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A diet high in a form of sugar found in sweetened soft drinks and junk food raises blood pressure among men, according to research likely to mean more bad news for beverage companies and restaurant chains.

One of two studies released on Wednesday provided the first evidence that fructose helps raise blood pressure. It also found that the drug allopurinol, used to treat gout, can alleviate the effect by reducing uric acid levels in the body.

The second study, which measured fructose intake in mice, suggested that people who consume junk foods and sweetened soft drinks at night could gain weight faster than those who don’t.

“These results suggest that excessive fructose intake may have a role in the worldwide epidemic of obesity and diabetes,” said Dr. Richard Johnson of the University of Colorado-Denver, who studied the link between blood pressure and men.

The findings provide the latest evidence of ties between sugar-rich diets and health problems that have prompted some experts to call for a tax on sugary soft drinks.

Fructose accounts for about half the sugar molecules in table sugar and in high-fructose corn syrup, the sweetener used in many packaged foods.

Johnson and colleagues at the Mateo Orfila Hospital in Spain studied 74 men given 200 grams of fructose per day on top of their regular diet. That amount is well above a daily intake of 50 grams to 70 grams of fructose consumed by most American adults.

Half the men were also given allopurinol.

After two weeks, the men who received only the fructose registered increases of six millimeters in systolic blood pressure — the top reading — and about three millimeters in diastolic or the bottom reading, the researchers told an American Heart Association meeting in Chicago.

REVERSIBLE EFFECT

Most of their blood pressure readings returned to normal levels after two months.

The men who did not get allopurinol also were twice as likely to develop metabolic syndrome, measured by risk factors such as too much abdominal fat, high blood pressure and poor cholesterol readings.

By contrast, those given allopurinol and fructose had significantly lower uric acid levels, and virtually no increase in systolic blood pressure or higher risk of metabolic syndrome.

For the second study, researchers in Ohio studied mice given fructose water to drink. Some had unrestricted access, while others received it during the day or at night.

“The first thing we noticed was that the mice on restricted access rushed to their drinking bottles to load up on the sweetened beverage, similar to teenagers who drink too many soft drinks,” said Mariana Morris of Wright State University in Dayton, Ohio.

The mice that drank fructose water during their regular daylight sleeping hours gained more weight and had higher stress hormone levels than the other mice.

“This model may be similar to the human condition of night time bingeing of fructose-laden foods and beverages,” Morris said.

The American Heart Association says women should eat no more than 100 calories of added processed sugar per day, or six teaspoons (25 grams), while most men should keep it to just 150 calories or nine teaspoons (37.5 grams). On average Americans consume 22 teaspoons (90 grams) or 355 calories of added sugar each day.

Marriages can be at risk when one partner is an excessive drinker and/or smoker, but the other isn’t, researchers say.

However, when their drinking and/or smoking habits are similar, both partners remain relatively satisfied with their marriage, according to the study published in a recent edition of the journal Addiction.

Researchers tracked 634 newly married couples for seven years, and at their first, second, fourth and seventh wedding anniversaries, the couples completed questionnaires about their marital satisfaction.

Overall, there were initial declines in marital satisfaction, followed by a leveling off after a few years. At each assessment, a difference in heavy drinking between spouses was more common than a difference in smoking. About 15 percent of the couples reported differences in both smoking and drinking habits, the study authors noted.

The information collected from the couples revealed important clinical information, said study author Gregory G. Homish, an assistant professor of health behavior, and colleagues in the University at Buffalo’s School of Public Health and Health Professions and the university’s Research Institute on Addictions.

“For example, if one partner of a heavy-drinking couple enters treatment for his/her alcohol use, the break-up of the ‘drinking partnership’ could have unintended negative outcomes for the couple,” Homish said in a news release from the university. “Therefore, approaches such as behavior couples therapy that assess and treat both partners could have a more beneficial outcome at both the individual and family level.”

In terms of research, “the current findings suggest that an assessment of substance use should extend beyond quantity and frequency of substance use and also incorporate information about the partner’s behavior,” Homish noted.

“Most studies that investigate the impact of substance use focus solely on individual-level risk factors and do not consider the impact of social network influences such as those that exist from a partner,” Homish stated in the news release.

If you get a nosebleed, don’t panic. Many nosebleeds look worse than they really are, says the American Academy of Family Physicians.

Here’s the academy’s advice on steps to help stop a nosebleed:
Sit down, and tilt your body forward slightly. Keep your head positioned above your heart, but allow the blood to drain from your nose, not down your throat.
Use your thumb and index finger and gently apply pressure near the end of the nose, at the soft part.
Hold your fingers in that position for at least five minutes, then check if the bleeding has stopped.
If the nose is still bleeding, hold it for at least 10 minutes more without releasing.
Place an ice pack or cold compress across your nose.
Leave the nose alone once it stops bleeding, and don’t blow your nose or bend over.

VIAGRA was administered to over 3700 patients (aged 19-87 years) during clinical trials worldwide. Over 550 patients were treated for longer than one year.

In placebo-controlled clinical studies, the discontinuation rate due to adverse events for VIAGRA (2.5%) was not significantly different from placebo (2.3%). The adverse events were generally transient and mild to moderate in nature.

In trials of all designs, adverse events reported by patients receiving VIAGRA were generally similar. In fixed-dose studies, the incidence of some adverse events increased with dose. The nature of the adverse events in flexible-dose studies, which more closely reflect the recommended dosage regimen, was similar to that for fixed-dose studies.

When VIAGRA was taken as recommended (on an as-needed basis) in flexible-dose, placebo-controlled clinical trials, the following adverse events were reported:

TABLE 2. ADVERSE EVENTS REPORTED BY ≥ 2% OF PATIENTS TREATED WITH VIAGRA AND MORE FREQUENT ON DRUG THAN PLACEBO IN PRN FLEXIBLE-DOSE PHASE II/III STUDIES

Other adverse reactions occurred at a rate of > 2%, but equally common on placebo: respiratory tract infection, back pain, flu syndrome, and arthralgia.

In fixed-dose studies, dyspepsia (17%) and abnormal vision (11%) were more common at 100 mg than at lower doses. At doses above the recommended dose range, adverse events were similar to those detailed above but generally were reported more frequently.

The following events occurred in < 2% of patients in controlled clinical trials; a causal relationship to VIAGRA is uncertain. Reported events include those with a plausible relation to drug use; omitted are minor events and reports too imprecise to be meaningful:

Body as a whole: face edema, photosensitivity reaction, shock, asthenia, pain, chills, accidental fall, abdominal pain, allergic reaction, chest pain, accidental injury.

Drawing on the power of DNA sequencing, National Institutes of Health researchers have identified a new group of genetic mutations involved in the deadliest form of skin cancer, melanoma. This discovery is particularly encouraging because some of the mutations, which were found in nearly one-fifth of melanoma cases, reside in a gene already targeted by a drug approved for certain types of breast cancer.

In the United States and many other nations, melanoma is becoming increasingly more common. A major cause of melanoma is thought to be sun exposure; the ultraviolet radiation in sunlight can damage DNA and lead to cancer-causing genetic changes within skin cells.

In work published in the September issue of Nature Genetics, a team led by Yardena Samuels, Ph.D., of the National Human Genome Research Institute (NHGRI) sequenced the protein tyrosine kinase (PTK) gene family in tumor and blood samples from people with metastatic melanoma. The samples were collected by the study’s coauthor Steven Rosenberg, M.D., Ph.D., a leading expert on melanoma and chief of surgery at the National Cancer Institute (NCI).

The PTK family includes many genes that, when mutated, promote various types of cancer. However, relatively little had been known about roles played by PTK genes in human melanoma. The NIH study was among the first to use large-scale DNA sequencing to systematically analyze all 86 members of the PTK gene family in melanoma samples.

The team’s initial survey, which involved samples from 29 melanoma patients, identified mutations in functionally important regions of 19 PTK genes, only three of which had been previously implicated in melanoma. The researchers then conducted more detailed analyses of those 19 genes in samples from a total of 79 melanoma patients.

One of the newly implicated genes stood out from the rest. Researchers detected mutations in the ERBB4 gene (also known as HER4) in 19 percent of patients’ tumors, making it by far the most frequently mutated PTK gene in melanoma. In addition, researchers found that many ERBB4 mutations were located in functionally important areas similar to those seen in other PTK oncogenes involved in lung cancer, brain cancer and gastric cancer.

Next, the researchers moved on to laboratory studies of melanoma cells with ERBB4 mutations. They found that these melanoma cells were dependent on the presence of mutant ERBB4 for their growth. What’s more, the melanoma cells grew much more slowly when they were exposed to a chemotherapeutic drug known to inhibit ERBB4. The drug, called lapatinib (Tykerb), was approved by the Food and Drug Administration in 2007 for combination use in breast cancer patients already taking the drug capecitabine (Xeloda).

Encouraged by their study results, the researchers are planning a clinical trial using lapatinib in patients with metastatic melanoma harboring ERBB4 mutations. The clinical trial will be conducted under the direction of Dr. Rosenberg at the NIH Clinical Center. “This collaborative study represents an ideal example of how sophisticated genetic analyses can be translated to the benefit of cancer patients,” said Dr. Rosenberg.

“We have found what appears to be an Achilles’ heel of a sizable share of melanomas,” said Dr. Samuels, who is an investigator in the Cancer Genetics Branch of the NHGRI’s Division of Intramural Research. “Though additional work is needed to gain a more complete understanding of these genetic mutations and their roles in cancer biology, our findings open the door to pursuing specific therapies that may prove useful for the treatment of melanoma with ERBB4 mutations.”

In addition to ERBB4, the researchers identified two additional PTK genes, FLT1 and PTK2B, with a relatively high rate of mutations in melanoma. Each of these genes was mutated in about 10 percent of the tumor samples studied.

NHGRI Scientific Director Eric D. Green, M.D., Ph.D., pointed out how such research is helping to lay the groundwork for the era of personalized medicine. “We envision a day when each cancer patient will have therapies tailored to the specific genetic profile of his or her tumor. Ultimately, this should lead to more effective and less toxic approaches to cancer care,” said Dr. Green, who directs the NIH Intramural Sequencing Center, which generated the DNA sequence data for the melanoma study.

In addition to NIH scientists, the team included a researcher from the Johns Hopkins Kimmel Cancer Center in Baltimore.

In May 2009, Dr. Samuel’s group reported in Nature Genetics another large-scale DNA sequencing study of a different group of genes involved in melanoma, the matrix metalloproteinase (MMP) gene family. This earlier study found that one gene, MMP-8, thought to spur cancerous growth actually served to inhibit it. Those findings are now helping to shape melanoma treatment strategies aimed at MMP genes.

VIAGRA (sildenafil citrate) is supplied as blue, film-coated, rounded-diamond-shaped tablets containing sildenafil citrate equivalent to the nominally indicated amount of sildenafil as follows:

Recommended Storage: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature].

The latest results from the longest-running study yet confirm that surgery is better than artery-opening angioplasty in preventing strokes caused by blockage of the carotid artery, the largest vessel carrying blood to the brain.

“In contrast with endovascular treatment [angioplasty], surgical patients had about half the rate of strokes in long-term follow-up,” said Dr. Martin M. Brown, a professor of stroke medicine at University College London Institute of Neurology, and a senior author of two reports in the October issue of the Lancet Neurology.

Brown is a leader of the so-called CAVATAS study, which has followed 504 people with carotid artery stenosis — narrowing — who were randomly assigned to have either the surgical procedure called endarterectomy or angioplasty.

“This was the first trial ever started comparing endovascular treatment with surgery,” Brown said. Some participants in the trial have been followed for as long as eight years.

Carotid surgery is not a major operation, because the artery is close to the surface of the neck. It sometimes is done under local anesthesia. The surgeon clamps the artery shut and cuts fatty deposits from its wall. Angioplasty uses an inflatable balloon to improve blood flow.

One of the reports said there were more minor strokes in the 30 days after treatment in the angioplasty group than in the surgery group. The incidence of strokes, as well as the mini-strokes called transient ischemic attacks (TIAs), was higher in the angioplasty group over the next eight years — 19.3 percent, compared to 17.2 percent in the surgery group.

But the number of people in the trial was small, so confirmation of the findings are needed from larger trials that are now in progress, the report said.

The second study reported on 413 CAVATAS participants who had periodic ultrasound examinations of the treated carotid arteries over the following five years. The study found that the incidence of severe re-narrowing of the carotid artery was much higher in the angioplasty group — 31 percent over five years, compared to 11 percent in those who had surgery. Strokes or TIAs occurred in 23 percent of those who had severe re-narrowing, compared to 11 percent of those who didn’t.

Implanting a stent — a flexible tube that helps keep the artery open — did reduce the incidence of blockage by about half in those who had angioplasty. But the overall superiority of surgery in reducing the risk of stroke was clear, the study authors said.

The CAVATAS results reinforce those of trials with shorter follow-ups, said Dr. Peter M. Rothwell, a professor of clinical neurology at the University of Oxford, who wrote an accompanying commentary in the journal.

“Taken together, all of the trials now show a substantially higher stroke risk associated with endovascular treatment compared to surgery,” Rothwell said.

The findings apply only to people who have symptoms — such as temporary loss of vision or speech — because of carotid narrowing, Brown noted. Symptomless carotid stenosis sometimes is detected in the course of a routine physical examination, and the decision on whether to treat, and the appropriate treatment, is then up to the physician and patient, he said.

“In North America, most physicians would recommend surgery,” Brown said. “In the United Kingdom, they are much more reluctant to operate on patients and would recommend medical treatment.”

That medical treatment would include drugs to control high blood pressure and high blood cholesterol, as well as lifestyle changes, he said.

The difference in treatment choice is not due to the nationalized health care system in Britain, Brown said. Rather, “in the British system you do not see a surgeon unless you see a physician first. In the United States, many patients go straight to the surgeon,” he said.

There are many surgeons in the United States, and “patients in the United States are more likely to want to have something done at once,” he added.

There is still a place for angioplasty in the treatment of carotid stenosis, Rothwell said. After an initial diagnosis, some people prefer not to have surgery, he said.

Erectile dysfunction: A common men’s health problem characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. Impotence can vary. It can involve a total inability to achieve an erection or ejaculation, an inconsistent ability to do so, or a tendency to sustain only very brief erections. Erectile dysfunction is also called impotence,

The risk of erectile dysfunction increases markedly with age. It is four-fold higher in men in their 60s compared with those in their 40s according to a study published in the Journal of Urology (2000;163:460-463). Men with less education are also more likely to experience impotence, perhaps due to a less healthy lifestyle, less healthy diet, more alcohol, or less exercise. Physical exercise tends to lessen the risk of impotence.

Erectile dysfunction can have emotional causes but most often it is due to a physical problem. The physical causes include diseases (such as diabetes and hypertension), injuries (such as from prostate surgery), side-effects of drugs (such as the protease inhibitors used in HIV therapy), and disorders (such as atherosclerosis) that impair blood flow in the penis. Impotence is treatable in all age groups. Treatments include psychotherapy, vacuum devices, surgery and, most often today, drug therapy.

Names — impotence versus erectile dysfunction: The word “impotence” is a venerable term that dates back to the 15th century. However, it literally means powerlessness and so may have pejorative connotations. Advertising for sildenafil (Viagra), the first oral medication approved by the US FDA for the treatment of impotence, popularized the more recent term “erectile dysfunction.” (A porcupine that cannot raise its quills to an upright position also can be said to have erectile dysfunction.)

Cable TV shows that attract a significant proportion of teenage viewers are also those that have the most ads for alcohol, new research has found.

Using Nielsen Media Research advertising industry data, researchers analyzed 600,000 ads for alcohol that aired on cable TV from 2001 through 2006. The researchers limited their analysis to shows that had an audience with less than 30 percent of viewers aged 12 to 20.

The study found that shows with a relatively higher percentage of viewers aged 12 to 20 had a higher frequency of alcohol ads, even after accounting for other factors that could explain ad placement decisions.

For every 1 percentage point increase in adolescent viewership, there was a 7 percent increase in beer ads, a 15 percent increase in spirits ads and a 22 percent increase in ads for low-alcohol refreshers or “alcopops,” which are juice- or soda-like beverages that contain alcohol.

Conversely, for every 1 percent increase in adolescent viewership, ads for wine decreased by 8 percent. Researchers said this statistic shows that it is possible for advertisers to avoid shows with young audiences.

Cable TV accounts for about 95 percent of nationally televised ads for alcohol, according to the study. Previous research has shown the typical teen watches more than 200 alcohol ads on television each year.

The study, which will appear in the October issue of the American Journal of Public Health, is the first to show an association between ad placement and teen cable TV viewership, the researchers point out in a news release issued by the University of California, Los Angeles.

“Alcohol advertisers have pledged to avoid audiences made up of more than 30 percent underage viewers — such as children’s programming,” said David H. Jernigan, director of the Center on Alcohol Marketing and Youth and an associate professor at the Johns Hopkins Bloomberg School of Public Health, in the news release. “However, many other shows have adolescent appeal. This research suggests that ads are aimed at groups that include a disproportionate number of teens, and that the alcohol industry’s voluntary self-monitoring is not working to reduce adolescent exposure to ads.”

The researchers noted that the study did not determine whether or not alcohol advertisers were targeting teens on purpose.

“The alcohol industry has consistently denied actively targeting teens, and our study isn’t designed to test that claim,” lead study author Dr. Paul J. Chung, assistant professor of pediatrics at Mattel Children’s Hospital UCLA and a senior natural scientist at the RAND Corp, stated in the news release. “However, the ultimate effect of their advertising strategies, intentional or not, appears to be greater exposure than might be expected if adults were the sole targets of ads.”

Adolescent alcohol abuse is a serious problem in the United States, according to the study. Research has shown adolescents who abuse alcohol have a greater likelihood of problem drinking later in life.

Other research suggests that alcohol ads can influence underage drinking.

“It’s difficult to document experimentally,” Chung added. “But there’s not too much doubt that advertising and marketing affect the behavior of both children and adults. Common sense tells us that if it didn’t work, companies probably wouldn’t be spending so much money on it.”

Advertising designed to make alcohol look cool, tasty and fun makes it more difficult for parents, teachers and clinicians to successfully teach kids to abstain, Chung added.

A simple test of blood circulation in the ankle could help doctors identify patients at high risk of suffering another stroke, researchers say.

The test compares blood flow in the ankle to that in the arm. A significant difference between the two readings could suggest that a patient suffers from peripheral artery disease, caused by fatty plaque buildup in the arteries of the extremities, the researchers explained in a news release from the American Heart Association.

Stroke survivors and those who have experienced transient ischemic attacks — also known as TIAs or mini-strokes — are at high risk of stroke if they have peripheral artery disease, the study authors noted.

In the study, which appeared online Aug. 27 in Stroke, researchers sought to figure out how the condition affects patients.

The researchers screened 102 survivors of strokes and mini-strokes by using a device similar to a blood-pressure cuff to check circulation in their ankles. They found that 26 percent of the patients had peripheral artery disease without symptoms. Those patients were three times more likely to suffer from stroke, heart attack or death within the next two years compared to those who didn’t have the condition.

The test “may be appropriate for screening stroke/TIA patients who may be at high risk for vascular events,” said lead researcher Dr. Souvik Sen, director of the Stroke Center at the University of North Carolina at Chapel Hill, in the news release. “The test is easily performed in less than 15 minutes at the physician’s office or at bedside in hospitalized patients.”