Scientific American Mind -  July 1, 2009

Fit Body, Fit Mind? Your Workout Makes You Smarter

How can you stay sharp into old age? It is not just a matter of winning the genetic lottery. What you do can make a difference

By Christopher Hertzog, Arthur F. Kramer, Robert S. Wilson and Ulman Lindenberger

As everybody knows, if you do not work out, your muscles get flaccid. What most people don’t realize, however, is that your brain also stays in better shape when you exercise. And not just challenging your noggin by, for example, learning a new language, doing difficult crosswords or taking on other intellectually stimulating tasks. As researchers are finding, physical exercise is critical to vigorous mental health, too.

Surprised? Although the idea of exercising cognitive machinery by performing mentally demanding activities—popularly termed the “use it or lose it” hypothesis—is better known, a review of dozens of studies shows that maintaining a mental edge requires more than that. Other things you do—including participating in activities that make you think, getting regular exercise, staying socially engaged and even having a positive attitude—have a meaningful influence on how effective your cognitive functioning will be in old age.

Further, the older brain is more plastic than is commonly known. At one time, the accepted stereotype was that “old dogs can’t learn new tricks.” Science has proved that this dictum must be discarded. Although older adults generally learn new pursuits more slowly than younger people do and cannot reach the peaks of expertise in a given field that they might have achieved if they had started in their youth, they nonetheless can improve their cognitive performance through effort—forestalling some of the declines in cognition that come with advancing age. As John Adams, one of the founding fathers and the second U.S. president, put it: “Old minds are like old horses; you must exercise them if you wish to keep them in working order.”

The news comes at a propitious time. The proportion of older adults in the U.S. and in other industrial nations continues to grow: in 1900, 4.1 percent of U.S. citizens were older than 65, but by 2000 that amount had jumped to 12.6 percent; by 2030, 20 percent of us will be in that category. From a societal point of view, prolonging independent functioning is both a desirable goal in itself and a way of deferring costs of long-term care. For individuals, maintaining optimal cognitive functioning is worthwhile simply because it promises to enhance quality of life through the years.

Mental Training
How to keep minds keen over an entire life span is a question philosophers have mulled since the earliest writings on record. As Roman orator Cicero put it: “It is exercise alone that supports the spirits, and keeps the mind in vigor.” Modern research in this field began in the 1970s and 1980s, with studies that demonstrated that healthy older adults can improve performance to a greater extent than had been previously assumed. The earlier research did not fully address certain questions, such as how long adults could retain the new skills they had acquired through training, whether those specifically developed skills would also positively influence other areas of cognition needed in everyday life, and whether the studies done with small numbers of subjects would be broadly applicable to most members of society.

The latest experiments confirm that cognitive training does show substantial benefits for older adults and that these effects can be relatively long-lasting. Around the turn of this past century the federal government’s National Institute on Aging funded a consortium of researchers to conduct a large-scale training study in a sample of older Americans. In 2002 psychologist Karlene Ball of the University of Alabama at Birmingham and her colleagues published initial results on more than 2,500 individuals older than 65 who had received about 10 sessions of cognitive training. Participants were randomly assigned either to a cognitive-process training group to learn how to excel in one of three areas—memory, reasoning or visual search—or to a control group of subjects who did not receive training. At a follow-up two years later, the team randomly selected a set of the initial participants to get booster training prior to evaluation. The results showed strong training-effect sizes in each group as compared with controls, along with a pattern of specificity in performance improvements. For example, individuals trained in visual search evinced strong gains in visual search performance but little improvement, relative to controls, on the memory and reasoning tests, a typical finding in training research. Data from retests five years later on the sample found that measurable training benefits were still present after the longer interval.

More impressive, however, are recent training studies that focus on what psychologists call executive function—how a person plans a strategic approach to a task, controls what is attended to, and how he or she manages the mind in the process. Unlike training that focuses on very specific skills, such as memorization strategies, training that aims to help people to control how they think appears to work on broader skills that are helpful in many situations that require thinking. For instance, psychologist Chandramallika Basak and her colleagues at the University of Illinois recently showed that training in a real-time strategy video game that demands planning and executive control not only improved game performance but enhanced performance on other tasks measuring aspects of executive control. Other results suggest that psychologists are learning how to train higher-level skills that may have a broader effect on cognitive function.

You don’t have to have specialized training, however, to achieve cognitive gains or ward off cognitive decline. Everyday activities such as reading can help. We reviewed evidence on activity-related cognitive enrichment in more than a dozen studies. In 2003 neuropsychologist Robert S. Wilson and his colleagues at Rush University Medical Center in Chicago recruited more than 4,000 elderly people from a geographically defined community and rated their frequency of participation in seven cognitive activities (for instance, reading magazines). At three-year intervals for a mean of nearly six years, participants completed an in-home interview that included brief tests of cognitive function. More frequent cognitive activity at the outset was associated with reduced rate of cognitive decline over time.

Getting Physical
Over the past decade several studies have underscored the link between physical activity and cognition. For instance, in a study published in 2001 neuropsychiatrist Kristine Yaffe of the University of California, San Francisco, and her colleagues recruited 5,925 women older than 65 at four different medical centers across the U.S. The participants were all free of any physical disability that would limit their ability to walk or pursue other physical activities. The volunteers were also screened to ensure that they did not have a cognitive impairment. The researchers then assessed their physical activity by asking the women how many city blocks they walked and how many flights of stairs they climbed daily and gave them a questionnaire to fill out about their levels of participation in 33 different physical activities. After six to eight years, the researchers assessed the women’s level of cognitive function. The most active women had a 30 percent lower risk of cognitive decline. Interestingly, walking distance was related to cognition, but walking speed was not. It seems that even moderate levels of physical activity can serve to limit declines in cognition in older adults.

Moderate movement is good, but toning your circulatory system with aerobic exercise may be the real key to brain fitness. In a 1995 study of 1,192 healthy 70- to 79-year-olds, cognitive neuroscientist Marilyn Albert of Johns Hopkins University and her colleagues measured cognition with a battery of tasks that took approximately 30 minutes to complete and included tests of language, verbal memory, nonverbal memory, conceptualization and visuospatial ability. They found that the best predictors of cognitive change over a two-year period included strenuous activity and peak pulmonary expiratory flow rate. In an investigation published in 2004 epidemiologist Jennifer Weuve of Harvard University and her colleagues also examined the relation between physical activity and cognitive change over a two-year period in 16,466 nurses older than 70. Participants logged how much time they spent per week in a variety of physical activities (running, jogging, walking, hiking, racket sports, swimming, bicycling, aerobic dance) over the past year and provided self-reports of walking pace in minutes per mile. Weuve’s group observed a significant relation between energy expended in physical activities and cognition, across a large set of cognitive measures.

The research that we have described thus far has examined mental performance over relatively short periods—just several years. A few studies have begun to look at what happens over longer timescales. In 2003 psychiatrist Marcus Richards of University College London and his colleagues examined in a cohort of 1,919 men and women the influence of self-reported physical exercise and leisure-time activities at age 36 on memory at age 43 and on memory change from ages 43 to 53. Analyses indicated that engagement in physical exercise and other leisure-time activities at 36 was associated with higher memory scores at 43. Physical activity at 36 was also associated with a slower rate of memory decline from 43 to 53 years of age after adjusting for spare-time activity and other variables. The data also suggested little memory protection for those who stopped exercising after 36 but protection for those individuals who began to exercise after this time.

In 2005 then graduate student Suvi Rovio of the Karolinska Institute in Sweden and her colleagues examined the relation between physical activity at middle age and risk of dementia an average of 21 years later, when the cohort was between 65 and 79 years of age. Subjects indicated how often they participated in leisure-time physical activities that lasted at least 20 to 30 minutes and caused breathlessness and sweating. Conducting such activity at midlife at least twice a week was associated with a reduced risk of dementia in later life. Indeed, participants in the more active group had 52 percent lower odds of having dementia than the more sedentary group did.

Mind-Body Connection
It makes sense that training or participation in mentally stimulating activities would help cognition, but it is perhaps less immediately obvious why physical activity would have such an effect. Consider the increasingly well-documented link between physical activity and disease. A plethora of studies have examined the health benefits of exercise and a nonsedentary lifestyle for prevention of disease. For example, we now know that physical activity reduces the risk of cardiovascular-related death, type 2 diabetes, colon and breast cancer, and osteoporosis. On the other hand, cardiovascular disease, diabetes and cancer have been associated with compromised cognition. Therefore, you might expect that increased physical activity and exercise would maintain cognition by reducing risk of diseases associated with cognitive decline.

In a study published in 2006 psychologist Stanley J. Colcombe of the University of Illinois and his colleagues examined the influence of fitness training on potential changes in brain structure. The six-month trial included 59 healthy but sedentary community-dwelling volunteers, age 60 to 79. Brain scans after fitness training showed that even relatively short exercise interventions can begin to restore some of the losses in brain volume associated with normal aging.

Supporting these findings, a large body of nonhuman animal research has demonstrated a number of changes in brain structure and function after animals are exposed to enriched, or complex, environments. Enriched environments usually include running wheels, a multitude of toys and objects to climb that are changed frequently, and animal companions. Exposure to such environments yields several physiological benefits. First, it increases the formation of new dendrite branches and synapses—the areas of neural cells that receive and send communication signals. It also increases the number of glial cells, which support the health of neurons, and expands the brain’s oxygen-supplying capillary network. Enriched environments foster the development of new neurons and create a cascade of molecular and neurochemical changes, such as an increase in neurotrophins—molecules that protect and grow the brain.

Doing puzzles and push-ups are helpful for some—but other factors also boost mental fitness. For one, getting involved in social groups both improves cognition in general and seems to help thwart the arrival of dementia. The traditional focus of this research has been on relatively objective measures of social isolation versus connectedness, including the extent to which a person participates in activities that prominently involve social interaction (such as doing volunteer work), the number of friends and relatives an individual contacts regularly (in other words, the size of his or her social network), and marital status. Findings about the positive aspects of attitudes and beliefs on adult cognition are spottier. In large part, positive beliefs and attitudes may have important indirect effects on cognitive enrichment because of their influence on the kinds of behaviors (for instance, exercise and mentally stimulating activities) that are known to be associated with cognitive enrichment.

More generally, individuals who are optimistic, agreeable, open to new experiences, conscientious, positively motivated and goal-directed are more likely to undergo successful aging, to take advantage of opportunities, to cope more effectively with life circumstances, to effectively regulate emotional reactions to events, and to maintain a sense of well-being and life satisfaction in the face of challenge.

And just as maintaining some activity patterns in old age may reduce risk of cognitive decline, the persistence of other patterns of behavior may actually increase the risk. Chronic psychological distress—resulting from depression, anxiety and neg­ative emotions such as anger and shame—is asso­ciated with a variety of negative outcomes in adulthood, including cognitive decline. The tendency to experience psycho­logical distress is often called neuroticism. Studies have consistently found a higher level of neuroticism to be linked to an increased incidence of Alzheimer’s disease and mild cognitive impairment in old age.

Enriching Cognition
Clearly, there is no magic pill or one-shot vaccine that inoculates the individual against cognitive decline in old age. Thus, public policy regarding cognitive enrichment should follow a health prevention model. Policy leaders might promote intellectual activities that are inherently meaningful for older adults, perhaps as embedded in larger social contexts (for example, the Elderhostel movement or adult continuing education). A critical issue for future research will be to understand how an engaged way of life can be promoted and implemented in midlife, during the working years. Given inevitable conflicts between work demands and time available for other roles (parenting, for one) and activ­ities, it would be useful to know whether work-­related activity programs (such as availability and use of physical exercise facilities at or near the workplace) could help foster an enriching lifestyle.

At the same time, the public must be aware that there is still much that is not known about cognitive fitness in old age, as well as some controversy about the magnitude and durability of mental exercise outcomes. People are beginning to market computer games and other means of exercising the mind, often making strong claims about the effectiveness of expensive products that have not been backed by actual scientific studies. Consumers should look for evidence demonstrating the benefits of any such products, which may not necessarily incorporate all the features needed to enhance mental fitness in old age.

The next decades offer much promise for expanding our knowledge about aging and cognition. We may soon discover whether the limits on successful cognitive functioning in old age that were once seen as insurmountable can ultimately be viewed as pessimistic assumptions that focused on observable age-related decline rather than the potential for maximizing human performance through cognitive enrichment. Just as advances in medical science may lead to increased longevity through vehicles such as effective treatments for dementia-causing illnesses, advances in psychological science can make important contributions to improving the quality of life of long-living older adults, in part by empirically demonstrating that attitudes and behaviors can promote cognitive functioning in old age and, more generally, by showing how behavioral interventions can help us all age successfully.

Note: This article was originally printed with the title, "Fit Body, Fit Mind?"

Further Reading

• Brain Trainers: A Workout for the Mind
• Avoiding Sugar Key to Ending Senior Moments
• A Recipe for Motivation: Easy to Read, Easy to Do
• Do anabolic steroids make you a better athlete?

• Ask the Brains: Is the Midlife Crisis a Myth?
• Does Exercise Really Make You Healthier?
• Fitness and the Brain: Can a Walk a Day Keep Alzheimer’s Away?
• Humans Marrying Robots? A Q&A with David Levy

By Robin Nixon, Special to LiveScience, May 26, 2009

Socialites and curmudgeons not only have different party demeanors, they may also have different brain structures, a new study suggests. But what came first — the incentive to charm or the bolstered brain anatomy — is still a matter of debate.
Forty-one randomly selected men filled out a questionnaire assessing their own tendency to, say, "make a warm personal connection." Those who reported being sociable and emotionally demonstrative also tended to have denser cell concentration in two brain structures: the orbitofrontal cortex and the ventral striatum, said the study’s head researcher Graham Murray of the University of Cambridge in the United Kingdom.
The research was published in the May 20 issue of the European Journal of Neuroscience.
Chicken or egg
Many studies have found correlations between the size of a particular brain structure and physical behavior, such as the classic finding that taxi drivers often have more developed hippocampi, structures associated with spatial memory. Whether the above-average geographic abilities existed before or only developed after the subjects became cabbies is unclear. The burgeoning field of social neuroscience is producing similar findings.

For example, the structural research by Murray and colleagues is backed by a recent study published in Nature Neuroscience and led by Michael Cohen. He showed that strong neuronal connections between the orbitofrontal cortex and striatum were also associated with social pleasure.
"Connectivity encourages growth of brain regions," Murray said, so taken together the studies suggest two causal relationships. A particular brain composition could create a warm personality, but experiencing social behavior could also create a social brain, he said.
Most likely it is both nature and nurture acting in tandem, creating "a snowball effect," Murray theorized. Experience spurs brain growth, brain growth influences behavior, behavior affects experience and around we go.
Personality develops most rapidly during childhood and adolescence, Murray said, but traits are never completely fixed. Even in adulthood, he continued, "social experiences could have their effect by changing brain structures over time."

Key to Survival
The identified brain areas also respond to pleasures, such as food and sex, that are necessary for species survival. Over the course of evolution, socializing may have also become a critical need, Murray said.
"Humans and our ancestors became the smart animals that we are because we had to deal with one another," agreed David Bjorklund of Florida Atlantic University, who was not involved in the current study. Social traits likely developed in response to certain environmental pressures, such as lack of food or extended juvenile periods, requiring humans to learn to cooperate, he said.
While other animals take pleasure in socializing, humans enjoy it in a definitively intricate way. We may have taken what was a simple survival mechanism and developed it into a complex pleasure, Murray said. Even today, "social interaction is vital for us," he said.

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Israeli expertise in ritual helps Africa combat AIDS

Docs trained in adult male circumcisions

By Joel Greenberg,Chicago Tribune,July 8, 2008

JERUSALEM — Inon Schenker, an AIDS prevention specialist, pulled out a medical logbook from a shelf and opened it to a page filled with handwritten entries.
The notations, from 1993, recorded ritual circumcisions performed on Jewish men from the former Soviet Union at the height of the wave of Immigration to Israel from Russia and neighboring republics.
The entries showed 32 circumcisions by a single doctor in a day’s work, an assembly-line rate that Schenker believes shows the potential in Israel for helping combat AIDS in Africa, where recent studies have shown male circumcision to be a significant protective measure against the disease.
In the heyday of Russian Immigration to Israel in the 1990s, about 1,000 adult male circumcisions a month were performed on newcomers in hospitals and clinics, in accordance with Jewish law.
“Israel is the only country with such experience in mass adult-male circumcision, and it can respond to a very important humanitarian challenge,” said Schenker, director of Operation Abraham, a project launched last year that dispatched Israeli surgeons to teach circumcision in Africa.

Israel’s experience vital

Because it is obligatory under Jewish law, male circumcision is nearly universal in Israel and was stepped up as immigrants from the former Soviet republics sought the procedure to affirm their Judaism and ease their integration in the Jewish state.
The ancient practice is mentioned in the Bible in a passage that describes how the patriarch Abraham circumcised his son at God’s command.
Jewish circumcision ordinarily is performed on newborns, but many of the immigrants hadn’t been circumcised in their countries of origin for various reasons, such as estrangement from Judaism, restrictions on religious rites in the Soviet era and pressure to assimilate in gentile society.
As the Russian immigrants flooded into Israel—about 1 million since 1989—the demand for adult circumcisions surged, and the country became a world leader in the field, with more than 80,000 procedures performed, according to various estimates.
Schenker, who is with the Jerusalem AIDS Project, a non-governmental group that promotes HIV prevention, is working to marry the experience accumulated in Israel with the urgent need in Africa for effective programs to fight the AIDS epidemic.

50% reduction in risk

A link between circumcision and AIDS prevention was shown in three studies conducted between 2004 and 2006 in South Africa, Uganda and Kenya, which found that the risk of contracting AIDS in heterosexual sex is 50 percent to 60 percent less among men who are circumcised.
The findings led the World Health Organization last year to recommend circumcision as an additional method for prevention of AIDS. WHO’s recommendations were endorsed at a gathering of African health ministers.
With the support of the Hadassah Medical Organization, which runs Israel’s main university hospital in Jerusalem and has provided most of the budget and equipment, the Jerusalem AIDS Project sent three delegations of surgeons to teach adult circumcision in Swaziland. The southern African nation has the highest prevalence of AIDS in the world — 26 percent in a population of about 1 million.
“This is part of Hadassah’s mission: outreach to other places,” said Dr. Shlomo Mor-Yosef, director general of the organization.
The Israeli surgeons visited Swaziland twice last year and again in February, training 10 local doctors in adult male circumcision and two others in the procedure on newborns. The Israeli teams included an Israeli Arab doctor with experience in Muslim ritual circumcision.
Prudence Mkhatshwa, chief nurse in male circumcision at the Family Life Association of Swaziland, a non-governmental group that partnered with the Israelis, said the training had helped to significantly raise the weekly rate of adult circumcisions and that the public response is growing. The procedure, conducted under local anesthesia, was first offered in Swaziland in 2006.
“Before, people were scared, but now they see the benefits and they are more willing to do it,” Mkhatshwa said from Mbabane, the Swazi capital. She said street billboards are promoting circumcision, in addition to condom use and abstention from casual sex, as methods of preventing AIDS.
Dr. Eitan Gross, a pediatric surgeon from Hadassah who served as the project’s medical director, said that working with the Swazi doctors and nurses was a “moving experience.” “You had a sense that you were doing something groundbreaking, and they were very grateful,” Gross said.

jogreenberg@tribune.com

Copyright © 2008, Chicago Tribune

Science Daily, September 24, 2007 — Researchers in California are reporting new evidence explaining pomegranate juice’s mysterious beneficial effects in fighting prostate cancer.

Juice from the pomegranate shows promise for fighting prostate cancer. (Credit: USDA Agricultural Research Service)
In a new study, Navindra Seeram and colleagues have found that the tart, trendy beverage also uses a search-and-destroy strategy to target prostate cancer cells.

In previous research, Seeram’s group found that pomegranate juice consumption had a beneficial effect for prostate cancer patients with rising prostate-specific antigen (PSA) levels. Such increases in PSA signal that the cancer is progressing, “doubling time” a key indicator of prognosis. Men whose PSA levels double in a short period are more likely to die from their cancer. Pomegranate juice increased doubling times by almost fourfold.

In the new study, they researchers discovered evidence in laboratory experiments that pomegranate works in a “seek and destroy” fashion. On consumption, ellagitannins (ET), antioxidants abundant in pomegranate juice, break down to metabolites known as urolithins. The researchers showed that the urolithins concentrate at high levels in prostate tissue after being given orally and by injection to mice with prostate cancer. They also showed that urolithins inhibited the growth of human prostate cancer cells in cell culture.

“The chemopreventive potential of pomegranate ellagitannins and localization of their bioactive metabolites in mouse prostate tissue suggest that pomegranate may play a role in prostate cancer treatment and chemoprevention,” the researchers state, recommending further clinical studies with pomegranate and prostate cancer patients.

This research, “Pomegranate Ellagitannin-Derived Metabolites Inhibit Prostate Cancer Growth and Localize to the Mouse Prostate Gland,” is scheduled for publication in the Sept. 19 issue of ACS’ Journal of Agricultural and Food Chemistry.

Note: This story has been adapted from a news release issued by American Chemical Society.

Source:http://www.sciencedaily.com/releases/2007/09/070924095856.htm

Prostate Cancer Treatment Can Speed Heart Attacks

Hormome-suppressing therapy linked to cardiac risk in study.

By Ed Edelson
HealthDay Reporter

FRIDAY, June 8 (HealthDay News) — The male hormone-suppressing treatment used against aggressive prostate cancer may help bring on earlier heart attacks in older men, new research suggests.

“The new finding is that in men who have risk factors for heart attack, even six months of androgen-suppression therapy [and] maybe as little as three months, can cause a heart attack to occur sooner by about 2.5 years,” said lead researcher Dr. Anthony D’Amico, chief of genitourinary radiation oncology at the Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston.

That finding, which comes from analysis of pooled data of studies in the United States, Australia and New Zealand, does not mean that such men should not be treated to suppress the activity of androgens — male sex hormones that spur the growth of prostate cancer cells, D’Amico said.

Instead, “the implication is that a man who needs hormonal therapy to avoid dying from cancer but also has risk factors for heart attack should be sent to a cardiologist for assessment and possible treatment of heart disease before starting hormonal therapy,” he said.

“We’re doing that,” D’Amico said. He noted that, “of about 50 men we referred in the last six months, five or six had significant coronary artery disease. They have had it treated and have gone through hormonal therapy without being affected.”

The findings are published in the June 10 issue of the Journal of Clinical Oncology.

Androgen suppression therapy (AST), as it is formally called, is reserved for men whose cancer is believed to have spread beyond the prostate or who have an aggressive form that is believed to have spread — something that occurs in perhaps 40 percent of cases, D’Amico said. “You give these drugs to starve the prostate cancer, and it dies,” he said.

Other side effects of AST are well-known. It can cause anemia, increase body fat, reduce muscle and cause an increase in harmful LDL (“bad”) cholesterol and a decrease in helpful HDL (“good”) cholesterol. But AST is also widely used, because it extends prostate cancer survival.

The new information on the treatment’s adverse cardiac effects comes from analysis of data from 1,372 men who received radiation treatment plus AST in three randomized trials and who were followed for at least five years.

A faster onset of heart attacks was observed in men over 65 who got AST for six months, the researchers found.

“This is one more reason to be careful when you recommend hormone therapy,” said Dr. Eric M. Horwitz, clinical director of radiation oncology at Fox Chase Cancer Center in Philadelphia. “They do have cardiac side effects.”

But AST will continue to be used in many cases, he added. “There is clearly a group of men where the benefits outweigh the risks,” he said. “This study shows that you have to weigh the pros and cons of the treatment, who gets benefits and who doesn’t.”

Men who benefit most are those with “aggressive, bulky prostate cancers,” according to Horwitz. “The benefits for them still outweigh the risk in terms of trying to cure the cancer. For men with less aggressive, less bulky cancers, you have to weigh the benefits versus the risks.”

Other efforts to get the best effect from AST while minimizing the damage are under way, D’Amico said. One method under study is to stop the treatment now and then. “For advanced prostate cancer, we don’t expect to keep the treatment going forever,” he said. “You can make it intermittent to get the same survival with less toxicity — six months on and six months off,” he said.

Also, some studies indicate that a shorter course of AST can be effective with fewer side effects — at least for some patients, D’Amico said. “We need to be better at selecting men for therapy and directing its course,” he said.

More information

A guide to prostate cancer is offered by the American Cancer Society.

(SOURCES: Anthony D’Amico, M.D., chief, genitourinary radiation oncology, Dana-Farber Cancer Institute, Boston; Eric M. Horwitz, M.D., clinical director, radiation oncology, Fox Chase Cancer Center, Philadelphia; June 10, 2007, Journal of Clinical Oncology)

Copyright © 2007 ScoutNews, LLC. All rights reserved.

A new blood test for prostate cancer, currently being tested, could one day revolutionize the way the disease is diagnosed and treated.

By Anne Underwood, Newsweek, April 26, 2007

April 26, 2007 – Prostate cancer is the second leading cancer killer among men, after lung cancer. The American Cancer Society projects that in 2007 there will be 219,000 new cases and 27,000 deaths. Yet detecting the disease early has always been problematic. The only blood test available now—a test for prostate-specific antigen (PSA)—is not good at distinguishing malignancies from benign prostate enlargement (BPH). And it’s useless for separating aggressive cancers from others that are so slow-growing they will likely never cause problems.

But a new blood test, described this week in the journal Urology, could change all that. In a study of 385 men, the new test was able to distinguish BPH from prostate cancer, and it pinpointed men who were healthy, even when their PSA levels were higher than normal. It also did the reverse—singling out men with cancer, even when their PSA levels were low. It may also distinguish cancer confined to the prostate from cancer that has spread beyond the gland. And it has the potential to dramatically reduce the number of biopsies performed every year. More trials are required, but if they’re as promising as this initial study, the new test could reach the market in two to three years.NEWSWEEK’s Anne Underwood spoke with the study’s senior author, Dr. Robert Getzenberg, director of urology research at Johns Hopkins University School of Medicine. Excerpts:

NEWSWEEK: Why is the PSA test so problematic?
GETZENBERG: In the 25 years we’ve been using it, the PSA test has changed the face of prostate-cancer treatment. When I started in this field, half of patients had their cancer detected when it had already spread outside the prostate. Today we’re finding cancer earlier, which is reducing mortality. But the test is problematic because PSA itself is not related to cancer. It’s a protease [an enzyme that chops up proteins]. It’s made by the prostate to keep the consistency of the ejaculate right, which is important. PSA may also protect against viral or bacterial invasions. But the prostate gland with cancer doesn’t make any more PSA than the normal prostate. The levels are elevated because the PSA is not going into the ejaculate where it’s supposed to go. Instead, it’s going into the bloodstream, because cancer makes the prostate gland more leaky.

How is your test different?
It’s a test for a structural protein found only in the nucleus of prostate-cancer cells, called early prostate cancer antigen-2, or EPCA-2. We don’t know its exact function, but it’s not expressed at all in normal cells. We think it gets into the blood through cell breakdown. Once it gets into the blood, it’s very stable and hangs around a long time.

Does the level in the blood vary with the severity of the condition?
There are clear differences in levels between men who are healthy, those with BPH, those with cancer that’s confined to the prostate and others whose cancer that has spread.

You studied men before and after prostate surgery. How did the levels change after surgery?
On average, six months later, the levels were at zero. Whatever caused the elevated EPCA-2 was removed.

How reliable is the test? Did you get any false positives?
About 3 percent of the time, when the test was positive, there was no prostate cancer there. In 6 percent of cases, there were false negatives [meaning the test came out negative but the patient did have cancer].

Still, that’s much better than the situation today, where men with elevated PSA levels go for biopsies, which 80 percent of the time turn out negative.
An estimated 1.3 million to 1.6 million men undergo biopsies every year to identify the 230,000 or so patients with cancer. We’re clearly over-biopsying.

And unless you stick the biopsy needle right into the tumor site—in other words, if you hit a part of the prostate without cancer—the biopsy will come out negative.
Doctors use ultrasound to guide the needle, but many lesions aren’t visible by ultrasound. Often, they’re very small. That’s why doctors perform 12 core biopsies per patient—that means 12 needles. Some do 18 or more. You’re looking for the equivalent of microscopic lesions inside a peach. Sometimes you hit it, sometimes you don’t.

I never realized it before, but that means biopsying for breast cancer is easier. You start with a mammogram that shows the precise location of the suspicious lump.
Breast cancer lesions are typically bigger and easier to visualize on imaging. They are sometimes multifocal [found in multiple locations], but not as frequently. In prostate cancer, on average, you have five to six lesions. The prostate is also less accessible.

So if future trials go as well as this one, the EPCA-2 test could potentially revolutionize prostate care.
It will be the tool for identifying men with prostate cancer and separating them from others with BPH and prostatitis [inflammation or infection of the prostate]. It will identify the group that needs aggressive therapy from those who can use watchful waiting. Now, because we don’t know which cancers are aggressive and which are indolent, we’re over-treating some patients and under-treating others.

Do you see this test being used in conjunction with the PSA test?
Initially, yes. There’s lots of work to do before we’re ready to throw out the PSA. Eventually, if doctors find that the PSA test doesn’t add much, they may decide they want to use EPCA-2 alone.

Do you foresee every man over 40 getting this test one day?
Yes, there’s a window when cancers are curable. You want to catch them early. I would say men should start in their 40s, because that would establish the baseline, the normal level. How it changes over time is instrumental.

How exciting is this?
We’ve had the data for more than a year. We’ve been going over every aspect of it again and again, because it’s almost too good for us to believe

URL: http://www.msnbc.msn.com/id/18328032/site/newsweek/from/RS.1/

International experts have backed the use of male circumcision in the prevention of HIV.

BBC News, March 28, 2007

The World Health Organization and UNAIDS said circumcision should be added to current interventions to reduce the spread of HIV.

Three African trials have shown that circumcision halved the rate of HIV infection in heterosexual men.

The recommendations largely apply to countries where rates of heterosexual transmission is high.

Experts warned that greater use of circumcision would not replace the need for other prevention methods, such as condoms.

But modelling studies have shown that if male circumcision was more widely available, millions of lives, particularly in sub-Saharan Africa would be saved.

WHO and UNAIDS said access to the procedure should be urgently scaled up in areas with high rates of heterosexual infection and low rates of male circumcision.

But warned that it was an additional intervention and would not replace programmes providing HIV testing, or prevention or treatment for sexually infected infections.

Men and their partners must also be given counselling to prevent them developing a false sense of security, they said.

Training and monitoring must be done to check circumcision is being done by appropriate health professionals in a sanitary environment with proper equipment.

And they stressed there was no evidence yet as to whether circumcision has any impact on the risk of infection for the woman or on the risk among men who have sex with other men.

Significant step

Kevin De Cock, director of HIV/AIDS at the World Health Organization said: “The recommendations represent a significant step forward in HIV prevention.”

“Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men.”

However, he said it would be years before the impact on the epidemic would be apparent.

Catherine Hankins, UNAIDS, said: “Being able to recommend an additional HIV prevention method is a significant step towards getting ahead of this epidemic.

“However, we must be clear: male circumcision does not provide complete protection against HIV.

“Men and women who consider male circumcision as an HIV preventive method must continue to use other forms of protection such as male and female condoms, delaying sexual debut and reducing the number of sexual partners.”

All three African trials were stopped early because the results were so dramatic – with reduced rates of new HIV infections of 48-60%.

There are several reasons why circumcision may protect against HIV infection.

Specific cells in the foreskin may be potential targets for HIV infection and also the skin under the foreskin becomes less sensitive and is less likely to bleed reducing risk of infection following circumcision.

When Aids first began to emerge in Africa, researchers noted that men who were circumcised seemed to be less at risk of infection but it was unclear whether this was due to differences in sexual behaviour.

Deborah Jack, chief executive of the National AIDS Trust, said: “These recommendations address many of the benefits of including male circumcision in a comprehensive HIV prevention package.

She added: “Additional research to determine the health impact for women and men who have sex with men is vital, as is ensuring that adequate resources are provided to fund existing prevention methods, as well as continue research into new technologies such as microbicides and vaccines.”

Story from BBC NEWS:

http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6502855.stm

Published: 2007/03/28 12:11:43 GMT

Court grants parents the right to impregnate stranger

with son’s sperm

JERUSALEM – In a precedent-setting decision, an Israeli court has ruled that a dead soldier’s family can use his sperm to impregnate a woman he never met.

Keivan Cohen, 20, was shot dead in 2002 by a Palestinian sniper in the Gaza Strip. He was single and left no will. But at the urging of his parents, a sample of his sperm was taken two hours after his death and has been stored in a hospital since.

When the family tried to gain access to the sperm, however, the hospital refused, on the ground that only a spouse could make such a request. Arguing that their son yearned to raise a family, his parents challenged that decision in court. And on Jan. 15, after a four-year legal battle, a Tel Aviv court granted the family’s wish and ruled that the sperm could be injected into a woman selected by Cohen’s family.

The ruling also ordered the Ministry of Interior to register any children born as a result of the insemination as children of the deceased.

“On the one hand I’m terribly sad that I don’t have my boy; it’s a terrible loss,” Rachel Cohen said in an interview in Monday’s Chicago Tribune. “But I’m also happy that I succeeded in carrying out my son’s will.”

Cohen did not return phone calls from The Associated Press.

Precedent-setting decision
Irit Rosenblum, a family rights advocate who represented the Cohen family, said the ruling was significant because it set a precedent for those seeking to continue bloodlines after death.

At the trial, Rosenblum presented testimony, including video recordings, in which Cohen expressed his desire to have children.

“He always said he wanted children,” she told The Associated Press. “But there were no regulations in the law that deals with using sperm from dead people.”

Rosenblum said soldiers increasingly have been leaving sperm samples, or explicit instructions on post-mortem extraction, before heading to battle.

She said she knew of more than 100 cases of Israeli soldiers who, before last summer’s war with Lebanese guerillas, asked to have their sperm saved if they were killed. American soldiers have also begun donating sperm before heading to Iraq, she said.

“I think it is a human revolution,” Rosenblum said. “Ten years ago, who would believe that a human being can continue after he has died. I think it is great for humanity.”

Rosenblum said the woman who is to act as surrogate mother has requested to remain anonymous.

“She’s like family to us,” Rachel Cohen told the Tribune. “Cruel and good fate brought us together.”

25-year study finds substantial benefit to controversial procedure

Circumcised males are less likely than their uncircumcised peers to acquire a sexually transmitted infection, the findings of a 25-year study suggest.

According to the report in the November issue of Pediatrics, circumcision may reduce the risk of acquiring and spreading such infections by up to 50 percent, which suggests “substantial benefits” for routine neonatal circumcision.

The current study is just one of many that have looked at this controversial topic. While most research has found that circumcision reduces the rates of HIV (the virus that causes AIDS), syphilis and genital ulcers, the results are more mixed for other STDs.

The American Academy of Pediatrics has called the evidence “complex and conflicting,” and therefore concludes that, at present, the evidence is insufficient to support routine neonatal circumcision.

In the current study, the researchers analyzed data collected for the Christchurch Health and Development Study, which included a large birth cohort of children from New Zealand. Males were divided into two groups based on circumcision status before 15 years of age. The presence of a sexually transmitted infection between 18 and 25 years of age was determined by questionnaire.

The 356 uncircumcised boys had a 2.66-fold increased risk of sexually transmitted infection compared with the 154 circumcised boys, lead author Dr. David M. Fergusson and colleagues, from the Christchurch School of Medicine and Health Sciences report.

Moreover, this elevated risk was largely unchanged after accounting for potential confounders, such as number of sexual partners and unprotected sex.

The authors estimate that had routine neonatal circumcision been in place, the rate of sexually transmitted infections in the current cohort would have been reduced by roughly 48 percent.

This analysis shows that the benefits of circumcision for reducing the risk of sexually transmitted infection “may be substantial,” the authors conclude. “The public health issues raised by these findings clearly involve weighing the longer-term benefits of routine neonatal circumcision in terms of reducing risks of infection within the population, against the perceived costs of the procedure,” they add.

URL: http://www.msnbc.msn.com/id/15593753/

By Shmuel Shapira, Israel 21C, October 29, 2006

Shmuel Shapira  is a professor, Hadassah University Hospital Deputy Director General and Director of Hebrew University-Hadassah School of Public Health

Israel has been always in the front of world clinical medicine, medical sciences and biotechnology. And in the last five years major promising scientific contributions have originated from different Israeli hospitals and faculties of medicine which are having worldwide implications. Here are just a few of the highlights which my medical and scientific colleagues at Israeli hospitals and research centers have been part of:

Ovarian tissue transplant
In a breakthrough that provides hope for woman undergoing chemotherapy during their fertile years, for the first time in the world, a cancer patient who had become sterile due to anti cancer chemotherapy treatment gave birth after undergoing a transplant of ovarian tissue. The ovarian slices had been taken from her body prior to initiation of chemotherapy treatment and preserved by freezing them.

Behind the stunning medical advance were Dr. Dror Meirow, Prof. Jehoshua Dor, and Dr. Jacob Levron of the IVF Fertility Unit at Sheba Medical Center. The global breakthrough was reported in The New England Journal of Medicine in 2005.

Human embryonic stem cells
Research in human embryonic stem cells is a rapidly developing and promising scientific field. These cells are in high demand because of their ability to reproduce almost infinitely and to differentiate into diverse tissues. The demand for cardiac and nerve cells production is crucial because damaged nerve and muscle cells do not regenerate following disease or injury.

In 2001, Drs Benjamin Reubinoff, Tamir Ben-Hur and their group from Hadassah Hebrew University Medical Center described in Nature Biotechnology Journal the derivation of neural progenitor cells from human embryonic stem cells. This is a significant stage in the study of early human development of neurons (nerve cells) and in the creation of an unlimited source of donor cells for neural transplantation therapy.

When human early nerve cells were transplanted into the brains of newborn mice, they had demonstrated wide distribution and differentiation in the recipient mice brain. These observations set the stage for future developments that may allow the use of human embryonic stem cells for the treatment of different neurological disorders and central nervous system trauma.

Umbilical cord stem cells
Israeli researchers are also at the forefront of research which could one day make heart transplants obsolete. Using stem cell technology, they’re developing a way to use the blood of a newborn baby’s discarded umbilical cord as an unlimited source of stem/progenitor cells that could be injected into the injured heart in order to regenerate damaged heart tissue.

Stem-cell based therapy has also emerged as a novel strategy to repair myocardial damage. In a breakthrough approach for regeneration of dead heart cells, Professors Jonathan Leor and Arnon Nagler at the Sheba Medical Center performed a pilot study to demonstrate the safety and feasibility of intracoronary delivery of umbilical cord blood ‘ progenitor cells into the infarcted myocardium of pigs, and to track cell migration and colonization.

Another group at Sheba led by Dr Sarah Ferber successfully modified liver cells to produce insulin. This may be a future method to cope with the so common and devastating disease; insulin dependent diabetes.

Stroke treatment
A collaboration between Hadassah University Hospital and the University of Pennsylvania found a safer way to benefit from the use of the potent drug -tissue-type plasminogen activator (tPA) for stroke while abolishing its serious side effects. This drug?s desired effect is fibrinolysis (liquefying blood clots) in the brain blood vessels and enabling better blood flow. These clots are the most common cause of stroke which is associated with high mortality and morbidity.

Until now, severe side effects brought on by tPA have limited its use. The research group found certain protein decreasea the neurotoxic effects of tPA while preserving its fibrinolytic qualities. This promising study for the management of patients suffering from ischemic stroke was published this year in the prestigious journal Nature Neuroscience.

Fetal well-being
Another pioneering work from Hadassah-Hebrew University Medical School offers a promise for the well being of pregnant woman and theirs fetuses and an optional remedy for other common gynecological disorders. A group led by Drs. Hanna, Yagel and Mandelbaum demonstrated the role played by decidual (part of the placenta) Natural Killers (dNK) at the human fetal maternal interface.

These unique cells play a role in the penetration of the early fetal cells into the uterine bed, and for the proliferation of blood vessels in the placenta. These DNK cells may also play an important role in the delicate fetal-maternal immunologic interaction. Advances based on the Hadassah study may enhance the understanding of preeclampsia (early toxicity of pregnancy), gynecological breakthrough bleeding, endometriosis (uterine tissues implanted in abnormal locations) and recurrent miscarriages. This pioneering study was published in Nature Medicine this year.

Hepatitis C prevention
An important contribution to preventive medicine was developed by a group lead by Dr Arieh Yaari at Soroka University Medical Center in Beersheva. This group described in the Journal of Medical Virology a novel saliva test for the early detection of hepatitis C.

The hepatitis C virus infects more than 170 million people around the world; 70% of these will develop severe side effects such as cirrhosis, liver failure and cancer of the liver.

This new saliva test will gradually replace the traditional blood test, and the much simpler and less resource demanding method will enhance mass screening resulting in improved containment of the disease and early treatment to prevent life threatening complications.

While years of war and terror have made Israel a world center of excellence for terror medicine and war surgery, they are fields that originated from critical necessities. That at the same time, the Israel medical community has developed the capabilities of being at the cutting edge of international biomedical research is indeed a great achievement.

Source:http://www.israel21c.com/bin/en.jsp?enDispWho=Views%5El268&enPage=BlankPage&enDisplay=view&enDispWhat=object&enVersion=0&enZone=Views&