Brain Tumour Risk in Relation to Mobile Telephone Use: Results of the INTERPHONE International Case–Control Study

Abstract

Background The rapid increase in mobile telephone use has generated concern about possible health risks related to radiofrequency electromagnetic fields from this technology.
Methods An interview-based case–control study with 2708 glioma and 2409 meningioma cases and matched controls was conducted in 13 countries using a common protocol.
Results A reduced odds ratio (OR) related to ever having been a regular mobile phone user was seen for glioma [OR 0.81; 95% confidence interval (CI) 0.70–0.94] and meningioma (OR 0.79; 95% CI 0.68–0.91), possibly reflecting participation bias or other methodological limitations. No elevated OR was observed ≥10 years after first phone use (glioma: OR 0.98; 95% CI 0.76–1.26; meningioma: OR 0.83; 95% CI 0.61–1.14). ORs were <1.0 for all deciles of lifetime number of phone calls and nine deciles of cumulative call time. In the 10th decile of recalled cumulative call time, ≥1640 h, the OR was 1.40 (95% CI 1.03–1.89) for glioma, and 1.15 (95% CI 0.81–1.62) for meningioma; but there are implausible values of reported use in this group. ORs for glioma tended to be greater in the temporal lobe than in other lobes of the brain, but the CIs around the lobe-specific estimates were wide. ORs for glioma tended to be greater in subjects who reported usual phone use on the same side of the head as their tumour than on the opposite side.
Conclusions Overall, no increase in risk of glioma or meningioma was observed with use of mobile phones. There were suggestions of an increased risk of glioma at the highest exposure levels, but biases and error prevent a causal interpretation. The possible effects of long-term heavy use of mobile phones require further investigation. 


http://www.medscape.com/viewarticle/723258?src=mp&spon=34&uac=126137EG

Yttrium-90 (90Y) RadioMicrosphere Therapy

June 16, 2010 (Salt Lake City, Utah) — Scintigraphy using single
photon emission computed tomography with an integrated x-ray computed
tomography scanner (SPECT/CT) to detect extrahepatic shunting could
help boost the safety of yttrium-90 (90Y) radiomicrosphere therapy in
the liver, according to a Cleveland Clinic study presented here at the
Society of Nuclear Medicine (SNM) 2010 Annual Meeting.

Microsphere technology has gained popularity among surgeons and
interventional radiologists as an effective organ-preserving method of
individually treating hepatic malignancies, noted lead investigator
and presenter Ron Young, technologist and manager of the nuclear
medicine department at the Cleveland Clinic in Ohio.

Mr. Young described how, in a typical procedure, the 20 to 40 μm glass
spheres imbedded with 90Y are injected into hepatic artery circulation
where they selectively embolize the tumor's microvasculature. Beta
particles emitted by the isotope kill cells in a 2.4 mm diameter
region around the tumor and spare healthy liver tissue.

Hepatic radiomicrosphere therapy is considered safe, with a
complication rate of less than 5%, Mr. Young reported. But he added
that many adverse events arise from the incomplete embolization of the
hepatic vessels under angiographic guidance before the procedure. It
can lead to severe pulmonary, gastrointestinal, and pancreatic
radiation burns after the 90Y particles are shunted from the liver.
Other complications include pancreatitis, cholestitis, and gastritis,
he told Medscape Radiology in an interview.

To minimize risk, technetium-99m (99mTc) microaggregated albumin (MAA)
imaging is performed to simulate extrahepatic shunting in the presence
of incomplete hepatic vessel embolization before the surgeon moves on
to the actual procedure, Mr. Young explained.

With guidance from staff interventional radiologist Abraham Levitin,
MD, Mr. Young and colleagues found that 99mTc-MAA SPECT/CT was 2.5
times more accurate than planar imaging in this role.

In 99 consecutive patients who underwent both imaging procedures,
extrahepatic shunting was detected in 23 patients with SPECT/CT and in
9 patients with the planar approach. The investigators did not perform
a detailed statistical analysis.

SPECT/CT also detected a hepatic thrombosis that was not observed on
planar images, Mr. Young noted. The finding led the surgical team to
minimize the lumen of the thrombosis in the inferior vena cava before
turning their attention back to liver treatment, he added.

The findings promise a significant improvement over the standard
technology, said Peter S. Conti, MD, professor of radiology, pharmacy,
and biomedical engineering at the University of Southern California in
Los Angeles. Dr. Conti was not involved with the study.

"The broader implications are that the use of SPECT/CT improves the
ability of the clinician to determine if patients are good candidates
for therapy," he said during an SNM-sponsored media briefing.

Hooman Kabiri, MD, who performs 90Y microsphere procedures at the Ohio
State University Medical Center in Columbus, said in a phone interview
that a shift to SPECT/CT would give him and other interventionist
radiologists more peace of mind.

"It can add to the sensitivity of detecting our ability to embolize
the communications between the hepatic and nonhepatic arteries. It is
a valuable tool in that respect," he told Medscape Radiology.

But shifting to SPECT/CT could also lead to unnecessary treatment
delays because of possible false positives, he cautioned. The 3%
adverse incident rate at Ohio State suggests that the actual rate of
extrahepatic shunting is much lower than the 23% rate identified with
SPECT/CT in the Cleveland Clinic study, he said about the trial.

A larger prospective study testing the relative clinical efficacy and
accuracy of the 2 imaging techniques is planned, Mr. Young told SNM
meeting attendees.

The study did not receive commercial support. Mr. Young, Dr. Conti,
and Dr. Kabiri have disclosed no relevant financial relationships.

Society of Nuclear Medicine (SNM) 2010 Annual Meeting: Abstract 2023.
Presented June 7, 2010.

Italian Scientists Find a Viral Link to Type 1 Diabetes

Italian researchers have found a link between a common virus and type
1 diabetes that may open the door to answers about what triggers the
disease in children.

Scientists at the University of Insurbia in Varese, Italy, tested the
blood of 112 children between two and 16 years of age immediately
after they had been diagnosed with type 1. The researchers were
looking for the presence of DNA left over from infection by an
enterovirus, a common, very mild virus that usually produces either no
symptoms or mild ones, such as aching muscles or rashes.

The scientists knew that previous studies have shown a possible link
between enteroviruses and the onset of type 2. Their study results
confirmed the link: 83 percent of the children with type 1 had
low-level enterovirus infection, compared to 7 percent of children
without the disease.

http://www.diabeteshealth.com/read/2010/06/17/6724/italian-scientists-find-a-viral-link-to-type-1-diabetes/

Hydrogen Sulfide: Potential Help for ED !!!

The stench of rotten eggs seems an unlikely aphrodisiac. But new research suggests that a foul-smelling gas could someday become the target of new drugs for erectile dysfunction.

Hydrogen sulfide is present in raw natural gas and in the odor of rotting eggs. Our bodies also produce tiny quantities of hydrogen sulfide, but the gas was long thought to be only a toxic by-product of metabolism.

Research early this decade revealed that many animals actually use hydrogen sulfide to help expand blood vessels. Chemicals that create these expansions in blood flow are called vasodilators.

In previous experiments in mice and monkeys, injecting hydrogen sulfide opened blood vessels and improved erections. But the same chemical pathways weren't yet proven to function in people.

The same enzymes that produce hydrogen sulfide in animals were present and functional in human tissue. The chemical reactions that produce hydrogen sulfide were generally the same, too. The scientists concluded that hydrogen sulfide does likely contribute to erections in men, just as in animal studies.

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Background Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both).

Methods We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point — a major adverse cardiac orcerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry.

Results Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001);> was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003).

Conclusions CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year. (ClinicalTrials.gov number, NCT00114972)

http://content.nejm.org/cgi/content/full/360/10/961?query=TOC

Blood Glucose Management for Type 2 Diabetes Reviewed

Specific key clinical recommendations, and their accompanying level of evidence rating, are as follows:

• Patients with impaired glucose tolerance should receive counseling and education regarding weight loss and physical activity (level of evidence, A).
• In patients with type 2 diabetes, the only medication proven to reduce mortality rates is metformin (level of evidence, A).
• Acarbose appears to be associated with a lower risk for CVD events (level of evidence, B).
• Oral agents should be continued initially when insulin is added to a regimen of oral medication. Long-acting insulin should be used at first, with initial dosage usually 10 units/day or 0.17 to 0.5 units/kg/day, and it should be titrated in increments of 2 units approximately every 3 days (level of evidence, C).

Metformin, a biguanide, is considered a first-line agent and has been shown to reduce progression from glucose intolerance to type 2 diabetes and to reduce mortality rates in patients with type 2 diabetes. The mechanisms of action of metformin are to decrease hepatic glucose output and sensitize peripheral tissues to insulin. To prevent 1 case of type 2 diabetes, the number needed to treat with metformin is 13.9.

Am Fam Physician. 2009;79:29-36.

Zoledronate's Benefits for Bone Persist for 2 Years After a Single Dose

NEW YORK (Reuters Health) Feb 23 - The beneficial effects on bone health of a single 5 mg dose of zoledronate last for at least 2 years, according to the first study to rigorously examine the duration of zoledronate's antiresorptive effects.

The study, by researchers in New Zealand, was published in the February issue of the Journal of Clinical Endocrinology and Metabolism.

"Optimizing the dosing interval for zoledronate is important," the researchers wrote, noting that compliance with oral bisphosphonate therapy can be poor and that less-frequent administration of such a drug will probably result in better adherence over the long term. They also point out that giving a 5 mg dose less frequently would substantially decrease treatment costs. Currently, zoledronate is given as a 5 mg dose once a year.

In the first year, consistent with previous reports, women receiving zoledronate experienced substantial decreases in levels of serum procollagen type-I N-terminal propeptide (P1NP) and beta-C-terminal telopeptide of type I collagen (beta-CTX) - both markers of bone turnover. In the second year, levels of these markers remained significantly lower in the zoledronate group than in the placebo group. Further, the magnitude of the differences between the 2 groups was similar at 12 and 24 months.

BMD also increased among the zoledronate group in the first year and remained higher than in the placebo group during the second year.

J Clin Encocrinol Metab 2009;94:538-544.

http://www.medscape.com/viewarticle/588584?src=mpnews&spon=34&uac=126137EG

for pgmeenotes by dv

Calcium Intake May Protect Against Cancer

February 26, 2009 — Calcium intake may protect against cancer, particularly gastrointestinal tract cancer, according to the results of a prospective study reported in the February 23 issue of theArchives of Internal Medicine.

"Dairy food and calcium intakes have been hypothesized to play roles that differ among individual cancer sites, but the evidence has been limited and inconsistent," write Yikyung Park, ScD, from the National Cancer Institute in Bethesda, Maryland, and colleagues. "Moreover, their effect on cancer in total is unclear."

Dairy food and calcium intakes were inversely associated with cancers of the digestive system in both men and women. Multivariate relative risk for the highest quintile of total calcium vs the lowest was 0.84 in men (95% CI, 0.77 - 0.92) and 0.77 in women (95% CI, 0.69 - 0.91). This reduction in the risk for gastrointestinal tract cancer was especially prominent for colorectal cancer, and supplemental calcium intake was also inversely associated with the risk for colorectal cancer.

"Our study suggests that calcium intake is associated with a lower risk of total cancer and cancers of the digestive system, especially colorectal cancer," the study authors write.

Vitamin B12 Useful for Recurrent Aphthous Stomatitis

February 20, 2009 — The results of a small trial suggest that vitamin B12 is a safe, effective, and inexpensive treatment for recurrent aphthous stomatitis (RAS).

"The frequency of RAS is as much as 25% in the general population, however, until now, there has been no optimal therapeutic approach," lead author Dr. Ilia Volkov, from Ben-Gurion University of the Negev, Beer-Sheva, Israel, said in a statement.

The cause of recurrent aphthous stomatitis is unknown and over the years a variety of treatments, including adhesive pastes, antiseptics, vitamins, herbs, and steroids have been tested. Although these treatments may reduce pain or the number of lesions in the short term, very few have had any lasting beneficial effect.

http://cme.medscape.com/viewarticle/588505?src=cmenews

for pgmeenotes by dv

Mutations in NR5A1 Associated with Ovarian Insufficiency

 The genetic causes of nonsyndromic ovarian insufficiency are largely unknown. A nuclear receptor, NR5A1 (also called steroidogenic factor 1), is a key transcriptional regulator of genes involved in the hypothalamic–pituitary–steroidogenic axis. Mutation of NR5A1 causes 46,XY disorders of sex development, with or without adrenal failure, but growing experimental evidence from studies in mice suggests a key role for this factor in ovarian development and function as well.

Conclusions NR5A1 mutations are associated with 46,XX primary ovarian insufficiency and 46,XY disorders of sex development.

Read Full Article at N.E.J.M : http://content.nejm.org/cgi/content/full/NEJMoa0806228?query=TOC

FDA Approves New Deep Brain Stimulation Device for OCD

February 20, 2009 – Doctors could soon treat patients with resistant obsessive-compulsive disorder (OCD) with an implantable device that stimulates the brain to block nerve signals that may cause OCD symptoms.

The US Food and Drug Administration (FDA) has announced approval of a humanitarian device exemption (HDE) for the deep brain stimulator. Such exemptions facilitate the development and marketing of medical devices that treat or diagnose a disease or condition that affects fewer than 4000 people a year in the United States.

The small battery-powered deep brain stimulator — called Reclaim DBS Therapy (Medtronic, Minneapolis, Minnesota) — is implanted near the abdomen or the collarbone and connected through a lead to electrodes in the brain. The device delivers intermittent electrical stimulation that blocks nerve signals. One device may be implanted with 2 leads, or 2 systems can be implanted to stimulate both sides of the brain.

Psoriasis Drug Linked to Deaths From Progressive Multifocal Leukoencephalopathy

February 19, 2009 — Three deaths from progressive multifocal leukoencephalopathy (PML) and a possible fourth case have been reported in patients taking the immunosuppressant drug efalizumab (Raptiva, Genentech, Inc), according to a public health advisory issued today by the US Food and Drug Administration (FDA).

(Our point of interest : Efalizumab is an anti-CD11a antibody immunosuppressant drug indicated for the treatment of adults with chronic moderate to severe plaque psoriasis.)

According to the FDA, all 4 patients had been taking efalizumab for at least 3 years and had taken no other immunosuppressant drugs.

The FDA is advising clinicians to follow patients who are receiving efalizumab closely, as well as those who have discontinued the drug, and to periodically reevaluate whether patients should continue to receive treatment.

Coffee Intake Associated With Decreased Stroke Risk in Women

February 19, 2009 — A new analysis of data from the Nurses' Health Study shows that long-term intake of up to 4 or more cups of coffee per day was not associated with an increased risk for stroke and actually appeared to be protective against stroke in women who did not also smoke.

Among women who currently smoked, there appeared to be no effect of coffee intake, neither raising nor lowering stroke risk. No association was seen with other caffeinated drinks, including tea or soft drinks, and decaffeinated coffee still showed a trend toward a protective effect.

The report was published online February 16 and will appear in the March 3 print issue of Circulation.

Full article at--

site:http://www.medscape.com/viewarticle/588445?src=mpnews&spon=34&uac=126137EG

FDA Approves Febuxostat for Chronic Management of Hyperuricemia in Patients With Gout

February 17, 2009 — The US Food and Drug Administration (FDA) last week approved febuxostat (Uloric), 40 mg and 80 mg, administered orally once daily, for chronic management of hyperuricemia in patients with gout, according to an announcement by Takeda Pharmaceuticals North American. This is the first new treatment option available for gout in more than 40 years.

In multiple clinical trials enrolling more than 4000 participants for up to 5 years in some studies, the xanthine oxidase inhibitor safely and effectively reduced serum uric acid levels in patients with hyperuricemia associated with gout.

CONFIRMS, the largest, pivotal, phase 3 clinical trial, showed that febuxostat 80 mg was superior to febuxostat 40 mg and allopurinol 300/200 mg at achieving the main study outcome of serum uric acid less than 6.0 mg/dL at the final visit (67%, 45%, and 42%, respectively; P < .001 for both comparisons).

The safety profile of febuxostat is well established, with liver function abnormalities, nausea, joint pain, and rash being the most frequently reported adverse reactions, occurring in at least 1% of febuxostat-treated patients, and at a rate at least 0.5% greater than placebo. Mild to moderate renal or hepatic impairment does not necessitate dose adjustments.

The mechanism of action of febuxostat is to inhibit xanthine oxidase, an enzyme that breaks down hypoxanthine (a purine base) to xanthine and then to uric acid, thereby reducing elevated levels of serum uric acid. Febuxostat is indicated for the chronic management of hyperuricemia in patients with gout, but not for the treatment of asymptomatic hyperuricemia.

Sleep Disturbance Linked to Tension Headache

February 16, 2009 — Sleep-seeking behavior to relieve pain may contribute to the development of insomnia in people with tension-type headache, according to the results of a study published in the February 15 issue of the Journal of Clinical Sleep Medicine.

"Insomnia has been identified as a risk factor for tension-type headache, although the pathogenesis of sleep disturbance in this population is unclear," write Jason C. Ong, PhD, from Rush University Medical Center in Chicago, Illinois, and colleagues. "The present study examined pain-related self-management strategies in a nonclinical, young-adult sample for preliminary evidence to support a novel hypothesis for the development of insomnia in this population."

The study sample consisted of 32 women with tension-type headache and 33 women with minimal pain who served as control subjects. The investigators studied self-report data on headache triggers, pain interference with sleep, and self-management strategies for pain.

Compared with the control group, the headache group had a significantly greater proportion of participants who reported sleep problems as a trigger of headaches, stress as a trigger of headache, and going to sleep as a strategy for dealing with pain. Ratings of pain interference with sleep were significantly higher in the headache group. Among the headache group, 81% reported that going to sleep was the most frequently used self-management strategy, and this group also rated going to sleep as the most effective strategy (5.5/7.0).

Read Details : http://www.medscape.com/viewarticle/588351?sssdmh=dm1.432287&src=nldne

Metabolic Syndrome Sufferers More Sensitive to Salt

February 16, 2009 (New Orleans, Louisiana) — A large population-based dietary intervention study conducted in rural China suggests that metabolic syndrome enhances blood pressure response to sodium so that sufferers are more salt sensitive than those without the syndrome.

"Our research shows that people who have the metabolic syndrome may benefit more from a low-sodium diet to reduce blood pressure," lead author Dr Jing Chen (Tulane University, New Orleans, LA) told heartwire. Chen and colleagues published their findings online February 16, 2009 in theLancet .

They also found that the risk of salt sensitivity rose progressively with increasing numbers of metabolic syndrome risk factors.

In an accompanying comment , Dr Gonghuan Yang (Chinese Center for Disease Control and Prevention, Beijing, China) says the reasons behind this new finding "require further research." Nevertheless, the "policy implications of Chen and coworkers' findings are clear," she says. With an estimated 23 million adults with metabolic syndrome in China, the study "lends support to lifestyle intervention, especially control of salt intake for [such] individuals."

Almost Two-Fold Higher Risk of Salt Sensitivity With Metabolic Syndrome

Colorectal Cancer Screening No Longer Recommended for Those Older Than 50 Years

ACPM 2009: Colorectal Cancer Screening No Longer Recommended for Those Older Than 50 Years

February 17, 2009 (Los Angeles, California) — The US Preventive Services Task Force (USPSTF) no longer recommends colorectal cancer screening for everyone older than 50 years.

In an update of its 2002 recommendation, the USPSTF now recommends that adults aged 50 to 74 years be screened in 1 of the following ways: every year with high-sensitivity fecal occult blood testing (FOBT); every 10 years with colonoscopy; or every 5 years with flexible sigmoidoscopy plus interval high-sensitivity FOBT.

The recommendation has a rating of A, meaning that the task force urges the clinician to provide the service to eligible patients and that there is good evidence that the service improves health outcomes, with benefits substantially outweighing harms, said USPSTF scientific director Mary Barton, MD, who presented the update here at Preventive Medicine 2009: The Annual Meeting of the American College of Preventive Medicine.

The task force also recommended against routine screening of people aged 76 to 85 years, although individual patients might have considerations that support screening.

In 2002, the USPSTF recommended screening for everyone older than 50 years. That year, the task force also noted that there was insufficient evidence to recommend for or against using computed tomography colonography (CTC) as 1 of the screening modalities.

Since then, several new studies have been performed that clarify the value of screening. The task force evaluated these data using a review conducted by the Oregon Evidence-Based Practice Center, which analyses clinical studies that federal, state, and private agencies use in making policy and coverage decisions.

Cell-Delivered Gene Transfer Shows Promise as HIV-1 Therapy

February 16, 2009 — A phase 2 clinical trial has demonstrated the safety of cell-delivered gene transfer for treating patients with HIV. Published online February 15 in Nature Medicine, the new study is the "first randomized, double-blind, placebo-controlled, phase 2 cell-delivered gene transfer clinical trial." The treated patients experienced no treatment-related adverse events, and CD4+ lymphocyte counts were higher in treated patients through 100 weeks of follow-up.

"Our study was the first to demonstrate...the feasibility of this approach to decrease HIV viral replication and to improve CD4 T cells (immune cells) in HIV-infected patients when antiretroviral therapy is stopped...compared to those who did not get this gene therapy," said first author Ronald T. Mitsuyasu, MD, professor of medicine and director of the University of California–Los Angeles Center for Clinical AIDS Research and Education, in an email to Medscape Pathology & Lab Medicine.

Clopidogrel Gene Mutation Linked to Higher Rate of Stent Thrombosis

February 13, 2009 (Munich, Germany) — A polymorphism in one of the genes responsible for metabolizing clopidogrel to its active form has been shown to be associated with an increased risk of stent thrombosis in patients undergoing PCI.

The study, published online February 4, 2009 in the European Heart Journal, was conducted by a group led by Dr Dirk Sibbing (Deutsches Herzzentrum, Munich, Germany).

The mutant *2 allele of the CYP2C19 gene occurs with a frequency of about 15%. In the current study, 25% of patients had one copy of the genotype (ie, were heterozygous) and 2% of the group were homozygous. Patients who were heterozygous had an increased risk of stent thrombosis compared with those without this genotype, and those who were homozygous had a higher risk again.

"The results of the present study identify patients at high risk for stent thrombosis and provide a rationale for administration of an intensified antiplatelet treatment in patients scheduled for coronary stent placement. Genetic determination of the CYP2C19 loss-of-function polymorphism may be beneficial in this setting, as high-risk patients can be identified prior to the planned procedure. High clopidogrel maintenance dosing or the use of novel and more potent P2Y12-receptor antagonists, such as prasugrel, may be potential treatment options for tailored antiplatelet therapy in CYP2C19*2 carriers"

Regular Aspirin Use Reduces Risk for Colorectal Cancer Precursors

February 13, 2009 — The results of observational studies and randomized trials suggest that regular use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the risk of developing colorectal adenomas, which are known precursors to colorectal cancer.

The results of 2 new studies, published in the February 18 issue of the Journal of the National Cancer Institute, add strength to the evidence that aspirin may be an effective means of chemoprevention in high-risk individuals.