A Genetic Test for Organ Rejection


Rejection hurts: A tissue biopsy from a heart transplant patient shows that the donor heart (pink) is being attacked by the patient’s immune cells (purple), indicating that the organ is being rejected.   Credit: Hannah Valantine



Rising levels of donor DNA in recipients’ blood could mean the organ is in danger



MIT Technology Review, March 30, 2011, by Emily Singer  —  A new test could provide a noninvasive way of monitoring heart transplant patients for organ rejection. The test, which relies on DNA sequencing to detect fragments of the donor’s DNA in the recipient’s blood, still needs to be validated in clinical trials. But physicians hope it will ultimately offer an easy way to detect the signs of organ rejection in all types of transplant patients, perhaps earlier than other approaches.

Organ rejection is still a common problem after a heart transplant—only 50 percent of patients are alive 10 years after the procedure—and transplant recipients must undergo constant monitoring for signs of organ rejection. For people with donor hearts, this typically means an invasive cardiac biopsy weekly for the first few months, then two to three times a year after that. The procedure is uncomfortable, costly, and somewhat risky.

Biopsies detect rejection by analyzing a small piece of tissue from the donor heart for signs that the patient’s immune system is attacking the organ. But in response to an immune attack, some of the cells in the transplanted organ die, releasing DNA into the bloodstream. The new test, published today in the Proceedings of the National Academy of Sciences, detects this DNA in a sample of the patient’s blood.

In the new study, researchers first compared donor and recipient DNA, searching for single letter differences that would distinguish DNA fragments from the two sources. They then designed a sequencing-based test that could detect a genetic profile unique to the donor. Analyzing blood samples collected from 39 transplant patients over several months, they found that rising levels of donor DNA correlated with the biopsy results. “It’s a very sensitive marker,” says Hannah Valantine, a cardiologist at Stanford and one of the researchers on the study. “The ratio of donor DNA remains stable in absence of rejection. But when there is rejection, we see a rise in donor DNA.”

Valantine says she got the idea after reading a paper published by Stanford engineer Stephen Quake in 2008 that described detection of fetal DNA in maternal blood. Quake’s team then did proof-of-concept tests in female patients with male donor hearts to confirm that it was possible to find this DNA.

“The test holds a lot of promise,” says Elaine Reed, director of Transplant and Immunogenetics Testing at the University of California, Los Angeles. Reed was not involved in the study. Because the results are specific to organ rejection, the test might be applicable to other organs as well, she says. For example, liver and kidney transplant patients are monitored using a blood test for an enzyme called creatinine. But rising levels of that enzyme can be linked to different kinds of damage, not just organ rejection, and it indicates that extensive damage has already occurred.



A Search Engine for the Human Body



Inside out: A close up of a CT processed by new software from Microsoft.
Credit: Microsoft Research




Microsoft software recognizes organs and other structures in medical images.

MIT Technology Review, March 30, 2011, by Tom Simonite  —  A new search tool developed by researchers at Microsoft indexes medical images of the human body, rather than the Web. On CT scans, it automatically finds organs and other structures, to help doctors navigate in and work with 3-D medical imagery.

CT scans use X-rays to capture many slices through the body that can be combined to create a 3-D representation. This is a powerful tool for diagnosis, but it’s far from easy to navigate, says Antonio Criminisi, who leads a group at Microsoft Research Cambridge, U.K., that is attempting to change that. “It is very difficult even for someone very trained to get to the place they need to be to examine the source of a problem,” he says.

When a scan is loaded into Criminisi’s software, the program indexes the data and lists the organs it finds at the side of the screen, creating a table of hyperlinks for the body. A user can click on, say, the word “heart” and be presented with a clear view of the organ without having to navigate through the imagery manually.

Once an organ of interest has been found, a 2-D and an enhanced 3-D view of structures in the area are shown to the user, who can navigate by touching the screen on which the images are shown. A new scan can also be automatically and precisely matched up alongside a past one from the same patient, making it easy to see how a condition has progressed or regressed.

Criminisi’s software uses the pattern of light and dark in the scan to identify particular structures; it was developed by training machine-learning algorithms to recognize features in hundreds of scans in which experts had marked the major organs. Indexing a new scan takes only a couple of seconds, says Criminisi. The system was developed in collaboration with doctors at Addenbrookes Hospital in Cambridge, U.K.

The Microsoft research group is exploring the use of gestures and voice to control the system. They can plug in the Kinect controller, ordinarily used by gamers to control an Xbox with body movements, so that surgeons can refer to imagery in mid-surgery without compromising their sterile gloves by touching a keyboard, mouse, or screen.

Kenji Suzuki an assistant professor at the University of Chicago, whose research group works on similar tools, says the Microsoft software has the potential to improve patient care, providing it really does make scans easier to navigate. “As medical imaging has advanced, so many images are produced that there is a kind of information overload,” he explains. “The workload has grown a lot.”

Suzuki says Microsoft’s approach is a good one, but that medical professionals might be more receptive to the design if it indexed signs of disease, not just organs. His own research group has developed software capable of recognizing potentially cancerous lung nodules; in trials, it made half as many mistakes as a human expert.

Criminisi sticks by the notion of using organs as a kind of navigation system but says that disease-spotting capability is also under development. He says, “We are working to train it to detect differences between different grades of glioma tumor”—a type of brain tumor.

The Microsoft group also intends the tool to be used at large scales. It could automatically index a collection of 3-D scans or other images, making possible new ways of tracking medical records, says Criminisi. Today, records are kept as text that describes scans and other information. A search tool that finds the word “heart”, for example, would not know if that meant it appeared in a scan or was mentioned in another context. If a hospital’s computer system indexed new scans, the Microsoft software could automatically record what was imaged in a person’s records and when.

Hormones, neural hormones, cortisol, catecholamines — all tend to be elevated in stress. Could they in some way be contributing to cardiovascular disease?


How to Control an Adrenaline Rush

Excess adrenaline is secreted by the adrenal glands due to elevated stress and can lead to heart disease, sleep disorders and indigestion. In such situations, controlling an adrenaline rush is inevitable. Here are some simple ways to help control it.

Introduction: Adrenaline Rush

Adrenaline, or epinephrine, as it is commonly known in the medical circle, is a hormone released by the adrenal glands. These glands are located above your kidneys and are around 7 cm (approx. 3 inches) in length. Adrenaline also acts as a neurotransmitter and has a significant effect on the lungs, heart and blood vessels. In a healthy body, approximately 75-80 percent adrenaline is released by the adrenal glands. Excess epinephrine secretion is due to chronic stress and controlling an adrenaline rush can be the only solution to the problem.

An adrenaline rush is often explained with the “fight or flight reaction” example, and is nothing but a physiological phenomenon that prepares your body to fight or run away for safety. Ever since man has used stone tools and fire for his safety, an adrenaline rush has always helped him to battle against wild animals and struggle to survive in dire circumstances. In ancient and medieval times, battle cries from soldiers were used to suppress the high adrenaline rush, so that they can stand their ground and fight, not flee away from the arena. In a nutshell, secretion of adrenaline is a natural alarm against unexpected and dangerous situations.

Stress and Adrenaline Rush

In modern times, an adrenaline rush is generally associated with high levels of stress. Yes, the “fight and flight reaction” happens during excessive stress as well. The natural alarm system switches on and adrenaline, along with cortisol, is secreted by the adrenal glands. The flow of adrenaline not only increases your blood pressure, but also elevates your heart rate. Controlling an adrenaline rush is very important because excess adrenaline flow and stress levels can lead to depression, heart diseases, indigestion and sleep disorders.

In a life full of challenges, deadlines, and work pressure, stress is inevitable and so is the excess adrenaline flow. This can have dire effects on your health. You will have to take control of the stressful situations and find ways to control the flow of adrenaline.

Easy Ways to Control Stress and Excess Adrenaline

Meditate and Do Some Simple Breathing Exercises: Meditation relaxes your mind and helps you control stress. Simple breathing exercises can alleviate stress levels. Practice deep breathing. It will help in lowering your adrenaline level. For more on breathing exercises and meditation, please read Useful Tips on Meditation: Achieving Good Health Can Be So Easy!

Get Plenty of Sleep: Higher levels of adrenaline can lead to sleep disorders. Getting plenty of sleep can help reduce stress levels. If you are having sleep problems, then you can try some simple yogic techniques to induce sleep.

Relaxation Techniques: You can practice various physical and mental relaxation techniques to reduce stress levels. Deep breathing and progressive muscular relaxation (PMR) techniques can help in controlling an adrenaline rush. In PMR, you need to tense your muscles (like clenching your hand) for a few minutes and then relax the muscles. A combination of deep breathing and PMR is a potent weapon against stress and high levels of adrenaline. You can also consider professional counseling to control stress.


Stress: Constant stress puts your health at risk: http://www.mayoclinic.com/health/stress/SR00001

Physical Techniques: Deep Breathing, Progressive Muscular Relaxation & The Relaxation Response: http://www.mindtools.com/stress/RelaxationTechniques/PhysicalTechniques.htm

Adrenaline – A Neurotransmitter: http://www2.ccc.uni-erlangen.de/projects/ChemVis/motm/biofunc.html

Adrenaline Definition: http://groups.molbiosci.northwestern.edu/holmgren/Glossary/Definitions/Def-A/adrenaline.html

Definition of Adrenaline: http://www.medterms.com/script/main/art.asp?articlekey=2155



Elevated Cortisol Levels: Overview

Under normal circumstances your body produces more cortisol in the morning than in the evening, giving you the energy that you need to begin your day. In the evening your cortisol level should drop by approximately 90%. Evening is generally the time when the stresses of the day are behind you, the time when you can relax and unwind. Scientific data is showing that elevated cortisol levels are becoming more commonplace

Causes and Development

As important and necessary as cortisol is, you can have too much of it circulating in your system. If you are constantly under stress, your cortisol level can remain elevated over long periods of time.

A recent study found that women who work outside the home and have family responsibilities tend to have elevated evening cortisol levels. Men, on the other hand, have the expected lower cortisol levels in the evening. This difference may reflect the additional work that many women do after they get home from their jobs.

Interestingly, differences between women and men in relationship to cortisol extend even further. One study, which examined the effect of harassment on cortisol levels, noted that recovery from stress was significantly different between men and women. Harassed men actually had the largest increase in cortisol levels, but once the stress was eliminated men returned to normal more quickly than women.

In a scientific investigation of 30,000 women and men in 30 countries, women were shown to be more likely than men to report feeling stress. In response to issues of family, work and money, whether they are in a relationship or not, a parent or not, women are more stressed than men in the same situation. Working women with children were found to have the highest stress levels.


Signs and Symptoms

An elevated cortisol level is not something you can immediately feel. If it is elevated for too long, over a period of months or years for example, you may begin to feel its effects because of the negative impact it has on your overall health. Besides impacting the immune system, fertility, and bone health, the list of the risks of high cortisol levels grows longer. New studies demonstrate that elevated cortisol levels can lead to abdominal weight gain, loss of verbal declarative memory (words, names, and numbers), insulin resistance, and Type 2 Diabetes.

Treatment and Prevention

Managing stress is a very important part of your healthcare program. A blood, urine or saliva hormone test for cortisol can serve as a stress barometer, warning you of continual exposure to stress, and therefore to potential disease. Testing will let you know if you need to do something about your stress, such as taking action to change your circumstances, or making strides in new areas of relaxation and stress relief. Once you know your cortisol level you can begin to take stress-reducing measures in your life and protect your long-term health.


Research now correlates chronically elevated levels of cortisol with blood sugar problems, fat accumulation, compromised immune function, exhaustion, bone loss, and even heart disease. Memory loss has also been associated with high cortisol levels. Continual stress can indeed have a negative impact on your health.

An additional problem of long-term elevations of cortisol is that the adrenal gland may wear itself out and no longer be able to produce even normal levels of cortisol. This is called “adrenal exhaustion” and is associated with man other health problems.



Does Stress Cause Weight Gain?

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR


This is an interesting question. Some people do tend to gain weight when under stress, but the cause of this weight gain is likely a mix of hormonal and psychological factors. The body has a system of hormonal checks and balances that may actually promote weight gain when you’re stressed out.

The so-called “stress hormone” cortisol is released in the body during times of stress along with the hormones epinephrine and norepinephrine that constitute the “fight or flight” response to a perceived threat. Following the stressful or threatening event, epinephrine and norepinephrine levels return to normal while cortisol levels can remain elevated over a longer time period. In fact, cortisol levels can remain persistently elevated in the body when a person is subjected to chronic stress.

Cortisol has many actions in the body, and one ultimate goal of cortisol secretion is the provision of energy for the body. Cortisol stimulates fat and carbohydrate metabolism for fast energy, in addition to stimulating insulin release and maintenance of blood sugar levels. The end result of these actions is an increase in appetite. Therefore, chronic stress, or poorly managed stress, may lead to elevated cortisol levels that stimulate your appetite, with the end result being weight gain or difficulty losing unwanted pounds.

Cortisol not only promotes weight gain, but it can also affect where you put on the weight. Researchers have shown that stress and elevated cortisol tend to cause fat deposition in the abdominal area rather than in the hips. This fat deposition has been referred to as “toxic fat,” since abdominal fat deposition is strongly correlated with the development of cadiovascular disease, including heart attacks and strokes.

Whether or not your stress levels will result in high cortisol levels and weight gain is not readily predictable. The amount of cortisol secreted in response to stress can vary among individuals, with some persons being innately more “reactive” to stressful events. Studies of women who tended to react to stress with high levels of cortisol secretion showed that these women also tended to eat more when under stress than women who secreted less cortisol. Another study confirmed that women who stored their excess fat in the abdominal area had higher cortisol levels and reported more lifestyle stress than women who stored fat primarily in the hips.

Experts agree that stress management is a critical part of weight-loss regimens, particularly in those who have elevated cortisol levels. Exercise is the best and fastest method for weight loss in this case, since exercise leads to the release of endorphins, which have natural stress-fighting properties and can lower cortisol levels. Activities such as yoga and meditation can also help lower your stress hormone levels. To effectively reduce elevated cortisol due to stress, lifestyle changes are essential.

In addition to possible hormonal causes, many people eat in an attempt to fulfill psychological needs when under stress, which may be another reason some people gain weight when experiencing stress.


There are often no symptoms of breast cancer, but sometimes women may discover a breast problem on their own. Signs and symptoms to be aware of may include:

  • A painless lump in the breast.
  • Changes in breast size or shape.
  • Swelling in the armpit.
  • Nipple changes or discharge.

Breast pain can also be a symptom of cancer, but this is not common.

Inflammatory breast cancer is a rare, fast-growing type of cancer that often causes no distinct lump. Instead, breast skin may become thick, red, and may look pitted — like an orange peel. The area may also feel warm or tender and have small bumps that look like a rash.

Signs of Inflammatory Breast Cancer

Inflammatory breast cancer is a rare, fast-growing type of cancer that often causes no distinct lump. Instead, breast skin may become thick, red, and may look pitted — like an orange peel. The area may also feel warm or tender and have small bumps that look like a rash.


Breast Cancer & Mammograms

The earlier breast cancer is found, the easier it is to treat. And mammograms, X-rays of the breast, can detect tumors before they are large enough to feel. The American Cancer Society recommends yearly mammograms beginning at age 40 for women at average risk. While the U.S. Preventive Services Task Force recommends a screening mammogram every two years from age 50 to 74. It also notes that before age 50, each woman should check with a doctor to find out what screening schedule is right for her, considering the potential benefits and harms from screening.

Besides a mammogram, your doctor may order additional imaging with breast ultrasound. An ultrasound can help determine the presence of cysts, fluid-filled sacs that are not cancer. An MRI may be recommended along with a mammogram for routine screening in certain women who have a higher risk of breast cancer.

It was once widely recommended that women check their own breasts once a month. But studies suggest these breast self-exams play a very small role in finding cancer. The current thinking is that it’s more important to know your breasts and be aware of any changes, rather than checking them on a regular schedule. If you want to do breast self-exams, be sure to go over the technique with your doctor.


First, don’t panic. Eighty percent of breast lumps are not cancerous. Lumps often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But you should let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it’s found the better. And if it’s not, testing can give you peace of mind.


The only sure way to determine whether a lump is cancer is to do a biopsy. This involves taking a tissue sample for further examination in the lab, sometimes through a small needle. Sometimes surgery is done to take part of or the entire lump for testing. The results will show whether the lump is cancer, and if so, what type. There are several forms of breast cancer, and treatments are carefully matched to the type of cancer.

Hormone-Sensitive Breast Cancer

Some types of breast cancer are fueled by the hormones estrogen or progesterone. A biopsy can reveal whether a tumor has receptors for estrogen (ER-positive) and/or progesterone (PR-positive). About two out of three breast cancers are hormone sensitive. There are several medications that keep the hormones from promoting further cancer growth.

The image shows a molecular model of an estrogen receptor.

HER2-Positive Breast Cancer

In about 20% of patients, breast cancer cells have too many receptors for a protein called HER2. This type of cancer is known as HER2-positive, and it tends to spread faster than other forms of breast cancer. It’s important to determine whether a tumor is HER2-positive, because there are special treatments for this form of cancer.

Breast Cancer Stages

Once breast cancer has been diagnosed, the next step is to determine how big the tumor is and how far the cancer has spread. This process is called staging. Doctors use Stages 0-4 to describe whether cancer is localized to the breast, has invaded nearby lymph nodes, or has spread to other organs, such as the lungs. Knowing the stage and type of breast cancer will help your health care team formulate a treatment strategy.



Breast Cancer Survival Rates

The odds of surviving breast cancer are strongly tied to how early it is found. According to the American Cancer Society, 100% of women with Stage 1 breast cancer live at least five years, compared to women without cancer – and many women in this group remain cancer-free for good. The more advanced the cancer, the lower this figure becomes. By Stage 4, the five-year relative survival rate declines to 20%. But these rates can improve as more effective treatments are found.


Breast Cancer Surgery

There are many types of breast cancer surgery, from taking out the area around the lump (lumpectomy or breast-conservation surgery) to removing the entire breast (mastectomy.) It’s best to discuss the pros and cons of each of these procedures with your doctor before deciding what’s right for you.


Radiation Therapy for Breast Cancer

Radiation therapy uses high-energy rays to kill cancer cells. It may be used after breast cancer surgery to wipe out any cancer cells that remain. It can also be used along with chemotherapy for treatment of cancer that has spread to other parts of the body. Side effects can include fatigue and swelling or a sunburn-like feeling in the treated area.

Chemotherapy for Breast Cancer

Chemotherapy uses drugs to kill cancer cells anywhere in the body. The drugs are often given by IV, but are sometimes taken by mouth or shot. Chemotherapy may be done after surgery to lower the odds of the cancer coming back. In women with advanced breast cancer, chemotherapy can help control the cancer’s growth. Side effects may include hair loss, nausea, fatigue, and a higher risk of infection.



Hormone Therapy for Breast Cancer

Hormone therapy is an effective treatment for women with ER-positive or PR-positive breast cancer. These are cancers that grow more rapidly in response to the hormones estrogen or progesterone. Hormone therapy can block this effect. It is most often used after breast cancer surgery to help keep the cancer from coming back. It may also be used to reduce the chance of breast cancer developing in women who are at high risk.



Targeted Drugs for Breast Cancer

Targeted therapies are newer drugs that target specific properties within cancer cells. For example, women with HER2-positive breast cancer have too much of a protein called HER2. Targeted therapies can stop this protein from promoting the growth of cancer cells. These drugs are often used in combination with chemotherapy. They tend to have milder side effects compared to chemotherapy.



Life After Diagnosis

There’s no doubt that cancer is a life-changing experience. The treatments can wear you out. You may have trouble managing daily chores, work, or social outings. This can lead to feelings of isolation. It’s crucial to reach out to friends and family for support. They may be able to go with you to treatments, help out with chores, or just remind you that you are not alone. Many people choose to join a support group — either locally or online.

Breast Reconstruction

Many women who have a breast removed choose to undergo reconstructive surgery. This replaces the skin, nipple, and breast tissue that are lost during a mastectomy. Reconstruction can be done with a breast implant or with tissue from somewhere else in your body, such as the tummy. Some women opt to begin reconstruction at the same time as their mastectomy. But it’s also possible to have reconstructive surgery months or years later.



Breast Forms

An alternative to breast reconstruction is to be fitted for a breast form. This is a breast-shaped prosthesis that fits inside your bra. Wearing a breast form allows you to have a balanced look when you are dressed — without undergoing additional surgery. Like reconstructive surgery, breast forms are often covered by insurance.



Breast Cancer: Why Me?

The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it is about 100 times more common in women. Other top risk factors include being over age 55 or having a close relative who has had the disease. But keep in mind that up to 80% of women with breast cancer have no family history of the illness.

Breast Cancer Genes

Some women have a very high risk of breast cancer because they inherited changes in certain genes. The genes most commonly involved in breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have up to an 80 percent chance of getting breast cancer at some point in life. Other genes may be linked to breast cancer risk as well.



Risk Factors in Your Control

Being overweight, getting too little exercise, and drinking more than one alcoholic beverage per day can raise the risk of developing breast cancer. Birth control pills and some forms of postmenopausal hormone therapy can also boost your risk. But the risk goes back to normal after these medications are stopped. Among survivors, good lifestyle choices may be helpful. Recent studies suggest that physical activity may help lower the risk of a recurrence and it’s a proven mood-booster.



Breast Cancer Research

Doctors continue to search for more effective and tolerable treatments for breast cancer. The funding for this research comes from many sources, including advocacy groups throughout the country. Many of the 2.5 million breast cancer survivors and their families choose to participate in walk-a-thons and other fundraising events. This links each individual fight against cancer into a common effort for progress.






First, don’t panic. Eighty percent of breast lumps are not cancerous. Lumps often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But you should let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it’s found the better. And if it’s not, testing can give you peace of mind.

ScienceDaily.com, March 29, 2011 — New research into the neurodegenerative disease, multiple sclerosis (MS) offers new insight into the link between sunlight, vitamin D3, and MS risk and severity. The research, published in the European Journal of Immunology, studies the relationship between the sunlight-dependent vitamin D3 hormone, immune cells, and the risk and severity of autoimmunity in an experimental model.

Expensive first-line treatments for MS modestly reduce the frequency of autoimmune attacks but do not slow disease progression, when the patient’s immune system operates against the body’s own tissues. More expensive second-line treatments slow disease progression but carry high risks.

The origin of MS attacks remains unknown. However, new research indicates that a patient’s vitamin D3 supply (derived mainly from sunlight exposure) is strongly related to disease activity; the fewest attacks and slowest progression occurred in patients with the highest vitamin D3 supplies. This research suggests that increasing vitamin D3 supplies might be a safe, effective and inexpensive therapy for MS.

“MS is a genetically and immunologically complex disease,” said lead author Dr. Colleen Hayes from the University of Wisconsin-Madison. “It is currently incurable, but environmental factors, such as vitamin D3, may hold the key to preventing MS and reducing the impact of the disease in MS patients.”

Dr Hayes’ team originally suggested that the sunlight dependent hormone D3 (1,25-dihydroxyvitamin D3) may restrain the autoimmune attacks that cause MS based on the strong negative correlation between sunlight exposure and MS prevalence, the need for UV light to catalyze vitamin D3 formation, and the presence of receptors for the vitamin D3 hormone in T lymphocytes. They proposed that the vitamin D3 hormone might act on these receptors to control the T lymphocytes responsible for autoimmunity.

“Our new study investigated the protective effects of the vitamin D3 hormone in an experimental model of MS when the hormone receptor was either present or absent in T lymphocytes. We found that the hormone’s protective effects were only evident when these receptors were present in autoimmune T lymphocytes. Our new data suggest that an action of the vitamin D3 hormone directly on pathogenic T cells leads to elimination of these cells,” said Hayes. Actions of the vitamin D3 hormone on other immune cells have not been ruled out, but such actions were not sufficient for protection from autoimmunity if the hormone could not act on the pathogenic T cells.

This information is important because it provides a plausible biological explanation for the negative correlation between UV light exposure and MS disease risk and severity,” concluded Hayes. “My research group and others around the world are building the scientific knowledge base needed to devise vitamin D-based strategies to prevent and treat MS” she adds. “There are many uncertainties and unanswered questions. However, understanding how sunlight and vitamin D3 may be working at the molecular level contributes greatly to our knowledge base and brings us closer to the goal of preventing this debilitating disease.”

GoogleNews.com, FORBES.com, March 29, 2011, by Jamie Stengle, DALLAS — Women who enjoy a daily dose of coffee may like this perk. A study suggests drinking at least a cup everyday might lower their risk of stroke.

Women in a Swedish study who drank a cup or more of coffee daily had a 22 to 25 percent lower risk of stroke, compared to those who drank less coffee or none at all.

Doctors say the study shouldn’t send non-coffee drinkers running to their local coffee house. The study doesn’t prove that coffee reduces stroke risk, only that coffee drinkers tend to have a lower stroke risk, and it’s not clear why.

The study followed about 35,000 women for about 10 years. Results of the study were published online Thursday in the American Heart Association’s journal Stroke.

By Andrew Weil MD, March 29, 2011  —  If you or a loved one has wondered if the heat that radiates from a laptop to your lap could have health consequences, you aren’t alone. Investigators at the State University of New York at Stony Brook carried out and published (in the journal Fertility and Sterility online Nov. 3, 2010) a study of 29 young men and how laptop heat affected their scrotal temperatures. (An increase in scrotal temperature by more than one degree Celsius [1.8 degrees Fahrenheit] can have damaging effects on sperm quality.)

The study showed that scrotal temperature increased within 10 to 15 minutes of holding a laptop computer on the lap; after an hour of this, scrotal temperature rose by 2.5 C – even when the men placed a lap pad under the computer.

Overheated testicles can be caused by:

  • Sitting with legs spread wide and a laptop computer placed on the lap, with or without a lap pad (with the lap pad, scrotal temperature will remain cooler for a while, but may edge up in less than 30 minutes)
  • Prolonged bicycling
  • Frequent use of saunas or hot tubs

However, a laptop is not the greatest threat to male fertility – the major causes are defects in reproductive anatomy or physiology, such as a damaged vas deferens (the tube that carries sperm from the testes), disease (including sexually transmitted diseases), hormonal disorders and chemotherapy. In addition to heat, environmental exposures to toxins and some chemicals can impair sperm production. But if you are trying to conceive, keep the laptop on a table or desk – not in the lap – just to be safe.

Online astroturfing is more advanced and more automated than anyone has imagined.

By George Monbiot. Published in the Guardian 23rd February 2011

Every month more evidence piles up, suggesting that online comment threads and forums are being hijacked by people who aren’t what they seem to be. The anonymity of the web gives companies and governments golden opportunities to run astroturf operations: fake grassroots campaigns, which create the impression that large numbers of people are demanding or opposing particular policies. This deception is most likely to occur where the interests of companies or governments come into conflict with the interests of the public. For example, there’s a long history of tobacco companies creating astroturf groups to fight attempts to regulate them.

After I last wrote about online astroturfing, in December, I was contacted by a whistleblower. He was part of a commercial team employed to infest internet forums and comment threads on behalf of corporate clients, promoting their causes and arguing with anyone who opposed them. Like the other members of the team, he posed as a disinterested member of the public. Or, to be more accurate, as a crowd of disinterested members of the public: he used 70 personas, both to avoid detection and to create the impression that there was widespread support for his pro-corporate arguments. I’ll reveal more about what he told me when I’ve finished the investigation I’m working on.

But it now seems that these operations are more widespread, more sophisticated and more automated than most of us had guessed. Emails obtained by political hackers from a US cyber-security firm called HB Gary Federal suggest that a remarkable technological armoury is being deployed to drown out the voices of real people.

As the Daily Kos has reported, the emails show that:

– companies now use “persona management software”, which multiplies the efforts of the astroturfers working for them, creating the impression that there’s major support for what a corporation or government is trying to do.

– this software creates all the online furniture a real person would possess: a name, email accounts, web pages and social media. In other words, it automatically generates what look like authentic profiles, making it hard to tell the difference between a virtual robot and a real commentator.

– fake accounts can be kept updated by automatically re-posting or linking to content generated elsewhere, reinforcing the impression that the account holders are real and active.

– human astroturfers can then be assigned these “pre-aged” accounts to create a back story, suggesting that they’ve been busy linking and re-tweeting for months. No one would suspect that they came onto the scene for the first time a moment ago, for the sole purpose of attacking an article on climate science or arguing against new controls on salt in junk food.

– with some clever use of social media, astroturfers can, in the security firm’s words, “make it appear as if a persona was actually at a conference and introduce himself/herself to key individuals as part of the exercise … There are a variety of social media tricks we can use to add a level of realness to all fictitious personas”

But perhaps the most disturbing revelation is this. The US Air Force has been tendering for companies to supply it with persona management software, which will perform the following tasks:

a. Create “10 personas per user, replete with background, history, supporting details, and cyber presences that are technically, culturally and geographically consistent. … Personas must be able to appear to originate in nearly any part of the world and can interact through conventional online services and social media platforms.”

b. Automatically provide its astroturfers with “randomly selected IP addresses through which they can access the internet.” [An IP address is the number which identifies someone’s computer]. These are to be changed every day, “hiding the existence of the operation.” The software should also mix up the astroturfers’ web traffic with “traffic from multitudes of users from outside the organization. This traffic blending provides excellent cover and powerful deniability.”

c. Create “static IP addresses” for each persona, enabling different astroturfers “to look like the same person over time.” It should also allow “organizations that frequent same site/service often to easily switch IP addresses to look like ordinary users as opposed to one organization.”

Software like this has the potential to destroy the internet as a forum for constructive debate. It makes a mockery of online democracy. Comment threads on issues with major commercial implications are already being wrecked by what look like armies of organised trolls – as you can often see on the Guardian’s sites. The internet is a wonderful gift, but it’s also a bonanza for corporate lobbyists, viral marketers and government spin doctors, who can operate in cyberspace without regulation, accountability or fear of detection. So let me repeat the question I’ve put in previous articles, and which has yet to be satisfactorily answered: what should we do to fight these tactics?



Dear Dr. Mirkin: Does exercise prevent heart attacks during lovemaking?

Yes, and the less often you exercise, the more likely you are to suffer a heart attack during lovemaking or exercise. Researchers checked 14 other studies and found that people who do not exercise, or exercise only occasionally, have a higher risk of suffering a heart attack during exercise or making love (JAMA, March 23/30, 2011). *People who exercise occasionally are three times more likely to suffer heart attacks during exercise than those who exercise regularly, and are five times more likely to die from a heart attack during exercise. *People who do not exercise regularly are 2.7 times more likely to suffer heart attacks while making love.

The more often you exercise, the better the protection. Each additional time a person exercises per week reduces risk for heart attacks during exercise or lovemaking. The chance of suffering a heart attack during exercise is less than two events per 10,000 patient-years. People who exercise only occasionally should check with their doctors, as lack of exercise is a risk factor for a heart attack during any physical activity.

How to Start an Exercise Program

By Gabe Mirkin, M.D., March 28, 2011  — If you want to become fit and use exercise to help prevent a heart attack, first check with your doctor to make sure that you do not have anything wrong with your heart or blood vessels. Intense exercise can increase your risk for a heart attack if you already have a damaged heart.

Pick any sport or activity that uses continuous motion (such as running, cycling, swimming, skating, rowing, dancing) that you think you might enjoy. Start out at a relaxed pace until your muscles feel heavy and then stop. For the first several days or weeks you may be able to exercise only for a few minutes. If your muscles feel sore the next day, take the day off. Increase the amount of time gradually until you can exercise 30 minutes a day at a relaxed pace and not feel sore. Then you are ready to begin your training for fitness. Try to increase the intensity of your exercise once a week. Do your jogging, cycling or whatever you have chosen as your sport at a slow pace to warm up. Then gradually increase the pace until you start to feel short of breath and your muscles start to feel sore, and then slow down. Then when you recover, pick up the pace again. Repeat these surges until your muscles start to stiffen and then quit for the day. Take the next day off and go easy the rest of the week. Then once a week, keep on making your one-day-a-week hard workout harder and harder. You will be continuously increasing your level of fitness.

The only way to strengthen any muscle is to contract the muscle against increasingly greater resistance. Your heart is a muscle, so the only way to make your heart stronger is to contract it against greater resistance. When you exercise, you alternately contract and relax your skeletal muscles. This alternate contraction and relaxation squeezes the veins near the muscles to pump blood toward the heart. Your heart is muscular balloon. The increased flow of blood returning to your heart goes inside the heart to stretch the balloon and the heart has to contract with greater force to pump the blood from inside the heart toward the body. The increased amount of blood inside the heart stretches the heart muscle to make it stronger.

The harder you contract your skeletal muscles, the more blood you pump toward your heart, the greater the stretch on the heart to make it stronger. So fitness is determined more by how hard you exercise than by how much you exercise because the harder you exercise, the stronger your heart muscle becomes. Going out and running 100 miles a week slowly does not make you very fit because you are not strengthening your heart very much with a little increase in circulation of blood, no matter how long you do it. Compare lifting a very light weight a thousand times in a row to lifting a very heavy weight 10 times in a row. The person lifting the heavy weight 10 times will become stronger than the person lifting a light weight a thousand times.

Should You Carry Weights while Walking or Jogging?

Gabe Mirkin, M.D. , March 28, 2011  —  The only advantage to exercising while carrying weights is that you can get more exercise while moving slowly. To strengthen your heart, you have to exercise vigorously enough to increase your heart rate at least 20 beats a minute above resting. How fast your heart beats depends on how much blood it has to pump to your body. When you run and carry hand weights, your heart has to pump blood to your exercising leg muscles and also has to do extra work to pump blood to your arm muscles. That means that you can achieve the same heart rate when you run more slowly.

Competitive runners should never carry hand weights. How fast you run in races depends on how fast you run in practice. Carrying hand weights slows you down, so you become a slower runner. Carrying weights also interferes with the natural motion of your arms while running. On the other hand, carrying weights can help to protect people who develop frequent running injuries. Carrying hand weights slows them down, so less force is directed at their leg muscles while they run. Hand weights will not do much to increase your arm strength; to become stronger, you must lift progressively heavier weights.

Should You Breathe Through Your Nose?

Gabe Mirkin, M.D. , March 28, 2011  —  People who exercise with their mouths closed aren’t working very hard. You can’t get enough air through your nose to meet your needs for oxygen when you exercise vigorously. The cross sectional area of the openings in your nose is less than one tenth the opening in the back of your mouth. That space is so narrow that when you pick up the pace, you could turn blue.

You don’t need to breath through your nose when you exercise in very cold weather. Your nose warms the air much more than your mouth does, but exercise causes your body to produce such large amounts of heat that air taken through your mouth at 40 degrees below zero Fahrenheit during exercise will be warmed almost 100 degrees before it reaches your lungs. Breathing air that cold hurts so much that you lose interest in exercising and seek shelter.

Your nose clears pollutants far more efficiently than your mouth does, but people with healthy lungs can exercise safely on polluted days. Pollutants that you breathe in through your mouth can be quickly cleared from your lungs. Your air tubes are lined with small hairs, called cilia, that sweep pollutants towards your mouth where you swallow them with your saliva and they pass from your body.


Target Health Presenting at the New York Biotechnology Association Annual Meeting


Dr. Jules T. Mitchel, President of Target Health will be chairing a panel at the Annual Meeting of the NY Biotechnology Association, being held at the Marriott Marquis in NYC on April 6-7, 2011. The panel, entitled “Successful Product Development: A Practical Guide,” will be held on April 7 between 8:30 – 9:45 AM. As failure of new therapies in the approval process seriously impact emerging companies, the panel will provide an overview of what it takes to do it right. Please let us know if you plan to attend.


The Panel includes:


Dr. Braham Shroot, CEO, Signum Biosciences
Dr. Richard Clark, The Wound Healing Laboratory, Stony Brook University
Dr. Henry Pan, CEO, Renascions Corporation


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. Target Health’s software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health website at:

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