Saturday, April 21, 2018

Journal Watch April 2018

Noninvasive Brain Stimulation May Help Prevent Migraines: Single-pulse transcranial magnetic stimulation device is safe and easy to use. The efficacy and tolerability of single pulse transcranial magnetic stimulation (sTMS) for the preventive treatment of migraine among 263 individuals with migraine (December 2014 to March 2016) was studied. Participants completed a one-month baseline headache diary followed by three months of treatment, including preventive (four pulses twice daily) and acute (three pulses repeated up to three times for each attack) treatment. The researchers observed a mean reduction of 2.75 headache days from baseline versus the performance goal (0.63 fewer headache days; P < 0.0001). Similarly, the 50 percent responder rate of 46 percent also significantly exceeded (P < 0.0001) the performance goal (20 percent). Compared to the performance goal, there were also significant reductions in acute medication use (P < 0.0001) and total headache days of any intensity (P < 0.0001). There were no serious adverse events reported, but there were reports of lightheartedness (3.7 percent), tingling (3.2 percent), and tinnitus (3.2 percent). Cephalalgia. 

Erenumbab Shows Promise for Hard to Treat Migraine: For patients with episodic migraine who have failed prior preventive migraine treatments (PMTs), erenumab is associated with an increase in the proportion of patients achieving a ≥50 percent reduction in mean monthly migraine days (MMDs), according to a study presented at the annual meeting of the American Academy of Neurology

Study finds 31% Don’t use Opioids After Surgery: Almost 63 percent of patients did not use opioids after having an elective procedure, according to a study presented at the annual meeting of the American Surgical Association 

Opiate Use Linked to Early Mortality in IBD Patients: Heavy use in Crohn's, heavy or moderate use in ulcerative colitis tied to increased risk of death. Clinical Gastroenterology and Hepatology 

Ibuprofen, acetaminophen more effective thanopioids in treating dental pain: Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain than opioids, according to new research that included 460 published studies. JOADA

Medical marijuana gets wary welcome from older adults, poll shows: Few older adults use medical marijuana, a new national poll finds, but the majority support its use if a doctor recommends it, and might talk to their own doctor about it if they developed a serious health condition. And two-thirds say the government should do more to study the drug's health effects. Science Daily 

Position statement: Avoid using medical marijuana to treat sleep apnea: Medical cannabis and synthetic marijuana extracts should not be used for the treatment of obstructive sleep apnea, according to a position statement from the American Academy of Sleep Medicine.

 School-based yoga can help children better manage stress and anxiety: Participating in yoga and mindfulness activities at school helps third-graders exhibiting anxiety improve their well-being and emotional health, according to a new study. Psychology Research and Behavior Management 

Practicing Tai Chi helps improve respiratory function in patients with COPD: Currently, pulmonary rehabilitation (PR) is used where available to improve exercise capacity and quality of life, but the treatment requires access to trained staff and specialized facilities. A new study looked at Tai Chi as a lower cost, more easily accessed treatment option. Investigators found that this slow, methodical form of exercise is equivalent to PR for improving respiratory function in patients with COPD. Chest  

Mind and Body Approaches for Substance Use Disorders from the National Center for Complementary and Integrative Health: Mindfulness-based approaches have shown some success when applied to the treatment of substance abuse and addiction. To date, there is not enough consistent data to support the use of acupuncture for substance use outcomes; however, there are some findings that suggest acupuncture may have positive effects as an adjunctive therapy for withdrawal/craving and anxiety symptoms. Only a few high-quality studies on acupuncture for smoking cessation have been conducted, so firm conclusions about its effectiveness cannot be drawn.

Small link for cannabis use, reduced cognitive functioning: For adolescents and young adults, frequent or heavy cannabis use has a small association with reduced cognitive functioning, according to research published online April 18 in JAMA Psychiatry.

• Approves the first medical device to use artificial intelligence to detect greater than a mild level of diabetic retinopathy in adults who have diabetes.
• Authorizes new use of test, first to identify the emerging pathogen Candida auris
• Approves first therapy for rare inherited form of rickets, x-linked hypophosphatemia
• Takes steps to protect consumers against dietary supplements containing dangerously high levels of extremely concentrated or pure caffeine
• Clears first contact lens with light adaptive technology
• Restricts sale and distribution of Essure
• Expands approval of Bilincyto for treatment of a type of leukemia in patients who have a certain risk factor for relapse
• Authorizes first fully interoperable continuous glucose monitoring system
• Expands approval of Adcetris for first line treatment of Stage III or IV classical Hodgkin lymphoma in combination with chemotherapy

Music intensifies effects of anti-hypertensive medication: Research shows anti-hypertensive drugs improve heart rate more in patients who listen to music after taking medication. Among musical genres, classical music is the one with greatest efficiency at reducing arterial pressure; authors of the study speculate whether music acts on the patients' parasympathetic system, increasing their capability of absorbing medication. Scientific Reports 

Lingering negative responses to stress linked with health a decade later: People whose negative emotional responses to stress carry over to the following day are more likely to report health problems and physical limitations later in life compared with peers who are able to 'let it go.'  Psychological Science

Number of Cigarettes Smoked Daily Tied to Stroke Risk: Among men younger than 50, more cigarettes smoked linked to increased risk of ischemic stroke. Stroke 

Exercise Prevents Falls in Elderly: The U.S. Preventive Services Task Force (USPSTF) concludes that exercise interventions may be beneficial for preventing falls in older adults; however, the evidence is insufficient to weigh the benefits and harms of vitamin D, calcium, and combined supplementation. These findings form the basis of two recommendation statements published April 17 in the Journal of the American Medical Association.

Exercise Best Defense for those at Genetic Risk for CVD: Fitness and physical activity are tied to lower risk of incident cardiovascular disease in the general population and among individuals with elevated genetic risk for cardiovascular diseases, according to a study published online April 9 in Circulation.

TBI Associated with Increased Risk of Subsequent Dementia: Traumatic brain injury (TBI) is associated with increased risk of dementia, according to a study published online April 10 in The Lancet Psychiatry.

Dietary supplement shows promise for reversing cardiovascular aging:A novel nutraceutical called nicotinomide riboside (NR_ has been found to kick-start the same biological pathways as calorie restriction does, and boost arterial health in people with mild hypertension. Supplementation also tends to improve blood pressure and arterial health, particularly in those with mild hypertension, the study found. The researchers found that 1,000 mg daily of NR boosted levels of another compound called nicotinamide adenine dinucleotide (NAD+) by 60 percent. NAD+ is required for activation of enzymes called sirtuins, which are largely credited with the beneficial effects of calorie restriction. It's involved in a host of metabolic actions throughout the body, but it tends to decline with age.Nature Communications

n-3 Fatty Acids Don't Seem to Be of Any Benefit in Dry Eye Disease: Supplementation with n-3 fatty acids is not associated with significant benefit in dry eye disease, according to a study published online April 13 in the New England Journal of Medicine

Consuming more than five drinks a week could shorten your life: Even moderate alcohol drinking linked to heart and circulatory diseases, study finds. drinking more alcohol is associated with a higher risk of stroke, fatal aneurysm, heart failure and death. The study compared the health and drinking habits of over 600,000 people in 19 countries worldwide and controlled for age, smoking, history of diabetes, level of education and occupation. Findings challenge the widely held belief that moderate drinking is beneficial to cardiovascular health, and support the UK's recently lowered guidelines. The Lancet

Links between eating red meat and distal colon cancer in women: A new study suggests that a diet free from red meat significantly reduces the risk of a type of colon cancer in women living in the United Kingdom. When comparing the effects of certain diets to cancer development in specific subsites of the colon, scientists found that those regularly eating red meat compared to a red meat-free diet had higher rates of distal colon cancer -- cancer found on the descending section of the colon, where feces is stored.  International Journal of Cancer 

People with Type 2 diabetes who eat breakfast later, more likely to have a higher BMI: Being an "evening person" is linked to higher body mass indices among people with Type 2 diabetes, and having breakfast later in the day seems to be what drives this association, according to a new article. Science Daily

High omega-6 levels can protect against premature death: Could omega-6 fatty acids protect you against premature death? The answer is yes, according to a new study. While protecting against death, omega-6 fatty acids also keep cardiovascular diseases at bay. “Linoleic acid is the most common polyunsaturated omega-6 fatty acid. We discovered that the higher the blood linoleic acid level, the smaller the risk of premature death,” says one of the researchers. The American Journal of Clinical Nutrition

Raw fruit and vegetables provide better mental health outcomes: Researchers have discovered raw fruit and vegetables may be better for your mental health than cooked, canned and processed fruit and vegetables. Frontiers in Psychology

Nut Consumption Associated with Reduced Risk of A-Fib: Nut consumption is associated with reduced risk of atrial fibrillation, according to a study published online April 16 in Heart.

Eating Pecans May Cut Risk of Cardiovascular Disease, Diabetes: Benefits seen in markers of cardiometabolic disease, including insulin sensitivity Nutrients 

Coffee Consumption Cuts Coronary Artery Calcification: Odds of coronary calcification significantly lower for never smokers drinking more than 3 cups/day. Journal of the American Heart Association

Antiepileptic Drugs Increase Risk ofAlzheimer’s Disease, Dementia: The use of antiepileptic drugs is associated with an increased risk of Alzheimer’s disease and dementia, according to a study published in the Journal of the American Geriatrics Society. Continuous use of antiepileptic drugs for a period exceeding 1 year was associated with a 15% increased risk of Alzheimer’s disease and with a 30% increased risk of dementia.

Blue-Light Therapy May Reduce Anxiety, Sleep Difficulties After Mild Traumatic Brain Injury: Morning use of blue-light therapy may increase cortical volume and help reduce trait anxiety and sleep difficulties in people with mild traumatic brain injury, according to preliminary findings of a prospective study presented at the 38th Annual Meeting of the Anxiety and Depression Association of America (ADAA).

Pembrolizumab is associated with significantly longer recurrence-free survival than placebo as adjuvant therapy for high-risk stage III melanoma, according to a study published online April 15 in the New England Journal of Medicine.

Fecal microbiota transplantation produces sustained improvements in cognitive and clinical outcomes: A single treatment using an optimized, targeted form of fecal microbiota transplantation (FMT) produces sustained clinical and cognitive improvements, according to the results of a long-term follow-up of patients with liver cirrhosis and hepatic encephalopathy (HE) who had participated in a short-term study. The original, randomized, open label study, which enrolled 20 outpatient men with cirrhosis and recurrent HE receiving standard-of-care (SOC) treatment, had previously reported that a single FMT enema after antibiotic pretreatment improved cognitive function at Day 20 and reduced HE episodes and hospitalizations over the following 5 months compared with SOC.1 The long-term outcomes of this study, which were presented today at The International Liver Congress™ 2018 in Paris, France, demonstrated sustained and statistically significant reductions in the number of HE episodes and hospitalizations as well as improvements in cognitive function over 1 year in the men who received FMT compared with the control group.

Neuromodulation Therapy Gives Relief FromHand Tremor: Non-invasive neuromodulation therapy using a custom stimulation pattern provides symptomatic relief from hand tremor in essential tremor, according to a study presented at the annual meeting of the American Academy of Neurology

Triple Therapy Tied to Reduced Rate of COPD Exacerbations: Benefits seen for triple therapy with fluticasone furoate, umeclidinium, and vilanterol. NEJM 

Calcium Channel Blockers May up Cancer Risk in Women: Use of short-acting calcium channel blockers (CCBs) is associated with increased risk of pancreatic cancer in postmenopausal women, according to a study presented at the annual meeting of the American Association for Cancer Research.

Physicians devise emergency and trauma care referral map for US: In response to repeated calls for an integrated emergency care system in the US, physicians rose to the challenge and divided the nation into hundreds of referral regions that describe how patients access advanced care, in a way that respects geopolitical borders. Annals of Emergency Medicine 

Three-Quarters of COPD Cases Are Linked to Childhood Risk Factors That Are Exacerbated in Adulthood: Three-quarters of chronic obstructive pulmonary disease (COPD) cases have their origins in poor lung function pathways beginning in childhood. These pathways are associated with exposures in childhood, and amplified by factors in adulthood, according to a study published in The Lancet Respiratory Medicine. While smoking remains the biggest risk factor for COPD, the study demonstrates that childhood illnesses (such as asthma, bronchitis, pneumonia, allergic rhinitis, eczema) and exposures to parental smoking are also linked to the disease. A second study in the journal also suggests that there could be a window of opportunity during childhood to reduce the risk of poor lung function in later life. Both studies identified pathways of how lung function changes over life, which are associated with different risk factors and disease risk in later life. The authors said that these insights are important for lung disease prediction, prevention, and treatment. 

Most Doctors' Offices Don't Offer Flexibility for Uninsured:Most uninsured patients can make primary care appointment but only if can pay full cash amount. Health Affairs 

Age affects how we predict and respond to stress at home: A recent study finds that older adults are better than younger adults at anticipating stressful events at home -- but older adults are not as good at using those predictions to reduce the adverse impacts of the stress. The Journals of Gerontology

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