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News from Annals of Internal Medicine

Tip sheet for the Nov. 4 issue of Annals of Internal Medicine

American College of Physicians

1. Stimulating Growth Hormone Increases Muscle Mass in Elderly Healthy Adults.

As people age, the decline of growth hormone secretion in the body may play a role in the development of frailty, the debilitating loss of fat and muscle tissue. Researchers sought to determine if stimulating growth hormone release in healthy older adults could alter body composition. In a randomized trial of 65 healthy older adults ranging in age from 60 - 81 years, participants were given either a placebo or an oral ghrelin mimetic. Oral ghrelin mimetic, or MK-677, is an experimental drug that stimulates normal release of growth hormone. Over one year, patients receiving the new drug increased their growth hormone levels to those of healthy young adults, resulting in an increase in lean, fat-free mass. Also, the body's sensitivity to insulin decreased, and blood sugar increased in people taking the new drug. However since neither the drug nor placebo had an effect on thigh muscle area, muscle strength, or function, the importance of the increase in fat-free mass is unknown. Studies in frail adults and studies that measure effects over several years will be needed to judge the importance of this new drug.


2. Changes in Patient Management Lead to Decreased Incidence, Deaths From Cardiogenic Shock

Cardiogenic shock is a state in which a weakened heart isn't able to pump enough blood to meet the body's needs. It is a medical emergency and is fatal if not treated immediately. While recent findings show a slightly lower incidence of cardiogenic shock compared to 10 years ago, data on temporal trends are conflicting. Researchers carefully reviewed data to assess associations of therapeutic management with death and shock development during hospitalization. They analyzed a hospital registry from Switzerland of more than 23,000 patients. They found that rates of cardiogenic shock in patients with acute coronary syndromes (a term that encompasses myocardial infarction and other conditions) declined from 1997 to 2006. Researchers found that rates of cardiogenic shock on admission remained constant, whereas the incidence of cardiogenic shock that began in the hospital as a complication of acute coronary syndrome steadily decreased over time. The decrease in cardiogenic shock coincident with an increase in angioplasty for acute coronary syndromes may mean that angioplasty is reducing the incidence of cardiogenic shock by improving blood flow to the damaged heart muscle.

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About the American College of Physicians and Annals of Internal Medicine

Annals of Internal Medicine (www.annals.org) is one of the five most widely cited peer-reviewed medical journals in the world. The journal has been published for 81 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (www.acponline.org), the largest medical specialty organization and the second-largest physician group in the United States.

ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.

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