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Neuroscience Articles

  • 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.

  • Boston Scientific to pay $18.5 mln in mesh case

    By Jessica Dye

    NEW YORK (Reuters) - Boston Scientific Corp was ordered Thursday to pay $18.5 million for injuries caused by transvaginal mesh devices, a plaintiffs' lawyer said, in the third courtroom loss for the company over the products.

    A jury in West Virginia federal court found the Massachusetts company liable to four women following a 10-day trial, according to their lawyer, Doug Monsour. The company was ordered to pay each of the four women damages ranging from $3.25 million to $4.25 million for the injuries.

    Jurors also said Boston Scientific had acted with "gross negligence" and awarded each woman $1 million in punitive damages, Monsour said.

    "This jury, after carefully thinking about the evidence for two days, came to the proper decision that this was a defective product," Monsour said.

    Boston Scientific said in a statement that it disagreed with the verdict and was considering its appeals options.

    The four plaintiffs say they suffered injuries such as pain during sex, nerve damage and infection as a result of the company's Obtryx device, which is used to treat stress urinary incontinence.

    Their claims are among more than 24,000 in U.S. state and federal courts against Boston Scientific over mesh devices.

    Plaintiffs' lawyers said at trial that Boston Scientific failed to perform sufficient safety testing in its rush to bring mesh products to market. They accused the company of using polypropylene to make the devices despite warnings that it was not meant to be permanently implanted in humans, and neglecting to tell doctors and women about those risks.

    Boston Scientific has fought back against claims that the devices are defective or were to blame for the women's complications.

    Last week, a Miami federal jury returned a $26.7 million verdict against Boston Scientific following a trial involving claims from four women over its Pinnacle device for treating pelvic organ prolapse. It did not award punitive damages.

    Earlier, a jury in Texas ordered the company to pay $73 million, which was later reduced to $34 million, in another mesh trial. Boston Scientific, however, won its first two mesh trials in Massachusetts state court.

    Boston Scientific is among seven major defendants, also including C.R. Bard and Johnson & Johnson's Ethicon Inc, that together are facing more than 60,000 mesh lawsuits in federal court.

  • Lawyers for the NFL defend concussion settlement

    By Daniel Kelley

    PHILADELPHIA (Reuters) - Lawyers for the NFL and a class of retired players defended a proposed multimillion-dollar settlement for concussions sustained while playing the game during a hearing on Wednesday, while critics called the deal inadequate.

    Most of the 20,000 former players involved in the class-action lawsuit back the deal, which provides payments of up to $5 million to those with the most serious neurological impairments.

    U.S. District Judge Anita Brody, who granted preliminary approval to the deal in June after the NFL agreed to remove a $675 million cap on payments, presided over the hearing and will decide if the settlement is fair.

    Brody is expected to make her final decision at a later date. She can approve the deal, demand revisions, or reject it flat-out, which would require the lawyers to rework the settlement with a blank slate.

    Brad Karp, a lawyer representing the NFL, said the settlement provides prompt payments to players while avoiding costly litigation that could last years and might leave players empty handed.

    "The league could have fought these claims, in my view, for many, many years," Karp said.

    The deal has its critics, in part, over how it treats players with chronic traumatic encephalopathy, or CTE, one of the most common neurological disorders suffered by football players.

    The proposed settlement calls for the NFL to pay $4 million to the families of those who died from CTE before July 7, 2014, while those diagnosed afterward would receive nothing.

    Steven Molo, who is representing a group players who oppose the deal, said the settlement releases the NFL from potentially billions of dollars in claims without acknowledging when it knew about the possibly life-altering danger of concussions.

    He also faulted the settlement for failing to cover future CTE deaths. "This is not a fair, adequate and reasonable settlement," Molo said.

    Chris Seeger, the lead lawyer for players who want the deal approved, said objections based on CTE compensation have been misleading.

    The settlement "compensates the injuries associated with CTE," he said. "CTE is not diagnosable in living people. It compensates the most serious neurocognitive impairments associated with TBI (traumatic brain injury)."

    Seeger said the settlement "maybe isn't perfect but it is really good and clearly fair."

  • U2's Bono fitted with metal plates, screws after bike accident

    By Reuters Staff

    NEW YORK (Reuters) - Bono, frontman of the Irish rock group U2, required hours of surgery for fractures to his face and shoulder blade and to have metal plates inserted in his arm after a cycling accident in New York's Central Park, Rolling Stone magazine said on Wednesday.

    The 54-year-old singer was trying to avoid another cyclist on Sunday when the accident occurred, forcing cancellation of the group's weeklong appearance on NBC's "The Tonight Show."

    "Bono was rushed to New York-Presbyterian/Weill Cornell Medical Center's Emergency Department and underwent 'multiple X-rays and CAT scans' followed by hours of surgery," the magazine said.

    It reported that the bone in the upper arm shattered in six places and tore through the skin, requiring three metal plates and 18 screws to repair the injury.

    On Monday, the singer had more surgery on his fractured left pinky.

    Bono's spokeswoman, when asked for a comment on the extent of his injuries and his prognosis, said there was nothing new to add beyond what was reported in Rolling Stone.

    The group announced the singer's accident and injuries in a statement on its website on Sunday.

    "Bono has injured his arm in a cycling spill in Central Park and requires some surgery to repair it. We're sure he'll make a full recovery soon, so we'll be back!" it said.

    An orthopedic surgeon told the magazine that Bono would need intensive therapy but was expected to make a full recovery. It was also unclear how Bono's injuries will affect the group's upcoming tour.

    Sunday's cycling accident was the second harrowing experience for the rocker in less than a week. A private plane in which Bono was traveling from Ireland to Germany last week lost its rear hatch as it was approaching Berlin airport. The pilot managed to land it safely.

    Last month, Bono also revealed on a British talk show that the reason he always wears his trademark sunglasses was because he has suffered from eye disease glaucoma for two decades. Glaucoma can lead to damage to the optic nerve and gets worse over time. Without treatment it can result in blindness.

    In 2010 Bono suffered a spinal injury while preparing for a tour and underwent emergency surgery in Germany. The injury delayed part of the tour.

  • How one Australian symphony orchestra protects players' ears

    By Kathryn Doyle

    (Reuters Health) - A program to protect Queensland Symphony Orchestra players in Australia from hearing loss is producing encouraging results, according to a new study.

    Sophisticated analyses of sound dynamics in concert halls led to a variety of measures that may also help professional musicians elsewhere, and amateurs, to preserve their hearing, researchers say.

    "Hearing loss amongst orchestral musicians is common - most players will know someone whose career has been affected by a hearing pathology of some sort," said lead author Ian O'Brien of the School of Medical Sciences at The University of Sydney in Australia.

    O'Brien is a clinical audiologist as well as a professional horn player with noise-induced hearing loss.

    The risk of hearing loss varies by individual and instrument, O'Brien told Reuters Health by email. "A trumpet player has a much greater exposure than, say a double bass player," he said.

    One recent study found professional musicians' risk for hearing damage is four times higher overall than that of nonmusicians (see Reuters Health article of May 9, 2014 here: http://reut.rs/1BNy4EZ).

    Awareness and education are the fundamental starting points in managing risk and mitigating exposure, O'Brien said, and there are many ways for individual musicians to reduce daily sound exposure with minimal impact on their music.

    The Queensland Symphony Orchestra's hearing conservation program is one of the most comprehensive in Australia, the authors write.

    Nine years ago, the orchestra started ongoing noise exposure monitoring, data reviews and plotting noise maps for concert halls and orchestra pits where the musicians played over a three-year period.

    "This is still the largest orchestral sound survey on record and the results have been used by several orchestras to plan their own approaches," O'Brien said.

    They investigated how the orchestra was laid out and whether or not using risers or acoustic screens would mitigate some of the noise exposure and the extent to which player seating could be rotated periodically.

    Risers enable sound to travel from the rear of the orchestra to the audience without having to push through rows of musicians, O'Brien said.

    They also supplied high-quality earplugs specifically designed for musicians, and the orchestra formed a "noise committee" with musicians and representatives to evaluate how the interventions were affecting musical performance.

    For the new study, researchers analyzed the orchestra archives since 2005, used player and management focus groups and an interview with the program's administrator to assess how effective the conservation program has been.

    In the most recent poll, seven percent of the musicians said they always used earplugs, 55 percent reported using earplugs occasionally and 11 percent said they still never used them, according to the results in the Annals of Occupational Hygiene.

    "Players who have not taken time to develop the skills necessary to adjust to the different experience of playing with earplugs (and who are not supplied with correctly fitting, high quality equipment) will inevitably reject such devices, which underscores the importance of ongoing training in hearing conservation for musicians," O'Brien said.

    All branches of musical performance, including classical, have their own specific problems and the implementation of noise control programs, which is now mandatory in Europe, has not proven to be a simple task, said Esko Toppila of the Finnish Institute of Occupational Health, who was not involved in the new study.

    Most programs like this in Europe have not yet had an impact on the safety of musicians, but the program in Queensland seems to be a rare success story, he said.

    "The interesting thing here is that they have been able to maintain the motivation of the musicians for a relatively long time," Toppila told Reuters Health by email. "My guess is that the program leads to an improved job satisfaction."

    Since 2005, the Queensland Symphony Orchestra has adopted wrap-around absorptive screens and a series of moveable diffusive panels for treating poor acoustic spaces, the authors write. Many brass and woodwind players now use electronic earplugs, they note.

    Noise induced hearing loss happens gradually and varies from individual to individual, making it difficult to judge if this conservation program has made hearing loss less common since 2005, O'Brien said.

    "The risks to amateur players are the same as that to professional players, although you would expect amateur players have lower exposure durations than full time professional players," he said.

    Hearing conservation training, as well as training in other aspects of musicians' health, should be included in college and high school music programs and is beginning to happen in some U.S., European and Australian institutions, he said.

    "As the hearing of a professional musician is central to their livelihood, it is of the greatest importance that this population are able to optimally maintain this sense throughout their career," O'Brien said.

    SOURCE: http://bit.ly/1xTQIHc Annals of Occupational Hygiene, online November 7, 2014.

Oncology Articles

  • 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.

  • Rushing to put on condoms may lead to problems

    By Andrew M. Seaman

    (Reuters Health) - Rushing to put on a condom may lead to problems that raise the risk of sexually transmitted infections, according to a new study.

    Survey responders, almost 60 percent of them women, were more likely to report condom breaks, leaks and slips when it was put on in a hurry, researchers found. Couples who rushed were also more likely to report not using a condom for the entire sex act.

    "The message is take your time," said Dr. Lydia Shrier. "If you're going to be using the condom, use it correctly so you avoid the type of problems we reported on."

    Previous research into condom problems were limited by having asked mostly men about their last sexual experiences, said Shrier, of Boston Children's Hospital and Harvard Medical School, the study's senior author.

    The new study used data collected from 2007 through 2011 from 512 men and women who sought treatment at five U.S. health clinics with reputations for diagnosing and treating sexually transmitted infections.

    The participants, whose ages ranged from 15 through 65, recorded their sexual encounters in an online diary for up to 180 days. In total, the data covered 8,856 instances of vaginal sex between men and women that included condoms.

    In about 7 percent of those sexual encounters, the participants reported being rushed while putting on the condoms.

    Overall, the condom broke, slipped off and leaked about 5 percent of the time when people rushed to put it on, compared to about 2 to 3 percent of times when they didn't rush.

    Additionally, 22 percent of people who were rushed while putting on a condom reported not using the condom throughout sex, compared to about 14 percent of people who were not rushed.

    "I think that this study demonstrates that being rushed when putting a condom on can produce a whole range of problems with a condom," Shrier said.

    The U.S. Centers for Disease Control and Prevention (CDC) says that consistent and correct use of condoms reduces the risk of infections such as Chlamydia and gonorrhea that are transmitted by sexual fluids. It also reduces the risk of ulcer conditions, such as herpes.

    Consistent and correct use is also effective at reducing the risk of acquiring HIV, the virus that causes AIDS, according to the CDC. It may also reduce the risk of human papillomavirus (HPV), which may cause genital warts and cervical cancer.

    "It works really well to prevent sexually transmitted infections when it's used correctly and consistently," Shrier said.

    She said people should be taught to take time and focus while putting on condoms to prevent the types of errors they found in this study.

    "Until we overcome all of those hurdles, condoms can't really work to prevent disease," Shrier said.

    SOURCE: http://bit.ly/11uByuY Sexually Transmitted Infections, online November 12, 2014.

  • Cuban doctor with Ebola is stable, fever reduced - official

    By Daniel Trotta

    HAVANA (Reuters) - The Cuban doctor who contracted Ebola while treating patients in Sierra Leone was in stable condition with a reduced fever and no further complications, a Cuban health official said Wednesday.

    The doctor, Felix Baez, 43, cannot recall any mistake in procedure that could have led to him catching the virus from a patient, said Jorge Perez, director of the tropical diseases hospital where Cuban doctors train for their Ebola missions.

    Baez, a specialist in internal medicine, is the first Cuban known to have contracted Ebola, which has killed at least 5,450 people since March in the worst outbreak of the disease on record.

    "He's doing fine. He's lost a little appetite but otherwise has no complications at the moment," Perez told Reuters a few hours before he was due to travel to Geneva to help with Baez's case.

    Baez, who is married with two children, was due to arrive in Geneva late Thursday, Perez said.

    Some 165 Cuban doctors and nurses have gone to Sierra Leone for six-month missions, with another 53 in Liberia and 38 in Guinea.

    The Cuban commitment has won international praise as more substantial than contributions from many wealthy countries.

    A Geneva doctor specializing in infectious diseases will organize Baez's care in a special hospital room separate from other wards at University Hospital, the Swiss Federal Office of Public Health said.

    British and Cuban doctors treating Baez in Sierra Leone reduced his fever from 39 degrees Celsius (102.2 degrees Fahrenheit) to 37 degrees C (98.6 degrees F) using the drug duralgina, said Perez, who has reviewed medical reports on Baez and has spoken to his supervisor in Sierra Leone.

    "He sent information saying he doesn't remember how or where, doesn't know what his mistake may have been in getting infected," Perez said.

    Doctors and nurses wear protective, full-body suits when treating Ebola patients with strict procedures on how to remove them. The Cubans trained for their mission for three weeks in Cuba and another 15 days upon arriving in West Africa.

    Baez, who normally works at a military hospital in Havana, was one of 15,000 volunteers for the Ebola mission and one of 465 who received training.

    "Be strong, Dad, everything's going to be all right," the doctor's elder son, second-year medical student Alejandro Baez, said via official website CubaSi. "All of Cuba is waiting for you."

    Baez also has an 18-month-old son, Felix Luis.

  • Drug spending tops $1 trln on hepatitis C, cancer therapies -study

    By Caroline Humer

    (Reuters) - Global pharmaceutical spending will break the trillion dollar mark in 2014, driven by high prices in the United States for novel treatments such as Gilead Sciences Inc's Sovaldi for hepatitis C and new cancer drugs, according to a study released on Thursday.

    Total spending on drugs will hit $1.06 trillion, an increase of 7 percent over 2013 levels, according to the report from the IMS Institute for Healthcare Informatics. The increase also reflected a slowdown in the introduction of cheaper generic versions of branded medicines.

    By 2018, IMS expects spending to rise to $1.3 trillion due to new breakthrough therapies.

    Hepatitis C drugs will add about $100 billion in total spending in the next few years, while cancer spending will rise to $100 billion and diabetes care will account for another $78 billion. Cancer drugs contributing to the high cost include Roche Holding AG's Perjeta and Kadcyla, Pharmacyclics Inc's Imbruvica and Amgen's Kyprolis.

    Drugmakers have come under pressure over high U.S. prices, particularly Sovaldi's list price of $1,000 per pill. State Medicaid offices and private insurers say the prices are too high to bear, while drugmakers defend them as reflecting the wider cost of developing medicines, many of which they say will never make a profit.

    U.S. spending accounts for about one-third of the total drug spend and is due to rise 11.7 percent in 2014 before the growth rate slows to an annual 5 percent increase after 2015.

    IMS's spending figures do not take into account manufacturer rebates, coupons and discounts, particularly in the United States, which will lower spending by about one half a percentage point during that time period, or $60 billion to $80 billion. In the 2009 to 2013 period, there was an estimated $63 billion in rebates, IMS said.

    "Within the U.S. market, we are seeing in aggregate higher levels of rebate, especially in the diabetes and respiratory therapy areas," said Murray Aitken, executive director of the IMS Institute for Healthcare Informatics.

    Rebates typically increase for drugs that are about to go off patent, then disappear once they are off patent, Aitken said.

    He declined to discuss specific drugs such as Lantus, which Sanofi said recently was coming under intense price pressure from U.S. insurers, and is due to go off patent in 2015.

Orthopedic Articles

  • 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.

  • Taking NSAIDs with fibrillation meds boosts risk of bleeding

    By Kathryn Doyle

    (Reuters Health) - People who take blood thinners for atrial fibrillation and also use common painkillers, even briefly, are more likely to suffer serious bleeding, according to a new study.

    The most common heart arrhythmia, atrial fibrillation (AF) affects 2.7 million people in the U.S., according to the American Heart Association.

    The irregularity of the heartbeat increases the risk for blood clots and stroke, so most patients are prescribed blood-thinning medications like warfarin to keep blood clots from forming, according to the National Institutes of Health.

    Blood thinners, technically known as anticoagulants, increase the risk of bleeding.

    Many common over-the-counter painkilling medicines also have blood-thinning effects. These painkillers, known as nonsteroidal anti-inflammatory drugs (NSAIDs), include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), and others.

    NSAIDs and anticoagulants affect the blood differently. The new study has shown that "using them in combination can have a serious impact on bleeding risk," said lead author Dr. Morten Lamberts of the Department of Cardiology at Gentofte University Hospital in Denmark.

    "Even short term NSAID treatment (two weeks) is associated with severe bleeding risk," Lamberts told Reuters Health by email.

    Until now, researchers assumed this would be the case, but did not know exactly how much the bleeding risk increased, he said.

    He and his team studied the medical records of more than 150,000 people in Denmark who were diagnosed with AF for the first time between 1997 and 2011.

    More than a third of the AF patients had been prescribed an NSAID in the years following their diagnosis, the researchers found. In Denmark, ibuprofen has been the only NSAID available over the counter since 2001. Other NSAIDs, like naproxen, require a prescription.

    Within three months after being prescribed two weeks of NSAID therapy in addition to AF treatment, 4 out of every 1,000 patients had experienced serious bleeding, compared to a rate of 1.5 serious bleeding events for every 1,000 patients not taking the additional painkillers, according to results in the Annals of Internal Medicine.

    Patients taking NSAIDs were also more likely to develop a blood clot than others.

    Some NSAIDs are known to increase blood clot risk, although the mechanism is not entirely known, Lamberts said. The new results indicate that even though combining anticoagulants and NSAIDs does increase bleeding risk, it is not offset by a similar decrease in blood clots, which would be desirable for these patients, he said.

    "The combination of aspirin or other antiplatelet drug plus oral anticoagulant drug is more dangerous because you block two clotting pathways," said Dr. Anne M. Gillis of the University of Calgary, who led the development of the first atrial fibrillation clinic in Canada.

    Gillis was not involved in the new study.

    Bleeding risk depends on underlying medical factors and extent of injury, she told Reuters Health by email.

    For instance, Gillis said, for someone with gastrointestinal disease, the risk of bleeding is higher in part due to the risk of ulcers from aspirin or NSAIDS and in part because their blood can't clot normally.

    "A minor cut to the hand will eventually stop bleeding but a major trauma or surgical intervention will be associated with a marked increase in risk of serious bleeding," Gillis added.

    Doctors, nurses and pharmacists generally tell patients what drugs to avoid while on blood thinners, but patients may forget, or not realize that drugs they were cautioned against are in many over-the-counter formulations, she said.

    "Common cold therapies may include ibuprofen plus drugs that are decongestants or cough suppressants and the individual may not pay close attention to this," Gillis said.

    "I believe many individuals do not perceive NSAIDs as having many serious side-effects, although our study shows the opposite with co-treatment with (anticoagulants)," Lamberts said.

    If a patient on anticoagulants for AF has a headache or minor pain, instead of taking an NSAID they should make sure they are not dehydrated and that there is not a musculoskeletal problem that could be helped by exercises, he said.

    "If medical treatment is needed, he recommends paracetamol, also known as acetaminophen.

    Patients should recognize that side effects can happen with all types of medication and consult a physician before combining drugs affecting the blood, Lamberts said.

    SOURCE: http://bit.ly/14FHfIY Annals of Internal Medicine, November 17, 2014

Transplant Articles

  • 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.

  • 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.

  • 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

  • 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.

  • Italian doctors suspected of taking bribes to discourage breastfeeding

    By Steve Scherer

    ROME (Reuters) - Italian police put 12 pediatricians under house arrest on Friday for allegedly accepting extravagant gifts from makers of baby milk formula to promote it in place of breastfeeding.

    Police have been investigating "a common and widespread practice" in which pediatricians "prescribe baby milk formula to newborns in exchange for bribes in the form of luxury gifts and costly holidays," a statement said.

    Two of the doctors put under arrest were chief pediatricians in hospitals, the statement said. Five sales representatives for three different companies and one executive were also under house arrest, police said, without giving names.

    The sales representatives "contacted the pediatricians to urge them to prescribe baby formula to newborns, going against unanimous scientific opinion on the need to promote the use of mother's milk," the police statement said.

    Carabinieri police Captain Gennaro Riccardi told Reuters the salespeople would hand out "hundreds of thousands of euros" in gifts to doctors employed by the state-run healthcare system if local sales figures were high.

    The gifts included iPhones, Apple computers, air conditioners, televisions, trips to India, the United States, Paris, London and Istanbul and luxury cruises, Riccardi said.

    "There are no adjectives to describe the gravity of these actions," Health Minister Beatrice Lorenzin said in a statement.

    Doctors went against "unanimous scientific opinion and the indications of the health ministry in convincing mothers to use powdered milk formula in place of mother's milk."

    According to the investigation, the management at DMF Dietetic Metabolic Food, an Italian company based near Milan, was directly involved in the kickback system, Riccardi said.

    A sales representative for Milan-based Mellin was among those arrested, but in the case of Mellin and another company it is not yet clear whether the sales representatives acted on their own or with the knowledge of their management, Riccardi said.

    A DMF employee told Reuters by telephone that company managers "are out of the office, are busy" and no one else was available to comment. In a statement, Mellin said it had no comment and that it would cooperate with authorities.

    Twenty-six search-and-seizure orders connected with the case are being carried out in four Italian regions.

    "We're still trying to find out the scale of the problem," Riccardi said.

  • Uganda plans to pass new version of anti-gay law by Christmas-lawmaker

    By Elias Biryabarema

    KAMPALA (Reuters) - Drafters of a revised anti-gay law want parliament to pass it in time to be a "Christmas gift" for Ugandans, a lawmaker said on Friday, after a controversial earlier version was quashed because of legal technicalities.

    Legislation passed by parliament almost a year ago, which would have punished gay sex with long prison terms, provoked a storm of international protest and led some donor countries to withhold aid. A constitutional court overturned the law in August.

    Abdu Latif Ssebagala, a member of a parliamentary committee formed in September to draft a new version, said it had finished the bill and was ready to present it to parliament for debate.

    "The draft is ready and we have strengthened the law, especially in areas of promotion and luring children. Next week we expect to meet the speaker to fix a date for the re-tabling to parliament," he told Reuters.

    Ssebagala said the committee wanted it passed within weeks so that Ugandans "can celebrate it as a Christmas gift".

    The earlier version would have punished gay sex with long prison terms, including life sentences for "aggravated homosexuality".

    The latter category included an HIV-positive person having gay sex or gay sex with anyone vulnerable, such as when the victim is disabled or a child in the perpetrator's care.

    In August, President Yoweri Museveni said he wanted the law amended to remove penalties for consenting adults. Ssebagala said however the new version still punished gay sex among consenting adults.

    In October the president wrote in a newspaper that re-introducing the law risked triggering a trade boycott by the West.

    Analysts say Museveni - expected to run for re-election in 2016 - is walking a tightrope, trying to appease his conservative domestic constituency while wary of alienating donors who finance about 20 percent of Uganda's budget.

    "This bill is inconsistent with fundamental freedoms and human rights ... accepting it would be a display of weakness rather than leadership," said Asia Russell, Uganda-based director of international policy at Health GAP, an HIV advocacy group.

    Like most of sub-Saharan Africa, Uganda is highly religious and socially conservative. Disapproval of homosexuality is widespread and attacks on gays common.

    Influential evangelical pastors have urged Ugandan legislators to reintroduce the law since it was quashed.

    Presidential spokesman Tamale Mirundi said Museveni "is a democrat" and could not dictate to parliament what to do.

    "We'll only know his views when the new law is passed and is sent to him for signing," he said.

    The constitutional court overturned the earlier law on the grounds parliament had passed it without the required quorum.

  • 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.

  • Appeals court order keeps Mississippi's sole abortion clinic open

    By Emily Le Coz

    JACKSON Miss. (Reuters) - Mississippi's sole abortion clinic will remain open after a federal appeals court refused on Thursday to reconsider its decision to block a state law that would have closed it.

    The law, passed in 2012, required doctors at the clinic to have admitting privileges at local hospitals, a standard they could not meet.

    A three-member panel of the 5th U.S. Circuit Court of Appeals in July upheld a lower court ruling blocking the law as a legal challenge continues. On Thursday, the appeals court denied Mississippi's request for a reconsideration of the injunction by the full court.

    "This is definitely good news," said Diane Derzis, who owns the Jackson Women's Health Organization, the only abortion clinic in Mississippi. "We've been waiting so long. It's a true Thanksgiving."

    Mississippi is among several states that have passed laws requiring abortion doctors to have admitting privileges at a hospital within 30 miles of their clinics.

    Abortion rights campaigners say the laws, some of which are under court review, impose medically unnecessary requirements targeting providers of the procedure.

    Anti-abortion advocates have countered that they are intended to protect women's health, though some have also said they would likely shutter clinics.

    "There are a lot of places women can go if they want an abortion," said Tanya Britton, a board member of Pro-Life Mississippi. "They can go to Louisiana. They can go to Arkansas. They can go to Alabama."

    Many hospitals refused to consider the admitting privileges applications of doctors working for the Jackson Women's Health Organization, which nearly closed as a result.

    A federal district court judge in 2012 issued a temporary injunction blocking the law because it would have forced women seeking abortions to go out of state. The same judge issued a second injunction in 2013 that remains in effect with Thursday's order.

    Advocates who brought the suit against Mississippi's law expect it to move forward at the trial court in 2015.

    The state has the option of asking the U.S. Supreme Court to lift the injunction, with a spokeswoman for the Mississippi Attorney General's Office saying it is considering its options.