Diet-Induced Cognitive Deficits: The Role of Fat and Sugar,Potential Mechanisms and Nutritional Interventions

It is of vital importance to understand how the foods which are making us fat also act to impair cognition. In this review, we compare the effects of acute and chronic exposure to high-energy diets on cognition and examine the relative contributions of fat (saturated and polyunsaturated) and sugar to these deficits. Hippocampal-dependent memory appears to be particularly vulnerable to the effects of high-energy diets and these deficits can occur rapidly and prior to weight gain. More chronic diet exposure seems necessary however to impair other sorts of memory. Many potential mechanisms have been proposed to underlie diet-induced cognitive decline and we will focus on inflammation and the neurotrophic factor, brain-derived neurotrophic factor (BDNF). Finally, given supplementation of diets with omega-3 and curcumin has been shown to have positive effects on cognitive function in healthy ageing humans and in disease states, we will discuss how these nutritional interventions may attenuate diet-induced cognitive decline. We hope this approach will provide important insights into the causes of diet-induced cognitive deficits, and inform the development of novel therapeutics to prevent or ameliorate such memory impairments.     

Removal of transurethral catheter during urodynamics may unmask stress urinary incontinence

PURPOSE: The measurement of Valsalva leak point pressure may have an important role in the treatment algorithm of women with stress urinary incontinence. However, some patients with stress urinary incontinence may not have leakage during standard urodynamic studies and, thus, the Valsalva leak point pressure cannot be determined. We hypothesized that the transurethral catheter may inhibit leakage during urodynamics. MATERIALS AND METHODS: We evaluated 21 consecutive women presenting with complaints of stress urinary incontinence who failed to have leakage on urodynamic studies. Bedside cystometry was performed, followed by urodynamics using a 6Fr transurethral catheter. When stress urinary incontinence was not noted, the catheter was removed and the Valsalva leak point pressure was measured using the intraabdominal pressure catheter. RESULTS: No woman had leakage on urodynamic studies with the catheter in place, although 11 of 21 had leakage after the catheter was removed and 15 had leakage on bedside cystometry. All 11 patients with leakage at catheter removal showed leakage on bedside stress testing. Mean Valsalva leak point pressure in those with leakage was 67 cm. water. CONCLUSIONS: Patients with a history of stress urinary incontinence and those with a positive bedside stress test who do not have leakage during a Valsalva maneuver on urodynamic studies should repeat the Valsalva maneuver with the catheter out. This technique may unmask stress urinary incontinence and allow the measurement of Valsalva leak point pressure.     

Nocturnal penile tumescence activity unchanged after long-term intracavernous injection therapy

PURPOSE: Anecdotal evidence suggests that some men have restored erectile function after long-term intracavernous injection therapy for erectile dysfunction. We objectively assessed this phenomenon using nocturnal penile tumescence testing. MATERIALS AND METHODS: In our retrospective study 19 men with a mean age of 53.5 years who had organic erectile dysfunction underwent nocturnal penile tumescence testing before and after prostaglandin E1 based intracavernous injection at least 6 months in duration. The nocturnal penile tumescence parameters measured included the number of erectile episodes, base and tip tumescence, and percent of time with rigidity greater than 70% at the penile base and tip. A 5-item questionnaire was given to all patients after the intracavernous injection period to assess subjective changes in erectile quality. RESULTS: Mean time on intracavernous injection was 2.42 years and mean injection frequency was 3.74 times monthly. Prostaglandin E1 only, and combined prostaglandin E1, phentolamine and papaverine were used in 7 and 9 cases, respectively. Nine patients believed that unaided erection improved after intracavernous injection and 6 achieved intercourse without injection who were unable to do so before injection. No statistically significant changes were noted in any of the 5 objectively measured nocturnal penile tumescence parameters. CONCLUSIONS: Long-term prostaglandin E1 based intracavernous injection may provide subjective improvement in erectile function in some men. However, as measured by nocturnal penile tumescence testing, no objective improvement in spontaneous erectile function occurs.     

A randomized, open-label, multicenter trial of immediate versus delayed intervention with darbepoetin alfa for chemotherapy-induced anemia

The optimal hemoglobin concentration at which to initiate erythropoietic therapy for chemotherapy-induced anemia (CIA) is not well defined. This randomized, open-label, multicenter study evaluated the ability of darbepoetin alfa (300 microg every 3 weeks) to maintain hemoglobin levels > or =10 g/dl in patients with CIA (hemoglobin > or =10.5 g/dl and < or =12.0 g/dl) randomized 1:1 to an immediate-intervention group (received darbepoetin alfa immediately) or observation group (received darbepoetin alfa if hemoglobin fell to <10 g/dl). In 201 evaluable patients, there was a significant difference between the two groups in the Kaplan-Meier proportion of patients with a hemoglobin decrease to <10 g/dl during weeks 1-13 (test period) (primary endpoint): 29% for immediate-intervention patients versus 65% for observation patients. Sixty-four patients in the observation group received darbepoetin alfa (delayed-intervention subgroup). The Kaplan-Meier proportion of patients who received transfusions was lower in the immediate-intervention group than in the delayed-intervention subgroup (14% versus 31% for the test period; 17% versus 36% over the whole study). The target hemoglobin level (> or =11 g/dl) was achieved by a higher percentage of patients (crude percentage) in less time in the immediate-intervention group (94% in 2 weeks) than in the delayed-intervention subgroup (73% in 6 weeks); hemoglobin endpoints for the delayed-intervention subgroup were calculated from recalibrated study week 1 (the date patients first received darbepoetin alfa). For both groups, a higher mean change in hemoglobin from baseline led to a greater improvement in Functional Assessment of Cancer Therapy-Fatigue scores. In conclusion, immediate intervention resulted in a significantly lower proportion of patients who experienced a decline in hemoglobin, lower requirement for transfusions, and greater proportion of patients achieving and maintaining the target hemoglobin level.