eMJA: In other journals

The results of the multinational ACCENT randomised trial have just been published, with encouraging results for sufferers of Crohn’s disease. Current treatment of moderate or severe Crohn’s disease includes long-term steroids (with a host of adverse side effects), and purine metabolites and methotrexate (which have a slow onset of action). Infliximab, a monoclonal antibody with a rapid onset of benefit, has now been shown, in responders, to give sustained relief with repeated doses. It was effective in some patients who had failed other treatments, and allowed patients taking steroids to either reduce their dose or stop taking steroids altogether.

Lancet 2002; 359: 1541-1549

	Sustained relief
	The results of the multinational ACCENT randomised trial have just been published, with encouraging results for sufferers of Crohn’s disease. Current treatment of moderate or severe Crohn’s disease includes long-term steroids (with a host of adverse side effects), and purine metabolites and methotrexate (which have a slow onset of action). Infliximab, a monoclonal antibody with a rapid onset of benefit, has now been shown, in responders, to give sustained relief with repeated doses. It was effective in some patients who had failed other treatments, and allowed patients taking steroids to either reduce their dose or stop taking steroids altogether. Lancet 2002; 359: 1541-1549

	Shortsighted
	Perhaps mother was right when she said holding books too close or reading in the dark would damage our eyes. A review of myopia, an increasingly common condition in which images focus in front of the retina, gives evidence that prolonged near work can cause myopia, and that overcorrecting myopia can make the condition worse. Genetic factors contribute to myopia, as does early deprivation of formed vision (such as untreated infants with congenital cataract) by causing elongation of the eye. Current theory is that prolonged near work leads to myopia via the blurred retinal image that occurs during near focus. The retinal blur initiates a biochemical process in the retina which stimulates biochemical and structural changes in the sclera and choroid, leading to axial elongation of the eye, and thus movement of the retina away from the eye’s focal point. BMJ 2002; 324: 1195-1199

	Bent backs
	Decreasing the physical load at work, especially for workers with low-back complaints, may be an important tool in preventing sick leave due to low back pain. This recommendation comes from a prospective study of sick leave (≥ 3 days) involving workers from 21 companies in a variety of industries throughout the Netherlands. A physical examination was completed at baseline, and videos were made of each worker to enable analysis of work-related physical factors. Three-year follow-up was available for 732 workers (mean age, 36.4 years; 25% female), of whom 149 had taken leave because of back pain. Trunk flexion, as well as trunk rotation and lifting, were significantly associated with sick leave for low back pain. A dose–response relation was found for trunk flexion, with those spending 15%–20% of their work time with their trunk flexed ≥ 30° being 3.2 times more likely to take leave than those whose job involved minimal flexion. Occup Environ Med 2002; 59: 323-328 Secret messengers Changes in myocardial gene expression, which would account for clinical improvement, have been found in the endocardium of patients with dilated cardiomyopathy who responded to beta-blockers. The study, from the United States, recruited patients who were being treated with digoxin and an ACE inhibitor, then randomly assigned them to additional treatment with metoprolol, carvedilol or placebo. Levels of messenger RNA (mRNA) in the endocardium for three categories of contractility-regulating genes were measured at baseline and after six months’ treatment. Patients who responded to beta blockers had an increase in sarcoplasmic-reticulum calcium ATPase mRNA and alpha-myosin heavy-chain mRNA and a decrease in beta-myosin heavy-chain mRNA, indicating molecular remodelling. N Engl J Med 2002; 346: 1357-1365

	A drink a day . . .
	Postmenopausal women who are looking for a healthy alternative to weak tea or low-fat milk may need to look no further than their vodka and orange. In a randomised controlled, crossover trial conducted in the United States, moderate alcohol consumption reduced insulin concentration and improved insulin sensitivity in 51 healthy women (mean age, 60 years). Each was supplied with a full diet intended to maintain current weight, and was not told whether her daily orange juice contained 0, 15, or 30 grams of ethanol. Fasting insulin, triglycerides and glucose were measured at the end of each eight-week dietary period. Consumption of alcohol 30g/day reduced fasting insulin by 19.2%, and increased insulin sensitivity by 7.2%, independent of body mass index, thus potentially reducing the risk of type 2 diabetes and cardiovascular disease. Unfortunately, as well as exceeding Australian guidelines for daily alcohol consumption, increased serum levels of two steroid hormones known to be risk factors for breast cancer were detected in those given alcohol. JAMA 2002; 287: 2559-2562