for outcomes . We ’ ve had that published in the Journal of Clinical Oncology and it ’ s had about 250 citations now .”
“ We probably over-treat a large number of patients . If you could predict those who are not going to respond at all , those patients should be targeted with other adjunct treatments . For example , if you could pick a patient who was going to have no response to radiotherapy , why would you subject them to six weeks of treatment with all the attendant side effects and complications ?”
They are currently researching that area and the immune response seems to be a strong predictor of responsiveness . On the other hand , defining the genetic signatures of cancers has not offered ways to individualise treatments , as was hoped .
“ Our work has highlighted a group of patients with stage 2 bowel cancers who do appallingly as regards survival outcomes , so we just give these patients chemotherapy . Tumour behaviour predicts the poor outcome – one of the most important markers is extramural vascular invasion , visible to pathologists , with the tumour invading out through blood vessels instead of going to the lymphatics .”
He said they now have the paradox where stage 2 or 3 colon cancers have equal survival outcomes . He suggested we are probably treating stage 3 patients really well and undertreating stage 2 patients .
The Bugs That Inhabit Us
Dr Oliver Waters , astroenterologist and general physician at the Centre for Inflammatory Bowel Disease ( Fremantle Hospital ), has a particular interest in how the bowel microbiome – the bugs that inhabit us – influences bowel disease and other things .
“ The gut microbiome appears to harvest energy and nutrients that we couldn ’ t otherwise and it also modulates the immune system . Emerging data from areas such as allergy , asthma and atopy shows that the microbiome may be key .”
The hygiene theory around rising atopy and autoimmunity in the Western world came into view , for which he said the seminal paper was by a Japanese group in 2009 . They used probiotics in neonate germ-free mice to ameloriate an allergic response to antigen , whereas adult mice did not benefit . He said science was trying to explain observations like these .
“ In inflammatory bowel disease , the genes in our population that have been associated with Crohns disease and ulcerative colitis haven ’ t change in 100 years , so something else has changed . Patients with IBD have a reduced biodiversity in their microbiome .”
Is this chicken or egg ? Studies from Australia and Scandinavia have shown that taking antibiotics ( particularly against anaerobes ) in childhood increases the risk of developing IBD in the future . Microbiome differences have been noted in people who are obese , and those with increased cardiovascular disease or diabetes .
“ It ’ s pointing perhaps to a dysbiosis of the microbiome , a narrowing of the biodiversity , which triggers someone into having a problem . If you look at gut flora , you have about 100 trillion bacteria , all anaerobes that are hard to culture – about 80 of the 5000 bacterial species . The big transition has been they can now do rapid DNA sequencing , the 16s ribosomal DNA which is specific to bacteria , and they can tell proportions of each , all backed up with massive computing power .”
New technologies have generated vast amounts of data . Oliver says probiotic use , using the microbiome to predict autoimmune disease , and exploring inheritance patterns ( e . g . twins have better microbiome concordance than spouses ) are emerging interests . However , the more they learn the more complicated it gets , making ‘ ah-ha ’ moments more difficult to attain .
“ The ultimate probiotic is a faecal transplant , and they are running trials of this in ulcerative colitis . The latest case studies of 10 children had three in remission at the end of four weeks . How efficacious it will be in the long term is another question .”
And faecal transplants have proven efficacy in people with intractable Cl difficile gut infections . The problem is standardising things for clinical trials .
PIVET MEDICAL CENTRE
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Fertility News
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by Medical Director Dr John Yovich
Vitamin D ... relevant for fertility
Vitamin D has known relevance to bone health and calcium homeostasis . My memory from medical student days is of rickets due to low Vitamin D but also unusual features and symptoms in children from hypercalcaemia , following ����������������������� milk in the post WW-II period .
In recent years , it has become concerning that Vitamin D status in the population is falling , causing a focus on various body systems where disorders might be ascribed . In the area of reproduction , �������������������� is reported with infertility as well as PCO and
Cholesterol molecule
endometriosis , and with diminished semen parameters . Pregnancy-induced disorders such as hypertension and gestational diabetes are also claimed but controlled prospective studies have not yet been reported .
���������������������������������������������������������������� ������������������������������������������������������������������ ����������������������������������������������������������������� ������������������������������������������������������������������ the 50nm / l cut-off and only 6 % at 75 nm / l , matching a recent report in ANZJOG from Cairns Base Hospital ( Bendall et al , 2012 ). This may correlate with our observation that sperm motility and morphology appears better among the males of far North Queensland compared to our Western Australian males who come mainly from the southern half .
We plan formal studies to check a vitamin D correlation but we already advise WA men … to take their shirt off and expose untanned skin to the sun for 20 minutes twice-a-week !
For ALL appts / queries : T : 9422 5400 F : 9382 4576 E : info @ pivet . com . au W : www . pivet . com . au
Continued on P32 medicalforum 31
Sunlight
Vitamin D molecule > The body ’ s main source of the seco-steroid Vitamin D3 – cholecalciferol with open B ring - is derived from the B spectrum of UV rays from the sun acting on cholesterol ( a sterol ) in pale areas of skin . Images courtesy Google public arena .