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“John Quincy, when he arrived in September for a holiday of several weeks, was shocked by his father's drastically deteriorating condition. `His sight is so dim that he could neither write nor read. He cannot walk without aid. He bears his condition with fortitude, but is sensible to all its helplessness. He receives some letters, and dictates answers to them. In general the most remarkable circumstances of his present state is the total prostration of his physical powers, leaving his mental faculties scarcely impaired at all.” (David McCullough. John Adams. New York: Simon and Schuster, 2001:637–8)

Science is growing faster in the European Union than in the United States. There has been a decline in the United States in the number of scientific publications since 1995. Based on the number of scientific publications per million people in the population, the United States now ranks eighth in the world in scientific output, behind Sweden, Denmark, Finland, the Netherlands, the United Kingdom, Belgium, and Austria. A possible reason for the comparative decline in US science output may be related to commercialisation. Since the number of patents remains high in the United States, researchers may be seeking patent protection before publishing their scientific results. (

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Because women with chest pain are more likely to have normal coronary arteries on radiographic studies, a higher mortality rate after myocardial infarction, and have poorer outcomes after coronary artery bypass surgery than men, it has been hypothesised that microvascular disease may be a more prominent problem in the development of myocardial ischaemia in women than in men. Now, a study based on the Arteriosclerosis Risk in Communities Study documents on retinal photographs that retinal arteriolar narrowing is related to the risk of coronary heart disease in women but is not in men. This observation lends support to the thesis that a more prominent microvascular role in the development of coronary heart disease is at play in women compared with men. (

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It is now clear that the use of interferon β for patients with multiple sclerosis reduces the number of exacerbations of the disease, although it is unclear whether it reduces the overall disability associated with the disease. One apparent side effect of this therapy has been thyroid dysfunction. It has been associated with hypothyroidism, in particular in patients with subclinical thyroid disease or with antithyroid autoantibodies. Now a prospective multicentre study from Italy documenting the thyroid function and autoimmunity in 152 patients with multiple sclerosis receiving interferon β therapy has been completed. Multiple sclerosis patients did not have an increased risk of subtle thyroid function abnormalities, subclinical thyroid disorders, or antithyroid autoantibodies. Nevertheless, there was a trend among the multiple sclerosis patients being treated for a greater prevalence of subclinical hypothyroidism and the authors suggest that a longitudinal study of thyroid function in multiple sclerosis patients receiving interferon β therapy needs to be undertaken. (

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Many advocates for legalisation of private marijuana consumption categorically state that chronic use of marijuana has no significant adverse health effects. Now, however, a multisite prospective cross sectional neurological study conducted in the United States among 122 frequent heavy cannabis users has been completed. Its results suggest that long term heavy cannabis users show impairments in memory and attention that endure beyond the period of intoxication and became worse with increasing regular cannabis use. Heavy cannabis use was defined as two joints per day or more. The extent to which these cognitive impairments may recover following cessation or reduction of cannabis use will be addressed in a follow up study. (

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Controversy surrounds the question of whether or not an elevated serum acid level is a true independent risk factor for cardiovascular disease. Now a prospective cohort study from the Macarthur Studies of Successful Aging has specifically investigated whether elevated serum uric acid levels are related to total mortality. This study found that high serum uric acid levels are not independently associated with increased total mortality in high functioning older women and men. The authors suggest that when evaluating the association between serum uric acid levels and mortality the potential confounding effect of underlying inflammation and other risk factors must be considered. (

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In a study from France, getting an annual flu shot seems to offer significant protection against stroke in older individuals. In this study involving 90 patients 60 years of age or older, who had had a stroke compared to 180 controlled subjects who had not, researchers found that only 41% of stroke patients had been vaccinated during the previous 5 years as compared with 56% of the controlled group. People older than 75 years of age were less likely to benefit from influenza vaccination, perhaps because other risk factors such as hypertension have a more substantial role in strokes in this older population. (

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Considerable evidence to document the association of sleep apnoea and sudden cardiac death. In a study from the Oxford Center of Respiratory Medicine, it was demonstrated that in patients with the most severe sleep apnoea the use of nasal continuous positive airway pressure during sleep reduces blood pressure and provides a significant vascular risk benefit and substantially improves excessive daytime sleepiness and quality of life. This was a randomised parallel trial of 118 men with obstructive sleep apnoea. (

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Scientists at the US Army Institute of Infectious Diseases have reported a simple method for generating the Ebola virus-like particles—assemblages of proteins shaped like the virus but with all the genetic material deleted, thus making them unable to replicate. This raises the hope that a vaccine might be developed to prevent infection with the Ebola haemorrhagic fever virus. (

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Coronary artery bypass surgery is an effective and frequently performed procedure. Nevertheless, it is associated with significant cerebral morbidity usually manifested as a decline in cognitive function or stroke. It has been estimated that the incidence of cognitive decline ranges from 3% to 50%, depending on patient characteristics, definition of the decline, and the general success rate of the surgeon involved. In a randomised controlled trial conducted in the Netherlands from 1998 to 2000 investigators demonstrated that patients who received coronary artery bypass graft surgery without cardiopulmonary bypass had improved cognitive outcomes 3 months after the procedure compared with those who had their surgery with the use of cardiopulmonary bypass. However, the effect was limited and became negligible at 12 months. This was a disappointing finding since it appears that surgeons cannot reduce the cerebral morbidity associated with coronary artery bypass graft surgery by utilisation of pump procedures. (

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