Electroacupuncture Improves AI-related Symptoms


Electroacupuncture appears to relieve symptoms associated with aromatase inhibitors (AIs) in breast cancer patients.

In study participants with AI-associated joint pain, electroacupuncture produced significant and “clinically relevant improvements” in fatigue, anxiety, and depression, compared with usual care. In addition, at 12 weeks, there was a nonsignificant improvement in sleep disturbance.

The study, published online July 30 in Cancer, builds on earlier findings that showed that electroacupuncture can decrease the joint pain by roughly 50% in breast cancer patients taking AIs (Eur J Cancer. 2014;50:267-276).

“Since many patients experience pain, fatigue, anxiety, and depression simultaneously, our results provide an opportunity to offer patients one treatment that may target multiple symptoms,” said lead author Jun Mao, MD, associate professor of family medicine and community health at the Perelman School of Medicine and director of the integrative oncology program at the Abramson Cancer Center in Philadelphia. “We see patients every day who are looking for ways to combat some of the side effects of their treatment.”

“Our study provides a novel understanding of how fatigue, sleep, and psychological distress relate to pain in patients with AI-related joint pain,” he explained in a statement.

Longer-term Trial Needed

In this study, patients were treated for 8 weeks, with a follow-up at 12 weeks. Acupuncture not only helped reduce these symptoms, the effects persisted for at least 4 weeks after treatment,
These findings need to be confirmed in a larger study with a longer follow-up period, Dr. Mao noted. At this time, it is unclear whether the acupuncture will need to be repeated periodically to maintain the effects.

“A longer-term trial is needed to answer this question,” Dr. Mao told Medscape Medical News. “Several participants remain in touch with us, outside of research, and their pain remains controlled without the need for continued treatments.”

Arthralgia is a common adverse effect of AI therapy, and frequent diagnoses include tendonitis, osteoarthritis, bursitis, and carpal tunnel syndrome. It is often cited as a reason patients discontinue therapy, and one study found that 13% stopped using AIs because of musculoskeletal problems.

Although it has not yet been established in the setting of AI therapy, research has demonstrated that pain in patients with breast cancer is often associated with fatigue, sleep disturbance, anxiety, and depression. The clustering of these symptoms might be explained by hypothalamic–pituitary–adrenal axis and sympathetic nervous system dysregulation.

Acupuncture Superior to Usual Care

Dr. Mao and colleagues evaluated the effect of electroacupuncture on fatigue, sleep, and psychological distress in breast cancer survivors who were experiencing joint pain related to AI therapy.

The study involved 67 women with a history of early-stage breast cancer (stage I to III) who had joint pain for at least 3 months that they attributed to their therapy.

The participants, who were all receiving AI therapy (anastrozole, letrozole, or exemestane), were randomly assigned to receive electroacupuncture, sham acupuncture, or usual care (control group).

In electroacupuncture, a small electric current is passed between pairs of acupuncture needles. For sham acupuncture, nonpenetrating needles were used at points at least 5 cm from the joint where pain was perceived to be maximal.

All participants were educated about joint pain, staying physically active, and continuing with current medical treatments (including prescription and over-the-counter pain drugs). Those in the control group were allowed to receive 10 real acupuncture treatments after 12 weeks of follow-up.

Patient-reported symptoms were measured prior at baseline, periodically during the study, and at follow-up 4 weeks after treatment.

At week 8, the average reduction in fatigue on the 10-point Brief Fatigue Inventory was 2 points greater in the acupuncture group than in the control group. This effect was maintained out to week 12.

Also at week 8, the average reduction in depression on the 14-point Hospital Anxiety and Depression Scale (HADS) was 2.4 points in the electroacupuncture group and 2.0 points in the sham group. These effects were maintained out to week 12.

At week 12, the average reduction in anxiety on the 14-point HADS was 2.2 points greater in the acupuncture group than in the control group. There was no reduction in the sham acupuncture group.

The positive effect of sham acupuncture on depression might have had to do with the interaction between the patient and provider, Dr. Mao explained. “Sham acupuncture was not physiological inert, as sensory stimulation of skin may create an effect,” he said. “In addition, patient–provider engagement and relaxation from the process of receiving acupuncture may produce a benefit. Overall, the magnitude of effect for electroacupuncture was more pronounced than sham, compared with usual care.”

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Migraine Linked to Carpal Tunnel Syndrome


A study for the first time has revealed a possible association between migraines and carpal tunnel syndrome (CTS), with migraines more than twice as prevalent in patients with CTS as in those without.

“The association of these two distinct disease processes is a fascinating connection that needs to be explored further,” study investigator Douglas M. Sammer, MD, chief of the Hand and Upper Extremities Division, Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, said in a statement.

“This association suggests the possibility, although not demonstrated in this study, of a common systemic or neurologic risk factor,” the authors write. In addition, migraine headache may be an early warning sign of increased risk for future CTS, they say.

The study was published online in Plastic and Reconstructive Surgery.

In a cross-sectional analysis of 25,880 adults who responded to the 2010 National Health Interview Survey, 952 (3.7%) had CTS and 4212 (16.3%) had migraine headache.

A case of CTS was defined as a respondent who answered “yes” to two questions: “Have you ever been told by a doctor or other health professional that you have a condition affecting the wrist and hand called carpal tunnel syndrome?” and “During the past 12 months have you had carpal tunnel syndrome?”

A case of migraine was defined as a respondent who answered “yes” to the question, “During the past 3 months, did you have severe headache or migraine?”
The study team found that migraine prevalence was higher in those with than without CTS (34% vs 16%; adjusted odds ratio [aOR], 2.60; 95% confidence interval [CI], 2.16 – 3.13).

CTS prevalence was also higher in persons with than without migraine headache (8% vs 3%; aOR, 2.67; 95% CI, 2.22 – 3.22).

CTS was associated with older age, female sex, obesity, diabetes, and smoking. Migraine headache was associated with younger age, female sex, obesity, diabetes, and smoking.

“Although we have theories, at this time we simply don’t know why people with carpal tunnel syndrome are more likely to have migraines, and vice versa,” Dr Sammer said. “A deeper understanding of how and why this connection exists may lead to earlier diagnosis or even the ability to implement preventive measures,” he added.

Unlike CTS, migraine has not historically been considered a compression neuropathy, the researchers note in their article. However, some recent evidence suggests that some migraine headaches may be associated with nerve compression around the head and neck and that some migraines may be successfully treated by targeted peripheral nerve decompression, they note.

“Based on the findings of this study and prior studies, it may be worthwhile in patients with migraine to perform an examination for peripheral nerve compression in the head and neck,” the authors suggest.

A key limitation of the study, say the researchers, is that the survey question for migraine headache was worded “migraine or severe headache.” This lack of specificity may have led to a number of false-positive respondents without true migraine headaches, they point out.

Another limitation is the fact that this was a survey-based study and did not consist of patients with CTS or migraine headache diagnoses confirmed by a medical professional.

Experts Weigh In, Urge Caution

Reached for comment, Matthew S. Robbins, MD, director, Inpatient Services, Montefiore Headache Center, chief of neurology, Einstein Division, Montefiore Medical Center, Bronx, New York, told Medscape Medical News that the study is “interesting and does address this connection for the first time.”

“From my own clinical practice, I do believe in the study results reported,” Dr Robbins said. “However, the emphasis on peripheral nerve compression as a cause or major factor for migraine is highly disputed, and most of us who diagnose, treat, and study patients with migraine regularly know that migraine is a problem of the brain.”

He added, “The labeling of the disorder as ‘migraine headache’ rather than ‘migraine’ also reflects a lack of emphasis on this point, as migraine features so many other symptoms aside from headache, as any patient would describe. Migraine is a disorder where there is an inherited sensitivity of the nervous system, and with time there is sensitization of broader pain pathways that elevate the risk of experiencing other pain conditions. That is why migraine is associated not just with carpal tunnel syndrome but low back pain, fibromyalgia, temporomandibular dysfunction, and other pain conditions — the list is long.”

Dr Robbins agrees that the methods for defining migraine in this study were “not ideal, [but] the authors took advantage of a large, established national database with immense power, so within the study mechanism this is a limitation to concede. However, it is likely that the question does capture many of those with active migraine.”

But Stephen Silberstein, MD, director of the Headache Center at Thomas Jefferson University, Philadelphia, Pennsylvania, has major concerns about the methods. The “crucial fundamental flaw” is defining migraine as having severe headache or migraine in the last 3 months.

“The only way to show an association is lifetime prevalence of migraine as opposed to any headache in the last 3 months, so the criteria questions they used are not adequate,” he told Medscape Medical News.

27 Life Changing Lessons to Learn from Nikola Tesla


27 Life Changing Lessons to Learn from Nikola Tesla

Known as the genius that lit the world, Nikola Tesla inspired nations to come together in the name of peace and science. And he also inspired me to write this post. As a visionary far ahead of his time, Nikola Tesla has become for me, a source of inspiration and great wisdom. And today I would like to share with you 27 of the many lessons I have learned from this incredible man.

Enjoy 🙂

1. Science can make more progress by studying the non-physical phenomena.

“The day science begins to study non-physical phenomena, it will make more progress in one decade than in all the previous centuries of its existence.” ~ Nikola Tesla

2. Your body is a priceless gift.

“Everyone should consider his body as a priceless gift from one whom he loves above all, a marvelous work of art, of indescribable beauty, and mystery beyond human conception, and so delicate that a word, a breath, a look, nay, a thought may injure it.” ~ Nikola Tesla

3. If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.

“If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.” ~ Nikola Tesla

4. Genius requires solitude.

“Be alone, that is the secret of invention; be alone, that is when ideas are born.” ~ Nikola Tesla

“Most persons are so absorbed in the contemplation of the outside world that they are wholly oblivious to what is passing on within themselves.”

5. The brain is only a receiver.

“My brain is only a receiver, in the Universe there is a core from which we obtain knowledge, strength and inspiration. I have not penetrated into the secrets of this core, but I know that it exists.” ~ Nikola Tesla

6. The gift of mental power comes from God.

“The gift of mental power comes from God, Divine Being, and if we concentrate our minds on that truth, we become in tune with this great power. My Mother had taught me to seek all truth in the Bible.” ~ Nikola Tesla

7. Instinct transcends knowledge.

“Instinct is something which transcends knowledge. We have, undoubtedly, certain finer fibers that enable us to perceive truths when logical deduction, or any other willful effort of the brain, is futile.” ~ Nikola Tesla

8. The more we know, the more ignorant we become.

“It is paradoxical, yet true, to say, that the more we know, the more ignorant we become in the absolute sense, for it is only through enlightenment that we become conscious of our limitations.” ~ Nikola Tesla

9. If the hate of men could be turned into electricity, it would light up the whole world.

“If your hate could be turned into electricity, it would light up the whole world.” ~ Nikola Tesla

10. If you can imagine it, you can achieve it.

“My method is different. I do not rush into actual work. When I get an idea I start at once building it up in my imagination. I change the construction, make improvements, and operate the device entirely in my mind.” ~ Nikola Tesla

11. When natural inclination develops into a passionate desire, one advances towards his goal in seven-league boots.

“When natural inclination develops into a passionate desire, one advances towards his goal in seven-league boots.” ~ Nikola Tesla

12. Life is a mystery to be lived.

“Life is and will ever remain an equation incapable of solution, but it contains certain known factors.”

13. Our virtues and our failings are inseparable.

“Our virtues and our failings are inseparable, like force and matter. When they separate, man is no more” ~ Nikola Tesla

14. Misunderstandings are always caused by the inability of appreciating another’s point of view.

“Fights between individuals, as well as governments and nations, invariably result from misunderstandings in the broadest interpretation of this term. Misunderstandings are always caused by the inability of appreciating one another’s point of view.”

15. You may live to see man-made horrors beyond your comprehension.

“You may live to see man-made horrors beyond your comprehension.” ~ Nikola Tesla

16. A man cannot be saved from his own foolishness by someone else’s efforts.

“My mother understood human nature better and never chided. She knew that a man cannot be saved from his own foolishness or vice by someone else’s efforts or protests, but only by the use of his own will.” ~ Nikola Tesla

17. Peace can only come as a natural consequence of universal enlightenment.

“What we now want is closer contact and better understanding between individuals and communities all over the earth, and the elimination of egoism and pride which is always prone to plunge the world into primeval barbarism and strife… Peace can only come as a natural consequence of universal enlightenment…” ~ Nikola Tesla

18. All that was great in the past was ridiculed.

“All that was great in the past was ridiculed, condemned, combated, suppressed — only to emerge all the more powerfully, all the more triumphantly from the struggle.” ~ Nikola Tesla

19. The future will evaluate each person according to his work.

“Let the future tell the truth, and evaluate each one according to his work and accomplishments. The present is theirs; the future, for which I have really worked, is mine” ~ Nikola Tesla

20. The influences that shape our destinies are very subtle.

“As I review the events of my past life I realize how subtle are the influences that shape our destinies.” ~ Nikola Tesla

21. It’s not the love you make. It’s the love you give.

“Its not the love you make. It’s the love you give.” ~ Nikola Tesla

22. The wonders of yesterday are today common occurrences.

“We crave for new sensations but soon become indifferent to them. The wonders of yesterday are today common occurrences.” ~ Nikola Tesla

23. Every living being is an engine geared to the wheel-work of the universe.

“Every living being is an engine geared to the wheel-work of the universe. Though seemingly affected only by its immediate surrounding, the sphere of external influence extends to infinite distance.” ~ Nikola Tesla

24. Patience is key. 

“That is the trouble with many inventors; they lack patience. They lack the willingness to work a thing out slowly and clearly and sharply in their mind, so that they can actually ‘feel it work.’ They want to try their first idea right off; and the result is they use up lots of money and lots of good material, only to find eventually that they are working in the wrong direction. We all make mistakes, and it is better to make them before we begin.”

25. Races and nations come and pass away, but man remains.

“The individual is ephemeral, races and nations come and pass away, but man remains.” ~ Nikola Tesla

26. We are all ONE.

“Though free to think and act, we are held together, like the stars in the firmament, with ties inseparable. These ties cannot be seen, but we can feel them.”

27. Money does not represent such a value as men have placed upon it.

“Money does not represent such a value as men have placed upon it. All my money has been invested into experiments with which I have made new discoveries enabling mankind to have a little easier life.”

Cabozantinib and Lenvatinib for Kidney Cancer Get OK in EU


Patients with kidney cancer in Europe who are not responding to treatment will soon have two new options to try, as cabozantinib (Cabometyx, Ipsen Pharma) and lenvatinib (Kisplyx, Eisai Europe Ltd) have been recommended for approval by the European Medicines Agency (EMA).

Both of these drugs are tyrosine kinase inhibitors, and both are recommended for use in patients with kidney cancer who have been previously treated with a vascular endothelial growth factor (VEGF) inhibitor. Cabozantinib is to be used as monotherapy, whereas lenvatinib is to be used in combination with everolimus (Afinitor, Novartis).

The drugs are already approved for this indication in the United States.

In its announcement, the EMA notes that the most common form of kidney cancer in adults is renal cell carcinoma (RCC). Advanced RCC includes both metastatic disease and locally advanced disease that cannot be removed by surgery. Despite the recent approval of new therapies for advanced RCC, many patients who do not respond to the existing treatments have a poor prognosis. Therefore, new treatment options are needed, the agency comments.

The EMA considers the kidney cancer indications for cabozantinib and lenvatinib to be accelerated approvals because both drugs were felt to address an unmet medical need.

The EMA also notes that both of these drugs are also used in thyroid cancer but are marketed for that indication under different trade names. Cabozantinib (as Cometriq) was approved in the EU in December 2013 for adults with medullary thyroid cancer, while lenvatinib (as Lenvima) was recommended for approval for patients with thyroid carcinoma in March 2015.

Clinical Data to Support Approval

Cabozantinib was recommended for approval mainly on the basis of a phase 3 trial (known as METEOR) involving 658 patients with metastatic RCC that had progressed after prior VEGF receptor tyrosine kinase inhibitor therapy. As previously reported by Medscape Medical News, this study showed the longest progression-free survival (PFS) ever seen in this setting, with 7.4 months on cabozantinib compared with 3.8 months on everolimus, which is the usual standard second-line therapy. In addition, preliminary results show an improved overall survival, with a median of 21.4 months on cabozantinib vs 16.5 months on everolimus.
The EMA notes that the most frequent adverse reactions associated with cabozantinib include diarrhea, fatigue, nausea, decreased appetite, palmar-plantar erythrodysesthesia syndrome (hand and foot redness, swelling, and pain), hypertension, and vomiting.

Lenvatinib was recommended for approval mainly on the basis of a phase 1b/2 trial involving 153 patients with metastatic or unresectable RCC who received at least one prior VEGF targeted therapy and were treated with lenvatinib plus everolimus or with one of these agents used alone. In this study, progression-free survival was 12.8 months on average for patients receiving the combination of lenvatinib and everolimus, compared with 5.6 months for patients treated with everolimus alone, based on independent review of radiologic images. In addition, encouraging signs of prolonged overall survival were seen in patients given the combination therapy. The most frequent adverse reactions include diarrhea, fatigue, decreased appetite, vomiting, nausea, and hypertension. Severe diarrhea occurred at a higher frequency in the combination group than in the everolimus group.

When assessing these data, the EMA’s Committee for Medicinal Products for Human Use considered that the benefits of lenvatinib plus everolimus outweigh its risks but requested that postauthorization studies be conducted to collect further data to complement data from the phase 1b/2 trial.

One Hour of Activity Offsets Risks From 8 Hours of Sitting


We have all heard by now of the dangers of too much sitting, but for those of us with sedentary jobs, there is now good news — an hour of moderate-intensity activity offsets the health risks of 8 hours of sitting.

That conclusion comes from a meta-analysis of trials involving more than 1 million individuals, reported online July 27 in The Lancet. It is one of a special series of papers on physical activity to coincide with the forthcoming Olympic Games.

This is the second time the journal has published such a series. The main message 4 years ago was that physical inactivity is a killer — leading to 5.3 million premature deaths annually worldwide, which is as many as caused by smoking and twice as many as associated with obesity. The finding prompted public health campaigns warning that “Sitting is the New Smoking” and that “Prolonged Sitting is Killing You.”

Dr Ulf Ekelund

The new message is that “it is possible to reduce — or even eliminate — these risks if we are active enough, even without taking up sports or going to the gym,” says lead author of the meta-analysis, Ulf Ekelund, PhD, from the Norwegian School of Sports Sciences in Oslo and Cambridge University, United Kingdom.

The study found that the health risks of sitting for 8 hours a day can be offset by 1 hour of moderate-intensity activity, which includes brisk walking (at 5.6 km/h) or cycling for pleasure (at 16 km/h). About a quarter of all individuals in the study reported this level of physical activity.

But even shorter periods of activity (about 25 to 25 minutes per day, which is the amount often recommended in public health guidelines) attenuated the mortality risks associated with prolonged sitting, the researchers found.

We cannot stress enough the importance of getting exerciseDr Ulf Ekelund

“For many people who commute to work and have office-based jobs, there is no way to escape sitting for prolonged periods of time,” Dr Ekelund said in a statement. “For those people in particular, we cannot stress enough the importance of getting exercise, whether it’s going for a walk at lunchtime, going for a run in the morning or cycling to work. An hour of physical activity is the ideal, but if this is unmanageable, then at least doing some exercise each day can reduce the risk,” he said.

“The world needs to get serious about physical activity,” the Lanceteditors write in anaccompanying editorial. The study by Ekelund and colleagues shows “how regular activity can diminish the increased mortality risk of prolonged sitting…[and] should help shift the current focus on reducing sitting times alone to more emphasis on regular activity,” they add.

Data From More Than a Million People

This is the first meta-analysis to use a harmonized approach to directly compare mortality between people with different levels of sitting time and physical activity, the researchers comment. They included 16 studies, with data on 1,005,791 individuals (aged >45 years) from the United States, Western Europe, and Australia.

The team confirmed the finding that prolonged sitting is associated with an increase in all-cause mortality. About 75% of these deaths were due to cardiovascular disease and cancer (breast, colon, and colorectal), Dr Ekelund commented.

As well as considering how long individuals sat each day, the researchers also divided the study participants into four equal-sized groups, depending on the amount of physical activity they reported. The least active group reported being active for less than 5 minutes per day, the next group was active for 25 to 35 min/day, the next group for 50 to 65 min/day, and the most active group for 60 to 75 min/day.

“Among the most active, there was no significant relation between the amount of sitting and mortality rates, suggesting that high physical activity eliminated the increased risk of prolonged sitting on mortality,” the researchers note.

But as the amount of physical activity decreased, the risk for premature death increased.

“A clear dose-response association was observed, with an almost curvilinear augmented risk for all-cause mortality with increased sitting time in combination with lower levels of activity,” the researchers comment.

These most active individuals were used as the referent group for the analysis (hazard ratio of 1).

At highest risk were individuals who reported the least amount of physical activity, even if they did not spend a long time sitting each day. For the group that was least active (less than 5 min/day) but also spent the least time sitting (less than 4 h/day), the hazard ratio for premature death was 1.27.

 This was significantly higher (P < .0001) than for individuals who were the most active (60 to 75 minutes of physical activity each day) but who also reported the longest periods of sitting (>8 h/day), who had a hazard ratio for premature death of 1.04.

This hazard ratio was not significantly different from the referent group, which led to the main conclusion that 1 hour of activity can offset 8 hours of sitting.

The researchers emphasized that the findings suggest that physical activity is particularly important, no matter how many hours a day are spent sitting.

 Speaking to reporters at a Lancet press briefing in London, Dr Ekelund said that the biological mechanisms behind these findings are unclear, but work in animal studies suggests that inactivity is linked to a decreased production of certain hormones.

He also emphasized the message about “moving more,” suggesting that people should walk as much as they can and that if they do need to sit for prolonged periods, they should break up those periods with short bursts of activity, such as walking for 5 minutes every hour.

Asked by Medscape Medical News if he practices what he preaches, Dr Ekelund, who is tall and lean, laughed and said yes, that he is in the high activity group. He is a keen cross-country skier and does about 5 to 7 hours of exercise each week.

Acupuncture Causes Brain Changes in Patients With Hand Pain


Acupuncture appears to thicken the cortex of patients with idiopathic hand pain while alleviating their pain, a new study suggests.

The finding provides new evidence for a condition resembling carpal tunnel syndrome but with a different cause, said first author, Norman Kettner, DC, chair of radiology at Logan University in Chesterfield, Missouri.

“This needs further investigation,” he told Medscape Medical News.

Dr Kettner presented the finding here at the American Pain Society (APS) 54th Annual Scientific Meeting.

Typical symptoms of carpal tunnel syndrome include pain and paresthesia over median-nerve innervated regions of the hand. But while conduction is decreased in the median nerves of some of these patients, it is normal in others.

To understand the differences in these two groups, Dr Kettner and his colleagues assigned 15 patients with idiopathic hand pain and 21 patients with carpal tunnel syndrome to 16 acupuncture treatments over the course of 8 weeks.

The carpal tunnel syndrome group averaged 49.2 years of age, while the idiopathic hand pain group averaged 38.5 years of age.

Acupuncture consisted of electrical stimulation at 2 Hz in points PC7 and TW5, with manual acupuncture at three additional points among HT3, PC3, SI4, LI5, LI10, and LU5 chosen by practitioners on the basis of their diagnoses.

The researchers measured the patients’ nerve latency and velocity using electrophysiologic testing. They used MRI to measure cortical thickness.

At baseline, median nerve conduction latency was significantly higher for the carpal tunnel group, and median nerve conduction velocity was significantly lower than in the idiopathic pain group and a control group of 13 healthy people.

Differences in ulnar nerve conduction latency and velocity did not significantly differ among the groups.

Also at baseline, average cortical thickness in the bilateral insula was greater in the idiopathic hand pain group than in the carpal tunnel group.

The nerve conduction measurements did not change significantly after acupuncture treatment.

On the other hand, cortical thickness increased in the left S1, right posterior cingulate cortex/precuneus, and bilateral insula after acupuncture in the idiopathic hand treatment group but not in the carpal tunnel group.
Meanwhile, scores on the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) improved for both the idiopathic hand pain and the carpal tunnel syndrome groups. The improvements were statistically significant at the conclusion of the acupuncture treatment and 3 months later (P < .05).

While the idiopathic pain group improved more on the BCTSQ than the carpal tunnel group, this difference was not statistically significant.

Table. Changes in the Boston Carpal Tunnel Syndrome Questionnaire

Treatment Interval Idiopathic Hand Pain (n = 15) Carpal Tunnel Syndrome (n = 21)
Baseline 2.7 2.8
Postacupuncture 1.9 2.1
3-month follow-up 1.7 2.2

In the patients with idiopathic hand pain, the greater the increase in insula thickness, the greater the reduction in symptom severity.

“This will help characterize a subset of carpal tunnel patients,” said Dr Kettner. “One weakness of pain medicine is the failure to subtype patients.”

One could conclude from this study that carpal tunnel syndrome has a strong peripheral nerve component that affects brain functioning, while idiopathic hand pain does not, said Roger B. Fillingim, PhD, director of the Pain Research & Intervention Center of Excellence at the University of Florida in Gainesville.

“It is a small, short-term study, so we don’t want to jump to conclusions,” he told Medscape Medical News.

One question the study does not address is whether other types of treatment, such as exercise or transcutaneous electrical nerve stimulation, would have similar effects as acupuncture, he pointed out.

Blueberries May Boost Memory in Mild Cognitive Impairment


Eating blueberries may improve thinking and memory skills in older adults with mild cognitive impairment (MCI), new research suggests.

“There is a very large, basic-science literature ― molecular studies, cellular studies, and animal studies ― that demonstrates cognitive enhancement with blueberries, but there are only just a few human studies to date,” said lead researcher Robert Krikorian, PhD, University of Cincinnati Academic Health Center, in Ohio.

He presented results of two human blueberry studies March 13 at the 251st National Meeting and Exposition of the American Chemical Society (ACS), in San Diego, California.

Memory, Well-being Boost

In one study, 47 adults aged 68 years and older with MCI were randomly allocated to consume a freeze-dried blueberry powder equivalent to a cup of blueberries or a placebo powder once a day for 16 weeks. The researchers carried out pre- and postintervention cognitive tests on all participants and brain imaging in a subset.

“There was improvement in cognitive performance and brain function in those who had the blueberry powder compared with those who took the placebo,” Dr Krikorian reported.

The cognitive tests included a verbal list–learning task, a simple paper-and-pencil line drawing motor task, a visual-spatial memory task that involved nonverbal information, and a semantic access task. In the blueberry group, there was a significant 72% improvement in semantic access and a 13% improvement in visual-spatial memory, Dr Krikorian told Medscape Medical News. “And we had marginal effects for the other tests ― that is, trends that were close to significant but didn’t reach significance.

“In addition, we found that the blueberry-supplemented subjects showed increased activation in certain regions of the left hemisphere of the brain, and that did not occur with placebo-powder subjects,” he said.

The other study included 94 adults aged 62 to 80 years who had complaints concerning subjective memory. They were randomly allocated to receive the blueberry powder, fish oil, fish oil plus the blueberry powder, or placebo for 24 weeks.
“This study was of similar design but involved a larger population of older adults with normal cognitive function, and the supplementation period was 24 weeks as opposed to 16. The findings weren’t as robust in this study,” Dr Krikorian said, perhaps because these patients had less severe cognitive problems when they entered the study.

“The other interesting result was that the blueberry-supplemented participants felt they were performing better in their everyday lives. They had a better sense of well-being and were making fewer memory mistakes and were less inefficient than they had been relative to those that received the placebo powder,” he noted.

The beneficial effects of blueberries could be due to the presence of anthocyanins, flavonoids shown to improve cognition in animals, Dr Krikorian said.

“It’s important to do this work and for other programs as well to replicate what we are finding,” he noted. “And we need to know much more about the mechanisms of action and the proper dose and intervention period. There are a host of questions that have to be answered with human research.”

Interpret With Caution

These findings are “intriguing but should be interpreted with caution,” Keith N. Fargo, PhD, director of scientific programs and outreach, Alzheimer’s Association, noted in an interview with Medscape Medical News.

“I think the thing for people to remember here is that it is a small study, so there may be something here, [or] there may not be something here. Other people have looked at blueberries and found some protective effect, so it’s not outside the realm of possibilities, and if it’s true, it could be exciting,” Dr Fargo said.

“As a population, we are aging, and it’s going to be important for all of us to try to eat as healthy as we can,” he added. “It’s probably not about a single dietary change. It’s probably about making sure you are physically active and keeping your body weight in check and making sure you are eating a reasonable diet. Those things are going to be helpful for your cardiovascular health, and things that are helpful for your cardiovascular health are also helpful for your cognitive function as you age,” he added.

Stressed-out Older Adults Risk Memory Woes


Older adults who live stressful lives are more than twice as likely to develop amnestic mild cognitive impairment (aMCI) than their less-harried peers, suggest findings from a longitudinal study of aging.

“Our study provides strong evidence that perceived stress increases the likelihood that an older person will develop aMCI. Fortunately, perceived stress is a modifiable risk factor for cognitive impairment, making it a potential target for treatment,” senior author Richard Lipton, MD, vice chair of neurology, Albert Einstein College of Medicine and Montefiore Health System, New York City, said in a statement.

“Perceived stress reflects the daily hassles we all experience, as well as the way we appraise and cope with these events,” added first author Mindy Katz, MPH, also from the Department of Neurology at Einstein. “Perceived stress can be altered by mindfulness-based stress reduction, cognitive-behavioral therapies, and stress-reducing drugs. These interventions may postpone or even prevent an individual’s cognitive decline,” she noted.

The findings were published online December 11 in Alzheimer Disease and Associated Disorders.

Robust Findings

The results stem from the ongoing Einstein Aging Study, a community-based cohort of adults aged 70 years and older. As part of the study, participants undergo yearly clinical evaluations, a neuropsychological battery of tests, psychosocial measures, and assessments of activities of daily living, and they provide self-reports (or reports by informants) of memory and cognitive problems. In 2005, the study began collecting data on stress using the Perceived Stress Scale (PSS). All participants were free of aMCI at their first PSS assessment.

Among a total of 507 participants, 71 developed aMCI during an average follow-up period of 3.6 years. High levels of perceived stress were associated with a greater risk of developing aMCI. In the fully adjusted model, for every 5-point increase in PSS, the risk for aMCI increased by 30% (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.08 – 1.58; P = .007).

“The consistency of results after covariate adjustment and the lack of evidence for reverse causation in longitudinal analyses suggest that these findings are robust,” the authors write.

Similar results were obtained when participants were divided into quintiles on the basis of their PSS scores. Those in the highest-stress quintile were nearly 2.5 times more likely to develop aMCI than those in the other four quintiles combined (HR, 2.44; 95% CI, 1.32 – 4.54; P = .005).

People in the high-stress group were more apt to be female and to have less education and higher levels of depression. However, depression did not significantly affect the relationship between stress and the onset of aMCI, the authors report. The impact of stress on aMCI was also unaffected by the presence of the APOE-ε4 allele.

Reverse Causality?

The researchers note that the effect of stress on cognitive function may be mediated through multiple physiologic pathways involving the central nervous, neuroendocrine, immune, and cardiovascular systems.

A limitation of the study, they say, pertains to use of the PSS to “operationalize chronic stress. Although it is likely that the predictive power of the PSS derives from its sensitivity to chronic sources of stress, the PSS is a global index that cannot distinguish among other stress effects such as specific major life events in the elderly (eg, residential transitions), appraisal processes, role stressors (eg, caregiving), heightened stressor reactivity, and dispositional traits (eg, tendencies toward worry or rumination),” they note.

Another potential limitation of this study is that stress may increase in response to developing cognitive impairment rather than serve as a risk factor for it.

Reached for comment, Elizabeth Munoz, PhD, postdoctoral scholar, Department of Psychology, University of California, Riverside, told Medscape Medical News that the study “contributes to the growing evidence that psychological stress influences cognitive health.”

“Our study in Psychology and Aging showed that perceived stress influences cognitive performance over a short timescale (biannual change), and Katz and colleagues’ paper further adds to the chain of evidence that perceived stress may contribute to pathological outcomes over time,” Dr Munoz said.

Probiotics Destroy Toxic Chemicals In Our Gut For Us


It is an awesome fact of nature that we have trillions of organisms within our body – containing completely foreign DNA – some of which break down toxic chemicals that we humans have created to kill other things, but are now killing us, e.g. pesticides. Who are these strange helpers?

Bacteria!

Wait. Aren’t bacteria supposed to harm us? Aren’t they the enemy in the endless war against infection?

Well, when our immunity fails, some can grow out of bounds opportunistically. But they respond to the environment within which they are raised, not unlike most other creatures. Provide organic, wholesome vegetables, for instance, and you have a hotbed of positive activity in your gut. Provide sugar, processed foods and an increasing burden of chemicals and it can get ugly in there!

Also, believe it or not, ancient bacteria teamed up with our cellular ancestors eons ago to produce the energy-producing organelles within our cells called mitochondria. So, are we really that different from bacteria? No, on some level, we ARE bacteria, spurning some researchers to describe us as “meta-organisms,” composed as we are of many different living systems working symbiotically.

So, let’s look at some of the amazing feats of these friendly bacteria….

  1. Bisphenol A Toxicity: Absorption/ExcretionBisphenol A(BPA) is an increasingly omnipresent petrochemical derivative with endocrine-disrupting properties (i.e. it messes up your hormones!) and is found in thermal printer receipts, all world paper currency, plastics, and many other consumer goods.[1] Sadly, it is not a matter of whether or not you will be exposed, but to what degree. Enter the probiotics Bifodobacterium breve and Lactobacillus casei. In rats exposed to BPA in their diet, blood concentrations of BPA dropped significantly and it was excreted in their feces 2.4 times more readily than the non-supplemented control group. The researchers concluded that the probiotics “…reduced the intestinal absorption by facilitating the excretion of BPA, and that these probiotics may suppress the adverse effects of BPA on human health.”
  2. Bisphenol A Toxicity: Degradation – Novel, bisphenol A-degrading bacterial strains were isolated from the traditional Korean fermented cabbage dish known as kimchi.[2] Three isolates of Bacillus pumilus were shown capable of degrading BPA. The researchers reported that these food-derived bacteria would make efficient and safer systems for the removal of BPA.  Logically, the consumption of kimchi (or the probiotics extracted from kimchi) would enable a human’s gastrointestinal tract to break down this harmful chemical, as well.
  3. Insecticide Toxicity – Here comes kimchi to the rescue again!  In 2009, the Journal of Agricultural and Food Chemistry revealed that the rather nasty insecticide chlorpyrifos (CP), which has been linked to neurological effects, developmental disorders and autoimmune disorders, may be no match for the bacteria that make possiblekimchi fermentation.[3] The researchers found the bacteria in kimchi turned CP into lunch (a source of carbon and phosphorous) and degraded it rapidly until day 3 (83.3% gone!) and degraded it completely by day 9! The superheroes in this story were identified as: Lactobacillus brevis WCP902, Lactobacillus plantarum WCP931, and Lactobacillus sakei WCP904.  But then things got even more amazing…..
    These toxin-muching superheroes were found to degrade four otherinsecticides:
  1. Coumaphos – Insecticide
  2. Diazinon
  3. Parathion
  4. Methylparathion

If you think the chemical-munching and degrading abilities of probiotics are amazing, then consider that probiotics perform thousands of vital functions within our body, and have been clinically researched to prevent and/or reduce the symptoms of close to 200 different diseases.

Healthy Bacteria Depend on the Health of the Soil, and the Health of the Soil Depends on YOU

When it comes to good bacteria, it is important to point out that humans do not live within a vacuum. The quality of the bacteria in our gut reflects the quality of the food we eat, which ultimately depends on the quality of the soil.

If you grow your vegetables in raw human sewage (from unhealthy folks), or factory-farmed animal waste, already preloaded with antibiotic resistant bacteria and chemicals, there is little hope that you will receive sufficient beneficial bacteria from that food.

What is more likely is that you will be exposed to highly pathogenic antibiotic resistant bacteria which have already survived decades worth of chemical and antibiotic exposure within the human gastrointestinal tract, or loads of zoological antibiotics used on the Concentrated Animal Feeding Operation (CAFO), almost guaranteeing your own microflora will be continually challenged with unhealthy, disease-promoting strains of bacteria.  This is one of the most disturbing and unspoken aspects of conventionally produced food, but there are others: gamma irradiation, bacteriophage-sprays, etc.

Moreover, new research indicates that our increasingly GMO-based global food production system which depends so heavily on broad-spectrum biocides like the active ingredient in Roundup “weedkiller,” namely,glyphosate, is destroying the fertility of the soil. Essential, and culturally ancient, food-starter bacteria – as used in fermented foods like cheese and yogurt – are disappearing in certain regions of the world. The soils have become saturated with herbicides that are destroying themicrobial biodiverisity, without which many of the foods that we consume would not be possible. When that lifeline to health which comes from the soil is cut off, our own health is compromised – perhaps irreversibly.

What does this mean? Planetary health and human health are no longer separable — truth is, they never were. We need to move beyond the concept that we can hermetically seal ourselves off from the ecological destruction and mass poisoning occurring all around us by only consuming “organic.” If things continue at the pace they are going, the word “organic” will have no meaning whatsoever – other than marketing spin.  The case of perchlorate accumulation in organic food makes this problem blatantly clear. In other words, unless we become activists on this issue, we will lose everything.

25 Cancer Stem Cell Killing Foods Smarter Than Chemo & Radiation


25 Cancer Stem Cell Killing Foods Smarter Than Chemo & Radiation

A new scientific review identifies 25 of the top foods and herbs which kill the cancer stem cells at the root cause of cancer malignancy. 

There are thousands of natural compounds that have been studied with demonstrable anti-cancer activity (check out over 600 on our cancer research database), but only a small subset of these have been proven to target and kill the cancer stem cells which lie at the root of cancer malignancy. Turmeric, for instance, we have featured a number of times for this “smart kill” property of targeting just the heart of cancerous tumors. More recently, ginger has been found in pre-clinical research to contain a compound up to 10,000 times more effective than the chemotherapy drug Taxol at killing breast cancer stem cells. Even common food like blueberry have special cancer killing properties, as discussed in a previous article: Research: Radiotherapy Causes Cancer, Blueberry Kills It.

A new study published in the journal Anticancer Research titled, “Natural Products That Target Cancer Stem Cells,” has made our job much easier of identifying this special category of cancer killers by reviewing the extant literature on the topic and listing the top 25 substances in this category. They are listed here below, along with some of their commonly recognizable dietary sources:

  1. Epigallocatechin-3-gallate (EGCG)Green Tea

  2. 6-Gingerol – Ginger

  3. β-Carotene – Carrot, Leafy Greens

  4. BaicaleinChinese Skullcap

  5. CurcuminTurmeric

  6. Cyclopamine – Corn Lilly [we do not suggest consuming this plant; this simply illustrates natural components exist that kill cancer stem cells]

  7. Delphinidin – Blueberry, raspberrry

  8. Flavonoids (Genistein) – Soy, red clover, coffee

  9. Gossypol – Cottonseed [we do not suggest consuming this plant; this simply illustrates natural components exist that kill cancer stem cells]

  10. Guggulsterone – Commiphora (myrrh tree)

  11. Isothiocyanates – Cruciferous vegetables

  12. Linalool – Mint

  13. Lycopene – Grapefruit, tomato

  14. Parthenolide – Feverfew

  15. Perylill alcohol – Mint, cherry, lavender

  16. Piperine – Black pepper

  17. Placycodon saponin – Playycodon grandifloruim

  18. Psoralidin – Psoralea corylilyfolia

  19. Quercetin – Capers, onion

  20. Resveratrol – Grapes, plums, berries

  21. Salinomycin – Streptomyces albus

  22. Silibinin – Milk Thistle

  23. Ursolic acid – Thyme, basil, oregano

  24. Vitamin D3 – Fish, egg yolk, beef, cod liver oil

  25. Withaferin A – Withania somnifera (ashwaganda)

Why are these substances so important?

The primary reason why conventional chemotherapy andradiotherapy have failed to produce any significant improvements incancer survival rates is because cancer stem cells are resistant to these interventions. In fact, chemotherapy and especially radiation are both capable of increasing the number and virulence of these cells in a tumor, while at the same time having the well known side effect of further damaging the patient’s immune system.

While the cancer industry is still very much resistant to incorporating the implications of these findings into their standard of care (which is highly unethical), there are an increasing number of health practitioners that will not turn their back on the truth and are very much interested in alternative ways to prevent and treat cancer using food and/or plant-based approaches.

The new study addresses the relevance of cancer stem cells as follows:

The cancer stem cell model suggests that tumor initiation is governed by a small subset of distinct cells with stem-like character termed cancer stem cells (CSCs). CSCs possess properties of self-renewal and intrinsic survival mechanisms that contribute to resistance of tumors to most chemotherapeutic drugs. The failure to eradicate CSCs during the course of therapy is postulated to be the driving force for tumor recurrence and metastasis. Recent studies have focused on understanding the unique phenotypic properties of CSCs from various tumor types, as well as the signaling pathways that underlie self-renewal and drug resistance.”

At present, the cancer industry has failed to produce a single drug that targets the cancer stem cell population of cells within a tumor, as confirmed by the study:

If indeed the CSC response is a vital criterion for cancer treatment evaluation, there are still no drugs in clinical use that specifically target CSCs.

The ability to selectively target cancer cells, and cancer stem cells in particular, while leaving intact the non-tumor cells in tissue is extremely important. We have created a section on our database that indexes research on these substances and now includes sixty seven of them here. We are also building a section that collates research cancer stem cells, a topic will no doubt become a central part of the future of cancer treatment, assuming the priority is to actually alleviate suffering and not just make money off of patients.

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