Yale study treating and preventing opioid dependency


NEW HAVEN, Conn. (WTNH) — The number of opioid dependent patients in the country is now a major public health issue. A Yale study and a legislative effort aims to treat and prevent addiction.

It’s estimated 100 million people in the U.S. need pain medication, but those who are addicted or overdose on it find themselves in the emergency department.

“Similar to any other chronic-relapsing disease in the emergency department, we screen and we often initiate treatment,” said Dr. Gail D’Onofrio.

She and Dr. David Fiellin did more than that. The Yale School of Medicine researchers offered them an opportunity to sign up for a multi-intervention study. They found that those treated with buprenorphine, brand name Suboxone, responded best.

“Not only did we find that twice as many patients who received the buprenorphine went into treatment and stayed there for 30 days, we also found there was a significantly less amount of patients who were in any inpatient services,” said Dr. D’Onofrio.

The drug also addressed the patient’s withdrawals and cravings.

“I don’t think they realized how effective the medications were and how readily available the medications could be for them,” explained Dr. Fiellin. “Essentially stop using the opiates in such a brief period of time, over usually six to 12 hours, they were able to stop using opiates.”

Prevention is just as important as treatment. Drug companies have come up with abuse deterrent formulation medications, or ADF’s.

“What this is for is to prevent people from abusing the drug,” said Jill Spineti with the Governor’s Prevention Partnership, adding that ADF’s also allow those who live with chronic pain get what they need.

“Certainly people can still take the drug as it’s meant to be, but usually with drug abusers they want to get high in a different way, so they can’t crush it, they can’t snort it, they can’t break it down to powder, they can’t inject as heroin,” she stressed.

Advocates are lobbying for the passage of a bill this legislative session so that ADF’s are covered by insurance in Connecticut. It was passed by the state Senate over the weekend and supporters are pushing for a full House vote before the session ends.

Meanwhile, the Yale study also found those treated with buprenorphine were more likely to get counseling and address their addiction. The hope is that more primary care physicians, community health, and HIV clinics will help expand patient access.


Anxious Students Strain College Mental Health Centers


ORLANDO, Fla. — One morning recently, a dozen college students stepped out of the bright sunshine into a dimly lit room at the counseling center here at the University of Central Florida. They appeared to have little in common: undergraduates in flip-flops and nose rings, graduate students in interview-ready attire.

But all were drawn to this drop-in workshop: “Anxiety 101.”

As they sat in a circle, a therapist, Nicole Archer, asked: “When you’re anxious, how does it feel?”

“I have a faster heart rate,” whispered one young woman. “I feel panicky,” said another. Sweating. Ragged breathing. Insomnia.

Causes? Schoolwork, they all replied. Money. Relationships. The more they thought about what they had to do, the students said, the more paralyzed they became.

Anxiety has now surpassed depression as the most common mental health diagnosis among college students, though depression, too, is on the rise. More than half of students visiting campus clinics cite anxiety as a health concern, according to a recent study of more than 100,000 students nationwide by the Center for Collegiate Mental Health at Penn State.

Nearly one in six college students has been diagnosed with or treated for anxiety within the last 12 months, according to the annual national survey by the American College Health Association.

The causes range widely, experts say, from mounting academic pressure at earlier ages to overprotective parents to compulsive engagement with social media. Anxiety has always played a role in the developmental drama of a student’s life, but now more students experience anxiety so intense and overwhelming that they are seeking professional counseling.

As students finish a college year during which these cases continued to spike, the consensus among therapists is that treating anxiety has become an enormous challenge for campus mental health centers.

Like many college clinics, the Center for Counseling and Psychological Services at the University of Central Florida — one of the country’s largest and fastest-growing universities, with roughly 60,000 students — has seen sharp increases in the number of clients: 15.2 percent over last year alone. The center has grown so rapidly that some supply closets have been converted to therapists’ offices.

More students are seeking help partly because the stigma around mental health issues is lessening, noted Stephanie Preston, a counselor at U.C.F.


Stress kits were distributed at an event at the University of Central Florida's Center for Counseling and Psychological Services. The kits included a stress ball, mints and crayons.Credit Douglas Bovitt for The New York Times

Ms. Preston has seen the uptick in anxiety among her student clients. One gets panic attacks merely at the thought of being called upon in class. And anxiety was among a constellation of diagnoses that became life-threatening for another client, Nicholas Graves.

Two years ago, Mr. Graves, a stocky cinema studies major in jeans, a T-shirt and Converse sneakers, could scarcely get to class. That involved walking past groups of people and riding a bus — and Mr. Graves felt that everyone was staring at him.

He started cutting himself. He was hospitalized twice for psychiatric observation.

After some sessions with Ms. Preston, group therapy and medication, Mr. Graves, 21, who sat in an office at the center recently describing his harrowing journey, said he has made great progress.

“I’m more focused in school, and I’ve made more friends in my film courses — I found my tribe,” he said, smiling. “I’ve been open about my anxiety and depression. I’m not ashamed anymore.”

Anxiety has become emblematic of the current generation of college students, said Dan Jones, the director of counseling and psychological services at Appalachian State University in Boone, N.C.

Because of escalating pressures during high school, he and other experts say, students arrive at college preloaded with stress. Accustomed to extreme parental oversight, many seem unable to steer themselves. And with parents so accessible, students have had less incentive to develop life skills.

“A lot are coming to school who don’t have the resilience of previous generations,” Dr. Jones said. “They can’t tolerate discomfort or having to struggle. A primary symptom is worrying, and they don’t have the ability to soothe themselves.”

Social media is a gnawing, roiling constant. As students see posts about everyone else’s fabulous experiences, the inevitable comparisons erode their self-esteem. The popular term is “FOMO” — fear of missing out.

And so personal setbacks that might once have become “teachable moments” turn into triggers for a mental health diagnosis.

“Students are seeking treatment, saying, ‘I just got the first C in my life, my whole life just got shattered, I wanted to go to medical school and I can’t cope,’” said Micky M. Sharma, president of the Association for University and College Counseling Center Directors and head of Ohio State University’s counseling center.


Stephanie Preston, a mental health counselor at the  University of Central Florida, says that more students are seeking help for mental health issues.Credit Douglas Bovitt for The New York Times

Anxiety is an umbrella term for several disorders, including social anxiety disorder and agoraphobia. It can accompany many other diagnoses, such as depression, and it can be persistent and incapacitating.

Students who suffer from this acute manifestation can feel their very real struggles are shrugged off, because anxiety has become so ubiquitous, almost a cliché, on campus.

Alexa, 18, has been treated for an anxiety disorder since middle school, when she was still feeling terrorized by monsters under the bed. She has just finished her freshman year at Queens College in New York.

If she had a severe episode during a test, afterward she would try to explain to her professors what had happened but they would dismiss her. “They’d say, ‘Your mind isn’t focused,’ or ‘That’s just an excuse,’ ” said Alexa, who wrote her college application essay about grappling with the disorder. She asked not to be fully identified for privacy reasons.

More often, anxiety is mild, intermittent or temporary, the manifestation of a student in the grip of a normal developmental issue — learning time management, for example, or how to handle rejection from a sorority.

Mild anxiety is often treatable with early, modest interventions. But to care for rising numbers of severely troubled students, many counseling centers have moved to triage protocols. That means that students with less urgent needs may wait several weeks for first appointments.

“A month into the semester, a student is having panic attacks about coming to class, but the wait list at the counseling center is two to five weeks out. So something the student could recover from quickly might only get worse,” said Ben Locke, associate director of clinical services at Penn State University and the lead author of the Penn State report.

By necessity, most centers can only offer individual therapy on a short-term basis. Ms. Preston estimates that about 80 percent of clients at U.C.F. need only limited therapy.

“Students are busting their butts academically, they’re financially strapped, working three jobs,” she said. “There’s nothing diagnosable, but sometimes they just need a place to express their distress.”

Even with 30 therapists, the center at U.C.F. must find other ways to reach more students — especially the ones who suffer, smoldering, but don’t seek help.

Like many college counseling centers, U.C.F. has designed a variety of daily workshops and therapy groups that implicitly and explicitly address anxiety, depression and their triggers. Next fall the center will test a new app for treating anxiety with a seven-module cognitive behavioral program, accessible through a student’s phone and augmented with brief videoconferences with a therapist.

It also offers semester-long, 90-minute weekly therapy groups, such as “Keeping Calm and in Control,” “Mindfulness for Depression” and “Building Social Confidence” — for students struggling with social anxiety.

The therapists have to be prepared to manage students who present a wide array of challenges. “You never know who is going to walk in,” said Karen Hofmann, the center’s director. “Someone going through a divorce. Mourning the death of a parent. Managing a bipolar disorder. Or they’re transgender and need a letter for hormone therapy.”

Indeed, Dr. Locke and his colleagues at Penn State, who have tracked campus counseling centers nationwide for six years, have documented a trend that other studies have noted: Students are arriving with ever more severe mental-health issues.

Half of clients at mental health centers in their most recent report had already had some form of counseling before college. One-third have taken psychiatric medication. One quarter have self-injured.

The fundamental goal of campus counseling centers is to help students complete their education. According to federal statistics, just 59 percent of students who matriculated at four year colleges in 2006 graduated within six years.

Studies have repeatedly emphasized the nexus between mental health and academic success. In a survey this year at Ohio State’s center, just over half of the student clients said that counseling was instrumental in helping them remain in school.

Anxiety-ridden students list schoolwork as their chief stressor. U.C.F.’s center and after-hours hotline are busiest when midterm and final exams loom. That’s when the center runs what has become its most popular event: “Paws-a-tively Stress Free.”

The other afternoon, just before finals week, students, tired and apprehensive, trickled into the center. The majority were not clients.


Students gathered around a therapy dog during an event at U.C.F.Credit Douglas Bovitt for The New York Times

At a tent outside, their greeter was the center’s mascot and irresistible magnet: a 14-pound Havanese, a certified therapy dog whom many clients ask to hold during individual sessions, stroking his silky white coat to alleviate anxiety.

“Bodhi!” they called, as he trotted over, welcoming them to his turf with a friendly sniff.

For the next two hours, some 75 students visited the center, sitting on floors for a heavy petting session with therapy dogs.

They laughed at the dogs’ antics and rubbed their bellies. They remarked on how nice it was to get a study break.

On the way out, the students were handed a smoothie and a “stress kit,” which included a mandala, crayons, markers, stress balls and “Smarties” candy.

Also tucked into the kit was a card with information about how to contact the center, should they ever need something more.


The doctor is online, and lawmakers are prescribing some rules


Dr. Mia Finkelston during a visit using LiveHealth Online, a form of telemedicine that allows the Maryland-based doctor to see patients across the country.

Joanna Leach knew it was time to see a doctor about her lingering cold. But getting to the doctor’s office during business hours was a daunting prospect for the working mom. And she wasn’t eager to wait in an urgent care center or walk-in clinic with a roomful of sick people.

So Leach decided to try something her health plan, Anthem Blue Cross and Blue Shield, had recently added to its benefits package. In the den of her Meriden home, she flipped open her laptop, signed up for a service called LiveHealth Online, and perused a list of Connecticut-licensed doctors. She picked an internist and, in a few minutes, was face-to-face – or screen-to-screen – with her.

Speaking by video, the doctor asked Leach about her symptoms, heard her breathe and cough, and diagnosed a sinus infection and bronchitis. An hour after going online, Leach picked up medication at her pharmacy.

“It was so simple,” she said.

That was Leach’s introduction to telemedicine, a way to receive medical care from a health care provider in another location using a phone, video or other technology. The uses vary widely, from patients videoconferencing with doctors via smartphone to rural emergency rooms using off-site experts to guide care for stroke patients.

Telemedicine — also referred to as telehealth — is expected to become a larger part of medical care as technology evolves, the emphasis on reducing health care costs grows and the demand for care outstrips the supply of medical providers, particularly in primary care.

But regulation of the practice has lagged. Many states in recent years have adopted laws or standards to address telehealth. In Connecticut, where little regulation currently exists for telehealth, lawmakers are considering adopting standards. And that’s brought forward a debate about the exact shape that telemedicine should take.

Proponents of telemedicine — including health insurers, advocates for seniors and some medical groups — say it can reduce barriers to accessing care, make medical services more convenient, cut down on unnecessary emergency room or urgent care visits, save money and help address demand for simple issues that busy physician practices don’t have time to handle.

But the growth of telemedicine — and the ability it provides for patients to be seen by out-of-state doctors with Connecticut licenses — has drawn concern from some physicians, who favor more restrictive regulations. They say there’s reason to worry about fragmentation of care, interfering with the doctor-patient relationship and the potential for patients to abuse the system. They favor more restrictive regulations.

The Senate Tuesday night unanimously passed a bill to establish standards for telehealth, including prohibiting doctors from using it to prescribe controlled substances and requiring that the telehealth provider give records of the interaction to the patient’s primary care provider if the patient gives consent.

Providers offering telehealth services to people in Connecticut would have to be licensed here, but wouldn’t be required to have a physical office in the state. The measure would also require insurance plans to cover telehealth services.

Some supporters of telemedicine, including business and insurance groups, have urged lawmakers to be cautious, warning that restrictions on a still-developing field could hamper its growth.

But Sen. Terry Gerratana, who is co-chair of the Public Health Committee and has taken a lead role on the bill, said it’s time for state law to begin to address the practice.

“We’re way behind,” Gerratana, D-New Britain, said. “Many states started long ago to regulate.”

Sen. Joe Markley, R-Southington, called the bill “admirably modest,” and said during the brief floor debate on the proposal that it would put the state on a path to take advantage of technology that can serve those who need care and save money.

Seeing patients at home or on the road


Dr. Mia Finkelston's profile page on the LifeHealth Online app. Patients can use it to choose a doctor licensed in their state.

Patients in Connecticut who go online searching for a doctor might find Dr. Mia Finkelston, who sees patients across the country from her computer in rural Maryland.

For more than 20 years, Finkelston worked in a “brick and mortar” practice in rural Maryland. But with three kids and a busy practice, life was getting hectic. Her patients often couldn’t get in to see her and sometimes went to the emergency room instead or saw other doctors.

She moved to telemedicine in December 2012, which she does through LiveHealth Online, the company Leach used for her cold.

The cases are less complex than what Finkelston saw in her office — a lot of flu and upper respiratory infections in the winter, rashes and allergies in the summer. On Sunday nights, she gets a lot of pediatric cases from parents wondering if their children are too sick to go to day care. Sometimes she sees patients at home in bed or business travelers in their hotel rooms. She once had a virtual visit from a family on a camping trip with a sick child.

She doesn’t turn many away because they have problems that don’t work with telemedicine; Finkelston said most tend to be younger and healthier, not those with extensive medical histories. But she sends patients elsewhere if diagnosing them would require something she can’t do remotely, like listening to their lungs if pneumonia is a possibility or looking into a child’s ear. She doesn’t prescribe narcotics or medications like muscle relaxants that can be abused.

Finkelston says telehealth fills a need.

“Doctors are busy in their offices. They don’t often have time to answer points 8, 9 and 10 on a patient’s list when they come in,” she said.

Proponents say telemedicine is meant to give patients more options, not replace the care doctors provide.


A list of doctors available to Connecticut patients through the LiveHealth Online app. None are based in Connecticut.

“The fundamental principle of going to a physician’s office to see a doctor is great, and we encourage it, and we try not to step on the toes of that if we can help it,” said Dr. Henry DePhillips, chief medical officer for Teladoc, which provides primary care telemedicine in 49 states, including Connecticut. “However, it’s really clear, for a variety of reasons, that there’s a significant mismatch…between the available supply of primary care services and the demand for primary care services.”

“We know that there are very few doctors’ offices across the country that are open to treat patients 24-7. And our goal is to help find ways to care for their patients,” said Dr. Peter Bowers, chief medical director at Anthem, which makes LiveHealth Online available to members for — in many cases — the same cost as an office visit. The company is also working with Connecticut doctors to use the service in their practices, starting with ProHealth Physicians, the largest primary care practice in the state.

Others point to telemedicine as a way to improve access to care for patients who have been disadvantaged. The Connecticut Hospital Association submitted testimony noting that evidence suggests that telehealth can help to address health disparities. The organization said gaps in outpatient care in the state often adversely affect minorities and the poor, and warned that too many restrictions on the use of telehealth could reduce the ability to reach vulnerable groups.

Community Health Center Inc., which has clinics across the state, tested a telemedicine model for Medicaid patients who needed cardiology care. The use of telemedicine saved money, and patient outcomes were similar to or better than those for patients who initially went in person, President and CEO Mark Maselli said in written testimony.

“Telemedicine is moving the delivery model creatively in many states and I worry that Connecticut is lagging because of the limitations currently placed on providers,” he wrote.

Doctors want tighter regulations

But some doctors say more restrictions are warranted.

Dr. Bob Russo, a Fairfield County radiologist and president of the Connecticut State Medical Society, said doctors are looking forward to using telemedicine to follow their own patients.

But he said his organization has concerns about its use between a doctor and patient who have no previous relationship, when the doctor doesn’t know the patient’s history.

“We object to the fact that somebody thinks it’s good medical care if you treat somebody without the medical exam, without the history,” he said.

He offered an example of a potential problem: a doctor might recommend surgery for a patient with acute diverticulitis. But if the patient would rather not have surgery, he could try telemedicine and omit information about his medical history so the doctor would be more likely to recommend medication instead of surgery, Russo said.

“Those are the sort of things, those kind of incidences, that worry us the most,” he said, adding that it could be difficult to reach a doctor for a followup if complications arise.

Still, Russo said he expects telemedicine to proliferate. “I do believe it’s going to be woven into the fabric of medicine, but I think it will be done correctly,” he said.

In testimony, the medical society and the Connecticut Chapter of the American College of Physicians wrote that telemedicine could allow a significant amount of medical care to be shifted out of the state or the country.

The models for telehealth vary. LiveHealth Online, for example, currently has no doctors based in Connecticut and uses many doctors who practice telemedicine fulltime, while Teladoc uses doctors with brick-and-mortar practices who do telemedicine on the side. Last month, 93 percent of Teladoc’s 268 Connecticut consults were done by Connecticut doctors.

Finkelston said she thinks the gaps between telemedicine advocates and skeptics could be bridged. Ideally, she said, doctors in brick-and-mortar practices could have a relationship with those practicing telemedicine. If a patient with an upper respiratory infection calls for an appointment, and the doctor doesn’t have a slot, he could refer the patient to “my colleague online.”


Meditation and yoga may ease diseases that cause gut pain


If you thought meditation was good only for your emotional well-being, think again: A new study suggests it may also alleviate the symptoms of two gut disorders.

The study looked at people who had either irritable bowel syndrome (IBS) or irritable bowel disease (IBD). It found that those who did yoga and meditation regularly for two months had fewer symptoms associated with the two gut disorders.

This mind/body intervention seemed to work by inducing genetic changes in the body, the study authors said. The findings suggest that stress-relieving meditation can suppress the activities of genes that help cause inflammation and other immune system problems in people with IBS or IBD, the study stated.

Previous research has shown that meditation can change people’s gene expression in some ways, but the new study is among the first to show an impact on gene expression in people with a specific disease, said lead researcher Braden Kuo, a gastroenterologist at Massachusetts General Hospital in Boston. The study used a mind/body technique called relaxation response, which a Harvard University doctor developed in the 1970s.

The new findings are especially interesting given that researchers have established a relationship between stress and digestive problems. Research has shown that psychological trauma can contribute to IBS, a disorder that leads to abdominal pain, constipation and diarrhea.

The condition is fairly common in the United States, affecting about 1 in every 10 people at some point in their lives, according to the International Foundation for Functional Gastrointestinal Disorders. Yet scientists do not exactly know what causes the disorder.

Although IBS and IBD can be mistaken as the same condition, they are actually very different. Unlike IBS, IBD involves chronic inflammation of the digestive tract. The two main types of IBD are ulcerative colitis, which affects the colon, and Crohn’s disease, which mostly affects the intestines but can occur anywhere in the digestive system.

However, IBS and IBD share some common factors: Both can be triggered by stress, and neither has real treatment options. The drugs currently available can only lessen the severity of symptoms and bring some temporary relief.

In the new study, researchers enrolled 19 people with IBS and 29 with IBD. They all underwent a nine-week program that included breathing exercises,meditation and yoga. They met for a group session every week and practiced the activities at home for 15 to 20 minutes every day.

Symptoms and genes

The researchers assessed the participants’ symptoms before, after and midway through the study, and they took blood samples for genetic analyses. However, the study did not include a separate control group of patients who did not practice meditation.

At the end of the study, the participants reported a reduction in their symptoms compared with what they experienced at the study’s start. A genetic analysis of their blood provided evidence of changes in genetic pathways related to the two disorders.

Significantly, more genetic changes were observed in people with IBD than in those with IBS, said Manoj Bhasin, who co-authored the study and is the director of bioinformatics at Beth Israel Deaconess Medical Center in Boston. Researchers found that more than 1,000 genes were altered in IBD patients over the study period, whereas only 119 genes changed in the people with IBS.

The activities of one inflammation-related gene were suppressed in both groups, according to the study. This suggests that meditation and similar practices may offset stress and inflammation, the researchers said.

“In both IBS and IBD, the pathway controlled by a protein called NF-kB emerged as one of those most significantly affected by the relaxation response,” Towia Libermann, a senior researcher for the study and an assistant professor at Harvard Medical School, said in a statement. It’s possible that relaxation techniques could help both people with IBS and those with IBD, he said.

The researchers noted two important limitations in the study: First, two tests that measured certain markers of inflammation in the blood showed no changes over the study period. Second, previous research has shown that even a placebo can sometimes produce adequate relief of IBS symptoms.


How Do I Know When To Stop 'Pushing Through The Pain' During My Workout?


The Question: How do I know when to stop pushing through the pain during my workout?

The Answer: We've all heard the infamous training phrase, "No pain, no gain," but there is a limit to how many times we can mutter "ouch" during a sweat session, and how high on the pain scale we can climb, before suffering real consequences. To better understand where to draw the line, The Huffington Post spoke with Dr. Jordan Metzl, a sports medicine physician at the Hospital for Special Surgery in New York City, about the ways in which he typically advises his patients.

"My general take is that if it doesn't hurt a little bit, you're not getting [more fit]," Metzl told The Huffington Post. "Pain and feeling uncomfortable is definitely a part of the exercise prescription for anybody who wants to help take their fitness to the next level, so that's important to think about. On the other hand, there is such a thing as unhealthy pain and being in an uncomfortable place."

So how do we know when too much is too much? It turns out there's a relatively easy way to distinguish between a few sore muscles and an actual injury that could grow more serious without proper care and attention.

"Pain that changes the way you move, pain that is in your bones and soft tissue is unhealthy pain," said Metzl. " So if a shin splint is changing the way you run or a shoulder problem is changing the way you swim, then you have to get that checked out, because that could be making a problem worse and creating another problem. That's the red flag I use."

Not all exercise pains lie within the muscular and skeletal systems, though. For example, if you're working to improve your cardiovascular fitness, there is a limit to how labored you want your breathing to be, or how high your heart right should go during the peak of a workout.

"Certainly, huffing and puffing means you're working harder," said Metzl. "But if that crosses over into feeling dizzy or fainting or those kinds of symptoms, then you've got to get that checked out as well."

Some may be familiar with the Borg scale, which measures levels of personal perceived exertion during exercise using a scale of one through 20. Many sports medicine physicians ask patients to fill out the scale as a part of their intake paperwork, and while it proves useful as a diagnostic tool, it does have its limitations. A 2008 study comparing hypertension patients' increased blood pressure levels to their subjective feelings of intensity during exercise using the Borg scale found that the patients' own assessment of pain was not enough to provide a true measure of the effects of exercise.

Another limitation is the fact that people's pain thresholds vary dramatically, meaning the same numbers can mean entirely different things to different athletes. A study from the Norwegian Institute of Public Health explored the potential roles both genetics and environmental factors play in determining a person's pain tolerance, but the extent of their effects requires further research.

When it comes to pushing through the pain, Metzl finds that women are more likely than men to move beyond the point of injury and worsen their condition before seeking medical attention.

"I think women are tougher than men, I do," he said. "In general, if a guy gets a bad pain they're like, 'Alright, this is terrible, I'm going to stop.' But women are just tougher and they will push themselves, which is both a blessing and a curse. The blessing is it makes them great athletes, but the curse is they sometimes make injuries that are moderate much worse, because they push through pain and don't listen to their bodies' cues."

The most common exercise injuries tend to be the result of overuse and overtraining. When left unacknowledged, tendonitis can turn into tendinosis, and a stress injury can become a stress fracture. It's critical to pay attention to your body's cues and address these types of pain in their early stages. Notice if your form is changing to compensate for a pain, and ask yourself if the pain is recurring and grows worse each time you perform that type of exercise. When it comes to knowing whether to push through the pain or get it checked out, your intuition can be mighty powerful -- so long as you listen to it.


Quitting smoking relies on stronger brain networks



Anyone who has tried to quit smoking knows the mind games required to resist cravings and tolerate withdrawal headaches and lethargy. A new study suggests that some hopeful quitters are just more mentally equipped to handle the challenge than others.

Researchers looked at the brain activity of a group of 85 heavy smokers (at least 10 cigarettes a day) using a method called fMRI, or functional magnetic resonance imaging. They found that people who had stronger connections between two regions of the brain -- one involved in reward, the other in controlling impulsive behavior -- were more likely to be successful at giving up smoking, at least for 10 weeks.

"This is the largest study to date where we've attempted to identify neural markers, or predictors, of later success in quitting smoking," said Joseph McClernon, associate professor of psychiatry and behavioral sciences at Duke University, who led the current study. Previous research has told us a lot about how long-term smoking alters the brain, and what the brain of a nonsmoker looks like.

Related: We know it can kill us: Why people still smoke

In the study, published in the journal Neuropsychopharmacology, researchers did fMRI scanning on participants one month before their quit date. Then on their quit date, participants received nicotine patches and checked in with the researchers over the following 10 weeks about whether they relapsed.

The participants who did not relapse could have a good shot of being out of the woods. "Most of the action relating to beating nicotine addiction takes place within the first month or two," said Jonathan Foulds, professor of public health sciences and psychiatry at Penn State University.

    The key difference among the participants who managed not to light up again came down to an area called the insula, a prune-sized section that lies deep in the brain. Those with the most activity in the insula were the ones who went on to successfully quit weeks later.

    Although it is unclear what the insula is doing, researchers think it acts like a bridge, connecting the reward region with the behavior control regions. The insula has also been linked to other types of drug addiction such as alcoholism.

    "It's a frontier area, and one that we are interested in going after in terms of interventions for smoking cessation," McClernon said.

    The idea is that doctors could one day try to identify smokers who have poor connectivity in this important insula region. Those who do could benefit from therapies such as neurofeedback or transcranial magnetic stimulation (TMS) to strengthen the connectivity.

    Although the effectiveness of these therapies for smoking cessation is still being investigated, the current findings could at least suggest an area of the brain that researchers could target, McClernon said. His group is currently testing whether neurofeedback that involves asking people to recall a time that they successfully resisted a temptation could increase connectivity through the insula.

    In addition, people with poor brain connectivity might need more help in quitting smoking, such as possibly giving successful quitters monetary rewards, McClernon noted.

    Another recent study suggested that fMRI could become a routine part of treating conditions, such as depression. If brain connectivity and the insula region turns out to be the key to quitting smoking, scans could also become part of smoking cessation programs.

    For his part, however, Foulds said there is not enough known about TMS or neurofeedback to gauge whether the current findings could help advance those therapies, and that they will probably not be affordable options anyway.


    A mysterious medical condition is killing toddlers to teens


    AUSTIN (KXAN) — On Feb. 5, 2013 Jessica and J. Pieratt welcomed their first child into the world, a healthy baby boy they named Moss. On Moss’ first birthday, he blew out the single candle as best he could, while the Pieratt’s gave out a sigh of relief.

    Moss turned 1 and was no longer at risk of Sudden Infant Death Syndrome, also known as SIDS, which affects babies up to 1 year of age. What the Pieratts did not know is there was something else that could threaten their child’s life — a mystery that affects toddlers to teens. “We didn’t think something like this could ever happen at all. Let alone he was almost 15 months at that time,” says Jessica.

    Trying to absorb the shock

    In April 2014, Moss then 14 months, woke up with a slight fever; the Pieratt’s thought it was related to him teething. “I gave him breakfast and he was acting kind of tired, so I thought I’d put him down for his morning nap,” remembers Jessica. When she went back into the room, Moss wasn’t breathing. Jessica screamed for her husband to call 911.

    When paramedics arrived, the child still had a faint pulse. Moss was rushed to Dell Children’s Medical Center. J. describes what happened over the next 36 hours, “He was on life support the entire time at the hospital. They did everything that they could and tried as many times to see if they could take him off life support, and we made the decision to do so. They gave us some few last moments with him in the hospital before he passed away.”

    The Pieratt’s tried to create a peaceful environment for Moss’ last moments. “At the time, trying to absorb the shock of everything that has transpired and yet still trying to salvage every little bit that you can are the last moments with your child,” says J. They sang Moss’ favorite songs, changed his last diaper and gave him his last bath, all while reflecting back on the happy times with Moss and overwhelmed with grief.

    “Once we knew that he wouldn’t survive this, I encouraged him to let go and that we loved him, ” says Jessica of saying goodbye to Moss.

    What killed Moss?

    More than a year after Moss’ death the Pieratt’s still don’t have any answers. His death was not only unexpected, it is unexplained. Moss’ autopsy shows nothing unusual.

    “That left us confused. Why, why did Moss pass away?” asks Jessica. After much research, Jessica’s mother found out it is a medical mystery called Sudden Unexplained Death in Childhood, also known as SUDC. SUDC is defined as the sudden death of a child greater than 1 year of age that remains unexplained after a thorough case investigation. Last year, SUDC affected 387 toddlers and teens nationwide. Between 2008-2012, SUDC claimed 201 children, 14 in Central Texas according to statistics provided to KXAN by the Texas Department of State Health.

    SUDC cases are rare and therefore, so is the research. “I think it’s highly important for participation in research. Within the last 1-2 years, the U.S. started a national sudden unexplained death registry in childhood,” says Dr. Arnold Frienrich of Pediatrix Cardiology at Dell Children’s Hospital. Dr. Frienrich is referring to the Sudden Death in the Young Registry. It’s funded in nine states or jurisdictions but not yet in Texas.

    Laura Crandall is on the advisory board for the registry and is also the co-founder of another registry called theSUDC Registry and Research Collabrative.

    Those Affected by Sudden Unexplained Death in 2013

    • 223 children ages of 1-4 years
    • 28 children ages 5-9 years
    • 29 children ages 10-14 years
    • 107 children ages of 15-19 years

    The SUDC Registry is based in New York with researchers from the Mayo Clinic doing genetic analysis on the children who’ve died, including Moss. “The research that has been done over the last seven years has all been done by private donations, mostly by families who’ve been affected, trying to change the future. We have not received government funding from research in this regard to date,” says Crandall.

    For Crandall, this fight is a personal one. “I became involved after the loss of my oldest daughter Maria, who died during a nap at the age of 15 months,” says Crandall. Seventeen years later, her daughter death is still unexplained and SUDC remains unpredicatable.

    “It is really frustrating. The ER side of me loves figuring out why someone is sick and by definition these are children where that doesn’t happen. We don’t know why they passed — in general, if we don’t know what’s causing the death there is nothing really that we could do to prevent something when we don’t understand what it is,” says Dr. Coburn Allen, who specializes in pediatric emergency medicine at Dell Children’s Hospital.

    Welcoming a new child while grieving another

    While grieving the loss of their first child, the Pieratt’s were getting ready to welcome their second. “I was four months pregnant when Moss passed away. Those five months of feeling like a parent and feeling like we got kicked out of the parent club. Then Madeline was born and I would say that is the most peace I’ve felt since Moss passed away,” says Jessica.

    It’s easy to see Madeline has given new life to the Pieratt’s in more ways than one. “Life now with Madeline is bitter sweet. With everything that we do with Madeline is a happy reminder because we get to use all of Moss’ things. We rock her in the same chair, get to read the same books we read to Moss,” says Jessica.

    Madeline is forever connected to the older brother she never met, she has his name. As a symbol of the Pieratt’s undying love, they named the little girl who helped them at their darkest time: Madeline Moss Pieratt.

    Finding hope

    Last year, the Pieratt’s traveled to New York to meet with other parents impacted by SUDC to share their story. While the deaths are rare, SUDC is getting national attention. Just last year, President Barack Obama signed into law the Sudden Unexpected Death Data Enhancement and Awareness Act, which allows the Centers for Disease Control to improve the consistency of collecting data during death investigations and autopsies in still births, Sudden Infant Death Syndrome and Sudden Unexplained Death in Childhood cases.

    The Pieratt’s hope one day to have answers into Moss’ death with the SUDC registry and prevent what happened to their family from happening to yours. The family has setup a foundation for Moss.


    Orthopedic Surgeons Largely Contribute To Opioid Epidemic, Study Reveals


    Understanding why physicians from various areas of expertise prescribe opioids helps the medical community as a whole combat opioid abuse, misuse and overdose. Even though emergency physicians are not likely to prescribe opioids to discharged patients, doctors from other medical fields are contributing to the opioid epidemic at a higher rate.

    Published in The Journal of the American Academy of Orthopaedic Surgeons (JAAOS), a new report found that orthopedic surgeons are prescribing opioids at an alarming rate. The study, which took a look at the country’s opioid epidemic and its impact on orthopedic care in 2009, revealed that orthopedic surgeons are the third-highest prescribers of opioid prescriptions among physicians in the United States (7.7%). This ranks them behind primary care physicians (28.8%) and internists (14.6%).

    Study co-author Dr. Brent J. Morris, a shoulder and elbow surgeon at Lexington Clinic Orthopedics, said in an interview that there are a variety of reasons why orthopedic surgeons prescribe opioid pain medications to patients. “Orthopedic injuries including broken bones can be very painful and may require casting or surgery to treat and these are often treated with an opioid pain medication during the initial recovery period,” he said.

    “Examples of these types of injuries include hip, shoulder, elbow, wrist, and ankle fractures among others,” Morris said. “It is also very reasonable to use a short course of opioid pain medications to help with the recovery following surgery.”

    Prescribing opioids, however, isn’t always the best option for a patient. Deciding whether or not to prescribe one isn’t an easy task for any orthopedic surgeon — or at least it shouldn’t be. “It is important for physicians to reassure patients that they intend to control their pain but emphasize the importance of doing so in a responsible manner,” he said. “Part of this responsibility involves minimizing the use of opioids whenever possible. Good communication between providers and patients is the key in setting expectations regarding pain control and the role for non-opioid treatments.”

    Non-opioid alternatives for managing a patient’s pain include: over-the-counter medications like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Another alternative to treating and managing pain in orthopedic pain is nerve blocks. Morris said they’re typically used in conjunction with surgery to limit additional pain following surgery.

    Study author Dr. Hassan R. Mir, associate professor of orthopedics and rehabilitation at Vanderbilt Orthopaedic Institute, said patients may face adverse effects from continued opioid use. “Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large,” Mir said.

    “Furthermore, pain control is an important determinant of patient satisfaction,” Mir added. “Physicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. Most patients truthfully represent their levels of pain, but unfortunately, a small percentage of patients use opioids non-therapeutically and ‘doctor shop’ for additional opioids, making this a delicate balancing act for orthopedic surgeons.”

    Nearly every state in the country has implemented a prescription monitoring program (PMP) to assist physicians with tracking prescriptions for controlled substances. These policies can assist physicians with decreasing opioid prescriptions for musculoskeletal pain. Several other areas for potential research include alternative multi-modal pain control regimens, clinician education, patient education, electronic health record utilization and clinical practice guidelines.

    “It is important for orthopedic surgeons and patients to understand the detrimental effects of opioid use on clinical outcomes across the spectrum of orthopedic subspecialties,” Mir said. “Opioid use has been associated with worse outcomes after work injuries, total knee arthroplasty, reverse shoulder arthroplasty, and spine surgery.”


    How a high-tech bra could be your next doctor


    (CNN)To find out all you need to know about your body's vital signs, all you need to do is to get dressed.

    The burgeoning market for intelligent clothing that can measure stats including your heart and respiratory rate has resulted in a broad range of wearables which could one-day act simultaneously as an on-call doctor.

    "[People] can be monitored 24/7 and not have to be in hospital to do it," says Bennet Fisher, of CircuiteX, the smart fabrics arm of Noble Biomaterials. "The data collected ... can provide a general profile of a person's health."

    It's all about silver

    The technology is based on the use of conductive yarns -- most commonly made with silver -- which are woven into fabrics to act as sensors that detect electrical signals, acting as electrocardiograms (ECGs) and electromyograms (EMGs) to measure heart rate and muscle activity respectively.

    The silver can either be woven in throughout a piece of clothing or else through tapes or patches sewn into specific regions.

      "You can put it in any close-fitting garment," says Andy Baker, CEO of SmartLife, whose t-shirts and sports bra are set to launch in September 2015. The closer the sensor to the skin, the better the signal detected.

      Signals are then transmitted to detectors -- in the form of apps on a smartphone or tablet -- easily carried by the wearer. The information collected can also be uploaded to the cloud or sent to a third party, such as a doctor. Baker thinks this line of clothing could revolutionize medical practices.

      "We could put a t-shirt on 20 people in a ward and a clinician can walk in with an i-Pad and see all 20 heart rates," says Baker. The rules of medical approval mean such an application is still a few years away, but Smartlife is targeting medical use by 2017. "We don't want to diagnose, just collect and share the data as they wish," adds Baker.

      SmartLife's electronic "brain" is hidden in its clothes and converts electrical signals into useful data.

      The sports-casual look

      The most prominent types of clothing in development were originally intended to monitor athletes as part of their training, but are now set to benefit the health of the general public.

      T-shirts, sports bras and shorts are currently being trialed by companies such as CircuiteX, SmartLife and Finland-based Clothing+.

      "If you become ill, in the hospital the doctor will first do some tests like take your pulse, blood pressure and temperature," says Mikko Malmivaara, head of marketing at Clothing+. This baseline information is crucial for doctors to get a snapshot of their patient's state of health. But longer-term data could be even more valuable as a comparison. "If the doctor had access to the patient's biodata from a longer period back, they could make a far better diagnosis, seeing trends in the data," adds Malmivaara.

      The close-fitting nature of sports shirts and bras makes them a popular choice among those developing the technology, with CircuiteX counting Victoria's Secret and Adidas among its clients now opting to enable their customers to track their vital signs.

      SmartLife and Clothing+ are also developing health vests to be worn under normal clothing either throughout the day or at crucial times of day -- such as during people's morning routine. The tomography vest developed by Clothing+ is aimed at cardiac patients. "During their normal routines ... the vest scans the lungs for fluid and ... can detect a weakening heart up to 10 days prior to a collapse," claims Malmivaara, who says that one of the symptoms of a failing heart is fluid accumulating in the lungs.

      The versatility of smart fabrics has enabled their use to extend beyond everyday apparel to clothing such as edema socks and materials such as smart bandages. The data collected also extends beyond heart rates to more specific indicators such as inflammation and pressure.

      Socks designed by Danish company Ohmatex monitor edema -- fluid retention commonly in the feet and legs -- by electronically measuring the circumference of the wearer's leg. The presence of fluid is an early warning sign of heart failure or pre-eclampsia. "Patients can be [made] aware of increased swelling," says Christian Dalsgaard, chief technical officer at Ohmatex. "Edema is not well understood but is an indicator something is wrong," he says.

      Next on the agenda for SmartLife are compression bandages that use two-way signals in and out of the fabric to track how far a bandage is being stretched, as well as the pressure it's putting on the wearer. This should help medical professionals to apply bandages securely and with more accuracy, in addition to then monitoring any movement in the wearer once fitted. "[Wounds] only heal if they have the correct pressure," says Baker.

      Ohmatex is not prioritizing everyday wearers but instead dedicated professions, ranging from firefighters to astronauts.

      Among its earlier innovations was the use of temperature sensors in fire suits to prevent firefighters overheating whilst in action, which have now been trialled in U.S. firefighter academies. "Heat stress can make a firefighter collapse due to dehydration and temperature shock," says Dalsgaard. Three signals are collected to monitor the temperature outside of a fire suit and heat levels close to the skin, with alarms then signaling when to leave.

      Currently in development -- in association with the European Space Agency (ESA) -- is smart clothing for astronauts to monitor muscle activity and wasting whilst in zero gravity. Astronauts need to exercise regularly when in space to prevent their muscles from wasting, as no forces are acting on them to keep them in shape. "If you don't [exercise] your muscles will decrease within 20 to 30 days and you won't walk when you return," says Dalsgaard. Data that gives a clear indication of an astronaut's muscle development could help to personalize their training regime.

      Dalsgaard hopes his new line of space clothing will be on the catwalks of the International Space Station in 2017.


      Sitting will kill you, even if you exercise


      (CNN) One of your favorite activities may actually be killing you.

      Our entire modern world is constructed to keep you sitting down. When we drive, we sit. When we work at an office, we sit. When we watch TV, well, you get the picture.

      And yet, a new study that's running in the Annals of Internal Medicine found that this kind of sedentary behavior increases our chances of getting a disease or a condition that will kill us prematurely, even if we exercise.


      Researchers from Toronto came to this conclusion after analyzing 47 studies of sedentary behavior.

      They adjusted their data to incorporate the amount someone exercises and found that the sitting we typically do in a day still outweighs the benefit we get from exercise. Of course, the more you exercise, the lower the impact of sedentary behavior.

        The studies showed sedentary behavior can lead to death from cardiovascular issues and cancer as well as cause chronic conditions such as Type 2 diabetes.

        Physical inactivity has been identified as the fourth-leading risk factor for death for people all around the world, according to the World Health Organization.

        Prolonged sitting, meaning sitting for eight to 12 hours or more a day, increased your risk of developing type 2 diabetes by 90%.

        So what can you do to reduce the time you spend engaged in an activity that is not good for you?

        The study authors did make some simple suggestions to help you sit less. One is to just be aware of how much you are sitting. That way you can make a goal of reducing that number a little bit each week.

        If you are at work, you could try a standing desk or make it a goal to stand up or walk around for a minute or three once every half an hour.

        If you watch TV at night, don't zoom ahead during the commercials with your DVR. Instead walk around or at least stand up during the show break.



        By Mark Davis, WTNH Chief Political CorrespondentPublished: October 1, 2014

        HARTFORD, Conn. (WTNH) — A midnight deadline has come and gone, so that means tens of thousands of people with Anthem Blue Cross Blue Shield are no longer in the network for five hospitals, including Hartford Hospital.

        Hundreds of thousands of Connecticut residents are in health insurance coverage limbo. It means hundreds of thousands of Connecticut residents will have to dig deeper into their pockets to pay higher co-pays for everything.

        The dispute between the state’s largest health insurance provider Wallingford based Anthem Blue Cross Blue Shield and the state’s largest healthcare network anchored by Hartford Hospital means policy holders will have to pay much higher, out-of-network, prices for their health care.

        The decision affects:

        • Hartford Hospital (including The Institute of Living and Jefferson House)
        • The Hospital of Central Connecticut in New Britain
        • MidState Medical Center in Meriden
        • William W. Backus Hospital in Norwich
        • Windham Hospital

        “Emergency care is still going to be covered at any of these hospitals as ‘in-network’ and if you are scheduled for surgery, had been before, or follow up care before or after October 1st, that will still be covered,” said Connecticut’s Deputy Insurance Commissioner Anne Melissa Dowling.

        Hartford HealthCare and Anthem broke off negotiations Tuesday night putting policy holders for other treatment in limbo as of Wednesday.

        In a statement Hartford Healthcare spokeswoman Rebecca Stewart said; “We remain open to discussions with Anthem to resolve this impasse.”

        Anthem spokesperson Sarah Yeager saying they will work to transition policy holders to in-network facilities like St Francis in Hartford, Yale-New Haven, and Western Connecticut Health Network. But thousands more Connecticut residents may also be affected because many large companies are self insured but may use Anthem to administer health benefits.

        “That affects those people as well, suddenly these people are ‘out of network’ so to us it’s a larger impact than just the ‘insured’ population,” said Vicki Veltri, Connecticut’s Health Care Advocate.

        You can get help navigating this from the Health Care advocate at 1-866-466-4446 and the state insurance department at 1-800-203-3447 or www.ct.gov/OHA and www.ct.gov/cid.

        If there’s still no agreement a month from now, five more hospitals and medical centers join the list. Both sides say they will keep negotiating.

        Here is a statement from Gov. Dannel Malloy and Lt. Gov. Nancy Wyman about the contract talks:

        “We are extremely disappointed that Anthem Health Plans, Inc. and the Hartford Healthcare Corporation have allowed their contract to expire today without negotiating a new one.

        “We’re not interested in assigning blame. We want to make sure that everyone in our state has access to affordable, high-quality healthcare. We simply cannot let profit margins stand in the way of that goal.

        “Both companies need to return to the table and work out a deal that protects the health of Connecticut residents.”

        Below is a statement from Attorney General George Jepsen and Healthcare Advocate Victoria Veltri:

        “We are profoundly disappointed that Anthem and Hartford Healthcare have been unable to reach an agreement by deadline, and we are very concerned about the impact that this situation will have on the thousands of Connecticut residents who now find that their hospital provider is no longer in network. We strongly urge the two parties to put the quality and continuity of patient care first and resolve this matter as quickly as possible.”

        Jepsen and Veltri said anyone who has problems receiving care should contact Anthem at 203-677-4000. Additional information is available at http://group.anthem.com/HHC

        Botox for fighting cancer?

        By Karen Weintraub

          | GLOBE CORRESPONDENT   AUGUST 25, 2014

        Botox may be the newest cancer-fighting agent. Cutting off nerve cells that feed tumors appears to stop cancers from progressing, new research suggests. Previous studies found that surgically cutting the nerves to the stomach, called the vagal nerves, could block cancer growth in several mouse models of stomach cancer. In a new study, published in the current issue of Science Translational Medicine, researchers showed that temporarily blocking the nerves with Botox can have the same benefit. Botox is commonly used to deaden the nerves of the face, paralyzing tiny muscles to smooth wrinkled skin. But it has other medical uses, including fighting migraines, muscle spasms, and excessive sweating. The toxin fades after about four months, enough time to make the cancer cells more sensitive to blasts of chemotherapy, said Timothy Wang, a coauthor of the paper and chief of the Division of Digestion and Liver Diseases at Columbia University.

        Cutting the nerves in people can cause some side effects — including nausea and vomiting. But “overall, it’s an operation that’s generally well tolerated,” Wang said. He isn’t too concerned about side effects from Botox, which wears off after 4-6 months.

        A trial of the Botox treatment in stomach cancer has started in Norway; at Columbia, researchers are beginning an effort to test Botox in pancreatic cancer patients. Because stomach and pancreatic cancers have usually spread by the time they are caught, Wang thinks patients may need drugs that limit acetylcholine throughout the body, not just in one spot.

        “That’s why we’re also thinking about drug therapy,” like chemotherapy, Wang said. “At low doses they might be tolerable.”


        One reason brain tumors are more common in men

        Terry A Davis     AUGUST 4, 2014 AT 8:29 AM


        New research at Washington University School of Medicine in St. Louis helps explain why brain tumors occur more often in males and frequently are more harmful than similar tumors in females. For example, glioblastomas, the most common malignant brain tumors, are diagnosed twice as often in males, who suffer greater cognitive impairments than females and do not survive as long.

        The researchers found that retinoblastoma protein (RB), a protein known to reduce cancer risk, is significantly less active in male brain cells than in female brain cells.

        The study appears Aug. 1 in The Journal of Clinical Investigation.

        "This is the first time anyone ever has identified a sex-linked difference that affects tumor risk and is intrinsic to cells, and that's very exciting," said senior author Joshua Rubin, MD, PhD. "These results suggest we need to go back and look at multiple pathways linked to cancer, checking for sex differences. Sex-based distinctions at the level of the cell may not only influence cancer risk but also the effectiveness of treatments."

        Rubin noted that RB is the target of drugs now being evaluated in clinical trials. Trial organizers hope the drugs trigger the protein's anti-tumor effects and help cancer patients survive longer.

        "In clinical trials, we typically examine data from male and female patients together, and that could be masking positive or negative responses that are limited to one sex," said Rubin, who is an associate professor of pediatrics, neurology and anatomy and neurobiology. "At the very least, we should think about analyzing data for males and females separately in clinical trials."

        Scientists have identified many sex-linked diseases that either occur at different rates in males and females or cause different symptoms based on sex. These distinctions often are linked to sex hormones, which create and maintain many but not all of the biological differences between the sexes.

        However, Rubin and his colleagues knew that sex hormones could not account for the differences in brain tumor risk.

        "Male brain tumor risk remains higher throughout life despite major age-linked shifts in sex hormone production in males and females," he said. "If the sex hormones were causing this effect, we'd see major changes in the relative rates of brain tumors in males and females at puberty. But they don't happen then or later in life when menopause changes female sex hormone production."

        Rubin used a cell model of glioblastoma to prove it is easier to make male brain cells become tumors. After a series of genetic alterations and exposure to a growth factor, male brain cells became cancerous faster and more often than female brain cells.

        In experiments designed to identify the reasons for the differences in the male and female cells, the team evaluated three genes to see if they were naturally less active in male brain cells. The genes they studied -- neurofibromin, p53 and RB -- normally suppress cell division and cell survival. They are mutated and disabled in many cancers.

        The scientists found RB was more likely to be inactivated in male brain cells than in female brain cells. When they disabled the RB protein in female brain cells, the cells were equally susceptible to becoming cancers.

        "There are other types of tumors that occur at different rates based on sex, such as some liver cancers, which occur more often in males," Rubin said. "Knowing more about why cancer rates differ between males and females will help us understand basic mechanisms in cancer, seek more effective therapies and perform more informative clinical trials."

        Story Source:

        The above story is based on materials provided by Washington University in St. Louis. The original article was written by Michael C. Purdy. Note: Materials may be edited for content and length.

        Concussion-detecting football helmet sensor developed by Western Michigan University students

        By Yvonne Zipp | yzipp@mlive.com 
        on July 18, 2014

        KALAMAZOO, MI — A player takes a bruising hit in a football game, but gets up afterward. Is he OK to keep playing or has he suffered a concussion?

        It's a matter of growing concern at all levels of the game -- from Pop Warner all the way up to the NFL. Players' tendency to "walk off" an injury just adds to the uncertainty.

        But what if a player's helmet could tell coaches and trainers whether he is concussed?

        A new product developed by Western Michigan University students aims to remove the guesswork in what is sometimes referred to as a "stealth" injury.

        "Football concussions are a very hot topic nowadays," said Ali Eshkeiti, a doctoral student in electrical engineering, who is one of four WMU students who have worked on the project for the past two years. "We hear about this problem everywhere -- on the news, on TV."

        Eshkeiti and other student engineers designed a pressure sensor for helmets using printed electronics. Data from the sensor can be relayed over Bluetooth to a smartphone, so that a coach or other team leader would instantly know the severity of an impact.The data also could be stored on a cloud-based server, so doctors and trainers could see a player's complete history.

        "Basically, this device or system would eliminate the possibility of inaccuracies from field judgments made by coaches, who rely on the self-assessment or self-reporting of players," said Massood Atashbar, professor of electrical and computer engineering at WMU and the team's faculty adviser. "The coach would receive real-time, actionable information when one of the players receives a potentially dangerous and serious impact to the head."

        A growing amount of research indicates that multiple concussions may create a higher risk of depression, chronic headaches, early-onset dementia and/or adult-onset attention-deficit hyperactivity disorder.

        After being named one of eight finalists out of 300 teams in a recent competition for young entrepreneurs, sponsored by the University of Michigan, the students formed a start-up, SafeSense Technologies LLC.

        They are currently seeking investors and grants to get the start-up off the ground. The sensor still requires more research and development before it is ready for the market, Atashbar said.

        "We are very excited," Atashbar said. "We think that we have an enabling technology that I personally expect can lead to a very usable product fairly soon."

        The impact-sensing technology could have a wide range of applications -- possibly even on the battlefield. For example, if placed inside a soldier's helmet, the sensor could measure the impact of a bomb blast or other type of trauma. The shock sensor also could be used in other sports, including lacrosse and hockey, Atashbar said.

        It could be especially valuable in sports where players tend to under-report symptoms, he added.

        "The players, because of the pressure, try to ignore the injury they have endured and continue playing," he said.

        The device not only would warn that a hit had taken place and its severity, but would also pinpoint its location on the head.

        "That would be helpful for doctors, who are treating that patient, whereas right now, they're not able to get that data," said Binu Baby Narakathu, another doctoral student who has taken a leadership role in the project. "Our application would be able to store or log that data so the doctors can retrieve past impacts and do their treatment accordingly."

        High Rotavirus Vaccination Rates Continue to Pay Off

        BY BRIDGET M. KUEHN on JUNE 9, 2014


        Rotavirus vaccination may have saved nearly $1 billion in health costs between 2007 and 2011, researchers estimated. (Image: CDC)

        The United States continues to see dividends from efforts to vaccinate young children against rotavirus infection, with fewer children hospitalized for diarrheal illness through 2011, according to an analysis published in the journal Pediatricstoday.

        In 2006, the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices first recommended vaccination of US infants with a pentavalent rotavirus vaccine, effective against 5 variants of rotavirus. Before that time, severe gastrointestinal illnesses caused by rotavirus infections sent between 55 000 and 70 000 children to the hospital each year, resulting in up to 60 deaths. A second vaccine, a monovalent version, was added to the recommended vaccines list in 2008.

        Previous studies documented decreased rates of diarrheal illness in the first 2 years after vaccination began. But limited data have been available on how the newer vaccine compares with the older one and whether the gains seen early on have been sustained over the long term. Eyal Leshem, MD, of the National Center for Immunization and Respiratory Diseases, and colleagues analyzed claims in the MarketScan Commercial Claims Encounters Database to compare rates of diarrheal illness in children younger than 5 years before vaccination was recommended and every year after, through 2011.

        They found that by December 2010, rotavirus vaccination rates among children younger than 5 years reached 58% for the pentavalent vaccine and 5% for the monovalent version. Compared with the rate of hospitalization for rotavirus-related illness in the prevaccination era (2000-2006), they found a 75% reduction in the hospitalization rate in 2007-2008, a 60% reduction in 2008-2009, 94% in 2009-2010, and 80% in 2010-2011.

        The rate of hospitalization for rotavirus among those vaccinated was reduced by 92% (for the pentavalent vaccine) and 96% (for the monovalent version) compared with hospitalization rates for rotavirus among unvaccinated children.

        Even unvaccinated children experienced decreased rates of rotavirus hospitalization after vaccination began, with a 50% reduction in 2007-2008, a 77% reduction in 2009-2010, and a 25% reduction in 2010-2011. Presumably, higher vaccination rates reduced the amount of rotavirus circulating in the population, protecting even those who were unvaccinated.

        The authors estimate that the rotavirus vaccination prevented 176 587 US children from being hospitalized for rotavirus between July 2007 and June 2011. Additionally, they estimated 242 335 fewer emergency department visits and about 1.1 million fewer outpatient visits for diarrheal illness during this period. About $924 million in health costs were saved as a result of these reductions, according to the authors’ calculations.


        Pancreatic cancer will be 2nd deadliest by 2030: Study

        May 19, 2014

        Pancreatic cancer is set to become the second deadliest cancer in the United States by 2030, new research predicts.

        If the projections hold, pancreatic cancer will bypass breast, prostate and colorectal cancers, ending up second only to lung cancer as the nation's deadliest cancer.

        "Overall, the cancer death rate in the U.S. is declining each year," said study author Lynn Matrisian, vice president of research and medical affairs with the Pancreatic Cancer Action Network in Manhattan Beach, Calif.

        "And the numbers of deaths caused by several major cancers such as lung, colorectal and breast are following that trend and dropping. However, little progress has been made with pancreatic cancer, and we've known that it was not following that trend," she said.


        Matrisian pointed to a combination of factors, including an aging population, the relative growth of high-risk minority populations and an underfunding of pancreatic cancer research.

        Other important factors include the difficulty in diagnosing pancreatic cancer early, and the need for better treatments.

        "The pancreas is located deep within the abdomen," she said, and the organ is tough to access and visualize by conventional scanning methods. Plus, "if the patient has any symptoms at all, they're often quite nonspecific and vague,"Matrisian said.

        The fact that the pancreas is surrounded by dense drug-blocking tissue is also a factor, she added, as is the disease's tendency to start spreading at an early stage.

        Matrisian's report was published online May 19 in the journal Cancer Research.

        The study authors noted that lung cancer is already the top cancer killer in the United States, a dubious designation it is in no threat of losing in the foreseeable future.

        To estimate a broad range of cancer fatality numbers more than a decade from now, the research team conducted an in-depth analysis of recent statistics that covered the 12 most common cancers for men and the 13 most common cancers for women.

        Investigators determined that for the next two decades breast cancer, prostate cancer and lung cancer will remain -- as they are today -- the top three cancers for men and women combined in terms of the sheer number of people being newly diagnosed.

        However, by 2030, thyroid, melanoma and uterine cancers will actually surpass colorectal cancer -- currently number four -- to rank as the fourth, fifth and sixth biggest cancers in absolute numbers.

        The picture in terms of cancer fatalities is somewhat different, however.

        Today lung, prostate and colorectal cancers are currently the number one, two, and three cancer killers of men in the United States, while for women the ranking is lung, breast and colorectal cancer.

        Lung cancer is predicted to remain the top cancer killer in 2030. But, the study team found that the second biggest cancer killer of both men and women combined will shift to pancreatic cancer, followed by liver cancer.

        Matrisian and her associates characterized the findings as a "call to action" that highlights an overall need for improving both pancreatic cancer diagnosis and treatment.

        Yet, on a positive note, Matrisian suggested that the future may prove somewhat brighter for pancreatic cancer, at least in terms of the amount of resources devoted to research. For example, she pointed out that a law passed in 2013 now requires that the U.S. National Cancer Institute place a renewed focus on improving diagnosis and treatments for a number of intractable cancers, including both pancreatic and lung cancer.

        Dr. Anirban Maitra, co-director and scientific director of the Sheikh Ahmed Bin Zayed Al Nahyan Center for Pancreatic Cancer Research at the M.D. Anderson Cancer Center in Houston, stressed that "pancreatic cancer is a very difficult disease to detect and treat." And given insufficient funding for research, he expressed little surprise with the projected trends.

        "We've known for years that pancreatic cancer was one of the few cancers for which the incidence and death rate were on the rise," he said, "while other major cancers have benefitted from significant progress leading to a decline in death rates. However, the publishing of this study is a stark reminder that much work lies ahead to improve outcomes for pancreatic cancer patients."

        Copyright © 2014 HealthDay. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

        Aspirin Benefits Some at Risk for Colon Cancer


         APRIL 23, 2014, 4:32 PM

        Many studies have found that regular aspirin use reduces the risk for colon cancer. Now scientists have found that aspirin may benefit some people far more than others.

        Aspirin apparently exerts a protective effect only in people with high levels of an enzyme called 15-PGDH, which is found in the gut’s lining.

        Researchers tracked aspirin use among 127,865 participants in two large national health surveys, and found 270 cancer cases in which 15-PGDH levels were tracked. The study appears online in Science Translational Medicine.

        They found that taking two regular-strength tablets a week had no significant effect on the risk for cancer in people with low levels of the enzyme. But in people with high levels, it cut the risk by 50 percent. The risk decreased with higher doses and longer duration of aspirin use.

        The effect persisted after controlling for many health and behavioral factors, including the use of other nonsteroidal anti-inflammatory drugs like ibuprofen (Advil) and naproxen (Aleve).

        Doctors don’t routinely test for 15-PGDH. But levels can be determined safely and inexpensively by doing an additional biopsyduring a colonoscopy, said the senior author, Dr. Andrew T. Chan, an associate professor of medicine at Harvard.

        “There is a real need to identify who will benefit from aspirin use,” said Dr. Chan, “and not introduce risk” — such as gastrointestinal bleeding — “to people who will not.”


        Viagra May Boost Risk of Deadly Skin Cancer, Study Finds

        April 7th 2014

        Men who use Viagra to get a boost in the bedroom could find that the little blue pill also increases the risk of developing melanoma, the deadliest form of skin cancer, a preliminary study finds.

        Researchers found that men who took sildenafil, best known as Viagra, were about 84 percent more likely to develop melanoma than men who didn’t take the drug.

        Because it’s just one early study, no one is suggesting that men stop taking Viagra to treat erectile dysfunction, said Dr. Abrar Qureshi, professor and chair of the dermatology department in the Warren Alpert Medical School at Brown University.

        “But people who are on the medication and who have a high risk for developing melanoma may consider touching base with their primary care providers,” said Qureshi, co-author of the study of nearly 26,000 men published Monday in JAMA Internal Medicine.

        Viagra may increase the risk of melanoma because it affects the same genetic pathway that allows the skin cancer to become more invasive, Qureshi said. Those who took the drug weren’t at higher risk of other, less-dangerous skin cancers, such as basal cell or squamous cell cancers.

        About 76,100 new melanoma cases are expected to be diagnosed in the U.S. in 2014, and about 9,710 people will die, including about 6,470 men.

        Qureshi and colleagues at several sites in the U.S. and China analyzed data about Viagra use and skin cancer from the Health Professionals’ Follow-up Study, a long-term study of male doctors and other health care workers.

        The average age of men in the study was 65 and about 6 percent had taken Viagra to treat erectile dysfunction. If men had ever used Viagra, the risk of developing melanoma was about double than for those who never used the drug. That finding held true even when the researchers adjusted for a family history of skin cancer, ultraviolet light exposure in the states where the men lived, other kinds of cancer and major illnesses and other factors.

        Primary care doctors who treat older men taking Viagra should check their patients for signs of skin cancer, said Dr. June Robinson of Northwestern University’s Feinberg School of Medicine, who wrote an accompanying editorial.

        She cautioned that the rate of increase in new melanoma cases in men actually slowed after Viagra entered the market in 1998, raising a “cautionary note” about the impact of sildenafil on melanoma.

        “But its role in the biological behavior of melanoma in older men warrants further study,” she said.


        Exercises Aim to Reduce ACL Tears in Kids

        Mar 25, 2014

        ABC News’ Ann Reynolds reports:

        Angela Owens said she was “shocked” when 9-year-old daughter Isabella blew out her knee while coming down from the high-bar during gymnastics practice.

        Isabella spent a year in physical therapy after undergoing ACL surgery.

        “It was something not even on my radar,” Owens said. “This is what happens to football players. … I thought she had a sore knee. I wouldn’t have even anticipated this was something that could have happened.”

        The anterior cruciate ligament (ACL) tear is an injury that professional athletes fear. It was the reason behind Lindsey Vonn’s absence from the Sochi Olympics, and it cost New England Patriots quarterback Tom Brady most of the 2008 season.

        RELATED: Tom Brady sheds light on rise in ACL tears in children.

        Doctors say they are seeing more torn ACL cases in elementary schools, from children playing tackle football to doing gymnastics, and the numbers are so large that pediatric orthopedic surgeons like Dr. Maureen Green at New York’s Hospital for Special Surgery are calling it an epidemic.

        “We recently looked at the database in New York and found a five- to six-fold increase over the last 20 years of ACL surgeries in children,” Green said.

        The ACL, the main stabilizing ligament of the knee, is not strong enough to take the strain of repeated movements by itself; the whole knee must be strong.

        Children who play the same sport repeatedly – doing just a few moves over and over again – are at risk and girls even more so. They are six times more likely to tear their ACL than boys, according to the PEP Program: Prevent Injury and Enhance Performance, which has developed exercise routines to lower the risk.

        New data says there’s a simple solution that reduces the risks: warm-up exercises to strengthen the muscles around the knee, no matter what sport.

        They involve jumping, stretching and flexing, simulating the movements that children used to do on playgrounds and in backyards.

        Isabella, now 10, has been working with a physical therapist at the Hospital for Special Surgery.

        “The physical therapists that I’ve had. … They noticed when I landed, instead of … using my hips, I used my knees so they gave me some exercises so I wouldn’t do that,” she said.

        The exercises take about 15 to 20 minutes and can be done before practice, according to the PEP program, which was developed by the Santa Monica Sports Medicine Research Foundation, and theFIFA 11+ warm-up program.

        Such warm-ups, according to one study, reduce childhood ACL tears by 74 percent. Now the goal is persuading coaches across the United States to adopt them.


        University to study cancer patients' mental health

        March 17, 2014

        Cancer doesn't attack just the cells of the people who have it. While research has shown that the toll cancer takes on the mental health of patients can lessen chances of recovery and outcomes, medicine has been slow to react to this knowledge.

        The University of Cincinnati Cancer Institute is part of a broad study that may bring change — by finding better measures of the mental health of cancer patients. The goal is to bring social and mental health professionals to patients' aid before they reach a crisis, as well as identify key moments when such help is likely to be needed.

        "We can give people the best chemotherapy (and other treatments) in the world," said Georgia Anderson, manager of palliative care and outpatient social work at the UC institute. "But if we're not checking in to see how they're doing as people, we may not get the best outcomes."

        The institute is one of 18 locations in the U.S. and Australia participating in the two-year Screening for Psychosocial Distress Program.

        The program, funded by a grant from the National Cancer Institute, is a joint project of the Yale University School of Nursing and the American Psychosocial Oncology Society.

        Anderson will work with Clair Bifro, malignant hematology and bone marrow transplant social worker at the institute, to lead the study locally.

        Under the study, newly referred patients facing bone marrow transplant and malignant hematology, breast, lung and gastrointestinal cancers initially will receive new screenings after their first visit with their cancer specialist.

        We can give people the best chemotherapy (and other treatments) in the world. But if we’re not checking in to see how they’re doing as people, we may not get the best outcomes.

        Georgia Anderson, University of Cincinnati Cancer Institute

        The program may be widened later to other cancer specialties.

        The UC institute has been using the National Comprehensive Cancer Network-approved distress thermometer, which measures a patient's mental state in a similar way to pain — on a scale of zero to 10, with 10 being the worst score.

        The scale is designed to make it easier for people to talk to their physicians about the emotional effects caused by the diagnosis, symptoms and treatment of cancer. Yet its roll-out has been a bit rocky, Anderson said.

        That's partly because different types of cancer patients have different needs and concerns.

        One patient may worry about being cured to return to work, while another may only be worrying if she'll live to see a loved one's graduation or wedding.

        "They want to know if they'll be able to do those things," Anderson said. But a newly diagnosed patient may be so flummoxed that he doesn't ask those kinds of questions, triggering stress.

        Under the study, Anderson and Bifro and their colleagues will work to identify specific stresses as a way to trigger better interventions; measure the effectiveness of psychosocial oncology services being provided, including testing, retesting and score tracking; and expand the program by demonstrating the need for services,

        including adding staff and incorporating practices into treatment plans.

        Cancer and mental health

        Depression and social isolation worsen the conditions of cancer patients, research shows. For example:

        — The impaired thinking and loss of memory due to depression can reduce a patient's adherence to treatment, weaken their motivation and promotes other problems such as unhealthy eating or misusing medications.

        — Imbalances in neuro-endocrine and immune system functions triggered by mental distress affect cell growth and replication – boosting the metabolism of tumors and suppressing the body's defenses.

        — Withdrawn and socially isolated women with breast cancer had a 66 percent higher risk of dying within six years, a 2006 study showed.

        — The stress associated with cancer can cause the onset or progression of other illness, especially heart disease.

        — Finally, the stress on patients can affect their whole family. Eight percent of families with a loved one with cancer delay or do not obtain medical care because of cost and worries about money.

        Source: Institute of Medicine of the National Academies

        Study: 2 percent of Americans have new hips, knees

        Tuesday, March 11, 2014

        It’s not just grandma with a new hip and your uncle with a new knee. More than 2 of every 100 Americans now have an artificial joint, doctors are reporting.

        Among those over 50, it’s even more common: Five percent have replaced a knee and more than 2 percent, a hip.

        “They are remarkable numbers,” said Dr. Daniel J. Berry, chairman of orthopedic surgery at the Mayo Clinic. Roughly 7 million people in the United States are living with a total hip or knee replacement.

        He led the first major study to estimate how prevalent these procedures have become, using federal databases on surgeries and life expectancy trends. Results were reported Tuesday at an American Academy of Orthopaedic Surgeons conference in New Orleans.

        More than 600,000 knees and about 400,000 hips are replaced in the U.S. each year. But until now, there haven’t been good numbers on how many people currently are living with new joints. The number is expected to grow as the population ages, raising questions about cost, how long the new parts will last, and how best to replace the replacements as they wear out over time.

        Why the boom?

        “People are aware that they’re a success” and are less willing to put up with painful joints, Berry said.

        The term “replacement” is a little misleading, said Dr. Joshua Jacobs, chairman of orthopedic surgery at Rush University Medical Center in Chicago and president of the orthopedic surgery association. What’s replaced is the surface of a joint after cartilage has worn away, leaving bone rubbing against bone and causing pain and less mobility.

        In a replacement operation, the ends of bones are removed or resurfaced and replaced with plastic, ceramic or metal materials.

        Arthritis is the main reason for these operations, followed by obesity, which adds stress on knees and hips. Baby boomers are wearing out joints by playing sports and doing other activities to avoid obesity. Knee replacement surgeries have more than tripled in the 45-to-64 age group over the last decade and nearly half of hip replacements now are in people under 65, federal numbers show.

        “It’s not for anybody who has pain in the joint,” Berry warned. Surgery won’t help people with pain and stiffness from arthritis but whose joints are not damaged, said Berry, who gets royalties from certain hip and knee implants.

        Surgery also is not for people who haven’t first tried exercise, medicines and weight loss, Jacobs said.

        But for a growing number of people, it can mean a big improvement in quality of life. Mary Ann Tuft, 79, who owns an executive search firm, said her right knee was painful for a decade before she had it replaced in 2005.

        “I live in downtown Chicago, take a lot of walks along the beach. I could barely walk a block” by the time the operation was done, she said. “I’m very social, but I found going to cocktail receptions where you had to stand a long time, I would just avoid them.”

        After the operation, “I felt better pretty much right from the beginning,” she said. “You don’t even know you have it in there, which is amazing.”

        Cynthia Brabbit, a dental hygienist from Winona, Minn., had hip replacement in 2007 when she was 52. She developed hip problems in her 20s that distorted her gait and even caused one leg to grow longer than the other.

        “I was running marathons, doing half marathons, playing tennis,” but the problem grew so bad she couldn’t even walk more than half a mile, she said.

        “Now I can walk an hour a day,” and is training for a 100-mile bike ride this summer, she said. “What a world of difference.”

        Not all patients have fared as well, though. Implant recalls and big patient lawsuits show the danger when a device is flawed.

        Last June, Stryker Corp. recalled certain hip implant products because of corrosion and other problems. Last month, another device maker, Biomet, agreed to pay at least $200,000 each to hundreds of people who received artificial hips that were later replaced.

        And in November, Johnson & Johnson agreed to pay $2.5 billion to settle roughly 8,000 patients’ lawsuits over an all-metal hip implant it pulled from the market in 2010.

        Even good implants can fail over time – about 1 percent or fewer fail each year. After 10 years, more than 90 percent of them are still functioning, Jacobs and Berry said.

        It costs about $20,000 for a knee or hip replacement, but a recent study suggests they save more, because they reduce lost work days and improve mobility.

        “There’s a cost for not doing the procedure,” Jacobs said.

        To help a joint replacement succeed and last, doctors recommend doing physical therapy to strengthen bones, muscles and the new joint. Other tips include maintaining a healthy weight, cross training so you don’t overdo one type of activity or sport, spending more time warming up and letting muscles and joints recover between workouts.


        FDA advisory panel: Naproxen’s CV risk no less than other NSAIDs

        February 11, 2014

        A panel of two FDA advisory committees voted 16-9 today against a conclusion that naproxen has a lower risk for cardiovascular thrombotic events compared with other nonsteroidal anti-inflammatory drugs.

        “The committee is divided,” Tuhina Neogi, MD, PhD, associate professor of medicine and epidemiology, Boston University School of Medicine, and panel chairperson and member of the Arthritis Advisory Committee, said before the vote. “There are a number of individuals who feel that there is a preponderance of data that show a pattern that naproxen may have lower risk than other nonselective and selective [nonsteroidal anti-inflammatory drugs(NSAIDs)], and yet there are others who feel that the preponderance of evidence is largely based on observational data which have a number of bias issues that limit interpretability in terms of its validity.”

        The FDA, which is not bound to advisory panel recommendations, will make a final decision at a later date.

        The panel, which also included the Drug Safety and Risk Management Advisory Committee, had heard testimony from FDA speakers and industry representatives, as well as public input, on the cardiovascular (CV) safety of naproxen compared with other NSAIDs during the 2-day meeting.

        The panel also voted 14-11 today in favor of a labeling question to reconsider advice regarding the latency of CV thrombotic risk. While current NSAID class labeling implies that CV thrombotic risk is not substantial with short treatment course, some studies have suggested there is no, or minimal latency period before the onset of CV thrombotic risk.

        “Despite the split vote, everyone is saying the same thing, that no one should be interpreting that that there is a risk-free period,” Neogi summarized after the vote. “The purpose of the wording is to minimize whatever risk there is, such that you take it at the shortest period of time at the lowest dose.”

        Earlier Tuesday, the panel heard from Garret FitzGerald, MD, Robert L. McNeil Jr. professor in Translational Medicine and Therapeutics, University of Pennsylvania, who spoke on the mechanistic basis for a CV hazard from NSAIDs.

        Industry representatives, including Pfizer, Iroko Pharmaceuticals, Novartis Pharmaceuticals, Bayer HealthCare and McNeil Consumer Healthcare, presented study results assessing NSAIDs and CV safety Monday.

        Steven E. Nissen, MD, MACC, chairman, cardiovascular medicine, Cleveland Clinic, presented data from the Prospective Evaluation of Celecoxib Integrated Safety vs. Ibuprofen Or Naproxen (PRECISION), an ongoing study of 22,621 patients with osteoarthritis or rheumatoid arthritisrandomly assigned treatment.

        “The evidence suggests that celecoxib, naproxen and ibuprofen remain in equipoise,” according to research presented by Pfizer. “PRECISION will provide important information on three commonly used prescription NSAIDs.”

        After Tuesday’s votes, panel members discussed any possible changes that should be made to the PRECISION trial and agreed it should continue.

        CV risk is less likely in patients using naproxen compared with other NSAIDs, according to some speakers on Monday. Andrew D. Mosholder, MD, MPH,medical officer, Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation Research, FDA, said, while thrombotic CV risks by compound were confounded by dose, “lesser risks [are] generally seen with naproxen.”

        Colin Baigent, BM, BCh, professor of epidemiology, University of Oxford, reported on a meta-analysis of randomized trials showing the cardiovascular and gastrointestinal effects of NSAIDs. He summarized that high-dose naproxen had lower major vascular event risk than other traditional NSAIDs, but “in patients on aspirin [eg, those at high vascular risk],” naproxen may interact with aspirin’s antiplatelet effect.”

        “Naproxen has the most favorable risk profile” in a study of NSAIDs and CV risk, Gunnar H. Gislason, MD, PhD, FESC, FACC, cardiology professor, Copenhagen University Hospital Gentofte, reported in a presentation of results from nationwide cohort studies. – Bruce Thiel



        Nuggets' Nate Robinson out for the season after ACL surgery

        January 31, 2014 

         Nate Robinson is out for the remainder of the season after having ACL surgery, the Nuggets announced Friday.

        “It's always tough to see one of your players go down with an injury,” general manager Tim Connelly said. “Nate is known for his heart and determination, so I have no doubt he will work hard to get back on the court as soon as possible. He has the full support of our team and organization.”

        Robinson injured the knee Jan. 29 against the Bobcats.

        The team is currently 22-22 and battling to stay in playoff position, and Robinson has been a siginificant sparkplug off their bench.

        Robinson, signed by Denver as a free agent on July 26, 2013, averaged 10.4 points and 2.5 assists in 44 games with the Nuggets this season.


        Winter Olympics 2014: Plushenko withdraws with injury, retires from skating

        February 13, 2014


        SOCHI, Russia (AP) -- Evgeni Plushenko's Olympics are over. His competitive career, too.

        The Russian star retired Thursday just after he withdrew from the men's event at the Sochi Olympics for medical reasons.

        The 31-year-old Plushenko is the only modern-era figure skater to win medals in four Olympics. He helped 

        SOCHI, Russia (AP) -- Evgeni Plushenko's Olympics are over. His competitive career, too.

        The Russian star retired Thursday just after he withdrew from the men's event at the Sochi Olympics for medical reasons.

        The 31-year-old Plushenko is the only modern-era figure skater to win medals in four Olympics. He helped Russia win the team gold over the weekend.

        "I think it's God saying, 'Evgeni, enough, enough with skating,' " said Plushenko, who originally was hurt in a training session Wednesday. "Age, it's OK. But I have 12 surgeries. I'd like to be healthy."

        In warmups before the short program, he fell on a triple axel and said it felt "like a knife in my back." He skated toward his coaches while bent over, then tried to loosen up by skating around the Iceberg rink some more.

        He then attempted another axel and botched it, shook his head and consulted with coach Alexei Mishin. When Plushenko's name was announced to the crowd seconds later -- to loud applause -- he skated to the event referee and withdrew.

        Before the latest injury, Plushenko said he planned to go out in style.

        "I said to myself, 'Evgeni, you must skate. It's two more days, short and long program,'" the 2006 Olympic gold medalist said.

        He also won Olympic silver in 2002 and 2010.

        Before leaving the ice, he held up both hands to the crowd as if to say he was sorry, and took a small bow.

        He was Russia's only man in the competition, so the host country will have no finisher in the event.

        Plushenko finished second at the Russian national championships and didn't appear headed for Sochi at all. He was added to the Russian roster late last month after a trial run-through in front of federation officials convinced them he was the country's best men's option.

        That decision paid off when he finished second in the team short program and first in the free skate, helping Russia to its first gold of the Sochi Games.

        In that final full practice Wednesday, he fell three times, but was laughing and joking with Mishin after two of the flops. Mishin even said Plushenko was "ready" for the men's event.

        That changed Thursday, and when Plushenko limped out of the arena, the cheers turned to mild applause from the stunned audience.

        "Some people say we had this plan from the very beginning, but we did not," he said. "We were going to go to the end. If I really wished to withdraw after the team event, I would have."


        Two Olympic ski jumpers injured in training falls


        February 12, 2014

        KRASNAYA POLYANA, Russia -- Gold medalist Kamil Stoch of Poland and Russian ski jumper Mikhail Maksimochkin both crashed during landings Wednesday night while training for the individual large hill event at the Sochi Olympics. 

        Wipeouts at Sochi

         Stoch, who won gold in the normal hill event on Sunday, was the last jumper of the night when he fell and was attended to by medical staff. He walked off the hill after having a brace put onto his left arm.

        Paramedics earlier immobilized Maksimochkin with a neck and back brace and strapped him down on a stretcher before taking him away. The Russian was taken from the RusSki Gorki Jumping Center in an ambulance escorted by a police car.

        Officials later quoted governing body FIS as saying that  Maksimochkin had not suffered any serious injuries, but had no further details.

        Maksimochkin attempted to stand up after falling, his skis separated by at least 10 meters. He then collapsed on the icy landing area, and medical officials rushed to his aid.

        The incident came after high winds delayed the start of the first round of training and forced the cancellation of a third round.

        © 2014 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.