November 30, 2006, 4:27 AM CT
Seven-point System Gauges Seriousness Of Heart Failure
simple points system may soon help guide therapy of elderly heart failure patients. Scientists at Washington University School of Medicine in St. Louis observed that by counting how a number of of seven easy-to-obtain health factors a patient has, physicians can estimate the patient's risk of dying.
The points system may steer doctors toward considering more aggressive therapys such as implantable defibrillators and pacemakers for those at low risk of death. However, elderly patients with a high risk may want to avoid stressful and unnecessary medical intervention and may benefit most from palliative or hospice care.
"It has typically been very difficult to predict how long a person hospitalized with heart failure may survive," says senior author Michael W. Rich, M.D., associate professor of medicine and a geriatric heart specialist at Barnes-Jewish Hospital. "That has made it hard for the treating doctor to know how aggressive to be with treatment."
Heart failure afflicts about 5 million people in the United States, hospitalizing more than a million patients each year. The occurence rate of heart failure increases with age, and with people 65 and older becoming the fastest growing segment of the population, the personal and financial burden of heart failure will likely increase.........
Posted by: Daniel Permalink Source
November 30, 2006, 4:17 AM CT
Vegetables May Help Protect Against Prostate Cancer
Our parents may have been on to something when they told us to eat our vegetables, finish eating every pea and bean on our plates.
In two separate studies it was observed that nutrients in certain foods might reduce the risk for prostate cancer, as per Jackilen Shannon, Ph.D., M.P.H., a member of the Oregon Health & Science University Cancer Institute and the Portland Veterans Affairs Medical Center. Shannon will present these findings Tuesday, Nov. 14 between 6 and 8 p.m. in Boston, Mass., at the Fifth Annual International Conference of the American Association of Cancer Research Frontiers in Cancer Prevention.
In the "Folate Nutrition, Alcohol Consumption and Prostate Cancer Risk" study, Shannon looked at the folate and alcohol consumption among two groups of veterans: 137 men who had been diagnosed with prostate cancer and 238 men who had a normal prostate specific antigen (PSA) level and thus were considered to be at low risk for prostate disease. Folate is found in foods such as dark, green leafy vegetables; liver; kidney; dried beans and mushrooms. Folate is mandatory for the production of red blood cells but also plays an important role in inhibiting a certain type of DNA damage known as methylation. DNA damage is believed to be important in the development of cancer.........
Posted by: Mark Permalink Source
November 29, 2006, 9:36 PM CT
Risks Increase On Episodic Antiretroviral Therapy
Results from one of the largest HIV/AIDS therapy trials ever conducted show that a specific strategy of interrupting antiretroviral treatment more than doubles the risk of AIDS or death from any cause. In the study, the researchers used two predetermined levels of CD4+ T cells, the primary immune cell targeted by HIV, to guide them in respectively suspending or restarting the study participants on antiretroviral treatment.
A report describing this researchwhich involved 318 clinical sites in 33 countriesappears in this week's issue of The New England Journal (NEJM). The trial, known as Strategies for Management of Anti-Retroviral Therapies, or SMART, was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
"The SMART trial has provided important new data that will help physicians and their HIV-infected patients make therapy decisions," says NIAID Director Anthony S. Fauci, M.D. "The study reflects an extraordinary global collaboration among hundreds of dedicated AIDS clinicians and thousands of their patients, all of whom should be commended for their contributions to this pivotal HIV/AIDS therapy study".
As HIV/AIDS has evolved into a chronic disease without a cure, lifelong antiretroviral treatment has become the norm. Lifelong treatment, however, can be difficult to adhere to as well as expensive. For these reasons, there has been a concerted research effort to test therapy interruption strategies that may enhance patients' quality of life and limit adverse drug effects. The experimental strategies vary in their approach to when to interrupt treatment. Some, like SMART, use a specific CD4+ count as a guide; others schedule regular time periods during which therapy is stopped (for example, alternating one month off and three months on).........
Posted by: Mark Permalink Source
November 29, 2006, 9:33 PM CT
preserve fertility after cancer
The Center for Reproductive Research at Northwestern University is launching a new, experimental research program for young women who may be at risk to lose their ovarian function and fertility following therapy for cancer.
The program, in which a woman's ovary is removed and frozen for possible future use, is being led by Teresa Woodruff, Ph.D., associate director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and executive director of the Institute for Women's Health Research at Northwestern's Feinberg School of Medicine. The long-term goal of the program is to be able to extract and mature eggs from cryopreserved (frozen) ovarian tissues to initiate pregnancies once cancer therapy has been completed.
"This breakthrough may permit not only the potential preservation of fertility options for women and girls with cancer, but also can be applied to normal in vitro fertilization patients. This procedure, when developed, could radically change the way infertility is viewed, reduce and eliminate embryo storage and provide better options for women who do not respond to hormonal treatment, " said Woodruff.
In recognition of the Cancer Center's commitment to providing fertility options to women and men with cancer, it has been recognized as a Fertile Hope Center of Excellence, the fifth medical center in the country to receive this designation. Fertile Hope is a non-profit organization that assists cancer patients faced with infertility.........
Posted by: Janet Permalink Source
November 29, 2006, 5:09 AM CT
A Sense Of Touch For Robotic Surgery Tools
Allison Okamura demonstrates her lab's scissor-based surgical simulator.
By substituting mechanical instruments for human fingers, robotic tools give surgeons a new way to perform medical procedures with great precision in small spaces. But as the surgeon directs these tools from a computer console, an important component is lost: the sense of touch.
Johns Hopkins scientists are trying to change that by adding such sensations, known as haptic feedback, to medical robotic systems. "Haptic" refers to the sense of touch.
"The surgeons have asked for this kind of feedback," says Allison Okamura, an associate professor of mechanical engineering at Johns Hopkins. "So we're using our understanding of haptic technology to try to give surgeons back the sense of touch that they lose when they use robotic medical tools".
Okamura is a leading researcher in human-machine interaction, especially involving mechanical devices that convey touch-like sensations to a human operator. In recent years, she has focused on medical applications as a participant in the National Science Foundation Engineering Research Center for Computer-Integrated Surgical Systems and Technology, based at Johns Hopkins. With funding from the National Institutes of Health and the NSF, she has established a collaboration with Intuitive Surgical Inc., maker of the da Vinci robotic system used in a number of hospitals for heart and prostate operations.........
Posted by: Scott Permalink Source
November 29, 2006, 4:56 AM CT
Painkillers May Threaten Power Of Vaccines
With flu-shot season in full swing and widespread anticipation of the HPV vaccine to prevent cervical cancer, a new University of Rochester study suggests that using common painkillers around the time of vaccination might not be a good idea.
Scientists showed that certain nonsteroidal anti-inflammatory drugs (NSAIDs), also known as cyclooxygenase inhibitors, react with the immune system in such a way that might reduce the effectiveness of vaccines.
The research has widespread implications: study authors report that an estimated 50 to 70 percent of Americans use NSAIDs for relief from pain and inflammation, even though NSAIDs blunt the bodys natural response to infection and may prolong it.
For years we have known that elderly people are poor responders to the influenza vaccine and vaccines in general, said principal investigator Richard P. Phipps, Ph.D., a professor of Environmental Medicine, and of Microbiology and Immunology, Oncology and Pediatrics. And we also know that elderly people tend to be heavy users of inhibitors of cyclooxygenase such as Advil, aspirin, or Celebrex. This study could help explain the immune response problem.
The study is available online in the Dec. 1, 2006, Journal of Immunology, and was funded in part by the National Institutes of Health. (See full study at: http://www.jimmunol.org/cgi/content/full/177/11/7811
Posted by: Janet Permalink Source
November 29, 2006, 4:34 AM CT
The impact of immunosuppressive medications
Patients with rheumatoid arthritis (RA) have an increased risk of heart attack and stroke. As per extensive evidence, the key driver for this increased risk of cardiovascular disease is the increased systemic inflammation characteristic of RA. Studies are less clear on whether medications that work to reduce RA's inflammatory symptoms provide protective benefits against cardiovascular events. Some data have suggested that the most potential biologic therapies, such as the TNF blockers, might reduce the risk of ischemic cardiovascular events.
To investigate, scientists at Harvard Medical School's Brigham and Women's Hospital compared the effects of a variety of immunosuppressive agents on cardiovascular events in a large sample of RA patients. Based on their findings, featured in the December 2006 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), TNF blockers were not linked to either a reduction or an increase in the risk of heart attack or stroke compared with the most usually used RA therapy, methotrexate. While certain anti-inflammatory drugs appeared to exacerbate the risk of heart attack and stroke for RA patients, especially among older women.
Drawing on a database of Medicare patients receiving a drug benefit from the state of Pennsylvania, the scientists identified 946 individuals who had been diagnosed with RA, prescribed an immunosuppressive agent, and hospitalized for either heart attack or stroke within a six-year period. These patients were defined as case subjects for studying the role of anti-inflammatory RA therapies in the risk of cardiovascular disease. Each case subject was matched by age and gender to ten controls. The controls, a total of 9,460 RA patients, did not experience cardiovascular events during the delineated period. All the subjects were over age 65 and most were female and white.........
Posted by: Mark Permalink Source
November 29, 2006, 4:24 AM CT
Don't Understand Prescription Medicine Labels?
When Michael Wolf paged though dusty, yellowing pharmacists logs from the 1890s at the Smithsonian National Museum of American History, he found the following entry about a druggists encounter with a confused patient: Shake well, a patient apparently read out loud to the pharmacist from his prescription bottle label. Does that mean I shake myself".
It sounds like the punch line of a bad joke, but it wasnt. And the confusion experienced by that patient more than a century ago hasnt changed much.
A number of people still dont fully understand the seemingly simple label instructions on their prescription medication, as per a new study of low-income patients by Wolf, Ph.D., assistant professor of medicine at Northwestern Universitys Feinberg School of Medicine. The study was published Nov. 29 online in Annals of Internal Medicine (www.anals.org). Wolf is presenting a position piece on how to improve those labels Nov. 29 at the American College of Physicians Foundation conference in Washington, D.C.
Wolf observed that nearly half of the patients in the study misinterpreted at least one or more out of the five prescription labels they were shown. Patients with low literacy made the most mistakes and frequently were unable to grasp four out of five label instructions. But even people with a high-school education and higher had problems.........
Posted by: Janet Permalink Source
November 28, 2006, 8:00 PM CT
How Old Is Too Old?
Average paternal age is increasing in the UK (and USA) Growing evidence shows that the offspring of older fathers have an increased risk of some birth defects, some cancers, including breast , prostate and nervous system and schizophrenia. The public health implications have not been widely anticipated or debated. In October, in the Journal of Epidemiology and Community Health , a paper was published, "Advanced Paternal age: How old is too old?', led by epidemiologist Dr. Isabelle Bray.calling for a discussion of this issue.
It is thought that there is an increased risk of certain conditions due to an accumulation of mutations etc. in the sperm of older men. It was cited that the "accumulation of damage to DNA in sperm of men age 36-57 is three times that of men <35.", They include studies of childhood cancers, childhood brain cancer, retinoblastoma, acute lymphoblastic leukemia all having increased incidence with advanced paternal age. The epidemiologists state in the article that as our appreciation of the genetic contribution to disease develops it seems probable that if the current trends in the timing of fatherhood continues, the consequences at a population level may be worth considering. To illustrate the possible scale of the effects, results from a Swedish population based cohort study have been used to estimate that the increase in paternal age since 1980 could account for 10% of new cases of schizophrenia diagnosed in the UK in 2002. Adverse health outcomes should be weighed up against potential social advantages and disadvantages for children born to older parents, mindful that these societal effects are likely to change over time. Possible interventions they imagine might include health promotions advising people about the risk of delaying childbearing or changes at a societal level (family benefits, etc.) that encourage couples to have children earlier rather than later.........
Posted by: Dorje Permalink Source
November 28, 2006, 5:11 AM CT
Aging Gene Protects Against Prostate Cancer
Cancer researchers at the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia have shown that a gene that is involved in regulating aging also blocks prostate cancer cell growth. The researchers, led by Kimmel Cancer Center director Richard Pestell, M.D., Ph.D., hope the newly found connection will aid in better understanding the development of prostate cancer and lead to new drugs against the disease.
SIRT1 is a member of a family of enzymes called sirtuins that have far-reaching influence in all organisms, including roles in metabolism, gene expression and aging.
"We know that sirtuins play a role in aging, and that the risk for prostate cancer increases with aging, but no one has ever linked the two until now," says Dr. Pestell, who is also professor and chair of cancer biology at Jefferson Medical College.
"We've shown that by making a prostate cancer with cells overexpressing a mutation for the androgen receptor, which is resistant to current forms of treatment, we can almost completely block the growth of these cells with SIRT1," he says. Dr. Pestell and his team report their findings in November in the journal Molecular and Cellular Biology.
As per Dr. Pestell, prostate cancer cells can express a mutation that makes patients resistant to current forms of therapy such as hormonal treatment. Such treatment focuses on inactivating the androgen receptor by giving agents that shut off testosterone production.........
Posted by: Mark Permalink Source