Author Interviews, Coffee, Heart Disease, Red Meat, Stroke / 15.11.2017

MedicalResearch.com Interview with: Coffee being poured Coffee pot pouring cup of coffee. copyright American Heart AssociationLaura Stevens University of Colorado Aurora, CO MedicalResearch.com: What is the background for this study? What are the main findings? Response: We started with asking ourselves how we could better predict cardiovascular and stroke outcomes.  In an ideal world, we would be able to predict cardiovascular disease (CVD) and stroke with 100% accuracy long before the occurrence of the event.  The challenge here is there are so many potential risk factors, and testing each one using traditional methods would be extremely time consuming, and possibly infeasible. Therefore, we used artificial intelligence to find potential risk factors that could be important for risk of CVD and stroke.  The results of this analysis pointed to consumption of coffee cups per day and the number of times red meat was consumed per week as being potentially important predictors of CVD. We then looked into these findings further using traditional statistical analyses to determine that increased coffee consumption and red meat consumption appeared to be associated with decreased risk of CVD.  The study initially used data from the Framingham Heart Study (FHS) original cohort. The findings from this data were then tested using data from 2 independent studies, the Cardiovascular Heart Study (CHS) and the Atherosclerosis Risk in Communities Study (ARIC), which both supported the association of increased coffee consumption with decreased CVD risk. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 15.11.2017

MedicalResearch.com Interview with: Dr. Mattias Brunström Department of Public Health and Clinical Medicine Umeå University,Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current guidelines recommend a systolic blood pressure treatment target below 140 mm Hg for most people. Since the publication of SPRINT however, many have suggested guidelines should be changed, recommending further blood pressure lowering. We performed a systematic review and meta-analysis of randomized clinical trials comparing different blood pressure targets or antihypertensive treatment verus placebo. We separated primary preventive trials from secondary preventive trials, and stratified primary preventive trials by mean baseline systolic blood pressure. The analyses included 74 trials, with in total > 300 000 participants. Interestingly, we found that treatment effect was dependent on baseline systolic blood pressure in people without previous CVD. While primary preventive treatment reduced the risk of death and cardiovascular disease if systolic blood pressure was 140 mm Hg or higher, treatment effect was neutral if systolic blood pressure was below 140 mm Hg. (more…)
Author Interviews, Colon Cancer, Race/Ethnic Diversity / 15.11.2017

MedicalResearch.com Interview with: Helmneh M. Sineshaw, MD, MPH American Cancer Society Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? Response: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in both men and women in the United Sates. Although overall CRC incidence and mortality rates are decreasing in the United States, rates are increasing in the younger population. Notwithstanding these patterns, CRC incidence and mortality rates continue to be higher in blacks than in whites. Although black-white survival disparity among patients with colorectal cancer is well documented in the literature and multiple factors have been proposed as potential contributors, the contributions of differences in demographic characteristics, insurance type, comorbidity, tumor presentation, and treatment receipt to the racial disparity in survival among nonelderly CRC patients are unknown. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 14.11.2017

MedicalResearch.com Interview with: Dr Andrew R. Chapman BHF Clinical Research Fellow University of Edinburgh Chancellors Building Edinburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: High-sensitivity cardiac troponin tests allow accurate measurement of cardiac troponin in the bloodstream. Currently, guidelines recommend we evaluate patients with suspected myocardial infarction using these tests, by looking for levels which are above the upper reference limit (99th centile). These troponin measurements are taken on arrival, and often repeated after admission to hospital up to six hours later. When levels are below this limit, the diagnosis of myocardial infarction is ruled out. However, using such a high limit in patients on arrival to hospital may not be safe, as lower risk stratification thresholds has been shown to reduce missed events,  and in these patients admission to hospital for repeat testing may not be necessary. However, there is no consensus as to the optimal threshold for use in practice. In a worldwide study of 23,000 patients from 9 countries, we have shown when high-sensitivity cardiac troponin I concentrations are below a risk stratification threshold of 5 ng/L at presentation, patients are at extremely low risk of myocardial infarction or cardiac death at 30 days, with fewer than 1 in 200 patients missed. Importantly, this threshold identifies almost 50% of all patients as low risk after a single blood test. As admission or observation of these patients is estimated to cost as much as $11 billion per year in the United States, this strategy has major potential to improve the efficiency of our practice. (more…)
Author Interviews, OBGYNE, Pediatrics / 14.11.2017

MedicalResearch.com Interview with: “1. pregnancy” by TipsTimesAdmin is licensed under CC BY 2.0Ulrika Nörby MScPharm, PhD Department of E-health and strategic IT Stockholm County Council Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: The use of ADHD medication has increased rapidly during the last 10 years, especially among young women. Thereby, questions regarding treatment with these drugs during pregnancy are common. Until now, data concerning fetal safety of ADHD medication have been sparse, especially when it comes to neonatal disorders. For amphetamine preparations, most previous studies concerned illicit drug use during pregnancy, which made it difficult to draw conclusions. Our objective was to estimate birth and neonatal outcomes after maternal use of prescribed ADHD medication during pregnancy. The main findings were that infants exposed to ADHD medication in utero had a somewhat increased risk of neonatal morbidity, especially CNS-related disorders. The odds ratio (OR) for a CNS-disorder was 1.9 for exposed infants compared to non-exposed infants. Further, exposed infants more often needed treatment at a neonatal intensive care unit (NICU), OR 1.5, and were more frequently moderately preterm, OR 1.3. The risk for CNS-related disorders and admission to a NICU was increased also compared to infants whose mothers used ADHD before or after, but not during, pregnancy. This finding suggests a causal relationship between treatment with ADHD medication and the neonatal outcomes. Because of large differences in maternal background characteristics between treated and non-treated women, it is however uncertain to what extent the higher neonatal morbidity is caused by the ADHD medication. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC / 14.11.2017

MedicalResearch.com Interview with: Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Overall, the incidence of myocardial infarction (MI) in the US has declined. However, it has remained stable in adults <50 years of age. We evaluated the statin eligibility of a cohort of adults who had an MI at a young age using current guidelines - the 2013 ACC/AHA guidelines for cholesterol treatment and the 2016 USPSTF guidelines on use of statins for primary prevention. In, our study we found that only 49% of these young adults would have been eligible for statin therapy prior to their MI according the 2013 ACC/AHA guidelines, and only 29% would have been eligible according to the USPSTF guidelines, despite a high prevalence of cardiovascular risk factors. These numbers were even more striking for women where only 18% were eligible for statin therapy according to the USPSTF guidelines. (more…)
Author Interviews, CT Scanning, Emergency Care, Pain Research / 14.11.2017

MedicalResearch.com Interview with: Jeff Perry, MD, MSc, CCFP-EM Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician and Epidemiology Program The Ottawa Hospital Ottawa, Ontario MedicalResearch.com: What is the background for this study? What are the main findings? Response: Headache accounts for about 1-2% of all emergency department visits.  One of the most feared diagnosis within these patients is subarachnoid hemorrhage. While investigations are clearly warranted for patients with a diminished level of consciousness or new focal neurological deficits, approximately 50% of patients with subarachnoid hemorrhage (SAH) have no focal or global neurological findings. Deciding whether to image headache patients with no deficits is difficult, especially since timely diagnosis and treatment results in substantially better outcomes. The desire to never miss a subarachnoid hemorrhage, however, contributes to escalating neuroimaging rates and a dogmatic adherence to lumbar puncture, even if the scan is negative, despite the very high sensitivity of computed tomography. However, a recent population-based study suggested that over 5% of confirmed subarachnoid hemorrhages were missed at initial presentation, especially in smaller hospitals. Therefore, identifying which headache patients require investigations to rule-out SAH is of great importance. We have previously derived (N=1,999) and refined (N=2,131) the Ottawa SAH Rule. In this study, we conducted an multicenter prospective cohort study at six tertiary care hospitals, and found that the Ottawa SAH Rule performed well, with an 100% sensitivity, and specificity of 13.6%. (more…)
Author Interviews, Heart Disease, Technology / 14.11.2017

MedicalResearch.com Interview with: Abdul Wase MD FACC FACP FHRS Clinical Professor of Medicine & Director, Cardiology Fellowship Program, Wright State University Boonshoft School of Medicine, Director, Electrophysiology Laboratories Good Samaritan Hospital, Dayton, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Implantable cardiac defibrillators (ICD) patients are subject to electromagnetic interferences (EMI) from outside electrical sources. TESLA electric vehicle has a large battery underneath the surface of vehicles, which may potentially interfere with the functioning of these devices. In the owner’s manual, TESLA warns that using mobile connector may impair the functioning of implantable pacemaker or a defibrillator. (more…)
Asthma, Author Interviews, JAMA, Orthopedics, Pediatrics / 14.11.2017

MedicalResearch.com Interview with: “Asthma” by Michael Havens is licensed under CC BY 2.0Teresa To, PhD Biostatistics, Design and Analysis Scientific Director The Hospital for Sick Children Dalla Lana School of Public Health, University of Toronto Institute for Clinical Evaluative Sciences Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: We studied asthma prescription drug use in Ontario children aged 2 to 18 years with physician diagnosed asthma between 2003 and 2014. We found that:
  1. Currently in Ontario, nearly 50% of children with asthma did not fill a prescription for an inhaled corticosteroid during the study period, despite these medications being considered the gold-standard for asthma management.
  2. Our findings did not show clinically important association between inhaled corticosteroids and fracture among children with asthma.
  3. However, systemic corticosteroids (oral or injection) are associated with higher fracture risk in children with asthma (17% higher risk).
(more…)
Author Interviews, Heart Disease, Nutrition / 14.11.2017

MedicalResearch.com Interview with: “Fresh Food” by Sonny Side Up! is licensed under CC BY 2.0   Dr. Kyla M Lara Icahn School of Medicine at Mount Sinai       MedicalResearch.com: What is the background for this study? What are the main findings? Response: This was the first study to evaluate whether dietary patterns of black and white adults living in the United States were associated with developing heart failure. We’re hearing a lot in the news about specific diets like low-fat, high protein, low carb, and other diets that decrease cardiovascular risk. We would love it, as physicians, if we could prescribe a specific diet to limit cardiovascular risk in our patients. I’m really excited about our study because instead of examining patterns of what we already know are healthy, we looked at foods people were regularly consuming in the United States and developed dietary patterns from this. This study is similar to other work we have done with stroke and heart attack. We used data from the NIH funded REGARDS study, also known as the Reasons for Geographic and Racial Differences in Stroke. More than 30,000 white and African-American adults were recruited from 2003-2007. From this group, we studied over 18,000 adults who successfully completed a dietary assessment called the Food Frequency Questionnaire. This was a really great group to study because people who live in this particular geographic area of the Southeastern United States, also known as the stroke belt, suffer from a higher risk of death from stroke. It’s extremely important for us to better understand the major risk factors that contribute to this and also cardiovascular disease. We used statistical techniques to derive 5 dietary patterns based on the types of foods participants tended to eat. • Convenience - Mexican and Chinese food, mixed dishes (both meat and bean) • Sweets - added fats, bread, chocolate, desserts, sweet breakfast foods • Southern - added fats, fried food, organ and processed meat, fatty milk • Alcohol/Salads - beer, wine, liquor, green leafy vegetables, salad dressings, nuts and seeds, coffee • Plant Based- fruit, vegetables, fruit juice, cereal, fish, poultry Each participant received a score for each pattern that reflected how closely their diet resembled that dietary pattern. This approach reflects the real world and how people eat. Over the 3135 days (8.6 years) of median follow up, 594 participants were hospitalized for incident HF. Greatest adherence to the plant-based dietary pattern during the study period was associated with a 28% risk reduction of developing heart failure. (more…)
Author Interviews, Cost of Health Care, Education, JAMA / 14.11.2017

MedicalResearch.com Interview with: Victoria Valencia, MPH Assistant Director for Healthcare Value Dell Medical SchoolThe University of Texas at Austin MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were surprised to find that despite the common anecdote that resident physicians in teaching environments order more lab tests, there was a lack of empirical data to support the claim that more lab tests are ordered for patients at teaching hospitals than at non-teaching hospitals. Our study of 43,329 patients with pneumonia or cellulitis across 96 hospitals  in the state of Texas found that major teaching hospitals order significantly more lab tests than non-teaching hospitals.  We found this to be true no matter how we looked at the data, including when restricting to the least sick patients in our dataset. We also found that major teaching hospitals that ordered more labs for pneumonia tended to also more labs for cellulitis, indicating there is some effect from the environment of the teaching hospital that affects lab ordering overall. (more…)
Author Interviews, Geriatrics, Heart Disease, JACC, UCLA / 14.11.2017

MedicalResearch.com Interview with: Kevin S. Shah, M.D. Cardiology Fellow, University of California, Los Angeles Ronald Reagan UCLA Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Heart failure (HF) is a chronic condition and progressive disease which is associated with a high-risk of hospitalization and death. One of the principle ways in which heart function is estimated is the use of ultrasound to calculate the ejection fraction of the heart, an estimate of the heart’s pump function. The ejection fraction can help predict how long patients will live and affects decision-making with regards to what medications may help their condition. A total of 39,982 patients from 254 hospitals who were admitted for Heart failure between 2005 and 2009 were included. They were followed over time to see if they were admitted to the hospital again or if they died during this period. We compared three subgroups within this large group of patients based on their estimated ejection fraction. Across subgroups, the 5-year risk of hospitalization and death was high when compared with the U.S. population. Furthermore, the survival for patients with a diagnosis of heart failure who have been hospitalized once for this condition have a similarly poor 5-year risk of death and re-hospitalization, regardless of their estimated ejection fraction. (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 14.11.2017

MedicalResearch.com Interview with: Barbara L. McAneny MD, CEO New Mexico Oncology Hematology Consultants, Ltd. Albuquerque, NM 87109  MedicalResearch.com:   What is the meant by value-based care? Response: There are a lot of people using this term to mean a variety of things, confusion is not surprising.  Generally it means a move to pay more for better patient outcomes and less for worse patient outcomes.  Currently in our Fee for Service system, there are a lot of services for which there are no fees. That deficiency keeps physicians from looking at non face-to-face delivery methods or the use of other health professionals to augment the care they give, because we can’t afford to give services that we aren’t paid to give. (more…)
Author Interviews, Cost of Health Care, Primary Care, University of Pennsylvania / 14.11.2017

MedicalResearch.com Interview with: Molly Candon, PhD Postdoctoral Fellow Leonard Davis Institute of Health Economics Center for Mental Health Policy and Services Research University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: We conducted a secret shopper study in 2012, 2014, and 2016 in which simulated Medicaid patients called primary care practices and attempted to schedule an appointment. When Medicaid fees were increased to Medicare levels in 2013 and 2014, primary care appointment availability increased. Once the federally-funded program ended in 2015, most states returned to lower fees. As expected, provider participation in Medicaid declined as well. (more…)
Author Interviews, Cost of Health Care, HIV, Lancet / 13.11.2017

MedicalResearch.com Interview with: Dr Valentina Cambiano PhD Institute for Global Health University College London London UK MedicalResearch.com: What is the background for this study? Response: Pre-Exposure Prophylaxis (PrEP) which involves the use of drugs, which are used to treat HIV, in people without HIV to prevent them from getting is a critical new advance in HIV prevention. It has been shown to reduce the risk of HIV infection by 86% and the benefits heavily out-weigh any concerns. However, introducing this intervention has a cost. When we started working on this study the National Health Services was discussing whether to introduce PrEP and if so for which populations. Unfortunately, at the moment NHS England is not providing Pre-exposure prophylaxis. However, a large study, the PrEP impact trial, funded by the NHS, has just started and this will provide PrEP to 10,000 people. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA / 13.11.2017

MedicalResearch.com Interview with: Ankur Gupta, MD, PhD Division of Cardiovascular Medicine Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Hospital Readmissions Reduction Program (HRRP), established under the Affordable Care Act, aimed to reduce readmissions from various medical conditions including heart failure - the leading cause of readmissions among Medicare beneficiaries. The program financially penalizes hospitals with high readmission rates. However, there have been concerns of unintended consequences especially on mortality due to this program. Using American Heart Association's Get With The Guidelines-Heart Failure (GWTG-HF) data linked to Medicare data, we found that the policy of reducing readmissions after heart failure hospitalizations was associated with reduction in 30-day and 1-year readmissions yet an increase in 30-day and 1-year mortality. (more…)
Author Interviews, Dermatology, J&J-Janssen, Pharmaceutical Companies, Rheumatology / 13.11.2017

MedicalResearch.com Interview with: Atul A. Deodhar, MD, MRCP, FACP, FACR Professor of Medicine Division of Arthritis & Rheumatic Diseases Medical Director, Rheumatology Clinics Medical Director, Immunology Infusion Center Oregon Health & Science University (OHSU)  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Phase 2, randomized, double-blind, placebo–controlled, multicenter trial was designed to evaluate the efficacy and safety of guselkumab (Tremfya®) compared with placebo in adults with active psoriatic arthritis, despite having received treatment with standard-of-care therapies, including anti-tumor necrosis factor (TNF)-alpha agents. In an observed analysis presented at ACR 2017, more than 70 percent of patients receiving guselkumab achieved at least a 20 percent improvement in signs and symptoms of disease (ACR 20) at week 56.  Findings also showed that improvements in tender and swollen joints, skin clearance, pain and physical function, and patient-reported quality of life outcomes reported at week 24, were maintained through week 56 in patients receiving guselkumab maintenance therapy (subcutaneous injections every eight weeks).  (more…)
Author Interviews, Education, Heart Disease, Pediatrics / 13.11.2017

MedicalResearch.com Interview with: Young girl learning Hands-Only CPR at the American Heart Association Hands-Only CPR training kiosk at Cincinnati-Northern Kentucky International Airport. copyright American Heart Association 2017 Photos by Tommy Campbell PhotographyMimi Biswas M.D., MHSc University of California Riverside School of Medicine and Riverside Community Hospital  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This started as  My son's science project. He wanted to make a video game to teach CPR based on a science fair website. It grew to teaching the whole 6th grade using the AHA CPR training kit alone vs adding the video game or music, staying alive, to help with compression rate.  We found that a 12 year can easily learn the basic concepts of calling for help and starting hands only CPR and they can physically perform effective CPR at this age. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Heart Disease, JACC, Nutrition, Salt-Sodium / 13.11.2017

MedicalResearch.com Interview with: Stephen P. Juraschek, MD, PhD Instructor of Medicine Beth Israel Deaconess Medical Center/Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The DASH-Sodium trial demonstrated that both the DASH diet and sodium restriction, individually and combined, lowered blood pressure in adults with pre-hypertension or stage 1 hypertension. Whether these effects varied by level of blood pressure prior to starting these interventions was unknown. In a secondary analysis of the original DASH diet it had been observed that the effects from DASH were greater among adults with higher blood pressure (systolic greater than or equal to 140 mm Hg) at baseline with the appearance of even greater effects among people with baseline systolic blood pressures above 150 mm Hg. However, this has never been shown. Furthermore, it was unknown whether sodium reduction followed a similar linear trend of greater effects among adults with more severely uncontrolled systolic blood pressure. In our study, we found that effects were indeed greater in adults with a baseline systolic blood pressure of 150 mm Hg or greater. Furthermore, the combined systolic blood pressure-lowering effect from both interventions was as high was 20 mm Hg. This is a magnitude comparable if not greater than medications for lowering blood pressure. (more…)
Author Interviews, Cancer Research, Orthopedics, Pharmacology / 13.11.2017

MedicalResearch.com Interview with: Charles L.Shapiro MD Professor of Medicine Director of Translational Breast Cancer Research Director of Cancer Survivorship Division of Hematology/Oncology Tisch Cancer Institute New York, NY MedicalResearch.com: What is the background for this study? What are the main findings? Response: The new 2017 ASCO guidelines for the use bone-modifying in individuals with bone metastases recently endorsed every 3-month zoledronic, because of high level evidence from three randomized trials, including our trial (published in Jama in Jan 2017, first author Himelstein et al) that giving zoledronic acid every 3-months was non-inferior to the standard of monthly zoledronic. The guidelines also concluded that there was not one preferred bone modifying agent of the other, despite the fact the comparing monthly zoledronic to monthly denosumab in women with bone metastases, denosumab delayed the time to first skeletal-related event (pathological fractures, necessity for radiation or surgery, and spinal cord compression) and subsequent events by 23% (or in absolute terms about 3 months) . Zoledronic acid became generic in 2013, whereas monthly denosumab is still patented until 2022-25. (more…)
Author Interviews, Psychological Science / 12.11.2017

MedicalResearch.com Interview with: Dr. Miguel Farias, DPhil Reader in Cognitive and Biological Psychology Coventry University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the past 20 years, cognitive psychologists have suggested that believing in the supernatural is something that comes to us 'naturally' or intuitively. Previous studies have suggested people who hold strong religious beliefs are more intuitive and less analytical, and when they think more analytically their religious beliefs decrease. Our new research has challenged this. We used various experimental methods, including field research in the pilgrimage route to Santiago de Compostela and neural stimulation. , by academics from Coventry University's Centre for Advances in Behavioural Science and neuroscientists and philosophers at Oxford University, suggests that is not the case, and that people are not 'born believers'. (more…)
Author Interviews, Autism, Genetic Research, Nature / 12.11.2017

MedicalResearch.com Interview with: Woo-Yang Kim, Ph.D Associate Professor Department of Developmental Neuroscience Munroe-Meyer Institute University of Nebraska Medical Center Omaha, NE 68198-5960 MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Autism impairs the ability of individuals to communicate and interact with others. About 75 percent of individuals with autism also have intellectual disability, which is characterized by significant limitations in cognitive functions and adaptive behaviors. While autism and intellectual disability are currently defined using behavioral criteria, little is known about the neuropathogenesis of these conditions. Recent genetic studies have reported that haploinsufficiency of ARID1B causes autism and intellectual disability. However, the neurobiological function of ARID1B during brain development is unknown. Our study investigated the neurobiological role of the gene in brain development. Using genetically-modified mice, we found that Arid1b haploinsufficiency leads to an excitation-inhibition imbalance by reducing the number of GABAergic interneurons in the cerebral cortex. Furthermore, we showed that treatment with a GABAA-receptor positive allosteric modulator rescues ASD-like behavior and cognitive dysfunction in Arid1b-haploinsufficient mice, suggesting an association between lower numbers of GABAergic interneurons and behavioral outcomes. Our findings suggest a pathogenic mechanism for Autism Spectrum Disorder and intellectual disability. (more…)
Author Interviews, Pain Research, Radiology / 12.11.2017

MedicalResearch.com Interview with: Dr. Alessandro Napoli Dipartimento di Scienze Radiologiche Unità di Terapia con Ultrasuoni Focalizzati Sapienza Università di Roma, Policlinico Umberto I Rome MedicalResearch.com: What is the background for this study? What are the main findings? Response: Low back pain and sciatica are very common conditions affecting at least 80% of the population (once in life) with detrimental impact on quality of life. Pain cause is often a lumbar disc herniation with sciatic nerve compression. Treatment strategy is primarily conservative (drugs and physical therapy) and when symptoms are persisting for more than 4 consecutive weeks, surgery is advocated. Many patients prefer to avoid surgery for multiple reasons (recurrence rate, risk-related to the intervention and post-surgical sequela). Technology advances with percutaneous techniques allowed more recently to fill the gap between conservative strategy and surgery for the management of lumbar disc herniation and related low back pain extending to the leg(s). Patients are offered local injection for symptoms relief with limited results. Therefore, other non-to-mini invasive approaches are clinically tested for prolonged clinical efficacy. Pulsed radiofrequency is a promising percutaneous approach mainly used for chronic pain. We aimed to test pulsed radiofrequency in patients refractory to conservative treatments, indicated to surgery. Our study demonstrated that radiofrequency with pulsed technique, performed under CT image guidance, is able to control pain in a surgical-free, single session, lasting 10 minutes. The procedure is highly attractive since can be considered nearly risk-free with high rate of success. In our series 80% of patients treated with pulsed radiofrequency resulted pain free (VAS pain score 0 out of 10) at 1, 3 and 12 months follow-up; 90% did not required anymore surgery. (more…)
Author Interviews, Gender Differences, Social Issues / 12.11.2017

MedicalResearch.com Interview with: Francesco Acciai PhD Postdoctoral Research Associate Food Policy and Environmental Research Group School of Nutrition and Health Promotion Arizona State University MedicalResearch.com: What is the background for this study? Response: In 2015 life expectancy at birth (e0) in the United States was lower than it was in 2014. In the previous 30 years, a reduction in life expectancy at the national level had occurred only one time, in 1993, during the HIV/AIDS epidemic. The decrease in life expectancy observed in 2015 is particularly worrisome because it was not generated by an anomalous spike in a specific cause of death (like HIV/AIDS in 1993). Instead, age-adjusted death rates increased for 8 of the 10 leading causes of death—heart disease, chronic lower respiratory diseases, accidents, stroke, Alzheimer's, diabetes, kidney disease, and suicide, according to the CDC. (more…)
Author Interviews, JAMA, Lung Cancer, Medical Imaging, Surgical Research, Vanderbilt / 10.11.2017

MedicalResearch.com Interview with: Amelia W. Maiga, MD MPH Vanderbilt General Surgery Resident VA Quality Scholar, TVHS MedicalResearch.com: What is the background for this study? What are the main findings? Response: Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. Our investigation adds to growing evidence that FDG-PET scans should be interpreted with caution in the diagnosis of lung cancer. Misdiagnosis of lung lesions driven by FDG-PET avidity can lead to unnecessary tests and surgeries for patients, along with potentially additional complications and mortality. To estimate FDG-PET diagnostic accuracy, we conducted a multi-center retrospective cohort study. The seven cohorts originating from Tennessee, Arizona, Massachusetts and Virginia together comprised 1188 nodules, 81 percent of which were malignant. Smaller nodules were missed by FDG-PET imaging. Surprisingly, negative PET scans were also not reliable indicators of the absence of disease, especially in patients with smaller nodules or who are known to have a high probability of lung cancer prior to the FDG-PET test. Our study supports a previous meta-analyses that found FDG-PET to be less reliable in regions of the country where fungal lung diseases are endemic. The most common fungal lung diseases in the United States are histoplasmosis, coccidioidomycosis and blastomycosis. All three fungi reside in soils. Histoplasmosis and blastomycosis are common across much of the Mississippi, Ohio and Missouri river valleys and coccidioidomycosis is prevalent in the southwestern U.S. These infections generate inflamed nodules in the lungs (granulomas), which can be mistaken for cancerous lesions by imaging. (more…)
Abuse and Neglect, Author Interviews, Cancer Research, ENT, JAMA, Smoking, Social Issues / 10.11.2017

MedicalResearch.com Interview with: Nosayaba Osazuwa-Peters, BDS, MPH, CHES Instructor, Department of Otolaryngology-Head and Neck Surgery Saint Louis University School of Medicine Member, Saint Louis University Cancer Center St Louis, Missouri  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Several studies have shown that there is an adverse effect of smoking on head and neck cancer survival; however, there are studies that show no effect between smoking and head and neck cancer. We wanted to investigate this problem using a single institution’s cancer dataset. Additionally, we wanted to understand the role of marital status in the smoking behavior of head and neck cancer patients, and to understand if smoking played any role in head and neck cancer survival. Our study confirmed that head and neck cancer patients who were smokers at the time of diagnosis had lower survival rates than nonsmokers. We also found that married head and neck cancer patients were less likely to be smokers and more likely to survive longer than those unmarried. (more…)
Abuse and Neglect, Author Interviews, Genetic Research, OBGYNE, Pediatrics / 10.11.2017

MedicalResearch.com Interview with: Professor Sir Nicholas Wald FRCP FRS Professor of Preventive Medicine Wolfson Institute of Preventive Medicine Barts and The London School of Medicine and Dentistry Queen Mary University of London London MedicalResearch.com: What is the background for this study? Response: Prenatal screening for Down’s syndrome (trisomy 21), Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13) by maternal plasma DNA analysis has an improved screening performance compared with conventional screening but is too expensive to be performed routinely and has a technical failure rate. The aim of the study was to take advantage of the improved screening performance of the DNA analysis in conjunction with the existing methods thereby providing a seamless testing interface between the “old” and the “new” methods that would detect a larger proportion of affected pregnancies with a much lower false-positive rate, at a much reduced cost compared with universal DNA testing and with no failed tests. The novel approach was to conduct a conventional screening test using a screening cut-off level that identifies about 10% of women with the highest risks of having an affected pregnancy (much higher than in conventional screening) and then to perform a DNA test using a portion of the original blood sample collected for the conventional test. Progressing to the DNA test was automatic for these high risk women without their having to be recalled for counseling and a fresh blood sample (ie as a reflex response hence the term “reflex DNA screening”). (more…)
Author Interviews, Gender Differences, HIV, Sexual Health / 09.11.2017

MedicalResearch.com Interview with: Adrian Juarez, PhD, RN Assistant Professor The State University of New York School of Nursing Department of Family, Community and Health Systems Sciences Buffalo, New York 14214     MedicalResearch.com: What is the background for this study? Response: HIV testing is considered the initial component of HIV eradication strategies such as “seek, test, treat, and retain.” This study examines the characteristics of an urban, transgender population in western New York when volunteering for an HIV test. The use of an intersectional lens was observed in order to determine the level of influence of sexual partnership types, previous HIV and STD testing, substance use, housing status referral source and racial/gender identification on HIV testing. (more…)
Author Interviews, Pediatrics, Social Issues, Weight Research / 09.11.2017

MedicalResearch.com Interview with: Dr. Jianghong Li, Senior Research Fellow WZB Berlin Social Science Center Berlin, Germany Telethon KIDS Institute, The University of Western Australia West Perth, Western Australia MedicalResearch.com: What is the background for this study? Response: Over the last three to four decades, the prevalence of child overweight/obesity and maternal employment has both increased worldwide. This co-occurrence has drawn much attention to the connection between these two trends. Previous studies, predominantly based on US samples and cross-sectional data, has linked longer working hours to children’s higher body mass index (BMI), suggesting that any maternal employment was a risk for child health. (more…)
Author Interviews, Dermatology, Infections, Johns Hopkins / 09.11.2017

MedicalResearch.com Interview with: Lloyd S. Miller, M.D., Ph.D. Vice Chair for Research, Department of Dermatology Associate Professor of Dermatology, Infectious Diseases, Orthopaedic Surgery & Materials Science and Engineering Faculty Member, Cellular and Molecular Medicine (CMM) and Pathobiology Graduate Programs Johns Hopkins Department of Dermatology Baltimore, MD 21231  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Staphylococcus aureus is a common bacterial skin pathogen and its abundance is greatly increased on affected skin of eczema patients, especially during disease flares. However, how S. aureus induces skin inflammation and exacerbates the skin inflammation is incompletely understood. In this study, we found that S. aureus exposure of mouse skin induced skin inflammation through an inflammatory mediator known as IL-36. (more…)