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Newswise — Stony Brook, NY, Embargoed Until 1 PM, EST; December 16, 2015 – A team of researchers from Stony Brook University, led by Yusuf Hannun, MD, the Joel Strum Kenny Professor in Cancer Research and Director of the Stony Brook University Cancer Center, have found quantitative evidence proving that extrinsic risk factors, such as environmental exposures and behaviors weigh heavily on the development of a vast majority (approximately 70 to 90 percent) of cancers. The finding, reported in the December 16 online issue of Nature, in a paper titled “Substantial contribution of extrinsic risk factors to cancer development,” may be important for strategizing cancer prevention, research and public health. Inspired by a January 2015 research paper in Science, which concluded that the majority of the variation in cancer risk among tissues is due to “bad luck,” the Stony Brook team used the same data to assess what leads to the risk of developing cancer. The interdisciplinary team of researchers from the Departments of Applied Mathematics and Statistics, Medicine, Pathology and Biochemistry, concluded the opposite – that most cancers are the result of external risk factors. “Cancer is caused by mutations in the DNA of cells, which leads to uncontrolled cell growth instead of orderly growth. But the development of cancer is a complex issue, and we as a scientific community need to have solid analytical models to investigate what intrinsic and extrinsic factors cause certain forms of cancer,” said Dr. Hannun, senior author of the paper. “Many scientists argued against the ‘bad luck’ or ‘random mutation’ theory of cancer but provided no alternative analysis to quantify the contribution of external risk factors,” explained Song Wu, PhD, lead author of the paper, and Assistant Professor in the Department of Applied Mathematics and Statistics, Stony Brook University. “Our paper provides an alternative analysis by applying four distinct analytic approaches.” They developed four distinct approaches to assess cancer risk. With these four approaches, they discovered collectively and individually that most cancers are attributed largely to external risk factors, with only 10-to-30 percent attributed to random mutations, or intrinsic factors. First, the researchers examined extrinsic risks by tissue cell turnover. In a data-driven approach, they re-examined the quantitative relationship between observed lifetime risk of cancer (ie, for lung, pancreatic, colorectal and other tissues) and division of the normal tissue stem cells in those groups reported in the Science paper. If intrinsic risk factors played a major role, the tissue with the similar stem cell divisions would show similar observed lifetime cancer risk. They found this pattern to be a rare one, and thus determined intrinsic factors played a vital role in only about 10 percent of cancers. These results are supported by strong epidemiologic evidence; for example studies showing that immigrants moving from countries with lower cancer incidence to countries with higher rates of cancer incidence acquire the higher risk in their new country. The researchers also mathematically surveyed and analyzed recent studies on mutational signatures in cancer, which are regarded as “fingerprints” left on cancer genomes by different mutagenic processes. Some 30 distinct signatures among various cancers were identified. They analyzed the signatures and categorized them as having intrinsic or extrinsic origins. They found that while a few forms of cancer had a greater than 50 percent of intrinsic mutations, the majority of cancers, such as colorectal, lung, bladder and thyroid cancers had large proportions of mutations likely caused by extrinsic factors. The team also analyzed the SEER (Surveillance, Epidemiologic and End Results Program) data, which showed that many cancers have been increasing in incidence and in mortality, suggesting that external factors contribute heavily to these cancers. Lastly, they used computational modeling to dissect the contribution of the intrinsic processes in the development of cancer, based on known gene mutations in cancer and the likelihood that they arise from intrinsic mutation rates. They found that when three or more mutations are required for cancer onset (which is a currently accepted parameter), intrinsic factors are far from sufficient to account for the observed risks, indicating small percentages of intrinsic cancer risks in many cancers. The four methods involved both data- and model-driven quantitative analyses, with and without using the stem cell estimations. The idea behind the overall approach was to assess cancer risk by multiple methods and not by a single type of analysis. Dr. Hannun concluded that their overall approach “provides a new framework to quantify the lifetime cancer risks from both intrinsic and extrinsic factors, which will have important consequences for strategizing cancer prevention, research and public health.” Co-authors of the paper include: Scott Powers of the Department of Pathology at Stony Brook University, and Wei Zhu, of the Department of Applied Mathematics and Statistics at Stony Brook University. All of the authors are collaborating investigators at the Stony Brook University Cancer Center. ###About Stony Brook University Part of the State University of New York system, Stony Brook University encompasses 200 buildings on 1,450 acres. Since welcoming its first incoming class in 1957, the University has grown tremendously, now with more than 25,000 students and 2,500 faculty. Its membership in the prestigious Association of American Universities (AAU) places Stony Brook among the top 62 research institutions in North America. U.S. News & World Report ranks Stony Brook among the top 100 universities in the nation and top 40 public universities, and Kiplinger names it one of the 35 best values in public colleges. One of four University Center campuses in the SUNY system, Stony Brook co-manages Brookhaven National Laboratory, putting it in an elite group of universities that run federal research and development laboratories. A global ranking by U.S. News & World Report places Stony Brook in the top 1 percent of institutions worldwide. It is one of only 10 universities nationwide recognized by the National Science Foundation for combining research with undergraduate education. As the largest single-site employer on Long Island, Stony Brook is a driving force of the regional economy, with an annual economic impact of $4.65 billion, generating nearly 60,000 jobs, and accounts for nearly 4 percent of all economic activity in Nassau and Suffolk counties, and roughly 7.5 percent of total jobs in Suffolk County. Greg FilianoMedia Relations ManagerSchool of MedicineStony Brook UniversityOffice of Communications and Marketing631-444-9343Gregory.filiano@stonybrookmedicine.edu

Newswise — Women with apple-shaped bodies – those who store more of their fat in their trunk and abdominal regions – may be at particular risk for the development of eating episodes during which they experience a sense of “loss of control,” according to a new study from Drexel University. The study also found that women with greater fat stores in their midsections reported being less satisfied with their bodies, which may contribute to loss-of-control eating. This study marks the first investigation of the connections between fat distribution, body image disturbance and the development of disordered eating. “Eating disorders that are detected early are much more likely to be successfully treated. Although existing eating disorder risk models comprehensively address psychological factors, we know of very few biologically-based factors that help us predict who may be more likely to develop eating disorder behaviors,” said lead author Laura Berner, PhD, who completed the research while pursuing a doctoral degree at Drexel. “Our preliminary findings reveal that centralized fat distribution may be an important risk factor for the development of eating disturbance, specifically for loss-of-control eating,” said Berner. “This suggests that targeting individuals who store more of their fat in the midsection and adapting psychological interventions to focus specifically on body fat distribution could be beneficial for preventing eating disorders. The study, titled “Examination of Central Body Fat Deposition as a Risk Factor for Loss-of-Control Eating,” was published in the American Journal of Clinical Nutrition. Berner is now a postdoctoral research fellow at the Eating Disorders Center for Treatment and Research at UC San Diego Health. Michael R. Lowe, PhD, a professor in Drexel’s College of Arts and Sciences, was a co-author, along with Danielle Arigo, PhD, who was a postdoctoral research fellow at Drexel and is now an assistant professor of psychology at the University of Scranton; Laurel Mayer, MD, associate professor of clinical psychiatry at the Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute,; and David B. Sarwer, PhD, professor of psychology in Psychiatry and Surgery at the Perelman School of Medicine at the University of Pennsylvania as well as director of clinical services at the Center for Weight and Eating Disorders. Mounting evidence suggests that experiencing a sense of loss-of-control during eating – feeling driven or compelled to keep eating or that stopping once one has started is difficult – is the most significant element of binge-eating episodes regardless of how much food is consumed, according to the researchers. “This sense of loss of control is experienced across a range of eating disorder diagnoses: bulimia nervosa, binge eating disorder and the binge-eating/purging subtype of anorexia nervosa,” said Berner. “We wanted to see if a measurable biological characteristic could help predict who goes on to develop this feeling, as research shows that individuals who feel this sense of loss of control over eating but don’t yet have an eating disorder are more likely to develop one.” “This sense of loss of control is experienced across a range of eating disorder diagnoses: bulimia nervosa, binge eating disorder and the binge-eating/purging subtype of anorexia nervosa,” said Berner. “We wanted to see if a measurable biological characteristic could help predict who goes on to develop this feeling, as research shows that individuals who feel this sense of loss of control over eating but don’t yet have an eating disorder are more likely to develop one." Using a large dataset that followed female college freshman for two years, the researchers preliminarily investigated whether body fat distribution is linked to body dissatisfaction over time and increases risk for the development or worsening of loss-of-control eating. The nearly 300 young adult women completed assessments at baseline, six months and 24 months, that looked at height, weight and total body fat percentage and where it’s distributed. Participants, none of whom met the diagnostic criteria for eating disorders at the start of the study, were assessed for disordered eating behaviors through standardized clinical interviews in which experiences of sense of loss of control were self-reported. In this sample, the researchers found that women with greater central fat stores, independent of total body mass and depression levels, were more likely to develop loss-of-control eating and demonstrated steadier increases in loss-of-control eating episode frequency over time. Women with a larger percentage of their body fat stored in the trunk region were also less satisfied with their bodies, regardless of their total weight or depression level. The findings indicate that storage of body fat in trunk and abdominal regions, rather than elsewhere in the body, is more strongly predictive of loss-of-control eating development and worsening over time, and that larger percentages of fat stored in these central regions and body dissatisfaction may serve as maintenance or exacerbation for loss-of-control eating. “Our results suggest that centralized fat deposition increased disordered eating risk above and beyond other known risk factors,” said Berner. “The specificity of our findings to centralized fat deposition was also surprising. For example, a one-unit increase in the percentage of body fat stored in the abdominal region was associated with a 53 percent increase in the risk of developing loss-of-control eating over the next two years, whereas total percentage body fat did not predict loss-of-control eating development.” According to Berner, more research is needed to explain the mechanism behind these findings, though she speculates that there are a number of reasons why this might happen. “It’s possible that this kind of fat distribution is not only psychologically distressing, but biologically influential through, for example, alterations in hunger and satiety signaling,” she said. “Fat cells release signals to the brain that influence how hungry or satiated we feel. Our study didn’t include hormone assays, so we can’t know for sure, but in theory it’s possible that if a centralized distribution of fat alters the hunger and satiety messages it sends, it could make a person feel out of control while eating.” The findings may apply to other disordered eating behaviors beyond loss-of-control eating, but more research is needed. “Body fat distribution hasn’t been studied in disorders characterized by binge-eating behaviors as much as it has in anorexia nervosa,” said Berner. “The participants in our sample didn’t develop eating disorder diagnoses within the two year period that we studied them, but this study suggests that future research should investigate whether individuals with greater central fat stores are more likely to develop bulimia nervosa and binge eating disorder."

Newswise — ANN ARBOR, Mich. — If you don’t have health insurance, or your insurance coverage still leaves you with big bills, hospitals are supposed to let you know if you qualify for free or reduced-price care, and to charge you fairly even if you don’t. That is, if they want to keep their tax-free nonprofit status under the Affordable Care Act’s new Section 501(r) rules. But a new study from the University of Michigan Institute for Healthcare Policy and Innovation finds many nonprofit hospitals have room to improve. Writing in the October 29 issue of the New England Journal of Medicine, the researchers report results from their review of Internal Revenue Service forms submitted by more than 1,800 nonprofit hospitals nationally. They looked at records for 2012, the first year hospitals had to comply with the ACA’s requirements and the most recent year for which data were available. A mixed bag of findings IHPI post-doctoral fellow Sayeh Nikpay, Ph.D., MPH and IHPI director John Z. Ayanian, M.D., MPP, call hospitals’ performance “far from perfect”. Their key findings: • Nearly all (94 percent) of the hospitals reported having a written charity care and emergency care policies, to guide them on deciding which patients could get free or reduced-price care. Though the ACA doesn’t tell hospitals which patients to offer discounts to, or how generous to be, it does say they must have such policies and make them known. • Only 29 percent of the hospitals reported they had begun charging uninsured and under-insured patients the same rate that they charged private insurers or Medicare. Such rates are often far lower than the “chargemaster” rates hospitals set as the starting point for negotiating with insurers about how much they will actually accept. • Only 42 percent of the hospitals reported they were notifying patients about their potential eligibility for charity care before attempting to collect unpaid medical bills. The ACA requires such notifications to give patients a chance to apply to get some or all of their costs written off. • One in five hospitals had not yet stopped using extraordinary debt-collection steps when patients failed to pay their medical bills. Such steps, such as reporting patients to credit agencies in ways that can damage their credit scores, placing liens on their property or garnishing their wages, are now banned. • Hospitals in states that have not expanded Medicaid reported having less generous charity care policies, and were less likely to have a policy about notifying patients of charity care options before they left the hospital. In general, patients have to be poorer to get free or discounted care in these states than in states that have expanded Medicaid. • Only 11 percent of hospitals reported having conducted a community health needs assessment in the past three years as of 2012. Such assessments, to identify pressing health issues in the population they serve, don’t necessarily affect charity care. Playing by the rules? Nonprofit hospitals are exempt from paying most taxes, which was valued at $24.6 billion in 2011. In return, they must justify their nonprofit status to the IRS each year by showing how much care they write off for those who cannot pay. When Congress wrote the ACA, they sought to use the tax tools available to them to reduce hospitals’ use of aggressive methods to pursue payment, and perhaps to prevent individual bankruptcies or credit score damage caused by medical bills. Though hospitals had to report for tax year 2012, the federal government did not issue final language about exactly how to comply and penalties for non-compliance until 2014. Nikpay and Ayanian will continue to study the issue as new IRS data become available. They are already working on 2013 data. “Hospitals are generally complying with the part of the rules that require they establish charity care policies and publicize them, but this may not impact the amount of charity care they provide,” says Nikpay, who is also a visiting scholar at the University of California, Berkeley. “So far, it appears many aren’t complying with the part of the rules that could increase their charity care.” Ayanian, a professor at the U-M Medical School with joint appointments in public policy and public health, says physicians and patients should familiarize themselves with policies at their hospitals. “Financial protection for patients is an under-recognized component of the ACA, and it’s important that hospitals are required to have policies, that they disclose these policies, and that they enable people to apply for help in a timely way,” he says. “This will be most important for patients living in states that have not expanded Medicaid to cover people with lower incomes. Hospitals in those states will likely experience additional demand for charity care because they now need to publicize their charity care policies and comply with other IRS provisions.” With these added requirements, hospitals may start to pull back on how generous they make their charity care policies – and Section 501(r) of the ACA does not set standards for that, Nikpay notes. As more Americans enroll in insurance plans that have high deductibles, they may find they need to ask for financial relief after a hospital stay. Even a single person earning $40,000 a year, or a family of four with an income of $80,000, might qualify for discounted care from many hospitals. Reference: New England Journal of Medicine, DOI: 10.1056/NEJMp1508605

Newswise — Women need to maintain good health years before they become pregnant. After all, healthy women are most likely to give birth to healthy babies. A web-based app, www.healthymomshra.com, can now help women gauge the level of their health and learn what changes they can make to enhance not only their own wellbeing, but also the health of any babies born to them in the future. “Our goal with the app is to encourage good health practices in women so they will be healthy for pregnancies, planned or unplanned,” said Adam T. Perzynski, PhD (Twitter: @ATPerzynski), director of the Patient Centered Medical Lab, and a sociologist with the Case Western Reserve University School of Medicine and MetroHealth Center for Health Care Research and Policy team, that developed the Healthy Moms Health Risk Assessment prototype at www.healthymomshra.com. Much infant mortality can be traced to low birth weight or early gestational birth age of newborns, which is often related to the poor health of the mother. The developers of the web-based app sought to help women reverse the major risk factors that negatively affect them in the categories of health habits, social support, driving safety, substance use, tobacco use, mental health, physical health, environmental risks, ethnicity, age and neighborhood of residence. The online Healthy Moms Health Risk Assessment features a user-friendly test where each question, regardless of a yes or no answer, is greeted with encouraging, helpful tips across the categories of health risks. All answers are based on Centers for Disease Control and Prevention (CDC) guidelines firmly grounded in scientific evidence. The test concludes with a report of the woman’s individual health risk in the categories. The report is color coded from green to red, so the more green the report, the better the test-taker’s health. “The main difference with this app is that it focuses on the preconception phase rather than exclusively on pregnant women,” Perzynski said. “Up to 50 percent of pregnancies are unplanned, so it’s important that a woman engage in healthy behaviors to prepare for the fact that she might become pregnant at some point.” Armed with latest wellness information from CDC for women, the Case Western Reserve team used flexible and scalable cloud-based computing environment to develop an app that would provide immediate, useful answers and offer a summary scorecard. The Healthy Moms Health Risk Assessment app was so impressive that it won an honorable mention at the recent Cleveland Medical Hackathon competition where the Case Western Reserve team vied with other teams to develop the best innovation to address an unmet health care need. “In many cases, mothers have health issues before they become pregnant, and those health issues can be challenging to resolve once they are pregnant,” Perzynski said. “We tailored our app to help women consider how health behaviors, activities and social circumstances might affect the health of a baby should a pregnancy happen, with the goal of empowering women to make healthy choices.”

Newswise — A new study in mice by researchers at Fred Hutchinson Cancer Research Center has found that a specialized type of immunotherapy — even when used without chemotherapy or radiation — can boost survival from pancreatic cancer, a nearly almost-lethal disease, by more than 75 percent. The findings are so promising, human clinical trials are planned within the next year. The study, led by Drs. Sunil Hingorani and Phil Greenberg, both members of the Clinical Research Division at Fred Hutch, tested the immunotherapy on mice genetically engineered to grow pancreatic tumors very similar to those of human pancreatic cancer. The mouse model, developed by Hingorani, already has led to a first-in-humans clinical trial that is showing early promise in some patients with advanced pancreatic cancer. Pancreatic cancer is notoriously difficult to treat, said Hingorani, because it recruits the body’s natural systems to construct both a tough physical barrier around tumors as well as an immune-cloaking device that keeps other, disease-fighting immune cells from recognizing the cancer. Unlike any other cancer, pancreatic tumors are able to survive with a significantly decreased blood supply. As a consequence, chemotherapy, commonly administered via the bloodstream, has a difficult time getting inside. The tumors not only commonly grow quite large before patients will ever notice something is wrong, but they are very prone to metastasize, or spread to other sites in the body. The investigators’ new study, published Thursday in Cancer Cell, breaches pancreatic cancer’s physical and immunological walls by using immunotherapy, a type of treatment that harnesses or refines the body’s own immune system, to recognize and destroy cancer cells. The researchers devised a therapy using T cells, disease-fighting immune cells, that they engineered in the lab to recognize and attack pancreatic cancer. T-cell therapy is showing promise as a treatment for several types of blood cancers, based on early results from Fred Hutch and other research centers, but aiming these cells at solid tumors like pancreatic cancer has historically proven more difficult, Hingorani said. Part of the challenge comes from the access to tumor cells — or lack thereof. T-cell therapy is administered through the bloodstream, like chemo. It’s easy enough to see why solid tumors may present more of a challenge to treat with this kind of immunotherapy than blood cancers such as leukemia and lymphoma. The researchers didn’t think the engineered T cells would stand a chance against pancreatic cancer on their own. But they needed somewhere to start, Greenberg said. But to their surprise, the T cells — engineered to recognize and kill cells bearing a protein called mesothelin, which is overproduced by virtually all pancreatic tumors — got into the mice’s tumors and started attacking them. In the mouse model of the disease — which is actually slightly more aggressive than the human version, Hingorani said — animals that received T cells engineered to recognize a non-cancerous protein survived on average 54 days after their cancer became detectable. Those that received the mesothelin-directed cells lived an average of 96 days, a 78 percent bump. Although the researchers weren’t expecting to take this first version of the T-cell therapy to clinic, that’s now their plan. Their team has already built the human version of the special T-cell protein that recognizes mesothelin. They’re planning to launch a phase 1 clinical trial to test the therapy’s safety in patients with advanced pancreatic cancer within the next year. “As best we can tell, this would be a better therapy than anything that exists for pancreatic cancer right now,” Greenberg said. “It’s hard to be this optimistic without ever having treated a pancreatic cancer patient with this [therapy], but the biology of what we’re doing looks so remarkably true and good.” The study was funded in part by the National Institutes of Health, the Giles W. and Elise G. Mead Foundation and Juno Therapeutics.

Newswise — A federally funded analysis of MRI scans of the aging hearts of nearly 3,000 adults shows significant differences in the way male and female hearts change over time. Results of the research, led by investigators at Johns Hopkins, do not explain exactly what causes the sex-based differences but they may shed light on different forms of heart failure seen in men and women that may require the development of gender-specific treatments, the scientists say. “Our results are a striking demonstration of the concept that heart disease may have different pathophysiology in men and women and of the need for tailored treatments that address such important biologic differences,” says senior study author João Lima, M.D., M.B.A., a professor of medicine and radiological science at the Johns Hopkins University School of Medicine and director of cardiovascular imaging at its Heart and Vascular Institute. The research, published online Oct. 20 in the journal Radiology, is believed to be the first long-term follow-up using MRI showing how hearts change as they age. Previous studies have assessed heart changes over time using ultrasound, but, the researchers say, MRI scans tend to provide more detailed images — and more reliable information — about the structure and function of the heart muscle. In both sexes, the main heart chamber, the left ventricle — which fills with and then forces out blood — gets smaller with time. As a result, less blood enters the heart and less gets pumped out to the rest of the body. But in men, the study reveals, the heart muscle that encircles the chamber grows bigger and thicker with age, while in women, it get retains its size or gets somewhat smaller. “Thicker heart muscle and smaller heart chamber volume both portend heightened risk of age-related heart failure but the gender variations we observed mean men and women may develop the disease for different reasons,” says lead investigator John Eng, M.D., associate professor of radiological science at the Johns Hopkins University School of Medicine. A condition that affects more than five million Americans, heart failure is marked by the gradual “floppiness” and weakening of the heart muscle and eventual loss of pumping ability. To lower the risk, cardiologists often prescribe medications designed to reduce the thickness of the heart muscle over time and boost cardiovascular performance. But the finding that in women, the heart muscle tends to shrink or remain the same size means they may not derive the same benefit from such treatments, researchers say. The research team cautions that its study was not designed to find what exactly fuels the differences in cardiac physiology between the sexes but says this “fascinating discrepancy” demands further investigation to figure it out. For the study, researchers analyzed MRI scans performed on nearly 3,000 older adults, ages 54 to 94, without preexisting heart disease. Participants were followed between 2002 and 2012, at six hospitals across the United States where each one of them underwent MRI testing at the beginning of the study and once more after a decade. The MRI scans provided researchers with 3-D images of the heart’s interior and exterior, allowing them to determine the size and volume of the heart muscle. Adding these to the already known density of the muscle, they were able to calculate its weight. Over a period of 10 years, the weight of the heart’s main pumping chamber — the left ventricle — increased by an average of 8 grams in men and decreased by 1.6 grams in women. The heart’s filling capacity — marked by the amount of blood the left ventricle can holds between heartbeats — declined in both sexes but more precipitously so in women, by about 13 milliliters, compared with just under 10 milliliters in men. The differences in size, volume and pumping ability occurred independently of other risk factors known to affect heart muscle size and performance, including body weight, blood pressure, cholesterol levels, exercise levels and smoking. The study is part of an ongoing, long-term project called the Multi-Ethnic Study of Atherosclerosis (MESA), which is following nearly 7,000 men and women of different ethnic backgrounds across the country. The study was designed to enroll adults with no symptoms of heart disease to determine who develops heart disease or heart failure, what factors precipitate the disease and who is more likely to die from it. Other institutions involved in the study include the University of Washington; the University of California, Los Angeles; Wake Forest Baptist Medical Center; Brigham and Women’s Hospital; the National Heart, Lung, and Blood Institute; Vanderbilt University; and Columbia University. The research was funded by the National Heart, Lung, and Blood Institute under grants N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169, and by the National Center for Research Resources under grants UL1-TR-000040 and UL1-RR-025005. Fast facts: --Men’s and women’s hearts don’t grow old the same way. --Aging hearts: Gender matters. --Gender differences in heart aging may underlie sex differences observed in heart failure. --Research points to need for gender-tailored treatments for age-related heart failure.

Newswise — ST. LOUIS -- Note to Mimi, Didi, Gigi, G-Ma and the rest of the gang who have swapped out your own pet names for Grandma: Being a grandparent is good for your health. So says Angela Sanford, M.D., assistant professor of geriatrics at Saint Louis University. “You can’t be unhappy around little kids. They’re mood lifters,” says the SLUCare geriatrician and mother of three children, ages 1, 2 and 3. “Little ones typically adore and look up to their grandparents, which is great for your sense of self-worth and self-esteem. By spending time with them, you know you’re helping them to become better people, which in turn helps you feel like you’re making a huge contribution to the world.” As boomers become grandparents, they’re redefining the role the same way they’ve redefined their roles since they were young. They’re embracing their change in family status with the type of enthusiasm they demonstrate when the next generation of the iPhone comes out, except amplified exponentially to the levels of a Led Zeppelin concert. And the good news is beyond the feel-good Hallmark moments that abound in simply being a grandparent, specific activities most grandparents enjoy with their grandchildren are actually good for them. Physical play: When you are active with your grandchild – playing tag, pushing a swing, walking around the zoo or wrestling on the living room floor – you are exercising, which is a key contributor to good health, Sanford says. “Exercise reduces your risk of falling, which is a really big deal. About 20 percent of the time falls cause serious injuries like broken bones that can undermine your ability to function independently,” she says. “You also tend not to focus on your aches and pains if you are active. But beyond the physical strength, agility and balance that you gain by being active, exercise improves your mood and is important for brain health. It gets the blood pumping to your brain and can prevent or slow the progression of dementia.” Cooking: Generally you eat healthier when you cook because you may be more likely to prepare whole foods (those located around the perimeter of a supermarket) instead of turning to quick, ready-to-eat processed foods. Measuring ingredients, stirring, chopping and pouring strengthen a variety of fine motor skills, which helps with arthritis or tremors, Sanford says. Sharing your own grandmother’s recipes with your grandchildren passes along a family legacy, and frequently the stories and family lore that go with it. This reminiscence strengthens cognition and is good for memory. But perhaps the most important part of cooking is what follows –- eating, Sanford says, because malnutrition in older adults is a huge problem. “A lot of older people simply don’t eat because they don’t have anyone to eat with,” Sanford says. “Enjoying a meal is a social activity, and sharing food and conversation makes eating a pleasant experience that we anticipate rather than something we have to do simply to survive.” Playing games and putting together puzzles: Games – cards, chess, matching, “I Spy,” trivia and video games – not only are fun, they’re also good for your memory, may stimulate visual-spatial skills and make you think in other ways – all great exercises for brain health. “Depending on what is involved with the game or if you add conversation to the mix, you improve your ability to multi-task, which can decline with aging,” Sanford says. Being generally busy: Let’s face it, kids get bored easily, so most grandparents mix it up when they’re spending time with a grandchild. They might read a book, listen to music, prepare a snack together, go on a walk, build a fort, play tag, watch a TV show and put together a puzzle. Tiring? Maybe, but it beats the alternative. “Activity triggers a whole cycle of well-being,” Sanford says. “It helps you eat, sleep and even digest food better -– which are problems many older adults have. And when you’re busy, you’re not sitting in a chair, thinking about the arthritis in your knees. You’re up and moving and sometimes you forget about the pain. Your whole body feels like it is working better.” Taking a nap: OK, you’ve got legitimate permission not to feel lazy when you join the young and restless by catching a few Z’s at naptime. “A short power nap of about 20 minutes can make you feel more alert and give you the extra energy to enjoy your day,” Sanford says. “Many executives close their doors for a little snooze to regenerate. The key is to not let yourself sleep for so long that you are too rested to go to bed at night.” Staying flexible: You had planned to go to the library, but your granddaughter would rather dig for worms in the backyard. You had all of the ingredients to bake chocolate chip cookies, but your grandsonhad his heart set on walking to the ice cream store instead. Sometimes you scuttle your plans, shift gears and move onto something else, which prepares you to be more flexible and resilient. That practice can serve you well whether you are dealing with a significant change, such as the loss of a loved one, or something much smaller, like your favorite waitress not working when you show up at a restaurant for dinner. “With kids, you have to go with the flow and be adaptable. It’s never about you and is always about them,” Sanford says. “But it’s great to have that variety of experiences, and being flexible is good for you. It helps you handle life’s highs and lows much better, so when things go wrong, you’re better able to adapt.” Saying prayers: When we pray, we stop and reflect on our blessings, which shifts our perspective from what we don’t have to what we do. Prayer and meditation helps us cope better with adversity. In addition, the act of slowing down to contemplate something bigger than ourselves is relaxing – slowing the heart rate, dropping blood pressure and making our breathing more constant – which can bring a feeling of peaceful tranquility. “When my children’s great grandfather, who is 90, visits every week, he prays with the kids,” Sanford says. “In addition to doing something that is meaningful for him and good for his health, he’s passing on to that generation the comfort that a religious belief can bring, a source of strength in times of trouble. When he talks to them about prayer, he feels as though he is doing his job in passing along important values.” For many grandparents, caring for their grandchildren offers the pleasures of being a parent without the pain. It reminds them of what they loved about a wonderful time of their life, when they were raising children, without having to be a disciplinarian or do other difficult jobs that come with parenting.   For others, being a grandparent gives them a chance to be more involved than they were with their own kids, especially if they were the breadwinner. And, of course, there is an endpoint. Typically, grandchildren go home. “Being a grandparent turns your focus outward. If you’re taking care of a little one, there’s no time for a pity party,” Sanford says. “But perhaps most important, being a grandparent lets you leave a legacy. Most of us aren’t going to be famous. But if you can make an imprint on those closest to us, when you’ve touched those around you in a profound way, that is what counts.” Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: infectious disease, liver disease, cancer, heart/lung disease, and aging and brain disorders.

Newswise — In their quest for healthy eating, many Americans are turning to restrictive diets – from vegan to Paleo to low-carb – that they believe are the most “pure” or beneficial. But when people decide to go beyond these and severely limit the types of foods they consume, they could be putting themselves at risk for nutritional deficiencies. People who obsessively refine and restrict their diet to conform to their ideal of what is healthy could be suffering from orthorexia nervosa – which translates from Greek as “correct appetite.” Although not an officially recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), orthorexia can be likened to clinically defined eating disorders, such as anorexia nervosa, says Charlotte Markey, a Rutgers University–Camden psychologist who teaches a course titled “The Psychology of Eating” and studies eating behaviors, body image and weight management. She is the author of Smart People Don’t Diet: How the Latest Science Can Help You Lose Weight Permanently. Rutgers Today spoke with Markey about this condition, how to identify it and how it is best treated. Rutgers Today: What is orthorexia? Markey: Orthorexia is a form of maladaptive eating that can begin with good intentions: People start eliminating foods they consider “impure” or “bad” – sweets, sugars, carbohydrates – and before they know it, they are eating a highly limited diet. They think there is room for improvement and that they can always eat “healthier.” They cut out sugar, then salt, then wheat, then dairy, and so on. They become obsessed with what they should not be eating and keep whittling down the foods they will allow – which often impacts them socially since food is such a part of our social experiences. Since they think they are doing the “right” thing, they don’t question that there might be a negative impact to their health. Rutgers Today: What are the dangers of orthorexia? Markey: What people don’t realize is that many of those foods they are restricting, like carbohydrates, which are an important source of energy, really do serve a function. When diets become so restrictive, more than nutritional deficiencies can result: Orthorexics also can experience low energy and are at risk for depression. In severe cases, orthorexia eventually leads to malnourishment when critical nutrients are eliminated from the diet. Rutgers Today: Can orthorexia be linked to other disorders clinically defined by the DSM-5? Markey: In the past edition of the DSM, there was a category called “Eating Disorders Not Otherwise Specified.” This classification would likely include people, like orthorexics, who are obsessed with food and how they eat. Anorexia nervosa can be similar psychologically to orthorexia in the respect that they are both a restrictive obsession when it comes to food – it’s just that orthorexics are more concerned with the quality of food rather than quantity. Anorexics eat far fewer calories than orthorexics, who oftentimes look “normal” in terms of weight. Rutgers Today: How can people tell if they or someone they love is orthorexic? Markey: The nutritional effects of this extreme dieting are not often obvious, but behavioral changes can be a red flag. What differentiates orthorexics from people who, say, avoid GMOs, are vegan or consume only organic foods, is that the quest for a healthy diet takes over their lives. They spend an inordinate amount of time thinking about food or they avoid social situations so as not to be tempted to eat the foods they are restricting. It’s time to be concerned when someone’s life is being negatively affected or there is evidence of the person being distraught. Rutgers Today: How is orthorexia treated? Markey: I advise a two-pronged approach to treatment. A registered dietitian can assess whether a person is being deprived of key nutrients and, if so, help him or her structure a diet that is more rounded. The person should also find a counselor who specializes in eating disorders. Often, when people engage in negative eating patterns there is an underlying mental health issue. Maladaptive eating behaviors can be linked with depression, addictions and even anxiety disorders such as obsessive compulsive disorder, which can be treated successfully with both medication and cognitive-behavioral therapy. While we want people to eat healthily, we don’t want any eating pattern to become such an obsession that it detracts from their psychological, and even physical, health. For more information or to interview Charlotte Markey, contact Patti Verbanas at 848-932-0551 orpatti.verbanas@rutgers.edu

Newswise — There are two common approaches to protecting humans from infectious disease: Targeting pathogens and parasites with medicines like antibiotics, or dealing with the conditions that allow transmission. A paper published today in the journal Nature Scientific Reports demonstrates the effectiveness of a third strategy: Adjusting the landscape of the human body to remove the mechanism that allows pathogens to cause disease. The discovery is the result of serendipity and collaboration between high-level scientists in different fields. "It was pure luck that I ended up on this paper," says Dan Theodorescu, MD, PhD, director of the University of Colorado Cancer Center. "Bill Petri and I had been social friends for years – Christmas parties, that kind of thing. When I was at Virginia it happened that we were on a recruitment committee together and the candidate was late, so we started talking." His conversation with William A. Petri, Jr., MD, PhD, chief of the Division of Infectious Diseases & International Health at the University of Virginia led to the idea of applying an innovative cancer science technique to the study of infectious disease. With first author Chelsea Marie, PhD, postdoctoral researcher in the Petri Laboratory at Virginia, the group decided to silence genes in human cells to discover if the loss of any single gene would confer immunity to the parasite E. histolytica, which infects 50 million people and causes 40,000-110,000 deaths via severe diarrhea worldwide. "Chelsea is a fearless experimenter. She took a library of cells that Dan had developed in his work with bladder cancer and then sequentially killed them with E. histolytica parasites," Petri says. Specifically, the group used the technique called RNAi to create a library of bladder cancer cells with thousands of independent, silenced genes. Then they challenged these cultures with the parasite E. histolytica. "We do this all the time in cancer research," Theodorescu says. "Commonly, we're looking for genes that, when silenced, will make cells more susceptible to chemotherapy." In this case the analogue of chemotherapy was the infectious, dangerous pathogen. "This amoeba is a cluster bomb – a voracious killer. In the back of my mind I was thinking the parasite was going to decimate the host cells no matter what we did with their genetics," Marie says. For the vast majority of cells in this genome-wide screen, Chelsea Marie was correct; E. histolytica decimated many thousands of these independent cell cultures. However, a small number of cells seemed to resist the parasite. Was this the random chance of lucky survival or had silenced genes somehow offered immunity to these cells? To find out, Marie discarded the killed cells and retested the cells that had survived; again she infected these survivor cells with E. histolytica. "It wasn't a fluke," says Marie. "We did this over nine generations of cells, each time selecting the cells that survived and then re-applying the parasite. Over these generations of selection, we saw the cultures becoming more and more enriched for cells lacking specific genes." Using next generation sequencing, Marie identified the genes that conferred resistance and found that many were involved in managing the flow of potassium into and out of human cells. Specifically, the identified genes KCNA3, KCNB2, KCNIP4, KCNJ3, and SLC24A3 are involved in what is called potassium transport. A follow-up experiment showed that new intestinal cells treated with E. histolytica showed potassium efflux – the flow of potassium from inside a cell out through the cell wall – directly before cell death. "We started to see a pretty clear line of reasoning," says Theodorescu. "The parasite was causing potassium efflux right before cell death and cells that happened to be unable to transport potassium didn't die." To ensure that lack of potassium transport was, in fact, causing resistance to the parasite, the group reversed the direction of their experiments. Marie started with new cells and used drugs to block their ability to transport potassium. Blocking potassium efflux created cells that were resistant to E. histolytica. "There is a clear need for new drugs targeting E. histolytica," Petri says. "Right now there is a single antibiotic that works against this parasite. We know that eventually the parasite will develop resistance to the antibiotic and at that point there's no plan B. This could be the plan B – targeting the human genes that enable the parasite to cause disease." Marie is pushing forward. She recently learned from a mentor at John's Hopkins how to isolate stem cells from human tissue to grow what she calls "mini guts" to test therapeutics that may be useful in human patients. And technological advances make this study's general technique more efficient, allowing the use of what are called CRISPR libraries instead of RNAi screens. "This is a major finding with translational implications for this infection that causes so many deaths worldwide, but also proof that this cancer-science approach can be used to explore genetic mechanisms of resistance in the field of infectious disease," Theodorescu says. The field of infectious disease has been focused on the infection, targeting pathogens and their transmission. This study shows that in addition to characteristics of the parasite, mortality due to disease can be prevented by manipulating characteristics of the host. 

Newswise — New Brunswick, N.J., September 8, 2015– Rutgers Cancer Institute of New Jersey is one of a few East Coast sites to offer a clinical trial investigating an experimental drug known as REGN1979 in the treatment of non-Hodgkin’s lymphoma (NHL) and chronic lymphocytic leukemia (CLL). The drug – designed to use the body’s own defenses to fight illness – targets a specific protein (called CD20) found in these particular types of cancer and targets another protein (called CD3) found on T-cells, a type of cell in the immune system. REGN1979 is designed to help T cells find and destroy B cells, including those cancerous B cells found in NHL and CLL. The goal is to determine how much of the drug can be given safely to patients who have the CD20 protein on their lymphoma or CLL cells. “By harnessing the body’s own natural defenses, there is an opportunity to provide alternate therapies for patients with NHL and CLL whose disease has stopped responding to standard treatments,” notes Rajat Bannerji, MD, PhD, medical oncologist and principal investigator of the trial at Rutgers Cancer Institute of New Jersey and associate professor of medicine at Rutgers Robert Wood Johnson Medical School. Participants are expected to be involved in the study for at least one year. Patients enrolled into the study will receive an infusion of the study drug through a vein. Participants also will be asked permission for scientists to study tissue samples taken from tumors or bone marrow collected during certain clinic visits. Adults aged 18 and older who are diagnosed with NHL or CLL and have had prior treatment with a particular antibody therapy (anti-CD20) are eligible to take part in the trial, provided they meet additional entry criteria. Prior to being enrolled into the study, participants would be required to undergo a number of tests including blood work and a physical exam. For more information on how to take part in this trial, sponsored by Regeneron Pharmaceuticals, Inc., individuals should call the Cancer Institute’s Office of Human Research Services at 732-235-8675 or e-mail cinjclinicaltrials@cinj.rutgers.edu. Clinical trials, often called cancer research studies, test new treatments and new ways of using existing treatments for cancer. At the Cancer Institute, researchers use these studies to answer questions about how a treatment affects the human body and to make sure it is safe and effective. There are several types of clinical trials that are currently underway at the Cancer Institute, including those that diagnose, treat, prevent, and manage symptoms of cancer. Many treatments used today, whether they are drugs or vaccines, ways to do surgery or give radiation therapy, or combinations of treatments, are the results of past clinical trials. As New Jersey’s only National Cancer Institute-designated Comprehensive Cancer Center, the Cancer Institute offers patients access to treatment options not available at other institutions within the state. The Cancer Institute currently enrolls more than 1,200 patients in clinical trials annually, including approximately 17 percent of all new adult cancer patients and approximately 70 percent of all pediatric cancer patients. Enrollment in these studies nationwide is fewer than five percent of all adult cancer patients. About Rutgers Cancer Institute of New JerseyRutgers Cancer Institute of New Jersey (www.cinj.org) is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center. As part of Rutgers, The State University of New Jersey, the Cancer Institute of New Jersey is dedicated to improving the detection, treatment and care of patients with cancer, and to serving as an education resource for cancer prevention. Physician-scientists at the Cancer Institute engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. To make a tax-deductible gift to support the Cancer Institute of New Jersey, call 848-932-3637 or visit www.cinj.org/giving. Follow us on Facebook at www.facebook.com/TheCINJ. The Cancer Institute of New Jersey Network is comprised of hospitals throughout the state and provides the highest quality cancer care and rapid dissemination of important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. System Partner: Meridian Health (Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, and Bayshore Community Hospital). Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Medical Center and Carol G. Simon Cancer Center at Overlook Medical Center. Affiliate Hospitals: JFK Medical Center, Robert Wood Johnson University Hospital Hamilton (CINJ Hamilton), and Robert Wood Johnson University Hospital Somerset.