Researchers ID potential prognostic marker for recurrence of head & neck squamous cell carcinoma

Molecular profiling may be useful for early diagnosis and treatment decisions, according to study published in the American Journal of Pathology

A new study provides the first evidence that the mediator complex subunit 15 (MED15) may play a crucial role in the pathophysiology of head and neck squamous cell carcinoma (HNSCC). MED15 overexpression was found to be associated with higher mortality rates in HNSCC patients with cancer recurrence, particularly in oral cavity/oropharyngeal tumors, according to the study published in the American Journal of Pathology. MED15 overexpression was also associated with heavy alcohol consumption, which is an HNSCC risk factor.HNSCC is the sixth most common cancer worldwide and has a high rate of recurrence and early metastatic disease, resulting in approximately 350,000 deaths each year. “Our findings suggest that MED15 may serve as a prognostic marker for HNSCC recurrence and as a therapeutic target in HNSCC patients suffering from recurrences,” said lead investigator Sven Perner, MD, PhD, of the Department of Prostate Cancer Research, Institute of Pathology, and the Department of Otorhinolaryngology at the University Hospital of Bonn (Germany).

Read the rest of the article at http://www.medicalnewstoday.com/releases/291264.php.

Morphine after tonsillectomy ‘potentially life-threatening’ for children

Painkilling medication is usually prescribed following most forms of surgery. However, the use of morphine to treat the post-operative pain of children having their tonsils removed could lead to potentially life-threatening respiratory problems, according to the findings of a new study.

The effects of morphine were so severe that the study’s Drug Safety Monitoring Board halted the study period early. In contrast, the study showed that ibuprofen could be used safely and effectively as an alternative.”These results should prompt clinicians to re-evaluate their post-tonsillectomy pain treatment regimen. Due to the unpredictable respiratory side-effects of morphine, its use as a first-line treatment with current dosage ranges should be discontinued for outpatient tonsillectomy,” says study co-author Dr. Doron Sommer.

Read the rest of the article at http://www.medicalnewstoday.com/articles/288534.php.

HPV vaccine highly effective against multiple cancer-causing strains

According to a multinational clinical trial involving nearly 20,000 young women, the human papilloma virus vaccine, Cervarix, not only has the potential to prevent cervical cancer, but was effective against other common cancer-causing human papillomaviruses, aside from just the two HPV types, 16 and 18, which are responsible for about 70 percent of all cases. That effectiveness endured for the study’s entire follow-up, of up to four years. The research was published in Clinical and Vaccine Immunology, a journal of the American Society for Microbiology.”The study confirms that targeting young adolescent girls before sexual debut for prophylactic HPV vaccination has a substantial impact on the incidence of high grade cervical abnormalities,” said corresponding author, Dan Apter, Director, The Sexual Health Clinic, Family Federation of Finland, Helsinki.The vaccine was extremely effective in young women who had never been infected with HPV. It protected nearly all from HPV-16 and -18, and protected 50-100 percent against different grades of precancerous transformation of cervical cells caused by other strains of HPV, including up to 100 percent of those with the immediate precursor grade to cancer. The women were followed for up to four years post-vaccination.

Read the rest of the article at http://www.medicalnewstoday.com/releases/289503.php.

Glioblastoma: Study ties 3 genes to radiation resistance in recurrent tumors

A new study identifies three genes that together enable a lethal form of brain cancer to recur and progress after radiation therapy.The findings might lead to new therapies that target cancer stem cells, say researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James), who led the study.The work focused on the brain cancer glioblastoma multiforme (GBM). It investigated a subset of cancer cells within those tumors that behave like stem cells and that sometimes survive radiation therapy. To understand how those cancer stem-like cells survive irradiation, the researchers examined the cancer-related gene EZH2, which is unregulated in GBM and other cancers.They discovered that in GBM stem-like cells – but not in other tumor cancer cells or in healthy body cells – EZH2 is regulated/controlled by a gene called MELK in combination with a second gene, FOXM1. The interaction of the three genes helps the cells survive therapy.

Read the rest of the article at http://www.medicalnewstoday.com/releases/288940.php.

Using 3-D printing, MakerBot and Feinstein Institute repair tracheal damage

Results are showcased at 51st Annual Meeting of The Society of Thoracic Surgeons

Investigators at The Feinstein Institute for Medical Research have made a medical breakthrough using 3D printing on a MakerBot® Replicator® 2X Experimental 3D Printer to create cartilage designed for tracheal repair or replacement. The results were reported today at the 51st Annual Meeting of The Society of Thoracic Surgeons in San Diego, in a presentation by Todd Goldstein, an investigator at the Feinstein Institute, part of the North Shore-LIJ Health System. This is a first for medical research where regular MakerBot PLA Filament was used to 3D print a custom tracheal scaffolding, which was combined with living cells to create a tracheal segment. For more information read here  http://www.medicalnewstoday.com/releases/288613.php.

The sense of smell uses fast dynamics to encode odors

Neuroscientists from the John B. Pierce Laboratory and Yale School of Medicine have discovered that mice can detect minute differences in the temporal dynamics of the olfactory system, according to research that will be published in the open access journal PLOS Biology.

The research team used light in genetically-engineered mice to precisely control the activity of neurons in the olfactory bulbs in mice performing a discrimination task. This approach to controlling neural activity, called optogenetics, allows for much more precise control over the activity of neurons of the olfactory system than is possible by using chemical odors. The “light-smelling” mice were able to detect differences as small as 13 milliseconds between the dynamics of these “virtual odors”.

Because olfactory bulbs exhibit dynamic neural activations in the range of many tens of milliseconds, the 13 millisecond detection limit suggested that mice should be able to discriminate these dynamics. The researchers tested this hypothesis by recording brief “movies” of the dynamic activity in the olfactory bulbs of one group of mice and projecting them back onto the olfactory bulbs of another group of naïve mice. The naïve mice were indeed able to discriminate between the movies, demonstrating that the neural dynamics of the bulb contain fundamental information about odors.

“This data is very exciting as it shows for the first time that the temporal dynamics of bulbar neural activity are meaningful to the animal”, remarked Associate Professor Justus Verhagen, the lead author on the paper. “Before optogenetics arrived as a new tool we had no means to test if this was true, we could read out the dynamic activity but could not impose it back on the brain and ask questions about its role in odor discrimination “.

These new findings build upon earlier evidence that olfactory processing in mice included temporal information about sniffs. “We knew from prior work by the team of Dr. Dima Rinberg that mice could accurately determine when their olfactory system was stimulated relative to the timing of sniffs. We now know that mice can also obtain this information directly by comparing the timing of activities among neurons. We hence think that the neural population dynamics are important for the sense of smell both independently of and relative to sniffing. Thus, a sniff can be the “start” signal from which the brain begins to analyze the times at which different neurons turn on, but the brain can also do this independently of the sniff by using the earliest neural activations themselves as “start” signals. Combined these mechanisms provide for a very robust means for the brain to use time information. However, we don’t yet know how these two forms of temporal information may interact”.

Dr. Verhagen’s lab is one of several at Yale and the John B. Pierce Laboratory that are studying the neurobiology of food and flavor perception. His lab is unique in applying the power of optogenetics in mice to study the spatio-temporal capabilities of the olfactory neural circuitry that underlies these vital perceptual functions.

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/287083.php

Could HIV make hearing worse?

Human immunodeficiency virus can be incredibly debilitating, leaving individuals vulnerable to serious illnesses. On top of this, researchers have now suggested that adults with the virus have poorer low- and high-frequency hearing than adults who do not have the disease.

 

The findings, published in JAMA Otolaryngology – Head and Neck Surgery, come after an evaluation of the pure-tone hearing thresholds of men and women, some with the human immunodeficiency virus (HIV+) and some without (HIV-).

HIV is a virus that impairs the immune system, making people with the condition increasingly susceptible to infection and disease. There is currently no cure, but HIV+ individuals can be given a combination of medicines called highly active antiretroviral therapy (HAART) to slow the spread of the virus.

Since HAART became widely used, there has been very little investigation into the relationship between HIV infection and hearing loss, according to the study authors.

“There have been limited data obtained on the effects of HIV-related medication use on hearing loss,” they write, “and in the few published studies, it is difficult to attribute the increases in hearing loss specifically to HIV medication use rather than age or cumulative noise exposure.”

Dr. Peter Torre III, of San Diego State University in California, and colleagues set out to determine whether HIV disease variables and HAART are associated with changes to pure-tone threshold levels – the softest sounds audible to individuals for the majority of the time.

Evaluating the pure-tone threshold averages

For the study, the researchers assessed the hearing of 262 men with an average age of 57 and 134 women with an average age of 48.

Of the men, 117 (44.7%) were HIV+, and of the women, 105 (78.4%) were HIV+. Participants were taken from the sites of the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study.

Pure-tone threshold levels were measured in both ears in a sound-treated room. The researchers tested a wide range of frequencies, from 250 Hz to 8,000 Hz.

The researchers discovered that high- and low-frequency pure tone averages (LPTA and HPTA) were significantly higher in the better ears of the HIV+ participants, indicating that their hearing was poorer than the HIV- participants.

Even after adjusting the findings for current CD4+ cell count, HIV viral load and long-term exposure to antiretroviral medication, the results remained the same.

“To our knowledge, this is the first study to demonstrate that HIV+ individuals have poorer hearing across the frequency range after many other factors known to affect hearing have been controlled for,” write the authors.

Poorer hearing also found in individuals with diabetes mellitus

“The participants were middle-aged,” write the authors, “so an HIV effect on LPTA was not expected, given the speculation that long-term [HAART] exposure or HIV itself contributes to premature aging.”

Although unexpected, the authors also note that hearing loss at both LPTA and HPTA has previously been observed to be more likely in adults with diabetes mellitus. “It is possible that both HIV infection and diabetes, being systemic diseases, could affect the neural function of the cochlea,” they suggest.

The study is limited by the fact that participants were only recruited from specific geographical areas, namely Baltimore, MA, and Washington, DC. For women, the ratio of HIV+ to HIV- participants was also uneven, and future studies could rectify these representational imbalances.

“Although we do not understand the mechanism of hearing loss found in our study, our results suggest that HIV+ individuals may have physiologic changes that mimic other chronic conditions that affect hearing levels,” conclude the authors.

Earlier this month, Medical News Today reported on a mouse study suggesting hearing loss could be prevented by a vitamin supplement that protects the nerves stimulating the cochlea.

Written by James McIntosh

 

 

More than three years after pulsed-KTP laser treatment, 96 percent of patients with early vocal-cord tumors are cancer-free

The first long-term study of a pioneering endoscopic laser treatment for early vocal-cord cancer, developed at Massachusetts General Hospital (MGH) and previously shown to provide optimal voice outcomes, finds that it is as successful as traditional approaches in curing patients’ tumors while avoiding the damage to vocal quality caused by radiotherapy or by conventional laser or cold-instrument surgery. The report in the December Annals of Otology, Rhinology & Laryngology describes results for the first 117 patients treated for vocal-cord cancer with the green-light potassium-titanyl-phosphate (KTP) laser by Steven Zeitels, MD, director of the MGH Voice Center and developer of the procedure.

“Use of the KTP laser, which eradicates blood vessels in a process called photoangiolysis, was conceived to treat vascular malformations in infants’ delicate skin; but we have demonstrated that this specialized laser is especially effective in treating vocal-cord cancer,” says Zeitels. “These tumors have a denser blood supply than the underlying vocal-cord tissue, preservation of which is necessary to retain optimal vocal quality. As reported in this paper, our success in curing patients with small tumors with the angiolytic KTP laser is extremely high and very high for those with mid-sized tumors.

“Since radiation can damage the non-cancerous tissue of one or both vocal cords and conventional laser surgery destroys more delicate vocal tissue than is necessary, KTP laser treatment typically produces better vocal results while being more cost-effective,” he adds. “And a key issue when selecting a treatment for vocal-cord cancer is that radiation is considered to be a single-use treatment. So it is important to preserve the option of radiotherapy for treating future, more substantial cancers, the development of which is not uncommon.”

Zeitels first reported the use of the yellow-light, pulsed-dye laser to treat early vocal-cord cancer ten years ago, and in 2006 he and his colleagues introduced treatment with the more precise green-light KTP laser. Initial results with the KTP laser, describing the outcomes for 22 patients an average of 27 months after their procedures, were announced at the 2008 American Broncho-Esophagological Association (ABEA) annual meeting and published in Annals of Otology, Rhinology & Laryngology. A 2013 paper in the same journal reported excellent vocal outcomes for the first 92 treated patients, but neither paper included the kind of follow-up data required to confirm the treatment’s long-term effectiveness in curing the tumors.

The current paper describes results for 117 patients treated with the green-light KTP laser between 2006 and 2010. Some had cancer invading both vocal cords, but none had received radiotherapy before the laser treatment. Of the 82 treated patients with small tumors, 96 percent (79 of 82) have had no recurrence more than three years after treatment, and 80 percent (28 of 35) of those with mid-size tumors also have had no recurrence. Among the 10 patients whose tumors did recur, radiation treatment was successful in controlling the cancer in 5. Overall 96 percent – 112 of 117 patients – of those treated have survived an average of almost four and a half years and are cancer-free without loss of their larynx. At this year’s ABEA annual meeting the researchers received the organization’s prestigious Broyles Maloney Award for their successful development of this innovative, minimally-invasive strategy for treating vocal cord cancer.

Since 2010, more than 75 additional patients have received pulsed-KTP laser treatment for early vocal-cord cancer at MGH. Zeitels recently treated a 13-year-old boy with vocal-cord cancer, a rare condition in one so young. The first child to receive the KTP laser cancer treatment, he was referred to Zeitels after cancer was discovered in a biopsy of what were originally believed to be benign human papilloma virus (HPV) warts. While in only the first months after treatment for tumors involving both vocal cords, the youth’s voice has returned to near normal for a young man of his age. (An endoscopic video showing before-and-after results for this patient may be viewed here:

Another important aspect of the green-light KTP laser approach, Zeitels adds, is that biopsy and treatment of patients whose cancer involves a single vocal cord usually can be accomplished in the same procedure, whereas radiotherapy requires a prior biopsy to determine the extent and location of the tumor, followed by daily radiation treatments over approximately six weeks. For patients with tumors involving both vocal cords, a planned second-stage KTP laser treatment is done to optimize their voice outcomes. In addition, Zeitels notes, the treatment’s mechanism of eradicating the blood vessels supplying a tumor – highly effective for conventional vocal-cord cancer – is even more useful for treating tumors caused by HPV infection, which are characterized by an excessive overgrowth of blood vessels.

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/286774.php

 

 

Racial disparities in ear infection treatment may contribute to antibiotic overuse

Black children are less likely to be diagnosed with and less likely to receive broad-spectrum antibiotics for ear infections than white children are, a new study has found. But the discrepancy in prescribing fewer broad-spectrum antibiotics means black children actually are more likely to receive care that aligns with the recommended guidelines for treating ear infections.

Two explanations for the observed disparities in care are overtreatment and overdiagnosis in white children, and undertreatment and underdiagnosis in black children. Addressing behaviors that contribute to these findings may cut down on differential care and antibiotic overuse, both significant public health concerns.

Led by researchers at the University of Utah, Emory University, and the Centers for Disease Control and Prevention (CDC), the study appears online in Pediatrics.

“These findings raise the possibility that physicians bring with them to the exam room cultural and racial biases that influence how they make a diagnosis and prescribe antibiotics,” says senior author Adam Hersh, M.D., Ph.D., assistant professor of pediatrics at the University of Utah School of Medicine.

Examination of medical records from across the nation shows that when children were brought to the doctor for upper respiratory infections that commonly lead to ear infections, 30 percent fewer black children (African-American and other black racial backgrounds) were diagnosed with ear infections compared to other children (95 percent white, 5 percent of other non-black racial backgrounds). Once diagnosed with an ear infection, black children were 20 percent less likely to receive a prescription for broad-spectrum antibiotics.

The results indicate that, whether intentional or not, black children are more likely to receive care that aligns with current ear infection treatment guidelines, which specifically recommend a prescription of narrow-spectrum antibiotics, rather than broad-spectrum antibiotics, as first-line treatment. What’s more, fewer ear infection diagnoses among black children suggest that in some cases, ear infections may be overdiagnosed in other children.

“These findings may indicate racial differences in the diagnosis of otitis media,” says first author Katherine Fleming-Dutra, M.D., pediatric emergency fellow at Emory University and Children’s Healthcare of Atlanta. “Additionally they may reflect inappropriate treatment of otitis media with the use of broad-spectrum antibiotics in a majority of U.S. children.”

Guidelines for treating ear infections have been updated in recent years in an effort to confront antibiotic overuse. Ear infections can be difficult to accurately diagnose, and it can be hard to distinguish bacterial from viral infections. Physicians sometimes err on the side of prescribing antibiotics when the diagnosis is uncertain, even though they are ineffective against viral infections. Overprescribing antibiotics, and unnecessary use of broad-spectrum antibiotics, can lead to adverse side effects such as severe diarrhea, and development of antibiotic-resistant bacteria.

“The use of antibiotics is the single most important driver of antibiotic resistance. Further, ear infections lead to more antibiotic prescriptions in the United States than any other diagnosis,” says co-author Lauri Hicks, D.O., medical director of Center for Disease Control’s Get Smart: Know When Antibiotics Work program. “By increasing our knowledge base about antibiotic prescribing behaviors, we can develop tools and interventions to improve antibiotic prescribing.”

The results were derived from a sample of 15,694 doctor visits for respiratory infections and 4,178 visits for ear infections made by children age 14 years and younger between the years 2008 to 2010. The samples extrapolate to a national estimate of 23.5 million, and 6.4 million annual visits, respectively.

Though not directly addressed by the study, one explanation for disparities in treatment are biases toward children and families of different races. “Overtreatment and overdiagnosis could result from the possibility that in some circumstances, parents may expect an antibiotic prescription, or physicians may perceive that they do,” says Hersh. “Physicians may tailor their diagnosis based on these perceptions of patient expectations.”

Another explanation, underdiagnosis of ear infection and undertreatment with broad-spectrum antibiotics, could result from a number of factors including differences in how frequently parents of black children seek care for their children with respiratory infections, or return for follow-up visits. Racial differences in the reported rate of medication allergies could also influence the choice of antibiotics.

The authors found that equal proportions of black children and children of other races made visits to the doctor for respiratory infections, suggesting that lower rates of ear infection diagnoses in black children are not the result of decreased access to care. But limitations to the analysis include an inability to determine whether the visits were first or follow-up visits, and whether patients had allergies, both of which could impact treatment.

“It is important to understand why certain children are not getting guideline-recommended antibiotics so that we can focus public health efforts to help providers improve their diagnosis and selection of antibiotics for children with otitis media,” says Fleming-Dutra.

http://www.medicalnewstoday.com/releases/285552.php

 

Picture courtesy to articles.mercola.com

 

 

Women’s finer sense of smell may be due to more brain cells

w research shows that women have more cells in the olfactory bulb – the area of the brain that is dedicated to sense of smell – than men. The authors of the study – published in PLOS ONE – suggest this may explain why women are reported to have a better sense of smell than men.

 

The study was led by a team from the Federal University of Rio de Janeiro in Brazil, where another group of researchers had developed the “isotropic fractionator” – a fast and reliable method of measuring the number of cells in a given brain region such as the olfactory bulb.

The olfactory bulb is the first region of the brain to receive signals about odors sensed via the nostrils. The ability to discriminate among odors and scents varies widely among individuals. Also, studies show marked differences between men and women, with women often outperforming men in many kinds of odor-sensing tests.

There are theories that sex differences in smell are due to cognitive and emotional influences rather than perceptual ability.

Previous studies that have looked for biological explanations for women’s apparent superior sense of smell have used brain scans to look for structural and volume differences. These have led to mixed results and left many questions still unanswered.

So Roberto Lent, a professor in the Institute of Biomedical Sciences at Rio’s Federal University, and colleagues set out to measure the biological evidence more directly – by counting the number of cells in women’s and men’s olfactory bulbs.

To this end they examined post-mortem brains from seven men and 11 women who were all healthy and aged over 55 when they died. None of the subjects had worked in jobs that required them to have exceptional sense of smell such as cookery or coffee-tasting.

Study found women’s brains have up to 50% more olfactory neurons

Using the isotropic fractionator, the team calculated the number of cells in the olfactory bulbs of these individuals and found that, on average, the women had 43% more cells in this brain region than the men. When they included only neurons in the count – that is leaving out other cells like glial or structural cells – this figure went up to nearly 50%.

The authors acknowledge that just finding this difference is not enough to prove that women have a superior sense of smell – it is not even enough to explain the findings of previous studies about differences in ability to differentiate, identify and remember scents and odors. However, Prof. Lent suggests:

“Generally speaking, larger brains with larger numbers of neurons correlate with the functional complexity provided by these brains. Thus, it makes sense to think that more neurons in the female olfactory bulbs would provide women with higher olfactory sensitivity.”

Since the brain does not accumulate many more cells as we grow, it would seem that women are equipped with these extra olfactory cells from the day they are born.

There are still many questions to explore, including why women should have this ability hard-wired into their brains, and what mechanism produces this greater quantity of olfactory cells in the female brain.

One theory is that a superior sense of smell helps mother and child to bond after birth; another is it also influences females’ selection of potential mates.

In October 2012, Medical News Today learned of another PLOS ONE study from the University of Pennsylvania that suggested losing sense of smell could be an early sign of Parkinson’s or Alzheimer’s disease, or another neurodegenerative disorder.

Written by Catharine Paddock PhD

http://www.medicalnewstoday.com/articles/284991.php