HHAL MEDICAL NEWS OCTOBER 2013

Diabetes May Lead to More Breast, Colorectal Cancer

 (HealthDay News) – Having diabetes mellitus increases breast and colorectal cancer incidence and cancer-specific mortality, according to research presented at the 2013 European Cancer Congress, held from Sept. 27–Oct. 1 in Amsterdam.

Kirstin De Bruijn, from the Erasmus University Medical Center in the Netherlands, and colleagues conducted a literature review to identify studies that evaluated the relationship between diabetes mellitus and breast and colorectal cancer incidence and cancer-specific mortality.

Based on 20 studies (1,930,309 patients), the researchers found that there was an overall hazard ratio (HR) of 1.23 for breast cancer incidence and 1.26 for colorectal cancer incidence. The HRs for cancer-specific mortality for breast and colorectal cancer were 1.38 and 1.3, respectively. The studies showed no evidence of publication bias or heterogeneity.

"With the expected rise in numbers of obese and diabetes mellitus patients, awareness and prevention should be incremented," the authors write. "Otherwise, incidences and mortality rates of two of the most common cancers will only tend to increase."

http://eccamsterdam2013.ecco-org.eu/Global/News/ECC-2013-Press-Releases-EN/2013/09/Diabetes-increases-the-risk-of-developing-and-dying-from-breast-and-colon-cancer.aspx

Beat Arthritis with Broccoli

Cruciferous vegetables – such as broccoli, Brussels sprouts, and cabbage – are a rich source of sulforaphane, a compound for which previous studies suggest an anti-inflammatory effect.  Ian Clark, from the University of East Anglia (United Kingdom), and colleagues have shown that sulforaphane slows down the destruction of cartilage in joints associated with painful and often debilitating osteoarthritis. The researchers found that mice fed a diet rich in the compound had significantly less cartilage damage and osteoarthritis than those that were not.  The study also examined human cartilage cells and cow cartilage tissue, finding that sulforaphane blocks the enzymes that cause joint destruction by stopping a key molecule known to cause inflammation. Observing that: “A [sulforaphane]-rich diet decreases arthritis score in the [destabilisation of medial meniscus] murine model of osteoarthritis,” the study authors conclude that: “[Sulforaphane] inhibits the expression of key metalloproteinases implicated in osteoarthritis … and blocks inflammation at … to protect against cartilage destruction in vitro and in vivo.”

http://www.eurekalert.org/pub_releases/2013-08/uoea-bcb082213.php

Consuming Specific Whole Fruits Is Associated with Lower Risk for Type 2 Diabetes

Muraki I et al., BMJ 2013 Aug 29; 347:f5001

Blueberries, grapes or raisins, apples, and pears conferred the most benefit.

Whole fruits are an abundant source of fiber, antioxidants, and other phytochemicals that may help to promote overall health.  Qi Sun, from Harvard School of Public Health (Massachusetts, USA), and colleagues analyzed data collected on 66,105 women enrolled in the Nurses' Health Study, 85,104 from the Nurses' Health Study II, and 36,173 men from the Health Professionals Follow-up Study. Every 4 years, subjects were surveyed as to how often they ate various foods and on their diabetes status, among other measures. While all participants were free of major chronic diseases at baseline, 6.5% developed diabetes during follow-up. Adjusted hazard ratios pooled across the three studies for diabetes risk per three whole fruit servings per week were: 0.74 for blueberries; 0.88 for grapes and raisins; 0.93 for apples and pears. Cantaloupe elevated the diabetes risk by 10%; whereas the risk was neutral for peaches, plums, apricots, prunes, oranges, and strawberries. Interestingly, the researchers found that the same amount of fruit juice correlated with a significant 8% elevated risk of developing diabetes.  The study authors conclude that: “Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.”

http://www.medpagetoday.com/Endocrinology/Diabetes/41272

Berry and citrus phenolic compounds inhibit dipeptidyl peptidase iv: implications in diabetes management Full Text 
Evidence-based Complementary and Alternative Medicine , 08/31/2013 Review Article 

Fan J et al. – Beneficial health effects of fruits and vegetables in the diet have been attributed to their high flavonoid content. Dipeptidyl peptidase IV (DPP–IV) is a serine aminopeptidase that is a novel target for type 2 diabetes therapy due to its incretin hormone regulatory effects. The results indicate that flavonoids, particularly luteolin, apigenin, and flavone, and the stilbenoid resveratrol can act as naturally occurring DPP–IV inhibitors.

http://www.hindawi.com/journals/ecam/2013/479505/

Blueberries Boost Heart Health

Blueberries are an abundant source of flavonoids – antioxidant compounds that occur in plants.   Jeremy Spencer, from the University of Reading (United Kingdom), and colleagues conducted two double-blind crossover trials involving 21 healthy men. The first study assessed the effect of 4 different doses of blueberry flavonoids on flow mediated dilation (FMD) – a marker of blood vessel elasticity, at 5 different timepoints.  The team observed that FMD increased at 1-2 hours post-consumption, and again at 6 hours post-consumption.  The researchers then investigated the effects of 5 different doses of blueberry polyphenols between timepoint 0 and one hour later.  They observed a dose-dependent response for consumptions up to 766 total blueberry polyphenols, after which the response reached a plateau.  Positing that the increases in flow-mediated dilation observed decreased the activity of nicotinamide-adenine dinucleotide phosphate (NADPH) – an enzyme involved in the production of free radicals, the study authors submit that: “Blueberry intake acutely improves vascular function in healthy men in a time- and intake-dependent manner.”

http://www.nutraingredients-usa.com/Research/Compelling-data-RCT-shows-blueberry-flavonoids-boost-endothelial-function-and-heart-health/

Rich Breakfast Improves Glycemic Control in Diabetes

 (HealthDay News) – Adults with type 2 diabetes who eat a large low-calorie breakfast heavy in protein and fat have better glycemic control than those who eat a small low-calorie breakfast, according to a study presented at the annual meeting of the European Association for the Study of Diabetes, held from Sept. 23–27 in Barcelona, Spain.

Hadas Rabinovitz, MD, from the Hebrew University of Jerusalem in Rehovot, Israel, and colleagues assessed glycemic control and hormone profile in 59 adults with type 2 diabetes who were randomly assigned to balanced hypocaloric diabetic diets with either a big breakfast (33% of total daily energy intake, with a higher percentage of protein and fat) or a small breakfast (12.5 % of total daily energy intake).

After 13 weeks, the researchers found that the big breakfast group had significantly greater reductions in hemoglobin A1c, systolic blood pressure, and hunger scores, and greater improvements in fasting glucose. The big breakfast group also had reductions in diabetes medication doses in a significantly greater proportion of patients, while the small breakfast group had a significantly greater proportion of patients with dose increases.

"A simple dietary manipulation of [a] big breakfast diet rich in protein and fat appears to have additional benefits compared to a conventional low-calorie diet in individuals with type 2 diabetes," Rabinovitz and colleagues conclude.

Effects of vitamin D supplementation on glucose metabolism, lipid concentrations, inflammation, and oxidative stress in gestational diabetes: a double-blind randomized controlled clinical trial 
American Journal of Clinical Nutrition, 10/18/2013  Clinical Article

Asemi Z, et al. – This study was designed to assess the effects of vitamin D supplementation on metabolic profiles, high–sensitivity C–reactive protein, and biomarkers of oxidative stress in pregnant women with gestational diabetes mellitus (GDM). Vitamin D supplementation in pregnant women with GDM had beneficial effects on glycemia and total and LDL–cholesterol concentrations but did not affect inflammation and oxidative stress.

Methods

• This randomized, double-blind, placebo-controlled clinical trial was conducted in 54 women with GDM.
• Subjects were randomly assigned to receive either vitamin D supplements or placebo. Individuals in the vitamin D group (n = 27) received capsules containing 50,000 IU vitamin D₃ 2 times during the study (at baseline and at day 21 of the intervention) and those in the placebo group (n = 27) received 2 placebos at the same times.
• Fasting blood samples were collected at baseline and after 6 wk of the intervention to quantify relevant variables.

Results

• Cholecalciferol supplementation resulted in increased serum 25-hydroxyvitamin D concentrations compared with placebo (+18.5 ± 20.4 compared with +0.5 ± 6.1 ng/mL; P < 0.001).
• Furthermore, intake of vitamin D supplements led to a significant decrease in concentrations of fasting plasma glucose (-17.1 ± 14.8 compared with -0.9 ± 16.6 mg/dL; P < 0.001) and serum insulin (-3.08 ± 6.62 compared with +1.34 ± 6.51 μIU/mL; P = 0.01) and homeostasis model of assessment–insulin resistance (-1.28 ± 1.41 compared with +0.34 ± 1.79; P < 0.001) and a significant increase in the Quantitative Insulin Sensitivity Check Index (+0.03 ± 0.03 compared with -0.001 ± 0.02; P = 0.003) compared with placebo.
• A significant reduction in concentrations of total (-11.0 ± 23.5 compared with +9.5 ± 36.5 mg/dL; P = 0.01) and low-density lipoprotein (LDL) (-10.8 ± 22.4 compared with +10.4 ± 28.0 mg/dL; P = 0.003) cholesterol was also seen after vitamin D supplementation.

http://ajcn.nutrition.org/content/early/2013/10/14/ajcn.113.072785.abstract

Coffee and caffeine intake and incidence of type 2 diabetes mellitus: a meta-analysis of prospective studies 
European Journal of Nutrition, 10/24/2013 Evidence Based Medicine 

Jiang X, et al. – Coffee and caffeine have been linked to type 2 diabetes mellitus (T2DM). A dose–response meta–analysis of prospective studies was conducted to assess the association between coffee and caffeine intake and T2DM incidence. Coffee and caffeine intake might significantly reduce the incidence of T2DM.

Methods

• Pertinent studies were identified by a search of PubMed and EMBASE.
• The fixed- or random-effect pooled measure was selected based on between-study heterogeneity.
• Dose–response relationship was assessed by restricted cubic spline.

Results

• Compared with the lowest level, the pooled relative risk (95 % CI) of T2DM was 0.71 (0.67–0.76) for the highest level of coffee intake (26 articles involving 50,595 T2DM cases and 1,096,647 participants), 0.79 (0.69–0.91) for the highest level of decaffeinated coffee intake (10 articles involving 29,165 T2DM cases and 491,485 participants) and 0.70 (0.65–0.75) for the highest level of caffeine intake (6 articles involving 9,302 T2DM cases and 321,960 participants).
• The association of coffee, decaffeinated coffee and caffeine intake with T2DM incidence was stronger for women than that for men.
• A stronger association of coffee intake with T2DM incidence was found for non-smokers and subjects with body mass index <25 kg/m².
• Dose–response analysis suggested that incidence of T2DM decreased by 12 % [0.88 (0.86–0.90)] for every 2 cups/day increment in coffee intake, 11 % [0.89 (0.82–0.98)] for every 2 cups/day increment in decaffeinated coffee intake and 14 % [0.86 (0.82–0.91)] for every 200 mg/day increment in caffeine intake.

http://link.springer.com/article/10.1007%2Fs00394-013-0603-x

Coffee and tea: Perks for health and longevity 
Current Opinion in Clinical Nutrition & Metabolic Care, 10/21/2013 Review Article 

Bhatti SK, et al. – Tea and coffee, after water, are the most commonly consumed beverages in the world and are the top sources of caffeine and antioxidant polyphenols in the American diet. The purpose of this review is to assess the health effects of chronic tea and/or coffee consumption. Coffee and tea can generally be recommended as health–promoting additions to an adult diet. Adequate dietary calcium intake may be particularly important for tea and coffee drinkers.

• Tea consumption, especially green tea, is associated with significantly reduced risks for stroke, diabetes and depression, and improved levels of glucose, cholesterol, abdominal obesity and blood pressure.
• Habitual coffee consumption in large epidemiological studies is associated with reduced mortality, both for all-cause and cardiovascular deaths.
• In addition, coffee intake is associated with risks of heart failure, stroke, diabetes mellitus and some cancers in an inverse dose-dependent fashion.
• Surprisingly, coffee is associated with neutral to reduced risks for both atrial and ventricular arrhythmias.
• However, caffeine at high doses can increase anxiety, insomnia, calcium loss and possibly the risk of fractures.

http://journals.lww.com/co-clinicalnutrition/Abstract/2013/11000/Coffee_and_tea___perks_for_health_and_longevity_.14.aspx

Cholesterol Drug May Slow Human Aging

Telomeres are the end caps of chromosomes, protecting the DNA complexes from deterioration during cell division. Telomere shortening is considered a marker of cellular aging, and prematurely shortened telomeres have been linked to increased risk of cancers, heart disease, dementia and death.  Giuseppe Paolisso, from the University of Naples (Italy), and colleagues worked with two groups of subjects. The first group was under chronic statin therapy, and the second group (control), did not use statins. When researchers measured telomerase activity in both groups, those undergoing statin treatment had higher telomerase activity in their white blood cells, which was associated with lower telomeres shortening along with aging as compared to the control group.  Writing that:  “statins, modulating telomerase activity, affect telomere erosion along with aging,” the lead researcher observes that: "By telomerase activation, statins may represent a new molecular switch able to slow down senescent cells in our tissues and be able to lead healthy lifespan extension."

http://www.eurekalert.org/pub_releases/2013-08/foas-sms082913.php

Commonly Prescribed Statin Linked to Memory Impairment

Research suggests that the commonly prescribed statin pravastatin may adversely affect cognitive function. Neil Marrion, Professor of Neuroscience at the University of Bristol's School of Physiology and Pharmacology, United Kingdom, and colleagues studied the effect of the commonly prescribed statins pravastatin and atorvostatin on learning and memory in rats. Results showed that pravastatin significantly impaired performance in simple learning and memory tasks, although the effect was fully reversible once treatment ended. No adverse cognitive effects were observed in rats treated with atorvastatin. The authors concluded: “Overall, these findings support clinical observations that statins have adverse cognitive effects in certain patients undergoing long-term treatment… All statins have been reported to potentially affect cognition and the whole class carry an FDA warning. Our data suggest that more detailed, pre-clinical studies to investigate different types of statins and cognitive function, including a wider range of doses of the drugs tested here, would be useful in determining the mechanisms involved and relative risks associated with different statin treatments.”

http://www.eurekalert.org/pub_releases/2013-09/uob-sfl092513.php

Statins and Cognition: A Systematic Review and Meta-analysis of Short- and Long-term Cognitive Effects

Abstract 

Objective

To evaluate the effect of statins on short-term cognitive function and the long-term incidence of dementia.

Patients and Methods

A systematic search was performed of MEDLINE, EMBASE, and the Cochrane Central Register from their inception to April 25, 2013. Adults with no history of cognitive dysfunction treated with statins were included from high-quality randomized controlled trials and prospective cohort studies after formal bias assessment.

Results

Sixteen studies were included in qualitative synthesis and 11 in quantitative synthesis. Short-term trials did not show a consistent effect of statin therapy on cognitive end points. Digit Symbol Substitution Testing (a well-validated measure of cognitive function) was the most common short-term end point, with no significant differences in the mean change from baseline to follow-up between the statin and placebo groups (mean change, 1.65; 95% CI, –0.03 to 3.32; 296 total exposures in 3 trials). Long-term cognition studies included 23,443 patients with a mean exposure duration of 3 to 24.9 years. Three studies found no association between statin use and incident dementia, and 5 found a favorable effect. Pooled results revealed a 29% reduction in incident dementia in statin-treated patients (hazard ratio, 0.71; 95% CI, 0.61-0.82).

Conclusion

In patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia.

http://www.mayoclinicproceedings.org/article/S0025-6196(13)00613-7/abstract?rss=yes

High-Dose Statins Reduce Periodontal Inflammation, Pointing to a Novel Effect

Patients with cardiovascular disease (or at high risk for it) who take high-dose statins show a lessening of gum and carotid inflammation, according to a study in the Journal of American College of Cardiology.

In the study, partially conducted by a statin maker, roughly 80 patients were randomized to 12 weeks' treatment with 80 or 10 mg of atorvastatin daily. Sixty underwent PET scans of the periodontal region and the carotid arteries to assess inflammation at baseline and at 4 and 12 weeks.

At 12 weeks, those in the 80-mg group showed a reduction in gum inflammation, which also correlated with carotid inflammatory measurements.

The authors call the observed reduction in non-arterial inflammation a cholesterol-independent or "pleiotropic" effect of statins. Editorialists offer a useful review of statin's mechanisms; they consider the work hypothesis-generating and comment that the clinical significance of the changes on PET scan "is entirely unknown."

JACC article

Effects of chocolate on cognitive function and mood: a systematic review 
Scholey A et al. – A systematic review was conducted to evaluate whether chocolate or its constituents were capable of influencing cognitive function and/or mood.

• Studies investigating potentially psychoactive fractions of chocolate were also included.
• Eight studies (in six articles) met the inclusion criteria for assessment of chocolate or its components on mood, of which five showed either an improvement in mood state or an attenuation of negative mood.
• Regarding cognitive function, eight studies (in six articles) met the criteria for inclusion, of which three revealed clear evidence of cognitive enhancement (following cocoa flavanols and methylxanthine).
• Two studies failed to demonstrate behavioral benefits but did identify significant alterations in brain activation patterns.
• It is unclear whether the effects of chocolate on mood are due to the orosensory characteristics of chocolate or to the pharmacological actions of chocolate constituents.
• Two studies have reported acute cognitive effects of supplementation with cocoa polyphenols.
• Further exploration of the effect of chocolate on cognitive facilitation is recommended, along with substantiation of functional brain changes associated with the components of cocoa.

http://www.ncbi.nlm.nih.gov/pubmed/24117885

Mulberry Compound May Modulate Blood Sugar

A staple remedy of folk medicine, mulberry leaf extract is found to contain the compound 1-deoxynojirimycin (DNJ) – found to inhibit the activity of the enzyme involved in carbohydrate digestion.  Hye In Chung, from Ewha Womans University (South Korea), and colleagues  enrolled 50 healthy men and women, each of whom was randomly assigned to one of five groups: four groups received a maltose powder drink containing 0, 1.25, 2.5, or 5 grams of mulberry leaf extract; the fifth group drank a beverage with 5 grams of the extract 30 minutes before consuming the maltose solution.  The team observed that  both the 2.5 and 5 gram mulberry doses lowered glucose levels. .No difference between pre- and simultaneous ingestion of mulberry extract and maltose was detected.  The study authors submit that: “The ingestion of [mulberry leaf extract] resulted in improved postprandial glycemic control in healthy subjects.”

http://www.nutraingredients-usa.com/Research/Mulberry-leaf-extract-shows-blood-sugar-management-potential-Human-data/

High-Fat, High-Calorie Diet Linked to Pancreatic Cancer

Researchers have found a link between cancer of the pancreas, one of the most deadly forms of cancer, and eating a high-fat, high-calorie diet. Dr. Guido Eibl, a member of the Jonsson Cancer Center and a professor in the department of surgery at the David Geffen School of Medicine at UCLA, and colleagues investigated the effects of diet-induced obesity on mice that have the same genetic mutation as that found in humans with the disease. Results showed that mice fed a diet high in fats and calories gained significantly more weight, had metabolic abnormalities, elevated insulin levels, displayed significant pancreas tissue inflammation, and developed pancreas intraepithelial neoplasias – known precursors to cancer. "The development of these lesions in mice is very similar to what happens in humans," said Professor Eibl. "These lesions take a long time to develop into cancer, so there is enough time for cancer-preventive strategies, such as changing to a lower-fat, lower-calorie diet, to have a positive effect."

UCLA study finds link between high-fat, high-calorie diet and pancreas cancer

Omega-3 s May Reduce Biological Age

Telomeres are the end caps of chromosomes, protecting the DNA complexes from deterioration during cell division. Telomere shortening is considered a marker of cellular aging, and prematurely shortened telomeres have been linked to increased risk of cancers, heart disease, dementia and death. Nathan O’Callaghan, from the Commonwealth Scientific and Industrial Research Organisation (CSIRO; Australia), and colleagues enrolled 33 men and women, ages 65 years and older, with mild cognitive impairment, assigning each to one of 3 groups: the first group received EPA (eicopentaenoic acid) omega-3 supplements (1.67 grams EPA & 16 g DHA.day), the second group received docosahexaenoic acid (DHA) omega-3 supplements (1.55 g DHA & 0.40 g EPA/day), and the third group received omega-6 linoleic acid (2.2 g/day) for six months. The team observed

that DHA reduced the shortening of telomeres, while omega-6 exerted the greatest shortening of telomere length. The study authors conclude that: “Telomeric shortening may be attenuated by [omega-3 polyunsaturated fatty acid] supplementation.”

http://www.nutraingredients-usa.com/Research/Omega-3-supplements-linked-to-younger-biological-age-in-older-people/

Resveratrol Effective Against Cancer After Metabolism

Resveratrol, a polyphenol found in red wine, is known to have anticancer properties; however, scientists had thought that it was metabolized so quickly by the body that it would be ineffective in clinical trials. Nevertheless, researchers at the University of Leicester's Department of Cancer Studies and Molecular Medicine in the United Kingdom have found that this is not the case. Professor Karen Brown and colleagues found that resveratrol can still be taken into cells after it has been metabolised into resveratrol sulfates. Once in the cell, enzymes then break down the sulfate metabolite, converting it back to resveratrol again. In fact, the results appeared to show that resveratrol may be more effective once it has been generated from resveratrol sulfate because the cellular concentrations achieved are higher. Encouragingly, the study also showed that resveratrol generated from resveratrol sulfate is able to slow the growth of cancer cells by causing them to digest their own internal constituents and stopping them from dividing. "Our study was the first to show that resveratrol can be regenerated from sulfate metabolites in cells and that this resveratrol can then have biological activity that could be useful in a wide variety of diseases in humans,” said Professor Brown. "Importantly, we did all our work with clinically achievable concentrations so we are hopeful that our findings will translate to humans.

http://www.eurekalert.org/pub_releases/2013-10/uol-rwc100213.php

Exercise May Be As Effective As Drugs for Some Conditions

Exercise May Be As Effective As Drugs for Some Conditions

(HealthDay News) – Exercise and drug interventions may be similar regarding their effect on mortality in the secondary prevention of coronary heart disease, stroke rehabilitation, and prevention of diabetes, according to research published online Oct. 1 in BMJ.

Huseyin Naci, of the London School of Economics and Political Science, and John P.A. Ioannidis, MD, of Stanford University in California, conducted a metaepidemiological study using meta-analyses (four for exercise and 12 for drug therapy) of randomized, controlled trials to examine the comparative effectiveness of exercise vs. drug therapy on mortality outcomes for four common medical conditions.

The researchers found no difference in outcomes for exercise vs. drug interventions for the secondary prevention of coronary heart disease and prediabetes. For stroke rehabilitation, exercise was more effective than drug treatments, including anticoagulants (odds ratio [OR], 0.09) and antiplatelets (OR, 0.1). Exercise was less effective than diuretics for heart failure outcomes (OR, 4.11).

"This comprehensive look at the existing body of evidence highlights the need to perform randomized trials on the comparative effectiveness of exercise and drug interventions," the authors write.

http://www.bmj.com/content/347/bmj.f5577

AHA: Treat Unhealthy Habits as Aggressively as High Cholesterol, Blood Pressure

Healthcare providers should treat unhealthy behaviors such as smoking, poor diet, and lack of exercise as aggressively as they treat high cholesterol, hypertension, and other markers of heart disease, according to a science advisory from the American Heart Association.

The advisory, published in Circulation, urges clinicians to provide the "5 A's" intervention to patients at low-to-moderate cardiovascular risk:

·         Assess a patient's risk behaviors.

·         Advise change.

·         Agree on an action plan.

·         Assist with treatment.

·         Arrange for follow-up care.

For patients at moderate-to-high risk, an interprofessional healthcare team (including the primary care provider and specialists such as dietitians and psychologists) must work together to provide intensive lifestyle intervention.

Circulation article (Free PDF)

Low Testosterone Increases Heart Disease Risk

Men with low testosterone levels may have a slightly increased risk of developing or dying from heart disease, say a group of European researchers who examined findings from studies on cardiovascular disease and testosterone published between 1970 and 2013. Whilst the studies suggested some sort of relationship, existing research found little evidence of a connection between low testosterone and artherosclerosis, and no relationship between testosterone levels and heart attacks. "When we reviewed the existing research into testosterone and cardiovascular disease, a growing body of evidence suggested a modest connection between the two. A specific pathogenesis did not come forward, but perhaps less frequently investigated events may play a role, such as thrombosis where a blood clot develops in the circulatory system or arrhythmia, where there is a problem with the heart beat or rate," said the study's lead author, Johannes Ruige, MD, PhD, of Ghent University Hospital in Belgium. "Gaps still remain in our understanding of low testosterone and cardiovascular disease. Ultimately, the goal is to more accurately assess the impact testosterone substitution therapy may have on the heart health of men who qualify for the treatment."

http://www.eurekalert.org/pub_releases/2013-09/tes-ltm092013.php

Positive Lifestyle Changes May Lengthen Telomeres

Eating a healthy diet, taking regular exercise, stress management, and having a good social life have long been known to promote healthy aging. However, for the first time researchers have found that making positive lifestyle changes can actually lengthen telomeres – the protective caps on the ends of chromosomes that affect how quickly cells age. Dean Ornish, MD, UCSF clinical professor of medicine, and colleagues studied 35 men with localized, early-stage prostate cancer to determine if lifestyle changes had any impact upon telomere length. Ten of the patients were asked to make lifestyle changes that included: a plant-based diet, moderate exercise (walking 30-minutes a day, 6-days a week); stress reduction (yoga-based stretching, breathing, and meditation). The other 25 study participants were not asked to make any major lifestyle changes. Results showed that the group that made the lifestyle changes experienced a significant increase in telomere length of approximately 10%. Furthermore, the more participants changed their behavior by adhering to the recommended lifestyle program, the more dramatic were their improvements in telomere length. On the other hand, the men in the control group had shorter telomeres (approximately 3% shorter) by the end of the 5-year-long study. “Our genes, and our telomeres, are not necessarily our fate,” said Professor Ornish. “These findings indicate that telomeres may lengthen to the degree that people change how they live. Research indicates that longer telomeres are associated with fewer illnesses and longer life.” Shortened telomeres have been linked with a variety of age-related diseases, including cancer, stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis and diabetes.

http://www.medicalnewstoday.com/articles/266168.php

Vitamin B Supplements May Reduce Stroke Risk

Research suggests that taking vitamin B supplements may help reduce the risk of stroke. Xu Yuming, of Zhengzhou University in Zhengzhou, China and colleagues analyzed 14 randomized clinical trials with a total of 54,913 participants. All of the studies compared B vitamin use with a placebo or a very low-dose B vitamin for a minimum of 6-months. Results showed that taking supplementary vitamin B lowered the overall risk of stroke by 7%. However, taking supplementary vitamin B did not appear to affect the severity of strokes or the risk of death from stroke. The authors concluded that vitamin B supplementation significantly reduces stroke risk by lowering levels of the harmful amino acid homocysteine.

http://www.eurekalert.org/pub_releases/2013-09/aaon-cvb091113.php

NHANES Data Show Cardiometabolic Benefits of Dietary Fiber, But Low U.S. Intake

Higher amounts of dietary fiber are associated with lower cardiometabolic risks, but Americans fall well below recommended intakes, an American Journal of Medicine study finds.

In a cross-sectional study, researchers used U.S. National Health and Nutrition Examination Survey data collected over a 12-year period to examine trends in the nation's fiber intake and to compare that with risk levels for metabolic syndrome, obesity, and cardiovascular inflammation as measured by C-reactive protein.

Daily fiber intake recommendations fall between 20 and 40 grams depending on age and sex, but averaged about 16 g overall in the participants. Levels increased by about a gram over the survey period. People in the highest quintile of consumption (more than 22.5 g) showed lower risks for cardiovascular inflammation than those in the lowest quintile (less than 8.1 g). Lower risks for obesity and metabolic syndrome, however, were noted only in white subjects.

American Journal of Medicine article

Brisk, Albeit Brief, Activity Beneficially Affects Weight

The current physical activity guideline for Americans is to get at least 150 minutes of moderate to vigorous physical activity, a week, which can be accumulated in eight to 10 minute periods. Jessie X. Fan, from the University of Utah (Utah, USA), and colleagues enrolled 2,202 women and 2,309 men, ages 18 to 64 years, who were free of impairments that otherwise compromise the ability tp walk, from the National Health and Nutrition Examination Survey (NHANES).  From 2003 to 2006, participants in the survey wore accelerometers for seven days, which captured data on their physical activity.  Researchers compared measurements of physical activity based on length of time and intensity. The study used body mass index (BMI), to measure weight status. A BMI between 18.5 and 24.9 is considered normal weight, whereas a BMI between 25 and 29.9 is overweight; and over 30 is obese.  Results show that for women, each daily minute spent in higher-intensity short bouts was related to a decrease of .07 BMI. In other words, each such minute offset the calorie equivalent of .41 pounds. This means that when comparing two women each 5-feet-5-inches tall, the woman who regularly adds a minute of brisk activity to her day will weigh nearly a half-pound less. Results were similar for men. Importantly for both, each daily minute of higher-intensity activity lowered the odds of obesity -- 5% for women, and 2% for men. The study authors conclude that: “Our findings showed that for weight gain prevention, accumulated higher-intensity [physical activity] bouts of [less than] 10 minutes are highly beneficial, supporting the public health promotion message that ‘every minute counts.’”

http://www.eurekalert.org/pub_releases/2013-09/uou-mia082613.php

Tiotropium Respimat Inhaler and the Risk of Death in COPD

Tiotropium delivered at a dose of 5 μg with the Respimat inhaler showed efficacy similar to that of 18 μg of tiotropium delivered with the HandiHaler inhalation device in placebo-controlled trials involving patients with chronic obstructive pulmonary disease (COPD). Although tiotropium HandiHaler was associated with reduced mortality, as compared with placebo, more deaths were reported with tiotropium Respimat than with placebo.

RESULTS

During a mean follow-up of 2.3 years, Respimat was noninferior to HandiHaler with respect to the risk of death (Respimat at a dose of 5 μg vs. HandiHaler: hazard ratio, 0.96; 95% confidence interval [CI], 0.84 to 1.09; Respimat at a dose of 2.5 μg vs. HandiHaler: hazard ratio, 1.00; 95% CI, 0.87 to 1.14) and not superior to HandiHaler with respect to the risk of the first exacerbation (Respimat at a dose of 5 μg vs. HandiHaler: hazard ratio, 0.98; 95% CI, 0.93 to 1.03). Causes of death and incidences of major cardiovascular adverse events were similar in the three groups.

CONCLUSIONS

Tiotropium Respimat at a dose of 5 μg or 2.5 μg had a safety profile and exacerbation efficacy similar to those of tiotropium HandiHaler at a dose of 18 μg in patients with COPD. (Funded by Boehringer Ingelheim; TIOSPIR ClinicalTrials.gov number,

http://www.nejm.org/doi/full/10.1056/NEJMoa1303342?query=TOC#t=articleTop

More Information on the Diabetes Drug Canagliflozin

Schernthaner G et al., Diabetes Care 2013 Sep 36:2508

Glycosylated hemoglobin is lowered by about 1%; genital fungal infections are a common side effect.

SSRIs After Stroke: Should They Be Used Routinely?

Mead GE et al., JAMA 2013 Sep 11; 310:1066

This meta-analysis suggests that these antidepressants improve outcomes, even in nondepressed patients.

Role of sirtuins in lifespan regulation is linked to methylation of nicotinamide.

Schmeisser K, Mansfeld J, Kuhlow D, Weimer S, Priebe S, Heiland I, Birringer M, Groth M, Segref A, Kanfi Y, Price NL, Schmeisser S, Schuster S, Pfeiffer AF,Guthke R, Platzer M, Hoppe T, Cohen HY, Zarse K, Sinclair DA, Ristow M.

Source

1] Department of Human Nutrition, Institute of Nutrition, University of Jena, Jena, Germany. [2].

Abstract

Sirtuins, a family of histone deacetylases, have a fiercely debated role in regulating lifespan. In contrast with recent observations, here we find that overexpression of sir-2.1, the ortholog of mammalian SirT1, does extend Caenorhabditis elegans lifespan. Sirtuins mandatorily convert NAD(+) into nicotinamide (NAM). We here find that NAM and its metabolite, 1-methylnicotinamide (MNA), extend C. elegans lifespan, even in the absence of sir-2.1. We identify a previously unknown C. elegans nicotinamide-N-methyltransferase, encoded by a gene now named anmt-1, to generate MNA from NAM. Disruption and overexpression of anmt-1 have opposing effects on lifespan independent of sirtuins, with loss of anmt-1 fully inhibiting sir-2.1-mediated lifespan extension. MNA serves as a substrate for a newly identified aldehyde oxidase, GAD-3, to generate hydrogen peroxide, which acts as a mitohormetic reactive oxygen species signal to promote C. elegans longevity. Taken together, sirtuin-mediated lifespan extension depends on methylation of NAM, providing an unexpected mechanistic role for sirtuins beyond histone deacetylation.

http://www.ncbi.nlm.nih.gov/pubmed/24077178

Which Fruits and Vegetables Reduce Bladder Cancer Risk?

Which Fruits and Vegetables Reduce Bladder Cancer Risk?

High consumption of fruits and vegetables had a protective effect against bladder cancer in Latino men, but not in men of other ethnic groups.

Neither smoking status nor ethnicity influenced the protective effects of diet in women.

The authors could not explain why a diet high in fruits and vegetables would reduce bladder cancer risk in women but not in men, but speculated that male current smokers may have benefited more than other males because smokers have been shown to have lower levels of antioxidants.

Smoking is the primary risk factor for bladder cancer and accounts for approximately 50% of cases of the disease in both men and women.²

References

1. Park S-Y, Ollberding NJ, Woolcott CG, et al. Fruit and vegetable intakes are associated with lower risk of bladder cancer among women in the multiethnic cohort study. J Nutr. 2013;143:1283–1292.

2. Freedman ND,  Silverman DT, Hollenbeck AR, et al. Association between smoking and risk of bladder cancer among men and women. JAMA. 2011;306(7):737-4

Meta-Analysis Finds ACE Inhibitors Superior in Patients with Diabetes

Angiotensin-converting-enzyme (ACE) inhibitors are the antihypertensive treatment of choice in adults with diabetes, according to a BMJ meta-analysis.

Researchers examined nearly 70 randomized trials evaluating 11 antihypertensive regimens in roughly 37,000 adults with diabetes. Outcomes included all-cause mortality, end-stage renal disease, and doubling of serum creatinine.

Among the findings:

·         Combination therapy with ACE inhibitors plus calcium-channel blockers appeared most likely to reduce all-cause mortality; beta-blockers showed a significant increase in mortality.

·         Only ACE inhibitors significantly prevented the doubling of serum creatinine, compared with placebo.

·         Outcomes did not differ significantly between ACE inhibitors and angiotensin-receptor blockers, but ACE inhibitors "consistently showed higher probabilities of being at the superior ranking positions among all outcomes," the authors write.

The authors conclude that ACE inhibitors should be first-line antihypertensive therapy in adults with diabetes, noting that calcium-channel blockers might be added when blood pressure cannot be controlled with ACE inhibitors alone.

BMJ article

Can Vitamin D Help Reduce Risk of Type 2 Diabetes?

Recruitment for the first large-scale clinical trial has begun to determine if a vitamin D3 supplement(cholecalciferol) helps prevent or delay type 2 diabetes in adults who have prediabetes.

RELATED: More on Endocrine Disorders

The multiyear Vitamin D and Type 2 Diabetes (D2d) study will enroll about 2,500 patients across 20 study sites. The study's aim is to learn if 4,000 IU vitamin D will prevent or delay type 2 diabetes in adults >30 years old with prediabetes. 

This dose is greater than the typical adult intake of 600–800 IU/day, but has been deemed appropriate for clinical research by the Institute of Medicine.

“Past observational studies have suggested that higher levels of vitamin D may be beneficial in preventing type 2 diabetes, but until this large, randomized and controlled clinical trial is complete, we won't know if taking vitamin D supplements lowers the risk of diabetes,” said Anastassios G. Pittas, MD, the study's principal investigator at Tufts Medical Center, Boston, MA.

Study researchers hypothesize that vitamin D can reduce the risk of diabetes risk by 25%. The double-blind study will also assess if sex, age or race affect the potential of vitamin D in reducing the risk of diabetes. Patients will be randomized to receive vitamin D or placebo. 

Check-ups for the study will occur twice a year, and patients will receive regular health care through their own health care providers. The study will continue until enough people have developed type 2 diabetes to be able to make scientifically valid comparison between the two groups–likely to be about four years.

http://www.empr.com/can-vitamin-d-help-reduce-risk-of-type-2-diabetes/article/317190/?DCMP=EMC-miscellaneous&CPN=brilpcp,invoka,emp_niacho,bisglt,breo_ellipta,lovap&spMailingID=7231971&spUserID=MzI0NDY5MDgwODUS1&spJobID=94503482&spReportId=OTQ1MDM0ODIS1

Severe Vit D Deficiency Linked to RA Presence in Early Inflammatory Arthritis

SAN DIEGO, CA—Vitamin D deficiency contributed to the presence of rheumatoid arthritis (RA) in patients with early inflammatory arthritis (EIA), researchers presented at the 2013 ACR/ARHP Annual Meeting.

Seung-Geun Lee, Department of Internal Medicine, Pusan National University Hospital, South Korea, and study authors investigated the status of vitamin D in patients with EIA (>1 swollen joint, symptom duration of <6 months, not explained by another disease) compared with healthy controls. A total of 101 patients with EIA and 101 healthy controls were included at a rheumatology center in South Korea from March 2012–February 2013. Patients with EIA had a mean baseline serum (OH) vitamin D level of 14.2ng/mL (range 5.5–67.9) and the healthy control group had a mean baseline serum (OH) vitamin D level of 16.3 (range 4.6–23.3).

Serum 25(OH) vitamin D levels were assessed by radioimmunoassay. EIA patients were subdivided into RA (n=38) and non-RA (n=63) as defined by the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria.

Study results showed there was no significant difference observed in serum 25(OH) vitamin D levels between EIA and control cohorts (median 14.2 vs. 16.3, P=0.229). In subgroup analyses, patients with RA had significantly higher swollen joint count (SJC), tender joint count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anti-citrullinated protein antibody (ACPA) and lower serum 25(OH) vitamin D levels than in non-RA patients.

Serum 25(OH) vitamin D levels in EIA patients were inversely correlated with the titer of ACPA (P=-0.214, P=0.031), SJC (P=-0.196, P=0.049) and patient's visual analogue scale (P=-0.202,P=0.043), researchers concluded.

Overall, severe vitamin D deficiency (<10ng/mL) was significantly associated with the diagnosis of RA (OR=3.259, 95% CI 1.137–9.342; P=0.028). “The serum vitamin D levels in patients with EIA were similar but the deficiency contributed to the presence of RA in this patient group,” concluded Dr. Lee.

http://www.empr.com/severe-vit-d-deficiency-linked-to-ra-presence-in-early-inflammatory-arthritis/article/318217/?DCMP=EMC-MPR_ACR2013&cpn=emp_niacho&spMailingID=7263016&spUserID=MjMzMjIyNjYwMQS2&spJobID=95235870&spReportId=OTUyMzU4NzAS1

Diet, Exercise, or Both for Knee Osteoarthritis?

Messier SP et al., JAMA 2013 Sep 25; 310:1263

Diet and exercise together best achieve physiological and functional improvements.

FDA Approves Addition to Cialis Labeling

Eli Lilly announced that the FDA has approved an addition to the Cialis (tadalafil) label to include data from a 26-week study that showed Cialis 5mg once daily started in combination with finasteride significantly improved the signs and symptoms ofbenign prostatic hyperplasia (BPH) as early as 4 weeks.

New Tool for Dementia Evaluation Approved by FDA

The FDA has approved Vizamyl (flutemetamol F 18; GE Healthcare) injection, for use with positron emission tomography (PET) imaging of the brain in adults being evaluated for Alzheimer's disease anddementia. Vizamyl is currently the only PET imaging tracer available that provides brain scans in color rather than in black and white.

RELATED: Neurologic Disorders Resource Center

Vizamyl is a radioactive diagnostic agent that works by attaching to beta amyloid and producing a PET image of the brain that is used to evaluate the presence of beta amyloid. 

A negative scan indicates there is little or no beta amyloid accumulation in the brain and the cause of the dementia is probably not due to Alzheimer's disease. A positive scan indicates there is probably a moderate or greater amount of amyloid in the brain. 

However, this does not establish a diagnosis of Alzheimer's disease or other dementia. While the approval of Vizamyl provides another tool for physicians to evaluate patients with cognitive decline, it does not replace other diagnostic tests used in evaluating Alzheimer's disease and dementia.

The effectiveness of Vizamyl was established in two studies comprised of 384 participants with a range of cognitive function. All participants were injected with Vizamyl and were scanned. Five independent readers then interpreted the images.  

The results demonstrated that Vizamyl correctly detected beta amyloid in the brain, and that the scans were reproducible where trained readers could accurately interpret the scans.

Vizamyl is the second brain imaging drug approved by the FDA to evaluate patients for Alzheimer's disease and dementia. In 2012, the FDA approved Amyvid (florbetapir F 18; Eli Lilly) injection to aid in the evaluation of adults for Alzheimer's disease and other causes of cognitive decline.

Vizamyl will be commercially available in 2014.

http://www.empr.com/new-tool-for-dementia-evaluation-approved-by-fda/article/318038/?DCMP=EMC-MPR_WeeklyNewsbrief&CPN=brilpcp&spMailingID=7258589&spUserID=MjMzMjIyNjYwMQS2&spJobID=95162366&spReportId=OTUxNjIzNjYS1

AHA Updates Statement on Secondary Prevention of Atherosclerotic Disease in Older Adults

The American Heart Association has issued an updated scientific statement on the secondary prevention of atherosclerotic cardiovascular disease in adults aged 65 and older, with an emphasis on those older than 75.

Published in Circulation, the statement reviews the benefits and risks of lifestyle interventions and pharmacotherapy for cardiovascular disease in older adults. Of particular use may be a table listing the recommended first-line antihypertensive agents for patients on the basis of their comorbidities. Another table reviews the common iatrogenic effects of secondary prevention drugs in the elderly.

Psychosocial issues such as depression and anxiety are addressed, as is cardiac rehabilitation.

Harlan Krumholz, a cardiologist with NEJM Journal Watch, said, "The review highlights the paucity of strong evidence available to guide practice in older individuals. Our approach must acknowledge the uncertainty and work to ensure the strategies are in alignment with patients' preferences, values and goals."

Scientific statement in Circulation

Screening by Ankle–Brachial Index for Peripheral Artery or Cardiovascular Disease

 Lin JS et al., Ann Intern Med 2013 Sep 3; 159:333

The U.S. Preventive Services Task Force concludes that evidence is insufficient to recommend for or against screening.

Endoscopic vs. Surgical Drainage of Pancreatic Pseudocysts

Varadarajulu S et al., Gastroenterology 2013 Sep 145:583

The endoscopic approach was as effective as surgery.

Drug for weight loss lowers type 2 diabetes risk in obese patients
Overweight and obese patients who took the weight-loss drug Qsymia, which combines phentermine and topiramate extended release, were 70.5% to 78.7% less likely than those in the placebo group to develop type 2 diabetes, a study found. Patients in the Qsymia arm also showed greater weight loss at 108 weeks compared with the controls, researchers wrote in Diabetes Care. MedPage Today

Plant Sterols the Better Cholesterol in Alzheimer's Disease? A Mechanistical Study

Amyloid-β (Aβ), major constituent of senile plaques in Alzheimer's disease (AD), is generated by proteolytic processing of the amyloid precursor protein (APP) by β- and γ-secretase. Several lipids, especially cholesterol, are associated with AD. Phytosterols are naturally occurring cholesterol plant equivalents, recently been shown to cross the blood–brain-barrier accumulating in brain. Here, we investigated the effect of the most nutritional prevalent phytosterols and cholesterol on APP processing. In general, phytosterols are less amyloidogenic than cholesterol. However, only one phytosterol, stigmasterol, reduced Aβ generation by (1) directly decreasing β-secretase activity, (2) reducing expression of all γ-secretase components, (3) reducing cholesterol and presenilin distribution in lipid rafts implicated in amyloidogenic APP cleavage, and by (4) decreasing BACE1 internalization to endosomal compartments, involved in APP β-secretase cleavage. Mice fed with stigmasterol-enriched diets confirmed protective effects in vivo, suggesting that dietary intake of phytosterol blends mainly containing stigmasterol might be beneficial in preventing AD.

http://www.jneurosci.org/content/33/41/16072.abstract

New Oral Anticoagulants and the Risk of Intracranial Hemorrhage

This meta-analysis reports a reduction in intracranial hemorrhage with use of newer oral anticoagulants compared  to warfarin in patients with atrial fibrillation.

http://app.jamanetwork.com/#page=issuesContainer

Intravenous vs. Oral Iron in Patients with Anemia

Litton E et al., BMJ 2013 Aug 15; 347:f4822

Compared with oral iron, IV iron led to higher hemoglobin levels and lowered the need for red-cell transfusion.

Imported Spices Commonly Tainted with Salmonella, Filth

Salmonella was present in 6.6% of imported spice shipments to the U.S. from 2007 to 2009, according to an FDA report. This prevalence was nearly twice the average for other FDA-regulated foods.

The agency isolated more than 80 different Salmonella serotypes from contaminated spice imports — 6.8% of these had antimicrobial-resistant properties.

The report also found that 12% of imported spice shipments were contaminated with filth, e.g, insects and animal hair.

Most spices consumed in U.S. homes are imported. The FDA identified 14 spice-related illness outbreaks globally from 1973 to 2010. The agency says the reasons for so few reported outbreaks could be that people tend to eat small quantities of spices and foodborne illnesses are underreported.

FDA draft risk profile (Free PDF)

FDA update (Free)

Associated Press story (Free)

Diet and metformin curb heart risk in type 2 diabetes, study finds
A study in Diabetes Care revealed diet-only intervention and metformin treatment were associated with a lower risk of cardiovascular conditions in type 2 diabetes patients compared with insulin monotherapy. Researchers also found that no other diabetes medication either taken alone or in combination with other treatments helped reduce the risk of cardiovascular events compared with insulin alone. DailyRx.com

Ministrokes can take a toll on quality of life, survival
Even a ministroke was associated with a shorter life expectancy and lower quality of life, according to a study in the journal Neurology. Researchers tracked about 1,200 stroke and ministroke survivors for five years and found that they lost 2.79 "quality-adjusted life years" on average compared with the general population. The more severe the stroke, the greater the effect on quality of life, a researcher said. HealthDay News

Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients
Achieving adequate control of risk factors for cardiovascular disease in patients with type 2 diabetes remains a clinical challenge. Interventions to achieve control of 3Bs coupled with modification of additional cardiovascular disease predictors are crucial for optimization of clinical outcomes in patients with type 2 diabetes. The American Journal of Medicine

Diabetes raises cirrhosis, carcinoma risk in liver disease patients
Data from 503 medical charts of patients with steatohepatitis-related liver disease revealed those with diabetes had higher odds of developing hepatocellular carcinoma, cirrhosis and encephalopathy compared with those who did not have diabetes. The results presented at the American College of Gastroenterology meeting underscore the need for increased screening methods in diabetes patients with steatohepatitis, researchers noted

Blood pressure meds may protect elderly from Alzheimer's disease
Researchers looked at data on more than 2,200 people ages 75 to 96 and found that those who regularly took common blood pressure drugs such as diuretics, angiotensin receptor blockers and ACE inhibitors were at least 50% less likely to develop Alzheimer's disease than nonusers. Among patients with signs of mild cognitive impairment, the use of diuretics was associated with a 50% reduced risk of Alzheimer's. The findings appeared in the journal Neurology. HealthDay News

Stress negatively affects health early in life
Racial and socioeconomic status differences in allostatic load exist during adolescence, confirming variation in the accumulation of stress biomarkers at younger ages. These findings contribute to the understanding of how early life adverse factors "get under the skin" and are possibly translated into increased risk for diseases later in life.

Fitness effect on coronary artery bypass graft
These data suggest that preoperative cardiorespiratory fitness provides an independent and additive marker for mortality after coronary artery bypass grafting. The American Journal of Cardiology 

Obesity before pancreatic cancer diagnosis tied to higher risk of death
Pancreatic cancer patients who were obese up to 20 years before receiving a cancer diagnosis had more than double the risk of dying compared with those who weighed less before diagnosis, according to a study in the Journal of Clinical Oncology. The analysis of data from the Nurses' Health Study and the Health Professionals Follow-Up Study also found that greater prediagnostic BMI was associated with increased likelihood of advanced-stage disease at diagnosis. MedPage Today

Hypernatremia and surgical outcomes
Preoperative hypernatremia is associated with increased perioperative 30-day morbidity and mortality. The American Journal of Medicine

Vitamin D for osteoporosis
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. (Free registration required.) The Lancet

Rate control vs rhythm control
In septuagenarian patients with atrial fibrillation, compared with rhythm-control, a rate-control strategy was associated with significantly lower mortality and hospitalization. The American Journal of Medicine

Comparing preoperative measures for postoperative atrial fibrillation
In this high-risk population, the authors were unable to demonstrate that any of the commonly used preventive agents were associated with lower rates of atrial fibrillation compared with alternatives or no treatment. The American Journal of Cardiology 

Antimuscarinics for urinary incontinence
In Veterans Affairs community living centers, antimuscarinic use for bladder incontinence showed that, especially oxybutynin IR, may need to be reconsidered as a first choice for prescribing in adults aged 65+. Over 200,000 individuals were evaluated. Increased fracture risk was found and little if any improvement in social engagement or quality of life. Further studies of alternative medications to determine their safety in this older population are needed. (Free abstract only.) Journal of the American Medical Directors Association

Beta blocker may help reduce heart attack damage, study finds
Heart attack patients who were treated with the low-cost beta blocker metoprolol on their way to the hospital had 20% less heart tissue damage than those who received a placebo, according to a study in the journal Circulation. Patients with less heart tissue damage are less likely to need an implantable defibrillator and other expensive treatments or require long hospitalization, researchers said. DailyRx.com

Proton pump inhibitors and hypomagnesemia
Case series suggest that long-term use of proton pump inhibitors (PPIs) is associated with hypomagnesemia, but the current literature lacks systematically collected data. This case-controlled study of hospitalized adults addresses this knowledge gap. The authors found that out-of-hospital PPI use was not associated with hypomagnesemia at the time of hospital admission to medical services, suggesting that PPI use is not likely to be a major contributor to hypomagnesemia. American Journal of Kidney Diseases

Linagliptin-insulin combo improves blood sugar control in type 2 diabetes
Taking linagliptin in addition to basal insulin was more effective than a placebo and insulin combination in controlling blood sugar levels for patients with type 2 diabetes, according to a study in the journal Diabetes Care. Sixteen percent of patients who took linagliptin attained an HbA1c of less than 7% after 52 weeks compared with 7% in the placebo group. DailyRx.com

CDC Offers Guidelines on Managing Food Allergies in Schools, Early Child Care

Clinicians with young food-allergic patients may want to have a look at a free publication from the CDC, "Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs."

The 100-page document emphasizes partnerships among parents, school authorities, and clinicians as a way to prevent emergencies. It also offers actions that, for example, school nurses and doctors can take to help manage the problem.

CDC guidelines (Free PDF)

Blood Glucose, HbA1c Levels Linked to Memory Performance

 (HealthDay News) – Lower hemoglobin A1c (HbA1c) and blood glucose levels are associated with better memory performance in healthy, older adults, according to a study published online Oct. 23 in Neurology.

Lucia Kerti, from Charité-University Medicine in Berlin, and colleagues examined the correlation between HbA1c and glucose levels on memory performance and hippocampal volume and microstructure in a cohort of 141 individuals without diabetes (72 women; mean age, 63.1 years). Memory was tested using the Rey Auditory Verbal Learning Test, and peripheral levels of fasting hemoglobin A1c, glucose, and insulin were assessed. Hippocampal volume and microstructure were assessed as indicated by gray matter barrier density on 3-tesla magnetic resonance imaging scans.

The researchers found that there were significant correlations for lower HbA1c and glucose levels with better scores in delayed recall, learning ability, and memory consolidation. A strong correlation remained for HbA1c with memory performance, even in multiple regression models. The beneficial effects of lower HbA1c on memory were partially mediated by hippocampal volume and microstructure.

"Our results indicate that even in the absence of manifest type 2 diabetes mellitus or impaired glucose tolerance, chronically higher blood glucose levels exert a negative influence on cognition, possibly mediated by structural changes in learning-relevant brain areas," the authors conclude

http://www.neurology.org/content/early/2013/10/23/01.wnl.0000435561.00234.ee.abstract

Carotid Stenting Tied to Higher Stroke Risk in Seniors

 (HealthDay News) – For patients undergoing a carotid intervention, age influences outcomes, according to a review published online Oct. 23 in JAMA Surgery.

George A. Antoniou, MD, PhD, from the Hellenic Red Cross Hospital in Athens, Greece, and colleagues conducted a systematic literature review to examine the influence of advanced age on the outcomes of carotid revascularization. Forty-four studies were included, reporting data on 512,685 carotid endarterectomy (CEA) and 75,201 carotid stenting (CAS) procedures.

The researchers found that CAS correlated with increased incidence of stroke in elderly vs. young patients (odds ratio, 1.56), while the cerebrovascular outcomes were equivalent for CEA in old and young age groups. Peri-interventional mortality risks were similar for CAS in old and young patients, but mortality was increased in elderly patients with CEA (odds ratio, 1.62). For both procedures, the incidence of myocardial infarction was increased for patients of advanced age (odds ratios, 1.64 for CAS and 1.30 for CEA). Publication date had a significant effect on peri-interventional stroke and mortality in CAS.

"It seems that CEA is associated with improved neurologic outcomes compared with CAS in elderly patients, at the expense of increased perioperative mortality, whereas both procedures are associated with increased risk of adverse cardiac events in advanced age," the authors write.

Abstract
Full Text

http://archsurg.jamanetwork.com/article.aspx?articleid=1757343

Prostate Cancer Risk Lower in Statin Users

Prolonged statin use is associated with a decreased risk of prostate cancer (PCa), but the extent of this protective effect varies by duration of use time and type of statin, according to a new study.

A team led by Alexander Lustman, MD, of Clalit Health Services in Tel Aviv, Israel, conducted a population-based cohort study of 66,741 men aged 45-85 years. The mean age at cohort entry was 58 years. During follow-up, 1,813 PCa cases were diagnosed and 11,245 men died. A total of 37,645 subjects (56%) had filled at least one prescription for a statin and 26,061 (39%) had filled prescriptions for statins for at least 12 months.

The longer statins were used, the greater the reduction in PCa risk. In a fully adjusted model, men who used statins for five years or more had a 78% decreased risk of a PCa diagnosis compared with non-users. Men who used statins for one to five years had a 45% decreased risk and those who used statins for three to 12 months had a 32% decreased risk, the researchers reported online ahead of print in Prostate Cancer and Prostatic Disease.

Risk reductions also varied by cumulative statin use. Compared with men who did not take statins, those who had a cumulative defined daily dose of 1-5,000, 5,001-10,000, 10,001-20,000, and 20,001 mg or higher had an 18%, 36%, 65%, and 76% decreased risk, respectively, in a fully adjusted model.

Moreover, the reduction in risk varied by type of statin. Compared with no statin use, men who used rosuvastatin for at least six months had an 80% decreased risk of PCa in a fully adjusted model. Men who used simvastatin or atorvastatin for at least six months had a 52% and 55% decreased risk. The risk was increased by 34% and 29% for men who used lovastatin or fluvastatin, respectively.

http://www.renalandurologynews.com/prostate-cancer-risk-lower-in-statin-users/article/317275/?DCMP=EMC-RENALUROLOGY_TODAYSUPDATE&CPN=run_viauro&spMailingID=7231173&spUserID=MzEwNzk3NDcxNDUS1&spJobID=94491986&spReportId=OTQ0OTE5ODYS1

Statin Use Is Associated with Excess Risk for Cataracts

Leuschen J et al., JAMA Ophthalmol 2013 Sep 19;

One more reason to carefully weigh the risks and benefits of statins, especially for primary prevention

Cardiologist Decries the 'Myth of the Role of Saturated Fat in Heart Disease'

An interventional cardiologist argues in BMJ against "the mantra that saturated fat must be removed to reduce the risk of cardiovascular disease." In addition, Aseem Malhotra writes that the obsession with cholesterol "has led to the overmedication of millions of people with statins."

Obesity rates paradoxically increased in the face of a concurrent reduction in fat consumption, he writes. "When you take the fat out, the food tastes worse. The food industry compensated by replacing saturated fat with added sugar."

Statins, he argues, work by being anti-inflammatory and by stabilizing coronary plaque — their effects on cholesterol are beside the point (and their side effects too frequent).

The essay concludes: "It is time to bust the myth of the role of saturated fat in heart disease and wind back the harms of dietary advice that has contributed to obesity."

BMJ essay (Free)

No Evidence That Screening Older Adults for Cognitive Impairment Improves Outcomes

While "it is clear" that brief tools to screen for cognitive impairment in older adults can identify dementia, there's "no empirical evidence" that early diagnosis improves outcomes for patients or caregivers, concludes an evidence review undertaken for the U.S. Preventive Services Task Force.

The review comes as the USPSTF prepares to update its 2003 statement on dementia screening, which concluded that the evidence was insufficient to recommend for or against it.

Among the findings of the current review:

·         The Mini-Mental State Examination, the best-studied tool, showed a sensitivity of 88% and a specificity of 86%; other instruments (e.g., the Clock Drawing Test) had an "acceptable" performance.

·         Acetylcholinesterase inhibitors conferred a small benefit, but the clinical importance was "uncertain," and side effects were common.

·         Evidence was limited on cognitive stimulation and physical activity.

Annals of Internal Medicine article

ACP Advises Against Chronic Kidney Disease Screening in Asymptomatic Adults

The American College of Physicians now recommends against screening for chronic kidney disease in asymptomatic adults who don't have CKD risk factors.

In new guidelines published in the Annals of Internal Medicine, the authors write: "In the absence of evidence that screening improves clinical outcomes, testing will add costs, owing to both the screening test and to additional follow-up tests (including those resulting from false-positive findings), increased medical visits, and costs of keeping or obtaining health insurance."

The guidelines also recommend:

·         against proteinuria testing in adults (with or without diabetes) taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II-receptor blocker (ARB);

·         treating patients with hypertension and stage 1 to 3 CKD with an ACE inhibitor or ARB;

·         prescribing statins to patients with elevated LDL cholesterol and stage 1 to 3 CKD.

Annals of Internal Medicine article

Outdoor Air Pollution Called a Leading Cause of Cancer Worldwide

Exposure to outdoor air pollution can cause lung cancer and is associated with an increased risk for bladder cancer, the U.N.'s International Agency for Research on Cancer concludes.

The IARC reviewed over 1000 research studies done on five continents. The principal sources of pollution were transportation, power plants, and industrial and agricultural emissions.

The agency notes that pollutant exposure has greatly increased in recent years, particularly in countries undergoing rapid industrialization. One IARC official said that, in addition to pollution's known effects on health "in general," it is "also a leading environmental cause of cancer deaths."

IARC announcement (Free PDF)

Background: Previous Physician's First Watch coverage of air pollution's health effects (Free)

Testosterone Gels Get Big Ad Push, But Many Clinicians Believe 'Low T' Doesn't Exist

Pumped up by expansive ad budgets last year, testosterone gels generated over $2 billion in U.S. sales, the New York Times reports. One manufacturer spent $80 million advertising its gel.

Aimed at aging men, the ads offer a solution to something called "low T" — which many clinicians believe is an "invented condition," according to the Times.

One source, an endocrinologist, commented: "There is no such disease." Another, a cardiologist, asks patients presenting with self-described low T why they would even get tested, since "there isn't really a normal."

A drug company spokesman said their product advertising is educational and meant to encourage patients to talk with their physicians "to determine if testing and treatment may be appropriate."

New York Times story (Free)

Alzheimer's: resveratrol targets certain protein interactions
http://mnt.to/l/4hxQ

Statin 'combats cognitive decline after surgery'
http://mnt.to/l/4htG

Protection against brain abnormalities provided by high serum omega-3 polyunsaturated fatty acid content
http://mnt.to/l/4htw

Rate of brain tissue loss doubled by genetic mutation linked to Alzheimer's disease
http://mnt.to/l/4htc

Scientists hope new soy flour will reduce dementia risk
http://mnt.to/l/4hsJ

Researchers identify biomarkers of Alzheimer's disease in spinal fluid  before onset of symptoms
http://mnt.to/l/4hsm

Stem cell-based approach manipulates brain cells, targets specific gene mutations causing dementia and ALS
http://mnt.to/l/4hsd

Protective pathway identified to counter toxicity associated with Alzheimer's disease
http://mnt.to/l/4hrp

Hardened arteries in elderly linked to brain plaques
http://mnt.to/l/4hpM

Progressive speech and language disorders an increased risk for teachers
http://mnt.to/l/4hqg

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** ANXIETY / STRESS News **

Cognitive behavioral therapy 'effective' for health anxiety
http://mnt.to/l/4htW

The biggest cause of anxiety and depression is traumatic life events
http://mnt.to/l/4hsP

Hormone produced during stressful situations primes the brain for post-traumatic stress disorder
http://mnt.to/l/4hrv

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** BONES / ORTHOPEDICS News **

Osteoporosis patients may benefit from treatments targeting NOX4 activity
http://mnt.to/l/4hrc

High-risk individuals in the European Union are not being diagnosed and treated for osteoporosis
http://mnt.to/l/4hqB

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** BREAST CANCER News **

Developing world faces breast cancer surge, study suggests
http://mnt.to/l/4htm

Every woman's right: Breast Reconstruction Awareness (BRA) Day marked with team approach
http://mnt.to/l/4hsk

Hormones in BRCA gene carriers 'explain cancer risk'
http://mnt.to/l/4hs4

New breast cancer imaging 'detects subtypes and early treatment repsonse'
http://mnt.to/l/4hpm

----------------------------------------------
** CANCER / ONCOLOGY News **

Clarified role of signal-relay proteins may help explain spread of cancer
http://mnt.to/l/4hwj

Targeting the common cancer protein KRAS
http://mnt.to/l/4hwc

The X chromosome often affected by mutations in cancer
http://mnt.to/l/4hw5

Light pulses stimulate designer peptides to initiate a death pathway in cancerous cells
http://mnt.to/l/4hsT

Scientists identify genetic errors  in 12 major cancer types
http://mnt.to/l/4hsg

MicroRNAs tackle cancer metastasis
http://mnt.to/l/4hrC

Link suggested between nervous system, certain thyroid cancers
http://mnt.to/l/4hqV

New approach may improve personalized cancer treatments
http://mnt.to/l/4hqF

DNA scanning technology leads to new library of cancer targets
http://mnt.to/l/4hqn

----------------------------------------------
** CARDIOVASCULAR / CARDIOLOGY News **

Clue to unlocking the mystery of life-saving heart drug offered by lung infections
http://mnt.to/l/4hqH

The American Heart Association recommends that doctors routinely evaluate patients' physical activity habits
http://mnt.to/l/4hq7

Why aerobic capacity decreases with age
http://mnt.to/l/4hq4

----------------------------------------------
** CHOLESTEROL News **

5-fold increase in high cholesterol risk to offspring when mother has high cholesterol before pregnancy
http://mnt.to/l/4hvw

Sanofi and Regeneron report positive top-line results with alirocumab from first Phase 3 study of a PCSK9 inhibitor for LDL cholesterol reduction
http://mnt.to/l/4hsG

----------------------------------------------
** DEPRESSION News **

Article sheds light on the link between depression and poor parenting
http://mnt.to/l/4hrz

Among mothers of low-income families, support structures do little to ease depressive symptoms
http://mnt.to/l/4hrk

Antidepressants during pregnancy: what's best for mom and baby?
http://mnt.to/l/4hqY

----------------------------------------------
** DERMATOLOGY News **

Baldness cure a step closer with promising new treatment
http://mnt.to/l/4hwW

----------------------------------------------
** DIABETES News **

Growing a miniature pancreas - a step towards the production of cells for diabetes therapy
http://mnt.to/l/4hrh

----------------------------------------------
** ENDOCRINOLOGY News **

Study finds that ghrelin, produced during stressful situations, primes the brain for post-traumatic stress disorder
http://mnt.to/l/4htV

----------------------------------------------
** FERTILITY News **

Women may be stopping IVF treatment prematurely
http://mnt.to/l/4hv6

IVF donors increase in US, alongside better birth outcomes
http://mnt.to/l/4hrS

----------------------------------------------
** FLU / COLD / SARS News **

Flu virus wipes out first wave of immune response
http://mnt.to/l/4hwq

----------------------------------------------
** HYPERTENSION News **

Actelion receives US FDA approval of Opsumit (macitentan) for the treatment of pulmonary arterial hypertension
http://mnt.to/l/4hwG

Risk of future stroke increased by hypertension during pregnancy
http://mnt.to/l/4hvR

Drugs for hypertension shown to decrease risk of Alzheimer's disease dementia
http://mnt.to/l/4hsf

Mindfulness training helps lower blood pressure
http://mnt.to/l/4hrM

Hypertension and happiness
http://mnt.to/l/4hqt

Lowering blood pressure through mindfulness-based stress reduction
http://mnt.to/l/4hqh

----------------------------------------------
** INFECTIOUS DISEASES / BACTERIA / VIRUSES News **

Study explores the role of uncertainty in infectious disease modelling
http://mnt.to/l/4hx5

New approach to detecting food contamination enables real-time testing of food and processing plant equipment
http://mnt.to/l/4hw2

Soil-based bacteria discovered in humans 'may trigger MS'
http://mnt.to/l/4hvN

Increasing number of U.S. adolescents lack antibodies to herpes simplex virus type 1
http://mnt.to/l/4hvz

Difficult-to-diagnose immunodeficiency disorder CVID caused by mutation in NFKB2 gene
http://mnt.to/l/4hv2

Treating parasitic infections with statin, osteoporosis drug combo
http://mnt.to/l/4htT

How to separate the good from the bad in bacteria
http://mnt.to/l/4htj

Antibiotics ineffective in decreasing risk of mortality when treating catheter-associated bacteriuria
http://mnt.to/l/4htf

Researchers track viral DNA in the cell
http://mnt.to/l/4ht9

Farm visits ideal for teaching children about germs
http://mnt.to/l/4hsS

Drug-resistant bacteria destroyed by narrow-spectrum UV light
http://mnt.to/l/4hsB

How Staph toxin disarms the immune system
http://mnt.to/l/4hsy

Bacteria-eating viruses found that fight C. diff 'superbugs'
http://mnt.to/l/4hsH

New type of antibacterial agent offers new approach to bacterial infection, other diseases
http://mnt.to/l/4hr6

Machine speeds concentration step in food-pathogen detection
http://mnt.to/l/4hqR

New device 'speeds up foodborne pathogen detection'
http://mnt.to/l/4hqd

----------------------------------------------
** MENTAL HEALTH News **

Body image satisfaction in middle-aged women
http://mnt.to/l/4hrQ

----------------------------------------------
** NEUROLOGY / NEUROSCIENCE News **

Basic science translates to human disease - two genetic wrongs make a biochemical right
http://mnt.to/l/4hwn

Similarities in how human and rodent subjects adapt to errors
http://mnt.to/l/4hwh

Cutting-edge microscopy reveals how neuron 'claws' in the brain enable flies to distinguish one scent from another
http://mnt.to/l/4hwd

Learning dialects shapes brain areas that process spoken language
http://mnt.to/l/4hw7

Delaying gratification, when the reward is under our noses
http://mnt.to/l/4hsM

The brains of retired American football players show unusual activity
http://mnt.to/l/4hvr

Psychologists report new insights on human brain, consciousness
http://mnt.to/l/4hvb

Bird model used to study the neural mechanisms underlying speech and language in humans
http://mnt.to/l/4htF

Is long-term response to traumatic brain injury affected by genetic variability?
http://mnt.to/l/4htD

Scientists are working across animal species in order to solve some of the riddles of human diseases
http://mnt.to/l/4htv

Chronic itching 'may be caused by pain neurons'
http://mnt.to/l/4htn

Anxiety gene may curb willingness to help others
http://mnt.to/l/4hsK

Birth 'prepares baby's brain for development'
http://mnt.to/l/4hrx

Mouse whiskers research reveals signal pathway from touch neuron to brain
http://mnt.to/l/4ht7

Neurons strengthen their synapses in order to remain active after loss of input
http://mnt.to/l/4hsR

In rare inherited disorder, gene mutation sheds light on protein's role in brain development
http://mnt.to/l/4hsj

Potential for 'mind control' after brain activity discovery
http://mnt.to/l/4hrZ

Researcher sees how different types of introspection are actually housed in the human brain
http://mnt.to/l/4hs7

Scientists create self-renewing antioxidant
http://mnt.to/l/4hrt

Discovery of new mechanism underlying translation-dependent synaptic plasticity
http://mnt.to/l/4hr4

Faces 'primarily differentiated by race and gender,' study shows
http://mnt.to/l/4hqm

Biomedical research improved by better understanding of the movements of C. elegans
http://mnt.to/l/4hqS

Novel fruit fly research offers lessons about traumatic brain injury
http://mnt.to/l/4hpZ

----------------------------------------------
** NUTRITION / DIET News **

Girls and boys respond differently to a school-based healthy diet intervention in Argentina
http://mnt.to/l/4hwF

Low-fiber diet tied to higher cardiometabolic risk
http://mnt.to/l/4hwk

'Traffic-light' labeling more effective than the standard nutritional labeling available on packaged products
http://mnt.to/l/4htX

Researchers maximize broccoli's cancer-fighting potential
http://mnt.to/l/4hsW

Food scientist creates citrus meatball recipe, improving nutritional quality without affecting taste
http://mnt.to/l/4hr3

----------------------------------------------
** OBESITY / WEIGHT LOSS / FITNESS News **

Portions of ready meals, pies and crisps 'out of control'
http://mnt.to/l/4hwM

Most new mums have low self-esteem and feel under pressure to lose baby weight, survey shows
http://mnt.to/l/4hwL

Tackling abdominal obesity with exercise and nutrition
http://mnt.to/l/4hvT

Spike in sugary drink consumption among California adolescents
http://mnt.to/l/4hvH

How healthy is housework?
http://mnt.to/l/4htN

Rapid reversal of diabetes after gastric banding surgery
http://mnt.to/l/4hrR

Study: weight-loss groups better than self-help approach
http://mnt.to/l/4hrX

Identifying neural circuits that regulate feeding behavior could lead to therapies that promote or decrease appetite
http://mnt.to/l/4hqQ

How bariatric surgery impacts health depends on type of surgery, patient characteristics
http://mnt.to/l/4hqs

Community-based weight loss intervention yields greater weight loss than self-help approach
http://mnt.to/l/4hq6

----------------------------------------------
** PRIMARY CARE / GENERAL PRACTICE News **

Comparison of male and female doctors:  females better but males more productive
http://mnt.to/l/4hvf

Physicians use mobile devices in nursing homes to check drug info, preventing adverse events
http://mnt.to/l/4ht8

A patients trust in a doctor could hinge on eye contact
http://mnt.to/l/4hs8

Health IT plays critical role in improving population health, says new report released at national primary care conference
http://mnt.to/l/4hqv

----------------------------------------------
** PROSTATE / PROSTATE CANCER News **

Researcher says Skid Row cancer study has implications for treatment today
http://mnt.to/l/4hvX

----------------------------------------------
** SENIORS / AGING News **

Program helps at-risk seniors in rural communities plan ahead for emergencies
http://mnt.to/l/4hwT

Discovery could slow ravages of aging
http://mnt.to/l/4hvJ

Groundbreaking project looks at dementia, other health factors in the 'oldest old'
http://mnt.to/l/4hvn

Falls and traumatic injuries dangerous for adults older than 65
http://mnt.to/l/4htp

The pursuit of improved physical and mental health: October issue of Health Affairs
http://mnt.to/l/4hsC

Survey details the changing nature of work and aging in America
http://mnt.to/l/4hqk

----------------------------------------------
** SEXUAL HEALTH / STDS News **

Phase 3 trial of 1-year contraceptive vaginal ring shows positive results
http://mnt.to/l/4hrw

Older sisters could aid prevention efforts aimed at reducing risky sexual behaviors among teen girls
http://mnt.to/l/4hr5

----------------------------------------------
** SLEEP / SLEEP DISORDERS / INSOMNIA News **

Lack of sleep may increase Alzheimer's risk
http://mnt.to/l/4hwv

Recent research on insomnia among military personnel and veterans
http://mnt.to/l/4htg

Sleep helps 'detox' your brain
http://mnt.to/l/4htt

The importance of sleep in maintaining a healthy lifestyle
http://mnt.to/l/4hqj

Allergy to bee stings could be a protective mechanism
http://mnt.to/l/4hBh

----------------------------------------------
** ALZHEIMER'S / DEMENTIA News **

Scientists discover 11 new Alzheimer's risk genes
http://mnt.to/l/4hDn

Researchers demonstrate preventive effect of sterols in Alzheimer's disease
http://mnt.to/l/4hCf

Study uncovers link between Alzheimer's and Parkinson's
http://mnt.to/l/4hB4

Researchers seeking early diagnostic for Alzheimer's disease
http://mnt.to/l/4hzV

Anavex encouraged by new sigma-1 receptor study that may explain therapeutic efficacy of ANAVEX 2-73 for Alzheimer's disease
http://mnt.to/l/4hyw

----------------------------------------------
** ARTHRITIS / RHEUMATOLOGY News **

Studies shed light on dangerous connection between rheumatoid arthritis and heart disease
http://mnt.to/l/4hCQ

Don't use biological disease modifying drugs in rheumatoid arthritis, to begin with, doctors urged
http://mnt.to/l/4hzY

The healthspan of seniors could be extended by controlling the triggers of age-related inflammation
http://mnt.to/l/4hxm

----------------------------------------------
** BONES / ORTHOPEDICS News **

Supplement cuts muscle loss in knee replacements
http://mnt.to/l/4hDf

Agluna&reg; treated devices significantly reduce infection rates
http://mnt.to/l/4hxx

Genkyotex collaborators elucidate role of NOX4 in osteoporosis
http://mnt.to/l/4hxp

----------------------------------------------
** BREAST CANCER News **

Breast radiotherapy linked to increased heart disease risk
http://mnt.to/l/4hDB

Among women with abnormal cancer screening, care delayed by social service barriers
http://mnt.to/l/4hD7

Breast cancer diagnosis can lead to positive personal growth
http://mnt.to/l/4hCX

Evaluation of all 24 genes implicated in breast cancer explains occurrence when women have normal BRCA genes
http://mnt.to/l/4hCp

Early onset breast cancer associated with mutations in novel tumor suppressor gene
http://mnt.to/l/4hCj

Drug-resistant breast tumors' defenses lowered by stealth nanoparticles
http://mnt.to/l/4hzW

'Photoacoustic mammoscope,' could someday be used for routine breast cancer screenings
http://mnt.to/l/4hzc

BRCA-related breast and ovarian cancers showing early response to Investigational PARP inhibitor
http://mnt.to/l/4hy2

----------------------------------------------
** CANCER / ONCOLOGY News **

From nano-dwarves to tumor assassins
http://mnt.to/l/4hDb

Fusion oncogene formation promoted by ionizing radiation exposure
http://mnt.to/l/4hCG

Recurrence of thyroid cancer 'could be predicted' with microRNAs
http://mnt.to/l/4hCk

Research reveals 3-way genetic switch for cancer metastasis
http://mnt.to/l/4hBY

Discovery of protein factories may lead to novel agents for the treatment of cancer
http://mnt.to/l/4hBq

Tumor factors that block muscle repair offer partial explanation for cancer wasting
http://mnt.to/l/4hB2

Coffee consumption cuts liver cancer risk
http://mnt.to/l/4hyQ

Resistance to certain anticancer drugs may be overcome by new nanopharmaceutical
http://mnt.to/l/4hxH

How cancer cells get energy and raw materials for growth from glucose opens doors to new therapies
http://mnt.to/l/4hxC

New method safely delivers potent anti-cancer compound
http://mnt.to/l/4hxk

Internet usage linked to cancer prevention behavior
http://mnt.to/l/4hwN

----------------------------------------------
** CARDIOVASCULAR / CARDIOLOGY News **

DIY and gardening may 'reduce risk of heart attack'
http://mnt.to/l/4hDH

Determining heart disease risk in type 1 diabetes patients
http://mnt.to/l/4hCc

Testosterone therapy for men may reduce risk of cardiovascular disease
http://mnt.to/l/4hzB

Saturated fat's role in heart disease is a myth, says heart specialist
http://mnt.to/l/4hz2

----------------------------------------------
** COLORECTAL CANCER News **

Red and processed meat 'increases colorectal cancer risk'
http://mnt.to/l/4hCt

Colorectal cancer: current screening guidelines 'may lead to missed diagnoses'
http://mnt.to/l/4hyN

The role played by estrogen in colon cancer prevention, treatment
http://mnt.to/l/4hx7

----------------------------------------------
** DEPRESSION News **

Variant gene form reduced antidepressant's ability to weaken emotional memories
http://mnt.to/l/4hyh

New moms with postnatal depression offered help over the internet
http://mnt.to/l/4hy8

----------------------------------------------
** DERMATOLOGY News **

Potential stem cell-based treatments for skin and sweat gland-related conditions
http://mnt.to/l/4hB3

----------------------------------------------
** DIABETES News **

Non-invasive technology may help people with type 1 and type 2 diabetes
http://mnt.to/l/4hD5

In mouse model of diabetic kidney disease, enzyme restores function
http://mnt.to/l/4hCT

Reactive oxygen species reduced in diabetes-associated nephrology
http://mnt.to/l/4hCJ

How diabetes predisposes individuals to Alzheimer's disease
http://mnt.to/l/4hzs

Researchers make a case for free fatty acids in obesity-related diabetes
http://mnt.to/l/4hyr

Can vitamin D supplementation reduce diabetes risk in patients with pre-diabetes?
http://mnt.to/l/4hxt

----------------------------------------------
** ENDOCRINOLOGY News **

Gene expression test clarifies thyroid biopsies
http://mnt.to/l/4hBG

----------------------------------------------
** FERTILITY News **

Over 60% of women aged 35 to 45 in England feel stigmatised for not having had children
http://mnt.to/l/4hBf

Contraception needed 3 weeks after giving birth, new mums warned
http://mnt.to/l/4hxs

----------------------------------------------
** FLU / COLD / SARS News **

New 3D virus model explains lack of common cold cure
http://mnt.to/l/4hFv

Flu vaccination linked to lower heart attack risk
http://mnt.to/l/4hxR

----------------------------------------------
** INFECTIOUS DISEASES / BACTERIA / VIRUSES News **

Risk of clostridium difficile infection may be higher in the obese
http://mnt.to/l/4hBt

Single mutation gives virus new target
http://mnt.to/l/4hx9

Produce-borne illness could be reduced by on-farm food safety plans
http://mnt.to/l/4hwX

----------------------------------------------
** MENTAL HEALTH News **

Interventions by non-mental health specialists may improve perinatal mental health disorders
http://mnt.to/l/4hyB

----------------------------------------------
** NEUROLOGY / NEUROSCIENCE News **

Number of patients declared 'brain dead' decreasing
http://mnt.to/l/4hDG

Greatly elevated risk of depression in children with brain injuries
http://mnt.to/l/4hCC

Students may need a break from school after concussion
http://mnt.to/l/4hDD

New 'mini-neural computer' discovered in brain
http://mnt.to/l/4hDC

New 'mini-neural computer' found in the brain
http://mnt.to/l/4hDq

The effect of timing of surgery to treat traumatic spinal cord injury on outcomes
http://mnt.to/l/4hBn

How our brain resists temptation in preference of 'future rewards'
http://mnt.to/l/4hzj

Study may explain why brain 'perceives limited information'
http://mnt.to/l/4hzL

Study points to possible treatment for brain disorders
http://mnt.to/l/4hyz

Brain 'shows signs of consciousness' under general anesthetic
http://mnt.to/l/4hyq

Protecting the brain starts at the synapse
http://mnt.to/l/4hy5

High blood sugar levels linked to memory loss
http://mnt.to/l/4hwQ

Continuous and prolonged mental challenge keeps an aging mind sharp
http://mnt.to/l/4hxf

----------------------------------------------
** NUTRITION / DIET News **

Population-wide vitamin and mineral deficiencies detected via new testing strategy
http://mnt.to/l/4hBL

----------------------------------------------
** OBESITY / WEIGHT LOSS / FITNESS News **

Peer pressure likely influences food choices at restaurants
http://mnt.to/l/4hCV

Daily control of body temperature governed by cell nucleus protein in brown fat cells
http://mnt.to/l/4hDs

Causes and possible interventions for childhood obesity
http://mnt.to/l/4hBx

Obesity may be caused by 'hunger gene'
http://mnt.to/l/4hC4

Risk factors and promising interventions for childhood obesity
http://mnt.to/l/4hy7

Weight loss surgery 'more effective than diet and exercise'
http://mnt.to/l/4hwK

----------------------------------------------
** PRIMARY CARE / GENERAL PRACTICE News **

Majority of GPs back Government's plan to charge migrants, survey finds, UK
http://mnt.to/l/4hB9

Patient outcomes improved by complete care
http://mnt.to/l/4hz8

Poll reveals that parents want e-mail consults with doctors but don't want to pay for them
http://mnt.to/l/4hxc

----------------------------------------------
** PROSTATE / PROSTATE CANCER News **

Seeking clonal origin of lethal prostate cancer
http://mnt.to/l/4hCH

Association between multiple, distinct Y chromosomes and excess risk of prostate cancer
http://mnt.to/l/4hCB

Decision Counseling Program makes prostate cancer treatment decisions easier
http://mnt.to/l/4hyv

Phase 3 trial of XTANDI&trade; in chemotherapy-naive patients meets both co-primary endpoints
http://mnt.to/l/4hys

----------------------------------------------
** SENIORS / AGING News **

Older volunteers in better physical health than younger peers
http://mnt.to/l/4hCq

Initiative aims to decrease hospitalization of nursing home residents
http://mnt.to/l/4hBW

Enhanced geriatric social work training the focus of three new centers
http://mnt.to/l/4hz7

----------------------------------------------
** SEXUAL HEALTH / STDS News **

'Sex drive slows' after stem cell transplantation
http://mnt.to/l/4hCy

----------------------------------------------
** SLEEP / SLEEP DISORDERS / INSOMNIA News **

Association between sleep apnea and subclinical myocardial injury
http://mnt.to/l/4hD4

Sleep apnea may hold hidden dangers for women
http://mnt.to/l/4hDm

Sleep apnea linked to early sign of heart failure
http://mnt.to/l/4hyV

Discovery of new biological links between sleep deprivation and the immune system
http://mnt.to/l/4hzH

Making progress toward a treatment for dangerous allergies
http://mnt.to/l/4hkq

----------------------------------------------
** ALZHEIMER'S / DEMENTIA News **

Peanut butter helps diagnose Alzheimer's disease
http://mnt.to/l/4hjP

Fat may be linked to memory loss
http://mnt.to/l/4hk8

Sleep-disordered breathing a possible risk factor for Alzheimer's disease
http://mnt.to/l/4hjk

Lesch-Nyhan syndrome, Alzheimer's, Parkinson's and Huntington's diseases impacted by new discovery
http://mnt.to/l/4hkh

Targeting epigenetic regulation could impact Alzheimer's disease
http://mnt.to/l/4hgf

----------------------------------------------
** ANXIETY / STRESS News **

Transcendental Meditation practice reduces trait anxiety
http://mnt.to/l/4hkQ

Pilot study tests biofeedback device in lowering grandmothers' stress
http://mnt.to/l/4hhc

----------------------------------------------
** ARTHRITIS / RHEUMATOLOGY News **

Technology to ease the pain of arthritis
http://mnt.to/l/4hpt

Potential new targets discovered for anti-inflammatory therapies
http://mnt.to/l/4hmT

Hope for knee osteoarthritis sufferers offered by 'mobility shoes'
http://mnt.to/l/4hk7

----------------------------------------------
** BONES / ORTHOPEDICS News **

Researchers reveal Innovative concept for knee cartilage treatment
http://mnt.to/l/4hnH

New report warns that osteoporosis is a major threat to women and their future independence
http://mnt.to/l/4hkM

Vitamin D supplements do not prevent osteoporosis
http://mnt.to/l/4hkL

----------------------------------------------
** BREAST CANCER News **

Good cholesterol and breast cancer risk
http://mnt.to/l/4hm7

Older women with invasive breast cancer afforded some protection by multivitamins and minerals
http://mnt.to/l/4hkv

Blood-brain barrier breached by anti-breast cancer drugs using new technique
http://mnt.to/l/4hkc

No trace of viral cause for breast cancer and glioblastoma
http://mnt.to/l/4hjj

Detecting BRCA1 and BRCA2 mutations via new, clinically validated diagnostic test
http://mnt.to/l/4hh5

New decision-making model helps women with early-stage breast cancer decide on most appropriate treatment
http://mnt.to/l/4hgq

----------------------------------------------
** CANCER / ONCOLOGY News **

Cell growth discovery has implications for targeting cancer
http://mnt.to/l/4hnG

More secrets of glioblastoma multiforme exposed by the Cancer Genome Atlas
http://mnt.to/l/4hnn

For childhood cancer survivors, preventable risk factors pose serious threat to heart health
http://mnt.to/l/4hnm

Cancer in EU cost 126 billion Euros in 2009
http://mnt.to/l/4hnx

Overweight kids at risk for esophageal and gastric cancer
http://mnt.to/l/4hmM

Protection from UV rays provided by circadian rhythms in skin stem cells
http://mnt.to/l/4hmL

Gene variation that offers skin protection from sun damage may increase risk for testicular cancer
http://mnt.to/l/4hmG

Standard, RHDVRT for bladder cancer has comparable tumor control, decreased toxicity
http://mnt.to/l/4hkX

Social media gives hope to cancer patients
http://mnt.to/l/4hkR

Study examines characteristics of thyroid cancer
http://mnt.to/l/4hkx

Potential new therapeutic target that prevents cell division
http://mnt.to/l/4hjc

Protein identified that may predict thyroid cancer recurrence
http://mnt.to/l/4hhL

USC researchers to grow organs to unlock secrets of how cancer tumors grow
http://mnt.to/l/4hhm

'Jekyll-and-Hyde' protein determines life and death of cancer cells
http://mnt.to/l/4hgx

Improving nutritional status before bladder cancer surgery improves outcomes
http://mnt.to/l/4hgr

The human body favors nanodiscs over nanorods
http://mnt.to/l/4hgg

----------------------------------------------
** CARDIOVASCULAR / CARDIOLOGY News **

Delay in treatment for heart attack leads to later return to work and earlier retirement
http://mnt.to/l/4hnK

Regenerating defective heart tissue in babies using amniotic stem cells
http://mnt.to/l/4hkn

In study of 14 million patients, whites found to be more prone to atrial fibrillation than other ethnic groups
http://mnt.to/l/4hkj

New Zilver&reg; PTX&reg; drug-eluting stent study data shows excellent SFA patency results at four years
http://mnt.to/l/4hjW

Stem cells delivered by patch effective in repairing cardiac damage weeks after heart attack occurs
http://mnt.to/l/4hjw

Increase in heart attacks due to air pollution
http://mnt.to/l/4hj2

Serious complications risk & high recurrence rates for pediatric atrial fibrillation
http://mnt.to/l/4hhb

Wonder compound resveratrol the basis for new potential treatment for atrial fibrillation
http://mnt.to/l/4hgJ

Noise from aircrafts increases cardiovascular disease risk
http://mnt.to/l/4hg5

----------------------------------------------
** CHOLESTEROL News **

Fitness trumps weight when it comes to the good cholesterol
http://mnt.to/l/4hkt

----------------------------------------------
** COLORECTAL CANCER News **

Minimally invasive colon cancer surgery leads to improved outcomes for elderly patients
http://mnt.to/l/4hhH

----------------------------------------------
** DEPRESSION News **

Mountaintop coal mining may increase risk for depression
http://mnt.to/l/4hmP

FNDC5/irisin produced during exercise may augment the brain's natural anti-degeneration pathways
http://mnt.to/l/4hmN

Animal study suggests stress-induced depression in new mothers spans generations
http://mnt.to/l/4hjG

Prenatal depression linked to offspring depression in adulthood
http://mnt.to/l/4hhv

Promising results from study of glutamatergic agents for mood and anxiety disorders
http://mnt.to/l/4hgd

----------------------------------------------
** DERMATOLOGY News **

Researchers demonstrate technological breakthrough for skin regeneration
http://mnt.to/l/4hpD

High voltage, short pulsed electric fields hold promise to reveal the enigma of scars and to induce scarless tissue regeneration
http://mnt.to/l/4hpq

Likely causes, treatment strategies identified for systemic scleroderma
http://mnt.to/l/4hm9

Global study highlights physician preference for topical treatments for actinic keratosis with short treatment duration to improve patient outcomes
http://mnt.to/l/4hmf

Improved wound healing with gene and stem cell therapy combination
http://mnt.to/l/4hkf

----------------------------------------------
** DIABETES News **

News from the Annals of Internal Medicine: Oct. 15, 2013
http://mnt.to/l/4hpS

For patients with diabetes, angioplasty and bypass surgery lead to similar long-term benefits for quality of life
http://mnt.to/l/4hnB

Study shows that diet and lifestyle advice for those with diabetes should be 'no different' from that for general public
http://mnt.to/l/4hn8

Compugen drug candidate demonstrates high effectiveness in type I diabetes animal model
http://mnt.to/l/4hkY

Safer drug combinations possible using available data
http://mnt.to/l/4hkk

Finding in type 1 diabetes overturns idea of zero insulin
http://mnt.to/l/4hjV

Poxel's anti-diabetic Imeglimin confirms its unique mechanism of action in type 2 diabetic patients
http://mnt.to/l/4hjd

Why diabetic retinopathy is difficult to treat
http://mnt.to/l/4hgw

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** EATING DISORDERS News **

What is anorexia nervosa?
http://mnt.to/l/4hpP

Association between eating disorders and reproductive health problems
http://mnt.to/l/4hhV

Genes increase risk for eating disorders
http://mnt.to/l/4hhC

Is food addiction a step closer to formal diagnostic status?
http://mnt.to/l/4hgG

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** ENDOCRINOLOGY News **

Echotherapy specialist Theraclion announces very encouraging clinical results in the noninvasive treatment of thyroid nodules
http://mnt.to/l/4hmV

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** FERTILITY News **

IVF technique increases pregnancy rates by 20%, study shows
http://mnt.to/l/4hjp

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** FLU / COLD / SARS News **

Reducing flu infections and mortality by expanding vaccination policies to include children
http://mnt.to/l/4hhR

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** INFECTIOUS DISEASES / BACTERIA / VIRUSES News **

Researchers discover chemical compounds that could lead to new antibiotics
http://mnt.to/l/4hpb

Study reveals structure of 'gateway' compound in lethal food-borne toxin
http://mnt.to/l/4hnS

McMaster lab digs for antibiotics in the dirt
http://mnt.to/l/4hmR

Epstein-Barr virus-associated diseases and cancer
http://mnt.to/l/4hmJ

Innate virus-killing power discovered in mammals
http://mnt.to/l/4hmB

Origin of MERS coronavirus identified
http://mnt.to/l/4hkN

Tackling polio in Pakistan requires better community engagement and stronger health systems
http://mnt.to/l/4hhQ

An evolutionary perspective provides better understanding of the HIV epidemic
http://mnt.to/l/4hhJ

Use of beta-blocker helps achieve target heart rate level without increase in adverse outcomes among patients in septic shock
http://mnt.to/l/4hhs

Use of hypothermia does not improve outcomes for adults with severe meningitis; may be harmful
http://mnt.to/l/4hhp

Scientists print microscopic 3D cages to study bacteria
http://mnt.to/l/4hgZ

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** MENTAL HEALTH News **

New study reveals huge lack of awareness and understanding of OCD across the UK
http://mnt.to/l/4hpL

Suicide rates and suicidal talk on Twitter
http://mnt.to/l/4hmq

Loving touch may be key to healthy sense of self
http://mnt.to/l/4hjQ

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** NEUROLOGY / NEUROSCIENCE News **

Protein links exercise to brain health
http://mnt.to/l/4hnN

Orthopaedic surgeons play crucial role in diagnosing mTBI among trauma care patients
http://mnt.to/l/4hnp

Region of brain develops abnormally in children who stutter
http://mnt.to/l/4hnj

Exercise may ward off Alzheimer's and Parkinson's
http://mnt.to/l/4hp5

Gene identified that is essential for normal nerve development
http://mnt.to/l/4hmH

Synapse formation in the brain: new theory
http://mnt.to/l/4hmy

New model for neurotransmitter release reported by Sudhof, Nobel Prize winner
http://mnt.to/l/4hmw

Children who stutter have less grey matter in brain's speech areas
http://mnt.to/l/4hmm

Mechanism meant to maintain efficiency of brain network involved in neurodegenerative disease
http://mnt.to/l/4hjf

New target found for drugs against brain cell death
http://mnt.to/l/4hhk

Improving understanding of brain anatomy and language in young children
http://mnt.to/l/4hhY

Predictable development pattern followed by primate brains
http://mnt.to/l/4hhS

Lives saved when 'Guidelines for Management of Severe Traumatic Brain Injury' adhered to
http://mnt.to/l/4hhN

New insights into how JC polyomavirus invades cells
http://mnt.to/l/4hgM

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** NUTRITION / DIET News **

Nutritional intervention for pediatric inpatients decrease hospital stay and costs
http://mnt.to/l/4hnY

Possible solution to liver problems linked to intravenous feeding
http://mnt.to/l/4hkW

Fatal flaw found in 40 years of federal nutrition research
http://mnt.to/l/4hkC

Healthier diets possible in low-income, rural communities in America
http://mnt.to/l/4hmh

New potential for nutrient-rich prairie fruits
http://mnt.to/l/4hjK

What are the benefits of cayenne?
http://mnt.to/l/4hk4

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** OBESITY / WEIGHT LOSS / FITNESS News **

President Taft's obesity fought with low-carb diet and correspondence
http://mnt.to/l/4hpG

Esophageal and gastric cancer a greater risk in later life for overweight adolescents
http://mnt.to/l/4hpc

Intestinal barrier sleeves, a promising approach for the treatment of obesity and diabetes
http://mnt.to/l/4hmZ

Worm study provides clues to better fat-loss therapies for humans
http://mnt.to/l/4hms

Less healthy food choices and higher calorie meals a greater temptation for users of school debit accounts
http://mnt.to/l/4hjt

Obesity and portion size
http://mnt.to/l/4hjs

Appetite decreased by snacking on almonds, no increase in body weight
http://mnt.to/l/4hjn

Overweight and obese children face high risk of hypertension
http://mnt.to/l/4hjC

Most mobile weight loss apps significantly lacking in helping users change lifestyles
http://mnt.to/l/4hj3

Study of fruit flies could help us understand food choice in obese people
http://mnt.to/l/4hhg

Could leptin explain the link between abdominal obesity and cardiovascular disease
http://mnt.to/l/4hgX

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** PRIMARY CARE / GENERAL PRACTICE News **

Continuity of care could cut delays in cancer diagnosis
http://mnt.to/l/4hkD

Quality of patient care drives physician job satisfaction
http://mnt.to/l/4hjJ

GPs unlikely to recommend alternative duties for injured workers
http://mnt.to/l/4hjm

Involve-visual to roll out GP video consultation service, UK
http://mnt.to/l/4hjh

Unhealthy lifestyles should be targeted by healthcare providers
http://mnt.to/l/4hgm

Physicians reach quality-improvement goals at Mass. General with the help of incentives
http://mnt.to/l/4hgk

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** PROSTATE / PROSTATE CANCER News **

Predictiing outcome in prostate cancer by measuring change in circulating tumor  cells
http://mnt.to/l/4hnV

Study finds high variability among primary care physicians in rate of PSA screening of older men
http://mnt.to/l/4hnD

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** SENIORS / AGING News **

Tackle aging, not cancer and heart disease, for 'better returns'
http://mnt.to/l/4hhj

Saving money by delivering meals to seniors
http://mnt.to/l/4hh7

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** SLEEP / SLEEP DISORDERS / INSOMNIA News **

Irregular bedtimes linked to kids' behavioral problems
http://mnt.to/l/4hnt

How the body's muscles accidentally fall asleep while awake - a  debilitating sleep disorder
http://mnt.to/l/4hng

Deficits caused by workweek sleep loss not totally recouped by sleeping in on the weekends
http://mnt.to/l/4hkr

Sleeping longer linked to faster decline in brain function
http://mnt.to/l/4hhB