Friday, September 7, 2012

University Of Hawaii Cancer Researchers Discover Gene Defect Responsible For Cancer Syndrome

University of Hawai'i Cancer Center researchers have discovered germline BAP1 mutations are associated with a novel cancer syndrome characterized by malignant mesothelioma, uveal melanoma, cutaneous melanoma and atypical melanocytic tumors. Germline mutations are hereditary gene defects that are present in every cell.

The study investigated two unrelated families with BAP1 defects and found an increase in the occurrence of mole-like melanocytic tumors that are non-cancerous flat or slightly elevated and pigmented skin lesions. These benign skin lesions were found to carry the BAP1 mutation and it was concluded that people with this specific type of melanocytic lesion are at higher risk of developing melanoma and mesothelioma.

This discovery provides physicians with a visual marker in identifying individuals that may carry germline BAP1 mutations. People having this syndrome should reduce their exposure to environmental risk factors such as UV radiation for melanoma and avoid erionite and asbestos exposure for mesothelioma. It will also help identify individuals who are at higher risk for melanomas which is usually cured with timely detection and to assist in the early detection of mesothelioma which typically leads to better prognosis.

"Identifying this gene as a cause of several cancers can tell us who is at risk in a family before the cancer develops," said Michele Carbone, MD, PhD, director of the UH Cancer Center and professor of pathology, John A. Burns School of Medicine. "We can advise patients to undergo routine exams and genetic testing for early diagnoses and treatment." Carbone is the leading author of the paper included in the August 30, 2012 issue of the Journal of Translational Medicine, published by BioMed Central.

This novel gene-testing has been patented by Carbone and colleagues and is performed exclusively at The Queen's Medical Center in Honolulu, Hawaii where they receive genetic samples from across the entire United States. Carbone previously discovered that individuals who carry BAP1 mutations are susceptible to developing mesothelioma and melanoma of the eye. This latest discovery builds on this and other research on the BAP1 mutation.
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Students Create Low-Cost Biosensor To Detect Contaminated Water In Developing Nations

Diarrheal disease is the second-leading cause of death in children under five years old - killing as many as 1.5 million children worldwide every year. These startling statistics from the World Health Organization (2009) point to the reason why a group of undergraduate students from Arizona State University is working to develop a low-cost biosensor - a simple device that would detect contaminated drinking water.

An interdisciplinary team of nine students is participating in the 2012 International Genetically Engineered Machine (iGEM) competition - a prestigious global event that challenges students to design and build simple biological systems made from standard, interchangeable parts.

The ASU team started its research during the summer to prepare for the synthetic biology competition. Its goal is to create a user-friendly, DNA-based biosensor that can detect major pathogens. The low-cost device would be used in the field rather than in a laboratory.

"We are developing a biosensor that will detect pathogenic bacteria, such as Shigella, Salmonella and E. coli, that cause diarrhea," said Ryan Muller, an undergraduate student in ASU's School of Life Sciences and an iGEM team leader. "Ideally, you would use our biosensor to check different water supplies in third world-countries to determine whether the water is safe to drink."

The team is working on two biosensor designs.

"The first one targets DNA," explained Nisarg Patel, a molecular biosciences and biotechnology major in School of Life Sciences, as well as a political science major. "Since each type of pathogen has different DNA, we want to create complementary sequences - sequences that match a specific DNA. We will take bacterial samples from the water, pull out the DNA and check whether it complements our DNA probe. If it does, it will produce a color response and then we'll know that the water is contaminated."

Made for portability, Patel said the second design tests the membranes of bacteria. When using the device to test water, if certain proteins attach to a bacterial membrane, the sample will turn blue - indicating the water is contaminated with a pathogen and would not be safe to drink.

"The advantage of this design over previous designs in the field lies in the cheap production of probes and the enzymatic chain reaction," said Abhinav Markus, a biomedical engineering student in ASU's Ira A Fulton Schools of Engineering. "Samples can be tested in the field with minimal cost and high sensitivity."

When the ASU iGEM team first met this summer, Madeline Sands, an anthropology major in the university's School of Human Evolution and Social Change, pitched the idea to build a low-cost biosensor. Sands previously traveled to Guatemala as part of an ASU field experience. There, she conducted community health research under the direction of Jonathan Maupin, a medical anthropologist. Sands realized that contaminated water presents a serious health problem for developing countries.

"With constant earthquakes, landslides and rains in Guatemala, it can often be difficult to determine if a water source is contaminated," said Sands. "My time there made it clear that having a way to detect contaminated water could lead to a further reduction in the incidence and morbidity of diarrhea."

In October, the team will present its device during the iGEM regional competition at Stanford University. If successful, they will move on to the global competition in November at Massachusetts Institute of Technology.
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Expressing Your Emotions Can Reduce Fear, UCLA Psychologists Report

"Give sorrow words." - Malcolm in Shakespeare's "Macbeth"

Can simply describing your feelings at stressful times make you less afraid and less anxious?

A new UCLA psychology study suggests that labeling your emotions at the precise moment you are confronting what you fear can indeed have that effect.

The psychologists asked 88 people with a fear of spiders to approach a large, live tarantula in an open container outdoors. The participants were told to walk closer and closer to the spider and eventually touch it if they could.

The subjects were then divided into four groups and sat in front of another tarantula in a container in an indoor setting. In the first group, the subjects were asked to describe the emotions they were experiencing and to label their reactions to the tarantula - saying, for example, "I'm anxious and frightened by the ugly, terrifying spider."

"This is unique because it differs from typical procedures in which the goal is to have people think differently about the experience - to change their emotional experience or change the way they think about it so that it doesn't make them anxious," said Michelle Craske, a professor of psychology at UCLA and the senior author of the study. "Here, there was no attempt to change their experience, just to state what they were experiencing."

In a second group, the subjects used more neutral terms that did not convey their fear or disgust and were aimed at making the experience seem less threatening. They might say, for example, "That little spider can't hurt me; I'm not afraid of it."

"This is the usual approach for helping individuals to confront the things they fear," Craske said.

In a third group, the subjects said something irrelevant to the experience, and in a fourth group, the subjects did not say anything - they were simply exposed to the spider.

All the participants were re-tested in the outdoor setting one week later and were again asked to get closer and closer to the tarantula and potentially touch it with a finger. The researchers measured how close subjects could get to the spider, how distressed they were and what their physiological responses were, focusing in particular on how much the subjects' hands sweated, which is a good measure of fear, Craske said.

The researchers found that the first group did far better than the other three. These people were able to get closer to the tarantula - much closer than those in the third group and somewhat closer than those in the other two groups - and their hands were sweating significantly less than the participants in all of the other groups.

The results are published in the online edition of the journal Psychological Science and will appear in an upcoming print edition.

"They got closer and they were less emotionally aroused," Craske said. "The differences were significant. The results are even more significant given the limited amount of time involved. With a fuller treatment, the effects may be even larger.

"Exposure is potent," she added. "It's surprising that this minimal intervention action had a significant effect over exposure alone."

So why were the people in the first group - those who performed what the life scientists call "affect labeling" - able to get closer to the tarantula?

"If you're having less of a threat response, which is indicated by less sweat, that would allow you to get closer; you have less of a fear response," said study co-author Matthew Lieberman, a UCLA professor of psychology and of psychiatry and biobehavioral sciences. "When spider-phobics say, 'I'm terrified of that nasty spider,' they're not learning something new; that's exactly what they were feeling - but now instead of just feeling it, they're saying it. For some reason that we don't fully understand, that transition is enough to make a difference."

The scientists also analyzed the words the subjects used. Those who used a larger number of negative words did better, in terms of both how close they were willing to get to the tarantula and their skin-sweat response. In other words, describing the tarantula as terrifying actually proved beneficial in ultimately reducing the fear of it.

"Doing more affect labeling seemed to be better," Lieberman said.

"That is so different from how we normally think about exposure therapy, where you try to get the person to think differently, to think it's not so bad," Craske said. "What we did here was to simply encourage individuals to state the negative."

"We've published a series of studies where we asked people, 'Which do you think would make you feel worse: looking at a disturbing image or looking at that disturbing image and choosing a negative emotional word to describe it,'" Lieberman said. "Almost everyone said it would be worse to have to look at that image and focus on the negative by picking a negative word. People think that makes our negative emotions more intense. Well, that is exactly what we asked people to do here. In fact, it's a little better to have people label their emotions - multiple studies now show this. Our intuitions here are wrong."

This is the first study to demonstrate benefits for affect labeling of fear and anxiety in a real-world setting, Craske and Lieberman said.

"The implication," Craske said, "is to encourage patients, as they do their exposure to whatever they are fearful of, to label the emotional responses they are experiencing and label the characteristics of the stimuli - to verbalize their feelings. That lets people experience the very things they are afraid and say, 'I feel scared and I'm here.' They're not trying to push it away and say it's not so bad. Be in the moment and allow yourself to experience whatever you're experiencing."

Craske and Lieberman are studying how this approach can help people who have been traumatized, such as rape victims and victims of domestic violence. The approach potentially could benefit soldiers returning from war as well.

"I'm far more optimistic than I was before this study," Lieberman said. "I'm a believer that this approach can have real benefits for people.

"There is a region in the brain, the right ventrolateral prefrontal cortex, that seems to be involved in labeling our feelings and our emotional reactions, and it is also associated with regulating our emotional responses," he said. "Why those two go together is still a bit of a mystery. This brain region that is involved in simply stating how we are feeling seems to mute our emotional responses, at least under certain circumstances."

"There's a trend in psychology of acceptance-based approaches - honestly label your feelings. This study has that flavor to it," Craske said.

Katharina Kircanski, a former UCLA graduate student and current postdoctoral scholar at Stanford University, is lead author of the study; she conducted this research as a graduate student in Craske's laboratory.
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'I Knew It All Along...Didn't I?' - Understanding Hindsight Bias

The fourth-quarter comeback to win the game. The tumor that appeared on a second scan. The guy in accounting who was secretly embezzling company funds. The situation may be different each time, but we hear ourselves say it over and over again: "I knew it all along."

The problem is that too often we actually didn't know it all along, we only feel as though we did. The phenomenon, which researchers refer to as "hindsight bias," is one of the most widely studied decision traps and has been documented in various domains, including medical diagnoses, accounting and auditing decisions, athletic competition, and political strategy.

In a new article in the September 2012 issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychological scientists Neal Roese of the Kellogg School of Management at Northwestern University and Kathleen Vohs of the Carlson School of Management at the University of Minnesota review the existing research on hindsight bias, exploring the various factors that make us so susceptible to the phenomenon and identifying a few ways we might be able to combat it. This article is the first overview to draw insights together from across different disciplines.

Roese and Vohs propose that there are three levels of hindsight bias that stack on top of each other, from basic memory processes up to higher-level inference and belief. The first level of hindsight bias, memory distortion, involves misremembering an earlier opinion or judgment ("I said it would happen"). The second level, inevitability, centers on our belief that the event was inevitable ("It had to happen"). And the third level, foreseeability, involves the belief that we personally could have foreseen the event ("I knew it would happen").

The researchers argue that certain factors fuel our tendency toward hindsight bias. Research shows that we selectively recall information that confirms what we know to be true and we try to create a narrative that makes sense out of the information we have. When this narrative is easy to generate, we interpret that to mean that the outcome must have been foreseeable. Furthermore, research suggests that we have a need for closure that motivates us to see the world as orderly and predictable and to do whatever we can to promote a positive view of ourselves.

Ultimately, hindsight bias matters because it gets in the way of learning from our experiences.

"If you feel like you knew it all along, it means you won't stop to examine why something really happened," observes Roese. "It's often hard to convince seasoned decision makers that they might fall prey to hindsight bias."

Hindsight bias can also make us overconfident in how certain we are about our own judgments. Research has shown, for example, that overconfident entrepreneurs are more likely to take on risky, ill-informed ventures that fail to produce a significant return on investment.

While our inclination to believe that we "knew it all along" is often harmless, it can have important consequences for the legal system, especially in cases of negligence, product liability, and medical malpractice. Studies have shown, for example, that hindsight bias routinely afflicts judgments about a defendant's past conduct.

And technology may make matters worse. "Paradoxically, the technology that provides us with simplified ways of understanding complex patterns - from financial modeling of mortgage foreclosures to tracking the flow of communications among terrorist networks - may actually increase hindsight bias," says Roese.

So what, if anything, can we do about it?

Roese and Vohs suggest that considering the opposite may be an effective way to get around our cognitive fault, at least in some cases. When we are encouraged to consider and explain how outcomes that didn't happen could have happened, we counteract our usual inclination to throw out information that doesn't fit with our narrative. As a result, we may be able to reach a more nuanced perspective of the causal chain of events.
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Promising New Drug Target For Inflammatory Lung Diseases

The naturally occurring cytokine interleukin-18, or IL-18, plays a key role in inflammation and has been implicated in serious inflammatory diseases for which the prognosis is poor and there are currently limited treatment options. Therapies targeting IL-18 could prove effective against inflammatory diseases of the lung including bronchial asthma and chronic obstructive pulmonary disease (COPD), as described in a review article published in Journal of Interferon & Cytokine Research, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free online at the Journal of Interferon & Cytokine Research website. (

Tomotaka Kawayama and coauthors from Kurume University School of Medicine, Fukuoka, Japan, University of Ryukyus, Okinawa, Japan, and Frederick National Laboratory for Cancer Research, Frederick, MD, review the growing evidence to support the important role IL-18 has in inflammation and how it may help to initiate and worsen inflammatory disorders such as arthritis, dermatitis and inflammatory diseases of the bowel and immune system. In the article "Interleukin-18 in Pulmonary Inflammatory Diseases" ( they describe the potential benefits of therapies aimed at blocking the activity of IL-18 to treat inflammatory lung disease.

"This review provides an interesting and thorough summary of the biology and potential application of IL-18 in the setting of inflammatory pulmonary disease," says Co-Editor-in-Chief Thomas A. Hamilton, PhD, Chairman, Department of Immunology, Cleveland Clinic Foundation.
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Strategies To Prevent Noise-Induced Hearing Loss, Tinnitus In Soldiers To Be Presented

Antioxidants, dietary supplements and high-tech brain imaging are among some of the novel strategies that may help detect, treat and even prevent noise-induced hearing loss and tinnitus among American troops, according to researchers at Henry Ford Hospital.

A culmination of nearly 25 years of research on noise-induced hearing loss - a growing medical issue that affects more than 12 percent of American troops returning from conflicts around the globe - will be presented Sept. 9 at the American Academy of Otolaryngology-Head & Neck Surgery annual meeting in Washington, D.C.

Led by Michael Seidman, M.D., the research team is the first to identify how acoustic trauma from machinery and explosive devices damages the inner ear cells and breaks down cell growth, much like age-related hearing loss.

"Improvised explosive devices, aircraft and other weaponry being used by the military are frankly deafening our troops," says Dr. Seidman, director of the Division of Otologic/Neurotologic Surgery in the Department of Otolaryngology-Head & Neck Surgery at Henry Ford Hospital.

"Noise-induced hearing loss doesn't just impact a person's ability to hear; it can cause balance issues, make it difficult to sleep and communicate, and even raise the risk for heart disease by increasing a person's blood pressure, lipids and blood sugar."

As part of his presentation, Dr. Seidman will explain how noise-induced hearing loss, as well as tinnitus-related traumatic brain injury, occurs based on research from Wayne State University's Jinsheng Zhang, Ph.D.

Dr. Zhang has developed a model of blast-induced tinnitus and hearing loss using a shock tube that generates a 194 decibel shock wave similar to many of the explosive devices being deployed against troops.

Further, Dr. Seidman will discuss the use of nutraceuticals, such as acetyl-l-carnitine, alpha lipoic acid and resveratrol - a substance found in red wine and red grapes - to mitigate hearing-related issues.

Based on initial results, Dr. Seidman says a nutraceutical with a resveratrol-based component may possibly hold the potential to not only prevent, but reverse hearing loss in certain circumstances for soldiers. This research is based on animal models, but will soon be tested with humans, to see if a pill could soon be developed to prevent acoustic trauma in troops.

In addition, Dr. Seidman will highlight new research on tinnitus, a chronic ringing of the head or ears that affects more than 50 million patients.

A study co-authored by Susan Bowyer, Ph.D., senior bioscientific researcher at Henry Ford Hospital, found that an imaging technique called magnetoencephalography (MEG) can determine the site of perception of tinnitus in the brain, which could in turn allow physicians to target the area with electrical or chemical therapies to lessen symptoms.

Although is no cure for tinnitus, several interventions are available, including dietary modification, the use of specific herbs and supplements, sound therapies, centrally acting medications and electrical stimulation of the cochlea and brain using implantable electrodes and an implantable pulse generator.

To date, Dr. Seidman has treated six patients with direct electrical stimulation to the brain, reducing the tinnitus in four of those patients.

In all, the team's work on noise-induced hearing loss and tinnitus has led to more than 50 peer-reviewed publications and several patents.

According to Dr. Seidman, more research and funding are needed in order to generate critical data to facilitate an understanding of the damage caused by acoustic trauma and develop strategies to mitigate that damage.
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Predicting How Patients With Social Anxiety Disorder Will Respond To Cognitive Behavioral Therapy

A new study led by MIT neuroscientists has found that brain scans of patients with social anxiety disorder can help predict whether they will benefit from cognitive behavioral therapy.

Social anxiety is usually treated with either cognitive behavioral therapy or medications. However, it is currently impossible to predict which treatment will work best for a particular patient. The team of researchers from MIT, Boston University (BU) and Massachusetts General Hospital (MGH) found that the effectiveness of therapy could be predicted by measuring patients' brain activity as they looked at photos of faces, before the therapy sessions began.

The findings, published this week in the Archives of General Psychiatry, may help doctors choose more effective treatments for social anxiety disorder, which is estimated to affect around 15 million people in the United States.

"Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them," says John Gabrieli, the Grover M. Hermann Professor of Brain and Cognitive Sciences at MIT, a member of the McGovern Institute for Brain Research and senior author of the paper.

Lead authors of the paper are MIT postdoc Oliver Doehrmann and Satrajit Ghosh, a research scientist in the McGovern Institute.

Choosing treatments

Sufferers of social anxiety disorder experience intense fear in social situations that interferes with their ability to function in daily life. Cognitive behavioral therapy aims to change the thought and behavior patterns that lead to anxiety. For social anxiety disorder patients, that might include learning to reverse the belief that others are watching or judging them.

The new paper is part of a larger study that MGH and BU ran recently on cognitive behavioral therapy for social anxiety, led by Mark Pollack, director of the Center for Anxiety and Traumatic Stress Disorders at MGH, and Stefan Hofmann, director of the Social Anxiety Program at BU.

"This was a chance to ask if these brain measures, taken before treatment, would be informative in ways above and beyond what physicians can measure now, and determine who would be responsive to this treatment," Gabrieli says.

Currently doctors might choose a treatment based on factors such as ease of taking pills versus going to therapy, the possibility of drug side effects, or what the patient's insurance will cover. "From a science perspective there's very little evidence about which treatment is optimal for a person," Gabrieli says.

The researchers used functional magnetic resonance imaging (fMRI) to image the brains of patients before and after treatment. There have been many imaging studies showing brain differences between healthy people and patients with neuropsychiatric disorders, but so far imaging has not been established as a way to predict patients' responses to particular treatments.

Measuring brain activity

In the new study, the researchers measured differences in brain activity as patients looked at images of angry or neutral faces. After 12 weeks of cognitive behavioral therapy, patients' social anxiety levels were tested. The researchers found that patients who had shown a greater difference in activity in high-level visual processing areas during the face-response task showed the most improvement after therapy.

Gabrieli says it's unclear why activity in brain regions involved with visual processing would be a good predictor of treatment outcome. One possibility is that patients who benefited more were those whose brains were already adept at segregating different types of experiences, Gabrieli says.

The researchers are now planning a follow-up study to investigate whether brain scans can predict differences in response between cognitive behavioral therapy and drug treatment.

"Right now, all by itself, we're just giving somebody encouraging or discouraging news about the likely outcome" of therapy, Gabrieli says. "The really valuable thing would be if it turns out to be differentially sensitive to different treatment choices."
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Survival 'Excellent' Following Living Donor Liver Transplantation For Acute Liver Failure

Patients in Japan who underwent living donor liver transplantation (LDLT) for acute liver failure (ALF) were classified as having excellent outcomes, with ten-year survival at 73%. The findings, published in the September issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD), suggest that the type of liver disease or treatment plan does not affect long-term patient survival following LDLT. Donor and patient age, however, does impact long-term outcome post-transplant.

According to the AASLD, roughly 2,000 Americans develop ALF-formally called fulminant hepatitis-each year, with many of these cases caused by acetaminophen (Tylenol) overdose, drug-induced liver injury, autoimmune liver disease, or viral hepatitis. Previous studies report patient survival from ALF was less than 15% before the era of liver transplantation and significantly better at more than 65% following transplantation.

LDLT-when a portion of a healthy liver from a living donor is used for transplantation-was developed as an alternative treatment option to overcome the shortage of deceased donor organs. A 2007 study by de Villa et al. found that LDLT accounts for less than 5% of liver transplants in the U.S. and Europe compared to more than 90% in Asia excluding mainland China.

"ALF is a rare, life-threatening condition where the rapid deterioration of liver function causes changes in mental activity and disrupts the body's blood clotting capabilities," explains lead author Dr. Yasuhiko Sugawara, Associate Professor in the Graduate School of Medicine at the University of Tokyo in Japan. "Expanding knowledge of treatment options, such as LDLT, that improve patient outcome is imperative."

Using data from the Intractable Liver Disease Study Group of Japan, researchers identified 209 ALF candidates who underwent living donor liver transplantation. The authors report that in patients who underwent LDLT the cumulative one-year, five-year and ten-year survival rates following transplantation were 79%, 74%, 73%, respectively. Patient age impacted short-term and long-term mortality, while donor age only affected long-term patient mortality.

"Our study demonstrates the benefit of LDLT in a Japanese population, which has less access to deceased donor organs," concludes Dr. Sugawara. "Prospective studies are needed to determine the overall impact of LDLT in all patients with ALF."

In a related editorial also published in Liver Transplantation, Professor Chung-Mau Lo with the University of Hong Kong and Queen Mary Hospital in Hong Kong, China, notes that LDLT for ALF patients has generated debate among experts in several areas: (1) reports in Western countries of inferior outcome with LDLT in high-urgency situations; (2) likelihood of ALF patients receiving a liver in countries with developed deceased organ donation programs; and (3) concern with coercion of donors and a possible increase of donor risk when the evaluation process is rushed in such an urgent situation.

"Deceased donor liver transplantation is dictated by the availability of the organ, and high-risk marginal grafts are frequently used. LDLT allows for early transplant to avoid waitlist mortality and better timing of the operation, which can be performed at the first sign of patient deterioration," concludes Professor Lo. "LDLT for ALF has developed in Asia because there is no choice. Is it possible that it may in fact be a better choice?"
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Childhood Sexual Abuse Linked To Later Heart Attacks In Men

Men who experienced childhood sexual abuse are three times more likely to have a heart attack than men who were not sexually abused as children, according to a new study from researchers at the University of Toronto. The researchers found no association between childhood sexual abuse and heart attacks among women.

In a paper published online this week in the journal Child Abuse & Neglect, investigators examined gender-specific differences in a representative sample of 5095 men and 7768 women aged 18 and over, drawn from the Center for Disease Control's 2010 Behavioral Risk Factor Surveillance Survey. A total of 57 men and 154 women reported being sexually abused by someone close to them before they turned 18 and 377 men and 285 women said that a doctor, nurse or other health professional had diagnosed them with a heart attack or myocardial infarction. The study was co-authored by four graduate students at the University of Toronto, Raluca Bejan, John Hunter, Tamara Grundland and Sarah Brennenstuhl.

"Men who reported they were sexually abused during childhood were particularly vulnerable to having a heart attack later in life," says lead author Esme Fuller-Thomson, Professor and Sandra Rotman Chair at University of Toronto's Factor-Inwentash Faculty of Social Work. "We had expected that the abuse-heart attack link would be due to unhealthy behaviors in sexual abuse survivors, such as higher rates of alcohol use or smoking, or increased levels of general stress and poverty in adulthood when compared to non-abused males. However, we adjusted statistically for 15 potential risk factors for heart attack, including age, race, obesity, smoking, physical inactivity, diabetes mellitus, education level and household income, and still found a three-fold risk of heart attack."

Co-author and PhD candidate Sarah Brennenstuhl notes that, "It is unclear why sexually abused men, but not women, experienced higher odds of heart attack; however, the results suggest that the pathways linking childhood sexual abuse to physical health outcomes in later life may be gender-specific. For example, it is possible that females adopt different coping strategies than males as women are more likely to get the support and counselling needed to deal with their sexual abuse."

"These findings need to be replicated in future scientific studies before we can say anything definitive about this link," cautions Fuller-Thomson. "But if other researchers find a similar association, one possible explanation is that adverse child experiences become biologically embedded in the way individuals react to stress throughout their life, particularly with respect to the production of cortisol, the hormone associated with the "fight-or-flight" response. Cortisol is also implicated in the development of cardiovascular diseases.
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Bosulif Approved By The FDA For Treatment Of Chronic Myelogenous Leukemia

The US Food and Drug Administration approved Bosulif as treatment for a rare disease, found in older adults, which attacks the blood and bone marrow and is known as chronic myelogenous leukemia (CML).

Approximately 5,430 people will be diagnosed with CML in 2012. The majority of people with CML have the Philadelphia chromosome, a genetic mutation where the bone marrow produces an enzyme called tyrosine kinase. This enzyme sparks excess creation of unhealthy and irregular white blood cells named granulocytes, which fight infection.

Bosulif is aimed towards patients with chronic, accelerated, and blast phase (extremely high levels of granulocytes) Philadelphia chromosome positive CML and who are also not responding to other therapies. Bosulif works by obstructing the tyrosine kinase signal that helps produce the abnormal granulocytes.

"With the approval of tyrosine kinase inhibitors, we are seeing improvements in the treatment of CML based on a better understanding of the molecular basis of the disease," said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research.

The FDA has approved other drugs such as imanitib, dasatinib, and nilotinib to treat many forms of CML. Bosulif was evaluated in a single clinical trial that included 546 adult patients who have chronic, accelerated, or blast phase CML. All patients in the study had CML that continued to progress after being treated with imanitib and dasatinib and/or nilotinib, or could not tolerate side effects of these treatments. Participants were all given Bosulif.

The effectiveness of Bosulif was determined by the amount of patients who experienced a major cytogenetic response (MCyR) within the first 24 weeks of treatment for chronic level CML. Findings showed patients who previously used imanitib reached MCyR after the initial 24 weeks. 52.8 percent of the patients who achieved MCyR at any time had a response that lasted 18 months or longer. Of the patients who were previously treated using imatinib, followed by dasatinib and/or nilotinib, 27 percent reached MCyR within 24 weeks. Among those who achieved MCyR at anytime, 51.4 percent had a response that lasted nine months or longer.

Of those patients with accelerated CML previously treated with at least imatinib, 33 percent had their blood counts return to normal, while 55 percent reached normal blood counts with no evidence of leukemia within the beginning 48 weeks of treatment. In addition, 15 percent of participants with blast phase CML achieved normal blood counts, while 28 percent achieved normal blood counts with no evidence of leukemia.

Common side effects seen associated with Bosulif are diarrhea, nausea, low levels of platelets in the blood, abdominal pain, anemia, vomiting, fever, and fatigue.
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Brain Scans Help Predict Treatment For Social Anxiety Disorder

Brain scans of patients with social anxiety disorder can help determine if cognitive behavioral therapy (CBT) could be an effective treatment option, suggests researchers from MIT, Boston University (BU), and Massachusetts General Hospital (MGH) in the Archives of General Psychiatry.

Either CBT or medications are normally used to treat social anxiety, but scientists have not been able to identify which of these treatments will suit a particular individual best.

By looking at photos of faces and measuring brain activity, the usefulness of therapy could be determined before the sessions even start, according to the team.

With about 15 million people in the United States struggling with the disorder, authors believe these findings will help doctors decide which treatment is right for each patient.

"Our vision is that some of these measures might direct individuals to treatments that are more likely to work for them," said John Gabrieli, lead author, the Grover M. Hermann Professor of Brain and Cognitive Sciences at MIT, and a member of the McGovern Institute for Brain Research.

Choosing The Right Treatment

CBT is known for changing the thought and behavior patterns that give the sufferer anxiety, such as feelings of intense fear in social settings that impair their ability to act normally. Some patients have anxiety because they think that others are watching them, however, the therapy shows that their beliefs are false and no one is judging them.

The current study is part of a larger one that MGH and BU conducted recently on cognitive behavioral therapy for social anxiety.

Gabrieli explained:

"This was a chance to ask if these brain measures, taken before treatment, would be informative in ways above and beyond what physicians can measure now, and determine who would be responsive to this treatment."
Although some patients find the idea of taking pills easier than going to therapy, it is not an effective method of treatment. Some doctors, on the other hand, are currently making decisions about treatment based on what their patient's insurance covers or because of potential drug side effects.

"From a science perspective there's very little evidence about which treatment is optimal for a person," Gabrieli commented.

In order to image patients' brains before and after treatment, functional magnetic resonance imaging (fMRI) was used. Imaging has never before been used as a way to predict a patient's reactions to a certain treatment, although some imaging studies have shown brain differences between patients with nueropyschiatric disorders and their healthy counterparts.

Measuring Differences in Brain Activity

Experts in the new study had subjects look at images of angry or neutral faces, in order to identify differences in brain activity as they observed. Social anxiety levels were tested after undergoing 12 weeks of CBT.

Results showed that those who benefited the most from therapy were the individuals who had shown a greater difference in activity in high-level visual processing areas during the face-response task.

It is unclear why activity in brain regions involved with visual processing would be a good indicator of treatment outcomes, according to Gabrieli. He believes it could be because the patients who received more benefits were those whose brains were already adept at separating different types of experiences.

The authors are carrying out further research to determine if brain scans can predict differences in response between cognitive behavioral therapy and drug treatments.

Gabrieli concluded:

"Right now, all by itself, we're just giving somebody encouraging or discouraging news about the likely outcome of therapy. The really valuable thing would be if it turns out to be differentially sensitive to different treatment choices."
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America's Health System Wasted $750 Billion In One Year

America's health care system is inefficient, suffers from data overload, is complex and very costly, a report from the Institute of Medicine (IoM) revealed today. The authors added that too many negative factors are undermining health care quality and affecting the USA's global competitiveness and economic stability. Despite all this, there are knowhow and tools in place to correct the deep faults within the country's health system so that costs may be reduced and the quality of care improved.

The authors of the report (the Committee) estimated that $750 billion was wasted nationwide on administration costs, fraud, pointless services, and some other problems. Apart from the economic toll these deficiencies place, they also result in patients having to suffer needlessly. Some studies have indicated that in 2005, about 75,000 deaths could have been averted if each state had delivered healthcare at the quality and efficiency levels of the best performing state.

The Committee said that aiming for just incremental upgrades and alterations carried out by individual hospitals or health care providers will have little impact on improving the nation's overall health care service.

America's health care needs to transform into a "learning system"

The only way the USA's healthcare system can really improve is to transform it into a learning system that continuously improves itself by "systematically capturing and broadly disseminating lessons from every care experience and new research discovery."

Health care authorities will need to embrace and implement new technologies that gather and analyze clinical data at the point of care, encouraging patients and their loved ones to become active contributors, and working towards total transparency and teamwork within health care organizations. Financial and other types of incentives which focus on quality and results should be placed into the system.

Committee chair Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland, said:

"The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck. Our health care system lags in its ability to adapt, affordably meet patients' needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value."

Keeping up with new treatments and breakthroughs

One of the main problems today is that healthcare providers cannot keep up with the rapid pace of new research discoveries and technological breakthroughs.

In an online communiqué, the IoM wrote "How health care organizations approach care delivery and how providers are paid for their services also often lead to inefficiencies and lower effectiveness and may hinder improvement."

The Committee said for a health system to be able to continuously evolve, excellent use of data is vital. In the USA, approximately 75 million people have two or more chronic conditions - for proper treatment and control, good coordination among multiple specialists and therapies is vital. Otherwise, the risk of misdiagnoses, clashing interventions, and dangerous drug interactions grows.

Doctors and patients often do not have useful and relevant data at the point of care where decisions are made. Currently, for new breakthroughs to become widely accepted and adopted can take several years. Only after 13 years did beta blockers become standard practice for heart attack victims.

Embracing mobile technologies and electronic health records would contribute considerably to a competent capture of health data, as well as disseminating that information. They wrote that "The National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable, the report says. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care."

During the last 40 years, health care costs have increased at a higher rate than inflation or the economy as a whole for 31 of them. The main thrust has been volume rather than quality as far as reimbursements are concerned, instead of paying a flat rate or rewarding providers according to patient outcomes, the authors added.

The report urges insurance providers, professional societies, researchers, and health economists to work together to find ways of measuring quality performance and to design new payment models and incentives that reward quality rather than volume.

So far, not many health care organizations, clinics or medical practices encourage patients and their families to become engaged in care decisions and management of their conditions, even though studies and examples abroad have proven that they lead to better outcomes and value for money.

The Committee wrote:

"To facilitate these interactions, health care organizations should embrace new tools to gather and assess patients' perspectives and use the information to improve delivery of care. Health care product developers should create tools that assist people in managing their health and communicating with their providers.

Increased transparency about the costs and outcomes of care also boosts opportunities to learn and improve and should be a hallmark of institutions' organizational cultures, the committee said. Linking providers' performance to patient outcomes and measuring performance against internal and external benchmarks allows organizations to enhance their quality and become better stewards of limited resources, the report says. In addition, managers should ensure that their institutions foster teamwork, staff empowerment, and open communication."
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Toddlers Choking On Liquid Detergent Capsules

A growing number of toddlers are inadvertently swallowing liquid detergent capsules, known as Liquitabs, doctors from the Royal Hospital for Sick Children, Glasgow, UK, Scotland reported in Archives of Childhood Diseases. In what the authors describe as a "significant public health issue", they urge detergent makers and packagers to review their packaging and safety warnings.

Laundry and dishwasher detergent Liquitabs should have childproof packaging and better safety warnings, after several reports have come in of young children swallowing contents of the capsules, the authors explained.

Over a period of 18 months, five children had to be treated for swallowing the liquitab capsule contents in one hospital in Glasgow alone; they ranged in age from 10 months to 24 months. When they were hospitalized they had a high pitched wheeze (stridor), which is usually a sign of some airway blockage.

Liquitabs contain alkaline cleaning agents which have a strong solvent action that can damage tissue, cause inflammation and painful swelling.

In severe cases the airways can become completely blocked; there is also the risk of lung damage as tissue in the esophagus is eroded - a potentially fatal complication.

The oldest patient, a 24-month old child, was treated with steroids and antibiotics. The other four younger ones needed to be intubated for several days to treat ulceration and swelling. One of them required surgery because the swelling and ulceration was so extensive.

Although all the patients in Glasgow made full recoveries, the authors wrote that the incidents had "a catastrophic impact on the child and family", as well as using up valuable intensive care resources.

In 2011, in the United Kingdom alone, 647 phone calls were received at the National Poisoning Information Service regarding the swallowing or eating of liquid detergent capsules. The Service also received 4,000 website visits on this theme.

The authors explained that over the last five years, the number of inquiries regarding children swallowing washing machine or dishwasher Liquitabs has more than doubled.

Detergent capsules are not childproof

Liquitabs do not currently come in childproof containers. At the moment, manufacturers and packaging companies are encouraged to comply to safety standards, but the whole scheme is voluntary, there is nothing legally binding them to adhere to any strict national standards. The doctors said that the contents of these capsules also place young children at risk of severe eye injury.

The authors, who have written to manufacturers alerting them to the current problems, said:

"To help prevent future potentially life threatening injuries, improved safety warnings and childproof packaging are urgently required."

It is not only the manufacturers' responsibility to keep these products out of children's reach, parents should also be extremely careful.

They wrote "Dishwasher and washing machine Liquitabs are now a common finding in most homes, but unfortunately, seem very attractive to young children due to their bright colouring and soft sweetie-like texture. We feel that the increasing trend in liquid detergent capsule ingestion poses a significant public health issue."
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West Nile Virus, Worst Year Ever Says CDC, USA

So far, this has been the worst year on record for West Nile virus infections, says the Centers for Disease Control and Prevention (CDC). 48 states have reported infections in humans, birds and/or mosquitoes. 1,993 people have been confirmed nationwide with WNV (West Nile virus) infection, of whom 87 have died. 54% (1,069) were classified as neuroinvasive disease and 924 as non-neuroinvasive disease. In neuroinvasive disease, the patient went on to develop encephalitis or meningitis.

Up to September 4th, more cases have been reported this year than ever before, says the CDC. West Nile virus first infected humans in the USA in 1999.

Six states make up over 70% of all cases - Michigan, Louisiana, Oklahoma, Mississippi, South Dakota and Texas. Nearly 45% of all reported cases in the USA come from Texas.

Below is a breakdown by states of West Nile virus human infections reported to ArboNET, as of September 4th, 2012 (Source: CDC):
  • Alabama
    Total cases 16. Deaths 1
  • Arizona
    Total cases 25. Deaths 1
  • Arkansas
    Total cases 31. Deaths 3
  • California
    Total cases 55. Deaths 2
  • Colorado
    Total cases 23. Deaths 0
  • Connecticut
    Total cases 6. Deaths 0
  • Delaware
    Total cases 1. Deaths 0
  • District of Columbia
    Total cases 1. Deaths 1
  • Florida
    Total cases 19. Deaths 0
  • Georgia
    Total cases 22. Deaths 3
  • Idaho
    Total cases 4. Deaths 0
  • Illinois
    Total cases 48. Deaths 2
  • Indiana
    Total cases 26. Deaths 3
  • Iowa
    Total cases 7. Deaths 0
  • Kansas
    Total cases 24. Deaths 1
  • Kentucky
    Total cases 3. Deaths 0
  • Louisiana
    Total cases 73. Deaths 6
  • Maryland
    Total cases 14. Deaths 1
  • Massachusetts
    Total cases 4. Deaths 0
  • Michigan
    Total cases 95. Deaths 5
  • Minnesota
    Total cases 41. Deaths 1
  • Mississippi
    Total cases 113. Deaths 4
  • Missouri
    Total cases 6. Deaths 1
  • Montana
    Total cases 1. Deaths 0
  • Nebraska
    Total cases 29. Deaths 1
  • Nevada
    Total cases 0. Deaths 0
  • New Hampshire
    Total cases 1. Deaths 0
  • New Jersey
    Total cases 8. Deaths 0
  • New Mexico
    Total cases 9. Deaths 0
  • New York
    Total cases 26. Deaths 3
  • North Carolina
    Total cases 4. Deaths 2
  • North Dakota
    Total cases 35. Deaths 0
  • Ohio
    Total cases 53. Deaths 1
  • Oklahoma
    Total cases 113. Deaths 7
  • Oregon
    Total cases 1. Deaths 0
  • Pennsylvania
    Total cases 14. Deaths 1
  • South Carolina
    Total cases 8. Deaths 0
  • South Dakota
    Total cases 119. Deaths 2
  • Tennessee
    Total cases 10. Deaths 0
  • Texas
    Total cases 888. Deaths 35
  • Utah
    Total cases 2. Deaths 0
  • Virginia
    Total cases 5. Deaths 0
  • West Virginia
    Total cases 2. Deaths 0
  • Wisconsin
    Total cases 6. Deaths 0
  • Wyoming
    Total cases 2. Deaths 0
  • Total Nationwide
    Total cases 1,992. Deaths 87
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