Clinical & Research
Ultrasound Shows Why Knuckles Are so Noisy
Written by Editor   
Friday, February 19, 2016 12:00 AM

Pop go the gasses…


The knuckle-cracking debate continues, with the latest evidence suggesting the resulting "pop" is due to cavity formation in the joint that subsequently allows dissolved gasses to escape.

Knuckles cracked under the surveillance of ultrasound imaging showed a cavity forming that corresponded with the cracking sound, followed by a white flash of gas that eventually dissipated. Researchers studied a total of 40 adults, 30 of whom habitually cracked their knuckles, and 10 who did not. They took ultrasound images of knuckles cracking and not cracking, totaling some 400 scans.

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Steroid Shots No Long-Term Help in Knee OA
Written by Editor   
Wednesday, February 17, 2016 12:00 AM

Knee Joint injections do not prevent structural damage in osteoarthritic knees.


Intra-articular steroid injections are not effective over the long term for preventing structural damage in knee osteoarthritis, a 2-year randomized trial found.  In the study, which was funded by the National Institutes of Health, there were no significant differences between patients who received injections of triamcinolone hexacetonide every 12 weeks and those given placebo.

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No Link Seen Between Smoking and Fatty Liver
Written by Editor   
Saturday, February 13, 2016 12:00 AM

Smoking was not associated with prevalent non-alcoholic fatty liver disease, but low levels of certain micronutrients did appear to have an association.  Vitamin D is involved in the regulation of inflammation, and is probably important in the pathogenesis of fatty liver disease. 

This report states that considering how prevalent fatty liver is, if we were able to do something as easy as measure vitamin D and treat the deficiency, it would be one less hurdle for patients.


Smoking was not associated with prevalent non-alcoholic fatty liver disease, but low levels of certain micronutrients did appear to have an association, a large cross-sectional analysis suggested.

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Deconstructing Chronic Low Back Pain in the Older Adult
Written by Editor   
Friday, February 12, 2016 12:00 AM

The objective of this study was to present the first in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on hip osteoarthritis (OA).

We present an algorithm and supportive materials to help guide the care of older adults with hip OA, an important contributor to CLBP. The case illustrates an example of complex hip-spine syndrome, in which hip OA was an important contributor to disability in an older adult with CLBP.

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More Kidney Disease Seen With Long-Term Statin Use
Written by Editor   
Wednesday, February 10, 2016 12:00 AM

This report says to scientists, physicians, funding agencies, and policy makers: Watch out, it seems that we still do not know enough about the long-term effects of these drugs on the overall well-being of patients.  


A large, 8-year retrospective study with a median 6.4-year follow-up associated long-term statin use with an increased risk of kidney disease.

Statin users showed a 30% to 36% greater prevalence of kidney disease during follow-up.  This study shows that “despite the use of statins for more than a quarter of a century, there are aspects about its long-term effects in noncardiac diseases that we do not know very well. We are missing more extensive, real-world data of the effectiveness of statins on total morbidity and all-cause mortality, and we need further studies specifically focusing on long-term outcomes in primary prevention." Moreover, “the new [ACC] guidelines . . . are projected to increase statin use to many more hundreds of millions of healthy people, and before we do that we better make sure that we are not causing harm,” the author  cautioned.

“Our paper says to scientists, physicians, funding agencies, [and] policy makers: 'Watch out, [it] seems that we still do not know enough about the long-term effects of these drugs on [the] overall well-being of patients.'"  Clinicians need to carefully monitor creatinine levels in patients taking statins.

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Mandibular Devices Work for Lowering Sleep Apnea BP
Written by Editor   
Wednesday, February 10, 2016 12:00 AM

Both CPAP and MAD are effective for sleep apnea.


Mandibular advancement devices are almost as effective as continuous positive airway pressure (CPAP) for lowering blood pressure in patients with obstructive sleep apnea, according to a systematic review and meta-analysis.

The analysis showed slightly greater systolic and diastolic blood pressure (BP) reductions in patients treated with CPAP, but the difference was not statistically significant.

CPAP has a proven track record for improving symptoms associated with sleep apnea, including hypertension, but compliance with the nasal mask treatment is poor. Mouth guard-like mandibular advancement devices (MADs), which open the airways by moving the lower jaw forward, tend to be better tolerated, but their impact on blood pressure has not been well studied.

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Phosphorus Pills Bring Weight Loss in Trial
Written by Editor   
Wednesday, February 10, 2016 12:00 AM
Phosphorus in foods and supplements may contribute to decreased body weight, BMI, waist circumference and reduce appetite this study indicates.

Phosphorus supplementation for overweight and obese individuals can lead to decreases in body weight, body mass index, waist circumference, and subjective appetite scores, according to new research from Lebanon.

“Given the increased prevalence of obesity among individuals consuming abundant quantities of food containing low levels of phosphorus, it was reasonable to postulate that decreased phosphorus intake may be involved in the development of obesity and its metabolic abnormalities,” the researcher said.  "Phosphorus supplementation (375 mg per main meal) halted weight gain ... and (increases in) BMI and significantly decreased waist circumference. At the same time, these changes were associated with early satiation."

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Infant Mortality Rises With Maternal Weight Gain
Written by Editor   
Tuesday, February 09, 2016 12:00 AM

Weight and pregnancy.  There is a correlation between increased weight and infant death. 


Women who gained a large amount of weight between pregnancies were at increased risk for infant death and stillbirth, a large population-based study in Sweden found.

Those whose BMI increased by at least four units after a first pregnancy were more likely to experience infant mortality or stillbirth in a second pregnancy compared to women whose weight remained stable.  There were significant interactions between BMI in the first pregnancy and weight change in terms of infant and neonatal mortality.

But even women who gained a smaller amount of weight had a larger risk of infant mortality than women whose weight remained stable. Women with a previously healthy weight, who gained two to more than four BMI units during pregnancy, had a greater risk of infant death compared to women whose weight remained stable.

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Pain Characteristics of Adolescent Spinal Pain
Written by Editor   
Monday, February 08, 2016 12:00 AM

While most kids can be regarded as healthy, here is when to be wary of back pain in adolescents. 


Although adolescent spinal pain increases the risk for chronic back pain in adulthood, most adolescents can be regarded as healthy. The aim of the present study was to provide data on localization, intensity and frequency of adolescent spinal pain and to investigate which physical and psycho-social parameters predict these pain characteristics.

Adolescents who suffered from pain in more than one spinal area reported higher pain intensity and frequency than those with pain in only one spinal area. Sleep disorders were a significant predictor for pain in more than one spinal area as well as a trend for frequent pain. Adolescents with frequent pain showed impaired balance on one leg standing with closed eyes

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Warning Signs May Precede Sudden Cardiac Arrest
Written by Editor   
Sunday, February 07, 2016 12:00 AM

Taking note of symptoms of potential cardiac arrest may help treatment. 


 Sudden cardiac arrest may not be as sudden as it is widely perceived to be, with warning symptoms occurring in a large percentage of patients in the days and even weeks before the event, researchers reported.

About half of patients who experienced out-of-hospital cardiac arrest reported symptoms such as chest pain and shortness of breath.  “The dogma has been that cardiac arrest is defined by its unexpected nature, but we found that warning symptoms did occur in a significant percentage of patients. This finding highlights a potential new window of opportunity to prevent deaths and even prevent sudden cardiac arrest from occurring,” the authors of this report note.

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Sympathetic and Parasympathetic Responses to Specific Diversified Adjustments to Chiropractic Vertebral Subluxations of the Cervical and Thoracic Spine
Written by Editor   
Sunday, February 07, 2016 12:00 AM

It appears that the area of the spine adjusted may have a direct effect on the autonomic nervous system. 


Chiropractors have suggested the positive effects of chiropractic adjustments on musculoskeletal and visceral health. Although there is a paucity of peer-reviewed studies in support of anecdotal perceptions, there are reports that provide evidence to support these perceptions. Moreover, although several studies have investigated chiropractic vertebral subluxation, spinal manipulative therapy, and cranial adjusting in relation to autonomic function, few studies have been done to link specific outcomes to specific levels adjusted.

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Low Vitamin D, Stress Fractures Often Go Together
Written by Editor   
Wednesday, January 27, 2016 12:00 AM

Vitamin D serum levels of less than 40 ng/mL seem to be directly associated with stress fracture.  Bringing serum levels to 40 - 80 ng/mL through 50,000 IU of vitamin D2 or vitamin D3 once a week for 8 weeks or 6000 IU daily through supplementation is a suggested therapy.


Active adults with serum vitamin D values under 40 ng/mL had an elevated risk for stress fractures regardless of their age, according to a study.  The study was small, with just 53 patients who had serum 25(OH)D concentrations measured within 3 months of having a stress fracture, but roughly half had vitamin D levels that qualified as insufficient or deficient under standards recommended by The Endocrine Society, and more than four out of five had non-optimal vitamin D levels under standards set by the Vitamin D Council, which considers a serum 25(OH)D range of 40 to 80 ng/mL to be sufficient.

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Life-Threatening Lower Back Pain
Written by Editor   
Monday, January 25, 2016 12:00 AM

Intra-abdominal bleed (e.g. aortic aneurysm), infection and tumor are the most dangerous causes of lower back pain and carry the potential for devastating consequences.  This paper identifies red flags that should raise suspicion of a serious disorder and suggests algorithms for proceeding.

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Flu Vaccine for All: A Critical Look at the Evidence
Written by Editor   
Sunday, January 24, 2016 12:00 AM

What is the evidence for the effectiveness of the the flu vaccine.  Good question.


Influenza vaccination is a yearly ritual. The Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend annual influenza vaccination for all healthy persons 6 months of age or older who are without contraindications.

Influenza vaccination now supersedes many other priorities of public health (such as obesity, illiteracy, and high school dropout), and we question whether so much time, effort, and money should be dedicated to flu vaccination while these other national healthcare priorities remain on the back burner.

The rationale for flu immunization as a national health priority is that influenza is a disease with serious complications, such as pneumonia, hospitalization, and death. If the reason for influenza vaccination is that flu is such a serious disease, then the relevant outcomes are whether vaccination improves morbidity and mortality from flu. However, after decades of vaccine use, it is hard to detect any public health impact. 

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Direct Evidence for Viral Infection of Neurons
Written by Editor   
Monday, January 18, 2016 12:00 AM

Direct evidence for viral infection of neurons has been demonstrated.


The first direct evidence that viruses can infect neuronal cells has been reported, giving more weight to the idea that viral infections may contribute to certain neurologic diseases.

This research shows that Epstein-Barr virus (EBV) and Kapok’s sarcoma–associated herpesvirus (KSHV) can infect and replicate in both cultured and primary neurons.

“We have demonstrated for the first time that a subgroup of herpes viruses can infect human neuronal cells and lead to full-blown infection, which causes death of the neuron and the generation of more viral particles, which can go on to infect other neurological cells and B cells,” the authors reported.

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Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus
Written by Editor   
Friday, January 15, 2016 12:00 AM

Kinesiotaping helped the participants in this study of 21 female patients with hallux valgus. 


The main aim of this study was to measure short-term effects of kinesiotaping on pain and joint alignment in the conservative treatment of hallux valgus.  For this group of female patients, pain and joint alignment were improved after a 10-day kinesiotape implementation in patients with hallux valgus. The findings showed short-term decreased pain and disability in hallux valgus deformity.

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Immediate Effects on Pressure Pain Threshold Following a Single Cervical Spine Manipulation in Healthy Subjects
Written by Editor   
Friday, January 15, 2016 12:00 AM

A study has found that cervical manipulation immediately increases pain threshold.  


A placebo, control, repeated-measures, single-blinded randomized study has been conducted  to compare the immediate effects on pressure pain threshold (PPT) tested over the lateral elbow region following a single cervical high-velocity low-amplitude (HVLA) thrust manipulation, a sham-manual application (placebo), or a control condition; and to analyze if a different effect was evident on the side ipsilateral to, compared to the side contralateral to, the intervention.   

The study found that the application of a manipulative intervention directed at the posterior joint of the C5-6 vertebral level produced an immediate increase in pressure pain threshold (PPT) over the lateral epicondyle of both elbows in healthy subjects. Effect sizes for the HVLA thrust manipulation were large, suggesting a strong effect of unknown clinical importance at this stage, whereas effect sizes for both placebo and control procedures were small, suggesting no significant effect.

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The SPRINT Trial and Hypertension Treatment
Written by Editor   
Thursday, January 14, 2016 12:00 AM

While hypertension control has benefits the absolute benefits are modest and the SPRINT study may not be the best indicator in a healthy population.


For over a decade a major advance in our understanding of the treatment of hypertension has been awaited.  The SPRINT trial was a randomized controlled trial comparing a systolic blood pressure target of <120 mm Hg versus <140 mm Hg among almost 10,000 patients with systolic hypertension who were over 50 years old (mean age 68) and who had cardiovascular risk factors, without a history of diabetes or stroke.

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Higher Resting Heart Rate Linked to Higher Mortality
Written by Editor   
Tuesday, January 12, 2016 12:00 AM

A faster heart rate may indicate a greater risk of all-cause mortality.  


A higher resting heart rate is associated with a higher risk for all-cause and cardiovascular mortality, even in those without traditional risk factors for cardiovascular disease.

Results from this meta-analysis suggest the risk of all-cause and cardiovascular mortality increased by 9% and 8% for every 10 beats/min increment of resting heart rate. The risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min...consistent with the traditionally defined tachycardia threshold of 90 or 100 beats/min for prevention of cardiovascular disease.

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Natural Anti-inflammatory Agents for Pain Relief
Written by Editor   
Monday, January 11, 2016 12:00 AM

This primer from the NIH of natural anti-inflammatory agents is well documented.


The inflammatory pathway is a complex biochemical pathway which, once stimulated by injury, leads to the production of inflammatory mediators whose initial effect is pain and tissue destruction, followed by healing and recovery.

Various studies have also shown that NSAIDs can delay muscle regeneration and may reduce ligament, tendon, and cartilage healing. Specifically, NSAIDs are believed to wipe out the entire inflammatory mediated proliferative phase of healing associated with WBC actions (days 0–4). A study of the effects of NSAIDs on acute hamstring injuries was done in humans by Reynolds et al., and these investigators concluded that patients who used NSAIDs did not experience a greater reduction of pain and soft-tissue swelling when compared with the placebo group. Interestingly enough, the authors noted that the NSAIDs’ group had worse pain associated with severe injuries compared with the placebo group.

The NSAIDs are also known to have adverse effects on kidney function. Dehydration or preexisting chronic renal failure or disease may predispose certain populations to acute renal failure through inhibition of prostaglandin synthesis, which can occur when taking NSAIDs. The National Kidney Foundation asserts that approximately 10% of kidney failures per year are directly correlated to substantial overuse of NSAIDs.

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Sleep Matters for Obesity
Written by Editor   
Sunday, January 10, 2016 12:00 AM

Healthy sleep and water consumption are two components for consideration in obesity.


When most people think about the behavioral therapy of obesity, they mostly focus on eating habits (personalized caloric restriction) and physical activity.

The idea that we must alter patients’ homeostasis and energy balance in favor of fat loss needs consideration as well. Obesity is extremely complex with many factors contributing to an imbalance, with other behavioral components involved as well. One of those is sleep, which is crucial and is perhaps an unsung hero of behavioral therapy.

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Research: Jan 2016
Written by Craig Benton, DC   
Thursday, January 07, 2016 12:00 AM

Compiled by Dr. Craig Benton

It seems that spinal manipulation is helpful for neck pain and whiplash associated disorders. 

http://www.ncbi.nlm.nih.gov/pubmed/26707074

 

95% of Canadian DCs use differential diagnosis on new patients

http://www.ncbi.nlm.nih.gov/pubmed/26500362

 

Integration of DC care in the military and VA has been successful.

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High-Dose Vitamin D Modulates Immune System in MS
Written by Editor   
Wednesday, January 06, 2016 12:00 AM

Vitamin D, in high doses, seems to have a beneficial immune system effect for patients with MS.


High doses of vitamin D3 (cholecalciferol) appear to be safe and tolerable in patients with multiple sclerosis (MS), according to a single-center, randomized, double-blind pilot study.  What’s more, 10,400 IU daily of cholecalciferol increased serum 25(OH)D levels to those thought to be sufficient in MS, and had effects on immune cells not seen in MS patients taking typical daily doses of the vitamin.

The study provides Class I evidence that cholecalciferol supplementation with 10,400 IU daily is safe and well-tolerated in patients with MS and exhibits in vivo pleiotropic immunomodulatory effects, they wrote.

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A Wireless Device to Stop Snoring
Written by Editor   
Monday, December 21, 2015 09:05 AM

Hundreds of millions suffer from snoring and countless millions more won't even admit they do it. Snoring is the sound that occurs when the airway is partially obstructed. It's an indicator of poor sleep.  "Often a very small movement or a very gentle push will stop the snoring. 

A startup technology company say they have developed a wireless solution to keep the annoying and often loud noise in check.  A solution to automate the nudging process has been developed, a device dubbed Nora. Its job is to listen for snores and give a nudge.

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MRI Shows Joints Recover Even Under Extreme Duress
Written by Editor   
Monday, December 21, 2015 08:54 AM

Ultra marathon runners joints demonstrated significant degradation, but the deficits resolved as the ultra marathon continued, and while there was an over 6% loss of grey matter in the brain, brain volume had returned to normal at 8 months post run.


A study of ultramarathoners who ran the whole of Europe demonstrated that with the exception of the patellar joint, nearly all cartilage segments of knee, ankle, and hindfoot joints showed a significant degradation within the first 1,500 to 2,500 km. But with continued running, the deficits resolved. “Further testing indicated that ankle and foot cartilage have the ability to regenerate under ongoing endurance running,"

"The ability of cartilage to recover in the presence of loading impact has not been previously shown in humans. In general, we found no distance limit in running for the human joint cartilage in the lower extremities."

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Caffeine-Loaded Energy Drink Increases Blood Pressure
Written by Editor   
Monday, December 21, 2015 08:11 AM

Researchers have documented a statistically significant increase in blood pressure and catecholamines in a group of young healthy adults who consumed one can of a commercially available energy drink.  In a small study consuming one 480-mL can of the energy drink, which contains 240 mg of caffeine, increased systolic blood pressure 6.2%, up from 108.4 mm Hg at baseline to 115.0 mm Hg. Consumption of a placebo beverage resulted in a 3.1% increase in systolic blood pressure, up from 108.3 mm Hg to 111.6 mm Hg. The differential blood-pressure response in this randomized, double-blind, crossover pilot study was statistically significant.

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Breastfeeding ‘Protects Against Diabetes’
Written by Editor   
Monday, December 21, 2015 08:06 AM

It appears, from a preliminary report, that breastfeeding can have a significant role in preventing diabetes.


New evidence has emerged on the role that breastfeeding could have in preventing diabetes.  Early results from a Canadian study suggest that breastfeeding reduces the risk of mothers and their offspring developing the condition.

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The Course of Low Back Pain in a General Population
Written by Editor   
Monday, December 21, 2015 07:49 AM

This study concludes Low back pain should not be considered transient and therefore neglected, since the condition rarely seems to be self-limiting but merely presents with periodic attacks and temporary remissions. 


To investigate the course of low back pain (LBP) in a general population over 5 years, a prospective population-based survey was conducted in 1991, 1992, and 1996, in Denmark.

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Less Sugar May Mean Better Insulin Sensitivity in Obese Children
Written by Editor   
Monday, December 21, 2015 07:19 AM

Restricting sugar led to improved insulin sensitivity in a small trial, pointing to the role of fructose on metabolic syndrome, researchers said.  When 43 children with obesity cut their dietary sugar from 28% to 10% of their diet and replaced it with starches, their metabolic parameters improved significantly after 9 days.

Children in the trial had lost a substantial amount of hepatic fat (22%) and visceral fat (7.3%), but not subcutaneous fat; and fasting insulin, initial area under the curve (IAUC), c-peptide, and Composite Insulin Sensitivity Index (CISI) improved.

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Changing Americans’ Diets Requires Efforts on Many Fronts
Written by Editor   
Sunday, December 20, 2015 09:50 PM

Researchers found that severe obesity costs state Medicaid programs almost $8 billion a year.


Physician discomfort with counseling for and treating obesity may be part of the reason that obesity costs continue to go up. Many physicians may be more comfortable treating obesity-related disease such as hypertension and high cholesterol than providing counseling and treating obesity." 

Researchers analyzed 2013 data from the CDC's Behavioral Risk Factor Surveillance System. The researchers found that severe obesity costs state Medicaid programs almost $8 billion a year, from $5 million in Wyoming to $1.3 billion in California. "These costs are likely to increase following Medicaid expansion and enhanced coverage of weight loss therapies in the form of nutrition consultation, drug therapy, and bariatric surgery," they noted.

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Sitting Time Not Associated With Risk of Death?
Written by Editor   
Wednesday, December 16, 2015 12:00 AM

Sitting per se, whether during leisure time, watching TV, or at work, irrespective of physical activity, is not associated with risk of death, shows a new study of 5000 participants.  The study tested the hypothesis that sitting time would predict all-cause mortality risk independently of moderate to vigorous physical activity and associations would vary by type of sitting.

Prior research has suggested that spending extended periods of time sitting down, either at work or during leisure time, is detrimental and contributes to mortality risk regardless of how much physical activity an individual undertakes. Sitting has even been dubbed "the new smoking."

In the new study, which ran for 16 years — one of the longest follow-ups in this area of research — 450 deaths were recorded, but no evident associations between any of the indicators of sitting and mortality were found.

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Immediate Effects of Spinal Manipulative Therapy on Myofascial Trigger Points
Written by Editor   
Sunday, December 13, 2015 12:00 AM

The purpose of this study was to investigate if spinal manipulative therapy (SMT) can evoke immediate regional antinociceptive effects in myofascial tissues by increasing pressure pain thresholds (PPTs) over myofascial trigger points in healthy young adults.  The study showed that SMT evokes short-term regional increases in PPT within myofascial tissues in healthy young adults.

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Simple Melanoma Risk Test: Count the Moles on an Arm
Written by Editor   
Saturday, December 12, 2015 12:00 AM

An individual's risk for melanoma can be quickly and simply assessed in primary care by counting the number of nevi on one arm, suggests a group of Italian and United Kingdom researchers.

Using data derived from a study of more than 3500 female twins, they found that total body nevus count (TBNC) is significantly predicted by the number of nevi on the arm.

"It's important because the number of moles on the body is strictly related to the risk of melanoma, and if you have more than 100 moles on your body, the risk increases by some five to six times in the white population,” the lead researcher said.

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Adverse Reaction to Aspirin Often Misdiagnosed as Allergy
Written by Editor   
Monday, November 30, 2015 09:23 AM

Up to a third of cardiology outpatients may be avoiding aspirin unnecessarily because of an erroneous belief that they are allergic, a new study suggests. 

"In 34% of charts, there were gastrointestinal [GI] symptoms listed, which is not a true aspirin allergy," the study said. "With true aspirin allergy, you can expect angioedema, anaphylaxis, respiratory symptoms, and skin reactions.  But abdominal pain, nausea, vomiting, and GI bleeds are adverse reactions, and there are procedures to manage this.

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Naproxen and Lower Back Pain
Written by Editor   
Monday, November 30, 2015 08:36 AM

Among patients with acute, nontraumatic, nonradicular lower back pain (LBP) presenting to the emergency department (ED), adding cyclobenzaprine or oxycodone/acetaminophen (Percocet) to naproxen therapy did not improve functional outcomes or pain at 1-week follow-up.  "These findings do not support the use of these additional medications in this setting."

Opioids, when combined with naproxen, are not more effective than naproxen alone for the majority of patients with low back pain. We demonstrated that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen is unlikely to benefit the patient. 

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High Cholesterol Linked to Tendinopathy
Written by Editor   
Monday, November 30, 2015 08:15 AM

High cholesterol levels are associated with tendon problems, according to a review of studies published in the British Journal of Sports Medicine.

Tendinopathy is a general term that is used to describe pain or abnormality in the tendons.  Nobody knows the exact cause of tendinopathy, but it is often associated with overuse.  However, about a third of cases of tendinopathy occur in people who are inactive. In fact, the condition is quite common in people who are obese.

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Here We Go Again:  Cardiologist Accused of Unnecessary Procedures
Written by Editor   
Friday, November 27, 2015 08:57 AM

Not all cardiologists have learned the seemingly obvious lessons from the overuse scandals from the past decade.  A scandal involving a cardiologist who is accused of enriching himself by performing hundreds of medically unnecessary procedures on his patients in a small town in Indiana. 

A "star" at his local hospital for 30 years. "He and his partners not only ran the most popular cardiology practice ... but were also the highest-paid heart doctors in the state in terms of Medicare reimbursements, records show.” The trio of medical doctors were paid nearly $5 million in combined Medicare payments in 2012, making them the three most reimbursed cardiologists in Indiana." One of the partners drove "a blue Porsche with the license plate 'Tick Doc.'"

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Any Alcohol Exposure in Pregnancy Is Risky for Baby
Written by Editor   
Friday, November 27, 2015 08:48 AM

Because children exposed to any amount of alcohol during pregnancy are at risk for fetal alcohol spectrum disorders (FASD), the American Academy of Pediatrics (AAP) reaffirmed its recommendation that no amount of alcohol is safe during pregnancy.  the CDC found that 7.6% of women who report continued alcohol use during pregnancy, and more alarmingly, 1.4% report binge drinking. Exposure to alcohol during the first trimester of pregnancy can impact the brain, as well as the musculoskeletal, ocular, and auditory systems.

In their latest clinical report the AAP reiterated that any exposure to alcohol during pregnancy increases a child's risk of FASD, ranging from alcohol-related neurodevelopmental disorder (ARND) to more severe alcohol-related birth defects (ARBD).

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Low-Protein Diet: Bad for Women's Bones?
Written by Editor   
Thursday, November 26, 2015 12:48 PM

Lifestyle factors such as diet can modify the risk of bone loss and fragility fractures.  The effects of some nutrients such as calcium and vitamin D on bone have been studied extensively, but less is known about other dietary components such as protein.  We've known since the 1920s that dietary protein affects calcium economy, but its exact role in calcium and skeletal metabolism has not been well defined.  This study demonstrates that a protein-restricted diet among young women resulted in significant decreases in calcium absorption, a finding that could have implications for women's skeletal health later in life, a researcher reported.

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Resistance Training Seems to Preserve BMD in Seniors
Written by Editor   
Thursday, November 26, 2015 12:19 PM

A recent study reports that older adults who diet and exercise are more likely to experience bone loss if they engage in only aerobic training rather than resistance training.  In older adults in a weight-stable state, exercise can help build bone mass, but it isn't known if bone mass would be lost during caloric restriction, she said.  Therefore, to see if the effects of two different types of exercise programs differentially influenced BMD in older adults.

After five months, bone mineral density (BMD) showed a modest decrease among those in an aerobic training plus calorie restriction group at the total hip and femoral neck after adjustment for age, sex, baseline body mass index (BMI) and BMD, and weight loss.In contrast, no change was seen in BMD for those participating in a resistance training plus calorie restriction program at the total hip or femoral neck.

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FDA Strengthens Warning that Non-aspirin NSAIDs can Cause Heart Attacks or Strokes
Written by Editor   
Wednesday, November 18, 2015 01:14 PM

The U.S. Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.

Based on their comprehensive review of new safety information, they are requiring updates to the drug labels of all prescription NSAIDs. As is the case with current prescription NSAID labels, the Drug Facts labels of over-the-counter (OTC) non-aspirin NSAIDs already contain information on heart attack and stroke risk. They will also request updates to the OTC non-aspirin NSAID Drug Facts labels.

Based on their review and the advisory committees’ recommendations, the prescription NSAID labels will be revised to reflect the following information:

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Med School Enrollment Hits New High
Written by Editor   
Wednesday, November 18, 2015 01:07 PM

The number of people applying to medical school increased by 6.2% for 2015, which followed a 3.1% jump the previous year, the Association of American Medical Colleges (AAMC) announced Thursday.

A total of 52,550 people applied to medical school in 2014 for enrollment in 2015; of those, 38,460 were first-time applicants, an increase of 4.8% from the previous year, the AAMC said.

Medical school enrollment for 2015 was 20,630, an all-time high and an increase of 25% since 2002, the association reported. Just over half of med school students were men (52%), a ratio that was unchanged from the previous year.

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In-home Test Kits Help Parents Lower Allergen Levels in Their Homes
Written by Editor   
Wednesday, November 18, 2015 01:03 PM

In-home test kits, coupled with patient education, helps parents reduce allergen levels in their homes, according to scientists from the National Institutes of Health. The researchers found that parents may become more motivated to participate in allergen reduction interventions, when they can actually see results for themselves.

The scientists specifically looked at dust mites, microscopic relatives of the spider, that live in dust on mattresses, bedding, upholstered furniture, carpets, curtains, and other soft furnishings. Dust mites contain allergens known to trigger symptoms in people who are allergic to them, and especially those with asthma.

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Myelin: A History, Function, and Potential
Written by Editor   
Tuesday, November 17, 2015 08:34 AM

Myelin is probably the hottest topic in multiple sclerosis research at the moment, but there was a time when the word was generally used to refer to any squishy white substance in the body.

Indeed, myelin has its roots in the Greek word for bone marrow, and it was at one point in history used to refer to this substance, along with others like it in the body.

So when exactly did myelin become solely the white fibrous material that insulates nerves in order to better conduct electrical signals?  A book on the history of glial cells -- non-neuronal cells that support the nervous system and include astrocytes and oligodendrocytes in the central nervous system and Schwann cells in the peripheral nervous system involves two chapters on oligodendroctyes and one on myelin, all of which involved extensive research to find original publications in various European languages.

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Ankle Fracture: No Added Value With Supervised Exercise Rehab
Written by Editor   
Tuesday, November 10, 2015 09:26 AM

For patients with isolated and uncomplicated ankle fracture, a supervised exercise-based rehabilitation program confers no additional benefits in activity limitation or quality of life compared with advice alone, according to data from the randomized Exercise or Advice After Ankle Fracture (EXACT) trial.

"We have previously shown that recovery of activity limitation after ankle fracture is rapid in the first 6 months and that adding passive stretch or manual therapy to a supervised exercise program did not enhance the benefits of exercise alone," the authors write. "It is possible that the lack of treatment effect we observed in this trial is attributable to the fact that rehabilitation cannot accelerate this rapid recovery. These findings and the findings of the present trial suggest that routine care for patients after isolated ankle fracture should include self-management advice at the time of removal of immobilization but not a supervised exercise program."

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Research this Week: Nov 13, 2015
Written by Craig Benton, DC   
Tuesday, November 10, 2015 12:00 AM

 

Here is a study from the ER department showing that opioids and muscle relaxers did not improve patient function for lower back pain after one week:

http://jama.jamanetwork.com/article.aspx?articleid=2463257

 

Here is another study stating strong opioids do not help significantly with non cancer musculoskeletal pain:

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A Proposed Model for Adaptations for SMT for Infants and Children
Written by Editor   
Thursday, November 05, 2015 09:27 AM

Spinal manipulative therapy (SMT) is currently used to treat and manage a wide variety of musculoskeletal conditions. The application of precisely controlled high-velocity, low-amplitude thrust to a joint during SMT is designed to restore motion in the targeted joint.  The thrust is applied in the paraphysiologic space of joint motion while taking care not to exceed the anatomical limit leading to joint trauma and pathology.

A literature review of tensile strength of adults and pediatric human spine specimens was performed to gather information about biomechanical forces and spinal differences of adults and children and to synthesize these findings into a scaling model to guide safety and clinical decisions for spinal manipulative therapy (SMT) for children and infants.

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Dietary Change Key to Improving Mental Health, Experts Say
Written by Editor   
Wednesday, November 04, 2015 08:07 AM

Dietary changes that reduce the incidence of, and prevent, mental health disorders are a cost-effective and efficacious means of improving mental health, urges a position statement released by the International Society for Nutritional Psychiatry Research (ISNPR).  It emphasizes that there is epidemiologic, basic scientific, and clinical evidence to show that diet both influences risk for and outcomes of mental health disorders.  Moreover, a number of nutrients are linked to brain health. The statement calls for more robust research to determine the clinical impact of dietary changes and to identify biomarkers.

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Metformin Link to Neuropathy, Vitamin B12 Deficiency, in Diabetes
Written by Editor   
Wednesday, November 04, 2015 08:03 AM

Metformin-related vitamin B12 deficiency might contribute to clinically significant peripheral neuropathy in diabetes patients, new research suggests.

Guidelines from European Association for the Study of Diabetes (EASD) and the American Diabetes Association do mention vitamin B12 deficiency as a risk of metformin treatment for type 2 diabetes.  Previous research has linked metformin use to vitamin B12 deficiency, raising concern that the drug may be contributing to peripheral neuropathy separate from the effect of the diabetes itself.

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Therapy Dogs to Get Evidence-Based Medicine Treatment
Written by Editor   
Tuesday, November 03, 2015 09:16 AM

Visits with therapy dogs have been known to improve a patient's mood, but researchers here are conducting a clinical trial to actually measure the benefit -- if there is one -- to pediatric cancer patients.

Children ages 3-17 who are within the first 4 months of their cancer diagnosis and their parents are randomly selected to receive either their standard of care treatment for diagnosis only or their standard care treatment plus 15-minute regular visits from a registered therapy dog. The study is ongoing, with data collection continuing through late 2015.

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Early Physical Therapy: Modest Benefit in Low Back Pain
Written by Editor   
Thursday, October 29, 2015 10:42 AM

When compared with usual care, treatment of recent-onset low back pain (LBP) with early physical therapy resulted in a statistically significant improvement in disability, but the benefit was not clinically significant. 

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