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Gene scanning 'could improve screening for oesophageal cancer'

NHS Choices - Behind the Headlines - Mon, 22/08/2016 - 17:20

"Simple test can now reveal which heartburn patients are at risk of oesophageal cancer," is the hopeful headline in the Daily Mail, reporting on a new study from researchers at Queen Mary University of London.

The researchers have been investigating whether a test for patients with Barrett's oesophagus may be able to predict the likelihood of the condition progressing to oesophageal cancer.

Barrett's is linked to gastro-oesophageal reflux disease (GORD), where acid leaks from the stomach back up into the throat. Stomach acid can aggravate the cells, so there is the potential for this condition to turn cancerous.

It's hard to precisely estimate cancer risk with this condition, however. The current thinking is around 1 in 10 people with GORD will develop Barrett's. Out of these people, around 1 in every 10 to 20 people will go on to develop oesophageal cancer.

So while the overall risk is small, it can still be distressing because of the uncertainty of outcome for people with Barrett's.

This latest research involved taking oesophageal cell samples from a sample of patients with Barrett's about three years apart to look at what factors predicted progression.

The researchers found progression was mostly linked to the degree of genetic diversity in the cells. Or, in the words of the lead researchers, some cells were just "born to be bad".

The follow-up time in this study is short, and it's not clear whether other risk factors were accounted for in the analysis or whether there are steps people can take to reduce their risk of cancer.

No doubt further larger studies of this technique are now being planned. 

Where did the story come from?

The study was carried out by researchers from a number of institutions, including Queen Mary University of London and the University of Amsterdam.

Funding was supported by the Dutch Cancer Foundation, the Netherlands Organization for Scientific Research, Fonds NutsOhra, the European Research Council, the Gut Club Foundation, and Abbott Molecular.

It was published in the peer-reviewed Nature Communications on an open access basis, so it is free to read online.

The Mail's reporting was accurate, providing information on oesophageal cancer, risk factors for the disease, and a description of Barrett's oesophagus. 

What kind of research was this?

This prospective cohort study aimed to assess whether a test performed on patients with non-cancerous Barrett's oesophagus may be able to predict whether the condition will progress to oesophageal cancer. 

Barrett's oesophagus is a condition where damage from the stomach acid eventually causes the cells in the lining of the oesophagus to change abnormally. It is often caused by acid reflux.

The abnormal cells are at an increased risk of becoming cancerous in the future, although this risk remains small. It's estimated 1 in every 10 to 20 people with Barrett's oesophagus will develop cancer within 10 to 20 years.

This type of study is useful for investigating links with factors that may be associated with cancerous change.

What did the research involve?

The researchers recruited adult patients with Barrett's oesophagus from an academic medical centre and six hospitals in The Netherlands.

Participants had to be aged 18 years or over and have endoscopy evidence of Barrett's oesophagus and no features of active oesophageal cancer.

All patients that developed cancerous change or oesophageal cancer within six months from the initial endoscopy were excluded from the study.

Endoscopic examinations with cell biopsy were carried out at the start of the study and then about every two to three years.

The researchers carried out laboratory tests on the biopsy samples to identify potential genetic markers and other disease features associated with progression. 

What were the basic results?

A total of 320 people with Barrett's oesophagus were included in the study, and were followed for an average period of 43 months.

During this time 20 (6.3%) people progressed, while eight people developed high-grade cancerous change and 12 developed oesophageal cancer.

The researchers found participants with little genetic diversity in their cell samples were unlikely to progress to cancer.

However, the opposite is true when genetic diversity is present. The researchers claim some cells are "born to be bad".

How did the researchers interpret the results?

The researchers concluded that genetic diversity correlates with the risk of Barrett's oesophagus progressing to cancer.

They say the level of genetic diversity over time does not appear to have an effect on the risk of progression to cancer – it seems to be  predetermined by the baseline level of diversity.

Conclusion

This prospective cohort study aimed to see whether a test performed on patients with non-cancerous Barrett's oesophagus may be able to predict whether the condition progressed to oesophageal cancer. 

Overall, they found genetic diversity in the oesophageal cell samples at the start of the study seemed to be linked to the risk of cancer progression.

However, the research has limitations to consider:

  • By design, this study is only able to draw links – it does not propose treatment or lifestyle steps to be taken to reduce risk.
  • The sample of patients in this study is small, so we cannot rule out that any associations seen are down to chance.
  • The length of follow-up it not sufficiently long to see how many of the participants went on to develop cancer, as this can take 10 to 20 years.
  • It is unclear whether the researchers have taken into account other risk factors for oesophageal cancer, such as smoking, drinking too much alcohol over a long period of time, being overweight or obese, and having an unhealthy diet.

The future aim of such a test could be to reduce the need for regular monitoring in patients at low risk of going on to develop cancer. But more research is needed to confirm the use of such a test.

The exact cause of oesophageal cancer is unknown, but stopping smoking, cutting down on alcohollosing weight and having a healthy diet may all help reduce your risk.

Links To The Headlines

Simple test can now reveal which heartburn patients are at risk of oesophageal cancer. Mail Online, August 19 2016

Links To Science

Martinez P, Timmer MR, Lau CT, et al. Dynamic clonal equilibrium and predetermined cancer risk in Barrett's oesophagus. Nature Communications. Published online August 19 2016

Categories: NHS Choices

Fresh appeal after latest inquest hearing to solve the 10 year riddle of what happened to Wisbech man Terry McSpadden

Ely Standard - Mon, 22/08/2016 - 17:14

The family of a father who went missing almost 10 years ago is hoping an inquest into his death will answer their questions before the end of the year.

Categories: Local Press

Blaze in Twentypence Road Wilburton was accidental say fire service

Ely Standard - Mon, 22/08/2016 - 16:11

At 1.44am on Saturday (20) crews from Cottenham and Sutton were called to a fire in the open in Twentypence Road, Wilburton.

Categories: Local Press

Viva’s production of ‘Made in Dagenham’ wows critics and sell-out crowds at Ediburgh Fringe Festival

Ely Standard - Mon, 22/08/2016 - 15:50

“Not a weak link in sight” with “a lot of strong performances” is how critics viewed Viva’s production of ‘Made in Dagenham’ as it took its place on the bill at the world-famous Edinburgh Fringe Festival.

Categories: Local Press

Mepal’s got talent! The 44th produce and craft show is a success

Ely Standard - Mon, 22/08/2016 - 15:26

Villagers showed off a range of talents at the 44th Mepal Produce and Craft Show.

Categories: Local Press

Police hope CCTV images might help clear up mystery of £1,000 alcohol theft from Ely supermarket

Ely Standard - Mon, 22/08/2016 - 15:11

Mainly whisky and brandy was stolen in a £1,000 theft of alcohol from an Ely supermarket.

Categories: Local Press

Chatteris legion members and their visit to the Menin Gate and service commemorate the Battle of the Somme at the Thiepval Memorial

Ely Standard - Mon, 22/08/2016 - 14:20

Chatteris branch of the Royal British Legion once more set of on a visit to the Menin Gate for the last post ceremony and the service to commemorate the Battle of the Somme at the Thiepval Memorial.

Categories: Local Press

Wildlife and play park officially opened in Welney as campaigners pledge to fight on to save Sandgate Meadow for future generations by having it designated as a village green

Ely Standard - Mon, 22/08/2016 - 10:30

Conservationist Tony Juniper officially opened Welney’s new wildlife haven watched by around 80 villagers.

Categories: Local Press

Lithuanian teenager living in Wisbech jailed for life after stabbing fellow countryman ‘in a drunken temper’ during late afternoon argument

Ely Standard - Mon, 22/08/2016 - 09:54

A Lithuanian teenager living in Wisbech has been jailed for life after being found guilty stabbing a man to death “in a drunken temper”.

Categories: Local Press

UPDATED: Missing teenager Samuel Creed found safe and well

Newmarket Journal - Sun, 21/08/2016 - 20:00
A 16-year-old boy who went missing today whilst on a day trip to Thorpeness has been found safe and well.
Categories: Local Press

Arrests after derby match between Ipswich Town and Norwich City

Newmarket Journal - Sun, 21/08/2016 - 18:58
A number of arrests have been made following today’s derby match between Ipswich Town and Norwich City.
Categories: Local Press

Wisbech councillor demands answers over threat to minor injuries units while MP Steve Barclay urges public to attend consultation meetings

Ely Standard - Fri, 19/08/2016 - 17:19

Questions will be asked and answers expected by Wisbech independent councillor Virginia Bucknor at a consultation meeting to discuss the proposed closure of the area’s minor injuries units.

Categories: Local Press

Animal research suggests Zika could affect the adult brain

NHS Choices - Behind the Headlines - Fri, 19/08/2016 - 16:30

"Zika virus may cause long-term memory damage, similar to Alzheimer's disease," The Daily Telegraph reports. At the moment such a claim is pure speculation as it is based on research into mice.

Currently, the effects of the Zika virus are thought to be short-term in adults, only presenting a threat to unborn babies. The short-term symptoms in adults are usually similar to the flu, such as fever and joint pain.

This latest research involved mice bred to have an immune deficiency to the Zika virus. Researchers found that after injecting the virus into their blood, it went on to have an effect on areas of the brain where new brain cells are created. If a similar effect occurred in humans there could be a potential impact on memory and thinking skills.

The last major Zika outbreak occurred in French Polynesia in 2013-2014. During this time the World Health Organization recorded an increase in the number of cases of Guillain-Barre syndrome (GBS); usually a rare neurological condition that can cause muscle weakness due to nerve damage. But the picture was complicated as the area was also in the grip of a dengue outbreak, which has also been associated with GBS.

As this was exploratory research, we don't yet know the implications of these findings for adults. The picture may become clearer once more data is analysed from the ongoing outbreak in the Americas.

If travelling to Zika-affected areas, then following standard advice about avoiding mosquito bites would be wise.  

Where did the story come from?

The study was carried out by researchers from the Howard Hughes Medical Institute, the University of California and the La Jolla Institute for Genomic Medicine, all in the US. It was funded by the National Institutes of Health, the Simons Foundation of Autism Research Initiative and the Howard Hughes Medical Institute. There appear to be no conflicts of interest.

The study was published in the peer-reviewed medical journal Cell Stem Cell on an open-access basis, which means you can read it for free online or download it as a PDF.

The UK media generally reported it accurately and, refreshingly, made clear from the start that this was animal research. Though as is so often the case, many headlines were needlessly alarmist, such as the Mail Online's choice of language about the virus possibly "devastating" human brains.

 

What kind of research was this?

This animal study in mice aimed to look at the effects of infection with Zika virus on the brains of adult mice.

Recent global attention has been drawn to the Zika virus outbreak and its link with cases of microcephaly, when the brain does not develop properly in babies. It has also been linked to Guillain-Barre syndrome, when the body's immune system attacks part of the peripheral nervous system.

Until now, the virus was thought only to affect pregnant women's babies, not the rest of the adult population. Short term symptoms experienced by some adults include a fever, rash, joint pain, headaches and vomiting.

Although Zika is considered a short-term infection in adult humans, the long-term effects on the adult brain have yet to be studied.

Animal studies are often used in the early stages of research to see how biological processes may happen in humans. However, we are not identical to animals and the implications for humans may need to be tested in other ways, especially to see if humans can develop immunity to the virus quickly.

 

What did the research involve?

This was complex laboratory research using mice to observe the effect of Zika virus on adult brain cells.

Mice were bred with immune deficiencies. At between five and six weeks old, researchers infected the mice with an Asian strain of the Zika virus.

Mice were injected in a way that introduced the virus into the bloodstream rather than directly into in the brain, to mimic the way the virus enters the bloodstream in humans.

To examine the potential for viral infection in the brain, the researchers screened sections of the brain from both infected mice and mock-treated mice.

The impact on brain cell division and loss was assessed using cell cycle markers. These are essentially fluorescent tags that allow the researchers to track how the virus spread through brain cells.

 

What were the basic results?

The researchers found that Zika virus was concentrated in the two sections of the brain where there is active cell division in adult mice. These were the subventricular zone (SVZ) of the anterior forebrain and the subgranular zone (SGZ) of the hippocampus. These are both areas of the brain where new brain cells are produced (neurogenesis).

The researchers found that when the Zika virus entered the bloodstream of the mice, there was pronounced evidence of Zika infection in these two brain areas, which led to cell death and reduced cell division.

The changes were found in the three mice infected with the Zika virus and not in the three mice who weren't infected.

The results suggested an increase in the death of neural cells in these two areas. The areas of the brain that were not associated with cell division were not affected by the virus.

 

How did the researchers interpret the results?

The researchers concluded that "the virus was able to infect SVZ and SGZ niche cells to a much greater degree than non-neurogenic regions."

They also "recognize that healthy humans may be able to mount an effective antiviral response and prevent entry into the CNS, but it remains a possibility that some immunocompromised humans and even some apparently healthy humans may be susceptible in ways modeled by the TKO mice [mice where certain immune cells had been 'knocked out']".

 

Conclusion

This experimental study in mice investigated the effect of Zika virus on adult brain cells, hoping to increase knowledge of the long-term outcomes of Zika virus on the adult brain. Zika was thought to be a short-term virus for adult humans without many long-term effects.

The researchers' experiments in mice found that the two small areas in the adult mouse brain containing cells active in cell division can be susceptible to pronounced Zika infection leading to cell death and reduced cell division.

While healthy humans may be able to mount an effective immune response to the virus, it is possible that immunocompromised humans may be susceptible in ways demonstrated by the mice.

However, as the authors point out, the study only used a single virus strain, a single mouse strain and was at a single point in time. There is more information needed before the implications for humans are understood.

Future studies are needed in infected humans to describe the effects of the Zika virus on the adult brain.

Public Health England provide an up-to-date overview of the current state of the Zika virus outbreaks in the Americas, as well as specific advice for certain groups, such as pregnant women or women planning to become pregnant.

Links To The Headlines

Zika virus may cause long-term memory damage, similar to Alzheimer's disease. The Daily Telegraph, August 18 2016

Could Zika devastate the brain like Alzheimer's? Virus attacks the area linked to learning and memory. Daily Mail, August 18 2016

ZIKA ALZ DANGER Zika virus can cause similar brain damage to Alzheimer's in adults, study finds. The Sun, August 19 2016

Links To Science

Li H, Saucedo-Cuevas L, Regla-Nava JA, et al. Zika Virus Infects Neural Progenitors in the Adult Mouse Brain and Alters Proliferation. Cell Stem Cell. Published online August 18 2016

Categories: NHS Choices

Haverhill man who beat woman with baseball bat while on bail for Bury assaults jailed

Newmarket Journal - Fri, 19/08/2016 - 15:40
A prolific offender who beat a woman with a baseball bat while on bail for assaulting two men has been jailed for more than five years.
Categories: Local Press

SEVERE WEATHER WARNING: ‘Unseasonably’ strong winds to hit county on Saturday

Newmarket Journal - Fri, 19/08/2016 - 14:20
The Met Office has issued a severe weather warning for Saturday.
Categories: Local Press

Roadworks on A14 at Bury St Edmunds to begin on Monday

Newmarket Journal - Fri, 19/08/2016 - 14:06
Roadworks are set to begin on the A14 at Bury next week with overnight closures.
Categories: Local Press

Inflatable fun as ThePORT Youth Group celebrates its one year anniversary

Ely Standard - Fri, 19/08/2016 - 13:04

ThePORT Youth Group celebrated its one year anniversary in style this week.

Categories: Local Press

Perfect painkiller? Safe alternative to opiates may have been found

NHS Choices - Behind the Headlines - Fri, 19/08/2016 - 13:00

The Independent has claimed: "Scientists discover what could be a 'perfect' painkiller without side effects".

Opiate-based painkillers such as morphine are extremely effective in relieving pain. The problem is that they are also addictive if taken on a medium- to long-term basis. Also morphine, if taken at high dosage, can cause potentially fatal breathing difficulties (respiratory depression).

New research suggests that a newly identified compound, PZM21, could be more effective at longer-lasting pain relief than morphine, without any of the attendant drawbacks.

The compound caused less activation of the brain's reward system compared to morphine, indicating that it may be less addictive. And when tested in mice it also resulted in less respiratory depression and constipation than morphine.

However, this was an early-stage laboratory study in mice. We don't know that this provides the whole answer, and findings would need to be replicated in humans.

It is also important to stress that when taking painkillers, more doesn't mean better. It can be extremely dangerous to take more than your recommended dose. This applies not only to prescription painkillers, but over-the-counter products such as paracetamol.

 

Where did the story come from?

The study was carried out by researchers from Stanford University School of Medicine, the University of California, UNC Chapel Hill Medical School – all in the US – and the Friedrich-Alexander-Universitat Erlangen-Nurnberg and the Paracelsus Medical University in Germany. It was funded by the US National Institutes of Health grants.

The study was published in the peer-reviewed medical journal Nature.

There may be a conflict of interest as several of the authors have filed a provisional patent on PZM21 and related molecules. Several are also consultants and co-founders of Epiodyne, a company seeking to develop new analgesics. Though these sort of links with industry, when it comes to researching drugs, are nothing out of the ordinary.

The UK media's reporting was generally accurate; with The Independent acknowledging the limitations of the drug as it "shows 'promise' as a replacement for opium-based drugs such as morphine – although it has only been tested in mice so far".

 

What kind of research was this?

This was an animal study that aimed to identify a new compound that could act as a more effective painkiller than morphine.

Morphine is an alkaloid from the opium poppy that is used to treat pain. Although the natural products morphine, codeine, and the semi-synthetic drug heroin, are more reliably effective at providing pain relief than raw opium, they have potentially lethal side effects. These include respiratory depression and constipation. Current opioid painkillers also have the negative side effect of being addictive.

Animal studies are often used in early stages of research to see how biological mechanisms may work in humans. However, humans are not identical to animals and there are many stages of development from animal-based studies to developing treatments for humans.

 

What did the research involve?

This was complex laboratory research that measured the painkilling properties of a new compound called PZM21 on mice. This compound is thought to work further down the painkilling pathway than morphine, so it was hoped that it would have fewer undesirable side effects.

The researchers compared PZM21 with morphine, another compound called TRV130 and placebo. They looked at the strength of pain relief, how long it lasted and whether it acted on the addiction centres in the brain. They also measured any effect on the breathing rate and constipation.

 

What were the basic results?

Pain relief from PZM21 lasted longer than morphine. The effectiveness and length of pain relief was assessed by seeing how well (or not) the mice tolerated exposure to heat.

It was found to last up to 180 minutes in mice. It was 40% effective at this time point compared to 5% for morphine. At 120 minutes, PZM21 was still able to exert 60% pain relief compared to 15% for morphine.

PZM21 caused less activation of reward pathways compared to morphine. This was assessed by studying how the mice moved. Rodents that are "high" tend to run round at great speed (which is known as an acute hyperlocomotive response).

PZM21 did not reduce the breathing rate compared to placebo. The rate during the injection for all of the mice was high at around 400 breaths per minute (normal is around 80 to 230). Morphine caused it to reduce to around 150 breaths per minute, while PZM21 and placebo reduced it to around 250 breaths per minute.

PZM21 caused less constipation than morphine.

 

How did the researchers interpret the results?

The researchers concluded that: "The structure-based approach led to a compound with novel properties; it was structurally distinct compared to previously explored opioid ligands, with not only substantial signalling bias but also with unexpected opioid receptor selectivity.

"These features have contributed to favourable biological effects, with long-lasting analgesia coupled to apparent elimination of respiratory depression, specificity for central over reflex analgesia, lack of locomotor potentiation and conditioned place preference, and hence a reduced potential for opioid-induced reinforcement for PZM21 and molecules like it."

 

Conclusion

This experimental study identified a new compound, PZM21, and investigated its effectiveness and safety in mice compared to morphine and TRV130. This research hopes to aid the development of an effective alternative to morphine that has none of the drawbacks, such as respiratory depression, constipation and addiction.

The researchers' experiments in mice found that PZM21 was more effective as a longer-lasting painkiller than morphine and that, at equal painkilling doses, had hardly any effect on respiratory depression, unlike morphine. They also found that compared to morphine, the constipating effect was reduced and the compound did not activate the dopaminergic reward system, a mediator of addiction.

This research helps take us one step closer to developing effective painkillers that are without the potentially lethal side effects of morphine. But this was an early stage experiment in mice. We don't know that this drug will provide the answer and findings will need to be confirmed in human studies.

While these findings may drive future drug research, it is unclear how long this process may take. 

Links To The Headlines

Scientists discover what could be a 'perfect' painkiller without side effects. The Independent, August 17 2016

An end to morphine? New drug could provide safer painkiller alternative amid opioid epidemic. Mail Online, August 17 2016

AN END TO MORPHINE? Boffins develop 'promising' new painkiller that is safer than morphine. The Sun, August 17 2016

Links To Science

Manglik A, Lin H, Aryal DK, et al. Structure-based discovery of opioid analgesics with reduced side effects. Nature. Published online August 16 2016

Categories: NHS Choices

Ely Leisure Centre given the green light after £1.5 million Sport England grant

Ely Standard - Fri, 19/08/2016 - 12:25

Building of the new East Cambridgeshire District Leisure Centre in Ely can begin after Sport England approved a £1.5 million lottery award.

Categories: Local Press

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