Stanford urologist finds childless men more at risk of death from cardiovascular disease

The risk of dying from cardiovascular disease is higher for childless men than for fathers, according to a large study led by a researcher at the Stanford University School of Medicine. The new study, which will be published online Sept. 26 in Human Reproduction, tracked some 135,000 male members of the American Association of Retired Persons over a 10-year period, in order to determine whether the number of offspring a man has offers any clues about that man's long-term health. The findings show an association between parental status and cardiovascular risk and should not be interpreted as proof of a cause and effect.
"This was the largest-ever study in the United States to examine the relationship between fatherhood and cardiovascular disease," said Michael Eisenberg, MD, assistant professor of urology at Stanford. Moreover, the study was carefully controlled to minimize confounding variables that might otherwise cloud investigators' capacity to generate meaningful results.
Eisenberg initiated the study while doing his urologic residency training at the University of California-San Francisco, and carried it through his joining the faculty at Stanford. (The paper's senior author is Mark Pletcher, MD, MPH, associate professor of epidemiology & biostatistics at UCSF.) He had wondered whether infertile men's long-term health outcomes might differ from those of fertile men, and he reasoned that the number of offspring a man fathered could be a rough proxy for ability to reproduce.
"So we asked: Is not having children a predictor of death from cardiovascular disease?" he said.
To find out, Eisenberg and his associates pored over data compiled from a series of questionnaires that hundreds of thousands of AARP members had completed over a period of about 10 years. The scientists narrowed their health-outcome analysis to some 135,000 married or formerly married men (about 95 percent of them white) who were all over age 50 when the study began. Their median age at the start of the study was 62.7 years old.
To ensure, as much as possible, that the men they were looking at had both the intent and the opportunity to reproduce, Eisenberg and his colleagues restricted their sample population to those who were married or had once been married. To further level the playing field, they also excluded men with any previous history of various health conditions including heart disease, stroke or a related condition, which could have impeded successful reproduction. The resulting subject group was thus in a state of relatively good initial health.
Over the study's duration, the investigators tallied mortality from between 60 and 70 different causes. Deaths were assessed via various methods including through Social Security Administration and other national databases as well as surviving relatives' responses to mailed questionnaires.
Next, all participants living or dead were grouped according to the number of children they had fathered, and mortality rates within each group were calculated. In their statistical analysis, Eisenberg and his colleagues corrected for body-mass index, self-reported activity levels and health status, tobacco and alcohol use, race, age, median household income, and education.
Over the course of the study, about 10 percent of the men died. About one in every five of those deaths was attributable to cardiovascular disease. That represented a 17 percent increase in the likelihood of a childless man's dying of a condition related to cardiovascular disease, compared with fathers.
The genders of the children a man had fathered made no difference in the likelihood of his succumbing to cardiovascular disease.
There was a somewhat higher overall risk of mortality from all causes among childless men. But this increase was almost entirely attributable to cardiovascular disease, without which no statistically significant uptick would have been seen, Eisenberg said.
Eisenberg, who specializes in male infertility and sexual dysfunction, noted that it was impossible, in this study, to directly assess a man's "reproductive intent." But eliminating unmarried men from his team's analysis brought childlessness a step closer to being a proxy for infertility. The connections between infertility, as observed via that proxy, and predisposition to death from cardiovascular disease raise an important question, Eisenberg said. "Is there a real biological cause behind both? Maybe we should look closer at the childless group." Since fertility issues can surface well before any obvious outward symptoms of cardiovascular disease, such a link could help flag cardiovascular risk sooner, leading to earlier and more effective intervention, he said.
The Eisenberg team's results are being published amid widespread reporting of a smaller recent study of some 600 Philippino fathers. The study showed that men with the highest levels of testosterone, the major male steroid hormone, at the study's start were more likely to find mates and become fathers than those with lower initial levels. The study also showed that levels of testosterone fell with parenthood.
Eisenberg suggested that if initially low testosterone levels do indeed predispose to fewer offspring, this may reflect broader underlying problems that could lead to a higher risk of cardiovascular disease in later life. At the same time, many scientists believe the capacity to nurture a child may benefit from a reduction in a man's testosterone levels. But such a parenthood-induced reduction in testosterone levels would no longer imply physiological defects of the sort that may be responsible for relatively low testosterone found in those who go childless. (Eisenberg stressed that his study did not assess testosterone levels in its subjects or consider whether fathers lived with their children.)
It's possible that many other factors besides testosterone account for fathers' lower cardiovascular risk. "Maybe having children causes men to have healthier behaviors, so fathers will live longer," said Eisenberg. Other studies have shown that men live longer if they don't live alone.
The National Cancer Institute funded the study, and two NCI researchers are among its co-authors. Other co-authors came from AARP and Baylor University.

**Source: Stanford University Medical Center

Una dieta adecuada es el sencillo remedio contra el estreñimiento infantil

De todas las opciones no farmacológicas para el estreñimiento infantil, la fibra es, sin duda, la más resolutiva de todas. Así lo apunta una revisión de nueve estudios en los que se analizan otros remedios como la ingesta de probióticos, prebióticos, movimiento físico e incluso terapias alternativas, por ejemplo, la homeopatía y el yoga.
Como explican los autores de este trabajo, publicado en la revista 'Pediatrics', el estreñimiento infantil es un problema común en la infancia. Según Gerardo Diego, jefe de Gastroenterología infantil en el Hospital La Paz de Madrid, "puede suponer el 3% de las consultas en Atención Primaria y entre el 10% y el 15% de las visitas en nuestra especialidad".
Es muy frecuente alrededor de los dos años, asegura María José Martínez, médico adjunto de la sección de Gastroenterología del Hospital Niño Jesús de Madrid. "Es el momento en el que empiezan a quitarles el pañal y a muchos niños les cuesta pasar a la siguiente fase".
Aunque el primer paso del tratamiento consiste en dar unas recomendaciones básicas de alimentación (cantidad adecuada de fibra y líquidos), existen otras medidas no farmacológicas sobre las que no hay demasiada literatura científica. Después de que este grupo de expertos de Países Bajos revisara nueve estudios con un total de 640 participantes, confirmaron que ninguno demostraba efecto alguno de los probióticos, prebióticos, movimiento físico o terapias alternativas como la acupuntura, la homeopatía o el yoga.
En España, comenta Martínez, "los padres no recurren a la medicina alternativa para el estreñimiento. Este comportamiento es más americano. Aquí, la mayoría acude al médico". Y es lo que deben hacer, subraya la especialista.
Cuando los padres observen que sus pequeños hacen pocas deposiciones y además son dolorosas, lo primero que tienen que hacer es pedir cita en Atención Primaria. Antes de nada, hay que descartar un posible problema orgánico, como ano anterior, aunque "esto sólo ocurre en un 1%-2% de los casos. El resto se debe a una alimentación inadecuada o cierta tendencia por herencia de los padres", señala el doctor Prieto.
"Analizamos la dieta que mantienen y la modificamos para que ingieran una cantidad adecuada de fibra (la edad más 5, traducidas las cifras a gramos por día) y líquidos", argumenta María José Martínez. Muchos beben poca agua y también hay casos en los que hay exceso de fibra (cereales, fruta y verdura). A pesar de lo que pueda parecer, esto último no ayuda. "En los menores de tres años, el intestino y el colon se mueven más despacio que en el adulto. Una excesiva cantidad de fibra crea un bolo fecal más grande de lo que su intestino puede mover".
Además de modificar la dieta, es fundamental crear hábitos defecatorios saludables, es decir, "que el niño se siente todos los días a la misma hora en el orinal y que apoyen siempre los pies en el suelo, para facilitar la presión", apunta la doctora.

-Evitar los supositorios
En los lactantes, "se recomienda ponerlos boca arriba con las piernas flexionadas hacia arriba, a la vez que se le masajea la tripa" y, por lo general, hay que evitar los supositorios y cualquier otra medida de estimulación rectal. "Se acostumbrarían a esto y crearían una especie de acto reflejo con el que sólo evacuarían con estímulo".
Sólo con la educación y la dieta, el estreñimiento leve mejora. Sin embargo, remarca el doctor Diego, cuando son más graves, "la fibra y los líquidos no resuelven y hay que indicar tratamiento farmacológico que ablande las heces y estimule la motilidad intestinal".
Según los dos especialistas españoles, es importante tratar este problema desde el inicio, ya que se podría cronificar y el abordaje sería más complicado.

**Pûblicado en "EL MUNDO"

People hospitalized with asthma 'less likely to die from swine flu'

People with asthma who are admitted to hospital with pandemic influenza H1N1 (swine flu) are half as likely to die or require intensive care than those without asthma, according to new research. The study, which is being presented at the European Respiratory Society's Annual Congress in Amsterdam, found that, despite asthma being among the commonest illnesses seen in patients admitted to hospital with H1N1, people with the condition had less severe outcomes.
In general, people with asthma are at risk of developing breathing difficulties when they have an infection, such as H1N1. When the lungs of people with asthma are infected with a virus, mucus and cells move into the narrow airways. This blocks the free movement of air.
The researchers studied 1,520 patients who were admitted to 75 hospitals in 55 cities and towns in the UK with the H1N1 virus. 480 (31%) of the people studied were aged under 16 yrs old. Asthma was the most common illness, affecting 385 (25%) of all patients.
The results showed that people with asthma and H1N1 more often had shortness of breath, more need for supplemental oxygen and greater severe respiratory distress than patients with H1N1 who did not have asthma. However, overall, people with asthma were half as likely to die or require high dependency or intensive care in hospital.
The link between asthma and less severe outcomes was seen even after the researchers took into account age, presence of other illnesses, and both antiviral and antibiotic use. What did seem to make a difference was that patients with asthma came to hospital earlier in the course of their H1N1 disease than other patients with flu. Also, those patients with asthma who had less severe outcomes were on regular inhaled steroids at the time of hospitalisation and received further steroids on admission.
Dr Malcolm Semple, from the University of Liverpool, said on behalf of the investigators: "Pandemic influenza can cause severe disease in people of all ages and those with asthma have a particularly high risk of needing hospital admission. Our results are the first to show that people with pandemic influenza and asthma for which they took regular inhaled steroids required less intensive treatment and had a better chance of recovering from H1N1. The prompt admission and appropriate hospital treatment of patients with asthma significantly improved their chance of recovery from pandemic influenza."

**Source: European Lung Foundation

Women who break a hip at increased risk of dying within a year

Women ages 65-69 who break a hip are five times more likely to die within a year than women of the same age who don't break a hip, according to a Kaiser Permanente Center for Health Research study funded by the National Institutes of Health and published online in the Archives of Internal Medicine. This paper breaks down death risk by age group. In addition to the finding for women ages 65-69, it finds that for women ages 70-79, a hip fracture doubles the risk of dying within a year. Most women 80 and older have the same risk of dying within a year whether they fracture their hip or not, but for women 80 and older who are in excellent health, a hip fracture nearly triples the risk of dying within a year.
"This study is a wake-up call that the first year after a hip fracture is a critical time for all elderly women, but especially for younger women, ages 65-69, who face a much higher death rate compared to their peers," said Erin S. LeBlanc, MD, MPH, lead author and investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "We need to do more to prevent hip fractures from occurring, and we need to study how best to care for women after fracture to prevent these deaths."
Other studies have found that women who break a hip are at higher risk for earlier death, but most of those studies concluded that the increased risk was not because of the fracture, but because of underlying health conditions such as heart disease, stroke, or diabetes. This study controlled for these underlying health conditions and also matched each woman who broke her hip with four women of the same age who didn't break a hip.
"Our study suggests that it is the hip fracture, and not just poor health, that puts these women at higher risk of dying," said Teresa Hillier, MD, MS, co-author and senior investigator at the Kaiser Permanente Center for Health Research. "We also found women are at the highest risk of dying within the first three months after hip fracture, which leads us to hypothesize that hospitalization, surgery and immobility lead to other complications that ultimately result in their death."
Another reason researchers think that hip fractures, and not other underlying health conditions, put women at higher risk of death is their finding involving women aged 80 and older. These women are often sicker to begin with and most of them face the same risk of dying within a year whether they break their hip or not. But when researchers looked at a subset of women who were 80 and older and were also in excellent health, they found that those who fractured a hip were almost three times more likely to die compared to their counterparts who didn't break a hip.

**Source: Kaiser Permanente

Researchers discover gene that is mutated in some blood cancers and predicts better survival

Geneticists have discovered that a gene involved in the modification of ribonucleic acid (RNA) is mutated in a significant proportion of people with a collection of blood cancers called myelodysplastic syndromes (MDS). The researchers found that mutations in the SF3B1 gene tended to be associated with a better prognosis, raising the possibility that patients could be screened for the mutation and their treatment tailored accordingly. Dr. Elli Papaemmanuil told the 2011 European Multidisciplinary Cancer Congress that she and her colleagues found mutations of the SF3B1 gene in 20.3% of MDS patients and that it was closely associated with a particular feature of MDS called ring sideroblasts, which are found in bone marrow. "This is the first time that a close relationship between a mutated gene in MDS and specific feature of the disease has been detected. Mutations were found in about two-thirds (64.6%) of patients whose disease was defined by the presence of ring sideroblasts," says Dr. Papaemmanuil, who is a postdoctoral research fellow working at the Cancer Genome Project at the Wellcome Trust Genome Centre (Cambridge, UK) under the leadership of Dr. Peter Campbell.
"Further analysis showed that patients with the SF3B1 mutation had significantly better overall survival and leukemia-free survival compared to those without the mutation. This suggests that the SF3B1 mutations drive a benign form of MDS. As these mutations can be detected easily in blood samples taken from patients, it may be feasible to identify a group of MDS patients with a benign prognosis who could receive less aggressive treatment -- without recourse to an invasive bone marrow biopsy to look for the presence of ring sideroblasts."
Dr. Papaemmanuil's presentation to the congress coincides with the simultaneous publication of a paper about the research in the New England Journal of Medicine.
MDS are a diverse group of chronic malignancies of the blood. MDS patients often develop severe anemia and require frequent blood transfusions. Their blood cell counts can fall due to progressive bone marrow failure, and, for a subset of patients with MDS, their disease can progress into acute myelogenous leukemia (AML). MDS occur mostly in people aged 60 and over, and, as more people live longer, these syndromes have become the most prevalent myeloid cancer, with an incidence of around 20 cases per 100,000 of the population in the over-70s. Although several genes have been identified as mutated in MDS, all but one are mutated in only 5-15% of cases, and usually at a lower rate in the more benign subtypes of the disease.

**Source: ECCO-the European CanCer Organisation

Un neurólogo norteamericano, puede ser un primer paso para la «lectura» del pensamiento

Seguramente habrá que esperar algunos años para que tengamos una máquina capaz de leer el pensamiento. Pero Jack Gallant, un neurólogo de la Universidad de Berkeley, ha dado un enorme paso en esa dirección al diseñar un dispositivo capaz de reconstruir las imágenes que está viendo una persona a partir de los datos proporcionados por un escáner cerebral que analiza la actividad mental de una persona. Si bien la imagen de salida del escáner cerebral no es aún 100% fiel a lo que ve el sujeto sometido al ensayo, es lo suficientemente buena como para que se pueda reconocer el vídeo que está mirando. ¡Asombroso!
El neurólogo Jack Gallant, de la Universidad de Berkeley (California), ha diseñado una máquina capaz de reconstruir las experiencias visuales que tiene una persona. El aparato funciona a partir de los datos proporcionados por un escáner de “resonancia magnética funcional” (o fMRI, por functional Magnetic Resonance Imaging), un procedimiento que permite mostrar en imágenes las regiones cerebrales que ejecutan una tarea determinada mediante un resonador similar al utilizado para los exámenes de diagnóstico, pero con modificaciones especiales en el software y el hardware.
Las resonancias IRMf no requieren de la aplicación de inyecciones de sustancia alguna y se basa en la llamada “vasodilatación cerebral local”. Se sabe que en la zona del cerebro que se está ejecutando una determinada tarea se produce una dilatación de los microscópicos vasos arteriales y venosos. Esta situación permite un mayor aporte de oxígeno a la zona a la vez que se produce una disminución en la cantidad relativa de desoxihemoglobina, la molécula resultante de la hemoglobina que ha cedido su oxigeno a los tejidos. Esta molécula se comporta como si fuese un imán microscópico y el IRMf aprovecha esos cambios para crear imágenes de la actividad cerebral.

-Cerca de «leer» el pensamiento
El equipo de Gallant ha creado una máquina capaz de reconstruir las imágenes que las personas están viendo a partir de los datos proporcionados por el IRMf. Dado que el sistema puede funcionar de forma continua, un observador puede “acceder” a un video tomado directamente de la mente de una persona que refleja lo que está viendo en tiempo real. Suena a ciencia ficción, y realmente lo es, a pesar de que las imágenes obtenidas no son idénticas a las que ven sus ojos. Estrictamente hablando, “leer el pensamiento de una persona” es algo que todavía no somos capaces de hacer, pero como habrás notado en el vídeo que acompaña este texto lo que ha logrado el equipo de la Universidad de Berkeley es realmente asombroso y constituye un enorme paso en esa dirección.
Para comprobar el funcionamiento de su máquina funciona Gallant realizó varias pruebas. Instaló el escáner cerebral en la cabeza de una serie de voluntarios, y luego les mostró una serie de vídeos de YouTube elegidos al azar. La máquina, después de analizar las señales cerebrales obtenidas de cada uno de los voluntarios pudo reproducir las imágenes que estaban viendo. No sabemos cuál será el próximo paso, pero todo parece indicar que leer el pensamiento de una persona puede ser posible. Y probablemente ocurra pronto.



**Publicado en "NEOTEO"

Shorter radiation course for prostate cancer is effective in long-term follow-up

A shorter course of radiation treatment that delivers higher doses of radiation per day in fewer days (hypofractionation) is as effective in decreasing intermediate to high-risk prostate cancer from returning as conventional radiation therapy at five years after treatment, according to a randomized trial presented at the plenary session, October 3, 2011, at the 53rdAnnual Meeting of the American Society for Radiation Oncology (ASTRO). "This long-term study confirms that hypofractionated radiation that shortens treatment by about two and a half weeks is a practical approach to effectively controlling prostate cancer, as compared to the more standard treatment for men with intermediate to high-risk prostate cancer," Alan Pollack, MD, chairman of radiation oncology at the University of Miami Miller School of Medicine in Miami, said.
The strategy to compress treatment schedules using hypofractionation is based on years of studies indicating that there could be a radiobiologic advantage to this approach. Prior research has indicated that tumor cells would be killed to a greater degree with hypofractionation than the potentially damaging effects on the surrounding normal tissues, namely the rectum, penile structures affecting erections and bladder. Another newer approach to hypofractionation incorporated into this trial is the use of intensity modulated radiotherapy (IMRT), which further limits dose to the normal tissues. IMRT has proven value in limiting side effects in the treatment of prostate cancer with external beam radiotherapy.
The study involved 303 men with intermediate to high-risk prostate cancer who were randomized to receive either hypofractionated IMRT or conventionally fractionated IMRT between 2002 and 2006. The high risk patients also received a form of hormone therapy for two years. The patients were followed for over five years to find out if their cancer returned by monitoring prostate specific antigen (PSA), a blood test and established indicator of prostate cancer recurrence when increasing levels are seen.
Dr. Pollack said, "we are still learning how best to apply hypofractionation and the results in this trial show that the technique is very effective."
The hypofractionation approach used was given in a shorter period of time with higher doses per day and was expected to be equivalent to four extra treatments using conventional fractionation. While the hypofractionation treatment was hypothesized to be superior, the same tumor control rates were observed. The conventionally fractionated patients had better outcomes than expected. The benefit of the hypofractionation method used was that comparable results were achieved in two and a half fewer weeks of treatment.
In terms of side effects, the rates were relatively low for both methods. There were identical long-term rates of bowel/rectal reactions and the frequency of unsatisfactory erections. There was, however, significantly higher bladder control in the conventionally fractionated patients.
"Late urinary symptoms were higher with hypofractionation but were low overall, particularly when the incidence of persistent urinary symptoms (<10 percent at five years) was analyzed, rather than just as an isolated event," Dr. Pollack said. "Hypofractionation is rapidly gaining momentum for many types of cancers. The results presented here bring us much closer to effectively treating prostate cancer in a shorter period of time, with acceptable side effects."

**Source: American Society for Radiation Oncology