Sperm are simple cells with a straightforward job: swim until they reach an egg, then fertilize it. But in mice, some sperm resort to divisive tactics in order to gain the advantage.

A study published on February 4 in the journal PLOS Genetics shows that a genetic variation in mouse sperm, called the t-type, can give a swimmer the upper hand. These t-type sperm are able to spread a protein called RAC1 that essentially poisons other sperm. T-type sperm plant the seeds of destruction early in their development, then fortify themselves against RAC-1, Brandon Specktor reports for Live Science. When it comes time to race for the egg, the t-type sperm can swim in a straight line while poisoned sperm swim in hapless circles until they die.

We found out that the level of this protein can be more or less active, depending on whether the sperm have the gene to make it, and whether that gene is flipped on like a light switch, says biologist Alexandra Amaral of the Max Planck Institute for Molecular Genetics to Kassidy Vavra at Inverse. The level of protein that is on has to be quite well regulated. If it is too much, sperm don't move well. And if its too low, it also doesnt move well theyre kind of in circles.

T-type sperm produce the RAC1 protein at full throttle.

If all of the sperm in a group are t-type, and theyre all making RAC1, they will all struggle because there is so much of the poisonous protein going around, Sara Rigby reports for Science Focus magazine. On the other hand, if there are no t-type sperm present, then all the other sperm remain relatively healthy and swim well because theres no overabundance of RAC1. However, if a cohort has a mix of t-type and normal sperm, then t-type will have the advantage.

"The trick is that the t-haplotype 'poisons' all sperm, but at the same time produces an antidote, which acts only in t-sperm and protects them," says Bernhard Herrmann, director of the Max Planck Institute for Molecular Genetics, in a statement. "Imagine a marathon, in which all participants get poisoned drinking water, but some runners also take an antidote."

The t-type sperm do the equivalent of poisoning the drinking water early in sperm development, affecting both themselves and their non-variant peers. All of the sperm inherit genes that make it difficult to interpret the chemical signals around them. But in the final cell division of sperm development, when half of a cells genes go to one sperm and the other half to another, only the sperm that inherit the t-type variation have an extra set of genes that reverses the poisons effect, per Live Science.

The poisoned sperm end up swimming in circles, unable to advance in their quest. But the impervious t-type sperm swim ahead. In this case, theres a 99 percent chance that the sperm that fertilizes the egg first will have the t-type variation. The research shows the importance of small genetic variations in sperms success, Amaral tells Inverse.

The study was conducted in about 100 mouse sperm cells, but not all species sperm behave the same way, University of California, Berkeley, cell biologist Polina Lishko tells Inverse. The study is preliminary, but future research could illuminate the specific molecular mechanism behind RAC1 that makes it damaging to sperm at high levels.

An earlier study showed a similar effect of RAC1 on bull sperm, which is more similar to human sperm than a mouses is. Amaral says that the team plans to conduct future research with human sperm, to see if RAC1 might be involved with some cases of male infertility.

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Mice Sperm Sabotage Other Swimmers With Poison | Smart News - Smithsonian Magazine

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It is not just a mother's love that endures.

A woman's influence on her children's health persists well into late middle age, according to a study published in the November issue of the European Journal of Preventive Cardiology.

The study, which enrolled almost 2,000 men and followed their families over 46 years - from 1971 to 2017 - found that the sons of women with heart-healthy lifestyles live nearly a decade longer without developing cardiovascular disease than those whose mothers have unhealthy lifestyles.

The study looked at the influence of both parents on offspring but found that men had little influence on their children's heart health in later life apart from the genes they passed on to them.

According to Dr Rohit Khurana, senior consultant cardiologist with The Harley Street Heart and Vascular Centre at Mount Elizabeth Medical Centre, told The New Paper: "While a pregnant woman's cardiovascular health (CVH) and lifestyle choices during pregnancy can affect her offspring's CVH, long-term CVH is also affected through parental behaviours and environmental influences.

"Children observe and acquire health behaviours within the family environment, with role modelling by primary caregivers being a significant contributor to children's long-term lifestyle choices.

"If primary caregivers, usually mothers, practise and instil a healthy lifestyle of balanced diets, regular exercise and minimal to zero alcohol and tobacco intake... their children are likely to continue those behaviours in adulthood.

"Those children will then pass good habits down to their children, thereby decreasing the risk of CVD (cardiovascular disease) within families for generations."

He added: "The research shows that parents, particularly mothers, are the gatekeepers of their children's CVH during formative years, which influences adult life. Numerous studies have proved that good lifestyle choices are a greater determining factor compared with genetics when it comes to optimal CVH."

According to the study, CVD incidence rates were higher among sons than daughters, (with one reason being that) women are less likely to indulge in risky behaviours.

For example, according to the World Health Organisation, about 40 per cent of the world's male population smokes, compared with only 9 per cent of women, and men are almost twice as likely to binge drink as women.

Studies also show that women generally eat more healthily and consume more fruit and vegetables than men.

Finally, women develop CVD later in life, after menopause and typically in their 60s or older; so fewer of the female participants in the study had reached the age when we would expect to see signs of CVD.

Mothers are still the primary caretakers of young ones, with more direct daily influence on diet and behaviour than fathers. They are still more likely to be disciplining, providing emotional support and generally monitoring the daily activities of their children.

Taking good care of your CVH during pregnancy is important because the heart works harder by increasing the body's blood volume to support a growing baby.

If you are a diabetic, a smoker or have high blood pressure during pregnancy, each of these things makes it harder for your heart to pump extra blood throughout your circulatory system, increasing the likelihood of maternal and neonatal mortality and morbidity.

This does not mean women with CVD risk factors should not get pregnant - it just means they should practise good preconception heart care including smoking cessation, cutting back on alcohol and weight management through regular exercise and a healthy diet rich in fruit, vegetables and fibre.

After women give birth, they should continue practising healthy behaviours at home as good examples to help children make positive choices, which become lifelong habits.

Telling children what to do will not always work as they need to see parents walk the talk.

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Sons of heart-healthy mums more likely to live 10 years longer: Study - The New Paper

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Full Guideline: Hormonal Replacement in Hypopituitarism in AdultsJCEM | October 2016Maria Fleseriu (Chair), Ibrahim A. Hashim, Niki Karavitaki, Shlomo Melmed, M. Hassan Murad, Roberto Salvatori, and Mary H. Samuels

The 2016 guideline addresses:

The guideline addresses special circumstances that may affect the treatment of patients with hypopituitarism, including pregnancy care, post-surgical care following pituitary or other operations, treatment in combination with anti-epilepsy medication, and care following pituitary apoplexya serious condition that occurs when there is bleeding into the gland or blood flow to it is blocked.

Recommendations from the guideline include:

+ 1.0 Diagnosis of hypopituitarism

Central adrenal insufficiency

Central hypothyroidism

GH deficiency

Central hypogonadism in males

Central hypogonadism in females

Central diabetes insipidus

+ 2.0 Treatment

Hormonal replacement in panhypopituitarism

Glucocorticoid replacement

Adrenal crisis

Thyroid hormone replacement

Testosterone replacement

Estrogen replacement in premenopausal women

GH replacement therapy

Diabetes insipidus

Interactions between replacement hormones

Glucocorticoids and GH

Glucocorticoids and thyroid hormone

Glucocorticoids and estrogen

GH and thyroid hormones

Estrogen and thyroid hormones

GH and estrogen

Glucocorticoids and diabetes insipidus

Risk of hormonal over-replacement in hypopituitarism

Bone disease

Cardiovascular risks in patients with hypopituitarism on replacement therapy

Glucocorticoid over-replacement

Thyroid replacement

+ 3.0 Special circumstances

Cushings disease

Prolactinomas

GH replacement in cured acromegaly after surgery and/or radiation

Perioperative management of hypopituitarism

Pituitary surgery

Non-pituitary surgery

Management of hypopituitarism in pregnancy

Glucocorticoids

Thyroid

Desmopressin

Growth hormone

Management of hypopituitarism in pituitary apoplexy

Treatment of hypopituitarism in patients receiving antiepileptic medications

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Hormone Replacement in Hypopituitarism Guideline Resources ...

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A gene therapy costing 16 crore is the only shot of life for nearly 200 children with Spinal Muscular Atrophy (SMA) Type 1, a rare genetic disease, in Karnataka.

Last month, the therapy Zolgensma was offered free to a 14-month-old baby from Bhatkal (Uttara Kannada) who was the lucky winner of a lottery through a compassionate access programme by Novartis, the Swiss drugmaker. This lottery is held once in two weeks for SMA children across the world and doctors at Baptist Hospital, that has a dedicated Paediatric Neuromuscular Service, are hoping more children will benefit.

The therapy is a one-time infusion that takes about an hour, Ann Agnes Mathew, Consultant Paediatric Neurologist and Neuromascular Specialist, at Baptist Hospital told The Hindu. The therapy was approved by U.S. regulators in May 2019 and has since then turned into a miracle drug for this rare disorder that destroys a babys muscle control.

SMA is a disease caused by loss of nerve cells, which carry electrical signals from the brain to the muscles. The protein needed for this signalling is coded by a gene for which everyone has two copies - one from the mother and the other from the father. A child develops this disorder only if both the copies are faulty. Without treatment, this disease is ultimately fatal, said Dr. Mathew. The disease as it progresses, makes it extremely difficult for the babies to carry out basic activities like sitting up, lifting their head or swallowing milk.

Pointing out that the current treatment options range from medicines, which increase these proteins, to replacing the faulty gene, the doctor said, Zolgensma is a revolutionary treatment, which works by supplying a healthy copy of the faulty gene, which allows nerve cells to then start producing the needed protein. That halts deterioration of the nerve cells and allows the baby to develop more normally.

The drug has a 14-day shelf life and when it was sent from U.S. for the Bhatkal baby, it was stuck with customs for three days in mid-January making doctors jittery. Dr. Mathew said she had to personally meet the Customs officials to get it released. When we explained the situation to them, they immediately released it. Any further delay would have been risky. The parents have taken a house on rent and are staying near the hospital for follow up. The baby is doing fine now, she said.

Pointing out that 38 babies had succumbed to the rare disease in Karnataka in over one-and-a-half years, Dr. Mathew said most families have given up hope as they cannot afford the treatment.

The Paediatric Neuromuscular Service at Baptist Hospital is a pioneering centre in the country with a multidisciplinary team of a paediatric neurologist, paediatric neuromuscular specialist, paediatric geneticist, paediatric pulmonologist, paediatric intensivist, paediatric cardiologist and paediatric endocrinologist providing comprehensive care under one roof. This service is run in collaboration with Organisation for Rare Diseases India, a NGO.

A Bengaluru-based couple - Naveen Kumar and Jyothi - have taken to crowdfunding on ImpactGuru.com, a crowdfunding platform, to cover the cost of Zolgensma therapy for their 10-month-old baby Janish who was diagnosed with SMA.

Mr. Kumar, who works as an insurance surveyor and barely earns 30,000 a month, cannot afford the expensive treatment.

The couple were counting their babys milestones after his birth in February 2020. They caught his first smile and his first laugh but baby Janish never went past his first two milestones. The parents then rushed him to a pediatrician and from there the baby was referred to Baptist Hospital, said Dr. Ann Agnes Mathew, who has been treating the baby for the last five months.

Piyush Jain, co-founder and CEO, ImpactGuru.com, said over 22 lakh has been raised so far for baby Janish from over 1,500 donors.

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Mega Doctor NEWS

Edinburg, TX Can a medical tool predict the risk of certain medications based on a patients genetics, and, if so, could this information lead to doctors customizing a patients drug therapy? The tool being studied at DHR Health Institute for Research & Development to answer these questions is Cipheromes Xentinel Lighthouse, and this pilot study will also evaluate the resulting savings in health-care costs.

After a stroke or heart attack, the standard treatment is Percutaneous Coronary Intervention (PCI), or stent placement. A stent opens blood vessels in the heart that have narrowed due to the buildup of plaque. Following PCI, doctors typically prescribe aspirin and a P2Y12 inhibitor, such as clopidogrel (Plavix), to reduce the risk of stent thrombosis, which is the formation of a blood clot on the surface of the stent.

Lighthouse is a support tool that allows physicians to predict how a patient will respond to drug therapies based on that patients genetic makeup. Cipherome, Inc. chose South Texas for this pilot project to better understand how the genetic differences in Hispanic/Latino patients relate to the effectiveness and safety of medications used to treat them.

Most prior studies to anticipate major bleeding caused by this drug therapy have been based on data collected from Caucasian patients, have not been based on apatients individual risk profile, and have not been strong predictors of thrombosis risk, says Dr. Herschl Silberman, a cardiologist at DHR Health and a Clinical Research Scientist, DHR Health Institute for Research & Development. This lack of effective clinical tools has resulted in high numbers of emergency room visits and patients being readmitted to the hospital with stent thrombosis, bleeding, and other complications.

In 2019 alone, over 1.5 million patients visited an emergency room or were hospitalized due to unexpected reactions to drug therapies, and 174,000 people in the U.S. lost their lives due to these adverse reactions. Recent studies show the possibility of an 80-percent reduction in PCI 90-day complications by using a patients personalized genetic information.

Personalized medicine brings great promise to improve outcomes for our patients and we are focused on pioneering innovative practical solutions that can produce better results for our clinicians and patients, says Dr. Sohail Rao, CEO of DHR Health Institute of Research and Development (DHR IRD). DHR IRDs credibility and service to the large Hispanic population in South Texas is the ideal place for our first deployment of clinical decision support systems, says Ilsong Lee, Cipherome CEO.

This study is open to patients 18 years of age and older who have been prescribed clopidogrel, prasugrel (Effient), or ticagrelor (Brilinta) after a PCI with at least one stent placement. There are two study arms, or groups, one receiving clopidogrel but no genotyping to identify the patients genetic makeup and the other receiving genotype-guided therapy. Patients in the study will be evaluated for a period of one year.

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The First Gene Based Project to be conducted in the Rio Grande Valley - Mega Doctor News

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Spondyloarthritis is an umbrella term that describes different types of arthritis. These types mainly affect the spine, but they can also cause symptoms in other parts of the body.

There has been some debate about whether spondyloarthritis is an autoimmune condition or an autoinflammatory condition. However, recent research suggests that spondyloarthritis is indeed an autoimmune condition.

This article will explore spondyloarthritis in detail. Specifically, it will examine the different types, symptoms, and treatment options associated with the condition.

There are several subtypes of spondyloarthritis. Each can involve a different part of the body.

The following sections will look at some of these types in more detail.

Ankylosing spondylitis is the most common form of spondyloarthritis. It involves ligaments, tendons, and joint capsules attaching to bones in the spine and peripheral joints.

It can cause the bones in the spine to fuse together, leading to stiffness and immobility.

Learn more about ankylosing spondylitis here.

This type of spondyloarthritis primarily involves the joints in the spine and pelvis.

Axial spondyloarthritis causes back pain and affects around 5.5 million people in the United States.

Like axial spondyloarthritis, the non-radiographic form also affects the spine and causes lower back pain.

However, the effects of non-radiographic spondyloarthritis are not visible on X-rays. They are only visible on more sensitive imaging tests, such as MRI scans.

Peripheral spondyloarthritis describes a number of spondyloarthritis subsets.

It mainly affects the hands and feet. However, it can also cause inflammation in the:

Both rheumatoid arthritis and spondyloarthritis are very common. Although they share some similarities, the conditions also have significant differences.

Spondyloarthritis tends to be more common in males, whereas rheumatoid arthritis is more common in females.

Rheumatoid arthritis symptoms typically start appearing when a person is around 4050 years of age. The symptoms of spondyloarthritis usually occur earlier than this.

The early symptoms of rheumatoid arthritis usually affect the hands and feet. The early symptoms of spondyloarthritis usually start with back pain.

Learn more about the early signs and symptoms of rheumatoid arthritis here.

People often develop spondyloarthritis in their teenage years or 20s. Those with the following characteristics may be more likely to experience spondyloarthritis:

It is important to note that spondyloarthritis is notoriously difficult to diagnose in females. This could mean that it is more common in females than some statistics may show.

Lower back or hip pain is a common early symptom. However, symptoms can vary depending on the type of spondyloarthritis a person has.

Inflammation elsewhere in the body is a symptom of spondyloarthritis. It can especially affect the:

Spondyloarthritis-related inflammation can cause:

Another symptom of spondyloarthritis and the swelling it causes is psoriatic rashes. These may appear differently depending on a persons skin color.

Learn more about psoriasis on black skin here.

These symptoms may be particularly painful first thing in the morning or after periods of rest.

Untreated spondyloarthritis could lead to a person developing the following conditions:

A person who is experiencing symptoms of spondyloarthritis should contact a doctor to treat the condition. This may help prevent these complications.

If a person has had chronic lower back pain since before the age of 40 years, they may have spondyloarthritis. People often assume that they simply have back pain due to poor posture or other mechanical issues.

Because the pain can come and go, some people may assume that the pain is not important. However, not seeking treatment for spondyloarthritis can lead to complications later on.

A person who suspects that they have spondyloarthritis should contact a doctor. They should provide the doctor with details about their pain onset and whether or not they have other inflammatory symptoms that might suggest the presence of spondyloarthritis.

A doctor will diagnose spondyloarthritis by taking a persons medical history and performing a physical exam.

Imaging can help confirm a diagnosis. The doctor may request an MRI scan if an X-ray does not show damage but a person has symptoms that suggest the presence of spondyloarthritis.

A blood test is also available for the HLA-B27 gene, which is a gene associated with the condition. However, testing positive for the gene does not necessarily mean that a person has spondyloarthritis.

The doctor can also perform ESR tests or CRP tests on the blood in order to determine if swelling is present in the body. This can also help diagnose spondyloarthritis.

The doctor may also choose to carry out a complete blood count, to diagnose anemia, or a metabolic panel, to analyze a persons kidney and liver function.

Sometimes, medical professionals can mistake spondyloarthritis for other similar conditions, which can delay diagnosis and treatment. This is especially the case among females.

There is currently no cure for this condition. However, treatment can help relieve the symptoms and slow the progress of the condition.

Some treatment options include:

Biologics are very effective but expensive. These drugs can also increase a persons risk of infection.

Also, physical therapy can help restore range of motion in the affected joints.

One 2020 study involved putting 100 people with axial spondyloarthritis, non-radiographic axial spondyloarthritis, or psoriatic arthritis with axial involvement on physical therapy treatment programs.

The therapy significantly improved the pain that the condition caused, including among those with secondary conditions such as fibromyalgia.

Occupational therapy can also help a person improve or maintain their ability to perform day-to-day activities. An occupational therapist can provide recommendations and assistive devices to help prevent further injury.

Living with spondyloarthritis can make performing certain everyday tasks more difficult, but it is possible to manage the symptoms. Also, the condition does not usually affect a persons life expectancy significantly.

Symptoms such as pain and fatigue may come and go, and treatments can help a person live with this condition.

Some behavioral changes can also make living with spondyloarthritis easier. These changes include:

There are also spondyloarthritis support groups available for people who may need additional support.

Not seeking treatment for spondyloarthritis can lead to complications. Joints can fuse, for example, which may cause severe stiffness or immobility.

The symptoms of spondyloarthritis can come and go. However, even if a person does not constantly experience symptoms, they should still contact a doctor.

Not seeking treatment can lead to more complications of the condition. For example, it could become increasingly painful.

With the right treatment, people with spondyloarthritis can live an active life. Although there is no way to cure the condition, it is possible to manage the symptoms and prevent disease progression.

Making certain behavioral changes and trying medical treatments can make the pain and inflammation of spondyloarthritis more manageable.

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Spondyloarthritis: Types, symptoms, treatment, and more - Medical News Today

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Even studies have presented that those children, who were born out of hypothyroidism mothers during pregnancy, have lower IQ and impaired psycho-motor (mental and motor) development. But, fret not! If the condition is properly controlled and treated well, then those women with hypothyroidism can also have healthier babies.

Since the thyroid gland of the unborn child takes time to function on its own, its completely dependent on the mother for the thyroid hormones. Development and functioning of babys thyroid gland do not take place until about the end of the first trimester of pregnancy. Therefore, its suggested that women should start getting their thyroid disorder managed before conceiving so that impaired neurological functioning, stunted growth and physical deformities in the children can be avoided.

There is always best to plan for pregnancy and to consult with your physician to ensure your thyroid status and treatment are optimised prior to becoming pregnant and monitored throughout your pregnancy. However, if this does not happen and you find out you are pregnant, you should contact your physician immediately to arrange for increased testing of your thyroid functions and a potential change in your medication.

Untreated or poorly controlled hypothyroidism can also lead to:- Miscarriage- Premature birth- Pre-eclampsia - StillbirthSo, it is vital for pregnant women with hypothyroidism to take the recommended thyroid medication consistently.

How Is Hypothyroidism Treated During Pregnancy? The treatment of hypothyroidism in pregnant women is similar to that of the regular treatment. Doctors recommend synthetic T4 so that it compensates the presence of essential hormones in the body. The medication should be taken regularly so that a steady blood level of thyroid hormone gets adjusted within the normal range as the requirement of thyroid hormones increases during pregnancy. Therefore, it is a routine practice to monitor the blood level of the thyroid stimulating hormone (TSH) during pregnancy. Hyperthyroidism women can have healthy pregnancy by getting early prenatal care and working with their healthcare providers in the management of their disease.

Also read: Expert Speak: How To Lower The Risk Of Neural Birth Defects

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Expert Speak: Hypothyroidism And Its Effect On An Unborn Child - Femina

Recommendation and review posted by Bethany Smith

The ongoing trial is enrolling patients at 62 locations in the United States and worldwide.

Neeraj Agarwal, MD, discusses the rationale for the ongoing phase 3 randomized, open-label, CONTACT-02 study (NCT04446117) of the multikinase inhibitor cabozantinib (Cabometyx) plus the PD-L1 inhibitor atezolizumab (Tecentriq) versus second novel hormone therapy (NHT; abiraterone acetate [Zytiga] or enzalutamide [Xtandi], etc) in patients with metastatic, castration-resistant prostate cancer (mCRPC) who previously received 1 NHT to treat metastatic castration-sensitive prostate cancer, non-metastatic CRPC, or mCRPC.

Primary outcomes measures are overall survival and progression-free survival, with objective response rate as a secondary outcome measure. The target enrollment is 580 patients, and there are 62 study locations for the trial in the United States and worldwide.

Agarwal is a professor of Medicine, physician and investigator at the Huntsman Cancer Institute, University of Utah. He directs the Genitourinary Oncology Program and the Center of Investigational Therapeutics, and co-leads the Experimental Therapeutic Program.

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Dr. Neeraj Agarwal discusses the ongoing phase 3 CONTACT-02 study of atezolizumab/ cabozantinib in mCRPC - Urology Times

Recommendation and review posted by Bethany Smith

Sen. Mitt Romney, R-Utah, returns to the chamber from a short break as House impeachment managers present their second day of arguments in the Senate trial of former President Donald Trump, at the Capitol in Washington, Thursday, Feb. 11, 2021. (AP Photo/J. Scott Applewhite)

By Christine B. Helfrich | The Public Forum

| Feb. 13, 2021, 1:00 p.m.

I am sad to see Sen. Mitt Romney joining Sen. Rand Paul in objecting to transgender youth participating in school sports. Romney said, They shouldnt be competing with people who are physiologically in an entirely different category, and I think boys should be competing with boys and girls should be competing with (girls) on the athletic field.

My niece is 62 and athletically gifted. I am 55 and am blessed with double vision. We are physiologically in an entirely different category. My nieces large public school volleyball team took a state championship. My tiny private schools team did not.

Should students be subjected to humiliating physical exams to determine their fitness to participate in team sports?

Sixteen states already allow student trans athletes to compete according to their gender identification in current school records and daily-life activities. The world has not come to an end.

Just because a physician or midwife pronounces a gender at birth, based on a view of external genitalia, doesnt mean that the baby will neatly conform to that designation.

There are many variations in sexual characteristics that include internal genitals, external genitals, gonads, chromosomes, gene expression, hormone levels, and brain structure.

In fact 1.7% of the population meets the definition of intersex, which is about as common as having red hair.

Sen. Romney please get your medical information from someone who doesnt present himself as a board certified ophthalmologist despite his self-created board being out of business since 2011.

Christine B. Helfrich, Millcreek

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Letter: Sad to see Romney objecting to transgender youth participating in sports - Salt Lake Tribune

Recommendation and review posted by Bethany Smith

Misfolded proteins (orange) in the endoplasmic reticulum may play a role in Wolfram syndromes many symptoms.

By Mitch LeslieFeb. 11, 2021 , 2:00 PM

Maureen Marshall-Doss says the first sign that her vision was deteriorating came when she misidentified the color of a dress. At a backyard get-together about 20 years ago, the Indianapolis resident pointed out an attractive yellow dress another woman was wearing. You see that as yellow? Shes wearing a pink dress, Marshall-Doss recalls her husband responding.

Today, Marshall-Doss is virtually blind. With help from custom made eyeglasses that magnify objects 500 times, I can see shapes, she says. But she can no longer drive and had to quit the job she loved as a school librarian. Along with her dimming vision, she has type 1 diabetes and has lost her sense of taste and smell.

Marshall-Doss is one of 15,000 to 30,000 people around the world with Wolfram syndrome, a genetic disease. For decades, the condition remained enigmatic, untreatable, and fatal. But in the past few years, insights into its mechanism have begun to pay off, leading to the first clinical trials of drugs that might slow the illness and sparking hopes that gene therapy and the CRISPR DNA-editing tool might rectify the underlying genetic flaws. Here is a rare disease that the basic science is telling us how to treat, says physiologist Barbara Ehrlich of the Yale School of Medicine.

The research could also aid more than the relatively few patients with Wolfram syndrome. Driving the diseases many symptoms is a malfunction of the endoplasmic reticulum (ER), the multichambered organelle that serves as a finishing school for many cellular proteins. Known as ER stress, the same problem helps propel far more common illnesses, including type 2 diabetes, amyotrophic lateral sclerosis (ALS), Parkinsons disease, and Alzheimers disease. Wolfram syndrome is the prototype of an endoplasmic reticulum disorder, says medical geneticist Fumihiko Fumi Urano of Washington University School of Medicine in St. Louis. Because Wolfram syndrome is simpler, says Scott Oakes, a cell biologist and pathologist at the University of Chicago, researchers think it could illuminate the mechanisms of other ER-disrupting diseases, which affect hundreds of millions of people worldwide.

In the late 1930s,four children with diabetes were going blind, and doctors were stumped. Like many other people in the United States struggling through the Great Depression, the siblings ate a paltry diet, subsisting on potatoes, bread, oatmeal, and a little milk. But after examining three of the children, Donald Wolfram, a physician at the Mayo Clinic in Rochester, Minnesota, and an ophthalmologist colleague ruled out malnutrition as the cause of their puzzling condition. Lead poisoning and syphilisthough common enoughwerent to blame, either. When Wolfram and his partner wrote up the cases in 1938, they concluded that the symptoms could be manifestations of an hereditary or acquired cerebral lesion.

The physicians were right that the syndrome eventually named for Wolfram is hereditary. Recessive mutations in the gene for a protein called wolframin are responsible for most cases, with glitches in a second gene causing most of the rest. However, the pair was wrong to think the defect lies only in the brain. Instead, the symptoms stem from widespread cell death. Its definitely a disease that affects the whole body, Marshall-Doss says.

The first sign of the illness, appearing when patients are children, is usually diabetes mellitus, or faulty sugar metabolism, sparked by the demise of insulin-secreting beta cells in the pancreas. Most patients also develop the unrelated condition diabetes insipidus, in which the pituitary gland doesnt dole out enough of a hormone that helps control the bodys fluid balance, causing the kidneys to produce huge amounts of urine.

Mutations in the gene for wolframin disrupt the endoplasmic reticulum and lead to cell death throughout the body, causing a range of symptoms.

V. Altounian/Science

Ellie White, 19, of Centennial, Colorado, who was diagnosed with Wolfram syndrome 12 years ago, says she hasnt had a full night of sleep since she was 3 years old. She gets up again and again to use the bathroom and monitor her blood sugar.

Yet she and other patients say that as disruptive as those problems are, they are not the diseases most dismaying consequence. The biggest symptom of Wolfram syndrome that affects me the most is my vision, White says. Because neurons in the optic nerve perish, patients usually go blind within 10 years of their first visual symptoms.

Other neurons die as well. As the disease progresses, brain cells expire, and walking, breathing, and swallowing become difficult. Most people with Wolfram syndrome die before age 40, often because they can no longer breathe. At 57, Marshall-Doss is one of the oldest patients; one of her mutated genes may yield a partly functional version of wolframin, triggering a milder form of the disease, Urano says.

Two advanceshave made it possible to begin to tackle those symptoms. The first was Uranos discovery nearly 20 years ago that linked Wolfram syndrome to ER stress. The ER is where about one-third of a cells newly made proteins fold into the correct shapes and undergo fine-tuning. Cells can develop ER stress whenever they are under duress, such as when they dont have enough oxygen or when misfolded proteins begin to pile up inside the organelle.

In test tube experiments, Urano and his colleagues were measuring the activity of genes to pinpoint which ones help alleviate ER stress. One gene that popped up encodes wolframin, which scientists had shown in 1998 was mutated in patients with Wolfram syndrome. Following up on that finding, Urano and his team determined that wolframin takes part in whats known as the unfolded protein response, which is a mechanism for coping with ER stress in which cells take steps including dialing back protein production.

Scientists think wolframin plays a key role in the unfolded protein response, though they havent nailed down exactly how. When wolframin is impaired, cells become vulnerable to ER stress. And if they cant relieve that stress, they often self-destruct, which could explain why so many neurons and beta cells die in the disease.

Defective wolframin may harm cells in other ways. The ER tends the cells supply of calcium, continually releasing and absorbing the ion to control the amount in the cytoplasm. Changes in calcium levels promote certain cellular activities, including the contraction of heart muscle cells and the release of neurotransmitters by neurons. And wolframin affects calcium regulation.

Beta cells genetically engineered to lack functional wolframin brim with calcium, Ehrlich and colleagues reported in July 2020 in theProceedings of the National Academy of Sciences. When exposed to lots of sugar, the altered cells release less insulin and are more likely to die than healthy beta cells, the team found. The cells share that vulnerability with beta cells from patients with Wolfram syndrome. We think that excess calcium is leading to excess cell death, Ehrlich says.

ER malfunctions could hamstring other organelles as well. The ER donates calcium to the mitochondria, the cells power plants, helping them generate energy. In 2018, a team led by molecular biologist Ccile Delettre and molecular and cellular biologist Benjamin Delprat, both of the French biomedical research agency INSERM, discovered that in cells from patients with Wolfram syndrome, mitochondria receive less calcium from the ER and produce less energy. Those underpowered mitochondria could spur the death of optic nerve cells, the researchers speculate.

Fumihiko Urano holds dantrolene, a muscle relaxant drug he helped test as a treatment for Wolfram syndrome.

The link between ER stress and Wolfram syndrome has been crucial for identifying potential treatments because otherwise we would have nothing to target, Urano says. But a second development was also key, he says: the advocacy and support of patient organizations, such as the Snow Foundation and the Ellie White Foundation, headed by its namesakes mother. The foundations have stepped up with money for lab research and clinical trials when other sources, including government agencies, didnt come through.

Scientists, patients, and their advocates say Urano also deserves much of the credit. Besides treating patients, he heads the international registry of cases and has taken the lead in organizing clinical trials, screening compounds for possible use as treatments, and devising potential therapies. Fumi is clearly the driving force, says Stephanie Snow Gebel, co-founder of the Snow Foundation, who about 10 years ago helped persuade him to forgo a plum job as department chair at a Japanese university and take over the Wolfram program at Washington University.

Patients could soonstart to reap the benefits. In 2016, Urano and colleagues started the worlds first clinical trial for the disease: a phase 1/2 study of dantrolene, an approved muscle relaxant. The molecule was a top performer when they screened 73 potential treatments for their ability to save cells with terminal ER stress. Dantrolene didnt improve vision in the 22 participants, including White, the scientists reported in an October 2020 preprint. But in some patients, beta cells appeared to be working better and releasing more insulin. The drug is safe, but Urano says it will need to be chemically tweaked to target its effects before future trials are warranted.

Researchers are pursuing other possible treatments targeting ER stress or calcium levels. In 2018, U.K. scientists launched a trial that will include 70 patients to evaluate sodium valproate, a therapy for bipolar disorder and epilepsy that, in the lab, prevents cells with faulty wolframin from dying. Last year, another compound that emerged from Uranos screens, the diabetes drug liraglutide, entered a clinical trial. Also last year, an experimental drug developed by Amylyx Pharmaceuticals for Alzheimers disease and ALS received orphan drug designation from the U.S. Food and Drug Administration for Wolfram syndrome because it curbs ER stress. That designation offers tax breaks and other incentives, and it will get trials started sooner, Urano says.

Ehrlich and her team have a candidate of their own that they have begun to test in rodents: the drug ibudilast, which is approved in Japan to treat asthma. The researchers found it reduces calcium levels in beta cells lacking wolframin and boosts their survival and insulin output. New screening projects may reveal still more candidates.

But Urano knows that even if a treatment receives approval, it would be only a Band-Aid for Wolfram syndrome. Hoping to develop a genetic cure, he and colleagues are introducing replacement genes into cells from patients and from mice engineered to replicate the disease. The researchers are endowing the cells with healthy copies of the gene for wolframin or the gene for a protein that reduces ER stress to determine whether they restore cellular function and reduce cell death. At INSERM, Delettre and colleagues are also evaluating whether directing a working gene into optic nerve cells can curtail vision loss in mice with faulty wolframin. The scientists are still gathering data, but early results suggest the treatment can halt the deterioration.

Urano and his collaborators have also turned to the genome editor CRISPR, deploying it to correct the gene defect in patients stem cells and then growing them into beta cells. When the researchers transplanted the revamped cells into mice with diabetes, the animals blood sugar returned to healthy levels, the team reported in April 2020 inScience Translational Medicine.

Stem cell biologist Catherine Verfaillie of KU Leuven is collaborating on the CRISPR research. But she notes that because the faulty wolframin gene affects so many tissues, researchers will have to figure out how to deliver the CRISPR components to most cells in large organs such as the brain and livera prospect she calls pretty daunting. Urano agrees, predicting that CRISPR-based Wolfram therapies might take 10 to 20 years to develop. The alternative approach, gene therapy, could reach clinical trials more quickly, in 3 to 10 years, he says, because researchers have more experience with gene therapy and have created several treatments that have already been approved for other illnesses.

Because it stems from a single genetic glitch, Wolfram syndrome could also help scientists tease out the role of the ER in more complex diseases, including neurological conditions, type 2 diabetes, and cancer. The ER also falters in those diseases, causing cells to die, but the mechanism is harder to discern because they stem from myriad genetic and environmental factors. In Alzheimers disease, for instance, neurons develop ER stress as misfolded proteins accumulate inside and outside the cells.

Besides deepening researchers understanding of other conditions, the research on Wolfram syndrome might even deliver candidate treatments. Everyone would be very excited if we can make advances in targeting ER stress in Wolfram syndrome, Oakes says. It would open up the whole field to doing this in other degenerative diseases.

More:
The race to treat a rare, fatal syndrome may help others with common disorders like diabetes - Science Magazine

Recommendation and review posted by Bethany Smith

Buckingham:For starters, I want to emphasize the importance of preventing your skin from aging in general, starting when youre young. When you go outside in the sun, wear protective hats, sunglasses, clothing, and sunscreen.

Your overall health impacts skin health too, so I recommend eating a healthy diet and exercising and not gaining excess weight.

People ask me what the most important components of skincare are, and I think its helpful to view those priorities in the same way we use the food pyramid to eat the right amount of certain foods for a healthy diet.

On that base layer of the pyramid is sunscreen, thats the most important thing. Put that on after using a good facial cleanser to wash away the dirt and oil on your face.

The middle box is a vitamin A derivative such as retinol or Retin-A. We have research that shows if you use these products consistently, you can increase your collagen production and your elastin as well as increasing the epidermal turnover. This can keep the skin looking healthy and less dull. The little box at the top of the pyramid is topical antioxidants like vitamin C, peptides, and pigment-reducing agents.

Once you have that good skincare foundation, there are interventions we can do to reverse the effects of aging.

These include neuromodulators, such as Botox, which can temporarily cause the muscle to not contract as robustly as it should, which reduces the appearance of wrinkles.

Microneedling uses a pen-shaped or roller device with fine needles that penetrate the dermal level and create very tiny punctures in the skin. It heals within a day and promotes the growth of new collagen and elastin. Radiofrequency microneedling uses an actual plastic plate that has needles embedded in it that are stamped or inserted into the skin. While the needles are in the face, it emits radio frequency heat energy, which amplifies the effect of microneedling.

There are several laser treatment options depending on the amount of intervention needed. By using concentrated light in different wavelengths, these treatments can rejuvenate skin by increasing the production of collagen and elastin.

Chemical peels can range from very light peels that cause just a small amount of flaking to more intense peels that can require up to 10 days of recovery and continuous application of healing ointment.

See the article here:
Ask a Castle Connolly Top Doctor: How Aging and Gravity Affect Your Skin - Everyday Health

Recommendation and review posted by Bethany Smith

Melatonin is a hormone your body naturally produces to induce sleep. It can also be purchased as an over-the-counter oral supplement to help ease insomnia or reset your body clock after traveling to a different time zone.

Melatonin is generally safe and effective in low doses, but you can overdose which can cause adverse side effects. Here is what you need to know about the side effects of melatonin and how to determine how much to take.

Low doses of melatonin cause relatively few side effects, but it is possible to take too much, says Nicole Avena, PhD, an assistant professor of neuroscience at Mount Sinai School of Medicine in New York City.

Melatonin supplements are not regulated by the US Food and Drug Administration (FDA) and therefore have no standardized dose. The typical dosage found in stores ranges from about one to five mg but can be found in doses as high as 10 mg.

Overdosing on melatonin can lead to side effects, including:

It's hard to say exactly how much melatonin is too much since there is no standardized dose, but it's best to start with the lowest dose possible and work up from there, says Alex Dimitriu, MD, founder of Menlo Park Psychiatry and Sleep Medicine in Menlo Park, California.

There is no known lethal dose of melatonin and no reports of death from taking too much melatonin, Dimitriu says, but taking too much can disrupt your natural circadian rhythm and internal body clock, causing you to actually have more trouble falling asleep.

What the research says: Some studies have shown that cancer patients can benefit from large doses of melatonin ranging from 20mg to 1,000mg, but these doses are generally not recommended for those with no underlying medical conditions.

The effects of taking large doses of melatonin don't appear to be lethal, Dimitriu says, but more research is needed to determine the long-term health implications of melatonin use and the effects of doses larger than 30mg.

The right dose of melatonin for you is the lowest possible dose that can help you sleep with minimal side effects, Dimitriu says. This can vary by individual.

General advice: For most people, a melatonin dose of 0.5 to 5 mg can effectively help them fall asleep. If you find this dose isn't effective, you can increase it from there under the guidance of your doctor.

Melatonin should only be used occasionally unless you have otherwise been instructed by a physician, Avena says. Melatonin is considered safe in low doses for short-term use, but there is little data available on its long-term effects and more research is needed to determine overall safety.

If you find you are relying on melatonin in order to fall asleep every night, Avena recommends lowering your dosage slowly. You may experience a few nights of less than great sleep as your body adjusts.

Relaxation techniques like meditation or breathing exercises can help you fall asleep without the help of a melatonin supplement.

"It is more important to have healthy sleep habits and a regular sleep schedule, exercise, and minimal stress, than to rely on any supplement, including melatonin for sleep," Dimitru says.

Melatonin is not addictive, but taking it every night can cause you to rely on it as part of your bedtime routine.

"People can become psychologically or biologically dependent on any supplement or medication they take, especially with sleep. People start associating substances and behaviors as part of the bedtime routine," Dimitriu says. "The bedtime routine may suffer if some of the parts are missing, whether it be a favorite blanket, bed, or supplement like melatonin."

It is impossible to become physically dependent on melatonin like you could with other substances, like alcohol, Avena says, but you can come to rely on it as a sleep association.

If you find you are needing to take melatonin every night to sleep, you may have another health condition, like anxiety or a sleep disorder that is affecting your ability to sleep, Dimitriu says.

"With melatonin, it is important to maintain healthy habits besides just using a supplement," Dimitriu says, "Our bodies and minds, if healthy and not anxious should be able to sleep naturally."

In small doses, melatonin supplements are a safe and effective way to help you fall asleep, but more research is needed to determine the long-term effects of taking melatonin regularly.

There is no known lethal dosage of melatonin, but taking more than 10 mg can cause side effects, like daytime drowsiness and headaches.

If you are relying on melatonin to sleep, talk with your doctor about ways to improve your sleep hygiene.

More:
Yes, you can overdose on melatonin here's how to find your proper dosage - Insider

Recommendation and review posted by Bethany Smith

According to cardiologist the prevalence of heart disease has transcended most diseases worldwide to be the leading cause of death. With 17 million people perishing from cardiovascular diseases worldwide, every year, the need to visit a heart doctor is rapidly expanding.

Heart doctors or cardiologists specialize in treating cardiovascular diseases by first observing the heart from multiple levels. An extensive examination is done to determine the root cause of the problem and find ways to heal the patient. Heart doctors also educate their patients on how to best take care of their hearts through lifestyle and diet choices and preventive medicine.

Cardiologists or heart physicians go through medical school before focusing on the heart specialty. With four years of medical school below their belt, they should have an additional three years of medical training specific to cardiology. This training seeks to prepare them for their fellowship, which requires another three years. Overall, a typical cardiologist has the minimum practice of around ten years before they start working professionally. Some have longer due to research degrees or additional fellowships.

Additional skills and interests of heart doctors include the willingness to motivate the patient and make critical judgments about management often after a complex decision making process. Being able to communicate efficiently and effectively with patients and staff is also important. Heart doctors should be confident and always be willing to learn more about the heart and vascular system.

There are telltale symptoms of heart problems that individuals should look out for and aim to seek medical attention as soon as possible:

When experiencing trouble breathing, it is best to see a cardiologist for assessment. Breathing should come naturally, and shortness of breath is a reason for concern.

Low blood flow to the brain can cause loss of consciousness or dizziness and light-headedness. It is important to ensure this is not caused by the heart, ie a heart arrhythmia. A visit to the heart doctor will examine the reasons why the heart isnt pumping blood to the brain.

An unstable sensation, dizziness can indicate the lack of adequate blood flow to the brain, potentially indicating a heart problem.

The occurrence of irregular heartbeats such as palpitations or a racing or erratic heartbeat might indicate heart disorders, warranting the heart physicians visit all the most crucial. Heart flutters also indicate the need for immediate treatment.

This can be due to various reasons, one of which might be angina or heart attack, caused by lack of enough oxygen reaching the heart. It is best to see your physician immediately to correct the diagnosis before the chest pains escalate to something much worse. The pain can sometimes spread to the arm, back, or jaw. Patients can also sometimes experience sweating and shortness of breath alongside the pain.

When visiting the heart physician, the patient will first answer several questions to determine the condition of their heart. These questions range from drug and family history to lifestyle habits, and their list of symptoms.

Next, the physician will conduct a series of tests to try and identify the cardiovascular conditions that the patient might have. These tests include:

An electrocardiogram tests the electrical activity of the heartbeat. This test examines the reason for chestpains, dizziness, and irregular heartbeats. This procedure involves attaching electrodes on your chest, arms and legs, and attaching them to the EKG machine, which records the hearts activity and records the information on a graph. This procedure is painless and takes around ten to fifteen minutes.

This test seeks to understand how the heart performs at a time when it requires the most blood flow, stress. The patient is attached to an EKG machine while on a treadmill. The heart physician monitors the ECG or echocardiogram to determine whether enough oxygen through proper blood flow is directed towards the heart.

The patient lies on a bed and a technician or heart specialist uses an ultrasound machine to look at the structure and function of the heart, and its valves. The test takes 20-30 minutes and no X-rays are used.

This procedure involves introducing a catheter to the blood vessel until it reaches the heart to diagnose heart problems. The catheter is injected with a dye, which exposes irregularities or blockages of the heart arteries.

After these tests, the heart physician will diagnose the results and advise on a suitable treatment plan. Depending on the heart condition, the heart physician will prescribe medications and advice on preventive and lifestyle changes. More severe complications will require heart surgery, depending on the situation.

It is paramount to maintain healthy lifestyle practices that will help prevent a visit to the cardiologist. Such practices include:

Read more:
All You Need to Know About a Heart Doctor Before Your Visit - Chiang Rai Times

Recommendation and review posted by Bethany Smith

Happy national "Satisfied With Being Single Day"!

I love that this falls right before Valentine's Day. It's a great way to embrace the solo life. It's also a great day to print out a picture of your ex. I know it sounds counter productive, but it's actually going to benefit you this weekend.

The benefit? Free wings. What's better than that? Hooters does this hilarious thing every year where they want to help you get over your ex, and in return they'll also give you some free food.

So I went to go check if the Hooters in Rockford is one of the participating locations, and it led me to a virtual survey about my ex. So of course I took it. Here's what the survey looked like -

So after I chose some of the hilarious options, they lead me here.

Then they made me pick a picture, and I wasn't really trying to shred an ex. So I picked a picture of the 97ZOK logo (oops).

Well, here we go.

I'M SORRY 97ZOK! I didn't mean it!

After all that virtual shredding, I was finally prompted to enter my information for a coupon to the Rockford location. So if you have an ex you're ready to get over, and you're also a wing lover, then this is the perfect way to celebrate Valentine's Day.

Also, I still recommend printing out a picture to ACTUALLY shred. Sounds like a great way to get over someone.

H/T DELISH

See the article here:
Hooters Will Give You Free Wings For Shredding a Pic of Your Ex - q985online.com

Recommendation and review posted by Bethany Smith

Though a peanut allergy is generally considered a pediatric issue, many people don't develop one until after turning 18 years old.

More than 800,000 of the 4.6 million U.S. adults who have peanut allergies didn't develop them until after reaching adulthood, according to a new study. That equates to 17% a larger percentage than previously believed.

The reasons behind late-onset peanut allergies are not completely understood, but the Northwestern University researchers who conducted the study suggest environmental factors and hormone fluctuations may play a role.

Other experts said a delayed or extended period of sensitization to peanuts could also be to blame or even a cross-reaction to some other allergens such as pollen. Research is ongoing to improve diagnosis, management and treatment of peanut allergies.

"Given the high prevalence of peanut allergy among U.S. adults, additional therapies are needed to help address this growing burden of disease,"Dr. Ruchi Gupta, director of the Center for Food Allergy and Asthma Research at Northwestern University,toldUPI.

The study's findings, published inThe Journal of Allergy and Clinical Immunology, stem from a survey of more than 40,000 adults.

Though 2.9% of respondents reported having peanut allergies, researchers found only 1.8% actually had convincing peanut allergies.Gupta said it is important for adults who think they have developed peanut allergies to be diagnosed by a physician instead of just avoiding peanuts.

Their doctors can teach them how best to avoid exposure and prescribe epinephrine, an emergency treatment for anaphylaxis, a severe allergic reaction.

Gupta also toldCNNthat more adults than children have peanut allergies. Only 15 to 20% of children with a peanut allergy will outgrow it by adulthood.

People who said they developed peanut allergies in adulthood were less likely to have been diagnosed by a physician compared to adults whose allergies emerged during childhood, researchers found.

They also were more likely to report multiple food allergies.They were less likely to have an epinephrine prescription 44% compared to 56%.

A food allergy develops when the immune system mistakenly labels the food as a threat and launches an attack against it, Harvard Health experts say.

For people with peanut allergies, even a small amount of peanuts can cause a serious, possibly life-threatening reaction. Symptoms usually start minutes after exposure, according to the Mayo Clinic.

The most common symptoms include skin reactions such as hives or redness, an itching or tingling in the mouth or throat, nausea or vomiting, tightening of the throat and wheezing.

Any severe reaction requires treatment with an epinephrine autoinjector and an emergency department visit. Anaphylaxis symptoms include trouble breathing, a sharp drop in blood pressure, a rapid pulse, dizziness and loss of consciousness.

Peanut allergies are a leading cause of fatal and near-fatal anaphylaxis. People who suspect they may have peanut allergies should get evaluated by their physicians as soon as possible.

The U.S. Food and Drug Administration has not approved any therapies for adults with peanut allergies, An oral immunotherapy has been approved for patients 4 to 17 years of age to help desensitize them to peanuts.

See more here:
More than 4.6 million US adults have peanut allergies, Northwestern University study finds - PhillyVoice.com

Recommendation and review posted by Bethany Smith

February 8, 2021

Theres a good reason medical checkups typically include a quick but gentle pat-down of your neck area by health care providers. Among other conditions, theyre looking for a goiter, an enlarged thyroid gland that may spell health problems but can also be harmless.

Goiters affect about 16 percent of people worldwide, ranging from just under 5 percent in the United States to 28.3 percent in Africa, according to the National Institutes of Health. But the most common cause of goiters globallya lack of the nutrient iodineisnt a significant issue in the U.S., where iodized salt is routinely used.

In our country, many goiters are idiopathic, meaning we dont know the reason why they occur, says Alexander Shifrin, M.D., an endocrine surgeon at Jersey Shore University Medical Center.

Still, various risk factors can make it more likely that youll develop a goiter. These include:

Located at the base of the neck, the thyroid produces hormones that regulate a variety of crucial bodily functions, ranging from helping us keep warm and use energy to fueling proper function of organs and muscles. The development of a goiter doesnt mean the gland isnt working. But this enlargement, which can happen slowly or quickly, may also signal the thyroid is making too much or too little hormone.

What signs of a goiter should you watch for? Dr. Shifrin says size matters. Watch for an enlargement of the thyroid, he says, including swelling at the base of your neck. Every enlarged gland should be checked for cancer.

According to the American Thyroid Association, you should also watch for these signs:

Most goiters arent cancerous, Dr. Shifrin says, but you should still have it checked by your primary physician or an endocrine specialist. Blood tests alone cant usually determine if thyroid cancer is present. Ninety percent of thyroid cancers are detected by palpating the gland and a thyroid ultrasound, Dr. Shifrin says.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

Follow this link:
Causes and Signs of an Enlarged Thyroid - Health Topics, Men's Health, Women's Health - Hackensack Meridian Health

Recommendation and review posted by Bethany Smith

Study Design: Cohort study design with retrospective and prospective components.

Methods: Women were eligible to participate in accordance with the CMS Quality Rating System technical specification for breast cancer screening. Eligible women with no documented screening for a mammogram from January 1, 2016, through November 7, 2017, were invited to participate in a campaign that included outreach about screening mammography as a no-cost covered benefit, education about screening mammography to detect asymptomatic disease, and a gift card to a local grocery merchant if the member obtained screening mammography by December 31, 2017.

Results: During December 2017, 20.8% (27/130) of eligible women obtained a screening mammogram compared with 7.8% (5/64) of eligible women during the nonintervention reference period of December 2016. Mammography screening increased by 170% during the study period in comparison with the reference period of a year earlier (prevalence ratio [PR], 2.7; 95% CI, 1.1-6.6; P=.02).

Conclusions: A one-time, time-limited cue-to-action pilot project consisting of outreach, education, and incentive increased uptake of screening mammography by women enrolled in a community health insurance plan providing health insurance coverage as part of the Affordable Care Act. This increase is statistically significant in the intervention period compared with the reference period (PR, 2.7; 95% CI, 1.1-6.6; P=.02). Despite a small sample size, the magnitude of the effect for this pilot study is encouraging and warrants future studies in a larger population.

Am J Manag Care. 2021;27(2):In Press

_____

Takeaway Points

Managed care organizations (MCOs) can help members achieve positive health outcomes through the consistent use and application of quality improvement activities. We demonstrated that an MCO can effectively target members to improve uptake of a preventive service through a series of cues to actions. MCOs should consider the findings from this pilot project as evidence that outreach, education, and incentives play a role in member decision-making with regard to using preventive services. This research also demonstrates that MCOs can effectively encourage members to use free, covered benefits available to them as part of the Affordable Care Act.

_____

Breast cancer is the most common cancer among women in the United States.1 The National Cancer Institute estimated that the number of new breast cancer cases and the number of deaths from breast cancer among women would approach 268,600 and 41,760, respectively, in 2019.2 However, despite these numbers, the population-adjusted mortality rate for breast cancer decreased by 36% from 1989 through 2012.3 This reduction is due to a variety of factors, including improved chemotherapeutic treatments, reduced hormone replacement use among women, and the continued use of screening mammography to identify breast cancer among asymptomatic women.3 Case-control studies show a reduction in breast cancerrelated mortality ranging from 36% to 70% for women who obtain screening mammography.4

In the United States,5 as in many countries around the world,6-8 national health officials have developed evidence-based guidelines to promote screening mammography among asymptomatic women. Guidelines from the US Preventive Services Task Force (USPSTF) indicate that women of average risk aged 50 through 74 years will receive the most benefit from regular biennial screening.5 With the introduction of the Patient Protection and Affordable Care Act (ACA), screening mammography became a covered, no-cost, preventive service.9

METHODS

Study Setting

Sendero Health Plans is a community-based health insurance plan serving an 8-county area of central Texas that offers health insurance on the ACA federal marketplace. In 2017, as part of its ongoing quality improvement focus, Sendero sought to increase uptake of screening mammography for members enrolled in its ACA line of business based on the USPSTF recommendation for mammography screening.10

Theoretical Basis

We used both the health belief model and the transtheoretical model as a basis for this pilot project. The health belief model includes a variety of theoretical constructs, such as perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action, to guide health promotion activities.11 The health belief model has been used to predict health behaviors for a variety of clinical issues, including screening for asymptomatic disease12 and helping to improve breast cancer screening rates among asymptomatic women.13-15 In this pilot project, we used cues to action to provide an overt action (ie, outreach and education) as a stimulus to asymptomatic women aged 52 to 74 years to undertake a known preventive intervention to identify breast cancer. In addition, a financial incentive, which is rooted in the transtheoretical model, was used to encourage women who may otherwise be ambivalent to undertake this health-seeking behavior to undergo screening mammography.16

Study Design

We conducted a pilot project using a cohort study design to determine if cues to action involving outreach about screening mammography as a no-cost benefit, education about screening mammography to detect asymptomatic disease, and a financial incentive using a gift card to a local grocery merchant would encourage women to obtain a screening mammogram. We focused on a time-limited, 6-week pilot project from November 17, 2017, through December 31, 2017. Women were identified and eligible to participate in this study based on the following inclusion and exclusion criteria (Figure 1).

Women had to be eligible to receive a screening mammogram based on the CMS Quality Rating System technical specification for breast cancer.17 Using this technical specification, we identified 277 women aged 52 to 74 years who were continuously enrolled in the Sendero IdealCare plan for the period October 1, 2015, to December 31, 2017.

We adjusted this group to include only 2 full years of data for analysis, removing 10 women who were eligible in the period from October 1, 2015, through December 31, 2015. This resulted in 267 women eligible for screening mammography in calendar years 2016 and 2017.

We identified all women in the 2016 and 2017 time period who had not received a screening mammogram by November 7, 2017, based on submission of a medical claim for Current Procedural Terminology code 77067 or Healthcare Common Procedure Coding System code G0202. One hundred women were identified. These women are defined as the population eligible for this study.

Women were not randomized or otherwise allocated to an intervention or nonintervention group, as it was deemed unethical to restrict individuals from receiving a secondary prevention examination with known positive health benefits.

Study Intervention

This study consisted of 3 interventions, all of which were targeted at women aged 52 to 74 years. The interventions were (1) outreach to inform women that screening mammography is a benefit available to them at no additional out-of-pocket cost as part of their Sendero health insurance; (2) educational information about the exam (adapted from material produced by the CDC), the benefits of screening mammography, and how to prepare for and what to expect on the day of the exam11; and (3) an incentive of a $50 gift card to a local grocery merchant to women who completed the screening mammography exam by December 31, 2017.

Materials were mailed to eligible women on November 17, 2017, just prior to the US Thanksgiving holiday period. Follow-up text messages were sent 12 days later on November 29, 2017. Follow-up phone calls were initiated between December 4 and December 21, 2017, some 17 days after the initial mailing, to assist women with scheduling a mammogram appointment or to answer questions about screening mammography. All written materials, texts, and phone calls were provided in English and Spanish.

A member of the research team (N.T.) who is bilingual in English and Spanish made follow-up phone calls to women eligible for the campaign. A script was developed, and the research team member was trained on how to use the script, how to address comments or questions not in the script, and how to provide scheduling assistance if requested. Calls were recorded for quality assurance purposes but were not monitored or reviewed at a later date. After identity verification, the member was asked if she:

Statistical Analyses

Data were obtained from medical claim submissions and included the date on which screening mammography occurred, the county and zip code of the individuals residence, and the individuals age in years. Data on income and federal poverty levels by county were obtained from the US Census; such data are not reported to Sendero by federal officials and, therefore, we do not have the ability to provide member-level data analysis on this information.18 Similarly, data on race and ethnicity are not provided to Sendero by federal officials.

Descriptive statistics included age and proportion of women eligible to participate in the health promotion campaign and were based on full-year data in 2016 and 2017, respectively. Chi-square goodness of fit tests were used to test the hypothesis that there is no difference by month when women choose to obtain a screening mammogram. A separate 2 test was conducted for each calendar year, as well as for the 2-year period of the study. A prevalence ratio (PR), the 95% CI, and a P value were calculated to compare the prevalence of women screened in the intervention period (December 2017) with the reference period of a year earlier (December 2016).

RESULTS

One hundred women were eligible to participate in the outreach, education, and incentive campaign. These 100 women were represented by 46 zip codes. Twenty-five zip codes were located in Travis County, 9 in Williamson County, 6 in Bastrop County, 3 in Hays County, 2 in Caldwell County, and 1 in Fayette County. Among these 46 zip codes, the median household income ranged from $38,100 to $136,138 and the percentage of people living at or below the federal poverty level ranged from 2.1% to 30.6%.18

Twenty-seven of the 100 individuals eligible for this intervention obtained a screening mammogram during the assessment month of December 2017. By comparison, 5 women obtained a screening mammogram during the reference period of December 2016. Women who received the intervention were 170% more likely to be screened in December 2017 compared with December 2016 (PR, 2.7; 95% CI, 1.1-6.6; P=.02).

During 2016 and 2017, 194 women obtained a screening mammogram (Table 1). The number of women who obtained a screening mammogram varied by month during 2016 (211=14; P=.23), during 2017 (211=42.62; P<.001), and across the 24-month reporting period of January 1, 2016, through December 31, 2017 (223=88.80; P<.001) (Table 2 and Figure 2). The difference was not significant in 2016, but it was statistically significant during 2017 and during the overall 2-year observation period. In both 2016 and 2017 the number of monthly screening mammograms varied: 2016 (range, 1-9) and 2017 (range, 4-27).

Follow-up texts were transmitted to 94 women based on contact preferences; 54 of the text messages were confirmed as having been received. Follow-up phone calls were initiated to 85 members based on contact preferences, with 145 attempted calls resulting in a conversation with 40 members. Of the 40 women contacted by phone, 15 had not scheduled a mammogram by the time of the call. Eight women (53.3%) accepted the offer of assistance to schedule an exam, 6 (40.0%) did not accept scheduling assistance, and 1 (6.7%) reported she had, unbeknownst to us, scheduled her mammogram prior to the call.

DISCUSSION

Two cues to action and 1 incentive component were used to encourage uptake of screening mammography among women aged 52 to 74 years. To our knowledge, no other health insurance plan in Texas has conducted a similar pilot project to increase uptake of a USPSTF preventive service as part of the ACA package of benefits.

Outreach and Education

The outreach and education cues to action informed women that screening mammography was a covered benefit of their health insurance policy, how screening mammography can identify breast cancer in its earliest stages when it is usually more effective to treat, and what screening mammography entails. Reminders tied to a specific date have been shown to improve uptake of screening mammography,19 which in our case were focused on a specific intervention time frame. Educational material has been shown to be a useful tool to encourage women to obtain screening mammography.20,21

The Incentive Component

The incentive component provided women with a $50 gift card to a local grocery merchant if they obtained their screening mammography between November 17, 2017, and December 31, 2017. The incentive was designed to encourage a healthy behavior among women for a known preventive service. However, the notion of a financial incentive sometimes prompts disquiet among those who believe that paying a person to obtain a known health benefit is somehow wrong or immoral, whereas others question the medium- or long-term viability of such an activity. We provide our insight into these notions from the health insurance company perspective.

First, we do not believe there is any reason to suggest or imply that providing a financial incentive to obtain a preventive service is somehow wrong; in fact, this notion strikes us as both paternalistic and judgmental. Financial incentives are a part of contemporary life and are used to guide people into making decisions. In health care, the goal is to encourage individuals to make healthy choices; therefore, it seems appropriate to provide incentives to encourage healthy behavior and thus maximize utility.22-24 As a form of trade, this is a voluntary action that, if implemented, benefits both parties.22 In this case, a woman obtains a preventive health service with demonstrated evidence of success and the health insurance company fulfills its obligations to promote the health and well-being of its members. If the woman chooses not to participate in the incentive program, which 73 did not for this campaign, then this is her right as would be expected of any type of voluntary transaction.

Second, with regard to the medium- and long-term viability, several items need to be considered. One is to identify the expected outcome of the financial incentive. The idea is not, as some might suggest, to pay a person to obtain a preventive service; rather, the idea is to use the incentive to introduce and support ongoing positive behavioral change. Further research on the impact of financial incentives and behavioral change within a community-based health insurance plan is needed.

Third, there may be a concern about the overall financial benefit of screening and early detection. Routine screening, simply put, is designed to identify disease in its earliest stage before it has had an opportunity to metastasize. Treating breast cancer in situ is more successful and less costly than treating metastatic cancer.25 For example, breast cancer in situ is reported to have mean per-patient costs of $48,477 and $71,909 at 0 to 6 months and 0 to 24 months post diagnosis, respectively. On the other hand, breast cancer that has spread beyond the breast tissue and may have entered the lymph node is reported to have mean per-patient costs of $84,481 and $159,442 at 0 to 6 months and 0 to 24 months post diagnosis, respectively.26 In our cue-to-action project, the maximum total expenditure for the financial incentive would have been $5000 if all women had participated in the pilot project. Had 1 case of breast cancer in situ been identified rather than waiting until regional lymph node involvement had occurred, the amount of money expended due to early treatment vs late-stage treatment would have more than offset the cost of the entire incentive program.

Women Who Choose Not to Be Screened

Women who choose not to be screened represent a small but important part of the overall population eligible for screening mammography. Of the 267 women eligible for screening, 73 (27.3%) in the 2-year period from January 1, 2016, to December 31, 2017, did not obtain screening mammography as part of their Sendero health insurance benefit. The research team member who made follow-up calls to members to encourage participation in this pilot project collected information about why women chose not to participate. Although this was not a primary outcome for this pilot study, we present here some of the qualitative findings from the conversations that took place with the 40 members who were contacted. (Each statement is from a specific person, with additional comment, if any, by the authors in brackets.)

This feedback indicates that primary care physicians play an important role in helping women make an informed decision about whether to obtain screening mammography. Further research on the impact of the role of the primary care physician and behavioral change to support secondary prevention campaigns is warranted.

Limitations

Several limitations have been identified with this study. The first limitation is the timing of the campaign and its potential impact on mammography screening uptake. The 6-week intervention time period included 3 major holidays, which may have limited participation and may have impacted service availability; however, based on discussions with our preferred mammography provider during the planning process, they did not indicate a lack of availability during the 6-week time period. Second, some campaign-eligible women may have already scheduled a mammogram before receiving campaign material in the mail. Third, although the campaign included 3 cues to action, we did not seek to, nor were we able to, ascribe variance to any particular cue to action. Fourth and finally, we are blinded to some data that could be useful in the analysis of these findings. Such data include income and race/ethnicity data, as this information is not provided by the federal Marketplace to health plans.

CONCLUSIONS

A one-time, time-limited cue-to-action pilot project consisting of outreach, education, and incentive increased uptake of screening mammography by women enrolled in a community health insurance plan providing health insurance coverage as part of the ACA. This increase is statistically significant in the intervention period compared with the reference period (PR, 2.7; 95% CI, 1.1-6.6; P=.02). Despite a small sample size, the magnitude of the effect for this pilot study is encouraging and warrants future studies in a larger population.

Acknowledgments

The authors would like to acknowledge the assistance and advice of current and former Sendero staff members and contractors Dr Avishek Kumar, Bryan Palma, Linda Burton, Tammy Liu, Norma Lozano, Rodolfo Ybarra, and Priscilla Gonzales in the development of this project. The authors would also like to thank Travis County taxpayers for their continued support of Sendero Health Plans.

Author Affiliations: The Litaker Group, LLC (JRL), Austin, TX; Sendero Health Plans (NT, WD), Austin, TX; University of Texas at Austin (RT), Austin, TX.

Source of Funding: Funding for this project was provided in the form of staff and contractor time by Sendero Health Plans.

Author Disclosures: Drs Litaker and Taylor are independent paid research consultants to Sendero Health Plans and received payment for their involvement in the preparation of this manuscript. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JRL, NT, WD, RT); acquisition of data (JRL, NT, WD, RT); analysis and interpretation of data (JRL, NT, RT); drafting of the manuscript (JRL, RT); critical revision of the manuscript for important intellectual content (JRL, RT); statistical analysis (JRL, NT, RT); provision of patients or study materials (NT); obtaining funding (WD); administrative, technical, or logistic support (JRL, NT, RT); and supervision (JRL).

Address Correspondence to: John R. Litaker, PhD, MSc, MMedSc, The Litaker Group, LLC, PO Box 160505, Austin, TX 78716. Email: john.litaker@litakergroup.com.

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2. Cancer stat facts: female breast cancer. National Cancer Institute. Accessed March 22, 2020. https://seer.cancer.gov/statfacts/html/breast.html

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4. Puliti D, Zappa M. Breast cancer screening: are we seeing the benefit? BMC Med. 2012;10:106. doi:10.1186/1741-7015-10-106

5. Clinical summary: breast cancer: screening. US Preventive Services Task Force. January 11, 2016. Accessed August 1, 2017. https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/breast-cancer-screening1

6. Breast Screen Australia: policy. Australian Government Department of Health. Updated June 5, 2020. Accessed July 1, 2020. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/policy

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8. Tonelli M, Gorber SC, Joffres M, et al; Canadian Task Force on Preventive Health Care. Recommendations on screening for breast cancer in average-risk women aged 40-74 years. CMAJ. 2011;183(17):1991-2001. doi:10.1503/cmaj.110334

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10. What is a mammogram? CDC. Updated September 14, 2020. Accessed October 1, 2020. https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm

11. Zheng Y, Mancino J, Burke LE, Glanz K. Current theoretical bases for nutrition intervention and their uses.In: Coulston AM, Boushey CJ, Ferruzzi MG, Delahanty LM, eds. Nutrition in the Prevention and Treatment of Disease. Elsevier; 2001:83-93. doi:10.1016/b978-012193155-1/50008-8

12. Urich A. The Health Belief Model. Pennsylvania State University Open Resource Publishing. Accessed March 10, 2020. https://psu.pb.unizin.org/kines082/chapter/the-health-belief-model/

13. Sohl SJ, Moyer A. Tailored interventions to promote mammography screening: a meta-analytic review.Prev Med. 2007;45(4):252-261. doi:10.1016/j.ypmed.2007.06.009

14. Yarbrough SS, Braden CJ. Utility of health belief model as a guide for explaining or predicting breast cancer screening behaviours.J Adv Nurs. 2001;33(5):677-688. doi:10.1046/j.1365-2648.2001.01699.x

15. Deavenport A, Modeste N, Marshak HH, Neish C. Closing the gap in mammogram screening: an experimental intervention among low-income Hispanic women in community health clinics.Health Educ Behav. 2011;38(5):452-461. doi:10.1177/1090198110375037

16. Slater JS, Parks MJ, Malone ME, Henly GA, Nelson CL. Coupling financial incentives with direct mail in population-based practice.Health Educ Behav. 2016;44(1):165-174. doi:10.1177/1090198116646714

17. 2018 Quality Rating System measure technical specifications. CMS. September 2017. Accessed October 1, 2017. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/Revised_QRS-2018-Measure-Tech-Specs_20170929_508.pdf

18. American FactFinder Community Facts. US Census Bureau. Accessed March 20, 2020. https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml

19. Buist DSM, Gao H, Anderson ML, et al. Breast cancer screening outreach effectiveness: mammogram-specific reminders vs. comprehensive preventive services birthday letters.Prev Med. 2017;102:49-58. doi:10.1016/j.ypmed.2017.06.028

20. Michielutte R, Sharp PC, Foley KL, et al. Intervention to increase screening mammography among women 65 and older.Health Educ Res. 2004;20(2):149-162. doi:10.1093/her/cyg108

21. Boling W, Laufman L, Lynch GR, Weinberg AD. Increasing mammography screening through inpatient education.J Cancer Educ. 2005;20(4):247-250. doi:10.1207/s15430154jce2004_14

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Recommendation and review posted by Bethany Smith

Its a mans world is an iconic, soulful ballad co-written by the late James Brown and recorded in February 1966 at Bob Gallos Talent Masters studio in New York City. And it is a song that celebrates the virtues of being a man while simultaneously acknowledging the many virtues of women. Something to note about this iconic, soulful ballad that reached No. 1 on the Billboard R&B chart and No. 8 on the Billboard Hot 100 more than 50 years ago is how it called attention to the many differences between men and women. Along with emotional and psychological differences, men and women are also remarkably different from a physiological standpoint. To understand to what extent, it helps to know a little more about the endocrine system in both genders.

What Science Has Revealed About the Male and Female Endocrine System

For those not as well-versed in human physiology, the male and female body houses an endocrine system. And this system is comprised of a network of hormone-secreting glands that allow the body to function optimally. In both genders, the primary hormones that make up the endocrine system include the pineal, pituitary, hypothalamus, thyroid, parathyroid, adrenal, and thymus glands. The pancreas is also one of the many glands that make up the endocrine system in both men and women. One key difference between the male and female endocrine system has to do with the reproductive glands.

Male and female bodies alike have reproductive glands that make conception possible. In men, this would be the testes. And in women, it would be the ovaries. The testes are responsible for secreting testosterone. The ovaries, on the other hand, secrete estrogen. When these glands secrete adequate amounts of their respective hormones, they play a vital role in contributing to homeostasis and enabling men and women to realize the joys of parenthood. However, if these hormone levels fall too low, it can lead to fertility issues and other physical health problems in men and women alike. For example, women with low estrogen levels, which correlates with estrone and estradiol levels below 17 and 15 nanograms per deciliter (ng/dL), respectively, will usually experience the following:

Much like women, men with low testosterone levels, typically below 280 ng/dL, will see their fair share of ill-effects, some of which include the following:

One of the biggest misconceptions when it comes to the endocrine system is that its ability to secrete estrogen applies only to women. And this couldnt be any further from the truth. While the ovaries and adrenal glands secrete estrogen in women, the testes and adrenal glands secrete estrogen in men. Of course, the amount of this hormone secreted in men is much lower. When estrogen levels are too high, delineated by estradiol and estrone levels greater than 40 and 50 picograms per milliliter (pg/mL), respectively, men are more likely to suffer from prostate enlargement.

Common Causes of Prostate Cancer

Along with an enlarged prostate resulting from high estrogen levels, men who also have low testosterone levels are more likely to develop prostate cancer, say researchers with the National Institutes of Health. The sentiment is further echoed by the Centers for Disease Control and Prevention (CDC), which notes that prostate cancer is the most common cancer in men, especially among those age 40 and over. Further, a study published by Science Daily revealed that men with high testosterone and high human growth hormone (HGH) levels are also at risk of developing prostate cancer. And it does not end there as prostate cancer can also stem from inherited gene mutations, acquired gene mutations, and poor dietary habits. Men who have the misfortune of developing prostate cancer will often experience the following symptoms:

How Is Prostate Cancer Diagnosed?

While symptoms detailed in this article generally correlate with prostate cancer, the only way for men to know for sure if they have developed the disease is to schedule an appointment with a urologist or oncologist. Two of the screening tests that these practitioners will use to determine if an individual has prostate cancer include a digital rectal exam (DRE) and a prostate-specific antigen (PSA) test. Some practitioners will arrange an ultrasound, magnetic resonance imaging (MRI), and may even order a biopsy if they observe prostate abnormalities that might be cancerous. If prostate cancer is confirmed, some practitioners may advise undergoing a prostatectomy.

What Is a Prostatectomy?

In short, a prostatectomy, otherwise known as prostate surgery, is a procedure that involves the partial or complete surgical removal of the prostate. This type of surgical procedure is a go-to for men with cancer affecting the prostate, which has not metastasized to other parts of the body, or an enlarged prostate. According to the American Cancer Society, the following are the different types of prostatectomy surgery that a physician might recommend to men diagnosed with either of these two health problems:

Consequences of Undergoing a Prostatectomy

As with any surgery, there are risks associated with undergoing a prostatectomy of any kind. Some of the ones frequently reported by men who have gone through with such a procedure include the following:

Ways to Ensure a Safe and Quick Recovery Following Prostatectomy Surgery

Indeed, numerous side effects can stem from undergoing prostatectomy surgery. However, according to most urologists, men who do the following are much less likely to encounter them:

Close medical supervision One of the best ways to ensure a safe and speedy recovery following prostatectomy surgery is to immediately contact your physician if youre experiencing excessive pain or bleeding post-surgery. After all, neglecting these issues can pave the way for infections and other complications that could significantly slow down the healing process.

Positive attitude Having a positive attitude aids in speeding up recovery and minimizing complications after a surgical procedure, say most naturopathic physicians. And prostatectomy surgery is no exception as a positive attitude can tamp down feelings of stress that would otherwise weaken the immune system and, in turn, slow down healing.

Avoiding accidents Another way to minimize complications while speeding up healing following prostatectomy surgery is by avoiding trauma to the urethra or bladder. For this reason, physicians often advise against engaging in strenuous activities, such as biking, running, or even having sex, while the body is still healing.

Prevention of Prostate Cancer: Testosterone and Human Growth Hormone Therapy

According to a study published by cancer.net, over 190,000 men will likely be diagnosed with prostate cancer by the end of 2020. But this doesnt mean that such a grim reality is unavoidable. There are things that men can do to lower their chances of developing the disease. For example, addressing hormone imbalance problems as soon as possible can significantly reduce the likelihood of developing prostate cancer. And this generally means taking medication to help boost low testosterone (find more about results of depo-testosterone in reviews of patients) or human growth hormone levels. Similarly, taking medication to lower high estrogen levels can help in this regard as well.

Natural Ways to Boost Immunity That Also Protects Against Prostate Cancer

Many of the same things that strengthen the immune system, which, in turn, lowers the risk of infection, can also protect against prostate cancer. Generally speaking, this comes down to healthy lifestyle habits, such as exercising regularly, consuming a healthy, well-balanced diet, and keeping stress to a minimum. Quitting smoking and minimizing alcohol consumption can further lower the risk of developing prostate cancer.

Bottom Line

All in all, men and women are more the same than they are different in that both have a higher chance of encountering life-altering diseases as they get older. Fortunately, breakthroughs in science and modern medicine, coupled with positive lifestyle choices, can go a long way toward keeping many age-related diseases, including prostate cancer in men and breast cancer in women, at bay.

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11 Best Male Enhancement Pills and Products in 2021: Review of the Top-Rated Sex Pills for Men - Cleveland Scene

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Chinese scientists have successfully prolonged the lives of mice by using CRISPR.

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February10, 20214 min read

Due to the unique consequences of the pandemic, we are able to catch a glimpse of a potential future. One where we sit, plugged into our computers, devoid of physical human connection. What will society look like after thepandemic? Will we continue to stay isolated? Surely advancements in technology have played key roles in prolonging our lives, allowing us to continue to work and socialise, but to what end? With these newly emerging technologies are we destined to live forever, in a suspended state, in front of the glow of our 4k computer screens? Will gene editing technologies be used to keep us alive forever so that we can binge watch infinite Netflix shows, send meaningless emails and scroll through social media feeds?

The Institute of Zoology of the China Academy of Science has successfully prolonged the lives of mice by using CRISPR/Cas 9. CRISPR has become a relatively simple and popular way to edit strands of DNA. The CRISPR/Cas 9 study found a gene tied to cellular senescence (which tells cells to stop growing) and also, that CRISPR/Cas9 treatment can make partially dormant theagingprocess. CRISPR/Cas9 treatment allowed mice to live 25% longer and be physically stronger. Biologists see these results being relatively easy to reproduce on humans in a clinical setting.

Existing in a world where individuals are able to receive treatment to live longer borders dystopian science fiction. The treatment can reduce the need for medical attention by potentially reducing injuries, heart attacks, and organ failures.

In part, due to breakthroughs in the tech and science industries, life expectancy in the 21st century is projected to steadily increase. In a study published in the Lancet, average life expectancy is predicted to rise in 35 industrialized countries by 4.4 years in men and women by 2030.

Life expectancy will likely increase as we migrate away from laborer positions. Currently, the National Center for Health Statistics puts unintentional accidents, primarily happening within labor positions, as the third leading cause of death in the U.S. Many industrialized countries, like the U.S., have been witness to a slow disappearance of the labor class, but the pandemic has made that increasingly more apparent. Businesses are shifting towards automated technology to replace physical human interactions to curb the spread of Covid-19. Even within agriculture andfarmingindustries, already abundant with machine automation, companies are pushing even further away from human labor in an effort to reduce virus rates.

Simultaneously, we are witness to the emergence of new and remote jobs and work settings.Homesare new sites for schooling, work, andentertainment. Before the pandemic, there was already a struggle to maintain a separation between home and work identities. The pandemic has exacerbated this problem. How do we find rest and recuperation when we are living within the office space? Time on the job stretches on forever as we receive work emails while watching Netflix with our families. If life expectancy in humans gets extended by using CRISPR/Cas 9 are we just creating our own version of purgatory? Is our future one where our time working stretches on seemingly infinitely while we simultaneously cease to age? Are we becoming the perfect machine, one that is held together by technological advancements that inadvertently disembody and dehumanize us?

Was society slowly transitioning toward isolation before the pandemic? Is isolation a byproduct of neoliberalism? Gated communities, mass incarceration, office cubicles, segregation in neighborhoods,retirementhomes, hospitals, national borders and private properties all verify how neoliberalism operates. Now we are being asked to isolate ourselves within the confines of our homes. When the pandemic is over, will people continue to order food, work, shop, and socialize from isolated and often virtual spaces or will we be able to shift back into the more public and physical? Will the last remaining physical laborers, those that are delivering goods to doorsteps, be replaced by driverless vehicles?

Here is the original post:
CRISPR Offers the Potential to Live Forever, But to What End? - Entrepreneur

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Testicular cancer is one of the most curable solid malignancies, even in advanced stages. However, the high cure rate among testicular cancer survivors (TCS) is offset by the long-term toxicity of oncologic treatments which include second malignant neoplasms, hypogonadism, pulmonary toxicity, and nephrotoxicity. Compared to the normal population, TCS have an increased risk of dying from circulatory diseases and infections. Such risk is particularly greater in patients who received chemotherapy.1

Elderly people are at high risk of developing cancer and have a decreased ability to control infections. These complications are greatly caused by immunosenescence, the aging process of the immune system. Immunosenescence is characterized by several changes in the lymphocyte subpopulations: there is a decrease in T cells and nave lymphocytes (B and T cells), while CD57+ and CD28- terminally differentiated senescent cells increase. The cell-cycle regulating protein p16INK4a is also a senescence biomarker; its expression in most tissues increases with cellular aging.2

Cytotoxic chemotherapy can induce cellular senescence in normal and cancer cells.3 Therefore, we hypothesized that TCS have premature immunosenescence, which may explain the aforementioned long-term complications. This pilot study aimed to search for lymphocyte senescence surface markers as well as p16INK4a gene expression among TCS who were given chemotherapy.4

Our team conducted a case-control study of TCS matched by age and gender with healthy controls. We included patients with at least threebleomycin, etoposide, and cisplatin (BEP) chemotherapy cycles and no evidence of disease for at least three months. Patients with high-dose chemotherapy were excluded. Peripheral blood mononuclear cells were isolated and lymphocyte subpopulations were analyzed by flow cytometry. B and T cells and their corresponding nave and memory subpopulations were defined according to their surface marker combinations. p16INK4a gene expression in T cells was measured using quantitative polymerase chain reaction.

We found that TCS who had previously received chemotherapeutic agents had statistically significant lower levels of total T cells and CD4+ T cells. Among the CD4+ T lymphocytes, TCS had less nave and increased effector memory cells. Within the CD8+ T lymphocytes, TCS exhibited a decrease in the percentage of nave cells and an increase in CD45RA + CD57+ cells (surface markers related to the later stages of differentiation). Furthermore, we found that there was a statistically significant higher p16INK4a gene expression in TCS as compared to the matched controls. These differences are highlighted in Figure 1.

Figure 1.Immunosenescence profile of testicular cancer survivors (TCS) compared with healthy controls.

Our data suggest that TCS previously treated with chemotherapy may have an immunological phenotype associated with immunosenescence. Potential confounders for these results (like diabetes and hypogonadism) were controlled and excluded. Chemotherapys causal effect, however, remains to be defined. Our study has several limitations, the most important being the cross-sectional nature of it, and we do not know if these alterations persist over time. Future evaluations are necessary to be done in a longitudinal study that allows a patients evaluation at diagnosis, during, and after oncologictreatments.

We believe that further studies are required to help elucidate the clinical implications of the premature immunosenescence in TCS. This is a group of patients that warrants special attention for they receive oncologic treatments at a very young age, and premature immunosenescence may impose many consequences during their lifespan.

Written by: Maria T Bourlon, MD, MSc, Twitter:@BourlonMaite, Francisco J Castro-Alonso, MD, Arturo Carballo, MD, Luis Llorente, MD, Instituto Nacional de Ciencias Mdicas y Nutricin Salvador Zubirn, Mexico City, Mexico

References:

Read more:
Immunosenescence Profile and Expression of the Aging Biomarker (p16INK4a) in Testicular Cancer Survivors Tr... - UroToday

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Anabolic steroids additionally called androgenic steroids are derivatives of testosterone, significant for advancing and keeping up muscle development and creating auxiliary male sex qualities, for example, an extending voice and facial hair. They are anabolic and increment protein inside cells, particularly in skeletal muscles, Anabolic steroids utilized restoratively in ailments to animate muscle increment, set off male adolescence and treat constant squandering conditions, comprising of malignancy and AIDS.

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Increment in geriatric populace drives the androgens and anabolic steroids commercial center, as more men are susceptible to hypogonadism. Also, ascend in weight issues in men propels the overall androgens and anabolic steroids market. The growing negative health status specifically within the developing countries is projected to fuel the growth of the marketplace during the forecast period. Besides, rise in government ventures for higher human services is attributed to the growth of the overall androgens and anabolic steroids market. Increment in occurrence of hypogonadism among men is anticipated to enlarge the worldwide androgens and anabolic steroids market all through the forecast span. Rise in impotence among men due to weight problems and tiredness is expected to enhance demand for androgens and anabolic steroids during forecast duration.

Anabolic Steroids Market can be segmented on basis of compound derivatives, mode of administration, applications, Distribution channels and geography.

On basis of synthetic derivatives, Anabolic steroids market is segmented as:

On basis of Modes of administration, Anabolic steroids is segmented as:

On basis of Applications, anabolic steroids is segmented as:

On basis of Distribution channels, anabolic steroids market is segmented as:

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Anabolic steroids include di-hydro-testosterone, testosterone, and other marketers. Anabolic steroids stimulate the improvement of male sex organs and male sexual characters including growth of beard and deepening of voice. Various varieties of tissues grow due to stimulation of anabolic steroids, specifically muscle and bone. Rise in red blood cells production is due to anabolic results. Androgens and anabolic steroids are used for the remedy of breast cancer in ladies, impotence, hypogonadism in men, and alternative therapy delayed puberty in adolescent boys. Anabolic steroids are also used for the treatment of numerous conditions with hormonal imbalance, weight loss, osteoporosis, and anemia. Anabolic steroids market can be segmented based on synthetic derivatives, mode of administration, application, end-user, and region. In terms of mode of administration, the market can be categorized into oral, injection, topical, skin patches and inhaler. Based on application type, anabolic steroids market can be divided into Anabolic, Androgenic and others. Based on distribution channels anabolic steroids market can be classified into hospital pharmacies, retail pharmacies and online pharmacies. The hospital pharmacies segment dominated the market owing to elevated availability of medications and hospitals being the first point of contact for treatment.

Anabolic steroids market in North America held the biggest marketplace share due to expanded prevalence of breast cancer in women. According to many researches, breast cancers is one of the main cause of death in U.S. Europe held the second largest share in anabolic steroids market because of accelerated occurrence of hypogonadism in men and delayed puberty in adolescent boys. The Anabolic steroids market in Asia Pacific is expected to grow at a fast pace during the forecast period attributable to multiplied government initiatives to get rid of breast cancer. Anabolic steroids market in Middle East & Africa is predicted to be driven via improved occurrence of impotence, hypogonadism in men, and behind schedule puberty in adolescent boys. The market in Latin America is projected to witness robust increase at some point of the forecast length due to accelerated government tasks within the fitness care sector.

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Europe to hold The major Piece of Cake in the Anabolic Steroids Market between 2020 and 2030 Jumbo News - Jumbo News

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Poultry production in low to middle income nations could substantially benefit from transferring beneficial genes between breeds to produce offspring with useful characteristics, researchers claim.

Sterile male and female chicken eggs have been implanted with reproductive cells from donor birds with the resulting chickens mated together to produce chicks of the donor breed. The chicks showed characteristics inherited from their real patents, the donor birds, along with the edited change to their DNA, rather than their surrogate parents. The gene editing outcome demonstrates an efficient way to introduce beneficial characteristics, the scientists claim, such as tolerance for warm climates or disease resistance.

Poultry production in low to middle income nations could benefit from gene editing, researchers claim. Photo: Mark Pasveer

Beneficial genes can be transferred from one breed into another via gene editing of embryos, in a single generation, and the method to control the reproductive genes can be carried by both parents known as Sire Dam Surrogate (SDS) mating can ensure that offspring will inherit a desired gene from both parents, and exhibit the characteristic associated with that gene. Commercial partner Cobb-Europe worked with a team from the Centre for Tropical Livestock Genetics and Health and the Roslin Institute to demonstrate their approach by using sterile male and female chickens, known as empty nest chickens, to transfer feather characteristics between breeds.

They removed reproductive stem cells (i.e. early stage cells that later develop into sperm and eggs) from chicken embryos using gene-editing technology, and used the same technology to introduce gene-edits into these reproductive cells from another breed. The altered reproductive cells were then implanted into surrogate parents the embryos of chicks and cockerels that were bred to be sterile. These surrogates were then hatched and mated with one another. Resulting offspring were of the donor breed and not that of their surrogate parents. They also had the new traits created by the gene-editing.

Researchers demonstrated their approach by repairing a natural generic change that causes distinctive white plumage in the White Leghorn breed. Chicks born to the sterile chickens now had a black plumage. Similarly, the team introduced a distinctive curly feather, which is believed to help Western African breeds cope with hot climates, into chicks bred from Light Sussex chickens a British breed. The concept could allow the transfer of useful traits among the worlds 1,600 chicken breeds and could boost animal productivity and welfare as well as safeguarding against changing environmental conditions.

Welcoming the developments, Professor Appolinaire Dijkeng, director of the Centre for Tropical Livestock Genetics and Health, said: Poultry is a key livestock animal for millions of smallholder farmers in low- and middle- income countries. Any gains in efficiency, productivity and health from introducing useful traits from other poultry breeds could significantly improve the lives of these farming families through increased food production and income.

Dr. Mike McGrew, one of the scientists who worked on the study, said: The SDS technique is being used now to test genetic variants present in different breeds of chicken and to improve our ability to 'biobank' breeds of chicken. Genome-edited chickens are not allowed in the food chain. However, we can still use the techniques presented in the paper to quickly validate genetic variants which can then be used in conventional breeding programmes. Selective breeding programmes use genotyping data of animals to identify animals and offspring of merit. The idea is to know which genetic sequences are important.

We can inform these breeding programmes that specific DNA sequences in their animals are beneficial and they can then pick the offspring carrying these DNA sequences for their breeding populations."

Heat resistance and disease resistance are the most important traits for our work with the Centre for Tropical Livestock Genetics and Health. For instance, the Frizzle feather genetic variant or 'trait' is hypothesised to cause the frizzly feather phenotype. Sometimes the background breed genetics of the animal is also important for the trait. We can now test now proven that a genetic variant or DNA sequence is causative for the trait. We have introduced the frizzle feather gene into the Light Sussex chicken and we will test if these chickens thrive at higher temperatures directly compared to Light Sussex chicken without the frizzle feather gene. This will prove that the frizzle feather gene on its own is beneficial for tropical environments.

The study was published in Nature Communications and the work was funded by the Bill and Melinda Gates Foundation and the UK Foreign, Commonwealth and Development Office through CTLGH as well as UKRI and Innovate UK.

Originally posted here:
Gene editing to enhance production in developing nations - Poultry World

Recommendation and review posted by Bethany Smith

At GEMS International School (GIS), the science team is made up of women teachers only. Image Credit: Supplied

Dubai: A Dubai school has plenty to celebrate this International Day of Women and Girls in Science today. Its science department comprises an all-female teaching staff.

Many people may expect greying men in lab coats tinkering around in the science department, but at GEMS International School (GIS), the science team is made up of women teachers and instructors only. They are led by head-of-the-department Tanja Kolarov, who specialises in biology and integrated sciences.

I fell in love with science

Tanja Kolarov

As a small child, I used to sit on the white desks of my grandfathers pharmaceutical lab and watch him make creams and shampoos for my sister and myself. This is where I fell in love with science. My background is in biochemistry, with a deep interest in genetics. Genetics and the ability to change genetic information fascinate me, said Kolarov, who has been at GIS for four years.

She added that science has always been a male-dominated profession. Women scientists have been around, Kolarov said, but had to work really hard to get acknowledged. Women have to empower other women. My mother always said that if you set your mind to it, you can do anything. With STEM [science, technology, engineering, maths] being an equal-opportunities field, more and more women are joining the science profession and wanting to teach science to promote it amongst girls.

The UAEs Minister of State for Advanced Technology is a young woman, Sarah Al Amiri. Still in her early 30s, Al Amiri is also the chairperson of the UAE Space Agency and credited with leading the countrys Mars mission, which on Tuesday achieved the rare success by inserting the Hope Probe into Martian orbit to study the Red Planets atmosphere in unprecedented detail.

Paradigm shift

Hiba El Majzoub

At GIS, chemistry teacher Hiba El Majzoub has witnessed an exponential increase in girls participation in STEM in recent times. We need to have a paradigm shift as there is a misconception around this career being a mostly male domain of work. Yet, throughout history, numerous female scientists have had valuable contributions to science and to the industry as well, she said.

Once such scientist, her favourite, is Marie Curie, the only woman to win Nobel prizes in two sciences (chemistry and physics). El Majzoubs favourite subject, of course, is chemistry. She said: Chemistry is a central and pivotal experimental science that supports our deeper understanding of our biological systems as well as our physical environment. This is why chemistry is the foundation for many disciplines such as medicine, biological and environmental sciences, engineering, and materials.

Quite debatable

Hoda Alawady

GIS science teacher Hoda Alawady said the lack of female representation in STEM occupations is quite debatable. She explains: Although science is one of the fields that is dominated by males, this is currently changing dramatically. More female students are choosing to study science for many reasons. Young girls are now exposed to STEM subjects and are encouraged to study science in schools and higher education. Teachers strive to create environments that are equally appealing to females and males. With more women in the field, young girls are able to recognise the career opportunities open to them. This encourages girls to earn more college and graduate degrees and pursue a science career.

Welcome dividend

Sangita Thakrar

Fellow science teacher Sangita Thakrar teaches chemistry, biology and physics up to grade 10. She said women have to work hard to fit into all-male or majority-male departments. This extra effort has led to a dividend. Many female scientists have to blaze their own trail and become pioneers in their own field. This does, however, allow for more creativity, said Thakrar. She is currently following the work of Tiera Guinn Fletcher, 22-year-old MIT graduate working for Nasa as a rocket structural analyst. She is a relatable inspiration to all the young aspiring scientists, especially girls, added Thakrar.

Priti Suresh

The GIS science team also includes physics teacher Priti Suresh. Reacting to a query on whether more and more girl students were opting for science studies and also whether more and more women were opting to teach science, Priti said: "It is encouraging to see more women as science educators in recent times.However, a lot of young girls are still reticent to pursue a career in science owing to decades of gender-biased conditioning that a profession in the sciences requires longer work-hours and tougher working conditions. On a positive note, the last few years have seen substantial encouragement from educators across curricula from primary school through high school, in addition to a host of universities offering scholarships and waivers to further the role of women in science."

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Meet the all-female team at this Dubai school's science department - Gulf News

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Charlie Thompson, Bridge House Farm, Long Buckby, Northamptonshire

It is fair to say Bridge House Farm is a global leader when it comes to the use of technology on pig units.

Not only is it one of the first farms to use EID and ultra-high frequency (UHF) tags, it is also using a feed system that individually feeds pigs in pens depending on their sex and size.

Charlie Thomson is the driving force behind the adoption of technology, working with industry leaders to help design a system that means he can record everything from individual birthweights and litter performance to weaning weights, intramuscular fat and conformation traits.

As a purebred herd supplying breeding stock for Genesus Genetics, Charlie is breeding Yorkshire pigs for the damline and Durocs for the sireline.

This makes accurate data vital, with all the information shared with Genesus Genetics, so continual genetic improvements can be made.

EID technology and bulk reading of pigs has made life so much easier for staff, and data capture more accurate especially useful as Charlie has a growing export demand for his pigs in China.

Using UHF tags allows pigs to be read in batches and from a distance, and the installation of fixed EID readers in the corridors means pig/group movements can be tracked between each stage of production.

But the technology does not stop there. has Charlie also invested in a phase feeding system which allows a tailored diet for each pen of pigs.

Pigs are fed on a curve, depending on their sex and breed due to their nutritional differences.

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But it is not just the technology that is helping this unit to fly.

The attention to detail across the team is second to none and the fact they are running an indoor intensive unit with pigs kept with entire tails and little tail biting is a testament to their hard work.

They are providing a whole range of environmental enrichment, from bowling balls to rope, wood and plastic, which are rotated daily.

If there are any signs a pig may be attempting to tail bite it is removed immediately from the pen and placed in with Durocs.

Charlie explains: Tail biting is very multi-factorial. However, we rarely see any problems in the Duroc pigs because they are so docile. So, if we see any tail biting in the Yorkshires, we remove the individual and place them in a pen with the Durocs and it calms them down and usually stops. Its like they teach them a lesson.

And it is no wonder the staff are so committed to this unit with facilities many could only dream of.

Significant investment in 2011 was made in a new staff room and separate male and female showering and changing facilities.

Development at Bridge House Farm has been made with biosecurity in mind.

Charlie, who is also a qualified vet, says it has been built like a castle, with an external fence/wall running the entire perimeter and no delivery drivers allowed on to the unit.

The environment is something Charlie is looking at closely to future-proof the farm.

In addition to the solar panels he has installed he is looking at acidifying slurry to make better use of it on the arable unit.

Charlie is an impressive pig producer who is innovative, brave, willing to try new things and has great enthusiasm and drive to further the genetics and his business. He is an advocate for showing high welfare in intensive slatted systems.

Zoe Davis, NPA

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NSF International work with the food industry to create consumer confidence from farm to food.

We work with farmers to help them demonstrate the quality of what they produce. Farm assurance covers animal welfare, food safety, traceability and provenance and environmental protection so consumers can be confident the food they eat is safe and responsibility produced.

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Awards 2020: Pig Farmer of the Year - Farmers Weekly - FarmersWeekly

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