Obesity May Play A Role In Erectile Dysfunction
A new study may be an important motivational tool for obese men to lose weight! According to a study published in The Journal of Sexual Medicine, the official journal of the International Society for Sexual Medicine, obese men with erectile dysfunction (ED) are shown to have low levels of hormones, such as testosterone. A correlation between certain conditions associated with obesity, particularly hypertension, are the most important determinants of obesity-related ED.
The link between obesity and male potency dates from the Byzantine era, when it was thought that a large stomach impaired a man’s ability to have sexual intercourse. This is particularly relevant today, as the prevalence of obesity has more than doubled in the last 25 years. Excess abdominal fat, cardiovascular disease, high blood lipids and type-2 diabetes characterize a condition known as metabolic syndrome, which has recently been associated with erectile dysfunction.
The study included 2,435 male patients who sought treatment at an outpatient clinic for sexual dysfunction between 2001 and 2007. The results showed that obesity was significantly associated with a higher physical contribution to ED, while there was no difference seen with relational or psychological determinants. As the severity level of obesity increased, levels of testosterone decreased (two out of three patients with morbid obesity had low testosterone). Obese patients were also more likely to have abnormalities in penile blood flow. Psychological disturbances related to obesity did not seem to play a major role in developing obesity-related ED.
“This is a landmark study in that it shows that sexual health is clearly linked to overall health, and that improving one’s general health provides a man the opportunity to improve his erectile function” states Dr. Irwin Goldstein, Alvarado Hospital’s Sexual Medicine Director and Editor-in-Chief of The Journal of Sexual Medicine.”
Alvarado Hospital is a 306-bed acute care hospital that also operates the San Diego Rehabilitation Institute and Advanced Spine Institute, which serves patients with either inpatient or outpatient rehabilitation needs. Alvarado has more than 500 on-staff physicians, 1,000 employees and 400 volunteers who provide quality care to East County San Diego. Alvarado Hospital’s programs include cardiac services, emergency medicine services, neuroscience, orthopedics, oncology, rehabilitation, general surgical services, sexual medicine, skull base surgery, sleep center, vascular services and surgical weight reduction. http://www.alvaradohospital.com
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Skin Cancer Ups Risk Of Further Cancers
Researchers studying nearly 23,000 cases of people treated for skin cancer found that melanoma, the most severe form, was linked to double the
risk of having another primary cancer and less severe skin cancers were also linked to further primary cancers but the risks were lower than after
melanoma.
The study was the work of scientists in Northern Ireland and France, and is published in the 6 January online issue of the British Journal
of Cancer.
Malignant melanoma, also known as melanoma, is the most serious of the skin cancers. In the UK more than 9,500 people are diagnosed with it and
2,000 die every year. The incidence for non-melanoma skin cancers, which includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC),
is more than 76,500 in the UK every year. This is according to registered cases, but estimates put the figure as high as 100,000 because this type of
cancer is not always reported.
The researchers studied 14,500 cases of BCC, 6,405 cases of SCC and 1,839 cases of melanoma reported between 1993 and 2002 to the Northern
Ireland Cancer Registry. They looked for patients that went on to develop a second primary cancer and compared them to the incidence of cancer in the
general population.
They found that compared to the general population, the risk of a new cancer was more than double after melanoma, and between 9 and 57 per cent for
BCC and SCC respectively. The people who had been diagnosed with non-melanoma skin cancer had nearly double the risk of developing melanoma
and a higher risk of developing a smoking-related cancer.
One of the authors of the study, Professor Liam Murray of Queen’s University Belfast, said in a statement:
“This study confirms that people with a diagnosis of skin cancer have an increased future risk of developing another type of cancer, especially one of
the other types of skin cancer or a smoking related cancer – and for those with melanoma the risk may be more than double that of the rest of the
population.”
Speculating on possible explanations he said sun exposure was an important risk factor for all types of skin cancer, so patients who have one are
perhaps more likely to go on and develop another. Another reason might also be that a new skin cancer is more likely to be spotted in patients that are already
under observation following treatment for skin cancer.
Murray also suggested a reason for the smoking-related cancers might be “because smoking predisposes to skin cancer as well as other cancers or because people who smoke may be more likely to
have generally unhealthy lifestyles including excessive sun exposure”.
Sarah Hiom, director of health information at Cancer Research UK said:
“These important findings could help doctors target health information more accurately to people who have been treated for skin cancer to help them
reduce their risk of developing a second cancer.”
“We know that lifestyle factors such as excessive UV exposure, smoking, being overweight and drinking too much alcohol can increase the risk of
cancer,” she said.
“Winter sun seekers in search of a fast tan boost should remember to cover up, to use factor 15 plus sun cream and avoid the midday sun to prevent
burning, as well as reduce the risk of developing a second cancer,” warned Hiom.
She said it was important to note that about two thirds of melanomas and 90 per cent of non-melanoma skin cancers come from UV exposure. Even
using a sunbed once a month or more increases the risk of skin cancer by more than half, and using one before the age of 35 increases the risk of
having melanoma by up to 75 per cent.
“Second primary cancers in patients with skin cancer: a population-based study in Northern Ireland.”
M M Cantwell, L J Murray, D Catney, D Donnelly, P Autier, M Boniol, C Fox, R J Middleton, O M Dolan, A T Gavin.
British Journal of Cancer 100, 174 – 177, published online 06 Jan 2009.
doi: 10.1038/sj.bjc.6604842
Click here for
Abstract.
Sources: Queen’s University Belfast.
Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Excessive Use Of Antiviral Drugs Could Aid Deadly Flu
Influenza’s ability to resist the effects of cheap and popular antiviral agents in Asia and Russia should serve as a cautionary tale about U.S. plans to use the antiviral Tamiflu in the event of widespread avian flu infection in humans, scientists say.
Researchers analyzed almost 700 genome sequences of avian influenza strains to document where and when the virus developed resistance to a class of antiviral drugs called adamantanes and how far resistant strains spread. The analysis suggests that widespread antiviral drug use can accelerate the evolution of drug resistance in viruses, and that resistant strains can emerge and spread rapidly.
The results should serve as a warning to those who consider Tamiflu the next great antiviral medication, the researchers say. Stockpiling Tamiflu has become a standard part of many government, business and health organization plans to prepare for a long-feared pandemic flu outbreak, especially in the event that avian flu mutates enough to infect and be easily transmitted among humans.
“We can’t necessarily say what we’ve seen in adamantanes is predictive of what will happen with Tamiflu. But in the larger dynamic, perhaps it serves as a cautionary tale,” said Daniel Janies, senior author of the study and an associate professor of biomedical informatics at Ohio State University.
“Fighting infection is an arms race, and if we’re not smart about how we use our arms and understand the evolutionary implications, then we will have ongoing and accelerating problems with drug-resistant microorganisms.”
Resistance to adamantanes among strains of seasonal influenza spiked in Asia in 2002, and by 2006 the agents were considered virtually worthless worldwide as a treatment for the flu because more than 90 percent of the strains had developed a resistance to the drugs.
With that knowledge, Janies and colleagues analyzed hundreds of avian flu genomes isolated from avian, feline and human hosts between 1996 and 2007. They found that about one-third of those samples carried mutations enabling the virus strains to resist the effects of adamantane drugs.
The researchers also looked at resistance to oseltamivir-based agents (Tamiflu is the brand name for oseltamivir phosphate), but found that fewer than 1 percent of all of the samples were resistant to that class of drugs. Different classes of antivirals target influenza in different ways in the hosts’ cells.
The study is published online in the journal Infection, Genetics and Evolution.
So far, avian flu, the H5N1 strain of the influenza A virus, has been restricted to fewer than 400 human cases worldwide, but the virus’s presence in birds has led to culling of large populations of infected species. Experts believe that to date, the avian flu can be transmitted to humans only from diseased birds. But the 63-percent death rate among the humans who had the virus has led to global concerns that if H5N1 were to become highly transmissible among humans, it could start an influenza pandemic.
Janies and colleagues obtained 676 whole genomes of influenza A/H5N1 available in Genbank, a public database of sequences supported by the National Institutes of Health, as of June 2007. They then used powerful supercomputers to analyze these genomes and their various mutations.
Adamantanes fight influenza by inhibiting the function of a protein called the membrane ion channel, or the M2 protein. According to the computational comparison of the avian flu genomes, upwards of one-third of the strains contained a key mutation that changed the M2 protein in a way that allowed the virus to escape the inhibiting effects of adamantanes. To evade adamantanes, mutations can occur at several positions on the protein, suggesting that influenza can evolve in many ways to resist the drug.
The researchers also were able to demonstrate that the resistance developed as a result of natural selection, because the avian flu virus strains experienced mutations that changed the M2 protein to evade the drug more often than one would expect by chance. Sometimes, dramatic changes to the genetic code occur when diverse strains of viruses shuffle whole genes among themselves in a process called reassortment. The analysis determined that any reassortment that occurred in the H5N1 strains studied did not lead to drug resistance.
The study also showed that the mutation-mediated cases of drug resistance didn’t start in just one strain of avian flu. One resistant strain originated in China and spread through Southeast Asia, while another strain that was originally susceptible to adamantanes spread to Indonesia and then independently developed resistance in that country. The Google Earth map offers a vivid visualization of exactly where in the world these resistant lineages originated and where they are spreading.
At the height of their popularity in China and Russia, adamantanes were added to over-the-counter cold medicines and were also given to animals in some agricultural settings.
“We don’t have hard data on how it was used or whether it was appropriately or inappropriately used, but in general, people are putting a lot of antimicrobials into the environment now,” Janies said. “When people do that, they change the selective landscape. The virus would rather remain in its wild type form, but that one gets killed by the drug. So according to the survival of the fittest, a slightly modified virus can spread by escaping the effects of the drug.”
Researchers believe that Tamiflu has not been used widely anywhere in the world except Japan, and no pattern of resistance similar to that seen for adamantanes has emerged. However, recent reports have suggested a spike of resistance to oseltamivir in strains of seasonal influenza have occurred in Northern Europe and Canada. In analyzing the avian flu genomes, the researchers looked for mutations that would show the virus’s ability to resist the oseltamivir class of drugs to which Tamiflu belongs. These drugs fight flu by inhibiting the neuraminidase protein in the virus.
“Resistance to Tamiflu was not nearly as widespread as is resistance to adamantanes,” Janies said. “But based on our results, we know resistance to Tamiflu can occur spontaneously in nature, we know it can occur in patients, and we know Tamiflu is widely used in Japan. We should continue to watch for resistance, and use this adamantane history as a warning.”
A critical part of any genome comparison is assembling supercomputers that allow researchers to put complex data into context.
“Genomes are represented as raw, partially annotated strings of letters. Each genome on its own doesn’t tell you much because all you see is a single state. What we need to see is change over time to find the evolutionary history. That requires computational power to match like regions of the genome, put the data into context and see the trajectory of the change,” Janies said.
The result is called a phylogenetic tree that documents the shared mutations. Phylogenetics is the study of the evolutionary relationships among various biological species believed to have a common ancestor. In this analysis, the phylogenetic tree is projected into Google Earth and animated to show when mutations emerged and where drug-resistant avian flu strains are traveling.
Key to any ongoing tracking of antiviral drug resistance will be the broad availability of genomic data, Janies said. The technology exists to do the job, but worldwide cooperation in data sharing is still a work in progress.
“Not all viruses that are isolated are sequenced, and not all viral genomes that have been sequenced are shared,” he said.
With this publication, Janies and colleagues have done some sharing of their own, establishing a service for other researchers at http://supramap.osu.edu.
“Anyone can go there, upload genomes, and our computers will calculate a tree for them and give them both the tree and that tree data mapped into the earth. We’re rolling out our methods and making our supercomputer available for anyone in the world to do this kind of work,” Janies said.
This research is supported by the U.S. Army Research Laboratory and the U.S. Army Research Office; the Hewlett Packard Corp.; the Ohio Supercomputer Center; and the Department of Biomedical Informatics and School of Biomedical Sciences within Ohio State’s College of Medicine.
Janies’ coauthors are Andrew Hill, Meredith Wilson and Robert Guralnick of the University of Colorado and Farhat Habib, a former Ohio State graduate student now at Kansas State University.
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Unique Skeletal Muscle Design Contributes To Spine Stability
The novel design of a deep muscle along the spinal column called the multifidus muscle may in fact be key to spinal support and a healthy back, according to researchers at the University of California, San Diego School of Medicine. Their findings about the potentially important “scaffolding” role of this poorly understood muscle has been published on line in advance of the January issue of the Journal of Bone and Joint Surgery.
“The multifidus muscle was formerly thought to be relatively unimportant based on its fairly small size,” said Richard L. Lieber, Ph.D., Professor and Vice Chair of UC San Diego’s Department of Orthopedic Surgery and Director of the National Center for Skeletal Muscle Rehabilitation Research, based at UC San Diego. Lieber is also Senior Research Career Scientist at the Veterans Affairs San Diego Health System. “Our research shows that it’s actually the strongest muscle in the back because of its unique design. It’s like a long, skinny pencil packed with millions of tiny fibers.”
The researchers discovered that the multifidus has a unique packing design consisting of short fibers arranged within rods, and that these fibers are stiffer than any other in the body. Using laser diffraction methods that they developed to measure muscle internal properties during back surgery, they demonstrated that the multifidus’ unique design serves a critical function as a stabilizer of the lumbar spine. These findings could have implications for surgery, according to Steven R. Garfin, M.D., Professor and Chair of UCSD’s Department of Orthopaedic Surgery.
“It is important to identify what each individual muscle does, and this is just a start, showing that the multifidus contributes significantly to spinal stabilization,” said Garfin. “The more we know about what muscles do, the better we can devise therapeutic interventions such as physical therapy to target specific muscles.”
Garfin explained that currently surgery to treat spinal disorders could actually disrupt the multifidus muscle, which could lead to decreased stabilization and lower back pain. Minimally invasive spine surgery techniques strive to minimize surgical trauma to these muscles in order to best preserve their function.
The lower back, or lumbar spine, can be vulnerable to many pain-causing injuries or disorders because the lumbar vertebrae carry the most body weight and are subject to the most force and stress along the spine. Muscular instability is a risk factor in many injuries and consequent chronic lower back pain, according to Lieber.
“The multifidus back muscle keeps us vertical and takes pressure off the discs,” said Lieber. “When muscle function is poor due to back problems, support is lost.”
He explained that many muscles get weaker as they are extended. But the researchers discovered that, unlike all other muscles, the multifidus actually becomes stronger as it lengthens, when the spine flexes.
“The length of the sarcomere the structure within the muscle cell where filaments overlap to produce the movements required for muscle contraction is shorter in the multifidus than in any other muscle cell,” explained study’s first author Samuel R. Ward, P.T., Ph.D., Assistant Professor of Radiology at UC San Diego School of Medicine. “But as it gets longer, for instance as a person leans forward, the multifidus actually strengthens.”
Contributing authors to the study include UCSD researchers Choll W. Kim, M.D., Ph.D., Carolyn M. Eng, B.S., Lionel J. Gottschalk, B.S.; and Akhito Tomiya, M.D., Ph.D. Tohoku University School of Medicine, Sendai, Japan. Research was supported by the Department of Veterans Affairs Rehabilitation, Research and Development; the National Institutes of Health and DePuy Spine of Raynham, MA.
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Heart Valves Implanted Without Open-Heart Surgery
An innovative approach for implanting a new aortic heart valve without open-heart surgery is being offered to patients at NewYork-Presbyterian Hospital/Columbia University Medical Center. Known as the PARTNER (Placement of AoRTic traNscathetER valves) trial, this Phase 3 multicenter study is being led by national co-principal investigators Dr. Martin Leon and Dr. Craig Smith and is focused on the treatment of patients who are at high risk or not suitable for open-heart valve replacement surgery.
The Edwards SAPIEN transcatheter heart valve, made of bovine pericardial tissue leaflets hand-sewn onto a metal frame, is implanted via one of two catheter-based methods — either navigated to the heart from the femoral artery in the patient’s leg, or through a small incision between the ribs and into the left ventricle. It is then positioned inside the patient’s existing valve, using a balloon to deploy the frame, which holds the artificial valve in place. Both procedures are performed on a beating heart, without the need for cardiopulmonary bypass and its associated risks.
“This breakthrough technology could save the lives of thousands of patients with heart valve disease who have no other therapeutic options,” says Dr. Leon, the study’s national co-principal investigator, associate director of the Cardiovascular Interventional Therapy (CIVT) Program at NewYork-Presbyterian Hospital and Columbia University Medical Center, and professor of medicine at Columbia University College of Physicians and Surgeons.
Annually, some 200,000 people in the U.S. need a new heart valve, but nearly half of them do not receive a new valve for a variety of reasons.
“This study may show that transcatheter valve replacement is a safe and effective alternative to open surgery, which remains the ‘gold standard’ for most patients,” says Dr. Smith, study co-principal investigator, interim surgeon-in-chief and chief of cardiothoracic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, and the Calvin F. Barber Professor of Surgery at Columbia University College of Physicians and Surgeons.
The transcatheter valve procedures take about 90 minutes, compared with four to six hours for open-heart surgery. In open-heart surgery, the surgeon cuts through the breastbone, stops the heart, removes the valve and replaces it. Open-heart surgery can require a two- to three-month recovery period, compared to only a few days for the transcatheter approach.
The PARTNER trial is a prospective randomized study with two separate treatment arms. In the surgical arm, patients are randomized to receive either the Edwards SAPIEN transcatheter heart valve or an Edwards surgical valve via open-heart surgery. In the non-surgical, medical management arm, patients considered to be non-operative are randomized to receive either the Edwards SAPIEN transcatheter heart valve or appropriate medical therapy.
The PARTNER trial is designed for patients with severe aortic stenosis — a narrowing of the valve that restricts blood flow from the heart — who are not good candidates for surgery due to age or other concurrent health factors.
The PARTNER trial will also be available at NewYork-Presbyterian Hospital/Weill Cornell Medical Center’s Ronald O. Perelman Heart Institute, led by surgeon Dr. Karl H. Krieger and interventional cardiologist Dr. Shing-Chiu Wong.
The Edwards SAPIEN transcatheter heart valve is manufactured by Edwards Lifesciences of Irvine, Calif., which is also funding the study.
Aortic Heart Valve Disease
The heart’s four valves each have two or three strong tissue flaps, or leaflets, which open and close with each heartbeat, approximately once every second throughout a person’s life. When working properly, heart valves ensure that blood flows in the right direction. But when damaged by congenital conditions or progressive disease, these valves can become defective and inhibit efficient blood flow to the body. The aortic valve in particular is prone to age-related stenosis, a narrowing and calcification of the valve opening that, over time, may inhibit adequate oxygenated blood flow to the circulatory system. Aortic valve stenosis may progress for years, with patients experiencing symptoms similar to those associated with aging such as increased fatigue and shortness of breath. As the condition deteriorates, patients also may experience angina (chest pain), light-headedness or fainting. Left untreated, aortic valve disease can ultimately lead to death. More than 5 million Americans have moderate to severe valve disease, where at least one valve does not work properly.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia’s College of Physicians & Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. For more information, please visit www.cumc.columbia.edu.
NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital, based in New York City, is the nation’s largest not-for-profit, non-sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 230,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children’s Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report’s guide to “America’s Best Hospitals,” ranks first on New York magazine’s “Best Hospitals” survey, has the greatest number of physicians listed in New York magazine’s “Best Doctors” issue, and is included among Solucient’s top 15 major teaching hospitals. The Hospital’s mortality rates are among the lowest for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation’s leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit http://www.nyp.org.
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Six Things Women Should Know About The Pap Test
January is Cervical Cancer Awareness Month and The University of Texas M. D. Anderson Cancer Center shares important information about the cervical cancer screening exam, the Pap test.
For many women, their annual Pap test is not something to look forward to; however, this test has the potential to make a huge difference in the lives of women everywhere. The Pap test detects cell changes, which may cause cervical cancer. If these cell changes are found and treated early, cervical cancer may be prevented.
Andrea Milbourne, M.D., associate professor in M. D. Anderson’s Department of Gynecologic Oncology, explores six facts women should know about this important test.
1. Increased sexual activity equals increased need for a Pap test.
Increased sexual activity raises a woman’s risk for acquiring the human papilloma virus (HPV). While HPV can be harmless, it also can cause cervical cancer by changing normal cells in the cervix.
“Because condoms do not provide 100 percent protection against HPV, women who are sexually active and not in a monogamous relationship need to be even more vigilant about following cervical cancer screening guidelines,” Milbourne said.
2. The HPV vaccine is a supplement, not a replacement for the Pap test.
Getting the HPV vaccine, or encouraging young female family members to consider it, is a great first step toward cervical cancer prevention. That being said, the vaccine is in no way a substitute for the Pap test.
“The vaccine may give women a false sense of security,” Milbourne said. “And because getting a Pap test is not what most women consider a favorite activity, getting the vaccine might cause them to procrastinate even more to make an appointment for their next Pap test.”
Because the HPV vaccine does not protect against all types of HPV, or other sexually transmitted diseases, it cannot be the only method of cervical cancer prevention. Women also should remember that cervical cancer doesn’t have many visible symptoms, which makes the Pap test significantly important in preventing cervical cancer.
3. Women should prepare for an upcoming Pap test.
Milbourne recommends a few tips to help women prepare for an upcoming test:
– Avoid douching or using vaginal medicines, spermicidal foams, creams or jellies 48 hours before the test.
– Do not have sexual intercourse 48 hours before the test.
– Reschedule a Pap test appointment if an unexpected heavy menstrual flow occurs on the day of the exam.
“Lubricants, spermicides, douching and sexual activity can interfere with the interpretation of Pap test results, potentially leading to incorrectly interpreted results or the need for repeat tests,” Milbourne said.
4. A woman is never too old to get her Pap test.
Of all the benefits that might come with growing older, skipping a regular Pap test for a sexually active woman over age 65 is not one of them.
As female life expectancy gets longer, many women continue to enjoy sexually active lives throughout their sixties and into their seventies.
“For women over age 65, cervical cancer is rare, but it does happen,” Milbourne said. “If you are over age 65, sexually active and not in a monogamous relationship, you should continue your annual Pap test, as you are still susceptible to HPV, which can cause cervical cancer.”
5. Women can afford a Pap test.
“Without health insurance or access to affordable health care, a Pap test can be costly,” Milbourne said. “For women who can not afford a Pap test, there may be places in your community where you can get one for free.”
6. Before the Pap test, cervical cancer was a leading cause of death in American women.
The American Cancer Society estimates that about 3,870 women died from cervical cancer in the United States during 2008. This number is low compared to annual statistics for other more common cancer types, such as breast or lung cancer, but what most people do not know is that cervical cancer was once one of the most common causes of cancer death in American women.
As the Pap test became a standard test for American women, doctors were able to find abnormal changes in the cervix before cancer developed. Between 1955 and 1992, the cervical cancer death rate declined by 74 percent.
“While the cervical cancer death rate continues to decline in the United States, women in countries where Pap tests are not as readily available or affordable still face the challenges, shared by American women more than 50 years ago,” Milbourne said.
Cervical cancer is the second largest cause of female cancer deaths worldwide, according to the World Health Organization, with 288,000 deaths each year. About 510,000 cases of cervical cancer are reported each year nearly 80 percent are in developing countries.
For additional information, visit http://www.mdanderson.org/focused.
M. D. Anderson experts available for interview:
Andrea Milbourne, M.D., Associate Professor, Department of Gynecologic Oncology
Milbourne’s interests include evaluating women with preinvasive disease of the lower genital track. She also is involved in providing counseling for women with non-gynecologic malignancies about contraception, preservation of fertility, and dealing with sexual and psychological issues during and after cancer treatment. Milbourne also treats pregnant patients with cancer. Milbourne is a collaborator in several research projects and currently is investigating fertility preservation during cancer treatments and novel approaches to cervical cancer screening.
Helen E. Rhodes, M.D., Associate Professor, Department of Gynecologic Oncology
Rhodes’ clinical focus includes providing comprehensive consultative gynecologic care for M. D. Anderson patients, regardless of their primary cancer diagnosis. She also provides evaluation and treatment for women with pre-malignant diseases of the female genital tract. Her surgical focus includes expanding the use of minimally invasive surgical techniques. Rhodes’ research interests include investigating optical imaging techniques as diagnostic tools for the vulva, vagina, cervix and ovary. She also serves as the director of colposcopy and preinvasive diseases in the Department of Gynecologic Oncology.
About M. D. Anderson
The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For five of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News and World Report.
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Gene Marker May Improve Odds Of Stem Cell Therapies For Disease
A single tumor-suppressor gene may provide a unique marker for senescence in Mesenchymal stem cells (MSCs) in vitro, while also playing a role in moving MSCs into senescence, researchers at the Human Health Foundation and the Sbarro Institute for Cancer Research and Molecular Medicine report. Their work was published in Stem Cells and Development.
The finding is important, since MSCs are currently being tested in cell and gene therapy for a number of human diseases.
When injected into the body, MSCs have the unique ability to differentiate into a variety of cells. But before they can be employed for therapeutic uses, the stem cells must be cultivated in vitro. During this process, MSCs are often compromised when they enter senescence, or aging, which limits their capacity to proliferate and differentiate into new tissues, making them useless for treatment.
In the current study, researchers studied senescent MSCs drawn from rats in vitro. MSCs in senescence showed a downregulation, or decrease, in several genes involved in stem cell self-renewal and DNA repair, including Rb1 and p107 gene expression.
However, pRB2/p130, a tumor suppressor gene first identified by Antonio Giordano, Director of the Sbarro Institute for Cancer Research and Molecular Medicine at the College of Science and Technology at Temple University and a “Chiara Fama” Professor at the University of Siena, Italy, and a co-author of the paper, became the prominent RB protein.
“By studying the process of senescence in MSCs we have arrived at new possibilities to improve the therapeutic capabilities of the stem cells in transplantation,” said Giordano.
“The presence of Rb2 during senescence raises the possibility it may provide an early marker of the process,” said co-author Umberto Galderisi, a Professor at the University of Naples and an Adjunct Associate Professor at the Sbarro Institute for Cancer Research and Molecular Medicine at Temple University. “Next we will work to confirm our data by seeing the impact when Rb2 is silenced in these stem cells.”
The Human Health Foundation (HHF) (http://www.hhfonlus.org) is a nonprofit organization designed to develop and fund biomedical research in Italy. Along with developing new medical research centers, HHF promotes and supports novel methods for the prevention, diagnosis and treatment of cancer and other illnesses; implements and designs new initiatives to exchange and spread the results of new research; and design original programs to inform and increase public awareness of health and research issues.
Sbarro Health Research Organization (http://www.shro.org), a leader in cancer, cardiovascular, and diabetes research, a nonprofit charitable organization, supports the Sbarro Institute for Cancer Research and Molecular Medicine located at Temple University in Philadelphia.
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NO Help: Nitric Oxide Monitoring Does Not Help Most Children With Asthma
The level of nitric oxide (NO) in an asthmatic’s exhaled breath can portend worsening asthma symptoms, and may even signify an imminent attack linked to underlying airway inflammation. This has made the monitoring of NO levels, particularly in children, of significant interest as a potential way to help clinicians fine-tune medications and improve treatment outcomes. However, a recent multi-center prospective study found that calibrating medications based on daily monitoring of the fractional exhaled nitric oxide (FENO) and symptoms in asthmatic children showed no significant improvement over medicating based on daily symptom monitoring alone.
The results were reported in the second issue for January of the American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society.
Johan C. de Jongste, M.D., Ph.D., at the Erasmus University Medical Center-Sophia Children’s Hospital in the Netherlands, and colleagues randomized 151 children from 15 academic centers and hospitals with mild to moderate asthma to a 30-week monitoring course. Families were called every three weeks and reported on the daily symptoms in the prior three weeks. The child’s medication was adjusted accordingly.
The researchers compared the rates of exacerbation, symptoms, use of medications and other endpoints between the last 12 weeks in the two groups. There were no significant differences whether or not FENO had been part of the daily monitoring. However, both groups enjoyed an impressive overall improvement in symptoms, despite a reduction of about 50 percent in inhaled steroid dose, suggesting considerable benefit of frequent monitoring.
“We speculate that daily supervision and frequent phone contacts have produced an improvement that could not be beaten by additional monitoring of FENO, most likely because of a ceiling effect on compliance,” wrote Dr. de Jongste.
The FENO group did, however, have nearly twice as many dosage changes as the symptom-only group, which supports the idea that the lack of difference may be a reflection on the limits of compliance, rather than an inherent limitation in the technique. Still, the added cost and apparent lack of benefit of daily FENO monitoring found in this study suggests that applying the technique in this way is not of benefit to the asthmatic population at large, when compared to daily symptom monitoring.
Another possible explanation for the lack of improvement is that FENO monitoring is most likely to prompt a medication change that symptom-only monitoring would not suggest in patients whose symptoms and underlying inflammation are in discord, but the current study was not designed to assess these patients independently.
Still, in light of these findings, it is clear that FENO monitoring should only be applied to those who stand to gain the most. “There can be no doubt that adding frequent assessments of FENO to management plans of most children and adults with asthma will add unjustifiable costs without providing clinical benefit. Whether there is a role for monitoring FENO to aid management of severe asthma is untested,” wrote Stephen Stick, Ph.D., of the Princess Margaret Hospital for Children in Perth, Australia and Peter Franklin, Ph.D., of the Centre for Asthma, Allergy and Respiratory Research at the University of Western Australia in Perth in an editorial that accompanied the article.
“We did not address other possible applications of frequent FENO monitoring, such as prediction of steroid effect. Loss of control, prediction and prevention of exacerbations, and tapering of steroids in symptom-free children who wheezed in the past,” noted Dr. de Jongste. “We think there is good reason to study these potential applications.”
Furthermore, as D. Robin Taylor, M.D., of the Dunedin School of Medicine at the University of Otago, in New Zealand, pointed out in separate editorial, “FENO measurements shed complementary light on the underlying inflammatory phenotype and, more importantly, on the potential response to anti-inflammatory treatment. Historically, this has been assessed either by empiric “trials of steroid” or, even more imperfectly. With reference to before/after changes in spirometry, serial or repeated FENO measurements in individual patients may provide additional diagnostic as well as prognostic insights.”
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Study On Origin Of Mutation That Causes Fatal Familiar Insomnia
A PhD thesis at the University of the Basque Country (UPV/EHU) has studied the origin of the mutation that causes Fatal Familiar Insomnia (FFI). In the Autonomous Community of the Basque Country there is a high rate of carriers of this mutation 50%of all the cases registered in the whole of Spain.
Fatal Familiar Insomnia (FFI) is one of the diseases considered as rare there are less than 100 cases described throughout the world. FFI prevents the patient getting to sleep to the point where she or he cannot ever sleep and which, after a number of months thus, causes death. ILF is a genetic illness caused by the D178N mutation and belonging to the group of diseases known as Transmissible Spongiform Encefalopathies (TSE).
The author of the PhD is Ms Ana Belén Rodríguez Martínez, who presented her thesis with the title, Fatal Familiar Insomnia in the Basque Country: the search for the founding effect of mutation D178N (-129M) and the effects of oxidative stress on retrospective samples. Ms Rodríguez has a degree in Biology and currently works as an associate researcher on a Neiker-Tecnalia project. She carried out her research thesis under the direction of Dr. Marian Martínez de Pancorbo, Profesor of Cell Biology at the UPV/EHU Pharmacy Faculty and of Dr. Juan José Zarranz, Head of Neurology at Cruces Hospital and Professor of Neurology in the Faculty of Medicine and Odontology at the UPV/EHU.
The undertaking of this PhD thesis has been possible thanks to the collaboration by and participation of health researchers and professionals from various spheres, both national and international (The bodies and institutions referred to are detailed at the end of the paper).
Origin of the mutation
In 1996, following on from the outbreak of the Creutzfeldt-Jakob (“mad cow”) disease, the European Union launched systems for monitoring the prionic group of illnesses the group to which FFI belongs. It was only then that the high rate of carriers of the mutation (D178N) responsible for FFI was detected in the Basque Country Autonomous Community (with 50% of all cases registered in Spain).
The area is characterised by its mountainous orography, and which has favoured cultural and genetic isolation. These features caused researchers to think that there might be a ‘founder effect’ of the mutation in the Basque Country ‘founder effect’ is when a new population of individuals is formed from a very small number, with a large proportion thereof carrying the same genetic characteristics.
Given this situation, three targets were set: to look for the possible founder effect of the D178N mutation amongst patients in the Basque Country; establish relations between carriers in the Basque Country with other cases in Spain and Europe; and fix the historical time of the most recent common ancestor.
Same genetic families
After studying cases of FFI in the Basque Country, the researcher observed that genetic families amongst the patients coincided with each other. She concluded, thus, that the high rate of the disorder is due to a ‘founder effect’ of the mutation in this geographical area. Moreover, genealogical data link most of the cases and fix the oldest mutation carrier generations in an area in the south of the Basque Country in the XVII and XVIII centuries.
In comparison with other regions, Dr. Rodríguez concluded that links can be established between cases in Germany and those of the Italian Veneto region, on the one hand; between Italians of Tuscany and some Spanish cases, on the other; and that not all Spanish cases have the same origin. On estimating the age of the most recent common ancestor, they were able to calculate that two of these variants of the mutation arose over 2,000 years ago.
Bodies and institutions collaborating:
The Autonomous Community of the Basque Country (CAPV)
- Epidemiological Monitoring System of the CAPV.
- Neurology Service and the Pathological Anatomy Service at Txagorritxu Hospital in Araba.
- Neurology Service, Santiago Hospital, Araba.
- Neurology Service, Cruces Hospital, Bizkaia.
- Neurology Service, Basurto Hospital, Bizkaia.
State (Spain)
- Carlos III Health Institute, Madrid.
- Immunology Service of the Creutzfeldt-Jakob Disease Biodiagnostic Unit at the Unit for Alzheimer Disease and Other Cognitive Disorders of the Hospital Clinic (Barcelona).
International
- Victor Segalen University, Bordeaux 2, France.
- National TSE Reference Centre, Göttingen, Germany.
- Department of Neurological Sciences, Bologna University, Italy.
Elhuyar Fundazioa
http://www.basqueresearch.com
Early Repeat Cesarean Riskier To Baby
Researchers in the US found that compared with deliveries at or after 39 weeks, elective repeat cesareans carried out before 39 weeks of gestation
were linked to higher risk of the baby having serious complications, including respiratory distress requiring mechanical ventilation and admission to
the NICU.
The study was the work of Dr Alan T.N. Tita, assistant professor at the University of Alabama at Birmingham (UAB) Department of Obstetrics and
Gynecology Division of Maternal-Fetal Medicine, and colleagues and is published online on January 8 in the New England Journal of Medicine,
NEJM.
For the study, Tita and colleagues studied records of 13,258 women who had elective repeat cesarean sections between 1999 and 2002 at 19
university-based clinical centers belonging to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Maternal-Fetal Medicine Units (MFMU) Network.
They selected the women from the Cesarean Section Registry of the MFMU network, which contained data on nearly 50,000 women who had already
had one cesarean and had either a repeat cesarean or a trial of labor in an MFMU network center over the 4 years of the study. The records they
selected were only of women who had an elective cesarean of a viable infant at 37 weeks or later, without other indications for early cesarean delivery
(eg labor or other obstetric or medical indications) before 39 weeks.
From the selected records, Tita and colleagues looked to see whether babies delivered at 37 weeks later died or were diagnosed with conditions such
as respiratory distress syndrome and/or transient tachypnea of the newborn, seizures, necrotizing entercolitis, newborn sepsis, and hypoxic ischemic
encephalopathy.
They also looked at whether the babies had required ventilator support during their first 24 hours of birth, had an umbilical cord arterial pH below 7.0
(was there enough oxygen in their bloodstream during birth), an Apgar score at five minutes of three or below (this assesses general health including
reflexes, breathing and muscle tone), were admitted to NICU (neonatal intensive care unit), or needed longer than usual hospitalization.
The results showed that of the 13,258 women who had elective repeat cesarean sections, 35.8 per cent were delivered before 39 weeks.
Infants born at 37 weeks were two times more likely to have conditions common to babies born too soon, and infants born at 38 weeks, were 1.5
times more likely.
Tita said these results, which corroborate those of other studies, emphasize the the importance of not delivering a baby before 39 weeks for the sake of
convenience.
“Unfortunately, these early deliveries are associated with a preventable increase in neonatal morbidity and NICU admissions, which carry a high
personal and economic cost,” said Tita.
“These findings support recommendations to delay elective delivery until 39 weeks gestation and should be helpful in counseling women on the
necessity of waiting to deliver,” he added.
In the ten years from 1996 to 2006, the rate of cesarean births in the US has risen from 20.7 to 31.1 per cent. Tita said that because this type of
delivery can be “scheduled to accommodate patient and physician convenience”, it introduces the risk that it might be performed earlier than is
appropriate:
“We knew from previous small studies that infants born before 39 weeks’ gestation are at increased risk for respiratory distress,” said Tita.
“Because nearly 40 percent of the cesareans performed in the United States each year are repeat procedures, we undertook this large study to describe
the timing of elective repeat cesareans and assess its relationship with the risk of various adverse neonatal outcomes,” he explained.
“Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes.”
Tita, Alan T.N., Landon, Mark B., Spong, Catherine Y., Lai, Yinglei, Leveno, Kenneth J., Varner, Michael W., Moawad, Atef H., Caritis, Steve N.,
Meis, Paul J., Wapner, Ronald J., Sorokin, Yoram, Miodovnik, Menachem, Carpenter, Marshall, Peaceman, Alan M., O’Sullivan, Mary J., Sibai, Baha
M., Langer, Oded, Thorp, John M., Ramin, Susan M., Mercer, Brian M., the Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units
Network.
N Engl J Med Volume 360, No 2, pages 111-120, published online 8 January 2009.
Click here for Abstract.
Sources: NEJM, University of Alabama at Birmingham.
Written by: Catharine Paddock, PhD
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