Doctors warn of codeine dangers after occurrence of acute confusion in daughter, 14

Lack of efficacy and risk of poisoning and craving suggest use of over-the-counter codeine narcotics may be unwarranted, says report

Doctors have issued a warning about the use of over-the-counter medications containing codeine following what is believed to be the first published lawsuit of acute disarray in a 14 -year-old girl.

The dangers associated with codeine in cough remedies, both prescribes and otherwise, are highly unnecessary because of the lack of evidence that they actually work, the experts said.

Many mothers still dedicate codeine products to their children, despite regulators fears. This may be because of what they perceive as its strength, and its analgesic impacts, medical professionals from Ireland say in an article in the publication BMJ Case Reports.

The girl was assured at a hospital A& E department after five days of fluctuating confusion and amnesia, according to the report. She had been sleeping up to 20 hours a day, had a decreased attention span and suffered from intermittent headaches.

She had falsely reported having completed tasks, such as having showered, her mothers told physicians, and she also switched speeches while doing her homework. The girl had flu-like symptoms over 15 days, during which she missed school, and had been taking two to three spoonfuls a day of oral codeine phosphate over this time.

Although the girl had not exceeded the recommended daily dosage of three to six spoonfuls, she had outstripped the maximum recommended duration of three days. In all, she was thought to have devoured 450 -6 75 mg of codeine, instead of the maximum of 270 mg over any course of treatment.

The symptoms abated five days after the girl was admitted to hospital. There was also no codeine in her urine. A clinical review 2 week after she was discharged proved she was well and free of symptoms.

Confusion is a relatively unusual complaint in codeine intoxication, say the doctors, highlighting the necessity of thorough investigations. Codeine does however often affect the central nervous system and breathing and can cause severe rub of the scalp and flushes.

In April, the European Medicines Agency warned physicians against giving codeine to children and adolescents. It reviewed international data relating to coughs and other respiratory infections, including four demises, arising from codeine poisoning in children aged between 17 days and six years.

For coughings and colds in under-1 2s, it should only be used in special circumstances, relevant agencies said. Older children and adolescents with breathing problems should also not use codeine , nor should patients of any age who were known to convert codeine into morphine at a faster rate than normal.

The authors of the BMJ article say that although there was no evidence of codeine craving in this case, other studies had raised questions over codeine dependence in adolescents and vulnerable adults.

The combination of lack of efficacy, danger of acute intoxication and dependency, suggests the use of over-the-counter codeine preparations may be unwarranted, they said.

The UKs Medicines and Healthcare Products Regulatory Agency said: Codeine is a strong medication authorised for pain relief. It is not recommended for use in children or adolescents for the symptoms of coughing and cold as it is associated with a risk of respiratory side-effects.

If anyone has any questions, they should speak to their GP or pharmacist who can best advise on alternative treatments.

Professor Nigel Mathers, honorary secretary of the Royal College of General Practitioners, said: GPs are aware of the risks links with prescribing codeine and, in line with current guidelines, as a general rule we would not recommend medications containing codeine for children unless other alternatives have been explored and only when it is really necessary.

We would certainly not recommend these drugs for patients who have other conditions, such as asthma. But codeine is an effective cough suppressant and widely accessible without a prescription, so if patients do choose to take medications that contain codeine, we would urge them to read the label carefully and stick to the recommended dose.

Neal Patel, a pharmacist and the head of corporate communications at the Royal Pharmaceutical Society, said: The UK Commission on Human Medicines advises that over-the-counter liquid medications that contain codeine should not be used for coughing suppression in people under 18.

There is only limited evidence that codeine is effective for treating cough and cold symptoms in children. The hazards outweigh the benefits for treating the symptoms of cough in this age group.

Codeine-containing medications are unsuitable for treating pain or coughing in children under the age of 12 due to the potential seriousnes of side-effects.

Pharmacists advise that, when used, codeine-containing medications should only be taken for three days and only at the recommended dosage, as it can cause addiction. People with coughings that last for more than two weeks should seek advice about the cause from a pharmacist or GP.

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Alzheimer’s link to herpes virus in brain, say scientists

Research exposes strains of virus more abundant in brains with early stage of disease, though uncertainly whether virus is a trigger or a symptom

The presence of viruses in the brain has been linked to Alzheimer’s disease in research that challenges conventional theories about the onset of dementia.

The outcomes, based on tests of brain tissue from virtually 1,000 people, found that two strains of herpes virus were far more abundant in the brains of those with early-stage Alzheimer’s than in healthy controls. However, scientists are divided on whether viruses are likely to be an active trigger, or whether the mind of people already on the path towards Alzheimer’s are simply more vulnerable to infection.

” The viral genomes were detectable in about 30% of Alzheimer’s brains and virtually undetectable in the control group ,” told Sam Gandy, professor of neurology at the Icahn School of Medicine at Mount Sinai, New York and a co-author of the study.

The survey also suggested that the presence of the herpes viruses in the brain could influence or control the activity of various types of genes linked to an increased risk of Alzheimer’s.

The scientists did not set out to look for a is connected with viruses and dementia. Instead they were hoping to pinpoint genes that were unusually active in the brains of people with the earliest stage of Alzheimer’s. But when they analyse brain tissue, comparing people with early-stage Alzheimer’s and healthy controls, the most striking differences in gene activity were not found in human genes, but in genes belonging to two herpes virus strains, HHV6A and HHV7. And the abundance of the viruses correlated with clinical dementia ratings of the donors.

” We didn’t go looking for viruses, but viruses kind of screamed out at us ,” said Ben Readhead, deputy professor at Arizona State University-Banner Neurodegenerative Disease Research Center and lead author.

Gandy said the team were initially” surprised and sceptical” about the results, based on brain tissue from the Mount Sinai Brain bank, and so recurred such studies use two further brain banks- in total 622 brains with signs of Alzheimer’s and 322 healthy control brains- and saw the very same genes.” We’ve tried to be conservative in our interpretation and replicated research results in three different brain banks, but we have to at the least recognise that these diseased brains are carrying these viral genomes ,” he added.

The scientists could not prove whether viruses actively contribute to the onset of illnes, but they discovered a plausible mechanism for how this could happen. Some of the herpes genes were found to be boosting the activity of several known Alzheimer’s genes.

David Reynolds, chief scientific police officers of Alzheimer’s Research UK, said this element was significant.” Previous studies have suggested that viruses might be linked with Alzheimer’s, but this detailed analysis of human brain tissue takes this research further, indicating a relationship between the viruses and the activity of genes involved in Alzheimer’s, as well as brain changes, molecular signals, and symptoms associated with the disease ,” he said.

However, others were more sceptical. Prof John Hardy, a geneticist at University College London, said:” There are some families with mutants in specific genes who always get this illnes. It’s difficult to square that with a viral aetiology. I’d urge an extremely cautious interpreting of these results .”

The viruses highlighted are not the same as those that cause cold sores, but much more common forms of herpes that nearly everyone carries and which don’t typically cause any problems. The examine in no way been shown that Alzheimer’s disease is contagious or can be passed from person to person like a virus- or that having cold sore increases a person’s risk of dementia.

There are currently 850,000 people living with dementia in Britain, and the number is projected to rise to a million by 2025 and 2 million by 2050. But despite hundreds of medication trials during the past decade, an effective therapy has not yet emerged.

” While these findings do potentially open the door for new therapy alternatives to explore in a disease where we’ve had hundreds of failed trials, they don’t change anything that we are all familiar with the risk and susceptibility of “Alzheimers disease” or our ability to treat it today ,” said Gandy.

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Cutting-edge theatre: world’s first virtual reality operation runs live

Dr Shafi Ahmed will carry out surgery live-streamed in virtual reality, a move experts hope will build healthcare more equitable and help medical training

This Thursday afternoon, Shafi Ahmed will lean over a patient and begin a delicate operation to remove cancerous tissue from a male patients bowel. He has performed such procedures many times before. But this time it wont be only his surgical squad who are in the room with him the world will be there too.

Showing from 1pm the approximately two-hour long procedure at the Royal London Hospital is the worlds first operation to be streamed live in 360 -degree video, allowing medical students, trainee surgeons and curious members of the public to immerse themselves in the medical event in real time.

A cancer surgeon at Barts Health NHS Trust, Ahmed believes the approach could attain healthcare more equitable, improving the training of surgeons the world over. With internet connections becoming better, smartphones get ever cheaper and merely a pair of lenses and some cardboard needed to make a virtual reality headset the costs, he says, pale in comparison to the expenditure of students travelling abroad to train. It is actually quite cost effective, he said.

Shot use two 360 -degree cameras and a number of lenses arranged around the theater, the operation can be viewed through the VR in OR app, utilizing a virtual reality headset that is likely to be paired with a smartphone. Those who do not have a headset can watch the video live online.

While videos showcasing surgical procedures have been around for years, Ahmed believes the new approach is more than a mere gimmick. The technology, he argues, brings a valuable new feature to education, letting viewers to focus not just on what the surgeon is doing, but also on what other members of the team are up to. There is likely to be noise, there will be the immersive factor so that will add different layers of educational value, he added.

George Hanna, professor of surgical sciences at Imperial College, London is cautiously optimistic about the benefits of the approach. If this technology allows the transfer of knowledge and abilities[ over] a wider range and in an easier route that would be very beneficial.

But he is quick to add that, compared with existing approaches for sharing scenes from the operating theatre, the new technology offers more of an upgrade than a revolution. It is a good video and broad broadcast with interactive[ possibilities ], he told, stressing that the operation itself is real rather than virtual.

It is not the first time that Ahmed has led the style in embracing modern technology in healthcare. As co-founder of the healthcare company Medical Realities( which will be streaming the operation in collaboration Barts Health and 360 -degree video experts Mativision ), he believes virtual reality, augmented reality and games all play a role in training medical students: two years ago he streamed a live operation using the augmented reality system, Google Glass, permitting viewers to ensure the procedure from a surgeons point of view.

But the new 360 -degree video, says Ahmed, offers a new, immersive approach, allowing users to assure beyond what the surgeon is looking at. Among the developments he envisages, Ahmed is keen to add graphics to the raw footage to provide additional information during the operation, as well as taking questions from those viewing the procedure.

[ During an operation] I am teaching people, talking to them, there is communication going on so itll be just an extension of that, he told. Whats more, in three to five years haptic devices could boost the experience further, he added. Companies are genuinely working on various gloves or bodysuits and devices so that it can replicate touch and feel, he told.

Such technologies, said Ahmed could be a boon to health care. But he added, the role of patients in agreeing to take part should not be forgotten. Ultimately, it is about the operation, about[ the patient ], about his cancer care and that has to be the priority for everyone, he said. The fact that patients have agreed to do this before with the Google Glass and again, it is quite reassuring and quite humbling.

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Darker sense of humour could be sign of dementia, tells analyse

Report by UCL polled relatives and discovered many told patients perception of what was funny changed dramatically and became inappropriate and graphic

An increasingly twisted sense of humour could be one of the early signs of dementia, a new examine has determined, including laughing at inappropriate moments.

The University College London research, published in the Journal of Alzeheimers disease,questioned the families and friends of 48 dementia patients, who had known them for more than 15 years before their cancer took hold, many whom noted that their relatives sense of humour had changed.

The study observed patients laughed at frankly inappropriate moments, including watching news reports about natural disasters, or find a car parked badly. One recalled a relative laugh after a loved one seriously scalded herself.

Dementia patients were likely to find satirical slapstick like Yes Prime Minister, or absurdist slapstick like Monty Python less funny than slapstick, like Mr Bean, such studies received. After the patients were diagnosed, respondents said that they noticed a shift in patients comedy predilections toward the fatuous and farcical.

All patient groups liked satirical and absurdist slapstick significantly less than healthy patients, the study told.

It detected an altered sense of humour is especially common in two specific types of dementia; semantic dementia and a variety of frontotemporal dementia, a difference noted for causing sufferers to lose their inhibitions and fight in social situations. A change in witticism was also frequently found in patients with Alzheimers disease.

Early on,[ they] laughed very loudly at things that were only mildly funny, flippant or over the top; now laughs all the time at things that are not especially funny and will say Im laughing and Im not sure why Im laughing, one respondent wrote. When I seriously scalded myself the other year,[ they] thought it was hilarious.

I have asthma[ they] laugh sometimes when I am fighting to get my breath, another relative wrote.

Many said the persons ripen or cultured sense of humour had disappeared, with relatives chuckling only at the most slapstick comedy or dirty jokes. Use to be very witty but that has all gone; humour has to be more obvious, laughs if others laugh, one wrote.

[ They have] little sense of humour at all, does not really find anything funny but will give a silly giggle or sneer when totally inappropriate, another wrote. One said their relatives humour was now very rude and graphic, everything is now funny.

Dr Simon Ridley, of Alzheimers Research UK, said relatives concerned about changes in the behaviour of their loved ones should contact their GP.

While memory loss is often the first thing that springs to mind when we hear the word dementia, this study highlightings the importance of looking at the myriad different symptoms that impact on daily life and relationships, he told the BBC .

A deeper understanding of the whole range of dementia symptoms will increase our ability to make a timely and accurate diagnosis.

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Brain experiments on primates are crucial, say eminent scientists

Two nobel laureates among 400 scientists who sign letter repudiating claims that use of primates is no longer medically useful

More than 400 scientists including two Nobel laureates have signed a letter stating that brain experimentations on primates are crucial to medical advances, in response to claims that they are cruel and no longer useful.

Last week, Sir David Attenborough and the primatologist Dame Jane Goodall called for an objective to the use of non-human primates in certain neuroscience experimentations, saying medical progress in this area could now be made without the use of monkeys.

In a letter to the Guardian, scientists including the Nobel laureates Sir John Gurdon and Sir John Walker, rejected this claim, arguing that primate research was still critical for developing therapies for dementia and other debilitating illnesses.

Neurodegenerative illness are a major and growing scourge of our ageing population, Walker told the Guardian. If we are to find ways for prevention and remedy, continued experimental access to primates under carefully controlled conditions is essential.

The latest round in the long-running debate on animal research was activated by a research paper, which concluded that there was no longer any need for experiments on primates involving motion restraint or fluid deprivation.

The review, by the campaign group Cruelty Free International( formerly the British Union for the Abolition of Vivisection ), suggested the need for such experimentations had been superseded by modern brain imaging techniques, such as MRI, and by the ability to construct records from patients brains during surgery.

Speaking in support of the findings, Attenborough told the Independent: The recognition that apes, surely, and to an extent other primates, are so akin to ourselves, and can suffer so much, as we are capable of, has transformed our posture, or should have transformed our stance, to using them for our own benefit.

Goodall, who has analyse wild chimpanzees in Tanzania over fives decades, told: To confine these primate relatives of ours to laboratory enclosures and subject them to experimentations that are often distressing and painful is, in my opinion, morally wrong.

However, scientists conveyed their concern that the importance of primate research had been played down.

Sir Colin Blakemore, an eminent neuroscientist and signatory of the Guardian letter, told: In the past year alone, research on monkeys has helped efforts to create new inoculations and therapies for Ebola, Zika and Aids, to develop new cholesterol-reducing drugs to prevent heart disease, and to design prosthetic devices for seriously disabled people. Somehow, we need to balance moral responsibility to human beings against moral obligations to animals.

Roger Lemon, emeritus prof at University College London, said the CFI review appeared to place animal welfare above that of patients. The newspaper suggests that all the work done in primates could be done in seriously ill patients. It suggests that they dont have that much respect for ill people.

Research on primates accounts for less than 0.1% of all animal research in the UK and this figure has been following a downward trend for the past few decades. In 2015, 3,612 procedures were carried out on primates, out of 4,142, 631 total procedures on all species( figures are given by procedure rather than by animal ).

The US National Institutes of Health announced last year that it would end the use of chimpanzees in medical research. Research on great apes( chimps, gorillas and orangutans) has been banned in the UK since the 1980 s, but other primates, such as marmosets and macaques continue to be used in neuroscience experiments, including in the development of new medications.

For instance, scientists at Kings College London estimate that around 80% of all narcotics for the therapy of Parkinsons were originally tested at the marmoset laboratory there. But some research carried out on primates relates to more basic questions about the organisation of the brain, for instance, how memory or the visual system works.

Vicky Robinson, the chief executive of the National Centre for the Replacement, Refinement and Reduction of Animals in Research( NC3Rs) said that both sides of the debate had been disingenuous about the value of the work.

One over-exaggerates the state of the available alternatives and the other generalises the medical benefits that research use these animals has delivered, she told. It is time for a great deal more transparency from both sides. Anything else undermines the science as well as downplaying the animal welfare concerns associated with these experiments.

Dr Katy Taylor, the director of science at Cruelty Free International, told: The utilize of non-human primates in neuroscience experimentations is a hugely controversial area of studies with profound ethical and moral fears. An increasing number within the scientific community question the morality and value of subjecting monkeys to such substantial high levels of suffering suffering that can involves invasive brain surgery, water deprivation, physical coercion and physical restraint.

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Happy events can cause potentially fatal rare heart condition

Joy can trigger same symptoms as Takotsubo syndrome, where heart changes shape after sad events, say scientists

A rare condition that triggers a potentially life-threatening weakening of the heart can be caused by happy events as well as emotional shocks such as grief or sadness.

Since 1990, physicians have recognised a condition known as Takotsubo syndrome, or TTS, which typically occurs in women after upsetting episodes such as the death of a spouse or mother, the breakdown of a relationship, or being diagnosed with cancer.

Now research has shown that the same outcome can follow happy or joyful events. Scientists have named the new condition happy heart syndrome.

TTS have contributed to characteristic changes in the shape of the heart. The main symptoms are breathlessness and chest pains but the condition is temporary and reversible after a few days or weeks. It is unusual for it to occur again in the same patient.

The researchers analysed data from 1,750 patients diagnosed with TTS in nine different countries. Of 485 patients for whom a definite emotional trigger could be identified, 96% had suffered sad and stressful events such as the loss of a loved one, attending a funeral, being hurt in an accident, or experiencing an illness or relationship problems. One obese patient was stricken after get stuck in the bath.

But in the case of the remaining 20 individuals, heart damage appeared to have been triggered by happy occasions including a birthday party, a bridal, a astonish celebration, the proposed establishment of a great grandchild, a favourite rugby squad winning a game and a trip to the opu. The findings are published in the European Heart Journal.

Dr Jelena Ghadri, from University Hospital Zurich in Switzerland, where the worlds first TTS registry is based, told: We have shown that the triggers for TTS can be more varied than previously known. A TTS patient is no longer the classic broken-hearted patient, and the disease can be preceded by positive feelings too.

Clinicians should be aware of this and also consider that patients who arrive in the emergency department with signs of heart attacks, such as chest pain and breathlessness, but after a happy event or emotion, could be suffering from TTS just as much as a similar patient presenting after a negative emotional event.

Our findings broaden the clinical spectrum of TTS. They also suggest that happy and sad life events may share similar emotional pathways that can ultimately cause TTS.

Takotsubo syndrome takes its name from a Japanese octopus trap that resembles the distorted shape of the left ventricle of a heart affected by TTS. The condition, which occurs abruptly, causes the heart chamber to balloon out at the bottom while the neck remains narrow.

Scientists are still trying to understand the mechanism behind TTS, which is thought to involve links between psychological stimuli, the brain, and the cardiovascular system.

In the study, 95% of both broken heart and happy heart patients were women. The average age of the broken group was 65 and of the happy group 71.

The studys co-author, Dr Christian Templin, also from University Hospital Zurich, said: Perhaps both happy and sad life events, while inherently distinct, share final common pathways in the central nervous system output, which ultimately lead to TTS.

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Stem cell therapies: medical experts call for strict international rules

Experts from 15 countries tell regulation needed to prevent vulnerable patients pursuing unproven and potentially deadly treatments

Medical and legal experts from around the world have unified to call for more stringent regulation of stem cell therapies to prevent people pursuing unproven and potentially deadly treatments overseas.

In a perspective piece for the US journal Science Translational Medicine, 15 experts from countries including the UK, the US, Canada, Belgium, Italy and Japan wrote that national efforts alone would not be enough to counter an industry offering unproven therapies to vulnerable patients.

Stem cell-based interventions are classified under diverse and potentially incompatible national regulatory frameworks, the authors wrote.

Approaches for international regulation not only need to develop consistent regulations over the commercialisation of medical practices and products but also need to give them teeth by developing cross-border partnerships for compliance.

Stem cells found in bone marrow and umbilical cord blood have long been used to successfully treat blood cancers including leukaemia and some immune illness. But those are among the few proven therapies. Legitimate and ethics-approved clinical trials by academic centres are also resulting, investigating the potential of stem cells to treat a wider range of diseases.

But some physicians are directly offering to the general public stem cell treatments for illness still under clinical trial or for which no evidence exists and for which the safety and efficacy is as yet unproven.

Deaths as a result of stem cell treatments have already resulted. In 2013 Sheila Drysdale died in a New South Wales nursing home after undergoing an unproven liposuction stem-cell therapy at a western Sydney clinic. Following Drysldales death, her doctor, Ralph Bright, gave a statement to police in which he claimed that stem-cell therapy could improve comorbidities and that stem cells could move from joints to other parts of the body to improve illnes in distant sites including lungs and brain, vision, mentation and pain.

In his report into Drysdales death, the coroner Hugh Dillon wrote that he could not say what motivated Dr Bright to perform this unproven, dubious procedure on Sheila Drysdale.

But regardless of his motivating, Dr Brights performance as a medical practitioner was, for the reasons outlined above, poor and resulted in Sheila Drysdales death.

The Medical Council of NSW investigated Bright and placed a number of restrictions on his right to practise. Bright is still authorised to practise stem cell therapy for patients with osteoarthritis or who are taking part in research studies approved by an ethics committee. He is also still allowed to treat patients returning for remaining injections of stored cells.

In 2013 a Queensland woman, Kellie van Meurs, died when she travelled to Russia to undergo stem-cell treatment for a rare neurological disorder. She died of a heart attack as a result.

Australias drug regulator, the Therapeutic Goods Administration, last year sought feedback on the regulation of autologous stem-cell therapies but is yet to publish those submissions. A TGA spokeswoman said the Administration was still examining the options for changes to the legislation to reflect public and industry opinions. The TGA currently considers autologous therapies, which involve treating someone with their own tissue or cells, to be a therapeutic good and, hence, does not govern them. Stem cells used for medical practise and therapeutic purposes are covered by different regulatory frameworks.

Associate Professor Megan Munsie, a University of Melbourne stem cell scientist and a co-author of the paper, said: The notion that stem cells are magical holds court in the community, along with this idea the advances in treatment are being held up by red tape.

Unethical health practitioners exploited this, she said, along with the vulnerability of patients with difficult-to-treat or incurable conditions.

There is a precedent for international regulation of this industry because regulations already exist around narcotics the way they are manufactured, she said.

This could be extended to the regulation to the stem cell and tissue-based therapies. This international stance would then force or foster stronger local regulations.

There have been successful endeavors by scientists to push back against unscrupulous physicians. In Italy scientists and regulators highlighted the unproven yet government-subsidised treatments being offered by the entrepreneur Davide Vannoni and fought to stop him. He was convicted of criminal charges but the sentence was subsequently suspended.

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Alzheimer’s: ultrasound safely delivers medications to damaged brains of mice

Scientists at Queensland Brain Institute find noninvasive technique slows progression of Alzheimers disease in mice

Australian researchers say they have made a promising step in the future treatment of Alzheimers disease after detecting ultrasound can effectively and safely deliver medications to the damaged brain.

Scientists at the Queensland Brain Institute discovered the noninvasive technique successfully penetrated the blood-brain obstacle to deliver a therapeutic antibody to the brain. This then slackened the progression of Alzheimers disease in mouse, according to a study published in the periodical Brain.

One of the major challenges impeding the therapy of Alzheimers is that the majority of drugs designed to treat the brain disease do not make it into the brain.

Ultrasound safely opens up the blood-brain barrier just a tiny bit and just for short time to let the antibody into the brain and, importantly, into the nerve cells where the damage passes, said Prof Jurgen Gotz, the result researcher at QBI.

Alzheimers disease is the most common form of dementia, with the number of dementia examples in Australia expected to rise to 900,000 by 2050.

Using scanning ultrasound technology, researchers at QBI delivered an antibody that specifically binds to a protein called tau implicated in the progression of Alzheimers.

Combining ultrasound with the antibody therapy is more effective than either treatment alone in removing the toxic protein clumps, say the researchers. We ultimately hope in the coming years to develop an ultrasound device that is not too bulky and can also be used to treat local patients, Gotz said. This device may clear toxic tau in patients on its own or it may be used by delivering therapeutic agents such as drugs or antibodies.

The lead author of the study, Dr Rebecca Nisbet, said this would have enormous benefits by making expensive therapy more cost-effective. Youre increasing the amount of therapeutic agents that they are able enter the brain, thereby reducing the number of a doses and the amount that needs to be delivered, she said.

The ultimate hope is the technique will also allow for the effective treatment of other brain diseases such as Parkinsons and motor neurone disease.

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The US Government Is Retiring All Research Chimpanzees

Two years ago, most of the chimps used for medical research in the United States were retired and sent to sanctuaries to live out the rest of their lives. Now, the United States National Institute of Health( NIH) has announced that it is shutting down its chimp medical research program once and for all.

As before, the 50 currently owned primates will be forwarded to sanctuaries. Another scheme, wherein 82 other chimpanzees are supported by the NIH but owned by other medical research facilities, will also be phased out over time. The director of the NIH, Francis Collins, spoke to Nature about the decision: I think this is the natural next step of what has been a very thoughtful five-year process of trying to come to words with the benefits and risks of trying to perform research with these very special animals. We reached a point where in that five years the necessity of achieving research has essentially shrunk to zero.

Around3 10 chimps were retired in 2013, in accordance with a recommendation from the Institute of Medicine( IOM ). Their report also set the bar extremely high for allowing chimpanzee experiments to take place, with only the most important, vital, time-dependent experiments permitted on the remaining 50. Most of the experimentations the IOMaccepted as serving the greatest is beneficial for humen involved research into infectious diseases.

Earlier this year, the U.S. government dedicated research chimps the same protection rights given to endangered species, means that almost all invasive research on them was proscribed. Non-invasive behavioral studies using chimpanzees were allowed to continue, however.

This may seem like a pioneering step, but a outlaw( or at least, incredibly severe restrictions) on using great apes for medical research is in place in several other countries already, including the Netherlands, New Zealand, Sweden, Germany, Austria and the United Kingdom, the last of which banned this type of research in 1986.

Image credit: The last 50 captive chimpanzees owned by the NIH will be put in sanctuaries. apple2 499/ Shutterstock

Chimpanzees were used for research because this is genetically and physiologically very similar to humen. Now, other animals will have to be used in their place. It is due to this similarity that many have argued that it is unethical to intentionally harm these primate cousins of ours in the name of medical research.

However , not everyone is happy with this decision. Allyson Bennet, a developmental psychobiologist at the University of Wisconsin-Madison, points out that the sanctuaries do not have the same welfare standards that applied to the NIH-supported centres. Other researchers that require chimpanzees for conservation work permitted even after the 2013 ruling arent happy either.

Peter Walsh, who was leading an effort to develop an Ebola vaccine for wild chimpanzees using captive specimen at the University of Louisiana, will now find his research has hit a significant, perhaps permanent, roadblock. There really is no other place to do conservation-related trials but the US biomed facilities, Walsh toldNature.

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DN-Abased test can spot cancer recurrence a year before conventional scans

Liquid biopsy diagnosed cancer recurrence up to a year before conventional scans in major lung cancer trial, and could buy crucial time for doctors

A revolutionary blood exam has been shown to diagnose the recurrence of cancer up to a year in advance of conventional scans in a major lung cancer trial.

The test, known as a liquid biopsy, could buy crucial time for doctors by indicating that cancer is growing in the body when cancer is still not detectable on CT scans and long before the patient becomes aware of physical symptoms.

It works by seeing free-floating mutated DNA, released into the bloodstream by succumbing cancer cells. In the trial of 100 lung cancer patients, scientists considered precipitous rises in tumour DNA in the blood of patients who would go on to relapse months, or even a year, later.

The findings add to building anticipation that the technology, which is already in widespread use in non-invasive prenatal tests for Downs syndrome, will have a major impact in cancer medicine.

Nitzan Rosenfeld of the Cancer Research UK Cambridge Institute, who was not involved in the most recent trial, predicts that most if not all cancer patients will be given the DN-Abased tests in future.

Even if only a fraction of cancers “that theyre” detected at a lethal stage will in future be seen at an early curable stage this will represent a great benefit in lives saved, he said.

In the latest trial, reported in the journal Nature, 100 patients with non-small cell lung cancer were followed from diagnosis through surgery and chemotherapy, having blood tests every six to eight weeks.

By analyze the patchwork of genetic defects in cells across each cancer, scientists made personalised genomic templates for each patient. This was then compared to the DNA floating in their blood, to assess whether a fraction of it matched that seen in their tumour.

Prof Charlie Swanton, a cancer geneticist at the Francis Crick Institute who led the work, described how circulating tumour DNA tracked the patients cancer status with remarkable accuracy. Of patients who would remain in remission, he said that Within 48 hours of surgery, the DNA falls down to undetectable.

By contrast, rising tumour DNA levels were seen in patients whose illnes would later recur, indicating that cancer remained in the lungs or had migrated to other organs, where it was lying dormant.

When the tests of 24 patients were analysed in detail, the scientists could say with 92% accuracy who would relapse.

I think this is going to be very useful clinically, said Swanton. This allows us to identify high risk patients. We have predictive value of 92% that your cancer is going to recur within 350 days.

The tests even uncovered an apparent outlier, a patient whose cancer had not yet resurfaced, but whose blood exam showed high levels of circulating tumour DNA.

We said either theres something wrong with our assay or this patients got recurring disease, said Swanton. Almost a year later, cancer indicated up on a CT scan.

The liquid biopsies also demonstrated whether chemotherapy was operate or if the disease had evolved resistance, as happens in the majority of stage 2 and 3 cancers. In future, this could allow physicians to switch to a more effective drug and spare patients gruelling but futile treatment.

Were giving all this toxic chemotherapy on the basis that only 1 in 20 patients will ever benefit, said Swanton. We could say this patient is not benefiting from chemotherapy so we should stop it. Or this patients disease is coming back but we cant see it on a CT scan so we should give more treatment.

This has got real, clear practical relevance now in lung cancer, he added.

Eileen Rapley, 74, a retired art teacher from London, entered the trial after being diagnosed with lung cancer a year ago. Since therapy, doctors discovered that Rapley had also developed a brain cancer, for which she has also been treated. Although the liquid biopsy did not guide her own care, she hopes the new test might lead to the kinds of improvements that screening techniques like mammograms have brought about for breast cancer.

That sort of research has helped so many, she said. Friends of mine with breast cancer, I cant think of any for years and years who have died, because there were early testing and early diagnosis.

The test used in the study relied on building a bespoke genetic template for each patient based on detailed analysis of tumor samples, with an estimated cost of over 1,300 per patient. However, Swanton predicts the same kind of profile could be built using computational methods from merely an initial blood exam, constructing the technology viable outside a purely research setting.

Were not a million miles away from that; it will probably happen in the next 2-3 years, he said.

Lung cancer causes more than one in five of all cancer deaths in the UK and, although incidence of the disease is dropping, survival has only improved fractionally in the past 40 years.

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