Traffic & Construction

We’ll send notice of road closures that might affect your commute.

* = required field

Traffic Updates

TRAFFIC CONGESTION AT STMC
We wanted to make you aware of a large transportation project around the STMC that will result in severe traffic problems:
  • The grade separation at Fred & Med will be a huge project lasting nearly two years. Please check the TxDot website for updates. Traffic will be impacted on both Medical and Fredericksburg roads.

For this reason, we are suggesting that you consider alternative routes through the STMC. We suggest you do this sooner rather than later.

Facility Construction

UNIVERSITY HEALTH SYSTEM
Hospital Construction

This project is in progress and should be complete by the end of the fourth quarter of 2013.


STMC Quarterly Construction Project Chart

(download pdf)


STMC Construction Projects through 2013

(download pdf)


The TXDOT Fredericksburg Road & Medical Drive Project

(view link)


To submit other construction project, please email Pam Leissener

Get Directions

Need directions to the Medical Center? Please enter your starting address and destination below.





Neuroscience Articles

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.

  • Hormones only one factor in sexual function during menopause

    By Kathryn Doyle

    (Reuters Health) - Testosterone and other reproductive hormones do play a role - but probably a small one - in women's feelings of sexual desire during menopause, according to a new study.

    Factors like emotional wellbeing and quality of the intimate relationship may be more important, says lead author Dr. John F. Randolph, Jr., of the University of Michigan Health System in Ann Arbor.

    "The big thing that came out of this is it has long been assumed or theorized that hormones played a big role, but it's been hard to prove," Randolph told Reuters Health. "Hormones definitely do play a role but it's not a big one."

    For the new study, researchers studied data from more than 3,000 middle-aged women participating for at least 10 years in an ongoing study that included annual questionnaires about sexuality and blood tests to measure hormone levels.

    The women were between 42 and 52 years old at the beginning of the study. By the 10th year, 77 percent were post-menopausal and 7 percent were using hormone replacement therapy.

    Yearly questionnaires addressed how often the women felt desire in the past six months to engage in any form of sexual activity either alone or with a partner, and how frequently they had done so. Those who reported having sexual activities with a partner were asked about their levels of arousal, ability to climax, frequency of vaginal or pelvic pain during intercourse and lubricant use.

    Women with higher levels of testosterone tended to report more frequent masturbation, more sexual desire and arousal than those with lower levels, according to the results published in the Journal of Clinical Endocrinology and Metabolism.

    Women who had higher levels of follicle stimulating hormone, which rises during menopause, tended to report masturbating, feeling arousal and experiencing orgasm less often than others.

    Hormones did not appear to be linked to pain with intercourse. Even for the other measures of sexual function, hormones only accounted for part of the picture, Randolph said.

    Those who said they had fewer sad moods and higher levels of satisfaction in their relationships also reported better sexual function.

    "Women's sexual function is pretty complicated and it would be naïve to assume only one factor is important," Randolph said.

    Men have 10 times as much testosterone as women, so it's harder to measure the influence of the hormone for females, he said. And it's new to consider a metric like masturbation frequency, which hasn't been studied much for this age group of women but is an important indicator of sexual function, he said.

    "Our work shows that there are a lot of other things that are equally or more likely to be important, the big ones are partner relationship and mood," Randolph said.

    "This is an article confirming the potential role of testosterone in women's sexuality independently from a partner and it adds a piece to the story that sexual function is driven by androgen but sexual behavior is related to the context, especially the partner," said Dr. Rossella Nappi of the Research Center for Reproductive Medicine and Unit of Gynecological Endocrinology and Menopause at the University of Pavia in Italy.

    Nappi was not involved in the new research.

    "Some women retain the ability to masturbate and climax across menopause because of higher androgen levels but maybe their sexual function with a partner is impaired due to many other reasons," she told Reuters Health by email.

    Testosterone seems to have a modest effect on sexual health for menopausal women, but it remains to be seen how it affects women at older ages, and whether or not testosterone therapy will at some point be a viable therapy, Randolph said.

    "It's a really hot topic with men right now because more people are asking for it and doctors are prescribing it," he said. "From a treatment perspective, we really don't know what the long term effects of giving testosterone are, and we need more information."

    The Endocrine Society has recommended against testosterone therapy for women based on the evidence at this point.

    "There are other things that probably have a bigger bearing on what's going on," Randolph said. "We should look at the whole picture rather than focusing on one single thing, and probably that means that testosterone as a treatment is not going to be something the vast majority of women will need."

    SOURCE: http://bit.ly/1pmxpEU Journal of Clinical Endocrinology and Metabolism, online November 20, 2014.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • 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.

Oncology Articles

  • U.S. Supreme Court Justice Ginsburg released from hospital

    By Reuters Staff

    WASHINGTON (Reuters) - U.S. Supreme Court Justice Ruth Bader Ginsburg, the oldest member of the nine-justice court, was released from a Washington hospital on Thursday after undergoing a heart procedure, a court statement said.

    Ginsburg, 81, had a stent placed in her right coronary artery at MedStar Washington Hospital Center on Wednesday to improve blood flow after she reported discomfort following routine exercise.

    "Justice Ginsburg was released from the hospital this morning," court spokeswoman Kathleen Arberg said in a statement.

    Ginsburg, appointed by President Bill Clinton in 1993, is the most senior liberal justice on the conservative-leaning court. As such, she is often the lead dissenting voice when the court is split 5-4.

    She has survived serious bouts with cancer in 1999 and 2009.

    In a July interview with Reuters, Ginsburg said she did not intend to leave the bench in the near future unless her health changed. She said she underwent regular medical check-ups for cancer and worked out twice a week with a personal trainer.

    "Thank goodness I haven't slowed down," Ginsburg said at the time.

  • FDA regs highlight harms of indoor tanning

    By Roxanne Nelson

    (Reuters Health) - Early in 2014, the United States Food and Drug Administration moved tanning lamps into a new category of "moderately harmful" medical devices, and with good reason, researchers say.

    In a review of the evidence that indoor tanning does damage, and has no health benefits, the study authors point out that the new rules will force device manufacturers and salons to do more to protect users.

    "We feel that this is a very positive move by the FDA," said Dr. Henry Lim, chairman of dermatology at Henry Ford Medical Center in Detroit, Michigan, and senior author of the review. "There is a lot of evidence that early and frequent use of tanning beds increases the risk of skin cancer."

    Among the new requirements is that all sunlamps have a "black box warning label" that says they shouldn't be used by people under age 18, Lim's team writes.

    This is the strictest warning that the FDA puts on products, and it is used when there is reasonable evidence of a serious hazard, Kim and his coauthors point out in the Journal of the American Academy of Dermatology.

    "The new regulations don't ban the use of tanning beds for children and teens," Lim cautioned. "That will be up to the discretion of the salons."

    However, the FDA guidelines will probably prompt more states to enact legislation, Lim told Reuters Health. Currently, 41 states including the District of Columbia have some type of regulation in place, such as requiring parental consent.

    Several states have completely banned indoor tanning for minors, as has Brazil. In July, Hawaii became the 10th state to do so, joining Vermont, California, Illinois, Louisiana, Minnesota, Oregon, Nevada, Texas and Washington.

    "Earlier exposure to indoor tanning is associated with a greater risk for developing basal cell carcinoma at a young age," said Margaret Karagas, director of the Children's Environmental Health and Disease Prevention Research Center at Dartmouth University in Hanover, New Hampshire.

    "The new FDA regulations reinforce the science that teens and young adults may be especially vulnerable to developing skin cancer if they use tanning beds," said Karagas. She was not involved in the review but recently published a study showing that a high proportion of patients with early-onset basal cell carcinoma had used indoor tanning.

    Basal cell carcinoma is the most common type of skin cancer. While it is not as dangerous as other types, it can be very destructive and disfiguring.

    However, Lim's team also points to studies that found people who were exposed to tanning beds before the age of 35 years had a significantly higher risk of developing melanoma, the deadliest type of skin cancer.

    In their report, the researchers review the science of how skin's exposure to ultraviolet light from tanning beds, or the sun, causes the DNA damage that can lead to cancer. "Tanning is a clinical manifestation of cellular stress," they emphasize.

    "Moreover, the common misconception that tanned skin offers protection from future UV radiation is proved false as there is no biochemical mechanism restricting further mutagenesis upon subsequent exposure," they write.

    The study team covers evidence that use of tanning beds can be addictive in the same way as a drug. And they point out that the devices primarily emit UV-A light, which is less effective at inducing skin to make vitamin D than UV-B, so there's no argument for a health benefit there.

    It's uncertain how much of an effect these new regulations will have on tanning bed users, Lim's team says.

    Nearly 30 million Americans use tanning beds each year, and more than 2 million of them are teenagers, according to the American Academy of Dermatology.

    Regular and heavy users are at the greatest risk, the authors note. More than 1 million people are estimated to use tanning salons each day in the U.S., indicating many repeat users. And about 70 percent of users are girls and young women between the ages of 16 and 29 years old.

    These data are the most troubling, they write, since young women are known to be the most at-risk population for developing melanoma associated with the use of tanning beds.

    "Pediatricians should counsel parents and patients about the risks of using tanning beds," Karagas said.

    Lim's team hopes their review will be used by doctors as a resource for doing just that.

    SOURCE: http://bit.ly/1prBRCr Journal of the American Academy of Dermatology, online November 11, 2014.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.

  • Breast cancer recurrence risk down since 1980s

    By Andrew M. Seaman

    (Reuters Health) - Rates of breast cancer recurrence fell by half or more between the 1980s and the early 2000s - likely due to improved treatments and increased screenings, according to a new study from Canada.

    The analysis of data on Canadian breast cancer patients offers reassurance that breast cancer survival is improving and also provides updated data to researchers, said the study's lead author, Dr. Karen Gelmon from the BC Cancer Agency in Vancouver, British Columbia.

    "It gives some contemporary numbers to people designing trials testing adjuvant treatments," she said.

    An earlier study, published in the 1990s and based on data from 1978 to 1988, found that women whose breast cancers fed off the hormone estrogen (so-called estrogen-receptor positive breast cancers) had a consistent risk of the cancer recurring over time. For breast cancers not driven by estrogen, recurrence risk was high for five years after successful treatment, but then dropped below the risk of those with estrogen-receptor (ER)-positive cancers.

    In the new study, published in the Journal of Clinical Oncology, Gelmon's team compared data on 7,178 women treated for early to moderately-advanced breast cancer during two different periods: 1986 to 1992, and 2004 to 2008.

    The researchers matched the cancer characteristics of each patient from the first period to a patient from the second period, including estrogen-receptor status as well as the presence of another protein on cancer cells, HER2.

    The HER2 molecule helps drive cancer-cell growth. Tumors with HER2 tend to be more aggressive than HER2-negative ones, the researchers note.

    Starting in the 1990s, drugs targeting molecules on cancer cells like HER2 became available. Together with improved early detection of less-advanced cancers, which gives such drugs a better chance of working, the targeted therapies have been credited with improving overall cancer survival

    In the new study, the overall risk of breast cancer recurrence for women in the later group was about 50 percent lower than for women in the earlier group, for each year after being cancer-free.

    Like the 1990s study, the new analysis found a high risk of recurrence within the first five years among women with cancers that were not driven by estrogen. Among women treated in the 2000s, that early increased risk was less dramatic, however.

    Specifically, the risk of recurrence after one year was about 11 percent among women from the earlier period with cancers not driven by estrogen, compared to about a 6 percent risk among women with the same type of cancer in the later period.

    "It showed we were doing better, but the peaks are still there," Gelmon said.

    The researchers also found that HER2-positive cancers saw some of the greatest reductions in recurrence risk.

    For example, the risk of recurrence in the second year of being cancer-free among women whose tumors were HER2-positive and ER-negative fell from about 23 percent in the earlier period to about 9 percent in the most recent period.

    The new study can't show why recurrence rates improved, but the researchers say it's most likely a result of screening leading to early detection and more "comprehensive and appropriate" treatments targeting specific cancer types.

    For example, they also saw large increases in the use of chemotherapy, and of drugs targeting estrogen-driven cancers, among the most recent patients.

    Drugs targeting HER2-positive cancers were not available in the earlier time period.

    "I think the most important thing is (the study) validates all these things we've been doing all these years," said Dr. Marleen Meyers, an oncologist and breast cancer expert at the NYU Langone Medical Center's Perlmutter Cancer Center in New York City.

    Meyers, who wasn't involved in the new study, also called the findings reassuring.

    "I think we continue to learn," she said. "I think this is very good, very positive information for women."

    SOURCE: http://bit.ly/1vOlzpm Journal of Clinical Oncology, online November 24, 2014.

Orthopedic Articles

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.

  • REFILE-Mindfulness program may improve some rheumatoid arthritis symptoms

    (Corrects spelling of Dr. Kreitzer's name in paragraphs 20 and 21)

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreitzer said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreitzer said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • 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.

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

  • Exercise may prevent excess weight gain during pregnancy

    By Shereen Lehman

    (Reuters Health) - Moderate exercise is encouraged during pregnancy for plenty of reasons, but it may also help women avoid gaining too much weight, say UK researchers.

    They reviewed studies since the 1990s looking at whether exercise alone helps prevent excess weight gain during pregnancy, and found that it does, or helps with weight loss after delivery, and found that it doesn't.

    They also found a total of only five solid studies on those questions.

    "There isn't enough research being conducted regarding the effects of exercise on gestational weight gain or postpartum weight loss," said Dr. Kirsty Elliot-Sale of the Sport, Health and Performance Enhancement Research Group at Nottingham Trent University, who led the review.

    "Of those few good - as defined by appropriate research design - studies, exercise seems to be an effective tool during pregnancy to limit excessive gestational weight gain but so far exercise (walking) has not been shown to be effective for postpartum weight loss," Elliot-Sale told Reuters Health by email.

    The U.S. Institute of Medicine advises women who are normal weight before they get pregnant to gain 25 to 35 pounds during their pregnancy. Women who are overweight should gain from 15 to 25 pounds, and obese women should gain from 11 to 20 pounds, according to IOM guidelines.

    Elliot-Sale said that weight gain exceeding the appropriate amount has implications for both mothers and infants. It also contributes to postpartum weight retention and ultimately, if unchecked, a higher risk of obesity.

    Elliot-Sale added that it's an area of research that urgently needs to be discussed and addressed.

    "Women should be supported and guided during this potentially overwhelming time and losing pregnancy-related weight should be made easier and not overtake this special time," she said.

    Elliot-Sale and colleagues reviewed the results of three research studies that compared exercise programs to regular care, or to other types of interventions during pregnancy, and two studies done during the year following pregnancy.

    The researchers found that, on average, women who exercised during their pregnancies gained about five pounds less than their counterparts who didn't exercise.

    There were no differences in weight loss after pregnancy between women who exercised and those who didn't, according to the results in the British Journal of Sports Medicine.

    Elliot-Sale said she still believes that exercise is the answer, which is why she's now conducting studies on weight loss after pregnancy.

    "Obviously, physical activity should be paired with good nutritional practices; however women should be cautioned not to overly restrict dietary energy intake whilst breastfeeding," Elliot-Sale said.

    "I love it and my niche happens to be women and heart disease and trying to get the OB/GYNs to take more of an active role in managing women's comprehensive health," said Dr. Mary Rosser.

    "I think the more we see in the literature studies like this, the more awareness it raises, not only on the patients' part, but I'm talking about the providers' part as well," said Rosser, an obstetrician/gynecologist at Montefiore Medical Center in New York.

    Rosser, who was not involved in the review, said the fact that only five studies were available highlights the need for more research.

    "I think that that's just more evidence that we need more randomized control trials to look at this issue, and it just increases our awareness," she said.

    Rosser said that excessive weight gain during pregnancy and weight retention between pregnancies is becoming more common. She added that doctors are seeing more women who are overweight before ever getting pregnant.

    Excessive weight gain could increase the risk of more complicated pregnancies, preeclampsia and gestational diabetes, she noted.

    "We also have now seen in the literature that women who have these problems during pregnancy are at up to five times greater risk of having cardiovascular disease in their lifetime," Rosser said.

    Rosser said that women who exercise before pregnancy are more likely to work out during pregnancy, but it's not too late to start an exercise program during pregnancy.

    "We have to educate women that it's okay to exercise during pregnancy," she said.

    Rosser advises women to talk to their obstetricians and ask about what kinds of activities are safe.

    "I am a fan of brisk walking, and if you have no other complications I think that's very helpful," she said. "And also psychologically it helps everyone to exercise."

    SOURCE: http://bmj.co/1yXEL1I British Journal of Sports Medicine, online November 18, 2014.

  • U.S. Supreme Court Justice Ginsburg released from hospital

    By Reuters Staff

    WASHINGTON (Reuters) - U.S. Supreme Court Justice Ruth Bader Ginsburg, the oldest member of the nine-justice court, was released from a Washington hospital on Thursday after undergoing a heart procedure, a court statement said.

    Ginsburg, 81, had a stent placed in her right coronary artery at MedStar Washington Hospital Center on Wednesday to improve blood flow after she reported discomfort following routine exercise.

    "Justice Ginsburg was released from the hospital this morning," court spokeswoman Kathleen Arberg said in a statement.

    Ginsburg, appointed by President Bill Clinton in 1993, is the most senior liberal justice on the conservative-leaning court. As such, she is often the lead dissenting voice when the court is split 5-4.

    She has survived serious bouts with cancer in 1999 and 2009.

    In a July interview with Reuters, Ginsburg said she did not intend to leave the bench in the near future unless her health changed. She said she underwent regular medical check-ups for cancer and worked out twice a week with a personal trainer.

    "Thank goodness I haven't slowed down," Ginsburg said at the time.

  • FDA regs highlight harms of indoor tanning

    By Roxanne Nelson

    (Reuters Health) - Early in 2014, the United States Food and Drug Administration moved tanning lamps into a new category of "moderately harmful" medical devices, and with good reason, researchers say.

    In a review of the evidence that indoor tanning does damage, and has no health benefits, the study authors point out that the new rules will force device manufacturers and salons to do more to protect users.

    "We feel that this is a very positive move by the FDA," said Dr. Henry Lim, chairman of dermatology at Henry Ford Medical Center in Detroit, Michigan, and senior author of the review. "There is a lot of evidence that early and frequent use of tanning beds increases the risk of skin cancer."

    Among the new requirements is that all sunlamps have a "black box warning label" that says they shouldn't be used by people under age 18, Lim's team writes.

    This is the strictest warning that the FDA puts on products, and it is used when there is reasonable evidence of a serious hazard, Kim and his coauthors point out in the Journal of the American Academy of Dermatology.

    "The new regulations don't ban the use of tanning beds for children and teens," Lim cautioned. "That will be up to the discretion of the salons."

    However, the FDA guidelines will probably prompt more states to enact legislation, Lim told Reuters Health. Currently, 41 states including the District of Columbia have some type of regulation in place, such as requiring parental consent.

    Several states have completely banned indoor tanning for minors, as has Brazil. In July, Hawaii became the 10th state to do so, joining Vermont, California, Illinois, Louisiana, Minnesota, Oregon, Nevada, Texas and Washington.

    "Earlier exposure to indoor tanning is associated with a greater risk for developing basal cell carcinoma at a young age," said Margaret Karagas, director of the Children's Environmental Health and Disease Prevention Research Center at Dartmouth University in Hanover, New Hampshire.

    "The new FDA regulations reinforce the science that teens and young adults may be especially vulnerable to developing skin cancer if they use tanning beds," said Karagas. She was not involved in the review but recently published a study showing that a high proportion of patients with early-onset basal cell carcinoma had used indoor tanning.

    Basal cell carcinoma is the most common type of skin cancer. While it is not as dangerous as other types, it can be very destructive and disfiguring.

    However, Lim's team also points to studies that found people who were exposed to tanning beds before the age of 35 years had a significantly higher risk of developing melanoma, the deadliest type of skin cancer.

    In their report, the researchers review the science of how skin's exposure to ultraviolet light from tanning beds, or the sun, causes the DNA damage that can lead to cancer. "Tanning is a clinical manifestation of cellular stress," they emphasize.

    "Moreover, the common misconception that tanned skin offers protection from future UV radiation is proved false as there is no biochemical mechanism restricting further mutagenesis upon subsequent exposure," they write.

    The study team covers evidence that use of tanning beds can be addictive in the same way as a drug. And they point out that the devices primarily emit UV-A light, which is less effective at inducing skin to make vitamin D than UV-B, so there's no argument for a health benefit there.

    It's uncertain how much of an effect these new regulations will have on tanning bed users, Lim's team says.

    Nearly 30 million Americans use tanning beds each year, and more than 2 million of them are teenagers, according to the American Academy of Dermatology.

    Regular and heavy users are at the greatest risk, the authors note. More than 1 million people are estimated to use tanning salons each day in the U.S., indicating many repeat users. And about 70 percent of users are girls and young women between the ages of 16 and 29 years old.

    These data are the most troubling, they write, since young women are known to be the most at-risk population for developing melanoma associated with the use of tanning beds.

    "Pediatricians should counsel parents and patients about the risks of using tanning beds," Karagas said.

    Lim's team hopes their review will be used by doctors as a resource for doing just that.

    SOURCE: http://bit.ly/1prBRCr Journal of the American Academy of Dermatology, online November 11, 2014.

  • Cigarette smoking by U.S. adults reaches record low - CDC

    By David Beasley

    ATLANTA (Reuters) - Cigarette smoking among U.S. adults last year touched its lowest on record, a drop spurred by higher prices, smoke-free policies and anti-smoking campaigns, the Centers for Disease Control and Prevention said on Wednesday.

    About 17.8 percent of American adults smoked cigarettes in 2013, down from 20.9 percent in 2005 and 42.4 percent in 1965, when the U.S. government began keeping records on smoking, the federal health agency said.

    While the continuing decline is encouraging, Brian King, a senior scientific advisor with the CDC's Office on Smoking and Health, said the rate is not on track to meet the federal goal of cutting adult cigarette smoking to 12 percent by 2020.

    "We need to accelerate the magnitude of the decline," he said.

    Tobacco use remains the leading cause of preventable disease in the United States, causing 480,000 premature deaths annually, according to the CDC.

    In addition to the overall decline in adult smokers, those who continue to smoke daily are cutting back, the CDC study found. U.S. smokers consumed an average of 14.2 cigarettes per day in 2013, down from 16.7 in 2005.

    The CDC said increased access to medications and programs that help smokers quit also have contributed to the drop in smoking rates.

    The U.S. Midwest has the highest adult cigarette smoking rate, and the West has the lowest, according to the study in the agency's Morbidity and Mortality Weekly Report.

    Lesbians, gays and bisexual adults smoke about 50 percent more cigarettes than heterosexual people, the report said.

    The agency also expressed concern over the increased use of electronic cigarettes - battery-powered cartridges that produce a nicotine-laced vapor for the "smoker" to inhale - and hookahs, or water pipes.

    The use of e-cigarettes by high school students tripled from 2011 to 2013 to 4.5 percent, according to a CDC survey released last week.

    The potential risks and benefits of e-cigarettes are subject to a fierce debate, with a lack of long-term scientific evidence on their safety.

    SOURCE: http://1.usa.gov/1vmlQya Morbidity and Mortality Weekly Report, November 28, 2014.

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.