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Helpful Bacteria May be Hiding in Your Appendix

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Your appendix is a small dead-end tube connected to a section of your large intestine. It has long been thought to be a vestigial remnant of some other organ, but there is little evidence for an appendix in our evolutionary ancestors. Few mammals have any appendix at all, and the appendices of those that do bears little resemblance to the human one.

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Some researchers now believe that the appendix is a “safe house” for commensal bacteria, the symbiotic germs that aid digestion and help protect against disease-causing germs.

The appendix is isolated from the rest of the gut, with an opening smaller than a pencil lead. In times of trouble, such as an infection that flushes the system, these commensal bacteria could hide out there, ready to repopulate the gut when the danger is past.

Biofilms, colonies of beneficial microbes, form in your large intestine. They aid digestion and protect against infection, while enjoying the protection and nutrition of the human host. Researchers have found biofilms on the epithelial lining of the appendix as well.

Sources:

* New York Times June 17, 2008

* The Journal of Theoretical Biology December 21, 2007; 249(4):826-31

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Vasectomy: Safe, Simple and Little Used

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Newer surgical techniques reduce the risk involved with having a vasectomy.
Vasectomy is a simple, painless procedure that is very effective in preventing pregnancy. Men usually have no side effects from vasectomy, and no change in sexual performance or function.

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Newer surgical techniques reduce the risk involved with having a vasectomy.

In Short:-

Vasectomies are safer and more cost-effective than tubal ligations, the sterilization technique for women, but remain relatively underused.

A new no-scalpel vasectomy technique significantly reduces complications.

The rate of unwanted pregnancies after vasectomy remains low; most of those pregnancies can be traced to patient error.

A tiny puncture and a little snip, done under local anesthetic — that’s essentially all there is to a vasectomy.

“Vasectomies are the safest, simplest, most cost-effective method of contraception we have,” said Dr. Edmund Sabanegh Jr., director of the Clinic for Male Fertility at the Cleveland Clinic Foundation.

They are also strikingly little-used. About 500,000 American men have the operation each year. More than twice as many women undergo tubal ligation for permanent contraception, even though that operation costs three to four times as much, requires general anesthesia and an abdominal incision, and carries a small but real risk of serious complications.

“There’s something about having a surgeon fiddling around down there with a scalpel that makes even tough guys squeamish,” said Dr. Marc Goldstein, director of the Center for Male Reproductive Medicine and Microsurgery at the Weill Medical College of Cornell University in New York.

And then there are the misconceptions that discourage many men from having vasectomies, especially the widespread and groundless worry that the procedure will lower testosterone levels and affect sexual performance.

Whatever the reasons in the United States, the situation is not the same among men everywhere. By the time they reach their 50s, roughly half of men in New Zealand have undergone vasectomies, according to Dr. Sabanegh, compared with fewer than one in six in the United States. In Canada, vasectomies outnumber tubal ligations.

Experts hope that recent advances in vasectomy techniques will ease some of the fears.

The chief advance is the no-scalpel vasectomy, a technique pioneered in China in the 1970s that has been steadily gaining popularity in the United States. In a traditional vasectomy, doctors make two half-inch incisions on either side of the scrotum to sever the vas deferens, the two narrow tubes that carry sperm from the testicles during ejaculation. The no-scalpel approach does away with the need for incisions.

In the new technique, doctors use their fingers to locate the vas deferens by feel through the thin skin of the scrotum.

“Once we’ve located the vas, we make a tiny poke-hole over it,” said Dr. Phillip Werthman, director of the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles. The hole can be gently expanded in a way that pushes blood vessels aside rather than cutting through them, so there is almost no bleeding. Using a hooked instrument, surgeons pull the vas through the hole, then cut it.

“A lot of men can’t even tell where the procedure was done afterwards, the hole we make is that small,” said Dr. Goldstein, who was the first Western doctor to travel to China to learn the technique. Compared with traditional techniques, no-scalpel vasectomies result in less bleeding, less postoperative pain and quicker recovery. They also require less time to perform — a little more than 10 minutes in the hands of an experienced surgeon.

Although the traditional incision method is still more widely used, that is likely to change as more and more medical schools teach the no-scalpel approach.

In another bid to win over squeamish males, some doctors have replaced the needles used to inject anesthesia into the scrotum with high-pressure jets that deliver painkillers through the skin.

“A lot of men’s biggest fear is that needle,” Dr. Werthman said, even though the actual needle used is so narrow that most men barely feel it. “Pressure injection takes the psychological edge off that,” he said, though many patients find the loud popping sound it makes unpleasant.

In the end, the success or failure of a vasectomy depends not on how surgeons reach the vas but how they block it. Many doctors use several methods to ensure that sperm don’t find another path. Along with cutting out a small section of the tube, they may burn the inner lining of the two remaining ends, clamp them and separate them.

With current techniques, the chance of an unwanted pregnancy occurring in the first year after a vasectomy is 1 in 1,000, Dr. Sabanegh said. Some of those failures are the fault of the patient, not the procedure. Because it can take several months for sperm remaining after a vasectomy to be washed out, men are counseled to use other contraception methods until tests show that their semen is free of active sperm. Many men don’t bother. In a 2006 study of 436 vasectomies, researchers at the Cleveland Clinic Foundation found that only three out of four returned for follow-up semen analysis, and only 21 percent followed the full instructions to continue to be tested until two specimens came up negative.

Sources: The New York Times : June 29, ’08

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Do Arthritis Drugs Cause Cancer?

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The U.S. Food and Drug Administration (FDA) is investigating whether four drugs used to treat rheumatoid arthritis and other immune system diseases might increase the risk of cancer in children.

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The FDA has received reports of 30 cases of cancer among children and young adults treated with the drugs. The agency did not make clear how many children had taken the drugs.

The drugs involved are:

1. Enbrel, sold by Amgen and Wyeth
2. Remicade, sold by Johnson & Johnson and Schering-Plough
3. Humira, sold by Abbott Laboratories
4. Cimzia, sold by the Belgian company UCB

All of the drugs block a protein called tumor necrosis factor, and are therefore known as TNF-blockers. They are used to treat not only rheumatoid arthritis but also psoriasis, Crohn’s disease and other immune diseases.

Because the drugs block part of the immune system, it’s long been known that they might contribute to a higher risk of cancers and infections. The drugs’ labels contain warnings as such, including warning about a risk of lymphomas, which are cancers of immune system cells.

Among adults, meanwhile, one study found that those given Humira or Remicade to treat rheumatoid arthritis had 2.4 times the cancer rate of those in control groups.

Sources: New York Times June 5, 2008

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Why Brain Surgeons Are Avoiding Cell Phones?

The use of a mobile phone is prohibited in some train company carriages

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Last week, three prominent neurosurgeons told CNN interviewer Larry King that they did not hold cell phones next to their ears. Dr. Keith Black, Dr. Vini Khurana, and CNN’s chief medical correspondent, Dr. Sanjay Gupta all maintained that the practice could be unsafe.

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Along with Senator Edward M. Kennedy’s recent diagnosis of a glioma, a type of tumor that critics have long associated with cell phone use, the doctors’ remarks have helped reignite the debate about cell phones and cancer.

According to the Food and Drug Administration, three large epidemiology studies since 2000 have shown no harmful effects. However, that the average period of phone use in those studies was about three years, which provides no information about the long-term exposures that could lead to cancer.

“What we’re seeing is suggestions in epidemiological studies that have looked at people using phones for 10 or more years,” says Louis Slesin, editor of Microwave News, an industry publication that tracks the research.
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Sources:

* New York Times June 3, 2008

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Fit, Not Frail: Exercise as a Tonic for Aging

Fact: Every hour of every day, 330 Americans turn 60.

Fact: By 2030, one in five Americans will be older than 65.

Fact: The number of people over 100 doubles every decade.

Fact:
As they age, people lose muscle mass and strength, flexibility and bone.

Fact: The resulting frailty leads to a loss of mobility and independence.

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The last two facts may sound discouraging. But they can be countered by another. Regular participation in aerobics, strength training and balance and flexibility exercises can delay and may even prevent a life-limiting loss of physical abilities into one’s 90s and beyond.

This last fact has given rise to a new group of professionals who specialize in what they call “active aging” and an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine. These recommendations are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

But you need not — indeed should not — wait for the government. Even if you have a chronic health problem or physical limitation, there are safe ways to improve fitness and well-being. Any delay can increase the risk of injury and make it harder to recoup your losses.

Miriam E. Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University in Boston and lead author of the new recommendations, observed last fall in The Journal on Active Aging that “with every increasing decade of age, people become less and less active.”

“But,” Dr. Nelson said, “the evidence shows that with every increasing decade, exercise becomes more important in terms of quality of life, independence and having a full life. So as of now, Americans are not on the right path.”

Jim Concotelli of the Horizon Bay Senior Communities in Tampa, who oversees fitness and wellness program development for communities for the elderly in several states, noted this year in The Journal on Active Aging that many older Americans were unfamiliar with exercise activities and feared that they would cause injury and pain, especially if they have arthritis or other chronic problems. Yet by strengthening muscles, he said, they can improve joints and bones and function with less pain and less risk of injury.

The key is start slowly and build gradually as ability and strength improve. Most important is simply to start — now— perhaps under the guidance of a fitness professional or by creating a program based on the guidelines outlined here.

Although medical clearance may not be necessary for everyone for the moderate level of activity suggested, those with a known or possible problem would be wise to consult a doctor. And a few sessions with a trainer can help assure that the exercises are being done correctly and not likely to cause injury.

Until recently, physical activity recommendations for all ages have emphasized aerobics, or cardiovascular conditioning, through moderate to vigorous activities like brisk walking, cycling, lap swimming or jogging for half an hour a day five or more days a week. For those unable to do 30 minutes at a time, the activities can be broken up into three 10-minute intervals a day. If you have long been sedentary, start with even shorter intervals.

For people who prefer indoor workouts, a treadmill, cross-trainer, step machine or exercise bike can provide excellent aerobic training for the heart, lungs and circulation. Those unable to do weight-bearing exercise might try swimming or water aerobics. Keep in mind that 30 minutes a day of aerobic activity five days a week is the minimum recommendation. More is better and can reduce the risk of chronic disease related to inactivity.

Contrary to what many active adults seem to believe, physical fitness does not end with aerobics. Strength training has long been advocated by the National Institute on Aging, and the heart association has finally recognized the added value of muscle strength to reduce stress on joints, bones and soft tissues; enhance stability and reduce the risk of falls; and increase the ability to meet the demands of daily life, like rising from a chair, climbing stairs and opening jars.

Strength training can be done in a gym on a series of machines, each working a different set of major muscle groups: hips, legs, chest, back, shoulders, arms and abdomen. Or it can be done at home with resistance bands or tubes, hand-held barbells or dumbbells or even body weight. One program, the Key 3 program diagrammed here, was devised by Michael J. Hewitt, research director for exercise science at the Canyon Ranch Health Resort in Tucson. It can be completed in 10 minutes with practice.

 

As Dr. Hewitt explained in the International Longevity Center-USA newsletter, skeletal muscles can only contract and thus are always arranged in pairs. “One muscle of the pair pulls to bend the joint (flexion), and its antagonist pulls to straighten the joint (extension).” Thus, a strengthening program must be balanced, he said, “pairing every pulling lift with an opposite pushing action.”

Dr. Hewitt emphasized that to reduce the risk of injury and premature muscle fatigue, the large muscles should be exercised first, followed by the smaller muscles, with the postural muscles exercised last. For example, one would start with chest and upper back muscles, then the arms and shoulders and finally the lower back and abdomen.

Muscles have to be overworked to grow stronger. The goal for each exercise is three sets of 8 to 12 repetitions to muscle fatigue. Muscles also need time to recover. So strength training should be done two or three times a week on nonconsecutive days.

The new recommendations add flexibility and balance to the mix. Improving balance and reducing the risk of falls is critical as you age — if you fall, break your hip and die of pneumonia, aerobic capacity will not save you. Ten minutes a day stretching legs, arms, shoulders, hips and trunk can help assure continued mobility, and daily exercises like standing on one foot and then the other, walking heel to toe or practicing tai chi can improve balance.

The recommendations, issued last August, are geared to healthy adults 18 to 64, with a companion set for those 65 and older or those 50 to 64 who have chronic health problems or physical limitations. Details can be found at www.acsm.org. Under “Influence,” click on Physical Activity Guidelines From ACSM and AHA.

The experts who made these recommendations urge all adults to adopt them now. As C. Jessie Jones, co-director of the Center for Successful Aging at California State University, Fullerton, said, “People can’t wait until they’re in residential or long-term care to get started.”

Sources: The New York Times

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