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Update August 2017


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Health & Wellbeing
 

Update August 26, 2017

Study boosts hope of ‘liquid biopsies’ for cancer screening

A patient has her blood drawn for a liquid biopsy during an appointment at a hospital in Philadelphia. Scientists have the first major evidence that such blood tests hold promise for screening people for cancer. (AP Photo/Jacqueline Larma, File)

Scientists have the first major evidence that blood tests called liquid biopsies hold promise for screening people for cancer. Hong Kong doctors tried it for a type of head and neck cancer, and boosted early detection and one measure of survival.

The tests detect DNA that tumors shed into the blood. Some are used now to monitor cancer patients, and many companies are trying to develop versions of these for screening, as possible alternatives to mammograms, colonoscopies and other such tests. The new study shows this approach can work, at least for this one form of cancer and in a country where it’s common.

“This work is very exciting on the larger scale” because it gives a blueprint for how to make tests for other tumor types such as lung or breast, said Dr. Dennis Lo of Chinese University of Hong Kong. “We are brick by brick putting that technology into place.”

He led the study, published Wednesday by the New England Journal of Medicine.  Lo is best known for discovering that fetal DNA can be found in a mom’s blood, which launched a new era of non-invasive testing for pregnant women.

The study involved nasopharyngeal cancer, which forms at the top of the throat behind the nose. It’s a good test case for DNA screening because it’s an aggressive cancer where early detection matters a lot, and screening could be tried in a population where the cancer is most common - middle-aged Chinese men.

Also, the Epstein-Barr virus is involved in most cases, so tests could hunt for viral DNA that tumors shed into the blood in large quantities, rather than rare bits of cancer cells themselves.

About 20,000 men were screened, and viral DNA was found in 1,112, or 5.5 percent. Of those, 309 also had the DNA on confirmatory tests a month later. After endoscope and MRI exams, 34 turned out to have cancer.

More cases were found at the earliest stage - 71 percent versus only 20 percent of a comparison group of men who had been treated for nasopharyngeal cancer over the previous five years. That’s important because early cases often are cured with radiation alone, but more advanced ones need chemotherapy and treatment is less successful.

Screening also seemed to improve how many survived without worsening disease - 97 percent at three years versus 70 percent of the comparison group.

Only one person who tested negative on screening developed nasopharyngeal cancer within a year.

The researchers estimate 593 people would need to be screened at a total cost of $28,600 to identify one cancer case. It may be worth it in Hong Kong, but maybe not in places like the U.S. where the disease is rare, and more people would have to be screened at a greater cost to find each case, said Dr. Richard Ambinder of Johns Hopkins School of Medicine, who wrote a commentary in the journal.

Still, “this is showing that liquid biopsies have great promise,” he said. “This is an advance that will indeed save lives.”

The study was sponsored by an Asian foundation and the Hong Kong government. Lo and some other authors founded Cirina, a Hong Kong-based company focused on early cancer detection, and get royalties related to DNA blood tests. In May, Cirina merged with Grail Inc., a California company working on cancer screening blood tests with more than $1 billion from drug companies and big-name investors such as Jeff Bezos and Bill Gates.


Pope Francis to Belgian Catholics: Stop offering euthanasia

Pope Francis has ordered a Belgian Catholic charity to stop offering euthanasia in its psychiatric hospitals. (AP Photo/Andrew Medichini, file)

Maria Cheng

London (AP) - Pope Francis has ordered a Belgian Catholic charity to stop offering euthanasia in its psychiatric hospitals.

In May, the Brothers of Charity group announced it would allow doctors to perform euthanasia at its 15 psychiatric hospitals in Belgium, one of only two countries - along with the Netherlands - where doctors are legally allowed to kill people with mental health problems, at their request.

To qualify, people must be in a state of “unbearable suffering” and at least three doctors, including one psychiatrist, must be consulted.

The charity said in a statement that euthanasia would only be performed if there were “no reasonable treatment alternatives” and that such requests would be considered with “the greatest caution.”

“We respect the freedom of doctors to carry out euthanasia or not,” the group said, noting that this freedom was “guaranteed by law.”

The Vatican press office said this week that the pope had asked the Belgians not to perform euthanasia.

The Catholic Church opposes euthanasia and the Holy See has begun investigating the decision to allow the procedure, which was made by the group’s lay board of directors.

The Belgian charity’s administrative headquarters in Rome issued a statement in May, arguing that allowing euthanasia “goes against the basic principles” of the Catholic Church.

“This is the very first time a Christian organization states that euthanasia is an ordinary medical practice that falls under the physician’s therapeutic freedom,” wrote the charity’s superior general, Rene Stockman, who delivered the request from Pope Francis via two letters.

“This is disloyal, outrageous and unacceptable.”

Mattias De Vriendt, a spokesman for the Belgium charity, said it had received the Vatican’s request but had not yet responded.

“We will take our time in the next few weeks to evaluate these letters,” de Vriendt said. He said the charity’s hospitals had received requests from patients seeking euthanasia recently but could not say whether any procedures had been performed.

The vast majority of patients seeking euthanasia in Belgium have a fatal illness like cancer or a degenerative disease. While the number of people euthanized for psychiatric reasons accounts for only about 3 percent of Belgium’s yearly 4,000 euthanasia deaths, there has been a threefold increase in the past decade.

Critics have previously raised concerns about Belgium’s liberal approach to euthanasia while advocates say that people with mental health illnesses should be granted the same autonomy as those with physical diseases.

The American Psychiatric Association says that doctors should not prescribe any methods to people who are not terminally ill to help them die.


Update August 19, 2017

Doctor told to stop marketing 3-person baby technique

 

The Food and Drug Administration warned a New York fertility doctor this month to stop marketing an experimental procedure that uses DNA from three people - a mother, a father and an egg donor - to avoid certain genetic diseases. (AP Photo/Andrew Harnik, File)

Linda A. Johnson, AP

U.S. regulators on Friday warned a New York fertility doctor to stop marketing an experimental procedure that uses DNA from three people - a mother, a father and an egg donor - to avoid certain genetic diseases.

The doctor, John Zhang, used the technique to help a Jordanian couple have a baby boy last year.

According to the Food and Drug Administration, Zhang said his companies wouldn’t use the technology in the U.S. again without permission, yet they continue to promote it.

The procedure is not approved in the U.S., and Congress has barred the FDA from even reviewing proposals to conduct such experiments.

A receptionist at Zhang’s New Hope Fertility Clinic in New York said late Friday that no one was available to comment. Zhang heads the clinic and a related company, Darwin Life Inc.

New Hope’s website touts having achieved the “first live birth” using this technology, along with other advanced fertility treatments it offers. The FDA’s letter to Zhang cites several other marketing claims, including a reference to “the first proven treatment for certain genetic disorders.”

The birth of the boy was disclosed last September. The mother carries DNA that could have given her child Leigh syndrome, a severe neurological disorder that usually kills within a few years of birth.

The experimental technique involves removing some of the mother’s DNA from an egg, and leaving the disease-causing DNA behind. The healthy DNA gets slipped into a donor’s egg, which is then fertilized. As a result, the baby inherits DNA from both parents and the egg donor - producing what’s been called “three-parent babies” - though the DNA contribution from the egg donor is very small.

People carry DNA in two places, the nucleus of the cell and in structures called mitochondria, which lie outside the nucleus. The technique is designed to transfer only DNA of the nucleus to the donor egg.

A medical journal report on the case said the procedure was done at the New York clinic and the embryo was taken to Mexico, where it was implanted. The procedure isn’t illegal in Mexico.

Last year, a report from a panel of U.S. government advisers said it is ethical to begin testing this approach in pregnancy as long as the first studies follow strict safety steps. The studies must include women at high risk of passing on a severe disease and, at first, implant only male embryos, so the alterations wouldn’t pass to future generations.

The FDA had requested the report, though the law against such experiments remains in force.

British regulators last year approved “cautious use” of the technique, and this year issued its first license to use it.

The child born last year through Zhang’s clinic is not the first to inherit DNA from three people. In the 1990s, some children were born after researchers used a different technique. But federal regulators intervened, and the field’s interest now has passed to the new approach.


Update August 12, 2017

Hints that lifestyle changes might guard against dementia

A section of a human brain with Alzheimer’s disease is on display at the Museum of Neuroanatomy at the University at Buffalo, in Buffalo, N.Y. (AP Photo/David Duprey, File)

Lauran Neergaard

Washington (AP) - Seek a good education. Control blood pressure and diabetes. Get off the couch. There are some hints, but no proof yet, that these and other lifestyle changes just might help stave off dementia.

A provocative report in the British journal Lancet Thursday, July 20, raised the prospect that a third of dementia cases around the world could be delayed or even prevented by avoiding key risks starting in childhood that can make the brain more vulnerable to memory loss in old age.

A recent U.S. report was much more cautious, saying there are encouraging clues that a few lifestyle changes can bolster brain health and that more research is critical.

Still, it’s never too early to try, said Lancet lead author Gill Livingston, a psychiatry professor at University College London.

“Although dementia is diagnosed in later life, the brain changes usually begin to develop years before,” she noted.

Early next year, a $20 million U.S. study will begin rigorously testing if some simple day-to-day activities truly help older adults stay sharp.

“We are in a frustrating position science-wise in terms of what are our options?” said cognitive neuroscientist Laura Baker of Wake Forest School of Medicine in North Carolina, who will lead the new study to find out.

In the meantime, Alzheimer’s specialists say there’s little down side to following some common-sense recommendations.

Consider physical activity, crucial for heart health. “If in fact it should also improve the prospects for cognitive function and dementia, all the better,” said Dr. Richard Hodes, director of the U.S. National Institute on Aging and an avid exerciser.

“Increased health of the body supports increased health of the brain,” Baker added.

Here’s the latest from this week’s Alzheimer’s Association International Conference on possible ways to guard your brain:

 Key Risks

A Lancet-appointed panel created a model of dementia risks throughout life that estimates about 35 percent of all dementia cases are attributable to nine risk factors - risks that people potentially could change.

Their resulting recommendations: Ensure good childhood education; avoid high blood pressure, obesity and smoking; manage diabetes, depression and age-related hearing loss; be physically active; stay socially engaged in old age.

The theory: These factors together play a role in whether your brain is resilient enough to withstand years of silent damage that eventually leads to Alzheimer’s.

Does changing these or other lifestyle factors really help?

Last month, the U.S. National Academies of Sciences, Engineering and Medicine reported there’s little rigorous proof. That report found some evidence that controlling blood pressure, exercise and some forms of brain training - keeping intellectually stimulated - might work and couldn’t hurt.

Why? What’s good for the heart is generally good for the brain. In fact, high blood pressure that can trigger heart attacks and strokes also increases risk for what’s called “vascular dementia.”

And exercising your gray matter may bulk up the brain, whether it’s from childhood education or learning a new language as an adult. The more you learn, the more connections your brain forms, what scientists call cognitive reserve. Some U.S. studies have suggested that generations better educated than their grandparents have somewhat less risk of dementia.

Other factors have less scientific support. Studies show people with hearing loss are more likely to experience memory problems, and have speculated that it’s because hearing loss leads to depression and social isolation - or that the brain works harder to deal with garbled sound, at the expense of other thinking skills. But so far there aren’t studies proving hearing aids reverse that risk.

In fact, the strongest evidence that lifestyle changes help comes from Finland, where a large, randomized study found older adults at high risk of dementia scored better on brain tests after two years of exercise, diet, cognitive stimulation and social activities.

Hunting Proof

Would those strategies help Americans, who tend to be sicker, fatter and more sedentary than Scandinavians? The Alzheimer’s Association is funding a study to find out, with enrollment of 2,500 cognitively healthy but high-risk older adults to begin next year.

Want to try on your own? They’ll test:

- Walking - supervised, so no cheating. Wake Forest’s Baker puts seniors on treadmills at the local YMCA to avoid bumpy sidewalks. She advises exercise newbies to start slow - about 10 minutes a day for a few days - and work up to longer walks, and go with a buddy so it’s harder to back out.

- A diet that includes more leafy greens, vegetables, whole grains, fish and poultry than the typical American menu.

- Certain brain games and what Baker called an “intellectual stimulation barrage,” outings and other steps that keep people social, not sitting home on a computer, while they exercise their brains.

- Improving control of medical conditions like high blood pressure and diabetes that are toxic to the brain.


Update August 5, 2017

Hearing is believing: Speech may be a clue to mental decline

In this July 6, 2017 photo, Kim Mueller, left, administers a test to Alan Sweet, where he describes an illustration, as part of a University of Wisconsin-Madison study on dementia. (AP Photo/Carrie Antlfinger)

Marilynn Marchione

Your speech may, um, help reveal if you’re uh ... developing thinking problems. More pauses, filler words and other verbal changes might be an early sign of mental decline, which can lead to Alzheimer’s disease, a study suggests.

Researchers had people describe a picture they were shown in taped sessions two years apart. Those with early-stage mild cognitive impairment slid much faster on certain verbal skills than those who didn’t develop thinking problems.

“What we’ve discovered here is there are aspects of language that are affected earlier than we thought,” before or at the same time that memory problems emerge, said one study leader, Sterling Johnson of the University of Wisconsin-Madison.

This was the largest study ever done of speech analysis for this purpose, and if more testing confirms its value, it might offer a simple, cheap way to help screen people for very early signs of mental decline.

Don’t panic: Lots of people say “um” and have trouble quickly recalling names as they age, and that doesn’t mean trouble is on the way.

“In normal aging, it’s something that may come back to you later and it’s not going to disrupt the whole conversation,” another study leader, Kimberly Mueller, explained. “The difference here is, it is more frequent in a short period,” interferes with communication and gets worse over time.

The study was discussed Monday at the Alzheimer’s Association International Conference in London.

About 47 million people worldwide have dementia, and Alzheimer’s is the most common type. In the U.S., about 5.5 million people have the disease. Current drugs can’t slow or reverse it, just ease symptoms. Doctors think treatment might need to start sooner to do any good, so there’s a push to find early signs.

Mild cognitive impairment causes changes that are noticeable to the person or others, but not enough to interfere with daily life. It doesn’t mean these folks will develop Alzheimer’s, but many do - 15 to 20 percent per year.

To see if speech analysis can find early signs, researchers first did the picture-description test on 400 people without cognitive problems and saw no change over time in verbal skills. Next, they tested 264 participants in the Wisconsin Registry for Alzheimer’s Prevention, a long-running study of people in their 50s and 60s, most of whom have a parent with Alzheimer’s and might be at higher risk for the disease themselves. Of those, 64 already had signs of early decline or developed it over the next two years, according to other neurological tests they took.

In the second round of tests, they declined faster on content (ideas they expressed) and fluency (the flow of speech and how many pauses and filler words they used). They used more pronouns such as “it” or “they” instead of specific names for things, spoke in shorter sentences and took longer to convey what they had to say.

“Those are all indicators of struggling with that computational load that the brain has to conduct” and supports the role of this test to detect decline, said Julie Liss, a speech expert at Arizona State University with no role in the work.

She helped lead a study in 2015 that analyzed dozens of press conferences by former President Ronald Reagan and found evidence of speech changes more than a decade before he was diagnosed with Alzheimer’s. She also co-founded a company that analyzes speech for many neurological problems, including dementia, traumatic brain injury and Parkinson’s disease.

Researchers could not estimate the cost of testing for a single patient, but for a doctor to offer it requires only a digital tape recorder and a computer program or app to analyze results.

Alan Sweet, 72, a retired state of Wisconsin worker who lives in Madison, is taking part in the study and had the speech test earlier this month. His father had Alzheimer’s and his mother had a different type of dementia, Lewy body.

“Watching my parents decline into the awful world of dementia and being responsible for their medical care was the best and worst experience of my life,” he said. “I want to help the researchers learn, furthering medical knowledge of treatment and ultimately, cure.”

Participants don’t get individual results - it just aids science.

Another study at the conference on Monday, led by doctoral student Taylor Fields, hints that hearing loss may be another clue to possible mental decline. It involved 783 people from the same Wisconsin registry project. Those who said at the start of the study that they had been diagnosed with hearing loss were more than twice as likely to develop mild cognitive impairment over the next five years as those who did not start out with a hearing problem.

That sort of information is not strong evidence, but it fits with earlier work along those lines.

Family doctors “can do a lot to help us if they knew what to look for” to catch early signs of decline, said Maria Carrillo, the Alzheimer’s Association’s chief science officer. Hearing loss, verbal changes and other known risks such as sleep problems might warrant a referral to a neurologist for a dementia check, she said. (AP)

Online:

Audio of example test: http://bit.ly/2sZklbU.
 


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HEADLINES [click on headline to view story]

Study boosts hope of ‘liquid biopsies’ for cancer screening

Pope Francis to Belgian Catholics: Stop offering euthanasia


Doctor told to stop marketing 3-person baby technique


Hints that lifestyle changes might guard against dementia


Hearing is believing: Speech may be a clue to mental decline


 



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