A new Israeli device the ReWalk -- worn like an exoskeleton and maneuvered with crutches -- promises to give mobility to paraplegics. The company developing it, Argo Medical Technologies, has made news that has circled the globe.

Cancer researchers have known for years that it was possible in rare cases for some cancers to go away on their own. There were occasional instances of melanomas and kidney cancers that just vanished. And neuroblastoma, a very rare childhood tumor, can go away without treatment.
The New York Times

Danish researchers have found that statins, the drugs widely used to control cholesterol, may have another beneficial effect: lowering the risk of death from pneumonia.
The New York Times

Older adults whose parents lived 100 years or longer are healthier than others their age and have dramatically lower risks of heart attack, stroke, diabetes or dying from any other cause, researchers at the Boston University School of Medicine report in a new study.
The New York Times

Medicare patients started on a thiazolidinedione for diabetes had a higher mortality rate and were more likely to develop congestive heart failure if given rosiglitazone (Avandia) than pioglitazone (Actos), researchers here reported.
MedPage Today

Medical expert: Glenn Smith, Ph.D.
Total time: 0:07:52 minutes

TheMayoClinic.com - Podcast

Author Sara Davidson talks to two medical scientists about how the body ages and the research on trying to extend our healthy life span.
The New York Times - Magazine - Video interview

This morning’s WSJ tells the story of Brian Kammerer who developed Alzheimer’s in his 40s, and the toll the illness takes on him and his family.

Early on, the CFO for a hedge fund forgets what a stapler is and calls his wife from the bathroom for help identifying it. He winds up unemployed. He stops driving.

Even now, at 51, his math skills remain sharp, but he has trouble recognizing neighbors he has known for two decades. Sometimes, he takes a cab to a nearby golf course without telling anyone and hitches a ride back from a stranger, says his wife, Kathy.

Some half a million Americans are living with early-onset Alzheimer’s, the WSJ says. An explainer from the federal Agency for Health Research and Quality gives some signs that go beyond basic loss of short-term memory:

• Problems finding or saying the right word.
• Inability to recognize objects.
• Forgetting how to use simple, ordinary things, such as a pencil.
• Forgetting to turn off the stove, close windows, or lock doors.

Now, just because you have occasional lapses — forgetting a name, leaving a window open — it doesn’t mean you have Alzheimer’s.

And, AHRQ reminds us, many cases of dementia aren’t Alzheimer’s. Often, they’re caused by factors that can be modified, such as depression, alcohol, or medication.

WSJ reporter Shirley Wang talks with Kathy Kammerer about the warning signs for her husband’s Alzheimer’s in this podcast.

The Wall Street Journal

Early-Onset Sufferers Juggle Children, Job and Dementia

Brian Kammerer, the 45-year-old chief financial officer of a small hedge fund, called his wife one day from a cellphone in the men's room of his Manhattan office building. A colleague had just asked him for something, he whispered, but he had no idea what it was.

"It clicks and it holds papers together," he said.

"A stapler?" Kathy Kammerer asked.

"I think that's what it's called," he replied.

Soon after that exchange in early 2003, the father of three was diagnosed with Alzheimer's disease, capping nearly five years of uncertainty and fear about his increasing forgetfulness and difficulty with language.

While most people who get Alzheimer's are over 65, Mr. Kammerer is one of about 500,000 Americans living with Alzheimer's or other dementias at an atypically young age. Alzheimer's takes a long time to develop -- usually, it isn't diagnosed until 10 years after the first symptoms appear -- but more Americans are identifying it early, thanks in part to aggressive screening programs pushed in recent years by groups including the Alzheimer's Foundation of America, a national alliance of caregivers.

The disease can be especially torturous when it creeps up on those in their 30s and 40s. As these patients move through Alzheimer's early stages, they are forced to cope with the dread of not knowing what is happening to them, often in the years when they're raising young children and building financial security. As the disease progresses, there are slip-ups to cover, appearances to keep up. When these "early onset" Alzheimer's sufferers are finally diagnosed, they face hard questions -- whom to tell and when, and what these divulgences mean for their jobs and health insurance.

There are no Alzheimer's cures now on the market. Current medications mitigate some symptoms but don't slow or halt the disease's progression. Pharmaceutical companies are working on new therapies that reduce or remove amyloid, a sticky substance in the brain thought to play a role in the disease. There are more medicines in development for Alzheimer's than any other neurologic disease except pain, according to Pharmaceutical Research and Manufacturers of America, the industry trade group. It will likely be years before a new generation of drugs makes it to market.

Now 51 years old, Mr. Kammerer, like many Alzheimer's patients, had no history of the disease in his family. He grew up on the north shore of Long Island, where he stood out at school for his talent with numbers. After attending college at the State University of New York-Albany, he got a job on Wall Street.

The Wall Street Journal

In Brief:

Heart attack and heart failure patients have a higher risk of a second heart attack or death if they take painkillers, including the generic drug ibuprofen and Celebrex, made by Pfizer, a Danish study has found.

Patients who had suffered a heart attack and were taking Vioxx, a painkiller that has been withdrawn from the market, had 2.7 times the risk of having another heart attack or dying compared with patients not taking painkillers, according to research presented Tuesday at the American Heart Association meeting in New Orleans. Patients taking Celebrex had double the risk; patients taking the generic diclofenac had 1.9 times the risk, and those taking ibuprofen had 1.3 times the risk, the study found.

Based on the findings, doctors should avoid prescribing nonsteroidal anti-inflammatory drugs for these patients, or give them at low doses, a researcher said.

Also Tuesday, researchers said that the risk of heart attacks and strokes for heart-stent patients taking the anti-clotting drug Plavix increased if they also took anti-ulcer medicines like Nexium.

Doctors implant about two million stents a year and often prescribe blood thinners like Plavix, made by Bristol-Myers Squibb and Sanofi-Aventis, to avoid clots. But the drugs raise the risk of stomach bleeding, so they also prescribe Nexium, made by AstraZeneca, or a rival drug in a group known as proton pump inhibitors. About a third of these patients suffered complications within a year, the study said.

The New York Times

Japanese researchers said Thursday they had created functioning human brain tissues from stem cells, a world first that has raised new hopes for the treatment of disease. Stem cells taken from human embryos have been used to form tissues of the cerebral cortex, the supreme control tower of the brain, according to researchers at the government-backed research institute Riken.

The research was led by Yoshiki Sasai at Riken Center for Development Biology in Kobe.

The tissues self-organized into four distinct zones very similar to the structure seen in human fetuses, and conducted neuro-activity such as transmitting electrical signals, the institute said.

Research on stem cells is seen as having the potential to save lives by helping to find cures for diseases such as cancer and diabetes or to replace damaged cells, tissues and organs.

The team’s previous studies showed stem cells differentiated into distinct cells but until now they had never organized into functioning tissues.

“In regenerative therapy, only a limited number of diseases can be cured with simple cell transplants. Transplanting tissues could raise hopes for greater functional recovery,” the institute said in a statement.

“Cultivated tissues are still insufficient and too small to be used to treat stroke patients. But study of in-vitro cultivation of more mature cortex tissues, such as those with six zones like in the adult human brain, will be stepped up,” it said.

The tissues could also serve as “a mini organ” for use in studying the cause of the Alzheimer’s disease and developing vaccines, it said.

Embryonic stem cells are harvested by destroying a viable embryo, a process that some people find unacceptable.

Riken said cortex tissues were also obtained from “induced pluripotent stem cells,” which are similar to embryonic stem cells but artificially induced, typically from adult cells such as skin cells. The cultivated tissues look like miniature mushrooms two millimeters in diameter.

The team also succeeded in making cortex tissues from the embryonic stem cells of mice. Using mouse tissues, scientists confirmed they had formed a network of neurons that properly respond to stimulus.

The tissues can also be selectively induced to different cortex types controlling memories, visual sensation and other tasks.

The findings of the study were published in the Nov 6 online journal Cell Stem Cell in the United States.

Japan Today

PHILADELPHIA, Nov. 4 -- For patients with early age-related macular degeneration, impaired night vision is a risk factor for progression to advanced disease, researchers here found.

The worst scores on an assessment of night vision were significantly associated with a drop in visual acuity and development of choroidal neovascularization and geographic atrophy through follow-up of at least five years, Gui-shuang Ying, Ph.D., of the University of Pennsylvania here, and colleagues reported in the November issue of Ophthalmology.

The associations remained significant after adjusting for baseline participant and ocular characteristics and established risk factors.

"Because of the ease of ascertainment compared with testing dark adaptation or rod sensitivity," the researchers said, "assessing night vision symptoms may be useful in identifying patients with early or intermediate age-related macular degeneration who are at a relatively high risk of progression."

"These results are consistent with the biological and psychological findings that rod photoreceptor degeneration precedes cone degeneration in early age-related macular degeneration, and that rod dysfunction may contribute to the later degeneration of cones because of their interdependence," the researchers said.

The results also implied that different pathophysiological processes resulted in choroidal neovascularization and geographic atrophy because of differences in their associations with night vision symptoms, they said.

In addition to providing independent predictive information about the progression of disease, the researchers said, measuring night vision symptoms may help identify patients for use in clinical trials evaluating agents for the prevention of geographic atrophy.

"Including only patients with night vision symptoms, and therefore higher risk of progression and loss of vision," they said, "would be one way to decrease the risk-benefit ratio in these clinical trials and to decrease the total sample size or follow-up period required to attain a specific amount of statistical power."

MEDPAGE TODAY

NEW HAVEN, Conn., Nov. 4 -- Patients 65 and older may fare better when they are brought into the decision-making of complex treatment trade-offs, researchers here said.

When patients with multiple medical conditions weighed outcomes of treatment options against one another, they typically preferred those that would achieve the outcome they most desired, Terri Fried, M.D., of Yale, and colleagues reported in the October issue of the Journal of the American Geriatrics Society.

"Prioritizing across all outcomes can help clarify what is most important to seniors who are faced with complex healthcare decisions," Dr. Fried said.

About 65% of older Medicare beneficiaries have at least two chronic conditions, and 24% have four or more, the researchers said. These patients often face complex care decisions when the treatment for one condition could worsen another -- which the researchers call "competing outcomes."

For example, if a patient with high blood pressure, heart disease, and osteoarthritis finds that the hypertension medication causes leg cramps that preclude the pool exercises needed to keep the arthritis symptoms in check, the patient may elect to stop taking it.

"I have high cholesterol," one participant said. "I took something but … I had such pain in my calf, so I was taken off whatever that was. I think [my cholesterol] is 241, and I'm willing to live with that."

Many participants initially thought of outcomes in terms of disease-specific goals, such as prevention of a stroke or heart attack. But during the discussions, they changed their focus to more global outcomes, such as quality of life, the researchers said.

For example, some participants, when debating taking a medication that would increase their risk of heart attack in order to treat pain, defined thresholds of decreased function at which they would become willing to take on a greater risk of cardiovascular mortality.

"When participants thought about outcomes in these global terms, they were able to weigh these more general outcomes against one another, in order to reflect on what was most important to them," the researchers wrote.

The researchers said that asking patients to prioritize their desired outcomes would enable physicians to subsequently determine a course of care that would most likely meet their priorities.

They said their study can only be used to "understand how older persons with coexisting conditions think about their illnesses and interventions and not to draw conclusions about their knowledge or perceptions."

However, they said, their findings suggest that asking older patients "to prioritize a set of global outcomes that can be applied across a spectrum of specific diseases may be one easily understood approach to eliciting values in a manner that can inform a range of healthcare decisions."

MEDPAGE TODAY

A 3-year longitudinal study

Objective: To investigate longitudinal change in the medical decision-making capacity (MDC) of patients with amnestic mild cognitive impairment (MCI) under different consent standards.

NEUROLOGY 2008;71:1474-1480

A multiethnic, population-based study of incident cases

Objective: To describe factors associated with survival in Alzheimer disease (AD) in a multiethnic, population-based longitudinal study.

NEUROLOGY 2008;71:1489-1495