ScienceBlog.com

Health

Lung cancer research concludes that early diagnosis as key for improving survival

Research published in the June edition of the Journal of Thoracic Oncology sought to investigate the time trends of surgical outcomes of patients with non-small cell lung cancer (NSCLC) between 1979 and 2008. The incidence of lung cancer continues to rise; therefore, countermeasures to decrease death rates have become an important public health issue. After analyzing the time trends, researchers postulated that the increase of patients diagnosed with early stages of adenocarcinoma contribute to the favorable prognostic and survival outcomes. Furthermore, the research highlights that prognosis of NSCLC patients has improved in recent years. The current treatment strategy for NSCLC depends on clinical staging, to which surgical resection is the first-line treatment for stages I to II. Moreover, only a few of the stage III cases are treated surgically. While the standards for surgical treatment have remained unchanged for a few decades, there have been a number of advances in perioperative, anesthetic, and intraoperative management, specifically over the past three decades. To gather insights on the correlation to overall survival, the present study retrospectively investigated the clinicopathologic features of NSCLC patients who underwent surgery and the corresponding time trends of surgical outcomes. To draw the analysis, researchers reviewed records of nearly 1,500 patients who underwent resection of NSCLC during the following five time intervals: (1) 1979 -- 1988, (2) 1989 -- 1993, (3) 1994 -- 1998, (4) 1999� and (5) 2004�. Overall results showed that the number of patients who underwent a resection, the percentage of pathologic stage IA lung cancers, their subsequent survival and the percentage of adenocarcinoma have all progressively increased over the almost 30 year span. The only variable that decreased was tumor size, indicating that diagnoses were increasingly earlier. Most notably survival rates for 1999-2004 and 2004-2008 were significantly better than any of the previous three periods. "The prognosis of NSCLC patients has been remarkably improved in recent years," explains lead study investigator Takeshi Hanagiri, MD, PhD. "The increase of patients with diagnosed with adenocarcinoma in the early stages is thought to strongly contribute to the favorable results, further reiterating the key factor of early diagnosis for improving the survival of lung cancer patients after surgical treatment. Thus, early diagnosis remains a key factor for improving the survival of lung cancer patients after surgical treatment" Journal of Thoracic Oncology (JTO) -- (journals.lww.com/jto) The JTO is a prized resource for medical specialists and scientists who focus on the detection, prevention, diagnosis and treatment of lung cancer. The JTO is the official monthly journal of the International Association for the Study of Lung Cancer (IASLC.org) and emphasizes a multidisciplinary approach, including original research (clinical trials and translational or basic research), reviews and opinion pieces.

Jun 15, 2010

Earth & Environment

Climate change increases hazard risk in alpine regions says research led by University of Exeter

Climate change could cause increasing and unpredictable hazard risks in mountainous regions, according to a new study from the University of Exeter and Austrian researchers. The study analyses the effects of two extreme weather events -- the 2003 heatwave and the 2005 flood -- on the Eastern European Alps. It demonstrates what impact events like these, predicted to become more frequent under a changing climate, could have on alpine regions and what implications these changes might have for local communities. The mean summer temperatures during the 2003 heat wave in a large area of the European Alps exceeded the 1961-1990 mean by 3-5˚C. This triggered a record Alpine glacier loss that was three times above the 1980-2000 average. Furthermore, melting permafrost caused increased rock-fall activity. The severe floods that occurred as a result of heavy rainfall in August 2005 were the most damaging for 100 years and led to high volumes of water and sediment being deposited downstream, causing an estimated €555 million worth of damage in Austria to buildings, railways, roads and industrial areas. In Switzerland, this has been estimated to have caused one quarter of all damage by floods, debris flows, landslides and rock falls recorded since 1972. Temperatures in the European Alps have increased twice as much as the global average temperature since the late nineteenth century and are predicted to rise by an average of 0.3-0.5˚C per decade in the next century. Global climate models currently fail to account for variations at a very local level. Therefore, the impact of climate change here is largely unknown. In some regions, this may be of greater concern because local environmental features, such as glaciers, pose a hazard. The biggest hazards tend to be concentrated in high altitude areas where there is mountaineering and skiing infrastructure. Worryingly, there is little public or local awareness of the issues. In addition, the impact of climate change is expected to be magnified in any snow or ice covered regions because melting snow drives further melting. Jasper Knight from the University of Exeter commented ''While human activity and land management are important factors, we expect that global warming will cause ongoing and accelerating ice loss in the European Alps over the next decades and centuries. This will have a significant impact on hazard type, location and frequency and a potentially negative effect on the region's economic engine -- tourism.'' Notes to editors Adapted from an article to be published in Science for Environment Policy published by the European Commission's DG Environment First published: Keiler, M Knight, J Harrison (2010). Climate change and geomorphological hazards in the eastern European Alps. Philosophical Transactions of the Royal Society A. 368: 2461-2479 Liz French or Esther White Press Office, University of Exeter +44 (0)1392 262307/263146

Jun 15, 2010

Health

Talking on your cell phone while driving may be hazardous to your close relationships

Warnings about the dangers of distracted driving while using a cell phone are prevalent these days, but cell phone use while driving may also put family relationships in jeopardy, says University of Minnesota professor Paul Rosenblatt. The same factors that make using a cell phone while driving more hazardous -- longer reaction times and impaired attention -- can also make family communication in that situation more risky, says Rosenblatt in an article in the current issue of Family Science Review. The article, authored by Rosenblatt and graduate student Xiaohui Li, provides a speculative theoretical analysis on the topic. Rosenblatt is a family social science professor in the university's College of Education and Human Development. "If we assume that the relationship risks involved in talking on a cell phone while driving are similar to the driving risks -- both tasks involve divided attention and distraction -- we can develop ideas about how a family relationship may be impaired," Rosenblatt says in the article. For example, studies have indicated that cell phone use while driving leads to slower reaction times on the road. This could translate to the driver's cell phone conversation as well. "A delay in the conversation could be a problem if the person (spouse or partner) on the other end of the conversation interprets the delayed reaction as an indicator of ambivalence, of not having a ready answer or of hiding something. This all leads to upsetting the partner," Rosenblatt says. And, what if the driver misses important details of the conversation? This could lead to misunderstandings and more hard feelings, he says. "In general, cell phone usage while driving might lead to missed relationship stop lights, slow reactions to dangerous relationship circumstances, loss of control of one's part of the interaction, and interaction mistakes that could lead to conflict, hurt feelings, misunderstandings, and possibly even serious damage to the relationship," Rosenblatt says in the article. The partner who is not driving might be worried about the driver's safety and may cut a conversation short so the driver can concentrate, but the driver might interpret that in a negative way. In addition to the relationship problems created by talking on cell phone while driving, a number of problems arise that both people have when one of them is driving while talking on a cell phone. The lack of visual cues including gestures, facial expressions and posture creates challenges. Poor cell phone reception and the noise from the automobile and the road can all contribute to misunderstandings, he says. In the article, Rosenblatt explores five hypothetical examples of possible relationship problems that could arise when a driver is talking with a family member via cell phone. The examples he explores include the partner asking the driver to run an errand; a family member calls with good news; a family member calls with bad news; arguments over the phone and apologies over the phone. Each of the scenarios can be wrought with frustration and misunderstanding. Most relationships can manage the added difficulties related to cell phone use. "However, for couples in which things have been so difficult that they both are considering ending the relationship, problems arising from a difficult phone conversation, may push their relationship to the tipping point," Rosenblatt says.

Jun 15, 2010

Health

Study: Specific PTSD symptoms related to anger and aggressiveness among Iraq/Afghanistan veterans

CHAPEL HILL -- Focusing on certain PTSD symptoms may be key to treating anger among Iraq/Afghanistan Veterans, according to a study by University of North Carolina at Chapel Hill and Veterans Affairs researchers. "Most returning veterans don't have PTSD or difficulty with anger or aggressiveness, but for the small subset who do, this study helps to identify related risk factors," said Eric Elbogen, PhD, lead author of the study, an assistant professor of psychiatry in the UNC School of Medicine and a staff psychologist at the VA Medical Center in Durham, N.C. "The data showed that PTSD symptoms such as flashbacks or avoiding reminders of a trauma were not consistently connected to aggressiveness," said Elbogen. "Instead, we found that post-deployment anger and hostility were associated with PTSD hyperarousal symptoms: sleep problems, being 'on guard,' jumpiness, irritability, and difficulty concentrating." From interviews with 676 veterans, Elbogen and VA colleagues identified features associated with anger and hostility, which result in increased risk of post-deployment adjustment problems as veterans transition to civilian life. Veterans who said they had difficulty controlling violent behavior were more likely to report witnessing pre-military family violence, firing a weapon during deployment, being deployed more than 1 year, and experiencing current hyperarousal symptoms. There was an association with a history of traumatic brain injury, but it was not as robust as the relationship to hyperarousal symptoms. Elbogen said, "Our data suggest the effects of traumatic brain injury on anger and hostility are not straightforward." Veterans with aggressive urges were more likely than others to report hyperarousal symptoms, childhood abuse, a family history of mental illness, and reexperiencing a traumatic event. Difficulty managing anger was associated with being married, having a parent with a criminal history, and avoiding reminders of the trauma, as well as hyperarousal symptoms. "As we learn more about risk factors and how to manage them, we'll be helping not only the veterans but their families and society at large. Veterans with these adjustment problems should seek help through the VA so we can best serve those who have served our country" Elbogen said. The study will appear on June 15 at AJP in Advance, the online advance edition of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association. Funding for this study was provided by the Department of Veterans Affairs, the University of North Carolina at Chapel Hill and the National Institute of Mental Health.

Jun 14, 2010

Health

Carotid artery ultrasound is an effective alternative to more invasive coronary angiography

New research from NYU Langone Medical Center shows that a simple, inexpensive and noninvasive carotid artery ultrasound of the neck can be used as a preliminary diagnostic tool for coronary artery disease (CAD). This may be an alternative to the standard, expensive and more invasive coronary angiography. The ultrasound test can also be used to rule out the diagnosis of CAD in patients presenting with reduced heart pump function. The new study appears in the June 2010 issue of the American Heart Journal. "Our research has identified that carotid artery ultrasound is capable of identifying the presence of severe and extensive coronary artery disease," said Harmony R. Reynolds, MD, assistant professor of Medicine and associate director of the Cardiovascular Clinical Research Center at NYU Langone Medical Center. "Based on our findings, physicians might consider using the carotid ultrasound test as an initial screen for CAD in patients with reduced heart pump function and no history of heart attack. If a patient tests positive for plaque buildup in the neck arteries, then it can be followed by angiography of the heart arteries." When a patient has reduced heart function, severe and extensive CAD is often the cause. CAD is a narrowing of the arteries in the heart caused by deposits of plaque. This condition reduces the flow of blood and oxygen to the heart and may lead to weakening of heart muscle and/or a heart attack. Traditional diagnosis of CAD is through coronary angiography. However, this test is an invasive and expensive catheter imaging procedure that is associated with risks from contrast material and radiation exposure. In the study, patients underwent the noninvasive carotid artery ultrasound to determine the artery's intima-media thickness (IMT) and presence or absence of plaque. Researchers concluded that carotid artery ultrasound is a valuable screening tool for diagnosing and excluding CAD when a patient has heart muscle weakness without a known cause. "Ultrasound of the carotid artery is a very widely available and inexpensive technique, offered at NYU Langone Medical Center and virtually all medical centers and even in many cardiologists' offices," said Glenn I. Fishman, MD, director of the Leon H. Charney Division of Cardiology and William Goldring Professor of Medicine at NYU Langone Medical Center. "The study, if replicated in a larger population, could change the screening of patients with unexplained decreased heart pump function, and potentially allow them to avoid the need for invasive coronary angiography." About NYU Langone Medical Center NYU Langone Medical Center is one of the nation's premier centers of excellence in healthcare, biomedical research, and medical education. For over 170 years, NYU physicians and researchers have made countless contributions to the practice and science of health care. Today the Medical Center consists of NYU School of Medicine, including the Smilow Research Center, the Skirball Institute of Biomolecular Medicine, and the Sackler Institute of Graduate Biomedical Sciences; and the NYU Hospitals Center, including Tisch Hospital, a 705-bed acute-care general hospital, Rusk Institute of Rehabilitation Medicine, the first and largest facility of its kind, and NYU Hospital for Joint Diseases, a leader in musculoskeletal care, a Clinical Cancer Center and numerous ambulatory sites.

Jun 14, 2010

Earth & Environment

Genome BC, Chile and Norway take another step closer to fully sequencing the salmon genome

Vancouver, BC - The economically important, environmentally sensitive Atlantic salmon species is one step closer to having its genome fully sequenced, thanks to an international collaboration involving researchers, funding agencies and industry from Canada, Chile and Norway. Genome BC partnered with the Chilean Economic Development Agency, InnovaChile, Norwegian Research Council, Norwegian Fishery and Aquaculture Industry Research Fund to form the International Cooperation to Sequence the Atlantic Salmon Genome (the Cooperation). Together they are well underway on a multi-million dollar, multi-phased project that will produce a genome sequence that identifies and maps all of the genes in the Atlantic salmon genome and can act as a reference/guide sequence for the genomes of other salmonids (e.g. Pacific salmon, rainbow trout and more distantly related fish such as smelt and pike.) Phase one of the project was awarded to Beckman Coulter Genomics to produce a 4X coverage genome using paired-end, plasmid, fosmid and BAC Sanger sequences. It is expected that this phase will be complete in January, 2011. The Cooperation is gearing up for phase two which will result in a high definition and well-annotated genome using primarily next generation sequencing technologies. The Cooperation is seeking interested parties (publically or privately funded genome sequencing centres, or public/private partnerships) to undertake phase two. Those wishing to express interest in phase two of the project need to do so by June 26, 2010. See www.genomebc.ca/partners/international-collaborators/ for complete details and contact information. Interested parties will be invited to attend a workshop in September in Toronto, Canada to present an approach to accomplishing the goal.

Jun 14, 2010

Earth & Environment

Oppenheimer-Phillips effect predicts fusion and beta decay Ni + d1

A relativistic interpretation of Casimir effect represents an enabling step for the numerous claims of excess heat in LENR.

Jun 14, 2010

Earth & Environment

Fermilab's MINOS experiment suggests difference in key neutrino and antineutrino property

BATAVIA, Illinois-Scientists of the MINOS experiment at the Department of Energy's Fermi National Accelerator laboratory today (June 14) announced the world's most precise measurement to date of the parameters that govern antineutrino oscillations, the back-and-forth transformations of antineutrinos from one type to another. This result provides information about the difference in mass between different antineutrino types. The measurement showed an unexpected variance in the values for neutrinos and antineutrinos. This mass difference parameter, called Δm2 ("delta m squared"), is smaller by approximately 40 percent for neutrinos than for antineutrinos. However, there is a still a five percent probability that Δm2 is actually the same for neutrinos and antineutrinos. With such a level of uncertainty, MINOS physicists need more data and analysis to know for certain if the variance is real. Neutrinos and antineutrinos behave differently in many respects, but the MINOS results, presented today at the Neutrino 2010 conference in Athens, Greece, and in a seminar at Fermilab, are the first observation of a potential fundamental difference that established physical theory could not explain. "Everything we know up to now about neutrinos would tell you that our measured mass difference parameters should be very similar for neutrinos and antineutrinos," said MINOS co-spokesperson Rob Plunkett. "If this result holds up, it would signal a fundamentally new property of the neutrino-antineutrino system. The implications of this difference for the physics of the universe would be profound." The NUMI beam is capable of producing intense beams of either antineutrinos or neutrinos. This capability allowed the experimenters to measure the unexpected mass difference parameters. The measurement also relies on the unique characteristics of the MINOS detector, particularly its magnetic field, which allows the detector to separate the positively and negatively charged muons resulting from interactions of antineutrinos and neutrinos, respectively. MINOS scientists have also updated their measurement of the standard oscillation parameters for muon neutrinos, providing an extremely precise value of Δm2. Muon antineutrinos are produced in a beam originating in Fermilab's Main Injector. The antineutrinos' extremely rare interactions with matter allow most of them to pass through the Earth unperturbed. A small number, however, interact in the MINOS detector, located 735 km away from Fermilab in Soudan, Minnesota. During their journey, which lasts 2.5 milliseconds, the particles oscillate in a process governed by a difference between their mass states. "We do know that a difference of this size in the behavior of neutrinos and antineutrinos could not be explained by current theory," said MINOS co-spokesperson Jenny Thomas. "While the neutrinos and antineutrinos do behave differently on their journey through the Earth, the Standard Model predicts the effect is immeasurably small in the MINOS experiment. Clearly, more antineutrino running is essential to clarify whether this effect is just due to a statistical fluctuation." The MINOS experiment involves more than 140 scientists, engineers, technical specialists and students from 30 institutions, including universities and national laboratories, in five countries: Brazil, Greece, Poland, the United Kingdom and the United States. Funding comes from: the Department of Energy and the National Science Foundation in the U.S., the Science and Technology Facilities Council in the U.K; the University of Minnesota in the U.S.; the University of Athens in Greece; and Brazil's Foundation for Research Support of the State of São Paulo (FAPESP) and National Council of Scientific and Technological Development (CNPq). Fermilab is a national laboratory funded by the Office of Science of the U.S. Department of Energy, operated under contract by Fermi Research Alliance, LLC.

Jun 14, 2010

Health

Internationally known neuroblastoma expert reviews progress versus challenging childhood cancer

Pediatric oncologist John M. Maris, M.D., describes the current state of the science in combating neuroblastoma, the most common solid cancer of early childhood. In his article in the June 10, 2010 New England Journal of Medicine, "Recent Advances in Neuroblastoma," Maris reviews the field's latest research knowledge -- much of it based on efforts by Maris and his colleagues at The Children's Hospital of Philadelphia. Maris directs a laboratory at CHOP in collaboration with the multicenter Children's Oncology Group (COG) using tissue samples from 5,000 patients -- the world's largest sample collection for neuroblastoma. A cancer of the sympathetic nervous system, neuroblastoma most commonly occurs as a solid tumor arising from the adrenal gland in the abdomen. Neuroblastoma remains one of the most puzzling of childhood cancers -- ranging from cases of widespread but benign tumors in infants that spontaneously and completely disappear, to high-risk subtypes in older children that are relentlessly aggressive. Maris is the chief of Oncology at Children's Hospital and director of the Hospital's Center for Childhood Cancer Research. Just three years ago, he wrote a review article on neuroblastoma for The Lancet. Since that time, a stream of discoveries from his lab has explored the genetic landscape of neuroblastoma. In 2008, Maris led the team that identified common DNA variations on chromosome 6, the first time researchers found the cancer's genetic origin. Later that year, Yael Mosse, M.D., collaborating at CHOP with Maris, reported that mutations in the ALK gene were the main cause of inherited neuroblastoma, and also played a role in many cases of non-inherited neuroblastoma. In 2009, Maris published two more gene studies, identifying common variants in the gene BARD1 and copy number variants on chromosome 1 that raised the risk of neuroblastoma. The latter study was the first ever to find a specific copy number variant that predisposes to a human cancer. The ultimate goal of basic research at CHOP is to translate findings into more effective treatments for children. To that end, the Cancer Center at CHOP is currently leading a clinical trial of an ALK inhibitor for children who have relapsed after neuroblastoma treatments. In his review, Maris describes other innovative therapies, such as a national immunotherapy trial by the COG, using monoclonal antibodies and cytokines to selectively target neuroblastoma cells. Another experimental treatment, developed at CHOP and other centers, uses MIBG, a radioactive isotope that zeroes in on neuroblastoma cells. Maris also cites federally sponsored collaborative programs designed to identify new drugs that will interrupt the key cell signaling pathways that drive neuroblastoma. To arrange an interview with Dr. Maris, contact Rachel Salis-Silverman at The Children's Hospital of Philadelphia at 267-426-6063. (email: [email protected])

Jun 14, 2010

Health

Specially trained nurse practitioner detected same breast abnormalities as surgeon

Women were just as likely to have breast abnormalities picked up by a specially trained nurse practitioner as a consultant breast surgeon, according to research published in the July issue of the Journal of Advanced Nursing. Researchers at Glamorgan Hospital, Wales, UK, compared the findings of 126 women examined by a nurse practitioner and consultant surgeon referred to a symptomatic breast disease clinic over a 13-month period. They produced exactly the same results in 92 per cent of cases. "All the assessments were carried out by the same nurse practitioner and consultant surgeon and there were no statistically significant differences between the two sets of results" says lead author Mr Gary Osborn, a Specialist Registrar in General Surgery at the hospital, which treats nearly 300 women with breast cancer a year. Key findings of the study included: The women referred to the clinic during the study period were aged between 20 and 78 with a median age of 54. Two of the 126 women had symptoms in both breasts, which means that 128 assessments were recorded. 74 women (59 per cent) had some sort of abnormality. 37 discrete lumps were discovered in 35 women, with the consultant surgeon missing two breast cysts and the nurse practitioner missing one. They recorded the same results in 34 of the 37 assessments, giving an agreement rate of 92 per cent. Nine of the women had breast cancer. Both assessors gave five of the cancers a score of P4 (suspected malignancy) or P5 (malignant) and four cancers were given a score of P3 (indeterminate lump). A single lump thought to be suspicious (P4) by the surgeon was correctly identified as a breast cyst by the nurse. The remaining abnormalities included harmless lumps filled with fluid (cysts), fibrous/glandular tissue (fibroadenomas) or fibrous tissue/blood vessels (papillomas). 114 patients had scans -- 31 per cent had mammograms, 26 per cent had ultrasounds and 32 per cent had both. There was no difference between the mammography requests ordered by the nurse and surgeon, but when it came to ultrasounds, the nurse ordered three extra scans and the surgeon ordered four extra. One of the extra scans ordered by the nurse identified a cyst and one of the extra scans ordered by the surgeon confirmed a benign lymph node. "In the UK, patients referred by their family doctor with suspected breast cancer should be seen by a specialist within two weeks" says Mr Osborn. "The reduction in junior doctors' working hours as a result of the European Working Time Directive makes this target harder to achieve and the risk is that patients may experience delays in assessment and diagnosis. "This study aimed to test the theory that trained nurse practitioners can perform an important role in assessing new patients in breast cancer clinics to ensure that they are seen as quickly as possible." The authors argue that the audit carried out at Glamorgan Hospital provides objective evidence that a nurse practitioner can become proficient in evaluating patients with symptomatic breast cancer. "Our study showed that the diagnostic accuracy shown by the nurse practitioner, together with the scans she requested, compared favourably with the consultant breast surgeon" says Mr Osborn. The team plan further research, with other members of staff and at other hospitals, to see if the encouraging results are replicated. "We believe that nurse practitioners can be a valuable asset to the multidisciplinary breast team if they received special training, consultant support and are subject to regular comparative audits" concludes Mr Osborn. "Their enhanced clinical skills can reduce the impact that working hours legislation is having on the availability of junior medical staff. "This in turn, can enable us to see more patients in clinics, reduce waiting times and meet Government targets." Notes to editors Breast disease diagnostic ability of nurse practitioners and surgeons. Osborn et al. Journal of Advanced Nursing. 66.7, pp 1452-1458. (July 2010). DOI: 10.1111/j.1365-2648.2010.05291.x Journal of Advanced Nursing is read by experienced nurses, midwives, health visitors and advanced nursing students in over 80 countries. It informs, educates, explores, debates and challenges the foundations of nursing health care knowledge and practice worldwide. Edited by Professor Alison Tierney, it is published 24 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. www.journalofadvancednursing.com Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or www.interscience.wiley.com

Jun 14, 2010

Health

Study reveals causes of survival disparities based on insurance among rectal cancer patients

Disparities in cancer stage and treatment are the main reasons why Medicaid-insured and uninsured rectal cancer patients are twice as likely to die within five years as privately insured patients. That is the conclusion of a new study published early online in Cancer, a peer-reviewed journal of the American Cancer Society. Because poorer survival among rectal cancer patients without private insurance is largely attributable to later cancer stage at diagnosis and inadequate treatment, disparities may be lessened through health care reform. A number of factors may account for survival disparities seen among patients with colorectal cancer. The likelihood that these patients might die prematurely may be influenced by cancer stage and treatment, health insurance status, and demographic factors such as age, sex, race/ethnicity, and poverty status. To explore the relative contribution of such factors on survival disparities, Anthony S. Robbins, MD, PhD, of the American Cancer Society in Atlanta and his colleagues conducted a study of insurance status and survival among 19,154 rectal cancer patients aged 18 to 64 years, using data from the National Cancer Data Base, a national hospital-based cancer registry. Patients were diagnosed in 1998 to 2002 and were followed through 2007. (The investigators restricted the study to rectal cancer rather than all colorectal cancer because it is staged and treated differently than colon cancer, and previous research on rectal cancer is more limited than research on colon cancer.) Dr. Robbins and his team examined the impact of 10 factors on 5-year survival: age, sex, race/ethnicity, cancer grade, cancer subtype, neighborhood education and income levels, treatment facility type, cancer stage, and treatment. After adjusting only for age, the researchers found that Medicaid-insured and uninsured patients had twice the risk of privately insured patients of dying within five years. After adjusting for all of the factors listed above, the investigators determined that rectal cancer patients insured through Medicaid had a 34 percent increased risk of dying within five years compared with privately insured patients. Uninsured patients had a 29 percent increased risk of dying within five years compared with privately insured patients. Disparities in cancer stage and treatment accounted for approximately 53 percent of the excess deaths, while factors other than stage and treatment accounted for approximately 17 percent. "Our main finding, that most of the excess mortality seen among uninsured and Medicaid-insured patients was explained by two modifiable factors (stage and treatment) suggests that improving insurance coverage and reducing cost-related barriers to primary care, colorectal cancer screening, and high-quality treatment would have a major impact on colorectal cancer survival disparities," said Dr. Robbins. Article: "Insurance status and survival disparities among non-elderly rectal cancer patients in the national cancer data base." Anthony S. Robbins, Amy Y. Chen, Andrew K. Stewart, Charles A. Staley, Katherine S. Virgo, and Elizabeth M. Ward. Cancer; Published Online: June 14, 2010 (DOI: 10.1002/cncr.25317). Author Contact: To arrange an interview with Dr. Robbins, please contact David Sampson at the American Cancer Society on [email protected] or +1 213.368.8523

Jun 13, 2010

Health

Brain MRI in children: 'Incidental' findings yield disclosure dilemmas for doctors, patients

Pediatricians whose patients undergo "routine" brain MRIs need a plan to deal with findings that commonly reveal unexpected-but-benign anomalies that are unlikely to cause any problem, reports a research team led by Johns Hopkins Children's Center investigators. "Doctors need to figure out what, if anything, they want to share with patients about such findings because they seldom require urgent follow-up," says senior investigator John Strouse, M.D., Ph.D., a hematologist at Hopkins Children's. In a report published online June 14 in the journal Pediatrics, Strouse and team describe the results of what they believe is the largest study to date of the frequency and type of unexpected brain findings in children who get MRI tests for reasons unrelated to these benign anomalies. The most common reasons for MRI testing in children are seizures and headaches or as a prerequisite for enrolling in certain studies. The patients in the Hopkins study, all of whom had sickle cell disease and were predominantly African-American, had brain MRIs before enrolling in a research study about their condition. The investigators emphasize that none of the brain anomalies discovered in the study were related to the patients' underlying condition, meaning the findings may apply to healthy children in general. Of the 953 children, ages 5 to 14, in the study, 63 (6.6 percent) had a total of 68 abnormal brain findings. None of the children required emergency treatment or follow-up, and only six children (0.6 percent) needed urgent follow-ups. The urgent findings involved changes suggestive of slow-growing tumors and a structural defect called Chiari malformation type 1, in which brain tissue extends into the spinal canal. None of the six children with urgent findings had any clinical symptoms suggestive of the anomalies. Because stumbling upon such unexpected findings -- especially ones of unclear clinical importance -- can lead to more, often unnecessary, tests and fear, the Hopkins study highlights the need for pediatricians to prepare for such discussions, Strouse says. And in the absence of guidelines on how to deal with such findings, many pediatricians, Strouse adds, feel so unprepared that they may forego the discussion altogether and simply refer the patient to a neurologist or a neurosurgeon for consultation. "Helpful as it is, imaging technology can open a Pandora's box, sometimes showing us things we didn't expect to see and are not sure how to interpret," says lead investigator Lori Jordan, M.D., Ph.D., a pediatric neurologist at Hopkins Children's. Twenty-five children (2.6 percent) required only routine follow-up for spinal cord anomalies or another, less serious subtype of Chiari malformation with minimal brain tissue protrusion into the spinal canal. Thirty-two children (3.4 percent) required no follow-up at all for a benign anatomical anomaly called cavum septum pellucidum, marked by the presence of a thin membrane separating the lateral ventricles of the brain, which along with Chari malformation were the most common anomalies in the study. Other abnormalities included brain cysts and cortical dysplasia, a condition in which certain nerve cells form abnormally in the wrong part of the brain and can lead to seizures. Co-investigators include Robert McKinstry, M.D., Ph.D., of St. Louis Children's Hospital; Michael Kraut, M.D., Ph.D., and James Casella, M.D., both of Hopkins; William Ball, M.D., of Cincinnati's Children's Medical Center; Bruce Vendt, B.S., M.B.A., and Michael DeBaun, M.D., M.P.H., both of Washington University School of Medicine, St. Louis. DeBaun and Casella are the chair and vice chair, respectively, of the multicenter clinical trial in children with sickle cell disease. The research was funded by the National Institutes of Health, the Doris Duke Charitable Foundation and the American Society of Hematology. Related on the Web: Flu Shots a Must For Kids With Sickle Cell Disease http://www.hopkinschildrens.org/Flu_Shots_a_Must_For_Kids_With_Sickle_Cell.aspx Infectious Disease Expert Discusses H1N1 in Kids; Quells Fears of H1N1 Vaccin http://www.hopkinschildrens.org/newsDetail.aspx?id=7270 Risk of Serious Flu-Related Sickness in Pregnant Women Outweighs Risk of Injectable Vaccine http://www.hopkinschildrens.org/Risk-of-Serious-Flu-related-Sickness-in-Pregnant-Women-Outweighs-Risk-of-Injectable-Vaccine.aspx Parent's Guide to H1N1 (Swine) Flu http://www.hopkinschildrens.org/flu-tips-for-parents.aspx Strokes: Not Just for Older Adults http://www.hopkinschildrens.org/Strokes-Not-Just-For-Older-Adults.aspx

Jun 13, 2010

Earth & Environment

New research into the deep ocean floor yields promising results for microbiologists

KNOXVILLE -- Research by a small group of microbiologists is revealing how marine microbes live in a mysterious area of the Earth: the realm just beneath the deep ocean floor. The ocean crust may be the largest biological reservoir on our planet. Beth Orcutt, a post-doctoral fellow at Aarhus University in Denmark and the University of Southern California, presented her new findings about this little researched realm today at Goldschmidt 2010, an annual conference sponsored by a number of international geochemical societies and hosted this year by the University of Tennessee, Knoxville, and Oak Ridge National Laboratory. "I think this research is exciting because it offers us a glimpse into a habitat on Earth that we know next to nothing about," Orcutt said. "If you consider how much ocean crust there is on Earth, and how much of that is hydrologically active, then this environment could be one of the most massive habitats for microbial life on Earth. There may be new species of life and new types of metabolism that we haven't discovered yet." There has been limited research into this deep marine crust, so Orcutt and her colleagues have developed new hole-boring technologies to study microbial life living beneath rock on the seafloor. Orcutt must use a robotic submarine to reach this realm, buried under 2660 meters (1⅔ miles) of water. Then she must drill through 260 meters (850 feet) of sediment. The microbes Orcutt and her team study receive no light that far beneath the ocean floor, so part of what they are exploring is how these microscopic organisms survive in such harsh conditions. Orcutt believes this research also can yield a new understanding of the potential for life on other planets. The subsurface under deep oceans is an extreme environment for any life to exist. Such environments may be present on other planets, so Orcutt theorizes that life might exist there in the form of microbial organisms. "I hope that the general public will understand that the ocean isn't just a giant pond with a featureless, unexciting bottom," Orcutt said. "The seafloor and sub-seafloor are exciting environments where microbes rule. We have to develop sophisticated experiments to try to learn more about these microbial habitats, experiments which will reveal new information about how life survives and thrives on Earth and maybe about how life may exist on other planets." This year's Goldschmidt Conference is being held during the week of June 13-18 in Knoxville. Several thousand geochemists from around the world are presenting new scientific discoveries dealing with the Earth, energy and the environment.

Jun 13, 2010

Health

University Hospitals Case Medical Center cardiologists discover cancer risks in blood pressure meds

University Hospitals Case Medical Center cardiologists have uncovered new research showing an increased risk of cancer with a group of blood pressure medications known as angiotensin-receptor blockers (ARBs). This class of drugs is used by millions of patients not only for high blood pressure but also for heart failure, cardiovascular risk reduction and diabetic kidney disease. University Hospitals Harrington-McLaughlin Heart & Vascular Institute's Drs. Ilke Sipahi, Daniel I. Simon and James C. Fang recently completed a meta-analysis of over 60,000 patients randomly assigned to take either an ARB or a control medication. Their findings are published online today at The Lancet Oncology. The researchers found that patients randomized to ARBs has "significantly increased risk of new cancer" compared to control patients. "We have found the risk of new cancers was increased with these medications by 8-11 percent," said Dr. Ilke Sipahi, associate director of heart failure and transplantation and assistant professor at Case Western Reserve University School of Medicine. "Most importantly, risk of lung cancer was increased by 25 percent." However, the research did not establish any link between ARBs and other types of cancer such breast cancer. "This is the first time an association between ARBs and cancer development is suggested," Dr. Sipahi continued. "While our findings are robust, they need to be replicated in other studies before they can be considered as definitive." Before this study, there were no major safety concerns with ARBs except for their use in pregnancy and in patients with chronic kidney or blockages of kidney arteries. Interestingly, previous animal studies with ARBs have been negative for cancer development. "In medicine, physicians must balance the benefits and risks of all drug and device therapies," said Dr. Daniel Simon, director of the Harrington-McLaughlin Heart & Vascular Institute at University Hospitals Case Medical Center and professor at Case Western Reserve University School of Medicine. "We recommend that patients discuss the findings of this study with their physicians since ARBs are effective agents in the treatment of high blood pressure and heart failure. Meta-analyses are a powerful tool to look at low frequency safety signals, but require confirmation with other approaches, such as large national health and managed care registries." About University Hospitals University Hospitals serves the needs of patients through an integrated network of hospitals, outpatient centers and primary care physicians. At the core of our health system is University Hospitals Case Medical Center. The primary affiliate of Case Western Reserve University School of Medicine, University Hospitals Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation and the world, including cancer, pediatrics, women's health, orthopedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics. Its main campus includes the internationally celebrated UH Rainbow Babies & Children's Hospital, ranked second in the nation for the care of critically ill newborns; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Ireland Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. For more information, go to www.uhhospitals.org

Jun 13, 2010