Monday, April 22, 2013
The prevalence of stage 3 CKD was highest among those with the lowest water intake in a cross-sectional analysis of a representative sample of the US population. The link between daily water intake and CKD was only significant for low vs. high intake of plain water (with individuals with a low intake being 2.36-times more likely to have CKD), but not for intake of beverages other than plain water. No association was evident between low water intake and cardiovascular disease. The American Journal of Nephrology analysis included 3427 adults who participated in the 2005-2006 National Health and Nutrition Examination Survey.
Genetic testing did not help predict who will develop type 2 diabetes in a study that tracked health outcomes for more than 15,000 European, South Asian, and Latino individuals over 3.3 years. The researchers looked at whether 16 single genetic changes, or single nucleotide polymorphisms, believed to be related to type 2 diabetes in Caucasians, played a role in the development of the disease for people of other ethnicities. Genetic associations are generally consistent across ethnic groups, and they only added marginal information to clinical factors for predicting who would develop diabetes. The findings are published in Diabetes Care.
Sunday, April 21, 2013
Compared with normal mice, mice genetically engineered to be unable to produce a protein called Epac1 had lower body weights, lower body fat percentages, lower plasma levels of the appetite-suppressing hormone leptin, and better glucose tolerance when fed a high-fat diet. Normal mice treated with an inhibitor of Epac1 had significantly lower levels of leptin in their blood plasma and enhanced leptin signaling in the brain. The Molecular and Cellular Biology findings demonstrate that Epac1 plays an important role in regulating adiposity and energy balance.
Patients diagnosed by electrocardiogram with left anterior fascicular block (LAFB), which involves scarring in a section of the hearts' left ventricle, had a 2.3-fold increased risk of congestive heart failure, an 89% increased risk of atrial fibrillation, and a 57% increased risk of dying over an average follow-up of 15.7 years in a recent JAMA analysis. The analysis included individuals in the Cardiovascular Health Study who were aged 65 years or older and were sampled from Medicare eligibility lists nationwide. Until now, LAFB was considered a benign electrocardiographic finding.
A recent randomized placebo-controlled JASN study of 120 patients with early stage CKD found no benefit to 40 weeks of treatment with the phosphate binder sevelamer carbonate, which is approved only for patients with kidney failure, for reducing heart muscle thickness and decreasing markers of blood vessel stiffness. Because only 56% of patients took more than 80% of the study medication, the subgroup of patients with more than 80% compliance was analyzed separately. Patients in the subgroup who took sevelamer excreted significantly smaller amounts of phosphate in their urine compared with those taking placebo. The sevelamer group also had reduced levels of FGF-23.
The AP (4/19) reports, "Bacteria commonly linked to raw milk and poultry is causing more and more food poisonings, health officials said." Over the past five years, the number of Campylobacter cases "grew by 14 percent," according to a report (pdf) released Thursday by the Centers for Disease Control and Prevention. Although the report, which the CDC refers to as "the nation's annual food safety report card," was "based on foodborne infections in only 10 states" (about 15% of the US population), it is considered to be a "good indicator of food poisoning trends."
The Wall Street Journal (4/19, A3, Tomson, Subscription Publication, 2.29M) adds that the report also showed a 43-percent increase over the 2006-2008 rate of infections from Vibrio bacteria. Last July, cases of Vibrio, which has symptoms similar to cholera, prompted the Food and Drug Administration to issue a consumer warning against eating shellfish from Oyster Bay Harbor in Nassau County, New York. The Journal notes that an FDA spokesperson said the agency is accelerating its efforts to gain jurisdiction over how states implement plans to control for Vibrio contamination.
The Los Angeles Times (4/19, Healy, 692K) "Booster Shots" blog says Vibrio and Campylobacter were "followed distantly by Shigella, Cryptosporidium, Escherichia coli, Vibrio, Yersinia, Listeria and Cyclosporidium," in the report. Of the "15,531 food-borne illnesses reported by the CDC's 10-site surveillance system in 2012, 4,563 resulted in hospitalization and 68 resulted in death." And although "Salmonella killed the largest number of infected patients, Listeria was the most deadly, killing 10.74% of the 121 patients who were infected by it."
In its coverage of the CDC report, Bloomberg News (4/19, Armour) notes that the "Obama administration has been slow to fully enact the 2011 Food Safety Modernization Act, which was supposed to be the most sweeping overhaul of US food safety in 70 years." One of the "two regulatory proposals" the FDA released "Jan. 4 to carry out the core of the food safety act would give companies one year to develop a formal plan for preventing the causes of food illness. The second would force produce farms with a 'high risk' of contamination to develop new hygiene, soil and temperature controls."
The CDC report is also covered by the Denver Post (4/19, Booth, 443K) "Daily Dose" blog, The Packer (4/19, Ohlemeier, 13K),HealthDay (4/19, Preidt), Medscape (4/19, Lewis) and MedPage Today (4/19, Petrochko).
FDA commissioner requests more funding. Reuters (4/19, Clarke) reports Food and Drug Administration Commissioner Margaret Hamburg, MD, asked Congress on Thursday for more funding to enable the agency to improve food safety and importation oversight, as well as to design chemical- and biological-threat countermeasures. During her testimony at a budget hearing yesterday, Dr. Hamburg told a Senate appropriations subcommittee that the FDA is reducing the amount of money allocated to travel expenditures and training to weather some $209 million in Federal sequestration cuts the agency faces. She also noted that the agency is funded in part, through taxpayers but that the bulk of the FDA's money is garnered through the user fees that pharmaceutical companies pay to accelerate new product reviews. Reuters quotes Dr. Hamburg as saying, "FDA is a true bargain among federal agencies."
Poor diet quality and obesity were each associated with a twofold increased risk of microalbuminuria in an American Journal of Kidney Disease study of 2354 adults aged 28 to 40 years without baseline microalbuminuria or an eGFR below 60 mL/min/1.73 m2. During 15 years of follow-up, microalbuminuria developed in 77 participants (3.3%). Individuals with one, two, or three unhealthy lifestyle-related factors (poor diet quality, current smoking, and obesity) had a 2.0, 3.7, and 5.1 times risk of microalbuminuria compared with individuals with no such lifestyle factors. The study results were reported by Renal & Urology News.
Twelve-month results of the prospective, multicenter, randomized trial RENOVA show that dialysis sites can be successfully kept open using stent grafts. In the study, 270 dialysis patients treated for collapsed access sites at 28 US centers were randomized: 138 underwent stent grafts while the remaining 132 had balloon angioplasty. After 1 year, 2.5 times more patients in the stent graft group were able to continue to use their dialysis access grafts than those who were being treated by balloon angioplasty alone (without invasive interim procedures). The results were presented at the Society of Interventional Radiology's 38th Annual Scientific Meeting.
The New York Times (4/17, Strom, Subscription Publication, 1.68M) reports the findings in report by the Environmental Work Group illuminated Federal data that claims over half of "samples of ground turkey, pork chops and ground beef collected from supermarkets for testing by the government contained a bacteria resistant to antibiotics." The 2011 data collected by the National Antimicrobial Resistance Monitoring System, which is jointly run by the FDA, the USDA and the CDC, reveals "a sizable increase in the amount of meat contaminated with antibiotic-resistant forms of bacteria, known as superbugs, like salmonella, E. coli and campylobacter." Dawn Undurraga, the nutritionist for the group, said the study "really raises a question about the antibiotics we are using in raising animals for meat." The Times also mentions the report was partially underwritten by a company that sells organic and antibiotic-free meat.
The Huffington Post (4/16, Tepper) adds, "These microbes are superbug versions of pathogens that, even in their milder forms, have devastating potential, including salmonella, E. coli and Campylobacter jejuni. The EWG report also pointed to other studies that suggest there are concerning levels of pathogens such as Yersinia enterocolitica and Staphylococcus aureus in meat." EWG experts also believe the "boom in superbugs is directly related to the increased use of antibiotics by factory farms."
Forbes (4/16, Hoffman, 928K) reports, "Almost 90 percent of all store bought meat also had signs of normal and resistant Enterococcus faecium – a bacteria that indicates the product came in contact with fecal matter at some point during or after processing." The bacteria are also responsible for 3.6 million cases of food poisoning a year.
When elastin, the protein that helps organs like the heart and lungs expand and contract, is exposed to sugar, it can slow or stop the ferroelectric switch that helps build and support connective tissue. Elastin is the source for ferroelectricity, an electrical property that occurs when a molecule switches from having a positive charge to a negative charge. Sugar's effect on elastin can result in hardening of tissues, according to a study in the journalPhysical Review Letters. The process is similar to glycation, which occurs in the development of diabetes and in aging.
The New York Times (4/15, A10, Fountain, Subscription Publication, 1.68M) reports, "Researchers at Massachusetts General Hospital in Boston have made functioning rat kidneys in the laboratory, a bioengineering achievement that may one day lead to the ability to create replacement organs for people with kidney disease." The researchers "said the rat kidneys produced urine in the laboratory as well as when transplanted into rats."
The Los Angeles Times (4/14, Brown, 692K) "Science Now" blog reports, "The advance could be good news for the 100,000 Americans waiting for donor kidneys for transplant, because it suggests that someday scientists might be able to grow custom-made kidneys for people, using a patient's own cells to seed tissues, said Dr. Harald Ott, a researcher at the Massachusetts General Hospital Center for Regenerative Medicine and senior author of a paper describing the discovery published online Sunday in the journal Nature Medicine."
Bloomberg News (4/15, Lopatto) reports, "Researchers at Massachusetts General Hospital in Boston stripped donor organs of kidney cells with a chemical bath, leaving a physical scaffold behind made up largely of proteins." The scientists "then repopulated the structure with cells from both newborn rats and humans, and allowed the cells to grow in an incubator." Although "the resulting organs weren't as efficient as natural ones, they kept the kidney's physical shape allowing transplant, the study reported."
The Boston Globe (4/15, Johnson, 250K) reports, "Five years ago, Ott described the technique, in a paper with the alluring subtitle, 'using nature's platform to engineer a bioartificial heart.'" When Ott was "a research fellow at the University of Minnesota, he had discovered that flushing a rat's heart with a detergent, such as one found in shampoo, could remove the living cells from the organ and leave behind a collagen matrix."
Scientists from the World Health Organization identified the uncontrolled use of pesticides and fertilizers as the cause of CKD affecting an estimated 450,000 individuals in Sri Lanka. Researchers noted abnormal levels of pesticide residues in samples from 31.6% of patients with CKD who were examined. The tests revealed the presence of high amounts of arsenic, lead, and cadmium. Asreported by SciDevNet, the cause of the high prevalence of the disease has been a mystery until now because of the absence of hypertension, diabetes, and/or kidney damage in the Sri Lankan patients with CKD.
Saturday, April 13, 2013
New research suggests that central body fat distribution, independent of BMI, is linked with an unfavorable pattern of kidney measures that could underlie increased kidney risks reported in observational studies. A JASN study of 315 healthy individuals with an average BMI of 24.9 kg/m2 (normal weight range BMI 18.5–24.9 kg/m2) found people with apple-shaped bodies tended to have lower kidney function, lower kidney blood flow, and higher blood pressure within the kidneys than people with pear-shaped bodies –even after adjusting for sex, age, mean arterial pressure, and BMI.
The ABC News (4/11, Mohney) "Medical Unit" blog reports, "New parents can be overwhelmed taking care of a newborn, but one birth consultant thinks one way to help parents cope is by literally not cutting the cord." According to the blog, "Mary Ceallaigh, a birth consultant and doula from Austin, Texas, is preaching the benefits of 'umbilical nonseverance' which involves letting the umbilical cord fall off naturally after birth." Meanwhile, "Dr. James Van Hook, director of Maternal Fetal Medicine at the University of Cincinnati Medical Center, says if doctors momentarily delay clamping the umbilical cord there is a chance that newborns can get a final transfusion of blood cells rich in stem cells and immunoglobulin that theoretically can help the infant fight off infections."
In continuing coverage, several national sources report the death count for China's H7N9 outbreak has reached 10, with 38 confirmed infections. Two articles published in the New England Journal of Medicine also discuss the symptoms of the virus and the difficulty of producing and distributing a vaccine for the strain. As in the past, researchers reiterate there is no evidence of human-to-human transmission.
USA Today (4/12, Weise, 1.71M) reports that US health agencies are mobilizing to combat a "new, highly virulent flu strain" that has infected 38 people in China and killed 10. USA Today notes, "This week, the Centers for Disease Control and Prevention activated its Emergency Operations Center at Level II, the second-highest level of alert. The last time that happened was during the Fukushima nuclear disaster after the Japanese tsunami in 2011." USA Today adds, "There have been no cases of the new flu reported outside China."
The New York Times (4/12, A6, Grady, Subscription Publication, 1.68M) reports, "A report on three of the first patients in China to contract a new strain of bird flu paints a grim portrait of severe pneumonia, septic shock and other complications that damaged the brain, kidney and other organs. All three died." The report, "by a team of researchers from China, was published Thursday in The New England Journal of Medicine along with a commentary from American health officials, who said the disease 'raises many urgent questions and global public health concerns.'"
The Los Angeles Times (4/11, Brown, 692K) reports the researchers wrote the "similarities between avian flus and the new virus may support the possibility that people catch the new H7N9 from birds and not from other people." However, the team also "found changes in the H7N9 viral genes that have made past flus more virulent in people." They noted, "Severe avian influenza A [H7N9] infections, characterized by high fever and severe respiratory symptoms, may pose a serious human health risk."
The Wall Street Journal (4/12, McKay, Subscription Publication, 2.29M) reports the scientists for the CDC wrote in a second article published in the New England Journal of Medicine Thursday that it would be difficult to create a vaccine for the H7N9 flu strain. The scientists note in the report that they are unsure if the new flu is localized to a few cases or is the case of a pandemic. They note it would also take months to produce and distribute the vaccine. In the meantime, they seek increased surveillance on people on animals in China to see if the virus is capable of human-to-human transmission.
Reuters (4/12, Steenhuysen) reports government researchers are currently started testing a "seed" strain of the virus in hopes of getting a jump on making a flu vaccine. This faster approach is the result of the Federal government collaborating with vaccine maker Novartis and unit of the J. Craig Venter Institute, which took a part of the virus' genetic code to develop a formula to create the virus from scratch. It is estimate that using this method reduced two months off the process of making the vaccine.
Bloomberg News (4/12, Gale) notes the description of the fatal illness for a 52-year-old Shanghai woman was detailed by doctors at Huashan Hospital in Shanghai in the journal Emerging Microbes & Infections. "Her illness, the first H7N9 avian influenza case to be described in a medical journal, highlights the seriousness of the new strain, which has sickened at least 38 people in eastern China, killing 10, in the past two months." The report noted the woman experienced an "early high fever" that reached "as high as 40.6 degrees Celsius (105.1 Fahrenheit)." Following several days, "she developed a cough, tightness in her chest and difficulty breathing. A chest X-ray showed severe pneumonitis and she was given antibiotics. Her condition worsened and a week after her symptoms began, she was hospitalized for acute respiratory distress syndrome and died the next day."
Forbes (4/11, Flannary, 928K) reports, "In Thailand yesterday, an official from the Food and Agriculture Organization at the United Nations expressed concern about the possible spread of the disease beyond China's borders, the Shanghai Daily also reported." The organization has also initiated "surveillance programs in Myanmar, Laos and Vietnam."
The Boston Globe (4/12, Kotz, 250K) reports in its "Daily Dose" blog that "the US Food and Drug Administration issued a harsh warning on Thursday against energy drinks and supplements containing dimethylamylamine (DMAA) telling consumers to stay away from it while adding that the agency was 'using all available tools at its disposal' to ensure that it's no longer sold on the marketplace." The American Academy of Pediatrics has said that over a third of kids consume energy drinks. "It's time for the FDA to crack down on these drink makers and for the FTC to investigate advertising practices of these companies to ensure that kids and parents are not being subjected to deceptive marketing practices," said Massachusetts Congressman and Senate candidate Edward Markey. The FDA has been attempting to more clearly distinguish between energy beverages and dietary supplements for the past four years.
In a preview of Friday night's upcoming broadcast, NBC News Rock Center (4/12, Klein, Specter, Taylor, 4.13M) adds that a supplement called Jack3d has gained popularity among some fitness enthusiasts for its use of 1,3 dimethylamylamine, or DMAA, which the FDA says is illegal. "The FDA has received 86 adverse event reports believed to be linked to DMAA," but Dr. Daniel Fabricant, director of the division of dietary supplements programs at the FDA, says banning it would be difficult. "We don't have pre-market approval…we don't evaluate [dietary supplement] products for safety or efficacy prior to them going to market," he stated. DMAA is even available at local retailers like GNC.
Friday, April 12, 2013
Research reveals that vascular calcifying progenitor cells in blood vessels can become either osteoblasts (which promote calcium accumulation) or osteoclasts (which reverse calcium accumulation), and that a drug can push these cells towards becoming osteoclasts instead of osteoblasts. Progenitor cells expressing both Sca-1 and PDGFRα cell surface proteins could differentiate into osteoblasts, while cells expressing only Sca-1 could differentiate into osteoblasts or osteoclasts. PPARγ agonists could coax progenitor cells that express only Sca-1 to become osteoclast-like, while they could not influence progenitors expressing both proteins. The PLOS Biology findings suggest new targets for reversing calcium accumulation in blood vessels.
At birth, individuals in the United States have a 59.1% overall lifetime risk of CKD stages 3a or higher, a 33.6% risk of developing CKD stage 3b or higher, an 11.5% risk of developing CKD stage 4 or higher, and a 3.6% overall lifetime risk of developing ESRD. Women have a greater CKD risk but a lower ESRD risk than men, and blacks of both sexes have higher risks of CKD stage 4 or higher than whites. The estimates, which are published in the American Journal of Kidney Diseases, are based on findings from a simulation study.
A component of egg whites – a peptide called RVPSL – helped lower blood pressure in laboratory rats with hypertension. The peptide is known to inhibit angiotensin-converting enzyme, like many medications prescribed to lower blood pressure. The short-term antihypertensive effect of RVPSL administered at a dose of 50 mg/kg body weight was comparable to Captopril at a 10 mg/kg body weight dose. The findings were presented at the American Chemical Society National Meeting.
A free Web-based tool can help to quantify a particular patient's risk of accepting a deceased-donor kidney that may have been infected by hepatitis C, compared with waiting for a better organ. In a new American Journal of Transplantation study, researchers used the tool to show that there are some types of patients for whom a survival benefit outweighs the risks of accepting a possibly infected organ. The investigators pooled data from published papers and national databases of patients and took various factors into account to come up with their model.
An analysis of 10,705 patients with hypertension validates the usual systolic blood pressure target of less than 140 mm Hg. Only 5% of patients who achieved this target experienced major cardiovascular events over 35.7 months vs. 7.6% of those whose readings remained at or above 140 mm Hg. This amounted to a 38% reduction in risk. Reducing readings to within the 10 mm Hg range below 130 mm Hg did not provide additional benefits. The American Journal of Medicine study found stroke benefits at levels less than 120 mm Hg, but they were offset by increased coronary events.
The combination of an angiotensin-converting enzyme inhibitor and a histone deacetylase inhibitor could maximally reverse the disease-associated expression of genes in the kidneys of a mouse model of HIV-associated nephropathy. The combination of these two inhibitors had an additive renoprotective effect by reducing proteinuria, improving kidney function, and attenuating kidney injury. The treatment also led to expected changes in the expression of certain disease-associated genes. The findings, published in the Journal of the American Society of Nephrology, suggest that this combination could have therapeutic potential for various kidney diseases.
The AP (4/9) reports that a Food and Drug Administration announcement Monday, "means a new version" of Bendectin (doxylamine, dicyclomine and pyridoxine), is "set to return to US pharmacies" under the brand name Diclegis (doxylamine succinate and pyridoxine hydrochloride), as a "safe and effective treatment" for morning sickness, or pregnancy-related nausea. At the time when lawsuits involving Bendectin began, the FDA "continued to call the drug safe; appeals courts ruled in favor of Bendectin maker Merrell Dow Pharmaceuticals; and eventually a US Supreme Court decision would render continuing suits unlikely." But in 1983, Merrell Dow stopped producing Bendectin, citing the high litigation costs as the reason. Diclegis, which is manufactured by the privately held Canadian company Duchesnay Inc., is expected to be available on the US market in the beginning of June.
Reuters (4/9, Clarke, Berkrot) adds that in a statement announcing the FDA approval, the Blainville, Quebec-based drug maker noted that doxylamine is a common ingredient in many antihistamines that are available over-the-counter and pyroxidine is vitamin B6. A generic version of Diclegis - Diclectin (doxylamine 10 mg/pyridoxine 10 mg delayed-release) - has been available in Canada for the past 30 years.