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News 27 april 2009

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New doctors, teaching physicians disagree about essential medical procedures to learn

Physicians teaching at medical schools and doctors who have just completed their first year out of medical school disagree about which procedures are necessary to learn before graduating, according to a new survey done by researchers at Wake Forest University School of Medicine. Participating physicians were asked to rate 31 basic clinical procedures – from throat culture to spinal tap – based on their importance in the first year after graduation from medical school. Faculty physicians rated 14 procedures as "must know," while new physicians agreed on only six of those 14 clinical procedures and placed five additional, completely different procedures in the "must know" category. The results of the survey appear in the most recent issue of Medical Teacher, a peer-reviewed publication. The authors say the results are understandable, given that the medical school curriculum often is based on experience, not structured evaluation. "Like a lot of clinical education in most medical schools, the third and fourth years are learning by doing – taking care of real patients," said Michael T. Fitch, M.D., Ph.D., the lead author of the paper and an assistant professor of emergency medicine at the School of Medicine. "So, the procedures the patients need end up being the ones students learn." Interestingly, Fitch said, the procedures rated as "must know" by new doctors were more invasive – spinal taps, incisions and drainage, intubation and inserting a central line, for example, than the more basic procedures identified as "must know" by the experienced, faculty physicians. The study states that many of the procedures where disagreement occurred are minimally invasive procedures such as drawing blood, which is frequently completed by non-physician staff in many institutions – a fact that may explain why new physicians felt that it was not essential to have known how to complete those procedures during internship.

Study Suggests Buddhist Deity Meditation Temporarily Augments Visuospatial Abilities

Meditation has been practiced for centuries, as a way to calm the soul and bring about inner peace. According to a new study in Psychological Science, a journal of the Association for Psychological Science, there is now evidence that a specific method of meditation may temporarily boost our visuospatial abilities (for example, the ability to retain an image in visual memory for a long time). That is, the meditation allows practitioners to access a heightened state of visual-spatial awareness that lasts for a limited period of time. Normally when we see something, it is kept in our visual short-term memory for only a brief amount of time (images will begin to fade in a matter of seconds). However, there have been reports of Buddhist monks who have exceptional imagery skills and are able to maintain complex images in their visual short-term memory for minutes, and sometimes even hours. Led by psychologist Maria Kozhevnikov of George Mason University, a team of researchers investigated the effects of different styles of Buddhist meditation on visuospatial skills. The researchers focused on two styles of meditation: Deity Yoga (DY) and Open Presence (OP). During DY meditation, the practitioner focuses intently on an image of deity and his or her entourage. This requires coming up with an immensely detailed, three-dimensional image of the deity, and also focusing on the deity's emotions and environment. In contrast, practitioners of OP meditation believe that pure awareness cannot be achieved by focusing on a specific image and therefore, they attempt to evenly distribute their attention while meditating, without dwelling on or analyzing any experiences, images, or thoughts that may arise.

Diminuendo – New Mouse Model for Understanding Cause of Progressive Hearing Loss

Scientists of Helmholtz Zentrum München have developed a new mouse model that can be associated with deafness. With this model they succeeded for the first time in showing that microRNA, a new class of genes, influences hearing loss. The respective microRNA seed region influences the production of sensory hair cells in the inner ear, both in the mouse and in humans. The findings have been published ahead of print in the current online issue of Nature Genetics. This study represents a major step forward in elucidating the common phenomenon of progressive hearing loss, opening up new avenues for treatment. Scientists of Helmholtz Zentrum München, led by Professor Martin Hrabé de Angelis, director of the Institute of Experimental Genetics, have developed a new mouse model with a genetic mutant in which a single base of a specific microRNA seed region has been altered. Mice carrying this miR-96 mutation suffer progressive hearing loss as they get older. Moreover, if they carry two of these mutants, their sensory hair cells are impaired from birth on. A number of genes associated with hearing loss were already known. "However, we were very surprised when with our new mouse model we discovered this new class of genes –microRNA – as genetic cause for this clinical picture," explained Dr. Helmut Fuchs, who conceived the idea of this mouse model and who is scientific -technical head of the German Mouse Clinic at Helmholtz Zentrum München.

Different treatment options in chronic coronary artery disease

Sometimes cardiologists and cardiac surgeons can agree! There is often disagreement between the professions of cardiology and cardiac surgery about the proper therapy for coronary artery disease (CAD)—and this can harm the patient. In the current edition of Deutsches Ärzteblatt International, an interdisciplinary team of authors consisting of cardiologists and cardiac surgeons provides answers to the question of when a bypass operation (ACB) and when percutaneous coronary intervention (PCI) is effective (Dtsch Arztebl Int 2009; 106(15): 253-61). Martin Russ, Jochen Cremer and coauthors show that ACB and PCI are of equivalent value and can be placed in a complementary treatment plan. The authors not only consider the results of randomized controlled studies, but extend their overview to the analyses of registries, which provide complementary data.

AUA counters mainstream recommendations with new best practice statement on PSA testing

The American Urological Association (AUA) today issued new clinical guidance – which directly contrasts recent recommendations issued by other major groups – about prostate cancer screening, asserting that the prostate-specific antigen (PSA) test should be offered to well-informed, men aged 40 years or older who have a life expectancy of at least 10 years. The PSA test, as well as how it is used to guide patient care (e.g., at what age men should begin regular testing, intervals at which the test should be repeated, at what point a biopsy is necessary) is highly controversial; however, the AUA believes that, when offered and interpreted appropriately the PSA test may provide essential information for the diagnosis, pre-treatment staging or risk assessment and post-treatment monitoring of prostate cancer. The new Best Practice Statement updates the AUA's previous guidance, which was issued in 2000. Major changes to the AUA statement include new recommendations about who should be considered for PSA testing, as well as when a biopsy is indicated following an abnormal PSA reading. According to the AUA, early detection and risk assessment of prostate cancer should be offered to well-informed men 40 years of age or older who have a life expectancy of at least 10 years. The future risk of prostate cancer is closely related to a man's PSA score; a baseline PSA level above the median for age 40 is a strong predictor of prostate cancer. Such testing may not only allow for earlier detection of more curable cancers, but may also allow for more efficient, less frequent testing. Men who wish to be screened for prostate cancer should have both a PSA test and a digital rectal exam (DRE). The Statement also notes that other factors such as family history, age, overall health and ethnicity should be combined with the results of PSA testing and physical examination in order to better determine the risk of prostate cancer. The Statement recommends that the benefits and risks of screening of prostate cancer should be discussed including the risk of over-detection, detecting some cancers which may not need immediate treatment "The single most important message of this statement is that prostate cancer testing is an individual decision that patients of any age should make in conjunction with their physicians and urologists. There is no single standard that applies to all men, nor should there be at this time," Dr. Carroll said. He also notes that the "panel carefully reviewed the most recently reported trials of PSA testing in both the United States and Europe before finalizing their guidelines. The strengths and limitations of these trials are reviewed in the guideline."

Obesity associated with higer risk for urinary tract infections

As body mass increases, so does a patient’s risk of urinary tract infection (UTI), according to Baltimore researchers. A new study, presented at the 104th Annual Scientific Meeting of the American Urological Association (AUA) assesses and stratifies this risk. Researchers evaluated insurance claims of 95,962 subjects over a five year period (from 2002 through 2006) to identify whether obesity is associated with a UTI diagnosis. The results show that, as BMI increased, the odds of being diagnosed with a UTI increased as well. This association was strongest for morbidly obese patients. “The effect of the obesity epidemic in the United States transcends any one medical specialty or condition,” said Anthony Y. Smith, MD, an AUA spokesman. “Patients with elevated body mass index should be vigilant about urologic health because even the most simple of urinary tract infections can be deadly if left untreated.”

Early brain activity sheds new light on the neural basis of reading

Most people are expert readers, but it is something of an enigma that our brain can achieve expertise in such a recent cultural invention, which lies at the interface between vision and language. Given that the first alphabetic scripts are thought to have been invented only around four to five thousand years it is unlikely that enough time has elapsed to allow the evolution of specialized parts of the brain for reading. While neuroimaging techniques have made some progress in understanding the neural underpinning of this essentially cultural skill, the exact unfolding of brain activity has remained elusive. Now, a better understanding of the brain basis of reading has been reported in research published in the open-access, peer-reviewed journal PLoS ONE. The research was led by Piers Cornelissen, Morten Kringelbach, Ian Holliday and Peter Hansen from the Universities of York, Oxford, Aston, and Birmingham UK, and was funded by the Wellcome Trust. The authors showed very early interactions between the vision and language domains during reading, with the speech motor areas of the brain (inferior frontal gyrus) being active at the same time (after a seventh of a second) as the orthographic word-form is being resolved within a brain region called the fusiform gyrus. This finding challenges the conventional view of a temporally serial processing sequence for reading in which letter forms are initially decoded, interact with their phonological and semantic representations, and only then gain access to a speech code. This finding has a potentially important clinical application in relation to developmental dyslexia (affecting between 15-30 million people in the US alone) and those with acquired reading disabilities through injury or disease. A better understanding of normal reading processes could potentially help these individuals.

New study overturns orthodoxy on how macrophages kill bacteria

For decades, microbiologists assumed that macrophages, immune cells that can engulf and poison bacteria and other pathogens, killed microbes by damaging their DNA. A new study from the University of Illinois disproves that. The study, published in the journal PLoS ONE, shows that macrophages focus their most potent poisons, known as reactive oxygen species (ROS), on targets outside the cytoplasm. Macrophages are voracious eaters that "swallow" cellular debris and invading organisms. They kill microbes with ROS. All aerobic cells inadvertently produce ROS that can, if left unchecked, damage DNA and other cellular components and cause cell death. Bacteria and animal cells contain special enzymes, called superoxide dismutases, which neutralize an important ROS, called superoxide. Macrophages have harnessed these lethal compounds, dumping large quantities of superoxide onto engulfed bacteria to kill them. Although macrophages direct ROS against invading bacteria, Salmonella typhimurium, the microbe used in the study, is adept at evading these defenses. The most virulent strains of S. typhimurium can survive and even propagate inside macrophages, eventually emerging to infect more cells. "It's been assumed that reactive oxygen species kill the bacteria by going into the cytoplasm and causing DNA damage," said medical microbiology professor James Slauch, who led the study. "You can find this idea over and over again in review articles and many immunological textbooks, but with no real data to back it up."

'Autoantibodies' may be created in response to bacterial DNA

Autoimmune diseases have long been regarded as illnesses in which the immune system creates autoantibodies to attack the body itself. But, researchers at the California non-profit Autoimmunity Research Foundation (ARF) explain that the antibodies observed in autoimmune disease actually result from alteration of human genes and gene products by hidden bacteria. Not long ago, scientists believed they had located all bacteria capable of causing human disease, But DNA discoveries in the last decade have led the NIH Human Microbiome Project to now estimate that as many as 90% of cells in the body are bacterial in origin. Many of these bacteria, which have yet to be named and characterized, have been implicated in the progression of autoimmune disease. In a paper published in Autoimmunity Reviews, the ARF team, under the guidance of Professor Trevor Marshall of Murdoch University, Western Australia, has explained how Homo sapiens must now be viewed as a superorganism in which a plethora of bacterial genomes – a metagenome – work in concert with our own. Marshall and team contend that the human genome can no longer be studied in isolation. "When analyzing a genetic pathway, we must study how bacterial and human genes interact, in order to fully understand any process related to the human superorganism," states Marshall. "Especially since some of these pathways contribute to the pathogenesis of autoimmune disease." For example, the team notes that the single gene ACE has an impact on myocardial infarction, renal tubular dysgenesis, Alzheimer's, the progression of SARS, diabetes mellitus, and sarcoidosis, yet recently ACE has been shown to be affected by the common species Lactobacillus and Bifidobacteria. Found in yogurt, these species are often considered to be innocuous or "friendly." "No one would argue that these species aren't present in the human body, yet there has been inadequate study of how these 'friendly' species affect disease," states Amy Proal, the paper's lead author. "What we thought were autoantibodies generated against the body itself can now be understood as antibodies directed against the hidden bacteria," states Marshall. "In autoimmune disease, the immune system is not attacking itself. It is protecting the body from pathogens."

Autism may be linked to being firstborn, breech births or moms 35 or older

Children who are firstborn or breech or whose mothers are 35 or older when giving birth are at significantly greater risk for developing an autism spectrum disorder, University of Utah School of Medicine researchers have reported in a new study with Utah children. In the April 27, 2009, online issue of the journal Pediatrics, the researchers showed that women who give birth at 35 or older are 1.7 times more likely to have a child with an autism spectrum disorder (ASD), compared with women between the ages of 20-34. Children diagnosed with ASD also were nearly 1.8 times more likely to be the firstborn child, the researchers found. Although they didn't identify a causal relationship between breech births and autism, children diagnosed with the disorder were more than twice as likely to have been a breech presentation, meaning they were not born head first. "The results of this study give us an opportunity to look more closely at these risk factors for children across the autism spectrum, and not only those diagnosed with autism," said first author Deborah A. Bilder, M.D., assistant professor of psychiatry. "This shows that further investigation of the influence of prenatal factors is warranted." Autism is a complex brain disorder that impairs social, communicative, and behavioral development and often is characterized by extreme behavior.

Inadequate sleep leads to behavioral problems

A recent Finnish study suggests that children's short sleep duration even without sleeping difficulties increases the risk for behavioral symptoms of ADHD. During the recent decades, sleep duration has decreased in many countries; in the United States a third of children are estimated to suffer from inadequate sleep. It has been hypothesised that sleep deprivation may manifest in children as behavioral symptoms rather than as tiredness, but only few studies have investigated this hypothesis. The researchers at the University of Helsinki and National Institute of Health and Welfare, Finland, examined whether decreased sleep leads to behavioral problems similar to those exhibited by children with attention-deficit/hyperactivity disorder (ADHD). 280 healthy children (146 girls and 134 boys) participated in the study. The researchers tracked the children's sleep using parental reporting as well as actigraphs, or devices worn on the wrist to monitor sleep. The children whose average sleep duration as measured by actigraphs was shorter than 7.7 hours had a higher hyperactivity and impulsivity score and a higher ADHD total score, but similar inattention score than those sleeping for a longer time. In multivariate statistical models, short sleep duration remained a statistically significant predictor of hyperactivity and impulsivity, and sleeping difficulties were associated with hyperactivity, impulsivity and inattention. There were no significant interactions between short sleep and sleeping difficulties. "We were able to show that short sleep duration and sleeping difficulties are related to behavioral symptoms of ADHD, and we also showed that short sleep, per se, increases behavioral symptoms, regardless of the presence of sleeping difficulties", says researcher Juulia Paavonen, MD, PhD. "The findings suggest that maintaining adequate sleep schedules among children is likely to be important in preventing behavioral symptoms. However, even though inadequate sleep seems to owe potential to impair behaviour and performance, intervention studies are needed to confirm the causality," Paavonen continues.

Packard/Stanford study suggests two causes for bowel disease in infants

New research from Lucile Packard Children's Hospital and the Stanford University School of Medicine is helping physicians unravel the cause of a deadly and mysterious bowel disease that strikes medically fragile newborn babies. The findings could lead to a better understanding of the disease and its medical management, and also shed light on the causes of sepsis, a major killer of children and young adults.
The bowel disorder, necrotizing enterocolitis, or NEC, is seen mainly among premature infants, affecting about one in every 2,000 births. A similar constellation of symptoms, also labeled NEC, is also seen in children born with congenital heart defects. The disease causes massive intestinal inflammation and impairs nutrient uptake. Complications can include perforation of the intestine and widespread infection of the abdominal cavity or blood — sepsis — as well as lasting consequences such as the need for bowel transplant or chronic intravenous feeding. The findings, which will appear in the May issue of the journal Pediatrics, suggest that the diagnosis of NEC in premature infants versus those with heart disease may actually encompass two distinct disease processes with different origins. "If we start accepting that we are looking at two different diseases, further research may be able to elucidate some differences in the disease process and help us tailor management," said senior study author Sanjeev Dutta, MD, assistant professor of surgery and pediatrics at Packard Children's and the School of Medicine. Right now, because physicians have such a poor understanding of what causes the disease, they can't tell which infants will be hardest hit, Dutta said. "At present, we're managing all cases the same way without addressing the concept that the child with heart disease may have a different underlying cause of NEC than the child with prematurity alone. We're giving support, but not really curing the disease." To gain insight into how necrotizing enterocolitis starts, Dutta and his collaborators investigated whether a pre-existing medical problem — congenital heart defects — affected the course of the disease. They reviewed medical records from 76 infants who had a congenital heart defect together with necrotizing enterocolitis and 126 infants who had necrotizing enterocolitis alone. All study subjects were patients at Packard Children's between May 1999 and August 2007. The researchers found that babies who had both necrotizing enterocolitis and a congenital heart defect fared better than those who had necrotizing enterocolitis alone. Even premature babies with heart defects did better than those who were premature alone. Babies who had heart defects were less likely than other affected infants to suffer intestinal perforation or abnormal narrowing of the bowel. They also were less likely to need surgery to resolve infection, to require an artificial drain through the abdominal wall for managing bowel perforation or to require removal of portions of diseased intestine. The findings suggest that infants with heart defects may be getting the disorder because of reduced blood flow to the bowel, while those with normal hearts may get the disease for other reasons, such as a bad reaction to oral feeding in premature infants with an underdeveloped gut. Both poor blood flow and gut immaturity have been blamed for NEC before, but the relative importance of each factor has been unclear.

Brain works best when cells keep right rhythms, new Stanford study suggests

It is said that each of us marches to the beat of a different drum, but new Stanford University research suggests that brain cells need to follow specific rhythms that must be kept for proper brain functioning. These rhythms don’t appear to be working correctly in such diseases as schizophrenia and autism, and now two papers published online by the journals Nature and Science demonstrate that precisely tuning the oscillation frequencies of certain neurons can affect how the brain processes information and implements feelings of reward. “A unifying theme here is that of brain rhythms and ‘arrhythmias’,” said Karl Deisseroth, MD, PhD, associate professor of bioengineering and of psychiatry and behavioral sciences and senior author of both papers. An arrhythmia is what cardiologists call a seriously irregular heartbeat. The new findings suggest that, like the cells that keep the beat of the heart (or the coxswain on a rowing team that calls out the rhythm of the strokes), certain brain cells can orchestrate oscillations that ultimately help govern behavior of other cells that are guided by those rhythms.

Prostate cancer therapy increases risk of fractures and cardiovascular-related death

Prostate cancer patients who undergo therapy to decrease testosterone levels increase their risk of developing bone- and heart-related side effects compared to patients who do not take these medications, according to a new analysis. Published in the June 1, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study indicates that preventive measures and careful scrutiny of patients' health can keep men from experiencing these potentially serious consequences. While medical treatments that decrease testosterone levels—called androgen deprivation therapy (ADT)—are important and effective therapies for men with prostate cancer, they can cause a variety of side effects including skeletal and cardiovascular complications, sexual dysfunction, periodontal disease, and mood disorders. Bone and heart complications are among the most serious side effects associated with ADT, but the actual risk patients have of developing these effects is unknown. Lockwood Taylor, MPH, of the University of Texas Health Science Center and colleagues conducted a study to assess this risk by analyzing all of the literature related to side effects from ADT published between 1996 and mid-2008. They found 14 studies (8 bone-related, 6 heart-related) that were suitable for analysis. The researchers' review revealed that men treated with ADT for prostate cancer had an increased risk of bone fractures and heart-related death, although the absolute risk for both was still low. For bone fractures, there was a 23 percent increased risk compared to prostate cancer patients who did not undergo the treatment. The absolute risk of fracture among ADT-exposed men was still only 7.2 per 100 person years. For heart-related death, the increased risk among ADT-exposed men was 17 percent higher compared to other prostate cancer patients. However, because the baseline risk is low, the increase translated to an additional one-to-two deaths per 1,000 men who received ADT. Two large studies also documented significant increases in diabetes risk associated with the therapy. "While the absolute risks of fracture and cardiovascular mortality are low among men treated with androgen deprivation therapy, preventive treatments may further reduce the risk of these serious adverse outcomes related to androgen deprivation therapy," the authors wrote. They also noted that because some patients may benefit from this therapy more than others, physicians should consider each patient's overall health and prostate cancer status when weighing treatment options.

Whiter laundry and a surprising new treatment for kids' eczema

It's best known for whitening a load of laundry. But now simple household bleach has a surprising new role: an effective treatment for kids' chronic eczema. Chronic, severe eczema can mar a childhood. The skin disorder starts with red, itchy, inflamed skin that often becomes crusty and raw from scratching. The eczema disturbs kids' sleep, alters their appearance and affects their concentration in school. The itching is so bad kids may break the skin from scratching and get chronic skin infections that are difficult to treat, especially from methicillin-resistant Staphylococcus aureus (MRSA). Researchers from the Northwestern University Feinberg School of Medicine have discovered powerful relief in the form of diluted beach baths. It's a cheap, simple and safe treatment that drastically improves the rash as well as reduces flare-ups of eczema, which affects 17 percent of school-age children. The study found giving pediatric patients with moderate or severe eczema (atopic dermatitis) diluted bleach baths decreased signs of infection and improved the severity and extent of the eczema on their bodies. That translates into less scratching, fewer infections and a higher quality of life for these children. The typical treatment of oral and topical antibiotics increases the risk of bacterial resistance, something doctors try to avoid, especially in children. Bleach kills the bacteria but doesn't have the same risk of creating bacterial resistance. Patients on the bleach baths had a reduction in eczema severity that was five times greater than those treated with placebos over one to three months, said Amy S. Paller, M.D., the Walter J. Hamlin Professor and chair of dermatology, and professor of pediatrics, at the Feinberg School. Paller also is an attending physician at Children's Memorial Hospital.

Building the lymphatic drainage system

Our bodies' tissues need continuous irrigation and drainage. Blood vessels feeding the tissues bring in the fluids, and drainage occurs via the lymphatic system. While much is known about how blood vessels are built, the same was not true for lymph vessels. Now though, Norrmén et al. have identified two of the lead engineers that direct drainage construction in the mouse embryo. The engineers are the transcription factors, Foxc2 and NFATc1. Foxc2 had been implicated in lymph vessel development already, but Norrmén and colleagues have now found that the factor specifically regulates a late stage of lymph development when large, valve-containing vessels arise from more primitive capillaries. The study will be published online April 27 (www.jcb.org) and will appear in the May 4 print issue of the Journal of Cell Biology. Foxc2 built the lymph vessel valves with the help of NFATc1, which was a known heart valve engineer. Norrmén and colleagues also showed that Foxc2 and NFATc1 physically interact and that many DNA binding sites for the two transcription factors are closely linked. This latter finding generated a long list of target genes that might be controlled by the two factors. The team now plans to investigate these targets as well as to work out the upstream molecular pathways controlling Foxc2 and NFATc1. Whatever the mechanisms, if the team can show that Foxc2 and NFATc1 also prompt lymph vessel regeneration in adults, boosting these factors could help patients with lymph drainage problems – including those that have suffered extensive tissue injuries, or have had lymph nodes removed as part of cancer treatment.

Scientists discover how to improve immune response to cancer at Princess Margaret Hospital

A team of scientists at The Campbell Family Institute for Breast Cancer Research (CFIBCR) at Princess Margaret Hospital and international collaborators have discovered how to trigger an improved immune response to cancer that could be included in new clinical trials that use a patient's own cells to destroy tumours. The findings, published online today in Nature Medicine (DOI 10.1038/nm.1953), demonstrate the tantalizing potential of immunotherapy in cancer treatment, says principal investigator Dr. Pamela Ohashi, co-director, CFIBCR. In the lab study, the scientists combined interleukin-7 (IL-7) – a key component of the immune system – with a viral vaccine to improve the ability of the cells of the immune system to attack tumours. The result was clear: The combination boosted immunity to tumours. "We are extremely excited because our research has revealed the unexpected ways IL-7 works to break down barriers that naturally block the immune response to tumours. This is important because current vaccine approaches for immune therapy induce a response in just 1% to 3% of patients," says Dr. Ohashi, a senior scientist in signaling biology who holds a Canada Research Chair in Autoimmunity and Tumour Immunity. She is also a Professor, University of Toronto, in the Department of Medical Biophysics and Immunology. " Dr. Tak Mak, co-author and CFIBCR director, says: "The promise of using the body's own defenses to fight cancer is enormous. The day is coming when immunotherapy may help spare cancer patients the toxic side effects of traditional therapies and greatly improve their quality of life while treating the disease. This is why we are planning to expand our immunotherapy research program at PMH." Dr. Mak is also a Professor, University of Toronto, in the Department of Medical Biophysics and Immunology.

Drinking diet soda may reduce the risk of forming kidney stones

Patients with stone disease could benefit from drinking diet soda. New research from the University of California, San Francisco suggests that the citrate and malate content in commonly consumed sodas may be sufficient to inhibit the development of calcium stones. The study was presented at the 104th Annual Scientific Meeting of the American Urological Association (AUA). Increased alkalinity is proven to augment citraturia, a known factor for calcium stones. Malate increases the amount of alkali delivered. Researchers measured the citrate and malate content of 15 popular diet sodas. The researchers found that Diet Sunkist Orange contained the greatest amount of total alkali and Diet 7-Up had the greatest amount of citrate as alkali. "This study by no means suggests that patients with recurrent kidney stones should trade in their water bottles for soda cans," said Anthony Y. Smith, MD, an AUA spokesman. "However, this study suggests instead that patients with stone disease who do not drink soda may benefit from moderate consumption."

Long-term complications of melamine consumption in children

Children with a history of consuming melamine-contaminated milk powder are at an increased risk of developing kidney stones and other urological complications. Researchers presenting two studies at the 104th Annual Scientific Meeting of the American Urological Association (AUA) found that melamine calculus occurred mostly in infants at six months to 18 months after consuming melamine-contaminated milk powder after birth but that the stones could be effectively managed with noninvasive treatment. In the first study, researchers analyzed the clinical data of 50 young children with double kidney stones who had a history of consuming melamine-contaminated milk powder. Researchers studied ultrasound images from each child, measuring kidney stone size, number, shape and location. Eighty-five percent of these cases occurred in children ages six to 18 months. Of these 50 children, 42 formed kidney stones in both kidneys; multiple stones were found in 18 children; and single stones were found in nine of them. Eleven children experienced kidney failure, in which the stone diameters of bilateral kidneys were significantly larger than those who did not experience kidney failure. In 21 cases, the stone was passed after non-operative hospital treatment in an average of eight days. Researchers in the second study analyzed the clinical data of 165 infants, aged 50 days to three years, with urinary stones who had a history of consuming melamine-contaminated milk powder. The children were divided into mild (25 cases), moderate (122 cases) and severe (18 cases) groups. Researchers found that the peak incidence of urolithiasis (urinary stones) was found in children aged six months to 12 months. Of these patients, 50.3 percent were asymptomatic, 16.9 percent experienced dysuria (painful urination), 14.6 percent had infantile colic, 10.9 percent experienced oliguria or anuria (decreased urine and absence of urine, respectively) and 7.3 percent had hematuria (blood in the urine). Acute urinary retention (the sudden inability to urinate) caused by urethral stones was found in five cases. The stone diameter ranged from 22mm to 16mm, and 63.5 percent of cases had 4-10 mm stones. All cases accepted non-operative treatment, except those cases with a bilateral stone and obstruction. After hospital treatment, the stone expulsion rate was 43 percent. "This study presents us with the long-term complications for children who had been fed with melamine contaminated products," said Anthony Atala, MD, an AUA spokesman. "Both parents and physicians should be vigilant of these signs and symptoms in children who may have consumed the contaminated milk powder."

Men treated for localized prostate cancer could benefit from pomegranate juice consumption

Pomegranate juice may slow the progression of post-treatment prostate cancer recurrence, according to new long-term research results being presented at the 104th Annual Scientific Meeting of the American Urological Association (AUA). Researchers found that men who have undergone treatment for localized prostate cancer could benefit from drinking pomegranate juice. The two-stage clinical trial followed a total of 48 participants over six years. Eligible participants had a rising PSA after surgery or radiotherapy, a PSA greater than 0.2 ng/ml and less than 5 ng/ml and a Gleason score of 7 or less. These patients were treated by drinking eight ounces of pomegranate juice daily. Currently, in the sixth year of treatment, active patients who remain on the study have a median total follow-up of 56 months. These participants continue to experience a significant increase in PSA doubling time following treatment, from a mean of 15.4 months at baseline to 60 months post-treatment, with a median PSA slope decrease of 60 percent, 0.06 to 0.024. Researchers compared active patients, who remain on the study, with non-active patients, who no longer remain on the study. Though these two groups demonstrated similar mean PSA doubling times at baseline, both the PSA doubling time prolongation and the decline in median PSA slope were greater in active patients when compared to non-active patients. "This study suggests that pomegranate juice may effectively slow the progression of prostate cancer after unsuccessful treatment," said Christopher Amling, MD, an AUA spokesman. "This finding and other ongoing research might one day reveal that pomegranate juice is an effective prostate cancer preventative agent as well." Parts of this ongoing study suggest that some patients may be more sensitive to the effects of pomegranate juice on PSA doubling time. Phase three of this study is currently underway to further evaluate the benefits of pomegranate juice in a placebo-controlled manner.