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Arthritis patients taking newer treatments do not have an overall increased cancer risk

Arthritis • • CancerMay 30 11

Only three percent (n=181) of patients in the study cohort receiving anti-tumour necrosis factor agents (anti-TNFs) for treatment of their arthritis developed a first cancer within nine years and overall risk was not dependent on the type of arthritis.

The nine year follow-up study conducted at Gentofte University Hospital, Denmark demonstrated that relative risk ((RR)=1.03 (95%confidence interval 0.82-1.30)) was not increased in patients treated with anti-TNFs compared to patients who had never taken anti-TNFs during 23,965 person-years follow-up. Overall cancer risk was not dependent on the type of arthritis including rheumatoid arthritis (RA) (n=3,496) (RR=1.05, 95% CI 0.82-1.34), psoriatic arthritis (PsA) (n=670) (RR=1.98, 95% CI 0.24-16.18) or other arthritis (n=499) (RR=0.79 95% CI 0.08-8.33).

“Some studies have suggested that taking anti-TNFs may increase an individual’s risk of cancer however this study provides long term evidence that an overall risk of cancer is not associated with this group of treatments”, said Dr. PhD, Lene Dreyer from the Department of Rheumatology at Gentofte University Hospital. “TNF is a small signalling molecule called a cytokine and is able to inhibit the development of tumours by interfering with signalling pathways. Therefore drugs targeting TNF can influence the development of tumours, although the extent of this impact remains unclear.”

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New treatment dissolves blood clots in brain tissue

Brain • • NeurologyMay 30 11

A new treatment that treats a subset of stroke patients by combining minimally invasive surgery, an imaging technique likened to “GPS for the brain,” and the clot-busting drug t-PA appears to be safe and effective, according to a multicenter clinical trial led by Johns Hopkins researchers.

The novel treatment, detailed for the first time at this week’s European Stroke Conference in Hamburg, Germany, was developed for patients with intracerebral hemorrhage (ICH), a bleed in the brain that causes a clot to form within brain tissue. This clot builds up pressure and leaches inflammatory chemicals that can cause irreversible brain damage, often leading to death or extreme disability. The usual treatments for ICH - either general supportive care such as blood pressure control and ventilation, which is considered the current standard of care, or invasive surgeries that involve taking off portions of the skull to remove the clot - have similar mortality rates, ranging from 30 to 80 percent depending on the size of the clot.

Seeking to improve these mortality rates and surviving ICH patients’ quality of life, Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine, and his colleagues developed and tested the new treatment on 60 patients at 12 hospitals in the United States, Canada, the United Kingdom and Germany. They compared their results to those of 11 patients who received only supportive care.

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When it comes to warm-up, less is more

Public HealthMay 30 11

University of Calgary Faculty of Kinesiology researcher Elias Tomaras says the idea came to him while watching track and field sprinters warm-up for a race. “If you watch sprinters, short distance speed skaters or cyclists before their race, they will often warm-up for one to two hours, including several brief bouts of high intensity exercise. From an exercise physiology point of view, it seemed like it might be pretty tiring.”

Many coaches and physiologists believe that a longer warm up provides an increase in muscle temperature, acceleration of oxygen uptake kinetics, increased anaerobic metabolism and a process called postactivation potentiation of the muscles. However, very few studies have studied if warm ups has a detrimental effect on performance.

As it turns out, the warm-up is one of the more contentious issues in high-performance sport. Different coaches have different theories and not a lot of quality research has been done to identify the optimal warm-up. Tomaras’ study, published recently in the prestigious Journal of Applied Physiology suggests that at the very least, athletes may want to lower the intensity and reduce the amount of time that they warm up.

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PGD can permit the birth of healthy children to women carrying mitochondrial DNA disease

Genetics • • Public HealthMay 30 11

Amsterdam, The Netherlands: Pre-implantation genetic diagnosis (PGD) can give women at risk of passing on a mitochondrial DNA disorder to their offspring a good chance of being able to give birth to an unaffected child, a researcher told the annual conference of the European Society of Human Genetics today (Monday). Dr. Debby Hellebrekers, from Maastricht University Medical Centre, Maastricht, The Netherlands, said that the scientists’ findings could have a considerable effect on preventing the transmission of mitochondrial diseases.

Mitochondria are cellular organelles involved in the conversion of the energy of food molecules into ATP, the molecule that powers most cellular functions. Disruptions of this energy-producing process, due to a defect in the mitochondrial DNA (mtDNA) or nuclear genes, can cause mitochondrial disorders which represent the most common group of inborn errors of metabolism. The manifestation of mtDNA disorders can be quite varied, but the diseases are almost always serious and, if they do not lead to death, they can result in life-long serious disability for children born with them. Symptoms of mtDNA disorders include loss of muscle co-ordination, visual and hearing problems, poor growth, mental retardation, heart, liver and kidney disease, neurological problems, respiratory disorders and dementia.

Prenatal diagnosis is in general not possible for mtDNA diseases, because the clinical signs cannot be reliably predicted from the mutation load (the relative amount of mutated mtDNA molecules) in chorionic villus sampling, so the team of scientists from The Netherlands, Australia, and the UK decided to look at whether PGD would be a better alternative. “If we could find a minimal level of mtDNA mutation load below which the chance for an embryo of being affected was acceptably low”, said Dr. Hellebrekers, “we could offer PGD to women who otherwise had little chance of giving birth to a healthy child.”

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