• Shift Work Throws Urologic Health Off Schedule

    Nonstandard shifts and a circadian rhythm disturbance known as shift work sleep disorder contribute to a significant increase in urinary tract symptoms and reproductive problems, according to three studies conducted at the Baylor College of Medicine in Houston.

    “A 45-year-old shift worker with shift work sleep disorder might look like a 75-year-old man in terms of his lower urinary tract symptoms,” John Sigalos, a medical student and investigator on one of the studies, said here at the American Urological Association 2017 Annual Meeting.

    The other studies presented demonstrate that male shift workers with shift work sleep disorder have lower testosterone levels and more hypogonadal symptoms than daytime workers, and that infertile shift workers, especially those who work rotating shifts, have significantly worse semen parameters than infertile men who work the day shift.

    In the United States, approximately 15% of the labor force works late-night or rotating shifts.

    Lower Urinary Tract Symptoms Study

    To determine the effect of poor sleep quality and shift work on lower urinary tract symptoms, Sigalos and his colleagues retrospectively reviewed the medical records of men treated at the Baylor andrology clinic from 2014 to 2016.

    All the men had completed the International Prostate Symptom Score (IPSS) to evaluate lower urinary tract symptoms, completed questionnaires about work schedules and sleep disorders, and had blood samples taken.

    Of the 2487 participants, 766 (30.8%) reported working nonstandard shifts in the previous month and, of these, 36.8% were considered to be at high risk for sleep disorders.

    Mean IPSS score was higher in shift workers with sleep disorders than in shift workers without, and daytime workers (7.77 vs 5.37 vs 6.84; P < .0001 between all groups).

    IPSS scores were 3.1 points lower in shift workers with sleep disorders than in shift workers without, after age, comorbidities, and testosterone levels were controlled for ( P = .0001).

    These findings suggest that poor sleep quality — rather than shift work itself — contributes to the increase in lower urinary tract symptoms. Patients at risk for shift work sleep disorder should be screened for lower urinary tract symptoms and counseled about the risk, Sigalos told Medscape Medical News.

    Hypogonadism Study

    The potential for hypogonadal symptoms and sexual dysfunction was examined by another group of Baylor investigators who used the same cohort of men.

    On multivariable analyses that controlled for age, Charlson comorbidity score, and testosterone levels, mean scores on the quantitative Androgen Deficiency in the Aging Male (qADAM) questionnaire were 0.8 points lower in nonstandard shift workers than in daytime workers ( P < .01). And mean qADAM score was 3.9 points lower in shift workers at high risk for sleep disorders than in shift workers at low risk ( P < .01).

    In addition, there was an independent association between high risk for shift work sleep disorder and lower testosterone levels after age, comorbidities, and history of testosterone supplementation were controlled for ( P < .01).

    Semen Parameters Study

    The effects of shift work and sleep quality on semen parameters and reproductive hormones in men were assessed in a prospective study by Taylor Kohn, MD, and his colleagues.

    The study participants — 75 infertile shift workers, 96 infertile nonshift workers, and a control group of 26 fertile men — completed questionnaires about shift work and sleep quality, and underwent semen analysis and hormone testing.

    Sperm density was significantly lower in infertile shift workers than in infertile nonshift workers ( P = .012), as were total motile counts ( P = .019) and testosterone levels ( P = .026).

    However, the differences in sperm motility, forward progression measures, luteinizing hormone levels, and follicle-stimulating hormone levels were not significant.

    All semen parameters were significantly lower in the infertile shift workers than in the fertile control group, and luteinizing hormone and follicle-stimulating hormone levels were significantly higher. Testosterone levels were about the same in the two groups.

    On linear regression that controlled for age, Charlson comorbidity index, tobacco use, and average income, there was a significant negative association between total motile count and shift work ( P = .039), and a significant positive association between total motile count and previous fertility ( P = .041).

    In addition, total motile counts were significantly lower in men who worked rotating shifts than in those who worked fixed shifts ( P < .05).

    The type of job shift workers performed also made a difference. Men who performed physical labor in environments where chemical use was common (such as oil fields and refineries) had significantly lower total motile counts than physical laborers without chemical exposure, medical workers, white-collar workers, and first responders ( P < .05).

    Sleep satisfaction also seemed to play a role. “When assessing reported overall sleep amounts in the previous month, follicle-stimulating hormone and testosterone levels trended downward as men became more unsatisfied with the amount of sleep they were getting,” Dr Kohn reported.

    Thinking Beyond the Prostate

    It is important for urologists to think beyond the prostate when treating men with lower urinary tract symptoms or sexual dysfunction, said Howard Adler, MD, clinical associate professor of medicine at the Stony Brook University School of Medicine in New York.

    When men present with symptoms like those reported in these studies, clinicians need to consider not only prostate-related symptoms, but also age-related changes in bladder function, renal function, and other medical conditions, such as diabetes, he told Medscape Medical News.

    At Stony Brook, Dr Adler explained, he and his colleagues have begun “asking patients about sleep habits and snoring, and are sending them for sleep studies to see if they have apnea or something else, especially patients with a lot of night-time urination.”

    The studies were supported by the Baylor College of Medicine. The authors and Dr Adler have disclosed no relevant financial relationships.

    American Urological Association (AUA) 2017 Annual Meeting: Abstracts MP13-12 and PD13-08 presented May 12, 2017; Abstract MP91-06 presented May 16, 2017.

    Written By: Neil Osterweil

    Article Source: http://www.medscape.com/viewarticle/880096#vp_1

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  • Gout Patients Should Be Screened for Erectile Dysfunction

    Erectile dysfunction (ED) is common and often severe in men suffering from gout, according to the results of a cross-sectional survey of men who presented to a rheumatology clinic.

    “These results strongly support the proposal to screen all men with gout for the presence of ED. Increasing awareness should in turn lead to earlier medical attention and treatment for this distressing condition,” said lead author Naomi Schlesinger, MD, chief, Division of Rheumatology, and professor of medicine at Rutgers–Robert Wood Johnson Medical School, in New Brunswick, New Jersey.

    The results of the study were presented here at the European League Against Rheumatism (EULAR) Congress 2014.

    The most common inflammatory arthritis in men older than 40 years, gout is caused by deposits of urate crystals in the joints and is associated with uricemia. The crystals cause inflammation, pain, and swelling, and the inflammatory component of the disease is linked to risk factors for cardiovascular disease and coronary artery disease.

    The cross-sectional study included 201 men aged 18 to 89 years who presented at a rheumatology clinic between August 2010 and May 2013. Of these, 83 had gout.

    Participants filled out a Sexual Health Inventory in Men (SHIM) questionnaire, which evaluates the ability to have an erection, the firmness of the erection, the ability to penetrate sufficiently for sexual intercourse, and sexual satisfaction. A score of ≤21 indicates ED; a score of ≤10 indicates severe ED.

    “Men don’t usually volunteer sexual complaints,” said Dr. Schlesinger. “The gout patients in our study were generally delighted and grateful that someone finally asked them about ED.”

    The mean SHIM score for all participants was 16.88. Patients with gout had a mean SHIM score of 14.38 compared with 18.53 in patients without gout ( P < .0001).

    A significantly greater percentage of patients with gout had ED compared with patients without gout (76% vs 52%, P = .0007). Also, significantly more men with gout had severe ED vs men without gout (43% vs 30%, P = .007).

    The presence of ED was significantly more frequent in gout patients aged 65 years or older, compared with men of the same age without gout ( P = .0001), and was significantly more likely to be severe ( P = .0002).

    A multivariate analysis adjusted for age, hypertension, low-density cholesterol level, glomerular filtration rate, obesity, and depression found that the association between gout and ED was statistically significant ( P = .0096).

    Silent Coronary Artery Disease

    “It is estimated that 1 in 5 men who present with ED have silent coronary artery disease. A man with ED, even with no cardiac symptoms, is a cardiac patient until proven otherwise,” said Dr. Schlesinger. “Perhaps we could say that the 3 ‘EDs’ are related: endothelial dysfunction leads to erectile dysfunction leads to early death.

    “Gout patients who present with ED have an increased rate of cardiovascular risk factors and concomitant silent coronary artery disease and should be evaluated,” she added.

    Maya Buch, MD, from the Leeds Institute of Rheumatology and Musculoskeletal Medicine, at the University of Leeds, United Kingdom, praised the authors of this study for providing new information on these conditions with overlapping risk factor — gout and cardiovascular disease.
    “These patients are at risk for cardiomyopathies, and there is no literature on ED and gout. We know that patients with gout have multiple comorbidities, and it’s clear that rheumatologists need to address that,” she explained.

    “I was surprised at how many patients with gout have ED. In addition to treating hyperuricemia in our patients with gout, we need to pay attention to cardiovascular risk factors. I hope that this study makes doctors more receptive to evaluating patients for ED,” she added.

    Dr. Schlesinger has disclosed no relevant financial relationships. Dr. Buch has received honoraria and consulting fees from AbbVie, Bristol-Myers Squibb, and Roche-Chugai and has a research grant from Pfizer, Inc.

    European League Against Rheumatism (EULAR) Congress 2014: Abstract OP0135. Presented June 13, 2014.

    Written By: Alice Goodman

    Article Source: http://www.medscape.com/viewarticle/826773

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  • Exercise can boost brain power, prevent heart damage

    Looking for a magic elixir for health? There’s more evidence exercise may be it, improving thinking skills in older adults and protecting against heart damage in obese people, two separate studies published Monday show.

    “Exercise has many, many benefits. … I don’t know that we fully understand why it has so many beneficial effects for so many organs and systems,” Dr. Roberta Florido, a cardiology fellow at the Johns Hopkins Hospital, told TODAY, as she listed some of the other known benefits, including improving depression, lowering blood pressure and strengthening muscles.

    “We should do a better job of telling our patients to exercise,” she added.

    In the first paper, published in the British Journal of Sports Medicine, researchers at the University of Canberra in Australia analyzed 39 previous studies looking into the effect of exercise on thinking skills in people over 50. That included things like memory, alertness and the ability to quickly process information.

    They found physical activity improved all of those skills regardless of a person’s cognitive status.

    The key was 45-60 minutes of moderate to vigorous exercise per session “on as many days of the week as feasible.” A combination of both aerobic exercise and resistance training worked best.

    Each type of exercise seemed to have different effects on the factors responsible for the growth of new neurons and blood vessels in the brain, said co-author Joe Northey, a PhD student at the University of Canberra Research Institute for Sport and Exercise.

    Tai chi was also helpful, though more evidence is needed to confirm this effect, the researchers note.

    “Age is a risk factor no one can avoid when it comes to cognitive decline,” Northey said. “As our study shows, undertaking just a few days of moderate intensity aerobic and resistance training during the week is a simple and effective way to improve the way your brain functions.

    Written By: A. Pawlowski

    Article Source: http://www.today.com/health/exercise-can-boost-thinking-skills-protect-against-heart-damage-t110740

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  • Understanding Inflammation

    Inflammation has been found to be an underlying cause in many diseases, making it a hot topic in the health media. But what do we really know about chronic inflammation and its effects on the body?

    As scientists have searched for the mysteries behind the diseases most likely to afflict us, they have alighted on one factor common to virtually all of them: inflammation. Chronic inflammation, headlines now regularly state, has a role in a host of common and often deadly diseases, including Alzheimer’s, arthritis, cancer, diabetes, heart disease, and possibly even depression.

    Unsurprisingly, this news brings with it a raft of self-proclaimed remedies purporting to fight inflammation. Diets, herbs, supplements, and exercise regimens have flooded the market with promises to keep inflammation in check and improve overall health.

    But is there evidence that over-the-counter products or sweeping lifestyle changes will reduce inflammation’s damaging effects? Scientists caution that despite its current high profile, inflammation remains a mystery. “Basic science hasn’t yet answered the major questions about inflammation,” says Michelle Petri, a rheumatologist and a director of the Johns Hopkins Lupus Center. Researchers like Petri have been studying low-level inflammation as a culprit in a number of diseases for decades. What they have discovered has led to an emerging understanding of how lifestyle choices—like diet, dental health, and exercise—may influence inflammation and its potentially damaging downsides.

    Despite its current high profile, Petri says, inflammation remains a mystery.


    Inflammation is a vital part of the human immune system. When harmful bacteria or viruses enter your body, when you scrape or twist your knee, the body’s defense system kicks into high gear. Chemicals ramp up the body to fight, bathing the damaged area with blood, fluid, and proteins; creating swelling and heat to protect and repair damaged tissue; and setting the stage for healing.

    Sentinel cells first alert the immune system to the presence of invaders. Another set of cells releases chemicals that signal the capillaries to leak blood plasma, which surrounds and slows down trespassers. Another group of sentinels, called macrophages, releases cytokines, which are specialized germ fighters. Immunizing B- and T-cells join in, destroying both the pathogens and the tissues they have damaged. Finally, a last wave of cytokines is released to end the job and signal the immune system that its work is done. Its mission completed, the immune system calls off its dogs.

    When our body’s powers of correction go wrong, however, they can work against us. Think of the acute heat and swelling that protect us during a normal immune response—a fever, or the redness and pain that surround a new injury, for example—and you can get a hint of what chronic inflammation is. Unlike the inflammation that follows a sudden infection or injury, the chronic kind produces a steady, low level of inflammation within the body that can contribute to the development of disease. It’s the result, in part, of an overfiring immune system. Low levels of inflammation can get triggered in the body even when there’s no disease to fight or injury to heal, and sometimes the system can’t shut itself off. Arteries and organs break down under the pressure, leading to other diseases, including cancer and diabetes.

    Scientists don’t fully understand how the immune system becomes short-circuited, but they have long known that some diseases, such as lupus and rheumatoid arthritis, emerge after the immune system has gone awry and attacked healthy tissue. Increasingly, as Americans and other Westerners live longer and get larger (35 percent of Americans are obese), researchers have also found that low-level immune responses triggered by extra weight and a lack of exercise can contribute to the development of other illnesses.

    “For a long time, we had the idea that inflammation was involved in certain autoimmune diseases, but now we’re seeing this lower level of inflammation in people who are obese and people who are sedentary,” says Kimberly Gudzune, a physician at Johns Hopkins and a clinical researcher who focuses on obesity. “We see a link between obesity and some diagnostic markers for inflammation, but we don’t know what causes them. We worry that there’s something brewing for these people, that they are at higher risk for heart disease, cancer, and diabetes.”

    ‘We see a link between obesity and some diagnostic markers for inflammation, but we don’t know what causes them. We worry that there’s something brewing for these people, that they are at higher risk for heart disease, cancer, and diabetes.’

    Researchers have discovered that fat cells can trigger the release of a steady, low hum of cytokines that, in lieu of an invader to attack, go after healthy nerves, organs, or tissues. As we gain weight, the release becomes prolific, affecting our body’s ability to use insulin, sometimes leading to type 2 diabetes.

    They have also learned that inflammatory cells can have an effect elsewhere in the body—for example, chronically infected and inflamed gums in the mouth can cause damage that leads to heart attack and stroke. And they know that inflammation contributes to congestive heart failure and uncontrolled hypertension, and that it somehow has a role in the tangled cells that are the hallmarks of Alzheimer’s disease.

    Researchers continue to find answers about how inflammation contributes to cancer. Inflammatory cells produce free radicals that destroy genetic material, including DNA, leading to mutations that cause cells to endlessly grow and divide. More immune cells are then called in, creating inflammation that feeds the growth of tumors.

    The link between inflammation and cancer can sometimes be direct. When too much stomach acid—a feature of the immune system that evolved to fight foodborne bacteria—creeps up the esophagus, it causes inflammation and chronic heartburn. Extended exposure to this acid changes the nature of the cells lining the esophagus, increasing the risk of cancer.

    In colon cancer patients, certain communities of bacteria associated with diarrhea can create cancer with help from inflammatory cytokines. Cells protected by mucus can become inflamed when that mucus wall is breached by bacteria, says Cynthia Sears, a doctor who specializes in infectious disease research at Johns Hopkins. “The lining in the colon makes peptides”—short chains of amino acids that act to protect the lining of the organ—“to thwart bacteria. If there aren’t enough peptides, bacteria can get a foothold, which means even more bacteria,” Sears says. As inflammation ramps up to fight it, so does the risk of cancer.


    If inflammation is the behind -the-curtain factor in so many diseases, what can we do to keep it at bay? Researchers admit that they’re still figuring this out.

    Petri has studied lupus for more than three decades and has been investigating the effects of chronic inflammation. “Lupus is basically friendly fire,” Petri explains. “We can’t get the immune system to calm itself down.”

    Treating chronic inflammation, whether for lupus or other chronic ailments, is a challenge. Researchers have an idea that inflammation exists as part of a self-reinforcing loop system. If they could figure out how to interrupt or reverse one stage in that loop, then they might be able to develop drugs to stop it. But how do you tone down the immune response enough to control the inflammation but not so much that a body can’t fight disease? “We’ve done 20 to 25 years of clinical trials on lupus drugs,” Petri says, by way of example. “We’ve had maybe one success and 30 failures.”

    Finding a drug that both interrupts the immune cycle and maintains a healthy immune response is important not just for people battling illness but for all of us as we age.

    Currently, there are no prescription drugs that specifically target chronic inflammation. (There are, of course, over-the-counter medications that treat the minor and temporary inflammation and accompanying pain caused by injuries or procedures, such as surgery. These are not meant to treat chronic inflammation.) Some drugs, such as hydroxychloroquine, once used to battle malaria, are useful in treating some lupus patients, but they don’t cure the disease. Aspirin and statins have shown promise in reducing inflammation in some people, but researchers aren’t sure how broadly useful such drugs are in that role. With the exception of far-from-perfect anti-inflammatory drugs, such as prednisone, a corticosteroid that brings with it a slew of side effects, scientists are still researching how best to contain inflammation. “We need something that can work broadly and quickly, and without a lot of side effects,” says Petri.

    Finding a drug that both interrupts the immune cycle and maintains a healthy immune response is important not just for people battling illness but for all of us, because as we age, inflammation increases in the body. Scientists aren’t sure how and why, but interestingly, the study of HIV is offering some insight.

    HIV triggers chronic inflammation in the body, even after medications have rendered levels of the virus undetectable in blood tests. Certain cytokines involved in that inflammation process can profoundly decrease testosterone levels, leading to muscle loss. “It’s possible that the chronic inflammation in people with HIV is similar to the chronic inflammation we see in aging,” says Todd Brown, an endocrinologist who researches the link between bodily markers for inflammation and chronic diseases found in people with HIV. If researchers can understand that process and create treatments to disrupt it in people with HIV, they could potentially translate their findings into treatments for similar muscle loss in aging.

    Jeremy Walston is a Johns Hopkins geriatrician who investigates immune system response and muscle function in the elderly. He has been searching for markers that highlight the early signs of inflammation. Some blood tests for inflammation markers exist, but the researchers have uncovered two new markers that they believe may predict mortality and mark signs of late-in-life decline. “These are powerful inflammatory molecules that, when chronically expressed, lead to declines in stem cells and a remodulation of the immune system,” says Walston. “They also contribute to cell death,” particularly in the elderly, he says.


    As the quest for diagnostic measures and therapies continues, researchers point to simple lifestyle measures we can all take to help prevent chronic inflammation. Scientists are skeptical of cure-all claims found in the new crop of anti-inflammation diet books, but they do recommend dropping pounds (and the harmful fat cells that come with obesity) and avoiding the now common American diet high in fats and sugars.

    “Losing weight can have profound effects on lowering inflammation,” says Brown, who adds that eating a diet rich in fruits and vegetables and low in fats, processed foods, and sugars is generally a good idea, though more study needs to be done to determine how it might affect inflammation. Exercising, which causes an acute inflammatory response in the short term, but an anti-inflammatory one when we regularly get moving, is another strong step to take, he adds.

    For most of us, keeping inflammation in check comes down to common sense basics: eat well, don’t smoke, get moving, get more rest, and see your doctor for regular physicals, which could help stop chronic inflammation before it becomes rampant.

    Other researchers advise getting plenty of sleep, lowering stress levels, and seeking out treatment for inflammation-inducing culprits, such as gum disease and high cholesterol levels. Avoid contact with heavy metals such as mercury, which is found in dangerous amounts in some large fish, and limit exposure to substances, such as diesel exhaust and cigarette smoke, that can set off the immune system. Additional studies by Brown and his colleagues have also shown some advantage in increasing our intake of omega-3 fatty acids and vitamin D, though more research is needed.

    Walston and others caution against popping dietary supplements touted as anti-inflammatory cures. Some so-called remedies, such as turmeric, taken in large amounts, may actually be toxic to the liver and other organs.

    For most of us, keeping inflammation in check comes down to common sense basics: eat well, don’t smoke, get moving, get more rest, and see your doctor for regular physicals, which could help stop chronic inflammation before it becomes rampant. “All of the things our grandmothers told us were good for us are actually good for us,” says Brown. “Until we have a more nuanced understanding of what inflammation does, that’s what we have to fall back on.”

    Written By: Michael Anft

    Article Source: http://www.johnshopkinshealthreview.com/issues/spring-summer-2016/articles/understanding-inflammation

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  • Benefits of Sermorelin w/GHRP2 in the First Six Months

    Sermorelin and GHRP2 both stimulate the patient’s own pituitary gland by binding to specific receptors that increase production and secretion of endogenous Human Growth Hormone (HGH). GHRP2 also acts as an appetite suppressant allowing for increased weight loss.

    First Month

    Weight loss/Body fat reduction

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    Second Month

    Improved muscle tone

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    Improved skin tone

    Improved nail growth

    Better digestion

    Weight loss/Body fat reduction

    Improved vision

    Enhanced sexual function

    Third Month

    Improved mental process

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    Increased libido

    Increased muscle size

    Faster recovery from muscle soreness

    Reduced PMS symptoms

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    Fourth Month

    Heightened improvements with all of the above

    At times improvements may seem to diminish or plateau

    Rejuvenation is still a process. Benefits should resume with continued improvements

    Fifth Month

    Improved weight loss and reduction of inches

    Improved skin texture and appearance

    Skin thickening and greater elasticity

    Reduction of skin wrinkles

    Thickening of hair with a shiny, healthy appearance

    Continuation of improved muscle tone

    Sixth Month

    Diminished cellulite

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