News

Erectile Dysfunction -- The Canary In The Mineshaft?

New research into urologic conditions - such as erectile dysfunction - indicate that these disorders could be associated with or precursors to more serious conditions, and suggest a need for practitioners to view these diseases in the greater context of total health as opposed to isolated disorders. A special session highlighting the association on urologic diseases with non-urologic conditions such as heart disease and metabolic syndrome was presented during the 102nd Annual Scientific Meeting of the American Urological Association. A special session for the media was moderated by Marshall L. Stoller, M.D.

ENDOTHELIAL DYSFUNCTION AND OXIDATIVE STRESS ASSOCIATED WITH THE METABOLIC SYNDROME CAN BE REVERSED BY A CHRONIC TREATMENT WITH SILDENAFIL (Abstract 686)

Metabolic syndrome is characterized by a number of conditions, including elevated blood pressure, excess body fat around the waist and insulin resistance. Many patients with these conditions also exhibit endothelial dysfunction with increases in oxidative stress and decreases in nitric oxide production - which has been related to erectile dysfunction (ED). Researchers from France explored whether treatment with sildenafil - a common pharmacologic treatment for ED - could improve endothelial dysfunction in a rat model.

Researchers administered sildenafil to fructose-fed rats to achieve plasma concentrations known to give efficacy in men and observed endothelial function and oxidative stress in the animals during treatment and one-week after treatment had been stopped. It was observed that chronic sildenafil treatment improved endothelial function and oxidative stress, suggesting that this treatment could be a benefit for cardiovascular indications as well as erectile dysfunction.

ERECTILE DYSFUNCTION AND CORONARY HEART DISEASE (Abstract 864)

Research has shown a connection between erectile dysfunction (ED) and cardiovascular disease (CVD) in men, and has established a need to consider one a precursor to the other. Researchers further evaluated the association of these two conditions and whether the association could be age-related.

A random sample of men from the Olmsted County population was evaluated by questionnaire, and community medical records of the subjects were examined. Logistical regression models examined the associations between ED and CVD. Men with CVD were 4.2 times more likely to have ED than men without heart disease. The results underscore a need to consider sexual function in men with heart disease and CVD in men with ED.

ERECTILE DYSFUNCTION, METABOLIC SYNDROME, HYPOGONADISM ARE INTERTWINED (Abstract 863)

If left untreated, metabolic syndrome can lead to an increased risk for diabetes mellitus and cardiovascular disease - both known risk factors for erectile dysfunction (ED). Hypogonadism, or low testosterone, is an etiological factor for metablic syndrome and an etiological factor in ED. Using a sample of men with ED, German researchers investigated symptoms and incidence of metabolic syndrome and hypogonadism.

771 erectile dysfunction patients were given comprehensive screening for symptoms of hypogonadism and metabolic syndrome over a two-year period. 18.3 percent had testosterone levels less than 12 nmol/L. Of this hypogonadal subgroup, average abdominal girth was 112.2 cm, 35 percent had arterial hypertension, 21 percent were dyslipemic and 14 percent had benign prostatic hyperplasia or lower urinary tract symptoms. In this group, eight men had not yet been diagnosed with diabetes mellitus, 12 had not been diagnosed with dyslipemia and five had not yet been diagnosed with heart disease. These results indicate a link between erectile dysfunction and other major health conditions, and suggest that erectile dysfunction be considered a portal to men's health. Treatment for erectile dysfunction should involve corresponding treatment of underlying metabolic syndrome conditions and hypogonadism.

SERUM BIOMARKERS OF ENDOTHELIAL FUNCTION AND OXIDATIVE STRESS AFTER DAILY DOSING OF SILDENAFIL IN TYPE 2 DIABETIC MEN WITH ERECTILE DYSFUNCTION (Abstract 955)

It is known that erectile dysfunction (ED), particularly in diabetic men, is often characterized by increased oxidative stress and decreased endothelial function. Johns Hopkins researchers investigated whether daily long-term sildenafil treatment can provide vasculoprotective effects in these patients in a multi-center, randomized, double-blind, placebo-controlled two-arm study. Using a group of 300 men with documented ED and type 2 diabetes mellitus, researchers measured serum biomarkers for endothelial function (cyclic guanosine monophosphate, or cGMP) and oxidative stress (8 isoprostane). Inflammatory cytokines were measured using Bio-Plex suspension array sytem assays for interleukin-6 and interleukin-8. Erectile dysfunction was measured based on affirmative responses to question 4 of the Sexual Health Inventory-Male which asks about a patient's ability to maintain an erection for sexual intercourse.

Endothelial function increased and oxidative stress decreased in the treatment group with no significant change noted in the placebo group. Erectile function improved in the treatment group with 22.8 percent at baseline and 58.2 percent at four weeks. Statistically significant change was not observed in the placebo group with 27.8 percent at baseline vs 30.7 percent at four weeks.

BODY MASS INDEX AFFECTS THE RESPONSE TO SILDENAFIL IN MEN WITH MODERATE AND SEVERE LOWER URINARY TRACT SYMPTOMS (Abstract 1161)

A known link has been established between erectile dysfunction (ED) and cardiovascular risk factors such as obesity. A link has also been suggested between these factors and lower urinary tract symptoms (LUTS). This study from researchers in Chicago and New York analyzed a multi-center, double-blind, placebo-controlled study of men explores the connection between body mass index (BMI) and response to sildenafil in patients with ED and LUTS.

Men with scores less than or equal to 25 on the Erectile Function domain of the International Index of Erectile Funcation and an International Prostate Symptom Score greater or equal to 12 were given 50 mg of sildenafil (or matching placebo) nightly or one hour before sexual activity. After two weeks, dose was increased to 100 mg with the option of returning to the original dose. Patients were evaluated for erectile function, IPSS and flow rate (Qmax) and assessed by BMI category. Sildenafil improved erectile function scores independent of baseline BMI and IPSS scores were decreased in men taking sildenafil yet similar between BMI groups. Flow rate was not affected by the drug. Higher BMI appeared to have an association with more severe ED.

NEPHROLITHIASIS AND THE RISK OF CARDIOVASCULAR DISEASE (Abstract 1362)

Stone disease is a urologic condition whose etiology has not been completely characterized. Researchers in San Francisco and Boston have hypothesized a connection between stone disease and cardiovascular disease (CVD) in a large-cohort prospective analysis of 4,747 patients with a history of nephrolithiasis. CVD was defined as myocardial infarction, angina, need for coronary artery bypass graft and ischemic or hemorrhagic stroke.

Risk of CVD in men with a history of nephrolithiasis was 1.15; the risk was highest for angina among individual outcomes analyzed. No increased stroke risk was observed. While the statistical risk for CVD in stone disease patients was modest, results correlate with other studies investigating a link between CVD and nephrolithiasis and may contribute to the etiology of stone formation and the counseling of patients.

GENERAL OBESITY AS MEASURED BY WAIST CIRCUMFERENCE IS PREDICTIVE OF SEVERITY OF LOWER URINARY TRACT SYMPTOMS, SEXUAL DYSFUNCTION AND COMPONENTS OF THE METABOLIC SYNDROME (Abstract 1508)

Increased body mass index (BMI) and other components of metabolic syndrome have been linked to a number of urologic disorders, including erectile and voiding dysfunction. Researchers from New York and Illinois suggest that measurement of waist circumference may be a useful predictor for the severity of lower urinary tract symptoms (LUTS) and prostate volume. Baseline parameters - International Prostate Symptom Score (IPSS), prostate volume (measured by ultrasound), serum prostate-specific antigen (PSA), flow rate and erectile and ejaculatory dysfunction - were gathered, along with data on the incidence of hypertension, coronary artery disease and diabetes mellitus were compared among the 88 men in the study. Men were divided into three groups based on waist circumference (30-36 inches, 36-40 inches and greater than 40 inches).

Significant positive relationships between waist circumference and prostate volume, PSA, IPSS, erectile dysfunction and ejaculatory dysfunction were observed. Flow rates were inversely related. Higher waist circumference was also associated with an increase in diabetes mellitus, hypertension and coronary artery disease. These data suggest that increased waist circumference is associated with voiding and sexual dysfunction, and increase in metabolic syndrome disorders.

###

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 15,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients, including UrologyHealth.org, an award-winning on-line patient education resource, and the American Urological Association Foundation, Inc., formerly AFUD.

Contact: Wendy Isett
American Urological Association

Constipation, IBS In Women May Be Alleviated By Novel Treatments

Three new therapy options, including two novel medications, showed promise in the treatment of irritable bowel syndrome (IBS), according to research presented at Digestive Disease Week 2007 (DDW). Participants in the studies who received one of the two investigational medications experienced significant relief in constipation, while a third study demonstrated the benefits of hypnotherapy in treating bowel and abdominal complications in children. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

"With few successful treatment options currently available for IBS sufferers, these studies represent promising progress in the treatment of this and other bowel disorders," said Mar'a Abreu, M.D., Director, Inflammatory Bowel Disease Center, Associate Professor of Medicine, Mount Sinai School of Medicine.

Lubiprostone Significantly Improves Symptom Relief Rates in Adults with Irritable Bowel Syndrome and Constipation (IBS-C): Data from Two, Twelve-week, Randomized, Placebo-Controlled, Double-blind Trials (Abstract #639f)

Lubiprostone is a novel therapy indicated for treatment of chronic idiopathic constipation in adults. Two twelve-week, independent studies showed patients who received lubiprostone were nearly twice as likely as those who did not receive the treatment to report moderate or significant relief of IBS symptoms. Endpoints included abdominal discomfort, stool consistency, straining and others. Lubiprostone was also well-tolerated, with only one percent of patients experiencing serious adverse events and only 22 percent of patients experiencing related adverse events, compared with 21 percent of patients on placebo.

The studies included more than 1,100 patients, most of whom were female (91.6%) and aged 18-65 years (91.7%). Participants were given either lubiprostone or placebo for 12 weeks and asked to rate their IBS symptoms. To be considered a monthly responder, patients had to report moderate relief four out of four weeks or significant relief two out of four weeks. Overall responders were defined as those who had been monthly responders two out of three months.

"The lubiprostone study demonstrates the continuing need for new and emerging therapies for IBS, especially for women," said Douglas A. Drossman, M.D., Co-Director, University of North Carolina Center for Functional Gastrointestinal and Motility Disorders in Chapel Hill, N.C., and lead author of the study. "We believe more research needs to be done to better determine lubiprostone's benefits and tolerability, but this study suggests people suffering from IBS and constipation may soon have another option for relief."

Dr. Drossman presented this study.

Effects of Novel, First-in-Class Guanylate Cyclase-C Activator, Linaclotide Acetate (MD-1100), on Gastrointestinal and Colonic Transit and Bowel Habits in Patients with Constipation-Predominant Irritable Bowel Syndrome (C-IBS) (Abstract #532)

Researchers are continually looking for unique pathways to treat digestive diseases, such as constipation and irritable bowel syndrome. Linaclotide is a novel therapy that works on a transmembrane protein in the lining of the gut called guanylate cyclase-C (GC-C). Specific gut hormones utilize GC-C to regulate intestinal fluid secretion. Linaclotide is unique in that it exerts its effect locally in the intestine while having minimal systemic exposure.

Thirty-six women suffering from IBS with constipation (IBS-C) were examined in a double-blind, placebo-controlled study, which consisted of a five-day baseline and a five-day treatment period. The endpoints were gastrointestinal transit and bowel function. Patients who received linaclotide experienced a significant acceleration of ascending colon emptying and overall colonic transit as well as a significant improvement in stool consistency, stool frequency, ease of passage and time to first bowel movement. The degree to which stool was loosened was strongly dependent on the dosage of linaclotide administered.

"Among the study participants, linaclotide was able to improve a range of bowel functions, which are typically impaired in patients with IBS-C," said Viola Andresen, M.D., of Mayo Clinic in Rochester, Minn., and lead author of this study. "Clearly additional studies are warranted, but we remain optimistic that this treatment may hold promise for people with constipation-predominant IBS."

Dr. Andresen presented this study

Hypnotherapy for Children with Functional Abdominal Pain or Irritable Bowel Syndrome: a Randomized Controlled Trial (Abstract #914)

As hypnotherapy has demonstrated effectiveness in adults with IBS, researchers sought to compare its effects in children to standard medical therapy commonly used for the condition as an alternative to drug therapy.

The study involved 53 patients between eight and 18 years old with FAP or IBS, who were administered six half-hour hypnotherapy sessions over a three-month period. Endpoints were pain intensity, pain frequency and other symptoms, such as nausea, headache and appetite, which were recorded at baseline, one, two, and three months after randomization and six and 12 months after therapy. Researchers defined "cure" as those who experienced greater than 80 percent improvement in pain.

The study revealed that hypnotherapy was superior to conventional therapy for children with longstanding functional abdominal pain (FAP) or IBS, curing 59 percent of the patients, versus just 12 percent of patients who received conventional therapy. After one year, the figures were 85 percent and 25 percent, respectively. Patients who received hypnotherapy also experienced less pain after treatment compared to the group that received conventional therapy.

"Our team was pleased to learn that the demonstrated benefits of hypnotherapy on IBS complications appear to be translatable to children," said Arine M. Vlieger, M.D., Ph.D., of St. Antonius Hospital in Nieuwegein, Netherlands, and lead author of the study. "Hopefully, these findings will be confirmed with additional research so that more children can experience relief from the symptoms of IBS without adherence to a medication regimen."

Dr. Vlieger will present this study on Wednesday, May 23, at 11:30 a.m. in Room 140.

###

Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 19-24, 2007 in Washington, D.C. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

Contact: Aimee Frank
American Gastroenterological Association

New Research Has Shown Vacuum Cleaning To Be Largely Ineffective At Removing Dust Mite Allergen

Conducted by the Woolcock Institute of Medical Research the research found that vacuum cleaning was an ineffective allergy avoidance measure because it removed dust mite allergen from carpets in an inconsistent and incomplete manner.

This is particularly true of worn carpets where the study results indicate vacuum cleaning may in fact change the distribution of dust mite allergen within the carpet, rather than removing allergen from all depths equally.

Woolcock Researcher Jason Sercombe said that given that carpets are a major reservoir of dust mite allergen and vacuum cleaning is the most common method of allergen control, the results are particularly relevant to professionals interested in limiting people's exposure to common allergens.

"The results also help to explain why many trials aimed at reducing people's exposure to indoor allergens - some even going so far as to install new furniture - have had limited success.

"Although soft furnishings such as beds contain more concentrated sources of allergy-causing protein produced by house dust mites (known as Der p 1), the large size of carpet means it is likely to contain a larger total amount of allergen than other items in a home," said Mr Sercombe.

"Allergen avoidance measures that rely solely on vacuum cleaning are likely to be of limited success unless more rigorous cleaning than standard home vacuuming is performed."

The Woolcock study also showed the type of vacuum cleaners with rotating brushes in the head removed more dirt and allergen from the carpets than those without. However, rotating brushes may serve to kick dust up into the air if the suction component of the cleaner is not operating properly.

For the first time, the study demonstrated that carpets after several years of use in domestic conditions not only contain large amounts of Der p 1 allergen but that this allergen occurs throughout the depth of carpets with no consistent pattern.

The Woolcock Institute conducted the study in an attempt to better understand how allergen avoidance measures can be applied to carpets. It examined the vertical distribution of the allergy-causing protein produced by house dust mites present in several used carpets before and after a standardised vacuuming procedure using either of two styles of dry vacuum cleaner.

"Overseas studies have found that vacuum cleaners with two or three layer bags performed better than those with a single layer bag, and the maintenance of the cleaner and integrity of seals and gaskets were important factors in effective cleaning," Mr Sercombe said.

"There are many vacuum cleaners on the market that claim to be suited to allergy sufferers. The most important aspect to look for is HEPA (high efficiency particulate air filter) filtration which is finding its way into some very affordable models."

Dust mite allergen exposure can be reduced by:

-- Washing bedding items weekly in hot water (55 degrees C or more, special anti-mite additives provide little additional benefit over hot water with normal detergent)
-- Avoiding non-washable items such as sheepskins
-- Regularly washing pillows and doonas and/or purchasing mite-resistant covers
-- Washing any stuffed toys

www.woolcock.org.au

Pimple Treatment And Causes

What Are Pimples And How Do I Fight Them?

Pimples are small skin lesions or inflammations of the skin. They are commonly caused by clogged or infected pores. Pimples usually develop after blackheads or whiteheads have become infected. When breakouts of pimples occur often, it is considered acne. There are many causes of acne, including bacterial folliculitis, keratosis pilatis and other skin conditions. It is highly recommended that if these conditions exist, that they are treated immediately. Often, if not treated, these conditions can lead to severe acne. Most times, when acne is ignored, it can leave visible scars on your skin.

Many teenagers experience pimple outbreaks. It is at this time that the skin attempts to adjust to hormonal changes that occur during puberty. However, many adults suffer from acne as well. Women typically develop pimple outbreaks during their menstrual cycle. This happens because hormones surge before or during menstrual cycles causing excess oil to clog pores.

Why Do Pimples Arise?

Our skin consists of millions of tiny pores. These pores are connected to oil glands. Once these oil glands are blocked by dirt or other factors, the oily substance, (called sedum) clogs our pores causing pimple outbreaks. A major contributor to the outbreak of pimples is the elevation of hormones, usually occurring during puberty or menstrual cycles in women. This results in the hormone by-product called DHT. This hormone by-product overstimulates the oil gland resulting in clogging of the pores, which then results in acne production. To address and help treat this problem, there are creams and ointments available over the counter. These ointments can easily be applied topically to the blemish. However, if the condition seems to worsen, it is recommended that you see a dermatologist or skin expert immediately.

How Do You Treat Pimples?

The best advice to maintain a good complexion is to address the problem of acne before it begins to exist. You can begin by following a regular skin cleansing regimen to rid your pores of unwanted particles and dirt. The easier it is for your skin to breathe, the fewer problems will occur. It requires some discipline and patience to maintain a skin regimen, but you will be thankful in the long run.

However, if you have an already existing skin condition, there are many things that can be done to help this ongoing problem.

It is advised not to attempt to extract the sedum yourself. This could lead to further infection and scarring. Another piece of good advice, is to avoid touching your face often, especially if you already have pimples. Increased friction on the pimple will cause it to close up further, making extraction a lot more difficult.

Purchase oil-free and antibacterial cleansers made especially to combat pimple outbreaks. Be careful not to over scrub, however. Your skin needs a certain amount of oil to remain healthy. Over scrubbing or over cleaning your skin may cause your skin to become too dry, which then may aggravate skin and will result in another set of outbreaks. Cleanse deeply, but moderately. In fact, some skin experts even recommend that you wash only with water and mild soap, such as baby soap. It is also advised not to switch cleansing products too often. This may also cause allergies and other skin problems.

If you feel you are able to treat your own outbreaks by extracting pimples, be sure to do so under extremely sanitary conditions. Only attempt to extract blackheads or whiteheads. If red pustules are manipulated, they may result in the spread of acne when then results in scarring of the skin. Use sterile materials and be sure to wash your hands thoroughly before and after extraction. In severe conditions, an injection is available from dermatologists or aestheticians called kenalog. This is a steroid that can aide in clearing the breakout in six to twenty hours.

If your pimple outbreaks recur often, it may be best to consult a doctor for treatment.

www.clearogen.com

Suicide Gene Therapy Kills Bowel Cancer Cells

An innovative type of gene therapy has for the first time succeeded in making bowel cancer cells commit suicide, according to a report in Cancer Research* this week.

The therapy, developed by Cancer Research UK-funded scientists at The Institute of Cancer Research, combines cutting-edge techniques to target tumour cells. Known as GDEPT (Gene-Directed Enzyme Prodrug Therapy), the treatment uses a virus to attack cancer cells.

But the researchers have added an extra gene to the virus. The virus is programmed to switch on the gene only if it reaches a tumour. When the gene is switched on, the virus produces a protein that activates an otherwise harmless 'prodrug', given separately.

Because this drug is only activated in tumours, it selectively kills only cancer cells. In normal tissue, the drug remains inactive, so healthy cells are not affected.

This is the first time such a therapy has proved successful at killing bowel cancer cells, albeit only in the laboratory. Cancer Research UK and The Institute of Cancer Research are supporting the development of the therapy, and hope to take it into early clinical trials in the future.

Lead researcher, Professor Caroline Springer of The Institute's Cancer Research UK Centre for Cancer Therapeutics, said: "We have developed a smart method to selectively target cancer cells. Normal cells are spared because the virus doesn't produce the protein that activates the drug unless it is inside a tumour.

"The beauty of our approach is that the cancer cells are made to commit suicide both by the virus and the activated drug ��" the two work in tandem. And once activated, the drug has the added bonus of causing the virus to produce more of the activating protein, which activates more of the drug, and so on. It's the first time we've seen a 'positive feedback loop' like this in a GDEPT therapy."

The drug damages DNA inside the cancer cells to the point where the cells stop functioning. They have no choice but to shut down and die.

Another benefit of the therapy is that it doesn't just kill only the cancer cells infected by the virus.

"We also see a significant 'bystander effect'," added Prof Springer. "This means the cells killed by the virus or the drug release signals into the tumour that tell neighbouring cancer cells to die too."

In lab experiments, mice with bowel tumours that received the therapy lived twice as long as those that did not. The researchers suggest their technique could one day be used as a treatment for advanced bowel cancer that doesn't respond to standard chemotherapy.

Professor John Toy, medical director of Cancer Research UK, said: "GDEPT therapy has been in development for several years. But this study shows the technique - always a smart therapy - is becoming ever more sophisticated. For the first time it has been shown to be effective at killing bowel cancer cells in a laboratory model of human colon cancer. This is another stride towards the possible use of GDEPT for cancer patients."

* Cancer Research, Vol 67 Issue 10

GDEPT: an oncolytic adenovirus is injected into the bloodstream. The virus's DNA contains an added gene for CPG2 (Carboxypeptidase G2) but the gene is controlled so that it is only translated in the presence of telomerase, an enzyme found in many cancers but much less so in normal tissue. When the virus reaches a tumour that is producing telomerase, the gene is translated and the virus produces the protein CPG2.

Meanwhile a "prodrug" is injected. A prodrug is an inactive form of a drug. In this case the prodrug, called ZD2767P, is activated by CPG2 - hence it is only activated in regions of the body where the virus is producing CPG2, i.e. in tumours.

The Institute of Cancer Research

The Institute of Cancer Research is Europe's leading cancer research centre with expert scientists working on cutting edge research. It was founded in 1909 to carry out research into the causes of cancer and to develop new strategies for its prevention, diagnosis, treatment and care. The Institute works in a unique partnership with The Royal Marsden NHS Foundation Trust, forming the largest comprehensive cancer centre in Europe. This relationship enables close daily contact with those on the frontline in the fight against cancer - the clinicians, the carers and most importantly, the patients.

About Cancer Research UK

· Together with its partners and supporters, Cancer Research UK's vision is to beat cancer.
· Cancer Research UK carries out world-class research to improve understanding of the disease and find out how to prevent, diagnose and treat different kinds of cancer.
· Cancer Research UK ensures that its findings are used to improve the lives of all cancer patients.
· Cancer Research UK helps people to understand cancer, the progress that is being made and the choices each person can make.
· Cancer Research UK works in partnership with others to achieve the greatest impact in the global fight against cancer.

www.cancerresearchuk.org

Health News Library in Chinese