Friday, January 18, 2013

HIV Patients May Benefit From Probiotics

Antiretroviral (ARV) drugs are the first line therapy for patients with HIV; however, ARV-treated, HIV-infected individuals still have a higher mortality rate than uninfected individuals. During the course of infection, HIV patients develop inflammation that damages the walls of the intestines, known as the gut mucosa, allowing intestinal microbes to escape and enter the blood stream to cause a life-threatening systemic infection. The health of the gut mucosa is significantly influenced by the complement of bacteria in the gut and there is mounting evidence that probiotic supplements benefit patients intestinal disorders, such as irritable bowel syndrome, C. difficile infection, and inflammatory bowel disease.

In this issue of the Journal of Clinical Investigation, researchers led by Jason Brenchley at the National Institute of Allergy and Infectious Disease, demonstrated that probiotic supplementation may also be beneficial for ARV-treated HIV patients. Brenchley and colleagues treated SIV-infected macaques (a model of human HIV-infection) with either ARV alone or ARV in combination with a mixture of probiotics. Macaques treated with probiotics had enhanced gastrointestinal immune function and decreased inflammation compared to macaques treated with ARV alone. In a companion article, Judith Aberg and colleagues at New York University School of Medicine discuss how these findings could benefit HIV patients.

TITLE: Probiotic/prebiotic supplementation of antiretrovirals improves gastrointestinal immunity in SIV-infected macaques

View this article at: http://www.jci.org/articles/view/66227?key=1cff041937d9040dfed7

ACCOMPANYING THE ATTENDING PHYSICIAN TITLE: Clash of the microbes: let's bring back the good guys

View this article at: http://www.jci.org/articles/view/66736?key=64b158b04e2a168811a3
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Simple Blood Test Reveals DNA Marker That Predicts Breast Cancer Recurrence

Medical researchers at the University of Alberta tested the DNA of more than 300 women in Alberta and discovered a 'genetic marker' method to help accurately profile which women were more apt to have their breast cancer return years later.

Sambasivarao Damaraju, a professor with the Faculty of Medicine & Dentistry, and at the Cross Cancer Institute just published his team's findings in the peer-reviewed journal, PLoS One. Using a simple blood test, Damaraju and his team, which included his PhD student Yadav Sapkota, scanned the entire human genome of 369 women who had been diagnosed with breast cancer. Of those, 155 had their cancer come back and 214 did not.

"If we can accurately predict which women are at high risk of breast cancer recurrence, it gives the physicians and oncologists treating those women time to design a more aggressive therapy in hopes of preventing the cancer from coming back," says Damaraju, who works in the Department of Laboratory Medicine & Pathology. "Treatment strategies could be tailor made for these women based on their genetic make-up and how susceptible it makes them to breast cancer recurrence."

Damaraju and his team focused their research on good prognosis breast cancer - cancer that has a high success rate in terms of initial recovery and treatment. About 70% of all breast cancers fall into this category. Yet despite the high success rate with initial treatment for this type of breast cancer, the overall numbers of those who died or had their cancer spread in this 'good prognosis' group are substantial. The numbers are high simply because so many people have this common 'good prognosis' cancer.

Currently, treatment options for breast cancer patients are based on what doctors know about the tumour itself - its size, grade and the absence or presence of certain markers within the tumour. Damaraju noted there are patients who are given an excellent prognosis based on what doctors see within the tumour, yet the cancer comes back. And other women remain cancer free even though their doctors said they had a poor prognosis based on information gleaned from the tumour. Damaraju thinks the accuracy of prognosis could be improved by complementing tumor based markers with the DNA marker that can be found through a simple blood test.

Damaraju and his team are continuing their research in this area and would like to reconfirm their findings in a larger study, pending further funding. The results from that study could be published in about three years, and he suspects about two years after that, the DNA predictor test could be tested in prospective clinical studies prior to making them widely available for women.

The research was funded by the Canadian Breast Cancer Foundation - Prairies/NWT region, and the Alberta Cancer Foundation.

"The impact of Dr. Damaraju's significant discovery on personalized treatment for breast cancer patients is substantial," says Canadian Breast Cancer Foundation - Prairies/NWT Region CEO Trish Bronsch. "Knowing individual risks of breast cancer and reccurrence provides doctors and oncologists with a better picture in which they can create a treatment plan to fit personal needs. We are very excited to have been able to help fund Dr. Damaraju and his team to this discovery."

"We are pleased to see donor dollars having a direct impact on outcomes that are important to Albertans--in this case earlier detection and improved treatment options for breast cancer recurrence," says Myka Osinchuk, CEO of the Alberta Cancer Foundation. "We are excited to follow Dr. Damaraju and his team to ensure those women successfully treated for breast cancer continue to live cancer-free lives.
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Body Language Conveys Intense Emotions Better Than The Face

Be it triumph or crushing defeat, exhilaration or agony, body language more accurately conveys intense emotions, according to recent research that challenges the predominance of facial expressions as an indicator of how a person feels.

Princeton University researchers report in the journal Science that facial expressions can be ambiguous and subjective when viewed independently. The researchers asked study participants to determine from photographs if people were experiencing feelings such as loss, victory or pain from facial expressions or body language alone, or from both. In some cases, a facial expression associated with one emotion was paired with a body experiencing the opposite emotion.

In four separate experiments, participants more accurately guessed the pictured emotion based on body language - alone or combined with facial expressions - than on facial context alone. Senior researcher and Princeton Professor of Psychology Alexander Todorov said that these results challenge the clinical - and conventional - presumption that the face best communicates feeling. Indeed, despite the findings, a majority of the study's participants sided with the face when asked how they gauge feelings, a misconception the researchers referred to as "illusory facial affect."

"We find that extremely positive and extremely negative emotions are maximally indistinctive," said Todorov, who worked with first author Hillel Aviezer, a psychology professor at Hebrew University of Jerusalem who conducted the work as a postdoctoral researcher under Todorov, and Yaacov Trope, a psychology professor at New York University.

"People can't tell the difference, although they think they can," Todorov said. "Subjectively people think they can tell the difference, but objectively they are totally at [random] chance of determining correctly. The message of this research is that there is a lot of information in body language people aren't necessarily aware of."

The paper in Science counters popular theories holding that facial expressions are universally consistent indicators of emotion. The most prominent, Todorov said, have been developed by psychologist and University of California-San Francisco professor emeritus Paul Ekman, whose work was fictionalized in the television series "Lie to Me."

Instead, facial movements may be "much blurrier" than those theories account for, Todorov said. In particular, he and his colleagues suggest that when emotions reach a certain intensity, the intricacies of facial expressions become lost, similar to "increasing the volume on stereo speakers to the point that it becomes completely distorted," he said.

"There's much more ambiguity in the face than we assume there is," Todorov said. "We assume that the face conveys whatever is in the person's mind, that we can recognize their emotions. But that's not necessarily true. If we remove all the other contextual clues, we might not be so good at picking out emotional cues."


Jamin Halberstadt, a psychology professor at the University of Otago in New Zealand, said that the work demonstrates in a new way that the physical cues of emotion are more varied and dependent on the emotion felt than predominating theories suggest. Halberstadt is familiar with the Princeton research but had no role it.

Based on theories of facial expression, one would intuit that intense emotions would be even easier to interpret from the face than subtle emotions, said Halberstadt, who studies cognitive-emotion interactions. Yet the research by Todorov, Aviezer and Trope demonstrates that facial movements at some point become secondary to the body.

"Before I read this paper, I would have thought that the body only provides contextual clues," Halberstadt said. "This is not saying that bodily context helps interpret an expression of emotion - it is saying that bodily context is the expression of emotion. And the face reveals a general intensity of feeling but doesn't communicate what the person is feeling exactly. The body is where the valid information comes from during intense feelings."

The Princeton research introduces an additional element to interpreting emotions that scientists "have to account for," Halberstadt said. In particular, interrogation and security-screening techniques - such as the U.S. Transportation Security Administration's Screening of Passengers by Observation Techniques (SPOT) program - have been developed based on facial expression research. The work by Todorov and his colleagues, however, suggests that a crucial bodily element may have been overlooked.

"This study really questions the primacy of the face in emotion," Halberstadt said. "Real emotional expressions are much more ambiguous, subtle and malleable than you would think from the research. Any application of emotion theory that relies on or assumes that emotional expressions reside primarily in the face should be under reconsideration from this kind of study."

For their study, the Princeton researchers used stock photos of people at six emotional "peaks": pain, pleasure, victory, defeat, grief and joy. In the first experiment, three groups of 15 people were shown only the facial expression, the body position or the face and body together, respectively. Participants who saw the face only had a 50-50 chance of being correct, whereas those who only saw a body or the face and body together were far more accurate.

Yet, these respondents also exhibited a high degree of illusory facial affect: 53 percent of people who saw the body-and-face photos said they relied on the face. Of a group for whom the pictures were described but not shown, 80 percent said they would rely solely on the face when determining the emotion pictured, while 20 percent they would look to the face and the body together. No one indicated they would judge by body language alone.

In the second experiment, photos were manipulated so that faces from one emotional peak such as victory were spliced onto a body from an opposing peak such as defeat. In those cases, participants more often determined the emotion to be that associated with the body.

For the third experiment, participants rated a variety of faces that fell with in the six emotional categories with ambiguous results. In fact, the authors report, respondents interpreted the positive faces as negative more than they did the negative faces. Those faces were then randomly put upon bodies in a situation of victory or pain, and victory or defeat. Again, study participants typically guessed the situation in accordance with what they gleaned from the body rather than the face.

The final experiment asked participants to mimic the facial expressions in the photos for victory and defeat. Those images were put onto corresponding or opposing body images of victory or defeat. A separate group of people then had to determine the feeling being shown in each image. As in the previous experiments, the body language more often influenced respondents, who labeled a feeling negative when a winning face was on a body of defeat, and vice versa.

If anything, Todorov said, the findings promote a more holistic view of understanding how people physically communicate feelings.

"This research involved very clear cases of positive and negative experiences, and yet people cannot tell them apart from the face," Todorov said.

"There are lots of cues that help us in the social environment, but we often think the face has this special status, that we can tell so much from it," he said. "In reality it tells us much less than we think."
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Emotional Memories Can Be Erased From Our Brains

Emotional memories that are recently formed can be erased from the human brain.

A new study by Thomas Agren, a doctoral candidate at the Department of Psychology, under the observation of Professors Mats Fredrikson and Tomas Furmark, has indicated that it is possible to erase newly formed emotional memories from the brain. This finding, published in Science, brings scientists a huge step forward in future research on memory and fear.

The results coincide previous research which suggested that memories of fear can be substantially modified into benign memories when they are ripe for change, and can be kept that way.

An enduring long-term memory is formed when individuals take in new information by using the process of consolidation, which is based on the formation of proteins. When we recall an event, a place, or anything from our past, the memory becomes unstable for a while. Another consolidation process begins, and the memory is restabilized.

This is because we are not remembering what originally happened, but instead, recalling what we remembered the previous time we thought about what happened, the authors explained.

Memory content can be impacted by interrupting the reconsolidation process that occurs after remembrance.

The participants in the study were shown a neutral picture, while given an electric shock at the same time. This was done so that the picture came to elicit fear, meaning a the subjects formed a fear memory. The picture was then displayed without any shock in order to activate the fear memory.

The reconsolidation process was disrupted in one experimental group by repeatedly showing presentations of the image. A control group was also observed, where the reconsolidation process was finished before the volunteers were shown the same repeated presentations of the picture.

In turn, the experimental group was not able to reconsolidate the fear memory, the fear they had previously connected with the picture dissipated.

The findings suggest that by disrupting the reconsolidation process, the memory was made neutral and no longer associated with fear. The scientists used a MR-scanner, which proved that the traces of that memory was no longer in the part of the brain that usually stores fearful memories, the nuclear group of amygdala in the temporal lobe.

Thomas Ågren concluded:

"These findings may be a breakthrough in research on memory and fear. Ultimately the new findings may lead to improved treatment methods for the millions of people in the world who suffer from anxiety issues like phobias, post-traumatic stress, and panic attacks."
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Genetic Clue Discovered For Why Women Outlive Men

A new study of mitochondrial DNA in fruit flies offers a number of clues that might explain why females tend to outlive males across much of the animal kingdom, including humans.

Researchers from Monash University in Australia and Lancaster University in the UK, write about their work in the 2 August online issue of Current Biology.

They found male fruit flies appear to have mutations in their mitochondrial DNA that affect how fast they age and how long they live.

Scientists use fruit flies as models for studies in genes and aging because their biological processes are remarkably similar to that of other animals, such as humans, and with a lifespan of about a month, it doesn't take too long to investigate generational effects.

Senior author Damian Dowling, a research fellow in the Monash School of Biological Sciences, told the press:

"All animals possess mitochondria, and the tendency for females to outlive males is common to many different species. Our results therefore suggest that the mitochondrial mutations we have uncovered will generally cause faster male aging across the animal kingdom."

"Intriguingly, these same mutations have no effects on patterns of aging in females. They only affect males," he added.

Mitochondria are special subunits of cells, about the same size as bacteria, that provide the energy for life. They combine sugar and oxygen into adenosine triphosphate or ATP, molecular packets of energy that are usable by cells.

Mitochondria have their own DNA that is quite separate from the cellular DNA in the nucleus of the cell.

And, unlike cellular DNA, which is inherited from the sperm and egg that fuse to make the new individual, mitochondrial DNA comes only from the egg.

Thus, as mitochondrial DNA is passed down from generation to generation, the process of natural selection has no opportunity to "screen out" mutations in mitochondrial DNA that might be harmful to males. The researchers refer to this as a "sex-specific selective sieve".

For their study, Dowling and colleagues looked at differences in longevity and biological aging in male and female fruit flies whose mitochondria came from different origins.

They found genetic variations in both male and female mitochondrial DNA, but only the male ones could be linked to life expectancy. There weren't just a few mutations in one place, there were several, spread all over the mitochondrial genome:

"... our results indicate that the mitochondrial mutation loads affecting male aging generally comprise numerous mutations over multiple sites," they write.

The researchers suggest the mutations are entirely due to the way mitochondrial DNA is passed down through the female line.

"If a mitochondrial mutation occurs that harms fathers, but has no effect on mothers, this mutation will slip through the gaze of natural selection, unnoticed. Over thousands of generations, many such mutations have accumulated that harm only males, while leaving females unscathed," Dowling explained.

In an earlier study that looked at the effect of mitochondria being passed down the female line, the team had also discovered a link with male infertility.

Dowling said combining this latest study with their earlier work suggests mitochondria are "hotspots" for mutations that influece male health.

"What we seek to do now is investigate the genetic mechanisms that males might arm themselves with to nullify the effects of these harmful mutations and remain healthy," said Dowling.
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Our Brains Make Men And Women See Things Differently

According to a new study, published in BioMed Central's open access journal Biology of Sex Differences, men and women have different ways of using the visual centers of their brains. Experts suggest that while females are better at distinguishing colors, males are more sensitive to fine detail and rapidly moving stimuli.

There are high concentrations of the male sex hormone (androgen) receptors throughout the cerebral cortex in the brain, particularly in the visual cortex, which is in charge of processing images.

Guys have 25% more neurons in the visual cortex than females because, during embryogenesis, androgens are responsible for controlling the development of those neurons.

The vision of men and women was compared by a team of researchers from Brooklyn and Hunter Colleges of the City University of New York. The experts observed people over the age of 16 from both college and high school, including students and faculty. Both sexes needed to have normal color vision and 20/20 sight (with glasses or contacts was considered fine), in order to participate.

Scientists learned that the color vision of men was shifted, after they asked the volunteers to describe colors shown to them across the visual spectrum. It also became clear that male subjects needed a slightly longer wavelength to experience the same hue as the female subjects.

It was not as easy for men to discriminate between colors as it was for women, meaning that the males had a broader ranger in the center of the spectrum.

In order to measure contrast-sensitivity functions (CSF) of vision, the researchers used an image of light and dark bars that were either horizontal or vertical, asking the participants to decide which one they saw. When the light and dark bars were alternated in each image, the image appeared to flicker.

The investigators found, by varying how quickly the bars alternated or how close together they were, that at moderate rates of image change, volunteers lost sensitivity for bars that were close together, and gained sensitivity when the bars were farther apart.

Both males and females had a harder time resolving the images over all bar widths when the image change was faster. However, men had an easier time resolving more rapidly changing images that were closer together than the women.

Professor Israel Abramov, lead author, explained:

"As with other senses, such as hearing and the olfactory system, there are marked sex differences in vision between men and women. The elements of vision we measured are determined by inputs from specific sets of thalamic neurons into the primary visual cortex.

We suggest that, since these neurons are guided by the cortex during embryogenesis, that testosterone plays a major role, somehow leading to different connectivity between males and females. The evolutionary driving force between these differences is less clear."
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Electronic Cigarettes Harm The Lungs

Electronic cigarettes, seen by many as a healthy alternative to tobacco smoking, do cause damage to the lungs, scientists from the University of Athens, Greece, explained at the European Respiratory Society's Annual Congress 2012, Vienna, on Sunday. Electronic cigarettes, also called e-cigarettes have also been marketed as effective smoking cessation devices.

Professor Christina Gratziou and team set out to determine what the short-term effects of smoking with e-cigarettes might be on different individuals, including those with no known health problems, as well as existing smokers with and without lung conditions.

They carried out experiments on 32 volunteers; of whom 8 were lifetime non-smokers and 24 were current regular smokers. Some of them had healthy lungs, while others lived with asthma or COPD (chronic obstructive pulmonary disease).
br> They were asked to use an electronic cigarette for 10 minutes, inhaling the vapors into their lungs. A spirometry test, as well as some others diagnostic procedures were used to measure their airway resistance. Airway resistance is used in respiratory physiology to measure the resistance of the respiratory tract to airflow coming in during inspiration (inhalation) and going out during expiration (exhalation).

They found that using an e-cigarette caused an instant increase in airway resistance that lasted for 10 minutes in the majority of the participants. Below are some of their findings:
  • Non-smokers - even among lifetimes non-smokers, using an e-cigarette for ten minutes raised their airway resistance to 206% from 182% (mean average); the researchers described this as a "significant increase".

  • Current regular smokers - among existing regular smokers, the spirometry tests revealed a significant rise in airway resistance to 220%, from 176% after using one e-cigarette for ten minutes.

  • COPD and Asthma patients experienced no significant increase in airway resistance from using one e-cigarette for ten minutes.
Professor Christina Gratziou, who is Chair of the European Respiratory Society Tobacco Control Committee, said:

"We do not yet know whether unapproved nicotine delivery products, such as e-cigarettes, are safer than normal cigarettes, despite marketing claims that they are less harmful. This research helps us to understand how these products could be potentially harmful.

"We found an immediate rise in airway resistance in our group of participants, which suggests e-cigarettes can cause immediate harm after smoking the device. More research is needed to understand whether this harm also has lasting effects in the long-term. "The ERS recommends following effective smoking cessation treatment guidelines based on clinical evidence which do not advocate the use of such products."

What are electronic cigarettes (e-cigarettes)?

Electronic cigarettes, also known as vaporizer cigarettes and e-cigarettes, are devices that people use, often instead of tobacco cigarettes, that release doses of water vapor that may or may not include nicotine. E-cigarettes are powered by a small battery.

Manufacturers, distributors and marketers of electronic cigarettes say that they are an effective and healthier alternative to tobacco smoking, because the user does not inhale harmful tobacco smoke, which contains over 4,000 toxic chemicals.

Regular e-cigarette users say that the device offers them a similar sensation to tobacco-cigarette smoking. However, as there is no combustion involved - there is no smoke.

Electronic cigarettes are long tube-like devices that either look like tobacco cigarettes or biros (ballpoint pens). Most of them have replaceable cartridges; some are throwaway ones.

E-Cigarette
The user places the device between his lips and sucks in, this action activates a heating element that immediately vaporizes a liquid solution. The vapor is inhaled. Learning how to use an e-cigarettes, especially for a regular tobacco-smoker, is straightforward because the action is virtually identical to what is done when you smoke a tobacco cigarette.

A typical electronic cigarette has the following components:
  • The mouthpiece - the replaceable cartridge is placed here. The user sucks or inhales from the mouthpiece.

  • The atomizer - a heating element which vaporizes the liquid solution. The vapors are inhaled. In most devices, the atomizer needs to be replaced every three to six months.

  • The battery - this is usually a rechargeable lithium-ion rechargeable battery. The battery is the power-source for the heating element. There is also some electronic circuitry in the device, such as the airflow sensor, a timed cutoff switch to prevent overheating, and a colored LED (light emitting diode) to indicate the device has been activated.
Electronic cigarettes are becoming increasingly popular, especially in Western Europe. It is estimated that many tens of millions of people worldwide are regular users.
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What Is Inflammation? What Causes Inflammation?

Inflammation is the body's attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens - and begin the healing process.

When something harmful or irritating affects a part of our body, there is a biological response to try to remove it, the signs and symptoms of inflammation, specifically acute inflammation, show that the body is trying to heal itself. Inflammation does not mean infection, even when an infection causes inflammation. Infection is caused by a bacterium, virus or fungus, while inflammation is the body's response to it.

The word inflammation comes from the Latin "inflammo", meaning "I set alight, I ignite".

Inflammation is part of the body's immune response. Initially, it is beneficial when, for example, your knee sustains a blow and tissues need care and protection. However, sometimes inflammation can cause further inflammation; it can become self-perpetuating. More inflammation is created in response to the existing inflammation.

According to Medilexicon's medical dictionary, Inflammation is:

"A fundamental pathologic process consisting of a dynamic complex of histologically apparent cytologic changes, cellular infiltration, and mediator release that occurs in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent, including the local reactions and resulting morphologic changes; the destruction or removal of the injurious material; and the responses that lead to repair and healing.

The so-called cardinal signs of inflammation are rubor, redness; calor, heat (or warmth); tumor, swelling; and dolor, pain; a fifth sign, functio laesa, inhibited or lost function, is sometimes added. All these signs may be observed in certain instances, but none is necessarily always present."


Plaque in coronary artery disease linked to inflammation - scientists from Stanford University, California, linked 25 new genetic regions to coronary artery disease. They found that people with coronary artery disease, the leading cause of death globally, are most likely predisposed to the disease because they have gene variants linked to inflammation.

Inflammation helps wounds heal

Wrist inflammation
Our immediate reaction to a swelling is to try to bring it down. Bearing in mind that inflammation is an essential part of the body's attempt to heal itself, patients and doctors need to be sure that the treatments to reduce swelling are absolutely necessary and to not undermine or slow down the healing process.

The first stage of inflammation is often called irritation, which then becomes inflammation - the immediate healing process. Inflammation is followed by suppuration (discharging of pus). Then there is the granulation stage, the formation in wounds of tiny, rounded masses of tissue during healing. Inflammation is part of a complex biological response to harmful stimuli. Without inflammation, infections and wounds would never heal.

Neuroscientists at the Lerner Research Institute at the Cleveland Clinic in Ohio found that inflammation actually helps to heal damaged muscle tissue. Their findings clash with how sportspeople with inflammation are treated - health professionals always try to control the inflammation to encourage healing. The researchers say their findings may lead to new therapies for acute muscle injuries caused by freeze damage, medications, chemicals and trauma.

Lan Zhou, M.D., Ph.D., said that patients should be very closely monitored when therapies to combat inflammation are used to make sure that the benefits of inflammation are not completely eliminated.

Inflammation is part of our innate immunity

Our innate immunity is what is naturally present in our bodies when we are born, and not the adaptive immunity we get after an infection or vaccination. Innate immunity is generally non-specific, while adaptive immunity is specific to one pathogen:

Whooping cough vaccine - example of immunity being specific to one pathogen
    After being vaccinated for whooping cough (pertussis), we develop immunity to Bordetella pertussis or Bordetella parapertussis, types of bacteria that cause pertussis. This is an example of adaptive immunity - the immunity was not there before receiving the vaccine.
Inflammation is seen as a mechanism of innate immunity.

What is the difference between chronic inflammation and acute inflammation?

Acute inflammation - starts rapidly (rapid onset) and quickly becomes severe. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks.

Examples of diseases, conditions, and situations which can result in acute inflammation include: acute bronchitis, infected ingrown toenail, sore throat from a cold or flu, a scratch/cut on the skin, exercise (especially intense training), acute appendicitis, acute dermatitis, acute tonsillitis, acute infective meningitis, acute sinusitis, or a blow.

Chronic inflammation - this means long-term inflammation, which can last for several months and even years. It can result from:
  • Failure to eliminate whatever was causing an acute inflammation
  • An autoimmune response to a self antigen - the immune system attacks healthy tissue, mistaking it (them) for harmful pathogens.
  • A chronic irritant of low intensity that persists
Examples of diseases and conditions with chronic inflammation include: asthma, chronic peptic ulcer, tuberculosis, rheumatoid arthritis, chronic periodontitis, ulcerative colitis and Crohn's disease, chronic sinusitis, and chronic active hepatitis (there are many more).

Our infections, wounds and any damage to tissue would never health without inflammation - tissue would become more and more damaged and the body, or any organism, would eventually perish.

However, chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever. Inflammation needs to be well regulated.

What happens during acute inflammation?

Within a few seconds or minutes after tissue is injured, acute inflammation starts to occur. The damage may be a physical one, or might be caused by an immune response.

Three main processes occur before and during acute inflammation:
  • Arterioles, small branches of arteries that lead to capillaries that supply blood to the damaged region dilate, resulting in increased blood flow

  • The capillaries become more permeable, so fluid and blood proteins can move into interstitial spaces (spaces between tissues).

  • Neutrophils, and possibly some macrophages migrate out of the capillaries and venules (small veins that go from a capillary to a vein) and move into interstitial spaces. A neutrophil is a type of granulocyte (white blood cell), it is filled with tiny sacs which contain enzymes that digest microorganisms. Macrophages are also a type of white blood cells that ingests foreign material.

    Klaus Ley, M.D., a scientist at the La Jolla Institute for Allergy & Immunology, reported in a study published in Nature that neutrophils are the human body's first line of defense; they are the main cells that protect us from bacterial infections. Their protective function is a positive one, however, they also have inflammatory properties that may eventually lead to heart disease and several autoimmune diseases, such as lupus. Effectively manipulating neutrophils is vital in disrupting inflammatory diseases.
When our skin is scratched (and the skin is not broken), one may see a pale red line. Soon the area around that scratch goes red, this is because the arterioles have dilated and the capillaries have filled up with blood and become more permeable, allowing fluid and blood proteins to move into the space between tissues.

Edema - the area then swells as further fluid builds up in the interstitial spaces.

The five cardinal signs of acute inflammation - "PRISH"
    An ingrown toenail
    An ingrown toenail with the five PRISH signs; pain, redness, immobility, swelling and heat

  • Pain - the inflamed area is likely to be painful, especially when touched. Chemicals that stimulate nerve endings are released, making the area much more sensitive.
  • Redness - this is because the capillaries are filled up with more blood than usual
  • Immobility - there may be some loss of function
  • Swelling - caused by an accumulation of fluid
  • Heat - as with the reason for the redness, more blood in the affected area makes it feel hot to the touch
The five classical signs of inflammation

Although Latin terms are still used widely in Western medicine, local language terms, such as English, are taking over. PRISH is a more modern acronym which refers to the signs of inflammation. The traditional Latin based terms have been around for two thousand years:
  • Dolor - Latin term for "pain"
  • Calor - Latin term for "heat"
  • Rubor - which in Latin means "redness"
  • Tumor - a Latin term for "swelling"
  • Functio laesa - which in Latin means "injured function", which can also mean loss of function
Dolor, Calor, Rubor, and Tumor were first described and documented by Aulus Cornelius Celsus (ca 25 BC-ca 50), a Roman encyclopaedist. Celcius is famous for creating De Medicina, which is thought to be the only surviving section of a vast encyclopedia. De Medicina was the main source of medical reference in the Roman world for pharmacy, surgery, diet and some other medical fields.

Functio laesa - it is not clear who first described and documented the fifth sign. The majority of attributions have gone to Thomas Sydenham (1624-1689) an English physician and Rudolph Carl Virchow (1821-1902), a German doctor, biologist, politician and pathologist. Virchow is seen as one of the founders of social medicine.

These five acute inflammation signs are only relevant when the affected area is on or very close to the skin. When inflammation occurs deep inside the body, such as an internal organ, only some of the signs may be detectable. Some internal organs may not have sensory nerve endings nearby, so there is be no pain, as is the case with some types of pneumonia (acute inflammation of the lung). If the inflammation from pneumonia pushes against the parietal pleura (inner lining of the surface of the chest wall), then there is pain.

Acute and chronic inflammation compared

The lists below show the difference between chronic and acute inflammation regarding the causative agents, which major cells are involved, features regarding onset, duration, and outcomes:

Acute Inflammation
  • Causative agents - harmful bacteria or injury to tissue
  • Major cells involved - mainly neutrophils, basophils (in the inflammatory response), and eosinophils (response to parasites and worms), and mononuclear cells (macrophages, monocytes)
  • Primary mediators - eicosanoids, vasoactive amines
  • Onset (when does the inflammation start) - straight away
  • Duration - short-lived, only a few days
  • Outcomes - the inflammation either gets better (resolution), develops into an abscess, or becomes a chronic inflammation
Chronic inflammation
  • Causative agent - non-degradable pathogens that cause persistent inflammation, infection with some types of viruses, persistent foreign bodies, overactive immune system reactions
  • Major cells involved - Macrophages, lymphocytes, plasma cells (these three are mononuclear cells), and fibroblasts
  • Primary mediators - reactive oxygen species, hydrolytic enzymes, IFN-γ and other cytokines, growth factors
  • Duration - from several months to years
  • Outcomes - the destruction of tissue, thickening and scarring of connective tissue (fibrosis), death of cells or tissues (necrosis)

Sleep quality and duration impacts on inflammation risk

Scientists at Emory University School of Medicine in Atlanta, Georgia, found in a study that sleep deprivation or poor sleep quality raise inflammation, which in turn increase the risk of developing heart disease and stroke.

The team gathered data on 525 middle-aged volunteers who had completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire, which asked detailed questions about sleep quality and duration.

They tested the participants' levels of various inflammatory markers, and then tried to see whether they could link them to quality and duration of sleep. The authors concluded:

"The researchers concluded that: "Poor sleep quality, and short sleep durations are associated with higher levels of inflammation."
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Boys Starting Puberty Earlier, Like Girls

Boys in the United States are reaching puberty some 6 months to 2 years earlier than a few decades ago, reflecting the trend in girls, according to a new study by the American Academy of Pediatrics (AAP) published online before print on Saturday. The study authors suggest more research should now be done to find out why this is happening.

Lots of published evidence shows girls are reaching puberty earlier, and this is now generally accepted, but until now, there hasn't been as much research on whether today's boys are also showing a similar tendency.

AAP researchers designed and carried out the study through hundreds of pediatricians all over the US who belong to the AAP Pediatric Research in Office Settings (PROS) network and contribute data for research on children's health.

Data from this same PROS network was used in a large study that in 1997 showed US girls were reaching puberty earlier.

Parents and Doctors Need to Know

The data for this latest study covers more than 4,100 boys, and was recorded by 212 pediatricians carrying out well-child care in 144 practices in 41 states.

A huddle of children
American boys appear to be reaching puberty at a younger age, with African-American boys entering puberty earlier than white or Hispanic boys.

Co-author Richard C. Wasserman, director of PROS, says:

"All parents need to know whether their sons are maturing within the contemporary age range, but, until now, this has not been known for US boys."

To assess puberty in boys, pediatricians measured two features: genital and pubic hair, and testicular enlargement, both standard indicators of start of puberty.

The results showed that puberty onset was happening some 6 months to two years earlier than it was several decades ago, according to records from that time.

Ethnic Differences

Overall, African-American boys are more likely to enter puberty earlier than white or Hispanic boys.

Across three ethnic groups, pediatricians recorded the earliest stage of puberty as 10.14 years in non-Hispanic white boys, 9.14 years in non-Hispanic African American boys and 10.4 years in Hispanic boys.

The authors write:

"The causes and public health implications of this apparent shift in US boys to a lower age of onset for the development of secondary sexual characteristics in US boys needs further exploration."

21st Century Standards

In a press statement, lead author Marcia E. Herman-Giddens thanks the doctors and boys who provided much needed data for "this exciting study":

"Contemporary data on the ages of pubertal characteristics in US boys from onset to maturity, lacking until now, are needed by pediatricians, public health scientists, and parents," she explains.

Wasserman says the landmark PROS study that was done in the 1990s provided up to date information on puberty in girls: it was logical there should be a similar one for boys:

"The PROS study provides 21st century standards," says Wasserman.

"Our pediatric endocrinologist colleagues now use the PROS puberty assessment training materials in their own studies and fellowship training," he adds.
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Indoor Laundry Drying Could Be Bad For Your Health

A combination of prolonged wet weather and reducing use of tumble dryers as a way to cut fuel bills, may encourage people to dry more clothes indoors, for instance on drying frames or by draping on radiators. But according to researchers in Scotland, this could pose health risks by increasing moisture that encourages moulds and dust mites, which is bad for people prone to asthma.

Also, while the intention may be to save energy and cost, that is not necessarily the result, say the researchers, from the Mackintosh Environmental Architecture Research Unit (MEARU) at The Glasgow School of Art, working with Strathclyde and Caledonian universities, because in order to dry off the 2 litres that the average load of washing releases into the air, people often turn up the heating.

The three-year research project, titled "Environmental Assessment of Domestic laundering", was funded by the Engineering and Physical Sciences Research Council (EPSRC). A report and press statement were released on 2 November.

Report co-author, Colin Porteous, a professor at MEARU, says:

"Because of increased awareness of the energy consumption of tumble dryers many people are choosing to dry clothes passively within their home."

"This results not only in a severe energy penalty, because of increased heating demand, but also a potential health risk due to higher moisture levels," he adds.


Socks drying indoors
Researchers suggest a strong correlation between drying laundry indoors and increased spore growth, which can exacerbate symptoms for sufferers of asthma, hay fever and other allergies.

The researchers examined the laundry habits of residents in a wide demographic mix living in social housing in the West of Scotland, and also carried out a detailed analysis of air quality and energy consumption.

They concluded indoor drying of laundry poses environmental, economic and health problems, and the tendency in the UK toward building smaller, more airtight homes, only serves to make things worse.

In ill-ventilated rooms, putting clothes on radiators to dry can account for up to a third of the moisture in the air, and creates ideal conditions for mould spores to grow and dust mites to thrive. Both these conditions are known triggers of asthma.

The researchers also point out that indoor drying of clothes that contain fabric conditioner is likely to increase the amount of cancer-causing chemicals in the air.

Indoor laundry drying also leads to increased use of energy, as radiators are often turned up to help the drying process, and/or windows are opened. This just worsens fuel poverty, already a major issue in the West of Scotland, say the researchers.

The team recommends people dry their laundry outdoors whenever possible, or use energy-efficient, condensing tumble dryers. If you have to dry your clothes indoors, then place them by a south facing window (the message is for people in the UK), using natural light and heat. An even better method is to place the clothes on a south-facing balcony, if you have one.

They also suggest, when creating new housing stock, planners and builders should make sure the designs cater for ways of drying laundry that do not contribute to poor air quality. The researchers have published a design guide with suggestions like: upgrading balconies and sunspaces, ensuring new homes have a drying space with its own heating and ventilation, communal laundry and drying facilities, and installing energy-efficient appliances.

The team is now discussing its findings with social housing authorities, with a view to their proposals being adopted as Housing Associations upgrade existing stock and build new homes.

However they argue more sweeping changes are necessary, including updating the Building Regulations so they apply to all new housing. Such a move would have many benefits, says Porteous:

"Our research gives strong justification for the changes both in terms of health and wellbeing, and associated economic impacts. It is our hope that current statutory and advisory standards will be modified to take them on board ensuring a healthy and economically sustainable living environment."
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How Cat Litter Parasite Toxoplasma Gondii Influences The Brain

New research led by a team at the Karolinska Institutet in Sweden reveals for the first time what the common "cat litter parasite" Toxoplasma gondii does once it gets into the brain. The study is important in the light of recent observations linking the parasite to risk-taking and other human behaviours, and associations with mental illness.

The researchers write about their findings in a paper published online on 6 December in the journal PLoS Pathogens.

Toxoplasma Infection

Infection by Toxoplasma gondii or Toxoplasma is called Toxoplasmosis. Estimates suggest between 30 and 50% of the global human population is infected. In Sweden the figure is nearer 20%. In the US, the Centers for Disease Control and Prevention (CDC), puts the number of infected men, women and children at 60 million. Animals can also become infected, especially domestic cats.

People usually contract the parasite by eating poorly cooked meat: according to the CDC, toxoplasmosis is the leading cause of death from foodborne illness in the US. Another way people become infected is by touching cat feces, hence the expression "cat litter parasite" because one way of touching cat feces is handling the cat litter tray.

The vast majority of people infected have few symptoms because their immune system usually stops the parasite from causing illness. In newly infected adults the parasite can cause mild flu-like symptoms, and then it usually enters a chronic dormant phase which was thought to be symptom free.

However, when the parasite enters the brain of fetuses, and people with weak immune systems, it can be fatal. Because of this risk, uninfected pregnant women should not touch cat litter trays.

Links to Mental Illness, Risk-Taking Behavior

There is an emerging view that the toxoplasmosis parasite is active to some extent during what was previously regarded as a purely "dormant phase".

For example, rats infected with the parasite lose their fear of cats, and are even attracted by their scent, making them easy prey. Scientists have suggested this is how the parasite assures its own survival and propagation: the cats eat the infected rats, shed more parasite through their feces, and that in turn helps to infect more rats.

Other studies have found schizophrenia, depression, anxiety, and other mental diseases are more common in people with toxoplasmosis, and there is also evidence to suggest infection by the parasite is linked to more extroverted, aggressive and risk-taking behavior.

In a study published in the July 2012 issue of the Archives of Psychiatry, researchers from Denmark's Statens Serum Institut and the University of Maryland in the US, found that women carrying IgG antibodies to Toxoplasma gondii when giving birth have a higher risk of self-harm or suicide later on.

While such a description sounds alarming, study senior author Antonio Barragan, researcher at the Center for Infectious Medicine at Karolinska Institutet and the Swedish Institute for Communicable Disease Control, says:

"At the same time, it's important to emphasize that humans have lived with this parasite for many millennia, so today's carriers of Toxoplasma need not be particularly worried."

Once in the Brain, Toxoplasma Spurs GABA Secretion

The researchers didn't examine how the toxoplasmosis parasite changes host behavior, they were more interested in what it does in the brain.

They found that it takes over one of the brain's neurotransmitters: the chemical messengers that carry signals between various parts of the brain.

In one test tube experiment, they infected human dendritic cells with the parasite. Dendritic cells form the frontline of the immune system, and play a key role in triggering and adapting immune responses. Once infected, the dendritic cells started secreting GABA, a chemical messenger.

In another experiment with live mice, the researchers tracked infected dendritic cells from their initial point of infection to other parts of the brain where they continued to affect the GABA system.

In their author summary, the researchers note:

"Dendritic cells are considered the gatekeepers of the immune system but can, paradoxically, also mediate dissemination of the parasite."

"This study establishes that GABAergic signaling modulates the migratory properties of dendritic cells and that the intracellular pathogen Toxoplasma gondii sequesters the GABAergic signaling of dendritic cells to assure propagation," they add.

GABA does a number of things, but one of them is to inhibit the sensations of fear and anxiety. People with mental illnesses such as schizophrenia, bipolar diseases, anxiety syndrome and depression show disturbances in GABA systems.

Barragan describes the parasite's ability to make the immune cells secrete GABA as "very clever" and says the finding was "as surprising as it was unexpected".

The researchers call for further studies.

"It would now be worth studying the links that exist between toxoplasmosis, the GABA systems and major public health threats," Barragan suggests.

A grant from the Swedish Research Council helped fund the study.
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Gargling Sugar Water Can Boost Your Self-Control

In order to have better self-control, all you have to do is gargle sugar water.

The finding came from a study at the University of Georgia, led by professor of psychology Leonard Martin and Matthew Sanders, a doctoral candidate also in the UGA Franklin College of Arts and Sciences, and was published in Psychological Science.

Fifty-one students were involved in the study and were asked to perform two assignments so that the team could test self-control.

In the first assignment, the subjects were asked to cross out the Es on a page from a statistics book, which has been known to diminish self-control.

In the second task, they were asked to identify the color of different words, which actually spell out the names of other colors, that were flashed on a monitor. This is called the Stroop test, in which the aim is to turn off a person's inclination to read the word instead of see the color.

The participants were divided into two groups - half rinsed their mouths with lemonade sweetened with sugar while they completed the Stroop test and the other group with Splenda-sweetened lemonade.

According to the results, students who rinsed with sugar responded to the color rather than the word significantly faster than those in the artificial sweetener group.

Martin explained:

"Researchers used to think you had to drink the glucose and get it into your body to give you the energy to (have) self control. After this trial, it seems that glucose stimulates the simple carbohydrate sensors on the tongue. This, in turn, signals the motivational centers of the brain where our self-related goals are represented. These signals tell your body to pay attention."


The Stroop test was completed in about three to five minutes. A measure of self-control was seen in the results, Martin said, but a glucose mouthwash might not be sufficient to fix certain self-control hurdles such as quitting smoking or losing weight.

"The research is not clear yet on the effects of swishing with glucose on long-term self-control," Martin said. "So, if you are trying to quit smoking, a swish of lemonade may not be the total cure, but it certainly could help you in the short run."

The ambition is seen in the form of self-values, or emotive investment, the authors revealed.

"It is the self-investment," Martin said. "It doesn't just crank up your energy, but it cranks up your personal investment in what you are doing. Clicking into the things that are important to you makes those self-related goals salient." According to the scientists, emotive enhancement is what results from the glucose, which causes people to be more aware of their desires and try harder at evoking the non-dominant response.

"The glucose seems to be good at getting you to stop an automatic response such as reading the words in the Stroop task and to substitute the second harder one in its place such as saying the color the word is printed in," he said. "It can enhance emotive investment and self-relevant goals."

Prior research on self-control demonstrated a considerable decrease in performance for the Stroop test. Studies have suggested, Martin said, that this is because the first task is too difficult that you just don't have the energy to complete the second assignment.

Martin continued:

We are saying when people engage in self-control, they ignore important aspects of their goals and feelings. If you have to stay late at work, for example, but you really want to be going home, you have to ignore your desire to go home. Doing so will help you stay late at work, but it may also put you out of touch with what you personally want and feel on later tasks. Swishing glucose can focus you back on those goals and feelings and this, in turn, can help you perform better on the second task. In short, we believe self-control goes away because people send away, not because they don't have energy. People turn it off on purpose."


The study's main goal was to identify the impact of swishing glucose on a psychological level. "We think it makes your self-related goals come to mind," Martin said.

The team is conducting more research to examine how people evoke emotive responses and how they interpret them.
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Promising Saliva Gland Test For Detecting Parkinson's

Testing a part of a person's saliva gland may be a way to diagnose Parkinson's disease, according to new research by the Mayo Clinic that will be presented at the American Academy of Neurology's annual meeting in March.

Parkinson's disease is a difficult disease to diagnose. Currently the only way to pinpoint the disease is to do a clinical exam to analyze a person's symptoms. To achieve a definitive answer, an autopsy is performed on the brain after a person has passed away.

Charles Adler, M.D., Ph.D., and main researcher of the study said:


"We have previously shown in autopsies of Parkinson's patients that the abnormal proteins associated with Parkinson's are consistently found in the submandibular saliva glands, found under the lower jaw. This is the first study demonstrating the value of testing a portion of the saliva gland to diagnose a living person with Parkinson's disease. Making a diagnosis in living patients is a big step forward in our effort to understand and better treat patients."


The study consisted of 15 people with a mean age of 68 who had Parkinson's disease for an average of 12 years. The participants chosen had also responded well to Parkinson's medication and did not have any previous saliva gland issues.

Saliva Glands
Diagram of the saliva glands.
1) Parotid Gland. 2) Submandibular Gland. 3) Sublingual Gland.

Two different saliva glands were biopsied: the minor saliva glands in the lower lip and the submandibular gland. The extracted tissues were then analyzed for evidence of the irregular Parkinson's protein.

Researchers suggest that one of the most important potential advantages this test could have is creating more accurate clinical trials. Parkinson's clinical trial participants currently do not always have Parkinson's disease, making it harder to test new therapies.

In nine of the eleven patients who had an adequate amount of tissue to examine, the irregular Parkinson's protein was found. The rate of positive outcomes in the biopsies of the lower lip glands seemed much lower than for the lower jaw gland.

Dr. Alder explained:

"This study provides the first direct evidence for the use of submandibular gland biopsies as a diagnostic test for living patients with Parkinson's disease. This finding may be of great use when needing definitive proof of Parkinson's disease, especially when considering performing invasive procedures such as deep brain stimulation surgery or gene therapy."

Parkinson's, A Progressive Disease

Parkinson's disease is an accelerating disease of the nervous system that affects movement. It starts slowly, sometimes with an unnoticeable hand tremor. Tremors are the hallmark symptoms of Parkinson's - the disease also comes with stiffness and slowing of motor skills.

Diagnosis is based on medical history, an assessment of symptoms and signs, a physical and neurological analysis, and eliminating possibilities of other disorders. Close to 30 percent of patients may be misdiagnosed early on in the disease.

Even though Parkinson's cannot be cured, medications can greatly reduce symptoms.
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Lung Cancer Screening For Heavy Smokers Recommended

People who have smoked at least a pack-a-day for thirty years should undergo lung cancer screening, the American Cancer Society announced today in its lung cancer screening guidelines.

The American Cancer Society says that doctors with access to high-tech lung cancer screening equipment, as well as treatment centers, should talk to their healthy patients who have been smoking heavily for at least three decades about having their lungs checked.

The Society added that even ex-smokers who gave up less than 15 years ago and smoked heavily for over thirty years should be advised to undergo screening.

According to the guidelines, doctors should tell their patients what the benefits and known harms linked to lung cancer screening are.

The American Cancer Society says that it came to this conclusion after a panel of experts reviewed a number of cancer screening studies that were published in academic journals over the last few decades.

Guidelines published in JAMA in May 2012 recommended that older, current and former heavy smokers should receive annual low-dose CT screening of their lungs.

What are the benefits and harms of lung cancer screening?

The authors of the latest guidelines say that the NLST (National Lung Screening Trial), which was published last year, strongly influenced their conclusions. The NLST involved 53,454 healthy males and females aged at least 55 years who were deemed at high risk of lung cancer because of their smoking history.

Half of them were assigned to the test group of low-dose spiral CT scan, while the other half, the "control group", underwent the standard single view chest X-ray. They were screened three times over a 24-month period. The researchers then checked to see how many were alive five to seven years later and assessed them.

Among those who had undergone the CT scans there were 356 lung cancer deaths, versus 443 deaths in the X-ray control group. The difference of 87 lives saved is a "statistically significant" number - a 20% drop in lung cancer death risk for those in the CT scan group.

The American Cancer Society wrote "One way of looking at this is: among about 27,000 people screened with a CT scan, 87 lung cancer deaths were prevented, but 356 lung cancer deaths still occurred."

Well designed clinical trials, such as the NLST one, help experts decide whether the benefits of screening outweigh the harms. The authors of the latest guidelines say that among healthy long-term heavy smokers or ex-smokers, the benefits of CT screening definitely outweigh the possible harms.

The experts wrote "A screening recommendation should only be made when the benefit clearly justifies the risk of harm."

What are the harms of screening? - despite the obvious benefits, the harms of screening must not be overlooked. Nearly 27,000 people underwent the 3-CT scans, of whom 40% had abnormal findings. They consequently had additional diagnostic tests, ranging from further CT scans to more invasive bronchoscopy, where a tube is placed down their throat into the lungs (via the mouth). Some of them underwent biopsies of the lung, an even more invasive procedure. The vast majority of the additional tests - 95% of them - did not result in a cancer diagnosis.

Sixteen patients who had received CT screening died within two months after an invasive diagnostic procedure that was carried out after their abnormal finding. Six of these 16 patients who died did not have lung cancer.

Even though nobody knows whether their deaths might have been caused by their invasive diagnostic procedures, the authors say that it reminds us that abnormal screening results can sometimes lead to dangerous diagnostic tests.

The NLST appears to show that for every five to six lives saved from CT-scan lung screening, one was lost because of the additional diagnostic procedures that an abnormal result caused.

Lung cancer screenings should be carried out in centers of excellence with experienced and well trained staff, so that the number of false positive screenings and extra invasive diagnostic tests are kept to a minimum, the Society added.

Lung cancer screening benefit for highest risk people

Lung cancer screening has the most benefit for healthy people at highest risk - those aged 55+ years with a long-term history of heavy smoking.

Lifetime non-smokers, or people with a history of light smoking do have a lung cancer risk, but the risk is not high enough to benefit from routine screening after the age of 55 - for them, the risk of harms from lung cancer screening is greater than the benefits.

The patient needs to make an informed decision

The American Cancer Society says that patients and health care professionals need to know about the benefits, limitations and harms associated with a screening test. Screening tests have limitations and may be linked to possible harms.

Examples of limitations include anxiety, worry, the inconvenience involved in further testing, and the complications and potentially life-threatening risks linked to some diagnostic tests that occur after a false-positive result.

There is concern that modern technology can detect small tumors that are no threat to the patient, even though they are technically cancerous tumors.

"Overdiagnosing" tumors can result in unnecessary procedures and treatments, which themselves raise the risk of complications and pointless discomfort and pain for the patient. In some cases patients' lives may be put at risk.

For doctors and people in the medical profession, keeping these "overdiagnosis" numbers down to a minimum is crucial.

In an online communiqué, the American Cancer Society wrote:

"Still, for the group of people at high risk, the benefit of screening may outweigh the potential risks. If you fall into that group, tell your health care professional about your smoking history so he or she can begin a conversation with you about lung cancer screening."
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Healthcare's Mobile Revolution - What Do We Know About Its Effectiveness?

Two systematic reviews by Caroline Free and colleagues from the London School of Hygiene & Tropical Medicine are published in PLOS Medicine this week and examine the evidence on whether mobile technology can help improve health behaviors, improve disease self-management, or help health care delivery processes. The researchers report that while mobile technology-based interventions have shown moderate benefits in a few specific contexts, not all outcomes are beneficial. Moreover, rigorous studies in low- and middle-income settings - where experts agree that mobile health has tremendous potential--largely do not exist.

In the first article, the scientists systematically searched for and analyzed all reported controlled trials of mobile technology interventions for health-care consumers with the aim to change health behavior or improve disease management. They identified 75 trials, of which 72 had been conducted in high-income countries. Three trials with low risk of bias showed clear benefits: two trials tested interventions developed to help smokers quit (both conducted in the UK), and one trial in Kenya examined an intervention that helped HIV-positive patients to take their medications accurately, which in turn improved their HIV viral load. The other trials showed modest or no benefits.

In the second publication, the researchers systematically reviewed trials that evaluated the effectiveness of mobile technology-based interventions for health care providers or services. They identified 32 trials of interventions designed to support communication among health care providers and 10 trials of interventions targeting communication between health services and health care consumers (appointment reminders and information regarding test results). None of those trials were conducted in low-income countries (though a recent update of the search identified one recently published trial from Kenya). The researchers found that while some interventions designed to provide support for health care providers modestly improved aspects of clinical diagnosis and management, other interventions were less successful. Most notably, the use of mobile technology-based photos for diagnosis sometimes resulted in incorrect diagnoses compared with face-to-face-diagnosis. SMS-based appointment reminders were better than no reminders but not better than reminders by phone or mail.

Given the much-heralded potential benefits of mobile health and the limited evidence available to date, the authors stress that additional rigorous tests of mobile health interventions are needed, especially tests in low- and middle-income settings, where the control group of "standard care" might be very different from the standard care available in high-income countries.
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