Onkologinės ligos

Paskelbti geriausi 2014 metų moksliniai darbai, diagnozuojant ir gydant plaučių ligas.

Nacionalinė Medikų Asociacija paskelbė 2015-05-10 23:17

Žurnale Annals of Internal Medicine apibendrinti geriausi 2014 metų straipsniai, kurie pateikia naujausią mokslinę informaciją apie difuzinių plaučių ligų, astmos, lėtinės obstrukcinės ligos, plaučių vėžio, respiracinių infekcijų diagnostiką ir gydymą. Plačiau...


Vaizdas: http://www.minglebox.com/medical/courses/other-medicine/pg-md-pulmonary-medicine

High-Value Research of 2014 Presented for Pulmonary Med

(HealthDay News) -- Articles relating to diffuse parenchymal lung disease, asthma, chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary diagnostics, and respiratory infections are included in a special update summary published online April 30 in the Annals of Internal Medicine.

Jess Mandel, M.D., from the University of California in San Diego, identified key studies published in 2014 that are highly relevant to the practice of pulmonary medicine.

Mandel included articles discussing beneficial therapies for idiopathic pulmonary fibrosis, which had previously eluded effective treatment. Another study described a select group of patients with severe asthma refractory to traditional therapies who may benefit from a monoclonal antibody-based therapy. For COPD, one trial demonstrated that inhaled corticosteroids may be withdrawn from treatment of some patients with stable disease, while a second trial demonstrated that azithromycin most effectively decreases acute exacerbations that necessitate antibiotics and glucocorticoids in certain subsets of patients. Low-dose computed tomography screening was reported to be cost-effective for lung cancer screening in appropriate patient groups. High sensitivity and specificity were reported in a meta-analysis of point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema, when experienced operators perform the test. Finally, oseltamivir was found to be modestly effective for influenza treatment in adults, although adverse events were reported.

"This article summarizes important studies published in 2014 that have the potential to substantially influence the practice of pulmonary and internal medicine," Mandel writes.

Mandel disclosed financial ties to the medical publishing industry.

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Paskelbtos 2014 metų hematologijos naujienos.

Nacionalinė Medikų Asociacija paskelbė 2015-05-08 00:23

Žurnale Annals of Internal Medicine apibendrintos 2014 metų hematologijos naujienos nuo piktybinių kraujo ligų gydymo iki kraujavimo ir krešėjimo korekcijos naujų rekomendacijų. Transfuziologijoje naujai apibrėžta, jog kraujo perpylimas septiniams ligoniams indikuotinas esant Hb žemiau 90 g/l, o ne žemiau 70 g/l. Plačiau...


Vaizdas: http://www.medical-tourism.com/article/used-and-reconditioned-hematology-analyzers.html

High-Value Research of 2014 Presented for Hematology

(HealthDay News) -- Articles relating to malignant hematology, transfusion medicine, and bleeding and clotting disorders are included in a special update summary published online April 30 in the Annals of Internal Medicine.

Alice D. Ma, M.D., from the University of North Carolina at Chapel Hill, summarized studies relating to benign and malignant hematologic conditions published in 2014 that are relevant to practicing internists.

Ma highlighted the use of a new agent, idelalisib, which was added to rituximab to treat frail, elderly, pretreated patients with chronic lymphocytic leukemia. A study that reported updated findings with personalized cellular therapeutics was also included for the treatment of relapsed acute lymphoblastic leukemia in children and adults. Studies in the field of transfusion medicine included one describing the superiority of a hemoglobin trigger of 70 g/L to a trigger of 90 g/L for determining when to transfuse blood to septic patients. An additional study examined the risk of hospital-acquired infections with red blood cell transfusions. Meta-analyses examined genomic-based strategies for warfarin dosing, and compared the best anticoagulant regimens for acute venous thromboembolism. A randomized trial found compression stockings to be ineffective for preventing post-thrombotic syndrome compared with sham compression hose.

"In addition to [these articles], it's also worth noting that in 2014, the American Society of Hematology published its second 'Choosing Wisely' list," Ma writes. "The Society has added five commonly used tests, treatments, and procedures in hematology that might not always be necessary."

Ma disclosed financial ties to the pharmaceutical and medical device industries.

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Mamogramos keturiasdešimtmetėms turi būti atliekamos pasirinktinai.

Nacionalinė Medikų Asociacija paskelbė 2015-04-22 06:10

Keturiasdešimtmetės moterys turi pasikonsultuot su savo gydytoju ir pačios nuspręsti, ar tikslinga atlikti mamogramą. Reguliarios mamogramos turi būti atliekamos nuo 50 metų amžiaus. Nustatyta, jog mamogramos apsaugo nuo krūties vėžio mirčių keturias iš 10000, kai jos atliekamos nuo 40 iki 49 metų, 8 - nuo 50 iki 59 metų ir 21 iš 10000 virš 60 metų amžiaus moterų. Plačiau...


Vaizdas: http://www.dailytelegraph.com.au/lifestyle/will-blood-tests-replace-mammograms/story-e6frf00i-1226557805168

Mammograms a Personal Decision for Women in Their 40s, Panel Says

(HealthDay News) -- Women in their 40s should talk with their doctors and then decide for themselves whether they need regular mammograms to screen for breast cancer before age 50, according to draft U.S. federal health guidelines.

The draft mammography guidelines issued April 20 by the U.S. Preventive Services Task Force (USPSTF) largely reiterate those that have been in place since 2009, the last time they were updated.

The guidelines still recommend mammograms to screen for breast cancer every two years for women ages 50 to 74.

However, those recommendations are still at odds with the American Cancer Society and the American College of Obstetricians and Gynecologists. Both of those groups recommend annual screening beginning at age 40.

In the proposed USPSTF update, the task force emphasized that women in their 40s should make a decision whether or not to receive mammograms every two years after talking about their individual risk factors with their doctors.

"We want to be able to empower women with the science, so they can understand the potential benefits as well as the potential harms, and make the decision that's right for them based on their own values, preferences and personal health history," said Dr. Kirsten Bibbins-Domingo, vice chair of the task force and a professor at the University of California, San Francisco School of Medicine.

That clarification could mean that insurance companies will have to start picking up the check for screening women in their 40s, even though it's not explicitly recommended, said Dr. Richard Wender, chief cancer control officer for the American Cancer Society.

"The task force does not make coverage decisions, and they don't comment on coverage decisions, but I think their guideline makes it clear that women should have the option to be screened starting at 40," Wender said. "They [the task force] are not going to make that comment, but the American Cancer Society certainly will."

The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts who regularly review the scientific evidence and make recommendations regarding health screening procedures and preventive medicine.

The USPSTF faced stiff criticism in 2009 when it raised the recommended age for regular mammogram screenings to 50. Women 40 to 49 were encouraged to talk with their doctor about the best time to start regular, every-other-year mammography.

The task force is standing by its 2009 guideline, noting that while the evidence shows that some women in their 40s will benefit from mammography, most will not, and some will be harmed.

Bibbins-Domingo said the 2009 guideline was "widely misinterpreted" as being against mammograms for all women in their 40s.

"The new recommendation is the same grade, a C grade, recommending in favor of screening for women in their 40s, but recognizing that on balance there are benefits that outweigh the harms, but only by a smaller amount," she said. "So therefore, women should be aware of both benefits and harms so they can make the decision that's right for them."

Wender agreed that the age recommendations are essentially the same.

"What's different is the messaging, but I wouldn't underestimate the importance of the messaging," he said. "The task force was really clear and careful to say the discussion about having a mammogram between a clinician and a woman should begin at 40. I hope and anticipate that will help clarify the misperception that the task force was against screening for women 40 to 49."

The most common harm from an unnecessary mammogram is a false-positive test, indicating that there is cancer where none exists, Bibbins-Domingo said. Women who receive a false positive have to undergo additional tests and procedures, and also must endure some anxiety until cancer is ruled out.

The most serious harm, however, can occur if a mammogram reveals a type of breast cancer that would not have threatened a woman's health during her lifetime, she added. Women who are "overdiagnosed" have to undergo surgery and cancer therapy that significantly diminish their quality of life while adding no extra years to their life span.

Wender agreed that the evidence shows that mammography becomes more beneficial as a woman ages.

"Starting at around 35, the risk of breast cancer goes up year by year until you're basically around 60," he said. "So at some point after 40, the benefit of screening starts to become substantially greater than the downsides associated with screening."

The benefits of mammography also increase with age. Regular screening can prevent about four breast cancer deaths per 10,000 women in their 40s, but eight per 10,000 for women in their 50s and 21 per 10,000 for women in their 60s, according to the task force report.

In the report, the task force also showed that the harms associated with mammography steadily decrease with age. For example, there more than 1,200 false positives for every 10,000 women who undergo mammography in their 40s; by their 50s, the false positive rate declines to over 900 per 10,000 women, and even further down to just over 800 per 10,000 in their 60s.

The American Cancer Society is currently re-evaluating its mammography recommendations as part of its regular review of the current scientific evidence, Wender said.

"We're updating our guideline and it will be out later this year, and we're looking at that pivot point again with the latest data," he said.

In its updated guidelines, the USPSTF also said it was unable to make a recommendation for or against the value of 3-D mammography screening, because there is not enough evidence to show whether it will save more lives and improve women's health.

The task force also couldn't say, based on the evidence available, whether additional screening tools like ultrasound or MRI could help women with dense breasts screen for cancer. Dense breasts are difficult to screen with standard mammography, and women with dense breasts are at increased risk of breast cancer, Bibbins-Domingo said.

The task force called for more research in both areas.

The public has until May 18 to comment on the draft guidelines, Bibbins-Domingo said.

More information

For more information on mammography, visit the U.S. National Institutes of Health.

SOURCES: Kirsten Bibbins-Domingo, M.D., Ph.D., vice chair of the U.S. Preventive Services Task Force, and professor, University of California, San Francisco School of Medicine; Richard Wender, M.D., chief cancer control officer, American Cancer Society


Intraperitoninė chemoterapija efektyvesnė.

Nacionalinė Medikų Asociacija paskelbė 2015-03-27 00:10

Išanalizavus 876 pažengusiu kiaušidžių vėžiu sergančių pacienčių gydymo taktiką nustatyta, jog po intraperitoninės chemoterapijos pacientės vidutiniškai išgyveno 61,8 mėnesio, o po intraveninės -51,4 mėnesio. Kiekvienas intraperitoninės chemoterapijos ciklas mirties riziką sumažina 12 proc. Plačiau...


Vaizdas: http://ovariancancer.blogspot.com/

Intraperitoneal Chemo Offers Lasting Benefit in Ovarian Cancer

(HealthDay News) -- Intraperitoneal (IP) chemotherapy offers lasting benefit for patients with advanced ovarian cancer, according to a study published online March 23 in the Journal of Clinical Oncology.

Devansu Tewari, M.D., from the Kaiser Permanente Irvine Medical Center in California, and colleagues examined long-term survival after IP chemotherapy in patients with advanced ovarian cancer. Data were analyzed for 876 patients from Gynecologic Oncology Group protocols 114 and 172, followed for a median of 10.7 years.

The researchers found that median survival was 61.8 months with IP therapy, compared with 51.4 months for intravenous therapy. IP therapy correlated with a reduced risk of death (adjusted hazard ratio [aHR], 0.77; P = 0.002). Among those with gross residual (≤1 cm) disease, IP therapy improved survival (aHR, 0.75 P = 0.006). For each IP chemotherapy cycle completed, the risk of death decreased by 12 percent (aHR, 0.88; P < 0.001). Clear/mucinous versus serous histology (aHR, 2.79), gross residual versus no visible disease (aHR, 1.89), and fewer versus more cycles of IP chemotherapy (aHR, 0.88) were factors associated with poorer survival (all P < 0.001). The IP regimen was more likely to be completed by younger patients; with each year of age there was a 5 percent decrease in probability of completion (odds ratio, 0.95; P < 0.001).

"The advantage of IP over intravenous chemotherapy extends beyond 10 years," the authors write. "Survival improved with increasing number of IP cycles."

One author disclosed financial ties to the pharmaceutical industry.

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Patalogai skirtingai interpretuoja krūties auglių tyrimus.

Nacionalinė Medikų Asociacija paskelbė 2015-03-18 02:11

Individualių patalogų krūties biopsijos tyrimų interpretacijos didžiąja dalimi (75,3 proc.) sutampa su ekspertų grupės bendru sutarimu nustatytomis diagnozėmis, rašoma žurnale Journal of the American Medical Association. Tyrime dalyvavo 115 patalogų, kurie nustatė 6900 individualių diagnozių. Atskirai pagal patologiją tyrimų rezultatų sutapimo nuošimtis buvo skirtingas - 87 proc. - tiriant gerybinius auglius be atipijos; 48 proc. su atipija; 84 proc. tiriant duktalinę karcinomą in situ; 96 proc. invazyvinės karcinomos tyrime. Plačiau...


Vaizdas: http://www.medicinenet.com/breast_cancer_pictures_slideshow/article.htm

Accuracy High for Pathologists Interpreting Breast Biopsy

(HealthDay News) -- Individual pathologists' interpretations of a single breast biopsy slide generally concur with expert consensus-derived reference diagnoses, according to a study published in the March 17 issue of the Journal of the American Medical Association.

Joann G. Elmore, M.D., M.P.H., from the University of Washington in Seattle, and colleagues quantified the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis in interpretation of breast biopsies. Participants interpreted slides from test sets of 60 breast biopsies; they were blinded to interpretations of other study pathologists and consensus panel members. Unanimous agreement of independent diagnoses was 75 percent among the three consensus panel members; there was 90.3 percent concordance with consensus-derived reference diagnosis. Data were included from 115 pathologists, providing 6,900 individual case diagnoses.

The researchers found that the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3 percent compared with the consensus-derived reference diagnosis. The overall concordance rate was 87 percent for diagnosis of benign without atypia; 48 percent for atypia; 84 percent for ductal carcinoma in situ; and 96 percent for invasive carcinoma. Among biopsies from women with higher versus lower breast density on prior mammograms, there was significantly higher disagreement with the reference diagnosis (overall concordance rate, 73 and 77 percent, respectively; P < 0.001). Pathologists who interpreted lower weekly case volumes, or worked in smaller practices or nonacademic settings also had higher disagreement with reference diagnosis.

"This study confirms that the majority of diagnoses, especially at either end of the spectrum from benign to invasive cancer, are readily and accurately made by practicing pathologists," write the authors of an accompanying editorial. "It also identifies areas of uncertainty that must be addressed, providing a framework for process improvement in the pathology and scientific communities, especially in the diagnosis of atypia."

One author disclosed financial ties to Genentech; assistance for the digital scanning equipment and digital viewer were provided by Ventana Medical Systems and HD View SL.

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Genetinės variacijos sąlygoja aspirino/NPUV sąsajas su storžarnės vėžiu.

Nacionalinė Medikų Asociacija paskelbė 2015-03-18 01:49

Dviejų atskirų nukleotidų polimorfizmas 12p12.3 chromosomoje, apsprendžia, ar asmens vartojamas aspirinas bei kiti nesteroidiniai priešuždegiminiai vaistai turės įtakos gaubtinės žarnos vėžio rizikos laipsniui. Tyrime dalyvavo 8634 asmenys, sergantys storosios žarnos vėžiu, ir 8553 asmenys kontrolinėje grupėje. Asmenims su tam tikra genetine variacija aspirinas ar kiti NPUV mažina gaubtinės žarnos vėžio riziką. Plačiau...


Vaizdas: http://www.elements4health.com/an-increase-in-leptin-could-promote-colorectal-cancer.html

Genetic Variation Impacts Aspirin/NSAID Link to CRC Risk

(HealthDay News) -- Two single nucleotide polymorphisms (SNPs) have been identified which confer differential benefit for aspirin and/or nonsteroidal anti-inflammatory drug (NSAID) use in relation to colorectal cancer risk, according to a study published in the March 17 issue of the Journal of the American Medical Association.

Hongmei Nan, M.D., Ph.D., from Indiana University in Indianapolis, and colleagues conducted a case-control study using data from studies involving 8,634 colorectal cancer cases and 8,553 matched controls. The authors tested gene × environment interactions between regular use of aspirin and/or NSAIDs and SNPs in relation to colorectal cancer risk.

The researchers found that, compared with non-regular use, regular use of aspirin and/or NSAIDs correlated with reduced risk of colorectal cancer (odds ratio [OR], 0.69). There was a genome-wide significant interaction with aspirin and/or NSAID use at the SNP rs2965667 at chromosome 12p12.3; aspirin and/or NSAID use correlated with lower risk of colorectal cancer for individuals with rs2965667-TT genotype (OR, 0.66), while a higher risk was seen among those with rare TA or AA genotypes (OR, 1.89). There was a genome-wide significant interaction with use of aspirin and/or NSAIDs with the SNP rs16973225 at chromosome 15q25.2; regular use correlated with lower risk for those with the AA genotype (OR, 0.66), while no association was seen for those with AC or CC genotypes (OR, 0.97; P = 0.76).

"Validation of these findings in additional populations may facilitate targeted colorectal cancer prevention strategies," the authors write.

One author disclosed holding a patent for aspirin as a colorectal chemopreventive agent; one author disclosed financial ties to the pharmaceutical industry.

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Eksperimentinė vakcina prieš herpes virusą teikia vilčių.

Nacionalinė Medikų Asociacija paskelbė 2015-03-11 02:05

JAV mokslininkai paskelbė, kad eksperimentuose su pelėmis sėkmaingai išbandyta nauja vakcina prieš herpes simplex 2 tipo virusą, rašoma žurnale eLife. Tačiau ekspertai pabrėžia, kad neretai sėkmingi rezultatai su gyvūnais nebūna sėkmingi eksperimentuose su žmonėmis. Plačiau...


Vaizdas: http://www.janigamds.com/dermatology/herpes-simplex-viruses/

HSV-2 Vaccine Shows Promise in Experimental Research

(HealthDay News) -- A new study in mice hints at the success of a vaccine against the herpes simplex virus. The research was published online March 9 in eLife.

Researchers at the Albert Einstein College of Medicine in New York City report that the vaccine was safe and effective in protecting mice against herpes simplex virus type 2 (HSV-2). While the findings are promising, experts note that results from animal studies often do not pan out in human trials.

"Developing a herpes vaccine is one of the holy grails of infectious disease research," study co-leader William Jacobs Jr., Ph.D., a professor of microbiology and immunology and of genetics at Einstein, said in a college news release.

Study co-leader Betsy Herold, M.D., chief of pediatric infectious diseases at Einstein, added that "genital herpes infections can not only be serious in and of themselves, but they also play a major role in fueling the HIV epidemic." She explained that "people infected with HSV-2 are more likely to acquire and to transmit HIV -- which further underscores the need to develop a safe and effective herpes vaccine."

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Gerybinių skydliaukės mazgų nereikia stebėti?

Nacionalinė Medikų Asociacija paskelbė 2015-03-04 01:59

Gerybiniai skydliaukės mazgai yra dažnai nustatomi, tačiau jų monitoringas, kurio reikalauja šiuo metu galiojančios rekomendacijos, nėra būtinas, rašoma žurnale Journal of the American Medical Association. Italų mokslininkai, tyrę 992  pacientus su gerybiniais skydliaukės augliais nustatė, kad penkerius metus 15 proc. auglių tūris padidėjo iki 50 procentų, 19 proc. sumažėjo. Tik 0,3 proc. atvejų išsivystė vėžys. Plačiau...


Vaizdas: http://www.medscape.com/viewarticle/840788

Study Challenges Management of Benign Thyroid Nodules

(HealthDay News) -- Benign thyroid nodules are common, and research suggests they don't need to be monitored as closely as current guidelines recommend. The findings were published in the March 3 issue of the Journal of the American Medical Association.

The new study challenges the need for close monitoring in many cases. Italian researchers followed 992 patients with presumably benign thyroid nodules. All patients had either had a biopsy, or had skipped the biopsy because an ultrasound showed their nodules to be tiny and free of suspicious features that could signal cancer.

Over five years of monitoring with yearly ultrasound scans, most patients' thyroid nodules showed no substantial change. For 15 percent, the nodule grew by 50 percent in volume, while it shrank for 19 percent. Most importantly, only five nodules -- or 0.3 percent -- were eventually diagnosed as thyroid cancer, the investigators found.

Anne Cappola, M.D., of the University of Pennsylvania Perelman School of Medicine in Philadelphia, who wrote an editorial published with the study, called the findings good news. "Patients diagnosed with benign nodules should all feel reassured that during the follow-up period, the likelihood of finding cancer is very low," Cappola told HealthDay. But, she added, the results also suggest that the current approach of monitoring patients is "not the most efficient way" to catch the small number who really have thyroid cancer. "We've probably been too aggressive with follow-up," she said.

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Ar ne per dažnai taikomas spidulinė terapija, gydant prostatos vėžį?

Nacionalinė Medikų Asociacija paskelbė 2015-02-23 01:16

Naujo tyrimo duomenimis, prostatos vėžio stebėjimo taktika nėra taikoma taip jau dažnai, kaip rekomenduojama, ir taikomas gydymas, kuris nėra būtinas, rašoma žurnale JAMA Oncology. Tyrimo autoriai teigia, kad prostatos vėžiu sergantys pacientai gydomi  per dažnai ir per dažnai jiems taikoma radioterapija. Plačiau...


Vaizdas: http://pasadenacyberknife.com/treatment-options/prostate-cancer

Radiation Therapy Most Common Treatment for Prostate Cancer

(HealthDay News) -- New research suggests that a wait-and-watch approach for prostate cancer isn't being used often enough, and that more men are being treated than may be necessary. The study appears online Feb. 19 in JAMA Oncology.

Additionally, the researchers expressed concern about the numbers of men being treated with radiation therapy, regardless of their tumor specifics. "Too many men are being treated for prostate cancer, and too many are being treated with radiation therapy," study lead author Karim Chamie, M.D., an assistant professor of urology at the University of California in Los Angeles, told HealthDay.

In the new study, the researchers aimed to figure out why many men don't choose the wait-and-watch option. The investigators tracked 37,621 men in the United States who were diagnosed with prostate cancer between 2004 and 2007. The researchers followed the men, who were all at least 65 when diagnosed, through 2009. Only 10 percent of those diagnosed chose to forgo treatment, at least temporarily, the investigators found. Almost 58 percent of the men chose radiation therapy, while 19 percent had their prostate removed.

Sandip Prasad, M.D., an assistant professor of urology at the Medical University of South Carolina in Charleston, who co-wrote a commentary in the same issue of the journal, didn't go as far as to say that radiation is overused. Still, he told HealthDay: "We believe treatment -- radiation or surgery -- shouldn't be 90 percent of what's being done."

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Saulės sukeltas odos pažeidimas tęsiasi ir tamsiu paros metu.

Nacionalinė Medikų Asociacija paskelbė 2015-02-23 01:01

Saulės ultravioletinių spindulių sukeltas odos pažeidimas, tęsiasi dar ilgai po saulės poveikio. Ląstelėje susidarantis melaninas ne tik apsaugo nuo UV spindulių (teigiams poveikis), bet ir pažeidžia DNR (neigiamas poveikis). Melanocituose, kuriuose nėra melanino, DNR pažeidžiamas tik veikiant UV spinduliams. Plačiau...


Vaizdas: http://www.beyondmedispa.com/women/face-treatments/pigmentation-sun-damage-thread-veins/

Sun Damage to Skin Can Continue After Dark

(HealthDay News) -- Skin damage caused by ultraviolet (UV) radiation continues long after sun exposure, even in the dark, according to a study published in the Feb. 20 issue of Science.

Researchers exposed mouse and human melanocytes to UV radiation. In melanocytes with melanin, DNA damage occurred not only immediately, but also hours after UV exposure ended. In melanocytes that didn't have melanin, the damage occurred only during UV exposure.

It was thought that melanin protected the skin by blocking UV light, but this study found that melanin has both protective and harmful effects. "If you look inside adult skin, melanin does protect against cyclobutane pyrimidine dimers. It does act as a shield. But it is doing both good and bad things," said study author Douglas Brash, Ph.D., in a Yale University School of Medicine news release. Brash is a clinical professor of therapeutic radiology and dermatology at Yale.

Scientists explained the process that caused DNA-related damage in the dark. UV light activated enzymes that stimulated melanin. This process, called chemiexcitation, created the same DNA damage in the dark that sunlight caused in daytime, according to the researchers. Chemiexcitation is a slow process and it may be possible to develop ways to prevent it, such as "an evening-after" sunscreen that might be able to block the transfer of damaging energy to the skin cells, the researchers said.

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