Dr. Michael Roizen, Cleveland Clinic Chief Wellness Officer, answers the question "How much exercise is enough?"

Three parts of exercise have been shown to be beneficial to health:

1. Moving the equivalent to 10,000 steps a day.
2. Resistance exercise for 30 minutes a week.
3. 20 minutes of cardiovascular exercise.

The videos are part of the Cleveland Clinic Let's Move It! program. See the CEO promoting it:

Human subjects are paid in Phase 1 clinical trials to test the toxicity levels of new drugs. Some make a profession out of it, but researchers worry about health risks.

References:
Clinical Trials: Professional Guinea Pigs. TIME.

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in hematology:

Transplantation in aplastic anemia

In patients with severe aplastic anemia over the age of 40 who received allogeneic hematopoietic cell transplantation from an HLA-identical sibling, overall survival was 65 percent.

Improved survival when rituximab is added to fludarabine plus cyclophosphamide in CLL

There were higher response rates and survival with six courses of FCR (fludarabine, cyclophosphamide, and rituximab) when compared with six courses of FC (fludarabine, cyclophosphamide).

Second generation tyrosine kinase inhibitors (TKIs) for CML

Trials comparing dasatinib or nilotinib to imatinib for chronic myeloid leukemia (CML) demonstrated faster and deeper responses with these second generation tyrosine kinase inhibitors.

Improved understanding of pathobiology of multiple myeloma

Virtually all multiple myeloma (MM) cases are preceded by a premalignant plasma cell proliferative disorder known as monoclonal gammopathy of undetermined significance (MGUS). The pathobiology of myeloma as a two-step process - first there is the establishment of a limited stage of clonal proliferation (MGUS); then there is progression of MGUS to MM.

Denileukin diftitox superior to placebo for relapsed mycosis fungoides

There were better response rates with the recombinant interleukin-2-diphtheria toxin fusion protein denileukin diftitox used for therapy of mycosis fungoides and Sezary syndrome.

Survival in sickle cell disease

The estimated survival at 18 years is now 94 percent for those with HbSS or HbS/beta(0) thalassemia and 98 percent for those with HbSC or HbS/beta(+) thalassemia.

References:
What's new in hematology. UpToDate.

From NBC Chicago:

Neurologist John Wapham lives in downtown Chicago, but he can see patients anywhere in the world ... from his apartment. And he does. He's an expert in treating strokes, and with the help of a robot and a broadband connection, he's able to be at a patient's bedside instantly.

View more news videos at: http://www.nbcchicago.com/video.

"This brings specialists to to the remotest parts of the country, and the world. I've popped open my laptop on Michigan avenue and treated patients in another state, " he says. And in the not too distant future, these robot doctors could be on the battlefield, or at the scene of a horrible car accident: instantly.

Some critics fear that telemedicine may not be accurate enough. For example, the accuracy of teledermatology was inferior to real-life clinic dermatology for melanoma diagnosis in a recent study: http://bit.ly/8A4oiu

References:
Robot Doctors: Future of Medicine? NBC Chicago.

Lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory enzyme expressed in atherosclerotic plaques, is a therapeutic target being assessed in trials of vascular disease prevention.

Lp-PLA2 activity and mass each show continuous associations with risk of coronary heart disease, similar in magnitude to that with non-HDL cholesterol or systolic blood pressure.

Lipoprotein structure (chylomicron). Image source: Wikipedia, GNU Free Documentation License.

People who get less than 6 hours sleep per night had an increased risk of dying prematurely in a recent study. Those who slept for less than that amount of time were 12% more likely to die early, though researchers also found a link between sleeping more than 9 hours and premature death.

The study aggregated decade-long studies from around the world involving more than 1.3 million people and found "unequivocal evidence of the direct link" between lack of sleep and premature death.

Just one sleepless night can hamper the body's ability to use insulin to process sugar in the bloodstream. Insulin sensitivity is not fixed in healthy people, but depends on the duration of sleep in the preceding night.

"Society pushes us to sleep less and less," one of the study investigators said, adding that about 20% of the population in the United States and Britain sleeps less than 5 hours.

Adults typically need between 7 and 9 hours sleep a night. If you sleep little, you can develop diabetes, obesity, hypertension and high cholesterol.

From CBS News:

A 2006 study questioned the acceptability of minor episodic memory loss in older adults as normal. Episodic memory loss includes things such as forgetting the name of a new acquaintance, a recent conversation, or an upcoming appointment.

People commonly undergo an age-related slowing of the ability to retrieve information. They might forget where they put their keys, but they usually remember eventually. But when Alzheimer's is involved, new information is never properly stored, meaning the affected person never learned it well enough to be able to retrieve it.

Related:
Senior Moments: Signs Of Alzheimer's? CBS News.
Memory problems not a normal sign of aging: study http://goo.gl/xb9M

This small BMJ study suggests the following risk factors for subsequent professional misconduct:

- male sex
- lower socioeconomic background
- early academic difficulties at medical school

The average daily salt intake in America is one and 1/2 teaspoon a day. This is 3,400 milligrams of sodium a day, or 1,100 milligrams more then the recommended maximum.

For people with congestive heart failure, a salty hot dog can trigger a trip to the hospital.

The experts say the new target for sodium intake should be set at 1,500 milligrams daily.

Oropharyngeal cancer is increasing at a "dramatic" rate, particularly in the male population http://goo.gl/JAko

Related:
Michael Douglas Has Stage IV Throat Cancer; Experts Weigh In. WebMD.
Catherine Zeta-Jones's fury at the doctors who missed her husband Michael Douglas's throat cancer. Daily Mail.

The earliest references to journal clubs are in the memoirs and letters of Sir James Paget, a British surgeon, who described a group at St. Bartholomew’s Hospital in London in the mid-1800s as “a kind of club … a small room over a baker’s shop near the Hospital-gate where we could sit and read the journals.”

Sir William Osler established the first formal medical journal club at McGill University in Montreal in 1875. The original purpose of Osler’s journal club was “for the purchase and distribution of periodicals to which he could ill afford to subscribe” (see the excerpts from Google Books below).

Listen to the Doctor: Cleve Francis, cardiologist and country singer.

Dr. Francis, who recently turned 65, is a genteel singer of country and pop songs. He favors vintage ballads.

A man inching up the line in a walker can't believe it. "You want his autograph? I get it on a prescription every three weeks," he says.

References:

Patients who received a test of two genes connected to warfarin sensitivity were 28 percent less likely to be hospitalized for a bleeding episode or blood clot than those whose safe and effective warfarin dosing was determined by traditional trial and error method.

The genetic tests, which are easily done with a cheek swab or blood sample, need only be performed once ever for each patient and cost somewhere between $200 and $400 - far less than even a brief hospital stay.

Warfarin Sensitivity Genotype Test - Mayo Clinic Video.

References:
Gene test can cut warfarin hospitalizations | Reuters.

Low-back pain is a common and costly problem. This study estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care.

Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider.

References:

A survey of 3,000 faculty members at the top 50 US medical schools has shown that women members earned $13,000 less than their male counterparts with the equivalent career position and professional activity.

There were no obvious reasons for the difference.

Drinkers of 15 or more units per week in any BMI category and obese drinkers had raised relative rates for all definitions of liver disease, compared with underweight/normal weight non-drinkers.

The relative excess risk due to interaction between BMI and alcohol consumption was 5.58.

Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two.

The occurrence of both factors in the same populations should inform health promotion and public health policies.

References:

The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure.

In each TIA cohort in this study, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SBP 6·22), independent of mean SBP.

Maximum SBP reached was also a strong predictor of stroke (HR 15).

Visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (top-decile HR for stroke: 3·25) independent of mean SBP.

Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.

References:

Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine.

Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects.

References:
Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy. NEJM, 2010.

Almost half of England's football managers have "significant" heart problems and their life-consuming, high-pressure jobs are a "recipe for potential disaster" according to cardiovascular experts. This is hardly surprising considering the range of emotions demonstrated by Fabio Capello (age 64), the current manager of the England national football team, in the video below:

A stressful soccer match affects everybody involved including the spectators.

The Fédération Internationale de Football Association (FIFA) World Cup, held in Germany from June 9 to July 9, 2006, provided an opportunity to examine the relation between emotional stress and the incidence of cardiovascular events. Cardiovascular events occurring in 4,000 patients in the greater Munich area were prospectively assessed by emergency physicians during the World Cup.

On days of matches involving the German team, the incidence of cardiac emergencies was 2.66 times that during the control period. For men, the incidence was 3.26 times that during the control period, and for women, it was 1.82 times that during the control period.

On those days, the highest average incidence of events was observed during the first 2 hours after the beginning of each match.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.

References:
Nearly half of football managers suffer serious heart problems. Independent, 2005.
Cardiovascular events during World Cup soccer. N Engl J Med. 2008 Jan 31;358(5):475-83.