Robert Finn

SAN FRANCISCO — Added to norepinephrine, low-dose vasopressin decreased mortality in one group of patients with septic shock, Dr. James Russell reported at the International Conference of the American Thoracic Society.

In a multicenter, randomized controlled trial, vasopressin at a dose of 0.03 U/min decreased mortality at 28 days and at 90 days in patients with less severe septic shock, but not in patients with more severe septic shock.

The reduction in mortality did not come at the expense of additional serious adverse events, said Dr. Russell of the University of British Columbia, Vancouver.

For the purposes of the trial, patients with more severe septic shock were defined as those needing more than 15 mcg/min of norepinephrine in the hour before randomization. Patients needing 5–15 mcg/min of norepinephrine formed the less severe group.

A total of 779 patients participated in the trial, all of whom were very ill, with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores averaging 27. About half of the patients were in the less severe subgroup.

The less severe patients receiving vasopressin in addition to norepinephrine had a 9% absolute reduction in the risk of death at 28 days (36% to 27%), and a 10% absolute reduction in the risk of death at 90 days (46% to 36%), when compared with patients taking norepinephrine alone.

In the patients in the more severe subgroup, vasopressin was not associated with significant decreases in mortality at either 28 days or 90 days.

Physicians conducting the study were blinded as to whether they were administering vasopressin or norepinephrine. Patients were started at a steady infusion rate of 5 mL/min, corresponding to 0.01 U/min of vasopressin or 5 mcg/min of norepinephrine. The study drug was titrated from 5 to 15 mL/min over the course of 40 minutes in order to reach a mean arterial pressure of 65–75 mm Hg.

Once the patients were stable for 8 hours and receiving open-label vasopressors, they were weaned off the study drug.

SAN FRANCISCO — Added to norepinephrine, low-dose vasopressin decreased mortality in one group of patients with septic shock, Dr. James Russell reported at the International Conference of the American Thoracic Society.

In a multicenter, randomized controlled trial, vasopressin at a dose of 0.03 U/min decreased mortality at 28 days and at 90 days in patients with less severe septic shock, but not in patients with more severe septic shock.

The reduction in mortality did not come at the expense of additional serious adverse events, said Dr. Russell of the University of British Columbia, Vancouver.

For the purposes of the trial, patients with more severe septic shock were defined as those needing more than 15 mcg/min of norepinephrine in the hour before randomization. Patients needing 5–15 mcg/min of norepinephrine formed the less severe group.

A total of 779 patients participated in the trial, all of whom were very ill, with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores averaging 27. About half of the patients were in the less severe subgroup.

The less severe patients receiving vasopressin in addition to norepinephrine had a 9% absolute reduction in the risk of death at 28 days (36% to 27%), and a 10% absolute reduction in the risk of death at 90 days (46% to 36%), when compared with patients taking norepinephrine alone.

In the patients in the more severe subgroup, vasopressin was not associated with significant decreases in mortality at either 28 days or 90 days.

Physicians conducting the study were blinded as to whether they were administering vasopressin or norepinephrine. Patients were started at a steady infusion rate of 5 mL/min, corresponding to 0.01 U/min of vasopressin or 5 mcg/min of norepinephrine. The study drug was titrated from 5 to 15 mL/min over the course of 40 minutes in order to reach a mean arterial pressure of 65–75 mm Hg.

Once the patients were stable for 8 hours and receiving open-label vasopressors, they were weaned off the study drug.

SAN FRANCISCO — Added to norepinephrine, low-dose vasopressin decreased mortality in one group of patients with septic shock, Dr. James Russell reported at the International Conference of the American Thoracic Society.

In a multicenter, randomized controlled trial, vasopressin at a dose of 0.03 U/min decreased mortality at 28 days and at 90 days in patients with less severe septic shock, but not in patients with more severe septic shock.

The reduction in mortality did not come at the expense of additional serious adverse events, said Dr. Russell of the University of British Columbia, Vancouver.

For the purposes of the trial, patients with more severe septic shock were defined as those needing more than 15 mcg/min of norepinephrine in the hour before randomization. Patients needing 5–15 mcg/min of norepinephrine formed the less severe group.

A total of 779 patients participated in the trial, all of whom were very ill, with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores averaging 27. About half of the patients were in the less severe subgroup.

The less severe patients receiving vasopressin in addition to norepinephrine had a 9% absolute reduction in the risk of death at 28 days (36% to 27%), and a 10% absolute reduction in the risk of death at 90 days (46% to 36%), when compared with patients taking norepinephrine alone.

In the patients in the more severe subgroup, vasopressin was not associated with significant decreases in mortality at either 28 days or 90 days.

Physicians conducting the study were blinded as to whether they were administering vasopressin or norepinephrine. Patients were started at a steady infusion rate of 5 mL/min, corresponding to 0.01 U/min of vasopressin or 5 mcg/min of norepinephrine. The study drug was titrated from 5 to 15 mL/min over the course of 40 minutes in order to reach a mean arterial pressure of 65–75 mm Hg.

Once the patients were stable for 8 hours and receiving open-label vasopressors, they were weaned off the study drug.

SAN FRANCISCO — Patients over the age of 70 do almost as well after heart transplants as younger recipients, unless they are infected with hepatitis C, according to a poster presentation by Dr. Jignesh K. Patel at the American Transplant Congress.

In a retrospective analysis, Dr. Patel and colleagues from the University of California, Los Angeles, compared 25 heart recipients aged 70-75 years (mean of 72 years) with 246 younger patients (mean of 56 years).

There were no differences between the groups in early cardiac allograft vasculopathy or in the percentage of patients being treated for rejection during the first year.

The younger patients did have a significantly higher 5-year survival rate than did the older patients–80% vs. 64%. However, when the investigators excluded from the analysis all patients with hepatitis C at the time of transplant and those receiving organs from hepatitis C-positive donors, the difference in 5-year survival failed to reach statistical significance. Three of the nine patients who died in the older age group had hepatitis C prior to transplantation.

Since all the older patients were classified as status 2, indicating relatively low-risk patients who did not require intravenous medications, the investigators selected only status 2 recipients for the control group.

SAN FRANCISCO — Patients over the age of 70 do almost as well after heart transplants as younger recipients, unless they are infected with hepatitis C, according to a poster presentation by Dr. Jignesh K. Patel at the American Transplant Congress.

In a retrospective analysis, Dr. Patel and colleagues from the University of California, Los Angeles, compared 25 heart recipients aged 70-75 years (mean of 72 years) with 246 younger patients (mean of 56 years).

There were no differences between the groups in early cardiac allograft vasculopathy or in the percentage of patients being treated for rejection during the first year.

The younger patients did have a significantly higher 5-year survival rate than did the older patients–80% vs. 64%. However, when the investigators excluded from the analysis all patients with hepatitis C at the time of transplant and those receiving organs from hepatitis C-positive donors, the difference in 5-year survival failed to reach statistical significance. Three of the nine patients who died in the older age group had hepatitis C prior to transplantation.

Since all the older patients were classified as status 2, indicating relatively low-risk patients who did not require intravenous medications, the investigators selected only status 2 recipients for the control group.

SAN FRANCISCO — Patients over the age of 70 do almost as well after heart transplants as younger recipients, unless they are infected with hepatitis C, according to a poster presentation by Dr. Jignesh K. Patel at the American Transplant Congress.

In a retrospective analysis, Dr. Patel and colleagues from the University of California, Los Angeles, compared 25 heart recipients aged 70-75 years (mean of 72 years) with 246 younger patients (mean of 56 years).

There were no differences between the groups in early cardiac allograft vasculopathy or in the percentage of patients being treated for rejection during the first year.

The younger patients did have a significantly higher 5-year survival rate than did the older patients–80% vs. 64%. However, when the investigators excluded from the analysis all patients with hepatitis C at the time of transplant and those receiving organs from hepatitis C-positive donors, the difference in 5-year survival failed to reach statistical significance. Three of the nine patients who died in the older age group had hepatitis C prior to transplantation.

Since all the older patients were classified as status 2, indicating relatively low-risk patients who did not require intravenous medications, the investigators selected only status 2 recipients for the control group.

SAN FRANCISCO — Children who receive living donor liver transplants are at risk of developing hepatitis B if they have low antibody titers, according to a poster presentation by Dr. Chih-Che Lin at the American Transplant Congress.

In a study of 60 pediatric liver recipients (average age, 1.6 years), two children developed new hepatitis B infections following the transplant. Both of these children had low levels—less than 1,000 IU/L—of antibodies to hepatitis B surface antigen (anti-HBs).

In contrast, none of the 47 children with anti-HBs titers more than 1,000 IU/L developed new hepatitis B infections. This was a statistically significant difference, wrote Dr. Lin and colleagues from the Chang Gung University, Taoyuan, Taiwan.

Of the two children with new hepatitis B infections, one received a graft from a donor who was positive for antibodies to hepatitis B core antigen (anti-HBc), and the other received a graft from a donor who was anti-HBc negative. The presence of antibodies to hepatitis B core antigen is a marker of acute, chronic, or resolved HB virus infection. The meeting was cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

SAN FRANCISCO — Children who receive living donor liver transplants are at risk of developing hepatitis B if they have low antibody titers, according to a poster presentation by Dr. Chih-Che Lin at the American Transplant Congress.

In a study of 60 pediatric liver recipients (average age, 1.6 years), two children developed new hepatitis B infections following the transplant. Both of these children had low levels—less than 1,000 IU/L—of antibodies to hepatitis B surface antigen (anti-HBs).

In contrast, none of the 47 children with anti-HBs titers more than 1,000 IU/L developed new hepatitis B infections. This was a statistically significant difference, wrote Dr. Lin and colleagues from the Chang Gung University, Taoyuan, Taiwan.

Of the two children with new hepatitis B infections, one received a graft from a donor who was positive for antibodies to hepatitis B core antigen (anti-HBc), and the other received a graft from a donor who was anti-HBc negative. The presence of antibodies to hepatitis B core antigen is a marker of acute, chronic, or resolved HB virus infection. The meeting was cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

SAN FRANCISCO — Children who receive living donor liver transplants are at risk of developing hepatitis B if they have low antibody titers, according to a poster presentation by Dr. Chih-Che Lin at the American Transplant Congress.

In a study of 60 pediatric liver recipients (average age, 1.6 years), two children developed new hepatitis B infections following the transplant. Both of these children had low levels—less than 1,000 IU/L—of antibodies to hepatitis B surface antigen (anti-HBs).

In contrast, none of the 47 children with anti-HBs titers more than 1,000 IU/L developed new hepatitis B infections. This was a statistically significant difference, wrote Dr. Lin and colleagues from the Chang Gung University, Taoyuan, Taiwan.

Of the two children with new hepatitis B infections, one received a graft from a donor who was positive for antibodies to hepatitis B core antigen (anti-HBc), and the other received a graft from a donor who was anti-HBc negative. The presence of antibodies to hepatitis B core antigen is a marker of acute, chronic, or resolved HB virus infection. The meeting was cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

A bivalent vaccine for human papillomavirus manufactured by GlaxoSmithKline has shown greater than 90% efficacy against high-grade cervical intraepithelial neoplasia, according to interim results from a large, randomized controlled trial published online in the Lancet.

The study, led by Dr. Jorma Paavonen and colleagues, is called the Papilloma Trial to Prevent Cervical Cancer in Young Adults (PATRICIA), and involves 18,644 women, aged 15–25 years, from 14 countries in Europe, Asia, and North America. The participants were randomly assigned to receive three injections of the human papillomavirus (HPV) vaccine or a hepatitis A vaccine at months 0, 1, and 6 (Lancet 2007; DOI:10.1016/S0140-6736[07]60946-5).

The study was sponsored by GlaxoSmithKline. Several study investigators were employees of the company, and others, including Dr. Paavonen of the University of Helsinki received consulting and lecture fees from the pharmaceutical firm.

The vaccine, Cervarix, has not yet been approved by the Food and Drug Administration. If it is approved, it will be competing against Merck's already released HPV vaccine, Gardasil. Cervarix is a bivalent vaccine, active against HPV types 16 and 18, which account for 70% of all cases of cervical cancer. Gardasil is a quadrivalent vaccine, active against HPV types 6 and 11 (the cause of 90% of genital warts) in addition to types 16 and 18.

In the current study, only 2 of the 9,319 women receiving Cervarix developed cervical intraepithelial neoplasia (CIN) of grade 2 or 3 and related to HPV 16 or 18, compared with 21 of the 9,325 women in the control group. This translates into an efficacy of 90%.

The vaccine also showed 89% efficacy against grade 1 or higher CIN.

Virtually all the women receiving the HPV vaccine (99.5%) had developed antibodies against HPV 16 and 18 after the second of the three injections.

In an accompanying editorial, Dr. Jessica A. Kahn of the University of Cincinnati and Dr. Robert D. Burk of the Albert Einstein College of Medicine, New York, described these results as “encouraging,” while sounding a note of caution (Lancet 2007; DOI:10.1016/S0140-6736[07]60947-7).

They noted that the follow-up time was only about 15 months, which is short compared with the several decades over which cervical cancer often evolves. The enrollment criteria in the trial were relatively narrow, so it's unknown whether seroconversion rates, antibody titers, and efficacy rates will be as high when the vaccine is distributed to a wider population.

Dr. Kahn and Dr. Burk also emphasized that the vaccine was not without side effects. Although generally well tolerated and safe, the HPV vaccine caused significantly more local adverse events such as pain, redness, and swelling, than did the hepatitis A vaccine. Risks of general adverse events, including arthralgia, fatigue, and myalgia, also were significantly higher in the HPV group.

Dr. Kahn and Dr. Burk stressed the need for the vaccine to be made available in less-developed regions of the world, where cervical cancer makes the largest contribution to years of life lost to cancer. “Poverty is strongly associated with high-risk HPV infection and cervical cancer,” they wrote. “If those who live in poverty cannot access highly effective interventions such as HPV vaccines, disparities could worsen dramatically.”

A bivalent vaccine for human papillomavirus manufactured by GlaxoSmithKline has shown greater than 90% efficacy against high-grade cervical intraepithelial neoplasia, according to interim results from a large, randomized controlled trial published online in the Lancet.

The study, led by Dr. Jorma Paavonen and colleagues, is called the Papilloma Trial to Prevent Cervical Cancer in Young Adults (PATRICIA), and involves 18,644 women, aged 15–25 years, from 14 countries in Europe, Asia, and North America. The participants were randomly assigned to receive three injections of the human papillomavirus (HPV) vaccine or a hepatitis A vaccine at months 0, 1, and 6 (Lancet 2007; DOI:10.1016/S0140-6736[07]60946-5).

The study was sponsored by GlaxoSmithKline. Several study investigators were employees of the company, and others, including Dr. Paavonen of the University of Helsinki received consulting and lecture fees from the pharmaceutical firm.

The vaccine, Cervarix, has not yet been approved by the Food and Drug Administration. If it is approved, it will be competing against Merck's already released HPV vaccine, Gardasil. Cervarix is a bivalent vaccine, active against HPV types 16 and 18, which account for 70% of all cases of cervical cancer. Gardasil is a quadrivalent vaccine, active against HPV types 6 and 11 (the cause of 90% of genital warts) in addition to types 16 and 18.

In the current study, only 2 of the 9,319 women receiving Cervarix developed cervical intraepithelial neoplasia (CIN) of grade 2 or 3 and related to HPV 16 or 18, compared with 21 of the 9,325 women in the control group. This translates into an efficacy of 90%.

The vaccine also showed 89% efficacy against grade 1 or higher CIN.

Virtually all the women receiving the HPV vaccine (99.5%) had developed antibodies against HPV 16 and 18 after the second of the three injections.

In an accompanying editorial, Dr. Jessica A. Kahn of the University of Cincinnati and Dr. Robert D. Burk of the Albert Einstein College of Medicine, New York, described these results as “encouraging,” while sounding a note of caution (Lancet 2007; DOI:10.1016/S0140-6736[07]60947-7).

They noted that the follow-up time was only about 15 months, which is short compared with the several decades over which cervical cancer often evolves. The enrollment criteria in the trial were relatively narrow, so it's unknown whether seroconversion rates, antibody titers, and efficacy rates will be as high when the vaccine is distributed to a wider population.

Dr. Kahn and Dr. Burk also emphasized that the vaccine was not without side effects. Although generally well tolerated and safe, the HPV vaccine caused significantly more local adverse events such as pain, redness, and swelling, than did the hepatitis A vaccine. Risks of general adverse events, including arthralgia, fatigue, and myalgia, also were significantly higher in the HPV group.

Dr. Kahn and Dr. Burk stressed the need for the vaccine to be made available in less-developed regions of the world, where cervical cancer makes the largest contribution to years of life lost to cancer. “Poverty is strongly associated with high-risk HPV infection and cervical cancer,” they wrote. “If those who live in poverty cannot access highly effective interventions such as HPV vaccines, disparities could worsen dramatically.”

A bivalent vaccine for human papillomavirus manufactured by GlaxoSmithKline has shown greater than 90% efficacy against high-grade cervical intraepithelial neoplasia, according to interim results from a large, randomized controlled trial published online in the Lancet.

The study, led by Dr. Jorma Paavonen and colleagues, is called the Papilloma Trial to Prevent Cervical Cancer in Young Adults (PATRICIA), and involves 18,644 women, aged 15–25 years, from 14 countries in Europe, Asia, and North America. The participants were randomly assigned to receive three injections of the human papillomavirus (HPV) vaccine or a hepatitis A vaccine at months 0, 1, and 6 (Lancet 2007; DOI:10.1016/S0140-6736[07]60946-5).

The study was sponsored by GlaxoSmithKline. Several study investigators were employees of the company, and others, including Dr. Paavonen of the University of Helsinki received consulting and lecture fees from the pharmaceutical firm.

The vaccine, Cervarix, has not yet been approved by the Food and Drug Administration. If it is approved, it will be competing against Merck's already released HPV vaccine, Gardasil. Cervarix is a bivalent vaccine, active against HPV types 16 and 18, which account for 70% of all cases of cervical cancer. Gardasil is a quadrivalent vaccine, active against HPV types 6 and 11 (the cause of 90% of genital warts) in addition to types 16 and 18.

In the current study, only 2 of the 9,319 women receiving Cervarix developed cervical intraepithelial neoplasia (CIN) of grade 2 or 3 and related to HPV 16 or 18, compared with 21 of the 9,325 women in the control group. This translates into an efficacy of 90%.

The vaccine also showed 89% efficacy against grade 1 or higher CIN.

Virtually all the women receiving the HPV vaccine (99.5%) had developed antibodies against HPV 16 and 18 after the second of the three injections.

In an accompanying editorial, Dr. Jessica A. Kahn of the University of Cincinnati and Dr. Robert D. Burk of the Albert Einstein College of Medicine, New York, described these results as “encouraging,” while sounding a note of caution (Lancet 2007; DOI:10.1016/S0140-6736[07]60947-7).

They noted that the follow-up time was only about 15 months, which is short compared with the several decades over which cervical cancer often evolves. The enrollment criteria in the trial were relatively narrow, so it's unknown whether seroconversion rates, antibody titers, and efficacy rates will be as high when the vaccine is distributed to a wider population.

Dr. Kahn and Dr. Burk also emphasized that the vaccine was not without side effects. Although generally well tolerated and safe, the HPV vaccine caused significantly more local adverse events such as pain, redness, and swelling, than did the hepatitis A vaccine. Risks of general adverse events, including arthralgia, fatigue, and myalgia, also were significantly higher in the HPV group.

Dr. Kahn and Dr. Burk stressed the need for the vaccine to be made available in less-developed regions of the world, where cervical cancer makes the largest contribution to years of life lost to cancer. “Poverty is strongly associated with high-risk HPV infection and cervical cancer,” they wrote. “If those who live in poverty cannot access highly effective interventions such as HPV vaccines, disparities could worsen dramatically.”

SAN FRANCISCO — Children who contract pulmonary lung infections in the year after receiving a lung transplant are 70% more likely to die than are those with no such infections, Dr. Lara A. Danziger-Isakov reported in a poster presentation at the American Transplant Congress.

This suggests that clinicians should consider prophylaxis in children judged to be at risk, concluded Dr. Danziger-Isakov, of the Cleveland Clinic, and her colleagues.

The multicenter, retrospective cohort analysis involved 555 patients at 12 centers, all of whom had data collected from the time of transplant until death, retransplantation, or 365 days after transplantation. During that time, 92 (17%) of those children contracted 99 pulmonary fungal infections, and 12 died.

The fungal infections occurred throughout the posttransplant year, with a mean of 78 days and a median of 26 days post transplant. Children with infections were significantly older than those without (15.2 years versus 12.6 years), and were significantly more likely to have pretransplant colonization. Candida and Aspergillus species were the most common organisms recovered from the infected children; 23% of the children with Aspergillus and the 7% of the children with Candida died, they said at the meeting cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

SAN FRANCISCO — Children who contract pulmonary lung infections in the year after receiving a lung transplant are 70% more likely to die than are those with no such infections, Dr. Lara A. Danziger-Isakov reported in a poster presentation at the American Transplant Congress.

This suggests that clinicians should consider prophylaxis in children judged to be at risk, concluded Dr. Danziger-Isakov, of the Cleveland Clinic, and her colleagues.

The multicenter, retrospective cohort analysis involved 555 patients at 12 centers, all of whom had data collected from the time of transplant until death, retransplantation, or 365 days after transplantation. During that time, 92 (17%) of those children contracted 99 pulmonary fungal infections, and 12 died.

The fungal infections occurred throughout the posttransplant year, with a mean of 78 days and a median of 26 days post transplant. Children with infections were significantly older than those without (15.2 years versus 12.6 years), and were significantly more likely to have pretransplant colonization. Candida and Aspergillus species were the most common organisms recovered from the infected children; 23% of the children with Aspergillus and the 7% of the children with Candida died, they said at the meeting cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

SAN FRANCISCO — Children who contract pulmonary lung infections in the year after receiving a lung transplant are 70% more likely to die than are those with no such infections, Dr. Lara A. Danziger-Isakov reported in a poster presentation at the American Transplant Congress.

This suggests that clinicians should consider prophylaxis in children judged to be at risk, concluded Dr. Danziger-Isakov, of the Cleveland Clinic, and her colleagues.

The multicenter, retrospective cohort analysis involved 555 patients at 12 centers, all of whom had data collected from the time of transplant until death, retransplantation, or 365 days after transplantation. During that time, 92 (17%) of those children contracted 99 pulmonary fungal infections, and 12 died.

The fungal infections occurred throughout the posttransplant year, with a mean of 78 days and a median of 26 days post transplant. Children with infections were significantly older than those without (15.2 years versus 12.6 years), and were significantly more likely to have pretransplant colonization. Candida and Aspergillus species were the most common organisms recovered from the infected children; 23% of the children with Aspergillus and the 7% of the children with Candida died, they said at the meeting cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

SAN FRANCISCO — People with obstructive sleep apnea have almost three times the risk of developing type 2 diabetes, according to a poster presentation by Dr. Nader Botros at the International Conference of the American Thoracic Society.

This increase in risk is independent of obesity, hypertension, age, race, and gender, commented Dr. Botros of Yale University, New Haven, Conn., in a press briefing.

Independent of other factors, obstructive sleep apnea (OSA) increases the risk of developing diabetes by 2.7 times. This is about the same magnitude as the increase in risk conferred by obesity alone, which was 2.9-fold increase in the study, Dr. Botros reported.

The study involved 544 patients who had been referred to the sleep laboratories at the Veterans Affairs Connecticut Healthcare System in West Haven, for an evaluation of suspected sleep-disordered breathing.

None of the patients included in the study had a known history of type 2 diabetes. Each patient underwent a full attended polysomnogram and was followed for up to 5 years.

Dr. Botros and his coinvestigators compared the 402 patients who were diagnosed with OSA with the 142 patients who did not qualify for the diagnosis.

Confirming other studies, patients with OSA were significantly older and heavier than the control patients were. Significantly greater percentages of patients with OSA were men and had hypertension at baseline.

The investigators divided the patients into quartiles based on their apnea-hypopnea index (AHI), a measurement of the severity of sleep apnea.

Compared with patients in the lowest quartile (those who had an AHI of less than 7), patients in the highest quartile (those with an AHI at least 46) had 4.6 times the risk of developing diabetes. Patients who were in the second and third quartile had intermediate hazard ratios, and the trend was statistically significant.

When the degree of hypoxia as measured by oxygen saturation was added to the multivariate analysis, OSA alone no longer emerged as a significant predictor of the development of type 2 diabetes, whereas hypoxia conferred a 2.9-fold increase in risk.

This indicates that at least some of the risk that was conferred by OSA can be explained by hypoxia.

The exact link between OSA, hypoxia, and type 2 diabetes remains unknown, Dr. Botros said, but there is evidence that sleep apnea activates the body's fight-or-flight response.

This in turn triggers a cascade of events including the production of high levels of cortisol, which has been tied to the development of insulin resistance and glucose intolerance. If these prediabetic conditions are left untreated, it can lead to the development of full-blown diabetes.

“Our next step will be to determine whether the treatment of sleep apnea can improve an individual's diabetic parameters and consequently the negative health affects of diabetes,” Dr. Botros said in a prepared statement.

This increase in risk for diabetes is independent of obesity, age, hypertension, race, and gender. DR. BOTROS

SAN FRANCISCO — People with obstructive sleep apnea have almost three times the risk of developing type 2 diabetes, according to a poster presentation by Dr. Nader Botros at the International Conference of the American Thoracic Society.

This increase in risk is independent of obesity, hypertension, age, race, and gender, commented Dr. Botros of Yale University, New Haven, Conn., in a press briefing.

Independent of other factors, obstructive sleep apnea (OSA) increases the risk of developing diabetes by 2.7 times. This is about the same magnitude as the increase in risk conferred by obesity alone, which was 2.9-fold increase in the study, Dr. Botros reported.

The study involved 544 patients who had been referred to the sleep laboratories at the Veterans Affairs Connecticut Healthcare System in West Haven, for an evaluation of suspected sleep-disordered breathing.

None of the patients included in the study had a known history of type 2 diabetes. Each patient underwent a full attended polysomnogram and was followed for up to 5 years.

Dr. Botros and his coinvestigators compared the 402 patients who were diagnosed with OSA with the 142 patients who did not qualify for the diagnosis.

Confirming other studies, patients with OSA were significantly older and heavier than the control patients were. Significantly greater percentages of patients with OSA were men and had hypertension at baseline.

The investigators divided the patients into quartiles based on their apnea-hypopnea index (AHI), a measurement of the severity of sleep apnea.

Compared with patients in the lowest quartile (those who had an AHI of less than 7), patients in the highest quartile (those with an AHI at least 46) had 4.6 times the risk of developing diabetes. Patients who were in the second and third quartile had intermediate hazard ratios, and the trend was statistically significant.

When the degree of hypoxia as measured by oxygen saturation was added to the multivariate analysis, OSA alone no longer emerged as a significant predictor of the development of type 2 diabetes, whereas hypoxia conferred a 2.9-fold increase in risk.

This indicates that at least some of the risk that was conferred by OSA can be explained by hypoxia.

The exact link between OSA, hypoxia, and type 2 diabetes remains unknown, Dr. Botros said, but there is evidence that sleep apnea activates the body's fight-or-flight response.

This in turn triggers a cascade of events including the production of high levels of cortisol, which has been tied to the development of insulin resistance and glucose intolerance. If these prediabetic conditions are left untreated, it can lead to the development of full-blown diabetes.

“Our next step will be to determine whether the treatment of sleep apnea can improve an individual's diabetic parameters and consequently the negative health affects of diabetes,” Dr. Botros said in a prepared statement.

This increase in risk for diabetes is independent of obesity, age, hypertension, race, and gender. DR. BOTROS

SAN FRANCISCO — People with obstructive sleep apnea have almost three times the risk of developing type 2 diabetes, according to a poster presentation by Dr. Nader Botros at the International Conference of the American Thoracic Society.

This increase in risk is independent of obesity, hypertension, age, race, and gender, commented Dr. Botros of Yale University, New Haven, Conn., in a press briefing.

Independent of other factors, obstructive sleep apnea (OSA) increases the risk of developing diabetes by 2.7 times. This is about the same magnitude as the increase in risk conferred by obesity alone, which was 2.9-fold increase in the study, Dr. Botros reported.

The study involved 544 patients who had been referred to the sleep laboratories at the Veterans Affairs Connecticut Healthcare System in West Haven, for an evaluation of suspected sleep-disordered breathing.

None of the patients included in the study had a known history of type 2 diabetes. Each patient underwent a full attended polysomnogram and was followed for up to 5 years.

Dr. Botros and his coinvestigators compared the 402 patients who were diagnosed with OSA with the 142 patients who did not qualify for the diagnosis.

Confirming other studies, patients with OSA were significantly older and heavier than the control patients were. Significantly greater percentages of patients with OSA were men and had hypertension at baseline.

The investigators divided the patients into quartiles based on their apnea-hypopnea index (AHI), a measurement of the severity of sleep apnea.

Compared with patients in the lowest quartile (those who had an AHI of less than 7), patients in the highest quartile (those with an AHI at least 46) had 4.6 times the risk of developing diabetes. Patients who were in the second and third quartile had intermediate hazard ratios, and the trend was statistically significant.

When the degree of hypoxia as measured by oxygen saturation was added to the multivariate analysis, OSA alone no longer emerged as a significant predictor of the development of type 2 diabetes, whereas hypoxia conferred a 2.9-fold increase in risk.

This indicates that at least some of the risk that was conferred by OSA can be explained by hypoxia.

The exact link between OSA, hypoxia, and type 2 diabetes remains unknown, Dr. Botros said, but there is evidence that sleep apnea activates the body's fight-or-flight response.

This in turn triggers a cascade of events including the production of high levels of cortisol, which has been tied to the development of insulin resistance and glucose intolerance. If these prediabetic conditions are left untreated, it can lead to the development of full-blown diabetes.

“Our next step will be to determine whether the treatment of sleep apnea can improve an individual's diabetic parameters and consequently the negative health affects of diabetes,” Dr. Botros said in a prepared statement.

This increase in risk for diabetes is independent of obesity, age, hypertension, race, and gender. DR. BOTROS

HOLLYWOOD, CALIF. – In treating children exposed to trauma, think about the DEFs once the ABCs are taken care of. That's the message Nancy Kassam-Adams, Ph.D., delivered at the annual meeting of the International Society for Traumatic Stress Studies.

“After Airway, Breathing, and Circulation, think about Distress, Emotional support, and Family,” said Dr. Kassam-Adams of Children's Hospital of Philadelphia.

A large percentage of children experience a serious injury or other trauma at some time during their childhood, and according to at least one study, 16% have posttraumatic stress symptoms months later, she said.

Parents are more likely to turn to their family doctor than to anyone else when seeking psychosocial assistance for children with acute stress, and in the 6 months after a serious injury 80% of families pay a median of three visits to their primary care physicians. These are golden opportunities to intervene and perhaps to prevent serious cases of posttraumatic stress disorder, Dr. Kassam-Adams said.

A child may experience distress from physical pain, anxiety, and grief or loss. One way to help is by assessing all of these factors, listening carefully to how the child understands the situation, correcting any misconceptions, and treating the child's physical ailments in a way that maximizes his or her control over the situation.

Reassurance and realistic hope can also be provided, and bereavement resources can be mobilized when necessary.

In assessing emotional support, ask both parent and child what works to help the child cope with difficult or scary things. Remember that the injured child is part of a family system, and other members of the family may have suffered injury or trauma as well.

Try to determine whether the family is coping well with the trauma and whether they will need outside help.

After the ABCs: DEFs of Traumatic Stress

HOLLYWOOD, CALIF. – In treating children exposed to trauma, think about the DEFs once the ABCs are taken care of. That's the message Nancy Kassam-Adams, Ph.D., delivered at the annual meeting of the International Society for Traumatic Stress Studies.

“After Airway, Breathing, and Circulation, think about Distress, Emotional support, and Family,” said Dr. Kassam-Adams of Children's Hospital of Philadelphia.

A large percentage of children experience a serious injury or other trauma at some time during their childhood, and according to at least one study, 16% have posttraumatic stress symptoms months later, she said.

Parents are more likely to turn to their family doctor than to anyone else when seeking psychosocial assistance for children with acute stress, and in the 6 months after a serious injury 80% of families pay a median of three visits to their primary care physicians. These are golden opportunities to intervene and perhaps to prevent serious cases of posttraumatic stress disorder, Dr. Kassam-Adams said.

A child may experience distress from physical pain, anxiety, and grief or loss. One way to help is by assessing all of these factors, listening carefully to how the child understands the situation, correcting any misconceptions, and treating the child's physical ailments in a way that maximizes his or her control over the situation.

Reassurance and realistic hope can also be provided, and bereavement resources can be mobilized when necessary.

In assessing emotional support, ask both parent and child what works to help the child cope with difficult or scary things. Remember that the injured child is part of a family system, and other members of the family may have suffered injury or trauma as well.

Try to determine whether the family is coping well with the trauma and whether they will need outside help.

After the ABCs: DEFs of Traumatic Stress

HOLLYWOOD, CALIF. – In treating children exposed to trauma, think about the DEFs once the ABCs are taken care of. That's the message Nancy Kassam-Adams, Ph.D., delivered at the annual meeting of the International Society for Traumatic Stress Studies.

“After Airway, Breathing, and Circulation, think about Distress, Emotional support, and Family,” said Dr. Kassam-Adams of Children's Hospital of Philadelphia.

A large percentage of children experience a serious injury or other trauma at some time during their childhood, and according to at least one study, 16% have posttraumatic stress symptoms months later, she said.

Parents are more likely to turn to their family doctor than to anyone else when seeking psychosocial assistance for children with acute stress, and in the 6 months after a serious injury 80% of families pay a median of three visits to their primary care physicians. These are golden opportunities to intervene and perhaps to prevent serious cases of posttraumatic stress disorder, Dr. Kassam-Adams said.

A child may experience distress from physical pain, anxiety, and grief or loss. One way to help is by assessing all of these factors, listening carefully to how the child understands the situation, correcting any misconceptions, and treating the child's physical ailments in a way that maximizes his or her control over the situation.

Reassurance and realistic hope can also be provided, and bereavement resources can be mobilized when necessary.

In assessing emotional support, ask both parent and child what works to help the child cope with difficult or scary things. Remember that the injured child is part of a family system, and other members of the family may have suffered injury or trauma as well.

Try to determine whether the family is coping well with the trauma and whether they will need outside help.

After the ABCs: DEFs of Traumatic Stress

LOS ANGELES — The use of statins—but not other lipid-lowering drugs—was associated with a substantial decrease in the incidence of prostate cancer in a large study of Finnish men, according to a poster presentation by Teemu Murtola at the annual meeting of the American Association for Cancer Research.

In a group of 23,320 men followed for up to 10 years in the Finnish Prostate Cancer Screening Trial, users of statins had a 4% incidence of prostate cancer, whereas non- users had an 8% incidence, a significant difference, said Mr. Murtola and his colleagues, of the University of Tampere (Finland).

The protective effect of statins was dose dependent. In statin users, men in the lowest quartile of total cumulative dose had a 6.2% incidence, whereas men in the highest quartile had a 1.8% incidence. The trend was statistically significant. Statin use was associated with significantly lower incidences of all categories of prostate cancer stages and grades. The greatest differences in incidence were observed for T2 (2.5% vs. 0.9%) and T3 cancers (0.6% vs. 0.2%).

Use of other cholesterol-lowering drugs, such as fibrates and resins, showed no significant association with prostate cancer incidence, stage, or grade. All categories of cholesterol-lowering drugs, including statins, resulted in significant decreases in median prostate-specific antigen (PSA) levels and median free/total PSA ratios.

The effect of cholesterol-lowering medications on PSA levels was most likely due to a metabolic factor common to cholesterol drug users, such as obesity.

LOS ANGELES — The use of statins—but not other lipid-lowering drugs—was associated with a substantial decrease in the incidence of prostate cancer in a large study of Finnish men, according to a poster presentation by Teemu Murtola at the annual meeting of the American Association for Cancer Research.

In a group of 23,320 men followed for up to 10 years in the Finnish Prostate Cancer Screening Trial, users of statins had a 4% incidence of prostate cancer, whereas non- users had an 8% incidence, a significant difference, said Mr. Murtola and his colleagues, of the University of Tampere (Finland).

The protective effect of statins was dose dependent. In statin users, men in the lowest quartile of total cumulative dose had a 6.2% incidence, whereas men in the highest quartile had a 1.8% incidence. The trend was statistically significant. Statin use was associated with significantly lower incidences of all categories of prostate cancer stages and grades. The greatest differences in incidence were observed for T2 (2.5% vs. 0.9%) and T3 cancers (0.6% vs. 0.2%).

Use of other cholesterol-lowering drugs, such as fibrates and resins, showed no significant association with prostate cancer incidence, stage, or grade. All categories of cholesterol-lowering drugs, including statins, resulted in significant decreases in median prostate-specific antigen (PSA) levels and median free/total PSA ratios.

The effect of cholesterol-lowering medications on PSA levels was most likely due to a metabolic factor common to cholesterol drug users, such as obesity.

LOS ANGELES — The use of statins—but not other lipid-lowering drugs—was associated with a substantial decrease in the incidence of prostate cancer in a large study of Finnish men, according to a poster presentation by Teemu Murtola at the annual meeting of the American Association for Cancer Research.

In a group of 23,320 men followed for up to 10 years in the Finnish Prostate Cancer Screening Trial, users of statins had a 4% incidence of prostate cancer, whereas non- users had an 8% incidence, a significant difference, said Mr. Murtola and his colleagues, of the University of Tampere (Finland).

The protective effect of statins was dose dependent. In statin users, men in the lowest quartile of total cumulative dose had a 6.2% incidence, whereas men in the highest quartile had a 1.8% incidence. The trend was statistically significant. Statin use was associated with significantly lower incidences of all categories of prostate cancer stages and grades. The greatest differences in incidence were observed for T2 (2.5% vs. 0.9%) and T3 cancers (0.6% vs. 0.2%).

Use of other cholesterol-lowering drugs, such as fibrates and resins, showed no significant association with prostate cancer incidence, stage, or grade. All categories of cholesterol-lowering drugs, including statins, resulted in significant decreases in median prostate-specific antigen (PSA) levels and median free/total PSA ratios.

The effect of cholesterol-lowering medications on PSA levels was most likely due to a metabolic factor common to cholesterol drug users, such as obesity.

LOS ANGELES — Finally, some good news for carnivores. Although several studies have linked a Western diet—including a high intake of red meat—to an increased risk of prostate cancer, a large prospective cohort study has narrowed the risk to well-done or very well-done meat.

The study, by Stella Koutros of the National Cancer Institute and colleagues, was presented as a poster at the annual meeting of the American Association for Cancer Research.

They found no association between prostate cancer and total consumption of meat, red-meat, chicken, bacon, sausage, processed meat, steak, hamburger, pork chops, or ham steaks. There also was no association between prostate cancer and the method used to cook the meat, including barbecuing, pan frying, or broiling.

Subjects in this analysis were enrolled in the Agricultural Health Study, a prospective cohort of 55,966 male pesticide applicators and their spouses in Iowa and North Carolina. After excluding more than 31,000 subjects for whom the investigators had no information on meat-cooking practices and another 1,424 subjects with prevalent cases of cancer, the investigators had 23,080 individuals and 197,017 person-years of follow-up available for analysis.

Among those individuals were 668 cases of prostate cancer, 613 of which were incident cases diagnosed after 1 year of follow-up. Advanced cases, defined as those in disease stage III or IV, numbered 140.

The subjects completed questionnaires on their dietary habits and cooking methods, and the investigators linked that data to a database of carcinogenic heterocyclic amines (HCAs) to estimate intake of three HCAs. The analyses were adjusted for age, state of residence, race, family history of prostate cancer, and smoking status.

The only statistically significant results involved the total intake of well-done or very well-done meat. Men in the highest tertile of total intake had a 22% higher risk of prostate cancer than those in the lowest tertile. Men in the highest tertile had almost twice the risk of having advanced prostate cancer as those in the lowest tertile.

Although high-temperature cooking methods result in the formation of carcinogenic HCAs, the increased risk associated with estimated intake of the three HCAs did not quite reach statistical significance. The researchers suggested that these HCAs may be correlated with the presence of other similar compounds that were not measured and that may be more closely related to prostate cancer risk.

LOS ANGELES — Finally, some good news for carnivores. Although several studies have linked a Western diet—including a high intake of red meat—to an increased risk of prostate cancer, a large prospective cohort study has narrowed the risk to well-done or very well-done meat.

The study, by Stella Koutros of the National Cancer Institute and colleagues, was presented as a poster at the annual meeting of the American Association for Cancer Research.

They found no association between prostate cancer and total consumption of meat, red-meat, chicken, bacon, sausage, processed meat, steak, hamburger, pork chops, or ham steaks. There also was no association between prostate cancer and the method used to cook the meat, including barbecuing, pan frying, or broiling.

Subjects in this analysis were enrolled in the Agricultural Health Study, a prospective cohort of 55,966 male pesticide applicators and their spouses in Iowa and North Carolina. After excluding more than 31,000 subjects for whom the investigators had no information on meat-cooking practices and another 1,424 subjects with prevalent cases of cancer, the investigators had 23,080 individuals and 197,017 person-years of follow-up available for analysis.

Among those individuals were 668 cases of prostate cancer, 613 of which were incident cases diagnosed after 1 year of follow-up. Advanced cases, defined as those in disease stage III or IV, numbered 140.

The subjects completed questionnaires on their dietary habits and cooking methods, and the investigators linked that data to a database of carcinogenic heterocyclic amines (HCAs) to estimate intake of three HCAs. The analyses were adjusted for age, state of residence, race, family history of prostate cancer, and smoking status.

The only statistically significant results involved the total intake of well-done or very well-done meat. Men in the highest tertile of total intake had a 22% higher risk of prostate cancer than those in the lowest tertile. Men in the highest tertile had almost twice the risk of having advanced prostate cancer as those in the lowest tertile.

Although high-temperature cooking methods result in the formation of carcinogenic HCAs, the increased risk associated with estimated intake of the three HCAs did not quite reach statistical significance. The researchers suggested that these HCAs may be correlated with the presence of other similar compounds that were not measured and that may be more closely related to prostate cancer risk.

LOS ANGELES — Finally, some good news for carnivores. Although several studies have linked a Western diet—including a high intake of red meat—to an increased risk of prostate cancer, a large prospective cohort study has narrowed the risk to well-done or very well-done meat.

The study, by Stella Koutros of the National Cancer Institute and colleagues, was presented as a poster at the annual meeting of the American Association for Cancer Research.

They found no association between prostate cancer and total consumption of meat, red-meat, chicken, bacon, sausage, processed meat, steak, hamburger, pork chops, or ham steaks. There also was no association between prostate cancer and the method used to cook the meat, including barbecuing, pan frying, or broiling.

Subjects in this analysis were enrolled in the Agricultural Health Study, a prospective cohort of 55,966 male pesticide applicators and their spouses in Iowa and North Carolina. After excluding more than 31,000 subjects for whom the investigators had no information on meat-cooking practices and another 1,424 subjects with prevalent cases of cancer, the investigators had 23,080 individuals and 197,017 person-years of follow-up available for analysis.

Among those individuals were 668 cases of prostate cancer, 613 of which were incident cases diagnosed after 1 year of follow-up. Advanced cases, defined as those in disease stage III or IV, numbered 140.

The subjects completed questionnaires on their dietary habits and cooking methods, and the investigators linked that data to a database of carcinogenic heterocyclic amines (HCAs) to estimate intake of three HCAs. The analyses were adjusted for age, state of residence, race, family history of prostate cancer, and smoking status.

The only statistically significant results involved the total intake of well-done or very well-done meat. Men in the highest tertile of total intake had a 22% higher risk of prostate cancer than those in the lowest tertile. Men in the highest tertile had almost twice the risk of having advanced prostate cancer as those in the lowest tertile.

Although high-temperature cooking methods result in the formation of carcinogenic HCAs, the increased risk associated with estimated intake of the three HCAs did not quite reach statistical significance. The researchers suggested that these HCAs may be correlated with the presence of other similar compounds that were not measured and that may be more closely related to prostate cancer risk.

LOS ANGELES — Radiologic technicians who work during pregnancy have twice the risk of having a child who develops lymphoma than those who do not work during pregnancy, according to a poster presentation by Kimberly J. Johnson, at the annual meeting of the American Association for Cancer Research.

On the other hand, working as a radiologic technician during pregnancy did not significantly increase the risk of leukemia or solid tumors among the offspring, Ms. Johnson of the department of pediatrics, division of epidemiology/clinical research, at the University of Minnesota, Minneapolis, and her colleagues wrote.

The study used 63 years' worth of self-reported data involving 81,354 offspring of 38,239 female members of the U.S. Radiologic Technologists cohort. During that time, 230 of their offspring developed leukemia, lymphoma, or solid tumors before the age of 19.

A radiologic technician was considered to have worked during pregnancy if she reported having worked during the child's birth year as well as the prior year.

After adjusting for maternal age and birth year in a multivariate analysis, the investigators found no significant changes in the hazard ratio for leukemia or for solid tumors, but the hazard ratio for lymphoma was 1.99.

To account for occupational radiation exposures that differed by a work era, the investigators separated the data for children born between 1921 and 1959 from those born between 1960 and 1984. The investigators noted a significant increase in the risk of lymphoma only for those children born during the later era.

The investigators are trying to determine whether there is a significant relationship between the estimated dose of radiation received during pregnancy and cancers among the offspring.

The study was supported by the National Cancer Institute, the University of Minnesota, and the American Registry of Radiologic Technologists.

LOS ANGELES — Radiologic technicians who work during pregnancy have twice the risk of having a child who develops lymphoma than those who do not work during pregnancy, according to a poster presentation by Kimberly J. Johnson, at the annual meeting of the American Association for Cancer Research.

On the other hand, working as a radiologic technician during pregnancy did not significantly increase the risk of leukemia or solid tumors among the offspring, Ms. Johnson of the department of pediatrics, division of epidemiology/clinical research, at the University of Minnesota, Minneapolis, and her colleagues wrote.

The study used 63 years' worth of self-reported data involving 81,354 offspring of 38,239 female members of the U.S. Radiologic Technologists cohort. During that time, 230 of their offspring developed leukemia, lymphoma, or solid tumors before the age of 19.

A radiologic technician was considered to have worked during pregnancy if she reported having worked during the child's birth year as well as the prior year.

After adjusting for maternal age and birth year in a multivariate analysis, the investigators found no significant changes in the hazard ratio for leukemia or for solid tumors, but the hazard ratio for lymphoma was 1.99.

To account for occupational radiation exposures that differed by a work era, the investigators separated the data for children born between 1921 and 1959 from those born between 1960 and 1984. The investigators noted a significant increase in the risk of lymphoma only for those children born during the later era.

The investigators are trying to determine whether there is a significant relationship between the estimated dose of radiation received during pregnancy and cancers among the offspring.

The study was supported by the National Cancer Institute, the University of Minnesota, and the American Registry of Radiologic Technologists.

LOS ANGELES — Radiologic technicians who work during pregnancy have twice the risk of having a child who develops lymphoma than those who do not work during pregnancy, according to a poster presentation by Kimberly J. Johnson, at the annual meeting of the American Association for Cancer Research.

On the other hand, working as a radiologic technician during pregnancy did not significantly increase the risk of leukemia or solid tumors among the offspring, Ms. Johnson of the department of pediatrics, division of epidemiology/clinical research, at the University of Minnesota, Minneapolis, and her colleagues wrote.

The study used 63 years' worth of self-reported data involving 81,354 offspring of 38,239 female members of the U.S. Radiologic Technologists cohort. During that time, 230 of their offspring developed leukemia, lymphoma, or solid tumors before the age of 19.

A radiologic technician was considered to have worked during pregnancy if she reported having worked during the child's birth year as well as the prior year.

After adjusting for maternal age and birth year in a multivariate analysis, the investigators found no significant changes in the hazard ratio for leukemia or for solid tumors, but the hazard ratio for lymphoma was 1.99.

To account for occupational radiation exposures that differed by a work era, the investigators separated the data for children born between 1921 and 1959 from those born between 1960 and 1984. The investigators noted a significant increase in the risk of lymphoma only for those children born during the later era.

The investigators are trying to determine whether there is a significant relationship between the estimated dose of radiation received during pregnancy and cancers among the offspring.

The study was supported by the National Cancer Institute, the University of Minnesota, and the American Registry of Radiologic Technologists.