Blood test for missing or damaged DNA could provide hint of a prostate cancer relapse

By Sophie Borland

A blood test for men with prostate cancer could detect if the illness is likely to be life-threatening, claim scientists.
At present it is extremely difficult for doctors to know whether a patient’s tumour is slow-growing - and harmless - or if it is deadly.
This means that thousands of men have to endure agonising surgery, chemotherapy or radiotherapy to remove tumours that may never have caused a problem.

Breakthrough: Researchers believe they've found a blood test that can determine the likelihood of prostate cancer returning

Now American scientists think they have come up with a method of predicting how quickly the tumour will spread.

 

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It could also determine whether the tumour is likely to return after surgery - which would warrant the patient having additional chemotherapy or radiotherapy.
The method involves testing the blood for a genetic abnormality - called the copy number variation, or CNV - that determines how quickly the cancer will spread.
Researchers at the University of Pittsburgh in the U.S, looked at the blood samples and records of 238 prostate cancer patients over a period of ten years.
They compared the levels of CNV with how the disease had progressed, as established from their medical records.

Hard cell: The method involves testing the blood for a genetic abnormality - called the copy number variation, or CNV

The academics found that in 69 per cent of patients the CNV blood test was able to correctly predict how quickly the tumour was growing.
In 81 per cent of cases it was able to determine whether it would return after treatment.
The scientists - whose work is published in the American Journal of Pathology - also tested patients’ tissue close to the tumours for levels of CNV and this showed similar success rates.
It is likely to be several years before the academics are able to develop a blood test to predict the speed prostate cancer will spread.
But lead researcher Dr Jian-Hua Luo, from the University of Pittsburgh School of Medicine, said in future it could prove to be ‘a more efficient and accurate way to predict the behaviour of prostate cancer.
‘For a patient diagnosed with prostate cancer, CNV analysis done on blood or normal tissues would eliminate the need for additional invasive procedures to decide a treatment mode.
‘For a patient already having a radical prostatectomy (surgery), CNV analysis on the tumour or blood sample may help to decide whether additional treatment is warranted to prevent relapse.’
New figures last week showed that 40,000 men are now being diagnosed with prostate cancer every year.
This increase is mainly due to greater use of the Prostate Specific Antigen (PSA) test, which measures levels of a chemical that is high when tumours are present.
But although the test has been credited with detecting some deadly cancer cases earlier, there are concerns it often causes ‘false alarms’.
And this month another group of American researchers claimed that surgery to remove prostate cancer is often ineffective.
A study involving 731 patients found that those who had operations were only 3 per cent more likely still to be alive 12 years later compared to those who didn’t have treatment.

Persistent cough 'could be warning sign of lung cancer': Stars who lost relatives to disease launch awareness campaign

By Claire Bates

Just one in 10 people realise that a persistent cough could be a key symptom of lung cancer, according to statistics released by the Government as it launches a campaign to raise awareness about the disease.
Despite the condition killing more people than any other form of cancer in England, very few people are aware a cough lasting three weeks is a sign of a potential sufferer.
An advertising drive backed by actor Ricky Gervais and TV presenter Jenny Frost will be launched tomorrow in a bid to raise awareness about the issue and improve earlier diagnosis in England.

Actor Ricky Gervais and singer Jenny Frost are both backing the Government's 'Be Clear on Cancer' campaign, after both lost a parent to lung cancer

It is hoped Be Clear on Cancer campaign will help save around 1,300 lives a year.
Health Minister Paul Burstow said: 'Lung cancer is the biggest cancer killer in this country but worryingly many people don't know the signs and symptoms that could save their lives.
'The earlier lung cancer is diagnosed, the better the chance of survival.
'The message from this campaign is simple; if you have a persistent cough for three weeks or more, visit your GP.'

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Lung cancer affects 33,000 people every year in England with the majority of cases occurring in people over the age of 55.
When diagnosed at its earliest stage, as many as 80 per cent of people are alive five years after diagnosis compared with only seven per cent diagnosed at a late stage.

Manchester United captain Sir Alex Ferguson lost both his mother and father to lung cancer, while Lynda Bellingham lost her sister

The campaign is being supported by a host of stars, many of whom have been touched personally by the disease. Manchester United captain Sir Alex Ferguson, 70, lost both parents to lung cancer.
He told the Manchester Evening News: 'My father was 66 when he died and my mother was only 64. Dad was diagnosed with lung cancer only a week after he retired and within 12 months it had killed him.
'Then my mum, who had smoked all her life, was diagnosed with lung cancer as well and she passed away a few years after my dad.'
Actor Ricky Gervais, who lost his mother to lung cancer when she was 74, said the condition was 'devastating'.
'It's a horrible, horrible disease,' he said.
Singer Jenny Frost cancelled her wedding in 2010 after her mother Rita succumbed to lung cancer.
Other celebrity supporters include actor Robert Powell, author Tony Parsons and actress Terry Dwyer who lost their fathers and Dragon Duncan Bannatyne who lost his mother. I'm A Celebrity star Stephanie Powers and writer Cassandra Jardine battled the disease themselves.

Campaign backers: Sir Alex Ferguson, Stephanie Powers, Tony Parsons and (bottom row) Linda Robson, Mark Lawrenson and Cassandra Jardine

The campaign follows an awareness-raising pilot in the Midlands in October last year. This showed improved knowledge of lung cancer and increased confidence in recognising the symptoms. There was a 23 per cent increase in attendance to primary care. Based on a sample of trusts, there was an increase in referrals for chest x rays and chest CT scans compared with the same period in the previous year.
Professor Sir Mike Richards, National Cancer Director for England, said: 'It is vital that cancer patients get treated quickly so they have the best chance of surviving. We have made early diagnosis central to our Cancer Outcomes Strategy.
'Earlier diagnosis of Lung Cancer combined with the best treatments could help save an additional 1,300 lives a year.'
Paula Chadwick, chief executive of the Roy Castle Lung Cancer Foundation, added: 'We really hope people will begin to associate a persistent cough as a symptom of lung cancer, the way they associate a lump as a symptom of breast or testicular cancer.'

Supporters: Ricky Gervais, Robert Powell, Nikesh Shukla, Lynda Bellingham with (bottom row left to right) Duncan Bannatyne,Tricia Penrose, Jenny Frost and Terri Dwyer

One in six cancers are caused by preventable infections

By Daily Mail Reporter

Two types of the human papilloma virus (HPV) cause around 70 per cent of all cervical cancers

One in six cancers are caused by preventable infections, research shows.
Infections cause around two million cancer cases a year, with 80 per cent of these effecting the developing world.

Of 7.5 million cancer deaths worldwide in 2008, 1.5 million were down to treatable or preventable infections, reports the Lancet Oncology.

Catherine de Martel and Martyn Plummer from the International Agency for Research on Cancer in France said: 'Infections with certain viruses, bacteria, and parasites are one of the biggest and preventable causes of cancer worldwide.

'Application of existing public-health methods for infection prevention, such as vaccination, safer injection practice, or antimicrobial treatments, could have a substantial effect on future burden of cancer worldwide.'

For the study the team estimated the proportion of cancers that could be attributed to infection globally and in eight regions by calculating the population attributable fractions (PAF) - the proportion of new cancers in a population that could have been prevented by an intervention.

They calculated that around 16 per cent of all cancers worldwide in 2008 were infection-related, with the fraction of cancers related to infection about three times higher in developing than in developed countries.

The fraction of infection-related cancers varied widely between regions, from 3.3 per cent in Australia and New Zealand to 32.7 per cent in sub-Saharan Africa.

Dr de Martel said: 'Many infection-related cancers are preventable, particularly those associated with human papillomaviruses (HPV), Helicobacter pylori, and hepatitis B (HBV) and C viruses (HCV).'

Since September 2008 there has been a national programme to vaccinate girls aged 12 to 13 against the human papilloma virus

Cervical cancer accounted for around half of the infection-related burden of cancer in women, and in men liver and gastric cancers accounted for more than 80 per cent.

Dr de Martel concluded: 'The 2011 UN high-level meeting on non-communicable diseases highlighted the growing global agenda for prevention and control of non-communicable diseases.

'But although cancer is considered a major non-communicable disease, a sizable proportion of its causation is infectious and simple non-communicable disease paradigms will not be sufficient.'

In an accompanying Comment, Goodarz Danaei from Harvard School of Public Medicine, Boston, said: 'Their estimates show the potential for preventive and therapeutic programmes in less developed countries to significantly reduce the global burden of cancer and the vast disparities across regions and countries.

'Since effective and relatively low-cost vaccines for HPV and HBV are available, increasing coverage should be a priority for health systems in high-burden countries.'

Less Inflammatory Bowel Disease Seen in Southern Latitudes

Women living in the southern latitudes of the United States have significantly lower rates of Inflammatory Bowel Disease (IBD) than those living in the country's northern regions, according to new research published online January 11, 2012, in Gut.
Similar trends have been reported in Europe in the past; however, this is the first study to evaluate the role of latitude on IBD incidence in the United States.
To investigate the issue, Hamed Khalili, MD, from the Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, and colleagues evaluated data on 175,912 women enrolled in the Nurses' Health Study I (NHS) in 1976, and in the NHS II in 1989.
The data included information on the women's state of residence at birth, at age 15 years, and at age 30 years. The states were categorized as being in the northern, middle, or southern tiers of each of the 4 time zones (eastern, central, mountain, and pacific).
Follow-up data taken in 2003 identified 257 cases of Crohn's disease and 313 cases of ulcerative colitis among the women, with the incidence of each disease increasing significantly according to increased latitude (P _trend < .01).
The residence at age 30 years showed the strongest association with risk for Inflammatory Bowel Disease.
The multivariate-adjusted hazard ratio for women residing in southern latitudes compared with those residing at northern latitudes at age 30 years was 0.48 (95% confidence interval, 0.30 - 0.77) for Crohn's disease and 0.62 (95% confidence interval, 0.42 - 0.90) for ulcerative colitis. The multivariate analysis was adjusted for age, body mass index, ancestry (Southern European, Scandinavian, other white, nonwhite), smoking, and oral contraceptive and hormone therapy use.
"In two large prospective cohorts of US women, the incidence of [ulcerative colitis and Crohn's disease] was significantly lower among women who resided in the southern latitudes, particularly in later life (age 30 years), than in those residing in the northern latitudes," Dr. Khalili and colleagues write.
"These results were consistent even after accounting for differences in self-reported ancestry and smoking, suggesting that other environmental or lifestyle factors correlated with geographical variation may mediate these associations."
The authors hypothesize that the main explanation for the reductions in southern latitudes is related to greater levels of sun exposure and to the higher levels of plasma vitamin D that are associated with ultraviolet (UV) radiation.
"UV radiation is the greatest environmental determinant of plasma vitamin D and there is substantial experimental data supporting a role for vitamin D in the innate immunity and regulation of inflammatory response," the authors write.
"The role of vitamin D in the pathogenesis of IBD is further supported by the observation that animal models of colitis have more severe inflammation in vitamin D receptor knock out animals or animals deficient in 1,25(OH)₂ vitamin D."
In addition, UV radiation is associated with regulation of T cells, as well as the production of interleukin (IL) 4 and IL-10, and the inhibition of IL-12, which suppresses the inflammatory response, they note.
Bincy P. Abraham, MD, an assistant professor of medicine in the Inflammatory Bowel Disease Program at Baylor College of Medicine in Houston, Texas, said that vitamin D, or a lack thereof, has been recognized as a potential risk factor for IBD, but its role is not entirely understood.
"Theoretically, vitamin D can play a role in inflammation: low levels may contribute to inflammation, and thus can be explained by the general north–south gradient of inflammatory bowel disease we have seen historically in the US, as well as Europe," Dr. Abraham told Medscape Medical News.
"However, knowing the vitamin D levels in both groups of patients is important in order to clarify this," added Dr. Abraham, who was not involved in the study. "This is because there could be other confounders — other environmental causes that we do not know about."
In her own research on Inflammatory Bowel Disease, Dr. Abraham found high levels of abnormal bone density among patients with IBD and vitamin D deficiency, but that research was also inconclusive regarding the vitamin's influence.
"It was difficult for us to determine a correlation of IBD disease activity and vitamin D levels due to too many confounding variables," she said, noting that, among potential variables, there is even a theory that refrigeration of food may increase the risk for Inflammatory Bowel Disease.
"My general sense is that [a correlation with vitamin D] is quite possible," Dr. Abraham concludes. "We may need to do additional, larger-scale studies of vitamin D levels and their association in contributing to the development of Inflammatory Bowel Disease."
The study received support from the National Institutes of Health and the Broad Medical Research Program of the Broad Foundation. The authors included a clinical investigator for the Damon Runyon Cancer Research Foundation, and one author is supported by a career development award from the IBD Working Group and the Crohn's and Colitis Foundation of America. Dr. Abraham has disclosed no relevant financial relationships.

Fecal Calprotectin Helps Spot Pediatric Inflammatory Bowel Disease

By David Douglas
NEW YORK (Reuters Health) Mar 16 - High fecal calprotectin (FC) levels identify children who need endoscopic exams for inflammatory bowel disease (IBD), UK researchers say.
FC is "far superior to commonly utilized blood parameters such as C-reactive protein and white cell count" as a marker of IBD, they reported online February 28th in The American Journal of Gastroenterology.
"This study robustly identifies fecal calprotectin as not only an important biomarker during the treatment of pediatric inflammatory bowel disease but also during the initial investigation of children with suspected disease," Iead author Dr. Paul Henderson told Reuters Health by email.
Dr. Henderson of the University of Edinburgh and colleagues reviewed data on 190 volunteers who had FC testing, including 91 with IBD and 99 controls.
In their own practice, the researchers use a cutoff of 200 mcg/g to define high levels.
In the study, the median FC at diagnosis in the IBD group was 1,265 mcg/g, compared to only 65 mcg/g in controls. In the patient group, values were similar whether with Crohn's disease, ulcerative colitis and unclassified Inflammatory Bowel Disease.
"Our work demonstrates that disease location and type do not influence FC at diagnosis and that FC performs far better than commonly used blood tests," Dr. Henderson said.
Senior author Dr. David C. Wilson added, "(FC) has indeed become our standard of care -- although no single test will be 100% correct in diagnostic terms, it is much superior to any (or a combination of all) commonly used blood 'inflammatory markers.'"
"A negative test is very helpful," he said, "and reduces the number of children in our practice going to invasive testing with GI endoscopy and biopsies; by contrast, a test showing more than 200 mcg/g strengthens our suspicion of Inflammatory Bowel Disease and will expedite further investigation, unless the clinical scenario has markedly improved."
Further studies are now required, but Dr. Wilson pointed out that "because it has become our standard of care, we are not placed to perform the definitive trial with blinded calprotectin usage and evaluation of suspected gut inflammation of children and young people generating robust data on reduction (or not) or need for GI endoscopy and biopsies."
In the meantime, he and his colleagues predict, someday "the routine use of FC in the pediatric setting should significantly enhance our ability to more accurately screen children for Inflammatory Bowel Disease."

Patients With IBD Fare Well on Their Travels

Patients with inflammatory bowel disease (IBD) who traveled to developed countries had a higher rate of illness compared with other travelers, but the rate of illness was the same for travel to developing or tropical regions. Most travel-related illnesses among the patients with IBD arose from sporadic flares of their disease, rather than increased susceptibility to enteric infections, suggested study authors Shomron Ben-Horin, MD, director of the IBD service, and coauthors from the Sheba Medical Center and Sackler School of Medicine of Tel-Aviv University in Tel Hashomer, Israel.
The research was published online November 3 and in the February print issue of Clinical Gastroenterology and Hepatology.
Compared with healthy control patients, the absolute increased risk for patients with IBD was small, and most episodes of illness that they experienced were mild, providing reassurance for many patients who want to travel.
Patients with IBD have often been advised to avoid travel, especially to developing countries, for fear of contracting infections or experiencing disease flares in regions with poor hygiene or potentially inadequate medical facilities. Self-imposed or physician-advised restrictions on travel can severely limit patients' quality of life or opportunities to do business abroad.
Because little data exist on the risk of travel for patients with Inflammatory Bowel Disease, the investigators performed a retrospective, case–control study comparing illnesses among patients with Inflammatory Bowel Disease (n = 222; 523 trips) and healthy control individuals (n = 224; 576 trips), using validated, structured questionnaires, interviews, and chart reviews. The questionnaires included items related to demographics, medical history (eg, travel clinic attendance, immunizations, and prophylactic and regular medications), details of all travel going back 5 years, and any illness during or within 3 months after any trips. The authors used the United Nations Human Developmental Index classification to identify developing and developed countries.
Individuals in the case group included individuals attending outpatient gastroenterology (GI) clinics at the medical center. Individuals in the control group included volunteers without known Inflammatory Bowel Disease who were drawn from hospital staff, their family members, and people escorting relatives undergoing endoscopies. The mean age of both groups was 37 years. Individuals in the control group received the same questionnaire as patients with IBD, but without IBD-specific items. The authors defined illness as any GI or non-GI episode.
Patients with Inflammatory Bowel Disease experienced illness in 15.1% of their trips compared with 10.9% of trips made by control patients (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.01 - 2.0; P = .04). For both patients with IBD and control participants, enteric disease accounted for 92% of the episodes, most of which were mild to moderate and resolved within a few days, the authors report. Only 5 patients with IBD and 4 control participants required hospital admission for any reason while traveling.
Travel to developed countries accounted for most of the difference in illness between patients with IBD and control participants. For the 2 groups, the rates of illness were the same when they went to developing regions (17% vs 21% of trips, respectively; P = .24).
Their rates of illness when traveling to developing countries (17% of trips) was not statistically different from when they went to developed countries (13.9% of trips; P = .32). They did, however, experience an almost 2-fold increased risk when traveling to the tropics compared with developed countries (OR, 1.9; 95% CI, 1.1 - 3.3; P = .02).
Control individuals experienced much less illness in developed countries (3.3% of trips) compared with travel in developing regions (21.4% of trips; OR, 6.6; 95% CI, 3.2 - 12.2; P < .001). When they went to the tropics, however, their rates of illness increased 10-fold compared with travel in developed countries (33.3% vs 3%, respectively; OR, 13.6%; 95% CI, 6.7 - 27.6; P < .001) and were not statistically different from the rate of illness for patients with IBD (P = .18).
Factors Influencing Travel-Related Risk
It appeared that underlying IBD activity was an important determinant of travel-related disease activity. Multivariate analysis showed that risk increased if patients experienced frequent flares (OR, 1.9; 95% CI, 1.1 - 3.4; P = .02) or had prior IBD-related hospitalizations (OR, 3.5; 95% CI, 1.3 - 9.3; P = .01). Among patients with IBD, disease remission for at least 3 months before traveling reduced the risk for travel-related illness by 70% (OR, 0.3; 95% CI, 0.16 - 0.5; P < .001). Patients in remission had the same risk for illness during travel as did individuals in the control group (12% vs 10.9%; P = .5).
In the multivariate analysis, there was no independent effect of the use of immunomodulatory drugs during the trip on the risk for illness during travel (P = .5).
Because the length of the trip may affect the likelihood of illness, the investigators normalized the results per 10 days of travel and found a 7% risk per 10 days for individuals in the case group vs 5% per 10 days for individuals in the control group (OR, 1.4; 95% CI, 1.01 - 1.96; P = .04). When stratified by trip duration, there was no increased risk for patients with IBD traveling to developing or tropic areas, in line with the nonnormalized analyses.
Travelers with IBD experienced disease flares within 3 months of returning to Israel after 16% of their trips. The incidence of flares was higher if travelers had experienced an episode of illness during the trip than for uneventful trips (43% vs 11.6%, respectively; OR, 7.4; 95% CI, 4.2 - 12.9; P < .001). The authors note that almost half of the patients with illness during the trip and flares afterward felt that the flare was a direct continuation of the episode during the trip.
The authors caution that the retrospective nature of the study makes it susceptible to recall bias, and they emphasize that it was not sufficiently powered to detect differences in rare opportunistic infections that may affect immunocompromised patients. They also warned that live attenuated vaccines such as those against yellow fever are contraindicated in such patients. Another limitation of the study is that it involved travelers from a single, developed country, and therefore the results may not be generalizable to travelers with IBD from other developed or developing countries.
Charles Ericsson, MD, professor of medicine, head of clinical infectious diseases, and director of the travel medicine clinic at the University of Texas Medical School at Houston; founding editor-in-chief of the Journal of Travel Medicine; and past-president of the International Society of Travel Medicine, told Medscape Medical News that the study is retrospective, albeit case-controlled, "so that immediately calls into question recall bias when you're asking people to remember trips up to 5 years later. I'm taking any of the data with a bit of a grain of salt." He said most of the illnesses were reportedly mild, but people tend especially to remember more severe illnesses.
"The data are OK as far as they go, but I think you're left with enough uncertainties that I will refuse to use data like this to say that I'm not going to worry about somebody with IBD when they travel to a developing country" and not offer them chemoprophylaxis against travelers' diarrhea, Dr. Ericsson said. Even if the incidence is not different from control participants, "when they do get travelers' diarrhea, I think the impact on the subject is profound because they don't know whether it's a flare of their IBD" that requires treatment or not, "and I'd rather prevent that conundrum to begin with." He admits he's "a fan of chemoprophylaxis" in general, offering rifaximin to his high-risk travelers, which is active in the upper GI tract, and therefore a good prophylactic agent.
Another issue "that does bug me a little bit is the outcome measurement [of] any illness," he said. He would have preferred the authors to distinguish enteric conditions from other types of illness. "They allude to the fact that...92% of the outcomes were enteric disease," he noted. "Then why not just study that 92%, to keep it clean? You would have a study that would have focused on the most important issue."
Dr. Ericsson also wondered about the meaning of the finding that the patients with IBD experienced more illness when they went to developed countries compared with control patients (P < .001), but not when they visited developing ones (P = .2). "What they didn't control for is the likelihood, I would think, that anybody traveling from a developed to another developed country may well not have been on a vacation but, rather, traveling for business, and was stressed out, and that's a known precipitator for a flare of your IBD," he noted. And he speculated that "the IBD people in fact are concerned about going to a developing country and take extra precautions," such as chemoprophylaxis or watching out for food and beverages.
The finding that people with IBD had such a high level of problems in developed countries, but not in developing ones, implies that they experienced only a very small level of travelers' diarrhea in developing countries. "It doesn't sit well with me," Dr. Ericsson said. "I'm not quite sure how to interpret it. I'm worried that there's confounding issues going on of behavioral differences that were not assessed."
Also, with a reported mean trip length of 22 days for both patients with IBD and control participants, he found the incidence of illness quite low compared with previous reports of travelers' diarrhea, depending on trip length. The specific countries, areas of the countries, and purposes of the trips may have affected the outcomes.
In summary, Dr. Ericsson said the study is valid as it is presented, but "it's the interpretation of it that has to be taken with a bit of a grain of salt." He said the findings may lead him to advise a patient with IBD who has had many flares to find out where to get treatment while traveling, as their risk for illness is increased.
He said that going forward, he would like to see a properly designed prospective case–control study implemented that looks at a sufficient number of patients with IBD as they travel, which may avoid some of the problems of recall bias during such a long period of a retrospective study as this one.
Dr. Ben-Horin has received consultancy fees from Schering-Plough and Abbott Laboratories. The other authors and Dr. Ericsson have disclosed no relevant financial relationships.

Fecal Calprotectin Helps Spot Pediatric IBD

By David Douglas
NEW YORK (Reuters Health) Mar 16 - High fecal calprotectin (FC) levels identify children who need endoscopic exams for inflammatory bowel disease (IBD), UK researchers say.
FC is "far superior to commonly utilized blood parameters such as C-reactive protein and white cell count" as a marker of IBD, they reported online February 28th in The American Journal of Gastroenterology.
"This study robustly identifies fecal calprotectin as not only an important biomarker during the treatment of pediatric inflammatory bowel disease but also during the initial investigation of children with suspected disease," Iead author Dr. Paul Henderson told Reuters Health by email.
Dr. Henderson of the University of Edinburgh and colleagues reviewed data on 190 volunteers who had FC testing, including 91 with IBD and 99 controls.
In their own practice, the researchers use a cutoff of 200 mcg/g to define high levels.
In the study, the median FC at diagnosis in the IBD group was 1,265 mcg/g, compared to only 65 mcg/g in controls. In the patient group, values were similar whether with Crohn's disease, ulcerative colitis and unclassified Inflammatory Bowel Disease.
"Our work demonstrates that disease location and type do not influence FC at diagnosis and that FC performs far better than commonly used blood tests," Dr. Henderson said.
Senior author Dr. David C. Wilson added, "(FC) has indeed become our standard of care -- although no single test will be 100% correct in diagnostic terms, it is much superior to any (or a combination of all) commonly used blood 'inflammatory markers.'"
"A negative test is very helpful," he said, "and reduces the number of children in our practice going to invasive testing with GI endoscopy and biopsies; by contrast, a test showing more than 200 mcg/g strengthens our suspicion of Inflammatory Bowel Disease and will expedite further investigation, unless the clinical scenario has markedly improved."
Further studies are now required, but Dr. Wilson pointed out that "because it has become our standard of care, we are not placed to perform the definitive trial with blinded calprotectin usage and evaluation of suspected gut inflammation of children and young people generating robust data on reduction (or not) or need for GI endoscopy and biopsies."
In the meantime, he and his colleagues predict, someday "the routine use of FC in the pediatric setting should significantly enhance our ability to more accurately screen children for Inflammatory Bowel Disease."

Youths With IBD May Need Large Doses of Vitamin D

By Megan Brooks
NEW YORK (Reuters Health) Apr 17 - In children and adolescents with inflammatory bowel disease (IBD) and insufficient serum vitamin D levels, taking 2,000 IU of vitamin D3 every day for six weeks, or a 50,000-IU dose of vitamin D2 every week, were both more effective at raising serum 25OHD concentration than 2,000 IU/day of vitamin D2.
Dr. Helen Pappa from Children's Hospital Boston, who worked on the study, told Reuters Health: "This is the first study to compare efficacy of three widely used vitamin D repletion regimens in children with vitamin D insufficiency. Findings from the study suggest that large vitamin D doses are needed to treat vitamin D insufficiency in this population, and that body weight rather than absorption affects regimen success in this population."
Based on the results of this study, "doses of 2,000 IU of vitamin D2 per day for six weeks should not be used because they may be inadequate in treating vitamin D insufficiency in adolescents with IBD," she said.
Vitamin D insufficiency (25OHD <20 ng/mL) is common in children with IBD and its treatment has not been studied, Dr. Pappa and colleagues said in a report online March 28 in the Journal of Clinical Endocrinology and Metabolism.
They enrolled in their study 71 patients with Inflammatory Bowel Disease between 5 and 21 years old and serum 25OHD <20 ng/ml.
All participants took oral elemental calcium (1,200 mg for those aged 11 or older and 800 mg for those younger than age 11) plus one of three vitamin D regimens: 2,000 IU vitamin D2 daily (study arm A; control), 2,000 IU vitamin D3 daily (arm B) and 50,000 IU vitamin D2 once weekly (arm C).
Sixty-one subjects completed the trial and two withdrew due to adverse events. All regimens were well tolerated, the researchers say. Adverse events occurred in one third of subjects overall, with no differences between the three arms. Most common were nausea (n=6), increased thirst and loss of appetite (n=5 each) and pruritus (n=4),
After six weeks of treatment, the mean changes from baseline in serum 25OHD were 9.3, 16.4 and 25.4 ng/mL in arms A, B and C, respectively.
Arms B and C experienced statistically significantly greater mean changes than arm A (Bonferroni adjusted p=0.03 and p=0.0004, respectively). "Serum 25OHD concentration increased on average by 130% and 190% in arms B and C, respectively, compared with just 62% in arm A," the researchers report.
Both arms B and C were 95% successful in raising serum 25OHD levels above 20 ng/mL; however, 62% of subjects in arm B and 25% in arm C did achieve a serum 25OHD level above 32 ng/mL, the investigators report. They estimate that a cumulative dose of 400,000 IU of vitamin D2 or 220,000 IU of vitamin D3 "would be sufficient to achieve this level."
The researchers say further studies are needed to "define a specific target serum 25OHD concentration and the best regimen by which to achieve and maintain this in young patients with Inflammatory Bowel Disease."
They also found that subjects who failed treatment were heavier, which supports weight-adjusted vitamin D dosing.
No change in serum parathyroid hormone (PTH) concentration was observed in any of the treatment arms. The authors note that baseline PTH levels were lower than reference PTH values for healthy children of similar age in their geographic region.
"PTH response to treatment was blunted suggesting a relative hypoparathyroidism in this population," Dr. Pappa said. None of the study subjects experienced hypercalcemia, hyperphosphatemia, or serum 25OHD concentration above 68 ng/mL after treatment.

Stress levels and smoking: Why your dad's bad habits may have wrecked your genes

By John Naish

For years, scientists and doctors have blamed illnesses on our parents, showing how conditions such as blindness and deafness can be passed down genetically, and bad lifestyle habits can put babies at risk of heart defects.

But medicine is increasingly pointing the finger specifically at fathers, with studies showing how male genes and even men’s diets and stress levels can create serious health problems for their offspring, including diabetes, depression and obesity.

This latest finding is part of a larger picture where scientists are starting to discover diseases passed from man to boy through the Y chromosome

It seems that the Bible warning holds true for health: the sins of the fathers really do plague their children — and this effect may pass on to their grandchildren, too.

The latest evidence in this newly emerging jigsaw comes from research that shows a common genetic flaw may increase a son’s risk of heart disease by 50 per cent.

Scientists at Leicester University who analysed samples from more than 3,000 men found that those with a common group of genetic traits (called haplogroup I) had a 50 per cent higher risk of coronary artery disease than men in other genetic groups.

This genetic flaw is at the centre of male genetic identity; it’s carried in the Y chromosome, responsible for determining that babies are born as boys (chromosomes are found in all cells and carry our genetic blueprint) — so it’s passed only from fathers to sons.

It is thought that as yet unidentified genetic flaws in men’s immune systems may cause chronic inflammation in their arteries, which can lead to heart disease.

The British Heart Foundation, which funded the study, said the findings could lead to new tests and treatments for coronary problems.

And while men can’t change their genes, they could benefit from learning if they have inherited this danger, says research scientist Lisa Bloomer, one of the study’s authors.

Indeed, while there are no tests for this haplogroup yet, if your father and uncles have had heart troubles, it is sensible to assume there is a strong chance you may be affected.

‘You can reduce your risk if you mitigate the effects of other dangers, such as your weight, blood pressure and cholesterol levels,’ says Ms Bloomer.

This latest finding is part of a larger picture where scientists are starting to discover diseases passed from man to boy through the Y chromosome.

‘It has already been found genes on this chromosome can increase people’s risk of being born with autism and for contracting HIV,’ says Ms Bloomer.

‘We need to do more work to understand how these problems occur.’

Men can pass on addictive behaviours and stress-related depression

Scientists are also learning how the bad effects of men’s lifestyle habits, such as their diet, stress levels, weight and smoking, can be transmitted through the genes in their sperm.

Just as disturbingly, it seems that men can pass on addictive behaviours and stress-related depression.

Here, it is not only sons who are affected but daughters, too, because these problems are passed on through genes that are not on the Y sex chromosome.

Early clues to this have been found by Washington University researchers who studied the sperm of a group of male heroin addicts.

The men’s sperm contained genes that had been changed from normal and would affect the development of any children they had.

These changes are called ‘epigenetic’ — alterations to a person’s genes that are caused by their lifestyle habits.

Significantly, the researchers found epigenetic changes that boosted the activity of OPRM1, a gene that controls how the body responds to its own  heroin-like feel-good hormones.

This change is believed to be a factor in making people more liable to develop addictions.

In a similar fashion, men may transmit stress-related diseases across generations.

Scientists at New York’s Mount Sinai School of Medicine say lab experiments on rats have found epigenetic changes in the semen of males who show signs of stress and anxiety after being isolated or threatened.

Their studies show that baby rats sired by these fathers show an increased vulnerability to stress, and become anxious and depressed more quickly than normal. They also have higher levels of stress hormones.

This is despite the fact that their mothers showed no such problems, according to the study published in the journal Biological Psychiatry.

This may offer one explanation as to why depression can run in families.

Even smoking when very young can affect men’s sperm — and surprisingly, this may make their sons prone to becoming overweight.

The discovery was made using survey results from the Avon Longitudinal Study of Parents and Children — an investigation into the health of 14,000 mothers and their children in the Bristol area.

It began in 1991 and is the most comprehensive study of its kind.

Professor Marcus Pembrey, a clinical geneticist at the Institute of Child Health in London, found men who smoked before puberty had sons who were fatter by the age of nine, even when other lifestyle factors were taken into account. There was no similar effect among women.

‘It seems that before puberty, our genes are tuned to suit the environment we are living in. It is these genetic changes that are passed down the male line,’ says Professor Pembrey.

Perhaps the most important factor in determining a man’s legacy to his children comes from his dietary habits.

This takes us into a newly emerging field of science called nutri- epigenomics — the study of how food can alter our genes.

‘Rather than “you are what  you eat”, this science shows “you are what your dad ate”,’ says Anne  Ferguson-Smith, professor of developmental genetics at Cambridge University.

She points to research that showed fathers who eat high-fat diets and are obese tend to have daughters with a high risk of developing diabetes.

These girls are born with low insulin levels and glucose intolerance — classic signs of the disease.

The research, published in the journal Nature, concluded that the problems seem to be transmitted through the father’s sperm.

Professor Ferguson-Smith warns in the journal Cell Metabolism that these studies show the problem of ill-health being passed from parents to children ‘is not only just maternal territory.

The father’s nutritional and metabolic status merits attention, too, if we are to optimise the health of his children and grandchildren’.

Parents must understand that having healthy offspring is a joint enterprise if their babies are to inherit healthy genes.

This is most starkly illustrated by a study that found obese mothers produced sons at risk of being morbidly overweight.

These boys grew up to father daughters who, in turn, had an inherited tendency to be perilously overweight.

The Biblical prediction turns out to be more complex than anyone thought: the lifestyle sins of both parents can be visited on their children and are passed on in ways we are only beginning to understand.

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How garlic can prevent a dicky tummy: Ingredient '100 times more powerful at fighting food poisoning than antibiotics'

By Daily Mail Reporter

Garlic: A powerful natural anti-bacterial

A key ingredient in garlic is 100 times more powerful than two popular antibiotics at fighting a leading cause of food poisoning, scientists have found.

Tests discovered that the  compound, diallyl sulphide, can easily breach a slimy protective biofilm employed by the bug to make it harder to destroy.

Not only is it a lot more powerful than antibiotics erythromycin and ciprofloxacin, it also takes a fraction of the time to work.

The discovery, published in the Journal of Antimicrobial Chemotherapy, could open the door to new treatments for raw and processed meats, and food preparation surfaces, that would reduce the toll of Campylobacter food poisoning.

Dr Michael Konkel, from Washington State University, said: 'This work is very exciting because it shows this compound has the potential to reduce disease- causing bacteria in the environment and in our food supply.

 

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'Campylobacter is the most common bacterial cause of food-borne illness in the United States and probably the world.'

Symptoms of the infection include diarrhoea, cramping, abdominal pain and fever.

The bacteria also triggers nearly a third of cases of a rare paralysing disorder called Guillain-Barre syndrome.

Campylobacter infection symptoms include diarrhoea, cramping, abdominal pain and fever

Most Campylobacter infections stem from eating raw or undercooked poultry or foods that have been cross-contaminated via dirty surfaces and utensils.

It is the most common cause of food poisoning in the UK, according to the Food Standards Agency, and was responsible for 88 deaths in England and Wales in 2009.

Popular diabetes drug 'could make anti-depressants more effective'

Anti-depressant citalopram was found to be more effective when used in conjunction with a popular diabetes pill

A popular diabetes drug used by almost a quarter of a million Britons could also treat depression, say scientists.
Actos, the brand name for pioglitazone, boosts the effects of antidepressants in patients whether they have diabetes or not according to new research.
Professor Shahin Akhondzadeh and colleagues treated 40 patients with moderate to severe depression with a common antidepressant, citalopram, either by itself or in conjunction with pioglitazone.
Over six weeks of treatment those who were also given pioglitazone reported lower symptoms of depression.
The preliminary study published online in Neuropsychopharmacology will need to be repeated using a larger group of patients, but the researchers say it has implications for how diabetes drugs which act in a similar way as Actos (pioglitazone) could be used to boost the effectiveness of currently available antidepressants.
A large proportion of patients treated with available antidepressant drugs fail to respond to medication. 

 

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Prof Akhondzadeh, of Tehran University of Medical Sciences in Iran, said: 'Despite the advent of several antidepressant medications, the treatment of major depressive disorder (MDD) is still far from optimal.
'A large proportion of patients with MDD do not respond to their first medication. To achieve favourable response, these patients are generally treated by either switching to another treatment or with augmentation therapy.
'Recently, combination therapy from the beginning of treatment has been suggested to achieve higher responses and remission rates.'

Actos is currently used to help to control blood sugar levels in people with type 2 diabetes

Actos was licensed in 2000 and helps to control blood sugar levels. It belongs to a class of drugs called thiazolidinediones which are widely used for the treatment of type 2 diabetes.
Prof Akhondzadeh said: 'To the best of our knowledge, this was the first randomised controlled trial that evaluated the role of pioglitazone in patients with MDD without any significant metabolic problems.
'Our study showed pioglitazone is an effective and safe adjunct to citalopram in patients with moderate-to-severe MDD.
'In particular pioglitazone is associated with high rate of early improvement - and thus response and remission - which makes this drug a potentially useful augmentative strategy in patients with moderate-to-severe MDD.'

Teenager, 19, who thought her watery eye was caused by make-up discovers it is CANCER tumour behind her nose

By Chris Parsons 

When Tasha Jilka began suffering from a watery left eye, she put the strange symptom down to her make-up or the seasonal weather.

But far from being an innocuous allergic reaction to cosmetics, the teenager's bizarre ailment was one which changed her life forever, as she was later diagnosed with cancer.

The 19-year-old's watery eye was caused by a rare cancer tumour called olfactory neuroblastoma at the back of her nose which left doctors eventually having to rebuild her whole face.

Rebuilding her life: Tasha Jilka has had extensive surgery to rebuild her face following the shock discovery of a cancer tumour behind her nose

Tasha's rare diagnosis was eventually made a year after she first suffered the watery eye, having been missed by doctors and opticians.
Her ordeal began in May 2008, when, aged 16, her symptoms began.

WHAT IS OLFACTORY NEUROBLASTOMA?

Also known as esthesioneuroblastoma, it is a very rare, malignant tumour that develops in the nose.
The tumors are believed to start in the olfactory nerve, which transmits impulses related to smell from the nose to the brain. 
Tumours can be slow-growing or aggressive. The condition is not thought to be inherited and the cause is unknown.
Common symptoms include a nasal obstruction, changes in sesnse of smell, facial pain, watery eyes and changes in vision.
Around 1,200 cases have been diagnosed since the condition was first identified in 1924. It appears to affect both genders and all races equally.
Treatments include surgery, radiation therapy, and possibly chemotherapy.
Five year survival following treatment ranges from 40 to 80 per cent, depending on the stage and grade of the tumour.

Source: hopkinsmedicine.org

Tasha, from Leicester, said: 'My left eye was very watery but I just put it down to make-up. It kept getting worse and I decided to go to my GP.

'It was put down to a cold and the weather and I was told it would go by itself.

 

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'I went back a few times when it didn’t get better and was referred to an optician, but they couldn’t find anything either.'
Four months later, her eye had got worse and she was referred to a Cambridgeshire hospital, as she was living near there at the time.
Tasha had an operation to clear a blocked tear duct - but it still did not solve her problems.
In 2009, when she and her family moved to Leicester, she again went to her doctor and was referred to specialists at Leicester Royal Infirmary.
Tasha said: 'I had a similar eye test but this time doctors also looked up my nose and could see a lump.'
A biopsy was taken and a short time later, Tasha’s cancer was diagnosed.
She said: 'When I was told it was as if they were talking about someone else. I knew it was serious.
'I thought it was a little lump in my face but the news began to sink in.'
In May 2010 Tasha had surgery to remove the tumour.
It was so severe that surgeons had to reconstruct her nose and she is still having problems with the vision in one eye.

Rare: Olfactory neuroblastoma is a form of cancer which affects the superior recess of the nasal cavity (stock picture)

She has had two major operations, one to remove the tumour and a second to rebuild her nose.
It has also meant the shape of her face has changed.
Tasha said: 'I am very strong and I am pulling through, but it is very hard.
'I feel if I had been diagnosed earlier and known more about the symptoms, I might not have had to have two such major operations.
'I have lost a lot of feeling in my face and my sense of smell.'
Tasha is now backing a campaign by charity the Teenage Cancer Trust to raise awareness of cancer in young people.