Author: Marie Benz MD FAAD
27 Nov Estimating Survival in Patients With Lung Cancer and Brain Metastases
MedicalResearch.com Interview with: [caption id="attachment_29726" align="alignleft" width="180"]
Dr. Paul W. Sperduto[/caption]
Paul W. Sperduto, MD, MPP, FASTRO
Minneapolis Radiation Oncology
University of Minnesota Gamma Knife Center, Minneapolis, Minnesota
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Analysis of past randomized clinical trials involving patients with brain metastases, an extremely heterogeneous population, suggested that the stratification tools of the past were inadequate to ensure those trials were comparing similar patients which made the results of those trials difficult to interpret or misleading.
So, in 2008, a new prognostic index, the Graded Prognostic Assessment (GPA) was designed and published to more accurately predict survival. In 2010, the GPA was refined when we learned survival and the factors that predict survival varied by diagnosis (i.e. lung, breast, melanoma, kidney cancer patients with brain metastases had different survival). Now we have learned survival also varies by gene mutations and the diagnosis-specific GPA for lung cancer is further refined in this article with this new information, specifically EGFR and ALK gene alterations. 27 co-authors from 12 academic medical centers contributed patients to this database which represents the largest study of lung cancer patients with brain metastases ever reported.
27 Nov Association Between Statin Use and Ischemic Stroke or Hemorrhage in Patients Taking Dabigatran for A Fib
MedicalResearch.com Interview with: [caption id="attachment_29867" align="alignleft" width="200"]
Dr. Tony Antoniou[/caption]
Dr. Tony Antoniou, PhD Research Scholar
Department of Family and Community Medicine and a Scientist
Keenan Research Centre of the Li Ka Shing Knowledge Institute
St. Michael's Hospital
Assistant Professor in the Department of Family and Community Medicine and
Leslie Dan Faculty of Pharmacy
University of Toronto, Toronto, Ontario
MedicalResearch.com: What is the background for this study?
What are the main findings?
Response: Dabigatran etexilate is an anticoagulant that is commonly used for stroke prevention in patients with atrial fibrillation. Absorption of dabigatran etexilate is opposed by intestinal P-glycoprotein, an efflux transporter. Once absorbed, dabigatran etexilate is converted to its active form by carboxylesterase enzymes. Unlike other statins, simvastatin and lovastatin can inhibit P-glycoprotein and carboxylesterase. This may result in increased absorption of dabigatran etexilate, thereby increasing the risk of bleeding. Conversely, inhibition of carboxylesterase may decrease the effectiveness of dabigatran etexilate.
27 Nov Gout Linked To Raised Risk of Erectile Dysfunction
MedicalResearch.com Interview with: [caption id="attachment_29648" align="alignleft" width="200"]
Dr. Edward Roddy[/caption]
Dr Edward Roddy
Clinical Senior Lecturer in Rheumatology and Honorary Consultant Rheumatologist
Arthritis Research UK Primary Care Centre
Research Institute for Primary Care & Health Sciences
Keele University
Staffordshire UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Both gout and erectile dysfunction (ED) are prevalent in the general population, and share some common risk factors such as obesity, alcohol consumption and comorbidity (vascular disease, renal disease etc). We undertook a retrospective cohort study in UK Clinical Practice Research Database, a large longitudinal UK database of UK computerised primary care records, to quantify the risk of incident ED in men with gout. We found that men with gout had 30% greater risk of developing erectile dysfunction than men without gout, after adjusting for confounding variables such as lifestyle factors and comorbidity, although the absolute increased risk was small (0.6%). We did a further analyses including men who already had ED when they were diagnosed with gout, finding that they were also at increased risk of being diagnosed with ED in the year before they developed gout, suggesting that hyperuricaemia, which people can have for decades before developing gout, may be a key reason to explain the increased risk of erectile dysfunction in people with gout. Apparently, some people who make use of content on websites similar to sex-hd.xxx to aid in alleviating their ED.
27 Nov STEMI Outcomes Improve For Both Genders, But More So For Men
Posted at 01:13h
in AHA Journals, Author Interviews, Gender Differences, Heart Disease, Surgical Research
MedicalResearch.com Interview with:
Dr. Stefano Savonitto
Director, Division of Cardiology
Manzoni Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Over the last 15 years, there has been a shift from fibrinolytic therapy for STEMI to primary angioplasty, which required a re-organization of the whole STEMI treatment network. Besides the higher reperfusion efficiency of primary angioplasty, as compared to lytic therapy, it has been a global upgrade of the STEMI care system that has reduced the rate of no reperfusion.
Elderly patients and women (who are, on average, also older than men) had theoretically the most to gain from this shift, but little data were available to assess this benefit.
In the present paper, we have shown that “lack of reperfusion” was reduced dramatically across all age groups and in both sexes, with a progressive and uniform increase in primary angioplasty, and a significant reduction in mortality. Almost as expected, elderly women were the category with the most relevant mortality benefit.
Nevertheless, after adjustment for age and other confounders, women continue to experience a higher mortality as compared to men. In the discussion of the paper, we propose some hypotheses for this persistently higher mortality in women.
27 Nov Low-Dose Regularly Timed Chemotherapy May Keep Some Resistant Cancers in Check
MedicalResearch.com Interview with: [caption id="attachment_29986" align="alignleft" width="150"]
Dr. Kelvin K. Tsai[/caption]
Kelvin K. Tsai, MD, PhD
Associate Investigator and Attending Physician
Laboratories for Tumor Aggressiveness and Stemness
National Institute of Cancer Research, National Health Research Institutes
Associate Professor and Principal Investigator
Laboratories of Advanced Molecular Therapeutics
Graduate Institute of Clinical Medicine
College of Medicine, Taipei Medical University, Taiwan
MedicalResearch.com: What is the background for this study?
Response: Human cancer is a complex organ consisting of a heterogenous collection of cancer cells and stroma cells. Many solid tumors such as breast cancer and pancreatic cancer are characterized by a pronounced stromal fibrosis termed desmoplasia. Studies showed that systemic chemotherapy can target not only cancer cells but also the stromal fibroblasts, which may have significant impacts on the treatment response in desmoplastic cancers.
We set out to study whether and how traditional “maximum tolerated dose (MTD)” chemotherapy affects the tumor fibroblasts and thereby modulates the treatment response, and if so how this therapy-induced stroma perturbation can be avoided or attenuated.
25 Nov Some Saturated Fatty Acids Linked To Risk of Coronary Artery Disease
MedicalResearch.com Interview with: [caption id="attachment_29966" align="alignleft" width="190"]
Dr. Qi Sun[/caption]
Dr. Qi Sun Sc.D, M.D., M.M.S.
Assistant Professor in the Department of Nutrition
Harvard T.H. Chan School of Public Heath
Boston
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Interpretation of existing human study data regarding saturated fat intake in relation to heart disease risk is quite confusing and distorted in certain publications. It is a fact that, depending on data analysis strategies, the effects of saturated fats may depend on which macronutrients they replace. For example, substituting saturated fats for refined carbohydrates will not lead to an elevated risk of heart disease because both nutrients are harmful whereas replacing saturated fats with good polyunsaturated fats results in risk reduction. In our current analysis, we clearly demonstrated that when total saturated fatty acids were replaced by polyunsaturated fatty acids, monounsaturated fatty acids, whole grain carbohydrates, and plant-based proteins, the diabetes risk would decrease.
Furthermore, we showed that major individual saturated fatty acids were all associated with an elevated heart disease risk.
25 Nov Inflammatory Biomarkers Found Linked to Risk of Mortality
MedicalResearch.com Interview with: Archana Singh-Manoux, PhD Research Professor (Directeur de Recherche) Epidemiology of ageing & age-related diseases INSERM,France MedicalResearch.com: What is the background for this study? What are the main findings? Response: A recent metabolomics study examined 106 biomarkers and found alpha-1-acid glycoprotein (AGP), an acute phase protein, to be the strongest predictor of five-year mortality. It is also unknown how well AGP compares with other sensitive, dynamic, and commonly measured markers of systemic inflammation, such as CRP and IL-6, as a predictor of mortality. We examined the association of these three inflammatory markers with short- and long-term mortality in a large sample of middle-aged adults, followed for 17 years. Our analysis of all-cause, cancer and cardiovascular mortality suggests that for all these outcomes IL-6 may be a better prognostic marker, both in the short and the long-term.25 Nov Children With Autism Miss Social Cues of Eye Contact
MedicalResearch.com Interview with: [caption id="attachment_29960" align="alignleft" width="126"]
Dr. Warren Jones[/caption]
Warren Jones, PhD
Director of Research, Marcus Autism Center
Children's Healthcare of Atlanta
CHOA Distinguished Chair in Autism
Asst. Professor, Dept. of Pediatrics
Emory University School of Medicine
Atlanta, Georgia 30329
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: These results help clarify an important and longstanding question in autism: why do children with autism look less at other people’s eyes?
Two ideas for reduced eye contact in autism have been proposed:
- One idea is that children with autism avoid eye contact because they find it stressful and negative.
- The other idea is that children with autism look less at other people’s eyes because the social cues from the eyes are not perceived as particularly meaningful or important.
This study is important because each idea reflects a very different understanding of what autism is. And maybe even more importantly, each idea reflects a very different view about the right treatment approach to autism and to reduced eye contact in autism.
To answer this question, we used eye-tracking technology to study how 86 children with and without autism paid attention to other people’s eyes.
Children were tested when they were just two years old, at their time of initial diagnosis.
24 Nov Penn Takes First Step in Development of Antibodies to HIV and Cure
MedicalResearch.com Interview with: [caption id="attachment_29950" align="alignleft" width="148"]
Dr. Katharine J Bar[/caption]
Katharine J Bar, MD
Assistant Professor of Medicine
Attending Physician, Infectious Diseases, Hospital of the University of Pennsylvania
Physician, International Travel Medicine, Perelman Center for Advanced Medicine
Director, Penn CFAR Viral and Molecular Core
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The passive administration of monoclonal antibodies has revolutionized many fields of medicine. Anti-HIV monoclonal antibodies are being explored as components of novel therapeutic and curative strategies, as they can both neutralize free virus and kill virus-infected cells. We sought to determine whether passive administration of an anti-HIV monoclonal antibody, VRC01, to chronically HIV-infected individuals on antiretroviral medications (ART) would be safe and well tolerated and could delay virus rebound after discontinuation of their ART.
23 Nov Genetic Predisposition To Irritable Bowel Syndrome Strengthened
MedicalResearch.com Interview with: Mauro D’Amato Ikerbasque Research Professor Head, Unit of Gastrointestinal Genetics, Department of Gastrointestinal and Liver Diseases BioDonostia Health Research Institute San Sebastian, Spain MedicalResearch.com: What is the background for this study? What are the main findings? Response: Irritable bowel syndrome (IBS) is a very common condition, whose underlying pathophysiology is poorly understood. People with IBS often complain certain foods trigger their symptoms and, at least in some patients, incomplete breakdown of carbohydrates may result in malabsorption with diarrhoea, bloating and abdominal pain. At the extreme of the spectrum of such clinical manifestations, this is what happens in a hereditary form of sucrose intolerance, the congenital sucrase-isomaltase deficiency (CSID) due to mutations in the Si gene that lead to defective enzymatic disaccharidase activity in the gut. Because IBS shows genetic predisposition, we tested the hypothesis that mutations and DNA variants affecting SI enzyme function may confer increased risk of IBS. We studied almost 2000 individuals from several clinics from Europe and USA, and found out that rare SI mutations and other more common defective DNA variants are indeed more frequent in patients than healthy controls.23 Nov Adjuvant Radiotherapy May Benefit Elderly ER- Breast Cancer Patients
MedicalResearch.com Interview with: Emily C. Daugherty, MD Upstate Medical University Radiation Oncology Resident, PGY-4 MedicalResearch.com: What is the background for this study? Response: Adjuvant radiation following breast conserving surgery has been well established in the management of early-stage breast cancer as it has been shown to decrease the incidence of ipsilateral breast tumor recurrences and also reduce breast cancer mortality. Large prospective trials have shown for elderly patients with favorable, ER positive pathology, omission of radiation after lumpectomy can be considered. However, women with ER negative disease were typically not included in these trials and given their higher risk for relapse as well as lack of effective endocrine therapy, we hypothesized that adjuvant radiation would benefit women over 70 years with early-stage, ER negative tumors.23 Nov New Imaging Technology Can Measure Potential for Vision Loss in Neurofibromatosis
MedicalResearch.com Interview with: [caption id="attachment_29930" align="alignleft" width="167"]
Dr. Marius George Linguraru[/caption]
Marius George Linguraru, DPhil, MA, MB
Principal Investigator
Associate Professor of Pediatrics and Radiology
George Washington University School of Medicine and Health Sciences
Children’s National Health System
Washington, DC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Neurofibromatosis type 1 (NF1) is the most common cancer predisposition syndrome affecting the central nervous with an incidence of one in 3,000 births. Nearly one in five children with NF1 develops an optic pathway glioma (OPG), a low-grade tumor of the anterior visual pathway (i.e., optic nerves, chiasm and tracts). These tumors are not amenable to surgical resection and can cause permanent vision loss ranging from a mild decline in visual acuity to complete blindness. Only half of children with NF1-OPGs will experience vision loss, typically between 1 to 6 years of age. The other half will never lose vision or require treatment.
All previous studies have consistently demonstrated that the change in NF1-OPG size is not related to the clinical outcome. For example, the optic pathway glioma size may be stable or even decrease, yet the vision will decline. Alternatively, the OPG size may increase, yet the clinical outcome remains stable or even improves. As no imaging or clinical features can identify which children with NF1-OPGs will ultimately lose vision, clinicians struggle to follow these children and decide when to intervene.
We used quantitative imaging technology to accurately assess in magnetic resonance imaging (MRI) the total volume of OPGs in NF1. We also determined the retinal nerve fiber layer thickness in these children, a measure of axonal degeneration and an established biomarker of visual impairment. The results were outstanding, as we showed for the first time that the volume of an optic pathway glioma is indeed correlated with the likelihood of vision loss in children with Neurofibromatosis type 1.
22 Nov Three Genes Responsible For Uncombable Hair Syndrome
MedicalResearch.com Interview with: Prof. Dr. Regina Betz and Dr. Buket Basmanav Ünalan (first author) Institute of Human Genetics University of Bonn Bonn, Germany MedicalResearch.com: What is the background for this study? What are the main findings? Response: Up to know, the cause for uncombable hair was totally unknown. We identified now mutations in three genes, all being responsible for uncombable hair syndrome. Of interest, the corresponding proteins, namely, PADI3, TGM3 and TCHH, are all in the same cascade that is responsible for the formation and mechanical strengthening of the hair shaft.22 Nov Cardiac Stress Testing Increases Modestly in Commercially Insured Patients
MedicalResearch.com Interview with: [caption id="attachment_29970" align="alignleft" width="200"]
Dr. Vinay Kini[/caption]
Vinay Kini, MD, MS
Division of Cardiovascular Medicine
Hospital of the University of Pennsylvania
The Leonard Davis Institute of Health Economics
University of Pennsylvania
Philadelphia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Recent studies have shown that use of cardiac stress tests has declined by about 25% among Medicare beneficiaries and by about 50% in Kaiser Permanente over the last several years. However, the reasons for these declines is not well understood. Decreases in the use of stress testing could be due to dissemination of appropriate use criteria and other clinical practice guidelines, advances in preventive care, reductions in reimbursement for testing, or other health system organizational characteristics.
Therefore, our goal was to determine whether similar declines in testing are observed among a nationally representative cohort of commercially insured patients. We identified over 2 million stress tests performed among 33 million members of the commercial insurance company, and found that there was a 3% increase in the overall use of stress testing in this cohort between 2005 and 2012. Declines in the use of nuclear SPECT tests were offset by increases in the use of stress echocardiography, exercise electrocardiography, and newer stress test modalities such as coronary computed tomography angiography.
The largest increase in use of testing was seen among younger individuals - there was a 60% increase in use of testing among patients aged 25-34, and a 30% increase among individuals aged 35-44.
22 Nov Involved Fathers Have Positive Impact on Pre-Adolescent Children
MedicalResearch.com Interview with: [caption id="attachment_29918" align="alignleft" width="200"]
Dr. Charles Opondo[/caption]
Charles Opondo, BPharm MSc PhD.
Researcher in Statistics and Epidemiology
National Perinatal Epidemiology Unit
Nuffield Department of Population Health
University of Oxford
Oxford
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our study measured fathers’ involvement in their child’s upbringing in infancy by looking at their emotional response to their child (e.g. feeling confident with the child, making a strong bond with the child), how involved they were in childcare (e.g. changing nappies, playing, night feeding, and also general care tasks around the house such as meal preparation) and their feelings of being a secure in their role as a parent (e.g. feeling included by mother in childcare, not feeling inexperienced with children).
We found that the children of fathers who scored highly in terms of their emotional response and feeling like a secure parent were less likely to have symptoms of behavioural problems when they were 9 or 11 years.
However, fathers being more involved in direct childcare did not seem to affect the child’s risk of having later behavioural problems.
22 Nov Squamous Cell Carcinoma of Lip Predominantly Affects White Men in Their Mid-60s
MedicalResearch.com Interview with: [caption id="attachment_29923" align="alignleft" width="200"]
Dr. Albert Han[/caption]
Albert Yoon-Kyu Han, PhD
Class of 2017
Medical Scientist Training Program
David Geffen School of Medicine at UCLA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Squamous cell carcinoma (SCC) of the lip makes up a large portion of oral cancers (25%). Most of the demographic and prognostic indicators for lip SCC are only available through retrospective case series. Thus, we used the national cancer database (Surveillance, Epidemiology, and End Results, or SEER) to examine the incidence, treatment, and survival of patients with lip SCC.
The main findings of this study were that lip Squamous cell carcinoma predominantly affects white men in their mid-60s. We also found that the determinants of survival for lip SCC include age at diagnosis, primary site, T stage, and N stage. More specifically, on the primary site, SCC of the upper and lower lip had similar survival, whereas SCC of the oral commissure was associated with decreased survival.
22 Nov More Surgeries, Fewer Deaths From Abdominal Aortic Aneurysms in US than UK
MedicalResearch.com Interview with: [caption id="attachment_29912" align="alignleft" width="200"]
Dr. Alan Karthikesalingam[/caption]
Alan Karthikesalingam MD PhD, NIHR
Academic Clinical Lecturer in Vascular Surgery
St George's Vascular Institute
London, UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background for this study was that the typical diameter at abdominal aortic aneurysm (AAA) repair, and the population incidence of AAA repair, have been known to vary considerably between different countries. This study aimed to observe whether a discrepancy in the population incidence rate of AAA repair between England and the USA was seen alongside a discrepancy in population rates of AAA-related mortality or AAA rupture in those countries.
22 Nov Surgical Oncologist Discusses Empathy as Critical Ingredient of Good Medical Care
MedicalResearch.com Interview with: [caption id="attachment_29908" align="alignleft" width="200"]
Dr. Dmitri Alden[/caption]
Dr. Dmitri Alden MD, FACS
Surgical Oncologist, specializes in liver cancer, bile duct cancer, metastatic ovarian cancer and pancreatic cancer at Lenox Hill Hospital, NY
Dr. Alden is an advocate of the role of empathy in medicine and discusses his passion for compassionate care in this interview.
Please see his bio and website at http://www.liversurgeryny.com.
MedicalResearch.com: Why do you feel that empathy is a vital part of treating a patient?
Response: Over the last decade many physicians, patients and other professionals began to recognize that medical care is much more than treatment with medications or an act of surgery. Healing involves pain and suffering and dealing with psychological issues connected to the stress of being taken out of one’s normal life routine. Pain is now considered a “vital sign” and only recently it became mandatory to address it properly and document it in a medical record. Empathy in my opinion is a “vital sign” of any relationship that forms between a patient and a medical professional. When expressed genuinely, it makes a tremendous impact on patient’s overall experience and recovery.
MedicalResearch.com: How do you define empathy in regards to medical treatment?
Response: Empathy is understanding and true genuine caring. Patients and doctors create a unique and very personal relationship built on trust and “chemistry”. The doctor’s ability to express empathy, step in the patient’s shoes, get to know their life, loves, personal problems and to structure care around this unique individual enhances the patient’s belief in the route of treatment chosen and the doctor’s ability to provide a cure.
MedicalResearch.com: Do you feel that the medical system doesn't emphasize empathy enough?
Response: Doctors are trained without an emphasis on empathy. They focus on acquiring immense amounts of information that need to be learned during medical school and residency. Emotions are currently left to the side in order to succeed. The end product is often a machine that knows what to do in any medical situation but has difficulty to connect on an emotional level. I feel that empathy is also a very important step towards achieving successful outcomes because a patient will feel more invested in following the doctor's advice if he feels there is compassion and understanding.
22 Nov ADHD: Heritability of Structural and Functional Brain Connectivity in Families
MedicalResearch.com Interview with: [caption id="attachment_29904" align="alignleft" width="200"]
Dr. Gustavo Sudre[/caption]
Gustavo Sudre, PhD
Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch
National Human Genome Research Institute
Bethesda, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: ADHD is the most common childhood neuropsychiatric disorder, affecting 7-9% of school age children. It is highly heritable (h2=0.7), but few risk genes have been identified. In this study, we aimed to provide quantitative brain-based phenotypes to accelerate gene discovery and understanding.
ADHD is increasingly viewed as resulting from anomalies of the brain’s connectome. The connectome is comprised of the structural connectome (white matter tracts joining different brain regions) and the functional connectome (networks of synchronized functional activity supporting cognition). Here, we identified features of the connectome that are both heritable and associated with ADHD symptoms.
22 Nov Cutaneous Fungal Infections Are Commonly Misdiagnosed
MedicalResearch.com Interview with: [caption id="attachment_29900" align="alignleft" width="160"]
Dr. Adam Friedman[/caption]
Adam Friedman, MD, FAAD
Associate Professor of Dermatology
Residency Program Director
Director of Translational Research
Department of Dermatology
George Washington School of Medicine and Health Sciences
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study was developed out of a session I and my colleague, Neal Bhatia, held at the 2016 Orlando Dermatology Aesthetic and Clinical Conference.
As an interactive session which had the audience answer whether they clinically thought an image was representative of a fungal skin infection or not, we collected audience responses and were impressed by how even dermatologists struggle with making this diagnosis clinically. This is not so surprising given the protean nature and diverse presentations of these infections, not to mention the many mimics which are not due to infection. Only one of the thirteen images shown was appropriately diagnosed by 90% of the audience. This highlights that the importance of using bedside diagnostic techniques such as KOH preps and culture to identify underlying cause in order to appropriately use the right therapy for the right condition.
22 Nov Compared To Other Blood Pressure Medications Diuretics Have Bone Protective Effect
Posted at 12:00h
in Author Interviews, Blood Pressure - Hypertension, Bone Density, JAMA, Kaiser Permanente, Osteoporosis, Pharmacology
MedicalResearch.com Interview with:
[caption id="attachment_29895" align="alignleft" width="200"]
Dr. Joshua I. Barzilay[/caption]
Joshua I. Barzilay, MD
Kaiser Permanente of Georgia
Duluth, GA 30096
MedicalResearch.com: What is the background for this study?
Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis.
Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified.
After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion.
22 Nov Multiple Sclerosis: Interim Report on the Safety and Efficacy of Long-Term Daclizumab Treatment for Up to Five Years
MedicalResearch.com Interview with Ralph Kern, M.D. Senior vice president, Worldwide Medical Biogen MedicalResearch.com: What is the background for this study? Response: Previously reported clinical trials of daclizumab demonstrated significant efficacy across clinical and MRI measures, compared to placebo and interferon beta-1a 30 mcg intramuscular (IM) injection, and established the therapy’s safety profile for up to two to three years. These trials were the basis for approval by health authorities in the United States, European Union and Australia. Daclizumab is a once-monthly, self-administered, subcutaneous therapy for relapsing forms of MS (RMS). At ECTRIMS we presented the first interim results from EXTEND, a long-term extension study. EXTEND is an ongoing multicenter, open-label study to evaluate the safety and efficacy of daclizumab treatment in more than 1,500 patients with RMS. This interim ECTRIMS analysis includes up to five years of data from patients who were previously enrolled in DECIDE. DECIDE was a Phase 3 study evaluating the effects of daclizumab relative to interferon beta-1a IM. In the new analysis, patients who were treated with interferon beta-1a IM for two to three years in DECIDE switched to daclizumab when they enrolled in EXTEND, and were compared to daclizumab patients treated continuously in both DECIDE and EXTEND.21 Nov Barriers to Healthful Eating Linked to More Rapid Kidney Function Decline
Posted at 18:15h
in Author Interviews, Johns Hopkins, Kidney Disease, Nutrition, Race/Ethnic Diversity
MedicalResearch.com Interview with:
[caption id="attachment_29753" align="alignleft" width="80"]
Dr. Deidra Crews[/caption]
Deidra C. Crews, MD, ScM, FASN, FACP
Associate Professor of Medicine, Division of Nephrology
Associate Vice Chair for Diversity and Inclusion, Department of Medicine
Director, Doctoral Diversity Program
Johns Hopkins University School of Medicine
Baltimore MD 21224
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Studies suggest that dietary patterns influence risk of kidney function decline. Barriers may hinder urban African Americans' following healthful diets that could mitigate their increased risk of kidney function decline.
In this study, we characterized contextual barriers to healthful eating among urban African Africans with hypertension and examined the association of these barriers to kidney function decline over 1 year. We examined the presence of healthy foods in neighborhood stores of study participants.
We also assessed them for food insecurity (the inability to afford nutritionally adequate and safe foods), directly observed and documented the presence of fruits and vegetables in their homes, and examined their fruit and vegetable intake via questionnaire.
21 Nov Deep Brain Stimulation Improves Parkinson’s Symptoms In Some Patients With SPG 11 Mutations
MedicalResearch.com Interview with: [caption id="attachment_29406" align="alignleft" width="120"]
Dr. Adolfo Ramirez Zamora[/caption]
Adolfo Ramirez Zamora, MD
Associate Professor of Neurology and
Phyllis E. Dake Endowed Chair in Movement Disorders
Department of Neurology
Albany Medical College
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients with SPG 11 mutations can present with motor symptoms characterized by juvenile onset dystonia, Parkinsonism and lower extremity spasticity. Parkinsonism appears to be responsive to levodopa therapy early in the disease but treatment is complicated by the occurrence of motor fluctuations resembling parkinson disease. Patients have short duration of medication effects, unpredictable response to medications along with generalized, excessive involuntary movements known as dyskinesias.
Deep Brain stimulation is a well-established treatment for movement disorders but it has never been used in this disease. We first report the clinical outcome obtained with globus pallidus internal deep brain stimulation in a patient with parkinsonism, dystonia, dyskinesias related to SPG 11. Additionally, we report for the first time the basal ganglia changes observed in the disease using intraoperative neuronal recordings. Patient had a sustained and remarkable response to stimulation over the next two years without side effects. Neurophysiologic changes revealed a unique pattern of neuronal firing despite of the resemblance to advance Parkinsons disease.
21 Nov Anion Gap Associated with Risk of ESRD in Adults with Moderate Chronic Kidney Disease
MedicalResearch.com Interview with:
Tanushree Banerjee, PhD
Research Specialist in the Department of Medicine
Division of General Internal Medicine
UCSF
MedicalResearch.com: What is the background for this study?
Response: Acidosis is usually noted in advanced chronic kidney disease (CKD) while it is relatively unexplored whether changes in the undetermined anions, as measured by anion gap occur earlier in the course of CKD.
Consumption of animal-sourced protein is acid-inducing and therefore such diet presumably increases undetermined anions. Since higher dietary acid load is associated with progression of CKD, we wanted to explore whether the increase in undetermined anions in moderate CKD is associated with CKD progression.
21 Nov Emergency Department Use High Among CKD Patients, Primarily for Heart Failure
Posted at 17:58h
in Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease, Kidney Disease
MedicalResearch.com Interview with:
[caption id="attachment_29537" align="alignleft" width="144"]
Dr. Paul E Ronksley[/caption]
Paul E Ronksley, PhD
Assistant Professor
Department of Community Health Sciences
Cumming School of Medicine
University of Calgary
Calgary Canada
MedicalResearch.com: What is the background for this study?
Response: Prior studies have observed high resource use among patients with chronic kidney disease (CKD), which is related to the medical complexity of this patient population. However, there has been limited exploration of how patients with CKD use the emergency department (ED) and whether utilization is associated with disease severity. While the ED is essential for providing urgent or emergent care, identifying ways of improving ED efficiency and decreasing wait times has been recognized as a priority in multiple countries. Improving coordination and management of care for patients with multiple chronic conditions (the norm for CKD) in an outpatient setting may meet health care needs and ultimately improve patient experience and outcomes while reducing the burden currently placed on the ED. However, this requires an understanding of ED use among patients with CKD and the proportion of use that is amenable to outpatient care. Using a large population-based cohort we explored how rates of ED use vary by kidney disease severity and the proportion of these events that are potentially preventable by high quality ambulatory care.
We identified all adults (≥18 years) with eGFR<60 mL/min/1.73m2 (including dialysis-dependent patients) in Alberta, Canada between April 1, 2010 and March 31, 2011. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of ED encounters, and followed until death or end of study (March 31, 2013). Within each CKD category we calculated adjusted rates of overall emergency departmentt use, as well as rates of potentially preventable ED encounters (defined by 4 CKD-specific ambulatory care sensitive conditions (ACSCs); heart failure, hyperkalemia, volume overload, malignant hypertension).
21 Nov New Online Fertility Calculators Predict Chance of IVF Success
MedicalResearch.com Interview with: [caption id="attachment_29707" align="alignleft" width="144"]
Dr. David McLernon[/caption]
David McLernon PhD MPhil BSc
Research Fellow in Medical Statistics
Medical Statistics Team
Institute of Applied Health Sciences
University of Aberdeen
Foresterhill Aberdeen
MedicalResearch.com: What is the background for this study?
Response: Normally when a couple attend a fertility clinic to begin IVF treatment they are only informed about their chances of having a baby for the first attempt of IVF. In actual fact the first treatment is often unsuccessful and many couples will go on to have several complete cycles of the treatment– each involving the transfer of one or two fresh embryos potentially followed by one or more frozen embryo transfers. We felt that a prediction model that could calculate the chances of having a baby over the complete package of treatment would provide better information for couples.
21 Nov Patients Who Start Dialysis in Hospital Setting Have More Comorbidities
[caption id="attachment_16840" align="alignleft" width="124"]
Dr. Csaba P. Kovesdy[/caption]
MedicalResearch.com Interview with:
Dr. Csaba P. Kovesdy
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many ESRD patients initiate dialysis in an inpatient setting. This practice is expensive, and carries potential risks (e.g. hospital associated infections, medication errors, etc.). There is very little information about the characteristics of patients who transition to ESRD (i.e. start dialysis) in an inpatient setting, and about their outcomes.
We examined a cohort of >50,000 US veterans who started dialysis during 2007-2011, and found that about half of them performed their first treatment in an inpatient setting. Compared to patients starting dialysis as outpatients, those who transitioned in an inpatient setting had a significantly higher prevalence of comorbid conditions, and were much less likely to have received pre-dialysis nephrology care, or to have a mature AV fistula or AV graft at the first hemodialysis treatment. Mortality was significantly higher in the inpatient start group, but the differences were attenuated by adjustment for comorbid conditions and vascular access.