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About one in four women who have tested positive for the human immunodeficiency virus (HIV) expect pregnancy and motherhood to be a part of their future, according to research from Ohio State University. A woman’s age at the time she learns of her HIV status appears to influence this decision. Women who learned of their HIV infection when they were under age 30 were almost four times more likely to say they wanted to become pregnant than were women who were over 30 when they learned they had HIV. The findings, published in the journal AIDS and Behavior, point to a need for clinicians to be aware that women with HIV might be struggling with decisions about motherhood—a relatively new phenomenon accompanying the increase in HIV-positive women of childbearing age and the longer survival rates among patients who receive treatment. In 2005, 29.5 percent of all new reported HIV infections and 27 percent of new AIDS cases in the United States were among women, according to the Centers for Disease Control and Prevention. That’s up from 20 years ago, when only 5 percent of new AIDS cases were reported in women.

 

STROKE: INCREASED INCIDENCE IN CHINA LINKED TO ECONOMIC PROSPERITY
A side effect of economic prosperity may be an increased risk of the most common type of strokes, researchers from China report in Stroke: Journal of the American Heart Association. In the study, the rate of blood clot-caused (ischemic) strokes in China increased by almost 9 percent per year between 1984 and 2004. However, despite an overall increase in the stroke rate, the risk of dying from a stroke decreased. The changes in the stroke rate and stroke mortality occurred during a time of rapid economic development and growth in China that greatly changed people’s lifestyles and healthcare, the researchers from Capital Medical University in Beijing said. The researchers noted that the rate of smoking, a major stroke risk factor, changed very little during the two-decade span. But other risk factors, such as obesity and high cholesterol, rose with the increased consumption of fat and cholesterol during the study period. Total fat intake in the study area increased to 97.4g/day in 2002 from 88.1g/day in 1983. Average blood cholesterol levels increased by 24 percent from 1984 to 1999. In addition, the prevalence rate of diabetes increased by 97 percent from 1994 to 2002 and the number of obese people in China increased by 13 percent in urban areas and by 85 percent in rural areas. These factors may have contributed to the transition in stroke rate and mortality.

 

A study from the University of Michigan Health System finds that obese children are much more likely than normal-weight children to have problems with airway obstruction and other breathing-related functions during surgery. Obese children were found to have a higher rate of difficult mask ventilation, airway obstruction, major oxygen desaturation (a decrease in oxygen in the patient’s blood), and other airway problems. The study, published in the journal Anesthesiology, reported that in addition to the problems the obese patients experienced during surgery, they also had a higher rate of illnesses and conditions including asthma, hypertension, sleep apnea, and Type II diabetes. These conditions all can contribute to problems during surgery.

 

STROKE: CONDITION MORE PREVALENT IN THE UNITED STATES THAN IN EUROPE
American adults have a higher prevalence of stroke than their European counterparts, due in part to a higher rate of stroke risk factors among Americans and barriers to care in the United States, according to a study presented at the American Stroke Association’s International Stroke Conference 2008. Compared to European men, U.S. men had 61 percent higher odds of having a stroke and U.S. women had almost twice the odds of stroke as European women, according to researchers from the Erasmus Medical Center in Rotterdam, The Netherlands. Most of this gap is among lower-income people—poor Americans who were much more likely to have had a stroke than poor Europeans. The gap in stroke prevalence is less marked between rich Americans and rich Europeans, the researchers reported. The age-adjusted prevalence rate of stroke varied considerably across countries. It was highest in the United States and lowest in the Mediterranean countries of Spain, Italy and Greece, as well as Switzerland. The researchers said that the higher prevalence of stroke in the United States and the lower stroke prevalence in Mediterranean populations may be due in part to cross-country differences in risk factors and to barriers to care in the United States.

 

The Wisconsin Alumni Research Foundation has been notified of the United States Patent and Trademark Office’s decision to uphold the claims of one of its key stem cell patents, the non-profit foundation said. The decision affects the patent for primate and human embryonic stem cells known as “913.” The decision to uphold the patent is the first in a review process that began in October 2006, when the patent office agreed to re-examine the patents following challenges brought by the New York-based Public Patent Foundation and the California-based Foundation for Taxpayer and Consumer Rights. Decisions on two other patents challenged by the groups are still pending.

 

An international research team headed by scientists at the University of Bonn has succeeded in identifying a gene that is responsible for a rare hereditary form of hair loss known as Hypotrichosis simplex. The scientists are the first to identify a receptor that plays a role in hair growth. They now hope that their research findings will lead to new therapies that will work with various forms of hair loss. The study, published in the online edition of Nature Genetics, may lead to an understanding of the mechanisms of hair growth. The genetic defect identified by the researchers prevents certain receptor structures on the surface of hair follicle cells from being correctly formed. It has been found that when messengers from outside bind to these receptors they trigger a chain reaction in the cell interior that is apparently needed for the hair follicle to function normally. The existence of a receptor that plays a specific role in hair growth was previously unknown to scientists.

 

A single change in a protein may play a role in whether someone develops Parkinson’s disease, according to researchers at the University of Florida Genetics Institute. In an article published in the Proceedings of the National Academy of Sciences, that they discovered that a protein commonly found in brain cells can be toxic if—at one pinpoint location in its amino acid structure—it lacks a chemical compound called a phosphate. When scientists used gene therapy to simulate a phosphate at this critical position in a rats, the rats’ brain cells didn’t develop the Parkinson-like pathology that would normally occur. They said the finding provides new insight into the fundamentals of Parkinson’s disease and the role of an abundant yet mysterious brain protein known as alpha-synuclein, which is believed to help brain cells communicate but may have a more sinister role in the development of neurological diseases.

Researchers have reported finding a new blood biomarker that enables close to 98 percent accuracy in predicting the spread of prostate cancer to regional lymph nodes. The study, published in the journal Clinical Cancer Research, used a new blood test to measure levels of endoglin, a plasma biomarker that has been previously shown to predict the spread of colon and breast cancer. When the University of Texas Southwestern Medical Center researchers added endoglin levels to their usual methods of prediction, the accuracy improved to 97.8 percent from 89.4 percent without endoglin. Blood levels of endoglin may allow doctors to predict the risk of cancer spread at an earlier stage and with higher accuracy than currently available methods, the researchers said.

PERSONALIZED MEDICINE: PROTEIN INDICATES TUMOR RESPONSE TO CHEMOTHERAPY

A technique that specifically “tags” tumors responding to chemotherapy may offer a new strategy for determining a cancer treatment’s effectiveness within days of starting treatment, according to researchers at Vanderbilt-Ingram Cancer Center. In a study published online in Nature Medicine, the researchers report the identification of a small protein that specifically recognizes tumors responding to chemotherapy. They show that the protein, when tagged with a light-emitting molecule, can be used to visualize cancer response in mice just two days after starting therapy. Improved monitoring of tumor response could help customize patient treatment and also speed up the development of new cancer drugs, the researchers said. Currently it takes two to three months to determine whether a therapy is effective for a patient. This research points to a means of quickly determining if a therapy is not effective so a patient can switch to an alternative therapy. The method detected response in a wide range of tumors—brain, lung, colon, prostate, and breast.

 

Overweight Hispanic children with normal blood-glucose levels showed elevated markers for blood vessel inflammation that may predispose them to developing both type 2 diabetes and cardiovascular disease, according to researchers from the Joslin Diabetes Center. The study, published in the journal Diabetes Care, is the first to focus on Hispanic children, already known to be at high risk for developing type 2 diabetes as a result of both genetic and lifestyle factors. The study looked at 38 Hispanic children and adolescents, ages 10 through 18. Twenty-one were obese but with normal blood-glucose levels, so they had not yet developed diabetes. The rest were considered lean. As a group, the obese subjects had significantly higher percentages of body fat than the lean group and were already showing signs insulin resistance. Overall, the obese group exhibited increased blood markers for subclinical or asymptomatic inflammation of the inner layer of blood vessels. Subclinical vascular inflammation is a key element in the development of cardiovascular disease and is closely associated with insulin resistance. It also predicts the development of type 2 diabetes.

HEART FAILURE: CASES CONTINUE TO RISE, BUT FALL AMONG THE VERY ELDERLY

A study from Duke University Medical Center finds that while the number of heart failure cases continues to rise overall, it is declining among the very elderly. The study, published in the Archives of Internal Medicine, found the incidence of heart failure fell most sharply among those aged 80 to 84 years old, from 57.5 to 48.4 per 1,000 person-years. At the same time, it rose from 17.5 cases to 19.3 cases per 1,000 person-years among those aged 65 to 69 years old. The study also found that the total number of Americans living with heart failure steadily increased over the ten-year study period, to 200,000 from about 140,000. Nearly 5 million people in the United States suffer from heart failure, and even though mortality from the disease has fallen slightly, it remains a very serious problem. Nearly a third of those diagnosed with heart failure will die within one year.

 

Acne patients who are highly anxious about their skin condition say they are less likely to participate in sport or exercise, according to researchers at the University of Bath in the United Kingdom. The study, published in the Journal of Health Psychology, involved 50 young to middle-aged adults recruited from a national acne support group. As well as saying that they were less likely to participate in sport or exercise, acne sufferers who perceived their skin to be negatively evaluated by others also experienced lower self-esteem and a poorer quality of life. This pattern was similar in both men and women. The researchers said that dermatological social anxiety is often overlooked in studies on motivation for sport and exercise in favor of physical inhibitions. The researchers said the finding will help develop new ways to encourage acne sufferers to stay more physically active.

 

PERSONALIZED MEDICINE: CUSTOMIZED TREATMENTS FOR SEPSIS REDUCE ICU STAY
Using a blood test and a decision algorithm, rather than standard hospital protocols, to determine the appropriate length of antibiotic therapy in patients with severe sepsis or septic shock can reduce duration of treatments, shorten ICU stays, and lower hospital costs—all without adverse effects on patients, according to researchers at the University Hospital in Geneva. The researchers, who published their findings in the American Journal of Respiratory and Clinical Care Medicine, said they have shown that it’s possible to customize antibiotic treatment duration in patients with septicemia based on a reliable and robust blood test. The study was the first randomized clinical trial in which a surrogate biochemical parameter was used to reduce the duration of antibiotic therapy in a population of critically ill patients admitted to the ICU for severe sepsis and septic shock.

 

A protein that stimulates blood vessel growth worsens ovarian cancer, but its production can be stifled by a tiny bit of RNA wrapped in a fatty nanoparticle, according to a research team led by scientists at the University of Texas M. D. Anderson Cancer Center. In a report in the Journal of the National Cancer Institute, the researchers report that the protein interleukin-8 (IL-8) is a potential therapeutic target in ovarian cancer. They showed high IL-8 expression in tumors is associated with advanced tumor stage and earlier death for ovarian cancer patients. Lab experiments and research in a mouse model show that short interfering RNA (siRNA) can cut IL-8 expression, reducing tumor size by attacking its blood supply. Interleukin-8 is overexpressed in many types of cancer and has previously been shown to promote tumor growth, new blood vessel growth known as angiogenesis, and metastasis, the spread of cancer to other organs.

HEART ATTACK AND STROKE: ASPIRIN MAY NOT HELP MANY PATIENTS

Up to 20 percent of patients taking aspirin to lower the risk of suffering a second cerebrovascular event do not have an antiplatelet response from aspirin, the effect thought to produce the protective effect, researchers at the University at Buffalo have shown. They said there is no definitive data on the frequency of this condition, known as aspirin resistance, but physicians were left with a best guess of between 5 percent and 50 percent. The study, published online in the Journal of Clinical Pharmacology, confirmed the figure is actually 20 percent through a strictly controlled study conducted over 29 months in 653 consecutive stroke patients seen at Dent Neurologic Institute offices in the Buffalo suburbs Amherst and Orchard Park.

Older Americans with the highest risk of stroke, but who have never suffered a stroke, also have the highest rate of cognitive decline, researchers at the American Stroke Association’s International Stroke Conference 2008 reported. Researchers from the University of Alabama in Birmingham said they found that people at high risk of stroke decline twice as fast as people considered at low risk. The researchers correlated the stroke risks of more than 17,000 patients with the results from a simple cognitive test and found the stroke risk scores tracked closely with the average age-, race-, and gender-adjusted annual cognitive decline. The participants were an average age of 65.9 and had average systolic blood pressure of 127.9.  Fifty-six percent of them had hypertension; 19.3 percent had diabetes, 21.9 percent suffered from heart disease; 6.5 percent had left ventricular hypertrophy, and 13.1 percent smoked. The higher your stroke risk score, the researchers said, the greater the cognitive decline.

Vitamin supplements do not protect against lung cancer, according to a study of more than 77,000 vitamin users. In fact, some supplements may even increase the risk of developing it, according to researchers at the University of Washington in Seattle. The study of supplemental multivitamins, vitamin C, vitamin E, and folate did not show any evidence for a decreased risk of lung cancer, the researchers said in an article published in the American Journal of Respiratory and Critical Care Medicine, but did show that increasing intake of supplemental vitamin E was associated with a slightly increased risk of lung cancer. The researchers said their findings have broad public health implications, given the large population of current and former smokers and the widespread use of vitamin supplements.

 

Taking the supplement ginkgo biloba had no clear-cut benefit on the risk of developing memory problems, according to a study published in the February 27, 2008, online issue of the journal Neurology. The three-year study involved 118 people age 85 and older with no memory problems. Half of the participants took ginkgo biloba extract three times a day and half took a placebo. During the study, 21 people developed mild memory problems, or questionable dementia: 14 of those took the placebo and seven took the ginkgo extract. Although there was a trend favoring ginkgo, the difference between those who took gingko versus the placebo was not statistically significant, the researchers said.

When the researchers took into account whether people followed directions in taking the study pills, they found that people who reliably took the supplement had a 68 percent lower risk of developing mild memory problems than those who took the placebo. The study also found that people taking ginkgo biloba were more likely to have a stroke or transient ischemic attack, or mini-stroke. Seven people taking ginkgo had strokes, while none of those taking placebo did. The researchers said further study is needed to determine whether gingko biloba has any benefits in preventing cognitive decline and whether it is safe.

 

Researchers at the European Society of Cardiology said there has been a 15 percent decrease in admissions of patients with myocardial infarction to emergency wards since a public ban on smoking came into effect in restaurants, hotels, and casinos in France in January. Similar results were published in Italy earlier this month by the Environmental Health Authority: researchers in Rome found an 11.2 percent reduction of acute coronary events since the January 2005 smoking ban took effect in Italy. The European Society of Cardiology researchers said while further studies are needed to confirm the strong decrease in smoking-related deaths over time, they argue the statistics show the same trend already observed in Italy, Ireland, and Scotland when these countries introduced their own bans on tobacco.

Patients who prefer to be highly involved in their treatment don't necessarily have better success managing chronic health conditions, according to a study from Veterans Affairs Iowa City Health Care System and the University of Iowa. The researchers surveyed 189 veterans with high blood pressure to determine their preferences for involvement in their healthcare. They found those who wanted an active role in their treatment had higher blood pressure and cholesterol over a 12-month span than those who wanted a less active role. The findings, published in the Annals of Behavioral Medicine, run counter to intuitive assumptions. Patients who preferred the most active role averaged a blood pressure of 141 over 79 and a low-density lipoprotein (LDL) cholesterol level of 112, while those who preferred the least active role averaged a blood pressure of 137 over 72 and an LDL of 92. The researchers speculate that one explanation is that patients who wanted an active role were dissatisfied with the relatively passive treatment of taking medication to control their conditions, and therefore may not have followed doctors' orders as well.

 

Canadian women diagnosed with early breast cancer lose, on average, more than a quarter of their income during the first 12 months after their diagnosis, according to a study published online in the Journal of the National Cancer Institute. Although a number of studies have assessed the economic impact of breast cancer on the healthcare system, few studies have examined the financial impact of the disease on patients and their families. The study, from researchers at Laval University in Quebec City, found that women lost 27 percent of the wages they would have earned in the 12 months following their diagnosis had they not been ill, even after all other forms of compensation had been taken into account. Ten percent of the women lost more than two-thirds of their income. The percentage of annual wages lost varied considerably in the study population. The women who were more likely to suffer large wage losses were less educated, lived farther from the hospital where they underwent treatment, had more serious disease, had less social support, required chemotherapy, or were self-employed, worked part-time or were recently hired at their current job.

Doubt has been cast over the current practice of administering intensive insulin therapy to all critically ill patients, according to a study published this week in the open access journal Critical Care. In certain groups of patients it could even be harmful, researchers from Harborview Medical Center and the University of Washington in Seattle report. This therapy is used widely in hospitals around the world, yet only one randomized, controlled trial showing unequivocal benefit has been published—and this trial focused mainly on patients who had undergone cardiac surgery. The researchers found that intensive insulin therapy in a mixed cohort of critically ill patients was not associated with a reduction in hospital mortality, but rather was associated with increased ICU and hospital mortality in some subgroups. The results, combined with data from the most recently concluded randomized trials, they said, suggest that broad use of intensive insulin therapy may be premature, and that additional randomized trials in diverse groups of critically ill patients is needed.