Interleukin-1{beta} stimulates the secretion of thymic stromal lymphopoietin (TSLP) from endometrioma stromal cells: possible involvement of TSLP in endometriosis

STUDY QUESTION

Is thymic stromal lymphopoietin (TSLP) involved in the pathophysiology of endometriosis?

SUMMARY ANSWER

TSLP is up-regulated by interleukin (IL)-1β and may be involved in the development of endometriosis.

WHAT IS KNOWN ALREADY

Endometriosis is a chronic inflammatory disease in which the Th2 immune response is activated and has been suggested to promote the disease. TSLP is a master cytokine that drive Th2 immune response.

STUDY DESIGN, SIZE, DURATION

A laboratory study.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Primary cultures of endometrioma stromal cells (ESCs) were treated with IL-1β, a typical inflammatory cytokine associated with endometriosis. Gene expression of TSLP in ESCs and secretion of TSLP protein from ESCs were studied using quantitative PCR and a specific ELISA. Interferon (IFN), a typical Th1 cytokine, and IL-4, a typical Th2 cytokine, were added to the culture to evaluate their effect on the IL-1β-induced secretion of TSLP. Inhibitors of p38 mitogen-activated protein kinase (MAPK), p42/44 MAPK and stress-activated protein kinase/Jun amino-terminal kinase (SAPK/JNK) were added to the culture to examine intracellular signals involved in IL-1β-induced TSLP secretion. The expression of TSLP in endometrioma tissue was examined by immunohistochemistry. The concentration of TSLP in the serum and peritoneal fluid (PF) of women with or without endometriosis was measured with a specific ELISA.

MAIN RESULTS AND THE ROLE OF CHANCE

IL-1β stimulated the expression of TSLP mRNA and secretion of TSLP protein from ESCs. IL-4 enhanced the IL-1β-induced TSLP secretion from ESCs, while IFN reduced it. Inhibitors of p42/44 MAPK, p38 MAPK and SAPK/JNK suppressed the IL-1β-induced secretion of TSLP from ESCs. Positive immunostaining of TSLP was observed in the stroma of endometrioma tissue. TSLP concentrations in the serum and PF were both higher in women with endometriosis compared with those without endometriosis.

LIMITATIONS, REASONS FOR CAUTION

The present study was only in vitro. The samples used for culture were endometrioma tissues, not including other types of endometriosis. Therefore, the present findings should be interpreted with caution.

WIDER IMPLICATIONS OF THE FINDINGS

This study provided new insights in the Th2 immune response-related mechanism in endometriosis.

STUDY FUNDING

This study is partly supported by grants from the Ministry of Health, Labour and Welfare, and the Ministry of Education, Culture, Sports, Science and Technology. The authors have no conflicts of interest to declare.

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microRNAs related to angiogenesis are dysregulated in endometrioid endometrial cancer

STUDY QUESTION

Which is the role of microRNAs (miRNAs) related to several angiogenesis regulators such as VEGF-A (Vascular endothelial growth factor-A) and TSP-1 (Thrombospondin-1) in endometrial cancer?

SUMMARY ANSWER

A dysregulated expression of miRNAs related to angiogenesis and an increase in the VEGF-A levels were observed in endometrial cancer in comparison with control. The different expression of miRNAs could modulate the expression of angiogenic and antiangiogenic factors, which may play an important role in the pathogenesis of endometrial cancer.

WHAT IS KNOWN ALREADY

Dysregulated miRNA expression has been previously evaluated in endometrial adenocarcinoma. To the best of our knowledge, there are no studies on the relationship between angiogenic factors and miRNAs in endometrial cancer.

STUDY DESIGN, SIZE, DURATION

Case–control study: 41 patients with histologically proven endometrioid endometrial cancer and 56 women without endometrial cancer.

PARTICIPANTS/MATERIALS, SETTING, METHODS

RNAs isolated from tissue samples were analyzed using the GeneChip miRNA 2.0 Array platform (Affymetrix). TaqMan qRT–PCR was used to assess the expression of the selected miRNAs related to angiogenesis (miR-15b, -16, -17-5p, -20a, -21, -125a, -200b, -210, -214*, -221, -222 and -424), and VEGF-A and TSP-1 mRNAs were assessed by qRT–PCR using SYBR Green. Protein levels were quantified by ELISAs.

MAIN RESULTS AND THE ROLE OF CHANCE

Compared with the miRNAs in the control endometrium, eight miRNAs (miR-15b, -17-5p, -20a, -125a, -214*, -221, -222 and -424) were significantly down-regulated and two miRNAs (miR-200b and -210) were significantly up-regulated in the cancerous endometrium. A significant increase in VEGF-A mRNA and protein expression and in TSP-1 protein levels (P <0.01) was observed in endometrial cancer. Moreover, significant inverse correlations between VEGF-A protein levels and miR-20a, -125a, -214*, -221, -222 and -424 were detected. In contrast, a positive correlation was observed between VEGF-A and miR-200b and -210. Furthermore, stage IB endometrial cancer was associated with a higher VEGF-A protein/mRNA ratio and lower miR-214*, -221 and -222 expression in comparison with stage IA.

LIMITATIONS, REASONS FOR CAUTION

Future functional studies (e.g. miRNA inhibition or ectopic overexpression) in cell culture models are needed to confirm the VEGF targeting by the miRNAs found in the present study.

WIDER IMPLICATIONS OF THE FINDINGS

The findings of the present study have potential implications for diagnostics and therapeutics of endometrial carcinoma.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by research grants from the Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica (Instituto de Salud Carlos III, Fondo de Investigación Sanitaria, PI080185, PI0110091) and Red RECAVA (RD06/0014/0004), by Consellería de Sanidad (AP-141/11) and Consellería de Educación (PROMETEO/2011/027), Generalitat Valenciana, by Beca Fibrinolisis 2009 and Becario 2010, 2011 from Fundación Española de Trombosis y Hemostasia and by the Fundación Investigación Hospital La Fe, Spain. None of the authors have any conflicts of interest.

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Projected Growth in $3 Billion Parkinson’s Treatment Market Gives RBCC a Bright Outlook

NOKOMIS, Fla.–(BUSINESS WIRE)–

The market for effective new treatments for Parkinsons disease and other degenerative neurological disorders is strong and projected to grow sharply in coming years. Thats good news for Rainbow Coral Corp.s (RBCC) biotech subsidiary, Rainbow Biosciences, as it closes in on a deal with Amarantus Biosciences, Inc. (AMBS)

The increasing market potential for Parkinsons therapies is what initially attracted RBCCs attention to Amarantus work. The Parkinson’s Disease Foundation estimates that as many as one million Americans suffer from Parkinson’s disease, and 60,000 new patients are diagnosed each year. Medication costs per person are believed to be around $2,500 each year and the total economic impact is estimated to be around $25 billion in the U.S. alone.

Most encouraging of all, the market for Parkinsons drugs could grow to a value of $3.75 billion by 2015, according to a report last year by Visiongain.

Growth in the Parkinson’s treatment market is being driven by new breakthroughs, and RBCC is working to help advance the timeline for a cure for the debilitating disease. RBCC is currently negotiating a potential definitive agreement with Amarantus, a company that could be on the verge of promising new diagnostic and therapeutic tools for Parkinsons patients and their doctors.

Amarantus owns the rights to a promising therapeutic protein known as MANF that prevents a type of cell death called apoptosis that could be the beginning of a cure for the disease. The company also owns the license to a groundbreaking diagnostic platform called NuroPro for Parkinsons that allows neurologists to accurately diagnose and track the progression of Parkinsons disease in patients. This groundbreaking test could potentially be on market in certain regions as early as 2013.

For more information on RBCCs biotechnology initiatives, please visit http://www.rainbowbiosciences.com/investors.html.

About Rainbow BioSciences

Rainbow BioSciences, LLC, is a wholly owned subsidiary of Rainbow Coral Corp. (OTCBB:RBCC). The company continually seeks out new partnerships with biotechnology developers to deliver profitable new medical technologies and innovations. For more information on our growth-oriented business initiatives, please visit our website at [www.RainbowBioSciences.com]. For investment information and performance data on the company, please visit http://www.RainbowBioSciences.com/investors.html.

Notice Regarding Forward-Looking Statements

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Moving Day to benefit National Parkinson Foundation held Sunday at MCC

University of Rochester neurologists as well as families touched by Parkinsons disease will be hitting the pavement this weekend to raise awareness and funds to help fight the disease.

The local Moving Day celebration, which includes a walk and other activities aimed at Parkinsons disease, is this Sunday, Sept. 16, on the grounds of Monroe Community College. While the actual walk begins at 10:30 a.m. and ends at noon, registration opens at 8:30 a.m. In addition to the walk, several events revolving around movement a key difficulty for patients with the disease will be held throughout the morning, including dance, yoga, Tai Chi, vocal and other physical exercises.

Moving Day is sponsored by the National Parkinson Foundation, which works to improve the quality of life for people with the disease through research, education and outreach. The goal of the Rochester Chapter of NPF this year is $65,000; so far the group has raised $26,000, already more than the total achieved last year. Funds will go to support the National Parkinson Foundation and its Rochester chapter, as well as Parkinsons research at the Medical Center.

Vicki Aspridy, registrar at the Simon School, is a member of the local chapter and part of the planning committee for the event. She is helping to organize Moving Day in honor of her mother, who had the disease late in life and passed away four years ago. A University team is being organized by neurologist Michelle Burack, M.D., Ph.D., who treats patients with the disease and also does research aimed at understanding and reducing the symptoms that patients experience.

For more information, visit http://MovingDayRochester.org.

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Researchers battle Parkinson’s disease using mouse model

Parkinsons disease may prove to be no match for a team of UH researchers at the Center of Nuclear Receptors and Cell Signaling.

CNRCS Director Jan-ke Gustafsson and professor Margaret Warner, along with their team of researchers, have found a link between beta-sitosterol present in many plants and good for preventing cholesterol absorption from ones diet and ALS-Parkinsons disease. This discovery may aid in the fight against Parkinsons and was recently published in Proceedings of the National Academy of Sciences.

Parkinsons disease is a chronic progressive neurological disease linked to a decrease in dopamine, production in the substantia nigra and marked by tremors in resting muscles, rigidity, slowness of movement, impaired balance and a shuffling gait.

If ALS-Parkinsons patients do have a defect in LXRbeta signaling, they will benefit from pharmaceuticals which target signaling of this receptor. Many such drugs are being developed at present, Warner said.

Authors Yubing Dai and Wanfu Wu researching in the CNRCS lab. | Amanda Hilow/The Daily Cougar

Gustafsson has had a long-standing interest in nuclear receptors because they are activated by the small molecules like hormones, and medication can be developed to increase or decrease their activity. In 1995, Gustafssons lab discovered two novel nuclear receptors one was LXRbeta. An efficient way to unmask the function of the newly discovered genes is to use gene technology to eliminate the hormone in mice and see what happens.

The receptor continues to show promise as a potential therapeutic target for this disease, as well as other neurological disorders, Gustafsson said in a press release for HealthNewsDigest.com. LXRbeta performs an important function in the development of the central nervous system, and our work indicates that the presence of LXRbeta promotes the survival of dopaminergic neurons, which are the main source of dopamine in the central nervous system.

During World War II, ALS-Parkinsons disease was prevalent in the Pacific Islands and Guam where there was a shortage of wheat. During that time, people had to make bread from cycad seeds, which contain a high level of beta-sitosterol.

The reason for the susceptibility of certain people in Guam to toxicity from beta-sitosterol remained a mystery until we developed the LXRbeta knockout mice, Warner said. These mice develop ALS-Parkinsons disease spontaneously as they age, and the disease is made worse if beta-sitosterol is added to their diet.

However, it was discovered that LXRbeta knockout mice did not need to be fed beta-sitosterol to develop Parkinsons disease. Meaning UH researchers have to look for the possibility that people develop ALS- Parkinsons disease because of defective LXRbeta signaling.

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Pittsburgh-area couple awarded for work with Parkinson’s disease patients

Tom and Carol Reid, of Plum, have been living with Parkinsons disease for 17 years, but its how they are helping others with the disorder that has earned them a big honor.

They will be awarded with the Local Hero award Saturday from the Davis Phinney Foundation.

Carol Reid remembers when she started noticing a change in her husband.

He was losing facial expression. I didn’t know what that meant. I just felt like you know, you’re not responding to me, she said. He was drooling. His eyes were watering. He was falling often.

Tom Reid went to the family doctor and was given Claritin for his watery eyes.

It took two years to get a second opinion and a diagnosis of Parkinsons, a neurodegenerative disease.

I was in a classical case of denial, said Tom.

Symptoms involve loss of motor control, affecting speech and movement.

Tom was a captain in the Army before becoming a corporate attorney. He enjoyed public speaking and using what he and his wife called his command voice.

Parkinsons has changed that.

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Brain Games Help Parkinson’s Patients

PARKINSONS & MEMORY: In addition to the motor symptoms in Parkinson’s disease, there are also cognitive symptoms which may be evident even in the early stages of the disease. These may include deficits in executive function (especially planning and attention), set-shifting (ability to alternate between two or more tasks), and memory. Approximately 25%-30% of Parkinson’s patients develop dementia. It is not yet known whether dementia is actually a symptom of Parkinson’s disease or whether patients with Parkinson’s disease are for some reason also at higher risk for dementia. A large number of Parkinson’s patients also experience psychiatric disorders such as depression, anxiety, or sleep disorders.

Because Parkinson’s disease damages neurons in the substantia nigra which produce dopamine, treatment usually involves drugs which work to counteract this shortage of dopamine. Parkinson’s patients may benefit from treatment with several kinds of drugs simultaneously. These drugs can often combat the motor symptoms for a long time, but as the disease progresses and the substantia nigra continues to degrade, the drugs eventually become less effective.

Some patients whose motor symptoms cannot be controlled by medication undergo brain surgery to destroy portions of the brain regions responsible for some of the motor symptoms in Parkinson’s disease, or benefit from deep brain stimulation (DBS) — using thin wires to stimulate electrical activity in the brain. There has also been controversial research involving implantation of cells from aborted fetuses into the brains of Parkinson’s patients in an attempt to regrow neurons in the substantia nigra; more recently, scientists are exploring the possibility of using stem cells isolated from healthy adults or grown in the laboratory. As yet, this work is still highly experimental. (Source: Memorylossonline.com)

UNIVERSITY OF MARLYAND STUDY: Researchers are looking to study the benefits of exercise for fitness, walking, balance, and memory. They are still enrolling participants, and those eligible for the study are people who have been diagnosed with Parkinsons disease and have mild to moderate gait or balance difficulty. The study is being conducted at the Veterans Affairs Medical Center at the University of Maryland School of Medicine in Baltimore, Maryland.

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Multiple Sclerosis Pill Approved by U.S. FDA

The U.S. FDA this week approved a once-a-day pill for the treatment of multiple sclerosis (MS). The pill, being branded as Aubagio by Sanofi S.A., is specifically for the treatment of adults with relapsing forms of MS.

In a clinical trial, the relapse rate for patients using Aubagio was about 30 percent lower than the rate for those taking a placebo, said Dr. Russell Katz, director of the division of neurology products in the FDAs Center for Drug Evaluation and Research. Multiple sclerosis can impair movement, sensation, and thinking, so it is important to have a variety of treatment options available to patients.

According to the National Institutes of Health, MS is a chronic autoimmune disease that affects the central nervous system. It disrupts the communication between the brain and the body, causing motor skill disruption for nearly every part of the body, depending on which nerves in the brain are damaged.

As for the drug itself, side effects seen during drug trials included diarrhea, abnormal liver tests, nausea, and hair loss. Also, the box warnings for the drug warn of possible liver problems and fetal harm, including the risk of birth defects. Doctors will have to check patients liver function and give a pregnancy test before starting treatment with Aubagio.

Many people living with MS struggle with the additional burden of injectable therapies administered daily to weekly, said Dr. Aaron Miller, medical director at the center for multiple sclerosis at Mount Sinai Medical Center. The FDAs approval of Aubagio, a new oral treatment option, is an encouraging advancement for the MS community and may be a valuable treatment for people living with this often debilitating disease.

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Sanofi multiple sclerosis pill gets US approval

Sanofi SA has won U.S. approval for its multiple sclerosis pill Aubagio – one of the two treatments for the chronic disease that could return the French drugmaker to growth after several blockbuster drugs lost patent protection.

The drug has been shown to be less effective than some rivals but has milder side effects and analysts say it could find favor among newly diagnosed patients. Around 35 percent to 40 percent of multiple sclerosis (MS) sufferers prefer to take no medication rather than face unwanted side effects.

“In a clinical trial, the relapse rate for patients using Aubagio was about 30 percent lower than the rate for those taking a placebo,” Russell Katz, director of the Division of Neurology Products at the Food and Drug Administration, said in a statement on Wednesday.

Aubagio is expected to launch on the U.S. market in a few weeks, a spokeswoman for Sanofi unit Genzyme said.

Multiple sclerosis, which has no cure, affects 2.5 million people worldwide. It is a chronic, often disabling disease that attacks the central nervous system and can lead to numbness, paralysis and loss of vision.

MS drugs Gilenya by Novartis and Biogen Idec Inc’s BG-12 are expected to dominate a market that JPMorgan analysts predict growing to $14 billion in 2015 from $9.6 billion last year.

Aubagio is seen grabbing a much smaller chunk of this market, reaching modest sales of $353 million in the United States and five major European countries by 2020, according to business intelligence firm Datamonitor.

Cheuvreux analyst Marcel Brand, who has a more optimistic forecast, predicts peak sales of Aubagio of 1.48 billion euros by 2018. “Although Aubagio is not as effective on relapse rates as Gilenya, it’s free of its longer-term side effects,” he said.

Patients taking Gilenya have to be monitored because the drug causes the heart rate to slow down in the first hours after ingestion.

European regulators are expected to give their response to Aubagio in the first quarter of 2013.

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Research and Markets: Global Multiple Sclerosis Drug Pipeline Capsule – 2012

DUBLIN–(BUSINESS WIRE)–

Research and Markets (http://www.researchandmarkets.com/research/k4b4f3/global_multiple_sc) has announced the addition of the “Global Multiple Sclerosis Drug Pipeline Capsule – 2012″ report to their offering.

This report is an outline of all the key research and development (R&D) activities of the global Multiple Sclerosis drug market. It covers information on key pipeline molecules in various stages of R&D including all the phases of clinical trials, preclinical research, and drug discovery. The report is up-to-date with full coverage of the licensing activities and partnerships.

This report helps executives to keep a track of their competitors and understand their pipeline molecules. The information presented in this report can be used for identifying the partners, prioritizing, evaluating opportunities, developing business development strategies, and executing in-licensing and out-licensing deals.

The report provides information on pipeline molecules by company and mechanism of action across the different stages of R&D. It includes registered / preregistered stage, phase 3 clinical trial, phase 2 clinical trial, phase 1 clinical trial, preclinical research, and drug discovery. It also provides information on pipeline molecules developed in leading geographies including the U.S., Canada, France, Germany, U.K., Italy, and Spain by various stages of R&D. Licensing activities and partnerships in the Multiple Sclerosis drug market is thoroughly covered by company and licensee with the deal summary.

Key Features of the Report:

– Multiple Sclerosis: Overview

– Multiple Sclerosis Drug Pipeline Overview

– Multiple Sclerosis Phase 3 Clinical Trial Drug Pipeline Insights

– Multiple Sclerosis Phase 2 Clinical Trial Drug Pipeline Insights

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FDA Approves New Multiple Sclerosis Drug Aubagio

By Matt McMillen WebMD Health News

Reviewed by Laura J. Martin, MD

Sept. 13, 2012 — The FDA has approved Aubagio (teriflunomide), a new drug for the treatment of multiple sclerosis (MS). The once-a-day tablet will be prescribed to adults with relapsing forms of the chronic, incurable disease.

In a two-year study, the Aubagio reduced yearly relapses by nearly a third compared to placebo. It also slowed the progression of the disease.

“We are greatly encouraged to see a new oral therapeutic option become available to people living with MS,” said Timothy Coetzee, PhD, chief research officer at the National MS Society, in a news release issued by the drug’s developer, Genzyme.

MS is the most common disabling neurological disease among young adults, according to the National Institute of Neurological Disorders and Stroke. About 400,000 people in the U.S. have MS. As many as two-thirds of them are women. The disease is usually diagnosed between the ages of 20 and 50.

MS often gradually worsens over time. It causes fatigue, pain, vision and muscle problems, and other difficulties.

Aubagio does not come without risks. The drug’s label will include a boxed warning that alerts to the risk of potentially fatal liver problems. The label advises that patients’ liver function should be tested before starting Aubagio and while on the drug.

The box warning also mentions the risk of birth defects. Women should not be pregnant when they start the drug and must use birth control while taking it.

Other possible side effects include diarrhea, abnormal liver tests, nausea, and hair loss.

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Aubagio (teriflunomide) Approved For Multiple Sclerosis Treatment, FDA

Editor’s Choice Main Category: Multiple Sclerosis Also Included In: Regulatory Affairs / Drug Approvals Article Date: 15 Sep 2012 – 0:00 PDT

Current ratings for: Aubagio (teriflunomide) Approved For Multiple Sclerosis Treatment, FDA

1.5 (2 votes)

According to experts, the Multiple Sclerosis prescribing market is worth $12 billion annually. If Aubagio becomes popular, it has the potential to become a major earner for its makers, Sanofi-Aventis. However, it is entering a highly-competitive market with very effective existing medications. Novartis’ Gilenya and Tysabri from Elan Corp are said to be more effective than teriflunomide.

Director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research, Russell Katz, M.D., director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research, said:

Multiple sclerosis is a long-term autoimmune, inflammatory disease of the central nervous system. Communication between the brain and other parts of the body are disrupted. Multiple Sclerosis is one of the most common causes of neurological disability in young adults. Twice as many females live with MS than males.

People with MS have episodes of relapses (worsening function), followed by remissions (recovery). Eventually, remission periods may be incomplete as the disease progresses. Aubagio has been approved for the initial phases of the disease.

According to clinical trial results, the following side effects among people taking Aubagio were reported: hair loss, nausea, abnormal liver test results, and diarrhea.

Aubagio contains a Boxed Warning explaining to doctors and their patients that there is a risk of liver problems, which may sometimes be fatal, as well as birth defects. Doctors should carry out blood tests beforehand to make sure liver function is normal. During treatment with Aubagio, liver functions tests should be performed periodically.

The Boxed Warning also alerts prescribers and their patients about some animal studies which linked the drug with a higher risk of fetal harm. That is why Aubagio is labeled as a Pregnancy Category X drug, meaning that female patients of childbearing age should have negative pregnancy test results (and use effective birth control therapy) before being considered for Aubagio treatment.

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Gingko biloba does not improve cognition in multiple sclerosis patients, study finds

ScienceDaily (Sep. 13, 2012) Many people with multiple sclerosis for years have taken the natural supplement Gingko biloba, believing it helps them with cognitive problems associated with the disease.

But the science now says otherwise. A new study published in the journal Neurology says Gingko biloba does not improve cognitive performance in people with multiple sclerosis. The research was published in the Sept. 5, 2012, issue of Neurology, the medical journal of the American Academy of Neurology. The current study was a more extensive look at the question after a smaller 2005 pilot study suggested there might have been some cognitive benefits in MS patients using the supplement. That study found that Gingko seemed to improve attention in MS patients with cognitive impairment.

But the larger follow-up study, conducted with patients at the Portland and Seattle Veterans Affairs medical centers, found no cognitive benefits to using Gingko.

“It’s important for scientists to continue to analyze what might help people with cognitive issues relating to their MS,” said Jesus Lovera, M.D., the study’s lead author, a former fellow at the Portland VA Medical Center and former instructor in Oregon Health & Science University’s Department of Neurology, where he did much of the work on the study. Lovera is now with the Department of Neurology at the Louisiana State University Health Sciences Center.

“We wanted to follow up on the earlier findings that suggested there may be some benefit. But we believe this larger study settles the question: Gingko simply doesn’t improve cognitive performance with MS patients,” said Lovera.

About one-half of people with MS will develop cognitive problems, and those cognitive problems can be debilitating in some people, said Dennis Bourdette, M.D., a co-author of the study, co-director of the VA MS Center of Excellence-West at the Portland VA Medical Center and chairman of the OHSU Department of Neurology. The most common problems relate to memory, attention and concentration, and information processing.

There is no known treatment that can improve cognition with MS patients — which is partly why MS patients and researchers had hoped that Gingko biloba could help.

Lovera was also the lead author in the 2005 study, conducted at OHSU. That study included 39 participants who were given Gingko biloba or a placebo. The new study included 120 participants given Gingko or a placebo.

The study was supported by a grant from the U.S. Department of Veterans Affairs Rehabilitation Research and Development Service.

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Dementia-Hearing Loss Link Prompts BHI to Urge Hearing Checks Among Baby Boomers, Gen Xers in Recognition of World …

WASHINGTON, Sept. 11, 2012 /PRNewswire/ — As evidence increases showing that there may be a connection between hearing loss and dementia, the Better Hearing Institute (BHI) is urging hearing checks among Baby Boomers and Gen Xers. Because most hearing loss can be managed with hearing aids, BHI also is encouraging those with hearing loss to be fitted with hearing aids when appropriate. BHI’s outreach efforts come in recognition of World Alzheimer’s DaySeptember 21.

To make it easier for anyone to determine if they need a comprehensive hearing test by a hearing healthcare professional, BHI is offering a free, quick, and confidential online hearing check atwww.hearingcheck.org.

Several studies have looked at the relationship between hearing loss and cognitive function. One such study,conducted by researchers at Johns Hopkins and the National Institute on Aging, and published in theArchives of Neurology, found that seniors with hearing loss are significantly more likely to develop dementia over time than those who retain their hearing. The study also found that the more hearing loss they had, the higher their likelihood of developing dementia.

According to the Johns Hopkins press release on the study, the reason for the link between the two conditions is unknown, but the investigators suggest that a common pathology may underlie both or that the strain of decoding sounds over the years may overwhelm the brains of people with hearing loss, leaving them more vulnerable to dementia. They also speculate that hearing loss could lead to dementia by making individuals more socially isolated, a known risk factor for dementia and other cognitive disorders.

According to BHI, these research findings should prompt people to take hearing loss seriously. BHI encourages Boomers and Gen Xers especially to get their hearing tested by a hearing healthcare professional who can provide a thorough examination and, if needed, fit them for hearing aids.

In an effort to improve the quality of life for people with Alzheimer’s disease, BHI advocates that hearing checks, hearing healthcare, and hearing aids when appropriate, be included in their regimen of care. According to the Institute, unaddressed hearing loss can present an added, unnecessary strain on individuals with Alzheimer’s disease, and also on caregivers who suffer from hearing loss themselves. BHI also advocates that hearing checks and hearing healthcare be part of the diagnostic process.

Studies show that although a significantly higher percentage of people with Alzheimer’s disease may have hearing loss, they’re also much less likely to receive attention for their hearing needs than their normally aging peers.

Research also shows that the use of hearing aids among Alzheimer’s patients with hearing loss, in combination with appropriate aural rehabilitation in a multidisciplinary setting, can help alleviate the symptoms of depression, passivity, negativism, disorientation, anxiety, social isolation, feelings of helplessness, loss of independence and general cognitive decline.

Because healthy hearing helps people remain socially and cognitively engaged, BHI urges all Baby Boomers, Gen Xers, and others to make hearing checks a regular part of their preventive healthcare.

About Alzheimer’s Disease

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Dementia patient’s family: "We needed justice"

COLLIER COUNTY, FL –

A veteran dementia patient was found lying in the woods, nearly dead. Five years later, his family says they finally have justice.

“We needed justice for my grandfather and people needed to be held accountable for their actions,” said Dederick’s granddaughter Lauren Carey, who searched tirelessly for five days to find her missing grandfather.

Then 88-year-old Loren Dederick, who passed away last year, went missing in 2007 after a medical transport mix-up.

A jury found TLC Non-Emergency Medical Transport at fault ordered the company to pay Dederick’s family $700,000 for his injuries and mental anguish.

“He laid there for five days with no food or water and no way out,” said Dederick’s. “He was dirty, ant bites all over, dehydrated and just really scared.”

“He was getting close to the time where he probably couldn’t sustain himself any longer,” said Dederick’s daughter Donna Ward.

The World War II veteran was taken to NCH North Naples hospital for chest pain on September 21, 2007.

When he was released, NCH accidentally gave a TLC transport driver Dederick’s old address, the HarborChase assisted-living facility on Airport-Pulling Road in Naples.

The driver, 44-year-old Dimas Herrera, took Dederick to that wrong address. According to testimony, nurses at the assisted-living center told Herrera that Dederick didn’t live there.

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National push to prevent dementia

Australia is leading the world with the first publicly funded program aimed at reducing the risk of developing dementia.

A new brain health program, Your Brain Matters, will be launched by Alzheimer’s Australia this week.

It was funded by the federal government in the 2012 budget, the first prevention program for dementia in the world to receive public funding, said Alzheimer’s Australia chief executive Glenn Rees.

He said this showed the condition was being treated as a chronic disease, rather than a normal part of ageing.

Mr Rees said the program was a guide to keeping the brain healthy by exercising the mind and body and eating a nutritious diet.

“It’s important to understand that while there is, as yet, no cure for dementia there are things we can all do now – like keeping your brain active, being fit and healthy and looking after your heart – which may help to reduce our risk of developing dementia, or slow cognitive decline in those already diagnosed with dementia,” Mr Rees said in a statement.

He said there was evidence to suggest that if physical inactivity could be reduced in Australia by five per cent every five years, this could cut dementia prevalence by 11 per cent by 2051.

This would equate to about 100,000 fewer Australians living with dementia by addressing just one risk factor, he said.

International Alzheimer’s expert Dr Serge Gauthier, of McGill University in Canada, who is visiting Australia as part of Dementia Awareness Week, said prevention programs were vital to try to stem the incidence of dementia.

About 280,000 Australians have dementia, with this figure set to soar to almost one million by 2050.

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National push to prevent dementia

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How many times, if ever, have you googled a patient?

According to a WSJ blog post two years ago, it mentioned and asked, "By now, it’s well known that almost anyone you meet — from a potential employer to a prospective date — might be searching for information about you online. But would you feel strange knowing that your doctor was Googling you?" The blog post goes on to say "The practice appears to be widespread, according to an essay in the latest edition of the Harvard Review of Psychiatry, and it raises some thorny ethical questions for doctors, particularly those dealing with mental health." 

Some folks actually wrote a paper on this.  I happen to come across this news from KevinMD who made mention of this on his site in April of 2010 in a post entitled "Should doctors Google their patients?"

Point is, apparently I am not the first one to think of this, do it or subsequently write about it, but here is my response.

As a physician/pathologist there are a number of forms of data available to you, specimen requisition information, clinical history, electronic medical records, laboratory tests, radiology studies, operative notes, etc...


LetmegoogleyouIn some cases, the information may not be available (brunt of work-up, radiology, pre-operative visit, etc...) performed outside your institution where these impressions and results may normally be available to you.  The specimen requisition may simply state "change in bowel habits" or "liver mass" without much more than patient name, age, sex and a MRN of little value beyond appropriate patient ID.  No radiology, laboratories, physical examination findings, incomplete operative note and/or a clinician/surgeon who did not perform anything beyond the endoscopy or operation and does not recall by phone 2 or 3 days after the "case" anything about medication history, social history, radiology from outside hospital or post-operative course (assumingly these are all "negative", "non-contributory" or "not worth remembering".  When one calls for additional information the question is usually answered in the form of another question "Is it cancer?", "Is the margin negative?", or "How many lymph nodes are involved?"

A recent "liver tumor" submitted by a private physician at our hospital, where the work-up was largely done elsewhere, including pre-operative screening and imaging had an unusual histology.  No additional information was available.  A call to the surgeon about occupation, social history and medication history was met with one response "Is the margin negative?"  If I didn't tell him the patient's first name he would not have known that either. 


DnacredithistoryGoogle did.  And where he worked (irrelevant) what his "Likes" were, hobbies, interests and favorite TV shows.  The data I saw did not necessarily help to replace the normally present clinical data (assuming accurate when it is available), did not make the diagnosis less or more likely by itself, assuming the infomation online was accurate (i.e. did I have the right "John Doe") but it did help to substantiate the findings, albeit given circumstantial data.

As KevinMD and the WSJ blog notes and reader comments mention, there are many issues with this.   For some physicians apparently, using Google and the Internet to find publicly available information about their patients may shed some light into their diagnoses or management.  

One physician commented "I've done it, and it yielded invaluable info on a sick non-psych patient. Nailed the diagnosis."

What if there is something "out there" about an overtly litiginous patient?  Or one who smokes, is an admitted alcoholic, brags about excessive BMI, has started a blog on his/her personal battle with cancer, could any of these influence your diagnosis or approach after finding out?  

Perhaps in some cases and that is the point - shouldn't you know to help the patient and providers?

I have yet to meet a hepatologist who has not googled the name of a drug, prescription, over-the-counter or "other" health food store variety to look up any reports of hepatotoxicity or chemical compunds in those drugs that have been associated with hepatotoxicity.  

An old cardiologist (older now) told me as a first-year medical student, "Keith, there are two keys to practicing medicine; 1.  Do everything the same way, everytime.  This lowers the likelihood you will miss something. Whether it is a taking a clinical history, physical exam, reading an EKG, reading a chest x-ray (from outside in, or inside out, top-down, down-up), however you choose to do it, do it the same way everytime. And 2.  Cheat.  Cheat all the time.  Meaning get as much information as you possibly can.  MD stands for medical detective.  Get information from as many sources as possible.

This was shortly before Ask Jeeves or Yahoo!

I wonder what he would do if he had Google and an unresponsive patient, missing clinical information, radiology studies, unresponsive surgeon, forgetful clinician, etc...

Does this replace physician communication, documentation, the EMR, solid clinical business practices, actually talking to the patient, looking at his/her medical records, the slide(s) or X-rays?  Of course not.  May it yield information not mentioned and potentially useful? Ask Google.

 

 

 

 

 

 

 

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Can 2007 ASCO/CAP Scoring Guidelines for HER2 Protein Expression and Gene Amplification Be Applied to Gastroesophageal Adenocarcinoma?

Review of: Tafe, LJ, Janjiigian
YY, Zaidinski M, et al.  Human Epidermal
Growth Factor Receptor 2 Testing in Gastroesophageal Cancer Correlation Between
Immunohistochemistry and Fluorescence In Situ Hybridization
Arch Pathol Lab Med; 2011;135:1460-1465.


Nrgastroher2Experienced pathologists are
familiar with the bumpy and often controversial evolution of HER2/neu testing
in breast cancer patients. 

First, there was a breast
cancer drug trial employing a poorly designed trial assay followed by release
of the high demand drug Herceptin into a medical system without a remotely
adequate companion assay.  This was
followed by a confusing application of multiple anti-HER2 antibodies in no
standardized immunohistochemical assays interpreted by a range of pathologists
using different criteria all in parallel with a separate evolution of different
FISH assays. 

Before arriving at a reasonable
degree of standardization as outlined in the 2007 ASCO CAP guidelines, there
was a relatively prolonged period of sometimes heated consternation over which
assay was best, under what conditions, and using interpretive criteria.  And, during that period, we wrestled with a
lot of published laboratory correlation studies—the vast majority lacking any
clinical outcome data.  It’s not pleasant
to recall all of this controversy associated with HER2 testing in breast cancer
but hopefully it is a reminder of mistakes not to be repeated. 

We should remember these
lessons as we step into a new era of anti-HER2 therapies for gastroesophageal
and almost certainly other cancers from other primary sites.  The combination of Herceptin and chemotherapy
was very recently proven effective against HER2 positive advanced gastric and
gastroesophageal junction carcinomas in the TOGA clinical trial. 


Gastricher2Of great importance, the
standardized HER2 scoring systems used for breast cancer were not used in this
trial.  Instead, a body of preceding work
suggested that an alternative scoring system was needed for gastroesophageal cancers.  Basically, the traditional breast scoring
requirement for complete circumferential staining was modified to score
incomplete basal lateral membrane staining of gastric cancers as positive. 

In the trial,
immunohistochemistry was slightly more powerful than FISH in predicting drug
response with therapeutic responses in IHC 3+ tumors as well as IHC 2+ FISH
amplified tumors but not in FISH amplified tumors with lower
immunohistochemical scores 1 and 2. 

As a result, in Europe patients
with advanced gastroesophageal adenocarcinoma who are HER2 3 positive by
immunohistochemistry or IHC 2 positive with FISH amplification are eligible for
Herceptin therapy.  Slightly differently
in the United States, metastatic tumors that are IHC 3+ or HER2 amplified by FISH
are eligible. 

Some investigators have not
bought into the modified HER2 scoring system and hope to justify a more uniform
application of the existing breast cancer scoring system across different tumor
types.  Reporting in the November 2011
issue of Archives of Pathology and Laboratory Medicine [provide reference],
senior author Violetta Barbashina and co-authors measure concordance between
immunohistochemistry and FISH for evaluating HER2 status in gastroesophageal
carcinomas. 

Notably, in contrast to the
clinically validated scoring criteria for gastroesophageal carcinoma
established by the TOGA trial for Herceptin therapy, these authors deliberately
applied more traditional HER2 scoring criteria that are established for breast
cancer. 

They evaluated 135 paraffin
embedded advanced gastroesophageal carcinomas from the pathology files of
Memorial Sloan Kettering Cancer Center by HER2 automated immunohistochemistry
using PATHWAY Rabbit Monoclonal Antibody 4B5 on a Ventana BenchMark stainer
and, by HER2 FISH using the Path Vision dual probe procedure. 

Again, in this study, both ICH
and FISH were interpreted using criteria for breast cancer per the 2007 ASCO
CAP scoring guidelines.  By ASCO CAP
guidelines, 16 of 16 or 100% of the IHC 3+ tumors were FISH amplified; 16 of 20
or 80% of FISH amplified tumors were IHC 3+. 

Overall, IHC FISH concordance
was 97% for IHC 0 tumors, 93% for IHC 1+ tumors and 100% for IHC 3+ tumors—all
very high concordance rates—but note, that I have not described the FISH IHC
concordance rate for equivocal IHC 2+ tumors. 
Among this group of 8 equivocal IHC 2+ tumors, three were amplified,
four unamplified, and one equivocal indicating a roughly 50% concordance
rate. 

Finally, the authors
reclassified their IHC and FISH scoring using modified TOGA clinical trial criteria
and obtained a similar but no identical concordance rate.  From this, the authors conclude that HER2
testing in gastroesophageal cancers can be performed using 2007 ASCO CAP
scoring guidelines for breast cancer. 
Think about it.  I do not think
that such a bold conclusion is supported by this work. 

In their discussion, the
authors also state that for gastroesophageal cancers IHC 1+ and 2+ results should
be resolved by what they call definitive FISH testing.  Both this statement and the conclusion that
we can apply breast cancer scoring criteria are not supported by any clinical
evidence. 

In fact, the TOGA clinical
trial data contradict the notion that FISH results are in any way more
definitive or more predictive than IHC results. 
The TOGA clinical trial data actually suggests that for gastroesophageal
cancers, IHC results are more predictive of drug response. 

The authors have done a large
amount of work and report very good correlation between PATHWAY Ventana
immunohistochemistry HER2 testing and Path Vision FISH results in
gastroesophageal cancer but as far as I can tell that is all.  I have yet to see any clinical
evidence—certainly not in this paper—to support their suggestion that ASCO CAP
breast cancer scoring is acceptable or that FISH HER2 results are the
definitive answer for gastric cancers. 

I hope that this is not the
beginning of numerous laboratory correlation studies on HER2 testing on gastric
or other types of cancer that lack clinical outcome data but spawn speculative
conclusions about clinical utility.  One
suggestion I would make if it has not already been done is to retrospectively
score TOGA clinical trial gastroesophageal cancers by ASCO CAP breast cancer
criteria and see which system best predicted drug response. 

Short of that effort, someone
would have to essentially repeat the TOGA trial to truly answer the question
posed by these authors. 

To my knowledge and for now,
the modified TOGA scoring criteria for gastroesophageal cancer HER2 status
remain uniquely validated by a clinical trial. 

Biologically, it seems
imprudent to expect standards for HER2 testing in breast cancer to translate
simply and unchanged across primary and anatomic sites from breast to stomach
to lung or any other organ.  That is not
the case for anti-EGFR drug modality or laboratory testing algorithms in lung
and colon cancers which have benefited from quite different anti-EGFR drugs and
laboratory testing strategies.  In lung
cancer, use of anti- HER2 therapies is currently investigative but already
there is some published literature indicting that HER2 gene mutation status
(not protein over expression and not gene amplification) may identify the
subset of lung cancer patients who respond to Herceptin. 

The name of the game is predicting
drug response and that requires empirical clinical outcome data.

 

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Jerry and his Doctors

Every once in awhile I come across another physician blog that tells it like it is without ranting and raving about managed care/insurance issues, hospital administrators or patients with unmet expectations.

This one comes from an internal medicine resident recounting an experience with a terminally-ill patient and end-of-life decisions, a living will, the needs of patients and the decisions made by an attending physician and a resident physician.

Her experiences remined me of the 3 months I spent as an intern in critical care units.  The discussion, and perhaps, more importantly, enforcement/following of living wills and the battles that ensue with families, doctors, housestaff, attendings and medical technology in the war against human disease.

For a sobering account and one doctor's piece of mind on this check out:

The only thing I had to do was help Jerry and I failed


Doctors-band-aid-300x243

 

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Sept 11 — Remembering 11 years later

At around 8 PM, on September 10, 2001 I was on one of the last LaGuardia - Reagan Delta shuttles to leave New York City. I was returning from a trip to the laboratory at the hospital located on the U.S. Military Academy base in West Point, NY.  We had completed a successful AABB blood bank inspection and was returning home to Washington.  It was a trip I had done several times previously as the pathology consultant to Keller Army Community Hospital and would do several more times over the next four years on frequent site visits and to cover frozen sections as Keller did not have a full-time pathologist.  This experience was the nidus for telepathology in the Army.  I figured there had to be an easier way to cover remote frozens than to fly to New York City or drive for hours each way for 15 minutes of work.  

NikkormatFT2 IMGP1333 On this particular trip, leaving LaGuardia, I was able to capture a few images of lower Manhattan and New York harbor. At the time, I was still taking pictures with a film camera (and still do sometimes but it is getting harder to find quality film and processing facilities...). After takeoff I pulled out my old but trusty Nikkormat FT2 camera, snapped on my equally old but reliable 200mm lens and was able to get off 3 exposures. 

The lighting cooperated despite slow film and my telephoto lens.  I like the grainy nature, particularly for black and white photos.  I did not realize what I had on the roll until many months later and saw what are likely some of the last images of the World Trade Center, particularly from the air.  I could not find the original negatives but was able to scan some 4x6 prints I had made.  About 12 hours after I took this picture, the first plane hit the North tower of the World Trade Center. 

WTC1 WTC3

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