Cancer Cliches to Avoid: I'm Not 'Brave'

Fighter, warrior, hero - some of the terms you might see used to describe people with cancer.

But according to a new survey, for some with the illness the words are seen as inappropriate rather than uplifting.

The UK poll by Macmillan Cancer Support of 2,000 people who have or had cancer found "cancer-stricken" and "victim" were also among the least-liked terms.

The charity said it showed how "divisive" simple descriptions of cancer can be.

Calling a person's cancer diagnosis a "war" or a "battle" and saying they had "lost their battle" or "lost their fight" when they died, were other unpopular descriptions, according to the poll carried out by YouGov.

Articles in the media and posts on social networks were found to be the worst offenders for using such language.

The survey found a preference for factual words to describe people with cancer, their diagnosis, and when someone with the illness dies.

'I'm not inspirational'

Mandy Mahoney, 47, has incurable metastatic breast cancer.

The outreach support worker, from London, was initially diagnosed with breast cancer in 2011 and it has since returned five times.

She said: "I think cancer-speak can be quite negatively loaded - the brave, fighter, warrior and survivor standard descriptors put an awful lot of pressure on the newly diagnosed."

Mandy said she also objected to describing people as "losing their battle" with cancer.

"That confers that you didn't fight or gave up," she said.

Instead, she prefers "clear, factual language" and describes herself simply as "living with incurable cancer".

"I'm not brave or inspirational, I'm just trying to live the life I have left well," she added.

However, Craig Toley, who was diagnosed with thyroid cancer in 2016 and is now in remission, said he thought some of the more positive terms could be empowering.

The 31-year-old, who is a powerlifter in his spare time, says: "Language like 'fight', 'struggle', 'warrior' and 'battle' will be interpreted differently by different people.

"Personally, I found those words helped empower me a lot and made me think of my cancer as a challenge I needed to fight.

"Everyone likes the story of a fighter."

'Divisive words'

Karen Roberts, chief nursing officer at Macmillan Cancer Support, said: "These results show just how divisive and 'Marmite' simple words and descriptions can be.

"Cancer throws all kinds of things your way, and struggling to find the words, and the emotional turmoil caused when our friends and family don't get it 'right' only makes lives feel even more upended.

"By drawing attention to this we want to encourage more people to talk about the words they prefer to hear, and stop the damage that can be caused to people's wellbeing and relationships."

Mandy said it was not necessary for people to "swallow a textbook and come up with all of the key phrases" to talk to someone with cancer, and it is fine to not always know what to say.

"If you tell me it's awkward and you don't know what to say I will find a way to make that right for you, and actually on some occasions I might say 'we don't have to talk about it'.

"But just be real."

Macmillan Cancer Support has launched a campaign to highlight the challenges posed by a cancer diagnosis and the support available.

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Gene Modified Chickens 'Lay Medicines'

Researchers at the University of Edinburgh's Roslin Institute have genetically modified chickens to produce human proteins in their eggs.

They hope the project will one day lead to lifesaving drugs that are much cheaper to make.

The team modified the genomes of the chickens so their eggs contain large amounts of high quality proteins.

Just three eggs contain a clinically significant dose, according to the scientists.

Initially the proteins will be used in research but laboratory tests have already found they work at least as well as equivalent drugs.

Protein-based therapies such as the cancer treatments Herceptin and Avastin can be effective where traditional drugs fail but they are highly expensive.

The new research - a collaboration between the institute and the university's spinout company Roslin Technologies - holds out the promise of a far cheaper production process.

We meet the medicine makers of tomorrow in a secure facility at the Institute.

Dozens of transgenic chickens are kept in rows of spacious pens.

Their job is straightforward enough: lay 300 eggs a year.

There are cockerels here too, something of a surprise to a townie like me.

Their purpose is twofold. Hens won't lay unless there's a cockerel in the vicinity.

Plus the males are required to make more transgenic chickens.

These creatures are not clones. New generations of protein producers are made in the conventional, biological way.

Professor Helen Sang of the Institute says it's a cost effective way of scaling up production:

"If you want more eggs you just need more birds."

"That's why in this pen we have a cockerel - and he can produce an awful lot of children in a short time.

"So we can produce a lot of hens in a short period if we want to bulk up the supply of the drug."

In a laboratory away from the cacophony of the chicken shed, Dr Lissa Herron of Roslin Technologies produces a tray of brown eggs that would grace any breakfast table.

But these ones will never enter the food chain. "It's quite old fashioned initially," she says.

"We just crack the egg. I've become quite adept at cracking eggs over the years."

The golden yolk is put to one side unneeded.

It's the egg white that contains the treasure: large quantities of medically important proteins.

"These proteins are really, really expensive to produce," she says, "because you can't just synthesise them in a chemistry lab.

"You need a living system to manufacture them because proteins are very large molecules, very complex and they need all of the machinery of a cell to make them and fold them properly."

So far the the chickens have been genetically modified to produce two types of protein.

One is Macrophage-CSF. It is being is being developed as a therapy that stimulates damaged tissues to repair themselves.

It is being produced in human and pig versions.

The other is called Interferon Alfa-2A.

"This is a human protein that is native in our bodies - it's expressed as part of our immune system," Dr Herron says.

"It has antiviral properties. It's also been found that is has some anti-cancer properties.

"It's a protein that is used in the clinic today - or has been for quite some time - for treating hepatitis and certain cancers."

Veterinary Medicine

As with all research into promising treatments there is a caveat. It can take decades of further research and testing before a breakthrough becomes a medicine.

However treatments for rare, so-called 'orphan' diseases can be fast-tracked - and drugs for animals tend to come on the market even more quickly.

By reducing the cost of protein therapies the new technique could create affordable treatments for farm animals and pets, opening up a new market in the veterinary sector.

Dr Herron knows just how effective protein therapies can be: she received an existing drug for inflammatory bowel disease.

"It was a pretty incredible thing," she says. "I went from Friday, when I was probably going to have my entire bowel removed, to Monday going home.

"It's pretty impressive type of stuff we can do with some of these drugs.

"So hopefully we can get these out there and treat some of these really difficult illnesses."

The team are confident they can expand the range of proteins chickens can lay.

The technique used to introduce the new genes into chicken DNA employed a lentivirus to deliver the payload.

It is long established but involves trial and error before the genes find their desired target.

The newer CRISPR/Cas method is expected to allow much more precise editing.

The researchers received strategic funding from the Biotechnology and Biological Sciences Research Council and published their findings in the journal BMC Biotechnology.

The chickens themselves are unaffected by the presence of human proteins in their systems.

Living in conditions superior to those of battery hens, they just go on laying eggs as normal.

EU regulations against GM organisms in the food chain mean neither they nor their eggs will end up on your plate.

But they could be pioneers in producing better and cheaper medicines.

Cheaper because they literally work for chicken feed.

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Video: Preventing Shingles

If you've had chickenpox, you're at risk for getting shingles, a very painful and potentially debilitating disease. Nearly one in three Americans will get shingles, and older adults are more at risk.

But adults age 50 and older can get protection from shingles simply by getting the shingles vaccine. Watch this public service announcement below to learn more.

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Two Dead After Pigeon Dropping Infection at Hospital

Two patients have died after contracting a fungal infection caused by pigeon droppings at the Queen Elizabeth University Hospital.

NHS Greater Glasgow and Clyde said an elderly patient died but from an unrelated cause.

Another infected patient has also died but the factors contributing to the death are still being investigated.

A non-public room, thought to contain machinery, was identified as a likely source. An investigation is under way.

A NHSGGC spokesman said: "Our thoughts are with the families at this distressing time.

"Due to patient confidentiality we cannot share further details of the two cases.

"The organism is harmless to the vast majority of people and rarely causes disease in humans."

NHSGGC confirmed a small number of vulnerable paediatric and adult patients are receiving medication to protect them against the airborne infection, which is a Cryptococcus species.

Portable HEPA air filter units have been installed in specific areas as an additional precaution.

Earlier on Saturday Teresa Inkster, lead consultant for infection control, said: "Cryptococcus lives in the environment throughout the world. It rarely causes infection in humans.

"People can become infected with it after breathing in the microscopic fungi, although most people who are exposed to it never get sick from it.

"There have been no further cases since the control measures were put in place."

Ms Inkster said experts are continuing to monitor the air quality.

She added: "It remains our priority to ensure a safe environment for patients and staff."

'Very unusual'

Prof Hugh Pennington, of Aberdeen University, said he was surprised to learn of the infection.

The epidemiologist said: "It is very unusual in the UK.

"It is quite common in other parts of the world, particularly in tropical parts and in the US and in countries like that, where they have more problems with this particular kind of fungus."

Prof Pennington said people with weak immune systems are most at risk.

He added: "When it gets into the blood stream a lot of people have fairly straightforward infections and it settles in the lungs but the big problem with this is that it can cause meningitis and, as we know, meningitis can be a very serious infection."

Prof Pennington said anti-fungal drugs are used to treat the infection but warned it can be fatal if it is not diagnosed.

Airborne infection

The expert said a key priority would have been stopping the airborne infection from entering the hospital's ventilation system.

He added: "Obviously they have stopped the pigeons getting into the machine room.

"It surprises me slightly that there was any there in the first place."

During the investigation, a separate issue arose with the sealant in some of the shower rooms.

NHSGGC said repairs are underway and our maintenance team are working to remedy this issue as quickly as possible with the minimum disruption.

As a further precaution, a specific group of patients are being moved within the hospital due to their clinical diagnosis and ongoing treatment.

The £842m QEUH opened in April 2015 and featured in the BBC series Scotland's Superhospital.

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IVF Dad 'Floored' Over Baby He Did Not Consent To

A father, whose ex-partner forged his signature to conceive a child via an IVF clinic, said he was "absolutely floored" when he found out.

The man, who can only be identified as ARB, sued IVF Hammersmith for damages for the cost of bringing up the girl.

Although judges found the clinic was in breach of contract, they rejected his claim for damages.

The clinic said it had "reinforced" its procedures since then "to ensure such a situation could not occur again".

The couple had a son together through IVF at the clinic in 2008, because, ARB said, they had "this romanticised idea" that a child would improve the relationship which "wasn't strong".

Following the procedure, a number of embryos were frozen and the couple signed agreements annually for these to remain in storage.

In 2010, the couple broke up.

After the split, the woman, known as R, provided the clinic with a "consent to thaw" form, forged with ARB's signature, resulting in successful conception, and the birth of a daughter.

"Out of the blue, she sent me a text message saying she was pregnant. I was absolutely floored," said ARB, who has since married his new partner.

The High Court in 2017 ruled against ARB's claim for damages because of a legal precedent in which the The House of Lords - now the Supreme Court - said that healthy children are always "a blessing".

Court of Appeal judge Lady Justice Nicola Davies DBE backed this view in December 2018, writing in her judgment that it was "morally unacceptable to regard a child as a financial liability".

However, Lady Justice also agreed with the High Court that the clinic had failed in its obligation to obtain ARB's "informed consent to the procedure".

Deception 'very unusual'

IVF Hammersmith said: "This has been a distressing case and we are deeply saddened by the effect it has had on all concerned.

"In this case as in all others, we adhered to the highest industry standards and we met all obligations as set out by the governing body at the time.

"Since then, we have reinforced our procedures to go above and beyond the industry standard to ensure such a situation could not occur again."

Industry regulator the Human Fertilisation and Embryology Authority (HFEA) said: "The deception in this case is very unusual."

It added that it "strengthened" its guidance in 2016 to "make it clear to clinics the steps they should take to ensure they do not fall victim to individuals who are determined to mislead them".

ARB said: "A great injustice has been inflicted upon us, for myself and my family and the wellbeing of my family.

"We needed to have that event exposed and a light shone upon it in order to find some measure of emotional closure around these tumultuous events."

He added he was in discussion with his legal team "about the next move".

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Lupus Research Alliance Announces Research Awards to Accelerate Development of New Therapies

Can "borrowed" drugs for treating other diseases protect the skin in patients with lupus? Can researchers coax the body to weed out harmful immune cells that drive tissue destruction in lupus? Those are just two of the innovative approaches for lupus therapies recognized by the Lupus Research Alliance with the latest round of its Target Identification in Lupus (TIL) grants. Seven outstanding scientists from across the United States will receive awards worth up to $600,000 for research projects designed to test promising strategies for treating lupus.

Mining Existing Drugs For New Lupus Therapies

Will a treatment inspired by malaria drugs work against lupus?

Keith Elkon, MD, University of Washington, will use his TIL grant to further investigate the safety and effectiveness of a promising lupus drug he and his colleagues developed. Dr. Elkon and his team had found that certain treatments for malaria reduced production of type I interferons, immune system molecules which promote inflammation. However, these drugs can be toxic and have other limitations. Dr. Elkon and his colleagues designed a better drug they call X6. If X6 performs well in tests on human cells and mice, they will apply for permission from the Food and Drug Administration to begin clinical trials.

Are old drugs the next lupus treatments?

David Levy, PhD, New York University School of Medicine, will use his TIL grant to investigate whether several drugs for treating other diseases are possible lupus therapies. He is looking for a safe way to block the effects of type I interferons without undermining patients' ability to fight infections.

Can drugs prevent immune cells from invading the skin?

With her TIL grant, Jillian Richmond, PhD, University of Massachusetts Medical School, will test several drugs in mice, including two that are already approved for other diseases, to find out whether they protect the skin. If any of these drugs work in the mice, researchers could test them in people with lupus skin symptoms.

Preventing Immune System Errors That Lead To Lupus

How can we remove autoreactive cells in lupus?

With his TIL grant, Eric Meffre, PhD, Yale University, will investigate whether a protein called PTPN22 promotes the production of defective B cells that can attack the body's own tissues.

He will also test mice with lupus to see if inhibiting PTPN22 allows the animals to eliminate these autoreactive B cells, what happens in people who don't have lupus. The results of his research might reveal whether PTPN22 is a good target for development of new drugs to treat lupus.

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Can we protect B cells from a bad influence?

Deepak Rao, MD, PhD, Brigham and Women's Hospital, also focuses on why B cells destroy patients' own tissues. Before B cells launch these attacks, they interact with immune cells known as helper T cells. With his TIL grant, Dr. Rao will investigate whether a specific type of helper T cells known as T peripheral helper cells are responsible for leading B cells astray. This work could reveal a new approach to prevent B cells from harming patients' tissues.

Can we switch off helper T cells that promote lupus?

Joseph Craft, MD, Yale University, will use his TIL grant to better understand the role of a protein known as NFAT that acts as a master switch in follicular helper T cells, a type of helper T cells that interact with harmful B cells. Dr. Craft will also test if calcineurin inhibitors, drugs under development for lupus nephritis, to work by blocking follicular helper T cells. The results of the proposed studies could also help pinpoint new molecules that might be therapeutically targeted in lupus.

Do carbohydrates lead to mistaken identity in lupus?

Lupus results from a case of mistaken identity-immune cells attack the body's normal cells as if they were invading microbes. Nan Yan, PhD, University of Texas Southwestern Medical Center, will use his TIL grant to test whether immune cells make this error because they confuse the carbohydrates on patients' cells for the carbohydrates of microbes. His research could lead to new targets for lupus treatments as well as new techniques for diagnosing the disease.

Only one new lupus drug has been approved in more than 60 years. The TIL grants are intended to change that by allowing researchers to pursue promising avenues that could lead to new treatments and a possible cure for lupus. If the current projects prove successful, at least three could directly lead to clinical trials in patients with lupus while others pave the way for the next wave of lupus treatments.

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New Potential Immunotherapy Target in Pancreatic Cancer Identified

Researchers have identified a new potential immunotherapy target in pancreatic cancer, which so far has been notoriously resistant to treatment with immune checkpoint blockade drugs effective against a variety of other cancers.

The University of Texas MD Anderson Cancer Center research team found overexpression of the immune checkpoint VISTA on immune cells, especially macrophages, that infiltrated pancreatic tumours. Their paper will be published online Friday at the Proceedings of the National Academy of Sciences.

"VISTA is a potential therapeutic target in pancreatic cancer, and there are several antibodies to block VISTA under clinical development," said co-senior author Padmanee Sharma, M.D., Ph.D., professor of Genitourinary Medical Oncology and Immunology. "Additional research also needs to be done to see if we can come up with other targets for these VISTA-positive cells as well."

Present immune checkpoint inhibitors that unleash an immune attack on cancer by blocking PD-1 and CTLA-4 brakes on T cells have been ineffective against pancreatic cancer, one of the most lethal cancers. The five-year survival rate for patients with pancreatic cancer is 7 per-cent or less.

The team, led by Sharma and 2018 Nobel Laureate Jim Allison, Ph.D., professor and chair of Immunology, set out to shed light on infiltration of immune cells and expression of immunity-inhibiting checkpoints in pancreatic cancer by comparing those tumours to melanoma, the cancer that is most vulnerable to immune checkpoint blockade.

They first analysed expression of nine immune inhibitory genes in 23 untreated, surgically removed pancreatic cancer tumours and found the results separated the patients into two groups, 11 with high-expression of inhibitory genes and 12 with low expression.

Those with low-expression of immune inhibitors had a median survival of 37 months versus 20 months for the high-expression group, indicating potential immune impact on overall survival.

Tumour architecture: Stroma and malignant cells

Pancreatic cancer tumours include a high density of stroma, non-malignant supportive cells, while melanoma is at the other end of the spectrum with minimal stroma. These differences came into play in the team's analyses. The pancreatic tumours were composed of 30 percent malignant cells and 70 percent stroma, while those proportions were flipped in melanoma tumours.

In addition to the vastly different ratio of stromal cells, the architecture of the tumor types also diverges, Sharma notes. "In melanoma, you have a large area of malignant cells surrounded by a thin layer of stroma. With pancreatic cancer, it's more like cancer cells, stroma, cancer cells, stroma ? blended."

Analysis of 29 untreated pancreatic cancer tumours and 44 untreated melanomas found heavier penetration of attacking immune T cells in melanoma as well as higher levels of cells expressing the inhibitory checkpoint molecules PD-1 and its activating ligand PD-L1, which are successfully targeted by inhibitors to treat melanoma. However, pancreatic tumours had much higher expression of VISTA.

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About a third of the pancreatic tumours had T cell penetration roughly equal to that found in melanoma, but the T cells were concentrated mainly in the stroma of the tumours, rather than the malignant cells, while they were evenly distributed between cancer cells and stroma in melanoma.

To the researchers, that makes sense. "In pancreatic cancer, you have much more stroma than malignant cells in the tumour. Why is that? I think it's how the tumour is growing," Sharma said.

Allison noted the stromal cells might be keeping the T cells out of the cancer cells.

VISTA and macrophages

VISTA is predominantly expressed on macrophages - "big eater" immune cells that engulf and digest microbes, cellular debris, and tumour cells as part of immune response. VISTA is known to deactivate T cells.

While the researchers found roughly equal density of CD68-positive macrophages in both tumour types, in pancreatic cancer they were again concentrated in the stroma. Macrophages in the pancreatic tumours had much higher expression of VISTA.

A separate comparison of three types of pancreatic tumour - untreated primary, treated metastatic and primary tumours pre-treated before surgery - found low penetration of T cells in the metastatic tumours and elevated levels of VISTA in the untreated primary and metastatic tumours.

Analysis of seven pancreatic samples found that CD68-positive macrophages had distinct PD-L1 and VISTA pathways that inhibit immune response separately. Experiments with T cells taken from tumours of three patients with metastatic pancreatic cancer showed that an active VISTA pathway decreased active T cell responses in the tumour to a greater degree than PD-L1 inhibition. This suggests treatment with PD-1/PD-L1 inhibition might fail because an untreated VISTA pathway still suppresses immune response.

Moon Shots Program collaboration

Future research will include exploration of combination therapy strategies to increase T cell infiltration, possibly using anti-CTLA-4 checkpoint inhibition, plus a VISTA antibody to target macrophages, Sharma said.

Allison and Sharma lead MD Anderson's immunotherapy platform, which thoroughly characterizes immune response to tumors and to treatment via immune monitoring of tumor samples before, during and after treatment. The platform team worked with MD Anderson's Pancreatic Cancer Moon Shot™ and Melanoma Moon Shot™, part of the institution's Moon Shots Program™, a collaborative effort to accelerate the development of scientific discoveries into clinical advances that save patients' lives.

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What is the Right Age to Lose Your Virginity?

Having sex too soon is the biggest regret of young people losing their virginity, a survey of British sexual behaviour suggests. More than a third of women and a quarter of men in their teens and early 20s admitted it had not been "the right time" when they first had sex.

People must be 16 or over to legally consent to sex.

The latest National Survey of Sexual Attitudes and Lifestyles poll says many people may not be ready at that age.

The Natsal survey, carried out every decade or so, gives a detailed picture of sexual behaviour in the UK.

For this latest work, published in BMJ Sexual & Reproductive Health, researchers at the London School of Hygiene and Tropical Medicine looked at the responses of nearly 3,000 young people who had completed the survey between 2010 and 2012.

The findings

The responses showed that nearly 40% of young women and 26% of young men did not feel that their first sexual experience had happened "at the right time".

When asked in more depth, most said they wished they had waited longer to lose their virginity. Few said they should have done it sooner.

Most had had sex by the time they were 18 - half had done it by the time they were turning 17.

Nearly a third had sex before turning 16.

Equally willing

The survey also looked at sexual competence or readiness - whether a person could reasonably make an informed decision about whether to have sex for the first time. For example, they had to be sober enough to have consented and should not have been acting on peer pressure.

Around half of the young women and four in 10 of the young men who responded failed this measure.

And almost one in five women and one in 10 men said they and their partner had not been equally willing to have sex at the time, suggesting some felt pressured to have intercourse.

Founder of the Natsal survey, Prof Kaye Wellings, said the age of consent was not an indicator that someone might be ready to become sexually active. "Every young person is different - some 15-year-olds may be ready while some 18-year-olds are not."

Co-researcher Dr Melissa Palmer said: "Our findings seem to support the idea that young women are more likely than young men to be under pressure from their partners to have sex.

"Although the survey results yielded some positive outcomes, such as nearly nine in 10 young people using a reliable method of contraception at first sex, further efforts are required to ensure that the broader wellbeing of young people is protected as they become sexually active."

She said sex education in schools should equip young people with the right negotiating skills to enable them to have safe and positive first sexual experiences.

When is the right time?

If you think you might have sex, ask yourself:

* Does it feel right?

* Do I love my partner?

* Does he/she love me just as much?

* Have we talked about using condoms to prevent STIs and HIV, and was the talk OK?

* Have we got contraception organised to protect against pregnancy?

* Do I feel able to say "no" at any point if I change my mind, and will we both be OK with that?

If you answer yes to all these questions, the time may be right. But if you answer yes to any of the following questions, it might not be:

Do I feel under pressure from anyone, such as my partner or friends?

* Could I have any regrets afterwards?

* Am I thinking about having sex just to impress my friends or keep up with them?

* Am I thinking about having sex just to keep my partner?

Source: NHS Choices

Isabel Inman from the sexual health charity Brook said: "We firmly believe that age and stage appropriate relationships and sex education (RSE) should start early in order to empower young people to make positive decisions that are right for them. We hope the introduction of mandatory RSE will provide this opportunity."

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Could Pomegranates Offer the Key to New IBD Treatments?

Studies of pomegranates, "the fruit of the gods," are increasingly revealing why they are so beneficial. Urolithin A, derived from pomegranates, and its synthetic equivalent could help treat inflammatory bowel disease, according to a new study.

Pomegranates may contain the secret to better gut health. The Centers for Disease Control and Prevention (CDC) suggest that around 3 million adults in the United States had a form of inflammatory bowel disease (IBD) in 2015.

IBD refers to two different conditions - Crohn's disease and ulcerative colitis - that are characterized by the long-term inflammation of the gastrointestinal tract, which includes the esophagus, stomach, and intestines.

In a new study, researchers from the University of Louisville in Kentucky identified a natural compound that could help improve IBD treatments. The researchers also explain the mechanisms through which it most likely fights IBD symptoms.

The compound, called urolithin A (UroA), is a metabolite produced as a result of the interaction of gut bacteria and certain polyphhenols present in pomegranates and some other fruits - particularly berries.

Specifically, ellagic acid - which is present in pomegranates and berries, such as blackberries, raspberries, and strawberries - interacts with the INIA P815 strain of Bifidobacterium pseudocatenulatum in the gut, thereby releasing UroA.

This compound also has a synthetic equivalent called UAS03, which has the same, if not a stronger, therapeutic effect in the case of IBD.

The researchers report their recent findings in a study paper in the journal Nature Communications.

How this substance protects gut health

Previous research indicating that UroA has multiple health benefits made the researchers keen to look into the substance's potential in the context of IBD treatments.

"Previous studies demonstrated inhibitory activities of urolithins in inflammation, proliferation, and aging in various models", the researchers write.

In this new study, they used a mouse model to study the way in which UroA and UAS03 could help with IBD. Their investigation revealed that both compound versions reduce inflammation in the gut by acting on the "bridges" between the cells that make up the tissue lining the gut.

UroA and UAS03 tighten these cell junctions, thus preventing toxins from passing through and causing inflammation.

"The general belief thus far in the field is that urolithins exert beneficial effects through their anti-inflammatory, anti-oxidative properties," says first study author Rajbir Singh.

"We have," he explains, "for the first time discovered that their mode of function also includes repairing the gut barrier dysfunction and maintaining barrier integrity."

Nutrient and gut bacteria interaction is key

Still, though the researchers encourage the consumption of pomegranates and other fruit that may lead to the release of UroA in the gut, they explain that this is no guarantee that IBD symptoms will not appear or that they will lessen.

This is most likely because the bacteria that assist in the production of this metabolite may not be present at the same level - or sometimes may not be present at all - in some people's gut microbiota.

So, partly for this reason, the researchers suggest that synthetic UAS03 may be more reliable and effective in the treatment of certain forms of IBD, such as acute colitis. UAS03 also has a more stable form compared with UroA.

According to the lead researcher Venkatakrishna Rao Jala, "Microbes in our gut have evolved to generate beneficial microbial metabolites in the vicinity of the gut barrier."

"However, this requires that we protect and harbor the appropriate gut microbiota and consume a healthy diet. This study shows that direct consumption of UroA or its analog can compensate for a lack of the specific bacteria responsible for production of UroA and continuous consumption of pomegranates and berries." - Venkatakrishna Rao Jala

In the future, the team aims to conduct further studies confirming the mechanisms accessed by UroA and UAS03, as well as their protective role in IBD.

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King's Researchers Receive £1.25 Million To Investigate Fatal Eating Disorder

A multidisciplinary team, led by Dr Marietta Stadler from the School of Life Course Sciences, has been awarded £1.25 million by the National Institute for Health Research (NIHR) to investigate an eating disorder where people with type 1 diabetes deliberately take too little insulin to try and control their weight.

Dr Stadler, awarded one of only five NIHR Clinician Scientist Fellowships nationally in 2018, said:

'Living with type 1 diabetes requires a demanding daily routine of regular blood-glucose testing, watching what you eat and self-injecting insulin. Perhaps this is why people with type 1 diabetes are twice as likely to suffer from an eating disorder as people without?

Studies show that between 8% and 36% of people with type 1 diabetes suffer from some form of eating disorder, which could be as many as 144,000 adults in the UK.'

A dangerous feature for patients in this group is missing insulin replacement doses deliberately in an attempt to lose weight.

This can trigger medical emergencies (such as diabetes ketoacidosis) and accelerates diabetes-related damage to vital organs. It is also associated with substantially increased mortality compared to people with type 1 diabetes without an eating disorder. Despite this there are, as yet, no evidence-based interventions to help manage the condition.

Dr Stadler and her colleagues aim to change this. STEADY (Safe management of people with Type 1 diabetes and Eating Disorder StudY) is a collaboration across King's Health Partners including: the Department of Diabetes; the Diabetes, Psychiatry & Psychology Unit (King's Institute of Psychiatry, Psychology & Neuroscience); the Diabetes Department at King's College Hospital and the Eating Disorders Unit at the South London and Maudsley.

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Over the next five years the team (including Professor Khalida Ismail, Professor Glenn Robert, Professor Janet Treasure and Dr David Hopkins) will bring together patients with type 1 diabetes and an eating disorder, doctors, nurses, psychologists and dietitians to design a programme based on patients' lived experiences. Researchers expect this to include a mix of both diabetic and psychiatric care, with elements of education and psychotherapy.

Dr Stadler said of the collaboration:

'You can't have a bunch of doctors deciding on an intervention, you have to have the people who've lived with the condition involved. They know what the day-to-day challenges are, what would potentially prevent them seeking help and what healthcare professionals can do to best support them.'

The NIHR said of the award:

'Our decision is based on research having a clear benefit to patients and the public within five years of the end of the funding period. Everything we fund should have a worthwhile and real effect in the NHS and Marietta's research was a great example of this'. Work on the STEADY project has already begun.

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Common Pain Relievers May Worsen C. Difficile Infection

A study finds that certain pain relievers may promote Clostridium difficile infection. The results may help improve the management of the condition and its symptoms.

Clostridium difficile infection is relatively common and can be serious. Clostridium difficile, also called C. difficile or C. diff, is a bacterium that causes inflammation of the colon.

This health condition commonly affects older adults in hospitals, and it often occurs after the use of antibiotic medications.

According to the Centers for Disease Control and Prevention, C. difficile led to almost half a million infections among patients in the United States in a single year.

More than 80 percent of these deaths occurred among people aged 65 years or older.

The medical community considers C. difficile to be a major cause of infectious disease death in the U.S. and the most common microbial cause of healthcare-associated infections in hospitals.

The excess healthcare costs of this condition can reach almost $5 billion each year for acute care facilities alone.

Anti-inflammatories could promote C. difficile

People who receive treatment with antibiotics have a higher risk of developing C. difficile because these drugs affect the natural flora of the gut.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce pain and decrease fever and inflammation, could also promote C. difficile infection.

The results of a new study that features in the journal mBio provide evidence of the connection between C. difficile and NSAIDs. Researchers from Vanderbilt University in Nashville, TN led the research in collaboration with scientists at the University of Michigan and the University of Arizona.

The researchers conducted the study using mice that they had infected with C. difficile. They divided the mice into two groups and treated one of the groups with an NSAID called indomethacin prior to infection.

At the end of the observation period, about 20 percent of the mice in the treatment group were still alive, while about 80 percent of the group that did not receive the NSAID had survived.

NSAIDs have a negative impact on the gut

Looking at the results of the study in mice, the researchers determined that even brief exposure to the NSAID prior to C. difficile inoculation increased the severity of the infection and reduced the chances of survival.

Further analysis revealed that the NSAID also altered the microorganisms that live in the digestive tract, called the gut microbiota. Additionally, this drug depleted the production of prostaglandins, which are hormone-like substances that play a crucial role in gastrointestinal health.

"We are always trying to think of modifiable risk factors for the disease," says David Aronoff, a microbiologist and infectious diseases expert at Vanderbilt University and the study leader.

The team concluded that NSAIDs impair the immune response of the intestine. Although indomethacin was the only NSAID that the study tested, Aronoff believes that the findings might also be valid for common NSAIDs, such as ibuprofen and aspirin, because they have similar biological mechanisms.

"Ultimately, these new results might guide how we treat people with C. diff, particularly with pain management. Right now, it's too early for our results to guide clinical care, but they should be a stimulus for future studies," concludes Aronoff.

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Researchers Examine Benefits of Oral Supplement For Patients With Thyroid Eye Disease

Fight for Sight and the Thyroid Eye Disease Charitable Trust are funding research to establish the benefits of using a type of oral supplement for UK patients with thyroid eye disease, which affects around 300,000 people in the UK.

Researchers from Imperial College Healthcare NHS Trust will recruit 110 patients with the condition who will be randomly selected to receive selenium tablets or a placebo. Selenium is a trace mineral that is essential for healthy thyroid function. Researchers will examine improvements to the patients' condition and quality of life.

A previous European study has shown that taking selenium supplements at the early stage of the disease can lead to a reduction in the symptoms associated with the condition. However, the results need further investigation since the original study did not measure selenium levels in the patients before they took the supplements.

This new study will provide valuable evidence as to whether there are any benefits or risks associated with taking selenium supplements.

Dr Neil Ebenezer, Director of Research, Policy and Innovation at Fight for Sight, said:

We need to establish whether there is a clear benefit from taking this oral supplement. The results could have a direct impact on the lives of patients living with thyroid eye disease and have significant implications on how this condition can be managed in the future."

Rebecca Ford, Chair of the Thyroid Eye Disease Charitable Trust Committee, said:

TEDct is delighted to be supporting this research looking at selenium levels in UK patients with thyroid eye disease. We hope this study will provide more information on the usefulness of selenium supplementation in this condition, and help medical professionals to give evidence-based advice that will help people affected by this disease make informed decisions about whether selenium will be helpful for them."

Miss Tessa Fayers from Imperial College Healthcare NHS trust, said:

I am delighted that we have received funding from Fight for Sight and Thyroid Eye Disease Charitable trust so that we can do this important research. The current UK guidelines are to recommend selenium supplementation to all patients with mild to moderate TED, when we do not know if it will help them or indeed if it could be causing them harm since the original study data on which these guidelines are based may not be translatable to our population."

She added: Moreover patients have to pay for these supplements themselves (they are not available on prescription) so patients could be wasting their money. This research should provide us with an answer to whether selenium should be recommended to our TED patients and how much benefit they might expect to get."

Related Stories

Thyroid eye disease is an auto-immune condition that is estimated to affect 300,000 people in the UK. The condition is caused by damage to fatty tissue and muscles behind the eyes which leads to inflammation. This can lead to double vision, loss of vision and severe disfigurement of the eyes which can significantly reduce the quality of life for people living with the disease.

Selenium levels in the blood vary depending on the geographical region the patient lives in, which affects the amount in their diet. Researchers will establish the selenium levels in the blood of a sample of TED patients in the UK population. They will also determine if any potential benefits for thyroid eye disease can be attributed to the change of selenium blood levels.

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Quadruple Amputee Given Double Hand Transplant

A woman from Renfrewshire who had been waiting for a double hand transplant for five years has successfully undergone the surgery.

Quadruple amputee Corinne Hutton, from Lochwinnoch, went through a 12-hour procedure at Leeds General Infirmary.

The news was announced by the charity Finding Your Feet, which the 47-year-old set up.

The campaigner lost her hands and feet in 2013 after suffering acute pneumonia and sepsis, which nearly killed her.

Speaking from her hospital bed after the operation, Ms Hutton thanked her medical team and said: "I've got hands, they look exactly like mine. They look amazing.

"I've got fingers, and they can move - I shouldn't be doing that right enough, but it's absolutely incredible. I'm so thrilled."

A message on the Finding Your Feet Facebook page added: "All of this happened on the anniversary of this beautiful community she created out of tragedy. You could call it fate."

Experts had been working to find suitable hands that were a match for the former businesswoman, who has campaigned to help raise awareness of organ and limb donation.

* Woman with no hands or feet in record Kilimanjaro climb

* Amputee's nude organ donation appeal

After more than a dozen false alarms over the years, she was informed this week that a match for her own blood group, skin tone and hand size had been found.

Finding Your Feet said she was taken by ambulance from her home to the hospital in West Yorkshire, where the surgery began at about 13: 00 on Monday.

The team working on the procedure included Prof Andrew Hart, who performed the surgery to remove her hands and lower legs in 2013 and has since become a close friend.

Prof Simon Kay, who led the team, performed the first double hand transplant in the UK in 2016, and Ms Hutton was his sixth procedure.

He said: "Corinne is one of the most positive, resilient and determined people I have met and despite all the hurdles she has faced she has now got the hands she wishes for.

"She didn't go into this lightly, she researched it deeply and understood the risks as well as the benefits.

"She realises what a remarkable life-affirming gift she has received from an unknown family devastated by grief and I know she will be forever grateful."

Supporting Amputees

Before she fell ill and was given a 5% chance of survival, Ms Hutton ran her own graphics company in Glasgow.

She now devotes her life to the charity she founded to support amputees throughout the UK.

Ms Hutton became the first female quadruple amputee to reach the summit of Mount Kilimanjaro, climbed Ben Nevis, abseiled, cycled around the Isle of Arran, took up skiing and ballroom dancing lessons.

Her charity has so far raised more than £700,000 through fundraising and donations.

In 2016 she also posed nude, with her body painted with organs and tissue that are deemed transplantable in a bid to help raise awareness of transplant issues.

The first woman to receive a double hand transplant in the UK was Tanya Jackson, who was motivated to go for the procedure after seeing Ms Hutton on television.

Inspire People

A spokesman for Finding Your Feet thanked those who have supported Ms Hutton throughout her journey.

He said: "Cor was close to losing hope about finding a match for a transplant, but that's not her style.

"She has accomplished an unbelievable amount since losing her limbs, and we're certain she'll continue to inspire people as she builds up strength and learns to use her new hands.

"It's bittersweet, because transplants require a donor. That person and her family have changed the lives of many today, and made it possible for a mum to hold her son's hand again. Cor will not waste a moment with what they've given her".

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Some HRT Tablets 'Linked to Higher Blood Clot Risk'

Women taking certain types of hormone replacement therapy (HRT) tablets could be more at risk from serious blood clots - although the overall risk is low, BMJ research suggests.

It found tablets containing equine oestrogen were linked with a slightly higher risk than other tablets.

And patches and gels for HRT were the safest but were underused.

GPs' leaders said HRT treatments were tailored to meet the needs of individual patients.

They said women should not panic or stop taking HRT. Instead, they should discuss any concerns at their next routine GP appointment.

HRT is used to relieve symptoms of the menopause such as hot flushes and night sweats, by replacing hormones that are at a lower level.

The treatments come in a number of different forms, including tablets, gels, cream and patches.

Most experts agree that HRT is a good and safe treatment - but there are some small potential risks, as NHS UK advice explains.

These include a small increased risk of certain serious health problems, such as blood clots and breast cancer.

Underused Treatments

This study, by University of Nottingham researchers, said the increased risk of taking HRT tablets was equivalent to nine extra cases of blood clots per 10,000 women per year.

The study looked at the prescription records of 80,000 women aged 40-79 who had developed blood clots and compared them with records of 390,000 women who had not.

For tablet treatments, the risk was found to differ for two types of oestrogens.

The risk of blood clots was 15% higher for the treatments containing oestrogen manufactured from horse urine than for the synthetic oestradiol, for both single and combined hormone treatments.

But there was no such risk for women using gels, patches or creams for HRT - also called transdermal treatment.

The study said this was the safest type of HRT and yet it appeared to be underused, with just 20% of prescriptions for this type of therapy.

According to the Royal College of GPs, most local NHS groups suggest prescribing tablets as a first-line treatment, unless medical issues suggest otherwise.

'Don't Panic'

Dr Yana Vinogradova, from Nottingham's school of medicine, said: "Our study has shown that, for oral treatments, different tablets are associated with different risks of developing blood clots, depending on the active components.

"It has also confirmed that risks of thrombosis for patients using HRT treatments other than tablets [patches or gels] is very low."

She added: "Our findings are particularly important information for women who require HRT treatment and are already at increased risk of developing blood clots."

Prof Helen Stokes-Lampard, who chairs the Royal College of GPs, said the observational study was "interesting" but could not prove that cases of blood clots - or deep vein thrombosis - had been caused by the tablets.

"As such, it is essential that more research is conducted in this area and taken into account as new clinical guidelines are updated and developed," she said.

She said current practice was to prescribe the lowest possible dose of HRT for the shortest possible time.

This happened after "a comprehensive discussion between the GP and their patient", she said, when treatments were tailored to meet the best interests of each individual.

 

"It's important that patients don't panic or stop taking HRT as a result of reading about this study but instead discuss their concerns at their next routine GP appointment or seek advice from a reputable website like NHS Choices," Prof Stokes-Lampard said.

Safety Information

Dr June Raine, from the Medicines and Healthcare products Regulatory Agency (MHRA), said details of the risks were included in the prescribing information for all HRT products.

"Previous studies have suggested a lower risk of blood clots with transdermal patches than with oral tablets, but these studies have included too few women using transdermal patches to allow firm conclusions to be drawn."

She added: "Any new significant information on the efficacy or safety of HRT tablets will be carefully reviewed and the information provided to healthcare professionals, and patients will be updated if appropriate."

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What is an Alanine Aminotransferase (ALT) Blood Test?

The liver makes several enzymes, including alanine aminotransferase, or ALT. These enzymes help break down proteins so that the body can digest them.

Besides helping the liver break down proteins, ALT helps the liver perform its basic functions. Some of these include:

* filtering toxins from the blood

* storing nutrients and iron

* producing bile, which aids digestion

Most ALT that the liver produces stays within the organ. However, when the liver is damaged or inflamed, it may release ALT into the bloodstream.

When this happens, the level of ALT in the blood rises. Therefore, doctors use an ALT blood test to screen for liver disease or damage. Learn more about the test in this article.

Uses

An ALT test can help a doctor diagnose various liver conditions. A doctor orders an ALT test to look for problems with liver function. Many people have this test as part of a comprehensive metabolic panel.

The comprehensive metabolic panel is a routine blood test that checks a person's glucose level, kidney function, and liver function. It is often part of a routine checkup that gives a doctor insight into an individual's overall health.

Other times, a doctor orders the ALT blood test as part of a series of blood tests called liver panels if they suspect that a person's liver is damaged or diseased.

Doctors may order liver panels if a person has symptoms of liver disease or damage.

Symptoms of liver problems include:

* yellowing of the eyes and skin (jaundice)

* pain in the upper right quadrant of the abdomen

* referred pain in the right shoulder

* easy bleeding or bruising

* intense itching

* pale stools

* swelling in legs or abdomen

These symptoms can indicate liver disease, injury, or another problem that may be affecting the liver.

Medical problems that can cause elevated ALT levels include:

Certain medications can also cause ALT levels in the blood to be high.

Often, these levels are elevated before symptoms of liver damage occur, making the test useful for people at risk of liver damage.

When a doctor can detect liver damage early, they may be better able to treat it and prevent further injury.

People at risk of liver damage or disease include:

* people with a family history of liver disease

* people who have diabetes

* people who are overweight

* people who consume a lot of alcoholic beverages

* people taking certain medications

Doctors routinely order liver panels to monitor diagnosed liver disease or injury. The results of these tests can show how well the treatment plan is working.

Understanding the results

A doctor can explain the results of an ALT test in detail. A person with a healthy liver will have an ALT level in the normal range. The normal range can vary from laboratory to laboratory.

According to the Mayo Clinic, the normal range for adult males is 7–55 units per liter. Females may have a lower upper limit normal than males.

Age can also affect results. A person should speak with their doctor about what their results mean.

If a person has results above the normal range, this may indicate liver damage.

Causes of elevated ALT levels include:

* the destruction of liver cells

* a lack of blood flow to the liver

* hepatitis

* cirrhosis, or severe scarring of the liver

* diabetes

* hemochromatosis, or iron buildup

* mononucleosis, an infection usually caused by the Epstein-Barr virus

* a tumor in the liver

* pancreatitis

Next steps

A person should discuss their results with their doctor, who can say if the numbers returned are within a normal range.

If a person's results are too low or high, a doctor can help determine the appropriate course of treatment.

People with higher ALT levels often need additional tests to discover the underlying cause of the liver damage and treat it.

Takeaway

An ALT blood test helps determine if a person has liver damage. Uncovering the cause of the problem often requires further testing.

The normal range for results tends to vary among facilities, and a doctor can discuss what the results mean on an individual basis.

Once they know the underlying cause of the liver damage, based on symptoms and test results, the doctor will discuss appropriate treatment options.

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Sponge offers Hope of 'Less Toxic' Chemotherapy

Scientists believe they may have found a way to make cancer chemotherapy treatment less toxic to the body. They have begun testing a tiny sponge that sits inside a vein and removes excess chemo drugs from the blood once they have attacked the target tumour.

Experts say the early work, in the journal ACS Central Science, offers hope of avoiding treatment side-effects, such as hair loss and nausea.

So far, it has been tried in pigs, but researchers want to test it in people.

If all goes well, those trials could happen within a couple of years, says scientist Dr Nitash Balsara, from the University of California.

How it works

The tubular device is 3D-printed - so it could be tailor-made to fit the patient.

Its mesh-like centre is covered with a special coating that absorbs the drug, but lets blood flow through the device unhindered.

Tests in pigs suggested it mopped up a chemotherapy drug called doxorubicin, removing about 64% of the drug from the bloodstream.

And it appeared to keep hold of the drug permanently. Continuously flushing out the device in the lab for a month after removal couldn't dislodge the drug.

That means it shouldn't leak any drug when the device is taken out of the body, say the researchers, who were funded by the National Institute of Health and the National Cancer Institute.

The device would be inserted during chemotherapy and then removed after the session has ended. Each chemotherapy session would require a new device.

Dr Balsara says the early results are promising and the device should work with other chemotherapy drugs if the coating is well matched.

"We feel that removing 50% of the drug will impact patient outcome substantially," he added.

Prof Steve Rannard, from Cancer Research UK, said: "This work is an exciting new approach to reduce the side-effects of chemotherapy.

"Chemotherapy is a cornerstone treatment for cancer that saves lives, but can have the unwanted impact of damaging healthy as well as cancerous tissue, which can lead to severe side-effects.

"This study demonstrates this approach can extract drug molecules from the blood and remove high levels of drugs that haven't been delivered to the cancer in animals, which could be an effective approach to address this challenge.

"We now need to build a greater body of evidence to ensure this technique is safe before we can see if this could be an effective approach in cancer patients."

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3 Common Drugs Can Reduce Severe Mental Health Symptoms

A new study revealed that three common drugs normally used to treat cardiovascular problems or diabetes could also aid in the treatment of some serious mental health conditions, such as schizophrenia.

Could we repurpose common drugs to treat mental health conditions?

Scientists at University College London (UCL) in the United Kingdom, Karolinska Institute in Stockholm, Sweden, and the University of Hong Kong conducted a study to see how some commonly prescribed drugs for physical health treatments can impact the symptoms of severe mental health conditions.

They did so using large population datasets.

"Serious mental illnesses," the study authors say, "including bipolar disorder, schizophrenia, and nonaffective psychoses, are associated with high levels of morbidity and are challenging to treat."

"Many drugs have been identified as having potential for repurposing in these disorders," they add in the introduction to their study paper.

The first author is Joseph Hayes, from UCL, and the paper appears in the journal JAMA Psychiatry.

Hayes and team decided to focus on three of the most common drugs for physical health issues:

According to Hayes, "This study is the first to use large population datasets to compare patient's exposure to these commonly used drugs and the potential effects on people with serious mental illnesses".

Fewer hospitalizations, reduced self-harming

The scientists analyzed the health-related data of 142,691 people from Sweden who had a serious mental health condition and were taking one or more of the three common drugs named above for a period of time.

Hayes and his team looked at records noting instances of self-harm and admittance to the hospital for reasons related to mental health. They compared the rates at which these events occurred while the participants were taking statins, LTCC, or biguanides with periods during which they did not take them.

The researchers found that during periods when they took statins, LTCC, or biguanides, people with a serious mental heath diagnosis registered fewer hospitalizations for psychiatric symptoms than in periods when they did not take this medication.

Also, people with bipolar disorder or schizophrenia attempted self-harm less often at times when they took any of the three common drugs. The same was true for individuals with non-affective psychosis during periods when they took LTCC, specifically.

These effects appear to be independent of whether or not the individuals took specialized drugs - such as antipsychotics, or mood stabilizers - that specifically target the symptoms of a particular mental health issue.

"Our research," according to Hayes, "provides additional evidence that exposure to [statins], LTCC antagonists, and biguanides might lead to improved outcomes for individuals with [serious mental illnesses]."

"All three studied drugs are globally licensed, commonly used, cheap, and relatively safe medications. They are therefore ideal candidates for repurposing. If substantiated, this study has considerable implications for clinical practice and drug development." ~ Joseph Hayes.

Although researchers know that statins, LTCC, and biguanides all interact with the central nervous system, it remains unclear how they impact it, exactly, in terms of biological mechanisms. This, the investigators point out, should be the focus of further studies.

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What to Know About the Adam's Apple

The Adam's apple is a lump of cartilage that sticks out from the throat. It is more prominent in males, and it serves no specific function. A person can remove or change the size of their Adam's apple with surgery.

Adam's apples develop during puberty and are not present in prepubescent children.

They are often more prominent in males, who tend to develop larger larynxes than females. As the larynx grows behind the Adam's apple, it pushes the lump of cartilage outward.

The size of the Adam's apple varies. Here, we describe what an Adam's apple is, why it develops, and options for removal or reduction.

What is an Adam's apple?

The Adam's apple is cartilage in the throat. The Adam's apple, also known as the laryngeal prominence, is made of cartilage. This is a connective tissue present throughout the body.

Cartilage is strong, but softer and more flexible than bone, and it makes up several other areas of the neck.

The Adam's apple develops during puberty. It grows around the front of the larynx, just above the thyroid. It is usually more prominent in males.

Why do Adam's apples develop?

During puberty, the larynx grows and pushes the developing Adam's apple outward.

The larynx, or voice box, is the area at the front of the neck that contains the vocal cords. These are folds of tissue that vibrate to produce sounds.

Along with other body parts, such as the mouth and nasal passages, the larynx produces the voice. It also protects the airways during swallowing.

The larynx grows extensively during puberty. A larger larynx produces deeper sounds, as there is more room for the vibrations to resonate.

The cartilage around the larynx forms a shield to protect it from injury. The Adam's apple protrudes as the larynx grows, but it serves no individual function.

Difference in males and females?

Both men and women have an Adam's apple. Both males and females develop Adam's apples, but they tend to stick out more in males than in females.

This is because the male larynx generally grows bigger and faster during puberty.

A larger larynx explains why males tend to have deeper and louder voices than females.

It is important to remember, however, that this is not always the case.

Hormonal differences affect the way that the larynx, and Adam's apple, develop. As a result of these differences, a male may have a smaller larynx and a voice with a higher pitch.

For the same reason, a female may have a larger larynx, a more prominent Adam's apple, and a voice with a lower pitch.

Adam's apple surgery and removal. The size of the Adam's apple does not impact physical health in any way.

However, the size can be problematic if a person feels that it does not match their body type or gender identity.

For example, someone with a prominent Adam's apple may feel uncomfortable with what they perceive as a masculine trait. Others may wish to have a bigger Adam's apple for the same reason.

It is possible to enlarge the Adam's apple by transplanting cartilage from elsewhere in the body.

It is also possible to remove excess cartilage from the area around the thyroid, reducing the size of the Adam's apple.

Can a big Adam's apple be a sign of another condition?

Conditions such as laryngitis can cause the Adam's apple to appear bigger. The Adam's apple does not serve any medically relevant function, and the size does not relate to any health condition.

However, some conditions can cause swelling in the larynx or growth in surrounding areas.

This can cause the Adam's apple to appear larger than usual.

Examples of these conditions include:

Treatment for a large Adam's apple varies, depending on the cause. It may involve medications such as antibiotics or corticosteroids.

If a person has cancer, treatment may involve surgery, radiation therapy, or chemotherapy.

Takeaway

The Adam's apple is a growth that protrudes from the thyroid cartilage. The size depends on how large the larynx grows, but Adam's apples are typically bigger in males.

A change in the size of a surrounding area can make the Adam's apple appear larger, and this can indicate a more serious underlying condition.

The Adam's apple itself does not impact health, but some people choose to change the size through surgery.

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