Health Technology Research Synopsis

21st Issue Date 26 DEC 2007

Compiled By Ralph Turchiano

www.healthresearchreport.me  www.vit.bz

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No Editors Top Five This issue:

*The Research reports are to few this holiday season

In This issue:

1. Elective Caesareans carry increased risk of breathing problems

2. Cholesterol-lowering drugs and the risk of hemorrhagic stroke

3. Turkish health workers condone wife beating

4. New clinical data shows chromium picolinate improves cognitive function

5. Green tea may protect brain cells against Parkinson’s disease

6. Vitamin B12 function may be diminished by excessive folate

7. Does treating worms in people with HIV slow progression to AIDS?

8. Walking and moderate exercise help prevent dementia

9. Breath test can discriminate between a bacterial overgrowth and IBS

10. Why don’t we get cancer all the time?

11. Why exertion leads to exhaustion

12. Why fish oil is good for you

Public release date: 11-Dec-2007

Elective Caesareans carry increased risk of breathing problems

Risk of respiratory morbidity in term infants delivered by elective Caesarean section: a cohort study BMJ Online First

Babies delivered by elective caesarean section around term carry up to a fourfold increased risk of breathing problems compared with babies delivered vaginally or by emergency caesarean section, concludes a study from Denmark published on bmj.com today.

The rate of delivery by elective caesarean section is increasing. Previous studies have shown that elective caesareans are linked to an increased risk of newborn respiratory problems.

The exact reasons for this are unknown, but one explanation is that hormonal and physiological changes associated with labour are necessary for lungs to mature and that these changes may not be present in infants delivered by elective caesarean section. Gestational age at the time of elective caesarean section may also be important.

This risk increased the earlier the caesarean was performed. A nearly fourfold increased risk was found at 37 weeks gestation, a threefold increase in risk at 38 weeks gestation, and a doubling of risk in infants delivered at 39 weeks gestation. Adjusting for maternal factors had little effect.

For example, at 37 weeks, 2.8% of infants delivered by intended vaginal delivery had general respiratory problems compared to 10% of infants delivered by elective caesarean section. At 38 weeks, the proportion was 1.7% compared to 5.1% and at 39 weeks, 1.1% compared to 2.1%.

Analyses after restriction to low risk pregnancies revealed slightly smaller risk estimates at 37 weeks gestation but essentially unchanged estimates at 38 and 39 weeks gestation for serious respiratory problems, whereas the estimates remained unchanged at all gestational ages for general respiratory problems.

They suggest that a significant reduction in neonatal respiratory morbidity may be obtained if elective caesarean section is postponed until 39 completed weeks of gestation.

Public release date: 12-Dec-2007

Cholesterol-lowering drugs and the risk of hemorrhagic stroke

ST. PAUL, Minn. – People taking cholesterol-lowering drugs such as atorvastatin after a stroke may be at an increased risk of hemorrhagic stroke, or bleeding in the brain, a risk not found in patients taking statins who have never had a stroke. But researchers caution the risk must be balanced against the much larger overall benefit of the statin in reducing the total risk of a second stroke and other cardiovascular events when making treatment decisions. The research is published in the December 12, 2007, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Overall, treatment was associated with a 16-percent reduction in total stroke, the study’s primary endpoint, as well as significant reductions in coronary heart events. However, secondary analysis found that the overall reduction in stroke included an increase in the risk of brain hemorrhage. Of those people randomized to atorvastatin, the study found 2.3 percent experienced a hemorrhagic stroke during the study compared to 1.4 percent of those taking placebo. The study also found there was a 21-percent reduction in ischemic stroke, a more common type of stroke involving a block in the blood supply to the brain, among people taking atorvastatin.

Other factors were also found to increase the risk of brain hemorrhage. For example, those who had experienced a hemorrhagic stroke prior to the study were more than five times as likely to suffer a second stroke of this kind. Men were also nearly twice as likely as women to suffer a hemorrhagic stroke. People with severe high blood pressure at their last doctor’s visit prior to the hemorrhagic stroke had over six times the risk of those with normal blood pressure.

The SPARCL trial was funded by Pfizer, the maker of atorvastatin.

Public release date: 12-Dec-2007

Turkish health workers condone wife beating

Domestic violence is an inherent problem in Turkey, and healthcare workers are doing little to combat the prevalence of wife beating, according to research published in the online open access journal, BMC Public Health. A survey of medical personnel reveals that a lack of training and a cultural acceptance of domestic violence may prevent victims from obtaining the support they desperately require.

173 medical staff from the emergency department of a Turkish university hospital responded to a questionnaire about domestic violence. 69.0% of the female and 84.7% of the male respondents declared that they agreed or partially agreed to at least one reason to justify physical violence.

Accepted grounds for intimate domestic violence included lying to or criticising the male and failure to care for children. Moreover, about three-quarters of the nurses and male physicians and over half of female physicians agreed that deceiving the husband justified physical punishment Deceiving the husband is a taboo in Turkey and it is among the most important reasons for honour murders.

Public release date: 13-Dec-2007

New clinical data shows chromium picolinate improves cognitive function

Nutrition 21’s Core4Life Advanced Memory Formula combines chromium picolinate, phosphatidylserine and DHA to improve brain health

PURCHASE, N.Y., December 13, 2007 – Nutrition 21, Inc. (NASDAQ: NXXI), a leading developer and marketer of chromium-based and omega-3 fish oil-based nutritional supplements, today announced the results of a clinical study that showed daily supplementation with 1000 mcg of chromium as chromium picolinate improved cognitive function in older adults experiencing early memory decline. The results of the randomized, double-blind, placebo-controlled study were presented to the medical community at a neurological meeting

Blood circulation and nutrient flow to the brain decrease as a result of aging, which can affect cognition. Previous studies have shown that chromium picolinate improves insulin sensitivity, which allows glucose, the brain’s main “fuel”, to be processed more efficiently

“Impaired glucose metabolism and insulin resistance have been linked to age-related cognitive decline, dementia and Alzheimer’s disease. These findings suggest that improving glucose metabolism with chromium picolinate supplementation may enhance cognition,” said Robert Krikorian, Ph.D., lead investigator and associate professor, Department of Psychiatry, University of Cincinnati College of Medicine. “These results are encouraging and indicate that further study of this intervention is warranted. Ultimately, we may find that chromium supplementation offers benefit to patients, given the prevalence of metabolic disorders and associated cognitive decline in the aging population.”

In this study, investigators used Nutrition 21’s proprietary chromium picolinate found in Core4Life™ Advanced Memory Formula™, a nutritional supplement specifically formulated to improve brain health. Core4Life Advanced Memory Formula contains a unique combination of chromium picolinate, phosphatidylserine (PS) and DHA. These ingredients all play an important role in helping improve memory and maintain brain health. PS and DHA are major components of healthy brain cell membranes and increase communication between brain cells while chromium picolinate increases glucose metabolism.

The randomized, double-blind, placebo-controlled study measured whether supplementation with chromium picolinate over a 12-week period might improve cognitive function in 21 adults aged 65 years and older with early memory decline. Study participants were asked to learn a list of words presented over several learning trials and, after a delay, were asked to remember the words. Those receiving the chromium picolinate supplement showed a trend for reduced interference from irrelevant words on the memory task (p = 0.12). In addition, on another task assessing fine motor control and speed, the subjects receiving chromium picolinate exhibited enhanced motor speed relative to those receiving placebo (p = 0.16).

Public release date: 13-Dec-2007

Green tea may protect brain cells against Parkinson’s disease

Philadelphia, PA, December 13, 2007 – Does the consumption of green tea, widely touted to have beneficial effects on health, also protect brain cells” Authors of a new study being published in the December 15th issue of Biological Psychiatry share new data that indicates this may be the case. The authors investigated the effects of green tea polyphenols, a group of naturally occurring chemical substances found in plants that have antioxidant properties, in an animal model of Parkinson’s disease.

Parkinson’s disease is a progressive, degenerative disorder of the central nervous system, resulting from the loss of dopamine-producing brain cells, and there is presently no cure. According to Dr. Baolu Zhao, corresponding and senior author on this article, current treatments for Parkinson’s are associated with serious and important side effects. Their previous research has indicated that green tea possesses neuroprotective effects, leading Guo and colleagues to examine its effects specifically in Parkinson’s. The authors discovered that green tea polyphenols protect dopamine neurons that increases with the amount consumed. They also show that this protective effect is mediated by inhibition of the ROS-NO pathway, a pathway that may contribute to cell death in Parkinson’s.

Dr. Zhao’s hope is that eventually “green tea polyphenols may be developed into a safe and easily administrable drug for Parkinson’s disease.” Dr. Krystal agrees, that “if green tea consumption can be shown to have meaningful neuroprotective actions in patients, this would be an extremely important advance.”

Public release date: 18-Dec-2007

Vitamin B12 function may be diminished by excessive folate

BOSTON (December 18, 2007) — In a study of adults aged 20 and over, researchers at Tufts University showed that homocysteine and methylmalonic acid are at much higher levels in individuals who have a combination of vitamin B12 deficiency and high blood folate levels than in individuals who are also vitamin B12 deficient but have normal folate levels.

Homocysteine and methylmalonic acid, compounds used by enzymes that contain vitamin B12, accumulate in the blood in patients who are vitamin B12 deficient. “Finding that the combination of high blood folate levels and low vitamin B12 status is associated with even higher levels of these compounds is a strong indication that the high folate is interfering with the action of these B12-containing enzymes, thus resulting in the exacerbation or worsening of the vitamin B12 deficiency,” says corresponding author Jacob Selhub, Ph.D., director of the Vitamin Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (USDA HNRCA).

In an earlier study, Selhub and co-authors Martha Savaria Morris, Ph.D., and Paul Jacques, D.Sc, also of the USDA HNRCA, have shown that the prevalence of anemia and cognitive impairment among U.S. elderly who are vitamin B12 deficient is much worse if this B12 deficiency is also accompanied by high blood folate rather than normal blood folate. This indicates that the worsening of the vitamin B12 deficiency, as indicated by higher homocysteine and methylmalonic acid due to high blood folate, is also manifested clinically through higher prevalence of anemia and cognitive impairment.

Results of the present study are published in the December 11 issue of the Proceedings of the National Academy of Sciences. Selhub and colleagues analyzed data from 10,413 adults who participated in two National Health and Nutrition Examination Surveys (NHANES). Slightly less than half of the participants (4,940) took part in phase 2 of the NHANES III, which was conducted between 1991 and 1994. The remaining 5,473 adults took part in NHANES conducted from 1999 to 2000 and from 2000 to 2002.

The authors intentionally used one NHANES survey conducted prior to 1998, the year the Food and Drug Administration required that all enriched cereal-grain products be fortified with folic acid, the synthetic form of folate, in order to help prevent birth defects in infants. “It is important to note that these adverse interactions between high folate blood levels and vitamin B12 deficiency were seen only in the study participants from the NHANES conducted between 1999 and 2002, after the fortification of flour and other cereals with folic acid,” says Selhub, who is also a professor at the Friedman School of Nutrition Science and Policy at Tufts University.

Folic acid is a synthetic form of the vitamin, which requires specific processing by the body for incorporation into the folate pool of the body. Naturally occurring folates, found in leafy vegetables, legumes and in many other fruits and vegetables, can be readily incorporated into the body’s folate pool and are believed to be beneficial even at higher intakes. “There is no reason to avoid foods with naturally occurring folate and it essential to consume B12 containing products such as eggs, meat, milk and poultry and even supplements if necessary,” says Selhub. “The combination of high blood folate and normal vitamin B12 status is actually beneficial to health.”

Ralph’s Note- It is frustrating that who ever edited the article did not distinguish between Folate and artificial Folic Acid till the very end. This will undoubtedly lead to further confusion over time.

Public release date: 18-Dec-2007

Does treating worms in people with HIV slow progression to AIDS?

Of the 25 million people infected with HIV-1 in Africa, as many as half are thought to be co-infected with worms (helminths), and there is evidence that these worms may result in a more rapid progression of HIV infection to AIDS. Does treating these worms (“de-worming”) slow down this progression.

In a new study published in the open access journal PLoS Neglected Tropical Diseases, Judd Walson and Grace John-Stewart at the University of Washington, Seattle, USA set out to answer this question. Their study found that there were simply not enough data to make any firm conclusions, and they call for larger, well-designed studies to help come to a definitive answer.

There were five studies in the final analysis. All five were limited by short follow up times. Only one of these was a randomized controlled trial (RCT)—it compared the effects of treating worms in people with HIV against no treatment. The trial did find some benefit from the de-worming treatment. In patients with HIV who did not receive the de-worming treatment, their viral load (a measure of the amount of HIV in their bloodstream) went up. In contrast, the viral load of patients who were de-wormed remained stable. However, de-worming was not associated with improvements in the patients’ immune status (as measured by the CD4 count) or in their clinical condition.

Public release date: 19-Dec-2007

Walking and moderate exercise help prevent dementia

ST. PAUL, Minn. – People age 65 and older who regularly walk and get other forms of moderate exercise appear to significantly lower their risk of developing vascular dementia, the second most common form of dementia after Alzheimer’s disease, according to a study published in the December 19, 2007, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The study found the top one-third of participants who exerted the most energy walking were 27 percent less likely to develop vascular dementia than those people in the bottom one-third of the group.

Participants who scored in the top one-third for the most energy exerted in moderate activities lowered their risk of vascular dementia by 29 percent and people who scored in the top one-third for total physical activity lowered their risk by 24 percent compared to those in the bottom one-third.

Public release date: 19-Dec-2007

Breath test can discriminate between a bacterial overgrowth and IBS

The gastrointestinal (GI) tract is colonized by bacteria immediately after birth; Escherichia coli, Streptococci and Clostridi are the first bacteria harboured by the colon, followed by anaerobic Enterococci, Lattobacilli and Bacteroidi. These commensal bacteria inhabiting the human intestine (i.e., intestinal microflora) participate in the development and maintenance of gut sensory and motor functions, including the promotion of intestinal propulsive activity; on the other hand, intestinal motility represents one of the major control systems of gut microflora, though the sweeping of excessive bacteria from the lumen. There is emerging evidence indicating that changes in this bi-directional interplay contribute to the pathogenesis of gut diseases, such as small intestinal bacterial overgrowth (SIBO).

These symptoms look like those of inflammatory bowel diseases (IBS) and, unfortunately, most of these patients with a bacterial overgrowth are inappropriately treated with topically-active non-steroidal anti-inflammatory agents. In fact, these compounds have no antibacterial activity and, therefore, they do not remove the causative factors of the symptoms (bacterial overgrowth) and are likely to provoke even severe adverse events.

The “breath test” is a recently developed test, which is able to detect elevated concentrations of hydrogen in the expired air. In presence of a SIBO, dietary carbohydrates are metabolised with production of massive amounts of hydrogen that are eliminated with the breath. Thus, the “breath test” consists in administering 50-75 grams of lactulose and assaying the concentrations of hydrogen in the expired air; if these concentrations exceed 10 to 20 part per million, the subject is suspected to have a SIBO and should be appropriately treated with antibiotics.

Public release date: 19-Dec-2007

Why don’t we get cancer all the time?

The seemingly inefficient way our bodies replace worn-out cells is a defense against cancer, according to new research.

Having the neighboring cell just split into two identical daughter cells would seem to be the simplest way to keep bodies from falling apart.

However that would be a recipe for uncontrolled growth, said John W. Pepper of The University of Arizona in Tucson.

“If there were only one cell type in the group, it would act like an evolving population of cells. Individual cells would get better and better at surviving and reproducing,” said Pepper, a UA assistant professor of ecology and evolutionary biology and a member of UA’s BIO5 Institute.

“When cells reach the point where they divide constantly, instead of only when needed, they are cancer cells.”

Instead, multicellular organisms use a seemingly inefficient process to replace lost cells, Pepper said. An organ such as the skin calls upon skin-specific stem cells to produce intermediate cells that in turn produce skin cells.

Although great at their job, the new skin cells are evolutionary dead ends. The cells cannot reproduce.

Losing the ability to reproduce was part of the evolutionary path single-celled organisms had to take to become multicellular, Pepper said.

What was in it for the single cells?

“Probably they got to be part of something more powerful,” Pepper said. “Something that was hard to eat and good at eating other things.”

Pepper and his colleagues published their paper, “Animal Cell Differentiation Patterns Suppress Somatic Evolution,” in the current issue of PLoS Computational Biology. Pepper’s co-authors are Kathleen Sprouffske of the University of Pennsylvania in Philadelphia and the Wistar Institute in Philadelphia and Carlo C. Maley of the Wistar Institute.

The National Institutes of Health, the Pennsylvania Department of Health, the Pew Charitable Trust and the Santa Fe Institute funded the research.

Pepper became curious about the origins of cooperation between cells while he was a postdoctoral fellow at the Santa Fe Institute in New Mexico.

“Organisms are just a bunch of cells,” he said.

“If you understand the conditions under which they cooperate, you can understand the conditions under which cooperation breaks down. Cancer is a breakdown of cooperation.”

Pepper and his colleagues used a kind of computer model called an agent-based model to compare different modes of cellular reproduction.

The results indicate that if cells reproduce by simply making carbon-copies of themselves, the cells’ descendants are more likely to accumulate mutations.

In contrast, if cellular reproduction was much more complicated, the cells’ descendants had fewer mutations.

Suppressing mutations that might fuel uncontrolled growth of cells would be particularly important for larger organisms that had long lives, the team wrote in their research report.

Ralph’s Note – This gives a different a way of thinking when it comes to cancer. In some aspects it can be when a cell line becomes to good at survival. Not from a defect or disease.

Public release date: 20-Dec-2007

The physiology of champions

What could be a greater test of the limits of human physiology than the Olympics” To mark the 2008 games in Beijing, the Journal of Physiology present a special issue focusing on the science behind human athleticism and endurance.

This unique collection of original research and in-depth reviews examines the genes that make a champion, the physiology of elite athletes, limits to performance and how they might be overcome.

Excess body heat is a barrier to performance in many sports, and a novel study by Romain Meeusen et al.1 shows that both the neurotransmitter systems have an important impact on the control and perception of thermoregulation.

Rats whose dopaminergic and the noradrenergic reuptake was inhibited – by the anti-smoking aid Xyban – were able to exercise twenty minutes longer than usual in the sweltering heat and tolerated higher core body temperature.

What genes makes a champion, asked Alun Williams et al”2 They identify 23 individual genetic variations that enhance athletic performance — “If the optimum genetic combination existed in one person, world records like Paula Radcliffe’s would probably be shattered.”

Left to nature, the odds of anyone alive having all 23 variations is just 200,000:1. But what might the future hold for genetic manipulation and testing”

It’s no surprise that Marcus Amman et al. have shown that tiring out a leg muscle will subsequently reduce your performance in a 5km cycling time trial — but would you have guessed that it is ‘all in the mind’”3

It is not the muscle’s own temporary weakness that reduces performance, they find, but instead the brain places an unconscious ‘brake’ on the central motor drive to the limbs and therefore regulates exercise performance

Public release date: 20-Dec-2007

Why exertion leads to exhaustion

Scientists have found an explanation for runners who struggle to increase their pace, cyclists who can’t pedal any faster and swimmers who can’t speed up their strokes. Researchers from the University of Exeter and Kansas State University have discovered the dramatic changes that occur in our muscles when we push ourselves during exercise.

We all have a sustainable level of exercise intensity, known as the ‘critical power’. This level can increase as we get fitter, but will always involve us working at around 75-80% of our maximal capacity. Published in the American Journal of Physiology: Regulatory, Integrative and Comparative Physiology, this research shows why, when we go beyond this level, we have to slow down or stop altogether. This is the first time that scientists have looked at processes taking place inside the muscles when we exceed the critical power.

The study showed that when we exceed our critical power, the normally-stable pH level in our muscles, is quickly pushed to levels typical of exhaustion. Moreover, the level of phosphocreatine in the muscles, a high-energy compound which serves as an energy reserve, is quickly depleted when exercise intensity exceeds the critical power.

Public release date: 25-Dec-2007

Why fish oil is good for you

It’s good news that we are living longer, but bad news that the longer we live, the better our odds of developing late-onset Alzheimer’s disease.

Many Alzheimer’s researchers have long touted fish oil, by pill or diet, as an accessible and inexpensive “weapon” that may delay or prevent this debilitating disease. Now, UCLA scientists have confirmed that fish oil is indeed a deterrent against Alzheimer’s, and they have identified the reasons why.

Reporting in the current issue of the Journal of Neuroscience, now online, Greg Cole, professor of medicine and neurology at the David Geffen School of Medicine at UCLA and associate director of UCLA’s Alzheimer Disease Research Center, and his colleagues report that the omega-3 fatty acid docosahexaenoic acid (DHA) found in fish oil increases the production of LR11, a protein that is found at reduced levels in Alzheimer’s patients and which is known to destroy the protein that forms the “plaques” associated with the disease.

The plaques are deposits of a protein called beta amyloid that is thought to be toxic to neurons in the brain, leading to Alzheimer’s. Since having high levels of LR11 prevents the toxic plaques from being made, low levels in patients are believed to be a factor in causing the disease.

Alzheimer’s is a debilitating neurodegenerative disease that causes memory loss, dementia, personality change and ultimately death. The national Alzheimer’s Association estimates that 5.1 million Americans are currently afflicted with the disease and predicts that the number may increase to between 11 million and 16 million people by the year 2050.

The researchers examined the effects of fish oil, or its component DHA, in multiple biological systems and administered the oil or fatty acid by diet and by adding it directly to neurons grown in the laboratory.

“We found that even low doses of DHA increased the levels of LR11 in rat neurons, while dietary DHA increased LR11 in brains of rats or older mice that had been genetically altered to develop Alzheimer’s disease,” said Cole, who is also associate director of the Geriatric Research Center at the Veterans Affairs Medical Center.

To show that the benefits of DHA were not limited to nonhuman animal cells, the researchers also confirmed a direct impact of DHA on human neuronal cells in culture as well. Thus, high levels of DHA leading to abundant LR11 seem to protect against Alzheimer’s, Cole said, while low LR11 levels lead to formation of the amyloid plaques.

Fish oil and its key ingredient, omega-3 fatty acids (found in fatty fish like salmon), have been a mainstay of alternative health practitioners for years and have been endorsed by the American Heart Association to reduce the risk of cardiovascular disease.

Fatty acids like DHA are considered “essential” fatty acids because the body cannot make them from other sources and must obtain them through diet. Years of research have shown that DHA is the most abundant essential fatty acid in the brain, Cole said, and that it is critical to fetal and infant brain development. Studies have also linked low levels of DHA in the brain to cognitive impairment and have shown that lower levels may increase oxidative stress in the brains of Alzheimer’s patients.

Based on the positive results, the National Institutes of Health is currently conducting a large-scale clinical trial with DHA in patients with established Alzheimer’s disease. For those patients, Cole said, it may be too late in the disease’s progression for DHA to have much effect. But he is hopeful that the NIH will conduct a large-scale prevention clinical trial using fish oil at the earliest stages of the disease — particularly because it is unlikely that a pharmaceutical company will do so, since fish oil in pill form is readily available and inexpensive.

Still to be determined, he said, “is what the optimal dose should be. It could be that a smaller amount might be helpful, especially in a place like the south of France, where people are already on a Mediterranean diet.”

Here in the United States, though, where fish consumption is not very high, the dose may need to be higher.

“There’s a deficiency of DHA to begin with,” Cole said, “and this may contribute to the low LR11 seen in many Alzheimer’s patients.”

Ralph’s Note- I don’t fully understand the disclaimer on how Omega-3’s may help prevent Alzheimer’s. But the longer you live the more likely you will get. You can also say the longer you live, the better the chance of getting hit by a meteor. Science needs to be pure, not having subjective opinions cloud the facts.