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 Tuần tin 40 (606) ngày 24-31/10/2010
Tin từ Reuteurs
Intervention Program Reduces Rates of Ventilator-Associated Pneumonia
NEW YORK (Reuters Health) Oct 25 - A multifaceted program aimed at increasing compliance with preventive
measures led to a sustained reduction in ventilator-associated pneumonias (VAP), a French team has shown.
But VAP rates were still substantial, and the authors suspect that "eliminating VAP in the intensive care unit may be an
unrealistic goal," they say in the November 15th issue of Clinical Infectious Diseases.
Dr. Jean-Christophe Lucet at Hopital Bichat-Claude-Bernard in Paris and colleagues note that many studies have
shown VAP rates can be decreased with single measures, and lately bundled preventive measures have been tried.
In their case, they developed a program for VAP prevention in the ICU at Bichat-Claude-Bernard Hospital focusing on
eight measures. "The multifaceted program significantly improved compliance with the eight targeted measures," the
team reports.
"Compliance with hand hygiene and glove-and-gown use rules was high at baseline (68% and 80%, respectively) and
remained stable over time," they continue.
Compliance with certain other measures was low at baseline and increased steadily over time, such as keeping
patients in the semirecumbent position (this rate rose from 5% to 58%), maintaining an endotracheal tube cuff
pressure 120 cm H2O (rose from 40% to 89%), using an orogastric tube rather than a nasogastric tube (from 52% to
96%), avoiding gastric overdistension (from 20% to 68%), decontaminating the patient's mouth with 0.12%
chlorhexidine at least 4 times per day (47% to 90%), and no use of nonessential tracheal suction (41% to 92%).
For the present study, Dr. Lucet's team compared VAP rates in the 45 months before the intervention with a 30-month
period after the program was launched.
Among patients who received ventilation for at least 48 hours, 23.2% had at least one VAP episode in the baseline
period compared to 14.1% in the intervention period (p<0.001), according to the report.
The pattern was similar when VAP occurrence was measured as the incidence density rate, expressed as the total
number of VAP episodes per 1000 ventilation days: 22.6 before and 13.1 during the intervention period (p<0.001).
The length of ICU stay was significantly shorter after the intervention. However, there were no significant differences
between the two periods in duration of mechanical ventilation or in the death rate.
"In conclusion," Dr. Lucet and colleagues write, "our program for preventing VAP in the ICU was successful, with
sustained improvements during 3 years. However, the VAP rates remained substantial despite high compliance with
most of the preventive measures, suggesting that some VAP episodes may not be preventable in the ICU setting."
In an accompanying editorial, Dr. Michael Klompas of Harvard Medical School in Boston, Massachusetts, takes issue
with two aspects of the study: limitations in its design and limitations to the surveillance definition of VAP.
"Ultimately," he writes, "the striking disparity in the impact of this bundle on VAP rates versus patient outcomes is
urgent impetus to develop a more objective surveillance definition for complications of mechanical ventilation rather
than proof that VAP cannot be eliminated."
Clin Infect Dis. Posted November 15, 2010. Abstract
Preeclampsia Protects Against Retinopathy in Preterm Infants (Vũ Mai)
NEW YORK (Reuters Health) Oct 25 - Among the many disadvantages of preeclampsia, Brazilian researchers have
found one beneficial effect: it protects preterm infants against severe retinopathy of prematurity (ROP).
It's likely that women with preeclampsia are in an antiangiogenic state and that an "antiangiogenic factor protects very
premature newborns from severe ROP," said senior author Dr. Renato S. Procianoy in e-mail to Reuters Health.
Given this possibility, Dr. Procianoy said, "We should (further study) the effect of antiangiogenic factors as preventive
treatment of ROP."
In an October 4th online paper in The Journal of Pediatrics, Dr. Procianoy and colleagues at Universidade Federal do
Rio Grande do Sul and Hospital de Clinicas de Porto Allegre report on a prospective cohort study of 324 preterm
neonates with a birth weight of no more than 1500 g and a gestational age of 32 weeks or less.
Ninety-seven babies (29.9%) had some stage of ROP, 24 (7.4%) had severe ROP, and the remaining 227 didn't have
the condition. The authors defined severe ROP as "treatable ROP at any stage 3 with plus (disease in zones I or II), or
threshold ROP, and stages 4 or 5."
Preeclampsia reduced the risk of severe ROP by 80% and of any ROP by 60%. A complete antenatal steroid
treatment course reduced the risk of any ROP by 54%. Maternal preeclampsia was the only significant protective
factor against severe ROP needing laser treatment.
J Pediatr. Posted online October 2, 2010. Abstract
Delayed Newborn Screening Advised for Preterm Infants
NEW YORK (Reuters Health) Oct 25 - Results of the newborn screening panel are quite likely to be falsely positive in
infants born preterm or with low birth weight, but accuracy improves when the tests are delayed a day or two, an Ohio
team reported online today in Pediatrics.

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Infants who weigh less than two pounds at birth account for a disproportionate number of false positive results
reported in newborn screens, senior investigator Dr. Henry T. Akinbi told Reuters Health by e-mail. "Our study was
designed to quantify this problem and to assess if the timing of specimen collection could be modified to minimize
false-positive screens in preterm infants," he said.
Dr. Akinbi, of Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, noted that
the current standard in most states -- screening at about 24 hours of life -- is appropriate for term newborns.
But "in preterm infants and sick full term infants, prematurity, illness and medications confound the assays used in
newborn screening, resulting in unacceptably high prevalence of false positive results," he said.
The study's conclusions are based on data from the Ohio State Newborn Screening Program Database on 448,766
neonates. Dr. Akinbi and his colleagues determined false positive rates for 18 tests for five birth weight categories:
<1000 g, 1000-1499 g, 1500-2499 g, 2500-3999 g, and >4000 g.
The numbers of false-positive results per 1000 newborn screens fell as infant weight increased, from 151.1 to 117.2,
27.1, 10, and 7.1.
False-positive rates showed a similar pattern when grouped according to gestational age.
Two tests accounted for 75% of false-positive results in the overall cohort and for 62% of false positives in very low
birth weight infants: thyrotropin/back-up thyroxine and 17-hydroxyprogesterone. For these two, the researchers
analyzed data according to infants' hour of age at the time of specimen collection. They found that thyrotropin/back-up
thyroxine levels were four-fold higher in specimens obtained before vs after 24 hours of age (20.1% vs 4.96%). Also,
they found, using blood samples drawn 48 hours after birth from infants born at less than 32 weeks gestation reduced
the rate of false-positive 17-hydroxyprogesterone tests by 44%.
For the latter parameter, "no true-positive screen would have been missed if blood specimen collection from preterm
infants had been delayed till 48 hour of age," Dr. Akinbi stated. "In contrast, half of the false positives would have been
avoided."
Is there no downside to delaying the screening of preterm newborns? "It is highly improbable that waiting till these
infants are 48 hours old to obtain blood specimens for newborn screen will result in any harm," Dr. Akinbi said.
"False-positive results engender an enormous amount of anxiety in parents that are dealing with a critically ill infant in
the intensive care unit. The strategy proposed in our report will ameliorate this problem," he concluded.
In a related article today, Reuters Health reports a study showing that when sepsis is suspected in a newborn, the
decision to give antibiotics should be based on complete blood counts (CBCs) in samples drawn at least four hours
after birth, because CBCs improve dramatically with increasing time over the first few hours of life.
Pediatrics. Posted online October 25, 2010. Abstract
Low testosterone a problem in cancer: study (Tú)
Monday, October 25, 2010
NEW YORK (Reuters Health) - Aging men with cancer may be more plagued by low levels of testosterone than their
tumor-free peers, U.S. researchers said Monday.
Dwindling levels of the male sex hormone were tied to sexual problems as well as decreased physical and emotional
wellbeing, they report in the Journal of Clinical Oncology.
"The consequences of low estrogen levels in women who have been treated for cancer, particularly breast cancer, are
well-known," said Victoria Rosenwald, a nurse at Beth Israel Cancer Center in New York City who worked on the
study. "But no one has paid much attention to low testosterone levels in men."
"We are beginning to investigate whether assessment of testosterone levels in male cancer patients should be part of
long-term care for survivors," Rosenwald added in an e-mail to Reuters Health.
Testosterone levels decline naturally as men age, but the consequences of that drop-off are unclear.
Solvay Pharmaceuticals, which funded the new study, makes a prescription ointment for men whose hormone levels
dip below 300 nanograms per deciliter of blood, a level widely considered deficient for an adult male.
But skeptics say the problems the ointment is supposed to treat may often just be the symptoms of old age, and there
is no agreement about how low the hormone has to go before it becomes an issue.
For the new study, researchers tested more than 400 men with cancers that were unrelated to testosterone.
Nearly half the men had total testosterone levels below 300 nanograms per deciliter. The researchers didn't compare
the men to a control group, but note that all other studies of men without cancer have found some percentage with
lowered testosterone levels, but far less than half.
The men in the current study with low testosterone also tended to be overweight or obese, and scored slightly lower
on a scale designed to measure quality of life than men with "normal" testosterone levels.
Rosenwald said low testosterone in cancer patients is "a much bigger problem than previously suspected."
It is unclear why so many cancer patients have low testosterone levels, and the study doesn't prove that testosterone
is at the root of the wellbeing issues reported by the patients.

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"We hope to do a careful testosterone replacement trial to see if we can improve their survivorship," said Dr. Stewart
B. Fleishman of Beth Israel Medical Center in New York.
SOURCE: http://link.reuters.com/puj22q Journal of Clinical Oncology, online October 25, 2010.
Study identifies potential stroke triggers

Tuesday, October 26, 2010

NEW YORK (Reuters Health) - Downing a few drinks or contracting an infection such as the flu seem to be connected
to a short-term spike in the risk of stroke, a new research review finds.
The findings, reported in the journal Stroke, do not prove that alcohol and infections act as stroke "triggers" in some
people, but they "strongly support" the notion that they do, the researchers say.
On the other hand, there is insufficient evidence on whether other suspected triggers -- like extreme stress or physical
exertion -- do in fact contribute to stroke, lead researcher Dr. Vincent Guiraud, of Hopital Sainte-Anne in Paris, told
Reuters Health in an email.
Triggers refer to behaviors or exposures that set off a temporary increase in a person's risk of a disease. A number of
studies, for example, have suggested that factors like heavy physical exertion, extreme stress and infections may
trigger heart attacks in some people.
The question of whether there are stroke triggers, however, has been less studied.
The new review attempted to pull together what is known about potential triggers of ischemic stroke -- the most
common form of stroke, in which a blood clot disrupts blood flow to the brain.
Guiraud and his colleagues found 26 studies conducted since the 1980s that identified a dozen factors related to a
short-term increase in stroke risk. Most of those studies focused on the potential roles of alcohol and infections in
triggering a stroke over the following hours to weeks.
Overall, the review found, people who downed 40 to 60 grams of alcohol -- equivalent to three or four standard drinks
in the U.S. -- showed a near-tripling in the risk of stroke over the next 24 hours.
A similar increase was linked to having more than 150 grams of alcohol, or about 10 standard drinks, in the past week.
Meanwhile, contracting any type of infection, such as a cold or flu, was linked to a two- to three-fold increase of
suffering a stroke over the next week to one month.
Only a few studies looked at other potential stroke triggers. One UK study of 200 stroke patients did find associations
between "negative emotion," anger and exposure to a "startling event" and an increased risk of stroke in the next two
hours. Another study linked psychological distress to a heightened stroke risk over the next three days, while a third --
of more than 40,000 Canadian stroke patients -- found that people had a higher risk on their birthdays compared with
other days.
If alcohol, infections or other factors do serve as stroke triggers, the absolute risk of any one person suffering a stroke
because of such an exposure would likely be small, according to Guiraud.
In theory, triggers would have a greater impact on people already at increased risk of stroke, due to factors like
established heart disease, smoking, diabetes or high blood pressure. However, Guiraud said his team lacked the data
to study that issue.
The study is important in that it offers an appraisal of the current knowledge on potential stroke triggers, according to
Dr. Craig Anderson of the George Institute for Global Health in Australia, who was not involved in the research.
"There have been substantial anecdotal case reports and case series suggesting certain triggers for ischemic stroke,
but until recently there has been a paucity of good epidemiological studies and sensible (physiological) explanations
for the link," Anderson, who is also a professor of stroke medicine and clinical neuroscience at the Sydney Medical
School, told Reuters Health in an email.
Even many of the studies in the current review had limitations that made them prone to error or biased results,
Anderson noted.
Among the weaknesses is the fact that most of the studies were so-called case-control studies, where people who had
suffered a stroke were interviewed about various exposures before their stroke, and compared with "control"
individuals who were asked about those same exposures.
A stronger design, according to Guiraud and his colleagues, would be the "case-crossover" study. In this type of study,
each stroke patient would serve as his or her own control, being asked about a particular exposure during a defined
period before the stroke, and during a different time period.
Case-crossover studies are not perfect either, but they make it easier for researchers to account for the many lifestyle
habits and other factors that vary from person to person.
Still, despite the limitations of studies done so far, Anderson said that there is an "increasing appreciation" that most
research on stroke risk factors has focused on more stable factors like average blood pressure. But, he said, daily
fluctuations in heart rate, blood pressure, hormonal activity and muscle function could also create fluctuations in short-
term stroke risk.

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In theory, drinking could, for example, cause heart-rhythm disturbances that dislodge a blood clot from the heart that
then travels into an artery supplying the brain, Guiraud and his colleagues note.
Similarly, infections could also contribute to heart-rhythm disruptions or have inflammatory effects in the blood vessels
that might lead to a stroke.
For now, the practical implications of the current findings "are still hypothetical," Guiraud said.
But, he added, it's possible that for people at heightened risk of stroke, avoidance of any established triggers could
complement the treatment of traditional stroke risk factors like high blood pressure.
For example, flu vaccination or antibiotic treatment of bacterial infections might help lower the odds of any short-term
spike in stroke risk. Some research, Guiraud's team notes, has found a link between flu vaccination and decreased
stroke risk.
However, studies are still needed to show whether any steps to avoid potential stroke triggers are actually effective,
according to Guiraud.
Metal pollution tied to Parkinson's disease
Last Updated: 2010-10-27 15:58:24 -0400 (Reuters Health)
By Lynne Peeples
NEW YORK (Reuters Health) - People living near a steel factory or another source of high manganese emissions are
at higher risk of developing Parkinson's disease, suggests a new study.
As many as one million Americans live with the degenerative disease, according to the Parkinson's Disease
Foundation. Pesticides from farms have long been suspected of upping the chances of developing Parkinson's, but
much less is known about the influences of city living.
"Environmental risk factors for Parkinson's disease have been relatively under-studied, especially in urban areas
where the overwhelming majority of Parkinson's disease patients reside," Dr. Brad A. Racette of the Washington
University School of Medicine in St. Louis, Missouri, told Reuters Health in an e-mail.
Earlier research had tied heavy metals to Parkinson-like brain damage, but it wasn't clear if they could also play a role
in people who aren't exposed to the metals as part of their job.
So Racette and his colleagues analyzed data on about five million Medicare beneficiaries who hadn't moved between
counties from 1995 to 2003. Then they compared Parkinson's rates to industry emissions of copper, lead and
manganese obtained from the Environmental Protection Agency.
By 2003, less than one percent of people in urban areas developed Parkinson's disease. In counties with little or no
release of the metals, 274 out of every 100,000 people had the disease, compared to 489 in counties with high
manganese levels.
The risk remained increased even after accounting for differences in age, sex and race, report the researchers in the
American Journal of Epidemiology.
Areas with high copper emissions also saw more cases of Parkinson's, but the increase was so slight it could have
been due to chance.
The researchers say they don't know whether manganese actually caused more people to get Parkinson's disease. It's
possible that other risk factors in counties with lots of manganese emissions could be to blame.
"Although the findings related to manganese are very compelling, future studies investigating individual patient
exposures and risk of Parkinson's disease will be required to confirm our study," said Racette.
"Understanding community level exposures to environmental toxins will be critical to determining the causes of most
cases of Parkinson's disease," he added. "If our findings are confirmed, our data would suggest that reducing
industrial metal emissions may result in a substantial reduction in the number of new cases."
SOURCE: http://link.reuters.com/zet52q American Journal of Epidemiology, online October 19, 2010.
Vaccine panel expands whooping cough coverage
Last Updated: 2010-10-28 10:20:02 -0400 (Reuters Health)
By Julie Steenhuysen
CHICAGO (Reuters) - An independent U.S. advisory panel is amending its recommendations for booster vaccines to
prevent whooping cough and expand protection from the disease that has made a comeback in several U.S. states.
The Advisory Committee on Immunization Practices voted on Wednesday to allow adolescents or adults whose
vaccine history is not known to get a booster shot of the "Tdap" vaccine for tetanus, diphtheria and pertussis, or
whooping cough, as soon as possible.
The committee, whose advice is usually followed by the U.S. Centers for Disease Control and Prevention, also
recommended that adults over 65 be given the vaccine to help prevent transmission to infants under a year old, who
are too young to be vaccinated.
Children aged 7 to 9 who have not been adequately vaccinated should be given the Tdap booster, it added.
Tdap vaccines, made by both Sanofi Aventis and GlaxoSmithKline, protect adolescents and adults from three once-
common killers - whooping cough, tetanus and diphtheria.
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But they are not approved for children aged 7 to 10 or people aged 65 and older. Two- to 6-year-olds get a different
vaccine, called DTaP, for the same three infections.
Tom Clark, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention, said in a telephone
interview the moves were intended to "close some gaps in our vaccination program."
Whooping cough is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis.
Public health officials from California told the panel that, to date, the state has had 10 infants younger than 2 months
old die from whooping cough. CDC researchers told the panel 6 to 8 percent of whooping cough cases are transmitted
from grandparents to children.
"We've definitely heard from grandparents who are told if they are 65, they can't get a Tdap vaccine to protect their
grandbabies. Now they can," Clark said.
Representatives from both GSK and Sanofi told the panel they intend to seek approvals for their vaccines from the
U.S. Food and Drug Administration.
Until then, doctors can give the vaccine on an off-label basis, Clark said.
New colon cancer test works without colonoscopy (Th Mai)
Last Updated: 2010-10-28 15:58:04 -0400 (Reuters Health)
By Maggie Fox
WASHINGTON (Reuters) - A new kind of test that finds evidence of colon cancer in the stool can also detect pre-
cancerous growths, and could potentially be an alternative to colonoscopies, researchers reported on Thursday.
The new test detected 87 percent of stage I, II and III colon tumors, which can be surgically removed, and found 64
percent of the biggest pre-cancerous growths, the researchers told a meeting of the American Association for Cancer
Research.
It finds altered DNA that has either turned a cell cancerous, or has started the changes that lead to cancer.
"The noninvasive stool DNA test we have developed is simple for patients, involves no diet or medication restriction,
no unpleasant bowel preparation, and no lost work time, as it can be done from home," said Dr. David Ahlquist, of the
Mayo Clinic in Rochester, Minnesota, who developed the test.
"Positive tests results would be followed up with colonoscopy."
The test looks for three genes that have been altered in a process called methylation.
Colorectal tumors develop in the lining of the colon and in the rectum. As fecal matter passed through the tract, it
collects some cells from these growths. The test can find even tiny amounts of altered DNA from these growths in a
stool sample.
Studies of 1,100 patients showed the test detected 64 percent of precancerous growths called adenomas that were
bigger than 1 cm (0.4 inch), which is considered the size most likely to turn into a tumor.
It found 85 percent of cancers, and 87 percent of the earlier-stage cancer that can potentially be cured by surgical
removal.
NEW TOOL
"This is the first study of a stool DNA test to show such promising results in detecting colorectal pre-cancer," Ahlquist
said in a statement.
"Colorectal cancer is a treatable disease if caught early, and this test shows great promise as a potential addition to
other available screening tools."
Colorectal cancer is the second-leading cancer killer in the United States and other developed countries.
The American Cancer Society estimates there will be about 122,000 new cases of colon cancer in 2010, with more
than 51,000 deaths.
It recommends that all Americans start getting tested for the disease at age 50.
In standard colonoscopies, a tiny camera is threaded up through the rectum. The device has a little pair of clippers on
the end to remove suspicious-looking growths called polyps so they can be tested to see if they might become
cancerous.
But only about half of those who should get tested do, in part because the procedure is embarrassing, uncomfortable
and can, in rare cases, cause injury.
Health experts hope that having a home-based test would encourage more people to get screened.
Experts wrestle with vaccinating boys for HPV (Minh Thúy)
Last Updated: 2010-10-28 17:00:57 -0400 (Reuters Health)
By Julie Steenhuysen
CHICAGO (Reuters) - U.S. vaccine advisers are weighing whether boys and young men should be vaccinated against
the human wart virus that causes a number of cancers, but some worry the vaccine is too costly to justify its use.
Merck & Co's Gardasil vaccine is approved for boys, safe and it would be cost-effective, CDC researchers and vaccine
experts told a meeting of the Advisory Committee on Immunization Practices on Thursday.
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Some men would also benefit from the vaccine, including homosexuals and bisexuals, who are at risk of developing
anal cancers and other conditions caused by the human papillomavirus, or HPV, the experts said.
HPV infection is best known as the primary cause of cervical cancer, but it can also lead to cancers of the anus, penis,
head and neck. Vaccinating men and boys could prevent some of these cancers.
Currently, U.S. Centers for Disease Control and Prevention recommends Gardasil vaccinations for girls and women
between the ages of 11 and 26.
And while doctors are free to use the vaccine for preventing genital warts in boys and men ages 9 through 26, U.S.
vaccine advisers last year declined to recommend routine vaccination for males.
But they did make it available to boys in the Vaccines for Children Program, a government-funded system that
provides vaccines to children eligible for the state-federal Medicaid health insurance plan and other uninsured
children.
The main reason the vaccine was approved was to prevent cervical cancer, which kills 4,000 women a year in the
United States. But various strains of HPV also cause disfiguring genital warts and anal, penile, head and neck
cancers.
Last year, the advisory committee only considered its use based on its ability to prevent genital warts. In that case, the
benefits did not seem to justify the vaccine's $360 cost.
Now, the CDC is taking up the issue again.
Dr. Lauri Markowitz, who heads the committee's HPV working group, told the meeting cases of anal cancers are
increasing in the United States, especially among women, and men who have sex with men.
"Estimates from various studies indicate that the incidence of anal cancer in men who have sex with men may be as
high as 37 cases per 100,000 men," she said.
Markowitz said her panel is considering several options. They could make no change, or they could vote to
recommend routine immunization of boys at age 11 or 12.
"With either of these options, there could be a specific recommendation of men who have sex with men," she told the
meeting.
Many also feel vaccinating adolescent males before they become sexually active is the best way to protect them
without requiring them to disclose their sexual orientation, she said.
Cost appears to be a major concern for those who oppose routine vaccination, Markowitz said, but many members
said they would reconsider their position if the vaccine were cheaper.
The Vaccines for Children Program pays $108 per dose of the vaccine, which is given in a series of three doses.
And there are practical reasons to expand coverage.
She said panel members who support routine vaccination cite studies showing the vaccine is safe and effective and
say vaccinating both girls and boys at the same time would be easier for doctors.
A national survey of doctors showed 36 percent of pediatricians and 24 percent of family medicine physicians are
administering the vaccine to males, experts told the CDC panel.
First-time dads' age tied to kids' schizophrenia risk (Liên)
Last Updated: 2010-10-28 11:44:02 -0400 (Reuters Health)
By Amy Norton
NEW YORK (Reuters Health) - Men who are relatively older at their first child's birth may be more likely than younger
first-time dads to have a child who eventually develops schizophrenia, hint results of a large Danish study.
Using data on more than 2 million people born in Denmark between 1955 and 1992, researchers found a link between
first-time fathers' age and the odds of any of their children developing schizophrenia.
In contrast, the connection was not seen among fathers who were relatively older only when their second- or later-born
child came into the world.
The findings, published in the American Journal of Psychiatry, add another layer to the relationship between parents'
age and children's schizophrenia risk.
It's known that schizophrenia is a disorder of disrupted brain development, and researchers have long believed that it
arises from a combination of genetic susceptibility and environmental factors -- with the suspects including viral
infections or poor nutrition during pregnancy.
A number of studies have also shown a relationship between parents' age at the time of a child's birth and that child's
risk of developing schizophrenia. However, most have suggested that the link to mothers' age is largely explained by
fathers' age.
Researchers have speculated that the explanation might rest in the fact that older fathers are more likely than younger
ones to have genetic abnormalities in their sperm, possibly including genetic abnormalities related to schizophrenia.
However, the new findings cast doubt on that theory, according to lead researcher Dr. Liselotte Petersen, of Aarhus
University in Denmark.

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If the theory were correct, then fathers' age at the birth of any child -- not just the first one -- should be related to
schizophrenia risk.
Instead, Petersen and her colleagues say, the findings give support to another theory: that men who have a
predisposition to schizophrenia, but do not themselves develop it, tend to have children later in life than other men.
However, the reasons for such "delayed fatherhood" remain unknown, Petersen told Reuters Health in an email.
One question, she said, is whether there could be factors -- genetic or environmental -- that both impair a man's fertility
and contribute to schizophrenia risk in his children. Another possibility is that men predisposed to schizophrenia are
more likely to have personality traits that affect their relationships and make it more difficult to find a partner.
The vast majority of children born to relatively older fathers will not develop schizophrenia, as the disorder is estimated
to affect 1 percent of the population.
However, a better understanding of the relationship between paternal age and schizophrenia risk could help uncover
some of the causes of the disorder, Petersen said.
For the current study, she and her colleagues used data from Denmark's national system of registers to track more
than 2.2 million citizens born between 1955 and 1992. Between 1970 and 2007, just over 14,200 of those individuals
were diagnosed with schizophrenia.
They found that the odds of a child developing schizophrenia tended to increase in tandem with a father's age, but
only his age at the birth of his first child.
Among fathers who were between the ages of 25 and 29 when their oldest child was born, there were 2,420 cases of
schizophrenia among their 448,538 children -- a rate of about 0.5 percent. The corresponding rate was 0.7 percent
among fathers who were in their 30s when their first child was born, just under 1.2 percent for fathers in their 40s, and
2 percent for those age 50 or older at the birth of their first child.
Family history of mental illness did not explain the connection between first-time fathers' age and their children's odds
of developing the disorder.
Researchers do not know why fathers' age, but not mothers', has been consistently connected to schizophrenia risk,
according to Petersen.
"In future studies," she said, "we will search for factors that are associated with delayed fatherhood in order to
understand and explain the effect of paternal age on schizophrenia risk."
Safety of Tylenol in heart patients questioned
Last Updated: 2010-10-28 15:25:04 -0400 (Reuters Health)
By Lynne Peeples
NEW YORK (Reuters Health) - A popular pain reliever long thought to be safe for the heart may not be so innocuous
after all, suggests a new study.
Acetaminophen is currently recommended for heart disease patients over ibuprofen, naproxen and other more potent
painkillers due to its presumed lack of cardiovascular side effects.
But the new findings suggest that the active ingredient in Tylenol may actually increase blood pressure, a known risk
factor for heart attack and stroke, just as much as the drugs patients have been told to avoid.
Acetaminophen "flew under the radar screen for 40 or 50 years without ever really being evaluated for its
cardiovascular safety," senior researcher Dr. Frank Ruschitzka of University Hospital Zurich, in Switzerland, told
Reuters Health.
"People think that it's been out there for so long that it must be safe," he added. "Well, that's simply wrong."
For their research, Ruschitzka and his colleagues randomly assigned 33 heart disease patients to take either a typical
daily dose of acetaminophen or a placebo pill, which looked and tasted the same but lacked the active ingredient, on
top of their heart medication for two weeks. They later swapped the patients' pills (those on acetaminophen took
placebo and vice versa) and followed them for another two weeks.
None of the patients were suffering pain at the time, as it would have been unethical to assign such a patient to a
placebo.
According to the researchers, there were no changes in blood pressure when patients were taking the placebo.
In contrast, when they were taking acetaminophen, they experienced a significant rise in blood pressure; on average,
systolic blood pressure (the top number in the blood pressure reading) rose from 122.4 to 125.3 mm Hg, while
diastolic blood pressure (the bottom number) rose from 73.2 to 75.4 mm Hg, yielding a blood pressure of 125.3 over
75.4 while taking acetaminophen. A normal blood pressure is around 120 over 80.
"In the very population that its use is recommended, acetaminophen increases blood pressure to the same extent as
has been previously shown with ibuprofen and other non-steroidal anti-inflammatory drugs," noted Ruschitzka.
Limitations of the study, the researchers note, include its relatively small sample size and short treatment period. They
recommend a larger clinical trial to more rigorously test acetaminophen's cardiovascular safety.

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The findings, reported in the journal Circulation, "challenge the commonly held belief that acetaminophen use can be
recommended casually," Dr. Andrew Chan of Massachusetts General Hospital, in Boston, who was not involved in the
study, noted in an email to Reuters Health.
Chan's own previous research found that the frequent use of acetaminophen might be associated with a modest
increase in the risk of cardiovascular events.
"Acetaminophen is not an innocent drug," said Ruschitzka. "People should discuss it with their doctors, and doctors
should be aware that it may increase blood pressure, especially at higher doses."
There are currently no alternatives to acetaminophen that are known to be safe for the heart, he added.
"You can take your acetaminophen, just be aware that your blood pressure may go up," advised Ruschitzka. He
highlighted the importance of getting frequent blood pressure tests and making dose adjustments as necessary.
"Certainly, in some cases, the benefits of acetaminophen for pain control outweigh the potential risks," added Chan.
"However, for other patients for whom the benefit may not be great, patients and doctors might want to reconsider
using acetaminophen over the long-term."
Therapy for women prone to miscarriage questioned
Last Updated: 2010-10-29 15:08:12 -0400 (Reuters Health)
By Rachael Myers Lowe
NEW YORK (Reuters Health) - Blood-thinning treatments for pregnant women with an inherited condition that makes
them susceptible to blood clots may do more harm than good, Danish researchers report.
Their study was designed to investigate the cause of repeat miscarriages in women with hereditary thrombophilia, a
tendency to form blood clots, not the safety of particular treatments.
Nevertheless, in the course of that work they found little difference between women with or without the known gene
mutations that cause thrombophilia, except for a higher likelihood of excessive bleeding during delivery among women
carrying the mutations. The researchers attribute that heavy bleeding to the "standard practice" of administering blood
thinners to pregnant women with thrombophilia.
The result "further emphasizes the need" to test the effect of blood thinners in women with repeated miscarriages and
the genetic mutations that cause thrombophilia in a large clinical trial, Dr. Marie Lund of Copenhagen University
Hospital's fertility clinic told Reuters Health in an e-mail, "since it cannot be excluded that blood thinners to this group
of women would in fact do more harm than good."
At least five known gene mutations increase an individual's tendency to form blood clots, but the most common of
these is estimated to be present in about 8 percent of the population. Many carriers may never experience a problem,
but they are at greater risk for dangerous clots.
An estimated one in 100 women experiences three or more consecutive miscarriages, which has been linked to a
number of factors, including the woman's age, chromosome abnormalities carried by her or the father, abnormalities in
the embryo, structural problems in the womb, infections, and certain blood conditions, including thrombophilia.
Thrombophilia can cause a blood clot in the placenta leading to miscarriage, so women with a genetic susceptibility to
thrombophilia are often given blood thinners during pregnancy to reduce that risk.
Dr. Lund and her colleagues wanted to know if women with repeated miscarriages and either of two particular genetic
mutations associated with thrombophilia were more likely to miscarry again, since previous research had produced
conflicting conclusions.
They looked at the medical records and pregnancies of 363 Danish women who had experienced recurrent pregnancy
loss. Thirty-five (9.7 percent) of the women tested positive for one of the two most common thrombophilia-related
mutations.
In the entire group, there were 224 live births, five still-births, 133 miscarriages and one early termination of pregnancy
due to chromosomal abnormalities. The live birth rate was higher for women without the mutations (63.4 percent) than
for women with the mutations (45.7 percent).
When other factors, such as the mother's age, smoking status, and previous number of miscarriages, were taken into
account, however, the differences in live birth rates between mutation-positive and mutation-negative women were
"found to be strong but not statistically significant," Lund said.
Such a thorough analysis of pregnancy outcomes in women with and without the thrombophilia-associated mutations
had not been conducted before, the authors note in the October 11 issue of the journal Human Reproduction.
The only difference of significance was in the rate of excessive bleeding at delivery, which was higher for the mutation-
positive women.
Finding excessive bleeding among the mutation carriers has implications for what is now a standard practice of
prescribing blood thinning treatments to thrombophilia-mutation carriers and sometimes to women without known
mutations who have experienced three or more miscarriages.
The evidence, the authors write, does "not support anticoagulation therapy" for women with unexplained miscarriages
but does suggest the need for more well designed clinical trials to investigate further.
Stress may have only small impact on weight
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Last Updated: 2010-10-29 12:08:11 -0400 (Reuters Health)
By Amy Norton
NEW YORK (Reuters Health) - Despite the common belief that stress causes people to pack on the pounds, a new
research review finds that, on average, stress has little long-term effect on weight.
The results are surprising, researchers say, given the widespread notion that stress - by causing people to reach for
junk food or skimp on exercise, for example -- is an important factor in weight gain.
When the investigators pulled together 32 previously published studies on the question, however, they found the
majority showed no association between people's stress levels and their weight gain over several years.
When the researchers combined the studies' results -- in what is known as a meta-analysis -- there was only a modest
association overall between stress and weight gain.
"When we started this meta-analysis, we assumed that there would be a substantial association between stress and
obesity, since the popular view is that stress contributes to weight gain," co-researcher Dr. Andrew Steptoe, of
University College London in the UK, told Reuters Health in an e-mail.
"But when we looked carefully at well-controlled scientific studies," he said, "effects were surprisingly small."
That does not necessarily mean that stress cannot have a significant influence on some people's weight, according to
Steptoe. The average effect of stress on weight might be small, but there could be wide variations among individuals,
he said.
Citing diet as one example, Steptoe noted that "some people may increase their food consumption under stress, while
others may stop eating and lose their appetites."
In addition, he said, different types of stress - whether associated with work, caregiving or specific life events -- might
have different effects on weight gain.
Examining those questions was beyond the scope of the data Steptoe and his colleagues had.
For the study, the researchers, led by Dr. Jane Wardle, also of University College London, analyzed 32 international
studies conducted mainly in the 1990s and 2000s.
All of the studies assessed participants' stress levels, then followed the subjects over time to see whether there was a
relationship between stress and subsequent weight gain. Most followed participants for one to seven years, but a few
were longer term projects that followed people for up to 38 years.
Some of the studies focused on participants' levels of work stress, while others gauged "general life stress," which
includes anything from major traumas like experiencing a serious illness or a divorce, to feeling overwhelmed by daily
hassles.
Overall, the researchers found, 69 percent of the studies uncovered no clear association between stress levels and
weight gain. One-quarter linked higher stress levels to greater weight gain, and the remaining 6 percent found that
greater stress was related to less weight gain over time.
When Wardle's team pooled the results of all the studies, they found a modest association between higher stress
levels and greater weight gain.
In general, the connection was stronger among men than among women -- an interesting finding, Steptoe said, since it
is "popular belief" that stress has a greater impact on women's weight.
One of the limitations of this review, according to the researchers, was that it could not examine the role of
psychological disorders - the included studies focused on exposure to stress, and not, for example, whether a person
developed depression in response to that stressor.
"The general message," Steptoe said, "is that, based on the best current scientific research, stress is not likely to play
a major role in increasing body weight or obesity for most people."
"It could be that some people are more affected than others," he added, "but rather little is known about this at
present."
He and his colleagues call for more research into the factors that might explain why one person puts on pounds in
response to stress and another does not.
Burning straw, dung tied to kids' anemia (Bảo)
Last Updated: 2010-10-29 13:12:12 -0400 (Reuters Health)
By Alison McCook
NEW YORK (Reuters Health) - Households in developing countries that regularly burn wood, straw, dung and other
natural materials are more likely to also contain children with anemia, a new report finds.
Families in 29 countries who burned so-called "biofuels" for cooking or heating were 7 percent more likely to include a
child with mild anemia.
When the researchers from McMaster University in Canada compared national-level data, they found that the
countries with more residents burning biofuels were also home to more children with moderate or severe anemia.

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"As a substantial proportion of people still rely on biofuels for domestic energy in developing countries, they need to be
aware that exposure to biofuel smoke is associated with health risks and that they need to protect their children and
themselves from being exposed to this harmful smoke," study author Hmwe Hmwe Kyu told Reuters Health.
Nearly half of children under the age of 5 living in developing countries develop anemia, putting them at risk of
cognitive impairments, developmental problems, and other serious, potentially life-threatening consequences.
Anemia is caused by a deficiency of blood cells or of hemoglobin, the iron-rich molecules within blood cells that
transport oxygen from the lungs to body tissues.
Inhaling smoke from burning biofuels has already been linked to a host of other health problems, such as low birth
weight and pneumonia in children.
In theory, burning biofuels could also cause anemia because the smoke contains pollutants such as carbon monoxide,
which binds to and reduces the available amount of hemoglobin, and other compounds that can destroy red blood
cells directly.
Burning natural materials for cooking and heating remains very common in developing countries, however, and the
number of people who rely on biofuels is expected to climb to 2.6 billion by 2030.
To investigate whether burning biofuels might indeed increase the risk of anemia, Kyu and colleagues reviewed data
collected from families living in 29 developing countries in Africa, Asia and the Caribbean region. In all, 117,454
children were represented in the study.
Given that other aspects of life in those countries might be behind an apparent biofuel-anemia link, the researchers
used statistical tools to control for the influence of poverty, childhood illness, smoking, and other potentially
confounding factors.
Reporting in the Annals of Epidemiology, they found that 24 percent of children had mild forms of anemia, and nearly
39 percent had a more moderate to severe form of the condition.
In addition, they found that the relationship between anemia and exposure to biofuels was exacerbated when children
also had diarrhea or a fever. In other words, compared with children who were not exposed to biofuel smoke and did
not have diarrhea, exposed children with diarrhea were 22 percent more likely to have mild anemia.
If breathing in smoke from natural materials is triggering childhood anemia, improved stoves might help, the authors
note - however, each unit likely costs anywhere from $25 to $150, Kyu said in an e-mail to Reuters Health.
They acknowledge that the smoke may not be the only source of the problem and they were unable to tease out the
possible roles of all other factors. "For example, we were not able to control for intestinal parasitic infections and lead
poisoning, which may have contributed to residual confounding in our study," Kyu added.
Kyu cautioned that the study focused on use of biofuels by individuals, and does not discuss the potential effects of
living near a facility manufacturing ethanol for widespread use, for instance. "The results may not apply to large-scale
biofuel efforts."
Immune system may help cancer cells hide: study
Last Updated: 2010-10-29 11:51:11 -0400 (Reuters Health)
By Maggie Fox
WASHINGTON (Reuters) - Cancer cells may find a hideout in the body's immune system, researchers said on
Thursday in a study that may help explain why tumors can come back after rounds of toxic chemotherapy.
Tests on mice showed that the stress of chemotherapy drives some tumor cells into the thymus, the gland that
produces immune cells known as T-cells.
The gland bathes these rogue tumor cells with protective agents, the researchers at the Massachusetts Institute of
Technology reported in the journal Cell. The findings suggest that cancer treatments need to attack this hiding place.
"Successful cancer therapy needs to involve a component that kills tumor cells as well as a component that blocks
pro-survival signals," MIT's Michael Hemann said in a statement.
"Current cancer therapies fail to target this survival response."
Hemann and colleagues tested mice with a type of cancer called Burkitt's lymphoma. They were treated with
doxorubicin, a standard chemotherapy drug.
The drug worked, as expected -- the tumors regressed. The mice were killed and examined.
"To analyze the effect of drug treatment on specific tumor niches, we harvested all primary lymphoid organs, including
peripheral lymph nodes, thymus, spleen and bone marrow, following doxorubicin treatment," the researchers wrote.
Most of these were clear, too -- except for the thymus. In fact, there were more tumor cells in the thymus after
chemotherapy than there had been before.
"Thus, the thymus represents a chemoprotective niche that protects lymphoma cells from doxorubicin-induced cell
death," the researchers wrote.
Mice genetically engineered to have tiny and dysfunctional thymuses survived better when infected with Burkitt's
lymphoma and then treated, so it appeared the thymus was doing something to protect the tumor cells.

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Lab tests suggested that the thymus secretes chemicals that protect immature cells from toxins, and the cancer cells
were just taking advantage of this, Hemann said.
More tests will be required to see if the same thing happens in people, they said, but it may be necessary to attack
certain immune system compounds such as IL-6 and one called Bcl2.
Infants' antibiotic use tied to bowel disease risk
Last Updated: 2010-10-29 10:26:12 -0400 (Reuters Health)
By Amy Norton
NEW YORK (Reuters Health) - Babies treated with antibiotics for middle-ear and other infections may have increased
odds of developing inflammatory bowel disease later in childhood, a small study suggests.
Canadian researchers found that among 36 children with either ulcerative colitis or Crohn's disease -- the two main
forms of inflammatory bowel disease (IBD) -- 58 percent had been prescribed at least one course of antibiotics in the
first year of life.
In contrast, only 39 percent of 360 IBD-free children studied for comparison had taken antibiotics during their first year.
The findings, published in the American Journal of Gastroenterology, do not prove that early antibiotic use causes IBD
in some children. But they support the theory that factors affecting the early-life balance of "good" and "bad" bacteria in
the intestines may contribute to IBD.
Both colitis and Crohn's disease are marked by chronic inflammation in the intestines, leading to symptoms like
abdominal pain and diarrhea. The conditions are thought to arise from an immune-system overreaction that injures the
body's own intestinal tissue, but the underlying reasons for the aberrant immune response are unclear.
There is a genetic component to IBD, since the conditions can run in families. However, experts believe that
environmental triggers -- such as diet, an infection, or exposure to tobacco smoke - likely combine with genetic
susceptibility to cause IBD in some people.
The new study appears to be the first to draw a connection between confirmed early antibiotic use and childhood IBD,
according to the researchers.
The design of the study does not, however, allow any conclusions about cause-and-effect, senior researcher Dr.
Charles N. Bernstein, of the University of Manitoba in Winnipeg, told Reuters Health in an e-mail.
Larger studies, as well as lab research into the effects of common antibiotics on different types of intestinal bacteria,
are still needed, he said.
In theory, early antibiotic use could create an imbalance in the potentially beneficial and potentially harmful bacteria
that establish residence in the gut during the first year of life. If the composition of these intestinal "microflora" is
altered, the immune system may begin to react abnormally to some of the bacteria.
For the current study, Bernstein and his colleagues analyzed medical records for 36 children diagnosed with either
ulcerative colitis or Crohn's between 1996 and 2008, at an average age of 8. Each child was compared with 10 IBD-
free children of the same age, sex and area of residence.
The researchers found that children with IBD were more likely to have been prescribed an antibiotic during the first
year of life -- most commonly for middle-ear infections, but also for respiratory and other types of infection.
Overall, antibiotic use in infancy was linked to a tripling of the risk of IBD relative to children who had no antibiotic
prescriptions in their first year of life.
While that relative increase in risk is large, any one child's absolute risk of developing IBD from antibiotic use -- if the
medications are, in fact, to blame -- would be small, according to Bernstein.
In the U.S., it's estimated that just over 1 million people have IBD, with new cases diagnosed at a rate of 10 per
100,000 people each year.
It is still possible that factors other than the antibiotics themselves explain the link between early use of the
medications and IBD risk. One alternative, according to Bernstein, is that certain conditions for which antibiotics are
used -- like middle-ear infections -- are related to IBD risk.
However, he added, the biological mechanisms that would underlie such a connection are not clear.
For now, Bernstein said, the findings offer a reminder "to avoid indiscriminate use of antibiotics when we can." Parents
should be aware that antibiotics are often unnecessary for respiratory infections; in fact, many are caused by viruses
and do not even respond to antibiotics, which target bacteria, he said.
As for the middle-ear infections so common in infancy, about 80 percent of children get better without antibiotics,
according to the American Academy of Pediatrics. In its treatment guidelines, the academy says that infants and
children without severe symptoms can often wait 48 to 72 hours before starting antibiotics to see if the infection
improves on its own.

Tin từ Medscape

Preoperative Steroid Dose Improves Recovery (Hiền)

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October 26, 2010 (San Diego, California) — A single preoperative dose of dexamethasone enhances recovery after
planned laparoscopic cholecystectomy (LC) surgeries, according to research presented here at the American Society
of Anesthesiologists 2010 Annual Meeting.
Previous research has indicated that steroid therapy can reduce the severity of postoperative nausea, vomiting,
fatigue, and pain. Researchers at NorthShore University Health System in Evanston, Illinois, conducted a study to
examine the effect of an 8-mg dose of dexamethasone on health status, including emotional state, physical comfort,
psychological support, physical independence, and pain. They used a validated 40-item quality-of-recovery (QoR-40)
scoring system during the first day after hospital discharge following LC surgery.
In the study, 120 patients scheduled for outpatient LC surgery were randomly assigned to receive either
dexamethasone (8 mg) or saline (control group) about 1 hour before the surgery, and then received standardized
anesthetic management. The team used the QoR-40 to quantify health status preoperatively on the morning of the
surgery and 24 hours after discharge from the Ambulatory Surgery Unit. Group assignment was blinded with respect
to clinicians, researchers, and patients.
There was no difference between the 2 groups in preoperative global and dimensional QoR-40 scores.
On postoperative day 1, the control group had significantly lower median global QoR-40 scores compared with the
dexamethasone group (161 vs 178; P < .0001). Patients in the control group had lower median QoR-40 scores in the
dimensions of emotional state (35 vs 41; P < .0001), physical comfort (45 vs 51; P < .001), and pain (26 vs 31; P < .
0001). There were no differences in the dimensions of psychological support and physical independence. Patients in
the dexamethasone group had a shorter hospital stay by about 70 minutes.
"As anesthesiologists, we've done a great job of making anesthesia much safer over the last 20 years, but patients still
suffer a fairly high incidence of adverse effects after surgery, such as nausea, vomiting, pain, loss of appetite, fatigue,
headache, and dizziness. Our study demonstrates in patients having outpatient procedures that the use of a small
dose of steroid can significantly enhance the quality of recovery," Glenn Murphy, MD, director of clinical research at
NorthShore University Health System, who presented the research, told Medscape Medical News.
Dr. Murphy acknowledged concerns that steroid use could cause hyperglycemia and an increased risk for wound
infection. His team has 2 other ongoing trials looking at hyperglycemia, and the first showed no increased risk for
hyperglycemia. He added that previous research has not revealed an increase in wound infection. "My guess is that
with a short-term steroid dose, there's probably a low risk of infection."
The results are similar to previous trials showing that dexamethasone reduces postsurgical adverse effects. "The
difference is that they evaluated the quality of recovery. Previous trials tended to focus on single issues, such as
nausea and vomiting. This is a much more global score, with fatigue, function, [and emotional state]. It's definitely an
advantage," Daniel Sessler, MD, professor of outcomes research at the Cleveland Clinic, in Ohio, who moderated the
session, told Medscape Medical News.
The trial was relatively small. "What's needed now is a really large trial in noncardiac patients," said Dr. Sessler.
Dr. Murphy and Dr. Sessler have disclosed no relevant financial relationships.
American Society of Anesthesiologists 2010 Annual Meeting: Abstract 1184. Presented October 18, 2010.
Practice Redesign May Improve Care for Falls and Urinary Incontinence
October 26, 2010 — Practice redesign can improve the care that community-based primary care physicians provide
for older patients with falls and urinary incontinence (UI), according to the results of a controlled trial reported in the
October 25 issue of the Archives of Internal Medicine.
"In primary care, medical care for age associated conditions, such as falls and [UI], is inadequate," write Neil S.
Wenger, MD, MPH, from the David Geffen School of Medicine at the University of California–Los Angeles, and
colleagues. "In collaboration with the American College of Physicians, we augmented the Assessing Care of
Vulnerable Elders practice redesign intervention to improve falls and UI care."
In this study performed in diverse communities, 5 nonrandomly selected primary care intervention practices with a total
of 26 physicians were compared with control practices including 18 physicians. The study sample consisted of patients
at least 75 years of age who screened positive for falls or fear of falling and UI. From October 30, 2006, to December
31, 2007, the multicomponent intervention involved efficient data collection, medical record prompts, patient education
materials, and physician decision support. The investigators compared quality of care for falls and UI at intervention vs
control sites.
Of 6051 patients screened, nearly half (2847; 47.1%) screened positive for falls or UI, including 46.1% in the
intervention group and 48.8% in the control group. After stratified random selection, 1211 patient medical records
across the 5 practices were assessed. Recommended care for falls was received by 60.0% of intervention patients
compared with 37.6% of control patients (P < .001), and recommended care for UI was received by 47.2% vs 27.8%,
respectively (P < .001).
Compared with healthcare professionals at the control practices, those at the intervention practices more often
performed a falls history, orthostatic blood pressure measurement, gait and balance examination, and UI history, and
were more likely to try behavioral treatments for UI first. Knowledge about falls and UI also increased more among
intervention than control group healthcare professionals.

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"Practice redesign can improve the care that community-based primary care physicians provide for older patients with
falls and UI," the study authors write. "Outcomes of such care improvements require further evaluation."
Limitations of this study include selection bias because the physician practice participants were voluntary and were
specifically interested in improving geriatric care, nonrandom selection of intervention and control sites limiting
generalizability, care measurement limited to what was recorded in the medical records, and failure to study clinical
outcomes of care.
"[T]his study demonstrates further development of a practice redesign intervention to improve care for falls and UI that
may be implemented in most primary care practices," the study authors conclude. "Components are publicly
available.... Future implementation efforts should measure clinical outcomes, which were unavailable in this study."
The Atlantic Philanthropies to the American College of Physicians supported this study. The study authors have
disclosed no relevant financial relationships.
Children at High Risk for Severe Illness or Death Should Get Influenza Vaccination Priority (Nga)
October 26, 2010 — Children at high risk for severe illness or death, including ethnic minorities and those with
specified preexisting disorders, should get influenza vaccination priority, according to the results of a study reported
online October 26 in the Lancet.
"Young people (aged 0–18 years) have been disproportionately affected by pandemic influenza A H1N1 infection,"
write Sir Liam Donaldson, MBChB, former Chief Medical Officer for England and now chair of the National Patient
Safety Agency, United Kingdom, and Nabihah Sachedina, MD, former clinical advisor to Sir Liam at the UK
Department of Health. "We aimed to analyse paediatric mortality to inform clinical and public health policies for future
influenza seasons and pandemics."
Using daily reporting systems and cross-checking of records, the investigators identified all pediatric deaths related to
pandemic influenza A H1N1 infection in England from June 26, 2009, to March 22, 2010. Influenza infection was
confirmed by laboratory results or death certificates. Detailed information regarding past medical history, presentation,
and clinical course of the acute illness was obtained from individual treating clinicians. The Health Protection Agency
provided case estimates of influenza A H1N1. Population mortality rates and case-fatality rates were the main study
endpoints.
There were 70 reported pediatric deaths related to pandemic influenza A H1N1, with a childhood mortality rate of 6 per
million population. Children younger than 1 year had the highest mortality rate. Compared with white British children,
who had 4 deaths per million (95% confidence interval [CI], 3 - 6 deaths), mortality rates were higher among
Bangladeshi children (47 deaths per million population; 95% CI, 17 - 103 deaths) and Pakistani children (36 deaths
per million population; 95% CI, 18 - 64 deaths).
Of the 70 children who died, 45 (64%) had severe preexisting disorders, and 15 (21%) were previously healthy. The
highest age-standardized mortality rate associated with a preexisting disorder was for chronic neurological disease
(1536 per million population).
Compared with children who died after admission, the 19 children (27%) who died before inpatient admission were
significantly more likely to have been healthy or to have had only mild preexisting disorders (P = .0109). Of 45 children
(64%) who had received oseltamivir, only 7 received it within 48 hours of symptom onset, and only 3 before hospital
admission. Only 2 of the children who died had received H1N1 vaccine.
"Vaccination priority should be for children at increased risk of severe illness or death from influenza," the study
authors write. "This group might include those with specified pre-existing disorders and those in some ethnic minority
groups. Early pre-hospital supportive and therapeutic care is also important."
Limitations of this study include the difficulty in achieving complete death ascertainment and those inherent in case-
fatality rates.
In an accompanying comment, Robert A. Fowler, MD, from the University of Toronto, and Philippe Jouvet, MD, PhD,
from the University of Montreal, both in Canada, note that in the United States, as well as in England, children and
young adults who were not expected to become severely ill because of influenza did so, and in greater numbers than
with seasonal influenza.
"With the luxury of post-pandemic hindsight and with the findings of Sachedina and Donaldson, we now know that the
2009–10 H1N1 infection was associated with severe illness and death in greater numbers of children and young adults
than previous influenza seasons with other influenza viruses," Dr. Fowler and Dr. Jouvet write. "Any talk of over-
reaction to 2009 H1N1 virus might lead to an underappreciation of the very real risks of influenza. The 2009 pandemic
was not nearly as severe as feared, but might have been even less so with increased vaccination availability and
uptake."
The Department of Health, United Kingdom, supported this study. Dr. Donaldson was the Chief Medical Officer for
England from 1998 to May 2010, advising the government on public health policy, including the management of the
pandemic. Dr. Sachedina supported him in this task from 2009 to 2010. Both authors have disclosed no relevant
financial relationships. Dr. Fowler and Dr. Jouvet have disclosed no other relevant financial relationships.
Lancet. Published online October 26, 2010.
Regional Anesthesia Improves Outcomes After Melanoma Surgery

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October 27, 2010 (San Diego, California) — In melanoma patients, regional anesthesia during lymph node dissection
leads to a better long-term prognosis than general anesthesia, according to research presented here at the American
Society of Anesthesiologists (ASA) 2010 Annual Meeting.
Patients with malignant melanoma are believed to harbor remote micrometastases and free tumor cells. After surgery,
the patient's immune system must keep these cells and microtumors in check. Perioperative stress, volatile
anesthetics, and opioids depress the immune system and could lead to worse outcomes in these patients.
"We have good information from animal studies, and our understanding of the tumor [is telling us] that we should
expect surgery [to be] risky for our patients," Gerhard Brodner, MD, PhD, professor of anesthesiology at Fachklinik
Hornheide in Muenster, Germany, who presented the research, told Medscape Medical News. Retrospective analyses
of radical prostatectomy and primary breast cancer surgery have shown a reduced incidence of recurrence with
regional anesthesia. The researchers set out to study regional anesthesia in melanoma.
They conducted a retrospective study using the medical records of 273 patients who underwent inguinal lymph node
dissection following the diagnosis of primary malignant melanoma of the leg. The surgeries were performed between
February 1998 and April 2005, and patients received either spinal or general anesthesia. Patient records were
examined through May 2009, with an end point of mortality during a 10-year postoperative observation period.
In all, 52 patients were given spinal anesthesia (bupivacaine 0.5%) and 221 patients were given general anesthesia,
either as balanced anesthesia with sevoflurane and sufentanil (n = 118) or as total intravenous anesthesia with
propofol and remifentanil (n = 103).
The team used Kaplan–Meier estimates of the effect on survival rate for independent predictors, including ASA class,
tumor size, and type of surgery (P < .001). A matched-pairs analysis showed no difference in these variables between
patients who received spinal anesthesia and those who received general anesthesia.
The analysis showed that patients receiving spinal anesthesia had better cumulative survival over 10 years (mean
survival time, 95.9 months; 95% confidence interval [CI], 81.2 - 110.5) than those receiving general anesthesia (mean
survival time, 70.4 months; 95% CI, 53.6 - 87.1; P = .087). The subgroup of balanced volatile anesthesia (intravenous
anesthesia excluded) confirmed the trend (mean survival time, 68.5 months; 95% CI, 49.6 - 87.5; P = .081).
The researchers have started a prospective randomized trial to confirm the results.
The results suggest that anesthesiologists "should avoid everything that could harm the balance between the immune
system and tumor cells," said Dr. Brodner.
There have been a series of retrospective studies on the effects of regional and general anesthesia, with mixed results
in different tumors, according to Daniel Sessler, MD, professor of outcomes research at The Cleveland Clinic in Ohio,
who moderated the session. "We really need to wait for prospective data," Dr. Sessler said, noting that there are at
least 3 large randomized prospective trials in progress.
"This is an intriguing theory, but it's absolutely not a basis for altering practice. There's good basic science, and strong
animal data support it. It's the human data that we're having problems with," said Dr. Sessler.
The study did not receive commercial support. Dr. Brodner and Dr. Sessler have disclosed no relevant financial
relationships.
American Society of Anesthesiologists (ASA) 2010 Annual Meeting: Abstract 1183. Presented October 19, 2010.
Gut Organisms May Influence Energy Absorption
October 27, 2010 (San Diego, California) — Changes in gut microorganisms may play a role in calorie absorption in
food and could influence whether someone gains or loses weight, investigators said here at Obesity 2010: The
Obesity Society 28th Annual Scientific Meeting.
In a small study of lean and obese men fed high- and low-calorie diets, the ratio of 2 major types of intestinal flora
differed according to the diet's energy content, lead author Rainer Jumpertz, MD, explained.
Dr. Jumpertz, a visiting fellow at the National Institutes of Health in Phoenix, Arizona, and colleagues studied 12 lean
and 9 obese men who were fed 3400-calorie and 2400-calorie diets in a random crossover design.
For 3 days, the men ate meals calculated to maintain their weight "to keep them metabolically stable," Dr. Jumpertz
told Medscape Medical News. Then each man was randomly assigned to either the higher- or lower-calorie regimen
for 3 days. This was followed by another 3 days on the maintenance diet, followed by the second calorie-controlled
diet, and concluded with another 3 days on the maintenance diet. The experimental diets were matched for
micronutrients such as vitamins and minerals, so they differed only in calorie content.
In each diet condition, stool samples from the men were subjected to bomb calorimetry, and calorie absorption was
determined by calculating the percentage of stool calories relative to calories ingested. Microbiota species were
identified by sequencing bacterial rRNA genes from the fecal bacterial DNA. The 2 major phyla present were
Firmicutes and Bacteroidetes.
Calorie absorption did not differ significantly among lean and obese volunteers on either experimental diet, although
the lean volunteers absorbed significantly more calories on the 3400-calorie than the 2400-calorie regimen (P = .04),
and overall there was considerable variation between individuals.
"We were very surprised to find rapid changes in the gut microbiota upon overfeeding individuals relative to their body
size, meaning that the Firmicutes and the Bacteroidetes, which comprise about 97% of the phylae in the gut
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microbiota, changed rapidly after only 3 days. That was a new finding that hasn't been seen before," Dr. Jumpertz
said. Higher calorie absorption was associated with an increase in the presence of Firmicutes, but when calorie
absorption dipped, Bacteroidetes predominated (P = .04).
"What we can conclude from our results is that the more we overfeed individuals, the more the Firmicutes are
represented: the Firmicutes go up and the Bacteroidetes go down with increasing nutrient load, and vice versa." He
noted that these findings support observations by other investigators that Bacteroidetes outnumber Firmicutes in
humans after people stay on a low-calorie diet for 1 year.
"This study in man exemplifies the complexities of the relationships between the microbiota, the host, and nutrient
intake," said Eamonn Quigley, MD, professor of medicine and physiology at the University College Cork Medical
School, in Cork, Ireland. "The story of this relationship is far more complex than initially suggested by animal work, and
while this study by no means discounts a role for the microbiota in nutrient absorption and the genesis of obesity, it
also illustrates how the microbiota itself may be manipulated by changes in nutrient intake." Dr. Quigley was not
involved in this research.
These findings suggest that individual differences in calorie or nutrient absorption may be a result of variations in gut
microflora, Dr. Jumpertz said. "I think the most important clinical finding of this study is definitely the association
between changes in gut microbiota with nutrient absorption itself. This kind of implicates that a calorie might not really
be a calorie for everybody."
Dr. Jumpertz and Dr. Quigley have disclosed no relevant financial relationships.
Preoperative Statin Use Reduces Mortality in Coronary Bypass Patients
October 28, 2010 (San Diego, California) — Preoperative statins reduce mortality in coronary bypass patients,
according to research presented here at the American Society of Anesthesiologists 2010 Annual Meeting.
Most patients undergoing coronary artery bypass graft (CABG) surgeries are treated with beta blockers, angiotensin
converting enzyme inhibitors, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins). The
researchers investigated the relationship between preoperative statin therapy and postoperative outcome and 1-year
survival in patients undergoing CABG.
The study was prospective and included 1034 patients undergoing CABG surgery at a single academic institution. Of
these, 703 patients received preoperative statin therapy, and 331 did not. The researchers analyzed risk factors,
postoperative complications, and mortality at 30 days and 1 year after surgery.
They used likelihood ratios with kappa optimization to build a risk model for mortality and C-statistic with area under
the curve values to evaluate the performance of the risk model. The researchers used univariate and bivariate (χ 2,
Fisher's exact, and Student's t-test) analyses to determine the association between statin therapy and mortality. For
both groups, the researchers calculated number needed to treat and odds ratios (ORs) with 95% confidence intervals
(CIs).
Mean age of the population was 65 years (standard deviation, 10 years; range, 42 - 81 years), 283 were women, and
751 were men. Predictive risk factors for mortality were found to be: creatinine level, higher than 130 μmol/L; left
ventricular ejection fraction percentage, lower than 40%; age, older than 75 years; New York Heart Association status,
3 or more; and no statin therapy. The model's specificity was 98.7%, its sensitivity was 40.6%, and the total error rate
was 4.9% (kappa value, 0.481; 95% CI for kappa, 0.34 - 0.62; C-statistic area under the curve values, 0.83).
At 1 month, 36 patients had died (3.48%), including 19 patients in the statin group (2.7%) and 17 patients in the
nonstatin group (5.14%; χ2 3.96; P < .05). At 1 year, 64 patients (6.19%) had died, including 28 in the statin group
(3.98%) and 36 in the nonstatin group (10.9%).
For statin users, risk for 1-year mortality was an OR of 0.340 (95% CI, 0.208 - 0.556); among nonstatin users, the OR
was 4.7 (95% CI, 2.3 - 9.8; χ2 18.40; P < .0001; Fisher's exact, 0.00003). Number needed to treat among statin users
was 14.5 (95% CI, 9.5 - 30.9), and these patients had a relative risk reduction of 63.4%.
"Preoperative statin therapy may provide a significant risk reduction in the CABG patient population," the researchers
wrote in the abstract.
"Statins lower lipid levels, but they also have other cardioprotective effects. The difference in mortality was already
significant 1 month after the operation," Tuula Kurki, MD, PhD, a cardiac anesthesiologist at Helsinki University
Hospital, in Finland, who presented the research, told Medscape Medical News.
Dr. Kurki noted that some patients discontinue statins for personal reasons, but the study results underscore the
importance of patients staying on statins preoperatively. "We cannot yet make hard conclusions, but we suggest that
all patients going into coronary bypass surgery should have statins at least 4 weeks before the operation, and of
course after," Dr. Kurki said.
"It's an interesting observation, but the thing you have to worry about is some bias between the 2 groups. Those things
can be very hard to tease out," Mark Nunnally, MD, an associate professor of anesthesiology at the University of
Chicago, in Illinois, who moderated the session, told Medscape Medical News.
The use of statins is gaining momentum as a result of a number of retrospective studies, according to Dr. Nunnally. "I
think a lot of people would be happy to see the data be solidified a little more in a prospective fashion, but the signal is
strong, and I can attest that many providers are now using the drugs in this setting."

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Delayed-Release Mesalamine Effective in Control of Diverticulitis Symptoms (Thúy)
October 28, 2010 (San Antonio, Texas) — A delayed-release formulation of the anti-inflammatory drug mesalamine
showed efficacy in the treatment of diverticulitis at 12 weeks and continued improvement of gastrointestinal symptoms
at 12 months compared with placebo, according to a study presented here at the American College of
Gastroenterology 2010 Annual Scientific Meeting and Postgraduate Course.
In the first US double-blind, placebo-controlled trial of mesalamine for diverticulitis, 117 patients were randomly
assigned within 7 days of confirmed acute diverticultis to receive a once-daily administration of either 2.4 g delayed-
release mesalamine (six 400-mg tablets) or placebo over 12 weeks. The treatment period was followed by a 9-month
treatment-free period.
Patients were assessed according to a global symptom score (GSS) for 10 gastrointestinal symptoms on a 0 to 6
Likert scale.
The results showed a GSS reduction of 2.9 points among patients receiving mesalamine compared with patients
receiving placebo at 12 weeks (P = .38), and subgroup analysis in the mesalamine-only group showed improvement in
complete symptom response (Likert = 0) at 12 weeks vs placebo (28.1% vs 13.8%; total n = 61; P = .083), which
persisted at 52 weeks (40.7% vs 18.2%; total n = 49; P = .045).
Higher efficacy of the drug was seen with rectosigmoid-specific symptoms, including urgency, tenesmus, diarrhea, and
constipation, with complete symptom response rates for mesalamine vs placebo at 56.3% vs 17.2% (P = .001) and
59.3% vs 27.3% (P = .013) at 12 and 52 weeks, respectively.
"The percent of responders and complete responders, meaning those who reported complete improvement in
symptoms, was statistically significant," said lead author Neil Stollman, MD, from Northern California Gastroenterology
Consultants, in Oakland.
"We also looked at the rectal sigmoid symptoms, thinking they might be more specific for this disorder, and there were
similarly high rates of statistical significance in improvement at week 12 and 1 year," he said.
No differences were seen between the mesalamine and placebo groups in diverticulitis recurrence rates, surrogate
markers, or safety outcomes.
A subgroup of mesalamine patients who were given a probiotic dietary supplement of Bifidobacterium infantis 35624
showed no improvement over those who did not receive the supplementation.
Dr. Stollman said limitations of the study included a relatively small number of patients, the relatively short treatment
period of 12 weeks, and the fact that the GSS was not a validated symptom score.
"This study certainly doesn't say start treating your diverticulitis patients right away with mesalamine, but it certainly
supports looking at this concept further," Dr. Stollman said.
"This really probably is one of the early US entries in a field I think you're going to be seeing a lot more of," he added.
He noted that 2 large US trials are currently under way with a different mesalamine with a much larger population of
500 plus people and a 2-year follow-up, in addition to several European trials. "I think we will start to see this coming
out again and again," Dr. Stollman said.
Mesalamine, a bowel-specific aminosalicylate drug, is currently indicated in the United States to treat ulcerative colitis
and mild to moderate Crohn's disease.
According to Lawrence R. Schiller, MD, from the Baylor University Medical Center, in Dallas, Texas, who moderated
the session, the investigation of an anti-inflammatory for diverticulitis stems from the observation that people who have
frequent recurrences of symptomatic diverticulitis and end up with surgery may be helped by the class of drugs.
"These people sometimes have a seemingly noninfectious inflammation of the wall of the colon near the diverticulae,
and some believe that suppressing this inflammation by using anti-inflammatory drugs such as mesalamine may
reduce symptoms," said Dr. Schiller. "This study tried to investigate this hypothesis."
He added: "No specific therapy is the standard of care for these patients at the present time, so I think the paper
voices an interesting concept and may alter our approach to symptomatic diverticular disease, if confirmed."
One Year After Stroke Hypertension Not Well Controlled in Most Patients
October 28, 2010 (Seoul, South Korea) — One year after having a stroke, most patients in a moderately large Danish
cohort were hypertensive. Their compliance with medication regimens appeared to be excellent, suggesting an
underuse of diuretics and combination therapies, the study authors suggest.
The study was presented here at the 7th World Stroke Congress.
Between April 2004 and September 2007, 1306 patients admitted to any of 3 hospitals in Copenhagen, Denmark, with
an acute stroke or first or recurrent transient ischemic attack (TIA) were included in a consecutive cohort. Researches
recorded antihypertensive treatment before the stroke, at hospital discharge, and 1 year later.
In this follow-up study of 421 patients from the original cohort, 75% of participants had had an ischemic stroke, 20% a
TIA, and 5% a hemorrhagic stroke. Their median age was 71 years (range, 61 – 80 years), 52% were men, 13% had a
diagnosis of diabetes at discharge, 39% were current smokers, and 52% had a body mass index (BMI) greater than 25
kg/m2.

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Lead study author Nete Hornnes, PhD, of the Clinical Research Centre at Hvidovre Hospital in Hvidovre, Denmark,
said at 2 to 3 days after being admitted to the hospital for their stroke, only 8% of this follow-up cohort had been
normotensive, with blood pressure (BP) less than 120/80 mm Hg.
At that time, prehypertension existed in 22% (defined as BP ≥120/80 mm Hg and <140/90 mm Hg). Most (70%) had
stage 1 (BP ≥140/90 and <160/100 mm Hg, 30%) or stage 2 (BP ≥160/100 mm Hg, 40%) hypertension, according to
definitions used in the US Joint National Committee's seventh report.
On admission for stroke, 45% of patients had been undergoing antihypertensive therapy and were receiving an
average of 1.7 antihypertensive drugs. At discharge, 61% were receiving treatment and were taking a mean of 1.6
drugs, and on follow-up, 67% were treated, with a mean of 1.7 drugs.
"Treatment with diuretics is often underused in patients with hypertension, and we found that of those treated, 53% of
patients had a diuretic on admission, 47% at discharge, and at follow-up half the patients were treated with diuretics,"
Dr. Hornnes said.
When surveyed, 99% of patients reported at least 80% compliance with diuretic use in the previous 2 weeks, and 83%
reported total compliance with diuretic use. For all antihypertensive medications, 98% of the patients declared 80%
compliance, and 93% declared 100% compliance.
BP measurements at 1-year follow-up were made with the patient in a sitting position using both arms with a digital BP
monitor after the patient was at rest for 5 minutes. Three readings at 10-minute intervals were made using the arm
with the highest systolic measurements. At follow-up only 12% had no hypertension.
Prehypertension existed in 29%, 31% had stage 1 hypertension, and 28% had stage 2 hypertension. "So more than
half of the participants were hypertensive 1 year after stroke," Dr. Hornnes reported. "No matter whether they were
untreated or [taking] one or more drugs, more than half of the patients had hypertension."
Table 1. Percentage of Patients with Hypertension (HT) by Number of Drugs
No. of Drugs No HT Pre-HT Stage 1 HT Stage 2 HT

0 15 31 33 21

1 7 27 35 31

2 13 33 24 30

≥3 10 18 36 36

As the number of risk factors increased, so did the proportion of patients with stage 1 or stage 2 hypertension. The
increase was most notable for stage 2 hypertension. The 7 risk factors that the researchers considered were age of 75
years or older, BMI of 25 kg/m2 or higher, excessive alcohol consumption, hypercholesterolemia, diabetes, inactivity,
and current smoking.
"You see there is a nice linear relationship between the number of risk factors and the proportion of patients with stage
2 hypertension," Dr. Hornnes said. From a regression analysis, the researchers found that systolic BP on day 2 or 3
after stroke was a significant predictor of systolic BP on follow-up, and so were age and smoking.
Table 2. Hypertension (HT) by Number of Risk Factors
No. of Risk Factors Stage 1 HT Stage 2 HT

0 25 7

1 35 14

2 34 25

≥3 30 36

Dr. Hornnes concluded that most patients were hypertensive 1 year after stroke despite good compliance with
antihypertensive medication regimens.
"More intensive antihypertensive treatment, including a diuretic, is needed in order to reduce these patients' risk of
further cardiovascular complications, and it's important to consider the whole risk factor profile of the patient," she
advised.
Verifying Compliance Data
Session moderator Hans-Christoph Diener, MD, PhD, professor and chairman of the Department of Neurology at the
University of Duisberg-Essen in Germany, challenged the compliance data, as he said, for the simple reason that "if
you simply ask patients whether they took medications, the compliance is always very high."
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He said he recently performed a series of studies in different diseases to check the patients' reports compared with
prescription refill data from insurance companies. In those studies he said there was a big discrepancy. "Ninety
percent of the people claimed to be compliant, but looking at the refills it was clear that only 50% of the patients were
compliant," he said.
Dr. Hornnes said in her study, nurses assisted patients in taking their pills, and there were pill containers to account for
use, so although the compliance may not have been as high as the reports indicated, she said she was confident that
compliance was quite high.
Dr. Diener said a positive confounder in the study was that nurses came to take BP measurements, and just knowing
that would probably induce patients to take their medications.
And he said about BP control in general, "I think on a global level it's a nightmare that we are still not able really to
control blood pressure even in healthcare systems as sophisticated as in Denmark. In Germany, it's exactly the same
problem."
Low Birth Weight: A Risk Factor for Childhood CKD?
October 28, 2010 — Low birth weight and being small for gestational age are independent risk factors for short stature
and low current weight in children with mild to moderate chronic kidney disease (CKD), and low birth weight could be a
risk factor for CKD in childhood, say investigators reviewing data from a multicenter prospective cohort study.
Among 426 participants in the Chronic Kidney Disease in Children (CKiD) study, birth weight less than 2500 g was
associated with a significant negative effect as measured by z-scores of −0.43 ± 0.14 (P < .01) for its effect on height
and −0.37 ± 0.16 (P = .02) for its effect on weight, report Larry A. Greenbaum, MD, PhD, from Emory University and
Children's Healthcare of Atlanta, in Georgia, and colleagues.
Similarly, being small for gestational age, defined as a birth weight below the 10th percentile for gestational age, had a
negative effect on current height (−0.29 ± 0.16; P = .07) and on current weight (−0.41 ± 0.19; P = .03).
Children with glomerular diagnoses (eg, focal segmental glomerulosclerosis, hemolytic uremic syndrome, familial
nephritis, immunoglobulin A nephropathy, et.) were more likely to have lower current weight than children with
nonglomerular diagnoses (obstructive uropathy, reflux nephropathy, aplastic/hypoplastic/dysplastic kidneys, autosomal
recessive polycystic kidney disease, renal infarct, etc).
"This is the first study showing an association between low birth weight and poor growth in children with CKD," said
Dr. Greenbaum in a press release. "The study also demonstrates that children with CKD are more likely to be born
with low birth weight than the general population. This occurs in children who are born with kidney disease and those
who acquire kidney disease during childhood. It is possible that low birth weight is a risk factor for the development of
kidney disease during childhood."
The investigators looked at data on growth outcomes recorded during 1393 visits from 426 eligible patients of the total
586 participants in the cohort as of September 2009. They looked for the possible effects of early developmental
anomalies using multivariate analyses.
The median patient age was 10.7 years. In all, 21% of patients had a glomerular diagnosis of CKD, and 79% had a
nonglomerular diagnosis. Slightly more than half of the participants (52%) had CKD for more than 90% of their lives.
The prevalence of low birth weight in the cohort was 17% compared with an overall rate in the United States ranging
from 7.4% to 8.3% in the decade beginning in 1996, the authors wrote. In addition, 14% of the children were small for
gestational age, and 40% had spent time in a neonatal intensive care unit.
The authors acknowledge that the study was limited by reliance on parental recall of children's birth history; the greater
frequency of very low z-scores for height and weight compared with frequency of very high z-scores for these
variables, which affected the normal distribution curve; and the observational nature of the study, opening the
possibility of unmeasured confounders.
Low birth weight has been shown in epidemiologic studies to be a risk factor for the development of CKD in adults. In
addition, low birth weight may be secondary to CKD in children with nonglomerular causes, which are generally
diagnosed shortly after birth, the authors note.
"However, participants with glomerular disease, which was diagnosed on average 7.5 years after birth (compared with
a nonglomerular disease which was diagnosed on average 0.1 years after birth), also had a higher than expected rate
of low birth weight and small gestational age. This raises the intriguing possibility that low birth weight may be a risk
factor for the development of CKD, even during childhood," Dr. Greenbaum and colleagues conclude.
Exposure to Bisphenol A Linked to Reduced Semen Quality (V Anh)
October 28, 2010 — Exposure to bisphenol A (BPA) is linked to reduced semen quality and sperm count, according to
the results of a study reported in the October 28 issue of the Journal of Fertility and Sterility.
"Compared with men without detectable urine BPA, those with detectable urine BPA had more than 3 times the risk of
lowered sperm concentration and lower sperm vitality, more than 4 times the risk of a lower sperm count, and more
than twice the risk of lower sperm motility," lead author De-Kun Li, MD, PhD, a reproductive and perinatal
epidemiologist at Kaiser Permanente's Division of Research in Oakland, California, said in a news release. "Similar
dose-response associations were observed among participants with only environmental BPA exposure at levels
comparable to men in the general United States population."

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BPA is a chemical created in the production of polycarbonated plastics and epoxy resins found in baby bottles, plastic
containers, the linings of cans used for food and beverages, and dental sealants. Although previous animal studies
showed harmful effects of BPA on the male reproductive systems of mice and rats, this is the first study to report an
adverse association between BPA and semen quality in humans. The trial is the third in a series by Li and colleagues
evaluating the effects of BPA on human sexual function. The first 2 studies, published in the November 2009 issue of
Human Reproduction and the May 2010 issue of the Journal of Andrology, found an association between both high
levels of BPA in the workplace and rising BPA levels in urine and worsening sexual function in men.
During this 5-year study, workers in participating factories in China were enrolled in the trial, and those with high urine
BPA levels were compared with those with low urine BPA levels. Of 888 eligible workers, 514 (58%) agreed to
participate, and 218 participants provided both urine and semen specimens and were included in the final analyses.
In-person interviews collected data on demographic characteristics, occupational history, and potential risk factors
thought to affect semen quality, such as smoking, alcohol use, chronic diseases, history of subfertility, exposure to
other chemicals and heavy metals, and recent exposure to heat sources such as a steam bath.
Risks for poor semen quality, including low sperm count and concentration and low sperm vitality and motility, were 2
to 4 times greater in men with high urine BPA levels than in those with low urine BPA levels. Urine BPA levels,
however, were not associated with semen volume or abnormal sperm morphology.
Even though there was a markedly reduced sample size in the group of men exposed only to low environmental BPA
sources, the inverse correlations between increased urine BPA level and lower sperm concentration and total sperm
counts remained statistically significant.
Limitations of the study include a high rate of participation decline when subjects learned of the need to provide
samples of both urine and sperm. However, it is highly unlikely that the choice to participate or not participate was
related to semen quality.
"The consistency of the findings between the current and [2 previous] studies, despite different exposure
measurements (urine BPA levels vs. BPA exposure in the workplace) and end points (semen quality vs. sexual
function), strengthens the validity of these findings," Dr. Li concluded. "The finding of the adverse BPA effect on
semen quality illustrates two points: first, exposure to BPA now has been linked to changes in semen quality, an
objective physiological measure. Second, this association shows BPA potential potency: it could lead to pathological
changes of the male reproductive system in addition to the changes of sexual function."
H1N1 Influenza Vaccine Safe for Pregnant Women
October 28, 2010 (Vancouver, British Columbia) — Last year's H1N1 influenza vaccine was safe for pregnant women
and was well tolerated. There was no difference in reported adverse effects between unvaccinated women and
women who received the H1N1 vaccine alone or with the seasonal influenza vaccine, except for arm soreness.
Stephanie Irving, MHS, epidemiologist at the Marshfield Clinic Research Foundation in Wisconsin, reported the results
of this survey of pregnant women who did or did not plan to be vaccinated here at the Infectious Diseases Society of
America (IDSA) 48th Annual Meeting.
Reported rates of hospitalization and death for pregnant women were higher than in the general population during the
2009 H1N1 pandemic. The United States Advisory Committee on Immunization Practices made pregnant women a
high priority for H1N1 vaccination. In prelicensure trials, the H1N1 vaccine appeared to be as safe as the seasonal
influenza vaccine. Targeting common acute adverse effects, the investigators set out to describe the postlicensure
safety profile of the H1N1 vaccine.
They recruited pregnant women 18 years or older (n = 767; gestation of less than 38 weeks) from the Marshfield Clinic
and from Kaiser Permanente Northwest in Portland, Oregon, who had not received the vaccine more than 24 hours
before enrollment. The women filled out a 14-day symptom and temperature diary.
The mean maternal age at enrollment was 28 years, 26% were covered by Medicaid or public insurance, and the
mean gestational age at enrollment was 18 weeks (range, 4 to 38 weeks). Of the 767 women, 68% received no
vaccination, 25% received the H1N1 vaccine only, 6% received the H1N1 and seasonal vaccines, and 1% received
only the seasonal vaccine. About 36% received the H1N1 vaccine in the first trimester (either alone or with the
seasonal vaccine), 28% in the second trimester, and 24% in the third trimester.
Complete symptom data were available for 571 women. The most frequently reported symptom on at least 1 day of
the reporting period was headache, reported by approximately 63% and 43% of participants at the Marshfield Clinic
and Kaiser Permanente Northwest sites, respectively, followed by nausea (49% and 38%), muscle ache (about 30%),
arm soreness (about 25%), chills (about 20% at both sites), and diarrhea (about 10% at both sites). A few participants
reported rash.
For all symptoms except arm soreness, the women who received either the H1N1 vaccine alone or with the seasonal
vaccine did not differ from unvaccinated women in reporting a symptom on at least 1 day of the reporting period. About
64% of women who received the H1N1 vaccine alone had arm soreness, as did 71% of women who received both
vaccines; only about 2% of unvaccinated women did.
Among the 20% of women who reported headaches, the majority were mild, with only about 12% to 18% of them rated
as moderate or severe. The headache reports did not differ between vaccinated and unvaccinated women. Similarly,
only about 20% of women reported nausea, mostly mild, and the prevalence of nausea did not differ from the

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unvaccinated cohort. Only about 10% reported muscle aches, which were generally mild and did not differ from
unvaccinated women. Arm soreness was virtually absent among the unvaccinated women and was generally mild
among vaccinated women who reported it. Virtually all participants were afebrile, and the vaccinated groups did not
differ from each other or from the unvaccinated group.
Limitations of the study were that it depended on unverified self-reported data, that the participants subjectively
assessed symptom presence and severity, and that the unblinded reporting was subject to potential bias. Also, the
reporting period was limited to 14 days, the study did not examine uncommon adverse events, and because the
population was enrolled in managed care, it might not be representative of the general American population.
Ms. Irving said that a study is underway to look at vaccination status and pregnancy complications and fetal outcomes.
Also, the current study is being replicated to examine the safety of the 2010 seasonal vaccine in pregnant women.
She concluded that "the study of 767 pregnant women did not find any serious short-term complications after H1N1
influenza vaccination. . . . Reported side effects of the vaccine were minimal. Women who received the vaccine were
not more likely to report any of the side effects for which we monitored [than] unvaccinated women, except for arm
soreness, as expected."
Andrew Pavia, MD, chair of the Pandemic Influenza Task Force for IDSA and chief of the Division of Pediatric
Infectious Diseases at the University of Utah in Salt Lake City, noted that pregnant women are "wisely suspicious" of
drugs in general, so it is a complicated message to them about influenza vaccine. Flu vaccines have previously been
shown to be safe during pregnancy; there was a question about the 2009 H1N1 vaccine only because it had not been
evaluated extensively.
"This additional information that, again, this vaccine, like other flu vaccines, was as safe in pregnant women as in
nonpregnant people was very helpful," he explained. Finally, he said, after several years of low vaccination rates
among pregnant women, more of them have been getting the flu vaccine, probably because obstetricians have been
advocating it.
Dr. Pavia said that all influenza can be particularly high risk for the mother (e.g., because of pneumonia and heart
problems) and for the baby during pregnancy and delivery. An added benefit, he said, is that vaccination of the mother
can protect the baby from flu for up to the first 6 months of life.
In another presentation at IDSA, Marci Drees, MD, MS, from the Department of Medicine at Christiana Care Health
System in Wilmington, Delaware, and Jefferson Medical College of Thomas Jefferson University in Philadelphia,
Pennsylvania, presented the findings of her study on factors affecting the acceptance of H1N1 vaccine by pregnant
women. This group has had one of the lowest uptake rates of flu vaccination among all high-priority groups, and they
had a disproportionately high mortality rate from the 2009 H1N1 virus.
Dr. Drees and colleagues administered a 12-question survey to new mothers on postpartum day 1 or 2 at their 900-
bed community-based academic medical center between February 1 and April 15, 2010. Among 307 women, 62% had
been vaccinated against the H1N1 virus, and 32% had been offered the vaccine but had refused.
In a multivariate analysis, a doctor's recommendation was one of the strongest predictors of acceptance of H1N1
vaccination (odds ratio [OR], 6.9; 95% confidence interval [CI], 2.7 - 17.6). If the woman had received the seasonal flu
vaccine while pregnant, she was more likely to receive the H1N1 vaccine as well (OR, 4.4; 95% CI, 2.4 - 8.1). In
addition, some or all family members or caregivers being vaccinated against H1N1 predicted the H1N1 vaccination of
the pregnant woman (OR, 2.8; 95% CI, 1.5 - 5.3). Non-Hispanic black women were 70% less likely to be vaccinated
against H1N1 (OR, 0.3; 95% CI, 0.2 - 0.7; P < .001 for all).
Among women choosing not to be vaccinated, safety concerns were the primary barrier. Many unvaccinated women
reported that they were not aware that they were at increased risk from the H1N1 flu.
The investigators emphasized the role of physicians in recommending vaccination and the need for continued
engagement with obstetrical providers to reinforce this message and to sustain high vaccination rates among pregnant
women. "Our study shows that if obstetrical providers and public health authorities really make a concerted effort to
vaccinate pregnant women for flu and educate them about the risks and benefits, they are willing to be vaccinated
even in a setting where the vaccine is often perceived as more risky than the usual seasonal flu vaccine," Dr. Drees
said.
Dr. Pavia said that because of the H1N1 virus, rates of immunization have gone up, primarily because of efforts by
pregnancy care providers. "The biggest predictor of not getting vaccinated has to do more with access to care . . . and
how the vaccine was presented to them as an option," he said.
Obesity Associated With Increase in Colorectal Adenoma Recurrence
October 28, 2010 (San Antonio, Texas) — Obese patients have a higher risk for colorectal adenoma recurrence than
those with a normal body mass index (BMI) at short- and long-term follow-up, according to a study that evaluated
patients as long as 12 years after a baseline colonoscopy.
Previous 4-year follow-up studies have shown an association between obesity and colorectal adenoma recurrence.
In the Polyp Prevention Trial (PPT), patients were followed for as long as 12 years (mean duration, 8.4 years). That
study found that, compared with patients with a normal BMI, those who were overweight or obese continued to show
an increased risk for adenoma recurrence at short- and long-term follow-up. The results were presented here at the
American College of Gastroenterology 2010 Annual Scientific Meeting and Postgraduate Course.
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"When we look at the results, being overweight was associated with an increased risk of adenoma recurrence,
compared with patients with a normal BMI," said Adeyinka Laiyemo, MD, lead author of the study.
"This suggests that lifestyle modification should be encouraged among these patients," said Dr. Laiyemo, assistant
professor of medicine in the Division of Gastroenterology at Howard University College of Medicine in Washington,
DC.
In the PPT-Continued Follow-Up Study, 760 patients who had colorectal adenoma at baseline and who underwent a
colonoscopy 1 and 4 years after enrollment were evaluated for up to 8 more years.
At baseline, about 50% of participants were overweight, 25% were obese, 66% were male, and mean age was 59.7
years.
The results showed that at 4-year follow-up, 378 patients considered overweight (baseline BMI, 25 to 29 kg/m 2) had a
relative risk (RR) for adenoma recurrence of 1.23 (95% confidence interval [CI], 1.03 - 1.46), compared with no
recurrence; RR for advanced adenoma was 1.18 (95% CI, 0.75 - 1.85).
In the 12-year follow-up for the overweight group, the RR for any adenoma was 1.18 (95% CI, 1.02 - 1.36); for
advanced adenoma, the RR was 1.14 (95% CI, 0.80 - 1.61).
In the obese group (baseline BMI, 30 kg/m2 or higher), the RR for any adenoma at 4-year follow-up was 1.19 (95% CI,
0.98 - 1.45) and for advanced adenoma was 1.23 (95% CI, 0.73 - 2.07). In the 12-year follow-up, the RR for any
adenoma was 1.20 (95% CI, 1.03 - 1.41) and for advanced adenoma was 1.25 (95% CI, 0.83 - 1.88).
The findings provide some important insights into yet another health risk associated with obesity — the potential for
the recurrence of colorectal adenomas. However, questions about whether weight loss can play a role in the risk for
recurrence were not answered, observed gastroenterologist Carol Burke, MD, director of the Center for Colon Polyps
and Cancer Prevention at The Cleveland Clinic Foundation in Ohio.
"The study demonstrated that an overweight or obese BMI at baseline was associated with a 20% risk for recurrent
adenomas, but not for advanced adenomas. So, [obesity] turns on the colon lining but doesn't seem to propel an
adenoma to become advanced," she explained.
"Unfortunately, the researchers did not exclude individuals whose BMI may have changed over the observation period,
so the effect of weight gain or weight loss in the observation period could have attenuated the observed effect," Dr.
Burke added.

Tin từ Heartwire

Tin từ Healthday
Radiation Before Surgery May Prevent Return of Rectal Cancer
Study found risk of recurrence 10 years later was cut nearly in half

MONDAY, Oct. 25 (HealthDay News) -- Patients who receive radiation before surgery for rectal cancer are about 50
percent less likely to experience a return of their cancer, a new Dutch study has found.
Local recurrence -- the return of cancer to the original tumor site and surrounding area -- is a major problem in the
treatment of rectal cancer patients, explained the researchers from Leiden University Medical Center in the
Netherlands.
This recurrence often occurs in lymph nodes in the mesorectum, which is fatty tissue near the rectum. That's why
many patients undergo a surgical procedure called total mesorectal excision (TME), which removes the entire
mesorectum and lymph nodes, the study authors explained.
The researchers found that radiation treatment before surgery cuts the risk of cancer recurrence after 10 years by
about half.
The study included more than 1,800 rectal cancer patients scheduled for TME. They were randomly selected to
receive short-term radiation before surgery or surgery alone. Ten years after treatment, the risk of local cancer
recurrence was 6 percent in the radiation/surgery group and 11 percent in the surgery-alone group, the investigators
reported.
The findings are to be presented Nov. 1 at the American Society for Radiation Oncology (ASTRO) annual meeting, in
San Diego.
"We believe that this short course of radiation will open a new window of opportunities in the treatment of rectal
cancer," study author and radiation oncologist Dr. Corrie Marijnen said in an ASTRO news release.
She added that the "study suggests that tumors in the middle rectum and stage III rectal cancer patients will most
greatly benefit from receiving radiation before surgery."
"TME is an important advance in the surgical management of rectal carcinoma. Unfortunately, the complexity of the
anatomy involved is such that even with expert surgery, there are still patients who will experience recurrence of their
cancer in the pelvic region, compromising their survival and markedly impairing the quality of their life," explained Dr.
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Bernadine Donahue, vice chair and clinical director of radiation oncology at Maimonides Cancer Center in New York
City.
"The large Dutch experience has helped identify which subsets of patients will benefit from preoperative radiation
therapy as a means of decreasing the risk of local recurrence. In the Dutch trial, an intense short course of radiation
therapy was delivered prior to surgery. This clearly improved tumor control and that is good news," Donahue noted.
"However, most North American facilities deliver [an] equivalent amount of radiation packaged as smaller amounts
daily over a longer period of time to decrease the likelihood of long-term toxicity. It remains to be seen what the long-
term side effects of the Dutch approach will be."
Experts note that studies presented at scientific meetings do not face the same peer-review scrutiny as those
published in reputable journals.
SOURCE: American Society for Radiation Oncology, news release, Oct. 25, 2010; Bernadine Donahue, M.D., vice
chair and clinical director, radiation oncology, Maimonides Cancer Center, New York City
Weight May Affect a Woman's Fertility (A Thành)
Obesity, underweight linked to poorer outcomes in studies

MONDAY, Oct. 25 (HealthDay News) -- A woman's weight influences her fertility, two new studies suggest.
In one study, researchers compared Society for Assisted Reproductive Technology (SART) data on 158,385
menstrual cycles with the height and weight of women. They found that cycle cancellation rates became more
common with increasing body mass index (BMI) and that the chances of not becoming pregnant, or failing to carry a
pregnancy to term, rose significantly with increasing obesity.
In the other study, researchers at Harvard University and Brigham and Women's Hospital in Boston examined the
quality of eggs and embryos from women with different BMIs.
Eggs from women with high and low BMIs were more likely than eggs from normal-weight women to produce
immature oocytes during an assisted reproductive technology (ART) cycle, leading to a lower likelihood of successful
embryo transfer and a lower live birth rate.
The studies were to be presented Monday at the annual meeting of the American Society for Reproductive Medicine in
Denver.
"Clearly a healthy body weight is an important advantage in all aspects of health, including reproductive health," Dr.
James Goldfarb, SART president, said in an American Society for Reproductive Medicine news release.
"We are hoping that with better information we can provide better help to our patients whose struggle with infertility
includes a struggle with weight," he said.
SOURCE: American Society for Reproductive Medicine, news release, Oct. 25, 2010

Cancer Risk From Radiation Doesn't Fade With Age

TUESDAY, Oct. 26 (HealthDay News) --Middle-aged adults may face as high a risk for developing cancer as a result
of radiation exposure as younger adults and children, new research suggests.
Although children are thought to be more sensitive to the long-term impact of radiation and related cancer risks, the
current observation runs counter to some previous research suggesting that as people age, their vulnerability to
radiation-induced cancer diminishes.
"Overall, the weight of the epidemiological evidence suggests that for adult exposures, radiation risks do not generally
decrease with increasing age at exposure," a team of authors from Columbia University in New York City said in a
news release.
The findings are published in the Oct. 25 online issue of the Journal of the National Cancer Institute.
The study's conclusion is based on a review of data concerning Japanese survivors of the atomic bomb, whose
radiation cancers were attributable to one of two causes: genetic mutations caused by radiation that turned normal
stem cells into precancerous cells, or an increase in the number of already existing precancerous cells.
Using a newly designed risk analysis model, the authors looked at the age of the survivors at the time the bomb was
dropped and then tracked the ensuing incidence of cancer.
In turn, they used the same statistical framework to predict cancer risk by age of radiation exposure among people
aged 30 to 60 in the U.S. population.
The finding: For some types of tumors, cancer risk does appear to increase following radiation exposure among
individuals in this age bracket -- a discovery they said could have practical implications, since most X-ray procedures
and jobs requiring radiation exposure involve middle-aged people.
In an accompanying editorial, John D. Boice of the International Epidemiology Institute in Rockville, Md., and
Vanderbilt University in Nashville, noted that prior studies contradict the current findings and that generalizing the
Japanese data to the U.S. population may be problematic.
But he concluded that the current effort "raises provocative hypotheses and conclusions that -- although preliminary --
draw attention to the continued importance of low-dose radiation exposures in our society."
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New Polio Vaccine Shows Major Advantages: Study
Bivalent oral vaccine targets two deadly strains of virus
TUESDAY, Oct. 26 (HealthDay News) -- A new bivalent oral vaccine that targets two deadly strains of polio -- types 1
and 3 -- triggers a stronger immune response than the existing trivalent vaccine and an immune response that's similar
to monovalent vaccines, a new study shows.
Use of trivalent and monovalent vaccines has reduced the number of countries where polio is endemic from more than
125 in 1988 to just four today. Transmission of polio virus types 1 and 3 persists in parts of Afghanistan, Pakistan,
India and Nigeria.
The bivalent oral vaccine is already widely used in efforts to halt transmission of polio virus types 1 and 3, but this
study set out to examine whether it triggers as much immunity as the other vaccines.
Between August and December 2008, researchers gave 830 newborns in India either the monovalent, bivalent or
trivalent vaccines in two doses, including one at birth and one 30 days later. Antibody levels were measured in blood
samples before vaccination and after the first and second doses of the vaccines.
Overall, the immune response induced by the bivalent vaccine was significantly higher than the trivalent vaccine and
similar to the monovalent vaccine, the investigators found.
The study was released online Oct. 25 in advance of publication in an upcoming print issue of The Lancet.
"The major advantages of the bivalent vaccine ... is that it will enhance individual and population immunity
simultaneously for both poliovirus types 1 and 3, without any serious loss in immunogenicity compared with the
[monovalent vaccines]," the researchers said in a news release from the publisher.
GI Endoscopy Complication Rates Higher Than Suspected: Study
Although there were more problems than previously estimated, most were minor, researchers found
MONDAY, Oct. 25 (HealthDay News) -- Complications following gastrointestinal endoscopies -- procedures performed
to detect ulcers, cancer and other conditions -- may be higher than previously estimated.
The good news is that most of the problems reported were minor, such as abdominal pain, and the rate of serious
complications is actually lower than previously suspected, according to a study published in the Oct. 25 issue of the
Archives of Internal Medicine.
Although the overall risk of complications was two to three times higher than had been reported, the risk of severe
complications, such as perforations and bleeding, heart attacks or even death, were lower than previous studies --
about half of that reported in earlier estimates, said study author Dr. Daniel Leffler, director of clinical research at the
Celiac Center at Beth Israel Deaconess Medical Center in Boston.
Gastrointestinal endoscopic procedures -- in which doctors use a thin, flexible tube with a fiber-optic light and a tiny
video camera at the tip to look inside the esophagus, stomach, intestines or colon -- are common in the United States,
with some 15 million to 20 million performed each year, the authors stated.
These authors took advantage of the Beth Israel Deaconess Medical Center electronic medical record system to
devise their own system to monitor emergency room visits and hospitalizations of patients who had had an endoscopy
within the past two weeks.
Previous research indicates that most post-endoscopy-related hospital visits occur within a 14-day time frame.
The system recorded 6,383 endoscopies and 11,632 colonoscopies between March 1 and Nov. 30, 2007. A total of
419 emergency department visits and 266 hospitalizations took place within two weeks following the procedures. Of
these, 134 (32 percent) of the emergency room visits were related to complications related to the endoscopies, as
were 76 (29 percent) of the hospitalizations.
Traditional reporting by physicians recorded only 31 such complications, the study authors noted.
Almost half of the visits were due to abdominal pain, 12 percent to gastrointestinal tract bleeding and 11 percent
involved chest pain, the researchers found.
Older patients were more likely to have complications.
Although most of the complications were minor, the cost of follow-up care was not. The average cost per emergency
room visit following endoscopy was $1,403 and the average cost of hospitalization for post-procedure complications
was $10,123, the researchers reported.
The findings may help guide how doctors counsel patients following one of these procedures.
"We've done a lot over the years to mitigate the risks of bleeding and perforation, and rightly so," Leffler said. "Now
[that] we know of the underlying iceberg of minor complications, we can really look at those because they're a
significant burden to patients and the health-care system. Most of these patients go home at the end of the day," he
noted.
"We can alert patients that [certain symptoms] are common and here are some things you can try -- heating pads,
things like that," he said. "If it's persistent and there are certain warning signs, they should let us know."

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Leffler also pointed out that electronic medical records might emerge as a more rigorous way to determine
complications from different hospital procedures.
Dr. Vivek Kaul, acting chief of the division of gastroenterology & hepatology at the University of Rochester Medical
Center, said he was not particularly surprised by the findings.
"These types of events are not uncommon," he said. And "symptoms should be triaged [for example, first by a phone
call to a doctor] before people are directed to the ER unless the symptoms are catastrophic. I don't think you can not
direct patients to call or go to the ER. Who wants to take the chance of missing that one patient that could be saved by
going to the ER."
Arteries of Obese Kids Aging Prematurely: Study
MONDAY, Oct. 25 (HealthDay News) -- The arteries of obese children have a degree of stiffness normally seen in
adults with heart disease, according to a new study.
Canadian researchers evaluated 63 obese children, average age 13, and 55 normal weight children. The obese
children had abnormal results on an ultrasound test of the heart and blood vessels that measured how fast blood
flowed through the body.
Of special note was stiffness of the aorta -- the body's largest artery, which carries oxygen-rich blood to all the other
arteries.
"The normal aorta has elastic qualities that buffer the flow of blood. When that elasticity is lost, aortic stiffness results --
a sign of developing cardiovascular disease," said study author Dr. Kevin Harris, from BC Children's Hospital in
Vancouver, in a Heart and Stroke Foundation of Canada news release. "Aortic stiffness is associated with
cardiovascular events and early death."
It's as if the aging process has been accelerated in the aortas of obese children, he added.
Future research should examine whether arterial stiffness in obese children can be reversed with treatment such as
improved diet and exercise, Harris said.
The study findings, to be presented Monday at the Canadian Cardiovascular Congress, are alarming, said Heart and
Stroke Foundation spokeswoman Dr. Beth Abramson.
"We know there is an association between unhealthy lifestyles and heart disease," she said in the news release. "Our
kids are at risk. Poor nutrition and inactivity are threatening their health and well-being. We must rethink the lifestyle
standards we have accepted as a society to protect the future health of our kids."
SOURCE: Heart and Stroke Foundation of Canada, news release, Oct. 25, 2010
Fish Oil Might Help Fight Gum Disease (V Mai)
Study found eating moderate amounts of omega-3 fatty acids seemed beneficial
TUESDAY, Oct. 26 (HealthDay News) -- Eating even moderate amounts of omega-3 fatty acids, typically found in
foods such as salmon and other fatty fish, may help ward off gum disease, new research suggests.
Researchers divided nearly 9,200 adults aged 20 and up participating in the National Health and Nutrition Examination
Survey between 1999 and 2004 into three groups based on their consumption of omega-3 fatty acids. Consumption
was assessed by asking participants to recall exactly what they'd eaten during the prior 24 hours.
Dental exams showed participants in the middle and upper third for omega-3 fatty acid consumption were between 23
percent and 30 percent less likely to have gum disease than those who consumed the least amount of omega-3 fatty
acids.
Specifically, the researchers found that the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic
acid (EPA) were associated with less gum disease. The association with linolenic acid (LNA) was not statistically
significant.
"Eating a very feasible amount of fatty fish seems to have a lot of benefit," said senior study author Dr. Kenneth
Mukamal, an associate professor of medicine at Harvard Medical School. "But we found no benefits to eating tons of
this stuff."
Since the study was a snapshot of a single day's diet, Mukamal said researchers could not determine exactly how
much fish oil people should consume regularly. But following guidelines from major organizations such as the
American Heart Association, which recommends eating fatty fish at least twice a week, is probably a good idea, not
just for gum disease but for overall health, they noted.
"There are a lot of benefits of omega-3 fatty acids. We have good evidence they prevent sudden death caused by
heart rhythm disturbances. We have some evidence omega-3 fatty acids can reduce the risk of heart attacks and
stroke," Mukamal said. "This is a great example of another potential benefit."
In the study, researchers took into account other factors that could affect the likelihood of having gum disease, such as
age, income, education and other health and socioeconomic factors.
The study is published in the November issue of the Journal of the American Dietetic Association.
Periodontitis is a chronic inflammation of the gums caused by bacteria that accumulate around the gum line, according
to background information in the study. Over time, the gum tissue can recede and separate from teeth, leading to

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"periodontal pockets," or spaces between the gums and the teeth, and loss of the bone that provides the supporting
structure for the teeth.
About 54 percent of men and 46 percent of women over age 30 in the United States experience gingival bleeding, the
earliest sign of periodontal disease, according to background information in an accompanying editorial.
In the general population, about 11 percent of adults aged 50 to 64 have moderate or severe periodontitis, rising to 20
percent of those over age 75. In the study, about 8.2 percent of participants had periodontitis.
The usual treatment of periodontitis is good dental hygiene, including manually removing bacteria during dental
appointments and applying local antibiotics to kill the bacteria, though there is disagreement among dentists about
how well local antibiotics work.
In an accompanying commentary, Elizabeth Krall Kaye, a professor in the department of health policy and health
services research at Boston University Henry M. Goldman School of Dental Medicine, said the study supports
incorporating fatty fish into one's diet, but not necessarily fish oil supplements.
"The study is interesting in that they studied a large population, and they saw some benefit just from consuming
moderate amounts of omega-3 fatty acids," Kaye said.
Other sources of omega-3 fatty acids include sardines, mackerel and swordfish, along with some nuts and seeds such
as walnuts and flax seed.
Brain Deficits Higher in Seniors Who Survive Blood Poisoning
Severe sepsis raises odds of some brain impairment, researchers say
TUESDAY, Oct. 26 (HealthDay News) -- Older adults who survive severe sepsis are at increased risk for new physical
limitations and problems with mental functioning, a new study indicates.
This largely invisible problem swells the rolls of nursing homes and puts an increased burden on caregivers and
families, as well as increasing the rate of depression and death among the elderly, the researchers said.
Also called "blood poisoning," sepsis is a potentially deadly infection in the blood or tissues that causes inflammation
throughout the body. In cases of severe sepsis, the infection may lead to heart problems, organ failure or a sometimes
fatal drop in blood pressure known as septic shock.
Researchers from the University of Michigan and colleagues analyzed data from 516 patients, average age 76.9, who
survived severe sepsis and compared them to 4,517 patients who survived a hospitalization that wasn't due to the
potentially life-threatening infection.
The study found that the prevalence of moderate to severe cognitive (brain) impairment was 10.6 percent higher
among the severe sepsis survivors, and they had a 3.3 times greater risk of developing moderate to severe brain
impairment than those hospitalized for reasons other than sepsis.
Severe sepsis survivors also had a higher rate of new limitations in physical functioning than those without
hospitalized without sepsis, with an additional average increase of 1.5 things they could no longer do per patient
among those who had no or mild to moderate functional limitations before they developed sepsis.
Their counterparts hospitalized for reasons other than sepsis had no change in cognitive function.
"Cognitive and functional declines of the magnitude seen after severe sepsis are associated with significant increases
in caregiver time, nursing home admission, depression and mortality. These data argue that the burden of sepsis
survivorship is a substantial, under-recognized public health problem, with major implications for patients, families and
the health-care system," Dr. Theodore J. Iwashyna, of the University of Michigan Medical School, and colleagues, said
in a news release.
They said hundreds of thousands of people develop severe sepsis each year in the United States, and nearly 20,000
new cases per year of moderate to severe cognitive impairment in elderly people may be due to sepsis.
"Thus, an episode of severe sepsis, even when survived, may represent a sentinel event in the lives of patients and
their families, resulting in new and often persistent disability, in some cases even resembling dementia," the
researchers wrote.
"Future research to identify mechanisms leading from sepsis to cognitive impairment and functional disability -- and
interventions to prevent or slow these accelerated declines -- is especially important now given the aging of the
population," they concluded.
The study appears in the Oct. 27 issue of the Journal of the American Medical Association.
New Insights on Who Should Take Erbitux for Colon Cancer
Contrary to previous research, some patients with KRAS gene mutation may benefit
TUESDAY, Oct. 26 (HealthDay News) -- New research challenges previous assumptions about how to treat metastatic
colon cancer in patients with a certain genetic mutation.
While guidelines have recommended that people with this type of cancer and mutations in their KRAS gene should not
receive the targeted therapy cetuximab (Erbitux), a new study finds that a subset of these patients might actually
benefit from taking the drug.
"Those drugs [cetuximab and its sister medication, panitumumab (Vectibix)] have been shown in a number of other
studies to be less effective in patients who have mutations of the KRAS gene," explained Dr. Durado Brooks, director
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of colorectal cancer at the American Cancer Society. "Those studies have been so convincing that the National
Comprehensive Cancer Network [which produces treatment guidelines] added KRAS testing as an element of
decision-making for using these drugs to determine whether or not these drugs are likely to be useful."
This new study, appearing in the Oct. 27 issue of the Journal of the American Medical Association, suggests that
researchers and clinicians both may need to drill down further in attempting to decipher which patients will benefit
most from different targeted therapies.
"Before, we have been lumping [different] KRAS mutations together," Brooks said. "This current article is saying we
may have been overly simplistic in our approach."
"It's a provocative report," added Dr. Steven Cohen, a medical oncologist with Fox Chase Cancer Center in
Philadelphia. "The mantra has been to lump [the two KRAS] mutations together. This gives us reason to second-guess
ourselves that we should not be excluding patients [with this one mutation] from this type of treatment."
Here, a group of European researchers looked at 579 patients for whom chemotherapy had not worked and who had
taken cetuximab in previous clinical trials.
For the analysis, patients were separated out, depending on whether they had the KRAS codon 12 mutation or the
KRAS codon 13 mutation.
Patients with the KRAS codon 13 mutation who were treated with cetuximab lived an average of 7.6 months, versus
5.7 months in those with the other mutation. Also, an average of four months transpired before disease progression,
versus about two months in the control group, the investigators found.
Those with the KRAS codon 13 mutation didn't respond as well to the drug as people with a normal version of the
gene, but they still responded.
While some experts may quibble with the study's methodology -- pooling data from several already-completed trials --
this may be the only way that enough patients with this relatively rare (codon 13) mutation could be collected for a
legitimate analysis, Cohen noted.
Maybe 5 percent of patients with metastatic colorectal cancer, which is cancer that has spread, have this particular
KRAS mutation, Cohen said.
Not only will more research need to be done before giving cetuximab to people with the codon 13 mutation becomes
common practice, but doctors, the cancer network and insurance companies will have to get on board, Cohen noted.
The cost of cetuximab can be $3,000 a week or higher (the treatment is delivered weekly).
"It's a major cost issue," Cohen said.
Gene Mutations May Blunt Plavix's Effectiveness, Study Finds
Variants can jeopardize success of stent placement procedures, researchers say
HealthDay Reporter
TUESDAY, Oct. 26 (HealthDay News) -- People with certain gene variants who take the blood-thinning drug Plavix
(clopidogrel) may be at increased risk for serious complications after coronary stent placement, a new study finds.
Having the gene variants seems to reduce the effectiveness of Plavix and put patients at higher risk of developing
blood clots in the stent, suffering a heart attack or stroke, or even dying, according to the research.
"Clopidogrel is one of the most commonly prescribed medications worldwide," said lead researcher Dr. Jessica L.
Mega, an instructor in medicine at Brigham and Women's Hospital and Harvard Medical School in Boston.
But, "not all patients experience the same anti-clotting effects of the medication. Some of this variation is based on
genetic variants in the CYP2C19 gene," she said.
For the study, published in the Oct. 27 issue of the Journal of the American Medical Association, Mega's team
conducted a meta-analysis of nine studies involving a total of 9,685 people. In a meta-analysis, researchers review
published studies to tease out data about particular outcomes.
In this case, the researchers looked for the effect that variants of the CYP2C19 gene had on people taking the
antiplatelet drug and undergoing angioplasty and stent placement to open a blocked artery.
Among the patients studied, 863 died or had a heart attack or stroke, and 84 developed blood clots in their stents.
The researchers found that 71.5 percent of the total patient group had no variant of the CYP2C19 gene. However,
26.3 percent had one variant and 2.2 percent had two variants of the CYP2C19 gene that appeared to affect the
body's response to Plavix.
Having one or two variants significantly increased the risk of death, heart attack or stroke, or developing blood clots in
the stents, the researchers found.
Plavix uses a liver enzyme to convert the drug to its active form. The genetic variants prevent all of the drug from
being converted, which increases the odds of poorer outcomes.
The study was limited, however, in that 95.8 percent of the patients studied were white and individual patient-level
data from the studies could not be combined, researchers noted.
Last March, the U.S. Food and Drug Administration said Plavix must carry a "black box" warning on its label, alerting
patients and doctors that some people don't metabolize the medication properly.
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"Almost one in three patients is not receiving ideal protection from ischemic events when treated with standard doses
of clopidogrel for coronary stenting," Mega said.
"Given how widely clopidogrel is used to treat patients with cardiovascular disease, determination of the optimal
antiplatelet treatment doses or regimens for individual patients is needed to tailor therapy appropriately," she added.
The findings raise the question of whether routine genetic testing of Plavix patients is needed, but some experts say
it's too early for that.
Dr. Gregg Fonarow, an American Heart Association spokesman and professor of cardiology at the University of
California, Los Angeles, noted that a clinical alert issued in July by the American College of Cardiology and American
Heart stated that "the evidence base is insufficient to recommend routine genetic testing at the present time in
clopidogrel-treated patients."
"There is no information that routine testing improves outcome in large subgroups of patients," Fonarow said. "Further
studies are needed to determine if routine genetic testing or platelet function testing and alteration of the antiplatelet
regimen based on these findings will improve clinical outcomes."
Another expert, Dr. Valentin Fuster, a professor at Mount Sinai School of Medicine in New York City and author of an
accompanying journal article, agrees that genetic testing isn't necessary.
"It's very nice that we learn about genetics, but to have a clinical applicability to the patient is still very far off," he said.
Dietary Fats Seem to Affect Sperm Quality
TUESDAY, Oct. 26 (HealthDay News) -- Men who eat foods containing a lot of saturated fats -- think burgers and fries
-- and monounsaturated fats may be harming their sperm, a new study by Harvard researchers suggests.
Men consuming a lot of these types of fats may be producing fewer and less active sperm.
Conversely, men who consume foods containing healthier, polyunsaturated fats such as omega-3 and omega-6 fatty
acids (fish, whole grains) may be producing healthier sperm, the study suggested.
"We observed significant relationships between dietary fat and semen quality," said lead researcher Dr. Jill Attaman,
an instructor in obstetrics, gynecology and reproductive biology. "This shows an association between modifiable
lifestyle factors, specifically nutrition, and male fertility potential."
The reasons for the apparent connection aren't clear, Attaman said. But, she added, different types of fats are treated
differently in the body.
"Polyunsaturated fats are important components of sperm cell membranes and may influence the ability of sperm to
fertilize an egg," she explained, adding that they "may [also] stimulate hormone production."
The results of the study were presented Monday at the American Society for Reproductive Medicine annual meeting,
in Denver.
For the study, Attaman's team analyzed the sperm of 91 men who were attending the Massachusetts General Hospital
Fertility Center in Boston. The men also answered questions about their diet and the types of fats they ate. A number
of the men also had levels of fatty acids in their sperm and semen measured, the researchers said.
The researchers found that men with the highest intake of saturated fat had 41 percent fewer sperm than men who ate
the lowest amount of saturated fat. And men with the highest intake of monounsaturated fat had 46 percent fewer
sperm compared with men with the lowest intake of monounsaturated fat.
On the other hand, men who had a higher intake of omega-6 polyunsaturated fats had greater sperm motility, and a
higher intake of omega-3 polyunsaturated fats was related to better sperm "morphology" -- the size and shape of
sperm.
"Whether these finding are important may depend on an individual male," Attaman said.
For example, a 40 percent difference is large, but may be important to some men and not to others. If a man has a
marginal sperm concentration, such as 25 million sperm per milliliter, a 40 percent reduction could bring his sperm
count down to 15 million per milliliter, which is abnormal, Attaman said.
But, if a man's sperm count is closer to 100 million per milliliter, a 40 percent decrease would still maintain a normal
sperm count of 60 million per milliliter, she said.
"That would be unlikely to make a difference in fertility potential," Attaman said.
Saturated fat is the main dietary source of high blood cholesterol and can be found mostly in foods from animals and
some plants, such as beef, veal, lamb, milk and cheese. Monounsaturated fats are found in vegetable oils such as
olive oil, canola oil, peanut oil, sunflower oil and sesame oil. Other sources include avocados, peanut butter, and many
nuts and seeds, according to the American Heart Association.
Polyunsaturated fats are found in fish, whole grains and some seeds and nuts.
Dr. David Katz, director of the Prevention Research Center at Yale Unioversity School of Medicine, said that "this is a
small study of association between variations in dietary intake, and variations in sperm quantity and function. It does
not directly prove cause-and-effect."
Some of the findings, such as an inverse association between monounsaturated fat intake, which is a staple of the
Mediterranean diet, and sperm count are counter-intuitive, he noted. The association between polyunsaturated fat

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intake, and in particular balanced intake of omega-6 and omega-3 fat, with sperm vitality is in accord with general
health knowledge, he said.
"Overall, the study makes this provocative suggestion: Not only is it true that we are what we eat, but we start to be so
before we are ever conceived," Katz said. "The dietary pattern of a father-to-be is affecting the composition of the
sperm that will be delivering half of the genes to a future son or daughter. So, it's one more reason to choose our
foods wisely."
SOURCES: Jill Attaman, M.D., instructor in obstetrics, gynecology and reproductive biology, Harvard Medical School,
Boston; Oct. 25, 2010, presentation, 66th annual meeting of the American Society for Reproductive Medicine, Denver
Healthy Living Can Prevent Nearly 25% of Colorectal Cancers (Tú)
TUESDAY, Oct. 26 (HealthDay News) -- As many as 23 percent of colorectal cancers could be prevented if people
followed five simple healthy lifestyle recommendations, Danish researchers say.
The recommendations -- which would improve overall health as well -- include exercise, a good diet, moderate
drinking, no smoking and maintaining a healthy weight, the researchers say.
"Even a modest difference in your lifestyle habits may have a substantial impact on your colorectal cancer risk," said
lead researcher Dr. Anne Tjonneland of the Institute of Cancer Epidemiology of the Danish Cancer Society in
Copenhagen.
Specifically, the recommendations are:
• At least 30 minutes of exercise a day.
• No more than seven drinks a week for women and 14 for men.
• Not smoking.
• Eating a healthful diet, defined as one high in fiber, with more than six servings (3 cups) a day of fruits and
vegetables, and low in red meat and processed meat (no more than just over a pound a week), with less than
30 percent of total calories derived from fat.
• A waist size no more than 34.6 inches for women and 40.1 inches for men.
The report is published online in the Oct. 27 edition of the BMJ.
For the study, Tjonneland and colleagues examined data on 55,487 men and women aged 50 to 64, who had not
been diagnosed with cancer.
All those in the study completed a lifestyle questionnaire, which asked about social factors, health status, reproductive
factors and lifestyle habits. They also completed a food frequency questionnaire that detailed what they ate over 12
months.
During 10 years of follow-up, 678 people developed colorectal cancer.
If all the participants (except for the healthiest men and women) had adopted just one additional lifestyle
recommendation, 13% of the colorectal cancer cases could have been avoided, the researchers found.
"For each additional lifestyle recommendation the participants followed, a reduction of 13 percent [in colorectal cancer]
was shown," Tjonneland said.
And if all those in the study had followed all five lifestyle recommendations, then there would have been 23 percent
fewer colorectal cancer cases, Tjonneland's group found.
"The hope is that this is an understandable message leading to an impact in the prevention of colorectal cancer," she
said.
Marji McCullough, strategic director of nutritional epidemiology at the American Cancer Society, said that "the study
shows the importance of following cancer prevention guidelines for lifestyle."
Colorectal cancer is the third most commonly diagnosed cancer in the United States and the third leading cause of
cancer death in men and women, she said.
"The majority of these cancers and deaths can be prevented by applying existing knowledge about cancer prevention,
such as lifestyle and by increasing the use of established screening tests," McCullough said. "Colorectal cancer is a
highly preventable cancer."
Dr. Floriano Marchetti, an assistant professor of clinical surgery in the division of colon and rectal surgery at the
University of Miami's Sylvester Comprehensive Cancer Center, added that "this study confirms on a large scale what
the impression of many other small studies have only hinted at."
"If you look at these lifestyle recommendations, they are not really horrible," he said. "This is not like people are asked
to be on a strictly vegetarian diet or become triathletes."
And the benefit is linear, Marchetti pointed out. "You modify something and you already have a return with minimal
investment. If you modify more, you have a better return," he said.
In another study in the same issue, Australian researchers found that people without a high school diploma who
received information about colon cancer screening through a decision aid featuring an interactive booklet and DVD
ended up more informed than those who received only standard screening information. However, the former group
was less likely to get screened.
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Although the decision aid did not encourage more people to undergo screening, at least it gave them the data they
needed to make an informed choice, the researchers said.
SOURCES: Anne Tjonneland, M.D., Ph.D., head of department, Institute of Cancer Epidemiology, Danish Cancer
Society, Copenhagen, Denmark; Marji McCullough, strategic director of nutritional epidemiology at the American
Cancer Society, Atlanta, Ga.; Floriano Marchetti, M.D., assistant professor of clinical surgery, Division of Colon and
Rectal Surgery, University of Miami Sylvester Comprehensive Cancer Center; Oct. 27, 2010, BMJ, online
Eating Whole Grains, Fewer Refined Grains, May Help Heart (Th Mai)
Substituting brown rice for white is one way to reduce harmful type of body fat, study finds

WEDNESDAY, Oct. 27 (HealthDay News) -- People who regularly eat whole grains rather than refined grains pack on
less of the type of fat linked to a higher risk for heart disease and type 2 diabetes, new research suggests.
In high amounts, visceral adipose tissue (VAT) -- the fat that surrounds the intra-abdominal organs -- is associated
with the onset of high blood pressure, high cholesterol and insulin resistance, health risk factors collectively known as
the "metabolic syndrome."
"VAT volume was approximately 10 percent lower in adults who reported eating three or more daily servings of whole
grains and who limited their intake of refined grains to less than one serving per day," said study co-author Nicola
McKeown, a scientist with Tufts University's nutritional epidemiology program at the Jean Mayer USDA Human
Nutrition Research Center on Aging.
"For example, a slice of 100 percent whole-wheat bread or a half-cup of oatmeal constituted one serving of whole
grains and a slice of white bread or a half-cup of white rice represented a serving of refined grains," she noted in a
Tufts news release.
The findings, recently published online in the American Journal of Clinical Nutrition, stem from an analysis of dietary
surveys and body-fat scans conducted among more than 2,800 men and women between the ages of 32 and 83.
Even after accounting for additional lifestyle factors including smoking history, alcohol consumption, fruit and
vegetable intake, percentage of calories comprised of fat, and physical activity routines, the authors found that
consuming several servings a day of whole grains is associated with lower amounts of VAT.
However, those who consumed three servings a day of whole grains and several daily servings of refined grains did
not appear to benefit from the whole grain-lower VAT connection.
"Whole grain consumption did not appear to improve VAT volume if refined grain intake exceeded four or more
servings per day," noted McKeown.
"This result implies that it is important to make substitutions in the diet, rather than simply adding whole grain foods,"
she advised. "For example, choosing to cook with brown rice instead of white, or making a sandwich with whole-grain
bread instead of white bread."
SOURCE: Tufts University, news release, Oct. 20, 2010
New Drug Shows Promise Against Certain Lung Cancers
For some patients, crizotinib shrank tumors with a particular genetic mutation
WEDNESDAY, Oct. 27 (HealthDay News) -- An experimental cancer drug is proving effective in treating the lung
cancers of some patients whose tumors carry a certain genetic mutation, new studies show.
Because the mutation can be present in other forms of cancer -- including a rare form of sarcoma (cancer of the soft
tissue), childhood neuroblastoma (brain tumor), as well as some lymphomas, breast and colon cancers -- researchers
say they are hopeful the drug, crizotinib, will prove effective in treating those cancers as well.
In one study, researchers identified 82 patients from among 1,500 patients with non-small-cell lung cancer, the most
common type of lung malignancy, whose tumors had a mutation in the anaplastic lymphoma kinase (ALK) gene.
Crizotinib targets the ALK "driver kinase," or protein, blocking its activity and preventing the tumor from growing,
explained study co-author Dr. Geoffrey Shapiro, director of the Early Drug Development Center and associate
professor of medicine at Dana-Farber Cancer Institute and Harvard Medical School, Boston.
"The cancer cell is actually addicted to the activity of the protein for its growth and survival," Shapiro said. "It's totally
dependent on it. The idea is that blocking that protein can kill the cancer cell."
In 46 patients taking crizotinib, the tumor shrunk by more than 30 percent during an average of six months of taking
the drug. In 27 patients, crizotinib halted growth of the tumor, while in one patient the tumor disappeared.
The drug also had few side effects, Shapiro said. The most common was mild gastrointestinal symptoms.
"These are very positive results in lung cancer patients who had received other treatments that didn't work or worked
only briefly," Shapiro said. "The bottom line is that there was a 72 percent chance the tumor would shrink or remain
stable for at least six months."
The study is published in the Oct. 28 issue of the New England Journal of Medicine.
In recent years, researchers have started to think of lung cancer less as a single disease and more as a group of
diseases that rely on specific genetic mutations called "driver kinases," or proteins that enable the tumor cells to
proliferate.
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That has led some researchers to focus on developing drugs that target those specific abnormalities. "Being able to
inhibit those kinases and disrupt their signaling is evolving into a very successful approach," Shapiro said.
The good news is that drugs such as crizotinib seem to work well in patients with the mutation, noted Dr. Roman
Perez-Soler, chairman of the department of oncology at Montefiore Medical Center and professor of medicine and
molecular pharmacology at the Albert Einstein College of Medicine in New York City. But the bad news is that it means
that patients who don't have the specific mutation won't be helped.
Only an estimated 2 percent to 7 percent of non-small-cell lung cancers have the ALK mutation, according to the
study.
"This is great news for people with this type of tumor," Perez-Soler said. "Researchers have identified a group of
patients, unfortunately a small group, who because of a very specific genetic abnormality are extremely sensitive to
these targeted treatments and as a result of that can benefit from this drug without toxicity. It's very encouraging."
In a second study in the same journal, crizotinib was effective in a 44-year-old man with inflammatory myofibroblastic
tumor, a rare form of sarcoma, which is also driven by the ALK abnormality, said Shapiro, who was senior author of
that paper.
Still, there are caveats. Over time, tumors can adapt to such targeted therapy, eventually rendering it ineffective,
experts said. In fact, a third study in the same journal identified ways in which lung cancers had already started to
mutate and overcome crizotinib.
Moreover, while drugs targeting a specific tumor genotype are promising, there could be so many different genotypes
that it would be impractical to come up with drugs targeting all of them, Perez-Soler said. Still other tumors might be
fueled by multiple abnormalities.
"Many cancers may be much more complicated," he said. "And every tumor is different. Each one has a number of
sophisticated ways to overcome interventions to block growth, and some may be better prepared than others to do
that. That is why you see heterogeneity in the response to the drug. There is no such thing as identical twins when we
talk about tumors."
Researchers are currently enrolling patients for a larger, Phase III clinical trial of crizotinib, Shapiro said. The study
was funded by Pfizer, which is developing crizotinib for clinical application, and by grants from the U.S. National
Cancer Institute, among others.
Lung cancer remains one of the most deadly cancers and new treatments are desperately needed, the researchers
said. "Advanced lung cancer still remains a very lethal disease," Shapiro said. "It's the biggest cancer killer of both
men and women in the U.S. and worldwide, and the unmet clinical need is extreme."
Children with ADHD Symptoms at Higher Risk of Obesity
Hyperactivity, impulsiveness associated with a 63 percent increase, researchers found
WEDNESDAY, Oct. 27 (HealthDay News) -- Children with symptoms of attention-deficit hyperactivity disorder (ADHD)
are at increased risk for obesity in adulthood, a new study claims.
Having three or more of any of the symptoms of ADHD -- such as inattention, hyperactivity or impulsivity -- significantly
increases the chances of being obese, according to researchers from Duke University Medical Center, who examined
federal data on 15,197 adolescents followed from 1995 to 2009.
"It's not just the diagnosis of ADHD that matters; it's the symptoms," study co-author Scott Kollins, director of the Duke
ADHD Program, said in a Duke news release.
Another study author agreed, adding that the more symptoms, the higher the risk.
"It's a dose effect. We showed that as the number of symptoms increase, the prevalence of obesity also increases,"
said study co-author Bernard Fuemmeler, director of the Pediatric Psychology & Family Health Promotion Lab in the
Department of Community and Family Medicine.
Even among children with only symptoms of hyperactivity or impulsiveness -- the most influential of the risk factors
studied -- the risk of obesity rose to 63 percent. These symptoms were also associated with greater weight gain in the
transition from adolescence to adulthood.
The data on the teens came from the U.S. National Longitudinal Study of Adolescent Health.
"The findings support the idea that certain self-regulation capacities, like the ability to regulate one's impulses, could
be a relevant trait to understanding why some people may be more vulnerable to obesity," Fuemmeler said, adding
that this might help with the design of interventions.
The study appears online in the International Journal of Obesity.
Teens Should Get Meningitis Booster Shot: CDC Panel
Vaccine doesn't last as long as believed, officials say
WEDNESDAY, Oct. 27 (HealthDay News) -- Teenagers should get a booster shot of the vaccine that protects against
bacterial meningitis, a U.S. health advisory panel recommended Wednesday.
The panel made the recommendation because the vaccine appears not to last as long as previously thought.
In 2007, the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices
recommended that the meningitis vaccine -- usually given to college freshman -- be offered to 11 and 12 year olds, the
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Associated Press reported. The vaccine was initially aimed at high school and college students because bacterial
meningitis is more dangerous for teens and can spread easily in crowded settings, such as dorm rooms.
At that time the panel thought the vaccine would be effective for at least 10 years. But, information presented at the
panel's meeting Wednesday showed the vaccine is effective for less than five years.
The panel then decided to recommend that teens should get a booster shot at 16.
Although the CDC is not bound by its advisory panels' recommendations, the agency usually adopts them. However, a
U.S. Food and Drug Administration official, Norman Baylor, said more studies about the safety and effectiveness of a
second dose of the vaccine are needed, the AP reported.
Some at the meeting wondered if it was even necessary to make such a decision. Cases of bacterial meningitis are at
historic lows, and a survey of more than 200 colleges and universities -- representing more than 2 million students -- in
the last academic year found 11 cases of bacterial meningitis and three deaths, the AP reported.
In a news release issued after the vote, the National Meningitis Association said it "supports [the] decision to maintain
meningococcal immunization at age 11-12 and to add a booster dose to provide increased prevention of disease
among adolescents throughout their high-risk years. This is a good public health decision that will protect our children
from meningococcal disease."
Meningitis is an inflammation of the membranes that cover the brain and spinal cord, and is usually caused by a viral
or bacterial infection. The disease can result in brain damage, hearing loss or learning disabilities, according to the
CDC.
In January, the New England Journal of Medicine published a study that found that rates of pneumococcal meningitis
have declined substantially since a vaccine was introduced in 2000.
The declines were seen not only in children given the vaccine but also in adults, suggesting a "herd immunity" effect,
the study authors noted.
To assess the effect of the vaccine, researchers from several universities analyzed surveillance data from 1998 to
2005 in eight states. The number of cases of the disease dropped 30 percent in that time, but the effect on the very
youngest and oldest was even more pronounced: Incidence decreased by 64 percent in those younger than 2 and by
54 percent in those older than 65.
Pancreatic Cancer Surprisingly Slow to Arise: Study
Researchers see 'window of opportunity' to raise survival rate
WEDNESDAY, Oct. 27 (HealthDay News) -- Pancreatic cancer takes much longer to develop than commonly thought,
say researchers who found a lag time of at least a decade between the emergence of key mutations and the formation
of the first cancer cells.
The finding may offer hope for someday catching and treating this often-fatal disease in its early stages, scientists say.
The study, published in the Oct. 28 issue of the journal Nature, also provides new insight into the genetics of
pancreatic cancer.
"What's important about this study is that it's objective data in support of why everyone should be screened for
pancreatic cancer and, more important, when they should be screened," said study co-author Dr. Christine Iacobuzio-
Donahue.
"I think [the data] is a major step toward impacting the survival rate of pancreatic cancer," added Iacobuzio-Donahue,
associate professor of pathology and oncology at the Sol Goldman Pancreatic Cancer Research Center at Johns
Hopkins School of Medicine in Baltimore, which led the multi-center study.
The researchers used tissue from seven patients who died of pancreatic cancer that had spread to other organs. First,
they extracted the DNA from cancer cells in the tissue. Then they sequenced the DNA, which contains operating
instructions for every type of cell in the body.
In every patient, the cancer had spread, or metastasized, from the pancreas to at least two other areas, most often the
liver, lung and abdominal lining. Similar cell mutations were found in the main tumor in the pancreas and in those other
areas.
The scientists also classified the types of mutations -- changes in a gene that occur before and after cancer spreads.
Both types of mutations were found in the primary cancer in the pancreas, years before it was known that the cancer
had spread.
Using mathematical models to track the cancer's progression, the team estimated it takes an average of 11.7 years for
the first cancer-causing mutation in a pancreatic cell to become a full-fledged cancer cell.
It then takes another 6.8 years, on average, for that cell to develop into a plum-sized cancerous tumor, after which at
least one tumor cell develops the ability to spread to other organs. Once the cell spreads, patients die an average of
two and a half years later.
"The science [in the study] is exquisite," said Dr. J. Leonard Lichtenfeld, deputy chief medical officer of the American
Cancer Society in Atlanta. "The researchers were able to make the point that what we know as cancer is really the end
stage of a very long process."

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In its early stages, cancer of the pancreas -- the gland that aids digestion and helps control blood sugar levels --
causes vague symptoms or none at all. That's why people are typically diagnosed after the cancer has spread beyond
the pancreas, and why the disease is often fatal. This year, pancreatic cancer will cause about 36,800 deaths,
according to the U.S. National Cancer Institute.
Because people with pancreatic cancer typically die within a year of diagnosis, it may seem as if this form of cancer
progresses rapidly, said Iacobuzio-Donahue.
"But what we've learned is that it is actually a long, slow process, and metastasis happens at the very end, within the
final two to three years. Before that time, there is a tremendous window of opportunity for screening," she said. "We
just have to modify our screening methods to better diagnose people at an earlier time point."
In the future, new imaging techniques and blood tests will offer hope for early detection, the study noted. And just as
people have a colonoscopy when they turn 50, "perhaps they should have an endoscopy of their upper gastrointestinal
organs that includes an ultrasound of the pancreas," said Iacobuzio-Donahue. Screenings for colon and breast
cancers are based on age and health history, rather than symptoms, she noted. "But we screen people for pancreatic
cancer based on how they feel," she said. "And by the time they feel sick, it's too late."
Lichtenfeld, however, says it's "a bit optimistic" to suggest that current technologies, such as ultrasound, can diagnose
pancreatic cancer early enough to make a difference. Another cancer with virtually no symptoms in its earlier stages --
ovarian cancer -- is not often found with ultrasound, he noted.
But "we're probably not far away" from the advanced screening techniques mentioned in the study, he said.
Noninvasive Test for Colon Cancer Shows Promise in Early Trial
Stool-based screen beats current versions, but results must be replicated in larger trials, experts say
THURSDAY, Oct. 28 (HealthDay News) -- A new noninvasive test to detect pre-cancerous polyps and colon tumors
appears to be more accurate than current noninvasive tests such as the fecal occult blood test, Mayo clinic
researchers say.
The search for a highly accurate, noninvasive alternative to invasive screens such as colonoscopy or sigmoidoscopy is
a "Holy Grail" of colon cancer research.
In a preliminary trial, the new test was able to identify 64 percent of pre-cancerous polyps and 85 percent of full-blown
cancers, the researchers reported.
Dr. Floriano Marchetti, an assistant professor of clinical surgery in the division of colon and rectal surgery at University
of Miami Sylvester Comprehensive Cancer Center, said the new test could be an important adjunct to colon cancer
screening if it proves itself in further study.
"Obviously, these findings need to be replicated on a larger scale," he said. "Hopefully, this is a good start for a more
reliable test."
Dr. Durado Brooks, director of colorectal cancer at the American Cancer Society, agreed. "These findings are
interesting," he said. "They will be more interesting if we ever get this kind of data in a screening population."
The study's lead researcher remained optimistic.
"There are 150,000 new cases of colon cancer each year in the United States, treated at an estimated cost of $14
billion," noted Dr. David A. Ahlquist, professor of medicine and a consultant in gastroenterology at the Mayo Clinic in
Rochester, Minn.
"The dream is to eradicate colon cancer altogether and the most realistic approach to getting there is screening," he
said. "And screening not only in a way that would not only detect cancer, but pre-cancer. Our test takes us closer to
that dream."
Ahlquist was scheduled to present the findings of the study Thursday in Philadelphia at a meeting on colorectal cancer
sponsored by the American Association for Cancer Research.
The new technology, called the Cologuard sDNA test, works by identifying specific altered DNA in cells shed by pre-
cancerous or cancerous polyps into the patient's stool.
If a DNA abnormality is found, a colonoscopy would still be needed to confirm the results, just as happens now after a
positive fecal occult blood test (FOBT) result.
To see whether the test was effective, Ahlquist's team tried it out on more than 1,100 frozen stool samples from
patients with and without colorectal cancer.
The test was able to detect 85.3 percent of colorectal cancers and 63.8 percent of polyps bigger than 1 centimeter.
Polyps this size are considered pre-cancers and most likely to progress to cancer, Ahlquist said.
The sensitivity of the test is much better than what has been seen in other stool screening tests, the ACS' Brooks
added. "But, showing that in a small group of samples is very different from demonstrating that in a population where
only a small number of individuals are going to have polyps of that size. Then we will know if this is a big step forward,"
he said.
According to Ahlquist, Cologuard is the first noninvasive test to detect pre-cancerous polyps, he added.
In addition, the test is the only one that is able to identify cancer in all locations throughout the colon, something which
other tests either can't or don't do well, Ahlquist said.
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One more advantage: patients do not need to do any special preparation before taking the test, something that other
tests require, he added.
Ahlquist noted that the test still needs to be refined. "We learned there are still some bugs and we can make the test
even better," he said.
Cologuard is not yet available for sale. Clinical trials comparing the test with colonoscopy are slated to start next year.
Ahlquist hopes that the test will be approved and available within two years.
Ahlquist noted that the cost of the test has not yet been established. It is expected to cost more than a fecal occult
blood test, but far less than a colonoscopy. A fecal occult blood test can cost as little as $23 while a colonoscopy can
total $700.
Another benefit is that it would probably need to be done once every three years, while the fecal occult blood test is
usually done yearly. Savings over time on a more accurate test done fewer times could justify the higher cost of the
Cologuard test, Ahlquist said.
In two other presentations at the meeting, researchers have linked key gene variants to the risk for colon cancer and
also to the prognosis of the disease.
In one study, researchers found that people who have long telomeres, the small strips of DNA that cover the ends of
chromosomes, have a 30 percent increased risk of developing colon cancer.
"Even for people their age, their telomeres were longer than you'd expect for healthy people," lead researcher Dr. Lisa
A. Boardman, an associate professor of medicine at the Mayo Clinic, said in a statement. "This suggests that there
may be two different mechanisms that affect telomere length and that set up susceptibility to cancer," she said.
In the other study, a research team led by Kim M. Smits, a molecular biologist and epidemiologist in the GROW-
School for Oncology and Developmental Biology at Maastricht University Medical Center in the Netherlands,
uncovered a surprise when it came to a gene variant on the KRAS gene called the G variant. This variant, long linked
to poorer outcomes in advanced colorectal cancer, actually predicted a better prognosis in early-stage colon cancer.
"You would intuitively think that the G variant would be associated with a poorer prognosis, as it is in late-stage
colorectal cancer, but that is not the case," Smits said in a statement.
Experts point out that studies presented at scientific meetings do not have to pass the rigorous peer review of studies
published in reputable journals.

Tin từ Medical News Today

Gel Alternative To Contraceptive Pill Shows Promising Results In Small Trial (Liên)
Article Date: 26 Oct 2010 - 10:00 PDT
A gel alternative to the contraceptive pill that women may only have to rub into the skin every day to prevent ovulation
has shown promising results in a small phase 2 clinical trial reported at a conference in the US this week.

The birth control gel, which the trial investigators referred to as Nestorone®-Estradiol (NES/E2), is being developed by
the drug firm Antares Pharma Inc, with corporate offices in New Jersey, in partnership with the not-for-profit Population
Council research center in New York, both in the US.

Dr Ruth Merkatz, director of clinical development of reproductive health at the Population Council presented the
findings of the trial in an oral session of the 66th Annual Meeting of the American Society for Reproductive Medicine
(ASRM) in Denver, Colorado, on Monday.

According to information on the Antares website, Nesterone is a "pipeline product" currently completing Phase 2 trials
and about to enter Phase 3.

The NES/E2 transdermal gel, which is is rubbed into the skin of the arms, thighs, shoulders or abdomen, contains two
hormones, a potent progestin close to progesterone, and natural estrogen (Estradiol), and has the same effect as the
combined oral pill, but without causing weight gain, nausea and reduced sexual desire.

For the study, the researchers recruited 18 healthy ovulating women in their 20s and 30s in Chile, the Dominican
Republic and the US. Over 7 months, the women tested three doses of NES/E2: a high dose (4.5mg Nesterone NES
and 1.5 mg Estradiol E2), a medium (3.0 mg NES, 1.0 mg E2), and a low (1.5 mg NES, 0.5 mg E2).

The results showed that the medium dose demonstrated "good ovarian suppression" and the researchers selected it
for further study.
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There was also minimal breakthrough bleeding during 3 weeks of use, and the participants reported that the gel was
easy to use and remember, and had few side effects. Their partners also reported no negative effects.

Merkatz and colleagues concluded that NES/E2 showed "promising results and may represent a safe, effective,
acceptable hormonal method of contraception".

They said more studies in larger groups should now be done.

The idea of a gel is thought to be more appealing to women than a skin patch, which can fall off and is visible.

Family planning experts said that while it is still early days, they welcomed the news because it gives women more
choice.
Aspirin After Prostate Surgery Or Radiation Therapy Halves Risk Of Death (Bảo)
Article Date: 26 Oct 2010 - 3:00 PDT
Aspirin therapy in addition to radiation therapy or surgery for prostate cancer can reduce a patient's risk of death by
over 50%, researchers from the University of Texas Southwestern Medical School in Dallas will reveal tomorrow at the
American Society for Radiation Oncology's 52nd Annual Meeting.
The scientists will explain details on a study which examined data on over 5,000 patients with cancer that had not
spread beyond the prostate gland - localized cancer.
Lead author, Kevin Choe, M.D., Ph.D.,said: Evidence has shown that anticoagulants may interfere with cancer growth
and spread. If the major effect of anticoagulants is preventing metastasis (the ability of cancer cells to spread to other
parts of the body), this may be why previous clinical trials with anticoagulation medications produced mixed results,
since most patients in these trials already had metastasis.
If the cancer has already metastasized, then anticoagulants may not be as beneficial.
The investigators examined data from the CaPSURE (Cancer of the Prostate Strategic Urological Research Endeavor)
database. They wanted to determine whether anticoagulants, blood-thinning drugs such as aspirin, enoxaparin,
warfarin, and/or clopidogrel had any impact on prostate cancer deaths among patients whose cancer had not
metastasized (spread).

They specifically assessed data on 5,275 patients with localized prostate cancer who had either received radiation
therapy or surgery - the two most common medical procedures for prostate cancer.

1,982 of the patients received anticoagulants. They were also classified as having high, intermediate or low-risk
disease.

The researchers found that among those on anticoagulants:

• The risk of dying from prostate cancer at 10 years went down from 10% to 4%
• Their risk of developing bone metastasis was significantly reduced
• Those with high-risk prostate cancer benefited the most. As treatment options for patients with high-risk
cancer are limited, the authors say this is great news.
• Aspirin offered greater benefits than the other anticoagulants
Kevin Choe said: Findings from this study are promising, however, further studies are necessary before the addition of
aspirin to prostate cancer therapy becomes standard treatment.
Breakthrough In Understanding Life-Threatening Childhood Liver Disease
Article Date: 28 Oct 2010 - 0:00 PDT
Researchers at the University of Colorado School of Medicine and The Children's Hospital have taken a big step
toward understanding what causes one of the most serious liver diseases in infants.
The disease is called biliary atresia, It blocks the bile ducts in young infants, through which bile, crucial for digestion,
flows to the small intestine. The disease is rare - it strikes in about one in 10,000 births. But it's life-threatening.
"It is fatal if not treated quickly," says Cara Mack, MD, who led the CU research.
Surgical removal of the blocked main bile duct can buy time but ultimately the treatment in the majority of cases is a
liver transplant during infancy or childhood, a procedure that is both complicated and expensive.
Until now, doctors weren't sure what caused biliary atresia, which is important to know in order to develop better
treatments. The CU researchers propose that an infection late in the third trimester of pregnancy or soon after birth
initiates the bile duct injury.

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The body fights off the infection and infants initially show no signs of a problem. But then, Mack says, the body
continues to battle as if the infection still was active. The body, however, is attacking itself -- the bile ducts specifically
-- not the infection. This is called an autoimmune process.
Why? Mack's research in a mouse model of the disease suggests that it may be that the bile ducts have been
changed and the body's protective system senses that. Or it may be that the bile ducts give off a protein that is similar
to proteins produced by the infection, launching the body's defenses into action. In these investigations, Mack and
colleagues identified an immune system compound, anti-enolase antibody, that reacts to both virus and bile duct
proteins. This antibody may contribute to the bile duct injury in biliary atresia.
"After a viral infection has resolved," Mack says, "the body's immune defenses turn on the bile ducts and cause
continued damage."
That leads to scarring of the bile ducts, eventually blocking them so that "bile is not able to flow from the bile ducts into
the intestines," says Mack, an associate professor in pediatrics with CU, who practices at The Children's Hospital in
Aurora.

The discovery, published recently in the journal Gastroenterology, isn't a cure. But it is a big step, "pointing the way to
new diagnostic tests and, eventually, to improved treatment options for this devastating disease," Mack says.
Glucosamine Causes The Death Of Pancreatic Cells (Hiền)
Friday 29 October 2010 00:08 PDT
High doses or prolonged use of glucosamine causes the death of pancreatic cells and could increase the risk of
developing diabetes, according to a team of researchers at Université Laval's Faculty of Pharmacy. Details of this
discovery were recently published on the website of the Journal of Endocrinology.
In vitro tests conducted by Professor Frédéric Picard and his team revealed that glucosamine exposure causes a
significant increase in mortality in insulin-producing pancreatic cells, a phenomenon tied to the development of
diabetes. Cell death rate increases with glucosamine dose and exposure time. "In our experiments, we used doses
five to ten times higher than that recommended by most manufacturers, or 1,500 mg/day," stressed Professor Picard.
"Previous studies showed that a significant proportion of glucosamine users up the dose hoping to increase the
effects," he explained.
Picard and his team have shown that glucosamine triggers a mechanism intended to lower very high blood sugar
levels. However, this reaction negatively affects SIRT1, a protein critical to cell survival. A high concentration of
glucosamine diminishes the level of SIRT1, leading to cell death in the tissues where this protein is abundant, such as
the pancreas.
Individuals who use large amounts of glucosamine, those who consume it for long periods, and those with little SIRT1
in their cells are therefore believed to be at greater risk of developing diabetes. In a number of mammal species,
SIRT1 level diminishes with age. This phenomenon has not been shown in humans but if it were the case, the elderly -
who constitute the target market for glucosamine - would be even more vulnerable.
"The key point of our work is that glucosamine can have effects that are far from harmless and should be used with
great caution," concluded Professor Picard.
The results obtained by Picard and his team coincide with recent studies that cast serious doubt on the effectiveness
of glucosamine in treating joint problems.
This study was co-authored by Mathieu Lafontaine-Lacasse and Geneviève Doré.
FDA Approves Teflaro For Bacterial Infections (A Thành)
Article Date: 30 Oct 2010 - 1:00 PDT
The U.S. Food and Drug Administration approved Teflaro (ceftaroline fosamil), an injectable antibiotic to treat adults
with community acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI),
including methicillin-resistant Staphylococcus aureus (MRSA).
Teflaro is an antibacterial agent in a class of drugs known as cephalosporins, which act by interfering with the bacterial
cell wall.
CABP is a bacterial infection that develops in the lungs of patients who are exposed to the bacteria in their normal
environment, and not in the hospital. ABSSSI is a bacterial infection of skin and skin structures that requires antibiotic
treatment and may require surgical treatment.
MRSA is a type of staph bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other
more common antibiotics such as oxacillin, penicillin, and amoxicillin. In the community, most MRSA infections are
skin infections. Severe or potentially life-threatening MRSA infections occur most frequently among patients in contact
with health care settings, according to the Centers for Disease Control and Prevention.
"These are serious and potentially life-threatening infections for which new treatment options are needed," said
Edward Cox, M.D., M.P.H, director, Office of Antimicrobial Products in FDA's Center for Drug Evaluation and
Research. "FDA is committed to facilitating new antibiotic drug development."
The safety and effectiveness of Teflaro was evaluated in four, Phase 3 clinical trials in patients ages 18 years and
older (two each in CABP and in ABSSSI). In the CABP trials, the comparator antibacterial treatment was Rocephin
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(ceftriaxone) and in the ABSSSI trials, the comparator antibacterial treatment was Vancocin (vancomycin) plus
Azactam (aztreonam).
In the CABP trials, 1,231 adult patients received Teflaro or Rocephin. Clinical response based on improvement in
signs and symptoms of pneumonia on Day 4 after starting therapy served as the key analysis endpoint. In both trials,
the effectiveness of Teflaro was comparable to Rocephin.
In the ABSSSI trials, 1,396 adult patients received Teflaro or Vancocin plus Azactam. Clinical response, including
cessation of spread of the lesion and absence of fever on Day 3, served as the key analysis endpoint. In both trials,
Teflaro was comparable to Vancocin plus Azactam.
The most commonly reported side effects in patients treated with Teflaro included diarrhea, nausea and rash. Teflaro
should not be used in patients with sensitivities to cephalosporin antibiotics.

Tin từ Science Daily

Researchers Find Pathway That Drives Spread Of Pediatric Bone Cancer In Preclinical Studies
Article Date: 27 Oct 2010 - 0:00 PDT
Researchers have identified an important signaling pathway that, when blocked, significantly decreases the spread of
pediatric bone cancer.

In their study, researchers at The University of Texas MD Anderson Children's Cancer Hospital in Houston found that
blocking the Notch pathway in mice decreased metastases in the lungs 15-fold. The results of a series of pre-clinical
studies were reported Sunday in an oral presentation at the 42nd Congress of the International Society of Pediatric
Oncology.

Their research showed that the Notch pathway and Hes1 gene play a key role in promoting the metastasis of
osteosarcoma, the most common form of bone cancer in children.

Approximately 400 children and teens under the age of 20 are diagnosed with osteosarcoma annually, and the
majority present with cancer that has already metastasized. The primary destination for the cancer to spread is to the
lungs, which accounts for more than 35 percent of pediatric patients dying from osteosarcoma.

"Knowing the initial results from blocking Notch in mice, we are encouraged to keep investigating the entire metastasis
process, so we can find additional therapies and targets to prevent cancer from spreading and growing," said Dennis
Hughes, M.D., Ph.D., lead investigator and assistant professor at MD Anderson Children's Cancer Hospital.

In addition to Notch and Hes1's role in metastasis, Hughes believes that their expression can be correlated with a
patient's prognosis. Hughes conducted a small retrospective study looking at patient samples, and 39 percent of
patients with high expression levels of Hes1 survived 10 years versus the 60 percent survival rate for patients who had
lower levels.

Ongoing research is studying the impact of various therapies, such as Gamma-secretase inhibitors and histone
deacetylase (HDAC) inhibitors, that regulate the Notch pathway and have the potential to affect cancer cell survival.
Hughes found that HDAC inhibitors actually increased the Notch pathway in osteosarcoma cells that had low Hes1
expression, which was an unfavorable response in that sample group. However, for cells that presented with high
Hes1 expression, where Notch was already maximized, the HDAC inhibitors led to osteosarcoma cell death.

"By defining vital signaling pathways in bone sarcomas, we hope small molecule inhibitors can be applied, leading to
longer survival and reducing morbidity and late effects from intensive chemotherapy," said Hughes.

"We also hope these new findings may apply to other solid tumors such as breast, prostate, colon and more, but we'll
need additional research to determine whether or not that is the case," he added.

Primary funding for the studies was provided through the Physician-Scientist Program at MD Anderson along with
additional support from the Jori Zemel Children's Bone Tumor Foundation, Hope Street Kids Foundation and Joan
Alexander Fund. Other collaborators include Pingyu Zhang, Ph.D., Yanwen Yang, Daniela Katz, M.D., and Patrick
Zweidler-McKay, M.D., Ph.D., from MD Anderson Cancer Center as well as Dafydd Thomas, M.D., Ph.D., from the
University of Michigan Medical Center.
Anti-Cholesterol Drugs Could Help Stave Off Seizures: UBC-Vancouver Coastal Health Research
Article Date: 27 Oct 2010 - 0:00 PDT
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Statins, the family of drugs used to lower cholesterol, might also reduce the risk of epileptic seizures in people with
cardiovascular disease, according to a new statistical study by a drug safety expert at the University of British
Columbia and Vancouver Coastal Health Research Institute. The findings could provide the basis for randomized,
controlled clinical trials to test the efficacy of the drugs as anti-epileptic medication.

The study, based on a database of 2,400 Quebec residents aged 65 and older, showed that those taking statins were
35 per cent less likely to be hospitalized with a diagnosis of epilepsy than those not taking the drug. The data was
culled from a larger database containing detailed information on 150,000 cardiovascular patients in Quebec.

Published today in the journal Neurology, the study does not prove causation but only reveals an association between
use of statins and the incidence of epilepsy. Such "observational" studies are crucial to generating hypotheses about
drugs, providing a basis for clinical trials.

Epilepsy, which affects 50 million people worldwide, is a brain disorder in which clusters of brain cells sometimes
signal abnormally, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms,
and loss of consciousness. It's estimated that 30 per cent of epilepsy patients continue having seizures despite
receiving the standard drug therapy.

This is the first large study involving humans to show a correlation between statins, the most prescribed class of
cardiovascular medications, and seizures, which may be life-threatening. One statin drug, atorvastatin (sold under the
trade name Lipitor), has been shown to decrease seizures and neuron death in rats. Statins also have shown
protective effects in other neurological disorders, including multiple sclerosis and spinal cord injury.

"Our data is compelling in that it opens doors for future studies to test this hypothesis in patients with epilepsy," says
Dr. Mahyar Etminan, a pharmacoepidemiologist and lead author of the article. Etminan is a scientist and clinical
pharmacist at the Centre for Clinical Epidemiology at Vancouver Coastal Health Research Institute and an assistant
professor in the Dept. of Medicine at UBC. "Such trials would show whether statins truly have a protective effect, and if
that effect is limited to certain types of statins or certain types of epilepsy."

"Our study suggests that statin use reduces the risk of developing epilepsy in persons over the age of 65 with
cardiovascular disease," says Dr. Ali Samii, a professor in the Department of Neurology at the University of
Washington, and co-author of the article. "The most plausible explanation is that statin use reduces the risk of stroke in
this population, and since strokes can increase the risk of epilepsy, statins reduce the risk of epilepsy because of
stroke prevention."

But Samii notes that other classes of cardiovascular drugs, such as beta-blockers and ACE inhibitors, also reduce the
risk of stroke, and yet they did not show the same effect. Therefore, statins may reduce the risk of epilepsy in this
patient population by mechanisms other than just stroke prevention.

Co-author Dr. James M. Brophy, of the McGill University Dept. of Medicine, provided the database used for the study.
The research was supported by the Vancouver Coastal Health Research Institute.
Obese Children Have Signs Of Heart Disease Typically Seen In Middle-Aged Adults
Article Date: 27 Oct 2010 - 1:00 PDT
The blood vessels of obese children have stiffness normally seen in much older adults with cardiovascular disease,
Dr. Kevin Harris today told the Canadian Cardiovascular Congress 2010, co-hosted by the Canadian Cardiovascular
Society and the Heart and Stroke Foundation. The clock is ticking and the shape of the 13 year-old-heart is changing -
for the worse.

"We were surprised to find that these obese children already have stiff blood vessels," says Dr. Harris from B.C.
Children's Hospital. "Aortic stiffness is an early indicator of cardiovascular disease in obese children." He says it is as if
the aging process has been accelerated in their aorta.

The aorta is the largest artery in the human body. It carries and distributes oxygen-rich blood to all the other arteries
and normally acts as a buffer to the pumping action of the heart. Increased stiffness of the aorta is typically associated
with aging and is a strong predictor of future cardiac events and mortality in adults.

"The normal aorta has elastic qualities that buffer the flow of blood. When that elasticity is lost, aortic stiffness results -
a sign of developing cardiovascular disease," Dr. Harris told the meeting. "Aortic stiffness is associated with
cardiovascular events and early death."

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The mean age of the children in Dr. Harris's study was 13 years.

Dr. Harris and colleagues evaluated 63 obese children and compared them with 55 normal weight controls. Blood
pressure was taken, lipids evaluated, and body mass index measured. Children then underwent echocardiography, or
ultrasound, of the heart and blood vessels. This test was used to determine the Pulse Wave Velocity in the aorta. This
is a measure of how fast blood flows and was one of the measures used to assess aortic stiffness.

"The systolic blood pressure was only marginally higher in these obese children," says Dr. Harris. Blood lipid levels -
total, HDL and LDL cholesterol - were normal. However, ultrasound of the heart showed that the Pulse Wave Velocity
and other measures of arterial health were already abnormal in the obese children.

He says these findings are highly significant because the elastic qualities of their aorta were impaired even though
other measures of heart health such as blood lipid levels and blood pressure were not dramatically different.

To see actual changes to the performance of the heart and blood vessels in obese children is extremely alarming,
says Heart and Stroke Foundation spokesperson Dr. Beth Abramson.

"We know there is an association between unhealthy lifestyles and heart disease. Our kids are at risk," she says.
"Poor nutrition and inactivity are threatening their health and well-being. We must rethink the lifestyle standards we
have accepted as a society to protect the future health of our kids."

The rate of childhood obesity has tripled over the last 25 years and it continues to increase, warns Dr. Abramson. Over
25 per cent of Canadian children between the ages of two and 17 years are overweight or obese, with the percent
increasing with age from 21 per cent among those two to five years to 29 per cent among those aged 12 to 17.

She notes that the health risks to overweight and obese children include heart disease, high blood pressure, and type
2 diabetes.

Dr. Harris says the next step should be to determine whether these changes are reversible with treatment such as
improved diet and exercise. This test may eventually be helpful in monitoring the progression of cardiovascular
disease in children and young adults.
Pain May Predict Liver Cancer Prognosis
Article Date: 27 Oct 2010 - 1:00 PDT
Understanding the role of pain hepatocellular carcinoma (HCC) or liver cancer is critical since pain has adverse effects
on quality of life and could be a predictor of survival, according to research reported in The Journal of Pain, published
by the American Pain Society.

Previous studies have established that predictors of survival for primary and metastsatic liver cancer patients include
an increase in upper abdominal pain. This study investigated whether pain in its own right might have prognostic
significance. The authors examined a database of 3,417 patients with liver cancer who presented with and without
pain. A Kaplan-Meier analysis was performed to determine the differences in survival for patients reporting pain and
those who did not.

The authors noted that pain is associated with decreased health-related quality of life in cancer patients and also with
increased disability and mood disorders. Pain, therefore, is a major component of quality of life evaluations, and
diminished quality of life is associated with poorer survival in several tumor types, including HCC.

The data base analysis showed that pain was linked with poorer survival in liver cancer patients who presented with
pain vs. those who did not. The mean survival in those with pain was 325 days vs. 498 days for patients who were
pain-free. The authors also evaluated the impact of tumor characteristics to determine if they alone could account for
the presence of pain and poorer survival rates. They reported that patients with pain had larger and more aggressive
tumors and had alphafetaprotien blood levels (a proven poor prognostic factor in liver cancer) that were twice as high
as in patients without pain.

The authors concluded that further investigation is needed to determine which quality of life factors are most predictive
for survival in liver cancer patients. Whether the treatment of pain can increase quality of life and improve survival
outcomes should be explored further in clinical trials.
Tin từ Medical News

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Tin từ WebMD

Tin từ Medwire

Low serum potassium levels linked to increased risk for Type 2 diabetes (V Mai)
By Helen Albert
26 October 2010
Arch Intern Med 2010; 170: 1745–1751
MedWire News: Low levels of serum potassium are significantly predictive for incident Type 2 diabetes, show results
from the ARIC Study cohort.
The Atherosclerosis Risk in Communities (ARIC) Study is an ongoing prospective cohort study that began in 1986. To
date, participants have been followed-up for 9 years in-person and 17 years over the telephone.
For the purposes of this study, Frederick Brancati (Johns Hopkins University, Baltimore, Maryland, USA) and
colleagues assessed links between baseline serum potassium levels and incident Type 2 diabetes in 12,209 ARIC
Study participants.
During the 9 years of in-person follow-up, 1475 individuals developed incident Type 2 diabetes.
When compared with participants with a normal-high potassium concentration (5.0-5.5 mEq/l), those with levels below
4.0, 4.0-4.4, and 4.5-4.9 mEq/l had significant 64%, 64%, and 39% increases in relative risk for incident Type 2
diabetes, respectively.
The team note that this increased risk persisted for an additional 8 years of telephone follow-up, based on self-
reported diabetes diagnosis, with baseline potassium levels lower than 5.0 mEq/l linked to a 20-30% increase in
relative risk for Type 2 diabetes.
The authors say that their findings cannot be used to prove causality, but say that they "deserve further investigation."
They suggest that "clinical trials should be developed to assess if increasing serum potassium, through medications,
pharmacologic supplementation, or increased dietary intake - all relatively simple interventions - could indeed reduce
the risk of incident diabetes mellitus."
The results of this study are published in the Archives of Internal Medicine.
Benefits of lipid-lowering therapy for the very elderly uncertain
By Nikki Withers
26 October 2010
Age Ageing 2010; 39: 674–680
MedWire News: More data are needed on the optimal level of cholesterol for the very elderly and the associated risks
and benefits of lipid-lowering therapy in this age group, says a team of Danish researchers.
Their review of observational studies and randomized control trials (RCTs) suggests that low cholesterol levels in very
elderly people may be associated with increased mortality rates.
However, they found no significant benefit from lipid-lowering treatment in terms of reducing total mortality in people
aged ≥80 years, and there are limited data on this subject focusing on this age group.
Line Petersen (University of Southern Denmark, Odense) and team analyzed 12 observational studies (13,622
participants aged 71-103 years) to determine an optimal cholesterol level in people aged ≥80 years, and four RCTs
(13,674 participants aged 70-82 years) and two observational studies (12,231 participants aged ≥80 years) to
determine whether lipid-lowering treatment should be initiated and continued in this age group.
The researchers report that mortality rates were highest among participants with total cholesterol levels less than 5.5
mmol/l (212.69 mg/dl), while an intermediate level of total cholesterol (approximately 6 mmol/l [232.02 mg/dl]) was
associated with the lowest rates of mortality.
They describe their findings as a "reverse J-shaped association between total cholesterol and all cause mortality,"
suggesting that mortality is highest when total cholesterol is lowest.
However, the authors note that although some elderly people have low total cholesterol due to a healthy
cardiovascular profile, others may have lower levels due to chronic or terminal illness. They say that there is no clear
optimal level of cholesterol in people aged ≥80 years.
None of the six studies included in their assessment demonstrated a beneficial effect of lipid-lowering treatment on
total mortality in this age group.
In particular, there was no evidence that statins decreased all-cause mortality in very elderly people without known
vascular disease, and the results even suggested that statins may increase mortality in this group overall.

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Writing in the journal Age and Ageing, Petersen and colleagues say that despite a large proportion of elderly patients
being treated with lipid-lowering drugs, it is still unclear whether they should be treated for the rest of their lives once
they have started lipid-lowering therapy, or whether treatment has different limits at older ages.
They conclude: "The optimal cholesterol level for people aged 80 or above is not known, neither is it known whether
lipid-lowering drugs should be used in this age group."
They add that the data are not sufficient to make any recommendations regarding lipid-lowering treatment in very
elderly patients.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a
trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
Titrated better than high-flow oxygen in COPD exacerbations
By Mark Cowen
27 October 2010
BMJ 2010; 341: c5462
MedWire News: Titrated oxygen treatment is associated with lower mortality rates than high-flow oxygen treatment in
patients suffering an acute exacerbation of chronic obstructive pulmonary disease (COPD), Australian research
shows.
"Oxygen is commonly administered to patients with an acute exacerbation of COPD, as well as for a range of other
medical emergencies, and can save lives by preventing severe hypoxemia," explain Michael Austin (University of
Tasmania, Hobart) and colleagues in the British Medical Journal.
Previous research has suggested that the use of titrated oxygen may be associated with less acidosis, a reduced need
for assisted ventilation, and reduced mortality compared with high-flow oxygen treatment in COPD exacerbations.
However, the evidence base for the benefit of titrated versus high-flow oxygen treatment is lacking, they add.
The team therefore studied in-hospital mortality data on 405 patients, aged 35 years or older, with a presumed acute
COPD exacerbation who were treated with oxygen by paramedics before hospital admission. Of these, 226 received
high-flow oxygen and 179 received titrated oxygen.
COPD was subsequently confirmed in 214 patients, of whom 117 received high-flow oxygen and 97 titrated oxygen.
Overall, 9% (n=21) of the 226 high-flow oxygen-treated patients and 4% (n=7) of the 179 titrated oxygen-treated
patients died after reaching hospital. In-hospital mortality in the subgroup of 214 patients with confirmed COPD was
9% (n=11) and 2% (n=2) for those who received high-flow and titrated oxygen, respectively.
Analysis revealed that in all patients, use of titrated oxygen was associated with a 58% reduction in relative risk for in-
hospital mortality compared with high-flow oxygen.
In patients with confirmed COPD, use of titrated oxygen was associated with a 78% reduction in risk for in-hospital
mortality compared with high-flow oxygen.
Furthermore, patients with confirmed COPD who received titrated oxygen were significantly less likely to have
respiratory acidosis or hypercapnia than those who received high-flow oxygen.
Austin and team conclude: "Titrated oxygen treatment significantly reduced mortality, hypercapnia, and respiratory
acidosis compared with high flow oxygen in acute exacerbations of COPD."
They add: "These results provide strong evidence to recommend the routine use of titrated oxygen treatment in
patients with breathlessness and a history or clinical likelihood of COPD in the prehospital setting."
Functional dyspepsia increases risk for disordered sleep
By Helen Albert
29 October 2010
American College of Gastroenterology 75th Annual Scientific meeting; San Antonio, Texas, USA: 15–20 October 2010
MedWire News: Disordered sleep is significantly more common in patients with functional dyspepsia (FD) than healthy
individuals, show results presented at the American College of Gastroenterology 75th Annual Scientific meeting in San
Antonio, Texas, USA.
"The key finding here is that disordered sleep may affect nerve function in the upper gastrointestinal tract which could
lead to worsening dyspepsia, creating a vicious cycle leading to more pain and more insomnia," said investigator Brian
Lacy from Dartmouth Medical School in Hanover, New Hampshire, USA, who presented the results.
He added that "future clinical trials for functional dyspepsia should include validated measures of sleep, as
improvements in functional dyspepsia symptoms may be mirrored by improvements in sleep."
For the purposes of the study, 260 FD patients (mean age 50 years; classified according to Rome III criteria) and 50
healthy controls (mean age 44 years) completed four validated questionnaires to assess sleep quality and mental and
physical wellbeing - the Hospital Anxiety and Depression (HAD) scale, the Short Form (SF)-12, the Insomnia Severity
Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI).
The FD patients also rated their symptoms as being mild (35%), moderate (52%), or severe (13%).

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The researchers found that participants with FD had a 3.25-fold increased relative risk for disordered sleep compared
with healthy controls. Women were also 2.36 times more likely to have disordered sleep than men, whereas routine
exercise appeared to protect against disordered sleep (58% reduction in relative risk compared with no exercise).
ISI and PSQI scores were generally higher in FD patients than controls, except for patients with mild FD who had
approximately the same ISI score as controls.
Of note, age, tobacco, and alcohol use were not associated with disordered sleep.
The team also found that patients with mild and moderate-to-severe FD had significantly higher HAD scores than
healthy controls, at 24.6 and 27.4 versus 9.6, respectively.
"Future clinical trials for FD should include validated measures of sleep, and improvements in FD symptoms may be
mirrored by improvements in sleep," suggest the investigators.
Risks for major comorbidities in COPD patients elucidated
By Mark Cowen
28 October 2010
Thorax 2010; 65: 956–962
MedWire News: Patients with chronic obstructive pulmonary disease (COPD) are nearly five times more likely to have
cardiovascular disease (CVD) or suffer a stroke than the general population, study results show.
"People with COPD are at high risk of hospitalization and death from CVD and cerebrovascular disease, and at
increased risk of diabetes mellitus (DM)," write Johanna Feary (University of Nottingham, UK) and team in the journal
Thorax.
However, they add: "Despite this, there is a paucity of data to quantify the degree to which these diseases coexist in
COPD."
To investigate further, the researchers examined the primary care records of 1,204,110 members of the general UK
population, aged at least 35 years on 25 February 2005, to identify all those diagnosed with one or more of the above
conditions.
Overall, 29,870 (2.5%) patients had COPD. Of these, 28.0% had CVD, 9.9% had suffered a stroke, and 12.2% had
DM, compared with 7.8%, 3.4%, and 6.5%, respectively, of the study population without COPD.
Cross-sectional analyses revealed that the risk for CVD, stroke, and DM was significantly greater in COPD patients
than in those without the condition, at odds ratios (ORs) of 4.98, 3.34, and 2.04, respectively.
Further age-related analyses that accounted for gender and smoking status revealed that the risk for acute
arteriovascular events associated with COPD was greatest in younger patients. For example, COPD patients aged 35-
44 years were 10.34 times more likely to suffer acute myocardial infarction and 3.44 times more likely to suffer a
stroke than COPD patients aged 75 years or older.
Feary and team conclude: "These data provide further evidence that, to improve patient care, health service models
for people with COPD and national guidelines need to recognize the extent to which these conditions are co-incident.
"It also provides additional evidence that, at the time of diagnosis of COPD, healthcare professionals must be
proactive and, where appropriate, must seek to promote early diagnosis and treatment, and aggressively target risk
factors in order to reduce the risk of premature mortality."
Certain oral contraceptive formulations still linked to breast cancer risk (Tú)
By Laura Dean
29 October 2010
Cancer Epidemiol Biomarkers Prev 2010; Advance online publication
MedWire News: Current use of oral contraceptives is associated with a moderately increased risk for breast cancer,
which is mainly attributed to levonorgestrel used in triphasic preparations, show results from the Nurses Health study
II.
Past use of levonorgestrel-containing triphasic contraceptives and current and past use of other formulations was not
associated with a significantly increased breast cancer risk, the researchers remark.
"Previous studies convincingly showed an increase in risk for breast cancer associated with current or recent use of
oral contraceptives from the 1960s to 1980s," note David Hunter (Harvard Medical School, Boston, Massachusetts,
USA) and colleagues.
To assess the association of contemporary oral contraceptive formulations with breast cancer risk, Hunter and team
analyzed data from 116,608 female nurses aged 25-42 years at study enrollment in 1989. Information on
contraceptive use was subsequently updated every 2 years and the risk for breast cancer was examined up to June
2001.
The researchers report that during 1,246,967 person-years of follow-up, 1,344 cases of invasive breast cancer were
diagnosed.
Past use of any oral contraceptive was not significantly related to breast cancer risk (relative risk=1.12], whereas
current use of any oral contraceptive was related to a marginally significant 1.33-fold increased risk for breast cancer.
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When the researchers analyzed the data according to the type of progestin formulation used, they found that current
users of triphasic ethinyl estradiol combined with levonorgestrel - commonly prescribed in the 1990s - had a significant
3.05-fold increased risk for breast cancer, compared with women who had never used oral contraceptives.
The age-standardized incidence of breast cancer among never-users of oral contraceptives was 98 per 100,000
person-years compared with 227 per 100,000 person-years among current users of the triphasic ethinyl estradiol plus
levonorgestrel formulation.
Of note, the most commonly used triphasic formulation contains norethindrone as the progestin rather than
levonorgestrel, and this was not associated with an increased breast cancer risk. There was also no increased risk for
levonorgestrel-containing nontriphasic formulations.
Hunter and co-authors conclude that their findings suggest "different oral contraceptive formulations might convey
different risks of breast cancer."
"Ongoing monitoring of these associations is necessary as oral contraceptive formulations change," they add in the
journal Cancer Epidemiology Biomarkers and Prevention.
Severe burn injuries in children cause rapid depletion in vitamin E
By Helen Albert
29 October 2010
Am J Clin Nutr 2010; Advance online publication
MedWire News: Children with severe burns have a dramatic decrease in levels of vitamin E stored in the adipose
tissue in the month after their injury, show study findings.
Researchers believe this deficiency could be damaging in such patients as it is likely to increase the risk for peripheral
neuropathy, a disorder common in burns patients and individuals with vitamin E deficiency.
Maret Traber (Oregon State University, Corvallis, USA) and colleagues used data obtained from several skin samples
taken from eight children, aged 2-16 years, with severe burns (45-93% of body surface area) during the first 4 weeks
after the initial injury.
The researchers measured α-tocopherol concentrations in the skin samples, as this is thought to more accurately
represent long-term vitamin E status than plasma vitamin E concentration.
A normal α-tocopherol level is thought to range from 200 to 700 nmol/g. Traber and co-authors found that in the first
week after injury α-tocopherol concentrations were an average of 199 nmol/g, ie, within the normal range. However,
mean levels were significantly lower in weeks 2 and 3, at 133 and 109 nmol/g adipose tissue, respectively.
When the eight children were considered individually, the team estimated that α-tocopherol in adipose tissue
decreased by around 6.1 nmol/g daily.
Of note, adipose tissue triglyceride concentrations also decreased over the first month following injury, but cholesterol
concentrations remained unchanged.
"This is one of the first studies we've done that measures vitamin E in the body tissues of children," said Traber.
"Vitamin E in adipose tissue does not fluctuate much on a short-term basis. To find this level of vitamin E loss in such
a short time was dramatic, unexpected, and somewhat alarming."
The authors conclude in the American Journal of Clinical Nutrition: "We theorize that increased vitamin E
supplementation may decrease neuropathy and improve this clinical problem."
They add: "Another central issue to be addressed is whether attenuation of vitamin E depletion is beneficial in terms of
postburn outcomes. Future studies are planned to address these questions."
New genetic susceptibility loci for psoriasis identified
By Lucy Piper
29 October 2010
Nat Genet 2010; Advance online publications
MedWire News: Researchers have found new psoriasis susceptibility loci that could aid diagnosis of the condition and
the development of new treatments.
In the first of five studies published advance online by Nature Genetics, a team of researchers led by Richard
Trembath (King's College London, UK) carried out a genome-wide association study involving 2622 individuals with
psoriasis and 5667 individuals without the skin condition.
They identified eight new genomic loci that showed a strong association with psoriasis, seven of which harboured
genes with recognized immune functions.
In replication studies involving more than 9000 individuals, the odds ratio estimates for the eight loci ranged from 1.12
to 1.40.
Moreover, the team reports an interaction between one of the loci, ERAP1, which regulates the MHC class I peptide
endoplasmic reticulum aminopeptidase 1, and the established HLA-C risk allele, with variation at the ERAP1 locus
only associated with psoriasis in individuals carrying the HLA-C risk allele.

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"Our findings implicate pathways that integrate epidermal barrier dysfunction with innate and adaptive immune
dysregulation in psoriasis pathogenesis," concludes the team.
Meanwhile, two other genome-wide association studies in the journal involving German participants identified a
psoriasis susceptibility locus at TRAF3IP2, which encodes a protein involved in interleukin (IL)-17 signaling.
"We thus speculate that a dysregulation of TRAF3IP2 might have a major impact on IL-17 signaling and, hence, on the
activation of nuclear factor (NF)-κB-pathways, leading to the upregulation of pro-inflammatory factors," Andre Franke,
from Christian-Albrechts-University in Kiel, Germany, and colleagues write.
Variation in the TRAF3IP2 gene was found to be associated with both psoriasis and psoriatic arthritis, suggesting
shared susceptibility.
André Reis, from the University of Erlangen-Nuremberg in Germany, and colleagues found that the coding variant
p.Asp10Asn at rs33980500 was the single nucleotide polymorphism most significantly associated with psoriatic
arthritis.
Binding of this TRAF3IP2 variant to TRAF6 was reduced in functional assays, note Reis et al. This suggests that
"p.ASP10Asn may modulate downstream signals of different crucial immunoreceptors through altered TRAF
interactions," they say.
"This may ultimately lead to a shift in balance between B- and T-cell responses and innate immunity into an
arthritogenic disequilibrium," the team suggests, providing a possible new and shared pathway for psoriatic arthritis
and psoriasis vulgaris.
For the fourth study, researchers led by James Elder, from the University of Michigan Medical School in Ann Arbor,
USA, carried out a meta-analysis of two recent psoriasis genome-wide association studies involving 1831 affected
individuals and 2546 controls, as well as a replication group of over 8000 individuals.
They identified three new susceptibility loci, including one at NOS2 (rs4795067), one at FBXL19 (rs10782001), and
one near PSMA6-NFKBIA (rs12586317).
NOS2 encodes inducible nitric oxide synthase, which is expressed by a subset of CD11c-positive, CD1c-negative,
tumor necrosis factor-α-producing inflammatory dendritic cells, which are markedly expanded in psoriatic lesions, while
FBXL19, an F-box family member inhibits NF-κB activity by lysine demethylation.
NFKBIA and PSMA6 are also both attractive candidate genes for psoriasis susceptibility, as NFKBIA encodes IκB-α,
an inhibitor of NF-κB signaling, and PSMA6 encodes a proteosomal subunit involved in MHC class I antigen
processing.
All three loci were also associated with psoriatic arthritis and purely cutaneous psoriasis.
The final study involved Chinese patients and identified six new psoriasis susceptibility loci - ERAP1, PTTG1, CSMD1,
GJB2, SERPINB8, and ZNF816A.
The researchers note that two of these loci, ZNF816A and GJB2, also showed evidence of association with psoriasis
in a replication group of European patients, and they also replicated an association between the TNIP1-ANXA6 locus,
which had been identified in the European population, in their Chinese population.
This finding suggests genetic heterogeneity of psoriasis within Chinese and European populations, say Xue-Jun
Zhang, from Anhui Medical University in Hefei, China, and colleagues.
High intake of sugar sweetened drinks increases risk for Type 2 diabetes
By Helen Albert
29 October 2010
Diabetes Care 2010; 33: 2477–2483
MedWire News: Results from a systematic review and meta-analysis show that individuals who drink 1-2 sugar
sweetened beverages (SSBs) per day have a significantly greater risk for developing Type 2 diabetes or the metabolic
syndrome than those who consume less than one per month.
Regular consumption of SSBs such as soft and fruit drinks, iced tea, and energy drinks has been linked to increased
risk for weight gain and obesity, say researchers.
However, less is known about their role in the development of the metabolic syndrome and Type 2 diabetes.
To investigate further, Frank Hu (University of Harvard, Boston, Massachusetts, USA) and colleagues carried out a
systematic review and meta-analysis of 11 studies including 330,250 participants. Of these, 5,803 had the metabolic
syndrome and 15,043 had Type 2 diabetes.
To be included, studies had to have a prospective cohort design, have an endpoint of the metabolic syndrome (three
studies) or Type 2 diabetes (eight studies), assess intake of SSBs and adjust for potential confounders.
Hu and team found that in the studies with Type 2 diabetes as an endpoint, individuals in the highest quintile of SSB
intake (1-2 servings/day) had a significant 26% increase in relative risk for Type 2 diabetes compared with those in the
lowest quintile (none or less than 1 serving/month).
In the studies with the metabolic syndrome as an endpoint, participants in the highest versus the lowest quintile of
SSB intake had a significant 20% increase in relative risk for the metabolic syndrome versus those in the lowest
quintile.
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These results provide "further support to limit consumption of these beverages in place of healthy alternatives such as
water to reduce obesity-related chronic disease risk" conclude the authors in the journal Diabetes Care.
Functional dyspepsia increases risk for disordered sleep
By Helen Albert
29 October 2010
American College of Gastroenterology 75th Annual Scientific meeting; San Antonio, Texas, USA: 15–20 October 2010
MedWire News: Disordered sleep is significantly more common in patients with functional dyspepsia (FD) than healthy
individuals, show results presented at the American College of Gastroenterology 75th Annual Scientific meeting in San
Antonio, Texas, USA.
"The key finding here is that disordered sleep may affect nerve function in the upper gastrointestinal tract which could
lead to worsening dyspepsia, creating a vicious cycle leading to more pain and more insomnia," said investigator Brian
Lacy from Dartmouth Medical School in Hanover, New Hampshire, USA, who presented the results.
He added that "future clinical trials for functional dyspepsia should include validated measures of sleep, as
improvements in functional dyspepsia symptoms may be mirrored by improvements in sleep."
For the purposes of the study, 260 FD patients (mean age 50 years; classified according to Rome III criteria) and 50
healthy controls (mean age 44 years) completed four validated questionnaires to assess sleep quality and mental and
physical wellbeing - the Hospital Anxiety and Depression (HAD) scale, the Short Form (SF)-12, the Insomnia Severity
Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI).
The FD patients also rated their symptoms as being mild (35%), moderate (52%), or severe (13%).
The researchers found that participants with FD had a 3.25-fold increased relative risk for disordered sleep compared
with healthy controls. Women were also 2.36 times more likely to have disordered sleep than men, whereas routine
exercise appeared to protect against disordered sleep (58% reduction in relative risk compared with no exercise).
ISI and PSQI scores were generally higher in FD patients than controls, except for patients with mild FD who had
approximately the same ISI score as controls.
Of note, age, tobacco, and alcohol use were not associated with disordered sleep.
The team also found that patients with mild and moderate-to-severe FD had significantly higher HAD scores than
healthy controls, at 24.6 and 27.4 versus 9.6, respectively.
"Future clinical trials for FD should include validated measures of sleep, and improvements in FD symptoms may be
mirrored by improvements in sleep," suggest the investigators.

WHO
Workshop on community public health measures implemented during the influenza A(H1N1) 2009 pandemic
Date: 26–28 October 2010
During the influenza A(H1N1) 2009 pandemic, in addition to pharmaceutical interventions such as influenza vaccine or
antivirals, WHO recommended public health measures (PHM) that could be implemented to reduce or delay the
transmission of the pandemic. These public health measures are for instance individual-level measures such as cough
etiquette and hand washing, or community-level measures such as border screening or school closures.
The objectives of the workshop are:
• to provide a forum for stakeholders to share data and experiences on public health measures implemented
during the influenza A(H1N1) 2009 pandemic;
• to collect information that will inform the updating of the WHO guidelines on public health measures during an
influenza pandemic; and
• to identify gaps in public health measures that require further studies.
Africa seizes chance against polio
More than 72 million children to be immunized across 15 countries to tackle remaining risks
26 OCTOBER 2010 | DAKAR | BRAZZAVILLE | GENEVA -- This week, Africa seizes an unprecedented chance to
drive out polio when 15 countries across the continent launch a synchronized mass immunization campaign to reach
72 million children, capitalizing on gains made this year. A total of some 290 000 vaccinators have been mobilized to
go door-to-door to deliver two drops of oral polio vaccine (OPV) to every child under five in areas considered at
"highest risk" of polio transmission.
Unprecedented cooperation
Africa's leaders demonstrated unprecedented cooperation and commitment to carry out a series of synchronized
immunization activities in 2009 and in March and April, 2010, following the spread of the disease from Nigeria which
came to infect 24 countries across west and central Africa and in the Horn of Africa. As a direct result of these
immunization campaigns, the polio outbreaks have slowed to a trickle. Across west Africa, only Liberia and Mali have

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recorded any cases in the past five months, while Nigeria – the only country in Africa never to have stopped polio
transmission – has slashed polio by 98% in the past year.
Risks of not completing eradication
However, recent weeks have shown the very real risks of not completing eradication, with a September case in Liberia
confirming residual transmission, a new importation of type 3 wild poliovirus into Mali (the first since 2001), and a case
in Uganda, which had been polio-free for more than a year. In all countries, rapid assessments are being conducted to
formulate an emergency response plan in which two additional mop-up rounds will be held. All countries in the West
Africa sub-region will again conduct two full campaigns in February and March, 2011, but high-quality immunization
campaigns must be complemented by enhanced routine immunization and strong disease surveillance.
With the outbreak in Angola (25 cases) having spilled over the border into neighboring provinces of the Democratic
Republic of the Congo (28 cases) - these two countries now represent the greatest threat to polio in Africa, having
recorded 48 of Africa's 58 cases in the past six months. However, the virus in DR Congo remains geographically
restricted and in Angola, steps by the Government to close vaccination coverage gaps in the most recent campaign –
which started on 1 October – saw the percentage of missed children in the key reservoir of Luanda fall from nearly
30% to 13%, while nationally, the percentage of missed children fell from 15% to 8%.
WHO's Regional Director for Africa, Dr Luis G. Sambo, acknowledged the recent steps taken by Angola and DR
Congo to close vaccination coverage gaps, with the Angolan Minister of Health personally vaccinating children on the
streets of Luanda during the October campaign. "In Africa," Dr Sambo said, "we are seeing the essential government
support that can make the difference between success and failure. But much more remains to be done to fill the gaps
if we are to protect the stunning gains made this year."
"We are on the cusp of an exciting possibility here," said Dr Gianfranco Rotigliano, UNICEF’s Regional Director for
West and Central Africa. "Political leaders across Africa answered the challenge posed by this dreadful disease and
the results are before us. It shows what can be done when there is leadership and dynamic partnership with donor
support around such an important health issue. We need to continue efforts to vaccinate and to put the needs of
children in Africa first."
Many volunteer vaccinators in these vaccination campaigns will be Rotarians, who have themselves given almost US$
1 billion to the polio eradication effort since 1985. Mr Ambroise Tshimbalanga Kasongo, chair of Rotary's African
PolioPlus Committee, called on international donors to stay the course to finish the job by filling the US$ 810 million
funding gap in the Global Polio Eradication Initiative Strategic Plan that aims to eradicate polio globally by 2013.
"Rotary's catch phrase is 'End Polio Now'," he said. "In Africa, the end of polio is in sight, but we are not there yet. To
think we could not reach the finishing line because of lack of financial resources is unacceptable."
The 15-country synchronized activities will cost approximately US$ 42.6 million, and are funded by the Bill & Melinda
Gates Foundation, the US Centers for Disease Control and Prevention (CDC), USAID, Rotary International, UNICEF
and the Governments of Germany and Japan.
Immunization activities
DR Congo and Angola will launch immunization activities from 28 October and 29 October, respectively, while the 10-
country synchronized campaigns are being launched from today (26 October) in Cote d'Ivoire, from 28 October in
Benin, Burkina Faso, Gambia, Guinea, Mali, Mauritania, Senegal and Sierra Leone, and from 29 October in Liberia.
Chad and Sudan will launch immunization activities on 1 November, while last week (from 23 October), Nigeria
immunized more than 29 million children in 20 high-risk northern states.
The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International,
the CDC and UNICEF.
Since the launch of the GPEI in 1988, the incidence of polio has been reduced by more than 99%. In 1988, more than
350 000 children were paralyzed each year in more than 125 endemic countries. Only four countries remain endemic:
Nigeria, India, Pakistan and Afghanistan.

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