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MINNEAPOLIS - A study of high school and college football players suggests that biomarkers in the blood may have potential use in identifying which players are more likely to need a longer recovery time after concussion, according to a study published in the July 3, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"With so many people sustaining concussions and a sizeable number of them having prolonged symptoms and recovery, any tools we can develop to help determine who would be at greater risk of problems would be very beneficial, so these results are a crucial first step," said study author Timothy B. Meier, PhD, of the Medical College of Wisconsin in Milwaukee and a member of the American Academy of Neurology.

The study involved 41 high school and college football players who experienced a concussion during the season. None of the players lost consciousness with their concussions. The players were matched with 43 football players of the same level, age and position who did not have a concussion during that season.

All of the participants had blood tests at the beginning of the season. Those who had concussions had blood tests within six hours after the injury, then again 24 to 48 hours later and also eight, 15 and 45 days later. Those who did not have concussions had tests at similar times for comparison.

The tests looked at levels of seven biomarkers for inflammation that have been related to more severe brain injury. Of the seven biomarkers, two were elevated for those with concussion at six hours after the injury compared to the athletes with no concussion. The biomarkers interleukin 6 and interleukin 1 receptor antagonist were both elevated at six hours after concussion.

For interleukin 6, levels at the beginning of the study were 0.44 picograms per milliliter (pg/mL) for those who later had concussions and 0.40 pg/mL for those who did not have concussions. At six hours after the injury, those with concussions had levels of 1.01 pg/mL, compared to levels of 0.39 at a similar time for those without concussions.

"These results demonstrate a meaningful increase in the levels of interleukin 6 for athletes who sustained a concussion compared to athletes who did not," said Meier.

Athletes with higher levels of interleukin 6 six hours after the injury were also more likely to take longer to recover from their symptoms. Overall, the athletes with concussions had symptoms for an average of 8.9 days. Eight of the 17 athletes with concussion and high interleukin 6 levels at six hours after injury, compared to their levels at the beginning of the season, still had concussion symptoms eight days after the injury.

"Eventually, these results may help us better understand the relationship between injury and inflammation and potentially lead to new treatments," Meier said.

A new review of evidence from the UK has found high levels of alcohol dependence among hospital inpatients. The researchers estimate one in five patients in the UK hospital system uses alcohol harmfully, and one in ten is alcohol dependent.

Currently little is being done to screen routinely for alcohol dependence in hospitals, and services for patients with alcohol dependence are limited. The researchers call for universal screening in hospitals for alcohol-related problems and improved training for hospital staff around alcohol-related conditions.

This new systematic review and meta-analysis, published in the scientific journal Addiction, provides the first robust estimates of alcohol-related conditions among UK hospital inpatients by pooling the results of 124 earlier studies covering a total of 1,657,614 participants.

The prevalence of alcohol-related conditions was already thought to be higher in hospital inpatients compared with the general population, but until now we have not had reliable estimates of the true overall prevalence of these conditions in the inpatient population. The review suggests harmful alcohol use is ten times higher in hospital inpatients, and alcohol dependence is eight times higher, compared with the UK general population.

The review also found that harmful use of alcohol is most prevalent in mental health inpatient units and alcohol dependence is found most commonly in patients attending accident and emergency departments.

Alcohol-related conditions are estimated to cost the National Health Service (NHS) approximately 3.5 billion pounds per year. Alcohol can cause a large number of medical conditions and without in-hospital screening many alcohol-related conditions may be missed and not receive appropriate treatment. Accurate prevalence estimates are vital to inform policy makers of the scale of the problem and are particularly timely given the UK government's development of a new alcohol strategy and the NHS 10-year plan, which includes funding allocations to combat alcohol-related conditions.

Lead researcher Dr Emmert Roberts, from the Institute of Psychiatry, Psychology & Neuroscience at King's College London, says: "Many doctors are aware that alcohol-related conditions are common among hospital inpatients, but our results suggest the problem is much bigger than anecdotally assumed. Dedicated inpatient alcohol care teams are needed to ensure this widespread problem is being addressed, particularly in the context of diminishing numbers of specialist community alcohol services in the UK."

Bottom Line: Data for 154,089 older men diagnosed with prostate cancer were used to analyze the association between androgen deprivation therapy, a hormone-suppressing therapy used to treat prostate cancer, and subsequent diagnosis of Alzheimer disease or dementia. Of the men, 62,330 (average age 76) received androgen deprivation therapy within two years of being diagnosed with prostate cancer and 91,759 men (average age 74) didn't have such treatment. Researchers report androgen deprivation therapy was associated with a higher likelihood of being diagnosed with Alzheimer disease or dementia compared with no androgen deprivation therapy over an average follow-up of eight years. The study has limitations to consider, including that the patients were Medicare enrollees and not enrolled in a health maintenance organization.

Authors: Ravishankar Jayadevappa, Ph.D., University of Pennsylvania, Philadelphia, and coauthors

(doi:10.1001/jamanetworkopen.2019.6562)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

An analysis of samples obtained from a well-studied cohort of over 1,000 patients affected by type 1 diabetes (T1D) for 50 years or longer has identified a protein that protects against an eye condition called diabetic retinopathy (DR) - one of the most common consequences of diabetes - which impacts most diabetic patients after 20 years of living with the disease. Injecting the protein into rodents blocked DR without causing severe side effects, suggesting that preserving or administering the protein could help avoid debilitating eye damage in diabetic patients. Many patients with long-term diabetes develop eye disorders such as DR, which has become a leading cause of vision loss in developed countries. Interestingly, 35% of these patients never develop severe DR even after decades of being diabetic, suggesting they may harbor protective factors against such complications. To solve this mystery, Hishashi Yokomizo and colleagues turned to the Medalist cohort, a unique group of patients affected by T1D for at least 50 years. They compared protein profiles in the retina or vitreous fluid from a total of 43 deceased Medalist patients with either severe or no-to-mild DR, 21 non-Medalist patients with diabetes, and 13 non-diabetic controls. The authors discovered that the patients who were protected from advanced DR had higher levels of RBP3, a protein secreted by light-sensing cells in the eyes. Injecting RBP3 into the eyes of mice protected the animals against induced DR, and analysis showed that the protein inhibited the harmful effects of the growth factor VEGF and curtailed the secretion of inflammatory molecules in retinal cells. Future work should aim to replicate these results in people with short-term T1D or type 2 diabetes, the authors say.

Gestational hypertension -- high blood pressure during pregnancy -- can have persisting adverse effects on the health of mothers and their infants. In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released clinical guidelines for hypertension in non-pregnant adults, which lowered the blood pressure threshold to diagnose hypertension, compared to previously established ones. However, the new ACC/AHA guidelines have not been adapted or applied to pregnant women. Researchers at Brigham and Women's Hospital and colleagues conducted the first-ever study to evaluate the impact these guidelines could have on detecting gestational hypertension. The results of the retrospective cohort study were published today in the journal Circulation Research.

"Timely, accurate diagnosis of gestational hypertension is crucial for preventing associated conditions for pregnant women like preeclampsia and postpartum chronic hypertension," said Jie Hu, MD, PhD, a postdoctoral researcher in the Division of Women's Health in the Department of Medicine at Brigham and Women's Hospital and the study's first author. "Infants born to women with gestational hypertension are more susceptible to preterm birth and adverse long-term health outcomes like young adulthood cardiovascular diseases."

Hu and the international collaborative team used systolic and diastolic blood pressure measurements obtained from the medical records of 16,345 women from a maternal and child health care hospital in Wuhan, China. Blood pressure measurements were recorded by obstetricians during prenatal care visits across various stages of pregnancy.

Using the 2017 ACC/AHA guidelines, the investigators identified 4,100 women (25.1 percent) with hypertension. In contrast, only 678 (4.2 percent) of the women were found to have hypertension using the previous guidelines, indicating a substantial increase in the prevalence of gestational hypertension compared to the previous definition.

The investigators acknowledge that the findings will need to be replicated in more ethnically, racially and socioeconomically diverse populations, as well as in other nations aside from China. Future studies are necessary to determine whether more frequent diagnoses of hypertension lead to improved neonatal outcomes for mothers and infants.

According to the researchers, current management strategies for gestational hypertension include continued observation and careful follow-up of blood pressure. Medication is only used in severe cases.

"Incorporating the 2017 ACC/AHA guidelines into prenatal care practice could improve detection of high blood pressure during pregnancy and the efforts to reduce adverse maternal and neonatal outcomes in the perinatal period that are related to gestational hypertension," said Hu.

A review of published studies found that estimates for the global prevalence of erectile dysfunction vary widely, ranging from 3% to 76.5%. The findings are published in BJU International.

The variation may reflect differences in study population ages and different definitions and assessment methods of erectile dysfunction.

Erectile dysfunction was linked with increased risks of cardiovascular disease, dementia, and early death.

The authors noted that early detection of erectile dysfunction may help improve quality of life in affected men, and also indicate when interventions may be warranted to prevent cardiovascular disease and early death. "Due to the sensitive nature of the topic, physicians should consider screening for erectile dysfunction in at-risk patients, as information may not be volunteered," they wrote.

Medications that target tumor necrosis factor alpha (TNFα), a protein involved in inflammation, have revolutionized the management of certain autoimmune diseases, but paradoxically, these agents might provoke the development of other autoimmune conditions.

In an Alimentary Pharmacology & Therapeutics study of 17,018 individuals with autoimmune diseases who were treated with anti-TNFα medications--mostly infliximab, etanercept, and adalimumab--and 63,308 individuals who were not, treatment with etanercept, but not other anti?TNFα agents, was linked with an elevated risk of developing inflammatory bowel disease: a twofold increased risk of Crohn's disease and a twofold increased risk of ulcerative colitis.

"This study established that there is an increased risk of developing inflammatory bowel disease in individuals taking etanercept. Recognition of this phenomenon is important for clinicians taking care of these patients," said lead author Joshua Korzenik, MD, of Brigham and Women's Hospital, in Boston. "Perhaps more importantly, this study suggests that inflammatory bowel disease may be one of the auto-immune diseases that can be provoked by anti-TNFα agents. This suggests that there may be a common mechanism of immune dysregulation underpinning these diseases."

In a Psycho-Oncology study of patients newly diagnosed with lymphoma or multiple myeloma, one-third of participants reported depressive symptoms around the time of diagnosis, and depressive symptoms were linked with shorter survival. Shorter survival was observed in both patients who remained depressed and patients who recovered from depressive symptoms.

The study included 255 patients, of whom 83 had depression. Over a median follow-up of approximately 3.5 years, 61 patients died. These included 30 patients in the "never depression" group, 6 patients in the "new-onset" group, 16 patients in the "remission" group, and 9 patients in the "persistent" group. These groups were based on depressive symptoms assessed before starting cancer treatment and one month later.

The risk of death was 3-times and 2-times higher in the "remission" and "persistent" groups, respectively, than in the "never depression" group; however, risk of death was not significantly greater in the "new-onset" group compared with the "never depression" group.

A treadmill exercise regime can reduce period pain and improve long-term quality of life, according to a new study published in the journal Contemporary Clinical Trials.

Researchers conducted a trial over a seven-month period to see how treadmill exercise benefited women suffering from primary dysmenorrhea, commonly known as period pain.

Women aged between 18 and 43 were asked to take part in a supervised aerobic training regime three times a week for four weeks, beginning the day after the end of their menstrual period, followed by unsupervised home exercise for six months. Their results were compared with a control group, who carried out their usual regimes.

The study found that the women who took part in the supervised exercise reported 6% less pain after four weeks and 22% less pain with continuing the exercise for an additional six months. Significant benefits of exercise were reported after the seven-month reporting period for other study measures, including higher quality of life and improved daily functioning. However, the participants did not report any increase in sleep quality following the trial.

The study is the first of its kind to examine the effect of treadmill exercise on measures such as pain intensity, sleep quality and overall quality of life.

Dr Leica Claydon-Mueller, Senior Lecturer at Anglia Ruskin University (ARU), said: "Women who have painful periods often take steps to actively avoid exercise - after all when you are in pain it is often the last thing that you want to partake in.

"However, this trial demonstrated that exercise significantly reduced pain for those people taking part in the programme, and they also reported reduced pain levels after four and seven months."

Dr Priya Kannan, of Hong Kong Polytechnic University, added: "The improvements in quality of life scores after seven months were noteworthy, although it was perhaps surprising that there was no significant difference in sleep quality to that of the control group.

"These multiple benefits might be considered a 'package deal' by women. The evidence supporting the use of aerobic exercise for managing pain, improving quality of life and improving daily functioning has been strengthened by the findings from this research."

A Journal of the American Heart Association analysis of information from a large health insurance database reveals that people living with HIV have an elevated risk of developing cardiovascular disease (CVD), particularly heart failure and stroke. The findings indicate that increased efforts to protect patients' cardiovascular health are needed.

For the study, researchers analyzed information on 19,798 people living with HIV and 59,302 age- and sex-matched uninfected individuals who were followed for an average of 20 months. People living with HIV had 3.2-times and 2.7-times higher risks of heart failure and stroke, respectively.

The association of HIV infection with CVD was especially strong for persons younger than 50 years of age and those without a prior history of CVD. People living with HIV did not have an increased risk of peripheral artery disease and only moderately increased risk of heart attack or atrial fibrillation.

"Our findings reinforce the importance of primary prevention of cardiovascular disease through control of risk factors such as high blood pressure or smoking in persons living with HIV," said lead author Alvaro Alonso, MD, PhD, of Emory University, in Atlanta.

An adequate consumption of milk and dairy products at different life stages can help prevent various chronic diseases. For example, there is a positive link between the moderate intake of milk during pregnancy and birth weight, length, and bone mineral content during childhood. In addition, a daily intake of milk and dairy products among elderly people may reduce the risk of frailty and sarcopenia.

These are just some of the conclusions of a systematic review of 14 articles dealing with the role of milk and dairy products in the prevention of chronic diseases. The findings of the review were recently published in Advances in Nutrition, the third most important scientific journal in the world in the field of Nutrition and Dietetics.

The review was conducted by scientists from different Spanish, European, and American universities, and coordinated by Professor Angel Gil of the University of Granada (UGR) and Professor Rosa M. Ortega of the Complutense University of Madrid. The work was funded via the European Union project H-2020 No. 734451 and supported thanks to the collaboration of Spain's Interprofessional Dairy Organisation (INLAC).

The study reviews worldwide scientific literature on the role of dairy products in health and in the prevention of chronic diseases (cardiovascular, metabolic syndrome, colon or bladder cancer, and type 2 diabetes). It also examines the effects of dairy products on growth, bone mineral density, generation of muscle mass, and during pregnancy or breastfeeding.
Milk and dairy products contain multiple nutrients and contribute to meeting the nutritional requirement for protein, calcium, magnesium, phosphorus, potassium, zinc, selenium, vitamin A, riboflavin, vitamin B12, and pantothenic acid. Yet the consumption of dairy products is on the decline, falling short of the level recommended in many countries, as the potential benefits of milk and dairy products are starting to be questioned.

This review, coordinated by the UGR, aims to evaluate and synthesise the scientific evidence on the effect of milk and dairy product consumption in terms of health and
prevention of various chronic diseases and all-cause mortality, bearing in mind the importance of maintaining an adequate quality of diet in the different stages of the life cycle. The evidence gathered in the study is based on the findings of meta-analyses and systematic reviews of observational studies, randomized controlled trials, and reviews.

Dairy products and chronic diseases

This review synthesizes the current scientific evidence pertaining to various topics of great interest to the scientific community. All refer to articles dealing with systematic review and/or meta-analysis, based on different types of study design. The topics studied in depth include:

Effect of milk and dairy product consumption during pregnancy and breastfeeding.

Effect of dairy product consumption on the height and bone mineral density of children.

Consumption of milk and dairy products and risk of mortality.

Effect of milk and dairy product consumption on the risk of frailty and sarcopenia, and cognitive performance in older people.

Effect of milk and dairy product consumption in the prevention of osteoporosis and osteoporotic fractures.

Consumption of dairy products in the prevention of metabolic syndrome.

Effect of milk and dairy product consumption on type 2 diabetes.

Effect of milk and dairy product consumption on cardiovascular diseases.

Association between dairy product consumption and the risk of colorectal cancer in adults.

Consumption of milk and dairy products and the risk of prostate cancer and mortality.

Consumption of milk and dairy products and the risk of bladder cancer.

Consumption of milk and dairy products and inflammatory biomarkers.

The role of fortified dairy products in cardio-metabolic health.

The researchers also found that a higher intake of dairy products presents no clear association with a decrease in total osteoporotic fracture or hip fracture risk, but there is an association with decreased vertebral fracture risk.

In the analysis of the differences between high vs. low consumption of dairy products, no association was identified between dairy product consumption and increased risk of mortality. The total intake of low-fat dairy products was associated with a reduced risk of metabolic syndrome, supporting the view that the consumption of dairy products does not increase the risk of cardiovascular disease and could have a slightly protective effect.

Inverse associations were observed between dairy product consumption and ischemic heart disease and myocardial infarction. Current scientific evidence also suggests that
the consumption of such products, especially low-fat dairy and yoghurt, may be associated with a lower risk of type 2 diabetes.

It has also been shown that moderate consumption of this food group is associated with a lower risk of colorectal cancer and bladder cancer, while no associations were found for prostate cancer. Nor has the intake of milk or dairy products been shown to demonstrate a proinflammatory effect on overweight or obese individuals, or on those presenting other metabolic abnormalities.

Fortification of dairy products with phytosterols and omega-3 fatty acids appears to constitute a suitable strategy for improving cardiometabolic risk biomarkers.

Pre-eclampsia is a potentially dangerous condition characterized by high blood pressure that arises in some pregnant women, but a review of published studies indicates that its effects on cardiovascular health can persist well after pregnancy.

The Australasian Journal of Ultrasound in Medicine analysis included 13 studies that measured cardiac function by transthoracic echocardiography between 6 months and 18 years following a pregnancy complicated by pre-eclampsia.

Studies are needed to determine whether long-term cardiovascular screening might benefit women with a history of pre-eclampsia.

"Pre-eclampsia is a real-life 'stress test' and the use of transthoracic echocardiography could help us detect early consequences on the heart before women experience symptoms," said co-author Archana Selvakumar Thayaparan, MbChb, of Western Health, in Australia.

Cancer has overtaken cardiovascular disease as the most common cause of death in Scottish adults with type 2 diabetes, according to a study published in the Journal of Diabetes Investigation.

Investigators examined the causes of death of people with type 2 diabetes in Ayrshire and Arran, Scotland between 2009 and 2014 and compared them with national mortality rates. The most common cause of death was cancer (27.8%) followed by heart disease (24.1%).

The study's results confirmed an increased risk of early death in individuals with type 2 diabetes compared with the general population, and they suggested that where cardiovascular risk factors are being treated aggressively, cancer takes on a greater importance in the cause of death.

Although there are effective treatments for gout, the most common form of inflammatory arthritis, a new Arthritis Care & Research study found that opioids are commonly prescribed to patients with gout who seek treatment at emergency departments.

In the study of 456 patients with acute gout discharged from emergency departments in Rhode Island, more than 28% received an opioid prescription. Of these, more than one-quarter of patients received 14 days or more of opioid prescriptions, longer than the natural course of a typical gout attack. Diabetes, gout attacks affecting multiple joints, and opioid use prior to admission were associated with an increased likelihood of receiving opioid prescriptions.

"We have a number of medications that can treat acute gout effectively, almost completely eliminating the need to use opioids. The fact that 28% of patients are being treated with opioids, and many longer than 2 weeks, is alarming and provides an opportunity to reduce the burden of prescription opioids," said co-lead author Deepan Dalal, MD, MPH, of Brown University Warren Alpert School of Medicine, in Providence.

Smoking is killing at least 17 Australians a day from preventable heart attacks, strokes and other cardiovascular conditions, new research led by The Australian National University (ANU) has found.

The study, the most in-depth in the world, shows for the first time how smoking harms all of the cardiovascular system - the heart and major blood vessels.

Lead researcher, Professor Emily Banks from the ANU National Centre for Epidemiology and Population Health, said the study examined the impact of smoking for every possible cardiovascular disease.

"That includes investigating the risk of heart attack, stroke, heart failure, heart muscle disease, rhythm problems, and gangrene in Australians from every walk of life: men, women, city, country, rich, poor," Professor Banks said.

"We found there is nowhere to run, nowhere to hide. Smoking causes terrible harm across the board.

"Our study shows that a population almost twice the size of Port Douglas is being wiped out in Australia each year - with smoking causing more than 6,400 cardiovascular deaths, including from heart attack and stroke."

CEO of the Heart Foundation John Kelly said: "This new evidence is disturbing. It demonstrates that our battle to eliminate the devastation tobacco brings to people's lives is far from over.

"We urge the Government to maintain tobacco control as a high priority and look forward to seeing it feature strongly in the new Prevention Strategy recently announced by the Minister for Health."

The research team tracked around 190,000 Australian smokers and non-smokers participating in the Sax Institute's 45 and Up Study for 36 different types of cardiovascular disease over seven years.

The study found smoking also causes 11,400 coronary heart hospitalisations a year - 31 per day.

"There are around 2.7 million smokers in Australia today," said Professor Banks.

"Those smokers have around triple the risk of dying from cardiovascular disease compared to people who have never smoked, and double the risk of a heart attack, a stroke or heart failure. They are also five times more likely to develop peripheral cardiovascular diseases like gangrene.

"If a smoker has a heart attack or a stroke, it is more likely than not that it was caused by smoking."

In what Professor Banks describes as "extremely alarming", the research also found a doubling in the risk of death from cardiovascular disease among those smoking an average of five cigarettes a day.

"A lot of people underestimate the risks of light smoking," said Professor Banks.

In good news, the research shows quitting smoking markedly reduces your risk of heart attacks, stroke and dying from cardiovascular disease compared with continuing to smoke.

"This study really reinforces how important it is to prioritise quitting," said Dr Sarah White, Director of Quit Victoria.

"Quitting at any age provides a whole host of health and other benefits and quitting by age 45 avoids about 90 per cent of the cardiovascular risks of smoking.

"And if you are a light or social smoker who thinks 'just a few' won't hurt, this study really shows you're kidding yourself that it's not doing damage.

"No matter how much you smoke or how long you have smoked, the best time to stop is right now. Call the Quitline, or talk to your GP or other health professional for advice."

The research is published in the international journal BMC Medicine and was undertaken in partnership with the Heart Foundation and Sax Institute.

Dr Martin McNamara, Deputy CEO of the Sax Institute and Chief Investigator on the 45 and Up Study, said: "The 45 and Up Study is the biggest long-term health study in Australia, and one of the biggest in the world - and these results make clear how the study can help us uncover new findings with important implications for health care services."