Zoster vaccine associated with lower risk of shingles in older adults

Vaccination for herpes zoster, a painful rash commonly known as shingles, among a large group of older adults was associated with a reduced risk of this condition, regardless of age, race or the presence of chronic diseases, according to a study in the January 12 issue of JAMA.

12 jan 2011--"The pain of herpes zoster is often disabling and can last for months or even years, a complication termed postherpetic neuralgia. Approximately 1 million episodes of herpes zoster occur in the United States annually, but aside from age and immunosuppression, risk factors for this condition are not known," the authors write. Although prelicensure data provided evidence that herpes zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions to show whether benefits of the vaccine can be generalized to conditions of clinical practice, according to background information in the article. The researchers note that this is particularly important for the herpes zoster vaccine, given the medical and physiological diversity in the elderly population for whom the vaccine is indicated.

Hung Fu Tseng, Ph.D., M.P.H., of Southern California Kaiser Permanente, Pasadena, Calif., and colleagues evaluated the risk of herpes zoster after receipt of herpes zoster vaccine among individuals in general practice settings. The study included community-dwelling adults, age 60 years or older, who were members of a managed care organization. There were 75,761 members in the vaccinated cohort, who were age matched (1:3) to 227,283 unvaccinated members.

Compared with the unvaccinated cohort, individuals in the vaccinated cohort were more likely to be white, women, and to have had more outpatient visits, and a lower prevalence of chronic diseases. There were 5,434 herpes zoster cases identified in the study (6.4 cases per 1,000 persons per year among vaccinated individuals and 13.0 cases per 1,000 persons per year among unvaccinated individuals). In the fully adjusted analysis, vaccination was associated with reduced risk of herpes zoster. The reduction in risk did not vary by age at vaccination, sex, race, or with presence of chronic diseases. Herpes zoster vaccine recipients had reduced risks of ophthalmic herpes zoster and hospitalizations coded as herpes zoster. Overall, the vaccine was associated with a 55 percent reduction in incidence of herpes zoster.

"Herpes zoster vaccine was licensed recently, which means the durability of its protection needs to be assessed in future studies. Meanwhile, however, this vaccine has the potential to annually prevent tens of thousands of cases of herpes zoster and postherpetic neuralgia nationally. To date, herpes zoster vaccine uptake has been poor due to weaknesses in the adult vaccine infrastructure and also due to serious barriers to the vaccine among clinicians and patients. Solutions to these challenges need to be found so that individuals seeking to receive herpes zoster vaccine will be able to reduce their risk of experiencing this serious condition," the authors conclude.

More information: JAMA. 2011;305[2]:160-166.

Provided by JAMA and Archives Journals

Protective properties of green tea uncovered

Regularly drinking green tea could protect the brain against developing Alzheimer's and other forms of dementia, according to latest research by scientists at Newcastle University.

11 jan 2011--The study, published in the academic journal Phytomedicine, also suggests this ancient Chinese remedy could play a vital role in protecting the body against cancer.

Led by Dr Ed Okello, the Newcastle team wanted to know if the protective properties of green tea – which have previously been shown to be present in the undigested, freshly brewed form of the drink – were still active once the tea had been digested.

Digestion is a vital process which provides our bodies with the nutrients we need to survive. But, says Dr Okello, it also means that just because the food we put into our mouths is generally accepted to contain health-boosting properties, we can't assume these compounds will ever be absorbed by the body.

"What was really exciting about this study was that we found when green tea is digested by enzymes in the gut, the resulting chemicals are actually more effective against key triggers of Alzheimer's development than the undigested form of the tea," explains Dr Okello, based in the School of Agriculture, Food and Rural Development at Newcastle University.

"In addition to this, we also found the digested compounds had anti-cancer properties, significantly slowing down the growth of the tumour cells which we were using in our experiments."

As part of the research, the Newcastle team worked in collaboration with Dr Gordon McDougall of the Plant Products and Food Quality Group at the Scottish Crop Research Institute in Dundee, who developed technology which simulates the human digestive system.

It is this which made it possible for the team to analyse the protective properties of the products of digestion.

Two compounds are known to play a significant role in the development of Alzheimer's disease – hydrogen peroxide and a protein known as beta-amyloid.

Previous studies have shown that compounds known as polyphenols, present in black and green tea, possess neuroprotective properties, binding with the toxic compounds and protecting the brain cells.

When ingested, the polyphenols are broken down to produce a mix of compounds and it was these the Newcastle team tested in their latest research.

"It's one of the reasons why we have to be so careful when we make claims about the health benefits of various foods and supplements," explains Dr Okello.

"There are certain chemicals we know to be beneficial and we can identify foods which are rich in them but what happens during the digestion process is crucial to whether these foods are actually doing us any good."

Carrying out the experiments in the lab using a tumour cell model, they exposed the cells to varying concentrations of the different toxins and the digested green tea compounds.

Dr Okello explained: "The digested chemicals protected the cells, preventing the toxins from destroying the cells.

"We also saw them affecting the cancer cells, significantly slowing down their growth.

"Green tea has been used in Traditional Chinese medicine for centuries and what we have here provides the scientific evidence why it may be effective against some of the key diseases we face today."

The next step is to discover whether the beneficial compounds are produced during digestion after healthy human volunteers consume tea polyphenols. The team has already received funding from the Biotechnology and Biological Sciences Research Council (BBSRC) to take this forward.

Dr Okello adds: "There are obviously many factors which together have an influence on diseases such as cancer and dementia - a good diet, plenty of exercise and a healthy lifestyle are all important."

Provided by Newcastle University

Women with both diabetes and depression at higher risk of dying from heart disease, other causes

Depression and diabetes appear to be associated with a significantly increased risk of death from heart disease and risk of death from all causes over a six-year period for women, according to a report in the January issue of Archives of General Psychiatry.

10 jan 2011--Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.

An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of type 2 diabetes were confirmed using a supplementary questionnaire.

During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.

When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.

"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.

"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.

More information: Arch Gen Psychiatry. 2011;68[1]:42-50.

Provided by JAMA and Archives Journals

Communication study reveals complexities of family decision-making

While a much hailed communication intervention works for families making decisions for chronically-ill loved ones in medical intensive care units, Case Western Reserve University researchers found the intervention was less effective for surgical and neurological ICU patients.

09 jan 2011--Barbara Daly and Sara Douglas, the study's lead researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve, attribute the varied results to different types of patients served by the three types of ICUs and differences among ICU cultures.

"We found the same approach is not going to have the same results for everyone," Daly said.

With the number of ICU patients predicted at more than 600,000 patients annually by 2020, researchers search for ways to help families make critical decisions for their loved ones. This study contributes to those ICU practices involving complex communication issues.

The researchers repeated a study from a Boston hospital that resulted in shorter stays and less unneeded tests and treatments when families were routinely informed through a systemized communications intervention about their family member's progress in a medical ICU. They compared the effect of the new communication system in 346 patients to usual practice in 135 patients.

The intervention involved a 30-minute communication meeting between the clinical staff and family, beginning five days after a patient requiring a ventilator was admitted to the ICU. The staff and family covered five components: medical update, preferences and goals for the patient, treatment plans, prognosis, and milestones (the markers that can tell whether a person is improving).

The meetings continued weekly until the patient was transferred to a regular hospital ward, to a long-term facility, went home or died.

According to Daly, the discussions are important because up to 40% of these ICU patients do not survive beyond two months if they have spent more than five days on a mechanical ventilator.

For survivors, the most likely outcome is for long-term care, which raises issues about the quality of life that the patient might want to have, she said.

Overall, the researchers found no significant differences between the control and intervention groups in length of stay in the ICU or in limitations of aggressive interventions.

"The Boston study had been the ideal situation where the director of the ICU was conducting the study and the ICU staff accepted the intervention as part of its routine practices, said Daly, professor of nursing and clinical ethics director at University Hospitals Case Medical Center. "We took the study into real-life situations."

Daly attributes the varying effectiveness of the new communication system to different ages and needs of patients in the medical, compared to surgical units and to differences in clinical staff attitudes towards decisions to limit aggressive interventions, such as feeding tubes and tracheostomy.

In the medical units, the patients generally are older and chronically ill—many suffering several chronic illnesses. The other ICUs generally serve younger patients who are more likely to have suffered a sudden acute health crisis, such as an emergency surgery or trauma from a motor vehicle accident.

Daly said many treatments in the medical ICU will not sustain life, and families face complicated end-of-life decisions to stop or continue ineffective treatments.

The research group also tracked conversational interchanges between family members and doctors.

All families received medical updates. About 86% of the meetings covered treatment plans; 94%, prognosis; 78 percent, preferences and goals; and only 68%, milestones.

Daly said analyses of the types of conversations found that 98% of the time was spent relaying facts about the patient, and only 2% was spent on personal, emotional, or relationship conversation.

The researchers also found that on average, doctors asked families one question, which was: "Do you have any questions?"

The families asked an average of six.

"Better communications is needed. Overall the process is not working as well as we would like and there are missed opportunities to better support families in their decisions," Daly concluded.

More information: "Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients," in the journal Chest.

Provided by Case Western Reserve University

On the road: Bike riding helps Parkinson's diagnosis

Neurologists examining a patient with early symptoms of Parkinson's disease should ask that individual to ride a bike, according to unusual research by Dutch doctors.

08 jan 2011--Distinguishing between patients with Parkinson's and those with a disorder known as atypical parkinsonism is important as the two conditions have different causes and treatments.

They share a set of shared symptoms, including limb tremor, slowed movement, muscle rigidity and unsteadiness -- and sometimes even advanced medical technology is unable to make an early distinction.

But, say researchers at the Parkinson Centre in Nijmegen, an effective, non-disruptive, low-cost diagnostic tool is this: can the patient ride a bike?

It may seem counter-intuitive, but people with "regular" Parkinson's often have a remarkable ability to ride a bike, as they have few problems with sideways balance and with the short, rhythmic movements needed to pedal, the doctors said in a letter published on Friday by The Lancet.

This task, though, is often too demanding for people with atypical parkinsonism, the umbrella term for half a dozen syndromes such as progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration.

Parkinson's disease comes from the death of cells in a key part of the brain called the substantia nigra that produce a neurotransmitter chemical called dopamine.

The standard treatment is a drug called levodopa, which the brain converts into dopamine. But the treatment does not work effectively, or may not even work at all, in atypical parkinsonism.

The Nijmegen doctors tested their theory on 111 patients with Parkinson-like symptoms and who were able to ride a bike at the start of the study.

Afterwards, 45 of the patients went on to be confirmed as having Parkinson's and 64 as having atypical parkinsonism.

During the 30 months that they were under study, two of the 45 later found to have Parkinson's stopped riding a bike, but the tally was 34 out of the 64 who were eventually diagnosed with the "atypical" disease.

"We suggest that the loss of the ability to cycle after disease onset might serve as a new red flag, signalling the presence of atypical parkinsonism," said the letter.

A blood test for Alzheimer's disease?

Scientists from the Florida campus of The Scripps Research Institute, have developed a novel technology that is able to detect the presence of immune molecules specific to Alzheimer's disease in patients' blood samples. While still preliminary, the findings offer clear proof that this breakthrough technology could be used in the development of biomarkers for a range of human diseases.

07 jan 2011--The study, led by Scripps Research Professor Thomas Kodadek, Ph.D., was published in the January 7, 2011 edition of the journal Cell.

Traditionally, antigens—a substance such as a protein from a virus or bacteria that stimulates an immune response—have been necessary for the discovery of antibody biomarkers. There has previously been no way to identify an antibody (a type of targeted immune molecule) without first knowing the antigen that triggers its production. The new study, however, challenges conventional wisdom and uses synthetic molecules rather than antigens to successfully detect signs of disease in patients' blood samples.

These synthetic compounds have many advantages – they can be modified easily and can be produced quickly in relatively large amounts at lower cost.

"Dr. Kodadek has conceived of a new approach for identifying antibody biomarkers of human disease that bypasses the conventional, but difficult, step of identifying the natural antigens or antigen mimics," said James M. Anderson, M.D., Ph.D., director of the National Institutes of Health (NIH) Division of Program Coordination, Planning, and Strategic Initiatives, who helps oversee the NIH Common Fund's Pioneer Award Program. "The results in the paper suggest great potential for using this approach to rapidly develop diagnostic biomarkers for a variety of significant human diseases. Such boldness to challenge conventional paradigms to achieve important scientific advances is a hallmark of the NIH Director's Pioneer Award Program, which supported much of this research."

"This study essentially puts an end to the notion that the only way to pull a potentially useful antibody from blood samples is with a specific antigen," said Kodadek. "Because the antigen identification problem has proven to be so difficult, we decided to take it out of the equation."

A Focus on the Immune System

To test the concept, Kodadek and his colleagues used comparative screening of combinatorial libraries of synthetic molecules – peptoids – against serum samples obtained from mice with a multiple-sclerosis-like condition or healthy controls. Those synthetic molecules that retained more immunoglobulin (IgG), a major type of antibody, from the blood samples of the diseased animals were identified as potential agents for capturing diagnostically useful molecules. This worked well.

The team next turned to serum samples from six Alzheimer's patients, six healthy individuals, and six Parkinson's disease patients. Three peptoids were identified that captured at least three-fold higher levels of IgG antibodies from all six of the Alzheimer's patients than any of the control or Parkinson's patients. The results showed that two of the peptoids bind the same IgG antibodies; a third binds different antibodies, resulting in at least two candidate biomarkers for the disease.

"We use these peptoids as a lure to capture the IgG antibodies," Kodadek said. "Some of these synthetic molecules recognize the antigen-binding sites of disease-specific antibodies well enough to pull them from blood samples, although they almost certainly don't bind as well as the native antigens. This ability should make it possible to short circuit the discovery of the natural antigens."

More information: "Identification of Candidate IgG Antibody Biomarkers for Alzheimer's Disease through Screening of Synthetic Combinatorial Libraries," by M. Muralidhar Reddy et al.

Provided by The Scripps Research Institute

Too many cancer screening options confuse patients, lead them to avoid screenings altogether

06 jan 2011-- Adhering to cancer screening recommendations is one of the best things people can do to reduce their risk of dying from cancer. But research at Virginia Commonwealth University Massey Cancer Center suggests that when patients are presented more than one colorectal cancer screening option, there is a greater chance of confusion and, therefore, a greater chance of neglecting screening recommendations.

The study, published in the journal Cancer Epidemiology, Biomarkers & Prevention, included data from more than 3,350 patients and provides the first empirical evidence linking multiple screening options with patient confusion, and patient confusion with screening adherence. Of the patients surveyed, the researchers found that 56 percent had discussed two or more colorectal cancer screening options with their physicians. Those patients presented with multiple options were 1.6 times more likely to be confused than those presented with one screening method. They also were 1.8 times less likely to follow screening recommendations.

The research was led by Resa M. Jones, M.P.H., Ph.D., assistant professor of epidemiology and community health at VCU Massey Cancer Center, whose recent research has been focused on evaluating barriers to colorectal cancer screenings.

“We found that confusion about multiple colorectal cancer screening options may act as a barrier to screening. Recognizing and minimizing confusion about the various options through public health messages, patient-physician communication and interventions could lead to increased screening adherence,” says Jones. “These results also have potential implications for other health-related topics where multiple options or choices are given.”

Currently, there are several different ways to screen for colorectal cancer: fecal occult blood testing, flexible sigmoidoscopy, colonoscopy and barium enema. These methods vary by frequency, accuracy, preparations, discomfort and cost. Additionally, the American Cancer Society and the U.S. Multi-Society Task Force on Colorectal Cancer now recommend more screening options than the U.S. Preventive Services Task Force suggests. All of these factors could add to patient confusion.

The data for this study were obtained using a questionnaire mailed to patients 50 to 75 years old who visited their doctor at least once in the past two years. Most of the patients earned more than $20,000 per year and were insured. Jones plans to further explore socioeconomic factors contributing to patient confusion about colorectal cancer screening and hopes to conduct a randomized trial to increase screening adherence in underserved populations by addressing barriers.

“Colorectal cancer is the second leading cause of cancer death. Patients whose cancers are detected early face much better outcomes than those diagnosed in later stages,” says Jones. “It’s important that patients have choices, but we have to be sure those choices are understood so that they don’t overwhelm the patient and become barriers to proper screening and care.”

Provided by Virginia Commonwealth University

TOP 10 MEDICINE PROGRESS

05 jan 2011--The first decade of the 21st Century brought a number of discoveries, mistakes, and medical advances that have influenced medicine from the patient's bedside to the medicine cabinet.

1. Human Genome Discoveries Reach the Bedside

In 2000, scientists in with the International Human Genome Project released a rough draft of the human genome to the public. For the first time the world could read the complete set of human genetic information and begin to discover what our roughly 23,000 genes do.

Mapping the human genome had become a race of time and money in the 1990s, with two competitors at the forefront: the government-funded Human Genome Project, which completed its task in 15 years with more than $3 billion in taxpayer money, and a private company, Celera Genomics, which was financed with $100 million and took less than a decade.

Both groups announced a rough draft at joint press conference on June 26, 2000.

In 2003 a "final" draft was released by researchers, and in 2007 more updates to the genome were published by Craig Venter, PhD, chief scientist behind Celera Genomics.

"It's the precursor for lots of medical advances," said Venter, now chairman and president of the nonprofit J. Craig Venter Institute.

"That was absolutely the hope for it, that it will begin to change things," said Venter, who was awarded the National Medal of Science by President Obama last month for his work on the human genome.

At the moment Venter sees more medical potential than medical achievements in genomic research. But when those advances do come, Venter predicts it will help preventative medicine and cut our rapidly accelerating medical costs from increasingly expensive treatments.

"I think the biggest area of the future will be preventive medicine," said Venter. "By understanding the genetic causes and links to disease we can spend more and more attention on preventing disease."

For example, Venter said doctors have developed a genetic test for a gene associated with prostate cancer, "and there's a drug available that greatly lowers the risk for prostate cancer in the future."

2. Doctors and Patients Harness Information Technology

Patients may not even think of it as they sign in with a pad and pen, then sit in the waiting room while the nurse pulls their file. But doctors say the Internet and information technology has actually changed the way they practice medicine for the better. Even doctors need to look things up from time to time.

"Early in practice, if I had a clinical question to research, I had to go to the library, pull out multiple years of the Index Medicus, look up the topic, write down the references, go to the stacks and pull the volumes of journals, find the article, read the article, go to the copy machine and make a copy& if I were lucky, I would have my answer in about four hours," said John Messmer, MD, associate professor at the Penn State College of Medicine in Hershey.

"Now I can be on rounds and in five minutes have more information on the topic than I need& on my iPod Touch, I can look up a medication, check the formulary to see if it's covered, check for interactions with a patient's other meds and double-check details of the pharmacology of the med plus quickly review the problem I am treating, and I don't even have to go online," said Messmer.

Information technology has also, to some degree, made life safer for the patient. Once admitted to a hospital, they get a bar code which matches their blood samples and their IVs.

"The ways in which computer systems are improving hospital care& are pervasive and radical," explained Margaret Humphreys, MD, PhD, editor of the Journal of the History of Medicine.

But many physicians have been reluctant to go digital because there is a significant upfront investment, which is why several of the healthcare reform measures now before Congress include provisions to underwrite some of this cost.

And with or without reform, the Obama administration has an ambitious program aimed at converting paper records to electronic health records. It has earmarked $20 billion to pay for the switch-over and named medical IT wonk David Blumenthal, MD, to serve as National Coordinator for Health Information Technology.

3. Anti-Smoking laws and Campaigns Reduce Public Smoking

There is no national smoking ban in the U.S., but 27 states and the District of Columbia have enacted smoking bans, including seven states that ban smoking in bars and casinos in recent years.

In a report issued last October, the Institute of Medicine said those public smoking bans have cut exposure to secondhand smoke, which, in turn, has contributed to a reduction in heart attacks and death from heart disease.

Lynn Goldman, MD, of Johns Hopkins Bloomberg School of Public Health, who chaired the committee that wrote the Institute's report, said the debate was over -- "Smoking bans work."

Experts in the history of medicine agreed.

"Anti-smoking campaigns (at least in the U.S.), including banning of smoking in workplaces and public places, [have] enormous impact across socioeconomic classes on many diseases," said Humphreys, who added that smoking increases the risk for strokes and many cancers.

In terms of the greatest good for the greatest number, there can be no doubt that the decline in smoking (through various means) has had the greatest impact," said Humphreys. "Virginia and North Carolina are just getting around to banning cigarettes in all restaurants now, so the public bans do track over the last 10 years."

While public smoking bans protect people from secondhand smoke, doctors say they also motivate people to quit.

"It's probably the most important 'doable' public health measure for decreasing morbidity and mortality," said Richard Kahn, MD, of Tenants Harbor, Maine. "There is good data that as it becomes more difficult for people to smoke, more will quit."

4. Heart Disease Deaths Drop by 40 Percent

Those looking for dramatic improvements in public health need look no further than the world of heart disease.

A mere 25 years ago, when a patient came to a hospital with a heart attack, the best that could be done was to put the patient in a darkened room, give him or her morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats, and hope for the best.

Heart attacks, called infarcts, were "big" and the damage to the heart muscle was often catastrophic, leading eventually to heart failure and death.

By contrast, today treating a heart attack is all about speed: speed the patient to the hospital so that a clot that blocks the life-saving flow of blood can be "busted" with drugs like the genetically engineered tissue plasminogen activator or tPA.

Or, if the problem is a vessel narrowed by buildup of plaque, a tiny flexible tube called a stent can be guided from an artery in the groin or the forearm up into the heart, where it is used to prop open the vessel to allow blood to flow normally.

Still other patients are sent to surgery, where surgeons have learned sophisticated techniques to sew new vessels into the heart to bypass diseased arteries.

Moreover, drugs that didn't exist 25 years ago -- chiefly statins like simvastatin, Lipitor, mevacor, and Crestor -- are now routinely used to slow the progression of atherosclerosis, the medical term that describes the build-up of the hard, waxy substance called plaque that narrows arteries.

Cardiologists say these efforts really began to bear fruit after 2000.

"In 1998/2000 the American Heart Association set a decade-long goal to reduce coronary heart disease and stroke and risk by 25% by 2010. We actually realized this goal by 2008 and have seen continued improvements in the reduction of deaths due to coronary heart disease and stroke," said Clyde Yancy, MD, of Baylor University Medical Center in Dallas, Texas. "As of today, we have seen a near 40 percent reduction in death due to coronary artery disease since 1998/2000.

Yancy said research shows about half of the gains in heart disease came from new treatment interventions, the other half (up to 60 percent) are due to prevention.

"Importantly, what this means is that the community 'gets it.' Better control of blood pressure, preemptive lowering of blood cholesterol levels, better diets, and reduced smoking are resulting in fewer (cardiac) events," he said.

5. Stem Cell Research: Laboratory Breakthroughs and Some Clinical Advances

Probably no area of research has so fired the public imagination and so ignited the fires of public controversy as that of stem cell research. In reality, this area has generated more political action than reproducible clinical advances -- the much-publicized ban on Federal funding of embryonic stem cell research was rescinded this year.

But the clinical advances with embryonic or adult stem cells -- even when they have come from pilot studies -- have been tantalizing.

For example, European researchers genetically manipulated bone marrow cells taken from two 7-year-old boys and then transplanted the altered cells back into the boys and apparently arrested the progress of a fatal brain disease called adrenoleukodystropy or ALD, which was the disease that affected the child in the movie "Lorenzo's Oil."

Cases like those fuel the promise of stem cell research, be it embryonic or adult stem cells. As the population ages, the opportunity for 'replacement parts' becomes more and more inviting, and I'm counting on stem cell research to give me, at least, new cartilage for my knees," joked Humphreys. "This seems likely to be the future of regenerative medicine."

Stem cell researcher George Daley, MD, PhD, of Children's Hospital in Boston, called progress in both adult and embryonic stem cell research this decade "breathtaking."

"Now we can make embryonic-like stem cells directly from skin cells, which makes it possible to model a multitude of human diseases in the petri dish. New drugs based on stem cells are being developed, and the first human clinical trial based on products of human embryonic stem cells is expected in 2010," said Daley. "The science of the past decade has been spectacular, and we're hopeful that in the next decade, we'll start to realize the promise of new stem cell therapies."

6.Targeted Therapies for Cancer Expand With New Drugs

Two blockbuster-targeted therapies burst on the cancer scene in late 1990s, and arguably changed forever the concept of cancer treatment, converting what was often a fatal disease into a chronic illness. The first, Herceptin, is a drug that targets a type of breast cancer that is characterized by a specific cancer gene -- an oncogene -- called HER-2.

Women whose cancers express HER-2, which is estimated to be about 25 percent of women with breast cancer, will respond to Herceptin even when other powerful chemotherapy drugs have failed.

Kimberly Blackwell, MD, of Duke University Medical Center, said doctors received a standing ovation when they presented the results of Herceptin drug trials.

"The introduction/approval of trastuzumab (Herceptin) and lapatinib (TyKerb) in breast cancer will prevent many women's breast cancers from recurring and have significantly improved survival for many women faced with breast cancer. More important, these drugs represent highly effective agents that target the cancer, not the patient," said Blackwell.

"Probably one of the only standing ovations I will witness in my career was when [it was] presented by Edward Romond at the Annual Meeting of the American Society of Clinical Oncology."

The other drug, a cancer pill called Gleevec, targets genetic mutation called bcr-abl (b.c.r. able) that causes cancer cells to grow and multiply in patients with a variety of cancers, including chronic myeloid leukemia or with a stomach cancer called GIST.

These two breakthrough agents opened the door to a number of cancer drugs that target specific molecules that control not only cell growth, but also the blood supply that feeds tumors.

7. Combination Drug Therapy Extends HIV Survival

Since the introduction of highly active antiretroviral therapy, or HAART, as this combination therapy approach is called, HIV/AIDS has evolved into a serious, but chronic disease with survival stretching into decades.

Moreover, this "cocktail" approach to treatment where drugs are combined in different ways or different sequences has become a model for treating other diseases ranging from lung cancer to heart disease.

"In 1996 a 20-year-old person in the U.S. with AIDS expected to live about three to five years and now expects to live to be 69 years. That is amazing," said John Bartlett, MD, past president of the Infectious Diseases Society of America. "Think of it -- in 1996 everyone in our HIV clinic was prepared to die. Now they all live. And most of them look great. They just need to take the meds."

"Next challenge is the cure," said Bartlett.

In more than a decade since the emergence of HAART, researchers have constantly refined the regimens to improve results, with evidence now emerging that some combinations may be more effecting patients with more extensive disease.

Thomas Coates, MD, of the University of California Los Angeles, pointed out that the HIV death rates are still dropping due to continual HIV research.

"The drop in death rates from HIV in the developed world (is) due to improved medications," Coates said. "There was the 10 percent drop in deaths due to HIV in the US between 2006 and 2007."

In Africa, where the HIV/AIDS crisis hits hardest today, Coates said doctors are slowly making progress-and in some cases real gains, which is the case with the use of antiretroviral drugs to block mother-to-infant HIV transmission.

"It has made a big difference in the developed world where vertical transmission rates have plummeted from over 1,000 at the peak to fewer than 100 per year (in the US)," said Coates. "Advances are being made in the developing world, with Botswana leading the way not with a 3% vertical transmission rate. It was the first and still is the most effective prevention strategy we have."

8. Minimally Invasive and Robotic Techniques Revolutionize Surgery

Ten years ago a patient would typically be left with a 10-inch scar when a doctor removed a kidney, but in late 2007 the surgeons at the Cleveland Clinic began removing kidneys through a single incision in the patient's navel.

And earlier this year, a Cleveland Clinic surgeon removed a diseased kidney from a woman using a technique called natural orifice translumenal endoscopic surgery or NOTES. In the case of the woman the kidney was removed through her vagina-an approach originally developed for hysterectomy.

Tiny metal hands carefully manipulating sutures deep inside the heart seems like a scenario pulled from "Star Trek," but the reality is that robotic surgery is occurring daily in a growing number of centers across the country.

The greatest benefit of tiny openings into the body rather than large incisions made by traditional surgery, may -- believers say -- be shorter and less painful recovery time.

Medical historian Sandra Moss, MD, believes this, especially after watching a sibling undergo a minimally-invasive surgery.

"My younger sister and I had the same operation 20 years apart. I was hors de combat (out of commission) for one month and loopy from pain meds for two weeks -- she was back at work in a few days on no pain medications," said Moss.

Doctors have also used robotic surgery to improve the accuracy of procedures, especially in cancer cases.

"Robotic surgery increased the ability of cancer surgeons to get clean margins as well due to the magnification of the structures," said Douglas Bacon, MD, of the Mayo Clinic in Rochester, Minn.

Richard Caselli, MD, of the Mayo Clinic in Scottsdale, Ariz., pointed out that robotic surgery "offers the potential for surgeons to operate on patients remotely."

But critics, and there are many, say the cost of the robotic hardware may outweigh the benefit. Moreover, critics say that the robot revolution is racing ahead of the evidence.

9. Study Finds Heart, Cancer Risk with Hormone Replacement Therapy

Until July 2002 most doctors treating middle-age women believed that giving their patients hormones -- either estrogen alone or estrogen combined with progestin -- would protect their hearts from the ravages of age that seemed to attack women after menopause.

Hormone replace therapy, or HRT, was also thought to be good for the bones, the brain, the skin, the figure, and the libido, and was considered the best treatment to control the annoying and sometimes disabling symptoms of menopause such as hot flashes, depression, and sleep disturbances.

And then the world changed, the National Heart Lung and Blood Institute, which was sponsoring a placebo-controlled trial of hormone replacement therapy in more than 161,000 healthy women, announced that it was shutting down the study because HRT increased the risk of heart attack, stroke, blood clots, and breast cancer.

It was the "oops" heard round the world.

Larry Norton, MD, of the Memorial Sloan-Kettering Cancer Center in New York City, believes the two biggest advances in breast cancer this decade was the targeted-breast cancer treatment with Herceptin and "the finding that postmenopausal hormone replacement is associated with a huge increase in the risk of breast cancer."

But the news from the Women's Health Initiative, as the study was known, wasn't all bad. HRT did reduce the risk of colorectal cancer and fractures and was proven to be an effective treatment for hot flashes and some other menopause symptoms.

10. Scientists Peer Into Mind With Functional MRI

Mind-reading has moved from carnival attraction to the halls of medicine with what is known as a functional MRI.

The medical mind-readers are not trying to identify a card randomly selected from a deck -- they are using sophisticated imaging techniques to map the way the mind works.

The process, often called fMRI, traces the working of neurons -- brain cells -- by tracking changes in the oxygen levels and blood flow to the brain. The more brain activity in one area, the more oxygen will be used and the more blood will flow to that area. The patient lies awake inside an MRI scanner. He or she is asked to perform a simple task, like identifying a color or solving a math problem.

As the patient answers the question, the fMRI tracks the areas of the brain that are activated by tracing the speed at which the cells metabolize the sugar, or glucose.

First developed in the early 1990s, fMRI began to shape research at the beginning of the decade.

"It has certainly taken off in the past 10 years as a means for studying the living human brain in action," said Caselli. "It has given us innumerable insights into cognition, social interactions, reward systems, decision-making, and so on."

Using this technique, researchers are learning valuable information about disease such as depression, brain cancer, autism, memorydisorders, and even conditions such as the skin disorder psoriasis.

Walking speed associated with survival in older adults

In an analysis that included data from 9 studies, having higher measures of walking speed among older adults was associated with increased length of survival, according to a study in the January 5 issue of JAMA.

05 jan 2011--"Remaining years of life vary widely in older adults, and physicians should consider life expectancy when assessing goals of care and treatment plans. However, life expectancy based on age and sex alone provides limited information because survival is also influenced by health and functional abilities," according to background information in the article. There are currently no well-established approaches to predicting life expectancy that incorporate health and function. Gait speed, or walking speed, has been recommended as a potentially useful clinical indicator of well-being among older adults.

Stephanie Studenski, M.D., M.P.H., of the University of Pittsburgh, and colleagues conducted a study to assess the association of gait speed with survival in older adults and to determine the degree to which gait speed explains variability in survival after accounting for age and sex. The study included a pooled analysis of 9 participating studies (collected between 1986 and 2000), using individual data from 34,485 community-dwelling adults age 65 years or older with walking speed data available at the beginning of the study, followed up for 6 to 21 years. Participants had an average age of 73.5 years; 59.6 percent were women; and 79.8 percent were white. Gait speed was calculated for each participant using distance in meters and time in seconds. All studies used instructions to walk at usual pace and from a standing start. The walk distance varied from 8 feet to 6 meters. The average gait speed of the participants was 0.92 meters (3 feet) per second.

During the course of the study, there were 17,528 deaths. The overall 5-year survival rate was 84.8 percent; the 10-year survival rate was 59.7 percent. The researchers found that gait speed was associated with differences in the probability of survival at all ages in both sexes, but was especially informative after age 75 years. At this age, predicted 10-year survival across the range of gait speeds ranged from 19 percent to 87 percent in men and from 35 percent to 91 percent in women.

"Predicted years of remaining life for each sex and age increased as gait speed increased, with a gait speed of about 0.8 meters [2.6 feet]/second at the median [midpoint] life expectancy at most ages for both sexes. Gait speeds of 1.0 meter [3.3 feet]/second or higher consistently demonstrated survival that was longer than expected by age and sex alone. In this older adult population the relationship of gait speed with remaining years of life was consistent across age groups, but the absolute number of expected remaining years of life was larger at younger ages," the authors write.

The researchers also found that predicted survival based on age, sex, and gait speed was as accurate as predictions based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization.

The authors suggest there are several reasons why gait speed may predict survival. "Walking requires energy, movement control, and support and places demands on multiple organ systems, including the heart, lungs, circulatory, nervous, and musculoskeletal systems. Slowing gait may reflect both damaged systems and a high energy cost of walking."

The researchers write that there are a number of ways gait speed might be used clinically, including helping to identify older adults with a high probability of living for 5 or 10 more years, who may be appropriate targets for preventive interventions that require years for benefit. Gait speed might be used to identify older adults with increased risk of early mortality, perhaps those with gait speeds slower than 0.6 meter (2 feet)/second. "In these patients, further examination is targeted at potentially modifiable risks to health and survival." Also, gait speed might be monitored over time, with a decline indicating a new health problem that requires evaluation.

"The data provided herein are intended to aid clinicians, investigators, and health system planners who seek simple indicators of health and survival in older adults. Gait speed has potential to be implemented in practice, using a stop watch and a 4-meter [13 feet] course. From a standing start, individuals are instructed to walk at their usual pace, as if they were walking down the street, and given no further encouragement or instructions. The data in this article can be used to help interpret the results. Gait speed may be a simple and accessible indicator of the health of the older person," the authors conclude.

More information: JAMA. 2011;305[1]:50-58.

Provided by JAMA and Archives Journals

Angry at God? If so, you're not alone, says psychologist

The notion of being angry with God goes back to ancient days. Such personal struggles are not new, but Case Western Reserve University psychologist Julie Exline began looking at "anger at God" in a new way.

04 jan 2011--"Many people experience anger toward God," Exline explains. "Even people who deeply love and respect God can become angry. Just as people become upset or angry with others, including loved ones, they can also become angry with God."

Exline, an associate professor in Case Western Reserve's College of Arts and Sciences, has researched anger toward God over the past decade, conducting studies with hundreds of people, including college students, cancer survivors and grief-stricken family members.

She and her colleagues report their results in the article, "Anger toward God: Social-Cognitive Predictors, Prevalence, and Links with Adjustment to Bereavement and Cancer" in the new issue of the Journal of Personality and Social Psychology.

Anger toward God often coincides with deaths, illnesses, accidents or natural disasters. Yet anger is not limited to traumatic situations. It can also surface when people experience personal disappointments, failures, or interpersonal hurts. Some people see God as ultimately responsible for such events, and they become angry when they see God's intentions as cruel or uncaring. They might think that God abandoned, betrayed, or mistreated them, Exline says.

Exline notes that it can be difficult for people to acknowledge their anger toward God. Many people are ashamed and don't want to admit their feelings, she says. In particular, people who are highly religious may believe that they should focus only on the positive side of religious life.

"But religion and spirituality are like other domains of life, such as work and relationships," Exline says. "They bring important benefits, but they can bring difficulties as well. Anger with God is one of those struggles," she adds.

According to Exline's findings, Protestants, African Americans, and older people tend to report less anger at God; people who do not believe in God may still harbor anger; and anger toward God is most distressing when it is frequent, intense, or chronic.

Overcoming anger at God, she says, may require some of the same steps needed to resolve other anger issues.

"People may benefit from reflecting more closely on the situation and how they see God's role in it," Exline suggests. "For example, they may become less angry if they decide that God was not actually responsible for the upsetting event, or if they can see how God has brought some meaning or benefit from a painful situation."

People who feel angry toward God also need to be reassured that they are not alone. Many individuals experience such struggles, she adds. She suggests that people try to be open and honest with God about their anger, rather than pulling away or trying to cover up their negative feelings.

More information: http://psychology. … d/index.html

Provided by Case Western Reserve University

7 Major Advances Predicted for Health & Medicine in 2011

In terms of advancement in the fields of science and medicine, 2010 was a stellar year. German doctors appeared to have cured a man of HIV. Doctors watched a drug called PLX4032 melt away the tumors of melanoma patients who otherwise were out of treatment options. And scientists created the first "synthetic life."

03 jan 2011--What significant advances can we expect in 2011? Here are seven predictions, provided by experts in these fields who gave the low down on what might promote our health next year.

Prediction 1: Results of a promising HIV vaccine will be announced.

An American man made international headlines this month when German doctors announced he had been cured of the virus that causes AIDS. The HIV-positive man had suffered from acute myeloid leukemia - a deadly blood cancer - so in 2007 the doctors performed a bone marrow transplant to treat the leukemia. They were lucky enough to find a bone marrow donor with a rare mutation, called Delta 32, that provides natural resistance to the human immunodeficiency virus.

Three years after the transplant, the man continued to show no signs of HIV.

But for all the media attention to this case, another scientific advance is likely to help more people battle HIV and AIDS in 2011.

In 2009, studies in Thailand showed a vaccine could reduce the risk of contracting HIV by about 30 percent. Dr. Susan Zolla-Pazner, an HIV researcher at the New York University Langone Medical Center in New York City, said it was the first sign of real success for an HIV vaccine, and a guide to future research.

"It was the first and only light in a very dark tunnel that suggested that we were beginning to get off of home plate in terms of making any progress," Zolla-Pazner said.

Reflecting on the case of the German achievement, Zolla-Pazner pointed out that only a tiny fraction of HIV patients would be able to find matching bone marrow from a naturally resistant donor, and even then, those patients would risk dying from the bone marrow transplant procedure.

"It shows that, in theory, with bone marrow transplants, you can cure [HIV], which is interesting. But certainly it is not anything that could be applied even on a small scale, let alone on a vast scale with millions of people," Zolla-Pazner said.

So instead of bone marrow transplants, Zolla-Pazner is setting her hopes on HIV vaccine advancements.

"If there's a clear answer about what that vaccine did to provide protection, it provides a foundation to build another vaccine," she said.

Zolla-Pazner said more results based on the experimental vaccine are expected to be announced in mid-2011.

Prediction 2: Many broken hearts will be fixed by freezing them.

The 2.2 million people in the United States afflicted with atrial fibrillation will see another tool in the fight against their condition in 2011: a device that freezes heart tissue.

A healthy heart contracts under a timed pattern of electrical signals, but people with atrial fibrillation have irregular electrical signals, causing the upper chambers of their heart to quiver instead of beat, according to the American Heart Association. Atrial fibrillation can lead to fatigue, shortness of breath, and even stroke.

This month the Food and Drug Administration approved the Arctic Front cardiac cryoablation catheter system device, which freezes sections of heart tissue instead of burning them with radio-frequency energy. Doctors can use the device to purposefully scar certain sections of the heart, blocking the irregular signals that create atrial fibrillation.

"This treatment model has shown to cure this disease in 70 percent of patients," said Dr. Moussa Mansour, who used the device in clinical trials at Massachusetts General Hospital in Boston.

"The old way [radio-frequency ablation] had a similar range of success, but we believe it is easier to do it in the new way," Mansour said. Now that the cryoablation technique has been approved, he added, more people will receive therapy.

Prediction 3: The lowered bar for lap-band surgery will have an impact on the decisions made by millions of obese Americans.

Surgery is one of the more controversial solutions to the nation's obesity problem, even though research shows stomach surgery for weight loss is sometimes the most effective treatment.

This coming year will open up the option of bariatric weight-loss surgery to millions more Americans. Until recently, only people with a body mass index (BMI) of at least 40, or those with BMIs of 35 and higher with another serious health problem related to their obesity, were candidates for lap-band surgery from Allergan, according to the FDA. In the lap-band procedure, a doctor places an inflatable silicon ring around the upper portion of the stomach and constricts it.

In late 2010, the FDA voted to change the eligibility criteria for the Allergan procedure. Now, most people with a BMI of 35 or higher, and patients with a BMI of 30 or higher who also have another serious medical condition, can undergo the operation.

"Only one in 50 people will keep 50 pounds off for one year using diet and exercise. It's just a profound waste of time for people who are obese," said Dr. George Fielding, an advocate of the surgery who works in the Division of Bariatric Surgery at NYU Langone Medical Center.

"Surgery does work, it's just so well established," he said. "All around the world, no matter what method you use, you can see results."

Fielding noted that if a person with diabetes and a BMI of 30 loses 50 pounds and keeps it off, he has an 80 percent chance of coming off their diabetes medications. "There are millions of people, literally, with the BMI of 30 and 35 who have diabetes," he said.

But physicians who specialize in weight loss warn about the dangers of opening a patient's body when there are other options.

"The issue with surgery, any kind of surgery - banding, bypass, etc. - is they work, by far, better than anything else. The problem is that they are surgery, so they're invasive, " said Dr. Lee Kaplan, director of the Massachusetts General Hospital's Weight Center. "They have risks associated with them. "

Kaplan said only 2 percent of patients who meet the criteria for weight-loss surgery actually undergo the procedure, in part because of the risks. Because of this, he doesn't think dropping the criteria by 5 BMI points will drastically change the odds of an obese person submitting to the procedure.

Kaplan acknowledged that research on people who've had weight-loss surgery has contributed to the understanding of exactly how the body can lose weight - or keep it on.

"We're learning an enormous amount from surgery, even though surgery itself is used infrequently," Kaplan said. Doctors used to think weight-loss surgery worked by making the stomach smaller, but they have found evidence that the surgery actually changes physiological mechanisms in the body that eventually determine whether or not a person gains weight, he said.

Prediction 4: School lunches will get a makeover that will lower obesity in the next generation.

More than about any surgery, obesity experts are excited about the Healthy, Hunger-Free Kids Act, which takes effect in 2011.

The new legislation raises the federal reimbursement rate for school lunches by 6 cents per meal, according to the American Academy of Pediatrics. The bill will allot an additional $4.5 billion toward school lunch programs over 10 years, and it has tasked the U.S. Department of Agriculture with creating nutrition standards for food sold through vending machines in schools.

"If you can tell a kid at age 5 or 6, 'Look, this food is really yummy - it just doesn't come from McDonald's, it's just fresh food,' then you've got a chance," Fielding said. "Once a kid is fat and 10 or 12 years old, it doesn't matter how much you're going to tell them, it's hot air."

"You can make the next generation have a chance by teaching them about healthy food," he said.

Kaplan called the legislation "terrific. "

"When the [school lunch] program was developed 50 years ago, the focus was not on obesity, it was on malnutrition," Kaplan said. "Now ... we see obesity is an even bigger problem than malnutrition."

Prediction 5: Restaurant menus that list calories will help us cut our daily total.

This year the nation will follow New York City in requiring restaurant chains to post calorie counts next to standard menu items. The mandate comes as part of the Patient Protection and Affordable Care Act, and requires chains with 20 or more locations to list calories by spring 2011.

Physicians who specialize in weight loss say the move will help some who don't realize their latte has 300 calories, or that their favorite dish might pack more than 1,000 calories. But the doctors aren't predicting whether it will make a dent in the nation's obesity rate.

"I don't think people care. If they did, they wouldn't be going to these stores, because they all know what they are," Fielding said.

The mandate also requires the listing of calories in vending machines and "similar retail food establishments," according to the FDA.

"I think it might help," Kaplan said. But realistically, the effect "is going to be quite modest."

However, Kaplan added, "I think the risk of doing this is essentially zero, and the benefit is undetermined. But with so little risk, I think we ought to do it."

Prediction 6: Genomics will find medicines that work for you.

Sequencing an entire human genome cost about $3 billion a decade ago. Last year it cost around $10,000, according to Dr. Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif.

Topol said he expects to see the price drop again in 2011, to about $4,000. And with lower financial barriers, he said, more medical advances from genomic research will come in the next year.

"This field is exploding," he said.

For example, Topol said, last year pharmacy benefit managers Medco and CVC/Caremark started examining the genes of patients on the widely used heart drug Plavix. The researchers identified two genes - called PON1 and CYP2C19 - that can determine how a person would respond to Plavix.

"These two genes explain why this drug, which is the second biggest drug in the world, is so inconsistent," Topol said. "Two-thirds of patients on Plavix do well, but the others either don't see the drugs' effects and/or suffer from side effects."

Genotyping has already found mutations that would determine a person's response to malaria drugs, blood thinners, and breast cancer therapy, Topol said.

For the hepatitis C drug interferon, Topol said, researchers have identified genes that could save about half of all hepatitis C patients from side effects.

"Fifty percent of people don't respond [to interferon], and that drug costs $50,000 and it makes you sick," Topol said. "That is a really striking example."

Genetic analysis "saves lots of money; it saves patients from being sick for years with a drug that doesn't help them."

Prediction 7: Genomics will help us understand cancer.

Topol predicted the low cost of genome sequencing will also bring good news in cancer research next year, "because the sequencing is becoming so much cheaper and fast, and because bioinformatics is getting more advanced," he said.

With faster technology, Topol said it's become increasingly feasible for cancer researchers to compare a person's genome - the "germ line" genome the patient was born with - with the mutated genome of his or her cancerous tumors, to find the genes that are driving the cancer. In other words, they'll find the genes that are making cancerous cells act cancerous.

Topol said such research has already benefited melanoma patients taking the powerful drug PLX4032. Genomic research has showed melanoma patients with tumors that have what's known as a BRAF mutation will benefit from the drug, while patients whose tumors don't have that mutation will likely get worse with the drug.