(October 3, 2008 - Insidermedicine) On a recent trip to Atlanta, we caught up with Dr. Larry Sperling, MD, a Cardiologist and the Director of Emory University's Center for Heart Disease Prevention.

If you believe there is someone conducting world class medical research in your area, and would like them to be featured on Insidermedicine's In the Spotlight, please contact us at nominate@insidermedicine.com

(October 3, 2008 - Insidermedicine) Being overweight and having elevated insulin levels are both risk factors for prostate cancer mortality, according to research published in The Lancet Oncology.

Here are some recommendations on screening for prostate cancer from the American Cancer Society:

•       The prostate-specific antigen (PSA) test and the digital rectal examination (DRE) should be offered beginning at age 50.

•       Men at high risk should begin testing at age 45. High-risk groups include men of African descent and men with a first-degree relative diagnosed at a young age.

•       Prior to testing, men should have an opportunity to learn about the benefits and limitations of early prostate cancer detection and treatment.

Researchers from Harvard University in Boston and McGill University in Montreal looked for an association between baseline and 8-years BMI and plasma C-peptide and subsequent prostate cancer death among 2,456 men diagnosed with prostate cancer.

Those who were overweight or obese before their diagnosis were significantly more likely to die of the disease than those of normal weight, even after controlling for Gleason grade and clinical stage. Higher plasma C-peptide levels were also associated with increased mortality, and those with both a high BMI and high plasma C-peptide were four times as likely to die of their disease.

Today's research highlights the need to control weight and avoid metabolic syndrome to improve the prognosis for prostate cancer. It also suggests that insulin-lowering agents may have a therapeutic effect for this condition.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.

(October 3, 2008 - Insidermedicine) Being overweight and having out of control insulin levels places men with prostate cancer at increased risk of dying, according to research published in The Lancet Oncology.

Here are some facts about prostate cancer:

•       It is one of the most common forms of cancer among men.

•       While there may be no symptoms in the early stages, prostate cancer can be uncovered early with routine screening. This typically involves a digital rectal exam and a blood test for prostate-specific antigen (PSA).

•       Most men should start being screened for prostate cancer after the age of 50. Those who are at higher risk should be screened sooner.

Researchers from Harvard University in Boston and McGill University in Montreal looked at the association between BMI and blood levels of C-peptide, a marker of the body's production of insulin, among nearly 2,500 men diagnosed with prostate cancer. Insulin levels often become imbalanced among overweight and obese individuals.

Men who were overweight or obese or who had out-of-control insulin levels before they were diagnosed with prostate cancer were more likely to die of this condition. In fact, men with both a high BMI and high C-peptide levels were four times as likely to die of prostate cancer as those with low BMI and C-peptide levels.

Today's research highlights the need control weight as a means of improving the prognosis for prostate cancer. It also implicates insulin in this disease and suggests that drugs that lower insulin levels may be beneficial.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.

(October 3, 2008 - Insidermedicine) From Wisconsin - According to research in the journal Cell, overeating causes dramatic changes in the brain which may lead to diabetes and heart disease. Working with mice, researchers found that a particular compound in the brain, which is normally inactive, became active when the mice were fed a high-fat diet. When the compound was active the body ignored signals from leptin, a hormone that regulates appetite, and insulin, which helps convert food into energy.

From Washington - According to research in the journal Cancer Immunology, Immunotherapy, a new anti-tumor vaccine for neuroblastoma and melanoma is showing promise. The new vaccine uses a tumor's own protein to cause an immune system response and has been shown to stop the growth of tumors in mice. The researchers believe that, in the near future, standard treatment plus the use of this vaccine may cure patients of tumors like neuroblastoma and melanoma.

And finally, from London - According to research in the journal Ophthalmology, the risk of eye infection has not been reduced by the introduction of new types of contact lenses. In a study of nearly 1,800 people, researchers found that the use of disposable contact lenses and silicone hydrogel lenses has not reduced the risk of microbial keratitis. The researchers also noted that wearing any type of lens overnight was associated with more than 5 times the risk for disease.

For Insidermedicine in 60, I'm Dr. Susan Sharma.

(October 2, 2008 - Insidermedicine) From Washington - According to a study in Consumer Reports, some of the most popular breakfast cereals marketed to children contain more than 50% sugar. In a study of 27 of the top selling breakfast cereals, 2 varieties contained more than 50% sugar, while another 9 contained more than 40% sugar. This amount is comparable to that found in a glazed doughnut. While it is important for children to eat breakfast, experts recommend cereals made with whole grains that are low in sodium and added sugar.

From Seattle - According to research in the American Journal of Roentgenology, those with appendicitis may benefit from a CT scan. In a study of 100 patients being evaluated for possible appendicitis, 29 had their treatment plans altered after undergoing a CT scan. Furthermore, CT findings ruled out appendicitis in 9 out of 18 cases where the likelihood of appendicitis was initially considered probable, and 3 out of 5 cases where appendicitis was considered "very likely".

And finally, from Cambridge - According to research in Biological Psychiatry, low levels of cortisol, the stress hormone involved in our "fight or flight" response, may be linked to antisocial behavior. In a study of 100 boys from mainstream schools and 75 teens known to exhibit antisocial behavior, researchers found that the cortisol levels in antisocial teens did not spike as they should when subjected to stressors. These findings indicate that antisocial behavior may be more biologically based than previously thought.

For Insidermedicine in 60, I'm Allison Chow from Queen's University.

(October 2, 2008 - Insidermedicine) One person reading a mammography scan aided by a computer is just as reliable as when two people read the scan, according to research published in the New England Journal of Medicine.

Here are some facts about mammography:

•    It is a type of X-ray taken of the breasts to screen for the presence of breast cancer.

•    Among women aged 50 to 69 years, mammography screening and appropriate follow-up can reduce the death rate from breast cancer by one-third.

•    Most of the benefits of mammography screening can be obtained if women undergo the test once every two to three years.

Researchers from the University of Aberdeen randomly assigned over 31,000 women who were undergoing a routine mammography scan to have their results read by one person with the aid of a computer, two people, or both strategies.

Among 227 cancers that were present, two readers identified 199 of them, while a single reader with computer aid identified 198. Both strategies were about equally able to detect cancer when it was present and correctly determine when no cancer was present. The only difference was that women were recalled for further testing slightly more often when the computer analysis was used than when two readers were used.

Today's research demonstrates that adding a computer analysis to the reading of mammographies can make one person as accurate as two at interpreting the results.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.

(October 2, 2008 - Insidermedicine) From Washington - According to a study in Consumer Reports, some of the most popular breakfast cereals marketed to children contain more than 50% sugar. In a study of 27 of the top selling breakfast cereals, 2 varieties contained more than 50% sugar, while another 9 contained more than 40% sugar. This amount is comparable to that found in a glazed doughnut. While it is important for children to eat breakfast, experts recommend cereals made with whole grains that are low in sodium and added sugar.

From Seattle - According to research in the American Journal of Roentgenology, those with appendicitis may benefit from a CT scan. In a study of 100 patients being evaluated for possible appendicitis, 29 had their treatment plans altered after undergoing a CT scan. Furthermore, CT findings ruled out appendicitis in 9 out of 18 cases where the likelihood of appendicitis was initially considered probable, and 3 out of 5 cases where appendicitis was considered "very likely".

And finally, from Cambridge - According to research in Biological Psychiatry, low levels of cortisol, the stress hormone involved in our "fight or flight" response, may be linked to antisocial behavior. In a study of 100 boys from mainstream schools and 75 teens known to exhibit antisocial behavior, researchers found that the cortisol levels in antisocial teens did not spike as they should when subjected to stressors. These findings indicate that antisocial behavior may be more biologically based than previously thought.

For Insidermedicine in 60, I'm Dr. Susan Sharma.

(October 2, 2008 - Insidermedicine) Welcome to Insidermedicine's If I Knew Then, where we learn from the collective wisdom of clinicians and researchers in medicine.

On a recent trip to Boston, we caught up with Deborah Washington, RN, MSN, who is the Director of Diversity in Patient Care Services at Massachusetts General Hospital.  The recipient of numerous nursing and leadership awards, Deborah identifies herself chiefly as a teacher of diversity issues in a patient care setting.

(October 2, 2008 - Insidermedicine) Single computer-aided mammography readings are as reliable as double readings, according to research published in the New England Journal of Medicine.

Here is some information about computer-aided mammography reading:

•    It refers to the use of computer algorithms to analyze digital mammograms.

•    Computer-aided single readings are standard practice for up to 30% of mammography readings in the U.S., but it is less popular elsewhere.

•    One limitation to the wider use of computer-aided mammography reading is ongoing controversy about its benefits.

Researchers from the University of Aberdeen randomized over 31,000 women undergoing mammographic screening to have their results undergo double reading, computer-aided single reading, or both strategies. The computer algorithm was set to a sensitivity of 88% for breast masses and 95% for calcifications.

Double readings identified 199 and computer-aided readings identified 198 out of 227 cancers. Double readings had a sensitivity of 87.7%, a specificity of 97.4%, and a positive predictive value of 21.1%. Computer-aided readings had a sensitivity of 87.2%, specificity of 96.9%, and positive predictive value of 18%. Recall rate was 3.4% with double readings and 3.9% with computer-assisted readings.

Today's research demonstrates how single computer-aided mammographic readings can be used as an alternative to double readings without sacrificing reliability.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.

(October 1, 2008 - Insidermedicine) A sub-type of the most frequently seen form of age-related macular degeneration may be triggered by double-stranded RNA viruses which include cold and flu viruses, according to research published in the New England Journal of Medicine.

Here are some facts about age-related macular degeneration:

•    It is a degenerative condition of the eye that can lead to blindness, usually starting with loss of central vision.

•    There are 2 types of macular degeneration: the wet and dry types. Dry is much more common, but cases of the wet type account for most cases of visual loss.

•    Treatments for the wet type of macular degeneration include, so-called hot and cold lasers and medicines that cause leaking blood vessels to close down.

Researchers from the Sichuan Academy of Medical Sciences in China looked for an association between a particular gene variant and age-related macular degeneration in over 400 patients with severe wet-type macular degeneration, over 200 with severe dry-type macular degeneration, over 150 with early-stage macular degeneration, and over 350 unaffected controls. The gene they investigated can be induced to kill retinal cells if it is stimulated by double-stranded RNA.

The researchers were able to show that a variant of the gene was linked with a reduced risk for developing a severe form of dry-type age-related macular degeneration called geographic atrophy. It was not associated with any of the other conditions.

Today’s research demonstrates a gene which may influence the retina's response to a viral infection, many play a role in the development of a common form of age-related macular degeneration. 

For Insidermedicine in Depth, I'm Dr. Susan Sharma.