Experts build crab-like robot to remove stomach cancer

SINGAPORE (Reuters) - Inspired by Singapore's famous chilli crab dish, researchers have created a miniature robot with a pincer and a hook that can remove early-stage stomach cancers without leaving any scars.

Mounted on an endoscope, it enters the patient's gut through the mouth. It has a pincer to hold cancerous tissues, and a hook that slices them off and coagulates blood to stop bleeding.

With the help of a tiny camera attached to the endoscope, the surgeon sees what's inside the gut and controls the robotic arms remotely while sitting in front of a monitor screen.

"Our movements are very huge and if you want to make very fine movements, your hands will tremble ... But robots can execute very fine movements without trembling," said enterologist Lawrence Ho, who helped design the robot.

Professor Ho, who works at Singapore's National University Hospital, said the robot helped remove early-stage stomach cancers in five patients in India and Hong Kong, using a fraction of the time normally taken in open and keyhole surgeries that put patients at higher risk of infection and leave behind scars.

Stomach, or gastric, cancer is the second leading cause of cancer deaths worldwide and is particularly common in east Asia. Diagnosis of gastric cancer usually occurs at a late stage of the disease when treatment is difficult and often unsuccessful.

Louis Phee, associate professor at Singapore's Nanyang Technological University's school of mechanical and aerospace engineering, helped design the robot with Ho.

They developed the robot after a seafood dinner in Singapore in 2004 with top Hong Kong surgeon Sydney Chung, who suggested they fashioned their device after the crab. Chung is best known for fighting SARS in Hong Kong in 2003.

"He (Chung) suggested we used the crab as a prototype. The crab can pick up sand and its pincers are very strong," said Ho.

"Many things are a certain way because they have evolved and adapted to certain functions ... we created something that followed the human anatomy and borrowed ideas from nature and incorporated the two."

The researchers formed a company last October and hope to make the robot commercially available in three years.

(This version corrects name of university)

(Reporting by Tan Ee Lyn; Editing by Sanjeev Miglani)

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New mental health manual is "dangerous" say experts

LONDON (Reuters) - Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and other experts said new categories of mental illness identified in the book were at best "silly" and at worst "worrying and dangerous."

"Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill," said Peter Kinderman, head of Liverpool University's Institute of Psychology at a briefing in London about widespread concerns over the manual.

"It's not humane, it's not scientific, and it won't help decide what help a person needs."

The DSM is published by the American Psychiatric Association (APA) and has symptoms and other criteria for diagnosing mental disorders. It is used internationally and seen as the diagnostic "bible" for mental health medicine.

No one from the APA was immediately available for comment.

More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.

Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medical zing behaviors most people would consider normal or just mildly eccentric, the experts said.

At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like "paraphilic coercive disorder" - and may allow offenders to escape prison by providing what could be seen as an excuse for their behavior, they added.

RADICAL, RECKLESS, AND INHUMANE

Simon Wessely of the Institute of Psychiatry at King's College London said a look back at history should make health experts ask themselves: "Do we need all these labels?"

He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognizing 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.

Allen Frances of Duke University and chair of the committee that oversaw the previous DSM revision, said DSM-5 would "radically and recklessly expand the boundaries of psychiatry" and result in the "lexicalization of normality, individual difference, and criminality."

David Pilgrim of Britain's University of Central Lancashire said it was "hard to avoid the conclusion that DSM-5 will help the interests of the drug companies."

"Madness and misery exist but they come in many shapes and sizes," he said. "We risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorized in rigid boxes.

"That would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise."

Nick Craddock of Cardiff University's department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM's broad categories were going wrong.

Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.

Other examples of diagnoses cited by experts as problematic included "gambling disorder," "internet addiction disorder" and "oppositional defiant disorder" - a condition in which a child "actively refuses to comply with majority's requests" and "performs deliberate actions to annoy others."

"That basically means children who say 'no' to their parents more than a certain number of times," Kinderman said. "On that criteria, many of us would have to say our children are mentally ill."

(Editing by Andrew Heavens)

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New mental health manual is "dangerous" say experts

LONDON (Reuters) - Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and other experts said new categories of mental illness identified in the book were at best "silly" and at worst "worrying and dangerous."

"Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill," said Peter Kinderman, head of Liverpool University's Institute of Psychology at a briefing in London about widespread concerns over the manual.

"It's not humane, it's not scientific, and it won't help decide what help a person needs."

The DSM is published by the American Psychiatric Association (APA) and has symptoms and other criteria for diagnosing mental disorders. It is used internationally and seen as the diagnostic "bible" for mental health medicine.

No one from the APA was immediately available for comment.

More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.

Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medical zing behaviors most people would consider normal or just mildly eccentric, the experts said.

At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like "paraphilic coercive disorder" - and may allow offenders to escape prison by providing what could be seen as an excuse for their behavior, they added.

RADICAL, RECKLESS, AND INHUMANE

Simon Wessely of the Institute of Psychiatry at King's College London said a look back at history should make health experts ask themselves: "Do we need all these labels?"

He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognizing 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.

Allen Frances of Duke University and chair of the committee that oversaw the previous DSM revision, said DSM-5 would "radically and recklessly expand the boundaries of psychiatry" and result in the "lexicalization of normality, individual difference, and criminality."

David Pilgrim of Britain's University of Central Lancashire said it was "hard to avoid the conclusion that DSM-5 will help the interests of the drug companies."

"Madness and misery exist but they come in many shapes and sizes," he said. "We risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorized in rigid boxes.

"That would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise."

Nick Craddock of Cardiff University's department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM's broad categories were going wrong.

Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.

Other examples of diagnoses cited by experts as problematic included "gambling disorder," "internet addiction disorder" and "oppositional defiant disorder" - a condition in which a child "actively refuses to comply with majority's requests" and "performs deliberate actions to annoy others."

"That basically means children who say 'no' to their parents more than a certain number of times," Kinderman said. "On that criteria, many of us would have to say our children are mentally ill."

(Editing by Andrew Heavens)

View the original article here

Metformin Preferred Drug for Type 2 Diabetes, Experts Say

MONDAY, Feb. 6 (HealthDay News) -- When it comes to the treatment of type 2 diabetes, the first line of defense is lifestyle changes such as losing weight and exercising more often.

But, if those lifestyle changes don't get blood sugar levels under control, the American College of Physicians (ACP) recommends the drug metformin as the first oral treatment that should be given.

If metformin alone can't control blood sugar levels, the ACP advises combining metformin with another blood-sugar lowering medication. But, the evidence isn't yet strong enough for the doctor's group to recommend one medication over another for combination therapy.

"Most diabetes medications do lower [blood sugar], but metformin is more effective with fewer side effects. And, the cost is less," said Dr. Amir Qaseem, director of clinical policy at the American College of Physicians, and the lead author of the new guidelines.

However, the ACP is recommending that metformin only be prescribed after someone has tried to change his or her lifestyle, he added.

"Diet, exercise and weight loss are so important in controlling type 2 diabetes. You can't just give pharmaceutical agents and not have lifestyle changes," Qaseem said.

The new guidelines are published in the Feb. 7 issue of the Annals of Internal Medicine.

Type 2 diabetes is a disease that causes high blood sugar levels. Over time, this can lead to blood-vessel damage in the eyes, kidneys, heart and nerves. Almost 26 million Americans have diabetes, and as many as 95 percent of those have type 2 diabetes, according to the new guidelines.

"Diabetes is a really important health-care issue in this country. It's a major cause of morbidity and mortality, and the prevalence of the disease is going up," Qaseem said.

Obesity and a sedentary lifestyle are significant risk factors for type 2 diabetes, although not everyone who has the disease is overweight.

There are currently 11 different classes of medications approved by the U.S. Food and Drug Administration for the treatment of type 2 diabetes, according to the guidelines. These medications work by lowering blood sugar levels.

To come up with the new guidelines on oral diabetes treatments, the reviewers looked at data for each available class of medication to assess how effective it was in lowering blood sugar, cholesterol and weight. They also looked at how much each medication was able to reduce the risk of complications from type 2 diabetes. And, they reviewed the safety of each type of medication.

They found that metformin was the most effective in lowering hemoglobin A1C (HbA1C) levels. HbA1C levels are a measure of long-term blood sugar control, estimating average blood sugar levels over several months.

The researchers also found that combination therapy with two drugs was more effective at lowering HbA1C than therapy with just one agent. However, when comparing different combination therapies, no particular combination stood out as superior to the others.

Metformin also appeared to be the most effective medication for lowering levels of LDL (bad) cholesterol, according to the guidelines. Metformin also seemed to be more effective at preventing all-cause mortality and heart disease.

Dr. Joel Zonszein, director of the clinical diabetes program at Montefiore Medical Center in New York City, said he would recommend starting medication along with lifestyle changes, instead of waiting to see if lifestyle medications work or not.

"Lifestyle changes fail in the majority of people. Why wait to start treating them? There should not be inertia. If you're more aggressive early in the disease you may be able to protect some of the beta cells," he said. Beta cells are cells in the pancreas that produce insulin, a hormone needed to metabolize carbohydrates in food.

Zonszein also said that many of the studies used to develop the new guidelines were short-term studies, often sponsored by drug manufacturers. He said to really know what treatments are best, longer-term studies are needed, as are studies that look at different combinations of diabetes medications.

He said he also would have liked the guidelines to address the use of cholesterol-lowering medications and blood-pressure lowering medications, as these are common problems seen in people with type 2 diabetes.

More information

The American Diabetes Association has more information on the types of oral medications available for type 2 diabetes.

View the original article here