Day: 09/29/2012

Cancer Genomics: Improved Understanding of Molecular Changes in Tumors Produces More-Specialized Treatments.

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For much of the history of cancer, tumors were characterized mainly by where they arose in the body. With the genomics revolution of recent years, scientists and physicians have increasingly been able to peer at the inner workings of tumor cells and pinpoint the specific genetic changes that transform them from their cells of origin into cancer.

This is the first part of a two-part story. The second part will examine the technology that makes it possible to perform genomic research on large numbers of tumor samples and will appear in the November issue of Center News Magazine.

What these investigators are learning answers questions that have long puzzled oncologists: Why do some patients with a certain type of cancer do well with treatment, while others receiving the same treatment do poorly? Why does a drug shrink one patient’s tumor but not another’s? Even in the current era of targeted therapies, in which drugs are designed to exploit cancer cells’ specific weaknesses, some patients respond better than others.

“We’ve known for a while that every type of cancer is really a mix of different types,” says Leonard Saltz, Chief of Memorial Sloan-Kettering’s Gastrointestinal Oncology Service. “We are getting smarter about starting to break down common cancers into more-specific subgroups so that we can figure out how to develop individualized treatments for patients.”

Advances have been made in collaborative studies, genetic testing, and clinical trials for certain types of lung cancer, colon cancer, melanoma, pancreas cancer, gastric cancer, soft tissue sarcoma, and acute myelogenous leukemia (AML), among others.

A Wealth of Information

Today a major focus of research is on looking for the molecular changes in patients’ tumors and drawing connections between mutations and clinical outcomes. This is possible due in large part to databases that record everything about patients’ treatment and the response to it and link those data anonymously to their tumor samples, which can then be genetically analyzed.

“The strength of the tissue samples that we use in these kinds of studies comes from being able to link them to our clinical databases,” says Murray F. Brennan, Vice President for International Programs at Memorial Sloan-Kettering and former Chair of the Department of Surgery, who has dedicated much of his career to developing prospective databases that can be linked to patients’ tissue samples. “In addition to collecting tumor samples, several years ago we also began collecting normal tissue, including blood, from our patients. This allows us to look not only for genetic mutations in the tumors themselves but also for genetic markers in the normal tissue that might indicate that a cancer has an inherited component.”

Improving the genetic understanding of what causes cancer ultimately will lead to treatments tailored to individual tumors. However, “when you look at all the genetic changes in one patient’s tumor, you get so much data that it’s hard to tell which mutations are driving the cancer and which are passengers going along for the ride,” says Samuel Singer, Chief of the Gastric and Mixed Tumor Service. “What helps you sort it out is when you have groups of patients with the same cancer, and you can begin looking for patterns across all of them.”

Many Memorial Sloan-Kettering investigators have research projects dedicated to teasing out these molecular differences in a variety of cancers — ranging from common types such as breast cancer and prostate cancer to rarer cancers, such as soft tissue sarcoma and a variety of pediatric tumors.

The Power of Collaborative Studies

Researchers from Memorial Sloan-Kettering are active in several multicenter collaborations that seek to understand the molecular changes that characterize cancer. The largest of these is The Cancer Genome Atlas (TCGA), a project jointly funded by the National Cancer Institute and the National Human Genome Research Institute — both parts of the National Institutes of Health.

Memorial Sloan-Kettering investigators have been involved in TCGA from its earliest stages, and Memorial Sloan-Kettering currently houses one of TCGA’s Genome Data Analysis Centers, which is co-led by computational biologist Chris Sander and molecular pathologist Marc Ladanyi. Memorial Sloan-Kettering researchers have been key participants in several TCGA projects, including detailed characterizations of glioblastoma (a type of brain cancer) and an in-depth analysis of ovarian cancer.

This summer, TCGA reported major analyses of colorectal cancer and squamous cell lung cancer, which makes up about 30 percent of all non-small cell lung cancers. “The colorectal study is the most comprehensive characterization of colorectal cancer to date,” says physician-scientist Timothy A. Chan, who was a key member of Memorial Sloan-Kettering’s team on this TCGA project. “This study highlights the benefits that can be afforded by the cancer genomics revolution, allowing us to dissect the molecular foundations of cancers and identify new targets for therapy that were not previously apparent.”

For patients with some types of cancer, genetic testing is already a standard part of treatment. For example, in patients with metastatic colorectal cancer the tumors are routinely tested for mutations in the gene KRAS. Treatment for this advanced form of the disease can include either the drug cetuximab (Erbitux®) or panitumumab (Vectibix®), both of which are antibodies that target mutations in the gene EGFR. However, researchers learned several years ago that for patients who have certain KRAS mutations in their tumors, these drugs are not effective. Testing helps ensure that the drugs are only given to those patients who are likely to benefit, sparing others unnecessary treatment and side effects.

Similarly, the most-frequent mutations in lung adenocarcinoma — another type of non-small cell lung cancer — are in EGFR and KRAS. Patients with tumors that have the EGFR mutation usually respond well to treatment with the targeted therapy erlotinib (Tarceva®). But adenocarcinomas with KRAS mutations are resistant to erlotinib, and patients with tumors that have this mutation are not given the drug.

In gastric cancers (cancers of the stomach and esophagus), researchers have found that some patients’ tumors have multiple extra copies of the gene HER2, a genetic abnormality that is also seen in many breast cancers. Data have shown that the drug trastuzumab (Herceptin®), part of the standard treatment for breast cancer patients whose cancers are found to carry the extra copies of HER2, is effective against this subset of gastric cancers as well. Based on these findings, trastuzumab is now a standard part of treatment for certain patients with gastric cancer.

Linking Genomics Discoveries to Clinical Trials

Genetic testing in lung cancer is conducted as part of the Lung Cancer Mutation Analysis Project (LC-MAP), which Memorial Sloan-Kettering Cancer Center launched in 2009 to look for all known mutations in lung adenocarcinoma tumors. Patients whose tumors have non-EGFR mutations may be offered participation in one of several clinical trials investigating new medicines that target these specific genetic defects.

“As additional mutations are discovered, they can be quickly included in the routine molecular analyses used at Memorial Sloan-Kettering,” says Mark G. Kris, Chief of the Thoracic Oncology Service. “At the same time, our investigators continue to probe specimens in which no known mutations were found to look for additional targets.”

Recently, Memorial Sloan-Kettering expanded its genetic testing to include tumors from patients with squamous cell lung carcinoma. This testing, which looks for an array of mutations, comes as part of the Squamous Cell Lung Cancer Mutation Analysis Program (SQ-MAP). The project, launched in October 2011, is modeled after the LC-MAP.

We want to make sure the genotyping is for mutations that can help oncologists choose the best available therapies for patients.

—Marc Ladanyi, molecular pathologist

This summer, Memorial Sloan-Kettering researchers reported that at least one of three cancer-causing mutations is detected in the tumors of more than half of patients with squamous cell lung cancer. Memorial Sloan-Kettering patients with tumors carrying one of these specific genetic aberrations are eligible for enrollment in clinical trials to test therapeutic agents. Two trials are already enrolling patients and the third is expected to start soon.

“In just one year, we’ve gone from having zero clinical trials of targeted therapies for our squamous cell lung cancer patients to now being able to offer trials to more than half of them,” says Paul K. Paik, a medical oncologist on Memorial Sloan-Kettering’s Thoracic Oncology Service and lead investigator of SQ-MAP.

Dr. Paik says the tumor testing will include more genetic mutations as they are identified, with SQ-MAP using these discoveries to sort patients into clinical trials. Dr. Paik was the key clinical member of Memorial Sloan-Kettering’s team in TCGA’s efforts to define molecular changes in squamous cell lung cancer.

Dr. Ladanyi, who worked with Dr. Paik to implement SQ-MAP, explains that the program’s purpose is to ensure that the vast amounts of genetic information generated by TCGA and other research efforts provide real-world benefits for patients. “We don’t want to be telling patients, ‘You have this very interesting mutation, but there’s nothing we can do about it,’” he says. “We want to make sure the genotyping is for mutations that can help oncologists choose the best available therapies for patients, even if some of these new drugs are available only in our clinical trials.”

Genetic testing of patients’ tumor samples can lead to participation in clinical trials for other types of cancer as well. In colon cancer, about 5 percent of patients’ tumors have mutations in the BRAF gene — a mutation also seen in about half of melanoma patients. The drug vemurafenib (Zelboraf®), which Memorial Sloan-Kettering played a lead role in developing, was approved by the US Food and Drug Administration last year to treat melanoma patients with BRAF mutations.

While an initial trial of this agent in colon cancer did not work, based on recent findings about BRAF in colorectal cancer, gastrointestinal medical oncologist and scientist Rona Yaeger is developing a clinical trial to evaluate the use of vemurafenib plus panitumumab in colorectal cancer patients with BRAF mutations. Dr. Kris and the thoracic team are also using vemurafenib to treat people with lung cancers that contain the same BRAF mutation.

In two ongoing studies, medical oncologist Eileen M. O’Reilly is testing a class of drugs called PARP inhibitors in certain patients with pancreas cancer. Investigators have noted that some pancreas cancers are associated with alterations in the BRCA and PALB2 genes, inherited mutations that are implicated in some breast and ovarian cancers. PARP inhibitors have already shown promise for treating those cancers, and Dr. O’Reilly’s trials are based on the idea that they could be effective against BRCA- and PALB2-related pancreas cancers as well.

Medical oncologist Yelena Y. Janjigian is evaluating the effectiveness of another experimental drug, called PU-H171, against gastric cancers that are characterized by amplification of the HER2 gene. PU-H171 was developed by Memorial Sloan-Kettering chemist Gabriella Chiosis and has been shown in the laboratory to block HER2 and induce cell death (apoptosis). Dr. Janjigian is looking for additional molecular markers beyond HER2 that will help determine which patients are most likely to benefit from the drug before beginning clinical trials.

For soft tissue sarcomas — rare cancers that arise in tissues such as fat, muscles, nerves, tendons, and blood and lymph vessels — Dr. Singer is systematically finding mutations and other changes in tumors. He is also creating cell lines from many tumor samples, which allow him to screen for new drugs that potentially may be effective against subsets of this cancer. “If you have a drug that targets a mutation found in 10 percent or 25 percent of patients, then you can begin to plan clinical trials,” he says.

Several trials are already under way based on the molecular understanding of sarcomas. One tests an investigational drug that blocks a factor called CDK4, which is known to be overactive in liposarcoma, one of the most common types of sarcoma.

Physician-scientist Ross Levine is looking for genetic markers that would enable more-accurate prognoses for leukemia patients. Another trial is being planned for the subset of liposarcoma patients who have certain changes in a gene called CEBP-alpha. The gene produces CEBP-alpha, a factor that controls how cells become more specialized, and when deficient it can lead to the development of extremely aggressive tumors. Investigators have found in the laboratory that for cancers with CEBP-alpha deficiency — about 25 percent of one subtype of liposarcoma — a class of drugs called HDAC inhibitors can be effective.

Genomic research is being done not only in solid tumors but also in leukemias. In March 2012, Memorial Sloan-Kettering researchers, led by medical oncologist and scientist Ross L. Levine, published a study that identified a set of genetic abnormalities that can be used to more accurately make prognoses in people with acute myelogenous leukemia (AML).

The finding could enable more than two-thirds of AML patients to be stratified into newly defined prognostic groups. This in turn helps clinicians know which subset of patients will actually benefit from intensive therapies such as a higher chemotherapy dose or a bone marrow transplant, and which patients will do well with standard care.

“We are very focused on developing new drugs, but there’s another important area that may grow out of genomics, and that is better methods for prognosis,” Dr. Brennan concludes. “It will be wonderful when we are able to identify patients whose cancers will not recur after surgery and allow them to avoid any unnecessary treatments, as well as the side effects that those treatments can cause.”

Source: Source: MCKCC

 

 

Targeted Therapy for Advanced Prostate Cancer Receives FDA Approval.

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The US Food and Drug Administration announced today that the drug enzalutamide, formerly known as MDV 3100, has been approved for the treatment of men with metastatic prostate cancer (prostate cancer that has spread beyond the primary tumor to other parts of the body).

Recently, the results of a large, multicenter phase III study showed that enzalutamide significantly increased survival in men with advanced disease. Investigators led by Howard I. Scher, Chief of Memorial Sloan-Kettering’s Genitourinary Oncology Service, first presented their findings at the American Society of Clinical Oncology’s Genitourinary Cancers Symposium in February 2012. The findings were reported online on August 15, 2012 in the New England Journal of Medicine.

Laboratory work conducted by Memorial Sloan-Kettering’s Charles L. Sawyers, Chair of the Human Oncology and Pathogenesis Program, and colleagues was instrumental in the development of this novel therapy.

“Prostate cancers that progress after standard hormone therapy and chemotherapy are notoriously difficult to treat,” Dr. Scher says. “We now have a new FDA-approved treatment that can prolong the lives of men with this disease.”

The Path to Approval

The trial that led to FDA approval, called AFFIRM, was an international phase III randomized, double-blind, placebo-controlled study of enzalutamide in men with prostate cancer who had been previously treated with one to two different types of chemotherapy, one of which contained docetaxel (Taxotere®).

Nearly 1,200 men were randomized to receive either enzalutamide or a placebo. On average, treatment with enzalutamide prolonged the lives of the men by nearly five months and reduced their risk of death by 37 percent when compared to the placebo group. As a result, the study was halted in November 2011 so patients in the placebo arm of the trial could be offered the drug.

“The results of the trial exceeded our expectations,” Dr. Scher comments. “It is extremely gratifying to see how the close integration of clinical studies and fundamental laboratory discoveries have come together to bring this new and effective therapy to patients.”

Enzalutamide: Blocking the Action

The male hormone testosterone and other androgens fuel the growth of prostate tumors, and some of the standard treatments for metastatic disease are drugs that stop the production or block the action of androgens – the equivalent of castration. Initially, most men respond to this treatment. But eventually the cancer progresses despite continued treatment, and they develop a more aggressive form of the disease called castration-resistant prostate cancer.

Earlier work by Dr. Sawyers and his enzalutamide co-inventor, chemist Michael Jung of the University of California, Los Angeles, determined that the reason for drug resistance was an increase in the tumor’s production of androgen receptors.

Enzalutamide is an oral androgen receptor-signaling inhibitor that targets multiple steps in the androgen receptor-signaling pathway, binding tightly to the androgen receptor and at the same time inhibiting it.

“The results of the AFFIRM trial – and now the FDA approval – represent a significant milestone for me personally and professionally,” Dr. Sawyers says. “The basic research that led to the development of the drug, and the collaborative efforts to bring that discovery into a clinical setting, should serve as a model for future drug development by investigators at academic institutions. The pride in knowing that one’s work will have an impact on patients’ lives is impossible to describe.”

Source: MCKCC

 

Acupuncture Confirmed Helpful for Chronic Pain.

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Chronic pain is an exceedingly common condition impacting an estimated 76.5 million Americans, one-third of whom describe their pain as severe and “disabling.” When it comes to treating ailments such as chronic pain, I definitely prefer non-toxic options to modern medicine’s poor excuses for “cures.”

One such option is acupuncture, which can be an effective option for a number of health problems, but pain in particular.

In a recent analysis published in the Archives of Internal Medicine,1 researchers concluded that acupuncture has a definite effect in reducing chronic pain, such as back pain and headaches – more so than standard pain treatment. Real acupuncture also produced slightly better results than using sham needles, which suggests the benefits of needling are due to more than the placebo effect.

According to Time magazine:2

“The findings counter those of the last large study on the subject, which found that the needle technique was no better than a fake acupuncture treatment – using random pricking with toothpicks – in reducing people’s pain. But Vickers says his meta-analysis of the data, in which researchers reviewed 29 previous studies involving 17,922 participants, does a few things the previous studies did not.

For one, he and his colleagues began by looking at only the most rigorous trials involving acupuncture and pain relief – those that directly compared acupuncture treatment with some type of sham needle therapy in which needles were either inserted only superficially or placed in locations that are not known by acupuncture standards to be key treatment points in the body.

The authors of the analysis contacted each of the researchers on the previous studies to discuss with them how they separated the two treatment groups. By limiting their review to the most robust studies published, the authors could assess with more confidence acupuncture’s true effect on participants’ reports of pain before and after treatment.”

Clear and Robust Effects of Acupuncture

The researchers also went the extra mile by retrieving the raw data on self-reported pain. By standardizing the various study participants’ responses, they were able to more accurately assess and compare them as a whole. The team discovered a “clear and robust” effect of acupuncture in the treatment of:

  • Back pain
  • Neck pain
  • Shoulder pain
  • Osteoarthritis
  • Headaches

On a scale of 0 to 100, participants who started out with a pain rating of 60 experienced an average 30 point drop (a 50 percent reduction) in response to the real acupuncture treatments (using needles); a 25 point drop when receiving sham acupuncture; and a mere 17 point drop when receiving “standard pain care” that did not include acupuncture. According to the lead author:3

“The effects of acupuncture are statistically significant and different from those of sham or placebo treatments… So we conclude that the effects aren’t due merely to the placebo effect.”

Furthermore, as reported by HealthDay:4

“The authors stressed that although the superiority of true acupuncture over sham acupuncture appeared to be relatively small, the real-world choice patients face is not between acupuncture or fake acupuncture but rather between acupuncture or no acupuncture at all. And in that context they suggested that their findings are ‘of major importance for clinical practice.’

‘Basically what we see here is that the pain relief difference from acupuncture versus no acupuncture is notable, and important, and difficult to ignore,’ [lead author] Vickers said.”

What is Acupuncture?

Acupuncture is an ancient Chinese medical practice with roots that go back thousands of years. According to the Eastern mindset, your body is a cohesive unit, or whole – a complex system where everything within it is inter-connected, and where each part affects all other parts. A major component is the acceptance of an invisible flow of chi (or ki). This chi can be translated as “energy” or “life force,” which circulates through meridians in your body. When energetic blocks or deficiencies occur within a meridian, an imbalance is created that can cause a ripple effect of physical symptoms. Needles inserted into certain points along the meridians can stimulate sluggish chi, disperse blocks, or otherwise manipulate the flow of energy.

In essence, lack of balance within this bio-energetic system – which also includes blood flow and nutrients – is the precursor to all illness. Your body exhibits symptoms when suffering from inner disease and if it is not rebalanced, these symptoms may lead to acute or chronic illnesses of all kinds.

Chinese medicine, contrary to Western allopathic medicine, does not treat symptoms, but rather seeks to find the origin of the imbalance that produced the symptoms in the first place. Another major difference is that acupuncture, which is part of Traditional Chinese Medicine (TCM), is remarkably safe with few, if any, negative side effects, so it certainly doesn’t hurt to try.

Traditionally, acupuncture is used to treat all kinds of health problems. In many Asian cultures, you see an acupuncturist in the same way you’d see a primary care physician here in the West, and in some US states acupuncturists are in fact considered primary health care physicians. Still, many Westerners have been slow to grasp this type of holistic view, where your body is perceived as being perfectly capable of self-correction and healing without drug intervention. Scientists are still at a loss to explain why acupuncture works, but for those who get relief or healing, the mechanics may not be of great importance.

Other Alternative Pain Treatments

Besides acupuncture, there are a number of treatment modalities that can help ease pain, such as:

  • Emotional Freedom Technique (EFT): Few people want to be told that their pain is psychological or emotional in origin, but there’s quite a bit of evidence that backs this up. Underlying emotional issues and unresolved trauma can have a massive influence on your health, particularly as it relates to physical pain. According to Dr. John Sarno, a psychiatrist who uses mind-body techniques to treat patients with severe low back pain, EFT has a greater than 80 percent success rate
  • Chiropractic adjustments: According to a recent study published in the Annals of Internal Medicine5 and funded by the National Institutes of Health, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain free in 12 weeks compared to those who took medication
  • Massage: Massage releases endorphins, which help induce relaxation, relieve pain, and reduce levels of stress chemicals such as cortisol and noradrenaline – reversing the damaging effects of stress by slowing heart rate, respiration and metabolism and lowering raised blood pressure. It is a particularly effective therapy for stress-related tension, which experts believe accounts for as much as 80 to 90 percent of disease
  • Neuro-Structural Integration Technique (NST): NST is a gentle, non-invasive technique that stimulates your body’s reflexes, which can provide relief for back pain. Simple movements are done across muscles, nerves and connective tissue, which helps your neuromuscular system to reset all related tension levels, promoting natural healing. The results can be both profound and lasting, and are usually apparent within two or three sessions.

More Natural Solutions for Pain

If you have chronic pain of any kind, please understand that there are many safe and effective alternatives to prescription and over-the-counter painkillers, though they may require some patience. Among the best are:

  • Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have also been found in many animal and clinical studies to have anti-inflammatory properties.
  • Reduce your intake of most processed foods as not only do they contain sugar and additives but most are loaded with omega-6 fats that upset your delicate omega 3-6 ratio, which will contribute to inflammation.
  • Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
  • Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.

In the meantime, you don’t need to suffer unnecessarily. Following are options that provide excellent pain relief without any of the health hazards that pain medications often carry.

  • Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
  • Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
  • Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.
  • Boswellia: Also known as boswellin or “Indian frankincense,” this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
  • Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.
  • Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a “joint lubricant” and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.
  • Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
  • Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body’s supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.

Source: Dr. Mercola

Are You Making These Sunshine Mistakes?

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While discussions about the health benefits from sun exposure typically center around vitamin D, which your skin produces in response to UVB rays, UVB exposure actually has a number of other health effects unrelated to vitamin D production – whether it’s from the sun or a safe tanning bed.

New evidence presented in the April-June issue of Dermato-Endocrinology1 confirms that exposure to the sun in appropriate and measured timeframes has a number of health benefits unrelated to vitamin D production, such as:

Enhancing mood and energy through the release of endorphins Protecting against and suppressing symptoms of multiple sclerosis (MS)
Treating skin diseases, such as psoriasis, vitiligo, atopic dermatitis, and scleroderma. UV radiation also enhances skin barrier functions Inducing nitric oxide (NO), which helps protect your skin against UV damage and offers cardiovascular protection, promotes wound healing through its antimicrobial effect, and has some anti-cancer activity
Melatonin regulation through the “third eye” of the pineal gland photoreceptors Relieving fibromyalgia pain
Standard treatment for tuberculosis 100 years ago, long before the advent of antibiotics Treating neonatal jaundice
Can be used to sterilize your armpits and eliminate the cause of most body odor Treating Seasonal Affective Disorder (SAD)
Synchronizing important biorhythms through sunlight entering your eye and striking your retina Regulating body temperature
Protecting against melanoma and decreasing mortality from it May be effective in treating T Cell lymphoma

UV Radiation has Long History of Use as Treatment of Disease

According to the featured Dermato-Endocrinology article:2

“Solar ultraviolet (UV) radiation has been used since ancient times to treat various diseases. This has a scientific background in the fact that a large number of molecules (chromophores) in different layers of the skin interacts with and absorbs UV.

…Phototherapy is a valuable option in the treatment of many psoriatic and nonpsoriatic conditions, including atopic dermatitis, sclerosing skin conditions such as morphea, scleroderma, vitiligo, and mycosis fungoides. Phototherapy is the treatment of certain skin disorders with UV radiation which can be produced by the sun, fluorescent lamps, short arc lamps with UV filters and lasers.

Depending on the shape of the spectrum of radiation emitted by the source, phototherapy can be divided into broadband UVB (290-320 nm), narrow band UVB (310-315 nm), monochromatic UVB (308 nm from an excimer laser), broadband UVA (320-400 nm) and UVA-1 (340-400 nm).

…Traditionally, broadband UVB phototherapy has been used to treat psoriasis, which is an inflammatory skin disease, characterized by keratinocyte hyperproliferation with 1-2 percent prevalence in the general population. However, now more often narrowband UVB or monochromatic UVB are used for the clearance of psoriasis. Narrow-band UVB clears psoriasis faster and produces longer remissions than broadband UVB. Action spectra for UV-induced erythema, DNA damage, photoimmunesuppression, squamous cell carcinoma and vitamin D synthesis are very similar, all in the UVB spectral region of 280-310 nm.

Narrowband UVB do not contain the most erythemogenic and carcinogenic wavelengths.

…Sunbathing or tanning beds seem to have a potential to reduce pain in patients with fibromyalgia. Patients with the chronic pain condition fibromyalgia have reported a greater short-term decrease in pain after exposure to UV compared with non-UV radiation exposure…” [Emphasis mine]

Why I Strongly Advise Using the Sun or Safe Tanning Bed

Another article written by Richard J. Wurtman3, while over 40 years old, still contains loads of interesting information about the health benefits of sunlight, and is well worth a read-through. If you have any interest, I strongly recommend you download this classic, superbly written 11-page PDF from the Massachusetts Institute of Technology. This article reveals the benefits of sun exposure and not merely swallowing a vitamin D tablet or capsule.

I am beyond convinced that you are missing the boat on vitamin D big time if you merely rely on swallowing pills or capsules. If you are on the fence about this or don’t believe me, please read Dr. Wurtman’s classic article.

Just as an example, he rightfully points out the role of sunlight on synchronizing the hormonal rhythms of your body. Melatonin, for example, which is synthesized by your pineal gland, is profoundly affected by light and dark, and proper exposure to bright sun during the day is important for maintaining your internal rhythm. Melatonin, as you may recall, is also a potent antioxidant with cancer-fighting properties, so please do not underestimate the importance of daily UV exposure – as well as the avoidance of artificial light after sunset.

Sensible Sun Exposure Actually Protects Against Melanoma

While the sun has gotten a bad rap, being portrayed as little more than a skin cancer-inducing object in the sky to be avoided at all cost, it’s important to consider that exposure to UVB light is actually protective against melanoma (the most lethal form of skin cancer). As documented in The Lancet:4

“Paradoxically, outdoor workers have a decreased risk of melanoma compared with indoor workers, suggesting that chronic sunlight exposure can have a protective effect.”

Another study in Medical Hypotheses5 suggested that indoor workers may have increased rates of melanoma because they’re exposed to sunlight through windows, and only UVA light, unlike UVB, can pass through window glass. (While UVB light gives you that tanned look and causes your skin to produce vitamin D, UVA rays are the ones associated with skin damage and skin cancer.) Since indoor workers, who get three to nine times less solar UV exposure than outdoor workers, are missing out on exposure to the beneficial UVB rays, they will have lower levels of vitamin D and therefore miss out on the “built-in” cancer protection offered by regular exposure to the sun, or a sun lamp.

The study even noted that indoor UV actually breaks down vitamin D3 formed after outdoor UVB exposure, which would therefore make vitamin D3 deficiency and melanoma risk even worse. A number of associations between regular sun exposure and decreased melanoma risk can be found in the medical literature. For example:

  • Occupational exposure, such as farmers and fishermen, and regular weekend sun exposure are associated with decreased risk of melanoma
  • Sun exposure appears to protect against melanoma on skin sites not exposed to sun light, and melanoma occurring on skin with large UV exposure has the best prognosis
  • Patients with the highest blood levels of vitamin D have thinner melanoma and better survival prognosis than those with the lowest vitamin D levels

Vitamin D Deficiency Common in Sick Kids

Still, there’s no getting around the fact that vitamin D, produced by your skin in response to UV radiation is a primary health benefit of sun exposure, as vitamin D influences an estimated 10 percent of all the genes in your body. This makes it a profoundly important factor for maintaining optimal health!

Two recent studies of critically ill children found that vitamin D deficiency is very common in sick children, and is associated with worse outcomes and extended hospital stays.6 Earlier studies had already linked vitamin D deficiency with worse outcomes in critically ill adults.

One study7 showed that two out of five children admitted to the study center’s pediatric hospital ward were deficient in the vitamin (below 20 ng/ml), and had more severe illness on admission. Children admitted with life-threatening septic shock had a median vitamin D level of just 19.2 ng/ml. The authors concluded:

“We found a high rate of vitamin D deficiency in critically ill children. Given the roles of vitamin D in bone development and immunity, we recommend screening of those critically ill children with risk factors for vitamin D deficiency and implementation of effective repletion strategies.”

The other study8, which included children and teenagers, found that nearly 70 percent of the participants were vitamin D deficient, with deficiency independently associated with longer ICU stays and more severe illness.

Low Vitamin D Levels May Raise Death Risk in Older Adults

Similarly, frail seniors with low levels of vitamin D have an increased risk of death, according to data analyzed by Oregon State University researchers. While the study, which was published in the European Journal of Clinical Nutrition9, showed that those with low vitamin D levels had a 30 percent greater risk, researchers said they couldn’t determine whether low vitamin D levels contributed to frailty, or if frail people had low vitamin D levels due to health problems.

According to the university’s news release10, about 70 percent of Americans and up to one billion people worldwide have insufficient levels of vitamin D. As I previously mentioned, the solution for this is not to inundate the food supply with supplemental vitamin D but merely encourage people to get as much safe sun exposure as possible to increase their vitamin D levels the way they were designed to. This will also help them reap some of the benefits mentioned in the table above.

Research has also found that sunlight exposure and higher vitamin D levels are both associated with decreased knee cartilage loss11 in patients with knee osteoarthritis.

All of these recent findings support previous research showing that vitamin D may lower your risk of dying from ANY cause.12 Truly, the health benefits of vitamin D levels are so numerous, I believe measuring your vitamin D levels may be your most important blood test, and optimizing your vitamin D levels through appropriate sun exposure or use of a safe tanning bed may be one of the most important things you can do to improve and maintain your health.

What Makes for a Safe Tanning Session?

While recent media reports are again trying to dissuade you from using tanning beds, the benefits of sunbeds far outweigh the risks, if and when you cannot get sufficient amounts of regular sun exposure. However, there are two primary concerns with tanning beds that you need to be aware of:

  1. UV dose. The FDA uses a unit called “one erythemal dose” as a means of calibration for the indoor tanning industry – which is just a fancy word for one tanning session. One erythemal dose equates to the amount of time it takes for a tanning device to produce erythema (slight pinkening of the average person’s skin), and this erythema indicates you have achieved a safe dose of UV – which translates to an optimal dose of vitamin D.

However, keep in mind that the erythemal dose can differ for each person based on skin type and strength of lamps – just as a safe “dose” of sunshine differs for people based on their skin type, geographic location, and time of day. Start with the lowest recommended dose (time) to avoid getting burned, especially if you are light skinned.

The FDA also makes recommendations about how often you should receive a dose, stating you should wait 24-48 hours between tanning sessions. The reason for this is that it takes at least 24 hours for the erythema to go away.

The FDA’s exposure schedule can be described as CONTROLLED SUNSHINE, making it a very safe way to receive the benefits of the sun while indoors. Once you have a base tan, you can then enjoy more time in the sun without burning, and in that respect, you receive some protection that you would not otherwise have.

  1. EMF exposure. Most tanning beds use magnetic ballasts to generate light. These magnetic ballasts are well known sources of EMF fields that can contribute to cancer. If you hear a loud buzzing noise while in a tanning bed, it has a magnetic ballast system. I strongly recommend you avoid these types of beds and restrict your use of tanning beds to those that use electronic ballasts.

What About Vitamin D Supplements?

If neither sun exposure nor a safe tanning bed are feasible, you’re well advised to take an oral supplement. However, you need to make sure you’re taking the right kind.

Most people know that D2 – the synthetic version commonly prescribed by doctors – is not as potent as D3. Each microgram of orally consumed 25-hydroxyvitamin D3 is about five times more effective in raising serum 25(OH)D than an equivalent amount of vitamin D2. However, besides being less potent, D2 supplements may actually do more harm than good overall.

A recent meta-analysis by the Cochrane Database13 looked at mortality rates for people who supplemented their diets with D2 versus those who did so with D3, the form naturally produced by your body, highlighting the significant differences between the two. The analysis of 50 randomized controlled trials, which included a total of 94,000 participants, showed:

  • A six percent relative risk reduction among those who used vitamin D3, but
  • A two percent relative risk increase among those who used D2

Recently, researchers from England and Australia collaborated on another interesting study, published in PLoS ONE, in which they investigated childhood D2 and D3 levels and subsequent psychotic experiences later in life.14 Dr. Anna-Marija Tolppanen and colleagues from the England and Australia, including two of my heroes, John McGrath and William Fraser, simply measured 25(OH)D2 and 25(OH)D3 in 5,346 subjects at age 9 and then assessed for psychotic experience, such as hearing voices or seeing things that are not there, three years later. Such psychotic experiences are associated with a higher risk of developing schizophrenia in later life.

Surprisingly, children with higher 25(OH)D2 levels had more, not fewer, psychotic experiences at age 12, whereas children with higher 25(OH)D3 levels had fewer psychotic experiences in later life. It’s well worth noting that the children with higher 25(OH)D3 got it from sun exposure, not supplements. Increasing amounts of evidence suggests that sun exposure simply cannot be adequately replaced by a vitamin D supplement – especially not the synthetic kind.

Is Low Vitamin D the Culprit in Cavities?

Lastly, the Vitamin D Council recently posted an article about vitamin D’s impact on dental health in children.15 Dr. John Cannell writes:

“Severe early childhood caries (S-ECC), also known as bottle rot, is a syndrome characterized by severe decay in the teeth of infants or toddlers. S-ECC is commonly caused by a bacterial infection with Streptococcus mutans. Its prevalence is epidemic; in the US, the rate is highest in minorities, at times infecting over 70 percent of minority children. The disease process begins with the transmission of the bacteria to the child, usually from the mother… Subsequent cavities and surgery is common.”

More than one study has investigated the potential link between vitamin D and cavities and found correlations between the two. Most recently, researchers at the University of Manitoba, Canada, found that children with S-ECC (severe early childhood caries) had significantly lower vitamin D levels than cavity-free children (20 ng/ml versus 25ng/ml) and were twice as likely to have levels below 30 ng/ml.16

Dr. Cannell also points out that this link was discovered around 90 years ago, when Dr. May Mellanby showed vitamin D supplementation decreased cavities in the 1920’s.

“Unfortunately, her work was forgotten. In addition, early work showed sunbeds were more effective in preventing cavities than was D2,” Dr. Cannell writes.

“Even more interesting, children with S-ECC had much higher levels of parathyroid hormone (high PTH is a marker for severe vitamin D deficiency) than cavity free children had. In fact, their PTH was more than triple the normal children and eight times more likely to be elevated than cavity free children. As the variation in PTH was greater than the variation in 25(OH)D, it made me think the obvious: that children all have different set points for vitamin D preventing carries. Thus, all children should have natural levels, around 50 ng/ml, to prevent S-ECC, a level where PTH is quite low, like the cavity free children had. This requires 1,000 IU/day/25 pounds of body weight, rounded up.”

Last year, William B. Grant also published a paper in the journal Dermato-Endocrinology discussing UVB exposure and vitamin D in reducing risk of dental caries.17 In it, he writes:

“Studies in the 1920s and 1930s noted that vitamin D and ultraviolet-B (UVB) irradiance reduced caries formation, the proposed mechanism being improved calcium absorption and metabolism. This paper reviews the history of studies of dental caries with respect to vitamin D, geographical location and available solar UVB doses…

The mechanism whereby UVB reduces risk of dental caries is likely through production of vitamin D, followed by induction of cathelicidin and defensins, which have antimicrobial properties. Serum 25-hydroxyvitamin D concentrations at or above 30-40 ng/ml should significantly reduce the formation of dental caries. It is unfortunate that the UVB and vitamin D findings were not given more consideration in the 1950s as a way to reduce the risk of dental caries when water fluoridation was being proposed.”

Guidelines for Safe and Effective Sun Exposure

While sun exposure is your best source for vitamin D, it’s important to understand that not all sun exposure will allow for vitamin D production. Sunlight is composed of about 1500 wavelengths, but the only wavelength that makes your body produce vitamin D are UVB-rays, when they hit exposed skin. The UVB-rays from the sun must pass through the atmosphere and reach where you are on the earth in order for this to take place. This obviously does not occur in the winter for many of us in the U.S., but the sun’s rays are also impeded during a fair amount of the year for people living in temperate climates.

Due to the physics and wavelength of UVB rays, they will only penetrate the atmosphere when the sun is above an angle of about 50° from the horizon. When the sun is lower than 50°, the ozone layer reflects the UVB-rays but let through the longer UVA-rays.

So how do you know if you have entered into the summer season and into the time of year, for your location, where enough UVB is actually able to penetrate the atmosphere to allow for vitamin D production in your skin?

The first step is to determine the latitude and longitude of your location. You can easily do this on Google Earth, or if you are in the U.S. you can use the TravelMath Latitude Longitude Calculator to find your latitude and longitude. Once you have obtained that you can go to the U.S. Navy site to calculate a table to determine the times and days of the year that the sun is above 50 degrees from the horizon.

Translated to the date and time of some places on the globe, it means for example: In my hometown of Chicago, the UVB rays are not potentially present until March 25, and by September 16th it is not possible to produce any vitamin D from the sun in Chicago. Please understand it is only theoretically possible to get UVB rays during those times. If it happens to be cloudy or raining, the clouds will also block the UVB rays. For a more detailed understanding of this, please view the following video, and/or read through the corresponding article.

Even Easier if You Have Apple System

Alternatively, if you have an iPhone or iPad you can download a free app called “D Minder”, which will make all the calculations for you. It was made by an Apple developer who was motivated to simplify the process after he watched the video above.

From a health perspective, it doesn’t make much sense to expose your skin to the sun when it is lower than 50 degrees above the horizon because you will not receive any valuable UVB rays, but you will expose yourself to the more dangerous and potentially deadly UVA rays. UVA’s have a longer wavelength than UVB and can more easily penetrate the ozone layer and other obstacles (like clouds and pollution) on their way from the sun to the earth. UVA is what radically increases your risk of skin cancer and photoaging of your skin. So while it will give you a tan, unless the companion UVB rays are available you’re likely doing more harm than good and should probably stay out of the sun to protect your skin.

During the times of the year when UVB rays are not present where you live you essentially have two options: You can use a safe tanning bed or oral vitamin D3.

Source: Dr. Mercola

 

 

Use of Vaptans Is Not Recommended for Hyponatremia in Cirrhosis.

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These costly drugs did not reduce mortality in a meta-analysis of randomized, controlled trials.

In patients with cirrhosis, hemodynamic changes lead to increased secretion of arginine vasopressin, which results in water retention and dilutional hyponatremia. Vaptans (nonpeptide vasopressin receptor antagonists) promote increased free water clearance with hypotonic dieresis. Although vaptans are approved for use in hyponatremic patients, their efficacy and safety in patients with cirrhosis is debated.

Now, investigators have conducted a systematic review and meta-analysis of 12 industry-funded, randomized, controlled trials that evaluated the safety and efficacy of vaptans (tolvaptan, satavaptan, and lixivaptan) in patients with cirrhosis and hyponatremia or ascites. Of 2266 total participants, 1483 received vaptans, and 783 controls received no intervention, placebo treatment, or a different diuretic agent (furosemide or spironolactone). The primary outcome was mortality; secondary outcomes included complications of cirrhosis, renal failure, serum sodium levels, mobilization of ascites, and adverse events.

Mortality was similar in the vaptan and control groups, as were rates of complications of cirrhosis and renal failure. Compared with controls, use of vaptans increased serum sodium levels (weighted mean difference, 2.02 mmol/L), reduced body weight (weighted mean difference, –1.82 kg), increased the time to the first large-volume paracentesis, and increased the rate of nonserious adverse events such as thirst and excessive urine volume. Subgroup and sensitivity analysis did not alter these findings.

Comment: This well executed meta-analysis demonstrated no survival benefit from the use of vaptans in patients with cirrhosis and ascites or hyponatremia. Although no serious adverse events occurred with the use of vaptans, nonserious adverse events were common. Because this class of drugs is expensive and its benefits are questionable, it cannot be recommended for routine clinical use in patients with cirrhosis.

Source: Journal Watch Gastroenterology

 

The Meaning of Addiction Has Changed — Addiction is Not a Characteristic of Things.

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Writing as editor of MedPage Today, the redoubtable George Lundberg* confidently (and briefly) declared: “All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction.”

George, are you behind times! The new definition of addiction in the American Psychiatric Association’s forthcoming manual doesn’t discriminate — any substance may be addictive. Moreover, the manual (DSM-5), soon to be released, will for the first time include a non-substance addiction (gambling), and may include a catch-all “behavioral addiction — not otherwise specified” category. That last bit is meant to indicate, well, that people may become addicted to anything. This is noted psychiatrically when a person seeks out an experience, ritual, or reward to the exclusion — and detriment — of all other goals and activities. The measure of addictiveness is how absorbing, compelling, and harmful to the person an involvement is. Nothing else matters.

While this may catch in the throats of many — “Why, then, anything can be addictive — email, my morning coffee, or my spouse/lover!” — others are jumping rapidly onto this bandwagon. One way to do so is to note that any captivating activity or experience shows up in the brain, to wit:

A team of scientists led by Nora Volkow at the National Institute on Drug Abuse have used positron emission tomography (PET) scans to show that even when cocaine addicts merely watch videos of people using cocaine, dopamine levels increase in the part of their brains associated with habit and learning. Dr. Volkow’s group and other scientists have used PET scans and functional magnetic resonance imaging to demonstrate similar dopamine receptor derangements in the brains of drug addicts, compulsive gamblers and overeaters who are markedly obese

There are a few things wrong with this formulation:

1) Do the addicts whose brains glow on seeing something actually pursue that object? Always? When do they or don’t they? Why or why not?

2) Do others who use cocaine or who enjoy eating and gambling (or — let’s get down to it — sex) within normal constraints also show dopamine activity in the brain when presented with images of these things? Then why aren’t they addicts? Or are they, but controlled addicts?

3) Can virtually anything be powerful enough for some people to show powerful neuroresponsiveness? Then why are we typecasting only a subset of things as addictive? Lundberg makes this mistake by telling us only some drugs are addictive, but not which ones (reminds you of the Republicans’ budget cuts, doesn’t it?). He implies that pharmaceuticals aren’t addictive (“Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh-Day Adventists, and the like”), but then maybe he hasn’t read I’m Dancing as Fast as I Can (tranquilizer addiction) or hasn’t been paying attention as prescribed painkillers rise to the top of the addictiveness list. (Dr. Lundberg, are marijuana and caffeine addictive?)

To quote Joseph Conrad in Victory, “There are more magic potions than your commonplace magician can imagine.” Virtually anything can be addictive for the “right” person at the “right” time — one of stress or disorientation, when that experience holds out significant and powerful associations for the person, when the person is not inclined or able to be restrained, when all consequences are damned. Addiction, you see, is not a label to be applied to specific things, but to an involvement a person creates in time and space.

Lundberg is the former editor of JAMA.

 

NASA Investigates Proton Radiation Effects on Cells.

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A team of researchers at NASA’s Johnson Space Center in Houston and Lawrence Berkeley National Laboratory in Berkeley, Calif., has found radiation from protons could further enhance a process that occurs during tumor progression. This information may help lead to better methods to protect astronauts from the harmful effects of radiation in space, as well as help cancer researchers on Earth better understand the effects of radiation treatment on the human body.

NASA is particularly interested in this research because protons, which are charged subatomic particles, are the main source of space radiation astronauts receive during spaceflights. The study was part of NASA’s ongoing effort to learn how to mitigate the effects of radiation during long-duration missions to destinations beyond low Earth orbit, such as asteroids and Mars.

“Our paper makes new discoveries on the potential risks from low doses of protons that occur outside of the tumor during radiation therapy, and to all tissues for astronauts exposed to space radiation,” said Francis A. Cucinotta, chief scientist for the Human Research Program Space Radiation Program Element at Johnson and one of the authors of the paper.

The objective of the researchers was to study the biological effects of low-energy protons on epithelial cells (membranous tissues found throughout the body) and the protons’ propensity to enhance a process that occurs during tumor progression. This process is called epithelial-mesenchymal transition (EMT), which has been associated with cancer progression. EMT also has been linked to radiation-induced fibrosis, one of the most common late effects of radiotherapy.

Notably, the study revealed protons alone can induce EMT-associated changes in normal human epithelial cells. Although the total body dose received in space is moderately low compared to what is received in radiotherapy, this study reveals that low doses of protons still may prompt EMT and result in potentially detrimental effects.

These studies were conducted at Johnson and at the NASA Space Radiation Laboratory at Brookhaven National Laboratory, Upton, N.Y.

Results of the study were published as “Protons Sensitize Epithelial Cells to Mesenchymal Transition” in the July 23 issue of the journal PLoS ONE.

Source: PLOS one/NASA

 

 

Antioxidants reduces heart attack in women.

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Eating lots of antioxidant-rich fruits and vegetables could help keep women’s heart attack risk low, according to a large new study.

Researchers from the Karolinska Institute found that women who consumed the most antioxidants from foods — not to mention ate nearly seven servings of fruits and vegetables each day — had a 20 percent decreased risk of having a heart attack over a 10-year period.

Even though past studies have not shown any immense benefit from taking antioxidant supplements on heart attack risk, the researchers noted that the positive effect observed in this study may be because the women ate actual fruits and vegetables.

“In contrast to supplements of single antioxidants, the dietary total antioxidant capacity reflects all present antioxidants, including thousands of compounds, all of them in doses present in our usual diet, and even takes into account their synergistic effects,” study researcher Dr. Alicja Wolk, DrMedSci, said in a statement.

The study, published in the American Journal of Medicine, is based on food consumption and health data from 32,561 women from Sweden between ages 49 and 83. Data was collected from 1997 until 2007.

By the end of the study period, 1,114 women had had a heart attack. Women who ate the most vegetables in the study consumed nearly three times more than those who ate the least vegetables in the study (just 2.4 servings per day).

Olive Oil:

Switching from butter to olive oil (or even olive oil to canola oil) can lower cholesterol levels. The “healthy” monounsaturated fats found in olive oil are still fats however, so use in moderation.

Nuts:

A large 2011 study found that swapping nuts for red meat as a leaner source of protein resulted in a 17 percent lower risk of stroke. The unsaturated fat in nuts can help reduce cholesterol in comparison to eating red meat, but nuts are still high in fat and calories, so be aware of portion sizes.

Berries:

Berries are rich in a type of antioxidant called polyphenols, which can lower blood pressure and boost “good” HDL cholesterol.
A 2011 study focussed on blueberries found that they contain a compound called anthocyanins (also found in other dark fruits like raspberries) that can protect against high blood pressure.

Oatmeal:

The soluble fiber in oatmeal (as well in other whole-grain foods, fruits and vegetables) reduces the absorption of “bad” LDL cholesterol into the bloodstream, helping to keep arteries clear.

Soy:

While the cholesterol-lowering claims of soy protein have been debated, there’s no question that it’s a low-fat source of protein when compared to fattier options, like red meat.

Dark Chocolate:

Thanks to compounds called flavonoids that operate like antioxidants, satisfying that sweet tooth can actually lower bad cholesterol, reduce blood pressure and prevent blood clots.

Popcorn:

When air-popped (read, not drenched in butter and smothered in salt), popcorn is actually a surprisingly good source of heart-healthy antioxidants and fiber, according to a 2009 study, because it’s technically a whole grain.

Tomatoes:

Tomatoes are the biggest source of lycopene (a powerful antioxidant) in the American diet, according to a 2011 review of literature on the topic. While more research is needed still, preliminary experiments suggest that lycopene could play a role in preventing cardiovascular problems due to its anti-inflammatory properties.

Seaweed:

Just like their leafy, green, land-grown counterparts, seaweeds pack some impressive benefits for the heart, including antioxidants and even some good fats.

Potatoes:

Sweet potatoes are packed with disease-fighting antioxidants, and both sweets and regular spuds contain fiber and potassium, key in keeping your heart functioning its best.

Coffee:

A 2011 study suggests that coffee is one of the biggest sources of antioxidants in the average person’s diet, and that caffeine is actually behind the heart-healthy effects of that morning (or afternoon) pick-me-up. Although more research is still needed to more clearly understand the process of how caffeine counteracts free radicals in the body, it seems to help fight heart disease, Alzheimer’s and more.

Alcohol:

A 2011 review published in the “British Medical Journal” found a 14 to 25 percent drop in heart disease in moderate alcohol drinkers compared to teetotalers.

For years, research has flip-flopped on the healthy or not debate over alcohol. While once-heralded resveratrol might not be worth all the hype, a recent Spanish study suggests it’s alcohol itself that has cardiovascular benefits, not just the compounds in red wine.

Source: AOL

Revisiting a Prediction Rule for Identifying Children at Low Risk for Appendicitis.

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Even after refinement, the rule is not sufficient for excluding this common diagnosis.

A previously published prediction rule developed at a single center classifies children as having low risk for appendicitis if they meet the following criteria: absolute neutrophil count 6.75 x 103/µL, absence of nausea, and absence of maximal tenderness in the right lower quadrant (RLQ). The rule yielded a sensitivity of 98% and specificity of 32%. Now, the investigators validated and refined the rule in a prospective cohort of 2625 children (age range, 3 to 18 years; mean, 11 years) who presented to 9 pediatric emergency departments during 1 year with abdominal pain of <96 hours duration and suspected appendicitis.

Overall, 1018 patients (39%) were diagnosed with appendicitis, and of these, 275 (27%) had a perforated appendix. Computed tomography was performed in 55% of patients, ultrasound in 37%, and both in 12%. The negative appendectomy rate was 9% (95 patients). Had the rule been applied, 22 unnecessary operations would have been prevented, but 42 patients with appendicitis would have been missed (sensitivity, 96%; specificity, 36%). A refined rule, consisting of absolute neutrophil count 6.75 x 103/µL and either no maximal tenderness in the RLQ or maximal tenderness in the RLQ and no abdominal pain with walking, jumping, or coughing, identified 400 patients as having low risk for appendicitis. The refined rule would have missed 19 patients with appendicitis, yielding a sensitivity of 98% and specificity of 24%.

Comment: The investigators failed to compare performance between these rules and clinical suspicion for appendicitis based on physical examination alone. Overall clinical gestalt should still be the basis for identifying children at low risk for appendicitis. When the diagnosis is uncertain, investigation should begin with ultrasound, followed by computed tomography if ultrasound is nondiagnostic.

Source: Journal Watch Emergency Medicine

Fukushima mutant butterflies spark fear of effect on humans.

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Genetic mutations have been found in three generations of butterflies living near Japan’s crippled Fukushima nuclear plant. The gruesome discovery has led scientists to fear that the leaking radiation could affect other species.

The study was published by Scientific Reports. Researches said that around 12 per cent of pale grass blue butterflies that had been exposed as larvae to nuclear fallout developed abnormalities, including broken or wrinkled wings, changes in wing size, color pattern changes, and wider-than-normal variations in numbers of spots on the butterflies.

Though the insects were mated in a lab well outside the fallout zone, about 18 per cent of their offspring displayed similar problems, said Joji Otaki, an associate professor at Ryukyu University in Okinawa, in southwestern Japan.

That figure rose to 34 per cent in the third generation of butterflies – even though one parent from each coupling was from a group unaffected by radiation.

Researchers also collected another 240 butterflies in Fukushima last September, six months after the disaster. Abnormalities were recorded in 52 per cent of that group’s offspring – “a dominantly high ratio,” Otaki told AFP.

The study began two months after a tsunami devastated parts of northeastern Japan in March 2011, triggering a nuclear disaster at the Fukushima facility. The Fukushima Daiichi plant leaked radiation, causing the evacuation of tens of thousands of residents from the surrounding area. It was the worst nuclear accident since the 1986 Chernobyl disaster in Soviet Ukraine.

To make sure the mutations were caused by radiation and not some other factor, researchers collected butterflies from unaffected regions of the country, and observed similar results after giving them low-dose exposures of radiation.

“We conclude that artificial radionuclides from the Fukushima Nuclear Power Plant caused physiological and genetic damage to this species,” said the study, published in Scientific Reports.

The findings raise fears over the long-term effects of radiation on people who faced exposure in the days and weeks following the accident.

There are claims that the effects of nuclear exposure have been observed on successive generations of descendants of people living in Hiroshima and Nagasaki, where the US dropped atomic bombs in the final days of World War II.

However, researchers and doctors deny claims that the Fukushima accident would lead to a rise in cancer or leukemia, diseases often associated with radiation exposure.

So far, no one is officially recorded as having died as a direct result of the Fukushima disaster. But many in the area, including workers decommissioning the crippled plant, worry about the long-term effects.

“Even if there is no impact now, we have to live with fear,” said Sachiko Sato, a mother of two, who temporarily fled from Fukushima. “And concerns will be handed down to my children and grandchildren.”

Source: Nature