Tiny vehicles for chemotherapy boost tumor-busting skills and reduce side effects 

Cancer plays a deadly game of hide-and-seek in the body, and the drugs sent to treat it are often the losers—as is the cancer patient. The drugs have trouble distinguishing between tumor cells and healthy ones and may drop their payload on the normal cells, causing miserable side effects and leaving nearby cancer cells untouched. Malignancies may also get a helping hand from the body's own leading defense weapon, the immune system. It often mistakes anticancer drugs for harmful bacteria or other foreign invaders and breaks them down. The shattered pieces are conveyed to the body's trash receptacles in the liver, kidneys and spleen, again, before they reach their intended target. Even when the drugs do manage to arrive at a tumor, many of them become entangled in the dense undergrowth of the malignant mass—unable to penetrate it completely.

Recent advances in nanomedicine are now allowing drugs to better traverse this fraught landscape and hit tumors where they live. The key is a uniquely crafted drug vehicle, wrapped in a protective outer shell, that shuttles the chemotherapy drugs through the body. Fine-grained control over the components from which the vehicles are built, which can be just a few billionths of a meter across, has let scientists create a specialized architecture that, among other things, does not trip immune system alarms. Researchers such as Kazunori Kataoka of the University of Tokyo and his colleagues have tucked potent chemotherapy drugs inside sheaths the size of a hepatitis C virus—some 200 times as small as a red blood cell. On a molecular level, those drugs look a lot more like something the body makes. These compounds also have the advantage of being able to slip into tumors and steer clear of healthy cells.

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This news is reprinted from http://www.scientificamerican.com/article/new-test-lets-women-pick-their-best-ivf-embryo/

To a physician, any disease-related death is one too many. But death is a certainty of life; and despite best efforts, deaths from cancer, heart disease and/or Alzheimer’s are more readily understood, albeit painfully accepted.

Not so with death near the time of birth.

To hear that a woman has died during her pregnancy, or shortly after giving birth, is seemingly more stunning to the senses. But all physicians and the general public need to take note of a statistic that, for years, has gone unnoticed by many: There has been a persistent increase in maternal mortality from pregnancy-related causes.

A “pregnancy-related death” is defined as “death of a woman while pregnant or within 1 year of pregnancy termination—regardless of the duration or site of the pregnancy—from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes.”

Since 1990, the rate of pregnancy-related deaths for all women in the United States has essentially doubled, according to the Centers for Disease Control and Prevention Pregnancy Mortality Surveillance System. Between 1987-1990, the rate was 9.1 pregnancy-related deaths per 100,000 live births; the rate in 2011 was 17.8/100,000

CDC researcher Dr. Andreea Creanga and colleagues published this data in the American College of Obstetricians and Gynecologists’ January 2015 issue of Obstetrics & Gynecology.

The data indicate that pregnancy-related mortality increased for all American women and within all age groups. The greatest threat is in women 40 years of age and older, regardless of race

 The increase of deaths in women of advanced maternal age is not surprising. American women are increasingly delaying childbirth until their later years, and many undergo assisted-reproductive procedures such as IVF. With that, there is a greater potential for many pregnant women to already carry chronic conditions such as hypertension, heart disease and diabetes. Add in race, social determinants and other demographic factors, and it’s easy to see that the kettle is a’brewing.

Additionally, Hispanics with less than 12 years of education, and Blacks who get pregnant outside of wedlock have higher rates of mortality.

…all physicians and the general public need to take note of a statistic that, for years, has gone unnoticed by many.

Black women have the highest risk of dying from pregnancy complications. Between 2006 and 2010, per 100,000 live births, the mean pregnancy-related mortality ratio in Hispanics was 11.7; Whites, 12.0; and 38.9 for Blacks

As a Black female ob-gyn who has treated thousands of patients of all races, I assuredly say it is time to change the history of Black women (and men’s) health. Black health matters must matter to Blacks.

Black women have the least successful healthcare outcomes for most killer diseases such as diabetes, hypertension, obesity, and heart disease. Some attribute this to lack of access to care, or no insurance. Those factors may play a role. For those who lack insurance, utilizing community health services, as well as better allocation of discretionary spending is advised. But even for Black women with access and insurance, less successful healthcare outcomes persist.

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Black women also experience unique psychosocial stressors—such as colorism, negative media imagery, lack of marriage-minded men—that, due to cortisol stimulation, affect their physical condition, decreases immunity and increases the risk of serious diagnoses.

The increase in pregnancy-related deaths for all American women is important data for obstetricians. But regardless of specialty, all physicians need to advise women patients—White, Black, Hispanic, Asian or other—that there must be a commitment to seek preventative health care, and begin prenatal care early in order to have not only healthy newborns, but healthy mothers alive to care for them.

Melody T. McCloud, MD, is an obstetrician-gynecologist and founder/medical director of Atlanta Women’s Health Care. She is an author, speaker and media consultant. Twitter: @DrMelodyMcCloud. Doximity: “Melody T. McCloud, M.D.” - See more at: http://www.physiciansweekly.com/pregnancy-related-deaths-rising-in-the-u-s/#sthash.CKSpEKwa.dpuf

The aorta is a major blood vessel carrying blood from the heart to the rest of the body. As the heart pumps blood, it first enters the aorta and is then delivered via connecting vessels to the rest of the body.

What is an Aortic Dissection?

Aortic dissection refers to a serious condition where there is a tear in the wall of a major artery leading to blood flow within the layers of the aorta. A tear in the inner lining causes blood to leak into the middle layers of the aorta thereby creating two passages for blood: the true lumen (the normal passage) and a false lumen (new passage).

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Blood flow into the new lumen leads to several complications like multiple tears and reduction in the amount of oxygen and nutrients reaching organs in the body. Reduced blood flow to the organs can lead to ischemia. The brain, heart, intestines, kidneys, arms and legs may be affected by an aortic dissection. In extreme cases, the aorta can also rupture.

Aortic dissection is not very common and males in the age group 60-80 are more prone to this condition. Aortic dissection symptoms are often confused with other heart conditions leading to delayed diagnosis. It can be detected early and, if treated on time, it improves survival rates.

Types of Aortic Dissection

Aortic dissections are divided based on which part of the aorta is affected:

• Type A is the most common and risky aortic dissection. It occurs in the part of the aorta that leaves the heart. It can also be a tear in the upper aorta (ascending), which can extend to the abdomen.

• Type B is a tear in the lower aorta (descending). This type can also extend to the abdomen.

Causes of Aortic Dissection
While the exact cause of aortic dissections are not known, some of the risk factors include:

•  Atherosclerosis – hardening of the arteries
•   Aging – occurring frequently among men in the age group 60-80
•   High blood pressure – which leads to weakening of the artery walls
•   Pregnancy
•   Heart surgeries (coronary bypass) and procedures (cardiac catheterization)
•   Connective tissue disorders like Marfan’s Syndrome
•   Rare genetic disorders like Turner Syndrome
•   Other inflammatory diseases that lead to vasculitis (damage to blood vessels)
•   Blunt injuries to the chest

Symptoms of Aortic Dissection

The symptoms of aortic dissection are often deceptive and can be mistaken for other heart disorders. It is critical to identify an aortic dissection to increase chances of survival. Some of the symptoms of aortic dissection are:

• Sudden and severe chest pain: This often gets mistaken as a heart attack because of the sudden onset and severity. Pain due to an aortic dissection is usually a sharp, searing pain. It is usually experienced below the chest bone and can extend to the arms, shoulders, neck, jaw, abdomen and hips.
• Fainting and giddiness
• Anxiety and confusion spells
• Rapid and heavy sweating
• Nausea and vomiting
• Weak, rapid pulse
• Breathing difficulties

 Rarely symptoms may include swallowing trouble due to pressure in the esophagus.
Diagnosis and Tests

An aortic dissection is sometimes difficult to detect as the symptoms often get confused with heart attack or other heart conditions. Some of the diagnostic tests used to detect an aortic aneurysm are:

• Chest X-Ray
• Chest MRI
• CT scan of the chest
• Doppler test
• Echocardiogram (ECG)
• Aortic angiography
• Transesophageal echocardiogram (TEE)

Treatment and Drugs

An aortic dissection is a serious condition requiring immediate treatment interventions. Surgery and medications are used to treat an aortic dissection. Surgery is required when the dissection occurs in the part of the aorta that leaves the heart. Dissection occurring in other parts of the aorta can be treated with medications.

The two surgical techniques include:

• Standard, open surgery where an incision is made in the chest or abdomen.
• Endovascular aortic repair where no major incisions are required.

Drugs like intravenous beta-blockers which reduce high blood pressure and reduce heart rate are usually prescribed. Sometimes vasodilators are used in combination with beta- blockers. Analgesics like morphine may be required to relieve the severe pain.

If the aortic valve is damaged, a valve replacement surgery is usually recommended.
Complications

An aortic dissection may lead to other complications due to stopped or decreased blood flow to other major organs and parts of the body. Some of the complications include:

• Organ damage to the brain, heart, kidneys and intestines
• Damage to the legs
• Stroke
• Aortic valve damage
• Death due to internal bleeding
• Prognosis

Though an aortic dissection is a life-threatening condition, early diagnosis and treatment can improve chances of survival. Most patients survive if immediate surgery is performed before the aorta ruptures. Chances of surviving a ruptured aorta are low. Most patients who survive need to be on lifelong medications for controlling high blood pressure. They need to be constantly monitored and need to follow a healthy lifestyle.
Prevention

Tips to avoid and prevent aortic dissections:

• Controlling blood pressure
• Avoiding smoking of cigarettes
• Maintaining ideal body weight
• Low-sodium diet with a good mix of fresh fruits and vegetables.
• Regular physical activity and exercise
• Pre-emption by checking out genetic risk factors and seeking medical help and counseling

This News is reprinted from site http://www.medindia.net/patients/patientinfo/aortic-dissection.htm

Food additives are non-nutritive substances added deliberately to any food product in small amounts to improve its color, texture, taste, flavor, consistency and shelf life. They integrate with the food item to become a component, thereby improving its quality. 

They integrate with the food item to become a component, thereby improving its quality.

Food additives are used during production, processing, treatment, packaging, transportation or storage of food.

 

The exact history of food additives is not known, but research indicates the existence of food additives to date back to the prehistoric man who added certain chemicals to smoked meat. Later methods like salting fish and meat to improve its shelf life, adding spices and indigenous herbs to food to improve its taste and pickling fruits using salt and vinegar, came into practice.

The use of food additives was minimum in the past when food was mostly prepared at home from fresh raw ingredients. Food items were seasonal and seldom available off season. Today we find most food being made available all round the year, enabling the urban population to enjoy food in great varieties.

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Food is also made available in places where it is not produced (e.g. fish in non-coastal region), due to the usage of food additives. The present day food industry has grown and flourished due to the liberal use of food additives. These additives have also led to the extensive production and marketing of 'easy-to-prepare' convenience foods.

This new is reprinted from site http://www.medindia.net/patients/patientinfo/food-additives.htm

By Shreeya Nanda, Senior medwireNews Reporter

Statin use prior to undergoing nephrectomy is not associated with survival outcomes in patients with localised renal cell carcinoma (RCC), research suggests.

The 10-year progression-free survival (PFS) rate was 80% for the 630 patients with nonmetastatic RCC who were taking at least one statin in the 3 months before undergoing radical or partial nephrectomy. This was comparable to the 79% PFS rate in the 1727 patients not taking statins at nephrectomy.

Ten-year cancer-specific and overall survival rates were also similar for statin users and nonusers, at 85% versus 84% and 59% versus 64%, respectively.

Multivariate analysis adjusting for factors such as age, gender, smoking status and body mass index also showed no significant association between statin use and either risk of disease progression, or RCC-related or all-cause mortality.

Nor was there an association between statin exposure and the risk of locally advanced pathological tumour stage or high tumour grade.

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Researcher Stephen Boorjian (Mayo Clinic, Rochester, Minnesota, USA) and co-workers note that their data are contrary to a previous study that noted a favourable effect of statin use on cancer progression and overall survival, a discrepancy that they attribute to the “extended follow-up” and 

adjustment for additional adverse pathological features in their study.

But the researchers point out that their findings “should not undermine the intended effect of statin therapy”, as statin use significantly reduced the risk of mortality resulting from non-RCC-related causes, with a hazard ratio of 0.70.

They conclude in Urologic Oncology: Seminars and Original Investigations: “As such, in light of ongoing controversy, future prospective analyses are warranted to elucidate the anticancer role of statin use among patients with surgically treated RCC.”

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

This news is republished from site http://www.news-medical.net/news/20150325/Limited-anticancer-role-for-preoperative-statins-in-localised-RCC-setting.aspx

Legal drugs such as OxyContin now kill more people than heroin and cocaine combined. While awareness of the dangers of illegal drugs has increased, many teens are still ignorant of the significant physical danger posed by legally prescribed drugs, according to a new study in Journal of Public Policy & Marketing.

"The CDC has classified the situation as an epidemic," write authors Richard Netemeyer (University of Virginia), Scot Burton (University of Arkansas), Barbara Delaney (Partnership for Drug Free Kids), and Gina Hijjawi (American Institutes for Research). "Prescription drugs are seen as blessed by a trusted institution, the FDA, while increasingly aggressive advertising by drug companies simultaneously floods parents and children with messages that these substances are safe, popular, and beneficial."

The current study recruited teens in shopping malls across the United States, asking them to complete a web-based questionnaire on their use of substances including alcohol, tobacco, and both legal and illegal drugs. They were also asked whether they struggled with anxiety, felt a desire to be popular, sought out exciting activities, and what level of risk they associated with prescription drugs.

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On the whole, prescription drug use increased in direct proportion to psychological states such as anxiety, and use of other restricted substances such as alcohol. Under some conditions, however, prescription drug abuse accelerated exponentially, such as when the level of anxiety or desire to be popular was at its very highest.

"Teens need help before they reach these tipping points for prescription drug abuse. Adults spotting teens with very high levels of anxiety and at least moderate use of other restricted substances should realize that these are students with a high likelihood of prescription drug abuse. Male teens with a high need to be popular and teens in general appear to be at exceptional risk. Campaigns must target parents as well, since they clearly underestimate both the physical risks of prescription drugs and the likelihood that their children will abuse these drugs," conclude the authors.

This news is republished from site http://www.news-medical.net/news/20150325/Many-teens-still-ignorant-of-significant-physical-danger-posed-by-legal-drugs.aspx

By Tara Haelle

HealthDay Reporter

MONDAY, March 23, 2015 (HealthDay News) -- For children with attention-deficit/hyperactivity disorder (ADHD), receiving more family-centered, compassionate care may be more effective than standard care, a new study found.

Researchers compared two types of "collaborative care," in which special care managers act as intermediaries between a family and their child's doctors.

One approach was standard collaborative care while the other was "enhanced," which meant the care managers had received several days of training to teach parents healthy parenting skills and interact with families in an open-minded, non-judgmental, empathetic way.

"I think it's a very powerful tool in medicine and it's being used more and more, but it's still not widespread in terms of how doctors interact with patients and their families," said study author Dr. Michael Silverstein, an associate professor of pediatrics at Boston University School of Medicine.

Silverstein added that the care managers who were trained did not have advanced degrees or formal mental health education and licensing. "This could be potentially significant for how to provide care in settings or among populations who might not be able to afford or have access to Ph.D.-level psychologists," he said.

One expert further explained the importance of collaborative care.

"Collaborative care attempts to improve adherence by checking in with families regularly to see how they are doing, helping to ensure they understand and agree with the treatment recommendations, and identifying and alleviating any obstacles to effective treatment that may arise as promptly as possible," explained Dr. Glen Elliott, chief psychiatrist and medical director of Children's Health Council in Palo Alto, Calif.

The findings were published online March 23 and will appear in the April print issue of the journal Pediatrics.

The researchers followed 156 children in an urban setting for one year after they were referred for testing for ADHD. The children were randomly assigned to receive standard collaborative care or enhanced collaborative care.

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Care managers delivering enhanced care received training in the Positive Parenting Program (Triple P) and a technique called motivational interviewing. Motivational interviewing uses empathy to build a relationship between a care manager and a family, which helps the family identify what it wants and develops the motivation to reach those goals, said Mayra Mendez, a program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John's 

Child and Family Development Center in Santa Monica, Calif.

"Based on a non-confrontational approach, motivated interviewing is conducted in an atmosphere of acceptance, compassion and equality," Mendez noted.

The children in this study, ranging from age 6 to 12, had not been diagnosed with ADHD at the start of the study but were recommended for testing by their primary care doctors. Ultimately, 40 percent of them were found to have ADHD symptoms that would qualify for a diagnosis.

After one year, the children as a whole showed improvements in hyperactivity, impulsivity, inattention and social skills, which is not surprising, Elliott said.

"Even without intervention, children with ADHD generally get less symptomatic over time," Elliott explained. "Absent a 'control' group [children who did not receive any care], it is hard to know how big an impact either of these interventions had on that general trend."

However, the researchers reported that significantly greater improvements in all these areas occurred among the children who had symptoms that would qualify for an ADHD diagnosis and received enhanced collaborative care -- but not among those who received collaborative care but did not end up having symptoms that would qualify for an ADHD diagnosis.

"ADHD has treatments known to work, but only if they are applied consistently," Elliott said.

Study author Silverstein explained that three factors can interfere with a child's ability to receive successful treatment. These include: difficulty adhering to the therapy (for economic, family or other reasons); a mother's mental health problems; and other conditions the child has, such as oppositional defiance disorder, depression, anxiety, learning disabilities or even post-traumatic stress disorder.

The enhanced collaborative care approach tried to help with those factors, Silverstein said.

One goal is to reduce "coercive parenting," a style that uses "authoritarian, threatening, punishing, shouting and non-reflective methods of disciplining children," Mendez said.

"It's negative feedback for things done wrong, rather than positive feedback when kids succeed," Mendez added. "Lots of evidence shows that it is effective in the short run but counterproductive in the long run."

Silverstein suspects that the children with ADHD symptoms who received enhanced collaborative care experienced more improvement because the family could better stick to the therapies that treated the child's condition.

"Motivational interviewing is an inherently patient or family-centric way of communicating," Silverstein said. "If done right, it allows patients or their parents to reflect on their own health behaviors from an empowered, non-judged position and builds trust between the family and the care team," he added.

"In this case, this type of communication style may have started a cascade of events that opened the door to increased receptivity to ADHD medication or to engagement with parenting advice offered through Triple P," Silverstein suggested.

"I would hope that if the benefits that we demonstrated bear out in future research, that insurance companies will see fit to pay for this because we know that kids that have ADHD symptoms that are not under control tend to have more injuries, have more interaction with the health care system and tend to get into trouble in school," Silverstein said.

Further, most components for enhanced collaborative care already exist in many communities, he said: "I see the challenge ahead being bundling these components into a coordinated care system." 

This News is Reprinted from site http://www.medicinenet.com/script/main/art.asp?articlekey=187573