One person injured in Franklin County accident.

first_imgFRANKLIN COUNTY, Ind. — One person was injured after an ice cream truck was involved in a roll-over accident in Franklin County on Sunday.According to the Franklin County Sheriff’s Department, Gregory A Leppert, 64, of Hamilton, Ohio was attempting to stop for a customer on US 52 near Hydes Road, when the rear brakes of the truck locked up, which caused him to drive off the right side of the roadway.Both Leppert and a passenger, Mark Isaacs, 62, of Hamilton, Ohio, were pinned in the vehicle and had to be extricated.Isaacs received injuries in the crash and was airlifted to the University of Cincinnati Hospital.last_img read more

Pipes scores 20 to lead Green Bay past N. Kentucky 73-59

first_img First Published: 31st December, 2019 12:14 IST PJ Pipes had a career-high 20 points as Green Bay defeated Northern Kentucky 73-59 on Monday night.Pipes hit 8 of 10 shots, including 4 of 6 on 3-pointers.Manny Patterson had 15 points and 10 rebounds for Green Bay (6-9, 1-1 Horizon League). JayQuan McCloud added 13 points, eight rebounds and eight assists, and Kameron Hankerson had six rebounds. Amari Davis, who led the Phoenix in scoring heading into the contest with 16 points per game, had eight points on 4-of-14 shooting.Jalen Tate had 11 points for the Norse (9-5, 1-1). Trevon Faulkner added 10 points. Tyler Sharpe, who was second on the Norse in scoring entering the contest with 17 points per game, was held to only six points on 3-of-10 shooting.NKU had won 47 of its last 53 games at home before hosting Green Bay.Green Bay faces Illinois-Chicago at home on Friday. Northern Kentucky plays Detroit Mercy on the road on Friday.___For more AP college basketball coverage: https://apnews.com/Collegebasketball and http://twitter.com/AP_Top25___Elements of this story were generated by Automated Insights, http://www.automatedinsights.com/ap, using data from STATS LLC, https://www.stats.com Associated Press Television News FOLLOW US Last Updated: 31st December, 2019 12:14 IST Pipes Scores 20 To Lead Green Bay Past N. Kentucky 73-59 PJ Pipes had a career-high 20 points as Green Bay defeated Northern Kentucky 73-59 on Monday night. SUBSCRIBE TO UScenter_img Written By WATCH US LIVE LIVE TV COMMENTlast_img read more

Transgender Labour activist Lily Madigan loses out on Jo Cox leadership place

first_img300 ‘transphobes’ leave Labour Party in protest over pro-trans policyLabour suspends councillor who branded Pride marchers ‘paedophiles’YouTube star Riyadh Khalaf: ‘My experience in school was horrific’PINK NEWS- eTN Chatroom for Readers (join us) The paper quoted anti-trans Labour members attacking Madigan for applying to the leadership programme founded after the murder of Labour MP Jo Cox last year.PinkNews understands her application has been rejected, though organisers behind the programme strongly supported her right to apply.She told PinkNews: “Whilst I was disappointed, I wasn’t surprised. I’ve only been a member of Labour since June and so hadn’t had much time to build up experience prior to applying in November.“I’m proud of what I’ve achieved in such a small frame of time, especially since applying but I understand why I still fall short of the standard of such a distinguished programme.“Fortunately, I have plenty to keep me busy this year including roles locally and a politics degree, as well as other political programmes and speaking engagements.“I have a lot to offer the Labour Party as well as the Trade Union movement and you can count on my continuing to stand up for disadvantaged members.”She also vowed to apply for the programme again at the end of 2018.When she first revealed applying for the course, The Times quoted a Labour member who called it a “monstrous insult” to women.Another Momentum member was quoted by the paper saying “women in the party are fuming” that Madigan has applied for a place on the programme.However 55 Labour activists involved in the Jo Cox Women in Leadership scheme wrote to defend Ms Madigan in response. The Times declined to publish the letter in spite of extensive coverage criticising the student.The abuse became so great at one stage that she begged transphobes and sections of the press to end their abuse.The 19-year-old wrote on Twitter last year: “Please stop. I can’t handle it anymore. I’m so mentally distressed that I can’t sleep or eat or go to school. No one deserves this.“There’s only so many times I can read lies or my deadname or misgendering. I’m just a teenager. Please just stop. I don’t want to do this anymore.”Please stop. I can’t handle it anymore. I’m so mentally distressed that I can’t sleep or eat or go to school. No one deserves this. There’s only so many times I can read lies or my deadname or misgendering. I’m just a teenager. Please just stop. I don’t want to do this anymore.— Lily Madigan (@madigan_lily) December 5, 2017Despite the abuse, the teen told PinkNews in an interview late last year that she won’t let transphobes stop her from pursuing her political passions.“The Labour Party is not only a safe place for transgender people but actively supports them with programmes like the Jo Cox women in leadership programme asking for underrepresented, and self identifying women.“We also have our leader Jeremy Corbyn calling for changes to the GRA to help trans people, and I’ve had the opportunity to ask him about transphobia in society and media and he gave a very supportive answer.”Despite the high-profile attacks, Lily says transphobes cannot stop her.“I’d love to be the first trans MP,” she said. “It’s about time.”Share this:TwitterFacebookLike this:Like Loading… PinkNews ExclusiveTransgender campaigner Lily Madigan has not been selected for the Jo Cox Women in Leadership programme.The teen activist faced national criticism when she applied for the role, particularly from The Times newspaper. last_img read more

What does a GM think in the fourth quarter when yo

first_imgWhat does a GM think in the fourth quarter when you see that 14-point lead disappear?We were in a couple different situations where we didn’t convert if we had to kick a field goal. Fourteen points isn’t enough against a team like the Bengals. Watching them on tape, they’ve got a bunch of weapons with A.J. and Marvin and Giovani Bernard, some of the stuff that he can do out of the backfield. So they put a tremendous amount of stress on your defense and they can score quickly. Andy Dalton does a great job of getting the ball out quickly. I know James Bettcher did I nice job last night dialing up on pressure, but at the same time when you dial up that much pressure there’s going to be times where you leave yourself susceptible to some big plays. Obviously they got some mismatches with Bernard on Kevin Minter and they hit us with a nice screen game on an all-out blitz so that’s the NFL game, they get paid too.Does a general manager think of playoffs?No, I’m thinking about the San Francisco 49ers. It’s like somebody asked me on a radio show last week about the accomplishments of the organization so far and have we arrived…we haven’t arrived. We haven’t won any championships yet. Our focus and our mindset is on winning the NFC West and it starts next week against the San Francisco 49ers. I think last year was a great lesson for us when we started off 9-1 and saw things quickly crumble away due to injuries and those sort of things. So you’ve got to take each week, each day, every game one at a time and I know our guys will be focused on San Francisco next week. Derrick Hall satisfied with D-backs’ buying and selling What stood out to you?When I went back and watched the tape this morning I think the story line that probably excited me the most was the contributions of our rookie draft class. When you look at J.J. Nelson, David Johnson with the touchdown, Rodney Gunter had a huge sack for us and of course Markus Golden with the sack and the strip—huge for us, on national TV and really made big contributions, which again for a bunch of young guys I think that that’s probably what stood out the most.What do you say about Carson Palmer and how he’s playing right now?He’s what makes everything go for us. There’s no doubt about that. For me it was a tale of two halves. I think early on Carson maybe tried to force a little bit and at the same time I don’t know that our offensive line matched their defensive line’s physicality, their level of intensity. Yet in the second half I felt like we did. We started to run the ball more effectively which obviously made our offense go. Early on, two times, we turned Geno Atkins loose, there were a couple guys who got beat physically in one-on-one situations, but again the level of intensity in the second half certainly was cranked up a notch.There wasn’t much mention of Tyrann Mathieu and Bobby Massie. Is that because they played so well that you didn’t need to talk about them? Your browser does not support the audio element. Former Cardinals kicker Phil Dawson retires Arizona Cardinals’ Larry Fitzgerald pumps his fist as he runs off the field after an NFL football game against the Cincinnati Bengals Sunday, Nov. 22, 2015, in Glendale, Ariz. The Cardinals defeated the Bengals 34-31. (AP Photo/Ross D. Franklin) Well in Ty’s situation they didn’t test him a lot. As far as Bobby, I thought Bobby played solid. There was a couple times where it felt like he overset and gave up some inside penetration. But I said early last week that they have a talented team. Across the board up front they have some guys who can rush the pass or create pressure who are physical. There was no point in time during the week or even last night that I knew it was going to be a cakewalk. I certainly felt like we would have our hands full.What kind of season is Patrick Peterson having from your standpoint?I will say this. Last year some of the concerns with Patrick, and we all know Pat’s one of the most talented corners in the league, I think there were some issues with consistency last year. And I think a lot of it had to do, I think, because of his playing weight and that sort of thing. This year, he came back in phenomenal shape – probably the best shape he’s been in as a pro – and his level of consistency he’s taken to a whole different level. His mindset, his competitiveness…he’s been phenomenal this year. Some of the stuff that he does, for fans or for me, when you see a ball caught for eight yards on him and you know we get frustrated, we put him in some really tough positions. The type of man with no help over the top that we ask him to play, it’s really a testament to him and his work ethic and just the fact that he’s a true pro, what he’s done for us this year. Last night you know he had an ankle injury. I don’t have any news on that just yet. I’m assuming he’ll be sore today but I’ll know a little bit more after he gets his MRI and I talk it over with Tom Reed and our medical staff. Comments   Share   If Patrick Peterson’s ankle isn’t that great, do you need to go after some cornerback depth this week?We have Robert Nelson who we elevated from the practice squad and I think he’s the type of guy that if he gets an opportunity, he’ll do a nice job. He’s played some real football, not just practice squad football, he’s played some real football for Cleveland last year and the guy’s got a really good skillset athletically. I think he just needs an opportunity. We’ll obviously look at the waiver wire, we’ll go back and look at our short list and see if there’s any guys worth bringing in, but again that’s too early now, not knowing the significance of Pat’s injury.Did you see Matt Barkley come running out last night in the towels?  I didn’t see it and I heard about it and I’m probably happy that I didn’t see it (laughs).That tells me that there is a chemistry that is forming. Can you talk about what is going on inside that locker room?No doubt. That’s the thing, the confidence and the trust and the loyalty that these guys have for each other has really become infectious and I don’t think you can put a value on that in the National Football League.  It’s one thing to have a talented roster but when you have 53 guys walk out of the locker room at one time and they have that type of confidence and trust and loyalty and respect for each other, man that’s a powerful, powerful tool. Any time you’re looking at your roster and you may have some holes or areas that you feel like you need to improve, when you have that type of confidence in your locker room that can overcome a lot of limitations.center_img The attention is going to keep coming. Do you embrace the new national spotlight or do you hate it?I think as a Cardinals fan or a Cardinals employee that you have to embrace it considering where we’ve come from. When I’ve talked about years and years of coming into Phoenix as a scout and seeing very little Cardinals paraphernalia around and to see this type of fan base grow the way they have and to see the stadium as energized as it was last night, seeing the club section completely full at least from my vantage point, it gives you a great sense of pride to be a Cardinal. That’s what I’ve always said, that the wins and losses are one thing but to see this fan base grow and to see the sense of pride in this community, to me is really what this is all about.You built this team. Where do you need to get better and where are you confident in your talent right now?It’s funny, I was talking about that this weekend. It’s one of those things where you hear someone like John Gruden, who I have a lot of respect for, and some other people come on national media and talk about how either we’re one of the most talented teams or the most talented team in the NFL yet at the same time I sit and I look at my board with the depth chart and I look at it and all I see is holes, areas where we need to improve, where we need to get better, where I need to do a better job. I think that goes back to being a perfectionist. I think there’s no question that you’d like to get to a point where you don’t have to manufacture that type of pressure consistently and you can have some guys who get off the edge and disrupt the quarterback. Last night it was nice to see Dwight do the inside spin and to do some of those other things, and he’s been a great pickup for us obviously but we have to find a way to be able to get more pressure off the edge, and we’ve got to do a little bit better job of putting ourselves in matchup situations, defensively and offensively just the consistency protecting the quarterback. There’s no doubt in my mind that we do have the weapons to be a force offensively, yet at the same time if we don’t have the right communication or we get beat up front everything falls apart. Sometimes, it’s best to go straight to the man in charge.And when it comes to the Arizona Cardinals’ roster, that man is Steve Keim.Arizona’s general manager since January 2013, Keim’s deft touch with the draft and free agency has led to the team becoming a contender in the NFC.Lucky for us, Keim happens to be a weekly guest on the Doug and Wolf Show, right here on Arizona Sports 98.7 FM. And since what he has to say is important, we thought it would be a good idea to put his words into print, allowing you to read what the GM is thinking. So, without further ado, here’s this week’s edition: The 5: Takeaways from the Coyotes’ introduction of Alex Meruelo – / 31 LISTEN: Steve Keim, Cardinals general manager Top Stories Grace expects Greinke trade to have emotional impactlast_img read more

Treatments for childhood cancer can devastate lives years later Scientists are trying

first_img 0 6% Treatments for childhood cancer can devastate lives years later. Scientists are trying to change that 1985 However, he discovered they no longer had cancer, but they weren’t healthy, either. Chemotherapy and, for lymphoma survivors, radiation used to shrink chest tumors had weakened hearts in ways he didn’t fully understand. Anywhere from months to more than a decade after treatment, they trailed into Lipshultz’s waiting room, frail and struggling to breathe.Those young people were among the first to sound the alarm that pediatric cancer treatment could have grave aftereffects. Some, such as those Lipshultz cared for, suffered from abnormal heart rhythm or heart failure. Others ran into a slew of health problems: a second cancer caused by treatment for the first, infertility, trouble learning, thyroid abnormalities, impaired lung function, kidney disease. As more children survived, more doctors learned just how high the price of survival could be. Abnormal lung function Hearing loss (GRAPHIC) N. DESAI/SCIENCE: (DATA) M. HUDSON ET AL., JAMA, 309, 2371 (2013) Click to view the privacy policy. Required fields are indicated by an asterisk (*) SETH DIXON/ST. JUDE CHILDREN’S RESEARCH HOSPITAL Pulmonary system 1975 25 Sign up for our daily newsletter Get more great content like this delivered right to you! Country 1995 Brain and spinal cord 100% Survival 5 years after cancer Email (LEFT TO RIGHT) DAVID RODRIGUEZ; JANE AUNE Hodgkin lymphoma For Ness, the roots of that rapid aging start with a truism of cancer treatment: While killing cancer cells, chemotherapy and radiation damage many healthy cells, too. Damaged cells often enter senescence—cellular old age—as a protective mechanism that allows them to expend less energy. From the results of cell aging studies, Ness speculates that in childhood cancer survivors, senescent cells “communicate with other cells around them,” telling those cells to senesce as well. Those “aged” cells also emit molecules that cause low-grade inflammation in the body, which is linked to aging in healthy people.Ness and colleagues are studying markers of biological aging; one, a protein called p16, is typically undetectable in healthy young adults. But the researchers are finding it in the blood of some young adult survivors—suggesting their cells may be following a trajectory similar to that of much older people.Kristopher Sarosiek, a cancer biologist at the Harvard T. H. Chan School of Public Health in Boston, is exploring a different link between cell damage during treatment and lasting debility. As a postdoc, he studied a form of cellular self-destruction called apoptosis. In healthy adults, cells were resistant to it, even when damaged. But in the developing tissues of healthy young mice, he found, “The apoptosis pathway is blowout high and incredibly active.”The reason? Young mice—and young children—are growing, and their bodies must wipe out any newly generated cells that are dysfunctional. Apoptosis accomplishes that. Anticancer treatments activate apoptosis in cancer cells—but also in healthy developing tissues, putting young cancer patients at high risk of tissue damage. Sarosiek points to a classic example: radiation to the brain. “You can give radiation therapy at very high levels to adults in the brain,” he says, “and they’ll experience slight neurocognitive damage. But if you do the same to a very young child, you can devastate their cognitive ability.” Sarosiek is now trying to understand, in a mouse model of radiation treatment, how pediatric cancer therapy activates apoptosis in healthy tissues.Whatever causes it, losing healthy cells during treatment can have a long-delayed impact, as Lipshultz’s decades of work have shown for the heart. In various studies, he found that children treated with a popular class of chemotherapy drugs called anthracyclines suffer a loss of heart muscle cells that can initially cause few or no symptoms. But over time, the muscle loss becomes a problem. The heart grows by stretching its existing muscle cells, not by making new ones. Once those children reach adulthood, “the mass of the heart is inadequate for the size of the body,” Lipshultz says. He has also found that some survivors experience a thinning of the walls of their heart or irreversible damage to heart muscle, further stressing the organ.Most striking, however, is the gulf in outcomes. “I have some childhood cancer survivors 30 years out who have totally normal hearts,” Lipshultz says. “I have others who died from therapy or needed a new heart.”Plotting a new course for patientsToday’s goal is to carve a different path for the next generation of cancer survivors—to ensure that they do not end up, years later, in the care of doctors like Lipshultz. “We’re not going to not treat cancer,” says Bruce Carleton, a clinical pharmacologist at the University of British Columbia in Vancouver, Canada. But knowing which children treatment is likely to hit hardest could help doctors minimize its effects.At Carleton’s hospital, treatment causes permanent hearing loss in 37% of children with cancer—an outcome that forever alters how a 2-year-old learning to talk understands and communicates with the world. In the mid-2000s, Carleton launched a DNA hunt for gene variants that can raise or lower the risk of hearing loss and heart problems from chemotherapy. For hearing loss, he identified three variants; for heart problems, he found three more. In 2014, as part of a study, he and colleagues began to offer testing to all newly diagnosed cancer patients at British Columbia Children’s Hospital, steps away.One was 13-month-old Aeson Moen, whose cancer created an agonizing choice. He came to the hospital from a town more than 4 hours’ drive east, and he had a large mass next to his spine, behind his heart. The diagnosis: high-risk neuroblastoma, a deadly childhood cancer. Aeson needed radiation—which would surely hit his heart as well—along with many doses of heart-hazardous anthracyclines.But then genetic testing flashed a warning. The toddler carried two gene variants for anthracycline cardiac toxicity, which Carleton’s lab calculated meant an 89% chance of severe heart damage; radiation would only ratchet up that number. Aeson’s risk was alarming, says his pediatric oncologist, Rod Rassekh. “We were especially worried about him.”Rassekh had never treated a neuroblastoma patient like Aeson without anthracyclines, but he began to wonder whether he should jettison them. He and colleagues found an alternative protocol from Europe: a single dose of anthracyclines combined with other chemotherapies and radiation. Even that one dose, though, might be enough to push Aeson’s heart into failure. “It made me feel more comfortable to leave that drug out than give it to him,” says his mother, Ana Moen.The hospital sought counsel from an ethicist. Ultimately, all agreed that Aeson’s parents, with Rassekh’s guidance, were making an informed decision. Aeson received anthracycline-free treatment, though it was hardly easy: He still endured many rounds of other chemotherapies, radiation, and a stem cell transplant. “Was I nervous, as his oncologist?” Rassekh says. “I was extremely nervous, thinking, ‘Are we making the right decision?’”More than 4 years later, Rassekh is beginning to exhale. Aeson started kindergarten last fall and will turn 6 next month. He is now cancer-free with a perfectly healthy heart. His first season of T-ball begins this spring. Neuroblastoma 2005 65% By Jennifer Couzin-FrankelMar. 14, 2019 , 2:00 PM Leukemia Cardiomyopathy Female infertility 62% Endocrine system Cardiovascular system A single patient could spark the awakening. Years ago, Lisa Diller, a pediatric oncologist at the Dana-Farber Cancer Institute in Boston, was horrified when she encountered a man in his 30s dying of stomach cancer, a disease almost certainly caused by radiation treatment he received as a teenager for Hodgkin lymphoma. “What the heck is going on here, and what are we going to do about it?” she recalls thinking.Today, cure rates for two common childhood cancers, Hodgkin lymphoma and standard-risk acute lymphoblastic leukemia, are more than 90% in the United States and Canada; overall, 83% of childhood cancer patients become long-term survivors. But in a 2014 study, 80% had at least one serious, disabling, or life-threatening health condition by age 45. Physicians and researchers are increasingly learning how cancer treatment reshapes the growth and development of small bodies into adulthood and beyond. As knowledge builds and the survivor population expands—it’s now approaching 500,000 in the United States—a burgeoning effort is underway to blunt the effects of cancer therapy.To understand the genesis of late effects of cancer treatment and how best to prevent and treat them, scientists are casting a wide net. They are studying drugs in zebrafish, walking mice with cancer on a treadmill, probing the cells of survivors, and testing DNA of newly diagnosed children. And in every lab, in every conversation with a family, scientists and physicians are walking a tightrope: Their greatest fear is jeopardizing a child’s survival from cancer, but they’re also striving to ensure good health in the decades to come.”I remember laying in bed thinking, ‘There’s got to be a better way to do this,’” says Gregory Aune, a pediatric oncologist at the University of Texas Health Science Center in San Antonio, who runs a lab studying how chemotherapies harm the heart. Aune was 16 when he was diagnosed with Hodgkin lymphoma. He lost 30 kilograms during treatment. In the years that followed, he experienced thyroid problems and underwent triple bypass heart surgery at 35. Despite treatment-induced infertility, he now has two pairs of twins born from sperm he banked before chemotherapy and radiation. Cancer was “presented to me as, ‘Just get through the therapy, and this will be over and [you] go back to normal.’” Instead, Aune says, “Your life trajectory changes. That’s one of the things we have to change about oncology.”How treatment affects growing bodiesKiri Ness first encountered childhood cancer survivors en masse at St. Jude Children’s Research Hospital in Memphis, Tennessee, after taking a job there in 2006. A physical therapist and epidemiologist, Ness knew that roughly one-third of survivors developed a second cancer by age 50, likely because of DNA damage to healthy cells during treatment; almost 10% had an underactive thyroid; and about 15% had heart dysfunction. Survivors who received radiation to the brain were less likely to be employed as adults than survivors who hadn’t needed that treatment. Children who endured a bone marrow transplant were at especially high risk of complications, including infertility and kidney failure.Ness wanted to meet survivors to better understand those long-term effects. St. Jude monitors several thousand survivors for life, and one after another streamed into her “human performance lab,” set up to assess their general health. Ness was startled. “They look like old people,” she remembers thinking about the adults in their 20s, 30s, and 40s. “They have wrinkled skin, they walk slowly, they’re weak, they have characteristic gait patterns that mostly elderly people have.”The inside mirrored the outside. Results from cardiac stress tests and muscle strength assessments were “similar to [those of] people in their 70s and 80s,” Ness says. Her reaction was identical to Diller’s. “I was like, ‘What is going on?’”Ness started to investigate. The youngsters lost muscle mass during cancer therapy, she found; after treatment ends, “it seems like they don’t ever become robust again.” Years later, their nervous systems might slow down: Reactions became more sluggish, and they lost cognitive function. In 2013, Ness and colleagues reported that of 1922 pediatric cancer survivors with an average age of 33, about 10% qualified as frail. Another 30% were “prefrail,” with some loss of endurance and muscle mass. The proportions mirror those in people older than 65. Country * Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People’s Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 25% 61% Nervous system Kiri Ness of St. Jude Children’s Research Hospital tests the leg strength of brain cancer survivor Isaac Walsh, now 21. Overall 75 More than 30 years ago, a new kind of patient began to appear in the cardiology clinic at Boston Children’s Hospital: young people whose cancer treatment first saved their lives and then threatened to kill them.Steven Lipshultz, a bespectacled pediatric cardiologist, examined them. They ranged from preschoolers to young adults, and all had recovered from leukemia, lymphoma, or other cancers. They were new to Lipshultz for a reason: Until recently, most children with cancer died.But in the 1980s, a medical miracle was in the making. Clinical trials had pointed to combinations of drugs and radiation that could rescue once-doomed children. Survival rates, in the single digits for leukemia in the 1960s, surged past 50% and kept climbing. Oncologists and families celebrated the formerly unimaginable: birthday parties, high school graduations, a life relieved of terrible stress and fear. “Children were told they’re free and clear, they’re cured,” says Lipshultz, now at the University at Buffalo, part of the State University of New York system. Abnormal cholesterol levels From hopelessness to hope Childhood cancer was once a death sentence, but today more than 80% of children and teenagers survive long term. This graph shows survival rates depending on the year a young person was diagnosed. 61% Diagnosed with Hodgkin lymphoma as a teenager, Gregory Aune went on to study the aftereffects of chemotherapy. Hormonal dysfunction 57% After the cure Adults who survive cancer as children can suffer long-term health effects. One study of 1700 people ages 18 to 60 explored how treatments toxic to an organ system—chemotherapy, radiation, or both—led to problems in the years ahead. The bars show the frequency of certain complications. 2014 Cataracts 50 12% Male infertility Memory problems 66% 21% (GRAPHIC) N. DESAI/SCIENCE: (DATA) NATIONAL CANCER INSTITUTE SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROGRAM Heart valve abnormalities “When I first started, I thought every family would want all the chemo, period,” to maximize the chance of a cure, Rassekh says. But he’s learning that many families are willing to forgo some treatments if doing so means better odds of good health. Rassekh recalls a 4-year-old he treated more than a decade ago for neuroblastoma, before the genetic testing was available. Reviewing her case, he found that she carried the same gene variants as Aeson. One year after treatment, the girl needed a heart transplant—and when the first transplant failed, she needed a second.This year, Carleton is expanding gene testing to nine more children’s hospitals across Canada. Other major gene sequencing efforts are underway. One of the broadest is through the pioneering Childhood Cancer Survivor Study (CCSS), which launched in 1994 and includes more than 25,000 survivors of childhood cancer diagnosed from 1970 to 1999 in the United States and Canada. By the end of the year, the CCSS will have sequenced the exomes—the protein-coding DNA—of more than 8000 of them, says Greg Armstrong, a pediatric neuro-oncologist at St. Jude and lead investigator of the CCSS.Changing a treatment protocol, as doctors did for Aeson, isn’t always possible. More than 4000 kilometers from Vancouver, a collaborator of the British Columbia group is weighing other uses of genetic results. “We’re not going to get rid of the anthracyclines” for everyone, says Jason Berman, a pediatric oncologist at Dalhousie University in Halifax, near Canada’s eastern edge, “but maybe we’ll have protective drugs” to give alongside them, particularly for patients genetically prone to the toxic effects.When he’s not caring for children with cancer, Berman runs a zebrafish lab and uses the small tropical fish to screen dozens of potential drugs. So far, he has hit on two that, when given with anthracyclines, protect a fish’s heart from damage without dulling chemotherapy’s effect on cancer cells. As his own hospital prepares to take up Carleton’s gene testing regimen, Berman envisions eventually testing new protective compounds on the children deemed at highest risk of heart damage.One such drug is already available: dexrazoxane, which is approved in the United States to minimize cardiac damage in patients with breast cancer and sometimes offered to children receiving cancer treatment. Lipshultz pioneered testing dexrazoxane with pediatric patients in the 1990s. Now, physicians are studying how well dexrazoxane heads off cardiac problems years after treatment. Lipshultz, pediatric oncologist Eric Chow at the Fred Hutchinson Cancer Research Center in Seattle, Washington, and others are tracking down hundreds of adults who received dexrazoxane during those early trials.Some researchers wonder whether ordinary exercise might safeguard the heart. At the University of Texas MD Anderson Cancer Center in Houston, pediatric oncologist Eugenie Kleinerman is considering whether brisk walks during treatment can protect cardiac function in young people with the bone cancer osteosarcoma. Like many in the field, she has a tragic story that set her on this path: Kleinerman cured a young woman of sarcoma only to learn that she’d collapsed and died from an apparent heart attack on a Michigan college basketball court years later. A self-described exercise nut, Kleinerman created a mouse model of osteosarcoma treatment in which the animals sustain heart damage from doxorubicin, an anthracycline drug. While getting twice-weekly chemo infusions, they’re put on a treadmill for a brisk 45-minute walk. Echocardiograms and autopsies revealed that, immediately after chemotherapy and 2 months later, mice that exercised had hearts indistinguishable from those of animals that hadn’t gotten chemotherapy, Kleinerman reported in April 2018 in the Journal of Pediatric Hematology/Oncology.Late last year, she launched a pilot study to determine whether an exercise program is feasible for adolescent and young adult osteosarcoma patients, who often have leg tumors. If it is, Kleinerman says she hopes to launch a larger trial to test whether the strategy can keep hearts healthy.Some pediatric oncologists see a field on the cusp of change. Their toolkit—largely from the 1980s and earlier, because new treatments are almost always designed for adults—is finally expanding. Novel targeted therapies and immunotherapies may have fewer, and certainly different, long-term effects. Meanwhile, clinical trials have helped pinpoint patients at lower risk of relapse or death; such children can sometimes be spared some hazardous therapy. Even for the childhood brain cancer medulloblastoma, among the most aggressive cancers, scientists are testing whether one low-risk group can safely decrease radiation. In 2016, Armstrong and CCSS colleagues reported in The New England Journal of Medicine the tangible effect of gentler treatment: Twelve percent of children who survived any cancer in the early 1970s died within 15 years of diagnosis, compared with 6% treated in the early 1990s.At 45, Aune still lives with the effects of cancer therapy. Recently, he found himself peering through a distorted mirror: In front of him sat a girl the same age he was at diagnosis, 16, with the same burden of Hodgkin lymphoma. And yet her trajectory would be different. She endured 3 months of treatment to his 9. She quickly returned to school full-time, whereas he needed an extra year to graduate. She avoided chest radiation, thanks to clinical trials more than a decade ago suggesting that most Hodgkin patients don’t need that brutal treatment—which left girls like her with a one-in-three chance of breast cancer by their mid-40s. “She’s going to do really well,” Aune predicts. Now, he says, it’s up to him and others to create a future as bright for the survivors still to come.Read more from Science’s special issue on pediatric cancer.last_img read more