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News Article | November 14, 2016
Site: www.sciencedaily.com

Women over the age of 50 who follow a high-protein diet could be at higher risk for heart failure, especially if much of their protein comes from meat, according to preliminary research presented at the American Heart Association's Scientific Sessions 2016. Researchers evaluated the self-reported daily diets of 103,878 women between the ages of 50 and 79 years, from 1993 to 1998. A total of 1,711 women developed heart failure over the study period. The rate of heart failure for women with higher total dietary protein intake was significantly higher compared to the women who ate less protein daily or got more of their protein from vegetables. While women who ate higher amounts of vegetable protein appeared to have less heart failure, the association was not significant when adjusted for body mass. "Higher calibrated total dietary protein intake appears to be associated with substantially increased heart failure risk while vegetable protein intake appears to be protective, although additional studies are needed to further explore this potential association," said Mohamad Firas Barbour, M.D., study author and internist at the Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, in Pawtucket. The findings were true regardless of age, race or ethnicity, level of education, or if the women had high blood pressure (2.9 percent), diabetes (8.3 percent), coronary artery disease (7.1 percent), anemia (3.4 percent), or atrial fibrillation (4.9 percent). The subjects were all participants in the Women's Health Initiative, an ongoing, long-term national dietary survey investigating strategies for reducing heart disease, breast and colorectal cancer, and osteoporosis. Researchers said other studies have found a link between increased protein from meat and cardiovascular risk in women. "Our findings should be interpreted with caution, but it appears that following a high-protein diet may increase heart failure risk," Barbour said. Because dietary self-reporting can be unreliable, the team also used special biomarker data to accurately calibrate daily protein intake -- doubly labeled water and urinary nitrogen. Doubly labeled water uses non-radioactive tracers to evaluate a person's metabolic energy while urinary nitrogen is used to determine actual amounts of dietary protein. "We used self-reported intakes of total dietary protein, and the quantity of protein women obtained from meat and vegetables based upon the Food Frequency Questionnaire," Barbour said. The Food Frequency Questionnaire is the most common dietary assessment tool used in large epidemiologic studies of diet and health. A self-administered booklet asks participants to report the frequency of consumption and portion size of approximately 125 items over a defined period. "While a better understanding of dietary risk is still needed, it appears that heart failure among postmenopausal women is not only highly prevalent but preventable by modifying diet," Barbour said. "Heart failure is highly prevalent, especially in post-menopausal women; therefore, a better understanding of nutrition-related factors associated with heart failure is needed." The American Heart Association recommends that people eat a dietary pattern that emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts while limiting red meat and sugary foods and beverages. For people who eat meat, choose lean meats and poultry without skin and eat fish at least twice a week -- preferably fish high in omega-3 fatty acids such as salmon, trout, and herring.


News Article | November 16, 2016
Site: www.sciencedaily.com

Repeatedly losing and regaining weight, known as weight cycling or yo-yo dieting, may increase the risk of death from heart disease among postmenopausal women who were of normal weight at the start of the study, according to research presented at the American Heart Association's Scientific Sessions 2016. "Weight cycling is an emerging global health concern associated with attempts of weight loss, but there have been inconsistent results about the health hazards for those who experience weight cycling behavior," said Somwail Rasla, M.D., study lead author and internal medicine resident at Memorial Hospital of Rhode Island, Alpert Medical School, Brown University, in Providence, Rhode Island. Researchers classified self-reported weight history from 158,063 post-menopausal women into four categories: stable weight, steady gain, maintained weight loss, and weight cycling. During a follow-up of 11.4 years, they found: Evidence indicates that being overweight in midlife increases the risk of dying from two types of heart disease. In the first type, coronary heart disease, the blood vessels to the heart become blocked by fat and other substances, decreasing blood flow to the heart. In the second type, sudden cardiac death, the heart's electrical system abruptly stops working, causing death. It is unclear whether losing and regaining weight in adulthood also increases the risk of death from these heart diseases, so the investigators looked at this relationship among postmenopausal women. The study has several limitations. First, the study was observational, therefore it could only show association and not a cause and effect relationship. In addition, the study relied on self-reports, which could be inaccurate. Since sudden cardiac death occurred relatively infrequently, the cases that did occur could have resulted from chance. Finally, the study included only older women. "More research is needed before any recommendations can be made for clinical care regarding the risks of weight cycling, since these results apply only to postmenopausal women and not to younger-aged women or men," Rasla said. In the United States and worldwide, heart disease is the leading cause of death. Obesity is a major risk factor, along with high blood pressure and cholesterol, diabetes, physical inactivity, poor diet, and smoking. One way to lower your risk factors is by following the American Heart Association's Life's Simple 7 program, which recommends: (1) manage blood pressure; (2) control cholesterol; (3) reduce blood sugar; (4) get active; (5) eat better; (6) maintain normal weight; and (7) stop smoking. Co-authors are Marina Garas, D.O.; Mary B. Roberts, M.S.; Molly E. Waring, Ph.D.; Christine M. Albert, M.D., M.P.H.; Deepika Laddu, Ph.D.; Marcia L Stefanick, Ph.D.; David K. Garas, M.B.A.; and Charles B. Eaton, M.D., M.S. Author disclosures are on the abstract. This study is funded by the National Heart Lung and Blood Institute.


News Article | November 15, 2016
Site: www.eurekalert.org

NEW ORLEANS, Nov. 15, 2016 -- Repeatedly losing and regaining weight, known as weight cycling or yo-yo dieting, may increase the risk of death from heart disease among postmenopausal women who were of normal weight at the start of the study, according to research presented at the American Heart Association's Scientific Sessions 2016. "Weight cycling is an emerging global health concern associated with attempts of weight loss, but there have been inconsistent results about the health hazards for those who experience weight cycling behavior," said Somwail Rasla, M.D., study lead author and internal medicine resident at Memorial Hospital of Rhode Island, Alpert Medical School, Brown University, in Providence, Rhode Island. Researchers classified self-reported weight history from 158,063 post-menopausal women into four categories: stable weight, steady gain, maintained weight loss, and weight cycling. During a follow-up of 11.4 years, they found: Evidence indicates that being overweight in midlife increases the risk of dying from two types of heart disease. In the first type, coronary heart disease, the blood vessels to the heart become blocked by fat and other substances, decreasing blood flow to the heart. In the second type, sudden cardiac death, the heart's electrical system abruptly stops working, causing death. It is unclear whether losing and regaining weight in adulthood also increases the risk of death from these heart diseases, so the investigators looked at this relationship among postmenopausal women. The study has several limitations. First, the study was observational, therefore it could only show association and not a cause and effect relationship. In addition, the study relied on self-reports, which could be inaccurate. Since sudden cardiac death occurred relatively infrequently, the cases that did occur could have resulted from chance. Finally, the study included only older women. "More research is needed before any recommendations can be made for clinical care regarding the risks of weight cycling, since these results apply only to postmenopausal women and not to younger-aged women or men," Rasla said. In the United States and worldwide, heart disease is the leading cause of death. Obesity is a major risk factor, along with high blood pressure and cholesterol, diabetes, physical inactivity, poor diet, and smoking. One way to lower your risk factors is by following the American Heart Association's Life's Simple 7 program, which recommends: (1) manage blood pressure; (2) control cholesterol; (3) reduce blood sugar; (4) get active; (5) eat better; (6) maintain normal weight; and (7) stop smoking. Co-authors are Marina Garas, D.O.; Mary B. Roberts, M.S.; Molly E. Waring, Ph.D.; Christine M. Albert, M.D., M.P.H.; Deepika Laddu, Ph.D.; Marcia L Stefanick, Ph.D.; David K. Garas, M.B.A.; and Charles B. Eaton, M.D., M.S. Author disclosures are on the abstract. This study is funded by the National Heart Lung and Blood Institute. Note: Scientific presentation time is 10:45 a.m. CT, Tuesday, Nov. 15 in the Science and Technology Hall, Population Science Section. Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www. .


News Article | November 14, 2016
Site: www.eurekalert.org

NEW ORLEANS, Nov. 14, 2016 -- Women over the age of 50 who follow a high-protein diet could be at higher risk for heart failure, especially if much of their protein comes from meat, according to preliminary research presented at the American Heart Association's Scientific Sessions 2016. Researchers evaluated the self-reported daily diets of 103,878 women between the ages of 50 and 79 years, from 1993 to 1998. A total of 1,711 women developed heart failure over the study period. The rate of heart failure for women with higher total dietary protein intake was significantly higher compared to the women who ate less protein daily or got more of their protein from vegetables. While women who ate higher amounts of vegetable protein appeared to have less heart failure, the association was not significant when adjusted for body mass. "Higher calibrated total dietary protein intake appears to be associated with substantially increased heart failure risk while vegetable protein intake appears to be protective, although additional studies are needed to further explore this potential association," said Mohamad Firas Barbour, M.D., study author and internist at the Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, in Pawtucket. The findings were true regardless of age, race or ethnicity, level of education, or if the women had high blood pressure (2.9 percent), diabetes (8.3 percent), coronary artery disease (7.1 percent), anemia (3.4 percent), or atrial fibrillation (4.9 percent). The subjects were all participants in the Women's Health Initiative, an ongoing, long-term national dietary survey investigating strategies for reducing heart disease, breast and colorectal cancer, and osteoporosis. Researchers said other studies have found a link between increased protein from meat and cardiovascular risk in women. "Our findings should be interpreted with caution, but it appears that following a high-protein diet may increase heart failure risk," Barbour said. Because dietary self-reporting can be unreliable, the team also used special biomarker data to accurately calibrate daily protein intake - doubly labeled water and urinary nitrogen. Doubly labeled water uses non-radioactive tracers to evaluate a person's metabolic energy while urinary nitrogen is used to determine actual amounts of dietary protein. "We used self-reported intakes of total dietary protein, and the quantity of protein women obtained from meat and vegetables based upon the Food Frequency Questionnaire," Barbour said. The Food Frequency Questionnaire is the most common dietary assessment tool used in large epidemiologic studies of diet and health. A self-administered booklet asks participants to report the frequency of consumption and portion size of approximately 125 items over a defined period. "While a better understanding of dietary risk is still needed, it appears that heart failure among postmenopausal women is not only highly prevalent but preventable by modifying diet," Barbour said. "Heart failure is highly prevalent, especially in post-menopausal women; therefore, a better understanding of nutrition-related factors associated with heart failure is needed." The American Heart Association recommends that people eat a dietary pattern that emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts while limiting red meat and sugary foods and beverages. For people who eat meat, choose lean meats and poultry without skin and eat fish at least twice a week - preferably fish high in omega-3 fatty acids such as salmon, trout, and herring. Co-authors are Farhan Ashraf, M.D.; Mary B. Roberts, M.Sc.; Matthew Allison, M.D., M.P.H.; Lisa Martin, M.D.; Karen Johnson, M.D.; Carolina Valdiviezo, M.D.; and Charles B Eaton, M.D. Author disclosures are on the abstract. This study is funded by National Heart Lung and Blood Institute. Note: Scientific presentation time is 10:40 a.m. CT, Monday, Nov.14, in the Science and Technology Hall, Population Science Theater. Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www. .


Castillo J.J.,Dana-Farber Cancer Institute | Winer E.S.,The Miriam Hospital | Olszewski A.J.,Memorial Hospital of Rhode Island
American Journal of Hematology | Year: 2014

Approximately a third of the patients with diffuse large B-cell lymphoma present with extranodal involvement. Our study aims to identify primary extranodal sites of disease associated with prognosis in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era. A secondary objective is to describe epidemiological and clinical characteristics of patients with extranodal DLBCL. We included adult patients from the Surveillance, Epidemiology and End Results (SEER) database (2004-2009) in whom DLBCL was the first malignancy diagnosed. Extranodal primary sites were divided into 12 groups according to the topography code reported by SEER. Multivariate overall survival (OS) analyses were performed using Cox proportional-hazard regression models adjusted for age, sex, race, and stage. From a total of 25,992 adult DLBCL patients included in our analysis, 32% presented with extranodal primary sites. Gastrointestinal tract (34%), head/neck (H&N; 14%), and skin/soft tissue (11%) were the most common. In comparison with nodal DLBCL, patients with extranodal involvement were older (with exception of skeletal sites) and presented with earlier stages. In the multivariate analysis, sites associated with worse OS rates were gastrointestinal (Hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.15-1.33; P <0.001), pulmonary (HR 1.59, 95% CI 1.38-1.83; P <0.001), and liver/pancreas (HR 1.58, 95% CI 1.35-1.85; P <0.001), whereas H&N was associated with better survival (HR 0.79, 95% CI 0.70-0.89; P <0.001). In this population-based study, primary extranodal sites of involvement are associated with distinct outcomes in patients with DLBCL. Gastrointestinal, pulmonary, and liver/pancreas sites had a significant worse outcome than nodal sites. © 2013 Wiley Periodicals, Inc.


Hotchkiss R.S.,University of Washington | Opal S.,Memorial Hospital of Rhode Island | Opal S.,Brown University
New England Journal of Medicine | Year: 2010

A pathway newly implicated in the immunosuppression observed in persons infected with the human immunodeficiency virus (HIV) may also be pertinent to immunosuppression associated with sepsis. Copyright © 2010 Massachusetts Medical Society. All rights reserved.


Olszewski A.J.,Brown University | Olszewski A.J.,Memorial Hospital of Rhode Island | Castillo J.J.,Brown University | Castillo J.J.,The Miriam Hospital
Cancer | Year: 2013

Background. Prognostic factors and outcomes in patients with marginal zone lymphoma (MZL) have been studied in small cohort studies, which may not reflect the population at large. Methods. Clinical characteristics and survival outcomes of adult patients with MZL who were diagnosed between 1995 and 2009 were evaluated using the Surveillance, Epidemiology, and End Results (SEER) database. The authors generated clinical prognostic models for subtypes of MZL and compared survival during the periods of 1995 through 2000, 2001 through 2004, and 2005 through 2009. Results. The prognosis was significantly better for patients with mucosa-associated lymphoid tissue (MALT) lymphoma (5-year relative survival rate of 88.7%; P <.0001) compared with those with the splenic MZL (SMLZ)or nodal MZL (NMZL) subtypes (5-year relative survival rates of 79.7% and 76.5%, respectively). There was evidence of improved outcomes in patients with NMZL and MALT lymphomas between 1995 and 2009 (P <.0001), with no difference noted in patients with SMZL (P =.56). Advancing age and the presence of B symptoms had prognostic significance in all MZL subtypes. Male sex and stage of disease were significant only for the NMZL and MALT categories. Survival in patients with MALT lymphomas varied depending on the site of origin, with a worse prognosis noted in those with gastrointestinal and pulmonary locations of origin (5-year incidence rate of lymphoma-related death, 9.5%-14.3%) compared with ocular, cutaneous, and endocrine sites (4.5%-7.8%; P <.0001). Conclusions. The survival for patients with SMZL is similar to that for those with NMZL, and unlike the NMZL and MALT subtypes, it has not improved over the past decade. The prognosis of patients with MALT lymphoma varies according to the anatomical site of origin. Cancer 2013. © 2012 American Cancer Society.


Olszewski A.J.,Memorial Hospital of Rhode Island | Desai A.,Memorial Hospital of Rhode Island
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose To determine the factors associated with the use of radiation therapy and associated survival outcomes in early-stage marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT). Methods and Materials We extracted data on adult patients with stage I/II MALT lymphoma diagnoses between 1998 and 2010 recorded in the Surveillance, Epidemiology, and End Results (SEER) database. We studied factors associated with radiation therapy administration in a logistic regression model and described the cumulative incidence of lymphoma-related death (LRD) according to receipt of the treatment. The association of radiation therapy with survival was explored in multivariate models with adjustment for immortal time bias. Results Of the 7774 identified patients, 36% received radiation therapy as part of the initial course of treatment. Older patients; black or Hispanic men; white, Hispanic, and black women; and socioeconomically disadvantaged and underinsured patients had a significantly lower chance of receiving radiation therapy. Radiation therapy administration was associated with a lower chance of LRD in most sites. In cutaneous, ocular, and salivary MALT lymphomas, the 5-year estimate of LRD after radiation therapy was 0%. The association of radiation therapy with overall survival in different lymphoma sites was heterogeneous, and statistically significant in cutaneous (hazard ratio 0.45, P=.009) and ocular (hazard ratio 0.47, P<.0001) locations after multivariate adjustment. Conclusions Demographic factors are associated with the use of radiation therapy in MALT lymphoma. Clinicians should be sensitive to those disparities because the administration of radiation therapy may be associated with improved survival, particularly in cutaneous and ocular lymphomas. © 2014 Elsevier Inc.


Todorov L.,Memorial Hospital of Rhode Island
Pain Physician | Year: 2011

Background: The application of radiofrequency (RF) has been successfully used in the treatment of chronic pain conditions, including facet arthropathy, sacroiliac joint pain, groin pain, radicular pain, cervicogenic headaches, and phantom limb pain. Due to the neurodestructive effect of continuous RF ablation and possible deafferentation sequelae, only pulsed radiofrequency (PRF) has been applied to peripheral sensory nerves. There are no previous reports of successful PRF application to the sural nerve. Objectives: To report on the successful use of PRF to the sural nerve for the treatment of ankle pain. To discuss current theories on the mechanism by which PRF produces pain relief. Methods: The report presented here describes the case of a 39-year old patient who sustained injury to her ankle. The patient was complaining of pain in the distribution of the sural nerve, which was confirmed by electrodiagnostic studies. The pain did not respond to oral and topical analgesics. The patient had short-term relief with a sural block with bupivacaine and triamcinolone. The patient then underwent PRF application to the right sural nerve for 240 seconds at 45 volts. Results: The patient reported complete relief. There was no pain recurrence 5 months after the procedure. Limitations: This report describes a single case report. Conclusions: It is conceivable that PRF may provide long-term pain relief in cases of sural nerve injury. The exact mechanism of the antinociceptive effect is still unknown. Possible mechanisms include changes in molecular structure by the electric field, early gene expression, stimulation of descending inhibitory pathways, and transient inhibition of excitatory transmission.


Grant
Agency: Department of Health and Human Services | Branch: | Program: STTR | Phase: Phase II | Award Amount: 2.68M | Year: 2010

DESCRIPTION (provided by applicant): Anthrax is recognized as a class A bio-threat microbial pathogen that is readily weaponized and exceedingly difficult to treat. This bacterium is highly virulent inducing lethal infection in immunologically normal hosts by its intrinsic capacity to disseminate rapidly and induce sepsis, along with its ability to generate two highly potent exotoxins, lethal toxin and edema toxin. In phase I of our STTR grant, we successfully demonstrated that a unique set of plasma proteins from human blood collectively known as Inter-alpha inhibitor proteins (IAIP) can salvage susceptible mouse strains with established anthrax spore-induced bacterial sepsis when administered concomitantly with standard antimicrobial agents. The level of protection afforded was significantly greater than that observed by antibiotic therapy alone. The dual actions of IAIP against anthrax as a systemic protease inhibitor therapy for sepsis and a specific anthrax toxin inhibitor make it a potentially attractive treatment strategy for managing patients who are infected with anthrax. IAIP has a documented safety record in clinical medicine as this endogenous human protein has already been used in clinical trials in patients with sepsis and other systemic inflammatory states. This existing clinical data indicates that IAIP could be rapidly deployed in the event of a bioterrorist event for actual clinical use with a reasonable level of assurance of its safety and efficacy. This phase II STTR grant application will expand upon these promising findings and provide the necessary preclinical confirmation of the therapeutic value of this protein as a biodefense strategy against anthrax. The proposed studies will have three major aims. The first aim is to scale up production of highly purified IAIP for human use and determine the pharmacokinetics and pharmacodynamics of these human proteins in two animal models of anthrax intoxication. The second aim will focus upon formulation and optimization studies of lyophilized IAIP to achieve a product with greater stability and the longer shelf life that is a prerequisite for the stockpile biodefense program. The final aim of this project will be the preclinical testing of IAIP therapy in two established large animal models of anthrax infection to satisfy the Animal Rule in the development of therapeutic agents against this biohazardous pathogen. PUBLIC HEALTH RELEVANCE: This Phase II STTR project is focused on the product development of inter-alpha inhibitor proteins for the protection of anthrax exposure from the possible occurrence of bioterrorism. The therapeutic proteins offer a unique, two-fold action by fighting the inflammation caused by exposure and targeting the cleaving enzyme responsible for anthrax toxicity.

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