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The 'Other' Cruciate Ligament: Newer Treatments For PCL Tears
While major advances have been made in the understanding of posterior cruciate ligament (PCL) anatomy and reconstruction, a literature review published in the July 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) finds that there must be continued advances in basic science research in order to determine the best course of treatment for those with PCL injuries.
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Maricopa Integrated Health System Reports 90 Percent Reduction In Pressure Ulcers
A retrospective analysis conducted by clinicians at Maricopa Integrated Health System (MIHS) found that a protocol of care using a standardized algorithm with advanced products reduced the prevalence of pressure ulcers by 90 percent, according to data presented this week at the 41st Annual Conference of the Wound, Ostomy and Continence Nurses (WOCN) Society.(1)
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Fertility Treatments Becoming More Common, Costly To Health Care System, CDC Says
The number of assisted reproduction procedures, such as in vitro fertilization, continues to increase at a rapid pace, with half of the 54,656 infants born in 2006 being twins, triplets or higher multiples, according to a series of Centers for Disease Control and Prevention reports, HealthLeaders Media reports. Since 2001, the number of live-birth deliveries -- which includes those in which at least one infant was born -- as the result of assisted reproductive technology increased by 41%, and the number of infants born as a result increased by 34%, according to CDC. ART services are offered at 483 medical centers, compared with 421 in 2001.According to CDC, ART procedures are more likely to result in multiple births, which produce higher rates of complication in the infants, such as prematurity, low birthweight and disability. CDC said that the cost of treating complications resulting from ART pregnancies totaled $1 billion in 2005, presenting an economic burden to hospitals and payers. The American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology recommend that doctors transfer one embryo in women younger than age 35, one or two in women ages 35 to 37, no more than three embryos in women ages 38 to 40 and up to five in older women and "extraordinary circumstances." However, CDC reported that about 16% of ART procedures since 2001 involved four or more embryos, and 5% involved five or more embryos, indicating that these guidelines were not widely followed. According to CDC, "In certain states, ART procedures are not covered by insurance carriers, and patients might feel pressured to maximize the opportunity for live-birth delivery by transferring multiple embryos." The report also noted that physicians might be implanting more embryos to increase the percentage of total live-birth deliveries by their patients. The report said that to "minimize the adverse maternal and child health effects associated with multiple pregnancies, ongoing efforts to limit the number of embryos transferred in each ART procedure should be continued and strengthened."Many hospitals consider ART a lucrative field because most patients undergoing the procedures have private insurance or pay out of pocket. However, health plans pass on the costs of complications to employers and the insured in the form of higher premiums, HealthLeaders Media reports. Thomas Moore, director of Obstetrical Services at the University of California-San Diego, said, "Even though private insurance pays a large percentage of the cost of caring for these newborns, it can be expensive for the health insurance industry overall," adding, "At $2,000 to $3,000 a day for intensive care, which can continue three and four months, that"s a cost that raises premiums across the board" (Clark, HealthLeaders Media, 6/12).
Sexual Health

Study Points Toward Relationship Between Cancer Stem Cells And Prognosis In Primary Breast Cancer

Breast cancer patients who received chemotherapy prior to surgery had heightened levels of cancer-initiating stem cells in their bone marrow, and the level of such cells correlated to a tumor"s lymph node involvement, according to research from The University of Texas M. D. Anderson Cancer Center. James Reuben, Ph.D., associate professor in the Department of Hematopathology, will present the findings in an oral presentation at the upcoming American Society of Clinical Oncology"s annual meeting. It"s the first prospective study to investigate the presence of breast cancer stem cells of primary breast cancer patients. The results suggest the need for additional biological therapies, as well as a potential and promising new direction for the study of micro-metastasis. It"s estimated that 30-40 percent of locally advanced breast cancer patients who appear disease-free after neoadjuvant treatment actually harbor undetectable, distant micro-metastasis, explained Reuben. Reuben describes cancer stem cells as tumor cells found in the bone marrow that are capable of self-renewal, thus a potential catalyst for recurrence and metastasis. "Until now, the concept of cancer stem cells and their resistance to chemotherapy has been described in the lab in animal models. With this study, we are characterizing cancer stem cells and consistently identifying them in breast cancer patients for the first time," said Reuben, the study"s first author. "Our research showed a higher presence of cancer stem cells correlated with more advanced disease, suggesting that they may one day be a prognostic factor for identifying those at greatest risk for metastasis and recurrence." Cancer stem cells are a small but important component of circulating (found in peripheral blood) and disseminating (found in the bone marrow) tumor cells, both already shown to be independent prognostic factors for breast cancer, in that they are self-renewing. Cancer stem cells have been described in previous preclinical models, but before now, have been extremely difficult to detect and characterize in cancer patients. The study enrolled 90 M. D. Anderson breast cancer patients from September 2006 to October 2008. Bone marrow aspirations were performed in all women at the time of their surgery. Of the 90 women, 29 (32 percent) had undergone neoadjuvant chemotherapy, and eight of the 29 had been treated with anti HER2 targeted therapy. All other patients had early-stage disease, and, therefore, did not need chemotherapy prior to surgery. Of the bone marrows collected, 61 were analyzed for estrogen receptor and HER-2 status, as well as expression of the transcription factor Notch-1. Using multi-color flow cytometry methods capable of detecting multiple markers and receptors on the surface of cells the researchers found patients who received neoadjuvant therapy featured a significantly higher presence of breast cancer stem cells and higher percentage of specific markers that are associated with breast cancer stem cells, compared to patients with early-stage disease. "As the cancer stem cells were concentrated in patients who had already received therapy, our research indicates their true resilience and lack of sensitivity to chemotherapy, as well as demonstrates a need for a more comprehensive study of micro-metastasis and molecular markers that target these illusive cells," said Reuben. "While intriguing, this is still early research and more research is needed to determine the true relationship between cancer stem cells, progression- and disease-free survival in breast cancer patients." The researchers also found the level of Notch-1 was lower in neoadjuvant treated patients and inversely correlated between the level of its expression and the percentage of breast cancer stem cells, suggesting that Notch signaling may play an integral role in the development of breast cancer stem cells. Reuben will present the node status research at his oral presentation in the Clinical Science Symposium session on Saturday, May 30 at 2:15 p.m. According to Massimo Cristofanilli, M.D., associate professor in M. D. Anderson"s Department of Breast Medical Oncology, these findings provide a direction for immediate concept and design of adjuvant clinical study. "Although early, the research stands highlights the concept that chemotherapy alone does not cure a significant number of primary breast cancer patients, and gives us an indication for a new line of therapeutic intervention that focuses on new biological agents that target cancer stem cells," said Cristofanilli, also a senior author on the study. "The research also presents a strong case for obtaining bone marrow specimens from locally advanced breast cancer patients undergoing surgery after neo-adjuvant therapy, with the rationale that it will lead to better monitoring of patients who may need additional treatment." Such studies are currently ongoing in collaboration with Anthony Lucci, M.D., associate professor in the Department of Surgery, also an author on the study, Reuben said. Also, based on these initial findings, a clinical trial with a Notch inhibitor is in development at M. D. Anderson. The study was funded, in part by grants from the State of Texas, National Cancer Institute, and the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic. In addition to Reuben, Cristofanilli and Lucci, other authors on the all-M. D. Anderson study include: Gabriel Hortobagyi, M.D., professor and chair of the Department of Breast Medical Oncology; Wendy Woodward, M.D., Ph.D., assistant professor in the Department of Radiology; Savitri Krishnamurthy, M.D., associate professor in the Department of Pathology; and Bang-Ning Lee, Ph.D., assistant professor; Hui Gao, Ph.D., post-doctoral fellow, Changping Li, M.D., post-doctoral fellow, and Evan Cohen, B.S., graduate student, all of the Department of Hematopathology. About M. D. Anderson The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world"s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For four of the past six years, including 2008, M. D. Anderson has ranked No. 1 in cancer care in "America"s Best Hospitals," a survey published annually in U.S. News & World Report. University of Texas M. D. Anderson Cancer Center


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