More Men with Early-stage Prostate Cancer Could Opt Out of Immediate Treatment

A new report on Swedish men with non-aggressive prostate cancer suggests that a lot more American men could safely choose to monitor their disease instead of seeking immediate radiation treatment or surgery.

Published in the Journal of the American Medical Association (JAMA) Oncology online Oct. 20, the report shows that well over half of 32,518 men in Sweden diagnosed with prostate cancers least likely to spread chose monitoring during a recent, five-year period over immediate treatment.

Led by researchers at NYU Langone Medical Center and its Perlmutter Cancer Center, an international team concluded that men are likely to choose monitoring once presented with the choice.

Called active surveillance, the monitoring option relies on regular blood tests, physical exams, and the periodic biopsy, or sampling, of prostate tissue to screen for any signs of a tumor’s growth before therapy is considered. The move to active surveillance, say the study authors, averts the risk of sexual dysfunction, as well as bowel and bladder problems that frequently accompany traditional therapies.

“The main conclusion here is that if the majority of men in Sweden have adopted this management strategy for very low- to low-risk prostate cancer, then more American men might choose this option if it were presented to them,” says lead study investigator and urologist Stacy Loeb, MD, MSc.

Among the study’s key findings was that from 2009 to 2014 the number of Swedish men with very low-risk cancer choosing active surveillance increased from 57 percent to 91 percent, and men with low-risk cancer choosing this option rose from 40 percent to 74 percent. Meanwhile, the authors report, the number of men in both groups who chose to simply wait, do no further testing, and postpone therapy unless symptoms develop — a passive practice called watchful waiting — dropped by more than half.

For the study, researchers analyzed data from Sweden’s National Prostate Cancer Register, one of the few such national databases in the world (and for which nothing comparable exists in North America).

Loeb, an assistant professor in the urology and population health departments at NYU Langone, and a member of Perlmutter, says that while increasing numbers of American men diagnosed with early-stage disease are choosing active surveillance, they still account for less than half of those for whom it is an option.

“Our findings should encourage physicians and cancer care professionals in the United States to offer such close supervision and monitoring to their patients with low-risk disease,” says Loeb. More American men opting for active surveillance, she adds, “could go a long way toward reducing the harms of screening by minimizing overtreatment of non-aggressive prostate cancer.”

Loeb says recent studies have suggested that some men with early-stage disease who opted for treatment later regretted it because of lingering problems, such as incontinence and impotence.

A large study also recently showed no difference in death rates a decade after diagnosis between those who chose active surveillance and those who chose immediate treatment, Loeb says. Meanwhile, there is a greater risk of side effects among men undergoing therapy. She cautions, however, that this pattern has not been confirmed for the Swedish men in the current study.

The U.S. National Cancer Institute estimates that 26,000 American men will die from the disease in 2016, with 181,000 getting diagnosed, most in its earliest stages.

Source: EurekAlert!

Clots in the Lung May Be the Cause of Fainting in Some Elderly

When elderly adults suffer a fainting spell, a blood clot in the lungs may be the culprit more often than doctors have realized, a new study suggests.

Italian researchers found that among 560 patients hospitalized for a first-time fainting episode, one in six had a pulmonary embolism — a potentially fatal blood clot in a lung artery.

One U.S. physician said the findings are eye-opening.

They do not mean that everyone who faints needs to be evaluated for pulmonary embolism, stressed Dr. Lisa Moores, a professor of medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md.

But the condition should be on doctors’ radar with certain patients, according to Moores, who is also with the American College of Chest Physicians. She wasn’t involved in the study.

“Pulmonary embolism may be a much more common cause than we’ve thought,” she said.

Most often, a pulmonary embolism is caused by a blood clot in the legs that dislodges and travels to the lungs, according to the U.S. National Institutes of Health.

The most common symptoms include chest pain, cough and difficulty breathing.

Pulmonary embolism occasionally causes fainting — and that has been considered a sign of a more-severe blockage, Moores said. That is, the clot is large enough to abruptly cut off blood flow to the brain and cause a loss of consciousness.

Still, Moores said, fainting spells are “certainly not at the top of the list” of pulmonary embolism symptoms.

Partly because of that, she explained, people hospitalized for fainting are not typically evaluated for pulmonary embolism — unless there are other suspicious symptoms, such as chest pain or swelling in the legs (a sign of a blood clot in the legs).

The new study appears in the Oct. 20 issue of the New England Journal of Medicine. Its aim was to figure out how often pulmonary embolism really is the culprit when people are hospitalized for fainting.

Researchers at 11 hospitals in Italy performed a “systematic workup” for pulmonary embolism in 560 patients admitted for a first-time fainting spell.

The patients were 76 years old, on average, and had been admitted from the ER for various reasons: The cause of their fainting was not apparent; there was reason to suspect a heart-related cause; they had other serious medical conditions; or they’d been injured when they fainted.

In the end, just over 17 percent — or roughly one in six — were diagnosed with pulmonary embolism.

That included 13 percent of patients who’d had a potential alternative explanation for their fainting, such as a heart condition.

Still, fainting spells can have many potential causes, Moores pointed out. Those include seizure, a drop in blood pressure (from dehydration or standing up quickly, for instance), and heart-rhythm disturbances.

So people who faint should not assume they have a pulmonary embolism, Moores stressed.

Study co-author Dr. Sofia Barbar, a physician at the Civic Hospital of Camposampiero in Padua, Italy, agreed.

Barbar stressed that the study focused on “high-risk” patients who had to be admitted to the hospital after arriving in the ER.

In general, she said, people who faint far more often have “reflex syncope.” That refers to a short-lived loss of consciousness due to certain triggers, such as seeing the sight of blood, or standing in a hot, crowded area.

But when it comes to certain patients, Barbar said, this study suggests that pulmonary embolism is a more common issue than thought.

“In elderly patients presenting with [fainting],” she said, “the attending physician in medical wards should consider [pulmonary embolism] as a possible differential diagnosis — particularly when an alternative explanation is not found.”

Source: U.S. Department of Health and Human Services

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Pulmonary embolism

1,000-Year-Old Chinese Liquor Wants to Be the New Tequila

The fiery Chinese grain liquor called baijiu has been distilled and quaffed in the homeland pretty much the same way for a millennium. Yet as these brands expand overseas, spirits companies are wondering: How would it taste with 7-Up?

Makers of the 106-proof alcohol that’s popular at wedding receptions and government banquets are coping with a steep revenue drop after President Xi Jinping ordered public servants to cut their expense tabs. Sales declined 13 percent, and store prices plunged by half.

With less than 1 percent of baijiu consumed abroad, Chinese distillers now want to transform the liquor into “the new tequila” for Americans and Europeans. So they’re diluting its stomach-burning potency, hiring mixologists to experiment with ginseng and tropical fruits, and promoting the concoctions at bars in New York, London, Sydney—even at Walt Disney World.

“We want to see baijiu have its moment in the world,” said Tony Tian, commercial director of Diageo Plc’s China White Spirits unit, which includes the high-end Shuijingfang brand. “Tequila had it, vodka had it. Why not baijiu?”

Venerable brands like Shuijingfang, less-expensive offerings such as Beijing Red Star Co. and startups such as ByeJoe and HKB are searching for the right ingredients that will do for baijiu what the margarita did for tequila. They’re trying grapefruit juice, Angostura bitters and brown sugar to mask a pungency considered on par with the durian fruit popular in Southeast Asia.

They’re also lowering the liquor’s alcohol content to make it more akin to the 80-proof spirits favored by Westerners, infusing bottles with flavorings and promoting the antioxidant powers of the main ingredient sorghum. The makers have nothing to lose and everything to gain, since exports made up just 0.1 percent of baijiu sales last year, according to statistics from London-based International Wine and Spirit Research.

“Baijiu is not a spirit you can just pour into a martini glass and grow an appreciation for its taste immediately,” said Orson Salicetti, co-founder of the Lumos bar in New York that serves about 40 different brands. “The trick to appreciating baijiu is embracing its unfamiliar flavor in cocktails.”

Varieties of baijiu, or “white liquor,” are made from sorghum, rice, wheat or corn, and can contain as much as 53 percent alcohol by volume. About 5.5 billion liters, or 1.5 billion gallons, were sold last year, according to London-based Euromonitor International.

Industry revenue last year was 766 billion yuan ($115 billion), compared with a peak of 882 billion yuan in 2012, when government officials were propping up demand and prices for top-shelf brands like Shuijingfang and Kweichow Moutai by gifting bottles or throwing boozy banquets. Xi’s edict ended that party.

“Baijiu must change, transform and explore,” said Song Shuyu, director of the China Alcoholic Drinks Association, a government oversight and promotion body.

Baijiu traditionally is imbibed in extra-small shot glasses during big, celebratory meals.

At least in China.

At nightspots abroad, Diageo advises bartenders to mix Shuijingfang, the brand it bought in 2011, with 7-Up to make it more palatable to non-Chinese. The world’s largest distiller, based in London, also created a recipe—similar to an Old Fashioned—it will promote in 50 Hong Kong bars by year’s end.

“We want to introduce our baijiu to Western drinkers slowly,” Tian said. “We want people to first try it in the context of a cocktail. They may be intrigued by it and then slowly move up to the real version.”

Shuijingfang has produced baijiu in Chengdu, southwest China, for 600 years. The distillery smells like strong blue cheese as grains ferment in rectangular pits. Workers follow enduring instructions dictating the direction in which grains are spread and the tempo with which the water is stirred.

After fermentation, baijiu is poured into urns that can sit for 35 years. A master blender mixes liquid from several urns before it’s poured into an iconic Shuijingfang bottle—a bottom-heavy, intricately etched glass meant to be the centerpiece of a banquet table.

Other old-school distillers like Beijing Red Star, which traces its lineage to 1680, are trying to keep pace with new varieties. It’s introducing Nuwa, which has 42 percent alcohol and comes in a grooved bottle for easy handling by harried bartenders.

And just like other industries, an adherence to tradition can create gaps where innovation germinates. Startups are developing cheaper, less-potent products with names like HKB and Byejoe, and using slick advertisements targeting 20-somethings.

The newcomers, founded by Westerners who lived in China or have Chinese heritage, are found in trendy nightspots in New York and London, and in mainstream vacation spots like Disney World.

HKB founder Charles Lanthier, who lived in Shanghai for four years while working in the finance industry, sources his baijiu from China and re-distills it in Italy. Backers of HKB, or Hong-Kong Baijiu, include the French investment fund Weber Investissements.

About 100 locations in New York use it in cocktails, he said.

“You can bring the heritage, but you also need to adapt to a certain consumption mode,” Lanthier said. “Tequila in the U.S. is not drunk the same way it was drunk in Mexico 20 years ago.”

Matt Trusch, whose dragon fruit- and lychee-infused baijiu is served at two Disney World bars in Florida, started Byejoe after living in Shanghai for 12 years. Backers include former NBA star Yao Ming’s investment team, according to the state-run China Daily newspaper, and Trusch said the company is profitable after four years.

“What we’ve done that the baijiu companies didn’t manage to do is create a product for the young consumer,” Trusch said. “There’s a demand in the market that’s not filled.”

Byejoe’s website includes a recipe using Starbucks frappuccino, Frangelico, creme de cacao and Bittermens orange cream citrate. There also are commercials featuring Byejoe drinkers at a hip nightspot.

A place just like that is Lumos, where bottles of HKB, Kweichow Moutai and Wuliangye line the shelves. Lumos serves a Sesame Colada—baijiu mixed with mangosteen, white sesame paste, caramelized pineapple and agave.

Salicetti and partner Qifan Li opened the bar in June 2015, and now Salicetti teaches classes on mixing baijiu with prune, basil and fig.

“It’s an evolution,” he said. “We introduce cocktails in a fun way.”

Down the bar, Kayla Deaton agreed. The 27-year-old, who works in finance, learned about baijiu while studying in Shanghai.

“I always sipped it and had the shot in China, but I actually prefer it in a cocktail,” she said. “It’s better if you add a little sugar.”

Source: Bloomberg

Chestnut Sweet for the Fall

Each piece of sweet is sold in Japan for 2,400 yen.

Fast-Food Calorie Labeling Unlikely to Encourage Healthy Eating, Finds NYU Study

Researchers from New York University show why fast-food menu calorie counts do not help consumers make healthy choices in a new study published in the Journal of Public Policy & Marketing.

The researchers found that only a small fraction of fast-food eaters – as little as 8 percent – are likely to make healthy choices as a result of current calorie labeling. The study comes just six months before a federal policy goes into effect requiring calorie labeling nationwide and provides recommendations for improving labeling that could boost the odds of diners making healthy choices.

“Health policies would benefit from greater attention to what is known about effective messaging and behavior change. The success of fast-food menu labeling depends on multiple conditions being met, not just the availability of calorie information,” said study author Andrew Breck, a doctoral candidate at NYU Wagner Graduate School of Public Service.

Calorie labeling on fast-food restaurant menus was designed to motivate consumers to change their behavior by providing them with health information. In 2006, New York became the first city to introduce labeling requirements for fast-food chains; Philadelphia and Seattle followed shortly after. On May 5, 2017, calorie labeling will go into effect nationwide, with the Food and Drug Administration requiring all chain restaurants with at least 20 locations to post calorie information.

But despite the rapid and widespread adoption of policies to require calorie counts at restaurants, most studies of calorie labels in fast-food restaurants in places that have already adopted labeling, including New York, have found little evidence that fast-food consumers are changing their behaviors in response to the labels.

These surprising findings become less so in light of research suggesting that simply providing calorie information may not create change. A framework created by Scot Burton of the University of Arkansas and Jeremy Kees of Villanova University outlined five conditions that need to be present in order for people to be swayed by calorie labeling at fast-food chains:

  1. Consumers must be aware of the labeling.
  2. Consumers must be motivated to eat healthfully.
  3. They must know the number of calories one should eat daily to maintain a healthy weight.
  4. Labeling must provide information that differs from consumers’ expectations of how many calories foods contain.
  5. Labeling must reach regular fast-food consumers.

In this study, the NYU researchers used Burton and Kees’ framework to better understand why menu calorie labeling policies have had a limited impact. The researchers used data collected in Philadelphia shortly after calorie labeling went into effect in the city in 2008. They analyzed responses from 699 consumers who completed point-of-purchase surveys at 15 fast-food restaurants throughout Philadelphia, as well as responses from 702 phone surveys of the city’s residents.

The surveys helped the researchers understand which of the conditions outlined by Burton and Kees were met. For instance, they asked if consumers noticed seeing calorie information in a fast-food restaurant and prompted them to estimate how many calories they should be consuming daily.

Based on the two surveys, the researchers found that a small minority of fast-food consumers met all conditions, and therefore would be expected to change their eating behavior as a result of menu calorie labeling. Only 8 percent of those surveyed in fast-food restaurants and 16 percent of those surveyed by phone met all five conditions: they were aware of menu labeling, were motivated to eat healthfully, could estimate their daily calorie intake, were surprised by calorie counts, and ate fast food ate least once a week.

A third of those surveyed by phone did not see calorie labels posted and nearly two thirds surveyed at point-of-purchase did not notice the calorie information. As a result, the researchers recommend that restaurants make calorie information more visible to consumers through clear signage and fonts that are large and in a noticeable color.

In addition, the researchers cited past experiments showing that people responded to calorie labeling on menus that included the average recommended daily calorie intake, or explained how much exercise would be needed to burn off different foods. While these experiments have not been used in the real world, these potential labeling improvements may hold value based on the lack of nutritional knowledge in the current study. Three-quarters of those surveyed by phone correctly estimated the number of calories they should consume daily, but this was true of less than half of those surveyed at point-of-purchase.

The researchers also note that the visibility of calorie labeling may encourage change through a different pathway: it may spur restaurants to reduce the calorie content of existing menu items and provide additional lower calorie options.

“We know that few regular fast-food eaters chose fast food because it is nutritious; they instead are motivated by cost and convenience,” said study author Beth Weitzman, professor of public health and policy at NYU Steinhardt School of Culture, Education, and Human Development. “However, requiring restaurants to make the calorie content of their menu items highly visible could cause restaurants to add new, healthy options to their menus.”

Source: New York University