• Eating for Two in the Obesity Era
• Minimizing Antibiotic Dental Prophylaxis
• Women’s Weight Gain Linked to Vitamin D Lack
• Hyperglycemia Is Associated with Poorer Outcomes Among Patients with Sepsis
• Is Interferon-β Ineffective at Reducing Disability in MS?
• Eating Disorders Common, Linked to Multiple Adverse Outcomes
• Travelers Insurance Companies Have Paid for Thousands of Off-label Prescriptions
• Study Says Doctors Increasingly Fill Prescriptions
• Bill Proposed to Deter Painkiller Abuse
• Women Who Seek Second-Trimester Abortions
• Turning Out the Lights on Tanning Bed Use Worldwide
• Wnt Inhibitor Stems Hair Growth
• New Lipid Biomarkers of Little Use in Predicting Cardiovascular Risk
BMJ 2012 May 17; 344:e2088
Eating for Two in the Obesity Era
Dietary interventions during pregnancy curbed maternal weight gain.
Women who begin pregnancy overweight or obese or who experience excessive gestational weight gain are at risk for adverse obstetric outcomes. Researchers conducted a meta-analysis of 44 randomized trials of lifestyle interventions designed to curtail weight gain during pregnancy. The selected trials enrolled >7000 women; interventions involved dietary modifications, physical exercise, or both.
Women participating in interventions had lower gestational weight gain than those who did not (reduction in weight gain, 1.4 kg). Participation in any intervention was associated with significantly lower risk for preeclampsia (relative risk, 0.7) and shoulder dystocia (RR, 0.4) and with trends toward lower risk for gestational diabetes, gestational hypertension, preterm delivery, intrauterine death, birth trauma, and hyperbilirubinemia. Reductions in weight gain were significant for all interventions, but were greatest among those receiving dietary advice (3.8 kg vs. 0.7 kg for physical activity and 1.1 kg for mixed approaches).
Comment: During pregnancy, excess weight gain is associated not only with adverse obstetric outcomes, but also with long-term health implications for women and their families. The finding that dietary interventions delivered during pregnancy can attenuate some of these risks is reassuring, although the weak efficacy of interventions aimed at physical activity is disappointing. Obstetric practices should be equipped to provide nutritional counseling — not just for overweight women, but for all women. Ideally, such counseling should not be reserved as a "teachable moment" of pregnancy; rather, it should be generally available to women and their families for maximal effects on health throughout life.
— Allison Bryant, MD, MPH Published in Journal Watch Women's Health July 19, 2012
Citation(s): Thangaratinam S et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: Meta-analysis of randomised evidence. BMJ 2012 May 17; 344:e2088. (http://dx.doi.org/10.1136/bmj.e2088)
http://www.ncbi.nlm.nih.gov/pubmed/22596383?dopt=Abstract
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MM: Good news to those planning a dental visit and wary of taking prophylactic antibiotics. It appears that you may not need to. Many people are apprehensive about a dental visit to start with and the idea that they may diminish their immune system and intestinal flora with prophylactic antibiotics merely adds to their anxeity. Look at overall risk factors first and re-consider if the use of these antibiotics is truly warranted.
Circulation 2012 Jul 3; 126:60
Minimizing Antibiotic Dental Prophylaxis
Studies conducted in the U.S. and France showed no increase in mouth flora–related infective endocarditis after drastic reductions in antibiotic use for dental procedures.
Invasive dental procedures have long been suggested as a cause of infective endocarditis (IE), because oral streptococci have been implicated in many cases of IE. Antibiotic prophylaxis for dental procedures has been recommended by the American Heart Association and other groups for decades, especially in patients at particular risk for IE. In 2002 in France (2007 in the U.S.; 2008 in the U.K.), guidelines were altered to drastically reduce the indications for such prophylaxis.
A study conducted in England showed no appreciable increase in viridans group streptococcal endocarditis (VGS-IE) during the years following antibiotic prophylaxis restriction (JW Infect Dis May 11 2011). Now, researchers have reported the results of two additional population-based studies on the topic.
Using the Mayo Clinic's Endocarditis Registry, DeSimone and colleagues assessed the incidence of VGS-IE among adults in Olmsted County, Minnesota, from 1999 (before restriction) through 2010 (3 years after restriction). Over this 12-year period, only 22 cases of VGS-IE were identified. The age- and sex-adjusted incidence per 100,000 person-years were 3.19 (95% confidence interval, 1.20–5.17) for 1999–2002, 2.48 (95% CI, 0.85–4.10) for 2003–2006, and 0.77 (95% CI, 0.00–1.64) for 2007–2010. The nationwide incidence of VGS-IE, derived from the Nationwide Inpatient Sample database, also remained stable during this period. Of the three cases identified in Olmsted County between 2007 and 2010, two patients had undergone no dental work during the preceding 6 months; the third had received clindamycin prophylaxis.
Duval and colleagues conducted three 1-year population-based surveys in three regions of France encompassing 11 million inhabitants aged 
20 years. All IE cases were validated by a panel of experts. The number of patients with definite, probable, or possible IE remained stable over time — 323 in 1991, 331 in 1999, and 339 in 2008. No increase was seen in VGS-IE incidence after publication of the more restrictive guidelines. However, the incidence of staphylococcal IE rose, especially among patients without previously known native valve disease.
Comment: Clearly, decreased use of dental antibiotic prophylaxis in the three populations studied has not resulted in increases in IE caused by oral bacteria. That such prophylaxis has never been helpful cannot be proven. But given the current findings and the fact that antimicrobial resistance is a major health problem, it seems prudent to reinforce guidelines that restrict antibiotic overuse.
— Stephen G. Baum, MD Larry Baddour, an author on the study conducted in Minnesota, is the Editor-in-Chief of Journal Watch Infectious Diseases. Dr. Baddour had no role in the writing or review of this summary.
Published in Journal Watch Infectious Diseases July 18, 2012
Citation(s): DeSimone DC et al. Incidence of infective endocarditis caused by viridans group streptococci before and after publication of the 2007 American Heart Association's endocarditis prevention guidelines. Circulation 2012 Jul 3; 126:60.
http://www.ncbi.nlm.nih.gov/pubmed/22689929?dopt=Abstract
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http://www.imakenews.com/eletra/mod_print_view.cfm?this_id=2481436&u=
vitalchoiceseafood&show_issue_date=F&issue_id=000601282&lid=bllwVSy&uid=b1h1R7NC
Women’s Weight Gain Linked to Vitamin D Lack
Study finds 4 out of 5 older women lack vitamin D … and that lack was linked to extra weight gain
by Craig Weatherby
Vitamin D – often called the sunshine-and-seafood vitamin – is unlike its companion micronutrients. It’s the only essential nutrient that exerts broad, hormone-like effects throughout the body, making a critical difference in virtually every organ and metabolic function. So perhaps it should come as little surprise that a new study links vitamin D “insufficiency” to added weight gain. The study focused on older women, and found that four out of five (80 percent) had insufficient levels of vitamin D … a finding with serious implications for bone health.
According to lead author Erin LeBlanc, M.D., “Nearly 80 percent of women in our study had insufficient levels of vitamin D. A primary source of this important vitamin is sunlight, and as modern societies move indoors, continuous vitamin D insufficiency may be contributing to chronic weight gain.” (KP 2012) The finding of a widespread lack of vitamin D was bad enough, but the researchers also found that women who lacked vitamin D gained more weight than those with blood levels deemed sufficient.
Dr. LeBlanc called that weight-gain finding unprecedented: “This is one of the first studies to show that women with low levels of vitamin D gain more weight, and although it was only two pounds, over time that can add up.” (KP 2012)
Study links vitamin D lack to gradual weight gain
The study was conducted by researchers from the Kaiser Permanente Center for Health Research, the University of Minnesota, the University of Pittsburgh, and the University of Maryland (Leblanc ES et al. 2012). The team recruited 4,659 women aged 65 and older, measured their vitamin D blood levels, and tracked their weight over a period of 4.5 years. They found that the women with insufficient levels of vitamin D gained about two pounds more than those with adequate levels. She made a key point about the limitations of epidemiological studies like theirs: “Our study only shows an association between insufficient levels of Vitamin D and weight gain, we would need to do more studies before recommending supplements to keep people from gaining weight.” (KP 2012)
Details of the study
Dr. LeBlanc noted that their study was conducted among older women who, for the most part, were not trying to lose weight … though some of them lost weight as a natural result of aging. About 60 percent of the 4,659 women in the study remained at a stable weight (within five percent of their starting weight) over the 4.5 year study period. A bit more than one-quarter (27 percent) lost more than five percent of their body weight, and 12 percent gained more than five percent of their body weight.
Most women in the study (78 percent) had less vitamin D in their blood than the level defined as sufficient by The Endocrine Society panel of experts who set clinical guidelines on Vitamin D deficiency: namely, 30 nanograms per millimeter (ng/ml). These women had higher weight to begin with: 148.6 pounds compared with 141.6 pounds for women whose vitamin D levels were 30 ng/ml or higher.
Among the 571 women who gained weight, those with insufficient vitamin D levels gained more weight – an average of 18.5 pounds over 4.5 years – than women who had sufficient vitamin D, who gained an average of 16.4 pounds over the same period.
This study is part of a larger project called the Study of Osteoporotic Fractures that has been ongoing for more than two decades, which is supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging.
Sources: Kaiser Permanente Center for Health Research (KP). Low Vitamin D Levels Linked to Weight Gain in Some Older Women. June 25, 2012. Accessed at:
http://www.kpchr.org/research/public/News.aspx?NewsID=73. Leblanc ES, Rizzo JH, Pedula KL, Ensrud KE, Cauley J, Hochberg M, Hillier For The Study Of Osteoporotic Fractures TA. Associations Between 25-Hydroxyvitamin D and Weight Gain in Elderly Women. J Womens Health (Larchmt). 2012 Jun 25. [Epub ahead of print]
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Am J Med 2012 Jul; 125:670.
Hyperglycemia Is Associated with Poorer Outcomes Among Patients with Sepsis
Among nondiabetic patients with sepsis admitted to a non-ICU hospital unit, in-hospital mortality rose and hospital length of stay increased as blood glucose concentrations increased.
Studies performed in the intensive care unit (ICU) setting suggest that controlling blood glucose leads to improved outcomes. Whether this is true in the non-ICU setting and whether there is a difference between patients with and without diabetes is unclear.
To explore this issue, researchers performed a secondary analysis of a prospective, observational cohort study involving adults who received treatment for suspected sepsis in the emergency department of a large medical center in Boston and were then admitted to a non-ICU ward of the same hospital. Between December 2003 and September 2004, 1849 patients were enrolled, of whom 539 (29%) had preexisting diabetes.
The mean time-weighted glucose concentration during the first 72 hours after admission was higher in diabetic patients than in nondiabetic ones (157 vs. 107 mg/dL; P<0.001), and a greater proportion of diabetic patients than nondiabetic patients received insulin during this time period (82% vs. 3%; P<0.001). Nondiabetic patients were significantly less likely to receive insulin even after adjustment for mean glucose concentration, age, and illness severity. Overall, hospital length of stay (LOS) was longer in diabetic patients, but in-hospital mortality was similar between groups. As the 72-hour mean glucose concentration increased, in-hospital mortality and LOS rose — but only among the nondiabetic patients. These patients had a 19% increase in mortality and a 10% increase in LOS for every 10 mg/dL rise in glucose.
Comment: This interesting study demonstrates an association between higher blood glucose concentrations and worse clinical outcomes among nondiabetic patients with sepsis. Still unanswered is whether the higher glucose concentrations are a cause or an effect — and thus whether better glycemic control might improve outcomes among these patients.
— Neil M. Ampel, MD Published in Journal Watch Infectious Diseases July 18, 2012
Citation(s): Schuetz P et al. Initial management of septic patients with hyperglycemia in the noncritical care inpatient setting. Am J Med 2012 Jul; 125:670.
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MM: Use of interferon for MS may be controversial but Vitamin D-3 should not be. There is almost a universal positive response from MS patients receiving high dose Vitamin D3.
Is Interferon-β Ineffective at Reducing Disability in MS?
Interferon-β did not reduce risk for progressing to using a cane in this controversial, population-based analysis.
Clinical trials of interferon-β (IFN-β) in relapsing–remitting multiple sclerosis (MS) have demonstrated reduction in sustained disability progression during 2-year follow-up (Ann Neurol 1996; 39:285 and Lancet 1998; 352:1498). Based on circumstantial evidence, IFN-β is assumed to be effective over many years, leading to a reduced risk for secondary-progressive MS. To investigate further, researchers conducted a population-based, case-control study, analyzing the risk for progression to sustained Expanded Disability Status Scale (EDSS) score of 6.0 (requiring assistance to walk 100 meters). They compared 868 patients treated with IFN-β from 1995 to 2004 with two control groups: a contemporary group (829 patients untreated during the same period) and an historical group (959 patients observed during the 10 years before IFN-β was available). Data came from a database believed to capture 80% of the British Columbia MS population and from a prescription drug database (for any form of IFN-β exposure).
After adjustment for sex, age, disease duration, and baseline EDSS score, IFN-β was associated with a nonsignificant 30% increase in risk for progression compared with the contemporary untreated cohort, and a 23% nonsignificant decrease compared with the historical cohort.
Comment: These investigators are to be commended on a well-conducted study, using exceptional epidemiological methods (e.g., including appropriate baseline characteristics to account for important measurable differences between the cohorts). Although a strong, significant benefit for IFN-β was not found, the results highlight the challenges in conducting such a study. The conclusions remain open to interpretation based upon how one weighs the value of the two different untreated cohorts.
The differences in baseline characteristics between the treated cohort and the untreated contemporary cohort, and the trend toward increased disability risk with IFN-β, support that IFN-β use was based on physician perceptions of more-severe disease. Although using an historical cohort can be problematic (e.g., because of major changes in MS diagnosis during that time), that analysis suggests a trend toward a benefit with IFN-β. As editorialists note, the power calculation of a 40% reduction may have been too large, leading to insufficient study power and a borderline P value. In addition, some of the IFN-β group may have started therapy relatively late in their disease, when they were already transitioning to secondary-progressive MS.
My interpretation is that physicians treating the study patients were adept at selecting patients for therapy based on risk for progressive disability. This "high-risk" treated group did favorably compared with historical controls. The study may have been too small to allow a definitive conclusion.
— Robert T. Naismith, MD Dr. Naismith has served as a consultant and speaker for manufacturers of interferon-β. He has received personal compensation from Bayer HealthCare, Biogen Idec, and EMD Serono, Inc.
Published in Journal Watch Neurology July 17, 2012
Citation(s):Shirani A et al. Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis. JAMA 2012 Jul 18; 308:247.
http://www.ncbi.nlm.nih.gov/pubmed/22797642?dopt=Abstract
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Eating Disorders Common, Linked to Multiple Adverse Outcomes
Certain eating disorders, such as binge eating disorder, are common among teenage girls and associated with various adverse outcomes, according to a Pediatrics study.
More than 8000 adolescent girls across the U.S. completed behavioral questionnaires every 1 or 2 years from 1996 through 2008. About 1% met criteria for bulimia, 2–3% for binge eating disorder, 2–3% for purging disorder, and up to 15% for eating disorder not otherwise specified.
Compared to girls without eating disorders, those with:
- bulimia were more likely to start using drugs during the study (odds ratio, 3.9);
- binge eating disorder were more likely to become overweight (OR, 1.9) or develop depressive symptoms (OR, 2.3);
- purging disorder were more likely to start binge drinking frequently (OR, 1.8);
- eating disorder not otherwise specified were more likely to begin using drugs (OR, 1.5), binge drinking (OR, 1.6), or experiencing depressive symptoms (OR, 1.3).
The researchers conclude that primary care clinicians must be made aware of the range of eating disorders to help ensure that patients needing treatment will be identified.
http://pediatrics.aappublications.org/content/early/2012/07/11/peds.2011-3663.abstract
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Travelers Insurance Companies Have Paid for Thousands of
Off-label Prescriptions
Cephalon Inc. has sued Travelers to stop the insurer from trying to recover millions of dollars it allegedly paid for off-label uses of Actiq. Travelers has demanded that Cephalon reimburse $17.4 million stemming from the off-label promotion of the drug; the promotions involve uses of a drug not approved by the FDA.
While Cephalon settled with U.S. federal and state regulators in 2008 over similar allegations, it said federal law entrusts the FDA with oversight of off-label promotion and does not give Travelers the right to bring its own case.
http://in.reuters.com/article/2012/07/13/teva-travelers-idINL2E8ID82Z20120713
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Study Says Doctors Increasingly Fill Prescriptions
Doctors are increasingly filling prescriptions for workman's compensation patients in Pennsylvania and New Jersey, sometimes getting paid much more per dose than a pharmacy, according to a study to be released Thursday by a research group funded by insurers and state governments. The Workers Compensation Research Institute studied nearly 5.7 million prescriptions paid under workers' compensation for about 758,000 claims from 2007 to 2011 in 23 states, including Pennsylvania and New Jersey.
In Pennsylvania, 20 percent of the prescriptions for patients filing workman's compensation claims were filled by a doctor, up from the 17 percent over a three-year period used in the study. The percentage of payments to doctors for prescriptions rose from 15 percent to 27 percent during the same period.
The study found that prices paid to doctors for certain drugs, including some painkillers, were higher than those paid to pharmacies, both retail and mail order. "We rarely see a medical cost driver that has grown this rapidly," Dr. Richard Victor, WCRI's executive director, said in a statement.
Recently, the New York Times reported that some distributors help some doctors set up pharmacies within offices, buy drugs in bulk, and then repackage them. Repackaging has allowed those distributors and doctors to claim a higher reimbursement price than pharmacies get. California has closed that loophole.
http://www.philly.com/philly/business/20120719_Study_says_doctors_increasingly_
fill_prescriptions.html
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MM: It is certainly true that drug diversion of prescription products has become perhaps the greatest form of drug abuse in North America. It is unfortunate that we find it necessary to establish physical changes to products to prevent this illicit use. This is especially pertinent at this time when healthcare costs are already skyrocketing and many generic painkillers could be removed from the market thereby increasing overall costs of pain medications of all types.
Bill Proposed to Deter Painkiller Abuse
House lawmakers are introducing legislation requiring most pain drugs to adopt abuse-deterring safeguards, the broadest congressional attempt at curbing the nation's prescription-drug problem. The bipartisan bill proposes to eventually require most of the nation's 137 million annual painkiller prescriptions to contain some form of abuse deterrence, including dosage forms that are more difficult for abusers to crush open or inject. The bill leaves vague the exact details of how drug makers could meet new standards. Currently, only a small number of branded products, such as Purdue Pharma LP's OxyContin or Endo Pharmaceuticals Inc.'s Opana, have in recent years been made with so-called tamper-resistant formulations. Most generics don't have such safeguards.
http://online.wsj.com/article/SB10000872396390444097904577535361145297688.html?_
nocache=1342723281896&user=welcome&mg=id-wsj
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Contraception 2012 Jun; 85:544
Women Who Seek Second-Trimester Abortions
Those who are younger, black, or less educated are more likely to terminate pregnancies after 12 weeks' gestation.
Most abortions in the U.S. are performed at or before 12 weeks' gestation. Second-trimester abortions are relatively difficult to access. To provide insight into the characteristics of women seeking second-trimester services, researchers evaluated data from 9493 evaluable responses to the Guttmacher Institute's 2008 Abortion Patient Survey.
Second-trimester abortions constituted 10.3% of all abortions. Rates of second-trimester abortion were highest in:
- Women who experienced three or more disruptive life events during the past year, such as intimate partner violence, physical or sexual abuse, and financial difficulties (14.8% of all abortions)
- Women younger than 18 (14.0%)
- Women who used private insurance or Medicaid to pay for the abortion (13.6%)
- Black women (13.4%)
- Women without high school degrees (13.1%)
Among second-trimester abortions, 5.9% of pregnancies were intended. Of all second-trimester abortions, 39.2% were performed at 
16 weeks' gestation. Among women who had to terminate intended pregnancies, 52.5% underwent abortions after 16 weeks. However, in only 7.9% of abortions after 16 weeks was the pregnancy intended. Black women were almost twice as likely as white women to terminate pregnancy this late.
Comment: In general, most women having second-trimester abortions state that they would have preferred to have had an earlier abortion. Although this report did not definitively state the indications for abortion, a substantial proportion of abortions late in the second trimester are performed for fetal and maternal indications; in such cases, many pregnancies are intended. Among women with unintended pregnancies, the occurrence of abortions in the second trimester often reflects problems accessing abortion services. Given that second-trimester terminations are more costly and difficult to perform and are associated with more risks than first-trimester abortions, more clinicians should be trained to provide early medical abortions, especially at clinics that serve the young and the poor.
— Anne A. Moore, APN, WHNP/ANP-BC, FAANP Published in Journal Watch Women's Health July 19, 2012
Citation(s): Jones RK and Finer LB. Who has second-trimester abortions in the United States? Contraception 2012 Jun; 85:544.
http://www.ncbi.nlm.nih.gov/pubmed/22176796?dopt=Abstract
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Arch Dermatol 2012 Jul 16 :
Turning Out the Lights on Tanning Bed Use Worldwide
A growing number of countries and U.S. states passed legislation to restrict access to tanning salons by young users.
Despite compelling evidence that tanning beds cause skin cancer, including melanomas, use continues to rise in the U.S. and around the world. The American Cancer Society reports that nearly one third of white American women 18–25 engaged in indoor tanning in 2010. Many organizations urged restricted access to tanning parlors for children 18 years and younger. A new study reports that these efforts have been partially successful.
In the 8-year period from 2003 to 2011, legislation restricting tanning bed use became increasingly common worldwide. In 2003, only two countries (France and Brazil), three U.S. states (Texas, Illinois, and Wisconsin), and one Canadian province (New Brunswick) placed age limits on indoor tanning bed use. (Another 17 states required guardian consent or accompaniment for minors.) By 2011, a complete ban on indoor tanning was in effect in Brazil, and 11 countries prohibited tanning for minors. In the U.S., 11 states had laws banning indoor tanning by minors, and 21 other states required guardian consent.
Comment: As more evidence shows the deleterious effects of tanning beds, increasing numbers of states and countries limit their use. These devices are used almost entirely for cosmetic purposes and are probably responsible for the dramatic increase in skin cancers in women younger than 40. Moreover, meta-analyses show that tanning bed use before the age of 30 is a risk factor for melanoma. Indoor tanning is popular among adolescents and carries particular risks for cancer and photoaging in young users. Dermatologists are to be commended — in the U.S., they have spearheaded much of the effort to legislate constraints on tanning bed use. However, we cannot rest on our laurels: Restrictions are still weak and insufficiently enforced in many states. We must continue to lead the way by lobbying for laws that, like restrictions on tobacco, limit access to carcinogenic indoor tanning devices.
— Craig A. Elmets, MD Published in Journal Watch Dermatology July 20, 2012
Citation(s) :Pawlak MT et al. Legislation restricting access to indoor tanning throughout the world. Arch Dermatol 2012 Jul 16 : [e-pub ahead of print].
(http://dx.doi.org/10.1001/archdermatol.2012.2080)
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MM: There may be hope for those who are follically challenged. This research may lead to a topical or injected product that will restore local hair growth. In my opinion, a topical product would be preferred and is likely more marketable and appealing to the general male and female public. The major difference will likely be effective dose and therefore cost of producing the drug. I predict that by the end of the decade such a product will be commercially available
J Invest Dermatol 2012 Jun; 132:1554
Wnt Inhibitor Stems Hair Growth
The DKK-1 protein affects the anagen-to-catagen transition in the hair cycle.
Anagen hair growth cycles become progressively shorter in men with male pattern baldness. Interfering with this premature termination of hair growth could conserve terminal hairs and mitigate balding. The anagen-to-catagen transition involves androgen-inducible transforming growth factors β1 and β2, but other androgen-related actions may also be at work. Recently, higher-than-normal levels of androgen-inducible Dickkopf-1 (DKK-1) protein have been found in biopsies of scalp skin in male pattern alopecia. DKK-1 inhibits the Wnt signaling pathway and, consequently, stem cell division. Stem cells generate hair and also produce the elongated hair follicles of the anagen phase. In the anagen-to-catagen transition, stem cells stop replenishing apoptotic hair bulb epithelial cells, leading to cessation of hair growth and involution of the hair follicle.
To determine whether DKK-1 is a catagen inducer, these investigators injected recombinant human DKK-1 Wnt-inhibitor protein into the hypodermis of mice. Premature catagen onset and decreased final hair-strand length resulted. (See this illustration of the normal hair cycle and the proposed mechanism by which DKK-1 elicits premature catagen.) Injection of a neutralizing antibody to DKK-1 delayed the anagen-to-catagen transition and increased final hair-strand length. Injection of recombinant DKK-1 also blocked Wnt/β-catenin signaling and induced apoptosis of outer root sheath keratinocytes.
Comment: These findings fit with previous data showing that stem cells and proper Wnt pathway signaling facilitate normal hair growth. Wnt proteins, such as Wnt10b, have also been shown to promote hair follicle growth in organ culture. In this study, injected Dickkopf-1 blocked appropriate Wnt signaling of stem cells, causing anagen growth to cease and hair follicles to regress. In male pattern baldness, high tissue levels of androgen-inducible DKK-1 may produce the same effects, leaving a balding scalp.
— Mark V. Dahl, MD Published in Journal Watch Dermatology July 20, 2012
Citation(s): Kwack MH et al. Dickkopf 1 promotes regression of hair follicles. J Invest Dermatol 2012 Jun; 132:1554
http://www.ncbi.nlm.nih.gov/pubmed/22358062?dopt=Abstract
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MM: It’s wonderful that we now have the ability to discern more about the human condition but we must be prudent in what we spend on testing as our resources are limited. If so little benefit is obtained from additional testing, wouldn’t it be wiser to look before we leap and assess when and if these tests should be utilized. Otherwise these are merely an opportunity for labs to elicit greater fees from patients, insurance companies and ultimately employers and consumers.
JAMA 2012 Jun 20; 307:2499.
New Lipid Biomarkers of Little Use in Predicting Cardiovascular Risk
A pooled analysis provides no justification for routinely adding any new tests to current lipid panels.
During the past decade, a myriad of new lipid biomarkers have been purported to correlate better than traditional lipid measures with cardiovascular risk. To assess the value of these novel biomarkers for routine use in risk prediction, investigators pooled data from 37 cohorts including more than 165,000 individuals with a median follow-up of 10 years.
The combination of apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I), lipoprotein(a) (Lp[a]), and lipoprotein-associated phospholipase A2 (Lp-PLA2) all performed worse than total cholesterol and HDL at predicting cardiovascular risk, and adding the newer markers to conventional risk factors improved risk prediction only slightly. By the authors' estimate, 13,622 of every 100,000 adults aged 40 or older would be classified at intermediate risk by conventional risk factors alone; the addition of combined apoB and apoA-I, Lp(a), or Lp-PLA2 would reclassify 1.1%, 4.1%, and 2.7%, respectively, to high risk. The estimated numbers requiring screening to prevent one cardiovascular event over 10 years were about 4500 for combined apoB and apoA-I, 800 for Lp(a), and 1000 for Lp-PLA2.
Comment: This study, the largest to date, suggests that novel lipid biomarkers add little incremental value to traditional lipid measures for risk prediction — the predictive power of lipoprotein(a), the best of the markers studied, was not good enough to recommend routine testing. Clinicians should reserve these tests for patients in whom conventional risk factors might not fully inform risk assessment or treatment decisions — for example, those with a strong family history of premature cardiovascular disease.
— JoAnne M. Foody, MD Published in Journal Watch Cardiology July 18, 2012
Citation(s): The Emerging Risk Factors Collaboration. Lipid-related markers and cardiovascular disease prediction. JAMA 2012 Jun 20; 307:2499.
http://www.ncbi.nlm.nih.gov/pubmed/22797450?dopt=Abstract
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