A second study randomized 130 severely obese adults (mostly women) to diet and exercise for 12 months, or to a 6-month period of diet alone followed by 6 months of diet and exercise. At 6 months, people in the combination diet-exercise group lost more weight than the diet-only group, but at 12 months, weight loss was similar in the two groups. Reimbursement for nonsurgical treatment of obesity is rare. Physicians should not be discouraged from implementing nonsurgical medical care approaches in this population, but payers need to rethink their policies.
大意：悪いお知らせ：ダイエット(食餌療法)と運動の組み合わせで一年間減量に取り組んだグループと最初の半年はダイエットだけで、後半の半年はダイエットと運動を組み合わせたグループとの間には、有意差は見られなかった。外科的手術を施さなければ、いずれの方法も減量効果に違いはないようだ。食餌療法や運動療法で減量を考えている人は、再考が必要だ。

　"Why I won't blog about heart failure" 　　(10/11/2010)英文記事は、CardioBriefからの引用。

　Shortly before that time, by clicking on the titles of the two posts which I found listed on the right side of the page under “recent posts”, I could see the first third of the blog post and sidebar. Surprised to see a number of highlighted words in the text of both the story and sidebar, I hovered over them and was shocked to see what jumped out. First was the picture of a man’s face and the message with it told me to support him for senator. Next out came an ad for baby lotion for diaper rash. And then springing from a word in my story on heart failure was a direct link to a website that sells genetic tests. Whoa! I’m sending my readers to a company that sells genetic tests? A journalist could write a story warning consumers to beware of genetic tests because of their limitations and shortcomings. These links from my story to commercial products were unacceptable to me. I couldn’t have ads jumping out of the words of my blog post. I consider that USN&WR, a well-known weekly news magazine, has crossed the line that is supposed to separate advertising from news and editorial content. I told the magazine this and said not to publish my blog with ads popping out of it. This separation of advertising and editorial content is a long-held tenet of journalism.
大意：医療作家で現在Johns Hopkins Universityで教鞭をとっているMary Knudson氏の投稿記事で、彼女がなぜU.S. News and World Report誌(USN&WR)のサイトから自身のブログ掲載を拒否するようになったかの経緯が書かれてあった。
　サイト上の彼女の記事の文章中にハイライトされた単語がいくつもあり、そこからは下院議員を支持しましょうというメッセージやオムツかぶれ用のベビーローションの広告も表れた。さらに、心不全に関する彼女の記事中の単語から遺伝子検査を売り込むサイトへ直接リンクされていた。「医療ジャーナリストなら、遺伝子検査の限界と欠陥に警鐘を鳴らす記事を書けるほどなのに。」と彼女は訴える。

　I have two objections to that. One is that USN&WR is well known for its special annual rankings of best hospitals. I would think that the magazine would consider it a conflict of interest to have a partnership with any of the hospitals it ranks. Wouldn’t a partnership between USN&WR and a hospital it ranks, that results in information routinely offered to readers by that hospital on the USN&WR website as part of news content, be interpreted as USN&WR favoring that hospital?
まず、優良病院のランク付けをしているUSN&WRが、特定の病院とpartnershipを結んでいるのはいかがなものかと疑問を投げかけている。
　My second objection is that no partnership should overtake a blogger’s right to control what words in her blog will link elsewhere and where they will link. Regarding linking the words “heart failure”, it would not be fitting for me to link to a particular medical center, particularly the Cleveland Clinic. To explain, I was diagnosed with heart failure in 2003 and had a hard time finding good care. Once I did and started getting better, I asked my fourth cardiologist, Edward Kasper, to write a book with me that would alert the public to heart failure and try to find the truth as best we could about all aspects of heart failure. I eventually recovered and have a heart that works normally. Along the way I learned a lot that I wanted to pass on to others and I spent years researching and writing the book with Ed, who happens to be the clinical chief of cardiology at another pretty good hospital, the Johns Hopkins Hospital. USN&WR was running a picture of the cover of our book alongside my first blog post and had embedded in my accompanying bio a link to the book's website.
次に、自身のブログ中の「心不全」という単語から特定の病院－Cleveland Clinic－にリンクが張られているのは受け入れられないとも訴えている。彼女は、利害関係にとらわれないサイトで心臓疾病に関する情報を伝えたいとの想いから、全米ネットワークを持つ健康に関するブログ開設に向けて準備している。


Rolofylline Fails (10/8/2010)　英文記事は、CardioBriefからの引用。

　Massie and colleagues randomized 2033 patients hospitalized with acute heart failure and impaired renal function to receive intravenous roloflylline or placebo. Earlier studies had suggested that the use of an adenosine A1-receptor antagonist might be beneficial in this patient population.
　　There was no difference between the two groups in the primary endpoint, which was based on survival, heart-failure status, and changes in renal function. At 60 days the rate of death or readmission for cardiovascular or renal causes was similar in both groups. The authors concluded that rolofylline “does not show promise in the treatment of acute heart failure with renal dysfunction.”
大意：The New England Journal of Medicineによると、治験薬rolofyllineを2033人の心不全および腎機能障害の患者に投与したところ、primary endpoint(主要評価項目)において、プラセボグループとの差異は見られなかったということだ。評価項目は、生存率、心不全や腎機能の改善など。
　
　By 60 days, death or readmission for cardiovascular or renal causes had occurred in similar proportions of patients assigned to rolofylline and placebo (30.7% and 31.9%, respectively; P=0.86). Adverse-event rates were similar overall; however, only patients in the rolofylline group had seizures, a known potential adverse effect of A₁-receptor antagonists.
投与60日後の死亡率、心循環器と腎臓由来の再入院率において、30.7％と31.9％と殆ど違いがなかった。有害事象発生率は同レベルだったものの、発作が起こったのはrolofyllineを投与したグループだった。


Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity(10/5/2010)
　英文記事は、CardioBriefからの引用。

Results: Sleep curtailment decreased the proportion of weight lost as fat by 55% (1.4 vs. 0.6 kg with 8.5 vs. 5.5 hours of sleep opportunity, respectively; P = 0.043) and increased the loss of fat-free body mass by 60% (1.5 vs. 2.4 kg; P = 0.002). This was accompanied by markers of enhanced neuroendocrine adaptation to caloric restriction, increased hunger, and a shift in relative substrate utilization toward oxidation of less fat.

Conclusion: The amount of human sleep contributes to the maintenance of fat-free body mass at times of decreased energy intake. Lack of sufficient sleep may compromise the efficacy of typical dietary interventions for weight loss and related metabolic risk reduction.

大意：睡眠とダイエットに深い相関関係があるとした研究。
Subjects(被験者)にそれぞれ８時間半と５時間半の睡眠を与えた結果、脂肪分の減量が前者1.4kgで後者0.6kg、脂肪分を除く体重の減少はそれぞれ1.5kgと2.4kgであった。
つまり、摂取エネルギー量を減らせば、十分な睡眠時間が脂肪のない身体の維持に貢献し、睡眠時間が不十分であると、減量ダイエット効果やメタボ対策効果が弱まる。

Acromegaly (8/24/2010)　
　The wrestler, Choi Hong-man, is an example of acromegaly, which comes from the Greek words for "extremities"(acro) and "great"(megaly), because one of the most common symptoms of this condition is abnormal growth of the hands and feet. He had to refrain himself from fighting tournaments due to the pituitary gland tumor, which may result in an altered facial appearance, enlargement of the hands and feet, sleep apnea, and carpal tunnel syndrome. More serious problems may include accelerated cardiovascular disease, hypertension, diabetes mellitus and possibly an increased risk of colon cancer. If the tumor develops before bone growth is completed in adolescence, the result will be gigantism.
　Patients with this disease had to pay for expensive medical expense for the treatment; however, it has been designated as incurable disease, which greatly relieve the financial burden.


Rimonabant (8/18/2010)
　Rimonabant is a drug for obesites, reducing appetite, and ultimately food consumption. The European Medicines Agency recommended doctors no longer prescribe rimonabant from October 2008, referring to no evidence for rimonabant’s prevention of adverse cardiovascular outcomes while rimonabant causes the effect of inducing serious neuropsychiatric side-effect.

　Four patients in the rimonabant group (0.04%) and one in the placebo group (0.01%) committed suicide. 364 (3·9%) patients assigned to rimonabant and375 (4·0%) assigned to placebo. With rimonabant, gastrointestinal (33% vs 22%), neuropsychiatric (32% vs 21%), and serious psychiatric side-effects (2·5% vs 1·3%) were significantly increased compared with placebo.
　
　In consequence, people with obesity should control their caloric intake and increase physical activity instead of relying on such drugs as rimonabant with potential side-effects. Sounds simple but easier said than done.


Breast Cancer (7/29)
　For women, the major killer is breast cancer. There have been no dramatic development on the life expectacy of patients diagnosed with this disease. In terms of not just the duration of survival, but the quality of the survival, more women are opting for mastectomy rather than lumpectomy though mastectomy seems to cause more serious side-effects and physical distress as well as psychological distress. Actually, however, local excision remains the high risk of recurrence. About 20 percent of women treated by lumpectomy probably end up having a mastectomy, which for some women is quite unacceptable. That's why when given a choice, if patients are truly informed of all the various risks involved with the different procedures, most of them will still prefer to opt for mastectomy. Avoiding radiotherapy is another reason for the option.
　For mammographic screening women from the age of 50 to 65 are the optimal age group, because that group seemed to achieve most benefit in terms of early detection of the disease. If that group is screened once every three years, we could reduce the mortality from breast cancer by 25 percent.


Developmental Disorders (7/27)
　ADHD, which stands for attention deficit hyperactivity disorder, is regarded as a disruptive behavior disorder. The school children with this disease break the rules in a classroom.
　It is said that excessive number of children are diagnosed with ADHD for doctors tend to apply criteria inaccurately. Even doctors have difficulty making the diagnosis of ADHD, and then how could teachers properly treat the children with this disease? The fact that ADHD tends to run in family also makes the problem more sensitive and complicated.
　If early intensive educational intervention is the only effective approach for this disease, the MEXT should show clear guidlines for behavioral method and therapy.

Is it safe? (7/25)　　　 　　　
　This is not necessarily a matter of medicine, but here "Is it safe?" is kept using in the conversation between a dentist and a patient. Interestingly, it is not a patient but a dentist who repeats this phrase. Oliveir played a Nazi dentist and Hoffman a patient in the film, Marathon Man.

　Olivier: Is it safe?
　Hoffman: You’re talking to me?
　Olivier: Is it safe?
　Hoffman: Is what safe?
　Olivier: Is it safe?
　Hoffman: I don’t know what you mean.
　　　　　I can’t tell you something’s safe or 　　　　　　not, unless I know specifically what 　　　　　　you’re talking about.
　Olivier: Is it safe?
　Hoffman: Tell me what the “it” refers to.
　Olivier: Is it safe?
　Hoffman: Yes, it’s safe, it’s very safe, it’s so
　　　　　 safe you wouldn’t believe it.
　Olivier: Is it safe?
　Hoffman: No. It’s not safe, it’s… very 　　　　
　　　　　 dangerous, be careful.
　
　This conversation is implausible, but it implies something essential in our life. The same question was kept pouring while the answers varied from Yes to No. How could it happen? It is because the patient has no idea of what is going on. We need to collect information and analize the fact, which is the only way to reach the truth.


Tumor (6/24)
　A medulloblastoma is a tumor that arise from poorly developmental cells in the inner part of the body.
　… certain developmental malformations or inflammatory masses may occasionally be called tumors.
　In the above two sentences, the term "developmental" is used; however, doctors claim that "developmental" be "differentiated." Poorly differentiated refers to how the cancer cells look under a microscope, which means the cells do not look much like normal breast cells. As normal cells develop, they differentiate, which means they change and become specialized depending on where in the body they are. For example, breast cells look differnt from liver cells. Therefore, it is important for cells to change and be differential.
cf. differentiated = 分化された

Alzheimer (6/19)
　Alzheimer’s Disease is the most common type of dementia. Dementia, which affects the brain and memory and makes you gradually lose the ability to think normally, occurs as a result of changes in the brain. It can become severe enough to affect daily activities.
　Alzheimer's Disease is not a normal part of aging. No one knows what causes Alzheimer’s Disease, but much research is being done. You may be more at risk if you had a family member with the disease.
　The signs start slowly and can vary or worsen over time. A person cannot control the signs.Treatment can help, but it does not cure the disease.
Signs may include:
•Memory loss, especially about recent events
•Confusion about time and place
•Poor judgment
•Trouble learning new information
•Changes in being able to do such things as drive, handle money, take medicine, cook, dress and bathe
　Looking at signs of Alzheimer's disease, there are some that I've been suffering from for these several years. They may come from either a mere aging or Alzheimer's disease. I find quite hard especially in remembering people's names; movie stars, comedians, singers, athletes, etc. Withstanding the fear of the disease, I'm learning things new, which entails trials and errors and can be often stressful. I feel, however, it is worthy of trying and endows me with mental satisfaction any other thing could not offer.　

Lifestyle disease (5/24)
　Lifestyle disease is something far away from me and so do I believe. I am slim , non-smoker, take much exercise and don't drink at all. Is there anything else necessary to ward off lifestyle disease? If you were a doctor, you might pontificate or point out with an air of importance; "Don't you like taking hard exercise, which makes you panting?" "Don't you like sweets?"
　Yes, you are right. I might have taken too much exercise. I like running fast more than walking or jogging. I've allowed myself to eat sweets after some exercise for it's a good excuse. I don't like to see my body deteriorating and try to do any exercise whatsoever regularly to keep myself in good shape: push-ups, sit-ups, calf raise and so forth. Consequently, I've tried to keep myself healthy in vain. The idea of lifestyle disease may change my whole lifestyle; eat less and exercise less.

注：英文のみのarticleは、私が書いたもの。大意を載せているarticleは、主にCardioBriefから引用したものである。