Genes point to varied diabetes subtypes
Tue, 18 Mar 2008 03:05:25 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - You've heard of Type 1 and Type 2 diabetes, but what about a kind called MODY? Diabetes is undergoing a genetics revolution that suggests there actually are many subtypes of the disease.
The discoveries already trigger important changes in treatment for a fraction of patients with some rare diabetes types caused by single genes gone awry — if they have a doctor aware of the findings.
"We've got a whole group of diabetologists who have never heard of this," laments Dr. Andrew Hattersley, a British physician-scientist who pioneered how to treat single-gene subtypes collectively known as MODY.
Yet the vast majority of diabetes is caused by complex interactions among numerous genes and modern lifestyles — and a flurry of genetic discoveries in the past year finally points to new ways of attacking the epidemic.
So this week, U.S. health officials are bringing 20 drug companies together with international gene specialists to jump-start the hunt for new therapies.
"We're trying to inspire some really creative thinking," says Dr. Francis Collins, gene chief at the National Institutes of Health, who organized the first-of-a-kind meeting.
Why does diabetes strike one person who's overweight but not another who's equally heavy? Why does one diabetic need dialysis while another has healthy kidneys despite decades of bad blood sugar? The newest gene work suggests there likely are even more subtypes that explain those differences, and that in turn may require personalized treatment just as MODY does.
Some 21 million Americans have diabetes, meaning their bodies cannot properly turn blood sugar into energy. Either they don't produce enough insulin or don't use it correctly.
With the Type 1 form, the body's immune system attacks insulin-producing pancreatic cells, so that patients require insulin injections to survive. It usually, but not always, strikes in childhood.
With the most common Type 2 form, the body gradually loses its ability to use insulin, so the confused pancreas churns out extra until eventually its cells wear out. Most at risk are the overweight.
Genetics research is showing diabetes is far more complicated than those simple demarcations:
_First there's MODY, shorthand for six different subtypes thought to account for 2 percent of all diabetes. Each is caused by a single, different gene. Suspicions arise when patients are extra hard to treat, especially skinny people diagnosed with Type 2 diabetes or young adults with diabetic relatives who abruptly seem to develop Type 1.
Consider Dan Humphries of Shawbury, England, who at age 16 was diagnosed with Type 1. His mother, a nurse with diet-controlled diabetes, questioned the diagnosis. But doctors insisted he was too skinny for other diabetes. They prescribed insulin that had Humphries passing out from low blood sugar even with small doses.
His mother sought out Britain's Peninsula Medical Center in Exeter, where Hattersley performed a gene test that showed Humphries' pancreas actually can make its own insulin. But a gene called HNF1-alpha was essentially putting that production to sleep.
Over a decade of research, Hattersley had found that old diabetes drugs called sulfonylureas neutralize that gene so insulim production resumes. Sure enough, Humphries, now 19, is fine with a quarter-tablet morning and night.
_That brings us to the 16 genes discovered so far to play a role in Type 2 diabetes, and at least 14 in Type 1.
Surprisingly, the Type 2 genes don't affect how the body uses insulin, thought to be the trigger. Instead, they alter how the pancreas makes insulin in the first place, explains Dr. David Altshuler of Harvard and the Massachusetts Institute of Technology.
So how healthy your pancreas starts out could determine how vulnerable you are to other diabetes triggers, like getting fat.
Collins points to one potential drug target: A gene with the sole job of getting zinc to insulin-creating cells. Zinc's a key part of the recipe; too little or too much, and insulin isn't secreted.
But randomly choosing a gene to target is "a shot in the dark," cautions Eric Schadt of Merck & Co., who will urge another approach at this week's meeting, hosted by the National Disease Research Interchange.
Monday in the journal Nature, Schadt reports finding how multiple genes work together in computer-like networks that suggest which will be master control switches — and thus good drug targets. Already, Merck has begun checking whether one network of obesity genes really might predict which overweight people get diabetes.
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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Gene info: http://www.diabetes.niddk.nih.gov/dm/pubs/mody/ and http://www.diabetesgenes.org
Growth hormones dont boost performance
Mon, 17 Mar 2008 22:32:45 GMTBy STEPHANIE NANO, Associated Press Writer
NEW YORK - Athletes who take human growth hormone may not be getting the boost they expected. While growth hormone adds some muscle, it doesn't appear to improve strength or exercise capacity, according to a review of studies that tested the hormone in mostly athletic young men.
"It doesn't look like it helps and there's a hint of evidence it may worsen athletic performance," said Dr. Hau Liu, of Santa Clara Valley Medical Center in San Jose, Calif., who was lead author of the review.
Growth hormone, or HGH, is among the performance enhancers baseball stars Roger Clemens and Andy Pettitte were accused of taking in the blockbuster Mitchell Report. Clemens denies using the hormone, while Pettitte admits using it.
But the new research has some limitations and sheds no light on long-term use of HGH. The scientists note their analysis included few studies that measured performance. The tests also probably don't reflect the dose and frequency practiced by athletes illegally using the hormone. Experiments like that aren't likely to be conducted.
"It's dangerous, unethical and it's never going to be done," said Dr. Gary I. Wadler, a member of the World Anti-Doping Agency and a spokesman for the American College of Sports Medicine.
Consequently, those in the field have to depend on such reviews or "what we hear on the ground," he added.
Human growth hormone is made by the pituitary gland and promotes growth. A synthetic version has been available since the 1980s and its use is restricted for certain conditions in children and adults, including short stature, growth hormone deficiency and wasting from AIDS.
Although banned for other uses, growth hormone has been used by a variety of athletes and was cited along with steroids as one of the performance-enhancing drugs abused by baseball players in the report in December by former Senate majority leader George Mitchell. Several athletes, including Pettitte, have said they used HGH while recovering from an injury, an issue not covered in the review.
"There are a lot of claims that it's this wonder drug," said Liu.
Wadler said one of the appeals of growth hormone for athletes is that it can't be detected in a urine test. A blood test will be available soon, and another is in development, he said.
"They think they are getting a free ride — they aren't getting a drug test," he said. "They believe they are stronger and bigger."
Liu and his colleagues at Stanford University sought to find out if growth hormone really could improve performance. They looked for the best published tests, those comparing participants who got the hormone to those who didn't get the treatment.
They analyzed 27 studies involving 440 participants. The results were released Monday by the Annals of Internal Medicine.
Researchers found that those who got the hormone put on about 5 pounds more of muscle, and lost about 2 pounds more of fat, although the fat loss wasn't statistically different. The researchers said some of the extra body mass could just be fluid buildup.
There was no difference found in strength or exercise stamina between the two groups, but there were only two strength studies and eight that measured exercise. Those who got the hormone had more side effects including swelling and fatigue.
The review couldn't consider long-term effects, since the longest study was three months, and most were much shorter.
The researchers also said the doses used in the research may be lower than those used by athletes, who may be combining growth hormone with other performance-enhancing drugs.
Dr. Alan Rogol of the University of Virginia and the Indiana University School of Medicine, said the work was a good review but had to rely on inadequate research.
"There are just tons of things we don't know," said Rogol.
The California researchers had support from Stanford, government agencies and Genentech Inc., which makes growth hormone; none of the groups had a role in the study. Two researchers also have been consultants or received grants from Genentech and other drugmakers.
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On the Net:
Annals of Internal Medicine: http://www.annals.org/
WHO Progress in fighting TB slows
Mon, 17 Mar 2008 22:32:21 GMTBy MARIA CHENG, AP Medical Writer
LONDON - The fight against the global tuberculosis epidemic has slowed to a crawl, the World Health Organization said in a report Monday. The worldwide rate of TB infection has been declining for several years. But between 2005 and 2006, the rate of new cases fell by less than 1 percent, far less than the annual decrease of 5 to 7 percent sought by health officials.
At the same time, drug-resistant TB is growing faster than ever, the WHO said last month.
Independent health experts criticized the WHO's TB policy as too passive, and urged a more proactive strategy.
WHO conceded the most recent decline in the overall infection rate "is very modest, and is not as fast as we would like it to be," said Dr. Marcos Espinal, executive secretary of the organization's Stop TB Partnership.
"Without new tools, we will not be able to break the back of this epidemic," he said, citing a lack of vaccines, outdated drugs, obsolete diagnostic tests and overwhelmed health systems as contributing to the slowdown against TB.
In 2006, there were an estimated 9.2 million new tuberculosis cases and 1.5 million deaths, the WHO said in its report, which was based on government data from 202 countries and regions.
India and China have the most cases, followed by Indonesia, South Africa and Nigeria, the report said.
By region, Asia has 55 percent of all TB cases, and Africa has 31 percent.
WHO acknowledged its treatment programs "have not yet had a major impact on TB transmission and incidence," according to the report, which assessed the WHO's efforts for the past 12 years.
WHO primarily works by recommending how governments and donors can best fight TB, and it is up to individual countries to decide how to spend funds. Last year, countries and donors spent about $2.3 billion on TB control. This year, WHO estimates that $3.1 billion will be needed to identify and treat TB patients.
The report said TB infection rates were stable in Europe, and declined about 3 percent in the United States.
In Africa, however, they were still increasing as the AIDS epidemic fuels transmission. TB in Africa has increased at least fivefold since the 1990s.
The report said 30 million people — or 84.7 percent of identified TB patients — have been cured through treatment.
Espinal acknowledged that WHO may not have enough evidence to show that its treatment strategy reduces transmission. The strategy works to cure people, he said, not necessarily to reduce the disease's spread.
Other experts countered that if treatment rates were as high as WHO claimed, there would be less drug-resistant tuberculosis.
Last month, WHO said drug-resistant TB was spreading faster than ever. Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5 percent of the 9 million new TB cases, WHO said.
Independent experts also criticized the WHO's reporting, saying it did not take into account those who are infected but not diagnosed, and was gathered from governments without being verified independently.
"This is a compilation of what the countries want to show," said Dr. Francis Varaine, coordinator of Medecins Sans Frontieres' tuberculosis working group. "Some of these data are too good to be true."
In developing countries, WHO's main tuberculosis treatment program depends on patients volunteering to be tested, instead of doctors seeking out patients.
WHO's Espinal estimated that only about 60 percent of infected patients are diagnosed.
"By the time a TB patient turns up, they have been coughing for weeks and have probably infected most of their family, friends, work mates and anyone else they were in contact with," said Ruth McNerney, a TB expert at London's School of Hygiene and Tropical Medicine. She said WHO's strategy was "like shutting the door after the horse has bolted."
Baby suffers from rare aging disease
Mon, 17 Mar 2008 23:00:29 GMTFRANKFORT, Ky. - If he's lucky, Zach Pickard will live past the age of 13. Zach, now 13 months old, suffers from Hutchinson-Gilford Progeria Syndrome, a disease that accelerates the aging process when the child is 18-24 months old.
Children with this syndrome die of heart disease at an average age of 13 after aging at a rate six to eight times faster than an average person. Approximately 100 cases have been formally identified in medical history and the odds of being diagnosed with it are roughly one in 8 million.
But, for now, Zach is like any other baby, learning to walk, say words like "mama" and "papa" and making his family laugh with funny faces. With his messy blonde hair, big blue eyes and infectious smile, Zach attracts attention wherever he goes.
"He yaks with strangers when we're in restaurants and he draws people to him," said his mother, Tina Pickard of Lexington. "If you meet him you love him."
Zach was 2 months old when his parents first realized something wasn't right with their boy. They took him to the doctor for unexplained skin bumps.
For nine months, Brandon and Tina Pickard went from doctor to doctor looking for an answer. Then, they ran across Dr. Ann Lucky, a pediatric dermatologist in Cincinnati.
Lucky was the first physician to suggest Zach be tested for Progeria. Like most physicians, Lucky had never diagnosed the disease before, but she Zach exhibited enough of the symptoms to warrant a test.
"At first we didn't believe this was possible because of the rarity of the syndrome," Tina Pickard said. "But I knew by the end of the day, after looking at information on the Internet, that this is what he had."
Exactly six weeks later, Zach was diagnosed with Progeria. It took some time, but the family came to accept Zach's diagnosis.
"We realized God had chosen to bless us with this baby. And we are honored. Truly honored," Tina Pickard said.
Right now, Zach is young enough that he isn't showing many physical symptoms. As he grows, however, the recognizable traits of Progeria will begin to show up: limited growth resulting in a short stature, hair loss, a small face, thin skin and a loss of body fat.
Now, the Pickards are trying to raise money and awareness of the rare disease that afflicts Zach.
Because heart disease is the number one killer in America, finding a cure will not only help children like Zach, but it may provide keys for treating millions of adults with heart disease and stroke associated with the natural aging process.
Researchers recently discovered the cause of Progeria in 2002. They believe it is caused by a mutation in the gene called LMNA, which makes the Lamin A protein. The defective Lamin A protein renders the nucleus of a cell unstable and that cellular instability appears to lead to the process of premature aging.
Zach's aunt, Kristin Pickard, organized a recent fundraiser in Frankfort, with the money going to the Progeria Research Foundation. Tina Pickard hopes that through this fundraiser, more people can know and understand the disease.
"Honestly, at the end of the day we have to be able to look at ourselves in the mirror and say that we've made a difference," Tina Pickard said. "We want to educate people and create awareness within the community that this foundation needs money."
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Information from: The State Journal
Genes May Determine Obesity After Weight Surgery
Tue, 18 Mar 2008 03:46:01 GMTMONDAY, March 17 -- Two obesity-related genetic variations may be associated with higher body mass index among severely obese patients who have bariatric surgery to help them lose weight, say American researchers.
Bariatric surgery is a highly effective treatment for severely obese patients, according to background information in the study. However, some patients don't lose weight after bariatric surgery.
"Identification of variables that determine the success of bariatric surgery have shown little consistency, and long-term success may depend on not yet identified factors," noted the researchers at the Geisinger Clinic in Danville, Pa.
They studied 707 severely obese patients who had gastric bypass surgery. Blood samples from the patients were analyzed for two common single nucleotide polymorphisms previously found to be associated with obesity. SNPs are variations caused by alteration of single building block of DNA.
The researchers found that about 21 percent of the patients had two copies of one obesity-related SNP, 13 percent had two copies of the other SNP, and 3.4 percent had two copies of both SNPs.
There was no significant BMI difference between patients with two identical copies of either one of the SNPs and those without two identical copies. However, patients with either two copies of both SNPs, or two copies of one and one copy of the other SNP, had much higher BMIs than other patients. Less than 20 percent of the patients in the study had these genetic features.
The findings were published in the March issue of the journal Archives of Surgery.
It's not known how these SNPs may influence obesity, but the researchers said their findings indicate "that the two genes may interact, suggesting that the physiological pathways in which each is involved may be linked in some way."
Learning more about obesity-related genetic factors that may negate the effects of bariatric surgery may prove "important in identifying patients at high risk for postoperative weight gain," the study authors concluded. "These studies may also represent some of the first specific examples of 'surgicogenomics,' paralleling the well-developed field of pharmacogenomics," (using genetic information to predict patients' responses to medications).
More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about surgery for severe obesity.
Doctor training urged to fight syphilis spread
Mon, 17 Mar 2008 22:36:56 GMTBy Julie Steenhuysen
CHICAGO - Syphilis is making a comeback in developed countries, spurred by illicit drug use and high-risk sexual behaviors, and many doctors are unprepared to recognize and treat it, U.S. researchers said on Monday.
They said syphilis has been on the rise since the beginning of the 21st century in high-income countries, but because the disease had been well controlled in the 1990s, doctors may not be screening for it.
"The key message here is that syphilis is again on the rise in several developing countries. In many of these countries we are seeing very high rates in men who have sex with men," said Dr. Kevin Fenton of the U.S. Centers for Disease Control and Prevention, whose study appears in the journal Lancet.
Fenton said the resurgence demands new training efforts among health-care professionals. "In many countries, physicians may have lost some of the skill sets associated with diagnosing syphilis," Fenton said in a telephone interview.
The CDC last week said the U.S. syphilis rate rose once again in 2007, marking the seventh consecutive year of increases. Homosexual and bisexual men accounted for 64 percent of syphilis cases in 2007, up from about 5 percent in 1999.
Syphilis infects some 12 million people worldwide every year. Most cases are acquired through sexual contact with a syphilis sore. Pregnant women can pass it on to their babies.
The recent resurgence is among a sub-group of men who have sex with men and engage in high-risk sex with multiple partners.
If not addressed, Fenton said the disease could become far more widespread.
"We have seen with other epidemics of sexually transmitted diseases that even if the initial rise occurs in men who have sex with men, it is unlikely to stay in that group for any long periods of time," Fenton said.
"The data suggest we are now seeing increases among heterosexuals in the U.S. and in Europe as well," he said.
Fenton and colleagues argue that the resurgence calls for swift public health intervention, including screening programs to prevent the spread of the infection, mass media campaigns, efforts to change behavior in high-risk groups and distribution of condoms.
"Efforts must be made to incorporate and evaluate new diagnostics tools, social network approaches, innovative evidence-based prevention interventions, robust disease surveillance and systematic monitoring and evaluation of prevention, treatment and care activities," they wrote.
Like many other sexually transmitted diseases, syphilis raises the likelihood of infection by or transmission of the human immunodeficiency virus, which causes AIDS.
Syphilis is caused by the bacterium Treponema palladium. It starts out as a sore, but progresses to a rash, fever, and eventually can cause blindness, paralysis and dementia.
India tries new ways to reach its underfed children
Tue, 18 Mar 2008 00:10:18 GMTBy Jonathan Allen
BADARWAS, India - A couple of months ago, Sheela Adivasi's infant son fell sick and his eyes filled with pus. By the time the infection cleared up, Deepak's pupils had turned a pearly white. He is now permanently blind.
It did not help matters that Deepak is malnourished, as are half of all young children in India. His belly is swollen, his dry skin speckled with dark dots, and his hair is thin and yellowing. Had he not been so starved of vitamins, he probably would have suffered only an itchy but harmless bout of pink eye.
Belatedly, he is getting some nutrients in a special clinic for malnourished children in Badarwas, a tiny town about an hour's drive from his mud-walled home in a village in the central state of Madhya Pradesh.
The clinic, a concrete room filled with a dozen beds and prone to powercuts, is part of India's latest attempt to reduce a malnutrition rate twice that of sub-Saharan Africa. For now, Deepak is far from the only child being reached too late.
It is a problem with "dire consequences for morbidity, mortality, productivity and economic growth," a World Bank report said in 2005, and shows little signs of fading even as India's economy booms.
Born underweight and then underfed during the crucial early stages of development, millions of Indian children grow up shorter, weaker and less smart than their better fed peers.
They end up less productive workers, too, costing India about 3 percent of national income, the bank said. The problem looks unlikely to disappear for at least the next couple of decades.
GOOD ADVICE
The nutrition centers, and measures such as paying pregnant women to give birth in a clinic rather than at home, are part of the government's National Rural Health Mission .
It was started in 2005 to bring health services to people used to a choice between pawning jewelry for doctor's fees or simply suffering.
The scheme is intended to plug gaps in an older program that failed to reach children in the most critical first two years of life, educate mothers about nutrition and reign in corruption which meant free food handouts went missing.
In Deepak's case, the difference some well-timed good advice could have made is obvious. In the 18 months since his birth, no food passed his lips until he arrived at the nutrition centre, according to his mother. She did not realize this was a problem.
"He only drinks milk," Sheela said as she sat sweating under a motionless ceiling fan as Deepak lay in her lap in torn shorts and a grubby jacket.
The registration book at the centre is filled with the purple thumbprints of illiterate, unschooled mothers like Sheela. She does not know her age -- a doctor, trying to be helpful, pulled open her mouth, looked at her teeth, and guessed about 25.
After marrying in her late teens Sheela left behind her village and moved in with her husband's family. She dislikes her mother-in-law, who she says has no interest in giving grandmotherly advice.
Workers at the centre will try to teach Sheela how best to care for her son, paying her 35 rupees a day and providing meals to compensate for her lost laborer's income.
Several times a day, Deepak sips a sweet mixture of ground puffed rice and sugar dissolved in milk with a little vegetable oil. Older children move on to fruit, eggs and lentils.
For Kasumal Adivasi, sitting a few beds away, the centre was a revelation. Like Sheela, she felt there was no one in her husband's village she could turn to for advice.
After 12 days at the centre, Tunda, her 2-year-old son, still has a distended stomach and a slightly grumpy disposition, but at least he is able to stand up again with his mother's help.
"I promise, promise, promise to remember what you told me," she told a nurse, before reciting some of the dietary tips she has learnt at the centre. She smiled with gratitude and relief, her hand resting on her pregnant belly.
STILL GAPS
The Madhya Pradesh government adopted the nutrition centers after liking what it saw at a pilot centre set up in the state by UNICEF. There are now more than 60 in Madhya Pradesh, and they are spreading to other states as part of the NRHM.
But UNICEF staff warn that the limited beds at the nutrition clinics are far from an end in themselves. They are a last resort, taking in only the most dangerously undernourished children. Two weeks later, they are discharged, most still malnourished, but no longer quite so at risk of dying.
"There are still big gaps in the guidelines," said Hamid El-Bashir, the UNICEF representative for Madhya Pradesh.
Under the rural health mission, health workers are being asked to help check malnutrition before it reaches such a bleak stage, but in places like Madhya Pradesh where healthy children are in a minority, locals can become inured to the signs.
"His hair just hasn't been washed," said one young village worker when her attention was brought to a young child with yellowing frizz on his scalp and scaly skin.
Some, like Biraj Patnaik, an advisor to the Supreme Court on nutrition, think good advice only goes so far, and India's top priority is fixing its graft-tainted food distribution system.
"Across the country women are rationing their own food, feeding their babies at their own personal cost," he said. "There's absolute hunger out there."
UNICEF's El-Bashir thinks fortified biscuits or similar so-called ready-to-use therapeutic foods used in some famine-hit African countries could be part of the solution.
Convincing India's government could be tricky though as it likes to promote traditional Indian food staples grown and cooked locally, saying it is cheap, creates jobs and is less prone to graft.
"RUTF has been a real revolution," El-Bashir said. "India cannot just say no."
1 in 5 U.S. Seniors Struggles With Memory Lapses
Tue, 18 Mar 2008 03:46:02 GMTBy Steven Reinberg
HealthDay Reporter
MONDAY, March 17 -- More than one-fifth of Americans over age 70 have some memory impairment that isn't classified as dementia, a new study finds.
While an estimated 3.5 million Americans suffer from dementia, another 5.4 million over age 70 have some memory loss that affects their lifestyle but isn't severe enough to limit their ability to function normally, the study authors said.
"An estimated 22 percent of individuals over age 70 have some type of cognitive impairment that does not reach the threshold of dementia," said lead researcher Brenda Plassman, an associate research professor of psychiatry at Duke University School of Medicine.
Previous studies hadn't been able to estimate this 22 percent number, Plassman said, adding, "The number is actually about 60 percent higher than the number who had dementia among the people in our study."
The findings are published in the March 18 issue of the Annals of Internal Medicine.
For the study, Plassman's team collected data on 856 people 71 years of age and older who were part of the Health and Retirement Study. The participants completed a neuropsychological exam, and close family members were asked about their relatives' memory and ability to do daily activities. The participants were followed from July 2001 through March 2005.
The researchers found that 22 percent of the participants had some form of memory loss that didn't reach the threshold for dementia. Among these people, about 24 percent had chronic health problems such as diabetes or heart disease that may have been the cause of their cognitive impairment.
"The people with cognitive impairment without dementia were at higher risk of progressing to dementia within a year or so," Plassman said. "We estimated that people with cognitive impairment without dementia progressed to dementia at about the rate of 12 percent a year."
"However, during the same time period, about 20 percent reverted back to normal cognition," Plassman said. "That's important, because these numbers are rather startling, and we don't want to give the impression that there's not hope out there," she added.
Plassman said she thinks that some of the people who reverted back to normal just didn't do well on the initial tests. "But I don't think we really know the answer," she said. "We need more research to determine who will progress to dementia and who will not."
People with cognitive impairment without dementia may encounter problems with daily living, Plassman said. For example, they may not be able to communicate their health problems to their doctors or be able to follow doctor's directions.
And "they may be at risk for being taken advantage of," Plassman said.
Colin Milner, chief executive officer of the International Council on Active Aging, thinks the fast pace of modern life may contribute to memory problems among seniors.
"If you take your time, you will find that there are a lot of things you can do without losing your edge," he said. "We get so busy that some of the symptoms that are associated with memory loss are also associated with a fast-paced lifestyle," he said.
Milner thinks the key to aging well is finding balance in your life. "We don't take the time to really enjoy experiences, books or the newspaper," he said. "Slow down and take in what's around you. When you do that, you'd be surprised at how much clearer everything is."
Milner also believes that keeping your mind active can help stave off cognitive decline. For example, he recommends playing "brain games," such as crossword puzzles
"If you can find a cognitive challenge on a regular basis that is fun and you enjoy doing, you can keep your mind sharp," Milner said. "Your brain is like your body -- use it or lose it."
More information
For more about memory, visit the U.S. National Library of Medicine.
Frying Tumors Can Boost Lung Cancer Survival
Tue, 18 Mar 2008 03:46:09 GMTBy Amanda Gardner
HealthDay Reporter
MONDAY, March 17 -- Needle-delivered frying or freezing technologies can be useful weapons against both lung and kidney cancers, new research shows.
In one study conducted in France, patients with advanced lung cancer who were not candidates for surgery underwent a procedure known as radiofr equency ablation , which basically heats the tumors and kills them.
Seventy percent of the patients with lung metastases or primary non-small cell lung cancer were still alive after two years -- similar to results seen after surgery.
Furthermore, 85 percent of patients with non-small cell primary lung cancer treated with RFA had no viable tumors visible on imaging one year later, while 77 percent had no viable tumors after two years.
"It means that you can actually do a very good job of local control of lung tumors in patients who aren't fit for surgery," said Dr. Damian Dupuy, a professor of diagnostic imaging at Warren Alpert Medical School at Brown University and director of tumor ablation at Rhode Island Hospital in Providence.
"The medical establishment, being very conservative, has always said if you aren't fit for surgery you just basically get chemo and radiation and most of the time [they] don't work well and you die of your tumor. But even the most unfit for surgery can have this procedure safely," Dupuy said.
The Brown researcher was not involved in the French study, but his group completed a lung cancer trial last year with similarly good results.
The new study, led by Dr. Thierry de Baere of Institute Gustave Roussy, in Villejuif, France, was to be presented Monday at the annual meeting of the Society for Interventional Radiology in Washington, D.C.
Lung cancer is the number one cancer killer in the United States and a full 25 percent of patients who have operable disease can't undergo surgery because of co-existing conditions, Dupuy noted.
"This is a huge advance for them," he said. "This procedure is done at almost every hospital that has an interventional radiologist, which is most. It's like a lung biopsy."
"If you have to stick a needle in to diagnose lung cancer anyway, why not do it in a single sitting?" Dupuy asked.
Most patients go home the same day, he noted. According to Dupuy, the p rocedure may also hold promise for pain relief in patients who are dying.
Two other studies presented at the meeting used the other end of the temperature spectrum -- cryoablation -- to successfully freeze and kill kidney cancer tumors.
"This is a minimally invasive, non-surgical cancer treatment without an incision, explained Dr. Christos S. Georgiades, lead author of one of the studies and an assistant professor of radiology and surgery at Johns Hopkins Hospital in Baltimore. "You put a probe, which is basically a needle, into the tumor, freeze the central volume of the tissue with temperatures close to negative 150 degrees centigrade. The patients don't feel the cold."
In Georgiades' study, the procedure was 95 percent effective for tumors 4 centimeters or smaller and almost 90 percent effective in tumors up to 7 centimeters in diameter after one year. This was in patients with disease that had not yet spread beyond the kidney, he noted.
"The technique has been around for a few years, but we're only now proving that it works," Georgiades said. "Patients have recovery close to that of surgery and many do not have to have surgery. Many procedures are done on an outpatient basis."
The third study, from the Barbara Ann Karmanos Cancer Institute in Detroit, looked at tumors treated with cryoablation whose average size was 2.8 centimeters. After 1.3 years, most of the tumors still came up on imaging as dead tissue, the team found.
More information
For more on these and other procedures, visit the Society of Interventional Radiologists.
