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Surgeons are no longer removing most of the lymph nodes in the underarm area when a biopsy near the area shows cancer, a major change in breast cancer management, according to a study published in the Journal of the American College of Surgeons.
Researchers evaluated data from 2.7 million patients with breast cancer in the U.S. and learned to what extent surgeons were following recommendations from the American College of Surgeons Oncology Group Z0011, or ACOSOG Z-11 trial, published four years ago.

They reported that most early-stage breast cancer patients with tumors in their sentinel lymph node who undergo lumpectomy do not benefit from surgical removal of the remaining lymph nodes in the underarm area, called completion axillary lymph node dissection or ALND, according to a news release. They found no difference in cancer recurrence and five-year survival between patients who underwent ALND and those who did not.

Researchers found a dramatic increase in the proportion of lumpectomy patients who underwent only a sentinel lymph node biopsy — SNB — without an ALND. The SNB-alone rate more than doubled — from 23% in 2009 to 56% in 2011, according to the study.

“As far as I know, our study is the first to show that the findings from the ACOSOG Z-11 trial have changed clinical practice for breast cancer patients nationwide,” lead author Katharine Yao, MD, FACS, director of the Breast Surgical Program at NorthShore University HealthSystem in Evanston, Ill., and clinical associate professor of surgery at the University of Chicago Pritzker School of Medicine, said in the release. “The Z-11 trial has had a huge impact because of the lower risks for patients who undergo SNB alone.”

Investigators found that 74,309 patients (of the 2.72 million cases diagnosed between 1998 and 2011) met criteria for having SNB alone but underwent lumpectomy and radiation therapy to the whole breast, according to the press release.

The rate of SNB alone cases reportedly increased from 6.1% in 1998 to 56% in 2011. 
Yao said findings suggest that some practitioners may feel uncomfortable not performing ALND in high-risk patients, and called for more education for surgeons.

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Medicine has changed a lot in the past 100 years. But medical training hasn't — until now. Spurred by the need to train a different type of doctor, some top medical schools around the U.S. are tearing up the textbooks and starting from scratch.

Most medical schools still operate under a model pioneered in the early 1900s by an educator named Abraham Flexner.

"Flexner did a lot of great things," says Dr. Raj Mangrulkar, associate dean for medical student education at the University of Michigan Medical School. "But we've learned a lot and now we're absolutely ready for a new model."

Michigan is one of many med schools in the midst of a major overhaul of their curricula.

For example, in a windowless classroom, a small group of second-year students is hard at work. The students are not studying anatomy or biochemistry or any of the traditional sciences. They're polishing their communication skills.

In the first exercise, students paired off and negotiated the price of a used BMW. Now they're trying to settle on who should get credit for an imaginary medical journal article.

"I was thinking, kind of given our background and approach, that I would be senior author. How does that sound to you?" asks Jesse Burk-Rafel, a second-year student from Washington state.

His partner, also a second-year student, objects; he also wants to be senior author. Eventually they agree to share credit, rotating whose name comes first on subsequent papers related to the imaginary research project.

It may seem an odd way for medical students to be spending their class time. But Dr. Erin McKean, the surgeon teaching the class, says it's a serious topic for students who will have to communicate life and death matters during their careers.

"I was not taught this in medical school myself," says McKean. "We haven't taught people how to be specific about working in teams, how to communicate with peers and colleagues and how to communicate to the general public about what's going on in health care and medicine."

It's just one of many such changes, and it's dramatically different from the traditional way medicine has been taught. Flexner's model is known as "two plus two." Students spend their first two years in the classroom memorizing facts. In their last two years, med students shadow doctors in hospitals and clinics. Mangrulkar says Flexner's approach represented a huge change from the way doctors were taught in the 19th century.

"Literacy was optional, and you didn't always learn in the clinical setting," he says. Shortly after Flexner published his landmark review of the state of medical education, dozens of the nation's medical schools closed or merged.

But today, says Mangrulkar, the two-plus-two model doesn't work. For one thing, there's too much medical science for anyone to learn in two years. And the practice of medicine is constantly in flux.

What Michigan and many other schools are trying to do now is prepare future doctors for the inevitable changes they'll face throughout a long career.

"We shouldn't even try to predict what that system's going to be like," he says. "Which means we need to give students the tools to be adaptable, to be resilient, to problem-solve — push through some things, accept some things, but change other things."

One big shift at many schools is a focus on how the entire health system works — rather than just training doctors how to treat patients.

Dr. Susan Skochelak, a vice president with the American Medical Association, is in charge of an AMA project that is funding changes at 11 schools around the country. She says the new teaching focus on the health care system has had an added benefit: Faculty members are learning right along with the students about some of the absurdities.

For example, she says, only because they have to guide students through the system do they discover things like the fact that some hospitals schedule patients for MRI and other tests around the clock.

"And one of my patients had to come and get their MRI at 3 a.m.," Skochelak says. " 'How do they do that?' " she says a faculty member asked her. " 'Do they have kids?' "

Physicians aren't always the best teachers about how the system works.

Doctors tend to focus on patient care, since that's what they know. However, Skochelak says, "If you hook [students] up with a clinic manager when you want them to learn about the system and what the system does, then the clinic manager focuses on the system."

Another major change to medical education aims at helping future doctors work as team players, rather than as the unquestioned leaders.

In a classroom at the University of California, San Francisco, several groups of students practice teamwork by working together to solve a genetics problem.

Joe Derisi, who heads the biochemistry and biophysics department at UCSF, is guiding more than teaching when he gently suggests a student's tactic is veering off course. "I would argue that it may not be as useful as you think," he tells the student. "But I'm obliging."

Onur Yenigun, one of the students in the class, says that working with his peers is good preparation for being part of a team when he's a doctor.

"When I'm in a small group I realize that I can't know everything," Yenigun says. "I won't know everything. And to be able to rely on my classmates to fill in the blanks is really important."

The medical schools that are part of the AMA project are already sharing what they've learned with each other. Plans are in the works, as well, to begin sharing some of the more successful changes with other medical schools around the country.

Written by Honor Whiteman

www.medicalnewstoday.com

Researchers have identified a signal in the amygdala brain region of young children that stimulates aversion to the opposite sex and induces interest in the opposite sex as children enter puberty.

Published in the Journal of Cognitive Neuroscience, the study challenges previous beliefs about the role of the amygdala, according to the researchers.

Lead investigator Eva Telzer, of the University of Illinois at Urbana-Champaign, says the amygdala was once believed to be a threat detector. "But increasing evidence indicates that it is activated whenever someone detects something meaningful in the environment," she notes. "It is a significance detector."

To reach their findings, Telzer and her team enrolled 93 youths aged 7-17 years to the study and assessed their attitudes toward children of the same sex and of the opposite sex. 

In addition, the researchers used functional magnetic resonance imaging (fMRI) to assess the brain activity of 52 youths aged 4-18 as they viewed same- and opposite-sex faces.

Amygdala activity wanes between the ages of 10 and 12

The team found that young children aged 4-7 years had more negative attitudes toward the opposite sex - a finding they say supports the "cooties" phenomenon, in which young children steer clear of the opposite sex with the belief that they may "contaminate" them if they get too close.

"Only the youngest children in our sample demonstrated a behavioral sex bias such that they rated same-sex peers as having more positive (and less negative) attributes than opposite-sex peers," say the researchers.

Interestingly, children of this age showed increased brain activity in the amygdala region of the brain as they viewed faces of the opposite sex. "And so we think the amygdala is signaling the significance of cooties at this developmental period," says Telzer.

The researchers found that among children between ages of 10 and 12, there was no difference in the amygdala's response to same- and opposite-sex faces.

However, they saw a significant increase in amygdala response to the opposite sex from 12 years onwards - just as children begin to enter puberty. The researchers say this may correspond with the "crush" phenomenon, in which pubescent youths become captivated with the opposite sex.

"When puberty hits, gender becomes more significant again, whether it's because your body is changing, or because of sexual attraction or you are becoming aware of more rigid sexual boundaries as you become more sexually mature," says Telzer. "The brain is responding very appropriately, in terms of what's changing developmentally."

In May 2014, Medical News Today reported on a study published in the Proceedings of the National Academy of Sciences, in which researchers found changes in cerebral blood flow levels differ between girls and boys during puberty, with such levels rising in girls and reducing in boys.

The researchers of that study - led by Dr. Theodore Satterthwaite of Perelman School of Medicine at the University of Pennsylvania - say the findings were linked to higher risk of anxiety in females and increased risk of schizophrenia in males.

"These findings help us understand normal neurodevelopment and could be a step toward creating normal 'growth charts' for brain development in kids," says Dr. Satterthwaite. "These results also show what every parent knows: boys and girls grow differently. This applies to the brain as well."

By Elizabeth Cohen and John Bonifield

www.cnn.com

Today, because of a CNN story and the generosity of donors from around the world, Kekula wears scrubs bearing the emblem of the Emory University Nell Hodgson Woodruff School of Nursing in Atlanta, where she's learning skills she can take back home to care for her fellow Liberians. 

"It's a surprise -- a young child like me who came from a very poor background coming to the U.S.," she said. "I'm thankful to CNN and I appreciate the people who made donations, and I'm thankful to Emory for accepting me to study."

At Emory, Kekula has asked for special training on certain skills, such as caring for burns, a common type of injury because children in Liberia sometimes fall into the open fires used for cooking. 

One of her instructors, Kelly Fullwood, said Kekula's an excellent student who has taught her teachers a thing or two about how to do procedures without costly equipment, as she's been forced to do in Liberia. 

"She fascinates me every day," Fullwood said. "She gets nursing. She gets what it's about."

Kekula, 23, was just a year away from finishing up her nursing degree in Liberia when Ebola struck and her mother, father, sister and cousin came down with the disease. Hospitals were full and no doctors would visit her home, so with just advice from a physician on the phone, Kekula took care of all four of her relatives at the same time. 

All but her cousin survived -- a high success rate considering that at the time, about 70% of Ebola patients were dying in Liberia.

Kekula couldn't continue her nursing education in Liberia, because the schools had closed. 

A CNN story about Kekula in September prompted donations from around the world to IAM, an organization that raises money to help African natives pay for education. 

David Smith, an associate dean at Emory's nursing school, said they accepted Kekula because they were struck by how both she and Emory each treated four Ebola patients at around the same time last year -- and Emory had dozens of doctors and nurses and millions of dollars in technology while Kekula had nobody and nearly no supplies.

"It was obvious to us that this woman was intelligent and strong and fearless," he said. 

Kekula is scheduled to return to Liberia in August. 

"These things that I have learned here I am going to take back to my fellow nurses," she said. "I love to care for people. I love to save lives."

www.sunnyskyz.com 

Matt and Danielle Davis had been married only seven months when a devastating motorcycle accident left Matt on life support and in a coma.

Given only a 10% chance of waking up, Davis told WTOC that doctors advised her to pull the plug on her husband. She recalled hearing them say, "That's what they'd want their family to do."

Danielle refused to give up on him. "We didn't really have a chance to start our life together, I wasn't going to give up."

Matt spent three months in the coma, and moved from the hospital to their home where Danielle cared for him 24/7.

Then one day, against all odds, Matt said, "I'm trying."

He eventually came out of his coma, but he didn't remember anything that had happened in the last three years. He retained no memory of his father's death, or even meeting and marrying his wife.

But in the time that has passed since the accident, Matt has made amazing progress. Physical therapy has helped him learn to walk again.

They play scrabble and enjoy going to yoga classes together, and he's recently started driving a stick shift car for fun because he loves cars.

"One conversation with Matt will change your life," Danielle shared. "He has a servant's heart and a love for people. He never complains or feels anger about his circumstance. He just wants to make a difference and give hope."

The couple is currently trying to raise funds for Matt to continue his therapy.

JOE PALCA

www.npr.org 

A promising technique for making brain tumors glow so they'll be easier for surgeons to remove is now being tested in cancer patients.

Eighteen months ago, Shots first told readers about tumor paint, an experimental substance derived from scorpion venom. Inject tumor paint into a patient's vein, and it will actually cross the blood-brain barrier and find its way to a brain tumor. Shine near-infrared light on a tumor coated with tumor paint, and the tumor will glow.

The main architect of the tumor paint idea is a pediatric oncologist named Dr. Jim Olson. As a physician who treats kids with brain cancer, Olson knows that removing a tumor is tricky.

"The surgeons right now use their eyes and their fingers and their thumbs to distinguish cancer from normal brain," says Olson. But poking around in someone's brain with only those tools, it's inevitable surgeons will sometimes miss bits of tumor or, just as bad, damage healthy brain cells.

So Olson and his colleagues at the Fred Hutchinson Cancer Center in Seattle came up with tumor paint. They handed off commercial development of the compound to Blaze Bioscience.

After initial studies in dogs showed promise, the company won approval to try tumor paint on human subjects. Those trials are taking place at the Cedars Sinai Medical Center in Los Angeles.

Dr. Chirag Patil is one of those surgeons. He says it's remarkable that you can inject tumor paint into a vein in a patient's arm, have it go to the brain and attach to a tumor, and only a tumor. "That's a concept that neurosurgeons have probably been dreaming about for 50 years," he says.

Patil says they've now used tumor paint on a about a half dozen patients with brain tumors. They use a special camera to see if the tumor is glowing.

"The first case we did was a deep tumor," says Patil. "So with the camera, we couldn't really shine it into this deep small cavity. But when we took that first piece out and we put it on the table. And the question was, 'Does it glow?' And when we saw that it glows, it was just one of those moments ...'Wow, this works.' "

In this first study of tumor paint in humans, the goal is just to prove that it's reaching the tumor. Future studies will see if it actually helps surgeons remove tumors and, even more importantly, if it results in a better outcome for the patient.

That won't be quick or easy. Just getting to this point has been a long slog, and there are bound to be hurdles ahead.

And even if tumor paint does exactly what it's designed to do, Dr. Keith Black, who directs neurosurgery at Cedars-Sinai, says it probably isn't the long-term solution to brain cancer. "Because surgery is still a very crude technique," he says.

Even in the best of circumstances, Black says, surgery is traumatic for the patients, and tracking down every last cell of a tumor is probably impossible. Plus, it's inevitable that some healthy brain tissue will be damaged in removing the tumor.

"Ultimately, we want to eliminate the need to do surgery," says Black. A start in that direction will be to use a compound like tumor paint to deliver not just a dye, but an anti-cancer drug directly to a tumor. That's a goal several research groups, including Jim Olson's, are working on.

By Laura Geggel

www.foxnews.com

A boy in Canada mysteriously became allergic to fish and nuts after he received a blood transfusion, according to a new case report.

The 8-year-old boy had no history of being allergic to any foods, and was undergoing treatment for medulloblastoma, a type of brain cancer. A few weeks after receiving a blood transfusion, he experienced a severe allergic reaction called anaphylaxis within 10 minutes of eating salmon, according to the report, published online April 7 in the Canadian Medical Association Journal.

His doctors suspected that the blood transfusion had triggered the reaction, they wrote in the report. After treating the patient with a drug containing antihistamines, the doctors advised him to avoid fish and to carry an epinephrine injector in case he had another reaction. [9 Weirdest Allergies]

But four days later, the boy was back in the emergency department after eating a chocolate peanut butter cup. Blood tests and a skin prick test suggested that he was allergic — at least temporarily — to peanuts and salmon, so his doctors advised him to avoid nuts and fish.

"It's very rare to have an allergic reaction to a previously tolerated food," said the report's senior author, Dr. Julia Upton, a specialist in clinical immunology and allergy at the Hospital for Sick Children in Toronto. "The overall idea is that he wasn't allergic to these foods," but in the blood transfusion, he received the protein that triggers an allergic reaction to them, she said.

That protein, called immunoglobulin E, is an antibody associated with food allergies, Upton said. When it encounters a specific allergen, it causes immune cells to release chemicals such as histamine that lead to an allergic reaction. 

However, because the boy's body itself did not make such antibodies against fish and nuts, his doctors said they suspected his allergies would go away within a few months.

Acquiring allergies from a blood donor is rare, but not without precedent. The researchers found two other case reports, both in adults, in which patients acquired temporary allergies from blood plasma. In a 2007 case, an 80-year-old woman had an anaphylactic reaction to peanuts. An investigation showed that her 19-year-old plasma donor had a peanut allergy, according to the report in the journal Archives of Internal Medicine.

In the new case, the 8-year-old also received plasma, the liquid part of blood that contains antibodies. The researchers inquired about the donor to Canadian Blood Services, and found that the donor did have an allergy to nuts, fish and shellfish. The service did not have any more blood from the donor, and subsequently excluded the individual from making future donations, the researchers said. 

About five months later, blood tests showed that the boy's immunoglobulin E levels to salmon and peanut were undetectable. By six months, his parents had gradually and successfully reintroduced nuts and fish back into their son's diet.

However, Upton said, "In general, we would recommend that this be done under medical supervision," just in case there is a medical emergency.

It's unclear how doctors could prevent future cases, she said. Neither Canadian nor American blood service organizations bar people with allergies from donating blood. And testing donated blood for levels of immunoglobulin E doesn't always predict allergies. Some people with high levels of immunoglobulin E don't have allergies, and others with low levels of the protein do, she said.

"Clearly, the safety of the [blood] supply is of everyone's utmost concern," but more research is needed to determine how best to avoid the transfer of allergies, and how frequently this happens, Upton said.

"I think it's hard to make sweeping recommendations based on one case report," Upton said.

In the United States, "If a donor is feeling well and healthy on the day of donation, they are typically eligible to donate," said Dr. Courtney Hopkins, the acting chief medical officer for the east division of the American Red Cross. "We will defer donors on the day of donation if they are not feeling well and healthy, if they have a fever, or if we notice they have problems breathing through their mouth."

Donors can learn more about blood-donation eligibility here. Individuals with allergies shouldn't be dissuaded from donating, Hopkins added.

"We always need blood. We always need blood donors," Hopkins told Live Science.

Written by James McIntosh

www.medicalnewstoday.com 

Researchers testing the origins of human breast milk samples available for purchase online found that around 10% of the samples they examined contained significant amounts of added cow's milk.

The pressure on parents to feed newborn infants with breast milk may be leading many to purchase human breast milk online. However, the milk they receive from online vendors may not match up to what is being offered.

"They purchase the milk online based on a posted description of the type and quantity of the milk or the health habits of the seller," writes study author Dr. Sarah Keim. "But when they think they're getting nutritious, high-quality breast milk, some of them are actually receiving human milk mixed with cow's milk."

Human breast milk is widely recognized as providing many health benefits to young infants. According to the American Academy of Pediatrics (AAP), breastfeeding can protect against diseases and conditions such as diarrhea, diabetes and childhood obesity.

However, many new mothers find themselves unable to breastfeed. In 2012, a survey published in Pediatrics found that two-thirds of mothers nursing newborns are unable to manage breastfeeding for as long as they intended.

"Some women are unable to produce enough milk for their infant or perceive they cannot meet their infant's needs, yet they may be reluctant to feed formula," write the researchers of the new study. For these mothers, the Internet represents an alternative way of providing human milk for their children.

'You do not truly know what you are receiving'

For the study, published in Pediatrics, Dr. Keim and her colleagues purchased 102 samples of what was advertised as human milk from sellers on the Internet. These milk samples were subjected to DNA testing in order to verify their human origins and to assess whether any cow's milk was also present.

While all of the purchased Internet samples contained human DNA, 11 also contained bovine DNA. Of these, 10 contained bovine DNA concentrations significant enough to suggest that cow's milk had been added to human milk, being so high that accidental contamination was unlikely.

The inclusion of cow's milk in human breast milk can be problematic for babies. It can potentially be harmful due to cow's milk allergies, health conditions or formula sensitivities. The inclusion of cow's milk could also reduce a baby's access to the essential nutrients and fats that are in formulas and human breast milk but not cow milk.

"The truth of the matter is that you do not truly know what you are receiving when you buy milk from a stranger over the Internet," explains Dr. Keim.

"Selling breast milk gives people an incentive to add cow's milk or formula to the milk in order to sell more. When money is involved in an unregulated process like this, you cannot know for sure that the milk is safe to give to your baby."

Although the sample used in the study is acknowledged as small by the authors, they state the sample is representative of Internet sellers and has given the researchers findings that may at least generalize to milk being sold via the Internet.

"Our findings confirm the previously theoretical risk that human milk being sold via the Internet may not be 100% human milk," the authors conclude. "Because buyers have little means to verify the composition of the milk they receive, all should be aware of the possibility that it may be adulterated."

Previously, in a report published in The BMJ, experts claimed that breast milk purchased online can pose serious health risks to infants, largely due to a lack of regulation. Human milk is not tested for contamination or disease and could be stored incorrectly.

www.sciencedaily.com

Pushing new frontiers in dementia research, Nanyang Technological University, Singapore (NTU Singapore) scientists have found a new way to treat dementia by sending electrical impulses to specific areas of the brain to enhance the growth of new brain cells.

Known as deep brain stimulation, it is a therapeutic procedure that is already used in some parts of the world to treat various neurological conditions such as tremors or Dystonia, which is characterised by involuntary muscle contractions and spasms.

NTU scientists have discovered that deep brain stimulation could also be used to enhance the growth of brain cells which mitigates the harmful effects of dementia-related conditions and improves short and long-term memory.

Their research has shown that new brain cells, or neurons, can be formed by stimulating the front part of the brain which is involved in memory retention using minute amounts of electricity.

The increase in brain cells reduces anxiety and depression, and promotes improved learning, and boosts overall memory formation and retention.

The research findings open new opportunities for developing novel treatment solutions for patients suffering from memory loss due to dementia-related conditions such as Alzheimer's and even Parkinson's disease.

This discovery was published in eLife, a peer-reviewed open-access scientific journal published by the Howard Hughes Medical Institute, the Max Planck Society and the Wellcome Trust.

Assistant Professor Ajai Vyas from NTU's School of Biological Sciences said, "The findings from the research clearly show the potential of enhancing the growth of brain cells using deep brain stimulation.

"Around 60 per cent of patients do not respond to regular anti-depressant treatments and our research opens new doors for more effective treatment options."

Dr Lim Lee Wei, an associate professor at Sunway University, Malaysia, who worked on the research project while he was a Lee Kuan Yew Research Fellow at NTU, said that deep brain stimulation brings multiple benefits.

"No negative effects have been reported in such prefrontal cortex stimulation in humans and studies have shown that stimulation also produces anti-depression effects and reduces anxiety.

"Memory loss in older people is not only a serious and widespread problem, but signifies a key symptom of dementia. At least one in 10 people aged 60 and above in Singapore suffer from dementia and this breakthrough could pave the way towards improved treatments for patients."

Growing new brain cells

For decades, scientists have been finding ways to generate brain cells to boost memory and learning, but more importantly, to also treat brain trauma and injury, and age-related diseases such as dementia.

As part of a natural cycle, brain cells constantly die and get replaced by new ones. The area of the brain responsible for generating new brain cells is known as the hippocampus, which is also involved in memory forming, organising and retention.

By stimulating the front part of the brain known as the prefrontal cortex, new brain cells are formed in the hippocampus although it had not been directly stimulated.

The research was conducted using middle-aged rats, where electrodes which sends out minute micro-electrical impulses were implanted in the brains. The rats underwent a few memory tests before and after stimulation, and displayed positive results in memory retention, even after 24 hours.

"Extensive studies have shown that rats' brains and memory systems are very similar to humans," said Prof Ajai who is a recipient of NTU's prestigious Nanyang Assistant Professorship award.

"The electrodes are harmless to the rats, as they go on to live normally and fulfil their regular (adult) lifespan of around 22 months."

The research was funded by the Lee Kuan Yew Research Fellowship which supports and promotes young and outstanding researchers in their respective areas of specialisation.