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Reviewed by Alina Shrourou, B.Sc. (Editor)Oct 30 2018Instead of destroying a tumors’ blood supply, a first-ever University of Guelph study has proven that opening up the vessels is potentially more effective when it comes to fighting ovarian cancer.This is because open vessels provide a clear pathway for treatment to attack the tumor.”There hasn’t been much hope for women with ovarian cancer,” said Prof. Jim Petrik, lead author of the ground-breaking study. “What we are working on has never been done before and it has the potential to make a significant impact on effective treatment.”Published recently in the journal Clinical Cancer Research, the study is the first to investigate the impact of establishing a healthy blood supply to the tumor prior to treatment in mice models with an advanced stage of ovarian cancer.Current treatment has focused on destroying all the blood vessels and starving the tumor, but it has had poor success, said Petrik.”When you cut off a tumors’ blood supply it often becomes more aggressive,” he said. “We developed an approach where you only kill off the dysfunctional blood vessels. The result is a smaller, calmer tumor with a good blood supply. Once you have established an effective vascular system, you can use that system to get treatment to the tumor.”The study was conducted on mice models with an advanced stage of ovarian cancer because this type of cancer often goes undetected until the late stages when survival is low. The current mortality rate for ovarian cancer is 80 per cent.The first step was to prune the blood vessels supplying the tumor. Tumors grow at an intense rate and this rapid growth results in a vast, yet dysfunctional, blood supply. Once a smaller, healthier blood supply to the tumor was created, the mice were then treated with an oncolytic virus. This novel treatment uses viruses to infect and kill cancer cells and also stimulate anti-tumor responses in the body.Related StoriesUsing machine learning algorithm to accurately diagnose breast cancerNew study to ease plight of patients with advanced cancerSpecial blood test may predict relapse risk for breast cancer patients”Using an oncolytic virus to treat ovarian cancer is currently underway in human clinical trials, but the success rate is very low. It’s difficult to get the virus to the tumor because of its dysfunctional vascular system.”By pruning the vessels to create a normal blood supply to the tumor, Petrik was able to dramatically increase the uptake and activity of the virus.”Using this combination of treatment we saw the tumor regress from an advanced state, but even more importantly we eradicated the spread of the cancer cells,” said Petrik. “With this type of cancer, the tumor will grow in the ovary to a large size and then typically spread to the abdomen causing perforation of the gut or sepsis. Women die from the metastatic nature of the disease not from the tumor.”Targeting the tumors’ blood supply and improving it rather than destroying it could also help other treatments, including chemotherapy, which are delivered through the vascular system, he added.”The treatment for ovarian cancer hasn’t really progressed in four decades. There are limited therapeutic advances, but these findings show that we may be able to improve the effectiveness of our current treatments if we improve the delivery system.” Source:https://news.uoguelph.ca/2018/10/novel-technique-can-potentially-improve-success-of-ovarian-cancer-treatment-study-reveals/ read more

Reviewed by Alina Shrourou, B.Sc. (Editor)Dec 10 2018It’s fast-paced, takes less time to do, and burns a lot of calories. High-intensity interval exercise is widely recognized as the most time-efficient and effective way to exercise. In a first-of-its-kind study, researchers from Florida Atlantic University have discovered another important health benefit of these short bursts of intense exercise with rest intervals. It could also be an effective strategy to prevent and combat cognitive dysfunction in obese individuals.Obesity reduces the expression of brain-derived neurotrophic factor (BDNF), a protein in the brain that promotes the survival of nerve cells or neurons. Lower levels of this protein are associated with Alzheimer’s disease, Parkinson’s disease, and obesity. Although studies have shown that obesity is a risk factor for cognitive dysfunction, the mechanisms of this relationship are not fully understood.To-date, studies on exercise and BDNF response in obese populations have only used continuous moderate-intensity exercise without rest intervals. FAU researchers and collaborators from the University of Texas at Austin and Purdue University, are the first to examine the modulatory role of obesity on exercise-induced BDNF release and to use an acute high-intensity interval exercise protocol as a practical model to measure the phenomena of BDNF release in both obese and normal-weight subjects. They also examined the potential relationship of exercise-induced BDNF with blood lactate and cortisol.Results of study, published in the journal Experimental Biology and Medicine, show that the BDNF response to acute high-intensity interval exercise was greater than continuous moderate-intensity exercise in obese subjects when compared to normal-weight subjects. Similarly, although acute high-intensity interval exercise induced greater blood lactate and plasma cortisol levels than continuous moderate-intensity exercise, obese subjects produced less blood lactate, but showed no difference in cortisol than normal-weight subjects.These findings suggest that acute high-intensity interval exercise may be a more effective protocol to upregulate BDNF expression in an obese population, independent of increased lactate and cortisol levels.”High-intensity interval exercise is a time-efficient strategy with similar or superior physiological benefits that promotes the expression of a growth factor typically associated with brain health, yet that appears to be down regulated in obesity,” said Chun-Jung (Phil) Huang, Ph.D., lead author and an associate professor in the Exercise Biochemistry Laboratory, Department of Exercise Science and Health Promotion, in FAU’s College of Education. “The relative simplicity and efficacy of high-intensity interval exercise supports its use as a preventive measure and as an intervention to combat obesity and other chronic disease conditions.”Related StoriesExercise during pregnancy can promote bone health of both mother and childHarnessing target of the brain chemical serotonin to combat obesityNew anti-obesity drug trial set to launch at Alberta Diabetes InstituteFor the study, male subjects participated in a counterbalanced and caloric equated experiment of high-intensity interval exercise. The high-intensity interval exercise protocol consisted of a five minute walking or jogging warm-up, followed by four high-intensity intervals lasting four minutes each, followed by three minutes of active recovery followed by each high-intensity interval. Blood samples were collected prior to, immediately following exercise, and an hour into recovery for measurements of serum BDNF, blood lactate, and plasma cortisol.Other findings from the study show statistically significant differences between the obese and normal-weight groups for body weight, BMI, systolic and diastolic blood pressures, and waist/hip circumferences and ratio. In addition, both the obese and normal-weight groups had comparable heart rate responses during both exercise protocols, demonstrating a similar relative exercise intensity and effort between groups. Therefore, the BDNF response was likely not influenced by disparities between aerobic fitness, with a greater level in obese subjects than normal-weight subjects following acute high-intensity interval exercise vs. continuous moderate-intensity exercise.”Increased levels of cortisol have been shown to down regulate BDNF expression, however, this relationship in response to exercise still remains equivocal,” Huang. “Specifically, our study and others, did not observe any correlation between cortisol and BDNF following either acute high-intensity exercise or continuous moderate-intensity exercise protocol, yet, the report of such is opposite.”Aerobic training has been shown to not only provide beneficial anti-inflammatory and cardiovascular benefits, but also reductions in age-related cognitive decline. It also has been shown to preserve brain volume and potentially improve blood flow.The Centers for Disease Control and Prevention estimates that about 93.3 million Americans were classified as obese in 2016. The annual medical costs of obesity were estimated at around $147 billion in 2008. Source:http://www.fau.edu/newsdesk/articles/hiie-obesity-cognition.php read more

Reviewed by James Ives, M.Psych. (Editor)Feb 7 2019Backed by a $5.1 million grant, University of North Carolina and University of Malawi College of Medicine physicians and scientists will launch a multi-pronged effort to combat cervical cancer in Malawi, a country in sub-Saharan Africa where cervical cancer is the leading cause of cancer death among women.The United States Agency for International Development (USAID), in partnership with the U.S. National Academies of Science, Engineering, and Medicine, will fund a total of $12 million for two new programs to prevent cervical cancer in sub-Saharan Africa, including the project in Malawi and one in Mozambique.”By screening women, we are able to detect and treat precancerous changes before they develop into cervical cancer,” said Jennifer Tang, MD, MSCR, co-principal investigator of the study for UNC, associate professor in the UNC School of Medicine Department of Obstetrics & Gynecology’s Division of Global Women’s Health and a member of the UNC Institute for Global Health & Infectious Diseases Malawi site. “Because women in Malawi weren’t getting screened, they were getting diagnosed very late. A late cervical cancer diagnosis is usually a death sentence in Malawi. That is why we’re trying to screen as many women as possible using a highly sensitive test, and to treat the women with evidence of precancerous lesions the same day. This increases the number of women screened and treated, and decreases loss to follow up.”Globally, the majority of cervical cancer deaths occur in low- and middle-income countries, according to the World Health Organization. The disease is linked to the sexual transmission of HPV, or human papillomavirus.Malawi has the second-highest cervical cancer rate of any country in the world, according to 2018 estimates from the HPV Information Centre. That is due to high rates of HPV as well as HIV, and low population-level screening and vaccination, said Satish Gopal, MD, MPH, member of the UNC Lineberger Comprehensive Cancer Center, cancer program director for UNC Project-Malawi and an associate professor in the UNC School of Medicine Division of Hematology/Oncology.In 2004, the Malawi Cervical Cancer Control Program set a target of screening 80 percent of eligible women for cervical cancer. Yet, less than a third had completed this screening as of 2015, according to data from the program.”Progress is being made, but there is a tremendous amount still to do to stem the cervical cancer epidemic,” said Gopal. “We need to understand how to most efficiently deliver the preventive services to the highest number of women, and avert these unnecessary cancer deaths.”With the new funds, UNC-Chapel Hill and the Malawi College of Medicine will evaluate the feasibility and cost-effectiveness of integrating self-collection HPV testing into voluntary family planning clinics and community-based sites in Malawi. The researchers also are planning to investigate the effectiveness of treating precancerous lesions using a method known as thermocoagulation in a “screen-and-treat” strategy.”We couldn’t be more proud of this team of U.S.- and African-trained investigators receiving such a large award to better understand the global burden of cervical cancer,” said Myron Cohen, MD, director of the UNC Institute for Global Health & Infectious Diseases. “UNC faculty and staff from across the campus have worked hard over the past 25 years to build a self-sustaining model of clinical care, research and training in Malawi for health professionals from the United States and in-country to succeed and improve health for all. This grant exemplifies this mission.”Recent technological advances have made the project possible, Tang said. HPV testing can now be completed rapidly to determine if a woman has a strain of the virus that is high-risk for causing cervical cancer. With the results, providers can determine which women might need same-day treatment of precancerous cervical lesions. Thermocoagulation involves using a portable, battery-operated device that can easily be used in settings with limited resources, she said.Related StoriesUsing machine learning algorithm to accurately diagnose breast cancerHow cell-free DNA can be targeted to prevent spread of tumorsSugary drinks linked to cancer finds study”Transportation is one of the biggest barriers to treatment for women in Malawi, along with cost,” she said. “We’re trying to save women from having to come to the clinic multiple times, spending money and time they don’t have. As soon as we find a problem, we are treating it immediately.”UNC physicians and researchers have been collaborating with Malawian health leaders since 1990 to provide clinical care and research for HIV and other sexually transmitted diseases. This partnership led to the establishment of the UNC Project-Malawi site in Lilongwe. As prevention and treatment interventions have improved the survival rates of people living with HIV in Malawi, cancer has emerged as a growing health problem in the country. In 2014, the Malawi Cancer Consortium was launched with funding from the National Cancer Institute to help fight cancer, and HIV-associated cancers in particular.Last year, Malawian leaders traveled to UNC-Chapel Hill to meet with Carolina leadership, physicians and scientists to prepare for the opening of Malawi’s first dedicated cancer center, which is expected this year and is being built adjacent to UNC Project-Malawi.The newly funded cervical cancer project builds on the results of a pilot study led by Lameck Chinula, MMED, FCOG, who is co-principal investigator for this project and the first Malawian-trained obstetrician and gynecologist at UNC Project-Malawi. During the pilot study, more than 400 rural women were screened for cervical cancer using a community-based screening approach, and then treated with thermocoagulation if they were found to have precancerous lesions.Chinula, who is also a research assistant professor in the UNC School of Medicine’s Department of Obstetrics and Gynecology, was trained in South Africa through funding from the UNC Institute for Global Health & Infectious Diseases partnership with the Fogarty AIDS International Training and Research Program and the Gilead Training Fellowship. To address another critical need, he was also trained to perform the surgical procedure used to treat invasive cervical cancer – radical hysterectomy – by two U.S. gynecologic oncology specialists. Chinula now strives to educate other clinicians, and Malawian women in general, to stop cervical cancer before it becomes deadly.”We would like to see providers maximize any contacts they have with women and use the most efficient, culturally-sensitive screening test available to identify patients needing treatment for cervical pre-cancer,” Chinula said. “By allowing women to self-collect specimens for HPV testing, we hope to empower and increase the number of women screened. As a clinician-researcher who has had to deliver the bad news of an incurable cervical cancer diagnosis in Malawi, I can look to the future with hope that a day will come when these diagnoses will be a rare occurrence.”According to the USAID, this is the first time the agency has funded programs to prevent cervical cancer in the context of broader women’s health, other than under the President’s Emergency Plan for AIDS Relief (PEPFAR). These new programs in Malawi and Mozambique will coordinate closely with PEPFAR investments in both countries.”Women who aren’t screened and treated for cervical cancer have a higher risk of dying of this preventable disease,” said UNC Lineberger’s Jennifer S. Smith, PhD, professor of epidemiology at the UNC Gillings School of Global Public Health. “We need to do all that we can to increase cervical screening rates globally. We’re testing a self-sampling technology that should increase screening coverage dramatically, but we do have unanswered questions about implementation within existing health care systems and cost. Study findings will inform future policy and implementation, not only for self-collection tests in Malawi, but other countries.”Source: http://unclineberger.org/news/unc-led-team-awarded-5-1m read more

Reviewed by Kate Anderton, B.Sc. (Editor)Mar 6 2019There’s no doubt that surgically implanted medical devices can improve lives.Hip and knee replacements can help people regain their mobility. Drug pumps can deliver doses of pain-relieving medicine on demand. And metal rods can stabilize spines and broken bones.But implanted devices can also do serious damage, as happened to Mechel Keel, who lives in Owosso, Mich.To fix her leaky bladder, an OB-GYN stitched a flexible mesh strap inside her pelvis in 2004. But within months, the mesh hardened and started cutting her insides.The pain kept her from returning to her job as a hairdresser. The injuries and scar tissue that developed required multiple surgeries to correct and also resulted in chronic infections.Keel said she understands why her doctor in Tennessee thought the high-tech mesh would help. But she also now feels she was treated like “a guinea pig.”“We were the testers,” she said. “There was no animal testing done. We were the animals.”Thousands of cases of complications from surgical mesh have been reported to the Food and Drug Administration. More and more ailments are being treated these days with medical devices, including implants. And most of these medical devices, unlike pills in a medicine cabinet, don’t go through human testing before being offered to patients.But some devices break down or malfunction in people’s bodies, and reports about sometimes debilitating injuries have led the FDA to rethink how it assesses medical devices before allowing them to be sold.For devices in which failure is obviously life-threatening, regulators have required some sort of human testing as part of the most stringent path — known as premarket approval. But most medical devices enter the market after manufacturers provide technical information and show that the devices are similar to others that have been legally sold previously.The FDA has acknowledged that some seemingly safe devices have caused major problems, and the agency has elevated the risk level of those products following reports of injuries, as it did with urogynecologic surgical mesh for some uses in 2016. “Unfortunately, the FDA cannot always know the full extent of the benefits and risks of a device before it reaches the market,” the agency said in a recent statement.“We have things like metal-on-metal hips,” said health journalist Jeanne Lenzer about a kind of orthopedic implant. “Outside the body, [they] seem to function just fine. They put them in little machines, rock them back and forth — they don’t break. [But] put them inside people, and something very different happens.”There have been massive recalls of hip implants, for example, due to devices causing swelling and pain. And there have been problems with weakened bones in patients who received hip implants that contained plastic.Lenzer wrote a scathing book, “The Danger Within Us,” about the device industry and said she was “dumbfounded” to find out how many devices never went through human testing the way drugs do.That’s in part because of a regulatory review process known as 510(k) for a section of the FDA law covering medical devices. Manufacturers typically show their product has “substantial equivalence” to a “predicate device” that has already been legally marketed.That standard can perpetuate problems. “You just say your device is like an old device, and the old device was never tested, nor was your device,” Lenzer said.In practice, sometimes the basis for a whole family tree of devices turns out to be defective. Pelvic mesh is a relevant example, with much of what’s on the market being based on mesh that was around prior to implementation of FDA regulations for medical devices in 1976. One study found that 16 percent of mesh on the market was designed like products that had been pulled from the market because of safety concerns.Thousands of women have filed suit — or reached settlements — with medical device companies that manufacture pelvic mesh.“I would want nothing if you could just give me my life back,” said Gloria Jones of Hillsdale, Mich., who is one of thousands who have settled with device manufacturers over faulty mesh. “They could have given me millions, but all I needed was my life back.”Jones, who has struggled to continue working through crippling abdominal pain as a middle school special-education teaching assistant, has had four surgeries to remove pieces and continues to require intravenous drugs to control infections.Related StoriesLipid-lowering drugs are underutilized for preventing atherosclerotic cardiovascular diseaseBariatric surgery should be offered to all patients who would benefitNew technology to harvest energy from the human knee“It seems like I get off one antibiotic, and three days later I have another one,” she said. “I would beg anybody who is even thinking of putting mesh in their bodies to stop and get a second opinion.”In response to problems reported with mesh, the FDA started requiring human testing for some of these products in recent years. The agency held an advisory committee meeting on Feb. 12 to discuss the safety and effectiveness of mesh and how it should be regulated.Manufacturers by and large have said they don’t oppose what the FDA is trying to do, calling the changes reasonable. But they have pushed back against calls to bring regulation of medical devices in line with that of pharmaceuticals.“If you’re treating someone for high cholesterol, the testing that you go through to ensure safety and effectiveness on a chemical that’s going to be used in your body to control your cholesterol is just very different than it would be for the implantation of a heart valve,” said Scott Whitaker, CEO of AdvaMed, a trade association for medical device companies. “Honestly, it’s apples and oranges.”Whitaker dismisses the idea that devices, which range from tongue depressors to surgical robots, should all go through human trials.“Testing should be as complete and as thorough and as ethical and as appropriate as possible. But it doesn’t all fit the same and can’t all fit the same standard,” Whitaker said. “And while we always strive for 100 percent, there are times when something might not go according to plan. It could also be because the surgery didn’t go as was planned.”The FDA declined NPR’s request for an interview. But the agency has released some written justification for the regulatory revamp.“We believe firmly in the merits of the 510(k) process,” FDA Commissioner Scott Gottlieb said in a November statement, noting that applications have more than doubled in size to an average of 1,185 pages. “But we also believe that framework needs to be modernized to reflect advances in technology, safety and the capabilities of a new generation of medical devices.”In the same statement, the agency addressed some specific shortcomings and charted plans to make changes to the process over the next few months: Dr. Michael Matheny, a Vanderbilt University professor who tracks medical devices, approves of the FDA’s incremental approach and calls it thoughtful.“It would really be unfortunate if patients wouldn’t consider any medical devices at all to be used in their bodies,” Matheny said. “But I do think being aware that there’s nothing without risk is also important.”Matheny notes, though, that in some ways the risks can be more profound for devices than medication. If the FDA recalls pills, a patient can at least stop taking them immediately, he said. With implanted devices, patients are sort of stuck, at least for a while — and that’s if surgeons can even safely remove them.This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News. This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. Pushing back on manufacturers that base any new device’s marketing application on one that’s more than 10 years old; More actively watching how devices perform once they’re on the market, rather than relying on patients to report problems; Scrapping the 510(k) name for something more descriptive, such as the “Safety and Performance Based Pathway.” read more