The daily addition of 75 g of whole-shelled walnuts to a typical
Western-style diet appears to have positive
effects on the vitality, morphology, and motility of sperm
in healthy men, according to the findings of a randomized, parallel,
2-group, dietary intervention trial.
Wendie A. Robbins, PhD, and colleagues from the University of California, Los Angeles, published their findings in Biology of Reproduction.
The authors note that despite the connection between food
and reproduction throughout history, the evidence of the effects
of diet on male fertility is lacking. "Dietary habits and
essential nutrients to promote successful reproductive outcomes
have been identified for the maternal peri-conceptional and
peri-natal period, but healthy dietary habits and essential nutrients
for paternal reproductive fitness are less clear," the
authors write.
"Evidence is particularly limited for men who routinely
consume Western-style diets that may lack optimal nutrients and
[polyunsaturated
fatty acid] profiles needed for healthy sperm and
fertility," they continue.
Via flyers posted on campus, the authors recruited 120
healthy men between the ages of 21 and 35 years who routinely consumed
a Western diet, 3 of whom only participated in a pilot
trial. After randomly assigning the remaining 117 participants to the
control (no dietary supplementation, n = 58) and walnut
supplementation (n = 59) groups for a 12-week trial, the authors
revealed
that sperm vitality (difference after 12 weeks, 5.5% ± 10.0%
vs 0.51% ± 7.4% in walnut vs control groups, respectively; P = .003), motility (difference after 12 weeks, 5.7% ± 13.4% vs 0.53% ± 10.4, respectively; P = .009), and morphology (normal forms: difference at 12 weeks, 1.1% ± 2.7% vs 0.1 ± 2.3, respectively; P = .03) were significantly improved in the walnut group compared with the control group.
The authors excluded men with known food allergies, histories of reproductive disorders or vasectomies, current smoking habits,
or current usage of antioxidant supplements, medications for chronic illnesses, or illicit drugs.
In addition, serum omega-3 and omega-6 fatty acid levels were significantly improved in the walnut group after 12 weeks (P = .0007 and .0004, respectively), although no differences were observed in sperm fatty acid levels after 12 weeks of walnut
supplementation.
The prevalence of sex chromosome disomy and sperm missing a sex chromosome were significantly lower in the walnut group after
12 weeks of supplementation (P = .002 and .01, respectively). Sperm α-linolenic acid levels were inversely correlated with the proportion of sperm missing
a sex chromosome (Spearman correlation coefficient, −0.41; P = .002)
No differences were observed between the baseline
characteristics of the control and walnut groups, excluding lower
follicle-stimulating
hormone levels in the walnut group (P = .04). The limitations of the study included the collection of blood samples only during daytime, preventing evaluation
of the effects of diurnal variations in sex hormone levels.
Would Sperm Improvements From Walnuts Persist for Infertile Men?
The authors noted that this study could not clarify whether
the effects observed in healthy adults will be applicable to those
with fertility issues. "Whether adding walnuts to the diet
will go beyond the shifts in sperm parameters as seen in this study
to improving birth outcomes for men within fertility clinic
populations or in the general population is not yet known and
will require further research," the authors write.
Dolores Lamb, PhD, director of the Center for Reproductive
Medicine at Baylor College of Medicine in Houston, Texas, and current
president of the American Society for Reproductive Medicine,
noted that walnut supplementation may represent a useful strategy
for some men with fertility problems.
"Importantly, if indeed subsequent studies show improvement
in fertility potential, this is a simple dietary intervention
that could be easily recommended for men with sperm
deficiencies caused by poor viability, poor morphology (for some
specific
defects), and lowered motility," Dr. Lamb told Medscape Medical News by email.
"While there is no doubt that many men with abnormal
morphology, vitality, or motility would not be helped by this
intervention
because of the clearly multifactorial basis of male
infertility, nevertheless, if a subset of infertile men can be helped,
this would be a positive advance," she concluded.
This study was funded through a grant from the California Walnut Commission. Dr. Lamb has received grant support from the
National Institutes of Health and from the William and Ella Owens Medical Research Foundation.
Sunday, 4 November 2012
Final Results in 'Definitive' Prostate Cancer Trial
BOSTON, Massachusetts — Two treatments are better than 1 for men with locally advanced prostate cancer, according to the final
results of a landmark cooperative-group trial.
Radiation therapy plus androgen-deprivation therapy (ADT) improved survival in these men, said senior investigator Padraig Warde, MBChB, from the Princess Margaret Hospital in Toronto, Ontario, Canada. He reported the results here at the American Society for Radiation Oncology 54th Annual Meeting.
Compared with ADT alone, the combination significantly improved overall survival by 30% and significantly reduced the risk of dying from the disease by 54%.
Of the 603 men randomized to the combination, 205 have died, as have 260 of the 602 men randomized to ADT alone. Median follow-up was 8.0 years.
The combination caused only a minimal increase in late treatment toxicity, Dr. Warde reported. For late gastrointestinal toxicity (above grade 2 proctitis), the combination had a small detrimental effect, compared with ADT alone (1.0% vs 0.3%).
"This is the definitive trial in patients who are suitable for radical treatment," Dr. Warde told Medscape Medical News, referring to men with locally advanced disease who are in good health and have a "reasonable life expectancy."
This is practice-changing.
"This is practice-changing," he added. The change that is needed is a shift away from treating locally advanced disease with
ADT alone, he added.
Dr. Warde hopes the message reaches urologists. They are the "gatekeepers" of prostate cancer treatment and the primary prescribers of ADT alone for locally advanced disease, he said. There is a mistaken belief among urologists that locally advanced disease is not curable, he added.
In his presentation, Dr. Warde quoted an anonymous urologist's wrongheaded justification for prescribing ADT by itself: "These men all have metastatic disease; adding radiotherapy to hormones is unnecessary and unkind."
An estimated 15% to 25% of all newly diagnosed prostate cancer is locally advanced, and therefore high risk, said Dr. Warde. Currently, a "huge" percentage of these cases in the United States — up to 45% — continue to be treated with ADT alone, he added.
ADT is easy to prescribe, which partially explains its widespread use in this setting, said Jeff Michalski, MD, from the Siteman Cancer Center and Washington University School of Medicine in St. Louis, Missouri, who was not involved with the study. "With ADT, there's an initial favorable response, but there is also an inevitable progression and decline in quality of life," he told Medscape Medical News.
Now data show that you compromise survival.
"Now data show that you compromise survival, too," with ADT alone, said Dr. Michalski.
Dr. Warde noted that his team's results are supported by a Scandinavian study, in which combination therapy provided better survival than ADT alone (Lancet. 2009;373:301-308).
Benefit May Be Underestimated
All of the men in the study by Dr. Warde and colleagues had T3/T4 disease or T2 prostate adenocarcinoma with a prostate-specific antigen (PSA) level above 40 μg/L, or had T2 prostate adenocarcinoma with a PSA level above 20 μg/L and a Gleason score of 8 or higher.
The patients were randomized from 1995 to 2005 to lifelong ADT (bilateral orchiectomy or luteinizing hormone-releasing hormone agonist) with or without radiation therapy.
The radiation therapy consisted of 65 to 69 Gy to the prostate, with or without radiation to seminal vesicles. If needed, 45 Gy was delivered to the pelvic nodes. "It was the standard dose at the time," said Dr. Warde.
The combination of radiation therapy plus ADT significantly improved overall survival (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.57 to 0.85; P = .0003) and disease-specific survival (HR, 0.46, 95% CI, 0.34 to 0.61; P <.0001), compared with ADT alone.
In the study, 199 patients (43%) died of disease and/or treatment (134 receiving ADT alone and 65 receiving the combination).
The results of this study are "exciting," but they might "underestimate" the effect of combination therapy, he added.
Radiation oncologists now use 76 to 80 Gy to the prostate, Dr. Warde pointed out. "We now have the technology to do better," he said.
Not all men with locally advanced disease should receive radiation, Dr. Warde noted. The general rule is that the combination of radiation and hormone therapy should be used in men with a life expectancy of 5 to 10 years. In older men with fewer years of life remaining and in men with considerable comorbidities, especially cardiovascular comorbidities, radiation should be avoided, he said.
Very Important Results
The interim results of this study were presented by Dr. Warde at the 2010 annual meeting of the American Society of Clinical Oncology, and were reported at that time by Medscape Medical News.
At that meeting, an expert placed the study in the context of earlier research.
Previous studies have established the value of combining hormone therapy and radiation therapy, said Timothy Gilligan, MD, from the Cleveland Clinic in Ohio. "Multiple randomized controlled trials have shown that men with high-risk locally advanced prostate cancer live longer if they receive hormone therapy at the same time as radiation therapy," he explained.
However, Dr. Gilligan said it was unclear whether it was the hormone therapy or the radiation therapy that was responsible for the improved survival in the previous studies.
This study provides clarity, he added. It "shows that radiation therapy makes a difference," he said.
The study was supported the National Cancer Institute, the Medical Research Council in the United Kingdom, and the National Cancer Research Network in the United Kingdom. Dr. Warde, Dr. Michalski, and Dr. Gilligan have disclosed no relevant financial relationships.
American Society for Radiation Oncology (ASTRO) 54th Annual Meeting: Abstract 8. Presented October 28, 2012.
Radiation therapy plus androgen-deprivation therapy (ADT) improved survival in these men, said senior investigator Padraig Warde, MBChB, from the Princess Margaret Hospital in Toronto, Ontario, Canada. He reported the results here at the American Society for Radiation Oncology 54th Annual Meeting.
Compared with ADT alone, the combination significantly improved overall survival by 30% and significantly reduced the risk of dying from the disease by 54%.
Of the 603 men randomized to the combination, 205 have died, as have 260 of the 602 men randomized to ADT alone. Median follow-up was 8.0 years.
The combination caused only a minimal increase in late treatment toxicity, Dr. Warde reported. For late gastrointestinal toxicity (above grade 2 proctitis), the combination had a small detrimental effect, compared with ADT alone (1.0% vs 0.3%).
"This is the definitive trial in patients who are suitable for radical treatment," Dr. Warde told Medscape Medical News, referring to men with locally advanced disease who are in good health and have a "reasonable life expectancy."
Dr. Warde hopes the message reaches urologists. They are the "gatekeepers" of prostate cancer treatment and the primary prescribers of ADT alone for locally advanced disease, he said. There is a mistaken belief among urologists that locally advanced disease is not curable, he added.
In his presentation, Dr. Warde quoted an anonymous urologist's wrongheaded justification for prescribing ADT by itself: "These men all have metastatic disease; adding radiotherapy to hormones is unnecessary and unkind."
An estimated 15% to 25% of all newly diagnosed prostate cancer is locally advanced, and therefore high risk, said Dr. Warde. Currently, a "huge" percentage of these cases in the United States — up to 45% — continue to be treated with ADT alone, he added.
ADT is easy to prescribe, which partially explains its widespread use in this setting, said Jeff Michalski, MD, from the Siteman Cancer Center and Washington University School of Medicine in St. Louis, Missouri, who was not involved with the study. "With ADT, there's an initial favorable response, but there is also an inevitable progression and decline in quality of life," he told Medscape Medical News.
Dr. Warde noted that his team's results are supported by a Scandinavian study, in which combination therapy provided better survival than ADT alone (Lancet. 2009;373:301-308).
Benefit May Be Underestimated
All of the men in the study by Dr. Warde and colleagues had T3/T4 disease or T2 prostate adenocarcinoma with a prostate-specific antigen (PSA) level above 40 μg/L, or had T2 prostate adenocarcinoma with a PSA level above 20 μg/L and a Gleason score of 8 or higher.
The patients were randomized from 1995 to 2005 to lifelong ADT (bilateral orchiectomy or luteinizing hormone-releasing hormone agonist) with or without radiation therapy.
The radiation therapy consisted of 65 to 69 Gy to the prostate, with or without radiation to seminal vesicles. If needed, 45 Gy was delivered to the pelvic nodes. "It was the standard dose at the time," said Dr. Warde.
The combination of radiation therapy plus ADT significantly improved overall survival (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.57 to 0.85; P = .0003) and disease-specific survival (HR, 0.46, 95% CI, 0.34 to 0.61; P <.0001), compared with ADT alone.
In the study, 199 patients (43%) died of disease and/or treatment (134 receiving ADT alone and 65 receiving the combination).
The results of this study are "exciting," but they might "underestimate" the effect of combination therapy, he added.
Radiation oncologists now use 76 to 80 Gy to the prostate, Dr. Warde pointed out. "We now have the technology to do better," he said.
Not all men with locally advanced disease should receive radiation, Dr. Warde noted. The general rule is that the combination of radiation and hormone therapy should be used in men with a life expectancy of 5 to 10 years. In older men with fewer years of life remaining and in men with considerable comorbidities, especially cardiovascular comorbidities, radiation should be avoided, he said.
Very Important Results
The interim results of this study were presented by Dr. Warde at the 2010 annual meeting of the American Society of Clinical Oncology, and were reported at that time by Medscape Medical News.
At that meeting, an expert placed the study in the context of earlier research.
Previous studies have established the value of combining hormone therapy and radiation therapy, said Timothy Gilligan, MD, from the Cleveland Clinic in Ohio. "Multiple randomized controlled trials have shown that men with high-risk locally advanced prostate cancer live longer if they receive hormone therapy at the same time as radiation therapy," he explained.
However, Dr. Gilligan said it was unclear whether it was the hormone therapy or the radiation therapy that was responsible for the improved survival in the previous studies.
This study provides clarity, he added. It "shows that radiation therapy makes a difference," he said.
The study was supported the National Cancer Institute, the Medical Research Council in the United Kingdom, and the National Cancer Research Network in the United Kingdom. Dr. Warde, Dr. Michalski, and Dr. Gilligan have disclosed no relevant financial relationships.
American Society for Radiation Oncology (ASTRO) 54th Annual Meeting: Abstract 8. Presented October 28, 2012.
Friday, 2 November 2012
AHA Issues Mechanical Circulatory-Support Guidance for Referring Docs
With a new guidance on device strategies and patient selection and a planned guidance on postoperative care, the American Heart Association (AHA) is trying to bring knowledge about mechanical circulatory support (MCS) beyond transplant centers and surgeons to the
doctors who are primarily responsible for caring for heart-failure patients [1].
An AHA scientific statement titled "Recommendations for the use of mechanical circulatory support: Device strategies and patient selection" is now published online October 29, 2012 in Circulation. Dr Jennifer L Peura (Medical University of South Carolina, Charleston) told heartwire that the AHA developed these recommendations for "referring physicians--general cardiologists or general physicians--who may not have the [MCS] technology in their area." The authors of the recommendations hope they will lead to more heart-failure patients being referred to an MCS device-implanting center earlier in the progression of their heart failure, before they develop hyponatremia or hypotension or need to undergo frequent hospitalizations.
"If you look at the major heart-failure guidelines, the recommendations for mechanical circulatory support are very few," she said. "This is a rapidly growing technology, and there are a lot of patients who would benefit, but there are also a lot of patients who, if we get to them too late, don't get much of a benefit."
These recommendations should help referring physicians know when to refer their patients to the centers that will provide mechanical circulatory support, she said. The document will also help surgeons and other clinicians at the advanced centers better communicate and build referral
relationships. "We're hoping this will be a resource to help them risk-stratify advanced heart-failure patients and identify the appropriate time to refer them for advanced therapy and, of course, to have an understanding of the contraindications and relative contraindications, so that they can have better insight into what patients would be good candidates in our hands [and the implanting centers]," she said.
The document explains both destination therapy and bridge-to-transplant therapy with ventricular-assist devices, but it is also the first guidance to explain "how to use short-term or percutaneous devices in the whole scheme of that, because [percutaneous devices] are implanted in the cath lab instead of the operating room in those circumstances, so [the guidelines] really help the referring physician [understand] how all that fits together."
All of the members of the writing committee are affiliated with centers that implant MCS devices, including include surgeons, heart-failure specialists, and MCS coordinators.
How to Care for Patients on Circulatory Support
Peura said her group is also developing a guidance for care of MCS patients after implantation of a circulatory-support device. "A lot of these patients are returning to home communities that may be hours from the implanting center. [We want to give] first responders, emergency medical services, emergency-department doctors, and the referring primary doctors guidance on how to take care of these patients."
She said the group also hopes to eventually develop recommendations on treating patients with advanced renal insufficiency. "We do see a lot of patients whose kidneys recover [with MCS], but many others may not, and if they are heart-kidney–transplant eligible, it may be reasonable to bridge them with a [ventricular-assist device], but there are many communities where outpatient dialysis is not available for that patient," she said. "We definitely need more research in that area."
Most of circulatory-support technology supports the left ventricle, but more research and guidance are needed on treating heart-failure patients with right heart failure, Peura said. "That's the Achilles' heel of left ventricular support."
An AHA scientific statement titled "Recommendations for the use of mechanical circulatory support: Device strategies and patient selection" is now published online October 29, 2012 in Circulation. Dr Jennifer L Peura (Medical University of South Carolina, Charleston) told heartwire that the AHA developed these recommendations for "referring physicians--general cardiologists or general physicians--who may not have the [MCS] technology in their area." The authors of the recommendations hope they will lead to more heart-failure patients being referred to an MCS device-implanting center earlier in the progression of their heart failure, before they develop hyponatremia or hypotension or need to undergo frequent hospitalizations.
"If you look at the major heart-failure guidelines, the recommendations for mechanical circulatory support are very few," she said. "This is a rapidly growing technology, and there are a lot of patients who would benefit, but there are also a lot of patients who, if we get to them too late, don't get much of a benefit."
These recommendations should help referring physicians know when to refer their patients to the centers that will provide mechanical circulatory support, she said. The document will also help surgeons and other clinicians at the advanced centers better communicate and build referral
relationships. "We're hoping this will be a resource to help them risk-stratify advanced heart-failure patients and identify the appropriate time to refer them for advanced therapy and, of course, to have an understanding of the contraindications and relative contraindications, so that they can have better insight into what patients would be good candidates in our hands [and the implanting centers]," she said.
The document explains both destination therapy and bridge-to-transplant therapy with ventricular-assist devices, but it is also the first guidance to explain "how to use short-term or percutaneous devices in the whole scheme of that, because [percutaneous devices] are implanted in the cath lab instead of the operating room in those circumstances, so [the guidelines] really help the referring physician [understand] how all that fits together."
All of the members of the writing committee are affiliated with centers that implant MCS devices, including include surgeons, heart-failure specialists, and MCS coordinators.
How to Care for Patients on Circulatory Support
Peura said her group is also developing a guidance for care of MCS patients after implantation of a circulatory-support device. "A lot of these patients are returning to home communities that may be hours from the implanting center. [We want to give] first responders, emergency medical services, emergency-department doctors, and the referring primary doctors guidance on how to take care of these patients."
She said the group also hopes to eventually develop recommendations on treating patients with advanced renal insufficiency. "We do see a lot of patients whose kidneys recover [with MCS], but many others may not, and if they are heart-kidney–transplant eligible, it may be reasonable to bridge them with a [ventricular-assist device], but there are many communities where outpatient dialysis is not available for that patient," she said. "We definitely need more research in that area."
Most of circulatory-support technology supports the left ventricle, but more research and guidance are needed on treating heart-failure patients with right heart failure, Peura said. "That's the Achilles' heel of left ventricular support."
Support Vest Cuts Sternal Wound Infections by 50% After Cardiac Surgery
A vest used to stabilize the chest following cardiac surgery has slashed the rate of deep sternal wound infections by 50%
in a large, prospective, multicenter, randomized trial [1]. Dr Michael Gorlitzer (Hospital Hietzing, Vienna, Austria) reported the results during a late-breaking clinical trial session here today at the
European Association for Cardio-Thoracic Surgery (EACTS) 2012 Annual Meeting.
"Sternal wound infections are a major cause of morbidity and mortality following cardiac surgery, and a problem all over the world, affecting up to 3%--or even 5%--of patients undergoing this type of operation," Gorlitzer told heartwire . Although antibiotics are used, other approaches are needed to try and reduce this complication. Approaches that have already been tried include the adoption of different techniques for closure of the sternum and wiring of the sternum, he explained. But "surgeons tend to focus on the pre- and intraoperative periods, when in fact they also need to pay attention postoperatively," he noted.
The support vest reduces the number of reoperations needed due to instabiltity and deep sternal wound infections (DSWI) as well as the length of postoperative stay in hospital, and is therefore "cost-effective due to reduction of major events," Gorlitzer said.
Vest Must Be Worn for Six Weeks Postop
Gorlitzer explained that the Posthorax sternum vest (Epple Inc, Vienna, Austria) is designed to stabilize the sternum after cardiac surgery--it allows normal breathing but acts as a shock absorber when the patient coughs. It is fitted with the help of a nurse after the patient leaves the intensive care unit, and is most effective if worn for around six weeks after surgery. The patient may remove the vest to wash it, and the vest itself can be laundered twice before it starts to lose its effectiveness. The vest costs around €120, although this will differ depending on where it is sold, Gorlitzer said.
In the study, 2539 patients who underwent cardiac surgery were randomized to wear the sternum support vest (n=1351) or not (n=1188). Patients were excluded if they underwent a heart transplant, were aged <20 years, had a congenital heart defect, or underwent mechanical reanimation or irradiation of the chest.
Although 933 patients were randomized to wear the vest, 202 patients did not receive it for varying reasons and 216 patients refused it. This tended to happen more often in the early days of the study when patients were unsure about the vest, Gorlitzer said, and he stressed that it is very important to educate patients. "We need to inform them before the operation what is going to happen afterwards--that they have to wear this vest and that it is a little uncomfortable," he explained.
Of the 1188 patients randomized not to receive the vest, 12 patients did get it, Gorlitzer said.
In an intention-to-treat analysis, the rate of the primary end point--deep sternal wound infection--was 1.04% in those who wore the vest compared with 2.27% in those who did not, a relative risk reduction of 56% (p<0.05).
Organic brain syndrome can increase the risk [of DSWI] 2.5-fold, something that was not previously appreciated.
It is important that the vest is worn for six weeks after the operation if possible, said Gorlitzer, noting that in this study,
34% of patients developed DSWI after leaving the hospital.
He noted that the vest can be uncomfortable, particularly when patients are lying down, and it can slip up and irritate the neck. The company is now working on a new design, which should improve the comfort and be available in a few months.
Organic Brain Syndrome Also Identified as Predictor of DSWI
Another important study finding was the identification of a new risk factor for DSWI: organic brain syndrome.
Organic brain syndrome occurs in some patients "who have a kind of psychotic episode after deep anesthesia," Gorlitzer explained. "They thrash around a lot and get agitated."
"We already know that diabetes and long duration of surgery can increase the risk of DSWI, but in this study we saw that organic brain syndrome can increase this risk 2.5-fold, something that was not previously appreciated. This is a very important message," said Gorlitzer.
Gorlitzer reports no conflicts of interest.
"Sternal wound infections are a major cause of morbidity and mortality following cardiac surgery, and a problem all over the world, affecting up to 3%--or even 5%--of patients undergoing this type of operation," Gorlitzer told heartwire . Although antibiotics are used, other approaches are needed to try and reduce this complication. Approaches that have already been tried include the adoption of different techniques for closure of the sternum and wiring of the sternum, he explained. But "surgeons tend to focus on the pre- and intraoperative periods, when in fact they also need to pay attention postoperatively," he noted.
The support vest reduces the number of reoperations needed due to instabiltity and deep sternal wound infections (DSWI) as well as the length of postoperative stay in hospital, and is therefore "cost-effective due to reduction of major events," Gorlitzer said.
Vest Must Be Worn for Six Weeks Postop
Gorlitzer explained that the Posthorax sternum vest (Epple Inc, Vienna, Austria) is designed to stabilize the sternum after cardiac surgery--it allows normal breathing but acts as a shock absorber when the patient coughs. It is fitted with the help of a nurse after the patient leaves the intensive care unit, and is most effective if worn for around six weeks after surgery. The patient may remove the vest to wash it, and the vest itself can be laundered twice before it starts to lose its effectiveness. The vest costs around €120, although this will differ depending on where it is sold, Gorlitzer said.
In the study, 2539 patients who underwent cardiac surgery were randomized to wear the sternum support vest (n=1351) or not (n=1188). Patients were excluded if they underwent a heart transplant, were aged <20 years, had a congenital heart defect, or underwent mechanical reanimation or irradiation of the chest.
Although 933 patients were randomized to wear the vest, 202 patients did not receive it for varying reasons and 216 patients refused it. This tended to happen more often in the early days of the study when patients were unsure about the vest, Gorlitzer said, and he stressed that it is very important to educate patients. "We need to inform them before the operation what is going to happen afterwards--that they have to wear this vest and that it is a little uncomfortable," he explained.
Of the 1188 patients randomized not to receive the vest, 12 patients did get it, Gorlitzer said.
In an intention-to-treat analysis, the rate of the primary end point--deep sternal wound infection--was 1.04% in those who wore the vest compared with 2.27% in those who did not, a relative risk reduction of 56% (p<0.05).
He noted that the vest can be uncomfortable, particularly when patients are lying down, and it can slip up and irritate the neck. The company is now working on a new design, which should improve the comfort and be available in a few months.
Organic Brain Syndrome Also Identified as Predictor of DSWI
Another important study finding was the identification of a new risk factor for DSWI: organic brain syndrome.
Organic brain syndrome occurs in some patients "who have a kind of psychotic episode after deep anesthesia," Gorlitzer explained. "They thrash around a lot and get agitated."
"We already know that diabetes and long duration of surgery can increase the risk of DSWI, but in this study we saw that organic brain syndrome can increase this risk 2.5-fold, something that was not previously appreciated. This is a very important message," said Gorlitzer.
Gorlitzer reports no conflicts of interest.
Sunday, 28 October 2012
Why Does the PSA Velocity Matter?
For many years, physicians have been using the absolute value of PSA to determine a man's risk for prostate cancer or whether his cancer has returned or progressed. In recent years, however, it has become more obvious that the rate of change of the PSA level (or PSA velocity) may be just as important as the raw number itself.
The New Role for PSA Velocity
Many prostate cancer experts now consider not only the PSA level, but how fast it is changing when determining whether to order further tests, when to start treatment, or what to tell their patients about prognosis.Numerous studies have now shown that a high PSA velocity (for example rapid doubling time of PSA or a rise of 0.35 ng/mL or more per year) may signal a rapidly growing cancer regardless of how high the absolute PSA level is.
Here's an example of what I mean:
A man goes for his routine screening PSA test and it comes back at 2.0 ng/mL. He is otherwise healthy and his physician is unconcerned by the result since 2.0 is not a "high" level in most cases. But, last year his PSA level was 1.0 ng/mL and the year before it was 0.5 ng/mL.Should these results worry him or his doctor?
Based on mounting evidence, the answer is likely "yes." In this example, a relatively low PSA level of 2.0 could be waved off as "normal." However, this man's PSA has doubled each year for two years. This is a high rate of change of PSA (such as a high PSA velocity) and could likely signify a rapidly growing cancer.
It is important to keep track of your own PSA levels over the years and alert your doctor to any trends that you notice. Physicians see thousands of patients a year and may simply overlook the fact that your PSA has been increasing rapidly.
Sources:
Carter HB, Ferrucci L, Kettermann A, et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. Journal of the National Cancer Institute 2006; 98(21):1521–1527.
Ng MK, Van As N, Thomas K, et al. Prostate-specific antigen (PSA) kinetics in untreated, localized prostate cancer: PSA velocity vs PSA doubling time. BJU Int. 2008 Oct 16.
Thursday, 25 October 2012
Foods That Cause Man Boobs
The most important thing to take away from this lesson is that you learn the foods that raise estrogen levels.
Don't take the title of this article too literally. Obviously, it's not like you'll eat some obscure food and wake up the next morning with Gynecomastia. Foods that bring on Man Boobs, do so by raising estrogen levels, causing your body to store fat cells behind the nipples and around the breast tissue.
When you're trying to lose man boobs, the whole point is to tone and burn your pectorals, working off that fatty tissue and replacing it with a tighter and more toned chest. If you're eating foods that raise estrogen levels, you'll be unknowingly working against your main goal.
So here I'll be listing the foods that will naturally raise your body's estrogen levels or reduce your body's testosterone levels and make it harder to burn chest fat. These tips not only apply to those with Gynecomastia, but also to those with Pseudogynecomastia because I include fatty foods in the "avoid it" list.
In case you've forgotten what Pseudogynecomastia is, it's Man Boobs caused by an overall excess amount of body fat rather than hormonal imbalances. People with Pseudogynecomastia should still avoid the foods mentioned below while they are on their weight loss regimen. The results will be much faster when you're fueling your body the right way. So without further ado...
Foods that Sabotage a Gynecomastia Diet
Marijuana
Okay, well technically it's not a food, but marijuana will definitely work against you when it comes to burning chest fat. Marijuana has been proven to increase the size of fat cells in men and women.
It also lowers testosterone levels which in effect creates a higher estrogen rich environment in the body. The effect? You guessed it, more fat store creation in the chest and breast area. No good.
Fatty Foods
This is just plain common sense. You shouldn't be munching on salty potato chips and cartons of ice cream. Keep trim and toned and you won't be giving your body any excuses to pack on additional fat.
Don't take the title of this article too literally. Obviously, it's not like you'll eat some obscure food and wake up the next morning with Gynecomastia. Foods that bring on Man Boobs, do so by raising estrogen levels, causing your body to store fat cells behind the nipples and around the breast tissue.
When you're trying to lose man boobs, the whole point is to tone and burn your pectorals, working off that fatty tissue and replacing it with a tighter and more toned chest. If you're eating foods that raise estrogen levels, you'll be unknowingly working against your main goal.
So here I'll be listing the foods that will naturally raise your body's estrogen levels or reduce your body's testosterone levels and make it harder to burn chest fat. These tips not only apply to those with Gynecomastia, but also to those with Pseudogynecomastia because I include fatty foods in the "avoid it" list.
In case you've forgotten what Pseudogynecomastia is, it's Man Boobs caused by an overall excess amount of body fat rather than hormonal imbalances. People with Pseudogynecomastia should still avoid the foods mentioned below while they are on their weight loss regimen. The results will be much faster when you're fueling your body the right way. So without further ado...
Foods that Sabotage a Gynecomastia Diet
Marijuana
Okay, well technically it's not a food, but marijuana will definitely work against you when it comes to burning chest fat. Marijuana has been proven to increase the size of fat cells in men and women.
It also lowers testosterone levels which in effect creates a higher estrogen rich environment in the body. The effect? You guessed it, more fat store creation in the chest and breast area. No good.
Fatty Foods
This is just plain common sense. You shouldn't be munching on salty potato chips and cartons of ice cream. Keep trim and toned and you won't be giving your body any excuses to pack on additional fat.
Understanding Gynecomastia - Cures and Treatments
What is Gynecomastia?
Gynecomastia is the enlargement of breast tissue in males. These are usually benign masses that are located behind the nipple area. The mammary glands will increase in size and proliferation caused by an imbalance of the hormones estrogen and testosterone. Commonly, it will emerge as a male goes through the puberty process, or later in life as hormone levels decrease beyond 50 years of age. Occasionally, the condition will remain throughout adulthood.
Every newborn infant begins life full of the female hormone estrogen from their mother at birth. Typically, this hormonal imbalance will correct itself naturally and the body develops into adulthood normally. However, a significant percent of males will develop what is commonly known as 'Gyno' or "man boobs". The medical term for this condition is called gynecomastia.
The Effects of Gynecomastis
Generally, gynecomastia does not present any major medical problems. However, it can cause a number of very difficult issues in terms of a man's self-esteem and lifestyle. Going through puberty is difficult enough without developing breasts in the locker room. Up to 65 % of 14-year-old boys have enlarged breasts, according to the American Academy of Family Physicians.
Adult males may not partake in activities that involve removing a shirt from embarrassment or shame. Even the most stringent workouts and diets may seem effective everywhere - except the chest. This is a frustrating condition that can interfere with a man living the life he really wants.
Hormonal Imbalance Explained
Androgen are the hormones that create male characteristics, such as hair growth, muscle and bone size, and a deeper voice. Estrogen is the hormone that contribute to female aspects such as breasts. Everyone has some of each in their bodies, it is the levels of hormones that matter.
Simply put, when these hormones are not in proper balance then development in unwanted areas can occur. Gynecomastia develops when a male has a higher ratio of estrogen to androgen than normal.
Cures and Treatments
The longstanding fix for gynecomastia has been ultimately resorting to cosmetic surgery to remove the excess tissue. Male breast reduction surgery is a costly and somewhat risky venture. Beyond that, it doesn't solve the problem and the breasts can resurface because the cause is still there.
Gynecomastia is the enlargement of breast tissue in males. These are usually benign masses that are located behind the nipple area. The mammary glands will increase in size and proliferation caused by an imbalance of the hormones estrogen and testosterone. Commonly, it will emerge as a male goes through the puberty process, or later in life as hormone levels decrease beyond 50 years of age. Occasionally, the condition will remain throughout adulthood.
Every newborn infant begins life full of the female hormone estrogen from their mother at birth. Typically, this hormonal imbalance will correct itself naturally and the body develops into adulthood normally. However, a significant percent of males will develop what is commonly known as 'Gyno' or "man boobs". The medical term for this condition is called gynecomastia.
The Effects of Gynecomastis
Generally, gynecomastia does not present any major medical problems. However, it can cause a number of very difficult issues in terms of a man's self-esteem and lifestyle. Going through puberty is difficult enough without developing breasts in the locker room. Up to 65 % of 14-year-old boys have enlarged breasts, according to the American Academy of Family Physicians.
Adult males may not partake in activities that involve removing a shirt from embarrassment or shame. Even the most stringent workouts and diets may seem effective everywhere - except the chest. This is a frustrating condition that can interfere with a man living the life he really wants.
Hormonal Imbalance Explained
Androgen are the hormones that create male characteristics, such as hair growth, muscle and bone size, and a deeper voice. Estrogen is the hormone that contribute to female aspects such as breasts. Everyone has some of each in their bodies, it is the levels of hormones that matter.
Simply put, when these hormones are not in proper balance then development in unwanted areas can occur. Gynecomastia develops when a male has a higher ratio of estrogen to androgen than normal.
Cures and Treatments
The longstanding fix for gynecomastia has been ultimately resorting to cosmetic surgery to remove the excess tissue. Male breast reduction surgery is a costly and somewhat risky venture. Beyond that, it doesn't solve the problem and the breasts can resurface because the cause is still there.
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