MRI helps identify patients with prostate cancer who may benefit from active surveillance

ScienceDaily (Sep. 24, 2012) — PSA screening has resulted in improved prostate cancer survival, but the high rate of diagnosis and treatment side effects raise concerns about overtreatment. In the quest to prevent overtreatment, "active surveillance" has emerged as a plausible option, encouraged for men whose tumors may not need immediate treatment and may never progress to more serious illness. Appropriate criteria for selecting patients for active surveillance are continuously debated. A group of investigators from Memorial Sloan-Kettering Cancer Center in New York report that adding endorectal magnetic resonance imaging (MRI) to the initial clinical evaluation of men with clinically low prostate cancer risk helps assess eligibility for active surveillance.

Their results are published in The Journal of Urology.

"Among patients initially diagnosed with clinically low risk prostate cancer, those with tumors not clearly visualized on MRI were significantly more likely to demonstrate low risk features when a confirmatory biopsy was performed, while patients with tumors clearly visualized on MRI were significantly more likely to have their disease status upgraded on confirmatory biopsy," says lead investigator Hebert Alberto Vargas, MD, Department of Radiology, Memorial Sloan-Kettering Cancer Center.

Researchers evaluated 388 patients who had an initial prostate biopsy performed between 1999 and 2010, had a Gleason score (measures prostate cancer aggressiveness) of 6 or less, and had a biopsy to confirm the assessment within 6 months of initial diagnosis. An endorectal MRI was performed in all patients between the initial and confirmatory biopsies.

MRI studies were interpreted by three radiologists with different levels of experience. One was a fellowship trained radiologist who had read only about 50 prostate MRI examinations before the study (reader 1). The second was a fellow with dedicated training in prostate imaging who had read approximately 500 prostate MRI examinations (reader 2). The third was a fellowship trained radiologist who had interpreted over 5,000 prostate MRI examinations (reader 3). They each assigned a score of 1 to 5 for the presence of tumor on MRI, with 1 being definitely no tumor and 5 being definitely tumor.

On confirmatory biopsy, Gleason scores were upgraded in 79 (20%) cases. Patients with higher MRI scores were more likely to have disease upgraded on confirmatory biopsy. An MRI score of 2 or less was highly associated with low risk features on confirmatory biopsy. Agreement on MRI scores was substantial between readers 2 and 3, but only fair between reader 1 and readers 2 and 3. "These results suggest that MRI of the prostate, if read by radiologists with appropriate training and experience, could help determine active surveillance eligibility and obviate the need for confirmatory biopsy in substantial numbers of patients," notes Dr. Vargas.

Active surveillance allows patients with low grade tumors avoid negative side effects of prostate cancer treatment including erectile dysfunction and bladder problems. The success of active surveillance relies primarily on the accurate identification of patients with low risk disease unlikely to have disease progression. "The fact that clear tumor visualization on MRI was predictive of upgrading on confirmatory prostate biopsy suggests that prostate MRI may contribute to the complex process of assessing patient eligibility for active surveillance," Dr. Vargas concludes.

In an editorial in the same issue of The Journal, Guillaume Ploussard, MD, PhD, of the CHU Saint-Louis, APHP, Paris, France, notes "The primary issue is to reduce the number of clinical settings in which the urologist and the patient face the situation of an increased PSA and an uncertain diagnosis. MRI might help to limit the risk of biopsy under grading. In cases of normal signal in the whole gland, the patient might be reassured and re-biopsy delayed. In cases of a suspicious nodule, re-biopsy would be better justified, and biopsy cores could target specific zones."

 

22.14 | 0 komentar | Read More

First two James Webb Space Telescope flight mirrors delivered to NASA

ScienceDaily (Sep. 24, 2012) — The first two of the 18 primary mirrors to fly aboard NASA's James Webb Space Telescope arrived at NASA's Goddard Space Flight Center in Greenbelt, Md.

The mirrors are going through receiving and inspection and will then be stored in the Goddard cleanroom until engineers are ready to assemble them onto the telescope's backplane structure that will support them.

Ball Aerospace, Boulder, Colo., under contract to Northrop Grumman, is responsible for the Webb's optical technology and lightweight mirror system. On September 17, 2012, Ball Aerospace shipped the first two mirrors in custom containers designed specifically for the multiple trips the mirrors made through eight U.S. states while completing their manufacturing. The remaining 16 mirrors will make their way from Ball Aerospace to Goddard over the next 12 months as they await telescope integration in 2015.

"These first two completed flight mirror assemblies arriving at Goddard are an important first step leading towards the integration of the mirrors onto the flight structure," said Lee Feinberg, NASA Optical Telescope Element Manager for the James Webb Space Telescope at the Goddard Space Flight Center in Greenbelt, Maryland. "These delivered flight mirrors meet their requirements, which is great news for Webb telescope being able to fulfill its scientific potential."

One of the Webb's science goals is to look back through time to when galaxies were young. To see such far-off and faint objects, Webb needs a large mirror. A telescope's sensitivity, or how much detail it can see, is directly related to the size of the mirror area that collects light from the objects being observed. A larger area collects more light, just like a larger bucket collects more water in a rain shower than a small one.

Webb's scientists and engineers determined that a primary mirror 6.5 meters (21 feet 4 inches) across is what was needed to measure the light from these distant galaxies. Each of the 18 hexagonal-shaped mirror assemblies that make up the primary mirror measures more than 1.3 meters (4.2 feet) across, and weighs approximately 40 kilograms, or 88 pounds.

The Webb will be the first space astronomy observatory to use an actively-controlled, segmented mirror. The Webb is critical for future infrared observations. The Webb will be the premier observatory of the next decade. It will study every phase in the history of our universe, ranging from the first luminous glows after the Big Bang, to the formation of stellar systems capable of supporting life on planets like Earth, to the evolution of our own Solar System. It is a joint project of NASA, the European Space Agency and the Canadian Space Agency.

07.09 | 0 komentar | Read More

Feeling guilty versus feeling angry: Who can tell the difference?

ScienceDaily (Sep. 24, 2012) — When you rear-end the car in front of you at a stoplight, you may feel a mix of different emotions such as anger, anxiety, and guilt. The person whose car you rear-ended may feel angered and frustrated by your carelessness, but it's unlikely that he'll feel much guilt.

The ability to identify and distinguish between negative emotions helps us address the problem that led to those emotions in the first place. But while some people can tell the difference between feeling angry and guilty, others may not be able to separate the two. Distinguishing between anger and frustration is even harder.

In a study forthcoming in Psychological Science, a journal of the Association for Psychological Science, psychological scientist Emre Demiralp of the University of Michigan and his colleagues hypothesized that clinically depressed people would be less able to discriminate between different types of negative emotions compared to healthy individuals. Clinically depressed people often experience feelings of sadness, anger, fear, or frustration that interfere with everyday life.

"It is difficult to improve your life without knowing whether you are sad or angry about some aspect of it," says Demiralp. "For example, imagine not having a gauge independently indicating the gasoline level of your car. It would be challenging to know when to stop for gas. We wanted to investigate whether people with clinical depression had emotional gauges that were informative and whether they experienced emotions with the same level of specificity and differentiation as healthy people."

The researchers recruited 106 people between the ages of 18 and 40 to participate in their study. Half of the participants were diagnosed with clinical depression and half were not. Over the course of seven to eight days, they carried a Palm Pilot, which prompted them to record emotions at 56 random times during the day. To report their emotions, they marked the degree to which they felt seven negative emotions (sad, anxious, angry, frustrated, ashamed, disgusted, and guilty) and four positive emotions (happy, excited, alert, and active) on a scale from one to four.

Demiralp and his colleagues looked at participants' tendency to give multiple emotions (e.g., disgusted and frustrated) similar rankings at a given point in time. According to their methodology, the more two emotions were reported together the less the person differentiated between these emotions.

The researchers found that clinically depressed people had less differentiated negative emotions than those who were healthy, supporting their hypothesis. Notably, they did not find the same difference between groups for positive emotions -- people with and without diagnosed clinical depression were equally able to differentiate between positive emotions. It is possible that people who are clinically depressed differentiate more between positive emotions as a coping mechanism.

Demiralp and his colleagues argue that the procedure used in the study to record emotions may be particularly useful in studying the emotional experience of clinically depressed people, paving the way for more treatment and therapy options in the future.

"Our results suggest that being specific about your negative emotions might be good for you," says Demiralp. "It might be best to avoid thinking that you are feeling generally bad or unpleasant. Be specific. Is it anger, shame, guilt or some other emotion? This can help you circumvent it and improve your life. It is one of our overarching goals to investigate approaches for facilitating this kind of emotional intelligence at a large scale in the population."

06.08 | 0 komentar | Read More

Cuba’s prenatal program improves low birth weights

ScienceDaily (Sep. 24, 2012) — Comprehensive prenatal care can decrease the rate of low birth weights, according to a study led by Dr. Yasmin Neggers, a University of Alabama researcher and professor of human nutrition and hospitality management.

Neggers and her colleague, Dr. Kristi Crowe, UA assistant professor of nutrition, traveled to Havana, Cuba during February 2012 to conduct research on the relationship between comprehensive prenatal care and rate of low birth weight in this developing country.

Low birth weight, or LBW, -- less than five and a half pounds at birth -- is a significant factor affecting neonatal mortality and predictor of newborn health.

Neggers, whose main research focus is nutrition during pregnancy, was intrigued by Cuba's low rate of LBW.

"Cuba, being a third-world, developing country, has a LBW rate that is half that of Alabama. It was kind of surprising."

She and Crowe, assistant professor of nutrition, looked at the factors that are usually linked to low birth weight such as smoking, gaining weight during pregnancy and alcohol intake.

All of those factors were not in Cuba's favor.

"All the typical risk factors that cause low birth rate are better in the United States and Alabama," Neggers said. "So, we looked at prenatal care, the care before and during pregnancy, and there was the difference. Prenatal care in Cuba is so much better than typical U.S. care, especially compared to Alabama."

Pregnant women in Cuba are provided free prenatal visits to their doctors very frequently, get adequate and regular screenings and health checks, including vitamin and mineral supplements, and get the proper remedies if something is amiss.

"Here, especially in poor and rural counties, prenatal care is often infrequent, and only half of the women get adequate prenatal care. Some just go to the emergency room to have the baby -- they never have any prenatal care."

Working with faculty at the University of Havana and the Cuban Institute of Nutrition and Hygiene, Neggers and Crowe are developing a proposal for further research.

03.35 | 0 komentar | Read More

Education, psychological support key for defibrillator patients

ScienceDaily (Sep. 21, 2012) — Because depression, anxiety and post-traumatic stress disorder are common among people with implanted cardioverter defibrillators, doctors and nurses should provide gender- and age-specific information on the potential psychological impact. Each month, 10,000 people, including children, have a defibrillator implanted to restore normal heart rhythm and prevent sudden cardiac death.

Improved patient education and ongoing psychological support will help people cope with the psychological distress of having an implanted defibrillator, according to a scientific statement from the American Heart Association.

The statement, published in the American Heart Association journal Circulation, is a comprehensive review of the psychosocial and quality of life for people who receive an implantable cardioverter defibrillator (ICD) to restore normal heart rhythm and prevent sudden cardiac death. It includes recommendations for improved patient care and identifies areas where more research is needed.

The authors recommend routine screening and appropriate treatment for anxiety, depression and post-traumatic stress disorder, which patients with ICDs often experience.

"A shock from an ICD can be lifesaving, but it can also affect a person's quality of life and psychological state," said Sandra B. Dunbar, R.N., D.S.N., chair of the statement writing group. "It's important to look at this issue now because 10,000 people have an ICD implanted each month. They range from older people with severe heart failure to healthy children who have a gene that increases the risk of sudden cardiac arrest."

Before implantation, clinicians should provide clear information about the benefits and limitations of the ICD, prognosis and impact on lifestyle including activity and occupation.

"Education and support need to include the patient and the family and be broader than just a focus on maintaining the device. Providers need to help patients address ICD-specific concerns about symptoms, heart disease treatment, physical activities and end-of-life issues," said Dunbar, who is also the Charles Howard Candler Professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.

Among the statement's recommendations to improve psychological outcomes, physicians and nurses should:

• Emphasize that the ICD protects against sudden death, but does not improve your underlying heart condition unless the device does other things, such as certain types of pacing.


• Assess the patient's concerns and psychological status at each follow-up visit.


• Develop a clear "shock plan" so patients and family members know what to do in the event of a shock.


• Help patients and their families deal with stressful situations that may develop with an ICD.


• Provide gender-specific, age-appropriate information for children and their families.

Although pediatric ICD recipients make up less than 1 percent of the ICD population, complications are more frequent and these patients will live with the defibrillators for a much longer period of time, according to the statement.

"Experiencing a shock is distressing and patients have a wide variety of responses," Dunbar said. "Some find it very reassuring that it's working, while others find the actual physical sensations frightening and overwhelming. That's why we suggest that clinicians provide an ongoing assessment of ICD patients' psychological needs."

The statement identified several areas for further research, including predicting which patients are likely to experience psychological distress and how to alleviate it; the level of sports participation and physical activity appropriate for children and teens with ICDs; and when and how to discuss potential ICD deactivation near the end of life.

Co-writers include Cynthia Dougherty, R.N., Ph.D.; Samuel Sears, Ph.D.; Diane L. Carroll, R.N., Ph.D.; Nathan Goldstein, M.D.; Daniel Mark, M.D.; George McDaniel, M.D.; Susan J. Pressler, R.N., Ph.D.; Eleanor Schron, R.N., Ph.D.; Paul Wang, M.D. and Vicki Zeigler, R.N., Ph.D.

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LIFR protein suppresses breast cancer metastasis, study suggests

ScienceDaily (Sep. 24, 2012) — A receptor protein suppresses local invasion and metastasis of breast cancer cells, the most lethal aspect of the disease, according to a research team headed by scientists from The University of Texas MD Anderson Cancer Center.

Reporting in Nature Medicine, the team described using high-throughput RNA sequencing to identify the leukemia inhibitory factor receptor (LIFR) as a novel suppressor of breast cancer metastasis, the spread of the disease to other organs.

"Based on our findings, we propose that restoring the expression or the function of key metastasis suppressors like LIFR could be used to block breast cancer metastasis," said lead investigator Li Ma, Ph.D., assistant professor in MD Anderson's Department of Experimental Radiation Oncology.

"Lack of clinically proven prognostic markers and therapeutic agents for metastasis are major barriers for eradicating breast cancer deaths," Ma said. "Although many metastasis-promoting genes have been identified, they have not been translated into clinical practice. The exceptions are the HER2- and VEGF-targeting agents, which have shown measurable but moderate benefit in the clinic."

Only a few genes have been established as metastasis suppressors, Ma said, and many researchers believe that such genes play only a minor role in metastasis.

The investigators in this study, however, found that LIFR is "highly relevant in human tumors." While 94 percent of normal human breast tissues show high LIFR expression, LIFR is downregulated or lost in a significant fraction of patients with ductal carcinoma in situ (DCIS) or invasive breast cancer, and loss of LIFR closely correlates with poor clinical outcomes.

Protein works by activating Hippo cascade to throttle YAP Ma said one of the major findings of the study is that LIFR suppresses both the invasion and colonization steps of metastasis by activating the Hippo kinase cascade that leads to functional inactivation of the transcriptional co-activator YAP.

"The LIFR protein is highly relevant in human cancer because it is down-regulated in about 40 percent of human breast cancers and completely lost in nearly 10 percent," Ma said. "Remarkably, in our study of approximately 1,000 patients, we found that loss of the LIFR protein in non-metastatic stages I to III breast tumors is highly associated with poor metastasis-free, recurrence-free and overall survival outcomes."

Ma noted that this work was regarded by peer reviewers as "a ground-breaking contribution" because it:

* Challenges the dogma that metastasis-suppressor genes are only a small component of metastasis compared with metastasis-promoting genes;

* Is the first report of a cell membrane receptor that activates Hippo signaling and has a critical function in cancer; and

* Might have a significant impact on clinical practice.

Ma said information about LIFR in cancer in the literature is very scarce. But some small studies have reported that LIFR is also lost in colon cancer and liver cancer through a gene-silencing mechanism called hypermethylation.

"There are many directions of research that should be pursued," Ma said. "For example, in order to develop LIFR-based methods of treatment, we must further understand the mechanism of its function and regulation of its expression."

Ma added that her group is generating LIFR conditional knockout mice to determine whether genetic deletion of LIFR in the breast will lead to tumorigenesis and metastasis.

Co-authors with Ma are Dahu Chen and Peijing Zhang, P h.D., of MD Anderson's Department of Experimental Radiation Oncology; Yutong Sun, Ph.D., Yongkun Wei, Ph.D., Abdol Hossein Rezaeian, Hui-Kuan Lin, Ph.D., and Mien-Chie Hung, Ph.D., all of MD Anderson's Department of Molecular and Cellular Oncology; Julie Teruya-Feldstein, M.D., of Memorial Sloan-Kettering's Department of Pathology; Sumeet Gupta of the Whitehead Institute for Biomedical Research; and Han Liang, Ph.D., of MD Anderson's Department of Bioinformatics and Computational Biology.

Lin, Hung and Ma are also affiliated with the Cancer Biology Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston. Mien-Chie Hung is additionally affiliated with the Center for Molecular Medicine and the Graduate Institute of Cancer Biology at China Medical University.

00.24 | 0 komentar | Read More

Researchers call for specialty metals recycling

ScienceDaily (Sep. 24, 2012) — An international policy is needed for recycling scarce specialty metals that are critical in the production of consumer goods, according to Yale researchers in Science.

"A recycling rate of zero for specialty metals is alarming when we consider that their use is growing quickly," said co-author Barbara Reck, a research scientist at the Yale School of Forestry & Environmental Studies.

Specialty metals, which include rare earth elements such as indium, gallium and germanium, account for more than 30 of the 60 metals in the periodic table. Because they are used in small amounts for very precise technological purposes, such as red phosphors, high-strength magnets, thin-film solar cells and computer chips, recovery can be so technologically and economically challenging that the attempt is seldom made.

"Specialty metals are used in products in only small amounts, but their value typically does not provide enough incentive to invest in a complicated recovery process. Also, the technology to do so is untested," said Thomas Graedel, the study's other co-author and Clifton R. Musser Professor of Industrial Ecology.

The researchers said improved design for recycling, deposits on consumer goods, recycling targets for specialty metals and financial incentives for industry to apply state-of-the-art separation techniques and recycling technologies would improve metal recycling.

"Metals are infinitely recyclable in principle, but, in practice, recycling is often inefficient or essentially nonexistent because of limits imposed by social behavior, product design, recycling technologies and the thermodynamics of separation," said Reck.

The researchers said that modern technology has produced a conundrum. The more intricate the product and the more diverse the materials it uses, the better it's likely to perform but the more difficult it is to recycle.

The benefit to recycling metals, they said, includes the potential to reduce the extraction of virgin ores, thus extending the life of those resources. The environmental impacts of metal production are reduced substantially when recycled materials, rather than primary materials, are used, and recycling a metal is generally much more energy-efficient than acquiring it from a mine.

"Depending on the metal and the form of scrap, recycling can save as much as a factor of 10 or 20 in energy consumption," Graedel said. "The situation clearly calls for international policy initiatives to minimize the seemingly bizarre situation of spending large amounts of technology, time, energy and money to acquire scarce metals from the mines and then throwing them away after a single use."

00.18 | 0 komentar | Read More

Obesity promotes prostate cancer by altering gene regulation

ScienceDaily (Sep. 25, 2012) — Prostate cancer is one of the most common cancers in men and early treatment is usually very successful. However, like other cancers, obesity increases the risk of aggressive prostate disease. New research, published in BioMed Central's open access journal BMC Medicine, finds that the fat surrounding the prostate of overweight or obese men with prostate cancer provides a favorable environment to promote cancer growth.

Fat is a generally underrated organ. Not only is it an energy store but it secretes a wide range of growth factors, cytokines and hormones, including leptin and adiponectin, and is a major player in the immune system, which protects the body from infection and disease. But too much fat can cause these systems to go haywire and can increase risk of diabetes, cardiovascular disease and cancer.

An international team led by Prof Gema Frühbeck and Dr Ricardo Ribeiro analyzed fat, from around the prostate, taken from patients undergoing surgery for prostate disease. Samples were included from men with benign prostatic hyperplasia (BPH), prostate cancer (PC), and from men where their cancer was no longer confined to the prostate. The men were also classified as being either lean (BMI<25) or overweight /obese (BMI>25).

Regardless of type of prostate disease the overweight men had different levels of gene activity in the fat surrounding their prostates compared to the lean men. This included genes which encode proteins involved in immunity and inflammation (such as LEP, which encodes the protein leptin), and cell growth and proliferation (including ANGPT1 which encodes angiopoietin 1), fat metabolism and programmed cell death.

Additionally the activity of more genes was altered between hyperplasia and prostate cancer, and between cancer and non-confined cancer, suggesting a gradual increase in dysregulation during cancer progression.

Prof Frühbeck explained, "Both LEP and ANGPT1 encode proteins which are thought to have roles beyond adipose tissue itself, especially because prostate cancer cells have receptors for leptin, and angiopoietin 1. Taken together with the abnormal activity levels of other genes they will ultimately foster fat mass growth, reduce immune surveillance, and promote the formation of new blood vessels, so producing a favorable environment for prostate cancer progression."

Dr Ribeiro continued, "In an increasingly obese population, understanding how fat, especially the fat surrounding the prostate, can influence the growth and severity of prostate cancer may provide an opportunity for implementing personalized lifestyle and therapeutic strategies."

This article is part of the thematic series Metabolism, Diet and Disease from BMC Biology and BMC Medicine.

22.14 | 0 komentar | Read More

Active video gaming linked with higher energy expenditure in children

ScienceDaily (Sep. 24, 2012) — Compared with rest and sedentary video game play, active video gaming with dancing and boxing were associated with increased heart rate, oxygen uptake and energy expenditure in a study of 18 school children in England, according to a report published Online First by Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

Low levels of physical activity have been linked to obesity. Active video game playing compared with traditional sedentary video game playing encourages more movement and could help children increase their physical activity levels, according to the study background.

Stephen R. Smallwood, M.Sc., and colleagues from the University of Chester, England, examined the physiologic responses and energy expenditure of active video gaming using a video game with a webcam-style sensor device and software technology that allows the player to interact directly without the need for a game controller, the authors explain in the background. The study included 10 boys and eight girls ages 11 to 15 years.

"Significant increases were observed in heart rate, VO₂ [oxygen uptake] and energy expenditure during all gaming conditions compared with both rest and sedentary game play," the authors comment.

The games, Dance Central and Kinect Sports Boxing, increased energy expenditure by 150 percent and 263 percent, respectively, above resting values and were 103 percent and 194 percent higher than traditional video gaming, according to the study.

"Although it is unlikely that active video game play can single-handedly provide the recommended amount of physical activity for children or expend the number of calories required to prevent or reverse the obesity epidemic, it appears from the results of this study that Kinect active game play can contribute to children's physical activity levels and energy expenditure, at least in the short term," the authors conclude.

22.14 | 0 komentar | Read More

Lho, Swiss Malah Bangga Desain Jam Dijiplak Apple

Bern - Pekan lalu Schweizerische Bundesbahnen, otoritas layanan kereta api di Swiss (SBB) menuding Apple menjiplak desain jam mereka di iOS 6. Keduanya pun akan segera mengadakan pertemuan khusus guna menyelesaikan masalah ini.

Informasi yang dilansir AFP dan dikutip detikINET, Selasa, juru bicara SBB Patricia Claivaz mengatakan, pihaknya yang meminta diadakan pertemuan khusus dengan Apple.

Namun dia belum bisa memastikan waktu pertemuan. Dia hanya menyebutkan, pihaknya akan bertemu dengan perwakilan Apple dalam beberapa hari atau pekan mendatang.

"Belum ada kesepakatan sejauh ini. Kami akan membicarakannya," jelasnya. Patricia pun menampik spekulasi yang menyebutkan SBB berniat meminta uang atas pelanggaran hak cipta yang dilakukan Apple.

"Kami justru bangga mengetahui merek sebesar Apple menggunakan desain kami," ujarnya lagi.

Desain jam ikonik tersebut diciptakan pertama kali pada 1955 oleh Hans Hilfiker. Desain sederhana ini selanjutnya menjadi bagian dari ikon nasional Swiss dan kini dilisensi Mondaine, perusahaan jam tangan Swiss.

Karena Apple menggunakan desain tersebut tanpa izin, maka pembesut iPhone ini dianggap telah melanggar hak cipta.

08.54 | 0 komentar | Read More