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Scientists have assumed that people’s brains shrink as they age, but researchers now suspect that’s not the case.

A study in the September issue of Neuropsychology examines long-term Dutch research into aging brains, which used neurological tests and MRI scans to measure parts of the brain.

The researchers looked at data from 1994 to 2005 for two groups: 35 people who were cognitively healthy and 30 people who did not have dementia but experienced cognitive decline during the time period. Both groups averaged about 69 years old.

Those whose cognitive skills declined also had brain shrinkage. That suggested to the researchers that the brain may not shrink much among healthy, older people who don’t suffer from cognitive decline.

Scientists in the past had failed to screen out people whose brains had shrunk because of brain disease, they said.

In other words, simply growing older may not make the brain become smaller.

“If future longitudinal studies find similar results, our conception of ‘normal’ brain aging may become more optimistic,” the study’s lead author, Saartje Burgmans, a graduate student at Maastricht University in Holland, said in a news release from the American Psychological Association.

Successful repair of nasal fractures is possible using either minimally invasive or traditional open surgery methods, as long as the procedure is appropriate for the type of fracture, researchers say.

The proper method may be selected by taking into account factors such as fracture type and degree of septal deviation (displacement of the bone and cartilage separating the nostrils), according to Dr. Michael P. Ondik and colleagues at Penn State Hershey Medical Center.

The treatment of nasal fractures is a controversial topic. Some surgeons recommend no intervention, some prefer closed reduction (minimally invasive repair), and others favor extensive open surgery, according to background information in a news release about the study.

“Closed reduction is a relatively simple procedure, at times producing acceptable outcomes. However, advocates of open reduction purport better cosmetic results and a high likelihood that closed reductions will eventually need a second operation using an open reduction technique,” the researchers wrote.

“Deciding which technique to use for a given nasal fracture can be challenging. Not all fractures can be treated using closed techniques and, conversely, not all fractures require the time and expense of an open reduction,” the study authors noted.

In this study, Ondik and his team looked at data from 86 patients treated for nasal fractures between 1997 and 2007. Of those, 41 had closed reduction and 45 had open surgery.

“There was no statistical difference in revision rate, patient satisfaction or surgeon photographic evaluation scores between the closed and open treatment groups when fractures were treated in the recommended fashion,” the researchers found.

Use of a treatment algorithm — a type of classification system — can help surgeons determine the best method of treatment for each individual fracture, they added.

Taking a combination form of hormone replacement therapy, which includes both estrogen and progestin, increases a woman’s risk for dying from lung cancer, a new study has found.

The finding stems from an analysis of data from the Women’s Health Initiative trial on 16,608 postmenopausal women, aged 50 to 79, in the United States who had been randomly assigned to take either a once-daily tablet of 0.625 milligrams conjugated equine estrogen plus 2.5 mg medroxyprogesterone acetate or a placebo.

After eight years, 73 women taking the hormone therapy and 40 women in the placebo group had died of lung cancer. That meant, according to the researchers, that women who took the drug were 71 percent more likely to die from the disease.

The study also found that women taking the hormone therapy were 28 percent more likely to be diagnosed with lung cancer, although the study noted that the finding was not statistically significant.

“Treatment with estrogen plus progestin in postmenopausal women … increased the number of deaths from lung cancer, in particular deaths from non-small-cell lung cancer,” concluded Rowan Chlebowski, of the Los Angeles Biomedical Research Institute at Harbour-UCLA Medical Center, and his colleagues.

The researchers urged that the findings “be incorporated into risk-benefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer … such as current smokers or long-term past smokers.”

Dr. Apar Kishor Ganti, from the University of Nebraska Medical Center in Omaha, wrote in an accompanying editorial that “because the optimum safe duration of hormone-replacement therapy in terms of lung cancer survival is unclear, such therapy should probably be avoided in women at a high risk of developing lung cancer, especially those with a history of smoking.”

In fact, Ganti questioned whether hormone therapy should be used at all.

“These results, along with the findings showing no protection against coronary heart disease, seriously question whether hormone-replacement therapy has any role in medicine today,” he wrote. “It is difficult to presume that the benefits of routine use of such therapy for menopausal symptoms outweigh the increased risks of mortality, especially in the absence of improvement in the quality of life.”

The study, which appears online and in an upcoming print issue of The Lancet, was released Sept. 19 to coincide with the European Cancer Organization meeting.

The prevalence of Alzheimer’s disease is accelerating at a rapid pace, and by next year 35.6 million people around the world will suffer from dementia — a 10 percent increase since 2005, a new report predicts.

Incidence of dementia will almost double every 20 years, reaching 65.7 million in 2030 and 115.4 million in 2050, according to the 2009 World Alzheimer Report from Alzheimer’s Disease International.

“We are confronting an emergency — we need to do something about this,” said Alzheimer’s Disease International Chair Dr. Daisy Acosta. Governments around the world must take notice and address the social, medical and economic issues related to dementia, she said.

“Life expectancy is increasing everywhere in the world, and that’s why the number of people with dementia are increasing,” she said.

According to the report, which analyzed data from 147 studies in 21 areas around the world, prevalence has increased fastest in low- and middle- income countries. Figures for Western Europe, South Asia and Latin America are higher than the 2005 estimates, while numbers have risen only slightly in North America.

In 2010, more than half (57.7 percent) of dementia cases will occur in low- and middle-income countries, and the proportion will jump to 70.5 percent by 2050, the report said.

The report highlights the challenges faced by governments and health-care systems worldwide to meet the needs of people living with Alzheimer’s and dementia, and their families and caregivers.

The global cost is estimated at $315 billion annually. But the toll dementia takes on patients, caregivers and families is also staggering, Acosta said. “Suffering is something you cannot calculate in money,” she said.

As demented individuals lose their ability to function and communicate with loved ones, caregivers, family and friends pay a heavy emotional price. Up to 75 percent of caregivers have significant psychological illness resulting from caregiving, and 15 percent to 32 percent suffer major depression, the report noted.

Low-income countries, where dementia is considered a normal part of aging, need to promote greater awareness of the disease, Acosta said. Over the next 20 years, some places like North Africa and the Middle East will see dementia cases increase 125 percent, the researchers predicted.

Wealthy countries, including the United States, need plans “to address the issues of the dementia patient,” she said.

Because the United States has no national plan for Alzheimer’s disease, research and treatment gains have lagged, said Harry Johns, chief executive officer of the Alzheimer’s Association. “We do not have a national plan like France does, like the United Kingdom does, like Australia does.”

“As a result, the investment in Alzheimer’s research is far lower than for other chronic diseases,” Johns said. “We have seen investments in cancer make a big difference, in heart disease make a big difference, in HIV/AIDS make a big difference, but the investment in Alzheimer’s research is dramatically lower than those other conditions.”

Dementia is characterized by a progressive deterioration in intellectual abilities, including memory, learning, orientation, language, comprehension and judgment. Alzheimer’s disease, the most common form of dementia, is fatal. The condition mainly affects people older than 65.

“This new report updates the sad fact that economic globalization and development is coupled to a globalizing dementia epidemic now projected to grow to an alarming 115 million victims worldwide,” said Greg M. Cole, associate director of the Alzheimer’s Disease Research Center at the David Geffen School of Medicine of the University of California Los Angeles.

The study emphasizes the personal tragedy of dementia and the growing economic and social burdens that developing countries face because of the rising costs of aging, Cole said.

“This study shows that aging populations, which were once only the problem of the developed countries like the United States, Japan and Europe, are also rapidly rising in Asia and Latin America,” Cole said. “It calls for efforts to find new treatments to care for the tens of millions of new victims in the developing countries and to help their overburdened caregivers.”

A worldwide effort is needed to cope with the increase in dementia, Cole said.

“What the world needs is prevention, but new drugs will necessarily be focused on treatment of diagnosed disease,” Cole said. “It takes many years to develop and test prevention methods so we have to act now. We can only hope that there are governments that are not too short-sighted or cognitively-impaired to generate the political will to make primary prevention happen.”

A daily dose of aspirin can prevent cancer in people with a genetic disorder that increases their risk of developing the disease, scientists said on Monday.

The finding could also have important implications for the wider population, although more research is needed and unraveling the connection will take some time since the benefits of aspirin were only seen after several years.

John Burn of the Institute of Human Genetics at Newcastle University in Britain said his study might also have uncovered a simple way of controlling stems cells that make tumors grow.

“We believe that aspirin may have an effect on the survival of aberrant (faulty) stem cells in the colon,” Burn said, presenting his findings at the ECCO-ESMO European cancer congress in Berlin.

Burn and colleagues tested 1,071 people with Lynch syndrome — an inherited condition that predisposes a person to a range of cancers, particularly of the colon — by giving some of them aspirin and some a placebo.

Follow-up tests after 10 years showed that although there was no difference in cancer rates after 29 months, a significant difference was detected after four years, with fewer people in the aspirin group developing colon cancer, Burn said.

“To date, there have been only six colon cancers in the aspirin group as opposed to 16 who took placebo,” he added. “There is also a reduction in endometrial cancer.”

People with Lynch syndrome have an increased risk of many cancers including stomach, colon, brain, skin, and prostate. Women carriers also have a high risk of developing endometrial and ovarian cancers.

Burn said that although people in the trial stopped taking aspirin, its effect clearly continued.

Colorectal is the second biggest cause of cancer death in the United States and Europe, where a total of 560,000 people develop the disease each year, and 250,000 die from it.

Aspirin, originally developed by Bayer, is a cheap over-the-counter drug which in low daily doses has been found to stave off the risk of heart attacks and strokes, as well as chase away occasional aches and pains.

Other scientists have previously found it can reduce the risk of developing colon cancer and suggested it does so by blocking the enzyme cyclooxygenase2, or COX-2, which promotes inflammation and cell division and is found in high levels in tumors.

But Burn said he thought this explanation was unlikely, and thinks that aspirin hits faulty stem cells before they mutate into pre-cancerous cells.

“If aspirin reduced the chances of such cells surviving, this would explain our results,” he said.

Despite its benefits, aspirin is also well known for causing stomach upsets. In the study, 11 patients on aspirin had stomach bleeds or ulcers compared with nine on placebo.

The team plans a further study using a larger group of patients taking differing aspirin doses.

As long as pregnant women don’t have any obstetric or other medical complications, they can follow the same precautions for air travel as the general population and fly safely, according to a revised Committee Opinion released today by The American College of Obstetricians and Gynecologists (ACOG) and published in the October issue of Obstetrics & Gynecology.

“Since 2001, when ACOG first issued a Committee Opinion on pregnancy and air travel, a number of observational studies have been published confirming that air travel is generally safe during an uncomplicated pregnancy,” said William H. Barth, Jr, MD, of Massachusetts General Hospital in Boston and chair of ACOG’s Committee on Obstetric Practice. “These new studies have made our previous recommendations stronger and more detailed.” The recent studies noted by Dr. Barth have shown no increase in adverse pregnancy outcomes among occasional air travelers.

The updated Committee Opinion also addresses concerns about exposure to cosmic radiation during air travel. Even the longest intercontinental flights will expose passengers to no more than 15% of the recommended limit of cosmic radiation exposure set by the National Council on Radiation Protection and Measurements and the International Commission on Radiological Protection. However, it is possible that flight crew or frequent flyers may exceed the recommended exposure limit. The Federal Aviation Administration provides a website tool at jag.cami.jccbi.gov/cariprofile.asp to help estimate exposure to cosmic radiation from specific flights.

“Questions from our patients about air travel during pregnancy are some of the most common during obstetric visits,” Dr. Barth said. “When a patient with an uncomplicated pregnancy asks about occasional flying, we should feel comfortable saying, ‘It’s safe.’”

All airline passengers, including pregnant women, can help minimize the risk of blood clots, especially on long flights, by wearing support stockings, moving their legs periodically, avoiding restrictive clothing, getting out of their seat and walking for a few minutes, and staying hydrated. Pregnant women should use their seatbelts continuously while seated to prevent the potential risk of trauma to the body in the event of sudden severe air turbulence. ACOG also says pregnant women may want to avoid gas-producing foods or drinks (such as carbonated soda) before a flight because gas trapped in the stomach expands as altitude increases, which can cause discomfort. Pregnant women who are experiencing pregnancy-related nausea may want to take a preventive anti-nausea medication before boarding the airplane.

According to ACOG, pregnant women who have medical or obstetric conditions that may be worsened by air travel or that could require emergency care should not fly at any time during their pregnancy. Women should check with their airline for specific requirements regarding pregnant women. Most commercial airlines allow pregnant women to fly up to 36 weeks of gestation, but restrictions may vary with each carrier.

A new tool to determine a woman’s risk of developing cervical cancer is being developed by researchers at the U.S. National Cancer Institute.

Their proposal appears as a Keynote Comment article in the Sept. 20 online edition and in the November print issue of The Lancet Oncology.

Cytology (cell testing) is the current first-line method of cervical cancer screening. If the results are abnormal, women undergo repeat cytology, or carcinogenic human papillomavirus (HPV) DNA testing, or are referred directly for a colposcopy, during which biopsies are taken from apparent lesions.

Complex consensus management algorithms are used to determine treatment, but these algorithms are becoming increasingly complex as new technologies become available, the researchers said in a news release from the journal.

“Instead of providing clinicians with algorithms, we propose to provide clinicians with their patient’s risk of developing cervical cancer. As a surrogate for cervical cancer, we propose to use cervical precancer, best defined as histological cervical intraepithelial neoplasia grade 3 (CIN3) or more severe (CIN3+), or less precisely by CIN2+, a common treatment threshold,” wrote Hormuzd A. Katki and colleagues.

The study authors noted that large amounts of data on risk of cervical precancer are being produced by clinical trials. This risk can be calculated when women are screened for cervical cancer, for those sent immediately to colposcopy, or at one-year, two-year, or three-year follow-up intervals.

“The risk of cervical precancer is a unifying concept to guide management, regardless of which combination of tests a woman has undergone, because risk of cervical precancer boils down to a complex battery of test results over time into a single percentage that forms a basis for action,” the research team wrote.

The FDA’s approval of Viagra on 27 March 1998 was a ground-breaking commercial event for the treatment of ED, with sales exceeding one billion dollars. Subsequently, the FDA approved Levitra (vardenafil) on 19 August 2003, and Cialis (tadalafil) on 21 November 2003.

Cialis was discovered by Glaxo Wellcome (now GlaxoSmithKline) under a partnership between Glaxo and ICOS to develop new drugs that began in August 1991. In 1993, the Bothell, Washington, biotechnology company ICOS Corporation began studying compound IC351, a phosphodiesterase type 5 (PDE5) enzyme inhibitor. In 1994, Pfizer scientists discovered that sildenafil, which also inhibits the PDE5 enzyme, caused penile erection in men participating in a clinical study of a heart medicine. Although ICOS scientists were not testing compound IC351 for treating ED, they recognized its potential usefulness for treating that disorder. Soon, in 1994, ICOS received a patent for compound IC351 (structurally unlike sildenafil and vardenafil), and Phase 1 clinical trials began in 1995. In 1997, the Phase 2 clinical studies were initiated for men experiencing ED, then progressed to the Phase 3 trials that supported the drug’s FDA approval. Although Glaxo had an agreement with ICOS to share profits 50/50 for drugs resulting from the partnership, Glaxo let the agreement lapse in 1996 as the drugs developed were not in the company’s core markets.

In 1998, ICOS Corporation and Eli Lilly and Company formed the Lilly ICOS, LLC, joint venture company to further develop and commercialize tadalafil as a treatment for ED. Two years later, Lilly ICOS, LLC, filed a New Drug Application with the FDA for compound IC351 (under the tadalafil generic name, and the Cialis brand name). In May 2002, Lilly ICOS reported to the American Urological Association that clinical trial testing demonstrated that tadalafil was effective for up to 36 hours, and one year later, the FDA approved tadalafil. One advantage Cialis has over Viagra and Levitra is its 17.5-hour half-life (thus Cialis is advertised to work for up to 36 hours, after which time there remains approximately 25 percent of the absorbed dose in the body) when compared to the four-hour half–life of sildenafil (Viagra).

In 2007, Eli Lilly and Company bought the ICOS Corporation for 2.3 billion dollars. As a result, Eli Lilly owned Cialis and then closed the ICOS operations, ending the joint venture and firing most of ICOS’s approximately 500 employees, except for 127 employees of the ICOS biologics facility, which subsequently was bought by CMC Biopharmaceuticals A/S(CMC).

Persons surnamed “Cialis” objected to Eli Lilly and Company’s so naming the drug, but the company has maintained that the drug’s trade name is unrelated to the surname.

A three-pronged approach to treating spinal cord injuries allowed paralyzed rats to walk without receiving signals from the brain, scientists report.

Spinal cord injuries result in paralysis when the nerve fibers that carry information to and from the brain are damaged or severed. Much of the focus of research into spinal cord injuries has been exploring ways of regenerating those nerve fibers and connections, which has so far met with limited success in people.

In the new study, rats were treated with a combination of drugs, electrical stimulation of the spinal cord and locomotor training, a rehabilitation technique. The combined treatment enabled the rats to walk with a near-normal gait on a treadmill, without the muscles receiving signals from the brain.

“The study demonstrates that the lower spinal cord has circuitry that is sufficient to support virtually normal, weight-bearing locomotion,” said senior study author V. Reggie Edgerton, a professor of physiological sciences and neurobiology at the University of California, Los Angeles.

The study appears in the Sept. 20 online edition of Nature Neuroscience.

Previous research has been able to coax a stepping motion using one or two of those techniques, said Susan Howley, executive vice president of research for the Christopher & Dana Reeve Foundation, which provided some funding for the current research. But this is the first study to achieve actual weight-bearing walking, as opposed to the motions of walking.

“The thing that’s very exciting about this is that for the first time they actually showed they can get these rats, with no input from the brain, to step near normally,” Howley said. “On the treadmill, they were able to bear weight and step virtually as well as they had been prior to the injury. That’s a remarkable achievement.”

In the study, researchers put rats whose lower legs were paralyzed in a harness on a slow-moving treadmill and gave them a drug called quipazine, a serotonin agonist that enhances the function of the spinal nerve circuitry. The researchers then used an epidural to apply electrical currents to the dura of the spinal cord, the protective membrane that surrounds it, below the point of injury.

The combination of drugs and electrical stimulation caused the rats to begin walking. Several weeks of daily locomotor training on the treadmill enabled near-normal weight-bearing walking — including backward, sideways and running.

Because the brain was still unable to direct the walking, the rats could only walk when hooked up to electrical stimulation on the treadmill.

Previous studies have shown that the nerve circuitry of the spinal cord is able to generate rhythmic activity that can direct leg muscles to step, the researchers said. With the right input, the nerves can learn to interpret sensory information from the stepping motion even without help from the brain.

“Previous research has shown the spinal cord can learn whatever task it’s being trained to do,” Edgerton said. “The spinal cord can interpret the sensory information associated with the stepping, respond to that sensory information and sustain the stepping based on the sensory information.”

Locomotive training is a rehabilitation technique that uses that concept to retrain the spinal cord circuitry after injury. Widely used in some European countries, locomotor training involves placing people with spinal cord injuries in harnesses while physical therapists move their legs in a walking motion.

People who undergo locomotor training often see improvements in respiration, bladder function, blood sugar levels and circulation below the level of the lesion, which can help prevent the skin breakdown that can occur as a result of paralysis, Howley said. Others even recover trunk stability, which can enable them to move from a bed to a wheelchair, or a wheelchair to a car, without assistance.

Though a treatment using the three-pronged approach is at least several years away, the study suggests the potential of using neuroprosthetic devices to activate spinal cord rhythmic circuitry, said study author Gregoire Courtine, a professor in the department of neurology at the University of Zurich in Switzerland. His team is currently developing a device that they hope to begin testing in small clinical trials in three to four years.

About 5.6 million Americans, or one in 50, has some level of paralysis, according to a survey released in April of 33,000 U.S. households by the Christopher & Dana Reeve Foundation. About one-quarter of the nearly 2 percent of the U.S. population living with paralysis is due to a spinal cord injury.

Your need for immunizations doesn’t end when you reach adulthood. Maintain protection against vaccine-preventable diseases for your health and for your family’s health. Be the example!

Immunizations are NOT just for kids! Whether a young adult, middle-aged adult, or senior citizen, we ALL need immunizations to keep us healthy. Transitioning to adulthood brings us into a new world, bringing a different level of responsibility that we carry for life, including the need to help protect our loved ones more than ever.
Do You Need Any Vaccines?

The specific immunizations you need as an adult are determined by factors such as your age, lifestyle, high-risk conditions, type and locations of travel, and previous immunizations. Throughout your adult life, you need immunizations to get and maintain protection against:
Seasonal influenza (flu) (In general, anyone who is 6 months or older can benefit from the protection of a flu vaccination.)
2009 H1N1 influenza (for adults 25-64 years old with high risk conditions; parents and caretakers of children younger than 6 months of age; and emergency medical services personnel) Initial doses are expected to be available by mid-October.
Tetanus, diphtheria and pertussis (whooping cough) (for adults up to 64 years, one lifetime dose)
Shingles (for adults 60 years and older)
Pneumococcal disease (for adults 65 years and older and adults with specific health conditions)
Human papillomavirus (HPV) infection (for women 26 years and younger)

Other vaccinations you may need include those that protect against hepatitis A, hepatitis B, chickenpox (varicella), and measles, mumps and rubella.

Note that the seasonal flu vaccine does not protect against the 2009 H1N1 flu. A new vaccine against 2009 H1N1 flu is being produced and will be available in the coming months as the best option for prevention of 2009 H1N1 infection.

Review the Adult Immunization Schedule (also available in Spanish) to see if you need any immunizations. Be sure to check this schedule for updates as new vaccines are developed for additional protection. The most recent addition to the schedule is the shingles vaccine for those 60 years and older.