Author Archives: Lussy James

lupus

Best Information: Researchers say the key to reversing lupus may be a combination of two existing drugs.

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Readers have been commenting on this story since it first appeared in February. Interest skyrocketed when the research was mentioned at a conference last month in Cuba. Here’s a sampling of the comments left by readers affected by lupus.

Lupus is a chronic autoimmune disease that knows no bounds and can damage any part of the body, from the skin to the joints to the organs.

There is no cure for lupus, a disease that flares up and then seems to disappear before returning again.

But researchers say they have discovered that by using a combination of two drugs that already exist, it’s possible to reverse lupus in mice.

In a new study published in Science Translational Medicine, researchers from the University of Florida, Gainesville, have found that by inhibiting certain metabolic pathways in immune cells it’s possible to combat lupus in mice.

Each year, 16,000 new cases of lupus are reported across the country. The disease affects about 1.5 million Americans, according to the Lupus Foundation of America.

Systemic lupus erythematosus, or lupus, is an autoimmune disease in which the immune system — which is supposed to protect the body from outside invaders — attacks the body’s own tissues, causing inflammation. Lupus can sometimes have similar symptoms to arthritis.

One marker of lupus is defective helper T cells, white blood cells that activate other immune cells. These T cells eat glucose and oxygen in order to produce energy.

For people with lupus, T cell metabolism is hyper-activated. Hyper-activated T cells mean increased inflammation, and for people with lupus, that means more physical damage.

The two drugs researchers tried in the current study have been shown to inhibit metabolic pathways before, but the combination seems to be the key to success.

“The most surprising result from this study was that the combination of the two metabolic inhibitors was necessary to reverse disease, when it could have been predicted based on models published by others that either one alone would work,” said study co-author Laurence Morel, Ph.D., director of experimental pathology and a professor of pathology, immunology, and laboratory medicine in the University of Florida College of Medicine, in an email to Healthline.

How Researchers Attacked Lupus

Researchers from the University of Florida decided to look at glycolysis — the conversion of glucose into energy — and mitochondrial metabolism — energy production in the cell — as they relate to T cell metabolism.

“The two processes regulate the energy states of immune cells, which are hyper-activated in lupus and responsible for initiating and sustaining the disease,” Morel said. “Our study is the first to report a detailed analysis of these cellular metabolic pathways in lupus.”

To attack lupus, the researchers decided to use two drugs that block glycolysis and mitochondrial metabolism. The drugs are 2DG (under development) and metformin (FDA-approved).

In doing so, the researchers effectively reversed lupus in mice. They also showed that T cells from human lupus patients with enhanced glycolysis and mitochondrial metabolism saw slower cellular metabolism when they were exposed to metformin.

The two drugs did not affect T cells in healthy mice. The drugs can also be used safely and at a modest cost, the scientists say.

Researchers said it appears that by using low doses of metabolic inhibitors in the hyper-activated immune cells of lupus mice, cellular metabolism normalizes. The two drugs lower cellular metabolic activity without blocking it entirely.

Read More: Do I have Lupus or RA, and What’s the Difference? »

“This study may also open the door to targeting other metabolic pathways,” Morel said. “In addition, such a new class of drugs may potentially benefit patients with lupus, as opposed to the more classic approach that typically relies upon immunosuppressive drugs.”

Before the drug duo can move into clinical trials, researchers need to compare the effects of the pair on human patients using it for other conditions. There is still more to be done on mice, including tests to determine whether metabolic inhibitors can be used alongside conventional lupus drugs.

The University of Florida researchers are also in the process of testing how long treatment can be stopped in mice before the disease flares up again.

Vitiligo

A Clever New Cure for Vitiligo? You Should Know

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Vitiligo is an autoimmune condition which causes the skin to lose its pigment and affects about 1% of people worldwide. Steroids or light therapy are the only treatment available, but they are oftenineffective. New treatments are potentially on the horizon though: Recent scientific understanding of the condition led a doctor at Yale University School of Medicine to come up with the idea of trying a drug normally used for rheumatoid arthritis. Dermatologist Brett King used the drug on Linda Lachance and within five months of treatment she had experienced significant repigmentation. The details of this case study have just been published in the Journal of the American Medical Association Dermatology.

Causation v Association
How can you work out how good a study is? One thing to look for is the difference between causation and association. Research may show, for instance, that people with lower than average vitamin D levels are more likely to get bowel cancer, but that does not mean that boosting levels of the vitamin will protect against the disease. Family doctor Margaret McCartney and Carl Heneghan, professor of Evidence Based Medicine at the University of Oxford explain the differences between causation and association.

London Bombings
It is almost a decade since bombs were detonated on three tube trains and a bus in London, killing 52 and injuring more than 700. Unusually the authorities in London took the step of proactively contacting people caught up in the bombings who were at risk of developing mental health problems, even phoning them at home to see if they might benefit from treatment. Not everybody caught up in an event like this develops post-traumatic stress disorder or PTSD, but in this case they found a significant minority were experiencing symptoms.


For the newly qualified clinical psychologist, Rachel Handley, her very first job was to provide cognitive behavioural therapy. She spent the next two years talking to people about their experiences and helping them to find ways of coping. Ten years on she tells Claudia about what sort of difficulties people came to her with.

brain injury

Top 10 Must-Know Facts About Brain Cancer Read Now

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Brain cancer occurs when a mass of cancer tissue, also known as brain tumor, interferes with the functioning of the brain. According to a recent estimate by WHO even though brain cancer occurs quite infrequently, it develops in about 22,000 new people every year along with 13,000 estimated deaths. Thus, understanding the facts about this disease becomes crucial. Today, we have with us Dr. Rakesh K Dua, Ms. Mch. Neurosurgery, Associate consultant at Neurosurgery Department of Rockland hospital, New Delhi who will tell us the top 10 facts about brain cancer.

  1. The most common type of brain cancer is Secondary brain cancer (i.e. cancer from other part of body has reached the brain). The second most common brain cancer is Gliobalastoma, which is the most common primary brain cancer.
  2. The survival rate for primary brain cancer (Gliobalastoma) is usually 10 – 12 months with all treatment including surgery + chemotherapy + radiotherapy. The survival rate for secondary brain cancer varies depending upon the status and type of primary (usually 6 – 12 months) cancer.
  3. Common symptoms of brain cancer are a progressively increasing headache, seizure, focal neurological deficits like weakness of hands/legs, speech problems, walking difficulty, visual disturbances, behavior changes etc.
  4. Treatment options depend upon the type of cancer. For primary brain cancer, surgery is the first treatment option followed by radiotherapy and chemotherapy. For secondary brain cancer, surgery+/- radiotherapy-chemotherapy and Gamma knife surgery are the options depending upon the size and number of the tumors.
  5. The brain tumors can also occur in children under 20 years.  The tumors common in 5 – 10 yrs of age are usually cancerous.
  6. Exposure to radiation is supposed to be one of the lead causes of brain cancer.
  7. There are varieties of brain tumors. No two tumors are alike. Not all brain tumors are cancerous also.
  8. Family history also plays a dominant role in brain cancer.
  9. Headache is one of the commonest symptoms, but the most important is the progressive increase in intensity and frequency of headache. Early morning headache is one of the characteristic symptoms.
  10. If it is primary brain cancer, then organ donation is not an issue, but in secondary brain cancer the patient may not be a candidate for donation.

Vaccine

What are some of the myths – and facts – about vaccination? You Should Know

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Q: What are some of the myths – and facts – about vaccination?

A: Myth 1: Better hygiene and sanitation will make diseases disappear – vaccines are not necessary. FALSE

Fact 1: The diseases we can vaccinate against will return if we stop vaccination programmes. While better hygiene, hand washing and clean water help protect people from infectious diseases, many infections can spread regardless of how clean we are. If people are not vaccinated, diseases that have become uncommon, such as polio and measles, will quickly reappear.

Myth 2: Vaccines have several damaging and long-term side-effects that are yet unknown. Vaccination can even be fatal. FALSE

Fact 2: Vaccines are very safe. Most vaccine reactions are usually minor and temporary, such as a sore arm or mild fever. Serious health events are extremely rare and are carefully monitored and investigated. You are far more likely to be seriously injured by a vaccine-preventable disease than by a vaccine. For example, in the case of polio, the disease can cause paralysis, measles can cause encephalitis and blindness, and some vaccine-preventable diseases can even result in death. While any serious injury or death caused by vaccines is one too many, the benefits of vaccination greatly outweigh the risk, and many more injuries and deaths would occur without vaccines.

Myth 3: The combined vaccine against diphtheria, tetanus and pertussis (whooping cough) and the vaccine against poliomyelitis cause sudden infant death syndrome. FALSE

Fact 3: There is no causal link between the administering of the vaccines and sudden infant death, however, these vaccines are administered at a time when babies can suffer sudden infant death syndrome (SIDS). In other words, the SIDS deaths are co-incidental to vaccination and would have occurred even if no vaccinations had been given. It is important to remember that these four diseases are life-threatening and babies who are not vaccinated against them are at serious risk of death or serious disability.

Myth 4: Vaccine-preventable diseases are almost eradicated in my country, so there is no reason to be vaccinated. FALSE

Fact 4: Although vaccine preventable diseases have become uncommon in many countries, the infectious agents that cause them continue to circulate in some parts of the world. In a highly inter-connected world, these agents can cross geographical borders and infect anyone who is not protected. In western Europe, for example, measles outbreaks have occurred in unvaccinated populations in Austria, Belgium, Denmark, France, Germany, Italy, Spain, Switzerland and the United Kingdom since 2005. So two key reasons to get vaccinated are to protect ourselves and to protect those around us. Successful vaccination programmes, like successful societies, depend on the cooperation of every individual to ensure the good of all. We should not rely on people around us to stop the spread of disease; we, too, must do what we can.

Myth 5: Vaccine-preventable childhood illnesses are just an unfortunate fact of life. FALSE

Fact 5: Vaccine preventable diseases do not have to be ‘facts of life’. Illnesses such as measles, mumps and rubella are serious and can lead to severe complications in both children and adults, including pneumonia, encephalitis, blindness, diarrhoea, ear infections, congenital rubella syndrome (if a woman becomes infected with rubella in early pregnancy), and death. All these diseases and suffering can be prevented with vaccines. Failure to vaccinate against these diseases leaves children unnecessarily vulnerable.

Myth 6: Giving a child more than one vaccine at a time can increase the risk of harmful side-effects, which can overload the child’s immune system. FALSE

Fact 6: Scientific evidence shows that giving several vaccines at the same time has no adverse effect on a child’s immune system. Children are exposed to several hundred foreign substances that trigger an immune response every day. The simple act of eating food introduces new antigens into the body, and numerous bacteria live in the mouth and nose. A child is exposed to far more antigens from a common cold or sore throat than they are from vaccines. Key advantages of having several vaccines at once is fewer clinic visits, which saves time and money, and children are more likely to complete the recommended vaccinations on schedule. Also, when it is possible to have a combined vaccination, e.g. for measles, mumps and rubella, that means fewer injections.

Myth 7: Influenza is just a nuisance, and the vaccine isn’t very effective. FALSE

Fact 7: Influenza is much more than a nuisance. It is a serious disease that kills 300 000 – 500 000 people worldwide every year. Pregnant women, small children, elderly people with poor health and anyone with a chronic condition, like asthma or heart disease, are at higher risk for severe infection and death. Vaccinating pregnant women has the added benefit of protecting their newborns (there is currently no vaccine for babies under six months). Most of influenza vaccines offer immunity to the three most prevalent strains circulating in any given season. It is the best way to reduce your chances of severe flu and of spreading it to others. Avoiding the flu means avoiding extra medical care costs and lost income from missing days of work or school.

Myth 8: It is better to be immunized through disease than through vaccines. FALSE

Fact 8: Vaccines interact with the immune system to produce an immune response similar to that produced by the natural infection, but they do not cause the disease or put the immunized person at risk of its potential complications. In contrast, the price paid for getting immunity through natural infection might be mental retardation from Haemophilus influenzae type b (Hib), birth defects from rubella, liver cancer from hepatitis B virus, or death from measles.

Myth 9: Vaccines contain mercury which is dangerous. FALSE

Fact 9: Thiomersal is an organic, mercury-containing compound added to some vaccines as a preservative. It is the most widely-used preservative for vaccines that are provided in multi-dose vials. There is no evidence to suggest that the amount of thiomersal used in vaccines poses a health risk.

Myth 10: Vaccines cause autism FALSE

Fact 10: The 1998 study which raised concerns about a possible link between measles-mumps-rubella (MMR) vaccine and autism was later found to be seriously flawed, and the paper has been retracted by the journal that published it. Unfortunately, its publication set off a panic that led to dropping immunization rates, and subsequent outbreaks of these diseases. There is no evidence of a link between MMR vaccine and autism or autistic disorders.

Other Diseases

10 Health Risks Linked to Rheumatoid Arthritis You Should Know

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More than RA

by Amanda Gardner

If you have rheumatoid arthritis (RA), be on the lookout for other health problems associated with the autoimmune disorder.

They may be caused by RA-related inflammation or RA treatments, or they may occur at higher rates for unknown reasons.

Regardless of the cause, most related conditions can be prevented or treated. Although it’s challenging to cope with the pain and fatigue of RA—much less other health problems—it makes sense to keep an eye out for the signs and symptoms of these conditions.

Bone thinning

RA can cause bone thinning andosteoporosis (which increases the risk of bone fractures), as can the inflammation-fighting corticosteroids used to treat it.

In addition, people with RA often cut back on activity due to pain, which can accelerate loss of bone and muscle mass, says Guy Fiocco, MD, assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine, in Temple.

Have regular bone-density scans and talk to your doctor about bone-strengthening medications and exercise. Also, get enough calcium and vitamin D, Dr. Fiocco says.

Heart disease and stroke

People with RA have about double the heart-disease risk as their same-age peers.

“Rheumatoid arthritis is considered equal to other [heart-disease] risk factors, such as diabetes, hypertension, increased lipids, smoking, and family history,” Dr. Fiocco says. “It’s at least as important as the other risk factors for premature heart disease and stroke.”

RA-related inflammation is thought to be the reason why, although some RA medications can contribute to the risk. People with RA should make an extra effort to eat heart-healthy food, manage other risk factors (like avoiding smoking), and monitor cholesterol and blood pressure.

Sjögren’s syndrome

Sjögren’s syndrome is an autoimmune disease that attacks the tear and salivary glands, causing dry eyes and mouth. It can arise on its own or as an added complication of rheumatoid arthritis.

Unfortunately, there’s no treatment for Sjögren’s, which can lead to vision problems and tooth decay because of the lack of saliva. Moisturizing eye drops, good dental hygiene, and drinking water can help prevent these problems.

Prescription drugs such as cevimeline (Evoxac) and pilocarpine (Salagen) can increase the production of saliva and tears. In severe cases, minor surgery can relieve dryness in the eyes.

Non-Hodgkin’s lymphoma

“The one cancer that’s definitely been linked to RA is non-Hodgkin’s lymphoma,” Dr. Fiocco says.

RA patients have a two to four times higher risk than people without RA. Other blood cancers, such as leukemia and other forms of lymphoma, as well as lung cancer and melanoma, may also be a problem. Not only is the disease itself a culprit, but some drugs are too.

In fact, methotrexate (Trexall) and antitumor necrosis factor drugs such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) carry a warning about increased lymphoma risk. But the benefits may still outweigh the risk, given that the risk is low overall.

Lung problems

Some 8% of people with RA develop interstitial lung disease, or scarring of the lungs, compared with only 1% to 2% of the general population, says Eric L. Matteson, MD, chair of rheumatology at the Mayo Clinic, in Rochester, Minn.

In addition to the joints, RA can attack the lungs and cause scarring. Over time, this can make breathing difficult. RA treatments such as methotrexate and glucocorticosteroids can increase the risk of interstitial lung disease.

People with RA may also develop inflammation in the lining of the lungs, or pleurisy, which can make breathing painful, and lung nodules, which can be mistaken for cancer.

Infections

RA drugs such as methotrexate, adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) suppress the immune system, boosting the risk of infection. That’s on top of an already-increased risk due to the disease itself. “Just having rheumatoid arthritis approximately doubles your infection risk independent of treatment,” says Dr. Matteson.

One risk is tuberculosis (TB), although it is less common in the U.S. than in developing nations.

Still, doctors routinely perform a skin test to check for TB before starting a person on immune-suppressing drugs, Dr. Fiocco says. If the test is positive, the doctor will treat the infection first.

Depression

Not surprisingly, depression affects more people with RA—perhaps up to twice as many—than those who don’t have the condition. Having to cope with RA in addition to functional disability, loss of independence, and decrease in quality-of-life all contribute to depression, Dr. Fiocco says.

One small study showed that only 1 in 5 RA patients talk to their doctor about depression. If you have symptoms of depression, get help.

“With the newer [RA] medications, a lot more quality of life is being maintained these days,” says Dr. Fiocco.

Anemia

RA can lead to anemia, which is a lack of red blood cells needed to transport oxygen in the body. RA inflammation can suppress the bone marrow that generates red blood cells.

“Anemia is directly related to the activity of the disease,” says Dr. Fiocco. “High levels of inflammation lead to greater degrees of anemia and these are closely correlated.”

Medication can also exacerbate the problem. If the anemia is due to inflammation, getting it under control will help, Dr. Matteson says. Drugs that spur red-blood-cell production can help too. And if you’re iron deficient, consider iron supplements, but keep in mind that highly active RA can inhibit iron absorption.

Vasculitis

A rare but potentially serious RA complication is vasculitis, or an inflammation of the blood vessels, Dr. Matteson says. Vasculitis causes sores from poor blood circulation in the skin, particularly in the fingers or toes, and can sometimes cause nerve damage in the hands and feet as well as your organs.

It’s a serious side effect to watch for, although it doesn’t affect a lot of patients. “Probably less than 1%, but if it does occur, it’s a very serious problem,” Dr. Matteson says.

Gastrointestinal bleeding

Another RA complication is gastrointestinal problems, primarily bleeding in the digestive tract and ulcers. This can be due to nonsteroidal anti-inflammatory drugs (NSAIDs), now available both over-the-counter (Advil or Aleve) and by prescription (Celebrex).

“The combination of NSAIDs plus steroids makes it even worse,” Dr. Fiocco says. GI bleeding can also cause or worsen anemia. If you’re taking a prescription NSAID, you should be monitored for this side effect.

If you’re taking an over-the-counter NSAID, stick to the recommended dosage and don’t take more than one NSAID, including aspirin, at a time.

Other Diseases

Examples of Personality Disorders With Distorted Thinking Patterns You Should Know

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Let’s look at some examples of specific personality disorders to help illustrate these dysfunctional thinking patterns and the types of interpersonal problems that are created as a result.

For instance, persons with Paranoid Personality Disorders exhibit suspicious thinking and therefore have difficulty trusting other people. They may misinterpret what other people say or do as intentional attempts to attack them, hurt them, or take advantage of them. In turn, they end up holding grudges and may act in ways that are overly defensive, hostile, or even aggressive. You can imagine this thought pattern will cause a lot of anxiety for the person who is paranoid, and that this type guardedness, defensiveness, and hostility is very unpleasant for the other people around them. Obviously, this type of distrust makes close relationships nearly impossible.

People with an Avoidant Personality Disordertend to think they are completely flawed and inferior to others. Persons with an Avoidant Personality Disorder are unable to recognize both their good and bad qualities. Their extremely negative self-image convinces them that other people see them in the same way (as flawed and inferior). Thus, they are certain no one will like them, and expect others will ridicule them. This leads them to avoid social situations because they anticipate these encounters will be painful and unpleasant experiences. Because of these thoughts, it is unlikely they will have any fun at parties or other social events and so they miss opportunities to have a fulfilling social life. Professionally, they might avoid social situations or avoid public speaking and hence miss out on professional and networking opportunities that usually benefit career development and advancement.

People with Schizotypal Personality Disorders exhibit odd beliefs. They might be extremely superstitious and have unusual beliefs in magic or the supernatural. Other people often find such a person odd and eccentric, and may feel uncomfortable being around someone who holds such strange and unusual ideas. People with Schizotypal Personality Disorder sense they are quite different from others and are often aware that other people seem uncomfortable around them. As a result, they have chronic feelings of just not “fitting in.”

People with Narcissistic Personality Disorder exhibit distorted thinking when they go back and forth between over-idealizing themselves, and then completely devaluing themselves. In addition, they have a tendency to over-estimate the importance or significance of their abilities and talents. Persons with a Narcissistic Personality Disorder frequently have fantasies of having unlimited power, success, or special talents. These over-idealized beliefs about themselves can cause them to behave in ways that are arrogant, ruthless, and entitled.  Such behavior frequently causes a lot of conflict with others.  For example, a person with a Narcissistic Personality Disorder may ignore the social custom of waiting in a queue to purchase a ticket.  Instead, they will march to the front of the queue, believing they are more important than the other people in line and are therefore entitled to special treatment.  Of course, the people waiting politely in the queue do not respond well and conflict erupts.  Eventually, the person with Narcissistic Personality Disorder is likely to run into a situation in which they realize they have some normal, human limitations.  When this occurs, they are likely to find it extraordinarily difficult to cope with this realization.  Any inkling of failure is hard for them to tolerate. The sudden realization of ordinary human limitations typically leads them to completely debase themselves, shifting from the over-idealized fantasy of unlimited success and special powers, to a devastating and paralyzing sense of complete worthlessness, shame, and defeat.

The pattern of black-or-white thinking is quite common in those with Borderline Personality Disorder. Things tend to be “all or nothing”, “black or white”, “all good, or all bad.” This way of viewing the world can create a lot of emotional suffering and is particularly devastating in relationships. Other people are seen as either “all good” meaning they are perfectly loving and available to meet their needs at all times, or they are “all bad” meaning they are malicious and hateful, with no shades of grey in between. Sometimes, their view of another person can shift in just a few seconds from “that person is completely wonderful” to “that person is horrible.” Take the example of a woman thinking that her partner is the most caring and loving person in the world. Of course, no one can achieve such a perfect ideal all the time so when her partner does one unloving or thoughtless act, such as forgetting their anniversary, the immediate conclusion becomes “He doesn’t love me. He is so mean and horrible.” Sometimes, it doesn’t stop there, because “If he doesn’t love me, he must hate me.” It is easy to understand that this pattern of interpreting relationships creates great distress and will provoke an intense emotional reaction in people who think like this. Subsequently, their partners may be quite baffled and distressed by these extreme ways of thinking.  In such cases, conflict is likely to be frequent.

It is important to note that even healthy, well-adjusted people without a personality disorder can also occasionally fall prey to some of the distorted thinking that we just described as characteristic of personality disorders. In fact, distorted thinking is quite common when people are feeling very distressed, depressed, or anxious. Again, recall that personality disorders are a variant form of normal, healthy personality so the difference is in the frequency, degree, and persistence of the distortion. For people with personality disorders the degree of their distortion is more extreme and occurs with greater frequency than for those people without a personality disorder. Additionally, people with personality disorders find it much more difficult to become aware of, and to challenge their distorted thinking.

As we have seen from these examples, distorted thinking patterns can impact both how a person feels, and how they behave. Recall, a person must exhibit at least two of the four core features that are characteristic of personality disorders before they will qualify for a diagnosis. This means someone who exhibits distorted thinking patterns would also have to exhibit at least one more characteristic before it is appropriate for them to receive a personality disorder diagnosis. This leads us to the second core feature of personality disorders: problematic affective (emotional) response patterns.

brain injury

A Viral Attack against Brain Tumors Read Now

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This year, more than 21,000 people will be diagnosed with some form of brain cancer, according to the National Cancer Institute. While benign forms are relatively easy to treat, malignant tumors require a combination of surgery, chemotherapy, and radiation. Even then, tumor cells may remain deeply lodged, replicating and spreading quickly through healthy brain tissue.

Now researchers at Yale University have found that a virus that’s in the same family as rabies effectively kills an aggressive form of human brain cancer in mice. Using time-lapse laser imaging, the team watched vesicular stomatitis virus (VSV) rapidly home in on brain tumors, selectively killing cancerous cells in its path, while leaving healthy tissue intact. What’s more, Anthony Van den Pol, lead researcher and professor of neurosurgery and neurobiology at Yale, says that VSV is able to self-replicate and produce secondary lines of defense.

“A metastasizing tumor is fairly mobile, and a surgeon’s knife can’t get out all of the cells,” says Van den Pol. “A virus might be able to do that, because as a virus kills a tumor cell, it could also replicate, and you could end up with a therapy that’s self-amplifying.”

In the past few years, scientists have looked to viruses as potential allies in fighting cancer. Researchers at the Mayo Clinic are engineering the measles virus to combat multiple myeloma, a cancer of the bone marrow. And while various groups have seen limited results after injecting herpes and polio-related viruses directly into brain tumors in mice, Van den Pol wanted to find a more effective cancer-killing strain.

His search for a virus candidate began six years ago, when he and his colleagues tested the effect of different viruses on brain tumors in culture. Repeatedly, VSV came out “at the top of the heap.” The team grew the virus through many generations, isolating strains that infected cancer cells quickly while having a slow effect on healthy cells. The researchers recently ran the most effective strain through a number of tests in live mice, and they’ve published their results in a recent issue of the Journal of Neuroscience.

In its experiment, the team transplanted glioblastoma–the most common and aggressive form of human brain cancer–into the brains of mice. Prior to transplantation, researchers genetically engineered the tumor cells to express a red marker, which, once inside the brain, would show up in laser microscopy scans. Similarly, Van den Pol inserted a green marker in VSV cells and injected the virus intravenously through the tail. Within a few days, researchers observed that the green virus found its way to the brain and selectively infiltrated red tumor masses and individual tumor cells, while avoiding normal cells. Van den Pol says that as the virus infects tumors, cancerous cells start to turn green, swelling up until they eventually burst.

“It’s like a balloon,” says Van den Pol. “If you keep blowing air into it, it explodes. The carcass is still there, but it’s no longer a balloon. And these are basically dead cells, unable to divide anymore or survive as intact cells.”

It’s not yet clear why VSV is such an effective tumor killer, although Van den Pol has several theories. One possible explanation may involve a tumor’s weak vascular system. Vessels that supply blood to tumors tend to be leaky, allowing a virus traveling through the bloodstream to cross an otherwise impermeable barrier into the brain, directly into a tumor.

Van den Pol says that VSV may also target cancer cells because of inherent defects in a tumor’s immune system. Typically, in the presence of a virus, normal cells launch an immune response by producing interferon, proteins that prevent viral infection in healthy cells. Tumors lack such strong viral defenses, providing an easy target for viruses.

There are several considerations that the team will have to face before moving to clinical trials. In its tests, the team observed live scans of the virus over a few days before sacrificing the animals for closer study. It remains to be seen how the virus will act on the brain over a longer timescale.

Additionally, the researchers used immuno-compromised mice. While these mice are still able to produce interferon as a local cellular defense, they have a weakened systemic immune system–one that’s unable to produce B and T cells that would otherwise destroy viruses. Van den Pol explains that such a weakened system allowed the team to insert transplanted human tumors in mice without their being rejected. However, in order to test the virus as an effective therapy, the team will have to make sure that a normal immune system doesn’t stamp out the virus before it has a chance to act on tumors.

“What usually happens with most of these tests is, you have a nice animal model where the virus spreads through the tumor,” says Samuel Rabkin, associate virologist in the department of neurosurgery at Massachusetts General Hospital. “In more-realistic models, the host may have a response to the virus that limits the effect.”

Vaccine

Vaccine treatment for prostate cancer Read Now

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Sipuleucel-T (Provenge) is a cancer vaccine. Unlike traditional vaccines, which boost the body’s immune system to help prevent infections, this vaccine boosts the immune system to help it attack prostate cancer cells.

The vaccine is used to treat advanced prostate cancer that is no longer responding to initial hormone therapy but that is causing few or no symptoms.

This vaccine is made specifically for each man. To make it, white blood cells (cells of the immune system) are removed from your blood over a few hours while you are hooked up to a special machine. The cells are then sent to a lab, where they are exposed to a protein from prostate cancer cells called prostatic acid phosphatase (PAP). The cells are then sent back to the doctor’s office or hospital, where they are given back to you by infusion into a vein (IV). This process is repeated 2 more times, 2 weeks apart, so that you get 3 doses of cells. The cells help your other immune system cells attack the prostate cancer.

The vaccine hasn’t been shown to stop prostate cancer from growing, but it seems to help men live an average of several months longer. As with hormone therapy and chemotherapy, this type of treatment has not been shown to cure prostate cancer.

Studies are now being done to see if this vaccine can help men with less advanced prostate cancer.

Possible side effects of vaccine treatment

Side effects from the vaccine tend to be milder than those from hormone therapy or chemotherapy. Common side effects can include fever, chills, fatigue, back and joint pain, nausea, and headache. These most often start during the cell infusions and last no more than a couple of days. A few men may have more severe symptoms, including problems breathing and high blood pressure, which usually get better after treatment.

Other Diseases

Baby Boomers: Bone Up on Treatments for Arthritic Hips and Knees Read Now

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It seems like only yesterday you were bounding across the tennis court with the finesse of a Williams sister. Now your hips and knees ache just getting out of bed in the morning. Well, you’re not alone. About 27 million Americans suffer from osteoarthritis, a deterioration of the cartilage tissue that cushions our joints. What’s more, that number is expected to swell to 67 million by 2030, when all Baby Boomers will have turned 65.

Though there are a wide range of treatments available to help relieve pain and maximize joint function, there isn’t now a cure or means of stopping the disease’s progression. We know the risk factors of osteoarthritis are age, obesity, genetics and the overuse of joints from work or sports. Women older than 45 are at a higher risk than men. Still, we don’t fully understand what causes cartilage to degenerate. And once it does, it doesn’t grow back.

Cartilage is a firm, slick tissue that allows joints to move with minimal friction. In osteoarthritis, the surface of the cartilage grows rough. When it wears down completely, you’re left with bone rubbing on bone. That can cause fragments of bone and cartilage to break off and float in the joint fluid. Bony spurs or extra bone can form around the joint. The result is pain, stiffness, decreased mobility and often a lot of creaking whenever you stand up or sit down.

Osteoarthritis can occur in any joint, but hands, knees and hips are among the most common. Onset usually occurs after age 40 and progressively worsens. Severity differs widely; about a quarter of those who suffer from osteoarthritis are severely disabled.

Treatments aim to reduce pain, increase movement

As scientists work to unravel the complexities of osteoarthritis, patients have sought to relieve pain and increase flexibility with all sorts of remedies, including such dubious ones as rubbing WD-40on their joints and wearing magnets and copper bracelets.

The medically recommended course starts with over the counter anti-inflammatory medicine and or painkillers, topical analgesics or physical or occupational therapy. (I’ve posted previously about correct, cautious use of the over-the-counter medications.) If those don’t work, prescription pain medication or corticosteroid injections are tried next. Corticosteriods injected into the affected joints can offer temporarily relief but shouldn’t be used more than a few times a year.

Some patients, such as baseball Hall of Famer Hank Aaron have found relief with injections of hyaluronic acid, which acts as a joint lubricator. It is a thick gel-like substance that occurs naturally in the fluid that surrounds the joints and acts as a lubricant to help them glide smoothly and absorb shock. With osteoarthritis, the amount of naturally produced hyaluronic acid is reduced.

The procedure involves injecting the gel directly into the cavity around the knee joint. A typical course is one injection a week for three- to five-weeks. Benefits take several weeks to be felt and are most effective in treating mild to moderate symptoms. Hyaluronic acid has only been FDA-approved for the knee. These products are usually made from processed chicken or rooster combs and should not be used in people with egg or poultry allergies.

The nutritional supplements glucosamine and chondroitin once were thought to have potential for reducing osteoarthritis pain. Although they still are marketed widely as improving joint health,recent studies, including an extensive work by the National Institute of Health, have determined they offer little demonstrable benefit to most patients with knee osteoarthritis, although they may offer some help in patients with moderate to severe knee pain.

Neither does clinical evidence support use of transcutaneous electrical nerve stimulation, a device to stimulate nerves with low-voltage electrical current.

One new source of relief may be Botox. Yes, the same botulinum toxin type A (Botox is a brand name) used to eliminate forehead wrinkles and crows’ feet showed promising results for patients with osteoarthritis of the knee in a small preliminary study, conducted at the VA Medical Hospital in Minneapolis. This is still in the study phase and exactly how it works is not completely understood.

Surgery is the next option

If conservative treatments don’t provide relief, the next step is surgery. There are a number of options for hips and knees. A popular one on which the evidence still is out is arthroscopic lavage and debridement.

In this minimally invasive procedure, a physician inserts a pencil-size camera and small instruments through a tiny incision. Then the joint is flushed with a sterile saline solution (lavage) and tissue fragments are surgically removed from the joint. Several studies, most notably a 2008 review from Britain’s The Cochrane Collaboration suggest the procedure is ineffective; other papers have recorded short-term relief in early-stage cases. Among these, a study just published in Current Orthopedic Practice reported that all 31 patients who received knee debridement enjoyed significant improvement; those with grade III osteoarthritis reported a 60 percent loss of that improvement after two years, versus a 10 percent loss in those with grade II. A recent study among patients with hip involvement showed that frequent arthroscopic procedures may extend the time before a total hip replacement is needed, especially in those who were younger and had milder arthritis.

Younger patients may be candidates for an osteotomy, in which joint bones are cut and repositioned to improve alignment.

The last resort is joint-replacement surgery, in which the damaged joint is removed and replaced with a prosthetic. Part or the entire joint may be replaced. In a procedure, called hip resurfacing, instead of removing the damaged hip ball, it is reshaped and capped with a metal prosthesis. Leaving more bone intact may be beneficial down the road if a second hip replacement is needed. More than 200,000 hip replacements and 600,000 knee replacements are performed every year in the U.S. By 2030, the numbers are expected to soar to 572,000 annual hip replacements and 3.48 million knee replacements, according to the American Academy of Orthopedic Surgeons.

Some surgeons recently have advocated a new, less invasive joint replacement, involving a smaller incision or two. In hip replacements, this approach also calls for the surgeon cutting between muscles rather than through them. The technique is debated among surgeons, with proponents contending that benefits include less pain and blood and a quicker recovery. Opponents question these benefits and counter that the surgery is significantly more difficult and takes longer to perform; they say it is therefore prone to an increase in complications. The American Association of Hip and Knee Surgeons says there is insufficient data now to recommend widespread use of this technique.

Metal woes

While joint replacement overall is one of the most successful surgeries in orthopedics, thousands of all-metal hip implants, put in place between 2003 and 2011, have created great concern here and abroad. These devices, dubbed metal-on-metal implants, are prostheses in which both the cup (which fits into the hip socket) and the ball of the joint both are made of metal, rather than a combination of metal and plastic or ceramic.

Early models of all-metal implants were abandoned in the 1970s because they were considered unstable. But nearly a decade ago, new models were introduced and aggressively marketed as the durable choice for active adults eager to bike, hike and pursue other exercises into their golden years. What physicians and patients have found, however, is that the metal ball and the metal cup in this set up, slide against each other during walking or running, causing metal fragments to flake off into the space around the implant; this, in turn, damages surrounding bone and tissue. The mountain of complaints has moved one major manufacture to issue a worldwide recall of some of these products in 2010.

And while artificial joints are expected to last 15- to 20-years, many of the all-metal models have failed within just a few years, with the highest such rates among women.

In a small number of patients, high levels of metal ions also have been found in the bloodstream, and this has raised the fear that toxic metal ions may cause cancer. However, a study published in the April 3 issue of The British Medical Journal concluded that patients with all-metal hip replacements do not have an increased risk of cancer in the first seven years after implant, though researchers added that long-term data need to be collected, as some cancers can take years to develop.

The number of Americans with problematic hip replacements is unknown, though an estimated 500,000 people here received all-metal hip implants. More than 3,500 of them have filed lawsuitsagainst manufactures. The first case goes to trial in December in Las Vegas.

Walk, swim or bike

There’s a long way from the onset of osteoarthritis to the need for joint replacement. And though we have no means of stopping its progression, there are ways to lessen risk. The unsurprising prescription: Weight management and exercise.

Running or tennis may be tough with joint pain. But swimming, walking, biking and yoga are among exercises that can reduce joint-stress by strengthening surrounding muscles. Mayo Clinicresearchers have found that strengthened quadriceps prevent deterioration of cartilage behind the kneecap.

As for weight, one recent study determined that 27 percent of hip replacements and 69 percent of knee replacements may be related to obesity; the more you weigh, the more pressure gets put on hips and knees.

So Boomers and seniors, make them Golden Years by staying as active as you can for the sake of your joint health; try different kinds of activities if some exercises are uncomfortable or give you twinges. And keep talking with your physician and other care-givers so you know about advances in technology, therapies, and, yes, surgeries, if these may keep you moving, feeling better, and experiencing less pain.

Cancer

9 Tips on How to Recognize Someone With Borderline Personality Disorder Read

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The proverb: “No good deed goes unpunished” is a good introduction to understanding the much misunderstood condition known as borderline personality disorder. Any personality disorder is a fixed, lasting pattern of thinking, feeling and acting that usually leads the person into emotionally and/or physically dangerous situations.

I’ve been treating a 43-year-old woman for 20 years. Because of our long-term history, one would think that she would know and trust me. However, the complexity of BPD became very clear when I volunteered to go with her to help her interpret the results after her uterine cancer was removed. She was scheduled to get a follow-up visit with her ob-gyn doctor, but she was so terrified of what she’d hear that she couldn’t bring herself to go. I was in the hospital that day so I offered to stop by during her visit and help my patient deal with whatever results she obtained. She said she was grateful and would go if I were present.

That day I went into the ob-gyn’s office with her and sat across from the doctor who reported great news that the patient was cancer-free. I nodded happily and felt good for her and the positive results. Out in the hallway, out of the other doctor’s hearing range, my patient yelled and cried.

“You colluded with her! I can’t believe how you doctors were so self-satisfied. You didn’t even consider me. You and that doctor talked down to me like I was a moron!”

“But you’re cancer-free! You’re okay. Aren’t you happy about that?” I was so surprised by her reaction I could hardly think or speak. Then I realized that she hadn’t even registered the positive news. She had been waiting for something negative and that was all she could hear or see.

“I hate you both!” she screamed and ran down the hall. I dashed after her, calling her name, but she jumped into an elevator and ran off.

Later that evening she called me to apologize and thank me for going with her. The good news had finally sunk in. Her reactions are indicative of how severely she suffers from borderline personality disorder and how difficult it is for her to process information and have healthy interpersonal relationships.

People with borderline personality disorder have incredible challenges when dealing with others and themselves because they have inflexible negative behavior patterns, an unstable self-image, uncontrollable emotions, and impulsivity. Their condition is due to a combination of genes, a childhood environment of abuse, turbulence and/or neglect, and erratic biochemistry.

You may be encountering a person with borderline personality disorder if you confront this type of behavior:

1) You are idealized sometimes as the greatest person alive, while at other times you are seen as the worst person. People with BPD often have skewed views of people, whether they be acquaintances or people that are an everyday part of their lives.

2) The person’s sense of self is distorted. The person doesn’t truly understand who he or she really is, so he or she tries on different behaviors. It is not uncommon for them to be distant, authoritative, friendly or hostile with the same person in the same day.

3) The person frantically tries to avoid what she considers abandonment. The person may act overly needy when their support system is removed, even temporarily, such as when a close friend goes on vacation.

4) The person tries to kill him — or herself or engages in self-mutilation. If you witness this behavior in anyone, immediately call 911.

5) The person is intensely reactive to situations or events that most people would just ignore or brush off. My patient’s reaction to the positive news about her cancer is a good example. Another example is the way a person with BPD might obsess about a situation or statement. If someone tells this individual something in an angry way, then he or she might keep thinking about the statement obsessively and cannot “let it go.”

6) He or she constantly feels empty or not really there. My patient reported these feelings of emptiness many times and often thought she wasn’t really in this world.

7) Anger is their most common emotion even when other feelings might be more appropriate. For example, when a person with BPD learns he/she has won a game in tennis, he or she might rant about the opponent instead of just enjoying the victory.

8) Paranoid thoughts are common. People with this disorder often become paranoid and imagine that people are “colluding” against them.]

9) These people act impulsively and in self-damaging ways, for example, engaging in compulsive sex, binge-eating or gambling. Because of this, BPD can often be confused with other personality disorders, such as histrionic personality disorder.

If you think a friend, co-worker or family member might be suffering from borderline personality disorder, encourage him or her to seek treatment. Sometimes, it’s best to avoid personal contact or deal with the person only in a group setting, such as the workplace or group outings. The most important tool is not to internalize the person’s behavior, or take it too personally. Remember it’s not about you. People with borderline personality disorder aren’t fully aware of their behavior and the effect on other people. Try to be as sympathetic as you can, but maintain appropriate boundaries to protect yourself.