23 Feb

Medical News Today: Eating fruits and vegetables reduces lung disease risk

Research, published this week in Thorax, finds a link between eating greater quantities of fruits and vegetables and lung health. They found it lowered the risk of developing chronic obstructive pulmonary disease in former and current smokers.
[Lungs colored X-ray]
Consuming more fruit and veg might stave off lung disease.

The health benefits of eating a range of fruits and vegetables are well documented; reams of research has already made this clear.

For instance, increasing their consumption helps reduce cardiovascular risk, maintain a healthy blood pressure, and stave off cancer, to name but a few.

Recently, there have been a number of studies demonstrating that consuming fruit and veg might also protect lung health.

Chronic obstructive pulmonary disease (COPD) is a range of conditions characterized by a narrowing of the airways, including emphysema and bronchitis. Worldwide, COPD currently affects more than 64 million people.

The major risk factor for COPD is smoking, and the World Health Organization (WHO) predict that, by 2030, it will become the third leading cause of death on a global basis.

COPD and dietary factors

Some earlier studies have found that dietary factors might play a role in COPD. To delve into this question in more detail, a group of researchers tracked the respiratory health of more than 44,000 Swedish men. Aged 45-79 at the start of the trial, the participants were followed for an average of 13.2 years, up to the end of 2012.

Each participant completed a food frequency questionnaire that collated how often they ate 96 different food items in 1997, the first year of the study. Other factors were also collected, including height, weight, education level, physical activity, and alcohol consumption.

The participants were asked how many cigarettes they smoked, on average, at ages 15-21, 21-30, 31-40, 41-50, and 51-60. Overall, 63 percent had smoked at one point in their life, 24 percent were current smokers, and 38.5 percent had never smoked.

Occurrences of COPD were registered across the time period; there were 1,918 in total. The rate of COPD in those who ate fewer than two portions of fruits and vegetables per day was 1,166 per 100,000 people in current smokers and 506 per 100,000 in former smokers.

However, for those eating five portions per day, the equivalent numbers were 546 and 255, respectively. This means that individuals eating five daily servings of fruits and vegetables had a 35 percent reduced risk of developing COPD compared with those eating two or less portions. When the reduction in risk was split into current and former smokers, the percentages were 40 percent and 34 percent, respectively.

Each extra serving of fruits and vegetables was associated with a 4 percent lower risk of COPD in former smokers and an 8 percent lower risk in current smokers.

Compared with individuals who had never smoked and who ate five or more portions of fruits and vegetables, current and former smokers who ate fewer than two daily portions were 13.5 times and six times more likely to develop COPD, respectively.

The authors conclude:

“The present findings confirm the strong impact of cigarette smoking on the development of COPD and also indicate that diet rich in fruit and vegetables may have an important role in prevention of COPD.

Nevertheless, nonsmoking and smoking cessation remain the main public health message to prevent development of COPD.”

Which fruits and vegetables reduced COPD risk?

As part of the analysis, the researchers assessed which particular foodstuffs were most effective at reducing the COPD risk. They found that green leafy vegetables, peppers, apples, and pears had the strongest influence on reducing risk.

However, berries, citrus fruits, bananas, root and cruciferous vegetables, tomatoes, garlic, onions, and green peas did not exert a significant effect.

Because smoking increases oxidative stress and inflammation, both of which are potentially involved in COPD, the antioxidants present in fruits and vegetables might help reduce their negative impact.

Although the study was conducted on a large scale, it still needs replication. An editorial, released in the same publication, written by Dr. Raphaelle Varraso and Dr. Seif Shaheen, argues that because this study is observational, no firm conclusions can be drawn regarding cause and effect; however, they write:

“[I]t could be argued that there is nothing to be lost by acting now. We would argue that clinicians should consider the potential benefits of a healthy diet in promoting lung health, and advocate optimizing intake of fruits and vegetables, especially in smokers who are unable to stop smoking.”

So, although more research will be needed before conclusions can be definitively drawn, quitting smoking and eating more fruits and vegetables is still the best course of action for overall health.

Read how an “airway-on-a-chip” could yield new treatments for COPD.

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Source: medicalnewstoday

23 Feb

Medical News Today: Periodontitis may be an early sign of type 2 diabetes

A new study suggests severe gum disease – also known as periodontitis – may be an early marker of type 2 diabetes.
[gums and teeth]
New research suggests there may be a link between gum disease and diabetes.

According to the latest data, diabetes affects approximately 422 million people worldwide, and this number is expected to increase.

In the United States, 29 million people live with the disease. Of these, over 8 million people have it but have not been diagnosed, according to the Centers for Disease Control and Prevention (CDC).

The CDC also estimate that 37 percent of American adults over the age of 20 have prediabetes.

New research – published in the journal BMJ Open Diabetes Research & Care
– suggests severe gum disease, or periodontitis, might be an early sign of diabetes.

The authors also suggest a simple finger stick diabetes screening procedure could be carried out in the dental office to avoid the adverse effects of leaving diabetes untreated.

Studying the link between severe gum disease and diabetes

Researchers from the University of Amsterdam in The Netherlands assessed a total of 313 participants from a dental clinic at the university.

Of these, 126 patients had mild-to-moderate gum disease, 78 patients had severe periodontitis, and 198 individuals did not have signs of gum disease.

Participants with periodontitis had a higher body mass index (BMI) than the rest, with an average BMI of 27. However, other diabetes risk factors – such as high blood pressure or high cholesterol – were similar across all three groups.

The researchers analyzed higher glycated hemoglobin (HbA1c) values in dry blood spots, and evaluated the differences in mean HbA1c values, as well as the prevalence of diabetes and prediabetes between the two groups.

HbA1c values measure the average level of blood sugar in the last 2-3 months. The dry blood spots were obtained by sampling participants’ blood using a finger pin-prick test.

Prediabetes is commonly considered to range between an HbA1C value of 39-47 millimoles per mol (mmol/mol).

Most diabetes cases found among those with periodontitis

The analysis revealed that those with the most severe form of periodontitis also had the highest HbA1c values.

The average HbA1c values for the severe gum disease group was 45 mmol/mol, compared with 43 mmol/mol in those with mild-to-moderate gum disease and 39 mmol/mol among those without gum disease.

Additionally, the researchers found a high percentage of people with suspected diabetes and prediabetes among participants with mild-to-moderate as well as severe gum disease.

In the severe gum disease group, 23 percent of study participants were suspected of diabetes, whereas 14 percent of the mild-to-moderate gum disease participants had suspected diabetes. In the severe gum disease group, 47 percent had prediabetes, and 46 percent of those in the mild-to-moderate group had prediabetes.

By comparison, 37 percent of those with no gum disease had prediabetes, and 10 percent had suspected diabetes.

Additionally, the researchers found previously undiagnosed cases of diabetes across the three groups: 8.5 percent of those with no gum disease and a little under 10 percent of those with mild-to-moderate gum disease had not been previously diagnosed with the disease until the study.

As much as 18 percent of those with severe gum disease had not been diagnosed with diabetes.

The study is observational, so it cannot explain a causal link between gum disease and diabetes. However, the authors suggest that screening patients with severe periodontitis for diabetes as part of dental medical practices might be an effective way of avoiding complications of the disease. The authors conclude:

“[The findings confirm] the assumption that severe periodontitis could be an early sign of undiagnosed diabetes […] The early diagnosis and intervention of prediabetes prevent the common microvascular and macrovascular complications and are cost-effective.”

Read about how insulin-producing cells could be formed using malaria drugs.

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Source: medicalnewstoday

23 Feb

Medical News Today: Schirmer's test: What to expect with the dry eye test

Doctors use the Schirmer’s test to work out if a person’s eyes make enough tears to keep the eyes moist. If the eyes don’t produce enough moisture, a doctor may choose to treat the patient for dry eye.

This article will look at exactly what the test entails and when people can expect it to be used. Alternative options to the Schirmer’s test will also be examined.


What is the Schirmer’s test?

Ladies tears
A Schirmer’s test has been used for around 100 years and measures tears, which keep the eye healthy and moist.

A Schirmer’s test determines whether a person’s eye produces enough tears to keep their eye moist and healthy. To conduct a Schirmer’s test, a doctor places a piece of filter paper inside the lower eyelid of both eyes and the person closes their eyes.

After 5 minutes, the doctor removes the filter paper. The doctor then assesses how far the tears have travelled on the paper.

In general, the smaller the amount of moisture on the paper, the fewer tears that person has produced. The test is mainly performed on people experiencing symptoms of dry eye.

The test is noninvasive and has been used for around 100 years. Despite its long history of use, newer tests are being developed to catch additional cases of dry eye that the Schirmer’s test cannot detect.

Why is the test used?

The Schirmer’s test confirms and determines the severity of dry eye. Symptoms of dry eye include the following:

  • excessive dryness in the eye
  • persistent watering or tearing of the eye
  • pain in the eye area
  • feeling of something being in the eye
  • chronic eye irritation
  • sensitivity to light

The Schirmer’s test may also be used to help diagnose Sjögren’s syndrome. This is an autoimmune disorder that causes decreased function in the eye and salivary glands, resulting in dry eyes and mouth.

In these cases, the Schirmer’s test is often used in conjunction with other tests to determine if Sjögren’s is present.

Who should have a Schirmer’s test?

Anyone who suspects that they suffer from dry eye should see an eye doctor promptly.
Additionally, anyone with any of the following symptoms should also consult an eye doctor:

Older lady with eye pain
A Schirmer’s test may be used if someone is showing symptoms of dry eye such as sensitivity to light, blurred vision, and difficulty wearing contact lenses.
  • sensitivity to light
  • a stinging, burning, or scratchy sensation in the eyes
  • difficulty with driving at night
  • stringy mucus in or around the eyes
  • eye redness
  • blurred vision or eye fatigue
  • a sensation of having something in the eyes
  • difficulty wearing contact lenses
  • watery eyes

When any of these symptoms persist for longer than a week, a doctor may send the person to a specialist or do a Schirmer’s test to determine whether dry eye is the cause of the symptoms.


What to expect

Preparation for the Schirmer’s test is minimal and simple. A person about to undergo the test will need to remove their contact lenses or glasses. In the case of contacts, the person should bring their glasses to wear after the test.

The Schirmer’s test lasts about 5 minutes. Before the test, a doctor may ask the person about their tolerance for having something touching their eye. If they express discomfort at the idea of having something touching the eye, the doctor may use numbing drops.

The doctor then places the strip of paper inside the lower eyelids and the individual will keep their eyes closed for 5 minutes. Most people consider the test to be mildly irritating or uncomfortable.

After the test, people should avoid rubbing their eyes for about 30 minutes. Additionally, they should not wear contact lenses for about 2 hours following the test. Besides these two considerations, there are no other short- or long-term side effects to the procedure.

What do the results mean?

eye doctor inspecting a patient
A doctor may recommend prescription eye drops for chronic dry eye.

The results are based on the amount of the tears produced as measured on the strip of paper.

A normal level of production is considered to be over 10 millimeters (mm) of tears on the paper. Anything under 10 mm is considered to be an abnormally low level of tear production. A measurement of less than 5 mm is considered severe dry eye.

These measurements are directly affected by the age of the person being tested, as older people produce fewer tears.

Depending on the result, a doctor may recommend various treatments. The most typical treatment for chronic dry eyes is prescription eye drops. If a person’s eyes are not severely dry, a doctor may advise a patient to use over-the-counter drops.

In some cases, additional treatment may be required to help treat and manage dry eyes.

Possible risks and considerations

There are no known risks to the Schirmer’s test since it is a very simple procedure. However, it should be noted that the Schirmer’s test does not always effectively diagnose cases of dry eye.

As a result, scientists are working on developing additional tests to help identify those groups of people for whom the Schirmer’s test is not effective.


Alternative tests

Other tests are being used and developed to help test for dry eye.

One test measures an iron-binding molecule called lactoferrin. The amount of lactoferrin present may be linked to tear production. As a result, people with dry eyes may find this test quite helpful as it can lead to specific treatment options for them.

Another test looks at the content of tears produced. In this test, tears are examined to see how much of an enzyme called lysozyme is present. Elevated levels in the eyes may cause dry eye.

A third alternative test uses special fluorescein eye drops. In this test, a person is given eye drops that contain a dye. In cases where patients do not have enough tears, it will take much longer for the eye to fully flush the dye out.

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Source: medicalnewstoday

23 Feb

Exercise a Powerful Ally for Breast Cancer Survivors

Exercise a Powerful Ally for Breast Cancer Survivors

News Picture: Exercise a Powerful Ally for Breast Cancer SurvivorsBy Kathleen Doheny
HealthDay Reporter

Latest Cancer News

TUESDAY, Feb. 21, 2017 (HealthDay News) — For breast cancer survivors, exercise may help lower their chances of dying from the disease more than other healthy habits, a new review suggests.

The Canadian researchers analyzed 67 published articles to see which habits made the most difference in reducing the risk of either breast cancer recurrence or death.

Exercise came out on top, reducing the risk of breast cancer death by about 40 percent, said review author Dr. Ellen Warner, a medical oncologist at Sunnybrook Odette Cancer Centre and a professor at the University of Toronto.

“It’s similar to the magnitude of chemotherapy or hormone therapy,” she said. “So, that’s pretty powerful.”

However, the review did not prove that exercise causes breast cancer risk to drop.

Besides exercise, the previous research looked at weight and weight gain, diet, smoking, alcohol and vitamin supplements.

The new review “pulls everything together,” said Leslie Bernstein, a professor in the department of population sciences at the City of Hope Comprehensive Cancer Center in Duarte, Calif. She first reported on the link between exercise and reduced breast cancer risk decades ago.

From the new review, Warner and her co-author Julia Hamer made several recommendations on what habits matter to reduce recurrence and death, but the effect of some habits remain inconclusive.

Besides exercise, the review found weight gains of more than 10 percent after diagnosis were linked to a greater risk of death. So, a 120-pound woman whose weight goes up to more than 132 pounds after diagnosis might increase her risk of dying.

No specific diet has been found better than another to reduce the risk of breast cancer returning, the review found. Warner said the advice to avoid soy, which has weak estrogens, was not supported by scientific studies.

Research on smoking cessation and breast cancer recurrence isn’t definitive, Warner said, but stopping smoking is crucial for other health-related reasons. Vitamin Csupplements may help, and vitamin D can help maintain bone strength, which is reduced with chemotherapy and hormonal therapy.

Finding which strategies work is important, the researchers said, since one-fourth of women diagnosed with early stage breast cancer will eventually die of cancer that has spread later.

Besides the information on exercise and weight, the information on diet is valuable, Bernstein said. Many women have avoided soy in their diets for fear of cancer recurrence. However, she said, the estrogens in soy are “so weak” that the evidence does not support avoiding them. “Of course, everything in moderation,” she said.

Bernstein agreed that research is inconclusive on many habits, in particular smoking and drinking. Even so, she said, “We have to counsel everyone to stop smoking. It may have no direct effect on breast cancer and risk of breast cancer death, but it is going to affect their risk of dying of something else,” she said.

Weight doesn’t affect all races equally, Bernstein said. For instance, she said, “the weight at diagnosis does not seem to affect African-American women as strongly as white women, even though African-American women are far more likely to die of breast cancer.”

Perhaps another factor is such a strong predictor of outcome, she said, that it overshadows the weight. However, experts still would advise keeping a healthy weight, Bernstein said.

Women who met recommended exercise levels had a stronger risk reduction, Warner said. She recommends at least 30 minutes of moderate-intensity activity at least five days a week, or 75 minutes of vigorous exercise, plus two to three strength-training sessions each week.

However, research on the best types of exercise are not conclusive, Bernstein said. “We don’t know what’s better, muscle building or cardio,” Bernstein said. “And the prescription has to change with age.”

Why exercise helps so much is not known, Warner said, but “I think it’s probably not pure exercise. People who exercise are more likely to do other healthy things.”

Even so, the exercise may modify the side effects from hormone therapy, she said. So, women on hormone therapy who exercise may be more likely to adhere to their treatment as prescribed.

Exercise also has anti-inflammatory effects, and that may help the body better keep cancer cells in check, Warner said. Excess weight can increase inflammation, she added.

Warner tells patients exercise is part of their treatment, and to consider it as crucial as their other therapies.

The findings were published Feb. 21 in the CMAJ (Canadian Medical Association Journal).

MedicalNews
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Ellen Warner, M.D., M.Sc., medical oncologist, Sunnybrook Odette Cancer Centre, and professor, medicine, University of Toronto; Leslie Bernstein, Ph.D., professor, department of population sciences, City of Hope Comprehensive Cancer Center, Duarte, Calif.; Feb. 21, 2017, CMAJ (Canadian Medical Association Journal

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Source: MediciNet

23 Feb

Brain Chip Helps Paralyzed 'Type' With Their Mind

News Picture: Brain Chip Helps Paralyzed 'Type' With Their MindBy Amy Norton
HealthDay Reporter

Latest Neurology News

TUESDAY, Feb. 21, 2017 (HealthDay News) — A microchip implanted in the brain helped paralyzed patients “type” on a computer via mind control, at the fastest speeds yet seen in such experiments.

It’s the latest step forward in research on “brain-computer interface” systems. Scientists have been studying the technology, with the aim of giving patients with paralysis or limb amputations more independence in their daily lives.

In the past several years, researchers at a few universities have given microchip implants to a small number of patients, which allowed patients to control robotic limbs using their thoughts.

And just last month, scientists reported on a noninvasive technology — using advanced brain imaging — that allowed four “locked-in” patients (with complete paralysis of all voluntary muscles) to answer yes-no questions.

All four patients had advanced amyotrophic lateral sclerosis (ALS) — commonly known as Lou Gehrig’s disease — and were completely unable to communicate.

The brain-computer technology is confined to the research lab for now. But scientists hope it will become available, in some form, for people to use at home within the next decade.

The new study involved three patients with severe limb weakness. Two had ALS, and the other had a spinal cord injury.

Each patient had one or two tiny silicon chips implanted in an area of the brain that controls movement. Signals from the patients’ brain cells could then be transmitted to a computer, where they were decoded into “point-and-click” commands that moved a cursor on an onscreen keyboard.

Two patients eventually learned to “type” at a speed of around 6 to 8 words a minute. That’s not far from the performance of your typical smartphone user, who achieves roughly 12 to 19 words per minute, the researchers added.

“This is obviously very early, and there’s a lot more work to be done,” said senior researcher Dr. Jaimie Henderson, a professor of neurosurgery at Stanford University School of Medicine in Stanford, Calif.

One of the biggest challenges will be making the system feasible for the real world, according to Henderson.

For now, the system is not user-friendly. It requires equipment and technical expertise that are not realistic outside of a lab.

But, Henderson said, the obstacles to a home version are surmountable. And he said he’s “hopeful” that can be done within the next 10 years.

The chips themselves are tiny — about the size of a baby aspirin — and are surgically implanted in the brain’s motor cortex (the movement command center). Each chip contains a network of electrodes that penetrate the brain to the thickness of a quarter.

From there, the electrodes are able to tap into the electrical activity of individual cells within the motor cortex.

Basically, when the patients thought about typing, the resulting electrical signals were delivered to the computer, interpreted by special algorithms, and then used to move an onscreen cursor.

The patients learned to move the cursor using different types of visualization, Henderson explained. One patient, for example, pictured her index finger tapping the keys.

Overall, the patients’ typing speeds were faster than any previously seen with this type of technology, according to Henderson. “We’re within the realm of communication capabilities that would be useful to people,” he said.

But to make the technology feasible for the real world, some challenges have to be overcome. For one, Henderson said, the technology needs to become wireless. It will also need to be “self-calibrating” and layperson-friendly.

“Right now, a technician needs to be present,” Henderson said.

Still, he and his colleagues say the technology could one day be applied to a range of devices, including smartphones and tablets.

The findings were published Feb. 21 in the journal eLife.

Jennifer Collinger is an assistant professor of physical medicine and rehabilitation at the University of Pittsburgh. She and her colleagues have been using brain-computer technology to help patients with paralysis or amputations learn to move a robotic arm — again, in the lab.

Several years ago, the Pitt researchers reported on a patient — a 53-year-old woman with quadriplegia (paralyzed in all four limbs) — who’d learned to move the robot arm using her mind. She’d accomplished feats like high-fiving the researchers and feeding herself chocolate.

Collinger agreed on the practical barriers to getting brain-computer technology into people’s homes.

There are also questions about how well the technology will work in the real world, and over the long haul.

“Can you maintain a high level of performance over time?” Collinger asked.

Still, she said the patients’ typing performance in this study was encouraging.

There is noninvasive technology aimed at helping patients with paralysis or ALS use computers — like eye-tracking devices. So, an implanted chip would need to perform well to be a good alternative, Collinger pointed out.

“I think we’re at the point where we can start to talk about whether this is a viable alternative to an approach like eye-tracking,” she said.

MedicalNews
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Jaimie Henderson, M.D., professor, neurosurgery, Stanford University School of Medicine, Stanford, Calif.; Jennifer Collinger, Ph.D., assistant professor, physical medicine and rehabilitation, University of Pittsburgh School of Medicine; Feb. 21, 2017, eLife, online

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23 Feb

Testosterone Therapy May Have Benefits, But Risks Too

News Picture: Testosterone Therapy May Have Benefits, But Risks TooBy Dennis Thompson
HealthDay Reporter

Latest Mens Health News

TUESDAY, Feb. 21, 2017 (HealthDay News) — Testosterone treatment can boost bone density and reduce anemia in older men with low levels of the hormone, but it might also open the door to future heart risks, a new set of trials suggests.

The findings come in the last four studies to be reported out of the Testosterone Trials, a set of seven overlapping federally funded year-long clinical trials conducted at 12 sites across the United States.

All told, the Testosterone Trials seem to indicate that the best use of testosterone therapy is for treatment of decreased sexual function in men with so-called “low T” (low testosterone levels), said Dr. Thomas Gill. He is a Yale University professor of geriatrics who ran one of the clinical trial sites.

But the trials also found that men receiving testosterone treatment experienced a significantly greater increase in arterial plaque than men not taking the hormone, Gill noted. That could raise their future risk of heart attack, stroke and heart disease.

“Even if it were used for sexual function, for which the evidence is strongest, I think you’d have to consider the potential for some adverse long-term consequences on cardiovascular disease,” Gill said.

The use of testosterone-replacement therapy has nearly doubled in recent years, from 1.3 million patients in 2009 to 2.3 million in 2013, according to the U.S. Food and Drug Administration.

This boom prompted an Institute of Medicine panel to urge new clinical trials investigating the usefulness and potential harm of testosterone treatment. In response, the U.S. National Institute on Aging (NIA) funded the Testosterone Trials.

The Testosterone Trials involved 790 men aged 65 and older with low levels of testosterone caused by aging, as well as symptoms that could be related to low T such as sexual problems, fatigue, muscle weakness, or impaired memory and thinking.

The first three sets of clinical trial findings came out a year ago, and focused on the three most-touted potential benefits of testosterone therapy: improvement of sexual ability; vitality; and physical function.

Those first reports revealed that testosterone could improve a man’s sexual desire and function, but wouldn’t do much to improve their overall vitality or physical function.

The last four Testosterone Trials were published Feb. 21 in the Journal of the American Medical Association:

  • Anemia trial. About 54 percent of men with unexplained anemia and 52 percent with anemia from known causes had clinically significant increases in their red blood cell levels after a year of testosterone therapy, compared with 15 percent and 12 percent, respectively, of those in a placebo group.
  • Bone trial. After one year, participants experienced significantly increased bone mineral density and estimated bone strength. The results were greater in the spine than the hip.
  • Cardiovascular trial. The study found that the volume of arterial plaque increased significantly more in the testosterone-treated group compared to the untreated “control” group.
  • Cognition trial. After a year of treatment, there was no significant change in verbal memory, visual memory or problem-solving.

JAMA Internal Medicine also published a study conducted outside the Testosterone Trials, which showed a short-term reduction in heart attacks and strokes among men receiving testosterone.

That study showed a 33 percent reduced risk of heart problems with an average follow-up of about three years, compared with non-testosterone users. However, it was not a clinical trial; researchers used the medical records of more than 8,800 men in California to draw their conclusions.

Even though the trials showed positive benefit for bone health and anemia, Gill said it’s not likely testosterone will be considered a first-line treatment for those conditions.

That’s because there already are other well-established and more effective treatments that focus on more specific sources of bone disease and anemia than low testosterone, Gill said.

“Those are potentially areas of extra benefit if a man were to be prescribed testosterone for sexual function,” Gill said. “It’s unlikely testosterone would be prescribed either for bone or for anemia.”

But, Dr. Bradley Anawalt said, taken together, all the Testosterone Trial findings show that testosterone could be a reasonable treatment for older men suffering more than one condition related to low T. Anawalt is a professor of endocrinology at the University of Washington in Seattle and a member of The Endocrine Society’s leadership council.

“If somebody walks into your office and their sex drive is a little low, their sense of vitality has dropped, and they have low bone mineral density, you might consider prescribing an antidepressant, Viagra and a bone therapy drug,” Anawalt said. “Maybe testosterone could be a reasonable substitute for all three.”

However, the new findings cast a shadow on the long-term effects of testosterone on heart health, Anawalt said. This would lead him to carefully weigh whether to prescribe the hormone to a man with low-but-normal testosterone levels and no outward symptoms related to low T.

“I would say, ‘We have uncertainty about the health effects of testosterone and your risk of heart attacks. I can’t in good conscience prescribe this testosterone to you. I think it’s a bad idea,'” he explained.

“But if you’re clearly low and you clearly have a disease caused by testosterone deficiency, I’d use the same data to say there’s nothing out there that says this is unsafe,” Anawalt continued.

American Heart Association President Stephen Houser said that while the accompanying study that detected decreased heart risk among testosterone users is “tantalizing,” the findings related to arterial plaque raise strong concerns about future risk of stroke and heart attack.

“If you have a heart attack, it’s hard to come back from that. If you have a stroke, it’s hard to come back from that,” said Houser, senior associate dean of research at Temple University in Philadelphia. “I want to be young again, too, but I don’t think there’s enough evidence out there that I would consider taking testosterone.”

Gill pointed out that there are also continuing concerns that testosterone therapy could increase a man’s risk of prostate cancer, much as estrogen therapy can increase the risk of breast cancer in women. However, the Testosterone Trials were too short-term to assess this risk.

Dr. Sergei Romashkan is chief of the clinical trials branch in the NIA’s division of geriatrics and clinical gerontology. The trials mark the beginning, rather than the end, of research into testosterone therapy, he said.

Romashkan noted that the FDA is working with the pharmaceutical industry to conduct additional large-scale clinical trials looking at the heart health effects of testosterone. Testosterone therapy currently carries a boxed warning of potential heart risks, mandated by the FDA.

“In no case was this a definitive study,” Romashkan said. “We have learned a lot more than we knew before this study started, but still not all questions are answered.”

MedicalNews
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Thomas Gill, M.D., professor, geriatrics, Yale University, New Haven, Conn.; Bradley Anawalt, M.D., professor, endocrinology, University of Washington, Seattle, and member, The Endocrine Society’s leadership council; Stephen Houser, Ph.D., American Heart Association president and senior associate dean, research, Temple University, Philadelphia; Sergei Romashkan, M.D., Ph.D., chief, clinical trials branch, division of geriatrics and clinical gerontology, U.S. National Institute on Aging; Feb. 21, 2017, Journal of the American Medical Association; Feb. 21, 2017, JAMA Internal Medicine

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23 Feb

Exercise a Powerful Ally for Breast Cancer Survivors

Exercise a Powerful Ally for Breast Cancer Survivors

News Picture: Exercise a Powerful Ally for Breast Cancer SurvivorsBy Kathleen Doheny
HealthDay Reporter

Latest Cancer News

TUESDAY, Feb. 21, 2017 (HealthDay News) — For breast cancer survivors, exercise may help lower their chances of dying from the disease more than other healthy habits, a new review suggests.

The Canadian researchers analyzed 67 published articles to see which habits made the most difference in reducing the risk of either breast cancer recurrence or death.

Exercise came out on top, reducing the risk of breast cancer death by about 40 percent, said review author Dr. Ellen Warner, a medical oncologist at Sunnybrook Odette Cancer Centre and a professor at the University of Toronto.

“It’s similar to the magnitude of chemotherapy or hormone therapy,” she said. “So, that’s pretty powerful.”

However, the review did not prove that exercise causes breast cancer risk to drop.

Besides exercise, the previous research looked at weight and weight gain, diet, smoking, alcohol and vitamin supplements.

The new review “pulls everything together,” said Leslie Bernstein, a professor in the department of population sciences at the City of Hope Comprehensive Cancer Center in Duarte, Calif. She first reported on the link between exercise and reduced breast cancer risk decades ago.

From the new review, Warner and her co-author Julia Hamer made several recommendations on what habits matter to reduce recurrence and death, but the effect of some habits remain inconclusive.

Besides exercise, the review found weight gains of more than 10 percent after diagnosis were linked to a greater risk of death. So, a 120-pound woman whose weight goes up to more than 132 pounds after diagnosis might increase her risk of dying.

No specific diet has been found better than another to reduce the risk of breast cancer returning, the review found. Warner said the advice to avoid soy, which has weak estrogens, was not supported by scientific studies.

Research on smoking cessation and breast cancer recurrence isn’t definitive, Warner said, but stopping smoking is crucial for other health-related reasons. Vitamin Csupplements may help, and vitamin D can help maintain bone strength, which is reduced with chemotherapy and hormonal therapy.

Finding which strategies work is important, the researchers said, since one-fourth of women diagnosed with early stage breast cancer will eventually die of cancer that has spread later.

Besides the information on exercise and weight, the information on diet is valuable, Bernstein said. Many women have avoided soy in their diets for fear of cancer recurrence. However, she said, the estrogens in soy are “so weak” that the evidence does not support avoiding them. “Of course, everything in moderation,” she said.

Bernstein agreed that research is inconclusive on many habits, in particular smoking and drinking. Even so, she said, “We have to counsel everyone to stop smoking. It may have no direct effect on breast cancer and risk of breast cancer death, but it is going to affect their risk of dying of something else,” she said.

Weight doesn’t affect all races equally, Bernstein said. For instance, she said, “the weight at diagnosis does not seem to affect African-American women as strongly as white women, even though African-American women are far more likely to die of breast cancer.”

Perhaps another factor is such a strong predictor of outcome, she said, that it overshadows the weight. However, experts still would advise keeping a healthy weight, Bernstein said.

Women who met recommended exercise levels had a stronger risk reduction, Warner said. She recommends at least 30 minutes of moderate-intensity activity at least five days a week, or 75 minutes of vigorous exercise, plus two to three strength-training sessions each week.

However, research on the best types of exercise are not conclusive, Bernstein said. “We don’t know what’s better, muscle building or cardio,” Bernstein said. “And the prescription has to change with age.”

Why exercise helps so much is not known, Warner said, but “I think it’s probably not pure exercise. People who exercise are more likely to do other healthy things.”

Even so, the exercise may modify the side effects from hormone therapy, she said. So, women on hormone therapy who exercise may be more likely to adhere to their treatment as prescribed.

Exercise also has anti-inflammatory effects, and that may help the body better keep cancer cells in check, Warner said. Excess weight can increase inflammation, she added.

Warner tells patients exercise is part of their treatment, and to consider it as crucial as their other therapies.

The findings were published Feb. 21 in the CMAJ (Canadian Medical Association Journal).

MedicalNews
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Ellen Warner, M.D., M.Sc., medical oncologist, Sunnybrook Odette Cancer Centre, and professor, medicine, University of Toronto; Leslie Bernstein, Ph.D., professor, department of population sciences, City of Hope Comprehensive Cancer Center, Duarte, Calif.; Feb. 21, 2017, CMAJ (Canadian Medical Association Journal

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23 Feb

Brain Chip Helps Paralyzed 'Type' With Their Mind

News Picture: Brain Chip Helps Paralyzed 'Type' With Their MindBy Amy Norton
HealthDay Reporter

Latest Neurology News

TUESDAY, Feb. 21, 2017 (HealthDay News) — A microchip implanted in the brain helped paralyzed patients “type” on a computer via mind control, at the fastest speeds yet seen in such experiments.

It’s the latest step forward in research on “brain-computer interface” systems. Scientists have been studying the technology, with the aim of giving patients with paralysis or limb amputations more independence in their daily lives.

In the past several years, researchers at a few universities have given microchip implants to a small number of patients, which allowed patients to control robotic limbs using their thoughts.

And just last month, scientists reported on a noninvasive technology — using advanced brain imaging — that allowed four “locked-in” patients (with complete paralysis of all voluntary muscles) to answer yes-no questions.

All four patients had advanced amyotrophic lateral sclerosis (ALS) — commonly known as Lou Gehrig’s disease — and were completely unable to communicate.

The brain-computer technology is confined to the research lab for now. But scientists hope it will become available, in some form, for people to use at home within the next decade.

The new study involved three patients with severe limb weakness. Two had ALS, and the other had a spinal cord injury.

Each patient had one or two tiny silicon chips implanted in an area of the brain that controls movement. Signals from the patients’ brain cells could then be transmitted to a computer, where they were decoded into “point-and-click” commands that moved a cursor on an onscreen keyboard.

Two patients eventually learned to “type” at a speed of around 6 to 8 words a minute. That’s not far from the performance of your typical smartphone user, who achieves roughly 12 to 19 words per minute, the researchers added.

“This is obviously very early, and there’s a lot more work to be done,” said senior researcher Dr. Jaimie Henderson, a professor of neurosurgery at Stanford University School of Medicine in Stanford, Calif.

One of the biggest challenges will be making the system feasible for the real world, according to Henderson.

For now, the system is not user-friendly. It requires equipment and technical expertise that are not realistic outside of a lab.

But, Henderson said, the obstacles to a home version are surmountable. And he said he’s “hopeful” that can be done within the next 10 years.

The chips themselves are tiny — about the size of a baby aspirin — and are surgically implanted in the brain’s motor cortex (the movement command center). Each chip contains a network of electrodes that penetrate the brain to the thickness of a quarter.

From there, the electrodes are able to tap into the electrical activity of individual cells within the motor cortex.

Basically, when the patients thought about typing, the resulting electrical signals were delivered to the computer, interpreted by special algorithms, and then used to move an onscreen cursor.

The patients learned to move the cursor using different types of visualization, Henderson explained. One patient, for example, pictured her index finger tapping the keys.

Overall, the patients’ typing speeds were faster than any previously seen with this type of technology, according to Henderson. “We’re within the realm of communication capabilities that would be useful to people,” he said.

But to make the technology feasible for the real world, some challenges have to be overcome. For one, Henderson said, the technology needs to become wireless. It will also need to be “self-calibrating” and layperson-friendly.

“Right now, a technician needs to be present,” Henderson said.

Still, he and his colleagues say the technology could one day be applied to a range of devices, including smartphones and tablets.

The findings were published Feb. 21 in the journal eLife.

Jennifer Collinger is an assistant professor of physical medicine and rehabilitation at the University of Pittsburgh. She and her colleagues have been using brain-computer technology to help patients with paralysis or amputations learn to move a robotic arm — again, in the lab.

Several years ago, the Pitt researchers reported on a patient — a 53-year-old woman with quadriplegia (paralyzed in all four limbs) — who’d learned to move the robot arm using her mind. She’d accomplished feats like high-fiving the researchers and feeding herself chocolate.

Collinger agreed on the practical barriers to getting brain-computer technology into people’s homes.

There are also questions about how well the technology will work in the real world, and over the long haul.

“Can you maintain a high level of performance over time?” Collinger asked.

Still, she said the patients’ typing performance in this study was encouraging.

There is noninvasive technology aimed at helping patients with paralysis or ALS use computers — like eye-tracking devices. So, an implanted chip would need to perform well to be a good alternative, Collinger pointed out.

“I think we’re at the point where we can start to talk about whether this is a viable alternative to an approach like eye-tracking,” she said.

MedicalNews
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Jaimie Henderson, M.D., professor, neurosurgery, Stanford University School of Medicine, Stanford, Calif.; Jennifer Collinger, Ph.D., assistant professor, physical medicine and rehabilitation, University of Pittsburgh School of Medicine; Feb. 21, 2017, eLife, online

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23 Feb

Testosterone Therapy May Have Benefits, But Risks Too

News Picture: Testosterone Therapy May Have Benefits, But Risks TooBy Dennis Thompson
HealthDay Reporter

Latest Mens Health News

TUESDAY, Feb. 21, 2017 (HealthDay News) — Testosterone treatment can boost bone density and reduce anemia in older men with low levels of the hormone, but it might also open the door to future heart risks, a new set of trials suggests.

The findings come in the last four studies to be reported out of the Testosterone Trials, a set of seven overlapping federally funded year-long clinical trials conducted at 12 sites across the United States.

All told, the Testosterone Trials seem to indicate that the best use of testosterone therapy is for treatment of decreased sexual function in men with so-called “low T” (low testosterone levels), said Dr. Thomas Gill. He is a Yale University professor of geriatrics who ran one of the clinical trial sites.

But the trials also found that men receiving testosterone treatment experienced a significantly greater increase in arterial plaque than men not taking the hormone, Gill noted. That could raise their future risk of heart attack, stroke and heart disease.

“Even if it were used for sexual function, for which the evidence is strongest, I think you’d have to consider the potential for some adverse long-term consequences on cardiovascular disease,” Gill said.

The use of testosterone-replacement therapy has nearly doubled in recent years, from 1.3 million patients in 2009 to 2.3 million in 2013, according to the U.S. Food and Drug Administration.

This boom prompted an Institute of Medicine panel to urge new clinical trials investigating the usefulness and potential harm of testosterone treatment. In response, the U.S. National Institute on Aging (NIA) funded the Testosterone Trials.

The Testosterone Trials involved 790 men aged 65 and older with low levels of testosterone caused by aging, as well as symptoms that could be related to low T such as sexual problems, fatigue, muscle weakness, or impaired memory and thinking.

The first three sets of clinical trial findings came out a year ago, and focused on the three most-touted potential benefits of testosterone therapy: improvement of sexual ability; vitality; and physical function.

Those first reports revealed that testosterone could improve a man’s sexual desire and function, but wouldn’t do much to improve their overall vitality or physical function.

The last four Testosterone Trials were published Feb. 21 in the Journal of the American Medical Association:

  • Anemia trial. About 54 percent of men with unexplained anemia and 52 percent with anemia from known causes had clinically significant increases in their red blood cell levels after a year of testosterone therapy, compared with 15 percent and 12 percent, respectively, of those in a placebo group.
  • Bone trial. After one year, participants experienced significantly increased bone mineral density and estimated bone strength. The results were greater in the spine than the hip.
  • Cardiovascular trial. The study found that the volume of arterial plaque increased significantly more in the testosterone-treated group compared to the untreated “control” group.
  • Cognition trial. After a year of treatment, there was no significant change in verbal memory, visual memory or problem-solving.

JAMA Internal Medicine also published a study conducted outside the Testosterone Trials, which showed a short-term reduction in heart attacks and strokes among men receiving testosterone.

That study showed a 33 percent reduced risk of heart problems with an average follow-up of about three years, compared with non-testosterone users. However, it was not a clinical trial; researchers used the medical records of more than 8,800 men in California to draw their conclusions.

Even though the trials showed positive benefit for bone health and anemia, Gill said it’s not likely testosterone will be considered a first-line treatment for those conditions.

That’s because there already are other well-established and more effective treatments that focus on more specific sources of bone disease and anemia than low testosterone, Gill said.

“Those are potentially areas of extra benefit if a man were to be prescribed testosterone for sexual function,” Gill said. “It’s unlikely testosterone would be prescribed either for bone or for anemia.”

But, Dr. Bradley Anawalt said, taken together, all the Testosterone Trial findings show that testosterone could be a reasonable treatment for older men suffering more than one condition related to low T. Anawalt is a professor of endocrinology at the University of Washington in Seattle and a member of The Endocrine Society’s leadership council.

“If somebody walks into your office and their sex drive is a little low, their sense of vitality has dropped, and they have low bone mineral density, you might consider prescribing an antidepressant, Viagra and a bone therapy drug,” Anawalt said. “Maybe testosterone could be a reasonable substitute for all three.”

However, the new findings cast a shadow on the long-term effects of testosterone on heart health, Anawalt said. This would lead him to carefully weigh whether to prescribe the hormone to a man with low-but-normal testosterone levels and no outward symptoms related to low T.

“I would say, ‘We have uncertainty about the health effects of testosterone and your risk of heart attacks. I can’t in good conscience prescribe this testosterone to you. I think it’s a bad idea,'” he explained.

“But if you’re clearly low and you clearly have a disease caused by testosterone deficiency, I’d use the same data to say there’s nothing out there that says this is unsafe,” Anawalt continued.

American Heart Association President Stephen Houser said that while the accompanying study that detected decreased heart risk among testosterone users is “tantalizing,” the findings related to arterial plaque raise strong concerns about future risk of stroke and heart attack.

“If you have a heart attack, it’s hard to come back from that. If you have a stroke, it’s hard to come back from that,” said Houser, senior associate dean of research at Temple University in Philadelphia. “I want to be young again, too, but I don’t think there’s enough evidence out there that I would consider taking testosterone.”

Gill pointed out that there are also continuing concerns that testosterone therapy could increase a man’s risk of prostate cancer, much as estrogen therapy can increase the risk of breast cancer in women. However, the Testosterone Trials were too short-term to assess this risk.

Dr. Sergei Romashkan is chief of the clinical trials branch in the NIA’s division of geriatrics and clinical gerontology. The trials mark the beginning, rather than the end, of research into testosterone therapy, he said.

Romashkan noted that the FDA is working with the pharmaceutical industry to conduct additional large-scale clinical trials looking at the heart health effects of testosterone. Testosterone therapy currently carries a boxed warning of potential heart risks, mandated by the FDA.

“In no case was this a definitive study,” Romashkan said. “We have learned a lot more than we knew before this study started, but still not all questions are answered.”

MedicalNews
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Thomas Gill, M.D., professor, geriatrics, Yale University, New Haven, Conn.; Bradley Anawalt, M.D., professor, endocrinology, University of Washington, Seattle, and member, The Endocrine Society’s leadership council; Stephen Houser, Ph.D., American Heart Association president and senior associate dean, research, Temple University, Philadelphia; Sergei Romashkan, M.D., Ph.D., chief, clinical trials branch, division of geriatrics and clinical gerontology, U.S. National Institute on Aging; Feb. 21, 2017, Journal of the American Medical Association; Feb. 21, 2017, JAMA Internal Medicine

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23 Feb

Exercise a Powerful Ally for Breast Cancer Survivors

Exercise a Powerful Ally for Breast Cancer Survivors

News Picture: Exercise a Powerful Ally for Breast Cancer SurvivorsBy Kathleen Doheny
HealthDay Reporter

Latest Cancer News

TUESDAY, Feb. 21, 2017 (HealthDay News) — For breast cancer survivors, exercise may help lower their chances of dying from the disease more than other healthy habits, a new review suggests.

The Canadian researchers analyzed 67 published articles to see which habits made the most difference in reducing the risk of either breast cancer recurrence or death.

Exercise came out on top, reducing the risk of breast cancer death by about 40 percent, said review author Dr. Ellen Warner, a medical oncologist at Sunnybrook Odette Cancer Centre and a professor at the University of Toronto.

“It’s similar to the magnitude of chemotherapy or hormone therapy,” she said. “So, that’s pretty powerful.”

However, the review did not prove that exercise causes breast cancer risk to drop.

Besides exercise, the previous research looked at weight and weight gain, diet, smoking, alcohol and vitamin supplements.

The new review “pulls everything together,” said Leslie Bernstein, a professor in the department of population sciences at the City of Hope Comprehensive Cancer Center in Duarte, Calif. She first reported on the link between exercise and reduced breast cancer risk decades ago.

From the new review, Warner and her co-author Julia Hamer made several recommendations on what habits matter to reduce recurrence and death, but the effect of some habits remain inconclusive.

Besides exercise, the review found weight gains of more than 10 percent after diagnosis were linked to a greater risk of death. So, a 120-pound woman whose weight goes up to more than 132 pounds after diagnosis might increase her risk of dying.

No specific diet has been found better than another to reduce the risk of breast cancer returning, the review found. Warner said the advice to avoid soy, which has weak estrogens, was not supported by scientific studies.

Research on smoking cessation and breast cancer recurrence isn’t definitive, Warner said, but stopping smoking is crucial for other health-related reasons. Vitamin Csupplements may help, and vitamin D can help maintain bone strength, which is reduced with chemotherapy and hormonal therapy.

Finding which strategies work is important, the researchers said, since one-fourth of women diagnosed with early stage breast cancer will eventually die of cancer that has spread later.

Besides the information on exercise and weight, the information on diet is valuable, Bernstein said. Many women have avoided soy in their diets for fear of cancer recurrence. However, she said, the estrogens in soy are “so weak” that the evidence does not support avoiding them. “Of course, everything in moderation,” she said.

Bernstein agreed that research is inconclusive on many habits, in particular smoking and drinking. Even so, she said, “We have to counsel everyone to stop smoking. It may have no direct effect on breast cancer and risk of breast cancer death, but it is going to affect their risk of dying of something else,” she said.

Weight doesn’t affect all races equally, Bernstein said. For instance, she said, “the weight at diagnosis does not seem to affect African-American women as strongly as white women, even though African-American women are far more likely to die of breast cancer.”

Perhaps another factor is such a strong predictor of outcome, she said, that it overshadows the weight. However, experts still would advise keeping a healthy weight, Bernstein said.

Women who met recommended exercise levels had a stronger risk reduction, Warner said. She recommends at least 30 minutes of moderate-intensity activity at least five days a week, or 75 minutes of vigorous exercise, plus two to three strength-training sessions each week.

However, research on the best types of exercise are not conclusive, Bernstein said. “We don’t know what’s better, muscle building or cardio,” Bernstein said. “And the prescription has to change with age.”

Why exercise helps so much is not known, Warner said, but “I think it’s probably not pure exercise. People who exercise are more likely to do other healthy things.”

Even so, the exercise may modify the side effects from hormone therapy, she said. So, women on hormone therapy who exercise may be more likely to adhere to their treatment as prescribed.

Exercise also has anti-inflammatory effects, and that may help the body better keep cancer cells in check, Warner said. Excess weight can increase inflammation, she added.

Warner tells patients exercise is part of their treatment, and to consider it as crucial as their other therapies.

The findings were published Feb. 21 in the CMAJ (Canadian Medical Association Journal).

MedicalNews
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Ellen Warner, M.D., M.Sc., medical oncologist, Sunnybrook Odette Cancer Centre, and professor, medicine, University of Toronto; Leslie Bernstein, Ph.D., professor, department of population sciences, City of Hope Comprehensive Cancer Center, Duarte, Calif.; Feb. 21, 2017, CMAJ (Canadian Medical Association Journal

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