Addicts’ Vulnerability to Drugs Linked to Family Ties in Study
The brains of addicts and their healthy siblings are different than those of unrelated, healthy volunteers, a study has found, suggesting vulnerability to drug dependency may be partly inherited. The aberrations were found in brain scans on 150 subjects. They exist in areas thought to govern self-control and habit- formation, the researchers said. Having a family member with an addiction raised the odds of becoming dependent about eightfold, said Karen Ersche, a researcher at the University of Cambridge in the U.K. and the study’s lead author.

Malaria deaths hugely underestimated - Lancet study
The research, published in the British medical journal the Lancet, suggests 1.24 million people died from the mosquito-borne disease in 2010.This compares to a World Health Organisation (WHO) estimate for 2010 of 655,000 deaths.But both the new study and the WHO indicate global death rates are now falling.The research was funded by the Bill and Melinda Gates Foundation.

tPA OK for 'Wake-Up' Strokes
 Patients who wake up with stroke symptoms that weren't present when they fell asleep can safely receive thrombolytic treatment with tissue plasminogen activator (tPA), even though the stroke onset time is unknown, a British study suggested.

Severe, Rapid Memory Loss Could Herald Stroke
Severe, rapid memory loss may be linked to, and might possibly predict, a future fatal stroke, Harvard researchers report. Steven Greenberg, MD, professor of neurology at Harvard Medical School, Boston, moderated the press briefing here and commented on the study. "The accepted dogma in many circles is that memory loss has nothing to do with blood vessels, and that 'it's all Alzheimer's disease,' but that dogma has been turned on its head in the past 10 years," he told reporters here.

Ursodeoxycholic Acid in Patients With Chronic Heart Failure
Endothelial dysfunction is commonly observed in patients with CHF, and it contributes to the limitation in exercise capacity that accompanies this condition. Bacterial lipopolysaccharide may trigger proinflammatory cytokine release and promote further endothelial dysfunction. UDCA, a bile acid used in the treatment of cholestatic liver disease, has anti-inflammatory and cytoprotective properties and may contribute to the formation of mixed micelles around lipopolysaccharide. These properties may help to improve peripheral blood flow in patients with CHF. This study sought to assess the effects of ursodeoxycholic acid (UDCA) on endothelial function and inflammatory markers in patients with chronic heart failure (CHF) and found that UDCA is well tolerated in patients with CHF and improves peripheral blood flow and is associated with improved markers of liver function. 

Bilateral subtotal thyroidectomy versus total thyroidectomy for Graves' disease
The extent of thyroid resection in Graves' disease remains controversial. The aim of this study was to evaluate long-term results of bilateral subtotal thyroidectomy (BST) compared with total thyroidectomy (TT) in patients with Graves' disease and mild active ophthalmopathy. Overall it was shown that TT for Graves' disease prevented recurrent hyperthyroidism but did not prevent the progression of ophthalmopathy compared with BST. 

Big BP Variation Between Arms Raises Red Flag
Differences in systolic blood pressure (SBP) of 10 mm Hg or more or 15 mm Hg or more between arms have been associated with peripheral vascular disease and attributed to subclavian stenosis. The authors investigated whether an association exists between this difference and central or peripheral vascular disease, and mortality. They found that a difference in SBP of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death.

Local administration of glucocorticoids decrease synovial citrullination in rheumatoid arthritis
Protein citrullination is present in the rheumatoid synovium, presumably contributing to the perpetuation of chronic inflammation in the presence of specific autoimmunity. As a result, the present study examined and found that effective anti rheumatic treatment will decrease the level of synovial citrullination with glucocorticoids which decrease synovial inflammation by decreasing the level of citrullination.

Pfizer Wins U.S. FDA Approval for Advanced Kidney-Cancer Treatment Inlyta
Pfizer Inc. (PFE), the world’s biggest drugmaker, won U.S. clearance to sell a new medicine for advanced kidney cancer in patients who have failed prior treatments. The Food and Drug Administration approved the drug, Inlyta, after concluding it helps prevent the cancer from progressing, the agency said today in a statement. Inlyta, known chemically as axitinib, worked better than Nexavar in a comparative study of 723 patients who had failed one prior therapy. Those treated with Inlyta lived a median of 6.7 months before their tumors got worse, two months longer than patients who received Nexavar, the FDA said.

Head/Neck Cancer Treatments Less Effective in HIV Patients
Definitive radiation therapy with or without chemotherapy was less tolerated and less effective in HIV-positive patients with head and neck squamous cell carcinoma than in HIV-negative patients in a single-institution retrospective study of 71 HIV-positive patients.

Postoperative adhesion prevention using a statin-containing cellulose film in an experimental model
Intraperitoneal adhesions are a common problem in abdominal surgery. The aim of this study was to compare the effectiveness of Statofilm, a novel antiadhesive film based on cross-linked carboxymethylcellulose and atorvastatin, with that of sodium hyaluronate–carboxymethylcellulose (Seprafilm®) in the prevention of postoperative intraperitoneal adhesions in rats. Overall the data suggest that the newly developed adhesion barrier Statofilm has better results than Seprafilm® in preventing postoperative adhesions in rats. A low-dose atorvastatin-containing film, such as Statofilm, could be evaluated for future clinical application.

Above Which Blood Pressure Level Does the Risk of Atrial Fibrillation Increase?
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, occurs in 1% to 2% of the general population,1 and its incidence is growing. Mostly because of the progressive aging of the population, the prevalence of AF is expected to double over the next 50 years. Hypertension is a well-known modifiable risk factor for AF, although it is unclear above which blood pressure (BP) level the risk of AF definitely increases and, even more important, which target BP level should be pursued to reduce the risk of AF in treated hypertensive patients. This article showed that in this population based, case-control study of 433 patients with incident AF and 899 controls, the risk of AF doubled in participants with systolic BP ≥150 mm Hg.

Aortic Event Rate in the Marfan Population
Optimal management, including timing of surgery, remains debated in Marfan syndrome because of a lack of data on aortic risk associated with this disease. This database was used to evaluate aortic risk associated with standardized care. Overall it was found that the risk of sudden death or aortic dissection remains low in patients with Marfan syndrome and aortic diameter between 45 and 49 mm. Aortic diameter of 50 mm appears to be a reasonable threshold for prophylactic surgery.

Milk Powder Cuts Gout Flares
Daily consumption of enriched skim milk powder could help prevent gout flares, a proof-of-concept study suggested. Compared with patients randomized to receive control treatment with simple powdered lactose, those given enriched skim milk powder had greater reductions in flares of gout during a three-month period (P=0.044), according to Nicola Dalbeth, MD, of the University of Auckland in New Zealand, and colleagues.

Antifungals with Warfarin pose greatest bleeding risk in elderly
Antibiotic medications are associated with an increased risk of bleeding among patients receiving warfarin. The recent availability of data from the Medicare Part D prescription drug program provides an opportunity to assess the association of antibiotic medications and the risk of bleeding in a national population of older adults receiving warfarin. This was a case-control study nested within a cohort of 38,762 patients aged 65 years and older who were continuous warfarin users. Exposure to any antibiotic agent within the 15 days of the event/index date was associated with an increased risk of bleeding (aOR 2.01; 95% CI, 1.62-2.50). All 6 specific antibiotic drug classes examined (azole antifungals [aOR, 4.57; 95% CI, 1.90-11.03], macrolides [aOR, 1.86; 95% CI, 1.08-3.21], quinolones [aOR, 1.69; 95% CI, 1.09-2.62], cotrimoxazole [aOR, 2.70; 95% CI, 1.46-5.05], penicillins [aOR, 1.92; 95% CI, 1.21-2.07], and cephalosporins [aOR, 2.45; 95% CI, 1.52-3.95]) were associated with an increased risk of bleeding.

Pulmonary hypertension predicts all-cause mortality in patients with heart failure
The presence of pulmonary hypertension (PH) in left ventricular systolic dysfunction (LVSD) and symptomatic heart failure is an ominous sign. There are insufficient data regarding the risk conferred by increasing severity of PH in patients with heart failure. This study found that  Pulmonary hypertension predicted all-cause mortality in a heterogeneous group of patients with heart failure. Each 5 mmHg rise in RVSP was associated with a 6% increased risk of death.

High Doses of Vitamin D to Reduce Exacerbations in Chronic Obstructive Pulmonary Disease
Low serum 25-hydroxyvitamin D (25-[OH]D) levels have been associated with lower FEV1, impaired immunologic control, and increased airway inflammation. Because many patients with chronic obstructive pulmonary disease (COPD) have vitamin D deficiency, effects of vitamin D supplementation may extend beyond preventing osteoporosis. This article explored whether supplementation with high doses of vitamin D could reduce the incidence of COPD exacerbations. Overall High-dose vitamin D supplementation in a sample of patients with COPD did not reduce the incidence of exacerbations. In participants with severe vitamin D deficiency at baseline, supplementation may reduce exacerbations.

High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality
This article sought to test the potential value of more frequent QT interval measurement in hospitalized patients through a prospective, observational study. In this study a corrected QT interval >500 msecs was considered prolonged. This article found QT prolongation to be common (24%), with Torsade de Pointes representing 6% of in-hospital cardiac arrests. Predictors of QT prolongation in the acutely ill population are similar to those previously identified in ambulatory populations. Acutely ill patients with QT prolongation have longer lengths of hospitalization and nearly three times the odds for mortality then those without QT prolongation.

Outcomes of Mild Therapeutic Hypothermia After In-Hospital Cardiac Arrest
Although the benefits of mild therapeutic hypothermia (MTH) in selected patients after out-of-hospital cardiac arrest have been consistently demonstrated, no controlled trial of MTH in selected patients after in-hospital cardiac arrest (IHCA) has been published. This article sought to assess the benefit of MTH after IHCA in patients meeting our institutions IHCA MTH inclusion criteria. Overall it found no difference in neurological outcome at discharge was detected in predominantly non-shockable IHCA patients treated with MTH. This finding, if confirmed with further study, may define a population of patients for whom this costly and resource intensive therapy should be withheld.

New Analysis Challenges Tamiflu Efficacy
A new review of the influenza drug oseltamivir (Tamiflu) has raised questions about both the efficacy of the medication and the commitment of its maker to supply enough data for claims about the drug to be evaluated by independent experts. It also raises questions about the entire process of systematic review.

More, Faster Weight Loss Seen With Gastric Bypass Than Banding
Gastric bypass surgery results in faster and longer-lasting weight loss than does gastric banding, according to a new study by Swiss investigators. A gastric bypass operation called Roux-en-Y involves reducing stomach size with staples and connecting the smaller "pouch" directly to the small intestine.

The Impact of Tiotropium on Mortality 
Tiotropium has been shown to improve lung function, quality of life, and exacerbations and reduce mortality when compared with placebo in COPD. It remains unclear whether benefits are seen when tiotropium is used in conjunction with inhaled corticosteroids (ICSs) plus long-acting β-agonists (LABAs). This study suggests that the addition of tiotropium to ICSs and LABA therapy may confer benefits in reducing all-cause mortality, hospital admissions, and oral corticosteroid bursts in patients with COPD. Triple therapy is widely used in the real-life management of COPD, with only limited scientific support. The study supports the use of triple therapy in COPD and provides a platform for randomized controlled trials specifically addressing this topic.

Influence of Season on Exacerbation Characteristics in Patients With COPD
Patients with COPD experience more frequent exacerbations in the winter. However, little is known about the impact of the seasons on exacerbation characteristics. This study followed 307 patients in the London COPD cohort from 1995-2009 and found that exacerbations are more severe between November and February. This contributes to the increased morbidity during the winter seasons.

Effect of Aspirin on Vascular and Nonvascular Outcomes
The net benefit of aspirin in prevention of CVD and nonvascular events remains unclear. The authors objective was to assess the impact (and safety) of aspirin on vascular and nonvascular outcomes in primary prevention. It was found that despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.

Increased Risk of Multiple Sclerosis after Traumatic Brain Injury
The etiology of multiple sclerosis (MS) is still not well known. Previous data show conflicting results regarding the association between MS and prior brain trauma. This study aimed to investigate the risk for MS following a traumatic brain injury (TBI) using a large-scale cohort study design and it found that patients with TBI are at higher risk for subsequent MS over a 6-year follow-up period.

Supplemental Oxygen Therapy in Medical Emergencies
In a review of earlier research, they found no support for routinely giving critically ill patients high-dose oxygen, a common practice among paramedics and emergency physicians. "There is not a single study that points to beneficial effects," said Dr. Yvo Smulders, a professor at VU University Medical Center in Amsterdam. "All of the evidence that we found points to detrimental effects."

Nicotine treatment of mild cognitive impairment
The authos of this article sought to assess the safety and efficacy of transdermal nicotine therapy on cognitive performance and clinical status in subjects with mild cognitive impairment (MCI). This study demonstrated that transdermal nicotine can be safely administered to nonsmoking subjects with MCI over 6 months with improvement in primary and secondary cognitive measures of attention, memory, and mental processing, but not in ratings of clinician-rated global impression. This authors conclude that this initial study provides evidence for nicotine-induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies.

Stroke Mimics and Intravenous Thrombolysis
The necessity for rapid administration of intravenous thrombolysis in patients with acute ischemic stroke may lead to treatment of patients with conditions mimicking stroke. This article analyzed stroke patients treated with intravenous thrombolysis in our center to characterize cases classified as stroke mimics. It was found that Stroke mimics were infrequent among intravenous thrombolysis–treated stroke patients in this cohort, and their treatment did not lead to harmful complications.

Association Between Marijuana Exposure and Pulmonary Function Over 20 Years
Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear. This article analyzed the associations between marijuana (both current and lifetime exposure) and pulmonary function and found that  occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.

Overtreatment of Enterococcal Bacteriuria: Less is More
The purposes of this study were to investigate the clinical outcomes of enterococcal bacteriuria and to determine whether current management is adherent to Infectious Diseases Society of America guidelines. This article found that providers often overtreat enterococcal ABU with antibiotics, particularly in patients with pyuria. Given the low incidence of infectious complications, efforts should be made to optimize the use of antibiotics in enterococcal bacteriuria.

Study Offers Clues to Why Some Don't Benefit From Asthma Drugs
Almost half of patients with mild or moderate asthma may have a different type of disease than those with more severe symptoms, perhaps explaining why common treatments don't work well for them, new research suggests. "We are beginning to understand that different 'flavors' of asthma probably have different molecular mechanisms," said Dr. John Fahy, director of the Airway Clinical Research Center at the University of California, San Francisco. He is the senior author of the new study, published online Friday in the American Journal of Respiratory and Critical Care Medicine.

ACR Appropriateness Criteria Released
The ACR Appropriateness Criteria® are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. By employing these guidelines, providers enhance quality of care and contribute to the most efficacious use of radiology. The guidelines are developed by expert panels in diagnostic imaging, interventional radiology, and radiation oncology. Each panel includes leaders in radiology and other specialties. There are 175 topics with over 850 variants in the December 2011 version.

Risperidone: Better Mania Control in Kids, but at a Price
Twice as many children and adolescents with bipolar I mania responded to first-line treatment with risperidone than with lithium or divalproex, data from a randomized trial showed. Risperidone treatment led to a response rate of 68.5% as compared with 35.6% for lithium and 24.0% with divalproex.  However, the improved response rate came at a cost of significantly more metabolic disturbances in the risperidone group, investigators reported online in Archives of General Psychiatry.

Daily Aspirin Tied to Age Related Macular Degenertation
Daily aspirin use may protect the heart but hurt the eyes, boosting the risk of age-related macular degeneration (AMD), researchers found. Late-stage "wet" AMD was 2.22 times more likely among daily aspirin users (95% CI 1.61 to 3.05) in a population-based study led by Paulus T.V.M. de Jong, MD, PhD, of the Netherlands Institute for Neuroscience and the Academic Medical Center, both in Amsterdam.

Cancer rates in U.S. keep falling
Cancer death rates are continuing to fall, dropping by 1.8 percent per year in men and 1.6 percent per year in women between 2004 and 2008, according to the American Cancer Society's annual report on cancer statistics released on Wednesday

Treatment of Unexplained Syncope: A Multicenter, Randomized Trial of Cardiac Pacing Guided by Adenosine 5'-Triphosphate Testing
Syncope commonly occurs in the general population, especially in the elderly; its origin remains unexplained in up to 40% of patients. Permanent cardiac pacing represents an effective therapy in patients with syncope of unknown origin that results from neurally mediated cardio-inhibition. The ATP test was introduced in 1986 as a convenient and safe tool to identify patients with syncope of unknown origin with neurally mediated cardiac inhibition. This patient-blinded, multicenter, randomized trial demonstrated that, in patients with syncope of unknown origin and a positive ATP test with no other precluding possible indications, cardiac pacing is an effective therapy, leading to a significant reduction of syncope recurrences. Although only some patients with syncope of unknown origin have a positive ATP test, this quick and safe procedure should be considered part of the armamentarium of syncope diagnosis.

Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in low-risk women
The authors of this article compared sublingual misoprostol with intramuscular oxytocin for prevention of postpartum hemorrhage (PPH) in low-risk vaginal birth. Overall it was shown that The efficacy of 400μg of misoprostol administered sublingually was equivalent to that of 10 units of oxytocin given intramuscularly for prevention of PPH in low-risk vaginal delivery.

Use Pulmonary Embolism Rule-Out Criteria 'With Confidence'
A clinical decision tool known as PERC (for Pulmonary Embolism Rule-out Criteria) is highly sensitive for excluding pulmonary embolism in patients with a low pretest probability, a new meta-analysis has shown. "Use of PERC could thus avoid the frequent expensive diagnostic imaging that typically results when a D-dimer result is positive," the investigators say.

Intracerebral Hemorrhage with Thrombolytic Therapy for Acute Pulmonary Embolism
Intracranial hemorrhage is one of the dreaded complications of thrombolytic therapy for acute pulmonary embolism. The authors identified patients with pulmonary embolism who may be at relatively high risk of intracerebral hemorrhage from those selected for thrombolytic therapy by their physicians and presumably thought to be of reasonable risk. Intracerebral hemorrhage was less frequent in those with a primary diagnosis of pulmonary embolism ,0.6%, than in those with a secondary diagnosis,1.7%. The prevalence of intracerebral hemorrhage was lower in patients aged 65 years or less with no kidney disease ,0.5%, than in patients aged more than 65 years or with kidney disease ,1.4%. The prevalence remained lower in those with a primary diagnosis ,0.4%, than in those with a secondary diagnosis ,0.9%.

Comparative efficacy of combination drug therapy in refractory epilepsy
The authors of study retrospectively examined treatment records of developmentally disabled adults with highly refractory epilepsy to determine whether any combinations of 8 of the most commonly used antiepileptic drugs (AEDs) possessed superior efficacy. Out of the 32 most frequently used AED combinations, we found that only the combination of lamotrigine and valproate had superior efficacy, measured against both an aggregate measure of other AED regimens to which patients were exposed, and in head-to-head comparisons with other AED combinations. We also found that while use of 2 concurrent AEDs provided improved efficacy over monotherapy, use of 3 AEDs at a time provided no further benefit over two.

Enoxaparin Plus Compression Stockings May Not Cut Mortality In Severely Ill Patients
"Severely ill hospital patients are at high risk for developing potentially fatal blood clots, and often wear compression stockings and/or take blood thinners to help lower this risk. However, adding the blood thinner Lovenox (enoxaparin) to the mix does not reduce their chances of dying from a blood clot, according to research appearing in the Dec. 29 issue of the New England Journal of Medicine." For patients who "were given Lovenox, the risk of death from any cause was 4.9 percent," while "this risk was 4.8 percent among those participants who were given a placebo."

Muscle pain and serum creatine kinase are not associated with low serum 25(OH) vitamin D levels in patients receiving statins
 Vitamin D deficiency has been associated in some studies with nonspecific musculoskeletal pain and, more specifically, with statin-induced myalgia, which was ameliorated by high-dose vitamin D supplements. The authors objective was to explore the association between vitamin D status and statin-induced myalgia and elevation of serum creatine kinase (CK). Overall there findings do not support an association between low 25OHD levels and statin-induced myalgia or CK-elevation.

Next-Generation Troponin I Assay May Help Speed MI Diagnosis
Now, an even more sensitive version of the test may be more helpful in ruling out a heart attack accurately and quickly, according to new research in the Journal of the American Medical Association. Researchers from Germany’s University Heart Center Hamburg who used the newly developed test were able to accurately rule out a heart attack close to 99% of the time by repeating the test. Among the 1,818 patients in the study, the more sensitive test proved to be more effective for ruling out heart attacks than regular troponin I testing.

Depression and Risk of Stroke
A history of depression may be associated with an increased risk of stroke. This article was aimed to determine the association between depression and risk of stroke by performing a meta-analysis of prospective studies. Overall this random-effects meta-analysis of 17 prospective studies involving 206 641 participants and 6086 cases demonstrated a significant positive association between depression and subsequent risk of stroke 

Vitamin D and Nonmelanoma Skin Cancer
The authors of this article sought to examine the association of serum 25-hydroxyvitamin D (25-OHD) with the risk of nonmelanoma skin cancer (NMSC), defined as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).  The study included 3223 white health maintenance organization patients who sought osteoporosis- or low-bone-density–related advice from 1997 to 2001.  An increased baseline serum 25-OHD level was significantly associated with an increased NMSC risk. This association was positive, though nonsignificant on less UV-exposed body sites, and UV exposure remains a likely confounder. The complex and confounded relationship of vitamin D, UV, and NMSC makes classic epidemiological investigation difficult in the absence of carefully measured history of cumulative UV exposure.

Effects of Thrombolytic Agents on Tympanostomy Tubes Occluded by Blood Clots
The authors of this article investigated the efficacy of various topical applications in opening a clotted tympanostomy tube (TT) using an in vitro model. They found that Thrombolytic agents and H2O2 were not effective in resolving TTs that were clotted with blood in an in vitro environment simulating the ear canal. Increasing concentrations of acetic acid are increasingly effective in this capacity.

Efficacy and safety of first-line rituximab in severe, acquired thrombotic thrombocytopenic purpura
This article assessed the efficacy and safety of rituximab in adults responding poorly to standard treatment for severe autoimmune thrombotic thrombocytopenic purpura. It was found that Adults with severe thrombocytopenic purpura who responded poorly to therapeutic plasma exchange and who were treated with rituximab had shorter overall treatment duration and reduced 1-yr relapses than historical controls.

Selection of Prophylactic Antimicrobial Agent May Affect Incidence of Infection in Small Bowel and Colorectal Surgery
Antibiotic prophylaxis guidelines suggest single-dose regimens are adequate, but comparisons of multiple agents are lacking. The authors compared post-operative infection rates retrospectively among six common prophylactic agents given as a single dose to colorectal surgery patients. Overall this article showed the use of Ertapenem was associated with a lower infection rate and that agent selection among prophylactic antibiotics is one of many factors associated with infection development in colorectal surgery patients.

HPV Screen Detects Lesions Earlier than Pap Test
DNA testing for human papillomavirus (HPV) picks up precancerous lesions earlier and prevents more cervical cancer than standard cytology screening alone, researchers found.

No Clear Winner For Antibiotic Treatment in Cdiff
Clostridium difficile infection is increasing in incidence and severity and the optimal treatment is unknown. The authors of this article sought to determine whether, among adults with C. difficile infection, treatment with certain antibiotics compared with others results in differences in initial cure, recurrence, and harms. 11 trials that included 1463 participants were identified. Three trials compared metronidazole with vancomycin; 8 compared metronidazole or vancomycin with another agent, combined agents, or placebo. Overall it was shown that no antimicrobial agent is clearly superior for the initial cure of C. difficile infection. Recurrence is less frequent with fidaxomicin than with vancomycin.

Smoking Raises Risk Of Squamous Cell Carcinoma Of The Skin In Women
Regular female smokers have a threefold higher risk of developing squamous cell carcinoma of the skin, researchers from Moffitt Cancer Center reported in Cancer Causes and Control. The authors said they found a slight increase in risk among regular male smokers, but a statistically insignificant one.

Urgent Statement on Antithrombotic Therapy of Atrial Fibrillation
In November 2009, the “Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2008)” were published as a partial revision of the Guidelines published in 2001,though significantly modified, and have been used widely as the best guidance for treatment for patients with atrial fibrillation(AF) in the clinical setting. The Guidelines defineantithrombotic therapy as the most important therapy of AF,and provide recommendations for patients in Japan on the basis of the results of domestic clinical trials.

Causes of Death Among Stillbirths
Stillbirth affects 1 in 160 pregnancies in the United States, equal to the number of infant deaths each year. Rates are higher than those of other developed countries and have stagnated over the past decade. There is significant racial disparity in the rate of stillbirth that is unexplained. This article sought to ascertain the causes of stillbirth in a population that is diverse by race/ethnicity and geography. Overall this systematic evaluation led to a probable or possible cause in the majority of stillbirths. Obstetric conditions and placental abnormalities were the most common causes of stillbirth, although the distribution differed by race/ethnicity.

Incidental Detection of Renal Cell Carcinoma is an Independent Prognostic Marker
The true effect of incidental detection on the survival of patients with renal cell carcinoma has been debated. We used centralized databases in Iceland to study prognostic factors of survival, focusing on the effect of incidental detection. This retrospective study included all living patients diagnosed with renal cell carcinoma in Iceland from 1971 to 2005. Hospital charts and histology were reviewed. This review found that with increased incidence and unchanged mortality the survival of patients with renal cell carcinoma has improved. This is mainly related to a steep increase in incidental detection. Incidental detection affects survival favorably and to a greater extent than can be explained by lower stage compared to the survival of patients diagnosed with symptoms.

The Association Between Length of Emergency Department Boarding and Mortality
Emergency department (ED) boarding has been associated with several negative patient-oriented outcomes, from worse satisfaction to higher inpatient mortality rates. The current study evaluated the association between length of ED boarding and outcomes.  There were 41,256 admissions from the ED. Mortality generally increased with increasing boarding time, from 2.5% in patients boarded less than 2 hours to 4.5% in patients boarding 12 hours or more. Mean hospital LOS also showed an increase with boarding time, from 5.6 days for those who stayed in the ED for less than 2 hours to 8.7 days for those who boarded for more than 24 hours. The increases were still apparent after adjustment for comorbid conditions and other factors.

Simvastatin Benefits in Subarachnoid Hemorrhage
The present study assessed the neuroprotective effects of simvastatin in a rodent model of experimental subarachnoid hemorrhage (SAH).Overall it was shown that the administration of simvastatin may represent a beneficial therapeutic approach able to reduce post-SAH cognitive dysfunction.

Ureteroscopy assisted retrograde nephrostomy: a new technique for percutaneous nephrolithotomy (PCNL)
Retrograde nephrostomy was first developed by Lawson et al. in 1983, and Hunter et al. reported 30 cases of retrograde nephrostomy in 1987. This procedure uses less radiation exposure and has a shorter duration compared with the previous percutaneous nephrostomy techniques. Retrograde nephrostomy using Lawson's procedure was reported in the late 1980s by several authors. But since then, few studies have been reported about this procedure due to the development of ultrasonography assisted percutaneous nephrostomy. With the arrival and development of the flexible ureteroscope (URS) both observation and manipulation in the renal pelvis are now easily achieved. The present procedure provides less radiation exposure, less bleeding, and a shorter procedure than previous percutaneous nephrostomy techniques. Using this procedure, after the needle has exited through the skin, no further steps are required in preparation for dilatation. In the present study, we continuously visualised from puncture to inserting the nephron-access sheath with the URS.

Docs Still Give Antibiotics for Ear Infection
The guidelines set forth by the American Academy of Pediatrics and the American Academy of Family Physicians on the management of acute otitis media have not appreciably altered antibiotic prescribing, a researcher reported here. Before the guidelines were issued in 2004, only 13% of physician visits for acute otitis media did not result in an antibiotic prescription being given, according to Margaret L. Hitzeman, who is a PharmD candidate, and Donald G. Klepser, PhD, both from the University of Nebraska in Omaha. The percentage rose to 16% between 2004 and 2006, but fell back to 12% in 2007 and 2008, Hitzeman reported in a poster session at the midyear clinical meeting of the American Society of Health-System Pharmacists.

Dapsone is an active salvage therapy for adult patients with immune thrombocytopenia relapsed or refractory to steroid and rituximab
Dapsone is an antibacterial sulfonamide with anti-inflammatory property which showed therapeutic activity in patients with immune thrombocytopenia (ITP) (1-6); the activity in patients who showed refractoriness to rituximab is unknown. The authors evaluated the effect of dapsone in 20 consecutive adult patients, median age 51 years, with primary ITP previously treated at least with steroids and rituximab. The median duration of dapsone therapy in responders and the median response duration were 31 and 42 months. None of responders lost response while on treatment. One patient in complete response interrupted dapsone after 9 months and still maintained the response after 48 months. None of the patients interrupted the treatment for toxicity. All patients were screened for normal G6PD; two patients showed mild increase of methemoglobinemia (MHb). These results highlight the therapeutic activity and good safety profile of dapsone in patients with ITP who previously failed rituximab treatment.

Prophylactic Antibiotics and Chest Tubes
No consensus exists as to whether antibiotic prophylaxis in tube thoracostomy as primary treatment for traumatic chest injuries reduces the incidence of surgical-site and pleural cavity infections. This systematic literature search was performed according to PRISMA guidelines to identify randomized clinical trials on antibiotic prophylaxis in tube thoracostomy for traumatic chest injuries. Overall Infectious complications are less likely to develop when antibiotic prophylaxis is administered to patients with thoracic injuries requiring chest drains after penetrating injury. 

Tigecycline Penetration into Skin and Soft Tissue
 Tigecycline, a derivative of minocycline, has antibacterial activity against common pathogens associated with complicated skin and soft tissue infections (cSSTIs), including methicillin-resistant Staphylococcus aureus. At present, there is a paucity of data concerning its penetration into skin and soft tissue (SST).  This study evaluated the penetration of tigecycline into SST in 25 patients (mean age, 52 years) with cSSTIs requiring surgical intervention. The authors found that there were higher concentrations of tigecycline in SST than in the serum at the same time point.

Increased Serum cholesterol levels increases survival after rtPA treatment in acute stroke
According to the reverse epidemiology hypothesis, high cholesterol levels might be protective and associated with greater survival rates under certain conditions. In stroke patients, a clear correlation between lipid levels and mortality after ischaemic and hemorrhagic strokes has been demonstrated. The aim of this study was to analyze the impact of lipid levels on 3-month mortality in patients with ischaemic stroke (IS) homogeneously treated with intravenous rtPA and admitted to a monitored acute stroke unit. If found that Survival of stroke patients receiving current, most effective medical treatment is related to blood cholesterol levels, with an inverse relationship between cholesterol and mortality. The mechanism of this apparently paradoxical situation remains unexplained but merits further research.

Flu Vaccination Rates Up, Especially Among Kids
Seasonal flu has been tame this year, but more people are getting vaccinated in hopes of protecting themselves against the virus, according to government data out today. The growth is strongest among children. Some 36.7% of children aged 6 months to 17 years had received a flu shot as of early November, an increase of 6.1 percentage points from the same time last year, according to a survey conducted by the Centers for Disease Control and Prevention.

Opioids May Be Overused for Chronic Stomach Pain
Prescriptions for opioid painkillers to treat chronic abdominal pain more than doubled in the United States between 1997 and 2008, according to a new study. This large increase of prescriptions written at outpatient clinics is concerning for several reasons, said lead author Dr. Spencer Dorn, an assistant professor of medicine at the University of North Carolina Medical School at Chapel Hill, and colleagues. The study appears in the December issue of the journal Clinical Gastroenterology and Hepatology.

Corticosteroid administration for patients with coronary artery aneurysms after Kawasaki disease may be associated with impaired regression
Corticosteroid administration in Kawasaki disease (KD) is controversial but accepted as treatment for patients who do not respond to initial treatment. The impact of corticosteroids on evolving coronary artery aneurysms (CAA) and future vascular remodelling is unknown. This study indicated that the use of corticosteroids in the acute phase of KD for patients with evolving CAAs may be associated with worsening involvement and impaired vascular remodelling and warrants further study.

Ablation Stops Paroxysmal Afib
First-line treatment of paroxysmal atrial fibrillation with catheter-based radiofrequency ablation gives patients more long-term relief from the cardiac rhythm disturbances than drug therapy, researchers suggested here. In all, 22 of the 146 patients who underwent ablation experienced any atrial fibrillation, compared with 43 of the 148 patients being treated with drugs (P=0.004), during the two-year period of the Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial, the researchers reported at the American Heart Association meeting.

Simvastatin administration reduces thromboxane production in subjects taking aspirin
Growing evidence indicates that statins may reduce thromboxane A2 synthesis and thrombin generation. We investigated the relationships between thromboxane production, thrombin generation, and oxidative stress in patients receiving aspirin before and after statin administration. This study shows that statins significantly reduce platelet TXA2 formation in patients taking low-dose aspirin and this effect is associated with attenuated thrombin formation in response to vascular injury.

Albumin infusion in patients undergoing large-volume paracentesis
Albumin infusion reduces the incidence of post-paracentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin such as artificial colloids and vasoconstrictors have been widely investigated. The aim of this meta-analysis was to determine whether morbidity and mortality differ between patients receiving albumin vs. alternative treatments. Overall this meta-analysis provides evidence that albumin reduces morbidity and mortality among patients with tense ascites undergoing large-volume paracentesis, as compared with alternative treatments investigated thus far. (Hepatology 2011.

Low-Dose Interleukin-2 in HCV-Induced Vasculitis
Patients with vasculitis induced by the hepatitis C virus (HCV) have reduced levels of regulatory T cells (Tregs). Resolution of HCV infection correlates with cure of vasculitis and the recovery of Treg levels. The authors of this article reasoned that interleukin-2, a cytokine that promotes Treg survival and function, could be beneficial for patients with vasculitis that is resistant to HCV therapy. The treatment did not induce effector T-cell activation, vasculitis flare, or increased HCV viremia. The authors observed a reduction in cryoglobulinemia in 9 of 10 patients and improvement of vasculitis in 8 of 10. The trial showed that low-dose interleukin-2 was not associated with adverse effects and led to Treg recovery and concomitant clinical improvement in patients with HCV-induced vasculitis, an autoimmune condition.

Urinary Sodium and Potassium Excretion and Risk of Cardiovascular Events
The precise relationship between sodium and potassium intake and cardiovascular (CV) risk remains uncertain, especially in patients with CV disease. This aricle sought to determine the association between estimated urinary sodium and potassium excretion (surrogates for intake) and CV events in patients with established CV disease or diabetes mellitus. This article found that the association between estimated sodium excretion and CV events was J-shaped. Compared with baseline sodium excretion of 4 to 5.99 g per day, sodium excretion of greater than 7 g per day was associated with an increased risk of all CV events, and a sodium excretion of less than 3 g per day was associated with increased risk of CV mortality and hospitalization for CHF. Higher estimated potassium excretion was associated with a reduced risk of stroke.

Beta Blockers Don't Decrease Sudden Cardiac Death in Hemodialysis Patients
Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure. This article was a Post hoc analysis of the Hemodialysis (HEMO) Study. Overall it was found that in hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.

Factors Associated With Mortality in 2-Year Survivors of Head and Neck Cancer
This authors of this article sought to determine the conditional survival rates of 2-year survivors of head and neck cancer and to identify risk factors of increased mortality thought a prospective, observational study. The authors found that in addition to older age and advanced stage, pain, poor overall quality of life, and tobacco use 2 years after diagnosis characterize patients who might need longer and more intense follow-up care to improve their observed and disease-specific survival. This information is useful in developing management plans for patients transitioning from a focus on cancer surveillance into survivorship.

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