http://www.medieigo.com/ 音声で配信する医学英語の学習番組です。医学記事や論文によく登場するイディオムを，毎週，簡単なフレーズとともに紹介していきます。 http://medieigo.com/articles/-/1000 メディエイゴ編集部 In a new study, those who had three to four aging signs had a 57 percent increased risk for heart attack and a 39 percent increased risk for heart disease. －receding hairline at the temples, baldness at the head’s crown, earlobe crease, or yellow fatty deposits around the eyelid.－ Individually and combined, these signs predicted heart attack and heart disease independent of traditional risk factors. Fatty deposits around the eye were the strongest individual predictor of both heart attack and heart disease. Heart attack and heart disease risk increased with each additional sign of aging in all age groups and among men and women. The highest risk was for those in their 70s and those with multiple signs of aging. The visible signs of aging reflect physiologic or biological age, not chronological age, and are independent of chronological age. Checking these visible aging signs should be a routine part of every doctor’s physical examination. Telltale visible signs of aging may predict heart disease LOS ANGELES, Nov. 6, 2012 -- If you look old, your heart may feel old, according to research presented at the American Heart Association’s Scientific Sessions 2012. In a new study, those who had three to four aging signs — receding hairline at the temples, baldness at the head’s crown, earlobe crease, or yellow fatty deposits around the eyelid (xanthelasmata) — had a 57 percent increased risk for heart attack and a 39 percent increased risk for heart disease. “The visible signs of aging reflect physiologic or biological age, not chronological age, and are independent of chronological age,” said Anne Tybjaerg-Hansen, M.D., the study’s senior author and professor of clinical biochemistry at the University of Copenhagen in Denmark. Researchers analyzed 10,885 participants 40 years and older (45 percent women) in the Copenhagen Heart Study. Of these, 7,537 had frontoparietal baldness (receding hairline at the temples), 3,938 had crown top baldness, 3,405 had earlobe crease, and 678 had fatty deposits around the eye. In 35 years of follow-up, 3,401 participants developed heart disease and 1,708 had a heart attack. Individually and combined, these signs predicted heart attack and heart disease independent of traditional risk factors. Fatty deposits around the eye were the strongest individual predictor of both heart attack and heart disease. Heart attack and heart disease risk increased with each additional sign of aging in all age groups and among men and women. The highest risk was for those in their 70s and those with multiple signs of aging. In the study, nurses and laboratory technicians noted the quantity of gray hair, prominence of wrinkles, the type and extent of baldness, the presence of earlobe crease and eyelid deposits. “Checking these visible aging signs should be a routine part of every doctor’s physical examination,” Tybjaerg-Hansen said. In a new study, those who had three to four aging signs had a 57 percent increased risk for heart attack and a 39 percent increased risk for heart disease. －receding hairline at the temples, baldness at the head’s crown, earlobe crease, or yellow fatty deposits around the eyelid.－ Individually and combined, these signs predicted heart attack and heart disease independent of traditional risk factors. Fatty deposits around the eye were the strongest individual predictor of both heart attack and heart disease. Heart attack and heart disease risk increased with each additional sign of aging in all age groups and among men and women. The highest risk was for those in their 70s and those with multiple signs of aging. The visible signs of aging reflect physiologic or biological age, not chronological age, and are independent of chronological age. Checking these visible aging signs should be a routine part of every doctor’s physical examination. Telltale visible signs of aging may predict heart disease LOS ANGELES, Nov. 6, 2012 -- If you look old, your heart may feel old, according to research presented at the American Heart Association’s Scientific Sessions 2012. In a new study, those who had three to four aging signs — receding hairline at the temples, baldness at the head’s crown, earlobe crease, or yellow fatty deposits around the eyelid (xanthelasmata) — had a 57 percent increased risk for heart attack and a 39 percent increased risk for heart disease. “The visible signs of aging reflect physiologic or biological age, not chronological age, and are independent of chronological age,” said Anne Tybjaerg-Hansen, M.D., the study’s senior author and professor of clinical biochemistry at the University of Copenhagen in Denmark. Researchers analyzed 10,885 participants 40 years and older (45 percent women) in the Copenhagen Heart Study. Of these, 7,537 had frontoparietal baldness (receding hairline at the temples), 3,938 had crown top baldness, 3,405 had earlobe crease, and 678 had fatty deposits around the eye. In 35 years of follow-up, 3,401 participants developed heart disease and 1,708 had a heart attack. Individually and combined, these signs predicted heart attack and heart disease independent of traditional risk factors. Fatty deposits around the eye were the strongest individual predictor of both heart attack and heart disease. Heart attack and heart disease risk increased with each additional sign of aging in all age groups and among men and women. The highest risk was for those in their 70s and those with multiple signs of aging. In the study, nurses and laboratory technicians noted the quantity of gray hair, prominence of wrinkles, the type and extent of baldness, the presence of earlobe crease and eyelid deposits. “Checking these visible aging signs should be a routine part of every doctor’s physical examination,” Tybjaerg-Hansen said. http://medieigo.com/common/dld/mp3/05dd83645e9df2a0db33ba6fdae4c1f5.mp3 Mon, 28 Jan 2013 12:00:00 +0900 English Learning MediEigo Podcasting http://medieigo.com/articles/-/999 メディエイゴ編集部 After more than 1,700 major cardiovascular disease events occurred during trial follow-up, we found that taking a daily multivitamin did not reduce their risk of major cardiovascular events, including heart attack, stroke and cardiovascular death. Multivitamins are the most common supplement taken by at least one-third of all U.S. adults. While multivitamins are typically used to prevent vitamin and mineral deficiency, there is an unproven belief that they may have benefits on other chronic diseases, including heart attack, stroke or cardiovascular death. The majority of men in our trial appeared to have, on average, good dietary habits. The question remains about how the long-term cardiovascular effects of daily multivitamin use might change among people with a wider range of nutritional status. It’s also important to note that taking a daily multivitamin appears to be safe, with no harm found. In addition, it’s also important to consider other potential effects of long-term multivitamin use, including a modest reduction in total cancer recently reported in our trial. A multivitamin a day doesn’t prevent cardiovascular disease in men LOS ANGELES, Nov. 5, 2012 -- For men 50 and older, taking a multivitamin a day may not prevent heart disease. That’s the finding of researchers who presented their late-breaking clinical trial at the American Heart Association’s Scientific Sessions 2012. Theirs is the first and only large-scale, long-term clinical trial examining daily multivitamin use and cardiovascular health. Other observational studies have netted inconsistent results. The full manuscript for A Randomized Trial of a Multivitamin (MVM) in the Prevention of Cardiovascular Disease in Men: The Physicians’ Health Study (PHS) II is published in the Journal of the American Medical Association. “Multivitamins are the most common supplement taken by at least one-third of all U.S. adults,” said Howard D. Sesso, Sc.D., M.P.H., lead researcher and Associate Professor of Medicine in the Division of Preventive Medicine at Brigham & Women’s Hospital in Boston, Mass. “While multivitamins are typically used to prevent vitamin and mineral deficiency, there is an unproven belief that they may have benefits on other chronic diseases, including heart attack, stroke or cardiovascular death.” The results are from the Physicians’ Health Study II, a clinical trial of 14,641 U.S. male physicians who were aged 50 years and older. Most are Caucasian. Half of all participants took a common multivitamin daily; the other half took a placebo daily. Researchers followed the physician participants for an average 11.2 years to determine if taking the multivitamin affected the occurrence of major cardiovascular events. “After more than 1,700 major cardiovascular disease events occurred during trial follow-up, we found that taking a daily multivitamin did not reduce their risk of major cardiovascular events, including heart attack, stroke and cardiovascular death. “It’s also important to note that taking a daily multivitamin appears to be safe, with no harm found. In addition, it’s also important to consider other potential effects of long-term multivitamin use, including a modest reduction in total cancer recently reported in our trial,” said J. Michael Gaziano, M.D., M.P.H., chief of the Division of Aging at Brigham and Women’s Hospital, and co-author of the study. The American Heart Association suggests that the best way to get the right nutrients is to eat a healthy, balanced diet that is high in fruits and vegetables, fiber-rich whole grains, contains oily fish twice per week, is low in saturated fat and sodium and limited in added sugars and trans fats. It’s not certain whether the findings would extend to younger men, women and other racial and ethnic groups, Sesso said. “The majority of men in our trial appeared to have, on average, good dietary habits.” he said. “The question remains about how the long-term cardiovascular effects of daily multivitamin use might change among people with a wider range of nutritional status. Other healthy habits, such as smoking cessation and increased physical activity, remain effective tools in preventing cardiovascular disease and other outcomes.” The National Institutes of Health funded the trial, along with an investigator-initiated grant from BASF Corporation. Pfizer provided the multivitamins and packaging, and DSM Nutritional Products, Inc. provided packaging. After more than 1,700 major cardiovascular disease events occurred during trial follow-up, we found that taking a daily multivitamin did not reduce their risk of major cardiovascular events, including heart attack, stroke and cardiovascular death. Multivitamins are the most common supplement taken by at least one-third of all U.S. adults. While multivitamins are typically used to prevent vitamin and mineral deficiency, there is an unproven belief that they may have benefits on other chronic diseases, including heart attack, stroke or cardiovascular death. The majority of men in our trial appeared to have, on average, good dietary habits. The question remains about how the long-term cardiovascular effects of daily multivitamin use might change among people with a wider range of nutritional status. It’s also important to note that taking a daily multivitamin appears to be safe, with no harm found. In addition, it’s also important to consider other potential effects of long-term multivitamin use, including a modest reduction in total cancer recently reported in our trial. A multivitamin a day doesn’t prevent cardiovascular disease in men LOS ANGELES, Nov. 5, 2012 -- For men 50 and older, taking a multivitamin a day may not prevent heart disease. That’s the finding of researchers who presented their late-breaking clinical trial at the American Heart Association’s Scientific Sessions 2012. Theirs is the first and only large-scale, long-term clinical trial examining daily multivitamin use and cardiovascular health. Other observational studies have netted inconsistent results. The full manuscript for A Randomized Trial of a Multivitamin (MVM) in the Prevention of Cardiovascular Disease in Men: The Physicians’ Health Study (PHS) II is published in the Journal of the American Medical Association. “Multivitamins are the most common supplement taken by at least one-third of all U.S. adults,” said Howard D. Sesso, Sc.D., M.P.H., lead researcher and Associate Professor of Medicine in the Division of Preventive Medicine at Brigham & Women’s Hospital in Boston, Mass. “While multivitamins are typically used to prevent vitamin and mineral deficiency, there is an unproven belief that they may have benefits on other chronic diseases, including heart attack, stroke or cardiovascular death.” The results are from the Physicians’ Health Study II, a clinical trial of 14,641 U.S. male physicians who were aged 50 years and older. Most are Caucasian. Half of all participants took a common multivitamin daily; the other half took a placebo daily. Researchers followed the physician participants for an average 11.2 years to determine if taking the multivitamin affected the occurrence of major cardiovascular events. “After more than 1,700 major cardiovascular disease events occurred during trial follow-up, we found that taking a daily multivitamin did not reduce their risk of major cardiovascular events, including heart attack, stroke and cardiovascular death. “It’s also important to note that taking a daily multivitamin appears to be safe, with no harm found. In addition, it’s also important to consider other potential effects of long-term multivitamin use, including a modest reduction in total cancer recently reported in our trial,” said J. Michael Gaziano, M.D., M.P.H., chief of the Division of Aging at Brigham and Women’s Hospital, and co-author of the study. The American Heart Association suggests that the best way to get the right nutrients is to eat a healthy, balanced diet that is high in fruits and vegetables, fiber-rich whole grains, contains oily fish twice per week, is low in saturated fat and sodium and limited in added sugars and trans fats. It’s not certain whether the findings would extend to younger men, women and other racial and ethnic groups, Sesso said. “The majority of men in our trial appeared to have, on average, good dietary habits.” he said. “The question remains about how the long-term cardiovascular effects of daily multivitamin use might change among people with a wider range of nutritional status. Other healthy habits, such as smoking cessation and increased physical activity, remain effective tools in preventing cardiovascular disease and other outcomes.” The National Institutes of Health funded the trial, along with an investigator-initiated grant from BASF Corporation. Pfizer provided the multivitamins and packaging, and DSM Nutritional Products, Inc. provided packaging. http://medieigo.com/common/dld/mp3/2ff3e135b61132228717bfa82b029a14.mp3 Mon, 21 Jan 2013 12:00:00 +0900 English Learning MediEigo Podcasting http://medieigo.com/articles/-/997 メディエイゴ編集部 Cooling patients resuscitated after sudden cardiac arrest to lower body temperatures may be associated with increased survival and better functional ability. Once a normal heartbeat is restored, treatment for comatose patients includes therapeutic cooling to decrease the body's oxygen requirements, which can help prevent brain damage associated with the cardiac arrest. In the study of 36 people in Madrid, Spain, researchers found that 44 percent of patients who underwent therapeutic cooling to 32C after cardiac arrest survived without severe brain dysfunction six months after treatment. That compared to 11 percent of those cooled to 34C. Although the results suggest a better outcome with lower levels of target temperature, they should be interpreted with caution. Since extremely low temperatures below 30C are associated with complications, it's critical to know the optimal level of cooling. Cooling cardiac arrest patients to lower body temps improved survival LOS ANGELES, Nov. 6, 2012 -- Cooling patients resuscitated after sudden cardiac arrest to lower body temperatures may be associated with increased survival and better functional ability, according to late-breaking clinical trial research presented at the American Heart Association's Scientific Sessions 2012.   The full manuscript for Pilot Trial of Two Levels of Hypothermia in Comatose Survivors from Out-of-Hospital Cardiac Arrest, is published in Circulation, a journal of the American Heart Association.   In the study of 36 people in Madrid, Spain, researchers found that 44 percent of patients who underwent therapeutic cooling to 32C (89.6F) after cardiac arrest survived without severe brain dysfunction six months after treatment. That compared to 11 percent of those cooled to 34C (93.2F).   Researchers defined dysfunction as the inability to perform the normal tasks of everyday living, including bathing, dressing and walking.   Each year in the United States, about 382,800 people suffer cardiac arrest outside of a hospital, according to the American Heart Association. The life-threatening condition occurs when the heart suddenly stops functioning. Immediate CPR and emergency medical care must be provided within minutes to restore a regular rhythm - or the person will not survive.   Once a normal heartbeat is restored, treatment for comatose patients includes therapeutic cooling to decrease the body's oxygen requirements, which can help prevent brain damage associated with the cardiac arrest. American Heart Association and International Liaison Committee on Resuscitation (ILCOR) recommendations are to cool body temperature to 32C-34C, but the optimal temperature within this range is unclear.   "Although the results suggest a better outcome with lower levels of target temperature, they should be interpreted with caution," said Esteban Lopez-de-Sa, M.D., lead researcher and head of the Cardiac Critical Care Unit and Clinical Cardiology at La Paz University Hospital in Madrid, Spain. "They may be due to multiple factors other than the effect of lower target temperature."   The benefits were observed in patients whose initial detected rhythm was shockable, he said.   Thirty-six patients with out-of-hospital cardiac arrest participated in the single-center trial, from March 2008-August 2011. Their average age was 64, 89 percent were male, and all were white.   Researchers randomly assigned patients to receive therapeutic cooling to either 32C or 34C for 24 hours, followed by gradual rewarming for 12-24 hours. Patients were cooled internally with intravenous cold saline followed by an internal catheter and temperature management system inserted directly into the main vein from the lower body to the heart.   "Since extremely low temperatures below 30C are associated with complications, it's critical to know the optimal level of cooling" Lopez-de-Sa; said. "The aim of the study was to provide initial information for future research about whether controlling hypothermia levels can improve outcome." Cooling patients resuscitated after sudden cardiac arrest to lower body temperatures may be associated with increased survival and better functional ability. Once a normal heartbeat is restored, treatment for comatose patients includes therapeutic cooling to decrease the body's oxygen requirements, which can help prevent brain damage associated with the cardiac arrest. In the study of 36 people in Madrid, Spain, researchers found that 44 percent of patients who underwent therapeutic cooling to 32C after cardiac arrest survived without severe brain dysfunction six months after treatment. That compared to 11 percent of those cooled to 34C. Although the results suggest a better outcome with lower levels of target temperature, they should be interpreted with caution. Since extremely low temperatures below 30C are associated with complications, it's critical to know the optimal level of cooling. Cooling cardiac arrest patients to lower body temps improved survival LOS ANGELES, Nov. 6, 2012 -- Cooling patients resuscitated after sudden cardiac arrest to lower body temperatures may be associated with increased survival and better functional ability, according to late-breaking clinical trial research presented at the American Heart Association's Scientific Sessions 2012.   The full manuscript for Pilot Trial of Two Levels of Hypothermia in Comatose Survivors from Out-of-Hospital Cardiac Arrest, is published in Circulation, a journal of the American Heart Association.   In the study of 36 people in Madrid, Spain, researchers found that 44 percent of patients who underwent therapeutic cooling to 32C (89.6F) after cardiac arrest survived without severe brain dysfunction six months after treatment. That compared to 11 percent of those cooled to 34C (93.2F).   Researchers defined dysfunction as the inability to perform the normal tasks of everyday living, including bathing, dressing and walking.   Each year in the United States, about 382,800 people suffer cardiac arrest outside of a hospital, according to the American Heart Association. The life-threatening condition occurs when the heart suddenly stops functioning. Immediate CPR and emergency medical care must be provided within minutes to restore a regular rhythm - or the person will not survive.   Once a normal heartbeat is restored, treatment for comatose patients includes therapeutic cooling to decrease the body's oxygen requirements, which can help prevent brain damage associated with the cardiac arrest. American Heart Association and International Liaison Committee on Resuscitation (ILCOR) recommendations are to cool body temperature to 32C-34C, but the optimal temperature within this range is unclear.   "Although the results suggest a better outcome with lower levels of target temperature, they should be interpreted with caution," said Esteban Lopez-de-Sa, M.D., lead researcher and head of the Cardiac Critical Care Unit and Clinical Cardiology at La Paz University Hospital in Madrid, Spain. "They may be due to multiple factors other than the effect of lower target temperature."   The benefits were observed in patients whose initial detected rhythm was shockable, he said.   Thirty-six patients with out-of-hospital cardiac arrest participated in the single-center trial, from March 2008-August 2011. Their average age was 64, 89 percent were male, and all were white.   Researchers randomly assigned patients to receive therapeutic cooling to either 32C or 34C for 24 hours, followed by gradual rewarming for 12-24 hours. Patients were cooled internally with intravenous cold saline followed by an internal catheter and temperature management system inserted directly into the main vein from the lower body to the heart.   "Since extremely low temperatures below 30C are associated with complications, it's critical to know the optimal level of cooling" Lopez-de-Sa; said. "The aim of the study was to provide initial information for future research about whether controlling hypothermia levels can improve outcome." http://medieigo.com/common/dld/mp3/910f2f280457b073ceb0a137f48a298c.mp3 Fri, 11 Jan 2013 12:00:00 +0900 English Learning MediEigo Podcasting http://medieigo.com/articles/-/915 メディエイゴ編集部 Data from a Phase III study show that the oral investigational drug trametinib delayed tumor growth and extended survival for patients with advanced melanoma who have BRAF mutations, compared with standard chemotherapy. Median progression-free survival was significantly greater in the trametinib group (4.8 months) than the chemotherapy group (1.5 months) -- a 55 percent reduction in the risk of progression. Interim overall survival was also longer among the patients treated with trametinib, with a 46 percent reduced risk of death; 81 percent of patients in the trametinib group were alive after six months of follow-up, versus 67 percent in the chemotherapy group. Side effects of trametinib were generally manageable. Severe adverse events included skin rash (7 percent of patients), eye problems (less than 1 percent), high blood pressure (12 percent) and reduced heart function (7 percent).  This is the first in a new class of targeted drugs that could benefit patients with melanoma who have BRAF mutations. Trametinib is likely to become another first-line treatment option for patients with advanced melanoma. 【ニュースリリース全文】※番組で取り上げた箇所は太字になっています。 News Release from American Society of Clinical Oncology on June 4, 2012 New MEK Inhibitor, Trametinib, Improves Survival in Advanced Melanoma   CHICAGO (June 4, 2012) -- Data from a Phase III study show that the oral investigational drug trametinib delayed tumor growth and extended survival for patients with advanced melanoma who have BRAF mutations, compared with standard chemotherapy. This is the first Phase III trial evaluating a melanoma treatment that inhibits a protein known as MEK -- part of the MAP kinase signaling pathway, of which BRAF is also a component. "This is the first in a new class of targeted drugs that could benefit patients with melanoma who have BRAF mutations. The findings show that targeting the MEK molecular pathway is a viable strategy for treating many people with the disease," said Caroline Robert, MD, PhD, Head of Dermatology at the Institute Gustave Roussy in Paris, France. "Trametinib is likely to become another first-line treatment option for patients with advanced melanoma." Only one targeted therapy, vemurafenib (Zelboraf), is currently approved for advanced melanoma. Vemurafenib targets a protein produced by a mutation in the BRAF gene that fuels melanoma growth, and is present in roughly half of patients with melanoma. MEK lies downstream from BRAF in the same signaling pathway. Since most patients taking vemurafenib eventually develop resistance to the drug and many experience serious side effects, MEK inhibitors could help address a continuing need for new therapies in these patients. In this study, known as METRIC, patients with advanced BRAF-mutated melanoma who had received up to one prior chemotherapy regimen were randomly assigned to receive trametinib (214 patients) or standard chemotherapy (108 patients; either dacarbazine or paclitaxel). Overall, 22 percent of patients who received trametinib responded to treatment, compared with 8 percent of those who received chemotherapy. Median progression-free survival was significantly greater in the trametinib group (4.8 months) than the chemotherapy group (1.5 months) – a 55 percent reduction in the risk of progression. Interim overall survival was also longer among the patients treated with trametinib, with a 46 percent reduced risk of death; 81 percent of patients in the trametinib group were alive after six months of follow-up, versus 67 percent in the chemotherapy group. Approximately half (47 percent) of patients whose disease progressed while on chemotherapy were permitted to take trametinib, so the overall survival advantage may ultimately prove to be greater if this "crossover effect" is taken into account, according to the researchers. Side effects of trametinib were generally manageable. Severe adverse events included skin rash (7 percent of patients), eye problems (less than 1 percent), high blood pressure (12 percent) and reduced heart function (7 percent). Data from a Phase III study show that the oral investigational drug trametinib delayed tumor growth and extended survival for patients with advanced melanoma who have BRAF mutations, compared with standard chemotherapy. Median progression-free survival was significantly greater in the trametinib group (4.8 months) than the chemotherapy group (1.5 months) -- a 55 percent reduction in the risk of progression. Interim overall survival was also longer among the patients treated with trametinib, with a 46 percent reduced risk of death; 81 percent of patients in the trametinib group were alive after six months of follow-up, versus 67 percent in the chemotherapy group. Side effects of trametinib were generally manageable. Severe adverse events included skin rash (7 percent of patients), eye problems (less than 1 percent), high blood pressure (12 percent) and reduced heart function (7 percent).  This is the first in a new class of targeted drugs that could benefit patients with melanoma who have BRAF mutations. Trametinib is likely to become another first-line treatment option for patients with advanced melanoma. 【ニュースリリース全文】※番組で取り上げた箇所は太字になっています。 News Release from American Society of Clinical Oncology on June 4, 2012 New MEK Inhibitor, Trametinib, Improves Survival in Advanced Melanoma   CHICAGO (June 4, 2012) -- Data from a Phase III study show that the oral investigational drug trametinib delayed tumor growth and extended survival for patients with advanced melanoma who have BRAF mutations, compared with standard chemotherapy. This is the first Phase III trial evaluating a melanoma treatment that inhibits a protein known as MEK -- part of the MAP kinase signaling pathway, of which BRAF is also a component. "This is the first in a new class of targeted drugs that could benefit patients with melanoma who have BRAF mutations. The findings show that targeting the MEK molecular pathway is a viable strategy for treating many people with the disease," said Caroline Robert, MD, PhD, Head of Dermatology at the Institute Gustave Roussy in Paris, France. "Trametinib is likely to become another first-line treatment option for patients with advanced melanoma." Only one targeted therapy, vemurafenib (Zelboraf), is currently approved for advanced melanoma. Vemurafenib targets a protein produced by a mutation in the BRAF gene that fuels melanoma growth, and is present in roughly half of patients with melanoma. MEK lies downstream from BRAF in the same signaling pathway. Since most patients taking vemurafenib eventually develop resistance to the drug and many experience serious side effects, MEK inhibitors could help address a continuing need for new therapies in these patients. In this study, known as METRIC, patients with advanced BRAF-mutated melanoma who had received up to one prior chemotherapy regimen were randomly assigned to receive trametinib (214 patients) or standard chemotherapy (108 patients; either dacarbazine or paclitaxel). Overall, 22 percent of patients who received trametinib responded to treatment, compared with 8 percent of those who received chemotherapy. Median progression-free survival was significantly greater in the trametinib group (4.8 months) than the chemotherapy group (1.5 months) – a 55 percent reduction in the risk of progression. Interim overall survival was also longer among the patients treated with trametinib, with a 46 percent reduced risk of death; 81 percent of patients in the trametinib group were alive after six months of follow-up, versus 67 percent in the chemotherapy group. Approximately half (47 percent) of patients whose disease progressed while on chemotherapy were permitted to take trametinib, so the overall survival advantage may ultimately prove to be greater if this "crossover effect" is taken into account, according to the researchers. Side effects of trametinib were generally manageable. Severe adverse events included skin rash (7 percent of patients), eye problems (less than 1 percent), high blood pressure (12 percent) and reduced heart function (7 percent). http://medieigo.com/common/dld/mp3/03fe61f99b11691f4b7447bdc038e989.mp3 Mon, 06 Aug 2012 12:00:00 +0900 English Learning MediEigo Podcasting http://medieigo.com/articles/-/912 メディエイゴ編集部 Results from an early-stage study show that treatment with the investigational drug BMS-936558 caused tumor shrinkage in up to a quarter of patients with advanced melanoma, kidney and non-small cell lung cancers.  Responses were observed in patients with melanoma (28%), renal cancer (27%), and non-small cell lung cancer (18%). Responses were seen both in patients with squamous and non-squamous cell subtypes of lung cancer. Many patients responded for 12 months or longer and had ongoing responses at the time of this report.  The drug was generally well-tolerated; serious toxicities were observed in 14 percent of patients. Side effects were generally consistent with those seen in other immune-focused therapies for cancer.  We were especially surprised to see activity in nearly 20 percent of patients with lung cancer, who are historically unresponsive to immune-based therapies. These findings mark what is probably the strongest anti-lung cancer activity observed to date with any immunotherapy. 【ニュースリリース全文】※番組で取り上げた箇所は太字になっています。 News Release from American Society of Clinical Oncology on June 2, 2012 Promising Activity for New PD-1 Targeted Immune Therapy   CHICAGO (June 2, 2012) -- Results from an early-stage study show that treatment with the investigational drug BMS-936558 caused tumor shrinkage in up to a quarter of patients with advanced melanoma, kidney and non-small cell lung (NSCLC) cancers. This antibody drug targets a key pathway in T-cells (white blood cells that help fight infection and cancer) called PD-1, which inhibits the body’s immune response to cancer. By blocking this pathway, BMS-936558 may re-activate the immune system to fight tumor cells. “It’s exciting to see this degree of anti-tumor activity from a single agent among patients with a range of cancers that had progressed despite standard therapies,” said Suzanne Topalian, MD, Professor of Surgery and Oncology at the Johns Hopkins University School of Medicine. “We were especially surprised to see activity in nearly 20 percent of patients with lung cancer, who are historically unresponsive to immune-based therapies. These findings mark what is probably the strongest anti-lung cancer activity observed to date with any immunotherapy.” This Phase I trial with expansion cohorts enrolled 296 patients with melanoma, colorectal, NSCLC, prostate and renal cancer that had progressed despite standard therapies. Responses were observed in patients with melanoma (26/94 patients; 28%), renal cancer (9/33 patients; 27%), and NSCLC (14/76 patients; 18%). Responses were seen both in patients with squamous and non-squamous cell subtypes of lung cancer. Many patients responded for 12 months or longer and had ongoing responses at the time of this report. The drug was generally well-tolerated; serious toxicities were observed in 14 percent of patients. Side effects were generally consistent with those seen in other immune-focused therapies for cancer. A sub-analysis of data from the trial also hints at a potential biomarker on cancer cells – a protein called PD-L1 – that could help predict which patients will respond to BMS-936558. Investigators analyzed tumor samples obtained from 42 patients prior to treatment initiation, for expression of the PD-L1 protein on the surface of tumor cells. After correlating the results with response data, they noted that over one-third of patients with PD-L1 positive tumors responded to the drug (9/25 patients; 36%), while none of the 17 PD-L1 negative patients had a response. Additional studies are planned to further assess the potential role of PD-L1 as a predictive marker of response to anti-PD-1 therapy. Results from an early-stage study show that treatment with the investigational drug BMS-936558 caused tumor shrinkage in up to a quarter of patients with advanced melanoma, kidney and non-small cell lung cancers.  Responses were observed in patients with melanoma (28%), renal cancer (27%), and non-small cell lung cancer (18%). Responses were seen both in patients with squamous and non-squamous cell subtypes of lung cancer. Many patients responded for 12 months or longer and had ongoing responses at the time of this report.  The drug was generally well-tolerated; serious toxicities were observed in 14 percent of patients. Side effects were generally consistent with those seen in other immune-focused therapies for cancer.  We were especially surprised to see activity in nearly 20 percent of patients with lung cancer, who are historically unresponsive to immune-based therapies. These findings mark what is probably the strongest anti-lung cancer activity observed to date with any immunotherapy. 【ニュースリリース全文】※番組で取り上げた箇所は太字になっています。 News Release from American Society of Clinical Oncology on June 2, 2012 Promising Activity for New PD-1 Targeted Immune Therapy   CHICAGO (June 2, 2012) -- Results from an early-stage study show that treatment with the investigational drug BMS-936558 caused tumor shrinkage in up to a quarter of patients with advanced melanoma, kidney and non-small cell lung (NSCLC) cancers. This antibody drug targets a key pathway in T-cells (white blood cells that help fight infection and cancer) called PD-1, which inhibits the body’s immune response to cancer. By blocking this pathway, BMS-936558 may re-activate the immune system to fight tumor cells. “It’s exciting to see this degree of anti-tumor activity from a single agent among patients with a range of cancers that had progressed despite standard therapies,” said Suzanne Topalian, MD, Professor of Surgery and Oncology at the Johns Hopkins University School of Medicine. “We were especially surprised to see activity in nearly 20 percent of patients with lung cancer, who are historically unresponsive to immune-based therapies. These findings mark what is probably the strongest anti-lung cancer activity observed to date with any immunotherapy.” This Phase I trial with expansion cohorts enrolled 296 patients with melanoma, colorectal, NSCLC, prostate and renal cancer that had progressed despite standard therapies. Responses were observed in patients with melanoma (26/94 patients; 28%), renal cancer (9/33 patients; 27%), and NSCLC (14/76 patients; 18%). Responses were seen both in patients with squamous and non-squamous cell subtypes of lung cancer. Many patients responded for 12 months or longer and had ongoing responses at the time of this report. The drug was generally well-tolerated; serious toxicities were observed in 14 percent of patients. Side effects were generally consistent with those seen in other immune-focused therapies for cancer. A sub-analysis of data from the trial also hints at a potential biomarker on cancer cells – a protein called PD-L1 – that could help predict which patients will respond to BMS-936558. Investigators analyzed tumor samples obtained from 42 patients prior to treatment initiation, for expression of the PD-L1 protein on the surface of tumor cells. After correlating the results with response data, they noted that over one-third of patients with PD-L1 positive tumors responded to the drug (9/25 patients; 36%), while none of the 17 PD-L1 negative patients had a response. Additional studies are planned to further assess the potential role of PD-L1 as a predictive marker of response to anti-PD-1 therapy. http://medieigo.com/common/dld/mp3/5ee98233c8bc8d5fb51e6dca02a15f2e.mp3 Mon, 30 Jul 2012 12:00:00 +0900 English Learning MediEigo Podcasting http://medieigo.com/articles/-/905 メディエイゴ編集部 A phase III randomized study of the investigational agent trastuzumab emtansine (T-DM1) vs. standard therapy using capecitabine and lapatinib found significant and clinically meaningful improvement in progression-free survival (PFS) for T-DM1 in women with HER2-positive locally advanced or metastatic breast cancer previously treated with a taxane and trastuzumab. The median PFS for patients receiving T-DM1 was 9.6 months, compared to 6.4 months in the group receiving capecitabine and lapatinib (a regimen known as XL) -- a difference that was statistically significant. After two years, 65.4 percent of the T-DM1 patients were alive, compared to 47.5 percent of the XL patients. The most common adverse events of Grade 3 or above for T-DM1 included thrombocytopenia (12.9 percent vs. 0.2 percent) and elevation in liver function tests. These side effects resolved when patients took a break from the drug. As a clinician who takes care of a lot of breast cancer patients, I’m pleased that this drug has very little dose-limiting toxicity. Patients don’t lose their hair from this drug. For patients facing metastatic breast cancer, this is a breakthrough. 【ニュースリリース全文】 ※番組で取り上げた箇所は太字になっています。  News Release from American Society of Clinical Oncology on June 3, 2012 New Treatment for HER2-Positive Advanced Breast Cancer, Trastuzumab Emtansine, Improves Progression-Free Survival Over Current Standard CHICAGO (June 3, 2012) -- A phase III randomized study of the investigational agent trastuzumab emtansine (T-DM1) vs. standard therapy using capecitabine (Xeloda) and lapatinib (Tykerb) found significant and clinically meaningful improvement in progression-free survival (PFS) for T-DM1 in women with HER2-positive locally advanced or metastatic breast cancer previously treated with a taxane and trastuzumab. T-DM1 is an experimental antibody-drug conjugate that consists of the antibody trastuzumab (Herceptin) linked to the cytotoxic drug emtansine (DM1). T-DM1 has not been approved by the Food and Drug Administration, and is not yet available outside of clinical trials. “The drug worked. It was significantly better than a very effective approved therapy for HER2 overexpressing metastatic breast cancer,” said lead study author Kimberly L. Blackwell, MD, professor of medicine and assistant professor of radiation oncology at Duke Cancer Institute at Duke University. “Also, as a clinician who takes care of a lot of breast cancer patients, I’m pleased that this drug has very little dose-limiting toxicity. Patients don’t lose their hair from this drug. For patients facing metastatic breast cancer, this is a breakthrough.” The international study, called EMILIA, randomized nearly 1,000 patients to receive either T-DM1 or XL every three weeks until their disease progressed or they experienced unmanageable toxicity. The median PFS for patients receiving T-DM1 was 9.6 months, compared to 6.4 months in the group receiving capecitabine and lapatinib (a regimen known as XL) – a difference that was statistically significant. After two years, 65.4 percent of the T-DM1 patients were alive, compared to 47.5 percent of the XL patients. This difference in statistical significance did not meet the trial’s predetermined statistical survival threshold for the first analysis. The second planned survival analysis planned for later in the study will provide additional information. The most common adverse events of Grade 3 or above for T-DM1 included thrombocytopenia (12.9 percent vs. 0.2 percent) and elevation in liver function tests. These side effects resolved when patients took a break from the drug, Dr. Blackwell said. Dose reductions were greater for patients in the XL group: 53.4 percent for capecitabine, 27.3 percent for lapatinib, and 16.3 percent for T-DM1. Patients in the XL group experienced more diarrhea (20.7 percent vs. 1.6 percent), hand-foot syndrome (redness, swelling, and pain on the palms of the hands or the soles of the feet) (16.4 percent vs. 0), and vomiting (4.5 percent vs. 0.8 percent). A phase III randomized study of the investigational agent trastuzumab emtansine (T-DM1) vs. standard therapy using capecitabine and lapatinib found significant and clinically meaningful improvement in progression-free survival (PFS) for T-DM1 in women with HER2-positive locally advanced or metastatic breast cancer previously treated with a taxane and trastuzumab. The median PFS for patients receiving T-DM1 was 9.6 months, compared to 6.4 months in the group receiving capecitabine and lapatinib (a regimen known as XL) -- a difference that was statistically significant. After two years, 65.4 percent of the T-DM1 patients were alive, compared to 47.5 percent of the XL patients. The most common adverse events of Grade 3 or above for T-DM1 included thrombocytopenia (12.9 percent vs. 0.2 percent) and elevation in liver function tests. These side effects resolved when patients took a break from the drug. As a clinician who takes care of a lot of breast cancer patients, I’m pleased that this drug has very little dose-limiting toxicity. Patients don’t lose their hair from this drug. For patients facing metastatic breast cancer, this is a breakthrough. 【ニュースリリース全文】 ※番組で取り上げた箇所は太字になっています。  News Release from American Society of Clinical Oncology on June 3, 2012 New Treatment for HER2-Positive Advanced Breast Cancer, Trastuzumab Emtansine, Improves Progression-Free Survival Over Current Standard CHICAGO (June 3, 2012) -- A phase III randomized study of the investigational agent trastuzumab emtansine (T-DM1) vs. standard therapy using capecitabine (Xeloda) and lapatinib (Tykerb) found significant and clinically meaningful improvement in progression-free survival (PFS) for T-DM1 in women with HER2-positive locally advanced or metastatic breast cancer previously treated with a taxane and trastuzumab. T-DM1 is an experimental antibody-drug conjugate that consists of the antibody trastuzumab (Herceptin) linked to the cytotoxic drug emtansine (DM1). T-DM1 has not been approved by the Food and Drug Administration, and is not yet available outside of clinical trials. “The drug worked. It was significantly better than a very effective approved therapy for HER2 overexpressing metastatic breast cancer,” said lead study author Kimberly L. Blackwell, MD, professor of medicine and assistant professor of radiation oncology at Duke Cancer Institute at Duke University. “Also, as a clinician who takes care of a lot of breast cancer patients, I’m pleased that this drug has very little dose-limiting toxicity. Patients don’t lose their hair from this drug. For patients facing metastatic breast cancer, this is a breakthrough.” The international study, called EMILIA, randomized nearly 1,000 patients to receive either T-DM1 or XL every three weeks until their disease progressed or they experienced unmanageable toxicity. The median PFS for patients receiving T-DM1 was 9.6 months, compared to 6.4 months in the group receiving capecitabine and lapatinib (a regimen known as XL) – a difference that was statistically significant. After two years, 65.4 percent of the T-DM1 patients were alive, compared to 47.5 percent of the XL patients. This difference in statistical significance did not meet the trial’s predetermined statistical survival threshold for the first analysis. The second planned survival analysis planned for later in the study will provide additional information. The most common adverse events of Grade 3 or above for T-DM1 included thrombocytopenia (12.9 percent vs. 0.2 percent) and elevation in liver function tests. These side effects resolved when patients took a break from the drug, Dr. Blackwell said. Dose reductions were greater for patients in the XL group: 53.4 percent for capecitabine, 27.3 percent for lapatinib, and 16.3 percent for T-DM1. Patients in the XL group experienced more diarrhea (20.7 percent vs. 1.6 percent), hand-foot syndrome (redness, swelling, and pain on the palms of the hands or the soles of the feet) (16.4 percent vs. 0), and vomiting (4.5 percent vs. 0.8 percent). http://medieigo.com/common/dld/mp3/da772bae053959d43c53ec8ae76c1cca.mp3 Tue, 24 Jul 2012 12:00:00 +0900 English Learning MediEigo Podcasting http://medieigo.com/articles/-/888 メディエイゴ編集部 The study enrolled patients who arrived in the emergency room (ER) with chest pain and who were at intermediate risk for a heart attack based on their symptoms and initial ER evaluation, which included blood tests and electrocardiogram results. Patients were randomly assigned to receive either a CT scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient’s situation and physician preference. The results showed that using CT scans to evaluate patients with chest pain in the ER reduced their average time spent in the hospital by 18 hours. Half of the patients receiving the CT scan were safely discharged within nine hours compared to only 15 percent of patients receiving standard care. The use of CT resulted in 10 percent to 20 percent cost savings to the ER over standard care. It shows that cardiac CT is ready for use in a pragmatic health care setting, as it is more effective than the standard ER evaluation. CARDIAC CT IS FASTER, MORE EFFECTIVE FOR EVALUATING PATIENTS WITH SUSPECTED HEART ATTACK CHICAGO (March 27, 2012) — Cardiac computed tomography angiography scans (CT scans that look at the heart) can provide a virtually instant verdict on whether chest pain is from blockage of the coronary arteries. When used early to evaluate chest pain, the scans save patients and hospitals time and money by allowing doctors to quickly determine who should be admitted for treatment for a heart attack and who can be safely sent home, according to research presented today at the American College of Cardiology’s 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field. The ROMICAT II study involved 1,000 patients at nine hospitals across the United States. The results showed that using CT scans to evaluate patients with chest pain in the emergency room (ER) reduced their average time spent in the hospital by 18 hours. Half of the patients receiving the CT scan were safely discharged within nine hours compared to only 15 percent of patients receiving standard care. The use of CT resulted in 10 percent to 20 percent cost savings to the ER over standard care. “These data suggest that doing a CT scan early benefits both patients and physicians,” said Udo Hoffmann, MD, MPH, director of cardiac imaging at Massachusetts General Hospital and the study’s lead investigator. “Physicians benefit because they can discharge many patients from the overcrowded ER very quickly, with solid reassurance that they’re not having a heart attack, while the standard evaluation takes much longer to assess whether the symptoms stem from blockages in their arteries. Patients benefit from an earlier diagnosis and can safely go home from the ER earlier.” About 6 million people come to hospital ERs in the United States each year complaining of chest pain, but only a fraction are actually having a heart attack or other major cardiac problems. Under the current standard of care, most individuals are observed in the hospital for one or two days and may be given one of several cardiac stress tests to assess their heart’s health. Cardiac CT scans allow doctors to quickly use X-ray images of the heart to identify whether a patient has blocked arteries or other cardiac problems. The study enrolled patients who arrived in the ER with chest pain and who were at intermediate risk for a heart attack based on their symptoms and initial ER evaluation, which included blood tests and electrocardiogram results. Patients were randomly assigned to receive either a CT scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient’s situation and physician preference. Because healthy patients were discharged much earlier and often needed just a CT scan and a single blood test, their health care costs were lower. “It looks like CT saves time and money for the health care system in those who have no blockages in their coronary arteries. Though only a modest amount of money is saved per patient, it may save a lot of money considering the millions of patients affected across the country,” Dr. Hoffmann said. “CT allows you to spend your health care dollars focusing on the people who are actually sick. One could argue that this is a better use of health care resources.” CT scans also provide useful prognostic information that doctors can refer back to if the patient experiences chest pain again. “If their CT scan shows clear heart arteries, we know from our previous ROMICAT I study that their prognosis over the next two years is really good, which can be useful farther down the road,” Dr. Hoffmann said. Other studies have offered somewhat conflicting assessments of the efficiency and effectiveness of using CT scans as the first diagnostic test for chest pain. This trial is unique because the CT scan was done much earlier in the evaluation process compared to other studies and was used in a real-life setting. Moreover, this was the first trial to show that physicians could act on the information from the CT scan in a way that improved a measure of care – safe earlier discharge – after ER presentation for chest pain. “It shows that cardiac CT is ready for use in a pragmatic health care setting, as it is more effective than the standard ER evaluation,” said Dr. Hoffmann. This study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. The study enrolled patients who arrived in the emergency room (ER) with chest pain and who were at intermediate risk for a heart attack based on their symptoms and initial ER evaluation, which included blood tests and electrocardiogram results. Patients were randomly assigned to receive either a CT scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient’s situation and physician preference. The results showed that using CT scans to evaluate patients with chest pain in the ER reduced their average time spent in the hospital by 18 hours. Half of the patients receiving the CT scan were safely discharged within nine hours compared to only 15 percent of patients receiving standard care. The use of CT resulted in 10 percent to 20 percent cost savings to the ER over standard care. It shows that cardiac CT is ready for use in a pragmatic health care setting, as it is more effective than the standard ER evaluation. CARDIAC CT IS FASTER, MORE EFFECTIVE FOR EVALUATING PATIENTS WITH SUSPECTED HEART ATTACK CHICAGO (March 27, 2012) — Cardiac computed tomography angiography scans (CT scans that look at the heart) can provide a virtually instant verdict on whether chest pain is from blockage of the coronary arteries. When used early to evaluate chest pain, the scans save patients and hospitals time and money by allowing doctors to quickly determine who should be admitted for treatment for a heart attack and who can be safely sent home, according to research presented today at the American College of Cardiology’s 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field. The ROMICAT II study involved 1,000 patients at nine hospitals across the United States. The results showed that using CT scans to evaluate patients with chest pain in the emergency room (ER) reduced their average time spent in the hospital by 18 hours. Half of the patients receiving the CT scan were safely discharged within nine hours compared to only 15 percent of patients receiving standard care. The use of CT resulted in 10 percent to 20 percent cost savings to the ER over standard care. “These data suggest that doing a CT scan early benefits both patients and physicians,” said Udo Hoffmann, MD, MPH, director of cardiac imaging at Massachusetts General Hospital and the study’s lead investigator. “Physicians benefit because they can discharge many patients from the overcrowded ER very quickly, with solid reassurance that they’re not having a heart attack, while the standard evaluation takes much longer to assess whether the symptoms stem from blockages in their arteries. Patients benefit from an earlier diagnosis and can safely go home from the ER earlier.” About 6 million people come to hospital ERs in the United States each year complaining of chest pain, but only a fraction are actually having a heart attack or other major cardiac problems. Under the current standard of care, most individuals are observed in the hospital for one or two days and may be given one of several cardiac stress tests to assess their heart’s health. Cardiac CT scans allow doctors to quickly use X-ray images of the heart to identify whether a patient has blocked arteries or other cardiac problems. The study enrolled patients who arrived in the ER with chest pain and who were at intermediate risk for a heart attack based on their symptoms and initial ER evaluation, which included blood tests and electrocardiogram results. Patients were randomly assigned to receive either a CT scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient’s situation and physician preference. Because healthy patients were discharged much earlier and often needed just a CT scan and a single blood test, their health care costs were lower. “It looks like CT saves time and money for the health care system in those who have no blockages in their coronary arteries. Though only a modest amount of money is saved per patient, it may save a lot of money considering the millions of patients affected across the country,” Dr. Hoffmann said. “CT allows you to spend your health care dollars focusing on the people who are actually sick. One could argue that this is a better use of health care resources.” CT scans also provide useful prognostic information that doctors can refer back to if the patient experiences chest pain again. “If their CT scan shows clear heart arteries, we know from our previous ROMICAT I study that their prognosis over the next two years is really good, which can be useful farther down the road,” Dr. Hoffmann said. Other studies have offered somewhat conflicting assessments of the efficiency and effectiveness of using CT scans as the first diagnostic test for chest pain. This trial is unique because the CT scan was done much earlier in the evaluation process compared to other studies and was used in a real-life setting. Moreover, this was the first trial to show that physicians could act on the information from the CT scan in a way that improved a measure of care – safe earlier discharge – after ER presentation for chest pain. “It shows that cardiac CT is ready for use in a pragmatic health care setting, as it is more effective than the standard ER evaluation,” said Dr. Hoffmann. This study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. http://medieigo.com/common/dld/mp3/9e184327b255becbaa69b4b8889383b2.mp3 Mon, 25 Jun 2012 12:00:00 +0900 English Learning MediEigo Podcasting http://medieigo.com/articles/-/885 メディエイゴ編集部 Cardiac computed tomography angiography scans (CT scans that look at the heart) can provide a virtually instant verdict on whether chest pain is from blockage of the coronary arteries. When used early to evaluate chest pain, the scans save patients and hospitals time and money by allowing doctors to quickly determine who should be admitted for treatment for a heart attack and who can be safely sent home. About 6 million people come to hospital emergency rooms (ERs) in the United States each year complaining of chest pain, but only a fraction are actually having a heart attack or other major cardiac problems. Physicians benefit because they can discharge many patients from the overcrowded ER very quickly, with solid reassurance that they’re not having a heart attack, while the standard evaluation takes much longer to assess whether the symptoms stem from blockages in their arteries. Patients benefit from an earlier diagnosis and can safely go home from the ER earlier. CARDIAC CT IS FASTER, MORE EFFECTIVE FOR EVALUATING PATIENTS WITH SUSPECTED HEART ATTACK CHICAGO (March 27, 2012) — Cardiac computed tomography angiography scans (CT scans that look at the heart) can provide a virtually instant verdict on whether chest pain is from blockage of the coronary arteries. When used early to evaluate chest pain, the scans save patients and hospitals time and money by allowing doctors to quickly determine who should be admitted for treatment for a heart attack and who can be safely sent home, according to research presented today at the American College of Cardiology’s 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field. The ROMICAT II study involved 1,000 patients at nine hospitals across the United States. The results showed that using CT scans to evaluate patients with chest pain in the emergency room (ER) reduced their average time spent in the hospital by 18 hours. Half of the patients receiving the CT scan were safely discharged within nine hours compared to only 15 percent of patients receiving standard care. The use of CT resulted in 10 percent to 20 percent cost savings to the ER over standard care. “These data suggest that doing a CT scan early benefits both patients and physicians,” said Udo Hoffmann, MD, MPH, director of cardiac imaging at Massachusetts General Hospital and the study’s lead investigator. “Physicians benefit because they can discharge many patients from the overcrowded ER very quickly, with solid reassurance that they’re not having a heart attack, while the standard evaluation takes much longer to assess whether the symptoms stem from blockages in their arteries. Patients benefit from an earlier diagnosis and can safely go home from the ER earlier.” About 6 million people come to hospital ERs in the United States each year complaining of chest pain, but only a fraction are actually having a heart attack or other major cardiac problems. Under the current standard of care, most individuals are observed in the hospital for one or two days and may be given one of several cardiac stress tests to assess their heart’s health. Cardiac CT scans allow doctors to quickly use X-ray images of the heart to identify whether a patient has blocked arteries or other cardiac problems. The study enrolled patients who arrived in the ER with chest pain and who were at intermediate risk for a heart attack based on their symptoms and initial ER evaluation, which included blood tests and electrocardiogram results. Patients were randomly assigned to receive either a CT scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient’s situation and physician preference. Because healthy patients were discharged much earlier and often needed just a CT scan and a single blood test, their health care costs were lower. “It looks like CT saves time and money for the health care system in those who have no blockages in their coronary arteries. Though only a modest amount of money is saved per patient, it may save a lot of money considering the millions of patients affected across the country,” Dr. Hoffmann said. “CT allows you to spend your health care dollars focusing on the people who are actually sick. One could argue that this is a better use of health care resources.” CT scans also provide useful prognostic information that doctors can refer back to if the patient experiences chest pain again. “If their CT scan shows clear heart arteries, we know from our previous ROMICAT I study that their prognosis over the next two years is really good, which can be useful farther down the road,” Dr. Hoffmann said. Other studies have offered somewhat conflicting assessments of the efficiency and effectiveness of using CT scans as the first diagnostic test for chest pain. This trial is unique because the CT scan was done much earlier in the evaluation process compared to other studies and was used in a real-life setting. Moreover, this was the first trial to show that physicians could act on the information from the CT scan in a way that improved a measure of care – safe earlier discharge – after ER presentation for chest pain. “It shows that cardiac CT is ready for use in a pragmatic health care setting, as it is more effective than the standard ER evaluation,” said Dr. Hoffmann. This study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Cardiac computed tomography angiography scans (CT scans that look at the heart) can provide a virtually instant verdict on whether chest pain is from blockage of the coronary arteries. When used early to evaluate chest pain, the scans save patients and hospitals time and money by allowing doctors to quickly determine who should be admitted for treatment for a heart attack and who can be safely sent home. About 6 million people come to hospital emergency rooms (ERs) in the United States each year complaining of chest pain, but only a fraction are actually having a heart attack or other major cardiac problems. Physicians benefit because they can discharge many patients from the overcrowded ER very quickly, with solid reassurance that they’re not having a heart attack, while the standard evaluation takes much longer to assess whether the symptoms stem from blockages in their arteries. Patients benefit from an earlier diagnosis and can safely go home from the ER earlier. CARDIAC CT IS FASTER, MORE EFFECTIVE FOR EVALUATING PATIENTS WITH SUSPECTED HEART ATTACK CHICAGO (March 27, 2012) — Cardiac computed tomography angiography scans (CT scans that look at the heart) can provide a virtually instant verdict on whether chest pain is from blockage of the coronary arteries. When used early to evaluate chest pain, the scans save patients and hospitals time and money by allowing doctors to quickly determine who should be admitted for treatment for a heart attack and who can be safely sent home, according to research presented today at the American College of Cardiology’s 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field. The ROMICAT II study involved 1,000 patients at nine hospitals across the United States. The results showed that using CT scans to evaluate patients with chest pain in the emergency room (ER) reduced their average time spent in the hospital by 18 hours. Half of the patients receiving the CT scan were safely discharged within nine hours compared to only 15 percent of patients receiving standard care. The use of CT resulted in 10 percent to 20 percent cost savings to the ER over standard care. “These data suggest that doing a CT scan early benefits both patients and physicians,” said Udo Hoffmann, MD, MPH, director of cardiac imaging at Massachusetts General Hospital and the study’s lead investigator. “Physicians benefit because they can discharge many patients from the overcrowded ER very quickly, with solid reassurance that they’re not having a heart attack, while the standard evaluation takes much longer to assess whether the symptoms stem from blockages in their arteries. Patients benefit from an earlier diagnosis and can safely go home from the ER earlier.” About 6 million people come to hospital ERs in the United States each year complaining of chest pain, but only a fraction are actually having a heart attack or other major cardiac problems. Under the current standard of care, most individuals are observed in the hospital for one or two days and may be given one of several cardiac stress tests to assess their heart’s health. Cardiac CT scans allow doctors to quickly use X-ray images of the heart to identify whether a patient has blocked arteries or other cardiac problems. The study enrolled patients who arrived in the ER with chest pain and who were at intermediate risk for a heart attack based on their symptoms and initial ER evaluation, which included blood tests and electrocardiogram results. Patients were randomly assigned to receive either a CT scan as their first diagnostic test or standard care, which could include a cardiac stress test or no tests at all, depending on the patient’s situation and physician preference. Because healthy patients were discharged much earlier and often needed just a CT scan and a single blood test, their health care costs were lower. “It looks like CT saves time and money for the health care system in those who have no blockages in their coronary arteries. Though only a modest amount of money is saved per patient, it may save a lot of money considering the millions of patients affected across the country,” Dr. Hoffmann said. “CT allows you to spend your health care dollars focusing on the people who are actually sick. One could argue that this is a better use of health care resources.” CT scans also provide useful prognostic information that doctors can refer back to if the patient experiences chest pain again. “If their CT scan shows clear heart arteries, we know from our previous ROMICAT I study that their prognosis over the next two years is really good, which can be useful farther down the road,” Dr. Hoffmann said. Other studies have offered somewhat conflicting assessments of the efficiency and effectiveness of using CT scans as the first diagnostic test for chest pain. This trial is unique because the CT scan was done much earlier in the evaluation process compared to other studies and was used in a real-life setting. Moreover, this was the first trial to show that physicians could act on the information from the CT scan in a way that improved a measure of care – safe earlier discharge – after ER presentation for chest pain. “It shows that cardiac CT is ready for use in a pragmatic health care setting, as it is more effective than the standard ER evaluation,” said Dr. Hoffmann. This study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. http://medieigo.com/common/dld/mp3/31cf466a4c85bf7f4f9a2488a49c3a6e.mp3 Mon, 18 Jun 2012 12:00:00 +0900 English Learning MediEigo Podcasting