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Monday, June 2, 2008

31 Places to Go This Summer

From left, Michael Venera/Cavallo Point; Kevin Moloney for The New York Times; Matt Furbert for The New York Times

The Golden Gate Bridge, Monument Valley and the White Mountains.

THERE used to be a time — oh, let’s call it 2007 — when summer was considered a time of almost limitless possibilities, a time of languorous vacations, of trips filled with the promise of discovery.

But the summer of 2008 is starting out like a cruel joke, with air travel increasingly a nightmare and with wildly escalating gas prices threatening to make the road trip all but obsolete. It’s almost enough to make you sit at home and catch up on episodes of “Gossip Girl.”

The summer vacation is still an inalienable right, however. And there is no reason to forgo it this year. It will just take a bit of creativity — and perhaps the willingness to stay a little closer to home this time around — to pull it off in 2008.

Thus, here are 31 options — from river rafting in eastern Oregon to biking in the White Mountains of New Hampshire — for a great summer vacation. Not one involves the terrifying conversion of dollars into euros, many can be enjoyed without ever getting on a plane, and the road trips are ones that actually justify filling up your tank, even if the price of gas hits $5 a gallon this summer.

1. TEXAS HILL COUNTRY

Who needs Europe? The Texas Hill Country, west of Austin and north of San Antonio, might be the next best thing to crossing the Atlantic. The region is lush, colorful and, unlike much of the pancake-flat state, dotted with beautiful green hills that are evocative of Tuscany or the south of France. Moreover, the region is speckled with 22 wineries (www.texaswinetrail.com) that buzz with food and music festivals year round. And towns like Fredericksburg offer a taste of the Old World, with German-style biergartens and schnitzelhäuser.

2. NEW HAMPSHIRE

With 800,000 acres of rugged terrain and biking trails, the White Mountains of New Hampshire are sometimes called the Moab of the East. And while you won’t get red-rock formations or Road Runner vistas, the White Mountains do offer their own purple majesty. The Cherry Mountain Loop near Twin Mountain, not far from Bretton Woods, features remote waterfalls and thick forests. The trails around North Conway, a small, outdoorsy town near the Maine border where volunteer riders maintain more than 100 miles of downhill paths, are popular. For trail information, see the New Hampshire Trails Bureau (www.nhtrails.org) and New England Mountain Bicycling Association (www.nemba.org).

3. LAS VEGAS

The much-hyped efforts of Las Vegas to turn itself into a family destination a few years ago pretty much fizzled — there’s still plenty of sin in Sin City — but anyone looking for a pool vacation for the kids this summer might want to consider this desert spot. The pool scenes at any number of hotels (including recent expansions at Mandalay Bay and the Excalibur) are fairly over-the-top, but few can rival the 15-acre “tropical oasis” at the Flamingo Las Vegas (888-902-9929; www.flamingolv.com), with four pools, a water slide, several waterfalls and a subterranean grotto that can be explored either on foot or by water. And for the adults, there’s even a swim-up blackjack table. Weekend rates for a room with two queen-size beds (suitable for a family of four) start about $140 this June and July.

4. PHILADELPHIA

There are enough history excursions in the City of Brotherly Love to fill an entire summer, including big landmarks like the National Constitution Center (215-409-6600; www.constitutioncenter.org), with its interactive displays in which kids can be sworn in as president or cast their ballots in authentic voting booths. But there’s also plenty to do off the history track — much of it affordable for a family weekend. For starters: the new $20 million Big Cat Falls exhibit at the Philadelphia Zoo (3400 West Girard Avenue; 215-243-1100; www.philadelphiazoo.org), where lions, tigers, baby pumas and snow leopards are on view. A quick trolley ride from Center City can take you to one of the nation’s oldest — and most lovely — botanical gardens, Bartram’s Garden (54th Street and Lindbergh Boulevard; 215-729-5281; www.bartramsgarden.org). For local flavor, it’s worth a lunch visit to John’s Roast Pork (14 East Snyder Avenue; 215-463-1951; www.johnsroastpork.com), where the made-to-order cheese steaks are legendary (the James Beard Foundation declared John’s one of “America’s Classics”). The Loews Philadelphia Hotel is well situated at 1200 Market Street (215-627-1200; www.loewshotels.com), with occasional family packages. Rooms with two double beds start at $179.

5. A WESTERN ROAD TRIP

You could join the thousands of visitors vying for a glance of the fabled Grand Canyon before retiring to cafeteria lines and dorm-size rooms (surrounded by those same throngs). Or you could opt instead to navigate a series of mind-bendingly beautiful mesas and wild canyons in the Capitol Reef National Park, in almost near solitude. En route from Las Vegas, is Bryce Canyon — shades of the Grand Canyon with a fraction of the tourists. A bit farther, in Torrey, Utah (population about 200), the Cafe Diablo on Main Street (435-425-3070; www.cafediablo.net), serves rattlesnake cakes with ancho-rosemary aioli, glazed salmon, and margaritas at outdoor tables with views of the surrounding mountains. The nearby Hell’s Backbone Grill in Boulder, Utah (population 1850), on the edge of Escalante’s enormous slick-rock chasm, also serves food that’s strikingly good (Utah North Highway 12; 435-335-7464). Along the way, the stretch of road on Highways 89 and 12 is one of the country’s most stunning. (Information on Capitol Reef National Park, including camping permits: www.nps.gov; 435-425-3791.)

6. MYRTLE BEACH, S.C.

The 55-acre Hard Rock Park (www.hardrockpark.com), billed as the “world’s first rock ’n’ roll theme park,” just opened in Myrtle Beach, complete with a Led Zeppelin-themed steel roller coaster and nightly fireworks set to Queen’s “Bohemian Rhapsody.” It may be an unlikely addition to this popular resort, best known for its golf courses, but it’s not the only reason to visit this summer. Many of the area’s hotels are offering deep discounts on their weekend rates, ranging from three-bedroom suites for $225 a night to two-bedroom golf villas starting at around $200.

7. MONTAUK, N.Y.

It’s cheaper, less crowded and arguably even prettier than the Hamptons. And now the party scene is getting a boost, too. Montauk, the salty surfing and artists’ village at the eastern tip of Long Island, welcomed a new hotel this season, the Surf Lodge, created by the same celebrity-wrangling folks who brought you the Cain nightclub in New York’s Chelsea neighborhood. The 32-room hotel is set on tranquil Fort Pond, and imports such Hamptons-like affectations as a mixologist, yoga gurus and a flip-flop-friendly restaurant helmed by the former “Top Chef” heartthrob Sam Talbot. (Surf Lodge, 183 Edgemere Street; 631-238-5190; www.thesurflodge.com.)

8. NIAGARA-ON-THE-LAKE

You won’t find much evidence of George Bernard Shaw at the Shaw Festival (www.shawfest.com) this year — just “Mrs. Warren’s Profession” and the seldom-performed “Getting Married.” But there are still excellent theatrical offerings this summer, including two Stephen Sondheim musicals, “A Little Night Music” and “Follies.” But even if you never go inside a theater, Niagara-on-the-Lake in Ontario has plenty to offer, including a lovely setting on Lake Ontario, a clutch of charming B & Bs and some excellent wineries — particularly Peller Estates (www.peller.com), with a restaurant featuring creative seasonal menus from its executive chef, Jason Parsons. The historic Prince of Wales Hotel, in the center of town (6 Picton Street; 905-468-3246), is an excellent place to park yourself for the weekend. Summer rates start at about 290 Canadian dollars, about the same in United States dollars.

9. SCOTTSDALE, ARIZ.

Downtown Scottsdale is turning into a desert version of Miami’s South Beach. No ocean of course, but plenty of late-night partying and a buzzing hotel scene. The latest arrival is the 224-room W Scottsdale (www.whotels.com/scottsdale), scheduled to open in August, featuring a Bliss spa, a 1,100-square-foot fitness center, a sprawling pool area (with 13 private cabanas) and a sushi restaurant. Rates start at $449.

10. CHESAPEAKE BAY

The calm waters of Chesapeake Bay are an idyllic setting for a summer afternoon sail. But don’t know your mast from your helm? Then check out the “Learn to Sail Package” being offered by the Tides Inn (www.tidesinn.com), a resort in Irvington, Va., set on an estuary that flows into the Rappahannock River and the Chesapeake. Starting at $2,495 for two people, the package includes four nights in a suite in a part of the hotel with a private boat slip and two and a half days of expert instruction that will enable you to earn a basic keelboat certificate. More of a landlubber? Stay behind and hang out at the spa, where the treatments include a lava shell massage and a Sedona clay body wrap.

11. PORTLAND, ORE.

As far as foodie havens go, Portland has been better known for its vegan cafes and eco-hippie cooperatives than for restaurants with gastronomic ambitions. But an emerging locavore movement has changed that. Drawn by the city’s low rents and artsy vibe, young chefs are breaking the culinary mold and tapping into the Northwestern bounty of local fisheries, small meat purveyors and artisanal farms. Sample the heat at places like Clyde Common (Southwest 10th and Stark; 503-228-3333; www.clydecommon.com), which serves novel dishes like crispy pork belly with blood orange marmalade.

12. MONUMENT VALLEY

You’ve seen it in countless spaghetti westerns and Marlboro ads. But the iconic red buttes and mesas of Monument Valley, in the heart of Navajo country, offers more than just postcard-ready views of the quintessential American West. The wind-scraped valley, which spreads along the Utah and Arizona border like a rock sculpture garden, also draws horseback riders, mountain bikers, river rafters and other outdoor enthusiasts. Sacred Monument Tours (www.monumentvalley.net) has horseback rides starting at about $57. Tours are also available at Goulding’s Lodge (www.gouldings.com), currently the only lodging in the valley, at least until the View Hotel (www.monumentvalleyview.com) opens sometime in the fall. Other services can be found through the Navajo Parks and Recreation Department (www.navajonationparks.org).

13. HIGHWAY 101, OREGON

Oregon’s Highway 101 may be a National Scenic Byway (www.byways.org), but that doesn’t mean you have to drive it. This coastal highway is also great for biking. Yes, there are some challenging uphill stretches, but the reward is fragrant old-growth forests, misty ocean cliffs and isolated coves that you’d miss whizzing by in a car. Plus, it’s easy to tack on a side trip to artsy little towns like Port Orford (www.portorford.org), the nearby historic Cape Blanco Lighthouse (www.capeblanco.org) and the Bandon Marsh National Wildlife Refuge, which is excellent for bird-watching. For lodging, try the eco-friendly Wildspring Guest Habitat (866-333-9453; www.wildspring.com), which has cedar cabins filled with art and antiques starting at $245.

14. THE SAN JUAN ISLANDS

Although the San Juan Islands in the Pacific Northwest can be reached by plane or boat, traveling by ferry will make you rethink your concept of mass transit. Although the ferries, part of the Washington State Department of Transportation (www.wsdot.wa.gov/ferries), are used mostly by commuters, these same ferries can be a leisurely (and economical) way to take in the stunning beauty of this popular tourist spot — an archipelago of more than 450 tiny islands roughly halfway between Seattle and Vancouver. In particular, the route of the Illahee, the 45-minute ride between San Juan Island and Orcas Island, has been described by a writer for the Travel section as “the most beautiful trip in the entire Washington State ferry system.”

15. THE BOUNDARY WATERS

Every summer, thousands of canoe paddlers head to the small Minnesota town of Ely to explore the Boundary Waters Canoe Area Wilderness, a 1.3 million-acre park that runs along the border between the United States and Canada. The frenzy sometimes gives Ely the feel of the Old West, with travelers loading up on food and liquor before heading out into the great unknown. But the sights and sounds of a boomtown are soon replaced by the lull of a canoe gliding through water and the near-absence of any other living soul. Among the many local outfitters is the Piragis Northwoods Company (www.piragis.com), which offers four-day weekend excursions over the summer, with rates starting at $695 a person.

16. QUEBEC CITY

The city’s celebration of its 400th anniversary will mean a full summer schedule of events, including a sound and light show with 2,000-foot-long grain silos serving as projection screens for images of the city; an exhibition of 277 pieces on loan from the Louvre at the Musée National des Beaux-Arts (866-220-2150; www.mnba.qc.ca); and — mais oui — a free concert by Celine Dion on Aug. 22 (418-648-2008; www.myquebec2008.com).

17. PASO ROBLES, CALIF.

Blame it on “Sideways.” Ever since that 2004 film uncorked central California as a discerning wine region, the boutique vineyards and wineries in Paso Robles have blossomed into the region’s next viticulture center. The number of bonded wineries has tripled to 170 in recent years, cultivating everything from cabernet sauvignon to zinfandel. Elegant hotels like the Hotel Cheval (1021 Pine Street; 866-522-6999; www.hotelcheval.com) have sprouted. And so have delectable restaurants and artisanal shops like Pasolivo Olive Oil (8530 Vineyard Drive; 805-227-0186; www.pasolivo.com). For tasting maps, see the Paso Robles Wine Country Alliance’s Web site, www.pasowine.com.

18. BAHIA HONDA KEY, FLA.

Pristine beaches. Crystal blue waters. Zero development. Bahia Honda Key (www.bahiahondapark.com) might be mistaken for a chic Brazilian preserve, but this 524-acre islet in the Lower Florida Keys, between Key West and Marathon, is actually a state park with beautiful beaches, amazing snorkeling and a precious biodiversity with nurse sharks and trumpet-shaped lily thorns. Even rarer are the prices. Admission is $3.50 for one person. Snorkeling rentals start at $3 for a mask. And the park has three duplex cabins, with showers and a deck, that run under $140 a night.

19. SAN FRANCISCO BAY AREA

Cavallo Point, a retreat center devoted to environmental health and sustainability, is opening on the grounds of the century-old Fort Baker, in Marin County across the Golden Gate from San Francisco. The latest step in the Bay Area’s slow-food obsession, the complex officially opens June 14, with rotating guest chefs, a spa, adventure programs and an eagerly awaited restaurant. Units in the historic section, set in former lieutenants’ and generals’ quarters, start at $350 for a room with a view and $250 for one without a view (888-651-2003; www.cavallopoint.com).

20. TELLURIDE, COLO.

Sometimes called Little Switzerland, with its steep peaks, crisp streams, alpine basins and swaths of wildflowers, the ski resort of Telluride becomes a hiking mecca in the summer. Guided day trips as well as technical rock climbs can be arranged through the San Juan Outdoor School (300 South Mahoney Drive; 970-728-4101; www.tellurideadventures.com), starting at $125 a person for a group of four or more. The three-day “adventure kids’ camp” program includes climbing, hiking and outdoor games for $325.

21. OWYHEE RIVER, OREGON

Snaking through the remote eastern desert of Oregon, the Owyhee River, with its deep sandstone cliffs and silty desert waters, has garnered comparisons to the Colorado River or the Salmon. But its mild white water and lazy meanderings make it manageable for those who aren’t experts but still want a classic river rafting adventure. An updated list of outfitters is available from the United States Bureau of Land Management office in Vale, Ore.; (541) 473-3144).

22. LAKE POWELL

With nearly 200 miles of clear blue water and stark red rock, Lake Powell is a boating paradise. The lake, which straddles the Utah-Arizona border in the Glen Canyon National Recreation Area, is the second-largest artificial reservoir in the United States, after Lake Mead. And since you’ll also need a place to stay, why not do so on a houseboat? Lake Powell Resorts & Marinas (888-896-3829; www.lakepowell.com) has a large fleet that includes the 46-foot-long Voyager XL, with an outdoor grill, stargazing cushions and enough beds to sleep eight, for $2,415 for three days.

23. FARMINGTON, N.M.

In New Mexico, not far from Colorado’s Mesa Verde National Park, in a cliff face near the La Plata River, sits a most bizarre — but intriguing — B.&B. option. Kokopelli’s Cave is a one-bedroom cave home carved from a 65-million-year-old sandstone formation, with Southwestern-style furniture, food-stocked kitchens, a washer and dryer — and views of the spectacular mountain ranges of the Four Corners region. The cave was blasted out in the 1980s by a geologist, Bruce Black, who planned to use it as an office. Instead, Mr. Black’s son and daughter-in-law made it their home and transformed it into a B. &B. soon after. Rates start at $240 a night depending on the number of guests. (505-326-2461; www.bbonline.com/nm/kokopelli).

24. MONTREAL

Whether your iPhone is loaded with chamber music or Arcade Fire, Montreal is music to all ears this summer. The Osheaga Music and Arts Festival (www.osheaga.com), a new showcase for avant-garde talent, is on Aug. 3 and 4. The huge Montreal Jazz Festival (www.montrealjazzfest.com) takes over the entire city from June 26 to July 6, with 3,000 performers including Leonard Cohen and Woody Allen (yes, that one). And every Sunday, Piknic Électronik brings the rising stars of Montreal’s electronic music scene to Jean Drapeau Park. The city’s revamped Web site (www.tourisme-montreal.org) has listings, maps and a nifty planner.

25. TANGLEWOOD, MASS.

For a little Brahms to go with your Brie, picnic under the stars at the Tanglewood Music Festival (www.tanglewood.org), the summer home of the Boston Symphony Orchestra in the pastoral Massachusetts Berkshires. Under the direction of James Levine, the symphony’s opera-rich season kicks off on July 5 with a concert performance of “Les Troyens” by Berlioz and continues with weekend-long Beethoven and Mozart festivals. John Williams also returns to conduct the popular “Boston Pops: Film Night at Tanglewood” on July 26, featuring selections from his latest blockbuster with Steven Spielberg, “Indiana Jones and the Kingdom of the Crystal Skull.”

26. BEARTOOTH ROAD

Charles Kuralt once called it America’s most beautiful highway, 68.7 miles of high-altitude, high-adrenaline road that zigzags through the Beartooth Mountains in Montana and Wyoming. He might have been right. The two-lane Beartooth All-American Road (www.beartoothhighway.com) climbs over 10,000 feet (Winnebago drivers: don’t bother), going from forest to alpine tundra in an hour. Dazzling sights await around every hairpin turn: 12,000-foot-plus mountains, waterfalls, glacial lakes, wildflowers and the occasional mountain goat. Besides gawking, the area offers fly-fishing, hiking, even summer skiing. Midway along the route, you’ll find affordable rooms at Top of the World Resort (2823 U.S. 212, Cody, Wyo.; 307-587-5368; www.topoftheworldresort.com) starting at $55, and plenty of other options in the gateway towns of Cooke City and Red Lodge in Montana.

27. PACIFIC NORTHWEST (BY RAIL)

Amtrak’s Empire Builder delivers a greatest hits of the American landscape. Beginning in Chicago, passing through the Great Plains and the other-worldly Glacier National Park and ending in Seattle or Portland, Ore., the roughly 48-hour ride is a throwback to the golden age of train travel. Old-fashioned dining cars serve freshly cooked meals (flat iron steak, roasted game hen) on tables decked out in white tablecloths. The panoramic sightseeing lounge and sleeping compartments have a certain “North by Northwest” charm. And rangers from the National Park service are periodically on board to provide narrative along the route as a part of a Trails and Rails program. Beyond the nostalgia, the Empire Builder cars were refurbished last year. Fares and accommodations vary; a mid-level two-berth roomette for two adults from Chicago to Seattle, with meals and nonalcoholic drinks, can range be $760 to over $900 (www.amtrak.com; 800-872-7245.)

28. SUNSHINE COAST

The Sunshine Coast of British Columbia certainly lives up to its name. Averaging upward of 2,400 hours of sunny skies a year, the resort area is two hours northwest of Vancouver and is dotted with scenic restaurants, hippie cafes and arty shops. Despite its popularity, the region remains pristine because the coastline is largely accessible by boat only. Kayakers will find marine life galore, including phosphorescent plankton that glow during moonlight paddles. Sunbathers will find long stretches of sandy beaches, lagoons and rocky tide pools. Lodging can be found near the town of Sechelt (www.sechelt.com). An affordable little resort called Rockwater Secret Cove (877-296-4593; www.rockwatersecretcoveresort.com) has its own beach, with rooms starting at 119 Canadian dollars.

29. JEMEZ SPRINGS, N.M.

The tiny town of Jemez Springs (www.jemezsprings.org), about an hour north of Albuquerque, is easy to miss. Except for an 1870s bathhouse in the center of town, there’s little to tempt visitors except for several Southwestern diners, a family-run winery and a Japanese Buddhist monastery. And that’s precisely its charm. You can spend the day hiking and fishing in the recently created Valles Caldera National Preserve (www.vallescaldera.gov), an 89,000-acre preserve inside a collapsed volcano, then spend the night soaking at the Jemez Springs Bathhouse (www.jemezspringsbathhouse.com), which was recently restored by the town and is fed by the smelly, steaming waters from the area’s natural hot springs. An hour soak is $15, and massages start at $37.

30. MANITOBA

On the surface, yoga and canoeing may seem like conflicting pastimes. Yoga involves stretching and letting your mind come to rest, while canoeing is about using force and repetitive motion. But marrying the two is exactly what Northern Soul Wilderness Adventures (www.northernsoul.ca) offers in the backwoods and glacial lakes outside Winnipeg, Manitoba. After paddling to a clearing in the forest, students lay down their mats and strike their yoga poses, surrounded by nothing but pine and scurrying chipmunks. The cost of the three-day trips (July 25 to 27 and Aug. 22 to 24) is 399 Canadian dollars. No prior canoeing or yoga experience is necessary. Meals are, not surprisingly, organic and vegetarian.

31. THE GLACIERS OF ALASKA

In the land of the midnight sun, perhaps no summer activity is more otherworldly than hiking Alaska’s majestic glaciers. Several outfitters offer guided summer excursions, including MICA Guides (800-956-6422; www.micaguides.com; $70 a person, plus entry fee into Glacier Park), which leads daytime and evening treks on Matanuska Glacier, two hours northeast of Anchorage. Midnight sun hikes on Alyeska Glacier are offered by Ascending Path (877-783-0505; www.theascendingpath.com; $139 a person) from June 13 to July 13, while more far-flung excursions are offered by North Star Trekking (www.glaciertrekking.com) and Above and Beyond Alaska (www.beyondak.com).

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Rare Surgeries

Rare Surgeries
If shows like House M.D. or ER have taught us anything, it’s that gift-wrapped medical mysteries with happy endings appeal to the public -- regardless of the story’s reliance on fact or “real” science. Step aside Hollywood, the following are a few exciting and rare surgeries. Unlike their made-for-TV spin-offs, however, these rare surgeries are real.

5 rare surgeries

1- Full face transplant

For 24 years, 30-year-old Frenchman Pascal Coler lived in silent agony on account of a genetic condition (neurofibromatosis) that turned him into a modern-day Elephant Man. The ridicule that his disfigured face drew in the streets became so severe that it forced him to live as a recluse and as a prisoner to his condition. Thanks to the courage to perform rare surgeries like face transplants, Coler no longer has to live in society’s shadows.

After 16 hours of surgery in March 2008, Mr. Coler emerged with new lips, cheeks, a nose, a mouth, and a smile. The remarkable procedure -- undertaken at Henri-Mondor Hospital in Creteil, France -- was hailed as the first full face transplant.

"At first we were quite frightened to do the transplant," said Dr. Laurent Lantieri, head of plastic surgery at Henri-Mondor. "We didn't know how the patient would tolerate the fact to have a new face." The result, however, was a tremendous success. The transformation is simply incredible and Coler said that "The operation has revolutionized my life. I can live as a normal human being for the first time."

How rare: Coler’s full face transplant was the first of its kind.

2- Six-way kidney transplant

What do doctors do if they have a patient in need of a kidney, a friend of the patient who is willing to donate, and incompatible tissue types? Welcome to modern medicine’s answer to musical chairs: the six-way kidney swap.

In April 2008, nine surgical teams at Johns Hopkins Hospital performed the world's first six-way, simultaneous and "domino" kidney transplants. Five of the six patients requiring transplant had willing donors who unfortunately didn’t match their tissue type, but did match that of another patient’s. An independent sixth donor was thrown into the mix, resulting in the now famous six-way swap. Simultaneity was required in order to prevent donors from backing out once their friend or loved one received a kidney.

Johns Hopkins Hospital has carried out a number of simultaneous transplants over the past three years, but this was the first six-way.

How rare: As rare surgeries often are, this was the first of its kind.

3- No-incision appendectomy

Appendectomies used to result in a week-long hospital stay and a large scar. Now, due to experimenting with rare surgeries, lucky appendectomy patients can expect to have their appendix removed through -- brace yourselves -- the vagina or anus. In March 2008, surgeons at the University of California, San Diego (UCSD), removed 24-year-old Diana Schlamadinger’s appendix through her vagina. Despite the horrific images this conjures, the surgery offers immense benefits in both recovery time and in pain reduction.

We may have fibbed a little when we called this a no-incision procedure as it require a small incision in the inner wall of the vagina (if you have one) and one more just below the belly button to allow the insertion of a camera to guide the operation. Within two days after the surgery, Diana (a student at UCSD) was recovering with almost no pain. "I feel kind of like I did too many sit-ups," she said.

How rare:
This surgery was the first of perhaps many.

4- Nerve transplant

After her son, Nick, had his hand paralyzed in a serious car crash, like any loving mother, Frankie Anderson-Harris wanted to help. On November 17, 2005, Frankie donated nerves from both her arms and legs to give her son’s hand new life. Her nerves were used to rejoin those that were severed in her son’s forearms. After the extraction, Frankie was left with numb spots on her feet and elbows; she was told that these sensations would dissipate over time. The surgery was completed successfully, but, as with any transplant surgery, there was fear that the host would reject the donor tissue. Nick was told he’d have to take immunosuppressive drugs for at least a year following the operation, after which point his body hopefully would have accepted the new nerves. "Sometimes you feel very, very helpless and it's nice to be able to do something," Nick’s mother said. "I was glad to be able to do it."

How rare: This rare surgery was one of only a dozen ever attempted at the time.

5- Robotic brain tumor removal

In May 2008, 21-year-old Paige Nickason had a tumor robotically removed from her brain. Using remote controls and an image screen, doctors at Foothills Medical Centre in Calgary guided a two-armed robot -- known as NeuroArm -- through a nine-hour procedure to remove the young woman’s tumor.

"Paige’s brain surgery represents a technical achievement in the use of image-guided robotic technology to remove a relatively complex brain tumor," said Dr. Garnette Sutherland, professor of neurosurgery at the University of Calgary and Paige’s surgeon. Interestingly, Dr. Sutherland attributed, at least partially, humankind’s development of manipulative robotic surgery techniques to popular video games. "We would all agree that our young children who have become immersed in video games represent the future generation of surgeons," he said.

The robotic arm that was used in Paige’s surgery was built in collaboration with engineers from MacDonald, Dettwiler and Associates, known for creating the International Space Station’s Canadarm and Canadarm2.

How rare:
This rare surgery was the first of its kind, ever.
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Legitimizing Marijuana

JANE WELLS of CNBC keeps a blog called Funny Business, but her recent reports on California’s medical marijuana industry are about a business that is increasingly being taken seriously. They amount to a short primer on how the business works and how the operators of the state’s estimated 500 dispensaries deal with the high risks and high costs of working in a legal gray area (cnbc.com).

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Alex Eben Meyer

Medical marijuana is legal in California, but federal law still bans sales. Amid the uncertainty that this creates — including the occasional raid by federal agents — a full-fledged industry has blossomed, taking in about $2 billion a year and generating $100 million in state sales taxes, CNBC reported.

Setting up a clinic “can cost as much as a hundred grand,” Ms. Wells reports. The equipment, the cuttings from which plants are grown and office space all tend to be expensive. And from there, the costs only grow, mostly in the form of legal fees. Many clinics keep lawyers on retainer.

Nonetheless, “this is the business model of the future,” says JoAnna La Force of Farmacy, an herbal remedy shop in Southern California. Ms. LaForce says her business is close to breaking even (medicalmarijuanafarmacy.com).

A slew of ancillary businesses has grown up around medical marijuana. Bill Britt, identified on the Web site as a patient, has found a new career as an expert witness in cases brought against dispensaries and patients, earning $250 to $350 a case.

He gained his expert knowledge by attending Oaksterdam University, a trade school in Oakland, Calif. At Oaksterdam (oaksterdamuniversity.com), students learn everything from “The Politics of Cannabis” to botany to business operations.

Getting into the quasi-legitimate marijuana business is a challenge, says Jeff Jones, chancellor of Oaksterdam’s Los Angeles campus. But, he adds, “The investment is well worth it, except for the federal risk.”

A DISTINCTION, OF SORTS As air travel grows increasingly nightmarish even as it gets more expensive, Patrick Smith, writer of Salon’s Ask the Pilot column, has been singing the praises of Southwest Airlines, the (relatively) cut-rate, bare-bones carrier (salon.com).

Southwest recently took first place in a survey of airline satisfaction conducted by the University of Michigan.

Mr. Smith’s initial explanation was this: “People don’t expect much. Southwest Airlines is nothing if not unpretentious” and has “mastered the art of get-what-you-pay-for satisfaction.”

His readers, though, thought otherwise. Many wrote to say that, though Southwest dispenses with a lot of perks, it offers a basic level of customer service that bigger airlines often do not.

Mr. Smith acknowledged that Southwest’s comparatively small size gave it an advantage in maintaining a consistent level of service. Nevertheless, it is “the last of a nearly vanished breed: an airline with a true personality, that large numbers of fliers have unwavering fondness for.”

BACK ON DRUGS As a test of airport security, a customs officer planted marijuana in the side pocket of a random suitcase at Narita International Airport in Tokyo, the BBC reports (news.bbc.co.uk).

The test failed when the sniffer dogs were unable to detect the pot. But the officer could not remember which bag he had used.

Using an actual passenger’s suitcase is against regulations, and the airport’s customs service has apologized.

Meanwhile, the marijuana is still out there. “Anyone finding the package has been asked to contact customs officials,” according to the BBC. So far, nobody has spoken up.

DAN MITCHELL

E-mail: whatsonline@nytimes.com.

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Foetal screening 'misses defects'

Pregnant woman
Pregnant women are offered a number of tests

Tests used in pregnancy only pick up half of potential chromosomal abnormalities, Italian research warns.

The team behind the work told a European genetics conference that women needed more information about their limitations, and the risks involved.

Some tests which sample the fluid around the baby can cause miscarriage.

The Royal College of Midwives said that the UK focused on a small number of common defects, with high quality information for women.

The tests do not even detect 100% of the common abnormalities
Dr Francesca Grati
TOMA Laboratory, Italy

Perhaps the best known example of a chromosomal abnormality is Down's syndrome, in which the foetus has an extra copy of one of the chromosomes.

It leads to babies who have development problems, a higher rate of cardiac defects and a characteristic facial appearance, although with the support of modern medicine, people with Down's can live in excess of 50 years.

One way to confirm the syndrome is via amniocentesis, in which a needle is used to take a sample of the fluid within the womb.

This test, which is not routinely offered to all pregnant women in the UK, can also reveal other, less common, chromosomal defects, such as Edward's syndrome and Patau syndrome.

Approximately one in 100 women who have the test will miscarry as a result.

Counselling 'fundamental'

Dr Francesca Grati, from the TOMA Laboratory in Busto Arsizio, looked at well over 100,000 prenatal diagnoses which used invasive tests such as amniocentesis, and looked to see which chromosomal abnormalities had been missed in the samples.

Addressing the European Society of Human Genetics conference in Barcelona, she said that the tests had only identified half the abnormalities present in the samples. "There are many others which are not picked up by these tests, and the tests do not even detect 100% of the common abnormalities."

She said it was "fundamental" that doctors should counsel their patients about the limitations of current screening methods, so that they could make an informed choice about the risks invasive tests such as amniocentesis.

However, a spokesman for the Royal College of Midwives said that it was right to focus testing on a small number of the most common defects, rather than bombard women with worrying information about very rare conditions.

She said: "I think we are very good at providing information to women in this country about these tests and their risks.

"If you were to tell women about 50 different conditions, some of which have a one in 150,000 chance of happening, they will not be able to absorb it."

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Genesis of a Virus

Scientists witness the birth of an HIV particle as it happens.

Emergent virus: Rockefeller University researchers have, for the first time, captured a virus in the act of replication and imaged the birth of HIV particles in real time. Each pinpoint of light seen here is actually an individual virus assembling inside the cell membrane.
Credit: Nolwenn Jouvenet, Paul Bieniasz, and Sanford Simon.

Over the years, HIV has proved a tricky target. No one could definitively show where in the cell it assembled, or when it was released. Certainly no one knew how long it took a single virus to be born. And so much of what's known about HIV and other viruses has been pieced together through experiments that rely on inference: microscopic and chemical probing of cells frozen in different states of viral infection provide only information about what was happening in that cell at a particular moment in time. Now researchers have been able to watch as hundreds of thousands of molecules assemble inside a cell to create a single particle of HIV.

"No one's ever actually observed virus particles assembling before," says Paul Bieniasz, a virology researcher at Rockefeller University and the Aaron Diamond AIDS Research Center, and one of the scientists involved in the project. Their study marks the first time that scientists have been able to observe a virus--any virus--being built, and it holds the potential to revolutionize the relationship that scientists have with the viruses they study.

The research is a collaboration between Bieniasz, an HIV specialist, and Sanford Simon, a biophysicist at Rockefeller who studies how large molecules enter and leave the cell. The scientists used a suite of inventive imaging techniques to record each step of the process, allowing them to watch as the virus assembled and then gradually budded off of its host cell. The entire process can occur in as few as six minutes.

At the heart of the research is an often overlooked microscopy trick called total internal reflection. This technique takes advantage of light's ability to bend. When light is shined through glass onto a cell's surface at a very steep angle, it begins to bend. The steeper the angle, the greater the bend, until the angle is so sharp that light reflects back into the glass and illuminates only the very thin area along the surface of the cell--an area otherwise impossible to visualize.

By homing in on this outer membrane, and tagging one of the virus's major structural proteins, called Gag, with a fluorescent protein, the researchers were able to watch as the molecules aggregated to form a single virion. Visually, it showed up as little bright spots appearing and disappearing, "like little stars appearing in the sky," Simon says. "It was really beautiful."

In order to make sure that what they were seeing really was the virus assembling, Simon and Bieniasz then tagged the Gag proteins with fluorescent molecules that change color when in close proximity to one another--something that would indicate that the proteins were assembling into a tightly packed structure. Sure enough, the fluorescent tags reacted, and their color change confirmed that Gag proteins were coming together to form a virus.

Once the researchers had determined that the Gag molecules were gathering in tight groups, the next thing they had to do was show that these assemblages were budding off from the cell surface to form completely independent virions. If that were happening, they reasoned, nothing should be visibly transferring back and forth between the newly formed virus particles and the inside of the cell. To test this, Simon and Bieniasz attached a different fluorescent protein to Gag, one that reacted to acid in its environment. When they acidified the cell's interior with a brief pulse of carbon dioxide, Gag molecules still connected to and exchanging protons with their parent cell should react quite quickly. Virions that had already pinched off should have a much slower response, proving themselves now to be independent entities no longer dependent on the host cell.

"It really is an important step forward," says Wesley Sundquist, a biochemist at the University of Utah who studies the life cycle of HIV. (He was not involved in the research.) "This is the first time we've been able to look at the behavior of real virion particles, and to do so in real time."

Unlike most techniques in biology, in which a scientist has to infer what's happening based on his or her observations, "here we could directly observe the process of assembly, and unequivocally show where it occurs and how long it takes," Bieniasz says.

In the future, HIV researchers may also be able to use these techniques to create far more precise therapeutics. Now that they have the means to better investigate individual steps of viral assembly, they could potentially figure out ways to interfere with the process. Bieniasz says that researchers could also use the same approach to investigate other viruses.

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Drugs to Grow Your Brain

Compounds that trigger the growth of new brain cells might help treat depression.

Newborn neurons: This image shows a section of the hippocampus, the part of the brain important for learning and memory. Mature neurons are shown in green, while newborn neurons are orange, and neural stem cells are red.
Credit: BrainCells Inc.

Drugs that encourage the growth of new neurons in the brain are now headed for clinical trials. The drugs, which have already shown success in alleviating symptoms of depression and boosting memory in animal models, are being developed by BrainCells, a San Diego-based start-up that screens drugs for their brain-growing power. The company hopes the compounds will provide an alternative to existing antidepressants and says they may also prove effective in treating cognitive disorders, such as Alzheimer's.

"The fact that you might be able to take small molecules to stimulate specific cells to regenerate in the brain is paradigm-shifting," says Christopher Eckman, a neuroscientist at the Mayo Clinic in Jacksonville, FL. "[This approach] takes advantage of the body's innate ability to correct itself when given appropriate cues." Eckman studies compounds that boost brain cell growth in models of neurodegenerative disease and is not involved with BrainCells.

In the last ten years, scientists have discovered that new neurons are born in the adult brain and that increases or decreases in this cell growth, known as neurogenesis, may be involved in myriad brain diseases, including depression, schizophrenia and stroke. Subsequent research has shown that existing drugs, including Prozac and other antidepressants, boost neurogenesis. In fact, that property may be an integral component of the drugs' effectiveness--for example; some experiments suggest that new cell growth in the hippocampus is necessary for antidepressants to work.

Scientists at BrainCells aim to exploit that finding by screening drugs expressly for their ability to boost brain cell growth. (While some existing drugs have this effect, they weren't selected for it.) Scientists select drug candidates by assessing their impact on human neural stem cells growing in a dish, examining how many new cells are born and how well they develop into fully differentiated neurons. The company is focusing mainly on drugs that are already on the market or have been tested in humans for other indications and therefore have a good safety profile.

After screening different types of antidepressant compounds that are already on the market, researchers at BrainCells found all the drugs have a similar ability to boost brain cell growth. However, existing antidepressants fail to help 30 to 50 percent of patients and often carry problematic side-effects. So the scientists began searching for other compounds that carry similar benefits but lack the side effects. "It's possibly that some people who don't respond to SSRIs [a common type of antidepressant] would respond to a drug that targets neurogenesis directly," says James Schoeneck, Braincells's chief executive officer.

Clinical trials of the company's lead candidate, known as BCI-540, began earlier this year. The drug, originally developed for Alzheimer's disease, boosts brain cell growth by 20 percent. These results are comparable to Prozac. "Because the drug had already been tested in 700 patients, we knew its safety profile," says Schoeneck. (Clinical trials for Alzheimer's were halted because of a high rate of placebo response.) Schoeneck says the drug has so far shown no signs of gastrointestinal or sexual side effects, two of the most problematic side effects of current antidepressants.

The company also plans to test the drug, which shows anti-anxiety effects in rodents, for Post-Traumatic Stress Disorder (PTSD), an anxiety disorder common in combat veterans and assault victims. But the role of neurogenesis in mood disorders is still controversial. "Not everyone is convinced that neurogenesis is integrally related to the cause of depression," says Arnold Kriegstein, director of the Institute for Regeneration Medicine at the University of California, San Francisco.

Drugs that boost brain cell growth may also aid cognition. Previous research has shown that neurogenesis in the hippocampus, a brain area integral to learning and memory, is important for maintaining plasticity in that part of the brain, which in turn is linked to memory function. "With aging, there's a decrease in neurogenesis," says Kriegstein. "The hypothesis is that if you could boost neurogenesis to compensate for that age-related decline, you might maintain functional levels."

BrainCells is also testing a compound, known as BCI-632, for its cognitive enhancing properties. "It's the most neurogenic compound we've seen," says Schoeneck. While the compound hasn't yet been tested in humans, it appears to boost at least one type of memory in rodents. The company aims to begin clinical trials next year.

Novel drug combinations may also have neurogenesis-boosting power. For example, researchers at Brain cells have found that a respiratory drug and a cardiovascular drug, both already on the market, seem to dramatically boost brain cell growth in cellular tests.

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China Tries to Halt Spread of Hand, Foot and Mouth Disease

iStockPhoto/Thomas Perkins

SHANGHAI—Chinese authorities have launched a nationwide public hygiene campaign in an effort to combat the spread of hand, foot and mouth disease (HFMD), which has killed 42 children and infected at least 30,000 youngsters throughout Asia since the end of April. The disease, caused by an unusually virulent strain of the intestinal flu known as enterovirus 71 (EV71), so far has spread from Mongolia to Vietnam, including most parts of eastern China, and health officials warn that the situation could get worse as the disease usually peaks during the summer heat of June and July. Already, Mongolia has shut all kindergartens and primary schools as a result of the spreading outbreak.

The hardest hit areas in eastern China have been in Anhui Province, especially the city Fuyang, where 23 died, and even Beijing was not spared: two children, one a resident and one a visitor, died from the disease last week, whose symptoms include a mild fever, rash on the hands and feet and open sores in the mouth. In the most severe cases it can lead to a heart and lung infection (pulmonary edema) as well as inflammation of the brain lining (meningitis) or of the brain itself (encephalitis)—conditions that can result in paralysis or death.

Health officials here have ordered residents, schools and business to take steps designed to prevent the disease's spread, including sterilizing furniture and toys with alcohol wipes as well as keeping symptomatic children at home. The national government also ordered kindergarten and primary schools to check kids twice daily for signs of the illness. In fact, health officials have ordered schools to close for two or three weeks if any child attending becomes severely sick or if more than two cases occur in one class.

Shanghai has had nearly 2,000 cases of the disease so far this year. "Until now, the number of deaths caused by hand, foot [and] mouth disease in Shanghai [had been] zero," Fang Weimin, director of the Health Supervision Agency of the Pudong New District of Shanghai, told me through my translator. "The education department should do the educational work to enhance the awareness and alertness of related people" to make sure that parents know precautions to take to prevent the disease and how to recognize symptoms in affected kids.

The disease is typically allowed to run its course and does not usually kill those infected, according to the U.S. Centers for Disease Control (CDC). Those afflicted are most commonly the poorest of the population, such as workers who have emigrated to the booming cities and then must pay hundreds of dollars (thousands of yuan) for treatment or, in the worst cases, funerals.

The English-language newspaper Shanghai Daily reported, for instance, that 31-year-old migrant worker Chen Weiming in Guangzhou, who earns just $145 (1,000 yuan) a month, had to borrow money from his family to scrape up $245 (1,700 yuan) for his four-year-old daughter's funeral. He also cannot afford the $720 (5,000-yuan) treatment that saved his seven-year-old and 18-month-old daughters, Shanghai Daily reported and therefore cannot take custody of them from the hospital until he can pay the fee.

The World Health Organization and the U.S. Department of Health and Human Services are helping the Chinese track the source of this year's unusually deadly outbreak and map its spread. The U.S. was the first country to identify the EV71 virus as one of the culprits behind this disease in 1969. But this outbreak is also being caused, in some cases, by another enterovirus—coxsackievirus A16, according to Shanghai authorities. The CDC considers the A16 virus the most common cause of HFMD.

Chinese authorities are also working on developing a vaccine against it, but do not expect to have one ready anytime soon. "This infectious disease usually starts in May and reaches its peak in July," Sun Shuguang, a mouth disease specialist, or stomatologist, at the Medical Center of Jingan District in Shanghai said through my translator. In lieu of a vaccine, he recommends that people take extra care to eat right to keep their immune systems strong, wash their hands regularly, and make sure their surroundings are sanitized.

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For People With Down Syndrome, Longer Life Has Complications

Gerry Thomas, 50, who has Down syndrome and Alzheimer’s, with his sister, Beth Thomas, in their Queens home.

His Superman T-shirt was bold and bright, but his face was creased with confusion. Gerry Thomas was stumped by a question most men can answer in an instant.

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James Estrin/The New York Times

Maryann Slattery, left, with her sister, Michele Stabile. “You just see a little bit of her dying all the time,” Ms. Slattery said.

“What’s your favorite beer?” asked his sister, Beth Thomas.

Mr. Thomas, 50, sitting in the house he and his sister share in Queens, squinted with intense concentration. He struggled to unravel the question, let alone remember the answer. Finally, he gave his sister an apologetic smile and shook his head. “I think I’m losing it,” he said.

Doctors had predicted that Mr. Thomas, born with Down syndrome, would be lucky to reach his 10th birthday. His longevity has come at a price, though.

Two years ago, it was determined that Mr. Thomas, at 48, had early-onset Alzheimer’s disease, adding new challenges of dementia to his already significant disabilities.

In a cruel coincidence that scientists do not yet fully understand, research has shown that people with Down syndrome, a chromosomal abnormality, have a much higher incidence of Alzheimer’s disease at an early age. Some studies have said that 60 to 75 percent of people over age 60 with Down syndrome will have Alzheimer’s, though Dr. Ira Lott, who is in charge of the Down syndrome program at the School of Medicine at the University of California, Irvine, said those studies have been limited in scope.

So as advances in health care have extended the average life expectancy of people with Down syndrome to more than 50 years today from 25 in 1983, doctors and family members are now struggling to cope with a double dose of disability.

Dr. Philip Levy, president of the Manhattan-based YAI/National Institute for People with Disabilities, said Alzheimer’s theft of memory and communication skills is particularly devastating for people with Down syndrome, who have a lower-than-average I.Q. but can make friends easily.

“Their social skills are one of the things that makes them feel very important; they get a lot of positive attention for that,” Dr. Levy noted. “So, when that is taken away, it is very, very cruel.”

Researchers at Columbia University, the New York Institute for Basic Research in Developmental Disabilities and the Kennedy Krieger Institute in Baltimore are trying to untangle the connection between Down syndrome and the early onset of Alzheimer’s disease. They are studying how age, sex, mental ability, cholesterol and estrogen levels may relate to the propensity for Down syndrome patients to develop symptoms of Alzheimer’s, using data from 20 years of assessments of 500 people with Down syndrome on things like whether they can use a toothbrush or comb, dress themselves, do basic math, remember lists of common words or copy drawings of geometric patterns.

There is the hope, too, that the research could have broader implications. “Is there something there that we may actually learn about that may actually prevent Alzheimer’s disease in other people as well?” said Dr. Brian Chicoine, medical director of the Adult and Teen Down Syndrome Center at the Lutheran General Hospital in Chicago.

At the same time, community groups are scrambling to provide services for the expanding population of those with Down syndrome and Alzheimer’s. Chapters of the Alzheimer’s Association nationwide have expressed interest in replicating a program pioneered in Rochester in 2006 that has served about 60 people who have both Down syndrome and Alzheimer’s.

The Rochester program provides workshops on things like changing the lighting and layout of a room to make it more comfortable for people with Alzheimer’s, grief counseling for relatives, and training for caregivers in how to bathe and feed patients in a calm, predictable way.

“There’s growing interest among the Alzheimer’s Association to meet the needs of this unique population,” said Paula Casselman, resource center director of the Rochester Alzheimer’s group.

There is no program like the Rochester one near Queens Village, where Ms. Thomas, 56, and her brother live in a small, cluttered house where they grew up. In fact, she said that she had decided to share her brother’s story in part because she did not know anybody else caring for someone at home who has both Down syndrome and Alzheimer’s.

She had no idea her brother was at a higher risk for Alzheimer’s until the diagnosis was made. Since their mother died a year ago, Ms. Thomas, who used to work part time as a nurse, now looks after her brother full time. She said she managed to build up some savings before quitting; her brother also receives $620 a month from a Social Security program.

“I am the psychologist, the chauffeur, mother, father, sister, friend, whatever,” she said in an interview. “And he’s my heart.”

When her brother was born in the Bronx, Ms. Thomas recalled, his family was told he was a “Mongolian idiot” and should be put in an institution. Instead, his parents took him home to their apartment, where he was welcomed by his older sister.

“I put my arms around him on the bed and I said, ‘This baby is mine, and you guys can go back to the hospital and get yourselves another baby.’ ” Ms. Thomas recalled. “He brings great joy to my life.”

But two years ago, lapses in memory and concentration started disrupting Mr. Thomas’s daily routine. He would become tangled in his sweat pants as he tried to dress in the morning, unable to tell back from front and unsure whether he was taking them on or off. On the volleyball court, he would forget when it was his turn to serve or how to switch positions.

Ms. Thomas went to her computer to research Alzheimer’s and was surprised to discover its deep connection to Down syndrome. “I was apprehensive about what I could do to manage him at home, because Alzheimer’s to me was just an old person’s disease,” she said. “I didn’t know how fast it was going to take him.”

Now, before any family gathering, Ms. Thomas walks her brother through old photographs to remind him who is who. She guides him step by step through simple tasks, like putting milk into his coffee, that he used to handle himself.

Grabbing a cup of coffee one recent morning, he scrunched up his face, straining to remember what to do. He looked pleadingly into her eyes, seeking help. Then he made a cartoon-style laugh, poking fun at himself, to end the tension. But he seemed frustrated and embarrassed.

“It makes you frus-ter-a-ted,” Ms. Thomas said, overemphasizing each syllable. “It’s just the Alzheimer’s.”

Mr. Thomas disagreed. “I don’t have that,” he said emphatically.

He was reluctant to discuss the disease, looking down when it was mentioned. He said he only has “a smidge” of the disease.

The genetic link between Down syndrome and Alzheimer’s has been known for decades, but has garnered attention only recently as many more Down patients began living long enough to develop Alzheimer’s.

There are about 350,000 people with Down syndrome in the United States. They have an extra copy of the 21st chromosome, which carries genes for the production of a protein, beta-amyloid. Overproduction of that protein results in what are known as amyloid plaques in the brain, which can manifest as Alzheimer’s disease and alter memory and brain function.

By age 40, all people with Down syndrome have the amyloid plaques in their brains, though not all develop Alzheimer’s symptoms immediately. Some people with Down syndrome live into their 50s, 60s and even 70s without ever actually contracting the disease.

“I think the hardest part is you just don’t know if Alzheimer’s is going to affect your child or not,” said Betsy Goodwin, founder and a board member of the National Down Syndrome Society, who has a 30-year-old daughter with Down syndrome. “It’s very difficult to make any long-term plans.”

For relatives of people with Down syndrome, the joy of watching them live long beyond expectations is sometimes mitigated by sorrow at seeing them disintegrate. And often the parents who dedicated themselves to raising a disabled child have died or have become too frail to handle the needs of a disabled adult with dementia.

Maryann Slattery, who lost her 80-year-old mother to Alzheimer’s eight years ago, is now watching her 45-year-old sister, Michele Stabile, who has Down syndrome, deteriorate from the disease.

Before her Alzheimer’s diagnosis two years ago, Ms. Stabile used to watch wrestling on television and sort her collection of wrestling cards. Now she can no longer tell one card from another. One recent afternoon, she sat at the kitchen table of a group home for people with disabilities in Cobble Hill, Brooklyn, shuffling through a box littered with brittle, broken rubber bands that once held the cards in neat piles. She still likes to hold the cards; they still feel smooth on her fingers.

“You just see a little bit of her dying all the time,” Ms. Slattery said. “With Alzheimer’s, it’s not just the person who has it. It’s the family.”

Five years ago, celebrating her 40th birthday, Ms. Stabile had a boyfriend, Freddie Goldstein, who was also developmentally disabled. She would give him a kiss when he caught the bus on his way to dialysis treatment several times a week. “Freddie was the love of her life,” Ms Slattery said. “She would be pretending to pick out engagement rings.”

But Ms. Stabile began to withdraw, no longer talking to people she met in the elevator or to her friends she saw in the day program she attended. And her behavior became unpredictable.

“She was laughing one minute and crying the next,” Ms. Slattery said. “It was like the pendulum swinging back and forth.” Now, the volatility has gone and Ms. Stabile is quiet and hauntingly calm, with the gait and slow, deliberate movements of a woman twice her age.

If Ms. Stabile is asked a question, she politely answers “yes,” even if she doesn’t fully understand it.

Her family is caught between gratitude and grief. Ms. Stabile has lived well beyond their expectations, but they want her future years to be good ones.

Ms. Slattery said that watching her sister struggle with Alzheimer’s is even harder than it had been living through her mother’s ordeal.

“My mom was in her late 70s, she was 80 years old,” she said. “It was difficult, but it’s more difficult with Michele because she was such a vibrant, outgoing person.”

Ms. Thomas is doing what she can to extend her brother’s ability to remember things and to act independently, and counts each day that she can joke and laugh with him as increasingly precious. She plans to take him on a cruise to the Caribbean.

Holding hands on the sofa in a living room decorated with certificates of Mr. Thomas’s sporting and community achievements, she teased him, “You’re getting to be an old, old man.”

“You can’t just hang out for the rest of your days. You have to get out and see how the rest of the world looks like,” she said. “There are a lot of things out there to see. I want him to see them all. If he remembers them, O.K.. If not, O.K.”

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Study suggests drug can cut risk of cancer's return

CHICAGO - A drug to prevent bone loss during breast cancer treatment also substantially cut the risk that the cancer would return, results that left doctors excited about a possible new way to fight the disease.

It is the first large study to affirm wider anti-cancer hopes for Zometa and other bone-building drugs called bisphosphonates. Zometa, made by Novartis AG, is used now for cancers that have already spread to the bone.

The new study involved 1,800 premenopausal women taking hormone treatments for early-stage breast cancer. Zometa cut by one-third the chances that cancer would recur - in their bones or anywhere else.

"This is an important finding. It may well change practice," said Dr. Claudine Isaacs, director of the clinical breast cancer program at Georgetown University's Lombardi Cancer Center.

About three-fourths of breast cancers occur in women after menopause. Zometa may help them, too, but it hasn't been tested yet in that age group.

The study was led by Dr. Michael Gnant of the Medical University of Vienna and reported yesterday at an American Society of Clinical Oncology conference in Chicago.

If a second, ongoing study also finds a benefit, doctors predict that Zometa will quickly be tested against other cancers that tend to spread, or metastasize, to bones, such as prostate and kidney cancer.

"Hugely important is whether this has to do with the fact that it just makes the bone hostile, somehow, to metastasis or if there is a more global anti-metastasis effect," said the oncology group's president, Dr. Nancy Davidson of the Johns Hopkins University.

"Either of those would be good and would teach us a lot about what to do next."

Breast cancer is the most common cancer in women. About 184,450 cases and 40,930 deaths from the disease are expected in the United States this year.

Standard treatments are surgery, chemotherapy, radiation and hormone-blocking drugs if the tumors are like those in the study - benefited by estrogen or progesterone.

The hormone-blockers often weaken bones, so bisphosphonates like the osteoporosis pill Fosamax have become increasingly popular to treat this side effect. However, using them to treat the cancer itself is a very different approach.

Lab studies hinted that it would work, and Gnant's is the first to test it in a large group of breast cancer patients.

All had surgery to remove their tumors and were taking hormone-blocking drugs - goserelin plus either tamoxifen or anastrozole - treatments that made them menopausal. Half also were given infusions of Zometa once every six months.

The women were treated for three years and studied for two more. By then, only 6 percent of those given Zometa had suffered a relapse or died, compared to 9 percent of the others. That translated to a 36 percent decline in risk.

Sixteen women given Zometa died versus 26 of the others - a difference that could have occurred by chance alone but an encouraging trend that doctors hope will mean better survival as the groups are followed for a longer time.


The study was sponsored by Zometa's maker, Swiss-based Novartis, and British-based AstraZeneca PLC, which makes Arimidex, the brand name of anastrozole. Gnant consults for the companies and several other breast cancer drugmakers.

Experts stressed that the results so far are only in women who were made menopausal by hormone-blocking treatments - not women who develop breast cancer after natural menopause.

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Drink This, Not That!

16 swaps that will save you big

My buddy, Bill, came to me a while back looking for advice on how to banish the bulging belly he had acquired in his later years. I skipped the diet lecture and instead gave him a copy of the book, Eat This, Not That!, and a single piece of advice: Start with the drinks chapter.

Four months later, Bill has adopted the simple food swap philosophy and dramatically altered his calorie intake without giving up the foods and drinks he loves. His reward: 25 pounds and three inches off of his waistline—in around six weeks!

I told Bill to start with beverages because between soda, coffee drinks, smoothies, and booze, he was sipping away more than a quarter of his daily calories. He’s not the only one. A study from the University of North Carolina found that we consume 450 calories a day from beverages, nearly twice as many as 30 years ago! This increase amounts to an extra 23 pounds a year that we're forced to work off—or carry around with us.

There’s good news and bad news when it comes to liquid calories. The bad news is they are the most difficult calories for us to gauge, because we have none of the greasy, cheesy visual cues we get when we go face-to-face with a plate of loaded nachos or a triple cheeseburger. The good news is that they are the easiest calories to cut from your diet. Just ask Bill.

I've identified the most bloating beverages in gas stations, bars, smoothie counters, and coffee shops across America and replaced them with sensible and satisfying stand-ins for a fraction of the caloric cost. So you can sip what you want, skip the diet, and still lose lots of weight this year.

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