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‘Where Does It Hurt?’: Primary Care Tips for Common Ortho Problems – Medscape

Posted: May 2, 2022 at 2:12 am

Knee and shoulder pain are common complaints for patients in the primary care office.

But identifying the source of the pain can be complicated, and an accurate diagnosis of the underlying cause of discomfort is key to appropriate management whether that involves simple home care options of ice and rest or a recommendation for a follow-up with a specialist.

Speaking at the 2022 American College of Physicians Internal Medicine Meeting, Greg Nakamoto, MD, Department of Orthopedics, Virginia Mason Medical Center, Seattle, Washington, discussed common knee and shoulder problems that patients often present with in the primary care setting, and offered tips on diagnosis and appropriate management.

The most common conditions causing knee pain are osteoarthritis and meniscal tears. "The differential for knee pain is broad," Nakamoto said. "You have to have a way to divide it down, such as if it's acute or chronic."

The initial workup has several key components. The first steps: Determine the location of the pain anterior, medial, lateral, posterior and then whether it stems from an injury or is atraumatic.

"If you have to ask one question ask where it hurts," he said. "And is it from an injury or just wear and tear. That helps me when deciding if surgery is needed."

Pain in the knee generally localizes well to the site of pathology, and knee pain of acute traumatic onset requires more scrutiny for problems best treated with early surgery. "This also helps establish whether radiographic findings are due to injury or degeneration," Nakamoto said. "The presence of swelling guides the need for antiinflammatories or cortisone."

Palpating for tenderness along the joint line is important, as is palpating above and below the joint line, Nakamoto said.

"Tenderness limited to the joint line, combined with a meniscal exam maneuver that reproduces joint line pain, is suggestive of pain from meniscal pathology," he said.

Imaging is an important component of evaluating knee symptoms, and the question often arises as to when to order an MRI.

Nakamoto offered the following scenario: If significant osteoarthritis is evident on weightbearing x-ray, treat the patient for the condition. However, if little or no osteoarthritis appears on x-ray, and if the onset of symptoms was traumatic and both patient history and physical examination suggest a meniscal tear, order an MRI.

An early MRI also is needed if the patient has had either atraumatic or traumatic onset of symptoms and their history and physical exams are suspicious for a mechanically locked or locking meniscus. For suspicion of a ruptured quadriceps or patellar tendon or a stress fracture, an MRI is needed urgently.

An MRI would be ordered later if the patient's symptoms have not improved significantly after three months of conservative management.

Nakamoto stressed how common undiagnosed meniscus tears are in the general population.A third of men aged 50-59 years and nearly 20% of women in that age group have a tear, he said. "That number goes up to 56% and 51% in men and women aged 70 to 90 years, and 61% of these tears were in patients who were asymptomatic in the last month."

In the setting of osteoarthritis, 76% of asymptomatic patients had a meniscus tear and 91% of patients with symptomatic osteoarthritis had a meniscus tear, he added.

Treatment will vary depending on the underlying etiology of pain. For a possible meniscus tear, the recommendation is for a conservative intervention with ice, ibuprofen, knee immobilizer, and crutches, with a follow-up appointment in a week.

Three types of injections also can help:

Cortisone for osteoarthritis or meniscus tears, swelling, and inflammation, and prophylaxis against inflammation

Viscosupplementation (intraarticular hyaluronic acid) for chronic, baseline osteoarthritis symptoms

Regenerative therapies (platelet-rich plasma, stem cells, etc) are used primarily for osteoarthritis (these do not regrow cartilage, but some patients report decreased pain)

The data on injections are mixed, Nakamoto said. For example, the results of a 2015 Cochrane review on cortisone injections for osteoarthritis reported that the benefits were small to moderate at 46 weeks, and small to none at 13 weeks.

"There is a lot of controversy for viscosupplementation despite all of the data on it," he said. "But the recommendations from professional organizations are mixed."

He noted that he has been using viscosupplementation since the 1990s, and some patients do benefit from it.

The most common causes of shoulder pain are adhesive capsulitis, rotator cuff tears and tendinopathy, and impingement.

As with knee pain, the same assessment routine largely applies.

First, pinpoint the location: Is the trouble spot the lateral shoulder and upper arm, the trapezial ridge, or shoulder blade?

Next, assess pain on movement: Does the patient experience discomfort reaching overhead or behind the back, or moving at the glenohumeral joint/capsule and engaging the rotator cuff? Check for stiffness, weakness, and decreased range of motion in the rotator cuff.

Determine if the cause of the pain is traumatic or atraumatic and stems from an acute injury versus degeneration or overuse.

As with the knee, imaging is a major component of the assessment and typically involves the use of x-ray. An MRI may be required for evaluating full- and partial-thickness tears and when contemplating surgery.

MRI also is necessary for evaluating cases of acute, traumatic shoulder injury, and patients exhibiting disability suggestive of a rotator cuff tear in an otherwise healthy tendon.

Some pain can be treated with cortisone injections or regenerative therapies, which generally are given at the acromioclavicular or glenohumeral joints or in the subacromial space. A 2005 meta-analysis found that subacromial injections of corticosteroids are effective for improvement for rotator cuff tendinitis up to a 9month period.

Surgery may be warranted in some cases, Nakamoto said. These include adhesive capsulitis, rotator cuff tear, acute traumatic injury in an otherwise healthy tendon, and chronic (or acute-on-chronic) tears in a degenerative tendon following a trial of conservative therapy.

Office Orthopedics for the Internist: Common Knee and Shoulder Problems. American College of Physicians (ACP-IM) Internal Medicine Meeting 2022. Presented April 29, 2022.

Roxanne Nelson is a registered nurse and an award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn.

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Ray Therapeutics Receives $4M in Funding From the California Institute for Regenerative Medicine (CIRM) – BioSpace

Posted: May 2, 2022 at 2:11 am

- Funding will Advance Development of Ray Therapeutics Optogenetics Technology Platform

- Company will Advance Ray-001 for the Treatment of Retinitis Pigmentosa

SAN DIEGO--(BUSINESS WIRE)-- Ray Therapeutics, a biotechnology company developing optogenetic gene therapies for patients with retinal degenerative conditions, announced today that the California Institute for Regenerative Medicine (CIRM) has awarded the company a $4M grant to support development of Ray-001, an optogenetic therapy for the treatment of retinitis pigmentosa and other inherited retinal diseases.

Retinitis pigmentosa (RP), is a heterogeneous group of genetic diseases that cause retinal degeneration leading to near or complete blindness for most patients. The severe loss of photoreceptor cells that occurs in this genetic degenerative disease leads to partial or complete blindness. At present, no effective treatment is available to restore vision once the photoreceptor cells have been lost.

Ray Therapeutics lead therapy RAY-001 for the treatment of retinitis pigmentosa, delivers light sensing channelrhodopsin to retinal cells, to potentially restore vision using the power of optogenetics. Based on the durability of treatment demonstrated in preclinical studies, RAY-001 is intended to be a one-time treatment via intravitreal injection that is sustainable for a lifetime. Unlike current RP gene therapies in development, which are targeted to specific genetic mutations or individuals with remaining photoreceptors that only address a small patient population, Ray-001 is mutation-independent.

Ray-001 has the potential to address a significant unmet need in patients who suffer from retinitis pigmentosa. The funding and strategic support from CIRM will accelerate development of our lead optogenetics candidate into clinical trials for blind and nearly-blind patients in desperate need of new therapies, without the need for supplementary eyewear or devices for additional light stimulation, said Paul Bresge, Chief Executive Officer, Ray Therapeutics. The unanimous positive vote from CIRMs independent reviewers, and obtaining the highest score in our application cohort, provides strong validation for our scientific rationale, program development and team. We look forward to advancing our candidate into clinical trials in retinitis pigmentosa."

Our goal is to always move the most promising research forward as fast as we can, said Dr. Maria T. Millan, President and Chief Executive Officer, California Institute for Regenerative Medicine (CIRM). A one-time treatment for retinitis pigmentosa such as Ray-001 would have significant impact for patients with this degenerative disorder. This technology also has the potential to serve the needs of underserved communities because RP has high prevalence in underserved, particularly Hispanic, ethnic populations. We look forward to supporting Ray Therapeutics in bringing this life-changing regenerative therapy to patients with genetic blinding disorders.

About Ray Therapeutics

Ray Therapeutics is developing novel optogenetics gene therapies for patients with blinding diseases. The company is developing its lead candidate Ray-001 in retinitis pigmentosa, a degenerative retinal disease with significant unmet medical need. The companys mission is to use optogenetics to restore vision, independent of genetic mutation for patients with inherited retinal diseases. Ray Therapeutics is based in San Diego, CA. For additional information, please visit http://www.raytherapeutics.com.

About CIRM

At CIRM, we never forget that we were created by the people of California to accelerate stem cell treatments to patients with unmet medical needs, and act with a sense of urgency to succeed in that mission.

To meet this challenge, our team of highly trained and experienced professionals actively partners with both academia and industry in a hands-on, entrepreneurial environment to fast track the development of todays most promising stem cell technologies.

With $5.5 billion in funding and more than 150 active stem cell programs in our portfolio, CIRM is the worlds largest institution dedicated to helping people by bringing the future of cellular medicine closer to reality.

For more information go to http://www.cirm.ca.gov.

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Predicting the Future of Food – Bon Appetit

Posted: May 2, 2022 at 2:10 am

Dr. Morgaine Gaye sweeps a hand over her blonde faux-hawk and smiles at me through oversize purple-tinted glasses. If she doesnt look the part of a self-proclaimed food futurologist, I dont know who does. The future, she tells me in her rapid-fire British accent, is all about Air Protein, a product that uses high-tech fermentation to turn carbon dioxide into chicken or whatever you want, really. Tens of millions of dollars are being invested into alternative proteins and air just might be one of the keys to feeding the worlds 9.8 billion people by 2050.

Thats nearly 2 billion more people than we (fail to) feed today, and an overwhelming amount of that growth, the UN predicts, will be in sub-Saharan Africa, where desert conditions make farming a challenge. Then theres that pesky issue of climate change. If the planet warms 2.7 degrees by 2040, as experts project, the implications could be devastating. Ongoing droughts, flooding, extreme weather, its all on the table. What may not be on the table: California avocados, predicted to go all but extinct by 2050.

The good news is that the food industry is already planning for those pressures, as Amanda Little investigates in her revelatory book The Fate of Food. I dont know that theres a future in which were all looking at a plate of wafers injected with specialized nutrients, she says. That just sounds like a culinary hell nobody wants to inhabit. Its the seeds, farming practices, technology, water, distribution, and behind-the-scenes innovations that are going to change the contents of our plates. Shes rooting for the avocados (though they might have to be grown indoorsand cost $20 a pop).

To take a look at what the future of food might look like, we talked to experts to come up with menu predictions for the future. For the years 2023 and 2024, scientists offered their insights on how food might change. But for 100 years from nowthe year 2122we spoke with people who were unafraid to make some bold claims: science fiction writers. See it all below.

Within the next decade, grocery stores will stock cell-cultured proteins. Stem cells are collected, put into bioreactors, and fed nutrients like glucose so that they grow into animal-free chicken, beef, pork, and even duck (as opposed to the meat alternatives we have today, which are very good imitations made with plant products). These proteins dont need room to graze and expel methane, dont waste uneaten parts of an animal, and are less likely to contain bacteria like salmonella. This is the beyond-Beyond burger.

Illustration by Haruko Hayakawa

The Menu

Personalized nutrition was the phrase I heard most from food industry experts, like the head of R&D at PepsiCo, which recently launched a sweat patch to tell you when you need more Gatorade (often). What 23andMe did for genetics, well see in the nutrition and gut-health departments. Imagine a wristwatch that pings you when your sodiums high. Cool! Creepy!

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Can hormone replacement therapy increase the risk of cancer? Dr Louise Newson weighs in – Express

Posted: May 2, 2022 at 2:07 am

HRT is a treatment designed to relieve the tricky symptoms of menopause. Its primary function is to replace or top up hormones that are at lower levels. The most important hormone is oestrogen, said Dr Newson.

Speaking on ITVs This Morning, the doctor continued: We now have a body identical oestrogen, its the same oestrogen we produce when were younger.

Its very safe, obviously, its safe because its our own hormone.

We also know that oestrogen on its own is associated with a lower risk of breast cancer and about 40 percent lower risk of dying from breast cancer.

However, theres conflicting evidence when it comes to the HRT form.

READ MORE:Long Covid: Four symptoms women more likely to experience, according to study

Cancer Research UK reports that hormone replacement therapy has been found to increase the risk of breast, ovarian and womb cancer.

However, the research portal also notes that this increased risk is small. Thats why in some cases the benefits of taking the hormone treatment could outweigh the risks.

Dr Newson also noted that the oestrogen used nowadays is much safer compared to the synthetic version used in the past.

Oestrogen isnt the only hormone you might need. The doctor said: Women that have a womb still need to have progesterone.

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And that has never been shown to be associated with the risk of breast cancer.

The risk of breast cancer for lots of types of HRT isnt there and actually there are some benefits.

But the treatment still remains heavily debated and many are worried about opting for HRT.

"We need to look at the evidence because thats the most important thing," the expert noted.

She continued: "When women have oestrogen on its own, if theyve got a womb, it can stimulate the lining of the womb, so yes theres an increased risk of womb cancer.

But we dont give women oestrogen on its own.

We give it with progesterone either as a capsuleor Mirena Coil and that thins the lining of the womb, so we dont have this risk, its a lot lower.

Dr Newson admitted that questionnaire study showed there might be a link. But she said that questionnaire studies dont represent good data, so that hasnt been proven.

We know that women who take the contraceptive pill have a lower risk of ovarian cancer, so HRT might be associated with a lower risk, she added.

Dr Newson concluded: The risk of breast cancer stems from WHI study that came out 20 years ago, using oral oestrogen and synthetic progestogens.

It showed that there was possibly an increased risk but when they re-analysed the data, this risk isnt statistically significant.

And women taking any type of HRT have a lower risk of dying from breast cancer.

The expert noted its also important to consider what women want as many, including Dr Newson herself, might take HRT for the benefits.

For example, the treatment has been also associated with a lower risk of conditions, including dementia, heart disease and osteoporosis.

Cancer Research UK recommends speaking to your GP to weigh up the pros and cons so you can consider your options.

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Hormone therapy education event held at LGBT Center – MSU Reporter

Posted: May 2, 2022 at 2:07 am

The Jim Chalgren LGBT Center hosted an information session on hormone replacement therapy (HRT) last Wednesday with representatives from Planned Parenthood. Hormone replacement therapy is used by both transgender and cisgender indiduals as part of a gender affirmation process and to treat gender dysphoria. Planned Parenthood provided promotional items and students were able to ask questions regarding HRT in a casual environment.

Jessica Voss is the LGBTQ care coordinater for Planned Parenthood and opened up the session with information on how Planned Parenthood uses informed consent to prescribe hormones to patients.

There are no requirements at the time, no recommendation from a therapist, no doctors note, or anything, said Voss. We are not interested in gatekeeping.

We just want to make sure you have good information that you need. Thats the informed part. This is what hormone therapy is. This is what it does. These are the effects. Heres how you take it. Then you give your consent, said Voss.

Many topics were discussed, including name changes while transitioning ones gender, the potentially permanent impacts of hormone replacement therapy, and different options with regards to hormone therapy.

Testosterone has a lot of permanent changes. I know some trans people who did testosterone for 5 years, got the thing they wanted and then they were done, they got their voice, they got their body hair, and they were like Im good now, said Tl Jordan, a youth coordinator for Planned Parenthood.

One topic that was brought up was how to maintain confidentiality whilst one was receiving hormone therapy if a student was on their parents insurance.

In theory, your healthcare privacy is your healthcare privacy but there are no guarantees, said Voss. Your parents could get a bill that you will have to explain.

Voss then went on to explain how a student could avoid their parents getting such a bill or statement, such as talking to their insurance company and signing up for paperless billing.

Those present at the session shared personal stories regarding their experiences using hormone therapies and other aspects of gender transitioning. Different metaphors to describe how they had been impacted by HRT, including having paint chipped off to reveal ones true character to expanding the number of colors in a crayon box from the standard eight to the 64 crayon box.

Transitioning and HRT is such a broad beautiful spectrum and I want to celebrate all the ways HRT can show up in our bodies that isnt just in that binary box of heres how a woman should be and thats how you should feel because thats not always the case, said Jordan.

Write to Jeremy Redlien at Jeremy.Redlien@mnsu.edu

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Global Hormone Replacement Therapy Masks Market 2022 Growth, Share, Trend, Segmentation and Forecast to 2028 themobility.club – themobility.club

Posted: May 2, 2022 at 2:07 am

The Brainy Insights aims to increase firms business acumen by giving functional and actionable insights with valuable data in Global Hormone Replacement Therapy Market. To satisfy the clients objectives of high-quality customized output in a short period, the organization has a robust collection, analytical, interpretational, and forecasting methodology for information extraction. The data analysis methods facilitate the synthesis of raw data into information utilized for factual analysis resulting in better decision-making.

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Quantitative analysis is based on historical and forecast years, with 2021 as the base year. Exhaustive methodologies gather the forecasted data from global and regional markets. The interpretation and analysis of raw data are performed in line with the buyers objectives. The holistic interpretation according to clients requirements will answer the most crucial market questions that are important in business decision-making.

The different qualitative tools used in the Hormone Replacement Therapy market include PESTEL analysis, PORTERS five forces, and SWOT analysis, for determining various attributes such as the opportunities and threats of new market entrants in the industry, the pricing and bargaining power of the buyers and the sellers, availability of substitute goods or services, and the market penetration of already established sellers in the market and the presence of suppliers and vendors.

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The global market has been segmented into the following regions, witnessing high demand and the presence of key players. These locations include: North America (United States, Canada & Mexico)

Asia-Pacific (Japan, China, India, Southeast Asian Countries & Australia etc)

Europe (Germany, UK, France, Italy, Spain, Russia, Netherlands & Belgium etc)

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All prominent participants in the Hormone Replacement Therapy market are investigated, and their business models and revenue segmentation are evaluated. The key vendors profiled in the Hormone Replacement Therapy market include Abbott Laboratories, Novartis, Pfizer, Inc., Mylan Laboratories, Merck and Co., Novo Nordisk, Bayer Healthcare, Eli Lilly, Genentech

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Ticking time bombs of DNA mutation may dictate when animals die – Livescience.com

Posted: May 2, 2022 at 2:05 am

Animals carry "mutational clocks" in their cells that dictate how quickly their DNA picks up mutations. And across species, animals tend to die once they've hit a certain number of mutations, new research finds.

It turns out that, in long-lived mammals like humans, these mutational clocks tick slower than they do in short-lived mammals like mice, meaning humans reach that threshold number of mutations at a later age than mice do. This discovery, the researchers said, could help solve a long-standing mystery in biology.

This mystery, known as Peto's paradox, describes a perplexing phenomenon that has defied explanation since the 1970s. At that time, scientists knew that animal cells accrued mutations in their DNA over time, and that as the number of mutations increased, so too did the risk of those cells turning cancerous. On paper, this suggests that the world's longest-living and largest animals should face the highest risk of cancer, because the chance of picking up cancer-causing mutations increases over time and as the total number of cells in an organism goes up.

But oddly enough, large, long-lived animals develop cancer at similar rates as tiny, short-lived creatures this is Peto's paradox. Now, in a new study, published April 13 in the journal Nature, scientists offer a partial potential solution to this puzzle: They discovered that short- and long-lived mammals both accumulate a similar number of genetic mutations over their lifespans, but the long-lived animals do so at a far slower rate.

"I was really surprised" at the strength of the relationship between lifespan and mutation rate in different species, said Alex Cagan, a staff scientist at the Wellcome Sanger Institute in England and first author of the study. The study results help explain one aspect of Peto's paradox, by showing that having a lengthy lifespan doesn't put animals at higher risk of cancer-causing mutations. However, the authors didn't find a strong link between animals' body masses and their mutational clocks, so their results don't address the question of why big animals don't have high rates of cancer.

Related: Scientists discover 4 distinct patterns of aging

The results do support the theory that animals age, at least in part, due to the build-up of mutations in their cells over time although the study doesn't reveal exactly how the mutations contribute to the aging process, Cagan said.

"Based on our results, yes, you can tell a mammal is close to the end of its species' lifespan when it has [approximately] 3,200 mutations in its colonic epithelial stem cells," which was the specific population of cells that the team analyzed. "But we don't think that it's because at 3,201, the animal will drop dead from mutation overload," Cagan said. Rather, the authors think that the relationship between animals' mutational clocks and aging might be a bit more nuanced.

To see how quickly mutational clocks tick in different mammals, the team analyzed genetic material from 16 species: humans, black-and-white colobus monkeys, cats, cows, dogs, ferrets, giraffes, harbor porpoises, horses, lions, mice, naked mole-rats, rabbits, rats, ring-tailed lemurs and tigers. Of these species, humans have the longest lifespan at roughly 80 years; mice and rats had the shortest lifespans, between about 3 and 4 years.

From each of these species, the researchers collected DNA from "crypts," which are tiny folds found in the lining of the small intestines and colon. The cells in each crypt all descend from a single stem cell, meaning they're all clones of that stem cell. Past studies suggest that, at least in humans, crypt cells pick up mutations at a constant rate as a person ages.

In total, the researchers analyzed more than 200 crypt tissue samples from the 16 species; each sample contained a few hundred cells, Cagan noted.

"The ability to sequence the genomes of very small cell populations (e.g. those that are found within one crypt) is fairly new, so this study could not have easily been done 20 years ago," said Kamila Naxerova, an assistant professor at Harvard Medical School and a principal investigator at the Massachusetts General Hospital Center for Systems Biology, who was not involved in the study.

Related: Anti-aging vaccine shows promise in mice will it work in humans?

The team determined the total number of DNA mutations present in each sample, and by taking each animal's age into account, they were able to estimate how quickly these mutations cropped up over the organism's lifespan. In some species, including dogs, mice and cats, the team had enough samples to compare the total number of mutations in individuals of different ages for instance, a 1-year-old mouse versus a 2-year-old mouse to double-check the accuracy of their mutation rate estimates.

Through their analysis, the authors discovered that, just like in humans, the crypt cells of other mammals also accrue mutations at a constant rate, year to year. But what was striking was that this mutation rate differed drastically between species. Human crypts accumulated the lowest number of new mutations each year, at only 47, while mouse crypts picked up the most, at a whopping 796 per year.

"This difference is staggering, given the large overall similarities between human and mouse genomes," Naxerov and Alexander Gorelick, a postdoctoral fellow at Harvard Medical School and Massachusetts General Hospital, wrote in an accompanying Nature commentary on the study.

Overall, the mutation rate of each species showed an inverse correlation to its lifespan, meaning that as an animal's lifespan increased the rate of new mutations per year decreased. That ultimately meant that "the total number of mutations at the end of an animal's life was roughly similar across species," Naxerova and Gorelick noted.

The new study doesn't hint at why long-lived animals' mutational clocks tick slower than those of short-lived animals, Cagan said. That said, an earlier study, published in October 2021 in the journal Science Advances, provides one explanation.

In that study, scientists sampled fibroblasts a type of cell found in connective tissue from the lungs of mice, guinea pigs, blind mole-rats, naked mole-rats and humans and then exposed these cells to a mutagen, or a chemical that damages DNA. "Our reasoning was that cells from long-lived species may cope much better with a mutagen than cells from short-lived species," said Jan Vijg, a professor and chair of the Department of Genetics at the Albert Einstein College of Medicine and senior author of the Science Advances report.

And that's just what they found. "Cells from a short-lived mouse quickly accumulated a lot of mutations, while in the very long-lived naked mole-rat or human, the same dose of mutagen did not even induce any mutations," said Vijg, who was not involved in the new Nature study. This suggests that long-lived animals may be better at repairing DNA damage and preventing mutations than short-lived animals, and this may partially explain why they accumulate mutations at a slower rate.

One limitation of both recent studies is that they each included just one cell type intestinal crypt cells or lung fibroblasts, Vijg said. That said, analyses of additional cell types would likely turn up similar results, he said. "I would expect that the findings would generalize to most other somatic cells," meaning cells that aren't eggs or sperm, Naxerova agreed.

Related: Natural rates of aging are fixed, study suggests

Cagan and his team are launching such studies into additional tissue types now. At the same time, they're moving beyond mammals to study a wide range of vertebrates and invertebrates, to see if the same relationship holds across the animal kingdom, he said. For example, the team recently got a hold of tissue samples from a super-rare Greenland shark that washed ashore in the U.K. and may have been about 100 years old at the time of its death, he said. Scientists estimate that this species can live at least up to 272 years, Live Science previously reported.

Within that research, Cagan's team hopes to reveal how the steady accumulation of mutations actually contributes to aging assuming it does at all, Cagan said. On this front, the team has proposed a theory.

They suggest that, as all somatic cells pick up mutations over time, some of those cells will develop mutations in critical genes that would normally regulate the cells' behavior. These corrupted cells become worse at their jobs but are able to multiply more efficiently than their neighbors, the theory suggests. And as these cells take over tissues in the body, this would ultimately cause organ systems to malfunction, leading to disease and death, Cagan said.

So "it's not that every cell stops working because it's accumulated a lot of mutations," he said. Rather, problematic mutations in specific cells cause those cells to go rogue, take over tissues and crowd out all the healthier, better-functioning cells. Therefore, the mutational clock of each species likely sets the pace at which these rogue cells take over, such that "it takes a lifetime before these clonal expansions of poorly functioning cells have disrupted the tissues so much that the animal can no longer function."

Such rogue cells could be described as "selfish," since they spread to the detriment of cells around them, Naxerov and Gorelick wrote in their commentary. There's evidence from animal studies that such selfish cells can emerge in the haematopoietic system the bodily system that makes blood and drive disease by contributing to chronic inflammation, Naxerov told Live Science.

"It could be that selfish clones in other organs contribute to disease and aging as well, but I think this is largely hypothetical for now," she said.

Originally published on Live Science.

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Sen. Orrin Hatch’s legacy tracks the GOP’s evolution on health – Wisconsin Public Radio

Posted: May 2, 2022 at 2:05 am

When it comes to health policy, former Utah Republican Sen. Orrin Hatch, who died Saturday at age 88, leaves a complex legacy of major legislative achievements, changing positions, compromises and fierce opposition. In many ways, though, Hatch's evolution and leadership on health policy during his four decades in the U.S. Senate mirror that of the Republican Party.

When he came to Washington as a neophyte politician after an upset victory in 1976, Hatch was a conservative firebrand, one of the early leaders of the "New Right" bent on dismantling the federal welfare state and banning abortion. A former trial lawyer, the new senator had never before held public office.

But the election of Ronald Reagan in 1980 and the Republican takeover of the Senate that made Hatch chairman of the powerful Labor and Human Resources Committee (now the Health, Education, Labor and Pensions Committee) turned him into something of a pragmatist. That pragmatism, it should be noted, was somewhat forced: Even though Hatch was technically the chair, there were enough moderate Republicans on the panel to give the ranking Democrat, Massachusetts' Edward Kennedy, effective control over what could be passed by the committee.

So Hatch learned to compromise and to legislate. In 1984, he negotiated with liberal Rep. Henry Waxman, D-Calif., what is still referred to as the "Hatch-Waxman Act." It's better known as the law that allowed, for the first time, approval of generic copies of brand-name drugs. Although far from a panacea, it is still the single-biggest advance in the fight to rein in high drug prices.

When the Democrats took back the Senate after the 1986 elections, Kennedy became chairman of the committee and Hatch, the ranking Republican. The two teamed up on a series of landmark legislative achievements, from the Ryan White program on AIDS treatment and the Americans with Disabilities Act to the first major federal child care law. And while Hatch was a strong foe of national health insurance, he and Kennedy ultimately pushed through Congress in 1997 the bill to create the Children's Health Insurance Program, which provides low-cost health insurance for low-income families who don't qualify for Medicaid.

The stridently anti-abortion Hatch was outspoken about his support for federal funding for research on embryonic stem cells derived from aborted fetuses. "I think it's the ultimate pro-life position, because I believe being pro-life is not just caring for the unborn but caring for those who are living," he told NPR in 2007.

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But like much of the Republican Party in Congress, Hatch returned to his conservative roots after the election of President Barack Obama in 2008. A supporter of the so-called individual mandate requiring people to have health insurance when it was the quasi-official GOP position in the early 1990s, Hatch became an outspoken foe. "Congress has never crossed the line between regulating what people choose to do and ordering them to do it," he said in 2010.

After moderate Utah Republican Sen. Robert Bennett was ousted in a primary in 2010 and replaced by conservative favorite Mike Lee, Hatch grew more conservative to win reelection in 2012. His final term in the Senate was marked by efforts to overturn the Affordable Care Act and further restrict abortion access. The devout Mormon, who in his spare time wrote lyrics for best-selling Christian music, even called the ACA "the stupidest, dumb-a** bill that I've ever seen. Now some of you may have loved it; if you do, you are one of the stupidest dumb-a** people I've ever met." He later apologized for the statement.

A former Kennedy aide, Jim Manley, told The Salt Lake Tribune that "no one epitomizes the rightward lurch of the Republican Party more than Sen. Hatch."

In one final twist, however, Hatch pushed as his successor the 2012 GOP presidential nominee, Mitt Romney. In just his first few years, Romney has become one of the most moderate Republicans in the chamber. That may prove to be Orrin Hatch's final legacy.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).

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Prior planning with preventive care | Off The Leash | rutlandherald.com – Rutland Herald

Posted: May 2, 2022 at 2:04 am

I love preventative care, love it. I like seeing healthy pets at their best and doing the things I can to keep them there. Of course, I also like getting sick or broken pets better. I dont even mind helping pets find a peaceful end. But by far my favorite thing is preventative care.

Preventative care runs a large gamut in veterinary medicine. There are so many ways that we can do less early so we dont have to do more later. The benefit to owners is that we have healthier pets for longer. The real truth is that ultimately preventative care saves money and stress. The other benefit is that it saves your pets health in many cases.

We know about vaccines. Even those opposed to some vaccines cant really argue against how vaccines have really changed the face of veterinary medicine. Vaccines are our first line of defense against many diseases, and in many cases have brought the caseload down very low.

In this region, we very rarely see parvo or distemper anymore because most dogs are vaccinated and our level of strays is low. Thirty years ago parvo was an amazingly huge deal and dogs were being wiped out in droves. Then an effective vaccine was developed and a deadly disease became almost 100% preventable.

I do occasionally run into a couple of misconceptions about vaccines. The first is that the Lyme vaccine can cause Lyme disease. It does not and cannot, that isnt how it works. The Lyme vaccine in people was more questionable, which is why it no longer exists. Dogs can still get Lyme disease when vaccinated. The vaccine stops the deadly form and greatly reduces symptoms, much like the corona vaccine. It doesnt mean we shouldnt take precautions, but it can prevent death (which in my book is huge.)

The main reasons owners balk at dental cleanings are the cost and the anesthesia. Getting regular cleanings can make both of those less of a factor. When teeth are less diseased and cleaned earlier we need fewer extractions and less involved cleaning. So the anesthesia is shorter, the procedure is easier and it is far cheaper. Once the teeth get severely affected, they often have to be pulled which is a much more complicated procedure. This can turn into several hours and surgical extractions.

Owners often tell us only to pull teeth if we have to, and I can fully assure you that pulling teeth is.....well, its an idiom for a reason! We always want to avoid this and the best way is routine home care and early dental cleanings.

I love taking lumps off early for several reasons. The reasons that matter to you are that smaller masses mean smaller incisions, shorter (cheaper) surgeries, and faster healing times. The reason that matters to me is that the sooner it is off the less chance it has had to be harmful.

There are certain lumps that we can tell are benign (will not spread), and lumps that we may have already biopsied. Sometimes we can tell from a needle aspirate what it is. If a lump is benign the benefit of removing it depends on size, location, and if a pet is bothering it. Often we dont know until we send the entire lump in, so removing them also gives us a final answer.

I talk about this all the time, but the better shape your pet is in the better their life will be. We can defer to future and past articles to discuss this in-depth. But the better body condition your pet is in the longer they will live and the healthier they will be. There are a lot of ways to achieve this, but the ultimate outcome is worth its weight in gold.

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Warning over common drug that could cause internal bleeding – New York Post

Posted: May 2, 2022 at 2:04 am

Doctors have warned against people over 60 taking a daily dose of aspirin.

It has been traditionally taken each day to slash the risk of a heart attack or stroke.

But a panel of top medics in the US this week changed their advice for older people.

They warned it could raise the risk of internal bleeding.

The US Preventative Services Task Force (USPSTF) also said 40-59 year olds should only takeaspirin dailyif they are at genetic risk of heart disease.

Those over 75should not take it because there is little benefit in older age.

Dr Michael Barry, USPTFs vice-chair and professor of Medicine at Massachusetts General Hospital, toldABC News: Based on current evidence, the task force recommends against people 60 and older starting to take aspirin to prevent a first heart attack or stroke.

Because the chance of internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age group.

The new guidance is only for patients starting up a course of aspirin.

Anyone on it already should continue, and not stop unless they have talked to their doctor.

A UK study from 2019 found itcan raise the risk of deadly bleeds by nearly 50 percent.

Kings College London researchers found taking it as a preventative treatment does help cut deadly cardiac events by 11 percent.

But it caused risk of major bleeding events to rocket by 43 percent, meaning one in 200 people treated with aspirin suffered a serious bleed.

The 2p-a-day painkiller is thought to make the blood less sticky.

Lead researcher, Dr Sean Zheng, said: There is insufficient evidence to recommend routine aspirin use in the prevention of heart attacks, strokes and cardiovascular deaths in people without cardiovascular disease.

This study shows that while cardiovascular events may be reduced in these patients, these benefits are matched by an increased risk of major bleeding events.

Aspirin use requires discussion between the patient and their physician, with the knowledge that any small potential cardiovascular benefits are weighed up against the real risk of severe bleeding.

Doctors recommend some people take a low dose of aspirin every day to prevent heart attacks and stroke.

The painkiller is also thought to reduce the risk of breast, colon, prostate and gastric cancers.

This story originally appeared on The Sun and was reproduced here with permission.

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Warning over common drug that could cause internal bleeding - New York Post

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