BRCA Screening of Ashkenazi Women Would Be Cost Effective

MedicalResearch.com Interview with:
Dr Ranjit Manchanda
Consultant Gynaecological Oncologist, St Bartholomew’s Hospital, London, UK
Honorary Sr Lecturer, Women’s Cancer, EGA Institute for Women’s Health, University College London, UK  and
Professor Ian Jacobs
Vice President, The University of Manchester
Dean & Head School of Medicine
Faculty of Medical & Human Sciences, Director
MAHSC (Manchester Academic Health Science Centre)

Medical Research: What is the background for this study? What are the main findings?

Dr. Jacobs:  Background- Women carrying a BRCA1/2 gene alteration have a very high risk of developing breast and ovarian cancer and men carrying this alteration have an increased risk of prostate and breast cancer. Approximately 45-65% women who have this inherited genetic change will develop breast cancer and 15-35% ovarian cancer. They also have a 50% chance of passing these genes on to their children. At risk individuals can access available options of screening and prevention through the National Health Service (NHS). Some population groups across the world are known to have a higher frequency of BRCA 1/2 gene alterations than others. One example is Ashkenazi Jews who have a 1 in 40 likelihood of having a BRCA1/2 gene alteration. This is 10-20 times higher than in the general non-Jewish population.

At present in the UK, genetic testing is available within the NHS to individuals who have a strong family history of cancer. However, many people are not aware of their family history or its significance and do not seek advice. Many other individuals with BRCA1/2 gene alterations do not have a family history at all. The current approach misses a large number of people at risk who could benefit from knowing about their BRCA 1/2 mutation status and the ability to access opportunities for prevention or screening. In order to address this the GCaPPS study has investigated the best method of screening for risk of inherited (familial) cancer by exploring the alternative approach of offering the genetic test to all men and women >18 years in the Ashkenazi Jewish population. It does so by comparing the benefits and disadvantages of: (i) The current system of testing only those with a family history and (ii) The new option of testing everyone in the population.

Main Findings: Over half of the BRCA1/BRCA2 carriers detected did not give a strong family history of cancer and would not have been identified by current family history based testing criteria used in the NHS (National Health Service) in the UK and most health systems internationally. Reassuringly population-based genetic testing in Ashkenazi Jews did not adversely affect short term psychological health or quality-of-life. A health economic analysis indicated that population-based screening for BRCA-mutations in Ashkenazi Jewish women ≥30years would be highly cost-effective compared to the traditional family history based approach. Such an approach if implemented could reduce the incidence of and deaths from breast and ovarian cancer as well as reducing cost and save the NHS funds.

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Crib Mattresses May Emit Phthalates

Ying Xu Assistant Professor, Ph.D. Department of Civil, Architectural and Environmental Engineering University of Texas, AustinMedicalResearch.com Interview with:
Ying Xu
Assistant Professor, Ph.D.
Department of Civil, Architectural and Environmental Engineering
University of Texas, Austin

Medical Research: What is the background for this study? What are the main findings?

Response: Phthalates have been widely used as plasticizers to enhance the flexibility of polyvinyl chloride (PVC) products.  They are ubiquitous and persistent indoor pollutants and may result in profound and irreversible changes in the development of human reproductive tract.

In this study, we found that the emissions of phthalates and phthalate alternatives increase significantly with increasing temperature.  We developed an emission model and validated the model via chamber experiments.  Further analysis showed that, in infant sleep microenvironments, an increase in the temperature of mattress can cause a significant increase in emission of phthalates from the mattress cover and make the concentration in breathing zone about four times higher than that in the room, resulting in potentially high exposure.  In residential homes, an increase in the temperature from 25 to 35 ºC can elevate the gas-phase concentration of phthalates by more than a factor of 10, but the total airborne concentration may not increase that much for less volatile compounds.

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ZUBSOLV® for Opioid Dependence: Trial Results Reported

Erik Gunderson, M.D., FASAM Assistant Professor Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine University of Virginia Principal Investigator of the studyMedicalResearch.com Interview with:
Erik Gunderson, M.D., FASAM
Assistant Professor
Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine University of Virginia
Principal Investigator of the study

Medical Research: What is the background for this study? What are the main findings?

Response: The ISTART/006 study was a randomized, multicenter, non-inferiority Phase 3 clinical trial designed to evaluate the efficacy of ZUBSOLV® (buprenorphine and naloxone) sublingual tablet (CIII) compared with generic buprenorphine tablets during induction and with Suboxone® film during stabilization of patients with opioid dependence. The co-primary endpoint was retention in treatment at day 3 (when patients began maintenance therapy with either ZUBSOLV or Suboxone film) and retention in treatment at day 15. Secondary endpoints included assessment of treatment effects on opioid withdrawal symptoms for ZUBSOLV versus Suboxone film via both the Clinical Opiate Withdrawal Scale (COWS) score and Subjective Opiate Withdrawal Scale (SOWS), and opioid cravings via the visual analogue scale (VAS).

758 patients participated in a two-day blinded induction phase randomized to ZUBSOLV or generic buprenorphine tablets, and on day 3 those taking the generic tablets were switched to Suboxone film for a 20-day open-label stabilization and early maintenance phase. At day 15, ZUBSOLV patients switched to Suboxone film and those taking Suboxone film switched to ZUBSOLV.

Please note ZUBSOLV currently is not indicated for induction treatment. In October 2014, Orexo submitted a sNDA to the FDA for that indication.

We found ZUBSOLV demonstrated comparable patient retention in treatment at days 3 and 15 versus generic buprenorphine and Suboxone film respectively, as well as no increased rate of withdrawal symptoms or opioid cravings versus Suboxone film. The safety profile of ZUBSOLV was similar to that of Suboxone film. Continue reading

Hot Flashes Linked With Increased Risk of Hip Fracture

Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles UCLA Medicine/GIM Los Angeles, CA 90024MedicalResearch.com Interview with:
Carolyn J. Crandall, MD, MS
Professor of Medicine
David Geffen School of Medicine
UCLA Medicine/GIM
Los Angeles, California 90024

Medical Research: What is the background for this study? What are the main findings?

Dr. Crandall: In a large group of postmenopausal women aged 50-79, we found that women who reporting having hot flashes at baseline had increased risk of hip fracture during the subsequent 8 years of observation, nearly double the risk compared with women who did not have hot flashes at baseline.
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Breast Assymetry Negatively Impacts Adolescent Psychological Health

Brian I. Labow, MD Director, Adolescent Breast Clinic Assistant in Surgery Assistant Professor of Surgery Harvard Medical School PrimaryMedicalResearch.com Interview with:
Brian I. Labow, MD
Director, Adolescent Breast Clinic
Assistant in Surgery Assistant Professor of Surgery
Harvard Medical School Primary

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Labow:  This study is part of our larger Adolescent Breast Disorder Study, in which we examine the impact of several breast disorders on adolescent girls and boys and measure the effect of treatment. In this present study we have found breast asymmetry, defined as having at least 1 cup size difference between breasts, can have a significant impact on the psychological wellbeing of adolescent girls.  Validated surveys were given to adolescent girls with breast asymmetry, macromastia (enlarged breasts), and healthy unaffected girls between the ages of 12-21 to assess a wide array of health domains. Girls with breast asymmetry had noted deficits in psychological wellbeing and self-esteem when compared to healthy girls of the same age.  These impairments were similar to those of girls with macromastia, a condition known to have significant negative mental health effects. Interestingly, these negative psychological outcomes did not vary by patient’s age or severity of breast asymmetry. Older and younger adolescents were negatively impacted similarly, as were those with lesser and greater degrees of breast asymmetry.

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Men and Women Receive Different Blood Pressure Medications

MedicalResearch.com Interview with:
Charlotta Ljungman, MD, PhD
Sahlgrenska University Hospital/Cardiology
Gothenburg, Sweden

Medical Research: What is the background for this study? What are the main findings?

Dr. Ljungman: The background of this study is the known differences between women and men regarding antihypertensive therapy. In studies both in Europe and the United States it has been shown that women are more often treated with diuretics and men with ACE-inhibitors. The reasons for these differences is not known but it has been suggested that differences in comorbidities between women and men can contribute to this finding. In our study we tested if comorbidities could explain the differences but could conclude that the differences persist even after taking comorbidities (mainly diabetes mellitsu and cardiovascular comorbidity) into account.

Women were more often treated with thiazide diuretics and beta blockers and men with ACE inhibitors and Ca channel blockers. Further women with diabetes and hypertension were not treated with ACEinhibitors and ARBS as often as their male counterparts.

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Blood Type O Linked To Lower Risk of Diabetes

MedicalResearch.com Interview with:
Dr Guy Fagherazzi
Center for Research in Epidemiology and Population Health
INSERM, Villejuif, France, and colleagues.

Medical Research: What is the background for this study? What are the main findings?

Dr. Fagherazzi: Our work has been based on previous findings regarding the associations between blood type and the risk of stroke or coronary heart disease, where people with the O blood group seamed to have lower risk of developping the disease. The suggested mechanisms could be also be involved with type 2 diabetes. And our results were in agreement with our first hypothesis.

We have followed more than 80 000 women from the E3N cohort study, during 18 years and we have found that individuals with the O blood type had lower risk of type 2 diabetes than the others (people with groups A, B and AB).
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CT Scan Predicts Stroke After TIA

Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, The Ottawa Hospital Epidemiology Program, F6 The Ottawa Hospital, Civic Campus Ottawa, OntarioMedicalResearch.com Interview with:
Jeff Perry, MD, MSc, CCFP-EM
Associate Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, The Ottawa Hospital
Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario

Medical Research: What is the background for this study? What are the main findings?

Dr. Perry: Currently it is not well known which patients with a TIA or a non-disabling stroke will have a subsequent stroke or die within the days to weeks following their initial event.  This study found that patients with acute ischemia, especially if it is associated with an old infarction or microangiopathy, are at a much higher risk for an early subsequent stroke.
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Mesenchymal Stem Cells Did Not Prevent Kidney Injury After Heart Surgery

Madhav Swaminathan, MBBS, MD, FASE, FAHA Associate Professor with Tenure Clinical Director, Division of Cardiothoracic Anesthesiology & Critical Care Medicine Department of Anesthesiology Duke University Health System Durham, NC 27710MedicalResearch.com Interview with:
Madhav Swaminathan, MBBS, MD, FASE, FAHA
Associate Professor with Tenure
Clinical Director, Division of Cardiothoracic Anesthesiology & Critical Care Medicine Department of Anesthesiology
Duke University Health System Durham, NC 27710

Medical Research: What is the background for this study? What are the main findings?

Dr. Swaminathan: The background is the need for salvage therapies for acute kidney injury (AKI,) which is a common complication in hospitalized patients. It is particularly a problem in the postoperative period after cardiac surgery. Preventive strategies have not worked well for decades. Hence the focus on strategies that target kidney recovery. Mesenchymal stem cells have been shown to be useful in enhancing kidney recovery in pre-clinical trials. We therefore hypothesized that administration of human Mesenchymal stem cells (AC607, Allocure Inc, Burlington, MA) to patients with established post-cardiac surgery AKI would result in a shorter time to kidney recovery. We conducted a phase 2, double blinded, placebo controlled, randomized clinical trial to test our hypothesis. Unfortunately we could not confirm the hypothesis and there were no significant differences in time to kidney recovery among patients that received AC607 versus placebo in 156 randomized cardiac surgery subjects.

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Triple Negative Breast Cancer: Tryptophan Degradation Pathway Promotes Metastatic Phenotypes

Thomas Rogers PhD Candidate- Cancer Biology Graduate Program Laboratory of Jennifer Richer Department of Pathology University of Colorado-Anschutz Medical Campus Laboratory of CU Cancer Center investigator, Jennifer Richer, PhD.MedicalResearch.com Interview with:
Thomas Rogers
PhD Candidate- Cancer Biology Graduate Program
Laboratory of Jennifer Richer
Department of Pathology
University of Colorado-Anschutz Medical Campus
Laboratory of CU Cancer Center investigator, Jennifer Richer, PhD.

Medical Research: What is the background for this study? What are the main findings?

Response:

Background: Survival while detached from a basement membrane is a critical trait of cancer cells progressing through the metastatic cascade. This is particularly important for the triple-negative breast cancer (TNBC) subtype, which lacks estrogen and progesterone receptors and does not have amplification of HER2, and has a peak risk of recurrence within the first three years post-diagnosis. Triple-negative breast cancer also has the highest mortality rate in the first five years as compared to other breast cancer subtypes. We performed global profiling of TNBC cells in adherent versus forced suspension culture conditions after24 hours. These data revealed that triple-negative breast cancer cells surviving in suspension upregulate multiple genes involved in tryptophan catabolism, also known as the kynurenine pathway, including the rate limiting enzyme tryptophan 2,3,-dioxygenase (TDO2) and kynureninase (KYNU). Kynurenine, a key intermediate metabolite of this pathway activates the aryl hydrocarbon receptor (AhR), which was also up-regulated in TNBC cells grown in forced-suspension culture.

Main Findings: Critical enzymes of the kynurenine pathway, TDO2 and KYNU, are upregulated in triple-negative breast cancer cells grown in forced-suspension culture. Furthermore, secreted kynurenine doubles in TNBC cells in forced-suspension culture as measured by high performance liquid chromatography (HPLC). Kynurenine activates the aryl hydrocarbon receptor in triple-negative breast cancer cells grown in forced-suspension culture. Targeting TDO2 and AhR with small molecule inhibitors or short hairpin RNAs decreased survival in suspension, migration/invasion, and proliferation of TNBC cells. Lastly, TDO2 gene expression is higher in invasive ductal breast carcinoma as compared to normal breast tissue and is significantly higher in estrogen receptor negative tumors as compared to estrogen receptor positive tumors. In addition, patients with higher (above-median) TDO2 expression in their primary tumor had significantly shorter overall survival than those with low TDO2.

Conclusions: The kynurenine pathway is activated in TNBC cells in forced suspension and facilitates the invasive/metastatic phenotype of this aggressive breast cancer subtype. Our findings support further investigations into targeting the enzyme TDO2 in TNBC as a novel therapeutic strategy with potential to reduce TNBC mortality rates. Kynurenine is well-known to suppress immune cell function via activation of AhR. Continue reading

Both Ibuprofen and Morphine Work For Childhood Fracture Pain

MedicalResearch.com Interview with:
Naveen Poonai MSc MD FAAP FRCPC
Paediatric Emergency Physician
Children’s Hospital, London Health Sciences Center
Assistant Professor Paediatrics and Internal Medicine
Schulich School of Medicine and Dentistry
London, Ontario,

Medical Research: What is the background for this study? What are the main findings?

Dr. Poonai: We found that in children discharged home with a fracture, both ibuprofen and oral morphine were effective at relieving pain. However, there were no significant differences in efficacy between the two agents and oral morphine was associated with more side effects.

MedicalResearch.com: What was most surprising about the results?

Dr. Poonai: The most surprising findings for us were that over 70% of children experienced pain significant enough to require analgesia once they were discharged home.  Furthermore, we were surprised to find that the anecdotally more potent agent morphine, was equivalent to ibuprofen for post-fracture pain relief in children.

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Smoking Cessation: Less Expensive Cytisine May Be As Effective As Nicotine Replacements

natalie_walkerMedicalResearch.com Interview with:
Natalie Walker, Ph.D.
National Institute for Health Innovation
School of Population Health, University of Auckland
Auckland, New Zealand

Medical Research: What is the background for this study? What are the main findings?

Dr. Walker: Cytisine is a plant-based alkaloid and is structurally similar to nicotine.  It is found in various plants from the Legume Family (Fabaceae), the third largest plant family on earth.  Cytisine is currently manufactured by Sopharma Ltd, Bulgaria (Tabex®) and Aflofarm Pharma, Poland (Desmoxan®) as a smoking cessation treatment, with the cytisine used in the tablets taken from a plant called Golden Rain (Laburnum anagyroides).  Cytisine has been available with and without prescription for smoking cessation since the 1960s, largely in Eastern Europe.   Cytisine is not currently registered for use in any Western countries (although regulatory approval is currently been sought for the USA , UK and Japan).

            We know from trial evidence that cytisine is better than a placebo for helping people quit smoking.  Cytisine is also one of the most affordable smoking cessation medicines available. It is much cheaper than nicotine patches, gum and/or lozenges and other smoking cessation medicine such as varenicline. This means smokers and governments are more likely to afford cytisine, especially those from low and middle income countries. However, we don’t know if cytisine is as good as nicotine patches and/or gum or lozenges, one of the most commonly used smoking cessation treatments in many western countries. We therefore undertook a pragmatic non-inferiority trial to answer this question, with recruitment of 1310 adult daily smokers who were motivated to quit, undertaken using the New Zealand national Quitline. Smokers were randomised to receive the standard 25 days of cytisine treatment or 8 weeks of nicotine patches and/or gum or lozenges.  Both groups received standard Quitline behavioural support.  Follow-up occurred at one week and one, two, and six months.

At all time points, cytisine was found to be better at helping people quit smoking than nicotine patches and/or gum or lozenges.  This finding was consistent irrespective of ethnicity, age, alcohol consumption, degree of cigarette dependence or whether participants smoked factory-made cigarettes or roll-your-owns. For reasons unknown, cytisine helped more women quit smoking than nicotine patches, gum and/or lozenges.  For men the effectiveness of the two products was similar.  Cytisine use made people less likely to relapse back to smoking. Those who did smoke when using cytisine didn’t enjoy smoking as much, and reduced the number of cigarettes they smoked.  Self-reported, non-medically verified adverse events were more common in those that used cytisine. Three out of every 10 people who used cytisine reported an adverse event, compared to 2 out of every 10 that used nicotine patches, gum and/or lozenges.  However the majority of reported side effects were mild and self-limiting. More people in the cytisine group experienced nausea, vomiting and sleep disturbances (e.g. bad dreams).

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Study Aims To Predict Outcomes of Neonatal Herpes Simplex Infections

Ann J. Melvin MD, MPH Division of Pediatric Infectious Disease Department of Pediatrics Seattle Children's Hospital, Seattle, WA 98105.MedicalResearch.com Interview with:
Ann J. Melvin MD, MPH
Division of Pediatric Infectious Disease
Department of Pediatrics
Seattle Children’s Hospital, Seattle, WA 98105.

Medical Research: What is the background for this study? What are the main findings?

Dr. Melvin: While relatively uncommon, neonatal Herpes Simplex Virus is a potentially devastating infection with significant morbidity and mortality.  We reviewed all of the neonatal HSV cases treated at our institution between 1993 and 2012 who had HSV DNA PCR results available from the plasma and/or CSF.  Most of the infants had quantitative PCR results available.  The objective of the study was to determine the clinical correlation of HSV PCR levels in the plasma and CSF.  We found a clear association between the plasma HSV level, clinical presentation and mortality.  All of the infants who died had HSV plasma DNA levels of greater than 7 log10 copies/ml.   However, neither plasma nor CSF HSV levels predicted neurologic outcome.   Clinical evidence of CNS disease was more predictive of neurologic outcome than was the CSF PCR level. We also showed the most sensitive test for diagnosis of neonatal HSV to be HSV PCR on the plasma.  However, no single test diagnostic test (plasma PCR, CSF PCR, surface cultures) was positive across all infants, so it is important to obtain samples from plasma, CSF and surface swabs in infants with symptoms consistent with HSV infection.

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What Causes Greater Variability in Lifespans In Black Americans?

Glenn Firebaugh, Ph.D. Roy C. Buck Professor of American Institutions, Sociology, and Demography College of the Liberal Arts The Pennsylvania State University University Park, PAMedicalResearch.com Interview with:
Glenn Firebaugh, Ph.D.
Roy C. Buck Professor of American Institutions, Sociology, and Demography
College of the Liberal Arts
The Pennsylvania State University University Park, PA

Medical Research: What is the background for this study? What are the main findings?

Dr. Firebaugh: Lifespans are more variable for blacks than for whites in the United States. The objective of this study was to determine why. Is it because blacks are more likely to die of causes, such as homicide, that disproportionately strike the young and middle-aged, or because age at death varies more for blacks than for whites among those who die of the same cause? It is primarily the latter. For almost all causes of death, age at death varies more among black victims than it does among white victims, especially for women. To be sure, some youthful causes of death, such as homicide and AIDS, are more prevalent among blacks, accounting for some of the greater variances in blacks’ lifespans. But these causes are largely offset by higher rates of suicide and drug poisoning deaths among whites. As a result, differences in causes of death for blacks versus whites on net account for relatively little of the difference in lifespan variance for blacks and whites.

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Burn Patients: White Blood Cell Motility Predictive of Sepsis

Daniel Irimia, M.D., Ph.D. Assistant Professor  Division of Surgery, Science & Bioengineering Massachusetts General Hospital and Harvard Medical School Associate Director, BioMEMS Resource Center Boston, MA 02129MedicalResearch.com Interview with:
Daniel Irimia, M.D., Ph.D.
Assistant Professor
Division of Surgery, Science & Bioengineering
Massachusetts General Hospital and Harvard Medical School
Associate Director, BioMEMS Resource Center
Boston, MA 02129

Medical Research: What is the background for this study? What are the main findings?

Response: Sepsis is affecting more than half of the patients with major burn injuries (20 percent of body surface) and is the leading cause of death among these patients.  Sepsis is also a significant complication for other critically ill patients. More than one million Americans are affected and it has been estimated that approximately 30% of these people die, despite significant advances in life support and antibiotics.  Early diagnosis is essential, and it has been calculated that every 6 hours of delay in a sepsis diagnosis decreases the chances of survival by 10 percent.

We have found that the motility of the white blood cells called neutrophils, inside a microfluidic device, is significantly altered two to three days before sepsis develops. Continue reading

NSAIDS May Prevent Some Squamous Cell Skin Cancers

Dr Catherine Olsen  |  Senior Research Officer QIMR Berghofer Medical Research Institute Royal Brisbane Hospital, QLD 4029MedicalResearch.com Interview with:
Dr Catherine Olsen  |  Senior Research Officer
QIMR Berghofer Medical Research Institute
Royal Brisbane Hospital, QLD 4029

Medical Research: What is the background for this study? What are the main findings?

Response: Squamous cell carcinomas (SCCs)are the second most common skin cancer occurring in white skinned populations. They cause significant morbidity as they can invade local structures (often the nose or ears) and they also have the potential to metastasize although most are successfully treated before any spread occurs. They are also very expensive cancers to treat because they are so common, posing a significant burden on health care budgets. NSAIDS have been shown to be protective for other cancers (e.g. colorectal and oesophageal cancer). This prompted use to evaluate all of the available evidence on NSAIDs use and SCC by conducting a systematic review and meta-analysis of the association.
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Pilots and Cabin Crew Fly With Greater Risk of Melanoma

Martina Sanlorenzo, MD Department of Dermatology Mount Zion Cancer Research Center University of California, San FranciscoMedicalResearch.com Interview with:
Martina Sanlorenzo, MD
Department of Dermatology
Mount Zion Cancer Research Center
University of California, San Francisco


Medical Research: What is the background for this study?

Dr. Sanlorenzo: We recently performed a meta-analysis and found an increased risk of melanoma in pilots and cabin crew. One of the possible occupational hazards responsible for this risk is UV radiation.

Medical Research: What are the main findings?

Dr. Sanlorenzo: We performed UV measurements in airplane cockpits during flight and we found that windshields blocked UV-B but allowed UV-A transmission. We compared the UV-A dose in airplanes with the UV-A dose in tanning beds, whose use is a known risk factor for melanoma. Pilots flying for 56.6 minutes at 30,000 feet received the same amount of UV-A carcinogenic effective radiation of a 20-minute tanning beds session.
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Age of Menarche Linked To Heart Disease Onset

MedicalResearch.com Interview with:
Dexter Canoy, PhD
Cancer Epidemiology Unit, Nuffield Department of Population Health
University of Oxford, United Kingdom

Medical Research: What is the background for this study? What are the main findings?

Response: Over a million middle-aged women in the UK who took part in our study between 1996 and 2001 provided information regarding their health and lifestyle, including their reproductive history such as age when they had their first menstruation. We followed them for over 10 years and identified those who developed heart disease (and other vascular diseases) by obtaining information on hospitalizations and death records. Our study demonstrates that on average, women with menarche before age 13 or after this age have slightly increased risks of developing heart disease, stroke and hospital admissions associated with hypertension. The increased risks for these vascular diseases were highest in women with menarche at age 10 years or younger, or age 17 years or older. This U-shaped association was consistently found among lean, overweight and obese women, among never, past or current smokers, or among women in low, middle or high socioeconomic group.

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Hospital-Based Exercise Program Reduced Pain, Improved Quality of Life

Sandra Goldsmith, MA, MS, RD Director of Public and Patient Education at Hospital for Special Surgery New York City.MedicalResearch.com Interview with:
Sandra Goldsmith, MA, MS, RD
Director of Public and Patient Education at Hospital for Special Surgery
New York City.

Medical Research: What is the background for this study? What are the main findings?

Response: Almost 50 million adults in the United States suffer from some form of musculoskeletal disorder, which can affect their mobility and quality of life. Osteoarthritis (OA) is the leading cause of disability in the U.S. and affects more than 70 percent of adults between the ages of 55 and 78. Research has shown that there is a connection between being physically active and maintaining joint health, pain relief and improved quality of life. This study attempts to support the efficacy of Hospital for Special Surgery’s hospital-based exercise programs in increasing physical activity and improving quality of life through pain relief and improved stiffness, fatigue and balance in the older adult community.

This study found that after taking the exercise classes, fewer participants reported experiencing a high level of muscle/joint pain from their condition (56 percent before the program started vs. 47 percent after completing the program). The study also reported improved quality of life, as evidenced by statistically significant reductions in how much their pain interfered with their general activities, ability to walk, mood, sleep and enjoyment of life. In addition, 83 percent of participants indicated a reduction in stiffness; 82 percent said they felt their balance improved; and 67 percent said they experienced less fatigue as a result of taking part in the program. Health outcomes were also related to the type of exercise class participants chose, with the greatest reduction in muscle/joint pain reported by those who took t’ai chi.

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Obesity Linked To Blood Pressure Day-to-Day Variability

Mohammed Elfaramawi , MD PhD MPH MSc Assistant Professor Epidemiology Department College of Public Health University of Arkansas for Medical Sciences Little rock, AR 72205 MedicalResearch.com Interview with:
Mohammed Elfaramawi , MD PhD MPH MSc
Assistant Professor
Epidemiology Department
College of Public Health
University of Arkansas for Medical Sciences
Little rock, AR 72205

Medical Research: What is the background for this study? What are the main findings?

Dr. Elfaramawi: A substantial increase in prevalence of obesity has been documented globally. In the USA, overweight and obesity are the second leading cause of preventable death in the USA, affecting ∼97 million adults. Evidence has accumulated showing that visit-to-visit blood pressure variability is associated with adverse cardiovascular outcomes. This study is one of few studies which explored the relationship between obesity and visit-to-visit blood pressure variability. Continue reading

DNR Orders Improved Quality of Life In Week Before Death

MedicalResearch.com Interview with:
Melissa Garrido, PhD

Research Health Science Specialist
GRECC, James J Peters VA Medical Center, Bronx, NY
Assistant Professor Brookdale Department of Geriatrics & Palliative Medicine
Icahn School of Medicine at Mount Sinai, New York, NY and

Holly G. Prigerson, PhD
Center for Research on End of Life Care
Weill Cornell Medical College New York, NY 10065

Medical Research: What is the background for this study? What are the main findings?

Response: Recent proposals in Congress encourage patients to engage in advance care planning and to complete advance directives. That is, patients are encouraged to have conversations about end-of-life care preferences and to document these preferences in writing (through living wills or medical orders such as do not resuscitate (DNR) orders) or to designate a durable power of attorney who can honor their preferences. The goal of advance care planning is to ensure that seriously ill patients receive care that matches their values. In this study, we used data from a prospective study of patients with advanced cancer and their caregivers to examine whether living wills, durable powers of attorney, and DNR orders were associated with better quality of life and lower estimated costs of care in the week before death. We examined these relationships among patients who did and did not express preferences for “heroic” end-of-life care (everything possible to remain alive).

Medical Research: What are the main findings?

Response: DNR orders were associated with better quality of life in the week before death among the entire sample. If patients have DNR orders completed, they are likely to have a better quality of life/quality of death than if they do not complete a medical order like this.

We did not find any evidence of a relationship between DNR orders and costs of care, nor did we find evidence of relationships among living wills or durable powers of attorney, quality of life, and costs of care. There was no evidence that relationships among advance care planning and outcomes differed by patient preferences for heroic care.
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Brain Injury: Using Music Video Eye Tracking To Predict Recovery

Uzma Samadani, MD. PhD. FACS. Chief Neurosurgeon New York Harbor Health Care System Co-Director Steven and Alexandra Cohen Veterans Center for PTSD and TBI Assistant Professor Departments of Neurosurgery, Psychiatry and Physiology & Neuroscience New York University School of Medicine New York , NY 10010MedicalResearch.com Interview with:
Uzma Samadani, MD. PhD. FACS.
Chief Neurosurgeon New York Harbor Health Care System
Co-Director Steven and Alexandra Cohen Veterans Center for PTSD and TBI
Assistant Professor Departments of Neurosurgery, Psychiatry and Physiology & Neuroscience
New York University School of Medicine New York , NY 10010

Medical Research: What is the background for this study? What are the main findings?

Dr. Samadani: Eye tracking has been used for 30 years to investigate where people look when they follow particular visual stimuli.  Tracking has not, however, been previously used to assess underlying capacity for eye movement.  We have developed a very unique eye tracking algorithm that assesses the capacity of the brain to move the eyes.

What we show in this paper is that with our eye tracking algorithm we can show
(1) normal people have eye movements that, within a particular range, have equal capacity for vertical and horizontal movement,
(2) people with specific weaknesses of the nerves that move the eyes up and down have decreased vertical capacity,
(3) people with weaknesses in the nerves that move the eyes to the side have decreased horizontal capacity,
(4) swelling in the brain can affect the function of these nerves and be detected on eye tracking,
(5) eye tracking may be useful as a potential biomarker for recovery from brain injury.

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Cocaine Chief Cause of Cardiovascular Death In Young People

MedicalResearch.com Interview with:
Luis F. Callado M.D., Ph.D.
Department of Pharmacology
University of the Basque Country
CIBERSAM

Medical Research: What is the background for this study? What are the main findings?

Dr. Callado: Cocaine is the most commonly used illicit stimulant drug in Europe. The use of cocaine has become a major issue for drug policy, with also important health implications, including potentially lethal cardiovascular complications. In this way, several case series have suggested a relationship between cocaine use and cardiovascular diseases in young adults. Furthermore, cocaine use has been also associated with sudden and unexpected death.

Our results demonstrate that the recent use of cocaine is the main risk factor for sudden cardiovascular death in persons between 15 and 49 years old. Thus, persons that consumed cocaine recently presented a 4 times higher risk for sudden cardiovascular death than those who did not use cocaine. The morphological substrate of sudden cardiovascular death associated to cocaine use is a structural pathology not diagnosed in life. Usually, sudden death is the first manifestation of the disease.

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Public Disclosure of Antibiotic Prescription Rates Decreased Usage

Dong Wook Shin, MD, MBA, DrPH Assistant Professor, Center for Health Promotion/Dept.of Family Medicine Seoul National University HospitalMedicalResearch.com Interview with:
Dong Wook Shin, MD, MBA, DrPH

Assistant Professor, Center for Health Promotion/Dept.of Family Medicine
Seoul National University Hospital

Medical Research: What is the background for this study? What are the main findings?

Response: In South Korea, the National Health Insurance provides universal coverage and the Health Insurance Review & Assessment Service (HIRA) oversees claims reviews. HIRA has reported the rates of antibiotic prescriptions for upper respiratory tract infections in each clinic via web site since 2006. We assessed the effect of public disclosure.

The main findings are that decreases of antibiotic uses were observed since the public disclosure of the prescription rates regardless of hospital level.
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Over Half Colon Cancer Deaths Due To Not Getting Screened

MedicalResearch.com Interview with:
Reinier G.S. Meester, M.Sc
Department of Public Health,
ErasmusMC, Rotterdam, Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: Despite decreasing death rates from colorectal cancer over the past decades, it still ranks as the second leading cause of cancer deaths in the U.S. Screening for colorectal cancer is highly effective, but only 58% of the eligible population reported up-to-date with screening. This suggests that a substantial proportion of current colorectal cancer deaths in the U.S. are avoidable.

We found that approximately 60% (32,200 deaths) of current deaths from colorectal cancer may be due to not receiving screening.
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