Pacifier, baby bottle or finger sucking may hamper a child’s speech development if the habit goes on too long.

In a study that took place in Patagonia, Chile, researchers associated the persistence of these sucking habits with an increased risk of speech disorders in preschool children. The children were more likely to have difficulty producing certain word sounds and to simplify their pronunciation.

The results were published Wednesday, Oct. 21, in BMC Pediatrics, an online, open-access medical journal.

A team led by Clarita Barbosa from Corporacion de Rehabilitacion Club De Leones Cruz Del Sur conducted the study, along with collaborators from the University of Washington (UW) Multidisciplinary International Research Training (MIRT) Program in the School of Public Health, the Department of Epidemiology, and the Department of Global Health.

Looking at a group of 128 children age 3 years to 5 years, the researchers gathered parents’ reports of each child’s feeding and sucking behaviors during infancy and evaluated the child’s speech. The researchers found that delaying giving a baby bottle until the child was at least 9 months old reduced the risk of later developing speech disorders, while children who sucked their fingers or who used a pacifier for more than 3 years were three times more likely to develop speech impediments.

“These results suggest extended sucking outside of breast-feeding may have detrimental effects on speech development in young children,” according to Barbosa. This finding is particularly relevant, as the use of baby bottles and pacifiers has increased over the past few decades. However, Barbosa is careful to note, “Although results of this study provide further evidence for the benefits of longer duration of breast feeding of infants, they should be interpreted with caution as these data are observational.”

Earlier studies by other researchers have suggested that babies’, toddlers’ and pre-schoolers’ sucking habits may influence their mouth, jaw and dental anatomy. Previous research also has suggested that breast feeding may be beneficial to developing coordinated breathing, swallowing and speech articulation.

In addition to Barbosa, other researchers on the study entitled “The Relationship of Bottle Feeding and Other Sucking Behaviors with Speech Disorder in Patagonian Preschoolers” were Sandra Vasquez, and Juan Carlos Velez Gonzales from Corporacion de Rehabilitacion Club De Leones Cruz Del Sur, Chile; and Mary A. Parada, Chanaye Jackson, N. David Yanez, Bizu Gelaye, and Annette L. Fitzpatrick, research associate professor of epidemiology, from the University of Washington School of Public Health, Seattle.

The study was completed while Parada and Jackson were research training fellows with the MIRT Program. The MIRT Program is supported by an award from the National Institutes of Health, National Center on Minority Health and Health Disparities.

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On the Net:

• University of Washington
• BMC Pediatrics

The International Osteoporosis Foundation (IOF) will issue a new 16-page report on FRAX® to mark World Osteoporosis Day on October 20, 2009. The report is available at http://www.iofbonehealth.org/publications/frax.html

The International Osteoporosis Foundation (IOF) will issue a new 16-page report on FRAX® to mark  World Osteoporosis Day on October 20, 2009. The report is available at http://www.iofbonehealth.org/publications/frax.html

FRAX®, or “ËœWHO Fracture Risk Assessment Tool’, is a free online tool developed by the World Health Organization at http://www.shef.ac.uk/FRAX/. The tool helps clinicians to better identify women and men in need of intervention (at highest risk of fragility fractures) and thereby to improve the allocation of limited healthcare resources. FRAX® utilizes several known clinical risk factors rather than BMD alone to calculate a patient’s 10-year fracture probability, thus making it particularly useful in regions where DXA technology is scarce or not available.

As a disease, osteoporosis is often neglected. Yet, paradoxically, it so common that, in many regions around the world, one in three women and one in five men over the age of fifty suffer fragility fractures that occur as a result of osteoporosis. These fractures can have a devastating impact on individuals, and represent an enormous socio-economic burden to health care systems and society as a whole. IOF President John Kanis said, “In issuing this new easy-to-read report, IOF hopes to bring understanding of FRAX® to a broad audience of health professionals so that more people at risk of debilitating fractures are identified and treated before these fractures occur.”

FRAX® currently receives nearly 60,000 hits per day, with numbers increasing as it is expanded to include more country-specific calculation tools. Now in web version 3.0, it is available in six different languages and for 18 different countries. The latest country models include Argentina, Belgium, Finland, Hong Kong (China), Lebanon and New Zealand.

The tool is also being continually upgraded and enhanced for greater efficiency and ease-of-use in clinical practice. For example, following the recent link between the UK calculation tool and the UK national guidelines website (http://www.shef.ac.uk/NOGG/), the US model now also integrates an accompanying statement from the National Osteoporosis Foundation (USA), based on their 2009 Clinician’s Guide. Furthermore, manufacturers of DXA scanners will soon integrate FRAX® into their operational software, combining BMD measurements with the calculation of absolute 10-year fracture probabilities.

Dr. Eugene McCloskey of the University of Sheffield and author of the IOF report, says, “I encourage clinicians to make FRAX® a part of their clinical assessment of patients. With timely treatment and advice, fractures and their serious repercussions can be prevented.”

The perception that antibiotic resistance is primarily the undesirable consequence of antibiotic abuse or misuse is a view that is simplistic and inaccurate, according to a recent report by the American Academy of Microbiology. The reasons behind the spread of resistance are much more complex, including appropriate antibiotic use, lack of proper sanitation and hygiene, and even the environment.

The report, “Antibiotic Resistance: An Ecological Perspective on an Old Problem,” is based on a colloquium convened by the Academy in October 2008. It states that resistance development is founded in the inevitability of microbial evolution. There are no scapegoats, and responsibility is partly due to medical practice, including patient demand, industrial practices, politics, and antibiotics themselves.

“Antibiotic resistance is an international pandemic that compromises the treatment of all infectious diseases. At the present time, resistance essentially is uncontrollable. The reasons behind the establishment and spread of resistance are complex, mostly multi-factorial, and mostly unknown. The colloquium consensus was that efforts must target both the bacterial transmission and antimicrobial use,” states colloquium co-chair, Jacques F. Acar, M.D. More research bridging medical, chemical, and environmental disciplines is needed now according to the Academy report.

Resistance is often portrayed as simply an undesirable consequence of antibiotic abuse or misuse, but the rate of antibiotic resistance emergence is related to all uses of drugs, not just misuse, and the total amount of antibiotics used and the environment also play roles. The main driving factor behind resistance may actually be a lack of adequate hygiene and sanitation, which enables rapid proliferation and spread of pathogens.

According to the report, it is possible to co-exist with resistance by developing new strategies to prevent resistance from spreading and, where it already exists, identify the strains we need to protect against, find new ways to treat resistance infections effectively in patients, and manage reservoirs of antibiotic strains in the environment. The report summarizes the current scientific understanding of antibiotic resistance, the scope of the problem, and methods at our disposal for detecting emergence and preventing spread. The knowledge gaps about the prevalence of resistant strains and resistant infections are highlighted as are the unique problems and challenges in developing countries. The continuation of antibiotic use for human and animal diseases is at stake unless worldwide efforts are taken. Research for new antibiotics under new paradigms must consider what the functions of these molecules are in nature, how resistant populations relate to them, and where and how to find them.

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On the Net:

• American Society for Microbiology
• American Academy of Microbiology

University of California, Davis, researchers studying the 2009 H1N1 influenza virus, formerly referred to as “swine flu,” have identified a group of immunologically important sites on the virus that are also present in seasonal flu viruses that have been circulating for years. These molecular sites appear to result in some level of immunity to the new virus in people who were exposed to the earlier influenza viruses.

More than a dozen structural sites, or epitopes, in the virus may explain why many people over the age of 60, who were likely exposed to similar viruses earlier in life, carry antibodies or other type of immunity against the new virus, immune responses that could be attributed to earlier flu exposure and vaccinations.

Researchers Zheng Xing, a project scientist, and Carol Cardona, a veterinarian and Cooperative Extension specialist, both of the UC Davis School of Veterinary Medicine, report their findings online in the journal of Emerging Infectious Diseases. The report will appear in the November print edition of the journal, published by the Centers for Disease Control and Prevention.

“These findings indicate that human populations may have some level of existing immunity to the pandemic H1N1 influenza and may explain why the 2009 H1N1-related symptoms have been generally mild,” Cardona said.

“Our hypothesis, based on the application of data collected by other researchers, suggests that cell-mediated immunity, as opposed to antibody-mediated immunity, may play a key role in lowering the disease-causing ability, or pathogenicity, of the 2009 H1N1 influenza,” Xing added.

He noted that immune responses based on production of specific cells, known as cytotoxic T-cells, have been largely neglected in evaluating the efficacy of flu vaccinations. In this type of immune response, the T-cells and the antiviral chemicals that they secrete attack the invading viruses.

About 2009 H1N1 influenza

The 2009 H1N1 virus is a new strain of influenza that first appeared in the United States in April 2009. Early on, it was referred to as “swine flu” because it was genetically similar to influenza viruses that normally occur in pigs in North America. Further study, however, revealed that the virus actually included genes from viruses found in birds and humans, as well as pigs.

At first, this H1N1 influenza virus apparently caused a high number of deaths among patients in Mexico and among people with certain pre-existing medical conditions. But as it has progressed to become a pandemic or geographically widespread virus, H1N1 has caused relatively mild symptoms and few deaths.

One hallmark of this new influenza virus, according to the Centers for Disease Control and Prevention, has been the presence of pre-existing antibodies against the virus in about one third of H1N1 2009 patients over the age of 60, a phenomenon that suggested some levels of immunity may have existed to the new pandemic H1N1 virus. The UC Davis research

To probe this phenomenon, the UC Davis researchers surveyed data from earlier studies of epitopes known to exist on different strains of seasonal influenza A. They found that these epitopes, present in other seasonal H1N1 influenza strains around the world and capable of triggering an immune response, were also present in the strains of H1N1 2009 that were found in California, Texas and New York.

Interestingly, although previous H1N1 viruses seem to have produced a protective antibody response in exposed people, these antibodies largely did not provide cross-protection for individuals infected with the H1N1 2009 strain of influenza. The researchers theorize that, rather than stimulating protective antibodies, the epitopes of the new H1N1 2009 virus produced an immune response by triggering production of cytotoxic T-cells, which boost a person’s immune defenses by killing infected cells and attacking the invading viruses.

Humans can mount two types of immune responses. One type is produced when the invading virus triggers production of protective antibodies that circulate in the bloodstream, and the other type, described above, is known as a cell-mediated immune response. It is produced when the invading virus triggers the activation of cytotoxic T-cells, a process that helps clear the virus from the body. Evidence from earlier studies suggests that cytotoxic T-cell immune immunity can be caused by either an active viral infection or by vaccination against such a virus.

Implications for avian influenza

The researchers note that about 80 percent of the epitopes found in seasonal influenza and flu vaccine viruses are also present in the highly pathogenic H5N1, or avian influenza, virus. They suggest that these epitopes may have protected some individuals infected with the highly pathogenic H5N1 virus through cytotoxic T-cell immunity.

However, the H5N1 virus rapidly reproduces itself and spreads so quickly within vital organs that the body may not be able to launch protective immunity, thus accounting for the high fatality rate of avian influenza.

Furthermore, only a fraction of the human population can recognize the specific epitopes necessary to cause the appropriate protective immune response, which may explain why the H1N1 2009 virus, as well as avian influenza, may vary in severity from person to person.

Xing and Cardona propose that immunity acquired from seasonal influenza or flu vaccinations may provide partial protection for patients infected with the avian influenza virus due to the shared epitopes essential for cytotoxic T-cell immunity.

This is supported by statistics from the World Health Organization indicating that there have been fewer avian influenza infections in people 40 years and older than there were in people under that age, and that the fatality rate of avian influenza was just 32 percent in the older age group but 59 percent in the younger group.

The researchers, therefore, suggest that repeated exposure to seasonal influenza viruses or flu vaccinations may have resulted in cytotoxic T-cell immunity to avian influenza, and that the same type of immunity may also have developed in people exposed to the H1N1 virus.

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On the Net:

• University of California – Davis
• Emerging Infectious Diseases

Researchers at the National Institutes of Health (NIH) have found that imaging can now be used as a tool for identifying severe cases of H1N1 and may play a key role in understanding the pathogenesis of the virus, possibly leading to earlier diagnoses of severe cases in the future, according to a study published online today in the American Journal of Roentgenology. The study will be published in the December issue of AJR.

Imaging revealed a severe case of H1N1 after a patient had tested negative using a nasal swab rapid antigen test. Radiography (standard X-ray) showed peripheral lung opacities, and computed tomography (CT) revealed peripheral ground-glass opacities. Both findings raised suspicion of H1N1 and reports revealed that the patient later died from a severe case of H1N1.

“The role of radiologic imaging in epidemic detection and response is evolving, with imaging being used as a tool for identifying severe cases,” said Daniel J. Mollura, M.D., lead author of the study. “At the Center for Infectious Disease Imaging (CIDI) at the NIH, the study of influenza is a priority with a focus on achieving early diagnosis and understanding its pathogenesis,” he said.

“Early CT may help clinicians recognize cases of severe influenza and monitor response to treatment. More cases will certainly need to be analyzed and compared in the future, but this is a promising early result,” said Dr. Mollura.

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On the Net:

• American Roentgen Ray Society
• AJR

In new papers appearing this month in Science and the Proceedings of the National Academy of Sciences, University of Illinois biochemistry professor Raven H. Huang and his colleagues describe the first RNA repair system to be discovered in bacteria. This is only the second RNA repair system discovered to date (with two proteins from T4 phage, a virus that attacks bacteria, as the first).

The novelty of the newly discovered bacterial RNA repair system is that, before the damaged RNA is sealed, a methyl group is added to the two-prime hydroxyl group at the cleavage site of the damaged RNA, making it impossible to cleave the site again. Thus, the repaired RNA is “better than new.”

This discovery has implications for protecting cells against ribotoxins, a class of toxins that kills cells by cleaving essential RNAs involved in protein translation. Because the enzyme responsible for methylation in the newly-discovered RNA repair system is the Hen1 homolog in bacteria, the finding has also implications for the understanding of RNA interference and gene expression in plants, animals, and other eukaryotes. The eukaryotic Hen1 is one of three enzymes (along with Dicer and Argonaute) essential for the generation of small noncoding RNAs of 19-30 nucleotides in RNA interference.

While the Science paper describes the mechanism of the entire RNA repair process, the article in PNAS focuses on the chemistry of the methylation reaction, specifically the crystal structure of the methyltransferase domain of bacterial Hen1. Because the eukaryotic Hen1 carries out the same chemical reaction, the study should further understanding of RNA interference in eukaryotic organisms.

“Hen1 is one of three essential enzymes in generating small noncoding RNAs for RNA interference in eukaryotes,” Huang said. “We found out that Hen1 homologs exist in bacteria, but bacteria have no RNA interference. Therefore, we were very curious to find out what bacterial Hen1 is used for.”

“Our studies demonstrated that bacterial Hen1 carries out the same chemical reaction as its counterpart in eukaryotes, which was not surprising,” he said. “What surprised us was that, instead of involvement in RNA interference, the bacterial Hen1 is part of a RNA repair and modification system. And Hen1 is responsible for producing the repaired RNA that is ‘better than new.'”

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On the Net:

• University of Illinois at Urbana-Champaign
• Science
• Proceedings of the National Academy of Sciences

The promising results of a six-month clinical trial of an AIDS vaccine have been called into question, according to two published accounts on Science magazine’s Web site and in The Wall Street Journal.

The reports cited AIDS researchers who received confidential briefings about the trial’s results, and said the effectiveness may be weaker than originally reported last month.

The U.S. Army, the Thai government and the U.S. National Institutes of Health, which helped fund the three-year, $105 million study, announced on September 24 that they had found the first vaccine that provided some protection against HIV, the AIDS-causing immunodeficiency virus. 

At the time, the researchers said the combination vaccine had produced a statistically significant 31% reduction in new HIV infections in a trial of more than 18,000 people in Thailand. 

While considered moderately effective, it was the first trial to suggest a successful AIDS vaccine might ultimately be possible.

The researchers also said there was only a 4 percent chance the difference was coincidental.

However, an Army scientist involved in the project said a second analysis of the data showed the results weren’t statistically significant, the Journal reported on Saturday.

In other words, the results could have been due to chance and the vaccine may not have been effective.

The additional data were available to the researchers on Sept. 24 when they announced the trial results, but they chose not to disclose them, the Journal quoted U.S. Army scientist Jerome Kim, who worked on the study, as saying.

News of the second analysis was first reported on the Web site of Science magazine, which cited researchers who said the secondary analysis suggested that the vaccine reduced infections by only 24%, rather than 31 % as originally reported.

Such secondary analyses are common for vaccine trials.

The first analysis included all 16,000 trial participants, while the secondary analysis excluded those who did not follow the experimental regimen. When that was done, the results were less compelling.

Dr. Anthony Fauci, director of one of the National Institutes of Health, acknowledged that second analyses of the data could show a weaker effect, but said the original results, which included every trial participant, were “the gold standard.”

Putting several biostatistical analyses in a news release “would have confused everybody,” Dr. Fauci told the New York Times, calling the idea that researchers were engaging in a cover-up “absurd.”

“They couldn’t be that stupid,” he said.

“They were already planning to give confidential briefings to experts. They were about to publish everything in a journal. And they were heading to Paris in three weeks to present the results to the world.”

Comprehensive details of the trial will be made available during an AIDS meeting in Paris that gets underway October 19.

Dr. Fauci said he had not been consulted on how to release the original results, but was asked to take part in a news briefing in Washington the following day because he had overseen the financing and was skilled in articulating complex science.

In hindsight, the Army’s decision to brief other players in the field before the late October Paris conference “backfired”, he said.

Some 33 million people were living with HIV in 2007, with about two million having died from AIDS that year, according to the latest data from the United Nations. 

There have been more than 100 HIV vaccine trials since 1987, none of which were successful until the Thai trial.

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On the Net:

• Science
• National Institutes of Health
• New HIV Vaccine Cuts Risk Of Infection

Children treated for arm fractures with ibuprofen had their pain reduced just as effectively as a combination of acetaminophen and codeine (Tylenol 3), with fewer adverse effects, in a randomized, double-blind trial.

The study tested ibuprofen, sold as Advil, Motrin and other brands, against acetaminophen plus codeine “” a combo called Tylenol No. 3 that is also sold in generic form.

“The children on ibuprofen did better,” said the study leader, Dr. Amy Drendel of the Medical College of Wisconsin in suburban Milwaukee. “They were more likely to play, they ate better and they had fewer adverse effects,” she said.

Among those kids taking ibuprofen, 29.5% reported an adverse effect. Among those taking the codeine-laced drug, 50.9% reported an adverse effect. Such reactions included nausea, vomiting, drowsiness, dizziness and constipation.

The results do not mean that ibuprofen beats acetaminophen for everyday pain relief in children or anyone else.

The study tested a specific use “” pain in the first three days after a broken arm “” and the acetaminophen was combined with the narcotic codeine, not tested alone.

Broken arms are one of the most common childhood injuries, with one study estimating that 18 percent of children will have a fracture some time during the first nine years of life.

Researchers randomly assigned 336 children ages 4 to 18 to go home with liquid versions of either ibuprofen or the acetaminophen-codeine combo after being treated for a broken arm at Children’s Hospital of Wisconsin. Neither the children, parents nor the doctors knew who received what treatment until the study ended.

“It’s tough enough as a child to have a broken arm without also having to deal with pain,” said Dr. Drendel. “It’s good for both emergency physicians and parents to have pain-management options that can help get a child back to playing as quickly as possible.”

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On the Net:

• Medical College of Wisconsin
• Annals of Emergency Medicine

A team of researchers led by The University of Texas M. D. Anderson Cancer Center unveiled results today from the largest-ever collaborative study addressing the treatment of a rare pediatric brain tumor. The findings suggest a new standard protocol could improve survival nearly two-fold for pediatric patients with choroid plexus tumors, as reported at the 41st Annual Meeting of the International Society of Pediatric Oncology (SIOP).

Johannes Wolff, M.D., professor in the Children’s Cancer Hospital at M. D. Anderson Cancer Center and lead investigator on the study, revealed that the protocol, consisting of three chemotherapy agents and radiation, had projected overall survival rates of 93 percent at one year, 82 percent at five years, and 78 percent at eight years.

“This SIOP 2000 study started 10 years ago and has grown to include more than 100 institutions from more than 20 countries,” said Wolff. “With the data we have, we can tell which patients are prone to do better and which ones have a poor prognosis. In addition, we’ve established a promising standard protocol for these patients.”

Choroid plexus carcinomas are malignant brain tumors that originate in the choroid plexus epithelium, which is the gland that produces cerebrospinal fluid. Often the tumors may block the flow of cerebrospinal fluid causing pressure to build in the brain and possibly enlarge the skull. It is a very rare tumor affecting approximately 1,500 children worldwide each year, occurring more often in infants.

Due to the rarity of the disease, there is no standard treatment protocol for the disease, but Wolff and other international researchers hope to change that through their studies. They also developed an innovative statistical module for institutions to use that will ensure quality and efficient data coming out of the study.

One surprising finding Wolff and fellow researchers discovered contradicted historical research, which originally showed the significant advantage of complete surgical resection. The SIOP 2000 study found that patients receiving the intense chemotherapy protocol had similar outcomes as those with complete resection, reducing the need for surgical treatment.

“We think the better outcomes had to do with the fact that physicians will prolong chemotherapy treatment if there is residual tumor,” said Wolff. “If we can prove this hypothesis, this would be an argument for extending treatment in the future.”

Wolff says the next step will be to begin another study that will investigate a four-armed chemotherapy protocol. This would investigate the possibility of adding another chemotherapy to further improve survival rates. The SIOP 2000 study used carboplatinum, etoposide and cyclophosamide in combination with radiation.

The study was funded through the German Children’s Cancer Foundation.

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On the Net:

• University of Texas M. D. Anderson Cancer Center
• International Society of Pediatric Oncology

One of the biggest mysteries about diabetes is why specialized cells in the pancreas stop secreting insulin, which the body needs in order to store glucose from food. A team from the Children’s Hospital of Eastern Ontario (CHEO) Research Institute has identified a protein that inhibits insulin production in mice – work that offers a new way of understanding, and perhaps of one day treating, both Type 1 and Type 2 diabetes.

A study to be published today in the leading international journal Cell Metabolism describes how a research group led by Dr. Robert Screaton, who holds the Canada Research Chair in Apoptotic Signaling at the University of Ottawa, used sophisticated genetic engineering to remove or ‘knock out’ the Lkb1 gene from beta cells of laboratory mice. The result was an increase in both the size and number of beta cells, as well as greater amounts of insulin stored and released by the cells.

Importantly, the improved beta cell function lasted for at least five months, even in mice fed a high-fat diet designed to mimic the high caloric intake associated with Metabolic Syndrome and Type 2 diabetes in humans.

“We were surprised by the impressive accumulation of Lkb1 in beta cells of diabetic mice, which suggested that Lkb1 might contribute to their impaired function. After removal of the Lkb1 gene, the beta cells grow larger, proliferate more, and secrete more insulin. It’s a one-stop shop for the much needed insulin”, said Dr. Screaton.

“The knockout mice on a high-fat diet have lower blood glucose. If this observation is confirmed in humans, it may give us another clue into the development of Type 2 diabetes, and perhaps new treatment options”.

“Type 1 and 2 diabetes, already common diseases, are showing disturbingly steady growth in incidence. The two conditions are among Canada’s, and indeed the globe’s, greatest health challenges,” said Dr. Alex MacKenzie, CEO of the CHEO Research Institute and a physician who treats children with diabetes at CHEO. “The findings of Dr. Screaton’s team introduce a novel and unanticipated potential therapeutic avenue for this costly and serious condition. It is some of the most important work to come out of our institute.”

Contributors to the study were lead author Accalia Fu, Andy Ng, and Dr. Chantal Depatie of the CHEO Research Institute; Dr. Gen-Sheng Wang, Dr. Fraser Scott, Ying He, and Dr. Rhian Touyz of the Ottawa Hospital Research Institute; Nadeeja Wijesekara and Dr. Michael Wheeler of the University of Toronto; and Dr. Nabeel Bardeesy of Harvard University.

The work was supported by grants from the Canadian Institutes of Health Research and the Canadian Foundation for Innovation.

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On the Net:

• Children’s Hospital of Eastern Ontario Research Institute
• Cell Metabolism

Alarming number of women undergo open surgery when minimally invasive biopsy has demonstrated equivalent accuracy, less cost and reduced risk of scarring

A special report published in the October issue of the Journal of the American College of Surgeons indicates that an alarming 35% of initial diagnostic breast biopsies in the United States are still being done using unnecessary open surgical techniques. This in spite of the fact that it costs as much as three times more than the much less invasive and equally accurate needle biopsy technique.

A panel of leading breast disease specialists recently convened at the International Consensus Conference on Image Detected Breast Cancer III and unanimously agreed that percutaneous needle biopsy represents “best practice” and should be the “gold standard” for initial diagnosis of breast abnormalities. The recommendations were reached after building clinical evidence since the preceding Consensus Conferences in 2001 and 2005, yet little progress is being made in reducing the number of open surgical biopsies being performed nationwide.

“In spite of considerable agreement in the medical literature and national recommendations published by industry thought leaders such as the American College of Surgeons and the American Society of Breast Surgeons, there was only a small decrease in the number of surgical biopsies since our last conference four years ago. 1,2 This slow rate of adoption is appalling considering the overwhelming benefits of needle biopsy versus open surgery for the initial diagnosis of breast cancer,” said Dr. Melvin Silverstein, medical director of Hoag Breast Care Center; clinical professor of surgery at the Keck School of Medicine, University of Southern California; and chair of the 2001, 2005 and 2009 Consensus Conferences. “Considering only 15-20% of abnormalities found by mammography turn out to be cancer, this means a significant number of women with benign lesions are undergoing unneeded diagnostic surgery when needle biopsy is equally effective for discovering cancer.”

Last year, approximately 1.7 million women underwent a breast biopsy to have a suspicious lump or imaging abnormality examined.1 During a breast biopsy, a small sample of tissue from the abnormal lesion is removed and sent to a pathologist to be analyzed microscopically to check for breast cancer. The tissue sample can be removed either through an open surgical biopsy or less invasive needle biopsy.

Women who undergo open surgical biopsy are generally put under anesthesia, and a physician creates an incision in the breast through which part of the lump is removed. Because an incision is required, open surgical biopsy carries the risk of infection, complications and scarring. Open biopsy also costs about two to four times more on average than a needle biopsy. During a needle biopsy, women are given local anesthesia, and a thin needle is used to withdraw small cores of tissue from the suspicious area. In some cases, imaging equipment may be used to guide the needle to the right spot. Unlike open surgical biopsy, minimally invasive needle biopsy may result in some bruising, but usually does not leave a scar. Additionally, the risks associated with needle biopsy are significantly less, as is patient recovery time.

“There are very few instances when needle biopsy is so technically difficult to perform due to a lesion’s position or other factors, that an open surgical biopsy would be needed as the initial diagnostic procedure,” said Dr. Silverstein.

At Hoag Breast Care Center, minimally invasive needle biopsy is the standard of care. In fact, only about one percent of the diagnostic biopsies performed at the center require an open surgical procedure. Needle biopsies provide detailed information about the nature of the breast tumor including biologic markers, histologic tumor grade, and lymphovascular invasion. This information can all be identified in the biopsy sample to aid in therapeutic decision-making before surgical intervention.

“If a lesion is diagnosed to be cancer before operative intervention, the surgeon can more precisely plan the optimal location of the incisions for maximum breast conservation,” Dr. Silverstein explains. “With pre-operative planning, more complete and precise removal of the cancer and its margins is more likely, generally sparing patients a second surgery. Additionally, the surgeon can make better use of oncoplastic techniques.”

The panel’s report in the Journal of the American College of Surgeons established comprehensive guidance for the diagnosis and treatment of patients with breast cancer. In addition to establishing best-practices for the method of breast biopsy, the paper describes stronger positions in support of the use of magnetic resonance imaging in diagnosis and preoperative planning, shortened radiology treatments, and the incorporation of oncoplastic techniques into surgical breast cancer practice.

References

1. Silverstein M, Recht A, Lagois M, et al. Image-Detected Breast Cancer: State-of-the-Art Diagnosis and Treatment. J Am Coll Surg 2009. 209:504-520.

2. Silverstein M, Lagios M, Recht A, et al. Image-Detected Breast Cancer: State-of-the-Art Diagnosis and Treatment. J Am Coll Surg 2005. 201:586-597

3. Clarke-Pearson EM, et al. Quality Assurance Initiative at One Institution for Minimally Invasive Breast Biopsy as the Initial Diagnostic Technique. J Am Coll Surg 2009. 208:75-79.

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On the Net:

• Hoag Memorial Hospital Presbyterian
• Journal of the American College of Surgeons

The antibiotic minocycline may revolutionize the treatment of strokes. A new study, published in the open access journal BMC Neuroscience, describes the safety and therapeutic efficacy of the drug in animal models.

Dr. Cesar V. Borlongan from the University of South Florida, USA worked with a team of researchers to test the treatment in laboratory experiments. He said, “To date, the thrombolytic agent tPA is the only effective drug for acute ischemic stroke; however, only about 2% of ischemic stroke patients benefit from this treatment due to its limited therapeutic window. There is a desperate need to develop additional neuroprotective strategies. This research is an important step in rectifying the treatment issues, presenting a new, more effective treatment for stroke patients”.

Every 5 minutes someone in the UK has a stroke and stroke currently accounts for almost 10% of deaths worldwide, claiming more lives than HIV/AIDS. During a stroke, a clot prevents blood flow to parts of the brain, which can have wide ranging short-term and long-term implications. This study recorded the effect of intravenous minocycline in both isolated neurons and animal models after a stroke had been experimentally induced. At low doses it was found to have a neuroprotective effect on neurons by reducing apoptosis of neuronal cells and ameliorating behavioral deficits caused by stroke.

According to Dr. Borlongan, “The safety and therapeutic efficacy of low dose minocycline and its robust neuroprotective effects during acute ischemic stroke make it an appealing drug candidate for stroke therapy. An on-going phase 1 clinical study funded by the National Institutes of Health is exploring the use of intravenous minocycline to treat acute ischemic stroke”.

Therapeutic targets and limits of minocycline neuroprotection in experimental ischemic stroke. Noriyuki Matsukawa, Takao Yasuhara, Koichi Hara, Lin Xu, Mina Maki, Guolong Yu, Yuji Kaneko, Kosei Ojika, David C Hess and Cesar V Borlongan. BMC Neuroscience (in press)

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On the Net:

• BMC Neuroscience

Researchers at the University of Toronto, St. Michael’s Hospital and Sunnybrook Health Sciences Center have discovered a previously unidentified form of circulation within the human eye which may provide important new insights into glaucoma, a leading cause of blindness.

For over a century, the eye has been considered to lack lymphatics, a circulation responsible for pumping fluid and waste out of tissues. The inability to clear that fluid from the eye is linked to glaucoma, a leading cause of irreversible blindness affecting over 66 million people worldwide.

“We challenged this assumption about a lack of lymphatics and discovered specialized lymphatic channels in the human eye,” said Prof. Yeni Ycel, a pathologist-scientist in U of T’s Faculty of Medicine and St. Michael’s Hospital, and lead author of the study which appears in the current issue of Experimental Eye Research.

Glaucoma is a degenerative disease believed to be caused by the death of nerve cells at the back of the eye and in vision centers of the brain. It is often associated with elevated pressure in the eye. Current treatments for glaucoma rely on eye drops or surgery to lower eye pressure either by reducing fluid formation or improving fluid drainage from the eye.

“Good vision depends on the stable flow of fluid into and out of the eye. Any disturbance of this delicate fluid balance can lead to high eye pressure and irreversible glaucoma damage,” said study co-author Dr. Neeru Gupta, Director of the Glaucoma Unit and Nerve Protection Unit at St. Michael’s Hospital and Professor of Ophthalmology at U of T.

The lymphatic circulation, distinct from blood circulation, carries a colorless fluid called, lymph containing extra water, proteins and antigens through lymphatic vessels to lymph nodes and then to the blood stream. This circulation is critical for the drainage of the fluid from tissues, clearance of proteins and immune monitoring of the tissue.

Using molecular tools and three-dimensional reconstruction, the team of researchers identified a rich network of lymphatic channels in the ciliary body of the human eye. These studies were confirmed by electron microscopy.

The discovery of a lymphatic circulation in the eye overthrows the idea that the eye is an immune privileged site due to the lack of lymphatics and has major implications for understanding eye inflammations and eye tumor spread, among other eye disorders.

“This ‘uveolymphatic’ circulation plays a role in the clearance of fluid from the eye, making it highly relevant to glaucoma. This discovery is exciting because it means we can focus on innovative treatment strategies for patients with glaucoma by specifically targeting this new circulation to lower eye pressure,” said Dr. Gupta.

According to the researchers, future studies will be directed at better understanding how to manipulate the lymphatic circulation in the eye. “It’s clear that if we want to develop new strategies to prevent blindness, we need to challenge existing beliefs, and hopefully open the door to new treatments for eye disease,” said Prof. Ycel, who also serves as Director of the Ophthalmic Pathology Laboratory in U of T’s Department of Ophthalmology and research Scientist at the Keenan Research Center at Li Ka Shing Knowledge Institute, SMH.

Glaucoma is expected to affect 80 million people worldwide by 2020. Although the disease can affect anybody, those with elevated eye pressure, the elderly, blacks and persons with a family member with glaucoma are at greatest risk. Other risk factors that may be associated with glaucoma include diabetes, high blood pressure and near-sightedness.

This study was a collaboration between the University of Toronto and two fully-affiliated hospitals: St. Michael’s Hospital and Sunnybrook Health Sciences Center. Other co-authors include Miles G. Johnston, Professor Laboratory Medicine and Pathobiology and scientist at Neuroscience Program, Sunnybrook Hospital, Tina Ly, Manoj Patel, Ersin GmÅŸ, Stephan A. Fraenkl and Eva Horvath from SMH, and Brian Drake, Sara Moore, Dalia Tobbia, Dianne Armstrong from Sunnybrook Hospital Research Institute. This research was supported by this work was supported by the Canadian Institutes of Health Research (85053), Nicky And Thor Eaton Fund, The Dorothy Pitts Fund, and Henry Farrugia Fund.

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On the Net:

• University of Toronto
• Experimental Eye Research

Primary care physicians not taking active role to treat post-transplant conditions

A recent study by researchers from the University of Colorado looked at post-transplant care to determine whether primary care physicians (PCPs) or hepatologists are better suited to manage the overall health care of patients who received a liver transplant (LT). Researchers learned that hepatologists believe metabolic complications to be common in LT patients, but not well controlled. The hepatologists surveyed also felt that PCPs should be responsible for managing these conditions, but that this group was not taking an active role. Full details of this study appear in the October issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.

In the U.S. approximately 6,000 liver transplants are performed annually. Since liver transplantation began in 1963, survival rates have increased dramatically with overall 1-year and 5-year patient survival rates at 86.9% and 73.6%, respectively. As long-term survival rates increase, metabolic complications such as cardiovascular diseases, diabetes, chronic renal insufficiency and bone disease become a concern to the welfare of LT patients.

Lisa Forman, M.D. and colleagues surveyed 280 hepatologists in programs that transplanted at least 8 adult livers during the 2004 study year. Of the 191 respondents, 86% were male with a mean age of 50 years and had been in practice for an average of 13 years. Close to half of the hepatologists who replied noted that they cared for 21-50 liver transplant patients each month, while only 2.1% stated that a PCP was a working member of the practice group’s post-transplant team.

Researchers found that more than 70% of hepatologists surveyed noted hypertension, chronic renal insufficiency, diabetes, and osteoporosis were present in at least 25% of patients 1 year post-transplant. The majority of respondents felt that these metabolic complications significantly contributed to morbidity and mortality 10 years after liver transplantation. Based on survey responses, the most commonly cited barriers to control post-transplant complications were dietary non-adherence, adverse effects of immunosuppressive agents, and inadequate primary care.

Approximately 75% of respondents felt that metabolic complications should be managed by PCPs, but believe that PCPs are adequately managing these health issues in only 38%-51% of LT recipients. “While there are many factors which influence the management of metabolic health concerns, the transplant community needs to be aggressive in influencing aspects that are modifiable such as PCP involvement,” stated Dr. Forman. “If PCPs are reluctant to treat LT patients, and hepatologists assume their overall care, perhaps transplant hepatology fellowships should include rotations in cardiology, endocrinology, rheumatology and nephrology to give fellows more exposure to the management of metabolic complications,” she suggested.

“Despite the fact that this study was based on perception rather than hard data, it does serve as a basis for future studies,” stated Bashar Aqel, M.D., from the Mayo Clinic in his editorial also published in the October issue of Liver Transplantation. The authors acknowledged this study was based on the perception of hepatologists without hard data collected on the prevalence of metabolic complications and noted that PCPs were not surveyed likely leading to a bias toward the hepatologist. “More research is needed to address the real prevalence of metabolic complications, adequacy of treatment and to identify the barriers to care in the treatment of metabolic complications after liver transplantation,” added Dr. Aqel.

Article: “Long-term management after liver transplantation: Primary care physician versus hepatologist,” J. Christie Heller, Allan V. Prochazka, and Lisa M. Forman. Liver Transplantation; Published Online: September 30, 2009 (DOI: 10.1002/lt.21786); Print Issue Date: October 2009.

Editorial: “Should or could transplant hepatologist become primary care physicians?” Bashar A. Aqel. Liver Transplantation; Published Online: September 30, 2009 (DOI 10.1002/lt.21837); Print Issue Date: October 2009.

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On the Net:

• Wiley-Blackwell
• Liver Transplantation

Some imported brands of dried plums, including Casa De Dulce Salted Plum Suckers, have elevated levels of lead, Texas health officials said.

Most of the plum products are sold as salted or candied treats in Hispanic and Asian markets, the Texas Department of State Health Services said in a release Friday.

Test results from a state laboratory in Austin, Texas, showed the dried plum products contained lead levels ranging from 0.11 parts per million to 30.3 parts per million, department spokesman Doug McBride said.

While lead should not be consumed in any amount, the Texas study used federal guidelines with a maximum of 0.1 parts per million for candy as a guide in assessing the lead levels in the dried plum products, McBride said.

The products shown to have elevated lead levels included the Salted Plum Suckers, Ka Po Preserved Plum from Wan Tom Food Co. LTD, Preserved Liquoriced Prune in a heart shaped box from Roxy Trading Co., Little Gregory’s Chinese Candy and Salados salted dried plums from Hinojosa Brothers, health officials said.

Discovery could lead to treatments for learning and memory deficits, particularly Noonan’s syndrome

As most good students realize, repeated studying produces good memory. Those who study a lot realize, further, that what they learn tends to be preserved longer in memory if they space out learning sessions between rest intervals. Neuroscientists at Cold Spring Harbor Laboratory (CSHL) have now discovered how this so-called “spacing effect” is controlled in the brain at the level of individual molecules.

Led by Professor Yi Zhong, Ph.D., the CSHL team has found that a protein called SHP-2 phosphatase controls the spacing effect by determining how long resting intervals between learning sessions need to last so that long-lasting memories can form. The study, carried out in a fruit fly model, will appear online in the journal Cell on October 2.

“Although there are many theories that explain the spacing effect at the psychological level and hundreds of studies that back them up, there has not been any understanding of this phenomenon at the neurobiological level,” says Zhong. “We have shown for the first time that the spacing effect has a genetic and molecular basis.”

Not only that, but Zhong’s team has also found that the duration of the resting intervals can be manipulated for achieving better memory by genetically altering SHP-2 phosphatase. “This ability to exploit the spacing effect’s molecular control to enhance memory could be useful in a wide range of settings such as education, advertising, and most importantly, in treating learning and memory disorders,” says Zhong.

How excess protein activity impedes long-term memory

Zhong has long been interested in genes that when mutated trigger learning and memory disorders such as Noonan’s syndrome, a genetically inherited disease with an incidence rate of 1 in 1000 to 1 in 2000 people. More than 50% of Noonan’s patients have mutations in a gene called PTP11, which encodes the SHP-2 phosphatase protein. In contrast to many disease-related mutations that shut off protein production or impair protein activity, these PTP11 mutations do the opposite ““ they boost the activity levels of SHP-2 phosphatase.

To understand how this change impedes long-term memory, Zhong’s team engineered these mutations into a gene in fruit flies called corkscrew that is the functional equivalent of PTP11 in humans. The mutant flies were taught to avoid certain odors via a training regimen of repeated learning sessions broken up by resting intervals lasting 15 minutes. But this training regimen, which induces long-term memory in normal flies, failed to work in the mutants because the increased activity of SHP-2 phosphatase disturbed the spacing effect.

Zhong’s team found that normally, as each learning period ends, SHP-2 phosphatase activity inside stimulated neurons triggers a wave of biochemical signals, which have to peak and decay before the next learning session can begin. “The repeated formation and decay of the biochemical signal during each rest interval induces long-term memory,” explains Zhong.

In normal flies, these signal waves took 15 minutes to peak and decay. In the mutants that had excess protein activity, however, the signaling wave took 40 minutes to decay, the team discovered. “A training regimen that includes only 15 minute rest intervals therefore fails in the mutants because increased SHP-2 phosphatase activity somehow causes the waves of signals to fall out of sync,” explains Zhong. “So it’s crucial that the period of rest should last as long as it takes for a signal wave to form and reset.”

In contrast to increased SHP-2 phosphatase activity, which lengthened the resting interval to 40 minutes, the team found that increased production of the protein with normal activity could shorten the duration of the resting interval to 2.5 minutes. “These findings suggest that SHP-2 phosphatase acts as a molecular timer that determines how long resting intervals should last,” says Zhong.

Reversing memory deficits

Zhong’s team has succeeded in reversing memory deficits in mutant flies in two ways. Either reducing the activity of mutated SHP-2 phosphatase to normal levels with drugs or simply altering training regimens to include 40-minute rest intervals instead of the normal 15 minutes both established long-term memory in the mutants.

“Our results suggest that longer resting intervals for Noonan’s patients might reverse their memory deficits,” says Zhong. His team is currently collaborating with clinicians to determine whether this intervention, which worked in flies, will also work in people afflicted with Noonan’s.

“Spacing Effect: SHP-2 Phosphatase Regulates Resting Intervals Between Learning Trials in Long-Term Memory Induction” appears in Cell on October 2nd. The full citation is: Mario R. Pagani, Kimihiko Oishi, Bruce D. Gelb and Yi Zhong.

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On the Net:

• Cold Spring Harbor Laboratory
• Cell

Embryonic stem cells provide model; goal is to prevent bone loss

An early laboratory success is taking University of Michigan researchers a step closer to parathyroid gland transplants that could one day prevent a currently untreatable form of bone loss associated with thyroid surgery.

The scientists were able to induce embryonic stem cells to differentiate into parathyroid cells that produced a hormone essential to maintaining bone density. The laboratory results in live cell cultures, published in Stem Cells and Development, need to be tested in further pre-clinical studies.

Parathyroid glands, four glands each the size of a rice grain that lie next to the thyroid in the neck, are easily damaged when surgeons operate on patients with cancerous or benign thyroid tumors. Without their calcium-regulating hormone, patients can develop osteomalacia, a severe form of bone loss similar to rickets that affects tens of thousands of people in the United States with muscle cramps and numbness in the hands and feet.

“We used human embryonic stem cells as a model for ways to work out the recipe to make parathyroid cells,” says Gerard M. Doherty, M.D., chief of endocrine surgery and Norman W. Thompson Professor of Endocrine Surgery at U-M Medical School.

The research illustrates the payoff of rapidly increasing knowledge about how embryonic stem cells give rise to other kinds of cells. That knowledge can be the springboard for influencing other cells to regenerate damaged parts of the body.

Doherty’s team used embryonic stem cells from a Bush administration-approved embryonic stem cell line to test a way to produce functioning, differentiated parathyroid cells to transplant into a patient and restore function.

With the recipe worked out, Doherty’s team anticipates developing a treatment that doesn’t use embryonic stem cells.

“We anticipate taking a person’s own cells and making them into parathyroid cells,” Doherty says. Using the patient’s own cells should eliminate the risk of rejection.

What’s next

Having demonstrated a method for leading embryonic stem cells to produce parathyroid cells, the team hopes to be able to repeat those steps using cells from the patient’s own thymus gland. The method involves no genetic modification of cells, a key goal of Doherty’s team.

“We want to have a process that will allow us to reintroduce cells into the patient’s body safely,” Doherty says.

Any successful treatment in people is five to 10 years away.

Additional U-M authors: Eve L. Bingham, Shih-Ping Cheng, Kathleen M. Woods Ignatoski

Funding: Michigan Center for Human Embryonic Stem Cell Research, U-M Department of Surgery

Citation: Stem Cells and Development, September 2009,18(7): 1071-1080.

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On the Net:

• University of Michigan Health System
• Endocrine Surgery at the University of Michigan
• Department of Surgery at the University of Michigan
• Michigan Center for hES Cell Research
• Stem Cells and Development

CARE bill ensures standards for nuclear medicine technologists across states

SNM is calling on Congress to support the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Act (CARE bill), which would ensure that states set minimum education and credentialing standards for nuclear medicine technologists. The bill (H.R. 3652) was introduced Sept. 28 in the U.S. House of Representatives by Rep. John Barrow (D-Ga.).

“The introduction of the CARE bill is excellent news,” said Cybil Nielsen, MBA, CNMT, president of SNM’s Technologists Section (SNMTS). “We have been working with many partners over the past several years to ensure that minimum standards are set across states for nuclear medicine technologists. We call on Congress to support this critical legislation.”

The CARE bill would set certification standards in the Medicare program for any personnel providing, planning and delivering all medical imaging examinations and radiation therapy. Ensuring that nuclear medicine technologists performing scans are certified by their states will increase the safety and accuracy of medical examinations and radiation therapy procedures and, in turn, the quality and value of care for patients. More than 16 million nuclear medicine scans are performed each year in the U.S.

“Patient safety is the highest priority for our patients,” said Michael Graham, MD, PhD, president of SNM. “This is a positive step toward ensuring that patients can rest assured that when they undergo a nuclear medicine procedure, it is being performed by a qualified expert who has undergone the necessary training.”

Until now, there have been no uniform standards in place to ensure that those performing nuclear medicine scans are qualified.

“In many states, no credentials for those performing nuclear medicine scans are required,” said Nielsen. “The CARE bill was created as a direct response to this concern to ensure that medical imaging is performed only by qualified technical personnel. The CARE bill reflects SNM’s longstanding commitment to education for our members and quality care for the patients we serve.”

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On the Net:

• Society of Nuclear Medicine

New prenatal tests for Down syndrome are soon to be offered to all pregnant women across the United States, yet telling an expectant couple that their child will be born with Down syndrome is a task very few physicians are trained for, claims research published in the American Journal of Medical Genetics. The study, which reviewed decades of surveys and interviews, offers several recommendations for how physicians can best deliver the news.

A 29-member research team, led by Dr. Brian Skotko from Children’s Hospital Boston, supported by the National Down Syndrome Society and informed by experts from across the field, reviewed surveys and research ranging from 1960 to present day to consider how prepared physicians felt they are to deliver a diagnosis. They also studied the opinions of couples who had received the diagnosis to determine the best way of delivering the news.

“Down syndrome (DS) remains the most common chromosomal condition. It occurs in one out of every 733 live births,” said Skotko. “Nearly every obstetrician can expect to have a conversation with expectant parents about the realities of life with DS, but very little research has been dedicated to understanding how physicians should communicate the news.”

The team found that in a 2004 survey approximately 45% of obstetric fellows rated their training as “barely adequate or nonexistent”; a similar survey four years later found little change as 40% thought their training was “less than adequate.” In 2005 a survey of 2,500 medical students showed that 81% believed they were “not getting any clinical training regarding individuals with intellectual disabilities.”

To improve this scenario the team set out to answer five critical questions which every physician should consider before delivering a diagnosis: Who is the best person to communicate the news? When is the best time to share the news? Where should the news be delivered? What information should be offered? How should the diagnosis be communicated?

The team found that while many sources are available, from trained counselors to midwives, expectant couples prefer to receive the news from the health care professional with the most knowledge, the physician.

Also, women who decided to undergo definitive prenatal testing for DS prefer to receive the diagnosis as soon as possible in the company of their husbands or partner, while women who had arranged for the diagnosis to be delivered by a phone call were better prepared for the news then those who received the news from an unarranged call. Women who received the diagnosis through an unscheduled call expressed intense resentment towards their obstetricians and counselors.

Regarding the amount of information a couple should be given, mothers emphasized that they should be provided with up-to-date information about DS, its causes and the expectations for a child living with DS today. This information should include descriptions of common or anticipated health conditions seen in infants and young children.

On top of this, parents found that they benefited from personal stories that demonstrate the potential and possibilities for children with DS and if possible if possible contact information for other parents who have children with DS should be made available.

Mothers emphasized that at the time of a diagnosis, physicians should discuss all options available to them, including continuing the pregnancy, offering the baby up for adoption after birth, or pursuing termination. In a survey of 71 women from the Netherlands who terminated their pregnancy after a diagnosis of DS, 34% indicated that the option of continuation was not raised.

Finally physicians should be mindful of how they communicate the news. In the largest study most mothers requested that physicians should not begin a conversation by saying “I’m sorry” or “unfortunately I have some bad news,” instead they should use neutral and nondirective language.

Unsurprisingly the team also suggests that outdated and offensive language such as “mongolism” should be avoided and instead phrases such as “a fetus with Down syndrome” should be adopted.

Ultimately the research review found that mothers who received the diagnosis prenatally and continued their pregnancy were happier with the birth of their child then those who received the diagnosis after the baby had been born. Receiving the diagnosis in advance seems to allow parents the needed time to overcome the shock and initial grief of the diagnosis and begin preparing and celebrating the upcoming birth of a child.

“Of the studies reviewed nearly all mothers reported feelings of initial shock, anger and fear following the diagnosis,” concluded Skotko. “Yet, these same mothers indicated that if physicians were to implement a few simple measures, as research suggests, the experience could be more sensitive to their emotions and needs.”

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On the Net:

• Wiley-Blackwell
• American Journal of Medical Genetics

Prostate cancer patients of low socioeconomic status are more likely to die than patients with higher incomes. That is the finding of a new study from Swiss researchers to be published in the December 1, 2009 issue of Cancer, a peer-reviewed journal of the American Cancer Society. The study’s findings indicate that poor prostate cancer patients receive worse care than their wealthier counterparts.

Many of the previous studies on socioeconomic status (SES) and prostate cancer mortality are from North America, particularly from the United States. Researchers wanted to know how disparities affected prostate cancer mortality in Switzerland, a country with an extremely well developed health care system and where healthcare costs, medical coverage, and life expectancy are among the highest in the world, Elisabetta Rapiti, M.D., MPH, of the University of Geneva and her colleagues conducted a population-based study that included all residents of the region who were diagnosed with invasive prostate cancer between 1995 and 2005.

The analysis included 2,738 patients identified through the Geneva Cancer Registry. A patient with prostate cancer was classified as having high, medium, or low socioeconomic status on the basis of his occupation at the time of diagnosis. The investigators compared patient and tumor characteristics, as well as treatments among the different socioeconomic groups.

Compared with patients of high socioeconomic status, those of low socioeconomic status were less likely to have their cancer detected by screening, had more advanced stages of cancer at diagnosis, and underwent fewer tests to characterize their cancer. These patients were less likely to have their prostates removed and were more likely to be managed with watchful waiting, or careful monitoring.

Patients with low socioeconomic status also had a 2-fold increased risk of dying from prostate cancer compared with patients of high socioeconomic status. “The increased mortality risk of patients of low socioeconomic status is almost completely explained by delayed diagnosis, poor work-up, and less complete treatment, indicating inequitable use of the health care system,” said Rapiti. The authors say lead time and length time biases linked to early detection through PSA screening may partially explain the survival advantage observed among high SES patients. However, they found that the differences by SES in prostate cancer mortality were limited to patients with advanced disease, for whom the impact of such biases is not as strong, and that treatment choice probably played a more important role. The authors say reducing health inequalities linked to socioeconomic status should receive high priority in public health policies, and that improving patients’ access to prevention and early diagnostic tests and ensuring that they receive standard treatments could help reduce the socioeconomic differences seen in this study.

Article: “Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis.” Elisabetta Rapiti, Gerald Fioretta, Robin Schaffar, Isabel Neyroud-Caspar, Helena M Verkooijen, Franz Schmidlin, Raymond Miralbell, Roberto Zanetti, Christine Bouchardy. Cancer; Published Online: September 28, 2009 (DOI: 10.1002/cncr.24607); Print Issue Date: December 1, 2009.

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On the Net:

• American Cancer Society
• Cancer

Subliminal messaging is most effective when the message being conveyed is negative, according to new research funded by the Wellcome Trust.

Subliminal images ““ in other words, images shown so briefly that the viewer does not consciously ‘see’ them ““ have long been the subject of controversy, particularly in the area of advertising. Previous studies have already hinted that people can unconsciously pick up on subliminal information intended to provoke an emotional response, but limitations in the design of the studies have meant that the conclusions were ambiguous.

Today, the journal Emotion publishes a study by a UCL team led by Professor Nilli Lavie, which provides evidence that people are able to process emotional information from subliminal images and demonstrates conclusively that even under such conditions, information of negative value is better detected than information of positive value.

In the study, Professor Lavie and colleagues showed fifty participants a series of words on a computer screen. Each word appeared on-screen for only a fraction of second ““ at times only a fiftieth of a second, much too fast for the participants to consciously read the word. The words were either positive (e.g. cheerful, flower and peace), negative (e.g. agony, despair and murder) or neutral (e.g. box, ear or kettle). After each word, participants were asked to choose whether the word was neutral or ’emotional’ (i.e. positive or negative), and how confident they were of their decision.

The researchers found that the participants answered most accurately when responding to negative words ““ even when they believed they were merely guessing the answer.

“There has been much speculation about whether people can process emotional information unconsciously, for example pictures, faces and words,” says Professor Lavie. “We have shown that people can perceive the emotional value of subliminal messages and have demonstrated conclusively that people are much more attuned to negative words.

“Clearly, there are evolutionary advantages to responding rapidly to emotional information. We can’t wait for our consciousness to kick in if we see someone running towards us with a knife or if we drive under rainy or foggy weather conditions and see a sign warning ‘danger’.”

Professor Lavie believes the research may have implications for the use of subliminal marketing to convey messages, both for advertising and public service announcements such as safety campaigns.

“Negative words may have more of a rapid impact,” she explains. “‘Kill your speed’ should be more noticeable than ‘Slow down’. More controversially, highlighting a competitor’s negative qualities may work on a subliminal level much more effectively than shouting about your own selling points.”

Subliminal advertising is not permitted on TV in the UK, according the broadcasting regulator Ofcom*. However, there have been a number of cases where the rules been stretched. In one particularly infamous case in 1997, comedian Chris Morris used a half-frame caption at the end of the satirical show Brass Eye to criticize the chief executive of Channel 4, Michael Grade, for heavily editing the controversial program. The description of his boss ““ “Grade is a ****” ““ would certainly have fallen into the category of negative words as described in Professor Lavie’s research.

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On the Net:

• Wellcome Trust
• Emotion

A promising discovery by McMaster University researchers has revealed an ideal starting point to develop new interventions for resistant infections

Antibiotic resistance has been a significant problem for hospitals and health-care facilities for more than a decade. But despite the need for new treatment options, there have been only two new classes of antibiotics developed in the last 40 years.

Now a promising discovery by McMaster University researchers has revealed an ideal starting point to develop new interventions for resistant infections.

Eric Brown, a professor and chair of the Department of Biochemistry and Biomedical Sciences, and a team of researchers from the Michael G. DeGroote Institute for Infectious Disease Research have identified a novel chemical compound that targets drug-resistant bacteria in a different way from existing antibiotics. The discovery could lead to new treatments to overcome antibiotic resistance in certain types of microorganisms.

The findings were published September 27 in the science research journal Nature Chemical Biology.

“Everyone reads the headlines about drug-resistant bugs, it’s a big problem,” said Brown, who holds the Canada Research Chair in Antimicrobial Research. “Really what we’re trying to do is understand whether or not there are new ways to tackle this problem.”

The research team, which included biochemists and chemists from McMaster University, used high-throughput screening to uncover the new class of chemical. The approach allows scientists to look for small molecules that kill bacteria as well as examine the molecular mechanisms and pathways they exploit.

Existing antibiotics destroy bacteria by blocking production of its cell wall, DNA or protein. The new McMaster-discovered compound, MAC13243, is directed at blocking a particular step in the development of the bacteria’s cell surface, which until now has not been recognized as a target for antibiotics.

“We’re excited about finding a new probe of a relatively uncharted part of bacterial physiology,” Brown said. “It’s a new way of thinking about the problem. Who knows, could this chemical become a drug? Anything’s possible. But at the very least we’ve advanced the field and created some tools that people can use now to try to better understand this pathway.”

Ranjana Pathania, a former postdoctoral fellow in the Brown lab and now an assistant professor at the Indian Institute of Technology Roorkee, is the lead author of the study. The research also involved collaborators in McMaster’s Department of Biochemistry and Biomedical Sciences and Department of Chemistry and Chemical Biology.

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On the Net:

• McMaster University
• Nature Chemical Biology

Frick’s Quality Meats of Washington, Mo., is recalling Braunschweiger that was mislabeled and contained undeclared milk ingredients, a federal agency said.

The 756 pounds of Braunschweiger was packaged as 16-ounce products with the label Premium Bologna, Poultry Free, Use by Dec. 15-09, the U.S. Department of Agriculture said Friday.

The label on the product said EST. 2949 inside the USDA mark of inspection.

The liver sausage, which contained undeclared milk ingredients, was produced on Aug. 13, 2009 and distributed to retail stores in Arkansas, Illinois, Kentucky, Missouri and Tennessee, Frick’s said in a statement.

Scientists label cells with colored or glowing chemicals to observe how basic cellular activities differ between healthy and cancerous cells. Existing techniques for labeling cells are either too slow or too toxic to perform on live cells. Now, a study reviewed by Philip Dawson, a member of Faculty of 1000 Biology and leading authority in chemistry and cell biology, describes a novel labeling technique that uses a chemical reaction to make live cancer cells light up quickly and safely.

Researchers at Massachusetts General Hospital developed a two-step process to specifically tag cancer cells. First, chemically modified antibodies home in on cancer cells. Then a chemical reaction called cycloaddition transfers a dye onto the antibody making the cancer cells glow when viewed through a microscope.

The novel cycloaddition reaction is fast, very specific, and requires minimal manipulation of the cells. Dawson comments that, in combining antibody binding with the cycloaddition, “low signal-to-noise ratios are achieved”. This new labeling technique could be used to track the location and activity of anti-cancer drugs, the location of cancer-specific proteins within the cell, or to visualize cancer cells inside a living organism.

Dawson concludes that cycloaddition will allow scientists to observe live cancer cells in the body, leading to a better understanding of cancer’s basic processes.

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On the Net:

• Faculty of 1000: Biology and Medicine