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"One day MRI brain scans may help predict whether older people will develop dementia new research suggests. In a small study MRI brain scans predicted with percent accuracy who would go on to develop dementia within three years according to research at Washington University School of Medicine in St. Louis and the University of California San Francisco. The findings presented Sunday Nov. at the Radiological Society of North America meeting in Chicago suggest that doctors may one day be able to use widely available tests to tell people their risk of developing dementia before symptoms arise. Right now its hard to say whether an older person with normal cognition or mild cognitive impairment is likely to develop dementia said lead author Cyrus A. Raji MD PhD an assistant professor of radiology at Washington Universitys Mallinckrodt Institute of Radiology. We showed that a single MRI scan can predict dementia on average . years before memory loss is clinically detectable which could help doctors advise and care for their patients. Alzheimers disease is a progressive irreversible brain disorder that destroys memory and thinking skills. The disease affects . million Americans according to the National Institutes of Health NIH. Neurologists can get a ballpark estimate of a patients risk of Alzheimers dementia using the MiniMental State Examination questionnaire or by testing for the highrisk form of the gene ApoE which increases a persons risk of Alzheimers by up to fold. Both tests were about to percent accurate in this study. Other assessments such as PET scans for plaques of Alzheimers proteins in the brain are good at detecting early signs of Alzheimers disease but available to few patients. PET scans cost thousands of dollars and require radioactive materials not found in a typical hospital. MRI brain scans are widely available and give doctors a glimpse into whats going on inside a persons brain. Raji and colleagues at the School of Medicine including Tammie Benzinger MD PhD a professor of radiology Parinaz Massoumzadeh PhD and Adedamola Adedokun as well as radiologist Pratik Mukherjee MD PhD of the University of California San Francisco analyzed MRI scans for physical signs of impending cognitive decline. They used a technique called diffusion tensor imaging to assess the health of the brains white matter which encompasses the cables that enable different parts of the brain to talk to one another. Diffusion tensor imaging is a way of measuring the movement of water molecules along white matter tracts Raji said. If water molecules are not moving normally it suggests underlying damage to white tracts that can underlie problems with cognition. Using information from the Alzheimers Disease Neuroimaging Initiative a multisite collaboration that pools data funding and expertise to improve clinical trials for Alzheimers disease Raji and colleagues identified people whose cognitive skills declined over a twoyear period and matched them by age and sex with people whose thinking skills held steady. The average age of people in both groups was . Then the researchers analyzed diffusion tensor MRI scans taken just before the twoyear period for all people. The researchers found that people who went on to experience cognitive decline had significantly more signs of damage to their white matter. The researchers repeated their analysis in a separate sample of people using a more refined measure of white matter integrity. With this new analysis they were able to predict cognitive decline with percent accuracy when looking at the whole brain. When the researchers focused on specific parts of the brain most likely to show damage the accuracy rose to percent. We could tell that the individuals who went on to develop dementia have these differences on diffusion MRI compared with scans of cognitively normal people whose memory and thinking skills remained intact Raji said. What we need now before we can bring it into the clinic is to get more control subjects and develop computerized tools that can more reliably compare individual patients scans to a baseline normal standard. With that doctors might soon be able to tell people whether they are likely to have Alzheimers develop in the next few years. Although there are no drugs available yet to prevent or delay the onset of Alzheimers disease identifying those at high risk of developing dementia within the next few years could still be beneficial the researchers said. People could make decisions on their financial and living arrangements while they are still in full control of their faculties."

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

"Antidepressant drugs really do work a major new international study has proven. Pooling data from trials including nearly patients researchers found all drugs analysed were more effective than placebos in the treatment of adults with acute depression. Authors of the studypublished yesterday in the Lancet http many more people could benefit from antidepressant medication. The study results represent the most comprehensive evidence currently available they wrote. In the international study published in the Lancet authors found that fluoxetinecommonly sold under then trade name Prozacwas one of the least effective antidepressants. Stephen CherninGetty Images More than million people worldwide have depression according to the World Health Organization http of which less than half recieve effective treatments. In many countries the rate drops to less than percent. In the U.S. the National Institute of Mental Health estimates https . million adults experienced at least one major depressive episode in . Approximately percent of these people received no treatment. In the U.K where a number of the study authors are based at least one million more people could benefit from drugs or psychotherapy senior author John Geddes said. Some drugs more effective than others The researchers analyzed existing studies of different drugs and found some were much more effective than others. Drugs ranged from more than one third more effective than a placebo to more than twice as effective. The best performers included amitriptyline and escitalopram while the worst included fluoxetinecommonly sold under the trade name Prozacand reboxetine which is not approved for sale in the U.S. A complex treatment picture The results add up to a complex treatment picture for what authors called one of the most common burdensome and costly psychiatric disorders worldwide in adults. Antidepressants do not improve symptoms in about percent of people study author Andrea Cipriani of Oxford University told a press briefing. While these results should reassure many people with depression that antidepressants can be effective this does not necessarily mean antidepressants should always be the first line of treatment he said. Talking therapies are thought to be about as effective as antidepressant medication but these are often much more expensive. Experts not involved in the research agreed the results were significant. Helen StokesLampard chair of the U.K.s Royal College of GPs expressed concern about the stigma surrounding antidepressant use. She said in a statement http Taking antidepressants is frequently portrayed as a negative thing or something done only when other therapies are not available or have failed but this in itself can add to the unfortunate stigma that sometimes exists around people with mental health conditions. But she also urged caution. Although antidepressants are of proven benefitas this study shows she said no doctor wants their patients to become reliant on medication. Putting a longheld controversy to bed Carmine Pariante a professor at the UKs Institute of Psychiatry Psychology and Neuroscience and spokesperson for the Royal College of Psychiatrists said the study finally puts to bed the controversy on antidepressants. James Warner an Imperial College London psychiatrist added Depression causes misery to countless thousands every year and this study adds to the existing evidence that effective treatments are available."

"Could root canal procedures go by the wayside in the nottoodistant future Scientists from the University of Nottingham and Harvard Universitys Wyss Institute hope so. Theyre developing a new treatment strategy that could someday help heal a damaged tooth using the patients own stem cells. Though the work is still in its early stages and has not yet been tested in people the scientists won an award from the Royal Society of Chemistry for their idea regenerative dental fillings. When dental pulp disease and injury happen a root canal is typically performed to remove the infected tissues explained Dr. Adam Celiz Marie Curie Research Fellow at the University of Nottingham. Instead of the current dental materials used on fillings https which are toxic to cells the new approach harnesses stem cells instead. What we found is a material that can potentially regenerate https components of a patients tooth https Celiz told CBS News. Were trying to provide an alternative material an alternative therapy he said because the current method involves the dentist removing all of the infected pulp tissue scraping it out and it can be very painful. The process works by stimulating native stem cells https_VAoHhAWCAUwAAclientinternaludscseusgAFQjCNEiGAgFaDFoMiYoDfdPQpYzwA inside teeth triggering repair and regeneration of pulp tissues. We hope to eventually encourage dentin regeneration. Dentin is the protective layer that sits on top of the pulp tissue. Its a barrier between enamel and the soft tissue that contains all the blood vessels and cells Celiz explained. CBS News chief medical correspondent Dr. Jon LaPook put it in simple terms The cells in the area of a root canal in the pulp those are normally asleep. Its like this material goes over and just taps it on the shoulder and says Wake up wake up and then it starts to repair itself. The stem cell procedure is in the earliest stages of development said Celiz. We have tested it in cell cultures and were moving it along into rodents he said. Its hard to put timeline on it but were talking years before we test it in humans. Were hoping this approach can bring regenerative medicine into the dentistry field said Celiz. If successful a treatment like this could someday offer significant benefits for millions of dental patients https each year."

"The controversial drug Avastin should be phased out as a treatment for metastatic breast cancer the Food and Drug Administration said Thursday citing recent studies that show its benefits may be outweighed by dangerous side effects. However patients currently taking Avastin as part of their chemotherapy regimen will not immediately be affected and doctors should use their medical judgment on whether to continue its use said Dr. Janet Woodcock of the FDAs Center for Drug Evaluation and Research. The announcement does not affect Avastins status as an approved therapy for lung cancer kidney cancer colorectal cancer and brain cancer. Reflecting splits in the medical community the European Medicines Agency said Thursday that Avastin would remain an approved therapy for breast cancer in European Union countries although only in one particular combination with the drug paclitaxel. Avastin first approved as a cancer treatment in helps by inhibiting a tumors blood supply. In the FDA granted Avastin whats known as accelerated approval of its use as a therapy for metastatic breast cancer cancer that has spread from one part of the body to another. The move was based on data in one preliminary study known as E. At that time researchers reported that Avastin when used in combination with other drugs extended the time that patients went without their illness getting worse a measure known as progressionfree survival or PFS. Along with the initial approval the FDA required Genentech Avastins maker to complete larger studies. The results of those studies were a bitter pill for patients thriving on Avastin and researchers excited by the promise of the early data. The E study found that for women taking Avastin plus paclitaxel the cancer stopped spreading for an average of fiveandahalf months more compared to those just taking standard chemotherapy. In the subsequent three larger studies the benefit was much smaller ranging from just days to about two months. None of the studies including the E study showed that patients getting Avastin lived longer than patients on standard chemotherapies. We now have four studies that show no survival benefit Woodcock said. Along with those disappointing findings serious side effects became apparent in patients taking Avastin including high blood pressure internal bleeding perforated internal organs heart failure and heart attacks and in some cases even swelling of the brain. Based on the new data an FDA advisory panel voted to reverse the accelerated approval in July. Thursdays announcement is only a first step in removing the FDAs approval for this drug in treating breast cancer patients. As part of the complex process Genentech has a right to appeal and company spokeswoman Charlotte Arnold said it would request a hearing to press its case. Physicians who favor Avastins use say the FDA is being overly cautious and that the drug can be used safely if patients are closely monitored. This is a very sad and confusing day for our patients said Dr. Joseph Sparano of MontefioreEinstein Center for Cancer Care in New York. Survival was consistently better at one year in all of the studies indicating that this is a safe and effective option. What makes this even more frustrating is that the drug will still be available to prescribe but will only be an option for those who can afford it rather than those who really need it. Avastins cost which can run to several thousand dollars a month has sometimes been used as an example by critics of the health care system who fear that costcutting may win out over patient care. After the advisory committees decision in July Sen. David Vitter RLouisiana wrote a letter to the FDA complaining that the FDA advisory committees concerns appear to have been based on costeffectiveness and adding that a reversal on accelerated approval would amount to costrationing. The FDA says it does not consider cost when evaluating the safety or effectiveness of a drug. Dr. Len Lichtenfeld deputy chief medical officer of the American Cancer Society said its clear that some women with metastatic breast cancer have benefited from Avastin but others not only have not benefited theyve been harmed. What we clearly need is a way for doctors to more accurately predict which women will have a better chance of benefitting from this important targeted therapy he said in a statement on the American Cancer Society website. Thursday Woodcock held out the possibility that Avastin might eventually prove helpful in a targeted group of patients. We certainly hope that additional data could be generated to see if there is a subset of tumors that would respond more than others she said. The FDA stands ready to work with Genentech on future studies. Such research is already underway Arnold said but its too early to discuss the findings. This is something Genentech is very committed to. Our scientists are dedicated to learning more about who might derive a greater benefit from Avastin she explained."

"An injection of stem cells into the eye may soon slow or reverse the effects of earlystage agerelated macular degeneration according to new research from scientists at CedarsSinai http Currently there is no treatment that slows the progression of the disease which is the leading cause of vision loss in people over . This is the first study to show preservation of vision after a single injection of adultderived human cells into a rat model with agerelated macular degeneration said Shaomei Wang MD PhD http lead author of the study published in the journal STEM CELLS and a research scientist in the Eye Program http at the CedarsSinai Board of Governors Regenerative Medicine Institute. http The stem cell injection resulted in days of preserved vision in laboratory rats which roughly equates to years in humans. Agerelated macular degeneration affects upward of million Americans. It occurs when the small central portion of the retina known as the macula deteriorates. The retina is the lightsensing nerve tissue at the back of the eye. Macular degeneration may also be caused by environmental factors aging and a genetic predisposition. When animal models with macular degeneration were injected with induced neural progenitor stem cells which derive from the more commonly known induced pluripotent stem cells healthy cells began to migrate around the retina and formed a protective layer. This protective layer prevented ongoing degeneration of the vital retinal cells responsible for vision. CedarsSinai researchers in the Induced Pluripotent Stem Cell iPSC Core http directed by Dhruv Sareen PhD http with support from the David and Janet Polak Foundation Stem Cell Core Laboratory first converted adult human skin cells into powerful induced pluripotent stem cells iPSC which can be expanded indefinitely and then made into any cell of the human body. In this study these induced pluripotent stem cells were then directed toward a neural progenitor cell fate known as induced neural progenitor stem cells or iNPCs. These induced neural progenitor stem cells are a novel source of adultderived cells which should have powerful effects on slowing down vision loss associated with macular degeneration said Clive Svendsen PhD http director of the Board of Governors Regenerative Medicine Institute and contributing author to the study. Though additional preclinical data is needed our institute is close to a time when we can offer adult stem cells as a promising source for personalized therapies for this and other human diseases. Next steps include testing the efficacy and safety of the stem cell injection in preclinical animal studies to provide information for applying for an investigational new drug. From there clinical trials will be designed to test potential benefit in patients with laterstage agerelated macular degeneration. Additional CedarsSinai authors include Dhruv Sareen PhD Yuchun Tsai PhD Bin Lu MD PhD Benjamin Bakondi PhD Sergey Girman PhD and Anais Sahabian PhD. This work was supported by the Simon and Beathrice Apple Stem Cell Fund for Eye Research the David and Janet Polak Foundation Stem Cell Core Laboratory National Institutes of Health R EY Department of Defense WXWH Foundation Fighting Blindness and the Knights Templar Eye Foundation Inc. Citation STEM CELLS. April Human iPSCderived neural progenitors preserve vision in an AMDlike model."

"COLUMBUS Ohio Antiinflammatory diets which tend to be high in vegetables fruits fish and whole grains could boost bone health and prevent fractures in some women a new study suggests. Researchers examined data from the landmark Womens Health Initiative to compare levels of inflammatory elements in the diet to bone mineral density and fractures and found new associations between food and bone health. The study led by Tonya Orchard an assistant professor of human nutrition at The Ohio State University appears in the Journal of Bone and Mineral Research. Women with the leastinflammatory diets based on a scoring system called the Dietary Inflammatory Index lost less bone density during the sixyear followup period than their peers with the mostinflammatory diets. This was despite the fact that they started off with lower bone density overall. Furthermore diets with low inflammatory potential appeared to correspond to lower risk of hip fracture among one subgroup of the study postmenopausal white women younger than . The findings suggest that womens bone health could benefit when they choose a diet higher in beneficial fats plants and whole grains said Orchard who is part of Ohio States Food Innovation Center. This suggests that as women age healthy diets are impacting their bones Orchard said. I think this gives us yet another reason to support the recommendations for a healthy diet in the Dietary Guidelines for Americans. Because the study was observational its not possible to definitively link dietary patterns and bone health and fracture outcomes. Rebecca Jackson the studys senior author and director of Ohio States Center for Clinical and Translational Science said the new findings support a growing body of evidence that factors that increase inflammation can increase osteoporosis risk. By looking at the full diet rather than individual nutrients these data provide a foundation for studying how components of the diet might interact to provide benefit and better inform womens health and lifestyle choices said Jackson who is national chair of the Womens Health Initiative steering committee. Previous studies have connected high levels of inflammatory markers in the blood to bone loss and to fractures in older women and men which prompted Orchard and her colleagues to wonder what theyd find if they took one more step back to the dietary choices that contribute to inflammation in the body. The Dietary Inflammatory Index developed to assess the quality of diet from maximally to minimally inflammatory based on nutrients consumed helped them accomplish that. Dietary information as well as data on bone density and fracture were collected from a large group of the participants in the Womens Health Initiative the largest study of postmenopausal womens health undertaken in U.S. history. Participants in the WHI were to when they enrolled in the study of prevention and control of common diseases impacting older women. Enrollment ran from to . For the new analysis the first of its kind the research team looked at dietary data from women and assigned inflammation scores based on food components that the women reported consuming in the three months prior to their enrollment. The researchers used bonemineraldensity data from a subset of women. Fracture data was collected for the entire study group. Orchard and her colleagues found a correlation only between highinflammatory diets and fracture in younger white women in the study. Higher scores were associated with an almost percent larger risk of hip fracture in Caucasian women younger than compared with the risk for women in the group with the lowest inflammatory scores. This suggests that a highquality lessinflammatory diet may be especially important in reducing hip fracture risk in younger women the researchers wrote. But in the study group overall moreinflammatory diets were not linked to fracture and in fact the researchers found a modestly lower risk of lowerarm and total fracture in women with the highest dietary inflammation scores. One possible explanation included in the study The women with lower inflammation scores were more physically active as a group and therefore were at a slightly greater risk of falls. Women with the leastinflammatory diets had lower bone mineral density overall at the start of the study but lost less bone than their highinflammation peers the researchers found. The lower bone density to start could be because women with healthier diets are more likely to be of a smaller build Orchard said. Larger people have higher bone density to support their larger frames. These women with healthier diets didnt lose bone as quickly as those with highinflammation diets and this is important because after menopause women see a drastic loss in bone density that contributes to fractures Orchard said. Vedat Yildiz of Ohio States Center for Biostatistics also worked on the study which was supported by the National Heart Lung and Blood Institute and the U.S. Department of Health and Human Services. CONTACT Tonya Orchard Orchard.osu.edu mailtoOrchard.osu.edu"

"Overweight people who used a new motivational intervention called Functional Imagery Training FIT lost an average of five times more weight than those using talking therapy alone shows new research published today by the University of Plymouth and Queensland University. In addition users of FIT lost .cm more around their waist circumference in six months and continued to lose weight after the intervention had finished. Led by Dr Linda Solbrig from the School of Psychology the research involved participants who were allocated either to FIT or Motivational Interviewing MI a technique that sees a counsellor support someone to develop highlight and verbalise their need or motivation for change and their reasons for wanting to change. FIT goes one step further than MI as it makes use of multisensory imagery to explore these changes by teaching clients how to elicit and practice motivational imagery themselves. Everyday behaviours and optional app support are used to cue imagery practice until it becomes a cognitive habit. Maximum contact time was four hours of individual consultation and neither group received any additional dietary advice or information. Dr Solbrig who completed the work as part of a PhD funded by The National Institute for Health Research NIHR Collaboration for Leadership in Applied Health Research and Care CLAHRC South West Peninsula said Its fantastic that people lost significantly more weight on this intervention as unlike most studies it provided no dietphysical activity advice or education. People were completely free in their choices and supported in what they wanted to do not what a regimen prescribed. The study showed how after six months people who used the FIT intervention lost an average of .kg compared with an average of .kg among the MI group. After months six months after the intervention had finished the FIT group continued to lose weight with an average of .kg lost compared with .kg in the MI group. Dr Solbrig continued Most people agree that in order to lose weight you need to eat less and exercise more but in many cases people simply arent motivated enough to heed this advice however much they might agree with it. So FIT comes in with the key aim of encouraging someone to come up with their own imagery of what change might look and feel like to them how it might be achieved and kept up even when challenges arise. We started with taking people through an exercise about a lemon. We asked them to imagine seeing it touching it juicing it drinking the juice and juice accidently squirting in their eye to emphasise how emotional and tight to our physical sensations imagery is. From there we are able to encourage them to fully imagine and embrace their own goals. Not just imagine how good it would be to lose weight but for example what would losing weight enable you to do that you cant do now What would that look sound smell like and encourage them to use all of their senses. As well as being delighted by the success of the study in the short term there are very few studies that document weight loss past the end of treatment so to see that people continued to lose weight despite not having any support shows the sustainability and effectiveness of this intervention. Trisha Bradbury was one of the participants allocated to the FIT study and she explains I lost my mum at and being myself with a variety of health problems my motivation was to be there for my daughter. I kept thinking about wearing the dress Id bought for my daughters graduation and on days I really didnt feel like exercising kept picturing how Id feel. Ive gone from stone to stone and have managed to lower the dosage I need for my blood pressure tablets. Id still like to lose a touch more but Im so delighted with the mindset shift. Professor Jackie Andrade Professor in Psychology at the University of Plymouth is one of the cocreators of FIT and she explains FIT is based on two decades of research showing that mental imagery is more strongly emotionally charged than other types of thought. It uses imagery to strengthen peoples motivation and confidence to achieve their goals and teaches people how to do this for themselves so they can stay motivated even when faced with challenges. We were very excited to see that our intervention achieved exactly what we had hoped for and that it helped our participants achieve their goals and most importantly to maintain them. The full study entitled Functional Imagery Training versus Motivational Interviewing for Weight Loss A randomised controlled trial of brief individual interventions for overweight and obesity is available to view in the International Journal of Obesity doi .s."

"Cancer patients undergoing chemotherapy may be able to avoid the accompanying muscle loss and malnutrition by taking fish oil supplements that contain omega fatty acids new research suggests. The finding is based on a small study involving just lung cancer patients. Nevertheless it raises hope that a simple noninvasive intervention might go a long way towards countering the fatigue poorer prognosis and impaired quality of life that can result from chemoinduced muscle mass loss. Fish oil may prevent loss of weight and muscle by interfering with some of the pathways that are altered in advanced cancer study author Dr. Vera Mazurak of the University of Alberta in Edmonton Canada said in a news release. This holds great promise because currently there is no effective treatment for cancerrelated malnutrition. Mazurak and her colleagues report their observations in the Feb. online edition of Cancer. To explore the therapeutic potential of fish oil supplements the authors offered cancer patients undergoing an initial week chemotherapy regimen a daily dose of . grams of a particular omega fatty acid called eicosapentaenoic EPA. While these patients took fish oil supplements throughout their chemotherapy treatment a second group of patients underwent the same regimen minus the fish oil. The results continual muscle and fat measurements revealed that the group that took no fish oil supplementation lost an average of just over pounds the supplement group lost no weight. Whats more blood analyses revealed that those in the fish oil group who had the biggest bump in bloodstream EPA concentrations also had the greatest muscle mass gains. Specifically nearly percent of those in the fish oil group either kept their prechemo muscle mass or gained muscle. By comparison less than percent in the nonsupplement group kept their original muscle mass. Total fat tissue measurements were unaffected by fish oil supplementation the team noted and no side effects were observed. The authors concluded that fish oil supplementation appears to be a safe and effective way to prevent malnutrition among cancer patients and may ultimately prove to be of benefit for other groups of people such as elderly patients who also face a significant ongoing risk for muscle loss. Lona Sandon a registered dietitian and assistant professor of clinical nutrition at the University of Texas Southwestern Dallas reacted with cautious optimism to the findings. Malnutrition is a big concern with cancer patients undergoing chemotherapy and radiation she noted. Because first of all they do have wasting from the cancer itself which is very metabolically active and eats up your energy stores. And then with chemotherapy there is some inflammation thats detrimental to the heart and muscle as it can cause muscle breakdown. And preservation of lean muscle tissue we know leads to better outcomes. So certainly this does seem to be promising Sandon said. And other similar studies have looked at omega and muscle preservation and have also suggested that fish oil can act to prevent inflammation caused by both disease and hardcore medications like chemotherapy agents. But I would caution that the amount of pure concentrated fish oil supplement the people in this study were given is a lot she added. Much much more than any recommended dietary allowance along the lines of two to three servings of fish per week. But she said I would say this is certainly worthy of continuing research and exploration. But meanwhile people should definitely not go out and start consuming huge amounts of fish oil. More information For more on chemotherapy visit the American Cancer Society http SOURCE Cancer Feb. news release Lona Sandon dietitian and assistant professor clinical nutrition University of Texas Southwestern Dallas"

"The gene responsible for cystic fibrosis httpshealth.nytimes.comhealthguidesdiseasecysticfibrosisoverview.htmlinlinenytclassifier was discovered in . Now years later a drug that tries to compensate for the genetic defect might be nearing the market. Vertex Pharmaceuticals https announced Wednesday morning that the drug VX https improved lung function in people with cystic fibrosis in a latestage clinical trial. The drug also reduced the frequency of disease exacerbations that required treatment with antibiotics httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsantibioticsindex.htmlinlinenytclassifier. The caveat is that VX is designed to counter one specific genetic mutation that accounts for about percent of cases of cystic fibrosis. Vertex is working on another drug for the most common mutation but that one is further behind in development. Still the news is expected to be greeted favorably by doctors and patients and by Wall Street. Ive been doing clinical trials for years in C.F. and these are amazing results Dr. Bonnie W. Ramsey https_Bonnie.html a lead investigator in the trial said in an interview. Dr. Ramsey a professor of pediatrics httpstopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicspediatricsindex.htmlinlinenytclassifier at the University of Washington httpstopics.nytimes.comtopreferencetimestopicsorganizationsuuniversity_of_washingtonindex.htmlinlinenytorg was briefed on the results by Vertex. The results were announced by a press release httpsinvestors.vrtx.comreleasedetail.cfmReleaseID and have not been peer reviewed by experts. About Americans and people worldwide have cystic fibrosis a disease caused by defects in a gene responsible for the transport of chloride ions across cell membranes. People with the disease tend to have very thick mucus in their lungs which leads to infections and lung damage. Many do not live past age . Two inhaled antibiotics and one drug that loosens mucus are approved to treat cystic fibrosis but nothing that directly improves chloride ion transport. In the trial those who received VX gained . percentage points more on a lung function test after weeks than those getting a placebo a difference that statistically was highly significant. Patients continued to take either drug or placebo for another weeks and the improvement was sustained. Lung function the primary endpoint of the trial was measured by how much a person could exhale in one second a standard test. Investors had been expecting around a percentage point improvement. In a note to clients Tuesday evening before the results were known an analyst at ISI Group Mark Schoenebaum https said that an improvement of percent would be a home run that could lead to million in annual sales for the drug. Dr. Ramsey who has received research grants from Vertex said that some patients could perceive a percentage point change in lung function. She said other results of the trial were encouraging. These included fewer exacerbations of the disease in those who got the drug fewer selfreported respiratory symptoms and a gain in weight which is good for people with cystic fibrosis who often have digestive problems. The saltiness of their sweat a measure used to diagnose the disease was markedly reduced suggesting that the drug was having an effect on chloride ion transport. The trial involved people age and older all with at least one copy of the particular mutation known as GD. The main side effects Vertex said were headache httpshealth.nytimes.comhealthguidessymptomsheadacheoverview.htmlinlinenytclassifier upper respiratory tract infections nasal congestion httpshealth.nytimes.comhealthguidessymptomsnasalcongestionoverview.htmlinlinenytclassifier rash and dizziness httpshealth.nytimes.comhealthguidessymptomsdizzinessoverview.htmlinlinenytclassifier. Vertex said it hoped to apply in the second half of the year for approval of VX in the United States and Europe. The company is awaiting results of a second trial of the drug this one in younger children. Vertex has not said how much it will charge for VX. But since there are only about Americans who are candidates for the drug the price is likely to be tens of thousands of dollars a year. Vertex based in Cambridge Mass. was founded in coincidentally the same year the cystic fibrosis gene was discovered. It has not yet had a big commercial success and had a . billion net loss in the last five years. The company is hoping that by late May it will win approval to sell a new type of drug for hepatitis C httpshealth.nytimes.comhealthguidesdiseasehepatitiscoverview.htmlinlinenytclassifier which analysts expect will be a blockbuster. The long time needed to develop a drug for cystic fibrosis is a lesson for those expecting a quick payout from the sequencing of the human genome which was completed a decade ago. It is not enough to know the gene behind a disease. It can take years of research to determine how a mutation actually causes a disease and then to design a drug that corrects the problem. Vertex received million in financial support from the Cystic Fibrosis Foundation one of the first nonprofit disease groups to give money to companies. These results are highly encouraging Robert J. Beall president of the foundation said in a statement Wednesday. They provide scientific evidence that support our longstanding belief that targeting the underlying defect of C.F. may have a profound effect on the disease."

"Reversing memory deficits and impairments in spatial learning is a major goal in the field of dementia research. A lack of knowledge about cellular pathways critical to the development of dementia however has stood in the way of significant clinical advance. But now researchers at the Lewis Katz School of Medicine at Temple University LKSOM are breaking through that barrier. They show for the first time in an animal model that tau pathology the secondmost important lesion in the brain in patients with Alzheimers disease can be reversed by a drug. We show that we can intervene after disease is established and pharmacologically rescue mice that have tauinduced memory deficits explained senior investigator Domenico Pratic MD Scott Richards North Star Foundation Chair for Alzheimers Research Professor in the Departments of Pharmacology and Microbiology and Director of the Alzheimers Center at Temple at LKSOM. The study published online in the journal Molecular Neurobiology raises new hope for human patients affected by dementia. The researchers landed on their breakthrough after discovering that inflammatory molecules known as leukotrienes are deregulated in Alzheimers disease and related dementias. In experiments in animals they found that the leukotriene pathway plays an especially important role in the later stages of disease. At the onset of dementia leukotrienes attempt to protect nerve cells but over the long term they cause damage Dr. Pratic said. Having discovered this we wanted to know whether blocking leukotrienes could reverse the damage whether we could do something to fix memory and learning impairments in mice having already abundant tau pathology. To recapitulate the clinical situation of dementia in humans in which patients are already symptomatic by the time they are diagnosed Dr. Pratic and colleagues used specially engineered tau transgenic mice which develop tau pathology characterized by neurofibrillary tangles disrupted synapses the junctions between neurons that allow them to communicate with one another and declines in memory and learning ability as they age. When the animals were months old the equivalent of age in humans they were treated with zileuton a drug that inhibits leukotriene formation by blocking the lipoxygenase enzyme. After weeks of treatment animals were administered maze tests to assess their working memory and their spatial learning memory. Compared with untreated animals tau mice that had received zileuton performed significantly better on the tests. Their superior performance suggested a successful reversal of memory deficiency. To determine why this happened the researchers first analyzed leukotriene levels. They found that treated tau mice experienced a percent reduction in leukotrienes compared with untreated mice. In addition levels of phosphorylated and insoluble tau the form of the protein that is known to directly damage synapses were percent lower in treated animals. Microscopic examination revealed vast differences in synaptic integrity between the groups of mice. Whereas untreated animals had severe synaptic deterioration the synapses of treated tau animals were indistinguishable from those of ordinary mice without the disease. Inflammation was completely gone from tau mice treated with the drug Dr. Pratic said. The therapy shut down inflammatory processes in the brain allowing the tau damage to be reversed. The study is especially exciting because zileuton is already approved by the Food and Drug Administration for the treatment of asthma. Leukotrienes are in the lungs and the brain but we now know that in addition to their functional role in asthma they also have a functional role in dementia Dr. Pratic explained. This is an old drug for a new disease he added. The research could soon be translated to the clinic to human patients with Alzheimers disease. Other researchers contributing to the study include Phillip F. Giannopoulos and Jian Chiu at the Alzheimers Center at Temple LKSOM. The research was funded in part by grants from The Wanda Simone Endowment for Neuroscience and the Scott Richards North Star Charitable Foundation. About Temple Health Temple University Health System TUHS is a . billion academic health system dedicated to providing access to quality patient care and supporting excellence in medical education and research. The Health System consists of Temple University Hospital TUH ranked among the Best Hospitals in the region by U.S. News World Report TUHEpiscopal Campus TUHNortheastern Campus Fox Chase Cancer Center an NCIdesignated comprehensive cancer center Jeanes Hospital a communitybased hospital offering medical surgical and emergency services Temple Transport Team a ground and airambulance company and Temple Physicians Inc. a network of communitybased specialty and primarycare physician practices. TUHS is affiliated with the Lewis Katz School of Medicine at Temple University and Temple University Physicians which is Temple Healths physician practice plan comprised of more than fulltime and parttime academic physicians in clinical departments. The Lewis Katz School of Medicine LKSOM established in is one of the nations leading medical schools. Each year the School of Medicine educates approximately medical students and graduate students. Based on its level of funding from the National Institutes of Health the Katz School of Medicine is the secondhighest ranked medical school in Philadelphia and the thirdhighest in the Commonwealth of Pennsylvania. According to U.S. News World Report LKSOM is among the top most appliedto medical schools in the nation. Temple Health refers to the health education and research activities carried out by the affiliates of Temple University Health System TUHS and by the Katz School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents."

"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"

"Cognitive behavioural therapy could help many people with a dental phobia overcome their fear of visiting the dentist and enable them to receive dental treatment without the need to be sedated according to a new study by Kings College London. Anxiety about visiting the dentist is common and becomes a phobia when it has a marked impact on someones wellbeing people with dental phobias typically avoid going to the dentist and end up experiencing more dental pain poorer oral health and a detrimental effect on their quality of life. Estimates from the most recent Adult Dental Health Survey in the UK suggest around one in ten people suffers from dental phobia. Cognitive behavioural therapy CBT is a shortterm therapy typically lasting sessions. CBT has been shown to help with a range of psychological problems most notably for depression and anxietyrelated disorders. Both cognitive and behavioural interventions have been shown to be successful in reducing dental anxiety and increasing dental attendance. The latest study published in the British Dental Journal looked at the characteristics of patients women and men attending a psychologistled CBT service and the outcomes of their treatment. Patients attending a clinic run by the Kings College London Dental Institute Health Psychology Service at Guys and St Thomas NHS Foundation Trust were surveyed for their levels of dental anxiety general anxiety depression suicidal thoughts alcohol use and oral healthrelated quality of life. Threequarters of those assessed scored or higher on the Modified Dental Anxiety Scale MDAS indicating dental phobia. The remainder all scored high on one or more items of the MDAS suggesting a specific fear of some aspect of dentistry. Fear of dental injections and the dental drill were the most common high scoring items on the MDAS. Nearly all patients reported a knockon effect from problems with their teeth mouth or gums on their daily living and quality of life. A proportion of the patients surveyed were found to have other psychological conditions had high levels of general anxiety and had clinically significant levels of depression. Suicidal thoughts were reported by of patients and four reported a recent intent to commit suicide. Individuals were referred to support services via the care of their GP and for suicide risk immediate action was taken based on local service guidelines. Of all patients referred fourfifths went on to have dental treatment without the need for sedation and had their dental treatment under sedation. The average number of CBT appointments required before a patient received dental treatment without sedation was five. Professor Tim Newton from the Dental Institute at Kings College London and lead author of the study said People with dental phobia are most commonly given sedation to allow them to become relaxed enough for a short period of time to have their dental treatment performed. However this does not help them to overcome their fear in the long term. The primary goal of our CBT service is to enable patients to receive dental treatment without the need for sedation by working with each individual patient to set goals according to their priorities. Our study shows that after on average five CBT sessions most people can go on to be treated by the dentist without the need to be sedated. However there is a need for people with dental phobia to be carefully assessed by trained CBT practitioners working with dental health professionals. Some of the patients referred to us were found to be experiencing additional psychological difficulties and needed further referral and management. CBT provides a way of reducing the need for sedation in people with a phobia but there will still be those who need sedation because they require urgent dental treatment or they are having particularly invasive treatments. Our service should be viewed as complementing sedation services rather than as an alternative the two together providing a comprehensive care pathway for the ultimate benefit of patients. A recent study published in the same journal coauthored by Professor Tim Newton showed that more women than men reported dental phobia in the Adult Dental Health Survey. Those with dental phobia were more likely to come from a lower income background have more caries in their teeth and suffer from poorer oral health overall."

"Take two tablets and a selfie Your doctors orders may one day include a smartphone video to make sure you took your medicine. Smartphone apps that monitor pilltaking are now available and researchers are testing how well they work when medication matters. Experts praise the efficiency but some say the technology raises privacy and data security concerns. Selfie medicine works like this Open an app on your phone show your pills put them in your mouth and swallow. Dont forget to show your empty mouth to the camera to prove todays dose is on its way. Then upload the video proof to the clinic. Fans say the technology addresses a big problem About half of drugs for chronic conditions arent taken as prescribed because of cost side effects or patient forgetfulness. With treatment for opioid addiction https a skipped dose can mean a dangerous relapse. The National Institute on Drug Abuse is funding research to tailor a smartphone app for those patients and see if theyll use it. If we can keep patients engaged we can keep them in treatment longer said lead researcher Dr. Judith Tsui of the University of Washington School of Medicine in Seattle. The next phase of her research will compare a group of patients who use the monitoring app called emocha with those who dont to see if theres a difference. At one Tennessee treatment center some patients with opioid addiction are already using the app to upload selfies of their daily dose and answer questions about how theyre doing. Every time they sign on it allows us to capture data. Are they having cravings Suicidal tendencies said Scott Olson CEO of Dallasbased Pathway Healthcare which is trying the app at its Jackson Tennessee site. Maybe a phone call from a counselor might make the difference between staying clean and a relapse. Olson thinks insurers will pay for the service with more evidence. For monitoring tuberculosis patients health departments pay roughly to per patient each month for systems that include encrypted data storage. A small health department might pay as little as a month. The idea of watching someone take their medicine called directly observed therapy or DOT has roots in tuberculosis https where one persons forgetfulness can be serious for everyone. If patients dont take all their antibiotics https their infectious TB germs can get stronger developing drug resistance and endangering the broader community. But taking a handful of pills daily for up to a year is difficult so public health departments traditionally sent workers to peoples homes and workplaces to watch them take their doses. Today many TB patients prefer remote monitoring. Nurses like it too. Nurse Peggy Cooley has used Skype for years to chat live with patients taking TB medicine. We can accomplish in a twominute phone call something that might have taken an hour to do and most of that hour was in the car said Cooley who works for the TacomaPierce County Health Department in Washington state. The new uploaded selfies dont need an appointment. They are a daily routine for many tuberculosis patients in Seattle San Francisco Los Angeles and Houston where savings on mileage and worker time amounted to in a recent year. In Boston Albuquerque and five other cities researchers are studying whether the technology works for hepatitis C a bloodborne virus thats surging among a new generation of injection drug users. New drugs for hepatitis C https can cure but theyre expensive for a week course of treatment so insurers want to make sure patients take them. I think it holds a lot of promise said researcher Dr. Alain Litwin of University of South Carolina School of Medicine whos testing whether patients do better when someone watches them take their pills. Whats next An insurer in Maryland plans to use the technology in diabetes and high blood pressure https to make sure Medicare and Medicaid patients take their medicine. Startups selling the apps say they could be used by faraway adult children monitoring an elderly parents daily pilltaking. Experts worry about privacy data security and penalties for poor pilltaking. Thats the biggest ick factor said Carolyn Neuhaus a medical ethicist at the Hastings Center in New York. You can imagine a program where benefits are tied to compliance and the insurer says We wont pay for medication anymore unless youre taking it correctly. Globally the rapid spread of smartphones creates an opportunity to eradicate TB say the app developers. But eliminating TB may take simpler cheaper technologies that can be scaled for millions of cases said Dr. Daniel Chin who leads TB efforts for the Bill and Melinda Gates Foundation. The group supports research in China and India on two homegrown technologies. Chinas tool about the size of a childs shoebox reminds patients to take their pills and saves data for review. In India the government favors a blister pill pack printed with phone numbers a patient punches out a daily pill then calls the revealed number. Worldwide TB kills more than . million people annually even though most deaths are preventable with treatment. If we are going to eliminate the disease we need technology said Dr. Richard Garfein of the University of California San Diego School of Medicine who helped develop one of the smartphone apps SureAdhere."

"This could be good news for those trying to prevent preterm labor New research published online in The FASEB Journal http suggests that exposing bitter taste receptors in the uterus to certain substances can stop many unwanted contractions that occur during premature labor. The biological mechanism of labor initiation remains unknown and a large percentage of preterm pregnancies do not respond well to current medications said Ronghua Zhuge Ph.D. associate professor within the University of Massachusetts Medical Schools Department of Microbiology and Physiological Systems in Worcester Massachusetts. The bitter taste receptors that we have found on uterine muscle could be one more piece of the puzzle to understand the onset of labor both at term and preterm and develop new therapeutics for preterm labor. Zhuge and colleagues attached strips of human and mouse uterine myometrium tissue also known as smooth muscle to a machine that measured their contraction efforts. The researchers first exposed the tissue to native hormones such as oxytocin and chemical compounds to make it contract mimicking normal or premature labor. They then exposed the tissue to bitter substances. By activating the bitter taste receptors in the uterus the bitter substances relaxed the contracted uterine muscle tissue more completely than the current drugs used to prevent preterm labor in humans. The researchers also found that giving mice bitter substances before they showed any premature contractions prevented them from having early deliveries. Submit to The FASEB Journal by visiting httpfasebj.msubmit.net and receive monthly highlights by signing up at http The FASEB Journal is published by the Federation of the American Societies for Experimental Biology FASEB. It is the worlds most cited biology journal according to the Institute for Scientific Information and has been recognized by the Special Libraries Association as one of the top most influential biomedical journals of the past century. FASEB is composed of societies with more than members making it the largest coalition of biomedical research associations in the United States. Our mission is to advance health and welfare by promoting progress and education in biological and biomedical sciences through service to our member societies and collaborative advocacy. Details Kaizhi Zheng Ping Lu Ellen Delpapa Karl Bellve Ruitang Deng Jennifer C. Condon Kevin Fogarty Lawrence M. Lifshitz Tiffany A. Moore Simas Fangxiong Shi and Ronghua Zhuge. Bitter taste receptors as targets for tocolytics in preterm labor therapy. FASEB J. doi.fj.RR http"

"Researchers have stopped a study of a new lung cancer drug saying its so effective they want to offer it to all the patients in the trial. The drug Keytruda is the same drug http former president Jimmy Carter says helped stall advanced melanoma that had spread to his brain. Keytruda was being tested for the first time in lung cancer patients who had not been treated at all yet. The researchers wanted to see how it worked against the standard chemotherapy cocktails. It worked at least as well if not better than the chemo so the researchers have stopped the study to give everyone a chance to take Keytruda Merck the company that makes the drug said. It helped patients live longer overall and helped them live longer without their tumors growing or spreading Merck said. The details are not available yet. We look forward to sharing these data with the medical community and with regulatory authorities around the world said Dr. Roger Perlmutter president of Merck Research Laboratories. Independent committees look at the details of the patients and how well they are doing in drug trials like these. It was one of these independent committees that recommended stopping the trial based on what they saw but that doesnt necessarily mean they shared the details with the company or anyone else. I suspect the findings were significant enough that this will be a practicechanging finding Dr. Pasi Janne lung cancer specialist at Harvard Medical School and the DanaFarber Cancer Institute told NBC News. Cancer research goes forward in slow steps. In tests of new drugs patients always get either the very best therapy already available or the new drug. Often they get both. Usually cancer drugs are only tested at first in patients who have tried everything else available and their cancer has come back anyway. I suspect the findings were significant enough that this will be a practicechanging finding. So its an important break for a company if its drug is the first one a patient gets and it works better than the socalled standard of care. The company now can ask the Food and Drug Administration if it will approve Keytruda to use as the first treatment a lung cancer patient tries. The FDA has given speedy approval to several new drugs in a class called checkpoint inhibitors including Keytruda. They treat cancer by stopping tumor cells from cloaking themselves against the normal healthy immune system response. They work on the principle that its not where cancer starts that matters but the genetic mutation http causes the cancer. So a lung tumor in one patient may look like the melanoma in another. Keytruda known generically as pembrolizumab http targets the activity of genes called PD antiprogrammeddeathreceptor and PDL. The interaction between the two genes lets some tumors escape detection and destruction by immune system cells. PD stops immune cells from attacking normal healthy cells by mistake. Tumor cells make PDL turn on PD when immune cells approach. This trial only included patients whose tumors cells made a lot of PDL. That is only a portion of people with lung cancer percent in one recent trial. Having seen patients benefit who failed existing therapies now doing well on these new therapies is fantastic. A rival drug BristolMyers Squibbs Opdivo works in a similar way to Keytruda and it has slightly different approval from the FDA for how it should be used. Immunotherapy is a whole new way of treating cancer including lung cancer said Janne who was not involved in the study. Having seen patients benefit who failed existing therapies now doing well on these new therapies is fantastic. Keytruda approved October last year for lung cancer and in for melanoma is pricey costing about a year for a course of treatment. Its approved for use with a specific test for PDL activity. The new drugs are less toxic and more precise than standard chemotherapy. But they are not free of sideeffects. Some are severe and can damage the lung colon liver kidneys hormoneproducing glands and the brain the FDA says. Lung cancer is the top cancer killer in the U.S. Its diagnosed in more than people a year and it killed nearly people last year according to the National Cancer Institute"

"The promise of genetic medicine is beginning to be fulfilled but its been a long hard slog. Take the story of Kalydeco http Its designed to treat people with a lung disease called cystic fibrosis. While not quite a cure the drug is extremely effective for some CF patients. But the success of Kalydeco has been more than two decades in the making. A good starting point for the story is Aug. . Thats the day scientists from the U.S. and Canada announced the discovery of the gene associated with the disease. It was the early days of gene hunting and the CF gene was a big prize. CF is the most common genetic disease in Caucasians. When people inherit a damaged form of the CF gene a critical protein inside cells doesnt work properly. As a result sticky mucus builds up in a patients lungs causing infections and making it hard to breathe. The announcement was supposed to be made in conjunction with three papers http in the Sept. issue of Science but a reporter for Reuters got hold of the story early. Science took the unusual step of allowing the scientists to speak to the media before publication. Article continues after this message from our sponsor At the time scientists predicted that a genetic test for CF was just around the corner. But they also thought a drug to treat the disease was in reach. The first prediction turned out to be right. But it wasnt until years later that we were able to find drugs that directly target the underlying cause of cystic fibrosis says Fred Van Goor who led the team at what is now Vertex Pharmaceuticals http that developed Kalydeco. So it was a long time between the discovery of the gene and the discovery of Kalyedco. It took awhile to find a drug that would help restore the function of the protein the CF gene makes. We tested over chemicals in cells with the defective protein that causes cystic fibrosis says Van Goor. One of those chemicals ultimately became a successful drug but it had to be modified so patients could take it by mouth and so it would last the right length of time in a patients body. From the start Van Goor and his colleagues knew there was a problem with Kalydeco It only works on a small subset of people with CF. They have to have a particular mutation in the CF gene or the drug is of little use. But for people who do have that mutation the drug works remarkably well. Emily Schaller was in one of the early studies of Kalydeco. As part of the study researchers first gave her a placebo then switched her to the active drug. She knew within days that something was different. I was with my brother in Florida and we were walking down the street and I took a deep breath and when I took a deep breath in and I let it out I didnt cough says Schaller. But not only did I not cough but I felt that my lungs were clear and that something huge had happened. It was just something I had never felt in my life before. Schaller isnt cured. She still has a damaged CF gene. The only way to fix that would be gene therapy http where a healthy form of the gene would supplant the damaged one. Although it seems simple in theory in practice gene therapy has been incredibly difficult to accomplish. Schaller isnt particularly bothered by that. Everyone talks about curing a disease cure CF cure these other diseases. But Kalydeco controls CF at the basic defect so Im OK with the other c word control because Im living it and Ive never felt better in my life. The time from gene discovery to successful drug may be shortening but there are only a handful of successful drugs so far and for a while at least the appearance of new ones will be slow. Theyre also likely to be expensive. Kalydeco costs in the neighborhood of per year."

"A small study claims children with autism may benefit from fecal transplants which involves introducing donated microbes into people with gastrointestinal disease to rebalance the gut. The Ohio State University Northern Arizona University and Arizona State University httpsnews.osu.edunewsyes researchers found a parallel between behavioral symptoms of autism and gastrointestinal distress and improvements to both after fecal transplant. Transplants are working for people with other gastrointestinal problems lead study author Ann Gregory a microbiology graduate student at The Ohio state University said in a news release. httpsnews.osu.edunewsyes And with autism gastrointestinal symptoms are often severe so we thought this could be potentially valuable. The researchers built off of previous findings that children with autism typically have fewer types of important bacteria in their guts and less bacterial diversity overall. The research team surmises the disparity is due to antibiotics prescribed within the first three years of life. The study which was published in the journal Microbiome included children with autism and moderate to severe gastrointestinal problems. The children ranged from to years old. A questionnaire was used to assess social skills irritability hyperactivity and communication. Parents and doctors reported improvements that lasted at least eight weeks after treatment. Children without autism were used as a control for the study the news release reported. httpsnews.osu.edunewsyes On average the score on a scale for ranking gastrointestinal symptoms dropped percent from the beginning to the end of treatment while average developmental age increased by . years according to the release. Researchers also asked the childrens doctors to perform pre and postdiagnostic evaluations which suggested lasting benefits. One of the studys limitations is its small size and researchers cautioned that families should not try to replicate the treatment at home. We have to be mindful of the placebo effect and we have to take the findings with a grain of salt Matthew Sullivan an associate professor of microbiology at The Ohio State University said in the release httpsnews.osu.edunewsyes. But it does give us hope."

"A Delaware team including Erin Crowgey PhD associate director of Bioinformatics with Nemours Biomedical Research has published a study in the peerreviewed journal BMC Bioinformatics showing that DNA patterns in circulating blood cells can be used to help identify spastic cerebral palsy CP patients Crowgey et al.. The work represents a collaboration among researchers at Nemours the University of Delaware UD and Genome Profiling LLC GenPro for short. Coauthors of the paper include Robert Akins PhD the project principal investigator who directs the Center for Pediatric Clinical Research and Development at NemoursAlfred I. duPont Hospital for Children UD molecular biologist Adam Marsh PhD who is chief science officer at GenPro and Karyn Robinson MS and Stephanie Yeager MS of Nemours Biomedical Research. Early diagnosis supports early intervention Cerebral palsy is a common yet understudied neurodevelopmental problem in the U.S. In fact there is no national surveillance here but the CDC estimates that in American children have the condition. CP is a group of disabilities with a wide spectrum of severity. Spastic CP the most common type is a lifelong condition characterized by joint stiffness spasms and muscle tightness that affects movement and posture and restricts the activity of affected children. Although most children with cerebral palsy are born with it diagnosis may be delayed until years of age. A diagnosis is made by monitoring motor milestones infants thought to be at risk for CP are enrolled in early intervention programs where their progress is closely watched. New and better ways to identify infants with CP are needed so that interventions can start earlier for more children. Nemours internationally recognized for its CP center at Alfred I. duPont Hospital for Children serves a diverse population of more than children and young adults with CP one of the largest programs in the U.S. Clinicians and researchers at Nemours continuously seek to improve the diagnosis and care of CP patients. Funding from the Swank Foundation enabled Nemours to develop a cerebral palsy tissue bank that stores blood and tissue samples from hundreds of surgical patients at Nemours. In the study the research team profiled blood samples collected in a blinded study from children and adolescents years to explore whether patients with spastic CP showed differences at the cellular level that routine orthopedic patients needing ACL repairs spinal fusions or other surgeries did not. The researchers identified a strong set of methylation markers or patterns that indicate differences in the genome between children with spastic CP and those without it. In a second study using samples from children aged years the researchers were able to validate their results and predict with percent accuracy whether the blood samples came from children who had CP. The evidence suggests that there is some epigenetic connection said Crowgey. If we can do a better job of screening for these at time of birth versus waiting for the disorder to be diagnosed at years of age then potentially well be able to deliver earlier therapeutics and have better outcomes and lower medical costs. Medicaid data show that annual medical costs for a child with CP are to times higher than for those without CP. The power of data science analytics and machine learning The study leverages a unique statistical method and software platform originally developed by Dr. Marsh at UD and commercialized by GenPro to measure methylation patterns in DNA a cells genetic code using next generation sequencing NGS data. NGS is a technique that enables scientists to decode DNA faster and more cheaply than traditional DNA sequencing methods. Each persons genome or complete set of DNA is like a word thats the length of billion characters but spelled with only the letters A T C or G. Traditional DNA sequencing techniques decode sections of DNA characters at a time while NGS takes advantage of parallel computing capabilities enabling scientists to decode millions of DNA fragments. Subtle changes in a patients physical health are paralleled by changes in DNA methylation making it a useful tool to understand disease. Many of the signals that we pick up are based on immune system shiftsmeaning the way a persons immune system responds to external stress events. When we find that epigenetic response or signal in the genetic sequencing it provides another line of evidence for clinicians to use in making decisions said Marsh. The approach uses sophisticated machine learning techniques and algorithms to sort through hundreds of gigabytes of NGS data looking for these distinct DNA methylation patterns. The data set is massive. Its not something a human can do. You need infrastructure machine learning data analysis and data science said Crowgey. Promising results more testing needed While the study findings indicate that there is a consistent signal present in circulating blood cells of children with spastic CP that remains from early childhood to the teenage years the researchers say they need to further study samples from different age groups including teenagers toddlers and infants from birth to years. Learning more about methylation signals across ages will allow the approach to be further refined to identify cases and also could provide researchers new clues to understanding the cellular processes involved in advancing CP and consequently new therapeutics to manage the disease. Were still in the early phases but the results are extremely promising and were excited about the sensitivity of the test that we are seeing in our retrospective analysis said Crowgey. If successful the researchers say the type of blood test in development also may be useful for other disorders such as infant leukemia. Akins was optimistic. This is an example of the kind of innovation that can happen when people with different skill sets collaborate. The experimental testing went from idea to validated execution in less than months. Were now working toward a goal of eventually forming a clinical diagnostic test and applying it to a broad population. Akins added that Nemours is in a unique position for such an undertaking with its large CP population its growing strength in data science and analytics and its recent acquisition of newborn screening for the state of Delaware. Many issues will need to be addressed but we predict routine screening for CP in the near years future he said. This research is funded by the Delaware Bioscience Center for Advanced Technology the National Science Foundation the American Academy for Cerebral Palsy and Developmental Medicine and Nemours. Pull out quote This blood test could be a game changer. The earlier the diagnosis the earlier we can direct therapies at the child. Specifically high intensity physical therapy and possibly early surgery to prevent more significant problems in the future and hopefully improve overall function and quality of life. M. Wade Shrader MD Chief Cerebral Palsy Center NemoursAlfred I. duPont Hospital for Children About Nemours Childrens Health System Nemours is an internationally recognized childrens health system that owns and operates the two freestanding childrens hospitals the NemoursAlfred I. duPont Hospital for Children in Wilmington Del. and Nemours Childrens Hospital in Orlando Fla. along with outpatient facilities in six states delivering pediatric primary specialty and urgent care. Nemours also powers the worlds mostvisited website for information on the health of children and teens KidsHealth.org and offers ondemand online video patient visits through Nemours CareConnect. Nemours ReadingBrightstart.org is a program dedicated to preventing reading failure in young children grounded in Nemours understanding that child health and learning are inextricably linked and that reading level is a strong predictor of adult health. Established as The Nemours Foundation through the legacy and philanthropy of Alfred I. duPont Nemours provides pediatric clinical care research education advocacy and prevention programs to families in the communities it serves."

"A study from Exact Sciences Corp. Nasdaq EXAS httpstudio.financialcontent.comprnewsPageQuoteTickerEXAS and Mayo Clinic released today by the American Association of Cancer Research AACR shows promise for the development of a bloodbased lung cancer test. Researchers conducted a multiround study of nearly patients which demonstrated high accuracy for detecting lung cancer at all stages. These results reveal an opportunity to detect lung cancer from a simple blood draw said Kevin Conroy chairman and CEO of Exact Sciences. Our collaboration with Mayo Clinic is efficiently identifying biomarkers for additional cancer applications on the same technology platform as Cologuard. AACR released an abstract of the study today ahead of the presentation of the results on April during the AACR annual meeting. The findings from the study of patients controls and cancers demonstrate that biomarkers in plasma achieved high accuracy for all types and stages of lung cancer. Using two independent regression modeling approaches a panel of four novel methylated DNA markers demonstrated a sensitivity of percent at a specificity of percent. More studies are needed to corroborate accuracy however this plasma DNA test approach appears to be a promising new method and may serve as a rational followup to the common findings of lung nodules on CT scanning and may have application in screening for lung cancer said David E. Midthun M.D. a pulmonologist at Mayo Clinic. Lung cancer is the leading cause of cancer mortality resulting in . million deaths globally and more than deaths in the United States every year. Most symptoms present in the late stages of the disease when the survival rate is only four percent. Early detection of lung cancer offers the opportunity to reduce mortality. Lung cancer screening is approved for smokers using chest CT scanning. This approach has a sensitivity for lung cancer above percent but its specificity may fall below percent a false positive rate of more than percent because indeterminate lung nodules are so common. Evaluation of these falsepositives leads to unnecessary costly and potentially harmful procedures. A bloodbased test may help guide next steps after a scan reveals an indeterminate nodule Mr. Conroy said. For example a positive blood test might suggest the need for a biopsy or surgery. In contrast a negative test might suggest a less aggressive approach. Such a test could offer the opportunity to significantly improve health outcomes and reduce the financial impact on the health care system. The abstract is available here http A poster presentation of the findings will take place Sunday April from p.m. to p.m. EDT at the Walter E. Washington Convention Center in Washington D.C. Halls AC Poster Section . About Exact Sciences Corp. Exact Sciences Corp. is a molecular diagnostics company focused on the early detection and prevention of the deadliest forms of cancer. The company has exclusive intellectual property protecting its noninvasive molecular screening technology for the detection of colorectal cancer. For more information please visit the companys website at http follow Exact Sciences on Twitter ExactSciences or find Exact Sciences on Facebook. Safe Harbor Statement This news release contains forwardlooking statements within the meaning of Section A of the Securities Act of as amended and Section E of the Securities Exchange Act of as amended that are intended to be covered by the safe harbor created by those sections. Forwardlooking statements which are based on certain assumptions and describe our future plans strategies and expectations can generally be identified by the use of forwardlooking terms such as believe expect may will should could seek intend plan estimate anticipate or other comparable terms. All statements other than statements of historical facts included in this news release regarding our strategies prospects financial condition operations costs plans and objectives are forwardlooking statements. Examples of forwardlooking statements include among others statements we make regarding expected future operating results anticipated results of our sales and marketing efforts expectations concerning payer reimbursement and the anticipated results of our product development efforts. Forwardlooking statements are neither historical facts nor assurances of future performance. Instead they are based only on our current beliefs expectations and assumptions regarding the future of our business future plans and strategies projections anticipated events and trends the economy and other future conditions. Because forwardlooking statements relate to the future they are subject to inherent uncertainties risks and changes in circumstances that are difficult to predict and many of which are outside of our control. Our actual results and financial condition may differ materially from those indicated in the forwardlooking statements. Therefore you should not rely on any of these forwardlooking statements. Important factors that could cause our actual results and financial condition to differ materially from those indicated in the forwardlooking statements include among others the following our ability to successfully and profitably market our products and services the acceptance of our products and services by patients and healthcare providers our ability to meet demand for our products and services the willingness of health insurance companies and other payers to cover Cologuard and reimburse us for our performance of the Cologuard test the amount and nature of competition from other cancer screening products and services the effects of the adoption modification or repeal of any healthcare reform law rule order interpretation or policy the effects of changes in healthcare pricing coverage and reimbursement recommendations guidelines and quality metrics issued by various organizations such as the U.S. Preventive Services Task Force the American Cancer Society and the National Committee for Quality Assurance regarding cancer screening or our products and services our ability to successfully develop new products and services our success establishing and maintaining collaborative licensing and supplier arrangements our ability to maintain regulatory approvals and comply with applicable regulations and the other risks and uncertainties described in the Risk Factors and in Managements Discussion and Analysis of Financial Condition and Results of Operations sections of our most recently filed Annual Report on Form K and our subsequently filed Quarterly Reports on Form Q. We undertake no obligation to publicly update any forwardlooking statement whether written or oral that may be made from time to time whether as a result of new information future developments or otherwise."

"A novel radionuclide drug tackles the challenge of prostate cancer imaging and takes a turn as a cancerkilling therapy for tumors in and out of the prostate according to research presented during the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging SNMMI. The drug works by delivering diagnostic or therapygrade radionuclides to cells that express a protein called prostatespecific membrane antigen PSMA found on the surface of prostate cancer cells and their metastatic counterparts throughout the body. Clinicians can diagnose or stage disease and monitor therapy with the aid of a special hybrid scanner used to perform minimally invasive positron emission tomography PET. Prostate cancer still represents one of the main causes for cancerrelated deaths among men said Matthias Eder PhD coauthor of the study and a researcher in the division of radiopharmaceutical chemistry at the German Cancer Research Center in Heidelberg Germany. The diagnosis and therapy of metastatic prostate cancer is still challenging. The current clinical methods are not sensitive enough for detecting disease beyond the prostate but we are convinced that this novel theranostic radiotracer represents a significant step forward that could have a major impact on the future of prostate cancer care. The PSMAinhibiting theranostic agent called PSMA is still in its initial stages but it could be ideal for the treatment of patients with hormonerefractory prostate cancers which are notoriously difficult to control and linked to poor prognosis. Options for these patients are few and they come with substantial adverse effects. Diagnosis and therapy with the theranostic agent PSMA could offer more effective and sensitive visualization better staging and significantly higher therapeutic potential. To be clear other PSMAbased theranostics have reached the research bench but previous contenders had too many limitations in terms of instability in live subjects a lack of imaging contrast between targeted tissue and background signal and increased PSMAassociated binding to normal organs such as the kidneys. This new radionuclide drug shows strong binding to the protein PSMA and is readily and safely taken up by malignant PSMApositive tumors. PSMA could represent a watershed moment for prostate cancer theranostics. For this research scientists first imaged mice with an imaginggrade radionuclide gallium to assess the diagnostic value of PSMA. Diagnostic imaging was followed by a therapygrade radionuclide lutetium which delivers a more powerful dose of radiation that penetrates and destroys the cells and tissues of tumors when combined with PSMA. This phase was followed by a firstinhuman clinical trial of both imaging and therapy in a single person. Results of the human study showed that imaging was effective for the evaluation of metastatic prostate cancer and subsequent therapy resulted in a drop in prostatespecific antigen levels from . to . nanograms per milliliter. Positive response to therapy was verified via combined PET and computed tomography PETCT a hybrid imaging system that shows both functional and structural aspects of the body. Approximately one out of seven men will be diagnosed with prostate cancer in their lifetime according to statistics from the American Cancer Society. About new prostate cancer diagnoses and prostatecancerrelated deaths are expected to occur in the U.S. this year. Scientific Paper PSMA a novel theranostic PSMA inhibitor for both diagnosis and endoradiotherapy of prostate cancer M. Benesova M. Schfer U. BauderWst K. Kopka M. Eder Radiopharmaceutical Chemistry German Cancer Research Center Heidelberg Germany C. Kratochwil A. AfsharOromieh W. Mier U. Haberkorn Department of Nuclear Medicine University Hospital Heidelberg Heidelberg Germany SNMMIs nd Annual Meeting June Baltimore Md. About the Society of Nuclear Medicine and Molecular Imaging The Society of Nuclear Medicine and Molecular Imaging SNMMI is an international scientific and medical organization dedicated to raising public awareness about nuclear medicine and molecular imaging a vital element of todays medical practice that adds an additional dimension to diagnosis changing the way common and devastating diseases are understood and treated and helping provide patients with the best health care possible. SNMMIs members set the standard for molecular imaging and nuclear medicine practice by creating guidelines sharing information through journals and meetings and leading advocacy on key issues that affect molecular imaging and therapy research and practice. For more information visit http"

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

"In a bold new approach ultimately aimed at trying to cure AIDS scientists used genetic engineering in six patients to develop blood cells that are resistant to HIV the virus that causes the disease. Its far too early to know if this scientific first will prove to be a cure or even a new treatment. The research was only meant to show that so far it seems feasible and safe. The concept was based on the astonishing case of an AIDS patient who seems to be cured after getting blood cells from a donor with natural immunity to HIV nearly four years ago in Berlin. Researchers are seeking a more practical way to achieve similar immunity using patients own blood cells. The results announced Monday at a conference in Boston left experts cautiously excited. For the first time people are beginning to think about a cure as a real possibility said Dr. John Zaia head of the government panel that oversees gene therapy experiments. Even if the new approach doesnt get rid of HIV completely it may repair patients immune systems enough that they can control the virus and not need AIDS medicines what is called a functional cure he said. Carl Dieffenbach AIDS chief at the National Institute of Allergy and Infectious Diseases agreed. Were hopeful that this is sufficient to give the level of immune reconstitution similar to what was seen with the patient from Germany he said. This is the first time researchers have permanently deleted a human gene and infused the altered cells back into patients. Other gene therapy attempts tried to add a gene or muffle the activity of one and have not worked against HIV. The virus can damage the immune system for years before people develop symptoms and are said to have AIDS acquired immune deficiency syndrome. The virus targets special immune system soldiers called Tcells. It usually enters these cells through a protein receptor or docking station called CCR. Some people about percent of whites fewer of minorities lack both copies of the CCR gene and are naturally resistant to HIV. One such person donated blood stem cells in to an American man living in Berlin who had leukemia and HIV. The cell transplant appears to have cured both problems but finding such donors for everyone with HIV is impossible and transplants are medically risky. So scientists wondered Could a patients own cells be used to knock out the CCR gene and create resistance to HIV A California biotechnology company Sangamo SANGuhmoh BioSciences Inc. makes a treatment that can cut DNA at precise locations and permanently edit out a gene. Dr. Jacob Lalezari director of Quest Clinical Research of San Francisco led the first test of this with the company and colleagues at the University of California in San Francisco and Los Angeles. He warned that it would be way overstated to suggest that the results so far are a possible cure. Its an overreach of the data. There are a lot of people out there with hopes and dreams around the Cword so caution is needed. In the study six men with HIV had their blood filtered to remove a small percentage of their Tcells. The genesnipping compound was added in the lab and about onefourth of the cells were successfully modified. The cells were mixed with growth factors to make them multiply and then infused back into the patients. Three men received about . billion modified cells. Three others received about billion. Three months later five men had three times the number of modified cells expected. As much as percent of their total Tcells appear to be the new type resistant to HIV Lalezari said. The sixth man also had modified cells but fewer than expected. In all six patients the antiHIV cells were thriving nearly a year after infusion even in tissues that can hide HIV when it cant be detected in blood. The cells are engrafting theyre staying in the bloodstream theyre expanding over time said Lalezari who has no personal financial ties to Sangamo the studys sponsor. The only side effect was two days of flulike symptoms. It will take longer to determine safety but several AIDS experts said they were encouraged so far. It is a huge step and a first for the field of genetics said John Rossi a researcher at City of Hope in Duarte Calif. where he and Zaia plan another study to test Sangamos approach. The idea is if you take away cells the virus can infect you can cure the disease. On Wednesday Dr. Carl June a gene therapy expert at the University of Pennsylvania will report partial results from a second federally funded study of people testing Sangamos product. He treated his first patient with it in July . Many questions remain People born without the CCR gene are generally healthy but will deleting it have unforeseen consequences Will HIV find another way into cells Certain types of the virus can use a second protein receptor though this is less common and usually when AIDS is advanced. Sangamo is testing a similar approach aimed at that protein too. How long will the modified cells last Will more be needed every few years Could doctors just infuse Sangamos product rather than removing cells and modifying them in the lab What might this cost Sangamo spokeswoman Liz Wolffe said its too early in testing to guess but it would be a premierpriced therapy in the neighborhood of Dendreon Corp.s new prostate cancer immune therapy Provenge . Yet AIDS drugs can cost a year so this could still be costeffective especially if its a cure. Jay Johnson who works for Action AIDS an advocacy and service organization in Philadelphia had the treatment there in September. My results are excellent he said. The overall goal is to not have to take medication and then hopefully lead maybe to a cure. Matt Sharp of suburban San Francisco also had the treatment in September. I would trade anything to not have to take a handful of medications every day for the rest of my life and suffer all the consequences and side effects he said. I may not live long enough to see the cure but I always hoped for a chance. Online AIDS informationhttp andhttp"

"Switching to public transport or cyclingwalking to get to work might help shed the pounds Strengthens case for incentivising walking or cycling to boost population health say researchers Switching from driving to work to using public transport walking or cycling might help commuters shed weight within a couple of years suggests res earch published online in the Journal of Epidemiology Community Health . Given that car use is high the findings strengthen the case for incentivising walking or cycling to boost population health suggest the researchers. They base their findings on t he responses of people to three waves of the British Household Panel Survey BHPS in and . The BHPS is a long term annual study of a representative sample of adult Britons which began in . At each time point respondents described their usual main mode of transport for their daily commute and provided details of their height and weight BMI in and in . The researchers used a series of analyses to see if changes in mode of transport were linked to changes i n weight over a two year period. In the first analysis which included respondents people had stopped driving to work and were either walking orcycling or taking public transport . The switchers tended to be younger and less likely to have access to a car than those who continued to drive. Those who chose to walk or cycle instead tended to have a lower household income and a shorter commute which became shorter still after making the switch while those who opted for public transport were significantly more likely to be more highly educated. Switching from a car to walking cycling or public transport was associated with a statistically significant average reduction in BMI of . kgm after taking account of other influential fac tors equivalent to a difference of around kg a person on average. The longer the commute the stronger was the association with a reduction in BMI of . kgm equivalent to a weight loss of around kg associated with journeys of more than minu tes and . kgm associated with journeys of more than minutes equivalent to weight loss of around kg on average. In the second analysis which included people switched from active to passive travel. Some stopped walkingor cycling an d switched from public transport usually a bus or coach to the car. Once again the switchers tended to be younger than those who continued with their mode of transport. Those who stopped walking or cycling to work were significantly less likely than those who stopped using public transport to be in a managerial or professional post. They also tended on average to have a shorter commute which lengthened after the switch. Those who had previously used public transport on the other hand had a short commute after the switch. But switching to a car was associated with a significant weight gain of around kg per person or . kgm after taking account of other influential factors. This is an observational study so no definitive conclusions can be drawn about cause and effect. Nevertheless the analysis of individual level changes in BMI over time between the two groups of switchers using data from a nationally representative survey strengthens their findings say the researchers. If a la rger proportion of commuters were able to abandon their cars for a more physically active commute this could help drive down the average population BMI they suggest. Combined with other potential health economic and environmental benefits associated with walking cycling and public transport these findings add to the case for interventions to promote the uptake of these more sustainable forms of transport they write. Research Impact of changes in mode of travel to work on changes in body mass index evidence from the British Household Panel Survey httpjech.bmj.comlookupdoi.jech About the journal The Journal of Epidemiology Community Health is one of more than specialist journals published by BMJ. The title is the official journal of the Society of Social Medicine. httpjech.bmj.com"

"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."

"An experimental procedure aimed at repairing spinal cord injuries is showing promise. It uses stem cells in the damaged areas in hopes of restoring function and movement. And for one patient it is promising. On April James Mason was an accident waiting to happen. There was nothing we could have done to change that night said Bob Gambuti. During an argument James Masons stepfather Bob Gambuti tried to stop him from getting into a car after Mason had been drinking. He grabbed onto me I grabbed onto him said Gambuti. He pulled my leg out and we fell back and his neck broke. CBS News I remember just hitting the ground said Mason. I remember the whole way with the stretcher. Gambuti said the most devastating part of the whole process was the first day that they lifted Mason out of a bed. And nothing moved Gambuti said. Just his head. That really hit hard. At that point I really wanted to go jump off a bridge. Mason was left a quadriplegic with just the slightest ability to move his arms. Doctors said he would never walk again. Gambuti a retired cop became his full time caregiver and found an experimental trial at New Yorks Mount Sinai Hospital. CBS News spoke with Mason just before he underwent delicate neck surgery to try and repair the demaged part of his spinal cord by injecting stem cells. CBS News Im just super excited ready to just get it done and go back to rehab and start proving the doctors wrong even more said Mason. The surgery performed by Dr. Arthur Jenkins took four hours. Researchers have followed Mason and five other patients all with the most severe spinal cord injuries. CBS News met up with Mason again three months after the surgery. Mason said he was already noticing changes. My wrist has gotten a lot stronger. Im able to grasp around a lot other things he said. CBS News And after six months he was noticing changes then too. I think its almost doubled with how much Ive gotten better he said. And got sensation back into my feet. I can feel pressure onto em throughout my legs. And theyve noticed that I have a little bit of movement into my hips now. Today the company sponsoring the trial reported four of the six patients experienced improvement in both motor strength and function. Dr. Jenkins who is not affiliated with the company has continued to monitor Mason. My two cents is it worked that this actually changed his neurological recovery and function Dr. Jenkins said. That his actual functional improvement is from the stem cells that were injected. Whats that like for Mason I mean I just have to keep pushing forward he said. Mason does not blame his stepfather for the accident in fact he is grateful. If I had gotten into my car I could have killed someone else someones mother someones father someones child. If I would have survived through that I wouldnt have been able to live with myself he said. Its odd and its tough and people say Im sorry. Dont be sorry. I still have him here Gambuti said. Mason believes the stem cells accelerated his recovery. But its hard to know what would have happened without them. More research will be needed to try to establish whether they actually repair damage to the spinal cord."

"By the time yearold Ava Christianson got to the National Institutes of Health this summer she had lost several grueling rounds to leukemia and was bracing for the next one. Intensive chemotherapy which cures up to percent of children with the most common type of leukemia hadnt kept her cancer from coming back. Neither had a painful bonemarrow transplant nor an experimental treatment. Her careworn father cried in the shower to hide his anguish. Her mother couldnt help but wonder Why is this happening to our child But Ava was fortunate in one respect. Discoveries in the burgeoning field of immunotherapy are offering lifelines to desperate patients who previously had none. Five years ago said her mother Bethany Christianson our doctor would have just had to tell us to go home. Instead in a fiveminute procedure at the NIH Clinical Center in late July the freckleface girl got another chance to beat the acute lymphoblastic leukemia ALL that has stalked her since age . She was infused with million of her own T cells a key part of the immune system that had been genetically modified to track down and kill her cancer like a pack of crazed dogs. Avas treatment called CAR Tcell therapy is one of the new immunotherapies that attempt to rally the bodys own defenses to fight malignancies. Unlike other cancer advances it is being tested widely in children because of its stunning effectiveness in ALL the most common pediatric cancer. In earlystage trials many patients who had repeatedly relapsed saw their leukemia disappear. Some remain cancerfree. Yet big questions surround the therapy and many scientists are urging caution. Theres very real promise with this approach but the immune system is complicated said Terry Fry the National Cancer Institute NCI scientist who is running Avas trial. Theres a lot that still needs to be worked out. Heres what you need to know about immunotherapy https Complications can be lethal one clinical trial was briefly halted in July after three young adults died of brain swelling. It is also far from clear that such a personalized approach possibly costing hundreds of thousands of dollars is economically viable on a large scale or will produce the lasting remissions that everyone hopes to see. U.S. researchers running CAR Tcell trials for children and adults with leukemia and lymphoma have reported remission rates up to percent in some cases. Thats a major achievement in a group whose cancer is emboldened by every treatment failure. But rates in other trials are considerably lower and many patients eventually relapse. The treatment is great about getting people into remission but not at keeping everyone in remission said Rebecca Gardner a pediatric oncologist at Seattle Childrens hospital. She ran an earlystage trial using CAR Tcell therapy in which of patients went into complete remission. By a year about half had relapsed either because their T cells had inexplicably disappeared or their cancer had changed so that the T cells could no longer recognize it. Leukemia is really smart she said. Avas family understands that better than most. She underwent her first CAR Tcell procedure in Minnesota last year but her leukemia returned within six months. Her treatment at NIH involved a nextgeneration version developed by NCI that used a different target for her marauding T cells. In this firstinhumans trial she is Patient No. . In late August the Christiansons learned that Ava had gone into remission. She and her mother who were still at the Clinical Center in Bethesda Md. gleefully rushed home to Wisconsin so Ava could start third grade. Her parents so frequently disappointed remain guardedly optimistic. Hope is all you have said her father Jay Christianson. Her mother added We just need this to work and to stay working. NCIs Fry is careful not to make any promises about an extended remission. I cant say thats going to be the case he said because we just dont know. Its too soon. Scientists have wanted for decades to marshal the immune system to vanquish cancer but their attempts have mostly been frustrated. In the past few years however breakthroughs have led to the development of two types of immunotherapy checkpoint inhibitors and CAR T cells that are generating enormous excitement. Checkpoint inhibitors are offtheshelf therapies aimed at unleashing the immune systems power to see and attack the disease. Used mostly in adults to date they are producing impressive results albeit in a minority of cases. The most prominent Jimmy Carter. The former president became the poster patient when he was successfully treated last year with a checkpoint inhibitor called Keytruda along with surgery and radiation for his advanced melanoma. Much of the earliest research for customized CAR Tcell therapy was conducted at NCI the University of Pennsylvania the Memorial Sloan Kettering Cancer Center and Seattle Childrens. The technology of CAR T cells is really a breakthrough especially for children said Michael Jensen director of the Ben Towne Center for Childhood Cancer Research at Seattle Childrens Research Institute. Almost all the initial work focused on CD a protein found on the surface of Bcell acute lymphoblastic leukemia. Scientists figured out ways to use a chimeric antigen receptor or CAR to reprogram T cells to recognize the protein and kill the cancer. Immunotherapy is showing benefits in an increasing number of cancers https Zane Esposito a yearold from Plano Tex. calls himself the TCell Explorer. He was diagnosed with ALL in June . I just thought my back hurt he said. I couldnt walk up the steps very well. Almost three years of treatment including punishing chemotherapy provided a couple of years of remission. His leukemia returned in January and this time it did not respond to treatment. Soon after Zane relapsed he and his father bumped into friends in a local doughnut shop who told them about a TV segment on CAR Tcell therapy. Paul Esposito searched online and found Gardners clinical trial in Seattle. Zane signed on got the treatment went back into full remission and gained pounds. His Texas doctors have talked about a bonemarrow transplant to increase the chance of a true cure but the Espositos have resisted. The Seattle doctors say it is not clear yet whether that is necessary or whether there would be still other options should Zanes cancer recur. Zane is moving on with dreams of competing on Chopped Junior to show off his homemade pasta and pizza. On July the day that Ava got her T cells he celebrated his th birthday. Ava was when she started having leg pains then trouble standing up. Her mother suspected Lyme disease. You never think of cancer with a child she said eyes filling as she recalled her daughters cancer diagnosis in November . The doctors assured the family that it was typical leukemia and curable. Like most children Ava quickly went into remission after starting the prescribed months of chemotherapy. But at home in Prescott a small Wisconsin city at the confluence of the Mississippi and St. Croix rivers things did not get easier for the Christiansons. In early Ava was hospitalized in Minneapolis for a lung infection. About the same time the couples second daughter Audrey was born weeks premature and hospitalized in a neonatal intensive care unit in St. Paul. Bethany who manages occupational therapists for a nursinghome chain and Jay a rural mail carrier shuttled between the Twin Cities visiting their daughters. I would be with Ava during the day and then when Jay got home he would stay with Ava and I would spend time with Audrey she said. No matter what you do you feel like a bad mom. A year or so after treatment began Ava relapsed. Now she was in a much more dangerous category children whose leukemia no longer responds to chemo. Her doctors arranged for a bonemarrow transplant with her baby sister as the donor. The transplant made her sick and the whole family miserable. Ava spent months in the hospital and then a year at home. Because of fears of infection she couldnt go out much. She missed all of first grade. But her parents had hope that the transplant would keep her cancer at bay. Brain cancer now the leading cause of cancer deaths in children https At a sixmonth checkup tests showed that the leukemia was back again. There were no more conventional treatments to try. But because of her two relapses Ava was now eligible for a CAR Tcell trial at the University of Minnesota Masonic Childrens Hospital. Her T cells would be genetically altered to go after CD.The number of cells then would be vastly increased and reinfused. It sounded like science fiction but Bethany Christianson found comfort in talking to the father of Emily Whitehead. In the yearold Pennsylvania girl became the first child to be treated with reprogrammed T cells for leukemia. She has been in remission ever since. Ava got her treatment in April after her cells were extracted via a tube inserted into her neck and five days later had a massive immune reaction with a high fever and intense pain. While that is typical some patients become dangerously ill. Yet Ava recovered fast went into remission and attended summer school where she learned how to make pigsinablanket and wrote her own cookbook. By then her parents had gotten used to living in the midst of remissions and relapses. When she felt better we would do everything we could Bethany said. They visited Robot World a scientifically themed attraction a few hours from Prescott. You dont put things off because you are always thinking What if Last fall doctors delivered the bad news. Avas cancer had changed. It was no longer producing the CD protein which meant her modified T cells could no longer recognize the disease. But the leukemia was still producing another common protein called CD and that offered an opportunity. As it happened Fry head of the bloodcancer section in NCIs pediatric oncology branch had already launched the worlds first trial using CAR Tcell therapy to focus on CD. It seemed an equally promising target that could broaden the therapys impact researchers thought. At the time they did not realize that a significant percentage of patients in the other trials might relapse because of changes in their cancer. Fry insisted as he designed the study that children be included despite everpresent concerns about exposing them to safety risks. He wanted to avoid a delay in testing what could be a lifesaving pediatric treatment. I didnt want to take two to three years on adults and then go back and do children he said. For a yearold with cancer a future staked on medicines hottest field http_story.html The clinical trial already has treated nearly two dozen leukemia and lymphoma patients through age . The majority have gone into remission although some have had their cancer return. While it is far too early to know longterm outcomes Fry said he is convinced the CD treatment holds much potential. He is planning another trial next year with the Stanford University School of Medicine. It will target both proteins CD and CD simultaneously. Once Ava relapsed after the Minnesota trial Frys study at the NIH Clinical Center appeared to be the only option. But there was no slot immediately available. With Ava deteriorating doctors put her on an experimental treatment that sent her into remission but had serious side effects. They immediately stopped the medication when they learned Ava might get her Tcell therapy in January she actually needed a high level of leukemia in her body to participate. But on this wrenching roller coaster of research and treatment it turned out that she still had to wait several more months. Avas cancer returned in June. Her T cells were extracted in preparation for the trial even as she got sicker and sicker. She was admitted to the Clinical Center in midJuly to a room with dancing penguins painted on the windows. The day before her therapy an ebullient Audrey burst into the room and the two sisters ran down the hall to a play space. Her mother was ready this time for the intense immune reaction that followed treatment although she still found it hard to watch Ava spike a fever of . When you see that temperature on the thermometer every bone in your body says its wrong to let it get that high Bethany said. Then suddenly its over. If his daughters cancer returns yet again I have no idea what well do Jay said. Were kind of up against the edge. Fry thinks she might be able to undergo a second round of her latest immunotherapy as long as her cancer is still producing CD proteins. Doctors in Minnesota also might recommend a second bonemarrow transplant something her parents dread saying it was the roughest treatment of all. For now Ava is happily back in school. I just want her to be a kid Bethany Christianson said. She has missed out on a lot of that."

"The American Academy of Pediatrics on Monday announced its first major shift on circumcision in more than a decade concluding that the health benefits of the procedure clearly outweigh any risks. There is clear evidence that supports the health benefits of circumcision said Susan Blank who led the member task force that formulated the new policy httppediatrics.aappublications.orgcgidoi.peds. being published in the journal Pediatrics. The statement and accompanying technical report httppediatrics.aappublications.orgcontente marks the first revision of the organizations position since when the academy backed away from circumcision. At that time the group which represents about pediatricians nationwide concluded that there was no clear evidence for or against circumcising newborns. The group affirmed that position in . Since then the popularity of circumcision in the United States has declined. Only about percent of newborn males are circumcised. The academys task force spent seven years combing through the latest research analyzing more than a thousand studies. Their conclusion For starters Blank says circumcision helps baby boys pretty much immediately. The health benefits of male circumcision include a drop in the risk of urinary tract infection in the first year of life by up to percent she says. Article continues after this message from our sponsor But theres a much bigger reason to do it Blank said. Circumcised males are far less likely to get infected with a long list of sexually transmitted diseases. It drops the risk of heterosexual HIV acquisition by about percent. It drops the risk of human papillomavirus HPV herpes virus and other infectious genital ulcers she says. It also reduces the chances that men will spread HPV to their wives and girlfriends protecting them from getting cervical cancer. Weve reviewed the data and you know we have gone through them with a finetooth comb and the data are pretty convincing she says. Critics however were not convinced. They liken the procedure to female genital mutilation. We have no right as parents or as physicians or adults to strap them down and chop off a normal part of their body. To do that is a human rights violation and an ethical travesty says Georgeanne Chapin httpintactamerica.orggchapin of the anticircumcision group Intact America http Chapin and other critics argue that the scientific evidence is questionable. For one thing the studies about HIV have only been done in Africa where AIDS is much more common among heterosexuals. Theyre cherrypicking their evidence she says. They act as though theres this huge body of literature. Its all the same couple of studies that have been regurgitated and reprogrammed. Over the past years all kinds of medical benefits have been proposed as resulting from cutting off the foreskin and they have all been disproven. Critics also question the safety of the procedure saying too many boys are damaged for life by botched circumcisions. But many experts say the academy is making the right call. They dismiss any comparison to female genital mutilation as grossly misleading and say male circumcision is about as safe as any procedure could be. Some think the academys position is long overdue and that the group should have gone even further and more forcefully recommended circumcision. I think that all healthy newborn babies should be circumcised says Edgar Schoen http_qualifications.html a professor emeritus at the University of California San Francisco. I feel about newborn circumcision the way I do about immunization Its a potent preventive health procedure that gives you a health advantage. For its part the pediatricians group hopes the new recommendations will encourage more parents to circumcise their sons and more insurance plans to pay for it. As Shots reported last week a lot of state Medicaid programs have stopped covering http_sthdl circumcision. Those families who choose circumcision should have access to circumcision. Cost should not be a barrier Blank says. The federal Centers for Disease Control and Prevention http has been promising for years now to issue the governments first guidelines about circumcision. But the CDC keeps delaying it and still has not said when that will happen."

"Pancreatic cancer is currently very difficult to detect while it is still resectable. A new blood test developed by researchers at Lund University in Sweden Herlev Hospital Knight Cancer Center and Immunovia AB can detect pancreatic cancer in the very earliest stages of the disease. The results have been published in the Journal of Clinical Oncology. Due to diffuse symptoms pancreatic cancer is usually diagnosed very late in the disease progression. Therefore despite pancreatic cancer representing less than of all cancer cases more people currently die from it than breast cancer. By pancreatic cancer is expected to be the second deadliest type of cancer in the world. Our test can detect pancreatic cancer with accuracy at stage I and II while there is still the possibility of successful surgical intervention. There is currently no cure and few treatment options for advanced pancreatic cancer which is the late stage when pancreatic cancer is usually diagnosed explains Carl Borrebaeck professor at the department of Immunotechnology at Lund University. The study used samples from patients in both Denmark and the US at different stages of the disease. The blood test is developed on a socalled antibody microarray that consists of hundreds of recombinant antibody fragments. These antibody fragments are specific for a number of immuneregulatory proteins cancerassociated antigens and so on. Since the immune system is the first to respond to threats like complex diseases such as cancer autoimmune diseases and infections the microarray was designed to mirror this early response. This provides information about the development of tumours long before being visible on CT or detected by ctDNA. From those hundreds of markers markers were selected to detect pancreatic cancer with accuracy at stage I and II. In the future the screening method could be used to screen people who are at a higher risk of developing pancreatic cancer such as those with a hereditary risk newly onset diabetes patients and patients with chronic inflammation of the pancreas. The next step has already been initiated which is a large US prospective study for high risk individuals."

"People with wellcontrolled type diabetes httpsdiabetes.webmd.comguidediabetesoverviewfacts had even better sugar control used less insulin https and lost an average of pounds in six months when taking the type diabetes httpsdiabetes.webmd.comguidediabetes_symptoms_types drug Victoza in a small clinical study. Those who continued treatment for a full year continued these improvements and felt much better overall says study leader Paresh Dandona MD of the State University of New York Buffalo. It is a dramatic change. They can see that their unexpected and unpredictable oscillations of blood sugar https are minimized. They also lost weight https Dandona tells WebMD. Over a protracted period of time as their diabetes https continues to be well controlled there is delightful improvement in patients wellbeing. At the annual meeting of the Endocrine Society in Boston Dandona reported the results of a study in which adults whose type diabetes https was well controlled with insulin https given via an insulin pump https received oncedaily Victoza for either one week or weeks. Continuous glucose monitoring showed that their blood sugar was as tightly controlled as possible with insulin https treatment. Yet all patients blood sugar peaked and dipped at unpredictable intervals. Adding Victoza to insulin therapy quickly eliminated these peaks and dips in blood sugar. After one week average fasting https and weekly blood sugar levels https each dropped by about . And during Victoza treatment patients needed less and less insulin. Their average dose of mealtime insulin decreased by seven units and their need for allday insulin dropped by eight units . Patients who continued treatment for weeks had further decreases in insulin doses and lost an average of pounds. This appeared to be due to reduced appetite and food intake. Hemoglobin Ac https levels dropped from . to a normal level of .. Some patients have now been treated for up to a year and the effect is as good as it was at the beginning Dandona said at a news conference webcast from Boston. Why Victoza Might Help Type Diabetes Victoza is a class of drug called a GLP receptor agonist. Its taken by injection one daily. Byetta https the other FDAapproved GLP agonist requires twicedaily injections. The GLP receptor agonists mimic the natural GLP peptide which is released from the gut after a meal. GLP increases insulin secretion from the pancreas https when blood https sugar is high and slows sugar absorption from the gut. It also lowers levels of glucagon a hormone that counteracts the effects of insulin. Victoza and Byetta slow the progression of type diabetes https But they hadnt previously been tested in type diabetes https because people with this type of diabetes https lack insulinproducing beta cells. But Dandona and colleagues wondered whether the glucagonlowering effects of these drugs might benefit people with type diabetes https Their clinical findings suggest that lowering glucagon may be a much greater benefit in type diabetes https than previously thought. Would Byetta work as well as Victoza in type diabetes That hasnt yet been tested but Dandona says it should have much the same effect. Neither Victoza nor Byetta is approved for use in type diabetes. Doctors could prescribe these medications https for type diabetes known as offlabel use but Dandona says this should be tried only by a endocrinologist specializing in diabetes and only with careful and frequent patient monitoring. GLP inhibitors act on the brain https to reduce appetite. Because of the weight loss https thin people with type diabetes should not use these drugs. However some of people with type diabetes are overweight https so the weight loss would be a benefit to such patients. Victoza has other more serious side effects. The most important are abdominal pain https nausea https and vomiting https although these side effects tend to lessen or go away after a week or two of treatment. Even so Dandona says these side effects cause about of type diabetes https patients to stop taking the drug. Although the Dandona study was performed without drug company support Victoza maker Novo Nordisk is paying for a larger clinical trial https Dandona already has asked the National Institutes of Health to support a largescale study if this larger study yields similar results to the current pilot study."

"Amsterdam The Netherlands A test that measures the levels of five chemicals in the breath has shown promising results for the detection of cancers of the oesophagus and stomach in a large patient trial presented at the European Cancer Congress . Together stomach and oesophageal cancer account for around . million new cancer diagnoses each year worldwide . Both tend to be diagnosed late because the symptoms are ambiguous meaning the fiveyear survival rate for these two types of cancer is only . The new research involving more than patients showed that the test could diagnose cancer with an overall accuracy of . Dr Sheraz Markar an NIHR Clinical Trials Fellow from Imperial College London under the supervision of Professor George Hanna told the Congress At present the only way to diagnose oesophageal cancer or stomach cancer is with endoscopy. This method is expensive invasive and has some risk of complications. A breath test could be used as a noninvasive firstline test to reduce the number of unnecessary endoscopies. In the longer term this could also mean earlier diagnosis and treatment and better survival. The trial was based on the results of previous research that suggested differences in the levels of specific chemicals butyric pentanoic and hexanoic acids butanal and decanal between patients with stomach or oesophageal cancer and patients with upper gastrointestinal symptoms without cancer. The new research aimed to test whether this chemical signature that seemed to typify cancer could be the basis of a diagnostic test. In the new study the research team collected breath samples from people at St Marys Hospital Imperial College Healthcare NHS Trust University College London Hospital and the Royal Marsden Hospital London. Of these had been diagnosed with stomach or oesophageal cancer and showed no evidence of cancer when they had an endoscopy. All the samples were analysed with a technique called selected ion flowtube mass spectrometry which is able to accurately measure small amounts of different chemicals in mixtures of gases such as breath. Researchers measured the levels of the five chemicals in each sample to see which ones matched to the chemical signature that indicated cancer. The results showed that the test was accurate overall with a sensitivity of and a specificity of . This means that not only was the breath test good at picking up those who had cancer sensitivity it was also good at correctly identifying who did not have cancer specificity. Dr Markar said Because cancer cells are different to healthy ones they produce a different mixture of chemicals. This study suggests that we may be able detect these differences and use a breath test to indicate which patients are likely to have cancer of the oesophagus and stomach and which do not. However these findings must be validated in a larger sample of patients before the test could be used in the clinic. Over the next three years the researchers will continue with a larger trial using the test with patients who are being given an endoscopy for gastrointestinal symptoms but not yet diagnosed with cancer. This will assess the ability of the test to pick up cases within a group that is likely to contain only a small percentage of cancers. The team is also working on breath tests for other types of cancer such as colorectal and pancreatic which could be used as firstline tests in general practice surgeries."

"An implanted combination cardiac resynchronization device and defibrillator reduces deaths from mild heart failure by compared with a defibrillator alone researchers reported Sunday. The report is the second one indicating that such combination devices which are about the size of a cellphone can save the lives of many of the million Americans with heart failure and many surgeons are already using them for that purpose. About of heart failure patients have the milder form of the disease for which the new study was conducted. The condition requires frequent hospitalizations and costs the U.S. healthcare system an estimated billion per year according to the American Heart Assn. Heart failure occurs when the muscles of the heart weaken and the ventricles fail to coordinate properly or synchronize reducing the ability of the organ to move blood throughout the body. In the most severe cases patients become so weak that they are bedridden or suffer a variety of symptoms such as shortness of breath buildup of fluid in the lungs and other organs confusion and fatigue. Patients with mild heart failure typically have few or no symptoms but both groups have an equally high risk of atrial fibrillation erratic heartbeats or death. A defibrillator applies a small electrical shock to the heart to halt the erratic heartbeats and restore normal function. Cardiac resynchronization therapy delivers a regular small electrical signal to the heart to maintain regular beating increasing the ejection fraction the amount of blood pushed into the cardiovascular system with each beat. The device has leads going to both ventricles to ensure that they are synchronized. Such devices are approved in the United States for treating patients with severe heart failure. Last year U.S. researchers reported that httparticles.latimes.comsepsciencesciheart a combination device manufactured by Boston Scientific reduced the death rate by for patients with moderate heart failure in a study of about patients. In September the Food and Drug Administration gave the company approval to market the device for this indication. In the new study Dr. Anthony S. L. Tang of the Ottawa Heart Institute and his colleagues studied mild heart failure patients at centers in Canada Australia Europe and Turkey. About half were given an implantable defibrillator manufactured by Medtronic Inc. of Minneapolis and half a combination device manufactured by the same company. The patients were followed for months. Tang reported at a Chicago meeting of the American Heart Assn. and in a report published online in the New England Journal of Medicine that the team observed a reduction in deaths in the patients treated with the combination device and a reduction in deaths and heart failurerelated hospitalizations. Fourteen patients had to be treated with the device to prevent one death. Complications were about twice as common with the combination device primarily because connecting the leads to the ventricles takes longer and requires a higher skill level. The extra leads also increase the possibility of infections. The study gives us reason for renewed enthusiasm about heart failure treatment said Dr. Clyde Yancy of the Baylor University Medical Center the immediate past president of the American Heart Assn. There has been a dearth of significant trials in mild heart failure for some time.... Whats good is that when we compare this to the other two studies we see some consistency of response. Dr. Alfred Bove a professor emeritus at Temple Medical School and an immediate past president of the American College of Cardiology noted that many surgeons are already installing the devices in patients with mild heart failure and only connecting the defibrillators not hooking up the second function until it is needed. The new study he said supports the idea that doing this works."

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

"An experimental vaccine that could hold off Alzheimers disease showed promising results in animal testing according to researchers at the University of Texas Southwestern Medical Center. Testing in mice showed that the vaccine safely prevents the buildup of substances in the brain associated with the fatal disease the team reported this week in the journal Alzheimers Research Therapy httpsalzres.biomedcentral.comarticles.s. There has been research in monkeys and rabbits as well and the researchers hope the vaccine will progress to human trials. If the vaccine proves safe and effective in humans it could slice the number of dementia diagnoses in half the studys senior author told USA TODAY. More The hidden side of dementia Families fight over care endoflife decisions finances estates https Dementia is a term used to broadly describe symptoms of cognitive decline Alzheimers disease is the most common cause of dementia. Doris LambrachtWashington a professor of neurology and neurotherapeutics at the University of Texas Southwestern Medical Center said researchers believe the vaccine could extend lives by preventing the disease from developing. If the onset of the disease could be delayed by even five years that would be enormous for the patients and their families LambrachtWashington said in a statement. The number of dementia cases could drop by half. Nov. MRI scan may predict which people will develop Alzheimers disease https Nov. Dark roast coffee might reduce risk of Alzheimers Parkinsons study suggests https LambrachtWashington said the study marks major progress toward a safe and effective vaccine. Previous attempts to find an Alzheimers vaccine either caused harmful side effects such as brain inflammation or used less effective approaches she said. The vaccine works by prompting the body to produce antibodies inhibiting the buildup of amyloid and tau two proteins that are hallmarks of the degenerative brain disease. The vaccine is one of several promising treatments aimed at reducing the buildup of those substances before they become deadly plaques and tangles in the brain. Top of Form Bottom of Form About . million Americans have Alzheimers disease according to the University of Texas. The number could double by ."

"New research offers hope for the first pill to treat a common problem in young women fibroids in the uterus. The growths can cause pain heavy bleeding and fertility problems and they are the leading cause of hysterectomies. In two studies a lower dose of a morning after contraceptive pill stopped the bleeding and shrank the fibroids. It worked as well as shots of a hormoneblocking drug that has unpleasant side effects. This is very very good news. The results are better than we expected said research leader Dr. Jacques Donnez of SaintLuc hospital at the Catholic University of Louvain in Brussels. Hes now testing intermittent longterm use of the pill to see if that could help women avoid surgery. The pill is called Esmya and it is awaiting marketing approval in Europe. Its a lowdose version of an emergency birth control pill called ella that came on the market in the United States about a year ago. The new fibroid pill still needs to be tested in the U.S. and wont be available anytime soon. Fibroids are benign growths in the uterus that are common in women during their childbearing years mostly in their late s and s. They usually go away after menopause. Treating fibroids isnt easy. Removing the uterus is the only cure other treatments include surgery to remove them or procedures to shrink them with ultrasound or pellets that cut off their blood supply. With the discovery that the hormone progesterone as well as estrogen promotes fibroid growth scientists have been looking at a class of drugs that can block progesterones effect on the uterus. Donnez and his colleagues in several European countries tested Esmya made by Swissbased PregLem. Their findings are in Thursdays New England Journal of Medicine. The two studies involved about premenopausal women whose fibroid symptoms were serious enough that surgery was planned. One study compared two doses of Esmya with a dummy pill for three months. The second tested Esmya against a monthly hormoneblocking shot that shrinks fibroids but causes hot flashes and with longterm use can thin bones.. Women in that study got a daily Esmya pill and a dummy shot each month or a hormone shot and a dummy pill. In both studies Esmya stopped the bleeding and shrank fibroids in most patients and worked as well as the shot but with fewer side effects. Menstrual bleeding was controlled in over percent of the women on Esmya many within a week compared to percent of those who took a dummy pill. At the end of the three months only about half of the participants went ahead with any kind of fibroid surgery. That allowed the researchers to observe whether improvements lasted over the next six months. They did for many of the Esmya patients while fibroids started growing after a month in the group that got the hormone shot. Donnez is now studying whether Esmya could be used longterm given periodically if symptoms return until menopause when fibroids usually disappear. That means some women depending on their age might avoid having surgery at all said Donnez. He does between six and hysterectomies a week for fibroids. Despite newer less invasive alternatives the rate of hysterectomies remains high Dr. Elizabeth Stewart a professor of obstetrics and gynecology at Mayo Clinic wrote in an editorial in the journal. Theres a need for good medical treatments and the new research represents an important step in that direction. Its amazing to me that so many women have uterine fibroids and yet the treatments we have available are pretty few and far between she said. The new pill is awaiting final European approval as a treatment before surgery following a recommendation from the European Medicines Agency in December. In the U.S. and Canada Esmya will be developed by Watson Pharmaceuticals Inc. which also sells prescription ella the contraception pill that helps prevent pregnancy for up to five days after sex. Watson spokesman Charlie Mayr said the company will soon start a study of the fibroids pill in the United States but it will be several years before it is ready for government review. It will seek approval in Canada early this year he said. Drugmaker PregLem paid for the latest studies. The researchers included company employees Donnez and others have been on its scientific advisory board."

"Each year five million people have wisdom teeth removed but its up in the air whether all of those surgeries were necessary. Wisdom teeth httpmyoms.orgprocedureswisdomteethmanagement also called the third molars are four teeth that grow at the very back of each corner of the mouth. For most people they start to grow in between ages and . Theyre thought to crowd out other teeth or cause tooth decay which is why many dentists and oral surgeons think its better to just nip those problems in the bud and take them out as a preventative measure. But theres a serious debate between dentists and oral surgeons should they preemptively remove someones wisdom teeth if the patient doesnt have any symptoms Simply put theres no right answer. It comes down to what you as a patient want. Heres what you need to know to figure that out. Dentists and oral surgeons are fighting over wisdom teeth Dentists and oral surgeons agree across the board that theres cause to remove wisdom teeth if a patient is in pain or if there are signs of disease popping up like tooth decay or infection. Thats an obvious choice. But taking out wisdom teeth when there arent any symptoms is where the professionals get into it. Many dental professionals stick with a watch and wait approach with wisdom teeth to avoid surgery if possible. Many people dont have adequate space in their jaw for the teeth to come into full position but that alone isnt justification of having them all removed says Dr. Scott Tomar of University of North Carolinas School of Dentistry. Tomar says that as a dentist he feels the risks of complication including infection and hitting nerves during surgery outweigh any benefits of preventative removal. In oral surgeon Dr. Jay Friedman called the preventative removals a public health hazard http in the American Journal of Public Health. The American Public Health Association has sided with this argument since when it formally opposed http the preventative removal of wisdom teeth. The same thing happened with tonsils http which doctors no longer remove just to get rid of the chance of infection later on. Americans spend an estimated billion a year having their wisdom teeth removed Some doctors though still see preventative oral surgery as being two steps ahead of the problem. If youre going to need your wisdom teeth out eventually why not have them removed when youre younger and are more likely to recover more easily Some think of removing the wisdom teeth early on as a way to lessen the crowding of other teeth You might not have symptoms now but you cant assume its gonna be that way for the rest of your life says Dr. Ray White an oral surgeon working at University of North Carolina. Rather than let the teeth cause problems later on many oral surgeons remove them. But a Cochrane review httpsummaries.cochrane.orgCDORAL_surgicalremovalversusretentionforthemanagementofasymptomaticimpactedwisdomteeth of randomized clinical trials found theres no evidence that removing wisdom teeth will prevent or reduce crowding of other teeth down the line. And a different Cochrane review http found that watching and waiting can may reduce the number of surgical procedures by percent or more. The question comes down to which side of the fence medical professionals fall on Its worth noting that oral surgeons make a good chunk of their paychecks by removing wisdom teeth so there is a financial incentive involved. Are there people gaming the system Sure. You dont get paid much for not doing anything White says. But Id hope we can get past that. The American Association of Oral and Maxillofacial surgeons says There is no pat answer https_based_third_molar_surgery.pdf cookbook recipe or flow chart that is universally accepted regarding the decision making process in these cases. So the question comes down to which side of the fence medical professionals fall on and what works best for their patients. The risks and benefits of removing your wisdom teeth Theres a chance that if you opt not to have your wisdom teeth taken out they might be fine for the rest of your life. Theres also a chance that theyll need to come out later. If thats the case you cant always plan for it. Opting to have them removed gives patients time to plan around the procedure which leaves people out of commission for about three days. But inconvenience isnt the only risk. The risk for complications increases as people get older and the duration of disability after the operation gets longer as people get older says oral surgeon Dr. Thomas Dodson. In some cases the extraction can be more painful if you wait Dodson says. Thats because the tooth is easier to remove if its roots arent fully developed. The common risks http related to the surgery include poor wound healing infection pain and uncontrolled bleeding. Nerve injury in rare cases of wisdom teeth removal can leave people with permanent numbness around the face and mouth according to the APHA. Americans spend billions each year on wisdom teeth Americans spend an estimated billion a year having million wisdom teeth removed http according to the American Public Health Association. Thats a hefty bill for something we may or may not need. How much it costs depends on how the molars are situated. A simple surgical extraction for a wisdom tooth thats showing through the gums should run about httpshealthcarebluebook.compage_ProcedureDetails.aspxiddatasetdentalgSurgicaltoothremoval according to Healthcare Bluebook. If its impacted pushed against another tooth and unable to fully come through the gum the cost jumps to about httpshealthcarebluebook.compage_ProcedureDetails.aspxiddatasetdentalgImpactedtoothremovalcompletelybony per tooth."

"Women who take hormone replacement therapy HRT to ease menopause symptoms like hot flashes and night sweats may be no more likely to die prematurely than women who dont take hormones a new study suggests. Many women have been reluctant to use hormones for menopause symptoms since when the federally funded Womens Health Initiative WHI study linked the treatments containing manmade versions of the female hormones estrogen and progestin to an increased risk of breast cancer heart attacks and strokes. The current study however looked at longerterm data from the WHI study and found no increased risk of death from all causes or from cancer or cardiovascular issues in particular associated with hormone use. Women seeking treatment for distressing hot flashes night sweats or other menopausal symptoms may find the mortality results reassuring said lead study author Dr. JoAnn Manson of Brigham and Womens Hospital and Harvard Medical School in Boston. Women go through menopause when they stop menstruating typically between ages and . As the ovaries curb production of the hormones estrogen and progesterone in the years leading up to menopause and afterward women can experience symptoms ranging from irregular periods and vaginal dryness to mood swings and insomnia. For the study researchers looked at data on women ages to who joined two WHI trials between and and were followed through . One trial tested estrogen alone against a placebo or dummy pill while the other trial tested estrogen taken in combination with progestin. Women were years old on average when they joined the trials and had already gone through menopause. They took hormones or a placebo for five to seven years and were followed for a total of years altogether. During the study period women died. Death rates were similar at about percent among women who took hormones and women who didnt researchers report in JAMA. Younger women in the study appeared to have better survival odds with HRT. Over the initial five to seven years when women were randomly assigned to take hormones or a placebo death rates were about percent lower among women aged to when they took HRT than when they didnt. For women who started hormones in their s or s however there wasnt a meaningful difference in death rates according to whether they got the treatment or a placebo during the initial years of the study. After years including both the treatment period and a decade or more of followup womens age when they joined the study no longer appeared to significantly influence death rates. One limitation of the study is that the WHI didnt look at different dosages of hormone pills and the findings may be different for other dosages or different types of therapy such as gels or creams or skin patches. Still the current study should ease concerns raised by earlier results from the WHI trials that an increased risk of breast cancer or heart attacks might translate into higher longterm mortality rates said Dr. Melissa McNeil author of an accompanying editorial and a womens health researcher at the University of Pittsburgh. Taking a combination of estrogen and progestin is associated with an increased risk of breast cancer but advances in screening and treatment since the WHI started now mean these tumors are unlikely to be fatal McNeil said by email. With additional years of followup it also appears that the increased heart attack risk associated with HRT in the initial results from the WHI trials is limited to older women McNeil added. Hormone therapy has been in and out of favor first it was good for all menopausal women then it was dangerous for all women McNeil said. The takehome message now is that for the right patient hormone therapy is safe and effective. SOURCE bit.lyjkqUFE httpbit.lyjkqUFE and bit.lyjopiX httpbit.lyjopiX JAMA online September . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"

"A Wisconsin woman traveled hundreds of miles to MedStar Georgetown University Hospital in Washington for a delicate operation replacing underarm lymph nodes lost in cancer surgery. A small but growing number of hospitals offer the procedure. See photos. A Wisconsin woman traveled hundreds of miles to MedStar Georgetown University Hospital in Washington for a delicate operation replacing underarm lymph nodes lost in cancer surgery. A small but growing number of hospitals offer the procedure. See photos. WASHINGTON AP Breast cancer treatment left Susan WolfeTank with an arm too painfully swollen to lift anything heavy or even fit into her usual clothing a debilitating condition that gets little attention and has no cure. Desperate the Wisconsin woman traveled hundreds of miles to seek a delicate operation replacing underarm lymph nodes lost in cancer surgery as a small but growing number of hospitals offer microsurgical attempts at relief from lymphedema that help some patients but not all. Right in this area feel that that is your lymph node Dr. David Song of MedStar Georgetown University Hospital in Washington told WolfeTank during a recent checkup. Song Georgetowns plastic surgery chief had removed healthy lymph nodes from WolfeTanks back and side and implanted them in the affected arm. As the new nodes took root her arm was shrinking. A delighted Songs only caution Take care of them by wearing a compression sleeve as prescribed. This isnt a cure. I will still have to be careful said WolfeTank of Hurley Wisconsin. But I will be able to crosscountry ski again just live a normal life. Look at my arm its incredible. Lymphedema is a chronic swelling often in an arm or leg that in severe cases can be disfiguring impair mobility cause disabling pain harden the skin and lead to infection. Lymph nodes work like biological pumps in a network thats part of the immune system. They drain watery fluid called lymph that traveling through tiny channels brings nutrients to cells and takes away bacteria and waste material. Lose or damage enough lymph nodes or channels in a particular area and that fluid builds up. Theres no good count but millions of Americans are estimated to have some degree of lymphedema and while it can be hereditary or result from injury many U.S. cases are a lasting side effect of treatment for a variety of cancers. Consider breast cancer. While better surgical techniques in recent decades have lowered the risk experts estimate that still about percent of breast cancer survivors who undergo a sentinel node biopsy removing a few nodes to check for spreading cancer will develop lymphedema. That risk jumps to about percent for women like WolfeTank who need additional lymph nodes removed because of more advanced cancer. Radiation causes further harm. Yet too often women arent warned about symptoms or checked for early signs when lymphedema is more easily treated said Dr. Sheldon Feldman of New Yorks Montefiore Einstein Center for Cancer Care. He coauthored physician guidelines issued this fall by the American Society of Breast Surgeons on prevention and treatment of breast cancerrelated lymphedema. Typical patients have had that swelling for a while Feldman said. Now the treatment is an uphill battle. The main treatment consists of wearing compression bandages and massage to bring down swelling. A lymphedema specialist initially prescribed a large pump that massaged WolfeTanks arm for an hour a night temporarily relieving some of the pain. But if I used my arm I was back to square one WolfeTank said. I didnt fit into my coat anymore. I live in the snow capital of Wisconsin. Im not supposed to shovel. Weve got to fix this. WolfeTank had struggled for four years when an oncologist recommended lymph node transfer. The rationale There are more lymph nodes in the bodys trunk than in the limbs more avenues to drain off fluid and thus it should be safe to move a few. Hunting for a surgeon WolfeTank found Song who transferred about five nodes along with supportive blood vessels and other tissue hoping theyd grow new channels to drain fluid. Its not the only option. A technique called lymphovenous bypass reroutes lymphcarrying channels going around damaged or missing nodes to drain into veins instead. Some surgeons use a variation of that technique protectively in hopes of preventing lymphedema from forming in the first place. During the initial cancer surgery they check which lymphcarrying channels the node removal left dangling and connect them to blood vessels to drain. Surgical options offer great potential note the breast surgeons new guidelines. But they dont work for everyone. About a third of lymph node transfer patients see some positive effect Song said. And Feldman noted that over about the past decade the microsurgeries have been studied only in small research trials and results vary with surgeon experience. One debate is whether to offer lymph node transfer early before patients build up as much damage as WolfeTank did. Insurance coverage also varies. Feldmans bottom line Patients considering microsurgery should be evaluated in a comprehensive lymphedema program to determine their best options. Copyright The Associated Press. All rights reserved. This material may not be published broadcast written or redistributed."

"Millions of people visit the websites of the Mayo Clinic American Cancer Society and the Centers for Disease Control and Prevention among others seeking authoritative health information. But are they receiving it When it comes to learning about the differences in risk among certain types of nicotine products many government websites are actually misleading or underinforming the public according to two researchers who analyzed the content of numerous health websites. This information quarantine in turn helps explain the woeful lack of public knowledge about relative risks violating basic consumer rights as well as the public health principles of individual rights and health literacy the researchers say. Writing in the International Journal of Drug Policy http Lynn Kozlowski of the University at Buffalo and David Sweanor of the University of Ottawa point out that many websites omit information showing that products such as ecigarettes smokeless tobacco and snus are far less harmful than traditional cigarettes. Public health ethics always has a concern to avoid any net harm to population health explains Kozlowski professor of community health and health behavior at UB and the papers lead author. The fear has been that much safer tobacco and nicotine products like snus smokeless tobacco and vape will possibly cause a net loss to public health because more people will use these products and these products may lead to cigarette use. This fear however is not based on actual evidence and cannot be used to suppress or otherwise keep the public uninformed of what is clearly known about the lower risks of these products adds Kozlowski PhD one of the worlds leading researchers on smoking behavior. An information quarantine functions similarly to a medical quarantine think of your favorite zombie movie or television show in which the infected person is secluded from everyone else to protect the overall public. In order to justify a quarantine there has to be clear evidence that the need to protect population health should overrule personal autonomy. In the case of providing information on differential health risks of nicotine products The evidence to date does not come close to establishing that there would be a loss to public health from making this information widely available from credible sources Kozlowski says. Kozlowski and Sweanor reviewed several major health websites including the CDC Mayo Clinic American Cancer Society Substance Abuse and Mental Health Services Administration and the National Cancer Institute and found three types of examples of information on smokeless tobacco but notomodest efforts to inform consumers of the significantly lower risks compared to cigarettes for lifelong users the researchers write. In fact they found that the Mayo Clinic perpetuated a misrepresentation discovered in erroneously informing visitors that smokeless tobacco was as dangerous as cigarettes. The day after the article was released the Mayo Clinic removed the headline replacing it with the still misleading statement that smokeless tobacco was not a safe product. People can only make as good a decision as the information available to them allows said Sweanor an adjunct professor in the University of Ottawas Faculty of Law who has spearheaded the development of worldleading tobacco control initiatives in Canada since the early s. The public is dramatically misinformed about the relative risks of substitutable tobacco and nicotine products. The risk differentials are huge but this is simply not known by a vast majority of those whose lives are at risk adds Sweanor. England has an example of a website Action on Smoking and Health ASH that gets it right on vaping the researchers said. A briefingDownload pdf http_.pdfqcigarettes posted on the site specifically states Compared to tobacco products electronic cigarettes are significantly safer. In their paper the researchers note that information on comparative risks is common for other products and activities like overthecounter medicines and even safety ratings of vehicles. They argue that the U.S. Food and Drug Administration FDA which regulates the sale of tobacco products isnt doing its part to inform consumers of important differences in harm among tobacco products. To illustrate their point Kozlowski and Sweanor use the example that if one type of alcoholic beverage caused in regular users to die prematurely as is the case with smoking traditional cigarettes while another caused massively fewer deaths consumers would want to know which product was the safer alternative. It would be scandalous even criminal to keep such facts from consumers the researchers write. Yet such facts are being kept from adult consumers of legal tobacconicotine products either by not informing or actively misinforming consumers. It is as if tobacco consumers were blindfolded and not allowed to see dramatic differences in harm from different products."

"U.S. researchers say they have found clear signs that blood clots in the lungs are being overdiagnosed exposing patients to potentially dangerous side effects from unnecessary drugs. Using national data the researchers found the rate of socalled pulmonary embolisms or PEs nearly doubled with the introduction of a new powerful diagnostic test more than a decade ago. Yet there was only a slight drop in deaths from the condition over the same period suggesting many of the clots were too small to cause harm. Rather than an epidemic of disease we think the increased incidence of PE reflects an epidemic of diagnostic testing that has created overdiagnosis the researchers write in the Archives of Internal Medicine. Its been estimated that more than Americans have a pulmonary embolism each year. The condition usually occurs when a blood clot travels from the legs to the lungs sometimes with fatal results. But with increasingly sophisticated tools doctors may be spotting clots that would never have been fatal in the first place. One such tool is called a CT chest scan which produces detailed images with highdose xrays and is being used in millions of patients every year in the U.S. In the years before when the technique was introduced per Americans were diagnosed with a pulmonary embolism annually. After that number rose to per . The number of deaths caused by the condition dropped only little however from . per in to . per in . This is consistent with overdiagnosis of pulmonary embolisms that may have caused very little harm may not have caused death said Dr. Renda Soylemez Wiener of Boston University who worked on the study. On the other hand the bloodthinning drugs used to treat blood clots increase the risk of bleeding in the brain or gastrointestinal tract for example. According to the new results such complications rose from three to five per people hospitalized with PE per year after doctors began using chest CT scans. The new findings add to other evidence showing that medical testing is on the rise across the U.S. although in many cases the impact on overall health remains unclear. CT scans expose patients to radiation for example which can increase the likelihood of developing cancer. And the dyes used to enhance the scan also cause kidney damage in a significant portion of people. I think doctors should think carefully about the pretest probability of a pulmonary embolism before they order this test Wiener told Reuters Health. Yet there is no easy solution at this point because untreated blood clots can be fatal she added. Right now it is a difficult place for the patient to be in Wiener said. SOURCE bit.lymmZKK httpbit.lymmZKK Archives of Internal Medicine online May . Our StandardsThe Thomson Reuters Trust Principles. httpthomsonreuters.comenaboutustrustprinciples.html"