Heidi Splete

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO - A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator's Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator’s Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator’s Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – A 0.04% tretinoin microsphere gel pump significantly reduced the number of acne lesions in preteens, based on data from a small pilot study of children aged 9-11 years. The findings were presented in a poster at the Orlando Dermatology Aesthetic & Clinical Conference.

Currently, no drug is approved in the United States for treating acne in children younger than 10 years, noted Dr. Lawrence Eichenfield, chief of pediatric dermatology at the University of California, San Diego, and his colleagues. However, identification and treatment of acne in younger children might prevent more severe acne in adolescence, thus reducing the physical and emotional scars of acne, as well as the financial cost to patients, the researchers wrote.

Dr. Eichenfield and his colleagues randomized 55 children to use either a 0.04% tretinoin microsphere gel (TMG) pump or a placebo pump. Two pumps of the medication or placebo were applied to the face after washing each evening for 12 weeks.

The children had moderate acne (grade III or higher) and a minimum of 30 facial lesions (including a minimum of 20 inflammatory lesions) at baseline, based on the IGA (Investigator’s Global Assessment) scale of acne severity. The patients were assessed at baseline and weeks 2, 4, 6, 8, 10, and 12.

At week 12, TMG patients had lesion counts reduced by an average of 44%, compared with 31% in the placebo group. This difference was statistically significant.

In addition, significantly more TMG patients than placebo patients achieved "excellent" results, (26% vs. 13%). More TMG patients than placebo patients achieved "clear" or "almost clear" status based on other scales, but these differences were not significant.

No significant differences in erythema, dryness, peeling, itching, or burning/stinging were observed between the two groups at any of the study visits.

A total of nine children discontinued the study. Of these, four TMG patients and one placebo patient discontinued because of adverse events, two TMG patients were lost to follow-up, and two TMG patients discontinued for personal reasons. The per-protocol study population excluded these 9 patients and 2 additional patients, for a total of 46 patients in the TMG group and 53 in the placebo group.

The findings were limited by the small size of the study. But the results suggest that TMG 0.04% was safe and well tolerated in preteen children with acne, and larger studies are warranted, the researchers said.

The study was sponsored by Johnson & Johnson. Dr. Eichenfield disclosed that he has served as an investigator without personal compensation, a consultant, or an adviser for the following companies: Astellas Pharma, Coria Laboratories, Galderma, Ortho Dermatologics, GlaxoSmithKline (Stiefel), Sanofi-Aventis, and Johnson & Johnson.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

ORLANDO – Mohs surgery is an appropriate choice for lentigo maligna patients because advances in immunostaining allow easier and more efficient identification of melanocytes on frozen sections, said Dr. Basil S. Cherpelis.

Recent literature shows the recommended 5-mm margin for melanoma is often inadequate, Dr. Cherpelis said at the Orlando Dermatology Aesthetic and Clinical conference.

The margins needed for successful treatment of lentigo maligna vary – 5 mm is enough for some melanomas, while others might need a 1-cm margin.

"It makes sense to use a method of intraoperative margin control," said Dr. Cherpelis, of the Moffitt Cancer Center at the University of South Florida in Tampa. "That’s what gives you the flexibility to adjust your margins based on the melanoma that you happen to be treating."

One option for intraoperative margin control is traditional frozen sections, Dr. Cherpelis said. But frozen sections offer a limited view of the margin, and they pose the problem of freeze artifacts, which can make the distinction between melanocytes and keratinocytes difficult. A second option is the square or perimeter method, but this method involves a 1-2 week wait for complete results, which is inconvenient for doctors and patients.

A third option is Mohs surgery. Literature shows that Mohs is effective for melanoma, with the benefits of entire visualization and same-day reconstruction, but it is not widely used, Dr. Cherpelis said. One reason: Melanomas on permanent sections have halos around them, making identification easy, but frozen sections have similar halos around keratinocytes and melanocytes.

Using immunostaining as part of Mohs surgery can solve the identification problem, but until recently immunostain protocols could take at least an hour.

Dr. Cherpelis and his colleagues have streamlined the process.

"We have been able to shorten our protocols down to 19 minutes for MART-1 [melanoma-associated antigen recognized by T cells] and 35 minutes for MITF [microphthalmia-associated transcription factor]," Dr. Cherpelis said (Derm. Surg. 2009;35:207-13; Am. J. Dermatopath. 2010; 32:319-25, respectively). The protocols make Mohs surgery easier because the immunostain helps clinicians easily identify melanocytes.

MART-1 (a cytoplasmic stain) is the most common immunostain, but some data suggest it can falsely label keratinocytes in inflamed skin or in pigmented actinic keratoses, Dr. Cherpelis said. It also can cause pseudo-confluence (the appearance of touching melanocytes). By contrast, MITF is a nuclear stain, so it does not have the problem of pseudo-confluence.

Dr. Cherpelis said he had no relevant financial disclosures.

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online at www.cdc.gov/vitalsigns. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online at www.cdc.gov/vitalsigns. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online at www.cdc.gov/vitalsigns. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

Approximately 68 million American adults have high blood pressure and 71 million have high cholesterol, and the conditions are uncontrolled in 37 million and 48 million, respectively, according to a Vital Signs report released by the Centers for Disease Control and Prevention on Feb. 1.

"Heart disease is the leading killer in America, and the bottom line is that high blood pressure and high cholesterol are out of control for most Americans who have these conditions," CDC director Dr. Thomas R. Frieden said during the teleconference accompanying the report’s release.

High blood pressure and high cholesterol remain top risk factors for life-threatening conditions including strokes, heart attacks, and vascular diseases, he added.

Dr. Frieden had a message for physicians: Controlling high blood pressure and cholesterol is one of the most important things you can do for your patients. Know how many of your patients have high blood pressure and high cholesterol, what proportion are controlled, and what can be done to help more patients get these conditions under control, he said.

"We have seen many examples of health systems, health programs, and doctors’ offices using information technology to support patients and drastically improve the levels of control, and that’s something that is needed throughout health care in this country," he added.

The report was based on data from the National Health and Nutrition Examination Survey (NHANES) on adults aged 18 years and older. The findings also indicate that approximately 20 million U.S. adults with high blood pressure and 37 million with high cholesterol are not being treated for these conditions.

The prevalence of control of high blood pressure was 29% among adults without health insurance, and the control of high cholesterol was less than 15% among those with limited access to health care. But at least 80% of individuals with uncontrolled high blood pressure and high cholesterol have health insurance, Dr. Frieden noted.

For those with health insurance, the characteristics of their specific plan are more likely to affect how likely they are to have high blood pressure or high cholesterol under control than are their personal characteristics, he said.

High blood pressure was defined as blood pressure greater than 140/90 mmHg or reported use of blood pressure–lowering medication. The national prevalence of high blood pressure remained stable over the past decade, although 70% of those with hypertension were being treated and 46% were being controlled, according to the report.

The criteria for high cholesterol included anyone taking cholesterol medication or having a LDL cholesterol level of 100 mg/dL or higher for high-risk individuals, 130 mg/dL or higher for intermediate-risk individuals, and 160 mg/dL for those at low risk.

The proportion of adults treated for high cholesterol increased from 28% to 48% over the past decade, and the proportion of those controlling their high cholesterol increased from less than 20% to more than 30%.

The findings were limited by the lack of data on individuals in nursing homes and other institutions that are not included in NHANES databases, the CDC researchers noted in the report.

About 100,000 deaths [in the U.S.] are preventable by simple, low-cost improvements in our ability to control high blood pressure and high cholesterol," said Dr. Frieden. "Better control can save lives and save money."

The report is available online. More detailed information can be found in the Feb. 1 issue of the weekly Morbidity and Mortality Report (MMWR early release/vol. 60; Feb. 1, 2011).

The life expectancy of Americans falls short compared to that of their counterparts in other high-income countries, and smoking and obesity are key contributors to the difference, the National Research Council of the National Academies reported.

The life expectancy at birth for U.S. men increased from 65 years in 1950 to 76 years in 2006; for U.S. women, it increased from 71 to 81 years. Similarly, life expectancy at age 50 for men in the U.S. increased from 23 to 29 years. For American women, that figure rose from 27 to 33 years. Still, the improved life expectancy in the United States – the world's top spender on health care – fell below that of eight other rich countries, including Australia, Japan, and Canada (see chart).

The National Council on Aging commissioned the report, “Explaining Divergent Levels of Longevity in High-Income Countries,” to identify factors behind the differences in life expectancy. The report focused on life expectancy at age 50, because at least 90% of newborns in high-income countries now survive to age 50 years. The data were based primarily on an analysis of cause-of-death statistics.

“Smoking appears to be responsible for a good deal of the divergence in female life expectancy,” according to the report. The researchers estimated that 78% of the difference in life expectancy between American women and those in other high-income countries was attributable to smoking. Similarly, among men, smoking accounted for 41% of the difference.

The reduction in smoking in the United States over the past 20 years is likely to pay off in improved longevity trends in future decades, the researchers noted. A reduction or increase in smoking rates appears to take 20–30 years to impact mortality, they added.

Obesity also plays a significant role in the lagging U.S. longevity. Based on data from several studies, obesity accounts for approximately 20%–35% of the difference in longevity between Americans and residents of other countries.

Physical inactivity, social integration, and healthcare systems also likely contribute to increased mortality and differences in life expectancy among countries, but evaluation of these risk factors has been limited to observational studies, the researchers noted.

The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering, which are private, nonprofit institutions. The report is available for purchase from the National Academies Press.

Vitals

Source Elsevier Global Medical News

The life expectancy of Americans falls short compared to that of their counterparts in other high-income countries, and smoking and obesity are key contributors to the difference, the National Research Council of the National Academies reported.

The life expectancy at birth for U.S. men increased from 65 years in 1950 to 76 years in 2006; for U.S. women, it increased from 71 to 81 years. Similarly, life expectancy at age 50 for men in the U.S. increased from 23 to 29 years. For American women, that figure rose from 27 to 33 years. Still, the improved life expectancy in the United States – the world's top spender on health care – fell below that of eight other rich countries, including Australia, Japan, and Canada (see chart).

The National Council on Aging commissioned the report, “Explaining Divergent Levels of Longevity in High-Income Countries,” to identify factors behind the differences in life expectancy. The report focused on life expectancy at age 50, because at least 90% of newborns in high-income countries now survive to age 50 years. The data were based primarily on an analysis of cause-of-death statistics.

“Smoking appears to be responsible for a good deal of the divergence in female life expectancy,” according to the report. The researchers estimated that 78% of the difference in life expectancy between American women and those in other high-income countries was attributable to smoking. Similarly, among men, smoking accounted for 41% of the difference.

The reduction in smoking in the United States over the past 20 years is likely to pay off in improved longevity trends in future decades, the researchers noted. A reduction or increase in smoking rates appears to take 20–30 years to impact mortality, they added.

Obesity also plays a significant role in the lagging U.S. longevity. Based on data from several studies, obesity accounts for approximately 20%–35% of the difference in longevity between Americans and residents of other countries.

Physical inactivity, social integration, and healthcare systems also likely contribute to increased mortality and differences in life expectancy among countries, but evaluation of these risk factors has been limited to observational studies, the researchers noted.

The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering, which are private, nonprofit institutions. The report is available for purchase from the National Academies Press.

Vitals

Source Elsevier Global Medical News

The life expectancy of Americans falls short compared to that of their counterparts in other high-income countries, and smoking and obesity are key contributors to the difference, the National Research Council of the National Academies reported.

The life expectancy at birth for U.S. men increased from 65 years in 1950 to 76 years in 2006; for U.S. women, it increased from 71 to 81 years. Similarly, life expectancy at age 50 for men in the U.S. increased from 23 to 29 years. For American women, that figure rose from 27 to 33 years. Still, the improved life expectancy in the United States – the world's top spender on health care – fell below that of eight other rich countries, including Australia, Japan, and Canada (see chart).

The National Council on Aging commissioned the report, “Explaining Divergent Levels of Longevity in High-Income Countries,” to identify factors behind the differences in life expectancy. The report focused on life expectancy at age 50, because at least 90% of newborns in high-income countries now survive to age 50 years. The data were based primarily on an analysis of cause-of-death statistics.

“Smoking appears to be responsible for a good deal of the divergence in female life expectancy,” according to the report. The researchers estimated that 78% of the difference in life expectancy between American women and those in other high-income countries was attributable to smoking. Similarly, among men, smoking accounted for 41% of the difference.

The reduction in smoking in the United States over the past 20 years is likely to pay off in improved longevity trends in future decades, the researchers noted. A reduction or increase in smoking rates appears to take 20–30 years to impact mortality, they added.

Obesity also plays a significant role in the lagging U.S. longevity. Based on data from several studies, obesity accounts for approximately 20%–35% of the difference in longevity between Americans and residents of other countries.

Physical inactivity, social integration, and healthcare systems also likely contribute to increased mortality and differences in life expectancy among countries, but evaluation of these risk factors has been limited to observational studies, the researchers noted.

The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering, which are private, nonprofit institutions. The report is available for purchase from the National Academies Press.

Vitals

Source Elsevier Global Medical News

ORLANDO — Oral apixaban reduced the incidence of major venous thromboembolism after joint replacement surgery by approximately half compared with enoxaparin, with no increased risk of bleeding, investigators have reported.

Of approximately 7,000 patients who underwent thromboprophylaxis after surgery, major VTE occurred in 0.68% of those who had received apixaban, compared with 1.50% who had been given enoxaparin. This was a significant difference, Gary E. Raskob, Ph.D., said.

Prevention of major venous thromboembolism is “a significant issue in health care in the United States,” where the number of knee and hip replacements is expected to increase, said Dr. Raskob, dean of the College of Public Health at the University of Oklahoma Health Sciences Center in Oklahoma City. To provide more precise estimates of the incidence of major VTE and safety outcomes, the researchers combined data from two phase III, randomized, double-blind trials of patients who had undergone knee (ADVANCE-2 study) or hip (ADVANCE-3) replacement. A total of 8,464 were randomized to apixaban, a novel orally administered factor Xa inhibitor (4,236 patients), or enoxaparin (4,228 patients).

Efficacy results related to VTE were based on 3,394 patients in each group. Major VTE occurred in 23 patients in the apixaban group (0.68%), vs. 51 patients in the enoxaparin group (1.50%).

Bleeding results were based on 4,174 apixaban patients and 4,228 enoxaparin patients. Major bleeding occurred in 31 patients in the apixaban group and 32 in the enoxaparin group (0.74% vs. 0.77%). Major bleeding at the surgical site occurred in 26 in the apixaban group and 27 in the enoxaparin group.

Dr. Raskob has financial relationships with Bristol-Meyers Squibb, Pfizer, Bayer, Johnson & Johnson, Sanofi Aventis, and Daiichi Sankyo.

To see an interview with Dr. Gary E. Raskob, go to

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

ORLANDO — Oral apixaban reduced the incidence of major venous thromboembolism after joint replacement surgery by approximately half compared with enoxaparin, with no increased risk of bleeding, investigators have reported.

Of approximately 7,000 patients who underwent thromboprophylaxis after surgery, major VTE occurred in 0.68% of those who had received apixaban, compared with 1.50% who had been given enoxaparin. This was a significant difference, Gary E. Raskob, Ph.D., said.

Prevention of major venous thromboembolism is “a significant issue in health care in the United States,” where the number of knee and hip replacements is expected to increase, said Dr. Raskob, dean of the College of Public Health at the University of Oklahoma Health Sciences Center in Oklahoma City. To provide more precise estimates of the incidence of major VTE and safety outcomes, the researchers combined data from two phase III, randomized, double-blind trials of patients who had undergone knee (ADVANCE-2 study) or hip (ADVANCE-3) replacement. A total of 8,464 were randomized to apixaban, a novel orally administered factor Xa inhibitor (4,236 patients), or enoxaparin (4,228 patients).

Efficacy results related to VTE were based on 3,394 patients in each group. Major VTE occurred in 23 patients in the apixaban group (0.68%), vs. 51 patients in the enoxaparin group (1.50%).

Bleeding results were based on 4,174 apixaban patients and 4,228 enoxaparin patients. Major bleeding occurred in 31 patients in the apixaban group and 32 in the enoxaparin group (0.74% vs. 0.77%). Major bleeding at the surgical site occurred in 26 in the apixaban group and 27 in the enoxaparin group.

Dr. Raskob has financial relationships with Bristol-Meyers Squibb, Pfizer, Bayer, Johnson & Johnson, Sanofi Aventis, and Daiichi Sankyo.

To see an interview with Dr. Gary E. Raskob, go to

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

ORLANDO — Oral apixaban reduced the incidence of major venous thromboembolism after joint replacement surgery by approximately half compared with enoxaparin, with no increased risk of bleeding, investigators have reported.

Of approximately 7,000 patients who underwent thromboprophylaxis after surgery, major VTE occurred in 0.68% of those who had received apixaban, compared with 1.50% who had been given enoxaparin. This was a significant difference, Gary E. Raskob, Ph.D., said.

Prevention of major venous thromboembolism is “a significant issue in health care in the United States,” where the number of knee and hip replacements is expected to increase, said Dr. Raskob, dean of the College of Public Health at the University of Oklahoma Health Sciences Center in Oklahoma City. To provide more precise estimates of the incidence of major VTE and safety outcomes, the researchers combined data from two phase III, randomized, double-blind trials of patients who had undergone knee (ADVANCE-2 study) or hip (ADVANCE-3) replacement. A total of 8,464 were randomized to apixaban, a novel orally administered factor Xa inhibitor (4,236 patients), or enoxaparin (4,228 patients).

Efficacy results related to VTE were based on 3,394 patients in each group. Major VTE occurred in 23 patients in the apixaban group (0.68%), vs. 51 patients in the enoxaparin group (1.50%).

Bleeding results were based on 4,174 apixaban patients and 4,228 enoxaparin patients. Major bleeding occurred in 31 patients in the apixaban group and 32 in the enoxaparin group (0.74% vs. 0.77%). Major bleeding at the surgical site occurred in 26 in the apixaban group and 27 in the enoxaparin group.

Dr. Raskob has financial relationships with Bristol-Meyers Squibb, Pfizer, Bayer, Johnson & Johnson, Sanofi Aventis, and Daiichi Sankyo.

To see an interview with Dr. Gary E. Raskob, go to

Source Heidi Splete/Elsevier Global Medical Newswww.rheumatologynews.com

WASHINGTON – The new Dietary Guidelines for Americans 2010, released Jan. 31, take a four-pronged approach focus to improving American’s dietary habits by recommending balancing calories and exercise to achieve a healthy body weight, restricting sodium and saturated fat, increasing consumption of whole grains and healthy fats, and developing mindful behaviors around eating and food preparation.

"We are putting some of the best information in people’s hands, and that’s a big step forward," said Health and Human Services Secretary Kathleen Sebelius, who presented the guidelines with Department of Agriculture Secretary Tom Vilsack. The guidelines are a joint effort of the U.S. Department of Health and Human Services and the Department of Agriculture.

The guidelines, intended for children aged 2 years and older and adults, include 23 recommendations in four categories, plus six additional recommendations for specific population groups. The guidelines are meant to include those at increased risk of chronic disease. The four categories are:

Balancing calories to reduce weight: Recommendations in this category include getting more exercise and balancing it against calorie intake as appropriate for weight maintenance or weight loss.

• Reducing certain foods and food components: The guidelines call for consuming less than 2,300 mg of sodium daily. The recommendation is no more than 1,500 mg for blacks, people aged 51 years and older, as well as anyone regardless of age who has hypertension, diabetes, or chronic kidney disease. Other recommended reductions include having saturated fats comprise less that 10% of daily calories, and consuming less than 300 mg of cholesterol daily.

• Increasing certain foods and nutrients: The recommendations repeat previous dietary guidelines that call for whole-grain foods to comprise half of Americans’ grain intake. Other recommendations include replacing solid fats , eating more seafood in favor of some red meat and poultry, replacing full-fat dairy products with low-fat or fat-free options, and consuming a variety of protein-rich foods including eggs, beans, nuts, and soy.

• Building healthy eating patterns and behaviors: In addition to 20 recommendations relating to diet and exercise, the new guidelines include 3 recommendations that are less food specific: Select an eating pattern that "meets nutrient needs over time at an appropriate calorie level;" and keep a food journal to assess how food and beverage choices fit into a healthy eating pattern; follow food safety recommendations when cooking and eating to reduce the risk of foodborne illness.

Courtesy of National Cancer Institute

Women of child-bearing age should boost iron intake by eating foods with easily absorbed heme iron and vitamin C–rich foods that enhance iron absorption. Additional recommendations include adding 400 mcg of folic acid daily for women, in addition to the folate found in a healthy diet. Recommendations for women who are pregnant or breast-feeding include eating 8-12 ounces of seafood per week, but limiting tuna consumption to 6 ounces per week and avoiding tilefish, shark, swordfish, and king mackerel because of their high mercury content. Pregnant women also are advised to take an iron supplement as recommended by their health care providers.

One additional recommendation for individuals aged 50 years and older: Consume vitamin B12-fortified foods as part of a daily diet or as supplements. However, the guidelines did not recommend a specific amount of daily B12 for this population.

Over the next few months, USDA and HHS will release consumer tips and tools to help Americans follow the guidelines, including a revised food pyramid.

For more information, check out the complete guidelines. 

WASHINGTON – The new Dietary Guidelines for Americans 2010, released Jan. 31, take a four-pronged approach focus to improving American’s dietary habits by recommending balancing calories and exercise to achieve a healthy body weight, restricting sodium and saturated fat, increasing consumption of whole grains and healthy fats, and developing mindful behaviors around eating and food preparation.

"We are putting some of the best information in people’s hands, and that’s a big step forward," said Health and Human Services Secretary Kathleen Sebelius, who presented the guidelines with Department of Agriculture Secretary Tom Vilsack. The guidelines are a joint effort of the U.S. Department of Health and Human Services and the Department of Agriculture.

The guidelines, intended for children aged 2 years and older and adults, include 23 recommendations in four categories, plus six additional recommendations for specific population groups. The guidelines are meant to include those at increased risk of chronic disease. The four categories are:

Balancing calories to reduce weight: Recommendations in this category include getting more exercise and balancing it against calorie intake as appropriate for weight maintenance or weight loss.

• Reducing certain foods and food components: The guidelines call for consuming less than 2,300 mg of sodium daily. The recommendation is no more than 1,500 mg for blacks, people aged 51 years and older, as well as anyone regardless of age who has hypertension, diabetes, or chronic kidney disease. Other recommended reductions include having saturated fats comprise less that 10% of daily calories, and consuming less than 300 mg of cholesterol daily.

• Increasing certain foods and nutrients: The recommendations repeat previous dietary guidelines that call for whole-grain foods to comprise half of Americans’ grain intake. Other recommendations include replacing solid fats , eating more seafood in favor of some red meat and poultry, replacing full-fat dairy products with low-fat or fat-free options, and consuming a variety of protein-rich foods including eggs, beans, nuts, and soy.

• Building healthy eating patterns and behaviors: In addition to 20 recommendations relating to diet and exercise, the new guidelines include 3 recommendations that are less food specific: Select an eating pattern that "meets nutrient needs over time at an appropriate calorie level;" and keep a food journal to assess how food and beverage choices fit into a healthy eating pattern; follow food safety recommendations when cooking and eating to reduce the risk of foodborne illness.

Courtesy of National Cancer Institute

Women of child-bearing age should boost iron intake by eating foods with easily absorbed heme iron and vitamin C–rich foods that enhance iron absorption. Additional recommendations include adding 400 mcg of folic acid daily for women, in addition to the folate found in a healthy diet. Recommendations for women who are pregnant or breast-feeding include eating 8-12 ounces of seafood per week, but limiting tuna consumption to 6 ounces per week and avoiding tilefish, shark, swordfish, and king mackerel because of their high mercury content. Pregnant women also are advised to take an iron supplement as recommended by their health care providers.

One additional recommendation for individuals aged 50 years and older: Consume vitamin B12-fortified foods as part of a daily diet or as supplements. However, the guidelines did not recommend a specific amount of daily B12 for this population.

Over the next few months, USDA and HHS will release consumer tips and tools to help Americans follow the guidelines, including a revised food pyramid.

For more information, check out the complete guidelines. 

WASHINGTON – The new Dietary Guidelines for Americans 2010, released Jan. 31, take a four-pronged approach focus to improving American’s dietary habits by recommending balancing calories and exercise to achieve a healthy body weight, restricting sodium and saturated fat, increasing consumption of whole grains and healthy fats, and developing mindful behaviors around eating and food preparation.

"We are putting some of the best information in people’s hands, and that’s a big step forward," said Health and Human Services Secretary Kathleen Sebelius, who presented the guidelines with Department of Agriculture Secretary Tom Vilsack. The guidelines are a joint effort of the U.S. Department of Health and Human Services and the Department of Agriculture.

The guidelines, intended for children aged 2 years and older and adults, include 23 recommendations in four categories, plus six additional recommendations for specific population groups. The guidelines are meant to include those at increased risk of chronic disease. The four categories are:

Balancing calories to reduce weight: Recommendations in this category include getting more exercise and balancing it against calorie intake as appropriate for weight maintenance or weight loss.

• Reducing certain foods and food components: The guidelines call for consuming less than 2,300 mg of sodium daily. The recommendation is no more than 1,500 mg for blacks, people aged 51 years and older, as well as anyone regardless of age who has hypertension, diabetes, or chronic kidney disease. Other recommended reductions include having saturated fats comprise less that 10% of daily calories, and consuming less than 300 mg of cholesterol daily.

• Increasing certain foods and nutrients: The recommendations repeat previous dietary guidelines that call for whole-grain foods to comprise half of Americans’ grain intake. Other recommendations include replacing solid fats , eating more seafood in favor of some red meat and poultry, replacing full-fat dairy products with low-fat or fat-free options, and consuming a variety of protein-rich foods including eggs, beans, nuts, and soy.

• Building healthy eating patterns and behaviors: In addition to 20 recommendations relating to diet and exercise, the new guidelines include 3 recommendations that are less food specific: Select an eating pattern that "meets nutrient needs over time at an appropriate calorie level;" and keep a food journal to assess how food and beverage choices fit into a healthy eating pattern; follow food safety recommendations when cooking and eating to reduce the risk of foodborne illness.

Courtesy of National Cancer Institute

Women of child-bearing age should boost iron intake by eating foods with easily absorbed heme iron and vitamin C–rich foods that enhance iron absorption. Additional recommendations include adding 400 mcg of folic acid daily for women, in addition to the folate found in a healthy diet. Recommendations for women who are pregnant or breast-feeding include eating 8-12 ounces of seafood per week, but limiting tuna consumption to 6 ounces per week and avoiding tilefish, shark, swordfish, and king mackerel because of their high mercury content. Pregnant women also are advised to take an iron supplement as recommended by their health care providers.

One additional recommendation for individuals aged 50 years and older: Consume vitamin B12-fortified foods as part of a daily diet or as supplements. However, the guidelines did not recommend a specific amount of daily B12 for this population.

Over the next few months, USDA and HHS will release consumer tips and tools to help Americans follow the guidelines, including a revised food pyramid.

For more information, check out the complete guidelines. 

WASHINGTON – The new Dietary Guidelines for Americans 2010, released Jan. 31, take a four-pronged approach focus to improving American’s dietary habits by recommending balancing calories and exercise to achieve a healthy body weight, restricting sodium and saturated fat, increasing consumption of whole grains and healthy fats, and developing mindful behaviors around eating and food preparation.

"We are putting some of the best information in people’s hands, and that’s a big step forward," said Health and Human Services Secretary Kathleen Sebelius, who presented the guidelines with Department of Agriculture Secretary Tom Vilsack. The guidelines are a joint effort of the U.S. Department of Health and Human Services and the Department of Agriculture.

The guidelines, intended for children aged 2 years and older and adults, include 23 recommendations in four categories, plus six additional recommendations for specific population groups. The guidelines are meant to include those at increased risk of chronic disease. The four categories are:

Balancing calories to reduce weight: Recommendations in this category include getting more exercise and balancing it against calorie intake as appropriate for weight maintenance or weight loss.

• Reducing certain foods and food components: The guidelines call for consuming less than 2,300 mg of sodium daily. The recommendation is no more than 1,500 mg for blacks, people aged 51 years and older, as well as anyone regardless of age who has hypertension, diabetes, or chronic kidney disease. Other recommended reductions include having saturated fats comprise less that 10% of daily calories, and consuming less than 300 mg of cholesterol daily.

• Increasing certain foods and nutrients: The recommendations repeat previous dietary guidelines that call for whole-grain foods to comprise half of Americans’ grain intake. Other recommendations include replacing solid fats , eating more seafood in favor of some red meat and poultry, replacing full-fat dairy products with low-fat or fat-free options, and consuming a variety of protein-rich foods including eggs, beans, nuts, and soy.

• Building healthy eating patterns and behaviors: In addition to 20 recommendations relating to diet and exercise, the new guidelines include 3 recommendations that are less food specific: Select an eating pattern that "meets nutrient needs over time at an appropriate calorie level;" and keep a food journal to assess how food and beverage choices fit into a healthy eating pattern; follow food safety recommendations when cooking and eating to reduce the risk of foodborne illness.

Courtesy of National Cancer Institute

Women of child-bearing age should boost iron intake by eating foods with easily absorbed heme iron and vitamin C–rich foods that enhance iron absorption. Additional recommendations include adding 400 mcg of folic acid daily for women, in addition to the folate found in a healthy diet. Recommendations for women who are pregnant or breast-feeding include eating 8-12 ounces of seafood per week, but limiting tuna consumption to 6 ounces per week and avoiding tilefish, shark, swordfish, and king mackerel because of their high mercury content. Pregnant women also are advised to take an iron supplement as recommended by their health care providers.

One additional recommendation for individuals aged 50 years and older: Consume vitamin B12-fortified foods as part of a daily diet or as supplements. However, the guidelines did not recommend a specific amount of daily B12 for this population.

Over the next few months, USDA and HHS will release consumer tips and tools to help Americans follow the guidelines, including a revised food pyramid.

For more information, check out the complete guidelines. 

WASHINGTON – The new Dietary Guidelines for Americans 2010, released Jan. 31, take a four-pronged approach focus to improving American’s dietary habits by recommending balancing calories and exercise to achieve a healthy body weight, restricting sodium and saturated fat, increasing consumption of whole grains and healthy fats, and developing mindful behaviors around eating and food preparation.

"We are putting some of the best information in people’s hands, and that’s a big step forward," said Health and Human Services Secretary Kathleen Sebelius, who presented the guidelines with Department of Agriculture Secretary Tom Vilsack. The guidelines are a joint effort of the U.S. Department of Health and Human Services and the Department of Agriculture.

The guidelines, intended for children aged 2 years and older and adults, include 23 recommendations in four categories, plus six additional recommendations for specific population groups. The guidelines are meant to include those at increased risk of chronic disease. The four categories are:

Balancing calories to reduce weight: Recommendations in this category include getting more exercise and balancing it against calorie intake as appropriate for weight maintenance or weight loss.

• Reducing certain foods and food components: The guidelines call for consuming less than 2,300 mg of sodium daily. The recommendation is no more than 1,500 mg for blacks, people aged 51 years and older, as well as anyone regardless of age who has hypertension, diabetes, or chronic kidney disease. Other recommended reductions include having saturated fats comprise less that 10% of daily calories, and consuming less than 300 mg of cholesterol daily.

• Increasing certain foods and nutrients: The recommendations repeat previous dietary guidelines that call for whole-grain foods to comprise half of Americans’ grain intake. Other recommendations include replacing solid fats , eating more seafood in favor of some red meat and poultry, replacing full-fat dairy products with low-fat or fat-free options, and consuming a variety of protein-rich foods including eggs, beans, nuts, and soy.

• Building healthy eating patterns and behaviors: In addition to 20 recommendations relating to diet and exercise, the new guidelines include 3 recommendations that are less food specific: Select an eating pattern that "meets nutrient needs over time at an appropriate calorie level;" and keep a food journal to assess how food and beverage choices fit into a healthy eating pattern; follow food safety recommendations when cooking and eating to reduce the risk of foodborne illness.

Courtesy of National Cancer Institute

Women of child-bearing age should boost iron intake by eating foods with easily absorbed heme iron and vitamin C–rich foods that enhance iron absorption. Additional recommendations include adding 400 mcg of folic acid daily for women, in addition to the folate found in a healthy diet. Recommendations for women who are pregnant or breast-feeding include eating 8-12 ounces of seafood per week, but limiting tuna consumption to 6 ounces per week and avoiding tilefish, shark, swordfish, and king mackerel because of their high mercury content. Pregnant women also are advised to take an iron supplement as recommended by their health care providers.

One additional recommendation for individuals aged 50 years and older: Consume vitamin B12-fortified foods as part of a daily diet or as supplements. However, the guidelines did not recommend a specific amount of daily B12 for this population.

Over the next few months, USDA and HHS will release consumer tips and tools to help Americans follow the guidelines, including a revised food pyramid.

For more information, check out the complete guidelines. 

WASHINGTON – The new Dietary Guidelines for Americans 2010, released Jan. 31, take a four-pronged approach focus to improving American’s dietary habits by recommending balancing calories and exercise to achieve a healthy body weight, restricting sodium and saturated fat, increasing consumption of whole grains and healthy fats, and developing mindful behaviors around eating and food preparation.

"We are putting some of the best information in people’s hands, and that’s a big step forward," said Health and Human Services Secretary Kathleen Sebelius, who presented the guidelines with Department of Agriculture Secretary Tom Vilsack. The guidelines are a joint effort of the U.S. Department of Health and Human Services and the Department of Agriculture.

The guidelines, intended for children aged 2 years and older and adults, include 23 recommendations in four categories, plus six additional recommendations for specific population groups. The guidelines are meant to include those at increased risk of chronic disease. The four categories are:

Balancing calories to reduce weight: Recommendations in this category include getting more exercise and balancing it against calorie intake as appropriate for weight maintenance or weight loss.

• Reducing certain foods and food components: The guidelines call for consuming less than 2,300 mg of sodium daily. The recommendation is no more than 1,500 mg for blacks, people aged 51 years and older, as well as anyone regardless of age who has hypertension, diabetes, or chronic kidney disease. Other recommended reductions include having saturated fats comprise less that 10% of daily calories, and consuming less than 300 mg of cholesterol daily.

• Increasing certain foods and nutrients: The recommendations repeat previous dietary guidelines that call for whole-grain foods to comprise half of Americans’ grain intake. Other recommendations include replacing solid fats , eating more seafood in favor of some red meat and poultry, replacing full-fat dairy products with low-fat or fat-free options, and consuming a variety of protein-rich foods including eggs, beans, nuts, and soy.

• Building healthy eating patterns and behaviors: In addition to 20 recommendations relating to diet and exercise, the new guidelines include 3 recommendations that are less food specific: Select an eating pattern that "meets nutrient needs over time at an appropriate calorie level;" and keep a food journal to assess how food and beverage choices fit into a healthy eating pattern; follow food safety recommendations when cooking and eating to reduce the risk of foodborne illness.

Courtesy of National Cancer Institute

Women of child-bearing age should boost iron intake by eating foods with easily absorbed heme iron and vitamin C–rich foods that enhance iron absorption. Additional recommendations include adding 400 mcg of folic acid daily for women, in addition to the folate found in a healthy diet. Recommendations for women who are pregnant or breast-feeding include eating 8-12 ounces of seafood per week, but limiting tuna consumption to 6 ounces per week and avoiding tilefish, shark, swordfish, and king mackerel because of their high mercury content. Pregnant women also are advised to take an iron supplement as recommended by their health care providers.

One additional recommendation for individuals aged 50 years and older: Consume vitamin B12-fortified foods as part of a daily diet or as supplements. However, the guidelines did not recommend a specific amount of daily B12 for this population.

Over the next few months, USDA and HHS will release consumer tips and tools to help Americans follow the guidelines, including a revised food pyramid.

For more information, check out the complete guidelines.