Showing posts with label about. Show all posts
Showing posts with label about. Show all posts

Sunday, December 5, 2010

Are Your Legs Telling You Something? People With Diabetes Urged To Take Steps To Learn About P.A.D.


Main Category: Diabetes
Also Included In: Vascular
Article Date: 22 Nov 2010 - 2:00 PST window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email icon email to a friend ? printer icon printer friendly ? write icon opinions ?
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P.A.D. occurs when arteries in the legs become narrowed or clogged with fatty deposits, reducing blood flow to the legs. This can result in leg muscle pain when walking, disability, amputation, and poor quality of life. Blocked arteries found in people with P.A.D. can be a red flag that other arteries, including those in the heart and brain, may also be blocked - increasing the risk of a heart attack or stroke.

November is National Diabetes Month, and the Vascular Disease Foundation and its P.A.D. Coalition are urging people with diabetes to be alert to the warning signs of P.A.D. People with P.A.D. may have one or more of the following symptoms:

- "Claudication" - fatigue, heaviness, tiredness or cramping in the leg muscles (calf, thigh or buttocks) that occurs during activity such as walking and goes away with rest.

- Foot or toe pain at rest that often disturbs sleep

- Skin wounds or ulcers on the feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks).

Unfortunately, P.A.D. is often a silent disease, causing no recognizable symptoms. National medical guidelines recommend that adults over 50 years of age with diabetes be tested for P.A.D. Testing should also be considered in patients under 50 years of age with diabetes and at least one other cardiovascular risk factors such as a history of smoking, abnormal cholesterol and/or high blood pressure. The test for P.A.D. is called the ankle-brachial index, a painless, non-invasive test that compares the blood pressure in the ankles with the blood pressure in the arms.

"Poor circulation in the legs - particularly in people with diabetes - is a serious problem," stated Joseph Caporusso, DPM, Chair of the P.A.D. Coalition. "Without proper blood flow, a minor problem such as a cut or blister may not heal properly and may lead to an infection. If not treated promptly, these problems can result in amputation of a toe, foot or part of the leg."

Source:
Vascular Disease Foundation
P.A.D. Coalition

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Friday, November 26, 2010

Two Reasons, One Recipe Campaign Launches To Educate Adults With Type 2 Diabetes And High Cholesterol About Healthy Food Choices


Main Category: Diabetes
Also Included In: Nutrition / Diet;??Cholesterol
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The "Two Reasons, One Recipe" campaign is launching to focus attention on the importance of reducing A1C (blood sugar) and LDL-C ("bad" cholesterol) in adults with type 2 diabetes and high cholesterol, two important risk factors for cardiovascular disease.* In fact, more than 50 percent of adults with type 2 diabetes also have high LDL cholesterol.(1)

Franklin Becker, acclaimed Executive Chef of Abe & Arthur's restaurant in New York City, and Dr. Yehuda Handelsman, Medical Director of the Metabolic Institute of America in Tarzana, Calif., have teamed up with Daiichi Sankyo, Inc., to educate adults who have type 2 diabetes and high LDL cholesterol about making healthy food choices. Diagnosed with type 2 diabetes at age 27, Chef Becker is committed to creating healthy and flavorful recipes for people to create at home, and helping them to make appropriate choices when they are eating out.

"For the millions of American adults with type 2 diabetes and/or high LDL-C, trying to understand what you can and cannot eat may seem like an overwhelming burden. As part of the 'Two Reasons, One Recipe' campaign, I've developed a number of great new recipes that are flavorful and healthy for people with either or both of these chronic health conditions," said Chef Becker. "After being diagnosed with type 2 diabetes and seeing other family members also struggle with this condition, I made adjustments to my cooking style. I've incorporated these changes into my recipes, which I look forward to sharing with others across the country who, like me, want and need to eat healthier food."

The "Two Reasons, One Recipe" campaign features an online educational resource, www.TwoReasonsOneRecipe.com, where adults with type 2 diabetes and/or high LDL-C can find Chef Becker's recipes, cooking and shopping tips, and helpful information about type 2 diabetes and high LDL cholesterol. The campaign is supported by Daiichi Sankyo, Inc., the marketer of Welchol® (colesevelam HCl), and is launching in November 2010, which is recognized around the world as Diabetes Awareness Month.

"For many of my adult patients with type 2 diabetes and elevated LDL-C, managing their diet is one of the greatest challenges they face on a daily basis, which is why I'm excited to be partnering with Chef Franklin Becker on the 'Two Reasons, One Recipe' campaign," said Yehuda Handelsman, MD, FACP, FACE, FNLA Medical Director of the Metabolic Institute of America in Tarzana, Calif. "In my experience, the best approach to help adult patients with type 2 diabetes and elevated LDL-C effectively manage their conditions is one that's comprehensive and includes the right balance of diet, exercise and medications, such as Welchol. Welchol is currently the only product approved by the FDA (U.S. Food and Drug Administration), in addition to diet and exercise, to lower both A1C and LDL-C in adults with type 2 diabetes and high cholesterol.** Ask your healthcare provider if Welchol is right for you."

According to the American Diabetes Association (ADA), about 23.6 million, or 8 percent of people in the United States, have diabetes, and every 21 seconds another person is diagnosed.(2,3) Approximately 90 to 95 percent of those diagnosed with diabetes have type 2 diabetes.(2) The ADA and the American College of Cardiology emphasize that it is critical to reduce both A1C and LDL-C levels, as more than 50 percent of adults with type 2 diabetes also have elevated LDL-C, greatly increasing their risk of cardiovascular disease.*(1,4,5) The ADA recommends that in general, adult patients with type 2 diabetes target an A1C level of less than 7 percent, and an LDL-C goal of less than 100 mg/dL.(6)

Welchol has not been shown to prevent heart disease or heart attacks.

Welchol should not be used to treat type 1 diabetes or a condition known as ketoacidosis. Welchol has not been studied as a single medicine for T2DM or in combination with all anti-diabetes medications. Welchol is not for everyone, especially those with a history of intestinal blockage, those with blood triglyceride levels of greater than 500 mg/dL, or a history of pancreatitis (inflammation of the pancreas) due to high triglyceride levels.

IMPORTANT INFORMATION ABOUT WELCHOL

Indications

Welchol is indicated as an adjunct to diet and exercise to:

-- reduce elevated low-density lipoprotein cholesterol (LDL-C) in patients with primary hyperlipidemia (Fredrickson Type IIa) as monotherapy or in combination with an hydroxymethylglutaryl-coenzyme (HMG CoA) reductase inhibitor (statin)

-- reduce LDL-C levels in boys and postmenarchal girls, 10 to 17 years of age, with heterozygous familial hypercholesterolemia, as monotherapy or in combination with a statin after failing an adequate trial of diet therapy

-- improve glycemic control in adults with type 2 diabetes mellitus

Important Limitations of Use

-- Welchol (colesevelam HCl) should not be used for the treatment of type 1 diabetes or for the treatment of diabetic ketoacidosis

-- Welchol has not been studied in type 2 diabetes as monotherapy or in combination with a dipeptidyl peptidase 4 inhibitor and has not been extensively studied in combination with thiazolidinediones

-- Welchol has not been studied in Fredrickson Type I, III, IV, and V dyslipidemias

-- Welchol has not been studied in children younger than 10 years of age or in premenarchal girls

Contraindications

Welchol is contraindicated in individuals with a history of bowel obstruction, those with serum triglyceride (TG) concentrations of >500 mg/dL, or with a history of hypertriglyceridemia-induced pancreatitis.

Warnings and Precautions

The effect of Welchol on cardiovascular morbidity and mortality has not been determined.

Welchol can increase serum TG concentrations particularly when used in combination with sulfonylureas or insulin. Caution should be exercised when treating patients with TG levels >300 mg/dL.

Welchol may decrease the absorption of fat-soluble vitamins A, D, E, and K. Patients on vitamin supplements should take their vitamins at least 4 hours prior to Welchol. Caution should be exercised when treating patients with a susceptibility to vitamin K or fat-soluble vitamin deficiencies. Caution should also be exercised when treating patients with gastroparesis, gastrointestinal motility disorders, a history of major gastrointestinal tract surgery, and when treating patients with dysphagia and swallowing disorders.

Welchol reduces gastrointestinal absorption of some drugs. Drugs with a known interaction with colesevelam (cyclosporine, glyburide, levothyroxine, and oral contraceptives [ethinyl estradiol, norethindrone]), should be administered at least 4 hours prior to Welchol. Drugs that have not been tested for interaction with colesevelam, especially those with a narrow therapeutic index, should also be administered at least 4 hours prior to Welchol. Alternatively, the physician should monitor drug levels of the co-administered drug.

To avoid esophageal distress, Welchol for Oral Suspension should not be taken in its dry form.

Due to tablet size, Welchol for Oral Suspension is recommended for, but not limited to, use in the pediatric population as well as in any patient who has difficulty swallowing tablets.

Phenylketonurics: Welchol for Oral Suspension contains 48 mg phenylalanine per 3.75 gram dose.

Adverse Reactions

In clinical trials, the adverse reactions observed in ≥2% of patients, and more commonly with Welchol than placebo, regardless of investigator assessment of causality seen in:

-- Adults with Primary Hyperlipidemia were: constipation (11.0% vs 7.0%), dyspepsia (8.3% vs 3.5%), nausea (4.2% vs 3.9%), accidental injury (3.7% vs 2.7%), asthenia (3.6% vs 1.9%), pharyngitis (3.2% vs 1.9%), flu syndrome (3.2% vs 3.1%), rhinitis (3.2% vs 3.1%), and myalgia (2.1% vs 0.4%)

-- Pediatric patients with heFH primary hyperlipidemia were: nasopharyngitis (6.2% vs 4.6%), headache (3.9 vs 3.1%), fatigue (3.9% vs 1.5%), creatine phosphokinase increase (2.3% vs 0.0%), rhinitis (2.3% vs 0.0%), and vomiting (2.3% vs 1.5%)

-- Adult patients with Type 2 Diabetes were: constipation (8.7% vs 2.0%), nasopharyngitis (4.1% vs 3.6%), dyspepsia (3.9% vs 1.4%), hypoglycemia (3.0% vs 2.3%), nausea (3.0% vs 1.4%), and hypertension (2.8% vs 1.6%)

Post-marketing experience: Due to the voluntary nature of these reports it is not possible to reliably estimate frequency or establish a causal relationship:

-- Increased seizure activity or decreased phenytoin levels have been reported in patients receiving phenytoin concomitantly with Welchol (colesevelam HCl)

-- Reduced International Normalized Ratio (INR) has been reported in patients receiving warfarin concomitantly with Welchol

-- Elevated thyroid-stimulating hormone (TSH) has been reported in patients receiving thyroid hormone replacement therapy

Pregnancy

Welchol is Pregnancy Category B

About Welchol (colesevelam HCl)

Welchol, along with diet and exercise, lowers LDL or "bad" cholesterol. It can be taken alone or with other cholesterol-lowering medications known as statins. Welchol, along with diet and exercise, also lowers blood sugar levels in adult patients with type 2 diabetes mellitus when added to other anti-diabetic medications (metformin, sulfonylureas, or insulin). Welchol was approved by the FDA to lower bad cholesterol in 2000 and to lower blood sugar levels in 2008. Welchol is available in two formulations, Welchol tablets and Welchol® for Oral Suspension.

Welchol should not be used to treat type 1 diabetes or diabetic ketoacidosis, and it has not been studied with all anti-diabetic medications. Welchol is not for everyone, especially those with a history of intestinal blockage, those with blood triglyceride levels of greater than 500 mg/dL, or a history of pancreatitis (inflammation of the pancreas) due to high triglyceride levels.

In clinical studies of adult patients with type 2 diabetes, Welchol lowered A1C, fasting blood sugar and LDL-C, important risk factors for heart disease. In clinical studies of patients with elevated LDL-C, Welchol lowered LDL-C when used alone or when added to other cholesterol-lowering medications known as statins. Welchol has not been shown to prevent heart disease or heart attacks.

References

1. Cheung BMY et al. Diabetes Prevalence and Therapeutic Target Achievement in the United States, 1999 to 2006. The American Journal of Medicine. 2009;122:443-453.

2. Center for Disease Control, National Diabetes Fact Sheet 2007.

3. American Diabetes Association. I Decide to Fight Diabetes Fact Sheet.

4. Brunzell JD, Davidson M, Furberg CD, et al. Lipoprotein Management in Patients with Cardiometabolic Risk: Consensus Statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care. 2008;31(4):811-822.

5. Buse JB, Ginsberg HN, Bakris GL, et al. Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus: A Scientific Statement From the American Heart Association and the American Diabetes Association. Circulation.

6. American Diabetes Association: Standards of Medical Care in Diabetes - 2010. Diabetes Care. 2010; 33 (Suppl 1): S11-S61

Source: Daiichi Sankyo

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Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

All opinions are moderated before being added.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

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Thursday, November 25, 2010

Scientists learn more about how kidneys fail and how new drugs may intervene

ScienceDaily (Nov. 16, 2010) ? Scientists are learning more about how protein gets in the urine when the kidneys begin to fail and how a new drug blocks it.

"We have known for a long time that renal failure comes with protein in your urine, especially in diabetes," said Dr. David Pollock, renal physiologist at the Medical College of Georgia Vascular Biology Center. It's also known that a new class of drugs called endothelin A receptor antagonists reduce protein in the urine.

New research published in the journal Hypertension connects the two, providing more information about how new drugs under study for kidney failure work.

The scientists have shown in rats that increased levels of the peptide endothelin 1 -- characteristic of conditions such as diabetes and high-salt diets -- increase the permeability of tiny kidney filters. The filters recycle key components such as red and white blood cells and proteins, including albumin, that help keep blood vessels from leaking fluid.

The increased permeability causes the proteins to be eliminated in the urine, resulting in a double whammy that likely includes generalized body swelling and further kidney damage. "Without albumin, the fluid just goes into your tissue," Pollock said.

"This filter, which is like cheesecloth, gets damaged in kidney failure and so you get more of these proteins in your urine. Filters start scarring over, you lose the nephron (the filter and its associated kidney cells) and so the kidneys slowly die," he said.

And that's just part of the damage. High endothelin levels also trigger inflammation, sending out proinflammatory molecules that attract inflammatory cells like white blood cells and macrophages to the kidneys, MCG researchers have shown. They also have shown that endothelin A receptor antagonists reduce this inflammatory response.

"There has been no drug that really targets diabetic nephropathy," said Mohamed A. Saleh, MCG graduate student and the study's first author. The study provides more scientific evidence that the new endothelin A receptor antagonists may be the first class of drugs to fit that bill, said Saleh, noting that his native Egypt, like the United States, has an increasing problem with diabetes.

The positive results were achieved without affecting blood pressure, the scientists noted. Endothelin receptor antagonists are known to have health benefit but precisely why was an unknown, said Pollock, corresponding author on the study. "A lot of people thought they just lower blood pressure and anything that lowers blood pressure is going to make your kidneys feel better," he said.

Endothelin 1 has A and B receptors and whether the peptide hurts or helps generally depends on which receptor it activates. The B receptor is considered the good guy, helping the kidney eliminate excess sodium, for example. The A receptor is generally considered a trouble maker that interferes with sodium excretion, constricts blood vessels and promotes inflammation.

The MCG scientists want to compare A inhibitors to another new class of drugs that blocks both the A and B receptors.

The research was funded by the National Heart, Lung and Blood Institute and an American Heart Association predoctoral fellowship and Egyptian government grant to Saleh.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Medical College of Georgia, via EurekAlert!, a service of AAAS.

Journal Reference:

M. A. Saleh, E. I. Boesen, J. S. Pollock, V. J. Savin, D. M. Pollock. Endothelin-1 Increases Glomerular Permeability and Inflammation Independent of Blood Pressure in the Rat. Hypertension, 2010; DOI: 10.1161/HYPERTENSIONAHA.110.156570

Note: If no author is given, the source is cited instead.


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Monday, November 22, 2010

6 Common Myths and Misconceptions About Diabetes

Nearly 24 million Americans?or 1 in 10 adults?have diabetes, according to the Centers for Disease Control and Prevention, which projects that by 2050, as many as 1 in 3 adults will have the disease. Diabetes is one of the major causes of heart disease, stroke, new cases of adult blindness, and leg and foot amputations not caused by injury. Those are facts.

Yet there are many mistaken beliefs about diabetes. Sue McLaughlin, former president of healthcare and education at the American Diabetes Association, offered her opinion of what she says are the six most common myths and misconceptions about diabetes, based on an ADA survey of more than 2,000 Americans released in 2009.

1. Diabetes is not that serious. In fact, diabetes causes more deaths than breast cancer and HIV/AIDS combined, McLaughlin says. Still, people with type 2 diabetes?the most common form of the disease?may go a long while, even years, before being diagnosed because they may downplay their symptoms or write them off to other causes. So if you are making frequent trips to the bathroom at night; experience extreme thirst, overwhelming fatigue, or blurry vision; or notice that you keep getting infections, ask your doctor to test you for diabetes. An early diagnosis can help ward off complications.

[Got Diabetes? Do These Things or You May Go Blind]

2. Eating too much sugar causes diabetes. "Certainly, anybody will benefit from eating less sugar...because it is not a nutrient-dense ingredient," McLaughlin says. That said, simply eating too much sugar does not cause diabetes.

[How Much Sugar Is Too Much?]

3. Being overweight causes diabetes. Just because a person gains weight doesn't mean she's going to get type 2 diabetes. Having a body mass index over 25 is just one of several risk factors for diabetes, but there are many overweight people who don't ever get the disease, McLaughlin says. Still, being obese?having a body mass index of 30 or more?is considered to be a major risk factor, and the increase seen in diabetes diagnoses has coincided with a dramatic increase in obesity in the United States, according to the CDC.

Other risk factors for diabetes include being older than 45, a lack of regular physical activity, or a family history of diabetes. You're also at risk if you have high blood pressure, high cholesterol, polycystic ovary syndrome, metabolic syndrome, or acanthosis nigricans (a condition that causes dark, thickened skin around the armpits or the neck). Having suffered from gestational diabetes during pregnancy or given birth to a baby weighing more than 9 pounds also raises the risk of the disease. And African-Americans, Hispanic Americans, Asian-Americans, and American Indians are at higher risk than are Caucasians.

[9 Shocking Diabetes Indicators]

4. Having diabetes means you must eat foods that are different from everyone else's. People with diabetes don't need to follow a restricted diet but instead should try to follow the same healthful eating guidelines as everyone else, including choosing foods that are lower in fat, higher in nutrients, and contain an appropriate amount of calories, McLaughlin says. "Everyone needs to be eating healthier. And if you haven't followed healthy eating habits before now, [a diagnosis] is a good wake-up call to make positive changes," she says.

Updated on 11/11/10: This is an updated version of a previously published story.


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Saturday, October 30, 2010

Epigenomics discovery yields new information about fat cells

ScienceDaily (Sep. 30, 2010) ? By creating a "map" of histone modifications in fat cells, investigators have discovered two new factors that regulate fat formation, a key step on the road to better understanding obesity, diabetes and other metabolic disorders. Led by investigators at Beth Israel Deaconess Medical Center (BIDMC) and the Broad Institute, the study appears in the October 1 issue of the journal Cell.

"These findings help to demonstrate the power of epigenomic mapping when it comes to gleaning key insights into fat cell formation," explains senior author Evan Rosen, MD, PhD, an investigator in the Department of Endocrinology, Diabetes and Metabolism at BIDMC and Associate Professor of Medicine at Harvard Medical School. Fat cells, also called adipocytes, play an integral role in regulating metabolism by controlling lipid and glucose balance.

To better understand how adipocytes control the genes that impart the specialized functions of these cells, the researchers turned to epigenomics, and specifically the arm of epigenomics known as histone modifications.

"Deoxyribonucleic acid [DNA] is tightly wound around proteins called histones, which, over time, can accumulate chemical modifications or 'marks,'" explains Rosen. "These marks instruct the cell which genes to turn on and off, and by mapping these modifications, we can gain important insights that would be unattainable through traditional means."

Unlike previous investigations, which examined fat cells at a single static time point, this new study mapped several histone modifications throughout the course of the fat cell development, using a technique called chromatin immunoprecipitation followed by massively parallel sequencing or ChIP-Seq. This method relies on the ability to sequence tens of millions of short stretches of DNA (in this case DNA bound to modified histones) and then to reassemble results into a coherent genome. In addition to following these histone markers across time, the scientists also mapped the markers across species.

"Our study looked at both mouse cells and human cells," explains Rosen. "This is key because each cell type can accumulate histone marks that actually have nothing to do with fat cell differentiation. Consequently, by comparing two different cell models, we were able to sift through and focus on the epigenetic marks that appeared in both cell types."

What emerged was a "core" set of histone modifications that formed the basis of a "road map" for the scientists to follow. And, by using this new map, the investigators discovered two transcription factors (proteins that control the copying of DNA into RNA) that regulate fat cell formation.

"We found two new transcription factors -- SRF and PLZF -- involved in fat cell development," explains Rosen. "We have essentially demonstrated how an epigenomic 'road map' can be used to identify biology that could not have been predicted through any other means." Subsequent experiments confirmed the proteins' roles in fat cell development: When either the SRF or the PLZF protein was decreased, fat cells generated at a faster rate and, conversely, when the amount of either protein was increased, fat cell development ceased.

"Although these particular studies were focused on the development of fat cells, we have reason to think that SRF and PLZF may be involved in the workings of mature fat cells as well," notes Rosen, adding that these new findings, therefore, have the potential to impact metabolic diseases such as obesity and Type 2 diabetes.

"The huge costs of obesity and metabolic disease, both in terms of health and from a financial standpoint, are making adipocyte biology increasingly important," he adds. "With these new findings we now have a better understanding of normal fat cell development, and going forward, we can compare normal fat cells to fat cells in disease states. If we can better understand why fat cells behave as they do, then we can work to develop therapies for obesity or diabetes."

This study was funded by grants from the National Institutes of Health and the American Diabetes Association.

Co-first authors of the study are Zhao Xu of BIDMC and Tarjei Mikkelsen of the Broad Institute. Coauthors include Broad Institute investigators Xiaolan Zhang, Li Wang and Eric Lander; and Jeffrey Gimble of the Pennington Biomedical Research Center, Louisiana University System.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Beth Israel Deaconess Medical Center.

Journal Reference:

Tarjei S. Mikkelsen, Zhao Xu, Xiaolan Zhang, Li Wang, Jeffrey M. Gimble, Eric S. Lander, Evan D. Rosen. Comparative Epigenomic Analysis of Murine and Human Adipogenesis. Cell, Volume 143, Issue 1, 156-169, 1 October 2010 DOI: 10.1016/j.cell.2010.09.006

Note: If no author is given, the source is cited instead.


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