A 2-in-1 medicine to treat diabetes has won federal approval, Merck & Co. Inc. said Saturday.
The tablet, called Janumet, combines a proprietary Merck drug with the older diabetes drug metformin.
Some patients with type 2 diabetes already take metformin and the newer drug, called Januvia, separately. Merck hopes the combination version will make it easier for those diabetics to control their blood sugar levels.
The Food and Drug Administration approved Januvia in October. That drug enhances the body's own ability to lower blood sugar levels. Novartis AG continues to seek FDA approval for a competing but similar drug, called Galvus.
Saturday, March 31, 2007
To sleep, perchance to dream: New insight into melatonin production
In the April 1 issue of G&D, a Korean research team led by Dr. Kyong-Tai Kim (Pohang University) describes how melatonin production is coordinated with the body's natural sleep/wake cycles.
Melatonin is a hormone produced by the pineal gland in the brain, which helps to regulate our bodies' circadian rhythm (the roughly-24-hour cycle around which basic physiological processes proceed). Normally, melatonin production is inhibited by light and enhanced by darkness, usually peaking in the middle of the night. Melatonin's expression pattern is mimicked by a protein called AANAT, which is a key enzyme in the melatonin biosynthesis pathway.
Dr. Kim and colleagues uncovered the mechanism of rhythmic control of AANAT mRNA translation, and thereby melatonin synthesis. The researchers found that rodent AANAT mRNA translation is mediated by IRES (internal ribosome entry site) elements in the 5' end of the transcript, through binding of another protein, called hnRNP Q. In fact, siRNA knock-down of hnRNP Q reduced AANAT and melatonin production under nocturnal conditions.
Melatonin is a hormone produced by the pineal gland in the brain, which helps to regulate our bodies' circadian rhythm (the roughly-24-hour cycle around which basic physiological processes proceed). Normally, melatonin production is inhibited by light and enhanced by darkness, usually peaking in the middle of the night. Melatonin's expression pattern is mimicked by a protein called AANAT, which is a key enzyme in the melatonin biosynthesis pathway.
Dr. Kim and colleagues uncovered the mechanism of rhythmic control of AANAT mRNA translation, and thereby melatonin synthesis. The researchers found that rodent AANAT mRNA translation is mediated by IRES (internal ribosome entry site) elements in the 5' end of the transcript, through binding of another protein, called hnRNP Q. In fact, siRNA knock-down of hnRNP Q reduced AANAT and melatonin production under nocturnal conditions.
For Athletes, the Next Fountain of Youth?
By BILL PENNINGTON
The latest curative leap to heal professional athletes and weekend warriors alike may sound like science fiction, but it could transform sports medicine. Some doctors and researchers say that in a few years the use of primitive stem cells from infants’ umbilical cord blood could grow new knee ligaments or elbow tendons creating a therapy that becomes the vanguard of sports injury repair.
Already, some sports agents are preparing to advise clients about banking stem cells from their offspring or from tissue taken from their own bodies as an insurance policy against a career-ending infirmity. Stem cell blood banks are promoting the benefits of stem cell therapies for the practical healing and rehabilitation of tendons, ligaments, muscle and cartilage. There are skeptics in the medical community who wonder how soon the technology will be viable, but enthusiastic advocates of the therapies say the time is near.
“It’s not a pie in the sky notion,” said Dr. Scott Rodeo, an orthopedist and award-winning research scientist at Manhattan’s Hospital for Special Surgery. “Maybe it’s not going to happen next year, but a three-to-five-year horizon is not unreasonable.”
Dr. Rodeo has already practiced these technologies in laboratory surgeries on rats, methods that will be especially useful when reconstructing the knee’s anterior cruciate ligament and the shoulder’s rotator cuff. Both are common sports maladies that can be particularly daunting to surgeons because the body generally does not mend or restore the damaged tissue after these injuries.
“In each case, stem cells clearly have some beneficial role in inducing tissue regeneration,” said Dr. Rodeo, who is also a team physician with the Giants and a former United States Olympic team doctor.
Some scientists say now is the time to safeguard athletic prodigies, even kindergartners.
The latest curative leap to heal professional athletes and weekend warriors alike may sound like science fiction, but it could transform sports medicine. Some doctors and researchers say that in a few years the use of primitive stem cells from infants’ umbilical cord blood could grow new knee ligaments or elbow tendons creating a therapy that becomes the vanguard of sports injury repair.
Already, some sports agents are preparing to advise clients about banking stem cells from their offspring or from tissue taken from their own bodies as an insurance policy against a career-ending infirmity. Stem cell blood banks are promoting the benefits of stem cell therapies for the practical healing and rehabilitation of tendons, ligaments, muscle and cartilage. There are skeptics in the medical community who wonder how soon the technology will be viable, but enthusiastic advocates of the therapies say the time is near.
“It’s not a pie in the sky notion,” said Dr. Scott Rodeo, an orthopedist and award-winning research scientist at Manhattan’s Hospital for Special Surgery. “Maybe it’s not going to happen next year, but a three-to-five-year horizon is not unreasonable.”
Dr. Rodeo has already practiced these technologies in laboratory surgeries on rats, methods that will be especially useful when reconstructing the knee’s anterior cruciate ligament and the shoulder’s rotator cuff. Both are common sports maladies that can be particularly daunting to surgeons because the body generally does not mend or restore the damaged tissue after these injuries.
“In each case, stem cells clearly have some beneficial role in inducing tissue regeneration,” said Dr. Rodeo, who is also a team physician with the Giants and a former United States Olympic team doctor.
Some scientists say now is the time to safeguard athletic prodigies, even kindergartners.
Panel Endorses New Anti-Tumor Treatment
By ANDREW POLLACK
The first therapy that would direct a cancer patient’s own immune system to attack tumors moved a step closer to approval yesterday when it was endorsed by a federal advisory committee.
The advisory panel to the Food and Drug Administration voted 13 to 4 that there was “substantial evidence” that the treatment was effective in men with advanced prostate cancer and 17 to 0 that the therapy was safe.
The votes increase the likelihood of F.D.A. approval for the therapy, Provenge, by the agency’s May deadline. Still, even panel members who voted for the drug expressed some reservations about the strength of the data. That could leave the door open for the agency to reject Provenge until a bigger trial, now under way, is completed in 2010.
Provenge was developed by Dendreon, a Seattle biotechnology company.
Approval of Provenge would open a new front in the war on cancer because its mode of action is different from that of existing drugs and radiation, which attack cancer cells directly. Provenge is a personalized therapy in which some of a patient’s white blood cells are removed, processed by Dendreon, then infused back into the body three or four days later.
Approval would also represent the first success after numerous setbacks in efforts to develop what are sometimes called cancer vaccines, not because they prevent cancer but because they harness the immune system to fight the disease after it develops.
“The positive recommendation from the advisory panel is an important step in the development of cancer vaccines,” said Dr. Lloyd J. Old, chairman of the Ludwig Institute for Cancer Research in New York, who has long worked on such vaccines. Dr. Old called the vote encouraging to a field that has “generated disappointment and controversy in the past.”
The first therapy that would direct a cancer patient’s own immune system to attack tumors moved a step closer to approval yesterday when it was endorsed by a federal advisory committee.
The advisory panel to the Food and Drug Administration voted 13 to 4 that there was “substantial evidence” that the treatment was effective in men with advanced prostate cancer and 17 to 0 that the therapy was safe.
The votes increase the likelihood of F.D.A. approval for the therapy, Provenge, by the agency’s May deadline. Still, even panel members who voted for the drug expressed some reservations about the strength of the data. That could leave the door open for the agency to reject Provenge until a bigger trial, now under way, is completed in 2010.
Provenge was developed by Dendreon, a Seattle biotechnology company.
Approval of Provenge would open a new front in the war on cancer because its mode of action is different from that of existing drugs and radiation, which attack cancer cells directly. Provenge is a personalized therapy in which some of a patient’s white blood cells are removed, processed by Dendreon, then infused back into the body three or four days later.
Approval would also represent the first success after numerous setbacks in efforts to develop what are sometimes called cancer vaccines, not because they prevent cancer but because they harness the immune system to fight the disease after it develops.
“The positive recommendation from the advisory panel is an important step in the development of cancer vaccines,” said Dr. Lloyd J. Old, chairman of the Ludwig Institute for Cancer Research in New York, who has long worked on such vaccines. Dr. Old called the vote encouraging to a field that has “generated disappointment and controversy in the past.”
Studies Lead to Withdrawal of Drug for Bowel Ailment
By GARDINER HARRIS
WASHINGTON, March 30 — The maker of Zelnorm, a medicine that treats constipation-related irritable bowel syndrome, stopped selling the drug Friday after federal drug officials concluded that it might cause heart attacks and strokes.
In 29 studies, 13 of 11,614 patients given Zelnorm had heart problems, including one who died. Just one of 7,031 patients given placebos had similar problems.
Officials at the Food and Drug Administration said the drug was not effective enough to merit such risks.
Executives at the drug’s maker, Novartis, the giant Swiss drug concern, said the studies’ findings could be a fluke and vowed to continue selling Zelnorm in Europe.
Driven by aggressive advertising, Zelnorm had $561 million in sales last year, up 34 percent from 2005. About 500,000 people are currently taking the medicine for the ailment, which is also known as I.B.S.
Patients criticized the food and drug agency’s decision.
“I can’t believe the F.D.A. would do such a thing. Why are they being so cruel?” asked Lori Egan, 39, of Fredericksburg, Va. “I would rather take my chances of having a heart attack than live in I.B.S. hell.”
WASHINGTON, March 30 — The maker of Zelnorm, a medicine that treats constipation-related irritable bowel syndrome, stopped selling the drug Friday after federal drug officials concluded that it might cause heart attacks and strokes.
In 29 studies, 13 of 11,614 patients given Zelnorm had heart problems, including one who died. Just one of 7,031 patients given placebos had similar problems.
Officials at the Food and Drug Administration said the drug was not effective enough to merit such risks.
Executives at the drug’s maker, Novartis, the giant Swiss drug concern, said the studies’ findings could be a fluke and vowed to continue selling Zelnorm in Europe.
Driven by aggressive advertising, Zelnorm had $561 million in sales last year, up 34 percent from 2005. About 500,000 people are currently taking the medicine for the ailment, which is also known as I.B.S.
Patients criticized the food and drug agency’s decision.
“I can’t believe the F.D.A. would do such a thing. Why are they being so cruel?” asked Lori Egan, 39, of Fredericksburg, Va. “I would rather take my chances of having a heart attack than live in I.B.S. hell.”
Medical Students Take iPod Sounds to Heart
PHILADEPLHIA, March 30 -- The iPod generation of medical students is swaying to the beat of mitral-valve regurgitation and aortic stenoses.
The sound of murmurs is music to the ears of these medical students who are being drilled in cardiac auscultation via downloadable MP3 files of beating hearts.
The training method draws on the power of repetition to teach abnormal heart sounds, said cardiologist Michael Barrett, M.D., of Temple University School of Medicine, in an interview.
For years, senior physicians have been murmuring about the failure of younger clinicians and physician wannabes to achieve the old-time sensitivity to the characteristic sounds of dysfunctional heart
The sound of murmurs is music to the ears of these medical students who are being drilled in cardiac auscultation via downloadable MP3 files of beating hearts.
The training method draws on the power of repetition to teach abnormal heart sounds, said cardiologist Michael Barrett, M.D., of Temple University School of Medicine, in an interview.
For years, senior physicians have been murmuring about the failure of younger clinicians and physician wannabes to achieve the old-time sensitivity to the characteristic sounds of dysfunctional heart
Friday, March 30, 2007
Adding Antidepressants to Mood Stabilizer Therapy Does Not Improve Outcomes in Bipolar Depression
March 30, 2007 — According to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a large placebo-controlled trial of community-dwelling patients with bipolar depression who were receiving mood stabilizers, adjunctive antidepressant therapy did not reduce symptoms of depression, but neither did it increase the risk for mania. These results are reported online in the March 28 Early Release issue of The New England Journal of Medicine and will appear in the April 26 print issue.
Lead author Gary S. Sachs, MD, from Massachusetts General Hospital in Boston, explained to Medscape, "One group of experts was saying 'When people get depressed, you should add an antidepressant,' and another group of experts was saying 'When you get depressed, if you do a really good job with a mood stabilizer, you don't need an antidepressant.' This study proved that the latter group was correct, and that it is perfectly reasonable to treat patients without the addition of antidepressant, as long as you are doing a good job with mood stabilizers."
Dr. Sachs and his team write that although antidepressants are effective in treating unipolar depression, data supporting their use in bipolar depression are scarce and not strong enough to guide clinical practice, and this raises concerns among some clinicians that these agents could increase the risk for new episodes of mania. Despite the lack of Food and Drug Administration approval of standard antidepressants for the treatment of bipolar depression, these agents are commonly added as an adjunct to mood stabilizers for these patients.
STEP-BD is sponsored by the National Institute of Mental Health and was designed to evaluate the effectiveness of treatments of bipolar disorder and provide results for routine clinical practice. The current report is from a controlled trial within STEP-BD.
Lead author Gary S. Sachs, MD, from Massachusetts General Hospital in Boston, explained to Medscape, "One group of experts was saying 'When people get depressed, you should add an antidepressant,' and another group of experts was saying 'When you get depressed, if you do a really good job with a mood stabilizer, you don't need an antidepressant.' This study proved that the latter group was correct, and that it is perfectly reasonable to treat patients without the addition of antidepressant, as long as you are doing a good job with mood stabilizers."
Dr. Sachs and his team write that although antidepressants are effective in treating unipolar depression, data supporting their use in bipolar depression are scarce and not strong enough to guide clinical practice, and this raises concerns among some clinicians that these agents could increase the risk for new episodes of mania. Despite the lack of Food and Drug Administration approval of standard antidepressants for the treatment of bipolar depression, these agents are commonly added as an adjunct to mood stabilizers for these patients.
STEP-BD is sponsored by the National Institute of Mental Health and was designed to evaluate the effectiveness of treatments of bipolar disorder and provide results for routine clinical practice. The current report is from a controlled trial within STEP-BD.
No Benefit of PCI Over Optimal Drugs for Preventing Events in Stable CAD
March 30, 2007 (New Orleans, Louisiana) — Percutaneous coronary intervention (PCI) plus stenting and optimal medical therapy is no better at preventing future events than optimal medical therapy alone in patients with stable coronary artery disease (CAD), according to the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. The much-anticipated results, presented here during a late-breaking clinical-trials session by lead investigator William E. Boden, MD, from the Buffalo General Hospital in Buffalo, NY, add fuel to the mounting fire about whether stents, including drug-eluting stents, are being overused for the treatment of stable CAD or for the prevention of future cardiac events.
Full results of the study were published simultaneously online in the March 27 Early Release issue of The New England Journal of Medicine.
"Although the addition of PCI to optimal medical therapy reduced the prevalence of angina, it did not reduce long-term rates of death, nonfatal myocardial infarction, and hospitalization for acute coronary syndromes," Dr. Boden and colleagues conclude in the article.
In an editorial accompanying the study, Judith S. Hochman, MD, from the New York University School of Medicine in New York, and P. Gabriel Steg, MD, from the Université Paris in Paris, France, say the study findings are practice changing.
"The COURAGE trial should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial healthcare savings," the editorialists write. "PCI has an established place in treating angina, but is not superior to intensive medical therapy to prevent myocardial infarction and death in symptomatic or asymptomatic patients such as those in this study."
Full results of the study were published simultaneously online in the March 27 Early Release issue of The New England Journal of Medicine.
"Although the addition of PCI to optimal medical therapy reduced the prevalence of angina, it did not reduce long-term rates of death, nonfatal myocardial infarction, and hospitalization for acute coronary syndromes," Dr. Boden and colleagues conclude in the article.
In an editorial accompanying the study, Judith S. Hochman, MD, from the New York University School of Medicine in New York, and P. Gabriel Steg, MD, from the Université Paris in Paris, France, say the study findings are practice changing.
"The COURAGE trial should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial healthcare savings," the editorialists write. "PCI has an established place in treating angina, but is not superior to intensive medical therapy to prevent myocardial infarction and death in symptomatic or asymptomatic patients such as those in this study."
ACC: Evidence Suggests Many Pathways for Thrombin Control in Acute Coronary Syndrome
NEW ORLEANS, March 30 -- When patients are being evaluated for antithrombin therapy in association with percutaneous coronary interventions, doctors have multiple choices that make it possible to tailor therapy, said a Cleveland Clinic investigator.
These choices include heparin, low molecular weight heparin, glycoprotein IIb/IIIa inhibitors, bivalirudin, and fondaparinux said A. Michael Lincoff, M.D, who is vice chairman for cardiovascular research at the clinic.
He discussed differing management strategies for antithrombin therapy at an industry symposium, held in conjunction with the American College of Cardiology meeting here.
"Acute coronary syndrome management is complicated because we don't have one-size-fits-all antithrombotic pathway because patients and conditions are different," said Dr. Lincoff, who served as moderator at the symposium, which was sponsored by the Medicines Company.
The foundation for treatment of patients with acute coronary syndromes is aspirin and on top of that is clopidogrel (Plavix), but even with aspirin and clopidogrel, which are considered relatively simple therapies, dose titration should be carefully monitored, Dr. Lincoff said.
Beyond aspirin and clopidogrel, doctors have to determine whether they should use glycoprotein IIb/IIIa inhibitors either upfront or during the procedure. Then, he said, comes the difficult choice--heparin or low molecular weight heparin or bivalirudin or fondaparinux?
These choices include heparin, low molecular weight heparin, glycoprotein IIb/IIIa inhibitors, bivalirudin, and fondaparinux said A. Michael Lincoff, M.D, who is vice chairman for cardiovascular research at the clinic.
He discussed differing management strategies for antithrombin therapy at an industry symposium, held in conjunction with the American College of Cardiology meeting here.
"Acute coronary syndrome management is complicated because we don't have one-size-fits-all antithrombotic pathway because patients and conditions are different," said Dr. Lincoff, who served as moderator at the symposium, which was sponsored by the Medicines Company.
The foundation for treatment of patients with acute coronary syndromes is aspirin and on top of that is clopidogrel (Plavix), but even with aspirin and clopidogrel, which are considered relatively simple therapies, dose titration should be carefully monitored, Dr. Lincoff said.
Beyond aspirin and clopidogrel, doctors have to determine whether they should use glycoprotein IIb/IIIa inhibitors either upfront or during the procedure. Then, he said, comes the difficult choice--heparin or low molecular weight heparin or bivalirudin or fondaparinux?
Novartis to stop constipation drug sale
2 hours, 8 minutes ago
Swiss pharmaceutical maker Novartis AG will stop selling a drug to relieve constipation after it was linked to a higher chance of heart attack, stroke and worsening heart chest pain that can become a heart attack, federal health officials said Friday.
Novartis agreed to withdraw Zelnorm at the FDA's request, the agency said in a public health advisory.
Zelnorm, also called tegaserod maleate, is a prescription medication approved for short-term treatment of women with irritable bowel syndrome with constipation and for patients younger than 65 with chronic constipation, the FDA said.
Doctors who prescribe Zelnorm should work with their patients and transition them to other therapies as appropriate, the FDA added.
Earlier this year, Novartis gave the FDA the results of new analyses of 29 clinical studies of Zelnorm for treatment of a variety of gastrointestinal tract conditions. The analyses showed 13 of 11,614 patients given Zelnorm had serious and life-threatening cardiovascular side effects, while just one of the 7,031 patients given dummy pills did, the FDA and Novartis said in separate statements.
The FDA has told Novartis it would consider allowing a limited reintroduction of Zelnorm "if a population of patients can be identified in whom the benefits of the drug outweigh the risks," the agency said.
Novartis said it believes the drug provides unique benefits.
"Although we have complied with the FDA's request and are collaborating with the agency, we continue to believe that Zelnorm provides important benefits for appropriate patients," said Dr. Stephen Cunningham, vice president and head of U.S. clinical development and medical affairs for Novartis.
Swiss pharmaceutical maker Novartis AG will stop selling a drug to relieve constipation after it was linked to a higher chance of heart attack, stroke and worsening heart chest pain that can become a heart attack, federal health officials said Friday.
Novartis agreed to withdraw Zelnorm at the FDA's request, the agency said in a public health advisory.
Zelnorm, also called tegaserod maleate, is a prescription medication approved for short-term treatment of women with irritable bowel syndrome with constipation and for patients younger than 65 with chronic constipation, the FDA said.
Doctors who prescribe Zelnorm should work with their patients and transition them to other therapies as appropriate, the FDA added.
Earlier this year, Novartis gave the FDA the results of new analyses of 29 clinical studies of Zelnorm for treatment of a variety of gastrointestinal tract conditions. The analyses showed 13 of 11,614 patients given Zelnorm had serious and life-threatening cardiovascular side effects, while just one of the 7,031 patients given dummy pills did, the FDA and Novartis said in separate statements.
The FDA has told Novartis it would consider allowing a limited reintroduction of Zelnorm "if a population of patients can be identified in whom the benefits of the drug outweigh the risks," the agency said.
Novartis said it believes the drug provides unique benefits.
"Although we have complied with the FDA's request and are collaborating with the agency, we continue to believe that Zelnorm provides important benefits for appropriate patients," said Dr. Stephen Cunningham, vice president and head of U.S. clinical development and medical affairs for Novartis.
Arthritis pain processed in brain’s 'fear zone,' first PET scans reveal
Researchers at The University of Manchester have discovered that arthritis pain, unlike that induced as part of an experiment, is processed in the parts of the brain concerned with emotions and fear.
A team led by Dr Bhavna Kulkarni has captured the first images of how the brain processes arthritis pain, using positron emission tomography (PET) scanners based at the Christie Hospital.
In a study funded by the Arthritis Research Campaign and published in 'Arthritis and Rheumatism' this week, they compare the brain areas involved in processing arthritic and experimental pain in a group of patients with osteoarthritis.
Dr Kulkarni said: "We knew from our previous neuro-imaging studies that experimentally-induced pain is processed in at least two brain networks, collectively known as the ‘pain matrix.’ The ‘medial pain system’ processes the emotional aspects such as pain’s unpleasantness, while the ‘lateral pain system’ processes the pain’s intensity, location and duration.
"We wanted to see whether the same applied to the clinical pain suffered by people with conditions like arthritis, as no direct comparisons of experimental and clinical pain had been undertaken in the same group of patients."
A team led by Dr Bhavna Kulkarni has captured the first images of how the brain processes arthritis pain, using positron emission tomography (PET) scanners based at the Christie Hospital.
In a study funded by the Arthritis Research Campaign and published in 'Arthritis and Rheumatism' this week, they compare the brain areas involved in processing arthritic and experimental pain in a group of patients with osteoarthritis.
Dr Kulkarni said: "We knew from our previous neuro-imaging studies that experimentally-induced pain is processed in at least two brain networks, collectively known as the ‘pain matrix.’ The ‘medial pain system’ processes the emotional aspects such as pain’s unpleasantness, while the ‘lateral pain system’ processes the pain’s intensity, location and duration.
"We wanted to see whether the same applied to the clinical pain suffered by people with conditions like arthritis, as no direct comparisons of experimental and clinical pain had been undertaken in the same group of patients."
Soy intake may stave off early prostate cancer
Fri Mar 30, 2007 12:27 PM ET
NEW YORK (Reuters Health) - Consumption of the estrogen-like "isoflavone" substances found in soy may reduce the risk of developing early prostate cancer, but isoflavones appear to be associated with advanced disease if prostate cancer does occur, Japanese researchers report.
Isoflavones found in traditional foods that Japanese eat throughout life may be protective against prostate cancer, Dr. Norie Kurahashi told Reuters Health, but we can not recommend isoflavones from supplements to those who don't consume them regularly, "because isoflavones may increase the risk of advanced prostate cancer."
Kurahashi and associates from the National Cancer Center, Tokyo, investigated the association between dietary isoflavones and risk of prostate cancer in a study of Japanese men, who generally consume large amounts of soy products and have a low rate of prostate cancer.
The study, which is reported in Cancer Epidemiology, Biomarkers & Prevention, involved some 43,500 men followed from 1995 through 2004. During that time, 307 of them were diagnosed with prostate cancer.
Consumption of isoflavones (principally genistein, but also daidzein and soy foods) was associated with a decreased risk of early prostate cancer, the authors report. Genistein and daidzein, however, were associated with an increased risk of advanced prostate cancer, the results indicate.
The protective effect of isoflavones for early prostate cancer was clearest among men over 60 years old, the researchers note, as was the association of isoflavone with an increased risk of advanced prostate cancer.
NEW YORK (Reuters Health) - Consumption of the estrogen-like "isoflavone" substances found in soy may reduce the risk of developing early prostate cancer, but isoflavones appear to be associated with advanced disease if prostate cancer does occur, Japanese researchers report.
Isoflavones found in traditional foods that Japanese eat throughout life may be protective against prostate cancer, Dr. Norie Kurahashi told Reuters Health, but we can not recommend isoflavones from supplements to those who don't consume them regularly, "because isoflavones may increase the risk of advanced prostate cancer."
Kurahashi and associates from the National Cancer Center, Tokyo, investigated the association between dietary isoflavones and risk of prostate cancer in a study of Japanese men, who generally consume large amounts of soy products and have a low rate of prostate cancer.
The study, which is reported in Cancer Epidemiology, Biomarkers & Prevention, involved some 43,500 men followed from 1995 through 2004. During that time, 307 of them were diagnosed with prostate cancer.
Consumption of isoflavones (principally genistein, but also daidzein and soy foods) was associated with a decreased risk of early prostate cancer, the authors report. Genistein and daidzein, however, were associated with an increased risk of advanced prostate cancer, the results indicate.
The protective effect of isoflavones for early prostate cancer was clearest among men over 60 years old, the researchers note, as was the association of isoflavone with an increased risk of advanced prostate cancer.
Pig cells still work in diabetic man after 10 yrs
HONG KONG (Reuters) - Cells from a pig transplanted into a diabetic man from New Zealand are still producing insulin nearly 10 years later, prompting a biotechnology company to plan research to see if others could benefit.
The case, profiled in a scientific journal issued on Friday, may pave the way for a cure for diabetes, said Bob Elliot, medical director of Australia's Living Cell Technologies (LCT).
The man, now 41, suffers from type 1 diabetes, when cells in the pancreas do not produce insulin -- a hormone needed to store or use sugar. This results in abnormally high sugar levels in the blood, or diabetes, which needs to be corrected with daily insulin injections.
The pig cells were injected into the man's abdomen in 1996, which helped reduce his insulin requirements by 34 percent for a year, researchers from the biotech firm wrote in a paper published in the latest issue of the journal Xenotransplantation.
The man insisted he still felt better in 2006 and convinced the company to examine him.
The case, profiled in a scientific journal issued on Friday, may pave the way for a cure for diabetes, said Bob Elliot, medical director of Australia's Living Cell Technologies (LCT).
The man, now 41, suffers from type 1 diabetes, when cells in the pancreas do not produce insulin -- a hormone needed to store or use sugar. This results in abnormally high sugar levels in the blood, or diabetes, which needs to be corrected with daily insulin injections.
The pig cells were injected into the man's abdomen in 1996, which helped reduce his insulin requirements by 34 percent for a year, researchers from the biotech firm wrote in a paper published in the latest issue of the journal Xenotransplantation.
The man insisted he still felt better in 2006 and convinced the company to examine him.
FDA Announces the Voluntary Withdrawal of Pergolide Products
The FDA yesterday announced that manufacturers of pergolide products (Permax and its generics, used to treat Parkinson disease) have voluntarily agreed to remove the drugs from the market.
The agreement follows recent publication of two studies that confirmed a link between pergolide and cardiac-valve regurgitation. If patients need to continue dopamine agonist therapy, the FDA recommends that physicians consider one of three other dopamine agonists approved for treating Parkinson disease that are not associated with heart-valve damage. If treatment is discontinued, it should be done gradually by reducing dosage; abrupt withdrawal from dopamine agonist therapy can be dangerous, the FDA warns.
The agreement follows recent publication of two studies that confirmed a link between pergolide and cardiac-valve regurgitation. If patients need to continue dopamine agonist therapy, the FDA recommends that physicians consider one of three other dopamine agonists approved for treating Parkinson disease that are not associated with heart-valve damage. If treatment is discontinued, it should be done gradually by reducing dosage; abrupt withdrawal from dopamine agonist therapy can be dangerous, the FDA warns.
Eicosapentaenoic Acid Reduces Nonfatal Coronary Events in Hypercholesterolemia
Consumption of the fish-oil component eicosapentaenoic acid (EPA) lowers rates of unstable angina and nonfatal coronary events in patients with hypercholesterolemia, researchers report in Lancet.
In an open-label, industry-sponsored trial, researchers randomized some 19,000 Japanese patients with total cholesterol levels at 6.5 mmol/L (roughly 250 mg/dL) or greater to receive either 1800 mg of EPA a day plus a statin, or statin alone. Five-year cumulative rates of major coronary events were 2.8% in the EPA group and 3.5% in controls (relative risk reduction, 19%). Rates of sudden cardiac and coronary death did not differ between the groups.
A commentary writer calls the results "unexpected," and says that "we must curb our infatuation with downstream risk factors and treatments, and focus on the fundamental risk factors for cardiovascular disease: dietary habits, smoking, and physical activity."
In an open-label, industry-sponsored trial, researchers randomized some 19,000 Japanese patients with total cholesterol levels at 6.5 mmol/L (roughly 250 mg/dL) or greater to receive either 1800 mg of EPA a day plus a statin, or statin alone. Five-year cumulative rates of major coronary events were 2.8% in the EPA group and 3.5% in controls (relative risk reduction, 19%). Rates of sudden cardiac and coronary death did not differ between the groups.
A commentary writer calls the results "unexpected," and says that "we must curb our infatuation with downstream risk factors and treatments, and focus on the fundamental risk factors for cardiovascular disease: dietary habits, smoking, and physical activity."
Robert Austrian, 90, Dies; Developed Major Vaccine
By LAWRENCE K. ALTMAN
Dr. Robert Austrian, who developed a pneumococcal vaccine that has saved the lives of hundreds of thousands of people, died Sunday in Philadelphia. He was 90.
The cause was a stroke, said Dr. Harvey M. Friedman, chief of infectious diseases at the University of Pennsylvania, where Dr. Austrian had taught and done research to prevent and treat infectious diseases for the last 40 years.
Dr. Austrian did much of the early research that led to the pneumococcal vaccine in New York City, working at Bellevue Hospital and then with Dr. Colin Macleod at the Rockefeller Institute. Later, he continued the research at Kings County Hospital and the State University of New York College of Medicine, both in Brooklyn. The college is now known as SUNY Downstate.
The vaccine can prevent the pneumonia, meningitis and blood system and other infections caused by the bacterium Streptococcus pneumoniae. These infections were long a major cause of illness and death among the elderly and the chronically ill throughout the world. Even healthy adults and infants suddenly died from them.
After the introduction of penicillin and other antibiotics after World War II, most doctors assumed that pneumococcal infections would no longer be a major cause of death, and they stopped prescribing a pneumococcal vaccine used at the time.
Dr. Austrian was unconvinced by the prevailing medical wisdom. Through his work as a clinician, epidemiologist and microbiologist, he showed that pneumococcal pneumonia remained a killer. Two vaccines based on Dr. Austrian’s work were licensed in 1977 and 1983.
Dr. Robert Austrian, who developed a pneumococcal vaccine that has saved the lives of hundreds of thousands of people, died Sunday in Philadelphia. He was 90.
The cause was a stroke, said Dr. Harvey M. Friedman, chief of infectious diseases at the University of Pennsylvania, where Dr. Austrian had taught and done research to prevent and treat infectious diseases for the last 40 years.
Dr. Austrian did much of the early research that led to the pneumococcal vaccine in New York City, working at Bellevue Hospital and then with Dr. Colin Macleod at the Rockefeller Institute. Later, he continued the research at Kings County Hospital and the State University of New York College of Medicine, both in Brooklyn. The college is now known as SUNY Downstate.
The vaccine can prevent the pneumonia, meningitis and blood system and other infections caused by the bacterium Streptococcus pneumoniae. These infections were long a major cause of illness and death among the elderly and the chronically ill throughout the world. Even healthy adults and infants suddenly died from them.
After the introduction of penicillin and other antibiotics after World War II, most doctors assumed that pneumococcal infections would no longer be a major cause of death, and they stopped prescribing a pneumococcal vaccine used at the time.
Dr. Austrian was unconvinced by the prevailing medical wisdom. Through his work as a clinician, epidemiologist and microbiologist, he showed that pneumococcal pneumonia remained a killer. Two vaccines based on Dr. Austrian’s work were licensed in 1977 and 1983.
Panel Endorses New Anti-Tumor Treatment
By ANDREW POLLACK
The first therapy that would direct a cancer patient’s own immune system to attack tumors moved a step closer to approval yesterday when it was endorsed by a federal advisory committee.
The advisory panel to the Food and Drug Administration voted 13 to 4 that there was “substantial evidence” that the treatment was effective in men with advanced prostate cancer and 17 to 0 that the therapy was safe.
The votes increase the likelihood of F.D.A. approval for the therapy, Provenge, by the agency’s May deadline. Still, even panel members who voted for the drug expressed some reservations about the strength of the data. That could leave the door open for the agency to reject Provenge until a bigger trial, now under way, is completed in 2010.
Provenge was developed by Dendreon, a Seattle biotechnology company.
Approval of Provenge would open a new front in the war on cancer because its mode of action is different from that of existing drugs and radiation, which attack cancer cells directly. Provenge is a personalized therapy in which some of a patient’s white blood cells are removed, processed by Dendreon, then infused back into the body three or four days later.
The first therapy that would direct a cancer patient’s own immune system to attack tumors moved a step closer to approval yesterday when it was endorsed by a federal advisory committee.
The advisory panel to the Food and Drug Administration voted 13 to 4 that there was “substantial evidence” that the treatment was effective in men with advanced prostate cancer and 17 to 0 that the therapy was safe.
The votes increase the likelihood of F.D.A. approval for the therapy, Provenge, by the agency’s May deadline. Still, even panel members who voted for the drug expressed some reservations about the strength of the data. That could leave the door open for the agency to reject Provenge until a bigger trial, now under way, is completed in 2010.
Provenge was developed by Dendreon, a Seattle biotechnology company.
Approval of Provenge would open a new front in the war on cancer because its mode of action is different from that of existing drugs and radiation, which attack cancer cells directly. Provenge is a personalized therapy in which some of a patient’s white blood cells are removed, processed by Dendreon, then infused back into the body three or four days later.
Internet Use Can Boost Breast Cancer Patients' Faith in Docs
Often, high-quality info validates what physicians have already told them, study finds
FRIDAY, March 30 (HealthDay News) -- Checking out high-quality breast cancer information online not only keeps patients informed about their disease, it may also boost their opinion about their doctor, new research shows.
Previous studies have found that many breast cancer patients go online to learn more about their disease. This is the first study to look at how patients' opinions about their doctors affect how they seek online information and support, and how the Web affects how patients regard their doctors, the study authors said.
In the study, a team at the University of Wisconsin-Madison's Center of Excellence in Cancer Communications Research tracked the opinions of 231 recently diagnosed breast cancer patients who were given a free computer and Internet access. The women were also trained to use an online health education and support system called Comprehensive Health Enhancement Support System (CHESS) "Living With Breast Cancer" program.
The researchers found that frequent use of the online information services was associated with both a poor doctor-patient relationship to begin with and with patients becoming more satisfied with their doctors later on.
FRIDAY, March 30 (HealthDay News) -- Checking out high-quality breast cancer information online not only keeps patients informed about their disease, it may also boost their opinion about their doctor, new research shows.
Previous studies have found that many breast cancer patients go online to learn more about their disease. This is the first study to look at how patients' opinions about their doctors affect how they seek online information and support, and how the Web affects how patients regard their doctors, the study authors said.
In the study, a team at the University of Wisconsin-Madison's Center of Excellence in Cancer Communications Research tracked the opinions of 231 recently diagnosed breast cancer patients who were given a free computer and Internet access. The women were also trained to use an online health education and support system called Comprehensive Health Enhancement Support System (CHESS) "Living With Breast Cancer" program.
The researchers found that frequent use of the online information services was associated with both a poor doctor-patient relationship to begin with and with patients becoming more satisfied with their doctors later on.
Thursday, March 29, 2007
FDA advisers OK prostate cancer vaccine
34 minutes ago
Federal health advisers have endorsed an experimental vaccine to treat advanced prostate cancer as safe and effective.
The Food and Drug Administration advisers voted unanimously Thursday to say Provenge is safe. They then voted 13-4 to say there is substantial evidence that it works in treating advanced prostate cancer that no longer responds to hormone treatment.
The FDA isn't required to follow the advice of its advisory committees, but it usually does. A final FDA decision on whether to approve Provenge, also called sipuleucel-T, is expected May 15. The vaccine is made by Seattle-based Dendreon Corp.
If approved, Provenge would become the third cancer vaccine but the first that is therapeutic. FDA-approved vaccines against liver and cervical cancer are both preventive.
Neither of two studies Dendreon submitted to the FDA in support of its application achieved their primary goal in showing Provenge delayed the progress of the disease, according to the agency.
However, the results of the first study suggested the vaccine could extend the lives of patients by 4.5 months compared to those given only dummy treatment. The only other prostate cancer drug shown to prolong the lives of patients is Taxotere, also called docetaxel.
A larger, ongoing study of Provenge is looking specifically at whether it increases longevity of prostate cancer patients.
Federal health advisers have endorsed an experimental vaccine to treat advanced prostate cancer as safe and effective.
The Food and Drug Administration advisers voted unanimously Thursday to say Provenge is safe. They then voted 13-4 to say there is substantial evidence that it works in treating advanced prostate cancer that no longer responds to hormone treatment.
The FDA isn't required to follow the advice of its advisory committees, but it usually does. A final FDA decision on whether to approve Provenge, also called sipuleucel-T, is expected May 15. The vaccine is made by Seattle-based Dendreon Corp.
If approved, Provenge would become the third cancer vaccine but the first that is therapeutic. FDA-approved vaccines against liver and cervical cancer are both preventive.
Neither of two studies Dendreon submitted to the FDA in support of its application achieved their primary goal in showing Provenge delayed the progress of the disease, according to the agency.
However, the results of the first study suggested the vaccine could extend the lives of patients by 4.5 months compared to those given only dummy treatment. The only other prostate cancer drug shown to prolong the lives of patients is Taxotere, also called docetaxel.
A larger, ongoing study of Provenge is looking specifically at whether it increases longevity of prostate cancer patients.
Blood pressure predicts stroke risk for all groups
Thu Mar 29, 2007 4:39PM EDT
NEW YORK (Reuters Health) - Systolic blood pressure is an important predictor of stroke risk among men and women and across racial groups, according to a report in the American Journal of Hypertension.
Systolic blood pressure -- the top reading of the blood pressure -- has been shown to be a better predictor of stroke than diastolic blood pressure - the lower reading -- among apparently healthy white men, the authors explain, but it is unclear whether this holds true for women and African Americans.
Dr. David W. Brown and colleagues from the Centers for Disease Control and Prevention in Atlanta, investigated whether various blood pressure parameters -- individually and in combination -- improved the prediction of stroke events, using data from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study.
The study population included 3295 men and 3462 women. Over a median follow-up of nearly 15 years, 113 fatal strokes occurred.
Brown's team found that increasing systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure were individually associated with an increased risk of fatal stroke.
NEW YORK (Reuters Health) - Systolic blood pressure is an important predictor of stroke risk among men and women and across racial groups, according to a report in the American Journal of Hypertension.
Systolic blood pressure -- the top reading of the blood pressure -- has been shown to be a better predictor of stroke than diastolic blood pressure - the lower reading -- among apparently healthy white men, the authors explain, but it is unclear whether this holds true for women and African Americans.
Dr. David W. Brown and colleagues from the Centers for Disease Control and Prevention in Atlanta, investigated whether various blood pressure parameters -- individually and in combination -- improved the prediction of stroke events, using data from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study.
The study population included 3295 men and 3462 women. Over a median follow-up of nearly 15 years, 113 fatal strokes occurred.
Brown's team found that increasing systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure were individually associated with an increased risk of fatal stroke.
Parkinson's drug pulled from market
By RANDOLPH E. SCHMID, AP Science Writer 46 minutes ago
A drug used by several thousand patients with Parkinson's disease is being pulled from the market because of reports of heart valve damage.
The Food and Drug Administration said Thursday that pergolide, sold under the name Permax and also in generic versions, is being withdrawn at the agency's request.
There are other drugs in the same class that can be substituted, Dr. Robert Temple of the FDA's office of drug evaluation said at a briefing.
At least 14 patients have needed to have heart valves replaced, Temple said, adding he believes that is an underestimate.
He estimated that between 12,000 and 25,000 people currently used the drug, which is known as a dopamine agonist.
"Our conclusion is that pergolide has no demonstrated advantage over other therapies," Temple said. "We believe almost all patients can be converted to another drug."
A drug used by several thousand patients with Parkinson's disease is being pulled from the market because of reports of heart valve damage.
The Food and Drug Administration said Thursday that pergolide, sold under the name Permax and also in generic versions, is being withdrawn at the agency's request.
There are other drugs in the same class that can be substituted, Dr. Robert Temple of the FDA's office of drug evaluation said at a briefing.
At least 14 patients have needed to have heart valves replaced, Temple said, adding he believes that is an underestimate.
He estimated that between 12,000 and 25,000 people currently used the drug, which is known as a dopamine agonist.
"Our conclusion is that pergolide has no demonstrated advantage over other therapies," Temple said. "We believe almost all patients can be converted to another drug."
Obesity boosts prostate cancer mortality
Obese men diagnosed with prostate cancer are more than twice as likely to die of the disease than their leaner peers, a new study shows.
They also have more than triple the risk that the cancer will spread beyond their prostate gland, Dr. Alan R. Kristal of Fred Hutchinson Cancer Research Center in Seattle and colleagues found.
"These results provide yet one more important reason for men to adopt healthful patterns of diet and physical activity to achieve and maintain a normal weight," Kristal and his team conclude in the medical journal Cancer.
A number of studies have linked excess weight with more advanced prostate cancer, Kristal and his team note, but evidence for the effect of obesity on actual outcome from the disease has been unclear. To investigate, they looked at 752 men who had been diagnosed with prostate cancer between 1993 and 1996 and followed for an average of 9.5 years.
They also have more than triple the risk that the cancer will spread beyond their prostate gland, Dr. Alan R. Kristal of Fred Hutchinson Cancer Research Center in Seattle and colleagues found.
"These results provide yet one more important reason for men to adopt healthful patterns of diet and physical activity to achieve and maintain a normal weight," Kristal and his team conclude in the medical journal Cancer.
A number of studies have linked excess weight with more advanced prostate cancer, Kristal and his team note, but evidence for the effect of obesity on actual outcome from the disease has been unclear. To investigate, they looked at 752 men who had been diagnosed with prostate cancer between 1993 and 1996 and followed for an average of 9.5 years.
Antidepressants Equal to Placebo in Bipolar Depression
BOSTON, March 29 -- If a depressed patient with bipolar disorder is taking a mood stabilizer such as lithium, adding an antidepressant has no more effect than a placebo, according to researchers here.
In a study of 366 depressed bipolar patients, durable recoveries were nearly identical, whether patients were randomized to an antidepressant or placebo, found Gary Sachs, M.D., of Massachusetts General Hospital here, and colleagues.
Also, there were no significant differences in a range of secondary endpoints of the 26-week trial, part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) collaboration, the investigators reported online in the New England Journal of Medicine, scheduled for the April 26 print issue.
American physicians have been generally cautious about using antidepressants in bipolar patients, fearing that the drugs would spark manic episodes, Dr. Sachs and colleagues noted.
There had been only limited evidence that medications effective in treating unipolar depression are beneficial in depressed bipolar patients, they said.
In a study of 366 depressed bipolar patients, durable recoveries were nearly identical, whether patients were randomized to an antidepressant or placebo, found Gary Sachs, M.D., of Massachusetts General Hospital here, and colleagues.
Also, there were no significant differences in a range of secondary endpoints of the 26-week trial, part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) collaboration, the investigators reported online in the New England Journal of Medicine, scheduled for the April 26 print issue.
American physicians have been generally cautious about using antidepressants in bipolar patients, fearing that the drugs would spark manic episodes, Dr. Sachs and colleagues noted.
There had been only limited evidence that medications effective in treating unipolar depression are beneficial in depressed bipolar patients, they said.
ACC: Biomarker May Help Distinguish Cardiac and Pulmonary Dyspnea
NEW ORLEANS, March 29 -- Office-based use of the biomarker pro-B-type natriuretic peptide (proBNP) to help diagnose the cause of dyspnea in the general population may be feasible, Danish researchers said here. The blood test has only been used in emergency care and for care of patients with established heart conditions, in part because of a lack of an algorithm to interpret the results in the general population.
But in a study of nearly 3,000 unselected individuals in the general population, proBNP was able to distinguish between heart failure or other cardiac causes of shortness of breath and lung-related dyspnea.
So found Rasmus Mogelvang, M.D., of Gentofte University Hospital in Hellerup, and colleagues, who reported at the American College of Cardiology meeting on an algorithm for diagnosis they devised.
ProBNP is not FDA approved for point-of-care testing and would require further study before adoption for widespread use in general practice. However, determining the etiology of dyspnea from office-based blood test results might, for instance, eliminate the need for ultrasound scans.
"The search for a biomarker to examine an entire population to distinguish the cause of dyspnea has been quite elusive so far," commented Mandeep R. Mehra, M.D., of the University of Maryland in Baltimore, who was a discussant at the presentation.
It could allow physicians to skip echocardiography in many cases, Dr. Mogelvang said.
But in a study of nearly 3,000 unselected individuals in the general population, proBNP was able to distinguish between heart failure or other cardiac causes of shortness of breath and lung-related dyspnea.
So found Rasmus Mogelvang, M.D., of Gentofte University Hospital in Hellerup, and colleagues, who reported at the American College of Cardiology meeting on an algorithm for diagnosis they devised.
ProBNP is not FDA approved for point-of-care testing and would require further study before adoption for widespread use in general practice. However, determining the etiology of dyspnea from office-based blood test results might, for instance, eliminate the need for ultrasound scans.
"The search for a biomarker to examine an entire population to distinguish the cause of dyspnea has been quite elusive so far," commented Mandeep R. Mehra, M.D., of the University of Maryland in Baltimore, who was a discussant at the presentation.
It could allow physicians to skip echocardiography in many cases, Dr. Mogelvang said.
Lack of care for older breast cancer patients
Older women with breast cancer get a lower level of care than younger women, researchers at The University of Manchester have found.
Compared to younger women, older women with breast cancer are less likely to be diagnosed via needle biopsy and triple assessment, less likely to undergo surgery and less likely to receive radiotherapy, the researchers report in this week’s British Journal of Cancer.
Such management of older women is likely to lead to higher rates of local recurrence of the disease and higher than necessary mortality.
Dr Katrina Lavelle, who led the study at the University’s School of Nursing, Midwifery and Social Work, explains: "We have found that older women from aged 70 and over are less likely to receive the same breast cancer care as younger women and that this is related to their age rather than differences in the biology of their tumour."
The highest incidence of breast cancer in England occurs in women aged 70 years and older. Older women also experience the worst survival – women aged 70-79 have a 76% five-year relative survival compared to 80% for all ages, and for women aged 80 plus this drops considerably to 61%, beyond what might be expected owing to an increase in age.
Compared to younger women, older women with breast cancer are less likely to be diagnosed via needle biopsy and triple assessment, less likely to undergo surgery and less likely to receive radiotherapy, the researchers report in this week’s British Journal of Cancer.
Such management of older women is likely to lead to higher rates of local recurrence of the disease and higher than necessary mortality.
Dr Katrina Lavelle, who led the study at the University’s School of Nursing, Midwifery and Social Work, explains: "We have found that older women from aged 70 and over are less likely to receive the same breast cancer care as younger women and that this is related to their age rather than differences in the biology of their tumour."
The highest incidence of breast cancer in England occurs in women aged 70 years and older. Older women also experience the worst survival – women aged 70-79 have a 76% five-year relative survival compared to 80% for all ages, and for women aged 80 plus this drops considerably to 61%, beyond what might be expected owing to an increase in age.
Omega-3 fatty acids affect risk of depression, inflammation
COLUMBUS , Ohio -- A new study suggests that people whose diets contain dramatically more of one kind of polyunsaturated fatty acid than another may be at greater risk for both clinical depression and certain inflammatory diseases.
The report, published online this week in the journal Psychosomatic Medicine, suggests that we need to balance out our intake of omega-6 and omega-3 fatty acids. The current typical American diet contains 20 times more omega-6 than omega-3, a ratio that researchers say should be lowered to 4-to-1, or even 2-to-1.
This is the most recent in a long series of experiments Ohio State University researchers have conducted on the links between psychological stress and immunity. The addition of dietary questions to studies that have previously focused solely on emotional and biochemical markers may yield important new clues about the immune system.
"In this study, we're looking at the intersection of behavior, immune function and diet. In past experiments, we concentrated only on the first two," explained Jan Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State and lead author on the paper.
The report, published online this week in the journal Psychosomatic Medicine, suggests that we need to balance out our intake of omega-6 and omega-3 fatty acids. The current typical American diet contains 20 times more omega-6 than omega-3, a ratio that researchers say should be lowered to 4-to-1, or even 2-to-1.
This is the most recent in a long series of experiments Ohio State University researchers have conducted on the links between psychological stress and immunity. The addition of dietary questions to studies that have previously focused solely on emotional and biochemical markers may yield important new clues about the immune system.
"In this study, we're looking at the intersection of behavior, immune function and diet. In past experiments, we concentrated only on the first two," explained Jan Kiecolt-Glaser, professor of psychiatry and psychology at Ohio State and lead author on the paper.
Study: Most angioplasties unneeded
By MARILYNN MARCHIONE, AP Medical WriterWed Mar 28, 7:58 PM ET
More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.
The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.
An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.
"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."
He led the study and gave results Monday at a meeting of the American College of Cardiology. They also were published online by the New England Journal of Medicine and will be in the April 12 issue.
More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.
The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.
An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.
"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."
He led the study and gave results Monday at a meeting of the American College of Cardiology. They also were published online by the New England Journal of Medicine and will be in the April 12 issue.
Adjunctive Antidepressants Associated with Neither Mania Nor Benefit in Bipolar Depression
Adjunctive paroxetine or bupropion in the treatment of depression associated with bipolar disorder offers no benefit over mood stabilizers alone but does not induce mania, according to a study published online by the New England Journal of Medicine.
Researchers randomized some 370 bipolar patients experiencing depressive episodes to up to 26 weeks of treatment with a mood stabilizer plus one of the two antidepressants or placebo. Rates of durable recovery (defined as at least 8 weeks of euthymia) were the same in the antidepressant (24%) and placebo (27%) groups, as were rates of cycling to mania (10% and 11%, respectively).
Journal Watch Psychiatry Editor-in-Chief Dr. Peter Roy-Byrne writes that the mania finding is reassuring, since "clinicians concerned about suicidality will continue to prescribe antidepressants for seriously depressed bipolar patients." An editorialist cautions that antidepressants may cause mania in the absence of mood stabilizers and that clinicians should check for a history of mania before initiating antidepressant treatment.
Researchers randomized some 370 bipolar patients experiencing depressive episodes to up to 26 weeks of treatment with a mood stabilizer plus one of the two antidepressants or placebo. Rates of durable recovery (defined as at least 8 weeks of euthymia) were the same in the antidepressant (24%) and placebo (27%) groups, as were rates of cycling to mania (10% and 11%, respectively).
Journal Watch Psychiatry Editor-in-Chief Dr. Peter Roy-Byrne writes that the mania finding is reassuring, since "clinicians concerned about suicidality will continue to prescribe antidepressants for seriously depressed bipolar patients." An editorialist cautions that antidepressants may cause mania in the absence of mood stabilizers and that clinicians should check for a history of mania before initiating antidepressant treatment.
Living With Alzheimer’s Before a Window Closes
By JANE GROSS
Mary Blake Carver gazes from the cover of a neurology magazine this month, under the headline “I’m Still Here!” She often feels like shouting the message to her friends, her children, her husband.
Ms. Carver, 55, is among the growing ranks of people in the early stages of Alzheimer’s disease, when short-term memory is patchy, organizational skills fail, attention wanders and initiative comes and goes. But there is still a window of opportunity — maybe one year, maybe five — to reason, communicate and go about her life with a bit of help from those around her.
Yet Ms. Carver is often lonely and bored. Her husband leaves her out of many dinner table conversations, both say, because she cannot keep up with the normal patter. He insists on buttoning her coat when she fumbles at the task. She was fired as a massage therapist because she lost track of time. So Ms. Carver fills her days by walking her neighborhood on the Upper West Side of Manhattan, always with her dog, so she looks like “an ordinary person,” she said, not someone with “nothing better to do.”
Mary Blake Carver gazes from the cover of a neurology magazine this month, under the headline “I’m Still Here!” She often feels like shouting the message to her friends, her children, her husband.
Ms. Carver, 55, is among the growing ranks of people in the early stages of Alzheimer’s disease, when short-term memory is patchy, organizational skills fail, attention wanders and initiative comes and goes. But there is still a window of opportunity — maybe one year, maybe five — to reason, communicate and go about her life with a bit of help from those around her.
Yet Ms. Carver is often lonely and bored. Her husband leaves her out of many dinner table conversations, both say, because she cannot keep up with the normal patter. He insists on buttoning her coat when she fumbles at the task. She was fired as a massage therapist because she lost track of time. So Ms. Carver fills her days by walking her neighborhood on the Upper West Side of Manhattan, always with her dog, so she looks like “an ordinary person,” she said, not someone with “nothing better to do.”
Just keep moving, ladies
Women in their 70s who keep active could be dodging painful arthritis symptoms, according to research published today in Arthritis Research & Therapy. The study is the first to show that the more you exercise, the better your chances of preventing the onset of stiff and painful joints.
Kristiann Heesch and colleagues at the University of Queensland, Australia examined data on middle-aged (48-55) and older (72-79) women collected using surveys over three years as part of the Australian Longitudinal Study on Women's Health. Excluding women who reported arthritis symptoms at the beginning of the study, the authors looked at those who began reporting stiff or painful joints 'often' and how much exercise they undertook.
The results suggest that for women in the older age bracket, doing a little over an hour of moderate physical activity each week will lessen your chances of developing frequent arthritis symptoms in the next three years. Pushing that up to 2 ½ hours per week is even more likely to prevent arthritis symptoms appearing. These results were not seen for the middle-aged group.
Kristiann Heesch and colleagues at the University of Queensland, Australia examined data on middle-aged (48-55) and older (72-79) women collected using surveys over three years as part of the Australian Longitudinal Study on Women's Health. Excluding women who reported arthritis symptoms at the beginning of the study, the authors looked at those who began reporting stiff or painful joints 'often' and how much exercise they undertook.
The results suggest that for women in the older age bracket, doing a little over an hour of moderate physical activity each week will lessen your chances of developing frequent arthritis symptoms in the next three years. Pushing that up to 2 ½ hours per week is even more likely to prevent arthritis symptoms appearing. These results were not seen for the middle-aged group.
Wednesday, March 28, 2007
Periodic Health Examination May Facilitate Cancer Screening
March 28, 2007 — The periodic health examination (PHE) is an appropriate time for primary care clinicians to encourage cancer screening and was linked significantly with patient completion of breast and colorectal cancer screening and prostate-specific antigen (PSA) testing, according to the results of a retrospective cohort study reported in the March 26 issue of the Archives of Internal Medicine.
"Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs)," write Joshua J. Fenton, MD, MPH, from the University of California, Davis, in Sacramento, California, and colleagues. "However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain."
The investigators determined the association between receipt of a PHE and cancer testing in a population-based cohort of 64,288 enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003. Endpoints included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and PSA testing.
During the study period, 52.4% of the enrollees received a PHE. Receiving a PHE was significantly associated with completion of colorectal cancer testing, after adjustment for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002 (incidence difference, 40.4% [95% confidence interval (CI), 39.4% - 41.3%]; relative incidence, 3.47 [95% CI, 3.34 - 3.59]).
"Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs)," write Joshua J. Fenton, MD, MPH, from the University of California, Davis, in Sacramento, California, and colleagues. "However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain."
The investigators determined the association between receipt of a PHE and cancer testing in a population-based cohort of 64,288 enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003. Endpoints included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and PSA testing.
During the study period, 52.4% of the enrollees received a PHE. Receiving a PHE was significantly associated with completion of colorectal cancer testing, after adjustment for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002 (incidence difference, 40.4% [95% confidence interval (CI), 39.4% - 41.3%]; relative incidence, 3.47 [95% CI, 3.34 - 3.59]).
Study sheds light on medication treatment options for bipolar disorder
For depressed people with bipolar disorder who are taking a mood stabilizer, adding an antidepressant medication is no more effective than a placebo (sugar pill), according to results published online on March 28, 2007 in the New England Journal of Medicine. The results are part of the large-scale, multi-site Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a $26.8 million clinical trial funded by the National Institutes of Health's National Institute of Mental Health (NIMH).
Bipolar disorder, a sometimes debilitating illness marked by severe mood swings between depression and mania, is usually treated with mood stabilizers such as lithium, valproate, carbamazepine or other medications that reduce mania. However, depression is more common than mania in bipolar disorder, and depressive episodes tend to last longer than episodes of mania. Antidepressant medications are often used in addition to a mood stabilizer for treating bipolar depression, but they are thought to confer a serious risk of a switch from a depressive episode to a manic episode.
Bipolar disorder, a sometimes debilitating illness marked by severe mood swings between depression and mania, is usually treated with mood stabilizers such as lithium, valproate, carbamazepine or other medications that reduce mania. However, depression is more common than mania in bipolar disorder, and depressive episodes tend to last longer than episodes of mania. Antidepressant medications are often used in addition to a mood stabilizer for treating bipolar depression, but they are thought to confer a serious risk of a switch from a depressive episode to a manic episode.
Early menopause related to bladder cancer risk
NEW YORK (Reuters Health) - Women who are relatively young when they go through menopause seem to be at increased risk of developing bladder cancer, researchers from the University of Minnesota School of Public Health in Minneapolis report.
Bladder cancer is quite common in the U.S., representing about 6 percent of all new cancer cases among men and 2 percent among women, Anna E. Prizment and colleagues point out in the International Journal of Cancer. It's well known that smoking and chemical carcinogens increase the risk, and that it goes up with age.
The researchers looked for factors associated with bladder cancer in a study of 37,459 women between the ages of 55 and 69 years from Iowa. The women were initially free from cancer in 1986, and they were followed through 2003.
Bladder cancer is quite common in the U.S., representing about 6 percent of all new cancer cases among men and 2 percent among women, Anna E. Prizment and colleagues point out in the International Journal of Cancer. It's well known that smoking and chemical carcinogens increase the risk, and that it goes up with age.
The researchers looked for factors associated with bladder cancer in a study of 37,459 women between the ages of 55 and 69 years from Iowa. The women were initially free from cancer in 1986, and they were followed through 2003.
Calcium, vitamin D may ward off colorectal cancer
NEW YORK (Reuters Health) - People who consume relatively high levels of calcium and dairy products and take vitamin D supplements seem to be protected to some degree against colorectal cancer, researchers have found.
"Colorectal cancer is one of the most commonly diagnosed cancers worldwide, and dietary factors are considered to be important in its risk," Dr. Song-Yi Park, of the University of Hawaii, Honolulu, and colleagues write in the American Journal of Epidemiology.
Park's team examined the association between calcium and vitamin D intake and the risk of colorectal cancer in 191,000 subjects between the ages of 45 and 75 years, who completed a food frequency questionnaire between 1993 and 1996.
"Colorectal cancer is one of the most commonly diagnosed cancers worldwide, and dietary factors are considered to be important in its risk," Dr. Song-Yi Park, of the University of Hawaii, Honolulu, and colleagues write in the American Journal of Epidemiology.
Park's team examined the association between calcium and vitamin D intake and the risk of colorectal cancer in 191,000 subjects between the ages of 45 and 75 years, who completed a food frequency questionnaire between 1993 and 1996.
Sedentary behavior linked to high blood sugar
By Michelle Rizzo
NEW YORK (Reuters Health) - People who tend to be sedentary -- as indicated by the amount of time they spend watching television -- are likely to have high levels of glucose in their blood, even though they may not be diabetic.
Dr. David W. Dunstan, of the International Diabetes Institute, Melbourne, Australia, and colleagues examined the association between television viewing and blood glucose levels, measured after fasting and after a glucose test-drink, in 3781 men and 4576 women in Australia. All of the subjects were free of diabetes at the time.
An interviewer assessed the participants' self-reported television viewing time in the previous week.
After accounting for physical activity time and for factors that can affect blood glucose, the investigators found that the more time women spent television viewing, the higher were their blood glucose levels two hours after they took the glucose test-drink.
This was not seen in men, according to the team's report in the medical journal Diabetes Care.
NEW YORK (Reuters Health) - People who tend to be sedentary -- as indicated by the amount of time they spend watching television -- are likely to have high levels of glucose in their blood, even though they may not be diabetic.
Dr. David W. Dunstan, of the International Diabetes Institute, Melbourne, Australia, and colleagues examined the association between television viewing and blood glucose levels, measured after fasting and after a glucose test-drink, in 3781 men and 4576 women in Australia. All of the subjects were free of diabetes at the time.
An interviewer assessed the participants' self-reported television viewing time in the previous week.
After accounting for physical activity time and for factors that can affect blood glucose, the investigators found that the more time women spent television viewing, the higher were their blood glucose levels two hours after they took the glucose test-drink.
This was not seen in men, according to the team's report in the medical journal Diabetes Care.
Sex and Antidepressants
Question
I have a patient who reported sexual side effects before with selective serotonin reuptake inhibitors (SSRIs). I started her on bupropion (Wellbutrin XL), but discontinued it because the patient could not tolerate headache for 2 weeks. I thought they would pass but they did not. Any suggestions about what I should do next?
Response from Michael E. Thase, MD Professor of Psychiatry, University of Pittsburgh Medical Center; Chief, Division of Adult Academic Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
About 1 in 3 patients treated with SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) experience significant sexual dysfunction.[1] Because this side effect can sometimes lessen with the passage of time, a "wait-and-see" approach is often initially prudent. When the sexual side effect persists across a number of weeks, therapeutic action is generally necessary. Options include reducing the dose of the offending medication, adding a second medication with "antidote-like" effects, and switching to an alternate medication with a lower likelihood of sexual side effects.[2]
Let's assume in the case described that dose reduction of the SSRI was attempted and resulted in a decrease in symptomatic benefit and the treating clinician opted to switch to bupropion. This is normally the best choice with respect to reversal of the SSRI-induced sexual dysfunction (ie, bupropion has about the same risk of causing sexual side effects as an inert placebo).[3] However, bupropion, classified as a norepinephrine-dopamine reuptake inhibitor, is mechanistically unrelated to SSRIs and there are the possibilities of different side effect issues and/or lack of response. In this particular case, headache has emerged as an unacceptable side effect during bupropion therapy.
I have a patient who reported sexual side effects before with selective serotonin reuptake inhibitors (SSRIs). I started her on bupropion (Wellbutrin XL), but discontinued it because the patient could not tolerate headache for 2 weeks. I thought they would pass but they did not. Any suggestions about what I should do next?
Response from Michael E. Thase, MD Professor of Psychiatry, University of Pittsburgh Medical Center; Chief, Division of Adult Academic Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
About 1 in 3 patients treated with SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) experience significant sexual dysfunction.[1] Because this side effect can sometimes lessen with the passage of time, a "wait-and-see" approach is often initially prudent. When the sexual side effect persists across a number of weeks, therapeutic action is generally necessary. Options include reducing the dose of the offending medication, adding a second medication with "antidote-like" effects, and switching to an alternate medication with a lower likelihood of sexual side effects.[2]
Let's assume in the case described that dose reduction of the SSRI was attempted and resulted in a decrease in symptomatic benefit and the treating clinician opted to switch to bupropion. This is normally the best choice with respect to reversal of the SSRI-induced sexual dysfunction (ie, bupropion has about the same risk of causing sexual side effects as an inert placebo).[3] However, bupropion, classified as a norepinephrine-dopamine reuptake inhibitor, is mechanistically unrelated to SSRIs and there are the possibilities of different side effect issues and/or lack of response. In this particular case, headache has emerged as an unacceptable side effect during bupropion therapy.
Diabetes-Parkinson's Link Grows Stronger
By Kathleen DohenyHealthDay Reporter 25 minutes ago
WEDNESDAY, March 28 (HealthDay News) -- As people with obesity-linked type 2 diabetes age, their risk of getting Parkinson's disease also climbs, a new study warns.
In fact, excess weight may explain why diabetics are at increased risk of getting the neurological disorder, a Finnish study suggests.
"These findings are important from a clinical and public health point of view," said study author Dr. Gang Hu, senior researcher at the National Public Health Institute in Helsinki. "Type 2 diabetes is increasing rapidly in all populations, and its impact on various health outcomes are not fully known or even explored."
His team's study -- the first large effort to follow people over time and evaluate the diabetes-Parkinson's link -- is published in the April issue of Diabetes Care.
Parkinson's disease affects about 1.5 million Americans, according to the National Parkinson Foundation. It occurs when certain brain cells or neurons die or become impaired. These cells normally produce a substance called dopamine, which helps regulate coordinated movement. Symptoms of Parkinson's include tremor, slow movement and difficulties keeping one's balance.
In type 2 diabetes, the body doesn't properly use insulin or doesn't make enough insulin, which is crucial for the body's uptake of glucose for energy. Excess weight is the major risk factor for type 2 diabetes.
A few other studies have looked at how prevalent type 2 diabetes is among patients with Parkinson's, but, according to Hu, "the results are inconsistent."
WEDNESDAY, March 28 (HealthDay News) -- As people with obesity-linked type 2 diabetes age, their risk of getting Parkinson's disease also climbs, a new study warns.
In fact, excess weight may explain why diabetics are at increased risk of getting the neurological disorder, a Finnish study suggests.
"These findings are important from a clinical and public health point of view," said study author Dr. Gang Hu, senior researcher at the National Public Health Institute in Helsinki. "Type 2 diabetes is increasing rapidly in all populations, and its impact on various health outcomes are not fully known or even explored."
His team's study -- the first large effort to follow people over time and evaluate the diabetes-Parkinson's link -- is published in the April issue of Diabetes Care.
Parkinson's disease affects about 1.5 million Americans, according to the National Parkinson Foundation. It occurs when certain brain cells or neurons die or become impaired. These cells normally produce a substance called dopamine, which helps regulate coordinated movement. Symptoms of Parkinson's include tremor, slow movement and difficulties keeping one's balance.
In type 2 diabetes, the body doesn't properly use insulin or doesn't make enough insulin, which is crucial for the body's uptake of glucose for energy. Excess weight is the major risk factor for type 2 diabetes.
A few other studies have looked at how prevalent type 2 diabetes is among patients with Parkinson's, but, according to Hu, "the results are inconsistent."
Zinc Found To Be A Link In Age-Related Macular Degeneration
An international research team including scientists at the University of Texas Medical Branch at Galveston (UTMB) and the Galveston-based spinoff Neurobiotex, Inc. has found high levels of zinc in deposits in the eye that are an indication of age-related macular degeneration (AMD) - the leading cause of blindness in the elderly in the developed world. The finding, published this month in the journal Experimental Eye Research, contributes to a better understanding of AMD and could facilitate the development of effective treatments, said UTMB ophthalmologist Erik van Kuijk, senior author of the study. AMD is a form of macular disease that affects the eye's central retina and afflicts millions of people (30 percent of them over 75 years old) in the United States alone. It is associated with defects of retinal pigment epithelial cells (RPE), the failure of which leads to progressive loss of vision. Despite the potentially devastating impact on patients' quality of life, no successful therapy to stop or reverse the progression of AMD is available in the majority of cases. An early sign and a presumed trigger of the eye disease is the formation of microscopic plaques, called "drusen," in the eye. Exactly what these plaque-like drusen do and why they form is not yet fully understood, the researchers noted. "We have discovered that the drusen in the eyes of those with AMD have very high levels of zinc," said van Kuijk, associate professor in the UTMB Department of Ophthalmology and Visual Sciences.
MRI for Opposite Breast Urged for New Breast Cancer Patients
SEATTLE, March 28 -- Three percent of new breast cancer patients also have mammographically occult malignant tumors in the contralateral breast that can be detected only by magnetic resonance imaging, researchers reported. Among 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammography and clinical examination of the other breast, MRI found that 30 (3.1%) women had cancer in that breast nonetheless. The MRI-detected contralateral tumors were small and all were node negative.
The mean diameter of the invasive tumors detected was 10.9 mm. Forty percent of the MRI-detected malignancies were ductal carcinomas in situ (4 mm or smaller in diameter).
So reported Constance Lehman, M.D., Ph.D., of the University of Washington here, and colleagues in the American College of Radiology Imaging Network (ACRIN) trial, which was published in the March 29 issue of the New England Journal of Medicine.
The mean diameter of the invasive tumors detected was 10.9 mm. Forty percent of the MRI-detected malignancies were ductal carcinomas in situ (4 mm or smaller in diameter).
So reported Constance Lehman, M.D., Ph.D., of the University of Washington here, and colleagues in the American College of Radiology Imaging Network (ACRIN) trial, which was published in the March 29 issue of the New England Journal of Medicine.
Arthritis pain, the brain and the role of emotions
Arthritis pain is processed in brain areas concerned with emotions and fear, finds study, indicating target for pain-relieving therapies
How does the brain process the experience of pain? Thanks to advances in neuroimaging, we now know the answer lies in a network of brain structures called the pain matrix. This matrix contains two parallel systems. The medial pain system processes the emotional aspects of pain, including fear and stress, while the lateral system processes the physical sensations—pain's intensity, location, and duration.
Marked by morning stiffness, joint aches, and flare-ups, the pain of arthritis tends to be acute and recurrent, in contrast to many chronic pain conditions. Arthritis pain therefore makes an ideal model for comparing common clinical pain with experimental pain. Inspired by this observation, researchers at University of Manchester Rheumatic Diseases Centre in the United Kingdom conducted the first study to compare directly the brain areas involved in processing arthritis pain and experimental pain in a group of patients with osteoarthritis (OA). Their results, published in the April 2007 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), shed light on the role of emotions in how patients feel arthritis pain.
How does the brain process the experience of pain? Thanks to advances in neuroimaging, we now know the answer lies in a network of brain structures called the pain matrix. This matrix contains two parallel systems. The medial pain system processes the emotional aspects of pain, including fear and stress, while the lateral system processes the physical sensations—pain's intensity, location, and duration.
Marked by morning stiffness, joint aches, and flare-ups, the pain of arthritis tends to be acute and recurrent, in contrast to many chronic pain conditions. Arthritis pain therefore makes an ideal model for comparing common clinical pain with experimental pain. Inspired by this observation, researchers at University of Manchester Rheumatic Diseases Centre in the United Kingdom conducted the first study to compare directly the brain areas involved in processing arthritis pain and experimental pain in a group of patients with osteoarthritis (OA). Their results, published in the April 2007 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), shed light on the role of emotions in how patients feel arthritis pain.
ACC: Diabetes Ups Aspirin Resistance
NEW ORLEANS, March 27 -- Aspirin resistance is more common among diabetics patients than nondiabetics, potentially requiring higher doses for adequate protection against a heart attack, researchers here said Resistance to low-dose aspirin recommended for cardioprotection was found among 13% to 37% of patients with diabetes but only 3% to 14% of nondiabetic patients with a history of coronary artery disease, said Paul A. Gurbel, M.D., of Sinai Hospital and Johns Hopkins in Baltimore.
Testing by platelet aggregation or thromboxane metabolite generation showed that increasing the dose to 162 mg or 325 mg eliminated the difference between groups, he reported at the American College of Cardiology meeting.
"The one size fits all mentality is not really appropriate in diabetic patients," Dr. Gurbel said. "In selected diabetic patients baby aspirin is not enough."
However, further evidence from larger studies would be needed before routine high-dose aspirin -- which increases bleeding risk -- or routine aspirin resistance testing could be recommended for patients with diabetes, he cautioned.
Testing by platelet aggregation or thromboxane metabolite generation showed that increasing the dose to 162 mg or 325 mg eliminated the difference between groups, he reported at the American College of Cardiology meeting.
"The one size fits all mentality is not really appropriate in diabetic patients," Dr. Gurbel said. "In selected diabetic patients baby aspirin is not enough."
However, further evidence from larger studies would be needed before routine high-dose aspirin -- which increases bleeding risk -- or routine aspirin resistance testing could be recommended for patients with diabetes, he cautioned.
Tuesday, March 27, 2007
Depression Severity Similar Among Primary Care and Psychiatric Clinics
Major depression severity is much the same in a psychiatric clinic as it is in the practice of a generalist, reported investigators.
"Conventional wisdom has held that depressed patients in primary care settings are less severely depressed, experience a milder course of illness, have a distinct symptom profile with more complaints of fatigue and somatic symptoms, and are more likely to have accompanying physical complaints than depressed patients seeking psychiatric specialty care," wrote Bradley N. Gaynes, M.D., M.P.H., of the University of North Carolina here, and colleagues in the STAR*D study.
But the study of more than 2,500 patients with major depressive disorder in both primary care and specialty practices found that while there slight differences in some measures, levels of moderately severe depression were similar, the STAR*D team reported in the March/April issue of the Annals of Family Medicine.
"Conventional wisdom has held that depressed patients in primary care settings are less severely depressed, experience a milder course of illness, have a distinct symptom profile with more complaints of fatigue and somatic symptoms, and are more likely to have accompanying physical complaints than depressed patients seeking psychiatric specialty care," wrote Bradley N. Gaynes, M.D., M.P.H., of the University of North Carolina here, and colleagues in the STAR*D study.
But the study of more than 2,500 patients with major depressive disorder in both primary care and specialty practices found that while there slight differences in some measures, levels of moderately severe depression were similar, the STAR*D team reported in the March/April issue of the Annals of Family Medicine.
Urine test may improve prostate cancer screening
NEW YORK (Reuters Health) - Testing for the prostate cancer gene 3 (PCA3) in urine may improve screening for prostate cancer, new research suggests.
Screening for prostate cancer usually involves measuring a protein in the blood called prostate specific antigen or PSA. High PSA levels suggest that cancer may be present and a biopsy is then performed to confirm the diagnosis.
Unfortunately, in some men with a high PSA, the biopsy comes back negative, leading doctors to question whether the patient does not have cancer or whether the cancer was missed on biopsy.
Men with elevated PSA levels, but negative prostate biopsy results, present a diagnostic dilemma, lead author Dr. Leonard S. Marks, from the University of California in Los Angeles, and colleagues note. "Watchful waiting" with regular PSA testing is often employed, but this can create anxiety and may also result in unnecessary medical procedures.
Screening for prostate cancer usually involves measuring a protein in the blood called prostate specific antigen or PSA. High PSA levels suggest that cancer may be present and a biopsy is then performed to confirm the diagnosis.
Unfortunately, in some men with a high PSA, the biopsy comes back negative, leading doctors to question whether the patient does not have cancer or whether the cancer was missed on biopsy.
Men with elevated PSA levels, but negative prostate biopsy results, present a diagnostic dilemma, lead author Dr. Leonard S. Marks, from the University of California in Los Angeles, and colleagues note. "Watchful waiting" with regular PSA testing is often employed, but this can create anxiety and may also result in unnecessary medical procedures.
Age-Specific PSA Cut-Offs Avoid Unnecessary Prostate Biopsies in Older Men
A population study presented here in a moderated poster session at the European Association of Urology 22nd Annual Congress shows that the introduction of age-specific cut-offs for prostate-specific antigen (PSA) levels used in prostate cancer screening will reduce the number of unnecessary prostate biopsies in older men who naturally have higher levels of PSA than younger men.The study was presented by David Connolly, MD, coinvestigator and research fellow in the Department of Urology at Belfast City Hospital in the United Kingdom. He told Medscape, "Northern Ireland is quite unique because we have a population-based database of all PSA tests in the whole country, so everybody who ever has a PSA [test] is on our database, and they are followed up through the [Northern Ireland] Cancer Registry to see whether or not they had a prostate biopsy [and] whether or not they were diagnosed with prostate cancer."This analysis examined men who had their first PSA test between the beginning of 1994 and the end of 2000. The study followed the men in the registry to the end of 2003.Of the 96,586 men included, 3537 (3.7%) had a confirmed diagnosis of prostate cancer during the study period. The mean (median) baseline serum PSA values of the control (no prostate cancer) and prostate cancer groups were significantly different: 4.5 (1.4) ng/mL and 148.4 (17.2) ng/mL (P < .001), respectively.
Prostate biopsy may be misleading in obese men
NEW YORK (Reuters Health) - In overweight or obese men, prostate biopsy may underestimate the aggressiveness of prostate cancer, research suggests.
"Even if a well-done biopsy shows low-grade cancer in an obese patient, there is still a reasonable likelihood that the patient may have high-grade disease," Dr. Stephen J. Freedland of Duke University Medical Center, Durham, North Carolina commented in a university statement.
A misleading prostate biopsy could lead to inadequate or inappropriate treatment of the cancer, he and colleagues warn in their report, published today in the journal Urology.
The prostate specific antigen, or PSA, is a blood test used to look for early signs of prostate cancer. Men who have a suspicious PSA result often undergo a prostate biopsy, which involves inserting a needle into the prostate to extract tissue for analysis. The results of the biopsy play a critical role in treatment decisions.
"Even if a well-done biopsy shows low-grade cancer in an obese patient, there is still a reasonable likelihood that the patient may have high-grade disease," Dr. Stephen J. Freedland of Duke University Medical Center, Durham, North Carolina commented in a university statement.
A misleading prostate biopsy could lead to inadequate or inappropriate treatment of the cancer, he and colleagues warn in their report, published today in the journal Urology.
The prostate specific antigen, or PSA, is a blood test used to look for early signs of prostate cancer. Men who have a suspicious PSA result often undergo a prostate biopsy, which involves inserting a needle into the prostate to extract tissue for analysis. The results of the biopsy play a critical role in treatment decisions.
Viable probiotics might help the critically ill
By David Douglas
NEW YORK (Reuters Health) - Therapy with viable probiotics stimulates the function of the immune system in critically ill patients in intensive care, Canadian researchers report.
Probiotics are dietary supplements, containing bacteria or yeast, which have potentially beneficial effects on the body. Probiotic cultures are sometimes recommended by physicians to re-establish the balance of the gut flora after a course of antibiotics or as part of a treatment for a gastrointestinal infection. Claims have also been made that probiotics strengthen the immune system.
"Live probiotic bacteria are effective in enhancing immune activity in patients at risk of developing sepsis, suggesting that viable probiotic preparations may be effective as adjunctive therapy under a variety of clinical conditions," senior investigator Dr. Karen Madsen told Reuters Health.
Multiple organ dysfunction syndrome is a major cause of mortality in intensive care units, Madsen, of the University of Alberta, Edmonton, and colleagues point out in the American Journal of Clinical Nutrition. The onset of multiple organ dysfunction syndrome is preceded by a breakdown in the gut's barrier function along with dysfunction of the immune system.
NEW YORK (Reuters Health) - Therapy with viable probiotics stimulates the function of the immune system in critically ill patients in intensive care, Canadian researchers report.
Probiotics are dietary supplements, containing bacteria or yeast, which have potentially beneficial effects on the body. Probiotic cultures are sometimes recommended by physicians to re-establish the balance of the gut flora after a course of antibiotics or as part of a treatment for a gastrointestinal infection. Claims have also been made that probiotics strengthen the immune system.
"Live probiotic bacteria are effective in enhancing immune activity in patients at risk of developing sepsis, suggesting that viable probiotic preparations may be effective as adjunctive therapy under a variety of clinical conditions," senior investigator Dr. Karen Madsen told Reuters Health.
Multiple organ dysfunction syndrome is a major cause of mortality in intensive care units, Madsen, of the University of Alberta, Edmonton, and colleagues point out in the American Journal of Clinical Nutrition. The onset of multiple organ dysfunction syndrome is preceded by a breakdown in the gut's barrier function along with dysfunction of the immune system.
Flavonoid-rich diets may help reduce heart disease
NEW YORK (Reuters Health) - Foods rich in flavonoids -- from apples and pears to dark chocolate and red wine -- may help shield postmenopausal women from coronary heart disease, cardiovascular disease and stroke, a new study shows.
Flavonoids are antioxidant compounds, found in many plant-based foods, and have been hypothesized to protect the heart by reducing levels of low-density lipoprotein or "bad" cholesterol and reducing inflammation, Dr. Pamela J. Mink of Exponent, Inc., and colleagues note. But studies investigating heart health and flavonoid levels in the diet have had mixed results, they add in the American Journal of Clinical Nutrition.
Flavonoids are antioxidant compounds, found in many plant-based foods, and have been hypothesized to protect the heart by reducing levels of low-density lipoprotein or "bad" cholesterol and reducing inflammation, Dr. Pamela J. Mink of Exponent, Inc., and colleagues note. But studies investigating heart health and flavonoid levels in the diet have had mixed results, they add in the American Journal of Clinical Nutrition.
Study finds coronary procedure adds no benefit over 'optimal medical therapy' alone
NEW ORLEANS, (March 27, 2007) -- Percutaneous coronary intervention plus optimal medical therapy does not improve outcomes in patients with coronary artery disease, compared with optimal medical therapy alone, according to study results presented yesterday at the 56th Annual Scientific Session of the American College of Cardiology in New Orleans, and published online in the New England Journal of Medicine.
The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial, conducted by the Cooperative Studies Program of the U.S. Department of Veterans Affairs (VA) and the Canadian Institutes of Health Research (CIHR), was a randomized, controlled study involving 2,287 patients with stable coronary artery disease treated at 15 VA medical centers, as well as 35 other U.S. and Canadian medical centers. The study, conducted between 1999 and 2004, was also supported by several pharmaceutical and biotechnology companies that contributed funding, drugs and medical devices or supplies.
The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial, conducted by the Cooperative Studies Program of the U.S. Department of Veterans Affairs (VA) and the Canadian Institutes of Health Research (CIHR), was a randomized, controlled study involving 2,287 patients with stable coronary artery disease treated at 15 VA medical centers, as well as 35 other U.S. and Canadian medical centers. The study, conducted between 1999 and 2004, was also supported by several pharmaceutical and biotechnology companies that contributed funding, drugs and medical devices or supplies.
Herbal extract extends life for heart failure patients
Compound is shown to be safe; adds 4 months to patient survival
An herbal medicinal substance, Crataegus Extract WS®1442, safely extends the lives of congestive heart failure patients already receiving pharmacological treatment for the disease, according to a study presented today at the American College of Cardiology’s 56th Annual Scientific Session. Crataegus Extract WS®1442 is an extract of leaves of the Crataegus tree, and is a natural antioxidant. The herb is currently approved for use in some European countries to treat early congestive heart failure, a condition in which the heart cannot pump enough blood to the body’s other organs. ACC.07 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further breakthroughs in cardiovascular medicine.
An herbal medicinal substance, Crataegus Extract WS®1442, safely extends the lives of congestive heart failure patients already receiving pharmacological treatment for the disease, according to a study presented today at the American College of Cardiology’s 56th Annual Scientific Session. Crataegus Extract WS®1442 is an extract of leaves of the Crataegus tree, and is a natural antioxidant. The herb is currently approved for use in some European countries to treat early congestive heart failure, a condition in which the heart cannot pump enough blood to the body’s other organs. ACC.07 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further breakthroughs in cardiovascular medicine.
Patient adherence for successful tuberculosis treatment
Nearly 2 million people die from tuberculosis each year, mainly in the poorest countries. The pathogen, Koch’s bacillus, can pass easily by aerial infection from one individual to another. The spread of the disease, favoured by the Aids epidemic and the appearance of multi-resistant strains, has led WHO to make tuberculosis control one of the world’s main health priorities. The existing treatment, which combines several antibiotics prescribed for a period of 6 to 8 months – as against 18 months to 2 years still only a few years ago – has proved efficient in 95 % of cases. However, this efficacy is called into question by the low adherence of patients to treatment, particularly in the most deprived areas, which are often indeed the worst hit by the disease. In spite of the WHO recommendation to administrate the treatment under the direct supervision of health care personnel who play the role of supporter (DOT : Directly observed therapy), more than 10% of patients stop the treatment before the prescribed period. This defaulting, along with irregularity in taking the medicines, creates increased risk of serious relapse, which opens the way to a rise in transmission events and the emergence of bacteria resistant to the prescribed antibiotics.
Heart intervention doesn't outweigh medicine in study
LEXINGTON, Ky. (March 27, 2007) -- In what some leading cardiologists are calling a "blockbuster" study, new research could alter the approach to treating patients who have cardiovascular disease but may not be at immediate risk of heart attack or stroke.
Co-authored by UK HealthCare's Linda and Jack Gill Heart Institute cardiologist Dr. David Booth, results of a five-year study released today showed that stable heart patients received no significant benefit in undergoing angioplasty when compared to patients treated with medication alone. The study, Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, is published in the current issue of the New England Journal of Medicine and was presented this morning at the American College of Cardiology’s annual scientific sessions in New Orleans.
More than 2,000 patients at 50 sites in North America, including the Lexington VA Medical Center at the University of Kentucky, were followed for four and a half years. The rate of death, heart attack and stroke was 19.5 percent in patients who had medication alone and 20 percent in patients who had percutaneous cardiac intervention, or PCI (procedures that involve clearing blocked vessels by inserting a catheter into a blood vessel, usually in the groin or arm, allowing the physician to access the blockage). While the study did show that patients who underwent PCI had the most relief from symptoms of angina, or mild chest pain that usually occurs with exertion and is relieved with rest and medication, patients who received medication alone also showed significant improvement in symptoms.
Co-authored by UK HealthCare's Linda and Jack Gill Heart Institute cardiologist Dr. David Booth, results of a five-year study released today showed that stable heart patients received no significant benefit in undergoing angioplasty when compared to patients treated with medication alone. The study, Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, is published in the current issue of the New England Journal of Medicine and was presented this morning at the American College of Cardiology’s annual scientific sessions in New Orleans.
More than 2,000 patients at 50 sites in North America, including the Lexington VA Medical Center at the University of Kentucky, were followed for four and a half years. The rate of death, heart attack and stroke was 19.5 percent in patients who had medication alone and 20 percent in patients who had percutaneous cardiac intervention, or PCI (procedures that involve clearing blocked vessels by inserting a catheter into a blood vessel, usually in the groin or arm, allowing the physician to access the blockage). While the study did show that patients who underwent PCI had the most relief from symptoms of angina, or mild chest pain that usually occurs with exertion and is relieved with rest and medication, patients who received medication alone also showed significant improvement in symptoms.
Adjuvant Androgen Deprivation Can "Cure" Nonmetastasized Prostate Cancer
March 26, 2007 (Berlin) — An analysis of 5 prospective randomized trials presented here at the European Association of Urology 22nd Annual Congress shows that adjuvant androgen deprivation with early hormone therapy can provide a normal life expectancy and effectively cure a significant proportion of men with M0 prostate cancer.Thomas Ebert, MD, PhD, head of the Department of Urology, EuromedClinic, Fuerth, Germany, initially indicated during his presentation that based on historical data from before the prostate-specific antigen (PSA) era, hormone therapy was believed to be a mainly palliative treatment for advanced prostate cancer. "We know now that adjuvant androgen deprivation following radiation therapy in M0 patients prolongs survival compared with radiation therapy alone," he added.However, Dr. Ebert and colleagues asked whether this early hormone therapy can actually normalize the life expectancy of the patient with nonmetastasized prostate cancer, as with the local interventions of radical prostatectomy and external radiation therapy (EBRT).This analysis used a Medline search to include all published peer-reviewed prospective randomized trials from the past 10 years of the effects of adjuvant castration therapy after local therapy compared with local therapy alone, with median follow-up of more than 5 years. The overall survival (OS) and progression-free survival (PFS) curves were compared with those of age-, time-, and country-matched men without prostate cancer from the Human Mortality Database.Five studies satisfied these inclusion criteria. Differences in OS could be calculated for 3 of these studies, as a comparison with the calculated normal life expectancies: the addition of adjuvant androgen deprivation to EBRT provided an OS that was not significantly different from the normal life expectancies of 70-year-old Belgium men (EORTC 22863) and 69-year-old Swedish men (Granfors), with many, but not all, 70-year-old US men (RTOG 85-31) showing a similar benefit.
Mobile Phone Use Unrelated to Increased Glioma Risk
NEW YORK (Reuters Health) Mar 23 - While mobile phone use does not appear to be associated with an increased risk of glioma, according to a new study, the intense use of these phones over many years may change the association and promote the growth of malignant brain tumors.
"Public concern has been expressed about the possible adverse health effects of mobile telephones, mainly related to intracranial tumors," Dr. Anna Lahkola, of the Radiation and Nuclear Safety Authority, Helsinki, and colleagues write in the April 15th issue of the International Journal of Cancer.
In a population-based, case-control study, the researchers examined the relationship between mobile phone use and risk of glioma. The study was carried out in Denmark, Finland, Norway, Sweden, and England between 2000 and 2004. Included were 1521 glioma patients and 3301 controls. Information on mobile phone use was collected using personal interviews.
Overall, 92% (1389) of cases and 94% (2945) of controls reported ever using a mobile phone. The investigators found no evidence of increased glioma risk related to regular mobile phone use (odds ratio = 0.78).
There were no significant associations observed with duration of use, years since first use, cumulative number of calls, or cumulative hours of use. When the team examined the linear trend, the OR for cumulative hours of use was 1.006 per 100 hours. There was also no relationship between glioma and years of use or number of calls.
"Public concern has been expressed about the possible adverse health effects of mobile telephones, mainly related to intracranial tumors," Dr. Anna Lahkola, of the Radiation and Nuclear Safety Authority, Helsinki, and colleagues write in the April 15th issue of the International Journal of Cancer.
In a population-based, case-control study, the researchers examined the relationship between mobile phone use and risk of glioma. The study was carried out in Denmark, Finland, Norway, Sweden, and England between 2000 and 2004. Included were 1521 glioma patients and 3301 controls. Information on mobile phone use was collected using personal interviews.
Overall, 92% (1389) of cases and 94% (2945) of controls reported ever using a mobile phone. The investigators found no evidence of increased glioma risk related to regular mobile phone use (odds ratio = 0.78).
There were no significant associations observed with duration of use, years since first use, cumulative number of calls, or cumulative hours of use. When the team examined the linear trend, the OR for cumulative hours of use was 1.006 per 100 hours. There was also no relationship between glioma and years of use or number of calls.
Drug-Resistant Tuberculosis Increasing From Use of Second-Line Drugs
March 23, 2007 — The March 23 issue of the Morbidity and Mortality Weekly Report (MMWR) describes 1993-2006 trends in extensively drug-resistant tuberculosis and in tuberculosis incidence in the United States."The worldwide emergence of extensively drug-resistant tuberculosis (XDR TB) and a provisional definition for this form of TB were first reported in November 2005," write N. S. Shah, MD, from Albert Einstein College of Medicine in Bronx, New York, and colleagues. "XDR TB presents a global threat and a challenge to TB-control activities in the United States. To prevent the spread of XDR TB, renewed vigilance is needed through drug-susceptibility testing, case reporting, specialized care, infection control, and expanded capacity for outbreak detection and response." The Emergency Global Task Force on XDR TB, convened by the World Health Organization in October 2006, revised the case definition to specify resistance to at least isoniazid and rifampin among first-line anti-TB drugs, resistance to any fluoroquinolone, and resistance to at least one second-line injectable drug (amikacin, capreomycin, or kanamycin).Using the revised case definition and provisional data for 2006, this report updates the 2006 report on XDR TB in the United States. The investigators analyzed US National TB Surveillance System (NTSS) data for reported XDR-TB cases from 50 states and the District of Columbia (DC) during 1993 to 2006. All culture-confirmed cases with initial drug-susceptibility test (DST) results reported for at least isoniazid and rifampin were included in the analysis.Of 49 cases (3% of evaluable multidrug-resistant [MDR] TB cases) meeting the revised case definition for XDR TB, 17 (35%) were reported during 2000 to 2006. Compared with cases identified during surveillance from 1993 to 1999, those from 2000 to 2006 were more likely to be in foreign-born persons and less likely to be in persons infected with human immunodeficiency virus (HIV). Of 202,436 culture-confirmed TB cases reported to NTSS during 1993 to 2006, 190,312 had initial DST results for at least isoniazid and rifampin, including 2927 cases (2%) with initial resistance to both drugs (MDR TB). Of 1665 (57%) of 2927 MDR-TB cases that had DST results reported for at least one fluoroquinolone and one injectable second-line drug, 49 cases (3%) met the revised definition of XDR TB, including 32 cases reported during 1993 to 1999 and 17 cases during 2000 to 2006. The 49 XDR-TB cases were reported from 9 states and 1 city, with the largest numbers reported from New York City (19 cases) and California (11 cases). Of 29 cases (59% of the 49 persons with XDR TB) for which HIV status was known, 16 (55%) were HIV-positive. Of 19 persons with XDR TB with known HIV status during 1993 to 1999, 14 (74%) were HIV-positive. Of 10 persons with known HIV status during 2000 to 2006, 2 (20%) were HIV-positive
VALIDD: Lowering Blood Pressure Improves Diastolic Dysfunction
Sue Hughes
Heartwire 2007. © 2007 Medscape
March 26, 2007 (New Orleans, LA) - Lowering blood pressure can improve diastolic dysfunction even in patients with mild hypertension, a new study has shown.
The Valsartan in Diastolic Dysfunction (VALIDD) trial, presented today at the American College of Cardiology 2007 Scientific Sessions, is the first large-scale randomized trial to assess a therapeutic intervention for improvement of diastolic function using new noninvasive Doppler technology. The study’s primary objective was to compare the effect on diastolic dysfunction of two antihypertensive regimens--one based on an inhibitor of the renin angiotensin system (RAS) and one based on other medications--in patients with mild hypertension. While there was no difference between these two groups, both groups showed a substantial reduction in blood pressure that was itself associated with a significant improvement in diastolic dysfunction.
Lead investigator Dr Scott Solomon (Brigham and Women’s Hospital, Boston, MA) said: “Our study has shown an important result. Diastolic dysfunction is an important pathophysiology between hypertension and heart failure, affecting around half of hypertension patients. Patients with diastolic dysfunction have an increased risk of developing heart failure, but there is no targeted therapy for this condition. This study suggests that lowering blood pressure is the most important thing we can do for patients with hypertension and diastolic dysfunction and shows that we need to be more aggressive in this regard even in patients with only mildly elevated blood pressure."
Heartwire 2007. © 2007 Medscape
March 26, 2007 (New Orleans, LA) - Lowering blood pressure can improve diastolic dysfunction even in patients with mild hypertension, a new study has shown.
The Valsartan in Diastolic Dysfunction (VALIDD) trial, presented today at the American College of Cardiology 2007 Scientific Sessions, is the first large-scale randomized trial to assess a therapeutic intervention for improvement of diastolic function using new noninvasive Doppler technology. The study’s primary objective was to compare the effect on diastolic dysfunction of two antihypertensive regimens--one based on an inhibitor of the renin angiotensin system (RAS) and one based on other medications--in patients with mild hypertension. While there was no difference between these two groups, both groups showed a substantial reduction in blood pressure that was itself associated with a significant improvement in diastolic dysfunction.
Lead investigator Dr Scott Solomon (Brigham and Women’s Hospital, Boston, MA) said: “Our study has shown an important result. Diastolic dysfunction is an important pathophysiology between hypertension and heart failure, affecting around half of hypertension patients. Patients with diastolic dysfunction have an increased risk of developing heart failure, but there is no targeted therapy for this condition. This study suggests that lowering blood pressure is the most important thing we can do for patients with hypertension and diastolic dysfunction and shows that we need to be more aggressive in this regard even in patients with only mildly elevated blood pressure."
Trans fats linked to greater heart disease risk
NEW YORK (Reuters Health) - A study published today supports recent efforts to rid the American diet of trans fats. In the study, women with the highest levels of trans fat in their blood had triple the risk of heart disease as those with the lowest levels.
"Humans cannot synthesize, or create, trans fatty acid. The only source is through diet," study chief Dr. Frank B. Hu of the Harvard School of Public Health, Boston, said in a written statement.
The main source of trans fat in the diet is partially hydrogenated oils that are plentiful in cookies, crackers, pastries and fried foods. "Eliminating the use of partially hydrogenated oils and other sources of trans fat in the U.S. diet -- as long as saturated fat intake doesn't increase -- will likely help reduce the burden of cardiovascular disease," Hu said.
Hu and colleagues analyzed blood samples obtained from 32,826 nurses between 1989 and 1990 as part of a long-term study that looked at the effect of oral contraceptives, diet and lifestyle on the development of heart and other diseases.
During 6 years of follow-up, 166 women developed heart disease and these women were matched to 327 healthy control women.
According to a report in the journal Circulation, the amount of trans fat in red blood cells correlated significantly with the amount of trans fat consumed and was associated with increased levels of "bad" LDL cholesterol and decreased levels of "good" HDL cholesterol.
"Humans cannot synthesize, or create, trans fatty acid. The only source is through diet," study chief Dr. Frank B. Hu of the Harvard School of Public Health, Boston, said in a written statement.
The main source of trans fat in the diet is partially hydrogenated oils that are plentiful in cookies, crackers, pastries and fried foods. "Eliminating the use of partially hydrogenated oils and other sources of trans fat in the U.S. diet -- as long as saturated fat intake doesn't increase -- will likely help reduce the burden of cardiovascular disease," Hu said.
Hu and colleagues analyzed blood samples obtained from 32,826 nurses between 1989 and 1990 as part of a long-term study that looked at the effect of oral contraceptives, diet and lifestyle on the development of heart and other diseases.
During 6 years of follow-up, 166 women developed heart disease and these women were matched to 327 healthy control women.
According to a report in the journal Circulation, the amount of trans fat in red blood cells correlated significantly with the amount of trans fat consumed and was associated with increased levels of "bad" LDL cholesterol and decreased levels of "good" HDL cholesterol.
Preventive Checkups Open Door to Cancer Screening
SACRAMENTO, Calif., March 26 -- Health-plan patients who take advantage of periodic routine physicals are more likely to be screened for colorectal cancer, and for breast or prostate cancer, found researchers here.
Of patients who received a prepaid health exam in 2002 to 2003, colon cancer screening was three times higher compared with patients who did not have a checkup, Joshua Fenton, M.D., of the University of California, Davis here, and colleagues reported in the March 26 issue of the Archives of Internal Medicine.
Breast cancer screening for women was slightly greater among the checkup patients, while PSA testing for eligible men was almost three times greater.
These findings emerged from a retrospective cohort study to determine the association between preventive checkups and cancer testing in a population-based sample of 64,288 enrollees in a Washington State health plan (Group Health Cooperative). Participants were 52 to 78 years old and eligible for colorectal, breast, or prostate cancer screening.
Tests included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and PSA testing.
Of patients who received a prepaid health exam in 2002 to 2003, colon cancer screening was three times higher compared with patients who did not have a checkup, Joshua Fenton, M.D., of the University of California, Davis here, and colleagues reported in the March 26 issue of the Archives of Internal Medicine.
Breast cancer screening for women was slightly greater among the checkup patients, while PSA testing for eligible men was almost three times greater.
These findings emerged from a retrospective cohort study to determine the association between preventive checkups and cancer testing in a population-based sample of 64,288 enrollees in a Washington State health plan (Group Health Cooperative). Participants were 52 to 78 years old and eligible for colorectal, breast, or prostate cancer screening.
Tests included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and PSA testing.
Radiofrequency ablation effective treatment for inoperable lung cancer
OAK BROOK, Ill.—Lung cancer patients who are not candidates for surgery now have another safe and effective treatment option: radiofrequency (RF) ablation, according to a new study published in the April issue of the journal Radiology.
The Brown Medical School and Rhode Island Hospital study showed that RF ablation used to treat early-stage, inoperable cancer resulted in outcomes that were equal to or better than those achieved through external beam radiation (EBT), a decades-old alternative to the surgical removal of cancerous tissue.
“In our study, RF ablation produced meaningful results in terms of both survival and tumor control,” said Damian E. Dupuy, M.D., director of tumor ablation at Rhode Island Hospital and professor of diagnostic imaging at Brown Medical School in Providence. “The best two-year survival rate for early-stage lung cancer using EBT is 51 percent, compared to 57 percent with ablation.”
The Brown Medical School and Rhode Island Hospital study showed that RF ablation used to treat early-stage, inoperable cancer resulted in outcomes that were equal to or better than those achieved through external beam radiation (EBT), a decades-old alternative to the surgical removal of cancerous tissue.
“In our study, RF ablation produced meaningful results in terms of both survival and tumor control,” said Damian E. Dupuy, M.D., director of tumor ablation at Rhode Island Hospital and professor of diagnostic imaging at Brown Medical School in Providence. “The best two-year survival rate for early-stage lung cancer using EBT is 51 percent, compared to 57 percent with ablation.”
Monday, March 26, 2007
Aspirin shows benefit in older women
By CARLA K. JOHNSON, Associated Press Writer1 hour, 14 minutes ago
Aspirin in low to moderate doses may lower the risk of death in women, particularly those who are older and prone to heart disease, a 24-year study of nearly 80,000 women suggests.
However, experts cautioned that the results are not definitive and that women should not take aspirin as a health preventive without talking to their doctor.
In this long-running study of nurses who were middle-aged and older, women who took aspirin had a 25 percent lower risk of death compared to those who never took it. Aspirin-takers had a 38 percent lower risk of death from cardiovascular disease and a 12 percent lower risk of death from cancer.
Many doctors advise people who've had heart attacks and strokes to take a daily 81-milligram baby aspirin, costing less than 50 cents a week. The new study suggests aspirin may help healthy women, too.
Aspirin in low to moderate doses may lower the risk of death in women, particularly those who are older and prone to heart disease, a 24-year study of nearly 80,000 women suggests.
However, experts cautioned that the results are not definitive and that women should not take aspirin as a health preventive without talking to their doctor.
In this long-running study of nurses who were middle-aged and older, women who took aspirin had a 25 percent lower risk of death compared to those who never took it. Aspirin-takers had a 38 percent lower risk of death from cardiovascular disease and a 12 percent lower risk of death from cancer.
Many doctors advise people who've had heart attacks and strokes to take a daily 81-milligram baby aspirin, costing less than 50 cents a week. The new study suggests aspirin may help healthy women, too.
More Diabetes, More Heart Disease: Study
Two-thirds of diabetics will die from heart attack or stroke, researchers warn
By Steven ReinbergHealthDay Reporter
MONDAY, March 26 (HealthDay News) -- As the number of Americans with type 2 diabetes has soared over the past 50 years, so, too, has heart disease linked to the blood sugar illness, researchers report.
"The proportion of heart disease due to diabetes has increased about 60 percent over time," said lead author Dr. Caroline S. Fox, a medical officer at the National Heart, Lung, and Blood Institute's Framingham Heart Study. "Compared with other risk factors for heart disease, diabetes is becoming more of an issue," she said.
"I'm not surprised, but I am frightened," added Dr. Larry Deeb, president for medicine and science at the American Diabetes Association. "If you have diabetes and you have a heart attack, you don't do as well and the death rates are worse," he said.
The only solution is to prevent diabetes, Deeb said. In one major prevention trial, "we showed that with a half-hour of exercise a day and the loss of 10 to 15 pounds, you reduce the new diabetes cases by over 58 percent," he said.
By Steven ReinbergHealthDay Reporter
MONDAY, March 26 (HealthDay News) -- As the number of Americans with type 2 diabetes has soared over the past 50 years, so, too, has heart disease linked to the blood sugar illness, researchers report.
"The proportion of heart disease due to diabetes has increased about 60 percent over time," said lead author Dr. Caroline S. Fox, a medical officer at the National Heart, Lung, and Blood Institute's Framingham Heart Study. "Compared with other risk factors for heart disease, diabetes is becoming more of an issue," she said.
"I'm not surprised, but I am frightened," added Dr. Larry Deeb, president for medicine and science at the American Diabetes Association. "If you have diabetes and you have a heart attack, you don't do as well and the death rates are worse," he said.
The only solution is to prevent diabetes, Deeb said. In one major prevention trial, "we showed that with a half-hour of exercise a day and the loss of 10 to 15 pounds, you reduce the new diabetes cases by over 58 percent," he said.
Drugs as Good as Angioplasty for Stable Heart Disease
By Steven ReinbergHealthDay Reporter
MONDAY, March 26 (HealthDay News) -- Aggressive drug therapy appears to be just as good as angioplasty for patients with stable heart disease, a new study finds.
"This is really good news for patients," said study lead author Dr. William E. Boden, a professor of medicine and public health at the University at Buffalo School of Medicine and Biomedical Sciences. "We have more treatment options for patients than we thought we did."
There has been a belief that patients with chronic stable heart disease need to have either an angioplasty or heart bypass surgery, Boden said. "There has been an unproven assumption that patients must proceed to some type of revascularization procedure," he said.
Patients with stable heart disease make up about three-quarters of all the patients who undergo angioplasty and receive stents in the United States, Boden noted. Angioplasty is a medical procedure that uses a balloon to open narrowed or clogged blood vessels of the heart. Usually, during the procedure a stent -- a wire mesh tube -- is placed in the vessel to keep it open.
"What the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial tells us is that optimal medical [drug] therapy, when combined with lifestyle changes, appears to be the equal of angioplasty and optimal medical therapy combined," Boden said.
The study results were presented Monday at the American College of Cardiology's annual meeting, in New Orleans, and will also be published in the April 12 issue of the New England Journal of Medicine.
MONDAY, March 26 (HealthDay News) -- Aggressive drug therapy appears to be just as good as angioplasty for patients with stable heart disease, a new study finds.
"This is really good news for patients," said study lead author Dr. William E. Boden, a professor of medicine and public health at the University at Buffalo School of Medicine and Biomedical Sciences. "We have more treatment options for patients than we thought we did."
There has been a belief that patients with chronic stable heart disease need to have either an angioplasty or heart bypass surgery, Boden said. "There has been an unproven assumption that patients must proceed to some type of revascularization procedure," he said.
Patients with stable heart disease make up about three-quarters of all the patients who undergo angioplasty and receive stents in the United States, Boden noted. Angioplasty is a medical procedure that uses a balloon to open narrowed or clogged blood vessels of the heart. Usually, during the procedure a stent -- a wire mesh tube -- is placed in the vessel to keep it open.
"What the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial tells us is that optimal medical [drug] therapy, when combined with lifestyle changes, appears to be the equal of angioplasty and optimal medical therapy combined," Boden said.
The study results were presented Monday at the American College of Cardiology's annual meeting, in New Orleans, and will also be published in the April 12 issue of the New England Journal of Medicine.
Computerized reminders boost mammography screening rates
Mayo Clinic study points way to improve quality, reduce costsFindings of a new Mayo Clinic study published this week in Archives of Internal Medicine show that a computerized mail and phone reminder program can significantly increase the percentage of patients receiving preventive health services and improve the value of health care.
"National evidence-based guidelines say every woman over age 40 should have a yearly mammogram, but only about 65 percent of women nationally have had one in the last two years," explains Rajeev Chaudhry, M.B.B.S., the Mayo Clinic physician who led the study. "In this study we showed we can increase that percentage through a team approach, and we're applying the findings to other chronic disease and preventive services, too."
"National evidence-based guidelines say every woman over age 40 should have a yearly mammogram, but only about 65 percent of women nationally have had one in the last two years," explains Rajeev Chaudhry, M.B.B.S., the Mayo Clinic physician who led the study. "In this study we showed we can increase that percentage through a team approach, and we're applying the findings to other chronic disease and preventive services, too."
'Shrug off' shoulder surgery myth, study suggests
Total shoulder replacements as safe as swapping out hips and knees, according to Hopkins researchers
Contrary to widespread belief, total surgical replacement of arthritic shoulder joints carries no greater risk of complications than replacement of other major joints, a Johns Hopkins study suggests.
In fact, the Johns Hopkins researchers say, their study shows that patients who undergo shoulder arthroplasty to relieve chronic and significant pain can expect significantly fewer complications, much shorter hospital stays and less costs than patients undergoing hip or knee replacement.
Contrary to widespread belief, total surgical replacement of arthritic shoulder joints carries no greater risk of complications than replacement of other major joints, a Johns Hopkins study suggests.
In fact, the Johns Hopkins researchers say, their study shows that patients who undergo shoulder arthroplasty to relieve chronic and significant pain can expect significantly fewer complications, much shorter hospital stays and less costs than patients undergoing hip or knee replacement.
Pain control after surgery reduces days of hospitalization
University of Pittsburgh study finds effective analgesia cuts length-of-stay by nearly a day
ORLANDO, Fla., March 26 -- Effective postoperative pain control using continuous peripheral nerve block reduced average length-of-stay by nearly a day, University of Pittsburgh School of Medicine physicians reported today during the 81st Clinical and Scientific Congress of the International Anesthesia Research Society at the Buena Vista Palace in Orlando, Fla.
Being able to decrease the time that patients spend in the hospital helps to reduce the patient’s exposure to the risk of hospital-acquired infection and associated complications, and also has an overall economic benefit, Jacques E. Chelly, M.D., Ph.D., professor and vice chairman of the department of anesthesiology at the University of Pittsburgh School of Medicine and his colleagues found.
"For many people, the prospect of having pain is more stressful than the surgery itself," said Dr. Chelly, who is presenting these study results at the meeting. "If they know that specialists in acute pain medicine can help to minimize the pain associated with surgery, these patients are less stressed and more willing to have the surgery they need."
ORLANDO, Fla., March 26 -- Effective postoperative pain control using continuous peripheral nerve block reduced average length-of-stay by nearly a day, University of Pittsburgh School of Medicine physicians reported today during the 81st Clinical and Scientific Congress of the International Anesthesia Research Society at the Buena Vista Palace in Orlando, Fla.
Being able to decrease the time that patients spend in the hospital helps to reduce the patient’s exposure to the risk of hospital-acquired infection and associated complications, and also has an overall economic benefit, Jacques E. Chelly, M.D., Ph.D., professor and vice chairman of the department of anesthesiology at the University of Pittsburgh School of Medicine and his colleagues found.
"For many people, the prospect of having pain is more stressful than the surgery itself," said Dr. Chelly, who is presenting these study results at the meeting. "If they know that specialists in acute pain medicine can help to minimize the pain associated with surgery, these patients are less stressed and more willing to have the surgery they need."
Severe dengue infections may go unrecognized in international travelers
Severe cases of a common travelers' infection may not be recognized if doctors rely on the World Health Organization's (WHO) guidelines for identifying it, according to a new study published in the April 15 issue of The Journal of Infectious Diseases, now available online.
Dengue is the most important emerging disease among international travelers, with a 30-fold increase in incidence over the past 50 years worldwide. Like malaria, dengue is transmitted to humans by mosquitoes.
Most cases are mild. Symptoms include fever, rash, headache, pain behind the eyes, and muscle and joint pain. According to the WHO, dengue hemorrhagic fever (DHF) is characterized by fever, low platelet count, clinical evidence of leaking capillaries, and spontaneous bleeding or fragile blood vessels. The most serious cases can lead to shock and death. There is no cure for dengue infection, but management of the disease's effects can prevent the worst outcomes.
Dengue is the most important emerging disease among international travelers, with a 30-fold increase in incidence over the past 50 years worldwide. Like malaria, dengue is transmitted to humans by mosquitoes.
Most cases are mild. Symptoms include fever, rash, headache, pain behind the eyes, and muscle and joint pain. According to the WHO, dengue hemorrhagic fever (DHF) is characterized by fever, low platelet count, clinical evidence of leaking capillaries, and spontaneous bleeding or fragile blood vessels. The most serious cases can lead to shock and death. There is no cure for dengue infection, but management of the disease's effects can prevent the worst outcomes.
New study shows benefits of quitting smoking
Giving up smoking can reduce the risk of dying from the disease by up to 70 percent, new research published in the American Journal of Epidemiology this week shows.
The research by the Asia Pacific Studies Collaboration (APCSC) confirms that cigarette smoking substantially increases the risk of dying from lung cancer in both Australia/New Zealand (ANZ) and Asia, and importantly highlights the continuing popularity of cigarette smoking across large parts of Asia, including China, where the harmful effects of smoking are still not widely appreciated.
The study of 500,000 adults also shows that the risks of dying from lung cancer were about 20 times higher among women who smoke compared with male smokers, a worrying finding given the increasing trend for women to take up the habit in many countries.
One of the paper's authors is Professor Konrad Jamrozik, from UQ's School of Population Health.
The research by the Asia Pacific Studies Collaboration (APCSC) confirms that cigarette smoking substantially increases the risk of dying from lung cancer in both Australia/New Zealand (ANZ) and Asia, and importantly highlights the continuing popularity of cigarette smoking across large parts of Asia, including China, where the harmful effects of smoking are still not widely appreciated.
The study of 500,000 adults also shows that the risks of dying from lung cancer were about 20 times higher among women who smoke compared with male smokers, a worrying finding given the increasing trend for women to take up the habit in many countries.
One of the paper's authors is Professor Konrad Jamrozik, from UQ's School of Population Health.
Fresh approach to diet and medication improves recovery after heart attack
NEW ORLEANS, La. (March 25, 2007) — After a heart attack, cardiovascular health and even survival can be improved by intensive dietary therapy and early dosing with a medication that blocks the harmful hormonal effects in the heart, according to research presented today at the American College of Cardiology's 56th Annual Scientific Session in New Orleans, La. ACC.07 is the premier cardiovascular medical meeting, bringing together cardiologists to further breakthroughs in cardiovascular medicine.
American Heart Association or Mediterranean Diet Improves Cardiovascular Outcomes After Myocardial Infarction Trial (Presentation Number 404-7)
A low-fat, low-cholesterol diet, as recommended by the American Heart Association (AHA), is equally beneficial for people who have had a heart attack as a Mediterranean-style diet rich in fish, monounsaturated fats, and other sources of omega-3 fatty acids, according to a community-based study that featured intensive nutrition counseling and tracked patients for an average of nearly four years.
American Heart Association or Mediterranean Diet Improves Cardiovascular Outcomes After Myocardial Infarction Trial (Presentation Number 404-7)
A low-fat, low-cholesterol diet, as recommended by the American Heart Association (AHA), is equally beneficial for people who have had a heart attack as a Mediterranean-style diet rich in fish, monounsaturated fats, and other sources of omega-3 fatty acids, according to a community-based study that featured intensive nutrition counseling and tracked patients for an average of nearly four years.
Place more than race tied to heart disease risk
Results presented at American College of Cardiology and American Heart Association’s Cardiovascular Disease and Epidemiology meetings
Where you live might play a bigger role in your risk for heart disease than your ethnicity or race. New research reveals that rural residents were more knowledgeable about healthy eating and heart disease risk than urban residents, but that urban residents were more motivated and optimistic about getting healthy. And further, these differences persisted when the researchers compared rural Caucasians to urban Caucasians. The findings could help healthcare professionals better target heart disease prevention programs.
Carol Homko, Ph.D., researcher and assistant professor at Temple University School of Medicine, suggests that the differences are partly due to lifestyle. Fresh fruits and vegetables are more plentiful and less costly in rural areas, where it's also easier and safer to exercise outside. Urban areas often lack good grocery stores, forcing residents to rely on corner stores that don't have many fresh food selections at reasonable prices.
Where you live might play a bigger role in your risk for heart disease than your ethnicity or race. New research reveals that rural residents were more knowledgeable about healthy eating and heart disease risk than urban residents, but that urban residents were more motivated and optimistic about getting healthy. And further, these differences persisted when the researchers compared rural Caucasians to urban Caucasians. The findings could help healthcare professionals better target heart disease prevention programs.
Carol Homko, Ph.D., researcher and assistant professor at Temple University School of Medicine, suggests that the differences are partly due to lifestyle. Fresh fruits and vegetables are more plentiful and less costly in rural areas, where it's also easier and safer to exercise outside. Urban areas often lack good grocery stores, forcing residents to rely on corner stores that don't have many fresh food selections at reasonable prices.
Study: Crestor not as effective as hoped
AstraZeneca PLC's Crestor cholesterol drug slowed thickening in the neck arteries of people at low risk for heart attacks and strokes, but it failed to reverse thickening as researchers had hoped for.
Thickening of arterial walls is a precursor to plaque buildup, which can lead to heart attacks and strokes. Crestor is approved primarily to reduce levels of bad cholesterol, but AstraZeneca hopes U.S. health regulators will approve expanding the product label to say it can improve atherosclerosis, or plaque buildup.
On its own, the new Crestor study probably won't support the wider use of Crestor and other statins by people at low risk for heart attacks and cardiovascular events. But further studies in this large population could support greater use.
"In our study, the agent not only slowed progression of disease, but also caused the disease to come to a complete halt," John Crouse, a heart specialist at Wake Forest University School of Medicine, said in an interview at the annual meeting of the American College of Cardiology. Results of the study were presented here Sunday and published online by the Journal of the American Medical Association.
Thickening of arterial walls is a precursor to plaque buildup, which can lead to heart attacks and strokes. Crestor is approved primarily to reduce levels of bad cholesterol, but AstraZeneca hopes U.S. health regulators will approve expanding the product label to say it can improve atherosclerosis, or plaque buildup.
On its own, the new Crestor study probably won't support the wider use of Crestor and other statins by people at low risk for heart attacks and cardiovascular events. But further studies in this large population could support greater use.
"In our study, the agent not only slowed progression of disease, but also caused the disease to come to a complete halt," John Crouse, a heart specialist at Wake Forest University School of Medicine, said in an interview at the annual meeting of the American College of Cardiology. Results of the study were presented here Sunday and published online by the Journal of the American Medical Association.
Berries belong to cancer-fighting superfoods: study
by Louise Daly1 hour, 38 minutes ago
An antioxidant found in blueberries and grapes may offer protection against colon cancer, according to a new study that suggests the humble berry should be added to the list of cancer-fighting superfoods.
In a small study on rats, the compound appeared to afford the animals a measure of protection against this type of malignancy.
All 18 rats were given a compound to induce colon cancer in a manner similar to human colon cancer development.
Nine of the rodents were then placed on a balanced diet, while the remainder was given the same diet with a supplement of the berry antioxidant pterostilbene.
At the end of eight weeks, the rats on pterostilbene had 57 percent fewer pre-cancerous lesions in their colon in comparison to the control group.
An antioxidant found in blueberries and grapes may offer protection against colon cancer, according to a new study that suggests the humble berry should be added to the list of cancer-fighting superfoods.
In a small study on rats, the compound appeared to afford the animals a measure of protection against this type of malignancy.
All 18 rats were given a compound to induce colon cancer in a manner similar to human colon cancer development.
Nine of the rodents were then placed on a balanced diet, while the remainder was given the same diet with a supplement of the berry antioxidant pterostilbene.
At the end of eight weeks, the rats on pterostilbene had 57 percent fewer pre-cancerous lesions in their colon in comparison to the control group.
Physicians may be obstacles to breast reconstruction
Significant differences in plastic surgery referral practices by general surgeons treating newly diagnosed breast cancer patients partially explain the low rates of breast reconstructive surgery in the United States, according to a new study. Published in the May 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study suggests that only one quarter of general surgeons refer most breast cancer patients for a reconstruction consultation at the time of treatment planning.
Despite the fact that insurance covers the procedure, only 16 percent of breast cancer patients treated with a mastectomy receive breast reconstruction in the US. Studies have shown that age and race predict low rates of this reconstructive procedure. However, studies also suggest that healthcare providers have an impact on utilization through their referral and information sharing practices.
Despite the fact that insurance covers the procedure, only 16 percent of breast cancer patients treated with a mastectomy receive breast reconstruction in the US. Studies have shown that age and race predict low rates of this reconstructive procedure. However, studies also suggest that healthcare providers have an impact on utilization through their referral and information sharing practices.
Sunday, March 25, 2007
Slow Down, Multitaskers; Don’t Read in Traffic
By STEVE LOHR
Confident multitaskers of the world, could I have your attention?
Think you can juggle phone calls, e-mail, instant messages and computer work to get more done in a time-starved world? Read on, preferably shutting out the cacophony of digital devices for a while.
Several research reports, both recently published and not yet published, provide evidence of the limits of multitasking. The findings, according to neuroscientists, psychologists and management professors, suggest that many people would be wise to curb their multitasking behavior when working in an office, studying or driving a car.
These experts have some basic advice. Check e-mail messages once an hour, at most. Listening to soothing background music while studying may improve concentration. But other distractions — most songs with lyrics, instant messaging, television shows — hamper performance. Driving while talking on a cellphone, even with a hands-free headset, is a bad idea.
In short, the answer appears to lie in managing the technology, instead of merely yielding to its incessant tug.
“Multitasking is going to slow you down, increasing the chances of mistakes,” said David E. Meyer, a cognitive scientist and director of the Brain, Cognition and Action Laboratory at the University of Michigan. “Disruptions and interruptions are a bad deal from the standpoint of our ability to process information.”
Confident multitaskers of the world, could I have your attention?
Think you can juggle phone calls, e-mail, instant messages and computer work to get more done in a time-starved world? Read on, preferably shutting out the cacophony of digital devices for a while.
Several research reports, both recently published and not yet published, provide evidence of the limits of multitasking. The findings, according to neuroscientists, psychologists and management professors, suggest that many people would be wise to curb their multitasking behavior when working in an office, studying or driving a car.
These experts have some basic advice. Check e-mail messages once an hour, at most. Listening to soothing background music while studying may improve concentration. But other distractions — most songs with lyrics, instant messaging, television shows — hamper performance. Driving while talking on a cellphone, even with a hands-free headset, is a bad idea.
In short, the answer appears to lie in managing the technology, instead of merely yielding to its incessant tug.
“Multitasking is going to slow you down, increasing the chances of mistakes,” said David E. Meyer, a cognitive scientist and director of the Brain, Cognition and Action Laboratory at the University of Michigan. “Disruptions and interruptions are a bad deal from the standpoint of our ability to process information.”
'Good fat' OK for heart attack patients
By MARILYNN MARCHIONE, AP Medical Writer1 hour, 3 minutes ago
A Mediterranean-style diet high in olive oil and other "healthy" fats is just as good as the classic American Heart Association low-fat diet for the 8 million Americans who have suffered a heart attack and want to prevent a repeat, new research suggests.
People on either diet had one-third the risk of suffering another heart attack, a stroke, death or other heart problem compared with heart patients eating in the usual way, the study found. The results of the study were presented Sunday at an American College of Cardiology conference.
Doctors said it was one of the best tests of specific diets on heart health, especially because participants stuck to it and achieved the goals for various fats that researchers set. The participants also were similar in treatments and other factors so the effect of the diets could be isolated.
"Both diets are prudent choices" for people at high risk of heart disease, said Dr. Katherine Tuttle of Providence Medical Research Center and Sacred Heart Medical Center in Spokane, Wash. She led the study and presented the results at the conference.
A Mediterranean-style diet high in olive oil and other "healthy" fats is just as good as the classic American Heart Association low-fat diet for the 8 million Americans who have suffered a heart attack and want to prevent a repeat, new research suggests.
People on either diet had one-third the risk of suffering another heart attack, a stroke, death or other heart problem compared with heart patients eating in the usual way, the study found. The results of the study were presented Sunday at an American College of Cardiology conference.
Doctors said it was one of the best tests of specific diets on heart health, especially because participants stuck to it and achieved the goals for various fats that researchers set. The participants also were similar in treatments and other factors so the effect of the diets could be isolated.
"Both diets are prudent choices" for people at high risk of heart disease, said Dr. Katherine Tuttle of Providence Medical Research Center and Sacred Heart Medical Center in Spokane, Wash. She led the study and presented the results at the conference.
Statin therapy slows progression of arterial thickening; halts but does not reverse atherosclerosis
Among low-risk middle-aged people with subclinical atherosclerosis, the cholesterol-lowering drug rosuvastatin reduces the rate of progression of arterial thickening and stops but does not reverse atherosclerotic disease, according to a study in the March 28 issue of JAMA. The study is being released early to coincide with its presentation at the American College of Cardiology's annual conference.
Lipid-lowering therapy has been shown to reduce cardiovascular events in a large number of studies. Statin drugs as well as other agents and lifestyle changes have also been shown to slow the progression of and even regress atherosclerosis, according to background information in the article. Atherosclerosis is the progressive thickening and hardening of the walls of medium-sized and large arteries as a result of fat deposits on their inner lining. Atherosclerosis is often advanced before symptoms appear, and it is not clear whether treatment is beneficial in middle-aged individuals with a low Framingham risk score (a measure used to predict the risk of cardiovascular disease) and mild to moderate subclinical atherosclerosis.
John R. Crouse III, M.D., of the Wake Forest University School of Medicine, Winston-Salem, N.C., and colleagues conducted a randomized study of 984 individuals. The Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin (METEOR) study was designed to investigate the effect of a 40-mg. dose of rosuvastatin on carotid intima-media thickness (CIMT, a measure of the thickness of the middle layers of the carotid arteries) over two years in middle-aged individuals with low Framingham risk scores, but with evidence of subclinical atherosclerosis.
"Rosuvastatin treatment was associated with a 49 percent reduction in LDL-C ["bad" cholesterol] level, a 34 percent reduction in total cholesterol level, an eight percent increase in HDL-C ["good" cholesterol] level, and a 16 percent reduction in level of triglycerides," the authors write.
Lipid-lowering therapy has been shown to reduce cardiovascular events in a large number of studies. Statin drugs as well as other agents and lifestyle changes have also been shown to slow the progression of and even regress atherosclerosis, according to background information in the article. Atherosclerosis is the progressive thickening and hardening of the walls of medium-sized and large arteries as a result of fat deposits on their inner lining. Atherosclerosis is often advanced before symptoms appear, and it is not clear whether treatment is beneficial in middle-aged individuals with a low Framingham risk score (a measure used to predict the risk of cardiovascular disease) and mild to moderate subclinical atherosclerosis.
John R. Crouse III, M.D., of the Wake Forest University School of Medicine, Winston-Salem, N.C., and colleagues conducted a randomized study of 984 individuals. The Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin (METEOR) study was designed to investigate the effect of a 40-mg. dose of rosuvastatin on carotid intima-media thickness (CIMT, a measure of the thickness of the middle layers of the carotid arteries) over two years in middle-aged individuals with low Framingham risk scores, but with evidence of subclinical atherosclerosis.
"Rosuvastatin treatment was associated with a 49 percent reduction in LDL-C ["bad" cholesterol] level, a 34 percent reduction in total cholesterol level, an eight percent increase in HDL-C ["good" cholesterol] level, and a 16 percent reduction in level of triglycerides," the authors write.
U.S. retirees bowled over by Wii
LOS ANGELES (Reuters) — Until two weeks ago, Ruth Ebert never had the slightest interest in the video games favored by her one and only granddaughter.
"I'm 82 years old, so I missed that part of our culture. Soap operas, yes. Video games, no," chirped Ebert, who recently started playing a tennis game on Nintendo's new Wii video game console at the Virginia retirement community she calls home.
"It was funny, because normally I would not be someone who would do that," said Ebert, who picked up the console's motion-sensing Wiimote and challenged the machine to a match.
"I played tennis, if you can call it that, as a high school student. I had such fun doing it," she said.
Ebert swung the Wiimote just like a tennis racquet and said playing the game reminded her of the feeling she had all those years ago.
While she took the early on-court lead, the Wii beat her in the end. Still, it hurt less than her real-world losses: "I didn't mind losing to a video game. It couldn't rub it in."
"I'm 82 years old, so I missed that part of our culture. Soap operas, yes. Video games, no," chirped Ebert, who recently started playing a tennis game on Nintendo's new Wii video game console at the Virginia retirement community she calls home.
"It was funny, because normally I would not be someone who would do that," said Ebert, who picked up the console's motion-sensing Wiimote and challenged the machine to a match.
"I played tennis, if you can call it that, as a high school student. I had such fun doing it," she said.
Ebert swung the Wiimote just like a tennis racquet and said playing the game reminded her of the feeling she had all those years ago.
While she took the early on-court lead, the Wii beat her in the end. Still, it hurt less than her real-world losses: "I didn't mind losing to a video game. It couldn't rub it in."
Japan experts link osteoarthritis to gene variant
HONG KONG (Reuters) - Researchers in Japan have identified a gene variant that may be responsible for osteoarthritis, a painful condition in the joints that affects more than 200 million people worldwide.
Osteoarthritis usually happens in old age, when there is a breakdown and loss of cartilage in the joints, leading to swelling and pain, and restricting mobility.
The scientists said in the journal Nature Genetics they had analyzed DNA from two groups of Japanese patients with hip osteoarthritis and found that the gene variant showed up more frequently in them than in a group that did not suffer from the disease.
The same variant was also found to be significantly more frequent in both Japanese and Chinese individuals suffering from osteoarthritis of the knee, they wrote.
"Association (between osteoarthritis and the variant gene) was found in Japanese populations and the association was replicated in a Chinese population," lead researcher Shiro Ikegawa at the SNP Research Center in Tokyo told Reuters.
Osteoarthritis usually happens in old age, when there is a breakdown and loss of cartilage in the joints, leading to swelling and pain, and restricting mobility.
The scientists said in the journal Nature Genetics they had analyzed DNA from two groups of Japanese patients with hip osteoarthritis and found that the gene variant showed up more frequently in them than in a group that did not suffer from the disease.
The same variant was also found to be significantly more frequent in both Japanese and Chinese individuals suffering from osteoarthritis of the knee, they wrote.
"Association (between osteoarthritis and the variant gene) was found in Japanese populations and the association was replicated in a Chinese population," lead researcher Shiro Ikegawa at the SNP Research Center in Tokyo told Reuters.
Heart failure medication provides some symptom relief
medication used to treat heart failure, tolvaptan, appears to improve some symptoms and signs of heart failure during hospitalization, but does not reduce the risk of re-hospitalization or death, according to two articles in the March 28 issue of JAMA. The study is being released early to coincide with its presentation at the American College of Cardiology's annual conference.
During the past 2 decades, there have been substantial advances in drug therapy for chronic heart failure (HF), but the number of annual hospitalizations for HF continues to increase, and the risk of death remains high among patients hospitalized with HF, according to background information in the first article. "To date, no treatment initiated at the time of hospitalization for acute decompensated [characterized by severe symptoms and signs] HF has been found to improve clinical outcomes. In fact, in randomized controlled trials of such treatments, the observed clinical benefits have been marginal at best, and concern has been raised about the adverse effect of these treatments on long-term clinical outcomes."
Marvin A. Konstam, M.D., of Tufts - New England Medical Center, Boston, and colleagues with the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan (EVEREST) trial, examined the long-term clinical outcomes of the heart failure medication tolvaptan. The trial, comprised of two short-term clinical status studies, included 4,133 patients hospitalized with heart failure at 359 North American, South American, and European sites between October 2003 and February 2006, and followed up during long-term treatment. Within 48 hours of hospital admission, the patients were randomly assigned to receive oral tolvaptan, 30 mg once per day (n = 2,072), or placebo (n = 2,061) for a minimum of 60 days, in addition to standard therapy.
During the past 2 decades, there have been substantial advances in drug therapy for chronic heart failure (HF), but the number of annual hospitalizations for HF continues to increase, and the risk of death remains high among patients hospitalized with HF, according to background information in the first article. "To date, no treatment initiated at the time of hospitalization for acute decompensated [characterized by severe symptoms and signs] HF has been found to improve clinical outcomes. In fact, in randomized controlled trials of such treatments, the observed clinical benefits have been marginal at best, and concern has been raised about the adverse effect of these treatments on long-term clinical outcomes."
Marvin A. Konstam, M.D., of Tufts - New England Medical Center, Boston, and colleagues with the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan (EVEREST) trial, examined the long-term clinical outcomes of the heart failure medication tolvaptan. The trial, comprised of two short-term clinical status studies, included 4,133 patients hospitalized with heart failure at 359 North American, South American, and European sites between October 2003 and February 2006, and followed up during long-term treatment. Within 48 hours of hospital admission, the patients were randomly assigned to receive oral tolvaptan, 30 mg once per day (n = 2,072), or placebo (n = 2,061) for a minimum of 60 days, in addition to standard therapy.
How Web 2.0 is changing medicine
Is a medical wikipedia the next step?
Few concepts in information technology create more confusion than Web 2.0. The truth is that Web 2.0 is a difficult term to define, even for web experts.1 Nebulous phrases like "the web as platform" and "architecture of participation" are often used to describe Web 2.0. Medical librarians suggest that rather than intrinsic benefits of the platform itself, it's the spirit of open sharing and collaboration that is paramount.2 The more we use, share, and exchange information on the web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work.
Few concepts in information technology create more confusion than Web 2.0. The truth is that Web 2.0 is a difficult term to define, even for web experts.1 Nebulous phrases like "the web as platform" and "architecture of participation" are often used to describe Web 2.0. Medical librarians suggest that rather than intrinsic benefits of the platform itself, it's the spirit of open sharing and collaboration that is paramount.2 The more we use, share, and exchange information on the web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work.
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