7 Amazing Juice Diet Recipes For Weight Loss. {Infographic}

If you find it difficult to eat your salads raw and are choosy based on what appeals to your taste buds, then why not consider putting them in a blender and giving it a whirl??

Add in a dash of salt organic sugar, and spices and voila….you start consuming a combination of healthy foods that now taste delicious together !!

Here are 7 simple yet yummy juice recipes to boost your weight loss regime:

juicing recipes for weight loss infographic

Rosetta Spacecraft’s Comet Water Discovery: What It Means for Earth

Where did Earth’s water come from? Comets? Asteroids?

New data from the Rosetta spacecraft exploring Comet 67P/Churyumov-Gerasimenko show that comets — once thought responsible for seeding Earth with water — might not have delivered most of the planet’s water after all. The new finding is giving scientists a more nuanced view of the solar system and its plethora of cosmic bodies.

An instrument called ROSINA on the European Space Agency’s Rosetta has found that the molecular makeup of the water on Comet 67P/C-G is very different from the water found in Earth’s oceans. This deuterium-to-hydrogen ratio throws a hitch into the theory that comets from Comet 67P/C-G’s region of space brought water to the Earth not long after the solar system formed, Kathrin Altwegg, principal investigator for ROSINA, said.

Comet 67P on Dec 1, 2014
If even a small number of comets like 67P/C-G impacted Earth in the early days of the solar system, it still would have greatly changed the molecular composition of the planet’s water today, according to Altwegg. Therefore, it seems unlikely that these kinds of comets brought water to Earth. Altwegg thinks it’s more probable that asteroids brought water to Earth.

“We knew that Rosetta’s in situ analysis of this comet was always going to throw up surprises for the bigger picture of solar system science, and this outstanding observation certainly adds fuel to the debate about the origin of Earth’s water,” Matt Taylor, ESA’s Rosetta project scientist, said in a statement.

While asteroids are dry, rocky bodies now, it’s possible that these space rocks were water-rich during the early days of the solar system. Altwegg thinks that asteroids may have bombarded the Earth about 800 million years after the formation of the solar system, bringing water to the early planet once it cooled after formation.

This European Space Agency graphic details the Rosetta spacecraft’s first measurements of the water on Comet 67P/Churyumov-Gerasimenko, which scientists say is surprisingly very different than the water found on Earth.
Pin It This European Space Agency graphic details the Rosetta spacecraft’s first measurements of the water on Comet 67P/Churyumov-Gerasimenko, which scientists say is surprisingly very different than the water found on Earth.
Credit: ESA/ATG medialab, ESA/Rosetta/NavCam, Altwegg et al. 2014View full size image
Scientists have measured the D to H ratio in meteorites from asteroids and found that the water content in these tiny samples is comparable to Earth’s water composition, Altwegg said.

Thanks to Rosetta, scientists now think that Kuiper Belt comets — found orbiting the sun beyond Neptune — are much more diverse than expected. In other words, not all comets are the same.

Although Comet 67P/C-G has a 6.5-year orbit that brings it near Jupiter, researchers still think that it originated in the Kuiper Belt.

Scientists measured the comet Hartley 2’s D to H ratio in 2011 and found that it was very close to that of Earth’s, leading scientists to conclude that comets like Hartley 2 (a Kuiper Belt comet) may have delivered water to the early planet. But because the ratio for Comet 67P/C-G is so off, it doesn’t seem like the comets from the Kuiper Belt could have seeded the planet with water.

Comet 67P/C-G’s D to H ratio is much higher than even comets found in the Oort Cloud, an icy mass of cosmic bodies on the outskirts of the sun’s influence. Comets in the Oort Cloud were ruled out as possible water deliverers long ago because of their different ratio.

“This surprising finding could indicate a diverse origin for the Jupiter-family comets — perhaps they formed over a wider range of distances in the young solar system than we previously thought,” Altwegg said. “Our finding also rules out the idea that Jupiter-family comets contain solely Earth oceanlike water, and adds weight to models that place more emphasis on asteroids as the main delivery mechanism for Earth’s oceans.”

NASA Admits To Chemtrails As They Propose Spraying Stratospheric Aerosols Into Earths Atmosphere

It’s really amazing how many people are waking up to the fact that “chemtrails” are different from “con-trails.” What was once considered a conspiracy to many is now a fact, chemicals are constantly sprayed into our atmosphere and have been for quite some time now. Not long ago, NASA personnel gave a lecture (that was also streamed live) at their Jet Propulsion Laboratory at the California Institute of Technology.

It was a series of talks by scientists and engineers exploring the topic of Geoengineering and Climate Intervention. (1) Some of you might be thinking, “Geoengineering, what is that?” Geoengineering encompasses strategies to combat and reduce the effects of global warming and climate change. It’s the deliberate and large-scale intervention in the Earth’s climatic system, and one of these methods, as illustrated in the lecture, is called Solar Radiation Management (SRM) by spraying stratospheric aerosols into the atmosphere. (1) The lecture outlines how SRM would require the equivalent of airplanes spraying aerosols into our atmosphere for decades. You can see this at approximately the 32 minute mark. It seems it’s already happening. These programs are also considering spraying Aluminum into the atmosphere (if not already doing it).

“There might be some good reasons to think about aluminum. Aluminum has four times the volumetric rate for small particles as does sulphur. That means you have roughly 16 times less the coagulation rate, and that’s the thing that really drives removal.” – David Keith, Canadian Environmental Scientists, Professor of Applied Physics at Gordon McKay, Professor of Public policy, Harvard University, President of Carbon Engineering. (2) The idea of spraying aluminum into our atmosphere goes way back, patents exist that clearly demonstrate the consideration of such materials that include the oxides of metals which have high emissivity. These include harmful substances like aluminum oxide and thorium oxide. A great patent example is one from the Hughes Aircraft Company that dates all the way back to 1990, that’s over twenty years ago. You can take a look at it here. “We do stuff in the stratosphere all the time off-course, so it’s not as though the stratosphere is absolutely pristine. But you don’t want to have people going off and doing things that involve large radioactive forgings, or programs that go on for extended periods or for that matter provide lots of reactive surfaces that could result in significant ozone destruction.” – M. Granger Morgan, Carnegie Mellon University, University and Lord Chair Professor of Engineering and Public Policy, National Academy of Sciences Member (2) Did you know that “they” do stuff in the atmosphere all the time? Is he referring to the Department of Defense? These programs are indeed backed by agencies like the CIA and NASA, they support the National Academy of Sciences with regards to geoengineering projects, and still do till this day. (3) (4) Why are Defense Intelligence Agencies in control?

Is this a national security issue? If so, that means happenings with regards to geoengineering might remain classified. Below is a visual I used from a previous article to give you a good idea about SRM. If you are a constant observer of the skies, as I am, it’s not hard to see that something is already going on. This has been voiced by various individuals from all over the world. For example, Rosalind Peterson, president and Co-Founder of the Agriculture Defense Coalition (ADC), and x United States Department of Agriculture (USDA) employee stated at a 2007 United Nations hearing on global warming that: “One of the things that’s affected by climate change is agriculture, but some of what we are seeing is man made, but man made in a different way than what you may guess. Weather modification programs, experimental ones done by private companies, the US government, are underway and there are more than 50 operations underway across the United States.

NASA Admits To Chemtrails As They Propose Spraying Stratospheric Aerosols Into Earths Atmosphere

All of these impact agriculture because they change the micro-climates needed for agriculture to survive. None of these programs are done with oversight. International corporations are modifying our weather all the time, and modifying it in ways that cover thousands and thousands of square miles. Most of it is chemically altered, so what happens is that we are putting ground based chemicals that are shot into the air that change and modify our weather.” You can read more, and view that full hearing here. A former premier of British Columbia felt so strong about the issue that he sent out a letter across Canada to multiple politicians voicing his concern. You can read more about that here. Neurosurgeon Russel L. Blaylock made some noise about health concerns as a result of nanoaluminum spraying, you can read about that here.

Anybody who looks out their window on a bright day and watches these trails will notice them spread out and expand until the sky is covered with them. Contrails don’t do that. There is plenty of evidence to suggest that these geonengineering techniques have already begun, and were initiated a long time ago. As far as global warming goes, that’s another controversial topic. There is no doubt climate change is occurring, but why and how is still not well understood. Is ‘global warming’ just a justification for geoengineering? Is geoengineering a cover for alternative agendas we don’t know about? These are important questions. No doubt that human activity has played a large role in the destruction of our environment.

watch the video. URL: https://www.youtube.com/watch?v=mEfJO0-cTis

2014 Top Stories in Cardiology: Heart Failure and Transplantation

The top development in heart failure in 2014 was the release of the PARADIGM-HF clinical trial results, which will lead to a change in our current practice guidelines for treating patients with heart failure with a reduced ejection fraction (HFrEF). PARADIGM-HF compared LCZ696 (a combined neprilysin inhibitor and angiotensin receptor blocker) and enalapril in patients with NYHA class II, III, or IV symptoms with HFrEF. Results showed that treatment with LCZ696 led to a 20% reduction in death from cardiovascular causes or hospitalization for heart failure when compared with enalapril. The beneficial effects of LCZ696 on cardiovascular death or heart failure hospitalization were seen in most of the subgroups who were examined, with the notable exceptions of black patients and patients with ejection fractions >35%. One subgroup who will require additional investigation is NYHA class IV patients, who only comprised 0.6% to 0.8% of the PARADIGM-HF patient cohort.

PARADIGM-HF is important to the field of heart failure for three reasons.

  1. The first is that this is the first new drug to be developed in heart failure since BiDil was approved by the FDA in 2005 for a narrow heart failure indication.
  2. The second is that LCZ696 has the potential to replace ACE inhibitors as a main therapy in the treatment of patients with HFrEF, and will thus be important for clinicians who care for heart failure patients.
  3. Lastly, the results of this study will open up numerous investigations regarding the mechanism of action of the neprilysin inhibitor in LCZ696, which may inhibit the breakdown of natriuretic peptides, adrenomedullin, and bradykinin. Thus, PARADIGM-HF may lead to new insights into the pathophysiology of heart failure.

LCZ696 is not yet approved by the FDA for the treatment of patients with heart failure; therefore, this study will not change the practice patterns of clinicians today. However, pending FDA approval, this drug will likely change the standards of care for patients with HFrEF. This statement notwithstanding, LCZ696 is likely to be priced considerably higher than generic ACE inhibitors. Accordingly, it will be also interesting to see a pharmaco-economic analysis of the PARADIGM-HF trial results.

2014 Top Stories in Cardiology: Cardiac Imaging

In assembling the top stories of 2014 in the field of cardiac imaging, we have focused on the major modalities of noninvasive imaging—echocardiography, nuclear cardiology, cardiac magnetic resonance imaging (CMR), and cardiac computed tomographic (CCT) imaging.


The management of patients with severe mitral regurgitation due to myxomatous degeneration of the valve, particularly if asymptomatic, remains vexing. Naji and colleagues1 reported on exercise echocardiographic and clinical data in almost 900 patients with myxomatous mitral regurgitation, the majority of whom were asymptomatic. Patients were followed for a composite outcome for an average of over 6 years. Significant predictors of adverse outcomes included percent of age-/sex-predicted metabolic equivalents, heart rate recovery, resting right ventricular systolic pressure, atrial fibrillation, and LV ejection fraction. The importance of this paper lies not only in the large population with long-term follow-up, but also with the incorporation of exercise parameters into the usual clinical data, which had not been done before in such a large population. In the absence of randomized trials addressing timing of mitral valve surgery for asymptomatic severe mitral regurgitation, which are unlikely to be performed, this type of observational data set will inform guidelines and practice patterns.

Nuclear Cardiology

Almost 10 years ago, the American College of Cardiology published the first of a series of papers on the appropriate use of medical testing, originally called “Appropriateness Criteria,” now referred to as “Appropriate Use Criteria” (AUC). The goal of these recommendations is to optimize the efficiency and value of cardiac testing, based as much as possible on the published literature but also incorporating critical expert opinion. Recommendations are grouped by common clinical indications, and are categorized as “appropriate,” “may be appropriate” (formerly “uncertain”), or “rarely appropriate” (formerly “inappropriate”). Studies categorized as rarely appropriate are generally thought to be low-yield, in low-risk populations as an example. While AUC documents have been published for all common cardiac imaging tests and also for disease states such as stable ischemic heart disease or heart failure, there exists almost no literature validating the AUC categories in a prospective way against clinical outcomes. In this important paper, Doukky and colleagues2 report on over 1500 outpatients who were clinically referred for SPECT myocardial perfusion imaging. The studies were classified based on the 2009 AUC for SPECT myocardial perfusion imaging into two categories as appropriate/uncertain or as inappropriate. Patients were followed for an average of over 2 years for adverse events. Among the studies categorized as being of appropriate/uncertain indication, the SPECT results showed the usual prognostic value, in that an abnormal study was associated with a higher risk for adverse events compared with a normal study. However, among the SPECT studies characterized as inappropriate, there was not demonstrable prognostic association. To some degree, this was a result of the very low event rate among those with inappropriate studies, in turn related to the very low prevalence of abnormal studies. Nonetheless, these data are the first to examine the AUC recommendations in terms of association with outcomes, and validate the recommendations of the AUC documents. The importance of this paper lies in the fact that, within the next few years, payors including CMS will be mandating incorporation of AUC into the stream of test-ordering behavior. Having well-validated criteria is a critical element in the widespread acceptance of this approach.

Cardiac MR Imaging

Several relatively small studies have suggested that the presence and/or extent of late gadolinium hyperenhancement (LGE) on CMR imaging in patients with hypertrophic cardiomyopathy is associated with the risk for adverse events or with markers of adverse events. In this largest study to date,3 the authors assembled almost 1300 patients with hypertrophic cardiomyopathy from several centers around the world who had CMR imaging and were followed for a median of over 3 years. There was a significant association between the extent of LGE and risk for sudden death events. Among patients without established risk factors for sudden death, the extent of LGE was associated with sudden death risk, and, among those without LGE, risk was very low. The importance of this data set is that it more clearly establishes the role of CMR imaging in the prediction of sudden death risk in patients with hypertrophic cardiomyopathy. For those in whom the ICD decision may be uncertain on the basis of the usual clinical risk factors, the presence or absence of a certain mass of LGE on CMR imaging can tip the scales one way or the other on that critical decision point. For patients without any of the established risk factors, the presence and extent of LGE may drive consideration for an ICD that might not otherwise have been entertained. This study population is much larger with longer follow-up than all previous studies, allowing much more statistical power in analysis.

Cardiac CT Imaging

The technology of cardiac CT angiography has evolved substantially over the last decade, and, while the focus of much of the literature has been to recapitulate and expand the application of this modality in the same way as invasive angiography has been done, more recently, increasing attention has been on the evaluation of “non-obstructive” coronary artery disease (CAD). This can be imaged more routinely with contemporary CT techniques. In this paper, Bittencourt and colleagues4 report on over 3000 patients who had CT angiography whose scans were evaluated for the presence and extent of obstructive as well as non-obstructive CAD, and who were followed for a median of over 3 years for the occurrence of cardiovascular death or nonfatal myocardial infarction. The expected relation of obstructive CAD to events was seen, but, of great interest, those patients with extensive non-obstructive CAD had a risk for events that was similar to that in patents with less extensive obstructive CAD. Non-obstructive plaque extent added incremental information to risk stratification. These data are important for advancing the possibility of incorporating information on extent of imaged plaque into risk assessments, which may, in the future, help guide treatment decisions, or decisions regarding intensity of risk-factor management.


While the mature imaging modalities of echocardiography and nuclear cardiology have long had published data sets involving thousands of patients with sophisticated statistical analyses, the studies cited above suggest that the more recently evolved modalities of cardiac MR and cardiac CT have also reached a similar point regarding the rigor of prognostic data sets and publications. As always, finer gradations of risk assessment and stratification do not necessarily translate into enhanced management for patients, and must be tested separately and not simply be assumed.

The toxicity of anti-VEGF agents when coupled with standard chemotherapeutics


Bevacizumab (Avastin®, Genentech, CA) was granted accelerated approval by the FDA for metastatic breast cancer in 2008. This occurred after the initial clinical trial, E2100, demonstrated an improvement in progression-free survival (PFS) and overall survival (OS) with the addition of bevacizumab to a standard chemotherapy. Unfortunately, the approval was rescinded in 2011 when two subsequent trials, AVADO and RIBBON-1, failed to show survival benefit. We compare and analyze the landmark trials E2100, AVADO and RIBBON-1, and suggest that the present-day clinical trial model may not be suited for the investigation of targeted therapies such as bevacizumab. The existing clinical trial model does not allow for modification of chemotherapeutic doses in a manner that maximizes the effect of biologic response modifiers and does not account for its “chemosensitizing” effect. The E2100, AVADO, and RIBBON-1 trials differed in the type and dose of chemotherapy, the dose and frequency of bevacizumab, and in the trial design, making it difficult to effectively compare and evaluate the results. The efficacy of combining bevacizumab with a maximum tolerated dose (MTD) of chemotherapy is also discussed in view of the observation that increased tumor response did not translate to an increase in survival. We suggest that even though angiogenesis inhibitors are non-toxic as monotherapies, they increase the toxicity of standard chemotherapy, and consequently a re-design of the now classic clinical trial model should be considered. Modifying the existing clinical trial model will lead to a more accurate evaluation of the safety and efficacy of bevacizumab and other biological agents in treating metastatic cancer.

Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial



In ventriculoperitoneal (VP) shunt surgery, laparoscopic assistance can be used for placement of the peritoneal catheter. Until now, the efficacy of laparoscopic shunt placement has been investigated only in retrospective and nonrandomized prospective studies, which have reported decreased distal shunt dysfunction rates in patients undergoing laparascopic placement compared with mini-laparotomy cohorts. In this randomized controlled trial the authors compared rates of shunt failure in patients who underwent laparoscopic surgery for peritoneal catheter placement with rates in patients who underwent traditional mini-laparotomy.


One hundred twenty patients scheduled for VP shunt surgery were randomized to laparoscopic surgery or mini-laparotomy for insertion of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication or failure within the first 12 months after surgery. Secondary endpoints were distal shunt failure, overall complication/ failure, duration of surgery and hospitalization, and morbidity.


The overall shunt complication/failure rate was 15% (9 of 60 cases) in the laparoscopic group and 18.3% (11 of 60 cases) in the mini-laparotomy group (p = 0.404). Patients in the laparoscopic group had no distal shunt failures; in contrast, 5 (8%) of 60 patients in the mini-laparotomy group experienced distal shunt failure (p = 0.029). Intraoperative complications occurred in 2 patients (both in the laparoscopic group), and abdominal pain led to catheter removal in 1 patient per group. Infections occurred in 1 patient in the laparoscopic group and 3 in the mini-laparotomy group. The mean durations of surgery and hospitalization were similar in the 2 groups.


While overall shunt failure rates were similar in the 2 groups, the use of laparoscopic shunt placement significantly reduced the rate of distal shunt failure compared with mini-laparotomy.

Google’s Top Searches of 2014

Americans looked to Google for information on Ebola, the ALS Ice Bucket Challenge and the actor Robin Williams’s suicide this year—all of which ranked among the hottest search terms of 2014. Google has announced the results of its “14th Annual Year in Search,” an inventory of the year’s most-searched-for keywords and phrases. The data gives us a chance to look back and relive some of the major events of 2014, many of them in science (see Scientific American’s list of the top 10 science stories of the year).

The searches that rank highest are those that have gained the most ground when compared with searches during a similar time period last year. In that sense, the results show not only what the world is looking to the Internet to find—but also subjects that were truly trending in 2014 after receiving little attention in 2013. Google captures 68 percent of Internet searches from desktops worldwide, according to NetMarketShare.

In this year’s results the ALS Ice Bucket Challenge comes in at number 6 among the top U.S. searches—representing the nation’s zeal for dumping cold water over our heads all summer to raise money for the ALS Association for research on treatments for the neurodegenerative disease amyotrophic lateral sclerosis (commonly known as Lou Gehrig’s disease). The phrase “What is ALS?” also ranked as number 2 among the top 10 most-searched questions starting with the phrase “What is…?”

“What is Ebola?” was the most searched phrase in that category, and Ebola was also the number 3 top search term overall in the U.S. “Ebola symptoms” also ranked first in a list of symptom-related searches—beating out pregnancy and the flu, in a country where true Ebola symptoms were detected far less frequently than either of the other two.

Hurricane Arthur, which hit the coast of North Carolina in mid-summer, was this year’s most searched natural event—whereas California’s drought didn’t even make the list, perhaps because it has been ongoing since 2011 (and so did not show the required spike in traffic). Arthur was followed by the magnitude 8.2 Chilean earthquake in April and the magnitude 6.0 tremblor that struck northern Californiain August.

In technology a Google Doodle commemorating the Philae Lander, a robotic probelaunched by the European Space Agency to land on and explore a comet, was the ninth-most popular doodle of the year in the U.S. and the Flappy Bird game was the fifth-most popular search term of all, ranking higher than either the ISIS terrorist army invasion in the Middle East or the events in Ferguson, Mo.

It also seems that if you want to be remembered, it pays to be in show business—all of the people whose deaths landed them in the top 10 list for most-searched-for losses were actors and actresses at some point in their careers, including the notable poet, singer and actress Maya Angelou who passed away on May 28.

As past coverage at Scientific American has shown, the most popular Google searches have many correlates both proposed and proved—a boost in searches on business and politics foretells a dive in the stock market, strange weather prompts people to search for climate change in a pattern that predicts their political affiliation, and a spike insearches for flu medicine could someday help us to see when and where the flu is actually striking.

Below is a selection of this year’s U.S. trends. If you spot any other science-related trends in Google’s master list, please note them as a comment.

Trending Searches

1.         Robin Williams
2.         World Cup
3.         Ebola
4.         Malaysia Airlines
5.         Flappy Bird
6.         ALS Ice Bucket Challenge
7.         ISIS
8.         Ferguson
9.         Frozen
10.       Ukraine

Trending Natural Events

1.         Hurricane Arthur
2.         Chile Earthquake
3.         Napa Earthquake
4.         Hurricane Iselle
5.         Oso Mudslide
6.         Hurricane Odile
7.         Arkansas Tornado
8.         Hurricane Julio
9.         Alaska Earthquake
10.       Hurricane Ana

Trending Symptoms

1.         Ebola
2.         Flu
3.         Pregnancy
4.         Asperger’s syndrome
5.         ALS
6.         Lupus
7.         Diabetes
8.         Lyme Disease
9.         Typhus
10.       Respiratory virus

Trending Searches for “How to…”

1.         Airdrop
2.         Contour
3.         Vote
4.         Kiss
5.         Craft
6.         Colorblock
7.         Wakeboard
8.         Refurbish
9.         Delegate
10.       DIY

Trending Searches for “What is… ”

1.         Ebola?
2.         ALS?
3.         ISIS?
4.         Bitcoin?
5.         Asphyxia?
6.         Gamergate?
7.         WhatsApp?
8.         MERS?
9.         Hamas?
10.       Airdrop?

Top Dog Questions

1.         Why do dogs eat grass?
2.         Do dogs dream?
3.         Why do dogs howl?
4.         Why do dogs have whiskers?
5.         Why do dogs chase their tails?
6.         How to clean dogs ears
7.         Why are dogs noses wet?
8.         How to stop dogs from digging
9.         How to introduce dogs
10.       Why do dogs bury bones?

Trending Google Doodles of 2014

1.         U.S. Valentine’s Day 2014
2.         World Cup 2014 #27 (Boss)
3.         2014 Winter Olympics
4.         Rubik’s Cube
5.         Doodle 4 Google 2014 U.S. Winner
6.         Nelson Mandela
7.         John Steinbeck
8.         Audrey Hepburn
9.         Philae Robotic Lander
10.       International Women’s Day 2014

Trending Selfies

1.         Selfie Olympics
2.         Monkey
3.         Oscar
4.         Obama
5.         Squirrel
6.         David Ortiz
7.         Zach Mettenberger
8.         Colin Powell
9.         Elephant
10.       Shark

Top/Trending Books

1.         Boy, Snow, Bird
2.         Blood Will Out
3.         Savage Harvest: A Tale of Cannibals, Colonialism, and Michael Rockefeller’s Tragic Quest for Primitive Art
4.         City of Heavenly Fire
5.         Flash Boys
6.         The Invention of Wings
7.         All the Light We Cannot See
8.         Words of Radiance
9.         Yes Please
10.       Capital in the Twenty First Century

Trending People
not including deaths

1.         Jennifer Lawrence
2.         Kim Kardashian
3.         Tracy Morgan
4.         Ray Rice
5.         Tony Stewart
6.         Iggy Azalea
7.         Donald Sterling
8.         Adrian Peterson
9.         Renée Zellweger
10.       Jared Leto

Trending Deaths

1.         Robin Williams
2.         Joan Rivers
3.         Philip Seymour Hoffman
4.         Maya Angelou
5.         Jan Hooks
6.         Harold Ramis
7.         Shirley Temple
8.         Lauren Bacall
9.         Mickey Rooney
10.       James Avery

Two Prostate Cancer Tests ‘Not Clinically Useful,’ Says NICE

Two tests designed to help identify prostate cancer in patients with negative or inconclusive results on prostate biopsy do not improve diagnosis enough to be recommended for clinical practice, says the United Kingdom (UK)’s healthcare watchdog.

In draft diagnostics guidance issued on December 17, the National Institute for Health and Care Excellence (NICE) recommends that the Progensa prostate cancer antigen 3 (PCA3) assay (Hologic GenProbe) and the Prostate Health Index (PHI) (Beckman Coulter) should not be used in the National Health Service in England.

PCA3 and PHI are both in vitro diagnostic tests for use in patients suspected of having prostate cancer who have negative or inconclusive findings on transrectal ultrasound prostate biopsy; these tests are used to determine the need for a second biopsy.

The appraisal was undertaken in the belief that the PCA3 or PHI may avoid second biopsies and associated complications by identifying patients unlikely to have a positive biopsy result and, thus, prostate cancer.

However, the draft guidance says that adding either of these tests to clinical assessment plus MRI is unlikely to improve diagnostic accuracy in clinical practice.

“Prostate biopsies are associated with discomfort and pain, as well as side effects including bleeding, problems with catheterisation and possible infections,” Carole Longson, PhD, NICE Health Technology Evaluation Centre director, commented in a statement.

“These tests would be of value if they were able to improve diagnostic certainty because it would reduce the number of prostate biopsies patients had to have, reducing patients’ anxiety,” she continued.

“However, the committee noted from the evidence that, although there were some improvements in diagnostic performance when PCA3 or PHI was added.

to clinical assessment alone, these improvements were very small.”

PCA3 Test Performed on Urine Sample

The PCA3 assay is an in vitro nucleic acid amplification test for determining levels of PCA3 RNA in urine. The urine sample is obtained after digital rectal examination, which releases prostate cells and RNA into the urinary tract.

As reported by Medscape Medical News, the PCA3 assay was approved for use in Europe in 2006, and received US Food and Drug Administration approval in 2012, based on a study involving 495 men at 14 clinical sites that indicated the assay had a negative predictive value for prostate cancer of 90%.

A further study conducted in 233 men with persistently elevated serum prostate-specific antigen (PSA) levels and at least one previous negative biopsy result suggested that the PCA3 assay may help reduce the number of biopsies performed in men suspected of having prostate cancer. The assay performed significantly better than serum PSA in predicting prostate biopsy outcome.

Furthermore, an analysis of 1072 men from the REDUCE (REduction by DUasteride of prostate Cancer Events) study suggested that higher PCA3 scores not only predicted a positive biopsy result but was also associated with a higher biopsy Gleason score.

Further improvements in the ability of the PCA3 assay to identify men with prostate cancer have been reported when used in combination with the TMPRSS2:ERG gene fusion, and with a panel of biomarkers.

PHI Is Blood Serum Immunoassay

In contrast, the PHI is an in vitro diagnostic multivariate index assay that combines three blood serum PSA immunoassays — PSA, free PSA, and p2PSA — into a single calculation (p2PSA/free PSA) × √total PSA.

The test is simple and inexpensive and has performed better than conventional PSA and free PSA measures in several studies for predicting overall and high-grade prostate cancer.
For the current draft NICE guidance, researchers from the External Assessment Group conducted three systematic reviews of the evidence, identifying 6 studies that reported the analytical validity and 31 that reported the clinical validity of the tests. No studies that reported the clinical validity of the tests were identified.

In addition, the group conducted a systematic review of the existing economic analyses of the PCA3 and PHI tests. Because no published economic studies met the inclusion criteria, the group designed their own de novo economic model designed to assess the cost-effectiveness of the tests.

After reviewing the available evidence, the guidance committee considered whether more research into the two assays was advisable.

Noting that any potential improvements to the tests would be small, the guidance says: “If the potential benefits of using the PCA3 assay and the PHI were realised, they were unlikely to be sufficiently large to offset the costs of the test and make a substantial difference to the number of people having a second biopsy unnecessarily.”

Bisphosphonates Linked to Lower Endometrial Cancer Risk

A class of drugs that prevents bone loss may also help reduce women’s risk of developing endometrial cancer, according to a new study published online December 22 in Cancer.

Women who had a history of taking bisphosphonates were about half as likely as women who had not taken the drugs to develop endometrial cancer.

The study looked only at bisphosphonates that contain nitrogen, which have the strongest anticancer effects among the class of drugs, according to prior studies.

Sharon Hensley Alford, PhD, from the Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, and colleagues looked at data from 29,254 women aged 60 years and older in the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The survey included a questionnaire on bone health and use of medications, including bisphosphonates.

Among the women who had used bisphosphonates, the researchers saw 8.7 cases of endometrial cancer per 10,000 person-years, compared with 17.7 cases per 10,000 person-years among women who had never used the drugs (rate ratio, 0.49; 95% confidence interval, 0.30 – 0.80).

After adjusting for a variety of variables, including age, race, smoking history, hormone therapy history, and body mass index, the hazard ratio for women taking the drugs compared with those not taking them was 0.56 (95% confidence interval, 0.34 – 0.93).
Endometrial cancer is the fourth most common cancer in women and the eighth most common cause of cancer death. Nearly half of all gynecologic cancers are endometrial. Endometrial cancer is most often diagnosed in women in their 60s and 70s, when they are postmenopausal and their bone density has decreased.

Previous research showed that bisphosphonates can slow tumor growth and the spread of cancer cells in patients with certain types of cancer, but no study had specifically looked at endometrial cancer.

The study’s main findings focused on the more common type 1 endometrial cancer, which is related to high estrogen levels. Researchers called for further studies with a larger sample to better assess the drug’s relationship to the more aggressive type 2 endometrial cancer, which is not hormonally related.