Cristina ya sabe lo que pondrá a la mesa en Nochebuena: espárragos con salmón ahumado, langostinos asados (así se ahorra la mahonesa), una ensalada y, de segundo, un pescado, que prefiere a la carne. No comerá pan, y así, a cambio, tomará turrón de postre, y roscón de Reyes cuando toque; lo regará todo con una copa de sidra, que le gusta.
Una tarde acompañando en sus compras navideñas a Cristina Ruiz, de 29 años, diabética de tipo II desde hace cuatro, desmonta mitos sobre esta enfermedad. Como que alguien con el azúcar alto no puede ni oler el dulce, o que ha de seguir de por vida una dieta draconiana de la que jamás debe salirse.
"Yo no estoy a dieta, no podría, qué horror. He aprendido a comer mejor y a adoptar hábitos de vida más saludables", comenta esta psicóloga madrileña que siempre había tenido sobrepeso y que al año de estar diagnosticada había bajado de los 98 a los 78 kilos. Ahora, además, acude regularmente al gimnasio, ella que antes no hacía ejercicio. Toma un antidiabético oral al día. ¿Su enfermedad? A raya.
Se considera que alguien padece diabetes cuando mantiene en ayunas valores de glucosa en sangre a partir de los 126 miligramos, algo que, a medio y largo plazo, le pone en riesgo de sufrir lesiones vasculares y de ver afectados órganos diana. Es decir, los ojos y los riñones.
"En España se calcula que existen unos cinco millones de personas en esta situación, de los que millón y medio están sin diagnosticar", lamenta Mercedes Maderuelo, jefa de comunicación de la Federación de Diabéticos Españoles. Ella considera que el gran reto actual es la educación. "Quien esté bien formado será capaz de autogestionar su patología", apostilla. Una patología bien gestionada mejora la calidad de vida, reduce el gasto sanitario y permite una existencia completamente normal. "¡Pues claro que pueden ir a un cumpleaños y comer tarta, o formar parte de la celebración navideña igual que el resto!", enfatiza Maderuelo.
La clave está en controlar, en saber que, además del azúcar, hay que reducir las calorías, las grasas y los hidratos de carbono, que acaban como glucosa en el organismo.
"Vamos a desdramatizar", pide Alfonso Calle, jefe de endocrinología y nutrición del hospital clínico San Carlos de Madrid. Al fin y al cabo, un diabético ha de seguir, es verdad que de manera más estricta, recomendaciones que, en realidad, toda la población debería atender. "No hay nada prohibido. La alimentación ha de ser variada. Se impone adoptar rutinas saludables en las que cabe, esporádicamente, algún extra".
El especialista no considera pecado el tradicional cordero (más graso), puesto que se trata de una ingesta puntual que además no afecta a los niveles de glucosa. Aunque sí al peso a medio plazo y si se consume de forma continuada. Otro plato típico, la lombarda, es muy adecuado porque contiene pocos carbohidratos. Recomienda no añadir patatas, y renunciar además a la ración de pan permite el lujo de acabar la cena con 40 o 50 gramos de algún dulce navideño. "Brindar con una copa de cava o vino es saludable, dos no las puedo recomendar y tres resultarían peligrosas", enumera.
Es un toma y daca, un constante juego de compensaciones y equilibrios que Cristina ha interiorizado y convertido en rutina. "Cien gramos de estas galletas dietéticas contienen 0,5 gramos de azúcar y 56 kilocalorías. Las María de toda la vida, 24 gramos de azúcar y menos de la mitad de calorías... ¿Cuáles me tomo? Pues depende; si tengo pensado ir al gimnasio, mejor las normales, porque la glucosa se quema rápido con el ejercicio mientras que la grasa cuesta más y se queda", reflexiona.
Nunca elige su marca preferida de refresco de cola, porque así bebe menos cantidad. Todo lo consume integral, arroz, pasta, pan, porque "su índice glucémico es más bajo".
Resulta evidente por qué la Asociación de Diabéticos de Madrid, a la que pertenece, la ha elegido a ella para este reportaje. Representa el perfil de quien, según el símil de Alfonso Calle, ha preferido no ir en taxi guiado por su especialista, sino sacarse el carné de conducir y ponerse al volante con su médico de copiloto.
En el otro extremo sigue habiendo muchos diabéticos que ni siquiera se han subido a este carro. Y prediabéticos (con valores de glucosa en sangre de 110 a 125 miligramos) que prefieren hacerse los suecos. "Es un error, deberían seguir las mismas recomendaciones, tenemos evidencias de que casi el 50% de los casos de diabetes se podrían prevenir", manifiesta el doctor, que agrega que la evolución desde la normalidad hasta la patología se relaciona directamente con el estilo de vida.
Calle aconseja a las personas en riesgo (con antecedentes familiares, valores al límite o enfermedades asociadas, como la hipertensión) que realicen actividad física regular y mantengan una alimentación sana. Tomar menos grasas saturadas y más poliinsaturadas y monoinsaturadas (frutas secos, pescado azul); menos azúcar, más frutas, verduras y legumbres; pocas bebidas azucaradas y bollería, y nada de precocinados.
Lo que no significa que no puedan brindar con una copa de cava esta Navidad.
**Publicado en "EL PAIS"
12 December 2011
Why women quit breast cancer drugs early
Why do so many postmenopausal women who are treated for estrogen-sensitive breast cancer quit using drugs that help prevent the disease from recurring? The first study to actually ask the women themselves -- as well as the largest, most scientifically rigorous study to examine the question -- reports 36 percent of women quit early because of the medications' side effects, which are more severe and widespread than previously known. The Northwestern Medicine research also reveals a big gap between what women tell their doctors about side effects and what they actually experience.
"Clinicians consistently underestimate the side effects associated with treatment," said lead investigator Lynne Wagner, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and a clinical psychologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University. "They give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don't want to be complainers and don't want their doctor to discontinue treatment. So no one knew how bad it really was for patients."
The symptom most likely to cause women to stop using the drugs was joint pain. Other side effects women reported as compromising their quality of life were hot flashes, decreased libido, weight gain, feeling bloated, breast sensitivity, mood swings, irritability and nausea.
Wagner's research was presented Dec. 9 at the 34th Annual San Antonio Breast Cancer Symposium.
The drugs, aromatase inhibitors, stop the production of estrogen in postmenopausal women, whose breast cancer cells are stimulated by estrogen. About two-thirds of breast cancers are estrogen sensitive, and aromatase inhibitors reduce the recurrence of cancer in postmenopausal women.
The women at highest risk for quitting the medications before the recommended five years are those who still are experiencing residual side effects from recent chemotherapy or radiation therapy when they start the aromatase therapy, according to the study. Women who had surgery for breast cancer but not chemotherapy or radiation therapy, or who weren't taking many other medications, were more likely to keep taking the aromatase medication.
"The more miserable they were before they started, the more likely they were to quit," Wagner said. "By the time they get through chemotherapy or radiation, they have to face five more years of another medication that will make them feel lousy. They feel like they already lost enough time to cancer and have reached their threshold for feeling bad."
"This is a wake-up call to physicians that says if your patient is feeling really beaten up by treatment, the risk of her quitting early is high," Wagner said. "We need to be better at managing the symptoms of our patients to improve their quality of life."
The new research exposes the disparity between clinicians' reporting of side effects and women's actual experiences. In a previous study, clinicians reported 5 percent of their patients experienced moderate to severe symptoms as a result of taking aromatase inhibitors. The new Northwestern study surveyed 686 women with a detailed questionnaire about their symptoms before treatment and at three, six, 12 and 24 months after starting treatment. The researchers found after three months of treatment that 33 to 35 percent of women had severe joint pain, 28 to 29 percent had hot flashes, 24 percent had decreased libido, 15 to 24 percent had fatigue, 16 to 17 percent had night sweats and 14 to 17 percent had anxiety. These numbers increased as women were on treatment longer.
Earlier studies also asked women to recall their symptoms after treatment ended, which is less accurate than reporting them at regular intervals while taking the drugs.
As a result of the side effects, 36 percent of women ended treatment before an average of 4.1 years. After two years, 10 percent had quit; the remainder quit between 25 months and the 4.1 years.
"These findings can help us identify women at risk for quitting the therapy, counsel them about the importance of staying on it and provide treatment for troubling side effects," Wagner noted.
Weight gain can be addressed with nutritional counseling, while mood swings and irritability can be treated with cognitive behavioral therapy or mind-body techniques, Wagner said. Joint pain can be tempered with nonsteroidal anti-inflammatory drugs, or women may be switched to a different hormonal medication. Nausea can be reduced with medication.
For the study, patients who had postmenopausal breast cancer filled out a 46-question survey rating their quality of life and symptoms associated with breast cancer and endocrine treatment. The survey included an item asking how much they were bothered by side effects of treatment from zero (not bothered) to four (severely bothered). For each additional one-point increase on this item, the patient's risk of quitting treatment early rose 29 percent. The patients were randomized to take one of two hormonal treatments (anastrozole or exemestane) daily for five years.
The research was funded by the National Cancer Institute.
*Source: Northwestern University
"Clinicians consistently underestimate the side effects associated with treatment," said lead investigator Lynne Wagner, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and a clinical psychologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University. "They give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don't want to be complainers and don't want their doctor to discontinue treatment. So no one knew how bad it really was for patients."
The symptom most likely to cause women to stop using the drugs was joint pain. Other side effects women reported as compromising their quality of life were hot flashes, decreased libido, weight gain, feeling bloated, breast sensitivity, mood swings, irritability and nausea.
Wagner's research was presented Dec. 9 at the 34th Annual San Antonio Breast Cancer Symposium.
The drugs, aromatase inhibitors, stop the production of estrogen in postmenopausal women, whose breast cancer cells are stimulated by estrogen. About two-thirds of breast cancers are estrogen sensitive, and aromatase inhibitors reduce the recurrence of cancer in postmenopausal women.
The women at highest risk for quitting the medications before the recommended five years are those who still are experiencing residual side effects from recent chemotherapy or radiation therapy when they start the aromatase therapy, according to the study. Women who had surgery for breast cancer but not chemotherapy or radiation therapy, or who weren't taking many other medications, were more likely to keep taking the aromatase medication.
"The more miserable they were before they started, the more likely they were to quit," Wagner said. "By the time they get through chemotherapy or radiation, they have to face five more years of another medication that will make them feel lousy. They feel like they already lost enough time to cancer and have reached their threshold for feeling bad."
"This is a wake-up call to physicians that says if your patient is feeling really beaten up by treatment, the risk of her quitting early is high," Wagner said. "We need to be better at managing the symptoms of our patients to improve their quality of life."
The new research exposes the disparity between clinicians' reporting of side effects and women's actual experiences. In a previous study, clinicians reported 5 percent of their patients experienced moderate to severe symptoms as a result of taking aromatase inhibitors. The new Northwestern study surveyed 686 women with a detailed questionnaire about their symptoms before treatment and at three, six, 12 and 24 months after starting treatment. The researchers found after three months of treatment that 33 to 35 percent of women had severe joint pain, 28 to 29 percent had hot flashes, 24 percent had decreased libido, 15 to 24 percent had fatigue, 16 to 17 percent had night sweats and 14 to 17 percent had anxiety. These numbers increased as women were on treatment longer.
Earlier studies also asked women to recall their symptoms after treatment ended, which is less accurate than reporting them at regular intervals while taking the drugs.
As a result of the side effects, 36 percent of women ended treatment before an average of 4.1 years. After two years, 10 percent had quit; the remainder quit between 25 months and the 4.1 years.
"These findings can help us identify women at risk for quitting the therapy, counsel them about the importance of staying on it and provide treatment for troubling side effects," Wagner noted.
Weight gain can be addressed with nutritional counseling, while mood swings and irritability can be treated with cognitive behavioral therapy or mind-body techniques, Wagner said. Joint pain can be tempered with nonsteroidal anti-inflammatory drugs, or women may be switched to a different hormonal medication. Nausea can be reduced with medication.
For the study, patients who had postmenopausal breast cancer filled out a 46-question survey rating their quality of life and symptoms associated with breast cancer and endocrine treatment. The survey included an item asking how much they were bothered by side effects of treatment from zero (not bothered) to four (severely bothered). For each additional one-point increase on this item, the patient's risk of quitting treatment early rose 29 percent. The patients were randomized to take one of two hormonal treatments (anastrozole or exemestane) daily for five years.
The research was funded by the National Cancer Institute.
*Source: Northwestern University
Justin Rattner, Director de Intel Labs a EL PAIS: ""El chip controlará ordenadores con la mente"
Ordenadores controlados por la mente, Internet en tres dimensiones, bomberos-robot que socorren en incendios y reconocimiento facial en las tiendas para vender más y mejor. Si preguntásemos por el futuro a los más de 2.000 investigadores de Intel Labs, estas serían sus apuestas.
"El portátil nació hace 15 años y ahí sigue, ¡ni siquiera ha matado al PC!"
La investigación de Intel, junto a la de Microsoft o IBM, es de las pocas que aún funciona a la vieja usanza, a lo grande. 4.700 millones de euros de presupuesto anual, una legión de científicos esparcidos por el mundo y un veterano al mando: "Soy al que le pagan por adivinar qué vendrá en cinco años", dice con un deje escéptico Justin Rattner, jefe de Intel Labs.
Al gigante de los microprocesadores le urge adivinarlo más que nunca. En la era de la movilidad, el ordenador corre peligro. En Estados Unidos las ventas siguen sin levantar cabeza y en Europa volvieron a caer un 3% en el tercer trimestre, según la consultora IDC. El bolsillo, castigado, no da para todo: teléfonos inteligentes, tabletas, consolas, portátiles... ¿Dejará el PC de ser el rey?
Rattner desmonta "exageraciones" encantado. "El portátil nació hace 15 años y ahí sigue, ¡ni siquiera ha matado al PC de sobremesa!", señala. "Nos empeñamos en hablar de giros dramáticos que no existen. Estamos viviendo una evolución de la plataforma, un progreso continuo. Quienes saben adaptarse a los cambios, sobreviven, y los que no, desaparecen. Ahora nosotros, y otras compañías como Google o Microsoft, tenemos que evolucionar el PC. Si no lo hacemos morirá".
Salpica sus respuestas aquí y allá con el nombre de Google, síntoma de que los tiempos han cambiado. Ambas compañías cerraron en septiembre un acuerdo para llevar los chips de Intel a los teléfonos Android. Si wintel (Window-Intel) fue la pareja ganadora en los ordenadores en la década pasada, en la siguiente algunos apuestan por Android e Intel (¿Indroid?) en los móviles y tabletas. "El primer Android con nuestro procesador saldrá al mercado antes de junio de 2012. Nos ha llevado un tiempo madurar la relación con Google pero después de trabajar con ellos en Google TV y en los Chromebooks, era el siguiente paso", explica Rattner.
Intel intentará colarse en móviles y tabletas, por si acaso, pero su apuesta sigue siendo el ordenador personal (PC). Portátiles ultrafinos, elegantes y con procesadores de bajo consumo que alargarán la batería varios días. "Creo que el ultrabook hará a la gente pensar sobre el verdadero sentido de las tabletas y su uso. Solo hay una compañía que las esté vendiendo con cierto volumen, Apple. Aún está por demostrar que haya mercado para estos equipos".
Rattner describe un futuro mixto, lleno de múltiples aparatos, en el que el portátil seguirá teniendo un hueco para entretenerse y crear a la vez. La evolución no la veremos tanto en el diseño, como en el software.
"Interactuaremos con estos equipos con la voz, con los gestos, con sonidos, y ellos nos identificarán y ofrecerán contenido personalizado. Por ejemplo: los músculos de la mano tiemblan de forma diferente en cada uno al coger un objeto. Hemos creado un mando a distancia que reconoce a las personas por estas vibraciones y selecciona al instante en la televisión sus canales y contenido favorito", señala. "Veremos mucha innovación en este terreno".
La Internet de las cosas, la conexión a la Red de cualquier aparato, ya está en marcha, pero Rattner coincide con otros científicos en vaticinar la Internet del cuerpo humano. "En Seattle desarrollamos un chip subcutáneo para controlar ordenadores con el pensamiento. Ahora se están incrustando en la ropa y en los aparatos. En 10 años los tendremos debajo de la piel".
"El portátil nació hace 15 años y ahí sigue, ¡ni siquiera ha matado al PC!"
La investigación de Intel, junto a la de Microsoft o IBM, es de las pocas que aún funciona a la vieja usanza, a lo grande. 4.700 millones de euros de presupuesto anual, una legión de científicos esparcidos por el mundo y un veterano al mando: "Soy al que le pagan por adivinar qué vendrá en cinco años", dice con un deje escéptico Justin Rattner, jefe de Intel Labs.
Al gigante de los microprocesadores le urge adivinarlo más que nunca. En la era de la movilidad, el ordenador corre peligro. En Estados Unidos las ventas siguen sin levantar cabeza y en Europa volvieron a caer un 3% en el tercer trimestre, según la consultora IDC. El bolsillo, castigado, no da para todo: teléfonos inteligentes, tabletas, consolas, portátiles... ¿Dejará el PC de ser el rey?
Rattner desmonta "exageraciones" encantado. "El portátil nació hace 15 años y ahí sigue, ¡ni siquiera ha matado al PC de sobremesa!", señala. "Nos empeñamos en hablar de giros dramáticos que no existen. Estamos viviendo una evolución de la plataforma, un progreso continuo. Quienes saben adaptarse a los cambios, sobreviven, y los que no, desaparecen. Ahora nosotros, y otras compañías como Google o Microsoft, tenemos que evolucionar el PC. Si no lo hacemos morirá".
Salpica sus respuestas aquí y allá con el nombre de Google, síntoma de que los tiempos han cambiado. Ambas compañías cerraron en septiembre un acuerdo para llevar los chips de Intel a los teléfonos Android. Si wintel (Window-Intel) fue la pareja ganadora en los ordenadores en la década pasada, en la siguiente algunos apuestan por Android e Intel (¿Indroid?) en los móviles y tabletas. "El primer Android con nuestro procesador saldrá al mercado antes de junio de 2012. Nos ha llevado un tiempo madurar la relación con Google pero después de trabajar con ellos en Google TV y en los Chromebooks, era el siguiente paso", explica Rattner.
Intel intentará colarse en móviles y tabletas, por si acaso, pero su apuesta sigue siendo el ordenador personal (PC). Portátiles ultrafinos, elegantes y con procesadores de bajo consumo que alargarán la batería varios días. "Creo que el ultrabook hará a la gente pensar sobre el verdadero sentido de las tabletas y su uso. Solo hay una compañía que las esté vendiendo con cierto volumen, Apple. Aún está por demostrar que haya mercado para estos equipos".
Rattner describe un futuro mixto, lleno de múltiples aparatos, en el que el portátil seguirá teniendo un hueco para entretenerse y crear a la vez. La evolución no la veremos tanto en el diseño, como en el software.
"Interactuaremos con estos equipos con la voz, con los gestos, con sonidos, y ellos nos identificarán y ofrecerán contenido personalizado. Por ejemplo: los músculos de la mano tiemblan de forma diferente en cada uno al coger un objeto. Hemos creado un mando a distancia que reconoce a las personas por estas vibraciones y selecciona al instante en la televisión sus canales y contenido favorito", señala. "Veremos mucha innovación en este terreno".
La Internet de las cosas, la conexión a la Red de cualquier aparato, ya está en marcha, pero Rattner coincide con otros científicos en vaticinar la Internet del cuerpo humano. "En Seattle desarrollamos un chip subcutáneo para controlar ordenadores con el pensamiento. Ahora se están incrustando en la ropa y en los aparatos. En 10 años los tendremos debajo de la piel".
**Publicado en "EL PAIS"
Researchers identify a novel therapeutic approach for liver cancer
Cancer of the liver -- rare in the United States but the third-leading cause of cancer death worldwide -- can result from environmental exposures or infections like chronic hepatitis, but the link is poorly understood. Now, researchers at Dana-Farber Cancer Institute have identified a mechanism in mice that triggers inflammation in the liver and transforms normal cells into cancerous ones. In addition, they demonstrated in a mouse model that a particular micro-RNA (miR-124) -- a member of a recently discovered class of molecular regulators -- could be harnessed to treat or even prevent liver cancer.
"In this study we are describing for the first time a micro-RNA that is able to prevent and treat liver cancer," said Dimitrios Iliopoulos, PhD, of Dana-Farber's Department of Cancer Immunology and AIDS. The findings are being published recently in the journal Cell. The authors said they plan to start a phase I clinical trial using miR-124 in liver cancer patients in 2012.
Iliopoulos and his colleagues found that in mice given a carcinogenic chemical, DEN, liver cancer is initiated by the activation of a molecular circuit that sets up an inflammatory state in the cells, leading to cancer. Once this inflammatory circuit is turned on even for a few days, it becomes permanent, sustaining its activity through a never-ending feedback loop -- a "snowball effect," as Iliopoulos termed it.
Iliopoulos previously identified a similar feedback circuit implicated in the development of breast cancer.
One element of the circuit is a micro-RNA called miR-124, the Dana-Farber team reported. Micro-RNAs are extremely short lengths of RNA -- a messenger molecule that helps the cell build proteins according to DNA instructions -- which are not translated into proteins. MiRNAs have been recently implicated in the pathogenesis of human diseases including different types of cancer.
The Dana-Farber team found that miR-124 and another key controller of the feedback circuit, HNF4α, showed reduced activity in the cancer cells. HFN4α is an essential factor in formation of liver cells and their proper function. When HNF4α is suppressed, said Iliopoulos, it creates a temporary state of inflammation in the cell -- a forerunner of cancer. "After only a few days, this transient inflammatory response is converted into a chronic inflammatory response by this feedback circuit that is continuously amplified," he said.
Because HNF4α and miR-124 interact with each other, the scientists hypothesized that boosting activity of miR-124 might restore normal activity in HNF4α, halting the runaway inflammatory cycle and causing tumors to stop growing.
To test this notion they administered systemically miR-124 once a week for four weeks to mice that had developed liver cancer by exposure to DEN. "We found that miR-124 suppressed more than 80 per cent of tumor growth and size" by causing the cancer cells to self-destruct, the scientists wrote. They observed no toxic effects in other essential organs, such as the kidneys, spleen, heart and lungs.
Further, they showed that giving miR-124 to mice exposed to DEN actually prevented the development of liver tumors.
"Our hope is that miR-124 potentially could be used as a preventive in patients at high risk of liver cancer because they have chronic hepatitis C or as a therapeutic agent in patients with liver cancer," said Iliopoulos.
"In this study we are describing for the first time a micro-RNA that is able to prevent and treat liver cancer," said Dimitrios Iliopoulos, PhD, of Dana-Farber's Department of Cancer Immunology and AIDS. The findings are being published recently in the journal Cell. The authors said they plan to start a phase I clinical trial using miR-124 in liver cancer patients in 2012.
Iliopoulos and his colleagues found that in mice given a carcinogenic chemical, DEN, liver cancer is initiated by the activation of a molecular circuit that sets up an inflammatory state in the cells, leading to cancer. Once this inflammatory circuit is turned on even for a few days, it becomes permanent, sustaining its activity through a never-ending feedback loop -- a "snowball effect," as Iliopoulos termed it.
Iliopoulos previously identified a similar feedback circuit implicated in the development of breast cancer.
One element of the circuit is a micro-RNA called miR-124, the Dana-Farber team reported. Micro-RNAs are extremely short lengths of RNA -- a messenger molecule that helps the cell build proteins according to DNA instructions -- which are not translated into proteins. MiRNAs have been recently implicated in the pathogenesis of human diseases including different types of cancer.
The Dana-Farber team found that miR-124 and another key controller of the feedback circuit, HNF4α, showed reduced activity in the cancer cells. HFN4α is an essential factor in formation of liver cells and their proper function. When HNF4α is suppressed, said Iliopoulos, it creates a temporary state of inflammation in the cell -- a forerunner of cancer. "After only a few days, this transient inflammatory response is converted into a chronic inflammatory response by this feedback circuit that is continuously amplified," he said.
Because HNF4α and miR-124 interact with each other, the scientists hypothesized that boosting activity of miR-124 might restore normal activity in HNF4α, halting the runaway inflammatory cycle and causing tumors to stop growing.
To test this notion they administered systemically miR-124 once a week for four weeks to mice that had developed liver cancer by exposure to DEN. "We found that miR-124 suppressed more than 80 per cent of tumor growth and size" by causing the cancer cells to self-destruct, the scientists wrote. They observed no toxic effects in other essential organs, such as the kidneys, spleen, heart and lungs.
Further, they showed that giving miR-124 to mice exposed to DEN actually prevented the development of liver tumors.
"Our hope is that miR-124 potentially could be used as a preventive in patients at high risk of liver cancer because they have chronic hepatitis C or as a therapeutic agent in patients with liver cancer," said Iliopoulos.
**Source: Dana-Farber Cancer Institute
Breast cancer patients face increasing number of imaging visits before surgery
Breast cancer patients frequently undergo imaging like mammograms or ultrasounds between their first breast cancer-related doctor visit and surgery to remove the tumor. Evaluations of these scans help physicians understand a person's disease and determine the best course of action. In recent years, however, imaging has increased in dramatic and significant ways, say researchers from Fox Chase Cancer Center. More patients have repeat visits for imaging than they did 20 years ago, and single imaging appointments increasingly include multiple types of imaging. The researchers, led by Richard Bleicher, MD, surgical oncologist at Fox Chase, found that between 1992 and 2005, the percentage of patients who had multiple (2+) imaging visits nearly quadrupled. Bleicher says additional visits present a burden to patients, many of whom are elderly, but the stress may be alleviated through better coordination and evaluation by physicians. Bleicher presented his group's findings Dec. 9 at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.
"The burden to the patient is increasing substantially," Bleicher says. "The number of days patients are having mammograms, MRIs, and ultrasounds is going up steadily year by year. They're having imaging done more frequently on separate dates during the preoperative interval than ever before. It's surprising."
The preoperative interval begins when a patient first reports to a doctor with a breast complaint and ends when the patient undergoes therapeutic surgery to resect a tumor. For the more than 65,000 patients involved in the study, the preoperative interval lasted 37 days on average. The Fox Chase researchers found that in 1992, roughly one in 20 cancer patients (4.9 percent) diagnosed with invasive, non-metastatic cancer underwent imaging twice or more during the preoperative interval. By 2005, that portion had climbed to about one in 5 (19.4 percent). In the extreme case, a small subset of 20 patients underwent mammograms on five or more visits during the preoperative interval.
The researchers also found that a single imaging visit increasingly includes multiple imaging types. In 1992, 4.3 percent of patients underwent multiple types of imaging; in 2005, that rate rose to 27.1 percent.
With the increased use of imaging, Bleicher says that for physicians, "the question becomes, 'How are we affecting patients overall with what we're ordering nowadays?'"
Previous studies have examined patient burden in terms of cost, but Bleicher says he hasn't seen studies that focus on the patient burden in terms of the patient's time. "I wanted to take a look at how things have been changing for patients and how many times they have to travel back and forth to get more imaging," he says. "Physicians need to keep in mind that it's hard enough for working people to take off from work and trek back and forth to appointments, but older people have infirmities, and it's harder to get around. The coordination of care is very important. We need to focus more on the burden to the patient."
Other studies have shown an increase in the cost of breast cancer care -- but the cost of imaging is rising even faster. "We know the costs are going up, but we don't know why," he says. "One reason might be the frequency and amount of imaging."
He points out that when more than one set of imaging is done on the same day, "There are perversities of the reimbursement system that may foster these separate visits, although I don't know if that's why we're seeing this phenomenon."
The researchers discovered the climbing trend after studying data on Medicare patients from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. Their results came from the records of 67,751 women who were treated for invasive, non-metastatic breast cancer with surgery and lymph node staging. The researchers omitted patients diagnosed with either metastatic disease or DCIS because those types of breast cancer require different approaches to imaging and treatment. The median age of the study participants was 75.
Bleicher says the patient's burden may be reduced if patients ask their providers why imaging is being done, and work together to make the process smoother. "If they do need imaging, then they might ask their physician, especially if they're of an older age, whether or not they think they're going to need additional types of imaging and if those can be scheduled together," he says.
The researchers are now diving deeper into their data to understand the trend and look for a better way to help breast cancer patients with imaging, Bleicher says. "We want to see whether or not there is a more efficient method of imaging the patients so that we're improving outcomes without increasing costs."
**Source: Fox Chase Cancer Center
"The burden to the patient is increasing substantially," Bleicher says. "The number of days patients are having mammograms, MRIs, and ultrasounds is going up steadily year by year. They're having imaging done more frequently on separate dates during the preoperative interval than ever before. It's surprising."
The preoperative interval begins when a patient first reports to a doctor with a breast complaint and ends when the patient undergoes therapeutic surgery to resect a tumor. For the more than 65,000 patients involved in the study, the preoperative interval lasted 37 days on average. The Fox Chase researchers found that in 1992, roughly one in 20 cancer patients (4.9 percent) diagnosed with invasive, non-metastatic cancer underwent imaging twice or more during the preoperative interval. By 2005, that portion had climbed to about one in 5 (19.4 percent). In the extreme case, a small subset of 20 patients underwent mammograms on five or more visits during the preoperative interval.
The researchers also found that a single imaging visit increasingly includes multiple imaging types. In 1992, 4.3 percent of patients underwent multiple types of imaging; in 2005, that rate rose to 27.1 percent.
With the increased use of imaging, Bleicher says that for physicians, "the question becomes, 'How are we affecting patients overall with what we're ordering nowadays?'"
Previous studies have examined patient burden in terms of cost, but Bleicher says he hasn't seen studies that focus on the patient burden in terms of the patient's time. "I wanted to take a look at how things have been changing for patients and how many times they have to travel back and forth to get more imaging," he says. "Physicians need to keep in mind that it's hard enough for working people to take off from work and trek back and forth to appointments, but older people have infirmities, and it's harder to get around. The coordination of care is very important. We need to focus more on the burden to the patient."
Other studies have shown an increase in the cost of breast cancer care -- but the cost of imaging is rising even faster. "We know the costs are going up, but we don't know why," he says. "One reason might be the frequency and amount of imaging."
He points out that when more than one set of imaging is done on the same day, "There are perversities of the reimbursement system that may foster these separate visits, although I don't know if that's why we're seeing this phenomenon."
The researchers discovered the climbing trend after studying data on Medicare patients from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. Their results came from the records of 67,751 women who were treated for invasive, non-metastatic breast cancer with surgery and lymph node staging. The researchers omitted patients diagnosed with either metastatic disease or DCIS because those types of breast cancer require different approaches to imaging and treatment. The median age of the study participants was 75.
Bleicher says the patient's burden may be reduced if patients ask their providers why imaging is being done, and work together to make the process smoother. "If they do need imaging, then they might ask their physician, especially if they're of an older age, whether or not they think they're going to need additional types of imaging and if those can be scheduled together," he says.
The researchers are now diving deeper into their data to understand the trend and look for a better way to help breast cancer patients with imaging, Bleicher says. "We want to see whether or not there is a more efficient method of imaging the patients so that we're improving outcomes without increasing costs."
**Source: Fox Chase Cancer Center
El mayor riesgo de perder al bebé se sufre en las primeras doce semanas de gestación
Una de cada cinco mujeres embarazadas acaba perdiendo a su bebé; esto es, un porcentaje del 20%. Demasiado, diríamos. Por eso, a la noticia de que vas a ser madre, siempre va unido el miedo a sufrir un aborto. El mayor riesgo se sufre en las primeras doce semanas de gestación; una vez superada esta barrera, parece que la madre respira ya un poco más tranquila y cada vez ve más cerca la llegada de su pequeño.
Hasta ahora no había forma de saber cuál es la probabilidad de éxito de un embarazo. Cierto es que todos conocemos algunos factores de riesgo, como pueden ser la edad de la madre y su salud, las anomalías cromosómicas del feto, el consumo de drogas y alcohol, el hecho de tener una vida demasiado ajetreada, la alimentación… Pero no dejaban de ser meras hipótesis. Hoy es posible saber con una fiabilidad bastante elevada qué embarazo seguirá adelante y cuál acabará, muy probablemente, en aborto. Y se lo tenemos que agradecer a un grupo de científicos británicos, que ha establecido una serie de variables que pueden medirse de manera relativamente fácil, cuya combinación puede decirnos el grado de éxito o fracaso en relación a un embarazo determinado. Lo han bautizado como ‘PVI’ (Índice de Viabilidad del Embarazo)
Este equipo de investigadores realizó un seguimiento entre 2009 y 2010 a un total de 102 mujeres con riesgo de aborto espontáneo que tenían entre seis y diez semanas de embarazo. Durante las cinco semanas que duró el estudio, se sometieron a ecografías, análisis de dolor y sangrado, medición de los niveles de progesterona y la hormona del embarazo, la gonadotropina coriónica humana (hCG). Un total de 22 embarazos se perdieron, mientras que 80 continuaron.
Hasta ahora no había forma de saber cuál es la probabilidad de éxito de un embarazo. Cierto es que todos conocemos algunos factores de riesgo, como pueden ser la edad de la madre y su salud, las anomalías cromosómicas del feto, el consumo de drogas y alcohol, el hecho de tener una vida demasiado ajetreada, la alimentación… Pero no dejaban de ser meras hipótesis. Hoy es posible saber con una fiabilidad bastante elevada qué embarazo seguirá adelante y cuál acabará, muy probablemente, en aborto. Y se lo tenemos que agradecer a un grupo de científicos británicos, que ha establecido una serie de variables que pueden medirse de manera relativamente fácil, cuya combinación puede decirnos el grado de éxito o fracaso en relación a un embarazo determinado. Lo han bautizado como ‘PVI’ (Índice de Viabilidad del Embarazo)
Este equipo de investigadores realizó un seguimiento entre 2009 y 2010 a un total de 102 mujeres con riesgo de aborto espontáneo que tenían entre seis y diez semanas de embarazo. Durante las cinco semanas que duró el estudio, se sometieron a ecografías, análisis de dolor y sangrado, medición de los niveles de progesterona y la hormona del embarazo, la gonadotropina coriónica humana (hCG). Un total de 22 embarazos se perdieron, mientras que 80 continuaron.
-Un herramienta «solida»
Tras analizar los datos, encontraron que había seis factores que tuvieron un mayor impacto sobre el riesgo de aborto involuntario: un historial de infertilidad, los niveles de progesterona y de hCG, el tamaño del feto, la cantidad de sangrado y la edad gestacional del bebé. Ninguno de estos factores por separado se pudo considerar determinante, pero combinando dos de ellos, la cantidad de sangrado y los niveles de hCG, se obtuvo suficiente información para predecir con eficacia si una gestación con riesgo de interrupción tenía posibilidades de continuar o si, por el contrario, no llegaría a término.
Los resultados del estudio muestran que el ‘PVI’ logró predecir de forma precisa la viabilidad del 94% de los embarazos y estimó correctamente el 77% de aquellos que se interrumpieron.
Kaltum Adam, médico del Servicio de Ginecología y Obstetricia del Hospital St. Mary de Manchester (Reino Unido) y responsable del trabajo, explica que se trata de una herramienta “sólida” para intentar evitar aquellos embarazos con riesgo de aborto cuando, “actualmente, todo lo que podemos hacer es cruzarnos de brazos y esperar lo mejor”. Además, el PVI permitirá a los médicos evitar intervenciones innecesarias ya que “hay mujeres que acaban sometiéndose a excesivos análisis de sangre y monitorizaciones”, al tiempo que se podrá definir con más precisión qué mujeres necesitarán realmente apoyo psicológico. No obstante, y dado que reconocen que el estudio ha contado con pocas mujeres, Adam y su equipo están buscando financiación para validar el modelo PVI con un ensayo clínico que al menos incluya a mil mujeres en riesgo.
Tras analizar los datos, encontraron que había seis factores que tuvieron un mayor impacto sobre el riesgo de aborto involuntario: un historial de infertilidad, los niveles de progesterona y de hCG, el tamaño del feto, la cantidad de sangrado y la edad gestacional del bebé. Ninguno de estos factores por separado se pudo considerar determinante, pero combinando dos de ellos, la cantidad de sangrado y los niveles de hCG, se obtuvo suficiente información para predecir con eficacia si una gestación con riesgo de interrupción tenía posibilidades de continuar o si, por el contrario, no llegaría a término.
Los resultados del estudio muestran que el ‘PVI’ logró predecir de forma precisa la viabilidad del 94% de los embarazos y estimó correctamente el 77% de aquellos que se interrumpieron.
Kaltum Adam, médico del Servicio de Ginecología y Obstetricia del Hospital St. Mary de Manchester (Reino Unido) y responsable del trabajo, explica que se trata de una herramienta “sólida” para intentar evitar aquellos embarazos con riesgo de aborto cuando, “actualmente, todo lo que podemos hacer es cruzarnos de brazos y esperar lo mejor”. Además, el PVI permitirá a los médicos evitar intervenciones innecesarias ya que “hay mujeres que acaban sometiéndose a excesivos análisis de sangre y monitorizaciones”, al tiempo que se podrá definir con más precisión qué mujeres necesitarán realmente apoyo psicológico. No obstante, y dado que reconocen que el estudio ha contado con pocas mujeres, Adam y su equipo están buscando financiación para validar el modelo PVI con un ensayo clínico que al menos incluya a mil mujeres en riesgo.
**Publicado en "ABC"
Mayo Clinic: How patients will respond to immunomodulator therapy for multiple myeloma
Research on the same protein that was a primary mediator of the birth defects caused by thalidomide now holds hope in the battle against multiple myeloma, says the study's senior investigator, Keith Stewart, M.B., Ch.B. of Mayo Clinic in Arizona. Dr. Stewart presented the results at the 53rd annual meeting of the American Society of Hematology in San Diego. The drug thalidomide achieved infamy in the early 1960s as the cause of severe birth defects after being given to pregnant mothers for morning sickness. However, this drug, along with the highly related compounds lenalidomide and pomalidomide, also help to treat blood cancers, and are used worldwide as a cornerstone of therapy for the bone marrow cancer multiple myeloma. These drugs modulate the immune system and together are called immunomodulators or IMiDs.
The exact mechanisms and targets through which these therapies work to enhance immune response or kill cancer cells have been largely unknown. As a result, knowing which patients to treat and how to separate out the positive properties of these drugs from side effects has been impossible.
After recent research identified a protein known as cereblon as a primary mediator of the birth defects caused by thalidomide, researchers theorized that cereblon may also orchestrate the anti-tumor properties and be the primary therapeutic target for multiple myeloma.
In this study, researchers tested the theory and found a possible link between resistance to IMiDs and presence of cereblon. The researchers then found that lowering the level of cereblon allows the IMiDs to work properly.
"Interestingly, some resistant patients had normal cereblon levels, suggesting that while cereblon may be an absolute requirement for response, there are likely other mechanisms present that play a role in drug resistance," says Dr. Stewart. "These findings help us understand which patients may be more or less likely to respond to therapy and allow us to focus on other ways we can target cereblon as a possible biomarker to improve treatment and patient outcomes in multiple myeloma. This work also suggests that we can begin to dissect out the cause of birth defects from the anti-cancer properties and develop safer drugs in the future."
**Source: Mayo Clinic
The exact mechanisms and targets through which these therapies work to enhance immune response or kill cancer cells have been largely unknown. As a result, knowing which patients to treat and how to separate out the positive properties of these drugs from side effects has been impossible.
After recent research identified a protein known as cereblon as a primary mediator of the birth defects caused by thalidomide, researchers theorized that cereblon may also orchestrate the anti-tumor properties and be the primary therapeutic target for multiple myeloma.
In this study, researchers tested the theory and found a possible link between resistance to IMiDs and presence of cereblon. The researchers then found that lowering the level of cereblon allows the IMiDs to work properly.
"Interestingly, some resistant patients had normal cereblon levels, suggesting that while cereblon may be an absolute requirement for response, there are likely other mechanisms present that play a role in drug resistance," says Dr. Stewart. "These findings help us understand which patients may be more or less likely to respond to therapy and allow us to focus on other ways we can target cereblon as a possible biomarker to improve treatment and patient outcomes in multiple myeloma. This work also suggests that we can begin to dissect out the cause of birth defects from the anti-cancer properties and develop safer drugs in the future."
**Source: Mayo Clinic
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