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Women willing to delay antibiotics for UTIs

More women than previously thought may be willing to delay taking antibiotics to treat a urinary tract infection in order to reduce the potentially unneeded use of antibiotics, a new Dutch study shows. More than one-third of women in the study with UTI symptoms said they were willing to wait a week to see if the infection would improve on its own before starting antibiotics. And more than 70 percent of the women who didn't use antibiotics for a week showed improvements or had their symptoms disappear completely, according to the study published May 30 in the journal BMC Family Practice. UTIs are more common in women than men, and are caused by E. coli bacteria in 80 to 90 percent of cases. The standard treatment for UTIs is a few days of antibiotic treatment, but the increasing emergence of antibiotic-resistant bacteria has become a serious concern, experts say. “To counteract this increasing resistance, the use of antibiotics should be limited in healthy patients who can also be cured without them,” study researcher Dr. Bart Knottnerus, from the University of Amsterdam said in an email. Studies show that when patients have UTI symptoms, most often, antibiotic treatment is started before the results of urine cultures, which look for the presence of bacteria, are known. “In fact, a culture is seldom done. Instead, the probability of a positive culture is estimated by asking questions and performing urine investigations,” Knottnerus said. “Since no test is perfect, some patients without UTI will get antibiotics, and some patients with UTI will not.” In the study, 137 patients were asked by their doctor to delay antibiotic treatment for one week. Fifty-one women were willing to wait. After one week, 28 of those women had still not used antibiotics and 20 of them reported clinical improvement. None of the participating women developed kidney infection, according to the study. Kidney infection is a serious condition that can occur if a UTI is left untreated, and needs a more aggressive antibiotic treatment. The researchers say that bladder infections seldom progress to the kidneys. “If a kidney infection occurs in a healthy woman, she can be cured by antibiotics,” Knottnerus said. “But to make sure that these antibiotics will still be effective in the future, it is important to limit their use in mild infections (like bladder infections).” It is important that women with UTI symptoms be monitored by a doctor if they choose to delay antibiotics. “If a woman gets ill (fever, shivering, flank pain), the infection may be progressing to the kidney,” Knottnerus said. Previous studies have shown that in somecases, patients recover from UTIs within a week without taking antibiotics. Knottnerus said the reason is that they either didn't have a UTI, or didn't need antibiotics to cure it. The body's defense mechanisms are often strong enough to fend off infections without any help from antibiotics, he said. Dr. Timothy Jenkins, assistant professor at the Division of Infectious Diseases, University of Colorado, said about the new study: “Progressive antibiotic resistance in bacteria is a major problem in the United States and worldwide, so it is very important that we develop novel strategies to reduce antibiotic use, such as the one proposed in this study.” Jenkins noted that antibiotic use in the Netherlands is extremely low, whereas antibiotic use in the United States is quite high. “Therefore, whether this study is applicable to women in the U.S. where the societal expectation for antibiotics is greater is not known,” he said. New guidelines published last week, from the Dutch College of General Practitioners, support the advice to delay antibiotic treatment for uncomplicated urinary tract infections, the researchers said. Copyright 2013 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.source : http://www.foxnews.com/health/2013/06/04/women-willing-to-delay-antibiotics-for-utis/

New cancer drug shows promise for treating advanced melanoma

The results were presented at the 2013 meeting of the American Society of Clinical Oncology today in Chicago by Dr. Antoni Ribas, professor of medicine in the UCLA division of hematology-oncology, who led the research. Following Ribas’ presentation, the study was published online ahead of press in the New England Journal of Medicine. The results are from the first clinical trial of the drug lambrolizumab (MK3475), which was discovered and developed by Merck…

Immunotherapy now used to treat cancers beyond melanoma

Diagnosed with advanced lung cancer over a year ago, Gabe Tartaglia was loath to undergo the kind of harsh chemotherapy that had devastated his sister before her death three years earlier from pancreatic cancer. He decided to enter a clinical trial for a new drug designed to trigger the immune system to fight cancer. The results were better than anyone expected. “Everything has shrunk,” said the 62-year-old contractor from Wolcott, Connecticut, who still goes for treatment every two weeks and has regular scans to keep tabs on his progress. “Some of the tumors you can't even see.” Just a few years ago, nobody believed it was possible to harness the immune system to respond to cancer, but drugs like nivolumab, the experimental Bristol-Myers drug Tartaglia receives, are showing promise, even in some patients who have never tried any other treatments. The drugs will be a main focus of this year's American Society of Clinical Oncology five-day meeting in Chicago beginning on May 31. Much of the attention will be trained on agents that disable a protein called programmed death 1, or PD-1, that enables tumors to evade the immune system. In addition to nivolumab, experimental drugs in the class include Merck's lambrolizumab and Roche's MPDL3280A, which work by blocking a partner protein known as PD-L1 (the L is for ligand). PD-L1 in turn works within cancer cells to shut down the immune response. Analysts and investors will be parsing the ASCO data for clues to the market potential for the drugs, which are expected to generate billions of dollars in annual sales. Nivolumab alone is forecast to have sales of $1.2 billion in 2017, according to Wall Street analysts tracked by Thomson Reuters Pharma. 'I GET TO COME HOME AND EAT' Part of the excitement comes from a Phase 1 study last year of nivolumab, which showed lasting response rates among 20 percent to 30 percent of a group of patients with multiple cancers, including lung cancer, a leading cause of cancer death that so far has shown limited response to immune system therapies. The trials are still in the early stages. Researchers are working to understand why most patients do not respond and are exploring combining immunotherapies with other treatments. Aside from the nuisance of frequent blood draws, Tartaglia has had few complaints. “The best part is, I get to come home and eat. I'm all set. Other people are throwing up,” he said of patients at Yale Cancer Center in New Haven who are still getting conventional chemotherapy. Normally, experimental cancer drugs are only used in patients who fail other treatments, said Dr Scott Gettinger, Tartaglia's doctor and an associate professor of medical oncology at the center. “Now we are starting to use immunotherapy drugs as first-line treatments … I know what first-line chemotherapy can do for lung cancer, and it's not great.” Patients with non-small-cell lung cancer, the most common form of lung cancer, who are treated with the current standard of care - chemo and Roche's Avastin - have a median survival of about a year, Gettinger said, noting that some of his patients have been on nivolumab for more than three years. “We haven't really realized the potential of this therapy,” he said. “As we learn how to use this drug, we are going to see higher response rates.” Another of Gettinger's patients, 68-year-old Bruce Leonard, tried chemotherapy, but his lung cancer returned after two years, prompting a decision to enter the nivolumab study. “I felt at the time that by just doing chemo again, at best I would see the same result,” the retired commodity buyer said. “About two months after I started (the trial), there was a 30 percent improvement … and it has gotten progressively better, to the point that with my last scan they found absolutely nothing.” Many patients do not respond to the treatments, but for those who do, the responses have been extraordinary; some patients have lived for years. Yervoy, Bristol-Myers' breakthrough melanoma treatment, only benefits about 10 to 15 percent of patients. Newer agents, such as nivolumab, have shown response rates ranging from 20 percent to 40 percent. A small study released earlier this month looking at a combination of the two drugs showed 53 percent of patients had their tumors shrink by at least half after 12 weeks. In 18 percent of patients on the dual therapy, tumors were no longer detectable. Bristol-Myers has three late-stage clinical trials of nivolumab in melanoma, two late-stage trials in lung cancer and one in kidney cancer. Last November, interim results from an early-phase trial of Merck's lambrolizumab in patients with advanced melanoma showed that it shrank tumors in 51 percent of patients after 12 weeks, compared with a typical response rate of about 5 percent for similar patients given conventional treatment. Merck plans to present an update of this study on June 2 at the ASCO meeting. The company also is studying its anti-PD-1 drug in so-called triple-negative breast cancer, a hard-to-treat form of the disease, as well as head and neck cancer, bladder cancer and lung cancer. Last month, lambrolizumab won designation from the U.S. Food and Drug Administration as a breakthrough therapy, which could speed its approval. “It's clear now that these medicines do have activity across a broader spectrum of tumors, and they seem to be remarkably potent in very challenging clinical oncology settings,” said Dr Gary Gilliland, a senior vice president who heads the oncology franchise at Merck Research Labs. In April, Roche reported results of a small safety study of its anti-PD-L1 drug MPDL3280A that showed anti-tumor activity against a variety of cancers including lung, kidney, colon and gastric cancers. Roche plans to start a Phase III study in lung-cancer patients. The findings are driving enthusiasm for immunotherapies. “It tells us these are poised to be the most important agents in oncology,” said Dr Antoni Ribas of the University of California Los Angeles' Jonsson Comprehensive Cancer Center. Citigroup research analyst Andrew Baum expects immunotherapies to form the backbone of treatments for up to 60 percent of cancers over the next decade, up from less than 3 percent today, transforming the treatment of cancer from a desperate struggle with death into a chronic disease, in which treatments keep patients alive for years. Baum estimates that would generate annual sales of $35 billion. “The current explosion in all ongoing approaches ... to utilize the immune system to seek and destroy cancer cells marks a watershed, analogous to the impact of HIV drugs transforming life expectancy in (patients infected with) HIV,” Baum said in a recent note to investors. YEARS, NOT MONTHS Doctors have been trying for decades to get the immune system to fight cancer with limited, sporadic success. But the disease has developed wily defenses that camouflage tumor cells. “The tide really turned in 2010 with the first presentation of pivotal data about ipilimumab,” said Dr Jedd Wolchok of Memorial Sloan Kettering Cancer Center of the drug now sold as Yervoy. In 2011 ipilimumab became the first immunotherapy drug to help extend the lives of patients with advanced melanoma. “We're very pleased that Yervoy prolongs survival in one out of five individuals, but there is still room for growth,” said Michael Giordano, senior vice president of global development for oncology and immunology at Bristol-Myers. “Our goal here is to have very long-term durable responses. We're not just trying to increase the patient's disease-free survival for a few months,” said Nils Lonberg, senior vice president of discovery biologics at Bristol-Myers. Lonberg envisions a day when immunotherapy will be as important a tool for oncologists as surgery, radiation and chemotherapy. Wolchok says the promise for immunotherapies is treatment responses that last. “The immune system is a dynamic organ. It remembers things,” he said.source : http://www.foxnews.com/health/2013/05/31/immunotherapy-is-not-just-for-melanoma-anymore/

Bicycle helmet laws linked to fewer child deaths

U.S. states that require children and teenagers to wear helmets report fewer deaths involving bicycles and cars, according to a new study. Researchers analyzed the number of U.S. bicycle deaths between 1999 and 2010 and found that states with bicycle helmet laws reported about 20 percent fewer bike-related fatalities among people younger than 16 years old. “The impetus is that when you make it a law, parents realize it's important and parents get their kids to do it,” said Dr. William Meehan, the study's lead author from Boston Children's Hospital. About 900 people die as a result of bicycle crashes every year in the U.S. and about three quarters of those are from head injuries, according to Meehan and his colleagues. Previous research has found that wearing a helmet may reduce a person's risk of a head or brain injury by up to 88 percent, but few studies have looked at the effect of helmet laws on national injury and fatality rates. Using a national database that tracks the number of traffic-related deaths in the U.S., the researchers compared the number of children and teenagers killed while riding their bicycles in the 16 states that enacted helmet laws around the start of the study in 1999 to states without helmet laws. In 1999, only 16 states had helmet laws and the overall rate of bicycle-related child deaths in the U.S. was 4 per million. Between January 1999 and December 2010, there were 1,612 bicycle-related deaths among children younger than 16 years old, the researchers found. During that time, states with helmet laws had 2 bicycle-related deaths for every 1 million children younger than 16 years old. That compares to 2.5 deaths for every 1 million children in states without helmet laws. After adjusting for other state characteristics known to be associated with traffic-related deaths - such as household income, and drunk or elderly driving laws - the states with helmet laws still had fewer reported deaths in that age group. “We would recommend that any state that doesn't have a mandatory bicycle helmet law for children consider one or institute one,” Meehan said. Dr. Frederick Rivara, a professor of pediatrics at the University of Washington and Seattle Children's Hospital, said it's nice that the new study shows states with helmet laws report fewer deaths, but he said it's important to remember that helmets can also prevent serious injuries. “Bicycle fatalities represent only the very tip of the iceberg,” said Rivara, who has studied bicycle helmet safety but was not involved with the new research. The American Academy of Pediatrics currently recommends that children wear a helmet approved by the Consumer Product Safety Commission every time they ride a bicycle. “Helmets are very effective. They're cheap, they're light, they're comfortable and they work,” Rivara said.source : http://www.foxnews.com/health/2013/05/30/bicycle-helmet-laws-linked-to-fewer-child-deaths/

New possibilities for prostate cancer treatment revealed

Published today in Science Translational Medicine, a study led by Monash University researchers has found prostate cancer cells that survive androgen withdrawal treatment. Previously unidentified, these cells are potential targets for future treatments. As they are present early in disease development, there is the possibility of therapy before the cancer reaches the aggressive, incurable stage. Prostate cancer is the most common form of cancer in men, with around 20,000 new cases diagnosed each year in Australia…

Pork industry hunts for deadly pig virus

The sudden and widespread appearance of a swine virus deadly to young pigs - one never before seen in North America - is raising questions about the bio-security shield designed to protect the U.S. food supply. The swine-only virus, the Porcine Epidemic Diarrhea Virus (PEDV), poses no danger to humans or other animals, and the meat from infected pigs is safe for people to eat. Though previously seen in parts of Asia and Europe, the virus now has spread into five leading hog-raising U.S. states. How it arrived in the United States remains a mystery. While the U.S. imports millions of pigs each year from Canada, it imports pigs from virtually no other country, and no Canadian cases of PEDV have been confirmed. Veterinarians and epidemiologists say pigs are infected through oral means, and that the virus is not airborne and does it not occur spontaneously in nature. In recent years, with the emergence of dangerous pathogens such as H1N1, also known as swine flu, and bovine spongiform encephalopathy (BSE) or mad cow disease, the United States and other countries have sought to secure defenses both on the farm and at the national borders to protect against barnyard epidemics. “We're just trying to get a handle on what's happening,” said Tom Burkgren, executive director of the American Association of Swine Veterinarians. “It's like drinking water out of a fire hose. We're getting hits from all over the place.” Overall numbers of confirmed cases and mortality rates are not yet available, though anecdotal evidence suggests there are devastating losses for farms that are hit. “If you've got it, it's bad,” said Mark Greenwood, vice president of agri-business capital at AgStar Financial Services, who said none of his clients have been affected. “I spoke to a farmer in the Midwest who had it show up in a 2,000-head barn of pigs, and had a 40 percent death loss.” A spokeswoman for U.S. Department of Agriculture's Animal and Plant Health Inspection Service told Reuters the agency is working with state agencies and pork industry officials to discover where the virus originated. THE VIRUS SPREADS Confirmed cases have been reported in five hog-raising states including Iowa, the largest U.S. hog producer with 20 million hogs, according to the USDA. While only seven farms have had confirmed cases since May 17, more cases are expected as labs sift through samples, say sources investigating the outbreak. Colorado, Indiana, Illinois and Minnesota reportedly have positive tests for PEDV, according to state veterinarians and agriculture department officials, and the National Veterinary Services Laboratory in Ames, Iowa. PEDV, most often fatal to very young pigs, causes diarrhea, vomiting and dehydration. It also sickens older hogs, though their survival rate tends to be high. Known as a “coronavirus” because of the crown-like spikes on its surface, the virus afflicted China in recent years and killed more than 1 million piglets. PEDV is spread most commonly by pigs ingesting contaminated feces. Investigators are focused on physical transmission, perhaps a PEDV infected pig, equipment marred with feces, or even a person wearing dirty boots or with dirty nails. The mystery about how the virus entered the United States is raising concern about potential holes in the bio-security shield designed to protect the U.S. food and farming sectors. “Like everything else, we screw up from time to time,” said Ronald L. Plain, professor of agricultural economics at University of Missouri in Columbia, Missouri. “We know so little about the transmittal of this virus. We can't be sure if it's happening because of something we're supposed to do right and didn't - or by some mechanism we don't know that we're supposed to do differently.” Initial reporting about the virus may have been delayed, say sources, because its symptoms can be confused with a more common malady, transmissible gastroenteritis (TGE). Also, states are not required to report cases of PEDV to the federal government, and farmers are not required to report to state veterinarians. As part of its assessment of the situation, USDA will email epidemiological surveys to swine veterinarians who are dealing cases of PEDV. Meanwhile, the veterinarians are sending samples to diagnostic labs, where technicians are scrambling gathering the tools needed to check the samples for PEDV - supplies many labs did not have prior to the outbreak. While most farmers are taking a wait-and-see approach, some told Reuters they are turning away unnecessary visitors and double checking to ensure their safety protocols are being followed. LOOKING NORTH The search for leads also has turned to the nation's borders and ports of entry - specifically, Canada, where the United States imported 5.7 million head of live hogs last year. Canada has never had a confirmed case of the virus, though it does not test for it, government officials said. “Canada has very effective import measures in place to address this risk,” said Dr. Rajiv Arora, senior staff veterinarian for the Canadian Food Inspection Agency's foreign animal disease section. Canada can import live breeding pigs, under permits, from either the United States or the European Union, Arora said. The animals are quarantined by CFIA for a period of time, then inspected and tested - although not for PEDV - before released. Canada imported C$1.7 million ($1.6 million) worth of live swine in 2012, including both slaughter-ready and breeder pigs, according to Canada's Agriculture Department. CHINA HARD HIT Veterinarians and agricultural epidemiologists in the United States are drawing grim lessons from the devastating effect PEDV has had in other countries where it has hit. The first reports of suspected PEDV came in 1971 in the United Kingdom. As years passed, PEDV spread across parts of Europe and Asia. Veterinary researchers later concluded that lax bio-security measures contributed to PEDV's spread in Asia. One of the worst known outbreaks of the virus hit China's pig herds in late 2010, according to the Centers for Disease Control and Prevention's Emerging Infectious Diseases Journal. Vaccines had limited effectiveness and PEDV over ran southern China killing more than 1 million piglets. The death rate for virus-infected piglets ranged from 80 percent to 100 percent. Biosecurity measures in the U.S. food supply have been beefed up over the years, and especially after the outbreaks of mad cow disease and swine flu. Both outbreaks posed risks to human health. Today, trucks carrying live animals are supposed to be cleaned before entering and leaving farms. At commercial hog operations, visitors routinely shower and change clothing before stepping into a barn. Overseas visitors typically wait several days before being in the presence of a commercially raised hog. But the food shield is not impermeable. “If it becomes clear that this is not a novel way for to be transmitted, and that there had to be physical contact, that's going to be a major concern,” said William Marler, a leading food-safety attorney. “It means that there was a failure in the system.”source : http://www.foxnews.com/health/2013/05/29/pork-industry-hunts-for-deadly-pig-virus/

Small molecule could have big impact on cancer

In a study published online May 28 in the journal Nature Communications, Ahn and his colleagues at UT Southwestern Medical Center describe the rational design of the molecule, as well as laboratory tests that show its effectiveness at blocking the cancer-promoting function of proteins called androgen receptors. Androgen receptors are found inside cells and have complex surfaces with multiple "docking points" where various proteins can bind to the receptor. …

GATA-3 is important for regulation and maintenance of immune system

GATA-3’s role in CD4 T-cells has been widely studied, but its role in CD8+ cells has received much less attention. "We want to know what the basic function of GATA-3 in regulating cell biology is, although it has been shown that GATA-3 is important for the function of CD4+ T cell type to clear extracellular parasites," said Yisong Wan, PhD, assistant professor of microbiology and immunology at the UNC School of Medicine and member of UNC Lineberger Comprehensive Cancer Center. The research, published online May 26 by Nature Immunology, shows that GATA-3 is required for the maintenance and function of CD8+ T-cells, a T-cell type mediating the immune response to clear pathogens, eradicate tumors and promote inflammation. …