HHAL MEDICAL NEWS JULY 2014
The Four Things That Can Predict How Long You'll Live
You eat right, hit the gym, avoid smoking, and don't drink too much -- but will your healthy lifestyle really pay off? Scientists say yes. According to a new study published in the journal Preventative Medicine, people can extend their life expectancies by avoiding four poor lifestyle habits: smoking, alcohol, poor diet, and inactivity.
Researchers at the University of Zurich studied 16,721 people, ages 16 to 90 from 1977 to 1993 with their corresponding deaths up until 2003. The purpose of the study was to determine what a healthy lifestyle looked like in numbers and to prove that avoiding unhealthy factors can help increase life expectancy. Some interesting findings: Smoking is the highest risk factor, with smokers having a 57 percent higher risk of dying prematurely. Also, people who engage in all four risk factors have a mortality risk that's two and a half times higher than someone who refrains from bad health habits.
Yahoo Shine could not reach co-study author Brian Martin, M.D., a professor at the Institute of Social and Preventive Medicine at the University of Zurich, for comment, however, he said in a university press release, "We were very surprised by the 2.5 fold higher risk when all four risk factors are combined.” For example, the probability of a 75-year-old man who incorporates all four risk factors surviving the next 10 years is only 35 percent. If he doesn’t engage in those four poor habits, his odds shoot to 67 percent; for a woman, it’s 47 and 74 percent respectively.
What's more, the impact of an unhealthy lifestyle worsens as a person ages. For 45-to-55-year-olds who smoke, drink, don't work out, and don't eat healthfully, those choices barely made a dent on their mortality rates, compared to the effect it had on the 65-to-75-year-olds. The odds of a 75-year-old man with none of the risk factors surviving the next 10 years is 67 percent, exactly the same for an unhealthy person who is 10 years younger.
Extreme Obesity May Cut 14 Years Off One's Life Results of a pooled data analysis show that adults with extreme obesity have increased risks of dying at a young age from cancer and other conditions, including heart disease, stroke, diabetes, and kidney and liver diseases. The study findings appear in PLOS Medicine.
Researchers from the National Cancer Institute first classified subjects according to their body mass index (BMI): normal, overweight, Class I obesity, Class II obesity, or Class III obesity. The analysis comprised of 20 large studies involving adults from the U.S., Sweden, and Australia. The researchers assessed the risk of premature death overall and the risk of premature death from specific causes in people who were Class III obese (n>9,500) vs. normal weight (n=304,000).
RELATED: FDA Considers Appetite-Curbing Implant for Severely Obese
The study found that people with Class III (or extreme) obesity were found to have a significant reduction in life expectancy compared with people of normal weight. Within the Class III obesity group, increasing BMI was correlated to increased risk of dying overall and from most major health causes. Years lost in life expectancy ranged from 6.5 years (BMI 40–44.9) to 13.7 years (BMI of 55–59.9). Researchers concluded there is a need to develop more effective interventions to fight extreme obesity.
One hour of physical exercise may counteract effects of sitting for six to seven hours a day. TIME (7/9, Park) reports on its website that “because exercise has a more powerful effect in helping the heart than sitting does in harming it, one hour of physical exercise could counteract the effects of sitting for six to seven hours a day, according to” research published in Mayo Clinic Proceedings. Investigators came to this conclusion after analyzing data “from the National Health and Nutrition Examination Survey, an ongoing series of health studies maintained by the” CDC. The researchers also found, however, that individuals “who logged less time sitting had better fitness, as measured on a treadmill test, than those who spent more hours in a chair or on the couch.”
Dividing daily protein intake evenly across meals may aid muscle protein synthesis. Forbes (7/16) contributor David Kroll writes, “Consuming a meal with 30 grams of high-quality protein has emerged as the average consensus from studies designed to maximize muscle protein synthesis across people of various ages, body mass, and activity levels.” Now, a new study published in the Journal of Nutrition has revealed that “muscle protein synthesis averaged 25% higher when participants ate the evenly-divided protein diet than when on the diet skewed toward a protein-rich dinner.” The eight-participant study received funding from the National Institute on Aging.
Whey Protein May Lower Glucose in T2DM (HealthDay News) — For patients with well-controlled type 2 diabetes, consumption of whey protein pre-load before a high-glycemic index breakfast correlates with a reduction in glucose levels, higher insulin responses, and higher glucagon-like peptide-1 (GLP-1) levels, according to a study published online July 7 in Diabetologia.
Daniela Jakubowicz, MD, from Tel Aviv University in Israel, and colleagues examined whether enhancing GLP-1 secretion with whey protein pre-load would be beneficial in type 2 diabetes. Fifteen individuals with well-controlled type 2 diabetes, who were not taking medications except sulfonylurea or metformin, were randomized to receive 50g whey in 250ml water or placebo followed by a standardized high-glycemic index breakfast. Following meal ingestion, the authors assessed plasma concentration of glucose, intact GLP-1, and insulin concentrations.
The researchers found that glucose levels were reduced by 28% after whey pre-load over the 180-minute post-meal period, with a uniform reduction during early and late phases. With whey pre-load, insulin and C-peptide responses were significantly higher (105 and 43%, respectively), with a 96% increase in early insulin response. Whey pre-load correlated with significantly higher total and intact GLP-1 levels (141 and 298%, respectively). There was no significant between-group difference observed in dipeptidyl peptidase 4 plasma activity after breakfast.
"Whey protein may therefore represent a novel approach for enhancing glucose-lowering strategies in type 2 diabetes," the authors write.
Full Text (subscription or payment may be required)
Biking Tied to PCa, But Not Reproductive Health A new study fuels the ongoing debate over the health risks of bicycle riding for men: Researchers found that cyclists who bike more may face a higher risk of prostate cancer, but not a greater chance of infertility or erectile dysfunction. The study appeared in the the Journal of Men's Health.
Researchers surveyed more than 5,000 male cyclists from 2012 to 2013. Eight percent of the men reported erectile dysfunction problems, although they weren't more common in men who biked more. The investigators did find links between erectile dysfunction and three factors -- high blood pressure, smoking, and older age. The researchers didn't find any link between more cycling and more cases of infertility, which 1 percent of the men reported.
Just under 1 percent of the men overall reported being diagnosed with prostate cancer. Those who biked the most, more than 8.5 hours a week, were much more likely to have prostate cancer than the other men. Of the 498 men who biked the most, 17 said they had prostate cancer (3.5 percent). Of those who biked the least, three out of 511 (0.5 percent) said they had prostate cancer, the findings showed.
However, the findings aren't definitive, and they conflict with previous research on impotence and infertility. Lead author Milo Hollingworth, M.B.B.S., a research associate at University College London, acknowledged to HealthDay that the findings are "difficult to interpret."
He stressed that "men shouldn't worry about increasing their risk of prostate cancer by cycling. Men should cycle as much as they did before. The benefits for your heart, lungs, whole body, and mental health are much more important."
Charge Up on Cherries Before Cycling
Cyclists who drank Montmorency tart cherry juice concentrate before a three–day simulated race experience less inflammation and oxidative stress.
Strenuous exercise can cause temporary inflammation and oxidative stress that can lead to muscle damage, muscle soreness and reduced capacity to recover quickly. Previous studies have found that tart cherries may exert beneficial effects on recovery following weight lifting exercise and marathon running. Glyn Howatson from Northumbria University (United Kingdom), and colleagues assessed the effects of Montmorency tart cherry juice concentrate on recovery following strenuous exercise from cycling. The researchers gave 16 well-trained, male cyclists about 1 ounce (30 ml) of Montmorency tart cherry juice concentrate mixed with water (equivalent to 90 whole Montmorency tart cherries per serving), or a calorie-matched placebo, twice a day for seven days. On days five, six and seven, the participants performed prolonged, high-intensity cycling intervals – exercise that was designed to replicate the demands of a three-day race. The team collected blood samples and found that markers of inflammation and oxidative stress were significantly lower in the cyclists who consumed the tart cherry juice concentrate compared to those who did not. At one point during the trial, oxidative stress was nearly 30% lower in the tart cherry group compared to the other group. The study authors conclude that: “The attenuated oxidative and inflammatory responses suggest [Montmorency tart cherry concentrate] may be efficacious in combating post-exercise oxidative and inflammatory cascades that can contribute to cellular disruption.”
http://www.choosecherries.com/press-material/new-study-demonstrates-impact-of-montmorency-tart-cherries-on-inflammation-and-oxidative-stress-after-high-intensity-cycling/
Running News: Short Distances Count; Heat Stroke a Bigger Danger Than Arrhythmia
Running just 5 minutes a day can extend one's life span. For endurance runners, heat stroke may be a bigger danger than cardiac disorders. These are the lessons learned from two new studies in the Journal of the American College of Cardiology.
In the first, researchers analyzed data from more than 55,000 adults. Compared with people who did not run, runners had a 30% reduction in all-cause mortality and a 45% reduction in cardiovascular mortality, resulting in a 3-year increase in life expectancy. Findings did not differ significantly based on running distance, duration, speed, or frequency. Editorialists advise physicians to offer a simple exercise prescription to patients: "15 min of brisk walking or 5 min of running is all it takes for most clinic patients."
In the second study, researchers retrospectively reviewed data from more than 137,000 runners who participated in endurance races in Tel Aviv. They found only two serious cardiac cases: one myocardial infarction and one hypotensive supraventricular tachycardia. However, serious cases of heat stroke (core body temperature above 104-105 degrees associated with multiorgan dysfunction) occurred in 21 runners; two cases were fatal, and 12 were life-threatening. The researchers say the diagnosis of heat stroke can be missed and mistaken for a cardiac disorder unless the core temperature — which can only be reliably obtained with a rectal measurement — is taken immediately.
JACC article on running 5 minutes a day (Free abstract)
JACC editorial on running and mortality (Subscription required)
JACC article on heat stroke (Free abstract)
JACC editorial on heat stroke (Subscription required)
Fitness in 50s Is An Anti–Aging Essential
Poor physical ability in your 50s may raise your risk of an early death
In a first-of-its-kind study to link physical ability of men and women in their 50s with the likelihood of dying, Rachel Cooper, from University College London (United Kingdom) and colleagues warn that poor physical capacity in midlife may raise a person’s risk of premature death. The team assessed data collected on 1,355 men and 1,411 women, all age 53 years when their fitness was measured, who were enrolled in the MRC National Survey of Health and Development in England, Scotland, and Wales. A visiting nurse assessed each participant’s ability to perform three physical tests. One test gauged hand grip strength, another evaluated a person’s ability to balance on one foot and the third noted the time it took the participant to stand up from a chair. The researchers then followed the participants for the next 13 years, using information from the National Health Service register to find out which had died. They took into account other factors that could influence the risk of death, including smoking, body size and a history of illnesses such as heart and lung problems at age 53. With 177 deaths during the follow-up period, the data suggested that the participants who performed in the lowest one-fifth on the tests were almost four times as likely to die during follow-up as people who completed the tasks best. Those who couldn’t perform any of the tests were more than eight times as likely to die as the top performers. Observing that: "Lower levels of physical capability at age 53 and inability to perform capability tests are associated with higher rates of mortality,” the study authors submit that: “Even at this relatively young age these measures identify groups of people who are less likely than others to achieve a long and healthy life.”
http://www.reuters.com/article/2014/05/08/us-physical-ability-death-idUSKBN0DO12W20140508
Study shows walking may improve Parkinson’s symptoms. The Los Angeles Times (7/3, Macvean) reports that “in yet another endorsement for getting on your feet and walking, researchers said Wednesday that people with mild to moderate Parkinson’s disease may improve their motor function, mood, fatigue levels and more by taking regular aerobic walks.” The research was published in the journal Neurology.
NBC News (7/3) reports that study author Dr. Ergun Uc of the University of Iowa and the Veterans Affairs Medical Center of Iowa City, said, “The results of our study suggest that walking may provide a safe and easily accessible way of improving the symptoms of Parkinson’s disease and improve quality of life.”
Fox News (7/2) reports that “researchers noted that safety was the biggest priority in their study and that they were very selective in choosing their participants.” Dr. Uc commented, “Our exercise program was administered after a careful selection of candidates who did not have dementia, who were able to walk independently without a cane or walker, and who did not have heart or lung disease or other serious medical/orthopedic problem.”
Also reporting this story are Reuters (7/3, Doyle), HealthDay (7/3), and MedPage Today (7/3).
Omega-3s Reduce Deadly Blood Clot Risks
A diet abundant in fish, combined with omega-3 fatty acid supplementation, may reduce the risk of venous thromboembolism by nearly 50%.
Encompassing the conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE), venous thromboembolism (VTE) is the third most common cardiovascular illness after acute coronary syndrome and stroke. IJ Hansen-Krone, from University of Tromso (Norway), and colleagues analyzed data collected on 23,621 men and women , ages 25 to 97 years, who were enrolled in the Tromso Study which followed subjects for an average of 16 years. During this period, there were 536 documented cases of VTE. Through data analysis, researchers ascertained that those participants who ate three or more servings of fish per week reduced their risk of VTE by 22%. Adding fish oil dietary supplements further enhanced the dietary benefits, with omega-3 dietary supplement consumers experiencing a 48% lower risk of VTE. The study authors conclude that: “a high weekly intake ([at or more than] 3 times/wk) of fish was associated with a slightly reduced risk of [venous thromboembolism], and the addition of fish oil supplements strengthened the inverse effect.”
http://www.nutraingredients-usa.com/Research/Omega-3s-heart-health-Fish-and-supplements-may-slash-venous-thromboembolism-risk-says-new-study/
Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life
The Journal of Sexual Medicine, 07/09/2014 Clinical Article Yassin DJ, et al. – Long–term testosterone undecanoate (TU) in men with Late–onset hypogonadism (LOH) and erectile dysfunction (ED) reduces obesity parameters and improves metabolic syndrome and health–related quality of life.
CONCLUSION: Long-term TU in men with LOH and ED reduces obesity parameters and improves metabolic syndrome and health-related quality of life.
http://www.ncbi.nlm.nih.gov/pubmed/24712761
Long-term associations of nut consumption with body weight and obesity
American Journal of Clinical Nutrition, 07/09/2014 Clinical Article Jackson CL, et al. – This study suggests that high consumption of nuts (especially walnuts) has been associated with lower diabetes risk. Therefore, regular consumption (approximately one handful daily) of nuts over the long term, as a replacement to less healthful foods, can be incorporated as a component of a healthy diet for the prevention of obesity and type 2 diabetes.
http://www.ncbi.nlm.nih.gov/pubmed/24898229
Mushrooms Stabilize Blood Sugar
Consuming portabella mushrooms may help to decrease the post–meal glycemic response.
Low in calories, fat-free, and abundant in Vitamin D, mushrooms are shown to promote healthy weight and boost immune function. Peter Horvath, from the University of Buffalo (New York, USA), and colleagues explored the consumption of portabella mushrooms among healthy men and women, on glucose levels. Enrolling 8 men and women, average age 23 years, with an average body fat of 19.7%, the subjects completed 3 modified Oral Glucose Tolerance Tests (OGTTs) over a two-week period. The OGTTs were evaluated in subjects who consumed one of three drinks, each equally sweet: a 75 g glucose drink; a 75 g glucose drink with 9.5 g portabella mushroom powder; or 9.5 g portabella mushroom powder with wstevia/flavored water. Fasting and 30-minute blood samples were collected for two hours. The data revealed that glucose levels were elevated after consumption of both the glucose-only and glucose- mushroom beverages, with levels of the latter higher in men at 30 minute, and women at 60 and 120 minutes. Insulin levels were higher after both glucose-only and glucose-mushroom beverage consumption than after mushroom-stevia beverage consumption; as well after mushroom-stevia, insulin levels showed a more gradual decline in women. Observing that: “Mushroom powder reduced postprandial hypoglycemia, rapid insulin decrease and elevated hunger in women compared to glucose alone,” the study authors submit that: “Mushrooms may moderate postprandial glucose related responses.”
http://medicalxpress.com/news/2014-05-benefits-mushroom-consumption.html
Glycated hemoglobin for the diagnosis of diabetes and prediabetes: Diagnostic impact on obese and lean subjects, and phenotypic characterization
Journal of Diabetes Investigation, 07/09/2014 Clinical Article Incani M, et al. – The aims of the present study were to evaluate the impact of glycated hemoglobin (HbA1c) criteria to diagnose diabetes and prediabetes compared with oral glucose tolerance test (OGTT), and to examine HbA1c in relation to body mass index. The agreement between HbA1c, fasting plasma glucose and 2–h glucose post–OGTT for the diagnosis of prediabetes was poor in the Italian population; whereas HbA1c ≥6.5% showed a relatively good agreement with OGTT for the diagnosis of diabetes. For the first time, the authors have shown that obesity class influences the diagnostic performance of HbA1c.
Methods
Treatment of the obese type 2 diabetes patient with severe insulin resistance: a 24-week, prospective, randomized, open-label, treat-to-target study: A pilot study to compare the efficacy of U-500 regular insulin plus metformin with U-500 regular insulin, metformin, and exenatide
Endocrine Practice, 07/09/2014 Clinical Article Distiller LA, et al. – The study aims to compare the efficacy of U–500 regular insulin plus metformin with U–500 regular insulin, metformin, and exenatide in improving glycaemic control in patients with severely insulin resistant Type 2 diabetes mellitus [T2DM]. U–500 regular insulin plus metformin is effective for the treatment of T2DM patients with severe insulin resistance. The addition of exenatide may ameliorate potential weight gain but provides no additional improvement in glycaemia.
Methods
http://onlinelibrary.wiley.com/doi/10.1111/jdi.12241/abstract;jsessionid=B655B562D2F22A2DA3A31A08D64D7B76.f02t01
Coffee Deters DNA Damage
Consuming dark-roast coffee appears to reduce levels of spontaneous DNA strand breaks.
Previously, studies have suggested that regular coffee consumption decreases oxidative damage in peripheral white blood cells. T. Bakuradze, from the University of Kaiserslautern (Germany), and colleagues investigated the consumption of a dark-roast coffee blend on the level of spontaneous DNA strand breaks. The researchers enrolled 84 healthy men to consume daily for 4 weeks either 750 ml of fresh coffee brew or 750 ml of water, subsequent to a run in washout phase of 4 weeks. The study coffee was a blend providing high amounts of both caffeoylquinic acids (10.18 ± 0.33 mg/g) and the roast product N-methylpyridinium (1.10 ± 0.05 mg/g). Before and after the coffee/water consumption phase, the researchers conducted assays to assess for spontaneous DNA strand breaks. Whereas at the study’s start, both groups exhibited a similar level of spontaneous DNA strand breaks – in the intervention phase, spontaneous DNA strand breaks slightly increased in the control (water only) group whereas they significantly decreased in the coffee group, leading to a 27 % difference. Observing that: “The consumption of the study coffee substantially lowered the level of spontaneous DNA strand breaks in [white blood cells,” the study authors write that: “We conclude that regular coffee consumption contributes to DNA integrity.”
http://www.nutraingredients-usa.com/Research/Could-coffee-protect-DNA-from-damage/
Chia Seeds Sprout Nutritional Benefits Most of us have had the dubious pleasure of receiving a Chia Pet as a “gift” at one time or another. These odd-looking clay figurines grew miraculous thick, green, curly “hair” from hundreds of tiny chia seeds when the clay had been moistened for several days.
The seeds stayed moist and sprouted quickly, in large part due to their hydrophilic nature. Chia seeds can absorb and retain up to 27 times their weight in water.
For the majority of gift recipients, the fun died quickly, as did the Chia Pet's hair. There seemed to be no point in trying to maintain the green locks beyond a few days. However, an expanding interest in chia seeds just may have us all trying to grow Chia Pets.
Background
Today's market for the nutritious chia seed would probably come as absolutely no surprise to the ancient peoples of southern Mexico and Central America. Civilizations such as those of the Aztec and Mayan Indians grew chia as a dietary staple.
Unless otherwise specified, the term “chia” usually refers to the chia species Salvia hispanica.1 S. hispanica is a rapidly growing biennial plant well-suited to arid climates and poor, sandy soil.1 Growing to a height of about 36 inches, the plant flowers in long clusters of deep blue and purple. The tiny seeds measure no more than 2 mm and are usually brown or black.
One chia plant can produce thousands of seeds. These seeds are composed of up to 40% oil, with the remaining structure high in protein and fiber. In today's use of chia, it is the oil that is of particular interest.
Science
Nutritionally, chia seed oil is more than 60% alpha-linolenic acid (ALA).2 This makes chia oil one of the highest in composition of this rich omega-3 fatty acid among all oil-bearing seeds. Research involving both chia seeds and chia oil verified that plasma ALA levels increased up to 91% at 2.5 hours postingestion and stayed elevated for nearly 24 hours.3
The role of omega-3 fatty acids in human health has been debated for many years. Even though the necessity of these compounds for health and well-being has never been disputed, the optimal recommended amount in daily foods and supplements is not as clear.
Unlike some other oil-bearing seeds, chia seeds do not require grinding for their oils to be released.4This characteristic makes them a more appealing ingredient in health-food snacks and cereals. A quarter-cup of chia seeds contains approximately 8mg of iron and 10g of fiber.
Chia seeds are being studied as a weight-modifying food. In one study of 62 overweight women (BMI ≥25), the participants were randomized to consume either 25g/day of chia seeds or placebo for a period of 10 weeks.5 Although plasma ALA levels increased significantly in the chia-seed group, these individuals had no statistically significant weight loss or change in body-fat percentage.
Summary
Very seldom does a product with very little downside surface. In the case of chia seeds, there seems to be mostly good news, without any bad news. As long as patients are counseled regarding the always present potential for allergy, chia seed compounds represent a healthy and tasty way to boost beneficial fatty acids and fiber.
http://www.empr.com/chia-seeds-sprout-nutritional-benefits/article/358667/2/
Defeat Diabetes in Two Minutes
High intensity training consisting of two minutes of exercise weekly, may help to prevent type–2 diabetes.
High intensity training, abbreviated as HIT, is a fitness regime characterized by short bursts of intensive physical activity. John Babraj, from Abertay University (United Kingdom), and colleagues enrolled 3 male and 11 female untrained individuals, average age 42 years, average BMI 24 -29 kgm2, to perform twice weekly exercise consisting of 10 × 6-second sprints with a one minute recovery between each sprint. The team assessed metabolic health (oral glucose tolerance test), aerobic capacity (incremental time to exhaustion on a cycle ergometer) and physical function (get up and go test, sit to stand test and loaded 50 m walk), before and after training. The HIT regimen, lasting 8 weeks, resulted in a significant improvement in aerobic capacity (8% increase in VO2 peak), physical function, and a reduction in blood glucose under the curve (6% reduction). The study authors submit that: “This study demonstrates for the first time the potential of [high intensity training] as a training intervention to improve skeletal muscle function and glucose clearance as we age.”
http://medicalxpress.com/news/2014-05-diabetes-minutes-academics.html
Catheter ablation helps atrial fibrillation patients live longer The team, from the University of Michigan (U-M) at Ann Arbor, reports the findings in the journal Heart Rhythm.
Atrial fibrillation is an age-related heart rhythm disorder caused by electrical "short-circuits" in the heart that impair its ability to pump blood efficiently and cause fluttering sensations in the chest.
People with atrial fibrillation have a higher risk ofstroke and heart attacks, and they also suffer a considerably poorer quality of life.
According to the World Heart Federation, who describe the condition as a "growing and urgent public health concern," atrial fibrillation is the most common sustained abnormal heart rhythm condition worldwide.
In Europe and the US, there are currently estimated to be about 9 million people with atrial fibrillation, and numbers are set to increase.
Catheter ablation led to 60% lower rate of deaths from cardiovascular events A new long-term study suggests that adult patients with atrial fibrillation whose heart rhythm is successfully restored with a minimally invasive procedure called catheter ablation, have a significantly reduced chance of early death from a heart attack or heart failure.
Catheter ablation is a minimally invasive procedure where an electrophysiologist delivers radiofrequency energy to the heart muscle through a specially designed catheter inserted into the left atrium or chamber of the heart.
The intention is to disrupt the short-circuits that are causing the irregular heart rhythm.
The catheter is inserted with a needle into a vein that runs up to the heart from the groin. A three-dimensional mapping system on a computer helps the doctor guide the catheter precisely to the correct location in the heart.
In this latest study, the U-M researchers showed that death from cardiovascular events dropped by 60% among adults who had their normal heart rhythm successfully restored with catheter ablation.
Lead author Dr. Hamid Ghanbari, an electrophysiologist at U-M's Frankel Cardiovascular Center, says:
"The study findings show the benefit of catheter ablation extends beyond improving quality of life for adults with atrial fibrillation. If successful, ablation improves life span."
Even older patients, and those with other conditions benefited He and his colleagues found that even older patients gained the cardiovascular survival benefits of the procedure, as did those with diabetes or a history of stroke, or who had sleep apnea, or a condition known as low-ejection fraction - an early sign of heart failure where the heart does not pump enough blood.
In an accompanying editorial, that characterizes catheter ablation of atrial fibrillation as "a death-defying endeavor," the authors describe the study results as encouraging for those involved in treating the debilitating heart condition.
For their investigation, Dr. Ghanbari and colleagues examined 10 years of follow-up medical data on over 3,000 adults who had received catheter ablation as a treatment for paroxysmal atrial fibrillation - where the condition comes and goes on its own. Most of the participants, whose average age was 58 when they received the treatment, were men.
The study is thought to be the first and longest to examine the clinical outcomes of catheter ablation.
http://www.medicalnewstoday.com/articles/280396.php
The combination of elevated triglycerides and abnormal fasting glucose (AFG) increases risk of cerebral infarction in patients with mild to moderate hypercholesterolemia
Journal of Cardiovascular Pharmacology and Therapeutics, 07/12/2014 Clinical Article Nakagami T, et al. – The authors explored the combined effect of elevated triglycerides (TGs) and glucose on cardiovascular disease (CVD) in a post hoc analysis of the large–scale Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study. The findings contribute to the formulation of the hypothesis that patients with hypercholesterolemia having AFG plus high TGs have an increased risk of cerebral infarction. These are compatible with the result from the main study that patients with hypercholesterolemia randomized to diet plus pravastatin had a reduced risk of cerebral infarction.
CONCLUSIONS: Our findings contribute to the formulation of the hypothesis that patients with hypercholesterolemia having AFG plus high TGs have an increased risk of cerebral infarction. These are compatible with the result from the main study that patients with hypercholesterolemia randomized to diet plus pravastatin had a reduced risk of cerebral infarction.
http://www.ncbi.nlm.nih.gov/pubmed/24906541
Steroid injections may provide little benefit for spinal stenosis patients. The New York Times (7/2, Belluck, Subscription Publication) reports that a new study published Wednesday in The New England Journal of Medicine shows that “a widely used method of treating a common cause of back and leg pain — steroid injections for spinal stenosis — may provide little benefit for many patients.” The research involved “400 patients at 16 sites.” The Times notes that “mostly, steroid injections are safe,” although “in April, the Food and Drug Administration warned that they may, in rare cases, cause blindness, stroke, paralysis or death, noting that injections have not been F.D.A.-approved for back pain and their effectiveness has ‘not been established.’”
HealthDay (7/2, Reinberg) reports that lead author Dr. Janna Friedly, an assistant professor of rehabilitation medicine at the University of Washington in Seattle, said, “These steroid injections aren’t helpful. There is no added benefit to the steroid itself, so if people are considering these injections, I would recommend that they consider an alternative.”
Epidural Steroids Generally Are Ineffective for Lumbar Spinal Stenosis
A steroid-lidocaine combination is essentially no better than lidocaine alone for patients with symptomatic central lumbar spinal stenosis, according to a New England Journal of Medicine study.
U.S. researchers randomized 400 patients with symptomatic stenosis to receive an epidural injection of either lidocaine alone or lidocaine plus a glucocorticoid. All patients had moderate-to-severe pain and functional disability. About 40% of each group requested and received a second injection at 3 weeks.
During 6 weeks of follow-up, mean scores on pain and disability scales improved substantially in both the steroid and no-steroid groups. However, at 6 weeks, no significant differences were observed betweenthe groups for either of these primary outcomes. At 3 weeks, small, statistically significant differences favored the steroid group, but these differences were deemed clinically unimportant.
At best, epidural steroids provide minimal transient benefit for patients with painful, disabling central lumbar spinal stenosis. According to a recent meta-analysis, the same is true for epidural steroids in patients with sciatica. An editorialist notes that some insurance companies require epidural injections as part of nonsurgical treatment before spinal stenosis surgery is approved; that policy obviously is misguided.
NEJM article (Free abstract)
Lipid-lowering therapy in patients 75 years and older: clinical priority or superfluous therapy
Progress in Cardiovascular Diseases , 07/12/2014 Clinical Article Phan BAP, et al. The incidence and prevalence of cardiovascular (CV)-related morbidity and mortality significantly increase with age. In the elderly, hypercholesterolemia with elevated total and low-density-lipoprotein cholesterol is a significant predictor of incident and recurrent CV disease. Multiple lines of evidence have established the benefit of statin therapy to lower cholesterol levels and reduce the risk of CV events as well as prevent progression of subclinical atherosclerotic disease. Elderly patients, particularly those older than 75 years, have not been well represented in randomized clinical trials evaluating lipid lowering therapy. The limited available data from clinical trials do support the benefit of statin therapy in the elderly population. Based upon these data, cholesterol treatment guidelines endorse statin therapy as the primary treatment of hypercholesterolemia in elderly patients, though caution is recommended given the greater number of co-morbid conditions and concern for poly-pharmacy common in the elderly. Additional research is needed to better establish the benefit of statin therapy in the elderly within the context of reducing CV risk, minimizing side effects, and improving overall quality of life. http://www.onlinepcd.com/article/S0033-0620(14)00040-1/abstract?rss=yes?rss=yes
Preventing Gallstone Formation During Weight Loss Both obesity and rapid weight loss are associated with an increased risk of gallstones, but ursodeoxycholic acid (UDCA) and/or high-fat weight loss diets could reduce the risk of gallstones during weight loss. A study published in Clinical Gastroenterology and Hepatology analyzed 13 randomized controlled trials of 1,836 participants undergoing weight loss via dieting or bariatric surgery comparing UDCA or high-fat weight loss diets in reducing gallstone risk. Compared to control interventions, UDCA reduced gallstone risk and trials of diet alone had significantly larger effects compared to bariatric surgery. UDCA lowered the risk of cholecystectomy for symptomatic stones (risk ratio, 0.20; 95% CI, 0.07–0.53), as did diets high in fat content compared with low fat content (risk ratio, 0.09; 95% CI, 0.01–0.61). The authors conclude that based on these results, UDCA and/or high-fat weight loss diets appear to prevent gallstone formation.
http://www.cghjournal.org/article/S1542-3565(13)01837-5/abstract
Soothe Stress with Chocolate
Fifty grams of dark chocolate a few hours before a stressful event may reduce elevations in stress hormones.
Mounting scientific evidence suggest that consuming dark chocolate confers therapeutic health effects, most notably on cardiovascular parameters. Swiss researchers reveal that dark chocolate (125 mg of epicatechin) may reduce elevations in stress hormones, when consumed prior to a stressful event. The team enrolled 65 healthy men, ages 20 to 50 years, who received either 50 g of dark chocolate, or placebo, two hours before a stress test. While stress markers increased among both groups, the dark chocolate group showed blunted responses for cortisol and epinephrine. Observing that: “flavonoid-rich dark chocolate intake buffers endocrine stress reactivity,” the study authors posit that dark chocolate may exert “inhibitory peripheral effects … on the biosynthesis and secretion of cortisol and catecholamines.”
http://www.nutraingredients-usa.com/Research/Stressed-Try-some-dark-chocolate-say-Swiss-scientists
For PAD Patients, a Little Chocolate May Go a Long Way (HealthDay News) — Consumption of dark chocolate may improve walking autonomy in patients with peripheral artery disease (PAD), according to research published online July 2 in the Journal of the American Heart Association.
Lorenzo Loffredo, MD, of the Sapienza University of Rome, and colleagues randomly assigned 20 patients with PAD (14 males and six females; mean age, 69 ± 9 years) to 40g of dark chocolate (>85% cocoa) or 40g of milk chocolate (≤35% cocoa) in a single-blind, cross-over study.
At two hours after dark chocolate ingestion, the researchers observed significant increases (allP<0.001) in maximal walking distance (+11%), maximal walking time (+15%), and serum levels of nitrite/nitrate (NOx) (+57%). They also observed significant decreases in serum levels of isoprostanes (−23%; P=0.01) and sNOX2-dp, a marker of blood NOX2 activity (−37%; P<0.001). No significant changes in these variables were observed after ingestion of milk chocolate. Serum levels of epicatechin and its methylated metabolite increased significantly following ingestion of dark, but not milk, chocolate.
"In conclusion, the results of this study suggest that short-term administration of dark chocolate improves walking autonomy with a mechanism involving its high content of polyphenols and perhaps mediated by an oxidative stress mechanism, which ultimately leads to enhanced nitric oxide generation," the authors write.
Full Text
Smart Dietary Choices to Avoid Stroke
People with diets higher in protein, especially from fish, may be less likely to have a stroke.
Numerous published studies report that a diet abundant in colorful fruits and vegetables may lower stroke risk. Xinfeng Liu, from Nanjing University School of Medicine (China), and colleagues completed a meta-analysis of 7studies with a total of 254,489 participants who were followed for an average of 14 years. The data revealed that the participants with the highest amount of protein in their diets were 20% less likely to develop a stroke, as compared to those with the lowest amount of protein in their diets. For every additional 20 grams per day of protein consumed, the risk of stroke decreased by 26%. The team advises, however, the protein of-choice is fish, and that red meat consumption should be limited, in accordance with other published studies associating it with increased stroke risk. The study authors conclude that: “These findings suggest that moderate dietary protein intake may lower the risk of stroke.”
http://medicalxpress.com/news/2014-06-diet-higher-protein-linked.html
High Red Meat Intake During Early Adulthood Is Associated with Elevated Risk for Breast Cancer
Farvid MS et al., BMJ 2014 Jun 10; 348:g3437
Substituting other sources of protein for red meat might lower risk.
In the Nurses' Health Study, red meat intake during early adulthood was associated with excess risk for breast cancer in premenopausal women after 12 years of follow-up. Now, the same investigators report on associations between dietary protein intake during early adulthood and risk for breast cancer after 20 years of follow-up; analysis involved 89,000 premenopausal nurses (mean age, 36) who completed dietary questionnaires at baseline.
More than 2800 cases of breast cancer were documented. Adjusted for multiple potential confounders, the highest median intake of red meat versus the lowest median intake (1.5 servings daily vs. about 1 serving weekly) was associated significantly with elevated risk for breast cancer overall (relative risk, 1.2). In contrast, higher intakes of poultry, fish, eggs, legumes, and nuts were not associated with elevated risk. When data were analyzed by menopausal status, higher poultry intake was associated with lower risk for breast cancer in postmenopausal women (RR, 0.7), but not in premenopausal women. The authors estimated that substituting one serving daily of legumes, poultry, or a combination of legumes, nuts, poultry, and fish for one serving daily of red meat was associated with significantly lower risks for breast cancer.
USPSTF Finalizes Recommendations on Carotid Artery Stenosis Screening
The U.S. Preventive Services Task Force has recommended against screening for asymptomatic carotid artery stenosis in the general adult population (grade D recommendation). Published in the Annals of Internal Medicine, the statement reiterates the group's 2007 guidance.
The harms of screening outweigh the benefits, the task force says. The groups notes that all screening strategies (e.g., ultrasonography, magnetic resonance angiography) "have imperfect sensitivity and could lead to unnecessary surgery and result in serious harms, including death, stroke, and myocardial infarction."
The recommendation applies to adults without histories of transient ischemic attack, stroke, or other neurologic symptoms.
USPSTF's recommendation statement in the Annals of Internal Medicine (Free)
Annals of Internal Medicine review (Free)
Annals of Internal Medicine editorial (Free)
USPSTF grades (Free)
USPSTF Publishes Pocket Guide to Preventive Care
The U.S. Preventive Services Task Force has published "The Guide to Clinical Preventive Services," a pocket guide with abridged versions of the group's recommendations on screening, counseling, and preventive medicine. The guide covers dozens of topics for children and adults, from abdominal aortic aneurysm screening to vitamin supplements for primary disease prevention.
USPSTF guide (Free)
USPSTF: No Asymptomatic Carotid Artery Stenosis Screening (HealthDay News) — The U.S. Preventive Services Task Force (USPSTF) recommends against screening for carotid artery stenosis in adults without a history of transient ischemic attack, stroke, or other neurological symptoms. These findings are presented in a final recommendation statement published online July 8 in the Annals of Internal Medicine.
Michael L. LeFevre, MD, MSPH, on behalf of the USPSTF, updated the 2007 recommendations on carotid artery stenosis screening. They commissioned a systematic evidence review to examine the accuracy of screening tests and externally validated risk stratification tools; the benefits and harms of asymptomatic carotid artery stenosis treatment with carotid endarterectomy or carotid angioplasty and stenting; and the benefits and harms of medications added to current standard medical treatment.
Based on the current evidence, the researchers recommend against asymptomatic carotid artery stenosis screening in the general adult population (Grade D recommendation). The findings apply to adults without a history of transient ischemic attack, stroke, or other neurological signs or symptoms.
"Such screenings are offered throughout the country in health fairs and other settings," writes the author of an accompanying editorial. "Potential consumers of these services should be aware that the test is unlikely to prevent them from having a stroke or to lead to improvements in their health."
Guideline Calls Routine Pelvic Exams Unnecessary
Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, an influential medical group said Monday.
There is no evidence that such pelvic exams are useful and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, the American College of Physicians said in a new practice guideline for doctors.
The college’s guideline was published in the Annals of Internal Medicine and was accompanied by an article reviewing the scientific evidence. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor’s office with medical complaints or who are pregnant.
“The pelvic exam has become a yearly ritual, but I think it’s something women don’t necessarily look forward to,” said Dr. Sandra Adamson Fryhofer, an internist in Atlanta who is a former president of the college. “A lot of women dread it.”
The new recommendation contradicts guidelines from the American College of Obstetricians and Gynecologists, which immediately reiterated its support for yearly pelvic exams.
A pelvic exam consists of three elements: inspection of the external genitalia, examination of the vagina and cervix, and the bimanual examination, in which the physician inserts two gloved fingers into a woman’s vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus, ovaries and fallopian tubes.
The exam takes up time during an annual physical and often requires the presence of a chaperone in the room, which raises costs.
The American College of Physicians reviewed studies of the procedure and concluded that pelvic exams were not accurate diagnostic screening tests for ovarian cancer. A dozen studies have suggested that many women experience pain or discomfort during the exams, and that they may be particularly traumatic for women who have been sexually assaulted.
The reviewers said that they could not even locate studies that had assessed whether routine pelvic exams of asymptomatic women could reduce death or disease from ovarian and other cancers, or benefit women with common benign conditions such as pelvic inflammatory disease, fibroids or warts.
Until about a decade ago, physicians routinely performed pelvic exams before prescribing oral contraceptives, and they used the exams to screen women for sexually transmitted infections and obtain cultures for testing. Those practices have largely been abandoned, and urine samples are now used to test for sexually transmitted infections.
In recent years some experts have suggested that pelvic exams are so discomforting that they may deter women from going to the doctor altogether.
Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose. But, they say, experienced physicians can use pelvic exams to find other problems, such as noncancerous fibroids, and to identify changes linked to urinary incontinence and sexual dysfunction.
“Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another,” said Dr. Barbara S. Levy, vice president for health policy at the obstetricians and gynecologists’ group.
“I’m not sure there’s evidence to support most of what we do on physical exams,” Dr. Levy added. “Lack of evidence does not mean lack of value.”
The new guideline comes as more routine procedures are critically evaluated in light of scientific studies, part of a move toward evidence-based medicine. Over the past few years, several new sets of guidelines have urged scaling back screening procedures for women in particular.
In 2009, the United States Preventive Services Task Force recommendedpostponing routine mammograms to detect breast cancer until age 50, provoking wide controversy. Many women have ignored the advice.
More recently, the task force, the American Cancer Society and the obstetricians and gynecologists’ group have recommended that, with some exceptions, women ages 21 to 65 should receive Pap smears every three years instead of annually.
Group recommends against routine pelvic exams.
Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis
American Journal of Clinical Nutrition, 07/16/2014 Review Article Evidence Based Medicine Afshin A, et al. – The authors systematically investigated and quantified associations of nut and legume consumption with incident ischemic heart disease (IHD), stroke, and diabetes. This systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.
Methods
CONCLUSION: This systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.
http://www.ncbi.nlm.nih.gov/pubmed/24898241
Lifelong Learning Leads to Longer Cognitive Acuity
Intellectual enrichment, starting early with education, in midlife with a stimulating career, and later in life with volunteerism and socializing, may help older men and women to preserve cognitive skills. Prashanthi Vemuri, from The Mayo Clinic (Minnesota, USA), and colleagues studied 1,995 men and women in their 70s and 80s, enrolled in The Mayo Clinic Study of Aging, who did not have dementia at the study’s start. Although education and employment seemed to be more important overall, mid- and later-life cognitive activity contributed to retention of cognitive skills with aging. .Those with less education early in life saw the largest benefit from mental stimulation in later life. As well, the team found that regardless of education and work history, people who engaged in challenging mental activities at least three times per week delayed the onset of cognitive decline by more than three years compared to those who did less. Reporting that: “Higher education/occupation scores were associated with higher levels of cognition … Higher levels of mid/late-life cognitive activity were also associated with higher levels of cognition, but the slope of this association slightly increased over time,” the study authors submit that: “Lifetime intellectual enrichment might delay the onset of cognitive impairment and be used as a successful preventive intervention to reduce the impending dementia epidemic.”
http://www.reuters.com/article/2014/06/23/us-cognitive-activity-dementia-idUSKBN0EY2KU20140623
How Do Fruits and Veggies Love Us? Let Us Count the Ways
The oft-cited five servings per day of fruits and vegetables was the optimal amount for limiting overall and cardiovascular mortality, but not cancer mortality, in a BMJ meta-analysis.
Culling data from 16 prospective, observational studies conducted since 1950, researchers found that the more fruits and vegetables people consumed each day (up to five total servings), the lower the risk for all-cause mortality. (A serving was defined as roughly 80 g, or 2.8 oz., of fruit or vegetable.)
In particular, for consumption of five servings versus no servings daily, the hazard ratio was 0.74 for all-cause mortality. Two servings of fruit and three of vegetables appeared to provide optimal benefits. In addition, each fruit or vegetable serving was associated with a 4% reduction in cardiovascular mortality. There was no significant association with cancer mortality.
BMJ article (Free)
Fragmented sleep may be as physically harmful as total lack of sleep. TIME (7/10, Hellmann) reports that according to a study published in the journal Sleep Medicine, “fragmented sleep could be as physically harmful as a total lack of sleep.” After studying “the sleep patterns of students using wristwatches that monitored when they were asleep or awake,” researchers “found that an interrupted night of sleep...is similar to having only four hours of consistent sleep.” People who had even one night of fragmented sleep experienced deleterious effects on their moods, cognitive ability and attention span.
Low Serum Vitamin D Level Is Associated with Excess Cardiovascular-Related Mortality
Schottker B et al., BMJ 2014 Jun 17; 348:g3656
Vitamin D levels were associated with cancer-related mortality only in patients with histories of cancer.
Sildenafil Use Is Associated with Elevated Risk for Melanoma
Li W-Q et al., JAMA Intern Med 2014 Jun 174:964
An association and biologic plausibility raise concerns, but change in practice would be premature.
Anti-Cancer Mechanism of Green Tea Revealed
Epigallocatechin gallate (EGCG) changes the metabolism of pancreatic cancer cells by suppressing the expression of an enzyme associated with cancer.
Lactate dehydrogenase A (LDHA) is an enzyme that is elevated in several human cancers, including pancreatic cancer. Wai-Nang Lee, MD, from the Los Angeles Biomedical Research Institute (LA BioMed; California, USA), and colleagues observe that epigallocatechin gallate (EGCG), the active biologic constituent in green tea, changes the metabolism of pancreatic cancer cells by suppressing LDHA expression. The researchers also found an enzyme inhibitor, oxamate, which is known to reduce LDHA activity, operated in the same manner: It also disrupted the pancreatic cancer cells metabolic system. The study authors submit that: “These results suggest that phytochemical [epigallocatechin gallate] and LDHA inhibitor oxamate confer their anti-cancer activities by disrupting the balance of flux throughout the cellular metabolic network.”
http://www.eurekalert.org/pub_releases/2014-05/labr-seh053014.php
Vitamin D Protects Against Liver Cancer
With an important role in liver function, Vitamin D may lower a person’s risk of hepatocellular carcinoma.
Liver cancers, hepatocellular carcinoma, and other sub-types, are collectively the sixth most common cancer and third highest cause of cancer-related deaths worldwide. Vitamin D has been shown to play an important role in liver function. Veronika Fedirko, from Emory University (Georgia, USA), and colleagues analyzed data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, involving over 520,000 participants from Western Europe. The study included 138 subjects that developed hepatocellular carcinoma between 1992 and 2010, after recruitment into the cohort. Each case was matched to a control by age, sex, study center, date and time of blood collection and fasting status. Blood vitamin D levels were measured by state-of-the-art liquid chromatography and tandem mass spectrometry. Findings indicated that higher levels of vitamin D in the body cut the risk of hepatocellular carcinoma in half. The study authors write that: “In this prospective study on Western European populations, serum levels of [vitamin D] were inversely associated with risk of hepatocellular carcinoma.”
http://medicalxpress.com/news/2014-06-vitamin-d-liver-cancer-european.html
The effect of green tea on blood pressure and lipid profile: A systematic review and meta-analysis of randomized clinical trials
Nutrition, Metabolism & Cardiovascular Diseases, 03/27/2014 Review Article Evidence Based Medicine Onakpoya I, et al. – The aim of this systematic review was to evaluate the evidence for or against the effectiveness of green tea (Camellia sinensis) on blood pressure and lipid parameters. Green tea intake results in significant reductions in systolic blood pressure, total cholesterol, and LDL cholesterol. The effect size on systolic blood pressure is small, but the effects on total and LDL cholesterol appear moderate. Longer–term independent clinical trials evaluating the effects of green tea are warranted.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24675010
Diabetes mellitus influences on cancer risk
Diabetes/Metabolism Research and Reviews, 07/10/2014 Review Article Szablewski L – Diabetes mellitus and cancer are common conditions, and their co–diagnosis in the same individual is not infrequent. The relative risks associated with type 2 diabetes are greater than twofold for liver, pancreatic, and endometrial cancer. Obtained results showed that patients with type 1 diabetes had elevated risks of cancers of the stomach, cervix, and endometrium. Type 1 diabetes is associated with a modest excess cancer risk overall and risks of specific cancers that differ from those associated with type 2 diabetes.
http://www.ncbi.nlm.nih.gov/pubmed/25044584
Consumption of fruits, vegetables, and seaweeds (sea vegetables) and pancreatic cancer risk: The Ohsaki Cohort Study
Cancer Epidemiology, 07/01/2014 Clinical Article Shigihara M, et al. – Studies on the effects of consumption of fruits, vegetables, and seaweeds on the incidence of pancreatic cancer are not conclusive. Total consumption of fruits, vegetables, and seaweeds was not associated with a reduced risk of pancreatic cancer.
http://www.ncbi.nlm.nih.gov/pubmed/24522236
Study warns processed food could hurt immune system. TIME (7/1) reported processed and fast food could cause health problems “such as increased inflammation, reduced control of infection, increased rates of cancer” and increased risk of allergy, citing a study unveiled in Nutrition Journal. In addition, “poor dietary choices get ‘encoded’ into both DNA scaffolding and into the gut microbiome,” which means that “food and lifestyle choices can permanently change the balance of bacteria in our bodies and can weaken the immune system.” Dr. Ian Myles, the study’s author and a doctor at the National Institute of Allergy and Infectious Diseases, noted that he was surprised by how heavily gut bacteria determined a child’s health. “Our bodies are a kind of mini-ecosystem, and anything that disturbs our bacteria can alter our health in profound ways,” he said.
Milk alternatives represent fastest-growing part of US dairy market. The Washington Post (7/5) reported that “milk alternatives make up just eight percent of overall milk sales in the United States, but for the past few years, they’ve represented the fastest-growing part of the dairy market, according to Mintel, a Chicago-based research firm.” These alternatives, which are often plant- or nut-based, “can be a saving grace for people with food allergies or lactose intolerance, or those who follow vegan diets.” The piece pointed out that “an estimated 12 percent of Americans suffer from lactose intolerance, according to the National Institutes of Health.”
Avoidance of sun exposure is a risk factor for all-cause mortality: results from the MISS cohort
Journal of Internal Medicine, 04/22/2014 Evidence Based Medicine Clinical Article Lindqvist PG, et al. – The results of this study provide observational evidence that avoiding sun exposure is a risk factor for all–cause mortality. Following sun exposure advice that is very restrictive in countries with low solar intensity might in fact be harmful to women's health.
Lindqvist PG1, Epstein E, Landin-Olsson M, Ingvar C, Nielsen K, Stenbeck M, Olsson H.
Author information Abstract BACKGROUND: Sunlight exposure and fair skin are major determinants of human vitamin D production, but they are also risk factors for cutaneous malignant melanoma (MM). There is epidemiological evidence that all-cause mortality is related to low vitamin D levels.
METHODS: We assessed the avoidance of sun exposure as a risk factor for all-cause mortality for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 and were aged 25 to 64 years at the start of the study. We obtained detailed information at baseline on their sun exposure habits and potential confounders. Multivariable flexible parametric survival analysis was applied to the data.
RESULTS: There were 2545 deaths amongst the 29 518 women who responded to the initial questionnaire. We found that all-cause mortality was inversely related to sun exposure habits. The mortality rate amongst avoiders of sun exposure was approximately twofold higher compared with the highest sun exposure group, resulting in excess mortality with a population attributable risk of 3%.
CONCLUSION: The results of this study provide observational evidence that avoiding sun exposure is a risk factor for all-cause mortality. Following sun exposure advice that is very restrictive in countries with low solar intensity might in fact be harmful to women's health.
http://www.ncbi.nlm.nih.gov/pubmed/24697969
Melatonin dietary supplement as an anti-aging therapy for age-related bone loss. Tresguerres IF1, Tamimi F, Eimar H, Barralet J, Prieto S, Torres J, Calvo-Guirado JL, Fernández-Tresguerres JA.
Introduction: Previous studies have shown that melatonin, an antioxidant molecule secreted from the pineal gland, is a positive regulator of bone mass. However, melatonin potential effects on bone mass have never been investigated in old population yet. The aim of this study was to assess the effects of dietary melatonin supplementation on mass accrual and biomechanical properties of old rat femora. Methods: Twenty 22-months-old male Wistar rats were divided into 2 randomly assigned groups. The first group was treated for 10 weeks with melatonin, whereas the second group left untreated (control). Rat femurs were collected, and their phenotypes and biomechanical properties were investigated by micro-computed tomography, histomorphometry and 3-point-bending test. Statistical analyses were performed by Student's two-tailed unpaired t-test. In all experiments, a value of p < 0.05 was considered significant. Results: Rats treated with melatonin had higher bone volume, bone trabecular number, trabecular thickness and cortical thickness in comparison to control group. Histomorphometric analyses confirmed the increase of bone volume in melatonin-treated rats. In agreement with these findings, melatonin-treated rats demonstrated with higher bone stiffness, flexural modulus and ultimate load compared to controls. Conclusion: These compelling results are the first evidence indicating that dietary melatonin supplementation is able to exert beneficial effects against age-related bone loss in old rats; improving the microstructure and biomechanical properties of aged bones.
Melatonin Could Help Nocturnal Pain From Shoulder Disorders (HealthDay News) — For patients with shoulder disorders such as a rotator cuff tear or frozen shoulder, melatonin may mediate nocturnal pain, according to a study published in the July 2 issue of The Journal of Bone & Joint Surgery.
Eunyoung Ha, MD, PhD, from Keimyung University in Daegu, South Korea, and colleagues examined whether melatonin mediates nocturnal pain in patients with a rotator cuff tear or frozen shoulder. They analyzed the expression of melatonin receptor 1A (MTNR1A) and 1B (MTNR1B) and of acid-sensing ion channel 3 (ASIC3) in subacromial bursa and joint capsule samples collected from 63 patients (21 with a rotator cuff tear, 22 with frozen shoulder, and 20 with shoulder instability [control group]).
The researchers found that, compared with the control group, MTNR1A, MTNR1B, and ASIC3 expression was significantly increased in both the rotator cuff tear and frozen shoulder groups. In primary cultured fibroblast-like synoviocytes treated with proinflammatory cytokines, interleukin-1β and tumor necrosis factor-α significantly stimulated MTNR1A and MTNR1B expression. ASIC3 expression and interleukin-6 (IL-6) production were induced with melatonin treatment at a physiological concentration (10nM). Melatonin-stimulated ASIC3 expression and IL-6 production were reversed with treatment with luzindole, a melatonin-receptor antagonist.
"Our study suggests that melatonin may play a role as a mediator of nocturnal pain with a rotator cuff tear or frozen shoulder, and this effect may be mediated via melatonin receptors," the authors write.
Abstract
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Incidence of lactic acidosis in patients with type 2 diabetes with and without renal impairment treated with metformin: a retrospective cohort study
Diabetes Care, 07/03/2014 Richy FF, et al. – The study aims to determine whether the use of metformin in type 2 diabetic patients with various kidney functions is associated with an increased risk of lactic acidosis (LA). The overall LA incidence rate for patients on metformin in this study was within the range of rates reported in the literature for patients with type 2 diabetes, and no significant difference was observed among patients with N, Mi, Mo, and Se function.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24879835
Metformin Use Decreases Risk of Prostate Cancer Diagnosis Use of the diabetes drug metformin is associated with a decreased risk of a prostate cancer (PCa) diagnosis, new findings suggest.
In a study of 12,226 men diagnosed with PCa and 122,260 population controls, Mark A. Preston, MD, of Massachusetts General Hospital in Boston, and colleagues found that men who used metformin had a significant 16% decreased risk of a PCa diagnosis in adjusted analyses compared with non-users. Among men who had undergone PSA testing in the previous year, metformin use was associated with a significant 34% decreased risk of a PCa diagnosis.
Diabetics on no medication or on other oral hypoglycemic agents did have a significant decrease in the risk of a PCa diagnosis, the researchers reported online ahead of print in European Urology.
The researchers identified study subjects using the Danish Cancer Registry and the Aarhus University Prescription Database.
In a previous Canadian study of older diabetic men published in the Journal of the National Cancer Institute (2013;105:1123-1131), researchers found no association between metformin use and PCa risk. The study included 5,306 PCa case subjects and 26,530 matched controls. A meta-analysis published in Cancer Epidemiology (2013;37:207-218) found that metformin can reduce the incidence of a number of cancers, but had no effect on PCa incidence.
Metformin May Improve Oncologic Outcomes in Bladder CA Patients Metformin therapy is associated with improved oncologic outcomes amongdiabetic patients undergoing radical cystectomy (RC) for bladder cancer, researchers reported at the Canadian Urological Association annual meeting in St. John's, Newfoundland.
In a retrospective study of 85 diabetic patients who underwent RC for muscle-invasive bladder cancer (MIBC) and high-risk non-muscle-invasive bladder cancer (NMIBC), Madhur Nayan, MD, of the University of Toronto, and colleagues found that those who used metformin had a significant 62% decreased risk of cancer recurrence and a significant 43% decreased risk of cancer-specific mortality compared with non-users in adjusted analyses. Dr. Nayan's team found no association between metformin use and overall survival. They also found no association between the use of other oral hypoglycemic and insulin and any of the previously mentioned outcomes.
Of the 85 patients in the study, 39 used metformin and 46 did not. The median follow-up was 50 months.
“The present study provides the longest reported follow-up for diabetic patients undergoing RC for MIBC and high risk NMIBC and is the first to demonstrate that metformin use is associated with improved oncologic outcomes in this patient population,” the authors concluded in a poster presentation.
With respect to study limitations, the researchers pointed to the relatively small number of patients and events. In addition, the metformin dose and duration of use prior to surgery was not assessed. The study also did not account for medication changes during follow-up.
In an interview with Renal & Urology News, Dr. Nayan noted that metformin has been evaluated for its chemopreventive effects in various malignancies, and randomized, controlled trials are underway looking at starting metformin in non-diabetic patients to improve their cancer treatment outcomes. Limited research is available, however, on the influence of metformin on bladder cancer outcomes.
“Our study suggests that metformin use among diabetic patients undergoing radical cystectomy is associated with improved relapse-free survival and bladder cancer specific survival,” Dr. Nayan said. “Given that metformin has demonstrated safety among non-diabetics, and given its low cost, further studies are warranted to evaluate potential therapeutic and preventative roles of metformin in patients with bladder cancer.”
At the 2014 American Urological Association annual meeting in Orlando, researchers reported on a study showing that diabetic prostate cancer (PCa) patients who took both metformin and a statin may be at lower risk of biochemical recurrence (BCR) after radical prostatectomy. Matthew Danzig, MD, and collaborators at Columbia University in New York analyzed data from 3,031 patients who underwent RP from 1987- 2010 and who had at least 6 months of follow-up. They excluded patients who received neoadjuvant or adjuvant therapy. The overall BCR rate was 23.7%. Diabetics had a rate of 30.5%, which was reduced to 28.3% with metformin use and 23.5% with statin use. Combined use further reduced the rate to 15%, similar to the 13% rate observed in non-diabetics who were taking statins.
A study published online ahead of print in European Urology found that metformin use is associated with a decreased risk of a prostate cancer diagnosis. In a study of 12,226 men diagnosed with PCa and 122,260 population controls, Mark A. Preston, MD, of Massachusetts General Hospital in Boston, and colleagues found that men who used metformin had a significant 16% decreased risk of a PCa diagnosis in adjusted analyses compared with non-users. Among men who had undergone PSA testing in the previous year, metformin use was associated with a significant 34% decreased risk of a PCa diagnosis. Diabetics on no medication or on other oral hypoglycemic agents did have a significant decrease in the risk of a PCa diagnosis.
The researchers identified study subjects using the Danish Cancer Registry and the Aarhus University Prescription Database.
Insulin or Sulfonylureas to Supplement Metformin in Patients with Diabetes?
Roumie CL et al., JAMA 2014 Jun 11; 311:2288
Insulin plus metformin was associated with higher all-cause mortality in a retrospective study.
Insulin, sulfonylureas often tied to ED visits, adverse events in seniors. The New York Times (7/1, Graham) “The New Old Age” blog reports that some aging patients with diabetes end up being switched to insulin or to medications called sulfonylureas, both of which greatly increase the risk of an older person’s blood sugar plunging, thereby “depriving the brain of oxygen and leading to collapse, loss of consciousness, and even death.” According to a studypublished in JAMA Internal Medicine in February, “among adults aged 65 and older, insulin and sulfonylurea drugs are the second most common medications associated with emergency department visits or hospitalizations and adverse drug events.’”
Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality
JAMA, 07/03/2014 Evidence Based Medicine Clinical Article Coresh J, et al. – The established chronic kidney disease (CKD) progression end point of end–stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of –57% or greater) is a late event. To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24892770
Angiotensin converting enzyme inhibitor usage and acute kidney injury: A secondary analysis of RENAL study outcomes
Nephrology, 07/03/2014 Clinical Article Wang AY, et al. – The current study indicate that acute kidney injury (AKI) is associated with increased mortality. However, the study confirms that in the RENAL study cohort, the use of ACEI during the study was not common and, after adjustment for time–dependent covariates, was not significantly associated with reductions in mortality.
CONCLUSION: In the RENAL study cohort, the use of ACEI during the study was not common and, after adjustment for time-dependent covariates, was not significantly associated with reductions in mortality. Further assessment of the effect of ACEI use in AKI patients is needed.
http://www.ncbi.nlm.nih.gov/pubmed/24894685
Patients Taking Lithium May Have Increased Risk of Renal Tumor Lithium-treated patients are at increased risk of renal tumors, according to French researchers.
In a retrospective study of 170 lithium-treated patients, renal tumors developed in 14 (8.2%) over a 16-year period. These tumors included 7 malignant and 7 benign tumors. The mean duration of lithium exposure at diagnosis was 21.4 years. The cancers included 3 clear-cell and 2 papillary renal cell carcinomas, 1 hybrid tumor with chromophobe and oncocytoma characteristics, and 1 clear-cell carcinoma with leiomyomatous stroma. The benign tumors included 4 oncocytomas, 1 mixed epithelial and stromal tumor, and 2 angiomyolipomas.
Lithium-treated patients had an incidence of renal tumors 7.5 times greater than that of the general French population, researchers reported in Kidney International (2014;86:184-190). Additionally, the researchers compared lithium-treated patients with chronic kidney disease (CKD) and a group of lithium-free CKD patients matched for age, sex, and estimated glomerular filtration rate. The frequency of renal cancer and oncocytoma was significantly higher in the lithium-treated group (4.1% vs. 0.3% and 2.4% vs. 0%, respectively).
Are Corticosteroids Effective for Cancer Pain? Conclusion MP 32 mg daily did not provide additional analgesia in patients with cancer receiving opioids, but it improved fatigue, appetite loss, and patient satisfaction. Clinical benefit beyond a short-term effect must be examined in a future study
http://jco.ascopubs.org/content/early/2014/07/02/JCO.2013.54.3926.short Organic foods found to have higher levels of antioxidants, lower levels of pesticides. The New York Times (7/13, Chang, Subscription Publication) reports that “a comprehensive review of earlier studies found substantially higher levels of antioxidants and lower levels of pesticides in organic fruits, vegetables and grains compared with conventionally grown produce.” The full findings will be published in the British Journal of Nutrition, and the Times notes that they “stop short of claiming that eating organic produce will lead to better health.”
The Huffington Post (7/12) reports that the study is “said to be the largest of its kind.” Lead study author Carlo Leifert said in a news release, “This study demonstrates that choosing food produced according to organic standards can lead to increased intake of nutritionally desirable antioxidants and reduced exposure to toxic heavy metals.” He added, “This constitutes an important addition to the information currently available to consumers which until now has been confusing and in many cases is conflicting.”
NPR (7/14, Charles) reports in its “The Salt” blog that antioxidants “can protect cells from the effects of aging, or from the sort of damage that can lead to cancer,” and study co-author Charles Benbrook, from Washington State University’s Center for Sustaining Agriculture and Natural Resources, “says this is a big reason why public health experts want us all to eat more fruits and vegetables.” Furthermore, “if organic produce provides more” antioxidants, “he says, ‘we think that’s a big deal.’”
A Blood Test That Can Predict Alzheimer's Disease? (HealthDay News) — A major advance has been made in creating a blood test to predict when at-risk people will develop Alzheimer's disease, according to scientists.
In a study that included more than 1,000 people, the British researchers identified proteins in the blood that were 87% accurate in forecasting which people with mild cognitive impairment would develop Alzheimer's within a year, BBC News reported.
The findings, published in the journal Alzheimer's and Dementia, will be used to improve studies of new drugs to treat Alzheimer's. "We want to be able to identify people to enter clinical trials earlier than they currently do and that's really what we've been aiming at," lead researcher Professor Simon Lovestone, of the University of Oxford in the United Kingdom, told BBC News.
However, the test may eventually be available for doctors to use on patients. "Having a protein test is really a major step forwards," Ian Pike, PhD, chief operating officer at Proteome Sciences in Cobham, U.K., told BBC News. "[It] will take several years and need many more patients before we can be certain these tests are suitable for routine clinical use; that process can start fairly quickly now."
Noninvasive eye exams may someday detect Alzheimer’s in earliest stages. The CBS Evening News (7/13, story 4, 2:00, Glor) reported that researchers have “announced the promising result of a study on a new test to pick up” signs of Alzheimer’s disease “years, if not decades, in advance. And they’re looking for the sign in an unusual place, the eye.”
The Washington Post (7/13, Kunkle) reported that according to two studies presented at the Alzheimer’s Association International Conference in Denmark, “noninvasive eye exams...might offer a way to identify Alzheimer’s in its early stages.” Researchers “investigated a possible link between levels of beta-amyloid in the eye — as detected by a new, relatively inexpensive imaging technology — and levels of the same protein in the brain, as seen through PET scans.” A second study “also found a link between levels of beta amyloid in the eye’s lens and inside the brain.”
The NBC News (7/14) website reported that by staining beta amyloid with “curcumin, a component of the common spice turmeric,” researchers “could detect it in the retina even before it began to accumulate in the brain.” The ability to detect Alzheimer’s years in advance may “mean earlier treatment, and could give people a chance to plan, said Maria Carrillo, vice president of medical and scientific relations at the Alzheimer’s Association.” Some medications for Alzheimer’s “work best early in the disease process,” Carrillo explained.
Also covering the studies are the Wall Street Journal (7/14, Wang, Subscription Publication), the CBS News (7/14, Dahler) website, and HealthDay (7/14, Preidt).
Reduced sense of smell may predict Alzheimer’s in people with mild memory problems. USA Today (7/13, Weintraub) reported that according to research to be presented at the Alzheimer’s Association International Conference in Denmark, “among people with mild memory problems, a reduced sense of smell effectively predicted who would go on to get Alzheimer’s.”
HealthDay (7/14, Gray) reports that a 215-participant study revealed that the “UPSIT/odor identification testing could theoretically be an affordable and quick screening test that could be followed up by more expensive, involved and accurate tests such as PET scans or cerebral spinal fluid studies” for the diagnosis of Alzheimer’s. A second study “found that among 757 participants, lower scores on the UPSIT smell test were associated with the transition to dementia and Alzheimer’s disease.” The underlying premise of both studies is that “the ability to smell is associated with the first cranial nerve, and is often one of the first things to be affected by cognitive decline.”
Inflammation and future risk of symptomatic heart failure in patients with stable coronary artery disease
American Heart Journal, 07/08/2014 Clinical Article Eisen A, et al. – The aims of this study were to evaluate the association between inflammatory markers and future HF risk in patients with stable CAD and to explore possible mediation by myocardial infarction (MI). Increased levels of CRP, fibrinogen, and WBC are independently related to the incidence of HF in patients with stable CAD
CONCLUSIONS: Increased levels of CRP, fibrinogen, and WBC are independently related to the incidence of HF in patients with stable CAD.
http://www.ncbi.nlm.nih.gov/pubmed/24766981
Diet and psoriasis, part I: Impact of weight loss interventions
Journal of the American Academy of Dermatology, 07/07/2014 Review Article Debbaneh M, et al. – In this study, the authors review the literature to examine the efficacy of weight loss interventions, both dietary and surgical, on psoriasis disease course. Obesity has been associated with a proinflammatory state and several studies have demonstrated a relationship between body mass index and psoriasis severity.
http://www.jaad.org/article/S0190-9622(14)01126-8/abstract?rss=yes?rss=yes
Adverse Effects of Thiazide Diuretics in Older Patients
Makam AN et al., J Am Geriatr Soc 2014 Jun 62:1039
Hyponatremia, hypokalemia, or decline in renal function occurred fairly frequently during the first 9 months of thiazide use.
Hyponatremia Linked to Hip Fracture Surgery New-onset hyponatremia is common following surgery for hip fractures, according to British researchers.
James Edward Rudge, MB, and Daniel Kim, MB, of City Hospital, Sandwell and West Birmingham Hospitals NHS Trust - Postgraduate Centre, Birmingham, UK, retrospectively studied 254 patients who underwent hip surgery in 2012.
The incidence of moderate (less than 135 mmol/L) and severe (less than 130 mmol/L) post-operative hyponatremia was 27% and 9%, respectively, the researchers reported online ahead of print in Age and Ageing.
Patients with moderate hyponatremia had a significantly longer hospital stay than normonatremic patients (30 vs. 21 days). Post-operative hyponatremia also was significantly associated with proton pump inhibitor use, selective serotonin re-uptake inhibitor use, and increasing number of medications.
Spironolactone use and higher hospital readmission for medicare beneficiaries with heart failure, left ventricular ejection fraction <45%, and estimated glomerular filtration rate <45 ml/min/1.73 m2
The American Journal of Cardiology, 07/08/2014 Clinical Article Inampudi C, et al. – The authors examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD. Among hospitalized patients with HFrEF and advanced CKD, spironolactone use was associated with higher all–cause readmission but had no association with all–cause mortality or HF readmission.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24846806
Does Heart Rate Affect Outcomes in Heart Failure Patients with Atrial Fibrillation?
Cullington D et al., JACC Heart Fail 2014 Jun 2:213
Resting heart rates were not associated with survival.
Lower heart rates are associated with better outcomes in patients with heart failure in sinus rhythm (SR). Is the same true for heart failure patients in atrial fibrillation (AF)? Between 1999 and 2010, investigators in the U.K. assessed 2039 patients with heart failure and left ventricle ejection fractions of ≤50%, 24% of whom were in AF at baseline. Of these, 841 were restudied after 1 year of treatment optimization; 22% were in AF. Mortality for all patients was assessed in 2011.
After median follow-up of 3.6 years, overall survival was shorter for patients in AF than for those in SR, but the difference was no longer significant after adjustment for other important clinical factors (e.g., age, sex, diabetes, heart failure class, medications). Among patients in SR, higher heart rates were associated with worse survival both before and after medical optimization, whereas resting heart rates were not associated with survival in patients with AF at either time point, although only seven patients had heart rates ≥110 beats per minute (bpm).
Insufficient sleep may affect fat cells, appetite and satiety hormones. USA Today (7/21, Hellmich, Today) reports that according to sleep scientists, “insufficient sleep affects appetite and satiety hormones as well as fat cells.” Not getting enough sleep is tied to “increased levels of a hunger hormone called ghrelin and decreased levels of the satiety/fullness hormone called leptin, which could lead to overeating and weight gain.” Insufficient sleep also “reduces fat cells’ ability to respond properly to the hormone insulin, which is crucial for regulating energy storage and use.”
Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis
The Lancet, 10/11/2013 Evidence Based Medicine Clinical Article Reid IR et al. – Findings from recent meta–analyses of vitamin D supplementation without co–administration of calcium have not shown fracture prevention, possibly because of insufficient power or inappropriate doses, or because the intervention was not targeted to deficient populations. Despite these data, almost half of older adults (older than 50 years) continue to use these supplements. Bone mineral density can be used to detect biologically significant effects in much smaller cohorts. Authors investigated whether vitamin D supplementation affects bone mineral density. Continuing widespread use of vitamin D for osteoporosis prevention in community–dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.
Methods
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61647-5/abstract?rss=yes
Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men Full Text
New England Journal of Medicine, 09/16/2013 Evidence Based Medicine Clinical Article Finkelstein JS et al. – Current approaches to diagnosing testosterone deficiency do not consider the physiological consequences of various testosterone levels or whether deficiencies of testosterone, estradiol, or both account for clinical manifestations. The amount of testosterone required to maintain lean mass, fat mass, strength, and sexual function varied widely in men. Androgen deficiency accounted for decreases in lean mass, muscle size, and strength; estrogen deficiency primarily accounted for increases in body fat; and both contributed to the decline in sexual function. The findings support changes in the approach to evaluation and management of hypogonadism in men.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24024838
Probiotics May Help Reduce Blood Pressure
Consuming probiotics may modestly improve blood pressure, according to a meta-analysis in Hypertension.
Researchers analyzed data from nine randomized, controlled trials including some 540 participants. Overall, the probiotic arms had a 3.56-mm Hg reduction in systolic blood pressure and a 2.38-mm Hg reduction in diastolic BP, relative to controls. Larger reductions in blood pressure were observed in trials in which baseline blood pressure was at least 130/85 mm Hg, when treatment lasted at least 8 weeks, and when the daily dose of probiotics contained a larger number of colony-forming units.
The authors note that although the treatment effect was "modest ... even a small reduction of BP may have important public health benefits and cardiovascular consequences." They conclude that their findings "suggest that probiotics may be used as a potential supplement for future interventions to prevent hypertension or improve BP control."
Hypertension article (Free abstract)
Energy drinks may increase desire to drink alcohol. TIME (7/18, Sifferlin) reports that research (7/18) published in Alcoholism: Clinical & Experimental Research suggests “that when people drink alcohol with energy drinks they have a stronger desire to keep drinking compared to people who just drank a vodka soda.” In the study, investigators “assigned 75 participants between the ages 18 and 30 to either just drink alcohol, or drink an alcohol and energy drink combination.”
Newsweek (7/18, Mejia) reports that study “participants were asked to take an Alcohol Urge Questionnaire 20 minutes before and after imbibing the libation to indicate how strong their desire was to continue drinking.” Individuals “who drank the alcohol and energy drink combo reported a greater increase in the urge to continue drinking alcohol than the group drinking only vodka.” Additionally, “the energy drink consumers...reported liking the cocktail more and wanting to drink more of it than those who only drank the vodka cocktail.”
The Today Show Online (7/18, Carroll) reports that Rebecca McKetin, the study’s lead author, said that the “findings suggest that energy drinks may increase the risk of people drinking to intoxication and consequently increase the risk of alcohol-related problems like drunk driving and alcohol-fueled violence.” Also covering the story are Reuters (7/18, Seaman) and HealthDay (7/18, Mozes).
A randomised, multicentre, double blind, placebo controlled trial to evaluate the efficacy and safety of cilostazol in patients with vasospastic angina
Heart, 07/17/2014 Exclusive Author Commentary Evidence Based Medicine Clinical Article Shin ES, et al. – Cilostazol has been shown to induce vascular dilatation, but its efficacy in patients with VSA is unknown. Authors conducted a randomised, double blind, placebo controlled trial to assess the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase 3, in patients with vasospastic angina (VSA). Cilostazol is an effective therapy for patients with VSA uncontrolled by conventional amlodipine therapy, and has no serious side effects.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24934484
Resveratrol levels and all-cause mortality in older community-dwelling adults
JAMA Internal Medicine, 05/13/2014 Evidence Based Medicine Clinical Article Semba RD, et al. – Resveratrol, a polyphenol found in grapes, red wine, chocolate, and certain berries and roots, is considered to have antioxidant, anti–inflammatory, and anticancer effects in humans and is related to longevity in some lower organisms. To determine whether resveratrol levels achieved with diet are associated with inflammation, cancer, cardiovascular disease, and mortality in humans. In older community–dwelling adults, total urinary resveratrol metabolite concentration was not associated with inflammatory markers, cardiovascular disease, or cancer or predictive of all–cause mortality. Resveratrol levels achieved with a Western diet did not have a substantial influence on health status and mortality risk of the population in this study.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24819981
Again, Niacin Proves Ineffective in Statin-Treated Patients with Vascular Disease
Anderson TJ et al., N Engl J Med 2014 Jul 17; 371:288
In a large randomized trial, niacin was associated with serious adverse effects but no cardiovascular benefit
In the 2011 AIM-HIGH trial, niacin (added to a statin) failed to improve outcomes in patients with cardiovascular disease (NEJM JW Gen Med Nov 15 2011). We now have results from another randomized niacin trial — the industry-sponsored HPS2-THRIVE study. The study involved nearly 26,000 patients with known vascular disease whose mean LDL and HDL cholesterol levels were 64 mg/dL and 44 mg/dL, respectively, while taking simvastatin (40 mg daily; with ezetimibe in some cases). Patients received either 2 g of extended-release niacin daily or placebo; niacin was combined with laropiprant, a drug that lessens niacin-related flushing.
During median follow-up of 4 years, niacin lowered LDL cholesterol levels by a mean of 10 mg/dL and raised HDL cholesterol levels by a mean of 6 mg/dL, compared with placebo. However, there was no significant difference between groups in incidence of major adverse cardiovascular events (13.2% vs. 13.7%; P=0.29), and even the subgroup with the lowest HDL cholesterol levels and highest triglyceride levels at baseline showed no benefit from niacin. Niacin was associated with a slight excess in overall mortality (6.2% vs. 5.7%; P=0.08). Niacin recipients had significant excess risk for serious adverse events traditionally associated with this drug (e.g., gastrointestinal, musculoskeletal, and diabetes-related), as well as for infection and bleeding.
Adverse Effects of Thiazide Diuretics in Older Patients
Makam AN et al., J Am Geriatr Soc 2014 Jun 62:1039
Hyponatremia, hypokalemia, or decline in renal function occurred fairly frequently during the first 9 months of thiazide use.
Effects of Blood Pressure on Development of Specific Cardiovascular Diseases
Rapsomaniki E et al., Lancet 2014 May 31; 383:1899
Hypertension at any age was associated with higher CVD incidence.
Muscle mass predicts longevity
This study demonstrates the survival predication ability of relative muscle mass and highlights the need to look beyond total body mass in assessing the health of older adults.The American Journal of Medicine
Early-onset diabetes patients have higher comorbidity risk
Patients with young-onset diabetes had a similar or worse metabolic risk profile compared with those with late-onset disease. This group had higher risks for cardiovascular-renal complications at any given age, driven by longer disease duration. The American Journal of Medicine
Albuminuria predictive of myocardial injury
The authors concluded that albuminuria was a strong predictor of periprocedural myocardial injury in patients undergoing percutaneous coronary intervention. The American Journal of Cardiology
What makes a good physician, according to patients
According to patients, the ability to listen attentively is a key attribute of high-quality physicians, followed by diagnostic accuracy. The Associated Press-NORC Center for Public Affairs Research survey respondents said markers of poor-quality physicians include not listening to patients and not spending enough time with patients. Physician experience, initial impressions after meeting and appointment scheduling all contribute to whether patients will select a given physician, according to the findings. BeckersHospitalReview.com
Study ties 2-year weight loss to lower diabetes odds
A study on the website of Diabetes Care says weight loss at two years was strongly associated with lower diabetes risk and better cardiometabolic profile in patients. However, weight cycling was linked to an increased risk of diabetes. PhysiciansBriefing.com/HealthDay News
Glycosylated hemoglobin association with coronary artery disease
Abnormal glucose metabolism is a major determinant of coronary artery disease and mortality in developed countries. Glycosylated hemoglobin (HbA1c) is a more stable, accurate parameter of glucose homeostasis than fasting glycemia, thus providing prognostic information in diabetics. However, its role and relationship with coronary artery disease remains unclear in nondiabetic patients. This study showed that among nondiabetic patients, higher HbA1c is significantly associated with risk of coronary artery disease. American Journal of Preventive Medicine
Shorter life expectancy seen in severely obese patients
Research published in PLOS Medicine showed life expectancy among severely obese individuals was 6.5 to 13.7 years shorter than people with normal weight. Heart disease appeared to be a major factor in mortality among heavier patients, followed by cancer, diabetes, and renal and kidney disease. HealthDay News
Study links large waist size to higher COPD risk
Women whose waist size was at least 43 inches and men whose waist size was at least 46 inches had a 72% greater risk of developing chronic obstructive pulmonary disease compared with those with a normal waist size, a study of more than 113,000 Americans ages 50 to 70 found. The study, published in the Canadian Medical Association Journal, also found that engaging in physical activity five times or more per week lowered COPD risk by 29% compared with being physically inactive. HealthDay News
Weight gain in cardiac patients who quit smoking
The majority of patients attempting to quit smoking gain weight 12 months post-myocardial infarction, with abstainers gaining more weight than those who return to smoking. Weight gain was associated with an increased prevalence of hypertension and diabetes. The American Journal of Medicine
Analysis questions need to fast before cholesterol tests
An analysis of data from the National Health and Nutrition Examination Survey III found that fasting before a lipid panel blood draw had no clinical benefit while burdening patients. No significant differences were seen between fasting and nonfasting LDL cholesterol levels in terms of heart-related or all-cause mortality. MedPage
Study links physical fitness to metabolic improvements
Sedentary behaviors were tied to increased blood pressure, waist size and body fat percentage, a study indicated. However, higher levels of physical fitness may cut adiposity and boost metabolism, researchers wrote in Mayo Clinic Proceedings. Business Standard (India)/Asian News International
Association between serum concentration of vitamin D and 1-year mortality in stroke patients
Cerebrovascular Diseases, 07/24/2014 Clinical Article Daubail B, et al. – In this study, the authors aimed to assess the association between 25–hydroxyvitamin D [25(OH)D] levels and 1–year mortality in stroke patients. A low serum 25(OH)D level at stroke onset may be associated with higher mortality at 1 year in patients <75 years old.
Methods
http://www.karger.com/Article/FullText/362534
Dietary fiber intake and mortality among survivors of myocardial infarction: prospective cohort study
BMJ, 05/06/2014 Evidence Based Medicine Clinical Article
Li S, et al. – The aim is to evaluate the associations of dietary fiber after myocardial infarction (MI) and changes in dietary fiber intake from before to after MI with all cause and cardiovascular mortality. In this prospective study of patients who survived MI, a greater intake of dietary fiber after MI, especially cereal fiber, was inversely associated with all cause mortality. In addition, increasing consumption of fiber from before to after MI was significantly associated with lower all cause and cardiovascular mortality.
Methods
http://www.ncbi.nlm.nih.gov/pubmed/24782515
Leukocyte Telomere Length Is Associated with Risk for Heart Disease
Paul S. Mueller, MD, MPH, FACP Reviewing Haycock PC et al., BMJ 2014 Jul 8; 349:g4227
People with the shortest telomeres had the highest risk for adverse coronary events.
Telomeres are structures at the end of chromosomes that shorten with each cell division, and telomere length is a marker for biological aging. Because telomere length varies among different people of the same chronological age, investigators performed this meta-analysis to assess the association between leukocyte telomere length and risk for cardiovascular (CV) disease.
Researchers identified 12 retrospective and 12 prospective studies (44,000 participants overall) in which leukocyte telomere length and adverse CV-related or cerebrovascular-related outcomes were reported. Participants were divided into three groups by telomere length. Compared with people in the longest telomere group, those in the shortest telomere group had significantly higher risk for coronary heart disease in both prospective and retrospective studies (overall relative risk, 1.5). Similar results were obtained in meta-analyses restricted to studies that were adjusted for conventional CV risk factors. Compared with people in the longest telomere group, people in the shortest telomere group had excess risk for cerebrovascular disease in all studies combined (RR, 1.4), but not in prospective studies alone.
Diabetes Linked to Increased Risk for Head and Neck Cancers
Patients with diabetes might face nearly a 50% increased risk for head and neck cancers, according to a retrospective, case-control study inJAMA Otolaryngology—Head & Neck Surgery.
Using Taiwanese health databases, researchers studied nearly 90,000 patients diagnosed with diabetes in 2002 and 90,000 matched controls without diabetes. During follow-up through 2011, head and neck cancers were diagnosed in 0.71% of diabetes patients and 0.50% of controls. After multivariable adjustment, diabetes patients showed a significant increase in the risk for head and neck cancer (hazard ratio, 1.48), owed mainly to increases in cancers of the oral cavity, oropharynx, and nasopharynx.
The authors note that the mechanisms underlying the association "remain unclear" but may involve "shared genetic risk factors, [diabetes]-related metabolic morbidities (e.g., hypertension and dyslipidemia), obesity, aging, and sex." They conclude that their findings underscore the necessity of monitoring diabetic patients for head and neck cancer.
JAMA Otolaryngology—Head & Neck Surgery article (Free abstract)
Enlarged Prostate Urination Problems Could Be Eased by Sitting Men with urination problems as a result of enlarged prostate may be better off sitting rather than standing to urinate, according to a recent systematic review and meta-analysis.
Ype de Jong, MD, and colleagues at Leiden University Medical Center in Leiden, The Netherlands, analyzed data from 11 studies that included healthy men and those with lower urinary tract symptoms (LUTS). Among men with LUTS, a sitting position during urination was associated with a significantly lower post-void residual volume (PVR) compared with standing, the researchers reported in PLoS One (2014;9:e101320).
Maximum urinary flow rate was increased and voiding time was decreased in the sitting position compared with standing, but these differences were not statistically significant. Among healthy men, urination position had no significant effect on urodynamic parameters.
“In patients with LUTS, an improved urodynamic profile approaching the effect of alpha-blockers is found in the sitting position,” the authors concluded. “Incorporating the positive effect of this voiding position in the management of LUTS could have a synergistic effect on improvement of urodynamics in this group of patients.”
Study: More medical chronic conditions lead to reduced life expectancy. TIME (7/25, Abrams) reports the “more medical chronic conditions” people have, the shorter their lives will be, citing a study unveiled in the journal Medical Care. Researchers from Johns Hopkins Bloomberg School of Public Health found “that nearly four in five Americans over the age of 67 have multiple chronic conditions such as heart disease, hypertension and diabetes.” Time notes that “on average, life expectancy” fell “by 1.8 years with each additional chronic condition among older Americans.”
Shift work linked to increased risk of type 2 diabetes. Forbes (7/25) contributor Robert Glatter, MD, writes that research published in Occupational and Environmental Medicine suggests that shift work may be associated with a higher risk of developing type 2 diabetes.
HealthDay (7/25, Dallas) reports that investigators “analyzed data from 12 international studies involving more than 226,500 people.” While “the findings weren’t able to show a direct cause-and-effect relationship, the researchers found that any amount of shift work was linked to a 9 percent greater risk for developing diabetes.” Additionally, “gender...played a role – for men engaged in shift work, the risk jumped to 37 percent.”
Secondary osteoporosis and metabolic bone disease in patients 50 years and older with osteoporosis or with a recent clinical fracture: A clinical perspective
Current Opinion in Rheumatology, 07/25/2014 Review Article Bours S, et al. – The purpose of this review is to provide guidance to clinicians about which laboratory tests should be performed in patients with osteoporosis or with a recent fracture. Furthermore, authors recommend performing the following tests in all patients with osteoporosis or a recent clinical fracture: calcium, phosphate, creatinine, albumin, erythrocyte sedimentation rate in all patients, 24 h urine calcium in men and serum testosterone in men less than 70 years. On indication, additional tests can be performed.
http://www.ncbi.nlm.nih.gov/pubmed/24841229
Association between osteoporosis and benign paroxysmal positional vertigo: A systematic review Full Text
BMC Neurology, 07/25/2014 Review Article Yu S, et al. – The authors conducted a systematic review to examine the association between osteoporosis and benign paroxysmal positional vertigo (BPPV). This systematic review provides insight into currently available evidence and elucidates the possible existence of an association between BPPV and osteoporosis (osteopenia). However, the evidence supporting that conclusion is not strong, and further studies are needed to clarify the association between these conditions.
Methods
CONCLUSIONS: This systematic review provides insight into currently available evidence and elucidates the possible existence of an association between BPPV and osteoporosis (osteopenia). However, the evidence supporting that conclusion is not strong, and further studies are needed to clarify the association between these conditions.
http://www.ncbi.nlm.nih.gov/pubmed/24886504
Smoking tied to increased suicide risk. The Los Angeles Times (7/17, Morin) reports in “Science Now” that according to a study published online July 16 in the journal Nicotine & Tobacco Research, “smoking and suicide may be more closely related than previously thought.”
HealthDay (7/17, Preidt) reports that the study found that “smoking may increase a person’s risk for suicide, but high cigarette taxes and smoking restrictions in public places lower that risk.” After analyzing “suicide rates across the United States between 1990 and 2004,” researchers found that “states that introduced higher taxes on cigarettes and stricter rules to limit smoking in public places saw suicide rates decline up to 15 percent, relative to the national average.”
Sleeping in cooler bedrooms may increase brown fat volume. The New York Times (7/17, Reynolds) “Well” blog reports that according to a study published online June 22 in the journal Diabetes, “cooler bedrooms could subtly transform a person’s stores of brown fat – what has lately come to be thought of as ‘good fat’ – and consequently alter energy expenditure and metabolic health, even into daylight hours.” For the study, National Institutes of Health-affiliated researchers asked “five healthy young male volunteers” to sleep in special climate controlled rooms there for a period of four months. The study found that “after four weeks of sleeping at 66 degrees, the men had almost doubled their volumes of brown fat.” Study senior author Francesco S. Celi, then of NIH and now at Virginia Commonwealth University, explained that it is indeed possible to “tweak your metabolic health by turning down the bedroom thermostat a few degrees.”
Diet rich in omega-3 fatty acids may decrease risk for ALS. HealthDay (7/16, Reinberg) reports that according to a study published online July 14 in JAMA Neurology, “a diet rich in omega-3 fatty acids may help cut [the] risk for the fatal neurodegenerative disease amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.” The study of some 1,000 patients with ALS revealed that patients “who ate the most foods containing omega-3 fatty acids had the lowest risk of developing” the disease.
Medscape (7/16, Hughes) reports that an accompanying editorial observed, however, that “there is not enough information from this one study to make any recommendations on dietary changes at present.”
Can Testosterone Improve Glucose Metabolism in Men with T2DM? Does testosterone therapy improve glucose metabolism in men with lowered testosterone and type 2 diabetes? A new study published in the journal Diabetes Care says no. In the trial, 88 men with type 2 diabetes and lowered testosterone were randomized to receive either IM testosterone undecanoate or placebo; the primary outcome measure was insulin resistance by homeostatic model assessment, the secondary measure was glycemic control by HbA1c. Despite a decrease in fat mass, testosterone treatment did not improve insulin resistance or glycemic control. Also, there was no reduction in visceral abdominal adiposity. Based on these results, researchers concluded that in obese men with modest reductions in testosterone and moderately controlled type 2 diabetes, testosterone treatment does not improve glucose metabolism.
Two papers identify possible molecular causes of cachexia. In an 1,100-word article, the Boston Globe (7/28) reports that “two research papers published this month, in the journals Nature and Cell Metabolism, identify possible molecular causes of” cachexia “that researchers hope could lead to potential treatments.” In the Nature study, researchers “found that after using an antibody to block the effects of the protein PTHrP in mice with lung tumors, symptoms of cachexia improved or were prevented.” Meanwhile, “the Cell Metabolism paper...states that inflammation plays a large role in turning white fat cells into brown fat cells, and found that anti-inflammatory therapies in mice alleviated symptoms of cachexia.”
Gaviscon Double Action Liquid (antacid & alginate) is more effective than antacid in controlling post-prandial oesophageal acid exposure in GERD patients: a double-blind crossover study
Alimentary Pharmacology and Therapeutics, 07/27/2014 Clinical Article De Ruigh A, et al. – This study compared the effectiveness of Gaviscon Double Action Liquid to an equivalent strength antacid without alginate in controlling post–prandial acid reflux in GERD patients. Gaviscon Double Action Liquid is more effective than an antacid without alginate in controlling post–prandial oesophageal acid exposure. However, the number and spatial distribution of reflux events within the oesophagus are similar. This suggests that Gaviscon main effectiveness relates to its co–localisation with and displacement/neutralisation of the post–prandial acid pocket, rather than preventing reflux.
Methods
Best Time of Day for a Testosterone Test Doctors often recommend that men with erectile dysfunction have their testosterone measured from 8 a.m. to 11 a.m., because levels are usually highest then and vary over a 24-hour period. But a new study has found that this variation occurs only in younger men.
Researchers retrospectively studied records of 2,569 men ages 26 to 84 who were evaluated at an erectile dysfunction clinic from 1985 to 2004. They sorted them into age groups, starting with 26- to 39-year-olds, and then in five-year groups up to age 84. They further divided them into two time groups: those who had their testosterone measured from 7 a.m. to 9 a.m. and those measured from 9 a.m. to 2 p.m. All the men had erectile dysfunction, a symptom of low testosterone levels.
The only men who showed a statistically and clinically significant decrease in levels between the two time periods were those younger than 45.
The lead author, Dr. Charles Welliver, a fellow at Southern Illinois University School of Medicine when the work was done, said that the timing of the test was unimportant for most men. “As long as the draw is done before 2 p.m.,” he said, “the value is still considered valid, except for the youngest two groups of men seen in this study.”
Repeat Colonoscopies Have Few Benefits for Some Patients (HealthDay News) — Repeat colonoscopies within 10 years are of little benefit to patients who had no polyps found on adequate examination; however, repeat colonoscopies do benefit patients when the baseline examination was compromised, according to research published in the August issue of Gastroenterology.
David A. Lieberman, MD, of the Oregon Health and Science University in Portland, and colleagues analyzed data for 17,525 asymptomatic patients who were found to have no polyps during a screening colonoscopy and received another colonoscopy within 10 years.
The researchers found that repeat colonoscopy within one year, typically done because of inadequate bowel preparation or incomplete exam for the baseline colonoscopy, showed a prevalence of large polyps (>9mm) of 6.5 percent (95% confidence interval [CI], 5.3–7.6%). This prevalence is similar to the rate found in the average-risk screening population. Among patients with an adequate baseline examination, the incidence of large polyps upon repeat colonoscopy was 3.1% (95% CI, 2.7–3.5%) within 1–5 years and 3.7% (95% CI, 3.3–4.1%) within 5–10 years.
"In light of the maturing body of evidence about the strong influence of sex, race/ethnicity, and other factors (e.g., tobacco, alcohol, diet) on the risk of neoplasia, individualized risk-based screening and surveillance algorithms should be developed," write the authors of an accompanying editorial.
The practice network has received funding from pharmaceutical and biomedical companies.
Abstract
Full Text
Ultrasound Effective for Detecting Kidney Stones
Ultrasound is safe and effective when used to detect and remove renal stones without exposing patients and operating room staff to radiation, according to separate reports.
A retrospective study published online ahead of print in Urology found ultrasound effective in the detection of renal stones. Toru Kanno, MD, PhD, and colleagues at Takeda General Hospital in Kyoto, Japan, followed 428 patients from 2009 to 2011who underwent noncontrast-enhanced computed tomography (NCCT) and ultrasound on the same day.
Ultrasound was able to detect all renal stones, as determined by NCCT, at a sensitivity of 70.0% and specificity of 94.4%. Looking at the ability of ultrasound alone to detect at least 1 stone, the authors found the modality had a sensitivity of 78.9% and specificity of 83.7%. The authors noted that the detection rate increased with stone size, and it was lower for the left upper calyx than for other sites.
Separately, in a feasibility study published online ahead of print in the Journal of Urology, Levi A. Deters, MD, and colleagues at Dartmouth Hitchcock Medical Center in Lebanon, NH, found that ultrasound offered an alternative to conventional fluoroscopy to guide surgeons during ureteroscopy for ureteral stones.
They followed 50 patients with symptomatic ureteral stones that were 8 mm or smaller without a significant ipsilateral stone burden. After temporizing ureteral stent placement, half of the patients were randomly assigned to ultrasound-guided ureteroscopy and the other half to fluoroscopy-guided ureteroscopy. Patients in the ultrasound arm were similar to those in the fluoroscopy arm in stone size (5.9 vs. 5.7 cm), age (56 vs. 52 years), and body mass index (31 vs. 30 kg/m2).
Researchers found no residual stone fragments on follow-up x-ray and ultrasound imaging in 86% of each group and no significant differences in complication rates among the two groups. Operative times and costs were also similar.
Is Hydroxychloroquine Effective for Patients with Symptomatic Sjögren Syndrome?
Gottenberg J-E et al., JAMA 2014 Jul 16; 312:249
The drug was no better than placebo in relieving dryness, fatigue, and pain.
Troubling symptoms of Sjögren syndrome include oral and ocular dryness, joint and soft-tissue pain, and fatigue. Rarely, patients have serious systemic involvement, such as renal disease, pulmonary disease, vasculitis, or lymphomas. Treatments include hydroxychloroquine, methotrexate, and biologic therapies (e.g., rituximab [Rituxan]), but none of these agents alter symptoms significantly in controlled trials. In this study, investigators in France randomized 120 patients with Sjögren syndrome to receive hydroxychloroquine or placebo for 24 weeks; all patients then received hydroxychloroquine between weeks 24 and 48. Patients who had previously received hydroxychloroquine or other immunosuppressants or who had systemic manifestations were excluded.
At 24 weeks, the proportion of patients who reported ≥30% reductions from baseline in at least two of three symptoms (i.e., dryness, fatigue, and pain) was no different in the two groups. In patients who received placebo for 24 weeks followed by hydroxychloroquine through week 48, dryness, fatigue, and pain scores at 48 weeks did not differ significantly from those at 24 weeks.
No Reduction in Atherosclerosis Progression with Menopausal Hormone Therapy
Menopausal hormone therapy may have favorable effects on some cardiovascular risk factors, but it doesn't reduce the progression of atherosclerosis, according to an Annals of Internal Medicine study.
Over 700 menopausal women were randomized to placebo or one of two low-dose hormone therapies (oral conjugated equine estrogens or transdermal 17β-estradiol, plus progesterone).
After 4 years, there was no difference between the groups in the study's primary endpoint — the progression of atherosclerosis as measured by carotid artery intima-media thickness (CIMT) — or in coronary artery calcium scores. Women in the equine estrogen group had improved lipid profiles, while women in the transdermal group had improved insulin sensitivity. Serious adverse event rates did not differ significantly across the groups.
The investigators offer several explanations for the findings, including a study population at low risk for atherosclerosis, a relatively short study duration, and the use of low-dose rather than high-dose estrogen.
Andrew Kaunitz, editor-in-chief of NEJM Journal Watch Women's Health, says that although it's still unclear what the long term effects of hormone therapy will be on cardiovascular events, the study "does not support using hormone therapy to prevent CVD events."
Annals of Internal Medicine article (Free abstract)
Boost Balance with Ballroom Dancing
About an hour of ballroom dancing 3 days a week, for 3 months, resulted in a 50% improvement in balance and fall reduction.
Banish These Beverages
Sugar sweetened beverages such as sodas and juice cocktails may elevate blood pressure.
Cap Off a Swim with Chocolate Milk
Not only did collegiate-trained swimmers recover better with chocolate milk after an exhaustive swim, they swam faster in time trials later that same day.
A Worthy 25-Minute Investment
Twenty-five minutes of moderate-to-vigorous exercise everyday may reduce prescription usage and hospital admissions, among men and women ages 70 and older.
Air Pollution May Prompt Cognitive Decline
Fine particulate matter air pollution, typified by vehicle exhaust, may hasten cognitive decline in older adults.
Your Breakfast Bowl
With a hearty texture, a bowl of instant oatmeal satiates hunger and can help you feel full longer.
Mechanism of Cancer-Contributing Gene Revealed
MYC, a gene linked to cancer, interacts with a non-coding RNA, to fuel cancer growth.
Probiotics Boost Infection Protection in Athletes
Daily probiotic supplements may reduce the incidence of gastrointestinal and upper respiratory tract infections.
Neural Bypass Technology Enables Movement in Paralyzed Patient
Neurobridge is an electronic neural bypass for spinal cord injuries that reconnects the brain directly to muscles, to enable voluntary and functional control of
Lifelong Learning Leads to Longer Cognitive Acuity
Education, career, and interpersonal activities may be key to retaining memory and thinking skills later in life.
EXERCISE
A Worthy 25-Minute Investment
Twenty-five minutes of moderate-to-vigorous exercise everyday may reduce prescription usage and hospital admissions, among men and women ages 70 and older.
Inflammation Intervention
Regular exercise may exert physiological changes that decrease inflammation on a local and systemic level.
Soccer Improves Diabetes Markers & Blood Pressure
Among men, 6 months of twice-weekly recreational soccer may reduce the risk for heart failure as well.
Steps to Keep Osteoarthritis At Bay
Walking 6,000 or more steps each day may protect those with or at risk of knee of osteoarthritis from developing mobility issues.
Retire… But Keep on Exercising
Men and women living in retirement communities who exercise regularly experience less physical decline as they age.
Defeat Diabetes in Two Minutes
High intensity training consisting of two minutes of exercise weekly, may help to prevent type-2 diabetes.
Short Daily Walk Promotes Independent Living
A 20-minute walk each day may ward off major physical disability and enhance quality of life.
Fitness in 50s Is An Anti-Aging Essential
Poor physical ability in your 50s may raise your risk of an early death.
Walking Promotes A Fit Heart
Regularly engaging in walking can help to maintain healthy heart rate variability, among men and women ages 60 and older.
Walking A Key Step Towards Creativity
Creative thinking may be fueled by taking a walk
** ALZHEIMER'S / DEMENTIA News **
Social contact, peer support and self-help can positively benefit people with dementia
http://mnt.to/l/4pBm
Human neurodegenerative diseases may be impacted by discovery of a new cellular garbage control pathway
http://mnt.to/l/4pzR
New studies presented at Alzheimer's Association International conference demonstrate diagnostic value of [<sup>18</sup>F]flutemetamol
http://mnt.to/l/4pyx
Neuronal edema in Alzheimer's disease rats reduced by acupuncture and moxibustion
http://mnt.to/l/4pxX
Bexarotene's effect on Alzheimer's may depend on severity of disease
http://mnt.to/l/4px5
Older adults benefit from fish oil supplements which reduce incidence of cognitive decline, may improve memory function
http://mnt.to/l/4pwg
Alzheimer's Association International Conference 2014 selected highlights
http://mnt.to/l/4pwm
Gardens could benefit dementia patients and their carers
http://mnt.to/l/4pvx
Genetic variant conveys significant protection against Alzheimer's disease
http://mnt.to/l/4pvs
Alzheimer's disease not prevented by B vitamins
http://mnt.to/l/4pvq
Signaling pathway for ginsenoside Rb1 promoting hippocampal neuronal neurite outgrowth
http://mnt.to/l/4ptX
Memory and learning deficits restored in Alzheimer's mouse models
http://mnt.to/l/4pvW
ANAVEX 3-71 highly effective and disease-modifying against all major Alzheimer's hallmarks in preclinical disease model
http://mnt.to/l/4ptJ
New data on possible protective behaviors and dementia risk factors emerges at Alzheimer's Association International Conference 2014
http://mnt.to/l/4pt8
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** ANXIETY / STRESS News **
Understanding a person's increased vulnerability to PTSD after Boston Marathon bombing
http://mnt.to/l/4pvz
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** BONES / ORTHOPEDICS News **
Increase in patients age 80 and older undergoing orthopaedic surgery
http://mnt.to/l/4pyR
Anthropology study shows quadrupedal humans are not products of 'devolution'
http://mnt.to/l/4pwQ
Best anticoagulants after orthopedic procedures depends on type of surgery
http://mnt.to/l/4pv3
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** CARDIOVASCULAR / CARDIOLOGY News **
Simulated human heart used to test drugs' effects
http://mnt.to/l/4pBp
Scientists create 'biological pacemakers' by transplanting gene into hearts
http://mnt.to/l/4pxq
Many at-risk heart disease patients lack guidance on beneficial aspirin treatment
http://mnt.to/l/4ptQ
Risk for atrial fibrillation may be increased by moderate alcohol use
http://mnt.to/l/4ptd
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** CHOLESTEROL News **
Niacin for cholesterol now linked to death risk, dangerous side effects and no benefits
http://mnt.to/l/4pwS
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** DIABETES News **
Insulin-secreting cells of the pancreas protected by autophagy
http://mnt.to/l/4pzK
Statins may reduce cardiovascular death in type 2 diabetes
http://mnt.to/l/4px2
Treatment reverses symptoms of type 2 diabetes in mice, without side effects
http://mnt.to/l/4pwT
Could a single injection stop diabetes?
http://mnt.to/l/4pxZ
Pre-diabetes label 'unhelpful and unnecessary'
http://mnt.to/l/4ptC
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** HYPERTENSION News **
Could consuming probiotics help lower blood pressure?
http://mnt.to/l/4pBs
Lean beef incorporated into diet helps lower blood pressure
http://mnt.to/l/4pzx
Screening for undiagnosed hypertension via electronic health records
http://mnt.to/l/4px4
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** MEN'S HEALTH News **
Adolescent males' developing masculinity
http://mnt.to/l/4pwf
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** MENTAL HEALTH News **
Mental health patients at highest risk of suicide in first two weeks after leaving hospital
http://mnt.to/l/4pv4
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** NEUROLOGY / NEUROSCIENCE News **
An important role in Down syndrome played by 'support' cells in brain
http://mnt.to/l/4pzT
In crush injury, how L-carnitine maintains the normal structure of the sciatic nerve
http://mnt.to/l/4pzF
Injured spinal cord neurons repaired by intranasal nerve growth factor
http://mnt.to/l/4pzD
Radial nerve injury for evaluating peripheral nerve repair in rhesus monkey model
http://mnt.to/l/4pzB
How 'good mothering' hardwires infant brain
http://mnt.to/l/4pzf
Two-way interaction between neurons and astrocytes plays an important role in the processes of learning and memory
http://mnt.to/l/4pyV
International research team discovers genetic dysfunction connected to hydrocephalus
http://mnt.to/l/4pz5
Brain-on-a-Chip axonal strain injury model highlights mitochondrial membrane potential threshold and assesses potential new therapeutic
http://mnt.to/l/4pyq
Protecting against neuron and synapse injury in immature rats
http://mnt.to/l/4py2
Findings in mice fuel the idea that processes of active movement and sensory processing are connected
http://mnt.to/l/4pxs
Deadly disease of the brain successfully treated in worms
http://mnt.to/l/4px3
Age-related changes in lateral ventricular width and periventricular white matter by diffusion tensor imaging
http://mnt.to/l/4pwK
Neural regeneration after TBI promoted by intravenous transplantation of BMSCs
http://mnt.to/l/4pwJ
In lead-exposed neonatal mice, chrysophanol attenuates injury to hippocampal neurons
http://mnt.to/l/4pwG
Researchers seeking to smuggle pharmacological agents across the blood-brain barrier
http://mnt.to/l/4pwh
Traumatic brain injury outcomes may be explained by hidden variations in neuronal networks
http://mnt.to/l/4pvV
Brain damage 'can follow even mild traumatic brain injury'
http://mnt.to/l/4pwC
Potential new approach to brain cancer treatments and a better understanding of Parkinson's disease
http://mnt.to/l/4pvn
After a concussion, persistent symptoms 'may be PTSD'
http://mnt.to/l/4pvh
Apparent diffusion coefficient does not reflect cytotoxic edema on the uninjured side after traumatic brain injury
http://mnt.to/l/4ptV
Following acute hemorrhagic anemia, SWI assesses signal strength in different brain regions
http://mnt.to/l/4ptR
Giving birth to a baby with cerebral palsy is less of a risk for immigrant mothers in Canada
http://mnt.to/l/4ptP
Could the cause of cerebral palsy run in the family?
http://mnt.to/l/4ptD
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** NUTRITION / DIET News **
The effects of starvation can be passed to future generations
http://mnt.to/l/4pyM
Last step before full genome sequence of bread wheat genome
http://mnt.to/l/4pyn
The Mediterranean diet has varied effects on cognitive decline among different races
http://mnt.to/l/4pxv
European children not eating enough fruit and veg
http://mnt.to/l/4pxY
Study maps EU school food policies for the first time
http://mnt.to/l/4pwx
ESPGHAN statement provides guidance on 'essential' technique for children with feeding and nutrition problems
http://mnt.to/l/4pvM
Experts recommend avoiding rice drinks for infants and young children due to concerns over arsenic content
http://mnt.to/l/4pvG
Soluble corn fibre may boost calcium absorption
http://mnt.to/l/4ptY
Antihypertensive and antioxidant activity in black beans
http://mnt.to/l/4ptr
What are the health benefits of pumpkin?
http://mnt.to/l/4ptm
Tooth plaque provides insight into our prehistoric ancestors' diet
http://mnt.to/l/4psH
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** OBESITY / WEIGHT LOSS / FITNESS News **
NBR1 protein plays a critical role in regulating obesity-induced inflammation that leads to metabolic disease
http://mnt.to/l/4pyL
Black women in weight management program experienced a reduction in their depression
http://mnt.to/l/4pzn
When it comes to food, obese women's learning is impaired
http://mnt.to/l/4pxt
TILDA study finds 4 out of 5 over 50s in Ireland are overweight or obese
http://mnt.to/l/4pxQ
Obesity and stress
http://mnt.to/l/4pvD
Could being overweight benefit our health?
http://mnt.to/l/4pvy
Sedentary behavior ameliorated by physical fitness
http://mnt.to/l/4ptj
Women's metabolism slowed by combination of stress and high-fat meals
http://mnt.to/l/4ptg
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** PRIMARY CARE / GENERAL PRACTICE News **
Home coaching visit decreases re-admission, costs for Medicare patients
http://mnt.to/l/4pzb
National Quality Forum cautions hospital performance measures must adjust for patient sociodemographic status or risk widening the care gap
http://mnt.to/l/4pyt
Effective, efficient research in health care settings: 4 lessons
http://mnt.to/l/4pvB
UK project finds 93% of health professionals recommend better training on how to care for people with a learning disability
http://mnt.to/l/4pvj
News from the Annals of Family Medicine
http://mnt.to/l/4ptb
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** PROSTATE / PROSTATE CANCER News **
Prostate cancer controlled for 10 years by robot-assisted surgery
http://mnt.to/l/4pxn
Early onset prostate cancer a newly identified, more aggressive subtype often linked to genetic mutations
http://mnt.to/l/4pw3
Prostate cancer is focus of two studies in JAMA Internal Medicine
http://mnt.to/l/4ptt
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** SENIORS / AGING News **
A gene identified that plays a surprising role in combating aging
http://mnt.to/l/4pz4
Walking out of necessity increases risk of outdoor falls in older adults
http://mnt.to/l/4pzr
Taking a new look at cognition and aging
http://mnt.to/l/4pxm
Antibiotic overuse risk in aged care residential setting in Australia
http://mnt.to/l/4pwr
Survey shows older Americans' health engagement and outlook on life improve
http://mnt.to/l/4pwp
Memories affected by environmental distractions nearly twice as likely in older adults
http://mnt.to/l/4pv6
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** SLEEP / SLEEP DISORDERS / INSOMNIA News **
Sleep problems that persist after a divorce can be harmful to your health
http://mnt.to/l/4pzw
During aging, lipoic acid helps restore, synchronize the "biological clock"
http://mnt.to/l/4pyS
PTSD, poor sleep quality and physical activity
http://mnt.to/l/4pxw
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** STROKE News **
Older people with previous stroke or vascular disease at higher risk of stroke after heart surgery
http://mnt.to/l/4pBt
Stroke rates declined 40 percent in both men and women 65 years and older over the last 20 years
http://mnt.to/l/4pyZ
Pairing a mechanical device with stroke patients
http://mnt.to/l/4pxy
What increases the neuronal plasticity of endogenous neural stem cells after focal cerebral ischemia?
http://mnt.to/l/4pwL
Study finds a 20-year decline in stroke risk and death rates
http://mnt.to/l/4pw5
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** WOMEN'S HEALTH / GYNECOLOGY News **
Study examines presence of uterine cancers among women at the time of hysterectomy using morcellation
http://mnt.to/l/4pBk
Breastfeeding goals affected by mother's return to work
http://mnt.to/l/4pyN
Homeless and unstably housed women in San Francisco suffer high rates of violence
http://mnt.to/l/4py9
On scientific field studies, sexual harassment and assault are common
http://mnt.to/l/4pwY
** ALLERGY News **
Cause of mysterious food allergy determined, new treatment strategy suggested
http://mnt.to/l/4pst
New allergen toolkit for healthcare catering launched in the UK
http://mnt.to/l/4ppr
Children on dairy farms less likely to develop allergies
http://mnt.to/l/4pnX
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** ALZHEIMER'S / DEMENTIA News **
Could eye and smell tests offer early Alzheimer's diagnosis?
http://mnt.to/l/4ptG
New analysis says Alzheimer's preventable in a third, not half of cases
http://mnt.to/l/4psN
Neurogenesis in Alzheimer's disease promoted by ADSCs transplantation
http://mnt.to/l/4psc
Noninvasive retinal imaging device may provide highly predictive early detection of changes associated with Alzheimer's disease
http://mnt.to/l/4pss
Four research trials show smell and eye tests offer potential to detect Alzheimer's early
http://mnt.to/l/4psr
Nasal mucosal inhalation of Alzheimer's disease vaccine attenuates Aβ1-42-induced cytotoxicity
http://mnt.to/l/4ppt
Scientists investigate the cause of memory impairment in Alzheimer's Disease through GABA from reactive astrocytes
http://mnt.to/l/4pp6
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** ANXIETY / STRESS News **
Health reported as the most common major stressful event in Americans' lives last year
http://mnt.to/l/4pnD
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** ARTHRITIS / RHEUMATOLOGY News **
Severity of osteoarthritis in mice reduced by omega 3 fatty acids
http://mnt.to/l/4ps3
Anti-arthritics can exacerbate other inflammatory diseases like periodontitis
http://mnt.to/l/4pqD
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** BONES / ORTHOPEDICS News **
Bone marrow hormone influences metabolism and health
http://mnt.to/l/4pmS
Proprietary calcium and collagen formulation KoACT® found to be superior for bone health
http://mnt.to/l/4pmm
Partial knee replacement safer than total knee replacement
http://mnt.to/l/4pm8
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** CARDIOVASCULAR / CARDIOLOGY News **
Could 'reading faces' improve rapid diagnosis of heart and lung problems?
http://mnt.to/l/4psT
'Self-competence' affects quality of life of children with pacemakers
http://mnt.to/l/4pr2
How P. gingivalis causes chronic inflammation in blood vessels
http://mnt.to/l/4pqQ
Hispanic Americans need culturally tailored heart care
http://mnt.to/l/4ppP
Pitt study finds telephone treatment of depression after cardiac bypass surgery improves outcomes and saves money
http://mnt.to/l/4pmK
Study estimates rate of survival following minimally invasive repair of failed bioprosthetic aortic valves
http://mnt.to/l/4pmF
Cardiovascular health adversely affected by sitting too much
http://mnt.to/l/4pm2
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** DIABETES News **
Diabetes diagnosed with inexpensive, portable microchip test
http://mnt.to/l/4psx
Nanotech microchip invented to diagnose type-1 diabetes
http://mnt.to/l/4psw
Inadequate support in schools for diabetic children
http://mnt.to/l/4prb
Apoptotic retinal ganglion cells reduced in diabetes by Inhibition of NgR expression
http://mnt.to/l/4pqz
Scientists discover clues why weight-loss surgery cures diabetes
http://mnt.to/l/4pqk
Hydrogen sulfide has potential health benefits in a range of issues, from diabetes to stroke, heart attacks and dementia
http://mnt.to/l/4ppm
Physicists show that the concentration of acetone in breath is a suitable marker of fat-burning during physical activity
http://mnt.to/l/4pnN
Advantages of standardizing diabetes treatments
http://mnt.to/l/4pmg
In people with diabetes, consuming whey protein before meals could help improve blood glucose control
http://mnt.to/l/4pkF
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** HYPERTENSION News **
Home blood pressure-monitoring kits save insurance companies money
http://mnt.to/l/4ppL
Treatment-resistant hypertension requires proper diagnosis
http://mnt.to/l/4pmr
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** MEN'S HEALTH News **
Hypnotic relaxation may ease the discomfort of men's hot flashes
http://mnt.to/l/4pqs
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** MENTAL HEALTH News **
Having strong social ties protects men from suicide death
http://mnt.to/l/4pqg
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** NEUROLOGY / NEUROSCIENCE News **
For learning/memory function, substance P in hippocampus versus striatal marginal division
http://mnt.to/l/4psb
The differentiation of adipose-derived stromal cells into astrocytes faces obstacles
http://mnt.to/l/4ps9
Anandamide can increase intracellular ca2+ concentration
http://mnt.to/l/4ps8
Spider toxin suggests a new way to protect crops from insect plagues, offers insight into human sodium channels
http://mnt.to/l/4ps2
Revolutionary technology enables scientists to navigate and analyze complex 3D images
http://mnt.to/l/4prW
Scientists shed new light on nerve cell growth
http://mnt.to/l/4prx
Four evidence-based indicators of concussion
http://mnt.to/l/4pr3
The optimal mitomycin C concentration for intact peripheral nerve structure and function
http://mnt.to/l/4pqR
Fusion protein of single-chain variable domain fragments and myasthenia gravis
http://mnt.to/l/4pqB
Repair of spinal cord injury: BMSCs with Nogo-66 receptor gene silencing
http://mnt.to/l/4pqy
How the brain processes emotions
http://mnt.to/l/4ppC
DARPA and UCLA project to restore brain injury patients' memories
http://mnt.to/l/4pqj
L-dopa medication could be helpful in the treatment of phobias and post-traumatic stress disorder
http://mnt.to/l/4ppB
Hippocampal cholinergic neurons protected in normal aging by thyroid hormone
http://mnt.to/l/4ppv
Neuroprotective effects of low concentration of lithium
http://mnt.to/l/4ppj
High earners in a stock market game found to have brain patterns that can predict bubbles and crashes
http://mnt.to/l/4pnb
How tumors weaken blood barrier in brain cancer patients explained
http://mnt.to/l/4pmX
Neural stem cell therapy led to spinal cord mass
http://mnt.to/l/4pmd
Explaining brain circuitry by dodging dots
http://mnt.to/l/4pkZ
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** NUTRITION / DIET News **
Absorption of vitamin A enhanced when avocados are eaten with tomatoes or carrots
http://mnt.to/l/4prp
Carbohydrates from the Okra plant can improve the quality of food products
http://mnt.to/l/4pr9
Organic and non-organic foods are compositionally different, says new study
http://mnt.to/l/4psq
Tofu consumption - surprise study findings
http://mnt.to/l/4pqC
Great tasting low-fat cheeses and cakes could soon be on the menu
http://mnt.to/l/4pqm
What are the health benefits of eggplant?
http://mnt.to/l/4pnd
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** OBESITY / WEIGHT LOSS / FITNESS News **
Obesity - surgery is not the only answer, say research scientists
http://mnt.to/l/4psW
Weight advice not provided by health providers of obese US firefighters
http://mnt.to/l/4psh
How Twitter can be used to address specific health issues, like childhood obesity
http://mnt.to/l/4prC
NICE consults on updated recommendations for treating obesity
http://mnt.to/l/4prR
Epigenetic effects of environmental impact on health
http://mnt.to/l/4pqG
Heart disease a greatly increased risk for obese young Hispanics
http://mnt.to/l/4ppb
View exercising as fun and you'll eat less later!
http://mnt.to/l/4pnP
Adolescents from southern Europe are less fit and more obese than their central-northern European peers
http://mnt.to/l/4pnt
'Extreme obesity' linked to 'substantially higher' death rates
http://mnt.to/l/4pmM
Young Hispanics often obese and at higher risk for heart diseases
http://mnt.to/l/4pmx
New wellness approach that focuses on mindfulness and intuitive eating is more effective than traditional weight-loss programs
http://mnt.to/l/4pkQ
Expanding waistlines likely caused by less exercise rather than more calories
http://mnt.to/l/4pkM
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** PRIMARY CARE / GENERAL PRACTICE News **
Patients should have access to their medical records
http://mnt.to/l/4psD
NHS could experience funding crisis before General Election, new analysis reveals
http://mnt.to/l/4ppx
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** PROSTATE / PROSTATE CANCER News **
Prostate cancer with depression leads to later diagnosis, less effective therapies
http://mnt.to/l/4pqw
Risk of aggressive prostate cancer may be increased by vasectomy
http://mnt.to/l/4ppY
Vasectomy linked with aggressive prostate cancer risk
http://mnt.to/l/4ppg
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** SENIORS / AGING News **
Keeping active pays off in your 70s and 80s
http://mnt.to/l/4pq8
Growing old with HIV: Age-related diseases are bigger problem for African American women
http://mnt.to/l/4pnf
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** SLEEP / SLEEP DISORDERS / INSOMNIA News **
Dietary manipulation of the body's internal biological clock
http://mnt.to/l/4pqP
The high price paid by parents of newborns for their interrupted sleep
http://mnt.to/l/4pnr
Sleep affected by the full moon - contradictory findings
http://mnt.to/l/4pn2
Symptoms of schizophrenia possible following sleep deprivation
http://mnt.to/l/4pkV
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** STROKE News **
History of stroke linked with increased risk of adverse outcomes after non-cardiac surgery
http://mnt.to/l/4psM
Study finds decrease in incidence of stroke and subsequent death
http://mnt.to/l/4psK
Patients with chronic stroke and cerebral palsy benefit from virtual reality interface device and brain neural networks
http://mnt.to/l/4psd
Increased stroke risk linked to high stress, hostility, depression
http://mnt.to/l/4prF
Psychological stress 'increases risk of stroke'
http://mnt.to/l/4ppQ
How patients respond to filiform needle acupuncture versus antidepressant drugs for poststroke depression
http://mnt.to/l/4pph
In acute cerebral ischemia, what aggravates hippocampal neuronal injury?
http://mnt.to/l/4ppf
Electrical stimulation of fastigial nucleus and cellular apoptosis in injured region
http://mnt.to/l/4pmY
Focal cerebral ischemia for neural regeneration studies: rat versus mouse models
http://mnt.to/l/4pmW
After chronic cerebral ischemia, 3-N-butylphthalide improves neuronal morphology
http://mnt.to/l/4pmV
Voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke
http://mnt.to/l/4pmT
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** WOMEN'S HEALTH / GYNECOLOGY News **
For older women, exercise is the best medicine
http://mnt.to/l/4ps7
ALZHEIMER'S / DEMENTIA News **
Unprecedented 3-D view of important brain receptor has implications for Alzheimer's, Parkinson's, schizophrenia, depression
http://mnt.to/l/4pbx
Abnormal blood clots in the brain offer drug target for Alzheimer's
http://mnt.to/l/4pbw
Looking to improve long-term care to aid rising numbers with dementia
http://mnt.to/l/4p56
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** ANXIETY / STRESS News **
The lasting impact of early life stress
http://mnt.to/l/4pbC
Brain circuits identified that are involved in stress-induced fevers
http://mnt.to/l/4p95
Could our hormones influence whether we vote?
http://mnt.to/l/4p88
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** ARTHRITIS / RHEUMATOLOGY News **
One third of total knee replacements in US are 'inappropriate'
http://mnt.to/l/4pbj
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** BONES / ORTHOPEDICS News **
Potential new therapeutic target for osteoporosis: MicroRNA that blocks bone destruction
http://mnt.to/l/4p8V
Muscle pacing method saw rats gain 30 percent of bone within targeted areas
http://mnt.to/l/4p8b
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** CARDIOVASCULAR / CARDIOLOGY News **
Could a happy marriage be the key to a healthy heart?
http://mnt.to/l/4p92
New blood test identifies "Sudden Cardiac Death" risk
http://mnt.to/l/4p7m
A self-powered cardiac pacemaker
http://mnt.to/l/4p6q
After heart attack, mortality risk can be halved by quitting smokeless tobacco
http://mnt.to/l/4p55
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** DIABETES News **
FDA approves Afrezza to treat diabetes
http://mnt.to/l/4pcp
Insulin therapy for type 2 diabetes 'may do more harm than good'
http://mnt.to/l/4pbZ
Preventing heart disease in diabetes by restoring thyroid hormones in heart
http://mnt.to/l/4p8m
Nice issues positive final guidance for INVOKANA® (canagliflozin) for type 2 diabetes
http://mnt.to/l/4p7q
Gastric bypass surgery improves diabetic patients' quality of life
http://mnt.to/l/4p79
'Manipulation of intestinal bacteria could offer a new approach to manage obesity and type 2 diabetes'
http://mnt.to/l/4p6n
Liraglutide for diabetes improves risk factors for heart disease
http://mnt.to/l/4p6m
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** ENDOCRINOLOGY News **
For hazard assessment, animal testing methods for endocrine disruptors should change
http://mnt.to/l/4p7J
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** HYPERTENSION News **
Childhood malnutrition linked to higher blood pressure in adults
http://mnt.to/l/4pc3
Genetic study suggests causal link between vitamin D deficiency and hypertension
http://mnt.to/l/4p8k
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** MENTAL HEALTH News **
Gender differences in use of mental health services
http://mnt.to/l/4p8B
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** NEUROLOGY / NEUROSCIENCE News **
Learn a language in your sleep
http://mnt.to/l/4pcr
New light-sensitive protein enables simpler, more powerful optogenetics
http://mnt.to/l/4pcn
Neuroscientists inhibit muscle contractions by shining light on spinal cord neurons
http://mnt.to/l/4p9S
Researchers explore the genetic underpinnings of nerve-cell spacing
http://mnt.to/l/4p9G
Did eating bugs make our early ancestors more intelligent?
http://mnt.to/l/4pbN
Scientists map molecular olfactory signatures of foodstuffs
http://mnt.to/l/4p9s
Traditional approaches in managing ABI-associated behavior challenged
http://mnt.to/l/4p8N
New insights for coping with personality changes in acquired brain injury
http://mnt.to/l/4p8n
Neurotoxin tetrodotoxin found in terrestrial environment for first time
http://mnt.to/l/4p84
New pediatric concussion guidelines
http://mnt.to/l/4p7K
Those with episodic amnesia are not 'stuck in time,' says philosopher Carl Craver
http://mnt.to/l/4p7D
Progress made in understanding how the brain processes visual information
http://mnt.to/l/4p7w
Team explains how mutated X-linked mental retardation protein impairs neuron function
http://mnt.to/l/4p7g
How aging can intensify damage of spinal cord injury
http://mnt.to/l/4p7f
Brain regions sensitive to facial color processing
http://mnt.to/l/4p6T
Learning by repetition impairs recall of details
http://mnt.to/l/4p68
Statistical analysis could improve understanding and treatment of different brain tumours
http://mnt.to/l/4p5J
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** NUTRITION / DIET News **
Research shows almonds reduce the risk of heart disease
http://mnt.to/l/4pcv
Current IV feeding safeguards against bloodstream infections need to be revized
http://mnt.to/l/4p8G
Insights into the diet of Neanderthals provided by oldest human faecal matter
http://mnt.to/l/4p83
The best way to avoid ingredient-based food fear
http://mnt.to/l/4p7P
What are the health benefits of mushrooms?
http://mnt.to/l/4p8Z
American children 'consuming too many vitamins and minerals'
http://mnt.to/l/4p7S
Detailed insights into the structure of milk during digestion could help in weight loss, drug delivery, formulas for premature babies
http://mnt.to/l/4p5d
Study suggests that neanderthals ate more vegetables than previously thought
http://mnt.to/l/4p4x
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** OBESITY / WEIGHT LOSS / FITNESS News **
Children who can identify unhealthy food logos are more likely to be overweight
http://mnt.to/l/4pbG
Large-scale patient data analytics can help create personalized, early intervention for metabolic syndrome
http://mnt.to/l/4pbp
The influence of westernisation spells danger for public health in Nigeria
http://mnt.to/l/4pbc
App focused on making obese adults less sedentary
http://mnt.to/l/4p9K
Obesity, high blood pressure, high triglycerides, and diabetes increase future risk for chronic kidney disease
http://mnt.to/l/4p97
Eating extra fruit and vegetables is healthy but may not reduce weight
http://mnt.to/l/4p7H
Roux-en-Y gastric bypass surgery may reduce heart disease risk
http://mnt.to/l/4p7c
Sleep, mood improves after substantial weight loss
http://mnt.to/l/4p78
Study finds that for gastric bypass patients, percent of excess weight loss differs by race and ethnicity
http://mnt.to/l/4p6F
Research finds BMI measurement may be missing 25 percent of children who could be considered obese
http://mnt.to/l/4p6B
After weight loss surgery, bone loss persists for 2 years
http://mnt.to/l/4p6g
Cushing disease: A case of mistaken identity
http://mnt.to/l/4p67
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** PRIMARY CARE / GENERAL PRACTICE News **
Changing roles of physicians with MBAs
http://mnt.to/l/4p9T
Study urges improvement in physicians' inconsistent record of ordering lab tests
http://mnt.to/l/4p9p
Lack of residency positions leaves foreign-trained physicians frustrated
http://mnt.to/l/4p9m
Care gaps in outpatient settings targeted by e-surveillance program
http://mnt.to/l/4p8T
Researchers estimate 5.8 million A&E visits occur after patients unable to see a GP in England
http://mnt.to/l/4p8w
Half of quality improvement studies fail to change medical practices
http://mnt.to/l/4p86
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** PROSTATE / PROSTATE CANCER News **
New treatment for enlarged prostate successful in dogs
http://mnt.to/l/4p6b
The effectiveness of focal treatment for prostate cancer compared to radical therapies in the long-term
http://mnt.to/l/4p5x
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** SENIORS / AGING News **
Longevity in women likely indicated by reproduction later in life
http://mnt.to/l/4p7Q
Research explains action of drug that may slow aging, related disease
http://mnt.to/l/4p7C
Aging contributes to rapid rates of genomic change, signaling challenges for personalized medicine
http://mnt.to/l/4p7x
UK research exposes barriers to fitness and fun for older people with sight loss
http://mnt.to/l/4p7b
Local governments lack funds for age-friendly infrastructure
http://mnt.to/l/4p6v
Challenges for personalized medicine caused by rapid rates of genomic change during aging
http://mnt.to/l/4p65
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** SLEEP / SLEEP DISORDERS / INSOMNIA News **
Brain function when aging adversely affected by little or poor sleep
http://mnt.to/l/4p9v
No link discovered between insomnia symptoms and high blood pressure
http://mnt.to/l/4p7X
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** STATINS News **
Study finds those most likely to adhere to statin therapy
http://mnt.to/l/4p5b
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** STROKE News **
Minimizing stroke injury by blocking key enzyme
http://mnt.to/l/4p9n
New way discovered to prevent some strokes
http://mnt.to/l/4p8r
New approach to clinical trials could boost participation
http://mnt.to/l/4p89
One partner can suffer when couples disagree on stroke recovery
http://mnt.to/l/4p5F
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** WOMEN'S HEALTH / GYNECOLOGY News **
Are routine pelvic exams 'more harm than good' for healthy women?
http://mnt.to/l/4pcB
Countdown to 2015 and beyond: fulfilling the health agenda for women and children
http://mnt.to/l/4pb5
Young women with PCOS are five times more likely to develop type 2 diabetes
http://mnt.to/l/4p6y
The Four Things That Can Predict How Long You'll Live
You eat right, hit the gym, avoid smoking, and don't drink too much -- but will your healthy lifestyle really pay off? Scientists say yes. According to a new study published in the journal Preventative Medicine, people can extend their life expectancies by avoiding four poor lifestyle habits: smoking, alcohol, poor diet, and inactivity.
Researchers at the University of Zurich studied 16,721 people, ages 16 to 90 from 1977 to 1993 with their corresponding deaths up until 2003. The purpose of the study was to determine what a healthy lifestyle looked like in numbers and to prove that avoiding unhealthy factors can help increase life expectancy. Some interesting findings: Smoking is the highest risk factor, with smokers having a 57 percent higher risk of dying prematurely. Also, people who engage in all four risk factors have a mortality risk that's two and a half times higher than someone who refrains from bad health habits.
Yahoo Shine could not reach co-study author Brian Martin, M.D., a professor at the Institute of Social and Preventive Medicine at the University of Zurich, for comment, however, he said in a university press release, "We were very surprised by the 2.5 fold higher risk when all four risk factors are combined.” For example, the probability of a 75-year-old man who incorporates all four risk factors surviving the next 10 years is only 35 percent. If he doesn’t engage in those four poor habits, his odds shoot to 67 percent; for a woman, it’s 47 and 74 percent respectively.
What's more, the impact of an unhealthy lifestyle worsens as a person ages. For 45-to-55-year-olds who smoke, drink, don't work out, and don't eat healthfully, those choices barely made a dent on their mortality rates, compared to the effect it had on the 65-to-75-year-olds. The odds of a 75-year-old man with none of the risk factors surviving the next 10 years is 67 percent, exactly the same for an unhealthy person who is 10 years younger.
Extreme Obesity May Cut 14 Years Off One's Life Results of a pooled data analysis show that adults with extreme obesity have increased risks of dying at a young age from cancer and other conditions, including heart disease, stroke, diabetes, and kidney and liver diseases. The study findings appear in PLOS Medicine.
Researchers from the National Cancer Institute first classified subjects according to their body mass index (BMI): normal, overweight, Class I obesity, Class II obesity, or Class III obesity. The analysis comprised of 20 large studies involving adults from the U.S., Sweden, and Australia. The researchers assessed the risk of premature death overall and the risk of premature death from specific causes in people who were Class III obese (n>9,500) vs. normal weight (n=304,000).
RELATED: FDA Considers Appetite-Curbing Implant for Severely Obese
The study found that people with Class III (or extreme) obesity were found to have a significant reduction in life expectancy compared with people of normal weight. Within the Class III obesity group, increasing BMI was correlated to increased risk of dying overall and from most major health causes. Years lost in life expectancy ranged from 6.5 years (BMI 40–44.9) to 13.7 years (BMI of 55–59.9). Researchers concluded there is a need to develop more effective interventions to fight extreme obesity.
One hour of physical exercise may counteract effects of sitting for six to seven hours a day. TIME (7/9, Park) reports on its website that “because exercise has a more powerful effect in helping the heart than sitting does in harming it, one hour of physical exercise could counteract the effects of sitting for six to seven hours a day, according to” research published in Mayo Clinic Proceedings. Investigators came to this conclusion after analyzing data “from the National Health and Nutrition Examination Survey, an ongoing series of health studies maintained by the” CDC. The researchers also found, however, that individuals “who logged less time sitting had better fitness, as measured on a treadmill test, than those who spent more hours in a chair or on the couch.”
Dividing daily protein intake evenly across meals may aid muscle protein synthesis. Forbes (7/16) contributor David Kroll writes, “Consuming a meal with 30 grams of high-quality protein has emerged as the average consensus from studies designed to maximize muscle protein synthesis across people of various ages, body mass, and activity levels.” Now, a new study published in the Journal of Nutrition has revealed that “muscle protein synthesis averaged 25% higher when participants ate the evenly-divided protein diet than when on the diet skewed toward a protein-rich dinner.” The eight-participant study received funding from the National Institute on Aging.
Whey Protein May Lower Glucose in T2DM (HealthDay News) — For patients with well-controlled type 2 diabetes, consumption of whey protein pre-load before a high-glycemic index breakfast correlates with a reduction in glucose levels, higher insulin responses, and higher glucagon-like peptide-1 (GLP-1) levels, according to a study published online July 7 in Diabetologia.
Daniela Jakubowicz, MD, from Tel Aviv University in Israel, and colleagues examined whether enhancing GLP-1 secretion with whey protein pre-load would be beneficial in type 2 diabetes. Fifteen individuals with well-controlled type 2 diabetes, who were not taking medications except sulfonylurea or metformin, were randomized to receive 50g whey in 250ml water or placebo followed by a standardized high-glycemic index breakfast. Following meal ingestion, the authors assessed plasma concentration of glucose, intact GLP-1, and insulin concentrations.
The researchers found that glucose levels were reduced by 28% after whey pre-load over the 180-minute post-meal period, with a uniform reduction during early and late phases. With whey pre-load, insulin and C-peptide responses were significantly higher (105 and 43%, respectively), with a 96% increase in early insulin response. Whey pre-load correlated with significantly higher total and intact GLP-1 levels (141 and 298%, respectively). There was no significant between-group difference observed in dipeptidyl peptidase 4 plasma activity after breakfast.
"Whey protein may therefore represent a novel approach for enhancing glucose-lowering strategies in type 2 diabetes," the authors write.
Full Text (subscription or payment may be required)
Biking Tied to PCa, But Not Reproductive Health A new study fuels the ongoing debate over the health risks of bicycle riding for men: Researchers found that cyclists who bike more may face a higher risk of prostate cancer, but not a greater chance of infertility or erectile dysfunction. The study appeared in the the Journal of Men's Health.
Researchers surveyed more than 5,000 male cyclists from 2012 to 2013. Eight percent of the men reported erectile dysfunction problems, although they weren't more common in men who biked more. The investigators did find links between erectile dysfunction and three factors -- high blood pressure, smoking, and older age. The researchers didn't find any link between more cycling and more cases of infertility, which 1 percent of the men reported.
Just under 1 percent of the men overall reported being diagnosed with prostate cancer. Those who biked the most, more than 8.5 hours a week, were much more likely to have prostate cancer than the other men. Of the 498 men who biked the most, 17 said they had prostate cancer (3.5 percent). Of those who biked the least, three out of 511 (0.5 percent) said they had prostate cancer, the findings showed.
However, the findings aren't definitive, and they conflict with previous research on impotence and infertility. Lead author Milo Hollingworth, M.B.B.S., a research associate at University College London, acknowledged to HealthDay that the findings are "difficult to interpret."
He stressed that "men shouldn't worry about increasing their risk of prostate cancer by cycling. Men should cycle as much as they did before. The benefits for your heart, lungs, whole body, and mental health are much more important."
Charge Up on Cherries Before Cycling
Cyclists who drank Montmorency tart cherry juice concentrate before a three–day simulated race experience less inflammation and oxidative stress.
Strenuous exercise can cause temporary inflammation and oxidative stress that can lead to muscle damage, muscle soreness and reduced capacity to recover quickly. Previous studies have found that tart cherries may exert beneficial effects on recovery following weight lifting exercise and marathon running. Glyn Howatson from Northumbria University (United Kingdom), and colleagues assessed the effects of Montmorency tart cherry juice concentrate on recovery following strenuous exercise from cycling. The researchers gave 16 well-trained, male cyclists about 1 ounce (30 ml) of Montmorency tart cherry juice concentrate mixed with water (equivalent to 90 whole Montmorency tart cherries per serving), or a calorie-matched placebo, twice a day for seven days. On days five, six and seven, the participants performed prolonged, high-intensity cycling intervals – exercise that was designed to replicate the demands of a three-day race. The team collected blood samples and found that markers of inflammation and oxidative stress were significantly lower in the cyclists who consumed the tart cherry juice concentrate compared to those who did not. At one point during the trial, oxidative stress was nearly 30% lower in the tart cherry group compared to the other group. The study authors conclude that: “The attenuated oxidative and inflammatory responses suggest [Montmorency tart cherry concentrate] may be efficacious in combating post-exercise oxidative and inflammatory cascades that can contribute to cellular disruption.”
http://www.choosecherries.com/press-material/new-study-demonstrates-impact-of-montmorency-tart-cherries-on-inflammation-and-oxidative-stress-after-high-intensity-cycling/
Running News: Short Distances Count; Heat Stroke a Bigger Danger Than Arrhythmia
Running just 5 minutes a day can extend one's life span. For endurance runners, heat stroke may be a bigger danger than cardiac disorders. These are the lessons learned from two new studies in the Journal of the American College of Cardiology.
In the first, researchers analyzed data from more than 55,000 adults. Compared with people who did not run, runners had a 30% reduction in all-cause mortality and a 45% reduction in cardiovascular mortality, resulting in a 3-year increase in life expectancy. Findings did not differ significantly based on running distance, duration, speed, or frequency. Editorialists advise physicians to offer a simple exercise prescription to patients: "15 min of brisk walking or 5 min of running is all it takes for most clinic patients."
In the second study, researchers retrospectively reviewed data from more than 137,000 runners who participated in endurance races in Tel Aviv. They found only two serious cardiac cases: one myocardial infarction and one hypotensive supraventricular tachycardia. However, serious cases of heat stroke (core body temperature above 104-105 degrees associated with multiorgan dysfunction) occurred in 21 runners; two cases were fatal, and 12 were life-threatening. The researchers say the diagnosis of heat stroke can be missed and mistaken for a cardiac disorder unless the core temperature — which can only be reliably obtained with a rectal measurement — is taken immediately.
JACC article on running 5 minutes a day (Free abstract)
JACC editorial on running and mortality (Subscription required)
JACC article on heat stroke (Free abstract)
JACC editorial on heat stroke (Subscription required)
Fitness in 50s Is An Anti–Aging Essential
Poor physical ability in your 50s may raise your risk of an early death
In a first-of-its-kind study to link physical ability of men and women in their 50s with the likelihood of dying, Rachel Cooper, from University College London (United Kingdom) and colleagues warn that poor physical capacity in midlife may raise a person’s risk of premature death. The team assessed data collected on 1,355 men and 1,411 women, all age 53 years when their fitness was measured, who were enrolled in the MRC National Survey of Health and Development in England, Scotland, and Wales. A visiting nurse assessed each participant’s ability to perform three physical tests. One test gauged hand grip strength, another evaluated a person’s ability to balance on one foot and the third noted the time it took the participant to stand up from a chair. The researchers then followed the participants for the next 13 years, using information from the National Health Service register to find out which had died. They took into account other factors that could influence the risk of death, including smoking, body size and a history of illnesses such as heart and lung problems at age 53. With 177 deaths during the follow-up period, the data suggested that the participants who performed in the lowest one-fifth on the tests were almost four times as likely to die during follow-up as people who completed the tasks best. Those who couldn’t perform any of the tests were more than eight times as likely to die as the top performers. Observing that: "Lower levels of physical capability at age 53 and inability to perform capability tests are associated with higher rates of mortality,” the study authors submit that: “Even at this relatively young age these measures identify groups of people who are less likely than others to achieve a long and healthy life.”
http://www.reuters.com/article/2014/05/08/us-physical-ability-death-idUSKBN0DO12W20140508
Study shows walking may improve Parkinson’s symptoms. The Los Angeles Times (7/3, Macvean) reports that “in yet another endorsement for getting on your feet and walking, researchers said Wednesday that people with mild to moderate Parkinson’s disease may improve their motor function, mood, fatigue levels and more by taking regular aerobic walks.” The research was published in the journal Neurology.
NBC News (7/3) reports that study author Dr. Ergun Uc of the University of Iowa and the Veterans Affairs Medical Center of Iowa City, said, “The results of our study suggest that walking may provide a safe and easily accessible way of improving the symptoms of Parkinson’s disease and improve quality of life.”
Fox News (7/2) reports that “researchers noted that safety was the biggest priority in their study and that they were very selective in choosing their participants.” Dr. Uc commented, “Our exercise program was administered after a careful selection of candidates who did not have dementia, who were able to walk independently without a cane or walker, and who did not have heart or lung disease or other serious medical/orthopedic problem.”
Also reporting this story are Reuters (7/3, Doyle), HealthDay (7/3), and MedPage Today (7/3).
Omega-3s Reduce Deadly Blood Clot Risks
A diet abundant in fish, combined with omega-3 fatty acid supplementation, may reduce the risk of venous thromboembolism by nearly 50%.
Encompassing the conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE), venous thromboembolism (VTE) is the third most common cardiovascular illness after acute coronary syndrome and stroke. IJ Hansen-Krone, from University of Tromso (Norway), and colleagues analyzed data collected on 23,621 men and women , ages 25 to 97 years, who were enrolled in the Tromso Study which followed subjects for an average of 16 years. During this period, there were 536 documented cases of VTE. Through data analysis, researchers ascertained that those participants who ate three or more servings of fish per week reduced their risk of VTE by 22%. Adding fish oil dietary supplements further enhanced the dietary benefits, with omega-3 dietary supplement consumers experiencing a 48% lower risk of VTE. The study authors conclude that: “a high weekly intake ([at or more than] 3 times/wk) of fish was associated with a slightly reduced risk of [venous thromboembolism], and the addition of fish oil supplements strengthened the inverse effect.”
http://www.nutraingredients-usa.com/Research/Omega-3s-heart-health-Fish-and-supplements-may-slash-venous-thromboembolism-risk-says-new-study/
Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life
The Journal of Sexual Medicine, 07/09/2014 Clinical Article Yassin DJ, et al. – Long–term testosterone undecanoate (TU) in men with Late–onset hypogonadism (LOH) and erectile dysfunction (ED) reduces obesity parameters and improves metabolic syndrome and health–related quality of life.
CONCLUSION: Long-term TU in men with LOH and ED reduces obesity parameters and improves metabolic syndrome and health-related quality of life.
http://www.ncbi.nlm.nih.gov/pubmed/24712761
Long-term associations of nut consumption with body weight and obesity
American Journal of Clinical Nutrition, 07/09/2014 Clinical Article Jackson CL, et al. – This study suggests that high consumption of nuts (especially walnuts) has been associated with lower diabetes risk. Therefore, regular consumption (approximately one handful daily) of nuts over the long term, as a replacement to less healthful foods, can be incorporated as a component of a healthy diet for the prevention of obesity and type 2 diabetes.
http://www.ncbi.nlm.nih.gov/pubmed/24898229
Mushrooms Stabilize Blood Sugar
Consuming portabella mushrooms may help to decrease the post–meal glycemic response.
Low in calories, fat-free, and abundant in Vitamin D, mushrooms are shown to promote healthy weight and boost immune function. Peter Horvath, from the University of Buffalo (New York, USA), and colleagues explored the consumption of portabella mushrooms among healthy men and women, on glucose levels. Enrolling 8 men and women, average age 23 years, with an average body fat of 19.7%, the subjects completed 3 modified Oral Glucose Tolerance Tests (OGTTs) over a two-week period. The OGTTs were evaluated in subjects who consumed one of three drinks, each equally sweet: a 75 g glucose drink; a 75 g glucose drink with 9.5 g portabella mushroom powder; or 9.5 g portabella mushroom powder with wstevia/flavored water. Fasting and 30-minute blood samples were collected for two hours. The data revealed that glucose levels were elevated after consumption of both the glucose-only and glucose- mushroom beverages, with levels of the latter higher in men at 30 minute, and women at 60 and 120 minutes. Insulin levels were higher after both glucose-only and glucose-mushroom beverage consumption than after mushroom-stevia beverage consumption; as well after mushroom-stevia, insulin levels showed a more gradual decline in women. Observing that: “Mushroom powder reduced postprandial hypoglycemia, rapid insulin decrease and elevated hunger in women compared to glucose alone,” the study authors submit that: “Mushrooms may moderate postprandial glucose related responses.”
http://medicalxpress.com/news/2014-05-benefits-mushroom-consumption.html
Glycated hemoglobin for the diagnosis of diabetes and prediabetes: Diagnostic impact on obese and lean subjects, and phenotypic characterization
Journal of Diabetes Investigation, 07/09/2014 Clinical Article Incani M, et al. – The aims of the present study were to evaluate the impact of glycated hemoglobin (HbA1c) criteria to diagnose diabetes and prediabetes compared with oral glucose tolerance test (OGTT), and to examine HbA1c in relation to body mass index. The agreement between HbA1c, fasting plasma glucose and 2–h glucose post–OGTT for the diagnosis of prediabetes was poor in the Italian population; whereas HbA1c ≥6.5% showed a relatively good agreement with OGTT for the diagnosis of diabetes. For the first time, the authors have shown that obesity class influences the diagnostic performance of HbA1c.
Methods
- Two cohorts were studied, one from an obesity clinic (n = 592) and one from subjects undergoing screening for diabetes (n = 462).
- All underwent OGTT and HbA1c measurement.
- In the obese cohort, HbA1c ≥6.5% (≥48 mmol/mol) showed a sensitivity of 69.3% for diabetes, whereas HbA1c 5.7–6.4% (39–46 mmol/mol) did not identify prediabetes well (sensitivity 39.1%).
- In the diabetes screening cohort, HbA1c had low sensitivities for both diabetes (39.2%) and prediabetes (53.3%)./”
- When participants were stratified according to body mass index class I–III, HbA1c agreement with the OGTT for diabetes was much higher (80%, P < 0.005) in class I obesity compared with class II–III obesity; whereas for prediabetes, HbA1c had a low sensitivity in all obes
Treatment of the obese type 2 diabetes patient with severe insulin resistance: a 24-week, prospective, randomized, open-label, treat-to-target study: A pilot study to compare the efficacy of U-500 regular insulin plus metformin with U-500 regular insulin, metformin, and exenatide
Endocrine Practice, 07/09/2014 Clinical Article Distiller LA, et al. – The study aims to compare the efficacy of U–500 regular insulin plus metformin with U–500 regular insulin, metformin, and exenatide in improving glycaemic control in patients with severely insulin resistant Type 2 diabetes mellitus [T2DM]. U–500 regular insulin plus metformin is effective for the treatment of T2DM patients with severe insulin resistance. The addition of exenatide may ameliorate potential weight gain but provides no additional improvement in glycaemia.
Methods
- Thirty patients with Type 2 diabetes and severe insulin resistance were screened and 28 were randomized to regular insulin U-500 plus metformin or the GLP-1 analogue exenatide, U-500 and metformin.
- HbA1c levels, body weight and insulin doses were documented at baseline, and at 12 and 24 weeks.
- The number and severity of any hypoglycaemic episodes were noted.
- There were 7 men and 7 women in each group [U-500 and metformin and U-500, metformin and exenatide].
- Overall, U-500 insulin and metformin, either alone or with the addition of exenatide, resulted in a significant improvement in HbA1c in both groups, with no significant difference between the two groups.
- There was no meaningful weight change in those utilising exenatide.
- Those on U-500 insulin and metformin alone had a tendency towards some weight gain.
- No severe hypoglycaemia occurred during the study period.
- Symptomatic hypoglycaemia was more common in the group on exenatide, but this occurred in only 5 patients and the clinical significance of this is uncertain.
- Insulin dosage changes on U-500 regular insulin were variable, but tended to be lower in those on exenatide.
http://onlinelibrary.wiley.com/doi/10.1111/jdi.12241/abstract;jsessionid=B655B562D2F22A2DA3A31A08D64D7B76.f02t01
Coffee Deters DNA Damage
Consuming dark-roast coffee appears to reduce levels of spontaneous DNA strand breaks.
Previously, studies have suggested that regular coffee consumption decreases oxidative damage in peripheral white blood cells. T. Bakuradze, from the University of Kaiserslautern (Germany), and colleagues investigated the consumption of a dark-roast coffee blend on the level of spontaneous DNA strand breaks. The researchers enrolled 84 healthy men to consume daily for 4 weeks either 750 ml of fresh coffee brew or 750 ml of water, subsequent to a run in washout phase of 4 weeks. The study coffee was a blend providing high amounts of both caffeoylquinic acids (10.18 ± 0.33 mg/g) and the roast product N-methylpyridinium (1.10 ± 0.05 mg/g). Before and after the coffee/water consumption phase, the researchers conducted assays to assess for spontaneous DNA strand breaks. Whereas at the study’s start, both groups exhibited a similar level of spontaneous DNA strand breaks – in the intervention phase, spontaneous DNA strand breaks slightly increased in the control (water only) group whereas they significantly decreased in the coffee group, leading to a 27 % difference. Observing that: “The consumption of the study coffee substantially lowered the level of spontaneous DNA strand breaks in [white blood cells,” the study authors write that: “We conclude that regular coffee consumption contributes to DNA integrity.”
http://www.nutraingredients-usa.com/Research/Could-coffee-protect-DNA-from-damage/
Chia Seeds Sprout Nutritional Benefits Most of us have had the dubious pleasure of receiving a Chia Pet as a “gift” at one time or another. These odd-looking clay figurines grew miraculous thick, green, curly “hair” from hundreds of tiny chia seeds when the clay had been moistened for several days.
The seeds stayed moist and sprouted quickly, in large part due to their hydrophilic nature. Chia seeds can absorb and retain up to 27 times their weight in water.
For the majority of gift recipients, the fun died quickly, as did the Chia Pet's hair. There seemed to be no point in trying to maintain the green locks beyond a few days. However, an expanding interest in chia seeds just may have us all trying to grow Chia Pets.
Background
Today's market for the nutritious chia seed would probably come as absolutely no surprise to the ancient peoples of southern Mexico and Central America. Civilizations such as those of the Aztec and Mayan Indians grew chia as a dietary staple.
Unless otherwise specified, the term “chia” usually refers to the chia species Salvia hispanica.1 S. hispanica is a rapidly growing biennial plant well-suited to arid climates and poor, sandy soil.1 Growing to a height of about 36 inches, the plant flowers in long clusters of deep blue and purple. The tiny seeds measure no more than 2 mm and are usually brown or black.
One chia plant can produce thousands of seeds. These seeds are composed of up to 40% oil, with the remaining structure high in protein and fiber. In today's use of chia, it is the oil that is of particular interest.
Science
Nutritionally, chia seed oil is more than 60% alpha-linolenic acid (ALA).2 This makes chia oil one of the highest in composition of this rich omega-3 fatty acid among all oil-bearing seeds. Research involving both chia seeds and chia oil verified that plasma ALA levels increased up to 91% at 2.5 hours postingestion and stayed elevated for nearly 24 hours.3
The role of omega-3 fatty acids in human health has been debated for many years. Even though the necessity of these compounds for health and well-being has never been disputed, the optimal recommended amount in daily foods and supplements is not as clear.
Unlike some other oil-bearing seeds, chia seeds do not require grinding for their oils to be released.4This characteristic makes them a more appealing ingredient in health-food snacks and cereals. A quarter-cup of chia seeds contains approximately 8mg of iron and 10g of fiber.
Chia seeds are being studied as a weight-modifying food. In one study of 62 overweight women (BMI ≥25), the participants were randomized to consume either 25g/day of chia seeds or placebo for a period of 10 weeks.5 Although plasma ALA levels increased significantly in the chia-seed group, these individuals had no statistically significant weight loss or change in body-fat percentage.
Summary
Very seldom does a product with very little downside surface. In the case of chia seeds, there seems to be mostly good news, without any bad news. As long as patients are counseled regarding the always present potential for allergy, chia seed compounds represent a healthy and tasty way to boost beneficial fatty acids and fiber.
http://www.empr.com/chia-seeds-sprout-nutritional-benefits/article/358667/2/
Defeat Diabetes in Two Minutes
High intensity training consisting of two minutes of exercise weekly, may help to prevent type–2 diabetes.
High intensity training, abbreviated as HIT, is a fitness regime characterized by short bursts of intensive physical activity. John Babraj, from Abertay University (United Kingdom), and colleagues enrolled 3 male and 11 female untrained individuals, average age 42 years, average BMI 24 -29 kgm2, to perform twice weekly exercise consisting of 10 × 6-second sprints with a one minute recovery between each sprint. The team assessed metabolic health (oral glucose tolerance test), aerobic capacity (incremental time to exhaustion on a cycle ergometer) and physical function (get up and go test, sit to stand test and loaded 50 m walk), before and after training. The HIT regimen, lasting 8 weeks, resulted in a significant improvement in aerobic capacity (8% increase in VO2 peak), physical function, and a reduction in blood glucose under the curve (6% reduction). The study authors submit that: “This study demonstrates for the first time the potential of [high intensity training] as a training intervention to improve skeletal muscle function and glucose clearance as we age.”
http://medicalxpress.com/news/2014-05-diabetes-minutes-academics.html
Catheter ablation helps atrial fibrillation patients live longer The team, from the University of Michigan (U-M) at Ann Arbor, reports the findings in the journal Heart Rhythm.
Atrial fibrillation is an age-related heart rhythm disorder caused by electrical "short-circuits" in the heart that impair its ability to pump blood efficiently and cause fluttering sensations in the chest.
People with atrial fibrillation have a higher risk ofstroke and heart attacks, and they also suffer a considerably poorer quality of life.
According to the World Heart Federation, who describe the condition as a "growing and urgent public health concern," atrial fibrillation is the most common sustained abnormal heart rhythm condition worldwide.
In Europe and the US, there are currently estimated to be about 9 million people with atrial fibrillation, and numbers are set to increase.
Catheter ablation led to 60% lower rate of deaths from cardiovascular events A new long-term study suggests that adult patients with atrial fibrillation whose heart rhythm is successfully restored with a minimally invasive procedure called catheter ablation, have a significantly reduced chance of early death from a heart attack or heart failure.
Catheter ablation is a minimally invasive procedure where an electrophysiologist delivers radiofrequency energy to the heart muscle through a specially designed catheter inserted into the left atrium or chamber of the heart.
The intention is to disrupt the short-circuits that are causing the irregular heart rhythm.
The catheter is inserted with a needle into a vein that runs up to the heart from the groin. A three-dimensional mapping system on a computer helps the doctor guide the catheter precisely to the correct location in the heart.
In this latest study, the U-M researchers showed that death from cardiovascular events dropped by 60% among adults who had their normal heart rhythm successfully restored with catheter ablation.
Lead author Dr. Hamid Ghanbari, an electrophysiologist at U-M's Frankel Cardiovascular Center, says:
"The study findings show the benefit of catheter ablation extends beyond improving quality of life for adults with atrial fibrillation. If successful, ablation improves life span."
Even older patients, and those with other conditions benefited He and his colleagues found that even older patients gained the cardiovascular survival benefits of the procedure, as did those with diabetes or a history of stroke, or who had sleep apnea, or a condition known as low-ejection fraction - an early sign of heart failure where the heart does not pump enough blood.
In an accompanying editorial, that characterizes catheter ablation of atrial fibrillation as "a death-defying endeavor," the authors describe the study results as encouraging for those involved in treating the debilitating heart condition.
For their investigation, Dr. Ghanbari and colleagues examined 10 years of follow-up medical data on over 3,000 adults who had received catheter ablation as a treatment for paroxysmal atrial fibrillation - where the condition comes and goes on its own. Most of the participants, whose average age was 58 when they received the treatment, were men.
The study is thought to be the first and longest to examine the clinical outcomes of catheter ablation.
http://www.medicalnewstoday.com/articles/280396.php
The combination of elevated triglycerides and abnormal fasting glucose (AFG) increases risk of cerebral infarction in patients with mild to moderate hypercholesterolemia
Journal of Cardiovascular Pharmacology and Therapeutics, 07/12/2014 Clinical Article Nakagami T, et al. – The authors explored the combined effect of elevated triglycerides (TGs) and glucose on cardiovascular disease (CVD) in a post hoc analysis of the large–scale Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study. The findings contribute to the formulation of the hypothesis that patients with hypercholesterolemia having AFG plus high TGs have an increased risk of cerebral infarction. These are compatible with the result from the main study that patients with hypercholesterolemia randomized to diet plus pravastatin had a reduced risk of cerebral infarction.
CONCLUSIONS: Our findings contribute to the formulation of the hypothesis that patients with hypercholesterolemia having AFG plus high TGs have an increased risk of cerebral infarction. These are compatible with the result from the main study that patients with hypercholesterolemia randomized to diet plus pravastatin had a reduced risk of cerebral infarction.
http://www.ncbi.nlm.nih.gov/pubmed/24906541
Steroid injections may provide little benefit for spinal stenosis patients. The New York Times (7/2, Belluck, Subscription Publication) reports that a new study published Wednesday in The New England Journal of Medicine shows that “a widely used method of treating a common cause of back and leg pain — steroid injections for spinal stenosis — may provide little benefit for many patients.” The research involved “400 patients at 16 sites.” The Times notes that “mostly, steroid injections are safe,” although “in April, the Food and Drug Administration warned that they may, in rare cases, cause blindness, stroke, paralysis or death, noting that injections have not been F.D.A.-approved for back pain and their effectiveness has ‘not been established.’”
HealthDay (7/2, Reinberg) reports that lead author Dr. Janna Friedly, an assistant professor of rehabilitation medicine at the University of Washington in Seattle, said, “These steroid injections aren’t helpful. There is no added benefit to the steroid itself, so if people are considering these injections, I would recommend that they consider an alternative.”
Epidural Steroids Generally Are Ineffective for Lumbar Spinal Stenosis
A steroid-lidocaine combination is essentially no better than lidocaine alone for patients with symptomatic central lumbar spinal stenosis, according to a New England Journal of Medicine study.
U.S. researchers randomized 400 patients with symptomatic stenosis to receive an epidural injection of either lidocaine alone or lidocaine plus a glucocorticoid. All patients had moderate-to-severe pain and functional disability. About 40% of each group requested and received a second injection at 3 weeks.
During 6 weeks of follow-up, mean scores on pain and disability scales improved substantially in both the steroid and no-steroid groups. However, at 6 weeks, no significant differences were observed betweenthe groups for either of these primary outcomes. At 3 weeks, small, statistically significant differences favored the steroid group, but these differences were deemed clinically unimportant.
At best, epidural steroids provide minimal transient benefit for patients with painful, disabling central lumbar spinal stenosis. According to a recent meta-analysis, the same is true for epidural steroids in patients with sciatica. An editorialist notes that some insurance companies require epidural injections as part of nonsurgical treatment before spinal stenosis surgery is approved; that policy obviously is misguided.
NEJM article (Free abstract)
Lipid-lowering therapy in patients 75 years and older: clinical priority or superfluous therapy
Progress in Cardiovascular Diseases , 07/12/2014 Clinical Article Phan BAP, et al. The incidence and prevalence of cardiovascular (CV)-related morbidity and mortality significantly increase with age. In the elderly, hypercholesterolemia with elevated total and low-density-lipoprotein cholesterol is a significant predictor of incident and recurrent CV disease. Multiple lines of evidence have established the benefit of statin therapy to lower cholesterol levels and reduce the risk of CV events as well as prevent progression of subclinical atherosclerotic disease. Elderly patients, particularly those older than 75 years, have not been well represented in randomized clinical trials evaluating lipid lowering therapy. The limited available data from clinical trials do support the benefit of statin therapy in the elderly population. Based upon these data, cholesterol treatment guidelines endorse statin therapy as the primary treatment of hypercholesterolemia in elderly patients, though caution is recommended given the greater number of co-morbid conditions and concern for poly-pharmacy common in the elderly. Additional research is needed to better establish the benefit of statin therapy in the elderly within the context of reducing CV risk, minimizing side effects, and improving overall quality of life. http://www.onlinepcd.com/article/S0033-0620(14)00040-1/abstract?rss=yes?rss=yes
Preventing Gallstone Formation During Weight Loss Both obesity and rapid weight loss are associated with an increased risk of gallstones, but ursodeoxycholic acid (UDCA) and/or high-fat weight loss diets could reduce the risk of gallstones during weight loss. A study published in Clinical Gastroenterology and Hepatology analyzed 13 randomized controlled trials of 1,836 participants undergoing weight loss via dieting or bariatric surgery comparing UDCA or high-fat weight loss diets in reducing gallstone risk. Compared to control interventions, UDCA reduced gallstone risk and trials of diet alone had significantly larger effects compared to bariatric surgery. UDCA lowered the risk of cholecystectomy for symptomatic stones (risk ratio, 0.20; 95% CI, 0.07–0.53), as did diets high in fat content compared with low fat content (risk ratio, 0.09; 95% CI, 0.01–0.61). The authors conclude that based on these results, UDCA and/or high-fat weight loss diets appear to prevent gallstone formation.
http://www.cghjournal.org/article/S1542-3565(13)01837-5/abstract
Soothe Stress with Chocolate
Fifty grams of dark chocolate a few hours before a stressful event may reduce elevations in stress hormones.
Mounting scientific evidence suggest that consuming dark chocolate confers therapeutic health effects, most notably on cardiovascular parameters. Swiss researchers reveal that dark chocolate (125 mg of epicatechin) may reduce elevations in stress hormones, when consumed prior to a stressful event. The team enrolled 65 healthy men, ages 20 to 50 years, who received either 50 g of dark chocolate, or placebo, two hours before a stress test. While stress markers increased among both groups, the dark chocolate group showed blunted responses for cortisol and epinephrine. Observing that: “flavonoid-rich dark chocolate intake buffers endocrine stress reactivity,” the study authors posit that dark chocolate may exert “inhibitory peripheral effects … on the biosynthesis and secretion of cortisol and catecholamines.”
http://www.nutraingredients-usa.com/Research/Stressed-Try-some-dark-chocolate-say-Swiss-scientists
For PAD Patients, a Little Chocolate May Go a Long Way (HealthDay News) — Consumption of dark chocolate may improve walking autonomy in patients with peripheral artery disease (PAD), according to research published online July 2 in the Journal of the American Heart Association.
Lorenzo Loffredo, MD, of the Sapienza University of Rome, and colleagues randomly assigned 20 patients with PAD (14 males and six females; mean age, 69 ± 9 years) to 40g of dark chocolate (>85% cocoa) or 40g of milk chocolate (≤35% cocoa) in a single-blind, cross-over study.
At two hours after dark chocolate ingestion, the researchers observed significant increases (allP<0.001) in maximal walking distance (+11%), maximal walking time (+15%), and serum levels of nitrite/nitrate (NOx) (+57%). They also observed significant decreases in serum levels of isoprostanes (−23%; P=0.01) and sNOX2-dp, a marker of blood NOX2 activity (−37%; P<0.001). No significant changes in these variables were observed after ingestion of milk chocolate. Serum levels of epicatechin and its methylated metabolite increased significantly following ingestion of dark, but not milk, chocolate.
"In conclusion, the results of this study suggest that short-term administration of dark chocolate improves walking autonomy with a mechanism involving its high content of polyphenols and perhaps mediated by an oxidative stress mechanism, which ultimately leads to enhanced nitric oxide generation," the authors write.
Full Text
Smart Dietary Choices to Avoid Stroke
People with diets higher in protein, especially from fish, may be less likely to have a stroke.
Numerous published studies report that a diet abundant in colorful fruits and vegetables may lower stroke risk. Xinfeng Liu, from Nanjing University School of Medicine (China), and colleagues completed a meta-analysis of 7studies with a total of 254,489 participants who were followed for an average of 14 years. The data revealed that the participants with the highest amount of protein in their diets were 20% less likely to develop a stroke, as compared to those with the lowest amount of protein in their diets. For every additional 20 grams per day of protein consumed, the risk of stroke decreased by 26%. The team advises, however, the protein of-choice is fish, and that red meat consumption should be limited, in accordance with other published studies associating it with increased stroke risk. The study authors conclude that: “These findings suggest that moderate dietary protein intake may lower the risk of stroke.”
http://medicalxpress.com/news/2014-06-diet-higher-protein-linked.html
High Red Meat Intake During Early Adulthood Is Associated with Elevated Risk for Breast Cancer
Farvid MS et al., BMJ 2014 Jun 10; 348:g3437
Substituting other sources of protein for red meat might lower risk.
In the Nurses' Health Study, red meat intake during early adulthood was associated with excess risk for breast cancer in premenopausal women after 12 years of follow-up. Now, the same investigators report on associations between dietary protein intake during early adulthood and risk for breast cancer after 20 years of follow-up; analysis involved 89,000 premenopausal nurses (mean age, 36) who completed dietary questionnaires at baseline.
More than 2800 cases of breast cancer were documented. Adjusted for multiple potential confounders, the highest median intake of red meat versus the lowest median intake (1.5 servings daily vs. about 1 serving weekly) was associated significantly with elevated risk for breast cancer overall (relative risk, 1.2). In contrast, higher intakes of poultry, fish, eggs, legumes, and nuts were not associated with elevated risk. When data were analyzed by menopausal status, higher poultry intake was associated with lower risk for breast cancer in postmenopausal women (RR, 0.7), but not in premenopausal women. The authors estimated that substituting one serving daily of legumes, poultry, or a combination of legumes, nuts, poultry, and fish for one serving daily of red meat was associated with significantly lower risks for breast cancer.
USPSTF Finalizes Recommendations on Carotid Artery Stenosis Screening
The U.S. Preventive Services Task Force has recommended against screening for asymptomatic carotid artery stenosis in the general adult population (grade D recommendation). Published in the Annals of Internal Medicine, the statement reiterates the group's 2007 guidance.
The harms of screening outweigh the benefits, the task force says. The groups notes that all screening strategies (e.g., ultrasonography, magnetic resonance angiography) "have imperfect sensitivity and could lead to unnecessary surgery and result in serious harms, including death, stroke, and myocardial infarction."
The recommendation applies to adults without histories of transient ischemic attack, stroke, or other neurologic symptoms.
USPSTF's recommendation statement in the Annals of Internal Medicine (Free)
Annals of Internal Medicine review (Free)
Annals of Internal Medicine editorial (Free)
USPSTF grades (Free)
USPSTF Publishes Pocket Guide to Preventive Care
The U.S. Preventive Services Task Force has published "The Guide to Clinical Preventive Services," a pocket guide with abridged versions of the group's recommendations on screening, counseling, and preventive medicine. The guide covers dozens of topics for children and adults, from abdominal aortic aneurysm screening to vitamin supplements for primary disease prevention.
USPSTF guide (Free)
USPSTF: No Asymptomatic Carotid Artery Stenosis Screening (HealthDay News) — The U.S. Preventive Services Task Force (USPSTF) recommends against screening for carotid artery stenosis in adults without a history of transient ischemic attack, stroke, or other neurological symptoms. These findings are presented in a final recommendation statement published online July 8 in the Annals of Internal Medicine.
Michael L. LeFevre, MD, MSPH, on behalf of the USPSTF, updated the 2007 recommendations on carotid artery stenosis screening. They commissioned a systematic evidence review to examine the accuracy of screening tests and externally validated risk stratification tools; the benefits and harms of asymptomatic carotid artery stenosis treatment with carotid endarterectomy or carotid angioplasty and stenting; and the benefits and harms of medications added to current standard medical treatment.
Based on the current evidence, the researchers recommend against asymptomatic carotid artery stenosis screening in the general adult population (Grade D recommendation). The findings apply to adults without a history of transient ischemic attack, stroke, or other neurological signs or symptoms.
"Such screenings are offered throughout the country in health fairs and other settings," writes the author of an accompanying editorial. "Potential consumers of these services should be aware that the test is unlikely to prevent them from having a stroke or to lead to improvements in their health."
Guideline Calls Routine Pelvic Exams Unnecessary
Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, an influential medical group said Monday.
There is no evidence that such pelvic exams are useful and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, the American College of Physicians said in a new practice guideline for doctors.
The college’s guideline was published in the Annals of Internal Medicine and was accompanied by an article reviewing the scientific evidence. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor’s office with medical complaints or who are pregnant.
“The pelvic exam has become a yearly ritual, but I think it’s something women don’t necessarily look forward to,” said Dr. Sandra Adamson Fryhofer, an internist in Atlanta who is a former president of the college. “A lot of women dread it.”
The new recommendation contradicts guidelines from the American College of Obstetricians and Gynecologists, which immediately reiterated its support for yearly pelvic exams.
A pelvic exam consists of three elements: inspection of the external genitalia, examination of the vagina and cervix, and the bimanual examination, in which the physician inserts two gloved fingers into a woman’s vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus, ovaries and fallopian tubes.
The exam takes up time during an annual physical and often requires the presence of a chaperone in the room, which raises costs.
The American College of Physicians reviewed studies of the procedure and concluded that pelvic exams were not accurate diagnostic screening tests for ovarian cancer. A dozen studies have suggested that many women experience pain or discomfort during the exams, and that they may be particularly traumatic for women who have been sexually assaulted.
The reviewers said that they could not even locate studies that had assessed whether routine pelvic exams of asymptomatic women could reduce death or disease from ovarian and other cancers, or benefit women with common benign conditions such as pelvic inflammatory disease, fibroids or warts.
Until about a decade ago, physicians routinely performed pelvic exams before prescribing oral contraceptives, and they used the exams to screen women for sexually transmitted infections and obtain cultures for testing. Those practices have largely been abandoned, and urine samples are now used to test for sexually transmitted infections.
In recent years some experts have suggested that pelvic exams are so discomforting that they may deter women from going to the doctor altogether.
Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose. But, they say, experienced physicians can use pelvic exams to find other problems, such as noncancerous fibroids, and to identify changes linked to urinary incontinence and sexual dysfunction.
“Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another,” said Dr. Barbara S. Levy, vice president for health policy at the obstetricians and gynecologists’ group.
“I’m not sure there’s evidence to support most of what we do on physical exams,” Dr. Levy added. “Lack of evidence does not mean lack of value.”
The new guideline comes as more routine procedures are critically evaluated in light of scientific studies, part of a move toward evidence-based medicine. Over the past few years, several new sets of guidelines have urged scaling back screening procedures for women in particular.
In 2009, the United States Preventive Services Task Force recommendedpostponing routine mammograms to detect breast cancer until age 50, provoking wide controversy. Many women have ignored the advice.
More recently, the task force, the American Cancer Society and the obstetricians and gynecologists’ group have recommended that, with some exceptions, women ages 21 to 65 should receive Pap smears every three years instead of annually.
Group recommends against routine pelvic exams.
Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis
American Journal of Clinical Nutrition, 07/16/2014 Review Article Evidence Based Medicine Afshin A, et al. – The authors systematically investigated and quantified associations of nut and legume consumption with incident ischemic heart disease (IHD), stroke, and diabetes. This systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.
Methods
- The authors systematically searched multiple databases to identify randomized controlled trials or observational studies that examined the relations.
- Studies were excluded if they reported only intermediate physiologic measures, soft cardiovascular outcomes, or crude risk estimates.
- Data were extracted independently and in duplicate.
- They assessed pooled dose–response relations by using a generalized least–squares trend estimation, and prespecified sources of heterogeneity were assessed by using metaregression.
- The potential for publication bias was explored by using funnel plots, Begg's and Egger's tests, and Duval and Tweedie trim–and–fill methods.
- Of 3851 s, 25 observational studies (23 prospective and 2 retrospective studies) and 2 trial reports met inclusion criteria and comprised 501,791 unique individuals and 11,869 IHD, 8244 stroke, and 14,449 diabetes events.
- The consumption of nuts was inversely associated with fatal IHD (6 studies; 6749 events; RR per 4 weekly 28.4–g servings: 0.76; 95% CI: 0.69, 0.84; I2 = 28%), nonfatal IHD (4 studies; 2101 events; RR: 0.78; 0.67, 0.92; I2 = 0%), and diabetes (6 studies; 13,308 events; RR: 0.87; 0.81,0.94; I2 = 22%) but not stroke (4 studies; 5544 events).
- Legume consumption was inversely associated with total IHD (5 studies; 6514 events; RR per 4 weekly 100–g servings: 0.86; 0.78, 0.94; I2 = 0%) but not significantly associated with stroke (6 studies; 6690 events) or diabetes (2 studies; 2746 events).
- A meta–regression did not identify the effect modification by age, duration of follow–up, study location, or study quality.
- Mixed evidence was seen for publication bias, but analyses by using the Duval and Tweedie trim–and–fill method did not appreciably alter results.
CONCLUSION: This systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.
http://www.ncbi.nlm.nih.gov/pubmed/24898241
Lifelong Learning Leads to Longer Cognitive Acuity
Intellectual enrichment, starting early with education, in midlife with a stimulating career, and later in life with volunteerism and socializing, may help older men and women to preserve cognitive skills. Prashanthi Vemuri, from The Mayo Clinic (Minnesota, USA), and colleagues studied 1,995 men and women in their 70s and 80s, enrolled in The Mayo Clinic Study of Aging, who did not have dementia at the study’s start. Although education and employment seemed to be more important overall, mid- and later-life cognitive activity contributed to retention of cognitive skills with aging. .Those with less education early in life saw the largest benefit from mental stimulation in later life. As well, the team found that regardless of education and work history, people who engaged in challenging mental activities at least three times per week delayed the onset of cognitive decline by more than three years compared to those who did less. Reporting that: “Higher education/occupation scores were associated with higher levels of cognition … Higher levels of mid/late-life cognitive activity were also associated with higher levels of cognition, but the slope of this association slightly increased over time,” the study authors submit that: “Lifetime intellectual enrichment might delay the onset of cognitive impairment and be used as a successful preventive intervention to reduce the impending dementia epidemic.”
http://www.reuters.com/article/2014/06/23/us-cognitive-activity-dementia-idUSKBN0EY2KU20140623
How Do Fruits and Veggies Love Us? Let Us Count the Ways
The oft-cited five servings per day of fruits and vegetables was the optimal amount for limiting overall and cardiovascular mortality, but not cancer mortality, in a BMJ meta-analysis.
Culling data from 16 prospective, observational studies conducted since 1950, researchers found that the more fruits and vegetables people consumed each day (up to five total servings), the lower the risk for all-cause mortality. (A serving was defined as roughly 80 g, or 2.8 oz., of fruit or vegetable.)
In particular, for consumption of five servings versus no servings daily, the hazard ratio was 0.74 for all-cause mortality. Two servings of fruit and three of vegetables appeared to provide optimal benefits. In addition, each fruit or vegetable serving was associated with a 4% reduction in cardiovascular mortality. There was no significant association with cancer mortality.
BMJ article (Free)
Fragmented sleep may be as physically harmful as total lack of sleep. TIME (7/10, Hellmann) reports that according to a study published in the journal Sleep Medicine, “fragmented sleep could be as physically harmful as a total lack of sleep.” After studying “the sleep patterns of students using wristwatches that monitored when they were asleep or awake,” researchers “found that an interrupted night of sleep...is similar to having only four hours of consistent sleep.” People who had even one night of fragmented sleep experienced deleterious effects on their moods, cognitive ability and attention span.
Low Serum Vitamin D Level Is Associated with Excess Cardiovascular-Related Mortality
Schottker B et al., BMJ 2014 Jun 17; 348:g3656
Vitamin D levels were associated with cancer-related mortality only in patients with histories of cancer.
Sildenafil Use Is Associated with Elevated Risk for Melanoma
Li W-Q et al., JAMA Intern Med 2014 Jun 174:964
An association and biologic plausibility raise concerns, but change in practice would be premature.
Anti-Cancer Mechanism of Green Tea Revealed
Epigallocatechin gallate (EGCG) changes the metabolism of pancreatic cancer cells by suppressing the expression of an enzyme associated with cancer.
Lactate dehydrogenase A (LDHA) is an enzyme that is elevated in several human cancers, including pancreatic cancer. Wai-Nang Lee, MD, from the Los Angeles Biomedical Research Institute (LA BioMed; California, USA), and colleagues observe that epigallocatechin gallate (EGCG), the active biologic constituent in green tea, changes the metabolism of pancreatic cancer cells by suppressing LDHA expression. The researchers also found an enzyme inhibitor, oxamate, which is known to reduce LDHA activity, operated in the same manner: It also disrupted the pancreatic cancer cells metabolic system. The study authors submit that: “These results suggest that phytochemical [epigallocatechin gallate] and LDHA inhibitor oxamate confer their anti-cancer activities by disrupting the balance of flux throughout the cellular metabolic network.”
http://www.eurekalert.org/pub_releases/2014-05/labr-seh053014.php
Vitamin D Protects Against Liver Cancer
With an important role in liver function, Vitamin D may lower a person’s risk of hepatocellular carcinoma.
Liver cancers, hepatocellular carcinoma, and other sub-types, are collectively the sixth most common cancer and third highest cause of cancer-related deaths worldwide. Vitamin D has been shown to play an important role in liver function. Veronika Fedirko, from Emory University (Georgia, USA), and colleagues analyzed data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, involving over 520,000 participants from Western Europe. The study included 138 subjects that developed hepatocellular carcinoma between 1992 and 2010, after recruitment into the cohort. Each case was matched to a control by age, sex, study center, date and time of blood collection and fasting status. Blood vitamin D levels were measured by state-of-the-art liquid chromatography and tandem mass spectrometry. Findings indicated that higher levels of vitamin D in the body cut the risk of hepatocellular carcinoma in half. The study authors write that: “In this prospective study on Western European populations, serum levels of [vitamin D] were inversely associated with risk of hepatocellular carcinoma.”
http://medicalxpress.com/news/2014-06-vitamin-d-liver-cancer-european.html
The effect of green tea on blood pressure and lipid profile: A systematic review and meta-analysis of randomized clinical trials
Nutrition, Metabolism & Cardiovascular Diseases, 03/27/2014 Review Article Evidence Based Medicine Onakpoya I, et al. – The aim of this systematic review was to evaluate the evidence for or against the effectiveness of green tea (Camellia sinensis) on blood pressure and lipid parameters. Green tea intake results in significant reductions in systolic blood pressure, total cholesterol, and LDL cholesterol. The effect size on systolic blood pressure is small, but the effects on total and LDL cholesterol appear moderate. Longer–term independent clinical trials evaluating the effects of green tea are warranted.
Methods
- Electronic searches were conducted in Medline, Embase, Amed, Cinahl and the Cochrane Library to identify relevant human randomized clinical trials (RCTs).
- Hand searches of bibliographies were also conducted.
- The reporting quality of included studies was assessed using a checklist adapted from the CONSORT Statement.
- Two reviewers independently determined eligibility, assessed the reporting quality of the included studies, and extracted the data.
- As many as 474 citations were identified and 20 RCTs comprising 1536 participants were included.
- There were variations in the designs of the RCTs.
- A meta-analysis revealed a significant reduction in systolic blood pressure favouring green tea (MD: -1.94 mmHg; 95% CI: -2.95 to -0.93; I2 = 8%; p = 0.0002).
- Similar results were also observed for total cholesterol (MD: -0.13 mmol/l; 95% CI: -0.2 to -0.07; I2 = 8%; p < 0.0001) and LDL cholesterol (MD: -0.19 mmol/l; 95% CI: -0.3 to -0.09; I2 = 70%; p = 0.0004).
- Adverse events included rash, elevated blood pressure, and abdominal discomfort.
http://www.ncbi.nlm.nih.gov/pubmed/24675010
Diabetes mellitus influences on cancer risk
Diabetes/Metabolism Research and Reviews, 07/10/2014 Review Article Szablewski L – Diabetes mellitus and cancer are common conditions, and their co–diagnosis in the same individual is not infrequent. The relative risks associated with type 2 diabetes are greater than twofold for liver, pancreatic, and endometrial cancer. Obtained results showed that patients with type 1 diabetes had elevated risks of cancers of the stomach, cervix, and endometrium. Type 1 diabetes is associated with a modest excess cancer risk overall and risks of specific cancers that differ from those associated with type 2 diabetes.
http://www.ncbi.nlm.nih.gov/pubmed/25044584
Consumption of fruits, vegetables, and seaweeds (sea vegetables) and pancreatic cancer risk: The Ohsaki Cohort Study
Cancer Epidemiology, 07/01/2014 Clinical Article Shigihara M, et al. – Studies on the effects of consumption of fruits, vegetables, and seaweeds on the incidence of pancreatic cancer are not conclusive. Total consumption of fruits, vegetables, and seaweeds was not associated with a reduced risk of pancreatic cancer.
http://www.ncbi.nlm.nih.gov/pubmed/24522236
Study warns processed food could hurt immune system. TIME (7/1) reported processed and fast food could cause health problems “such as increased inflammation, reduced control of infection, increased rates of cancer” and increased risk of allergy, citing a study unveiled in Nutrition Journal. In addition, “poor dietary choices get ‘encoded’ into both DNA scaffolding and into the gut microbiome,” which means that “food and lifestyle choices can permanently change the balance of bacteria in our bodies and can weaken the immune system.” Dr. Ian Myles, the study’s author and a doctor at the National Institute of Allergy and Infectious Diseases, noted that he was surprised by how heavily gut bacteria determined a child’s health. “Our bodies are a kind of mini-ecosystem, and anything that disturbs our bacteria can alter our health in profound ways,” he said.
Milk alternatives represent fastest-growing part of US dairy market. The Washington Post (7/5) reported that “milk alternatives make up just eight percent of overall milk sales in the United States, but for the past few years, they’ve represented the fastest-growing part of the dairy market, according to Mintel, a Chicago-based research firm.” These alternatives, which are often plant- or nut-based, “can be a saving grace for people with food allergies or lactose intolerance, or those who follow vegan diets.” The piece pointed out that “an estimated 12 percent of Americans suffer from lactose intolerance, according to the National Institutes of Health.”
Avoidance of sun exposure is a risk factor for all-cause mortality: results from the MISS cohort
Journal of Internal Medicine, 04/22/2014 Evidence Based Medicine Clinical Article Lindqvist PG, et al. – The results of this study provide observational evidence that avoiding sun exposure is a risk factor for all–cause mortality. Following sun exposure advice that is very restrictive in countries with low solar intensity might in fact be harmful to women's health.
Lindqvist PG1, Epstein E, Landin-Olsson M, Ingvar C, Nielsen K, Stenbeck M, Olsson H.
Author information Abstract BACKGROUND: Sunlight exposure and fair skin are major determinants of human vitamin D production, but they are also risk factors for cutaneous malignant melanoma (MM). There is epidemiological evidence that all-cause mortality is related to low vitamin D levels.
METHODS: We assessed the avoidance of sun exposure as a risk factor for all-cause mortality for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 and were aged 25 to 64 years at the start of the study. We obtained detailed information at baseline on their sun exposure habits and potential confounders. Multivariable flexible parametric survival analysis was applied to the data.
RESULTS: There were 2545 deaths amongst the 29 518 women who responded to the initial questionnaire. We found that all-cause mortality was inversely related to sun exposure habits. The mortality rate amongst avoiders of sun exposure was approximately twofold higher compared with the highest sun exposure group, resulting in excess mortality with a population attributable risk of 3%.
CONCLUSION: The results of this study provide observational evidence that avoiding sun exposure is a risk factor for all-cause mortality. Following sun exposure advice that is very restrictive in countries with low solar intensity might in fact be harmful to women's health.
http://www.ncbi.nlm.nih.gov/pubmed/24697969
Melatonin dietary supplement as an anti-aging therapy for age-related bone loss. Tresguerres IF1, Tamimi F, Eimar H, Barralet J, Prieto S, Torres J, Calvo-Guirado JL, Fernández-Tresguerres JA.
Introduction: Previous studies have shown that melatonin, an antioxidant molecule secreted from the pineal gland, is a positive regulator of bone mass. However, melatonin potential effects on bone mass have never been investigated in old population yet. The aim of this study was to assess the effects of dietary melatonin supplementation on mass accrual and biomechanical properties of old rat femora. Methods: Twenty 22-months-old male Wistar rats were divided into 2 randomly assigned groups. The first group was treated for 10 weeks with melatonin, whereas the second group left untreated (control). Rat femurs were collected, and their phenotypes and biomechanical properties were investigated by micro-computed tomography, histomorphometry and 3-point-bending test. Statistical analyses were performed by Student's two-tailed unpaired t-test. In all experiments, a value of p < 0.05 was considered significant. Results: Rats treated with melatonin had higher bone volume, bone trabecular number, trabecular thickness and cortical thickness in comparison to control group. Histomorphometric analyses confirmed the increase of bone volume in melatonin-treated rats. In agreement with these findings, melatonin-treated rats demonstrated with higher bone stiffness, flexural modulus and ultimate load compared to controls. Conclusion: These compelling results are the first evidence indicating that dietary melatonin supplementation is able to exert beneficial effects against age-related bone loss in old rats; improving the microstructure and biomechanical properties of aged bones.
Melatonin Could Help Nocturnal Pain From Shoulder Disorders (HealthDay News) — For patients with shoulder disorders such as a rotator cuff tear or frozen shoulder, melatonin may mediate nocturnal pain, according to a study published in the July 2 issue of The Journal of Bone & Joint Surgery.
Eunyoung Ha, MD, PhD, from Keimyung University in Daegu, South Korea, and colleagues examined whether melatonin mediates nocturnal pain in patients with a rotator cuff tear or frozen shoulder. They analyzed the expression of melatonin receptor 1A (MTNR1A) and 1B (MTNR1B) and of acid-sensing ion channel 3 (ASIC3) in subacromial bursa and joint capsule samples collected from 63 patients (21 with a rotator cuff tear, 22 with frozen shoulder, and 20 with shoulder instability [control group]).
The researchers found that, compared with the control group, MTNR1A, MTNR1B, and ASIC3 expression was significantly increased in both the rotator cuff tear and frozen shoulder groups. In primary cultured fibroblast-like synoviocytes treated with proinflammatory cytokines, interleukin-1β and tumor necrosis factor-α significantly stimulated MTNR1A and MTNR1B expression. ASIC3 expression and interleukin-6 (IL-6) production were induced with melatonin treatment at a physiological concentration (10nM). Melatonin-stimulated ASIC3 expression and IL-6 production were reversed with treatment with luzindole, a melatonin-receptor antagonist.
"Our study suggests that melatonin may play a role as a mediator of nocturnal pain with a rotator cuff tear or frozen shoulder, and this effect may be mediated via melatonin receptors," the authors write.
Abstract
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Incidence of lactic acidosis in patients with type 2 diabetes with and without renal impairment treated with metformin: a retrospective cohort study
Diabetes Care, 07/03/2014 Richy FF, et al. – The study aims to determine whether the use of metformin in type 2 diabetic patients with various kidney functions is associated with an increased risk of lactic acidosis (LA). The overall LA incidence rate for patients on metformin in this study was within the range of rates reported in the literature for patients with type 2 diabetes, and no significant difference was observed among patients with N, Mi, Mo, and Se function.
Methods
- This study was a retrospective analysis of U.K. patient records from the Clinical Practice Research Datalink database from 1 January 2007 to 31 December 2012. Inclusion criteria were 1) diagnosis of type 2 diabetes before 1 January 2007, 2) treatment with metformin, and 3) at least one assessment of renal function between 2007 and 2012.
- Renal function was assessed by glomerular filtration rate and categorized as normal (N), mildly reduced (Mi), moderately reduced (Mo), or severely reduced (Se) function.
- The outcome of the study was LA.
- A total of 77,601 patients treated with metformin for type 2 diabetes were identified.
- There were 35 LA events (10.37 [95% CI 7.22–14.42] per 100,000 patient-years) of which none were fatal and 23 were linked to a comorbidity.
- No significant difference in the incidence of LA was observed across N, Mi, Mo and Se renal function groups (7.6 [0.9–27.5], 4.6 [2.00–9.15], 17 [10.89–25.79], and 39 [4.72–140.89] cases per 100,000 patient-years, respectively).
http://www.ncbi.nlm.nih.gov/pubmed/24879835
Metformin Use Decreases Risk of Prostate Cancer Diagnosis Use of the diabetes drug metformin is associated with a decreased risk of a prostate cancer (PCa) diagnosis, new findings suggest.
In a study of 12,226 men diagnosed with PCa and 122,260 population controls, Mark A. Preston, MD, of Massachusetts General Hospital in Boston, and colleagues found that men who used metformin had a significant 16% decreased risk of a PCa diagnosis in adjusted analyses compared with non-users. Among men who had undergone PSA testing in the previous year, metformin use was associated with a significant 34% decreased risk of a PCa diagnosis.
Diabetics on no medication or on other oral hypoglycemic agents did have a significant decrease in the risk of a PCa diagnosis, the researchers reported online ahead of print in European Urology.
The researchers identified study subjects using the Danish Cancer Registry and the Aarhus University Prescription Database.
In a previous Canadian study of older diabetic men published in the Journal of the National Cancer Institute (2013;105:1123-1131), researchers found no association between metformin use and PCa risk. The study included 5,306 PCa case subjects and 26,530 matched controls. A meta-analysis published in Cancer Epidemiology (2013;37:207-218) found that metformin can reduce the incidence of a number of cancers, but had no effect on PCa incidence.
Metformin May Improve Oncologic Outcomes in Bladder CA Patients Metformin therapy is associated with improved oncologic outcomes amongdiabetic patients undergoing radical cystectomy (RC) for bladder cancer, researchers reported at the Canadian Urological Association annual meeting in St. John's, Newfoundland.
In a retrospective study of 85 diabetic patients who underwent RC for muscle-invasive bladder cancer (MIBC) and high-risk non-muscle-invasive bladder cancer (NMIBC), Madhur Nayan, MD, of the University of Toronto, and colleagues found that those who used metformin had a significant 62% decreased risk of cancer recurrence and a significant 43% decreased risk of cancer-specific mortality compared with non-users in adjusted analyses. Dr. Nayan's team found no association between metformin use and overall survival. They also found no association between the use of other oral hypoglycemic and insulin and any of the previously mentioned outcomes.
Of the 85 patients in the study, 39 used metformin and 46 did not. The median follow-up was 50 months.
“The present study provides the longest reported follow-up for diabetic patients undergoing RC for MIBC and high risk NMIBC and is the first to demonstrate that metformin use is associated with improved oncologic outcomes in this patient population,” the authors concluded in a poster presentation.
With respect to study limitations, the researchers pointed to the relatively small number of patients and events. In addition, the metformin dose and duration of use prior to surgery was not assessed. The study also did not account for medication changes during follow-up.
In an interview with Renal & Urology News, Dr. Nayan noted that metformin has been evaluated for its chemopreventive effects in various malignancies, and randomized, controlled trials are underway looking at starting metformin in non-diabetic patients to improve their cancer treatment outcomes. Limited research is available, however, on the influence of metformin on bladder cancer outcomes.
“Our study suggests that metformin use among diabetic patients undergoing radical cystectomy is associated with improved relapse-free survival and bladder cancer specific survival,” Dr. Nayan said. “Given that metformin has demonstrated safety among non-diabetics, and given its low cost, further studies are warranted to evaluate potential therapeutic and preventative roles of metformin in patients with bladder cancer.”
At the 2014 American Urological Association annual meeting in Orlando, researchers reported on a study showing that diabetic prostate cancer (PCa) patients who took both metformin and a statin may be at lower risk of biochemical recurrence (BCR) after radical prostatectomy. Matthew Danzig, MD, and collaborators at Columbia University in New York analyzed data from 3,031 patients who underwent RP from 1987- 2010 and who had at least 6 months of follow-up. They excluded patients who received neoadjuvant or adjuvant therapy. The overall BCR rate was 23.7%. Diabetics had a rate of 30.5%, which was reduced to 28.3% with metformin use and 23.5% with statin use. Combined use further reduced the rate to 15%, similar to the 13% rate observed in non-diabetics who were taking statins.
A study published online ahead of print in European Urology found that metformin use is associated with a decreased risk of a prostate cancer diagnosis. In a study of 12,226 men diagnosed with PCa and 122,260 population controls, Mark A. Preston, MD, of Massachusetts General Hospital in Boston, and colleagues found that men who used metformin had a significant 16% decreased risk of a PCa diagnosis in adjusted analyses compared with non-users. Among men who had undergone PSA testing in the previous year, metformin use was associated with a significant 34% decreased risk of a PCa diagnosis. Diabetics on no medication or on other oral hypoglycemic agents did have a significant decrease in the risk of a PCa diagnosis.
The researchers identified study subjects using the Danish Cancer Registry and the Aarhus University Prescription Database.
Insulin or Sulfonylureas to Supplement Metformin in Patients with Diabetes?
Roumie CL et al., JAMA 2014 Jun 11; 311:2288
Insulin plus metformin was associated with higher all-cause mortality in a retrospective study.
Insulin, sulfonylureas often tied to ED visits, adverse events in seniors. The New York Times (7/1, Graham) “The New Old Age” blog reports that some aging patients with diabetes end up being switched to insulin or to medications called sulfonylureas, both of which greatly increase the risk of an older person’s blood sugar plunging, thereby “depriving the brain of oxygen and leading to collapse, loss of consciousness, and even death.” According to a studypublished in JAMA Internal Medicine in February, “among adults aged 65 and older, insulin and sulfonylurea drugs are the second most common medications associated with emergency department visits or hospitalizations and adverse drug events.’”
Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality
JAMA, 07/03/2014 Evidence Based Medicine Clinical Article Coresh J, et al. – The established chronic kidney disease (CKD) progression end point of end–stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of –57% or greater) is a late event. To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.
Methods
- Individual meta–analysis of 1.7 million participants with 12 344 ESRD events and 223 944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data.
- Transfer of individual participant data or standardized analysis of outputs for random–effects meta–analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012.
- End–stage renal disease (initiation of dialysis or transplantation) or all–cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR.
- The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline.
- Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3–46.3) for changes of –57% in estimated GFR and 5.4 (95% CI, 4.5–6.4) for changes of –30%.
- However, changes of –30% or greater (6.9% [95% CI, 6.4%–7.4%] of the entire consortium) were more common than changes of –57% (0.79% [95% CI, 0.52%–1.06%]).
- This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria.
- Average adjusted 10–year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99% (95% CI, 95%–100%) for estimated GFR change of –57%, was 83% (95% CI, 71%–93%) for estimated GFR change of –40%, and was 64% (95% CI, 52%–77%) for estimated GFR change of –30% vs 18% (95% CI, 15%–22%) for estimated GFR change of 0%.
- Corresponding mortality risks were 77% (95% CI, 71%–82%), 60% (95% CI, 56%–63%), and 50% (95% CI, 47%–52%) vs 32% (95% CI, 31%–33%), showing a similar but weaker pattern.
http://www.ncbi.nlm.nih.gov/pubmed/24892770
Angiotensin converting enzyme inhibitor usage and acute kidney injury: A secondary analysis of RENAL study outcomes
Nephrology, 07/03/2014 Clinical Article Wang AY, et al. – The current study indicate that acute kidney injury (AKI) is associated with increased mortality. However, the study confirms that in the RENAL study cohort, the use of ACEI during the study was not common and, after adjustment for time–dependent covariates, was not significantly associated with reductions in mortality.
CONCLUSION: In the RENAL study cohort, the use of ACEI during the study was not common and, after adjustment for time-dependent covariates, was not significantly associated with reductions in mortality. Further assessment of the effect of ACEI use in AKI patients is needed.
http://www.ncbi.nlm.nih.gov/pubmed/24894685
Patients Taking Lithium May Have Increased Risk of Renal Tumor Lithium-treated patients are at increased risk of renal tumors, according to French researchers.
In a retrospective study of 170 lithium-treated patients, renal tumors developed in 14 (8.2%) over a 16-year period. These tumors included 7 malignant and 7 benign tumors. The mean duration of lithium exposure at diagnosis was 21.4 years. The cancers included 3 clear-cell and 2 papillary renal cell carcinomas, 1 hybrid tumor with chromophobe and oncocytoma characteristics, and 1 clear-cell carcinoma with leiomyomatous stroma. The benign tumors included 4 oncocytomas, 1 mixed epithelial and stromal tumor, and 2 angiomyolipomas.
Lithium-treated patients had an incidence of renal tumors 7.5 times greater than that of the general French population, researchers reported in Kidney International (2014;86:184-190). Additionally, the researchers compared lithium-treated patients with chronic kidney disease (CKD) and a group of lithium-free CKD patients matched for age, sex, and estimated glomerular filtration rate. The frequency of renal cancer and oncocytoma was significantly higher in the lithium-treated group (4.1% vs. 0.3% and 2.4% vs. 0%, respectively).
Are Corticosteroids Effective for Cancer Pain? Conclusion MP 32 mg daily did not provide additional analgesia in patients with cancer receiving opioids, but it improved fatigue, appetite loss, and patient satisfaction. Clinical benefit beyond a short-term effect must be examined in a future study
http://jco.ascopubs.org/content/early/2014/07/02/JCO.2013.54.3926.short Organic foods found to have higher levels of antioxidants, lower levels of pesticides. The New York Times (7/13, Chang, Subscription Publication) reports that “a comprehensive review of earlier studies found substantially higher levels of antioxidants and lower levels of pesticides in organic fruits, vegetables and grains compared with conventionally grown produce.” The full findings will be published in the British Journal of Nutrition, and the Times notes that they “stop short of claiming that eating organic produce will lead to better health.”
The Huffington Post (7/12) reports that the study is “said to be the largest of its kind.” Lead study author Carlo Leifert said in a news release, “This study demonstrates that choosing food produced according to organic standards can lead to increased intake of nutritionally desirable antioxidants and reduced exposure to toxic heavy metals.” He added, “This constitutes an important addition to the information currently available to consumers which until now has been confusing and in many cases is conflicting.”
NPR (7/14, Charles) reports in its “The Salt” blog that antioxidants “can protect cells from the effects of aging, or from the sort of damage that can lead to cancer,” and study co-author Charles Benbrook, from Washington State University’s Center for Sustaining Agriculture and Natural Resources, “says this is a big reason why public health experts want us all to eat more fruits and vegetables.” Furthermore, “if organic produce provides more” antioxidants, “he says, ‘we think that’s a big deal.’”
A Blood Test That Can Predict Alzheimer's Disease? (HealthDay News) — A major advance has been made in creating a blood test to predict when at-risk people will develop Alzheimer's disease, according to scientists.
In a study that included more than 1,000 people, the British researchers identified proteins in the blood that were 87% accurate in forecasting which people with mild cognitive impairment would develop Alzheimer's within a year, BBC News reported.
The findings, published in the journal Alzheimer's and Dementia, will be used to improve studies of new drugs to treat Alzheimer's. "We want to be able to identify people to enter clinical trials earlier than they currently do and that's really what we've been aiming at," lead researcher Professor Simon Lovestone, of the University of Oxford in the United Kingdom, told BBC News.
However, the test may eventually be available for doctors to use on patients. "Having a protein test is really a major step forwards," Ian Pike, PhD, chief operating officer at Proteome Sciences in Cobham, U.K., told BBC News. "[It] will take several years and need many more patients before we can be certain these tests are suitable for routine clinical use; that process can start fairly quickly now."
Noninvasive eye exams may someday detect Alzheimer’s in earliest stages. The CBS Evening News (7/13, story 4, 2:00, Glor) reported that researchers have “announced the promising result of a study on a new test to pick up” signs of Alzheimer’s disease “years, if not decades, in advance. And they’re looking for the sign in an unusual place, the eye.”
The Washington Post (7/13, Kunkle) reported that according to two studies presented at the Alzheimer’s Association International Conference in Denmark, “noninvasive eye exams...might offer a way to identify Alzheimer’s in its early stages.” Researchers “investigated a possible link between levels of beta-amyloid in the eye — as detected by a new, relatively inexpensive imaging technology — and levels of the same protein in the brain, as seen through PET scans.” A second study “also found a link between levels of beta amyloid in the eye’s lens and inside the brain.”
The NBC News (7/14) website reported that by staining beta amyloid with “curcumin, a component of the common spice turmeric,” researchers “could detect it in the retina even before it began to accumulate in the brain.” The ability to detect Alzheimer’s years in advance may “mean earlier treatment, and could give people a chance to plan, said Maria Carrillo, vice president of medical and scientific relations at the Alzheimer’s Association.” Some medications for Alzheimer’s “work best early in the disease process,” Carrillo explained.
Also covering the studies are the Wall Street Journal (7/14, Wang, Subscription Publication), the CBS News (7/14, Dahler) website, and HealthDay (7/14, Preidt).
Reduced sense of smell may predict Alzheimer’s in people with mild memory problems. USA Today (7/13, Weintraub) reported that according to research to be presented at the Alzheimer’s Association International Conference in Denmark, “among people with mild memory problems, a reduced sense of smell effectively predicted who would go on to get Alzheimer’s.”
HealthDay (7/14, Gray) reports that a 215-participant study revealed that the “UPSIT/odor identification testing could theoretically be an affordable and quick screening test that could be followed up by more expensive, involved and accurate tests such as PET scans or cerebral spinal fluid studies” for the diagnosis of Alzheimer’s. A second study “found that among 757 participants, lower scores on the UPSIT smell test were associated with the transition to dementia and Alzheimer’s disease.” The underlying premise of both studies is that “the ability to smell is associated with the first cranial nerve, and is often one of the first things to be affected by cognitive decline.”
Inflammation and future risk of symptomatic heart failure in patients with stable coronary artery disease
American Heart Journal, 07/08/2014 Clinical Article Eisen A, et al. – The aims of this study were to evaluate the association between inflammatory markers and future HF risk in patients with stable CAD and to explore possible mediation by myocardial infarction (MI). Increased levels of CRP, fibrinogen, and WBC are independently related to the incidence of HF in patients with stable CAD
CONCLUSIONS: Increased levels of CRP, fibrinogen, and WBC are independently related to the incidence of HF in patients with stable CAD.
http://www.ncbi.nlm.nih.gov/pubmed/24766981
Diet and psoriasis, part I: Impact of weight loss interventions
Journal of the American Academy of Dermatology, 07/07/2014 Review Article Debbaneh M, et al. – In this study, the authors review the literature to examine the efficacy of weight loss interventions, both dietary and surgical, on psoriasis disease course. Obesity has been associated with a proinflammatory state and several studies have demonstrated a relationship between body mass index and psoriasis severity.
http://www.jaad.org/article/S0190-9622(14)01126-8/abstract?rss=yes?rss=yes
Adverse Effects of Thiazide Diuretics in Older Patients
Makam AN et al., J Am Geriatr Soc 2014 Jun 62:1039
Hyponatremia, hypokalemia, or decline in renal function occurred fairly frequently during the first 9 months of thiazide use.
Hyponatremia Linked to Hip Fracture Surgery New-onset hyponatremia is common following surgery for hip fractures, according to British researchers.
James Edward Rudge, MB, and Daniel Kim, MB, of City Hospital, Sandwell and West Birmingham Hospitals NHS Trust - Postgraduate Centre, Birmingham, UK, retrospectively studied 254 patients who underwent hip surgery in 2012.
The incidence of moderate (less than 135 mmol/L) and severe (less than 130 mmol/L) post-operative hyponatremia was 27% and 9%, respectively, the researchers reported online ahead of print in Age and Ageing.
Patients with moderate hyponatremia had a significantly longer hospital stay than normonatremic patients (30 vs. 21 days). Post-operative hyponatremia also was significantly associated with proton pump inhibitor use, selective serotonin re-uptake inhibitor use, and increasing number of medications.
Spironolactone use and higher hospital readmission for medicare beneficiaries with heart failure, left ventricular ejection fraction <45%, and estimated glomerular filtration rate <45 ml/min/1.73 m2
The American Journal of Cardiology, 07/08/2014 Clinical Article Inampudi C, et al. – The authors examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD. Among hospitalized patients with HFrEF and advanced CKD, spironolactone use was associated with higher all–cause readmission but had no association with all–cause mortality or HF readmission.
Methods
- The authors examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD.
- Of the 1,140 patients with HFrEF (EF <45%) and advanced CKD (estimated glomerular filtration rate [eGFR] <45 ml/min/1.73 m2), 207 received discharge prescriptions for spironolactone.
- Using propensity scores (PSs) for the receipt of discharge prescriptions for spironolactone, they estimated PS–adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for spironolactone–associated outcomes.
- Patients (mean age 76 years, 49% women, 25% African–American) had mean EF 28%, mean eGFR 31 ml/min/1.73 m2, and mean potassium 4.5 mEq/L.
- Spironolactone use had significant PS–adjusted association with higher risk of 30–day (HR 1.41, 95% CI 1.04 to 1.90) and 1–year (HR 1.36, 95% CI 1.13 to 1.63) all–cause readmissions.
- The risk of 1–year all–cause readmission was higher among 106 patients with eGFR <15 ml/min/1.73 m2 (HR 4.75, 95% CI 1.84 to 12.28) than among those with eGFR 15 to 45 ml/min/1.73 m2 (HR 1.34, 95% CI 1.11 to 1.61, p for interaction 0.003).
- Spironolactone use had no association with HF readmission and all–cause mortality.
http://www.ncbi.nlm.nih.gov/pubmed/24846806
Does Heart Rate Affect Outcomes in Heart Failure Patients with Atrial Fibrillation?
Cullington D et al., JACC Heart Fail 2014 Jun 2:213
Resting heart rates were not associated with survival.
Lower heart rates are associated with better outcomes in patients with heart failure in sinus rhythm (SR). Is the same true for heart failure patients in atrial fibrillation (AF)? Between 1999 and 2010, investigators in the U.K. assessed 2039 patients with heart failure and left ventricle ejection fractions of ≤50%, 24% of whom were in AF at baseline. Of these, 841 were restudied after 1 year of treatment optimization; 22% were in AF. Mortality for all patients was assessed in 2011.
After median follow-up of 3.6 years, overall survival was shorter for patients in AF than for those in SR, but the difference was no longer significant after adjustment for other important clinical factors (e.g., age, sex, diabetes, heart failure class, medications). Among patients in SR, higher heart rates were associated with worse survival both before and after medical optimization, whereas resting heart rates were not associated with survival in patients with AF at either time point, although only seven patients had heart rates ≥110 beats per minute (bpm).
Insufficient sleep may affect fat cells, appetite and satiety hormones. USA Today (7/21, Hellmich, Today) reports that according to sleep scientists, “insufficient sleep affects appetite and satiety hormones as well as fat cells.” Not getting enough sleep is tied to “increased levels of a hunger hormone called ghrelin and decreased levels of the satiety/fullness hormone called leptin, which could lead to overeating and weight gain.” Insufficient sleep also “reduces fat cells’ ability to respond properly to the hormone insulin, which is crucial for regulating energy storage and use.”
Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis
The Lancet, 10/11/2013 Evidence Based Medicine Clinical Article Reid IR et al. – Findings from recent meta–analyses of vitamin D supplementation without co–administration of calcium have not shown fracture prevention, possibly because of insufficient power or inappropriate doses, or because the intervention was not targeted to deficient populations. Despite these data, almost half of older adults (older than 50 years) continue to use these supplements. Bone mineral density can be used to detect biologically significant effects in much smaller cohorts. Authors investigated whether vitamin D supplementation affects bone mineral density. Continuing widespread use of vitamin D for osteoporosis prevention in community–dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.
Methods
- Authors searched Web of Science, Embase, and the Cochrane Database, from inception to July 8, 2012, for trials assessing the effects of vitamin D (D3 or D2, but not vitamin D metabolites) on bone mineral density.
- They included all randomised trials comparing interventions that differed only in vitamin D content, and which included adults (average age >20 years) without other metabolic bone diseases.
- They pooled data with a random effects meta–analysis with weighted mean differences and 95% CIs reported.
- To assess heterogeneity in results of individual studies, they used Cochran's Q statistic and the I2 statistic.
- The primary endpoint was the percentage change in bone mineral density from baseline.
- Of 3930 citations identified by the search strategy, 23 studies (mean duration 23•5 months, comprising 4082 participants, 92% women, average age 59 years) met the inclusion criteria.
- 19 studies had mainly white populations.
- Mean baseline serum 25–hydroxyvitamin D concentration was less than 50 nmol/L in eight studies (n=1791).
- In ten studies (n=2294), individuals were given vitamin D doses less than 800 IU per day.
- Bone mineral density was measured at one to five sites (lumbar spine, femoral neck, total hip, trochanter, total body, or forearm) in each study, so 70 tests of statistical significance were done across the studies.
- There were six findings of significant benefit, two of significant detriment, and the rest were non–significant.
- Only one study showed benefit at more than one site.
- Results of our meta–analysis showed a small benefit at the femoral neck (weighted mean difference 0•8%, 95% CI 0•2—1•4) with heterogeneity among trials (I2=67%, p<0•00027).
- No effect at any other site was reported, i
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61647-5/abstract?rss=yes
Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men Full Text
New England Journal of Medicine, 09/16/2013 Evidence Based Medicine Clinical Article Finkelstein JS et al. – Current approaches to diagnosing testosterone deficiency do not consider the physiological consequences of various testosterone levels or whether deficiencies of testosterone, estradiol, or both account for clinical manifestations. The amount of testosterone required to maintain lean mass, fat mass, strength, and sexual function varied widely in men. Androgen deficiency accounted for decreases in lean mass, muscle size, and strength; estrogen deficiency primarily accounted for increases in body fat; and both contributed to the decline in sexual function. The findings support changes in the approach to evaluation and management of hypogonadism in men.
Methods
- Authors provided 198 healthy men 20 to 50 years of age with goserelin acetate (to suppress endogenous testosterone and estradiol) and randomly assigned them to receive a placebo gel or 1.25 g, 2.5 g, 5 g, or 10 g of testosterone gel daily for 16 weeks.
- Another 202 healthy men received goserelin acetate, placebo gel or testosterone gel, and anastrozole (to suppress the conversion of testosterone to estradiol).
- Changes in the percentage of body fat and in lean mass were the primary outcomes.
- Subcutaneous– and intraabdominal–fat areas, thigh–muscle area and strength, and sexual function were also assessed.
- The percentage of body fat increased in groups receiving placebo or 1.25 g or 2.5 g of testosterone daily without anastrozole (mean testosterone level, 44+–13 ng per deciliter, 191+–78 ng per deciliter, and 337+–173 ng per deciliter, respectively).
- Lean mass and thigh–muscle area decreased in men receiving placebo and in those receiving 1.25 g of testosterone daily without anastrozole.
- Leg–press strength fell only with placebo administration.
- In general, sexual desire declined as the testosterone dose was reduced.
http://www.ncbi.nlm.nih.gov/pubmed/24024838
Probiotics May Help Reduce Blood Pressure
Consuming probiotics may modestly improve blood pressure, according to a meta-analysis in Hypertension.
Researchers analyzed data from nine randomized, controlled trials including some 540 participants. Overall, the probiotic arms had a 3.56-mm Hg reduction in systolic blood pressure and a 2.38-mm Hg reduction in diastolic BP, relative to controls. Larger reductions in blood pressure were observed in trials in which baseline blood pressure was at least 130/85 mm Hg, when treatment lasted at least 8 weeks, and when the daily dose of probiotics contained a larger number of colony-forming units.
The authors note that although the treatment effect was "modest ... even a small reduction of BP may have important public health benefits and cardiovascular consequences." They conclude that their findings "suggest that probiotics may be used as a potential supplement for future interventions to prevent hypertension or improve BP control."
Hypertension article (Free abstract)
Energy drinks may increase desire to drink alcohol. TIME (7/18, Sifferlin) reports that research (7/18) published in Alcoholism: Clinical & Experimental Research suggests “that when people drink alcohol with energy drinks they have a stronger desire to keep drinking compared to people who just drank a vodka soda.” In the study, investigators “assigned 75 participants between the ages 18 and 30 to either just drink alcohol, or drink an alcohol and energy drink combination.”
Newsweek (7/18, Mejia) reports that study “participants were asked to take an Alcohol Urge Questionnaire 20 minutes before and after imbibing the libation to indicate how strong their desire was to continue drinking.” Individuals “who drank the alcohol and energy drink combo reported a greater increase in the urge to continue drinking alcohol than the group drinking only vodka.” Additionally, “the energy drink consumers...reported liking the cocktail more and wanting to drink more of it than those who only drank the vodka cocktail.”
The Today Show Online (7/18, Carroll) reports that Rebecca McKetin, the study’s lead author, said that the “findings suggest that energy drinks may increase the risk of people drinking to intoxication and consequently increase the risk of alcohol-related problems like drunk driving and alcohol-fueled violence.” Also covering the story are Reuters (7/18, Seaman) and HealthDay (7/18, Mozes).
A randomised, multicentre, double blind, placebo controlled trial to evaluate the efficacy and safety of cilostazol in patients with vasospastic angina
Heart, 07/17/2014 Exclusive Author Commentary Evidence Based Medicine Clinical Article Shin ES, et al. – Cilostazol has been shown to induce vascular dilatation, but its efficacy in patients with VSA is unknown. Authors conducted a randomised, double blind, placebo controlled trial to assess the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase 3, in patients with vasospastic angina (VSA). Cilostazol is an effective therapy for patients with VSA uncontrolled by conventional amlodipine therapy, and has no serious side effects.
Methods
- Between October 2011 and July 2012, 50 patients with confirmed VSA who had >=1 angina episodes/week despite amlodipine therapy (5 mg/day) were randomly assigned to receive either cilostazol (up to 200 mg/day) or placebo for 4 weeks.
- All patients were given diaries to record the frequency and severity of chest pain (0–10 grading).
- The primary endpoint was the relative reduction of the weekly incidence of chest pain.
- Baseline characteristics were similar between the two groups.
- Among 49 evaluable patients (25 in the cilostazol group, 24 in the placebo group), the primary endpoint was significantly greater in the cilostazol group compared with the placebo group (-66.5±88.6% vs -17.6±140.1%, respectively, p=0.009).
- The secondary endpoints, including a change in the frequency of chest pain (-3.7±0.5 vs -1.9±0.6, respectively, p=0.029), a change in the chest pain severity scale (-2.8±0.4 vs -1.1±0.4, respectively, p=0.003), and the proportion of chest pain–free patients (76.0% vs 33.3%, respectively, p=0.003) also significantly favoured cilostazol.
- Headache was the most common adverse event in both groups (40.0% vs 20.8%, respectively, p=0.217).
http://www.ncbi.nlm.nih.gov/pubmed/24934484
Resveratrol levels and all-cause mortality in older community-dwelling adults
JAMA Internal Medicine, 05/13/2014 Evidence Based Medicine Clinical Article Semba RD, et al. – Resveratrol, a polyphenol found in grapes, red wine, chocolate, and certain berries and roots, is considered to have antioxidant, anti–inflammatory, and anticancer effects in humans and is related to longevity in some lower organisms. To determine whether resveratrol levels achieved with diet are associated with inflammation, cancer, cardiovascular disease, and mortality in humans. In older community–dwelling adults, total urinary resveratrol metabolite concentration was not associated with inflammatory markers, cardiovascular disease, or cancer or predictive of all–cause mortality. Resveratrol levels achieved with a Western diet did not have a substantial influence on health status and mortality risk of the population in this study.
Methods
- Prospective cohort study, the Invecchiare in Chianti (InCHIANTI) Study (“Aging in the Chianti Region”), 1998 to 2009 conducted in 2 villages in the Chianti area in a population–based sample of 783 community–dwelling men and women 65 years or older.
- Twenty–four–hour urinary resveratrol metabolites.
- Primary outcome measure was all–cause mortality.
- Secondary outcomes were markers of inflammation (serum C–reactive protein [CRP], interleukin [IL]–6, IL–1{beta}, and tumor necrosis factor [TNF]) and prevalent and incident cancer and cardiovascular disease.
- Mean (95% CI) log total urinary resveratrol metabolite concentrations were 7.08 (6.69–7.48) nmol/g of creatinine.
- During 9 years of follow–up, 268 (34.3%) of the participants died.
- From the lowest to the highest quartile of baseline total urinary resveratrol metabolites, the proportion of participants who died from all causes was 34.4%, 31.6%, 33.5%, and 37.4%, respectively (P = .67).
- Participants in the lowest quartile had a hazards ratio for mortality of 0.80 (95% CI, 0.54–1.17) compared with those in the highest quartile of total urinary resveratrol in a multivariable Cox proportional hazards model that adjusted for potential confounders.
- Resveratrol levels were not significantly associated with serum CRP, IL–6, IL–1{beta}, TNF, prevalent or incident cardiovascular disease, or cancer.
http://www.ncbi.nlm.nih.gov/pubmed/24819981
Again, Niacin Proves Ineffective in Statin-Treated Patients with Vascular Disease
Anderson TJ et al., N Engl J Med 2014 Jul 17; 371:288
In a large randomized trial, niacin was associated with serious adverse effects but no cardiovascular benefit
In the 2011 AIM-HIGH trial, niacin (added to a statin) failed to improve outcomes in patients with cardiovascular disease (NEJM JW Gen Med Nov 15 2011). We now have results from another randomized niacin trial — the industry-sponsored HPS2-THRIVE study. The study involved nearly 26,000 patients with known vascular disease whose mean LDL and HDL cholesterol levels were 64 mg/dL and 44 mg/dL, respectively, while taking simvastatin (40 mg daily; with ezetimibe in some cases). Patients received either 2 g of extended-release niacin daily or placebo; niacin was combined with laropiprant, a drug that lessens niacin-related flushing.
During median follow-up of 4 years, niacin lowered LDL cholesterol levels by a mean of 10 mg/dL and raised HDL cholesterol levels by a mean of 6 mg/dL, compared with placebo. However, there was no significant difference between groups in incidence of major adverse cardiovascular events (13.2% vs. 13.7%; P=0.29), and even the subgroup with the lowest HDL cholesterol levels and highest triglyceride levels at baseline showed no benefit from niacin. Niacin was associated with a slight excess in overall mortality (6.2% vs. 5.7%; P=0.08). Niacin recipients had significant excess risk for serious adverse events traditionally associated with this drug (e.g., gastrointestinal, musculoskeletal, and diabetes-related), as well as for infection and bleeding.
Adverse Effects of Thiazide Diuretics in Older Patients
Makam AN et al., J Am Geriatr Soc 2014 Jun 62:1039
Hyponatremia, hypokalemia, or decline in renal function occurred fairly frequently during the first 9 months of thiazide use.
Effects of Blood Pressure on Development of Specific Cardiovascular Diseases
Rapsomaniki E et al., Lancet 2014 May 31; 383:1899
Hypertension at any age was associated with higher CVD incidence.
Muscle mass predicts longevity
This study demonstrates the survival predication ability of relative muscle mass and highlights the need to look beyond total body mass in assessing the health of older adults.The American Journal of Medicine
Early-onset diabetes patients have higher comorbidity risk
Patients with young-onset diabetes had a similar or worse metabolic risk profile compared with those with late-onset disease. This group had higher risks for cardiovascular-renal complications at any given age, driven by longer disease duration. The American Journal of Medicine
Albuminuria predictive of myocardial injury
The authors concluded that albuminuria was a strong predictor of periprocedural myocardial injury in patients undergoing percutaneous coronary intervention. The American Journal of Cardiology
What makes a good physician, according to patients
According to patients, the ability to listen attentively is a key attribute of high-quality physicians, followed by diagnostic accuracy. The Associated Press-NORC Center for Public Affairs Research survey respondents said markers of poor-quality physicians include not listening to patients and not spending enough time with patients. Physician experience, initial impressions after meeting and appointment scheduling all contribute to whether patients will select a given physician, according to the findings. BeckersHospitalReview.com
Study ties 2-year weight loss to lower diabetes odds
A study on the website of Diabetes Care says weight loss at two years was strongly associated with lower diabetes risk and better cardiometabolic profile in patients. However, weight cycling was linked to an increased risk of diabetes. PhysiciansBriefing.com/HealthDay News
Glycosylated hemoglobin association with coronary artery disease
Abnormal glucose metabolism is a major determinant of coronary artery disease and mortality in developed countries. Glycosylated hemoglobin (HbA1c) is a more stable, accurate parameter of glucose homeostasis than fasting glycemia, thus providing prognostic information in diabetics. However, its role and relationship with coronary artery disease remains unclear in nondiabetic patients. This study showed that among nondiabetic patients, higher HbA1c is significantly associated with risk of coronary artery disease. American Journal of Preventive Medicine
Shorter life expectancy seen in severely obese patients
Research published in PLOS Medicine showed life expectancy among severely obese individuals was 6.5 to 13.7 years shorter than people with normal weight. Heart disease appeared to be a major factor in mortality among heavier patients, followed by cancer, diabetes, and renal and kidney disease. HealthDay News
Study links large waist size to higher COPD risk
Women whose waist size was at least 43 inches and men whose waist size was at least 46 inches had a 72% greater risk of developing chronic obstructive pulmonary disease compared with those with a normal waist size, a study of more than 113,000 Americans ages 50 to 70 found. The study, published in the Canadian Medical Association Journal, also found that engaging in physical activity five times or more per week lowered COPD risk by 29% compared with being physically inactive. HealthDay News
Weight gain in cardiac patients who quit smoking
The majority of patients attempting to quit smoking gain weight 12 months post-myocardial infarction, with abstainers gaining more weight than those who return to smoking. Weight gain was associated with an increased prevalence of hypertension and diabetes. The American Journal of Medicine
Analysis questions need to fast before cholesterol tests
An analysis of data from the National Health and Nutrition Examination Survey III found that fasting before a lipid panel blood draw had no clinical benefit while burdening patients. No significant differences were seen between fasting and nonfasting LDL cholesterol levels in terms of heart-related or all-cause mortality. MedPage
Study links physical fitness to metabolic improvements
Sedentary behaviors were tied to increased blood pressure, waist size and body fat percentage, a study indicated. However, higher levels of physical fitness may cut adiposity and boost metabolism, researchers wrote in Mayo Clinic Proceedings. Business Standard (India)/Asian News International
Association between serum concentration of vitamin D and 1-year mortality in stroke patients
Cerebrovascular Diseases, 07/24/2014 Clinical Article Daubail B, et al. – In this study, the authors aimed to assess the association between 25–hydroxyvitamin D [25(OH)D] levels and 1–year mortality in stroke patients. A low serum 25(OH)D level at stroke onset may be associated with higher mortality at 1 year in patients <75 years old.
Methods
- From February to December 2010, 382 Caucasian stroke patients admitted to the Department of Neurology of the University Hospital of Dijon, France, were enrolled prospectively.
- Demographics and clinical information including stroke severity assessed using the National Institutes of Health Stroke Scale score were collected.
- The serum concentration of 25(OH)D was measured at baseline.
- Multivariable Cox regression models were used to evaluate the association between 1-year all-cause mortality and serum 25(OH)D levels treated as either a log-transformed continuous variable or dichotomized (<25.7 and ≥25.7 nmol/l) at the first tertile of their distribution.
- Of the 382 stroke patients included, 63 (16.5%) had died at 1 year.
- The mean 25(OH)D level was lower in these patients (32.3 ± 22.0 vs. 44.6 ± 28.7 nmol/l, p < 0.001), and survival at 1 year was worse in patients in the lowest tertile of 25(OH)D levels (defined as <25.7 nmol/l); log-transformed 25(OH)D levels were inversely associated with 1-year mortality (hazard ratio, HR = 0.62; 95% confidence interval, 95% CI: 0.44-0.87; p = 0.007), and patients with 25(OH)D levels <25.7 nmol/l were at a higher risk of death at 1 year (HR = 1.95; 95% CI: 1.14-3.32; p = 0.014).
- In multivariable analyses, the association was no longer significant but a significant interaction was found for age, and stratified analyses by age groups showed an inverse relationship between 25(OH)D levels and 1-year mortality in patients aged <75 years [HR = 0.38; 95% CI: 0.17-0.83; p = 0.015 for log-transformed 25(OH)D levels, and HR = 3.12; 95% CI: 0.98-9.93; p = 0.054 for 25(OH)D levels <25.7 vs. >25.7 nmol/l].
http://www.karger.com/Article/FullText/362534
Dietary fiber intake and mortality among survivors of myocardial infarction: prospective cohort study
BMJ, 05/06/2014 Evidence Based Medicine Clinical Article
Li S, et al. – The aim is to evaluate the associations of dietary fiber after myocardial infarction (MI) and changes in dietary fiber intake from before to after MI with all cause and cardiovascular mortality. In this prospective study of patients who survived MI, a greater intake of dietary fiber after MI, especially cereal fiber, was inversely associated with all cause mortality. In addition, increasing consumption of fiber from before to after MI was significantly associated with lower all cause and cardiovascular mortality.
Methods
- Prospective cohort study.
- Two large prospective cohort studies of US women and men with repeated dietary measurements: the Nurses’ Health Study and the Health Professionals Follow–Up Study.
- 2258 women and 1840 men who were free of cardiovascular disease, stroke, or cancer at enrollment, survived a first MI during follow–up, were free of stroke at the time of initial onset of MI, and provided food frequency questionnaires pre–MI and at least one post–MI.
- Associations of dietary fiber post–MI and changes from before to after MI with all cause and cardiovascular mortality using Cox proportional hazards models, adjusting for drug use, medical history, and lifestyle factors.
- Higher post–MI fiber intake was significantly associated with lower all cause mortality (comparing extreme fifths, pooled hazard ratio 0.75, 95% confidence interval 0.58 to 0.97).
- Greater intake of cereal fiber was more strongly associated with all cause mortality (pooled hazard ratio 0.73, 0.58 to 0.91) than were other sources of dietary fiber.
- Increased fiber intake from before to after MI was significantly associated with lower all cause mortality (pooled hazard ratio 0.69, 0.55 to 0.87).
http://www.ncbi.nlm.nih.gov/pubmed/24782515
Leukocyte Telomere Length Is Associated with Risk for Heart Disease
Paul S. Mueller, MD, MPH, FACP Reviewing Haycock PC et al., BMJ 2014 Jul 8; 349:g4227
People with the shortest telomeres had the highest risk for adverse coronary events.
Telomeres are structures at the end of chromosomes that shorten with each cell division, and telomere length is a marker for biological aging. Because telomere length varies among different people of the same chronological age, investigators performed this meta-analysis to assess the association between leukocyte telomere length and risk for cardiovascular (CV) disease.
Researchers identified 12 retrospective and 12 prospective studies (44,000 participants overall) in which leukocyte telomere length and adverse CV-related or cerebrovascular-related outcomes were reported. Participants were divided into three groups by telomere length. Compared with people in the longest telomere group, those in the shortest telomere group had significantly higher risk for coronary heart disease in both prospective and retrospective studies (overall relative risk, 1.5). Similar results were obtained in meta-analyses restricted to studies that were adjusted for conventional CV risk factors. Compared with people in the longest telomere group, people in the shortest telomere group had excess risk for cerebrovascular disease in all studies combined (RR, 1.4), but not in prospective studies alone.
Diabetes Linked to Increased Risk for Head and Neck Cancers
Patients with diabetes might face nearly a 50% increased risk for head and neck cancers, according to a retrospective, case-control study inJAMA Otolaryngology—Head & Neck Surgery.
Using Taiwanese health databases, researchers studied nearly 90,000 patients diagnosed with diabetes in 2002 and 90,000 matched controls without diabetes. During follow-up through 2011, head and neck cancers were diagnosed in 0.71% of diabetes patients and 0.50% of controls. After multivariable adjustment, diabetes patients showed a significant increase in the risk for head and neck cancer (hazard ratio, 1.48), owed mainly to increases in cancers of the oral cavity, oropharynx, and nasopharynx.
The authors note that the mechanisms underlying the association "remain unclear" but may involve "shared genetic risk factors, [diabetes]-related metabolic morbidities (e.g., hypertension and dyslipidemia), obesity, aging, and sex." They conclude that their findings underscore the necessity of monitoring diabetic patients for head and neck cancer.
JAMA Otolaryngology—Head & Neck Surgery article (Free abstract)
Enlarged Prostate Urination Problems Could Be Eased by Sitting Men with urination problems as a result of enlarged prostate may be better off sitting rather than standing to urinate, according to a recent systematic review and meta-analysis.
Ype de Jong, MD, and colleagues at Leiden University Medical Center in Leiden, The Netherlands, analyzed data from 11 studies that included healthy men and those with lower urinary tract symptoms (LUTS). Among men with LUTS, a sitting position during urination was associated with a significantly lower post-void residual volume (PVR) compared with standing, the researchers reported in PLoS One (2014;9:e101320).
Maximum urinary flow rate was increased and voiding time was decreased in the sitting position compared with standing, but these differences were not statistically significant. Among healthy men, urination position had no significant effect on urodynamic parameters.
“In patients with LUTS, an improved urodynamic profile approaching the effect of alpha-blockers is found in the sitting position,” the authors concluded. “Incorporating the positive effect of this voiding position in the management of LUTS could have a synergistic effect on improvement of urodynamics in this group of patients.”
Study: More medical chronic conditions lead to reduced life expectancy. TIME (7/25, Abrams) reports the “more medical chronic conditions” people have, the shorter their lives will be, citing a study unveiled in the journal Medical Care. Researchers from Johns Hopkins Bloomberg School of Public Health found “that nearly four in five Americans over the age of 67 have multiple chronic conditions such as heart disease, hypertension and diabetes.” Time notes that “on average, life expectancy” fell “by 1.8 years with each additional chronic condition among older Americans.”
Shift work linked to increased risk of type 2 diabetes. Forbes (7/25) contributor Robert Glatter, MD, writes that research published in Occupational and Environmental Medicine suggests that shift work may be associated with a higher risk of developing type 2 diabetes.
HealthDay (7/25, Dallas) reports that investigators “analyzed data from 12 international studies involving more than 226,500 people.” While “the findings weren’t able to show a direct cause-and-effect relationship, the researchers found that any amount of shift work was linked to a 9 percent greater risk for developing diabetes.” Additionally, “gender...played a role – for men engaged in shift work, the risk jumped to 37 percent.”
Secondary osteoporosis and metabolic bone disease in patients 50 years and older with osteoporosis or with a recent clinical fracture: A clinical perspective
Current Opinion in Rheumatology, 07/25/2014 Review Article Bours S, et al. – The purpose of this review is to provide guidance to clinicians about which laboratory tests should be performed in patients with osteoporosis or with a recent fracture. Furthermore, authors recommend performing the following tests in all patients with osteoporosis or a recent clinical fracture: calcium, phosphate, creatinine, albumin, erythrocyte sedimentation rate in all patients, 24 h urine calcium in men and serum testosterone in men less than 70 years. On indication, additional tests can be performed.
- Newly diagnosed secondary osteoporosis and other metabolic bone diseases (SECOB) have been found in 5–48% of patients with osteoporosis.
- In patients with a recent fracture, new SECOB is found in 10–47% of patients with osteoporosis, and in 26–51% if all patients with a fracture regardless of bone mineral density (BMD) are screened.
- More than one SECOB can be found in the same patient, even when they have already known SECOB.
- In primary hyperparathyroidism, hyperthyroidism, hypercortisolism, and multiple myeloma, both SECOB and its treatment have an impact on BMD and fractures.
- For other SECOBs, no treatment is available, or there are no data about the effect of treatment of the SECOB on BMD and fractures.
http://www.ncbi.nlm.nih.gov/pubmed/24841229
Association between osteoporosis and benign paroxysmal positional vertigo: A systematic review Full Text
BMC Neurology, 07/25/2014 Review Article Yu S, et al. – The authors conducted a systematic review to examine the association between osteoporosis and benign paroxysmal positional vertigo (BPPV). This systematic review provides insight into currently available evidence and elucidates the possible existence of an association between BPPV and osteoporosis (osteopenia). However, the evidence supporting that conclusion is not strong, and further studies are needed to clarify the association between these conditions.
Methods
- Four electronic databases (PubMed, EMBASE, Cochrane Library, and the China Network Knowledge Infrastructure) were searched to identify all papers, published in either English or Chinese, examining the association between osteoporosis (osteopenia) and BPPV.
- Seven studies were eligible for analysis, though these studies included some weaknesses.
- Most of the studies demonstrated a correlation between osteoporosis (osteopenia) and the occurrence and recurrence of BPPV, especially in older women.
- Patients with osteoporosis may require more canalith–repositioning procedures.
CONCLUSIONS: This systematic review provides insight into currently available evidence and elucidates the possible existence of an association between BPPV and osteoporosis (osteopenia). However, the evidence supporting that conclusion is not strong, and further studies are needed to clarify the association between these conditions.
http://www.ncbi.nlm.nih.gov/pubmed/24886504
Smoking tied to increased suicide risk. The Los Angeles Times (7/17, Morin) reports in “Science Now” that according to a study published online July 16 in the journal Nicotine & Tobacco Research, “smoking and suicide may be more closely related than previously thought.”
HealthDay (7/17, Preidt) reports that the study found that “smoking may increase a person’s risk for suicide, but high cigarette taxes and smoking restrictions in public places lower that risk.” After analyzing “suicide rates across the United States between 1990 and 2004,” researchers found that “states that introduced higher taxes on cigarettes and stricter rules to limit smoking in public places saw suicide rates decline up to 15 percent, relative to the national average.”
Sleeping in cooler bedrooms may increase brown fat volume. The New York Times (7/17, Reynolds) “Well” blog reports that according to a study published online June 22 in the journal Diabetes, “cooler bedrooms could subtly transform a person’s stores of brown fat – what has lately come to be thought of as ‘good fat’ – and consequently alter energy expenditure and metabolic health, even into daylight hours.” For the study, National Institutes of Health-affiliated researchers asked “five healthy young male volunteers” to sleep in special climate controlled rooms there for a period of four months. The study found that “after four weeks of sleeping at 66 degrees, the men had almost doubled their volumes of brown fat.” Study senior author Francesco S. Celi, then of NIH and now at Virginia Commonwealth University, explained that it is indeed possible to “tweak your metabolic health by turning down the bedroom thermostat a few degrees.”
Diet rich in omega-3 fatty acids may decrease risk for ALS. HealthDay (7/16, Reinberg) reports that according to a study published online July 14 in JAMA Neurology, “a diet rich in omega-3 fatty acids may help cut [the] risk for the fatal neurodegenerative disease amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.” The study of some 1,000 patients with ALS revealed that patients “who ate the most foods containing omega-3 fatty acids had the lowest risk of developing” the disease.
Medscape (7/16, Hughes) reports that an accompanying editorial observed, however, that “there is not enough information from this one study to make any recommendations on dietary changes at present.”
Can Testosterone Improve Glucose Metabolism in Men with T2DM? Does testosterone therapy improve glucose metabolism in men with lowered testosterone and type 2 diabetes? A new study published in the journal Diabetes Care says no. In the trial, 88 men with type 2 diabetes and lowered testosterone were randomized to receive either IM testosterone undecanoate or placebo; the primary outcome measure was insulin resistance by homeostatic model assessment, the secondary measure was glycemic control by HbA1c. Despite a decrease in fat mass, testosterone treatment did not improve insulin resistance or glycemic control. Also, there was no reduction in visceral abdominal adiposity. Based on these results, researchers concluded that in obese men with modest reductions in testosterone and moderately controlled type 2 diabetes, testosterone treatment does not improve glucose metabolism.
Two papers identify possible molecular causes of cachexia. In an 1,100-word article, the Boston Globe (7/28) reports that “two research papers published this month, in the journals Nature and Cell Metabolism, identify possible molecular causes of” cachexia “that researchers hope could lead to potential treatments.” In the Nature study, researchers “found that after using an antibody to block the effects of the protein PTHrP in mice with lung tumors, symptoms of cachexia improved or were prevented.” Meanwhile, “the Cell Metabolism paper...states that inflammation plays a large role in turning white fat cells into brown fat cells, and found that anti-inflammatory therapies in mice alleviated symptoms of cachexia.”
Gaviscon Double Action Liquid (antacid & alginate) is more effective than antacid in controlling post-prandial oesophageal acid exposure in GERD patients: a double-blind crossover study
Alimentary Pharmacology and Therapeutics, 07/27/2014 Clinical Article De Ruigh A, et al. – This study compared the effectiveness of Gaviscon Double Action Liquid to an equivalent strength antacid without alginate in controlling post–prandial acid reflux in GERD patients. Gaviscon Double Action Liquid is more effective than an antacid without alginate in controlling post–prandial oesophageal acid exposure. However, the number and spatial distribution of reflux events within the oesophagus are similar. This suggests that Gaviscon main effectiveness relates to its co–localisation with and displacement/neutralisation of the post–prandial acid pocket, rather than preventing reflux.
Methods
- Fourteen GERD patients undertook two 3.5-h high-resolution manometry/pH-impedance studies during which they ate a standardised meal.
- In a double-blinded randomised crossover design they then took Gaviscon or CVS brand antacid, each with 18 mmol/L acid neutralising capacity.
- The primary outcome was distal oesophageal acid exposure; secondary outcomes were number of reflux events, proximal extent of reflux, nadir pH of the refluxate, mechanism of reflux and reflux symptoms scored with a validated instrument.
- Ten patients completed the study.
- Gaviscon studies had significantly less distal oesophageal acid exposure and greater nadir refluxate pH in the 30–150 min post-prandial period than antacid studies.
- There were no differences in the number of reflux events (acid or weakly acidic) or the number of proximal reflux events (15–17 cm above the LES) with either study medication.
Best Time of Day for a Testosterone Test Doctors often recommend that men with erectile dysfunction have their testosterone measured from 8 a.m. to 11 a.m., because levels are usually highest then and vary over a 24-hour period. But a new study has found that this variation occurs only in younger men.
Researchers retrospectively studied records of 2,569 men ages 26 to 84 who were evaluated at an erectile dysfunction clinic from 1985 to 2004. They sorted them into age groups, starting with 26- to 39-year-olds, and then in five-year groups up to age 84. They further divided them into two time groups: those who had their testosterone measured from 7 a.m. to 9 a.m. and those measured from 9 a.m. to 2 p.m. All the men had erectile dysfunction, a symptom of low testosterone levels.
The only men who showed a statistically and clinically significant decrease in levels between the two time periods were those younger than 45.
The lead author, Dr. Charles Welliver, a fellow at Southern Illinois University School of Medicine when the work was done, said that the timing of the test was unimportant for most men. “As long as the draw is done before 2 p.m.,” he said, “the value is still considered valid, except for the youngest two groups of men seen in this study.”
Repeat Colonoscopies Have Few Benefits for Some Patients (HealthDay News) — Repeat colonoscopies within 10 years are of little benefit to patients who had no polyps found on adequate examination; however, repeat colonoscopies do benefit patients when the baseline examination was compromised, according to research published in the August issue of Gastroenterology.
David A. Lieberman, MD, of the Oregon Health and Science University in Portland, and colleagues analyzed data for 17,525 asymptomatic patients who were found to have no polyps during a screening colonoscopy and received another colonoscopy within 10 years.
The researchers found that repeat colonoscopy within one year, typically done because of inadequate bowel preparation or incomplete exam for the baseline colonoscopy, showed a prevalence of large polyps (>9mm) of 6.5 percent (95% confidence interval [CI], 5.3–7.6%). This prevalence is similar to the rate found in the average-risk screening population. Among patients with an adequate baseline examination, the incidence of large polyps upon repeat colonoscopy was 3.1% (95% CI, 2.7–3.5%) within 1–5 years and 3.7% (95% CI, 3.3–4.1%) within 5–10 years.
"In light of the maturing body of evidence about the strong influence of sex, race/ethnicity, and other factors (e.g., tobacco, alcohol, diet) on the risk of neoplasia, individualized risk-based screening and surveillance algorithms should be developed," write the authors of an accompanying editorial.
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Ultrasound Effective for Detecting Kidney Stones
Ultrasound is safe and effective when used to detect and remove renal stones without exposing patients and operating room staff to radiation, according to separate reports.
A retrospective study published online ahead of print in Urology found ultrasound effective in the detection of renal stones. Toru Kanno, MD, PhD, and colleagues at Takeda General Hospital in Kyoto, Japan, followed 428 patients from 2009 to 2011who underwent noncontrast-enhanced computed tomography (NCCT) and ultrasound on the same day.
Ultrasound was able to detect all renal stones, as determined by NCCT, at a sensitivity of 70.0% and specificity of 94.4%. Looking at the ability of ultrasound alone to detect at least 1 stone, the authors found the modality had a sensitivity of 78.9% and specificity of 83.7%. The authors noted that the detection rate increased with stone size, and it was lower for the left upper calyx than for other sites.
Separately, in a feasibility study published online ahead of print in the Journal of Urology, Levi A. Deters, MD, and colleagues at Dartmouth Hitchcock Medical Center in Lebanon, NH, found that ultrasound offered an alternative to conventional fluoroscopy to guide surgeons during ureteroscopy for ureteral stones.
They followed 50 patients with symptomatic ureteral stones that were 8 mm or smaller without a significant ipsilateral stone burden. After temporizing ureteral stent placement, half of the patients were randomly assigned to ultrasound-guided ureteroscopy and the other half to fluoroscopy-guided ureteroscopy. Patients in the ultrasound arm were similar to those in the fluoroscopy arm in stone size (5.9 vs. 5.7 cm), age (56 vs. 52 years), and body mass index (31 vs. 30 kg/m2).
Researchers found no residual stone fragments on follow-up x-ray and ultrasound imaging in 86% of each group and no significant differences in complication rates among the two groups. Operative times and costs were also similar.
Is Hydroxychloroquine Effective for Patients with Symptomatic Sjögren Syndrome?
Gottenberg J-E et al., JAMA 2014 Jul 16; 312:249
The drug was no better than placebo in relieving dryness, fatigue, and pain.
Troubling symptoms of Sjögren syndrome include oral and ocular dryness, joint and soft-tissue pain, and fatigue. Rarely, patients have serious systemic involvement, such as renal disease, pulmonary disease, vasculitis, or lymphomas. Treatments include hydroxychloroquine, methotrexate, and biologic therapies (e.g., rituximab [Rituxan]), but none of these agents alter symptoms significantly in controlled trials. In this study, investigators in France randomized 120 patients with Sjögren syndrome to receive hydroxychloroquine or placebo for 24 weeks; all patients then received hydroxychloroquine between weeks 24 and 48. Patients who had previously received hydroxychloroquine or other immunosuppressants or who had systemic manifestations were excluded.
At 24 weeks, the proportion of patients who reported ≥30% reductions from baseline in at least two of three symptoms (i.e., dryness, fatigue, and pain) was no different in the two groups. In patients who received placebo for 24 weeks followed by hydroxychloroquine through week 48, dryness, fatigue, and pain scores at 48 weeks did not differ significantly from those at 24 weeks.
No Reduction in Atherosclerosis Progression with Menopausal Hormone Therapy
Menopausal hormone therapy may have favorable effects on some cardiovascular risk factors, but it doesn't reduce the progression of atherosclerosis, according to an Annals of Internal Medicine study.
Over 700 menopausal women were randomized to placebo or one of two low-dose hormone therapies (oral conjugated equine estrogens or transdermal 17β-estradiol, plus progesterone).
After 4 years, there was no difference between the groups in the study's primary endpoint — the progression of atherosclerosis as measured by carotid artery intima-media thickness (CIMT) — or in coronary artery calcium scores. Women in the equine estrogen group had improved lipid profiles, while women in the transdermal group had improved insulin sensitivity. Serious adverse event rates did not differ significantly across the groups.
The investigators offer several explanations for the findings, including a study population at low risk for atherosclerosis, a relatively short study duration, and the use of low-dose rather than high-dose estrogen.
Andrew Kaunitz, editor-in-chief of NEJM Journal Watch Women's Health, says that although it's still unclear what the long term effects of hormone therapy will be on cardiovascular events, the study "does not support using hormone therapy to prevent CVD events."
Annals of Internal Medicine article (Free abstract)
Boost Balance with Ballroom Dancing
About an hour of ballroom dancing 3 days a week, for 3 months, resulted in a 50% improvement in balance and fall reduction.
Banish These Beverages
Sugar sweetened beverages such as sodas and juice cocktails may elevate blood pressure.
Cap Off a Swim with Chocolate Milk
Not only did collegiate-trained swimmers recover better with chocolate milk after an exhaustive swim, they swam faster in time trials later that same day.
A Worthy 25-Minute Investment
Twenty-five minutes of moderate-to-vigorous exercise everyday may reduce prescription usage and hospital admissions, among men and women ages 70 and older.
Air Pollution May Prompt Cognitive Decline
Fine particulate matter air pollution, typified by vehicle exhaust, may hasten cognitive decline in older adults.
Your Breakfast Bowl
With a hearty texture, a bowl of instant oatmeal satiates hunger and can help you feel full longer.
Mechanism of Cancer-Contributing Gene Revealed
MYC, a gene linked to cancer, interacts with a non-coding RNA, to fuel cancer growth.
Probiotics Boost Infection Protection in Athletes
Daily probiotic supplements may reduce the incidence of gastrointestinal and upper respiratory tract infections.
Neural Bypass Technology Enables Movement in Paralyzed Patient
Neurobridge is an electronic neural bypass for spinal cord injuries that reconnects the brain directly to muscles, to enable voluntary and functional control of
Lifelong Learning Leads to Longer Cognitive Acuity
Education, career, and interpersonal activities may be key to retaining memory and thinking skills later in life.
EXERCISE
A Worthy 25-Minute Investment
Twenty-five minutes of moderate-to-vigorous exercise everyday may reduce prescription usage and hospital admissions, among men and women ages 70 and older.
Inflammation Intervention
Regular exercise may exert physiological changes that decrease inflammation on a local and systemic level.
Soccer Improves Diabetes Markers & Blood Pressure
Among men, 6 months of twice-weekly recreational soccer may reduce the risk for heart failure as well.
Steps to Keep Osteoarthritis At Bay
Walking 6,000 or more steps each day may protect those with or at risk of knee of osteoarthritis from developing mobility issues.
Retire… But Keep on Exercising
Men and women living in retirement communities who exercise regularly experience less physical decline as they age.
Defeat Diabetes in Two Minutes
High intensity training consisting of two minutes of exercise weekly, may help to prevent type-2 diabetes.
Short Daily Walk Promotes Independent Living
A 20-minute walk each day may ward off major physical disability and enhance quality of life.
Fitness in 50s Is An Anti-Aging Essential
Poor physical ability in your 50s may raise your risk of an early death.
Walking Promotes A Fit Heart
Regularly engaging in walking can help to maintain healthy heart rate variability, among men and women ages 60 and older.
Walking A Key Step Towards Creativity
Creative thinking may be fueled by taking a walk
** ALZHEIMER'S / DEMENTIA News **
Social contact, peer support and self-help can positively benefit people with dementia
http://mnt.to/l/4pBm
Human neurodegenerative diseases may be impacted by discovery of a new cellular garbage control pathway
http://mnt.to/l/4pzR
New studies presented at Alzheimer's Association International conference demonstrate diagnostic value of [<sup>18</sup>F]flutemetamol
http://mnt.to/l/4pyx
Neuronal edema in Alzheimer's disease rats reduced by acupuncture and moxibustion
http://mnt.to/l/4pxX
Bexarotene's effect on Alzheimer's may depend on severity of disease
http://mnt.to/l/4px5
Older adults benefit from fish oil supplements which reduce incidence of cognitive decline, may improve memory function
http://mnt.to/l/4pwg
Alzheimer's Association International Conference 2014 selected highlights
http://mnt.to/l/4pwm
Gardens could benefit dementia patients and their carers
http://mnt.to/l/4pvx
Genetic variant conveys significant protection against Alzheimer's disease
http://mnt.to/l/4pvs
Alzheimer's disease not prevented by B vitamins
http://mnt.to/l/4pvq
Signaling pathway for ginsenoside Rb1 promoting hippocampal neuronal neurite outgrowth
http://mnt.to/l/4ptX
Memory and learning deficits restored in Alzheimer's mouse models
http://mnt.to/l/4pvW
ANAVEX 3-71 highly effective and disease-modifying against all major Alzheimer's hallmarks in preclinical disease model
http://mnt.to/l/4ptJ
New data on possible protective behaviors and dementia risk factors emerges at Alzheimer's Association International Conference 2014
http://mnt.to/l/4pt8
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** ANXIETY / STRESS News **
Understanding a person's increased vulnerability to PTSD after Boston Marathon bombing
http://mnt.to/l/4pvz
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** BONES / ORTHOPEDICS News **
Increase in patients age 80 and older undergoing orthopaedic surgery
http://mnt.to/l/4pyR
Anthropology study shows quadrupedal humans are not products of 'devolution'
http://mnt.to/l/4pwQ
Best anticoagulants after orthopedic procedures depends on type of surgery
http://mnt.to/l/4pv3
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** CARDIOVASCULAR / CARDIOLOGY News **
Simulated human heart used to test drugs' effects
http://mnt.to/l/4pBp
Scientists create 'biological pacemakers' by transplanting gene into hearts
http://mnt.to/l/4pxq
Many at-risk heart disease patients lack guidance on beneficial aspirin treatment
http://mnt.to/l/4ptQ
Risk for atrial fibrillation may be increased by moderate alcohol use
http://mnt.to/l/4ptd
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** CHOLESTEROL News **
Niacin for cholesterol now linked to death risk, dangerous side effects and no benefits
http://mnt.to/l/4pwS
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** DIABETES News **
Insulin-secreting cells of the pancreas protected by autophagy
http://mnt.to/l/4pzK
Statins may reduce cardiovascular death in type 2 diabetes
http://mnt.to/l/4px2
Treatment reverses symptoms of type 2 diabetes in mice, without side effects
http://mnt.to/l/4pwT
Could a single injection stop diabetes?
http://mnt.to/l/4pxZ
Pre-diabetes label 'unhelpful and unnecessary'
http://mnt.to/l/4ptC
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** HYPERTENSION News **
Could consuming probiotics help lower blood pressure?
http://mnt.to/l/4pBs
Lean beef incorporated into diet helps lower blood pressure
http://mnt.to/l/4pzx
Screening for undiagnosed hypertension via electronic health records
http://mnt.to/l/4px4
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** MEN'S HEALTH News **
Adolescent males' developing masculinity
http://mnt.to/l/4pwf
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** MENTAL HEALTH News **
Mental health patients at highest risk of suicide in first two weeks after leaving hospital
http://mnt.to/l/4pv4
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** NEUROLOGY / NEUROSCIENCE News **
An important role in Down syndrome played by 'support' cells in brain
http://mnt.to/l/4pzT
In crush injury, how L-carnitine maintains the normal structure of the sciatic nerve
http://mnt.to/l/4pzF
Injured spinal cord neurons repaired by intranasal nerve growth factor
http://mnt.to/l/4pzD
Radial nerve injury for evaluating peripheral nerve repair in rhesus monkey model
http://mnt.to/l/4pzB
How 'good mothering' hardwires infant brain
http://mnt.to/l/4pzf
Two-way interaction between neurons and astrocytes plays an important role in the processes of learning and memory
http://mnt.to/l/4pyV
International research team discovers genetic dysfunction connected to hydrocephalus
http://mnt.to/l/4pz5
Brain-on-a-Chip axonal strain injury model highlights mitochondrial membrane potential threshold and assesses potential new therapeutic
http://mnt.to/l/4pyq
Protecting against neuron and synapse injury in immature rats
http://mnt.to/l/4py2
Findings in mice fuel the idea that processes of active movement and sensory processing are connected
http://mnt.to/l/4pxs
Deadly disease of the brain successfully treated in worms
http://mnt.to/l/4px3
Age-related changes in lateral ventricular width and periventricular white matter by diffusion tensor imaging
http://mnt.to/l/4pwK
Neural regeneration after TBI promoted by intravenous transplantation of BMSCs
http://mnt.to/l/4pwJ
In lead-exposed neonatal mice, chrysophanol attenuates injury to hippocampal neurons
http://mnt.to/l/4pwG
Researchers seeking to smuggle pharmacological agents across the blood-brain barrier
http://mnt.to/l/4pwh
Traumatic brain injury outcomes may be explained by hidden variations in neuronal networks
http://mnt.to/l/4pvV
Brain damage 'can follow even mild traumatic brain injury'
http://mnt.to/l/4pwC
Potential new approach to brain cancer treatments and a better understanding of Parkinson's disease
http://mnt.to/l/4pvn
After a concussion, persistent symptoms 'may be PTSD'
http://mnt.to/l/4pvh
Apparent diffusion coefficient does not reflect cytotoxic edema on the uninjured side after traumatic brain injury
http://mnt.to/l/4ptV
Following acute hemorrhagic anemia, SWI assesses signal strength in different brain regions
http://mnt.to/l/4ptR
Giving birth to a baby with cerebral palsy is less of a risk for immigrant mothers in Canada
http://mnt.to/l/4ptP
Could the cause of cerebral palsy run in the family?
http://mnt.to/l/4ptD
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** NUTRITION / DIET News **
The effects of starvation can be passed to future generations
http://mnt.to/l/4pyM
Last step before full genome sequence of bread wheat genome
http://mnt.to/l/4pyn
The Mediterranean diet has varied effects on cognitive decline among different races
http://mnt.to/l/4pxv
European children not eating enough fruit and veg
http://mnt.to/l/4pxY
Study maps EU school food policies for the first time
http://mnt.to/l/4pwx
ESPGHAN statement provides guidance on 'essential' technique for children with feeding and nutrition problems
http://mnt.to/l/4pvM
Experts recommend avoiding rice drinks for infants and young children due to concerns over arsenic content
http://mnt.to/l/4pvG
Soluble corn fibre may boost calcium absorption
http://mnt.to/l/4ptY
Antihypertensive and antioxidant activity in black beans
http://mnt.to/l/4ptr
What are the health benefits of pumpkin?
http://mnt.to/l/4ptm
Tooth plaque provides insight into our prehistoric ancestors' diet
http://mnt.to/l/4psH
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** OBESITY / WEIGHT LOSS / FITNESS News **
NBR1 protein plays a critical role in regulating obesity-induced inflammation that leads to metabolic disease
http://mnt.to/l/4pyL
Black women in weight management program experienced a reduction in their depression
http://mnt.to/l/4pzn
When it comes to food, obese women's learning is impaired
http://mnt.to/l/4pxt
TILDA study finds 4 out of 5 over 50s in Ireland are overweight or obese
http://mnt.to/l/4pxQ
Obesity and stress
http://mnt.to/l/4pvD
Could being overweight benefit our health?
http://mnt.to/l/4pvy
Sedentary behavior ameliorated by physical fitness
http://mnt.to/l/4ptj
Women's metabolism slowed by combination of stress and high-fat meals
http://mnt.to/l/4ptg
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** PRIMARY CARE / GENERAL PRACTICE News **
Home coaching visit decreases re-admission, costs for Medicare patients
http://mnt.to/l/4pzb
National Quality Forum cautions hospital performance measures must adjust for patient sociodemographic status or risk widening the care gap
http://mnt.to/l/4pyt
Effective, efficient research in health care settings: 4 lessons
http://mnt.to/l/4pvB
UK project finds 93% of health professionals recommend better training on how to care for people with a learning disability
http://mnt.to/l/4pvj
News from the Annals of Family Medicine
http://mnt.to/l/4ptb
----------------------------------------------
** PROSTATE / PROSTATE CANCER News **
Prostate cancer controlled for 10 years by robot-assisted surgery
http://mnt.to/l/4pxn
Early onset prostate cancer a newly identified, more aggressive subtype often linked to genetic mutations
http://mnt.to/l/4pw3
Prostate cancer is focus of two studies in JAMA Internal Medicine
http://mnt.to/l/4ptt
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** SENIORS / AGING News **
A gene identified that plays a surprising role in combating aging
http://mnt.to/l/4pz4
Walking out of necessity increases risk of outdoor falls in older adults
http://mnt.to/l/4pzr
Taking a new look at cognition and aging
http://mnt.to/l/4pxm
Antibiotic overuse risk in aged care residential setting in Australia
http://mnt.to/l/4pwr
Survey shows older Americans' health engagement and outlook on life improve
http://mnt.to/l/4pwp
Memories affected by environmental distractions nearly twice as likely in older adults
http://mnt.to/l/4pv6
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** SLEEP / SLEEP DISORDERS / INSOMNIA News **
Sleep problems that persist after a divorce can be harmful to your health
http://mnt.to/l/4pzw
During aging, lipoic acid helps restore, synchronize the "biological clock"
http://mnt.to/l/4pyS
PTSD, poor sleep quality and physical activity
http://mnt.to/l/4pxw
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** STROKE News **
Older people with previous stroke or vascular disease at higher risk of stroke after heart surgery
http://mnt.to/l/4pBt
Stroke rates declined 40 percent in both men and women 65 years and older over the last 20 years
http://mnt.to/l/4pyZ
Pairing a mechanical device with stroke patients
http://mnt.to/l/4pxy
What increases the neuronal plasticity of endogenous neural stem cells after focal cerebral ischemia?
http://mnt.to/l/4pwL
Study finds a 20-year decline in stroke risk and death rates
http://mnt.to/l/4pw5
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** WOMEN'S HEALTH / GYNECOLOGY News **
Study examines presence of uterine cancers among women at the time of hysterectomy using morcellation
http://mnt.to/l/4pBk
Breastfeeding goals affected by mother's return to work
http://mnt.to/l/4pyN
Homeless and unstably housed women in San Francisco suffer high rates of violence
http://mnt.to/l/4py9
On scientific field studies, sexual harassment and assault are common
http://mnt.to/l/4pwY
** ALLERGY News **
Cause of mysterious food allergy determined, new treatment strategy suggested
http://mnt.to/l/4pst
New allergen toolkit for healthcare catering launched in the UK
http://mnt.to/l/4ppr
Children on dairy farms less likely to develop allergies
http://mnt.to/l/4pnX
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** ALZHEIMER'S / DEMENTIA News **
Could eye and smell tests offer early Alzheimer's diagnosis?
http://mnt.to/l/4ptG
New analysis says Alzheimer's preventable in a third, not half of cases
http://mnt.to/l/4psN
Neurogenesis in Alzheimer's disease promoted by ADSCs transplantation
http://mnt.to/l/4psc
Noninvasive retinal imaging device may provide highly predictive early detection of changes associated with Alzheimer's disease
http://mnt.to/l/4pss
Four research trials show smell and eye tests offer potential to detect Alzheimer's early
http://mnt.to/l/4psr
Nasal mucosal inhalation of Alzheimer's disease vaccine attenuates Aβ1-42-induced cytotoxicity
http://mnt.to/l/4ppt
Scientists investigate the cause of memory impairment in Alzheimer's Disease through GABA from reactive astrocytes
http://mnt.to/l/4pp6
----------------------------------------------
** ANXIETY / STRESS News **
Health reported as the most common major stressful event in Americans' lives last year
http://mnt.to/l/4pnD
----------------------------------------------
** ARTHRITIS / RHEUMATOLOGY News **
Severity of osteoarthritis in mice reduced by omega 3 fatty acids
http://mnt.to/l/4ps3
Anti-arthritics can exacerbate other inflammatory diseases like periodontitis
http://mnt.to/l/4pqD
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** BONES / ORTHOPEDICS News **
Bone marrow hormone influences metabolism and health
http://mnt.to/l/4pmS
Proprietary calcium and collagen formulation KoACT® found to be superior for bone health
http://mnt.to/l/4pmm
Partial knee replacement safer than total knee replacement
http://mnt.to/l/4pm8
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** CARDIOVASCULAR / CARDIOLOGY News **
Could 'reading faces' improve rapid diagnosis of heart and lung problems?
http://mnt.to/l/4psT
'Self-competence' affects quality of life of children with pacemakers
http://mnt.to/l/4pr2
How P. gingivalis causes chronic inflammation in blood vessels
http://mnt.to/l/4pqQ
Hispanic Americans need culturally tailored heart care
http://mnt.to/l/4ppP
Pitt study finds telephone treatment of depression after cardiac bypass surgery improves outcomes and saves money
http://mnt.to/l/4pmK
Study estimates rate of survival following minimally invasive repair of failed bioprosthetic aortic valves
http://mnt.to/l/4pmF
Cardiovascular health adversely affected by sitting too much
http://mnt.to/l/4pm2
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** DIABETES News **
Diabetes diagnosed with inexpensive, portable microchip test
http://mnt.to/l/4psx
Nanotech microchip invented to diagnose type-1 diabetes
http://mnt.to/l/4psw
Inadequate support in schools for diabetic children
http://mnt.to/l/4prb
Apoptotic retinal ganglion cells reduced in diabetes by Inhibition of NgR expression
http://mnt.to/l/4pqz
Scientists discover clues why weight-loss surgery cures diabetes
http://mnt.to/l/4pqk
Hydrogen sulfide has potential health benefits in a range of issues, from diabetes to stroke, heart attacks and dementia
http://mnt.to/l/4ppm
Physicists show that the concentration of acetone in breath is a suitable marker of fat-burning during physical activity
http://mnt.to/l/4pnN
Advantages of standardizing diabetes treatments
http://mnt.to/l/4pmg
In people with diabetes, consuming whey protein before meals could help improve blood glucose control
http://mnt.to/l/4pkF
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** HYPERTENSION News **
Home blood pressure-monitoring kits save insurance companies money
http://mnt.to/l/4ppL
Treatment-resistant hypertension requires proper diagnosis
http://mnt.to/l/4pmr
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** MEN'S HEALTH News **
Hypnotic relaxation may ease the discomfort of men's hot flashes
http://mnt.to/l/4pqs
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** MENTAL HEALTH News **
Having strong social ties protects men from suicide death
http://mnt.to/l/4pqg
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** NEUROLOGY / NEUROSCIENCE News **
For learning/memory function, substance P in hippocampus versus striatal marginal division
http://mnt.to/l/4psb
The differentiation of adipose-derived stromal cells into astrocytes faces obstacles
http://mnt.to/l/4ps9
Anandamide can increase intracellular ca2+ concentration
http://mnt.to/l/4ps8
Spider toxin suggests a new way to protect crops from insect plagues, offers insight into human sodium channels
http://mnt.to/l/4ps2
Revolutionary technology enables scientists to navigate and analyze complex 3D images
http://mnt.to/l/4prW
Scientists shed new light on nerve cell growth
http://mnt.to/l/4prx
Four evidence-based indicators of concussion
http://mnt.to/l/4pr3
The optimal mitomycin C concentration for intact peripheral nerve structure and function
http://mnt.to/l/4pqR
Fusion protein of single-chain variable domain fragments and myasthenia gravis
http://mnt.to/l/4pqB
Repair of spinal cord injury: BMSCs with Nogo-66 receptor gene silencing
http://mnt.to/l/4pqy
How the brain processes emotions
http://mnt.to/l/4ppC
DARPA and UCLA project to restore brain injury patients' memories
http://mnt.to/l/4pqj
L-dopa medication could be helpful in the treatment of phobias and post-traumatic stress disorder
http://mnt.to/l/4ppB
Hippocampal cholinergic neurons protected in normal aging by thyroid hormone
http://mnt.to/l/4ppv
Neuroprotective effects of low concentration of lithium
http://mnt.to/l/4ppj
High earners in a stock market game found to have brain patterns that can predict bubbles and crashes
http://mnt.to/l/4pnb
How tumors weaken blood barrier in brain cancer patients explained
http://mnt.to/l/4pmX
Neural stem cell therapy led to spinal cord mass
http://mnt.to/l/4pmd
Explaining brain circuitry by dodging dots
http://mnt.to/l/4pkZ
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** NUTRITION / DIET News **
Absorption of vitamin A enhanced when avocados are eaten with tomatoes or carrots
http://mnt.to/l/4prp
Carbohydrates from the Okra plant can improve the quality of food products
http://mnt.to/l/4pr9
Organic and non-organic foods are compositionally different, says new study
http://mnt.to/l/4psq
Tofu consumption - surprise study findings
http://mnt.to/l/4pqC
Great tasting low-fat cheeses and cakes could soon be on the menu
http://mnt.to/l/4pqm
What are the health benefits of eggplant?
http://mnt.to/l/4pnd
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** OBESITY / WEIGHT LOSS / FITNESS News **
Obesity - surgery is not the only answer, say research scientists
http://mnt.to/l/4psW
Weight advice not provided by health providers of obese US firefighters
http://mnt.to/l/4psh
How Twitter can be used to address specific health issues, like childhood obesity
http://mnt.to/l/4prC
NICE consults on updated recommendations for treating obesity
http://mnt.to/l/4prR
Epigenetic effects of environmental impact on health
http://mnt.to/l/4pqG
Heart disease a greatly increased risk for obese young Hispanics
http://mnt.to/l/4ppb
View exercising as fun and you'll eat less later!
http://mnt.to/l/4pnP
Adolescents from southern Europe are less fit and more obese than their central-northern European peers
http://mnt.to/l/4pnt
'Extreme obesity' linked to 'substantially higher' death rates
http://mnt.to/l/4pmM
Young Hispanics often obese and at higher risk for heart diseases
http://mnt.to/l/4pmx
New wellness approach that focuses on mindfulness and intuitive eating is more effective than traditional weight-loss programs
http://mnt.to/l/4pkQ
Expanding waistlines likely caused by less exercise rather than more calories
http://mnt.to/l/4pkM
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** PRIMARY CARE / GENERAL PRACTICE News **
Patients should have access to their medical records
http://mnt.to/l/4psD
NHS could experience funding crisis before General Election, new analysis reveals
http://mnt.to/l/4ppx
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** PROSTATE / PROSTATE CANCER News **
Prostate cancer with depression leads to later diagnosis, less effective therapies
http://mnt.to/l/4pqw
Risk of aggressive prostate cancer may be increased by vasectomy
http://mnt.to/l/4ppY
Vasectomy linked with aggressive prostate cancer risk
http://mnt.to/l/4ppg
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** SENIORS / AGING News **
Keeping active pays off in your 70s and 80s
http://mnt.to/l/4pq8
Growing old with HIV: Age-related diseases are bigger problem for African American women
http://mnt.to/l/4pnf
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** SLEEP / SLEEP DISORDERS / INSOMNIA News **
Dietary manipulation of the body's internal biological clock
http://mnt.to/l/4pqP
The high price paid by parents of newborns for their interrupted sleep
http://mnt.to/l/4pnr
Sleep affected by the full moon - contradictory findings
http://mnt.to/l/4pn2
Symptoms of schizophrenia possible following sleep deprivation
http://mnt.to/l/4pkV
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** STROKE News **
History of stroke linked with increased risk of adverse outcomes after non-cardiac surgery
http://mnt.to/l/4psM
Study finds decrease in incidence of stroke and subsequent death
http://mnt.to/l/4psK
Patients with chronic stroke and cerebral palsy benefit from virtual reality interface device and brain neural networks
http://mnt.to/l/4psd
Increased stroke risk linked to high stress, hostility, depression
http://mnt.to/l/4prF
Psychological stress 'increases risk of stroke'
http://mnt.to/l/4ppQ
How patients respond to filiform needle acupuncture versus antidepressant drugs for poststroke depression
http://mnt.to/l/4pph
In acute cerebral ischemia, what aggravates hippocampal neuronal injury?
http://mnt.to/l/4ppf
Electrical stimulation of fastigial nucleus and cellular apoptosis in injured region
http://mnt.to/l/4pmY
Focal cerebral ischemia for neural regeneration studies: rat versus mouse models
http://mnt.to/l/4pmW
After chronic cerebral ischemia, 3-N-butylphthalide improves neuronal morphology
http://mnt.to/l/4pmV
Voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke
http://mnt.to/l/4pmT
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** WOMEN'S HEALTH / GYNECOLOGY News **
For older women, exercise is the best medicine
http://mnt.to/l/4ps7
- ALLERGY News **
Leading immunologists call for equity for patients with jack jumper ant allergies in Australia
http://mnt.to/l/4pk7
New, simple method to identify food allergies
http://mnt.to/l/4pgq
----------------------------------------------
** ALZHEIMER'S / DEMENTIA News **
Alzheimer's blood test breakthrough reported in new study
http://mnt.to/l/4pkX
Mouse model confirms how Alzheimer's and cerebrovascular disease interact
http://mnt.to/l/4pjq
The generation and survival of neurons prevented by a 'switch' in the brains of Alzheimer's and stroke patients
http://mnt.to/l/4pj7
Drugs that boost autophagy may help fight neurological diseases
http://mnt.to/l/4phV
Neurodegenerative disease risk enhanced by glitch in garbage removalrisk
http://mnt.to/l/4phQ
Researchers identify urgent need for Alzheimer's drug development
http://mnt.to/l/4phr
Researchers propose 'simpler, more reliable' Alzheimer's diagnosis
http://mnt.to/l/4phX
Researchers identify urgent need for Alzheimer's disease drug development
http://mnt.to/l/4pcg
----------------------------------------------
** ANXIETY / STRESS News **
Stress reduction from just 25 minutes of mindfulness meditation
http://mnt.to/l/4ph8
PTSD prevention: potential drug target identified
http://mnt.to/l/4pdC
----------------------------------------------
** ARTHRITIS / RHEUMATOLOGY News **
Rheumatoid arthritis treatment set to change following research on inflammasomes
http://mnt.to/l/4pgD
Research on inflammasomes opens new therapeutic avenues for treatment of rheumatoid arthritis
http://mnt.to/l/4pft
----------------------------------------------
** BONES / ORTHOPEDICS News **
Tooth protein offers promise for bone regeneration
http://mnt.to/l/4pgK
Research into halting muscle wastage aided by hibernating frogs
http://mnt.to/l/4pcK
----------------------------------------------
** CARDIOVASCULAR / CARDIOLOGY News **
New trial suggests cheaper drugs for common heart attack procedure could improve outcomes and save health budgets millions
http://mnt.to/l/4pjM
Task Force recommends against screening for carotid artery stenosis in general adult population
http://mnt.to/l/4pjH
Could light be used to treat atrial fibrillation painlessly?
http://mnt.to/l/4pjm
Shift workers who give blood may reduce their risk of heart disease
http://mnt.to/l/4pgL
Dark chocolate 'may improve walking ability for PAD patients'
http://mnt.to/l/4phh
Polyphenols could yield small benefit for people with PAD
http://mnt.to/l/4pgv
Atrial flutter successfully treated by catheter ablation
http://mnt.to/l/4pf7
Important new information on genetic risk of sudden cardiac death
http://mnt.to/l/4pdg
----------------------------------------------
** DIABETES News **
Insulin pumps 'more effective than injections' for type 2 diabetes
http://mnt.to/l/4phy
Combined aerobic and resistance training may be best for controlling blood sugar in diabetes
http://mnt.to/l/4pgC
Obesity linked to type 2 diabetes by an absent protein
http://mnt.to/l/4pgx
Human gastrointestinal cells retrained to produce insulin
http://mnt.to/l/4pcH
----------------------------------------------
** EATING DISORDERS News **
Psychological issues around emotional overeating not addressed by UK healthcare professionals
http://mnt.to/l/4pg9
----------------------------------------------
** ENDOCRINOLOGY News **
During the winter months more males are born left-handed
http://mnt.to/l/4phS
Testosterone therapy not found to increase heart attack risk
http://mnt.to/l/4pgg
----------------------------------------------
** ERECTILE DYSFUNCTION / PREMATURE EJACULATION News **
Cycling and risk for erectile dysfunction, infertility, prostate cancer
http://mnt.to/l/4pkB
Around two thirds of Viagra consumed in the Netherlands may be illegal, warn Dutch experts
http://mnt.to/l/4pdq
----------------------------------------------
** HYPERTENSION News **
Clinical trials of metabolic syndrome drug likely in the near future
http://mnt.to/l/4pjw
Hypertension, antihypertension medication and risk of psoriasis
http://mnt.to/l/4phz
----------------------------------------------
** MENTAL HEALTH News **
You can overcome your obsessions with internet treatment: no talking, just writing
http://mnt.to/l/4pjZ
----------------------------------------------
** NEUROLOGY / NEUROSCIENCE News **
Peripheral nerve regeneration visualization
http://mnt.to/l/4pkw
Inducing cell differentiation by light through the use of light-inducible receptor tyrosine kinases
http://mnt.to/l/4pkn
New UK research for patients with very rare diseases
http://mnt.to/l/4pkd
Do not disturb! How the brain filters out distractions
http://mnt.to/l/4pjK
A dominant hemisphere for handedness and language?
http://mnt.to/l/4pjG
Key to fighting brain disease could lie in boosting appetite of cells
http://mnt.to/l/4phY
Low brain protein levels associated with neurodegeneration
http://mnt.to/l/4phH
What happens in female brains during courtship and mating may be revealed by fruit fly research
http://mnt.to/l/4pgy
Motörhead and the dangers of headbanging
http://mnt.to/l/4pg3
The science behind the 'dream-like states' of psychedelic drugs
http://mnt.to/l/4pdw
Patients with severe ME receive 'inadequate care'
http://mnt.to/l/4pfZ
Among patients with TBI, maintaining higher hemoglobin concentration or receiving hormone EPO does not improve neurological outcomes
http://mnt.to/l/4pfh
----------------------------------------------
** NUTRITION / DIET News **
Hospital patients being screened for malnutrition but nutrition care is lacking
http://mnt.to/l/4phq
Safe seafood project develops tools for detection of pharmaceutical residues
http://mnt.to/l/4phC
What are the health benefits of cantaloupe?
http://mnt.to/l/4phv
----------------------------------------------
** OBESITY / WEIGHT LOSS / FITNESS News **
Rise in obesity 'due to decline in exercise, not over-eating'
http://mnt.to/l/4pkD
Sibling composition impacts childhood obesity risk
http://mnt.to/l/4pk9
With calorie restriction, a less-studied fat tissue releases adiponectin, which is linked to reduced risk of diseases like diabetes
http://mnt.to/l/4pjf
A major factor that drives the thermogenic process identified, helps explain how brown fat burns energy
http://mnt.to/l/4pjd
Why high-protein weight loss diets can work
http://mnt.to/l/4pj9
Study may explain 'healthy' obesity
http://mnt.to/l/4pj3
Process identified that affects fat distribution and metabolic syndrome
http://mnt.to/l/4pgT
----------------------------------------------
** PRIMARY CARE / GENERAL PRACTICE News **
UK Health Select Committee right to call for changes in care for people with long-term conditions
http://mnt.to/l/4pjp
Australia lagging behind in shared health decision making
http://mnt.to/l/4phM
UK welfare reforms are increasing GP workload and harming patients, finds BMJ investigation
http://mnt.to/l/4pdn
----------------------------------------------
** SENIORS / AGING News **
Geriatric health assessment should include nutrition screening
http://mnt.to/l/4phn
Evaluations critical to ensure continued competency of older drivers
http://mnt.to/l/4pcz
----------------------------------------------
** SLEEP / SLEEP DISORDERS / INSOMNIA News **
Your reaction to stress may increase your risk for insomnia
http://mnt.to/l/4phN
Community socioeconomic deprivation linked to sleep duration in twin study
http://mnt.to/l/4pgQ
Shortness of sleep 'speeds up' aging of the brain
http://mnt.to/l/4pd6
----------------------------------------------
** STROKE News **
Traditional Chinese medicines maintain stabilization of the internal environment of neurovascular units
http://mnt.to/l/4pkz
Secondary stroke prevention therapies on the rise, Australia
http://mnt.to/l/4pfQ
How kangaroos use their tails as a 'fifth' leg provides new insight into why we walk the way we do
http://mnt.to/l/4ph7
----------------------------------------------
** WOMEN'S HEALTH / GYNECOLOGY News **
Birth control computer chip 'could be on sale by 2018'
http://mnt.to/l/4pmv
When dealing with intimate partner violence, female veterans want options, follow up support
http://mnt.to/l/4pjB
Effects of conflict on women's reproductive health need to be managed sensitively
http://mnt.to/l/4pjg
More health professionals needed to tackle FGM 'national scandal', says Unite
http://mnt.to/l/4phk
Success Factors: Ten countries spotlighted for reducing mortality rates
http://mnt.to/l/4pcX
ALZHEIMER'S / DEMENTIA News **
Unprecedented 3-D view of important brain receptor has implications for Alzheimer's, Parkinson's, schizophrenia, depression
http://mnt.to/l/4pbx
Abnormal blood clots in the brain offer drug target for Alzheimer's
http://mnt.to/l/4pbw
Looking to improve long-term care to aid rising numbers with dementia
http://mnt.to/l/4p56
----------------------------------------------
** ANXIETY / STRESS News **
The lasting impact of early life stress
http://mnt.to/l/4pbC
Brain circuits identified that are involved in stress-induced fevers
http://mnt.to/l/4p95
Could our hormones influence whether we vote?
http://mnt.to/l/4p88
----------------------------------------------
** ARTHRITIS / RHEUMATOLOGY News **
One third of total knee replacements in US are 'inappropriate'
http://mnt.to/l/4pbj
----------------------------------------------
** BONES / ORTHOPEDICS News **
Potential new therapeutic target for osteoporosis: MicroRNA that blocks bone destruction
http://mnt.to/l/4p8V
Muscle pacing method saw rats gain 30 percent of bone within targeted areas
http://mnt.to/l/4p8b
----------------------------------------------
** CARDIOVASCULAR / CARDIOLOGY News **
Could a happy marriage be the key to a healthy heart?
http://mnt.to/l/4p92
New blood test identifies "Sudden Cardiac Death" risk
http://mnt.to/l/4p7m
A self-powered cardiac pacemaker
http://mnt.to/l/4p6q
After heart attack, mortality risk can be halved by quitting smokeless tobacco
http://mnt.to/l/4p55
----------------------------------------------
** DIABETES News **
FDA approves Afrezza to treat diabetes
http://mnt.to/l/4pcp
Insulin therapy for type 2 diabetes 'may do more harm than good'
http://mnt.to/l/4pbZ
Preventing heart disease in diabetes by restoring thyroid hormones in heart
http://mnt.to/l/4p8m
Nice issues positive final guidance for INVOKANA® (canagliflozin) for type 2 diabetes
http://mnt.to/l/4p7q
Gastric bypass surgery improves diabetic patients' quality of life
http://mnt.to/l/4p79
'Manipulation of intestinal bacteria could offer a new approach to manage obesity and type 2 diabetes'
http://mnt.to/l/4p6n
Liraglutide for diabetes improves risk factors for heart disease
http://mnt.to/l/4p6m
----------------------------------------------
** ENDOCRINOLOGY News **
For hazard assessment, animal testing methods for endocrine disruptors should change
http://mnt.to/l/4p7J
----------------------------------------------
** HYPERTENSION News **
Childhood malnutrition linked to higher blood pressure in adults
http://mnt.to/l/4pc3
Genetic study suggests causal link between vitamin D deficiency and hypertension
http://mnt.to/l/4p8k
----------------------------------------------
** MENTAL HEALTH News **
Gender differences in use of mental health services
http://mnt.to/l/4p8B
----------------------------------------------
** NEUROLOGY / NEUROSCIENCE News **
Learn a language in your sleep
http://mnt.to/l/4pcr
New light-sensitive protein enables simpler, more powerful optogenetics
http://mnt.to/l/4pcn
Neuroscientists inhibit muscle contractions by shining light on spinal cord neurons
http://mnt.to/l/4p9S
Researchers explore the genetic underpinnings of nerve-cell spacing
http://mnt.to/l/4p9G
Did eating bugs make our early ancestors more intelligent?
http://mnt.to/l/4pbN
Scientists map molecular olfactory signatures of foodstuffs
http://mnt.to/l/4p9s
Traditional approaches in managing ABI-associated behavior challenged
http://mnt.to/l/4p8N
New insights for coping with personality changes in acquired brain injury
http://mnt.to/l/4p8n
Neurotoxin tetrodotoxin found in terrestrial environment for first time
http://mnt.to/l/4p84
New pediatric concussion guidelines
http://mnt.to/l/4p7K
Those with episodic amnesia are not 'stuck in time,' says philosopher Carl Craver
http://mnt.to/l/4p7D
Progress made in understanding how the brain processes visual information
http://mnt.to/l/4p7w
Team explains how mutated X-linked mental retardation protein impairs neuron function
http://mnt.to/l/4p7g
How aging can intensify damage of spinal cord injury
http://mnt.to/l/4p7f
Brain regions sensitive to facial color processing
http://mnt.to/l/4p6T
Learning by repetition impairs recall of details
http://mnt.to/l/4p68
Statistical analysis could improve understanding and treatment of different brain tumours
http://mnt.to/l/4p5J
----------------------------------------------
** NUTRITION / DIET News **
Research shows almonds reduce the risk of heart disease
http://mnt.to/l/4pcv
Current IV feeding safeguards against bloodstream infections need to be revized
http://mnt.to/l/4p8G
Insights into the diet of Neanderthals provided by oldest human faecal matter
http://mnt.to/l/4p83
The best way to avoid ingredient-based food fear
http://mnt.to/l/4p7P
What are the health benefits of mushrooms?
http://mnt.to/l/4p8Z
American children 'consuming too many vitamins and minerals'
http://mnt.to/l/4p7S
Detailed insights into the structure of milk during digestion could help in weight loss, drug delivery, formulas for premature babies
http://mnt.to/l/4p5d
Study suggests that neanderthals ate more vegetables than previously thought
http://mnt.to/l/4p4x
----------------------------------------------
** OBESITY / WEIGHT LOSS / FITNESS News **
Children who can identify unhealthy food logos are more likely to be overweight
http://mnt.to/l/4pbG
Large-scale patient data analytics can help create personalized, early intervention for metabolic syndrome
http://mnt.to/l/4pbp
The influence of westernisation spells danger for public health in Nigeria
http://mnt.to/l/4pbc
App focused on making obese adults less sedentary
http://mnt.to/l/4p9K
Obesity, high blood pressure, high triglycerides, and diabetes increase future risk for chronic kidney disease
http://mnt.to/l/4p97
Eating extra fruit and vegetables is healthy but may not reduce weight
http://mnt.to/l/4p7H
Roux-en-Y gastric bypass surgery may reduce heart disease risk
http://mnt.to/l/4p7c
Sleep, mood improves after substantial weight loss
http://mnt.to/l/4p78
Study finds that for gastric bypass patients, percent of excess weight loss differs by race and ethnicity
http://mnt.to/l/4p6F
Research finds BMI measurement may be missing 25 percent of children who could be considered obese
http://mnt.to/l/4p6B
After weight loss surgery, bone loss persists for 2 years
http://mnt.to/l/4p6g
Cushing disease: A case of mistaken identity
http://mnt.to/l/4p67
----------------------------------------------
** PRIMARY CARE / GENERAL PRACTICE News **
Changing roles of physicians with MBAs
http://mnt.to/l/4p9T
Study urges improvement in physicians' inconsistent record of ordering lab tests
http://mnt.to/l/4p9p
Lack of residency positions leaves foreign-trained physicians frustrated
http://mnt.to/l/4p9m
Care gaps in outpatient settings targeted by e-surveillance program
http://mnt.to/l/4p8T
Researchers estimate 5.8 million A&E visits occur after patients unable to see a GP in England
http://mnt.to/l/4p8w
Half of quality improvement studies fail to change medical practices
http://mnt.to/l/4p86
----------------------------------------------
** PROSTATE / PROSTATE CANCER News **
New treatment for enlarged prostate successful in dogs
http://mnt.to/l/4p6b
The effectiveness of focal treatment for prostate cancer compared to radical therapies in the long-term
http://mnt.to/l/4p5x
----------------------------------------------
** SENIORS / AGING News **
Longevity in women likely indicated by reproduction later in life
http://mnt.to/l/4p7Q
Research explains action of drug that may slow aging, related disease
http://mnt.to/l/4p7C
Aging contributes to rapid rates of genomic change, signaling challenges for personalized medicine
http://mnt.to/l/4p7x
UK research exposes barriers to fitness and fun for older people with sight loss
http://mnt.to/l/4p7b
Local governments lack funds for age-friendly infrastructure
http://mnt.to/l/4p6v
Challenges for personalized medicine caused by rapid rates of genomic change during aging
http://mnt.to/l/4p65
----------------------------------------------
** SLEEP / SLEEP DISORDERS / INSOMNIA News **
Brain function when aging adversely affected by little or poor sleep
http://mnt.to/l/4p9v
No link discovered between insomnia symptoms and high blood pressure
http://mnt.to/l/4p7X
----------------------------------------------
** STATINS News **
Study finds those most likely to adhere to statin therapy
http://mnt.to/l/4p5b
----------------------------------------------
** STROKE News **
Minimizing stroke injury by blocking key enzyme
http://mnt.to/l/4p9n
New way discovered to prevent some strokes
http://mnt.to/l/4p8r
New approach to clinical trials could boost participation
http://mnt.to/l/4p89
One partner can suffer when couples disagree on stroke recovery
http://mnt.to/l/4p5F
----------------------------------------------
** WOMEN'S HEALTH / GYNECOLOGY News **
Are routine pelvic exams 'more harm than good' for healthy women?
http://mnt.to/l/4pcB
Countdown to 2015 and beyond: fulfilling the health agenda for women and children
http://mnt.to/l/4pb5
Young women with PCOS are five times more likely to develop type 2 diabetes
http://mnt.to/l/4p6y