Wearable Device Study Confirms Moderate-to-Vigorous Physical Activity Linked To Decreased Mortality

MedicalResearch.com Interview with:

I-Min Lee, MD, ScD Professor of Medicine, Harvard Medical School Professor of Epidemiology, Harvard T.H. Chan School of Public Health Brigham and Women's Hospital Boston, MA 02215

Dr. Lee

I-Min Lee, MD, ScD
Professor of Medicine, Harvard Medical School
Professor of Epidemiology, Harvard T.H. Chan School of Public Health
Brigham and Women’s Hospital
Boston, MA 02215

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The fact that physical activity lowers the risk of premature mortality is not a new fact – we have many studies showing this.  However, previous studies have primarily relied on self-reported physical activity, and self-reports tend to be imprecise.  Based on these self-report studies, we know that physical activity is associated with a 20-30% reduction in mortality rates.  And, these self-report studies also have focused on moderate-to-vigorous intensity physical activity, since they are more reliably reported than lighter intensity activity.  We have little information on whether light-intensity activities (e.g., light household chores, very slow walking such as when strolling and window shopping) are associated with lower mortality rates.

We now have “wearables” – devices that can more precisely measure physical activity at low (as well as higher) intensities, and sedentary behavior.  The present study, conducted between 2011 and 2015, investigated a large cohort of older women (n=16,741; mean age, 72 years)  who were asked to wear these devices for a week – thus, providing detailed physical activity and sedentary behavior measures.  During an average follow-up of about two-and-a-half years, 207 women died.  The study confirmed that physical activity is related to lower mortality rates.

What is new and important is how strong this association is when we have more precise measures of physical activity – the most active women had a 60-70% reduction in mortality rates, compared with the least active, during the study.  For context, non-smokers have about a 50% risk reduction, compared to smokers, which is why patients (and doctors) should pay attention to being physically active.

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Anti-TNF Agents In Inflammatory Bowel Disease Linked to Small Increased Risk of Lymphoma

MedicalResearch.com Interview with:
ANSM
Rosemary Dray-Spira, MD, PhD
Department of Epidemiology
French National Agency for Medicines and Health Products Safety (ANSM)
Saint-Denis, France

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Anti-tumor necrosis factor (anti-TNF) agents are increasingly used for the management of inflammatory bowel diseases (IBD), either alone or in combination with thiopurines. Their clinical benefits have been largely assessed, however they may expose to potentially serious adverse effects. While an increased risk of lymphoma has been established with thiopurines, up to now such a risk of lymphoma remained uncertain with anti-TNF agents.

In this study based upon a large, nationwide cohort of 189,289 patients with IBD, the use of anti-TNF agents alone was found associated with a 2 to 3 fold increase in the risk of lymphoma, similarly to thiopurines alone. In addition, the combination of these two treatments was associated with a 6 fold increase in the risk of lymphoma, ie a higher risk than with each treatment used alone. Although these differences are statistically significant, the risk of lymphoma among patients exposed to anti-TNF agents is less than 1 case per 1000 person-years.

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Labels of Majority of Online Cannabidiol Extracts Contain Inaccuracies

MedicalResearch.com Interview with:

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Marijuana plant (Cannabis sativa)

Marcel Bonn-Miller, PhD
Adjunct assistant professor
Department of Psychiatry
Leader of the Substance Abuse and Anxiety Program
U.S. Veterans Affairs Department 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A 2015 study found that edible cannabis products (e.g., brownies, cookies, drinks) are often mislabeled.  The FDA has also sent warning letters to a handful of companies selling cannabidiol extracts because of inaccurate labeling of content. This led us to conduct a systematic evaluation of the label accuracy of all cannabidiol extracts sold online.  We tested 84 products from 31 different companies.

The primary take-home of this study is that nearly 70 percent of all cannabidiol extracts sold online had over 10% more or less cannabidiol than advertised; 26% of products were over-labeled (less cannabidiol than indicated) and 42% of products were under-labeled (more cannabidiol than indicated).

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Nearly Half of Adolescents Had At Least One Sunburn In Past Year

MedicalResearch.com Interview with:
“Dymchurch Beach - May 2012 - Sunburn with Matching Bikini” by Gareth Williams is licensed under CC BY 2.0
Dawn M. Holman, MPH
Behavioral Scientist
Division of Cancer Prevention and Control
Centers for Disease Control and Prevention

MedicalResearch.com: What is the background for this study?

Response: Scientific evidence clearly shows that even one sunburn during adolescence can increase a person’s chances of developing skin cancer as an adult. Surprisingly, little research has been done to understand the factors associated with sunburn during this phase of life. The CDC wanted to examine beliefs, behaviors, and demographic characteristics that might be associated with adolescent sunburns in hopes that the findings could inform future intervention efforts. We used data from the 2015 YouthStyles survey (adolescents aged 12 to 17 years) to explore this research question

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Kidney Failure From Diabetes Decreasing Across US

MedicalResearch.com Interview with:
Nilka Ríos Burrows, MPH, MT (ASCP)
Lead, Chronic Kidney Disease Initiative
CDC Division of Diabetes Translation. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Kidney failure treated with dialysis or a kidney transplant is called end-stage renal disease (ESRD).  ESRD is a costly and disabling condition often resulting in premature death.

During 2000–2014, kidney failure from diabetes among U.S. adults with diabetes decreased by 33%, and it declined significantly in most states, the District of Columbia, and Puerto Rico. No state experienced an increase in kidney failure from diabetes. Continued awareness and interventions to reduce risk factors for kidney failure, improve diabetes care, and prevent type 2 diabetes might sustain these positive trends.

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African Americans Do Worse After Joint Replacements, But Only In Disadvantaged Neighborhoods

MedicalResearch.com Interview with:

Susan M. Goodman, MD Director of the Integrative Rheumatology and Orthopedics Center of Excellence Hospital for Special Surgery

Dr. Goodman

Susan M. Goodman, MD
Director of the Integrative Rheumatology and Orthopedics Center of Excellence
Hospital for Special Surgery 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have previously reported that African Americans who have poorer health outcomes, may be disproportionately impacted by community factors. For African Americans undergoing knee replacement, no difference in pain and function was seen compared to whites in communities with little poverty, while in poor communities, African Americans had poorer outcomes. We wondered if this was generally true or if this only applied to knee replacements.

We found similar results; African Americans in richer neighborhoods have comparable outcomes to whites, but as poverty increases- in this study measured as percent with Medicaid coverage- outcomes worsen in a step wise fashion.

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Novel PDE4 Inhibitor Improves Symptoms of Autism Disorder Fragile X Syndrome in Animal Model

MedicalResearch.com Interview with:

Dr. Mark E. Gurney, PhD MBA

Dr. Gurney

Dr. Mark E. Gurney, PhD MBA
Chairman & CEO, Tetra Discovery Partners Inc.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Fragile X is a genetic condition. Affected patients display a range of behavioral and other symptoms, including seizures, sleep disorders, anxiety, irritability, hyperactivity, autism, mild-to-severe cognitive impairment and intellectual disability.

BPN14770 is a novel therapeutic agent that selectively inhibits phosphodiesterase-4D (PDE4D). Inhibition of PDE4 has been validated as a treatment strategy by many research groups in the Fragile X field, but non-selective PDE4 inhibitors have been associated with significant GI side-effects that have limited those drugs’ use. As a selective inhibitor, such side-effects were not seen for BPN14770 in a Phase 1 clinical trial in healthy young and elderly adults.

In the current study, daily treatment of Fragile X knock-out (FXS) mice with BPN14770 showed a reduction in hyperarousal, improved social interactions and natural behaviors, and changes in nerve structure in the prefrontal cortex of the brain, the portion of that brain associated with cognition. Moreover, the drug’s benefit persisted for two weeks after all drug was cleared from the mice. At the same time, the behavior of normal mice treated with the drug remained unchanged. Examination of neurons from the prefrontal cortex of the treated FXS mice showed an improvement in dendritic spine morphology.

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FDA Advisory Committee Recommended Approval of First Gene Therapy For Inherited Eye Disease

MedicalResearch.com Interview with:
Dr. Stephen M. Rose, PhD Chief Research Officer Foundation Fighting BlindnessDr. Stephen M. Rose, PhD
Chief Research Officer
Foundation Fighting Blindness

Dr. Rose discusses the FDA advisory panel unanimously recommended approval of Spark Therapeutics’ Gene Therapy Luxturna  for the treatment of patients with vision loss due to confirmed biallelic RPE65-mediated inherited retinal dystrophies, a group of rare blinding conditions caused by one of more than 220 different genes.

MedicalResearch.com: Would you tell us a little about IRD? Whom does it affect and how?  How common is this disorder?

Response: The retina at the back of the eye is responsible for collecting light and turning it into signals that are transmitted to the brain and interpreted as vision. Think of the retina as the film in a camera, or more recently the sensor at the back of a digital camera. Inherited rare retinal degenerations are when the retina at the back of the eye deteriorates and loses its ability to capture light, thereby leading to blindness.

iRDs can affect anyone, no matter race or ethnicity. These are inherited conditions that are passed down from parents to children, if a parent or both parents are either affected already or are carriers for a variant in any of the over 250 genes responsible for retinal degeneration.

There are over 15 different types of iRDs, with retinitis pigmentosa being the most common with a US affected population around 100,000. The rest of the iRDs make up another approximately 100,000 affected individuals in the US, so there are about 200,000 total affected individuals in the US. Worldwide these iRDs affect somewhere around one to two million individuals.

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Medical Tetrahydrocannabinol May Be Beneficial For Seizures and Chemotherapy Side Effects

MedicalResearch.com Interview with:

Dr. Wong

Dr. Wong

Shane Shucheng Wong, MD
Massachusetts General Hospital
Boston, Massachusetts 

MedicalResearch.com: What is the background for this study?

Response: Medical cannabis is now legal in 29 states and the District of Columbia, and in those areas with active programs, children and adolescents can legally access medical cannabis with certification from their doctor and consent from a parent. This means that doctors and families need to understand what we know and what we don’t yet know about medical cannabis in order to make the best decision for the health of the individual child. Two synthetic cannabinoids – compounds that act on specific receptors in the brain – have been approved for medical use in the U.S., both of which mimic a form of THC (tetrahydrocannabinol), the compound responsible for the “high” of recreational cannabis use. Dronabinol (Marinol) is approved to treat chemotherapy-induced nausea and vomiting in both children and adults, while the pediatric use of nabilone (Cesamet) carries a caution. A third cannabinoid, cannabidiol, is currently in phase 3 trials for treatment of seizures.

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Men and Women Have Different Perspectives on Infidelity

MedicalResearch.com Interview with:
Mons Bendixen and Leif Edward Ottesen Kennai
r 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Using infidelity scenarios, we aimed to study coupled women and men’s willingness to forgive their partner’s infidelity and their beliefs about being forgiven when cheating on their partner.

The study therefore reproduces the core findings from an earlier study by Friesen, Fletcher & Overall (2005) that looked at cognitive biases in forgiveness following actual transgressions in couples (some severe, others minor).

The theoretical framework for our study is Error Management Theory (EMT), developed by the evolutionary psychologists Martie Haselton & David Buss. EMT makes specific predictions regarding beliefs about being forgiven for own transgressions. Transgressors will underperceive signals of forgiveness, they tend not to believe they are forgiven despite signals of forgiveness from their partner (e.g., “don’t worry about it” and “I forgive you”).

MedicalResearch.com: This sound a little odd, how can misperception be evolutionary adaptive?

Response: The evolved function of this biased belief is, according to EMT, to guide the organism toward reparative behavior securing that the transgressions are fully mended. Lack of biased beliefs may be a potential threat to the relationship, because reparative behaviors signal remorse, empathy, and willingness to commit. Lack of reparative behaviors increase the risk of the relationship ending up on the rocks.

MedicalResearch.com: Why did you consider forgiveness of infidelity?

Response: We studied reactions to anticipated infidelity. Infidelity represents one of strongest threat to any intimate relationship. Infidelity may be primarily sexual: having a sexual affair, or primarily emotional, being deeply and emotionally involved with somebody else.

We know that women and men differ in their responses to sexual and emotional infidelity. Across studies using a variety of methods and samples, compared to women, men seem to be less upset by imagining their partner falling in love with someone than imagining their partner having sex with someone. Typically, men become more jealousy of sexual infidelity, women of emotional infidelity. This sex difference origins from the “mother’s baby – father’s maybe” dilemma, and the sex difference in minimum parental investment. We have previously published several papers on jealousy.

MedicalResearch.com: Who were the participants?

Response: We invited students and their partners to take part in a study on infidelity and forgiveness. 92 couples participated. At arrival, they were guided to separate rooms to fill in the questionnaires. After completion, each participant returned the questionnaires in a sealed envelope, and the couple received debriefing and two cinema tickets.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We found a robust negative forgiveness bias following one’s own imagined infidelity for both male and female transgressors. Relative to the likelihood of being forgiven, transgressors reported that they believed less that their partner would forgive their cheating.

We found diminished negative forgiveness bias for emotionally unfaithful men, but not for sexually unfaithful women. Emotionally unfaithful men evinced less bias in the analyses of their partner’s expressed forgiveness. Relative to women, men not only seem to be more willing to forgive emotional infidelity by their partner, they also tend to believe more that their emotional infidelity will be forgiven – put more simply: Men underestimate the distress women experience in emotional infidelity, and are maybe a little naïve about the threat their partners emotional infidelity poses.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: What is most striking with our results is how men do not quite understand how serious women perceive and deem emotional infidelity to be; while men cannot be described as naïve about this aspect of their relationship, they certainly are not as concerned with emotional infidelity as women are.

Even though both men and women perceive both emotional and sexual infidelity as relationship threats, they have very different appreciations of the severity of especially emotional infidelity. This is true for both own and partner’s transgressions. This may potentially be a source of misunderstanding, conflict and miscommunication in couples, and maybe a topic that couple counselors need to address.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Rather than studying imagined infidelity, future research may study couples seeking counseling or therapy following actual infidelity, including questions on beliefs of being forgiven, reparative behaviors, signals of forgiveness, and internal (non-communicated) forgiveness.

 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Forgiving the Unforgivable: Couples’ Forgiveness and Expected Forgiveness of Emotional and Sexual Infidelity From an Error Management Theory Perspective.

Bendixen, Mons,Kennair, Leif Edward Ottesen,Grøntvedt, Trond Viggo

Evolutionary Behavioral Sciences, Sep 28 , 2017, No Pagination Specified

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

Exercise, Vision Testing and Osteoporosis Evaluation Are Keys To Fall Prevention

MedicalResearch.com Interview with:

Andrea C. Tricco PhD, MSc Scientist and Lead of the Knowledge Synthesis Team Associate Professor Dalla Lana School of Public Health, University of Toronto Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews

Dr. Tricco

Andrea C. Tricco PhD, MSc
Scientist and Lead of the Knowledge Synthesis Team
Associate Professor Dalla Lana School of Public Health, University of Toronto
Associate Editor Journal of Clinical Epidemiology, BMC Medical Research Methodology, Systematic Reviews

MedicalResearch.com: What is the background for this study?

Response: Falls are the leading cause of injury among older adults and account for $2 billion in direct health-care costs annually ($31 billion in costs to Medicare in the United States in 2012). We aimed to determine which types of fall-prevention programs may be effective for reducing falls in older people.

MedicalResearch.com: What are the main findings?

Response: Exercise, along with vision assessment and treatment, as well as an assessment and possible modification of a person’s living environment, reduced the risk of injurious falls by 23% compared to usual care.

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Risk of Gastric Cancer Increased With Long-Term Proton Pump Inhibitors

MedicalResearch.com Interview with:
Dr. Wai Keung Leung
Professor, Division of Gastroenterology & Hepatology
Department of Medicine
Assistant Dean, LKS Faculty of Medicine
University of Hong Kong
Hong Kong

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It remains controversial whether proton pump inhibitors will increase the risk of gastric cancer. Although previous studies have shown a possible increase in risk in patients taking long-term proton pump inhibitors (PPI), these studies are confounded by the presence of H. pylori infection. In this population-based study from Hong Kong, we have determined the risk of gastric cancer development in more than 63,000 H. pylori-infected subjects who had the bacterium eradicated by a course of  clarithromycin-based triple therapy and continued to take PPI or H2-receptor antagonist (H2RA).

After adjusting for various baseline differences among those PPI and non-PPI users, we found that the risk of gastric cancer was increased by 2.4-fold in those who used long-term PPI. The risk was in tandem with the frequency and duration of PPIs treatment. The risk increased from 5-fold to 8-fold for more than 1-year and 3-year use of PPI, respectively. Similar increase in risk was not observed among those who took H2RA, a weaker acid suppressive agent.

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Chronic Valvular Heart Disease Linked To White Matter Brain Changes

MedicalResearch.com Interview with:
Dr. Keun-Hwa Jung MD PhD

Program in Neuroscience, Neuroscience Research Institute of SNUMRC
College of Medicine
Seoul National University
First author: Dr. Woo-Jin Lee MD
Department of Neurology
Seoul National University Hospital
Seoul, South Korea 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cerebral white matter hyperintensity is a prevalent consequence of brain aging process and associated with various complications. One of the main mechanisms underlying the progression of white matter hyperintensity is chronic dysfunction of the glymphatic system which maintains metabolic homeostasis in brain. Glymphatic system is the route where the cerebrospinal fluid enters into the brain parenchyma and is cleared out with soluble wastes to the perivascular space of the cerebral small veins, peri-meningeal lymphatic vessels, deep cervical lymph nodes, and finally to the right atrium.

Although the integrity of the glymphatic system is dependent on the adequate drainage of cerebral veins and lymphatics to the downstream chamber, the right atrium, the impact of hemodynamic changes in right-sided cardiac chambers on the development of white matter hyperintensity have not been elucidated.

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Single Injection of Klotho Gene Protected Animals From Cognitive Decline

MedicalResearch.com Interview with:

Dr Miguel Chillon PhD Department of Biochemistry and Molecular Biology Universitat Autonoma Barcelona Spain

Dr. Chillon

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.

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Trained Volunteers Can Deliver Effective Brief Smoking Cessation Advice

MedicalResearch.com Interview with:
“Stop smoking!” by Emil_95 is licensed under CC BY 2.0
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.

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Failure of Dental Fillings Is At Least Partially Genetically Determined

MedicalResearch.com Interview with:
“Dental Mold_002” by Ano Lobb is licensed under CC BY 2.0
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.

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Dual Antiplatelet Therapy Found Beneficial Over Aspirin Alone Following CABG Surgery

MedicalResearch.com Interview with:

Nayan Agarwal MD Intervention Cardiology Fellow, University of Florida, Gainesville, FL

Dr. Agarwal

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).

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Decorative Drinking Glasses Can Contain Harmful Levels of Metals

MedicalResearch.com Interview with:
Themed Merchandised products affectedDr 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.

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Bariatric Surgery Associated With Reduced Risk of Obesity-Related Cancers

MedicalResearch.com Interview with:

Daniel P. Schauer, MD, MSc Associate Professor, Internal Medicine University of Cincinnati College of Medicine Division of General Internal Medicine Cincinnati OH 45267-0535

Dr. Schauer

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.

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Hormones Affect Carotid Plaque Stability and Stroke Vulnerability

MedicalResearch.com Interview with:

Marija Glisic Epidemiology, Erasmus MC

Marija Glisic

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.

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Irritable Bowel Syndrome with Constipation Patients Frustrated With Limited Treatment Options

MedicalResearch.com Interview with:

Eamonn M.M. Quigley, M.D. Director, Lynda K. and David M. Underwood Center for Digestive Disorders Houston Methodist Hospital

Dr. Quigley

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.

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Most Adolescents Not Receiving Important Health Care Preventive Services

MedicalResearch.com Interview with:

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

Dr. Adams

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.

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Severity of Firearm Injuries Escalates Over Ten Years

MedicalResearch.com Interview with:

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

Yi Zuo

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.
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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).

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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.

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Air Pollution Linked To Increased Mortality, Especially In Developing Cities

MedicalResearch.com Interview with:
“air pollution, beijing” by 大杨 is licensed under CC BY 2.0Longjian 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.  

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Vasopressin-Inhibitor Tolvaptan Reduces Kidney Function Decline in Polycystic Kidney Disease

MedicalResearch.com Interview with:
Dr. TorresVicente 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.

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Methadone As First Line Opioid in Cancer Pain Management

MedicalResearch.com Interview with:

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

Dr. Mercadante

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.

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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.

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Poor Functional Status Predicts Increased Mortality After Dialysis Initiation

MedicalResearch.com Interview with:

Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH

Dr. Shah

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.

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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.

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Anti-Fibrotic Drug May Block Cardiac Scarring That Leads To Heart Failure

MedicalResearch.com Interview with:

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

Dr. Péault

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.

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Elderly Frail Patients At Higher Risk Of Mortality After Dialysis Initiation

MedicalResearch.com Interview with:

Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH

Dr. Shah

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.

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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.

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Chronic Inflammation in Midlife May Predispose To Smaller Brain Volumes and Memory Ability In Seniors

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.

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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.

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Coffee – Caffeine Linked To Decreased All-Cause Mortality in Kidney Disease Patients

MedicalResearch.com Interview with:
Coffee Wikipedia imageMedicalResearch.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)

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Post-Menopausal Hormones Mitigates Effects of Stress on Cortisol and Working Memory

MedicalResearch.com Interview with:

Alexandra Ycaza Herrera, Ph.D. Postdoctoral Scholar Leonard Davis School of Gerontology Department of Psychology University of Southern California Los Angeles, Ca 90089

Dr. Herrera

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.

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Atopic Dermatitis Modestly Raises Risk of 5-Year All Cause Mortality

MedicalResearch.com Interview with:

Alexander Egeberg, MD PhD Gentofte Hospital Department of Dermatology and Allergy Kildegårdsvej 28 2900 Hellerup Denmark 

Dr. Egeberg

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.

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Teaching Hospitals See Largest Number of Homeless Emergency Room Patients

MedicalResearch.com Interview with:

Ruirui Sun, Ph.D. AHRQ

Dr. Sun

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).

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Marijuana Use Linked To Cognitive Impairment In HIV Patients

MedicalResearch.com Interview with:

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

Dr. Saitz

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.

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Half Of People Who Died of Opioid Overdoses Tested Positive For Fentanyl

MedicalResearch.com Interview with:
“no drugs” by Anderson Mancini is licensed under CC BY 2.0
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.

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With Aging, Males and Females Express Genes Differently

MedicalResearch.com Interview with:
Dr Mandy Peffers BSc MPhil PhD BVetMed FRCVS
Wellcome Trust Clinical Intermediate Fellow
Institute of Ageing & Chronic Disease
Faculty of Health & Life Sciences
University of Liverpool Liverpool UK

MedicalResearch.com: What is the background for this study?

Response: The project was an extension of Louise Pease’s MSc research project in bioinformatics which aimed to re-analyse existing RNA-seq data to determine age related changes in gene expression in musculoskeletal tissues that may lead to the development of degenerative diseases.  From existing literature we identified that degenerative diseases such as osteoarthritis and tendinitis were more prevalent in females and became more frequent following menopause.  We looked at the biology of the cohort we were trying to assess and discovered a gender imbalance, we hypothesised that this was why few results had been obtained from the original analysis. So we developed a research proposal that detailed extending the existing data to publicly available data and merging the experiments; to increase the number of replicates available and balance the experimental design.  We conducted multiple analyses and discovered that splitting samples by age and gender obtained the most significant results, and that whilst in a lot of cases the same genes were being differentially expressed, they were changing in opposite directions.  Louise remembered her statistics lecturer Gerard Cowburn (Ged) taught her about the assumptions of statistical tests, in particular covariance analysis (which has previously been used to show that age and gender do not affect gene expression) assumed that under the conditions being tested data points were not opposites.  Realising that this assumption had been violated by the data she began to think about what other assumptions we were working with and how to test their validity.

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Caffeine Linked To Decrease in All-Cause Mortality in Chronic Kidney Disease Patients

MedicalResearch.com Interview with:

Miguel Bigotte Vieira MD Centro Hospitalar Lisboa Norte Lisbon, Portugal

Dr. Bigotte Vieira

Miguel Bigotte Vieira MD
Centro Hospitalar Lisboa Norte
Lisbon, Portugal 

MedicalResearch.com: What is the background for this study? What are the main findings?

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)

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Study Finds ACE Inhibitors and Statins Can Be Safe In Type I Diabetes

MedicalResearch.com Interview with:
M. Loredana Marcovecchio, M.D.
Clinical Scientist and
Professor David Dunger M.D.
Director of Research
Professor of Paediatrics
University of Cambridge

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The efficacy and safety of ACE Inhibitors and statins in adolescents have been shown in the context of hypertension and familial hypercholesterolemia, respectively. However, there is a lack of data on the long-term use of these drugs in those with type 1 diabetes and, in particular, there is no clear indication for their use in patients with increased albumin excretion.

The Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT) was a multi-centre, international study, set up by investigators in the UK, Australia and Canada to explore if drugs already used to lower blood pressure (ACE inhibitors) and cholesterol levels (Statins) in adults with diabetes could reduce the risk of kidney, eye and cardiovascular disease in adolescents with Type 1 diabetes.

Neither ACE inhibitors nor statins significantly reduced the albumin-creatinine ratio during the 2-4 year trial period. However, some of the secondary outcomes suggest that the drugs may have important benefits.

Treatment with the ACE inhibitor resulted in a 43% reduction in the rates of progression to microalbuminuria, which was not statistically significant, but it could have important clinical implications. Preventing even intermittent cases of microalbuminuria is known to reduce the future risk of kidney and cardiovascular complications.

Statin therapy led to reduced levels of lipid levels, which could reduce long-term risk for cardiovascular complications.

These findings could translate into long-term benefits, but follow-up of this unique cohort will be essential. The essential biological samples and data provided by the participants will continue to inform our future understanding and our options for effective therapies for this vulnerable group of young people with type 1 diabetes.

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Defective Viral Genomes May Indicate Greater Flu Virus Severity

MedicalResearch.com Interview with:
Ana Falcón
Department of Molecular and Cellular Biology
National Center for Biotechnology
Spanish National Research Council (CNB-CSIC)
Madrid, Spain

MedicalResearch.com: What is the background for this study?

Response: Influenza A virus (IAV) infection can be severe or even lethal in toddlers, the elderly and patients with certain medical conditions. Infection of apparently healthy individuals nonetheless accounts for many severe disease cases and deaths, suggesting that viruses with increased pathogenicity co-circulate with pandemic or epidemic viruses.

IAV virulence and pathogenesis are dependent on complex, multigenic mechanisms involving the viral genetic characteristics, the host conditions, the virus-host interactions, and the host response to the infection. Influenza virus pathogenicity has been studied in depth for many years, and several amino acid changes have been identified as virulence determinants, however, a general pathogenicity determinant has not been characterized.

A proportion of influenza virus particles have defective genome RNAs (Defective Viral Genomes-DVGs) due to internal deletions of viral segments. The DVGs have the 3’ and 5’ ends of the parental RNA segments, and most have a single, large central deletion that generates viral RNAs of 180–1000 nucleotides. The presence of DVGs potentiates the host response in cultured cells and in animal models and leads to attenuated infection, possibly through recognition of double-stranded RNA by receptors that activate antiviral signaling cascades.

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Physician Extenders Can Modestly Reduce Wait Times For a Dermatology Appointment

MedicalResearch.com Interview with:

Eliot N. Mostow, MD, MPH Professor & Chair, Dermatology Section Department of Internal Mediciine Northeast Ohio Medical University

Dr. Mostow

Eliot N. Mostow, MD, MPH
Professor & Chair, Dermatology Section
Department of Internal Mediciine
Northeast Ohio Medical University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for the study is my continued interest in what is sometimes called health services research. That is, how do we improve our ability to deliver optimal medical care from a healthcare system perspective? Simply put, one of the most frequent criticisms about getting a dermatologist to see if patient is that there are delays in scheduling (wait times are too high). I’m not sure this is really justified, as it seems to take a long time to get into psychiatrists, gynecologists, and other specialists in our community as well.

That being said, since I’m in the dermatology community and our community has been utilizing physician assistants and nurse practitioners more frequently for many years now, we thought it was worthwhile to explore whether this was having an impact on wait times to get a visit in a dermatologist’s office.

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Chocolate Milk May Promote Weight Gain in Children and Adolescents

MedicalResearch.com Interview with:

Jorge E. Chavarro, M.D., Sc.D. Assistant Professor of Nutrition and Epidemiology Harvard T.H. Chan School of Public Health Assistant Professor of Medicine Harvard Medical School Boston, MA 02113

Dr. Chavarro

Jorge E. Chavarro, MD, ScD
Associate Professor
Departments of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Channing Division of Network Medicine
Department of Medicine
Brigham and Women’s Hospital and Harvard Medical School
Boston, MA 02115

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that sugared sweetened beverages (SSBs) promote excessive weight gain and obesity in children. The excess sugars in chocolate milk and other flavored milks puts them in a category that may be closer to sugared sweetened beverages than to plain milk. However, data on whether flavored milks promote weight gain is scarce.

We followed a cohort of 5,321 children and adolescents over a four year period to evaluate whether intake of chocolate milks was related to weight gain. We found that children who increased their intake of flavored milk gained more weight than children whose intake of flavored milk remained stable over this period. Moreover, among those children who did not drink any chocolate milk at baseline, those who started drinking chocolate milk over the course of the study gained substantially more weight than children who remained non-consumers of chocolate milk.

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Pesticide Residues On Fruits & Vegetables Associated With Increased Risk of Pregnancy Loss

MedicalResearch.com Interview with:

“Pesticide spraying” by jetsandzeppelins is licensed under CC BY 2.0

“Pesticide spraying” by jetsandzeppelins

Yu-Han Chiu, M.D., M.P.H., Sc.D
Department of Nutrition
Harvard T.H. Chan School of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Animal experiments suggest that ingestion of pesticide mixtures at environmentally relevant concentrations decreases the number of live-born pups. However, it is unclear whether intake of pesticide residues has any adverse effects in humans, especially for susceptible populations such as pregnant women and their fetuses. Therefore, in this study we examined the association of preconception intake of pesticide residues in fruits and vegetables with pregnancy outcomes among 325 women undergoing assisted reproduction.

We found that intake of high pesticide residue fruits and vegetables were associated with higher risks of pregnancy loss, while low pesticide residue fruit and vegetable intake was associated with lower risks of early pregnancy loss. These data suggest dietary pesticide exposure within the range of typical human exposure may be associated with adverse reproductive consequences

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Limiting Calories Changes Mitochondria, The Main Hub For Energy Metabolism

MedicalResearch.com Interview with:
Alicia J. Kowaltowski, MD, PhD

Professor of Biochemistry
Departamento de Bioquímica, IQ, Universidade de São Paulo
Cidade Universitária
São Paulo, SP, Brazil

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We recently found that brain mitochondria from calorically-restricted animals can take up more calcium than mitochondria from animals that eat ad libitum (or “all they can eat”; doi: 10.1111/acel.12527). Calcium is a well-know regulator of energy metabolism, as is caloric intake, but this was the first evidence that limiting caloric intake changed calcium handling by mitochondria, the main hub for energy metabolism. As a result, we decided to investigate if this result was specific for the brain or happened in other tissues, focusing on the liver because of its central importance in metabolic control.

We found that liver mitochondria from calorically-restricted mice take up substantially more calcium than ad libitum fed mice. We also found that this result is related to a change in the amount of ATP within the mitochondria; ATP can complex calcium ions effectively due to its negative charges. Finally, we were able to correlate the increase in calcium uptake by liver mitochondria to a very strong protection of caloric restriction livers against ischemia/reperfusion damage.

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