The study is the first to identify common genetic variants influencing stroke risk in the United States and may lead to better treatments, they reported on Wednesday.

While other stroke-related genes have been discovered, none involved such a wide portion of the population, said Eric Boerwinkle of The University of Texas Health Science Center.

“This is a first step in unraveling the genetic contributions of this debilitating disease,” said Boerwinkle, whose team was one of several contributing to the study published in the New England Journal of Medicine.

Stroke is the third-leading cause of death in the United States and causes serious long-term disabilities for many worldwide.

Boerwinkle said the teams found two genetic variants on chromosome 12 near two genes that are implicated in stroke. One, called WNK1, is associated with blood pressure control and the other, NINJ2, is linked with brain injury repair.

The two genes, next to each other, both are also strongly linked with ischemic stroke, which is the most common type of stroke and is caused by blocked blood vessels in the brain.

Boerwinkle said it is not clear which specific gene is implicated, but he said the most likely suspect is NINJ2.

They found two single-letter changes in the DNA, known as single nucleotide polymorphisms or SNPs — pronounced “snips” — near NINJ2 that seem to send the strongest stroke “signal.” One is found in about 20 percent of whites they checked and 10 percent of African-Americans.

Having just one copy of this genetic variation can raise the risk of ischemic strokes by about 30 percent, he said — although the study says it is unlikely the SNPs are the actual cause of stroke but probably associated with the actual genetic cause.

The findings come from an analysis of the genetic code of more than 19,000 people in the United States and Europe taking part in four long-term studies of cardiovascular risks.

The teams were looking for SNPs among 1,544 people who had strokes, compared with 18,058 people who did not.

Boerwinkle said more work needs to be done to sort out which genes are at play, but he said the findings should give drug companies a new target for researching better treatments.

Dr. Walter Koroshetz, deputy director of the U.S. National Institute of Neurological Disorders and Stroke, which supported the study, said the findings are not strong enough to alter a patient’s stroke prevention strategy.

But he said the results “will lead scientists to direct their attention to new, important biologic mechanisms and hopefully new treatments to prevent stroke.”

Scientists uncover genetic risks for stroke

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The law has been in the works since October last year after a huge scandal erupted over contaminated milk which killed at least six children and sickened nearly 300,000 others in China.

“The law will see the establishment of a monitoring and supervision system, a set of national standards on food safety, a recall system, and severe punishment for offenders,” the official Xinhua news agency said.

China’s huge and poorly regulated food industry is regularly hit by scandals involving unsafe foods which harm public health and result in product recalls both at home and abroad.

In September, the tainted milk scandal — one of the biggest to hit the industry — caused a huge outcry, leading to China-made dairy product recalls and bans across the world.

A court in January sentenced the head of Sanlu — the dairy firm at the heart of the scandal — to life in prison for “manufacturing and selling fake or substandard products.”

Two others were sentenced to death over the incident, which saw the industrial chemical melamine added to watered-down milk to make it appear higher in protein.

Xinhua gave no further details of the content of the food safety law, but according to a previous report by the state-run agency, it would make health authorities directly responsible for approving additives in processed foods.

The agency also said it would prevent food safety authorities from issuing inspection exemptions to major food producers, as happened in the tainted milk scandal.

The law was passed by the National People’s Congress Standing Committee, China’s top legislature.

China approves food safety law: state media

The warning — which won’t be a “black box” warning — applies to all antiepileptic medications, including those used to treat psychiatric disorders, migraines, and other conditions, as well as epilepsy.

Here is a list of the medications required to add the warning:

* Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
* Clonazepam (marketed as Klonopin)
* Clorazepate (marketed as Tranxene)
* Divalproex sodium (marketed as Depakote, Depakote ER, Depakene)
* Ethosuximide (marketed as Zarontin)
* Ethotoin (marketed as Peganone)
* Felbamate (marketed as Felbatol)
* Gabapentin (marketed as Neurontin)
* Lamotrigine (marketed as Lamictal)
* Lacosamide (marketed as Vimpat)
* Levetiracetam (marketed as Keppra)
* Mephenytoin (marketed as Mesantoin)
* Methosuximide (marketed as Celontin)
* Oxcarbazepine (marketed as Trileptal)
* Phenytoin (marketed as Dilantin Suspension)
* Pregabalin (marketed as Lyrica)
* Primidone (marketed as Mysoline)
* Tiagabine (marketed as Gabitril)
* Topiramate (marketed as Topamax)
* Trimethadione (marketed as Tridione)
* Zonisamide (marketed as Zonegran)

Some of those drugs are also sold generically.
Monitor Patients

“Patients being treated with antiepileptic drugs for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior,” Russell Katz, MD, says in an FDA news release.

Katz, who directs the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research, says that “patients who are currently taking an antiepileptic medicine should not make any treatment changes without talking to their health care professional.”

The FDA also issued a public health alert about the risk and asked health care professionals to notify patients, their families, and caregivers about the risk, so that patients may be closely observed. And the FDA has ordered epilepsy drugmakers to create a risk evaluation and management strategy, including a medication guide for patients, addressing the risk.
Epilepsy Drugs and the FDA

Today’s FDA actions are based on the agency’s review of 199 clinical trials of 11 epilepsy drugs. The review, which the FDA released in January, showed that patients taking those drugs had almost twice the risk of suicidal behavior or thoughts than patients taking a placebo.

That difference was about one additional case of suicidal thoughts or behaviors for every 500 patients treated with antiepileptic drugs instead of placebo.

Four patients who were randomly assigned to take one of the epilepsy drugs committed suicide. There were no suicides in the placebo group. But the results weren’t sufficient to make conclusions about drugs’ effects on completed suicides.

The biological reasons for the increased risk of suicidal thoughts and behavior observed in patients being treated with antiepileptic drugs are unknown, notes the FDA.

In July, the FDA held a public meeting of an independent committee of experts who reviewed the data. The committee agreed with the FDA about the increased risk of suicidality and recommended warning about that risk in the drugs’ labels and in medication guides, rather than requiring a “black box” warning, which is the FDA’s sternest warning.

FDA Orders Suicide Risk Warning for Epilepsy Drugs

Smoking increases the risk of developing colorectal cancer by about 18 percent and the risk of dying from the malignancy by about 25 percent, according to the study, which was published in the Dec. 17 issue of the Journal of the American Medical Association.

“Smoking is significantly associated with colorectal cancer incidence and mortality,” said the study’s lead author, Edoardo Botteri, a biostatistician in the division of epidemiology and biostatistics at the European Institute of Oncology in Milan, Italy.

“People should be aware that smoking increases the risk of cancer not only in organs where there is direct contact with tobacco-related carcinogens, such as lung, oropharynx, larynx and upper digestive tract, but also in organs where exposure to tobacco degradation products is indirect, such as the pancreas, kidney, bladder, cervix, colon and rectum,” explained Botteri.

Tobacco is responsible for about 100 million deaths during the past century and more than 5 million deaths a year, according to background information in the study. Yet, the study pointed out, there are still more than 1 billion smokers worldwide. Eighty percent of lung cancers are directly attributable to smoking, reports the study.

However, the connection to colorectal cancer isn’t as conclusive.

To assess whether or not there is, in fact, a link, Botteri and his colleagues analyzed data from 106 observational studies that varied from small trials containing just several hundred participants to very large trials with more than 1 million participants.

When the researchers looked at the pooled risk, they found that smoking was associated with an 18 percent rise in the odds of getting colorectal cancer.

And, Botteri added, “There was an increase in risk with increasing number of cigarettes per day and pack-years — the number of packs of cigarettes smoked per day multiplied by years of consumption.”

The increased risk began after about 10 years of smoking and increased until it reached statistical significance after 30 years.

“That doesn’t mean that there is no increased risk for people who smoked less than 30 years,” noted Botteri, “It just means that there is strong evidence that exposure of 30 years or more increases the risk of colorectal cancer.”

The researchers also found that smoking increased the risk of death from colorectal cancer by 25 percent.

Dr. Michael Thun, vice president emeritus of epidemiology and surveillance research at the American Cancer Society, said the study will be of most interest to researchers that study colon cancer, and he doesn’t believe the findings will change screening recommendations.

Another message remains the same, he added: “With or without a relationship to colorectal cancer, the message is to avoid all forms of tobacco.”

Botteri, however, believes that doctors should be “more vigilant” about making sure that smokers are compliant with current screening recommendations, and that perhaps, the initial screening age should be lowered for smokers.

washingtonpost.com

Previous studies have linked moderate alcohol consumption with a decreased risk of cardiovascular disease. Hoping to find the same protective effect in the brain, Carol Ann Paul of Wellesley College in Massachusetts and colleagues conducted magnetic resonance imaging (MRI) and health exams on 1,839 adults participating in the Framingham Offspring Study between 1999 and 2001. The participants were of an average age of 60 and none had evidence of clinical dementia or had suffered a stroke. Each were asked how much alcohol they consumed each week, and were then classified as abstainers, former drinkers, or low (one to seven drinks per week), moderate (eight to 14 drinks per week) or high (more than 14 drinks per week) consumers of alcohol. Almost 38 percent of men and more than 44 percent of women fell into the “low-consumption” category.

The researchers found no protective affect on the normal, age-related shrinkage in brain volume. To the contrary, the more a person drank, the more their brain volume diminished. The participant’s brain volumes were measured as a percent of total cranial volume. After adjusting for age, body size, weight and other factors, those in the lowest drinking category had brain volumes of 78 percent of their total cranial volume, compared with 78.6 percent in abstainers. Those in the highest drinking category had brain volumes of 77.3 percent. Interestingly, although men were more likely than women to report being moderate or heavy drinkers, the link between brain volume and alcohol wasn’t as strong in men. For men, only those who were heavy drinkers had a smaller brain volume than those who consumed little or no alcohol where women, even moderate drinkers, had a smaller brain volume than abstainers or former drinkers. The researchers note this gender difference could be due to biological factors, including women’s smaller size and greater susceptibility to alcohol’s effects.

Paul says that while it is unclear why even modest amounts of alcohol may shrink the brain, alcohol is “known to dehydrate tissues, and constant dehydration can have negative effects on any sensitive tissue.” Brain volume decreases with age at an estimated rate of 1.9 percent per decade. At the same time, the brain acquires white matter lesions as it gets older. Lower brain volumes and larger white matter lesions are associated with the progression of dementia and problems with thinking, learning and memory.

“The public health effect of this study gives a clear message about the possible dangers of drinking alcohol,” the study authors concluded. “Prospective longitudinal studies are needed to confirm these results as well as to determine whether there are any functional consequences associated with increasing alcohol consumption.”

However, James Garbutt, M.D., professor of psychiatry at the University of North Carolina at Chapel Hill notes that the study did not demonstrate that the smaller brain volume actually impaired memory or mental function. In addition, the differences between brain volumes in drinkers and non-drinkers were quite small—less than 1.5 percent between abstainers and heavy drinkers. “We’re talking very small differences here,” he says. “We’re not seeing 10 to 20 percent shrinkage.” And while admitting that reduction in brain mass is an interesting finding, he says “we have a long way to go to figure out the implications of it.”

The findings are published in the October issue of the Archives of Neurology.

Medical Updates – Alcohol’s Effect on the Brain | Health News

The findings challenge the popular impression — and marketing pitch — that bottled water is purer than tap water, the researchers say.

However, all the brands met federal health standards for drinking water. Two violated a California state standard, the study said.

An industry group branded the findings “alarmist.” Joe Doss, president of the International Bottled Water Association, said the study is based on the faulty premise that a contaminant is a health concern “even if it does not exceed the established regulatory limit or no standard has been set.”

The study’s lab tests on 10 brands of bottled water detected 38 chemicals including bacteria, caffeine, the pain reliever acetaminophen, fertilizer, solvents, plastic-making chemicals and the radioactive element strontium. Though some probably came from tap water that some companies use for their bottled water, other contaminants probably leached from plastic bottles, the researchers said.

“In some cases, it appears bottled water is no less polluted than tap water and, at 1,900 times the cost, consumers should expect better,” said Jane Houlihan, an environmental engineer who co-authored the study.

The two-year study was done by the Washington-based Environmental Working Group, an organization founded by scientists that advocates stricter regulation. It found the contaminants in bottled water purchased in nine states and Washington, D.C.

Researchers tested one batch for each of 10 brands. Eight did not have contaminants high enough to warrant further testing. But two brands did, so more tests were done and those revealed chlorine byproducts above California’s standard, the group reported. The researchers identified those two brands as Sam’s Choice sold by Wal-Mart and Acadia of Giant Food supermarkets.

In the Wal-Mart and Giant Food bottled water, the highest concentration of chlorine byproducts, known as trihalomethanes, was over 35 parts per billion. California’s limit is 10 parts per billion or less, and the industry’s International Bottled Water Association makes 10 its voluntary guideline. The federal limit is 80.

Wal-Mart said its own studies did not turn up illegal levels of contaminants. Giant Food officials released a statement asserting that Acadia meets all regulatory standards. Acadia is sold in the mid-Atlantic states, so it isn’t held to California’s standard. In most places, bottled water must meet roughly the same federal standards as tap water.

The researchers also said the Wal-Mart brand was five times California’s limit for one particular chlorine byproduct, bromodichloromethane. The environmental group wants Wal-Mart to label its bottles in California with a warning because the chlorine-based contaminants have been linked with cancer. It has filed a notice of intent to sue.

Wal-Mart spokeswoman Shannon Frederick said the company was “puzzled” by the findings because testing by suppliers and another lab had detected no “reportable amounts” of such contaminants. She said Wal-Mart would investigate further but defended the quality of its bottled water.

The researchers recommend that people worried about water contaminants drink tap water with a carbon filter.

Bottled water has contaminants too, study finds – Yahoo! News

Speaking at the World Economic Forum in the port of Tianjin, Wen did not announce new initiatives but he said the government would work to instill business ethics in light of the milk contamination and a string of earlier product safety disasters.

“We plan not only to revitalize the food industry and the milk powder industry, we will try to ensure that all China-made products are safe for consumers and consumers can buy with assurance,” he said.

Even before the uproar over contaminated milk, China’s manufacturing industry had been under intense scrutiny after the industrial chemical melamine and other industrial toxins were found last year in exports ranging from toothpaste to a pet food ingredient.

The milk scandal erupted this month when the public learned that melamine, which is used to make plastics and fertilizer, had been found in milk powder and was linked to kidney stones in children. Contamination has since turned up in liquid milk, yogurt and other products made with milk.

Four deaths have been blamed on the bad milk and some 54,000 children have developed kidney stones or other illnesses after drinking tainted baby formula.

Authorities say suppliers might have added melamine, which is rich in nitrogen, to watered-down milk to deceive quality tests because the chemical registers as protein.

The incident “has revealed to us that in the process of development, the government should pay more attention to business ethics and social morality,” Wen said.

He defended the handling of the crisis by the Beijing government, which has in the past been accused of being reluctant to come clean in situations that could potentially embarrass the communist leadership.

“When this kind of problem of food safety occurs, we do not cover it up,” Wen said. “We face it candidly and have taken bold moves to address it. I think this has laid a good foundation for resolving problems.”

His comments came a day after the General Administration of Quality Supervision, Inspection and Quarantine sought to reassure people by saying random samples from 296 batches of liquid milk, yogurt and other milk products from 47 brands found none tested positive for melamine.

But authorities in Hong Kong said late Saturday that melamine was detected in Chinese-made milk tablets and in cookies made by Japan’s Lotte China Foods Co. On Thursday, Macau’s Health Bureau reported that melamine in cookies made by Lotte was 24 times the safe limit.

Earlier in the week, contaminated baby cereal was discovered in Hong Kong and snack foods in Japan. Taiwan reported three children and a mother with kidney stones in the island’s first cases possibly linked to the crisis.

Health experts say ingesting a small amount of melamine poses no danger, but in larger doses the chemical can cause kidney stones and lead to kidney failure. Infants are particularly vulnerable.

American welfare group said Saturday that almost a dozen Chinese orphans were among those sickened by the tainted milk.

The children, who live in orphanages around the country, are being treated for kidney stones at hospitals after drinking Sanlu brand powdered milk, the Half the Sky Foundation said on its Web site.

“All orphanages using identified tainted brands have changed to either fresh milk or to a brand that has been identified as safe,” said Jenny Bowen, executive director of the Berkeley, Calif.-based group that provides services, supplies and work crews to 41 Chinese orphanages.

Bowen said the foundation had contacted China’s Ministry of Civil Affairs, which is working to provide guidance to institutes that house babies.

A woman who answered the telephone Saturday at the ministry said a letter had been sent a few days ago to local governments urging them to inspect orphanages. She did not have other details and gave only her surname, Zhang, as is common with Chinese officials.

Chinese leader vows better food safety, ethics on Yahoo! Health

In December of 2007, a 35-year-old Illinois woman began to feel stroke-like symptoms during intercourse. With numbness on one side of her face, slurred speech, and weakness in her left arm, she sought care at a medical facility and her condition worsened considerably over the next few hours. Face paralysis, garbled speech, and no movement in the left arm led the doctors to apply a clot-dissipating drug directly to the clot in her brain in an urgent effort to stop the stroke from progressing, and it worked. There was immediate improvement, and the stroke symptoms were nearly erased within 12 hours of the procedure.

Jose Biller, M.D., Professor and Chair of the neurology department at Loyola University in Chicago was the head of the medical team that treated the woman, and the experienced spawned a report that appeared in the September issue of Journal of Stroke and Cerebrovascular Diseases. The doctor initially looked further into the case because the woman was healthy with no history of cardiovascular disease; she was a young non-smoker with no known health concerns.

Strokes triggered by sex and/or orgasm are said to be rare in young people, but the factors that combine to cause the strokes in those situation are not uncommon, it is only their convergence that makes them unique. And the factor that Biller has examined is a minor heart defect called PFO, a patent foramen ovale, which is a small opening in the wall between the two upper chambers of the heart that allows blood to bypass the lung and flow straight to the brain.

PFO is common and can be found in one out of every four adults. The connection to the stroke is that 40 percent of people who suffer a cryptogenic stroke, which is one with no known cause, have a PFO. And the PFO’s trigger point is typically excessive strain that affects blood flow, such as during an orgasm, combined with a blood clot that breaks free and enters the heart, falls into the small opening, and follows through to the brain. This makes the entire process a relatively uncommon one, but the connection is significant enough to inspire more research.

Upon investigation of the patient, it was discovered that she did have one risk factor for clotting, which was her prescriptive birth control pills, which can lead to blood clots. And the woman did have a blood clot in a main vein of her right leg, which was the clot that found its way through her heart at the moment of her sexual experience, which ultimately caused her stroke. The patient was ultimately advised to cease taking the pills and schedule surgery to repair the heart defect, though the surgery is not recommended for the majority of people with a PFO.

In essence, many factors must collide at the precise time to coincide with sex for such a stroke to take place. Biller’s study noted that this should not be a concern for the average person. He emphasized, “This is a rare occurrence.”

Strokes, on the other hand, affect more than 700,000 Americans each year. According to the National Institute of Neurological Disorders and Stroke, approximately 160,000 of them do not survive, and many who do live with serious disabling consequences like partial paralysis and compromised brain function.

Some of the risk factors for stroke, especially in younger people, are migraine headaches, drug use, diseases that cause blood clotting, and athletic injuries that can cause a tear in neck arteries.

Sexual Health – Minor Heart Defect Can Cause Stroke After Sex | Health News

The three animals had been nursed with milk powder for more than a year, said Zhang Xu, a veterinarian with the Hangzhou Zhangxu Animal Hospital.

The orangutans and lion cub at the Hangzhou Safari Park near Shanghai were found to have kidney stones Wednesday after concerned officials sent them to Dr. Zhang for a checkup.

The milk powder was made by the Sanlu Group, which is at the center of the tainted milk scandal. The industrial chemical melamine has been found in a growing range of Chinese-made dairy products, and it has been blamed for sickening 54,000 infants in China and killing four.

“The milk powder crisis made us very worried about the health situation of baby animals,” Ju Lijia, the park’s public affairs manager, said by phone on Wednesday. “We stopped feeding with Sanlu after it was found to be tainted.”

Officials at the Beijing Zoo and zoos in the other major cities of Shanghai, Guangzhou and Xian said they had no cases of animals sickened from milk powder. An official at the world’s most famous panda sanctuary, the Wolong Nature Reserve, said the baby pandas there were not fed milk formula.

Lion Cub and Baby Orangutans Sickened by Tainted Chinese Milk – NYTimes.com

In Hong Kong, Heinz Foods this week recalled its vegetable formula baby cereal after some samples of it tested positive for melamine. In Taiwan, Pizza Hut said it had found cheese packets similarly contaminated. Officials in Macao, a Chinese territory, said Friday that the chemical had turned up in koala-shaped cookies made by a Japanese-owned company. And several African nations moved to ban imports of Chinese dairy products this week.

In the United States, the Food and Drug Administration said Friday that some instant coffee and tea drinks, all containing a nondairy creamer made in China, had been recalled for fear of contamination. It is the first recall in the United States growing out of the melamine scare.

The F.D.A. said the King Car Food Industrial Company of Taiwan had called back seven products sold under the Mr. Brown label, mostly sold in stores specializing in Asian foods. The company’s tests in Taiwan had determined that its nondairy creamer, which was made in China, was contaminated by melamine, the F.D.A. said. No contaminated products have actually been found on American shelves.

The F.D.A. also said that it had itself extensively tested milk-based products imported from China into the United States in recent weeks. It said it had found no contamination so far.

King Car Food recently began buying the nondairy creamer from China, where Shandong Duqing Inc. produces it, said Linda Chen, manager for the Sunny Maid Corporation, the importer. She said that as the adulteration scandal unfolded, King Car Food had begun tests of its products and found the nondairy creamer to be contaminated. She said the instant products were not imported in large quantities.

These instances are increasing fears that products from China’s troubled dairy industry could pose health risks worldwide. In China, the government has said that melamine-tainted dairy products have sickened more than 50,000 children.

Exports of food ingredients from China have boomed in recent years. Some health experts say it may take some time to determine whether melamine seeped into food products that incorporated any of those ingredients.

The World Health Organization on Friday warned health officials around the world to be alert for dairy products of Chinese origin that could be tainted. Health officials in the United States and Europe have issued similar warnings.

Supermarket shelves in China are still largely empty of domestic dairy brands while the government investigates the safety of the country’s dairy supply.

Another setback hit the Chinese dairy industry on Friday, when one of China’s biggest candy makers said it had halted sales of a popular brand, White Rabbit Creamy Candy, after tests found some candies tainted with melamine.

Many big companies are scrambling to assure customers that their products are safe. Starbucks has replaced fresh milk with soy milk in many of its stores in China. McDonald’s said the ice cream in its restaurants in China was untainted, and Kraft said its Oreo cookies did not contain dairy fillings from China.

Asia Food Tainting Spreads, Leading to Recall in U.S. – NYTimes.com