Breast Cancer Recurrence Rate Not Up With Autologous Fat Transfer

THURSDAY, Nov. 15, 2018 — For patients with breast cancer, reconstruction with autologous fat transfer (AFT) seems not to increase the rate of locoregional recurrence versus conventional breast reconstruction, according to a study published online Oct. 10 in JAMA Surgery.

Todor Krastev, M.D., Ph.D., from the Maastricht University Medical Center in the Netherlands, and colleagues matched 287 patients with 300 affected breasts receiving AFT between 2006 and 2014 to 300 nonexposed control patients based on age, type of oncologic surgery, tumor invasiveness, and disease stage. AFT patients were followed for a mean of 9.3 years, including 5.0 years following AFT; control patients were followed for a mean of 8.6 years after primary surgery.

The researchers identified eight locoregional recurrences in the treatment group and 11 among the control group, for an unadjusted hazard ratio of 0.63 (95 percent confidence interval, 0.25 to 1.60; P = 0.33). In relevant subgroups based on the type of oncologic surgery, tumor invasiveness, or pathologic stage, there were no increased locoregional recurrence rates. With respect to distant recurrences or breast cancer-specific mortality, no increased risks were detected with AFT.

“In line with reported rates from other published matched cohorts, there is no clinical evidence so far to suggest that AFT leads to increased rates of cancer relapse in patients with breast cancer,” the authors write.

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Posted: November 2018

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8 Women Reveal the Tinder Opening Line They Actually Responded to

It’s not always easy to break the ice—especially on a dating app. And sadly, when it comes to apps like Tinder, men are usually expected to make the first move. That’s a lot of pressure!

Even if you come up with a perfect opening line, chances are it usually won’t get a response. That’s because women are constantly inundated with messages from guys who think they’re being clever, when in fact, they’re just coming off as creepy. Most women can smell a traditional pickup line from a mile away, which is why you have to put in the extra effort to be engaging and creative.

Instead of becoming one of those matches that sits idly in an empty text box, try these tips for dating app opening lines that verified ladies themselves have approved. Who knows? You might just get a drink or two out of it.

Break barriers.

Getty ImagesAleksandarNakic

We say to hell with tradition! It’s nearly 2019. Time to shake things up. Put the ball in her court and encourage her to make the first move. And even more points to you if you do it with a wry sense of humor.

“The best opening like I’ve ever heard was: ‘I’m bad at this, so I’m going to buck the Tinder trend and let you make the first move, if that’s okay.’” —Ann, 29.

Ask her two questions.

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Women like options. We also like to feel special. Give us both by asking us two specific questions about ourselves, whether it’s “So I see you like The West Wing. Do you identify more with Josh or Toby?” or “Love the photo of you in Venice—what was the best restaurant you went to there?”

“I always like when men begin with two questions. Not just any questions — questions specific to my profile. I like when they show they’ve looked past my pictures and are taking an interest in the things I have said. I prefer two questions because if I don’t want to answer one, I have a second option.” —Brooke, 30

Focus on your profile over your pics.

Getty ImagesYiu Yu Hoi

This cannot be stressed enough. Every woman we spoke with emphasized that interest in their profile is much more important to them than interest in their photos. Make this your Golden Rule: when you send your opening message, ask about things she’s written on her profile, in addition to what you can see from her photos.

“The most important part, for me, is that a guy opts for my profile over my pictures. Yes, we all put up pictures that make us look attractive, but hopefully you’re looking to actually talk to me, as well. Any attempt at personalization is awesome. Steer clear of the pet names.” —Lauren, 28

Flattery will get you…everywhere.

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You don’t have to be a suck-up, but a simple compliment never goes out of style. People like to feel attractive. If you combine a compliment about their physical appearance with one about their likes/interests, then you’ve got this in the bag.

“My favorite opening line probably has to be a compliment. Not a sexual one, but one that shows I caught their attention in some way. Yes, it can be about my pictures and appearance, but nothing derogatory or implying that I’m getting naked for you.” —Sally, 32

Use artistry.

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It’s 2017, but old-fashioned whimsy never goes out of style.

“One guy told me an entire story about our potential first date using only emojis. On the one hand, it showed he had a lot of time on his hand, but on the other it made me smile and showed he was creative and had a sense of humor.” —Gabby, 30

Offering to buy her food never hurts.

Getty ImagesSinan Saglam / EyeEm

Women on Tinder don’t want a pen pal. We are looking for someone to date. Put it out there right away that not only are you interested, but you’re going to take the initiative and ask us out. And if you make the explicit offer to buy us food, so much the better.

“I like keeping it light, but also practical. Ask me something random, like ‘Hawaiian or pepperoni?’ And then buy me pizza.” —Susan, 31

Pay attention to her photos and bio

Getty ImagesHero Images

If you’re feeling her style, pay attention to her pictures. Ask thoughtful questions based on actual facts she has presented about herself. Read about her interests ad look at the activities she’s engaged in in photos.

“Tinder is a hellscape most of the time. I don’t want to see the word ‘hey.’ I want to see that you’ve read what I wrote in my bio and are present enough to ask me about it. It makes you stand out from the crowd. We ladies get plenty of weird pick up lines from random dudes. It may seem like a low bar, but paying attention to detail goes a really long way. If she’s hiking with her best friend in one of her photos, tell her how fun the hike looked. Ask if she goes hiking often. It will help you in the long run.” —Jasmine, 29

Don’t be afraid to be vulnerable

Getty ImagesTim Robberts

She’s on a dating app and she doesn’t expect you to be a bleeding-heart emotional mess, but that doesn’t mean you can’t show vulnerability. Being able to shine through as a genuine, thoughtful person will make her feel at ease.

“I respond to guys who are sincerely nice, not meaning ones who refer to themselves as nice. That’s a huge red flag. I like a guy who tells me details about his life and passions right away. Showing you’re not scared to open up about things in your life shows that you’re not a huge tool bag, but someone worth getting to know. Just remember, tell the truth. We always know when you’re lying!” —Gabby, 27

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Why early diagnosis of autism should lead to early intervention

Research suggests children can be reliably diagnosed with autism before the age of two. It also shows that many of the behavioural symptoms of autism are present before the age of one.

These behaviours include decreased interest in social interaction, delayed development of speech and intentional communication, a lack of age-appropriate sound development, and unusual visual fixations.

Preliminary results of a study in the Wellington region indicate most children are diagnosed when they are around three years old. However, there is arguably little point of providing early diagnosis if it does not lead to evidence-based early intervention.

Early start

The Early Start Denver Model (ESDM) is a promising therapy for very young children (between one and five years) with, or at risk for, autism. ESDM uses play and games to build positive relationships in which the children are encouraged to boost language, social and cognitive skills.

Where ESDM differs most from traditional intervention is that behavioural teaching techniques are embedded within this play. This includes providing clear cues for a behaviour, and rewarding that behaviour. Parents, therapists and teachers can use ESDM techniques within the children’s play and daily routines to help them reach developmentally appropriate milestones.

For example, a child who does not yet talk, may be learning to reach for preferred items. A child who has a lot of language may be learning to answer questions like “what is your name?”.

Initial research conducted in the United States, where the model was developed, suggests that ESDM is particularly effective when implemented for more than 15 hours a week by trained therapists in the home environment.

Improved cognition in early childhood

The model was adopted in Australia where the government funds autism specific early childhood centres. Research conducted in these centres indicates that children receiving ESDM intervention from trained therapists show greater improvements in understanding and cognitive skills than children who were not receiving treatment.

In New Zealand there is no government funding for such therapy. As a result, the cost of providing this intensive level of early intervention is beyond the budget of most families. There is also a lack of trained professionals with the technical expertise to implement such therapies.

For these reasons, we are working with the Autism Intervention Trust and Autism New Zealand to develop a New Zealand-specific low-intensity approach to delivering ESDM. The team is using the research of what is effective overseas and is applying it within a New Zealand context.

Mainstream schooling

New Zealand takes an inclusive approach to education. The main goal of the research programme therefore is for children with autism and their families to receive support earlier so that they can get a better start in their development and go on to mainstream schools.

One project involves training kindergarten teachers in ESDM. Inclusion of ESDM strategies in kindergartens is the biggest unknown because there is little teacher training in New Zealand around how to best support children with autism in mainstream settings.

A second project involves providing parent coaching and then adding on a small amount of one-on-one therapy. This will provide some preliminary evidence as to whether adding a minimal amount of one-on-one therapy is any more beneficial that just coaching parents.

Each project involves examining specific measures of communication, imitation (a key early learning skill children with autism typically struggle with) and social engagement with others.

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How exercise could help fight drug addiction

The siren call of addictive drugs can be hard to resist, and returning to the environment where drugs were previously taken can make resistance that much harder. However, addicts who exercise appear to be less vulnerable to the impact of these environmental cues. Now, research with mice suggests that exercise might strengthen a drug user’s resolve by altering the production of peptides in the brain, according to a study in the journal ACS Omega.

Re-exposure to drug-related cues, such as the location where drugs were taken, the people with whom they were taken or drug paraphernalia, can cause even recovered drug abusers to relapse. Prior studies have shown that exercise can reduce craving and relapse in addicts, as well as mice. Although the mechanism was unknown, exercise was thought to alter the learned association between drug-related cues and the rewarding sensations of taking a drug, possibly by changing the levels of peptides in the brain. Jonathan Sweedler, Justin Rhodes and colleagues at University of Illinois at Urbana-Champaign decided to explore this theory by quantifying these peptide changes in mice.

Mice were given cocaine injections over four days in special chambers with a distinctive floor texture to produce a drug association with that environment. The animals were then housed for 30 days in cages, some of which included a running wheel. The researchers found that mice that exercised on these wheels had lower levels of brain peptides related to myelin, a substance that is thought to help fix memories in place. Re-exposure to the cocaine-associated environment affected running and sedentary mice differently: Compared with sedentary mice, the animals with running wheels showed a reduced preference for the cocaine-associated environment. In addition, the brains of re-exposed runners contained higher levels of hemoglobin-derived peptides, some of which are involved in cell signaling in the brain. Meanwhile, peptides derived from actin decreased in the brains of re-exposed sedentary mice. Actin is involved in learning and memory and is implicated in drug seeking. The researchers say these findings related to peptide changes will help to identify biomarkers for drug dependence and relapse.

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Rest easy: Insomnia does NOT cause an early death

Rest easy: Insomnia does NOT cause an early death, finds largest study ever into lack of sleep

  • Review of more than 36m people found no evidence it affects mortality
  • But critic argues while most can cope with insomnia, it is serious for some
  • Insomnia is the most common sleep disorder; affects 10-to-30% of people 
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Insomnia sufferers should rest easy as the largest ever study into the lack of sleep found it does not cause an early death.

A review of more than 36million people revealed there is no evidence struggling to nod off or waking in the night affects mortality.

But a critic argues that while the majority may be able to cope with a few sleepless nights, for some the health consequences can be devastating.


The largest ever study into lack of sleep found insomnia does not cause an early death (stock)

In the first review of its kind, researchers from Flinders University, Adelaide, analysed 17 studies investigating a possible link between insomnia and mortality.

The studies were carried out all over the world for an average of 11 years. Most were made up of patients who self-reported insomnia, while some were officially diagnosed.

Insomnia was defined as either being frequent – struggling to nod off on three or more nights a week – or ongoing – sleeplessness lasting more than a month.

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Results suggest that while insomnia may lead to everything from depression and anxiety to diabetes and dementia, it does not actually affect a person’s lifespan.

The study was published in the journal Sleep Medicine Reviews. 

The researchers, led by Dr Nicole Lovato, believe this should reassure those who toss and turn at night that they are not more likely to pass away prematurely.

WHAT IS INSOMNIA?

Insomnia means you regularly have problems sleeping. It usually gets better by changing your sleeping habits.

You have insomnia if you regularly: find it hard to go to sleep, wake up several times during the night, lie awake at night, wake up early and can’t go back to sleep, still feel tired after waking up

Everyone needs different amounts of sleep. On average, adults need 7 to 9 hours, while children need 9 to 13 hours.

You probably don’t get enough sleep if you’re constantly tired during the day.

The most common causes of insomnia are: stress, anxiety or depression, excessive noise, an uncomfortable bed or alcohol, caffeine or nicotine.

Insomnia usually gets better by changing your sleeping habits. For example, going to bed and waking up at the same time every day, and only going to bed when you feel tired.

Source: NHS

But, they stress, only 17 studies were analysed, which all had a relatively short follow-up time. Longer trials are therefore required to confirm the findings.

They also note cognitive behavioural therapy, which aims to help insomniacs develop coping skills, correct attitudes about sleep and modify poor habits, remains the gold standard of treatment.   

But Dr Russell Foster, head of the Sleep and Circadian Neuroscience Institute at the University of Oxford, argues insomnia can be serious for some.

He told The Times: ‘We recently did a study on teenage sleep. If you just took the average, you would think, “What is all the fuss about?”.

‘However, if you look at the spread of the data you can see 30 per cent are showing really poor sleep.’

For these select few, insomnia may be extremely serious, he added.  

Insomnia is the most common sleep disorder, affecting between 10 and 30 per cent of people. 

It is generally defined as difficulty nodding off, staying asleep or feeling exhausted during the day. 

Previous studies have suggested a lack of sleep increases a person’s heart rate and the time between beats, which was thought to lead to an early death.

However, the current study’s authors argue evidence supporting this is limited, with many studies being small and not adjusting for factors such as smoking or obesity. 

This comes after scientists discovered a ‘sleep switch’ that may be essential to a decent night’s shut eye last month.

A cluster of cells in the region of the brain responsible for sleep become activated as mice are nodding off, according to a study by the Beth Israel Deaconess Medical Center.

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5 rules that will not let diabetes

The incidence of diabetes can be prevented in 80% of cases, it was stated by the acting Minister of health Suprun. According to her, 50% of cases of type 2 diabetes people living with him, not knowing that they are sick, for this disease characterized by long duration without showing critical symptoms.

The expert said about what rules are necessary to avoid getting diabetes.

Rule 1: balanced diet. According to the doctor, is particularly at risk with respect to the risk of diabetes is the consumption of high-calorie foods that are high in sugar and different additives. In addition, you should abandon or minimize the quantity of processed food – sausages, products made from white flour and rice.

Not to diabetes, it is important to eat fiber – vegetables and fruits. The expert was advised to eat regularly legumes – they are a regular presence on the table allows you to eat less calories not to gain weight and to have the minimum risk of developing diabetes.

Rule 2: maintain a healthy weight. Suprun stressed that obesity and a larger waist is the evidence of insulin resistance, which is developing prediabetes and then diabetes. Fat affects the maintenance of levels of sugar and cholesterol in the blood, so it is important to stay at one weight and not to gain weight. The greater the share of body fat, the higher the risk of diabetes.

Rule 3: be physically active. You must use any possibility for movements. Weekly body should get about 150 minutes of aerobic activity of moderate character or 75 minutes of intense exercise.

Rule 4: do not smoke. Scientific evidence suggests that smokers are 30-40% more likely to develop type 2 diabetes than non smokers. The risk of diabetes in smokers is higher due to the fact that substances from cigarette smoke getting to them in the body, causing inflammation, damage and oxidation of cells.

Rule 5: be examined. If some people in my family are diabetics, it is vital to check the blood sugar level and seek treatment if increasing. The concentrations of sugars from 5.7 to 6.4 is a serious reason for such appeals.

Renamedialog wrote about what foods can lead to diabetes.

The Tendon transplant to work in a cross-band OP

In many cases, a SURGERY after a cruciate ligament tear is useful. Often, the cruciate ligament is replaced by the graft by a Tendon. As the OP runs out and what to keep in mind after the Operation.

An adverse movement, a sound like a whip, and a sudden pain, a ligament tear, sometimes faster than many suspect. The two cruciate ligaments are actually very robust, because they play for the stability of the knee joint has an important role: Together with the Outer and inner band forming the ligamentous apparatus of the knee joint, the knee with each movement and strengthens.

Seen from the side, the two bands intersect – therefore, you will have your name. A cross band runs from the Shin bone down the front to the thigh bone obliquely upward and backward (anterior cruciate ligament), the other one from the Shin from the bottom rear of the thigh obliquely to the front upper (posterior cruciate ligament). You have to prevent the femur sliding too far backwards and the Shin bone too far forward. Is one of the bands ripped (cruciate ligament rupture), can only produce an Operation with the necessary stability in the knee joint.

After an injury, and is suspected to have a ligament tear you should definitely go to the doctor. This can clarify with the patient what therapy is for a cure is necessary. Conservative methods, such as a targeted muscle building through physiotherapy, in each case, necessary in order to strengthen the knee after the injury. However, a pure muscle – building can replace alone, never a broken cross-band that shows the statistics: over 90 percent of the patient’s instability in the knee joint after sole treatment with conservative methods still.

About the author

Norbert Wynands is a specialist in surgery, accident surgery and sports medicine. He is senior physician of the Department of trauma and reconstructive surgery at the red cross hospital in Lindenberg.

Although the healing from the physical condition of the Person and your personal claim to your physical activity, the person Concerned, however: The younger and the more active, the more recommend is a surgery in which the ligament is replaced. With the following operational method of a cruciate ligament rupture can be treated.

Cross-band SURGERY with tendon graft

A virtually universal method of operation of the cruciate ligament by a tendon graft, the tendon of the thigh muscle (semitendinosus tendon, or quadriceps) or the patellar tendon of the patient is taken. The latter is the connection between the lower leg and kneecap. This minimally invasive, arthroscopic surgery (single-bundle reconstruction) is now one of the Standard methods of treatment and can be done up to one year after the injury.

When the Operation is first removed through a small incision in the replacement tendon. This is about a twenty to thirty centimeters long tendon is then placed four on top of each other, so that you are reduced to a quarter of the length and their tensile strength is significantly increased. Then be drilled in both the femur and in the tibia bone a small, approximately two-centimeter-long channels. By this, the two Ends are pulled tendon Replacement, tensioned and then fixed. The aim is that the replacement tendon in the subsequent conservation phase, with the bone fully fuses, so that the function of the cruciate ligament is largely restored.

Fasten the cross band set with a tear-resistant thread

The Fixation of the cruciate ligament set can be done using various techniques. One of these is the “Tight Rope”method is: The replacement tendon is pulled with a particularly tear-resistant medical thread (Tight Rope) by hauling technique in the drilled bone channels – first through the channel in the leg rail, then into the channel in the femur. This type of pulley allows the replacement tendon to take up slack in the best possible way.

In order to fix the string on the thigh bone, rolling papers, a small Metal about the filament introduced. As soon as the tendon was pulled through the top of the bone canal, the leaves on the outer side of the femur. Now it has a larger surface than the Radius of the drilled bone channel and thereby prevents a sliding Back of the cross-band set. Subsequently, the tendon is tensioned, and on the outer side of the opposite Shin bone is fixed with a screw.

With the time, the thread and the replacement tendon around the fabric, the Replacement ligament is based. In the subsequent conservation phase, the Tendon axes with the bone. The screw loosens over time, the metal flakes and the thread will remain in the knee of the patient.

Physical therapy is a Must

After a cruciate ligament tear should be waiting with the Operation until the knee of the patients want to completely off, and also is pain-free. Only then is it possible that the cruciate ligament replace the normal proportions of the Body. Often, concomitant injuries associated with cruciate ligament tears such as a meniscus tear. These are also only in a worn woolen knee completely visible and need to be treated in order to obtain an intact joint.

Even if surgery, everything runs optimally, can be replaced the function of the natural cruciate ligament, never to 100 percent. However, it can be manufactured by means of a minimally invasive procedure and the relevant volume set, the stability of the knee joint.

Without an accompanying physiotherapy and without the will of the patient, regain mobility and strength in the leg, but. Those who make the effort and diligently by the skilled person recommended, and injury to and healing degree of coordinated Exercises, therefore, has the prospect to be able to his knee after six to eight months to fully re-charge. An external knee brace (orthosis) is the patient in everyday life also safety, and prevents Twisting of the knee.

lasmiditan

INDIANAPOLIS, Nov. 14, 2018 /PRNewswire/ — Eli Lilly and Company (NYSE: LLY) has announced the submission of a New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) for lasmiditan for the acute treatment of migraine with or without aura in adults.

Lasmiditan is an investigational, oral, centrally-penetrant, selective serotonin 5-HT1F agonist that is structurally and mechanistically distinct from other approved migraine therapies and lacks vasoconstrictive activity. It is the first and only molecule in the "-ditan" class under evaluation for the acute treatment of migraine in adults. If approved, it could represent the first significant innovation for the acute treatment of migraine in more than two decades.

The NDA for lasmiditan includes data from two Phase 3 single-attack studies (SAMURAI and SPARTAN), which evaluated the safety and efficacy of lasmiditan for the acute treatment of migraine. In both studies, at two hours following the first dose of lasmiditan, the percentage of patients who were migraine pain-free was significantly greater compared to placebo. These results were significant across all studied doses. Lasmiditan also met the key secondary endpoint, with a significantly greater percentage of patients free of their most bothersome symptom (MBS) compared with placebo at two hours following the first dose. In these studies, patients chose their MBS from sensitivity to light, sensitivity to sound or nausea. The most commonly reported adverse events after lasmiditan dosing were dizziness, paresthesia, somnolence, fatigue, nausea, muscle weakness and numbness. Data from these studies were presented at the American Headache Society (AHS) annual meeting and the American Academy of Neurology (AAN) annual meeting.

About Migraine

Migraine is a disabling, neurologic disease characterized by recurrent episodes of severe headache accompanied by other symptoms including nausea, vomiting, sensitivity to light and sound, and changes in vision.1,2 More than 30 million American adults have migraine, with three times more women affected by migraine compared to men.3,4,5,6 According to the Medical Expenditures Panel Survey, the total unadjusted cost associated with migraine in the U.S. is estimated to be as high as $56 billion annually, yet migraine remains under-recognized and under-treated.3,7,8

About Lasmiditan

Lasmiditan is an investigational, first-in-class molecule under evaluation for the acute treatment of migraine. Lasmiditan uses a novel mechanism of action which selectively targets 5-HT1F receptors, including those expressed in the trigeminal pathway, and has been designed for the acute treatment of migraine without the vasoconstrictor activity associated with some migraine therapies. Data from two Phase 3 single-attack studies (SAMURAI and SPARTAN) have been presented at the American Headache Society (AHS) annual meeting and the American Academy of Neurology (AAN) annual meeting. In March 2017, Lilly completed the acquisition of CoLucid Pharmaceuticals, including lasmiditan, which was originally discovered at Lilly.

About Lilly's Commitment to Headache Disorders

For over 25 years, Lilly has been committed to helping people suffering from headache disorders, investigating more than a dozen different compounds for the treatment of migraine, cluster headache and other disabling headache disorders. These research programs have accelerated the understanding of these diseases and furthered the advancement of Lilly's comprehensive late-stage development programs studying galcanezumab-gnlm for prevention of migraine and cluster headache, and lasmiditan for the acute treatment of migraine. Our goal is to make life better for people with headache disorders by offering comprehensive solutions to prevent or stop these disabling diseases. The combined clinical, academic and professional experience of our experts helps us to build our research portfolio, identify challenges for healthcare providers and pinpoint the needs of patients living with migraine and cluster headache.

About Eli Lilly and Company

Lilly is a global healthcare leader that unites caring with discovery to make life better for people around the world. We were founded more than a century ago by a man committed to creating high-quality medicines that meet real needs, and today we remain true to that mission in all our work. Across the globe, Lilly employees work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to communities through philanthropy and volunteerism. To learn more about Lilly, please visit us at www.lilly.com and www.lilly.com/newsroom/social-channels.  P-LLY

This press release contains forward-looking statements (as that term is defined in the Private Securities Litigation Reform Act of 1995) about Emgality (galcanezumab-gnlm) as a treatment for patients with migraine and as a potential treatment for patients with episodic cluster headaches; lasmiditan as a potential treatment for patients with migraine; and tanezumab as a potential treatment for patients with osteoarthritis, chronic low back pain and cancer pain and reflects Lilly's current belief. However, as with any pharmaceutical product, there are substantial risks and uncertainties in the process of development and commercialization. Among other things, there can be no guarantee that Emgality, lasmiditan or tanezumab will receive additional regulatory approvals. There can also be no guarantee that any of these molecules will be commercially successful. For further discussion of these and other risks and uncertainties, see Lilly's most recent Form 10-K and Form 10-Q filings with the United States Securities and Exchange Commission. Except as required by law, Lilly undertakes no duty to update forward-looking statements to reflect events after the date of this release.

SOURCE Eli Lilly & Company

Posted: November 2018

lasmiditan FDA Approval History

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Why natural depression therapies are better than pills

Winter is upon us. And with it comes the annual worsening of depressive symptoms. Sadly, in the United States, suicide continues to claim more lives than firearms, and suicide rates are increasing in nearly all states. The U.S. Centers for Disease Control and Prevention reports that death by suicide has increased by 30 per cent since 1999 and a similar trend is observed in Canada.

I was distressed but not surprised to learn that these increases occurred over a period of time in which use of antidepressants skyrocketed by 65 per cent. By 2014, around one in eight Americans over the age of 12 reported recent antidepressant use.

I practice critical-care medicine in Guelph, Ontario. Sadly, 10 to 15 per cent of my practice is the resuscitation and life support of suicide and overdose patients.

It is not uncommon for these patients to have overdosed on the very antidepressants they were prescribed to prevent such a desperate act. The failures of antidepressants are a clear and present part of my clinical experience.

Wedded to drugs that barely work

Ten years ago, when finishing medical school, I carefully considered going into psychiatry. Ultimately, I was turned off by my impression that thought leaders in psychiatry were mistakenly wedded to a drug treatment that barely works.

A 2004 review by the Cochrane Foundation found that when compared against an “active” placebo (one that causes side effects similar to antidepressants), antidepressants were statistically of almost undetectable benefit.

Studies that compared antidepressants to “dummy” placebos showed larger but still underwhelming results. On the 52-point Hamilton Depression Rating Scale (HDRS), patients who took the antidepressants fluoxetine (Paxil) or venlafaxine (Effexor) experienced an average decrease of 11.8 points, whereas those taking the placebo experienced an average decrease of 9.6 points.

I am not suggesting that antidepressants do not work. I am suggesting that they are given a precedence in our thinking about mental health that they do not deserve.

I leave it to readers to look at the Hamilton Depression Rating Scale and decide for themselves whether a drop of 2.5 points is worth taking a pill with myriad potential side effects including weight gain, erectile dysfunction and internal bleeding.

It might be, but do note that taking an antidepressant does not seem to decrease the risk of suicide.

Natural therapies that work

The far more exciting and underplayed point, to me, is that multiple non-drug treatments have been shown to be as effective. As a staunch critic of alternative medical regimes such as chiropractic, acupuncture and homeopathy, it surprises me to note that the following “natural” therapies have rigorous, peer-reviewed scientific studies to support their use:

1. Exercise

In 2007, researchers at Duke University Medical Center in North Carolina randomly assigned patients to 30 minutes of walking or jogging three times a week, a commonly prescribed antidepressant (Zoloft), or placebo. Their results? Exercise was more effective than pills!

A 2016 review of all the available studies of exercise for depression confirms it: Exercise is an effective therapy. And it’s free!

2. Bright light therapy

You know how you just feel better after an hour out in the sun? There probably is something to it. Bright light therapy is an effort to duplicate the sun’s cheering effects in a controlled fashion. Typically, patients are asked to sit in front of a “light box” generating 10,000 Lux from 30 to 60 minutes first thing in the morning.

A review of studies using this therapy showed significant effect. The largest study showed a 2.5 point drop on the HDRS, roughly equal to that seen from antidepressants.

The sun gives 100,000 lux on a clear day and I can’t think of a reason why sunlight itself wouldn’t work, weather permitting.

3. Mediterranean diet

This one surprised me when it came out last year. Researchers in Australia randomly assigned depressed patients to receive either nutritional counselling or placebo social support.

The nutritionists recommended a Mediterranean diet, modified to include local unprocessed foods.

Thirty-two per cent of the depressed dieters experienced remission versus eight per cent of those who only received social support, a far larger effect than seen in antidepressant trials.

4. Cognitive Behavioural Therapy (CBT)

This is the best recognized of the “natural” treatments for depression and the evidence is indisputable.

CBT is as effective as antidepressants but more expensive in the short term. However, antidepressants stop working when you stop taking them, whereas the benefits of CBT seem to last.

And as an aside, it is very difficult to overdose fatally on a bottle of therapy.

I freely admit that the trials I have mentioned are smaller than the major antidepressant trials. But whereas antidepressants are projected to bring in almost $17 billion a year for the pharmaceutical industry globally by 2020, the jogging and sunlight industries will never have the resources to fund massive international trials. With this in mind, I am convinced that they are at least as worthwhile as the pills.

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