UT Health Science Center

7703 Floyd Curl Drive
San Antonio, TX 78229
P 210.567.7000
www.uthscsa.edu

uthsca

the UT Health Science Center Overview

The University of Texas Health Science Center at San Antonio serves San Antonio and the 50,000 square-mile area of South Texas. It trains more than 3,000 students every year in affiliated hospitals, clinics and healthcare facilities around the area. The center is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools to award certificates, baccalaureate, master’s, doctoral and professional degrees.

Educational programs available at the Health Science Center range from medicine, dentistry and nursing to graduate  biomedical sciences and health professions such as clinical laboratory sciences, physical therapy and occupational therapy. The center’s School of Medicine is fully accredited by the Liaison Committee on Medical Education and is recognized as one of the best in the state and nation.

The Health Science Center is a respected and internationally recognized biomedical research university promoting the discovery, development and dissemination of biomedical solutions. Research conducted at the Health Science Center ranges from cancer therapy, longevity and aging studies, and pregnancy and newborn conditions to community-based health promotion in women and children, integration of medicine and science, and psychiatric genetic research.

The School of Medicine’s faculty practice is UT Medicine San Antonio which includes the Cancer Therapy & Research Center (CTRC), one of the elite cancer centers in the country to be designated as a National Cancer Institute Cancer Center.

Neuroscience Articles

  • Full-day preschool programs promote kindergarten readiness

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Kids who attended full-day preschool programs were more ready for kindergarten and had fewer absences than kids who attended half-day preschool programs, according to a new study.

    It is surprising that full-day preschoolers performed better in many different domains, including language, math, socio-emotional and physical health, according to lead author Arthur J. Reynolds of the Institute of Child Development and Human Capital Research Collaborative at the University of Minnesota in Minneapolis.

    Full-day preschoolers also had 45 percent fewer chronic absences than half-day preschoolers, he noted.

    Reynolds and his coauthors evaluated preschoolers at the end of the 2012-2013 school year in 11 Chicago schools, including predominantly black or Hispanic children age four to five.

    For the full-day program, 409 kids attended the Child-Parent Center for seven hours a day, while 573 kids had attended the three-hour version of the program.

    Kids in the seven-hour programs scored higher on language, math, socio-emotional development, and physical health tests, though the differences were modest in some cases.

    Literacy and thinking skill scores were similar for both groups, according to results in JAMA.

    Full-day kids had fewer absences than kids in the three-hour programs.

    Around half of the kids in the full-day programs were 'chronically absent,' missing at least 10 percent of school days, compared to almost 72 percent of kids in half-day programs.

    Full-day preschoolers averaged 936 hours of instruction for the year, compared to 418 hours for the half-day preschoolers, more than double the hours of instruction, Reynolds noted.

    "The general expectation is that greater exposure to a good program should yield better results than lesser exposure, and this study is an example of that," said Lawrence J. Schweinhart of the HighScope Educational Research Foundation in Ann Arbor, Michigan.

    "But some studies have not confirmed this general expectation, probably because the programs were not so good," he told Reuters Health by email.

    Schweinhart wrote an editorial about the results.

    The measured differences in school readiness were equivalent to a four to five month advantage for the full-day group, Reynolds said. More than 80 percent of full-day preschoolers met national norms for total school readiness compared to 59 percent of half-day preschoolers.

    It is possible, but very unlikely, that kids in the full-day program might be different from kids in the half-day program in other ways that would explain the advantage in school readiness, Reynolds told Reuters Health by email.

    "We focused on children in the same schools and they had equivalent performance at the beginning of the year and were similar in many characteristics," he said.

    Cost is the main drawback of full-day preschool programs, which are nearly double the cost of part-day programs, he said.

    "Higher income families have this choice, but most lower income families that rely on state pre-k or school programs don't have much choice," Reynolds said.

    Typical state pre-k or head start programs are only part-day, he said.

    "Our study shows the advantages of increasing the availability of full-day publicly funded programs," he said. "Not enough full-day programs are available today, especially that are high in quality."

    The Midwest Child-Parent Center program in this study has highly qualified teachers, small classes, active learning opportunities, many supports for families, and support for staff that are essential for high quality learning experiences, he noted.

    As the study only included preschoolers, it did not link kindergarten readiness with later academic performance or other measures of success.

    "I have my doubts that the added value of full-day over part-day found in this study will show up in longer-term results," Schweinhart said.

    But preschool will likely lead to better long-term results than no preschool, he said.

    SOURCE: http://bit.ly/1xYwLk6 JAMA, online November 25, 2014.

  • Double arm transplant recipient thanks doctors in Boston

    By Richard Valdmanis

    BOSTON (Reuters) - A 40-year-old quadruple amputee on Tuesday thanked the Boston surgeons who performed a rare dual arm transplant on him last month and described the experience of getting the new limbs as surreal.

    Will Lautzenheiser, who lost his arms and legs to a streptococcal infection in 2011, said he has limited function in the new arms, which are encumbered by wrappings to help with healing.

    The arms were attached from an anonymous donor in a nine-hour operation at Brigham & Women's Hospital.

    "I want to thank the doctors for their great service," an emotional Lautzenheiser said at a news conference at the hospital. "I want to thank everyone."

    He said having the new limbs was "incredible" and "surreal."

    Lautzenheiser, a former professor of film production and screenwriting at Boston University and Montana State University, has a long stretch of therapy ahead but hopes to return to his career.

    The family of the anonymous donor told Lautzenheiser in a statement issued Tuesday that it hoped he would make a "wonderful recovery, and that your loved ones will be able to enjoy your warm embrace."

    The surgery involved 35 medical staff, including 13 surgeons, according to Brigham & Women's Hospital.

    While rare, there have been other double-arm transplants in the United States recent years. In 2012, a U.S. soldier who lost all four limbs in a roadside explosion in Iraq had double-arm transplant surgery at Johns Hopkins in Baltimore.

  • For rural veterans with PTSD, telemedicine may help

    By Kathryn Doyle

    (Reuters Health) - For the many veterans with post-traumatic stress disorder (PTSD) who don't have access to a trained mental health care team, connecting with such a team remotely by phone and video chats may help, a new study suggests.

    At least 500,000 veterans in the Veterans Health Administration (VHA) system, or nearly 10 percent of the VHA population, were diagnosed with PTSD in 2012, the researchers write in JAMA Psychiatry.

    Previous studies have found that PTSD treatments delivered by interactive video are equivalent to therapy given in person, according to lead author John Fortney of the VA Puget Sound Health Care System in Seattle, Washington.

    "PTSD services are available to all Veterans enrolled in the VA, but each veteran's perceptions about their access to care can depend on many factors," Fortney told Reuters Health by email.

    "We know that 38 percent of VA patients diagnosed with PTSD live in rural areas, and that two thirds live closer to one of VA's 825 Community Based Outpatient Clinics than to a large Medical Center (VAMC), which underscores the importance of striving to provide the highest quality PTSD care in these clinics," he said.

    For the new study, researchers included 265 middle-aged vets with severe PTSD symptoms at one of the outpatient clinics without onsite psychiatrists or psychologists from 2009 through 2011. Patients were recruited from Shreveport, Louisiana, Little Rock, Arkansas and Loma Linda, California.

    Half received the outpatient clinic's ordinary care, and the other half were connected to an additional care team at a larger medical center via telemedicine, including nursing care managers and pharmacists calling their homes and psychiatrists providing consultations by video-chat at the outpatient clinic. The psychiatrists then gave feedback and treatment recommendations to providers at the clinic through electronic medical records.

    Psychologists delivered cognitive processing therapy, a specific behavioral therapy developed to treat PTSD, by video chat.

    During the study, more than half of the telemedicine group received cognitive processing therapy, compared to 12 percent of the comparison group.

    Patients in the telemedicine group had bigger decreases in Posttraumatic Diagnostic Scale scores at the six and 12-month mark than the comparison group, according to the authors.

    There was no difference in medicines prescribed or taken between the two groups, the authors write.

    "Dr. Fortney's intervention developed a method to extend the reach of the specialized PTSD services to the community primary care clinics by using telehealth technology," said Michele Spoont, Health Psychologist in the Minneapolis VA Health Care System and assistant professor in the Departments of Psychiatry and Psychology at the University of Minnesota.

    "Not only does it make it easier for veterans to get the specialized treatments, but maybe it will help those veterans who are hesitant to go to a mental health program get evidence-based PTSD treatment if it is offered in a primary care setting," Spoont told Reuters Health by email.

    She was not involved in the new research.

    Veterans should seek mental health care if they experience irritability or anger problems, depression, anxiety, insomnia, nightmares or unwanted memories about traumatic experiences, or if they're self-medicating with alcohol or drugs, having difficulty doing normal day-to-day activities because of emotional problems or difficulty concentrating, uncharacteristic conflict with family or friends, or having suicidal or violent thoughts or impulses, Spoont said.

    "Any VA primary care provider can help them get connected with mental health services," she said. "They can also call their local VA or go on the VA website to find locations near them for access to mental health services." (http://www.va.gov/)

    Not all patients are comfortable with interactive video technology, but the vast majority of patients are highly satisfied receiving psychiatric and psychological services via interactive video, Fortney said.

    "Many components of the telemedicine-based collaborative care model are currently available in the VA, including care manager programs, telepsychiatry, and in person Cognitive Processing Therapy," Fortney said. "However, it is not common to see the delivery of Cognitive Processing Therapy combined with the other components of the telemedicine-based collaborative care model."

    It would be feasible to implement this telemedicine strategy in the VA, but more research first needs to identify the strategies that would need to be put into place in order to promote the widespread adoption of this particular model of care, he said.

    SOURCE: http://bit.ly/15ep4dD JAMA Psychiatry, November 19, 2014.

  • Helmets, engine size important in child deaths on ATVs

    By Kathryn Doyle

    (Reuters Health) - Child deaths from crashes of all-terrain vehicles (ATVs), which dipped after 1985, began to climb again around 2001, and 12- to 15-year-olds accounted for more than half of all fatalities, according to a new study of Consumer Product Safety Commission data.

    The data include kids killed at ages six through age 18, but deaths in each age group were influenced by different risks, the authors write.

    "We know what all of the dangerous strategies are: no helmets, double riding, kids riding big ATVs with powerful engines, riding at night, but here they've narrowed down on fatalities," said Dr. Brendan Campbell, director of the Pediatric Trauma and Injury Prevention Center at Connecticut Children's Medical Center in Hartford, who was not involved in the new analysis.

    The American Academy of Pediatrics recommends that no one under age 16 operate or ride on an ATV.

    "This article reiterates to us that a lot under that age are riding and continue to die," Campbell said. "The younger you are, the more dangerous it is proportionally."

    Compared to adults, children under age 16 are at more than 12 times the risk for injury from an ATV accident, according to a 2001 study.

    That high risk is likely due to physical and mental immaturity, lack of training, riding on roadways, not wearing a helmet and other factors, the authors of the new study write.

    To determine the major contributors to ATV fatalities among younger kids, Gerene M. Denning and colleagues from the Roy J. and Lucille A. Carver College of Medicine and the University of Iowa in Iowa City analyzed data on 10,000 ATV-related deaths between 1985 and 2009 - including 3,240 in kids under age 18.

    When they grouped victims by age, they found 234 deaths in children younger than six, 849 deaths in youngsters aged six to 11, and 1,469 fatalities in kids ages 12 to 15.

    "Even among ATV riders, I think most people know that for a six- or seven- or eight-year-old, riding is very dangerous," Campbell told Reuters Health by phone.

    Pediatric deaths fell by more than 20 percent between 1985 and 1997, but returned to 1985 levels around 2000 and rose by another 40 to 140 percent by 2006, depending on the age group.

    Engine size also increased around 2000, the authors note. Over the whole study, adult-sized vehicles were involved in 95 percent of fatalities among kids younger than 16.

    Kids age 12 to 17 were more likely to be riding an adult-sized ATV than younger kids.

    "This study echoes our study in New Zealand by suggesting that behavior is the main risk factor for fatal ATV accidents," said Boaz Shulruf, an associate professor in the Office of Medical Education at the University of New South Wales in Sydney, Australia.

    The fact that the researchers identified a temporal change in the types of ATVs involved in fatal accidents, in that they got bigger over time, is a real call for action, he said.

    More than two-thirds of crashes among kids age 12 and older involved a collision with another vehicle or object, whereas most of the younger children died in non-collision events.

    Younger victims were more likely to be passengers, and older kids were more likely to be boys and to die in a roadway crash as opposed to an off-road crash. Almost one in five fatal crashes among older teens involved alcohol.

    More than 60 percent of all pediatric fatalities involved a head injury. Helmets reduced the likelihood of a head injury by 58 percent. For all age groups, 70 to 80 percent of kids were not wearing helmets, according to the analysis in Pediatrics.

    The authors of the study did not respond to a request for comment.

    The challenge now is "to translate this into public health policy," Campbell said.

    One way to do that would be to make helmet use mandatory, but since that has been difficult to institute even for motorcycles, it seems even more unlikely for ATVs, he said.

    "In Canada, ATVs have to be registered, but there's real resistance to that in the U.S." he said.

    And statewide helmet laws do not apply to private property, where many ATVs are used, Campbell noted.

    "If you don't ride ATVs and live in rural America, it's hard to understand that these are part of people's lives," he said.

    In any case, "put a helmet on your head," he said. For every ATV fatality, there are many more accidents, traumatic brain injuries and hospitalizations, he said.

    SOURCE: http://bit.ly/11Pnf4y Pediatrics, November 24, 2014.

  • CORRECTED-REFILE-U.S. government proposes more transparency in clinical trials

    (Rewrites sixth paragraph to clarify what clinical trials are affected)

    By Reuters Staff

    (Reuters) - U.S. health officials on Wednesday proposed significantly expanding what researchers are required to report about clinical trials of drugs, devices, and other interventions, addressing concerns that data crucial to patients and physicians is kept secret.

    The rules, which are open for public comment until Feb. 19, apply to the database ClinicalTrials.gov, operated by the National Institutes of Health (NIH).

    Researchers are documenting ever-more cases in which unfavorable study results are withheld from the public.

    "The proposals take important steps toward greater transparency, but there are also disappointments," said Kay Dickersin, director of the Center for Clinical Trials at the Johns Hopkins Bloomberg School of Public Health.

    One change would require that human studies funded even partly by the NIH, including surgical procedures and behavioral therapies such as for obesity, not only be registered at ClinicalTrials.gov but also report summary results. Previously, there was no such requirement.

    Absent NIH funding, clinical trials assessing the safety of experimental or approved drugs regulated by the U.S. Food and Drug Administration would not have to report that data.

    But researchers would be required to report other results, a significant expansion of the current requirement, which allows data to remain secret if, for instance, they find a drug or other therapy to be ineffective.

    "This proposed rule would close an important gap" by making additional information about clinical trials publicly available, FDA commissioner Dr. Margaret Hamburg said in a statement.

    In a 2013 study, scientists found that of hundreds of trials they examined half never published results. An analysis of scores of studies of the influenza drug Tamiflu reported in April that published studies painted the drug as safer and more effective than confidential clinical-trial reports submitted to regulators.

    Johns Hopkins' Dickersin, who has criticized the lack of transparency in clinical trials, praised the requirement that studies of additional uses of approved drugs, such as whether a neuralgia drug also works against migraines, report results. Currently, doctors are permitted to prescribe such "off-label" use of approved drugs, never knowing whether a study showed they do not work for the additional disorder.

    One disappointment, Dickersin said, is that the proposals do not require researchers to reveal details of study protocols, such as what endpoints - heart attacks, for example - it aims for and how. That might let a manufacturer conceal unfavorable results.

    Of the 178,000 studies registered on ClinicalTrials.gov, summary results have been posted for 15,000.

Oncology Articles

  • Hookah smokers are inhaling benzene

    By Shereen Lehman

    (Reuters Health) - High levels of benzene, a chemical in crude oil and gasoline, are present in hookah smokers and nonsmokers after they attend social events where the water pipes are used, a new report says.

    Benzene exposure is a known risk factor for leukemia. Since there are no safe levels of benzene exposure, interventions to prevent or reduce hookah smoking or regulate the tobacco products are needed, say the authors.

    "Hookah smoking involves tobacco which is simply hazardous to the health of those who smoke it, and those who socialize or live with them," Nada Kassem, who led the study, told Reuters Health in an email.

    Burning charcoal is needed to heat the hookah tobacco to generate the smoke, said Kassem, who is the associate director at the Center for Behavioral Epidemiology and Community Health at San Diego State University.

    "In addition to inhaling toxicants and carcinogens found in the hookah tobacco smoke, hookah smokers, and non-smokers who socialize with them, also inhale large quantities of charcoal combustion-generated toxic and carcinogenic emissions," she said, adding that benzene is present in both tobacco smoke and the burnt charcoal emissions.

    Kassem and colleagues had 105 hookah smokers and 103 non-smokers spend an average of three hours at either a hookah lounge or a house party where hookah was smoked.

    In the journal Cancer Epidemiology, Biomarkers and Prevention, they explain that urine levels of a substance called SPMA can be used to assess exposure to benzene.

    SPMA stands for S-phenylmercapturic acid, a byproduct of benzene.

    In hookah smokers, benzene uptake quadrupled after they smoked hookah tobacco in hookah lounges, and doubled after they smoked hookah tobacco in private homes, Kassem said.

    In non-smokers, the uptake of benzene did not change after events in private homes but increased 2.6 times after attending a social event in a hookah lounge.

    "This important study adds to the growing literature demonstrating that water pipe tobacco smoking exposes user to many of the same smoke toxicants to which cigarette smokers are exposed," Thomas Eissenberg told Reuters Health by email.

    Eissenberg, a researcher with Virginia Commonwealth University in Richmond, studies water pipe smoking but wasn't involved in this study. In comments to Reuters Health earlier this year, he noted that hookah smokers often mistakenly believe the water in the pipe filters out the dangerous toxins in the smoke - which is not the case. (See Reuters Health article of May 16, 2014, here: http://reut.rs/S4ccA0.)

    Eissenberg said this new study highlights one of the many risks of hookah smoking while also addressing concerns about previous work having been done in laboratories and not natural settings.

    "Both the laboratory and the naturalistic studies are consistent with one another, that water pipe tobacco smoke contains many toxicants, including nicotine that causes dependence, tobacco-specific nitrosamines that cause cancer, carbon monoxide that causes cardiovascular disease, and now benzene that causes leukemia, and water pipe tobacco smokers have these same toxicants in their bodies after they smoke tobacco in a water pipe," Eissenberg said.

    He said a growing body of literature clearly points to the need to regulate water pipe tobacco and water pipe tobacco smoking at least as strictly as tobacco cigarettes.

    Eissenberg also noted that in this study, nearly one in five hookah smokers said they smoked a water pipe daily.

    "There is an oft-repeated myth that water pipe use in this country is only occasional and thus somehow not harmful," Eissenberg said, "In fact, inhaling toxic smoke involves substantial health risk, and there are many individuals in this country who inhale toxic water pipe smoke every day."

    SOURCE: http://bit.ly/1FjdOJB Cancer Epidemiology, Biomarkers and Prevention, online November 21, 2014.

  • FDA tightens guidelines on technique for uterine fibroid surgery

    By Toni Clarke

    WASHINGTON (Reuters) - The U.S. Food and Drug Administration has tightened its guidelines on the use of a uterine surgical technique, saying it has been linked to the spread of a rare type of cancer.

    The agency said on Monday it is recommending that a boxed warning be placed on laparoscopic power morcellator devices used to treat uterine fibroids. Such an FDA warning is the strongest that a medication or treatment can carry while still remaining on the U.S. market.

    The devices are used to slice fibroid and uterine tissue into small pieces inside the body, allowing it to be removed through a small opening. The procedure is designed to shorten recovery time and reduce wound-site infections.

    Yet the technique can cause injury to local tissues and organs and spread unsuspected malignant tissue to places outside the uterus. In April, the FDA issued an alert discouraging use of the devices to remove fibroids due to these concerns.

    The FDA estimates that 1 in 350 women who have fibroid surgery have an unsuspected uterine cancer.

    Fibroids are often benign and may cause pelvic pain and bleeding. Sometimes a hysterectomy is required to remove them.

    Johnson & Johnson's Ethicon unit, the biggest maker of morcellator devices, suspended sales of the device following the FDA's advisory.

    A spokesman for the company was not immediately available to comment on the FDA's latest announcement.

    The agency said the devices should not be used to remove tissue containing fibroids in patients who are peri-or post-menopausal, or whose fibroids could be removed intact through the vagina or small incision. This group accounts for most women with fibroids who undergo surgery.

    The devices should also not be used in procedures in which the tissue is known or suspected to be cancerous, the agency said.

    "The two contraindications help to clarify the narrow population of patients in which laparoscopic power morcellation may be an appropriate therapeutic option," the FDA said in a statement.

    "For example, some younger women who are interested in maintaining their ability to have children or wish to keep their uterus intact after being informed of the risks may be candidates for this procedure."

    The recommendation follows a July meeting of an FDA advisory panel, which suggested a boxed warning - in which the risks are highlighted in a black box - would be useful.

  • Pay per puff? Caffeine stick? E-cigarette boom sparks race for new patents

    By Martinne Geller and Ben Hirschler

    LONDON (Reuters) - Electronic cigarette makers are racing to design and buy variations of a technology that has lit a billion-dollar boom, created a new vocabulary, and prompted a backlash from health officials worried about the impact of the new smokeless devices.

    Research by Thomson Reuters shows that China - with over 300 million smokers - is the front runner in the manufacture and development of so-called e-cigarette technology, while new versions being patented include a "pay as you go" computer-assisted device and others that can deliver caffeine instead.

    In 2005 just eight e-cigarette inventions were described in published patents. By 2012 the figure had jumped to 220 and by last year there were over 500 inventions, according to an analysis by the IP & Science business of Thomson Reuters. So far this year the total has reached 650. (A single invention may be covered by several patents.)

    The original technology, involving battery-powered heating systems that vaporize nicotine-laced liquid, is credited to Hon Lik, a Chinese medical researcher with a 20-a-day habit, in 2003.

    His invention has since become so popular that the market is now estimated to be worth $3.5 billion. Both big tobacco firms and small entrepreneurs are falling over themselves to find new ways to "vape" - a verb suddenly so mainstream the Oxford English Dictionary named it 2014's Word of the Year.

    Imperial Tobacco last year snapped up the patents owned by the company Hon co-founded in a deal worth $75 million, and is suing rivals for a range of alleged patent infringements.

    Part of the rush to create new devices can be explained by the prospect of stiffer regulation on existing ones after the World Health Organization said it wanted to see this, along with bans on indoor use, advertising and sales to minors.

    While proponents see e-cigarettes as important tools for harm reduction, critics fear the devices may instead fuel a new wave of nicotine addiction and cite a lack of long-term scientific evidence to support their safety.

    For a graphic showing the invention boom, click here: http://link.reuters.com/jyh53w

    PAY AS YOU GO

    Of more than 2,000 e-cigarette inventions tracked by Thomson Reuters, 64 percent originate in China, where over half of men smoke. In second place is the United States, with 14 percent, followed by South Korea with 9 percent.

    Some patented suggestions target smokers looking to regulate their nicotine intake and their spending. While offerings already on the market include thousands of e-liquid flavors from menthol to marshmallow, and even a smartphone app to show how much you are using, new patents go a step further.

    Tobacco giant Philip Morris International describes an e-cigarette that would allow users to "pay as you go" by buying a certain number of doses via computer application connected to their e-cigarette. Customers could also program the device to shut off after a certain number of puffs per use to help limit intake.

    Other smaller players aim to deliver doses of caffeine and other additives instead of nicotine.

    A unit of mCig Inc sells VitaCigs containing vitamins and supplements such as valerian and collagen, while a company called Energy Shisha sells a caffeinated vaping stick. Patents filed by others, including Fuma International, mention tetrahydrocannabinol (THC), the active chemical in cannabis.

    In general, e-cigarette patents relate to systems for heating and vaporizing liquids, as well as for charging the electronic systems, whether in a "cigalike" device or a larger "tank" system, which doesn't resemble a cigarette but gives a better "vaping" experience.

    China's domination of the market reflects not only its huge number of smokers but also a wider drive by the Chinese government to forge a knowledge economy. By maximizing patents it hopes to replace the ubiquitous "Made in China" label by "Designed in China."

    Since 2011, China has been the world's top patent filer for all inventions, according to the World Intellectual Property Office. Its scientists and companies now lay claim to intellectual property rights on everything from telecoms to medicine.

    "Patenting globally is rising significantly year on year, driven by Chinese patenting generally," said Bob Stembridge, senior patent analyst at Thomson Reuters IP & Science.

    "But I would say the e-cigarette field is growing faster than the general trend, and the bias toward China is greater than in global patenting."

  • With gene mutations, second breast cancer risk rises over time

    By Kathryn Doyle

    (Reuters Health) - Women who are genetically susceptible to breast cancer and develop it in one breast are at higher than average risk for a tumor in the other breast, and that risk may increase as time goes on, according to a new analysis.

    Mutations in the BRCA 1 or 2 genes increase the risk for several types of cancer and account for 5 percent to 10 percent of breast cancers, according to the National Cancer Institute.

    Researchers from Spain reviewed 20 studies of the risk of cancer in the second breast of BRCA 1 and 2 carriers.

    For breast cancer patients with the BRCA 1 mutation, the risk of a cancer in the opposite breast rose from 15 percent at five years after diagnosis to 27 percent at 10 years and 33 percent at 15 years.

    For the BRCA 2 mutation, the risk increased from nine percent at five years to 19 percent at 10 years to 23 percent at 15 years.

    For women with neither mutation, the risk of cancer in the opposite breast stayed low at 3 percent and 5 percent at the five and 10 year marks, according to results in the journal The Breast. There wasn't enough data to estimate the 15-year risk in this group, the authors write.

    Even though the risk for cancer of the second breast is much higher for BRCA carriers, it still means there is a 70 to 80 percent chance that they won't develop breast cancer 10 to 15 years later, said Dr. Katharine Yao, who wasn't involved with the new study but directs the breast surgical program at NorthShore University HealthSystem in Chicago.

    "(Women) should be concerned but also realize that we have very effective ways to monitor the breast with breast MRI and mammograms which detect cancer at an early stage (small size, node negative) and at a stage that is easily treatable and has a good prognosis," Yao told Reuters Health by email.

    The new data have been known for some time, said Dr. Todd Tuttle, a surgeon at the University of Minnesota in Minneapolis who was not involved in the review.

    "I think most of these women should strongly consider contralateral prophylactic mastectomy because their risk of contralateral breast cancer is so high," Tuttle told Reuters Health by email.

    "However, there are some groups of patients who may not benefit from that procedure including those patients who have a high stage first cancer and those who have other considerable medical problems," he said.

    A study Tuttle led earlier this year found that for women without the mutation, removing the other breast does not extend life (see Reuters story of August 15, 2014 here: http://reut.rs/1AlZUUu).

    Though it doesn't appear to extend life, the extra mastectomy does help avoid future breast imaging and maintain aesthetic symmetry, so some women without the mutations may still prefer it, he said.

    In another study in February of this year, women with stage I or II breast cancer and BRCA mutations did survive longer with double vs single mastectomy.

    For women who do not have the BRCA mutations, "patients do often overestimate their contralateral breast cancer risk and do not realize how low it really is," Yao said.

    SOURCE: http://bit.ly/1uNf1Wx The Breast, online November 7, 2014.

  • Overweight cancer patients may be malnourished

    By Kathryn Doyle

    (Reuters Health) - Overweight cancer patients may benefit from being tested for malnutrition, according to a new study.

    Obesity increases the risk for cancer, so many patients are overweight or obese at diagnosis, and are typically not screened for malnutrition because they appear to be well-nourished, the authors write in the Annals of Oncology.

    Obese cancer patients also tend to survive longer than underweight patients and that may further discourage nutritional screening, they add.

    But recent studies have found that overweight people can also be undernourished, said lead author Dr. Ioannis Gioulbasanis of the chemotherapy department at Larissa General Clinic in Thessaly, Greece.

    "However, it was the percentage of those patients found to be at nutritional risk that was surprisingly high in our study, around 50 percent, and that was at baseline, just after cancer diagnosis," Gioulbasanis told Reuters Health by email.

    He and his coauthors studied 1,469 patients with advanced cancer in France and Greece. Of those, 594 were overweight or obese.

    With nutritional screenings and questionnaires, researchers determined whether the overweight and obese cancer patients were well nourished, "at risk," or malnourished.

    Screening included questions about weight loss, mobility, psychological stress, medical history, eating habits and how they viewed their own nutritional status.

    Almost half the overweight and obese cancer patients were "at risk" for being malnourished and 12 percent were already malnourished, according to results.

    Researchers followed the patients through chemotherapy treatment and measured the period between cancer diagnosis and death, which was available for 357 patients.

    Well nourished patients survived an average of almost 18 months, compared to eight months for the "at risk" group and between six and seven months for the malnourished group.

    Some overweight cancer patients who also have well-developed musculature will have a good prognosis, but those with excess fat and muscle loss, called 'sarcopenia,' generally have a very poor prognosis, Gioulbasanis said.

    Most of the undernourished obese people in this study probably had sarcopenic obesity, he said.

    "An obese or overweight patient who presents to a cancer center may have been 50 pounds heavier four months ago," said Sarah Lowe, who researches nutrition and public health at the University of North Carolina, Chapel Hill.

    "The fact that they are still overweight or obese may visually camouflage their compromised nutrition status, but they are still likely nutritionally depleted and at risk for continued significant weight loss."

    Malnutrition in cancer patients can increase the risk for infection, treatment toxicity and healthcare costs while decreasing treatment response, quality of life and life expectancy, she said.

    "In my opinion, all cancer patients should ask to be referred to a dietitian," Lowe said. "Many if not all treatments, whether it's surgery, chemotherapy, radiation, or chemoradiation can result in significant nutrition-related side effects that can have a huge impact (on) patients' quality of life and nutrition status."

    There are no specific guidelines or nutritional protocols designed for overweight cancer patients, Gioulbasanis said.

    It is unclear whether obese cancer patients benefit from maintenance of their heavy body weight or whether some limited degree of weight loss could be in some way desirable, he said.

    "In any case, adequate protein intake and preservation of muscle mass should be the target," he added.

    Gioulbasanis said overweight cancer patients should be included in nutritional screening, which is usually done by a nurse. Those who are malnourished should then be referred for a nutritional consultation.

    SOURCE: http://bit.ly/11iHasH Annals of Oncology, online October 30, 2014.

Orthopedic Articles

  • Double arm transplant recipient thanks doctors in Boston

    By Richard Valdmanis

    BOSTON (Reuters) - A 40-year-old quadruple amputee on Tuesday thanked the Boston surgeons who performed a rare dual arm transplant on him last month and described the experience of getting the new limbs as surreal.

    Will Lautzenheiser, who lost his arms and legs to a streptococcal infection in 2011, said he has limited function in the new arms, which are encumbered by wrappings to help with healing.

    The arms were attached from an anonymous donor in a nine-hour operation at Brigham & Women's Hospital.

    "I want to thank the doctors for their great service," an emotional Lautzenheiser said at a news conference at the hospital. "I want to thank everyone."

    He said having the new limbs was "incredible" and "surreal."

    Lautzenheiser, a former professor of film production and screenwriting at Boston University and Montana State University, has a long stretch of therapy ahead but hopes to return to his career.

    The family of the anonymous donor told Lautzenheiser in a statement issued Tuesday that it hoped he would make a "wonderful recovery, and that your loved ones will be able to enjoy your warm embrace."

    The surgery involved 35 medical staff, including 13 surgeons, according to Brigham & Women's Hospital.

    While rare, there have been other double-arm transplants in the United States recent years. In 2012, a U.S. soldier who lost all four limbs in a roadside explosion in Iraq had double-arm transplant surgery at Johns Hopkins in Baltimore.

  • Young climbers injured as often as kids in other sports

    By Janice Neumann

    (Reuters Health) - Rock-climbing teens suffer about as many injuries as young ice hockey or soccer players, most often straining or spraining their hands and fingers and developing tendonitis, says a new study from Canada.

    The risks, the study authors say, are as high as 4.44 injuries per 1,000 hours of climbing.

    More work is needed to explore what's leading to the mishaps and how to prevent them, the researchers write in the British Journal of Sports Medicine.

    "The hard part is that there isn't yet enough research to definitively say what all the risk factors for injury in youth climbing are, so it is not yet possible to create injury prevention programs," said Kaikanani Woollings, who led the study, in an e-mail to Reuters Health.

    A 2013 report from the nonprofit Outdoor Foundation estimates that in the U.S. in 2012, roughly 1.5 million youth between the ages of six and 17 participated in bouldering and climbing, either indoors on artificial climbing walls or outdoors on real rock faces.

    Woollings and her colleagues at the University of Calgary in Alberta found that 15- to 19-year-olds were 11 times more likely to suffer injuries in climbing or bouldering than 11- to 14-year-olds. The older teens were six times more likely to be injured if they had been hurt in a previous sport, and five times more likely if they used preventive taping for protection.

    The 66 recreational and 50 elite (competitive) climbers in the study, who were recruited from rock climbing facilities in Alberta, answered survey questions about their climbing experience and their injuries in the past 12 months.

    The elite climbers were mainly male and tended to weigh more than the recreational climbers, who were mostly female. The recreational group climbed an average of about seven hours a week and the elites climbed about 13 hours weekly.

    Most of the teens spent an average of seven hours per week, nine months per year doing indoor climbing and six hours per week, three months per year doing outdoor climbing.

    At least one injury per climber was the norm, and nearly a third of participants had multiple injuries. Adult climbers have a similar rate of injuries, the authors note.

    After hand and finger strains and sprains, the most common injuries involved shoulders, knees and ankles. Nearly half the injuries were caused by repetitive overuse.

    Falls accounted for 32 percent of injuries, mainly to the lower extremities. Half these involved the knee and ankle.

    More than half of the climbers were treated for their injuries by a doctor or other health care provider.

    Woollings, who is research coordinator for the Sport Injury Prevention Research Center at the University of Calgary, has been an avid rock climber since age 16, participating in three world championships. She also coaches a youth climbing team. Like most climbers, she said, she and her students have been injured in the sport.

    Dr. Alan Ewert, professor and chair of environmental health at Indiana University in Bloomington, told Reuters Health that previous studies hadn't focused on youth.

    "I think it reflected what's really happening out there," said Ewert, who has done indoor and outdoor climbing for years.

    "Given the fact that particularly elite climbers are active several times a week, I wouldn't say (the injury rates are) high or low but expected," said Ewert, who was not involved in the study. "It would be totally unexpected to not accrue injuries like that."

    Woollings said injuries might be prevented by warm-ups with stretching beforehand, especially involving the upper body, and then beginning with easy climbing and slowly shifting to more difficult climbing.

    "I have known coaches to use shoulder injury prevention exercises from swimming and by the same token, we can use what we know from yoga, gymnastics and many other activities to help shape our own injury prevention strategies," Woollings said.

    "We should teach kids to be cognizant about their climbing - be smart, use safe practices, and if it hurts, stop."

    SOURCE: http://bmj.co/1xPvKbk British Journal of Sports Medicine, online November 10, 2014.

  • Overweight cancer patients may be malnourished

    By Kathryn Doyle

    (Reuters Health) - Overweight cancer patients may benefit from being tested for malnutrition, according to a new study.

    Obesity increases the risk for cancer, so many patients are overweight or obese at diagnosis, and are typically not screened for malnutrition because they appear to be well-nourished, the authors write in the Annals of Oncology.

    Obese cancer patients also tend to survive longer than underweight patients and that may further discourage nutritional screening, they add.

    But recent studies have found that overweight people can also be undernourished, said lead author Dr. Ioannis Gioulbasanis of the chemotherapy department at Larissa General Clinic in Thessaly, Greece.

    "However, it was the percentage of those patients found to be at nutritional risk that was surprisingly high in our study, around 50 percent, and that was at baseline, just after cancer diagnosis," Gioulbasanis told Reuters Health by email.

    He and his coauthors studied 1,469 patients with advanced cancer in France and Greece. Of those, 594 were overweight or obese.

    With nutritional screenings and questionnaires, researchers determined whether the overweight and obese cancer patients were well nourished, "at risk," or malnourished.

    Screening included questions about weight loss, mobility, psychological stress, medical history, eating habits and how they viewed their own nutritional status.

    Almost half the overweight and obese cancer patients were "at risk" for being malnourished and 12 percent were already malnourished, according to results.

    Researchers followed the patients through chemotherapy treatment and measured the period between cancer diagnosis and death, which was available for 357 patients.

    Well nourished patients survived an average of almost 18 months, compared to eight months for the "at risk" group and between six and seven months for the malnourished group.

    Some overweight cancer patients who also have well-developed musculature will have a good prognosis, but those with excess fat and muscle loss, called 'sarcopenia,' generally have a very poor prognosis, Gioulbasanis said.

    Most of the undernourished obese people in this study probably had sarcopenic obesity, he said.

    "An obese or overweight patient who presents to a cancer center may have been 50 pounds heavier four months ago," said Sarah Lowe, who researches nutrition and public health at the University of North Carolina, Chapel Hill.

    "The fact that they are still overweight or obese may visually camouflage their compromised nutrition status, but they are still likely nutritionally depleted and at risk for continued significant weight loss."

    Malnutrition in cancer patients can increase the risk for infection, treatment toxicity and healthcare costs while decreasing treatment response, quality of life and life expectancy, she said.

    "In my opinion, all cancer patients should ask to be referred to a dietitian," Lowe said. "Many if not all treatments, whether it's surgery, chemotherapy, radiation, or chemoradiation can result in significant nutrition-related side effects that can have a huge impact (on) patients' quality of life and nutrition status."

    There are no specific guidelines or nutritional protocols designed for overweight cancer patients, Gioulbasanis said.

    It is unclear whether obese cancer patients benefit from maintenance of their heavy body weight or whether some limited degree of weight loss could be in some way desirable, he said.

    "In any case, adequate protein intake and preservation of muscle mass should be the target," he added.

    Gioulbasanis said overweight cancer patients should be included in nutritional screening, which is usually done by a nurse. Those who are malnourished should then be referred for a nutritional consultation.

    SOURCE: http://bit.ly/11iHasH Annals of Oncology, online October 30, 2014.

Transplant Articles

  • Double arm transplant recipient thanks doctors in Boston

    By Richard Valdmanis

    BOSTON (Reuters) - A 40-year-old quadruple amputee on Tuesday thanked the Boston surgeons who performed a rare dual arm transplant on him last month and described the experience of getting the new limbs as surreal.

    Will Lautzenheiser, who lost his arms and legs to a streptococcal infection in 2011, said he has limited function in the new arms, which are encumbered by wrappings to help with healing.

    The arms were attached from an anonymous donor in a nine-hour operation at Brigham & Women's Hospital.

    "I want to thank the doctors for their great service," an emotional Lautzenheiser said at a news conference at the hospital. "I want to thank everyone."

    He said having the new limbs was "incredible" and "surreal."

    Lautzenheiser, a former professor of film production and screenwriting at Boston University and Montana State University, has a long stretch of therapy ahead but hopes to return to his career.

    The family of the anonymous donor told Lautzenheiser in a statement issued Tuesday that it hoped he would make a "wonderful recovery, and that your loved ones will be able to enjoy your warm embrace."

    The surgery involved 35 medical staff, including 13 surgeons, according to Brigham & Women's Hospital.

    While rare, there have been other double-arm transplants in the United States recent years. In 2012, a U.S. soldier who lost all four limbs in a roadside explosion in Iraq had double-arm transplant surgery at Johns Hopkins in Baltimore.

  • HIV drugs show promise in treating common eye disease

    By Will Dunham

    WASHINGTON (Reuters) - A class of drugs used for three decades by people infected with the virus that causes AIDS may be effective in treating a leading cause of blindness among the elderly.

    HIV drugs called nucleoside reverse transcriptase inhibitors (NRTIs), including AZT and three others, blocked age-related macular degeneration in mice and worked well in experiments involving human retinal cells in the laboratory, researchers said on Thursday.

    In HIV-infected people, NRTIs block an enzyme the virus uses to create more copies of itself. The new research shows the drugs also block the activity of a biological pathway responsible for activating inflammatory processes in the body.

    It is that previously unrecognized quality that makes NRTIs promising for treating macular degeneration as well as graft-versus-host disease, a rarer ailment that can occur after a stem cell or bone marrow transplant, the researchers said.

    University of Kentucky ophthalmologist Dr. Jayakrishna Ambati, who led the study published in the journal Science, said macular generation affects an estimated 50 million people worldwide.

    "With the aging of the population, it is projected to affect 200 million people by the year 2020. It is therefore critical that we develop new and improved treatments for this disease, which is growing like an epidemic," Ambati said.

    Macular degeneration causes cells to die in the macula, a part of the eye located near the center of the retina that permits vision in fine detail.

    The chronic disease has two forms: "dry" and "wet." Several treatments exist for "wet" macular degeneration but only about a third of patients get significant vision improvement. There are no approved treatments for the "dry" form, which is much more common but less severe.

    The "wet" type occurs when abnormal blood vessels grow under the macula and leak blood and fluid. The "dry" form occurs when cells in the macula break down.

    In the new study, the NRTIs blocked a powerful collection of proteins that can kill cells in the retina, preserving vision in mice.

    Researchers are planning for clinical trials in the coming months and it could be known in as soon as two to three years whether the drugs are effective in treating macular degeneration in people, Ambati said.

    Because these inexpensive drugs are already approved by the U.S. Food and Drug Administration and have a good safety record, they could be "repurposed" rapidly to treat other illnesses, he added.

    SOURCE: http://bit.ly/1F8kMB3 Science, online November 20, 2014.

Women’s Health Articles

  • Medical group needed convincing to let mom pump breast milk

    By Randi Belisomo

    (Reuters Health) - Dr. Megan McInerney, a physician at Indiana University, did not anticipate a conflict this summer when she asked to be allowed to pump breast milk for her infant son during a ten-hour licensing examination.

    But the third year pulmonary and critical care fellow was shocked by the response from the American Board of Internal Medicine (ABIM), a certification body for internists and internal sub-specialists, to which she had paid a $2,200 exam fee.

    "We give no accommodations to nursing mothers," the ABIM wrote, citing the Americans with Disabilities Act and explaining that nursing mothers do not qualify for protections under that law.

    The irony of such a message from a medical organization was not lost on McInerney, who had committed herself to breastfeeding her son for one year.

    "This is what my biology is, I have a responsibility to provide for my son, and I am supported by medical literature," McInerney told Reuters Health.

    Without time to pump during the exam, she feared engorgement, extreme discomfort, possible infection or a diminished milk supply. After six "unsatisfying" e-mail exchanges with the ABIM, McInerney contacted a lawyer, and then, the American Civil Liberties Union.

    "You can't look at it outside of the context of the stereotype that women with babies belong in the home and have no business trying to further their careers," said ACLU attorney Galen Sherwin, who made a formal demand to the ABIM on McInerney's behalf. "To deny these requests puts women at a serious disadvantage."

    Following the ACLU's request, the ABIM reversed its decision in September, agreeing to allow McInerney an additional 30 minutes of break time and to provide a private room where she could express breast milk.

    McInerney took the examination on November 12 in Indianapolis. She pumped breast milk twice during the day, one more time than she says she would have been able to otherwise, within scheduled breaks. "I still would have pumped, but I probably would have had to sacrifice doing all the other things like eating lunch, getting enough to drink and using the restroom," she said.

    The ACLU maintains McInerney's request was protected by both state and federal civil rights law, as well as by Indiana's public accommodations law. "It shouldn't take the intervention of the ACLU to get a test administrator to do this," Sherwin said. "It is leveling the playing field, and without it, women taking these grueling, all-day exams would be in very distracting and medically risky situations."

    In a statement to Reuters Health, the ABIM thanked McInerney for voicing such concerns and stated an aim to balance its obligation to providing an "equitable exam experience" while meeting candidates' diverse needs.

    "Our initial reply to her inquiry to provide additional time or space to pump her breast milk did not adequately address her needs," the statement read. "Because of Dr. McInerney, we have re-evaluated and changed our procedures as they relate to nursing mothers."

    The ABIM's new policy requires that nursing mothers request accommodation by an examination's registration deadline. Requests must include documentation from a medical provider demonstrating the need for such an accommodation, such as a physician's letter stating the candidate's delivery date and the anticipated frequency and durations of sessions to express breast milk.

    This policy change came as welcome news to both McInerney and her counsel at the ACLU, but lawyers there are concerned that other professionals taking licensing exams may still face similar challenges.

    "The medical profession is not uniformly walking the walk when supporting women coming back to work after childbirth," Sherwin said.

    McInerney said her legal challenge was "the right thing to do," not only to address her own needs- but those of female colleagues.

    "As a medical community," she added, "we should be leading the way in providing accommodations for women to be able to provide breast milk to their infants in their first year of life."

  • Little understood chemicals cut men's fertility

    By Ronnie Cohen

    (Reuters Health) - A new study suggests that chemicals in sunscreen may impair men's ability to father children, government scientists say.

    But other experts question whether the chemicals wound up in men's urine from sunscreen or through another route. The FDA has not authorized the substances - benzophenone-2, known as BP-2, and 4-hydroxybenzophenone, known as 4-OH-BP - for use in sunscreens.

    BP-2 does show up as an ingredient in aftershaves, colognes, antiperspirant and other personal-care products.

    "The study raises really important questions about these types of compounds and their effects on health," said Renee Sharp of the Environmental Working Group (EWG) in Oakland, California, who was not involved in the new research.

    "But the question it doesn't answer is where these compounds are really coming from. They could come from a huge variety of products," she told Reuters Health.

    Although the chemicals that appeared to hamper men's reproductive ability in the study are not known to be ingredients in sunscreen, scientists say they could be breakdown products of ultraviolet-radiation filters that do get used in the manufacture of those products.

    Researchers from the National Institutes of Health and the New York State health department studied 501 couples from Michigan and Texas who stopped using contraceptives between 2005 and 2009 and wanted to get pregnant.

    Each participant provided a single urine sample and kept daily journals on sex, menstruation and pregnancy testing, according to a report in the American Journal of Epidemiology.

    Women had higher urine concentrations of each of five chemical compounds tested, the study found, but their exposures did not significantly delay pregnancy.

    Among the men, however, those with the highest urine levels of BP-2 had a 30 percent lower chance of impregnating their partners within a year, the research found. Couples in which the man had high urine concentrations of 4-OH-BP also had significantly reduced odds of pregnancy within a year.

    The researchers acknowledge that a study such as this one, with just one urine sample tested, can't prove cause and effect.

    Still, said author Germaine M. Buck Louis, the findings suggest that certain sunscreen chemicals might impair men's reproductive ability.

    At the same time, she cautioned about the need for protection from the sun's harmful rays, to prevent skin cancers.

    Louis is a senior investigator at the National Institute of Child Health and Human Development.

    "Nobody should panic," she told Reuters Health. "We are not recommending that people stop using these compounds. We began looking at these UV filters because of how widespread these are in the population."

    Jane Muncke, managing director of the Food Packaging Forum Foundation in Zurich, Switzerland, agrees that the compounds have found their way into the environment. But she questioned how they arrive.

    "In general, it is very difficult to get exposure data or information on the use of certain chemicals," said Muncke, who was not involved with the current study.

    "This study illustrates this problem well. Here important health effects from chemical exposures are documented, but knowing how to avoid these chemicals is almost impossible for people," she told Reuters Health by email.

    Muncke said BP-2 is used in food-packaging ink, which has been known to migrate into dry food from cardboard.

    The other suspect chemical, 4-OH-BP, breaks down from benzophenone-3, known as BP-3 or oxybenzone, in urine, she said. Oxybenzone is widely used in sunscreen but did not significantly affect pregnancy chances in the current study.

    EWG recommends against using sunscreen with oxybenzone. Its website says oxybenzone acts like estrogen, can trigger allergic reactions, and has been linked to health harms, including endometriosis in older women.

    Oxybenzone also is used in food-packaging and in printing ink, Muncke said.

    "We have real concerns about oxybenzone," Sharp said. "There are plenty of alternatives. Consumers should definitely be using safer sunscreens."

    Dr. Shelley Ehrlich, an obstetrician-gynecologist and environmental epidemiologist at Cincinnati Children's Hospital Medical Center whose research focuses on environmental exposures to endocrine-disrupting chemicals, told Reuters Health the new study "really opens our eyes and makes us think we need to be looking at this so we can better inform the public."

    Ehrlich, who wasn't involved in the research, advises people to keep using sunscreen but to read labels and cover as much of their bodies as possible.

    "There are things you can do other than slathering on sunscreen all over the place," she said. "Still use sunscreen, but use hats and protective clothing, and wash it off once you go indoors."

    SOURCE: http://bit.ly/1ELILG3 American Journal of Epidemiology, online November 13, 2014.

  • FDA tightens guidelines on technique for uterine fibroid surgery

    By Toni Clarke

    WASHINGTON (Reuters) - The U.S. Food and Drug Administration has tightened its guidelines on the use of a uterine surgical technique, saying it has been linked to the spread of a rare type of cancer.

    The agency said on Monday it is recommending that a boxed warning be placed on laparoscopic power morcellator devices used to treat uterine fibroids. Such an FDA warning is the strongest that a medication or treatment can carry while still remaining on the U.S. market.

    The devices are used to slice fibroid and uterine tissue into small pieces inside the body, allowing it to be removed through a small opening. The procedure is designed to shorten recovery time and reduce wound-site infections.

    Yet the technique can cause injury to local tissues and organs and spread unsuspected malignant tissue to places outside the uterus. In April, the FDA issued an alert discouraging use of the devices to remove fibroids due to these concerns.

    The FDA estimates that 1 in 350 women who have fibroid surgery have an unsuspected uterine cancer.

    Fibroids are often benign and may cause pelvic pain and bleeding. Sometimes a hysterectomy is required to remove them.

    Johnson & Johnson's Ethicon unit, the biggest maker of morcellator devices, suspended sales of the device following the FDA's advisory.

    A spokesman for the company was not immediately available to comment on the FDA's latest announcement.

    The agency said the devices should not be used to remove tissue containing fibroids in patients who are peri-or post-menopausal, or whose fibroids could be removed intact through the vagina or small incision. This group accounts for most women with fibroids who undergo surgery.

    The devices should also not be used in procedures in which the tissue is known or suspected to be cancerous, the agency said.

    "The two contraindications help to clarify the narrow population of patients in which laparoscopic power morcellation may be an appropriate therapeutic option," the FDA said in a statement.

    "For example, some younger women who are interested in maintaining their ability to have children or wish to keep their uterus intact after being informed of the risks may be candidates for this procedure."

    The recommendation follows a July meeting of an FDA advisory panel, which suggested a boxed warning - in which the risks are highlighted in a black box - would be useful.

  • Boutique fitness studios harden bodies with personalized approach

    By Dorene Internicola

    NEW YORK (Reuters) - Boutique studios that offer a more personal approach to fitness and a softer ambience than big box gyms are a growing part of the $22.4 billion U.S. industry.

    IHRSA, the International Health, Racquet & Sportsclub Association that is the trade association of the fitness industry, noted in its 2014 Health Club Consumer Report that personalized fitness studios, or boutiques, captured 21 percent of the market in 2013, which rose from $21.8 billion in 2012.

    ModelFIT, a New York boutique studio co-founded by a trainer of supermodels that offers bulk-free fitness to clients on and off the runway, is an example of the customized fitness trend.

    Despite the leggy lure of its name, fitness experts say the ModelFit workouts, which incorporate a mix of Pilates, yoga, balance, movement and stability training are based in science and suitable for all body types of women and the occasional man.

    "We're not pushing you to kill yourself at gym," said co-owner Vanessa Packer, of the studio that does not feature the pounding music and sweaty culture that characterize many gyms.

    Justin Gelband, a trainer and the director of the fitness classes at the studio has been dubbed "The Model Whisperer" for his work with Victoria's Secret and Sports Illustrated models.

    The fitness routines and exercises at the studio target small muscles that go unnoticed and unused. Workouts typically employ tools such as bodyweight, medicine balls, Pilates discs, and circuit training.

    "Using those muscles lengthens, tones, and leans out the body, sort of sculpting it," Packer explained.

    Cardio-driven classes, like boxing which includes punching and kicking, also mix in other techniques like very light hand and leg weights, resistance bands and trampoline bouncing.

    Although men are welcome, Packer said, the bulk of clients are women, both young and old.

    Exercise physiologist Jessica Matthews said boutique studios' commitment to whole-body fitness is good science.

    "I love seeing words like stability, mobility, movement training," said Matthews, who teaches exercise science at Miramar College in San Diego, California. "The idea of spot reduction, or targeting one specific area is a myth."

    Like other boutique studios that focus on personal fitness and pitch to a certain audience, Matthews said Gelband's experience with models give it an added allure.

    "We all want to look like that and he may be playing off that desire, but I'm optimistic that he imparts good knowledge," she said.

  • Maintaining a firm grip differs for men and women

    By Ronnie Cohen

    NEW YORK (Reuters Health) - A simple grip-strength test might someday help doctors identify patients' risk for potentially disabling conditions later in life, but interventions likely would differ for men and women, a new study suggests.

    Using data from the Swedish Adoption/Twin Study of Aging, researchers found gender differences in potential reasons why men and women lose their ability to maintain a firm grip.

    A strong grip is helpful for activities of daily living. Carrying grocery bags, lifting cartons of milk or juice, holding securely onto railings - all require a good grip.

    Grip strength, which has been shown to be an indicator of overall muscle strength, is often used as a marker of physical functioning and biological vitality, lead author Ola Sternang told Reuters Health.

    Chandra Reynolds, a psychologist on Sternang's team, said grip strength has been associated with falls and can be predictive of risk for dying.

    For the men in their study, working at physically intense jobs in young adulthood was associated with a steep decline in grip strength with aging, and so - for unexplained reasons - was being married in late midlife, the study found.

    Among women, those who smoked, reported early midlife stress and were diagnosed with dementia suffered the steepest declines in grip strength as they aged, according to the study published in Age and Ageing.

    Sternang, a psychologist, is a senior researcher at the Institute of Gerontology at Jonkoping University and at Stockholm University, both in Sweden.

    "The thing that surprised me most was the obvious gender difference in the risk-factor pattern during the adult life span," he said in an email.

    Reynolds, a University of California at Riverside psychology professor, noted that the findings in women seemed straightforward compared to the findings in men.

    "It seems there are more lifestyle-related factors for women, like smoking and stress," she told Reuters Health in a telephone interview.

    "For men, it was more physical functioning and chronic conditions. That could mean different interventions for men and women," she said.

    But the findings on men were complicated and in some cases counterintuitive, the authors note in their paper. Why, for example, would being married in late midlife predict a steep decline in grip strength?

    "For men, it's just a more complex story," Reynolds said. "The men's data need more unpacking."

    For Amy Yorke, a physical therapist and professor at the University of Michigan-Flint who wasn't involved in the study, the findings brought to mind her grandfather, a farmer who suffered from arthritis in his shoulders and his hands in his later years as a result of overusing them as a younger man.

    "What we experience early in our life does have an impact in how we perform later in life," she told Reuters Health in a telephone interview. "Men that tend to have more labor-intensive jobs tend to have less grip strength later in life."

    Sternang and Reynolds and their colleagues measured grip strength over 22 years in 849 participants who were 50 to 88 years old at the start. They found that women's grip strength began declining steeply on average at age 67, while men's significant decline began at age 72.

    Prior research has shown that grip-strength tends to peak on average between the ages of 30 and 40 and then decrease over time in both men and women. But, the authors say, men's grip strength decreases faster with age than women's, and the gender gap narrows slightly.

    "There's no pill that's going to change the fact that we're going to get weaker as we get older," Yorke said. "The only thing we can do is to be more active."

    But not too active, not in a repetitive way that can cause problems, researchers warn.

    "Although we think about physical activity as being important to physical health, and it is," Reynolds said, "we also have to think about strenuous physical activity as not always contributing to health in positive ways."

    Yorke would like to see grip strength measurements taken at the same time as height, weight and blood pressure during physical exams.

    "It's a very easy measure," she said. "Just like they track my height and weight, there should be a conversation about how strong you are."

    SOURCE: http://bit.ly/1ve9l97 Age and Ageing, online November 1, 2014.