Day: 09/30/2015

Medical marijuana naturally alleviates diabetic nerve pain

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A growing body of scientific literature suggests that cannabis can help treat various illnesses and symptoms, from chemo-induced nausea on one end to muscle spasms on the other end. Within the spectrum of ailments, preliminary research published in the Journal of Pain suggests that inhaled cannabis may help reduce the pain of diabetic peripheral neuropathy (DPN).

DPN is a problem among diabetics, whose bodies are unable to properly process sugar in the blood. Symptoms of diabetes may include frequently urinating, extreme exhaustion, blurry vision, dry mouth and itchy skin.

Though severe, these symptoms are dwarfed by diabetic neuropathy, which causes permanent nerve damage throughout the body. DPN occurs in approximately half of diabetics, and an estimated 15 percent experience pain. It can affect different limbs; however, the most common nerve damage among diabetics is in the feet and legs. Pain caused by DPN can be mild to severe.

Unfortunately, treatment options for DPN are limited. FDA-approved treatment options for DPN are ineffective for some diabetics. In addition, DPN is a progressive disease, meaning treatment options for it may wane over time. The best way to prevent DPN from occurring or worsening is by keeping blood glucose levels in check. Nevertheless, for many diabetics, this is easier said than done.

MARIJUANA AS A TREATMENT OPTION FOR DPN

It has been suspected that cannabis can provide pain relief. Research on animals found a correlation between cannabis and nueropathic pain relief; however, no studies have been conducted on cannabis as a treatment option for pain caused by DPN specifically.

In an effort to be better understand the effects cannabis can have on DPN pain, researchers from the University of California San Diego conducted a double-blind, placebo study on 16 participants suffering from the condition. The researchers examined the relationship between low, medium and high doses of cannabis, and pain levels. Participants inhaled cannabis vapor as opposed to smoking it in order to achieve the quickest pain-relieving results.

The participants were exposed to a placebo and three different doses of 1 percent THC, the compound in cannabis know for its pain-relieving effects. Each session was separate by two weeks. The researchers recorded the pain levels at 5, 15, 30, 45 and 60 minutes, and then every 30 minutes for three hours, after participants took the placebo or inhaled the cannabis.

CANNABIS HELPS TREAT DIFFERENT TYPES OF PAIN

Results of the study showed that their was a dose-dependent pain reduction from the inhaled cannabis. It was able to provide relief for both spontaneous pain (pain which occurs in the absence of stimulus) and evoked pain (pain caused by a stimulus); however, the cannabis provided the most consistent relief for spontaneous pain.

“These findings along with previous studies suggest that cannabis might have analgesic benefit in neuropathic pain syndromes, including treatment-refractory DPN,” said Mark S. Wallace, M.D., professor of anesthesiology at the University of California, San Diego, School of Medicine.

The authors of the study reported that patients experienced feeling either euphoric or drowsy after inhaling the cannabis, which may limit the use of the herb as an acceptable painkiller. The researchers did not find that cannabis severely limited the attention span and memory of the participants.

The study was small and preliminary in scope. Nevertheless, it adds to the growing body of evidence that marijuana can provide some relief for neuropathic pain.

“This small, short-term, placebo-controlled trial of inhaled cannabis demonstrated a dose-dependent reduction in diabetic peripheral neuropathy pain in patients with treatment-refractory pain. This adds preliminary evidence to support further research on the efficacy of the cannabinoids in neuropathic pain,” the authors of the study concluded.

Early exposure to ‘good’ gut bacteria may reduce asthma

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Infant with dummy

Infants can acquire ‘good’ gut bacteria in their first three months of life that may protect them from asthma

Babies who have acquired four key bacteria in their gut by the age of three months may be protected against asthma, a new study suggests.

The finding by Canadian researchers, published today in Science Translational Medicine, could lead to tests to identify babies most at-risk of developing asthma and even inoculations to prevent its onset.

The study also adds weight to the “hygiene hypothesis” that suggests an obsession with clean home environments has fuelled a dramatic rise in asthma rates across western societies since the 1950s.

For the study the researchers analysed stool samples collected at age three months and one year of 319 children participating in the larger Canadian Healthy Infant Longitudinal Development (CHILD) study.

The study showed lower levels of four specific gut bacteria – Faecalibacterium,Lachnospira, Veillonella and Rothia – in three-month-olds who were later found to be at an increased risk for asthma.

However, differences in levels of these bacteria were negligible by the time children reached one year, meaning the first three months were the critical time period for a baby’s developing immune system.

“It shows there’s a short, maybe 100-day window for giving babies therapeutic interventions to protect against asthma,” said study lead co-author Professor Stuart Turvey, Pediatrics Professor at the University of British Columbia.

However, Professor Turvey, a former Australian Rhodes Scholar, said while the finding was significant there was still much to learn about the bacteria, nicknamed FLAVR.

Potential for probiotic treatments

Professor Turvey said most babies naturally acquired the FLAVR bacteria from their environments, but they were unsure why they would not be in equal levels in some babies.

“These are not particularly well-characterised bacteria so we are not exactly sure where they come from,” Professor Turvey said.

“We are trying to understand which bits of the FLAVR are important and if it could possibly be safe to give that to children.”

As part of the study, the researchers replicated the work in mice and found an inoculation of FLAVR in newborn mice helped protect them against developing asthma.

This suggested long term they could develop some “probiotic-style treatment” for children that would prevent the onset of asthma, he said.

Professor Turvey said it was likely the first outcome of the study would be to develop a marker for children at the highest risk of asthma.

“In the first couple of months we could test their stool and test for the presence of FLAVR,” he said.

He said the study also highlighted the importance of “prudent” use of antibiotics in very young children as the study confirmed previous work that showed a link between antibiotic use in the first year and asthma.

‘We need to change our relationship with bacteria’

He also said the study might reveal the mechanism behind the “hygiene hypothesis”.

“This idea that exposure to infections in early life protects from asthma and allergic disease has mostly been through epidemiology,” he said, pointing to studies of children with pets and those who lived on farms.

“This shows that a likely mechanism for that protection is through the bacteria that children house in their gut.”

Professor Turvey said the study showed “we need to change our relationship with bacteria”.

“We co-evolved and they are really important for our health as well,” he said.

The team was now working with researchers in Ecuador who have a study similar to the Canadian CHILD study to see if the findings can be replicated in another population.

Blood seeping from the walls, killer doctors: ICU hallucinations haunt a staggering number of patients

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The doctors were standing in the corner of Cheryl Misak’s room, wearing little Christmas party hats and getting more and more drunk. Then, they stripped naked and paraded the patients around the intensive care unit one by one, taunting and humiliating them to their giddy delight.

The delusion felt completely and utterly real, one of many that became seared into Misak’s mind after she nearly died in a Toronto ICU from acute respiratory syndrome and sepsis caused by a devastating infection.

In 1998, the philosopher and former University of Toronto provost survived serious multiple organ failure. But she also experienced terrifying moments of “utter insanity” in the ICU. She left hospital so frail and emaciated she refused to have her picture taken.

With the slightest exertion, searing nerve pain shot up her body like fire, from the soles of her feet to her neck. She couldn’t sleep; the sounds of the ICU stayed with her for a year — the whoosh and beep of the ventilator, the patients moaning in pain or anguish in the beds next to her. She would break into a cold sweat at the sound of an ambulance siren.

Misak experienced forms of a terrifying phenomenon researchers have only begun to fully grasp.

Tens of thousands of Canadians who survive a life-threatening illness or injury every year are left with new and profound thinking, memory and psychological problems that can make them feel as if they are losing their minds, say Canadian researchers leading the largest study of its kind of ICU “survivors” and their caregivers.

UNIVERSITY OF TORONTO

The problems can linger for months, sometimes years. Some people never recover.

The phenomenon has been dubbed “post-intensive care syndrome.” It is a constellation of symptoms that can include devastating muscle weakness, cognitive dysfunction on the order of early Alzheimer’s disease or moderate traumatic brain injury, anxiety, depression and full-blown post-traumatic stress disorder.

One study published in April found 25 per cent of those who survive an ICU admission have symptoms of post-traumatic stress disorder (PTSD) between one and six months after leaving hospital.

That’s as high as those seen in combat soldiers or victims of rape, says the study’s co-author Dr. Dale Needham, a Canadian-born and trained doctor, now a professor of medicine at Johns Hopkins University School of Medicine in Baltimore.

They become the “forgotten patients,” experts say, struggling to understand why they’re having such a hard time returning to “normal” after being pulled from death.

“People will tell me, ‘I should be grateful, you saved my life,’” says Dr. Margaret Herridge, a professor of medicine at the University of Toronto and a world expert in the legacy of critical illness.

Instead, some hit rock bottom, and suffer such paralyzing depression they have thoughts of killing themselves.

More than 250,000 people are admitted to ICUs every year in Canada. Seventy-five per cent survive to be discharged. Of those, up to half will experience symptoms of post-ICU syndrome. People of all ages are at risk, and the pool of ICU survivors will only swell, as baby boomers grow older, and sicker.

It’s not clear what’s driving post-ICU syndrome. Some believe it is a brain dysfunction caused by the illness or injury itself. But what’s done to patients in the ICU — including frequent overuse of sedation and physical restraints that can make them feel as if they’re being imprisoned or tortured — can also drive the after-shocks of intensive care.

Fotolia

Fotolia

The old thinking was that deep sedation decreases agitation and makes people less likely to pull out breathing tubes or interfere with their care in other ways. Doctors also believed that it would be far more psychologically disturbing for patients to be awake and alert, than heavily snowed under with drugs.

But high doses of some sedatives may contribute to ICU delirium — widespread brain dysfunction that can promote paranoid delusions the brain lays down as “real” memories, Herridge says.

Slices of reality get completely distorted, she explains, often whipped into “persecutory” delusions that someone is trying to hurt, even kill them. People have had delusions they were stabbed in the neck with a knife when a central line was inserted into a large central vein, or sexually assaulted when a catheter was inserted into the femoral artery in their groin.

“I’ll tell people I can assure you that you were not sexually assaulted in the ICU,’ and they’ll say, ‘How do you know that for sure?’ ” Herridge says.

Some patients have described blood seeping from the walls and floors, or rats racing in the room, or children with no faces.

“Back when I started, everybody was heavily sedated. We didn’t want to wake them up until we thought they were getting better,” says Louise Rose, TD nursing professor in critical care research at Sunnybrook Health Sciences Centre in Toronto.

But research shows delusional memories — or none at all — are far more harmful than lucid and accurate ones. While the move now is to use less sedation, some patients still emerge from the ICU completely amnesic, the entire period a total blackout. One patient who spent months in an ICU once told Rose, “I have no memory, and I still find that no memory terrifying.”

Others can leave the ICU feeling weak, anxious and depressed. Many are unable to return to work. Marriages can break apart.

But unlike heart attack or stroke survivors, there is no standard followup care for ICU patients, a situation Herridge finds incredible.

“I think this is why we’re on a crusade about this — why on Earth do we invest so much in the ICU, and the critical illness portion of this person’s care, but we’re not investing in their recovery? It makes no sense.”

In April 1998, then a 38-year-old mother of two young children, Misak woke one night with “screaming pain” in her joints. She assumed she had caught her six-year-old son’s flu.

Two days later, barely able to walk and her blood pressure plummeting, she was rushed by ambulance to the ICU, where doctors frantically began pumping antibiotics into her. Her kidneys had shut down; her lungs were starting to collapse.

She was connected to a ventilator and put in a drug-induced coma. Tests showed invasive group A streptococcus, toxic bacteria that can eat away at the flesh, causing amputations.

“When it gets into your respiratory tract, it’s even worse, because they can’t hack off the infected limb,” Misak says.

She has early flickers of memories, “but it was when I was being brought out of the drug-induced coma that I became fully psychotic,” Misak remembers.

She was convinced one of the doctors was trying to kill her. With a tube down her throat, she couldn’t speak; she could barely raise her hand. She was desperate to get off the breathing machine and hallucinated the ICU team went to each bed and “merrily extubated” every single patient, except her.

Misak says being on a ventilator “was awful beyond belief.” Research suggests one in three ICU patients who require mechanical ventilation experience symptoms of PTSD that can last up to two years. Heavy sedation can also increase the time patients are on ventilators.

In Canada, hundreds of ICU beds are filled every day with medically stable patients who have been on a ventilator for 21 days or longer.

Specialized “weaning” programs can succeed in liberating 60 to 70 per cent of them. But only a few exist across the country — the largest at Toronto East General Hospital.

“These are the sickest of the sickest of the ICU survivors,” says respirologist Dr. Ian Fraser, medical director of the hospital’s prolonged-ventilation weaning program. The patients here have been on ventilators, on average, two months.

“It’s almost as if they have survived the acute illness but now suffer from the consequence of every last reserve in their body being drained,” he says.

At the weaning centre, a highly skilled team works to try to get patients breathing on their own again: there is less noise, more privacy and minimal or zero sedation. The goal is to have no long-term ventilation patients in any ICU in Ontario, because the longer someone is on a mechanical breathing machine, the greater the risk of dying, or never coming off.

Canadians are also leading efforts to minimize the use of powerful sedatives, and to screen for delirium in the ICU, and treat it aggressively. Herridge and her team are pushing for national standards for organized ICU followup and rehabilitation, through their RECOVER program with the Canadian Critical Care Trials Group.

Today, Misak travels the globe, speaking at medical meetings about her near-death experience in the ICU. She has written about the challenges in deciding whether a seemingly competent patient is actually fit to make decisions about his or her care.

In the ICU, she appeared perfectly competent: She responded to the doctors’ questions. She sat in bed, reading the London Review of Books. Inside, she was a “psychological mess,” secretly filled with fear and loathing for her lifesavers.

Misak says patients and families need to be educated about ICU delirium and what may follow in the weeks, and months, after being discharged.

“We owe it to our most vulnerable patients that their care doesn’t stop when they exit the doors of the ICU,” she says. “These things can happen to any one of us.”

Drugs Go Under Cover as Platelets to Destroy Cancer

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    Scientists say they have for the first time developed a technique that coats anticancer drugs in membranes made from a patient’s own platelets, allowing the drugs to last longer in the body and attack both primary cancer tumors and the circulating tumor cells that can cause a cancer to metastasize. The work reportedly was tested successfully in an animal model.

    “There are two key advantages to using platelet membranes to coat anticancer drugs,” says Zhen Gu, Ph.D., corresponding author of a paper on the work and an assistant professor in the joint biomedical engineering program at North Carolina State University and the University of North Carolina at Chapel Hill. “First, the surface of cancer cells has an affinity for platelets; they stick to each other. Second, because the platelets come from the patient’s own body, the drug carriers aren’t identified as foreign objects, so last longer in the bloodstream.”

    “This combination of features means that the drugs can not only attack the main tumor site, but are more likely to find and attach themselves to tumor cells circulating in the bloodstream, essentially attacking new tumors before they start,” adds Quanyin Hu, a Ph.D. student and lead author of the paper (“Anticancer Platelet-Mimicking Nanovehicles”), which appears in Advanced Materials

    Here’s how the process works. Blood is taken from a patient (a lab mouse in the case of this research) and the platelets are collected from that blood. The isolated platelets are treated to extract the platelet membranes, which are then placed in a solution with a nanoscale gel containing the anticancer drug doxorubicin (Dox), which attacks the nucleus of a cancer cell.

    The solution is compressed, forcing the gel through the membranes and creating nanoscale spheres made up of platelet membranes with Dox-gel cores. These spheres are then treated so that their surfaces are coated with the anticancer drug TRAIL, which is most effective at attacking the cell membranes of cancer cells.

    When released into a patient’s bloodstream, these pseudo-platelets can circulate for up to 30 hours as compared to approximately six hours for the nanoscale vehicles without the coating. When one of the pseudo-platelets comes into contact with a tumor, three things happen more or less at the same time.

    First, the P-Selectin proteins on the platelet membrane bind to the CD44 proteins on the surface of the cancer cell, locking it into place. Second, the TRAIL on the pseudo-platelet’s surface attacks the cancer cell membrane. Third, the nanoscale pseudo-platelet is effectively swallowed by the larger cancer cell. The acidic environment inside the cancer cell then begins to break apart the pseudo-platelet, thus freeing the Dox to attack the cancer cell’s nucleus.

    In a study using mice, the researchers found that using Dox and TRAIL in the pseudo-platelet drug delivery system was significantly more effective against large tumors and circulating tumor cells than using Dox and TRAIL in a nano-gel delivery system without the platelet membrane.

    “We’d like to do additional pre-clinical testing on this technique,” notes Dr. Gu. “And we think it could be used to deliver other drugs, such as those targeting cardiovascular disease, in which the platelet membrane could help us target relevant sites in the body.”

MRI Technique Could Reduce Need for Breast Biopsies

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Unenhanced diagnostic MRI-diffusion-weighted imaging with background suppression (DWIBS) mammography can help exclude malignancy in women with suspicious X-ray screening mammograms without the use of ionizing radiation or a contrast agent, according to a new study published online in the journal, Radiology). The method has the potential to reduce unnecessary biopsies—as well as emotional distress—for breast cancer screening patients if used as a complement after the regular screening clarification procedure.

Sebastian Bickelhaupt, M.D., of the German Cancer Research Center, Heidelberg, Germany, and colleagues conducted a prospective institutional review that included 50 women (mean age, 57.1 years; range, 50-69 years), who gave informed consent and who had suspicious screening mammograms and an indication for biopsy from September 2014 to January 2015. Before biopsy, full diagnostic contrast-enhanced MR imaging was performed that included DWIBS (b = 1500 sec/mm2). Two abbreviated protocols (APs) based on maximum intensity projections (MIPs) were evaluated regarding the potential to exclude malignancy: DWIBS (AP1) and subtraction images from the first post-contrast and the unenhanced series (AP2). Diagnostic indexes of both methods were examined using the McNemar test and were compared with those of the full diagnostic protocol and histopathologic findings.

Of the 50 participants, 24 (48 percent) had a breast carcinoma. With AP1 (DWIBS), the sensitivity was 0.92 (95 percent confidence interval [CI]:0.73, 0.98), the specificity was 0.94 (95 percent CI: 0.77, 0.99), the negative predictive value (NPV) was 0.92 (95 percent CI: 0.75, 0.99), and the positive predictive value (PPV) was 0.93 (95 percent CI: 0.75, 0.99). The mean reading time was 29.7 seconds (range, 4.9–110.0 seconds) and was less than 3 seconds (range, 1.2–7.6 seconds) in the absence of suspicious findings on the DWIBS MIPs. With the AP2 protocol, the sensitivity was 0.85 (95 percent CI: 0.78, 0.95), the specificity was 0.90 (95 percent CI: 0.72, 0.97), the NPV was 0.87 (95 percent CI: 0.69, 0.95), the PPV was 0.89 (95 percent CI: 0.69, 0.97), and the mean reading time was 29.6 seconds (range, 6.0–100.0 seconds).

Unenhanced diagnostic MR imaging–DWIBS mammography achieved a comparable accuracy to the full diagnostic protocol and to abbreviated contrast-enhanced protocols when used as a complementary method after screening mammography, according to researchers.

“The comprehensive method is fast and robust to perform as a complement to routine mammography. Along with lack of need for intravenous contrast agent administration, ad-vantages include its short acquisition time of less than seven minutes and short reading time of less than 30 seconds,” the authors write.

 

Has giant LIGO experiment seen gravitational waves?

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An improbable rumour has started that the observatory has already made a discovery — but even if true, the signal could be a drill.

On 25 September, a sensational rumour appeared on Twitter: Lawrence Krauss, a cosmologist, reported hearing that the world’s largest gravitational-wave observatory had seen a signal, barely a week after its official re-opening.

The rumour had been spreading around physics circles for at least a week. If it is true, and if the signal seen by the Advanced Laser Interferometer Gravitational-Wave Observatory (LIGO) genuinely represents the signature of a gravitational wave, it would confirm one of the most-elusive and spectacular predictions of the general theory of relativity almost exactly 100 years after Albert Einstein first proposed it.

But those are two big ifs. LIGO will not confirm or deny the rumours. “The official response is that we’re analysing the data,” says spokesperson Gabriela González, a physicist at Louisiana State University in Baton Rouge. Gonzalez was upset at the possibility that someone in the LIGO team might have initiated the rumour, although Krauss and other researchers told me that they did not hear it directly from members of the LIGO collaboration.  “I give it a 10–15% likelihood of being right,” says Krauss, who works at Arizona State University in Tempe.

And even if LIGO has seen some promising data, it could be the result of an elaborate drill — a false signal deliberately injected into the detectors to train LIGO’s data-analysis team. At this stage, only three people would know the truth, and they would not reveal that until much later, when the collaboration is ready to publish a paper and to hold a press conference.

LIGO on the lookout

In principle, LIGO could have already spotted a signal. Its two detectors, in Hanford, Washington, and Livingston, Louisiana,operated from 2002-2010 without detecting any gravitational waves — ripples in the fabric of space–time that, according to Einstein’s theory, are produced by cataclysmic events such as the merging of two black holes. LIGO’s interferometers bounce laser beams between mirrors at the opposite ends of 4-kilometre-long vacuum pipes, aiming to detect passing gravitational waves that stretch and compress the length of the pipes — along with the rest of space.

But Advanced LIGO, which officially began taking data on 18 September, represents a US$200-million overhaul. The detectors are now three times more sensitive than their predecessors, González says, and they have already stayed simultaneously online for up to 24 hours at a time. (This is a big improvement from earlier runs, when operations could be interrupted by a truck hitting a pothole on a road kilometres away from either site).

The detectors are expected to run for three months before shutting down for a further upgrade. Some in the LIGO collaboration reckon that they have a one-in-three chance of recording an event during that time, making a detection over days or weeks of operation improbable.

But LIGO also conducted several ‘engineering runs’ beginning in June, during which the detectors were both running and recording data. Those data have been examined, though some in the collaboration have cautioned against this. At the time, the team was still calibrating the instruments and understanding noise — such as fluctuations in the laser beams or thermal vibrations — that would make it hard to pick out genuine signals. (Detecting gravitational waves is an extremely delicate task, as it involves measuring changes in the length of each interferometer’s arms by about one part in 1022).

Rapid analysis

Even if a signal has been seen, and if it is a genuine discovery, an official announcement probably will not happen until next year. The Advanced LIGO team plans to give itself about three months from the time of a signal detection to analyse it, write up a paper and vote to decide whether to announce it.

But an astrophysical event such as the collision of two black holes could produce an unequivocal detection of gravitational waves, if it happened in a galaxy close enough to the Milky Way to produce a loud signal, several LIGO members have told me.

This is especially true for what gravitational-wave scientists call a ‘chirp’: a clean-looking sinusoidal wave that becomes higher in pitch and louder as time goes by, resembling the sounds of certain birds. Chirps are the signature of two neutron stars or black holes as they spiral into each other, emitting gravitational waves in the process. In the final stages of the stars’ dance, the waves soar past the 10-Hertz pitch threshold needed for the Advanced LIGO to detect a signal.

False alert

But then there is the other possible scenario: that the researchers have seen a false signal planted deliberately as a drill. The LIGO is almost unique among physics experiments in practising ‘blind injection’. A team of three collaboration members has the ability to simulate a detection by using actuators to move the mirrors. “Only they know if, and when, a certain type of signal has been injected,” says Laura Cadonati, a physicist at the Georgia Institute of Technology in Atlanta who leads the Advanced LIGO’s data-analysis team.

Two such exercises took place during earlier science runs of LIGO, one in 2007 and one in 2010. Harry Collins, a sociologist of science at Cardiff University, UK, was there to document them (and has written books about it1). He says that the exercises can be valuable for rehearsing the analysis techniques that will be needed when a real event occurs. But the practice can also be a drain on the team’s energies. “Analysing one of these events can be enormously time consuming,” he says. “At some point, it damages their home life.”

The original blind-injection exercises took 18 months and 6 months respectively. The first one was discarded, but in the second case, the collaboration wrote a paper and held a vote to decide whether they would make an announcement. Only then did the blind-injection team ‘open the envelope’ and reveal that the events had been staged.

Thick and fast

Researchers hope that, once Advanced LIGO completes further upgrades a year from now, it will detect mergers between black holes and between neutron stars on a regular basis, perhaps ten times a year. And if detections become routine, the researchers will learn to recognize them virtually in real time.

Advanced LIGO could detect the loudest merger signals for a minute or more, meaning that computers in the control rooms would make loud noises and send out automatic alerts even before the event is over. The idea of this is to flag possible events to astronomers, who could then search the sky for the type of ‘fireworks’ — such as supernova explosions — that might be associated with gravitational waves.

Chad Hanna, a physicist at Pennsylvania State University in University Park who leads the search for mergers, told me earlier this year that he has already got permission from his wife to keep his mobile phone on at night, waiting to receive alerts. “When the signal of a merger arrives, we’ll know 30 seconds later,” he says.

5 reasons why you should choose raw, organic honey

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In addition to supporting local businesses, there are many health benefits that come along with choosing raw, organic honey over its more processed counterparts.

  1. It’s antimicrobial. There’s a reason why people say you should have tea with honey and lemon when you’re sick – and it’s because honey actually kills bacteria.
  2. It soothes coughs. Honey is safer than any OTC medicine you can take, and it reduces the severity and frequency of coughs and sore throats.
  3. Raw honey helps to promote healing across the body.
  4. Raw organic honey is rich in nutrients and antioxidants.
  5. It is the perfect sugar substitute; it’s naturally cultivated and is much better for you than traditional table sugar.

Honey has many other healthy benefits, but it’s important to buy raw, organic honey. Processed honey is stripped of all its value by the pasteurization process and often has added ingredients like corn syrup.

“Fine Tuning” Engineered T Cells May Extend Immunotherapy Approach to More Cancer Types

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A T cell bound to multiple beads

An engineered CAR T cell (center) binding to beads, which cause the T cell to divide. In CAR T cell therapy, the engineered T cells are expanded into the hundreds of millions and then infused back into the patient.

Engineering immune cells to have a decreased ability to bind to their targets on cancer cells doesn’t appear to impair their ability to kill cancer cells, but it may cause them to spare healthy cells that have low levels of the same molecular target.

The findings, which come from two new studies performed in cancer cell lines and mice, suggest a way to make an investigational form of immunotherapy, known as CAR T cell therapy, a potential treatment option for more cancers, say the investigators who led the studies.

Results from both studies were published September 1 in Cancer Research.

Overcoming ‘On-Target, Off-Tissue’ Toxicity

To date, CAR T cell therapy has been tested primarily in blood cancers, demonstrating remarkable results in some patients, including complete remissions that have lasted for many years in patients with advanced disease.

Producing this therapy is a highly complex process that involves engineering T cells collected from patients’ blood to produce special receptors on their surfaces — called chimeric antigen receptors, or CARs. The CARs are designed to bind to specific molecules, or antigens, that are found at higher than normal levels (overexpressed) on the surface of cancer cells. The engineered T cells are then grown in the laboratory into hundreds of millions of cells and infused back into the patient.

A substantial obstacle to extending the study of CAR T cells to patients with solid tumors has been “on-target, off-tissue toxicity,” where the engineered T cells “don’t discriminate between cancer cells and normal cells,” explained Daniel W. Lee, M.D., of NCI’s Center for Cancer Research, who is leading clinical trials of CAR T cells in children with cancer.

This phenomenon is a result of the difficulty in finding suitable target antigens on cancer cells in solid tumors that aren’t also found on normal cells, which makes them susceptible to attack by the T cells, a direct cause of side effects.

Affinity Tuning to the Rescue?

By decreasing the affinity of the engineered T cells for their target antigens, this new approach may offer a way to overcome this barrier, authors from both studies suggested.

In the first study, a research team led by Yangbing Zhao, M.D., Ph.D., of the University of Pennsylvania, tested CAR T cells engineered to target the HER2 protein (also called ErbB2), which is overexpressed in approximately one-fourth of breast cancers, as well as in several other solid tumors.

Dr. Zhao and his colleagues manufactured a series of CAR T cells that had either a strong attraction (high affinity) or a low attraction (low affinity) to HER2. Studies in cell lines and mice showed that the affinity of the CAR T cells for HER2 affected their ability to distinguish between low- and high-HER2 expressing cells.

For example, in mice bearing HER2 overexpressing tumors on one side of their body and low HER2 expressing tumors on the other side, inoculating them with the high-affinity CAR T cells shrunk tumors on both sides. But when the mice were inoculated with the low-affinity CAR T cells, only the high HER2-expressing tumors regressed, while the low-expressing tumors continued to grow.

The second study, led by Laurence Cooper, M.D., Ph.D., of Ziopharm Oncology Inc., formerly of The University of Texas MD Anderson Cancer Center, and his colleagues, reported similar findings in a different experimental model. The research team constructed CAR T cells that had either high or low affinity for EGFR, a tumor-associated antigen that is overexpressed in more than 60 percent of human glioblastoma tumors, among other cancers, but in low levels on normal cells.

In an animal model of glioblastoma that overexpresses EGFR, both the high- and low-affinity CAR T cells shrank the tumors. But, because of their toxicity, overall, the high-affinity T cells did not substantially improve how long mice lived compared with untreated mice. Survival was improved, however, in mice treated with the low-affinity CAR T cells. In mice with low EGFR expressing tumors (a stand-in for normal cells with low EGFR expression), the high-affinity CAR T cells shrank tumors and appreciably improved how long some mice lived, whereas the low-affinity CAR T cells had little effect on tumors or survival.

Much of the research to improve CAR T cell performance has been focused on enhancing the activation of T cells by modifying the portion of the engineered receptor that is inside the cell, Dr. Cooper explained in a news release.

“Our study has shown that another possibility is to tweak the extracellular portion of the CAR that docks with the tumor by adjusting its affinity for the target protein,” he said.

Still Work To Do

More research is needed to determine whether low-affinity CAR T cells are a viable option for solid tumors, Dr. Lee cautioned.

The mouse models used in these studies, for example, are very limited in their ability to predict side effects from low-affinity CAR T cells, he continued.

“And, theoretically, the price one pays for an affinity-tuned CAR is a lower response rate or the depth of response—a partial response versus complete response,” Dr. Lee said. “We just won’t know this until these CARs enter clinical trials.”

Affinity-tuned CAR T cells are just one option being studied for extending this treatment approach to patients with solid tumors, he added. “The field is actively trying to overcome this limitation.”

Is Alkaline Water Extra Healthy or a Hoax?

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Is Alkaline Water Extra Healthy or a Hoax?
Pouring bottled alkaline mineral water into a glass 

Many alternative health experts say that alkaline water — whether purchased in bottles or created from your own tap with a pricey do-it-yourself ionizing purifier — is an extra-healthy type of water to drink, with claims that it slows the aging process, increases energy, helps people with fertility issues, regulates your body’s pH level and prevents chronic diseases like cancer.

Does alkaline water hold up to all this hype?

Drinking at least eight 8-ounce glasses of water every day is important to our overall health. More than fifty percent of our bodies are made of water, and staying properly hydrated is essential to every bodily function.

If you think about it, water is practically a miracle drink. It keeps our bodies hydrated, and it’s calorie-free!

But what about alkaline water? Is it even better than regular water? Let’s take a look at the facts.

What Is the PH of Alkaline Water?

Is Alkaline Water Extra Healthy or a Hoax?
pH strips testing the acidity or alkalinity of water Photo Creditdeyangeorgiev/iStock/Getty Images

Some of you may recall from high school chemistry class that pH is the measure of the acidity or alkalinity of any substance or solution. The pH (potential hydrogen) scale runs from zero to 14, with 7 as the neutral mid-point. Liquids with a pH of 1 are very acidic, and liquids with a pH of 13 are very alkaline.

Pure water is smack dab in the middle with a pH that is close to 7.

Alkaline water, also called ionized water, has a higher pH than regular water — generally between 7 and 9.5

Take an Eye Exam on Your Laptop

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I’ve just taken an eye exam — not in a spiffy doctor’s office with fancy contraptions, but in my living room with my smartphone and laptop.

A new site called Opternative promises the high-tech, hands-off equivalent of a refraction test — one of the exams performed by an eye doctor to measure a prescription for eyeglasses or contact lenses — in the comfort of your own home.

To do the test, you need to have smartphone, a computer and at least 12 feet of space. You also have to be between the ages of 18 and 40. Unfortunately, I don’t make the cut, but for the purpose of experiencing this service first hand, I shaved an even 10 years off of my real age and did the test anyway. What’s a little white lie for science?

The actual exam is simple. You start by stepping 10 feet away from your computer — which Opternative calibrates and walks you through using a credit card and your own shoe size. Once you are set up, it’s an easy dive into the D.I.Y. exam. The test includes a series of visual tests, some with one eye covered, looking at various shapes, patterns, numbers and letters on the screen. You’re guided through the process with audio and video prompts, and respond to questions by clicking through multiple-choice questions using your smartphone as a remote control for the test.

At the end of the test, it asks you to fill out your medical and eye history, choose glasses or contacts ($40), or both ($60), and then wait for an ophthalmologist licensed in your state to review the exam and issue a prescription. Easy right? You’ll have a digital eye prescription within 24 hours.

Except, that’s not what happened to me.

Shortly after finishing the exam, I received a series of emails from someone at Opternative support, advising me to go see an eye doctor in person. The company promptly refunded my $40 and offered to help me find a trusted doctor in my area. They also helpfully recommended that I pick up a pair of +1.50 reading glasses.

Wait. Rejection. What happened?

With my permission, Aaron Dallek, the company’s co-founder, spoke with the California-based ophthalmologist who reviewed my exam to find out why he chose not to issue a prescription. There were apparently a few red flags from my medical history that kept me from fooling the system.

First, I hadn’t ever seen an eye doctor in person, other than doing regular eye checks with my family physician. Second, I had mentioned some fuzziness around lights while driving at night, and some reading issues when my eyes are tired. While those symptoms are perfectly common for a 44-year-old (my real age), they are cause for concern for someone who reports their age as 34, which is what I did.

Even though I fooled no one, in my quest to test Opternative, I still found the process to be straightforward and relatively hassle-free. Opternative is best suited for the person who finds themselves between eye exams and simply needs a new pair of glasses or wants to try a new brand of contact lenses. And the firm says it plans to expand its test to the over-40 crowd next year.

Now some bad news. You’ll need 25 uninterrupted minutes to take the test. Unfortunately, it’s also not covered by insurance, and it’s only available in 30 states so far. Most important, it’s not a comprehensive eye exam so it’s not a good option for people who have an unusual symptom or are worried about their eye health, including diseases such as glaucoma, cataracts and diabetes.

Even so, for people who are candidates for the service, the company says the results are statistically equivalent to a traditional in-person exam. The firm says data from a clinical trial showed that participants achieved at least 20/25 vision with the prescription generated by the Opternative self-test. Those results are statistically equivalent to a traditional in-person exam.

Opternative does have a disclaimer at the bottom of its homepage: “Opternative’s service does not include any type of eye health exam. Our service only provides patients with a refractive eye exam, which measures a person’s prescription for glasses or contact lenses.”

Even so, the American Optometric Association does not support online eye exams. The A.O.A. president, Dr. Steven Loomis, has said he’s concerned that eye patients may try to skip in-person appointments entirely once they get a taste of digital convenience.

“Opternative knows it’s not offering anyone an eye exam, yet they claim that they are,” Dr. Loomis said in an email. “We actively oppose inferior and outright bad patient care, and instances when technology can be abused in a way that leaves patients misled, misinformed or confused about the state of their own health.”

Adding to the criticism from the optometry community is a lawsuit alleging one of Opternative’s co-founders used proprietary information from the National Board of Examiners in Optometry for a different website business. The complaint, which isn’t related to Opternative’s online eye exams and has been settled, does seem to have created a public relations challenge for the firm.

What does all of that have to do with the convenience of getting a prescription for glasses or contacts? Nothing for me. Heeding Opternative’s advice, I made an appointment with an eye doctor, and spent two hours in his office and more than $500 to end up back where I started: With a pair of reading glasses and the knowledge that my eyesight just isn’t what it used to be.

I personally did not feel misled by my online eye exam experience, but I am not surprised that eye doctors are wary about online services. Other medical professionals have expressed similar reservations about telemedicine, but a number of new digital services are now delivering online consultations anyway. It was only a matter of time before the eyes have it too.