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Grim Prediction

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Published July 16, 2024

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Good morning! Scientists have given us something new to worry about—galactic cosmic radiation (GCR)—but it’s only a problem when we leave Earth’s magnetic field. A new study suggests that GCR—along with microgravity—wreaks havoc on human kidneys and is one reason none of us likely has the right stuff to endure a lengthy space mission. First author Dr. Keith Siew shares his grim prediction: “...while an astronaut could make it to Mars, they might need dialysis on the way back.” That could thwart our Mars Exploration Program and any billionaire’s summer plans.

If scientists can solve this cosmic conundrum, we’ll all win. “Any drugs developed for astronauts may also be beneficial here on Earth, eg, by enabling cancer patients’kidneys to tolerate higher doses of radiotherapy, the kidneys being one of the limiting factors in this regard.”

Streamlining Detection of Aggressive Prostate Cancer

MEN’S HEALTH HAPPENINGS

A new urine test for prostate cancer could render standard testing as antiquated as paper maps. Authors of a recent study say the new test aligns with a seismic shift in cancer screening objectives: looking for clinically significant cancer, not just any cancer.

MPS walked so MPS 2.0 could run

The NIH-backed research team behind MyProstateScore (MPS), a two-gene urine test for early prostate cancer detection, has now unveiled MyProstateScore 2.0 (MPS2). This 18-gene urine test not only identifies early prostate cancer but also differentiates between aggressive and slow-growing forms. Across multiple trials involving urine and tissue samples from approximately 800 men with prostate cancer, the test demonstrated 95% sensitivity for prostate cancer grade group 2 or greater, and 99% for grade group 3 or greater. Further, it ruled out grade group 1 cancer with almost 100% accuracy. Per study author Arul M. Chinnaiyan, “If you’re negative on this test, it’s almost certain that you don’t have aggressive prostate cancer.”

One major snag remains: researchers cannot predict how the test performs in diverse ethnic populations, given that the study sample included primarily white participants.

Key takeaways

A new generation of prostate cancer testing stands poised to write its own story, one in which a noninvasive test may rule out clinically significant prostate cancer. What does this mean in practical terms, ie, biopsy reduction? Researchers estimated that implementing this test could decrease the incidence of unnecessary biopsies by approximately 35% to 42%. This marks a substantial improvement over other biomarker tests, which typically reduce unnecessary biopsies by 15% to 30%, and far surpasses the 11% reduction achieved by PSA testing alone.

FDA Updates . . .

Rethinking Cognitive Assessment Tests

NEURO NEWS

In other diagnostic testing news, cognitive assessments may be entering a new era of innovation for primary care. You’re familiar with the traditional barriers to such testing: lack of time, prohibitive costs, equipment requirements, ambiguous next steps, and no accounting for cultural diversity. Well, a new test claims to hurdle each of these—in record time.

Meet 5-Cog

The new five-minute cognitive detection tool, aptly named 5-Cog, assesses patients’ memory recall, cognition-to-gait capabilities, and proficiency at matching symbols to images. Nonclinician personnel can administer the test, and patients from culturally diverse backgrounds and those from various reading levels can complete it. But wait, there’s more. The test pairs with an electronic health record–embedded clinical decision tree, pointing you toward clear next steps.

Does it work?

In a single-blinded randomized clinical trial of >1,200 older adults with cognitive issues from economically challenged areas, the tool significantly enhanced dementia care. Use of the tool tripled the likelihood of improved care activities and markedly increased diagnoses, lab tests, imaging, and specialist referrals in comparison with a control group. Of note, the number of hospital visits remained consistent between the intervention and control groups.

Key takeaways

5-Cog circumvents biases related to cultural, educational, and linguistic differences, offering a solution to cognitive health disparities in underserved communities. And its ease of use by any staff member simplifies the administration of care and is ideal for primary care. While the tool appears to streamline the diagnosis and management of cognitive disorders, its role in improving outcomes still needs validation.

Guideline Updates

Lifting the Bar on Post-Retirement Workouts

LONGEVITY LEARNINGS

Retirement is the ideal time to finally learn the rules of pickleball, move to Del Boca Vista (phase 2), and begin to LHS. LHS? The acronym, born from Gen Z’s relentless drive toward language efficiency, stands for “Lift Heavy Sh**Stuff.” And according to the latest study comparing exercise regimens in older age, following this fitness mantra may promote greater longevity.

Racking and stacking the evidence

Smaller studies and those with shorter follow-up durations have shown the benefits of heavy lifting, but now a randomized controlled trial of nearly 500 healthy Danish retirees adds more scientific muscle to the evidence. Researchers split participants into three exercise groups for one year and issued them Gen Z-approved acronyms: (1) heavy resistance training (HRT), (2) moderate-intensity training (MIT), and a non-exercising control group (CON). Assessments were taken at baseline, after the intervention, and at two and four years after the study's initiation.

The HRT group uniquely maintained significant leg strength gains three years post-intervention, which researchers chalked up to possible neural adaptations. Both training groups saw no change in visceral fat over four years, whereas the control group had an increase. However, handgrip strength, lean leg mass, and leg extensor power diminished across all three groups.

Key takeaways

The prevailing data indicate that declining leg strength strongly predicts mortality in older adults, emphasizing the need for leg strengthening exercises. According to the authors, “In well-functioning older adults at retirement age, one year of heavy resistance training may induce long-lasting beneficial effects by preserving muscle function.” What’s a reasonable fitness plan? That varies by individual, but the HRT group’s regimen suggests a model:

How often? Three days per week

How many? Three sets of 6 to 12 reps

How much? Weights at 70%-85% of one-rep max

Achieving this goal obviously requires physical ability and access to gym equipment. But for those able, the message is clear: LHS.

Check out our podcast Exercise Patterns and Effect on Mortality

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

Alissa Scott, Author
Aylin Madore, MD, MEd, Editor
Margaret Oliverio, MD, Editor
Ariel Reinish, MD, MEd, Editor
Emily Ruge, Editor

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A CASE OF HYPERGLYCEMIA SECONDARY TO HYPERCORTISOLISM

SPONSORED BY CORCEPT THERAPEUTICS INCORPORATED

Meet Millie, an active schoolteacher who was diagnosed with T2DM 10 years ago. She is frustrated with her health issues, as they now impact her ability to function at work and home.

Clinical Presentation

Obesity (214 lb, 32.5 kg/m²BMI, 30-lb weight gain over 6 months)
Uncontrolled T2DM (HbA1c >11%)
Hypertension (120/85 mmHG)
Hyperlipidemia
Depression
Medication burden (4 antidiabetics, 1 antihypertensive, 1 hyperlipidemic, and 1 antidepressant)

Consider the clinical picture: Millie has multiple metabolic derangements and a high medication burden. Is something deeper at play?