Dr. Jerry Wolinsky,[/caption]
Jerry S. Wolinsky, MD
Emeritus Professor in Neurology
McGovern Medical School
The University of Texas Health Science Center at Houston
Houston’s Health University
Department of Neurology
Houston, Texas 77030
MedicalResearch.com: What is the background for this study?
Response: Multiple sclerosis (MS) clinically is a very heterogeneous disease. It presents in considerably different ways and has a very poorly predictable clinical course. In an attempt to better communicate between experts in the field, there have been multiple attempts to categorize “typical” courses of the disease. How we think about the disease is in part driven by these somewhat artificial categories that lump our patients into those with relapsing forms of the disease (relapsing remitting with or without accumulating clinical disability, and secondary progressive with accumulating disability eventually occurring even in the absence of apparent clinical episodes of the disease), and primary progressive MS, where patients are slowly or sometimes rather rapidly accumulating disability in the absence of prior clinical relapses.
However, the distinctions between multiple sclerosis patients are not always as clear as the definitions would suggest, and it is certain that patients with primary progressive multiple sclerosis sometimes have clinical relapses after years of never having had relapses, and show MRI evidence of having accumulated many lesions in the brain over the course of their disease. Until now, none of the drugs that have shown benefit for relapsing disease have been able to convincingly show clinical benefit for patients with primary progressive disease, and for that matter have shown variable results when attempted in patients categorized as having secondary progressive courses. While some of our currently approved drugs have shown hints of benefit when tried in major clinical trials in primary progressive MS, the results were not been robust enough to seek regulatory approval.
The Oratorio study design was based on lessons learned from prior trials in primary progressive and relapsing forms of MS, as well as the recognition that B cells might play an important role in the immunopathogenesis of disease based on a considerable amount of preclinical work and observations in patients with multiple sclerosis.
Dr. Nicola Barclay[/caption]
Dr. Nicola Barclay, BA(Hons), MSc, PhD.
Lecturer in Sleep Medicine
Sleep and Circadian Neuroscience Institute (SCNi)
Nuffield Department of Clinical Neurosciences
Sir William Dunn School of Pathology
University of Oxford
MedicalResearch.com: What is the background for this study?
Response: We know that extreme sleep deprivation impairs our cognitive functions, particularly attention. This impairment in attention is likely to be driven by physiological mechanisms that change across the waking day (increasing sleep pressure), but also by factors associated with our biological clock. The timing of physiological processes particularly related to attention differ between morning and evening type people (our so called early morning larks and night owls), and so we hypothesised that morning and evening types would differ in their impairments in attention at different times of day, prior to and following 18 hours of sustained wakefulness.
Prof. Jamal Tazi[/caption]
Prof. Jamal Tazi
Institut de Génétique Moléculaire de Montpellier
University of Montpellier
Montpellier, Cedex, France
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Intense drug discovery efforts in the metabolic field highlight the need for novel strategies for the treatment of obesity. In this study we have used a novel approach to uncover novel drugs to treat obesity. Our approach is based on the finding that in humans the energy expenditure balance can be controlled by a single gene LMNA gene that can produce two different proteins with opposing effect on energy expenditure. We identified a molecule ABX300 that targets the expression of LMNA gene and favors energy expenditure leading to fat loss.
Prof. Cathryn Glazener[/caption]
Prof. Cathryn Glazener PhD
Health Services Research Unit
University of Aberdeen
Aberdeen,UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prolapse is a condition that affects up to half of all women after childbirth. Women notice a bulge or discomfort in their vaginas due to pressure from the bladder, bowel or womb moving downwards. Women who have surgery for their prolapse have a 3 in 10 chance of needing at least one more operation, so the success rate is not great. Gynaecologists hoped that by reinforcing their repairs the success rate would get better.
PROSPECT was a pragmatic, multicentre randomised controlled trial conducted in 35 centres across the UK. Women undergoing their first operation for prolapse were randomised to having a standard repair of the front or back wall of the vagina, or a repair reinforced by synthetic non-absorbable mesh, or a biological graft.
We found that, in contrast to previous research, women were just as likely to be cured after standard surgery rather than reinforced repairs. They were just as likely to have other symptoms such as bladder or sexual problems, and other adverse effects such as infection, bleeding or pain.
However, about 1 in 10 of the women who had mesh did have mesh exposure when a small portion of the mesh becomes visible through the vaginal wall. Although many women did not have symptoms, about half of those women needed a small operation to remove or bury the exposed mesh.
Dr. Roger Zemek[/caption]
Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit,
Children’s Hospital of Eastern Ontario
Ottawa, ON
MedicalResearch.com: What is the background for this study?
Response: While current concussion protocols endorse the conservative view that children should avoid physical activity until completely symptom-free, there is little evidence beyond expert opinion regarding the ideal timing of physical activity re-introduction. In fact, while rest does play a role in concussion recovery, protracted physical rest may actually negatively impact concussion recovery. Further, physiological, psychological, and functional benefits of early physical rehabilitation are observed in other disease processes such as stroke (which is an example of a severe traumatic brain injury). Therefore, our objective was to investigate the relationship between early physical activity (defined within 7 days of the concussion) and the eventual development of persistent post-concussion symptoms at one month.
Dr. Eyal Cohen[/caption]
Eyal Cohen, MD, MSc, FRCP(C)
Staff Physician, Paediatrics
The Hospital for Sick Children
Associate Scientist, Research Institute
Child Health Evaluative Sciences
Associate Professor, University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Major structural or genetic congenital anomalies affect approximately 2 percent to 5 percent of all births in the United States and Europe. Mothers of children born with major congenital anomalies face serious challenges such as high financial pressures, as well as the burden of providing care to a child with complex needs within the home setting, which can impair a mother's health. Little is known about the long-term health consequences for the mother. We assessed whether the birth of an infant with a major congenital anomaly was subsequently associated with an increased risk of death of the infant's mother.
The population-based study (n = 455,250 women) used individual-level linked Danish registry data for mothers who gave birth to an infant with a major congenital anomaly between 1979 and 2010, with follow-up until December 31, 2014. A comparison group was constructed by randomly sampling, for each mother with an affected infant, up to 10 mothers matched on maternal age, parity (the number of children a woman has given birth to), and year of infant's birth. Mothers in both groups were an average age of 29 years at delivery. After a median follow-up of 21 years, there were 1,275 deaths (1.60 per 1,000 person-years) among 41,508 mothers of a child with a major congenital anomaly vs 10,112 deaths (1.27 per 1,000 person-years) among 413,742 mothers in the comparison group. Mothers with affected infants were more likely to die of cardiovascular disease, respiratory disease, and other natural causes.
Grapes
Psoriasis[/caption]
Mohammed D. Saleem, MD
Department of Dermatology
Wake Forest School of Medicine
Medical Center Boulevard
Winston-Salem, NC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Over the past several years’ numerous research studies have identified comorbidities associated with psoriasis. The media has increasingly become involved with presenting these findings and patients commonly bring these concerns to their physician. The comorbidities are often presented as a relative risk, which can overestimate the effects of exposure, especially when the incidence is quite small. Comorbidities presented as attributed risk or number needed to harm might be a better measure for understanding the association between an exposure and comorbidity.
We found that although the relative risk of many diseases associated with psoriasis can be quite large, the attributed risk was small.
Dr. Igho Onakpoya[/caption]
Igho Onakpoya MD MSc
University of Oxford
Centre for Evidence-Based Medicine
Nuffield Department of Primary Care Health Sciences
Oxford UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Several medicines used to treat obesity have been withdrawn from the market over the last few years. However, the reasons for, and time trends about their withdrawals have not been systematically researched.
We identified 25 anti-obesity medicines withdrawn from the market over the last 50 years. 23 of these analogues of amphetamine or fenfluramine, i.e., neurotransmitters.
The reasons for withdrawal in the overwhelming majority of instances were cardiovascular or psychiatric adverse reactions, and drug abuse and dependence.
Dr. Theodore Brasky[/caption]
Theodore Brasky, PhD
The Ohio State University
Comprehensive Cancer Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a significant amount of data to suggest that long-term, regular use of nonsteroidal anti-inflammatory drugs (NSAIDS; examples include aspirin and ibuprofen) are associated with reduced risks of several cancers. Although the data across studies are inconsistent, one such candidate is endometrial cancer, which is the most common gynecologic cancer. There is good evidence that the use of these medications is associated with improved prognosis among patients diagnosed with colon cancer. Despite the importance of inflammation in endometrial cancer progression, very few have examined whether use of NSAIDs is associated with risk of death or recurrence from the disease. The study we published is the first of its kind to examine NSAID use comprehensively and in a study of over 4,000 patients.
Dr. Manfred Boehm[/caption]
Manfred Boehm M.D.
Senior Investigator
Laboratory of Cardiovascular Regenerative Medicine
Center for Molecular Medicine
NHLBI-NIH
Bethesda, MD 20892
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Common atherosclerosis (hardening of blood vessels) is the leading cause for vascular diseases worldwide. Vascular calcification is a critical component of atherosclerosis and an indicator of negative outcomes. This process is highly regulated and dynamic. However, the underlying mechanism is poorly understood and no direct treatment is available to stop or reverse this devastating buildup of calcium crystals in the vessel wall. Arterial calcification due to deficiency of CD73 is a rare inherited vascular disease characterized by extensive calcification of blood vessels caused by mutation in a gene encoding an enzyme that generates a compound called Adenosine outside of cells. The lack of this important enzyme, CD73, activates a compensatory mechanism to generated Adenosine by an alternative enzyme. Unfortunately, increased activity of this other enzyme is causing accelerated vascular calcification. By using the patient’s own cells, this study characterized the compensatory signaling pathway and discovered several new treatment strategies.
Dr. Yusuke Tsugawa[/caption]
Yusuke Tsugawa, MD, MPH, PhD
Department of Health Policy and Management
Harvard T. H. Chan School of Public Health,
Department of Medicine
Brigham and Women’s Hospital and Harvard Medical School
Boston, Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We analyzed a 20% sample of Medicare beneficiaries hospitalized with a medical condition in 2011-2014, and found that patients treated by female doctors have lower mortality and readmission rates than those cared for by male doctors.
Karin Nielsen[/caption]
Karin Nielsen, MD, MPH
Professor of Clinical Pediatrics
Division of Pediatric Infectious Diseases
David Geffen School of Medicine at UCLA
Director, Center for Brazilian Studies
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our research was a prospective study in which pregnant women in Rio de Janeiro who developed a rash in the last 5 days between the end of 2015 to mid 2016 were screened for possible infection with Zika virus by a special molecular test (PCR) which looked for the virus in blood or urine. Women who were found to have Zika virus in either blood, urine or both were followed throughout time to look for pregnancy and infant outcomes. We also followed women who had a negative PCR test for Zika as a comparison group. By July 2016, we had outcomes known for 125 Zika affected pregnancies, of these 58 had abnormal outcomes, with 9 fetal losses and 49 babies who had abnormal findings on physical exam or brain imaging, all consistent with neurologic abnormalities. This meant 46% of the pregnant women in our study had an abnormal pregnancy outcome, and 42% of live birth infants were found to have an abnormality in the first few months of life.
Dr. Bradley Johnston[/caption]
Bradley C. Johnston, PhD
Prevention Lab, Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute
Peter Gilgan Centre for Research and Learning
Toronto, Ontario
MedicalResearch.com: What is the background for this study?
Response: I am scientist at The Hospital for Sick Children and a professor of clinical epidemiology at the University of Toronto and McMaster University in Canada. I have a particular interest in research methodology and preventive medicine. As a research methodologist I am interested in how researchers get to their conclusions. In particular I am interested in the “uncertainty” in estimated treatment or exposure effects.
Many guidelines have methodological issues but it was suspected that the nutritional guidelines were especially problematic. Our study in Annals of Internal Medicine set out to document the issues systematically with respect to sugar intake recommendations from authoritative guidelines.
Dr. Mathew Dupre[/caption]
Matthew E. Dupre, Ph.D.
Associate Professor
Department of Community and Family Medicine &
Duke Clinical Research Institute (DCRI)
Duke University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There have been a handful of recent studies showing how divorce and widowhood increase one’s risk of suffering a serious health event such as a heart attack or stroke. Our research is the first to show that an individual’s marital history can have significant consequences for their prognosis after having a stroke.
We found that people who never married and those with a history of marital loss were significantly more likely to die after suffering a stroke than those who were stably married. We also found that adults who experienced more than one divorce or widowhood in their lifetime were about 50% more likely to die after having a stroke than those in a long-term stable marriage. We were also somewhat surprised to find that remarriage did not seem to reduce the risks from past marital losses.
Kay Deckers[/caption]
Kay Deckers, MSc
PhD student
School for Mental Health and Neuroscience
Department of Psychiatry and Neuropsychology
Maastricht University
The Netherlands
MedicalResearch.com: What is the background for this study?
Response: In an earlier review (https://www.ncbi.nlm.nih.gov/pubmed/25504093), we found that renal dysfunction was one the new candidate risk factors of dementia and needed further investigation.
MedicalResearch.com: What are the main findings?
Response: Albuminuria is associated with an increased risk of developing cognitive impairment or dementia.
Dr. Charles Bangham[/caption]
Charles Bangham PhD ScD
Division of Infectious Diseases, Department of Medicine
Imperial College London
London, UK
MedicalResearch.com: What is the background for this study?
Response: Multiple sclerosis (MS) is a neurological disease of the brain and spinal cord, often beginning in the 20s and 30s which can cause both attacks (relapses) and disability over time. Most people with the condition have intermittent episodes of illness at first, but about two-thirds go on to develop a progressive form, known as secondary progressive MS. In this form, there is a gradual loss of nerve cells in the brain, resulting in shrinkage of the brain and progressive disability.
Neither the initiating cause of Multiple sclerosis nor the reasons for this brain shrinkage are known, and existing treatments for the early phase of the condition are unsatisfactory.
Dr. Catteruccia[/caption]
Flaminia Catteruccia PhD
Associate Professor of Immunology and Infectious Diseases
Department of Immunology and Infectious Diseases
Boston, Massachusetts 02115
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Mosquito control via lethal insecticides is a key method for reduction of malaria transmission. As insecticide resistance is spreading, new intervention methods are urgent. Our study demonstrates that studies on mosquito biology can provide novel, much needed tools for malaria control. We show how key aspects of mosquito physiology and Plasmodium development can be significantly disrupted in the female Anopheles mosquito by agonists of the insect steroid hormone 20-hydroxyecdysone (20E). Modeling of the data predicts that the integration of 20E agonists in malaria control programs would significantly reduce malaria prevalence to a similar extent as insecticides, but without imposing severe costs to mosquito populations
Heather Hampel[/caption]
Heather Hampel, MS, LGC
Associate Director, Division of Human Genetics
Associate Director, Biospecimen Research
Professor, Internal Medicine
Licensed Genetic Counselor
The Ohio State University Comprehensive Cancer Center
Columbus, OH 43221
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study was part of the Ohio Colorectal Cancer Prevention Initiative, a statewide study being conducted at 50 hospitals that includes universal tumor screening for Lynch syndrome. For the subset of 450 colorectal cancer patients diagnosed under age 50, we performed multi-gene cancer panel testing regardless of the results of their tumor screening for Lynch syndrome since early age of diagnosis is a red flag that a cancer might be hereditary.
Dr. Elizabeth Foglia[/caption]
Elizabeth Foglia, MD MSCE
Assistant Professor of Pediatrics
University of Pennsylvania Perelman School of Medicine
Attending Neonatologist
Hospital of the University of Pennsylvania
The Children's Hospital of Philadelphia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Pulse oximetry is a non-invasive method of monitoring oxygen saturation that is frequently used to monitor ill newborns and infants. Previous studies of adults with hypoxemia (low blood oxygen levels) demonstrated that pulse oximetry is less accurate in adults with dark skin, compared to adults with light skin. We sought to determine if skin pigment affects the accuracy of pulse oximetry in infants with hypoxemia.
We studied 2 widely used pulse oximeters, and we did not find evidence that skin pigment affects the accuracy of pulse oximetry in infants with hypoxemia.
However, the overall performance (combined accuracy and precision) of both oximeters was poor. In addition, one oximeter (the Nellcor Oximax) consistently overestimated the measured blood oxygen level.
Dr. Maximilian F. Konig[/caption]
Maximilian F. Konig, MD
Division of Rheumatology,
Johns Hopkins University School of Medicine
Current affiliation:
Department of Medicine
Massachusetts General Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response:The idea that rheumatoid arthritis (RA), an autoimmune disease that leads to chronic joint inflammation and destruction, may be initiated by a bacterial infection is not novel, but has been posited for more than a century. Based on the clinical observation that patients with RA frequently have severe periodontal disease (gum disease), gum inflammation has long been thought to contribute to disease development in RA. However, limited understanding of the mechanisms that fuel and sustain the autoimmune attack in RA made it difficult to pinpoint a specific bacterial trigger.
In recent years, our understanding of the abnormal immune response that attacks the joints in patients with RA has grown exponentially, and we now know that disease-specific autoantibodies (ACPAs) target modified self-proteins (this modification is known as citrullination). It is this abnormal immune response against citrullinated proteins that appears to drive the joint (and sometimes lung) inflammation seen in rheumatoid arthritis. Recent studies from our laboratory at The Johns Hopkins University (led by principle investigator Felipe Andrade, MD, PhD) suggested that an immune cell called the neutrophil, which normally protects us from infection at sites like the oral cavity or anywhere else in the body, also appears to be the source of the proteins attacked in RA. We were therefore interested to understand what drives the association of gum disease, an inflammation commonly triggered by bacteria, with RA.
Dr. Frederick Grover[/caption]
Frederick L. Grover, M. D.
Professor, Division of Cardiothoracic Surgery
Past Chair, Department of Surgery
University of Colorado School of Medicine-Anschutz Medical Campus
Aurora, CO
Past President, Society of Thoracic Surgeons
Vice Chair, Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Following approval of the first transcatheter aortic heart valve late in 2011 the TVT-R was established and data entry was mandated by CMS for all patients who were undergoing transcatheter valve therapy. Data is currently collected on transcatheter aortic valves (TAVR) from two companies, transcatheter mitral clip procedures (TMC), transcatheter mitral valve in valve or valve in ring procedures and aortic valve in valve procedures. A report is published annually jointly in the Journal of the American College of Cardiology (JACC) and the Annals of Thoracic Surgery (ATS). This report contains data from the beginning of 2012 through December 31, 2015. Peoperative risk factors, operative details and outcomes data are collected prior to procedures, during the hospitalization, 30 days post procedure and at one year and later data can be collected by linking to CMS administrative data.
For this annual report we concentrated on touching on some of the highlights since the length of the manuscript is limited. We discussed the trends in TAVR, since this is the most common procedure performed, the last two years’ experience in mitral clips since a very detailed paper was published on this last year, and the mitral valve in valve and ring since the results for this procedure were impressively good.
In regard to TAVR, 418 sites perform this procedure and the number of cases in 2015 increased from 16,295 in 2014 to 24,808. Very importantly, mortality and complications have been decreasing each year, probably related to improvements in the technology with smaller catheter and sheath sizes leading to less vascular complications, greater experience of those doing the procedures, a less sick group of patients going initially from those too ill to do an open operation on, to very high risk to high risk according to approval criteria. The age of the patients however is most often in the 80s.
Dr. Salyers[/caption]
Michelle P. Salyers Ph.D.
Professor, Psychology
Director, Clinical Psychology Program
Director, ACT Center of Indiana
Affiliated Scientist, Regenstrief Institute, Inc.
Indiana University-Purdue University
Indianapolis, IN
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Professional burnout among healthcare providers is receiving more attention in research and in public press. There have long been speculations that the level of burnout may be related to quality of care provided, and many studies have been done linking provider burnout with different aspects of quality of care.
This study brings together that literature, to summarize and quantify the link between professional burnout in healthcare provider and the quality of care they provide. We were able to combine data from 82 independent samples, across health care disciplines, settings, and types of quality indicators. We found small to medium relationships between provider burnout and indicators of quality of care.