Depression Linked To Worse Heart Failure Outcomes in Blacks

 Dr. Robert J. Mentz MD Assistant Professor of Medicine Director, Duke University Cooperative Cardiovascular Society Advanced Heart Failure and Cardiac Transplantation Duke University Medical Center Duke Clinical Research InstituteMedicalResearch.com Interview with:
Dr. Robert J. Mentz MD
Assistant Professor of Medicine
Director, Duke University Cooperative Cardiovascular Society
Advanced Heart Failure and Cardiac Transplantation
Duke University Medical Center
Duke Clinical Research Institute

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

Dr. Mentz: Previous studies have shown that depression is associated with worse outcomes in heart failure patients; however, most of these prior studies were conducted in primarily white patient populations. The impact of depressive symptoms on outcomes specifically in blacks with heart failure has not been well studied. We used data from the HF-ACTION trial of exercise training in heart failure patients, which collected data on depressive symptoms via the Beck Depression Inventory (BDI-II), to assess the association between depressive symptoms and outcomes in black patients as compared with white patients. We found that in blacks with heart failure, baseline symptoms of depression and worsening of symptoms over time were both associated with increased all-cause mortality/hospitalization.

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Gene Expression Profile Improves Melanoma Risk Assessment

Pedram Gerami, M.D.Associate Professor of Dermatology Director, Melanoma Research Northwestern Skin Cancer Institute Northwestern UniversityMedicalResearch.com Interview with:
Pedram Gerami, M.D.
Associate Professor of Dermatology
Director, Melanoma Research
Northwestern Skin Cancer Institute
Northwestern University

MedicalResearch: What is the basis and background for performing this study?

Dr. Gerami: Most of the existing literature shows that Sentinel Lymph Node Biopsy (SLNB) will identify 25 to 35 percent of patients who will ultimately die of metastatic melanoma. Hence while SLNB is reported to be the strongest predictor of outcome for melanoma, the vast majority of patients who ultimately die of metastatic melanoma have a negative Sentinel Lymph Node Biopsy result. Hence in this study we aimed to determine whether a GEP assay developed by Castle bioscience could be used independently or in conjunction with SLNB to better detect those patients who are at high risk for developing metastatic disease and dying from melanoma.

MedicalResearch: What are the findings of the study?

Dr. Gerami: Our study, which examined the use of a Gene Expression Profile (GEP) assay developed by Castle Biosciences and Sentinel Lymph Node Biopsy alone and in combination in a multi-center cohort of 217 patients, demonstrated that the use of the GEP identified more than 80 percent of patients who develop melanoma

Combining the two methods showed that patients predicted to be high risk based on the GEP test alone had similar rates of disease progression whether they were SLNB positive or negative. Patients who were SLNB negative and predicted to be low risk using the GEP test had lower rates of disease progression than the SLNB negative group as a whole.

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Seizure Medication Reduced Optic Neuritis In Multiple Sclerosis

dr-raju-kapoor.jpgMedicalResearch.com Interview with:
Dr. Raj Kapoor
National Hospital for Neurology and Neurosurgery
University College London Hospitals NHS Foundation Trust

Medical Research: What is the background for this study?

Dr. Kapoor: Current treatments for Multiple Sclerosis do not prevent disability which accumulates from relapses, or which progresses between relapses. Experimental work suggests that the neurodegeneration which underlies disability could be prevented using agents which block voltage gated sodium channels. We have tested this possibility using treatment with the sodium channel blocker phenytoin in patients with acute optic neuritis. We tested whether phenytoin could prevent the degeneration seen in the retinal nerve fiber layer and macula after an attack of optic neuritis.

Medical Research: What are the main findings?

Dr. Kapoor: The main findings are that the group of patients treated with phenytoin had less degeneration in the retinal nerve fiber layer (rnfl) and in the macula (mv) in the eye affected by optic neuritis than the group treated with placebo. Phenytoin treatment reduced the degeneration by 30 % (rnfl) – 34% (mv).

Medical Research: What should clinicians and patients take away from your report?

Dr. Kapoor: This is a study designed to test the concept of neuroprotection, and it appears that the treatment was successful. Phenytoin did not lead to better vision after optic neuritis, but our trial was too small to determine whether phenytoin could achieve this. By providing proof of concept for the treatment target, however, and by demonstrating neuroprotection so robustly, we hope to open a door to even better treatments to prevent disability in Multiple Sclerosis.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kapoor: The trial suggests that proof of neuroprotection using different treatment targets could be sought in similar trials in optic neuritis. Better treatment effects could be achieved by refining the trial design, for example by looking for drugs with more potent effects on the relevant sodium channels, by treating even earlier from the onset of optic neuritis, and by combining such neuroprotection with other treatments to promote remyelination and to suppress inflammation in Multiple Sclerosis.

Citation:

2015 AAN abstract :

Phenytoin is Neuroprotective in Acute Optic Neuritis: Results of a Phase 2 Randomized Controlled Trial

 

MedicalResearch.com Interview with: Dr. Raj Kapoor (2015). Seizure Medication Reduced Optic Neuritis In Multiple Sclerosis 

HPV Vaccine Provides Protection at Multiple Sites

Daniel C. Beachler, PhD, Postdoctoral fellow Infections and Immunoepidemiology Branch of the National Cancer Institute (NCI) MedicalResearch.com Interview with:
Daniel C. Beachler, PhD
Postdoctoral fellow
Infections and Immunoepidemiology Branch of the
National Cancer Institute (NCI)

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

Dr. Beachler: HPV is a common sexually transmitted infection. Individuals can acquire HPV infections in the epithelium of their cervical, anal and oral sites, and occasionally these infections lead to cancer. There are three prophylactic HPV vaccines on the market that can protect against HPV at these sites among those not been previously exposed to HPV.
This study examined the effect of HPV vaccination of 18-25 year old women at all three anatomic sites. The combined multi-site HPV vaccine efficacy has not been reported previously. It was unknown whether the vaccine may protect non-infected sites against HPV infection or re-infection in women exposed to HPV prior to vaccination.
We observed that the HPV vaccine provides the strongest protection at all three sites among women unexposed to HPV before vaccination. Additionally, we observed some protection at the non-infected sites in women who were previously infected with HPV.

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AFib Increases Hospital Costs For Young and Older Stroke Patients

Guijing Wang, PhD Senior health economist Division for Heart Disease and Stroke Prevention Centers for Disease Control and PreventionMedicalResearch.com Interview with:
Guijing Wang, PhD
Senior health economist
Division for Heart Disease and Stroke Prevention
Centers for Disease Control and Prevention

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

Dr. Wang: Our study is one of the first to analyze the impact of hospital costs related to atrial fibrillation (or AFib) in a younger stroke population. To determine these findings, we examined more than 40,000 hospital admissions information involving adults between the ages of 18 and 64 with a primary diagnosis of ischemic stroke between 2010 and 2012.

Although AFib is more common among those ages 65 and older, with strokes among younger adults on the rise in the U.S., we wanted to take a comprehensive look at AFib’s impact on hospital costs for these patients. AFib is associated with a 4- to 5-fold increased risk of ischemic stroke, which is the most common type of stroke.

Overall, our research found that AFib substantially increased hospital costs for patients with ischemic stroke – and that was consistent across different age groups and genders of those aged 18-64. Of the 33,500 first-time stroke admissions, more than seven percent had AFib, and these admissions cost nearly $5,000 more than those without the condition. In addition, we found that both the costs of hospitalization, as well as the costs associated with AFib, were higher among younger adults (18-54) than those aged 55 to 64.

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Increased Air Pollution Linked To More Strokes, Smaller Brain Volumes

Elissa Hope Wilker, Sc.D. Beth Israel Deaconess Medical Center Cardiovascular Epidemiology Research Harvard Medical SchoolMedicalResearch.com Interview with:
Elissa Hope Wilker, Sc.D.
Beth Israel Deaconess Medical Center
Cardiovascular Epidemiology Research
Harvard Medical School

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

Dr. Wilke: Long-term exposure to ambient air pollution is associated with cerebrovascular disease and cognitive impairment, but the impact on structural changes in the brain is not well understood. We studied older adults living in the greater Boston area and throughout New England and New York and we looked at the air pollution levels and how far they lived from major roads. We then linked this information to findings from MRI studies of structural brain images. Although air pollution levels in this area are fairly low compared to levels observed in other parts of the world, we found that people who lived in areas with higher levels of air pollution had smaller brain volumes, and higher risk of silent strokes. The magnitude of association that we observed for a 2 µg/m3 increase in fine particulate matter (PM2.5) (a range commonly observed across urban areas) was approximately equivalent to one year of brain aging. The association with silent strokes is of concern, because these are associated with increased risk of overt strokes, walking problems, and depression.

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Parent-Training Improves Behavioral Problems In Children With Autism

MedicalResearch.com Interview with:
Lawrence Scahill, MSN, PhD and Karen Bearss, PhD
Department of Pediatrics, Marcus Autism Center
Children’s Healthcare of Atlanta and Emory University
Atlanta, Georgia

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

Response: Autism spectrum disorder (ASD) affects an estimated 0.6 to 1% of children worldwide.

In young children with ASD (e.g. 3 to 7 years of age) up to 50% also have disruptive
behaviors such as tantrums, aggression, self-injury and noncompliance. When present,
these disruptive behaviors interfere with the child’s readiness to make use of educational and other supportive services. The presence of disruptive behaviors also hinders the acquisition of routine daily living skills.

Parent Training has been shown to be effective for young children with disruptive behaviors who do not have Autism spectrum disorder – but it has not be well-studied in children with ASD.

The current multisite study shows that parent training is effective in reducing serious behavioral problems in young children with ASD. This is the largest randomized trial of a behavioral intervention in children with ASD.  180 children were randomly assigned to parent training or parent education. Both treatments were delivered individually to parents over 24 weeks.

Serious behavioral problems were reduced by almost 50% in the parent-training group compared to about 30% for parent education. A clinician who was blind to treatment assignment rated positive response in 69% of children in the parent training group compared to 40% for parent education. In addition, 79% of children who showed a positive response to parent training at the end of the 24-week trial maintained benefit at 6 months post treatment.

Parent training provided parents with specific strategies on how to manage tantrums, aggression, self-injury and noncompliance in children with autism spectrum disorder. Parent education provided up-to-date and useful information about ASD, but no instruction on how to address behavioral problems. Parents were engaged in the study treatments as evidenced by the low drop-out rate of 10% .

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Opioid Tampering By Health Care Providers Can Lead To Hepatitis C Transmission

MedicalResearch.com Interview with:
ChongGee Teo, MD, PhD
Chief, Laboratory Branch
Division of Viral Hepatitis
CDC

Medical Research: What is the background for this study?

Dr. Teo: Hepatitis C outbreaks in the course of providing healthcare continue to occur. Some happen when hepatitis C virus (HCV) is transmitted to patients following breakdowns in safe injection and infection control practices, and mishaps during surgery. Another route of provider – to patient HCV transmission is diversion, self-injection and substitution of opioids intended for anesthetic use (collectively referred to as “tampering”). A patient acquires infection when an HCV-infected provider, who is an injecting drug user, self-injects from a syringe prefilled with opioid anesthetic, fills the syringe with a volume substitute (e.g., saline or water), and then administers the adulterated preparation to the patient.

The study consisted of two parts:
1) to quantify the extent that anesthetic opioid tampering contributes to hepatitis C outbreaks by analyzing healthcare-associated outbreaks occurring between 1990 and 2012 in developed countries.

2) to estimate the probabilities of provider-to-patient transmission reflecting the “real-world” setting in which a patient presents for health care, unaware of risks posed by procedures conducted by a provider who may or may not be an injecting drug user or HCV infected.

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PARP Inhibitor Combo For Cancer Patients With and Without BRCA Mutation

Dr. Timothy Yap MD, PhD Timothy Yap, MD, PhD, NIHR BRC The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust London, United Kingdom.MedicalResearch.com Interview with:
Timothy Yap, MD, PhD, NIHR BRC
The Institute of Cancer Research and
The Royal Marsden NHS Foundation Trust
London, United Kingdom.

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

Dr. Yap: This is a novel phase I trial assessing for the first time if the PARP inhibitor olaparib can be combined with the AKT inhibitor AZD5363. The study was undertaken at the Royal Marsden and The Institute of Cancer Research in London, England. This targeted combination was based on strong preclinical rationale demonstrating synergy between both drugs in BRCA positive tumors and also antitumor activity in non-BRCA positive tumors. Although olaparib was recently approved by the FDA for treating advanced ovarian cancer associated with defective BRCA genes, antitumor efficacy in different non-BRCA tumors is yet to be established.

The key finding for this study was that it was indeed possible to combine both drugs safely, with multiple patients with different cancers responding, including patients with and without BRCA1/2 mutations. We also assessed a new intrapatient dose escalation phase I trial design in this study, and demonstrated that the novel design could be successfully implemented, with completion of the dose escalation phase in 2 schedules of the combination with just 20 patients in 7.5 months.

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CPAP For Sleep Apnea May Decrease Atrial Fibrillation Recurrence

Dr. Larry Chinitz MD Professor of Medicine and Director, Cardiac Electrophysiology NYU Langone Medical CenterMedicalResearch.com Interview with:
Dr. Larry Chinitz MD

Professor of Medicine and Director, Cardiac Electrophysiology
NYU Langone Medical Center

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

Dr. Chinitz: The treatment algorithms proposed currently for maintenance of sinus rhythm in patients with atrial fibrillation focus on use of anti-arrhythmic drugs and catheter ablation. Data available to evaluate the effect of modification of known adverse clinical factors on atrial fibrillation recurrence is scant.

Obstructive sleep apnea in a known factor associated with both new onset atrial fibrillation as well as its recurrence after catheter ablation. Through a meta-analysis of available data we found that use of continuous positive airway pressure in patients with sleep apnea was associated with a 42% relative risk reduction in recurrence of atrial fibrillation. This effect was similar across patient groups irrespective of whether they were medically managed or with catheter ablation.
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