Medical advances making it possible for dogs like Cassidy to romp on all four legs.
An injury prevented Juniper from walking normally. Frostbite damaged the hind legs of Meadow. And Andre gnawed off his paws to escape from a wolf trap.
Until a few years ago, there wasn't much hope for these and other disabled animals of ever leading normal lives again. But thanks to advancements in veterinary medicine, and the small but growing field of animal prosthetics, it's now possible for pets and farm animals with missing limbs to walk, run and romp on all four legs.
Cassidy, a shepherd mix, with a caramel-colored coat, was recently outfitted with a carbon fiber leg similar to ones that amputee runners use.
"We just came back from the beach and he's able to run all day," said Cassidy's owner, Steve Posovsky, a retired dentist in Delray Beach, Fla.
The adopted stray -- found wandering the streets of the Bronx on three legs -- is a medical pioneer, becoming the first dog to successfully undergo osseointegration orthopedic surgery, a procedure that may one day benefit humans.
During the four-hour operation, a titanium implant was inserted into Cassidy's right hind leg bone -- designed by veterinarian Denis Marcellin-Little and his colleagues at North Carolina State University in Raleigh -- so that a custom prosthetic limb could later be screwed into the visible tip. The result is an artificial leg that behaves more like a natural limb.
"It's not that different from a total joint replacement," said Marcellin-Little of the surgery. "And, clearly, we have a lot of experience fixing joint prosthetics to bone. That's done in hundreds of thousands of people each year worldwide."
Since Cassidy's surgery in July 2008, a handful of veterinarians in the United States and Europe have used osseointegration to replace limbs of other family dogs and cats.
Marcellin-Little, a professor of orthopedics, currently has three patients -- all dogs that will soon undergo the $7,000 procedure that replaces a missing lower extremity of an otherwise healthy leg.
Entire limbs cannot be replaced, he said.
In Cassidy's case, it's taken 18 months between the surgery and receiving his permanent prosthetic leg in March.
"It's not simple, cheap or quick," Marcellin-Little said of the process.
That's because all equipment is designed and hand-built for each patient, and the experimental surgery must be rehearsed beforehand to make sure it goes smoothly.
It takes around three months of healing time before weight is put on the leg; the animal then must re-learn how to walk on all four feet.
For six weeks, Posovsky patiently helped Cassidy inch across the bedroom, putting one leg in front of the other. The hours upon hours of training finally paid off when one morning Cassidy began to walk on his own.
For most animal owners, externally attached prosthetics are a faster, less-expensive option.
OrthoPets, in Denver, manufactures prosthetics and braces for about 1,200 animals worldwide each year. Most are dogs, but they've also worked with cats, cows, birds, llamas, horses, even an orangutan.
"We joke that if it has an appendage and a heartbeat, we can usually help out," said Amy Kaufmann.
She started the business six years ago with her husband, Martin, who previously worked in the human prosthetics field.
The external prosthetics are built to "last a lifetime" by using tough industrial grade plastic, said Kaufmann. To combat chafing and irritation the devices are lined with special color-changing foam that turns black, alerting owners if a problem arises.
For an animal to be outfitted with an artificial limb, which is attached with straps, Kaufmann said front legs must still have the elbow joint and part of the radius and ulna. The knee joint, as well as part of the tibia and fibula, must be present on rear legs.
Prosthetics for cats and dogs cost between $600 and $800. The price for larger animals, such as cows, llamas and horses, ranges from $800 to $2,000.
For Cassidy, the three-legged shepherd, even the most sophisticated external prosthetic didn't work. Marcellin-Little made two different artificial limbs for him. But because of Cassidy's odd-shaped leg, the devices didn't stay on.
That's when Posovsky and his wife, Susan, decided to move forward with osseointegration, in hopes of giving their dog the joy of being able to go for long walks with them on the beach.
"Cassidy had every reason not to be a nice dog, and have an attitude," said Posovsky of the practically hairless mutt he adopted from the pound. "But this dog -- you can't even make him mad if you tried. That's how sweet he is. He is just the most wonderful, deserving, loving animal there is."
It may give doctors new tool in treating and managing heart disease, experts say.
Adding a computed tomography test to measure calcium in coronary arteries improves predictions of future heart disease, a new study finds, but no one knows yet whether it's worth the cost and risk due to radiation exposure.
"This kind of evidence gives encouragement to go on and do additional testing, but it shouldn't convince us that this test should be done routinely," said Dr. Philip Greenland, a professor of preventive medicine at Northwestern University Feinberg School of Medicine, and a member of the team reporting the study in the April 28 issue of the Journal of the American Medical Association.
Computed tomography uses X-rays to get a detailed picture of heart structure. Its use in diagnosing existing heart disease has become controversial because X-ray exposure increases the risk of cancer. The new study of nearly 6,000 healthy Americans was done to see whether the technique could improve the predictive power of existing cardiac risk factors such as high blood pressure, high cholesterol and obesity.
The study began in July 2000 and ran through May 2008. It used two models to predict the five-year risk of a heart attack, resuscitated cardiac arrest or death from coronary heart disease: the traditional risk factors; or those risk factors plus the coronary artery calcium score.
At 5.8 years, the participants had experienced 209 coronary heart disease problems and 122 "major events" -- that is, heart attacks, deaths from coronary heart disease, or cardiac arrest followed by resuscitation.
The second model, which used the regular risk factors plus the calcium scan, was able to predict an additional 23 percent of the participants who would go on to experience a harmful cardiovascular event. In addition, 13 percent the model reclassified as low-risk did not experience an adverse event.
But does that added predictive power make a difference in terms of saving lives and reducing unnecessary treatment?
"We didn't look at that," Greenland said. "What we can say here is that additional testing looks like it improves prediction. Whether it improves clinical outcome requires a different kind of study."
The first steps toward such a study have been taken. "We are in discussions with the National Heart, Lung, and Blood Institute and have been encouraged to submit a proposal," Greenland said.
Such a study might involve tens of thousands of participants and cost over $100 million, said Dr. Andrew J. Einstein, director of cardiac computed tomography research at Columbia University Medical Center in New York City.
The study would aim at determining whether more intensive treatment of traditional risk factors would improve survival of people classified as high-risk by the coronary artery calcium score. "No study has compared patients who had intensive preventive therapy with those who didn't and see if it makes a difference in terms of the number of heart attacks people have," Einstein said. "That study would be the ideal."
Such a trial needn't be as expensive as Einstein estimates, Greenland said. He puts the cost at "between $29 million and $50 million" and notes that the U.S. Institute of Medicine lists that kind of trial among the top 100 that should be done using funds provided for comparative effectiveness research in the newly approved health care program.
Cancer risk and cost are also parts of the equation. A well-controlled computed tomography scan gives about twice the radiation exposure as a mammogram, Greenland said. A new large-scale trial could show whether the added risk is justified by the number of lives saved, and the same is true of the cost, estimated to run between $200 and $600 per scan.
"Concern about radiation for any individual is minimal, and the cancer issue is 20 years down the line," said Dr. Joseph Ladapo, a clinical fellow in medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. Incidental findings of a scan, such as possible lung problems, can also help justify its widespread use, Ladapo said.
But the time for widespread use has not arrived, Greenland noted. The new study results "are not an endorsement for screening," he said.
Finding could help the elderly or sick who lose interest in food, researchers say.
Laughing can boost the appetite in the same way that exercise does, a finding that could help people eat more when they're sick or depressed, a researcher says.
"The value of the research is that it may provide those who are health-care providers with new insights and understandings and thus further potential options for patients who cannot use physical activity to normalize or enhance their appetite," Dr. Lee S. Berk, a preventive care specialist and psycho-neuro-immunology researcher at Loma Linda University's Schools of Allied Health and Medicine in California said in a news release from the Federation of American Societies for Experimental Biology.
Berk and a colleague have studied laughter and contend that "Laughercise" -- their term for repetitive "mirthful laughter" -- boosts the immune system.
In the study, Berk and colleagues recruited 14 volunteers to watch different kinds of videos -- funny or distressing -- over a three-week period.
Those who watched funny videos experienced changes in hormone levels that are linked to greater appetite. The changes are similar to those experienced by people when they exercise moderately.
"We are finally starting to realize that our everyday behaviors and emotions are modulating our bodies in many ways," Berk said.
The study was to be presented at the annual Experimental Biology meeting, April 24 to 28, in Anaheim, Calif.
Researchers prove that beneficial ingredients penetrate eye tissue.
Beneficial ingredients in green tea penetrate into the tissues of the eye and may help protect beside glaucoma and other eye diseases, says a new study. Researchers analyzed eye tissue from rats that drank green tea and found that the lens, retina and other tissues absorbed major amounts of green tea catechins, which are antioxidants believed to protect the eye. Catechins contain vitamin C, vitamin E, lutein and zeaxanthin.
The action of the green tea catechins in dropping harmful oxidative stress in the eyes lasted for up to 20 hours.
"Our results specify that green tea consumption could benefit the eye against oxidative stress," wrote Chi Pui Pang of the department of ophthalmology and visual sciences at the Chinese University of Hong Kong, Hong Kong Eye Hospital, and colleagues.
The findings are published in the Journal of Agricultural and Food Chemistry.
Preceding to this study, it wasn't known if the catechins in green tea traveled from the digestive system into the tissues of eyes.
Cochlear implants yielded best results when put in those younger than 18 months, researchers find.
Inserting cochlear implants early significantly improves spoken language comprehension and expression in young children who have severe hearing loss, a new study shows.
Researchers assessed spoken language development over three years in 188 children who underwent cochlear implantation before they were 5. The improvements in spoken language performance were much greater than would have been predicted by the children's pre-implant scores on tests of spoken language and comprehension.
The younger the children were when they underwent cochlear implantation, the greater the improvement.
A cochlear implant -- sometimes called a "bionic ear" -- is a small electronic device surgically implanted in the inner ear that stimulates the auditory nerve and allows people who are profoundly deaf to hear many types of sounds.
"Significantly higher rates of comprehension and expression were noted in children undergoing implantation at younger than 18 months compared with children undergoing implantation at ages between 18 and 36 months and at older than 36 months," research leader Dr. John K. Niparko, of the Johns Hopkins University School of Medicine, said in a news release.
In fact, most children who received implants prior to 18 months of age showed trends in improvement that paralleled those of the "control" group of children without hearing loss, Niparko added. Cochlear implantation after 18 months of age, however, was associated with less favorable trends of improvement in performance "and greater variability in measures of both comprehension and expression," he said.
He and his colleagues also found that greater rates of improvement were associated with higher levels of residual hearing prior to cochlear implantation, better parent-child interaction and higher socioeconomic status.
These findings underscore the need to develop objective tools that can evaluate the benefits of hearing amplification in the development of spoken language "and guide timely intervention" with hearing implants, the researchers concluded.
The study appears in the April 21 issue of the Journal of the American Medical Association.
New review finds significant number of mammograms, PSA tests spot tumors that don't need treating.
A new review suggests that doctors need to address the problem of overdiagnosis in cancer care -- the detection and possible treatment of tumors that may never cause symptoms or lead to death.
The review authors found that about 25 percent of breast cancers found through mammograms and about 60 percent of prostate cancers detected through prostate-specific antigen (PSA) tests may be examples of overdiagnosis. And about half of lung cancers detected through some screening tests may also represent overdiagnosis, they added.
For several types of cancer -- thyroid, prostate, breast, kidney and melanoma -- the number of new cases has gone up over the past 30 years, but the death rate has not, the authors noted. Research suggests that more screening tests are responsible for the increased diagnosis rate, they explained.
"Whereas early detection may well help some, it undoubtedly hurts others," Dr. H. Gilbert Welch and Dr. William Black, of the VA Medical Center in White River Junction, Vt., and the Dartmouth-Hitchcock Medical Center, wrote in a news release from the U.S. National Cancer Institute. "Often the decision about whether or not to pursue early cancer detection involves a delicate balance between benefits and harms . . . different individuals, even in the same situation, might reasonably make different choices."
In a commentary, Dr. Laura Esserman, of the University of California at San Francisco, and Dr. Ian Thompson, of the University of Texas Health Science Center at San Antonio, wrote: "What we need now in the field of cancer is the coming together of physicians and scientists of all disciplines to reduce the burden of cancer death and cancer diagnosis. We must advocate for and demand innovation in diagnosis and management, fueled by science, harnessing modeling, molecular and immunology tools to address this problem."
The review is published in the April 22 online edition of the Journal of the National Cancer Institute.
These bacteria can cause pneumonia and meningitis, researchers point out
The advent in 2000 of the PCV7 vaccine to battle bacteria that causes pneumonia, meningitis and sepsis (blood infection) in children has caused notable changes in strains that cause these illnesses, researchers report.
Most worrisome is the recent spread of strains not covered by the vaccine, the team aid.
Immunizations with the PCV7 vaccine is now recommended for all children before the age of 2.
American researchers found that the most common cause of invasive pneumococcal infections is now a strain called serotype 19A, which is not covered by the PCV7 vaccine. The studies also found a rise in infections caused by antibiotic-resistant pneumococci.
One study, an analysis of 2001-07 data by Boston University researchers, revealed that only 15 percent of serious pneumococcal infections in Massachusetts were caused by one of the seven strains covered by the PCV7 vaccine. The remaining 85 percent were caused by other strains, most commonly serotype 19A.
Because infections with PCV7-targeted strains decreased and infections with strains not covered by the vaccine increased, there was little change in the overall rate of serious infections. The fatality rate among children with serious infections was 1.4 percent, and most of the deaths occurred in patients younger than 1 year old.
An increase in serious infections caused by serotype 19A since the introduction of PCV7 was also noted by researchers at the University Of Texas Southwestern Medical Center in Dallas.
Both teams also found a significant rise in infections caused by antibiotic-resistant pneumococci -- mainly serotype 19A -- and stressed the need for continued monitoring of trends in invasive pneumococcal infections.
The studies are published in the April issue of the Pediatric Infectious Disease Journal.
Excessive drinking promotes cellular changes, study finds.
Researchers say they've gained new insight into a link at the cellular level between alcohol consumption, aging and cancer.
The key appears to lie in telomeres, structures at the end of chromosomes that shorten as people get older. Telomeres are also thought to shorten because of excessive drinking.
Researchers thought that people with shorter telomeres due to heavy drinking would face a higher risk of cancer.
"Heavy alcohol users tend to look haggard, and it is commonly thought heavy drinking leads to premature aging and earlier onset of diseases of aging. In particular, heavy alcohol drinking has been associated with cancer at multiple sites," lead researcher Dr. Andrea Baccarelli, head of a research center at the University of Milan, said in a statement.
In the study, researchers analyzed DNA in 59 people who drank heavily (nearly one in four consumed at least four alcoholic drinks a day) and 197 people who drank at various levels.
Researchers found that telomere lengths were much shorter in those who drank a lot of alcohol.
"The decrease we found in telomere length is very sharp, and we were surprised to find such a strong effect at the cellular level," Baccarelli said.
The study was to be presented Wednesday at the American Association for Cancer Research annual meeting, in Washington, D.C.
Men who put on pounds after prostatectomy nearly double odds of recurrence, one study finds.
Men treated for prostate cancer that smokes or put on excess pounds raise their odds of disease recurrence and of dying from the illness, two new studies show.
The findings were presented Tuesday at the American Association for Cancer Research's annual meeting in Washington, D.C.
In the first report, a team led by Dr. Jing Ma, an associate professor of medicine at Brigham and Women's Hospital in Boston found that obesity and smoking may not be risk factors for developing prostate cancer, but they do increase the odds that a man who has the illness will die from it.
Being heavy and smoking "predispose men to a significantly high risk of cancer-specific and all-cause mortality," Ma said during a Tuesday morning news conference.
"Compared to lean non-smokers, obese smokers had the highest risk of prostate cancer mortality," she said.
For the study, Ma's team collected data on more than 2,700 men with prostate cancer who took part in the Physicians Health Study. Over 27 years of follow-up, 882 of the men died, 11 percent from the cancer.
The researchers found that both weight gain and smoking boosted the risk for dying from the cancer. In fact, every five-point increase in body mass index (BMI) increased the risk for dying from prostate cancer by 52 percent. BMI is a measurement of height versus weight, with the threshold of overweight set at a BMI of 25 and the threshold for obesity set at a BMI of 30.
In addition, men who smoked increased their risk for dying from the cancer by 55 percent, compared with men who never smoked, the study found.
"These data underscore the need for implementing effective preventive strategies for weight control and reducing tobacco use in both healthy men as well as prostate cancer patients," Ma said.
In a second report, a team led by Corinne E. Joshu, a postdoctoral fellow in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, found that men who gained weight after having their prostate removed were almost twice as likely to see their cancer return as were men who maintained their weight.
"Weight gain may increase the risk of prostate cancer recurrence after prostatectomy," Joshu said during the AACR news conference. "Obesity, especially among inactive men, may also contribute to the risk of prostate cancer recurrence," she said.
For the study, Joshu's team collected data on more than 1,300 men with localized prostate cancer who underwent prostatectomy between 1993 and 2006. In addition, the men completed a survey on diet, lifestyle and other factors such as weight, height and physical activity five years before surgery and again one year after the procedure.
By the end of the study in 2008, 102 men saw their prostate cancer return. These men were older, more likely to have more aggressive tumors and less likely to have a family history of prostate cancer, compared with men whose cancer did not return, the researchers found.
Furthermore, men who had gained at least five pounds before surgery or up to one year after surgery had almost a two-fold greater chance of seeing their cancer return than did men who did not gain weight, Joshu said.
Five years before undergoing a prostatectomy, 54 percent of the men were overweight and nine percent were obese. Among men who gained weight in the year after surgery, the average weight gain was about 10 pounds. Becoming obese after surgery increased the risk for a recurrence of prostate cancer 1.7-fold, the researchers said.
"By avoiding obesity and weight gain," Joshu said, "men with prostate cancer may be able to both prevent recurrence but also improve their overall well-being."
In another report presented Monday at the meeting, Katherine A. McGlynn, a senior investigator at the U.S. National Cancer Institute, said that the proper control of diabetes might cut people's odds of developing liver cancer.
The researchers used the SEER-Medicare linked database to collect data on more than 5,600 people diagnosed with liver cancer. Among them, 63 percent of the cancers were associated with conditions such as diabetes, alcohol-related disorders and hepatitis C, chronic hepatitis B, obesity and several rare metabolic disorders. The relationship was highest for Asians, at 67.9 percent, and lowest for blacks, at 53.5 percent, the researchers noted.
Among the risk factors, the leading cause of liver cancer was diabetes (33.5 percent). Other factors determined to be contributors to liver malignancy were alcohol-related disorders (23.9 percent), hepatitis C (20.7 percent), hepatitis B (5.7 percent), rare metabolic disorders (3.1 percent) and obesity (2.7 percent).
That left 37 percent of liver cancers with indeterminate origins, McGlynn noted. "We have a long way to go because one-third of the tumors are not explained by these risk factors," she said during Tuesday's news conference.
Metformin linked to tumor reduction in mouse study.
New research in mice suggests that metformin, a drug widely used to treat type 2 diabetes, may guard against lung cancer.
The drug's prospects are not yet confirmed because researchers still need to test it in people. But, in mice, "this well-tolerated, FDA-approved diabetes drug was able to prevent tobacco carcinogen-induced lung tumors," Dr. Phillip A. Dennis, senior investigator in the medical oncology branch of the U.S. National Cancer Institute, said in a news release from the American Association for Cancer Research.
Dennis and colleagues treated mice with metformin for 13 weeks after exposing them to a chemical derived from nicotine. The drug reduced lung tumors by 40 percent to 50 percent when given by mouth and by 72 percent when given by injection.
Dennis said the levels of the drug given to mice would be easy to reach in humans.
The findings are slated to be presented Monday at the American Association for Cancer Research's annual meeting, in Washington D.C.
Study found multivitamins, calcium tablets had protective effect.
Women who take multivitamin tablets along with calcium supplements seem to have a reduced risk of developing breast cancer, new research suggests.
The authors of the study, which is to be presented Sunday at the American Association for Cancer Research annual conference in Washington, D.C., did not separate out which specific vitamins might be beneficial but suggested that the interactions of different vitamins together might account for the beneficial effect.
"The effect was seen with multivitamins, not with single vitamins," said study co-author Dr. Jaime Matta, a professor of pharmacology, physiology and toxicology at Ponce School of Medicine in Ponce, Puerto Rico. "It's possible that the vitamins work better together than individually."
"We found that taking multivitamins and calcium supplements were strongly protective against breast cancer," said Dr. Manuel Bayona, a professor in the public health program at the Ponce School of Medicine. "Which vitamins exactly? We don't know because they were multivitamins."
The findings, however, do seem to contradict previous reports that the supplement forms of various single vitamins including E and C don't prevent breast cancer in women. Other studies have suggested a protective effect for individual vitamins.
The new study won't do much to settle that confusion, one expert said. "The results are interesting but it's a small study," said Joanne Dorgan, an epidemiologist with Fox Chase Cancer Center in Philadelphia. "At this point in time, most of the big studies don't support an association."
For this study, the authors compared vitamin and calcium intakes of 268 women with breast cancer and 457 women without breast cancer, all in Puerto Rico.
They also measured the ability of the women's DNA to repair itself, a function that is critical to keeping cancer at bay.
"We've known that DNA repair capacity is linked to several other types of cancer," said Matta. "DNA repair capacity is very, very linked to breast cancer risk."
Here, women who were older, had low DNA repair capacity levels, a family history of breast cancer and who had not breast-fed all had a higher risk of breast cancer.
Taking a multivitamin tablet reduced the risk of tumors by about 30 percent, while calcium supplements reduced the risk by 40 percent, the study authors noted.
But when the DNA repair capacity was taken out of the equation, calcium was no longer protective, strongly suggesting that calcium's protective effect came only from its influence on DNA repair.
Vitamins, on the other hand, seemed to have a beneficial effect even beyond contributions to DNA repair, the researchers said.
One drawback of the study is that the authors did not measure women's actual vitamin levels, instead relying on responses to questionnaires. Participants most likely bought widely available brands at chain drug stores. "People here usually don't have access to very sophisticated health food stores or specialty vitamin stores," noted Matta.
The study authors are now looking at ways to use DNA repair capacity function as a marker for breast cancer risk, much like cholesterol is used as a marker for heart disease.
"We're developing new technology that would make measuring DNA repair capacity more inexpensive, faster and easier to do," Matta said.
Still, another expert said the new study was less than convincing.
"The totality of the evidence to date does not support taking vitamins and calcium for breast cancer prevention," said Marji McCullough, strategic director of nutritional epidemiology for the American Cancer Society. "There are other reasons women may wish to take calcium, for example for bone health."
Finding may offer new ways to predict odds for the disease, researchers say.
Women who were thin as young girls are at increased risk for breast cancer as they age compared to women who were larger in girlhood, a new study finds.
Researchers examined the link between childhood body size and tumor characteristics in over 2,800 Swedish breast cancer patients and a control group of more than 3,100 women without breast cancer.
"Our main finding was that a large body type at age seven years was associated with a decreased risk of postmenopausal breast cancer," said study author Jingmei Li in a press release.
Although a large body type in girls is strongly associated with other known risk factors for breast cancer, such as early menstruation, a high adult BMI and breast density, Li said, a large body type at age seven "remained a significant protective factor after adjustment for these other issues."
"It appears counterintuitive that a large body size during childhood can reduce breast cancer risk, because a large birth weight and a high adult BMI have been shown to otherwise elevate breast cancer risk. There remain unanswered questions on mechanisms driving this protective effect," Li said.
The findings may offer a new way to help determine a woman's breast cancer risk.
"Given the strength of the associations, and the ease of retrieval of information on childhood shape from old photographs, childhood body size is potentially useful for building breast cancer risk or prognosis models," Li and colleagues concluded.
The study appears April 15 in the journal Breast Cancer Research.
The benefits of fruits and vegetables in staving off cancer exist, but they're not as strong as earlier believed, a new study reports.
Eating an extra 200 grams a day of fruits and vegetables (about two servings) resulted in only a 3 percent reduction of cancer risk, which was described as "very weak," according to the study available online in the Journal of the National Cancer Institute.
The World Health Organization, Centers for Disease Control and Prevention and the American Cancer Society all promote people to maintain a healthy lifestyle and eat five servings of produce a day for cancer defensive benefits. Scientists think fruits and vegetables have anti-cancer compounds, affecting enzymes, immune organism and hormone levels.
Researchers raised the vision that people who ate more fruits and vegetables could have lower cancer risks because they had generally healthier lifestyles, "such as lower intake of alcohol, never smoking, short duration of tobacco, and advanced level of physical activity." These could've been factors rather than just fruit and vegetable ingestion.
Previous studies have touted the benefits of produce, with result of 20 to 30 percent reduced cancer rates. The latest finding from the European study was low in contrast."Diet is a difficult pattern and lifestyle," Boffetta said. "Cancer is complex disease. It's suspect that one thing will explain the other."
The study does not contradict existing American Cancer Society guidelines about eating five servings a day to diminish cancer risk, said Dr. Michael Thun, the organization's vice president emeritus of epidemiology. It reaffirmed accessible notions that higher intake lowered cancer risk, he said.
"In my view, there is a good remains of evidence that fruit and vegetables do matter for cancer -- it certainly matters for heart disease," Thun said. "It's not as strong as early studies suggested."
Decades of study have shown that eating processed red meat increases risk of cancers in the digestive tract and that obesity is associated with colorectal and breast cancer. But "the narrative on vegetables and fruits has been harder to nail down," Thun said.She pointed out eating fruits and vegetables has benefits further than the cancer realm.
"It does facilitate with lowering weight and blood pressure, lowering diabetes risk or lowering blood sugar. Those are all health profit that increase lifespan significantly."They also offer soluble and insoluble fiber, minerals, high nutrients and low calories, she added.
Findings could lead to development of more targeted treatments, researcher says.
Genetic analysis of a woman with breast cancer has yielded important information about an extremely dangerous type of breast cancer that largely affects blacks and younger women, say U.S. researchers.
By comparing three genomes -- the genome of a 44-year-old black woman who had "triple negative" breast cancer and the genomes of her breast tumor and a metastatic tumor that developed in her brain -- the scientists identified 20 genetic changes in a subset of breast tumor cells that probably played a role in the spread of the cancer that led to her death within a few months.
The findings suggest that sequencing entire genomes of cancer patients, along with the genomes of their primary and metastatic tumors, could improve understanding of how tumors spread and possibly lead to the development of new drugs that target important cancer-causing genetic errors, according to the researchers, from the Washington University School of Medicine in St. Louis.
"We are getting an intimate look at the lethal spread of a breast cancer, which is now possible because we can sequence entire genomes quickly at reasonable cost," Elaine Mardis, co-director of the university's Genome Center and the study's senior author, said in a university news release.
"This work lays the foundation for understanding the genetic basis of tumor progression and metastasis and for identifying new drug targets that can improve the outlook for women with this disease," she added.
But experts note that many taking them already face higher risk for suicide.
Some anticonvulsants used to treat epilepsy and other conditions may increase the risk of suicide, attempted suicide or violent death, a new study finds.
While these drugs are used primarily to control epileptic seizures, they are also approved treatments for other conditions, such as bipolar disorder, mania, migraine and chronic nerve pain.
"Anticonvulsant medications have important therapeutic benefits, but they also have associated risks that both provider and patient need to remain aware of," said study author Dr. Elisabetta Patorno, a research fellow at Brigham and Women's Hospital and Harvard Medical School in Boston.
"Physicians should discuss associated risks and benefits with their patients, and together determine the best treatment course for the underlying medical condition," she said. "Both patients and health-care professionals should be alert to early symptoms that might potentially be associated with suicidal risk."
The report is published in the April 14 issue of the Journal of the American Medical Association.
For the study, Patorno's group used the HealthCore Integrated Research Database, which has data on prescriptions and adverse side effects. Specifically, they looked at almost 300,000 patients aged 15 and older in 14 states that started taking anticonvulsant medications between July 2001 and December 2006.
During that period, the researchers identified 801 attempted suicides, 26 completed suicides and 41 violent deaths -- 868 combined suicidal acts or violent deaths.
Patorno's group found an increased risk of suicidal acts among patients taking the anticonvulsants gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), tiagabine (Gabitril) and valproate, compared with people taking the anticonvulsant topiramate (Topamax).
In 2008, the U.S. Food and Drug Administration instructed manufacturers of anticonvulsants to include a label warning about the increased risk of suicidal thoughts or actions associated with these drugs.
"I do not think that the results should affect physician behavior at this time," said Dr. Orrin Devinsky, director of the Epilepsy Center at NYU Langone Medical Center.
"Anti-epileptic drugs are used primarily in patients with epilepsy and patients with psychiatric disorders; both groups have well-known increased risk for suicidal behavior," Devinsky said.
This study found the probability of suicidal acts after starting topiramate were relatively low compared to four other anticonvulsant medications, he said.
"The question is if there was a bias with regards to patients selected on these medications, and also whether these results, which were statistically significant, would be replicated and have clinical significance," Devinsky said.
"It is possible that a new cohort would reveal a different profile, reflecting the random nature of the patient population and a selection bias of how doctors prescribe drugs," he added.
Dr. Ewald Horwath, a professor of psychiatry & behavioral sciences at the University Of Miami Miller School Of Medicine, said the study may be misleading.
"The study did not take adequate account of why people were taking the anticonvulsant," Horwath said. The authors noted that many of the people in the study were taking these drugs to treat bipolar disorder and depression, "conditions that are associated with higher suicide rates," he said.
Horwath noted that another study of patients with bipolar disorder found these drugs actually decreased the risk for suicide.
'Good' cholesterol levels linked to age-related macular degeneration, studies show.
Two new studies provide more evidence of a genetic link between an eye disease that affects millions of older people and the regulation of so-called "good" cholesterol in the body.
The researchers don't fully understand the connection, nor are they near finding better treatments for the eye disease, known as age-related macular degeneration (AMD). Still, they say the results could lead to future advances.
Scientists had been exploring the cholesterol-eye disease link for some time, noted Anand Swaroop, an investigator with the National Eye Institute and lead author of one of the reports. "But somehow, their studies did not get much attention. Hopefully now the genetic evidence is so strong that people will explore those possibilities in much more detail," Swaroop said.
An estimated 10 million or more people in the United States develop AMD each year, including about 25 percent of people over the age of 65 and 30 percent to 35 percent of those over 75, Swaroop said. The disease affects an area of the retina known as the macula, causing people to lose the ability to see in the central area of their field of vision.
"You cannot see straight," Swaroop explained. In the most severe cases, "you cannot drive, and you cannot do day-to-day things in life."
For some patients, the disease can cause blindness.
The cause appears to be a blend of genes and environment. "Genes alone do not cause the disease, and environment alone cannot cause the disease," Swaroop said.
In the new studies, researchers examined the genetic makeup of hundreds of people with and without age-related macular degeneration. Those with the condition turned out to share a particular variant of a gene known as LIPC, which regulates the metabolism of high-density lipoprotein (HDL) cholesterol in the blood.
But what is the link, exactly? It's not clear if high levels of HDL ("good") cholesterol might somehow boost a person's risk of developing the eye disease. That would create a complication if treatments designed to prevent the eye disease harmed cardiovascular health by lowering levels of "good" cholesterol. The reverse -- a treatment that boosted HDL cholesterol but also raised the risk of the eye disease -- would be a problem, too.
In any case, the researchers believe there isn't a direct cause-and-effect relationship, in which the genes in question cause both high levels of good cholesterol and raise the risk of the eye disease.
It's possible that the eye disease might have something to do with how the body transports nutrients in the blood, said Dr. Johanna Seddon, co-author of the other study and director of Tufts University Medical Center's Ophthalmic Epidemiology and Genetics Service.
Or, she said, a third factor might be involved.
In the big picture, said Swaroop, "we know today a lot more than we knew last month and last year." But that doesn't mean a better treatment -- or a cure -- for the eye disease is around the corner.
The studies are published in the April 12-16 online edition of the Proceedings of the National Academy of Sciences.
Premature hardening of the arteries in arms and legs seen in many patients under 55: study
Severe peripheral vascular disease may be much more common in younger American adults and women than previously suspected, according to a new study.
The disease causes a narrowing in blood vessels that carry blood to the arms, legs, kidney and stomach and leads to symptoms that include pain and cramping in the legs during exercise.
Researchers analyzed data on 994 men and women, age 55 and younger, treated in the Wake Forest University School of Medicine Vascular Center between 1998 and 2009. They found that most of them had premature atherosclerosis (hardening of the arteries). Severe premature arterial disease of the legs (64 percent) was the most common finding.
Among the other findings:
130 patients had surgery to unblock the carotid artery and improve blood flow from the heart to the brain.
87 patients had mesenteric vascular disease -- a narrowing or blockage of one or more of the three major arteries that supply blood to the small and large intestines.
49 patients had repair of abdominal aortic aneurysms, which occur when a large blood vessel supplying blood to the abdomen, pelvis and legs swells and is in danger of bursting.
46 patients had restricted blood flow in the arms because of an embolism or blocked blood vessels in wrist and/or palm.
19 patients had Buerger's disease, a rare disease of the arteries and veins of the arms and legs that can lead to infection, gangrene and amputation. The condition is strongly linked to smoking and the use of snuff and chewing tobacco.
192 patients (19 percent) had arterial disease in multiple organs.
Advanced damage from hardening of the arteries was present in 88 percent of the patients.
The findings suggest a need for better detection of early clinical signs of systemic atherosclerosis, researchers said.
The study was slated to be presented Saturday at an American Heart Association conference in San Francisco.
It's easy to help your children get their optional 60 minutes of daily physical activity, according to the Alliance for a Healthier Generation.
For starters, join them. That's the best way to convince kids to be active. And you can split the fun and health benefits, too.
The group also suggests that adults:
Encourage children to get on their bicycles, roller skates or blades and scooters. Make sure they wear helmets and protecting pads.
Teach children to walk as often as feasible, such as to a friend's house, to the store, around the mall or any other place where it's safe to walk. If they don't have a particular end, suggest that they take the dog for a walk.
Twist up the music and dance. It doesn't have to be strict or perfect, just have fun.
Organized sports aren't the only way to take pleasure in team activities. Children can meet with a few friends to play street hockey, shoot some hoops, kick a soccer ball or toss about a football or baseball. Check neighborhood pastime centers for open gym times and for activities such as tennis or swimming.
Teach children how to get younger kids doing active effects such as hopscotch, jump-rope, tag, hide-and-seek, kickball, T-ball, hula hoops or kite flying.
Poor people are more likely to die within five to 10 years after heart surgery than more rich people, U.S. researchers report.
They followed 15,156 white men, 6,932 white women, 678 black men and 564 black women who had heart bypass or valve operation between 1995 and 2005 and found that the poorest patients were 19 to 26 percent more expected to die within five years of surgery than the wealthiest patients, in any case of race or gender.
No matter what race or gender, poor people have higher death rates than rich within initial decade.
"We were surprised that constantly and pervasively, through every way of looking at the data, it turns out this isn't about skin color or gender. It's about being poor," study author Colleen G. Koch, a cardiac anesthesiologist and vice chair for research and education in the department of cardiothoracic anesthesia at the Cleveland Clinic, said in a news let go.
However, the researchers did find that poor patients were considerably more likely to be black and female.Koch and colleagues also found that inferior patients had more atherosclerosis, serious cardiovascular disease, prior heart attacks, left ventricular dysfunction, heart failure, high blood pressure, prior stroke, peripheral artery disease, treated diabetes, and chronic disruptive pulmonary disease. They were also more likely to be smokers.
The study appears in the recent issue of the journal Circulation: Cardiovascular Quality and Outcomes.
Poorer patients didn't have a considerably higher death rate while in hospital immediately after surgery. Factors such as financial problems, learning barriers, and lack of referrals to cardiac rehabilitation programs may donate to increased risk of death among poor patients in the years after heart surgery, Koch said.
Their survival rates might raise during better access to primary prevention, earlier identification of risk factors, better access to long-term interventions, and enrollment in cardiac rehab programs, Koch said. Cardiac rehab normally includes monitored exercise, nutritional analysis, emotional support, and education.
Researchers find frequent returns to hospital for treatment, at higher rates than expected.
People with sickle cell disease often visit hospitals repeatedly in search of treatment, according to new research.
In eight states studied, researchers found that one-third of sickle cell patients who visited the hospital returned within 30 days in search of pain relief. Young people, between the ages of 18 and 30, were especially likely to seek care.
"I think it's not so much a failure of the hospital itself, but a failure of us being able to prevent these complications and being able to treat them," said Dr. George R. Buchanan, a pediatrics professor at University of Texas Southwestern Medical Center, who is familiar with the study findings.
An estimated 70,000 to 100,000 people in the United States have sickle cell disease, an inherited and often-painful condition that causes red blood cells to turn into a sickle shape. Blacks are most vulnerable to the disease, but other races can develop it too.
"The cells are very inflexible and they clog up the blood vessels," Buchanan said. Oxygen fails to get to tissues in the bone, heart and brain, he said, often leading to severe pain -- "like the pain of a heart attack" -- and organ failure.
Stem-cell treatments can cure the disease, but "the problem is it's risky and only a small minority of patients have a donor, usually a brother or sister, whose bone marrow matches theirs," Buchanan said.
The new study, published in the April 7 issue of the Journal of the American Medical Association, aimed to determine how often sickle cell patients seek acute care from hospitals.
Researchers from the Medical College of Wisconsin and the Children's Research Institute at Children's Hospital of Wisconsin analyzed statistics from hospitals in eight states for the years 2005 and 2006. A total of 21,112 sickle cell patients visited the hospitals in Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina and Tennessee.
The researchers found 41 percent of patients aged 18 to 30 returned to hospitals within 30 days of visits in order to get relief for pain.
"What many people do not realize is that so many of these patients live with some level of chronic pain every day, which they try to control at home through various methods. It is when the pain becomes acutely worse, and debilitating, that they seek acute care," said Dr. Claudia R. Morris, an attending physician at Children's Hospital Oakland Research Center in California, who's familiar with the study findings.
The people with sickle disease typically visited the hospital several times a year, and were more likely to do so if they were insured through government programs like Medicaid.
The rate of return visits to the hospital is "extraordinarily high," more than doctors previously realized, and that suggests the quality of care received by patients "leaves something to be desired," Buchanan said.
"We need more skilled providers interested in sickle cell disease and with knowledge about it to provide continuity of care to these individuals," Buchanan noted.
Morris added that better access to specialty clinics would probably help patients insured by the government avoid so many hospital visits. And in the long run, she said, better care could save money.
"This study is important because it provides benchmark data to evaluate the quality of management of sickle cell disease symptoms," said Dr. Carolyn M. Clancy, the director of the U.S. Agency for Healthcare Research and Quality, which helped fund the study.
"The next step is to determine why patients are being rehospitalized or seeking emergency department treatment at this rate and to make improvements in their care," Clancy added in a news release.
Life expectancy is reduced by 10 years on average, study finds.
People who develop cancer at a young age require lifelong monitoring and are at an increased risk of early death, according to the results of two new studies.
In one report, published in the April 6 issue of the Annals of Internal Medicine, researchers estimated the cumulative effect of disease- and treatment-related death risk in 15-year-old patients who had survived at least five years after treatment for childhood cancer.
The computer model developed by the study authors showed that health risks faced by childhood cancer survivors shorten their life span by an average of 10 years. That reduction in life expectancy varied according to the type of cancer. For example, survivors of kidney cancer died about four years earlier than the general population, while bone and brain cancer survivors died about 18 years earlier.
This shortened life expectancy could be the result of cancer treatments with long-term toxicity that were used in previous decades, the researchers noted.
When caring for childhood cancer survivors, doctors should consider past cancer treatments and their long-term effects, according to the authors of an accompanying editorial.
Another study published in the same issue of the journal found a substantially elevated risk of breast cancer among young women who had chest radiation for cancer when they were children or young adults. These women require lifelong monitoring for breast cancer, the researchers explained.
While evidence suggests that MRI and mammography beginning at age 25 may be the best screening approach for these women, the researchers said further research is needed to learn more about the potential benefits and threats of the additional radiation exposure associated with this type of screening program.
Different pancreatic cells change into beta cells, suggesting new therapy for type 1 diabetes.
Certain cells in the pancreas can regenerate themselves into insulin-producing cells after normal insulin-producing cells have been destroyed, as happens in type 1 diabetes, a new study found.
Swiss researchers discovered that when they destroyed the insulin-producing cells, known as beta cells, in mice to induce an artificial form of type 1 diabetes, other cells in the pancreas called alpha cells then changed into insulin-producing beta cells.
"The adult pancreas can regenerate new beta cells even if they are totally absent -- like in type 1 diabetes," said the study's senior author, Pedro Herrera, a professor in the department of cell physiology and metabolism at the University of Geneva Medical School.
Diabetes experts cautioned, however, that far more research is needed to see if the process could benefit people with type 1 diabetes, an autoimmune disease in which the immune system attacks the beta cells in the pancreas that produce insulin, the hormone that allows people to convert food into energy. People with type 1 diabetes must rely on insulin therapy for the rest of the lives.
And if such a process occurs in humans, or could be induced to occur, one large roadblock remains. In type 1 diabetes, the immune system attack on beta cells appears to go on indefinitely, which is why people who've had transplants of insulin-producing cells eventually must go back on insulin. The immune system destroys the transplanted beta cells, too.
"Any time you're thinking about any type of a cure or really good treatments for type 1 diabetes, you have to consider both the beta cells and the immune side," said Andrew Rakeman, the scientific program manager in beta cell regeneration at the Juvenile Diabetes Research Foundation (JDRF). The JDRF funded a portion of the new research.
"At this point, it's unknown whether reprogrammed alpha cells would be vulnerable. Alpha cells are normally not destroyed by the immune system, but in regenerating, they're losing traits that make them alpha cells to turn into beta cells. So, it's likely that they'll appear to the immune system as beta cells," Rakeman said.
To induce type 1 diabetes in the mice, the Swiss researchers exposed the rodents to a toxin that destroyed just their beta cells. Alpha cells are normally found in the pancreas alongside beta cells. Alpha cells secrete a hormone called glucagon that counteracts the effects of too much insulin and helps the body maintain normal blood sugar levels.
More than 99 percent of the beta cells were destroyed in the mice. The researchers labeled alpha cells with a fluorescent protein so they could track those cells.
They found that when nearly all of the beta cells had been destroyed, if mice were given insulin therapy to keep them alive, the alpha cells spontaneously changed into functioning beta cells. After enough alpha cells converted into beta cells, insulin therapy was no longer needed.
The new research, published April 4 in the online edition of the journal Nature, is the first to show that this change can happen naturally and spontaneously, the study authors said. Previous research has been able to change adult cells into insulin-producing cells, but that change required genetic manipulation, which might make it harder to develop a type of drug to reproduce the effect.
Rakeman said what's exciting in this new study is that "reprogramming is something that can happen naturally. If one can delineate what's causing it to happen in mice, it might be possible to find interventions to induce that to happen in humans."
Herrera said the researchers want to learn more about how the alpha cells undergo this change, and they also want to learn whether other cells can undergo these types of conversions.
Dr. David Kendall, chief scientific and medical officer at the American Diabetes Association, said, "Anything that speaks of a potential source of new insulin producing cells is pretty exciting.
"However," he added, "I always have cautious enthusiasm for such findings. Early promise is not always a guarantee, and a number of mouse findings haven't translated well in human research."
Women who took the birth control pill start in the late 1960s lived longer than those not at all on the pill, a new study says.
British researchers observed more than 46,000 women for almost four decades from 1968. They compared the number of deaths in women on the pill to those who never took it.
In the study, women on the pill usually took it for almost four years. Experts finished the pill cut women’s risk of dying from bowel cancer by 38 percent and from any other diseases by about 12 percent.
Slightly higher death rates were establish among women under 30 on the pill, but that began to be reversed by age 50. Doctors aren’t sure accurately why the pill may lower death rates. It contains synthetic hormones to contain ovulation, which may have some role in preventing certain diseases.
Previous studies have found the pill does not elevate the risk of dying. It also may protect next to ovarian and endometrial cancer, but slightly enlarge the chances of breast and cervical cancer. It may also be that women on the pill are somehow in good health than those that aren’t.
Because the study only observed women on the pill compared with those who weren’t, researchers weren’t able to make any hypotheses about origin and effect. “In the longer term, the health payback of the contraceptive pill outweigh any risks,” Richard Anderson, a gynecologist at the University of Edinburgh, said in a statement. Anderson was not connected to the BMJ study.
But he said the findings might not be expected to women using modern contraceptive pills, which may have a different risks than earlier products. The risks may also be higher depending on when women start enchanting the pill and how long they are on it.
“Many women, particularly those who used the first generation of oral contraceptives many years ago, are likely to be reassured by our results,” Philip Hannaford of the University of Aberdeen in Scotland, the study’s lead researcher, said in a statement.
Hannaford and colleagues said the pill’s risks and profit may vary worldwide, depending on how it is used and each patient’s health risks.
