Author: Marie Benz MD FAAD
07 Nov Single Injection of Klotho Gene Protected Animals From Cognitive Decline
Posted at 11:53h
in Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Genetic Research, Nature
MedicalResearch.com Interview with:
[caption id="attachment_38035" align="alignleft" width="200"]
Dr. Chillon[/caption]
Dr Miguel Chillon PhD
Department of Biochemistry and Molecular Biology
Universitat Autonoma Barcelona
Spain
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Klotho is a protein with an anti-aging and neuroprotective role. Recent studies show it prevents the development of cognitive problems associated with aging and Alzheimer's disease. Klotho works mainly by inhibiting the insulin / IGF-1 signaling pathway and decreasing the damage caused by oxidative stress in the brain. One of the latest results revealed that the concentration of Klotho in cerebrospinal fluid is significantly lower in Alzheimer's patients than in human controls of the same age; and it is lower in the elderly with respect to young adults.
Our study used a gene therapy strategy to introduce the Klotho gene into the Central Nervous System of adult animals. With just a single injection of the Klotho gene, young adult animals were protected over time from the cognitive decline associated with aging in old animals. These exciting results pave the way to further advances in research and the development of a neuroprotective therapy based on Klotho.
07 Nov Trained Volunteers Can Deliver Effective Brief Smoking Cessation Advice
MedicalResearch.com Interview with:
Dr. Man Ping Wang, PhD
School of Nursing
University of Hong Kong
Hong Kong
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Smoking cessation (SC) services can effectively increase the chance of abstinence, but few smokers proactively seek help from these services worldwide. Smoking cessation guidelines recommend referring smokers to SC services, but such referrals were usually conducted in a passive way (e.g. providing contacts of these services and asking smokers to use them). Actively referring smokers may increase use of smoking cessation services and abstinence rates.
Previous studies were mostly conducted in clinical settings. We investigated the efficacy of using trained volunteers to actively refer smokers recruited in the community to smoking cessation services in this cluster randomized control trial. We found that smokers who received a brief cessation advice and active referral had significantly higher abstinence rate and smoking cessation service use rate at 6-month follow-up, compared with smokers who received a minimal advice and a self-help booklet.
07 Nov Failure of Dental Fillings Is At Least Partially Genetically Determined
MedicalResearch.com Interview with:
Alexandre R. Vieira, DDS. MS, PhD
Professor, Director of Clinical Research, Director of Student Research
Department of Oral Biology
Center for Craniofacial and Dental Genetics
Department of Pediatric Dentistry
School of Dental Medicine
Department of Human Genetics
Graduate School of Public Health
Clinical and Translational Sciences Institute
University of Pittsburgh
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: One aspect is the dilemma between continuing to use dental amalgams and the perception that composite resins are not as durable.
We show that composite resin restorations can perform similarly to dental amalgams for the first 5 years. But the most remarkable is that composite resin failures may be related to certain individual risk factors, such as genetic variation.
07 Nov Dual Antiplatelet Therapy Found Beneficial Over Aspirin Alone Following CABG Surgery
MedicalResearch.com Interview with: [caption id="attachment_34397" align="alignleft" width="138"]
Dr. Agarwal[/caption]
Nayan Agarwal MD
Intervention Cardiology Fellow
University of Florida,
Gainesville, FL
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Optimal antiplatelet strategy post CABG remains controversial with guidelines still evolving. Though aspirin monotherapy is the therapy of choice, but some studies have suggested a benefit of dual antiplatelet (DAPT). Question also remains if choice of antiplatelet therapy strategy is influenced by clinical presentation (acute coronary syndrome [ACS] versus non ACS) or CABG technique ( off pump versus on pump).
The current meta-analysis of 8 randomized control trials and 9 observational studies with a total of 11,135 patients demonstrated that at a mean follow up of 23 months, major adverse cardiac events (MACE) (10.3% versus 12.1%, RR 0.84, confidence interval (CI) 0.71-0.99); all-cause mortality (5.7% versus 7.0%, RR 0.67, CI 0.48-0.94) and graft occlusion (11.3% versus 14.2%, RR- 0.79, CI- 0.63- 0.98) were less with DAPT compared with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. Subgroup analysis demonstrated that benefit of DAPT was independent of clinical presentation (ACS versus non ACS) or CABG technique (off pump versus on pump).
07 Nov Decorative Drinking Glasses Can Contain Harmful Levels of Metals
MedicalResearch.com Interview with:
Dr Andrew Turner
Reader in Environmental Science (Biogeochemistry and Toxicology)
School of Geography, Earth and Environmental Sciences
University of Plymouth, UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We had a project looking at toxic metals in consumer plastics and paints and as part of the study analysed decorated glassware product. With respect to the latter, and from a health perspective, it is concerning that metals that have been banned or restricted by so many industries over the past few decades are still used to decorate contemporary drinking glassware. Drinking glasses that are most hazardous are those where the décor extends into the lip area within 2 cm of the rim, and those that target children.
06 Nov Bariatric Surgery Associated With Reduced Risk of Obesity-Related Cancers
MedicalResearch.com Interview with: [caption id="attachment_38011" align="alignleft" width="142"]
Dr. Schauer[/caption]
Daniel P. Schauer, MD, MSc
Associate Professor, Internal Medicine
University of Cincinnati College of Medicine
Division of General Internal Medicine
Cincinnati OH 45267-0535
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity is associated with many types of cancer and bariatric surgery is the most effective treatment for severe obesity. We conducted a retrospective cohort study of patients undergoing bariatric surgery between 2005 and 2012 with follow-up through 2014 using data from Kaiser Permanente using 5 study sites. The study included 22,198 patients who had bariatric surgery matched to 66,427 nonsurgical patients with severe obesity.
We found that bariatric surgery was associated with a reduced risk of cancer. The risk reduction was greatest for the cancers that are associated with obesity including postmenopausal breast, endometrial, colon, and pancreatic cancers, as well as esophageal adenocarcinoma.
06 Nov Hormones Affect Carotid Plaque Stability and Stroke Vulnerability
MedicalResearch.com Interview with: [caption id="attachment_38007" align="alignleft" width="119"]
Marija Glisic[/caption]
Marija Glisic
Epidemiology, Erasmus MC
MedicalResearch.com: What is the background for this study?
Response: Carotid atherosclerosis is one of most important risk factors for developing stroke. Carotid atherosclerotic plaques characterized by lipid core presence and intraplaque haemorrhage are considered to be unstable, and therefore more prone to rupture and lead to consequent stroke. Sex differences have been observed in carotid plaque composition as well as in stroke incidence. Sex hormones, particularly estrogen and testosterone actions are suggested to underlie the observed sex differences in atherosclerosis. Experimental evidence suggests a direct action of estradiol and testosterone on the vascular system, affecting various mechanisms that may impact plaque composition and subsequently stroke risk.
06 Nov Irritable Bowel Syndrome with Constipation Patients Frustrated With Limited Treatment Options
MedicalResearch.com Interview with: [caption id="attachment_38003" align="alignleft" width="133"]
Dr. Quigley[/caption]
Eamonn M.M. Quigley, M.D.
Director, Lynda K. and David M. Underwood Center for Digestive Disorders
Houston Methodist Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The BURDEN IBS-C (Better Understanding and Recognition of the Disconnects, Experiences, and Needs of Patients with Irritable Bowel Syndrome with Constipation) Study was designed to develop a better understanding of the experiences and attitudes associated with IBS-C.
This study consisted of more than 1,300 individuals who met IBS-C criteria (mean age 46 years; 73 percent of respondents were female) and completed the author-developed, IRB-approved online questionnaire. The study also evaluated, through an approximately 45-minute long questionnaire, more than 325 healthcare providers who treat patients with IBS-C.
Notably, the study found many patients experienced stress, lost productivity and described a feeling of frustration with their condition. HCPs recognize this frustration, yet underestimate how many patients have “accepted” their condition. Both patients and healthcare providers (HCPs) also noted a lack of satisfaction in currently available prescription treatments for IBS-C.
Detailed findings can be found here.
06 Nov Most Adolescents Not Receiving Important Health Care Preventive Services
MedicalResearch.com Interview with: [caption id="attachment_37911" align="alignleft" width="100"]
Dr. Adams[/caption]
Sally H. Adams, PhD, RN
Specialist, Division of Adolescent and Young Adult Medicine
Adolescent and Young Adult Health National Resource Center
University of California, San Francisco
Benioff Children’s Hospital
San Francisco, CA 94118
MedicalResearch.com: What is the background for this study?
Response: Major causes of adolescent illness and mortality are preventable. To address this, in the 1990s, professional medical organizations developed healthcare provider guidelines for the delivery of adolescent preventive healthcare. These include the receipt of anticipatory guidance and risk screening services in the effort to promote healthy behaviors and avoid risky behaviors that are intended to be covered within a preventive care visit, but could be addressed in other healthcare visits.
The adolescent developmental period is an important time for adolescents to be engaged with the healthcare system. Transitioning from childhood to adulthood, adolescents are becoming increasingly independent - having more responsibility and freedom for decision making in many areas, including healthy choices in behaviors and activities. While families and community settings (schools, churches) play strong roles in this process, the healthcare system also plays an important role.
06 Nov Severity of Firearm Injuries Escalates Over Ten Years
MedicalResearch.com Interview with: [caption id="attachment_37791" align="alignleft" width="200"]
Yi Zuo[/caption]
Yi Zuo
Lead Biostatistician
Center for Clinical Translational Epidemiology and Comparative Effectiveness Research
Preventive Medicine & Epidemiology
Department of Medicine
Boston University School of Medicine
Boston, MA 02118
MedicalResearch.com: What is the background for this study?
Response: Non-fatal firearm injuries constitute approximately 70% of all firearm trauma injuries in the United States. However, patterns of severity of those injuries are poorly understood.
06 Nov Anticoagulant Warfarin May Lower Cancer Risk
MedicalResearch.com Interview with: Gry Haaland, MD James Lorens PhD, Professor The Department of Biomedicine University of Bergen MedicalResearch.com: What is the background for this study? Response: Antitumor activity of the common blood thinner warfarin has been reported in several experimental cancer model systems. We therefore considered whether warfarin is cancer protective. Using the comprehensive national health registries in Norway, we examined cancer incidence among a large number of people taking warfarin (92,942) and compared to those not taking warfarin (more than 1.1 million).06 Nov SPRINT Trial: Greater Mean Blood Pressure Reductions Linked To Increased Risk of Kidney Function Decline
MedicalResearch.com Interview with: Rita Magriço MD Hospital Garcia de Orta Almada, Portugal MedicalResearch.com: What is the background for this study? What are the main findings? Response: The SPRINT trial showed that in non-diabetic patients with high cardiovascular risk, intensive systolic blood pressure treatment (<120 mmHg) was associated with lower rates of major cardiovascular events and mortality. However, intensive treatment was unexpectedly associated with increased kidney function decline. We thought that lowering blood pressure could compromise kidney perfusion, evaluated by mean arterial pressure (MAP). If so, the magnitude of MAP reduction was expected to be associated with kidney function decline. We hypothesized that a greater difference between the baseline MAP and the lowest achieved MAP may be associated with a higher risk of kidney function decline. Our analysis supports this hypothesis. We discovered that MAP reduction >20 mmHg in patients with a target systolic BP <120 mmHg was associated with higher incidence of kidney function decline. The benefit-risk balance of intensive treatment seemed to be less favourable with greater MAP reduction. Prospective studies evaluating the effect of MAP reduction in addition to hypertension treatment target on kidney function decline and cardiovascular events are warranted.06 Nov Air Pollution Linked To Increased Mortality, Especially In Developing Cities
MedicalResearch.com Interview with:
Longjian Liu, M.D., Ph.D. MSc (LSHTM), FAHA
Associate Professor
Department of Epidemiology and Biostatistics
Dornsife School of Public Health, and
Adjunct Associate Professor,
College of Medicine
Drexel University
Nesbitt Hall-RM515, 3215 Market ST
Philadelphia PA, 19104
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This is an international collaborative project, supported by Drexel Office of International Programs, and Chinese Academy of Sciences.
The main findings are air pollution has posted a serious public health issue in China, specifically in urban cities.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Air pollution is an international issue, we must take action, specifically in developing counties with rapid urbanization, like China.
06 Nov Vasopressin-Inhibitor Tolvaptan Reduces Kidney Function Decline in Polycystic Kidney Disease
MedicalResearch.com Interview with:
Vicente E. Torres, M.D., Ph.D.
Director of the Mayo Clinic Translational Polycystic Kidney Disease (PKD) Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Experimental work pioneered by Dr. Jared Grantham showed that cyclic AMP, an intracellular signaling molecule, promotes the development and growth of cysts. Vasopressin, a hormone produced by the pituitary gland, stimulates the production of cyclic AMP in the collecting ducts, from which most cysts derive in autosomal dominant polycystic kidney disease (ADPKD). While this effect of vasopressin is necessary for the kidneys to concentrate and reduce the volume of urine, it promotes the development and growth of cysts in patients with ADPKD. Dr. Vincent Gattone realized that inhibiting the action of vasopressin could be protective in polycystic kidney disease. Work in our and other laboratories confirmed that suppression of vasopressin production, release or action reduces cyst burden, protects kidney function, and prolongs survival in rodent models of the disease.
This experimental work provided a strong rationale for clinical trials of tolvaptan, a vasopressin V2 receptor antagonist. Tolvaptan reduced the rate of kidney growth in the TEMPO 3:4 trial, in patients with early ADPKD. It also reduced the rate of decline in kidney function, measured by the estimated glomerular filtration rate (eGFR), from 10.1 to 6.8 mL/min/1.73 m2 over three years. The eGFR benefit was maintained during two additional years when all the patients were treated with tolvaptan in an open label extension of the TEMPO 3:4 trial (TEMPO 4:4). Safety laboratory tests performed every four months showed elevations of liver transaminases in blood in 4.4% of tolvaptan and 1% of placebo-treated patients. Three of 1,271 tolvaptan-treated patients during TEMPO 3:4 and TEMPO 4:4 had evidence of potentially serious drug-induced liver injury. These abnormalities occurred all within the first 18 months of exposure to tolvaptan.
Based on the TEMPO 3:4 results, tolvaptan was approved for the treatment of rapidly progressive ADPKD in Japan, Canada, European Union, Switzerland and South Korea. In the United States, the Food and Drug Administration requested additional data to further evaluate the efficacy and safety of this drug. The REPRISE trial was performed to determine the efficacy and safety of tolvaptan in patients with later stage ADPKD.
06 Nov Methadone As First Line Opioid in Cancer Pain Management
MedicalResearch.com Interview with: [caption id="attachment_37962" align="alignleft" width="104"]
Dr. Mercadante[/caption]
Sebastiano Mercadante, MD
Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit
La Maddalena Cancer Center
Department of Anesthesia, Intensive Care & Emergencies
University of Palermo
Palermo, Italy
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are many clinical experiences suggesting that methadone, when optimally used by skilled physicians, has invaluable properties in the management of cancer pain. Methadone used as first opioid may provide interesting advantages due to the low tendency to induce tolerance, while providing a clinical profile similar to that of other opioids. Moreover, methadone possesses other extra-opioid effects that can be of interest.
06 Nov Non-Medical Factors Affect Racial Disparities in Kidney Transplant Wait Lists
MedicalResearch.com Interview with: Yue-Harn Ng, MD University of New Mexico MedicalResearch.com: What is the background for this study? What are the main findings? Response: African Americans (AA) have a higher incidence of end-stage renal disease but lower rates of kidney transplantation (KT) compared to whites (WH). Disparities persist after adjusting for medical factors. We assessed the relationship of non-medical (eg. cultural, psychosocial, knowledge) factors with kidney transplantation wait-listing (WL) within the context of racial differences. In this longitudinal cohort study, we found that African American patients were less likely to be wait-listed compared to White patients. This difference was influenced by factors including age, comorbidities, socio-economic status, being on dialysis, having a living donor, transplant knowledge and social support.06 Nov Poor Functional Status Predicts Increased Mortality After Dialysis Initiation
MedicalResearch.com Interview with: [caption id="attachment_37895" align="alignleft" width="116"]
Dr. Shah[/caption]
Silvi Shah, MD, FACP, FASN|
Assistant Professor
Division of Nephrology
University of Cincinnati
Cincinnati, OH
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%.
Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes. In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.
06 Nov PPIs for Reflux Linked To Increased Risk of Chronic Kidney Disease
MedicalResearch.com Interview with: Charat Thongprayoon, MD Bassett Medical Center Cooperstown, NY 13326 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We conducted a meta-analysis including 5 observational studies with 536,902 patients to assess the risks of chronic kidney disease (CKD) and/or end-stage kidney disease (ESRD) in patients who are taking proton pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs). We found a statistically significant association between the use of PPI and 1.3-fold increased risk of CKD or ESRD development. Compared with H2Ras, the use of proton pump inhibitors was significantly associated with 1.3-fold higher risk for CKD development. Conversely, there was no significant association between the use of H2RAs and chronic kidney disease.05 Nov Anti-Fibrotic Drug May Block Cardiac Scarring That Leads To Heart Failure
MedicalResearch.com Interview with: [caption id="attachment_37907" align="alignleft" width="100"]
Dr. Péault[/caption]
Bruno Péault PhD
Professor and Chair, Vascular Regeneration
Center For Cardiovascular Science
MRC Centre for Regenerative Medicine
Scientific Director, BHF Laboratories
The University of Edinburgh and
Professor, David Geffen School of Medicine at UCLA
Orthopaedic Hospital Research Center
University of California at Los Angeles
Los Angeles, CA 90095-7358
MedicalResearch.com: What is the background for this study?
Response: Kidney, lung, liver, muscle, heart are among the many organs which can be severely affected by fibrosis, a natural scarring process whereby healthy tissues are replaced by a fibrous non-functional substitute. For instance, the billions of cardiac muscle cells that die after a heart infarct, consequently to blood supply interruption, are replaced by a fibrotic scar that cannot contract, reducing the capacity of the heart to pump blood, and leading often to heart failure. There is currently no efficient treatment of fibrotic scars, the basic cellular component of which is the myofibroblast, a cell of unremarkable appearance and unclear origin. The transforming growth factor β (TGFβ) molecule triggers fibrosis development after being activated, via the extra-cellular matrix, by αv integrins, which are adhesion molecules present at the surface of the target cells.
To gain further insight into the cells that drive fibrosis in the heart and skeletal muscle, and explore ways to control this deleterious process, mice were used in which cells expressing the β receptor for PDGF (platelet derived growth factor) have been genetically tagged with a green fluorescent protein, a system previously used by Prof. Neil Henderson to trace fibrosis in the diseased liver (cells naturally expressing PDGFRβ are, in their vast majority, perivascular cells surrounding small blood vessels, as well as some interstitial fibroblasts). Skeletal muscle was injured by a small incision or with a targeted injection of cardiotoxin, a snake venom compound that locally kills myofibers, while the heart was damaged by prolonged infusion of angiotensin II. In both settings, progression of fibrosis was followed over time and contribution of green fluorescent cells – i.e. those expressing PDGFRβ – was assessed.
04 Nov Elderly Frail Patients At Higher Risk Of Mortality After Dialysis Initiation
MedicalResearch.com Interview with: [caption id="attachment_37895" align="alignleft" width="116"] Dr. Shah[/caption]
Silvi Shah, MD, FACP, FASN
Assistant Professor, Division of Nephrology
University of Cincinnati
Cincinnati, OH
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes.
In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.
04 Nov Acute Care Hospitalizations Prior To Initiation of Dialysis Signal Greater Mortality Risk
MedicalResearch.com Interview with: Charuhas Thakar, MD Professor Director of the Division of Nephrology Kidney CARE program University of Cincinnati MedicalResearch.com: What is the background for this study? What are the main findings? Response: Based on the plausibility that pre-dialysis health status can impact outcomes after initiation of chronic dialysis, we examined large national USRDS dataset with linked Medicare claims prior to dialysis. We found that 88% of patients who initiate dialysis experience at least one acute care hospitalization in two years preceding their dialysis start. If they do, that is associated with a significant increase in the risk of mortality at one year. We also examined effect of different types of hospitalizations in the pre-dialysis period – Cardiovascular, Infections, both, and neither of the two. There were statistical differences in the effect of type of hospitalization and post dialysis mortality.04 Nov Chronic Inflammation in Midlife May Predispose To Smaller Brain Volumes and Memory Ability In Seniors
Posted at 01:46h
in Alzheimer's - Dementia, Author Interviews, Johns Hopkins, Memory, Mental Health Research
MedicalResearch.com Interview with:
Keenan A. Walker, PhD
Johns Hopkins University School of Medicine
Baltimore, MD
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is quite a bit of evidence linking immune function with dementia. For example, several of the risk genes for Alzheimer’s disease are known to play a key role in immune functioning and the regulation of inflammation. We conducted the current study to determine whether systemic inflammation earlier in life might be a risk factor for neurodegeneration decades later. This long temporal window allows us to get closer to understanding causality. That is, which comes first – systemic inflammation or brain volume loss.
Using a large community sample, we found that individuals with higher levels of blood inflammatory markers during midlife tended to have smaller brain volumes in select regions and reduced memory ability as older adults. We found the strongest associations between systemic inflammation and brain volume loss in brain regions most vulnerable Alzheimer’s disease.
04 Nov Chronic Insomnia Associated With Higher Risk of End Stage Kidney Disease and Mortality
MedicalResearch.com Interview with: Dr. Jun Ling (Lucy) Lu, MD, CCRP Senior Clinical Research Coordinator in the Department of Medicine Csaba P Kovesdy MD FASN Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Memphis TN, 38163 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Around one third of the world’s population suffers from insomnia. Previous studies showed that sleep disorders affect the hypothalamic–pituitary–adrenal axis and the sympatho-adrenal system, which may cause abnormalities in several organ systems and pathways causing metabolic or cardiovascular abnormalities. However, there is inadequate evidence of an association between chronic insomnia and adverse renal outcomes. After examining 938,473 US veterans (4.4% of them had chronic insomnia) with baseline estimated eGFR >60 ml/min/1.73m2, we found that chronic insomnia is associated with a 43% higher risk of all-cause mortality, a 2.5-fold higher incidence of eGFR ≤45ml/min/1.73m2, a 2.3-fold higher ESRD risk, and with rapid loss of kidney function.04 Nov Coffee – Caffeine Linked To Decreased All-Cause Mortality in Kidney Disease Patients
MedicalResearch.com Interview with:
MedicalResearch.com Interview with:
Miguel Bigotte Vieira, MD
Centro Hospitalar Lisboa Norte
Lisboa, Portugal
Response: An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the association between caffeine consumption and mortality in patients with chronic kidney disease (CKD) remains unclear. We examined the association between varying levels of caffeine consumption and mortality among 2328 patients with CKD in a prospective nationwide cohort, using the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2010.
A dose-dependent inverse association between caffeine and all-cause mortality was observed in patients with CKD. This association was independent of influential factors including age, gender, race, annual family income, education level, estimated GFR, albumin/creatinine ratio, hypertension, smoking status, dyslipidemia, body mass index, previous cardiovascular events and diet: consumption of alcohol, carbohydrates, polyunsaturated fatty acids and fibers.
Comparing with 1st quartile of caffeine consumption, adjusted HR for death was 0.88 (95% CI, 0.68-1.44) for 2nd quartile, 0.78 (95% CI, 0.60-1.01) for 3rd quartile and 0.76 (95% CI, 0.59-0.97) for 4th quartile (p=0.027 for trend across quartiles)
04 Nov Post-Menopausal Hormones Mitigates Effects of Stress on Cortisol and Working Memory
MedicalResearch.com Interview with: [caption id="attachment_37876" align="alignleft" width="112"]
Dr. Herrera[/caption]
Alexandra Ycaza Herrera, Ph.D.
Postdoctoral Scholar
Leonard Davis School of Gerontology
Department of Psychology
University of Southern California
Los Angeles, Ca 90089
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previous research has shown that estradiol treatment after menopause can reduce the stress response when exposed to a stressor, including the cortisol response to stress. Other work has shown that stress can impair certain types of memory. We wanted to test whether post-menopause estradiol treatment would not only attenuate the cortisol response to stress, but if it could also reduce the negative effects of stress on memory. In particular, we tested the effects on a type of memory called working memory. Working memory allows us to maintain and update information we need to readily access in short-term memory. For example, imagine you stop at the grocery store after work and only have a mental list of the items you need to make dinner. Working memory is the memory type engaged in helping you maintain and update your mental list of items as you grab items off the shelves and check them off your list.
We recruited women through the Early versus Late Intervention Trial with Estradiol, a randomized, double-blinded, placebo-controlled clinical trial. Women who participated in our study had received nearly 5 years of either estradiol or placebo.
We found that women receiving estradiol showed significantly smaller cortisol responses to stress and less of an effect of stress on working memory than women that had been receiving placebo.
03 Nov Atopic Dermatitis Modestly Raises Risk of 5-Year All Cause Mortality
MedicalResearch.com Interview with: [caption id="attachment_36560" align="alignleft" width="133"]
Dr. Egeberg[/caption]
Alexander Egeberg, MD PhD
Gentofte Hospital
Department of Dermatology and Allergy
Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In recent years, a number of studies have examined associations between atopic dermatitis and various comorbidities. However, although comorbidities are extensively being examined, cause-specific mortality in patients with atopic dermatitis has not been examined. We examined 8,686 adults with atopic dermatitis, and compared these with 86,860 age- and sex-matched individuals from the general population.
In total, patients with atopic dermatitis had a 27% higher relative risk of all-cause mortality over a five-year period. Specific causes of death were due to infectious-, cardiovascular-, and urogenital diseases, respectively.
03 Nov Teaching Hospitals See Largest Number of Homeless Emergency Room Patients
MedicalResearch.com Interview with: [caption id="attachment_37860" align="alignleft" width="150"]
Dr. Sun[/caption]
Ruirui Sun, Ph.D.
AHRQ
MedicalResearch.com: What is the background for this study?
Response: Homeless people are more likely than the members of the general public to use emergency department (ED) services, and it is usually at teaching hospitals when they seek medical care (Kushel et al., 2001; Bowdler and Barrell, 1987). This Healthcare Cost and Utilization Project (HCUP) Statistical Brief studies patient characteristics, insurance coverage and clinical profile of the ED visits among homeless individuals by hospital teaching status, during 2014 from eight States (AZ, FL, GA, MA, MD, MO, NY, and WI).
03 Nov Marijuana Use Linked To Cognitive Impairment In HIV Patients
MedicalResearch.com Interview with: [caption id="attachment_37849" align="alignleft" width="107"]
Dr. Saitz[/caption]
Richard Saitz, MD, MPH, FACP, DFASAM
Department of Community Health Sciences
Boston University School of Public Health
Clinical Addiction Research and Education (CARE) Unit
Section of General Internal Medicine, Department of Medicin
Boston University School of Medicine and Boston Medical Center
Boston , Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many people living with HIV infection use alcohol and other drugs including marijuana. People with HIV infection are also susceptible to cognitive dysfunction from many causes from HIV infection itself to aging.
The main findings were that among people with HIV and substance use disorder, lifetime marijuana and alcohol use were not associated with cognitive dysfunction, likely due to competing risks. But current marijuana use was associated with cognitive dysfunction.
03 Nov Half Of People Who Died of Opioid Overdoses Tested Positive For Fentanyl
MedicalResearch.com Interview with:
Julie K. O’Donnell, PhD
Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
CDC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The opioid overdose epidemic has killed over 300,000 Americans from 1999 to 2015—including 33,091 in 2015. Over this time, the epidemic has evolved from being primarily driven by prescription opioids to increasingly being driven by illicit opioids. The first wave of the epidemic began in 1999 with a steep increase in deaths involving prescription opioids, such as hydrocodone, oxycodone, and morphine. The second wave began in 2010 with rapid increases in overdose deaths involving heroin. The third wave of the epidemic began in 2013, with significant increases in overdose deaths involving synthetic opioids—particularly those involving illicitly-manufactured fentanyl (IMF), which are commonly laced into heroin products. Most recently, the IMF market continues to evolve, with an ever-widening array of illicitly manufactured fentanyl analogs being distributed.
This report indicates that over half of people in 10 states who died of opioid overdoses tested positive for fentanyl during the second half of 2016. The report found that out of a total of 5,152 opioid overdose deaths, almost 3,000 tested positive for fentanyl, and over 700 tested positive for drugs that have similar chemical structures to fentanyl (fentanyl analogs) – including the extremely potent fentanyl analog, carfentanil, which is used to sedate large animals.