rates of decline in the semantic memory which is memory of verbal information. They also had slower rates of decline in a test of perceptual speed or the ability to quickly compare letters objects and patterns. The study did not find a significant difference in the rate of decline in episodic memory recollection of personal experiences working memory shortterm memory used in mental function in the immediate present and visuospatial ability comprehension of relationships between objects. The results were the same after researchers adjusted for other factors that could affect memory and thinking skills such as education physical activity smoking and participating in mentally stimulating activities. Further the protective association of seafood was even stronger among individuals with a common genotype APOEe that increases the risk of developing Alzheimers disease. The APOE is a gene involved in cholesterol transport to neurons. About percent of the population carries the APOEe gene although not everyone who has the gene will develop Alzheimers disease."

"Osteoporosis medications called bisphosphonates are known to reduce the risk of bone fractures. But they also appear to extend life although researchers dont yet know how they do this. In a study of people released Wednesday Australian scientists found that people taking bisphosphonates which include the medications Fosamax Boniva and Actonel gain an extra five years of life compared with people with osteoporosis who were taking other forms of therapy for the illness such as calcium vitamin D or hormone therapy and those taking no therapy. The death rate for women taking bisphosphonates was . per personyears compared with . for women taking hormone therapy . for women taking calcium and vitamin D and . for women taking no treatment. In men bisphosphonates also lowered the death rate compared with other therapies. In a group of women with osteoporotic fractures over the age of you would expect to die over a period of five years a coauthor of the study Jacqueline Center of Sydneys Gravan Institute of Medical Research said in a news release. Among women in that age group who took bisphosphonates the death rate dropped to . Its not clear what accounts for this benefit. It could be that people taking bisphosphonates are generally healthier or get better overall healthcare. But the researchers suggest that the link is tied to physiology. When people age and lose bone heavy metals like lead and cadmium which are stored in bone over a lifetime are released into the bloodstream and can affect health. Preventing bone loss may prevent the release of these toxic substances and the damage they do. Bisphosphonates do produce side effects such as heartburn however. In a small number of people the medications cause bonehealing problems after dental surgery. The study appears online in the Journal of Clinical Endocrinology Metabolism httpjcem.endojournals.orgcgicontentabstractjc.vmaxtoshowhitsRESULTFORMATauthorCenterfulltextosteoporosissearchidFIRSTINDEXsortspecrelevanceresourcetypeHWCIT."

"Armed with new knowledge about how neurodegenerative diseases alter brain structures increasing numbers of neurologists psychiatrists and other clinicians are adopting quantitative brain imaging as a tool to measure and help manage cognitive declines in patients. These imaging findings can help spur beneficial lifestyle changes in patients to reduce risk for Alzheimers disease. The concept that cognitive decline can be identified early and prevented by applying quantitative brain imaging techniques is the focus of Hot Topics in Research Preventive Neuroradiology in Brain Aging and Cognitive Decline a review published online in American Journal of Neuroradiology AJNR. Author Cyrus Raji M.D. Ph.D. of UCLA and an international team suggest a framework in which neuroradiologists work as part of a team of clinical neuroscientists neurologists psychiatrists neuropsychologists etc. to apply quantitative neuroradiology towards prevention of cognitive decline in populations at high risk for dementia namely those with lifestyle genetic and other associated risk factors. I believe neuroradiology and especially quantitative MRI technology will have a huge impact in the future of diagnosis and treatment of Alzheimers disease since there is compelling evidence for the baseline size of hippocampus as a key determinant of risk for future cognitive decline and since many lifestyle factors can cause atrophy or expansion in the volume of this critical brain structure says neurologist Majid Fotuhi M.D. Ph.D. of Johns Hopkins University. Such work is already happening at UCLA and other institutions that meld these approaches into novel ways to improve patient care. We are working closely with neuroradiologists to redefine how we can reduce risk for Alzheimers with quantitative neuroimaging that helps us pinpoint symptomrelevant volume loss in the brain and subsequent targets for tracking our lifestylebased interventions says Dr. David Merrill a geriatric psychiatrist at UCLA Medical Center. Recent advances have improved the ability to characterize imaging markers along the trajectory of Alzheimers disease starting in the preclinical phase. These markers including structural functional and molecular imaging are being used in the AD diagnositc criteria AANIA says Howard Aizenstein M.D. Ph.D. a psychiatrist at University of Pittsburgh. Fotuhi sees imaging findings as a unique motivator for patients to make positive lifestyle changes. Patients seem to enjoy reviewing results of their imaging studies more so than reading the results of their blood tests or other clinical evaluations. For example they can see with their own eyes whether there are any strokes or atrophy in their brain. This can have a powerful impact on them and on their determination to make changes in their lifestyle in order to improve their brain health he adds. Among the lifestyle and risk factors that can be altered to potentially prevent cognitive declines are obesity diet sleep hypertension diabetes depression supplementation smoking and physical activity. It is estimated that as many as million cases of Alzheimers dementia worldwide can be prevented with as little as a reduction in the burden of preventable lifestyle. The article is available online at http A related blog post is at http The American Journal of Neuroradiology AJNR is published monthly by the American Society of Neuroradiology ASNR a professional association of more than members who specialize in diagnostic radiology of the central nervous system brain head and neck through the use of Xray MRI CT and angiography. The ASNR was founded in and is headquartered in Oak Brook Illinois. American Journal of Neuroradiology Enterprise Dr. Suite Oak Brook IL REFERENCES Sperling RA Aisen PS Beckett LA et al. Toward defining the preclinical stages of Alzheimers disease Recommendations from the National Institute on AgingAlzheimers Association workgroups on diagnostic guidelines for Alzheimers disease. Alzheimers dementia The Journal of the Alzheimers Association. . doi.j.jalz.... Barnes DE Yaffe K The projected effect of risk factor reduction on Alzheimers disease prevalence. Lancet Neurol ."

"Johnson Johnson said on Tuesday its blockbuster drug Stelara was found to be effective in treating a chronic bowel disease in a latestage trial. Two doses of Stelara already approved for psoriasis psoriatic arthritis and Crohns disease was tested in patients with moderatetosevere ulcerative colitis UC who had failed prior therapy. Both mgkg and mg doses of the intravenous treatment showed clinical remission in significantly more patients compared with those on placebo after eight weeks the company said. The treatment and the placebo arms reported similar proportion of side effects with one patient on the mgkg dose dying following excessive bleeding JJ said. Sponsored The patient had no prior history of high blood pressure or cirrhosis the drugmaker said. More than half of UC patients have not experienced remission with currently available treatment options the studys lead investigator Bruce Sands said. Stelara which brought in sales of . billion in the second quarter of is also being tested in autoimmune disease lupus. Ulcerative colitis which affects about people in the United States annually is a chronic condition causing abdominal pain intestinal ulcers bloody diarrhea and weight loss. Current treatments include Pfizer Incs Xelijanz an oral treatment for adults patients with moderatetosevere UC and Merck Cos Renflexis. This story has been refilled to correct the dosage to mg not mgkg in paragraph Reporting by Manogna Maddipatla in Bengaluru Editing by Sriraj Kalluvila Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Coronary artery disease is a condition in which a waxy substance called plaque builds up inside the arteries which supply oxygenrich blood to your heart. Eventually an area of plaque can rupture and cause a blood clot to form on the plaques surface. If the blockage isnt treated quickly the portion of heart muscle fed by the artery begins to die. This heart damage may go unrecognized and lead to severe or longlasting problems. Coronary artery bypass grafting CABG is a surgical procedure that improves blood flow to the heart by bypassing clogged arteries. CABG was once thought to be too risky for patients with the longterm effects of coronary artery disease left ventricular dysfunction when the left side of the heart is unable to pump normally and heart failure when the heart cant pump enough blood to meet the bodys needs. Early studies of the safety and effectiveness of CABG excluded most patients with these conditions. The procedure was typically used to relieve disabling angina or chest pain. A team led by Dr. Eric J. Velazquez of Duke University Medical Center conducted a year randomized controlled trial to investigate the effects of CABG on patients with coronary artery disease that shows sign of left ventricular dysfunction and heart failure. More than patients were included in the clinical trial. They were randomly assigned to receive either CABG plus medical treatment or medical treatment alone. The medical treatment included guidelinedirected medications and devices. Patients had followup evaluations every months for the first year and then every subsequent months. An extension study evaluated the year outcomes of the surgical intervention. Almost all the participants were included in the year followup results. The research was funded by NIHs National Heart Lung and Blood Institute NHLBI. Results were published online in the New England Journal of Medicine on April . Death from any cause occurred in patients in the CABG group and in patients receiving medical treatment alone. A total of patients in the CABG group and patients in the medical treatment group died from cardiovascular causes. In addition the bypass surgery was associated with an overall .year increase in median survival time . vs. . years. These results show that CABG improves survival for people with coronary artery disease left ventricular dysfunction and heart failure. The current year followup provides new important insights about patient subgroups that are more likely to benefit from CABG as compared to medical therapy alone explains NHLBI Director Dr. Gary H. Gibbons. As such we now have a solid evidence base to inform patient care and the future development of clinical practice recommendations. Related Links Who to Treat with Statins https Fending Off Cardiovascular Disease https Coronary Heart Disease http Coronary Heart Disease Risk Factors http Heart Disease in Women http What is Heart Surgery http Heart Failure http References CoronaryArtery Bypass Surgery in Patients with Ischemic Cardiomyopathy. https Velazquez EJ Lee KL Jones RH AlKhalidi HR Hill JA Panza JA Michler RE Bonow RO Doenst T Petrie MC Oh JK She L Moore VL DesvigneNickens P Sopko G Rouleau JL STICHES Investigators. N Engl J Med. Apr . Epub ahead of print. PMID . Funding NIHs National Heart Lung and Blood Institute NHLBI."

"Scientists in Britain say they have developed a blood and urine test that can detect autism in children. Researchers at the University of Warwick said the test believed to be the first of its kind could lead to earlier diagnosis of autism spectrum disorders ASD in children who could then be given appropriate treatment much earlier in their lives. ASDs mainly affect a persons social interaction and communication with symptoms that can include speech disturbances repetitive andor compulsive behaviour hyperactivity anxiety and difficulty adapting to new environments. As there is a wide range of ASD symptoms diagnosis can be difficult and uncertain particularly at the early stages of development. It is estimated that about one in every people in the UK has ASD with more boys diagnosed with the condition than girls. Scientists said their research found a link between ASD and damage to proteins in blood plasma. They found the most reliable of the tests they developed was examining protein in blood plasma which found children with ASD had higher levels of the oxidation marker dityrosine DT and certain sugarmodified compounds called advanced glycation endproducts AGEs. Genetic causes are thought to be responsible for about a third of cases of ASD while the rest are believed to be caused by a combination of environmental factors mutations and rare genetic variants. However researchers believe their new tests could reveal yettobeidentified causes of ASD. They also confirmed the previously held belief that mutations of amino acid transporters are a genetic variant associated with ASD. The Warwick team worked with collaborators at the University of Bologna in Italy who recruited children who had been diagnosed with ASD along with a control group of other children between the ages of five and . Blood and urine samples were taken from the children for analysis. The Warwick team discovered there were chemical differences between the two groups. Working with a further collaborator at the University of Birmingham the changes in multiple compounds were combined using artificial intelligence algorithm techniques to develop a mathematical equation to distinguish between ASD and healthy controls. The outcome was a diagnostic test better than any existing method. They said the next steps were to repeat the study with further groups of children to confirm the good diagnostic performance and to assess if the test could identify ASD at very early stages indicate how the ASD is likely to develop further to more severe disease and assess if treatments were working. The research was led by Naila Rabbani reader of experimental systems biology at the University of Warwick who said Our discovery could lead to earlier diagnosis and intervention. We hope the tests will also reveal new causative factors. With further testing we may reveal specific plasma and urinary profiles or fingerprints of compounds with damaging modifications. This may help us improve the diagnosis of ASD and point the way to new causes of ASD. The research has been published in the journal Molecular Autism https Note added February The UK autism research charity Autistica provided the following comment to the Guardian This is a small earlystage study which may explain one biological difference in autism. At this stage the results presented are not strong enough to suggest that this method could be used for the diagnosis of autism. For example we dont know whether this technique can distinguish autism from ADHD anxiety or other similar conditions. There have been many previous attempts to develop a biological test for autism. Still the best way to diagnose autism is through clinical interview and observation which takes into account the many features of autism."

"Treatment guidelines suggest that nearly half of those over age nearly million people in the United States at least consider a cholesterol httphealth.nytimes.comhealthguidesnutritioncholesteroloverview.htmlinlinenytclassifierlowering statin to reduce heart attack risk. But a new large study of people who had an inexpensive heart scan found that half of those who were statin candidates had no signs of plaque in their heart and very little chance of having a heart attack in the next decade. Some cardiologists say the results could go a long way toward helping patients make a more informed choice about whether to begin taking the drugs. The test is a CT scan httphealth.nytimes.comhealthguidestestctscanoverview.htmlinlinenytclassifier that looks for calcium httphealth.nytimes.comhealthguidestestserumcalciumoverview.htmlinlinenytclassifier in coronary arteries a signal that plaque is present. It used to be expensive about but now typically costs between and . Still it is generally not covered by insurance and so is not often used to assess risk. The Xray httphealth.nytimes.comhealthguidestestxrayskeletonoverview.htmlinlinenytclassifier dose is about that of a mammogram httphealth.nytimes.comhealthguidestestmammographyoverview.htmlinlinenytclassifier. Advocates for the scan say it should be used to derisk people. It can let those who do not want to take statins know whether their chance of a heart attack is actually extremely low. Maybe this is a tool to actually do less said Dr. Harlan M. Krumholz a Yale cardiologist and senior author of the paper httpcontent.onlinejacc.orgarticle.aspxarticleID published on Monday in the Journal of the American College of Cardiology. For those who have no objections to taking statins there is no need for a heart scan Dr. Krumholz said. But for those who are reluctant to take them he said I am willing to use this to refine their risk estimate. Others say the test can lead to an array of other medical problems some of which are gravely serious. The only reason to do things is to feel better or to live longer said Dr. Peter Libby a cardiovascular disease specialist at Harvards Brigham and Womens Hospital. With the scans he said that has yet to be established. Heart researchers have long known that plaques in coronary arteries start out as pimplelike bumps but get waxy and hard and filled with calcium as time passes. Calcium shows up as white flecks in CT scans. The hard plaques are not the dangerous ones it is the softer ones that rupture and cause a heart attack. But the amount of calcium in arteries can give a good idea of the presence or extent of coronary artery disease. Dr. Krumholz and Dr. Khurram Nasir a preventive cardiologist at Baptist Health South Florida who conceived the new study reasoned that research on heart scans had not been designed to help doctors make treatment decisions they face today. Current guidelines have vastly increased the number of people who are eligible to take statins. Many people though are reluctant to take them. So the investigators asked could a scan identify those whose actual risk is lower than what was calculated The study subjects were nearly men and women ages to and included blacks whites Hispanics and Asians who were recruited in through . According to todays guidelines half had risk scores high enough that a statin would be recommended or should be considered. But guidelines then were more conservative and in accordance with them the subjects did not take the drugs. All had heart scans and half had no calcium visible on the scans. The subjects were followed for years. It turned out that the actual incidence of heart attacks or disabling chest pain httphealth.nytimes.comhealthguidessymptomschestpainoverview.htmlinlinenytclassifier in those with zero calcium was half or less than what the risk calculator predicted. For example a person who according to the current risk calculator has a percent risk of a heart attack in the next decade should take a statin the guidelines say. But if that person has a calcium score of zero the actual risk turned out to be percent below the . percent threshold for recommending a statin according to the guidelines and below the percent risk for considering a statin. Dr. Nasir said he has been using the studys findings in his clinic. First he asks patients for whom statins are recommended according to the current guidelines if they would want to avoid taking the drugs if they turn out to have a calcium score of zero and an actual risk of less than percent. Most tell him that they would. He then sends them for a scan. But the study was observational not the highest level of evidence. The problem critics say is that there has never been a rigorous study randomly assigning people to a change in treatment based on a scan and demonstrating that the change improves outcomes. Dr. Libby of Harvard for one is leery. Although very few heart attacks may have occurred over a decade in people with no calcium he said noncalcified plaques may be developing that could cause trouble. And the time span for worrying about a heart attack is more than a decade he said. One problem with the scans is what doctors call incidentalomas unexpected incidental findings like lung nodules httphealth.nytimes.comhealthguidessymptomsnodulesoverview.htmlinlinenytclassifier. The new study reported such findings in percent of patients but radiologists have reported incidences in the double digits. All too often these findings start patients on a diagnostic odyssey getting tests and biopsies sometimes exploratory surgery only to find that there was nothing wrong. Routine heart scans of tens of thousands of people would uncover a not negligible number of incidentalomas Dr. Libby said. Then there will be the people with no symptoms of heart disease who turn out to have a high calcium score. Dr. Libby explains what often happens next The doctor suggests an angiogram httphealth.nytimes.comhealthguidestestarteriogramoverview.htmlinlinenytclassifier an Xray of the arteries. It shows one of the arteries is percent blocked. The cardiologist inserts a stent httphealth.nytimes.comhealthguidessurgerystentoverview.htmlinlinenytclassifier a wire cage to keep the artery open although many researchers doubt stents httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsstentsindex.htmlinlinenytclassifier will prevent heart attacks in symptomless people on todays medical therapy. Now the patient with the newly inserted stent has to take a powerful anticlotting drug and aspirin for at least the next year. Because the drugs make bleeding more likely the patient notices blood in his stool. Before he can have a colonoscopy httphealth.nytimes.comhealthguidestestcolonoscopyoverview.htmlinlinenytclassifier to check on the blood he has to stop the anticlotting drugs for a week. But without them he risks getting a clot at the site of the stent and having what could be a fatal heart attack. Now we have taken a healthy person asymptomatic and turned him or her into a patient Dr. Libby said. But others like Dr. Daniel Soffer a general internist at the University of Pennsylvania see a real benefit in using heart scans to derisk patients. All the other biomarkers get blown away compared to the calcium score he said adding that it is far and away the best marker of risk. The new study justifies to him a practice he began years ago of using scans with the belief that they could be better than a risk calculator for some patients. One of his patients Rena H. Barnett had a scan a decade ago. Her mother died of a heart attack and Mrs. Barnett knew her level of LDL cholesterol the bad kind was very high at . But she said statins and other cholesterollowering drugs made her depressed and made her muscles ache so much she could not get out of bed in the morning. She tried lowering her LDL level by becoming a vegetarian but it did not budge. Relaxation with yoga did not help. But when Mrs. Barnett had a heart scan she learned that her calcium score was zero. Five years later she had another scan. Zero again. For now Mrs. Barnett is not taking anything to lower her cholesterol levels. Its not that I feel good about it. It would be nice to have it lower she said. But her anxiety has lifted."

"Scientists at the University of York have found a way of distinguishing between fatal prostate cancer and manageable cancer which could reduce unnecessary surgeries and radiotherapy. A recent study showed that more than men were being unnecessarily treated with surgery or radiotherapy for every single life saved. It is believed that success rates could be hindered as a result of treating all prostate cancers in the same way. A team at the University of York and the University of British Columbia Canada however have designed a test that can pick out lifethreatening prostate cancers with up to accuracy. Professor Norman Maitland from the University of Yorks Department of Biology said Unnecessary prostate treatment has both physical consequences for patients and their families but is also a substantial financial burden on the NHS where each operation will cost around . Cancers that are contained in the prostate however have the potential to be actively monitored which is not only cheaper but has far fewer negative sideeffects in patients with nonlife threatening cancer. It is now understood that to find the different levels of cancer scientists have to identify genes that have been altered in different cancer types. The team analysed more than cancer tissue samples and compared them with noncancer tissue to search for patterns of a chemical group that is added to part of the DNA molecule altering gene expression. A persons age what they eat and how they sleep for example impacts on chemical alterations to genes and which ones are turned on and off. This is part of the normal functioning of the human body and can tell individuals apart but the process can sometimes go wrong resulting in various diseases. Professor Maitland said In some diseases such as cancer genes can be switched to an opposite state causing major health issues and threat to life. The challenge in prostate cancer is how to look at all of these patterns within a cell but hone in on the gene activity that suggests cancer and not only this what type of cancer dangerous or manageable To put it another way how to do we distinguish the tiger cancer cells from the pussycat cancer cells when there are millions of patterns of chemical alterations going on many of which will be perfectly healthy The team needed to eliminate the noise of the genetic patterns that make individuals unique to leave them with the patterns that indicate cancer. They were able to do this using a computer algorithm which left the team with possible genetic markers for prostate cancer. Dr Davide Pellacani who began these studies in York before moving to the University of British Columbia said Using this computer analysis not only could we see which tissue samples had cancer and which didnt but also which cancers were dangerous and which ones less so. Out of almost a million markers studied we were able to use our new tools to single out differences in cancer potency. To take this method out of the laboratory the team are now investigating a further trial with new cancer samples and hope to involve a commercial partner to allow this to be used for patients being treated in the NHS. The research published in the British Journal of Cancer was funded by The Freemasons of the Province of Yorkshire North and East Ridings and The Masonic Samaritan Fund. Yorkshire Cancer Research Prostate Cancer UK The British Columbia Cancer Agency Strategic Priorities Fund."

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

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

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

"Taking the pregnancy hormone estriol along with their conventional medications helped patients with relapsingremitting multiple sclerosis RRMS avoid relapses according to results of a Phase II randomized placebocontrolled study led by UCLA researchers. The study published online in Lancet Neurology was truly translational. The UCLA team took observations from the bedside tested them in the laboratory and took those findings back again to patients in clinical trials said the studys lead author Dr. Rhonda Voskuhl professor in the UCLA Department of Neurology and director of UCLAs Multiple Sclerosis Program. Its long been observed that during the second half of pregnancy women with RRMS have reduced relapses but the reason was unclear. It is also during this period that the fetal placenta produces estriol increasing the hormone levels in the blood. This protection during pregnancy occurs not only in MS but also in other autoimmune diseases such as psoriasis and rheumatoid arthritis. Voskuhl took this information to the lab. She hypothesized that increased estriol in the blood might play a role in suppressing a womans immune system so that the fetus is not rejected as being foreign having half of the fathers proteins. This temporary suppression of the immune system would be good for pregnant mothers with autoimmune diseases. Her team found that treatment with estriol was protective in the MS model. That led to a successful pilot clinical trial in at UCLA and then the Phase II trial launched in at UCLA and other sites across the United States. The beauty of estriol is that it is not a shot and can be taken in pill form and also that its not a new drug. It has decades of safety behind it said Voskuhl who holds the Jack H. Skirball Chair for Multiple Sclerosis in the UCLA Department of Neurology. Also current MS treatments are very complex to manufacture. These findings hopefully will pave the way for oral safe treatments that are more widely accessible since estriol is simple and naturally occurring. Multiple sclerosis is an autoimmune disease of the central nervous system where immune cells from the blood attack the tissue surrounding the brains nerve fibers. Called myelin this tissue is like the insulation wrapped around an electrical wire. When the myelin is damaged it interferes with the ability of the nerves to send signals to and from the brain resulting in symptoms including cognitive problems difficulty with walking poor vision and other disabilities. In RRMS there are clear episodes of inflammatory activity or relapses. During a relapse there are new or worsening symptoms accompanied by inflammatory lesions in the brain. A relapse can continue anywhere from several days to months. Relapses are usually followed by remission or improvement. However some residual symptoms may remain and after many years people with RRMS often transition to a progressive form of the disease. During the progressive phase there are no longer relapses but instead gradual worsening of permanent disabilities and loss of brain volume or atrophy. In the lab Voskuhl and her team discovered that estriol potentially provides a onetwo punch against the disease both reducing the ability of immune cells to attack the brain while also making brain cells more resistant to damage if any immune cells do make it through. Specifically they showed that estriol treatment improved cognition and prevented atrophy of the cognitive region of the brain. It seems that during pregnancy estriol can both suppress the immune system and protect the brain for not only is it important to avoid rejection of the fetus as foreign it is also critical to protect the developing fetal brain. While these two effects may be designed to protect the fetus they may also be exactly what the doctor ordered for women with MS. In Voskuhl completed the pilot study in which nonpregnant women with MS were given estriol yielding a greater than percent drop in inflammatory lesions in the brain within only six months of treatment. In the Phase II study researchers enrolled patients with allocated to the estriol group and to the placebo group. Both arms continued their conventional medication injectable glatiramer acetate. The team found that the patients taking estriol had a third to a half as many relapses compared to those taking the placebo with this improvement occurring over and above that provided by their conventional treatment. In addition when estriol levels were the highest there was improved cognitive function and less atrophy of the brain area related to cognition. The treatment was well tolerated during the two years the volunteers took estriol and the only significant side effect was irregular menstruation. To date there is no FDA approved treatment for MS that improves disabilities. These two trials are very unique in that neither were funded by a pharmaceutical company. Rather they were funded by the National Institutes of Health NIH and the National Multiple Sclerosis Society consistent with the new NIH policy that more research should focus on sex differences in disease. Additional major funding was from the Conrad N. Hilton Foundation whose mission it is to improve the lives of disadvantaged people throughout the world. Synthetic Biologics Inc. provided estriol and placebo for the multicenter trial and has licensed certain rights from UCLA. Going forward Voskuhl hopes to see a Phase III trial conducted to replicate these findings since this is necessary for FDA approval of estriol for MS. She continues to seek support to advance this as well as other MS research projects. It is estimated that more than . million people are affected by MS worldwide. Approximately percent of patients are diagnosed at onset with RRMS the most common form of MS. Story Source Materials https provided by University of California Los Angeles Health Sciences http Note Content may be edited for style and length. Journal Reference . Rhonda R Voskuhl HeJing Wang T C Jackson Wu Nancy L Sicotte Kunio Nakamura Florian Kurth Noriko Itoh Jenny Bardens Jacqueline T Bernard John R Corboy Anne H Cross Suhayl DhibJalbut Corey C Ford Elliot M Frohman Barbara Giesser Dina Jacobs Lloyd H Kasper Sharon Lynch Gareth Parry Michael K Racke Anthony T Reder John Rose Dean M Wingerchuk Allan J MacKenzieGraham Douglas L Arnold Chi Hong Tseng Robert Elashoff. Estriol combined with glatiramer acetate for women with relapsingremitting multiple sclerosis a randomised placebocontrolled phase trial. The Lancet Neurology DOI .S httpdx.doi.org.S"

"An estimated percent of people are at risk of developing knee osteoarthritis OA in their lifetime. According to a network metaanalysis research article published in the May issue of the Journal of the American Academy of Orthopaedic Surgeons JAAOS the nonsteroidal antiinflammatory drug NSAID naproxen was ranked most effective in individual knee OA treatment for improving both pain and function and is considered a relatively safe and lowcost treatment method. Nonsurgical treatments for knee OA supported by previous research evidence include strength training lowimpact aerobic exercises NSAIDs and weight loss in individuals with a body mass index over . This new research analyzed data from multiple trials to determine the relative effectiveness of various nonsurgical treatments for knee OA. The treatments that were compared and ranked included acetaminophen ibuprofen intraarticular IA or joint injections of cortisone plateletrich plasma PRP hyaluronic acid HA several NSAIDs such as naproxen celecoxib and diclofenac and both oral and IA placebo. This is the first comprehensive mixedcomparison analysis comparing bestevidence scientific research and excluding lower quality studies that can bias the outcomes said lead author and orthopaedic surgeon David Jevsevar MD MBA. Using a statistical ranking technique we worked to provide evidence regarding which of the most common NSAIDs are most likely to decrease pain and improve function and we attempted to fill in the gaps in evidence for more inconclusive treatments such as HA PRP and corticosteroids. Authors analyzed randomized controlled trials that examined knee OA treatments for at least days and included a minimum of participants per study group. Knee OA treatments were ranked on a scale of one to five with one being the most effective. They found the following For pain reduction cortisone injections provided the greatest shortterm to weeks pain relief followed by ibuprofen PRP injections naproxen and celecoxib. Naproxen ranked the highest for probability for improving function followed by diclofenac celecoxib ibuprofen and PRP injections. Naproxen was ranked the most effective individual knee OA treatment for improving both pain and function followed by cortisone injections PRP injections ibuprofen and celecoxib. HA injections did not achieve a rank in the top five treatments for pain function or combined pain and function. An analysis of articles also found that results with HA are not significantly different from those with IA placebo for treatment of knee OA. Because knee OA has both a high disease burden and high treatment costs additional prospective studies using similar outcomes timelines and measures of clinically important changes are needed explained Dr. Jevsevar. While the information in this analysis is helpful to physicians patients also can benefit from these findings and use it with their doctors to weigh all possible treatment options. Although the use of NSAIDs for arthritic conditions such as knee OA has potential risks including heart attack and stroke existing evidence indicates that naproxen has less potential for adverse cardiovascular events. More information about the AAOS and JAAOS Follow the AAOS on Facebook Twitter and Instagram Follow the conversation about JAAOS on Twitter Disclosures From the Department of Orthopaedics DartmouthHitchcock Medical Center Lebanon NH Dr. Jevsevar American Academy of Orthopaedic Surgeons Rosemont IL Mr. Shores Mr. Mullen Ms. Schulte and Dr. Cummins and Franciscan Orthopedic Associates Tacoma WA Dr. Brown. J Am Acad Orthop Surg . DOI .JAAOSD"

"Concentrating on music can provide enough distraction to ease the pain of people with significant anxiety according to a new study. Researchers from the University of Utah Pain Research Center studied the effectiveness of music as a pain reliever on study participants. The volunteers were asked to follow a melody so they could identify the tones that stood out. While tackling the assignment they received safe pain shocks with fingertip electrodes. The study published in the December issue of the Journal of Pain found that pain was reduced as the demands of the music task rose. The researchers explained that the music competed with the participants pain pathways. By triggering emotional responses and engaging the participants minds the music task helped to ease their pain. Participants with the most anxiety about the pain became more engrossed in the musiclistening task than those who were less anxious according to a journal news release. The study authors suggested that experiencing little anxiety lowered the participants ability to focus on the task. The researchers concluded that people with a lot of anxiety who can become preoccupied by activities such as listening to music can reduce discomfort by using this type of painrelief strategy. Doctors should take patients personality traits into consideration before suggesting pain therapies such as music the authors said. More information The American Music Therapy Association provides more information on music therapy http SOURCE American Pain Society news release Dec."

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

"A new type of stem cell treatment for people with type diabetes appears to help reeducate rogue immune system cells which allows cells in the pancreas to start producing insulin again. The treatment which combines a patients immune system cells with stem cells from a donors cord blood even worked in people with longstanding diabetes who were believed to have no insulinproducing ability. Although the treatment didnt wean anyone off insulin completely average blood sugar levels dropped significantly which would reduce the risk of longterm complications. Our study brings a new hope for people with type diabetes. If we can control the autoimmunity we may reverse the diabetes. We showed that the islets cells can start to work again said Dr. Yong Zhao an assistant professor in the section of endocrinology diabetes and metabolism at the University of Illinois at Chicago. This treatment could potentially be useful in other autoimmune diseases such as lupus and rheumatoid arthritis. Its quite remarkable that this approach based on the reeducation of immune cells might work so well. The concept is very intriguing and the treatment seems to be so simple and so safe said Dr. Luca Inverardi deputy director of translational research at the Diabetes Research Institute University of Miami School of Medicine. But hes also reasonably cautious he said. The followup is long up to weeks but its not long enough to declare victory against diabetes yet said Inverardi. Also he noted that the study involved only Chinese people and that type diabetes is a bit different in that population. He said hed like to see larger studies with a more diverse population followed for a longer time. Results of the study were published online Jan. in the journal BMC Medicine. Type diabetes an autoimmune disease occurs when the bodys immune system cells mistakenly attack the insulinproducing beta cells in the pancreas. Because their beta cells dont produce enough or any insulin people with type diabetes have to replace the lost insulin through injections to survive. Stopping that autoimmune attack appears to be crucial to any treatment that hopes to cure or reverse type diabetes. Zhaos team developed a completely new approach. They take blood from a patient and separate out the immune system cells lymphocytes. They briefly expose those cells to stem cells from umbilical cord blood from an unrelated infant and return the lymphocytes alone to the patients body. The researchers have dubbed this Stem Cell Educator Therapy because while exposed to the stem cells the lymphocytes seem to relearn how they should behave. The study participants who were to years old had had type diabetes for an average of nine years. Six had some residual beta cell function and six did not. Both groups were given stem cell educator therapy. The other three people served as the control group. The researchers measured Cpeptide a protein fragment thats a byproduct of insulin production and found that the educator therapy group had improved levels of Cpeptide at weeks. These levels continued to improve until weeks and remained stable through the followup at weeks. There were no changes in Cpeptide in the control group. The average daily dose of insulin dropped almost percent after weeks for the group with some beta cell function and percent in those with no beta cell function suggesting that the group with no beta cell function now produced insulin. That means if you stop the autoimmune reaction you may see beta cell regeneration or there might be other precursor cells in the pancreas. If these data are confirmed this is a very provocative and remarkable finding Inverardi said. The average hemoglobin AC level dropped . percent for those with residual beta cell function and . percent for those without beta cell function. AC levels measure average blood sugar levels over two to three months and people with type diabetes are advised to maintain AC levels below percent. A drop of percent in AC levels can reduce the risk of complications. This was an initial clinical trial designed to test for safety. Zhao said that in future trials he hopes that with additional treatments people might get off insulin altogether. But even if thats not possible the recovery of some beta cell function would be welcome news. In the absence of complete remission there are very sizable advantages to having some beta cell function Inverardi noted. Both experts said the treatment appears safe with no risk of rejection. No significant side effects were reported during the trial other than some arm soreness where blood was taken and returned. More information Learn more about type diabetes from the Nemours Foundations KidsHealth Web site httpkidshealth.orgparentmedicalendocrinetype.html. SOURCES Yong Zhao M.D. Ph.D. assistant professor section of endocrinology diabetes and metabolism department of medicine University of Illinois at Chicago Luca Inverardi M.D. deputy director of translational research at the Diabetes Research Institute University of Miami School of Medicine and research professor of medicine microbiology and immunology University of Miami Miller School of Medicine Jan. BMC Medicine online"

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

"For two decades Patricia DiGiusto struggled with severe asthma httpshealth.nytimes.comhealthguidesdiseaseasthmaoverview.htmlinlinenytclassifier. Powerful medications and frequent use of her inhaler could not prevent repeated trips to the emergency room. On one particularly bad night Ms. DiGiusto watched from her hospital bed as doctors and nurses prepared to insert plastic tubing down her windpipe to help her breathe. Gasping for air she was certain she would not survive. Ill never forget that feeling said Ms. DiGiusto a speech pathologist in Braintree Mass. The feeling that Im never going to see my kids or husband again and that asthma is finally going to get me. Two years ago Ms. DiGiustos doctor told her about a new procedure called bronchial thermoplasty the first nondrug therapy approved by the Food and Drug Administration for patients with severe asthma. During the procedure a doctor guides a bronchoscope into a patients airways. There it heats the lungs to degrees Fahrenheit cooler than a cup of coffee but warm enough to shrink the smooth muscle in the airways which swells during an asthma attack and restricts breathing. After the procedure the airways no longer are so prone to constricting studies show. Asthma patients suffer fewer attacks and need fewer hospital visits. Ms. DiGiusto had the procedure in March . Since then she has ended most of her medications and has not had a single asthma attack. Im a language therapist she said but I cant even think of the word to describe how much better this has made my life. Across the country about million people suffer from asthma. Every year about die because of it. Avoiding allergens and using inhaled medications are enough to keep asthma under control in most patients. But for the minority with severe persistent asthma medication and lifestyle changes are not enough. Frequent hospital trips are almost inevitable and powerful steroids httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicssteroidsindex.htmlinlinenytclassifier like prednisone which can cause thinning bones cataracts httpshealth.nytimes.comhealthguidesdiseasecataractoverview.htmlinlinenytclassifier depression and other debilitating side effects become a necessity. Nationwide asthma treatment costs exceed billion a year and over half of that is spent on severe asthmatics who make up only percent of the asthma population. Doctors say bronchial thermoplasty has given them a new weapon in the battle against severe asthma and many patients call it lifechanging. But the procedure is expensive costing around and insurers have been reluctant to cover it. As a result many people who need it doctors say are forced to go without it. For those of us in the field who work with severe asthmatics and see how limited they are its frustrating because we have this new therapy weve seen it work and the data says it works said Dr. Roy St. John a pulmonary disease specialist at Columbus Pulmonary and Critical Care in Ohio. But the big insurers have all denied it. Although bronchial thermoplasty was approved by the F.D.A. only two years ago clinical studies on it began in . Since then about patients across the country have had the procedure. It takes place in three steps each separated by about three weeks. Each time a different section of the lungs is treated. Some patients report temporary coughing mucus and other respiratory symptoms brought on by irritation of airways. But several fiveyear studies showed no longterm safety issues. And researchers at Washington University School of Medicine found that compared with a control group https bronchial thermoplasty patients saw their asthma attacks drop by a third their emergency room visits fall by percent and the number of days they lost from work and school drop by percent. This isnt a cure but it is definitely a breakthrough said Dr. Pratik S. Patel director of Interventional Pulmonary Medicine at Newark Beth Israel Medical Center in New Jersey. Its not going to get rid of asthma but it is going to reduce symptoms and hospitalizations and make patients more functional in their daily life. For now the procedure is only for severe asthmatics who unlike a vast majority of asthma patients cannot keep flareups at bay with standard medications said Dr. Kyle Hogarth an assistant professor of medicine at the University of Chicago who was involved in clinical studies of the treatment. There are millions and millions of asthmatics he said. There will not be millions of thermoplasty patients. Still even patients with severe asthma often are denied insurance coverage for the procedure. Susan Pisano a spokeswoman for Americas Health Insurance Plans the industry trade group said insurers are awaiting the results of an additional fiveyear clinical trial required by the F.D.A. when it approved bronchial thermoplasty. That trial will not be completed until at least . Until then Ms. Pisano said many insurers are denying coverage on the grounds the procedure is experimental. The issue here for health plans is the longterm safety and efficacy have yet to be established she said. But three fiveyear studies have already been completed. Many asthma specialists believe that insurers are taking a shortsighted approach. The onetime cost of they say is dwarfed by the tens of thousands of dollars in hospital bills and medication costs that a severe asthmatic can easily accumulate in a single year. One such patient Alberto Gaulion a retired importer in Miami estimated that for much of the last decade his insurer Blue Cross Blue Shield spent about a year on his medical care. Every two or three weeks I had to go to the hospital he said and I was taking everything that was on the market. I was on a cocktail of drugs. Blue Cross would not cover the procedure for him so Mr. Gaulion paid out of pocket when he had it in . Since then he has had no hospital visits and no asthma attacks and takes only one medication instead of five. Now I can breathe he said and Im saving my insurance company a fortune. Dr. Charlene McEvoy a director of an asthma center run by Health Partners the largest health plan in Minnesota believed in thermoplasty enough to push the insurer to start covering it. Dr. McEvoy argued that it made economic sense and earlier this year Health Partners agreed. When plans look at the cost savings I think theyre going to cover it said Dr. McEvoy an assistant professor of medicine at the University of Minnesota. You have to show that theres a return on investment."

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

"A clinical trial published in The Lancet a top medical journal shows that an intensive procedure that completely wipes out the immune system and then regenerates a new one using blood stem cells can eliminate all signs of damaging brain inflammation in people with early aggressive multiple sclerosis MS and facilitate lasting recovery. Led by Dr. Harold Atkins and Dr. Mark S. Freedman of The Ottawa Hospital and the University of Ottawa the trial included participants who were followed for up to years. The . million trial was funded by the MS Society of Canada and its affiliated Multiple Sclerosis Scientific Research Foundation. The research was also supported by The Ottawa Hospital Foundation The Ottawa Hospital Department of Medicine and Canadian Blood Services. Our trial is the first to show the complete longterm suppression of all inflammatory activity in people with MS said Dr. Atkins a stem cell transplant physician and scientist at The Ottawa Hospital and associate professor at the University of Ottawa. This is very exciting. However it is important to note that this therapy can have serious side effects and risks and would only be appropriate for a small proportion of people with very active MS. People with MS who have had significant disability for a long time would likely not benefit. This procedure should be considered as a treatment option for people with early aggressive MS said Dr. Freedman a neurologist and senior scientist at The Ottawa Hospital and professor at the University of Ottawa. Although this trial was relatively small it was intensive with the longest prospective followup of any such treatment group to date and that is what makes the results so convincing. However this is a very complex procedure that should only be performed at very specialized centres with expertise in both the management of MS patients and blood stem cell transplantation. MS affects approximately . million people around the world causing symptoms that range from blurred vision to extreme fatigue to partial or complete paralysis. It occurs when the immune system which normally protects against foreign diseasecausing organisms mistakenly attacks the bodys own central nervous system which includes the brain spinal cord and optic nerve. Early in the disease people often experience temporary episodes of worsening symptoms accompanied by active inflammation in the brain called relapses whereas later on disease progression is inevitable. The trial evaluated a treatment called immunoablation and autologous hematopoietic stem cell transplantation IAHSCT. The procedure begins by giving a person medication to coax their hematopoietic stem cells to migrate from their bone marrow into their blood. These stem cells are then collected from the blood purified and frozen. Then high doses of chemotherapy drugs are used to eliminate the persons diseased immune system. The stem cells are then transplanted back into the same person so that they can give rise to a new immune system that has no memory of the previous pattern of attacking the central nervous system. The trial included participants with aggressive relapsing MS. They were followed for anywhere between four and years after treatment with a median posttreatment follow up of . years. After the treatment Not a single participant experienced a clinical relapse zero relapses in patientyears whereas before treatment the participants experienced an average of . relapses per year relapses in patientyears. Not a single new active inflammatory lesion could be detected in the brains of any of the participants zero lesions on MRI scans whereas before the treatment participants had lesions on scans. Not a single participant required MSspecific drugs to control their disease. percent of participants experienced a complete stop in disease progression. The average rate of brain shrinkage typically a measure that correlates with MS progression returned to levels associated with normal aging. percent of participants experienced some lasting reversal of symptoms such as vision loss muscle weakness and balance problems. Some participants were able to return to work or school regain the ability to drive get married and have children. Trial participant Jennifer Molson was diagnosed with MS in when she was just . She received her transplant in . Before my transplant I was unable to walk or work and was living in assisted care at The Ottawa Hospital Rehabilitation Centre she said. Now I am able to walk independently live in my own home and work full time. I was also able to get married walk down the aisle with my Dad and dance with my husband. Ive even gone downhill skiing. Thanks to this research I have been given a second chance at life. The MS Society is proud to be a part of an important turning point in the treatment of MS said Yves Savoie CEO and President of the MS Society of Canada. What started as a bold idea has translated into a treatment option for people living with highly active relapsing MS. Publication of the results from this study will inform clinicians of the risks and benefits of the procedure and pave the way for further research which could help people with all forms of MS. A variation of this procedure has been used to treat leukemia for decades but its use for autoimmune diseases is relatively new said Dr. Atkins who is also the Medical Director of the Regenerative Medicine Program at the Ottawa Hospital Research Institute. It is only used in very severe cases because participants face a significant risk of infection and other sideeffects including death. The risks are similar to those faced by leukemia patients undergoing this kind of treatment. Indeed one participant in this study died of liver failure due to the treatment and another required intensive care for liver complications. The treatment regimen was modified over the course of the study to reduce toxicity but all participants still developed fevers which were frequently associated with infections. Several recent clinical trials from other groups have examined this procedure in people with MS said Dr. Freedman who is also the Director of MS Research at The Ottawa Hospital. Our study is unique in that we used a stronger cocktail of drugs to eliminate the immune system we followed the participants for a very long time and the majority of our participants have had significant longlasting responses. People who are interested in this therapy should speak with their own neurologist who can request a referral to The Ottawa Hospital MS Clinic or another major hospital with experience in this area. Note that The Ottawa Hospital cannot treat people without valid Canadian health coverage. This study was approved by the Ottawa Health Sciences Network Research Ethics Board and is registered at httpsclinicaltrials.govctshowNCT. The lead researchers are affiliated with the Stem Cell Network the Ontario Institute for Regenerative Medicine and the University of Ottawa Brain and Mind Research Institute. We thank the patients from across Canada who participated in this clinical trial as well as their family members said Marjorie Bowman trial coordinator and advanced practice nurse at The Ottawa Hospital. Their courage and dedication are remarkable. Full reference Immunoablation and autologous haemopoietic stemcell transplantation for aggressive multiple sclerosis a multicentre singlegroup phase trial. Harold L Atkins Marjorie Bowman David Allan Grizel Anstee Douglas L Arnold Amit BarOr Isabelle BenceBruckler Paul Birch Christopher Bredeson Jacqueline Chen Dean Fergusson Mike Halpenny Linda Hamelin Lothar Huebsch Brian Hutton Pierre Laneuville Yves Lapierre Hyunwoo Lee Lisa Martin Sheryl McDiarmid Paul OConnor Timothy Ramsay Mitchell Sabloff Lisa Walker Mark S Freedman. The Lancet. Epub June . http Audiovisual Photos of Dr. Atkins Dr. Freedman Marjorie Bowman and Jennifer Molson are available here. Video clips and additional photos of trial participants are available upon request. About The Ottawa Hospital Inspired by research. Driven by compassion. The Ottawa Hospital is one of Canadas largest learning and research hospitals with over beds approximately staff and an annual budget of over . billion. Our focus on research and learning helps us develop new and innovative ways to treat patients and improve care. As a multicampus hospital affiliated with the University of Ottawa we deliver specialized care to the Eastern Ontario region but our techniques and research discoveries are adopted around the world. We engage the community at all levels to support our vision for better patient care. See http for more information about research at The Ottawa Hospital. About the Multiple Sclerosis Society of Canada and Multiple Sclerosis Scientific Research Foundation The MS Society of Canada is dedicated to finding a cure for multiple sclerosis by funding leadingedge research and improving the quality of life of those affected by the disease. The Multiple Sclerosis Scientific Research Foundation funds large innovative multicentre collaborative studies that will lead to major advances in the field of MS. A unique Canadian resource the Foundations main funding source is the MS Society of Canada. Please visit mssociety.ca or call to make a donation or for more information. About the University of Ottawa The University of Ottawa is home to over students faculty and staff who live work and study in both French and English. Our campus is a crossroads of cultures and ideas where bold minds come together to inspire gamechanging ideas. We are one of Canadas top research universitiesour professors and researchers explore new approaches to todays challenges. One of a handful of Canadian universities ranked among the top in the world we attract exceptional thinkers and welcome diverse perspectives from across the globe. http"

"Duke University researchers have developed a handheld device for cervical cancer screening that promises to do away with uncomfortable speculums and highcost colposcopes. The pocket colposcope is a slender wand that can connect to many devices including laptops or cell phones. If widely adopted women might even use the device to selfscreen transforming screening and cure rates in lowincome countries and regions of the United States where cervical cancer is most prevalent. Cervical cancer is the fourth most common cancer in women with more than new cases occurring annually worldwide. In the United States physicians diagnose more than cases each year. While more than American women die of the disease each year the mortality rate has dropped more than percent in the past four decades largely due to the advent of wellorganized screening and diagnostic programs. While the Pap smear can be performed by a nonspecialist colposcopy requires visualization of the cervix relying on highly trained professionals and expensive equipment that is not easily accessible to underserved populations. These factors make cervical cancer more prevalent in women living in low socioeconomic communities. In a new paper published on May in the journal PLOS One researchers from Duke believe they have found a better way. The mortality rate of cervical cancer should absolutely be zero percent because we have all the tools to see and treat it said Nimmi Ramanujam the Robert W. Carr Jr. Professor of Biomedical Engineering at Duke. But it isnt. That is in part because women do not receive screening or do not follow up on a positive screening to have colposcopy performed at a referral clinic. We need to bring colposcopy to women so that we can reduce this complicated string of actions into a single touch point. Current standard practices for cervical cancer screening require three things a speculum a colposcope and a trained professional to administer the test. The speculum is a metal device designed to spread the vaginal walls apart. The colposcope is a magnified telescopic device and camera designed to allow medical professionals to look through the speculum to see the cervix which is located three to six inches inside the vagina. Colposcopes and people who know how to use them are difficult to find in many lowincome regions both domestically and internationally. Ramanujam believes she can replace at least two of these requirements. Her laboratory has developed an allinone device that resembles a pocketsized tampon with lights and a camera at one end. Health providers or even women themselves are able to capture images of the cervix using the rounded tip of the device to manipulate its position if necessary. The device also includes a channel through which contrast agents used for the cervical cancer screening procedure can be applied. We recruited volunteers on Dukes campus to try out the new integrated speculumcolposcope design said Mercy Asiedu a graduate student working on the project in Ramanujams lab. Nearly everyone said they preferred it to a traditional speculum and more than percent of the women who tried the device were able to get a good image. Those that couldnt felt that they just needed some practice. Ramanujam and Asiedu are now working on clinical trials to see how their design stacks up against the traditional colposcopy used with a speculum. By using both methods to visualize the cervix the researchers will be able to make a direct comparison. Asiedu is also working to automate the screening process. By using image processing and machine learning to teach computers how to spot signs of precancerous and cancerous cells Asiedu hopes to remove the need for a trained physician at any point in the screening process and shift the task to midwives community health workers and even the women themselves. There have been a few other attempts to come up with a better solution but none of them have succeeded said Asiedu. One design using an inflatable cylinder proved just as uncomfortable as a traditional speculum. Another using directed airflow is just as bulky and expensive as a modern colposcope. With our handheld lowcost design were hoping to redefine the entire procedure. This work was supported by the National Institutes of Health RCA RCA. CITATION Design and Preliminary Analysis of a Vaginal Inserter for SpeculumFree Cervical Cancer Screening Asiedu MN Agudogo J Krieger M Miros R ProescholdBell RJ Schmitt JW Ramanujam N. PLOS One May . DOI .journal.pone."

"Novartis will seek regulatory approval this year for a new kind of antiinflammatory heart drug though some experts fear fatal infection risks and a high price may overshadow the medicines limited benefits. FILE PHOTO A general view shows the Rhine river and the headquarters of Swiss pharmaceutical company Novartis AG in Basel Switzerland March . REUTERSArnd Wiegmann Keenly awaited clinical trial results released on Sunday showed heartattack survivors on one of three doses of canakinumab were percent less likely to suffer another major cardiac event than those on a placebo. Novartis had said in June that the drug met its goal in the study but details were only unveiled at European Society of Cardiology meeting in Barcelona. One leading expert described the benefit as modest. Patients getting canakinumab also suffered significantly more deaths from infections than those on placebo but on the positive side they appeared to be at lower risk of cancer. There was no significant difference in the rate of deaths from all causes between the placebo group and those on canakinumab. The modest absolute clinical benefit of canakinumab cannot justify its routine use in patients with previous myocardial infarction until we understand more about the efficacy and safety tradeoffs and unless a price restructuring and formal costeffectiveness evaluation supports it wrote Dr. Robert Harrington chair of the Stanford University School of Medicine in an editorial in the New England Journal of Medicine. Canakinumab had stirred considerable scientific interest because it appears to finally deliver proof that fighting inflammation offers a promising new way to counter heart disease in patients who already get cholesterollowering treatment. Subsequently some analysts boosted their revenue estimates for the Novartis medicine into the billions of dollars while awaiting the data announced on Sunday. Canakinumab is already approved as Ilaris for rare autoimmune conditions. Vas Narasimhan Novartiss head of global drug development said the drugmaker plans to go to regulators in the fourth quarter to seek approval for canakinumab to treat heartattack victims with high levels of inflammation. He downplayed critics who said the benefit was small saying that one large subgroup in the socalled Cantos trial had shown a percent reduction in cardiovascular risk. Novartis also plans to underscore canakinumabs potential cancer fighting properties with the European Medicines Agency and the U.S. Food and Drug Administration. SEPARATE TRIALS Thats after an analysis of Cantos data found total cancer mortality among patients getting canakinumab was significantly lower than in those receiving the placebo. Narasimhan who said the company now plans to start separate cancer trials for canakinumab said the drug could be particularly suitable for smokers with risks of both lung cancer and heart problems. With the oncology findings promising but only preliminary the company is planning additional studies in lung cancer starting next year he said. Ilaris now costs about per patient annually for treating rare immune conditions and brings in some million in yearly sales for the Swiss company though its price is likely to be slashed should it win approval in the heart setting. Novartis initially struggled with the sluggish launch of its last heart drug the peryear Entresto so it is understandably concerned about the reception for canakinumab. While Narasimhan said it was too early to discuss pricing he argued socalled PCSK cholesterol drugs that cost about annually should not be relied on as a yardstick. In view of the additional oncology findings we dont think you should just think about this as a cardiovascular drug Narasimhan said. I dont think you can necessarily just make comparisons to existing benchmarks such as the PCSKs. Even so Tim Anderson a Bernstein analyst said the marginal data are not compelling enough to dispel what for Novartis will remain a pricing conundrum should canakinumabs approval be expanded for heart patients. If the company cuts the price of the product in its current orphan indications then it instantly sacrifices sales which currently total about million per year with the hope that future sales in a new CV setting will more than offset this Anderson said in a note. Some have wondered whether a particularly highrisk subgroup could be identified where canakinumabs current price can be justified he said. We are not hopeful here. Reporting by John Miller Editing by Ben Hirschler and Ralph Boulton Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Preliminary research suggests that a single injection of a manmade protein might lower levels of bad cholesterol. Given in the abdomen AMG reduced lowdensity lipoprotein LDL cholesterol levels among a group of healthy volunteers. The shot turned off a newly identified cholesterol regulator PCSK which interferes with the livers ability to clear bad cholesterol from the bloodstream. The findings were presented Monday at the American Heart Association AHA annual meeting in Orlando Fla. The study was funded by AMG manufacturer Amgen Inc. High cholesterol is a major risk factor for heart disease. The first step toward lowering cholesterol is typically lifestyle changes which include eating a lowfat diet and regular physical activity. For some medications such as statins must be added to get cholesterol levels where they ought to be. Even this is not enough to get everyones numbers into the safety zone and not everyone can tolerate currently available medications. An LDL of less than mgdL of blood is considered optimal. Study author Clapton Dias medical sciences director of clinical pharmacology and early development at Amgen in Thousand Oaks Calif. said this shot could be given as an addon to current cholesterollowering therapies for people who are not getting as low as they should be or as a standalone treatment for people who cant tolerate existing lipidlowering drugs. Cardiovascular disease is the number one cause of death in the U.S. and while statins are very effective a good proportion of people are not meeting their goals and in this setting the shot could be a valuable addition he said. The study included men and two women aged to who did not have elevated cholesterol levels. Participants received one of five doses of the new drug delivered via shot or intravenously or a placebo. Researchers measured LDL cholesterol levels for to days after treatment. The new drug did hit its target PCSK and decreased levels of LDL cholesterol by up to percent. There were also decreases seen in levels of total cholesterol and apoB tiny fat particles in the blood that also increase the risk for heart disease. Levels of triglycerides and good HDL cholesterol were not altered by the medication and there were no serious side effects reported. Now researchers are testing the new shot in people who have high cholesterol. Cardiologists were cautiously optimistic about the novel therapy. Former AHA President Dr. Ralph Sacco said that it is too early to make any predictions about what role if any this therapy will have in lowering cholesterol levels but it could one day fill an important void. Even though statins are so effective at lowering cholesterol and reducing risk for heart disease and stroke they do need to be taken every day and they can have certain side effects in some people said Sacco who is also chairman of neurology at the University of Miami. Statin side effects can include liver damage andor muscle pain. This new shot may provide a more longlasting approach especially if it could be given once a month Sacco said. Dr. Dan Rader director of preventive cardiology at the University of Pennsylvania said that PCSK is the hottest target for new treatments to lower LDL cholesterol. And these study results will probably fuel that fire he added. A plus percent reduction in LDL with a single dose of this antibody is impressive he said. It is the early days but the data look strong. We now need more data with people who have repeated dosing and are followed for longer periods of time Rader added. There are still plenty of people who cant achieve adequate LDL levels with existing drugs including statins he noted. Plus people may find it easier to get a shot every two weeks or monthly than to take a pill every day. Research presented at meetings should be considered preliminary until published in a peerreviewed medical journal. More information Learn about existing treatments for high cholesterol at the American Heart Association http_UCM__Article.jsp. SOURCES Clapton Dias Ph.D. medical sciences director of clinical pharmacology and early development Amgen Inc. Thousand Oaks Calif. Ralph Sacco M.D. chairman neurology University of Miami Miller School of Medicine and past president American Heart Association Dan Rader M.D. director preventive cardiology University of Pennsylvania Philadelphia Nov. presentation American Heart Association annual meeting Orlando Fla."

"In a small phase I clinical trial Johns Hopkins Kimmel Cancer Center researchers say they show for the first time that the experimental drug guadecitabine SGI is safe in combination with the chemotherapy drug irinotecan and may overcome resistance to irinotecan in patients with metastatic colorectal cancer. Results of the study are expected to be presented April at the American Association for Cancer Research AACR Annual Meeting in New Orleans abstract CT. Guadecitabine works to reverse a socalled epigenetic change in cancer cells known as methylation which may alter genetic activity in cells in a way that can block the action of tumorsuppressing genes pushing cells to become cancerous and resistant to therapy. By reversing this change in cancer cells the drug restores cancer cells vulnerability to drugs such as irinotecan. The clinical trial included patients with metastatic colorectal cancer who had been treated previously with irinotecan and whose disease was progressing. The patients were divided into four groups each receiving different doses of guadecitabine in combination with irinotecan over an average period of four months. During the study patients had at least one imaging scan to retest the extent and location of their cancers with patients experiencing stable disease for more than the fourmonth period on average and one patient experiencing a partial response to the treatment measured as at least a percent reduction in the size of the tumors. Although the studys main purpose was to test the safety rather than the effectiveness of guadecitabine doses we were very happy to see some patients who benefited from the combination of the therapies for many months to more than a year says Nilofer Azad M.D. professor of oncology at the Johns Hopkins University School of Medicine. The study also showed signs that guadecitabine reduced methylation among the cancer cells. We did see that giving a higher dose of the drug seemed to produce a better methylation response among patients says Valerie Lee M.D. a fellow at the Johns Hopkins Kimmel Cancer Center. However it seemed that patients were responding at all levels of the drug. Among the side effects of the combined treatment patients experienced neutropenia a low count of the infectionfighting white blood cells called neutrophils five patients with neutropenia had fevers three patients became anemic and two patients developed thrombocytopenia a lowered count of bloodclotting platelets. Other side effects included diarrhea three patients fatigue two patients and dehydration two patients. There was one death during the study possibly resulting from febrile neutropenia caused by the treatment. The current study was based on previous studies in the laboratory of Nita Ahuja M.D. director of the Sarcoma and Peritoneal Surface Malignancy Program and professor of surgery at the Johns Hopkins University School of Medicine which showed that guadecitabine limited the growth of colorectal cancer cell lines when combined with irinotecan says Azad. The drug combination is being tested in an ongoing phase II clinical trial NCT in a larger group of metastatic colorectal cancer patients at multiple institutions to determine the effectiveness of the dual therapy compared with chemotherapy regimens that do not include guadecitabine says Azad. Scientists leading the new study will also look for biomarkers in patients that could help determine which of them are most likely to benefit from guadecitabine and irinotecan. Lee says the research team will measure the amount of methylation in patients cells when they begin their treatment and the presence of genes associated with irinotecan resistance among other possible biomarkers. In there were more than people in the U.S. diagnosed with colon cancers. Fiveyear survival rates among people with localized colon cancers are more than percent but they are only percent in those with metastatic cancer. Guadecitabine is an experimental drug that has not been approved for use by the U.S. Food and Drug Administration. It is manufactured by Astex Pharmaceuticals a supporter of the Johns Hopkinsled study. The research was also supported by the Van Andel Research Institute SUCAACR Epigenetics Dream Team. Other scientists who contributed to the research include Judy Wang Anup Sharma Zachary Kerner Stephen Baylin Ellen Lilly and Thomas Brown from Johns Hopkins Anthony El Khoueiry from the University of Southern California Henk Verheul and Elske Gootjes from Vrije Universiteit in the Netherlands and Peter Jones from the Van Andel Research Institute."

"Low doses of the antidepressant Lexapro escitalopram cooled off hot flashes better than placebo in about menopausal women according to a new study. We believe escitalopram provides an option for treating moderate to severe hot flashes that are disrupting peoples lives and quality of life says study researcher Ellen Freeman PhD a research professor in the department of obstetricsgynecology and psychiatry at the University of Pennsylvania School of Medicine Philadelphia. In the study Freeman found the antidepressant reduced both the number and severity of hot flashes compared to placebo. Previous studies of other antidepressants have yielded mixed results according to Freeman. The new study findings suggest Lexapro can provide an option for women reluctant to take hormone therapy. The findings are published in TheJournal of the American Medical Association. Antidepressants for Hot Flashes Lexapro Study Freeman and colleagues assigned women who were experiencing hot flashes either to a group which took to milligrams a day of Lexapro or a placebo for eight weeks. The women on average about age did not know whether they were taking the drug or the placebo. The women were asked to keep daily diaries noting the frequency and severity of their hot flashes. At the study start the average frequency of hot flashes was nearly per day. When Freemans team looked at the sevenday average of hot flash frequency at week eight in those who kept the daily diaries they found Those taking the antidepressant reported . hot flashes a day a decline of or about four and fewer a day. Those taking the placebo reported . hot flashes a day a decline of or about three fewer a day. The severity of the hot flashes went down more in the Lexaprotreated women than those on placebo. On a point scale the average overall hot flash severity score at the study start was .. At week eight those on Lexapro reported an average severity score of . termed mild to moderate. Those on placebo by week eight had a severity score of .. While of the women in the Lexapro group had a decrease of at least in hot flash frequency at the eightweek mark of those in the placebo group did. A reduction is pretty good Freeman says. The researchers followed up three weeks after the study ended and the women had stopped taking the drug or placebo. They found those in the drug group reported a bigger increase in hot flashes than did those in the placebo group. No serious adverse events were reported in either group Freeman says. The study was funded by the National Institute on Aging and other sources. Freeman reports having received research support from Forest Laboratories Inc. and other pharmaceutical companies that make antidepressants. For this study Forest which makes escitalopram provided the drug and placebo pills but no funding. Exactly how the drug relieves hot flashes is not known Freeman says. The cause of hot flashes is not really known she says. It is thought that the antidepressant works by providing more of the hormone serotonin to the brain she says. Lexapro is approved for depression in adults and teens to and for anxiety disorder in adults. Its use for hot flashes is considered offlabel. Offlabel drugs are prescribed for uses that have not been approved by the FDA. Second Opinion The new study findings are no surprise to Amanda Richards MD assistant professor of obstetrics and gynecology at the University of Miami Medical School who reviewed the study for WebMD. She has prescribed antidepressants for hot flashes for some of her patients including some who had cancer and went into surgical menopause after ovary removal with generally good success she says. Its not that it takes them away completely she says of the drugs effects on menopausal symptoms. But she finds as did the study researchers that the antidepressants do reduce the number and severity of the hot flashes. A typical patient prescribed an antidepressant for hot flashes she says will come back a couple weeks later thanking me saying they can now work they can manage their hot flashes. There could be a decline in libido she tells patients on antidepressants. But some will take that side effect she says in return for hot flash relief."

"For years negative reports have surrounded artificial sweeteners claiming evidence of everything from being a carcinogen to causing cardiovascular disease. But now new research suggests a popular sugar substitute could lead to new treatments for some of the most common types of cancers. In findings presented at the National Meeting and Exposition of the American Chemical Society ACS a team of researchers from the University of Florida College of Medicine examined how saccharin the artificial sweetener that is the main ingredient in Sweet N Low Sweet Twin and Necta reacted with a protein found in aggressive cancer cells. The protein called carbonic anhydrase IX CA IX regulates pH in and around cancer cells allowing tumors to thrive and potentially metastasize to other parts of the body. It is found in a wide range of aggressive cancers including breast lung liver prostate pancreatic and kidney cancer. If you disrupt this pH balance via blocking CA IX activity you can stop these cancer cells from growing and proliferating study author Brian Mahon a graduate research assistant at the University of Florida told FoxNews.com. Mahon said the research stemmed from a study from the University of Florence in Italy that suggested saccharin would selectively block the activity of CA IX. He said his team led by University of Floridas Dr. Robert McKenna wanted to further investigate saccharins effect in treating cancer. It never ceases to amaze me how a simple molecule such as saccharin something many people put in their coffee every day may have untapped uses including as a possible lead compound to target aggressive cancers McKenna said. CA IX is not normally found in healthy human cells. McKenna said thats why its a prime target for anticancer drugs as they would cause little to no side effects to healthy tissue surrounding the tumor. Previous attempts to find an element that blocks CA IX without damaging other cells have been unsuccessful. Researchers used Xray crystallography to determine how saccharin binds to CA IX and are using that information to develop ways to finetune and improve its anticancer treatment potential. The goal is to develop drugs that could slow the growth of these cancers and potentially make them less resistant to chemo or radiation therapies. Currently saccharins effects are being tested on breast and liver cancer cells. This result opens up the potential to develop a novel anticancer drug that is derived from a common condiment that could have a lasting impact on treating several cancers McKenna said. Researchers warn the findings dont warrant adding large quantities of artificial sweeteners to your diet but they say their findings may offer promise for the development of an anticancer drug derived from an ingredient that ironically was once considered a possible carcinogen."

"Exposure to bright light can raise testosterone levels and lead to greater sexual satisfaction in men with low sexual desire according to the results of a small scientific trial. Scientists at the University of Siena in Italy found that regular earlymorning use of a light box similar to those used to combat Seasonal Affective Disorder or SAD helped men increase testosterone and improved their sex lives. Andrea Fagiolini a professor who led the study and presented it at the European College of Neuropsychopharmacology conference in Vienna on Monday said the treatment may prove useful during the Northern hemispheres darker winter months. The increased levels of testosterone explain the greater reported sexual satisfaction he said. In the Northern hemisphere the bodys testosterone production naturally declines from November through April and then rises steadily through the spring and summer with a peak in October. Low sexual desire can affect significant numbers of men after the age of with studies finding that up to percent of men report problems. Fagiolinis team recruited men diagnosed with either hypoactive sexual desire disorder or sexual arousal disorder both characterized by a lack of interest in sex. After taking baseline readings they divided the men into two groups and gave one regular treatment with a bright light box while the control or placebo group was treated with a light box adapted to give out significantly less light. We found fairly significant differences Fagiolini said. Before treatment both groups averaged a sexual satisfaction score of around out of . But after treatment the group exposed to the bright light was scoring sexual satisfaction scores of around .. In contrast the control group only showed an average score of around . after treatment. Editing by Alexander Smith Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Its still very early but scientists say a test based on a patients saliva might someday help detect Alzheimers disease. Saliva is easily obtained safe and affordable and has promising potential for predicting and tracking cognitive decline but were in the very early stages of this work and much more research is needed study author Shraddha Sapkota a neuroscience graduate student at the University of Alberta in Canada said in a news release from the Alzheimers Association. The study was to be presented Sunday at the Alzheimers Association International Conference in Washington D.C. Experts note that studies presented at medical meetings are typically considered preliminary until published in a peerreviewed journal. In the study Sapkotas team tested the saliva of people with Alzheimers disease people with whats known as mild cognitive impairment a decline in memory and thinking thats sometimes a precursor to dementia as well as people whose mental skills were normal for their age. They found that the saliva of people with Alzheimers had different levels of certain substances compared to the saliva of healthy people or those with mild cognitive impairment. Experts agreed that the findings held promise but much more research will be needed. This is a very preliminary study with a small number of subjects and the results are far from conclusive said Dr. Allison Reiss head of the Inflammation Section at WinthropUniversity Hospital in Mineola N.Y. She believes the current study lacks information on possible confounding factors things such as coexisting illnesses medications hydration state tobacco use and multiple other variables that could influence whats found in the saliva samples. There are many gaps in the evidence Reiss said. It is uncertain whether the strength and consistency of the relationship between these metabolites in saliva and Alzheimers risk will be maintained in a large multicenter study. Still Dr. Paul Wright chair of neurology at North Shore University Hospital in Manhasset N.Y. said the research is still in its infancy but very promising. If a saliva test lives up to its promise one advantage is the ease of obtaining a sample he said. But that convenience also brings its own problems Wright added. People might ask for a test even when they dont show any signs of dementia and this may result in anxiety and depression if there is a false positive result he said. For that reason larger studies are needed to corroborate and validate their findings Wright said. More information The U.S. National Institute on Aging has more about Alzheimers disease https SOURCES Paul Wright M.D. chair neurology North Shore University Hospital Manhasset N.Y. and Long Island Jewish Medical Center New Hyde Park N.Y. Allison Reiss M.D. head Inflammation Section WinthropUniversity Hospital Mineola N.Y. Alzheimers Association news release July"

"When I tore my rotator cuff in I had conventional laparoscopic surgery to repair it. The outcome was excellent but the recovery was long and horrible. The orthopedist wouldnt let me drive for six weeks or run swim or lift weights for three months. I suffered through weeks of torturous physical therapy. It was nearly six months before I felt normal again. So in after a nurse improperly administered a vaccination that resulted in chronic pain and an MRI revealed another rotatorcuff tear I vowed I would not go through shoulder surgery or its aftermath again. Cortisone injections and physical therapy didnt help so I decided to try something else plateletrich plasma a therapy that uses the bodys natural healing properties to mend injuries. Its practitioners believe it will transform orthopedics. Based on my experience with it I think they are right. It may not work for every condition or for everyone. But it worked for me. PRP therapy is popular for sports injuries but does it work https_story.htmltida_inl Before undergoing PRP treatment I read quite a bit about it learning that it holds promise for healing softtissue injuries such as tearing of the rotator cuff the group of tendons and muscles that provide stability to the shoulder tennis elbow plantar fasciitis Achilles tendinitis patella tendinitis and hamstring tears it may even provide relief for mild to moderate osteoarthritis. PRP works and the results have been amazing says John Ferrell the sports medicine physician who treated me. There still needs to be more research done to perfect the process but it will change the way orthopedics is practiced in the future. We will be more preventive. We will be able to treat ailments noninvasively and at an earlier stage. The procedure involves collecting several ounces of blood from a patients arm spinning the blood in a centrifuge to concentrate the platelets and injecting the concentrated platelets into the injury site to stimulate healing. Platelets the blood cells that promote clotting contain hundreds of proteins called growth factors that are important in repairing injuries. PRP works by acting like a stemcell magnet says Ferrell who practices at Regenerative Orthopedics Sports Medicine which has several offices in the Washington area. It releases growth factors that signal stem cells to come and help regenerate the injured area. Rotatorcuff tendon partial tears are notorious for not healing because of the poor blood supply there. PRP actually creates new blood vessels that feed the tendon the proper nutrients it needs to heal. A recent pilot study httpjournals.plos.orgplosonearticleid.journal.pone. conducted at the Glen Sather Sports Medicine Clinic at the University of Alberta on rotatorcuff tears supports this. It showed tissue healing in five of seven of the patients who received PRP as well as improvements in their pain and function. The researchers call the results clinically relevant despite the studys small size and say the next step should be a larger controlled clinical trial. Ive heard some skeptics call PRP a cure looking for a disease but it is being used in so many areas of medicine now with promising outcomes says Marni Wesner a sports medicine physician at the clinic and one of the studys authors. The potential for benefit from PRP is real. I had my first appointment with Ferrell last October to find out whether PRP might help me. By then my painful shoulder had been keeping me up nights for more than a year. It bothered me while swimming and lifting weights and while getting dressed. By performing several tests to assess my strength and range of motion Ferrell discovered that my left shoulder the site of the tear was considerably weaker than my right. He then used ultrasound to find the tear and showed it to me on a monitor. It turned out to be larger than indicated in the static MRI pictures I had obtained earlier. Before deciding whether PRP was right for me he had to be sure that the tear was the source of my pain and weakness. He injected an anesthetic into the tear then he ran the strength tests again. My strength was significantly better. This meant that the tear was causing my problems and fixing it probably would restore strength and function to my shoulder and end my pain. I had the first PRP injection on Oct. . It was painful and the aching persisted for about hours. I had one bad night followed by an uncomfortable day. After that the pain stopped. Still Ferrell advised me to baby the shoulder to use my other arm when holding a dog leash and to skip swimming and weights for two weeks. Running was fine. He also recommended physical therapy after two weeks. After what I went through in those were restrictions I could live with. Ferrell told me not to use nonsteroidal antiinflammatories such as ibuprofen for a week after the injection because the goal is to encourage not stifle inflammation. Other pain relievers such as acetaminophen were okay. We want to stimulate an acute inflammatory reaction which will trigger the healing cascade to start to work Ferrell says. Because there is not yet enough research on PRP and because some studies have shown mixed results insurance will not cover it. Still it has significant cost savings compared with surgery Ferrell says. The average treatment is two injections which costs about at his practice whereas rotatorcuff surgery runs about he says although insurance often covers most of the costs of surgery. With additional research insurance may ultimately pay for PRP. Unfortunately there is little financial incentive to conduct such studies because there is nothing for the Food and Drug Administration to approve such as a drug or device. The centrifuges already are licensed and the procedure uses a patients own blood which is regarded as safe. The American Academy of Orthopaedic Surgeons which says PRP holds great promise describes the risk as minimal. Those who seek this treatment must look for a clinician with considerable PRP experience someone who does the procedure several times a day not once or twice a month and who has a good success rate Ferrell says. Moreover you see the greatest results when the injections are done under direct visualization with ultrasound he adds. By February the ultrasound showed my tear to be about percent healed. The remaining tear was quite small. Ferrell recommended a second injection to finish the job. I had it on March . When I returned to see him on April I was feeling pretty good. No pain no problems. He rolled in the ultrasound machine and I was not surprised by the results. The tear was completely gone."

"Every year when Morton Pollner had his checkup he worried that doctors would find something on his lung. For years they didnt. Then his luck ran out. My reaction was Well you smoked for years. You got away with it for another years and this is it. I thought it was a death sentence he says. Pollner who lives in Monroe N.Y. was when he was diagnosed with lung cancer. Like many patients his age he didnt expect there would be any effective treatment. Lung cancer is the second most common cancer in men and women. And it is mainly a disease of older people. Only about percent of lung cancer patients are under and the average age http at diagnosis is about . Older patients are frequently not offered curative treatment like surgery because they and their families and even their doctors often think they wont be able to tolerate it. So they are referred for supportive care to control symptoms rather than surgery to remove the cancer. But many patients can survive and even thrive after surgery says Dr. Prasad Adusumilli https a thoracic surgeon at Memorial Sloan Kettering Cancer Center in New York. He was senior author of a study httpascopubs.orgdoifull.JCO... published in the Journal of Clinical Oncology in October. The study looked at more than patients with Stage nonsmall cell lung cancer who had surgery to remove their tumor. About percent of the patients were years old or older and about percent were at least . And he found that a surprising number of these older patients did quite well. One year after surgery more people had died from other causes than died from lung cancer. And after five years almost out of patients were alive and cancer free. They did well and beat their lung cancer Adusumilli says proving that when it comes to surgery for early stage lung cancer age should not be a limiting factor. This was the case for Morton Pollner who is one of Adusumillis patients. His cancer had not spread and Adusumilli told him there was a good possibility the cancerous tissue could be completely removed and he could go back to leading a normal life. That was seven years ago. Today Pollner is cancer free and enjoying life. Whatever I get from here on its like gravy he says. Surgery isnt the answer for all older lung cancer patients according to Dr. Len Lichtenfeld httppressroom.cancer.orglenlichtenfeld deputy chief medical officer of the American Cancer Society. Patients with heart or other health problems may not be candidates. At the same time he says its important to recognize that patterns of aging have changed over the past two decades. Seventy today is not the same as it was years ago Lichtenfeld says. Older adults are more functional both physically and mentally than ever before and he says the medical community needs to adjust its thinking about what treatments older cancer patients can tolerate. We shouldnt allow numerical age to be the deciding factor Lichtenfeld says."

"Diseases like Alzheimers start years even decades before the first symptoms of memory loss shows up. And with rates of those diseases rising experts say that more primary care physiciansnot neurology expertswill have the task of identifying these patients early so they can take advantage of whatever early interventions might be available. If we had a simple blood test a cholesterol test for Alzheimers disease that would help says Dr. Ronald Petersen director of the Alzheimers Disease Research Center at the Mayo Clinic but we dont. But Petersen has a potential solution and according to a new paper released Wednesday in the journal Neurology httpneurology.orglookupdoi.WNL. his Alzheimers test has promise. Petersen and his team wanted to develop a test that any physician can administer to patients without the need for any new technology or expensive equipment. Petersen believes that the test they came up with could become a useful tool for any physician even those without special training in the brain. What we are trying to do is give them some help so they can be as efficient as possible without ignoring these important cognitive issues he says. In the first phase of the test his researchers simply collected information from patients medical chartstheir age family history of Alzheimers factors such as diabetes or smoking that have been linked to Alzheimers and whether the patient had ever reported problems with memory. In the next phase they studied the results of the patients basic mental exam as well as of a psychiatric evaluation because depression and anxiety have been connected to Alzheimers. And another factor that emerged as important in developing the diseasehow quickly the participant could walk a short distance. We were a little surprised says Petersen. But whats nice about it is that its a nice noncognitive motor factor so its looking at another aspect of brain function. MORE This Alzheimers Breakthrough Could Be a Game Changer httptime.comthisalzheimersbreakthroughcouldbeagamechanger Petersen suggests that every physician should get this information on their patients at age that way they can have a baseline against which to compare any changes as their patients age. Only if they show such changes a slower walk for example or worsening signs of depression or memory issues should they move on to the third phase of the test which is a blood analysis. That would look for known genetic factors linked to Alzheimers including the presence of certain versions of the ApoE gene. Currently the only way to truly separate out those on the road to Alzheimers is to conduct expensive imaging tests of the brain or to do a spinal tap an invasive procedure that extracts spinal fluid for signs of the amyloid protein that builds up in the disease. We have either expensive techniques or invasive techniques and its not practical to do them from a public health screening standpoint says Petersen. MORE New Test May Predict Alzheimers Years Before Diagnosis httptime.comalzheimersbloodtest While his test is a possible solution to that problem he acknowledges that the results need be repeated before its recommended on a wide scale to physicians across the country. But those who scored higher on the test of risk factors had a sevenfold higher chance of developing mild cognitive impairment than those with lower scores. For now even if doctors identify patients around age who might be at higher risk of developing cognitive impairment there isnt much they can do to interrupt the process. But they can direct them toward clinical trials of promising new drugs to address Alzheimers dementia which may slow the cognitive decline considerably."

"If youre looking to lose those extra pounds you should probably add reducing stress and getting the right amount of sleep to the list say researchers from Kaiser Permanentes Center for Health Research in Portland. In fact although diet and exercise are the usual prescription for dropping pounds high stress and too little sleep or too much of it can hinder weight loss even when people are on a diet the researchers report. We found that people who got more than six but less than eight hours of sleep and who reported the lowest levels of stress had the most success in a weightloss program said study author Dr. Charles Elder. Elder speculates if you are sleeping less or more than recommended and if your stress levels are high you will not be able to focus on making behavioral changes. These factors may also have a biological impact he added. If you want to lose weight things that will help you include reducing stress and getting the right amount of sleep Elder said. The report funded by the U.S. National Institutes of Health is published in the March online edition of the International Journal of Obesity. In this twostep trial obese adults were first counseled about lifestyle changes over a week period. Recommendations included cutting calories a day eating a diet rich in fruits vegetables and whole grains by following the Dietary Approaches to Stop Hypertension DASH diet approach and exercising at least three hours a week. In addition the researchers asked the participants questions about sleep time depression insomnia screen time and stress. During this part of the trial the participants lost an average of almost pounds. The percent of the participants who lost at least pounds went on to take part in the next phase of the trial. Those in the second phase of the trial continued their diet and exercise program. Elders team found the right amount of sleep and stress reduction at the start of the trial predicted successful weight loss. Lower stress by itself predicted more weight loss during the first phase of the trial they added. Declines in stress and depression were also important in continuing to lose weight during both phases of the trial as were exercise minutes and keeping food diaries Elders group found. Dr. David L. Katz director of the Prevention Research Center at Yale University School of Medicine said that while we often tend to look at health one condition at a time the reality is that health is best viewed holistically. People who are healthy and vital tend to be healthy and vital not because of any one factor but because of many. And the factors that promote health eating well being active not smoking sleeping enough controlling stress to name a few promote all aspects of health he added. This study shows that people are more likely to lose weight when not impeded by sleep deprivation stress or depression he said. Anyone who has ever tried to lose weight probably could have said much the same from personal experience. Similarly weight loss reduced stress and depression. This too is suggested by sense and common experience as it is affirmed by the science reported here Katz said. The important message is that weight loss should not be looked at with tunnel vision Katz said. Improving sleep may be as important to lasting weight control efforts as modifying diet or exercise. Managing stress is about physical health as well as mental health. This study encourages weight loss in a more holistic context he said. Another study presented earlier this month at the American Heart Association scientific sessions held in Atlanta found that people of normal weight eat more when they sleep less. Columbia University researchers discovered that sleepdeprived adults ate almost calories more a day on average than those who got enough sleep. And the extra calories mostly came from saturated fat which can spell trouble for waistlines. The researchers came to their conclusions which should be considered preliminary until published in a peerreviewed journal after following men and women of normal weight. They monitored the eating habits of the participants as they spent six days sleeping four hours a night and then six days sleeping nine hours a night or the reverse. If sustained the dietary choices made by people undergoing short sleep could predispose them to obesity and increased risk of cardiovascular disease the researchers wrote in an American Heart Association news release. More information For more information on obesity visit the U.S. National Library of Medicine http SOURCES Charles Elder M.D. M.P.H. Center for Health Research Kaiser Permanente Portland Ore. David L. Katz M.D. M.P.H. director Prevention Research Center Yale University School of Medicine New Haven Conn. March International Journal of Obesity online"

"The common antibiotic doxycycline can disrupt the formation of negative associations in the brain according to new research from UCL and the University of Zurich. The study published in Molecular Psychiatry was a preregistered placebocontrolled doubleblind randomised controlled trial in healthy volunteers. In the first session participants were given either doxycycline or a placebo and learnt to associate a certain colour with an electric shock. A week later they were shown the colours again accompanied by a loud sound but no shocks and their fear responses were measured. The fear response was lower in participants who had doxycycline in the first session compared to those who had the placebo suggesting that the fear memory was significantly suppressed by the drug. Other cognitive measures including sensory memory and attention were not affected. When we talk about reducing fear memory we are not talking about deleting the memory of what actually happened explains lead author Professor Dominik Bach UCL Wellcome Centre for Neuroimaging Max Planck UCL Centre for Computational Psychiatry and Ageing Research and University of Zurich Division of Clinical Psychiatry Research. The participants may not forget that they received a shock when the screen was red but they forget to be instinctively scared when they next see a red screen. Learning to fear threats is an important ability for any organism helping us to avoid dangers such as predators. Overprediction of threat however can cause tremendous suffering and distress in anxiety disorders such as PTSD. Posttraumatic stress disorder PTSD is a term for a broad range of psychological symptoms that can develop after someone experiences or witnesses a traumatic event. PTSD is caused by an overactive fear memory and the new research shows that doxycycline can reduce the fear memory response in healthy volunteers. We have demonstrated a proofofprinciple for an entirely new treatment strategy for PTSD explains Professor Bach. The theory is based on the recent discovery that our brains need proteins outside nerve cells called matrix enzymes to form memories. Matrix enzymes are found throughout the body and their overactivity is involved in certain immune diseases and cancers. To treat such diseases we already have clinically approved drugs that block these enzymes including the antibiotic doxycycline so we wanted to see if they could help to prevent fear memories from forming in the brain. Our results support this theory opening up an exciting avenue of research that might help us to find treatments for PTSD. Using drugs to prevent PTSD would be challenging since in the real world we dont know when a traumatic event is about to occur. However there is growing evidence that peoples memories and associations can be changed after the event when they experience or imagine similar situations. This is called reconsolidation and we now plan to test the effect of doxycycline on reconsolidation of fear memories. If this is successful we would hope to apply the technique to more clinically realistic models of PTSD within a few years. The work was supported by the Swiss National Science Foundation University of Zurich and Wellcome. In the first session participants were given either doxycycline or a placebo and put in front of a computer. The screen would flash either blue or red and one of the colours was associated with a chance of receiving a painful electric shock. This happened times with the colours appearing in random order so that participants learnt to associate the bad colour with the shock. A week later under no medication participants returned to repeat the experiment. This time there were no electric shocks but a loud sound played after either colour was shown. Participants fear responses were measured by tracking their eye blinks as this is an instinctive response to sudden threats. The fear memory response was calculated by subtracting the baseline startle response the response to the sound on the good colour from the response to the sound when the bad colour was showing"

"Experts have known for some time that light therapy can improve the mood of people who feel especially down when the days get shorter and gloomier. But now a study has found that light therapy also works in treating nonseasonal depression. The research published Wednesday httphttparchpsyc.jamanetwork.comarticle.aspxdoi.jamapsychiatry..belabs.comdin JAMA Psychiatry is significant because major depression is one of the most common mental health disorders in the United States and one of the leading causes of disability worldwide. Light therapy is cheap easy to use and comes with few side effects compared to medication such as antidepressants said lead author Raymond Lam a professor of psychiatry at the University of British Columbia. Previous research on light therapy for nonseasonal depression has been limited. This study shows a new provensafe treatment of depression that is probably both more effective and less expensive than drug treatment or anything else said Dan Kripke a psychiatrist and professor emeritus at the University of California San Diego who has studied the topic but was not involved in the latest trial. Its a.m. and youre depressed. How technology is transforming mental health care. https_story.html The researchers said enough clinical evidence now supports mental health professionals recommending light therapy as a treatment for depression. Most people typically receive medication and psychotherapy but medications dont work in all cases and theres a shortage of providers in many areas. Why its so hard to find a mental health professional https Lam and his colleagues followed patients and evaluated whether light therapy improved their mood when it was used both with and without fluoxetine or Prozac a commonly prescribed antidepressant. Over eight weeks participants were exposed daily to minutes from a fluorescent light box soon after waking up. Some participants were instead given placebo pills and placebo devices. Although the light therapy helped many patients it provided the most benefit to those who were also taking the antidepressant. About percent of those using light therapy with the antidepressant reported feeling almost back to normal Lam said. Researchers have two main theories on why light therapy works. One is that it affects the biological clock in the brain. Theres some evidence that depression like jet lag occurs when the biological clock is out of sync and light helps to correct that Lam said. Light is also believed to affect neurotransmitters in the brain. Those are considered important for the development of depression and are the targets of most antidepressant medications."

"Novo Nordisks NOVOb.CO https topselling diabetes drug Victoza cut the risk of heart attack stroke and cardiovascular death by percent in a closely watched study but the result disappointed investors who had hoped for more. The logo of Danish multinational pharmaceutical company Novo Nordisk is pictured on the facade of a production plant in Chartres northcentral France April . REUTERSGuillaume SouvantPoolFile Photo The stock fell around percent in Copenhagen on Tuesday. Victoza is only the second diabetes drug to show such heart benefits after Eli Lilly LLY.N https and Boehringer Ingelheims pill Jardiance. Victozas effect was evident across risks. To me the impressive thing about this trial is the consistency across clinical endpoints and its robustness said John Buse professor of medicine at the UNC School of Medicine who worked on the study. He believes doctors approach to type diabetes treatment will now start to shift to a greater focus on minimising overall risks rather than simply cutting blood sugar levels. Because about half of deaths in people with diabetes are caused by heart disease reducing heart risk is considered essential to their care. But investors had been anticipating a bigger effect. Jefferies analyst Jeffrey Holford said market expectations had been for a midtohigh teens percent reduction in complications. There was also concern that Victoza did not appear to lower heart risks in American patients monitored in the study despite doing so in other parts of the world and producing a solid result globally. Novo the worlds biggest diabetes company had said in March that Victoza cut heart risks significantly in the study but the scale of the benefit was only disclosed on Monday. Researchers told the American Diabetes Associations ADA annual meeting that . percent of patients on Victoza died from cardiovascular causes or suffered nonfatal heart attacks or strokes against . percent of those on placebo. Deaths from heart disease were percent lower in the Victoza group. The Jardiance trial last year showed a similar percent overall relative risk reduction and a percent reduction in cardiovascular deaths. The Victoza trial known as Leader had been designed to show Novos drug did not increase heart risk so its superiority is welcome news for the company especially as Sanofis SASY.PA https rival Lyxumia failed to show heart benefits in an earlier test. Victoza which had sales of . billion last year is the biggest seller in a class of drugs known as GLP analogues that stimulate insulin production. I think physicians will look to GLPs with greater enthusiasm Buse said in an interview. Oncedaily Victoza is typically prescribed as a third or fourth option after patients have first tried various oral medicines. The significance of this is that now we can start to change the conversation around diabetes management from one of lets manage your blood sugar to one of lets manage your risk of complications Buse said. Mads Krogsgaard Thomsen Novos chief science officer said the results should encourage doctors to use Victoza earlier since they could now see it offered lifeexpanding treatment. The findings which involved following patients for a median . years were also published online in the New England Journal of Medicine. Gastrointestinal upset was the biggest side effect with Victoza. There were fewer cases of pancreatitis which has been viewed as a potential problem but more cases of pancreatic cancer although the difference was not statistically significant. ADVERTISING Since U.S. regulators have demanded studies for new diabetes medicines to show there is no increase in heart risk opening a new battleground between different treatments. Lilly is conducting a similar large study to try and prove the heart benefits of its onceweekly GLP drug Trulicity. The Leader study was funded by Novo and the U.S. National Institutes of Health. Editing by Jason Neely and Keith Weir Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

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

"Eating a Mediterranean diet supplemented with extra virgin olive oil was associated with a relatively lower risk of breast cancer in a study of women in Spain according to an article published online by JAMA Internal Medicine. Breast cancer is a frequently diagnosed cancer and a leading cause of death in women. Diet has been extensively studied as a modifiable risk factor in the development of breast cancer but epidemiologic evidence on the effect of specific dietary factors is inconsistent. The Mediterranean diet is known for its abundance of plant foods fish and especially olive oil. Miguel A. MartnezGonzlez M.D. of the University of Navarra in Pamplona and CIBEROBN in Madrid Spain and coauthors analyzed the effects of two interventions with the Mediterranean diet supplemented with extra virgin olive oil EVOO or nuts compared with advice to women to follow a lowfat diet. Study participants in the two intervention groups were given EVOO one liter per week for the participants and their families or mixed nuts grams per day grams of walnuts . grams of hazelnuts and . grams of almonds. The study was conducted within the framework of the large PREDIMED Prevencin con Dieta Mediterrnea trial which was designed to test the effects of the Mediterranean diet on the primary prevention of cardiovascular disease. From to women ages to and at high risk of cardiovascular disease were recruited. Women were randomly assigned to the Mediterranean diet supplemented with EVOO n the Mediterranean diet supplemented with nuts n or the control diet with advice to reduce their dietary intake of fat n. The women were an average age of . years old had an average body mass index of . most of them had undergone menopause before the age of and less than percent used hormone therapy. During a median followup of nearly five years the authors identified confirmed incident new cases of malignant breast cancer. The authors report that women eating a Mediterranean diet supplemented with EVOO showed a percent multivariableadjusted hazard ratio of . relatively lower risk of malignant breast cancer than those allocated to the control diet. Women eating a Mediterranean diet supplemented with nuts showed a nonsignificant risk reduction compared with women in the control group. The authors note a number of limitations in their study including that breast cancer was not the primary end point of the trial for which the women were recruited the number of observed breast cancer cases was low the authors do not have information on an individual basis on whether and when women in the trial underwent mammography and the study cannot establish whether the observed beneficial effect was attributable mainly to the EVOO or to its consumption within the context of the Mediterranean diet. The results of the PREDIMED trial suggest a beneficial effect of a MeDiet Mediterranean diet supplemented with EVOO in the primary prevention of breast cancer. Preventive strategies represent the most sensible approach against cancer. The intervention paradigm implemented in the PREDIMED trial provides a useful scenario for breast cancer prevention because it is conducted in primary health care centers and also offers beneficial effects on a wide variety of health outcomes. Nevertheless these results need confirmation by longterm studies with a higher number of incident cases the authors conclude. Editors Note Can Diet Prevent Breast Cancer In a related editors note Mitchell H. Katz M.D. a deputy editor of JAMA Internal Medicine writes Of course no study is perfect. This one has a small number of outcomes only incident cases of breast cancer the women were not all screened for breast cancer with mammography they were not blinded to the type of diet they were receiving and all were white postmenopausal and at high risk for cardiovascular disease. Still consumption of a Mediterranean diet which is based on plant foods fish and extra virgin olive oil is known to reduce the risk of cardiovascular disease and is safe. It may also prevent breast cancer. We hope to see more emphasis on Mediterranean diet to reduce cancer and cardiovascular disease and improve health and wellbeing. JAMA Intern Med. Published online September . doi.jamainternmed... Available preembargo to the media at httpmedia.jamanetwork.com. Editors Note Authors made conflict of interest and fundingsupport disclosures. Please see the article for additional information including other authors author contributions and affiliations financial disclosures Media Advisory To contact study corresponding author Miguel A. MartnezGonzlez M.D. email Jesus Diaz at jediazunav.es mailtojediazunav.es or call . To contact Editors Note author Mitchell H. Katz M.D. email mediarelationsjamanetwork.org mailtomediarelationsjamanetwork.org"

"Walnuts https have long been touted as a healthy whole food but new research just upped the homely nuts reputation another notch. In a study by researchers from the Hospital Clinic of Barcelona and Loma Linda University more than older healthy adults were asked to add either a handful of walnuts to their daily diets or to follow their normal diet without eating nuts. After one year both groups experienced minimal body weight triglyceride and HDL cholesterol changes but the walnuteaters had significant reductions in LDL cholesterol bad cholesterol compared to the nutfree control group. The research shows the wellknown cholesterollowering https effect of eating walnuts works equally well in the elderly even in the long term the authors reported at the Experimental Biology conference in San Diego. Given walnuts are a highenergy food a prevailing concern has been that their longterm consumption might be associated with weight gain said study author Dr. Emilio Ros director of the Lipid Clinic Endocrinology Nutrition Service at the Hospital Clinic of Barcelona in a press statement. Its encouraging to see that eating walnuts may benefit this particular population. Other walnut studies presented at the conference funded in part by the California Walnut Commission suggested the omega fatty acidrich nut may also benefit gut bacteria https and help reduce inflammation. Elisabetta Politi nutrition director of the Duke Diet and Fitness Center at Duke University said We advocate that people eat nuts https including walnuts because they are high in healthy fat low in carbohydrates and a good source of protein. Politi said a serving of walnuts is about halves which adds up to calories. Theyre rich in fiber folic acid and potassium. Walnuts are especially heart healthy because they have more polyunsaturated fat than almonds cashews peanuts pecans pistachios and macadamia nuts per serving. Walnut oil https can be a good alternative too in dressings and for light basting Politi said. Its still important to remember portion control especially for people on weight loss programs warned Politi. Try a serving in a snack bag. Eat walnuts mindfully she said."

"Two drugs already on the market an antifungal and a steroid may potentially take on new roles as treatments for multiple sclerosis. According to a study published in Nature today researchers discovered that these drugs may activate stem cells in the brain to stimulate myelin producing cells and repair white matter which is damaged in multiple sclerosis. The study was partially funded by the National Institute of Neurological Disorders and Stroke NINDS part of the National Institutes of Health. Specialized cells called oligodendrocytes lay down multiple layers of a fatty white substance known as myelin around axons the long wires that connect brain cells. Myelin acts as an insulator and enables fast communication between brain cells. In multiple sclerosis there is breakdown of myelin and this deterioration leads to muscle weakness numbness and problems with vision coordination and balance. To replace damaged cells the scientific field has focused on direct transplantation of stem cellderived tissues for regenerative medicine and that approach is likely to provide enormous benefit down the road. We asked if we could find a faster and less invasive approach by using drugs to activate native nervous system stem cells and direct them to form new myelin. Our ultimate goal was to enhance the bodys ability to repair itself said Paul J. Tesar Ph.D. associate professor at Case Western Reserve School of Medicine in Cleveland and senior author of the study. It is unknown how myelinproducing cells are damaged but research suggests they may be targeted by malfunctioning immune cells and that multiple sclerosis may start as an autoimmune disorder. Current therapies for multiple sclerosis include antiinflammatory drugs which help prevent the episodic relapses common in multiple sclerosis but are less effective at preventing longterm disability. Scientists believe that therapies that promote myelin repair might improve neurologic disability in people with multiple sclerosis. Adult brains contain oligodendrocyte progenitor cells OPCs which are stem cells that generate myelinproducing cells. OPCs are found to multiply in the brains of multiple sclerosis patients as if to respond to myelin damage but for unknown reasons they are not effective in restoring white matter. In the current study Dr. Tesar wanted to see if drugs already approved for other uses were able to stimulate OPCs to increase myelination. OPCs have been difficult to isolate and study but Dr. Tesar and his colleagues in collaboration with Robert Miller Ph.D. professor at George Washington University School of Medicine and Health Sciences in Washington D.C. developed a novel method to investigate these cells in a petri dish. Using this technique they were able to quickly test the effects of hundreds of drugs on the stem cells. The compounds screened in this study were obtained from a drug library maintained by NIHs National Center for Advancing Translational Sciences NCATS. All are approved for use in humans. NCATS and Dr. Tesar have an ongoing collaboration and plan to expand the library of drugs screened against OPCs in the near future to identify other promising compounds. Dr. Tesars team found that two compounds in particular miconazole an antifungal and clobetasol a steroid stimulated mouse and human OPCs into generating myelinproducing cells. Next they examined whether the drugs when injected into a mouse model of multiple sclerosis could improve remyelination. They found that both drugs were effective in activating OPCs to enhance myelination and reverse paralysis. As a result almost all of the animals regained the use of their hind limbs. They also found that the drugs acted through two very different molecular mechanisms. The ability to activate white matter cells in the brain as shown in this study opens up an exciting new avenue of therapy development for myelin disorders such as multiple sclerosis said Ursula Utz Ph.D. program director at the NINDS. Dr. Tesar and his colleagues caution that more research is needed before miconazole and clobetasol can be tested in multiple sclerosis clinical trials. They are currently approved for use as creams or powders on the surfaces of the body but their safety administered in other forms such as injections in humans is unknown. Offlabel use of the current forms of these drugs is more likely to increase other health concerns than alleviate multiple sclerosis symptoms. We are working tirelessly to ready a safe and effective drug for clinical use Dr. Tesar said. This work was supported by the NINDS NS NS NS the New York Stem Cell Foundation and the Myelin Repair Foundation New York City. The NINDS http is the nations leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The National Center for Advancing Translational Sciences is a distinctly different entity in the research ecosystem. Rather than targeting a particular disease or fundamental science NCATS focuses on what is common across diseases and the translational process. The Center emphasizes innovation and deliverables relying on the power of data and new technologies to develop demonstrate and disseminate advancements in translational science that bring about tangible improvements in human health. For more information visit http About the National Institutes of Health NIH NIH the nations medical research agency includes Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic clinical and translational medical research and is investigating the causes treatments and cures for both common and rare diseases. For more information about NIH and its programs visit https NIHTurning Discovery Into Health Reference Najm et al. Drugbased modulation of endogenous stem cells promotes functional remyelination in vivo Nature April ."

"Fasting diets have gained popularity in the past few years but the scientific evidence proving that they keep us healthy while they help us lose weight is sparse. Now researchers have shed light on what one type of timerestricted eating does to the body. In a small preliminary study httpscontent.iospress.comarticlesnutritionandhealthyagingnha researchers put obese volunteers on the diet a form of intermittent fasting. Followers of the popular regime eat during an eighthour window in this case between a.m. and p.m. And for the hours in between they consume only caloriefree drinks such as water. For weeks the scientists measured various factors including the participants fat mass blood pressure and cholesterol and glucose levels. The researchers compared the results to existing data from a separate weight loss trial carried out between and . Individuals who ate between a.m. and p.m. consumed around fewer calories resulting in a loss of percent body weight and their blood pressure dropped by around mm Hg. However their fat mass insulin resistance and cholesterol levels were similar to the control groups. Krista Varady one of the studys authors and associate professor of kinesiology and nutrition at the University of Illinois at Chicagos School of Applied Health Sciences said in a statement that the takehome message from the study is that cutting out certain foods or counting calories arent the only effective methods for losing weight. The authors noted that the results mirror those from previous studies of other forms of intermittent fasting including alternate day fasting where an individual eats normally every other day. But one of the benefits of the diet may be that it is easier for people to maintain. We observed that fewer participants dropped out of this study when compared to studies on other fasting diets said Varady. Further research is now needed to uncover whether works better than other fasting diets in terms of weight loss and health benefits. The studys authors acknowledged that their preliminary data offers promise for the use of timerestricted feeding as a weight loss technique in obese adults but longerterm largescale randomized controlled trials are needed. Varady stressed that when it comes to weight loss people need to find what works for them because even small amounts of success can lead to improvements in metabolic health. Commenting broadly on faststyle diets James Catterson of the Institute of Healthy Ageing at University College London who was not involved in the study previously told https https the jury is still out on fasting diets. He said that the data on the effects of fasting in animals are more convincing probably because animals can be investigated in large sample sizes and in a highly controlled environment that is almost impossible to replicate in humans. There are also many studies that either report no overall effect or sometimes the opposite. And this is where it gets a bit murky as it is very difficult to put proper controls in place when performing studies to do with nutrition Catterson said. He concluded So far the consensus seems to be lets wait until more rigorous studies with larger sample sizes that adjust for confounding lifestyle behaviors have been performed before we conclude anything prematurely."

"For men who have prostate cancer thats considered intermediate risk radiation plus four months of hormone therapy appears to improve survival a new study finds. This combination of treatments however was not effective in men with either lowrisk prostate cancer or advanced disease the researchers said. Men with highrisk cancer need longterm hormone therapy. The hormone therapy is known as androgen deprivation therapy. Its designed to reduce the levels of male hormones androgens in the body since they can stimulate the growth of prostate cancer cells. For patients with early localized cancer of the prostate who were treated with radiation therapy by adding shortterm androgen deprivation therapy we improved their cure rates and increased their chance of living years from percent to percent said lead researcher Dr. Christopher U. Jones from Radiological Associates of Sacramento Calif. But when the researchers looked closely at those findings they found that patients with lowrisk prostate cancer did not need hormone therapy because the chance they would survive with radiation alone was already almost percent Jones said. And while short term hormonal therapy is not very toxic there are still some toxicities Jones noted. We dont want to treat any man unnecessarily with that type of treatment. We really want to make sure if we are going to recommend that treatment the person really needs it he said. On the other hand hormone therapy plus radiation was most effective in patients with intermediaterisk prostate cancer. We decreased the risk of dying from prostate cancer in those patients from percent to percent at years Jones said. For patients with highrisk prostate cancer using hormone therapy for just a short while is not effective he added. We know from other studies that shortterm androgen deprivation therapy isnt enough. You need to give longterm androgen deprivation therapy in addition to radiation to have the best results Jones said. The report was published in the July issue of the New England Journal of Medicine. For the study Jones team randomly assigned almost men with prostate cancer to radiation therapy alone or in combination with four months of hormone therapy. The hormone therapy started two months before radiation. Side effects of male hormone therapy can include erectile dysfunction impotence loss of sex drive hot flashes growth of breast tissue loss of muscle and bone mass weight gain nausea liver problems fatigue memory problems and mood swings. In October the U.S. Food and Drug Administration asked manufacturers to add a warning that certain drugs used in hormone therapy including the one used in the study were linked to a small but increased risk of diabetes heart attack stroke and sudden death in men. In this study men treated with hormone therapy experienced a much higher percentage of liver damage toxic effects of radiation treatment were similar in both groups. Over an average of over nine years of followup percent of the men who had combination therapy were alive compared with percent of the men who received radiation therapy alone the researchers found. Overall hormone therapy reduced the risk of dying from prostate cancer over years from percent to percent Jones said. He noted that the radiation treatments in use today differ from those given in when the trial began. We can give to percent higher doses of radiation now than we could then and we can do it more safely and more accurately he said. So that brings into question how much if any hormone therapy is needed he added. An ongoing trial among patients with intermediate risk prostate cancer aims to answer that question Jones said. We are going to find out if androgen deprivation therapy still applies to patients treated with modern techniques he said. This study in conjunction with what we know about hormonal therapy really nails home the conclusion that hormonal therapy should not be used in men with lowrisk disease because the risks outweigh any conceivable benefit commented Dr. Anthony DAmico chief of radiation oncology at Brigham and Womens Hospital in Boston and author of an accompanying journal editorial. DAmico noted that new studies using uptodate highdose radiation also found that the addition of shortterm hormone therapy improved outcomes at five years for men with intermediate risk prostate cancer compared with radiation alone. If you are in the lowrisk category stay away from hormone therapy. It does no good. It can hurt DAmico said. If you have anything beyond lowrisk prostate cancer the hormonal therapy helps he said. Its just a matter of how long you need it for. It could be four months six months or longer. These findings are good news for some men since the effects of short term of hormone therapy are reversible DAmico said. Its not three years where men are changed forever he said. More information For more information on prostate cancer visit the American Cancer Society http SOURCES Christopher U. Jones M.D. Radiological Associates of Sacramento Calif. Anthony DAmico M.D. Ph.D chief radiation oncology Brigham and Womens Hospital Boston July New England Journal of Medicine"

"When it comes to shedding pounds and improving or eliminating type diabetes gastric bypass surgery may be better than other surgical weightloss procedures two new studies find. But obese patients should be careful to choose surgeons who have performed a high volume of these procedures before committing said Dr. Guilherme M. Campos lead author of one of two papers appearing in the February issue of the Archives of Surgery. Gastric bypass and lapbanding are the two most common surgical weightloss procedures performed in the United States. The former involves stapling the stomach so food has to bypass a section of the small intestine meaning you get full faster and less food gets absorbed into the gut. Lapbanding introduced in involves separating the stomach into two sections with a band so simply speaking eating too much becomes more difficult. Its a diet with a seatbelt said Dr. Mitchell Roslin chief of bariatric surgery at Lenox Hill Hospital in New York City and Northern Westchester Hospital in Mt. Kisco N.Y. In a third type of weightloss procedure known as sleeve gastrectomy surgeons remove part of the stomach. The study led by Campos compared weight loss and diabetes outcomes in patients who underwent gastric bypass surgery with patients who underwent lapbanding. Gastric bypass is considered riskier and more technically demanding than the band. All patients were morbidly obese with a bodymass index higher than and in each group had type diabetes. Although Campos is now an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health in Madison he conducted the study while at the University of California San Francisco. In the bypass group patients lost an average of percent of their excess weight vs. percent for those in the lapbanding group. Threequarters of those undergoing gastric bypass surgery saw their diabetes improve or resolve vs. only half in the other group. The average cost of a bariatric surgery is nearly according to a recent study from Johns Hopkins University. Like all surgeries weightloss surgery carries its own set of possible risks including bleeding blood clots infection and leaks from sites where body tissues are sewn or stapled together according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Later complications may include malnutrition hernias and a tendency in about one in people to regain much of the weight they lost as a result of the procedure. In Campos study roughly equal numbers of patients in each group experienced complications after one year percent in the gastric bypass group compared to percent in the lapbanding group these included infection internal bleeding and blood clots but no deaths. More people in the bypass group had complications right after the surgery. More of those undergoing lapbanding however needed repeat surgeries percent vs. percent. The second study conducted in Taiwan and led by Dr. WeiJei Lee of the MinSheng General Hospital involved randomly assigning obese but not morbidly obese patients with type diabetes to receive gastric bypass surgery or sleeve gastrectomy. Almost all of those undergoing gastric bypass surgery percent had their diabetes resolved vs. only half in the other group these numbers declined to percent and percent after a year. Those in the gastric bypass group also lost more weight and there were no serious complications in either group. There are various theories to explain why gastric bypass may be superior including one that attributes the success to changes in hormones that control the metabolism of blood sugar. And certain procedures may still be preferable for certain patient populations added Roslin such as bands for patients with lower BMI who dont have so many metabolic challenges. Everyone thinks that all weightloss operations are the same even the doctors and the surgeons. But theyre different and they have different resolutions of comorbidities and probably should be used for different indications he said. An editorial accompanying the studies noted the results should be interpreted with caution since longerterm data is not yet available. More information Visit the American Society for Metabolic and Bariatric Surgery for more on weightloss procedures http_fs_surgery.pdf. SOURCES Guilherme M. Campos M.D. Ph.D. associate professor surgery University of Wisconsin School of Medicine and Public Health Madison Mitchell Roslin M.D. chief bariatric surgery Lenox Hill Hospital New York City and Northern Westchester Hospital Mt. KisCo N.Y. February Archives of Surgery"

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

"Nucleix Ltd. httpsnucleix.com a leading cancer detection company announced today positive results from a clinical study designed to evaluate its innovative Lung EpiCheck a blood test for early detection of lung cancer. The results will be presented in a poster presentation titled Lung EpiCheck Results of the Training and Test Sets of a MethylationBased Blood Test for Early Detection of Lung Cancer httpslibrary.iaslc.orgconferenceprogramproduct_idauthorcategorydatesession_typesessionpresentationkeywordEpiCheck at the IASLC th World Conference on Lung Cancer httpswclc.iaslc.org hosted by the International Association for the Study of Lung Cancer to take place on September in Toronto Canada. In the study blood was prospectively collected from centers and biobanks in Europe and Israel. The samples were used for detection of lung cancer with the Lung EpiCheck blood test. Lung EpiCheck was validated on this independent test set comprising lung cancer cases and current or former smoker controls. Results show specificity of and a sensitivity of with an Area Under the Curve AUC of . These results demonstrated similar performance to the preceding training set results from lung cancer cases and current or former smoker controls. In particular in the nonsmallcell lung carcinoma group n the most prevalent type of lung cancer affecting about of lung cancer patients Lung EpiCheck was able to identify correctly approximately of patients. With a correct identification of of stage I patients of stage II of stage III and of stage IV patients. In the small cell lung cancer group n Lung EpiCheck was able to identify correctly of the patients with a sensitivity of in the limited stage and at the extensive stage. Lung cancer is the leading cause of death from cancer worldwide due to the high incidence of the disease and the low rate of diagnosis at early and more curable stages stated Prof. Mina Gaga the President of the European Respiratory Society ERS and a lead investigator in the study. Clearly we must establish screening programs for lung cancer worldwide. At the moment lowdose computerized tomography LDCT screening which has been shown to reduce mortality from lung cancer in the very large NLST study is only reimbursed in the US for highrisk individuals. LDCT screening is not reimbursed in Europe or most areas in the world while there is still a debate about its cost and safety. Screening is however necessary in order to identify lung cancer at early operable stages for the entire atrisk population so currently not only CT screening but also methods of molecular screening are being tested. I am therefore very encouraged with the results of this study showing that EpiCheck has the ability to identify both nonsmallcell and smallcell lung cancer at early stages with a high level of sensitivity and specificity. Such promising results combined with the simplicity of the test could allow us to detect lung cancer at the early stages and hence improve year survival from about to about . This will offer significant added value in the fight against lung cancer. We are very excited to present the best published clinically validated results of a blood test for the early detection of lung cancer said Opher Shapira PhD CEO of Nucleix. Furthermore these results were validated prospectively in an independent cohort. Currently early stage lung cancer can be detected either accidentally when testing for other conditions or by using lowdose CT scans which are costly carry associated risks such as high radiation and are employed only for a very highrisk population. Early detection of lung cancer can be a gamechanger in the fight against this devastating disease and we are looking forward to begin extensive clinical trials in the US Europe and China next year in order to get the test to the market as soon as possible at an affordable price. About Lung EpiCheck The Lung EpiCheck blood test is based on a proprietary molecular biomarker technology which combines new biochemical assays and sophisticated algorithms. The technology is based on identification and analysis of subtle changes in DNA methylation patterns a powerful tool for distinguishing between cancer and healthy cells and thus for detection of tumors in the body. Dying tumor cells release cellfree DNA cfDNA into the blood where cancerspecific methylation changes can be detected at any disease stage. The Lung EpiCheck blood test detects changes in DNA methylation in markers in cfDNA associated with lung cancer. About Lung Cancer Lung cancer is the deadliest and most common of all cancer types. It is estimated that there are about . million new cases of lung cancer annually worldwide and about . million die from the disease each year. The reason for the high mortality rate is that currently most cases are detected when the patient becomes symptomatic which is usually at late stages of the disease. To date there is no adequate screening process for the early detection of lung cancer bringing year survival rate to approximately . In addition there is a welldefined risk group for developing the disease mostly smokers and former smokers above the age of . In the US lowdose CT is available for screening of individuals years old who smoked at least pack a day for years which represent less than half of the lung cancer population. Therefore a screening test aimed at the entire risk group to assist in the early detection of the disease is highly needed and can dramatically increase lung cancer survival. About Nucleix Nucleix Ltd. develops manufactures and markets innovative noninvasive molecular cancer diagnostic tests. Its highly sensitive and specific tests are based on identification of subtle changes in methylation patterns. Nucleixs technology is based on a combination of a new biochemical assay in conjunction with sophisticated algorithms. The Companys pipeline includes CE Mark Bladder EpiCheck for the noninvasive detection of bladder cancer based on a urine test Lung EpiCheck a screening diagnostic blood test for early detection of lung cancer Liver EpiCheck a blood test for liver cancer detection in patients with cirrhosis and Pan Cancer EpiCheck a molecular diagnostic tool for early detection of multiple cancer types in blood samples all based on Nucleixs proprietary and innovative epigenetic platforms. Investors in the Company include OrbiMed and other leading investors. For further information please visit http SOURCE Nucleix"

"Giving the antidepressant drug Prozac to people who have just had a stroke could help them to regain more control over their movements and allow more of them to live independently scientists said Monday. The antidepressant drug Prozac also known as fluoxetine are seen on a table in Leicester central England February in this posed photograph. REUTERSDarren Staples In the largest study yet of the effect of this type of antidepressant on stroke recovery French researchers found that stroke patients given Prozac improved their scores in motor skills tests more than those given a placebo or dummy pill. Experts commenting on the findings said they had enormous potential to change clinical practice and raised the question of whether most stroke patients with motor skill problems should be treated with this relatively cheap type of antidepressant. Stroke is the single largest cause of adult disability and the thirdlargest cause of death in the developed world. The cost of caring for its victims who often have motor function difficulties like paralysis or weakness on one side puts a heavy burden on already stretched healthcare systems. A few previous small trials had already suggested that giving drugs like Prozac which belongs to a drug class known as selective serotonin reuptake inhibitors SSRIs might improve motor skill recovery after stroke. Prozac was developed by Eli Lilly and is now available in a cheaper generic form as fluoxetine. Hemiplegia paralysis to one side of the body and hemiparesis weakness on one side of the body are the most common disabilities after stroke and scientists believe SSRIs might help improve movement by increasing the level of the brain chemical serotonin in the central nervous system. The positive effect of the drug on motor function... suggests that the neuronal ... action of SSRIs provides a new pathway that should be explored further said Francois Chollet of Toulouse University Hospital who led this research. In the study conducted between March and June and published in The Lancet Neurology journal Monday patients in France were given either Prozac or a placebo for three months starting between five and days after they had suffered a stroke. All patients were also given physiotherapy and had their motor skills tested at the start of the trial and on day . Significantly greater improvements in motor function were recorded after three months in patients taking Prozac where the average test score improved by . points than in the placebo group where the average improvement was . points. There were also more independent patients and depression was less common in the Prozac group than in the placebo group and side effects of the drug were rare and mild researchers said. Commenting on the study Robert Robinson and Harold Adams from the University of Iowa in the United States said it could change the way doctors treat stroke victims in future but more research is needed to see if the effects continue over time. Roger Bonomo director of stroke care at Lenox Hill Hospital in New York said another way to look at the implications of this trial would be as justification for treatment of poststroke depression before it progresses. Depression after stroke is a common enough complication to have raised the question of treating with antidepressants early after stroke he said in an emailed comment. If motor function is also more likely to improve then treating before symptoms of depression emerge is likely to be even more beneficial. Editing by Tim Pearce 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."

"Women who undergo mammograms every two years instead of every year have fewer falsepositive results but the tradeoff is a slightly higher risk of being diagnosed with latestage breast cancer new research finds. After years biennial mammograms reduced the risk of falsepositives by about onethird and over a lifetime that would accumulate said Rebecca Hubbard lead author of a study published in the Oct. issue of Annals of Internal Medicine and funded by the U.S. National Cancer Institute. But the increase in breast cancer diagnoses wasnt statistically significant she said. And breast cancer stage was only analyzed in women who actually developed cancer. On the other hand among roughly women screened between and and followed for a decade more than half who received annual mammograms were called back at least once because of a falsepositive result and to percent were recommended to get a biopsy. Fewer women about percent who had biennial screening were called back because of a falsepositive while . percent were referred for a biopsy. Having a previous mammogram for comparison purposes sliced the rate of falsepositives in half. For the study researchers used data from NCIs Breast Cancer Surveillance Consortium. Women undergoing onceyearly mammograms need to be prepared for possible call backs and being prepared may reduce the anxiety around such an event the authors stated. This is the latest volley in an ongoing debate about when to start mammography screening in women. In the U.S. Preventative Services Task Force USPSTF a governmentsponsored organization startled the world by recommending that women start mammograms at age instead of and then only once every two years rather than once a year. The move released an outcry in the medical community leading to this and other studies to try to determine the best timing for mammograms the only screening tool shown to reduce deaths from breast cancer. The new study gives a nod in the direction of the UPSTF recommendations but practitioners arent necessarily ready to let go of the longstanding onceayear recommendation. Hubbard an assistant investigator with Group Health Research Institute in Seattle Wash. said she definitely wouldnt make a specific recommendation for individual women. I feel its really an individual choice where a woman needs to think about her own risk tolerance and also their own breast cancer risk. This gives women more information as to what the risks and benefits of mammography are added Dr. Stephanie Bernik chief of surgical oncology at Lenox Hill Hospital in New York City. Its a personal choice as to whether or not you absolutely have to screen at . As breast surgeons were still going to advocate that mammograms start at . A second study in the same journal issue looked at more than U.S. women screened from to and found that newer digital mammography and older film mammography were similarly accurate in finding cancer in women ages through . But in premenopausal women in their s who tend to have denser breast tissue digital mammography performed better. Again though the risk of falsepositives was higher than with film mammography. There was a tradeoff here as well said Hubbard who was also an author of this study. In general in women aged to the two modalities performed pretty equivalently but in younger women the sensitivity of digital mammography was a little bit better so it found more cancers but there was also a bigger decrease in specificity resulting in more falsepositives. More information The U.S. National Cancer Institute has more on mammography http"

"An experimental drug preserved and even improved the walking ability of boys with Duchenne muscular dystrophy httphealth.nytimes.comhealthguidesdiseaseduchennemusculardystrophyoverview.htmlinlinenytclassifier in a clinical trial raising hopes that the first effective treatment for the disease may be on the horizon. Boys with the disease who received the highest dose of the drug had a slightly improved ability to walk after weeks of treatment the drugs developer Sarepta Therapeutics announced httpinvestorrelations.sareptatherapeutics.comphoenix.zhtmlcpirolnewsArticleIDhighlight Wednesday. By contrast the boys who received a placebo suffered a sharp decline in how well they could walk. The drug called eteplirsen also appeared to restore levels of the crucial protein that muscular dystrophy httphealth.nytimes.comhealthguidesdiseasemusculardystrophyoverview.htmlinlinenytclassifier patients lack to about half of normal levels Sarepta said. I think this changes the entire playing field for muscular dystrophy said Dr. Jerry R. Mendell director of the gene therapy and muscular dystrophy programs at Nationwide Childrens Hospital in Columbus Ohio and the lead investigator in the trial. There are many caveats. The trial had only patients with only four receiving the high dose and four the placebo and the data has not been reviewed by experts. It is also unclear how long the effects of the drug would last or if safety issues would arise with longer treatment. Also eteplirsen would be appropriate for only about percent to percent of Duchenne patients those with the particular genetic mutation the drug is meant to counteract. However a similar approach might work for some other mutations. Duchenne which affects as many as Americans mainly boys and young men is the most severe common form of muscular dystrophy a disease made more prominent by years of Jerry Lewis telethons. Those with the disease make barely any dystrophin a protein necessary for muscles to function. Patients typically lose the ability to walk as teenagers and die by age . While steroids httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicssteroidsindex.htmlinlinenytclassifier which reduce inflammation can slow progression of the disease they have undesirable side effects. Eteplirsen which Sarepta says has shown no side effects so far is vying with a similar drug being developed by GlaxoSmithKline to become the first medicine that works by directly countering the cause of the disease. Eteplirsen could also be the first drug to reach the market for Sarepta since it was founded years ago. It changed its name recently from AVI BioPharma httptopics.nytimes.comtopnewsbusinesscompaniesavibiopharmaincindex.htmlinlinenytorg to distance itself from its underachieving past. Shares of Sarepta nearly tripled on Wednesday closing at .. And the stock had already roughly quadrupled since July when Sarepta announced some interim results from the study. The study measured how far the boys could walk in six minutes. Those who received the higher dose walked an average of meters farther after weeks of treatment than at the beginning of the trial a gain of about percent. The boys in the placebo group walked fewer meters at the end than at the beginning a decline of about percent. One possible reason for skepticism is that two of the boys on a lower dose of the drug rapidly lost the ability to walk even though the level of dystrophin in their muscles increased substantially. Our columnist Andrew Ross Sorkin and his Times colleagues help you make sense of major business and policy headlines and the powerbrokers who shape them. Top of Form Bottom of Form Top of Form While the company excluded those boys from its analysis as outliers the Food and Drug Administration might not do so. That could make it harder for the Sarepta to win approval for the drug based only on this small trial something the company hopes to do. If you wait and require this company to do another twoyear study a lot of these boys are going to be in a wheelchair Christopher Garabedian the Sarepta chief executive said in an interview. Patient groups may also put some pressure on the Food and Drug Administration to approve the drug quickly. But some also want Sarepta to make the drug available to more patients on a compassionate basis even before approval. Tenyearold Max Leclaire of Saxtons River Vt. who has been receiving the highest dose in the trial can now walk up stairs without having to pull himself up by the handrail according to his mother Jenn McNary. Hes no longer riding the handicap bus to school she said. But Ms. McNary said Sarepta had refused to provide the drug to Maxs yearold brother Austin who could not be in the trial because he already could not walk. Mr. Garabedian said Sarepta did not have the money or the manufacturing capacity to make the drug available outside of clinical trials. That would be the quickest path to insolvency he said. If eteplirsen gets to market it would come nearly three decades after the discovery of the gene responsible for Duchenne. It would also represent a success after decades of setbacks for the technology eteplirsen uses called antisense which is a way of turning off specific genes. Eteplirsen actually turns off just one part of the dystrophin gene known as exon which contains a mutation that in some patients stops production of dystrophin. By skipping over this exon muscle cells can produce an imperfect form of dystrophin that nonetheless is at least partly functional."

"Today marks a significant step forward in the prevention and treatment of leprosy as the Infectious Disease Research Institute IDRI and American Leprosy Missions announce the start of a Phase clinical trial in humans for a promising leprosy vaccine candidate the first vaccine developed specifically for leprosy. Characterized by the World Health Organization as a neglected tropical disease leprosy also known as Hansens disease is one of the most ancient diseases known to humankind and is caused by the bacteria Mycobacterium leprae. Nearly a quarter of a million people worldwide have leprosy which causes disfiguration of the skin and mucous membranes as well as progressive and incurable nerve damage. While drug therapy exists for leprosy it must be taken for many months has many side effects and often is given too late to reverse the permanent damage caused by the bacterial infection. A viable vaccine to prevent andor treat leprosy is the next step in the effort to bring this disease to an end. Scientists at IDRI along with national and international collaborators including the National Hansens Disease Program and the National Institute of Allergy and Infectious Diseases NIAID part of the National Institutes of Health with financial support from American Leprosy Missions have developed a promising leprosy vaccine candidate designed to help treat leprosy and prevent exposed individuals from developing disease and the resulting disabilities. Based on data generated in preclinical studies the vaccine candidate called LepVax has progressed to Phase I clinical testing in the United States the first stage of safety testing in human volunteers. The clinical trial is focused on safety as well as evaluating the immune response to the vaccine. While previous attempts have used vaccines primarily developed for other diseases this is the first totally defined vaccine candidate developed specifically for leprosy using the latest technologies and offering no less than those exposed to leprosy deserve said Steven Reed Ph.D. IDRI President CEO Founder. The leprosy vaccine program at IDRI has benefited greatly from what weve learned in the development of tuberculosis vaccine candidates over the past two decades. Although the bacteria that cause tuberculosis and leprosy are related leprosy vaccine development posed great challenges. This vaccine represents a unique accomplishment requiring the most advanced technologies in molecular biology and immunology and American Leprosy Missions has been there from the beginning. IDRI scientists have also developed two vaccine candidates for tuberculosis both in clinical stages of development. We are thrilled that after years and an investment of over . million made possible by our faithful donors and partners a leprosyspecific vaccine is beginning a Phase I clinical trial says Bill Simmons President and CEO of American Leprosy Missions. We believe this may be the most exciting breakthrough in leprosy treatment since multidrug therapy the current treatment for leprosy was launched in the s. We look forward to this vaccine improving the health outcomes of people diagnosed with leprosy. And it may be that this vaccine can lead to interruption of the transmission of leprosy all together. What a tremendous legacy this would leave for millions of people worldwide. The vaccine was developed through significant efforts in screening and identifying M. leprae proteins that trigger an effective immune response. IDRI scientists then produced a fusion of four leprosy proteins which is combined with IDRIs proprietary immunestimulating adjuvant GLASE. With recent developments in vaccine technology IDRI scientists can now induce protective responses even after infection meaning it could be possible to prevent disease development in people already infected with the leprosy bacterium. This generation of a vaccine to prevent and possibly treat leprosy is the result of years of research. The development has been complicated by the fact that the organism that causes leprosy cannot be grown in culture in the laboratory Reed explained. This is a unique example of a vaccine produced by totally synthetic methods. Reed added that without the foresight and support of American Leprosy Missions there would be no leprosy vaccine candidate. The vision and support of American Leprosy Missions has been tremendous as weve worked with them throughout the years moving from our work in developing a leprosy diagnostic to our current focus on a successful leprosy vaccine he said. The progress weve had to date would not have been possible without American Leprosy Missions financial support and guidance. Early results from the Phase I study should be available in and the partners are currently exploring mechanisms to advance the vaccine through laterphase clinical trials should results from the Phase I study clinical trial NCT support further evaluation. The vaccine candidate will serve as part of an overall strategy to end leprosy which will require detection prevention and treatment. IDRI had developed technology to enable a rapid affordable pointofcare diagnostic test which was funded by NIAID grant numbers RAIA and RAI. In addition to IDRI and American Leprosy Missions a variety of partners are taking part in efforts to eliminate leprosy including Novartis and the Novartis Foundation. Reed along with scientists from a variety of scientific organizations recently published Innovative tools and approaches to end the transmission of Mycobacterium leprae in The Lancet Infectious Diseases outlining what is needed to achieve this goal. Together with scientific government and NGO partners the Novartis Foundation develops and implements strategies to help interrupt leprosy transmission while Novartis donates the treatment for leprosy free of charge. About IDRI As a nonprofit global health organization IDRI Infectious Disease Research Institute takes a comprehensive approach to combat infectious diseases combining the highquality science of a research organization with the product development capabilities of a biotech company to create new diagnostics drugs and vaccines. Founded in IDRI has employees headquartered in Seattle with nearly partnerscollaborators around the world. For more information visit http About American Leprosy Missions American Leprosy Missions based in Greenville South Carolina is the oldest and largest Christian organization in the United States dedicated to curing and caring for people affected by leprosy and related diseases. It funds projects and partners in countries across Africa Asia and the Americas. During its more than year history American Leprosy Missions has provided holistic care to four million people around the world including medical treatment and training Christian outreach community development and vaccine research. For more information visit http SOURCE Infectious Disease Research Institute Related Links http"

"EMBARGOED FOR RELEASE A.M. ET TUESDAY AUGUST Media Advisory To contact Paul D. Miller M.D. call or email millerccbraol.com mailtomillerccbraol.com. To contact editorial coauthor Anne R. Cappola M.D. Sc.M. email Abbey Anderson at Abbey.Andersonuphs.upenn.edu mailtoAbbey.Andersonuphs.upenn.edu. To place an electronic embedded link to this study and editorial in your story These links will be live at the embargo time httpjama.jamanetwork.comarticle.aspxdoi.jama.. httpjama.jamanetwork.comarticle.aspxdoi.jama.. Among postmenopausal women with osteoporosis at risk of fracture daily injection of the drug abaloparatide for months significantly reduced the risk of new vertebral and nonvertebral fractures compared with placebo according to a study appearing in the August issue of JAMA. Osteoporosis is associated with substantial social economic and public health burdens. Based on U.S. Census data a study estimated the prevalence of osteoporosis among women to years of age at . million. It has been estimated that the lifetime risk of osteoporotic fracture for a yearold woman is percent. Additional therapies are needed for prevention of osteoporotic fractures. As a result of its mechanism of action it has been hypothesized that the drug abaloparatide a synthetic peptide would have a more pronounced anabolic i.e. bone growing action on bone compared with the osteoporosis drug teriparatide. Paul D. Miller M.D. of the Colorado Center for Bone Research Lakewood Colo. and colleagues randomly assigned postmenopausal women with osteoporosis to receive daily injections for months of placebo n abaloparatide n or teriparatide n . The trial was conducted at sites in countries. Among women average age years completed the study. New vertebral fractures occurred less frequently in the active treatment groups vs placebo in . percent n of participants in the abaloparatide group in . percent n of participants in the teriparatide group and in . percent n of those in the placebo group. The estimated event rate for nonvertebral fracture was lower with abaloparatide vs placebo . percent in the abaloparatide group . percent in the teriparatide group and . percent in the placebo group. Bone mineral density BMD increases were greater with abaloparatide than placebo. Incidence of hypercalcemia the presence of abnormally high levels of calcium in the blood was lower with abaloparatide . percent vs teriparatide . percent. Overall there were no differences in serious adverse events between the treatment groups. Further research is needed to understand the clinical importance of risk difference the risks and benefits of abaloparatide treatment and the efficacy of abaloparatide vs other osteoporosis treatments the authors write. doi.jama.. the study is available preembargo to the media at the For the Media website httpmedia.jamanetwork.com Editors Note This study was funded by Radius Health. Please see the article for additional information including other authors author contributions and affiliations financial disclosures etc. Editorial Osteoporosis Therapy in Postmenopausal Women With High Risk of Fracture Ultimately which therapy is selected for osteoporosis treatment may be less important than identifying and initiating an approved treatment write Anne R. Cappola M.D. Sc.M. of the Perelman School of Medicine at the University of Pennsylvania Philadelphia and Associate Editor JAMA and Dolores M. Shoback M.D. of the University of California San Francisco in an accompanying editorial. The bar is high for any preventive treatmentin 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 to prevent fracture 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. doi.jama.. the editorial is available preembargo to the media at the For the Media website httpmedia.jamanetwork.com Editors Note Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported."

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

"A study led by researchers at CedarsSinai and NeuroVision Imaging LLC httpneurovision.com provides the scientific basis for using noninvasive eye imaging to detect the pathological hallmarks of Alzheimers. The experimental technology developed by CedarsSinai and NeuroVision scans the retina using techniques that can identify betaamyloid protein deposits that mirror those in the brain. Accumulations of neurotoxic betaamyloid protein can be detected with positron emission tomography or PET scans and analysis of cerebrospinal fluid but these are invasive inconvenient and costly making them impractical for routine screening and followup evaluation. This is the first study demonstrating the potential to image and quantify retinal findings related to betaamyloid plaques noninvasively in living patients using a retinal scan with high resolution. This clinical trial is reinforced by an indepth exploration of the accumulation of betaamyloid in the retina of Alzheimers patients versus matched controls and a comparison analysis between retina and brain pathologies. Findings from this study strongly suggest that retinal imaging can serve as a surrogate biomarker to investigate and monitor Alzheimers disease said Maya KoronyoHamaoui Ph.D. httpneurovision.comaboutus an associate professor of Neurosurgery and Biomedical Sciences and a research scientist at the Maxine Dunitz Neurosurgical Institute at CedarsSinai and a cofounder inventor and scientist at NeuroVision. She is the senior leading author of an article in JCI Insight published online Aug. . As a developmental outgrowth of the central nervous system that shares many of the brains characteristics the retina may offer a unique opportunity for us to easily and conveniently detect and monitor Alzheimers disease said Keith L. Black M.D. httpneurovision.comaboutus chairman of NeuroVision chair of the Department of Neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at CedarsSinai. We know that Alzheimers begins as many as or years before cognitive decline becomes evident and we believe that potential treatments may be more effective if they can be started early in the process. Therefore screening and early detection may be crucial to our efforts to turn the tide against the growing threat of this devastating disease. Steven Verdooner httpneurovision.comaboutus NeuroVision CEO said the imaging system leverages the companys expertise in autofluorescence imaging of the retina using a specialized ophthalmic camera and sophisticated image processing software. Its exciting to see these studies demonstrating the power of the technology applied to the Alzheimers field. Our goal is to develop a product that is easy to use affordable and widely accessible. We look forward to the potential of retinal imaging playing a vital role in solving the problem of Alzheimers both in identifying and monitoring those who may be affected by the disease. Our next step is to continue with clinical trials building upon the existing pharmaceutical company collaborations to ensure our technology is ready for the medical community to help manage this disease. The studys first author Yosef Koronyo httpneurovision.comaboutus a research associate at CedarsSinai and a scientist and inventor at NeuroVision said the latest findings cap a decade of study that has produced several landmark discoveries. In our research group published an article providing the first evidence for the existence of Alzheimersspecific plaques in the human retina and we demonstrated the ability to detect individual plaques in live mouse models using a modified ophthalmic device. After adapting the technology for human application the researchers initiated several ongoing clinical trials in the United States and Australia to determine the feasibility of detecting and quantifying betaamyloid plaques in patients with the disease. In the new article the researchers report on a patient clinical trial to demonstrate the feasibility of identifying betaamyloid in the eye using autofluorescence imaging. They also provide detailed analyses and several new findings on Alzheimers pathology in the retina results of research with donated eyes and brains of deceased patients with confirmed Alzheimers disease and controls. Among key findings the researchers report a .fold increase in retinal plaque burden in patients with Alzheimers compared to controls and they provide observations regarding geometric distribution and layer location of amyloid pathology in the retina. With the imaging technologys ability to detect autofluorescence signal related to retinal betaamyloid these findings may lead to a practical approach for largescale identification of the atrisk population and monitoring of Alzheimers the researchers say. The article provides new insights into the diseases manifestations in the retina and information on the optical imaging system. Here are several highlights The first histologic quantitative analysis of retinal plaque clusters or hot spots containing the most toxic forms of betaamyloid with specific distribution patterns in superior peripheral regions that were previously unexplored. A detailed analysis of betaamyloid deposit types using electron microscopy. The first report of certain Alzheimersrelated pathologies in the retina including vascular amyloid pathology. The demonstration of a significant correlation between retinal and brain plaques and coexistence of neuronal loss. The first feasibility study for noninvasively detecting presumed amyloid deposits in retinas of living patients. The demonstration of a fully automated calculation quantifying retinal autofluorescence that showed a .fold increase in patients with Alzheimers compared with controls. Researchers from NeuroVision CedarsSinai the Doheny Eye Institute Retina Vitreous Associates Medical Group Retinal Consultants Medical Group Sutter Neuroscience Institute UCLA Geriatric Research Education and Clinical Center Veterans Greater Los Angeles Healthcare System and the University of Southern California contributed to the research and article. KoronyoHamaoui Verdooner Koronyo and Black are founding members of NeuroVision. Funding was provided by a National Institutes of HealthNational Institute on Aging NIA award AG KoronyoHamaoui NVI The Saban Family Foundation and The Marciano Family Foundation KoronyoHamaoui. About NeuroVision Imaging LLC NeuroVision http was formed in and is headquartered in Sacramento California. Dr. Keith Black the companys chairman and cofounder is an internationally recognized neurosurgeon researcher and thought leader in areas of brain and bloodbrain barrier function enhancing the therapeutic effects of treatments in the brain and optical imaging of the brain. He is the chair of CedarsSinais Department of Neurosurgery. Steven R. Verdooner NVIs CEO as well as a company director is an experienced medical technology industry veteran who has successfully developed commercialized and marketed ophthalmological imaging and measurement systems for other diagnostic applications. Clinical trials were approved by Quorum Review Seattle Washington IRB and the U.S. Department of Health and Human Services FWA. Human tissues were obtained from the USC Alzheimers Disease Research Center ADRC Neuropathology Core Los Angeles CA IRB protocol HS. Animal studies were approved by the CedarsSinai Medical Center Institutional Animal Care and Use Committee IACUC and the Division on Laboratory Animal Medicine DLAM at UCLA."

"Obese patients who swallowed balloon capsules that helped them eat less lost an average of pounds roughly two times more weight than patients who just dieted and exercised researchers report. The capsule was inflated with gas via a catheter when it reached the stomach. As many as three balloons were placed over three months and all of the balloons were removed after six months. The balloons made patients feel full the researchers explained. In addition to the balloons patients followed a moderate diet and behavior modification program. Whether the weight loss will last over the long term isnt known said lead researcher Dr. Aurora Pryor director of the Bariatric and Metabolic Weight Loss Center at Stony Brook University in New York. The study lasted a year but we dont know what happens after that Pryor said. If they are able to stick to their newfound lifestyle with their diet and exercise program they could maintain their weight loss she said. The longterm results are dependent on patients keeping their motivation to stay with their diet and exercise programs. The balloon treatment will be available starting in January but the cost hasnt been announced Pryor said. The device called the Obalon Balloon System was approved in September by the U.S. Food and Drug Administration. An advantage of the balloons is that patients have no downtime and can go back to work the same day the researchers said. There is no sedation or recovery time when the balloons are placed but there is sedation when the balloons are removed so you wouldnt want to go back to work after that Pryor added. Pryor believes balloons are a better option for patients who are candidates for weight loss surgery but dont want surgery. For people who want to lose some weight but dont feel they are heavy enough for surgery or theyre afraid of surgery this is a really good next step to help them jump start their weight loss she suggested. The findings were to be presented Friday at the annual meeting of the American Society for Metabolic and Bariatric Surgery and the Obesity Society in New Orleans. Research presented at meeting is considered preliminary until published in a peerreviewed journal. One weightloss expert expressed some doubts about the findings. I still question the efficacy of balloons said Dr. Mitchell Roslin chief of obesity surgery at Lenox Hill Hospital in New York City. While there is potentially easier insertion that does not require sedation I still doubt after removal there will be weight loss he said. Roslin said patients who have other treatments that restrict their ability to eat such as bands and bypass operations that reduce the size of the stomach often regain lost weight over time. As time goes on weight loss will be about lifestyle changes he said. The only argument for the balloon is that it starts the lifestyle changes Roslin said. It may make it easier to become motivated he said. But I believe that few will maintain weight loss two years after any balloon. For the study Pryor and her colleagues randomly assigned nearly obese patients to receive a real or sham device. All patients also had minutes of lifestyle therapy every three weeks. After six months patients with the Obalon balloons had them removed. During the time patients had the balloons and for six months after the researchers monitored their weight loss. The investigators also followed those who had not received the balloon therapy. People treated with the balloons lost an average of percent of their weight compared to less than percent for those who received the sham device the researchers found. Six months after the balloons were removed nearly percent maintained the weight loss they achieved during treatment Pryor said. As for side effects one patient had a bleeding stomach ulcer while taking high doses of pain pills after a knee replacement. Most patients percent suffered from stomach cramps and nausea which nearly percent said were mild or moderate. The results were also presented at a medical meeting in May. One health and nutrition expert noted that a balloon does not equal a lifestyle change. A gastric balloon may help with weight loss but will do nothing to improve diet quality and overall health said Dr. David Katz. He is director of the YaleGriffin Prevention Research Center in Derby Conn. and president of the American College of Lifestyle Medicine. The role for such technologybased approaches to weight control should be a small one he said. Such devices may be alternatives to bariatric surgery in some cases. But they should not distract us from the far better solution at the population level practices programs and policies that make eating well and being active a cultural norm Katz said. More information Visit the U.S. Centers for Disease Control and Prevention https for more on obesity. SOURCES Aurora Pryor M.D. professor surgery and director Bariatric and Metabolic Weight Loss Center Stony Brook University N.Y. Mitchell Roslin M.D. chief obesity surgery Lenox Hill Hospital New York City David Katz M.D. M.P.H. director YaleGriffin Prevention Research Center Derby Conn. and president American College of Lifestyle Medicine Nov. presentation Obesity Week New Orleans"

"Prestigious international medical journal Nature publishes review article citing nonprescription IBgard as clinically supported approach in managing IBS Latest in growing scientific and medical recognition of IBgard as an effective safe and welltolerated option in the management of IBS IBgard mentioned alongside other mainstream IBS management options such as drug therapies nutrition and psychotherapy Builds on a previous review article where the lead author cited peppermint oil as the most effective option in management of IBS BOCA RATON Fla. Sept. PRNewswire IM HealthScience IMH today announced that the growing medical consensus on the utility of peppermint oil in Irritable Bowel Syndrome IBS has been highlighted once again by comments in a recent prestigious publication Nature Reviews Disease Primers an international peerreviewed scientific journal. The publication has published a comprehensive review article exploring Irritable Bowel Syndrome IBS. It included a favorable review of IBgard a novel formulation of peppermint oil developed as a medical food specifically for the dietary management of IBS. The lead author of the review article entitled Irritable Bowel Syndrome http was Paul Enck M.D. Department of Internal Medicine VI Psychosomatic Medicine and Psychotherapy University Hospital Tbingen Tbingen Germany. In the section of the article discussing management options for IBS Dr. Enck and the accompanying panel of researchers stated peppermint oilis beneficial in reducing IBS symptoms. The researchers also concluded that A novel formulation of peppermint oil designed to cause sustained release in the small bowel was superior to placebo in causing a reduction in total symptoms. Nature publishes broad review articles called Primers that cover global aspects of various diseases and describe all aspects from epidemiology disease mechanisms diagnosis screening and prevention management and quality of life. The review articles are authored by an international panel of academic scientists translational researchers and clinicians. IBS considerably affects quality of life and places an enormous burden on patients physicians and the healthcare system said Brooks D. Cash M.D. A.G.A.F. F.A.C.G. F.A.C.P. F.A.S.G.E. Professor of Medicine in the Gastroenterology Division at the University of South Alabama in Mobile Ala. The results of these studies add to the growing body of medical evidence supporting the utility of IBgard a novel formulation of peppermint oil in improving the symptoms patient satisfaction and quality of life of patients with IBS. The understanding of IBS has expanded considerably over the past decade with many new studies in part driven by the development of new therapeutic agents. Additionally Dr. Cash was the lead study author of the IBSREST study which demonstrated that IBgard provided a statistically significant reduction in the Total IBS Symptom Score TISS in as early as hours and at four weeks. Growing Medical Support for Peppermint Oil in the Management of IBS The World Gastroenterology Organization WGO issued global IBS guidelines in September which recommended peppermint oil in managing IBS as a firstline therapy option. The consensus report entitled Irritable Bowel Syndrome A Global Perspective http guides health providers in the best management of IBS through recommendations based on the latest evidence and resulting from a global expert consensus process based on best current practice. An international scientific and medical review team reported that there are a range of agents available to treat IBS and physicians should be knowledgeable about the efficacy and risk profile of any option they are about to prescribe. The review team concluded that as a firstline therapy option peppermint oil is superior to placebo in improving IBS symptoms and the risk of adverse events is no greater with peppermint oil than with a placebo. These evidencebased guidelines go through a rigorous process of authoring editing and peer review. They are available in English Spanish Portuguese French Mandarin and Russian. WGO formed in and incorporated in is a federation of member societies and regional associations of gastroenterology representing more than individual members worldwide focusing on the improvement of standards in gastroenterology training and education on a global scale. Additionally the support from the medical community builds on a previously important review article about the use of peppermint oil in IBS. In a metaanalysis by Dr. Enck entitled Therapy Options in Irritable Bowel Syndrome httpjournals.lww.comeurojghabstracttherapy_options_in_irritable_bowel_syndrome..aspx published in The European Journal of Gastroenterology Hepatology Dr. Enck and the authors concluded that the highest efficacy in the management of IBS is currently found in peppermint oil. Among the thirteen IBS options that Dr. Enck and the authors reviewed only peppermint oil had the lowest NNT number needed to treat of patients needed for one patient to benefit from the therapy. About Irritable Bowel Syndrome One in six Americans experience Irritable Bowel Syndrome IBS a frustrating underdiagnosed and undertreated condition characterized by recurrent abdominal pain often associated with alteration in stool frequency andor form. Bloating is also a common symptom experienced by patients with IBS. Recent understandings of the root causes of IBS point to gut mucosal barrier dysfunction and malabsorption. About IBgard IBgard is a medical food specially formulated for the dietary management of IBS. IBgard capsules contain solid state microspheres of peppermint oil including its principal component lMenthol in a unique delivery system. With its patented Site Specific Targeting SST technology pioneered by IM HealthScience IBgard capsules release Ultramen an ultrapurified peppermint oil quickly and reliably to the small intestine where its actions help manage IBS. Peppermint oil can help toward normalizing the digestion of food and the absorption of nutrients which have been compromised by IBS. Peppermint oil has also been shown to normalize intestinal transit time. IBgard was studied in a pivotal randomized placebocontrolled doubleblinded multicenter trial called the Irritable Bowel Syndrome Reduction Evaluation and Safety Trial IBSREST. The study findings were accepted by a leading peerreviewed scientific journal called Digestive Diseases and Sciences and published in February . The data showed that IBgard demonstrated a statistically significant reduction in the Total IBS Symptom Score TISS in as early as hours and at four weeks. The TISS represents a composite score of eight individual IBS symptoms. Currently there are limited options for patients with IBS that offer effective and rapid relief especially during a flareup. Over healthcare practitioners including gastroenterologists are estimated to have already used IBgard for their patients. In a recent nationwide survey of gastroenterologists IBgard was the number one recommended peppermint oil for IBS. Like all medical foods IBgard does not require a prescription but it must be used under medical supervision. Only doctors can diagnose IBS. The usual adult dose of IBgard is capsules as needed up to three times a day not to exceed capsules per day. IBgard is available to patients in the digestive aisle at most CVSpharmacy Walgreens and Rite Aid stores nationwide and now increasingly in independent drug stores and grocery stores across the country. About IM HealthScience IM HealthScience IMH is the innovator of IBgard for the dietary management of irritable bowel syndrome. It is a privately held company based in Boca Raton Florida that is also the innovator of FDgard for the dietary management of functional dyspepsia. It was founded in by a team of highly experienced pharmaceutical research and development and management executives. The company is dedicated to developing products to address gastrointestinal issues where there is a high unmet need. The IM HealthScience advantage comes from developing products based on its patented targeteddelivery technologies called Site Specific Targeting SST. For more information visit http to learn about the company or http or http Enck P. Aziz Q. Barbara G. Farmer A.D. Fukudo S. Mayer E.A. et al. March online. Irritable bowel syndrome. Nature Reviews Disease Primers . doi .nrdp... Copyright World Gastroenterology Organization WGO. All rights reserved. Irritable Bowel Syndrome A Global Perspective. Enck P. Junne F. Klosterhalfen S. Zipfel S. Martens U. . Therapy options in irritable bowel syndrome. European Journal of Gastroenterology Hepatology . doi .MEG.bea. SOURCE IM HealthScience Related Links http"

"How to treat patients who have microinvasive breast cancer tumors that are mm or less in size the thickness of a dime is somewhat controversial. Can these tiny tumors affect the lymph nodes and spread cancer to other areas of the body Physicians at the Virginia Piper Cancer Institute wanted to know if surgical procedures to test the lymph nodes for cancer were always necessary. They examined the outcomes of patients who were treated between and . Only . percent had positive lymph nodes indicating the rare possibility of metastatic cancer. And the only patients with positive lymph nodes had microinvasive tumors that were associated with relatively large noninvasive tumors ductal carcinoma in situ or DCIS. These findings allow surgeons to select which patients with microinvasive tumors may actually benefit from lymph node sampling while sparing other patients from this procedure said Tamera Lillemoe M.D pathologist and a study coauthor. The study funded by Engelsma Family Foundation and Abbott Northwestern Hospital Foundation was published recently in The Breast Journal the official journal of the National Consortium of Breast Cancers. About Virginia Piper Cancer Institute Abbott Northwestern Hospital The Virginia Piper Cancer Institute part of Allina Health provides comprehensive care through all aspects of cancer prevention early detection and treatment to help individuals maintain quality of life and find ways to live with and beyond cancer. The Institute was founded in at Abbott Northwestern Hospital. In addition to retaining its first place ranking for the best hospital in the Twin Cities and second in the State of Minnesota in the U.S. News World Reports best hospital rankings Abbott Northwestern has received nursing magnet certification a recognition earned by only five percent of hospitals nationwide. Allina Health is dedicated to the prevention and treatment of illness and enhancing the greater health of individuals families and communities throughout Minnesota and western Wisconsin. A notforprofit health care system Allina Health cares for patients from beginning to endoflife through its clinics hospitals retail pharmacies specialty care centers and specialty medical services home care home oxygen and medical equipment and emergency medical transportation services. For more information visit us at allinahealth.org httpallinahealth.org Facebook Twitter YouTube or Healthy Set Go."

"An experimental drug dramatically reduced the toxic plaques found in the brains of patients with Alzheimers disease a team reports httpnature.comarticlesdoi.nature in the journal Nature. Results from a small number of patients who received a high dose of the drug called aducanumab https_usresearchpipelinebiogenpipeline.html hint that it may also be able to slow the loss of memory and thinking. If that hint of a clinical benefit is confirmed it would be a game changer in the fight against Alzheimers disease says Dr. Eric Reiman httpbanneralz.orgaboutusourleadership.aspx executive director of the Banner Alzheimers Institute in Phoenix. Reiman wrote a commentary that accompanies the study in Nature. But it will take much larger studies to show for sure whether aducanumab really does slow down Alzheimers disease Reiman says. Officials of Biogen https_usresearchpipelinebiogenpipeline.html which is developing the drug were also cautious about interpreting the results of the study which included patients in the early stages of Alzheimers disease. We think we have something important here says Dr. Alfred Sandrock https_usaboutbiogenleadershipleadershipdetail.sandrock_alfred.html chief medical officer for Biogen. We hope were right because if its true it would benefit millions of patients. But we dont know were right yet. The results are encouraging for pharmaceutical companies that have spent billions of dollars on efforts to come up with the first drug to treat the underlying cause of Alzheimers. Those efforts have failed to produce a single approved drug http so far. But last summer Biogen began presenting its results with aducanumab at scientific meetings including the Alzheimers Association https International Conference in July. These early reports suggested the drug had a remarkable ability to remove plaques in the brain. Sign Up For The Health Newsletter See how medical research insurance coverage and other news affect your health sent weekly. Top of Form Email address Bottom of Form By subscribing you agree to NPRs terms of use https and privacy policy https It was surprising encouraging and thoughtprovoking to see such a striking reduction of existing plaques Reiman says. The publication httpdx.doi.org.nature in Nature on Wednesday provides details about those early reports. Biogen has already begun two much larger studies of aducanumab. They will include a total of patients and results are still several years off. But there are reasons to think aducanumab may succeed where other drugs have failed. One is that the drug appears to ignore benign forms of amyloid protein while attacking the toxic forms thought to damage brain cells. Another is that aducanumab seems to enhance the ability of existing immune cells in the brain to devour toxins including amyloid. But theres a downside. The process of removing plaque sometimes causes fluid to build up in the brain. In rare cases it can also cause bleeding. These side effects are known as amyloidrelated imaging abnormalities or ARIA. We were actually anticipating that we would see it Sandrock says. And the researchers did. Twenty patients dropped out of the trial because of adverse effects. If aducanumab works in larger studies it could help settle a longrunning debate about whether amyloid is really the root cause of Alzheimers. This idea is known as the amyloid hypothesis https_betaamyloid.pdf. And large studies showing that removing amyloid can preserve memory and thinking would go a long way toward validating the amyloid hypothesis Sandrock says. Results like those could also lead to the first approved drug to treat the underlying cause of Alzheimers rather than just the symptoms."

"A less common form of obesity surgery may spur more weight loss than its far more popular cousin gastric bypass but at the price of greater longterm risks researchers reported Tuesday. The study published in the Annals of Internal Medicine followed severely obese patients who were randomly assigned to either gastric bypass surgery or a more extensive procedure known as duodenal switch. Two years after surgery duodenal switch patients had lost more weight about pounds more on average. People shed a substantial amount of weight with either type of surgery. Gastric bypass patients cut an average of pounds while duodenal switch patients dropped about . But those extra pounds came with nearly double the complication rate. Of the duodenal switch patients percent had problems like abdominal pain vomiting diarrhea and intestinal obstruction. And several suffered longterm malnutrition something not seen in the gastric bypass group. Duodenal switch is not a popular procedure. In a study it accounted for just percent of weightloss or bariatric surgeries done in the U.S. and percent in Europe. The technique is often reserved for superobese patients with a body mass index BMI of or higher though some surgeons perform it with less severely obese patients too explained Dr. Torgeir T. Sovik of Oslo University in Norway the lead researcher on the new study. As duodenal switch can be associated with more adverse events this procedure should only be performed in carefully selected patients by a dedicated bariatric team Sovik told Reuters Health in an email. And a closer followup after surgery is required after such procedures. But an expert not involved in the study went further. This is an operation that should probably go away said Dr. Edward H. Livingston a professor and surgeon at the University of Texas Southwestern Medical Center in Dallas. The average weight loss seen with either gastric bypass or duodenal switch will improve or reverse obesityrelated ills like diabetes sleep apnea and knee arthritis according to Livingston who wrote an editorial published with the study. So for those medical conditions it probably wouldnt matter if a person lost pounds or pounds over two years. Sponsored BMI is a measure of weight relative to height. A BMI between . and . is considered normal weight and above is obese. The patients in the current study were a fairly healthy group despite having a BMI of or more. After two years those whod had a duodenal switch showed a greater improvement in their cholesterol levels. But those levels were nearnormal in both groups to begin with Livingston noted. That begs the question he said of whether the extra weight loss actually accomplished anything. The answer is no Livingston said. In the U.S. where about people underwent weightloss surgery in gastric bypass is the most common form chosen. During gastric bypass the upper portion of the stomach is stapled off to create a smaller pouch that restricts the amount of food a person can eat at one time. The surgeon also creates a bypass around the rest of the stomach and a portion of the small intestine which limits the bodys absorption of food. Duodenal switch is more extensive. The surgeon removes part of the stomach and the remaining sleevelike stomach is attached to the final section of the small intestine that puts even greater limits on the bodys absorption of calories and nutrients. Both surgeries carry the longterm risk of nutritional deficiencies and people need to take supplements and carefully monitor their diets for a lifetime afterward. But the risks of nutrient deficiencies are greater with duodenal switch and include some not seen with gastric bypass Livingston pointed out. Some people for instance may have severe calcium and vitamin D loss leading to weak and fragile bones. Other problems include severe protein deficiency and night blindness caused by vitamin A deficiency which is also reversible with extra vitamin A treatment. In this study three of the duodenal switch patients developed protein malnutrition two developed night blindness and one had a severe iron deficiency that needed to be treated with iron infusions. Livingston said his advice to people considering weightloss surgery is to avoid duodenal switch. Its just not a good operation he asserted. But he also questioned the value of weightloss surgery in general for severely obese people who do not have medical conditions that stand to improve or resolve after surgery. In general experts say that surgery could be an option for anyone with a BMI of or higher that translates roughly to a man who is at least pounds overweight or a woman who is pounds overweight. Livingston said he thinks more caution is in order when a very obese person is otherwise healthy. Along with the risks of surgery he said there is still uncertainty about whether it actually lengthens peoples lives. Some studies have suggested it might but not all. In a study recently published in the Journal of the American Medical Association Livingston and his colleagues found no survival advantage among severely obese patients whod undergone weightloss surgery versus those who hadnt. The study involved U.S. veterans who underwent some form of weightloss surgery at an average age of about and more than vets who had only nonsurgical care. There was no evidence that surgery improved longevity over the next seven years. We really dont even know if theres a survival benefit Livingston said. That he added makes the risks of duodenal switch seem even less worthwhile. But according to Sovik duodenal switch might be appropriate for some superobese patients. In the U.S. he said about one in three weightloss surgery candidates have a BMI of or higher. And studies suggest that a sizable percentage of those people will still have a BMI higher than after gastric bypass. In this study onequarter of gastric bypass patients still had a BMI that high two years after surgery versus none of the duodenal switch patients. More extensive monitoring after duodenal switch Sovik noted can help detect and manage side effects. He pointed out though that larger longerterm studies are still needed to show whether the extra weight loss with duodenal switch ultimately improves severely obese patients health and extends their lives. SOURCE bit.lymQAUrf httpbit.lymQAUrf Annals of Internal Medicine online September . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"Dominic Gessler lifts two squirming mice from their cages. Sherri Epstein flinches but Gessler coaxes her to hold out her hands. He places the small animals in her palms and they skitter in tiny circles tickling her skin. Now says Gessler. Which one used to have Canavan disease A few miles away at Epsteins home in Worcester Massachusetts a young woman lies in bed her thin limbs bent and still her curly red hair splayed across a pillow. This is Rachel Epsteins yearold daughter born with Canavan diseasea debilitating fatal brain disorder. As a newborn Rachel opened her mouth as if to scream but made no sound. As an infant she never moved in her sleep. When Rachel failed to lift her head by six months of age an early intervention therapist suspected she had cerebral palsy. Epstein wishes it had been so. Instead Rachel had inherited a mutated version of a gene called ASPA from each of her parents. Without a healthy copy of that gene her cells could not produce a protein needed to break down acid in the brain. So the acid built up then slowly ate away at the insulation protecting Rachels neurons turning her white matter into a sponge pocketed with fluidfilled sacs. As a result Rachel does not talk she cannot see or control her limbs or other bodily functions she has seizures and will likely not live to adulthood. There is no treatment and no cure for Canavan disease. Yet standing in a room at the University of Massachusetts Medical School Epstein holds a mouse that once had the same symptoms as Rachelbut now runs effortlessly over her outstretched fingers. Weeks before the mouse was treated with a single intravenous injection of a gene therapy drug developed in the lab of Gesslers doctoral adviser microbiologist Guangping Gao. The drug is the fruit of Gaos year career in gene therapy. Gao did not always believe the drug would ever make it out of the laboratory because the field of gene therapy has been plagued with seemingly insurmountable obstacles including the deaths of test subjects. Over the past five years however there has been a resurgence of gene therapy in neuroscience. Scientists now argue it is our best and perhaps only chance at curing many diseases of the brain. And attuned to the multibilliondollar potential of this new class of drugs large pharmaceutical companies including Novartis Shire AstraZeneca and GSK are joining the fray. More than biotech companies are currently developing viral gene therapies while others are working to directly edit genes. Gene therapies are coming along fast and furious. Theyre going to earn their place says Kevin Starr cofounder of Third Rock Ventures a venture capital firm invested in three gene therapy companies. We are probably in the greatest innovative period of understanding human disease and how to make cures ever. A FedEx Truck to the Brain The concept of gene therapy is straightforward beautiful even Fix an illness caused by a faulty gene by replacing or supplementing a healthy new copy of the gene. In other words use genes as medicine. For example one of the earliest human tests of gene therapy was in when two young girls with severe combined immunodeficiency SCID received repeated infusions of their own white blood cells modified to fix a defective gene. It workedwith continued treatments both children showed signs of a restored immune system and went on to lead normal lives. Gao first met a Canavan patient in at a party celebrating his discovery of the gene and mutations that caused the disorder. A family wheeled over their yearold with Canavan disease to the young scientist who realized that the boy had donated tissue to his research project. Id held his DNA in my hands. I had found what was wrong with his DNA recalls Gao then a Ph.D. student. Yet he had no way to fix it. At that moment I knew what I would do for the rest of my lifefind a cure for the disease says Gao. And other than gene therapy there was no other way. Gene therapy is wellsuited for treating inherited brain diseases. First most drugs cant get through the brains formidable bloodbrain barrier but something small like a virus with a healthy gene tucked inside can do it. Additionally the brain is a closed compartment so the risks of gene therapy are minimizedother parts of the body the liver or the lungs say are undisturbed. In the early s Gao was a student without a lab of his own. So he sought out James Wilson at the University of Pennsylvania a rising star in the field of gene therapy. For the next years Gao would work for Wilson engineering new and better viruses for the therapies called viral vectors. These molecular FedEx trucks can be loaded with healthy versions of genes and deliver them to the correct location in the body. Gao was in the right place at the right time. By more than gene therapy clinical trials were approved in the U.S ranging in illnesses from cancer to blood disorders to graftversushost disease. Wilson eagerly moved from the lab into human trials starting with five studies utilizing a modified version of an adenovirus a common virus known to cause respiratory infections in people. One of those trials enrolled a teenager named Jesse Gelsinger. Gelsinger suffered from a genetic liver condition kept under control with pills and diet but he volunteered for the study to help find a cure for infants with a fatal form of his disorder. When Gelsinger received the gene therapy in September the adenoviral vector triggered a violent immune response that damaged his liver and shut down his lungs. Four days after the injection he was dead. His death shuttered gene therapy funding and research in the United States. Europeans continued on buoyed by an announcement in that gene therapy had cured a group of children with SCID. But within a few years five of them had developed leukemia from the treatment. One died and scientists fled the field. Gao who was not directly involved in the clinical trial that led to Gelsingers death doesnt like to talk about it now saying only that he doesnt blame Wilson. Gao kept his head down and quietly continued to work on other types of safer viral vectors. The most promising candidate was adenoassociated virus AAVa virus that grows in the presence of adenovirus but is a completely different type. AAVs are not quite as efficient as adenoviruses at getting genes into human cells but they are much safer The human immune system barely notices the viruss outer coat or dress as Gao calls it. And AAVs do not integrate into the genome of human cells which is what caused leukemia in some of the SCID patients. In Gao struck out on his own taking a job as director of a brandnew gene therapy center at UMass. The paint on his office walls was still wet when Sherri Epstein walked in. A parttime administrative assistant in the building next door Epstein had seen Gaos appointment in a local newspaper. Epstein introduced herself and told Gao about Rachel and her previous attempt at gene therapy. Five years earlier doctors running the firstever Canavan gene therapy trial drilled six tiny holes into Rachels skull inserted thin catheters and delivered their drug to parts of her brain. It was safe but it didnt work. Not long after that initial meeting Epstein brought Rachel to visit the lab. Once again Gao was standing in front of a desperate parent and dying child. At the time only one gene therapy had been commercially approved in the world a cancer drug in China. Regulators in the U.S. and Europe were highly skeptical of the safety and efficacy of such treatments. Gao knew he had to be careful and was determined to not repeat the errors of his predecessors by rushing into human trials. Instead he spent the next eight years methodically producing a novel gene therapy for Canavan disease. He has spent over million in federal and university research funds developing and testing it in hundreds of mice with the disease. Gaos graduate student Seemin Ahmed initiated the lab work in and accomplished a proofofconcept with a firstgeneration gene therapy that could partially rescue the disease based on AAV an ideal AAV vector to get into the brain. The AAV therapy is so good at slipping into the brain that one can deliver the drug intravenously into the blood and it passes through the bloodbrain barrier to penetrate all areas of the brain. No drilling into the skull required. Gessler a young German scientist studying to be a neurosurgeon joined the project in and has since built on Ahmeds work optimization the therapy with an improved gene construct that produces times as many copies of the needed protein as earlier versions. Gessler will never forget the first time he tested the optimized therapy in a live animal. He injected it into a young sick mouse hunched over with no control over its muscles. When Gessler returned to assess the results he couldnt find the mouse. He worried he had mislabeled a cage. He hadnt. The mouse was there acting just as healthy as the control mice. Today the treatment has cured Canavan disease in two different strains of mice engineered to have the disease. A dozen freezers line the long hallway in Gaos laboratory each filled to the brim with preserved tissues and viruses. We have the therapy. We are ready says Gao grinning like a schoolchild. The last barrier is financial but not impossible to overcome. Gao estimates it will require million to million to launch the first human clinical trialsbut the potential profits are already attracting biotech attention. Two companies which Gao declined to name have approached him about getting involved in the effort. Making the BillionDollar Bet The office of Voyager Therapeutics in Cambridge Massachusetts epitomizes a trendy startup glass doors whiteboard walls minimalist orangeaccented dcor and a communal area with free drinks and snacks. It smells like caffeine and money. But unlike tech startups this office is flanked on either side by laboratories full of microscopes and viruses. The company is developing gene therapies for a handful of central nervous system disorders including Parkinsons Huntingtons and Lou Gehrigs disease. Voyager CEO Steven Paul has worked in the pharmaceutical industry developing drugs for brain disorders for over years and witnessed the tribulations of gene therapy. Hes ardent that now is finally the right time. Investors agree. Venture firms have invested more in gene therapy since than they did during the whole previous decade and therapies for the brain far and away lead the pack according to Dow Jones VentureSource. Last February when Voyager was just a year old it inked a deal with Genzyme for million up front and up to million in future milestone payments including for the companys severe brain disease programs. Voyager followed that with million in investor financing in April and an million initial public offering in November. Philadelphiabased Spark Therapeutics developing gene therapies for rare eye diseases accumulated million in funding after going public in just two years and scoring a sizable licensing deal with Pfizer. Cambridgebased Bluebird Bio ended last year with a whopping million in cash and cash equivalents. In the Magazine https It used to be that Big Pharma wasnt interested in rare diseases Companies thought these markets were too small says Paul. But with the right price tag even a therapy sold to only a few hundred patients can make billions. Glybera the first Europeanapproved gene therapy sparked pricing debates when it debuted at . million per shot. While insurance companies and health care providers struggle to figure out what they are willing and able to recommend and pay for theres no doubt a market exists. Gene therapy investments have become so abundant that some academics are turning from government support toward venture capital. R. Jude Samulski who developed the first AAVs for gene therapy back in the s recently founded a biotech company in North Carolina Bamboo Therapeutics to tap into that revenue stream. It is developing therapies for rare genetic diseases that result in progressive nerve death including Duchenne muscular dystrophy Canavan disease Friedreichs ataxia and giant axonal neuropathy. The company expects to begin human trials as soon as next year. Europe is beginning to see a trickle of gene therapy approvals including a green light in April for a treatment of type of SCID. The U.S. field waits on an influx of positive clinical data. Gene therapy will have a product in the U.S. approved by the FDA within two years says Gao. For sure. That will mostly likely be a treatment for the eyes this past October Spark had a Phase III win when a gene therapy to correct an inherited form of blindness successfully restored vision to the maximum possible benefit in patients according to the company. It plans to seek FDA approval for the treatment this year. Bluebird is also in latestage development of a gene therapy for the Lorenzos Oil disease adrenoleukodystrophy which like Canavans targets white matter in the brain. The therapy LentiD is performed on cells outside of the body The company removes blood stem cells from bone marrow of a patient treats them with a gene therapy in a dish then washes out the virus tests the genemodified cells and reinfuses them into the patients body. For all the recent improvements gene therapy will not be a cureall. For instance the approach is less likely to improve diseases where more than one gene is implicated or the cause is not known. In conditions like Parkinsons disease and Alzheimers disease for example the approach may lead to symptomatic relief but not a cure. And the risks have not entirely dissipated. You always have to think of benefit versus risk with any therapy says Paul. We pick diseases where the risk of not treating is very bad. Most children with Canavan disease die before age though some survive into their s and s. While Gao and Gessler believe their therapy will be most effective in newborn infants who test positive for the mutation they also cant forget Rachel and other older Canavan patients. With them in mind Gessler recently decided to test whether the therapy might also work for older mice. How long could he wait after a mouse had developed the disease to treat and still rescue it Gessler administered the therapy in sick teenage mice weeks old in human time adult mice weeks and mature mice weeks. Then he waited nervously. On a cold bright day in February I catch up with Gessler in Gaos sixthfloor corner office. He is smiling. We just got the oneyear data for the sixweektreated mice Gessler says. They are completely normal. After meeting with Gessler I travel an hour north to a pediatric nursing home where Rachel now livesa utilitarian brick building tucked behind Main Street in a quaint Massachusetts town. Rachel is lying in bed beneath a purple blanket a unicorn pillow at her feet. An episode of Friends plays in the background. Epstein is painting Rachels nails when I arrive. She adjusts the TV monitor closer to Rachels face. Shes legally blind but I think she understands everything says Epstein. She eventually asks about Gesslers experiments treating older mice a hint of hope in her voice. Epstein is not desperateshe has accepted Rachels lot in lifebut like any parent she will always desire the best for her child. I tell her about the recent mouse results and she smiles. The sun outside is setting and Epstein returns to painting her daughters nails a bright bubble gum pink."

"There may soon be a new tool in the fight against childhood obesity http Prebiotics reduce body fat in children who are overweight or obese by altering their gut microbiota according to new research published in Gastroenterology http the official journal of the American Gastroenterological Association AGA http Prebiotics are nondigestible food ingredients such as fiber that act as fertilizers to help stimulate the growth of good bacteria already in the gut different from probiotics which introduce new bacteria into the system. This is a welldesigned trial that demonstrates how a prebiotic could potentially help combat one of the most prevalent and costly conditions afflicting children in the developed world overnutrition by targeting the gut microbiome said Geoffrey A. Preidis MD PhD a member of the AGA Center for Gut Microbiome Research and Education http scientific advisory board. It is promising to see this evidence that alteration of the gut microbiota can be used to restore health. As a clinician I hope that continued research into prebiotics will lead to a new strategy for the treatment of obesity. Method For this study researchers from the University of Calgary Alberta Canada performed a doubleblind placebocontrolled trial with participants. Participants included children to years old who were classified as overweight or obese th percentile of body mass index but otherwise healthy. Participants were randomly assigned to groups given either the prebiotic fiber oligofructoseenriched inulin or a placebo once daily for weeks. The prebiotic was provided as a white powder mixed in water. Powdered fiber mixed in a water bottle taken once a day is all we asked the children to change and we got what we consider some pretty exciting results it has been fantastic added Raylene A. Reimer PhD RD professor and researcher in the Faculty of Kinesiology at University of Calgary who led the study. Results Based on fourmonth intervention data the annual projected body weight increase in the prebiotic group would be kilograms . pounds within the expected healthy range whereas the projected increase in the placebo group was kilograms . pounds almost triple the expected yearly weight increase. Thus supplementation with the prebiotic improved outcomes in children who were overweight or obese. Importantly the researchers show that the prebiotic induced specific gut bacterial shifts compared to placebo. Why is this important This is the first randomized controlled study to assess comprehensive changes in gut microbial composition with prebiotic intervention in children who are overweight and obese. Excess weight in childhood tends to persist into adulthood and is an early risk factor for obesityassociated morbidity and mortality highlighting the importance of early intervention. Whats next The metabolic and microbial findings from this study provide a foundation for a larger clinical trial in the pediatric population. Prebiotics are inexpensive and noninvasive and therefore a plausible dietary treatment in the overweight and obese pediatric population. Resources What is Obesity http_for_patientsobesitywhatisobesity Grant Support This work was supported by grants from the BMO Financial Group Endowed Research Fund in Healthy Living Alberta Childrens Hospital Foundation Alberta Childrens Hospital Research Institute and the Canadian Institutes of Health Research MOP. Clinicaltrials.gov no NCT. Reference Nicolucci A.C. Hume M.P. Martnez I. Mayengbam S. Walter J. Reimer R.A. Prebiotic Reduces Body Fat and Alters Intestinal Microbiota in Children With Overweight or Obesity. Gastroenterology doi .j.gastro... http About the AGA Institute The American Gastroenterological Association is the trusted voice of the GI community. Founded in the AGA has grown to more than members from around the globe who are involved in all aspects of the science practice and advancement of gastroenterology. The AGA Institute administers the practice research and educational programs of the organization. http About Gastroenterology Gastroenterology the official journal of the AGA Institute is the most prominent scientific journal in the specialty and is in the top percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system including the liver and pancreas as well as nutrition. The journal is abstracted and indexed in Biological Abstracts Current Awareness in Biological Sciences Chemical Abstracts Current Contents Excerpta Medica Index Medicus Nutrition Abstracts and Science Citation Index. For more information visit http Like AGA http and Gastroenterology http on Facebook. Follow us on Twitter AmerGastroAssn http AGA_Gastro httpstwitter.comAGA_Gastro New Check out our videos on YouTube http Join AGA on LinkedIn http"

"The policy response to the opioid epidemic http is frequently framed as a conflict If you pull back the opioid painkillers that led to the epidemic you are going to harm the pain patients who use these opioids to treat their pain. In effect youre trading one problem addiction for another undertreatment of chronic pain. A new study httpannals.orgaimarticlepatientoutcomesdosereductiondiscontinuationlongtermopioidtherapysystematic published in the Annals of Internal Medicine however offers a cause for optimism Reviewing the research so far it found that it may be possible to reduce doses for patients in longterm opioid therapy and improve their pain outcomes. So doctors can potentially pull back the opioids that launched the current drug overdose crisis and still successfully treat pain patients. Now by this latest studys own admission the evidence is of generally poor quality. Most of the studies reviewed were of poor methodology or sample size while only a few were of fair or good quality. The review also only looked at patients who volunteered to taper off opioids meaning this research does not prove that involuntarily pulling patients off the drugs will lead to similar outcomes. Suffice to say then a lot more research is necessary before this issue is settled. But the new study does offer a glimmer of hope in a fairly grim opioid epidemic Maybe it is possible to reduce the amount of dangerous opioids that patients are consuming and still alleviate peoples pain. What the study found For the latest review of the evidence researchers looked at studies that collectively provided data on more than pain patients who were weaned off at least some opioids. Though the researchers found a lot of studies to pool from they generally graded these studies as very low in quality and methodology. Researchers then identified the studies none of which were graded as good quality that evaluated painrelated outcomes for patients after longterm opioid therapy was tapered. Focusing on the fairquality studies they found that after opioid dose reductions patients on average saw improved pain function and quality of life. The authors provide a few possible explanations for this Perhaps the nonopioid pain treatments such as physical therapy and meditation that accompanied dose reductions simply produced better results than the opioids did. Maybe the opioids themselves caused problems that negatively impacted function or quality of life such as constipation fatigue poor sleep and depressed mood. Its possible that opioid dose reduction also resolved whats known as opioidinduced hyperalgesia a paradoxical response in which patients receiving opioids become more sensitive to painful stimuli. Or the researchers suggested the observational studies simply showed reverse causation that is patients successfully tapered opioids because pain severity decreased. The findings do not mean that doctors can now simply yank patients off opioids and expect them to get better. For one the reviewed studies generally looked at the results of tapering when patients are slowly weaned off opioid painkillers a process that Stanford psychiatrist Anna Lembke told me https can take months or even years. Crucially the studies also looked at what happened when these reductions in opioid doses were paired with alternative treatments including alternative medicines like acupuncture interdisciplinary pain programs and medicationassisted treatment for addiction. This is very very different from a situation in which a patient is taken off opioids and effectively left stranded without any other form of care. As the researchers readily admit the study also had several major limitations. Most of the studies analyzed were of poor quality meaning theres a serious need for better research in this area. And the studies only evaluated voluntary reductions in opioid doses its entirely possible that involuntary reductions in opioid doses would lead to sharply different outcomes. We should be cautious in interpreting the findings Joseph Frank lead author of the study told me. He emphasized that more research needs to be done to fill important gaps in our knowledge. He added I want patients and their doctors to use caution in applying this. A few pain patients will still benefit from opioids One of the studys implications is that opioids actually arent a good treatment for chronic pain. This isnt new. As the Centers for Disease Control and Prevention concluded http in its summary of the research there are simply no good longterm studies looking at the effects of opioids on longterm pain outcomes while there are many studies showing that longterm opioid use can lead to bad results in other areas including addiction and overdose. That does not mean opioids are never an effective treatment for chronic pain. As addiction and pain experts often tell me health care can vary vastly from patient to patient. Some patients feel worse on opioids while others report quick pain relief. Some patients experience grueling withdrawal if taken off opioids while for others the symptoms are much less severe. Some patients are at unusually high risk for addiction while many most in fact arent. And so on. In a few cases then opioids will still be the best answer for some individual chronic pain patients. When prescribed carefully on a schedule that works to diminish the excessive buildup of tolerance they can work for some people. But as Stanford pain specialist Sean Mackey emphasized to me https opioids should not be a firstline treatment due to the risks and alternatives should be tried first. This then is another key caveat to the study Its findings shouldnt be applied to every patient. Like much of health care each case will typically require individual evaluations to see what works. There are people who do well with tapering opioids Stefan Kertesz an addiction researcher at the University of Alabama Birmingham who was not involved in the study told me. There are people who do not do well with tapering. But the study suggests that getting some patients off opioids could improve their pain outcomes. The key is convincing patients that this truly can work so they buy into the treatment and genuinely follow through with it and making nonopioid treatments for pain accessible enough that patients see them as realistic options. Alternative pain treatments need to be made more accessible The reality though is nonopioid pain treatments are often out of reach for many Americans. Patients may not have insurance to cover the treatment. Even if they do have insurance their health plan might not cover comprehensive pain care. And even if they do have insurance and their health plan covers pain treatments there may not particularly in rural areas be a nearby pain clinic or doctor who can actually provide the care these patients are seeking. This is something the studys authors readily acknowledge. Its an important part of this challenge Frank said. These nonopioid strategies that were tested in these research studies are not adequately available. Several of the studies were done in pain centers where they have expert programs and those just are not widespread. In fact the lack of access to nonopioid strategies may be one big reason that doctors resorted to opioids in the first place. The drugs offered an easy answer if ultimately an ineffective one to the many problems doctors faced including patients who had complicated pain problems that physicians didnt fully understand and tight schedules driven by the current demands of the health care system that made it hard to take the time to work through a patients individual problems. More on all that in my interview with Lembke http To address this Frank argued that patients need better access to pain treatments. And doctors especially primary care doctors who are frequently the first people patients see in the health care system also need to be better trained to deal with chronic pain. These solutions could help a lot of people According to one study http from the Institute of Medicine million US adults suffer from chronic pain. The opioid epidemic shows that if this care isnt made available patients may end up resorting to drugs that can literally get them killed or as has been reported httpsoup.silverchaircdn.comoupbackfileContent_publicJournalpainmedicine.pme..pdfExpiresSignatureBoOUYyZhOCUNKFwJKedZoKdgzGBDhlWZycrQCyjbWVigBononmpNtSsvnxqzOfoFyfcxrfemdReYYCvGpuHXRnXnRWKyzQzEDfNBvaqpdHMZirvyEtJSWQzdTZSVFHjtwQHNsOgOkfAvXmqHMMgaBztYcDymCUemQkMWucGUiZPZssvDaNCSupibyEJzJsDvkiIHFnxGHXcveqARTvQWPDvZUZBSgfyBoZSTwWHFmLMjesPGivMbOXKvTLbxvrfCHDJByhoACUDw__KeyPairIdAPKAIUCZBIALVPAVWQ in other tragic cases http they may kill themselves once the pain grows too bad. The newest study however noted that there is no good research yet looking at these two potential outcomes if pain patients are taken off opioids. Not only do we lack the data but I have seen and heard of countless cases of overdose and suicide from people who have been involuntarily discontinued Kertesz said emphasizing this is strictly based on anecdotal observations. One day in June in my inbox were deaths. Opioid policy is a balancing act The findings show the balancing act of opioid policy Even if doctors need to pull back opioids they must be careful to ensure patients suffering from debilitating pain and other problems can still meet their other care needs. Its not just pain care. When dealing with opioid users who are addicted doctors and policymakers also need to ensure that addiction treatment is available. Otherwise these patients will likely try to find another source of drugs even if it means resorting to a riskier opioid such as heroin or fentanyl https to satisfy their cravings. Theres good evidence this happened to many but not all opioid painkiller users A study httparchpsyc.jamanetwork.comarticle.aspxarticleid in JAMA Psychiatry found percent of heroin users in treatment started with painkillers and a analysis http by the CDC found people who are addicted to painkillers are times more likely to be addicted to heroin. The fundamental problem is many of these patients dont get addiction treatment once they lose access to painkillers or before they progress to heroin or fentanyl. Without the option of treatment opioid users only answer to averting dependenceinduced withdrawal becomes harder drugs. Yet based on a report httpsaddiction.surgeongeneral.gov by the surgeon general only percent of Americans with drug use disorders get specialty treatment. That doesnt mean that reducing prescriptions is a mistake. By stopping doctors from unscrupulously prescribing the drugs governments can potentially stop opioids from flowing to new users who didnt really need the drugs and could have developed addictions had they been allowed to get painkillers. But the reduction has to be paired with increased access to addiction care and it frequently hasnt been. Beyond addiction treatment Kertesz argued that policymakers should also address some of the underlying conditions that drive addiction. He emphasized the need for broader mental health care given that people often have mental health issues that can make addiction more likely. Who is at higher risk John with PTSD and a dose of milligrams a day or James who has no PTSD and is on milligrams a day Kertesz said. Based on his reading of the data its John with PTSD on the milligrams. But as is true for addiction and pain treatments adequate mental health care is also out of reach for many patients showing just another way that the US health care system isnt built to adequately address the full needs of patients. All of this shows why the policy solution to the opioid epidemic isnt as easy as simply pulling back prescription opioids To avoid exacerbating existing problems or causing new ones policymakers need to consider the other needs of people who were perhaps getting opioids they didnt really need."

"Contrary to earlier reports giving acetaminophen Tylenol etc. for pain and fever does not worsen asthma in young children with the condition concludes a randomized trial in the August New England Journal of Medicine. The Acetaminophen Versus Ibuprofen in Children with Asthma AVICA trial led by researchers at Boston Childrens Hospital for the National Heart Lung and Blood Institutes Asthma Network AsthmaNet is the only blinded randomized controlled trial to date to prospectively compare acetaminophen headtohead with ibuprofen Motrin etc. in children with asthma. The site study should settle a debate that originated when several retrospective studies seemed to indicate that children had exacerbations of their asthma when receiving Tylenol for pain andor fever. We found no matter how you slice it there was absolutely no difference between Tylenol and Motrin says senior investigator and corresponding author Wanda Phipatanakul MD MS of Boston Childrens Hospitals Division of Allergy and Immunology. Our findings should alleviate the concerns for safety that were based on observational data. The study enrolled children to years old with mild persistent asthma. Their families were randomized to use either acetaminophen or ibuprofen as indicated for pain and fever over a week period. Both groups received the same asthma control therapies daily inhaled glucocorticoids as needed inhaled glucocorticoids and daily oral leukotriene receptor antagonist. The asthma therapies were given in varying order as part of a concurrent randomized trial making this in effect a trial within a trial. Medication adherence was closely monitored. Of the original children percent completed the study. Children in the acetaminophen and ibuprofen groups used similar amounts of these medications for pain andor fever median . doses. During the weeks there were no statistically significant differences between groups The number of asthma exacerbations per child averaged . in the acetaminophen group versus . in the ibuprofen group. At least one asthma exacerbation occurred in percent of the acetaminophen group vs. percent of the ibuprofen group. At least two episodes occurred in and percent respectively. The percentage of days with full asthma control were virtually the same for acetaminophen and ibuprofen . and . percent respectively. Use of rescue medication albuterol was essentially the same . vs. . puffs per week. Unscheduled healthcare visits for asthma were equivalent averaging . vs. . episodes per child. While the study was modest in size it was powered to detect any clinically significant differences more so than past retrospective studies Phipatanakul notes. There was no difference that would cause me to be alarmed she says. The researchers note that earlier studies linking acetaminophen with increased asthma symptoms did not use a randomized design. Those studies therefore couldnt rule out the possibility that the asthma exacerbations were caused by the respiratory infections themselves. The toddler age is a wheezy age when kids are developing asthma but they also get a lot of fevers and colds says Phipatanakul. Without a randomized design its hard to tease out the effects of medications. Since the study was limited to young children with mild persistent asthma receiving asthma controller therapy the authors also note that their findings may not apply to other age groups or children with more severe asthma. Further studies will be necessary to answer those questions. William J. Sheehan MD of Boston Childrens Hospital was first author on the paper. The study was funded by The National Heart Lung and Blood Institutes Asthma Network AsthmaNet and grants from the National Institutes of Health HL HL HL HL HL HL HL HL HL HL TR TR TR TR KAI and KAI. About Boston Childrens Hospital Boston Childrens Hospital is home to the worlds largest research enterprise based at a pediatric medical center where its discoveries have benefited both children and adults since . More than scientists including seven members of the National Academy of Sciences members of the Institute of Medicine and members of the Howard Hughes Medical Institute comprise Boston Childrens research community. Founded as a bed hospital for children Boston Childrens today is a bed comprehensive center for pediatric and adolescent health care. Boston Childrens is also the primary pediatric teaching affiliate of Harvard Medical School. For more visit our Vector and Thriving blogs and follow us on our social media channels BostonChildrens http BCH_Innovation http_Innovation Facebook and YouTube."

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

"I admit it. I have a mummy tummy also known as mommy pooch. You know that soft jelly belly you retain after having a baby it makes you look a few months pregnant. Ive tried to convince myself that the pooch is a valiant badge of motherhood but who am I kidding The pooch bothers me. And it turns out it has been causing back pain. So when I hear that a fitness coach and doctor have come up with a technique that can flatten the pooch quickly and easily I think Why not A few weeks later Im rolling out a yoga mat with a dozen other moms and pregnant women in San Francisco. We will see a dramatic change says Leah Keller httpsleahkeller.com who leads the class. You can easily expect to see inches off your waist in three weeks of time Keller says. Thats not an unrealistic expectation. Article continues after this message from our sponsor We had patients that were even one year out from giving birth and they still had such great benefit from the exercises. Dr. Geeta Sharma OBGYN WeillCornell Medical Center Decked out in purple yoga pants and leather cowboy boots Keller is a personal trainer from New York City. She has developed an exercise that allegedly shrinks the mommy pooch. There is science to back up the method she says. A doctor at Weill Cornell and I did a study on the exact same program were going to do Keller says. And we found percent of women achieved full resolution. OK Wait a second. Two inches off my belly in three weeks That sounds too good to be true. I decide to do a little digging into the science of mummy tummy and Kellers claim. Putting the sixpack back together It turns out the jelly belly actually has a medical name diastasis recti httpsmedlineplus.govencyarticle.htm which refers to a separation of the abdominal muscles. And its quite common. Last year a study from Norway reported httpbjsm.bmj.comcontent about a third of moms end up with diastasis recti a year after giving birth. This is such a ubiquitous issue says Dr. Geeta Sharma httpsweillcornell.orggeetasharma an OBGYN at Weill Cornell Medical CenterNew York Presbyterian Hospital. And its not just a cosmetic problem. Diastasis recti can cause another problem for new moms lower back pain. People can start feeling some back pain because the core is weakened Sharma says. The Diastasis Recti During pregnancy the abdominal muscles responsible for a six pack stretch apart left to accommodate a growing fetus. After birth the muscles dont always bounce back leaving a gap known as the mommy pooch. Source Nick SousanisCourtesy of Sustainable Fitness Incorporated How To Test For Diastasis Recti Theres a simple way to see whether you have diastasis recti . Lie flat on your back with your knees bent. . Put your fingers right above your belly button and press down gently. . Then lift up your head about an inch while keeping your shoulders on the ground. . If you have diastasis recti you will feel a gap between the muscles that is wider than an inch. In rare occasions the tissue in the abdomen isnt just stretched but it is also torn a bit. This can cause a hernia Sharma says. If theres a defect in a layer of tissue called the linea alba then the bowel can poke through Sharma says. Thats going to be more dangerous. A hernia may require surgery. So I will refer patients to a general surgeon to have a CT scan if theres really a true concern about a hernia Sharma says. Diastasis recti arises during pregnancy because the growing fetus pushes the abdominal muscles apart specifically the rectus abdominal muscles. These are the muscles that give you a six pack says Dr. Linda Brubaker httpproviders.ucsd.edudetailslindabrubakerobstetrics__gynecologysan_diego an OBGYN at the University of California San Diego. People think these muscles go horizontal across the belly. But they actually go vertical from head to toe. The rectus abdominal muscles should be right next to each other on either side of the belly button Brubaker says. There shouldnt be much of gap between them. But during pregnancy a gap opens up between the muscles right around the belly button. Sometimes that gap closes on its own but other times it stays open. That leaves a spot in the belly where there is very little muscle to hold in your stomach and other organs a spot that can be to inches wide. That lets the organs and overlying tissue bulge out and cause mommy pooch. To flatten the area women have to get those abdominal muscles to realign. And that is where the exercises come into play. If you search online for ways to fix diastasis recti youll turn up a deluge of exercise routines all claiming to help coax the abdominal muscles back together. But the quality of much of that information isnt good Brubaker says. Some of it is actually potentially harmful. Even some exercises aimed at strengthening the abdomen can exacerbate diastasis recti says Keller including simple crunches. You have to be very careful she says. For example please dont ever again in your life do crossover crunches http or bicycle crunches http They splay your abs apart in so many ways. That said there are a few exercise programs for diastasis recti that many doctors and physical therapists support. These include the Tupler Technique httpsdiastasisrehab.com Kellers Dia Method httpthediamethod.com and the MuTu System httpsmutusystem.comwhattheexpertssay in the U.K. Most such courses taught once a week for an hour in New York San Francisco and at least a few other places tend to run about four to weeks and cost around to . Some places offer online classes and videos which are much less expensive. The American College of Obstetricians and Gynecologists also recommends abdominal exercises for the perinatal period. But the organizations guidelines dont provide details such as which exercises work best or how often women should do them and for how long. Plus ACOG focuses more on preventing diastasis than on fixing the problem it recommends strengthening the abdomen before and during pregnancy. . Talia Herman for NPR The best way is prevention says Dr. Raul Artal httpobgyn.slu.eduindex.phppageraulartalmd an OBGYN at St. Louis University who helped ACOG write its exercise guidelines for the perinatal period. The best way to do that is to exercise during pregnancy. But as Sharma the Cornell OBGYN points out no one has really vigorously studied these various exercises to see whether they actually fix diastasis recti. Theres a general knowledge that exercise is going to help Sharma says. But no one has really tested them in a standardized way. In fact the few studies that have been done havent been high enough quality to draw conclusions researchers in Australia said https a few years ago. Sharma hopes to change that. A few years ago she teamed up with Keller to start to gather some evidence on her technique. We did a pilot study to see if the method is helpful for women Sharma says. The study was small just women. But the results were quite promising. After weeks of doing Kellers exercise minutes a day all the women had fixed their diastasis recti Sharma and Keller reported httpjournals.lww.comgreenjournalAbstractPostnatal_Exercise_Can_Reverse_Diastasis_Recti..aspx at ACOGs annual meeting few years ago. We had patients that were even one year out from giving birth and they still had such great benefit from the exercises Sharma says. We love to see that there is something we can do to help women. Talia Herman for NPR Now Sharma says she is working to put together a larger study to really nail down when the exercise works and how well. Tight and tighter Back at the class in San Francisco Keller is taking us moms through the key exercise. Its surprisingly simple to do. The exercise is a very small very intense movement thats almost imperceptible Keller says. OK. Were going to do another set. Sitting on the floor crosslegged with our hands on our bellies we all take a big breath. Let the belly fully expand Keller says. And then as we exhale we suck in our belly muscles as far back as theyll go toward the spine. Now were going to stay here near the spine. Hold this position she says. Then we take tiny breaths. With each exhale we push our stomachs back further and further. Tight tighter Keller chants rhythmically. You can do the exercise in several different positions Keller says sitting crossedlegged sitting on your knees standing with knees slightly bent on all fours or laying on your side in the fetal position. The key is to be sure your back is flat and that you do the exercise minutes each day changing positions every two minutes or so. For the rest of the time your belly is pulled all the way back into the spine. The fingertips on the bellybutton are really important for this reason she says. So you know that youre squeezing tight tighter with the belly and youre never bulging the bellybutton forward. This is our fourth week of class and weve been doing this same exercise on our own every day for at least minutes. So its judgment day. Time to see whether weve flattened our bellies and resolved the diastasis recti. Keller pulls out a measuring tape and starts wrapping it around womens middles. She also has us lie down on the floor so she can measure the separation in our abdominal muscles. One by one there is success after success. Several moms completely closed up their abdominal separations. Many lost inches from their bellies. One woman had amazing results. Oh my goodness you lost nearly four inches from your belly circumference Keller exclaims. Thats amazing How did I fare Well after three weeks I didnt completely close up the abdominal separation. My separation decreased from . inches to . inches. But I did drop more than an inch from my belly circumference. And I am quite happy with the results. My abs are definitely firmer. And regularly doing this exercise brought a bonus benefit My lower back pain has almost completely gone away. I continued to do the exercises after the class had finished. I checked with in Keller three weeks later to have her measure my diastasis recti. At that point the separation had dropped down to . inches which meant technically I no longer have diastasis recti."

"Eating walnuts may reduce the risk for Type diabetes in women a large new study concludes. Previous studies have suggested an inverse relationship between tree nut consumption and diabetes. Though the findings are correlational walnuts are uniquely high in omega and omega fatty acids which may be of particular value in Type diabetes prevention. The scientists writing in the April issue of The Journal of Nutrition httpsjn.nutrition.orgcontent.full.pdfhtml used dietary and health data on women participating in a large continuing study of womens health. Beginning in they collected data on walnut consumption and followed the women for the next years. They found cases of Type diabetes. Women who ate walnuts tended to weigh less consume more fish and exercise more than those who did not. But researchers controlled for these and many other factors and found that compared with women who ate no walnuts those who consumed ounces of walnuts or more a month reduced their risk for Type diabetes by percent. Theres been a lot of research on nuts in general in relation to cardiovascular health said the senior author Dr. Frank B. Hu a professor of medicine at Harvard. This is the first on walnuts and diabetes. Walnuts may have some unique benefits. The study was supported with grants from the National Institutes of Health and the California Walnut Commission."

"It may be possible to assess a mans fertility by checking his anogenital distance the gap between his scrotum and anus a new study suggests. Previous studies in animals have shown that anogenital distance is an important measure of genital development and may be shorter in males with abnormal development and dysfunction of the testicles the Baylor College of Medicine researchers explained. Furthermore a study from the University of Rochester published in March in Environmental Health Perspectives found that men with shorter anogenital spans had lower sperm counts poorer quality sperm lower sperm concentrations and lower motility. In the new study the Baylor group investigated whether anogenital distance differed in fertile and infertile men. They measured the scrotumanus distance as well as the penis length of infertile and fertile men visiting an andrology clinic. The infertile men had a significantly shorter anogenital distance and penis length than the fertile men the study found. Dr. Michael Eisenberg a male reproductive medicine and surgery fellow in the Baylor urology department and the studys lead author said the study has two main implications. First this could represent a noninvasive way to test testicular function and reproductive potential in adult men he said in a Baylor news release. And second it suggests that gestational exposures and development may impact adult testicular function. Further research is needed to compare techniques for measuring anogenital distance and assess their accuracy he and his colleagues said. One expert whos done her own research in this area applauded the study. This is an important paper showing once again that anogenital distance is a strong predictor of semen quality said Shanna H. Swan vice chair for research in the department of preventive medicine at Mount Sinai Childrens Environmental Health Center New York City.This paper also provides new data on infertile men who have shorter less masculine anogenital distance. Swan said that she and her colleagues published similar findings last month. Together the two studies make a strong case that this simple measure the anogenital distance reflects early genital development and predicts semen quality and fertility she said. But one urologist said the the finding is too preliminary to introduce into clinical practice however. We would all like a simple noninvasive way to predict potential problems with fertility in men but unfortunately this one is not ready for prime time said Dr. Elizabeth Kavaler a urology specialist at Lenox Hill Hospital in New York City. We have a long way to go before we can use anogenital distance as a determinant of future fertility in men. The study was published online May in PLoS One. More information The American Academy of Family Physicians has more about male infertility httpfamilydoctor.orgonlinefamdocenhomemenreproductive.html. SOURCES Shanna H. Swan PhD vice chair for research department of preventive medicine Mount Sinai Childrens Environmental Health Center New York City Elizabeth Kavaler M.D. urology specialist Lenox Hill Hospital New York City Baylor College of Medicine news release May"

"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."

"Millions of Americans suffer from pet allergies that prevent them from enjoying the benefits of owning a dog or a cat http Thea Joyce is among them but couldnt bear the thought of having to give up her two cats Kirby and Lennon. It was really bad Joyce told FoxNews.com. I was just itchy all the time and sneezing all the time. I was really uncomfortable and miserable. Joyce tried overthecounter medications but couldnt find relief. She consulted an allergist at Weill Cornell MedicineNew YorkPresbyterian Hospital where a clinical trial involving immunotherapy toothpaste was taking place. The toothpaste called Allerdent works to keep breath fresh and fight cavities while also offering the same benefits as an allergy shot or drops. Researchers found that applying the extracts found in a shot to the lining of a patients mouth worked just as well to alleviate symptoms. The patients who came in were treated for the very things that they were sensitive to and that included indoor allergens like dustmite and pet dander as well as outdoor allergens such as tree pollen grass pollen ragweed pollen Dr. William Reisacher an associate professor of otolaryngology and director of allergy services at Weill Cornell MedicineNew YorkPresbyterian Hospital told FoxNews.com. Joyce who lives in the Bronx New York signed on for the yearlong study that required six of the volunteers to brush their teeth for two minutes using two pumps of the toothpaste in either the morning or night and the other six to use drops under their tongue. Volunteers using the toothpaste were also required to log their usage in a journal. Both groups reported a significant decrease in their symptoms including Joyce who was in the toothpaste group. Allerdent is not covered by insurance meaning Joyce spends about every three months but said the cost is worth it. I used to be so irritable because I was so uncomfortable Joyce said. But now I dont really feel allergy symptoms anymore. To find a prescribing doctor for Allerdent in your area or to find more information visit Allovate.com. httpallovate.com"

"Taking prenatal vitamins https may reduce the risk of having a child with autism https new research shows. It appears that women who reported taking prenatal vitamins starting three months prior to conception https and through the first month after conception https seem to have a reduced chance their child will develop autism https says study researcher Irva HertzPicciotto PhD professor of epidemiology and environmental health at the MIND Institute and Department of Public Health University of California Davis. Taking prenatal vitamins was found even more protective for mothers and children who had a highrisk genetic makeup https The study is published online in Epidemiology. The research needs to be duplicated HertzPicciotto tells WebMD. Still she says the finding points to a geneenvironment interaction that may possibly help explain some cases of autism. Autism spectrum disorders https marked by impaired language repetitive behaviors and social difficulties now affect up to one in children according to the CDC. Prenatal Vitamins and Autism Risk The researchers looked at three groups of children all aged to . All were enrolled in the CHARGE study CHildhood Autism Risks https from Genetics and Environment from to . The groups included children with autism with autism spectrum disorder children with typical development Mothers reported their use of prenatal vitamins or other supplements https before during and after pregnancy https The researchers collected blood https from all family members to evaluate their genetic makeup. They focused on genes known to play a role in folate metabolism https These genes include MTHFR and COMT as well as others. Folate and other B vitamins https are crucial to brain https development. Overall HertzPicciotto says For the women who didnt take prenatal vitamins there was about a higher risk of having a child with autism. The risk rose if the mothers or the children had a highrisk gene form. The mothers with the highrisk form of MTHFR had a . times higher chance of a child developing autism she says than mothers without this highrisk form who did take the prenatal vitamins. Children who had the highrisk COMT gene form were seven times as likely to have autism as children without it whose mothers did take the vitamins. Overall it does look like there are at least a couple of genes here either the mothers genotype or the childs genotype that show this interaction ... magnifying the size of the effect from not taking the vitamins HertzPicciotto says. Exactly why the prenatal vitamins may protect against autism is not clear she says. It may be that the vitamins contribute to high levels of folate. Genes Vitamins Play Roles Many other studies have shown the benefits of prenatal vitamins on preventing birth defects https says Alycia Halladay PhD director of research for environmental sciences for Autism Speaks an advocacy and research organization. However she says There hasnt been any published data about a prenatal vitamin and autism. She reviewed the study findings for WebMD but was not involved in the research. It adds to the body of evidence that prenatal vitamins are an important health habit for women of childbearing age she says. To me the big news of the study is they were able to document a geneenvironment interaction. They found an effect with vitamins alone Halladay says in protecting against autism. When they looked at the genetic makeup of those mothers and children the differences became even bigger. Women of childbearing age who may become pregnant or those planning pregnancy should ask their doctors advice about taking prenatal vitamins she says."

"An antibody treatment reduces the rate of flareups by nearly percent in patients with a subgroup of treatmentresistant chronic obstructive pulmonary disease COPD according to the results of two large international trials presented today at the European Respiratory Society International Congress in Milan Italy and simultaneously published in the New England Journal of Medicine. The goal of precision medicine is to give the right treatment to the right patient said lead author Frank Sciurba M.D. director of the Center for COPD and Emphysema and UPMC Pulmonary Function Exercise Physiology Laboratory and visiting professor in the Division of Pulmonary Allergy and Critical Care Medicine University of Pittsburgh School of Medicine. These findings are the first example of a precision therapy that is uniquely effective in a subgroup of patients with treatmentresistant COPD. COPD a progressive lung disease characterized by airway obstruction and chronic lung inflammation affects million Americans. There is significant variation between patients in the cells and other proteins responsible for lung inflammation so there are actually many different subtypes of COPD said Sciurba. One subgroup called eosinophilic predominant COPD is present in as many as percent of patients and is characterized by elevated levels of a type of white blood cell known as eosinophils he said. The new study reports the results from two Phase III clinical trials evaluating the efficacy of mepolizumab an antibody treatment that reduces the number of eosinophils in the blood in moderate to severe treatmentresistant eosinophilic COPD by blocking the proinflammatory effects of interleukin. Patients included in the trials were still having flareups despite a year of a standard treatment known as triple inhaled therapy that includes bronchodilators and glucocorticoids. These patients already have been given every treatment we have to offer them and are still having flareups that significantly interfere with their quality of life and can lead to deterioration in lung function and higher mortality said Sciurba. We hoped to be able to offer them an option. Mepolizumab is already approved by the Food and Drug Administration FDA to reduce symptom flareups and improve quality of life in eosinophilic asthma. The first trial termed METREX was conducted at sites in countries from to . A total of COPD patients were stratified by blood eosinophil counts and randomized to receive either milligrams of mepolizumab or placebo delivered under the skin every four weeks for one year. The patients with high eosinophil counts who received mepolizumab had a statistically significant percent lower rate of moderatesevere exacerbations . per year compared to . per year than those in the placebo group. The exacerbation rate in the low eosinophil group treated with the biologic did not differ from placebo. The time to the first exacerbation also was higher with mepolizumab than placebo but only in the high eosinophil group. In a second simultaneous trial termed METREO the team assessed the effect of a higher dose of mepolizumab in patients with elevated eosinophil levels. Patients were randomized to receive or milligrams of mepolizumab or placebo with the same delivery method and schedule as METREX. Similar to METREX the exacerbation rate was reduced by percent in the high eosinophil group after milligrams of mepolizumab. The METREO results narrowly missed statistical significance. The milligram dose did not provide an advantage over the lower dose. An analysis of data from both trials found that as baseline blood eosinophil counts increased so did mepolizumabs reduction in the annual exacerbation rate. This finding indicates that patients with higher initial eosinophil counts benefited more from mepolizumab than those with lower eosinophil counts Sciurba said. The safety profile of mepolizumab did not differ from placebo in either trial. In addition to providing a new treatment option for patients with treatmentresistant moderate to severe COPD the new results also are important because they identify a potential biomarker for the disease and demonstrate that eosinophilic inflammation plays a role in flareups in COPD Sciurba said. Pitts Division of Pulmonology Allergy and Critical Care Medicine has a legacy of pioneering treatments for lung disease. UPMC also is home to a leading lung transplant program. The findings in these trials exemplify what we hope to achieve not only in COPD but across all lung diseases with regards to a precision approach to treatment said division chief Rama Mallampalli M.D. Funding for both trials was provided by GlaxoSmithKline which plans to seek approval from the FDA for the use of mepolizumab in eosinophilic COPD. Additional authors on the study are Ian Pavord F.Med.Sci. D.M. University of Oxford UK Pascal Chanez M.D. Ph.D. CIC Nord AixMarseille University France Gerard Criner M.D. Temple University Huib Kerstjens M.D. Ph.D. University of Groningen the Netherlands Stephanie Korn M.D. Ph.D. Mainz University Hospital Germany Njira Lugogo M.D. Duke University JeanBenoit Martinot M.D. CHU UCL Namur Belgium Hironori Sagara M.D. Ph.D. Showa University Japan and Frank Albers M.D. Ph.D. Eric Bradford M.D. Stephanie Schweiker Harris B.Sc. Bhabita Mayer M.Sc. David Rubin M.D. and Steven Yancey M.Sc. all of GlaxoSmithKline. Patients wishing to learn more about the research being performed at the Center for COPD and Emphysema can call or email ecrcupmc.edu mailtoecrcupmc.edu. About the University of Pittsburgh School of Medicine As one of the nations leading academic centers for biomedical research the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates Pitt has ranked among the top recipients of funding from the National Institutes of Health since . In rankings recently released by the National Science Foundation Pitt ranked fifth among all American universities in total federal science and engineering research and development support. Likewise the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs for which it is recognized as an innovative leader and to training highly skilled compassionate clinicians and creative scientists wellequipped to engage in worldclass research. The School of Medicine is the academic partner of UPMC which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the regions economy. For more information about the School of Medicine see http http"