Medical News Today: How an existing diabetes drug controls pancreatic cancer

New research suggests that targeting a particular cell signaling pathway with the diabetes drug metformin might offer a way to stop the progression and spread of pancreatic cancer.
pancreatic cancer cell
Pancreatic cancer kills more than 44,000 people in the U.S. every year.

The study — which was led by Rutgers Cancer Institute of New Jersey in New Brunswick — is to feature at the 2018 annual meeting of the American Association for Cancer Research, which will be held in Chicago, IL.

This study is not the first to suggest metformin as a potential treatment for pancreatic cancer, but it is the first to show that the underlying mechanism involves the drug’s effect on the REarranged during Transfection (RET) cell signaling pathway.

“Our data,” says senior investigator XiangLin Tan, who is an assistant professor of epidemiology in the School of Public Health at Rutgers Cancer Institute of New Jersey, “indicate that targeting RET with metformin may be an attractive and novel strategy for the prevention and treatment of pancreatic cancer progression and metastasis.”

Pancreatic cancer

Pancreatic cancer is a cancer that starts in the cells of the pancreas, which is an organ behind the stomach that helps with digestion and blood sugar control.

The estimates for the United States suggest that around 55,440 people will find out that they have pancreatic cancer in 2018, and approximately 44,330 people will die of the disease.

Though it is only responsible for 3 percent of all cancers in the U.S., pancreatic cancer accounts for around 7 percent of deaths from cancer.

Because pancreatic cancer is hard to detect in the early stages, most cases are not diagnosed until the disease has started to spread. This makes it harder to treat and often leaves people with much poorer prospects compared with other types of cancer.

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Metformin and cancer

Metformin is a drug that is approved for the treatment of type 2 diabetes. The plant it comes from, the French lilac Galega officinalis, has been used to ease the symptoms of diabetes since the Middle Ages.

However, thanks to the evidence from extensive laboratory experiments and numerous studies that have followed large groups of people, there is now a lot of interest in the possibility that metformin might also be effective against cancer.

This interest has led to clinical trials that are testing metformin not only as a cancer treatment, but also as way to prevent cancer in people at higher risk, such as those who have already had one cancer and have a higher risk of developing another type.

Laboratory investigations have revealed several ways in which metformin interacts with cells and tissue that might explain its anti-cancer effects.

These studies revealed, for example, that the drug can target and kill cancer stem cells, control inflammation responses, and block a cell signaling pathway — called mammalian target of rapamycin — that plays an important role in tumor growth and progression.

None of these, however, have identified the specific mechanism by which metformin might act against pancreatic cancer.

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Metformin and the RET signaling pathway

RET is a cell membrane receptor that sends and receives signals from the cell’s environment. It is also an enzyme that becomes active when it binds to a particular molecule. Together, these roles make RET a key player in the control of cell proliferation, survival, and death.

Prof. Tan and colleagues decided to investigate RET because the receptor and the molecule that it attaches to are strongly expressed in pancreatic cancer and are also linked to the spread of the cancer and worse survival after surgery.

In their experiments, they found that metformin reduced RET signaling in some pancreatic cancer cell lines.

The team also found that silencing RET by other means, as well as treatment with metformin, significantly reduced cell migration.

Therefore, the researchers conclude that blocking RET signaling is at least one of the mechanisms through which metformin stops the growth and spread of pancreatic cancer cells.

Completion of this study will form the basis for developing a novel clinical intervention strategy for inhibiting the growth and spread of pancreatic cancer using metformin and/or other selective RET inhibitors.”

Prof. XiangLin Tan

The scientists call for further studies to identify the precise manner in which metformin alters RET signaling in pancreatic cancer.

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Medical News Today: What causes a lump under the chin?

A swollen lump under the chin can be troubling, but it is usually not a cause for concern. Swollen lymph nodes, cysts, and allergies may cause these lumps to form.

A lump can appear anywhere in the soft area under the chin and jawline. The lump may be large, small, firm, or soft, depending on the cause. The surrounding skin may feel tight and tender, or even painful.

Anyone concerned about symptoms or unsure about the cause of a lump should see a doctor.

Symptoms and causes

Many conditions can cause a lump to form beneath the chin. Accompanying symptoms and the size and shape of the lump will likely differ, depending on the cause.

Below are common causes of a lump under the chin. Some are simple, while others require medical care to prevent complications.

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Swollen lymph nodes

Woman feeling lymph nodes under chin for lump.
Swollen lymph nodes may cause a lump to the left or right of the chin.

Lymph nodes are located throughout the body, but a person can only feel those close to the skin’s surface, such as the nodes in the armpits or close to the chin.

Infections can often cause lymph nodes to swell. This may lead to a noticeable lump to the left or right of the chin. The swelling is a typical response of the immune system.

A lump caused by a swollen lymph node will be soft or flexible. It may be tender to touch, but it is usually not painful. The swelling should go away within 2 to 3 weeks.

The following viral or bacterial infections often cause swollen lymph nodes:

  • a cold or flu
  • ear infections
  • sinus infections
  • measles or chickenpox
  • strep throat
  • mononucleosis
  • an abscessed tooth
  • syphilis
  • Lyme disease
  • HIV or AIDS

If an infection is to blame, the lump should disappear as the infection clears up. A trip to the doctor and antibiotics may be necessary.

Benign tumors

A benign growth or tumor may cause a lump to form under the chin. Types of benign growths include cysts, fibromas, and lipomas. These are usually harmless and treatable.

Cysts. A cyst is a sac filled with fluid or debris. Cysts can form during an infection, and may slowly fill over time. Those under the jaw may be sebaceous cysts, resulting from blockages in the sebaceous glands or ducts. Damage from acne in the area can also cause cysts to form.

Fibromas. A fibroma is a round lump that can be soft or hard. They are usually found around the mouth and are not common under the chin. They usually cause no other symptoms and may signal Cowden’s disease, an inherited illness that causes benign growths to form frequently.

Lipomas. Lipomas are growths of fat cells under the skin. A lipoma lump will be soft, move easily, and have no coloration. Lipomas tend to grow very slowly, are rarely cancerous, and will usually cause no other symptoms.

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Certain cancers

Male patient explaining problem with throat and neck to female doctor with clipboard.
Various cancers may cause a lump to form under the chin, making an early diagnosis essential.

Cancers of the salivary gland, skin, or lymph nodes can cause a lump to form under the chin.

Hodgkin disease and leukemia may also lead to swollen lymph nodes.

Cancerous lumps are typically hard to the touch and may have an odd shape. There may be pain in the area if the lump is touching any nerve cells. If this continues, a person may feel partial numbness or tingling in the area.

Other symptoms of cancerous lump include:

  • a mole near the lump that changes shape or color
  • feeling a constant “lump in the throat”
  • difficulty swallowing or breathing
  • lumps in other areas near lymph nodes, such as the testicles, breasts, or armpits
  • sudden weight loss
  • a lump that keeps growing or changes shape
  • a suddenly or persistently weakened immune system
  • difficulty digesting
  • vocal changes or hoarseness
  • cysts that grow back rapidly after they are removed or drained
  • growths that discharge pus or blood

A doctor may suggest a biopsy to determine if the lump is benign or cancerous. They may recommend surgical removal.

If the lump is cancerous, doctors may also recommend radiation therapy or chemotherapy.

Treatment will vary, and a doctor will often present different options.

Other possible causes

A range of other factors can cause a lump to form under the chin. These may include:

  • a bug bite or sting, especially if the skin tends to have strong reactions
  • allergies to foods or products
  • acne
  • boils
  • salivary duct stones
  • tonsillitis
  • keloid scars
  • hematomas
  • goiters
  • medical conditions, such as rheumatoid arthritis or lupus
  • an injury, such as a cut or a broken bone
  • damage to the sebaceous glands in the chin

When to see a doctor

Doctor pointing at patients chin in front of laptop.
Any unusual lumps on the body with no obvious cause should be assessed by a doctor.

Because of the wide range of possible causes, a professional diagnosis is essential. Unless the cause of a lump is apparent, consult a doctor for a diagnosis and treatment.

Seek professional advice if cancer is suspected, or if a lump:

  • continues to grow
  • lasts for longer than a few weeks
  • feels very hard

The sooner a person receives treatment, the better the outcome is likely to be.

A doctor may recommend antibiotics to treat any possible infections. They may also need to take a closer look at the lump and request an imaging test.

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A lump under the chin is usually not a sign of a severe condition. These lumps tend to disappear on their own.

Often, they are the result of lymph nodes swelling in response to infections, such as those that cause a cold or flu.

Some conditions that cause lumps to form under the chin require medical treatment. Contact a doctor for a diagnosis.

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Medical News Today: What causes nausea before a period?

Some people experience nausea just before they get their period. This is common and is not usually a cause for concern.

Nausea before a period could be caused by many factors, including cramps, premenstrual syndrome (PMS), and pregnancy. If symptoms are severe, this could indicate an underlying condition such as endometriosis.

PMS is the main cause of nausea before a period. Around 20 to 50 percent of women experience PMS in the 7 to 10 days before their period.

Read on to learn about possible causes and treatments for nausea before a period.

Is nausea before a period normal?

Woman on the couch holding her stomach due to nausea before period
As well as nausea before a period, other symptoms may include a headache, fatigue, and muscle aches.

Nausea before a period is common. What matters most, however, is what is normal for the individual.

Feeling nauseated before a period may be a regular symptom for some people. However, a sudden change in PMS symptoms can indicate an underlying medical problem.

A person should also see a doctor if they are:

  • experiencing this symptom for the first time
  • unable to keep down any food
  • losing weight due to frequent vomiting
  • feeling dehydrated
  • experiencing vomiting that gets worse over several days

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Nausea before a period is often caused by PMS. However, there are some other possible causes, so it is wise to speak to a doctor if the symptoms are unusual or interfering with everyday activities.

Causes for nausea before a period include:

Premenstural syndrome (PMS)

PMS is a very common cause of nausea before a period. A person often experiences additional symptoms of PMS, including a headache, dizziness, fatigue, diarrhea, and muscle aches.

Researchers are still unsure about what causes PMS, and why some people experience it and others do not.

Possible explanations for PMS include:

  • Serotonin levels. Serotonin is a brain chemical linked to mood. There is some evidence that serotonin levels are lower before periods begin. Low serotonin can cause depression, anxiety, and other symptoms.
  • Nutritional deficiencies. Not eating enough calcium or magnesium may make PMS worse.
  • Endocrine disorders. The endocrine system regulates hormone levels. Problems with it due to diabetes, thyroid disease, polycystic ovarian syndrome (PCOS), or other diseases may make PMS worse.
  • Hormonal shifts. Estrogen and progesterone are highest after ovulation because these hormones play key roles in pregnancy. When a period begins, estrogen and progesterone levels fall. Women with PMS typically experience nausea either right before a period or right after it starts.
  • Genetics. While doctors have not identified specific genes linked to PMS, it seems to run in families.

Hormones are the body’s chemical messengers, so changes in hormone levels can affect how it responds to many experiences.

A 2018 study of women undergoing breast cancer surgery under general anesthesia, found a link between menstruation and vomiting. Women were much more likely to experience vomiting after surgery when they were getting their periods.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. People with PMDD typically also have serious mood swings and may have depression and anxiety.


Endometriosis is when tissue similar to the tissue that lines the uterus develops outside of it, sticking to other organs, such as the ovaries and fallopian tubes.

Some women with endometriosis do not have symptoms. For others, endometriosis can be debilitating, causing intense pain and heavy bleeding during a period and even throughout the month. Endometriosis is also a leading cause of infertility.

One study found higher rates of stomach and digestive problems in women with endometriosis. Around 85 percent of women with endometriosis reported gastrointestinal problems during the previous year.

In addition to nausea, they also reported gas, bloating, diarrhea, stomach pain, and constipation.


Nausea and vomiting are among the earliest signs of pregnancy. These symptoms may appear even before a woman misses her period.

Shortly after a fertilized egg implants itself in the uterus, a woman’s body begins producing human chorionic gonadotropin hormone (HCG).

HCG may play a role in morning sickness. It is also how most home pregnancy tests detect pregnancy.

Illness or infection

Not all symptoms that happen during a period are due to menstruation. Food poisoning, stomach viruses, food sensitivities, and a range of other health issues may cause nausea around the time of a period.

People experiencing nausea before their period for the first time, especially if it is severe or accompanied by vomiting or intense stomach pain, may have an unrelated illness or infection.


doctor and patient getting diagnosis
Women who often experience nausea before a period should discuss it with their doctor.

Anyone experiencing frequent nausea before their period should talk to a doctor about possible underlying causes. The treatment they recommend will depend on what is responsible for nausea.

Some strategies that may help reduce mild nausea include:

  • taking anti-nausea medication, such as Gravol or Pepto-Bismol
  • monitoring food intake with a food diary to check for anything that might trigger nausea near a period

If nausea before a period is caused by an underlying medical condition, a doctor may recommend:

  • birth control pills, which can help regulate hormones and are sometimes prescribed for endometriosis, PMDD, and PMS
  • surgery to remove endometrial tissue that is outside of the uterus
  • antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), which can help regulate serotonin levels and reduce symptoms of PMDD and PMS

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Nausea is a common premenstrual symptom. For most people with nausea before a period, the symptoms can be managed with over-the-counter medications and by avoiding any trigger foods.

However, if nausea does not improve with conservative methods or if it is interfering with daily life, a person should speak to a doctor who specializes in menstrual health and work with them to come up with a treatment plan.

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Medical News Today: Could mindfulness prevent major depression?

A new study reveals that eight weeks of mindfulness meditation may help to prevent major depressive disorder in people with subclinical depression.
a woman meditating by the sea
Researchers suggest that mindfulness meditation could help to prevent major depression.

Subclinical depression, which is also referred to as subthreshold depression, is defined as the presence of depressive symptoms that are not yet severe or persistent enough to warrant a diagnosis of major depressive disorder (MDD).

Depressive symptoms include feelings of sadness, hopelessness, or guilt, lack of energy and fatigue, problems sleeping, difficulty concentrating, and suicidal thoughts.

If such symptoms are present almost every day for a minimum of 2 weeks, then this would usually warrant a diagnosis of MDD, or major depression.

Study co-author Dr. Samuel Y.S. Wong — of the Jockey Club School of Public Health and Primary Care at the Chinese University of Hong Kong — and colleagues note that around 10–24 percent of people are estimated to be affected by subclinical depression in their lifetime, and the condition is a key risk factor for MDD.

Previous research suggests that psychotherapy may be a beneficial treatment strategy for subclinical depression, and that it could limit the progression to MDD.

For the new study, recently published in the Annals of Family Medicine, Dr. Wong and colleagues investigated whether mindfulness meditation might benefit people with subclinical depression.

Mindfulness meditation is a psychological practice that focuses on being fully aware of experiences in the present moment, rather than being distracted by what is happening around us.

“[…] although the developers of behavioral activation have suggested and encouraged therapist use of mindfulness as a therapeutic method to reduce rumination in depressed patients,” write the authors, “no large study has explicitly combined behavioral activation techniques with mindfulness skills and evaluated their combined effectiveness in reducing depressive symptoms.”

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Major depression lower in meditation group

The researchers enrolled 231 adults, all of whom had subclinical depression, to their study. Subjects were recruited from 16 outpatient clinics in Hong Kong.

Subjects were randomized to one of two groups for a total of 8 weeks: 115 participants took part in a 2-hour session of mindfulness meditation each week, while the remaining 116 participants received usual care, with no psychological intervention.

The team used the Beck Depression Inventory-II scale to assess depressive symptoms among the subjects at study baseline and 8 weeks, 5 months, and 12 months later.

At 12 months, the researchers found that the subjects in the mindfulness meditation group were less likely to have developed MDD than those who received usual care; MDD was identified in 10.8 percent of participants in the mindfulness meditation group, compared with 26.8 percent in the usual care group.

What is more, the study revealed that mindfulness meditation was associated with a small reduction in depressive symptoms at 12 months, compared with usual care.

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According to the National Institute of Mental Health, around 16.2 million adults in the United States had at least one episode of major depression in 2016.

Based on these study results, Dr. Wong and colleagues suggest that mindfulness meditation could be one strategy to help prevent MDD.

The researchers conclude:

[…] we have shown that BAM [behavioral activation with mindfulness] is a potentially feasible and efficacious intervention for reducing depressive symptoms and preventing major depression among people with subthreshold depression in primary care.”

The team plans to conduct further studies that will look at how mindfulness meditation could be integrated into primary care settings as a way of reducing MDD.

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Medical News Today: How brown fat could lead to better weight loss drugs

Our bodies store two types of fat: brown, which burns calories to generate heat, and white, which typically acts as the body’s store of energy. Excess weight results from too much fat being stored in the body. Could we look to brown fat’s molecular makeup to come up with better drugs for obesity?
person standing on scales
Researchers study brown fat in search of better weight management therapies.

The Centers for Disease Control and Prevention (CDC) estimate that more than a third of adults in the United States live with obesity.

It is a metabolic condition and top risk factor for a range of diseases, from diabetes to cancer.

A 2017 report indicated that we are in the midst of an obesity pandemic, with rates on the rise worldwide and the U.S. ranking first in this worrying trend.

For these reasons, scientists are constantly looking to come up with healthful lifestyle strategies that will help people to maintain a desirable weight. At the same time, researchers continue to investigate the biological mechanisms behind weight loss and gain in an effort to devise more effective drugs for treating obesity.

Researchers from the Salk Institute of Biological Studies in La Jolla, CA, are now looking to brown adipose tissue, or brown fat, to find more effective ways of addressing obesity.

Senior investigator Ronald Evans and his colleagues are trying to understand exactly what gives brown tissue its distinct charcteristics. This insight, the team argues, may help them to come up with effective drugs that will act on excess white adipose tissue.

The results of their study have now been published in the journal Cell Reports.

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One gene may hold the key

Specifically, the scientists wanted to learn more about the thermogenic characteristics of brown fat — that is, how it responds to environmental temperature and metabolic factors in order to produce heat.

Previous studies had already shown that some types of brown adipose tissue were “activated” to turn calories into heat when the body was exposed to lower surrounding temperatures.

“We were interested in what maintains brown fat, even when we’re not exposed to cold all the time,” explains first study author Maryam Ahmadian.

The researchers worked with mice, zooming in on a gene that is very active in brown fat cells: estrogen-related receptor gamma.

What they found was that this gene is always expressed in brown fat cells, independently of whether or not the body is exposed to cold ambient temperatures. At the same time, they discovered that this gene is never expressed in white fat cells.

When studying mice in which the estrogen-related receptor gamma gene had been switched off so that it could not be expressed in brown fat cells, Evans and team noted that brown adipose tissue began to resemble white adipose tissue in its molecular structure and mechanisms.

In their paper, the researchers refer to this effect as the “whitening of brown adipose tissue.”

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Findings may lead to better therapies

Another outcome related to the “whitening” of brown fat in these genetically engineered mice was that none of them were able to handle cold temperatures, whereas around 80 percent of normal mice can adjust to such environmental changes.

At the same time, when it came to the metabolism of the animals — or how much weight they put on — Evans and team did not find any significant differences between the regular mice and their genetically engineered counterparts.

Put together, these findings suggest that the expression of the estrogen-related receptor gamma gene allows brown fat to remain “brown” and respond adequately to cold temperatures.

This not only advances our understanding of how the body responds to cold, but could lead to new ways to control the amount of brown fat in the body, which has links to obesity, diabetes, and fatty liver disease.”

Ronald Evans

Another aspect of the researchers’ experiments was informed by the fact that the estrogen-related receptor gamma gene encodes a protein that accesses cells’ nuclei and influences the expression of other genes.

Additional experiments revealed that estrogen-related receptor gamma targets a number of genes — such as Ucp1, Coxa1, and Pparα — that have been linked to brown fat mechanisms and obesity, but never before to this protein.

The team writes that further studies should investigate what effects activating the estrogen-related receptor gamma gene in white fat cells would have. They hope that this move might make white fat cells behave similarly to brown fat cells, making this a viable strategy for therapies targeting obesity and diabetes.

Moreover, they point out that it is important to make sure that estrogen-related receptor gamma has the same roles in humans’ brown adipose tissue as it does in that of mice.

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Medical News Today: New drug could reduce hot flashes ‘by 72 percent’

A trial of a new class of drug finds that it can reduce menopausal hot flashes by nearly three quarters within 4 weeks, and that this effect starts within 3 days of starting to take it.
bottle of pills
A new class of drug could reduce some of the symptoms of menopause.

The experimental compound, which was initially developed to treat schizophrenia, still needs to undergo further trials to fully evaluate its safety and effectiveness in relieving hot flashes in menopausal women.

However, the researchers are hopeful that the new class of drug will soon offer an effective alternative for women who should not or do not wish to undergo hormone replacement therapy (HRT).

The results of the trial were reported in 2017. But more recently, the researchers carried out a new analysis that looked in more detail at the time course of the drug’s effects.

The findings of the new analysis, which was led by Imperial College London in the United Kingdom, are published in the journal Menopause.

“We already knew,” says senior study author Waljit Dhillo, who is a professor in the Department of Medicine at Imperial College London, “this compound could be a game-changer for menopausal women and get rid of three quarters of their hot flashes in 4 weeks.”

“But this new analysis,” he continues, “confirms the beneficial effect is obtained very quickly — within just 3 days.”

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The menopause, hot flashes, and HRT

The menopause is a stage in a woman’s life in which her periods stop and her level of the horhome estrogen — which is produced by the ovaries — begins to decline and she loses her ability to become pregnant naturally. This typically occurs between the ages of 45 and 55.

“Hot flashes” is a common term for the recurring, temporary episodes of “vasomotor symptoms,” in which women approaching and going through menopause experience flushing, hot sensations in the face and upper body.

In the United States, around three quarters of all menopausal women report experiencing hot flashes.

Some women will feel hot flashes as no more than annoyances or embarrassments, but for many others, the episodes can be very uncomfortable, causing clothes to become drenched in sweat.

Hot flashes can also occur at night, during sleep, and therefore result in night sweats. In some cases, the symptoms are severe enough to impact quality of life.

Each woman’s experience of hot flashes tends to follow a pattern that is unique to her. Typically, their frequency increases as she approaches the menopause, then reaches a peak for around 2 years after the menopause and gradually wanes thereafter.

The experience of hot flashes can last from 6 months to 5 years, although in some cases, they can linger for 10 years or longer.

HRT has helped to ease the symptoms of the menopause in many women. However, because it is based on estrogen, it is not without risk.

For example, in their paper, the study authors mention that HRT is not recommended for women with a history of breast cancer. Other research has also linked HRT to ovarian cancer risk.

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Big reduction in hot flashes within 3 days

The new paper describes how an experimental compound — referred to as MLE4901 — was tested in a randomized, double-blind, and placebo-controlled trial. The participants were 37 menopausal women of age 40–62 who were having at least seven hot flashes per day.

The team randomly assigned the women to receive a 4-week course of either a daily 80-milligram dose of the drug or a placebo.

After the 4 weeks, the women then switched over, so that those on the drug then took the placebo and those on the placebo then took the drug, for another 4 weeks.

The results revealed that when they were taking the experimental drug, the women experienced, on average, fewer hot flashes over the 4 weeks, when compared with the average number experienced over the 4 weeks when they took the placebo.

But an equally important trial result — which became apparent when the researchers carried out the new time-course analysis — was that the compound began to show a “significant effect” within just 3 days.

For example, by day 3 of treatment with the drug, the frequency of the hot flashes reduced by 72 percent “compared with baseline” and showed a “51 percentage point reduction compared with placebo,” note the study authors.

The size of this effect “persisted throughout the 4-week period,” they add, further observing that the drug also reduced severity of hot flashes by 38 percent by day 3.

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New drug could relieve many symptoms

Prof. Dhillo says that because MLE4901 has side effects that impact the liver, it will be other drugs with the same action that will be tested further in trials. One trial has already started in the U.S.

The researchers think that the compounds work by inhibiting neurokinin B (NKB), a substance in the brain that previous studies in animals and humans have suggested may trigger hot flashes.

The new analysis also found that the new drug relieved daytime hot flashes as well as night-time ones.

Also, the women reported that the number of hot flashes that disrupted their sleep at night fell by 82 percent and that they experienced 77 percent less impairment to concentration when on the drug.

However, the researchers could not say whether these further improvements were a result of fewer hot flashes or a direct result of the compound’s effect on the brain.

They are hopeful, nevertheless, that the drug may directly improve many menopausal symptoms — from hot flashes to sleeping disruption and impaired concentration, and even weight gain — because of the many parts of the brain affected by NKB.

Prof. Dhillo notes that the trial has enabled them to find a “new therapeutic use for the compound — which had previously been sitting on the shelf unused” — and that they expect that within 3 years, it will be making “a tangible difference to the lives of millions of women.”

This class of new drugs may provide women with a much-needed alternative to HRT.”

Prof. Waljit Dhillo

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Medical News Today: What are flu vaccines made of and why?

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Medical News Today: Ten essential oils to relieve a cough

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Medical News Today: Over 400,000 U.S. deaths per year caused by lead exposure

Past exposure to lead may be to blame for over 400,000 deaths in the United States every year, according to a new study published in The Lancet Public Health.
chemical symbol for lead
Researchers find that even low lead exposure can be a big killer.

From an analysis of more than 14,000 people in the U.S., researchers found that exposure to low lead levels from the late 1980s to the mid-1990s was linked to a higher risk of cardiovascular and all-cause death over the next 20 years.

Led by Prof. Bruce Lanphear, from Simon Fraser University in Canada, the study is the first to use a nationally representative sample to investigate how low levels of lead exposure affect mortality in the U.S.

Lead is a chemical element that is naturally present in soil and water. Lead was once widely used in petrol, plumbing, paint, and other consumer products, but as it emerged that high exposure to the chemical — defined as having a blood lead level of 5 micrograms per deciliter (μg/dL) or higher — can be toxic to humans and animals, efforts have been made to reduce its use.

However, the new study from Prof. Lanphear and colleagues suggests that even lower levels of lead exposure can pose significant harm to health.

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The health risks of lead exposure

According to the U.S. Environmental Protection Agency (EPA), children are most susceptible to the harms of lead exposure; their developing bodies absorb the chemical in higher amounts and their brains and nervous systems and more sensitive to it.

In children, lead exposure may cause developmental, behavioral, and learning problems, as well as anemia and problems with hearing.

In adults, exposure to lead may cause reproductive problems, a reduction in kidney function, and increased blood pressure.

For this latest research, Prof. Lanphear and his team sought to determine how exposure to lead contributes to all-cause mortality and cardiovascular disease (CVD) mortality in the U.S.

“No studies have estimated the number of deaths in the U.S.A. attributable to lead exposure using a nationally representative cohort, and it is unclear whether concentrations of lead in blood lower than 5 μg/dL, which is the current action level for adults in the U.S.A., are associated with cardiovascular mortality,” the researchers explain.

To reach their findings, the team analyzed the data of 14,289 adults in the U.S. who were a part of the Third National Health and Nutrition Examination Survey.

Subjects were enrolled in the study between 1988 and 1994. Blood samples were taken from each participant at study baseline, and these were measured for levels of lead.

“Our study estimates the impact of historical lead exposure on adults currently aged 44 years old or over in the U.S.A., whose exposure to lead occurred in the years before the study began,” explains Prof. Lanphear.

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Even low levels of lead are harmful

Baseline blood lead levels ranged from less than 1 μg/dL to 56 μg/dL. The average blood lead level was 2.7 μg/dL, and a total of 3,632 study participants had a level of 5 μg/dL or higher.

Over an average 19.3 years of follow-up, a total of 4,422 deaths occurred. Of these, 1,801 were from CVD and 988 were from heart disease.

The study revealed that adults who had high lead levels in their blood were 37 percent more likely to die from all causes during the follow-up period, compared with those who had a lower level of 1 μg/dL.

These subjects were also 70 percent more likely to die from CVD, and their risk of death from heart disease was doubled.

Using these data, the team calculated that blood lead levels higher than 1 μg/dL are responsible for around 412,000 deaths in the U.S. each year. Of these, around 256,000 are from CVD.

These results remained after accounting for a number of possible confounding factors, including participants’ age, sex, body mass index (BMI), diet, smoking status, and alcohol intake.

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Are there any ‘safe levels’ of toxicants?

Prof. Lanphear and team admit that there are some limitations to their research. For example, they point out that their study relied on a single blood test from each subject at baseline, so they were unable to determine the “effect of further lead exposure.”

Additionally, they note that they could not control for exposure to other contaminants that might affect cardiovascular health, such as arsenic or air pollution.

Still, these results indicate that lead exposure could have a larger impact on our health than we thought.

Our study calls into question the assumption that specific toxicants, like lead, have ‘safe levels,’ and suggests that low-level environmental lead exposure is a leading risk factor for premature death in the U.S.A., particularly from cardiovascular disease.”

Prof. Bruce Lanphear

“Currently, low levels of lead exposure are an important, but largely ignored risk factor for deaths from cardiovascular disease,” adds Prof. Lanphear.

“Public health measures,” he goes on, “such as abating older housing, phasing out lead-containing jet fuels, replacing lead-plumbing lines, and reducing emissions from smelters and lead battery facilities, will be vital to prevent lead exposure.”

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Medical News Today: These antibiotics may endanger vascular health

A type of antibiotic used in treating bacterial infections has been tied to many adverse health events, leading specialists to advise caution in the prescription of these drugs. Recent evidence now confirms that they increase the risk of aortic disease, which is a condition that damages the main artery of the human body.
antibiotic medication concept photo
Fluoroquinolones, a type of antibiotic, could endanger vascular health.

Fluoroquinolones are a type of antibiotic sometimes prescribed in the treatment of various bacterial infections, from bacterial sinusitis to urinary tract infections.

Howevery, they have been flagged as bringing potentially dangerous side effects.

So, in 2016, the Food and Drug Administration (FDA) “approved safety labeling changes […] to enhance warnings about their association with disabling and potentially permanent side effects and to limit their use.”

Recent longitudinal studies linked the use of these antibiotics with a significantly increased risk of aortic disease, which is a vascular condition wherein the aorta — the body’s main blood-carrying vessel — is affected.

Aortic disease is characterized either by aneurism (when the artery dilates) or dissection (when it ruptures), and both of these events can be life-threatening.

A new study — led by researchers from the Karolinska Institutet in Stockholm, Lund University (both of which are in Sweden), and the Statens Serum Institut in Copenhagen, Denmark — has now confirmed some of these worrying associations.

However, lead researcher Björn Pasternak — from the Department of Medicine at the Karolinska Institutet — says that there’s a ray of hope amid the general doom and gloom.

Our results confirm the findings in the previous studies but suggest that the increased risk is not as pronounced as indicated by those studies.”

Björn Pasternak

The findings have been published in The BMJ.

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Fluoroquinolones more than double risk

The researchers worked with data sourced from national health registers — the National Prescribed Drug Register, National Patient Register, Statistics Sweden, and Swedish Cause of Death Register — submitted between July 2006 and December 2013.

They compared the risk of aortic disease in 360,088 people treated with fluoroquinolones with the risk of developing this condition among an equal number of participants treated with a different type of antibiotic: amoxicillin.

The researchers’ analysis revealed a 66 percent higher risk of developing aortic aneurism or dissection among people who had been administered fluoroquinolone antibiotics.

“This increase,” the authors write, “corresponded to an absolute difference of 82 […] cases of aortic aneurysm or dissection per 1 million treatment episodes [over a] 60-day risk period.”

They admit that — similarly to previous studies — the new research was of an observational nature, and therefore it was unable to establish that fluoroquinolones caused aortic disease.

Yet Pasternak argues that the study’s size and strong methodology mean that its results provide the most credible evidence unearthed to this point.

“Although the absolute risk increase was relatively small,” the researchers explain, “the study’s findings should be interpreted in the context of the widespread use of fluoroquinolones.”

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An underlying mechanism behind the link between fluoroquinolone use and aortic disease may be that these antibiotics “turn on” the activity of certain enzymes that can harm the integrity of internal tissue.

“One of the factors involved in the development of aortic disease is increased activity in tissue-degrading enzymes known as matrix metalloproteinases,” explains Pasternak.

“We know that fluoroquinolones induce the activity of these enzymes,” he adds, “which is also thought to underlie the more well-known adverse effect of tendon pain and rupture.”

Further studies should aim to clarify whether particular types of fluoroquinolone antibiotic are more harmful to vascular health than others. Also, more focus should be placed on understanding the biological mechanisms at play, the researchers conclude.

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