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Escobar-Hoyos, center, holds her recent award, with Kenneth Shroyer, the chairman of the Department of Pathology at Stony Brook on the left and Steven Leach, the director of the David M. Rubenstein Center for Pancreatic Cancer Research on the right. Photo by Cindy Leiton

By Daniel Dunaief

While winter storm Niko in February closed schools and businesses and brought considerable precipitation to the region, it also coincided with great news for Luisa Escobar-Hoyos, who earned her doctorate from Stony Brook University.

Escobar-Hoyos, who is a part-time research assistant professor in the Department of Pathology at Stony Brook University and a postdoctoral fellow at Memorial Sloan Kettering Cancer Center, received word that she was the sole researcher selected in the country to receive the prestigious $600,000 Pancreatic Cancer Action Network–American Association for Cancer Research Pathway to Leadership Award.

When she heard the news, Escobar-Hoyos said she was “filled with excitement.” After she spoke with her husband Nicolas Hernandez and her current mentor at MSKCC, Steven Leach, the director of the David M. Rubenstein Center for Pancreatic Cancer Research, she called her parents in her native Colombia.

Her mother, Luz Hoyos, understood her excitement not only as a parent but as a cancer researcher herself. “My interest in cancer research started because of my mom,” Escobar-Hoyos said. Observing her example and “the excitement and the impact she has on her students and young scientists working with her, I could see myself” following in her footsteps.

The researcher said her joy at winning the award has blended with “a sense of responsibility” to the growing community of patients and their families who have developed a deadly disease that is projected to become the second leading cause of cancer-related death by 2020, according to the Pancreatic Cancer Action Network, moving past colorectal cancer.

The Pancreatic Cancer Action Network has awarded $35 million in funding to 142 scientists across the country from 2003 to 2016, many of whom have continued to improve an understanding of this insidious form of cancer.

David Tuveson, the current director of the Cancer Center at Cold Spring Harbor Laboratory, received funds from PanCan to develop the first genetically engineered mouse model that mimics human disease. Jiyoung Ahn, the associate director of the NYU Cancer Institute, used the funds to discover that two species of oral bacteria are associated with an over 50 percent increased risk of pancreatic cancer.

Over the first decade since PanCan started awarding these grants, the recipients have been able to convert each dollar granted into $8.28 in further pancreatic cancer research funding.

In her research, Escobar-Hoyos suggests that alternative splicing, or splitting up messenger RNA at different locations to create different versions of the same protein, plays an important part in the start and progress of pancreatic cancer. “Her preliminary data suggest that alternative splicing could be associated with poorer survival and resistance to treatment,” Lynn Matrisian, the chief science officer at PanCan, explained in an email. “The completion of her project will enhance our understanding of this molecular modification and how it impacts pancreatic cancer cell growth, survival and the progression to more advanced stages of this disease.”

Escobar-Hoyos explained that she will evaluate how mutations in transcriptional regulators and mRNA splicing factors influence gene expression and alternative splicing of mRNAs to promote the disease and aggression of the most common form of pancreatic cancer. Later, she will evaluate how splicing regulators and alternatively spliced genes enriched in pancreatic ductal adenocarcinoma contribute to tumor maintenance and resistance to therapy.

Escobar-Hoyos will receive $75,000 in each of the first two years of the award to pay for a salary or a technician, during a mentored phase of the award. After those two years, she will receive $150,000 for three years, when PanCan expects her to be in an independent research position.

Escobar-Hoyos said her graduate research at Stony Brook focused on ways to understand the biological differences between patients diagnosed with the same cancer type. She helped discover the way a keratin protein called K17 entered the nucleus and brought another protein into the cytoplasm, making one type of tumor more aggressive.

While Escobar-Hoyos works full time at Memorial Sloan Kettering, she continues to play an active role in Kenneth Shroyer’s lab, where she conducted experiments for her doctorate. She is the co-director of the Pathology Translational Research Laboratory, leading studies that are focused on pancreatic cancer biomarkers. The chair in the Department of Pathology, Shroyer extended an offer for her to continue to address the research questions her work addressed after she started her postdoctoral fellowship.

“When you do research projects and you develop them from the beginning, they are like babies and you really want to see how they evolve,” Escobar-Hoyos said. Numerous projects are devoted to different aspects of K17, she said.

Shroyer said Escobar-Hoyos had already been the first author on two landmark studies related to the discovery and validation of K17 even before her work with pancreatic cancer. “She has also conducted highly significant new research” that she is currently developing “that I believe will transform the field of pancreatic cancer research,” Shroyer wrote in an email.

Shroyer hopes to recruit Escobar-Hoyos to return to Stony Brook when she completes her fellowship to a full-time position as a tenure track assistant professor. “Based on her achievements in basic research and her passion to translate her findings to improve the care of patients with pancreatic cancer, I have no doubt she is one of the most promising young pancreatic cancer research scientists of her generation,” he continued.

Yusuf Hannun, the director of the Stony Brook Cancer Center, said Escobar-Hoyos’s work provided a new and important angle with considerable promise in understanding pancreatic cancer. “She is a tremendous example of success for junior investigators,” Hannun wrote in an email.

Escobar-Hoyos said she is hoping, a year or two from now, to transition to becoming an independent scientist and principal investigator, ideally at an academic institution. “Because of my strong ties with Stony Brook and all the effort the institution is investing in pancreatic research” SBU is currently her first choice.

Escobar-Hoyos is pleased that she was able to give back to the Pancreatic Cancer Action Network when she and a team of other friends and family helped raise about $4,000 as a part of a PurpleStride 5K walk in Prospect Park earlier this month.“I was paying forward what this foundation has done for me in my career,” she said.

Matrisian said dedicated scientists offer hope to patients and their families. “Researchers like Escobar-Hoyos spark scientific breakthroughs that may create treatments and ultimately, improve the lives of patients,” she suggested.

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Implications for thyroid removal are lifelong

By David Dunaief, M.D.

Dr. David Dunaief

It is very interesting that the amount of coverage by the lay press concerning thyroid nodules does not reflect the number of people who actually have them. More than 50 percent of people have thyroid nodules detectable by high-resolution ultrasound (1); however, news coverage for general, nonphysician audiences is infrequent.

You can understand how coverage should be more in the forefront. Fortunately, most nodules are benign. A small percent, 4 to 6.5 percent, are malignant, and the number varies depending on the study (2). Thyroid nodules are being diagnosed more often incidentally on radiologic exams, such as CT scans of the chest, MRI scans, PET scans and ultrasounds of the carotid arteries in the neck (3).

There is a conundrum of what to do with a thyroid nodule, especially when it is found incidentally. It depends on the size. If it is over 1 centimeter, usually it is biopsied by fine needle aspiration (FNA) (4). This is the cutoff point for thyroid nodules found with a radiologic exam. Most are asymptomatic. However, if there are symptoms, these might include difficulty swallowing, difficulty breathing, hoarseness, pain in the lower portion of the neck and a goiter (5).

FNA biopsy is becoming more common. In a study evaluating several databases, there was a greater than 100 percent increase in thyroid FNAs performed over a five-year period from 2006 to 2011 (6). This resulted in a 31 percent increase in thyroidectomies, surgeries to remove the thyroid partially or completely.

However, the number of thyroid cancers diagnosed with the surgery did not rise in this same period. To make matters even more confusing, from 2001 to 2013, the number of thyroid cancers increased by 200 percent. In the study authors call for more detailed guidelines, which are lacking for thyroid nodules. Though the number of cancers diagnosed has increased, the mortality rate has remained relatively stable over several decades at about 1,500 patients per year (7). Thyroid nodules in this study were least likely to be cancerous when the initial diagnosis was by incidental radiologic exam.

Treating borderline results

As much as 25 percent of FNA biopsies are indeterminate. We are going to look at two modalities to differentiate between benign and malignant thyroid nodules when FNA results are equivocal: a PET scan and a molecular genetics test. A meta-analysis (a group of six studies) of PET scan results showed that it was least effective in resolving an unclear FNA biopsy. The PET scan was able to rule out patients who did not have malignancies significantly but did not do a good job of identifying those who did have cancer (8).

On the other hand, a molecular-based test was able to potentially determine whether an indeterminate thyroid nodule by FNA was malignant or benign (9). This test was a combination of microRNA gene expression classifier with the genetic mutation panel. I know the test combination sounds confusing, but the important takeaway is that it was more effective than previous molecular tests in clarifying whether a patient had a benign or cancerous nodule.

Unlike in the PET scan study above, the researchers were able to not only rule out the majority of malignancies but also to rule them in. It was not perfect, but the percent of negative predictive value (ruled out) was 94 percent, and the positive predictive value (ruled in) was 74 percent. The combination test improved the predictive results of previous molecular tests by 65 to 69 percent. This is important to help decide whether or not the patient needs surgery to remove at least part of the thyroid. The trial used hospital-based patients, but follow-up studies need to include community-based practices.

Is a negative FNA definitive?

We know that FNA is the gold standard for determining whether patients have malignant or benign thyroid nodules. However, a negative result on FNA is not always definitive for a benign thyroid nodule. When this occurs, it is referred to as a false negative result. In a retrospective (looking back at events) study, from the Longitudinal Health Insurance Database in Taiwan, 62 percent of thyroid nodules that were cancerous were diagnosed with one biopsy, and 82 percent were found within the year after that biopsy (10). However, about 17 percent of patients needed more than two FNA biopsies, and 19 percent were diagnosed after one year with cancerous thyroid nodules.

Significance of calcification on ultrasound

Microcalcifications in the nodule can be detected on ultrasound. The significance of this may be that patients with microcalcifications are more likely to have malignant thyroid nodules than those without them, according to a small prospective study involving 170 patients (11). This does not mean necessarily that a patient has malignancy with calcifications, but there is a higher risk. The results demonstrated that more than half of the malignant thyroid nodules, 61 percent, had microcalcifications.

Good news

As I mentioned above, most thyroid nodules are benign. The results of one study go even further, showing that most asymptomatic benign nodules do not progress in size significantly after five years (12). This was a prospective (forward-looking) study involving 992 patients with between one and four benign thyroid nodules diagnosed cytologically (by looking at the cells) or by ultrasound. The factors that did contribute to growth of about 11 percent of the nodules were age (<45 years old had more growth than >60 years old), multiple nodules, greater nodule volume at baseline and being male.

The authors’ suggestion is that the current paradigm might be altered and that after the follow-up scan, the next ultrasound scan might be five years later instead of three years. However, they did discover thyroid cancer in 0.3 percent after five years.

Thyroid function may contribute to risk

In considering risk factors, it’s important to note that those who had a normal thyroid stimulating hormone (TSH) were less likely to have a malignant thyroid nodule than those who had a high TSH, implying hypothyroidism. There was an almost 30 percent prevalence of cancer in the nodule if the TSH was greater than >5.5 mU/L (13).

The bottom line is that there is an urgent need for new guidelines regarding thyroid nodules. Fortunately, most nodules are benign and asymptomatic, but the number of cancerous nodules found is growing. We are getting better at diagnosing nodules. Why the death rate remains the same year over year for decades may have to do with the slow rate at which most thyroid cancers progress, especially two of the most common forms, follicular and papillary.

References: (1) AACE 2013 Abstract 1048. (2) Thyroid. 2005;15(7):708. (3) uptodate.com. (4) AACE 2013 Abstract 1048. (5) thyroid.org. (6) AAES 2013 Annual Meeting. Abstract 36. (7) AACE 2013 Abstract 1048. (8) Cancer. 2011;117(20):4582-4594. (9) J Clin Endocrinol Metab. Online May 12, 2015. (10) PLoS One. 2015;10(5):e0127354. (11) Head Neck. 2008 Sep;30(9):1206-1210. (12) JAMA. 2015;313(9):926-935. (13) J Clin Endocrinol Metab. 2006;91(11):4295.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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By Linda Toga, Esq.

Linda Toga, Esq.

THE FACTS: Since my grandchildren, twin boys, were born seven years ago, I have cared for them five days a week while my daughter and son-in-law worked. My daughter is in the process of a divorce and my son-in-law will likely have shared custody. He is threatening to prohibit me from seeing the boys.

THE QUESTION: What rights do I have as a grandparent to see my grandchildren?

THE ANSWER: Since you have clearly been a big part of your grandchildren’s lives up to this point and have developed a meaningful relationship with the boys as a result of the extensive time you’ve spent caring for them, your interest in having a continued relationship with your grandchildren is protected by the New York Grandparent Visitation Statute (Domestic Relations Law §72).

The statute is designed to protect the interests of grandparents who have fostered a deep and significant relationship with their grandchildren. Unlike some similar statutes in other states, the New York statute does not require the grandparent to prove the existence of special factors in order to maintain visitation rights. In fact, some argue that the statute is too “grandparent friendly” and that it unfairly infringes upon the rights of fit and loving parents to make important child-rearing decisions.

HOW IT WORKS: When fairness dictates continued access by a grandparent to a grandchild, a grandparent who is denied access to that grandchild may petition the court for visitation rights. Notice of the petition must be given to the parent(s) or guardian(s) of the minor child who is advised of the date on which the court will conduct a hearing to determine if the grandparent’s request will be granted.

The court engages a two-prong test when deciding a grandparent visitation case. The first question the court must answer is whether the grandparent has “standing” to seek visitation. In other words, the court must determine if the grandparent has developed a relationship with the grandchild that deserves protection.

There are many factors considered by the court including the quantity and quality of time the grandparent has spent with the grandchild. A grandparent who has not played a significant role in the life of her grandchild and who has had very little contact with her grandchild will likely be found to not have standing. If that case, the petition will be dismissed.

Based upon the facts you’ve provided, it is likely that the court would find that you have standing. Once standing is found, the court will conduct a hearing to determine if grandparent visitation is in the best interest of the grandchild.

Based on testimony from the grandparent, the parent and either the grandchild or an attorney appointed by the court to represent the grandchild’s interests, the court must decide if denying grandparent visitation will adversely impact the grandchild. It is helpful to the grandparent’s position if there are other people with personal knowledge of the relationship between the grandparent and the grandchild who are willing to testify in support of visitation.

Of course, the parent or guardian can also arrange for people to testify in opposition to visitation. If the court is convinced that the grandchild will suffer if the grandparent is denied visitation rights, the court likely will grant the grandparent’s petition stating that visitation is in the best interest of the grandchild. A visitation schedule may be ordered if the parties cannot agree to a schedule on their own. If the determination of the court is that visitation with the grandparent is not in the child’s best interest, the petition will be denied.

Although courts are generally reluctant to interfere in a parent’s fundamental right to make decisions concerning the care and custody of their child, New York courts are not required to give deference to a parent’s decision about grandparent visitation. In other words, under the New York statute, there is no presumption that decisions made by a fit parent are, in fact, in their child’s best interest.

When the grandparent-grandchild relationship is particularly strong and when the grandchild is clearly dependent on the grandparent, the court may grant visitation against the parent’s wishes even when the parent is deemed fit. Although parents’ rights groups claim that the statute is unconstitutional because there is no presumption in favor of the parent, to date New York courts have upheld the statute.

Before seeking court intervention, grandparents who are denied access to their grandchild should try to reach an agreement concerning visitation with the parent or guardian of the grandchild. Litigation introduces uncertainty to the situation and comes with a considerable emotional and financial cost to the parties. In addition, the potential harm to the grandchild as a result of being put it the middle of a dispute between his parent and his grandparent may be significant. If an agreement cannot be reached, it is best to seek the counsel of an attorney with experience in this area of the law.

Linda M. Toga, Esq. provides legal services in the areas of estate planning, probate, estate administration, litigation, wills, trusts, small business services and real estate from her East Setauket office.

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By Matthew Kearns, DVM

Spring has sprung and as I look at my waistline it is obvious I put on a few extra pounds during the winter months. Fighting obesity is a year-round battle in both people and pets. The questions arise however: Are there factors predisposing pets to obesity? If so, what are they?

Breeds

Studies have shown that certain canine breeds such as cairn terriers, West Highland terriers, Scottish terriers, Shetland sheepdogs, basset hounds, Cavalier King Charles spaniels, dachshunds, beagles, cocker spaniels and Labrador retrievers all are predisposed to obesity. Conversely, site hounds (greyhounds, Italian greyhounds, whippets, Afghan hounds, etc.) seem to be more resistant to obesity.

Feline breeds including the domestic short hair, domestic medium hair, domestic long hair and Manx breeds are predisposed to obesity. Unfortunately, it is estimated that regardless of breed, approximately 25 percent of all cats owned in the U.S. are obese.

Exercise/Environment

This one is kind of self-explanatory. Dogs and cats that are more active or are encouraged to exercise have less problems with obesity. It is important to differentiate between consistent, low-impact exercise versus trying to lose all the weight in one day. We don’t want to predispose our pets to heat stroke or orthopedic injuries.

Spay/Neuter

In both cats and dogs the loss of certain hormones associated with the reproductive system will affect metabolism. Through studies it is estimated that the calorie requirements drop by about 25 percent after a spay or neuter.

Ironically, all of the feeding recommendations on the cans and bags of dog/cat food are by an association called AAFCO (Association of American Feed Control Officials). The AAFCO recommendations are based on studies on intact dogs and cats (dogs and cats that were never spayed or neutered).

I could see that if one follows those recommendations one would be going to the store more often to buy more food. Unfortunately, that also means that we are overfeeding our pets. Therefore, the recommendation at our clinic is to decrease the amount of food by approximately 25 percent (from what is recommended on the packaging) after your dog or cat is spayed or neutered.

Age

As dogs and cats age their calorie requirements drop. In your average sized dog it is estimated that its overall calorie requirements drop by approximately 20 percent past age 7. Although I could not find similar data in cats, I would say from experience the same is true for them. There are some dogs and cats that are more active and may need more calories, but this is something to be taken on a case-by-case basis.

Nutrition

This topic is easy. Cheaper brands tend to use lower quality proteins and carbohydrates that predispose to obesity. If possible, spend a little more now on a higher quality diet and it will pay off in the long run. I hope this information helps us to win the battle on obesity and improve the quality of life for our pets.

Thanks for reading, Dr. Matt.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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By Elof Axel Carlson

On March 20, 1997, I was happy to see my first Life Lines column in the Arts and Lifestyles section of publisher Leah Dunaief’s North Shore newspapers. Since then more than 400 Life Line columns have appeared for which I am grateful.

It has been my good fortune, since I was a teenager, to be a storyteller. I learned that the best way to understand something is to tell it out loud like a story. It worked in high school and it has been an asset in my teaching whether at the graduate level or for courses on science for nonmajors.

This column has been my connection to a largely unknown audience. When I was teaching at Stony Brook University, I regularly ran into strangers at the supermarket who would give me feedback. I learned from Editor Heidi Sutton that the online version of the TBR newspaper site has a substantial number of readers of this column.

To celebrate this anniversary, I will share with you the story of the newest field of the life sciences, synthetic genomics. A team of scientists led by Jef Boeke at NYU published an article in Science describing their success in making synthetic chromosomes for yeast cells. Yeast has 16 chromosomes and 6,275 genes. Those 16 chromosomes also contain 12,156,677 base pairs that make up its DNA.

The DNA sequence was worked out in 1996 so that knowledge goes back to the time I was writing the first batch of articles for this column. The NYU study has synthesized five of the 16 chromosomes and tested them in yeast cells to show that they function. They removed nonfunctional genes and inserted components that do not play a role in gene function or metabolism.

They also have created a 17th chromosome that contains a set of genetic tools. These include genes that repair mutations, genes that shuffle genes more effectively to speed up new mutation production when a desired type is sought, and genes that make new products or boost their production. Different strains of yeast cells make bread, beer and wine.

Boeke’s team hopes to complete the remaining chromosomes this year. For their long-range plans they hope the synthetic yeasts they make will produce antibiotics, vitamins, painkillers, hormones and other biological products for the pharmaceutical industry. They hope their synthetic yeasts will have a wide range of uses in making breads fortified with vitamins and proteins.

Think of having synthetic yeast-made varieties of food on a space journey to Mars where opportunities to grow plants are limited for a journey that might take months or years. They are following federal regulations to make sure their yeast is safe and they do not plan on making new species or new forms of life. But all new inventions of science lead to new outlets; so I will not be surprised years from now to see artificial life-forms made to do useful things like digesting industrial wastes and degrading them to harmless components.

Imagine if you could engineer a yeast cell to concentrate the gold from ocean water. Imagine a synthetic yeast that could pull the carbon dioxide from the air and turn it into gasoline or coal so that carbon dioxide levels are actually lowered while carbon-based fuels are made without mining for them.

I have never been a practical person and such applications, while easy for me to imagine, are not as satisfying as the knowledge that synthetic genomics can provide. Synthesizing the 16 chromosomes from off-the-shelf chemicals and forcing yeast cell cytoplasm to accept an artificial nucleus is not the same to me as finding out what that cytoplasmic material does and how it works.

Is it, as one geneticist remarked, a “playground for the genes?” Or will it turn out to house something so new to our field of biology that we can’t even imagine its components and functions? Will this too be synthesized once it is successfully tackled by a future generation of scientists?

I am not worried about applications to germ warfare. Most military planners know that germ warfare is a risky way to wage it because it is not easy to immunize your own nation’s citizens before you manufacture and launch new germ warfare agents against an enemy. There is also the war crimes risk for those involved if they are on the losing side of the war.

I am also not worried about runaway contagions as unexpected consequences of scientific studies. I strongly believe government regulations are essential to protect the public’s health and the NYU team is rigidly following those guidelines.

I celebrate this accomplishment because it is opening up a new field of science and some of the persons learning about this might be among the first to apply that new scientific knowledge to medicine, industry and our ever-changing conception of life and our stewardship for fostering it.

Elof Axel Carlson is a distinguished teaching professor emeritus in the Department of Biochemistry and Cell Biology at Stony Brook University.

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Don't cut your lawn shorter than 3 inches or you'll damage it. Stock Photo
A baker’s dozen lawn tips

By Ellen Barcel

Well, winter is over and it’s time to think about spring and gardening and that includes your lawn. If you followed recommendations, you fertilized your lawn last October and patched bare spots. You removed fallen leaves. Now, what should you be doing?

1. Remove any leaves from the lawn that may have accumulated over the winter. These can be composted, but leaves do take longer to break down than greenery so it’s best to shred them. The more surface exposed, the faster the composting process will happen.

2. Gather up any broken branches that came down during the winter’s storms. I use this wood for my fireplace, but each wood has a different scent. Apple wood is wonderful but weeping willow wood is definitely not. If you have a chipper you can turn downed wood into mulch.

3. If you had a lot of weeds in your lawn last year, consider applying pre-emergent weed killer. Personally, I just mow them over since they’re green, but if it’s a problem for you, spread the weed killer.

4. If you haven’t patched bare spots or new ones developed, spring is the ideal time to do that. Most of the lawn grasses we grow on Long Island are cool weather grasses and grow best in spring and fall.

Don’t plant grass right up against tree trunks as the bark can be damaged during mowing. Photo by Ellen Barcel

5. In general, grass won’t grow well in very shady areas. The plants need sun, but fescue tolerates some shade. So, when patching, look for mixes that note that they do well in some shade.

6. Turn on (and repair as needed) any irrigation system you have once the danger of frost has passed.

7. You can spread fertilizer after the beginning of April. (Suffolk County law prohibits spreading it before that time to prevent chemicals from polluting the groundwater. Lawns just don’t take up fertilizer from November through March.) Don’t apply fertilizer to zoyzia grass until it has greened up, however, since it is a warm weather grass.

8. When mowing, don’t cut the lawn shorter than 3 inches. Remember these are plants and if you “scalp” them, you can kill them. They need a certain amount of greenery to thrive. While it’s tempting to cut the lawn really short so you don’t have to do it that often, you’ll damage the lawn.

9. Leave the clippings on the lawn as they will break down and return nutrients to the soil. If you must gather them up, then compost them.

10. Don’t walk on the grass, for the same reason. You wouldn’t walk on your tomato plants or bean plants, so don’t walk on the grass. Install some sort of walkways for frequently trodden paths.

11. If your soil is substantially below a pH of 6.0 to 7, you need to periodically add lime to sweeten the soil. So, test your soil, then follow the manufacturer’s direction on quantity and frequency of application.

12. Generally, on Long Island, your lawn needs 1 inch of water per week. On average, Long Island gets 4 inches of rain per month. During spring and fall, and with cooler temperatures, rain frequently takes care of this need, but come the heat of summer you will probably have to supplement the rain. However, be on the lookout for periods of drought like we’ve had the last two years. Remember that two inches of rain all at once, quickly drains from the soil.

13. Don’t plant grass close up to the base of trees. If you do, the trees may be damaged as you mow each week. Instead, put mulch and/or annuals or perennials around the base of trees. That way, a “weed wacker” won’t damage the tree bark.

Ellen Barcel is a freelance writer and master gardener. To reach Cornell Cooperative Extension and its Master Gardener program, call 631-727-7850.

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Diet choices and vitamin B3 have surprising effects

By David Dunaief

Dr. David Dunaief

Warmer weather is finally upon us, we now have long, sunny days and, soon, the beach. However, longer sun exposure does increase the risk of skin cancer. Melanoma is the most serious skin cancer, but fortunately it is not the most common. Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) are more prevalent, in that order. Here, we will focus on these two types.

The incidences of these skin cancers are very difficult to pin down because they are not readily reported. However, most of us either know someone who has had these types of skin cancer or have had them ourselves. There were roughly 3.5 million nonmelanoma skin cancer treatments in the U.S. in 2006, with the number of treatments increasing 77 percent from 1992 to 2006 (1). SCC and BCC outcomes diverge, with the former having a higher risk of metastases compared to the latter, which tends to grow much slower (2).

These skin cancers may present in different ways. BCC may have a bump that is pearly, waxy, light-colored or pink or flesh-colored or brown. It may bleed, ooze and crust, but may not heal, and can be sunken in the middle (3). SCC has the appearance of a growing nodule. It may also be scaly or crusty and may have flat reddish patches. It may be a sore that also may not heal. It is found on sun-exposed areas, more commonly the forehead, hands, lower lip and nose (3). Interestingly, SCC develops over years of gradual UV sun exposure, while BCC develops more like melanoma through intense multiple sporadic burns (4).

The more well-known risks for these types of skin cancer include sun exposure (UV radiation), light skin, age, ethnicity and tanning beds (2). But there are other risk factors, such as manicures. There are also ways to reduce risk with sunscreen reapplied every two hours, depending on what you are doing, but also NSAIDs (nonsteroidal anti-inflammatory drugs) and even vitamin B3. Let’s look at the research.

Beyond skin cancer

Though nonmelanoma skin cancers (NMSCs) have far less potential to be deadly, compared to melanoma, there are other risks associated with them. In the CLUE II cohort study of over 19,000 participants, results show something very disturbing: A personal history of NMSC can lead to other types of cancer throughout the body (5). The increased risk of another type of cancer beyond NMSC is 103 percent in those with BCC and 97 percent in those with SCC, both compared to those who did not have a personal history of NMSC.

Tanning beds — No surprise

We know that tanning beds may be a cause for concern. Now the FDA has changed the classification of tanning beds from low to moderate risk and requires a warning that they should not be used by those under the age of 18 (6). The catch is that this does not have teeth; if tanning salons ignore the new rules, there is no punishment.

However, in a prospective (forward-looking) study, results show that people’s responses to warnings depended on how the warnings were framed (7). Compared to the text-only FDA warning requirement, graphic warnings that emphasized the risks of skin cancer were more likely to help people stop using tanning beds, whereas graphic warnings that demonstrated the positive benefits of not using these devices had no effects. So you may have to scare the daylights out of those in their teens and early twenties.

A recent study showed that drying lamps used after a manicure could lead to skin cancer.

Manicure risk, really?

I am told women and some men love manicures. Manicures cannot possibly be dangerous, right? Not so fast. It is not the actual manicure itself, but rather the drying process that poses a risk. In a prospective study, results show that drying lamps used after a manicure may increase the risk of DNA damage to the skin, which could lead to skin cancer, though the risk is small per visit (8).

There were a lot of variables. The shortest number of visits to increase the risk of skin cancer was eight, but the intensity of the UVA irradiance varied considerably in 17 different salons. The median number of months it took to have carcinogenic potential with exposure was around 35, or roughly three years. The authors recommend either gloves or suntan lotion when using these devices, although both seem to be somewhat impractical with wet nails. It’s best to let your nails dry naturally.

Vitamin B3 to the rescue

Many vitamins tend to disappoint when it comes to prevention. Well, hold on to your hat. This may not be the case for vitamin B3. In the Australian ONTRAC study, the results showed that vitamin B3 reduced the risk of developing NMSC by 23 percent, compared to those who took a placebo (9). Even better was the fact that SCC was reduced by 30 percent.

The most interesting part about this study is that these results were in high-risk individuals who had a personal history of NMSC. The participants were given B3 (nicotinamide 500 mg) twice daily for one year.

After the patients discontinued taking B3, the benefits dissipated within six months. The study was on the small side, including 386 patients with two or more skin cancer lesions in the last five years, with a mean of eight lesions. The side effects were minimal and did not include the flushing (usually neck and facial redness) or headaches seen with higher levels of niacin, another derivative. The caveat is that this study was done in Australia, which has more intense sunlight. We need to repeat the study in the U.S. Nicotinamide is not expensive, and it has few side effects.

NSAIDs as beneficial?

Results have been mixed previously in terms of NSAIDs and skin cancer prevention. However, a more recent meta-analysis (nine studies of varying quality, with six studies considered higher quality) showed that especially nonaspirin NSAIDs reduced the risk of SCC by 15 percent compared to those who did not use them (10).

Diet — The good and the bad

In terms of diet studies, there have been mixed positive and neutral results, especially when it comes to low-fat diets. These are notoriously difficult to run because the low-fat group rarely remains low fat. However, in a prospective dietary study, results showed that effects on skin cancer varied depending on the foods. For those who were in the highest tertile of meat and fat consumption, compared to those in the lowest tertile, there was a threefold increased risk of a squamous cell cancer in those who had a personal history of SCC (11). But what is even more interesting is that those who were in the highest tertile of vegetable consumption, especially green leafy vegetables, experienced a 54 percent reduction in skin cancer, compared to those in the lowest consumption tertile.

Thus, know that there are modifiable risk factors that reduce the risk of nonmelanoma skin cancer and don’t negatively impact your enjoyment of summer. There may be easy solutions to help prevent recurrent skin cancer, as well, that involve both medication and lifestyle modifications.

References: (1) Arch Dermatol. 2010;146(3):283. (2) uptodate.com. (3) nih.gov. (4) Br J Cancer. 2006;94(5):743. (5) J Natl Cancer Inst. 2008;100(17):1215-1222. (6) federalregister.gov. (7) Am J Public Health. Online June 11, 2015. (8) JAMA Dermatol. 2014;150(7):775-776. (9) ASCO 2015 Annual Meeting: Abstract 9000. (10) J Invest Dermatol. 2015;135(4):975-983. (11) Am J Clin Nutr. 2007;85(5):1401.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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By Barbara Beltrami

Even in the days when we can access any produce from just about anywhere all year long, when asparagus show up in great quantities in the supermarket at lower prices, when the stalks are pencil thin and the tips tight, we know spring has arrived and we can abandon the brussels sprouts and winter squash that have sustained us through the fall and winter.

It is not uncommon for asparagus to make their seasonal debut at Easter or Passover dinner and then to show up on our tables in many forms and preparations throughout the spring. In addition to the usual steamed, roasted or grilled versions, delightful themselves, there are so many ways to take advantage of this tender green veggie. Ever think of making an asparagus bisque with crab meat? Asparagus pesto? An asparagus and haricot vert (thin French green bean) salad with tarragon vinaigrette? Read on.

Asparagus Bisque

YIELD: Makes 4 to 6 servings

INGREDIENTS:

2 pounds fresh asparagus, washed and trimmed, then cut into one-inch pieces

3 tablespoons extra virgin olive oil

1 medium onion, diced

2 cloves garlic, minced

1 leek, white part only, washed and cut into 1-inch pieces

2 ribs celery, sliced into 1-inch pieces

1 large potato, peeled and diced

Salt and freshly ground white pepper, to taste

6 cups chicken or vegetable broth

½ cup cream or milk

½ pound fresh or frozen and defrosted lump crab meat, broken into bite-size pieces

Fresh chives, for garnish

DIRECTIONS: Steam asparagus until soft and just on the verge of turning yellowish green. Heat oil in a medium skillet; add onion, garlic, leek, celery and potato; sauté until onion, leek and celery are opaque, but not golden and potato is soft but not mushy. Add asparagus, salt and pepper and broth. Bring to a simmer and cook for 10 minutes. Let cool until just warm and puree entire mixture in food processor until smooth. Add milk or cream and pulse a few times. Serve warm or at room temperature. Garnish with crab meat and chives. Serve topped with crackers or croutons.

Asparagus Pesto

Asparagus Pesto

YIELD: Makes 4 to 6 servings

INGREDIENTS:

1 pound fresh asparagus

½ cup freshly grated Parmesan cheese

½ cup pignoli nuts

½ cup extra virgin olive oil

1 garlic clove

1 tablespoon freshly squeezed lemon juice

¼ cup Italian flat leaf parsley leaves

Coarse salt and freshly ground black pepper, to taste

DIRECTIONS: Wash and peel asparagus; snap off bottoms of stems. Slice into 2-inch pieces. Steam until asparagus are tender but still a nice bright green, 5 to 10 minutes depending on thickness of stems. Place in food processor; add remaining ingredients and process until smooth, 30 seconds to 1 minute. Serve at room temperature with linguine, spaghetti or any delicate pasta, gnocchi, crudités or toasted baguette slices.

Asparagus, Green Bean and Cherry Tomato Salad with Tarragon Vinaigrette

YIELD: Makes 6 to 8 servings

INGREDIENTS:

1 pound asparagus, steamed until tender but still bright green

1 pound green beans, sliced diagonally into 1-inch pieces and steamed until tender but still a bright green

12 cherry tomatoes, cut into wedges

½ cup minced Italian flat leaf parsley leaves

1 large shallot, thinly sliced

2 to 3 scallions, washed, trimmed and thinly sliced

1 garlic clove, bruised

¼ cup extra virgin olive oil

Juice of one medium fresh lemon

1 teaspoon prepared Dijon mustard

1 level tablespoon fresh tarragon leaves, minced or 1 teaspoon dried

Salt and pepper, to taste

DIRECTIONS: In a medium bowl toss together the asparagus, green beans, tomatoes and parsley. In a small bowl vigorously whisk together the remaining ingredients to make the dressing. When ready to serve, toss veggies with dressing. Tastes best if not refrigerated. Serve with chicken or fish and crusty French bread.

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Photo from Kent Animal Shelter

MEET JACK!

Photo from Kent Animal Shelter

Poor poor Jack … This handsome boy used to have a home, until his owner was diagnosed with cancer. No longer being able to care for him, she had no other choice but to bring him to Kent Animal Shelter. Jack is a 5-year-old lab mix. He’s friendly, energetic and would love to be your new best friend. And guess what, Jack is already crate trained and is house trained to boot! You really can’t go wrong with this goofy guy. Jack would love to have all of your attention, so it would be best if he were an only pet. He comes neutered, microchipped and is up to date on all his vaccines.

Kent Animal Shelter is located at 2259 River Road in Calverton. For more information on Jack and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.

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“The first duty of wine is to be red. The second is to be a Burgundy.”

— Alec Waugh, 1898-1981, British novelist, “In Praise of Wine,” 1959

By Bob Lipinski

The superb 2015 vintage is described by Jancis Robinson, M.W. as “seriously impressive.” The vintage produced excellent red and white wines across the board. The red wines I tasted were loaded with heaps of ripe, concentrated fruit, good acidity and considerable flavor. The whites displayed a fine balance between fruit, acidity and alcohol. Fruit was dominant in most of the wines I tasted with a striking array of flavors.

Bob LIpinski

At a recent trade tasting featuring the 2015 Burgundies, there were more than 100 wines to taste, and although I tried my best, I couldn’t taste them all! Below are some of my tasting notes.

2015 J.J. Vincent, Pouilly-Fuissé “Marie Antoinette”: (The name a tribute to Jean Jacques Vincent’s mother, Marie Antoinette Vincent): Pale straw-colored with an abundant bouquet of almonds, green apples, and citrus. Medium-bodied and quite refined, with layers of peach, melon and minerals.

2015 Château Fuissé, Pouilly-Fuissé “Tête de Cru”: Light and quite refreshing bouquet of minerals and apples with some toasted notes. Flavor is rich, tasting of vanilla, yellow plum and citrus.

2015 Château Fuissé, Pouilly-Fuissé “Les Combettes”: Bouquet of citrus, tropical fruit and pear. In the mouth, it is refreshing, medium-bodied and balanced, with flavors of yellow plums, orange and licorice.

2015 Château Fuissé, Pouilly-Fuissé “Les Brûlés”: Light straw-colored with a light bouquet of pear, apples and citrus. A full-flavored wine tasting very much of honey, butterscotch, coconut, toasted nuts and vanilla.

2015 Billaud-Simon, Chablis “1er Cru Mont de Milieu”: Complex nose combines citrus fruit with melon notes, enticing tangerine flavor and firm acidity.

2015 Billaud-Simon, Chablis “1er Cru Vaillons”: Medium-bodied, dry, lively and clean tasting with flavors of spices, peach and orange and a minerally finish and well-balanced aftertaste.

2015 Billaud-Simon, Chablis “Vaudésir Grand Cru”: A spicy bouquet and flavor of oranges, peaches and melon, with plenty of vanilla. Clean, minerally finish and lingering aftertaste.

2015 Billaud-Simon, Chablis “Montée de Tonnerre 1er”: Refreshing aroma of oranges, peaches and citrus. Nutty with flavors of tart tangerine, melon and a sort of minerally chalky character.

2015 Armand Rousseau,“Gevrey-Chambertin”: Deeply colored with a medium-full bouquet of plums, roses, violets and citrus. Full in the mouth with tart plums and spicy cherries. Great finish.

2015 Armand Rousseau, “Charmes-Chambertin Grand Cru”: Deep ruby color; full bouquet of raspberries and Marasca cherries; silky with layers of berries, light tannins and citrus. What a wine!

2015 Armand Rousseau, “Clos de la Roche Grand Cru”: Bright ruby color: bouquet of jammy spices, plums, cola and cinnamon. Almost a sweetness in the mouth with concentrated fruit, tannin and berries.

2015 Armand Rousseau, “Chambertin Grand Cru”: This wine stole the show (to me). Sweet, concentrated, jammy, spicy fruit; layers of fruit, blackberries, chocolate and damson plums.

Bob Lipinski, a local author, has written 10 books, including “101: Everything You Need to Know About Whiskey” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on wine, spirits and food and is available for speaking engagements. He can be reached at www.boblipinski.com or [email protected]m.

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