Lung cancer

 Scientists believe they have discovered a way to "steer" the immune system to kill cancers.

Researchers at University College, London have developed a way of finding unique markings within a tumour - its "Achilles heel" - allowing the body to target the disease.
But the personalised method, reported in Science journal, would be expensive and has not yet been tried in patients.
Experts said the idea made sense but could be more complicated in reality.
However, the researchers, whose work was funded by Cancer Research UK, believe their discovery could form the backbone of new treatments and hope to test it in patients within two years.
They believe by analysing the DNA, they'll be able to develop bespoke treatment.
People have tried to steer the immune system to kill tumours before, but cancer vaccines have largely flopped.
One explanation is that they are training the body's own defences to go after the wrong target.
The problem is cancers are not made up of identical cells - they are a heavily mutated, genetic mess and samples at different sites within a tumour can look and behave very differently.

'Exciting'

They grow a bit like a tree with core "trunk" mutations, but then mutations that branch off in all directions. It is known as cancer heterogeneity.



The international study developed a way of discovering the "trunk" mutations that change antigens - the proteins that stick out from the surface of cancer cells.
Professor Charles Swanton, from the UCL Cancer Institute, added: "This is exciting. Now we can prioritise and target tumour antigens that are present in every cell - the Achilles heel of these highly complex cancers.
"This is really fascinating and takes personalised medicine to its absolute limit, where each patient would have a unique, bespoke treatment."
There are two approaches being suggested for targeting the trunk mutations.
The first is to develop cancer vaccines for each patient that train the immune system to spot them.
The second is to "fish" for immune cells that already target those mutations and swell their numbers in the lab, and then put them back into the body.

'Early days'

Dr Marco Gerlinger, from the Institute of Cancer Research, said: "This is a very important step and makes us think about heterogeneity as a problem and why this gives cancer this big advantage.



"Targeting trunk mutations makes sense from many points of view, but it is early days and whether it's that simple, I'm not entirely sure.
"Many cancers are not standing still but they keep evolving constantly. These are moving targets which makes it difficult to get them under control.
"Cancers that can change and evolve could lose the initial antigen or maybe come up with smokescreens of other good antigens so that the immune system gets confused."

Analysis

James Gallagher, health editor, BBC News website
Harnessing the power of the immune system - what's known as immunotherapy - is the most exciting field in cancer and probably in all of medicine right now.
But while that excitement is justified, claims that a cure for cancer is around the corner are not.
Medical research is littered with the graves of hyped treatments that just never worked.
Two decades ago, gene therapy was "hype-central" and we're still waiting for it to transform medicine.
This study demonstrates some spectacular science that furthers understanding of how the immune system and cancer interact.
But this new knowledge has not been used to treat a single patient. There have not even been animal studies. So there is a real risk it will not work.
Even if it does, this is an hugely expensive approach that would need to be customised to every patient in a process that takes more than a year from start to finish.

Some immunotherapy treatments work spectacularly with some patients' cancer disappearing entirely.
They take the brakes off the immune system, freeing it up to fight cancer.
The researchers hope the combination of removing the immune system's brakes and then taking over the steering wheel, will save lives.
Professor Peter Johnson, from Cancer Research UK, said the research had shown "impressive results in the clinic" and although "the technology is complicated and quite recent... once you start doing it the cost will come down".

'Elegant study'

Dr Stefan Symeonides, clinician scientist in experimental cancer medicine at the University of Edinburgh, said designing a personalised vaccine was currently impractical, especially when a patient needed treatment straight away.
But he added that the "very elegant" study did provide a ground-breaking insight into current immunotherapy drugs, which do not yet work for most people.
"It's not just the number of antigens, it's how many of the cancer cells have them," he said.
"This data will be quoted in discussions for years, as we try to understand which patients benefit from immunotherapy drugs, which ones don't, and why, so we can improve those therapies."
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Obesity is the biggest threat to women's health and the health of future generations, warns England's chief medical officer Dame Sally Davies.
Her annual report, which focuses on women this year, said tackling obesity should be a national priority to avert a "growing health catastrophe".
She said the food industry needed to do more or it should face a sugar tax.
Dame Sally is also calling for better treatment of ovarian cancer and more open discussion on incontinence.
England's top doctor said obesity was so serious it should be a priority for the whole population, but particularly for women because too often it shortened their lives.
In England in 2013, 56.4% of women aged 34-44 and 62% of women aged 45-54 were classified as overweight or obese.
Obesity increases the risk of many diseases including breast cancer, type 2 diabetes and heart disease.

Sugar tax

Dame Sally warned that if the food industry did not clean up its act then new taxes may be the only option.
She told the BBC: "I think it is inevitable that manufacturing has to reformulate and resize, that supermarkets and others need to stop cheap promotions on unhealthy food and putting unhealthy food at the check-out, and limit advertising dramatically.
"I think we're at a tipping point. If industry won't deliver then we'll have to look at a sugar tax."
Elsewhere in the report, the chief medical officer recommended that:
  • clinical staff be better trained to recognise and respond to violence against women, including female genital mutilation, domestic abuse and sexual violence
  • more research is needed to improve maternal and child mental and physical health
  • more research on screening tests, preeclampsia and foetal growth is also needed
  • children should receive integrated personal, social, health and economic education (PSHE) with sex and relationships education (SRE) at school
  • a full range of contraception services should be available to all women, at all reproductive ages

Pregnancy health

Dame Sally highlighted the fact that women had to look after their physical and mental health during pregnancy for the sake of their children and grandchildren.




Calculate your BMI (body mass index)
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Five ways to help women lose weight




If a woman is obese during pregnancy, research indicates there is an increased chance of miscarriage and premature birth.
A woman's overall health during pregnancy also has an impact on the health of the child in later life, the report said.




A pregnant woman's health affects the conditions inside the womb which in turn can have life-long consequences for the health of the child including the risk of obesity or type 2 diabetes.
Dame Sally said she wanted to "bust the myth" that women should eat for two when pregnant, adding a healthy diet with fruit and vegetables and avoiding alcohol was important.
Prof Nick Finer, from University College London's Institute of Cardiovascular Science, said obesity was now "the most pressing health issue for the nation".
"Estimates of the economic costs of obesity suggest they will bankrupt the NHS.
"Elevating the problem of obesity to a national risk could help to address the current 'laissez faire' attitude to this huge, angry, growing health catastrophe," he said.








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Media captionSize acceptance campaigner Kathryn Szrodecki: "It's scare tactics...the biggest killer for women is dementia and Alzheimer's"
The report makes 17 recommendations across a range of women's health issues.
In her report, Dame Sally highlighted the need for early diagnosis and treatment of eating disorders, such as anorexia, bulimia and binge-eating, which are more common in women than men.
She recommended that everyone with an eating disorder should have access to a new and enhanced form of psychological therapy, called CBT-E, which is specifically designed to treat eating disorders.
This should be available to all age groups across the country, she said.
Lorna Garner, from Beat, the charity that supports people with eating disorders, said the recommendation would have "a dramatic and positive impact on a very large proportion of the individuals diagnosed with eating disorders".





What is CBT-E?

It's a one-to-one psychological therapy which focuses on changing the patient's views on body image and helping them to accept their bodies as they are.
The 'E' stands for enhanced because it is tailored to the individual, with the aim of helping them to learn more productive ways of thinking, feeling and behaving.
Keeping patients engaged in the process and preventing any relapses is a key part of the therapy.
Extensive studies have shown that it works for all eating disorders, with a 66% success rate for people with bulimia and binge-eating disorders.
The therapy lasts from five to nine months and can also be used on children over 14 years old.
Therapists can be trained online to deliver CBT-E, which helps patients to be treated quickly.




Ovarian cancer survival is lower in England than in other comparable countries
The report also called for better treatment for ovarian cancer, which kills more women in England than any other gynaecological cancer.
With survival from the cancer among the lowest among developed nations, Dame Sally recommends longer operating times to increase the likelihood that all the cancer is removed during surgery.
Training in specialised surgical skills to remove gynaecological cancers and an audit of treatments are also highlighted in the report.

Taboo issues

There should be more awareness of women's problems "below the waist" and more discussion of taboo topics such as urinary and faecal incontinence and the menopause, the report said.
More than five million women suffer from incontinence in the UK, a condition that can seriously affect the quality of their lives.
Bosses should also make it easier for women to discuss their menopausal symptoms without embarrassment, which could help them reduce their sick leave and improve their wellbeing at work.
Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, said women should be placed at the centre of their care throughout their lives.
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BY RUTH HARRISON




Coud your kid be a child genius? Coud your kid be a child genius? Getty
EVERY parent thinks their child is a genius but there’s a way to be sure from an early age – and it involves a RAISIN.
Scientists have found that by placing the fruit under a cup and telling a toddler not to touch it, they can tell how clever the youngster will turn out to be.
While most two-year-olds make an immediate grab, those who resist for one whole minute will score an average 19 per cent higher on tests by the time they are eight, the University of Warwick found.
Here, RUTH HARRISON reveals other tell-tale signs of a high IQ from birth up to the age of ten.


Newborn

EXTRA HEAVY


Chubby baby ... you might have a genius on your hands


Chubby baby ... you might have a genius on your hands Getty
WOMEN who give birth to hefty babies can rejoice at news that the heavier a newborn, the higher their intelligence.
A study of more than 3,000 babies published in the British Medical Journal found that larger birth weights meant slightly higher IQ.
It is thought to be down to the fact that heavier babies have been better nourished.


Age one & two

HEARS EXTRA LANGUAGES
MANDARIN? French? Spanish? Can you talk to your child in a different language?
One trick to encouraging brain development in a toddler is if it is spoken to in different languages, according to a report in scientific journal Child Development.
Those born to parents who speak more than one language perform better on IQ tests.
So parents and parents-to-be, it’s time to brush up on those foreign tongues.


Age three

TALLER THAN OTHERS
FOR your child to have the best chance of reaching great heights, they have to stand at er . . . a great height.
Tall kids are more likely to ace tests, according to a study by the National Bureau of Economic Research.
The study team noted: “As early as age three, before schooling has had a chance to play a role, and throughout childhood, taller children perform significantly better on cognitive tests.”


Age four

CAN PAINT A PERSON




They might not be Picasso but arty kids are usually smarter They might not be Picasso but arty kids are usually smarter Getty
ARTISTIC youngsters who can create a realistic image of a human by this age are more likely to be more intelligent in their teens.
Researchers at King’s College London studied 15,000 pictures drawn by four-year-olds and found that those with an early eye for art were more likely to do better in later IQ tests.


Age five

TELLING LIES EARLY ON
FIBBING can be a good thing. Researchers found that children who do it at an early age are more likely to do well in later life.
A Canadian study of 1,200 children aged two to 17 found that kids who are able to lie early on are more intelligent.
The experts from the Institute of Child Study at Toronto University say this is because the complex processes involved in conjuring up a tale are a good indicator of a child’s IQ.


Age six

PLAYS A MUSICAL INSTRUMENT




Musical kids are more emotionally developed Getty
PLAYING a musical instrument helps boost a child’s emotional intelligence at this age.
Musical kids are more emotionally developed
Researchers at the University of Vermont College of Medicine looked at the brain scans of 232 healthy children aged six to 18.
They found that the more a child played an instrument, the better their skills with “anxiety management and emotions.”


Age seven

BETTER THAN AVERAGE READER




Kids who read do well in intelligence tests Getty
LOTS of reading early on is a key indicator of higher intelligence in later years, scientists have found.
Those kids who have better-than-average reading skills at the age of seven, immersing themselves in novels, perform well in IQ tests as teenagers, according to a joint study by the University of Edinburgh and King’s College London back in 2014.
Kids who read do well in intelligence tests

Age eight

LOVES STAYING UP LATE
IS your lass or lad of around this age always pushing back bedtime?
Research by the London School of Economics shows that clever adults are more likely to stay up late and started the habit at an early age.
Researchers noted: “More intelligent children are more likely to grow up to be nocturnal adults who go to bed late and wake up late on both weekdays and weekends.”


Age nine

SCOFFS A GOOD BREAKFAST


Most important meal for the brain


Most important meal for the brain Getty
IF your child is eating a healthy breakfast at this age, their chances of achieving above-average marks in academic tests are doubled.
Those downing cereals, breads and dairy in the morning do best in assessments at the end of Key Stage Two, according to a University of Cardiff study of 5,000 pupils aged nine to 11.


Age ten

LOVES TO HAVE A GOOD CHAT


Talkative children often smarter


Talkative children often smarter Getty
BY the age of ten, your child can be tested by Mensa to find out their specific IQ level.
Key indicators of smartness, Mensa says, include a love of talk, making up different rules for boardgames and getting fed up with other children.
If you think your child could make the genius grade, take a look at mensa.org.uk for its IQ tests.
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Before you reach for that second piece of bread at dinner, consider this: the foods you are eating are showing up in your face as wrinkles, blemishes, bags and more.
If you can identify and eliminate your skin-aging triggers, you are also able to heal your gut, stop the process of “digest-aging” and reverse these effects on your skin.
As a naturopathic doctor, I noticed some secondary effects when treating my patients’ primary health concerns. Patients frequently came in for consultations and health advice on how to eradicate nagging issues, such as eczema. When discovering the root cause of chronic symptoms, I prescribed a lifestyle change, including foods to incorporate and to avoid, all according to the patient’s unique DNA. I realized that by applying these principles, my clients have since commented on the way their skin glows, increased levels of energy and an overall increased sense of well-being, which included a minimization of the originally treated ailment.

Further investigation and research has led me to identify four main culprits for premature skin aging: Gluten Face, Dairy Face, Wine Face and Sugar Face.

Gluten Face

Typically, gluten face will have a blemished forehead, cheeks and the chin area. Dark patches around the chin area are very characteristic of this face of aging. Puffy and red cheeks will complete a textbook case of Gluten Face. Gluten has a protein that can cause “leaky gut syndrome,” which means food proteins can escape into the circulatory system, thereby causing inflammation.

Dairy Face
Cow’s milk is meant to feed baby cows. For humans, it contains over 60 different hormones in just one glass. It changes your natural hormone levels that can cause acne, inflammation and puffy eyelids. The facial symptoms of diary face are seen through swollen eyelids, widespread acne and pronounced blemishes with a concentration on the chin area. Pale and lifeless cheeks with unattractive bags and dark circles around the eye area underline these undesirable symptoms that dairy brings about.

Wine Face
Arguably the most common face found in nearly all adults at one point or another is Wine Face. Alcohol not only dehydrates the skin, but it also extends the element of fermented sugar that adds to the effects that wine and alcohol have. Symptoms for Wine Face include pronounced lines and blemishes between the eyebrows and forehead area. Droopy and “lazy” looking eyelids paired with enlarged pores and feathery lines across your cheeks makes this one of the most unattractive and dangerous skin agers.

Sugar Face
Sugar is an addiction that affects many children and adults without realizing the real and dangerous effects of it. Sugar causes glycation, in which the sugar in your bloodstream attaches to proteins to form harmful new molecules called advanced glycation end products (AGEs). The more sugar you eat, the more AGEs you develop. Your face will tell the tale when you have been indulging in your favorite sugary treats. Sugar Face shows up through lines and wrinkles on the forehead, sagging eye lids, a very gaunt and lifeless look that is grey and pasty, and thinning skin with pustular/cystic acne.

It is not all doom and gloom, and the idea is not to stop living your life. The four-week program in my new book, "Younger Skin Starts in the Gut," will give you a chance to reset your lifestyle regime. After you have completed the four weeks and reverse the signs of the four faces of aging, then you can incorporate some of your favorite treats back into your diet. Apply the 80/20 rule—eighty percent of the time, follow the good principles of the four-week program. During the other 20 percent, when in Rome, enjoy that bowl of pasta and cup of gelato.
Dr. Nigma Talib is a world-renowned naturopathic doctor, aesthetician and leading authority on holistic health who has become celebrated for her expertise in the treatment of anti-aging. Her celebrity clients include Penelope Cruz, Sienna Miller, Kate Bosworth, Rosie Huntington-Whiteley and many others. She lives in London, England. For more go to her website healthydoc.com .
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Urinary incontinence is leaking of urine that you can't control. Many men and women suffer from urinary incontinence. We don't know for sure exactly how many. That's because many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done. So they suffer in silence.
Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don't want to be too far from a toilet. Urinary incontinence can keep people from enjoying life.
Many people think urinary incontinence is just part of getting older. But it's not. And it can be managed or treated. Learn more here. Talk to your doctor. Find out what treatment is best for you.

Key Statistics

A quarter to a third of men and women in the U.S. suffer from urinary incontinence. That means millions of Americans. About 33 million have overactive bladder (also known as OAB representing symptoms of urgency, frequency and with or without urge incontinence.
Studies show that many things increase risk. For example, aging is linked to urinary incontinence. Pregnancy, delivery, and number of children increase the risk in women. Women who have had a baby have higher rates of urinary incontinence. The risk increases with the number of children. This is true for cesarean section (c-section) and vaginal delivery.
Women who develop urinary incontinence while pregnant are more likely to have it afterward. Women after menopause (whose periods have stopped) may develop urinary incontinence. This may be due to the drop in estrogen (the female sex hormone). Taking estrogen, however, has not been shown to help urinary incontinence.
Men who have prostate problems are also at increased risk. Some medications are linked to urinary incontinence and some medicines make it worse. Statistics show that poor overall health also increases risk. Diabetes, stroke, high blood pressure and smoking are also linked.
Obesity increases the risk of urinary incontinence. Losing weight can improve bladder function and lessen urinary incontinence symptoms.

What happens normally?

Female Urinary Tract
Female Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved
Male Urinary Tract
Male Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved
The brain and the bladder control urinary function. The bladder stores urine until you are ready to empty it. The muscles in the lower part of the pelvis hold the bladder in place. Normally, the smooth muscle of the bladder is relaxed. This holds the urine in the bladder. The neck (end) of the bladder is closed. The sphincter muscles are closed around the urethra. The urethra is the tube that carries urine out of the body. When the sphincter muscles keep the urethra closed, urine doesn't leak.
Once you are ready to urinate, the brain sends a signal to the bladder. Then the bladder muscles contract. This forces the urine out through the urethra, the tube that carries urine from the body. The sphincters open up when the bladder contracts.

What are the types of urinary incontinence?

Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence:

Stress Urinary Incontinence (SUI)

With SUI, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.
SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking my happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe.
Nerves carry signals from the brain to the bladder and sphincter
Nerves carry signals from the
brain to the bladder and sphincter
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
There are no FDA approved medicines to treat SUI yet, but there are things you can do. Ways to manage SUI include "Kegel" exercises to strengthen the pelvic floor. Lifestyle changes, vaginal and urethral devices, pads, and even surgery are other ways to manage SUI.
To learn more about SUI risk factors, diagnosis and treatments visit our SUI article page.

Overactive Bladder (OAB)

OAB is another common type of urinary incontinence. It is also called "urgency" incontinence. OAB affects more than 30% of men and 40% of women in the U.S. It affects people's lives. They may restrict activities. They may fear they will suddenly have to urinate when they aren't near a bathroom. They may not even be able to get a good night's sleep. Some people have both SUI and OAB and this is known as mixed incontinence.
With OAB, your brain tells your bladder to empty - even when it isn't full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate.
The main symptom of OAB is the sudden urge to urinate. You can't control or ignore this "gotta go" feeling. Another symptom is having to urinate many times during the day and night.
OAB is more likely in men with prostate problems and in women after menopause. It is caused by many things. Even diet can affect OAB. There are a number of treatments. They include life style changes, drugs that relax the bladder muscle, or surgery. Some people have both SUI and OAB.
To learn more about OAB risk factors, causes and treatments visit our OAB page.

Mixed Incontinence (SUI and OAB)

Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.

Overflow Incontinence

With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should.
One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called "dribbling."
This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.





Case study: Finding help





Jacq Emkes is a 55-year-old teacher who lives in Bedford. Her problems with continence started in 2009 after a womb operation.
She says: "I didn't know who to turn to for help. But recently I found out there is a continence service locally."
She says this helped her find out about the different products that are available and that there were specialist physiotherapists and nurses who could help.
"It is a question of trying to build up trained and qualified staff and build up awareness," she says.
"My life has been changed hugely and my wellbeing too. But it is not impossible and it has got easier and easier to cope.
"With greater knowledge and awareness I feel much more able to cope."




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Vitamin D supplements may help people with diseased hearts, a study suggests.
A trial on 163 heart failure patients found supplements of the vitamin, which is made in the skin when exposed to sunlight, improved their hearts' ability to pump blood around the body.
The Leeds Teaching Hospitals team, who presented at a meeting of the American College of Cardiology, described the results as "stunning".
The British Heart Foundation called for longer trials to assess the pills.
Vitamin D is vital for healthy bones and teeth and may have important health benefits throughout the body but many people are deficient.

The average age of people in the study was 70 and, like many people that age, they had low levels of vitamin D even in summer.
"They do spend less time outside, but the skin's ability to manufacture vitamin D also gets less effective [with age] and we don't really understand why that is," said consultant cardiologist Dr Klaus Witte.
Patients were given either a 100 microgram vitamin D tablet or a sugar pill placebo each day for a year.
And researchers measured the impact on heart failure - a condition in which the heart becomes too weak to pump blood properly.
The key measure was the ejection fraction, the amount of blood pumped out of the chambers of the heart with each beat.
In a healthy adult, the figure is between 60% and 70%, but only a quarter of the blood in the heart was being successfully pumped out in the heart failure patients.
But in those taking the vitamin pills, the ejection fraction increased from 26% to 34%.
Dr Witte told the BBC News website: "It's quite a big deal, that's as big as you'd expect from other more expensive treatments that we use, it's a stunning effect.
"It's as cheap as chips, has no side effects and a stunning improvement on people already on optimal medical therapy, it is the first time anyone has shown something like this in the last 15 years."
The study also showed the patients' hearts became smaller - a suggestion they are becoming more powerful and efficient.





In the UK, people over 65 are advised to take 10 microgram supplements of the vitamin.
However, Dr Witte does not think high-dose vitamin D should be routine prescribed just yet.
He told the BBC: "We're a little bit off that yet, not because I don't believe it, but data have shown improvements in heart function, they may show improvements in symptoms and we now need a large study."
It is also not clear exactly how vitamin D is improving heart function, but it is thought every cell in the body responds to the vitamin.
Most vitamin D comes from sunlight, although it is also found in oily fish, eggs and is added to some foods such as breakfast cereals.
Prof Peter Weissberg, from the British Heart Foundation, cautioned that the patients seemed no better at exercise.
And added: "A much bigger study over a longer period of time is now needed to determine whether these changes in cardiac function can translate into fewer symptoms and longer lives for heart failure patients."
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