HHAL  MEDICAL NEWS DECEMBER 2013

2000 Steps a Day May Keep the Doctor Away

Walking 2000 steps a day — about 20 minutes of moderate-intensity walking — can lower the odds of cardiovascular events among high-risk adults, according to an analysis from the NAVIGATOR trial published in the Lancet.

Researchers studied some 9300 adults aged 50 and older with existing cardiovascular disease or impaired glucose tolerance and at least one additional cardiovascular risk factor. Ambulatory activity was measured with a pedometer for 7 days at baseline and 1 year.

During roughly 6 years' follow-up, 531 cardiovascular events occurred. Each 2000-step/day increment in ambulatory activity at baseline was associated with a roughly 10% lower risk for cardiovascular events. Similarly, each 2000-step increase in activity from baseline to 1 year was associated with an 8% lower risk, while each 2000-step decreaseconferred an 8% higher risk.

Commentators say the trial "adds compelling and reassuring evidence for the benefits of physical activity on cardiovascular health."

Lancet article

Long Walks Lower Stroke Risk

Walks of an extended duration may help to reduce the odds of stroke, among older men.

Walking is a popular form of physical activity, one that can be conducted by  older adults who live independently. Barbara J. Jefferis, from the University College London (United Kingdom), and colleagues studied 3,435 healthy men, ages 60 to 80 years, who were enrolled in the British Regional Heart Study. Following the subjects for an average of 10.9 years, the investigators tracked cardiovascular blood markers including C-reactive protein (CRP), D-dimer, and N-terminal pro-brain natriuretic peptide (NT-proBNP). The team observed that men who walked 8 to 14 hours per week were at one-third lower risk of stroke, compared to men who walked no more than three hours a week or did not walk at all. The stroke risk was about two-thirds lower for men who walked more than 22 hours per week. The association was found to be independent of walking pace and activity level. Reporting that: “Time spent walking was associated with reduced risk of onset of stroke in dose-response fashion,” the study authors submit that: "Walking could form an important part of stroke-prevention strategies in older people.”

http://www.medpagetoday.com/Cardiology/Strokes/42919

Exercise Lowers Key Marker of Inflammation

People who engage in vigorous-intensity physical activity reduced their risks of exhibiting elevated levels of C-reactive protein (CRP).

C-reactive protein (CRP) is a key marker of inflammation, with a number of studies linking elevated CRP to cardiovascular disease.  Michael Richardson, from the University of North Florida (Florida, USA), and colleagues examined data collected on 6,242 subjects enrolled in the 1999-2006 National Health and Nutrition Examination Survey (NHANES). WThe researchers found that people who exercise vigorously for 500 MET (metabolic equivalents) per week, displayed a 27% reduction in the odds of having elevated C-reactive protein levels, as compared to people who did not exercise.  As well, the team observed that people who exercised vigorously but did not reach the recommended levels also showed lower odds ratio for being in the high C-reactive protein level when compared with individuals who did not exercise vigorously during the week. 

http://www.medpagetoday.com/MeetingCoverage/WCIR/42804

Exercise Interventions Can Prevent Injurious Falls in Elders

Khoury F et al., BMJ 2013 Oct 29; 347:f6234

Most exercise programs included balance training.

Falls cause substantial morbidity among elders and are costly. Although exercise interventions can prevent falls in older adults, whether such interventions also prevent fall-associated injuries is unclear. To determine the effects of fall-prevention exercise interventions on fall-related injuries, investigators in France conducted a meta-analysis of 17 randomized trials that involved 4300 community-dwelling elders (mean age, 77).

Most exercise programs included gait-, balance-, and strength-training components. Four outcomes were assessed: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Compared with no intervention or placebo intervention (e.g., general health education class), exercise interventions significantly lowered the number of falls resulting in any injury (ranging from minor bruises to serious injuries such as fractures or head trauma; rate ratio, 0.6), falls resulting in medical care (RR, 0.7), falls resulting in serious injuries (RR, 0.6), and falls resulting in fractures (RR, 0.4). The interventions were effective regardless of baseline fall risk.

     This meta-analysis convincingly shows that exercise interventions prevent falls and fall-related injuries — both minor and major — in elders. Elders should be encouraged to participate in such programs, because one in three elders falls every year, falls are a leading cause of nonfatal and fatal injuries, and falls are associated with US$30 billion in direct medical costs annually.

Dietary Fiber Is Still Good for You

Dietary fiber's salutary effects on health — specifically in preventing cardiovascular disease — are reaffirmed in a BMJ meta-analysis.

Researchers examined 22 cohort studies in predominantly Westernized countries that looked at the relation between fiber intake and cardiovascular risk. Most data were from food-frequency questionnaires. The analysis presents risks based on dose-response curves rather than simple "high" or "low" intakes.

Overall, total fiber intake was inversely associated with cardiovascular risk. Specifically, each 7 grams a day of fiber intake was associated with a risk ratio of 0.9 for both coronary heart disease and cardiovascular disease. Only insoluble fiber (wheat bran, brown rice, and other whole grains) had a significant lowering of risk.

Both the researchers and an editorialist acknowledge the limitations of dietary-recall studies. The editorialist writes that despite this, "clinicians should enthusiastically and skillfully recommend" more fiber in their patients' diets.

BMJ article

Eating Nuts While Pregnant May Protect Offspring Against Allergies

Frequent nut consumption during pregnancy could protect offspring against nut allergies, according to a JAMA Pediatrics study.

Researchers studied physician-confirmed tree nut and peanut allergies among roughly 8200 children (ages 10 to 14 years) whose mothers had completed food-frequency questionnaires around the time they were pregnant.

Mothers who ate five or more servings of nuts per week had reduced risk for nut allergy among their offspring (adjusted odds ratio, 0.58), compared with those who ate less than one serving per month. Risk reductions were observed with just one to four weekly servings. For mothers with existing allergies to tree nuts, high consumption of peanuts (or vice versa) was associated with a nonsignificantly increased allergy risk in their children.

An editorialist concludes: "Pregnant women should not eliminate nuts from their diet as peanuts are a good source of protein and also provide folic acid, which could potentially prevent both neural tube defects and nut sensitization."

JAMA Pediatrics article 

Antihypertensive Effect of Flaxseed: From Lab to Clinic

 Rodriguez-Leyva D et al., Hypertension 2013 Dec 62:1081

In a small, randomized trial, increased flaxseed consumption was associated with substantial reductions in blood pressure.

In animal studies, flaxseed has demonstrated antiatherogenic and anti-inflammatory properties and beneficial effects on vascular contractile function. To examine the effects of flaxseed ingestion on systolic and diastolic blood pressure (BP) in patients with peripheral arterial disease (PAD), investigators conducted a double-blind, placebo-controlled, randomized trial supported by several Canadian agricultural-industry initiatives. For 6 months, 110 PAD patients received various food products containing 30 g of milled flaxseed or placebo for daily consumption. Mean baseline BP was similar in both groups.

By 6 months, 13 patients from the flaxseed group and 11 from the placebo group had dropped out of the study. Body weight, waist circumference, and body mass index did not differ significantly between the two groups. At 1 month, plasma levels of the omega-3 fatty acid alpha-linolenic acid and enterolignans — used as biomarkers of dietary compliance — had doubled and increased tenfold, respectively, in the flaxseed group; these increases persisted through 6 months. At 6 months, systolic and diastolic BPs were lower in the flaxseed group than in the placebo group by 10 mm Hg and 7 mm Hg, respectively. Reductions in systolic and diastolic BP in the flaxseed group were greater in patients with baseline systolic BP ≥140 mm Hg than in the cohort as a whole (15/7 mm Hg vs. 7/5 mm Hg).

Omega-3s May Combat Degenerative Vision Condition

Dietary supplementation of omega-3 fatty acids may combat inflammation in the eye and improve vision, among people with dry age-related macular degeneration.

Age-related macular degeneration (AMD) is the primary cause of blindness in individuals ages 50 years and older.  Tassos Georgiou, from the Ophthalamos Research & Educational Institute (Cyprus), and colleagues administered 3.4 g of eicosapentaenoic acid (EPA) and 1.6 g of.docosahexaenoic acid (DHA) on a daily basis for 6 months, to patients with dry AMD.  The team observed: "significant improvement in vision acuity occurred in 100% of patients …  within four and half months after omega-3 supplementation.”

http://www.nutraingredients-usa.com/Research/Omega-3-may-have-benefits-for-dry-AMD-Pilot-Study/

Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use

Conclusions FO was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission

Abstract

Background The effects of fish oil (FO) in rheumatoid arthritis (RA) have not been examined in the context of contemporary treatment of early RA. This study examined the effects of high versus low dose FO in early RA employing a ‘treat-to-target’ protocol of combination disease-modifying anti-rheumatic drugs (DMARDs).

Methods Patients with RA <12 months’ duration and who were DMARD-naïve were enrolled and randomised 2:1 to FO at a high dose or low dose (for masking). These groups, designated FO and control, were given 5.5 or 0.4 g/day, respectively, of the omega-3 fats, eicosapentaenoic acid + docosahexaenoic acid. All patients received methotrexate (MTX), sulphasalazine and hydroxychloroquine, and DMARD doses were adjusted according to an algorithm taking disease activity and toxicity into account. DAS28-erythrocyte sedimentation rate, modified Health Assessment Questionnaire (mHAQ) and remission were assessed three monthly. The primary outcome measure was failure of triple DMARD therapy.

Results In the FO group, failure of triple DMARD therapy was lower (HR=0.28 (95% CI 0.12 to 0.63; p=0.002) unadjusted and 0.24 (95% CI 0.10 to 0.54; p=0.0006) following adjustment for smoking history, shared epitope and baseline anti–cyclic citrullinated peptide. The rate of first American College of Rheumatology (ACR) remission was significantly greater in the FO compared with the control group (HRs=2.17 (95% CI 1.07 to 4.42; p=0.03) unadjusted and 2.09 (95% CI 1.02 to 4.30; p=0.04) adjusted). There were no differences between groups in MTX dose, DAS28 or mHAQ scores, or adverse events.

Conclusions FO was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs with similar MTX use. These included reduced triple DMARD failure and a higher rate of ACR remission.

http://www.mdlinx.com/internal-medicine/news-article-exit-page.cfm/4945742

Spearmint & Rosemary in the Battle Against Alzheimer’s

Enhanced extracts made from special antioxidants in spearmint and rosemary improve learning and memory, suggests data from a laboratory animal model.

Oxidative damage is considered one of the hallmarks of the aging process, with a number of previous studies demonstrating that the structural and functional damage to mitochondria characteristic in Alzheimer’s Disease.  Susan Farr, from St. Louis University (Missouri, USA), and colleagues administered enhanced extracts made from special antioxidants found in spearmint and rosemary, to a mouse model of age-related cognitive decline. The team found that a higher-dose rosemary extract compound was effective for improving memory and learning in three tested behaviors. The lower-dose rosemary extract, as well as the compound made from spearmint extract, improved memory in two behavioral tests. As well, the researchers observed that the enhanced herb extracts reduce the markers of oxidative stress. The  study authors conclude that: “The current results indicate that the extracts from spearmint (carnosic acid) and rosemary (rosmarinic acid) have beneficial effects on learning and memory and brain tissue markers of oxidation that occur with age in [a laboratory animal model].

http://www.slu.edu/x89155.xml

Effects of disease modifying anti-rheumatic drugs on subclinical atherosclerosis and endothelial dysfunction which has been detected in early rheumatoid arthritis: 1-year follow-up study

Abstract 

Objective

The study was designed to explore the effect of disease modifying anti-rheumatic drugs (DMARDs) on synovial inflammation as well as on atherosclerotic indices in patients with early rheumatoid arthritis (RA).

Methods

The study included 35 early RA patients (disease duration <12 months). Inflammatory variables, like erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hsCRP) were measured. Carotid intima-media thickness (cIMT) and endothelial dependent flow-mediated vasodilatation (ED-FMD) were measured by high-resolution ultrasonography. Disease activity of RA was assessed by disease activity score (DAS28) and quality of life was determined by Health Assessment Questionnaire-Disability Index (HAQ-DI) Score. All the above parameters were assessed both at baseline and follow-up after 1 year. Patients were treated with methotrexate (MTX), hydroxycholoroquine (HCQ) and sulfasalazine (SSZ) depending on their disease activity.

Results

After a year of treatment, variables like ESR, hsCRP, DAS28 and HAQ-DI showed significant improvement (p < 0.0001 for each variable). However, there was no such significant change observed in the lipid profile after 1 year from the baseline. Average body mass index (BMI) of patients remained same at the one year follow-up. The cIMT values after 1 year decreased significantly [0.43 ± 0.08 mm] from the baseline [0.50 ± 0.16 mm] [p = 0.002]. Similarly, in case of FMD%, the post-1-year treatment values [7.57 (4.04–13.03)] improved significantly from the baseline [5.26 (2.9–10.6)] [p = 0.041].

Conclusion

Subclinical atherosclerosis and endothelial dysfunction are demonstrable features even in early RA which improved after therapy. Early intervention of RA with DMARDs not only controls the disease but also retards the atherosclerotic progression

http://www.semarthritisrheumatism.com/article/S0049-0172(13)00008-5/abstract?rss=yes

Vitamin D Supplementation Increases Lower Limb Muscle Strength

SAN DIEGO, CA—Vitamin D supplementation has a positive effect on global muscle strength; specifically, lower limb muscle strength, a meta-analysis presented at the 2013 ACR/ARHP Annual Meeting has found.

Citing evidence that vitamin D plays a role in tissue that includes skeletal muscle and previous studies have suggested a deficiency of vitamin D is associated with low muscular strength, Charlotte Beaudart, PhD Candidate, of the Department of Public Health, Epidemiology and Health Economics at the University of Liège, Liège, Belgium, and colleagues examined systematic research of randomized controlled trials that assessed the effect of vitamin D supplementation on muscle strength conducted between 1966 and February 2013.

Data sources included Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, a manual review of the literature and congressional abstracts. The quality of the randomized controlled trials was evaluated using Jadad criteria.

“All forms and doses of vitamin D supplementation, with or without calcium supplementation, compared with placebo or control were included,” Beaudart reported. “Muscle strength was assessed either by grip strength and/or lower limb muscle strength.”

Of 214 articles, 19 randomized controlled trials met the inclusion criteria, with a mean quality Jadad score of 3.8 (of 5) points. A total of 4,824 individuals were included; mean age was 66 years.

“Results reveal a significant positive effect of vitamin D supplementation on global muscle strength with a standardized mean difference (SMD) of 0.096 (95% CI 0.007–0.184; P=0.034),” the investigators reported.

No significant between-study heterogeneity (Q-value 23.6; P=0.21; I²=19.6%) or publication bias were found.

Sweet potato for type 2 diabetes mellitus 
Cochrane Reviews, 11/04/2013 Evidence  Based Medicine  Clinical Article

Ooi CP, et al. – Sweet potato (Ipomoea batatas) is among the most nutritious subtropical and tropical vegetables. It is also used in traditional medicine practices for type 2 diabetes mellitus. Research in animal and human models suggests a possible role of sweet potato in glycaemic control. To assess the effects of sweet potato for type 2 diabetes mellitus. There is insufficient evidence about the use of sweet potato for type 2 diabetes mellitus. In addition to improvement in trial methodology, issues of standardization and quality control of preparations – including other varieties of sweet potato – need to be addressed. Further observational trials and RCTs evaluating the effects of sweet potato are needed to guide any recommendations in clinical practice.

Sweet potato (Ipomoea batatas) is a plant found in the tropical and subtropical belts and is one of the most nutritious tropical and subtropical vegetables. As well as being popular in cooking in countries in Asia-Pacific, Africa and North America, sweet potato is also used in traditional medicine for the treatment of diabetes mellitus. We decided to investigate whether there is enough evidence from medical trials to show whether sweet potato works as a treatment for diabetes. This review of randomised controlled trials found only three studies (with a total of 140 participants) that evaluated the effects of sweet potato for type 2 diabetes mellitus compared with a fake medicine (placebo). All these trials were of very low quality. Two studies with 122 participants showed improved long-term metabolic control of blood sugar levels as measured by glycosylated haemoglobin A1c (HbA1c) which was moderately lowered by 0.3% in participants who were given 4 g sweet potato tablets a day for three to five months. The duration of treatment ranged from six weeks to five months. No study investigated diabetic complications, death from any cause, health-related quality of life, well-being, functional outcomes or costs. Adverse effects were mostly mild, and included abdominal distension and pain. There are many varieties of sweet potatoes and sweet potato preparations. More trials are needed to assess the quality of the various sweet potato preparations as well as to evaluate further the use of different varieties of sweet potato in the diet of diabetic people.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009128.pub3/abstract

Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: A systematic review and meta-analysis Full

Yina M, et al. – Patients with type 2 diabetes have increased cancer risk and cancer–related mortality, which can be reduced by metformin treatment. However, it is unclear whether metformin can also modulate clinical outcomes in patients with cancer and concurrent type 2 diabetes. These results suggest that metformin is the drug of choice in the treatment of patients with cancer and concurrent type 2 diabetes.

Diatetes and cancer are not two separate irrelavant diseases, but are biologically related. There is evidence that diabetic patients have increased cancer risk and cancer-related mortality. (2). If there is no contraindications, cancer patients with concurrent type 2 diabetes should be advised to use metformin or metformin-containing regimen for their diabetic control, except lung cancer. This is because metformin or metformin-containing diabetic treatment is associated with increased overall survival and cancer-specific survival. (3). There is insufficient evidence to suggest metformin use in lung cancer patient with concurrent type 2 diabetes. (4). The mechanisms of survival benefit associated with metformin is mediated by direct effect of tumor inhibition and indirect effect of not inducing hyperinsulinemia, compared with other diabetic medications. (5). Metformin treatment is relatively safe in cancer patients. It is not carciongenic and does not promote tumor growth.

Conclusion. These results suggest that metformin is the drug of choice in the treatment of patients with cancer and concurrent type 2 diabetes.

http://www.ncbi.nlm.nih.gov/pubmed/24258613

 Extended-release niacin therapy and risk of ischemic stroke in patients with cardiovascular disease 
Stroke, 09/24/2013  Clinical Article

Teo KK et al. – In Atherothrombosis Intervention in Metabolic Syndrome with low HDL/High Triglycerides: Impact on Global Health Outcomes (AIM–HIGH) trial, addition of extended–release niacin (ERN) to simvastatin in participants with established cardiovascular disease, low high–density lipoprotein cholesterol, and high triglycerides had no incremental benefit, despite increases in high–density lipoprotein cholesterol. Preliminary analysis based on incomplete end point adjudication suggested increased ischemic stroke risk among participants randomized to ERN. Although there were numerically more ischemic strokes with addition of ERN to simvastatin that reached nominal significance, the number was small, and multivariable analysis accounting for known risk factors did not support a significant association between niacin and ischemic stroke risk.

Conclusions—Although there were numerically more ischemic strokes with addition of ERN to simvastatin that reached nominal significance, the number was small, and multivariable analysis accounting for known risk factors did not support a significant association between niacin and ischemic stroke risk.

http://stroke.ahajournals.org/content/44/10/2688.abstract

Green Coffee Extract: A Weight-Loss Aid?

Green coffee is simply coffee that has not been "cooked." Green coffee products are made from unroasted coffee beans, usually from the plant Coffea arabica.¹ Most of the world enjoys coffee products that are manufactured from roasted coffee beans.

The most widely known natural component of coffee is caffeine but, in reality, coffee contains hundreds of bioactive chemicals, many of which are more significant than caffeine.¹ Green coffee products have become widely popular as a potential weight-loss aid. 


Background


Green coffee extract contains chlorogenic acid, which is derived from a major group of phenolic compounds.² Green coffee beans contain nearly twice the concentration of chlorogenic acid as do roasted beans. Chlorogenic acid is a major component of many OTC weight-loss products and acts independently of caffeine.²

The theorized mechanism of action by which green coffee produces weight loss is through the inhibition of the enzyme glucose-6-phosphatase.³ In vitro, glucose-6-phosphatase induces the enzymatic process of glucose production in the liver.³ It is this step in the metabolic pathway that researchers attribute to the known reduction of glycemic disorders in long-term coffee-drinkers.⁴ 


Science 


Green coffee extract is believed to aid weight loss. One trial evaluated the responses of 16 overweight adults who had been randomized to high-dose extract, low-dose extract, or placebo in a 22-week study.⁵ Body weight decreased by a mean of 8 lbs, with a mean drop in body fat of more than 4%.⁵ 


In another study, 50 volunteers with body mass indices >25 were randomized to placebo or to treatment with green coffee extract.⁶ After 60 days, members of the treatment group had lost an average of 5.7% of their body weight, with a shift in the muscle-mass-to-fat-mass ratio of +4.1%/-0.7% from baseline.⁶

In a trial designed to compare the effect of green coffee vs. roasted coffee on BP measurements, researchers randomized more than 200 subjects to either a placebo coffee drink or a drink with low, medium, or high chlorogenic-acid content.⁷

Each participant drank one cup of the treatment coffee per day and recorded BP readings for one month. At the end of the trial, not only were the BP readings of the placebo group higher than the BP readings of the treatment group, but a definite dose-response curve for the three treatment dose levels also was seen.

This indicates that the beneficial effect of coffee intake on BP has nothing to do with caffeine, but rather with the chlorogenic acid content. These findings have been validated by multiple studies examining different green coffee extract concentrations and populations.^{8, 9} In each trial, a statistically significant reduction of systolic BP was seen with no documented adverse effects. 


Researchers looking at human vasoreactivity monitored nitric oxide activity in individuals after daily intake of a measured amount of green coffee extract. For four months, parameters indicative of endothelial function were monitored daily. At the end of the test period, the vasodilatory response was found to be significantly higher in the test group than in the placebo group, and total plasma homocysteine levels were also lower than at baseline.¹⁰ 


A small lab study using human cell culture lines focused on the chemoprotective and antigenotoxic activities of green coffee extract.¹¹ Human colon and liver cells were treated with a dose-calculated solution of chlorogenic acid and cultured under the same conditions as the placebo cell cultures. Both cell lines were then tested for levels of oxidative stress, such as membrane disruption, DNA damage, and cell death.

This article originally appeared on Clinical Advisor.

  Insulin Sensitizers Linked With Reduced Risk of Cancer in Women

 (HealthDay News) – Insulin sensitizers, particularly thiazolidinedione use, may reduce the risk of cancer in female patients with type 2 diabetes, according to research published online Dec. 5 in Diabetes, Obesity and Metabolism.

Grace E. Ching Sun, DO, from the Cleveland Clinic, and colleagues retrospectively analyzed the electronic health record-based Cleveland Clinic Diabetes Registry (25,613 patients) and cross-indexed it with the histology-based tumor registry (48,051 cancer occurrences) over an eight-year period (1998–2006).

The researchers found that over the study period there were 892 incident cancer cases. Prostate and breast cancers were the most common (14.5% and 11.7%, respectively). The cancer risk in women was decreased 32% with thiazolidinedione use compared with sulphonylurea use (hazard ratio [HR], 0.68). The cancer risk was reduced 21% with insulin sensitizers (biguanides and thiazolidinediones) compared to insulin secretagogues (sulphonylureas and meglitinides) (HR, 0.79). In men there were no differences in oral diabetes therapies and risk of cancer.

"Oral insulin sensitizers are associated with decreased malignancy risk in women with type 2 diabetes mellitus," Sun and colleagues conclude.

One author disclosed financial ties to the pharmaceutical industry; the diabetes registry was supported by funds from the pharmaceutical industry.

Abstract
Full Text

Combination in Patients With Diabetes Mellitus and Acute Coronary Syndrome

Acute coronary syndromes (ACS) in patients with diabetes mellitus (DM) are associated with a high risk for major adverse cardiovascular events (MACEs) despite statin treatment. The impact of combined bezafibrate and statin therapy in patients with DM and ACS has not been specifically investigated. The aim of this study was to evaluate the association of combined therapy with 30-day MACEs in patients with DM participating in the nationwide Acute Coronary Syndrome Israeli Surveys (ACSIS). The study population comprised 3,063 patients with DM from the ACSIS 2000, 2002, 2004, 2006, 2008, and 2010 enrollment waves who were alive at discharge and received statins. Of these, 225 (7.3%) received on discharge combined bezafibrate and statin therapy, and 2,838 (92.7%) were treated with statins alone. MACEs were defined as a composite measure of death, recurrent myocardial infarction, recurrent ischemia, stent thrombosis, ischemic stroke, and urgent revascularization. The development of 30-day MACEs was recorded in 8% patients receiving combination therapy and 14.2% of those receiving statins alone (p = 0.01). Crude 1-year mortality and 30-day rehospitalization rates were also significantly lower in patients receiving combination therapy: 4.0% versus 8.1% (p = 0.03) and 13.3% versus 21.6% (p = 0.003), respectively. Multivariate analysis identified combined therapy as an independent predictor of reduced risk for 30-day MACEs, with an odds ratio of 0.56 (95% confidence interval 0.34 to 0.92), corresponding to a 44% relative risk reduction. In conclusion, a significantly lower risk for 30-day MACEs was observed in statin-treated patients with DM who also received bezafibrate after ACS. Signals regarding improvement of 30-day rehospitalization and 1-year mortality rates emerged as wel

http://www.ajconline.org/article/S0002-9149(13)01917-6/abstract?rss=yes

Colorectal Cancer Associated with Decreased Variety in Gut Microbiota

Patients with colorectal cancer have a narrower range of fecal bacteria, according to a study in the Journal of the National Cancer Institute. Editorialists express enthusiasm for the results, but caution that "a lot more research" is needed before the findings can be used clinically.

Researchers analyzed bacterial DNA from fecal samples that were collected roughly 25 years ago in a case-control study of patients with colorectal cancer; the controls were patients undergoing elective surgery. Fecal samples were collected after confirmation of the diagnosis, but before therapy.

Patients with cancer had decreased overall diversity of bacteria in their gut relative to the controls. For example, they had a lower relative abundance of Clostridia species, but an increased presence ofFusobacterium.

The editorialists write that the "exciting" findings echo similar observations that have suggested a role for the microbiota in colorectal cancer.

JNCI article

Wider Role for HDL in Controlling Inflammation?

You may have wondered how HDL plays its "good cholesterol" role. According to a Nature Immunology study, HDL increases the activity of a transcriptional regulator, ATF3, which limits the inflammatory responses in macrophages.

The study authors think that this action of HDL "may be beneficial in other chronic inflammatory diseases."

Nature Immunology article 

At Least Half of Cardiovascular Risk Associated with Adiposity Is Mediated by Metabolic Risk Factors

The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects)., Lancet 2013 Nov 22;

Blood pressure alone accounted for one third of excess risk for coronary heart disease.

HbA_1c and Severe Hypoglycemia in Type 2 Diabetes

Lipska KJ et al., Diabetes Care 2013 Nov 36:3535

Hypoglycemia appears to be more common at both the lowest and highest glycosylated hemoglobin levels.

Exposure to Arsenic and Incident Cardiovascular Disease

Moon KA et al., Ann Intern Med 2013 Nov 19; 159:649

Even low to moderate exposure is associated with elevated risk for heart disease and stroke.

Should We Lower Blood Pressure in Acute Ischemic Stroke?

He J et al., JAMA 2013 Nov 17;

In a randomized trial, outcomes were neither better nor worse with early antihypertensive therapy.

Duration of Diabetes Impacts Outcomes at Any Age

 (HealthDay News) – Type 2 diabetes morbidity and mortality are associated with disease duration and advancing age, according to a study published online Dec. 9 in JAMA Internal Medicine.

Elbert S. Huang, MD, MPH, from the University of Chicago, and colleagues compared rates of diabetes complications and mortality across age categories (60–69 years, 70–79 years, ≥80 years) and diabetes duration categories (0–9 years and ≥10 years) using data from 72,310 older patients with type 2 diabetes.

The researchers found that for older adults with shorter diabetes duration the most common nonfatal complications were cardiovascular complications and hypoglycemia. For example, among 70- to 79-year-olds with short duration of diabetes, coronary artery disease and hypoglycemia rates were higher (11.47 and 5.03 per 1,000 person-years, respectively) than end-stage renal disease, lower limb amputation, and acute hyperglycemic events (2.6, 1.28, and 0.82 per 1,000 person-years, respectively). Patients in the same age group with a long duration of diabetes had a similar pattern (rates of 18.98 and 15.88, compared with 7.64, 4.26, and 1.76, respectively). For a given age group, longer disease duration was associated with a considerable increase in the rates of each outcome, especially hypoglycemia and microvascular complications. The rates of hypoglycemia, cardiovascular complications, and mortality increased with advancing age for a given duration of diabetes, while the rates of microvascular complications remained stable or decreased.

"The data from this study may inform the design and scope of public policy interventions that meet the unique needs of elderly patients with the disease," the authors write.

Abstract

What You Need to Know About the New ACC/AHA Guideline 

Diet Influences Cancer

Men with prostate cancer who consumr a low-fat fish oil diet show beneficial changes in their cancer tissue.

Prostate cancer is a leading cause of death among men in the United States. University of California/Los Angeles (UCLA; California, USA) researchers have previously found that a low-fat diet with fish oil supplements eaten for four to six weeks prior to prostate removal slowed the growth of cancer cells in human prostate cancer tissue compared to a traditional, high-fat Western diet. Led by William Aronson, that study  also found that the men on the low-fat fish oil diet were able to change the composition of their cell membranes in both the healthy cells and the cancer cells in the prostate. They had increased levels of omega-3 fatty acids from fish oil and decreased levels of the more pro-inflammatory omega-6 fatty acids from corn oil in the cell membranes, which may directly affect the biology of the cells.  The present study reports that men with prostate cancer who ate a low-fat diet and took fish oil supplements have lower levels of pro-inflammatory substances in their blood and a lower cell cycle progression (CCP) score, which may help prevent prostate cancers from becoming more aggressive.

Soy and Tomato Combo Best For Prostate Cancer Prevention

Study results suggest that eating a combination of tomatoes and soy foods offers the most effective protection against prostate cancer.

New research suggests that men could help to protect themselves from prostate cancer by eating a combination of tomatoes and soy foods. John Erdman, a professor of food science and nutrition at the University of Illinois, and colleagues studied the effect of diet on mice genetically engineered to develop an aggressive form of prostate cancer.  Between the age of 4 and 18-weeks old the mice were fed 1 of 4 diets: 10% whole tomato powder; 2% soy germ; 10% whole tomato powder and 2% soy germ; or a control diet containing neither tomato nor soy. Results showed that only 45% of mice fed a combination of tomato and soy had developed prostate cancer by the end of the study, whereas 66% of mice who received tomato or soy developed the disease. In contrast, 100% of mice in the control group developed prostate cancer. "Eating tomato, soy, and the combination all significantly reduced prostate cancer incidence. But the combination gave us the best results,” said Professor Erdman. Study co-author Krystle Zuniga added: "The results of the mouse study suggest that 3 to 4 servings of tomato products per week and 1 to 2 servings of soy foods daily could protect against prostate cancer." The researchers recommend eating whole tomatoes and drinking soy milk instead of taking lycopene and soy isoflavones supplements.

http://www.eurekalert.org/pub_releases/2013-05/uoic-sat050813.php

Coffee Compounds Assist Heart Health

Polyphenols in coffee may improve the function of the cells lining blood vessels among healthy men.

The cells that line blood vessels, known as the endothelium, perform many functions including to maintain elasticity of blood vessels and regulate the activity of immune cells. Endothelial function is measured by detecting transient increases in blood flow, a marker known as the reactive hyperemia index (RHI). Japanese researchers enrolled a group of healthy, non-diabetic men in a study in which each was randomly assigned to consume = a 75 g glucose load either with or without green coffee bean polyphenols. The team observed that blood glucose and insulin levels increased after both interventions, and there were no differences between the groups. However, the reactive hyperemia index rose significantly in the polyphenol group, as compared to their starting levels. The study authors conclude that: "These findings suggest that a single ingestion of [coffee polyphenols] improves peripheral endothelial function after glucose loading in healthy subjects.”

http://www.nutraingredients-usa.com/Research/Coffee-polyphenols-show-heart-health-potential-for-healthy-men-Study/

Chelation Therapy Reduces Heart Attacks & Death

The treatment that is utilized to detoxify the body is shown to reduce the incidence of cardiovascular events and death in people with diabetes.

Chelation therapy reduces cardiovascular events for older patients with diabetes

Chelation treatments reduced cardiovascular events, such as heart attacks, and death in patients with diabetes but not in those who did not have diabetes, according to analyses of data from the National Institutes of Health-funded Trial to Assess Chelation Therapy (TACT). However, researchers say more studies are needed before it’s known whether this promising finding leads to a treatment option.

Chelation is a chemical process in which a substance is delivered intravenously (through the veins) to bind atoms of metals or minerals, and hold them tightly so that they can be removed from the body. Chelation is conventionally used as a treatment for heavy metal (like lead) poisoning, although some people use chelation as an unapproved and unproven treatment for conditions like heart disease.

Chelation therapy is not approved by the U.S. Food and Drug Administration to treat heart disease. However, use of chelation therapy to treat heart disease and other health problems grew in the United States between 2002 and 2007 by nearly 68 percent to 111,000 people, according to the 2008 National Health Statistics Report.

The diabetes subgroup analysis of TACT was published today in Circulation: Cardiovascular Quality and Outcomes and presented at the American Heart Association’s Scientific Sessions 2013. TACT is a study supported by NIH’s National Center for Complementary and Alternative Medicine (NCCAM) and National Heart, Lung, and Blood Institute (NHLBI).

TACT’s initial report was published in the March 27, 2013, issue of The Journal of the American Medical Association. This previous report showed that infusions of a form of chelation therapy using disodium ethylene diamine tetra-acetic acid (EDTA) produced a modest but statistically significant reduction in cardiovascular events in all EDTA-treated participants. However, further examination of the data showed that patients with diabetes were significantly impacted by chelation therapy while patients without diabetes were not.

The patients with diabetes, which made up approximately one third of 1,708 participants, demonstrated a 41 percent overall reduction in the risk of any cardiovascular event; a 40 percent reduction in the risk of death from heart disease nonfatal stroke, or nonfatal heart attack; a 52 percent reduction in recurrent heart attacks; and a 43 percent reduction in death from any cause. In contrast, there was no significant benefit of EDTA treatment in the subgroup of 1,045 participants who did not have diabetes.

“These are striking results that, if supported by future research, could point the way towards new treatments to prevent complications of diabetes,” said Gervasio A. Lamas, M.D., the study’s principal investigator and chairman of medicine and chief of the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami Beach.

From 2003 to 2010, 1,708 adults aged 50 and older were enrolled in TACT, of whom 633 had diabetes. Study participants had suffered a heart attack 6 weeks or more before enrollment (on average, the heart attack occurred about 4.5 years earlier). The participants were assigned randomly to receive 40 infusions of disodium EDTA chelation solution or a placebo solution. Patients also were randomly assigned to receive high doses of oral vitamins and minerals or an identical oral placebo. Most participants also took standard medicines for heart attack survivors, such as aspirin, beta blockers, and statins. They were followed for a minimum of 1 year and up to 5 years, with followup ending in October 2011.

TACT was not designed to discover how or why chelation might benefit patients with diabetes.

“Although subgroup analyses of clinical trials do not provide definitive answers, they are very useful in identifying future research questions,” said Josephine Briggs, M.D., Director of NCCAM. “The effects seen in this population are large and very intriguing. This analysis suggests strongly that more research is needed to examine possible benefits of chelation in diabetics and the potential mechanisms.”

“We share Dr. Briggs’s interest in these compelling findings,” said Michael Lauer, M.D., Director of the NHLBI’s Division of Cardiovascular Sciences. “Additional studies are needed before we can determine the potential place of EDTA chelation therapy, if any, in the treatment of patients with coronary artery disease and diabetes.”

TACT was supported by grants from the NIH’s NCCAM (U01AT001156) and NHLBI (U01HL092607).

For more information or to arrange an interview with an NIH spokesperson, please contact the NCCAM Communications Office at 301-496-7790 or nccampress@mail.nih.gov. To schedule an interview with Dr. Lamas, contact Robert Alonso at 305-674-2600 or Robert.Alonso@msmc.com. Follow Dr. Lamas on Twitter  .

Part of the National Institutes of Health, the mission of The National Center for Complementary and Alternative Medicine (NCCAM) is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care. For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM website at http://nccam.nih.gov. Follow us onTwitter  , Facebook  , and YouTube  .

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online atwww.nhlbi.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visitwww.nih.gov.

New JNC 8 Hypertension Guidelines: What Does the Panel Recommend Now?

The Eighth Joint National Committee (JNC 8) has released new guidelines on the management of adult hypertension. 

RELATED: Cardiovascular Disease Resource Center

The authors formed nine recommendations which are discussed in detail along with the supporting evidence. Evidence was taken from randomized controlled trials, the gold standard for establishing efficacy and effectiveness. Some of the new major recommendations include:

1.  In patients aged ≥60 years, initiate pharmacologic treatment in systolic BP ≥150mmHg or diastolic BP ≥90mmHg and treat to a goal systolic BP <150mmHg and goal diastolic BP <90mmHg.  (Strong Recommendation–Grade A)

2.  In patients aged <60 years, initiate pharmacologic treatment at diastolic BP ≥90mmHg and treat to a goal <90mmHg. (For ages 30–59 years, Strong Recommendation–Grade A; For ages 18–29 years, Expert Opinion–Grade E)

3.  In patients aged <60 years, initiate pharmacologic treatment at systolic BP ≥140mmHg and treat to a goal <140mmHg. (Expert Opinion–Grade E)

4.  In patients aged ≥18 years with chronic kidney disease, initiate pharmacologic treatment at systolic BP ≥140mmHg or diastolic BP ≥90mmHg and treat to goal systolic BP <140mmHg and goal diastolic BP <90mmHg. (Expert Opinion–Grade E)

5.  In patients aged ≥18 years with diabetes, initiate pharmacologic treatment at systolic BP ≥140mmHg or diastolic BP ≥90mmHg and treat to a goal systolic BP <140mmHg and goal diastolic BP <90mmHg. (Expert Opinion–Grade E)

6.  In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, CCB, ACE inhibitor, or ARB. (Moderate Recommendation–Grade B) This recommendation is different from the JNC 7 in which the panel recommended thiazide-type diuretics as initial therapy for most patients.

7.  In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation - Grade B; for black patients with diabetes: Weak Recommendation–Grade C)

8.  In the population aged ≥18 years with chronic kidney disease, initial (or add-on) antihypertensive treatment should include an ACE inhibitor or ARB to improve kidney outcomes. (Moderate Recommendation–Grade B)

9.  If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in Recommendation 6. If goal BP cannot be reached with two drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using only the drugs in Recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. (Expert Opinion–Grade E)

The full guidelines have been published online at JAMA.

Risk of Developing Diverticulitis Lower Than Thought

(HealthDay News) – Only about 4% of patients with an incidental finding of diverticulosis progress to acute diverticulitis in the long term, according to research published in the December issue ofClinical Gastroenterology and Hepatology.

Kamyar Shahedi, MD, of the University of California in Los Angeles, and colleagues retrospectively analyzed data from the Veterans Affairs Greater Los Angeles Healthcare System from January 1996 through January 2011 to measure the long-term risk of acute diverticulitis among patients with diverticulosis discovered incidentally during colonoscopy.

The researchers found that 95 of 2,222 patients with diverticulosis (4.3%) developed diverticulitis during the 11-year follow-up period. Among these patients, 23 (1%) met the rigorous definition of diverticulitis. The median time-to-event for the development of diverticulitis was 7.1 years. For each additional decade of age at the time of diagnosis of diverticulosis, the risk of developing diverticulitis was reduced by 24% (hazard ratio, 0.76).

"These results question the traditional teaching about the rate of progression from incidental diverticulosis to acute diverticulitis," the authors write. "Moreover, they also suggest that patients who are diagnosed with diverticulosis at a younger age may incur more risk of developing diverticulitis."

Shire Development funded the study; several authors disclosed financial ties to pharmaceutical companies, including Shire Pharmaceuticals.

Abstract
Full Text

Metformin Leads to Modest Reductions in BMI Among Nondiabetic Children

Adding metformin to lifestyle interventions in nondiabetic children leads to modest reductions in BMI, but the clinical benefit is uncertain, according to a review in JAMA Pediatrics.

Researchers examined data from 14 randomized trials comparing metformin with a control intervention in some 950 overweight or obese children aged 10 to 16 years without diabetes. For the most part, participants received metformin plus a lifestyle intervention or a lifestyle intervention alone.

In studies lasting 6 to 12 months, metformin plus lifestyle interventions conferred a 1.4-unit greater reduction in BMI than lifestyle interventions alone. Gastrointestinal events were the most common side effects.

The researchers write: "Although these findings are based on statistically significant, moderate-strength evidence, the clinical benefit of such a small reduction in BMI is certainly questionable." They call for larger trials to "determine whether there are specific patients who may have a clinical, and not just statistical, benefit from treatment."

JAMA Pediatrics article

Some ARBs May Outperform Others in Lowering CV Risk in Diabetes

The angiotensin-receptor blockers telmisartan and valsartan might help prevent major cardiovascular events better than other ARBs in patients with diabetes, according to a CMAJ study.

Using Canadian databases, researchers identified 54,000 older adults with diabetes who were first-time users of ARBs. After multivariable adjustment, both telmisartan and valsartan were associated with about a 15% reduction in risk for hospital admission for acute myocardial infarction, heart failure, or stroke, compared with irbesartan. The risk was not significantly reduced for candesartan or losartan.

The authors conclude that "a class effect may not be assumed when using angiotensin-receptor blockers for the prevention of diabetes-related macrovascular complications or heart failure, and that telmisartan and valsartan may be the preferred drugs for this indication." Meanwhile, a commentator concludes, "without appropriately designed randomized controlled trials, there is scant evidence to support preferring one drug in this class over another for patients with type 2 diabetes."

CMAJ article 

ACE-Inhibitors and ARBs Associated with Reduced Need for Dialysis in Advanced CKD

Use of either angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) — but not the two together — may reduce the need for dialysis in patients with advanced chronic kidney disease, a JAMA Internal Medicine study finds.

Researchers in Taiwan studied antihypertensive use among roughly 28,000 patients who had predialysis stage 5 CKD, hypertension, and anemia.

During a median 7 months' follow-up, patients taking ACE-inhibitors or ARBs had a lower likelihood of long-term dialysis (hazard ratio, 0.94) and the composite outcome of dialysis or death (HR, 0.94), compared with nonusers. Concomitant ACE-inhibitor/ARB use wasn't associated with risk reduction. Hospitalization for hyperkalemia was more common among ACE-inhibitor/ARB users than nonusers (9.2% vs. 6.7%).

Commentators write: "For selected patients with no history of severe hyperkalemia or prior repeated episodes of acute kidney injury and with good adherence to laboratory monitoring, clinicians may elect to continue [renin-angiotensin-aldosterone system] blockade even in advanced CKD in an effort to delay the onset of end-stage renal disease."

JAMA Internal Medicine article

Optimal Testosterone Levels Predict Better Survival in Older Men

Optimal testosterone levels are a biomarker for better survival in older men, according to a new study.

The study of 3,690 community-dwelling men aged 70-89 years showed that those with midrange levels of testosterone and dihydrotestosterone (DHT) had the lowest all-cause mortality and those with higher DHT had lower mortality from ischemic heart disease (IHD). Estradiol levels did not predict all-cause or IHD mortality.

Of the 3,690 men, 974 (26.4%) died, including 325 who died from IHD. Men who died had significantly lower mean baseline total testosterone levels (12.8 vs. 13.2 nmol/L), DHT levels (1.4 vs. 1.5 nmol/L), and estradiol (71.6 vs. 74.0 pmol/L), Bu Beng Yeap, MBBS, PhD, of Fremantle Hospital in Fremantle, Western Australia, and colleagues reported online ahead of print in The Journal of Clinical Endocrinology & Metabolism.

After controlling for other risk factors, men in the second and third quartiles of total testosterone had a significant 18% and 22% decreased risk of death from any cause, respectively, compared with those in the first quartile. Men in the third quartile of DHT had a significant 24% decreased risk of death from any cause compared with men in the first quartile. Death risk was not significantly lower among men in the fourth quartile of total testosterone or DHT compared with the first quartile.

Additionally, results showed that men in the third or fourth quartiles of DHT had a significant 42% and 31% decreased risk of death from IHD, respectively, compared with men in the first quartile.

Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels.

IMPORTANCE:

Rates of testosterone therapy are increasing and the effects of testosterone therapy on cardiovascular outcomes and mortality are unknown. A recent randomized clinical trial of testosterone therapy in men with a high prevalence of cardiovascular diseases was stopped prematurely due to adverse cardiovascular events raising concerns about testosterone therapy safety.

OBJECTIVES:

To assess the association between testosterone therapy and all-cause mortality, myocardial infarction (MI), or stroke among male veterans and to determine whether this association is modified by underlying coronary artery disease.

DESIGN, SETTING, AND PATIENTS:

A retrospective national cohort study of men with low testosterone levels (<300 ng/dL) who underwent coronary angiography in the Veterans Affairs (VA) system between 2005 and 2011.

MAIN OUTCOMES AND MEASURES:

Primary outcome was a composite of all-cause mortality, MI, and ischemic stroke.

RESULTS:

Of the 8709 men with a total testosterone level lower than 300 ng/dL, 1223 patients started testosterone therapy after a median of 531 days following coronary angiography. Of the 1710 outcome events, 748 men died, 443 had MIs, and 519 had strokes. Of 7486 patients not receiving testosterone therapy, 681 died, 420 had MIs, and 486 had strokes. Among 1223 patients receiving testosterone therapy, 67 died, 23 had MIs, and 33 had strokes. The absolute rate of events were 19.9% in the no testosterone therapy group vs 25.7% in the testosterone therapy group, with an absolute risk difference of 5.8% (95% CI, -1.4% to 13.1%) at 3 years after coronary angiography. In Cox proportional hazards models adjusting for the presence of coronary artery disease, testosterone therapy use as a time-varying covariate was associated with increased risk of adverse outcomes (hazard ratio, 1.29; 95% CI, 1.04 to 1.58). There was no significant difference in the effect size of testosterone therapy among those with and without coronary artery disease (test for interaction, P = .41).

CONCLUSIONS AND RELEVANCE:

Among a cohort of men in the VA health care system who underwent coronary angiography and had a low serum testosterone level, the use of testosterone therapy was associated with increased risk of adverse outcomes. These findings may inform the discussion about the potential risks of testosterone therapy.

http://www.ncbi.nlm.nih.gov/pubmed/24193080

BMD Testing Every 2 Years May Not Improve Fracture Risk Prediction

The current practice of testing bone mineral density every 2 years in older adults may be too frequent, suggests a JAMA study.

Roughly 800 adults (mean age, 75) underwent two femoral neck BMD tests an average of 3.7 years apart as part of the Framingham Osteoporosis Study. After 10 years of follow-up, the addition of BMD change to a model predicting fracture risk did no better than use of baseline BMD alone. With a second BMD test, the percentage of patients with a hip fracture reclassified as high risk increased only 3.9%, while those with a major osteoporotic fracture who were upgraded to high risk increased 9.7%.

The authors conclude: "The current clinical practice of repeating a BMD test every 2 years to improve fracture risk stratification may not be necessary in all adults 75 years or older untreated for osteoporosis. Further study is needed to determine an appropriate rescreening interval and to identify individuals who might benefit from more frequent rescreening intervals."

JAMA article

Effect of Soy Protein Isolate Supplementation on Biochemical Recurrence of Prostate Cancer After Radical ProstatectomyA Randomized Trial

Importance  Soy consumption has been suggested to reduce risk or recurrence of prostate cancer, but this has not been tested in a randomized trial with prostate cancer as the end point.

Objective  To determine whether daily consumption of a soy protein isolate supplement for 2 years reduces the rate of biochemical recurrence of prostate cancer after radical prostatectomy or delays such recurrence.

Design, Setting, and Participants  Randomized, double-blind trial conducted from July 1997 to May 2010 at 7 US centers comparing daily consumption of a soy protein supplement vs placebo in 177 men at high risk of recurrence after radical prostatectomy for prostate cancer. Supplement intervention was started within 4 months after surgery and continued for up to 2 years, with prostate-specific antigen (PSA) measurements made at 2-month intervals in the first year and every 3 months thereafter.

Intervention  Participants were randomized to receive a daily serving of a beverage powder containing 20 g of protein in the form of either soy protein isolate (n=87) or, as placebo, calcium caseinate (n=90).

Main Outcomes and Measures  Biochemical recurrence rate of prostate cancer (defined as development of a PSA level of ≥0.07 ng/mL) over the first 2 years following randomization and time to recurrence.

Results  The trial was stopped early for lack of treatment effects at a planned interim analysis with 81 evaluable participants in the intervention group and 78 in the placebo group. Overall, 28.3% of participants developed biochemical recurrence within 2 years of entering the trial (close to the a priori predicted recurrence rate of 30%). Among these, 22 (27.2%) occurred in the intervention group and 23 (29.5%) in the placebo group. The resulting hazard ratio for active treatment was 0.96 (95% CI, 0.53-1.72; log-rank P = .89). Adherence was greater than 90% and there were no apparent adverse events related to supplementation.

Conclusion and Relevance  Daily consumption of a beverage powder supplement containing soy protein isolate for 2 years following radical prostatectomy did not reduce biochemical recurrence of prostate cancer in men at high risk of PSA failure.

http://jama.jamanetwork.com/article.aspx?articleID=1710457&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=MASTER%3AJAMALatestIssueTOCNotification07%2F09%2F2013

FDA warns of renal failure with Byetta

The FDA has notified healthcare professionals that the Prescribing Information for Byetta (exenatide injection, from Amylin and Lilly) has been revised to include information on post-marketing reports of altered kidney function, including acute renal failure and insufficiency.

Fiber intake and heart disease risk
Low dietary fiber intake from 1999 to 2010 in the US, and associations between higher dietary fiber and a lower prevalence of cardiometabolic risks, suggest the need to develop new strategies and policies to increase dietary fiber intake. The American Journal of Medicine

Antibiotics overprescribed for skin infections
Approximately half of uncomplicated skin infections involved avoidable antibiotic exposure. Antibiotic use could be reduced through treatment approaches using short courses of a single antibiotic. The American Journal of Medicine 

Metformin has different cardiac effects on men and women
Metformin treatment alone was associated with lower fat metabolism and increased cardiac glucose uptake in women, but it had negative effects on heart metabolism in men, according to a study in the American Journal of Physiology -- Heart and Circulatory Physiology. Researchers said the findings shed light on why diabetes drug trials show conflicts and also underscore the need to determine optimal treatments for men and women. HealthDay News(12/16), RedOrbit 

Older women spend a majority of their day being sedentary
Among more than 7,200 older women, the average amount of time spent in sedentary behavior was 9.7 hours each day, or 65.5% of their waking hours, according to a study published in JAMA. Researchers noted that about one-third of sedentary periods lasted approximately 30 minutes. Family Practice News

Handgrip predicts hip surgery outcome
In older patients with hip fractures, early grip strength evaluation might provide important prognostic information regarding the patient's future functional trajectory. The American Journal of Medicine 

High-density lipoprotein function in heart failure
This study concluded that high-density lipoprotein function is significantly impaired, and oxidation products of arachidonic and linoleic acids are markedly elevated, in patients with heart failure compared to non-heart failure controls. The American Journal of Cardiology(12/15/2013)

Cholesterol, statins and longevity from age 70 to 90
The debate over cholesterol and statins is even more controversial when talking about the elderly. A research study out of Israel found that statin use from age 85 to 90 was actually associated with decreased mortality. Also surprisingly, survival was significantly increased in those treated with statins versus no statins aged 78 to 85. The noninterventional nature of the study may limit conclusions that can be drawn from it, but it will certainly stimulate debate, and, hopefully, further studies. (Free abstract only.) Journal of the American Medical Directors Association(12/2013)

Age, disease duration affect morbidity in type 2 diabetes
A report in JAMA Internal Medicine revealed that age and disease duration played key roles in hypoglycemia and other complications in type 2 diabetes patients. Researchers examined 72,310 patients and found hypoglycemic events ranged between 3 per 1,000 person-years in youngest patients with the shortest disease duration to 19.6 per 1,000 person-years among the oldest patients with the longest disease duration, which suggest that intensive glucose control may not yield benefits in the latter group. Family Practice News 

Narrow- and broad-spectrum antibiotics work equally well in pneumonia
U.S. researchers looked at nearly 500 patients with pneumonia aged 2 months to 18 years and found no substantial differences in readmission rates, fever duration and length of oxygen time between those treated with narrow-spectrum antibiotics and those given broad-spectrum drugs. However, the study published in the journal Pediatrics showed that the length of stay in the narrow-spectrum group was 10 hours shorter than the broad-spectrum patients.DailyRx.com

Fiber intake and heart disease risk
Low dietary fiber intake from 1999 to 2010 in the US, and associations between higher dietary fiber and a lower prevalence of cardiometabolic risks, suggest the need to develop new strategies and policies to increase dietary fiber intake. The American Journal of Medicine

Dietary Supplements Blamed for Sharp Rise in Drug-Related Liver Injuries

Dietary supplements, including many marketed for muscle-building and weight loss, account for a spike in drug-related liver injuries over the past decade, according to a front-page story in Sunday's New York Times. Many patients ultimately recover, but some end up requiring transplants or dying from liver failure.

Supplements accounted for nearly 20 percent of drug-related liver injuries that led to hospitalization in 2010-2012, the Times reports, up from 7 percent in 2004. The data, from the NIH's National Liver Network, showed that many of the products were bodybuilding supplements that contained steroids not listed on the label. Use of green tea extract was also frequently reported. The extract contains catechins, which are said to increase metabolism; in high doses, they can cause liver toxicity.

Of over 50,000 supplements sold in the U.S., less than 1% have been examined well enough to determine their adverse effect profile, one expert told the Times.

New York Times story

Early Doses of Warfarin Paradoxically Associated with Higher Stroke Risk

Patients with atrial fibrillation seem to be at increased risk for ischemic stroke when starting warfarin prophylaxis, according to a case-control study in the European Heart Journal.

The study was undertaken after trials of both apixaban and rivaroxaban noted increased stroke risks among patients transitioning to open-label warfarin. This study was funded by the makers of apixaban.

Using a U.K. database, researchers examined a cohort of some 70,000 patients with AF; they matched 5500 cases of ischemic stroke with 55,000 controls. AF patients initiating warfarin therapy had a 71% increased risk for ischemic stroke within the first 30 days of therapy, compared with those on no anticoagulants. The risk was highest in the first week. However, the warfarin group had half the stroke risk after 30 days.

The authors say the observed "paradoxical procoagulant effect" may be due to warfarin's effect in blocking some endogenous anticoagulants.

European Heart Journal article

* ALZHEIMER'S / DEMENTIA News **


Enzyme BACE1 may be important in predicting onset of Alzheimer disease
http://mnt.to/l/4jxV

Older Native-Americans and African-Americans with diabetes at increased risk for dementia
http://mnt.to/l/4jvk

Risk for Alzheimer's disease doubled by rare gene variants
http://mnt.to/l/4jtQ

Making dementia friendly neighbourhoods
http://mnt.to/l/4jtq

New IMI project to revolutionise clinical trials for Alzheimer's drugs
http://mnt.to/l/4jsQ

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** ANXIETY / STRESS News **

High levels of maternal care has life-long impact on vulnerability to stress
http://mnt.to/l/4jxQ

Sniffing out danger: Rutgers scientists say fearful memories can trigger heightened sense of smell
http://mnt.to/l/4jx2

High rates of  PTSD, depression suffered by contractors who worked in conflict zones
http://mnt.to/l/4jsC

Symptoms of combat-related psychological trauma eased by new brief therapy
http://mnt.to/l/4jst

Fear conditioning likely cause of acute stress related to prolonged viewing of media coverage of Boston Marathon bombings
http://mnt.to/l/4jrB

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** ARTHRITIS / RHEUMATOLOGY News **

Experimental compound dramatically reduces joint inflammation
http://mnt.to/l/4jtK

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** BONES / ORTHOPEDICS News **

Temperature-sensitive gelling scaffolds developed to regenerate craniofacial bone
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Evidence-based recommendations for platelet-rich plasma
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In murine osteoporosis, choloroquine reduces formation of bone resorbing cells
http://mnt.to/l/4jrG

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** BREAST CANCER News **

Scientists halt first step of breast cancer spread in mice
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Myriad's HRD&trade; test significantly predicts response to cisplatin treatment in triple negative breast cancer patients in second research study
http://mnt.to/l/4jzy

New drug combination delayed disease progression for subgroup of women with metastatic breast cancer
http://mnt.to/l/4jy6

First in-human trial of endoxifen shows promise as breast cancer treatment
http://mnt.to/l/4jxC

Younger, early breast cancer patients often undergo unnecessary staging, imaging procedures at time
http://mnt.to/l/4jxz

Everolimus added to exemestane boosts overall response in postmenopausal women with advanced breast cancer
http://mnt.to/l/4jyZ

Certain advanced breast cancer patients may benefit from surgery before other treatment, UPMC-advised study finds
http://mnt.to/l/4jwH

New models of drug-resistant breast cancer point to better treatments
http://mnt.to/l/4jwD

Deep sequencing of breast cancer tumors to predict clinical outcomes after single dose of therapy
http://mnt.to/l/4jwB

Breast cancer drug halves cases in high-risk women
http://mnt.to/l/4jwq

In lower-risk breast cancer patients, Herceptin plus Taxol highly effective
http://mnt.to/l/4jv3

Genetic signature identifies patients with more aggressive triple-negative cancers
http://mnt.to/l/4jtW

Identifying aggressive breast cancers in black women
http://mnt.to/l/4jtJ

Novel Agent Set for Unique Clinical Test in Inflammatory Breast Cancer
http://mnt.to/l/4jtF

Exercise protects against aggressive breast cancer in black women
http://mnt.to/l/4jtD

Event-free and overall survival results from NeoALTTO trial
http://mnt.to/l/4jtC

Identifying breast cancer patients most likely to benefit from trastuzumab
http://mnt.to/l/4jtB

Highly effective treatment option identified for patients with HER2-positive breast cancer
http://mnt.to/l/4jtz

Some older patients with breast cancer may avoid radiotherapy
http://mnt.to/l/4jty

Breast cancer screening: benefit more consistent across studies than previously understood
http://mnt.to/l/4jtx

Older breast cancer survivors benefit from exercise programs
http://mnt.to/l/4jsG

Association between oncometabolite accumulation and breast cancer prognosis
http://mnt.to/l/4jrH

Biomarker linked to aggressive breast cancers, poor outcomes in African-Americans
http://mnt.to/l/4jr6

Guideline-recommended breast cancer treatment affected by economic factors
http://mnt.to/l/4jr3

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** CANCER / ONCOLOGY News **

'Breakthrough' may lead to new treatment for fatal childhood cancer
http://mnt.to/l/4jzq

Partially blocking blood vessels' energy source may stop cancer growth, blindness & other conditions
http://mnt.to/l/4jy3

Cancer diagnosis more likely to limit careers for patients from rural areas
http://mnt.to/l/4jxf

Helping cancer researchers make sense of the deluge of genetic data
http://mnt.to/l/4jwQ

Childhood cancer survivors suffer symptoms in adulthood
http://mnt.to/l/4jwr

Magnetic nanoparticles to cure cancer
http://mnt.to/l/4jwg

Mechanism of cancer spread identified
http://mnt.to/l/4jvV

FDA-approved lung cancer medication shrinks chordoma in mice
http://mnt.to/l/4jvS

Improved cooling cap for chemotherapy hair loss 'more effective'
http://mnt.to/l/4jwf

Researchers refute cancer 'avalanche effect'
http://mnt.to/l/4jvB

Defending medical oncology to assure quality care for cancer patients
http://mnt.to/l/4jwh

One step closer to understanding a deadly childhood brain cancer
http://mnt.to/l/4jtP

Finnish research unveils novel cancer cell DNA damage repair mechanism
http://mnt.to/l/4jtt

Scientists shed new light on the fight against cancer - They have discovered how the anti-tumor activity of immune cells can be restored
http://mnt.to/l/4jtc

Drugs identified that enhance oxidative stress as possible weapon against most common pediatric soft tissue tumor
http://mnt.to/l/4jsy

New method devised to measure life's tugs and nudges
http://mnt.to/l/4jsn

New technique could help bring cancer biomarkers to clinic
http://mnt.to/l/4jr2

Gene discovered that plays a part in one per cent of all cancers
http://mnt.to/l/4jqZ

Mechanism identified that is implicated in brain cancer and a drug that decreases brain tumor growth
http://mnt.to/l/4jqY

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

Medtronic announces first human implant of world's smallest, minimally invasive cardiac pacemaker
http://mnt.to/l/4jwS

Repairing human hearts with  biomaterials
http://mnt.to/l/4jvx

After placing carotid stent, surgeons suggest skipping the balloon
http://mnt.to/l/4jvw

Younger women more likely to have and die from acute myocardial infarction
http://mnt.to/l/4jvg

Optimal framework for heartbeats
http://mnt.to/l/4jvd

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

HDL finding may lead to molecular approach for treating inflammation
http://mnt.to/l/4jrT

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

MRI assessment of rectal cancer provides crucial prognostic information to improve survival for patients
http://mnt.to/l/4jw9

6-million-euro European study to combat bowel cancer
http://mnt.to/l/4jtM

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

Peripheral immune system may regulate vulnerability to depression
http://mnt.to/l/4jxP

FDA approves first generic versions of antidepressant drug Cymbalta
http://mnt.to/l/4jwy

Exercise may increase libido among women taking antidepressants
http://mnt.to/l/4jvX

Seasonal affective disorder: could you spot the signs?
http://mnt.to/l/4jvr

Gene discovered that may predict human responses to specific antidepressants
http://mnt.to/l/4jss

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

New FDA cleared Theradome&trade; Laser Therapy Helmet hair loss treatment created by former NASA scientist
http://mnt.to/l/4jsc

New ways to repair wounds and reduce impact of aging on the skin
http://mnt.to/l/4jvj

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

Illinois institute of technology works to develop artificial pancreas systems for use during and after exercise
http://mnt.to/l/4jxx

New study shows link between perfluorinated compounds and diabetes
http://mnt.to/l/4jxn

Diabetes drugs affect hearts of men, women differently
http://mnt.to/l/4jx7

Outcomes of care for children and young people with diabetes is improving, yet overall diabetes control remains poor in 1 in 4, UK
http://mnt.to/l/4jx6

Wayne State discovers potential treatment for skin and corneal wound healing in diabetics
http://mnt.to/l/4jwP

SIRT5 regulation has dramatic effect on mitochondrial metabolism
http://mnt.to/l/4jts

Risk factor for liver cancer increased by diabetes across ethnic groups
http://mnt.to/l/4jr5

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

Fatty acids crucial to embryonic development
http://mnt.to/l/4jxT

Ethical concerns about marketing loans for fertility treatments
http://mnt.to/l/4js7

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

Goji berries protect against the flu in new study
http://mnt.to/l/4jww

Effectiveness of influenza vaccines may be significantly improved by brief laser-light treatment
http://mnt.to/l/4jtT

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

epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England
http://mnt.to/l/4jzm

From friend to foe: How benign bacteria evolve to virulent pathogens
http://mnt.to/l/4jy2

Salmonella jams signals from bacteria-fighting mast cells
http://mnt.to/l/4jxW

Collaborating proteins allow Nipah virus to 'break into' cells
http://mnt.to/l/4jzn

Reservoirs of staph can lurk deep within the nose
http://mnt.to/l/4jvh

Scientists reveal choreographed stages of salmonella infection
http://mnt.to/l/4jtX

Scientists explore the mechanisms of viruses' shells
http://mnt.to/l/4jtv

New findings reveal protein structure in rubella virus
http://mnt.to/l/4jtm

Recycled plastic turned into 'nanofibers' to attack fungal infection
http://mnt.to/l/4jsR

Comparing penicillin and 'big gun' antibiotics for treating less severe childhood pneumonia
http://mnt.to/l/4jsj

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

Civilians trained by American mental health professionals bring healing to trauma victims of Libya's civil war, Baylor study finds
http://mnt.to/l/4jwN

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

Scientists discover way to enhance self-control
http://mnt.to/l/4jwJ

Faulty receptor in the brain 'muddles memories'
http://mnt.to/l/4jwn

Discovery of mechanism controlling Tourette Syndrome tics
http://mnt.to/l/4jvy

New app measures battery life for brain stimulation patients
http://mnt.to/l/4jwd

Schools raise test scores, but not abstract reasoning skills
http://mnt.to/l/4jwc

Sleep problems due to traumatic brain injury improved by dietary amino acids in mouse model
http://mnt.to/l/4jvc

Nonconcussion head impacts in contact sports linked to brain changes and lower test scores
http://mnt.to/l/4jv7

Early brain development influenced by poverty
http://mnt.to/l/4jtV

Observing the brain's cellular response to concussion
http://mnt.to/l/4jtG

Prolonged disorders of consciousness - new RCP guidance to help healthcare staff and families
http://mnt.to/l/4jtk

Embolic material at site of fatal hemorrhage occurring days after flow-diversion aneurysm treatment
http://mnt.to/l/4jt2

Realistic hands-on models created for neurosurgical training using multimaterial 3D printers
http://mnt.to/l/4jsZ

A concussion can lead to depression years later
http://mnt.to/l/4jsq

Blows to the head could affect brain, memory and thinking
http://mnt.to/l/4jrw

How the brain learns new skills while retaining old ones
http://mnt.to/l/4jsg

Athletes experience fewer concussions at higher elevations
http://mnt.to/l/4js2

Initial consensus recommendations for studies of neurofibromatosis
http://mnt.to/l/4jrW

Zinc supplementation and aluminum-induced neurotoxicity
http://mnt.to/l/4jrK

Prion protein can trigger spongiform encephalopathy and neurodegeneration
http://mnt.to/l/4jrJ

In rat model researchers use neural prosthesis to restore behavior after brain injury
http://mnt.to/l/4jrz

We each live in a unique odor world
http://mnt.to/l/4jqX

Scientists film early concussion damage and describe brain's response to injury
http://mnt.to/l/4jqW

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

What are the health benefits of coffee?
http://mnt.to/l/4jym

What are the health benefits of carrots?
http://mnt.to/l/4jy7

Vitamin supplements a waste of money?
http://mnt.to/l/4jwv

What are the benefits of cod liver oil?
http://mnt.to/l/4jvG

Young women 'need better support' for healthy eating
http://mnt.to/l/4jt9

Aspartame 'safe' at current levels, says European food regulator
http://mnt.to/l/4jt3

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

Study links sleep to mood disturbance and poor quality of life in obese
http://mnt.to/l/4jzw

Exercise counters effect of Christmas excess on metabolism
http://mnt.to/l/4jz2

Ear acupuncture 'boosts weight loss'
http://mnt.to/l/4jxs

Burger consumption in restaurants associated with higher obesity risk in African-American women
http://mnt.to/l/4jvW

Kids' movies guilty of mixed messages about eating habits
http://mnt.to/l/4jth

Important role may be played by tumor-suppressing genes in obesity, diabetes, heart disease and cancer
http://mnt.to/l/4jvm

Pediatric obesity patients like telehealth services
http://mnt.to/l/4jv9

&euro;4.9m project to help Europeans manage their weight
http://mnt.to/l/4jrv

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

Clinical Commissioning Groups in England serve too many masters
http://mnt.to/l/4jxj

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

Tracking zinc in cells for prostate cancer diagnosis
http://mnt.to/l/4jsN

Experts cite new drug therapies as rationale for improvements in prostate cancer guidelines, coordination
http://mnt.to/l/4js6

Finding may lead to new prevention and treatment methods for prostate cancer
http://mnt.to/l/4jrZ

Researchers reveal potential biological factor contributing to racial disparities in prostate cancer
http://mnt.to/l/4jr4

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

Reconceptualizing the study of population aging
http://mnt.to/l/4jxp

'Significant minority' of Dutch public backs euthanasia for elderly
http://mnt.to/l/4jwZ

Technology could revolutionize gaming, fall detection among the elderly, and more
http://mnt.to/l/4jw2

Dramatic rise expected in hip fractures as Hong Kong's over 70s population increases
http://mnt.to/l/4jtS

Researchers seek a unified theory of aging
http://mnt.to/l/4jrQ

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

Using novel method, study resolves 50-year 'chlamydial anomaly'
http://mnt.to/l/4jvL

Recent reproductive coercion associated with unintended pregnancy, says Children's Hospital of Pittsburgh of UPMC expert
http://mnt.to/l/4jtj

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

Sleep deprivation and increasing age linked to diabetes
http://mnt.to/l/4jwG

How sleep-deprivation affects the body
http://mnt.to/l/4jvf

** ALLERGY News **

Dogs in the house protect against asthma, infection
http://mnt.to/l/4jDs

Allergy increase in rural Poland likely related to EU membership
http://mnt.to/l/4jB2

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

In Alzheimer's, the brain area attacked links learning and rewards
http://mnt.to/l/4jDF

Complex and intricate ways water behaves in cells
http://mnt.to/l/4jDB

The nanomaterial of tomorrow may be found in Alzheimer-substance
http://mnt.to/l/4jB9

Massive neuron death in Alzheimer's may be caused by raw ingredients of plaques & tangles working in concert
http://mnt.to/l/4jz7

Regenstrief and IU investigators identify first biomarker linked to delirium duration
http://mnt.to/l/4jBt

Brain blood vessel cells may be therapeutic targets for Alzheimer's disease
http://mnt.to/l/4jyG

Next-generation whole exome sequencing sheds more light on Alzheimer's risk
http://mnt.to/l/4jyC

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

Hair analysis found elevated stress hormone concentrations in obese children as young as 8
http://mnt.to/l/4jDX

Journal of Experimental Biology: Coping with stress in a changing world
http://mnt.to/l/4jDJ

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

Postmenopausal women: higher mortality linked to RA, antibodies
http://mnt.to/l/4jH8

AUC for non-arthroplasty treatment of osteoarthritis of the knee approved by AAOS
http://mnt.to/l/4jCt

New mechanism revealed for arthritis progression
http://mnt.to/l/4jBf

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

Glass specialists help create new generation of joint and bone treatments
http://mnt.to/l/4jFY

Nearly 8% of hip implants not backed by safety evidence
http://mnt.to/l/4jFq

Fetal stem cell grafts successfully help brittle-bone babies
http://mnt.to/l/4jCN

Combating muscle wasting and obesity by tweaking energy consumption
http://mnt.to/l/4jzR

Cause, not result, of inherited muscle diseases may be nuclei in wrong place
http://mnt.to/l/4jzG

Increased mortality following second hip fracture
http://mnt.to/l/4jyX

Exercise in middle age protects against sarcopenia and helps maintain muscle strength and physical performance
http://mnt.to/l/4jyW

Increased risk of hip fracture following wrist fracture
http://mnt.to/l/4jyL

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

A tomato-rich diet may reduce breast cancer risk, study shows
http://mnt.to/l/4jG4

Task Force recommends BRCA mutation screening for high-risk women
http://mnt.to/l/4jFV

For women with chemo-resistant breast cancer, bisphosphonate treatment fails to improve outcomes
http://mnt.to/l/4jyT

Adding drug to standard chemo shows promise for women with triple-negative breast cancer
http://mnt.to/l/4jyS

Promising breast cancer drugs put on fast track
http://mnt.to/l/4jyQ

Metastatic breast cancer patients with elevated circulating tumor cells do not benefit from changing chemo
http://mnt.to/l/4jyB

Improved outcomes for women with triple-negative breast cancer with new pre-surgery combination therapy
http://mnt.to/l/4jyz

Progression of advanced breast cancer not delayed by new combination therapy
http://mnt.to/l/4jyy

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

New data for engineering immune cells shows early promise in solid tumors
http://mnt.to/l/4jJp

Different stem cells responsible for muscle-invasive and non-muscle invasive bladder cancers
http://mnt.to/l/4jDn

Radiation therapy to treat uterine cancer linked with increased risk of bladder cancer later in life
http://mnt.to/l/4jD5

Regulation of Cancer-Causing Protein Could Lead to New Therapeutic Targets
http://mnt.to/l/4jBw

New therapies for cancer likely following discovery of ancient chemical bond
http://mnt.to/l/4jzV

Promising results for personalized brain tumor vaccine
http://mnt.to/l/4jC6

Blocking tumor-associated macrophages decreased glioblastoma's growth & extended survival in mice
http://mnt.to/l/4jz8

Spontaneous fusion with macrophages empowers cancer cells to spread
http://mnt.to/l/4jz5

Evidence of Savings in Accountable Care Organizations and Cancer Care
http://mnt.to/l/4jyq

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

In the first 30 days of warfarin use, risk of stroke increases among atrial fibrillation patients
http://mnt.to/l/4jDT

Atrial fibrillation, a growing global health concern
http://mnt.to/l/4jDq

Atrial fibrillation is a 'growing global health problem,' WHO says
http://mnt.to/l/4jFZ

High-fiber diet linked to lower risk of heart disease
http://mnt.to/l/4jCW

Stress-sensitivity gene linked to heart attacks, death
http://mnt.to/l/4jDL

Pre-participation screening to prevent cardiovascular complications in sports
http://mnt.to/l/4jyR

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

European Commission approves update of Erbitux metastatic colorectal cancer labeling to patients with RAS wild-type tumors
http://mnt.to/l/4jJw

EGF receptor ecto-domain mutations: When to screen and when not to screen
http://mnt.to/l/4jDr

Decoding the link between calcium deficiency and colon cancer
http://mnt.to/l/4jyN

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

Data highlight glial sensitivity to stress
http://mnt.to/l/4jCB

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

New discoveries could lead to hair and skin regeneration
http://mnt.to/l/4jFM

Antioxidant supplements reduce levels of oxygen radicals within chronically infected wounds & weaken biofilm sealing these wounds
http://mnt.to/l/4jCq

Bedside Pressure Mapping helps reduce pressure ulcers
http://mnt.to/l/4jBy

Breakthrough study sheds light on skin cell migration in wound healing process
http://mnt.to/l/4jyD

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

Oramed announces successful results of its oral insulin for the treatment of type 1 diabetes
http://mnt.to/l/4jJm

Researchers develop new strategy for potential 'insulin pill'
http://mnt.to/l/4jGc

Family centred approach reduces weight in South Asians
http://mnt.to/l/4jGQ

Walking 2,000 more steps each day reduces cardiovascular risk
http://mnt.to/l/4jFP

Diagnosed diabetes, pre-diabetes, and gestational diabetes on the rise among privately insured Americans
http://mnt.to/l/4jzg

----------------------------------------------
** EATING DISORDERS News **

When young teens are afraid of gaining weight
http://mnt.to/l/4jB7

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

Endocrine-disrupting activity linked to birth defects, infertility near fracking sites
http://mnt.to/l/4jzT

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

Freezing sperm Improves the chances of fatherhood after treatment for Hodgkin lymphoma
http://mnt.to/l/4jCZ

IVF success could double with new way of detecting faulty egg cells
http://mnt.to/l/4jG2

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

Nyack hospital implements procedures to protect patients during flu season
http://mnt.to/l/4jJs

Flu and cold top the 2013 chart of medical search terms
http://mnt.to/l/4jJn

A step closer to developing a 'universal' flu vaccine
http://mnt.to/l/4jBT

Will we have a flu-free Christmas? UK reporting half the number of flu cases compared to this time last year
http://mnt.to/l/4jFh

Reducing flu viruses' glucose supply weakens the microbes' ability to infect mammalian cells in lab cultures
http://mnt.to/l/4jz6

Scientists find first definitive proof of MERS coronavirus in dromedary camels
http://mnt.to/l/4jBn

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

New high blood pressure guidelines released by committee
http://mnt.to/l/4jC7

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

Virus 'hijacks' immune response in host cells
http://mnt.to/l/4jGL

Scientists look to tackle bacterium that is major cause of diarrhea, vomiting
http://mnt.to/l/4jGn

Antimicrobial option offered by pecan shell extracts for preventing listeria in organic meats
http://mnt.to/l/4jC3

Spaceflight has profound effects on fungal pathogen
http://mnt.to/l/4jBZ

Using air transportation data to predict pandemics
http://mnt.to/l/4jxM

Researchers create method to target and kill harmful bacteria
http://mnt.to/l/4jCv

Pathogen is possible source of pandemic
http://mnt.to/l/4jBG

French National Health Authority recommends routine vaccination with Zostavax&reg; to protect seniors against shingles
http://mnt.to/l/4jCR

Virus grows 'temporary tail' to attack E. Coli, researchers discover
http://mnt.to/l/4jBN

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

Gene involved in adolescent brain development may play a role in mental health vulnerability
http://mnt.to/l/4jCf

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

Neurexin2 identified as a novel target for potential therapy of neurodegeneration in Spinal Muscular Atrophy patients
http://mnt.to/l/4jDM

Diagnosis of myopathy improved by new gene mutation
http://mnt.to/l/4jD7

The brain's data compression mechanisms
http://mnt.to/l/4jCx

Potential new therapeutic approach to promote tissue regeneration & repair of broken cell connections
http://mnt.to/l/4jCs

Stem cell therapy for spinal cord injury
http://mnt.to/l/4jCm

Patients in vegetative state able to recognize loved ones' faces
http://mnt.to/l/4jDt

With nearly a million variations on 400 smell receptors, everyone senses smell differently
http://mnt.to/l/4jyc

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

Girls, Hispanic children have higher malnutrition rates in US
http://mnt.to/l/4jJk

Nutritionally unhealthy foods in ads for kids
http://mnt.to/l/4jDx

Understanding how dietary habits are connected through the generations could have valuable benefits for community health
http://mnt.to/l/4jDm

Small rewards encourage children to eat fruit and veg
http://mnt.to/l/4jBY

What are the health benefits of avocados?
http://mnt.to/l/4jDw

Government's voluntary approach to improving hospital food is not working, argues expert
http://mnt.to/l/4jFs

What are the health benefits of chocolate?
http://mnt.to/l/4jzM

Multivitamins 'waste of money,' say medical experts
http://mnt.to/l/4jCg

Parents approve of nutrition report cards
http://mnt.to/l/4jyd

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

Beverage sugar tax targets minorities' health
http://mnt.to/l/4jBV

Increase in body mass relates to increase in health care costs
http://mnt.to/l/4jBC

Body mass index 'in and of itself' increases risk of developing chronic kidney disease
http://mnt.to/l/4jyj

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

Hospital C-suite survey projects ACO participation to double in 2014
http://mnt.to/l/4jFS

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

Scientists unlock prostate cancer protein in move which could lead to improved cancer vaccines
http://mnt.to/l/4jCz

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

GRU researcher develops moisturizing lozenges for dry mouth
http://mnt.to/l/4jGf

DNA unravels in aging cells
http://mnt.to/l/4jzS

Evaluating potential age-promoting compounds
http://mnt.to/l/4jzJ

Older women spend almost 10 hours a day sedentary
http://mnt.to/l/4jBB

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

Study confirms narcolepsy as an autoimmune disease
http://mnt.to/l/4jG3

Timing important when putting toddlers to bed
http://mnt.to/l/4jBD

In men with sleep apnea, CPAP therapy improves golf performance
http://mnt.to/l/4jyM

----------------------------------------------
** STATINS News **

An apple a day keeps vascular mortality at bay, study suggests
http://mnt.to/l/4jBj

----------------------------------------------
** STROKE News **

Stroke risks increase with high levels of anxiety
http://mnt.to/l/4jGp

----------------------------------------------
** TROPICAL DISEASES News **

Exploring evolution of bacteria that may be useful in the fight against dengue
http://mnt.to/l/4jBL

Scientists discover genetic marker of drug-resistant malaria
http://mnt.to/l/4jDD

New discovery could help combat the spread of sleeping sickness
http://mnt.to/l/4jzb

Mechanism by which fungus kills mosquito larvae - verdict of accidental death
http://mnt.to/l/4jBp

Climate change likely to lead to decline in snail fever in Africa
http://mnt.to/l/4jyK

Protection against what can be a fatal rickettsial infection
http://mnt.to/l/4jyr

----------------------------------------------
** WOMEN'S HEALTH / GYNECOLOGY News **

Non-significant reduction in the amount of candida in women who were taking oral garlic tablets
http://mnt.to/l/4jBX