The Imperfectsarrives on Netflix on Sept. 8! Its a science fiction series following three young adults who are on the hunt to track down the mad scientist who transformed them into monsters through experimental gene therapy when they were youth.

Netflix dropped a teaser forThe Imperfects during Geeked Week, and it instantly got people pumped for the shows release. Then, on Sept. 1, the streamer released the exciting official trailer, and now everyones counting down the days until the show drops.

Fortunately, were only a day away fromThe Imperfects release on Netflix. In the meantime, weve decided to get to know the cast. While most of the cast consists of up-and-coming actors, there are also some familiar faces.

Below, we shared a cast and characters guide to whos who in the Netflix science fiction series!

The Imperfects. Italia Ricci as Dr. Sydney Burke in episode 107 of The Imperfects. Cr. Courtesy Of Netflix 2022

Italia plays the role of Dr. Syndey Burke, a gifted scientist looking to fix her past mistakes by helping Juan, Abbi, and Tilda track down the evil scientist who gave them monstrous side effects.

Where have you seen her before?

You might recognize Italia from her role as April Carver in the ABC Family television seriesChasing Life. She also had roles in the TV showsSupergirl,Designated Survivor andThe Good Doctor.

Whats next?

Its unknown what Italia will star in next, but you can catch her as Dr. Sydney Burke inThe Imperfects.

Social media:Instagram

The Imperfects. Iaki Godoy as Juan Ruiz in episode 101 of The Imperfects. Cr. Dan Power/Netflix 2022

Iaki portrays the role of Juan Ruiz, an aspiring graphic novelist who ends up being turned into a chupacabra throughDr. Alex Sarkovs experiment.

Where have you seen him before?

Iaki is best known for his roles in the television seriesLa querida del Centauro,Sin miedo a la verdadandNetflixsWho Killed Sara?

Whats next?

Well see him next in the live-action television adaptation ofOne Piece for Netflix.

Social media:Instagram

The Imperfects. Morgan Taylor Campbell as Tilda Weber in episode 103 of The Imperfects. Cr. Dan Power/Netflix 2022

Morgan plays Tilda Weber, a lead singer of a band whose dreams are crushed after she developssuper-hearing and a destructive vocal power through Dr. Alex Sarkovs experiment. She basically has powers similar to a banshee.

Where have you seen her before?

You mightve seen Morgan in the musical seriesZoeys Extraordinary Playlist and/or the comedy filmSadies Last Days on Earth. She also played Harper in the 2017 superhero filmPower Rangers.

Whats next?

Its unknown what Morgan will star in next at the moment.

Social media:Instagram

The Imperfects. Rhianna Jagpal as Abby Singh in episode 101 of The Imperfects. Cr. Dan Power/Netflix 2022

Rhianna plays Abbi Singh, a determinedgeneticist who develops abilitiesthat give her a Succubus-like control over anyone around her after undergoing Dr. Alex Sarkovs experiment.

Where have you seen her before?

Rhianna is known for her roles in the teen rom-comTo All the Boys: Always and Forever,the sci-fi seriesMotherland: Fort Salem and the anthology seriesTwo Sentence Horror Stories.

Whats next?

Rhiannas following projects are unknown at the moment.

Social media:Instagram

The Imperfects. Rhys Nicholson as Dr. Alex Sarkov in episode 101 of The Imperfects. Cr. Dan Power/Netflix 2022

Rhys portrays the role of Dr. Alex Sarkov, an evil scientist whose goal is torewrite the human genome and bring about the next stage of human evolution. He experimented on Juan, Abbi, and Tilda and turned them intomonster-human mutants.

Where have you seen them before?

You might recognize Rhys as a judge onRuPauls Drag Race Down Under.

Whats next?

You can catch Rhys in season 2 ofRuPauls Drag Race Down Under.

Social media:Instagram

The Imperfects. Kyra Zagorsky as Finch in episode 103 of The Imperfects. Cr. Courtesy Of Netflix 2022

Kyra plays Isabel Finch, a woman who wants to track down Dr. Alex Sarkov for her own reasons. However, if she finds Dr. Alex Sarkov before Juan, Abbi, and Tilda do, they might not be able to become human again.

Where have you seen her before?

You might know Kyra from her roles in the TV showsContinuum,Helix,ArrowandThe 100.

Whats next?

Its unknown what projects Kyra will star in next.

Social media:Twitter

The Imperfects. Celina Martin as Hannah in episode 110 of The Imperfects. Cr. Courtesy Of Netflix 2022

Celina portrays the role of Hannah Moore, a woman who also underwent Dr. Alex Sarkovs experimental gene therapy. Hannah has a hard time balancing helping Juan, Tilda, and Abbi while also assisting Isabel Finch.

Where have you seen her before?

Celina is known for her roles in the television seriesThe Other Kingdom and the dystopian thrillerLevel 16.

Whats next?

She doesnt have any upcoming projects at the moment.

Social media:Instagram

The Imperfectslands on Netflix on Sept. 8 at 12:00 a.m. PT/3:00 a.m. ET!

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The Imperfects cast guide: Whos who in the Netflix sci-fi series? - Netflix Life

Recommendation and review posted by Bethany Smith

This as-told-to essay is based on a conversation with Helena McCabe, the 34-year-old founder of The TBCD Foundation from Gotha, Florida. It has been edited for length and clarity.

Three days. That's how long I gave myself to grieve before I got into action. Getting a terminal diagnosis for my 16-month-old son was, hands down, the worst day of my life but I've never been a quitter.

If you talk to my friends, they'll tell you I'm the person to call when you're getting the runaround and need someone to get things done. Fiery, committed, and loyal, there was no way that I was going to concede and watch my son die.

Max was diagnosed with a TBCD tubulin folding cofactor D gene mutation, an ultrarare genetic-neurological condition, two days before Thanksgiving in 2021. He was 16 months old then, and he's 2 years old now. It's like ALS for babies, and affects his ability to walk and talk. Kids with TBCD mutations usually lose all purposeful movement and vision by the age of 4, and the average lifespan is under five years.

TBCD is referred to as an orphan disease. The medical community often uses this term to describe a disease so rare that the medical and pharmacological industries have given up researching treatments because not enough people experience it for there to be a profit margin.

There are currently about 20 children in the world diagnosed with TBCD; since we've begun awareness campaigns with other TBCD families, other families with children who have been misdiagnosed with things like cerebral palsy are discovering that they actually have TBCD but the number of people diagnosed and still alive is unlikely to have broken 30.

That means it might be more common than originally thought, and because the gene is not included in standard prenatal-genetic testing and diagnosis tests, people have no way to know if they're carriers without specifically testing for it.

Before my husband and I conceived, we had our genetics tested because cystic fibrosis runs in his family. The doctor gave us the green light as far as that was concerned; we were good to go. Because TBCD is so rare, screening for it is not included in standard genetic testing and we came to find out both of us are carriers. Our neurologist said that it's so rare, we would have had better odds winning the lottery twice, which obviously would have been better.

When my husband and I talked about what we were going to do, we decided to go all-in on helping all kids with TBCD and started The TBCD Foundation, which is dedicated to raising funds for research.

Several families with children who had TBCD did not jump on board the way I thought they would. For some people, it's more painful to hope than it is to deal with the anticipatory grief. Most parents don't even get a second opinion when their child receives a terminal diagnosis. But we did find two other mothers who were happy to help.

Between the three of us, we emailed thousands of researchers. We emailed everyone who might be able to do anything; any researcher who had written a paper on it or worked on something similar. Each time, we were met with the same response different variations of "no."

Without funding, and given that TBCD is an orphan disease, no one wanted to touch it. That was until we heard from Dr. Allison Bradbury, an assistant professor in the Department of Pediatrics at Ohio State College of Medicine and a principal investigator in the Center for Gene Therapy at the Abigail Wexner Research Institute.

After seeing Landon one of the other children from the TBCD Foundation on the news in January 2022, Bradbury reached out to us. She let us know that she wanted to help. Her work focuses on research and therapy development in the field of rare pediatric-neurodegenerative disorders, and she was willing to talk.

Ever since Bradbury came on board to help us with the research, we've learned a lot about the disease and how it affects every patient differently. For example, now I know that where the mutation lies on the gene dictates how quickly the disease will affect the person.

Max is one of the luckier patients, as his mutation is all the way at the back of the gene. That means he may have more wax in his proverbial candle than some other children diagnosed with TBCD, but with the progressively debilitating disease threatening his eyesight, the few words he's able to say, and his movements growing more compromised with each passing day, we don't have time to waste.

We're going through the first level of the research, and so far, we have promising results. Bradbury is using a technique proven successful in other rare genetic conditions that replaces the broken DNA with a healthy copy. The faster we can utilize this therapy, the more lives we can save and the higher quality of life we can preserve for Max and other patients.

It's going to take $2,000,000 for us to get to clinical trials for Max and the other kids with TBCD. These clinical trials have the potential to save his and the other kids' lives. While there are no guarantees, this is the best hope Max and these kids have for a healthier, happier life.

When Max was diagnosed, I realized I had a choice: accept it, or fight like hell. Instead of sitting, sobbing, and watching my baby boy die, I'm fighting for his life with all I have. My goal isn't for Max to have a normal life, but for him to have a happy one. And that is possible if we can get the funding for this research.

More here:
My son has a rare terminal genetic disorder called TBCD - Insider

Recommendation and review posted by Bethany Smith

IRVINE, Calif. & BASEL, Switzerland(BUSINESS WIRE)Great Place to Work and Fortune magazine have named Urovant Sciences as one of the 2022 Best Workplaces in BioPharma. This is Urovants first time being named to this prestigious list, this year coming in at 17th place. Earning a spot means that Urovant is one of the best biopharma companies to work for in the country.

The Best Workplaces in BioPharma award is based on analysis of survey responses from more than 36,000 employees from Great Place to Work-Certified companies in the biopharma industry. In that survey, 89% of Urovants employees said Urovant is a great place to work. This number is 32% higher than the average U.S. company.

Its an honor to be recognized by Fortune and Great Place to Work, said James Robinson, CEO of Urovant Sciences. We like to say we are Powered by People and Possibilities. Developing a diverse, welcoming, and action-oriented culture has been and continues to be a priority at Urovant. This allows us to advance patient care through our culture with values of integrity and compassion, bold innovation through inclusion, and achievement through collaboration.

The Fortune Best Workplaces in BioPharma list is highly competitive. Great Place to Work, the global authority on workplace culture, selected the list using rigorous analytics and confidential employee feedback. Companies were considered if they are a Great Place to Work-Certified organization.

Great Place to Work is the only company culture award in America that selects winners based on how fairly employees are treated. Companies are assessed on how well they are creating a great employee experience that cuts across race, gender, age, disability status, or any aspect of who employees are or what their role is.

It is our honor to spotlight the Best Workplaces in BioPharma, said Michael C. Bush, CEO of Great Place to Work. We applaud their commitment to inclusive, high-trust cultures.

In addition to becoming a certified Great Place to Work earlier this year, Urovant was named one of the Best Places to Work for the second year in a row by the Orange County Business Journal.

About Urovant Sciences

Urovant Sciences is a biopharmaceutical company focused on developing and commercializing innovative therapies for areas of unmet need, with a dedicated focus in urology. The Companys lead product, GEMTESA(vibegron), is an oral, once-daily (75 mg) small molecule beta-3 agonist for the treatment of adult patients with overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency. GEMTESA was approved by the U.S. FDA in December 2020 and launched in the U.S. in April 2021. GEMTESA is also being evaluated for the treatment of OAB in men with benign prostatic hyperplasia. The Companys second product candidate, URO-902, is a novel gene therapy being developed for patients with OAB who have failed oral pharmacologic therapy. Urovant Sciences, a wholly-owned subsidiary of Sumitovant Biopharma Ltd., intends to bring innovation to patients in need in urology and other areas of unmet need. Learn more about Urovant at http://www.Urovant.com or follow on Twitter, LinkedIn or Instagram.

About Sumitovant Biopharma

Sumitovant is a technology-driven biopharmaceutical company accelerating development of new potential therapies for patients with high unmet medical need. Through our subsidiary portfolio and use of embedded computational technology platforms to generate business and scientific insights, Sumitovant has supported development of FDA-approved products and advanced a promising pipeline of early-through late-stage investigational assets for other serious conditions. Sumitovants subsidiary portfolio includes wholly-owned Enzyvant, Urovant, Spirovant, and Altavant, and one majority-owned subsidiary that is publicly listed: Myovant (NYSE: MYOV). Sumitomo Pharma is Sumitovants parent company. For more information, please visit http://www.sumitovant.com.

About Best Workplaces in BioPharma

Great Place to Work selected the Best Workplaces in BioPharma by gathering and analyzing confidential survey responses from more than 36,000 employees at Great Place to Work-Certified organizations in the biopharma industry. Company rankings are derived from 60 employee experience questions within the Great Place to Work Trust Index survey. Great Place to Work determines its lists using its proprietary For All methodology to evaluate and certify thousands of organizations in Americas largest ongoing annual workforce study, based on over 1 million survey responses and data from companies representing more than 6.1 million employees, this year alone. Read the full methodology.

About Great Place to Work

Great Place to Work is the global authority on workplace culture. Since 1992, they have surveyed more than 100 million employees worldwide and used those deep insights to define what makes a great workplace: trust. Their employee survey platform empowers leaders with the feedback, real-time reporting and insights they need to make data-driven people decisions. Everything they do is driven by the mission to build a better world by helping every organization become a great place to work For All.

Learn more at greatplacetowork.com and on LinkedIn, Twitter, Facebook and Instagram.

About Overactive Bladder

Overactive bladder (OAB) is a clinical condition that occurs when the bladder muscle contracts involuntarily. Symptoms may include urinary urgency (the sudden urge to urinate that is difficult to control), urgency incontinence (unintentional loss of urine immediately after an urgent need to urinate), frequent urination (usually eight or more times in 24 hours), and nocturia (waking up more than two times in the night to urinate).1

Approximately 30 million Americans suffer from bothersome symptoms of OAB, which can have a significant impairment on a patients day-to-day activities.1, 2

About GEMTESA

GEMTESA is a prescription medicine for adults used to treat the following symptoms due to a condition called overactive bladder:

It is not known if GEMTESA is safe and effective in children.

IMPORTANT SAFETY INFORMATION

Do not take GEMTESA if you are allergic to vibegron or any of the ingredients in GEMTESA.

Before you take GEMTESA, tell your doctor about all your medical conditions, including if you have liver problems; have kidney problems; have trouble emptying your bladder or you have a weak urine stream; take medicines that contain digoxin; are pregnant or plan to become pregnant (it is not known if GEMTESA will harm your unborn baby; talk to your doctor if you are pregnant or plan to become pregnant); are breastfeeding or plan to breastfeed (it is not known if GEMTESA passes into your breast milk; talk to your doctor about the best way to feed your baby if you take GEMTESA).

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

What are the possible side effects of GEMTESA?

GEMTESA may cause serious side effects, including the inability to empty your bladder (urinary retention). GEMTESA may increase your chances of not being able to empty your bladder, especially if you have bladder outlet obstruction or take other medicines for treatment of overactive bladder. Tell your doctor right away if you are unable to empty your bladder. The most common side effects of GEMTESA include headache, urinary tract infection, nasal congestion, sore throat or runny nose, diarrhea, nausea, and upper respiratory tract infection. These are not all the possible side effects of GEMTESA. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Please click here for full Product Information for GEMTESA.

UROVANT, UROVANT SCIENCES, the UROVANT SCIENCES logo and Powered by People and Possibilities are trademarks of Urovant Sciences GmbH, registered in the U.S. and in other countries. All other trademarks are the property of their respective owners. 2022 Urovant Sciences. All rights reserved.

From Fortune. 2022 Fortune Media IP Limited. All rights reserved. Used under license.

Contacts

Urovant Sciences

Alana Darden Powell

Vice President, Corporate Communications

949-436-3116

alana.darden@Urovant.commedia@urovant.com

Sumitovant BiopharmaMaya Frutiger

VP, Head of Corporate Communications

media@sumitovant.com

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Urovant Sciences Named 17th on the List of Fortune Best Workplaces in BioPharma (2022) - - Portada-online.com

Recommendation and review posted by Bethany Smith

Naturopathic Physician Dr. Michelle Sands transforms menopause and perimenopause care with a holistic approach to hormone replacement therapy and midlife menopause support. Dr. Sands believes all women deserve to feel amazing in their bodies and seeks to achieve this by providing affordable and accessible personalized care through her virtual health platform, Glow Natural Wellness.

Every woman will go through menopause, but Dr. Michelle Sands founded GLOW Natural Wellness because she believes that no woman should have to suffer through hot flashes, night sweats, intimate dryness, weight gain, and other change-of-life symptoms. These symptoms directly result from the dramatic drop in hormones such as estrogen, progesterone, and testosterone during the menopause transition.

Even more important is that women understand the importance of maintaining optimized hormone levels when it comes to protecting themselves from chronic disease. Without adequate estrogen levels, a womans risk of heart disease, diabetes, osteoporosis, Alzheimers, and all-cause mortality increases. Bioidentical Hormone Replacement, when dosed and delivered correctly, can reduce those risks and extend life. The problem is that this conversation is not happening in most doctors offices.

Studies show that when women seek medical care for the symptoms of menopause, 75 percent of them are sent home without treatment, Dr. Sands said. An estimated 1.3 million women enter menopause every year in the U.S. alone. Yet less than 20 percent of physicians, including OB/GYNs, are trained to treat them properly.

Dr. Sands, a licensed Naturopathic Physician, and Female Health and Hormone Expert, has created The Healthy Hormone Club to provide affordable and accessible testing, treatment, and education for this underserved demographic.

What is menopause

Menopause is a point in time 12 months after a woman's last period. The 10-15 years leading up to that point are called Perimenopause. During this period, women may have changes in their monthly cycles due to declining levels of estrogen and progesterone. By the time they reach menopause, estrogen and progesterone have plummeted to barely-there levels. Common symptoms include hot flashes, night sweats, mood swings, osteoporosis, fatigue, and more.

Menopause is one day, Dr. Sands said. The next day, you are postmenopausal for the rest of your life. Hormone replacement therapy is a great way to support the body through the menopause transition and throughout post-menopause.

Answering the most asked menopause and perimenopause questions

Hormone Harmony

Dr. Michelle Sands published a book, Hormone Harmony Over 35: A New, Natural, Whole-Body Approach to Limitless Female Health, to share her approach to optimal health with the public. She reveals her evidence-based 21-day plan to restore hormonal balance, reduce stress, and naturally detoxify the body.

A womans body can no longer make vital hormones once she is postmenopausal, and it can quickly affect her quality of life, Dr. Sands said. The GLOW Natural Wellness team helps clients understand their symptoms and how to navigate them using a personalized and holistic approach. A typical protocol will consider a patients health history, current symptoms, laboratory test results, and health goals. In addition to bioidentical hormone replacement therapy, a focus on nutrition, stress reduction, movement, nutraceuticals, and mindfulness is key for the best possible outcomes.

Conclusion

A mother herself, Dr. Michelle Sands, knows how draining life can be for women struggling with menopause symptoms. She is passionate about helping women harness the power of their DNA to elevate their genetic expression and live vibrantly, not just by optimizing health physically, but also mentally, emotionally, and spiritually.

Women experiencing menopause or perimenopause symptoms are encouraged to visit the GLOW Natural Wellness website to learn more about bioidentical hormone replacement therapy.

Glow Natural Wellness

Dr. Michelle Sands

United States

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Dr. Michelle Sands Treats Menopause Symptoms Through GLOW Natural Wellness Hormone Replacement Therapy - Benzinga

Recommendation and review posted by Bethany Smith

Hormone replacement therapy has a bad reputation because of potential risks to long-term health. A new look at the evidence could change our relationship with HRT - and the menopause

By Caroline Williams

Angus Greig

THE mood swings I could handle. Ditto the night sweats, irregular periods and alibido that swung between randy teenager and old maid. Then the menopause came for my brain and enough was enough. Ifageing naturally meant giving up the job I love because I could no longer think, I was out. Bring on the hormone replacement therapy.

Within weeks, I found energy reserves that I had forgotten I had. The urge to crawl into bed mid morning disappeared and was replaced with a clear head and renewed zest for life.

It was quite the transformation. So much sothat one of the first things I wanted to do with my new mental clarity was to dig in to thescience behind what was happening to me. Was I experiencing an age-related hormonal deficiency that I had, sensibly, nipped in the bud? Or was I guilty of jumping on the latest well-being bandwagon, making a big fuss about a natural life stage that would soon pass?And, importantly, am I protecting my long-term health by taking HRT or risking it?

These are questions that scientists have been grappling with for more than 80 years, ever since the first HRT was approved by the US Food and Drug Administration. Premarin, made from oestrogens extracted from the urine of pregnant horses, was licensed in the early 1940s for the treatment of hot flushes and night sweats, the most common menopausal symptoms. There are many others, ranging from heart palpitations and joint pain to brain fog, anxiety and depression.

These symptoms are eminently treatable with HRT. Yet its use has been controversial

Continue reading here:
Should you take HRT? Here's how to think clearly about the risks - New Scientist

Recommendation and review posted by Bethany Smith

Primary hyperparathyroidism ( PHPT) primarily affects women after menopause.

Around 2-3 per cent of women develop a mild variant of the disease following menopause. PHPT is a disease that causes an increase in the level of calcium in the blood.

Calcium is an important mineral in the body, of which there should be neither too much nor too little. Those with mild PHPT only have a minor elevation of calcium levels and usually do not have any symptoms.

Mild PHPT is a relatively common condition in women who have gone through menopause. Unfortunately, it is often overlooked in routine health examinations, says Jens Bollerslev, adjunct professor at the Institute of Clinical Medicine at the University of Oslo and senior physician at Oslo University Hospital.

Now, however, he and his colleagues have good news for PHPT patients.

Four small glands in the neck, called parathyroid, regulate the level of calcium in the blood. In people who have PHPT, one or more of these glands are overactive.

Common treatment of PHPT has been to remove overactive glands through surgery. The aim has been to reduce the risk of early death and of potentially developing other diseases because of the elevated calcium levels.

However, researchers in Norway, Sweden and Denmark have found that it is not necessary to perform surgery on patients who have the mild variant of the disease, where the calcium level is only slightly higher than usual.

Our study suggests that it is safe not to remove the overactive glands in patients with mild PHPT, at least over a ten-year perspective, Mikkel Pretorius says.

He is a PhD candidate at the Institute of Clinical Medicine at the University of Oslo (UiO) and senior physician at the Department of Endocrinology, Morbid Obesity and Preventive Medicine at Oslo University Hospital.

From left: Ansgar Heck, Jens Bollerslev, Kristin Godang and Mikkel Pretorius. (Photo: Oslo University Hospital)

In the study, Pretorius and colleagues found out that the vast majority of people with mild PHPT had good health over a ten-year period, regardless of whether or not the overactive gland had been removed.

A few patients with mild PHPT developed other diseases and complications, and a few died during the 10-year duration of the study. This, however, seems unrelated to whether or not the patients underwent surgery. There were no differences on these measures between the two groups.

Our study shows that the health of patients who did not have surgery was just as good as the health of patients who did have surgery, Jens Bollerslev, who led the study, says.

Ansgar Heck, researcher and senior physician at the Section for Special Endocrinology at Oslo University Hospital, puts it like this:

This study allows us to give better advice to patients. Patients will also be able to base their choice between surgery and a wait-and-see attitude on more information."

Visual abstract: Annals of Internal Medicine. (Image: Pretorius et al.)

The parathyroid glands secrete the parathyroid hormone PTH. This hormone ensures that calcium is moved from the skeleton to the bloodstream. An overactive gland secretes too much of the hormone, which leads to higher calcium levels.

Researchers and professionals in the medical field assume that the disorder in the parathyroid gland and the disease PHPT increases the risk of developing other diseases such as cardiovascular disease, kidney disease and osteoporosis.

Osteoporosis is the same as bone fragility. The disease makes the skeleton weaker and more prone to bone fractures.

The assumed increased risk of getting other diseases is the reason why common treatment has been to remove the overactive gland. Nevertheless, there is a lack of research documenting the risk.

In real terms, we do not know whether the assumption of increased morbidity and death is true for people with mild PHPT, Bollerslev explains. We also do not know whether the development of disease is connected with the higher calcium levels or the higher levels of the hormone PTH, or both.

Although patients who have the mild variant of the disease do not appear to need surgery, the healthcare system should ensure that this patient group is followed-up.

It is important to follow the development of the calcium level and the potential development of other diseases annually. If patients develop osteoporosis, one must decide whether surgery or other treatment is necessary after all, Bollerslev says.

The slightly higher level of calcium in the blood is often discovered by chance during a blood test.

If we see a higher level of calcium, it is important to examine the patient further to find out whether the patient also has higher levels of the hormone PTH. Because it may be that there is another reason for the higher calcium level, Heck says.

PHPT is much less common among men and among people under the age of 50. There is currently little research on how the disease affects these groups.

We do not know whether men and younger people who have the disease also have an increased risk of getting other diseases, Bollerslev says.

Another unanswered question is whether there is a smooth transition between what is considered mild PHPT and what is considered severe PHPT.

In severe PHPT, the level of calcium in the blood is much higher and patients usually have symptoms or complications. Surgery is then recommended.

191 patients with mild PHPT participated in the study. All participants were over 50 years of age and had a slightly elevated level of calcium in their blood. The patients had no symptoms or other diseases that could be directly linked to PHPT.

The patients were randomly divided into two groups, where one group underwent surgery and the other group was observed without surgery.

The researchers then followed up the patients in the two groups over a ten-year period in order to compare their state of health and any development of other disease with and without surgery.

This is the largest and longest lasting randomised study on this common disease. The study also shows that with good Scandinavian cooperation we can answer research questions that are relevant to the rest of the world, Pretorius states.

Reference:

Pretorius et al. Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation, Annals of Internal Medicine, 2022. DOI: 10.7326/M21-4416 Abstract.

Summary for Patients: Mortality and Morbidity in Mild Primary Hyperparathyroidism, Annals of Internal Medicine, 2022.

Read more:
Hormone disease that mostly affects menopausal women should not lead to surgery in mild cases - Sciencenorway.no

Recommendation and review posted by Bethany Smith

Posted By: Jan Larson McLaughlinAugust 31, 2022

Teal ribbons adorn downtown Bowling Green and other communities across the U.S. as part of a nationwide campaign during the month of September, which is Ovarian Cancer Awareness Month.

Locally, the campaign is spearheaded by the Ovarian Cancer Connection, a non-profit organization serving northwest Ohio and southeast Michigan.

Ovarian cancer impacts 21,000 more women each year.

Turn the Towns Teal is a national campaign in all 50 states, with the mission of raising awareness of the symptoms of ovarian cancer. Knowing the symptoms and risk factors of the cancer can lead to early detection with a 90-95% success rate.

Although the primary mission is to raise awareness to the symptoms of ovarian cancer, the national campaign also promotes support for survivors.

Potential symptoms may include:

If any symptom persists for 10 days to two weeks, consult your gynecologist or physician.

Risk factors for ovarian cancer may include genetic predisposition, family history, hormone replacement therapy, increasing age or reproductive history and infertility.

Do not ignore the risk factors and symptoms of ovarian cancer. If something does not feel right, contact your local physician or gynecologist.

Continue reading here:
'Turn the Towns Teal' ribbons raise awareness of ovarian cancer BG Independent News - BG Independent Media

Recommendation and review posted by Bethany Smith

NEWYou can now listen to Fox News articles!

Twenty-five years ago, when I was a young medical student on one of my first hospital rotations, the soft-spoken senior physician leading our team asked us one day on rounds, "what is all medication?" Met with blank stares, he then answered for us: "Poison. All medication is poison." He didnt mean that the drugs we were giving our patients were killing them, but that we had a responsibility to be cautious when using them, as they also have the potential to harm.

Its a lesson many of my physician colleagues are ignoring in their opposition to burgeoning legislation in several states that would prohibit "gender-affirming" therapies for children with gender dysphoria, including Ohio HB 454, currently the subject of contentious debate in my home state. Those therapies include hormones to stop puberty and change external sexual characteristics, and surgeries to alter anatomy to that of the opposite sex. As a doctor and a father, I have watched the role many in my profession have played in this debate with increasing concern and dismay. Physician involvement in this kind of therapy for children is horribly irresponsible and worthy of contempt.

The standard in medicine is that the onus is on those proposing any treatment to reliably demonstrate that treatment is safe and effective. In the case of children with gender dysphoria, the medical evidence for hormone therapy and surgery is weak and conflicting, with poor quality studies that are riddled with shortcomings and bias. Moreover, data supporting the safety of long-term hormone treatment in these children is largely nonexistent.

BOSTON CHILDREN'S HOSPITAL DELETES REFERENCES TO VAGINOPLASTIES FOR 17-YEAR-OLDS AMID ONLINE FUROR

Infertility is common after hormone therapy, and bone and cardiovascular health are at risk as well. Crucially, there is also data to show that those who undergo surgical therapy are vastly more likely to suffer lifelong mental unrest and even commit suicide, and that those consequences may not surface until a decade or more after surgery. In recent years, an increasing number of accounts of children who "transitioned," then subsequently "detransitioned" in adulthood, have illustrated the difficulty of reversing the effects that hormones and surgery have on young bodies and minds.

"I'm Not a Girl" is written by Maddox Lyons and Jessica Verdi about a transgender child. (YouTube/Screenshot)

Sadly, in a pattern that has become all too common in the COVID-19 era, U.S. physician advocates for these kinds of treatments have vastly overstated the results of their studies, downplayed any potential side effects, declared the issue "settled science," and then used that declaration as a cudgel to attack anyone who disagrees. In contrast, many of our European counterparts, including the United Kingdom, France, Sweden, and Finland, have recently hit the brakes on such therapy for children, recognizing that the data is poor and the long-term side effects are unclear.

Whats more, the ability of children to assent to any medical treatment is limited by the state of their brain development. Its long been known that the prefrontal cortex, the area of the brain that is responsible for planning and making impulse-free decisions, is not fully developed until about age 25. Thats why we dont let 10-year-olds eat ice cream all day long, why we dont let 16-year-olds buy alcohol, and why rental car companies charge 21-year-olds a young renters fee. Physicians who treat children with gender dysphoria know this well, but many inexplicably suspend that knowledge when it comes to life-altering hormonal and surgical therapy. In doing so, theyre betraying the trust of the vulnerable children and parents who have come to them for help.

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There is even an increasing chorus of voices within the transgender community itself who, unlike my ostensibly judicious colleagues, recognize these issues with childhood decision-making, and have spoken against such therapies for children.

More fundamentally, the very notion of chemically and surgically altering a child because they feel like they are the opposite sex runs counter to some basic truths that humanity has traditionally taught its children. Namely, that their feelings sometimes dont reflect objective reality, that there are some absolute constants in the world (one of them being their biologic sex), and that their physical existence is not a mistake. The idea that their body is somehow "wrong" is a message that should never be given to a child.

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Like all who seek out medical care, children with gender dysphoria and their families deserve compassion and honesty from their physicians. What many are getting instead are misleading, ideologically driven recommendations, resulting in physical and psychological mutilation that is difficult or impossible to reverse. Thats true poison to our profession, and it needs to stop.

LeRoy Essig, M.D. is a pulmonary, critical care, and sleep medicine physician practicing in Columbus, Ohio. He is a graduate of Princeton University and The Ohio State University College of Medicine.

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Diabetesis a common condition that affects one in 10 people, that's over 37 million Americans, according to the Centers for Disease Control and Prevention While that's an alarming number, there are ways to help lower the risk. Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies tells us, "Diabetes is a serious medical condition that can lead to several health complications, including heart disease, kidney damage, and blindness. Fortunately, there are several things that people can do to reduce their chance of developing diabetes. Here are five lifestyle changes that can help to prevent diabetes. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell says, "Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. When blood sugar levels are too high, it can strain the organs and lead to complications such as heart disease, stroke, kidney disease, and vision problems. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes usually develops in childhood or adolescence and is caused by an autoimmune reaction that destroys the beta cells in the pancreas that produce insulin. Type 2 diabetes usually develops in adulthood and is characterized by insulin resistance, when the body cannot effectively use the insulin it produces. Diabetes can be managed through lifestyle changes such as diet, exercise, and medication.

According to the Centers for Disease Control and Prevention (CDC), more than 30 million people in the United States have diabetes. However, it is estimated that one in four is undiagnosed and unaware of the condition. This is particularly concerning because diabetes can lead to several serious health complications, including heart disease, stroke, kidney disease, and blindness. That is why it is so important to get screened for diabetes if you think you may be at risk. If you have a family history of diabetes, your doctor might recommend getting screened at an earlier age. There are several ways to test for diabetes, but the most common is the A1C test. This test measures your average blood sugar levels over two to three months and can be done at your doctor's office or a local clinic. If you have diabetes, it is essential to work with your healthcare team to manage your condition and prevent complications. People with diabetes can live long and healthy lives with proper treatment and care."

Dr. Mitchell explains, "Being overweight or obese is the number one risk factor for type 2 diabetes. About 80 percent of people with this form of diabetes are overweight or obese. There are several reasons why carrying extra weight increases your risk of developing diabetes. First, excess body fat makes it difficult for the body to use insulin effectively. When the body can't use insulin properly, blood sugar levels rise. This is known as insulin resistance. Insulin resistance is a major cause of type 2 diabetes. In addition, carrying extra weight puts extra strain on the body's organs and systems, including the pancreas, which produces insulin. Over time, this can lead to damage and dysfunction. Finally, fat tissue produces hormones contributing to insulin resistance and high blood sugar levels. For all these reasons, people who carry extra weight are at a much higher risk of developing diabetes than those of a healthy weight."6254a4d1642c605c54bf1cab17d50f1e

According to the Centers for Disease Control and Prevention, "Not getting enough physical activity can raise a person's risk of developing type 2 diabetes. Physical activity helps control blood sugar (glucose), weight, and blood pressure and helps raise "good" cholesterol and lower "bad" cholesterol. Adequate physical activity can also help reduce the risk of heart disease and nerve damage, which are often problems for people with diabetes."

Dr. Mitchell reminds us, "Eating a healthy diet is essential for many reasons. It can help you maintain a healthy weight, have more energy, and avoid heart disease, stroke, and diabetes. Diabetes is a condition that affects how your body uses blood sugar. If you have diabetes, your body either doesn't make enough insulin or can't use it as well as it should. This causes blood sugar levels to rise. Over time, high blood sugar levels can lead to serious health problems, such as heart disease, kidney disease, nerve damage, and eye problems. Eating a healthy diet is one of the best ways to prevent or delay type 2 diabetes. A healthy diet includes fruits, vegetables, whole grains, and lean proteins. Limiting sugar, saturated fat, and trans fat is also essential. If you already have diabetes, eating a healthy diet can help you control your blood sugar levels. It can also help you prevent or delay complications of the disease."

Dr. Mitchell says, "Smoking is a leading cause of preventable death in the United States and a significant risk factor for developing diabetes. Smokers are more likely to develop type 2 diabetes than non-smokers, and the risk increases with the number of cigarettes smoked daily. Quitting smoking not only lowers your risk of developing diabetes but also helps to improve blood sugar control if you already have the disease. In addition, quitting smoking decreases your chances of developing other serious health problems, such as heart disease, stroke, and cancer. If you smoke, quitting is one of the best things you can do for your health. Talk to your doctor about ways to help you quit smoking for good."

Dr. Mitchell shares, "Monitoring blood sugar is essential in preventing diabetes because it allows people to see how their diet and lifestyle choices affect their blood sugar levels. For example, if someone eats many sugary foods, they might see a spike in their blood sugar levels. By monitoring their blood sugar, they can change their diet or lifestyle to help prevent their blood sugar from reaching diabetic levels. In addition, monitoring blood sugar can also help people with diabetes to keep their condition under control. They can adjust their insulin doses accordingly by knowing their blood sugar levels. Thus, monitoring blood sugar is an essential tool in both preventing and managing diabetes."

Heather Newgen

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Every year, more than one million women in the United States enter menopause when a woman stops menstruating and hasnt had her period for 12 months in a row. When you think of menopause, hot flashes, insomnia, mood changes, and night sweats may come to mind. But heart disease the No. 1 killer of women, causing 1 in 3 deaths a year, according to the American Heart Association (AHA) should also be high on your list of menopause related health concerns.

Heart disease risk increases with age for both men and women. But there are heart disease risk factors especially associated with ovarian aging, says Chrisandra Shufelt MD, associate director of the Mayo Clinic Center for Womens Health in Jacksonville, Florida, which is the complex process marked by changes in hormone levels that occurs, ending with menopause. Aging ovaries produce less estrogen and follicle-stimulating hormone; a drop in these hormones is linked to heart disease risk.

Heres a rundown of the risks associated with heart disease in women in menopause and what you can do to lower the risk.

Menopause drives detrimental changes in your cholesterol and blood fats, which can lead to artery-clogging atherosclerosis.

According to an AHA Scientific Statement published in Circulation in December 2020 about menopause and cardiovascular disease risk, your total cholesterol and your bad cholesterol (LDL-C and apolipoprotein B levels) may go up and your good cholesterol (HDL) is likely to go down, which is bad news since we need HDL to move out extra cholesterol that our body doesnt need. Having too much cholesterol in your blood can cause the formation of plaque (hardened deposits) in your arteries, and can ultimately lead to a heart attack or stroke.

After age 40, women are more likely to pack on the pounds, especially around the midsection. What changes in menopause that puts our hearts at risk is the shift of where we start to lay down fat, Dr. Shufelt says. Fat around the midsection and vital organs, such as the liver, can increase your risk of heart disease, even if youre at a healthy body weight, according to astudy published in 2021 in Circulation.

Want to know if youre at risk? Get a tape measure. Research shows that postmenopausal women with a body mass index (BMI) estimates body fat by weight and height within normal range and a waist circumference of more than 35 inches are at increased risk of dying from heart disease, compared with women with a normal BMI without midsection body fat. If your waist circumference is more than 35 inches, talk to your doctor about how to optimize this number, which may include diet, exercise, or weight loss surgery, according to the AHA.

In menopause, or even in late premenopause or perimenopause when periods start to skip women are more likely to develop metabolic syndrome, which is a combination of conditions, including excess belly fat, high cholesterol, and elevated blood sugar, according to the AHA statement. In other words, menopause is linked to an increased risk of metabolic syndrome, which puts you at a higher risk for heart disease, diabetes, and stroke.

Depression can take its toll on your heart. Stress and anxiety can reduce blood flow to the heart, causing your heart rate and blood pressure to rise, as well as increase stress hormone levels, like cortisol, which can up your risk for heart disease, according to the American Heart Association.

A landmarkstudy published in 2019 in Menopause, known as the Study of Womens Health Across the Nation (SWAN), which enrolled 3,302 women between age 42 and 52 and followed them for 23 years, reported that depressive symptoms were higher during late peri- and postmenopause than premenopause. In a subset study, the SWAN Mental Health study, women were 2 to 4 times as likely to experience a major depressive episode in menopause or early postmenopause compared with premenopausal women. Still, women who have had a bout of depression before menopause may be more susceptible to having depression again in menopause. According to a study published in 2017 in Medicine & Science in Sports & Exercise, women with a history of depression are 5 times more likely to a have major bout of depression in menopause.

Its important to discuss depression at the time of perimenopause and menopause, Shufelt says. Talk to your doctor if youre feeling persistently sad, anxious, hopeless, irritable, or fatigued. Dont ignore depression symptoms, she cautions. Many effective treatment options are available, including medications and psychotherapy.

Restless sleep is often one of the first symptoms of menopause and perimenopause. Chronic disrupted sleep can be a risk factor for heart disease. When youre sleeping, your blood pressure naturally takes a dip. If you dont get enough sleep, your blood pressure can stay higher for a longer period, according to the Centers for Disease Control and Prevention. High blood pressure above 130/80 mmHg can increase your risk of heart disease and stroke.

Menopause may be the reason for your disrupted sleep, or it could be sleep apnea, the risk of which also rises during menopause and is associated with heart disease risk. If women are having high blood pressure changes, we dont want to say, Oh, this is just menopause. We want to also think about things like sleep apnea, Shufelt says. While having hypertension doesn't necessarily mean you have sleep apnea, it could be worth screening. Talk to your doctor about being evaluated for sleep apnea, especially if your blood pressure is on the rise.

If youre waking up often due to menopause symptoms, such as hot flashes, you should also talk to your doctor about hormone replacement therapy. We dont use estrogen replacement to prevent heart disease, but we do use it to manage bothersome symptoms, Shufelt says. If you cant sleep through the night because youre having night sweats all night, thats also a disruptive symptom. Estrogen patches, in which a low dose of estrogen is applied through the skin, may help ease menopausal symptoms, including disrupted sleep.

You could spend roughly 30 years of your life or more living with menopause, so its important to take hold of your heart health, notes Shufelt. Heres what you can do:

See your doctor regularly. After 50, every woman should have an annual checkup, Shufelt says. Yearly appointments can help you keep track of your numbers like your cholesterol, weight, blood pressure, and blood sugar, and keep those numbers within a healthy range to reduce your heart disease risk.

If youre at high risk for heart disease because of high cholesterol or weight gain, or if heart disease runs in your family, your doctor may recommend more screening tests. People with a family history of heart disease are at higher than average risk of heart disease. For those people, we might use tools to assess their risk, such as a coronary calcium scan, Shufelt says.

In women at higher than average risk for heart disease due to family history, the coronary artery calcium (CAC) test offers a more precise assessment to help guide treatment and medication decisions. The CAC test is an X-ray that takes images of your heart and helps detect and measure calcium-containing plaque in your arteries, which can increase your risk for a heart attack. The scan is a good tool to virtually look at your heart, Shufelt says.

Consider hormone replacement therapy. We dont use estrogen replacement to prevent heart disease, but we do use it in low doses for bothersome menopausal symptoms, such as having night sweats that prevent you from sleeping, Shufelt says.

The latest hormone therapy guidelines from the North American Menopause Society,published in 2022 in Menopause Shufelt was a coauthor no longer recommend using the lowest dose of supplemental hormones for the shortest time for menopause symptom relief. The guidelines now state the appropriate amount of time, Shufelt says, which varies per person. Theres a certain percentage of women who will have troublesome menopausal symptoms for years. Every woman is different, Shufelt says.

If you enter menopause before age 45 (because of chemotherapy, hysterectomy, or premature ovarian insufficiency, a type of early menopause in younger women), hormone replacement therapy is also recommended by the North American Menopause Society. Premature menopause (before age 40) or early menopause (before age 45) without hormone replacement therapy can accelerate your risk of heart disease, Shufelt says.

When you enter menopause at an earlier age, its important to get a dose of estrogen in an amount your body would otherwise naturally produce at this time. These are women who should have estrogen naturally in their bodies, Shufelt says. If youre in premature or early menopause and youre eligible, Shufelt recommends using a dose of estrogen and progesterone through the time of natural menopause, at age 52, to replace what your body would naturally produce.

Keep up the good work (-out). Exercise can lower the risk of heart disease as you age. According to the study from 2017 in Medicine & Sports Science in Sports and Exercise, the lifetime risk of heart disease in women who exercise was about 12 percent lower from age 45 to 85, compared with women in that age group who werent physically active.

The American Heart Association recommends that men and women get moderate exercise 150 minutes or more per week in addition to not smoking, eating a healthy diet, losing weight if you need to, and managing blood pressure, cholesterol and blood sugar. Menopause is an opportunity to know your numbers and look at your lifestyle because exercise and diet are the backbone and the cornerstone of cardiovascular disease prevention, Shufelt says.

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5 Signs Your Heart Is Changing During Menopause - Everyday Health

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By The ASCO Post StaffPosted: 8/30/2022 3:05:00 PM Last Updated: 8/30/2022 2:21:19 PM

Women with a breast cancer diagnosis undergoing procedures for fertility preservation are not at an increased risk for recurrence of the disease or disease-specific mortality, according to the results of a study from the Karolinska Institutet in Sweden that followed participants for 5 years on average. The findings were published by Marklund et al in JAMA Oncology.

Almost 1 in 10 women affected by breast cancer are of childbearing age and are at risk of becoming infertile from chemotherapy treatment. With the hope of being able to have children after completing cancer treatment, many women choose to undergo procedures for fertility preservation with or without hormonal stimulation. These methods include cryopreservationthe freezing of embryos, female gametes (oocytes), and ovarian tissue.

It is not unusual that women with hormone-positive breast cancer or their treating doctors opt out of the procedures for fertility preservation because of the fear that these procedures will increase the risk of cancer recurrence or death. In some cases, women are also advised to wait 5 to 10 years before trying to conceive, and with increasing age, fecundity in all women decreases. More knowledge is therefore needed about the safety of procedures for fertility preservation at the time of a breast cancer diagnosis, said the studys first author, Anna Marklund, MD, PhD, a researcher in the Department of Oncology-Pathology at the Karolinska Institutet.

Study Details

In this study, researchers at the Karolinska Institutet and Karolinska University Hospital investigated whether procedures for fertility preservation in connection with a breast cancer diagnosis entail an increased risk of disease recurrence or death. The study followed the women for 5 years on average.

The registry study covered 1,275 women of childbearing age who were treated for breast cancer between 1994 and 2017 in Sweden. Of these, 425 underwent procedures for fertility preservation with or without hormonal stimulation. The control group of 850 women were treated for breast cancer but did not undergo procedures for fertility preservation.

The women who underwent procedures for fertility preservation and the women in the control group were matched on age at diagnosis, calendar period at diagnosis, and health-care region. The statistical data were taken from both nationwide health-care registers and population registers with data on outcomes, disease- and treatment-related variables, and socioeconomic characteristics.

Results

The proportion of women without relapse over the 5 years was 89% among those who underwent hormonal stimulation of the ovaries, 83% among women with ovarian tissue freezing, and 82% among women who did not undergo procedures for fertility preservation.

Five years after treatment for breast cancer, the survival rate was 96% in the group that underwent hormonal stimulation to freeze eggs or embryos, 93% in the group that underwent procedures for fertility preservation who did not undergo hormone stimulation, and 90% in the group that did not undergo procedures for fertility preservation.

We did not see any increased risk of relapse or mortality when procedures for fertility preservation were undertaken, compared to the women who did not undergo procedures for fertility preservation. This is valuable information that can contribute to changed care routines when it comes to young women with breast cancer who want to preserve their fertility, said senior study author Kenny Rodriguez-Wallberg, MD, PhD, Adjunct Professor and Research Group Leader in the Department of Oncology-Pathology, Karolinska Institutet, and Chief Physician at Karolinska University Hospital.

The researchers plan to follow up on the results after another 5 years.

Disclosure: The study was funded by the Swedish Cancer Society, Radiumhemmet's Research Funds, the Breast Cancer Association, Region Stockholm, and Karolinska Institutet. For full disclosures of the study authors, visit jamanetwork.com.

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If you want to brighten your mood, you have options: You could get your happy hormones (aka, endorphins) pumping with some exercise, call a friend who always makes you laugh, or snuggle up with a cheesy Netflix movie. What you maynotknow is that the contents of your fridge can also lift your spiritsso long as you look out for an internal medicine doctor's three essential mood-boosting nutrients.

As health professionals, internal medicine doctors pride themselves on having a more personal approach to medicine because they tend to work with people who suffer from chronic, often severe, illnesses. They also look at their patient's health through a holistic lens in order to determine the root of their health issues. And thus, these MDs tend to have some compelling insight when it comes to how, say, your diet affects your mood.

"Our brains are a reflection of what we put into our bodies, and one of the most important ways that we influence them is the quality of what we eat," says internal medicine doctor Austin Perlmutter, MD, author and Senior Director of Science and Clinical Innovation at Big Bold Health. "A brain-nutrient rich dietof which the Mediterranean diet is a great examplemay help support the brain and specifically mental health through pathways that range from neurotransmitters to inflammation to the gut-brain axis."

Look, things get a little complicated when you whip out the term "gut-brain axis," but the TL; DR is this: A growing body of research suggests that since about 95 percent of your serotonin (a happiness hormone) is produced in your gut,andyour gut is lined with nerves and neurons, what goes in your belly may affect the quality of your mood. And thus, when you're feeding your belly, you're also feeding your brain. I know, I know: Science is cool.

Ready to start priming your brain for a better outlook on life? Ahead, Dr. Perlmutter name drops the big three nutrients you need to boost your mood (and includes a grocery shopping list to help you check out with your brain in mind). Ready to eat?

You may already know that omega-3 fatty acids are basically the prom queen of fatty acids. And according to Dr. Perlmutter, incorporating more of them into your diet can seriously pep up your brain.

"Omega-3 fats can be found in plant foods like nuts and seeds, but the omega-3s that have been best studied for their link to mental health are docosahexaenoic acid (DHA) and especially eicosapentaenoic acid (EPA)which are primarily found in higher concentrations in cold-water fish like salmon, sardines, mackerel, herring and anchovies, as well as in supplement forms," says Dr. Perlmutter.

There's also evidencethat omega-3s can help reduce clinical anxiety and could ease symptoms of depression, although more research is needed. And beyond the brain, omega-3s also boost blood flow, improve skin health, and contribute to the overall health of cell membranes.

Learn more about the benefits of omega-3s:

"Polyphenols are a large groupthink thousandsof plant molecules. Eating certain types of antioxidant-rich polyphenols has been linkedto lower risk for depression, while otherresearchsuggests that eating more polyphenols overall may be helpful for overall mental status andbrain protectionagainst certain types of dementia," says Dr. Perlmutter.

Polyphenols are commonly found in fruits and veggies (particularly in berries, red onions, and tempeh), as well as coffee, tea, dark chocolate, and spices like turmeric and cloves.

Relatively new to the field of scientific research, probiotics are on the rise as a nutrient that may be majorly beneficial to your brain. "A myriad of recent studies have suggested that one of the biggest ways we can influence our brains is through the health of our gut, including the microbes that live there.Thats in part because our gut is where the majority of our immune system is located, and these immune cells may affect what gets into our bloodstream and therefore influences our brains," says Dr. Perlmutter.

While more studies need to be conducted on probiotics, Dr. Perlmutter notes that you can try promoting a healthy gut-brain connection by eating more prebiotic foods, or foods that feed the good bacteria in the gut. "For those who can tolerate it without significant GI issues, eating more leafy greens, whole grains may be a good place to start, and if you want to get specific, dandelion greens, Jerusalem artichoke, garlic, onions and leeks are thought to be excellent sources of prebiotic fiber," he says.

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There's more than 100 different types of cancers and pancreatic canceris considered one of the deadliest because there's oftentimes no early warning signs. It's not diagnosed until a later stage, which makes treatment challenging. Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies tells us, "Pancreatic cancer is one of the most aggressive and difficult-to-treat forms of cancer. Unfortunately, it is also one of the most common types of cancer, with over 60, 000 new cases diagnosed each year in the United States alone. While many risk factors for pancreatic cancer, some lifestyle choices can increase the likelihood of developing the disease. Here are five lifestyle choices that have been linked to an increased risk of pancreatic cancer." Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell says, "Pancreatic cancer is a type of cancer that starts in the pancreas. The pancreas is a gland located in the abdomen, behind the stomach. The pancreas has two main functions: to produce enzymes that help digest food and hormones, such as insulin, that regulate blood sugar levels. Pancreatic cancer usually starts in the cells lining the pancreas' ducts. These cells are called exocrine cells. Less often, pancreatic cancer begins in the hormone-producing cells of the pancreas, called islet cells. When pancreatic cancer begins in the exocrine cells, it is called exocrine pancreatic cancer. When it starts in the islet cells, it is called an islet cell tumor or neuroendocrine tumor. Most pancreatic cancers are exocrine tumors."6254a4d1642c605c54bf1cab17d50f1e

Dr. Mitchell states, "Pancreatic cancer is a very aggressive form of cancer and is difficult to treat. It seldom causes symptoms in its early stages, so it is often not discovered until it has spread to other body parts. By the time most people are diagnosed with pancreatic cancer, the disease has already spread beyond the pancreas and cannot be cured. However, treatment may help people live longer and improve their quality of life. Pancreatic cancer is one of the few cancers for which there is no widely available screening test, so it is essential to be aware of the signs and symptoms of the disease. If you have any concerns, please consult your doctor. Early diagnosis and treatment of pancreatic cancer can improve survival rates."

"According to the American Cancer Society, smokers are two to three times more likely than nonsmokers to develop pancreatic cancer," Dr. Mitchell shares. "Smoking is thought to be responsible for approximately 25% of all pancreatic cancers. The link between smoking and pancreatic cancer is thought to be due to the many harmful chemicals found in tobacco smoke. These chemicals damage DNA, leading to the development of cancerous cells. Smoking damages the pancreas, making it more difficult for this vital organ to function correctly. This can lead to chronic inflammation, which further increases the risk of pancreatic cancer. Quitting smoking is the best way to reduce the risk of developing this deadly disease."

Dr. Mitchell emphasizes, "Obesity is a major risk factor for pancreatic cancer. Obese people are nearly twice as likely to develop pancreatic cancer as those of average weight. There are several ways in which obesity increases the risk of pancreatic cancer. First, excess fat tissue produces hormones that can promote the growth of cancer cells. Second, obesity increases inflammation throughout the body, which is known to play a role in cancer development. Finally, obesity makes it more difficult for the body to process sugar, leading to insulin resistance and an increased risk of pancreatic cancer. By maintaining a healthy weight, you can help reduce your risk of this deadly disease."

"There is a strong link between diabetes and pancreatic cancer," Dr. Mitchell explains. "People with diabetes have a two- to three-fold higher risk of developing pancreatic cancer than those without diabetes. The link between diabetes and pancreatic cancer is likely due to the high levels of blood sugar associated with diabetes. High blood sugar levels can damage cells and lead to inflammation, both of which can increase the risk of cancer. Pancreatic cancer is also more common in people with type 2 diabetes, the most common form of the disease. This may be because type 2 diabetes is often associated with obesity, another risk factor for pancreatic cancer. If you have diabetes, it's important to control your blood sugar levels and maintain a healthy weight to lower your risk of pancreatic cancer."

Dr. Mitchell says, "A healthy diet is essential for many reasons, including reducing your risk of developing pancreatic cancer. Pancreatic cancer is more common in people who are overweight or obese, and those who consume a diet high in sugar and fat are also at an increased risk. While the exact cause of pancreatic cancer is unknown, it is thought that excess insulin production may play a role. Insulin is a hormone that helps to regulate blood sugar levels, and when blood sugar levels are constantly high, it can damage cells and lead to cancer. A diet high in sugar and fat raises blood sugar levels, increasing pancreatic cancer risk. Additionally, eating a lot of red and processed meats has also been linked to an increased risk of pancreatic cancer. So, if you want to reduce your risk of this disease, it's essential to maintain a healthy weight and eat a balanced diet low in sugar, fat, and red meat."

"A sedentary lifestyle has been linked to an increased risk of pancreatic cancer," Dr. Mitchell tells us. This is likely because a sedentary lifestyle leads to obesity, a known risk factor for pancreatic cancer. In addition, a sedentary lifestyle can lead to inflammation, which is also a risk factor for pancreatic cancer. Finally, a sedentary lifestyle can lead to insulin resistance, another known risk factor for pancreatic cancer. While other factors can contribute to the development of pancreatic cancer, a sedentary lifestyle is considered one of the most important. Therefore, it is essential to stay active and avoid sitting for long periods in order to reduce your risk of pancreatic cancer."

Dr. Mitchell says this "doesn't constitute medical advice and by no means are these answers meant to be comprehensive. Rather, it's to encourage discussions about health choices."

Heather Newgen

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Sophie Jackson, 26, might not be here today if she had listened to her doctor. She noticed a large lump on her right breast, so she decided to have it checked out by her general physician. But the provider told her it was likely due to her menstrual cycle and that they would have to wait another four weeks to see if anything had changed before they could do anything.

But the lump turned out to be anything but ordinary. She was diagnosed with invasive ductal carcinoma, an aggressive form of cancer, a short while later.

I cried my eyes out and first asked if I was going to die and second if I was going to lose all my hair, Jackson said. Other than the lump I had no other symptoms whatsoever. It felt completely random, and the diagnosis was such a shock.

Jackson is no stranger to cancer. She works as an oncology nurse as part of the U.K.s National Health Service (NHS). Given her experience with the issue, she decided to get a second opinion and pushed for a referral to a breast cancer clinic.

She said she was disappointed by her GPs initial reaction.

I felt let down. The doctors initially thought it was nothing purely based on age, she explained. I feel frustrated on the guidance out there with the stereotypical lumps to look for such as being hard or non-moveable as mine met all the criteria to be what they classed as nothing.

She sought the advice of a specialist, who diagnosed her with breast cancer after running a few tests. They caught it late, and Jackson knew she was in for a long, arduous road to recovery. Since being diagnosed in November, she has been through ten rounds of radiotherapy and underwent surgery to remove the tumor.

Jackson is now cancer-free thanks to her quick thinking. She recently returned to work at University Hospitals Dorset and said the experience has left her with a better understanding of what her cancer patients are going through.

Unfortunately, doctors told her that the tumor is likely to return within the next two years considering the aggressive nature of her disease.

While she is happy to be back at work, Jackson is also mourning the chance to be a mother because she went through medically induced menopause during treatment. She now takes regular injections to reduce the amount of estrogen in her body. High levels of the female sex hormone can increase the risk of breast cancer tumors growing.

Jackson is now on a mission to spread the word about her experience. She encourages women of all ages to get checked for breast cancer and to seek a referral if they need a second opinion.

If Id left it four weeks like the GP suggested, it may have spread in that time and Id have been looking at an incurable diagnosis.

Breast cancer is the second most prevalent cancer in the U.S., with 288,000 diagnoses a year. It accounts for 30% of all female cancers in the country.

Jackson also admitted that she was frustrated throughout the experience because she already knew how the process works.

When I was diagnosed it was extremely overwhelming usually you drip feed patient information as it is way too much to take on at once. I didnt have that luxury and instead was instantly aware of facing surgery, chemo, losing my hair and becoming infertile at such a young age. I think my job did help in a way as I didnt have the expected anxieties about chemo, she added.

I knew what would happen, I knew the drugs, and I knew and trusted the people giving it to me which saved a lot of worrying. It felt really strange receiving chemotherapy drugs Id given to other patients before, like an out of body experience. I was also in disbelief seeing my name on the chemo bag and having my details checked when it was usually me on the other side.

She also learned more about what it was like for her patients to lose their hair. Jackson eventually lost all the hair on her head and started wearing scarves instead.

Coming back to work has forced Jackson to face her fears of her cancer coming back, but she is doing her part to help others advocate for proper medical care.

Id just love to spread awareness that cancer can affect you at a young age even with no family history, no genetics, no risk factors other than taking the contraceptive pill, she said. Early detection has saved my life so its so important to check monthly and push to get things checked out. You are never wasting anyones time.

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Oncology Nurse Diagnosed with Cancer After Her Physician Dismissed Her Lump as Probably Nothing - Scrubs Magazine

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Putting on weight is one of the easiest things to do, especially during the last couple of years when our lives were completely disrupted. The 'Quarantine 15' is real and John Morton, MD, MPH, MHA, medical director of bariatric surgery at Yale New Haven Health System says, "We are definitely seeing weight gain," Dr. Morton says. "You can put on 30 pounds really quicklyyou can do it in three months." That said, it's time to get back into shape and drop the excess weight. Eat This, Not That! Health spoke with Dr. Hector Perez, a board-certified general and bariatric surgeon with Bariatric Journal who shares how much belly fat is too much for men and how to lose it. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Perez explains, "A common way people use to judge if they have too much abdominal fat is to measure their waistline with a tape measure. Men are considered to have too much abdominal fat if they have a waist measurement of more than 40 inches, while women are considered to have too much abdominal fat if they have a waist measurement of more than 35 inches. Having these measurements is generally considered unhealthy and puts you at greater risk for various health conditions.

To get more accurate results, however, you can get a CT, MRI, or DEXA scan to measure your abdominal fat. These are generally considered more accurate methods, but they're also more expensive and not as readily available. Doctors will usually only recommend these tests if they suspect you have a serious health condition related to your abdominal fat."

Dr. Perez tells us, "Carrying too much abdominal fat is generally considered unhealthy because it's associated with a greater risk of developing various health conditions. These include heart disease, stroke, type 2 diabetes, and certain types of cancer. Abdominal fat also produces hormones and substances that can contribute to inflammation, which has been linked to a variety of health problems."

Dr. Perez reminds us, "Fixing your diet is one of the most effective ways to lose abdominal fat. Eating a diet that's high in whole foods, including plenty of fruits, vegetables, and lean protein, and low in processed foods can help you shed pounds all over, including from your belly. Make sure to also limit refined carbs, sugary drinks, and excessive alcohol intake, as these can all contribute to excess abdominal fat.

"A healthy diet alone isn't enough to lose abdominal fat," Dr. Perez emphasizes. "You'll also need to incorporate regular exercise into your routine. Aim for at least 30 minutes of moderate-intensity cardio per day, and include strength training a few days per week as well. These activities help burn calories and can lead to overall weight loss, which will reduce the amount of fat stored in your abdomen."

According to Dr. Perez, "One of the most important but often overlooked aspects of losing abdominal fat is getting enough sleep. Most adults need around 7-8 hours of sleep per night, but many people get far less than that. When you're tired or have low energy levels, you're more likely to make poor food choices and be less active, both of which can contribute to weight gain. So make sure you're getting enough shut-eye each night to help support your weight loss efforts."6254a4d1642c605c54bf1cab17d50f1e

Dr. Perez says, "Experiencing high levels of stress can also lead to weight gain. When you're stressed, your body releases cortisol, a stress hormone that can trigger your appetite. This is why people often turn to food for comfort when they're feeling stressed. Find ways to manage your stress levels through relaxation techniques like yoga or meditation, and make an effort to reduce the amount of stress in your life."

Heather Newgen

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Are You a Man With "Too Much" Abdominal Fat? Here's How to Lose it Eat This Not That - Eat This, Not That

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-- Progression-Free Survival Efficacy of Trodelvy Consistent with That Observed in the TROPiCS-02 Intention-to-Treat Population --

-- Results Presented at ESMO 2022 Highlight Trodelvy as a Potential Treatment Option in HR+/HER2-Low and IHC0 Status Metastatic Breast Cancer --

FOSTER CITY, Calif.--(BUSINESS WIRE)--Gilead Sciences, Inc. (Nasdaq: GILD) today announced new data from a post hoc subgroup analysis from the Phase 3 TROPiCS-02 study evaluating Trodelvy (sacituzumab govitecan-hziy) versus comparator chemotherapies (physicians choice of chemotherapy, TPC) in patients with HR+/HER2- metastatic breast cancer who progressed on endocrine-based therapies and at least two chemotherapies. The analysis examined progression-free survival (PFS) in the intention-to-treat population by HER2-immunohistochemistry (IHC) status, and the results demonstrated that Trodelvy improved median PFS vs. TPC in both HER2-low (IHC1+ and IHC2+/ISH-negative) and IHC0 groups.

Summary of results:

HER2-low

IHC0

ITT

Trodelvy arm(n=149)

TPC arm(n=134)

Trodelvy arm(n=101)

TPC arm(n=116)

Trodelvy arm(n=272)

TPC arm(n=271)

Median PFS(months)

6.4

4.2

5.0

3.4

5.5

4.0

Hazard ratio(95% confidenceinterval)p-value

0.58(0.42-0.79)

0.72(0.51-1.00)

0.66(0.53 0.83)p=0.0003

Detailed findings will be presented at a mini-oral session (Abstract #1362) during the European Society for Medical Oncology (ESMO) Congress 2022 in the vry Auditorium, Paris Expo Porte de Versailles, on September 10.

These data demonstrate Trodelvys efficacy across HER2-low and IHC0 status in pre-treated metastatic breast cancer patients in the TROPiCS-02 trial, said Professor Peter Schmid, Professor of Cancer Medicine; Centre Lead, Centre of Experimental Cancer Medicine; Director, Barts Breast Cancer Centre. Once patients have developed resistance to endocrine-based therapies, their prognosis is extremely poor. The results highlight the potential for Trodelvy as a treatment option for people living with pre-treated HR+/HER2- metastatic breast cancer, regardless of their HER2-negative status.

These results show Trodelvy improved progression-free survival regardless of HER2 status in this pre-treated patient population and reinforce the strength of clinical activity in a population where need is highest, said Bill Grossman, MD, PhD, Senior Vice President, Therapeutic Area Head, Gilead Oncology. Trodelvy is already transforming the standard of care in second-line metastatic triple-negative breast cancer, and were excited about its potential in other breast cancers where there is significant need for new treatment options.

In the study, HER2 negativity was defined per American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) criteria as immunohistochemistry (IHC) score of 0, IHC 1+ or IHC 2+ with a negative in-situ hybridization (ISH) test.

Trodelvy has not been approved by any regulatory agency for the treatment of HR+/HER2- metastatic breast cancer. Its safety and efficacy have not been established for this indication. Gilead has submitted a supplemental Biologics License Application (sBLA) to the U.S. Food and Drug Administration (FDA) based on data from TROPiCS-02; these data will also be shared with health authorities outside the U.S.

Sacituzumab govitecan is currently included in the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines)i. This includes a Category 1 recommendation for use in adult patients with second-line metastatic triple-negative breast cancer (defined as those who received at least two prior therapies, with at least one line for metastatic disease). It also has a Category 2A preferred recommendation for investigational use in HR+/HER2- advanced breast cancer after prior treatment including endocrine therapy, a CDK4/6 inhibitor and at least two lines of chemotherapy.

Trodelvy has a Boxed Warning for severe or life-threatening neutropenia and severe diarrhea; please see below for additional Important Safety Information.

About HR+/HER2- Breast Cancer

Hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer is the most common type of breast cancer and accounts for approximately 70% of all new cases, or nearly 400,000 diagnoses worldwide each year. Almost one in three cases of early-stage breast cancer eventually become metastatic, and among patients with HR+/HER2- metastatic disease, the five-year relative survival rate is 30%. As patients with HR+/HER2- metastatic breast cancer become resistant to endocrine-based therapy, their primary treatment option is limited to single-agent chemotherapy. In this setting, it is common to receive multiple lines of chemotherapy regimens over the course of treatment, and the prognosis remains poor.

About the TROPiCS-02 Study

The TROPiCS-02 study is a global, multicenter, open-label, Phase 3 study, randomized 1:1 to evaluate Trodelvy versus physicians choice of chemotherapy (eribulin, capecitabine, gemcitabine, or vinorelbine) in 543 patients with HR+/HER2- metastatic breast cancer who were previously treated with endocrine therapy, CDK4/6 inhibitors and two to four lines of chemotherapy for metastatic disease. The primary endpoint is progression-free survival per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) as assessed by blinded independent central review (BICR) for participants treated with Trodelvy compared to those treated with chemotherapy. Secondary endpoints include overall survival, overall response rate, clinical benefit rate and duration of response, as well as assessment of safety and tolerability and quality of life measures. More information about TROPiCS-02 is available at https://clinicaltrials.gov/ct2/show/NCT03901339.

About Trodelvy

Trodelvy (sacituzumab govitecan-hziy) is a first-in-class Trop-2 directed antibody-drug conjugate. Trop-2 is a cell surface antigen highly expressed in multiple tumor types, including in more than 90% of breast and bladder cancers. Trodelvy is intentionally designed with a proprietary hydrolyzable linker attached to SN-38, a topoisomerase I inhibitor payload. This unique combination delivers potent activity to both Trop-2 expressing cells and the microenvironment.

Trodelvy is approved in more than 35 countries, with multiple additional regulatory reviews underway worldwide, for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) who have received two or more prior systemic therapies, at least one of them for metastatic disease. Trodelvy is also approved in the U.S. under the accelerated approval pathway for the treatment of adult patients with locally advanced or metastatic urothelial cancer (UC) who have previously received a platinum-containing chemotherapy and either programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor.

Trodelvy is also being developed for potential investigational use in other TNBC and metastatic UC populations, as well as a range of tumor types where Trop-2 is highly expressed, including hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer, metastatic non-small cell lung cancer (NSCLC), metastatic small cell lung cancer (SCLC), head and neck cancer, and endometrial cancer.

U.S. Indications for Trodelvy

In the United States, Trodelvy is indicated for the treatment of:

U.S. Important Safety Information for Trodelvy

BOXED WARNING: NEUTROPENIA AND DIARRHEA

CONTRAINDICATIONS

WARNINGS AND PRECAUTIONS

Neutropenia: Severe, life-threatening, or fatal neutropenia can occur and may require dose modification. Neutropenia occurred in 61% of patients treated with Trodelvy. Grade 3-4 neutropenia occurred in 47% of patients. Febrile neutropenia occurred in 7%. Withhold Trodelvy for absolute neutrophil count below 1500/mm3 on Day 1 of any cycle or neutrophil count below 1000/mm3 on Day 8 of any cycle. Withhold Trodelvy for neutropenic fever.

Diarrhea: Diarrhea occurred in 65% of all patients treated with Trodelvy. Grade 3-4 diarrhea occurred in 12% of patients. One patient had intestinal perforation following diarrhea. Neutropenic colitis occurred in 0.5% of patients. Withhold Trodelvy for Grade 3-4 diarrhea and resume when resolved to Grade 1. At onset, evaluate for infectious causes and if negative, promptly initiate loperamide, 4 mg initially followed by 2 mg with every episode of diarrhea for a maximum of 16 mg daily. Discontinue loperamide 12 hours after diarrhea resolves. Additional supportive measures (e.g., fluid and electrolyte substitution) may also be employed as clinically indicated. Patients who exhibit an excessive cholinergic response to treatment can receive appropriate premedication (e.g., atropine) for subsequent treatments.

Hypersensitivity and Infusion-Related Reactions: Serious hypersensitivity reactions including life-threatening anaphylactic reactions have occurred with Trodelvy. Severe signs and symptoms included cardiac arrest, hypotension, wheezing, angioedema, swelling, pneumonitis, and skin reactions. Hypersensitivity reactions within 24 hours of dosing occurred in 37% of patients. Grade 3-4 hypersensitivity occurred in 2% of patients. The incidence of hypersensitivity reactions leading to permanent discontinuation of Trodelvy was 0.3%. The incidence of anaphylactic reactions was 0.3%. Pre-infusion medication is recommended. Observe patients closely for hypersensitivity and infusion-related reactions during each infusion and for at least 30 minutes after completion of each infusion. Medication to treat such reactions, as well as emergency equipment, should be available for immediate use. Permanently discontinue Trodelvy for Grade 4 infusion-related reactions.

Nausea and Vomiting: Nausea occurred in 66% of all patients treated with Trodelvy and Grade 3 nausea occurred in 4% of these patients. Vomiting occurred in 39% of patients and Grade 3-4 vomiting occurred in 3% of these patients. Premedicate with a two or three drug combination regimen (e.g., dexamethasone with either a 5-HT3 receptor antagonist or an NK1 receptor antagonist as well as other drugs as indicated) for prevention of chemotherapy-induced nausea and vomiting (CINV). Withhold Trodelvy doses for Grade 3 nausea or Grade 3-4 vomiting and resume with additional supportive measures when resolved to Grade 1. Additional antiemetics and other supportive measures may also be employed as clinically indicated. All patients should be given take-home medications with clear instructions for prevention and treatment of nausea and vomiting.

Increased Risk of Adverse Reactions in Patients with Reduced UGT1A1 Activity: Patients homozygous for the uridine diphosphate-glucuronosyl transferase 1A1 (UGT1A1)*28 allele are at increased risk for neutropenia, febrile neutropenia, and anemia and may be at increased risk for other adverse reactions with Trodelvy. The incidence of Grade 3-4 neutropenia was 67% in patients homozygous for the UGT1A1*28, 46% in patients heterozygous for the UGT1A1*28 allele and 46% in patients homozygous for the wild-type allele. The incidence of Grade 3-4 anemia was 25% in patients homozygous for the UGT1A1*28 allele, 10% in patients heterozygous for the UGT1A1*28 allele, and 11% in patients homozygous for the wild-type allele. Closely monitor patients with known reduced UGT1A1 activity for adverse reactions. Withhold or permanently discontinue Trodelvy based on clinical assessment of the onset, duration and severity of the observed adverse reactions in patients with evidence of acute early-onset or unusually severe adverse reactions, which may indicate reduced UGT1A1 function.

Embryo-Fetal Toxicity: Based on its mechanism of action, Trodelvy can cause teratogenicity and/or embryo-fetal lethality when administered to a pregnant woman. Trodelvy contains a genotoxic component, SN-38, and targets rapidly dividing cells. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with Trodelvy and for 6 months after the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with Trodelvy and for 3 months after the last dose.

ADVERSE REACTIONS

In the ASCENT study (IMMU-132-05), the most common adverse reactions (incidence 25%) were fatigue, neutropenia, diarrhea, nausea, alopecia, anemia, constipation, vomiting, abdominal pain, and decreased appetite. The most frequent serious adverse reactions (SAR) (>1%) were neutropenia (7%), diarrhea (4%), and pneumonia (3%). SAR were reported in 27% of patients, and 5% discontinued therapy due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence 25%) in the ASCENT study were reduced neutrophils, leukocytes, and lymphocytes.

In the TROPHY study (IMMU-132-06), the most common adverse reactions (incidence 25%) were diarrhea, fatigue, neutropenia, nausea, any infection, alopecia, anemia, decreased appetite, constipation, vomiting, abdominal pain, and rash. The most frequent serious adverse reactions (SAR) (5%) were infection (18%), neutropenia (12%, including febrile neutropenia in 10%), acute kidney injury (6%), urinary tract infection (6%), and sepsis or bacteremia (5%). SAR were reported in 44% of patients, and 10% discontinued due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence 25%) in the TROPHY study were reduced neutrophils, leukocytes, and lymphocytes.

DRUG INTERACTIONS

UGT1A1 Inhibitors: Concomitant administration of Trodelvy with inhibitors of UGT1A1 may increase the incidence of adverse reactions due to potential increase in systemic exposure to SN-38. Avoid administering UGT1A1 inhibitors with Trodelvy.

UGT1A1 Inducers: Exposure to SN-38 may be substantially reduced in patients concomitantly receiving UGT1A1 enzyme inducers. Avoid administering UGT1A1 inducers with Trodelvy.

Please see full Prescribing Information , including BOXED WARNING.

About Gilead Sciences

Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis and cancer. Gilead operates in more than 35 countries worldwide, with headquarters in Foster City, California.

Forward-Looking Statements

This press release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that are subject to risks, uncertainties and other factors, including Gileads ability to initiate, progress or complete clinical trials within currently anticipated timelines or at all, and the possibility of unfavorable results from ongoing or additional clinical trials, including those involving Trodelvy; uncertainties relating to regulatory applications for Trodelvy and related filing and approval timelines, including with respect to the pending sBLA for Trodelvy, and pending or potential applications for the treatment of metastatic TNBC, mUC, HR+/HER2- breast cancer, NSCLC, SCLC, head and neck cancer, and endometrial cancer, in the currently anticipated timelines or at all; Gileads ability to receive regulatory approvals for such indications in a timely manner or at all, and the risk that any such approvals may be subject to significant limitations on use; the possibility that Gilead may make a strategic decision to discontinue development of Trodelvy for such indications and as a result, Trodelvy may never be commercialized for these indications; and any assumptions underlying any of the foregoing. These and other risks, uncertainties and other factors are described in detail in Gileads Quarterly Report on Form 10-Q for the quarter ended June 30, 2022, as filed with the U.S. Securities and Exchange Commission. These risks, uncertainties and other factors could cause actual results to differ materially from those referred to in the forward-looking statements. All statements other than statements of historical fact are statements that could be deemed forward-looking statements. The reader is cautioned that any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, and is cautioned not to place undue reliance on these forward-looking statements. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation and disclaims any intent to update any such forward-looking statements.

U.S. Prescribing Information for Trodelvy including BOXED WARNING, is available at http://www.gilead.com.

Trodelvy, Gilead and the Gilead logo are trademarks of Gilead Sciences, Inc., or its related companies.

For more information about Gilead, please visit the companys website at http://www.gilead.com, follow Gilead on Twitter (@GileadSciences) or call Gilead Public Affairs at 1-800-GILEAD-5 or 1-650-574-3000.

i Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer Version 4.2022. National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed August 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

View source version on businesswire.com: https://www.businesswire.com/news/home/20220902005309/en/

Jacquie Ross, Investorsinvestor_relations@gilead.com

Nathan Kaiser, MediaNathan.kaiser@gilead.com

Source: Gilead Sciences, Inc.

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New TROPiCS-02 Data in HR+/HER2- Metastatic Breast Cancer Patients Demonstrates Progression-Free Survival Benefit of Trodelvy Regardless of Their HER2...

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Newswise A new paper inFamily Practice,published by Oxford University Press, indicates that overweight patients are more inclined to disagree with their healthcare providers on advice on weight loss and lifestyle.

The World Health Organization estimates obesity nearly tripled between 1975 and 2016. General practitioners have a key role in medical care targeting weight loss and obesity. The quality of information, mutual comprehension, and agreement between doctors and patients affect a patients health status, compliance, satisfaction, and confidence towards his or her doctor. Previous research has shown patients and doctors often have dissimilar attitudes about weight. Patients tend to attribute excess weight to factors that they cannot control (e.g. genetics, hormones), whereas physicians tend to attribute it to behavioral, and thus controllable, factors (e.g. nutrition, physical activity). While many factors contribute to patients weight and health, these differences in perception of weight could degrade doctor-patient interaction.

This study aimed to analyze whether the interaction between patients and their doctors, as measured by their disagreement on information and advice given during the consultation, varied according to the patients body mass index.

Twenty-seven general practitioners and 585 patients from three regions in France participated in the quantitative phase of the project in September and October of 2007 and answered questionnaires collecting both general practitioners and patients perceptions of information and advice given at the end of the consultation.

Researchers here explored differences concerning the patients and doctors declarations about actions, information, and advice during the same visit, the patients health status, and the perceived quality of their relationship. For example, the questions about weight loss were: Did your doctor advise you to lose weight during the consultation? (Answered by patients) and its mirror Did you advise this patient to lose weight during the consultation? (Answered by doctors). Differences in answers given by doctors and their patients were used to define disagreement.

Agreement between patients and doctors was weak (20 to 40 percent agreement) or moderate (40 to 60 percent agreement) for most of the questions, including questions about actions, information, advice, and patients health status discussed during the doctors appointment. Agreement was very weak (less than 20 percent agreement) for questions about the perceived quality of the patient-doctor relationship.

Researchers also found that there was more doctor-patient disagreement the more overweight the patient was. Disagreement was particularly pronounced for advice given by doctors on weight and lifestyle issues. Compared to patients with a normal BMI, overweight patients were more likely to disagree with their doctors regarding advice given on weight loss, advice given on doing more physical activity, and advice about nutrition.

An exploration of the patient's representations and difficulties related to weight could be offered by the general practitioners as a basis for discussion and appropriate support, said the studys lead author, Latitia Gimenez.

The paper, Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey, is available at:https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmac086.

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Overweight patients more likely to disagree with their doctors - Newswise

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Blood sugar is a vital part of our overall well-being and when there's an imbalance your health is at risk for serious complications like heart disease, kidney disease and stroke. "Simply put, it's your body's main source of energy. You can't survive without it," Dr. Bayo Curry-Winchell, Urgent Care Medical Director and Physician, Carbon Health and Saint Mary's Hospital tells us. The symptoms of high blood sugar can range from subtle to signs you can't ignore and Dr. Curry-Winchell explains what to look out for and why. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

According to the Cleveland Clinic, "Hyperglycemia, or high blood glucose, occurs when there is too much sugar in the blood. This happens when your body has too little insulin (the hormone that transports glucose into the blood), or if your body can't use insulin properly. The condition is most often linked with diabetes."

Dr. Curry-Winchell explains, "A blood sugar level (glucose) greater than 180, one to two hours after eating is considered too high. A number from 100 to 125 is considered too high if you haven't eaten for at least 8 hours."

According to Dr. Curry-Winchell, "Too much sugar in the bloodstream for an extended amount of time will damage your blood vessels responsible for delivering blood to organs such as your heart and kidney."

Dr. Curry-Winchell tells us, "Not everyone will notice signs of high blood sugar. Some of the symptoms can be subtle such as fatigue or an increase in thirst can develop slowly."

"Extra sugar (glucose) does not mean more energy," Dr. Curry-Winchell emphasizes. "The body is not able to use the excess sugar to fuel what your body needs for extra activity."

"The kidneys are unable to filter excess sugar in your blood and respond by attempting to remove it which increases the amount of time/frequency you urinate and puts you at risk for dehydration," says Dr. Curry-Winchell.

Dr. Curry-Winchell explains, "If you are losing weight (involuntarily), although your appetite has increased or stayed the same. This happens because there isn't enough insulin to respond to excess glucose in the body. To supply your body with energy, the body uses stored fat and muscle."

Dr. Curry-Winchell tells us, "Elevated glucose levels can increase the amount of blood vessels that form behind the eye (retina). The extra vessels are harmful and can lead to a risk of becoming blind."6254a4d1642c605c54bf1cab17d50f1e

"Nerve damage also referred to as neuropathy can occur which can signal numbness or tingling in your fingers, toes, hands, and feet," Dr. Curry-Winchell says.

Heather Newgen

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Warning Signs Your Blood Sugar is "Dangerously High" Eat This Not That - Eat This, Not That

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Introduction

Over the last decade, social media has increasingly become a resource for patients seeking information about their health. Studies have shown that the majority of patients are now seeking medical information online,1,2 with patients preferring sites such as Facebook and Twitter.3 These sites have grown to serve as free, attractive, and easy to use apps, with up to 85% of patients using social media to search for health information.4 Physicians and others in the medical field have knowingly increased their presence on these platforms to better educate and disseminate factual medical information, understanding that social media may be the first place that patients turn to for advice and information.57

As with many other fields of medicine, social media research in ophthalmology has primarily focused on sites such as Facebook, Twitter, Instagram and LinkedIn.811 However, these are not the only social media sites that patients are turning to for medical advice. With over 52 million and growing daily active users, Reddit is a popular social media site that patients are frequently turning to for specific medical advice because of its discussion forum type format.12 Reddit has proven to be a source of valuable patient information in other medical fields, such as dermatology, psychiatry, and radiology.1315 Despite its growing popularity, Reddit has yet to be fully explored within the field of ophthalmology.

Reddit offers a unique patient perspective because unlike other social media sites, its users are largely anonymous. This allows for them to make candid posts and comments in the various, individual communities that Reddit hosts on its site, known as subreddits. Within these subreddits, users are given the opportunity to upvote or downvote posts and comments to increase the visibility of information that the community deems useful. The vast majority of ophthalmology information can be found in two main ophthalmology subreddits, r/EyeTriage and r/Ophthalmology. A previous cross-sectional study analyzed the content of posts made in the r/EyeTriage subreddit, giving some insight into the information that patients are seeking within this community.16

The goal for this study is to investigate the other ophthalmology subreddit, r/Ophthalmology, to determine what topics in ophthalmology are of greatest interest to Reddit users and whether ophthalmic care is being recommended to those seeking advice. This information will allow us to better understand the perspectives and discussion of the ophthalmology patient population on Reddit.

This cross-sectional study analyzed posts and comments on the Reddit subreddit r/Ophthalmology to understand eye-related patient concerns. r/Ophthalmology was created on June 29, 2011 with the goal of answering general questions about eye topics by the public.17 As stated by the moderator, u/arcadeflyer, specific patient questions should be redirected to a different subreddit r/EyeTriage.18 Additionally, every post on the subreddit includes an automatic comment by an automoderator that explicitly states that questions from patients about their personal health will be removed. Despite this, many posts on the subreddit continue to be patient questions, providing a wealth of data for analysis. The subreddit is frequented by a wide variety of ophthalmic professionals, including ophthalmologists, optometrists, and ophthalmic technicians. Every user that makes a post is required to identify their background within the text and every user on the subreddit has the opportunity to self-identify their profession, which appear next to their username when they make posts or comments. Posts on the subreddit include advice, links, questions, topics for discussion, personal stories, and educational resources.

The public and anonymous posts and comments on r/Ophthalmology were accessed using the Python Reddit API Wrapper. This allowed the Python software to access the data structures within the Reddit interface and extract the necessary data. There was no interaction with individuals to retrieve this data and this data can be accessed without a Reddit account. Given the public and anonymous nature of this data, Institutional Review Board approval was not needed.19 Posts and comments from March 18, 2018 to November 9, 2020 were analyzed and those that were deleted or removed on or prior to November 9, 2020 were not included in the analysis.

After the extraction of posts and comments, the data was pre-processed to prepare it for analysis (Figure 1). The automoderator comment was removed from each post and excluded from analysis. Following this, all text within post and comments was analyzed for unique references to ophthalmic conditions from the American Academy of Ophthalmologys (AAOs) Eye Health A-Z through a keyword search and the frequency of each reference was evaluated. To isolate posts and comments for references to different types of medical care, the data was parsed for posts and comments that included ophth, opth, opto, eye doctor, professional, physician, primary care, appointment, medicine, medication, insurance, prescribe, or prescription, similar to previous methodology analyzing medical Reddit data.13 The resulting posts and comments were then evaluated to determine if they mentioned or recommended either ophthalmic care or other medical care. Medical care is defined as medical intervention, treatment, or professional evaluation.

Figure 1 Data processing and analysis flowchart.

Posts were considered to be recommending any type of medical care if (1) it was mentioned only within the comments of a post and not within the title or body of the post itself and (2) at least 1 commenter encouraged the original poster or another commenter to seek care. Posts were considered to be mentioning any type of medical care if (1) it was mentioned within the comments of a post or (2) within the title and/or body of the post itself. Posts that were found to both recommend and mention care were categorized as recommending care. Comments were considered to be recommending any type of medical care if the commenter encouraged the original poster or another commenter of the same post to seek care. Comments were considered to be mentioning any type of care if it was mentioned within the comment. Again, the presence of both a recommendation and mention was categorized as a recommendation of care. Posts and comments that referenced both ophthalmic care and other forms of medical care were considered references to ophthalmic care. Post and comments that did none of the above were also noted. Ophthalmic care was defined as references specifically to ophthalmologists, optometrists, and eye doctors. Counts of posts and comments in these various categories were then analyzed.

Statistical analysis was done in Python using built-in statistical packages for frequency and count analysis (Python Software Foundation. Python Language Reference, version 2.7. Available at http://www.python.org).

A total of 919 posts with 5345 non-automoderator comments were posted between March 18, 2018 and November 9, 2020. While posts that ask patient-specific questions were said to have been removed by the automoderator, almost half (403/919) of the posts available on the subreddit were found to be referencing patient questions. Furthermore, two-thirds (612/919) of the posts involved conversation surrounding medical care either within the post, subsequent comments, or both. Of the 5345 comments analyzed, 1196 were found to reference any type of medical care.

Amongst the 919 posts analyzed from r/Ophthalmology, the majority either mention (49%) or recommend (9.5%) ophthalmic care (Figure 2, Table 1). 7.7% of the posts mention other medical care and a negligible amount (0.4%) go as far as to recommend other medical care. Amongst the 5345 comments, the vast majority (78%) made no reference to medical care (Figure 3, Table 1). Of the 1196 comments that referenced any type of care, 66% mentioned ophthalmic care and 11% recommended ophthalmic care (Figure 3). Other forms of medical care were mentioned in 22% of comments and recommended in 1% of comments.

Table 1 Number of References to Medical Care in Posts and Comments

Figure 2 References to medical care in posts.

Figure 3 References to medical care in comments.

Searching within posts for ophthalmic conditions found in the AAOs Eye Health A-Z list demonstrated 312 unique instances of these keywords. This analysis revealed that posters were most commonly discussing flashes and floaters (48/312). Glaucoma (24/312), retinal detachments (21/312), and headaches (21/312) were also commonly brought up by posters. Almost half (61/125) of the ophthalmic conditions within the Eye Health A-Z list were absent from post discussions in this subreddit. A chart of commonly discussed ophthalmic conditions in posts of this subreddit can be found in Figure 4.

Figure 4 Top 20 ophthalmic conditions mentioned in posts.

Similar analysis within the comments of posts led to the discovery of 586 unique references to ophthalmic conditions. The most common condition within the comments, cataracts (71/586), differed from that discussed within posts. However, glaucoma (52/586) and flashes and floaters (45/586) were found to be common between the two analyses. A chart of commonly discussed ophthalmic conditions in comments of this subreddit can be found in Figure 5. The conditions discussed within the comments were also found to be slightly more diverse than those in the posts, with only 54 of the 125 conditions absent from conversation. Fifty-eight of the conditions were found to be discussed in both the posts and the comments.

Figure 5 Top 20 ophthalmic conditions mentioned in comments.

The r/Ophthalmology subreddit is a popular social media platform for patients to seek and share information about eye concerns. Analysis of the interactions show that close to two-thirds of posts discuss medical concerns despite these posts being strongly discouraged and deleted from the subreddit. The persistence of posts seeking medical advice on this platform suggests that there is a need for increased patient education on ophthalmic conditions. Patients were found to discuss a variety of topics within this group, with conversation in posts and comments largely being dominated by discussion surrounding retinal detachments, cataracts, and glaucoma. As these are common ophthalmic concerns of patients seen in-office, this study highlights topics that could benefit from increased patient education.

While it is clear that patients are looking for medical information within this subreddit, these results also demonstrate that 75% of comments did not mention or recommend users to seek any type of medical care. Of the comments that referenced care, only a minority went as far as to recommend some type of medical care. These findings highlight the discrepancy between the number of users seeking medical advice on this platform and how often they are told to see a professional for their concerns. This can partially be attributed to the growing amount of self-diagnosis that patients partake in, given the amount of health information accessible to them, and medical advice they receive from others on the internet. Patients may be hopeful to receive medically accurate information about their concerns online, however a previous study suggests that ophthalmologists make up a minority of the self-identified users that frequent the other ophthalmology subreddit, r/EyeTriage.16 This can result in a greater reliance on the advice of other Reddit users, increasing the risk of misinformation. In addition, many of the posts and comments mentioning ophthalmic care do so in the context of users wondering or unsure if they should seek this type of care. A study analyzing the r/EyeTriage subreddit also found that patients posting about ophthalmic concerns demonstrated anxiety and worry with patients most commonly seeking diagnoses, highlighting the potential vulnerable state that patients may be in when seeking ophthalmic care information online.16 This suggests that there is room for improvement in educating patients about circumstances in which they should seek ophthalmic care. Ophthalmologists can play a key role in improving patient education about a variety of sight-threatening conditions by understanding what ophthalmic information patients are seeking online as a result of this study. This type of education will improve patient outcomes and better educate those who may be giving advice to others online.

When considering what patients are discussing within posts, the increased frequency of flashes and floaters appearing in conversation suggests that patients are turning to this platform to ask others what they should do when experiencing these symptoms. While one of the most common reasons for acute onset flashes and floaters is a posterior vitreous detachment, patients should be aware that they need to be appropriately evaluated in order to rule out a possible retinal detachment.20,21 Patient education strategies aimed to decrease delayed presentation of certain ophthalmic concerns may be useful tactics for ophthalmologists to use in office. One particular acronym, FLASH, can help patients remember the following symptoms for vision-threatening eye emergencies: flashes and floaters, loss of vision, aching pain, second image, help.22 This education can also help address the other commonly brought up topics in posts, glaucoma and headaches. Patients experiencing acute angle closure glaucoma may often presents with headaches and blurry vision,23 both of which are encompassed by the acronym. This can help patients with these concerns know to seek immediate medical attention as opposed to turning to the advice of those on the internet. It is important to note that patients are not exclusively bringing up acute medical concerns in posts. Posts are also made by those seeking more information about chronic conditions they may have such as glaucoma, astigmatism, dry eye, and uveitis. These results can help guide further patient education both on social media and in the office.

Within comments, users of the r/Ophthalmology subreddit are found to be commonly discussing similar topics to those found in posts. This suggests that the comments may be frequently used for other users to give advice on topics brought up in posts. As there is no qualification necessary for a layperson to give medical advice online, it is important that eye professionals are acutely aware of the discussions taking place. The knowledge of the results of this study can help inform ophthalmologists and optometrists on what education they should focus on disseminating. The benefit of this is twofold: (1) Patients are inherently better educated about eye conditions and can more appropriately assess when to seek medical care and (2) if they are giving advice on the internet, they will be less likely to spread misinformation to others. Methods of patient education can be divided into social media resources and non-social media resources. Outside of social media, ophthalmologists can make use of the variety of patient education resources available through the AAO, including pamphlets, videos, and diagrams.24 Many ophthalmologists also have personalized patient education information sheets that can be included in after-visit summaries. These resources are additionally helpful from a patient perspective because they can include links to reputable resources that patients can rely on to further their own education on particular topics. These types of resources tend to be more static, whereas the wide spectrum of social media platforms can give ophthalmologists creative freedom to decide how to disseminate patient education, including text, photo, and video-based material. While engaging in social media can be time-intensive, it is important for physicians to recognize that up to 80% of their patient population is seeking information about their health online.25 Within the field of ophthalmology, social media has been gaining more momentum and the AAO provides guidelines that may help ophthalmologists use social media to market their practices.26 Extending use of social media to educate patients can help ophthalmologists reach those who may otherwise lack other resources to access health information while also helping to build their practice.25

Reddit as a social media platform for health information offers unique advantages and perspectives. Unlike other social media sites, Reddit allows for patients to easily create accounts that give them anonymity. This has been found to facilitate more supportive and instrumental conversation about medical conditions, especially in situations where stigma may be involved.27 The platform creates a space in which patients do not feel like they are broadcasting their concerns or revealing too much personal information to those that they know, as they would on sites such as Twitter and Facebook.2830 The r/Ophthalmology subreddit may possibly attract more ophthalmologist subscribers than that of r/EyeTriage given that the subreddit more adamantly discourages patient-specific questions. Physicians are well aware of the professional consequences of giving specific medical information on the internet.31 The anonymity provided by Reddit and the rules of the r/Ophthalmology subreddit gives ophthalmologists the freedom to interact within the group without feeling obligated to respond to patient questions, making it more likely that they have a greater presence there than in r/EyeTriage. This makes the subreddit an accessible platform for ophthalmologists to disseminate education materials for patients while getting input from other users of various backgrounds, already found to be effective in other fields of medicine.32,33 This type of engagement with patients and others can help increase overall ophthalmic knowledge in the general population.

This study is not free of limitations, both with Reddit itself as a data source and the study methodology. As this study relies on data directly from the r/Ophthalmology subreddit, it is important to consider that this forum is also frequented by others with an interest in ophthalmology, such as medical students, residents, and other eye professionals. With 56% percent of available posts discussing topics outside of medical advice, conversations would be expected to fall outside of mentioning or recommending any type of medical care, serving as a confounder when attempting to determine whether patients are appropriately being recommended to seek care. Additionally, the subreddit rules make it likely that more posts were made discussing patient-specific questions but were deleted prior to data extraction from the site. Further research into the posts and comments in this subreddit since the time of data extraction may prove valuable in better understanding the conversations about ophthalmology on this social media platform. In evaluating the conditions that patients are discussing on r/Ophthalmology, it is possible that conditions outside of those included in the AAOs Eye Health A-Z list were discussed and not captured in these results. A more exhaustive list of ophthalmic symptoms and diseases may yield greater information about topics of conversation. The pre-processing methodology used to identify posts and comments with references to medical care has been previously described, but may have unintentionally excluded a small number of conversations related to patient questions. Future studies analyzing Reddit data may benefit from a more robust natural language processing approach to thoroughly process this complex data source.

In summary, Reddit data, specifically the r/Ophthalmology subreddit, offers unique insight into the conversations that patients are having about their eye health on social media. Patients were found to ask specific questions about their health on the platform, leading to increased self-diagnosis and spread of medical advice from other Reddit users. Within these patient-specific conversations, ophthalmic care was often mentioned, but there is room for increased patient education in this space to better inform patients about both acute and chronic ophthalmic conditions. Ophthalmologists, and others in the vision community, can use the results of this study to tailor patient education towards commonly discussed ophthalmic conditions found in the r/Ophthalmology subreddit. This approach can help improve patient safety while decreasing the spread of misinformation.

There is no funding to report. The abstract of this paper was presented at the Association for Research in Vision and Ophthalmology 2021 as a poster presentation with interim findings. The posters abstract was published in Abstract Issue 2021 in Investigative Ophthalmology & Visual Science: https://iovs.arvojournals.org/article.aspx?articleid=2773677.

The authors report no conflicts of interest in this work.

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2. Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the internet and its implications for health care providers: findings from the first health information national trends survey. Arch Intern Med. 2005;165(22):26182624. doi:10.1001/archinte.165.22.2618

3. Antheunis ML, Tates K, Nieboer TE. Patients and health professionals use of social media in health care: motives, barriers and expectations. Patient Educ Couns. 2013;92(3):426431. doi:10.1016/j.pec.2013.06.020

4. Marar SD, Al-Madaney MM, Almousawi FH. Health information on social media. Saudi Med J. 2019;40(12):12941298. doi:10.15537/smj.2019.12.24682

5. Wexner SD, Petrucci AM, Brady RR, Ennis-OConnor M, Fitzgerald JE, Mayol J. Social media in colorectal surgery. Colorectal Dis. 2017;19(2):105114. doi:10.1111/codi.13572

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7. De Martino I, DApolito R, McLawhorn AS, Fehring KA, Sculco PK, Gasparini G. Social media for patients: benefits and drawbacks. Curr Rev Musculoskelet Med. 2017;10(1):141145. doi:10.1007/s12178-017-9394-7

8. Micieli JA, Tsui E. Ophthalmology on social networking sites: an observational study of Facebook, Twitter, and LinkedIn. Clin Ophthalmol. 2015;9:285290. doi:10.2147/OPTH.S79032

9. Clarke C, Smith E, Khan M, Al-Mohtaseb Z. Social media and ophthalmology: perspectives of patients and ophthalmologists. J Med Syst. 2018;42(12):258. doi:10.1007/s10916-018-1079-2

10. Micieli R, Micieli JA. Twitter as a tool for ophthalmologists. Can J Ophthalmol. 2012;47(5):410413. doi:10.1016/j.jcjo.2012.05.005

11. McGregor F, Somner JEA, Bourne RR, Munn-Giddings C, Shah P, Cross V. Social media use by patients with glaucoma: what can we learn? Ophthalmic Physiol Opt. 2014;34(1):4652. doi:10.1111/opo.12093

12. Patel S. Reddit claims 52 million daily users, revealing a key figure for social-media platforms. Wall Street Journal; December 1, 2020. Available from: https://www.wsj.com/articles/reddit-claims-52-million-daily-users-revealing-a-key-figure-for-social-media-platforms-11606822200. Accessed April 4, 2021.

13. Parks R, Newsom EC, Park JH, Lawrence N. Skincare addiction on reddit: dermatology enthusiasts talk skin. Dermatol Surg. 2020;46(10):13721374. doi:10.1097/DSS.0000000000002060

14. Primack BA, Shensa A, Sidani JE, et al. Social media use and perceived social isolation among young adults in the U.S. Am J Prev Med. 2017;53(1). doi:10.1016/j.amepre.2017.01.010

15. Munawar K, Prabhu V. Radiology on Reddit: a content analysis and opportunity for radiologist engagement and education. Curr Probl Diagn Radiol. 2021;50(3):362368. doi:10.1067/j.cpradiol.2021.02.001

16. Mahjoub H, Prabhu AV, Sikder S. What are ophthalmology patients asking online? An analysis of the eye triage subreddit. Clin Ophthalmol. 2020;14:35753582. doi:10.2147/OPTH.S279607

17. r/Ophthalmology. Reddit. Available from: https://www.reddit.com/r/Ophthalmology. Accessed March 28, 2021.

18. u/arcadeflyer. Sticky: new Subreddit, r/ eyetriage, for patient questions. r/Ophthalmology; January 27, 2019. Available from: http://www.reddit.com/r/Ophthalmology/comments/ak7i27/sticky_new_subreddit_reyetriage_for_patient/. Accessed March 28, 2021.

19. Guidance on research using social networking sites. Available from: https://research.cofc.edu/administration/documents/policies-documents/IRB_SNSguidance.pdf. Accessed July 8, 2022.

20. Hollands H, Johnson D, Brox AC, Almeida D, Simel DL, Sharma S. Acute-onset floaters and flashes: Is this patient at risk for retinal detachment? JAMA. 2009;302(20):22432249. doi:10.1001/jama.2009.1714

21. Sharma P, Sridhar J, Mehta S. Flashes and Floaters. Prim Care. 2015;42(3):425435. doi:10.1016/j.pop.2015.05.011

22. Jairath N, Commiskey P, Kaplan A, Paulus YM. FLASH: a novel tool to identify vision-threating eye emergencies. Int J Ophthalmic Res. 2020;6(1):336343.

23. Khazaeni B, Khazaeni L. Acute closed angle glaucoma. In: StatPearls. StatPearls Publishing; 2022. Available from:. http://www.ncbi.nlm.nih.gov/books/NBK430857/. Accessed March 13, 2022.

24. Patient education. Available from: https://store.aao.org/patient-education.html. Accessed August 7, 2022.

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26. Use social media to market your practice. American Academy of Ophthalmology; January 1, 2016. Available from: https://www.aao.org/eyenet/article/use-social-media-to-market-your-practice. Accessed August 7, 2022.

27. Choudhury MD, De S. Mental health discourse on reddit: self-disclosure, social support, and anonymity. In: Proceedings of the 8th International Conference on Weblogs and Social Media, ICWSM 2014. Michigan, USA; January 1, 2014:7180.

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Read more from the original source:
Ophthalmology Inquiries on Reddit: What Should Physicians Know? | OPTH - Dove Medical Press

Recommendation and review posted by Bethany Smith

Starting back in high school in 2015, Annie Uyeki was always anxious when she had to leave a class. I wondered, What does my teacher think? she says. Anywhere from two to three times in an 82-minute class period, Uyeki had to step out. Her body demanded it.

Now a lacrosse player at Vassar College, Uyeki was used to infrequent occurrences of excruciating pain that came with irregular and unbearable periods. She started taking birth control pills to help regulate themshe just wanted to feel comfortable in her own body, function as an athlete and compete at the highest level without pain.

But, as she tried to find a birth control method that would prevent pregnancy and help her body cope with relentless cramps and pain, the pill only made her life worse. Maybe this type of pill was a bad fit, she thought. Uyeki switched from one type to another, but her pain didnt change. Her mental health suffered.

Multiple doctors sent a message to Uyeki: [It] might just be your body. You might just be uncomfortable in your body.

Frustrated, she refused to believe it was normal, that it was fine to not get through her day because she was in so much pain.

I feel like birth control almost changed my personality a little bit. I was just so on edge all the time, so irritable. When I told my doctor about this, there seemed to be no real solution, Uyeki says.

Somehow, sometime, it became normal for the insufferable pain, negative side effects and an altered mental state to seamlessly find its way into the athlete lifestyle.

For many collegiate athletes, the birth control pill has brought more harm than good, negatively impacting their bodies and minds. On June 24, the Supreme Court added an additional complicating factor to athletes relationship with the pill. The reversal of Roe v. Wade, the 1973 landmark decision that protected abortion rights in the United States, strips reproductive control further, which naturally may increase the pills popularity. A lack of in-state abortion access may be an athletes sole reason for going on the pill or another form of hormonal birth control (even as advocates say the restrictions on abortions may also lead to restrictions on contraceptives).

With increasing restrictions around reproductive health care, athletes are calling for more conversation and research about the pills health hindrances, some of which have existed long before the overturn of Roe.

Dorothy DiMascio-Donohue, a student at Tufts and member of the nationally ranked womens ultimate Frisbee team, laughed on the phone when explaining how vocal shes been to her teammates about life on the pill.

It feels like a wash of gray has been painted over everything you see and feel, she says. [It is] a little less passionate, a little less colorful, a little worse to endure. And the worst part is that we were told that this is normal. Its almost indescribable how it feels to be on these hormones, but it is noticeable and important. Especially as an athlete, I want to choose a form of birth control that wont make my cramps worse, impeding my performance. I might even want to choose one that will make me feel better.

For DiMascio-Donohue, the relationship between her mental health and athletic performance is the biggest factor. In pursuit of physical control, she lost mental control, with the pill worsening her anxiety and depression. To manage period cramps and take control over pregnancy prevention with a form of birth control she has agency over, she sacrificed her mental and physical wellbeingwhat her athletic performance depends on.

Even as so many athletes and non-athletes alike do reap great benefits from the pill, the side effects are a common conundrum.

Lizzie, who asked Sports Illustrated to identify her by first name only, was aware from a young age that her body was on display. It started with ice skating, before she hit her teen years. She always compared her body to her older sisters; she wanted to be thinner. That thought pattern led to restrictive eating habits, low nutrition and low food consumption, which began to impact her menstrual cycle. Her mother found out that her period stopped and immediately brought her to the doctor. Lizzie left with a birth control prescription to regulate her hormones. She was 15, and there was no conversation about side effects. Months later, she was crushed by anxiety.

I had never experienced anything like this and I never correlated it to birth control, but I do know I started this one thing, then this happened, Lizze says.

Birth controland the side effects that came with itremained part of Lizzies daily timeline. As a Division I college rower, the mental health downfall conflicted with the lifestyle of a collegiate athlete. She gained more weight during her monthly cycle, which added extra stress to regular team weigh-ins. Every mood swing, every period of anxiety or depression, was brought to the next level while rowing in college. Her GPA suffered even when her school-focused anxiety heightened and her depression was at a peak, torpedoing her athletic performance.

A 2018 report shows that the pill is most popular with patients between 20 and 29the prime age for college athletes. When Dr. Alysia Robichau, a sports medicine physician in Conroe, Texas, prescribes the pill, she looks at five criteria: weight, period flow/length, acne, mood swings and reason for going on the pill. Robichau also considers a family history of blood clots, one of the pills more severe possible side effects. There are roughly 150 to 200 types, brands and styles of birth control pills. They each have different combinations of hormones that work for different reasons, and different pills may cause mood or mental health issues. They normally contain estrogen and progesterone, two hormones key in reproductive development that help regulate menstrual cycles. Progesterone-only pills are more commonly given to people who are breastfeeding.

For Sophia Worth, the tiny pill she takes at 10 every night helps manage the onset of endometriosis, which plagues her family lineage. Endometriosis, simply put, is a painful disorder that involves the tissue that lines ones uterus. Symptoms include, but are not limited to, extreme pain in the back, stomach, irregular menstrual cycles and heavy bleeding.

Worth was just 15 when she started taking the pill because symptoms were far too severe to ignore. A rising junior at Missouri as the goalie for the womens soccer team, she found success with the pill, but it has to be taken at the same time every day to work properly. The strict schedule it requires doesnt mix well with the demanding life of a D-I athlete. Road games are a recipe for prescription mishaps; time-zone changes almost ensure a missed dosageeven just one missed pill can cause a hormonal imbalance.

In terms of your athletic performance, when your hormones are out of whack, your mood is messed up, your body feels wack, it messes with your sleep and all of those things are aspects that are always hammered home to us as athletes, Worth says.

The pill helps to avoid physical pain that would trouble her athletic lifestyle, but the solution adds a hormonal imbalance and her body chemistry is nonetheless altered. Weight gain is the most expected side effect, as Robichau explained that doctors estimate users typically gain two to eight pounds on the pill. Uyeki gained roughly 20 pounds. Robichau herself was an elite level gymnast at LSU and went on birth control pills in college, but with strict instructions to not gain weight.

Uyeki remembers when practices would end with a lecture about the importance of staying hydrated or a reminder to maximize sleep. One common issue among the athletes standing around her in the huddle wasnt insomnia or dehydration. It was hormone-related, but that wasnt ever valued; the topic was flat-out ignored.

For decades, information about birth control in relation to athletes was sparse. With women already more likely to tear their ACLs than men, research recently took off to study how oral contraceptive pills factor in. Robichau says most research is not yet conclusive, but a 2021 study from Penn State College of Medicine found that a large percentage of women who sustained ACL tears were taking an estrogen and progesterone birth control pill at the time of injury.

In 2009, researchers from Texas A&M found that oral birth control use impaired muscle gains in young women and was associated with lower hormone levels. The conclusion was followed with a clear statement: There still needs to be more research about the relationship between muscle loss and birth control. Especially in a Roe-overturned world.

In 1988, IUDs were reintroduced to the U.S. market after approval from the FDA. But doctors had always been hesitant to insert them in people who had not given birth previously. The procedural aspect of IUD insertion sparked uncertainty, especially for athletes who could spoil their careers with one mishap.

With IUDs given to only a limited group as a birth control option, the pills popularity increased.

In college athletic communities, it wasnt uncommon for a student to be instructed by a coach or program to go on the pill. High-intensity training meant athletes were at risk of losing their regular period if they didnt get enough fuel to support their training. Red S or Relative Energy Deficiency in Sport, the formal name for when athletes suffer from low bone density, energy deficiency or potentially disordered eating, scared coaches.

In the early 2000s, the vast majority of college programs were run by men, which meant less talk of periods and hormones. To combat Red S, and avoid potential conversations of periods or pregnancy, coaches encouraged their athletes to take the pill. If they werent eating enough, if bones weakened, at least they got their period.

Instead of individualized methods that fit ones body, blanket approaches put the pill in many athletes daily routine, with no warning of side effects or the realization that the pill is not the solution for everyone, or that there are other options.

Victoria Jackson, a pro runner with endorsements from Nike who was a Pac-10 champion at Arizona State, was on the pill like many other endurance athletes in the early 2000s. She didnt go off the pill until she was ready to start a family.

When I went off the pill, it was like the clouds parted, Jackson says. For the last decade and half, I was a little bit sad all the time. I was in a low-level depressive state. I am not an expert but from my personal experience, I realized [the pill] had an effect on my mental health, and that had never been part of the conversation.

In the mid-to-late 2000s, Jackson says research-based coaches began reversing the standard that those before them set and encouraged athletes to go off the pill. A decision with good intentions was made by the wrong people.

You would have coaches involved in the reproductive health and womens health decisions made by athletes, sometimes not in consultation with medical professionals, making those athletes vulnerable, Jackson says.

Jackson, a professor and historian at ASU, is advocating for clear conversations about life off birth control since many athletes have stopped taking the pill.

Other athletes who spoke to SI had similar beneficial results. Lizzie switched off the pill junior year of college to an IUD and says her mental health benefited greatly, as did her athletic performance. DiMascio-Donohue is in a similar place.

I was miserable for so long, she says, now off birth control. This gray filter on life is now removed.

The landscape of college athletes will be different heading into the fallespecially in states with abortion bans. In Missouri, where Worth plays, an added anxiety now lingers.

Thinking about the intimate and sexual details of my life having to be disclosed to my coaching staff in the case that something happened and I were to get pregnant, all these other questions arise, what if they are allowed to say, No, you cant go to another state and do this? she says.

The decision to prevent people from receiving in-state procedures may be the one reason an athlete needs to go on the pill, despite its health risks.

Data gathered by The Washington Post revealed that many elite womens college sports programs are also disproportionately concentrated in states with abortion bans and expected bans or where the future of abortion rights is uncertain.

Given the universal uncertainty but life altering repercussions, Jackson encourages college coaches to develop a plan. Future recruits and parents will have questions, especially in states that ban abortions: where to go, what to do. But medically, the plan should be advised by outside professionals.

Team meetings can no longer focus just on nutrition, and practices cant end with only a reminder to sleep well that night like Uyeki and other athletes have dealt with their entire life. The bodily autonomy athletes once had is now restricted. The pill may be an athletes best bet in a post-Roe landscapeand, students and advocates say, thats far from ideal.

More College Sports Coverage:

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The Trouble With the Pill - Sports Illustrated

Recommendation and review posted by Bethany Smith

For young students, seeking reproductive health resources available in the area may be difficult to find.

Fosnight Center embraces the uniqueness of each individual in an effort to ensure all feel safe and welcome regardless of intersectional identities, said Casey Duncan, the director of administrative services for the Fosnight Center for sexual health in Asheville.

The director said the Fosnight Center provides inclusive healthcare for all bodies. The center covers gender affirming care, gynecology and urology services, sexual and integrative medicine and physical therapy.

At the Fosnight Center, we recognize the pieces and put them together to create an individualized treatment plan through a multidisciplinary team approach, Duncan said. You will have the opportunity to be evaluated by our medical providers, pelvic health physical therapist and sex therapist in order to look at the whole picture of your health concern.

The director said the sexual health center provides gender inclusive contraceptive care, gender affirming hormone therapies, STI testing and preventative care.

According to the CDC, before the overturning of Roe 65.3% of people born with a uterus were using contraceptives.

We pride ourselves on creating a safe space for all our patients and clients. Duncan said. We believe everyone deserves to love their body.

The Fosnight director said the center is passionate about reproductive freedom and bodily autonomy for all.

We are committed to cultivating an inclusive environment that benefits all our providers, staff, clients, patients and the community, Duncan said.

Duncan said the sexual health center accepts most commerical insurances and has self-pay discounts.

According to Planned Parenthood, after the overturn of Roe v. Wade on June 24, many Planned Parenthood centers were forced to close leavingmany low income young adults struggling to find affordable testing and sexual health clinics.

The staff understand the unique needs and challenges of being a college student, said Jay Cutspec, the director of Health and Counseling at UNC Asheville.

Cutspec said students receive basic reproductive care and services at UNCA comparable to a family physicians office.

We adapt our services to meet the unique needs of college students, Cutspec said. We have a diverse staff from a variety of backgrounds and experiences.

The health and counseling director said they advise students to make the Health and Counseling Center their first step. If they cannot provide specific services or have unmet needs, students will be referred to the most appropriate community provider.

The phone number for the Health and Counseling Center is (828)-251-6520.

We also understand that for many students, this may be the first time that they have to manage their own healthcare, Cutspec said. We try to educate them on how to manage the healthcare system.

Cutspec said the only charge for a visit to the Health and Counseling Center is for possible medication prescription or lab tests received during the visit.

The Menstrual Equity Club on UNCAs campus takes these matters into their own hands providing safer sex supplies, menstrual products and community health resources.

We have had the pleasure of partnering with organizations such as the Western North Carolina Aids Project and Planned Parenthood, said Samantha Mazze, a UNCA student studying psychology and co-president of the equity club.

Through these collaborations we have been able to provide the campus population with free HIV testing and guest speaker community health educators, Mazze said.

Mazze said the club members pride themselves on providing safe spaces for students to discuss reproductive justice, campus community needs and concerns.

The UNCA student said this was their third year being a part of the Menstrual Equity club.

The co-president said in the past year one of the biggest projects the club worked on was providing free menstrual products in all bathrooms on campus.

One of our goals for this next year is to make sure all students on campus have access to these essential supplies regardless of the bathroom they use, said Mazze.

Mazze said another project the club organizes is the packing party, a Halloween goodie bag filled with menstrual products, candies, stickers and more for students. The co-president said with events like packing parties the club donates supplies back to the community.

The UNCA student said the presence of organizations like the menstrual equity club are crucial because voices are not being heard.

We continue to see people of color and the LGBTQ+ community be consistently overlooked by our healthcare and justice systems, said Mazze.

Mazze said after their graduation they want to continue their efforts in reproductive health, and become a sex therapist.

The co-president said students wishing to get involved can follow the clubs instagram page @uncaforme or join the email list [emailprotected].

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UNCA and Asheville clinics priortize inclusive healthcare The Blue Banner - The Blue Banner

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A dramatic presentation at the 2022 American Society of Clinical Oncology Annual Meeting changed treatment standards seemingly overnight for women with previously treated metastatic HER2-low breast cancer. However, fundamental questions remain.

A dramatic presentation at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting changed treatment standards seemingly overnight for women with previously treated metastatic HER2-low breast cancer. However, fundamental questions remain. What is HER2-low breast cancer? Are low levels of HER2 meaningful drivers of cancer progression? How can oncologists predict which patients will benefit from treatment with the antibody-drug conjugate (ADC) fam-trastuzumab deruxtecan-nxki (Enhertu)?

Investigators of the phase 3 DESTINY-Breast04 trial (NCT03734029) enrolled previously treated patients with HER2-low metastatic breast cancer, which was defined for the trial as a score of 1+ on immunohistochemical (IHC) analysis or an IHC score of 2+ and negative results on in situ hybridization (ISH). Among the 557 patients who were randomly assigned 2:1 to trastuzumab deruxtecan or physicians choice of single-agent chemotherapy, the median progression-free survival (PFS) was 9.9 months in the trastuzumab deruxtecan group vs 5.1 months in the physicians choice group (HR, 0.50; 95% CI, 0.40-0.63; P < .0001). Overall survival (OS) was 23.4 months with trastuzumab deruxtecan vs 16.8 months with physicians choice (HR, 0.64; 95% CI, 0.40-0.86; P = .003).1

In addition to extending PFS and OS, trastuzumab deruxtecan was also better tolerated than the chemotherapies that physicians selected. Adverse events of grade 3 or higher were observed in 52.6% of the patients who received trastuzumab deruxtecan and 67.4% of those who received physicians choice. Adjudicated, drug-related interstitial lung disease or pneumonitis occurred in 12.1% of the patients who received trastuzumab deruxtecan, and 0.8% of patients died.

News of the results elicited a rare standing ovation at the ASCO meeting, and the FDA subsequently approved the agent for the treatment of patients with HER2-low metastatic disease in August 2022 (Table).2

Establishing definitive parameters for HER2-low disease is still a task set before oncologists and pathologists. Approximately 60% of breast cancers qualify as HER2 low based on the definition in DESTINY-Breast04.3 And although targeted drugs have transformed outcomes for the 15% to 20% of patients with breast cancer with significantly elevated HER2 expression, this was the first time that a drug targeted at HER2 proved beneficial to patients who met this definition of HER2-low breast cancer.4

HER2 is a membrane tyrosine kinase expressed at low levels by many healthy cells that is dramatically overexpressed (40- to 100-fold) by a minority of cancers that can have several million HER2 receptors per cell.5

Existing IHC assays were optimized to distinguish overexpression from normal expression. They have an adequate dynamic range for that purpose but [are] suboptimal to distinguish different HER2 groups among tumors with lower levels of expression. Almost all breast cancers do express some HER2, and an IHC result of 0 is often the result of an artifact caused by formalin fixation rather than truly representing no HER2 protein present. For that reason, current IHC assays are unfit for the purpose of creating a new category of HER2 low, said Antonio C. Wolff, MD, a professor of oncology at Johns Hopkins University and director of breast cancer trials in the Womens Malignancies Program at Johns Hopkins Kimmel Comprehensive Cancer Center in Baltimore, Maryland. Therefore, rather than creating a new category, for now it is better to simply describe the eligibility criteria used for the study to identify patients who could be candidates for this drug.

Testing HER2 expression levels has long been a challenge. In 2007, 9 years after the initial approval of trastuzumab (Herceptin), an expert panel convened by ASCO and the College of American Pathologists (CAP) concluded that both IHC and ISH returned inaccurate results in approximately 20% of cases. They recommended testing standards for HER2 overexpression that, among other improvements, sometimes combined the 2 methods to reduce the error rate.6 Those first ASCO/CAP guidelines were updated in 2013 and again in 2018, but even the most recent guidelines make no mention of HER2-low cancers. They also give no advice for separating cancers with small amounts of HER2 expression from cancers that do not express HER2 at all because, as the authors note, data from [the NSABP-B-47; NCT01275677 trial] confirmed the lack of benefit from adjuvant trastuzumab for patients whose tumors lack gene amplification and are IHC 1+ or 2+. Consequently, HER2 gene amplification assessed by ISH or protein overexpression assessed by IHC remains the primary predictor of responsiveness to HER2-targeted therapies in breast cancer.7

Amplification or overexpression of HER2 has long been known to drive tumor growth and aggressiveness. Before the development of targeted therapies, HER2-positive status was associated with shorter survival.8 The question now, which has been investigated in a pair of recent studies, is whether having low levels of HER2 expression produce different cancer progression and outcomes than having no HER2 at all.

In the first of those studies, findings from which were presented at the 2022 ASCO meeting, investigators mined the National Cancer Database for outcome data on patients with metastatic breast cancer whose cancers scored 0 (HER2 0) or 1+/2+ (HER2 low) on IHC testing. There were no differences between the 6865 HER2-0 patients and the 17,771 HER2-low patients in age, race, year treated, location, income, insurance status, Charlson Deyo comorbidity index score, laterality, T stage, N stage, or use of systemic therapy. There was, however, a difference in hormone receptor status; HER2-low tumors were half as likely to have concomitant hormone receptornegative status. Among hormone receptornegative patients, the 3-year survival rate was 33.8% for HER2-low and 32.2% for HER2-0 patients. Among hormone receptorpositive patients, the survival rate was 60.9% in HER2-low and 55.6% in HER2-0 patients. HER2-low status was associated with longer survival on multivariable regression analysis (HR, 0.91; 95% CI, 0.87-0.95), even with propensity score matching (HR, 0.92; 95% CI, 0.89-0.96). In a subset analysis isolated to hormone receptorpositive cases, HER2 low remained correlated with improved survival (HR, 0.93; 95% CI, 0.89-0.98) with propensity-matched multivariable regression analysis.9

In the second study, whose results were published inJAMA Oncology, investigators compared outcomes of 5235 consecutive patients with nonmetastatic HER2-low or HER2-0 breast cancer who underwent surgery between January 2016 and March 2021 at Dana-Farber Brigham Cancer Center in Boston, Massachusetts. Although the patient populations were different (metastatic vs nonmetastatic cancers), the definitions of HER2 low (IHC score of 1+ or 2+) and HER2 0 (IHC score of 0) were the same as in the previously mentioned study. Also, in that study, hormone receptor expression was significantly more common among HER2-low tumors than HER2-0 tumors (90.6% vs 81.8%;P < .001).

Investigators also found a correlation between the expression of estrogen receptors (ERs) and HER2.Patients with HER2-0 tumors experienced higher pathologic complete response rate (pCR) than patients with HER2-low tumors after neoadjuvant chemotherapy (26.8% vs 16.6%;P = .002). However, after controlling for hormone receptor and ER status, there were no significant differences in pCR, disease-free survival, distant diseasefree survival, or OS between patients with HER2-low and HER2-0 breast cancer.10

We wanted to look at the prognosisfor patients withHER2-lowbreast cancercompared [with]HER2-0breast cancer. We explored data from our institutions largeprospectivedatabase anddiscovered that theydont have a different prognosis, if you correct for the expression of the estrogen receptor, said senior study author Sara M. Tolaney, MD, MPH, chief of the Division of Breast Oncology at Susan F. Smith Center for Womens Cancers at Dana-Farber Cancer Institute. In our mind, if the prognosis of these cancers is not different, it suggests that theyre really not biologically different cancersand low HER2 expressionis likely notan oncogenic driver for that cancer.

Tolaney stressed that while this finding provides new information about tumor behavior, it should do nothing to dampen excitement about trastuzumab deruxtecans apparent effect on HER2-low tumors. Theres no need for an ADC to target an oncogenic driver. If it can reliably bind to the tumor, it can deliver the chemotherapy exactly where it needs to, she said. It is very critical to understand if tumors are HER2-lowpositive, not because its associated with a different prognosis, but rather because its allowing you to utilize a very novel therapythat can dramatically impact patients outcomes.

Of course, given that both studies used IHC to separate patients whose tumors were HER2 low from those whose tumors were HER2 0, some tumors were categorized incorrectly in both studies. Indeed, in data from a new study from Yale Cancer Center in New Haven, Connecticut, investigators concluded that current IHC tests struggle severely to differentiate between IHC 1+ and IHC 0 tumors.

In this study, investigators collected data from a survey conducted by CAP and a Yale-based study of concordance among 18 pathologists reading 170 breast cancer biopsies. The CAP analysis showed that 19% of the cases read by 1400 laboratories generated results with less than 70% agreement between a HER2 score of 0 vs 1+. In the second part of the study, in which 18 pathologists read the same slides from a selected set of breast cancer biopsies using the 4-point scale, there was only 26% agreement among pathologists on scores of 0 and 1+.

Investigators said the disagreement was due to the poor quality of the current IHC test in this critical range that will likely determine which women are eligible for trastuzumab deruxtecan.11

Although the test returns 4 different scores0, 1, 2, or 3it is not actually designed to differentiate 0s from 1s. Its designed to give you a yes/no answer about whether a tumor massively overexpresses HER2 in a way that would make trastuzumab a good treatment, said senior study author David Rimm, MD, PhD. Rimm is the Anthony N. Brady Professor of Pathology and a professor of medicine at Yale University School of Medicine. He also serves as director of Yale Pathology Tissue Services, director of the Yale Cancer Center Tissue Microarray Facility, and director of the Physician Scientist Training Program in Pathology Research. Weve always known this, but the results of this study indicate that the biggest factor in determining whether a result is interpreted as a 0 or a 1+ is chance, and that will likely lead to the mismanagement of many patients in terms of who gets treated with trastuzumab deruxtecan.

Is it possible to develop a test that more accurately distinguishes tumors with low HER2 expression from those with no HER2 expression (Figure12)? Weve already developed one, Rimm said, adding that diagnostic companies are also developing higher sensitivity tests because of the large unmet need. Of course, youd need to validate any test thats developed, but that can be done in a reasonable time frame.

The IHC tests inability to differentiate between low and nonexistent levels of HER2 expression also creates a potential problem with the DESTINY-Breast04 results. To be eligible for the study, patients needed to have a tumor that tested HER2 IHC 1+ or IHC 2+ without gene amplification. Patients with IHC 0 were not eligible for the study, and it is quite plausible that this antibody-drug conjugate would be active in them too, but this must be confirmed, Wolff said.Some evidence exists about the effect of trastuzumab deruxtecan in patients whose tumors receive IHC scores of 0 from the phase 2 DAISY trial (NCT04132960), which reported results during the European Society for Medical Oncology Breast Cancer Congress 2022 and the 2021 San Antonio Breast Cancer Symposium.

Investigators in DAISY assigned 186 patients with metastatic breast cancer to 1 of 3 cohorts based on HER2 IHC expression: IHC 3+ or IHC 2+/ISH+ (cohort 1; n = 68); IHC 2+/ISH- or IHC 1+ (cohort 2; n = 72); and IHC 0+ (cohort 3; n = 37). All patients received 5.4 mg/kg trastuzumab deruxtecan intravenously on day 1 of 21-day cycles.

Best objective response (BOR) favored cohort 1 (71.0%; 95% CI, 58.3%-81.0%) over cohort 2 (37.5%; 95% CI, 26.4%-50.0%) and cohort 3 (30.0%; 95% CI, 16.0%47.0%). Investigators also found that those in cohort 1 had the longest median PFS at 11.1 months compared with 6.7 months in cohort 2 and 4.2 months in cohort 3.13,14 These results indicate that trastuzumab deruxtecan is more effective in patients with IHC scores of 1+ than it is in patients with IHC scores of 0, but it says nothing about the relative effectiveness of trastuzumab deruxtecan vs other treatments in patients with IHC scores of 0. It is therefore possible that many such patients would receive some benefit.

I predict that a lot of savvy oncologists will, upon having a patients IHC test come back 0, advise that patient to send the sample to be read at a different lab, knowing theres a strong chance it will be upgraded to a 1 and they will qualify for this treatment, Rimm said. Patients will want to try this medication. Those results were spectacular.

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Metastatic Breast Cancer Enters a New Era of HER2 Classification - OncLive

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When discussing fitness, a major focus is often on the number of calories you eat and burn during exercise, especially when it comes to weight loss or weight gain. But did you know you're still burning calories even at rest? Even though exercising is important and has many health benefits, it only makes up a small percentageof the calories you burn throughout the day. In fact, most of the calories you burn go toward involuntary activities and everyday tasks like cooking and cleaning.

There are many factors that determine how many calories you burn at rest versus during a workout, so we spoke to experts to get a clearer explanation. Read on to find out how many calories you burn daily and why it's helpful to know these details.

As you can imagine, the number of calories burned varies per person. Your total daily energy expenditure is the number of calories you burn in a day, including exercise. In order to get this figure, you first need to find out a few other calculations.

One of these key figures is your basal metabolic rate, which is the minimum number of calories your body needs to burn to maintain basic functions such as heart rate, breathing and digestion. "The number of calories your body burns while you're at rest is determined by your BMR," saidDr. Brittany Robles, an OB-GYN physician and a National Academy of Sports Medicine certified personal trainer. Things that affect your BMR include your age, weight, muscle mass and activity level. Your BMR accounts for about 60 to 75% of your daily energy expenditure.

A helpful way to determine an estimate of what your BMR is, is by using the popular Harris-Benedict Equation. This formula takes into account your weight, height, age and gender.

BMR calculations based on men and women:

Men: BMR = 66.5 + (13.75 * weight in kilograms) + (5.003 * height in centimeters) - (6.75 * age)

Women: BMR = 655.1 + (9.563 * weight in kg) + (1.850 * height in cm) - (4.676 * age)

Knowing your BMR can be helpful if one of your goals is to lose weight, but Robles says to keep in mind that this method is only an estimate. "The most accurate way to measure your BMR is through indirect calorimetry, which involves measuring your oxygen consumption and carbon dioxide production," she said. Generally, it's not necessary to go this far to measure your BMR since it's expensive, mainly used in research settings and isn't practical for everyday use.

Once you have an estimate of your BMR, you can use it to find your TDEE. To figure this out, you need to multiply the BMR and your activity factor. There are different types of formulas you can find online, but the Harris-Benedict Equation is the most popular and uses a rubric for activity factors that range from sedentary, moderate to strenuous. The rubric used is: 1.2 (for sedentary), 1.5 (for moderate) and 1.7 (for strenuous) and 1.9 (for very active individuals).

Your body also burns calories through activities such as fidgeting, walking or doing other everyday tasks.

Besides BMR, your resting metabolic rate, the thermic effect of food, non-exercise activity thermogenesis and exercise-related activity thermogenesis also play an important role.

RMR: RMR and BMR tend to be used interchangeably because both make up the basis for how many calories you burn when you're not exercising. The difference is your RMR looks at the number of calories you burn when you're at rest, including regular activities like eating, while BMR only looks at the number of calories you burn for vital functions like breathing. To find out your RMR, you use the same BMR formula to get a result.

TEF: The thermic effect of food is the number of calories your body burns in order to digest and absorb food. The TEF accounts for 10% of your daily energy expenditure. To find this number, calculate: BMR X 0.1= TEF.

NEAT: Non-exercise activity thermogenesis is the number of calories your body burns through activities that are not exercise, such as fidgeting, walking or doing other everyday tasks. It makes up about 15% of a sedentary person's total daily energy expenditureand up to 50% or more for highly active people. Your occupation heavily influences your NEAT. Hence, why a construction worker or someone who works on their feet all day will have a higher NEAT number than someone who works at a desk all day.

In order to find out your NEAT number, you first need to know your total daily energy expenditure figure. Once you determine the figure that fits your lifestyle best, you'll be able to get your NEAT number.

The formula used to calculate NEAT is: TDEE - (BMR + TEF) = NEAT

EAT: Finally, EAT refers to intentional exercise and accounts for an estimated 15 to 30%of your total energy expenditure. Therefore exercise doesn't make up for much of your overall calories burned daily.

"All of these factors play a role in how many calories you burn in a day," said Robles. "RMR and BMR make up the basis for how many calories you burn at rest, and TEF and NEAT add to this total by representing the number of calories you burn through activity."

Individuals with higher muscle mass tend to burn more calories at rest than those with less.

Now that you know about the different ways our bodies burn calories, it's important to understand how your lifestyle habits can influence this too. Matt Scarfo, a National Academy of Sports Medicine certified personal trainer, told CNET, "People with larger bodies burn more calories than those with smaller bodies because they need to keep their blood flowing, their muscles oxygenated and their cells operating." Additionally, if your body composition changes, the number of calories you burn at rest will change.

"Individuals with higher muscle mass tend to burn more calories at rest than those with less, since muscles require a lot of energy," explained Scarfo. Hormone cycles can also affect your energy needs, which is why some women get hungry during the high hormone phase of their cycle, leading up to their period.

Then there are the changes that come with aging. "As you age you will often lose muscle mass, which leads to a slower metabolism," saidRachel Macpherson, an American Council on Exercise certified personal trainer and certified nutrition specialist. "Menopause and reduced testosterone can cause metabolic slow down as you age too," she added.

Therefore if you're trying to lose weight, gain weight or maintain your weight, knowing an estimate on how many calories you burn regularly can give you a better guideline on how many calories you should be intaking a day. "If you want to lose weight, you can decrease your calorie intake from your total daily energy expenditure, but only a small one so as not to slow your metabolism too much," explained Macpherson. Likewise, if you want to gain muscle or weight, you will need to eat more than you burn.

It's important to remember that most of these calculations that determine how many calories you burn while exercising or at rest are simply estimates. They can help serve as a guide to help you better understand the different ways your body burns calories, but they're not definitive. If you're looking to lose weight, gain weight or simply maintain your weight, it's best to receive advice from a certified dietitian nutritionist.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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How Your Body Burns Calories At Rest, During Workouts and More - CNET

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On August 28, the United States sent two Ticonderoga-class guided-missile cruisers through the Taiwan Strait, the first such freedom-of-navigation mission since House Speaker Nancy Pelosis visit to Taiwan was met by a large-scale show of force by China. Beijing, of course, protested the sailing. On June 13, the Chinese foreign ministry declared, There is no such thing as international waters in international maritime law. Beijing claims that Taiwan is a renegade province, thus making all the waters between it and the mainland an internal waterway.

The United States usually only sends one warship at a time, a destroyer. Sending both the USS Antietam and USS Chancellorsville, the largest surface warships in the fleet except for aircraft carriers was meant to be a strong demonstration of resolve in the wake of Beijings live-fire exercises around the self-governing island. Chinas state media, however, tried to downplay this, arguing the US is fully aware of and fear of the PLA's capability so that it needs two warships to accompany with each other to embolden themselves But the Ticonderoga-class cruiser is a very old warship, and the PLA's Type 055 is much more advanced. Beijing is also aware that nine Ticonderoga-class ships are slated to be decommissioned. The USS Vella Gulf was in fact taken out of service three weeks before its sister ships sailed through the Taiwan Strait. It had served only twenty-nine years out of its designed thirty-five-year lifespan.

The Navy has tried to justify retiring the cruiser force early because it costs more to maintain older ships, putting a strain on maintenance funding and the capacity of the ship repair industry. Seven of the cruisers are in some phase of a service-life extension and modernization program, which is requiring significant manpower at repair yards, running years late, and costing more than the service budgeted for. Theyre eating us alive in terms of our ability to get maintenance back on track, which is where we need to be, Chief of Naval Operations Adm. Mike Gilday told a recent conference.

So, the real problem is an inadequate naval industrial base to support a fleet large enough to carry out its global missions and meet the challenge of a fast-growing Chinese navy that seeks to control the Pacific Rim. At risk are the territories and trade of every nation in the region, not just Taiwan. The collapse of the American commercial shipbuilding industry decades ago denies the U.S. Navy mobilization capacity, whereas China has created the largest shipbuilding industry in the world.

The most cited target number for the size of the Navy comes from its 2016 goal of 355 manned ships. Of these, only 104 were Large surface combatants (cruisers and destroyers), which at the time included the Ticonderoga-class cruisers. The Navy currently has 300 battle force ships (up from a low of 279 in 2007, which was less than half as many as at the end of the Cold War). In April, the Navy issued a new plan with alternatives based on funding. Under Alternative 1, the Navy would have 300 manned ships in 2035 and grow to 316 manned ships by fiscal year (FY) 2052. Under Alternative 2, the Navy would have 300 manned ships in 2035 and grow to 327 manned ships by FY2052. These two options assume no real increase in funding. Under Alternative 3, which hopes for a very modest 3-5 percent real growth in funding, the Navy would still have 300 manned ships in 2033 but would grow to 367 manned ships by FY2052. These figures do not provide much solace for those who believe there will be crises in the Indo-Pacific involving China well before 2035.

According to the recently released Chief of Naval Operations Naval Plan 2022, To simultaneously modernize and grow the capacity of our fleet, the Navy will require 3-5% sustained budget growth above actual inflation. Short of that, we will prioritize modernization over preserving force structure. This will decrease the size of the fleet until we can deploy smaller, more cost-effective, and more autonomous force packages at scale. The Nation cannot afford to cede influence to China or Russia. Nor can it afford to lose combat credibility. And that decrease already calls for decommissioning of twenty-four ships in the FY2023 budget, more than just the cruisers. The autonomous force packages will be unmanned vehicles, some with significant firepower, but they will not begin to join the fleet until after 2027.

The Navy has estimated to Congress that expanding the fleet even at the modest pace of Alternative 3, would require an additional $13 billion per year to build, man, and operate a larger fleet. When President Biden issues an Executive Order canceling $300 billion or more in student loans, after enacting a series of spending bills amounting to some $3.8 trillion in additional spending for pandemic recovery, infrastructure, green industry development, and other projects, the Navys request seems hardly noticeable. Yet its legislative prospects are uncertain despite the bipartisan consensus on the China threat.

Warships are not just procured; they need to be built, which brings the industrial base back to the center of discussion. In 2019, I wrote a piece for the U.S. Naval Institute that went beyond concern for backlogs in repair and maintenance to point out that there was no excess capacity to handle battle damage if the Navy actually had to engage in sea battles for the first time since World War II. None of these problems have been remedied in the years since and there is even now a question of whether a larger fleet can be built, let alone maintained.

On August 25, Admiral Gilday stated that We have an industrial capacity thats limited. In other words, we can only get so many ships off the production line a year. My goal would be to optimize those production lines for destroyers, for frigates, for amphibious ships, for the light amphibious ships, for supply ships. Gilday noted that he wanted to produce three destroyers and two or three submarines a year, but there are doubts that there is room for a third destroyer or submarine at U.S. shipyards. This is not a new problem. Much work was done in 2017 calling for new investment in shipyard capacity for construction and maintenance. Human capital is also needed as the shipyard workforce is aging. Shortages in skilled labor are an economy-wide problem but deserve special public attention when it impacts national security.

Newport News Shipbuilding and Virginia Peninsula Community College have teamed up to offer a program to foster solid careers in a strategic field that can provide satisfaction beyond a paycheck. More such programs should follow across the country as the supply chains for the defense industry are national. Yet, even if the needed increases in training, innovation, and funding are forthcoming, it will take years to send more warships to sea.

This is why it seems so risky to decommission major warships when short-term dangers loom. Beijing is watching closely for a moment when the balance of power in the Indo-Pacific shifts enough to offer an opportunity to strike. Peace depends on deterrence and deterrence depends on the capabilities that exist each day, not a decade or two from now. The Ticonderoga-class cruisers may not be the most modern warships but they still pack a punch with 122 missile cells plus additional launchers for Harpoon anti-ship missiles and torpedoes. Its Aegis radar needs an upgrade but is still better than most of what anyone else has afloat. Best of all, it exists and can hold the line until something better comes along to take its place rather than leave a void the Chinese will try to exploit.

William R. Hawkins is a former economics professor who served on the professional staff of the U.S. House Foreign Affairs Committee. He has written widely on international economics and national security issues for both professional and popular publications.

Image: Flickr/U.S. Navy.

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Build to Deter: The Navy Needs More Ships to Take on China - The National Interest Online

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Spacecraft running low on fuel could get a refill from an orbital station by the year 2025, according to a startup named Orbit Fab that reckons it can charge $20 million to top up your tank.

The American upstart believes there's a market for its planned service because the growing number of companies launching satellites want their hardware to have longer working lives. One way to achieve lengthier missions is orbital refueling.

Orbit Fab is therefore hoping to build, for want of a better word, a depot 300 km from Earth in geostationary orbit that can send out shuttles each containing, say, 100kg of hydrazine to visiting satellites and potentially other spacecraft that need a refill and can plug into the tanks.

And suitably capable spacecraft could dock with the depot to pick up fuel for themselves or to take to satellites and other craft, SpaceNews reported.

Orbit Fab's rendering of its refueling station ... Click to enlarge

Co-founder and chief development officer Jeremy Schiel said government agencies and private operators have "expressed explicit interest to get refueled in the next three to five years." He also said that the design of the fuel depot system is "basically done," and that the company is now working on designing its fuel shuttles.

"It's much easier to come up with a price for GEO [geostationary orbits] because it's one orbit," Schiel explained. "You're going to have to have a different price point on each different orbit in low earth orbit because of how you're going to get there. We're tackling the easy commercial price of GEO first and then we'll start working our way down."

Astroscale, an orbital debris removal biz, is the only customer that has publicly signed up for the satellite refueling service. Orbit Fab has committed to supplying 1,000 kilograms of xenon propellant to top up Astroscale's Life Extension In-Orbit (LEXI) satellites, which are capable of being refueled in space and are scheduled to launch in 2026 into geostationary orbit.

These satellites, and other future craft, need to include Orbit Fab's Rapidly Attachable Fluid Transfer Interface (RAFTI) ports that the fuel shuttles will use to top up visiting craft.

Spacecraft in geostationary orbits today won't have RAFTI ports, and Orbit Fab will need to come up with another method of refueling them. Schiel said the startup will have to rely on third-party vehicles that are compatible with what's already in space as well as Orbit Fab's hardware, such servicing spacecraft built by Northrop Grumman or Astroscale.

"They can go service the legacy satellites and we can service the servicing vehicles that are coming online," Schiel said. "Eventually, when everyone's flying a RAFTI fueling port, we can start going directly to them."

The Register has sought further comment from Orbit Fab.

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Startup wants to build a space station that refuels satellites by 2025 - The Register

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