Hyperthermia Treatment for Cervical Cancer

Upon its inception in recent years, Gardasil has become one of the most common vaccines for teenage girls. It helps to protect against two types of human papillomavirus (HPV) that cause about 75% of cervical cancer cases. Despite this, about 11,000 women are diagnosed with cervical cancer each year and 4,000+ women die in the USA each year from this disease. Most cervical cancers are squamous cell carcinomas, which arise in the squamous epithelial cells that line the cervix. The second most common type is adenocarcinoma, which arises in glandular epithelial cells. Treatments for cervical cancer depend on the stage to which the cancer has progressed. Once it gets to fairly advanced stages, the most common treatments include chemotherapy and radiation. However, and age-old treatment known as hyperthermia is also beginning to be used to treat cervical cancer.

Thousands of years ago, the ancient Egyptians and Greeks used heat to destroy cancerous tumors. This therapy technique, known as hyperthermia, is a treatment which is now being used to fight against cervical cancer. Since tumor cells have a compact vascular structure, they have difficulty dissipating heat and therefore cause cancer cells to undergo apoptosis, or "programmed cell death," in direct response to heat. However, while it is able to attack cancer cells, healthy tissues can more easily maintain a relatively constant temperature due to their vascular structure.

Different levels of heat are able to be used and thus have a different affect on the cancerous cells. Intense heating will cause denaturation of vital cellular proteins, which rapidly kills cells within the tumor. Moderate heating will have more subtle changes, and will prove to be more effective in conjunction with other types of treatments. Increasing temperature in areas where cancer cells are present will cause blood vessels to vasodilate and thus increase blood flow to the area. Increased perfusion will enhance the rate at which medications are delivered. When radiation alone is used to treat advanced cervical cancer, the three-year survival rate is 57% and significantly rises to 83% when radiation is coupled with hyperthermia treatment.

http://www.cancer.gov/cancertopics/factsheet/Therapy/hyperthermia

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102211746.html

http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Patient/page1

http://www.ncbi.nlm.nih.gov/pubmed/16754343

Should Men be Vaccinated With the Gardasil vaccine?

After class on Wednesday I decided to do some research to see if the gardasil vaccine should be given to boys as well as girls. A study that I found done in 2009 found that yes they should be given the vaccine. Gardasil is a vaccine that protects against the Human Papillomavirus (HPV). The vaccine was designed to protect people against 4 types of HPV 6, 11, 16, and 18. Two types that cause 90% of genital warts cases and two types that cause 75% of cervical cancer cases. The vaccine was released in 2006 and recommended for women between the ages of 9-26. The vaccine is composed of 3 shots that are administered over a 6 month period.

The vaccine was recommended to girls to prevent them from developing cervical cancer later in life. The idea was to give the girls the vaccine before they became sexually active and before they had a chance to acquire HPV. So one obvious reason that it is recommended for men is to prevent women from getting it from the men. Gardasil has also been shown to be effective at preventing cancers of the penis and anus that are also associated with HPV. Also, the vaccine is shown to be effective at preventing 90% of genital warts cases.

In a study funded by Merck 4,065 men between the ages of 16-26 participated in a randomized, double blind, placebo-controlled trial. All of the men were HPV free at the time of the study and they participated in the study for two to three years. It was found that the men in the vaccine group were 65.5% less likely to contract genital warts from the 4 types of HPV that are covered by the vaccine. The vaccine was found to protect men from 90.4% of genital warts in the men that actually received all 3 doses of the vaccine.

In 2009 the FDA released a statement in which they recommended the use of the vaccine in men between the ages of 9-26. The makers of gardasil Merck also recommend that the vaccine be given to men. Since HPV is the most common sexually transmitted disease in men and women it would be very beneficial if both men and women get vaccinated with gardasil.

For More Information:

Gardasil Protects Men and Boys too

Gardasil.com

FDA Press Release

Merck Study

http://www.livestrong.com/article/178203-how-does-gardasil-work/

Mens Worst Nightmare: Synchronized Menstrual Periods

Girls, have you ever noticed that living with other females ultimately results in the feeling that you all have similar menstruation periods? This would be any man's nightmare. Synchronized menstrual periods are known to be caused by pheromones secreted by other women that you are in close contact with over time. Pheromones are secretions given off that trigger other animals in the same species senses. Odors from different phases of you menstruation cycle give off chemicals that could either shorten or lengthen the female's cycles around you. However this theory on the effects of pheromones and menstruation is constantly being debated due to the inability of duplication.

The first study of this in 1971 by McClintock, used lab rats and specific pheromones to prove that menstrual synchrony occurs from other females pheromones. At the time some significance was found between the different pheromones and cycles but the results are not repeatable, leaving no evidence for mammal female synchrony. McClintock's study only left variables that needed to be further tested such as pheromones; directly or indirectly related to moderate cycles.

J.Harrison, RN, RNP discusses a possible link to one pheromone that is under study for possible relation to synchrony in a blog post under (2006,WebMD). 5Alpha-androstenol is one pheromone possibly linked in menstrual synchrony, and a pheromone found in underarm secretions in women. The ability to smell the pheromone and see changes in the women's cycle would show that the hormone could be related. The many studies done either had women with a large percentage synchronized and not exposed to the pheromone (specifically studied), or the ability to smell the pheromone and no synchrony occur.

Looking at this from an evolutionary standpoint, females synchronizing their menstrual periods would be beneficial for populations overtime. For some animals in packs having all the females reach their peak of fertility at the same time could help the males reproduce at a significantly higher rate rather than chancing with each female. However, this also depends on whether the males can tell when the females are in heat. Possibly humans at one time synchronized and over time the need for this behavior decreased or they synchronize due to pheromones.

Most of the research done on menstrual synchrony is not consistent or duplicable. Also we have to consider that all women differ in many variables that alter menstruation such as stress, body weight, age and individual menstrual cycle lengths. The possibility that women in the same living arrangements and all menstruate at the same time can be not only physiological but just by chance.

Sources:

Harrison-Hohner, Jane, RN RNP. (2010). Do Women's Cycles Sync Up. Below the Belt: Women's Health. Retrieved from

http://blogs.webmd.com/womens-health/2010/10/do-womens-cycles-sync-up.html

Schank, J.C. (2006). Do Human Menstrual-Cycle Pheromones Exist? Human Nature, 17(4), 448-470. Retrieved from EBSCO host.

In Vitro Fertilization

Infertility affects nearly 6.1 million Americans. This is roughly 10% of men and woman of reproductive age. In vitro fertilization or IVF was first performed successfully in the United States in 1981. It is estimated that over 250,000 babies have been born as a result of IVF. However less than 5% of infertile couples use IVF to become pregnant. It is typically used for a woman who has blocked fallopian tubes or lacks fallopian tubes all together. It is also used when a man suffers from endometriosis which is problems with the sperm such as low sperm count.

There are 5 steps to the IVF process. The first step is to prescribe fertility medications to allow more than one egg to ripen at once. This is called ovulation induction. Multiple eggs are desired due to the possibility that some of the eggs won't develop or become fertilized. The second step is a minor surgical procedure to remove the eggs from the ovaries. This surgery is usually guided by ultrasound. They are removed using a hollow needed and the process is called follicular aspiration. The third step is to obtain sperm through ejaculation in order to fertilize the eggs. The fourth step is a process called insemination where the sperm and the eggs are placed in incubators in a laboratory. The eggs are then monitored to confirm whether fertilization occurred and to make sure the cell division is taking place. The fifth and final step is to transfer the now called embryos into the uterus. This can be done anytime within 1-6 days after fertilization but is usually done between days 2-3.

Each time embryos are inserted into the uterus, it is called a cycle. The success rate of one cycle depends on the age of the woman. For woman under the age under 35 the success rate is 30-35%. 25% for women ages 35 to 37, 15-20% for woman 38 to 40 and 6-10% for women over 40. Of the cycles that result in a live birth, 63% are single babies, 32% are twins, and 5% are triplets or more. The average cost of one cycle is $12,400.

More information on IVF can be found at the American Pregnancy Association and emedicine health

Tubal Pregnancy

The realization of the news of a tubal pregnancy, also known as an ectopic pregnancy, can be some of the most heart wrenching news for a mother to be. A tubal pregnancy occurs when an egg has been fertilized, but does not make it down into the uterine lining to become implanted in the uterus. This is projected to happen to 1 out of every 50 pregnancies. In over 95% of tubal pregnancies the egg stops traveling in the fallopian tubes, which is where it got its name. There are similar occurrences where the egg will travel and become implanted in the abdomen or the cervix. These are called abdominal or cervical pregnancies. All three of these types of pregnancies lead to severe issues due to the fallopian tubes, abdomen, and cervix not having enough space for growth or nutrient rich tissues to support the fetus's needs. The uterus has the best conditions for a fetus to grow and develop because it has great stretching abilities and it has all of the nurturing tissues for a normal pregnancy to develop correctly. Due to lack of space for growth in the fallopian tubes, abdomen, or cervix, sooner or later the organ will burst. In turn, both the fetus and the mother’s lives are in danger because of severe bleeding. A woman’s fetus suffering a tubal pregnancy will not survive.

Diagnosing a tubal pregnancy can be somewhat difficult because most of the symptoms are exactly like a normal pregnancy. These symptoms include nausea, vomiting, frequent urination, missed periods, fatigue, abnormal vaginal bleeding, low back pain, slight cramping on one side of the pelvis, and breast tenderness.

Some first warning signs of a tubal pregnancy are often sharp and stabbing pain in the pelvis and abdomen or vaginal bleeding. Some woman may even suffer from pain in their shoulder or neck due to the organ bursting and blood building up, which can irritate certain nerves. Dizziness or fainting and low blood pressure due to blood loss are other symptoms that can imply a tubal pregnancy.

A tubal pregnancy can be caused by smoking, pelvic inflammatory disease (PID), surgery on the fallopian tube, or a previous ectopic pregnancy in the fallopian tube. All of these causes lead to an egg’s inability to move through the fallopian tubes due to scar tissue.

Depending on how far along the tubal pregnancy is there are different types of treatments used. To avoid any incisions or general anesthesia, a medicine called methotrexate can be used to end the pregnancy. This treatment usually only works when the mother’s pregnancy hormone levels are low, during the first six weeks of pregnancy, or when the fetus has no heart activity. Surgery can also be used as a treatment if the tubal pregnancy has already ruptured and caused bleeding. If it is possible, laparoscopic surgery is used, which only causes a small incision. Some tubal pregnancies can miscarry on their own. A doctor can detect this by testing the woman’s pregnancy hormone levels.

Sources:
http://kidshealth.org/parent/pregnancy_center/your_pregnancy/ectopic.html
http://www.webmd.com/baby/tc/ectopic-pregnancy-treatment-overview
http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm

Male or Female? : The Curse of Gender Syndromes

The common phrases, “Looks aren’t everything” or “Physical appearances can be deceiving,” offered by elders to younger generations in times of heartbreak and disappoint or simply to heed warning could also be used in more literal situations, such as, gender syndromes. One syndrome discussed in our A&P textbook, “Anatomy and Physiology: The Unity of Form and Function,” was Androgen-Insensitivity Syndrome that causes a genetic male to have the external genitalia and secondary sex characteristics of a female; however, the internal genitalia are characteristic of a male.

Another gender/genetic syndrome that can occur in males is Klinefelter Syndrome, which occurs when a male inherits one or more extra X chromosomes. An XXY male is conceived as a result of a breakdown in meiosis of the sex cell in the mother or father. Normally, the 46 chromosomes in a cell of the parent divide into two cells each containing 23 chromosomes. The synthesis of an egg with two X chromosomes or a sperm containing an X and Y chromosome occurs mid-meiosis during the exchange of genetic material between paired chromosomes; the two X’s of a female and the X and Y of the male fail to pair and exchange genetic material. An extra X chromosome causes a testosterone deficiency due to unsuppressed follicle-stimulating and luteinizing hormones. Klinefelter syndrome is the most common chromosomal disorder, affecting 1 in every 500 men. Klinefelters is undetectable in males in the first few years of life unless the mothers undergo prenatal testing, such as, amniocentesis or chorionic villus. The first signs of an individual with Klinefelter's occurs in early development, pre-puberty, in the form of immature speech and language skills, sensitivity to sounds, touch, and movement, and delayed gross and fine motor functions. During puberty the phenotypic traits of males with Klinefelter syndrome become more evident; pubescent males experience excessive breast development, lack of facial and auxiliary hair growth, small testicles and penis, longer legs and arms, broader hips, and low energy levels.
If not detected before birth, most individuals discover they have Klinefelters Syndrome as adults from infertility test results. Due to the extremely low levels of testosterone, all Klinefelter's males are infertile; however, recent advancements in male infertility treatment have shown that males can undergo testicular sperm extraction combined with in vitro fertilization to conceive a child.

Males with Klinefelter Syndrome have an increased risk at developing autoimmune disorders, most commonly, type I diabetes, thyroiditis, and lupus erythematosus. Also, their enlarged breasts put them at the same risk level for breast cancer as women. Similarly, they experience the effects of menopause just as women, such as, decreased bone-calcium density and decreased libido. Individuals can decrease their risk of certain health problems through testosterone replacement therapy. Beginning routine testosterone injections at the onset of puberty has proven to increase bone and muscle strength and promote growth of facial and body hair. As a result, an individual’s mood and self-confidence will increase, which will decrease their chance of developing depression providing a greater quality of life.

http://my.clevelandclinic.org/disorders/klinefelter_syndrome/hic_understanding_klinefelter_syndrome_a_guide_for_xxy_males_and_their_families.aspx

http://www.milwaukeebd.com/images/milwaukeebdcom/bizcategories/1535/BrochureAndPhotos/98/Klinefelter_Brochure_.pdf

http://www.mayoclinic.com/health/klinefelter-syndrome/DS01057/DSECTION=complications

http://my.clevelandclinic.org/PublishingImages/HIC/klinefelter%20xy%20nih.gif

http://www.aafp.org/afp/2005/1201/p2259.html

Effects of Low Levels of Iron on Aerobic Activity

Aerobic exercise, because of its reliability on oxygen delivery to working and active muscles, can be negatively affected by a low level of iron in the body. Decreased oxygen to skeletal muscles during activity will cause pyruvic acid to be converted to lactic acid as opposed to sending it through aerobic respiration to produce larger amounts of ATP.

Some of the key symptoms that will be present if you are suffering from iron deficiency are fatigue, headache, weakness, irritability, pale skin color, or an increased heart rate. This list is not all inconclusive, and hemoglobin and hematocrit levels should be tested to determine if iron deficiency is present.

There are a few ways that iron can be lost during exercise. The first is a shortage in hemoglobin due to an iron deficiency. Iron is a key component of hemoglobin, which consists of four globins that are each attached to one heme group. Each heme group binds oxygen to a ferrous ion (Fe²⁺) that sits at its center. One heme group has the ability to attach one oxygen molecule to it, so the entire hemoglobin molecule can attach a total of four oxygen molecules. Low levels of hemoglobin due to an iron deficiency therefore reduce the amount of oxygen that is delivered to skeletal muscles during aerobic activity. Another way that iron can be lost during exercise is through an incidence called “foot strike hemolysis”. Foot strike hemolysis is the destruction of red blood cells in the feet due to constant impact during running. Other common ways that athletes can have a decrease of iron in their blood is through a decreased ingestion of iron, sweating, a decreased absorption of iron in the small intestine, and through the use of aspirin and other anti-inflammatory drugs which reduce your body’s ability to absorb iron. Females have an added complication, as they can also lose greater amounts of iron through menstruation.

However it may happen, low amounts of iron will continue to hurt athletic performance if something isn’t done that allows these athletes to consume greater amounts of iron. The most sensible way to accomplish this would be to increase the amount of iron that an athlete includes in their diet. Lean red meats, dark green leafy vegetables, eggs, and nuts are all foods that are naturally rich in iron. Vitamin C also helps to make iron more absorbable, so increasing your intake of foods that are rich in Vitamin C will help to positively affect iron levels. Consuming tannins, which are present in coffee and tea, along with consuming large amounts of calcium can all negatively affect iron absorption and are not recommended to be consumed simultaneously with iron.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001610/

http://ods.od.nih.gov/factsheets/iron/#h3

http://www.anemia.org/patients/feature-articles/content.php?contentid=000244&sectionid=00015

http://www.healthline.com/hlbook/nut-distance-running

Erectile Dysfunction and Low Testosterone Levels Linked to Death by Major Cariovascular Events?

As if having erectile dysfunction isn’t bad enough, researchers have found that many men with erectile dysfunction and low testosterone levels have an increased chance of dying of a major cardiovascular event. First it is important to understand what erectile dysfunction is.

Erectile dysfunction is a male’s repeated inability to have or sustain an erection. An erection occurs due to the filling of the corpora cavernosa of the penis with blood. The corpora cavernosa is a chamber of the penis made up of spongy tissue. After the mind is stimulated and sends a signal to the local nerves causing the muscles of this chamber to relax, blood begins to flow into the spongy tissue. The increased blood flow will create pressure that causes the penis to expand. A membrane called the tunica albuginea traps the blood in the spongy tissue of the chamber. This helps sustain the erection.

The components of the penis involved in an erection are shown in the figure to the right. When the muscles contract again, the blood flow is stopped allowing the erection to be reversed. If a problem occurs in any of the steps leading to an erection, the erecting may not occur or might not be sustainable.

Now how does testosterone affect an erection, or contribute to erectile dysfunction disorder? Testosterone actually does not directly affect an erection. It has an indirect affect because it helps stimulate a male’s sexual interest. Without the testosterone fueling a man’s sexual interest, the stimulation for an erection may not happen or may not be enough for a strong erection could occur.

5% of men who have erectile dysfunction have been diagnosed with low levels of testosterone. This small portion of men were also found to have a higher rate of mortality caused by a major cardiac event. Neither the low testosterone, or erectile dysfunction were directly connected to the cardiac event, however, the men with the lowest testosterone levels were found to have a statistically significantly higher rate of mortality than the men with normal or higher testosterone levels (the reason for this is still to be determined). The information leading to this conclusion came from a study which was conducted on 1687 subjects with erectile dysfunction. 137 of the patients had a major cardiac event within 4.3 years, and 15 of them died.

The researchers hope to conduct another study with more test subjects to help further solidify their hypothesis that men with erectile dysfunction coupled with low testosterone have a greater chance of dying due to a major cardiac event. However, this hypothesis was proven with the sample size used.

Sources:
http://www.sciencedaily.com/releases/2010/04/100426181612.htm
http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/
http://www.whitelotuseast.com/Erection.htm

Can ghrelin levels and leptin levels reduce your weight without exercise?

So constantly I argue with my mother to work out if she wants to lose weight, and tell her that it’s the only way. Later she tells me that if she eats right she can still lose weight. Then echos of Dr. Vanata, my nutrition professor, saying Ghrelin over and over came into my mind. Ghrelin is a peptide hormone produced by the stomach that stimulates feeding which is sometimes called the hunger hormone. The levels of ghrelin rise prior to a meal and fall quickly after consumption of food. The rise in Ghrelin also stimulates the hormone Neuropeptide Y (NYP) which is a hormone like factor in the brain that powerfully stimulates appetite. Along with Ghrelin, Leptin also stimulates the NYP. Leptin is a hormone produced by adipose cells that signals the amount of body fat content that influences food intake. Opposing signals from ghrelin and leptin link to how much they both stimulate NYP which maintains weight in the body. So can Ghrelin and leptin be controlled in weight loss was my next question.

Based on a study in Washington University with thirteen obese subjects ghrelin was tested to see if it could be regulated with proper dieting. All subjects were at least 18 years old and had had stable body weight for at least three months. Criteria for exclusion included chronic medical or psychiatric illness, pregnancy, tobacco use, substance abuse, consumption of more than two alcoholic drinks per day, aerobic exercise for more than 30 minutes three times per week, and previous gastrointestinal surgery. In this study leptin, insulin, and ghrelin levels were measured to determine if their levels changed throughout the study. At the end of the study there was weight lost and it was associated with lower levels of leptin, insulin, blood pressure, and increase insulin sensitivity. Researchers did this by spanning meals within 4 to 5 hours of each other with low-fat, high-protein, liquid-formula diet of 1000 kcal per day, supplemented with daily multivitamins and minerals, for three months. Subjects then underwent a gradual transition over the course of two weeks to a solid diet containing fat, protein, and carbohydrates. Ghrelin levels rose after weight loss in this study and led to conclusions in how it operates in our metabolism. Exogenous ghrelin decreases the metabolic rate and increased ghrelin beyond what the body is regularly used to increases body weight. The study concluded plasma ghrelin levels rise with diet-induced weight loss and suggests that increased levels of circulating ghrelin may participate in the adaptive responses that constrain such weight loss.

http://www.ncbi.nlm.nih.gov/pubmed/12023994