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Specialized System Speeds Heart Attack Treatment By Ed Edelson HealthDay Reporter , HealthDay Posted: 2008-01-16 17:09:39 WEDNESDAY, Jan. 16 (HealthDay News) -- A citywide system in Ottawa, Canada, designed to rush heart attack patients to a specialized center for artery-opening treatment dramatically cut the time it took to perform the potentially lifesaving procedure, cardiologists report. The procedure is balloon angioplasty, in which a balloon is threaded into a blood vessel and inflated to restore flow in a coronary vessel blocked by a clot. The American Heart Association has set a goal of no more than 90 minutes from diagnosis of a heart attack to angioplasty. And that goal was met for almost 80 percent of the cases handled by specially trained paramedics, according to a report in the Jan. 17 issue of the New England Journal of Medicine. "We have developed a system in which the paramedics do an ECG [electrocardiogram] in the field," said Dr. Michel R. Le May, professor of medicine at the University of Ottawa Heart Institute, and lead author of the report. "They call through a dedicated cell phone line to the Heart Institute to notify the STEMI team that they are arriving. Then, they go straight to the catheter lab." STEMI stands for ST-segment elevation myocardial infarction, the deadliest kind of heart attack, and the catheter lab is where angioplasty is done. The average "door-to-balloon time" for the 135 heart attack patients handled by that specialized system for the year beginning May 1, 2005, was 69 minutes. By contrast, time to treatment for the 209 patients sent from emergency rooms was 123 minutes. That produced a difference in survival numbers, with six deaths in the following six months for people treated through the paramedic system (4.4 percent), compared to 12 deaths (5.7 percent) for those who went through emergency rooms. The survival figures should be regarded cautiously, Le May said, in part because the numbers were small, and a number of factors affect survival. A good deal of coordination was needed to set up the system, he said. Ottawa, a city of 800,000, has four major hospitals, and all agreed to have heart attacks handled by the Heart Institute, rather than sending patients to the nearest hospital. Paramedics had to be trained to do electrocardiograms in the field, which was done in collaboration with the four hospitals, and the special telephone lines had to be established, the report said. The program also includes treatment "in all aspects of cardiology," such as advice on diet and exercise, as well as smoking cessation when necessary, Le May said. Drug therapy for risk factors such as high cholesterol levels and blood pressure is started in the hospital and continued at home. Careful planning would be needed to start a similar system in a larger city, Le May said. "In a city with multiple catheter labs, you would have to get cardiologists together to work out a way for patients to be directed to catheter labs," he said. "You would have to sit down and develop specific pathways -- this hospital on this day, that hospital on that day." And while Ottawa's improvement in survival may not be definitive, "we know from larger studies that there is a good correlation between lower door-to-balloon time and lower mortality," Le May said. Dr. Alice Jacobs, professor of medicine at Boston University and a spokeswoman for the American Heart Association, said the Ottawa system fits right in with the heart association's program to improve care for STEMI patients. "The American Heart Association understands that there is not a 'one-size-fits-all' solution," Jacobs said. Local affiliates of the association "are being convened into task forces that are identifying ways to establish national recommendations for STEMI systems on a local level in view of geography, resources and existing legislation and regulation." It's also "critically important" for people to know what to do when a heart attack occurs in their presence, Jacobs said. She stressed "the importance of avoiding delays at the onset of symptoms and activating the Emergency Medical Service by calling 911, rather than driving themselves, or being driven by family or friends, to the emergency department." More information To learn more about the warning signs of a heart attack and what to do, visit the American Heart Association. SOURCES: Michel R. Le May, M.D., professor of medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Alice Jacobs, M.D., professor of medicine, Boston University, and spokeswoman, American Heart Association; Jan. 17, 2008, New England Journal of Medicine HealthDay Logo --- Copyright © 2008 ScoutNews, LLC. All rights reserved. 01/16/2008 17:00 EST

Genetic Mutations

Genetic Mutations Boost Prostate Cancer Risk By Steven Reinberg HealthDay Reporter , HealthDay Posted: 2008-01-16 17:09:39 WEDNESDAY, Jan. 16 (HealthDay News) -- A new blood test that looks at five genetic variants could one day predict the risk of developing prostate cancer, a new study says. Researchers found that among men with four of the five variants, the risk of prostate cancer is increased 400 percent to 500 percent, compared to men with none of the variants. And if a man has these gene variants and a family history of prostate cancer, his risk of developing the disease increases more than 900 percent. "There are five genetic variants that have been shown to be associated with prostate cancer risk," said lead researcher Dr. Jianfeng Xu, a professor of epidemiology and cancer biology at Wake Forest University School of Medicine. For the study, the researchers examined DNA samples from 2,893 men with prostate cancer and compared them with DNA of 1,781 healthy men. All the men participated in a prostate cancer study in Sweden. The researchers found that each of these common genetic variants was independently associated with prostate cancer risk. The five variants plus a family history of prostate cancer accounted for 46 percent of prostate cancer patients. The effect of each variant is too small to be useful in predicting the risk for prostate cancer, Xu said. "But if you have four of these variants your risk is increased fourfold, which is something we have never seen before," he said. The five genetic locations include three on chromosome 8q24, one on chromosome 17q12, and one on chromosome 17q24.3, according to the report, published online Jan. 16 in the New England Journal of Medicine. When family history of prostate cancer is added to the mix, the results become more striking, Xu said. "Family history is the sixth factor," he said. "For a man with five gene variants and a family history the risk is increased tenfold." Xu thinks that by using these gene variants and family history as a guide, "we can use this information to predict which men have a risk of developing prostate cancer." Currently, age, race and family history are the three risk factors associated with increased risk of prostate cancer. The researchers said the study is important because it's one of the first to show how a combination of several genes can affect disease risk. Genomics teams across the United States are looking for combinations of genes that may contribute to common diseases such as cancer, diabetes and asthma, according to background information for the study. Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, said the findings are important, but it's not yet clear how they could be used in clinical practice. "This study is helping us understand the role of genetic variants in the risk for prostate cancer," Brooks said. But, he added, "If you develop a test and tell a man you have five times the risk of developing prostate cancer as other men, what do you do with that?" Brooks also noted that these genetic variants don't indicate if the disease is aggressive and needs aggressive treatment, or if it's a slow-growing cancer that may not need immediate treatment. "We still need to find markers of disease aggressiveness. We still need better treatments," he said. Prostate cancer is the most common type of cancer in American men, other than skin cancer. It is the second leading cause of cancer death in men, behind lung cancer, according to the American Cancer Society. The society estimates that there will be about 218,890 new cases of prostate cancer in the United States this year, and about 27,050 men will die of the disease. More information To learn more about prostate cancer, visit the U.S. National Cancer Institute. SOURCES: Jianfeng Xu, M.D., Dr.PH., professor, public health and cancer biology, Wake Forest University School of Medicine, Winston-Salem, N.C.; Durado Brooks, M.D., director, prostate and colorectal cancer, American Cancer Society, Atlanta; Jan. 16, 2008, New England Journal of Medicine, online

Is it Safe to Eat?

Cloned Animals Are Safe to Eat, FDA Says By LAURAN NEERGAARD, AP Posted: 2008-01-16 11:01:12 Filed Under: Health, Healthy Living WASHINGTON - Meat and milk from cloned animals is as safe as that from their counterparts bred the old-fashioned way, the Food and Drug Administration said -- but sales still won't begin right away. cow The decision removes the last big U.S. regulatory hurdle to marketing products from cloned livestock, and puts the FDA in concert with recent safety assessments from European food regulators and several other nations. "Meat and milk from cattle, swine and goat clones are as safe as food we eat every day," said Dr. Stephen Sundloff, FDA's food safety chief. But the government has asked animal cloning companies to continue a voluntary moratorium on sales for a little longer - not for safety reasons, but marketing ones. USDA Undersecretary Bruce Knight called it a transition period for "allowing the marketplace to adjust." He wouldn't say how long the moratorium should continue. "This is about market acceptance," Knight added, who said he would be calling a meeting of industry leaders to determine next steps. Regardless, it still will be years before many foods from cloned animals reach store shelves, for economic reasons: At $10,000 to $20,000 per animal, they're a lot more expensive than ordinary cows, meaning producers likely will use clones' offspring for meat, not the clone itself. And several large companies - including dairy giant Dean Foods Co. and Hormel Foods Corp. - have said they have no plans to sell milk or meat from cloned animals because of consumer anxiety about the technology. But FDA won't require food makers to label if their products came from cloned animals, although companies could do so voluntarily if they knew the source. Last month, meat and dairy producers announced an industry system to track cloned livestock, with an electronic identification tag on each animal sold. Customers would sign a pledge to market the animal as a clone. But that system is voluntary, and there is no way to tell if milk, for example, came from the daughter of a cloned cow. "Both the animals and any food produced from those animals is indistinguishable from any other food source," Sundloff said. "There's no technological way of distinguishing a food that's come from an animal that had a clone in its ancestry. It's not possible." The decision was long-expected, but controversial. Debate has been fierce within the Bush administration as to whether the FDA should move forward, largely because of trade concerns. Consumer advocates petitioned against the move, and Congress had passed legislation urging the FDA to study the issue more before moving ahead. "The FDA has acted recklessly," said Sen. Barbara Mikulski, D-Md., who sponsored that legislation. "Just because something was created in a lab, doesn't mean we should have to eat it. If we discover a problem with cloned food after it is in our food supply and it's not labeled, the FDA won't be able to recall it like they did Vioxx - the food will already be tainted. "If you ask what's for dinner, it means just about anything you can cook up in a laboratory," said Carol Tucker-Foreman of the Consumer Federation of America, who pledged to push for more food producers to shun clones. The two main U.S. cloning companies, Viagen Inc. and Trans Ova Genetics, already have produced more than 600 cloned animals for U.S. breeders, the vast majority cattle, including copies of prize-winning cows and rodeo bulls. "We certainly are pleased," said Trans Ova President David Faber, who noted that previous reports by the National Academy of Sciences and others have reached the same conclusion. "Our farmer and rancher clients are pleased because it provided them with another reproductive tool," he added. It was a day forecast since Scottish scientists announced in 1997 that they had successfully cloned Dolly the sheep. Ironically, sheep aren't on the list of FDA's approved cloned animals; the agency said there wasn't as much data about their safety as about cows, pigs and goats. By its very definition, a successfully cloned animal should be no different from the original animal whose DNA was used to create it. But the technology hasn't been perfected - and many attempts at livestock cloning still end in fatal birth defects or with deformed fetuses dying in the womb. Moreover, Dolly was euthanized in 2003, well short of her normal lifespan, because of a lung disease that raised questions about how cloned animals will age. The FDA's report acknowledges that, "Currently, it is not possible to draw any conclusions regarding the longevity of livestock clones or possible long-term health consequences" for the animal. But the agency concluded that cloned animals that are born healthy are no different than their non-cloned counterparts, and go on to reproduce normally as well. "The FDA says, 'We assume all the unhealthy animals will be taken out of the food supply,'" said Joseph Mendelson of the Center for Food Safety, a consumer advocacy group that opposes FDA's ruling. "They're only looking at the small slice of cloned animals that appear to be healthy. ... It needs a lot further study."
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